Forequarter Amputation and Resection of Ribs 1-4 for Chronic Osteomyelitis.

A 78-year-old woman with a history of breast cancer, melanoma, and radiation therapy presented with worsening chronic osteomyelitis and radiation necrosis of her clavicle, scapula, and upper ribs. Despite treatment with vancomycin, she experienced significant lymphedema and near-total loss of motor function in the left upper extremity. Given the progression of the disease and diminished functionality of the limb, a forequarter amputation was determined to be the only viable option beyond supportive care. The forequarter amputation was successful, and it involved the removal of the left clavicle, scapula, ribs 1-4, and the upper extremity. Within a month, the patient regained independence in all activities of daily living, highlighting the potential for improved quality of life from surgical interventions under certain circumstances. Our case serves as a reminder that the utility of the forequarter amputation extends beyond its most common uses, such as trauma or sarcoma, and in rare cases can be an option for refractory osteomyelitis of the proximal upper extremity and chest wall.

Getting ready for prime time: Recommended adaptations of an Empathic Communication Skills training intervention to reduce lung cancer stigma for a national multi-center trial.

Building upon prior work developing and pilot testing a provider-focused Empathic Communication Skills (ECS) training intervention, this study sought feedback from key invested partners who work with individuals with lung cancer (i.e. stakeholders including scientific and clinical advisors and patient advocates) on the ECS training intervention. The findings will be used to launch a national virtually-delivered multi-center clinical trial that will examine the effectiveness and implementation of the evidence-based ECS training intervention to reduce patients' experience of lung cancer stigma. A 1-day, hybrid, key invested partners meeting was held in New York City in Fall 2021. We presented the ECS training intervention to all conference attendees (N = 25) to seek constructive feedback on modifications of the training content and platform for intervention delivery to maximize its impact. After participating in the immersive training, all participants engaged in a group discussion guided by semi-structured probes. A deductive thematic content analysis was conducted to code focus group responses into 12 distinct a priori content modification recommendations. Content refinement was suggested in 8 of the 12 content modification themes: tailoring/tweaking/refining, adding elements, removing elements, shortening/condensing content, lengthening/extending content, substituting elements, re-ordering elements, and repeating elements. Engagement and feedback from key invested multi-sector partner is a valuable resource for intervention content modifications. Using a structured format for refining evidence-based interventions can facilitate efforts to understand the nature of modifications required for scaling up interventions and the impact of these modifications on outcomes of interest. ClinicalTrials.gov Identifier: NCT05456841.

This study was done to get feedback from people who are involved with patients with lung cancer (PwLCs) including scientists, clinicians, and patient advocates on training in Empathic Communication Skills (ECS). The training is intended to reduce PwLCs experience of lung cancer stigma. The feedback is being used to help prepare for launching the training program in multiple cancer centers across the USA to test how well the training will work to reduce the stigma felt by PwLCs. A one-day, hybrid (in-person and virtual attendees) meeting was held in New York City in October 2021. We presented the original version of the ECS training program to all conference attendees (N = 25) to get feedback on modifications to improve the training program for the larger study planned at many cancer centers. After the training, all meeting attendees participated in a semi-structured group discussion. The content of the discussion was analyzed and sorted into 12 distinct categories that were defined before the meeting. Changes to the content were suggested in 8 of the 12 categories. These changes included tailoring/tweaking/refining, adding elements, removing elements, shortening/condensing content, lengthening/extending content, substituting elements, re-ordering elements, and repeating elements. Engaging and getting feedback from people involved in a topic is a good way to improve content and delivery of training materials.

Effect of Antigen Retrieval on Genomic DNA From Immunodissected Samples.

Immunohistochemical (IHC) staining is an established technique for visualizing proteins in tissue sections for research studies and clinical applications. IHC is increasingly used as a targeting strategy for procurement of labeled cells via tissue microdissection, including immunodissection, computer-aided laser dissection (CALD), expression microdissection (xMD), and other techniques. The initial antigen retrieval (AR) process increases epitope availability and improves staining characteristics; however, the procedure can damage DNA. To better understand the effects of AR on DNA quality and quantity in immunodissected samples, both clinical specimens (KRAS gene mutation positive cases) and model system samples (lung cancer patient-derived xenograft tissue) were subjected to commonly employed AR methods (heat induced epitope retrieval [HIER], protease digestion) and the effects on DNA were assessed by Qubit, fragment analysis, quantitative PCR, digital droplet PCR (ddPCR), library preparation, and targeted sequencing. The data showed that HIER resulted in optimal IHC staining characteristics, but induced significant damage to DNA, producing extensive fragmentation and decreased overall yields. However, neither of the AR methods combined with IHC prevented ddPCR amplification of small amplicons and gene mutations were successfully identified from immunodissected clinical samples. The results indicate for the first time that DNA recovered from immunostained slides after standard AR and IHC processing can be successfully employed for genomic mutation analysis via ddPCR and next-generation sequencing (NGS) short-read methods.

