Laparoscopic sleeve gastrectomy conversion to gastric bypass: conversion rate over time, predictors of conversion, and weight loss outcomes.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is the most common Bariatric procedure in the United States; however, the frequency of conversion to Roux-en-Y gastric bypass (RYGB) is unknown. OBJECTIVES: The primary aim was to determine the conversion rate over time from LSG to RYGB. The secondary objectives were to evaluate factors associated with conversion and postconversion weight loss outcomes. SETTING: Single Academic Institution, Center of Bariatric Excellence. METHODS: A retrospective analysis of all LSG from 2011 to 2020 was done. Kaplan-Meier analysis was utilized to estimate the conversion rate over time after LSG. Cox regression was utilized to identify predictors of future conversion. RESULTS: Of 875 LSGs, 46 were converted to RYGB from 2011 to 2020. Median follow-up was 2.6 years, and 7-year follow-up rate was 59.9%. The 1-year conversion rate was 1.4%, increasing to 3.8%, 9.0%, and 12.6% at 3, 5, and 7 years respectively. Female gender (hazard ratio [HR] = 4.2, P = .05) and age <55 (HR = 3.5, P = .04) were associated with greater chance of conversion. Preoperative asthma (HR = 1.7, P = .14) and gastroesophageal reflux disease (GERD) (HR = 1.5, P = .18) trended toward higher conversion but were not significant. Of those with body mass index (BMI) >35 at time of conversion, the mean total body weight loss (TBWL) was 13.0% at the time of conversion. This subgroup had additional 13.6% of TBWL 1-year after conversion. CONCLUSIONS: Conversion of LSG to RYGB increased with time to 12.6% conversion rate at 7-years. Patients with GERD prior to LSG had a nonsignificant trend toward conversion, while younger patients and females had significantly higher rates of conversion. There may be additional weight loss benefit for patients converted to RYGB.

Rates of Recurrent Marginal Ulcer in Gastric Bypass Patients Undergoing Revisional Surgery.

INTRODUCTION: The rate of marginal ulcer (MU) following primary Roux-en-Y Gastric Bypass (RYGB) is approximately .6-16%. Few studies have evaluated recurrence rates following surgical revision for MU. The primary aim of this study was to determine the rate of MU recurrence following revision. The secondary aim was to evaluate the impact of truncal vagotomy (TV) on the recurrence rates and analyze potential risk factors associated with the recurrence of MU after revision. METHODS: We conducted a retrospective cohort study examining data at a single tertiary academic medical center. Adult patients with a history of RYGB who underwent gastrojejunostomy revision for recurrent MU between the years of 2003-2020 were included. We sought to determine our overall rate of MU following revision, with and without TV. Additionally, we examined the association of risk factors with MU recurrence. Fisher's exact test was used to determine the statistical significance of recurrence rates between the groups. RESULTS: We included 90 patients in the study. The overall recurrence rate for MU was 16.7%. Of the 90 patients, 35 (35.4%) patients underwent TV at the time of revision. The recurrence rate of MU after GJ revision with TV was 14.3% in comparison to those without TV, 18.2% (P = .775). Smoking, steroid, alcohol use, history of cardiac surgery/intervention, and helicobacter pylori were not significantly associated with recurrent MU following revision. CONCLUSIONS: The rate of recurrence after revision for MU is high. Adding TV trended towards decreased MU recurrence after revisional surgery, however not significant. Larger studies are needed to evaluate risk factors associated with recurrent MU after revision.

Prediction of effective humoral response to SARS-CoV-2 vaccines in healthy subjects by cortical thickness of post-vaccination reactive lymphadenopathy.

