Association between school racial/ethnic composition during adolescence and adult health.

OBJECTIVES: School racial/ethnic segregation in U.S. schoolsDifferences in school racial/ethnic composition may increase health disparities by concentrating educational opportunities that confer long-term health benefits in schools serving predominantly wwhite students. For racial minority students, high concentrations of white students may increase exposure to racismis also associated with psychologicstress, which may ultimately reduceing the long-term health benefits from educational opportunities. Meanwhile associations of racial/ethnic academic tacking within schools and health have been mixed. We sought to test whether: 1) differences in racial/ethnic composition between schools and, 2) racial/ethnic distribution of students in academic tracks within schools are associated with long-term health benefits or risks for white, Black and Latinx students. METHODS: We analyzed the National Longitudinal Study of Adolescent to Adult Health (12,438 participants, collected 1994-2008), to test whether the school-level segregation (percent of non-Latinx white students at participants' school during adolescence) was associated with adult health outcomes at ages 18-26 & 24-32, controlling for contextual factorscomparing Black, Latinx, and white students, and controlling for contextualf factors. A secondary analysis explored whether racial/ethnic cohorting across levels of English courses was associated with each health outcome. RESULTS: Attending a school with a higher percent of white students was associated with higher adult depression scores, substance abuse, and worse self-rated health for black Black students; lower depression scores, better self-rated health, and alcohol abuse for white students; and no health differences for Latinx students. Greater within school racial/ethnic cohorting across English courses was associated with increased odds of alcohol abuse for white students; decreased odds of alcohol abuse for Black and Latinx students; and decreased odds of drug abuse for Black students. CONCLUSION: Among Bblack youth, attending a school with a higher percentage of white students is associated with worse behavioral health in adulthood. Understanding the potential impacts of school racial/ethnic composition on health is critical to designing policies that maximize access to opportunity and health.Education policies should comprehensively address school quality and racism to maximize adult health.

It's not just an ileus: disparities associated with ileus following ventral hernia repair.

PURPOSE: We sought to identify risk factors associated with postoperative ileus following ventral hernia repair. METHODS: Utilizing the Nationwide Inpatient Sample (NIS) from 2008 to 2012, we identified adult patients that underwent either open or laparoscopic hernia repair for umbilical and ventral hernias with a diagnosis of umbilical/ventral hernia. We excluded cases with diagnosis of obstruction and bowel gangrene that underwent bowel resection, or with missing data. Risk variables of interest were age, sex, race, income status, insurance status, elective admission, comorbidity status (using the validated van Walraven Score), complications (mechanical, respiratory, postoperative infection, cardiovascular, intraoperative), morbid obesity, procedure type, conversion to open, mesh use, hospital type (rural, urban non-teaching, urban teaching), bed size, and region (northeast, midwest, south, west). Univariate analysis comparing patients with ileus vs control was performed. We then performed multivariable analysis using logistic regression, adjusting for all the risk variables, with ileus as the dependent variable. RESULTS: 30,912 patients were identified that met criteria. Of these, 2660 (8.61%) had postoperative ileus during their stay at the hospital. Univariate analysis showed all risk variables were associated with development of ileus with the exception of income status (p = 0.2903), elective admission (p = 0.7989), mesh use (p = 0.3620), and hospital bed size (p = 0.08351). Median length of stay was 7 days in the ileus cohort vs 3 days in control (p < 0.0001). Median total charges (adjusted to 2012 dollars) was $54,819 vs $35,058 (p < 0.0001). We then performed logistic regression adjusting for all risk variables and found that age (OR 1.66, p < 0.0001), male sex (OR 1.51, p < 0.0001), Black race (OR 1.49, p < 0.0001), comorbidity status (OR 1.12, p < 0.0001), laparoscopic cases converted to open (OR 1.55, p < 0.0001), postoperative complications (mechanical: OR 2.32, p < 0.0001, respiratory: OR 1.54, p < 0.0001, postoperative infection: OR 2.12, p < 0.0001, cardiovascular: OR 1.57, p = 0.0006, intraoperative: OR 1.29, p = 0.0200) were independently associated with increased risk of ileus. However, laparoscopic vs open (OR 0.76, p < 0.0001), elective admission (OR 0.91, p = 0.0378), and northeast vs south hospital region (OR 0.74, p < 0.0001) were independently associated with decreased risk of ileus. CONCLUSION: We performed a large observational study looking for risk factors associated with ileus following ventral hernia repair. Race and region of treatment are independent risk factors associated with ileus following ventral hernia repair, and a potential source of disparities in care and increased admission length and higher cost of care. Further prospective studies are warranted.

