Cancer Screening for Transgender Individuals: Guidelines, Best Practices, and a Proposed Care Model.

Few transgender-specific cancer screening recommendations exist. This review aims to cover current guidelines and practice patterns of cancer screening in transgender patients and, where evidence-based data are lacking, to draw from cisgender screening guidelines to suggest best practices for transgender patients based on anatomic inventory. Sufficient evidence does not exist to determine the long-term effects of gender-affirming hormone therapy on cancer risk. In the future, cancer screening and prevention should be focused on anatomic inventory and high-risk behaviors.

Infectious complications associated with perioperative blood transfusion in partial or radical nephrectomy.

INTRODUCTION/BACKGROUND: Perioperative allogeneic blood transfusion (PBT) is associated with increased infectious risk for many surgical procedures, although this has not been thoroughly explored for extirpative renal surgery. Underlying mechanisms may be related to an alteration of the patient immune response. We aimed to assess the infectious complications associated with PBT after radical or partial nephrectomy. METHODS/MATERIALS: The Nationwide Inpatient Sample (1996-2015) was queried for patients undergoing radical or partial nephrectomy. We assessed rates of infectious complications in patients who did and did not receive PBT. Infections were index complications and included sepsis, abscess, pneumonia, urinary tract infection, and wound infection. Multivariable logistic regression was used to examine the risk of infectious complications accounting for age, gender, race, insurance, income, surgery type and approach, length of stay, comorbidity, and PBT. RESULTS: We identified 140,183 patients undergoing partial or radical nephrectomy during the study period with 17,874 (12.7%) receiving PBT. The rate of PBT was stable throughout the study period (Cochran-Armitage, P= 0.97). Patients receiving PBT compared to those without were relatively older (proportion of age >70, 42.6% vs. 30.5%), non-white (25.4% vs. 21.1%), who underwent radical nephrectomy (84.3% vs. 77.4%), and with longer hospital stay (9.1 vs. 5.1 days; all P< 0.001). On multivariable analysis, PBT was associated with higher odds of any infectious complication (OR 1.56, 95% CI 1.5-1.68, P< 0.001). During the study period, the risk of infectious complications was persistently increased in those receiving PBT. CONCLUSION: PBT is independently associated with an increased risk of postoperative infections for patients undergoing partial or radical nephrectomy. This may be due to underlying transfusion-related immunomodulatory mechanisms. While PBT is necessary in many instances to promote patient survival, providers should remain cautious when providing PBT after extirpative renal surgery.

Acidification of Model Cheese Brines To Control Listeria monocytogenes.

Cheese brines are often used for prolonged periods, with adjustments made only to pH and salt content. Pathogens, including Salmonella enterica Typhimurium, Escherichia coli O157:H7, and Listeria monocytogenes, have been shown to survive long periods in model and commercial brines under common brining conditions. The objective of this study was to determine the survival of L. monocytogenes in model cheese brines, with and without whey added at 2%, when acidified to a pH of 2 using food-grade acids. Survival in untreated brines over a 6-month period was also assessed. Cultures of L. monocytogenes were propagated to induce salt and acid tolerance prior to inoculation at ∼6 log CFU/mL into model brines (pH 5.2, 20% NaCl). Following a week-long adaption period at 12°C, inoculated brines were acidified to pH 2.0 within 15 min using either hydrochloric, acetic, citric, or lactic acid, held at that pH for up to 24 h, and neutralized prior to enumeration and enrichment. Overall, each acid treatment was capable of achieving ≥5-log reductions in L. monocytogenes counts within 135 min at pH 2. Hydrochloric acid required the lowest volume to achieve treatment pH and was the most effective treatment in the absence of whey. However, it was the least effective in the presence of whey. Acetic acid produced rapid inactivation in both brines but required impractical volumes of acid to reach the treatment pH. Citric acid was similarly effective in both brines but was the second least effective in terms of time to achieve a ≥5-log reduction. Although only slight and insignificant differences were observed, lactic acid appears to be the more practical and promising approach for the inactivation of L. monocytogenes in cheese brines by producing the most rapid inactivation in the presence and absence of whey. Acidification as a preventive control for L. monocytogenes could increase adoption of brine treatments by small-scale cheese producers, thereby reducing food safety risks.