PURPOSE: To study the association between ultrasound cortical thickness in reactive post-vaccination lymph nodes and the elicited humoral response and to evaluate the performance of cortical thickness as a predictor of vaccine effectiveness in patients with and without a previous history of COVID-19 infection. METHODS: A total of 156 healthy volunteers were recruited and followed prospectively after receiving two COVID-19 vaccination doses using different protocols. Within a week after receiving the second dose, an axillary ultrasound of the ipsilateral vaccinated arm was performed, and serial post-vaccination serologic tests (PVST) were collected. Maximum cortical thickness was chosen as a nodal feature to analyze association with humoral immunity. Total antibodies quantified during consecutive PVST in previously-infected patients and in coronavirus-naïve volunteers were compared (Mann-Whitney U test). The association between hyperplastic-reactive lymph nodes and effective humoral response was studied (odds ratio). The performance of cortical thickness in detecting vaccination effectiveness was evaluated (area under the ROC curve). RESULTS: Significantly higher values for total antibodies were observed in volunteers with a previous history of COVID-19 infection (p < 0.001). The odds ratio associating immunized coronavirus-naïve volunteers after 90 and 180 days of the second dose with a cortical thickness ≥ 3 mm was statistically significant (95% CI 1.52-6.97 and 95% CI 1.47-7.29, respectively). The best AUC result was obtained comparing antibody secretion of coronavirus-naïve volunteers at 180 days (0.738). CONCLUSIONS: Ultrasound cortical thickness of reactive lymph nodes in coronavirus-naïve patients may reflect antibody production and a long-term effective humoral response elicited by vaccination. CLINICAL RELEVANCE STATEMENT: In coronavirus-naïve patients, ultrasound cortical thickness of post-vaccination reactive lymphadenopathy shows a positive association with protective antibody titers against SARS-CoV-2, especially in the long term, providing new insights into previous publications. KEY POINTS: • Hyperplastic lymphadenopathy was frequently observed after COVID-19 vaccination. • Ultrasound cortical thickness of reactive post-vaccine lymph nodes may reflect a long-term effective humoral response in coronavirus-naïve patients.

Bariatric revisional surgery for gastrogastric fistula following Roux-en-Y gastric bypass positively impacts weight loss.

BACKGROUND: Gastrogastric fistula (GGF) is a rare complication from Roux-en-Y gastric bypass (RYGB). It is a known risk factor associated with weight recidivism and an indication for Bariatric Revisional Surgery (BRS). OBJECTIVES: The primary outcome of this study is to evaluate perioperative outcomes and the long-term total body weight loss (TBWL) outcomes following revision. SETTING: Single Academic Institution, Center of Bariatric Excellence. METHODS: We selected patients who had primary bariatric surgery and BRS from 2003 to 2020, followed by BRS for GGF. Patients' demographics, perioperative outcomes, and TBWL were analyzed. RESULTS: One hundred five patients underwent BRS for GGF. Mean body mass index (BMI) at index operation and revision was 51.6 ± 10.1, and 42.4 ± 11.2 respectively. Ninety percent of patients had open primary RYGB, and 69% had open revisional surgery. The median length of stay after BRS was 3 days. The 30-day reintervention rate was 19%. The 30-day readmission rate was 34%. Of the 77 patients included for weight loss analysis, the mean %TBWL after primary RYGB was 34% ± 14. The total mean %TBWL at the time of revision was 18.8%, translating into a weight regain of 13.6% ± 9.5. The total mean %TBWL after revision was 37.6% ± 11.4, translating into TBWL of 18.8% ± 9.4 after revision when compared to TBWL at revision time. CONCLUSIONS: Our results demonstrate that revision for GGF can be safely performed, however is associated with higher morbidity than primary bariatric surgery. Revision for GGF results in significant long-term weight loss.

Stratified Preoperative A1c is not Significantly Associated With Clavien-Dindo Major Complications Following Bariatric Surgery in the MBSAQIP Database.

BACKGROUND: Type 2 Diabetes Mellitus (T2DM) is highly prevalent comorbidity in patients with morbid obesity. It is still unclear whether a cutoff value of preoperative A1c represents an increased risk for major postoperative complications following Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG). METHODS: Retrospective MBSAQIP Participant Use File cohort for both years 2017 and 2018 were analyzed to evaluate the relationship between HbA1c in patients with morbid obesity and T2DM undergoing bariatric surgery, and the 30 days postoperative major complications by Clavien-Dindo classification (III/IV). We used an HbA1c cutoff of <7, > =7, and stratified by 1% increment for a total of 11 groups. We used univariate and multivariate logistic regression to analyze the outcome of the complications. Predicted probabilities were calculated for major complications. All statistical tests were two-sided with a P-value of less than .05 considered as a cut-off for statistical significance. RESULTS: Of 42,181 patients that met inclusion criteria, there were 20,955 identified with HbA1c <7%, and 21,226 patients with HbA1c >7%. Utilizing HbA1c <7% as a cutoff, we found no consistent statistical significance in the major postoperative complication in patients with HbA1c >7%, and when stratified with 1% increment between groups. We also found no significance between groups with risk adjustment. CONCLUSIONS: Extensive analysis of the large MBSAQIP cohort didn't result in a clinically significant association between stratified HbA1c and 30-day Clavien-Dindo major complications (III/IV) following Roux-en-Y Gastric Bypass (RYGB) and (SG).

