Acceptance of organ xenotransplantation among Latin American immigrants resident in the United States.

BACKGROUND: Making xenotransplantation socially acceptable is the first step in working toward the promotion of this potential therapy option for providing transplant organs. OBJECTIVE: To analyze the attitude toward xenotransplantation among the Latin American population resident in Florida (the USA), and to determine the variables affecting this attitude. METHODS: A sample of Latin American residents in the state of Florida was randomized and stratified according to nationality, age, and sex (n = 1524). Attitude was assessed using a validated questionnaire (PCID-XenoTx Rios) which was self-completed anonymously. STATISTICAL ANALYSIS: descriptive analysis, Student's t-test, the chi-square test, and a logistic regression analysis. RESULTS: The questionnaire completion rate was 95% (n = 1450). If it was assumed that xenotransplanted organs functioned as well as human ones, 10% (n = 147) would be in favor, 73% (n = 1092) against, and 17% (n = 246) undecided. If the results were worse, only 2% (n = 35) would be in favor. This favorable attitude was related to country of origin (Honduras and Guatemala; P < 0.001); age (P < 0.001); sex (women; P < 0.001); marital status (married; P < 0.001); descendents (yes; P < 0.001); level of formal education (secondary education and university; P < 0.001); participation in voluntary prosocial activities (yes; P < 0.001); having spoken about donation and transplantation within the family (yes; P < 0.001); a partner's favorable attitude toward transplantation (P = 0.040); religion (catholic; P < 0.001); knowing the attitude of one's religion toward donation (yes; P < 0.001); previous experience of donation and/or transplantation (yes; P < 0.001); a belief that one might need a transplant in the future (yes; P < 0.001); and a favorable attitude toward human donation (yes; P < 0.001). The following were associated with attitude in the multivariate analysis: age (≥40 yrs; OR = 1.152); marital status (married; OR = 500); prosocial activities (yes, I participate in them; OR = 9.196. No, but I would like to; OR = 332.538); religion (catholic; OR = 2000); attitude toward deceased organ donation (in favor; OR = 2000); and previous experience of donation and/or transplantation (yes; OR = 500). CONCLUSIONS: The attitude of Latin Americans resident in Florida toward xenotransplantation is very negative, and is determined by many psychosocial factors, mainly related to their prior attitude toward the different kinds of human organ donation.

The level of acceptance of spanish medical students of the transplantation of solid organs from animals: a stratified and multicentre study.

INTRODUCTION: Research into the transplantation of solid organs from animals (xenotransplantation) is generating interest and curiosity given that this could be a way of resolving the shortage in transplant organs. However, the fact is that currently xenotransplantation is far from becoming a clinical practice. OBJECTIVE: To analyse the attitude of medical students from Spanish universities towards the donation of organs from animals and to determine the factors affecting their attitudes. TYPE OF STUDY: A sociological, interdisciplinary, observational and multicentre study in Spain. STUDY POPULATION: Students enrolled on the medical degree in Spain (n = 34 000). SAMPLE SIZE: A sample of 9598 students (a confidence level of 99% and precision of ± 1%) stratified by geographical area and academic year. Instrument of measurement: A validated questionnaire of attitude towards organ xenotransplantation (PCID-XenoTx RIOS) which was self-administered and completed anonymously. RESULTS: A completion rate of 95.7% (n = 9275) was obtained. If the results of xenotransplantation were as good as in human donation, 81% (n = 7491) would be in favour, 3% (n = 308) against and 16% (n = 1476) undecided. The following variables affected this attitude: sex (P < 0.001); academic year (P < 0.001); discussion of transplantation with one's family (P < 0.001) and friends (P < 0.001); the opinion of one's partner (P < 0.001); the respondent's attitude towards organ donation (P < 0.001); religion (P < 0.001); and participation in altruistic activities (P < 0.001). The following variables persisted in the multivariate analysis: (1) being a female (OR = 1.794; P < 0.001); (2) academic year (OR = 2.487; P < 0.001); (3) having spoken about the issue with one's family (OR = 1.200; P = 0.019); (4) the favourable opinion of one's partner (OR = 1.526; P = 0.028); (5) an attitude in favour of donation (OR = 2.087; P < 0.001); (6) being an atheist/agnostic, (OR = 2.5; P < 0.001); and (7) a belief that one's religion is in favour of transplantation (OR = 1.317; P = 0.005). CONCLUSIONS: Spanish medical students have a favourable attitude towards xenotransplantation. This willingness and interest could be a decisive platform for the development and strengthening of research, both for centres with a pre-clinical xenotransplantation programme and new healthcare centres.

Outpatient Thyroid Surgery in a Low-Surgical Volume Hospital.

