Epidemiologic patterns of adolescent idiopathic scoliosis detection and treatment in new york state.

The purpose of this study is to examine the epidemiologic trends of adolescent idiopathic scoliosis (AIS) detection and treatment in New York State (NYS), including disparities in access. The New York Statewide Planning and Research Cooperative System database was reviewed to identify patients who underwent treatment for, or were diagnosed with, AIS from 2008 to 2016. Age determined adolescence; and the surgery date, 3-digit zip code, sex, race, insurance status, institution and surgeon license number were recorded to identify such trends. The geographical distribution was assembled from an NYS shapefile, obtained from the Topologically Integrated Geographic Encoding and Referencing database with analysis performed using tigris R. In total 54 002 patients with AIS, 3967 of whom were surgically treated, were identified for analysis. Diagnoses spiked in 2010. Females were diagnosed and underwent surgical treatment more frequently than males. AIS was diagnosed and treated in white patients more frequently than in black and Asian patients combined. From 2010 to 2013, the patients self-paying for surgical treatment decreased more than other payment modalities. Medium-volume surgeons continually increased the number of cases performed, whereas low-volume surgeons exhibited the opposite pattern. High-volume hospitals had a decrease in the number of cases from 2012 and were overtaken by medium-volume hospitals in 2015. Most procedures are performed within the New York City (NYC) area, though AIS was common in all NYS counties. AIS diagnoses increased after 2010, with fewer patients self-paying for surgery. White patients underwent more procedures than minority patients. Surgical cases were disproportionally performed in the NYC area compared to statewide.

The Flaw in Formalist Accounts of Circumvention Tourism.

Circumvention tourism is a form of medical tourism that occurs when individuals travel abroad to receive treatments that are a prohibited in their home county but permitted in a destination country. This paper explores this question: Should individuals be punished by their home countries for engaging in circumvention tourism? Guido Pennings, Richard Huxtable, and I. Glenn Cohen have all argued for what I call "formalist accounts" of circumvention tourism. That is, they try to show that certain types of circumvention tourism should or should not be punished in principle. Against them, I show that questions about circumvention tourism's punishability cannot be answered in the abstract. Whether individuals should be punished depends too much on the prima facie morality of the treatments being performed and the prohibitions being circumvented.

The ethical indefensibility of heartbeat bills.

Recently, several states in the United States have sought to adopt more restrictive abortion policies. Most have tried to enact "heartbeat bills" that prohibit most abortions once a fetal heartbeat becomes detectable. This article explores this question: Are heartbeat bills ethically defensible? I argue that they are not. There are at least four problems with them. First, heartbeat bills rely on a problematic understanding of human death. Second, they contradict and even undermine the leading arguments in ethics against abortion. Third, they are ambiguous not just in terms of when they judge fetal heartbeats to be detectable but also in what they deem to be heartbeats. Finally, there is a case to be made that heartbeat bills are disingenuous, both in their intentions and in their underlying motives.

Procreative responsibilities and the parental obligation objection.

This essay presents a challenge to the parental obligation objection. This objection is usually made by abortion opponents who argue that because child support laws hold men postnatally responsible for children they helped bring into existence (even when they did not intend to become parents), women too have prenatal parental responsibilities that should prevent them from ending pregnancies through abortions. My essay draws on recent publications in bioethics that distinguish procreative from parental responsibilities. This distinction was originally developed to clarify the duties of third-party participants in assisted reproduction. However, the distinction inadvertently poses a problem for the parental obligation objection, for it raises questions about whether women who do not wish to carry a child to term have parental rather than procreative responsibilities. It does not necessarily follow that the objection must be wrong. But rather, that there is an explanatory gap in it. If abortion violates procreative responsibilities, then drastic changes must be made to fertility medicine. Conversely, there does not appear to be non-question-begging criteria that would explain why pregnant women must have parental responsibilities, in addition to procreative ones, whereas third-party participants in assisted reproduction, such as fertility doctors, embryologists, gamete donors, and surrogates, have only procreative responsibilities.