Numerical Analysis of Micro-Residual Stresses in a Carbon/Epoxy Polymer Matrix Composite during Curing Process.

The manufacturing process in thermoset-based carbon fiber-reinforced polymers (CFRPs) usually requires a curing stage where the material is transformed from a gel state to a monolithic solid state. During the curing process, micro-residual stresses are developed in the material due to the different chemical-thermal-mechanical properties of the fiber and of the polymer, reducing the mechanical performance of the composite material compared to the nominal performance. In this study, computational micromechanics is used to analyze the micro-residual stresses development and to predict its influence on the mechanical performance of a pre-impregnated unidirectional CFRP made of T700-fibers and an aeronautical grade epoxy. The numerical model of a representative volume element (RVE) was developed in the commercial software Abaqus® and user-subroutines are used to simulate the thermo-curing process coupled with the mechanical constitutive model. Experimental characterization of the bulk resin properties and curing behavior was made to setup the models. The higher micro-residual stresses occur at the thinner fiber gaps, acting as triggers to failure propagation during mechanical loading. These micro-residual stresses achieve peak values above the yield stress of the resin 55 MPa, but without achieving damage. These micro-residual stresses reduce the transverse strength by at least 10%, while the elastic properties remain almost unaffected. The numerical results of the effective properties show a good agreement with the macro-scale experimentally measured properties at coupon level, including transverse tensile, longitudinal shear and transverse shear moduli and strengths, and minor in-plane and transverse Poisson's ratios. A sensitivity analysis was performed on the thermal expansion coefficient, chemical shrinkage, resin elastic modulus and cure temperature. All these parameters change the micro-residual stress levels and reduce the strength properties.

Influence of Co2+, Cu2+, Ni2+, Zn2+, and Ga3+ on the iron-based trimetallic layered double hydroxides for water oxidation.

In this work, we synthesized five novel iron-based trimetallic layered double hydroxides (LDHs) by the urea-assisted co-precipitation method for the electrocatalytic water oxidation reaction (WOR). In particular, the synthesized electrocatalysts were labeled CoCuFe-LDH, ZnNiFe-LDH, ZnCoFe-LDH, ZnCuFe-LDH, and CoGaFe-LDH. The electrocatalysts were thoroughly characterized by means of Ultraviolet-visible spectroscopy (UV-Vis), N2 adsorption/desorption, and X-ray photoelectron spectroscopy (XPS). We analyzed the changes in the electronic structures, changes in the surface area, and the oxygen vacancies, respectively. X-ray diffraction (XRD) and transmission electron microscopy (TEM) showed that the materials had the hydrotalcite-like structure typical of LDHs. Electrochemical results indicated that the best electrocatalyst was the CoGaFe-LDH achieving an overpotential of 369.9 mV at 10 mA cm-2 and a Tafel slope of 64.8 mV dec-1 in alkaline conditions (KOH 1 M). Additionally, this material displayed a charge transfer resistance (R ct) of 30.1 Ω cm2. Electrochemical measurements indicated that the materials containing Zn2+ exhibit low kinetics; whilst materials with Co2+ or Ga3+ yield the best performances. The catalytic activity of the CoGaFe-LDH can be attributed to the decrease of the R ct caused by electronic effects due to the addition of the Ga3+, lowering the thermodynamic barriers and thus enhancing the electron transfer. This work opens the door for a new approach to design efficient multimetallic catalysts based on the transition metals for WOR.

