Publications by authors named "Bruce Lindgren"

132 Publications

Challenging proximal hypospadias repairs: An evolution of technique for two stage repairs.

J Pediatr Urol 2020 Dec 11. Epub 2020 Dec 11.

Division of Pediatric Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Electronic address:

Introduction: Proximal hypospadias repair remains challenging. Our approach to the first stage of two-stage proximal hypospadias repairs has evolved from using Byars' flaps to preputial inlay grafts in anatomically suitable cases and pedicled preputial flaps in more complex repairs. We reviewed our outcomes, hypothesizing that inlay grafts and pedicled preputial flaps were associated with lower complication risks than Byars' flaps.

Study Design: A single institution, retrospective, cohort study of consecutive two-stage, primary, proximal hypospadias repairs performed from 2007 to 2017 was conducted. Patients with <6 months follow-up and incomplete operative reports were excluded. Risk of complications (fistula, dehiscence, diverticulum, meatal stenosis, stricture) were evaluated following urethroplasty and stratified by first-stage repair technique. As technique refinements have been made since 2012, comparisons between two temporal subgroups (those who underwent repair in 2007-2012 and in 2013-2017) were made.

Results: 78 of 127 patients met inclusion criteria. Overall complication rate was 47% (Summary Table). Median follow-up was 25.4 months (range 6.4-128.5 months) after urethroplasty. Pedicled preputial flaps (hazards ratio [HR] 0.30; 95% Confidence Interval [CI] 0.14-0.65) and inlay grafts (HR 0.32; 95% CI 0.11-0.95) were associated with lower complication risks compared to Byars' flaps (Summary Table). Median time to complication was significantly shorter for Byars' flaps (5.7 months) than for inlay grafts (40.6 months) and pedicled preputial flaps (79.2 months) by Kaplan Meier analysis. Temporal subgroup comparisons showed that overall complication rates decreased from 70% to 31% (p = 0.001), but differences in complication rates by first-stage technique were not statistically significant.

Discussion: In our cohort, repairs with Byars' flaps had the highest complication rate, which is consistent with our observations that urethras tubularized from Byars' flaps lack appropriate backing and are hypermobile and irregular. To overcome these shortcomings, modifications were made to our approach to two-stage proximal hypospadias repairs with the use of inlay grafts and pedicled preputial flaps quilted to the underlying corporal bodies to optimize the stability of the urethral plate. Our preliminary results are promising.

Conclusion: Approach to the first stage of two-stage repairs affects outcomes. Pedicled preputial flaps and inlay grafts were associated with lower complication risks than Byars' flaps. Refinement of technique and patient selection may have resulted in fewer complications in the short term. However, long-term follow-up is needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpurol.2020.12.008DOI Listing
December 2020

Association between intra-operative meatal mismatch and urethrocutaneous fistula development in hypospadias repair.

J Pediatr Urol 2020 Dec 4. Epub 2020 Dec 4.

Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA; Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Feinberg School of Medicine at Northwestern University, 633 N. St. Clair Street, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA. Electronic address:

Introduction: The Glans-Meatus-Shaft (GMS) Score is a pre-operative phenotypic scoring system used to assess hypospadias severity and risk for post-operative complications. The 'M' component is based on pre-operative meatal location, but meatal location sometimes changes after penile degloving, resulting in 'meatal mismatch.'

Objective: To identify: 1) the incidence and clinical predictors of meatal mismatch, and 2) the association of meatal mismatch with post-operative urethrocutaneous fistula development.

Study Design: We performed a retrospective cohort study on patients who underwent primary hypospadias repair at a single center from 2011 to 2018. Meatal mismatch was defined as: upstaging (meatus moving more proximally after degloving), downstaging (moving more distally after degloving), or none. Covariates included: pre-degloving meatal location, chordee severity, penoscrotal anatomy, pre-operative testosterone, and number of stages for repair. To test the association between meatal mismatch and fistula development, we constructed two, nested, multivariable Cox proportional hazards regression models with and without meatal mismatch and compared them with the likelihood ratio test. A sensitivity analysis excluded patients with <6 months of follow-up.