Why Inconsistency Arguments Matter.

Abortion opponents are sometimes accused of having inconsistent beliefs, actions, and/or priorities. If they were consistent, they would regard spontaneous abortions to be a greater moral tragedy, or they would adopt more frozen in vitro fertilization embryos, or they would support more robust social welfare programmes for children and single parents, or so on and so forth. Nicholas Colgrove, Bruce Blackshaw, and Daniel Rodger have recently argued that such inconsistency arguments 'fail en masse.' They propose three main objections: The Diversity Objection, The Other Beliefs Objection, and The Other Actions Objection. This paper argues that they are incorrect. First, Colgrove et al.'s objections rely on misrepresentations of inconsistency arguments, their structure and the extent to which their proponents have addressed counterarguments to them. Second, none of their objections show that these arguments fail as a whole.

Using Stereochemistry to Control Mechanical Properties in Thiol-Yne Click-Hydrogels.

The stereochemistry of polymers has a profound impact on their mechanical properties. While this has been observed in thermoplastics, studies on how stereochemistry affects the bulk properties of swollen networks, such as hydrogels, are limited. Typically, changing the stiffness of a hydrogel is achieved at the cost of changing another parameter, that in turn affects the physical properties of the material and ultimately influences the cellular response. Herein, we report that by manipulating the stereochemistry of a double bond, formed in situ during gelation, materials with diverse mechanical properties but comparable physical properties can be obtained. Click-hydrogels that possess a high % trans content are stiffer than their high % cis analogues by almost a factor of 3. Human mesenchymal stem cells acted as a substrate stiffness cell reporter demonstrating the potential of these platforms to study mechanotransduction without the influence of other external factors.

Early Detection of Hepatocellular Carcinoma Recurrence in the Posttransplant Population: A Comparison of RETREAT and Cleveland Clinic Florida Scoring System.

BACKGROUND: Liver transplantation (LT) for hepatocellular carcinoma (HCC) is curative in most cases; however, recurrence is observed in some patients. The Risk Estimation of Tumor Recurrence After Transplant (RETREAT) score is an externally validated scoring system for prediction of post-LT HCC recurrence. The Cleveland Clinic Florida Scoring System (CCFSS) is a potential new scoring system for prediction of HCC recurrence. Our study aimed to compare the RETREAT and CCFSS. METHODS: We conducted a retrospective cohort study of 52 adult patients with HCC who underwent LT at a tertiary care center. Mantel-Haenszel chi-square analyses were conducted to compare the RETREAT and CCFSS classifications for detecting HCC recurrence. RESULTS: A total of 52 patients underwent LT. The median follow-up period was 37 months. Four patients had post-LT HCC recurrence, with all recurrences occurring within 2 years of LT. The RETREAT score was better able to detect low, moderate, and high levels of risk (P < .001), compared to the CCFSS score (P = 0.480). Both risk scores had a sensitivity of 75%; the specificity of the RETREAT score was 95.8%, whereas the specificity of the CCFSS was 60.4%. Alpha-fetoprotein level at the time of LT was associated with HCC recurrence (P = .014). CONCLUSIONS: This is the first study to evaluate the CCFSS as a potential new scoring system to predict HCC recurrence after LT. The RETREAT score is more specific than the CCFSS. The incorporation of alpha-fetoprotein level at the time of LT improves the estimation of HCC recurrence in the post-LT period.

Using Stereochemistry to Control Mechanical Properties in Thiol-Yne Click-Hydrogels.

The stereochemistry of polymers has a profound impact on their mechanical properties. While this has been observed in thermoplastics, studies on how stereochemistry affects the bulk properties of swollen networks, such as hydrogels, are limited. Typically, changing the stiffness of a hydrogel is achieved at the cost of changing another parameter, that in turn affects the physical properties of the material and ultimately influences the cellular response. Herein, we report that by manipulating the stereochemistry of a double bond, formed in situ during gelation, materials with diverse mechanical properties but comparable physical properties can be obtained. Click-hydrogels that possess a high % trans content are stiffer than their high % cis analogues by almost a factor of 3. Human mesenchymal stem cells acted as a substrate stiffness cell reporter demonstrating the potential of these platforms to study mechanotransduction without the influence of other external factors.