The Impact of Androgen Deprivation Therapy on COVID-19 Illness in Men With Prostate Cancer.

BACKGROUND: TMPRSS2, a cell surface protease regulated by androgens and commonly upregulated in prostate cancer (PCa), is a necessary component for SARS-CoV-2 viral entry into respiratory epithelial cells. Previous reports suggested a lower risk of SARS-CoV-2 among PCa patients on androgen deprivation therapy (ADT). However, the impact of ADT on severe COVID-19 illness is poorly understood. METHODS: We performed a multicenter study across 7 US medical centers and evaluated patients with PCa and SARS-CoV-2 detected by polymerase-chain-reaction between March 1, 2020, and May 31, 2020. PCa patients were considered on ADT if they had received appropriate ADT treatment within 6 months of COVID-19 diagnosis. We used multivariable logistic and Cox proportional-hazard regression models for analysis. All statistical tests were 2-sided. RESULTS: We identified 465 PCa patients (median age = 71 years) with a median follow-up of 60 days. Age, body mass index, cardiovascular comorbidity, and PCa clinical disease state adjusted overall survival (hazard ratio [HR] = 1.16, 95% confidence interval [CI] = 0.68 to 1.98, P = .59), hospitalization status (HR = 0.96, 95% CI = 0.52 to 1.77, P = .90), supplemental oxygenation (HR 1.14, 95% CI = 0.66 to 1.99, P = .64), and use of mechanical ventilation (HR = 0.81, 95% CI = 0.25 to 2.66, P = .73) were similar between ADT and non-ADT cohorts. Similarly, the addition of androgen receptor-directed therapy within 30 days of COVID-19 diagnosis to ADT vs ADT alone did not statistically significantly affect overall survival (androgen receptor-directed therapy: HR = 1.27, 95% CI = 0.69 to 2.32, P = .44). CONCLUSIONS: In this retrospective cohort of PCa patients, the use of ADT was not demonstrated to influence severe COVID-19 outcomes, as defined by hospitalization, supplemental oxygen use, or death. Age 70 years and older was statistically significantly associated with a higher risk of developing severe COVID-19 disease.

Axillary lymph node imaging in mRNA, vector-based, and mix-and-match COVID-19 vaccine recipients: ultrasound features.

OBJECTIVES: To assess ultrasound characteristics of ipsilateral axillary lymph nodes after two doses of four different COVID-19 vaccination protocols, to determine whether these parameters differed with age, and to describe how they changed on follow-up imaging. METHODS: A total of 247 volunteer employees from our center who had received two doses of COVID-19 vaccination were recruited and followed prospectively. Axillary ultrasound of the ipsilateral vaccinated arm was performed the week after receiving the second dose to analyze lymph node features (number, long-axis, cortical thickness, morphology, and vascular imaging). Axillary lymphadenopathy resulting from four vaccination protocols-mRNA (BNT162b2, mRNA-1273), ChAdOx1-S, and mix-and-match-was compared. Analysis was conducted using the Kruskal-Wallis test and post hoc analysis with Bonferroni corrections. Nodal reactogenicity was evaluated for two age groups: young (< 45 years old) and middle-aged ( ≥ 45 years old). All parameters were compared between both groups using an unpaired-sample Student t test. A p value < 0.05 was considered statistically significant. RESULTS: Significantly higher values for total number of visible nodes, cortical thickness, Bedi's classification (p < 0.001), and vascularity (p < 0.05) were observed in mRNA vaccine recipients compared to full ChAdOx1-S protocol recipients. Moreover, mix-and-match protocol recipients showed greater nodal cortical thickness and higher Bedi's classification than full ChAdOx1-S recipients (p < 0.001). Analyses between age groups revealed greater cortical thickness, Bedi's classification, and color Doppler signal in younger patients (p < 0.05). CONCLUSIONS: Nodal parameters of Bedi's classification and cortical thickness were more often increased in mRNA and mix-and-match vaccine recipients when compared to ChAdOx1-S vaccine alone, especially in younger patients. KEY POINTS: • Hyperplastic lymphadenopathy was observed more frequently in mRNA and mix-and-match vaccine protocols compared to full vector-based vaccination. • Higher values for cortical thickness, Bedi's classification, and color Doppler signal parameters were identified in younger patients. • Observed lymph node findings normalized in greater than 80% of patients by the third month following vaccination.

