COVID-19 exacerbating ESRD induced pericardial effusion requiring pericardial window: A case report.

INTRODUCTION: Pericardial effusion can lead to cardiac tamponade requiring immediate management. Pericardial windows are an effective measure to surgically drain recurrent effusions. PRESENTATION OF CASE: We present a case of a 53-year-old male with recurrent pericardial effusion secondary to ESRD and exacerbated by COVID-19 infection, describing the successful management of an uncommon clinical scenario. A sub-xiphoid pericardial window and right sided thoracostomy was performed. DISCUSSION: There are limited case reports highlighting recurrent pericardial effusion management, secondary to ESRD and COVID-19 in a post renal transplant patient, through a subxiphoid pericardial window. CONCLUSION: COVID-19 infection can exacerbate pericardial effusion in a patient with ESRD, post renal transplant. Preventing cardiac tamponade, a sub-xiphoid pericardial window remains an effective measure in treating recurrent pericardial effusion.

Quantitation of pretreatment serum interferon-γ-inducible protein-10 improves the predictive value of an IL28B gene polymorphism for hepatitis C treatment response.

UNLABELLED: Polymorphisms of the IL28B gene are highly associated with sustained virological response (SVR) in patients with chronic hepatitis C treated with peginterferon and ribavirin. Quantitation of interferon-γ-inducible protein-10 (IP-10) may also differentiate antiviral response. We evaluated IP-10 levels in pretreatment serum from 115 nonresponders and 157 sustained responders in the Study of Viral Resistance to Antiviral Therapy of Chronic Hepatitis C cohort, including African American (AA) and Caucasian American (CA) patients. Mean IP-10 was lower in sustained responders compared with nonresponders (437 ± 31 vs 704 ± 44 pg/mL, P < 0.001), both in AA and CA patients. The positive predictive value of low IP-10 levels (<600 pg/mL) for SVR was 69%, whereas the negative predictive value of high IP-10 levels (>600 pg/mL) was 67%. We assessed the combination of pretreatment IP-10 levels with IL28B genotype as predictors of treatment response. The IL28B polymorphism rs12979860 was tested in 210 participants. The CC, CT, and TT genotypes were found in 30%, 49%, and 21% of patients, respectively, with corresponding SVR rates of 87%, 50%, and 39% (P < 0.0001). Serum IP-10 levels within the IL28B genotype groups provided additional information regarding the likelihood of SVR (P < 0.0001). CT carriers with low IP-10 had 64% SVR versus 24% with high IP-10. Similarly, a higher SVR rate was identified for TT and CC carriers with low versus high IP-10 (TT, 48% versus 20%; CC, 89% versus 79%). IL28B genotype and baseline IP-10 levels were additive but independent when predicting SVR in both AA and CA patients. CONCLUSION: When IL28B genotype is combined with pretreatment serum IP-10 measurement, the predictive value for discrimination between SVR and nonresponse is significantly improved, especially in non-CC genotypes. This relationship warrants further investigation to elucidate the mechanisms of antiviral response and prospective validation.

Ranking United States University-Based General Surgery Programs on the Academic Achievement of Surgery Department Faculty.

OBJECTIVE: Rankings of residency programs are highly influential and utilized by residency applicants. Existing ranking resources often use opaque criteria that may include bias or do not accurately represent the academic achievement of current faculty. This study aims to create an updated general surgery residency ranking list based on the academic achievements of their respective surgery department faculty members. DESIGN: One hundred and six general surgery residency programs were selected from the American Medical Association Residency & Fellowship Programs Database. The names of faculty members affiliated with the departments of surgery were manually obtained. Lifetime and five-year h-indexes, a sum of grant awards from the National Institute of Health and Veterans Affairs, and a tally of journal editorial board positions were collected for the faculty. Metrics were compared among surgical departments, and the corresponding residency programs were ranked accordingly. SETTING: The study evaluated university-based general surgery residency programs in the United States from 2017 to 2019 via assessing their respective institutions' departments of surgery. PARTICIPANTS: A total of 7568 faculty members were evaluated. Faculty were required to be full-time, clinical surgeons to meet inclusion criteria. RESULTS: Based on a composite of all measured criteria, the top overall surgery department was at the University of Michigan. Massachusetts General Hospital had the highest lifetime and five-year h-indexes. Brigham and Women's Hospital had the most National Institute of Health funding, and the University of Pittsburgh Medical Center had the most Veterans Affairs funding. Washington University in St. Louis/Barnes Jewish Hospital had the most editorial board positions in their department. CONCLUSIONS: The academic success of departments of surgery was evaluated to develop a ranking list of general surgery residency programs. Through utilizing standardized methods and several measures of academic achievement, this comprehensive general surgery residency classification system will allow residency applicants to make more informed decisions.

Lanthanide extraction selectivity of a tripodal carbamoylmethylphosphine oxide ligand system.