BACKGROUND: To determine the safety and outcome of outpatient thyroid surgery in a small low-surgical volume hospital. To evaluate clinical and social factors that may prohibit outpatient thyroid surgery. METHODS: Retrospective analysis of all thyroid surgery performed at a low-surgical volume hospital from August 2006 to July 2014. One-hundred and sixty patients underwent thyroid surgery during the study period. Electronic medical records were reviewed for all patients. Data collection included demographic information, extent of thyroid surgery, length of hospital stay, laboratory/pathology results, co-morbidities, and complications. RESULTS: Of the 160 patients who underwent thyroid surgery, 109 (68.1%) were discharged on the day of surgery. Forty-three patients (26.9%) were admitted for 23-h observation and eight patients (5%) required full admission (longer than 24 h). Sixty-one patients (38.1%) underwent a total thyroidectomy, while 99 patients (61.9%) underwent a hemithyroidectomy. Complications included four temporary recurrent laryngeal nerve (RLN) injuries (2.5% patients/1.8% of total RLN at risk), one permanent RLN injury (0.63% patients/0.45% of total RLN as risk), one temporary bilateral RLN injury (0.63%), two delayed hematomas (1.3%), and eight cases of transient hypocalcemia (5%). CONCLUSION: Outpatient thyroid surgery can be performed safely in a low-surgical volume center. Reasons for a longer stay include clinical as well as social factors.

Hemangioblastoma arising from the submandibular gland.

OBJECTIVE: The objective was to document and describe the clinical features of a hemangioblastoma arising from a submandibular gland. METHODS: A case report of a 63-year-old man with a right submandibular gland hemangioblastoma. RESULTS: Submandibular gland excision and histological examination revealed a hemangioblastoma. Subsequent evaluation with imaging studies found no association with von Hippel-Lindau disease. CONCLUSION: We report the first presentation of a hemangioblastoma arising in a salivary gland. Further evaluation of patients with a hemangioblastoma is recommended given the neoplasms' association with von Hippel-Lindau disease.

Self-sorting of deformable particles in an asynchronous logic microfluidic circuit.

A microfluidic circuit can automatically sort deformable particles based on the hydrodynamic resistance that the particles induce in a constrained microfluidic channel while flowing through it.

How Does Time Affect the Antimicrobial Activity of Super-Oxidized Commercial Antiseptic Solutions? An In Vitro Test.

This study aimed to identify variation in the minimum biocidal concentration (MBC) over time, comparing three commercial super-oxidized solutions with different chemical compositions. In the bactericidal assay, the following bacteria were tested: Escherichia coli (ATCC 25922), Pseudomonas aeruginosa (ATCC 27853), Staphylococcus aureus (ATCC 25923), and for each ATCC, one wild-type strain was used. In vitro experiments were performed in triplicate at 0, 60, and 120 days of follow up. A commercial formulation based on sodium and chloride ions (SCSS) was tested using a standard accelerated aging protocol. Data were analyzed with the Friedman and Wilcoxon signed-rank tests. The results showed that super-oxidized solution bases of 20 ppm of sodium (SSS) had a significant change in MBC at 120 days (p < 0.001), whereas SCSS remained stable during the same period (p = 0.18). However, after accelerated aging treatment, the MBC of SCSS increased (p < 0.001). With our proposed approach, the two SSS showed MBC variation at 120 days, whereas SCSS showed stability over time, similar to chlorhexidine, but lost its bactericidal properties after accelerated aging treatment.

Prediction of Thyroid Hormone Replacement Following Thyroid Lobectomy: A Long-term Retrospective Study.

OBJECTIVE: Following thyroid lobectomy, patients are at risk for hypothyroidism. This study sought to determine the incidence of postlobectomy thyroid hormone replacement as well as predictive risk factors to better counsel patients. STUDY DESIGN: Retrospective cohort study. SETTING: Patients aged 18 to 75 years treated in a single academic institution who underwent thyroid lobectomy from October 2006 to September 2017. METHODS: Patients were followed for an average of 73 months. Demographic data, body mass index, size of removed and remnant lobe, preoperative thyroid-stimulating hormone (TSH) level, final thyroid pathology, and presence of thyroiditis were collected and analyzed. Risk factors were evaluated with chi-square analyses, t tests, logistic regression, and Kaplan-Meier analysis. RESULTS: Of the 478 patients reviewed, 369 were included in the analysis, 30% of whom eventually required thyroid hormone replacement. More than 39% started therapy >12 months postoperatively, with 90% treated within 36 months. Patient age ≥50 years and preoperative TSH ≥2.5 mIU/L were associated with odds ratios of 2.034 and 3.827, respectively, for thyroid hormone replacement. Malignancy on final pathology demonstrated an odds ratio of 7.76 for hormone replacement. Sex, body mass index, volume of resected and remaining lobes, and weight of resected lobe were not significant predictors. CONCLUSION: Nearly a third of patients may ultimately require thyroid hormone replacement. Age at the time of surgery, preoperative TSH, and final pathology are strong, clinically relevant predictors of the need for future thyroid hormone replacement. After lobectomy, patients should have long-term thyroid function follow-up to monitor for delayed hypothyroidism.