Experimental and theoretical study of novel aminobenzamide-aminonaphthalimide fluorescent dyads with a FRET mechanism.

In this work, both experimental and theoretical methods were used to study the photophysical and metal ion binding properties of a series of new aminobenzamide-aminonaphthalimide (2ABZ-ANAPIM) fluorescent dyads. The 2-aminobenzamide (2ABZ) and 6-aminonaphthalimide (ANAPIM) fluorophores were linked through alkyl chains (C2 to C6) to obtain four fluorescent dyads. These dyads present a highly efficient (0.61 to 0.98) Förster Resonant Energy Transfer (FRET) from the 2ABZ to the ANAPIM due to the 2ABZ emission and ANAPIM excitation band overlap and the configurational stacking of both aromatic systems which allows the energy transfer. These dyads interact with Cu2+ and Hg2+ metal ions in solution inhibiting the FRET mechanism by the cooperative coordination of both 2ABZ and ANAPIM moieties. Both experimental and theoretical results are consistent and describe clearly the photophysical and coordination properties of these new dyads.

Unilateral axillary adenopathy induced by COVID-19 vaccine: US follow-up evaluation.

OBJECTIVES: This study was conducted in order to investigate COVID-19 vaccine influence on unilateral axillary lymph nodes, comparing nodal basal features with their characteristics after the first and second vaccination dose. METHODS: Ninety-one volunteer employees from our center who participated in the BNT162b2 (Pfizer-BioNTech) vaccination campaign were prospectively recruited. A total of three axillary ultrasound evaluations of the ipsilateral vaccinated arm were performed: before vaccination, the week after the first dose and the week after the second dose. The following findings were recorded: the total number of visible nodes, the maximum measurements of the diameter and cortex, Bedi's classification, and color Doppler evaluation. The collected data were compared using paired-sample Student's t-test for quantitative continuous variables and Wilcoxon rank-sum test for ordinal variables. Additional analyses were performed after classifying patients according to the previous history of COVID-19 disease. Differences among both groups were evaluated with the Mann-Whitney U test. Variables with a p value < 0.05 were considered statistically significant. RESULTS: Comparative analyses between the three US examinations showed a statistically significant augmentation of total visible nodes, maximum diameter, cortical thickness, grade of Bedi's classification, and Doppler signal (p < 0.001). Analyses between patients with and without previous COVID-19 infection showed a higher lymph node response in naïve patients compared to those who were previously infected. CONCLUSIONS: According to our results, both doses of COVID-19 vaccine induced an increase of all axillary lymph node parameters with statistically significant differences, especially in coronavirus-naïve patients. KEY POINTS: • Pfizer COVID-19 vaccine induces a high incidence of ipsilateral axillary lymphadenopathy. • US scan identified an increase of all lymph nodes parameters, especially in coronavirus-naïve patients.

Optimizing the Efficiency of a Cytocompatible Carbon-Dots-Based FRET Platform and Its Application as a Riboflavin Sensor in Beverages.

In this work, the Förster resonance energy transfer (FRET) between carbon dots (CDs) as energy donors and riboflavin (RF) as an energy acceptor was optimized and the main parameters that characterize the FRET process were determined. The results were successfully applied in the development of an ultrasensitive ratiometric fluorescent sensor for the selective and sensitive determination of RF in different beverages. Water-soluble CDs with a high quantum yield (54%) were synthesized by a facile and direct microwave-assisted technique. The CDs were characterized by transmission electron microscopy (TEM), Fourier transform infrared spectroscopy (FTIR), dynamic light scattering (DLS), Zeta potential, and UV-visible and molecular fluorescence spectroscopy. The study of the FRET process at two donor concentrations showed that the energy transfer efficiency decreases as the donor concentration increases, confirming its dependence on the acceptor:donor ratio in nanoparticle-based systems. The results show the importance of optimizing the FRET process conditions to improve the corresponding output signal. The variation in the ratiometric signal with the concentration of RF showed linearity in a concentration range of 0 to 11 µM with R2 = 0.9973 and a detection limit of 0.025 µM. The developed nanosensor showed good selectivity over other possible types of interference. The sensor was then applied for the determination of RF in beverage samples using the standard addition method with recoveries between 96% and 106%. Preliminary cytocompatibility tests carried out with breast cancer cells (MDA-MB-231) revealed the nanosensor to be cytocompatible in its working concentration regime, even after long incubation times with cells. Altogether, the developed RF determination method was found to be fast, low-cost, highly sensitive, and selective and can be extended to other samples of interest in the biological and food sectors. Moreover, thanks to its long-lasting cytocompatibility, the developed platform can also be envisaged for other applications of biological interest, such as intracellular sensing and staining for live cell microscopy.