Preoperative nutritional counselling in patients undergoing oesophagectomy.

BACKGROUND: Patients undergoing surgery for oesophageal cancer are at high risk of malnutrition due to pathology and neoadjuvent therapy. This study sought to determine if oesophageal cancer patients undergoing oesophagectomy achieve superior clinical outcomes when preoperative nutritional counselling is performed. METHODS: Oesophageal cancer patients undergoing oesophagectomy were retrospectively divided into cohorts based on those who received (n = 48) and did not receive (n = 58) preoperative nutritional counselling. We compared weight loss, length of stay, 30-day readmission related to nutrition or feeding tube problems, and 90-day mortality. RESULTS: Per cent weight loss was less in patients who received preoperative nutritional counselling. There was a trend toward decreased mean length of stay and there were fewer readmissions for feeding tube-related complications in patients who received counselling. CONCLUSIONS: Nutritional counselling before surgery may lead to decreased weight loss and reduced readmissions for feeding tube-related complications in patients with oesophageal cancer undergoing oesophagectomy.

NPARS-A Novel Approach to Address Accuracy and Reproducibility in Genomic Data Science.

Background: Accuracy and reproducibility are vital in science and presents a significant challenge in the emerging discipline of data science, especially when the data are scientifically complex and massive in size. Further complicating matters, in the field of genomic-based science high-throughput sequencing technologies generate considerable amounts of data that needs to be stored, manipulated, and analyzed using a plethora of software tools. Researchers are rarely able to reproduce published genomic studies. Results: Presented is a novel approach which facilitates accuracy and reproducibility for large genomic research data sets. All data needed is loaded into a portable local database, which serves as an interface for well-known software frameworks. These include python-based Jupyter Notebooks and the use of RStudio projects and R markdown. All software is encapsulated using Docker containers and managed by Git, simplifying software configuration management. Conclusion: Accuracy and reproducibility in science is of a paramount importance. For the biomedical sciences, advances in high throughput technologies, molecular biology and quantitative methods are providing unprecedented insights into disease mechanisms. With these insights come the associated challenge of scientific data that is complex and massive in size. This makes collaboration, verification, validation, and reproducibility of findings difficult. To address these challenges the NGS post-pipeline accuracy and reproducibility system (NPARS) was developed. NPARS is a robust software infrastructure and methodology that can encapsulate data, code, and reporting for large genomic studies. This paper demonstrates the successful use of NPARS on large and complex genomic data sets across different computational platforms.

Integration of smoking cessation and lung cancer screening.

The National Lung Screening Trial demonstrated a decrease in both lung cancer mortality and overall mortality in enrollees aged 55-74 with a 30 pack-year smoking history using low-dose computed tomography (LDCT). Lung cancer screening in high-risk groups is supported by the United States Preventive Services Task Force, the National Comprehensive Cancer Network, and multiple other organizations. Inclusion for any lung screening program requires a history of smoking, and many undergoing screening are currently smoking. Screened patients are not only at risk for developing lung cancer, but also carry the risk of developing a host of other smoking related diseases, and cessation at any point is beneficial. Counseling and pharmacotherapy are evidence-based strategies which are well known to help people quit smoking. However, as lung cancer screening is an emerging and evolving field, the integration of cessation resources in screening programs is not uniformly done, and when it is done, there is no standardized approach. The goals of this review are to discuss the rationale for integrating smoking cessation resources in lung cancer screening, review what types of resources may be effective, and discuss different strategies of how integration can be done. Ultimately, the overarching goal of any lung cancer screening program is not merely to find more nodules, or diagnose more cases of cancer, but to help screened patients live longer, better lives. Smoking cessation broadens the impact of any lung cancer screening program well beyond the endpoints of cancer diagnosis and cancer mortality to reduce risk from many other diseases, and can positively impact many more patients than the small percentage that have cancer.

