Prostate biopsy sepsis prevention: external validation of an alcohol needle washing protocol.

PURPOSE: Transrectal ultrasound-guided prostate biopsy (TRUS-Bx) is associated with a 1-8% risk of post-biopsy sepsis (PBS). A recent study described an isopropyl alcohol needle washing protocol that significantly decreased PBS rates. The current study examined the efficacy of this technique in our clinic population. MATERIALS AND METHODS: Data were reviewed for 1250 consecutive patients undergoing TRUS-Bx at the Charlie Norwood VA Medical Center from January 2017 to January 2023. Needle washing was adopted in February 2021. Complications occurring within 30 days after TRUS-Bx were recorded. RESULTS: There were 912 patients in group 1 (without needle washing) and 338 in group 2 (with needle washing). Groups had equivalent demographic features, and men of African descent comprised 70% of patients. Standard 12 core biopsies were done in 83% and 82% in groups 1 and 2, respectively (p = 0.788). Total complication rates were 4% and 2% in groups 1 and 2, respectively (p = 0.077). There were 13 sepsis events in group 1 (1.4%) and none in group 2 (p = 0.027). Clavien-Dindo Grade I-III complications occurred in 25 (2.7%) and 7 (2.1%) patients in groups 1 and 2, respectively (p = 0.505). Standard antibiotic prophylaxis (PO fluoroquinolone and IM gentamicin) was given in 80% and 86% of patients in groups 1 and 2, respectively (p = 0.030). Subset analysis limited to patients who received standard prophylaxis showed a significant difference in sepsis rates (1.5% vs 0%; p = 0.036). CONCLUSIONS: Adoption of isopropyl alcohol needle washing was associated with a significant decrease in PBS events.

A Comparison of 2 Debriefing Rubrics to Assess Facilitator Adherence to the PEARLS Debriefing Framework.

INTRODUCTION: Many educators have adopted the Promoting Excellence and Reflective Learning in Simulation (PEARLS) model to guide debriefing sessions in simulation-based learning. The PEARLS Debriefing Checklist (PDC), a 28-item instrument, and the PEARLS Debriefing Adherence Rubric (PDAR), a 13-item instrument, assess facilitator adherence to the model. The aims of this study were to collect evidence of concurrent validity and to evaluate their unique strengths. METHODS: A review of 130 video recorded debriefings from a synchronous high-fidelity mannequin simulation event involving third-year medical students was undertaken. Each debriefing was scored utilizing both instruments. Internal consistency was determined by calculating a Cronbach's α. A Pearson correlation was used to evaluate concurrent validity. Discrimination indices were also calculated. RESULTS: Cronbach's α values were 0.515 and 0.714 for the PDAR and PDC, respectively, with ≥0.70 to ≤0.90 considered to be an acceptable range. The Pearson correlation coefficient for the total sum of the scores of both instruments was 0.648, with a values between ±0.60 and ±0.80 considered strong correlations. All items on the PDAR had positive discrimination indices; 3 items on the PDC had indices ≤0, with values between -0.2 and 0.2 considered unsatisfactory. Four items on both instruments had indices >0.4, indicating only fair discrimination between high and low performers. CONCLUSIONS: Both instruments exhibit unique strengths and limitations. The PDC demonstrated greater internal consistency, likely secondary to having more items, with the tradeoff of redundant items and laborious implementation. Both had concurrent validity in nearly all subdomains. The PDAR had proportionally more items with high discrimination and no items with indices ≤0. A revised instrument incorporating PDC items with high reliability and validity and removing those identified as redundant or poor discriminators, the PDAR 2, is proposed.

Simple virus-free mouse models of COVID-19 pathologies and oral therapeutic intervention.

The paucity of preclinical models that recapitulate COVID-19 pathology without requiring SARS-COV-2 adaptation and humanized/transgenic mice limits research into new therapeutics against the frequently emerging variants-of-concern. We developed virus-free models by C57BL/6 mice receiving oropharyngeal instillations of a SARS-COV-2 ribo-oligonucleotide common in all variants or specific to Delta/Omicron variants, concurrently with low-dose bleomycin. Mice developed COVID-19-like lung pathologies including ground-glass opacities, interstitial fibrosis, congested alveoli, and became moribund. Lung tissues from these mice and bronchoalveolar lavage and lung tissues from patients with COVID-19 showed elevated levels of hyaluronic acid (HA), HA-family members, an inflammatory signature, and immune cell infiltration. 4-methylumbelliferone (4-MU), an oral drug for biliary-spasm treatment, inhibits HA-synthesis. At the human equivalent dose, 4-MU prevented/inhibited COVID-19-like pathologies and long-term morbidity; 4-MU and metabolites accumulated in mice lungs. Therefore, these versatile SARS-COV-2 ribo-oligonucleotide oropharyngeal models recapitulate COVID-19 pathology, with HA as its critical mediator and 4-MU as a potential therapeutic for COVID-19.

Esophageal Liposarcoma: A Case Report and Review of the Literature.

Liposarcomas are extremely rare occurrences in the esophagus. Here, we present an unusual case of esophageal liposarcoma that contributed to a long history of dysphagia before a definitive diagnosis was reached. The case is that of a 61-year-old woman who complained of dysphagia and foreign body sensation in her throat and was found to have a large filling defect within the cervical esophagus on barium esophagogram. She underwent endoscopic resection of the mass and was diagnosed with a five-centimeter long, well-differentiated esophageal liposarcoma, confirmed with fluorescence in situ hybridization for MDM2 gene locus amplification. Subsequent laser ablation of the tumor bed was conducted with no recurrences noted to date. Proper histologic identification, alongside adjunctive cytogenetic and molecular diagnostics, followed by definitive surgical resection and extended follow-up, are emphasized as critical in optimizing outcomes for this disease. A review of the existing English-language medical literature relating to esophageal liposarcoma was performed and summarized.