Obesity and surgical complications of pancreaticoduodenectomy: An observation study utilizing ACS NSQIP.

BACKGROUND: An estimated 38% of US adults are obese. Obesity is associated with socioeconomic disparities and increased rates of comorbidities, and is a known risk factor for development of pancreatic cancer. As a fourth leading cause of death in the United States, pancreatic cancer is commonly treated with a pancreatico-duodenectomy (PD), or Whipple procedure. Data regarding the effects of obesity on post-operative complication rate primarily comes from specialized centers, however the results are mixed. Our aim is to elucidate the effects that obesity has on outcomes after PD for pancreatic head cancer using a national prospectively maintained clinical database. METHOD: The 2010-2015 American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) Participant Use Files (PUF) were used as the data source. We identified cases in which PD was performed (CPT code 48150) in the setting of a postoperative diagnosis of pancreatic cancer (ICD9 code 157.0). We excluded cases that had emergency admissions, BMI ≤18.5 kg/m2, intraoperative wound classification of III or IV, and disseminated cancer. Cases with missing BMI, preoperative albumin, operative time, LOS data were also excluded. Multiple imputation for missing sex, race, functional status, and ASA classification using chained equations was performed.16 Patients that had BMI ≥30 kg/m2 were considered obese, and patients with BMI <30 kg/m2 were used as control. RESULTS: 3484 patients underwent pancreaticoduodenectomy for pancreatic cancer. 860 patients were identified as obese. Propensity score analysis was performed matching age, sex, race, functional status, presence of dyspnea, diabetes, hypertension, acute renal failure, dialysis dependence, ascites, steroid use, bleeding disorders, history of chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), weight loss, American Society of Anesthesiologists (ASA) classification, and preoperative albumin levels. After matching, obese patients had higher risk of 30-day postoperative complications compared to control, including organ space wound infections (OR 1.38, 95% CI 1.07-1.79, p = 0.0128), returning to the operating room (OR 1.39, 95% CI 1.01-1.91, p = 0.0461), failure to extubate for greater than 48 h (OR 1.60, 95% CI 1.09-2.34, p = 0.0153), death (OR 1.68, 95% CI 1.01-2.78, p = 0.0453), septic shock (OR 2.22, 95% CI 1.46-3.38, p = 0.0002), pulmonary embolism (OR 2.42, 95% CI 1.07-5.45, p = 0.0332), renal insufficiency (OR 2.67, 95% CI 1.33-5.38, p = 0.0058). Sensitivity analysis yielded similar results with the exception of risk for return to the operating room, death, and pulmonary embolism, P > .05. CONCLUSION: In this large observational study using a national clinical database, obese patients undergoing PD for head of pancreas cancer had increased risk of postoperative complications and mortality in comparison to controls.

Outcomes in video-assisted thoracoscopic surgery lobectomies: challenging preconceived notions.