Smoking Cessation in Clinical Practice: How to Get Patients to Stop.

Tobacco use is an etiologic agent for many diseases treated by cardiac, vascular, and thoracic surgeons and contributes to increased perioperative complications and long-term risk. Smoking cessation may be challenging for patients and can be frustrating for clinicians. Lack of familiarity and pessimistic views toward cessation methods lead to underuse by physicians. Evidence-supported measures that increase chances of cessation include direct physician advice, approved pharmacotherapy, structured counseling, and a follow-up plan. Approved pharmacotherapy consists of varenicline, bupropion, or nicotine replacement therapy in the form of long-acting patches and short-acting forms of nicotine such as gum, lozenges, prescription nasal spray, or prescription inhaler. Direct physician advice is critical and strengthened when combined with more in-depth counseling from a specialist who may have more expertise and time. Integrating assessment and referral to counseling services into a clinical workflow can deliver resources in an efficient manner with the goal of providing the best available resources to all patients.

Hyalinizing Clear Cell Carcinoma of the Lung: Case Report and Review of the Literature.

OBJECTIVES: Hyalinizing clear cell carcinoma (HCCC) is common in head and neck sites but extremely rare in the lung. This case report describes an HCCC in the lung of a 54-year-old female patient. METHODS: We summarize the histomorphologic, immunophenotypic, and molecular features for our and three previously reported HCCCs of the lung with emphasis on potential diagnostic pitfalls. RESULTS: Sections of a well-circumscribed 3.5-cm lung mass were characterized by a bronchocentric tumor growing in sheets, nests, and cords in a background of hyalinized stroma. Tumor cell appearance was clear to eosinophilic, lacking significant pleomorphism or mitotic activity. By immunohistochemistry, the tumor cells were strongly positive with antibodies to pan-keratin, p63, and CK5/6 while negative for CK7, CK20, thyroid transcription factor 1, napsin A, chromogranin, and synaptophysin. Next-generation sequencing demonstrated an EWSR1-ATF1 fusion transcript. CONCLUSIONS: Awareness of key morphologic features of pulmonary HCCC is crucial for the recognition of this rare entity in the lung. Ancillary studies, including immunohistochemistry and molecular testing, are essential for the distinction from its mimics.

Successful Treatment of Esophageal Necrosis Secondary to Acute Type B Aortic Dissection.

Esophageal necrosis after descending aortic dissection has been described but with no reports of successful treatment. A 66-year-old man with aortic dissection extending from the left subclavian artery through the common iliac arteries subsequently experienced esophageal necrosis. He underwent thoracic esophagectomy, cervical end esophagostomy, and open gastrostomy tube placement. Gastrointestinal continuity was established with a gastric tube conduit in the substernal plane. An oral diet was tolerated after reconstruction. Treatment of esophageal necrosis after aortic dissection may require esophageal diversion and esophagectomy. Esophageal continuity can later be restored while avoiding the posterior mediastinum.

Myxoid mesenchymal neoplasm presenting as massive arm and chest wall oedema with pleural effusion.

Myxoid mesenchymal tumours are a heterogeneous group of neoplasms characterised histologically by their abundant mucoid and myxoid extracellular matrix (ECM). Encompassing a broad spectrum of clinical behaviour ranging from benign to malignant, there are more than 60 reactive and neoplastic entities currently classified under its domain. Its varied clinical and histopathologic features continue to pose a diagnostic challenge to clinicians and pathologists. Here, we describe a rare case of myxoid mesenchymal tumour presenting as oedema of the upper extremity with pleural metastasis and partial response to chemotherapy, which to the best of our knowledge has not yet been described in the literature.

Particulate Exposure at two Arkansas Racinos; Unsafe Environments?

The purpose of this pilot project was to initiate data collection on secondhand smoke (SHS) for two racinos (racetrack casinos) exempted from Arkansas' 2006 Clean Indoor Air Act. Air quality was assessed during regular hours in sites open to the public. All measurements of fine particulates (PM2.5) within both facilities exceeded maximal safe EPA standards for an equivalent 24-hour average exposure. The exemptions as they stand, fail to protect all interested citizens.