Hepatitis C Virus NAT-Positive Solid Organ Allografts Transplanted Into Hepatitis C Virus-Negative Recipients: A Real-World Experience.

BACKGROUND AND AIMS: Hepatitis C virus (HCV)-viremic organs are underutilized, and there is limited real-world experience on the transplantation of HCV-viremic solid organs into recipients who are HCV negative. APPROACH AND RESULTS: Patients listed or being evaluated for solid organ transplant after January 26, 2018, were educated and consented by protocol on the transplantation of HCV-viremic organs. All recipients were HCV nucleic acid test and anti-HCV antibody negative at the time of transplant and received an HCV-viremic organ. The primary outcome was sustained virological response (SVR) at 12 weeks after completion of direct-acting antiviral (DAA) therapy (SVR12 ). Seventy-seven patients who were HCV negative underwent solid organ transplantation from a donor who was HCV viremic. No patients had evidence of advanced hepatic fibrosis. Treatment regimen and duration were at the discretion of the hepatologist. Sixty-four patients underwent kidney transplant (KT), and 58 KT recipients had either started or completed DAA therapy. Forty-one achieved SVR12 , 10 had undetectable viral loads but are not eligible for SVR12 , and 7 remain on treatment. One KT recipient was a nonresponder because of nonstructural protein 5A resistance. Four patients underwent liver transplant and 2 underwent liver-kidney transplant. Three patients achieved SVR12 , 1 has completed DAA therapy, and 2 remain on treatment. Six patients underwent heart transplant and 1 underwent heart-kidney transplant. Six patients achieved SVR12 and 1 patient remains on treatment. CONCLUSIONS: Limited data exist on the transplantation of HCV-viremic organs into recipients who are HCV negative. Our study is the largest to describe a real-world experience of the transplantation of HCV-viremic organs into recipients who are aviremic. In carefully selected patients, the use of HCV-viremic grafts in the DAA era appears to be efficacious and well tolerated.

Robust alginate/hyaluronic acid thiol-yne click-hydrogel scaffolds with superior mechanical performance and stability for load-bearing soft tissue engineering.

Hydrogels based on hyaluronic acid (HA) exhibit great potential as tissue engineering (TE) scaffolds as a consequence of their unique biological features. Herein, we examine how the advantages of two natural polymers (i.e. HA and alginate) are combined with the efficiency and rapid nature of the thiol-yne click chemistry reaction to obtain biocompatible matrices with tailored properties. Our injectable click-hydrogels revealed excellent mechanical performance, long-term stability, high cytocompatibility and adequate stiffness for the targeted application. This simple approach yielded HA hydrogels with characteristics that make them suitable for applications as 3D scaffolds to support and promote soft tissue regeneration.

Hydrogen sulfide exposure reduces thermal set point in zebrafish.

Behavioural flexibility allows ectotherms to exploit the environment to govern their metabolic physiology, including in response to environmental stress. Hydrogen sulfide (H2S) is a widespread environmental toxin that can lethally inhibit metabolism. However, H2S can also alter behaviour and physiology, including a hypothesized induction of hibernation-like states characterized by downward shifts of the innate thermal set point (anapyrexia). Support for this hypothesis has proved controversial because it is difficult to isolate active and passive components of thermoregulation, especially in animals with high resting metabolic heat production. Here, we directly test this hypothesis by leveraging the natural behavioural thermoregulatory drive of fish to move between environments of different temperatures in accordance with their current physiological state and thermal preference. We observed a decrease in adult zebrafish (Danio rerio) preferred body temperature with exposure to 0.02% H2S, which we interpret as a shift in the thermal set point. Individuals exhibited consistent differences in shuttling behaviour and preferred temperatures, which were reduced by a constant temperature magnitude during H2S exposure. Seeking lower temperatures alleviated H2S-induced metabolic stress, as measured by reduced rates of aquatic surface respiration. Our findings highlight the interactions between individual variation and sublethal impacts of environmental toxins on behaviour.