Results: Of 485 patients, 99 (20%) exhibited meatal mismatch, including 75 (15%) with upstaging and 24 (5%) patients with downstaging (Figure). Meatal mismatch was significantly associated with penoscrotal webbing, number of stages for repair, and pre-degloving meatal location, with downstaging being associated with more proximal meatal location. Over a median follow-up of 7.3 months (interquartile range 2.0-20.9), fistulae developed in 56 (12%) patients. On multivariable analysis, meatal upstaging was associated with a 3-fold increased risk of fistula development (Hazards Ratio [HR]: 3.04, 95% Confidence Interval [CI]: 1.44-6.45) compared to no mismatch. Meatal downstaging had similar risk of fistula development compared to no mismatch (HR: 0.99, 95% CI: 0.29-3.35). Multi-stage compared to single-stage repair was associated with reduced risk of fistula development (HR: 0.24, 95% CI: 0.09-0.66). The likelihood ratio test favored the model that included meatal mismatch. The sensitivity analysis showed similar findings.

Discussion: Our short-term results suggest that meatal mismatch may be an important additional consideration to the GMS score as a tool to assess hypospadias severity, counsel families, and predict outcomes. Longer-term studies are needed to enhance the precision of risk stratification in hypospadias.

Conclusions: Meatal mismatch occurred in 20% of patients undergoing hypospadias repair. Among this cohort, meatal upstaging was associated with a 3-fold increased risk of post-operative urethrocutaneous fistula development.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpurol.2020.11.034DOI Listing
December 2020

Clinical Characteristics of Idiopathic Intracranial Hypertension in Patients Over 50 Years of Age: A multicenter clinical cohort study.

Am J Ophthalmol 2020 Nov 27;224:96-101. Epub 2020 Nov 27.

Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA. Electronic address:

Purpose: To characterize the clinical features of idiopathic intracranial hypertension (IIH) in patients >50 years of age compared to the typical IIH population and existing data for this older cohort.

Design: Retrospective, clinical cohort study.

Methods: Medical records of 65 patients >50 years of age at first diagnosis of IIH were reviewed based on the Modified Dandy Criteria from 4 academic centers. Each center provided randomly selected controls from IIH patients <50 years of age for each study patient at their location. Data recorded included patient demographics, presenting symptoms, medications, coexisting medical conditions, cerebrospinal fluid (CSF) opening pressure, treatments, and neuro-ophthalmic data from initial and final visits.

Results: Compared to controls, the older cohort showed the following characteristics: fewer females (n = 51 [78.5%] vs. controls: n = 60 [92.3%]; P = .045), fewer headaches (n = 33 [50.8%] vs. controls: 52 [80.0%]; P = .001), more frequent incidental discoveries of papilledema (n = 19 [29.2%] vs. controls: 7 [10.8%]; P = .015), and lower CSF opening pressure [median: 33 cm HO [range: 21-58 cm HO] vs. the median for controls: 34 cm HO [range: 24-67 cm HO; P = .029).

Conclusions: Patients with IIH diagnosed at >50 years of age were less often female and had lower CSF opening pressure, fewer headaches, a higher chance of incidentally identified papilledema, and body mass index similar to that of younger IIH patients. Older IIH onset was not associated with worse visual outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajo.2020.11.007DOI Listing
November 2020

Urinary Tract Infection After Robot-assisted Laparoscopic Pyeloplasty: Are Urine Cultures and Antibiotics Helpful?

Urology 2021 Feb 26;148:235-242. Epub 2020 Nov 26.

Department of Urology, Northwestern University Feinberg School of Medicine; Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. Electronic address:

Objective: To evaluate how variations in peri-operative urine culture (UCx) and antibiotic prophylaxis utilization following robot assisted laparoscopic pyeloplasty (RALP) affect post-RALP urinary tract infection (UTI) rates in children, then use data to generate a standardized care pathway.

Methods: Patients undergoing RALP at a single institution from January 2014 to October 2018 were retrospectively reviewed. Patients with vesicoureteral reflux, neurogenic bladder, intermittent catheterization, <=2 months follow-up after stent removal, or age >=18 years were excluded. UCx use, UCx results, and pre- and post-RALP antibiotic use were recorded. The primary outcome was symptomatic UTI, tracked until 60 days after stent removal. UTI was defined as presence of fever or urinary symptoms, a positive UCx with >=10,000 colony forming units of one uropathogen, and a positive urinalysis.