Early Imaging and Molecular Changes with Neoadjuvant Bevacizumab in Stage II/III Breast Cancer.

This prospective, phase II study evaluated novel biomarkers as predictors of response to bevacizumab in patients with breast cancer (BC), using serial imaging methods and gene expression analysis. Patients with primary stage II/III BC received bevacizumab 15 mg/kg (cycle 1; C1), then four cycles of neoadjuvant docetaxel doxorubicin, and bevacizumab every 3 weeks (C2-C5). Tumour proliferation and hypoxic status were evaluated using 18F-fluoro-3'-deoxy-3'-L-fluorothymidine (FLT)- and 18F-fluoromisonidazole (FMISO)-positron emission tomography (PET) at baseline, and during C1 and C5. Pre- and post-bevacizumab vascular changes were evaluated using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Molecular biomarkers were assessed using microarray analysis. A total of 70 patients were assessed for treatment efficacy. Significant decreases from baseline in tumour proliferation (FLT-PET), vascularity, and perfusion (DCE-MRI) were observed during C1 (p ≤ 0.001), independent of tumour subtype. Bevacizumab treatment did not affect hypoxic tumour status (FMISO-PET). Significant changes in the expression of 28 genes were observed after C1. Changes in vascular endothelial growth factor receptor (VEGFR)-2p levels were observed in 65 patients, with a > 20% decrease in VEGFR-2p observed in 13/65. Serial imaging techniques and molecular gene profiling identified several potentially predictive biomarkers that may predict response to neoadjuvant bevacizumab therapy in BC patients.

A fluorescent PET probe based on polyethyleneimine-Ag nanoclusters as a reversible, stable and selective broad-range pH sensor.

In this work, nanoclusters (NCs) of Cu and Ag capped with hyperbranched polyethyleneimine (PEI) were prepared using chemical reduction by a one-step hydrothermal method. The PEI coated-NCs were characterized by high-resolution transmission electron microscopy, ζ potential, thermogravimetric analysis, dynamic light scattering, Fourier-transform infrared, UV-visible, and fluorescence spectroscopy. The PEI-NCs exhibited strong absorption and fluorescence, high stability, and excellent water dispersibility. The resulting PEI-NCs showed a reversible and linear response of fluorescence intensity with pH over a wide range (3-11); however, PEI-AgNCs showed a better reversibility and sensitivity than PEI-CuNCs. Unlike several types of pH sensors based on modified NCs, which are based on a nanoparticle aggregation/disaggregation mechanism, the response of our sensor is based on a photoinduced electron transfer process, which gives it a high reversibility. This method was successfully applied in pH measurements in tap water and green tea samples, with excellent results, indicating its practical utility for these applications. A visual device was obtained by immobilizing PEI-AgNCs into agarose hydrogels at different pH values. The results show that the proposed sensor can be used as a pH visual detector. Besides, the light emission of the nanosensor was corroborated by fluorescence microscopy, confirming that the nanosensor based on PEI-AgNCs has great potential to be used in cellular imaging.

Prescription Patterns of Daratumumab in Patients with Multiple Myeloma in Underprivileged Circumstances: A Multicenter Experience in Mexico.

