Percutaneous MitraClip Device or Surgical Mitral Valve Repair in Patients With Primary Mitral Regurgitation Who Are Candidates for Surgery: Design and Rationale of the REPAIR MR Trial.

Background The current standard of care for the treatment of patients with primary mitral regurgitation (MR) is surgical mitral valve repair. Transcatheter edge-to-edge repair with the MitraClip device provides a less invasive treatment option for patients with both primary and secondary MR. Worldwide, >150 000 patients have been treated with the MitraClip device.

Creation and evaluation of a novel, interdisciplinary debriefing program using a design-based research approach.

Background: The emergency department (ED) witnesses the close functioning of an interdisciplinary team in an unpredictable environment. High-stress situations can impact well-being and clinical practice both individually and as a team. Debriefing provides an opportunity for learning, validation, and conversation among individuals who may not typically discuss clinical experiences together.

Diagnosis of "cribriform" prostatic adenocarcinoma: an interobserver reproducibility study among urologic pathologists with recommendations.

Accurate diagnosis of cribriform Gleason pattern 4 (CrP4) prostate adenocarcinoma (PCa) is important due to its independent association with adverse clinical outcomes and as a growing body of evidence suggests that it impacts clinical decision making in PCa management. To identify reproducible features for diagnosis of CrP4, we assessed interobserver agreement among 27 experienced urologic pathologists of 60 digital images from 44 radical prostatectomies (RP) that represented a broad spectrum of potential CrP4. The following morphologic features were correlated with the consensus diagnosis (defined as 75% agreement) for each image: partial vs.

Racial and Ethnic Diversity in Academic Emergency Medicine: How Far Have We Come? Next Steps for the Future.

Although the U.S. population continues to become more diverse, black, Hispanic, and Native American doctors remain underrepresented in emergency medicine (EM).

Urban air quality and associations with pediatric multiple sclerosis.

Background: We previously identified air quality as a risk factor of interest for pediatric multiple sclerosis. The purpose of this study is to more closely examine the association between the six criteria air pollutants and pediatric MS as well as identify specific areas of toxic release using data from the Toxic Release Inventory.

Methods: Pediatric MS cases ( = 290) and healthy controls ( = 442) were included as part of an ongoing case-control study.

Drivers of Cervical Deformity Have a Strong Influence on Achieving Optimal Radiographic and Clinical Outcomes at 1 Year After Cervical Deformity Surgery.

Objective: The primary driver (PD) of cervical malalignment is important in characterizing cervical deformity (CD) and should be included in fusion to achieve alignment and quality-of-life goals. This study aims to define how PDs improve understanding of the mechanisms of CD and assesses the impact of driver region on realignment/outcomes.

Methods: Inclusion: radiographic CD, age >18 years, 1 year follow-up.

Effect of food-related stress conditions and loss of agr and sigB on seb promoter activity in S. aureus.

Staphylococcal enterotoxin B (SEB) causes staphylococcal food poisoning and is produced in up to ten times higher quantities than other major enterotoxins. While Staphylococcus aureus growth is often repressed by competing flora, the organism exhibits a decisive growth advantage under some stress conditions. So far, data on the influence of food-related stressors and regulatory mutations on seb expression is limited and largely based on laboratory strains, which were later reported to harbor mutations.

Recommendations for comprehensive intraprocedural echocardiographic imaging during TAVR.

Recent multicenter trials have shown that transcatheter aortic valve replacement is an alternative to surgery in a high risk population of patients with severe, symptomatic aortic stenosis. Echocardiography and multislice computed tomographic imaging are accepted tools in the pre-procedural imaging of the aortic valve complex and vascular access. Transesophageal echocardiography can be valuable for intraprocedural confirmation of the landing zone morphology and measurements, positioning of the valve and post-procedural evaluation of complications.

A network that performs brute-force conversion of a temporal sequence to a spatial pattern: relevance to odor recognition.

A classic problem in neuroscience is how temporal sequences (TSs) can be recognized. This problem is exemplified in the olfactory system, where an odor is defined by the TS of olfactory bulb (OB) output that occurs during a sniff. This sequence is discrete because the output is subdivided by gamma frequency oscillations.

Aberrant miR-182 expression promotes melanoma metastasis by repressing FOXO3 and microphthalmia-associated transcription factor.