BACKGROUND: Most thoracic surgical procedures in the United States are being performed by general surgeons (GSs) without any advanced training. With the recent approval of computed tomography screening for lung malignancy in high-risk populations, the number of thoracic oncologic resections is expected to rise. Previous literature has demonstrated consistently worsened outcomes for patients undergoing thoracic surgical procedure when done by nonthoracic fellowship-trained surgeons. Using the American College of Surgeons National Surgical Quality Improvement Project database, we examined short-term outcomes in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for malignancy. MATERIALS AND METHODS: Data were obtained from the American College of Surgeons National Surgical Quality Improvement Project from 2010-2015. We identified patients who had an International Classification of Disease 9 diagnosis of lung cancer (162) who underwent VATS lobectomy (current procedural terminology 32663). We included only adults (≥18y) and elective cases. We excluded patients who had preoperative diagnosis of sepsis, contaminated wound class, or those patients with missing American Society of Anesthesiologists classification, morbid obesity, functional status, length of stay (LOS), or sex, and race information. We identified two groups by specialty: GS versus cardiothoracic (CT) surgeon. We then performed univariate analysis. We then performed propensity score analysis using a 1:3 ratio of general surgery patients to CT patients. Outcomes of interest included 30-d postoperative mortality, 30-d postoperative morbidity, and LOS. RESULTS: A total of 4105 patients were identified, 607 performed by GSs, 3508 performed by CT surgeons. The mean age for patients who underwent lobectomies by GSs was 68.6 versus 67.8 in the CT surgeon group (P < 0.05). The majority were female (58.09% GS versus 57.74% CT surgeon). There was a statistically significant difference in race between groups; patients were more likely to be African American in the CT surgeon group. Operative time was lower in the GS group as opposed to the CT surgeon group 179 min versus 196 (P < 0.01). Univariate analysis (mortality <0.1 CT surgeon and GS) and 1:3 propensity score matched analysis (0.08 GS% versus 0.08% CT surgeon) failed to demonstrate a significant difference in mortality. There was a statistically significant difference in median LOS between groups (6.2 GS versus 5.1 CT surgeon). Univariate and propensity matched analyses of pneumonia, sepsis, wound infection, deep vein thrombosis, transfusion requirement, myocardial infarction stroke, postoperative renal insufficiency, failure to wean, pulmonary embolism, reintubation, and deep organ space infection all failed to demonstrate a statistically significant difference between our groups of interest. Urinary tract infection was noted to be higher in the GS group operating room 2.29 as compared to the CT surgeon group (P value 0.02). CONCLUSIONS: In this large observational study, we found that VATS lobectomies performed by GS compared to the matched CT surgeon cohort had shorter operative time, and there was no difference in major postoperative morbidity or mortality. However, LOS was higher and there was increased risk of urinary tract infection in the GS compared to matched CT surgeon cohort.

Predicting 30-day postoperative mortality for emergent anterior abdominal wall hernia repairs using the American College of Surgeons National Surgical Quality Improvement Program database.

PURPOSE: Anterior abdominal wall hernias are among the most commonly encountered surgical disease. We sought to identify risk factors that are associated with 30-day postoperative mortality following emergent abdominal wall hernia repair using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. METHODS: A retrospective analysis of data from the ACS NSQIP from 2005 to 2010 was performed. Patients were selected using Current Procedural Terminology (CPT) and International Classification of Disease 9 Clinical Modification (ICD9) codes for the repair of inguinal, femoral, umbilical, epigastric, ventral, or incisional hernias that were incarcerated, obstructed, strangulated, or gangrenous. Only emergent cases occurring within two days of admission and admitted as inpatients were included. Univariate and multivariable analysis was performed. A risk score was also created. RESULTS: There were 4298 cases of emergent anterior abdominal wall hernia surgery. The most common was inguinal (25.3 %), followed by incisional (23.8 %), umbilical (23.5 %), ventral (12.1 %), femoral (8.8 %), and epigastric (6.5 %) hernias. Multivariable analysis demonstrated six statistically significant predictors of short-term mortality, including history of congestive heart failure (CHF) [odds ratio (OR) 8.24, 95 % confidence interval (CI) 4.05-16.75), age (OR 5.52, 95 % CI 3.48-8.77), history of peripheral vascular disease (PVD) (OR 4.98, 95 % CI 2.08-11.92), presence of ascites (OR 3.16, 95 % CI 1.64-6.08), preoperative blood urea nitrogen (OR 1.35, 95 % CI 1.22-1.49), and preoperative white blood cell count (OR 1.22, 95 % CI 1.02-1.45). The C-statistic for the risk model was 0.858. CONCLUSION: We present a large study on short-term mortality following emergent anterior abdominal wall hernia repairs based on the ACS NSQIP with a derived risk model that demonstrates excellent discriminative ability.

Is it time to rethink our management of dialysis patients undergoing elective ventral hernia repair? Analysis of the ACS NSQIP database.

PURPOSE: The number of patients on chronic dialysis is steadily increasing each year. There is little data that describes the outcomes in dialysis patients following elective ventral hernia repair, one of the most common general surgery procedures. Our objective was to compare the mortality and morbidity rates in dialysis versus nondialysis patients following elective ventral hernia repair. METHODS: We analysed the ACS NSQIP database to identify patients that underwent elective ventral hernia repair from 2005 to 2010. Univariate analysis and multivariate logistic regression was performed on all patients included. The main outcome variables were mortality and morbidity, length of hospital stay, and return to the operating room. RESULTS: Following elective ventral hernia repair, dialysis patients were more likely to die within 30 days or experience at least one morbidity. Dialysis patients were more likely to experience an infectious, pulmonary or vascular complication. Patients on dialysis also had a 2-fold greater risk of returning to the operating room within 30 days and stayed in the hospital an average of 1.3 days longer than nondialysis patients. Similar results were found after adjustment for demographics and comorbidities using multivariable logistic regression. CONCLUSION: This is one of the largest studies demonstrating the outcomes of a specific general surgery procedure in dialysis patients. Chronic dialysis prior to elective ventral hernia repair is associated with an increased risk of 30-day mortality, morbidity, and return to the operating room. Dialysis patients are susceptible to infectious, pulmonary, and vascular post-operative complications.