BACKGROUND: Despite novel therapies, multiple myeloma (MM) remains an incurable malignancy, daratumumab (DARA) being a major game changer, may be a good option for treatment. AIMED OF THE STUDY: To assess the prescription patterns of DARA in patients with MM in Mexico. METHODS: 47 patients with MM were analyzed in 13 different hospitals in Mexico. RESULTS: Five (10.5%) of patients received DARA as first line therapy, 13 (27.5%) as second line, whereas 29 (62%) received its in ≥3rd line. In 32% DARA was used in combination with dexamethasone, 64% received DARA on a triple combination, and 4% as a 4 drug combination. Eighty three percent of patients had a response, including 32% in complete remission. Progression free survival (PFS) was higher in patients in ISS stage 1, and in patients achieving ≥PR. Overall survival (OS) was lower in patients not achieving ≥PR, in patients having increased LDH, and extramedullary disease. Grade 1-2 infusion related reactions were present in 34%, and grade 3-4 neutropenia and lymphopenia in 25 and 17% of the patients. CONCLUSIONS: In Mexico, 62% of patients with MM received DARA as a third or further line of treatment. DARA employed as a doublet or triplet combination is useful in relapsed/refractory patients with tolerable adverse events.

Innovative standardized reporting template for prostate mpMRI improves clarity and confidence in the report.

PURPOSE: The goal of the current study was to evaluate the effect of a standardized prostate mpMRI reporting template on urologists' understanding and confidence in counselling a patient on the results of the MRI. To do this we performed a survey study to assess the understanding and confidence of urologists reviewing reports prior to (pre) and after (post) adoption of a standardized mpMRI template. METHODS: Six urologists reviewed ten pre- and post- mpMRI templated reports and completed a survey to assess the clarity of key elements and the confidence in counseling the patient. The urologists were blinded to the study objective. Nonparametric constrained permutation test for significance was performed to compare the results prior to and after implementation of the template. RESULTS: 29 pre- and 30 post-template mpMRI reports were reviewed. The average score for the post-template reports was significantly higher (10.7 ± 0.6 vs 7.5 ± 2.7 [ p< 0.001]) regardless of the reviewer. Urologists were also overall more confident in counselling patients when the standardized mpMRI reporting template had been used. CONCLUSION: Implementation of a standardized template for reporting of prostate mpMRI findings resulted in improved clarity and confidence in counselling patients. Radiologists should consider implementing a standardized reporting template to improve clinicians' understanding and confidence of the report.

Diagnostic yield of repeat evaluation for asymptomatic microscopic hematuria after negative initial workup.

PURPOSE: The American Urological Association guideline for asymptomatic microhematuria recommends in patients with a negative initial workup, repeat workup should be considered for those with persistent/recurrent microhematuria. However, there is little data on the yield of repeat evaluation. Our hypothesis was that repeat workup yields a low detection rate of urologic malignancy. MATERIALS AND METHODS: We retrospectively reviewed all patients at our institution who underwent microhematuria workup with cystoscopy and upper tract imaging from May 2010 to June 2016. Microhematuria was defined as ≥3 RBCs/HPF on a properly collected specimen in the absence of a benign cause. Demographics, age, smoking history, history of radiation, and findings on repeat cystoscopy and imaging were collected. Our primary endpoint was a new diagnosis of urologic malignancy. RESULTS: Our initial cohort included 1,332 patients, of whom 21 were diagnosed with urothelial carcinoma and 7 with suspicious renal masses on initial workup. A total of 637 patients with negative initial workup had persistent/recurrent microhematuria. Repeat cystoscopy was performed in 161 (25%) patients at a median of 39 months, and repeat upper tract imaging was performed in 317 (50%) patients at a median of 39 months. Overall, repeat cystoscopy revealed new bladder cancer in 2 (1.2%) patients and repeat imaging revealed new suspicious renal mass in 4 (1.3%) patients. CONCLUSIONS: We observed a low number of newly diagnosed malignancies among patients with persistent/recurrent asymptomatic microhematuria who had a prior negative workup. Additional research is required to determine the utility of a repeat AMH workup.