The highly aggressive character of melanoma makes it an excellent model for probing the mechanisms underlying metastasis, which remains one of the most difficult challenges in treating cancer. We find that miR-182, member of a miRNA cluster in a chromosomal locus (7q31-34) frequently amplified in melanoma, is commonly up-regulated in human melanoma cell lines and tissue samples; this up-regulation correlates with gene copy number in a subset of melanoma cell lines. Moreover, miR-182 ectopic expression stimulates migration of melanoma cells in vitro and their metastatic potential in vivo, whereas miR-182 down-regulation impedes invasion and triggers apoptosis.

Re-defining pseudoptosis from a 3D perspective after short scar-medial pedicle reduction mammaplasty.

Background: Bottoming out is a well-known phenomenon described with reduction mammaplasty (RM). To date, the evaluation of post-operative bottoming out remains an imprecise science. The following study reports the application of three-dimensional (3D) photography to objectively investigate changes in breast morphology.

Spontaneous renal artery dissection.

Spontaneous renal artery dissection (SRAD) is a rare event, and thus may be a challenge for physicians to diagnose and treat. We report a case of SRAD in a healthy 56-year-old male who presented with flank pain, fever, and elevated white blood cell count. The patient was initially diagnosed with nephrolithiasis versus pyelonephritis and was admitted for observation.

Breast cancer clinical and translational research: analogies and implications for prostate cancer.

Breast and prostate cancer, respectively, are the most common cancers in women and in men in the United States. The management of locally advanced prostate cancer involves a multidisciplinary approach, bearing similarity to the therapeutic approach to breast cancer. Better understanding of the molecular biology of these cancers and the identification of the role played by the cancer stem cells and the tumor microenvironment may translate into better clinical decision making regarding risk classification and treatment allocation.

Psychosomatic concepts in chronic pain.

Unlabelled: This self-directed learning module highlights the obstacles faced by physicians treating chronic pain, in particular, the occasional lack of correlation between test results and symptoms, and the treatment pitfalls that may occur. A review of psychosomatic pain disorders is presented along with a psychodynamically based diagnostic and management approach. Popular mind-body treatments for chronic pain are presented with pertinent references.

Autologous transfusion and other approaches to reduce allogeneic blood exposure.

When used as the sole source of transfused blood, the principal advantage of autologous blood transfusion is the avoidance of transmission of infectious agents and the avoidance of the purported adverse immunomodulatory effects of allogeneic transfusion. In the 1990s, however, the risks of transfusion-transmitted diseases have been greatly reduced, and estimates of the cost-effectiveness of pre-operative autologous blood donations now vary between 2470 dollars and 3,400,000 dollars per quality-adjusted year of life saved, depending on assumptions about the existence and magnitude of any adverse immunomodulatory effects of allogeneic transfusion. There is a paucity of randomized controlled trials evaluating the clinical outcomes and the cost-effectiveness of autologous transfusion procedures, and this situation is unlikely to change in the near future because of the difficulties in conducting such trials.

Depression and stroke.

Depression in stroke patients was observed many years ago but only recently has become the subject of systematic study. While estimates of depression vary, some have noted its occurrence in more than half of stroke patients. Our understanding of depression has been facilitated by refinements in diagnostic categories, analysis of contributing factors including the biology of depression, and refinements in evaluation to include cognitive and linguistic impairments that are common after stroke.

Extracranial repair of cerebrospinal fluid fistulas: technique and results in 37 patients.

Although neurosurgeons have traditionally preferred intracranial repair for the management of cerebrospinal fluid (CSF) fistulas, this approach is associated with the complications of a craniotomy, anosmia, and a high incidence of recurrent fistulas. Extracranial repair, on the other hand, produces no central nervous system morbidity, preserves olfaction, and is associated with a low incidence of recurrence. Although there have been several reports of extracranial repair of CSF fistulas by otorhinolaryngologists, this approach has received scant mention in the neurosurgical literature.

The importance of severity of illness in assessing hospital mortality.

Each year, the Health Care Financing Administration (HCFA) releases a report comparing hospital mortality rates with predicted rates. Some argue that the HCFA's prediction model does not adequately account for patient severity. We tested this hypothesis by comparing the HCFA's model (replicated as closely as we could) to a second that added a severity measure (the Stage of Principal Diagnosis at Admission, a subscale of the Severity of Illness Index).