Incidence and risk factors for 90-day hospital readmission following video-assisted thoracoscopic anatomical lung resection†.

OBJECTIVES: The objective of this study was to identify risk factors for 90-day hospital readmission after video-assisted thoracoscopic surgery (VATS) anatomical lung resections. METHODS: This study is a retrospective analysis of data collected from 481 patients discharged after VATS lobectomy or segmentectomy (January 2012-February 2016). Univariable and stepwise logistic regression analyses were used to identify risk factors for hospital readmission. RESULTS: Hospital readmissions occurred in 59 patients (12.3%). Twenty-three (39%) of them were readmitted after the first 30 days following operation. A short hospital stay (<3 days) was associated with only 3.6% readmission, while 21% of patients with a hospital stay longer than 7 days were readmitted. The most frequent cause of readmission was pneumonia in 17 patients accounting for 26% of all readmissions. Eighteen patients were readmitted for problems related to prolonged chest drain management. Readmission for chest pain occurred in six patients in this VATS population. One hundred and one patients experienced prolonged air leak. Their readmission rate was 21% vs 11% in patients without prolonged air leak (P < 0.0001). The 90-day mortality rate after the initial discharge was similar in readmitted and non-readmitted patients (0 vs 1.2%, Fisher's exact test, P = 1). Stepwise logistic regression analysis showed that the only patient-related factor independently associated with readmission was low body mass index (<18.5 kg/m2) (P < 0.0001). CONCLUSIONS: Readmissions after VATS anatomical lung resections are not uncommon. More than one-third of readmissions occur between 30 days and 90 days from the index operation. Patients should be counselled about the risk of readmission to set realistic expectations of the surgical procedure.

Self-healing, stretchable and robust interpenetrating network hydrogels.

A self-healable stretchable hydrogel system that can be readily synthesized while also possessing robust compressive strength has immense potential for regenerative medicine. Herein, we have explored the addition of commercially available unfunctionalized polysaccharides as a route to synthesize self-healing, stretchable poly(ethylene glycol) (PEG) interpenetrating networks (IPNs) as extracellular matrix (ECM) mimics. The introduction of self-healing and stretchable properties has been achieved while maintaining the robust mechanical strength of the orginal, single network PEG-only hydrogels (ultimate compressive stress up to 2.4 MPa). This has been accomplished without the need for complicated and expensive functionalization of the natural polymers, enhancing the translational applicability of these new biomaterials.

An immortalised mesenchymal stem cell line maintains mechano-responsive behaviour and can be used as a reporter of substrate stiffness.

The mechanical environment can influence cell behaviour, including changes to transcriptional and proteomic regulation, morphology and, in the case of stem cells, commitment to lineage. However, current tools for characterizing substrates' mechanical properties, such as atomic force microscopy (AFM), often do not fully recapitulate the length and time scales over which cells 'feel' substrates. Here, we show that an immortalised, clonal line of human mesenchymal stem cells (MSCs) maintains the responsiveness to substrate mechanics observed in primary cells, and can be used as a reporter of stiffness. MSCs were cultured on soft and stiff polyacrylamide hydrogels. In both primary and immortalised MSCs, stiffer substrates promoted increased cell spreading, expression of lamin-A/C and translocation of mechano-sensitive proteins YAP1 and MKL1 to the nucleus. Stiffness was also found to regulate transcriptional markers of lineage. A GFP-YAP/RFP-H2B reporter construct was designed and virally delivered to the immortalised MSCs for in situ detection of substrate stiffness. MSCs with stable expression of the reporter showed GFP-YAP to be colocalised with nuclear RFP-H2B on stiff substrates, enabling development of a cellular reporter of substrate stiffness. This will facilitate mechanical characterisation of new materials developed for applications in tissue engineering and regenerative medicine.

Self-assembly and friction of glycerol monooleate and its hydrolysis products in bulk and confined non-aqueous solvents.

