Primary Liver Cancer: An NCDB Analysis of Overall Survival and Margins After Hepatectomy.

BACKGROUND: Intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC) constitute the majority of primary liver cancers. This retrospective review aimed to determine whether site of care is a significant predictor of patient outcome after hepatectomy as measured by overall survival, hazard ratios (HRs), and resection margin status. METHODS: Data regarding patients with a new diagnosis of ICC and HCC who underwent hepatectomy were analyzed from the national cancer database. The patients were divided into two cohorts: those receiving treatment at academic cancer centers (ACCs) and those receiving treatment at community cancer centers (CCCs). The study adjusted for confounding variables and selection bias using propensity score matching. Median overall survival (months), hazard ratios, and resection margin status (R0, R1/R2, unknown) were examined. RESULTS: The inclusion criteria were met by 10,463 patients. After propensity matching, 5600 patients remained, with half receiving treatment at ACCs and half at CCCs. Median overall survival from the date of diagnosis for patients undergoing hepatectomy was longer at ACCs than at CCCs (28.3 vs 24.8 months; p < 0.001). Additionally, multivariable Cox proportional hazards models showed that treatment at CCCs was associated with poorer survival than treatment at ACCs (HR, 1.226; 95% confidence interval [CI], 1.142-1.316; p < 0.0001). Treatment facility designation also was a predictive indicator of resection margin status, with patients at CCCs exhibiting higher odds of R1/R2 resections (odds ratio [OR], 1.41; 95% CI, 1.19-1.67; p < 0.0001). CONCLUSION: Hepatectomy for ICC and HCC performed at ACCs was associated with improved outcomes compared with CCCs. Centralization of care to ACCs may lead to improved patient outcomes.

Automatic Digital Analysis of Chromogenic Media for Vancomycin-Resistant-Enterococcus Screens Using Copan WASPLab.

Vancomycin-resistant enterococci (VRE) are an important cause of health care-acquired infections (HAIs). Studies have shown that active surveillance of high-risk patients for VRE colonization can aid in reducing HAIs; however, these screens generate a significant cost to the laboratory and health care system. Digital imaging capable of differentiating negative and "nonnegative" chromogenic agar can reduce the labor cost of these screens and potentially improve patient care. In this study, we evaluated the performance of the WASPLab Chromogenic Detection Module (CDM) (Copan, Brescia, Italy) software to analyze VRE chromogenic agar and compared the results to technologist plate reading. Specimens collected at 3 laboratories were cultured using the WASPLab CDM and plated to each site's standard-of-care chromogenic media, which included Colorex VRE (BioMed Diagnostics, White City, OR) or Oxoid VRE (Oxoid, Basingstoke, United Kingdom). Digital images were scored using the CDM software after 24 or 40 h of growth, and all manual reading was performed using digital images on a high-definition (HD) monitor. In total, 104,730 specimens were enrolled and automation agreed with manual analysis for 90.1% of all specimens tested, with sensitivity and specificity of 100% and 89.5%, respectively. Automation results were discordant for 10,348 specimens, and all discordant images were reviewed by a laboratory supervisor or director. After a second review, 499 specimens were identified as representing missed positive cultures falsely called negative by the technologist, 1,616 were identified as containing borderline color results (negative result but with no package insert color visible), and 8,234 specimens were identified as containing colorimetric pigmentation due to residual matrix from the specimen or yeast (Candida). Overall, the CDM was accurate at identifying negative VRE plates, which comprised 84% (87,973) of the specimens in this study.

Acute and persistent effects of commonly used antibiotics on the gut microbiome and resistome in healthy adults.

Antibiotics are deployed against bacterial pathogens, but their targeting of conserved microbial processes means they also collaterally perturb the commensal microbiome. To understand acute and persistent effects of antibiotics on the gut microbiota of healthy adult volunteers, we quantify microbiome dynamics before, during, and 6 months after exposure to 4 commonly used antibiotic regimens. We observe an acute decrease in species richness and culturable bacteria after antibiotics, with most healthy adult microbiomes returning to pre-treatment species richness after 2 months, but with an altered taxonomy, resistome, and metabolic output, as well as an increased antibiotic resistance burden. Azithromycin delays the recovery of species richness, resulting in greater compositional distance. A subset of volunteers experience a persistent reduction in microbiome diversity after antibiotics and share compositional similarities with patients hospitalized in intensive care units. These results improve our quantitative understanding of the impact of antibiotics on commensal microbiome dynamics, resilience, and recovery.

Blast Injury to the Hand: Assessing the Injury Pattern and Functional Outcome of the Thumb.

BACKGROUND: In the United States, approximately 30% of about 10,000 annual blast injuries involve the hand, causing a broad spectrum of injury severity. The first web space is typically most severely affected. As the carpometacarpal (CMC) joint is critical to the unique function of the thumb, we evaluated typical patterns of injury to this joint, subsequent salvageability and functional outcomes of the thumb. METHODS: We conducted a retrospective chart review on patients with blast injuries to the hand from January 1995 through July 2019 and excluded penetrating trauma. We assessed hand function as reported in occupational therapy records. Injury severity was classified independently by structures. RESULTS: Twenty-one patients were included, two with bilateral injuries, for a total of 23 hands. Eighteen patients had injuries to one or both thumbs, for a total of 20 thumbs evaluated. Average follow-up was 1.58 years. Most injuries qualified as severe in at least one category: soft tissue, neurovascular, or bone/joint. All 10 CMC joint dislocations required surgical fixation and pinning. Eight patients had applicable occupational therapy notes available. Severely injured thumbs had statistically significant decreased range of motion (ROM) at the interphalangeal joint, metacarpophalangeal joint and with radial abduction compared to mildly injury thumbs (P value 0.02, 0.03, 0.04, respectively). CONCLUSIONS: Blast injury to the hand often results in severe deficits, frequently affecting thumb functionality and irreversibly altering occupational capabilities. Half the patients studied had severe damage to the thumb CMC joint. Objectively, severely injured thumbs had significantly worse ROM than mildly injured thumbs.