Smectic-A and smectic-C phases and phase transitions in 8S5 liquid-crystal-aerosil gels.

High-resolution x-ray scattering studies of the nonpolar thermotropic liquid crystal 4-n-pentylphenylthiol-4'-n-octyloxybenzoate (8S5) in aerosil gel nanonetworks reveal that the aerosil-induced disorder significantly alters both the nematic to smectic-A and smectic-A to smectic-C phase transitions. The limiting 8S5 smectic-A correlation length follows a power-law dependence on the aerosil density in quantitative agreement with the limiting lengths measured previously in other smectic-A liquid crystal gels. The smectic-A to smectic-C liquid crystalline phase transition is altered fundamentally by the presence of the aerosil gel. The onset of the smectic-C phase remains relatively sharp but there is an extended coexistence region where smectic-A and smectic-C domains can exist.

Transcription of Epstein-Barr virus-encoded nuclear antigen 1 promoter Qp is repressed by transforming growth factor-beta via Smad4 binding element in human BL cells.

In Epstein-Barr virus (EBV)-infected BL cells, the oncogenic EBV-encoded nuclear antigen 1 (EBNA 1) gene is directed from the latent promoter Qp. Yeast one-hybrid screen analysis using the -50 to -37 sequence of Qp as the bait was carried out to identify transcriptional factors that may control Qp activity. Results showed that Smad4 binds the -50 to -37 sequence of Qp, indicating that this promoter is potentially regulated by TGF-beta. The association of Smad4 with Qp was further confirmed by supershift of EMSA complexes using Smad4-specific antibody. The transfection of a Qp reporter construct in two EBV(+) BL cell lines, Rael and WW2, showed that Qp activity is repressed in response to the TGF-beta treatment. This repression involves the interaction of a Smad3/Smad4 complex and the transcriptional repressor TGIF, as determined by cotransfection assay and coimmunoprecipitation analysis. Results suggest that TGF-beta may transcriptionally repress Qp through the Smad4-binding site in human BL cells.

Dihydropyrimidine dehydrogenase activity in a Korean population.

Dihydropyrimidine dehydrogenase (DPD) is the major metabolic enzyme in the catabolism of 5-fluorouracil, and the activity in normal tissues shows a wide variation among individuals. Recent studies demonstrate the relevance of DPD in the pharmacokinetics, toxicity, and antitumor efficacy of 5-fluorouracil. We investigated the DPD activity in peripheral blood mononuclear cell form 114 healthy subjects in Korea. The DPD activities in healthy volunteers were shown to follow a unimodal distribution. The mean of the activity was 0.28 +/- 0.16 nmol/min/mg protein. A wide (13-fold) intersubject variability was observed (range, 0.06-0.80 nmol/min/mg protein), and, on average, DPD activity in women (0.26 +/- 0.14) was 13% lower than in men (0.30 +/- 0.16). These findings indicate that the activity of DPD in this study was higher than in reports of research with French and white American populations.

Chromosomal abnormalities of a new nasopharyngeal carcinoma cell line (NPC-BM1) derived from a bone marrow metastatic lesion.