COVID-19 Pandemic Significantly Decreases Acute Surgical Complaints.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic significantly reduced elective surgery in the United States, but the impact of COVID-19 on acute surgical complaints and acute care surgery is unknown. STUDY DESIGN: A retrospective review was performed of all surgical consults at the Hospital of the University of Pennsylvania in the 30 days prior to and 30 days following confirmation of the first COVID-19 patient at the institution. Consults to all divisions within general surgery were included. RESULTS: Total surgical consult volume decreased by 43% in the post-COVID-19 period, with a significant reduction in the median daily consult volume from 14 to 8 (P < .0001). Changes in consult volume by patient location, chief complaint, and surgical division were variable, in aggregate reflecting a disproportionate decrease among less acute surgical complaints. The percentage of consults resulting in surgical intervention remained equal in the 2 periods (31% vs 28%, odds ratio 0.85, 95% CI 0.61-1.21, P = .38) with most but not all operation types decreasing in frequency. The rise in the COVID-19 inpatient census led to increased consultation for vascular access, accommodated at our center by the creation of a new surgical procedures team. CONCLUSION: The COVID-19 pandemic significantly altered the landscape of acute surgical complaints at our large academic hospital. An appreciation of these trends may be helpful to other Departments of Surgery around the country as they deploy staff and allocate resources in the COVID-19 era.

Pre-Grazing Herbage Mass Affects Grazing Behavior, Herbage Disappearance, and the Residual Nutritive Value of a Pasture during the First Grazing Session.

During the first hours after the allocation of a grazing strip (first grazing session, GS), dairy cows eat most of the daily dry matter (DM) available. There are few studies that analyze how the grazing-down process changes the characteristics of the pasture during the first GS. The objective of this study was to evaluate the effect of two pre-grazing herbage masses (HM; medium herbage mass (MHM) and high herbage mass (HHM) on the DM disappearance, grazing behavior of dairy cows, and the residual nutritive value of a pasture during the first GS. Two groups of twelve dairy cows were used to evaluate the grazing-down process, during a period of 62 days. The pre-grazing HM modified the bite rate, bite mass, and dry matter intake during the first GS. The pre-grazing HM affected the process of herbage disappearance of the pasture, especially during the first 60 min of the GS. The nutrient selection differential for acid detergent fiber was greater for HHM compared with MHM (0.93 vs. 0.86). In conclusion, pre-grazing HM affects the structural characteristics and the residual nutritive value of the pasture. The grazing process in the first GS was modified by the HM, affecting the defoliation and the DM disappearance rate of the pasture.

Bis-quaternary ammonium gemini surfactants for gene therapy: Effects of the spacer hydrophobicity on the DNA complexation and biological activity.

Gemini surfactants (GS) have been highlighted as attractive gene carriers for a few years now; however, key aspects of the role of the GS chemical structure on the DNA-GS complexation and subsequent biological activity remain to be determined. Aiming to elucidate the effects of the GS spacer hydrophobicity, this work was focused on the biophysical characterization of the self-assembly, DNA complexation, cytocompatibility, and DNA transfection of a series of bis-quaternary ammonium GS with fixed side alkyl chains of 14 carbons and varying head-to-head alkyl chain spacers of 4, 6, and 14 carbons (referred to as GS4, GS6, and GS14, respectively). The characterization was carried out by a battery of experimental techniques including UV-vis and fluorescence sprectroscopies, ζ potential, dynamic light scattering (DLS), isothermal titration calorimetry (ITC), and flow cytometry, among others. Overall, the spectroscopic results showed that the self-assembly of the GS was favored with the spacer hydrophobicity since lower values of critical micelle concentration (CMC) were observed for samples with longer spacer chains. On the other hand, the ITC results revealed that the DNA-GS complexation was driven by an initial electrostatic attraction between DNA and GS monomers/micelles followed by complementary hydrophobic interactions which strengthen the DNA-GS binding, the latter being more pronounced for GS with longer spacers. Finally, the biological tests demonstrated that while GS with moderate hydrophobicity (GS4 and GS6) yielded outstanding levels of cytocompatibility and DNA transfection over a range of concentrations, the most hydrophobic sample (GS14) proved to be cytotoxic upon administration to cultured HeLa cells (p < 0.05). In our opinion, the fundamental information here presented might be pivotal not only for understanding the DNA-GS complexation mechanism, but also for developing efficient GS-based carriers for gene therapy.