Four tripodal carbamoylmethylphosphine oxide (CMPO)-based ligands are reported here and assessed with regard to lanthanide (Ln) coordination chemistry and selective extraction of lanthanide ions from aqueous solution. Inspired by previous liquid-liquid extraction studies that suggested a preference for terbium(iii), the current work further probes the extraction behavior of a tris-(2-aminoethyl)amine (TREN) capped, ethoxy substituted CMPO ligand with respect to the entire series of lanthanides. Upon confirmation of Tb3+ extraction selectivity versus the whole series, experiments were conducted to assess the effect of increasing the alkyl chain length within the ligand TREN cap, as well as changing the CMPO substituents by replacing the ethoxy groups with more hydrophobic phenyl groups to promote solubility in the organic extraction solvent. Extraction efficiencies remained low for most lanthanides upon increasing the cap size, with %E values consistently around 5%, and a complete loss of Tb3+ preference was noted with a decrease in %E from 18% to 3.5%. For the agent employing the original, smaller TREN cap but with phenyl substituents on the CMPO units, an increase in extraction toward the middle of the row was again observed, albeit modest, with relatively high %E values for both Gd3+ and Tb3+versus the other lanthanides (13 and 11%, respectively). A more dramatic extraction selectivity for the phenyl substituted ligand was achieved upon modification of the ligand to metal ratio, with a 100 : 1 ratio resulting in a near linear decrease in %E from 41% for La3+ to 3.7% for Lu3+. Finally, modification of the TREN capping scaffold by adding an oxygen atom to the central nitrogen led to consistently low %E values, revealing the effect of TREN cap oxidation on Ln extraction for this tripodal CMPO ligand system.

Pediatric Calvarial Bone Thickness in Patients With and Without Aural Atresia.

OBJECTIVE: To compare temporal bone thickness along a three-dimensional arc of potential osseointegrated implant sites for bone-anchored hearing aids in children with and without aural atresia using computed tomographic imaging (CT). STUDY DESIGN: Retrospective case review. SETTING: Tertiary children's hospital. PATIENTS: Children with or without aural atresia aged less than 11 years who had a temporal bone CT. INTERVENTION (S): Calvarial bone volume on CT was rendered in three-dimensional and thickness was reconstructed and measured at up to 12 defined sites along an arc of recommended implant sites. MAIN OUTCOME MEASURE (S): Determining whether a majority of observed potential implant sites have 2, 3, or 4 mm of bone thickness while controlling for age differences and atresia status. RESULTS: A total of 40 atretic (from 34 patients) and 34 control (from 34 patients) temporal bones were compared using CT. Likelihood ratio tests indicated that diagnosis did not have a statistically significant effect on whether patients reached thresholds of 2, 3, or 4 mm at most observed sites (p = 0.781, 0.773, and 0.529, respectively) when adjusting for age. For all children measured, 93% had >50% of measured points greater than or equal to 2 mm thick. CONCLUSION: Most children had greater than 2 mm of temporal bone thickness at >50% of the sites measured regardless of age or atresia diagnosis. The likelihood of reaching 4 mm of thickness at most sites improves with age. In unilateral patients, there was not a significant difference in thickness between affected and unaffected sides. There was also no significant difference in thickness when comparing patients with atresia to those without.

Amplification of thymidylate synthetase in metastatic colorectal cancer patients pretreated with 5-fluorouracil-based chemotherapy.

Resistance to 5-fluorouracil (5-FU) represents a major contributor to cancer-related mortality in advanced colorectal cancer patients. Genetic variations and expression alterations in genes involved in 5-FU metabolism and effect have been shown to modulate 5-FU sensitivity in vitro, however these alterations do not fully explain clinical resistance to 5-FU-based chemotherapy. To determine if alterations of DNA copy number in genes involved in 5-FU metabolism-impacted clinical resistance to 5-FU-based chemotherapy, we assessed thymidylate synthetase (TYMS) and thymidine phosphorylase (TYMP) copy number in colorectal liver metastases. DNA copy number of TYMS and TYMP was evaluated using real time quantitative PCR in frozen colorectal liver metastases procured from 62 patients who were pretreated with 5-FU-based chemotherapy prior to surgical resection (5-FU exposed) and from 51 patients who received no pretreatment (unexposed). Gain of TYMS DNA copy number was observed in 18% of the 5-FU exposed metastases, while only 4% of the unexposed metastases exhibited TYMS copy gain (p = 0.036). No significant differences were noted in TYMP copy number alterations between 5-FU-exposed and -unexposed metastases. Median survival time was similar in 5-FU-exposed patients with metastases containing TYMS amplification and those with no amplification. However, TYMS amplification was associated with shorter median survival in patients receiving post-resection chemotherapy (hazard ratio = 2.7, 95% confidence interval = 1.1-6.6; p = 0.027). These results suggest amplification of TYMS amplification as a putative mechanism for clinical resistance to 5-FU-based chemotherapy and may have important ramifications for the post-resection chemotherapy choices for metastatic colorectal cancer.