An epithelial cell line, NPC-BM1, was established from a bone marrow biopsy of a female Taiwanese patient with nasopharyngeal carcinoma (NPC). Histopathology of the bone marrow biopsy and xenografts grown in severe combined immunodeficiency mice showed that the tumor was a nonkeratinizing, poorly differentiated carcinoma. NPC-BM1 cells grown as monolayers had a doubling time of 28.5 hours. Chromosome analysis showed that NPC-BM1 had the following features: 1) hypotetraploidy with a modal chromosome number of 87 (84-90); 2) numerically and structurally normal chromosomes 18; 3) numerical abnormalities without apparent structural alterations on chromosomes 14, 16, 17, 19, and 20; 4) ten structural abnormalities, t(1;9)(p11;q11), t(3;?;4)(p13;?;q13), add(4p),del(6p), i(8) [corrected] (q10),der(?)t(?;12),(?;p12),[corrected] add(21)(p11), del(X)(q24), add(X)(q22), and marker 1 (M1), in all metaphases examined, which were found to be present in two to five cell lines from primary NPC tumors reported previously; and 5) four other abnormalities, t(2;?;2)(p11.2;?;q21),t(11;22)(q11;q11),i(22)(q10), and marker 2 (M2), unique to this metastatic cell line. To the best of our knowledge, NPC-BM1 is the first NPC cell line derived from a distant metastatic site. Further evaluation of this cell line and additional metastatic NPC cell lines as well as primary NPC cell lines with respect to relations between the timing, karyotypic anomalies, and immunobiological characteristics in NPC progression and metastasis is warranted.

Identification of a promoter for the latent membrane protein 1 gene of Epstein-Barr virus that is specifically activated in human epithelial cells.

Latent membrane protein 1 (LMP 1) is one of two Epstein-Barr virus (EBV)-encoded proteins that expressed in nasopharyngeal carcinoma (NPC) cells. Previous studies showed that a 3.5-kb transcript of the LMP 1 gene, in addition to the 2.8-kb transcript, was detected in a B95-8-EBV-containing, nude mice-passaged NPC tumor, C15. This indicated that a transcript was initiated from a region 5' to the putative promoter, ED-L1. We have isolated an EBV variant from a NPC tissue, and this virus strain contained a more pathogenic LMP 1 gene. DNA sequence analysis of the 5'-upstream region showed distinct variations as compared to that of B95-8 strain. To test if the LMP 1 gene of the NPC strain also contained an upstream promoter, we generated a series of deletion plasmids encompassing positions -1,030 to +20 of the LMP 1 promoter and tested for their abilities to drive the expression of the reporter gene in human epithelial cell lines, C-33A and NPC-TW076. We found that the region between -643 and -496 contained a promoter activity that was approximately five-fold higher than the putative promoter, ED-L1. This region between -643 and -496 was designated as ED-L1E. C-33A cells containing the genomic clone pT7(E) or the clone that had deleted a 94-bp ED-L1 sequence (delta94) was used to determine the transcription initiation sites by RNase protection assay. Results showed that a transcription initiation site was located at nucleotide 170,099 ("A") of EBV genome. The transcript was expressed in NPC biopsies and in human primary normal epithelial cells transfected with pT7(E) and delta94, respectively, as examined by reverse transcriptase-polymerase chain reaction (RT-PCR) analysis. Furthermore, the ED-L1E was not regulated by the EBV-encoded nuclear antigen 1-mediated transcriptional enhancer family of repeats (FR) in C-33A cells. Our results suggested that the ED-L1E was specifically activated in epithelial cells. The biological significance of the selective usage of the ED-L1E promoter was discussed.

Detection of an Epstein-Barr-virus variant in T-cell-lymphoma tissues identical to the distinct strain observed in nasopharyngeal carcinoma in the Taiwanese population.

An EBV variant has been identified in NPC tissues in Taiwan. This EBV variant contains a point mutation in exon I of the LMP I gene. This mutation results in the loss of an XhoI site at nt 169,426, which is present in strain B95-8. In addition, this variant contains a 30-bp deletion in exon 3 of the gene. The recent demonstration of the prevalence of EBV-containing nasal and peripheral T-cell lymphoma in this region drove us to evaluate the presence of this NPC-EBV strain in 7 cases of T-cell lymphoma, as well as in 48 NPC tissues, 2 cases of Hodgkin's disease and I B-cell lymphoma. Four samples of normal lymph node tissue, 40 of normal nasopharynx tissue and 78 throat washings of healthy individuals were included for comparison. We used sequence-specific primers and the polymerase chain reaction (PCR) method to amplify LMP I gene fragments containing these variations. Mutations were then confirmed by restriction-enzyme digestion and the DNA sequencing analysis. Our results showed that 57 of 58 tumor-tissues samples were EBV-positive. Among them, 56, including 6 T-cell-lymphoma samples, belonged to the NPC strain. This strain of EBV was also present in 92% of EBV-positive normal nasopharynx tissues and in 84% of EBV-positive throat washings of the healthy individuals tested. These results suggest that the NPC-EBV strain is prominently present in Taiwan.