Atomistic molecular dynamics simulations are used to study the self-assembly and friction of glycerol monooleate mixed with oleic acid, glycerol, calcium oleate, or water in n-heptane and toluene solvents. The aim is to determine how chemical degradation products of glycerol monooleate could lead to changes in structural and frictional properties. In bulk solution, almost all mixtures studied contain self-assembled reverse micelles. Under confinement between sheared mica surfaces, the reverse micelles disintegrate, but the distribution of molecules between the surfaces and the centre of the fluid layer depends sensitively on the chemical composition, with more polar mixtures showing stronger adsorption. The measured kinetic friction coefficient is correlated with the extent of surface adsorption: while degradation products lead to increases in the friction coefficient in most cases, all changes are more pronounced when there is less surface adsorption.

Biogelx: Cell Culture on Self-Assembling Peptide Gels.

Aromatic peptide amphiphiles can form self-supporting nanostructured hydrogels with tunable mechanical properties and chemical compositions. These hydrogels are increasingly applied in two-dimensional (2D) and three-dimensional (3D) cell culture, where there is a rapidly growing need to store, grow, proliferate, and manipulate naturally derived cells within a hydrated, 3D matrix. Biogelx Limited is a biomaterials company, created to commercialize these bio-inspired hydrogels to cell biologists for a range of cell culture applications. This chapter describes methods of various characterization and cell culture techniques specifically optimized for compatibility with Biogelx products.

Selecting for Disabilities: Selection Versus Modification.

This essay considers one argument used to defend parents who use preimplantation genetic diagnosis (PGD) to select for deafness and other disabilities. Some bioethicists have argued that a distinction should be drawn between genetically modifying embryos to possess disabilities and using PGD to select embryos that already present markers of them, and that the former is unethical because it inflicts avoidable harms onto the resulting children, whereas the latter is permissible because it allows children with potentially impaired abilities to exist. This essay raises doubts about whether a meaningful moral distinction can be drawn between modification and selection. Arguments which distinguish modification from selection can be understood in two ways. One is to read them as presenting a No Harm, No Foul argument. Another is to read them as presenting a Harming Versus Letting Be argument. Neither succeeds, however, either in establishing a meaningful moral distinction between modification and selection, or in showing that the second is morally permissible in contradistinction to the first.

Ninety-Day Mortality After Video-Assisted Thoracoscopic Lobectomy: Incidence and Risk Factors.

BACKGROUND: We evaluated the incidence and risk factors of 90-day mortality rate after video-assisted thoracoscopic (VATS) lobectomy. METHODS: Retrospective analysis on 733 VATS lobectomies or segmentectomies (January 2012 to February 2016), including 66 operations converted to open operation. Several patient-related and surgical variables were tested to verify their association with 90-day mortality using univariable and logistic regression analyses. A score was assigned to each variable in the final model by proportionally weighting the regression odds ratios (ORs) and assigning 1 point to the smallest one. A total score was generated for each patient by adding the individual points. The patients were finally grouped into classes of risk. RESULTS: In-hospital/30-day mortality rate was 1.9% (14 patients). Additionally, 4 patients died after discharge between 30 and 90 days. Total 90-day mortality rate was 2.5% (18 patients). Regression analysis showed that factors significantly associated with 90-day mortality were male sex (OR 12, p = 0.001), carbon monoxide lung diffusion capacity (Dlco) less than 60% (OR 4.8, p =0.001), and operative time longer than 150 minutes (OR 4.2, p = 0.03). A score was developed assigning 1 point to the variables Dlco and operative time and 3 points to the variable male sex. The total score ranged from 0 (155 patients) to 5 points (32 patients). Patients were grouped into five risk classes showing an incremental 90-day mortality rate (class A, 0; class B, 0.38%; class C, 0.93%; class D, 5.65%; class E, 18.75%, p < 0.0001). CONCLUSIONS: Our results represent important information to be shared with the patients during surgical counseling. It can also assist multidisciplinary tumor board discussion about treatment selection.