Outcomes after free tissue transfer for composite oral cavity resections involving skin.

BACKGROUND: Resections involving oral cavity mucosa, bone, and skin present a unique challenge. Optimizing outcomes often requires technically demanding reconstruction. The purpose of this study is to evaluate outcomes of several reconstructive approaches for patients with composite through-and-through defects, with a focus on the osteocutaneous radial forearm free flap (RFFF). METHODS: We conducted a retrospective evaluation of the cohort of patients treated for composite through-and-through defects with cutaneous involvement who underwent free flap reconstruction from August 2012 through October 2015. RESULTS: Seventeen patients received a single flap (12 cases of osteocutaneous RFFF), whereas 10 patients underwent a combination of flaps. Complication rates and functional outcomes were favorable in patients who underwent osteocutaneous RFFFs. The supraclavicular artery island flap (SCAIF) was used as a second flap in 3 cases. CONCLUSION: The osteocutaneous RFFF provides a valuable reconstructive option for complex composite resection defects involving skin. When 2 flaps are required, the SCAIF is a viable alternative to a second free flap or pectoralis flap.

Late displacement of a Montgomery thyroplasty implant following endotracheal intubation.

OBJECTIVES: We document a late displacement of a thyroplasty implant following endotracheal intubation. METHODS: A 66-year-old man was referred to our clinic with a chief complaint of breathy dysphonia immediately following an elective inguinal hernia repair under general endotracheal anesthesia. The patient's medical history was significant for a medialization laryngoplasty with a Montgomery implant 14 years earlier. RESULTS: Examination and computed tomographic scanning of the neck confirmed displacement of the implant. The patient underwent revision medialization laryngoplasty with successful restoration of his voice quality. CONCLUSIONS: This case report illustrates a potential complication of endotracheal intubation in patients who have previously undergone vocal fold medialization procedures.

Improved Synthesis for Modular Ascarosides Uncovers Biological Activity.

A versatile synthesis of modular ascarosides, a family of signaling molecules from Caenorhabditis elegans and other nematodes, via hydrogenolysis of a cyclic sulfate derived from methyl-α-l-rhamnopyranoside is reported. The route enables selective introduction of different side chains at the 1, 2, and 4 positions of the sugar, as demonstrated for ascarosides from C. elegans and Pristionchus pacificus. Bioassays with synthetic samples of 4'-tigloyl ascaroside mbas#3 revealed its role as an avoidance or dispersal signal.

Acceptance of living liver donation among medical students: A multicenter stratified study from Spain.

AIM: To analyze the attitude of Spanish medical students toward living liver donation (LLD) and to establish which factors have an influence on this attitude. STUDY TYPE: A sociological, interdisciplinary, multicenter and observational study. STUDY POPULATION: Medical students enrolled in Spain (n = 34000) in the university academic year 2010-2011. SAMPLE SIZE: A sample of 9598 students stratified by geographical area and academic year. Instrument used to measure attitude: A validated questionnaire (PCID-DVH RIOS) was self-administered and completed anonymously. Data collection procedure: Randomly selected medical schools. The questionnaire was applied to each academic year at compulsory sessions. STATISTICAL ANALYSIS: Student´s t test, χ(2) test and logistic regression analysis. RESULTS: The completion rate was 95.7% (n = 9275). 89% (n = 8258) were in favor of related LLD, and 32% (n = 2937) supported unrelated LLD. The following variables were associated with having a more favorable attitude: (1) age (P = 0.008); (2) sex (P < 0.001); (3) academic year (P < 0.001); (4) geographical area (P = 0.013); (5) believing in the possibility of needing a transplant oneself in the future (P < 0.001); (6) attitude toward deceased donation (P < 0.001); (7) attitude toward living kidney donation (P < 0.001); (8) acceptance of a donated liver segment from a family member if one were needed (P < 0.001); (9) having discussed the subject with one's family (P < 0.001) and friends (P < 0.001); (10) a partner's opinion about the subject (P < 0.001); (11) carrying out activities of an altruistic nature; and (12) fear of the possible mutilation of the body after donation (P < 0.001). CONCLUSION: Spanish medical students have a favorable attitude toward LLD.

Otologic assessment of blast and nonblast injury in returning Middle East-deployed service members.

OBJECTIVES/HYPOTHESIS: To determine if tympanic membrane perforation offers any protection from inner ear damage and determine the incidence and pattern of otologic blast injury in military personnel returning from deployment. STUDY DESIGN: Retrospective analysis of US service members injured in Operation Iraqi Freedom and Operation Enduring Freedom from October 2006 to October 2007. METHODS: One-hundred ten blast-injured patients were compared to 54 nonblast-injured patients returning from deployment. Data captured included audiogram results, presence of tympanic membrane perforation, demographic data, location and nature of injury, loss of consciousness, sleep disturbance, confusion, and symptoms of headache, dizziness, memory loss, and tinnitus. RESULTS: Of 110 blast-injured patients, 18 patients suffered tympanic membrane perforation (16%), of which nine patients suffered bilateral tympanic membrane perforation (8%). Blast patients suffered more hearing loss than controls as measured by pure-tone averages of varying speech reception frequencies and at 6,000 Hz. Of the blast patients who recorded an audiogram, nearly 24% suffered moderate to profound hearing loss. There was no statistically significant difference in hearing outcomes between blast-injured patients with tympanic membrane perforations and those without; however, when comparing patients with unilateral perforations with their contralateral ear, there was a difference in hearing thresholds at 6,000 Hz. There was a significantly increased risk of tinnitus, memory loss, headache, and dizziness between blast-injured patients compared to controls. CONCLUSIONS: Due to its violent nature, blast exposure causes greater neuro-otological manifestations and deserves prompt otologic evaluation.

Gongylonema: a parasitic nematode of the oral cavity.

We report a rare parasitic nematode infection in a 26-year-old healthy African American man. Gongylonema nematode infections in humans are unique in their ability to localize in the submucosa of the oral cavity and oropharynx. Humans are incidental hosts for the Gongylonema nematode, which is more commonly found in rudimentary animals, birds, and rodents. Approximately 50 cases of human Gongylonema infections have been reported worldwide, including 11 documented cases in the United States.(1) The pathogenesis, characteristic clinic findings, and identification features will be discussed.

Laryngeal mask airway use in otologic surgery.

OBJECTIVE: The purpose of this study was to evaluate the safety and efficacy of the laryngeal mask airway (LMA) compared with oral endotracheal tube (ETT) in general anesthesia in patients who underwent otologic surgery. STUDY DESIGN: Retrospective review. SETTING: Military tertiary care teaching hospital. PATIENTS: A retrospective chart review study was conducted on 484 patients who underwent otologic surgery at a large military tertiary care teaching hospital from January 2002 to August 2005. A review of otologic surgical cases using the LMA (n = 167) was compared to a similar cohort managed with an oral ETT (n = 317). MAIN OUTCOME MEASURES: The patient's age, weight, indication for surgery, comorbid conditions, American Society of Anesthesiologists classification, duration of surgery, and adverse events were recorded. Specific data reviewed included airway complications, intraoperative times, anesthetic medications, postoperative nausea and vomiting, and time spent in the postanesthesia care unit. RESULTS: There were no major airway complications in either group requiring an emergency airway. A significant decreased use of neuromuscular blocking agents was noted in the LMA group. Statistical analysis of variances was performed using 2-sample Wilcoxon rank-sum (Mann-Whitney U) test and Fisher's exact test. The time in the operating room to the start of surgery and the time from completion of surgery to patient exiting the operating room were shorter for the LMA group than for the ETT group. There were no statistical differences in postanesthesia care unit time or postoperative nausea and vomiting. CONCLUSION: The LMA offers a safe alternative in children and adults to endotracheal intubation with no observed increased risk of airway complications in patients undergoing otologic surgery.

Pseudotumor hemofílico. Presentación de un caso / Hemophilic pseudotumor. A case report

El pseudotumor hemofílico es una complicación infrecuente en pacientes con antecedentes de hemofilia, que se presenta en el 1-2% de los casos.Se comunica el caso de un paciente de sexo masculino, de 62 años de edad, con antecedentes de hemofilia tipo A, que consultó por la presencia de una tumoración indolora en el muslo derecho, que había aparecido aproximadamente un año antes, luego de un antecedente traumático.Además de los aspectos clínicos, se valoraron y revisaron los diferentes hallazgos radiológicos por distintos métodos de imágenes (radiología convencional, ultrasonografía, tomografía computada y resonancia magnética), teniendo en cuenta sus características típicas y atípicas.Si bien el diagnóstico definitivo de pseudotumor hemofílico se efectuó mediante la anatomía patológica, los antecedentes y técnicas imagenológicas permitieron caracterizar adecuadamente la lesión y contribuir al correcto abordaje terapéutico...