Results: A total of 152 patients were included (72% male [73% circumcised], 61% white, and 23% Hispanic). One underwent a re-operative pyeloplasty, yielding 153 encounters. Eight patients (5.2%; 95% CI 1.7-8.7%) developed post-RALP UTI. Uncircumcised status and use of pre-operative prophylactic antibiotics were associated with post-RALP UTI (P = .03 and P < .01, respectively). Use of post-RALP antibiotics, whether prophylactic or therapeutic, was not associated with lower UTI rates (P = .92). Positive pre-RALP UCx and positive intra-operative stent removal UCx were associated with higher UTI rates (P = .03 and P < .01, respectively).

Conclusion: UTI occurred in 5.2% of our cohort of >150 patients. As post-RALP antibiotic use was not associated with lower UTI rates, prophylactic antibiotics may be reserved for patients with risk factors. A standardized care pathway could safely reduce unnecessary utilization of UA/UCx and antibiotics.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.urology.2020.09.054DOI Listing
February 2021

Improving Knowledge of Mohs Surgery in Patients and Families with 3D-Printed Models and Video Animation: A Survey-Based Cohort Study.

J Am Acad Dermatol 2020 Sep 19. Epub 2020 Sep 19.

Veterans Affairs Hospital, Mohs Surgery Service, Minneapolis, MN; Department of Dermatology, University of Minnesota Medical School, Minneapolis, MN; Zel Skin & Laser Specialists, Edina, MN. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaad.2020.09.049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7973000PMC
September 2020

Robot-assisted laparoscopic diverticulectomy with ureteral reimplantation.

J Pediatr Urol 2020 Aug 20;16(4):508-509. Epub 2020 Jun 20.

Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatric Urology, 225 E. Chicago Ave., Chicago, IL, 60611, USA. Electronic address:

Objective: The objective is to describe our experience with robot-assisted laparoscopic diverticulectomy with extravesical ureteral reimplantation in a pediatric patient.

Methods: A 7-year-old male presented with a symptomatic urinary tract infection secondary to Staphylococcus epidermidis. The patient was found to have a large congenital paraureteral bladder diverticulum on work-up. His options were discussed and he proceeded with robotic diverticulectomy. Intraoperatively, the diverticulum was found to obscure the left ureteral orifice, which necessitated synchronous dismembered extravesical ureteral reimplantation.

Results: Robot-assisted laparoscopic diverticulectomy with extravesical ureteral reimplantation was performed. The procedure time was 283 min, and estimated blood loss was 3 mL. The patient was discharged home on post-operative day 1. He was last seen in clinic six months after surgery and was doing well without any recurrent urinary tract infections.

Conclusion: This video demonstrates a robotic approach for the treatment of complex congenital bladder diverticula. Robotic surgery offers the benefits of good visualization in the pelvis, minimal blood loss, and quick convalescence. Key portions of the diverticulectomy and ureteral reimplantation are clearly illustrated in this video, which can help other surgeons adopt this technique.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpurol.2020.06.009DOI Listing
August 2020

The role of subjective responses in electronic cigarette uptake and substitution in adult smokers.

Drug Alcohol Depend 2020 07 25;212:107999. Epub 2020 Apr 25.

University of Minnesota, Department of Psychiatry and Masonic Cancer Center, 717 Delaware St SE, Minneapolis, MN, 55414, United States.

Background: While a majority of cigarette smokers who use electronic cigarettes (e-cigarettes) choose to continue using cigarettes, completely switching to e-cigarettes is necessary to reduce tobacco-related harm. Whether specific subjective responses to e-cigarettes are associated with extent of smoking reduction and complete switching from cigarettes to e-cigarettes is unclear. This study determined whether initial subjective responses to e-cigarettes related to the successful substitution of e-cigarettes for cigarettes and extent of cigarette and e-cigarette use.

Methods: Adult cigarette smokers (N = 58) uninterested in quitting were asked to completely substitute their cigarettes with an e-cigarette (Vuse Solo) for 8 weeks. At week 1, subjective responses to e-cigarettes were measured using the Product Evaluation Scale and Drug Effects/Liking Survey. A Poisson regression examined whether any of these initial subjective responses were associated with smoke-free days, e-cigarette puffs, and cigarettes smoked between weeks 6 and 8 after adjustment for potential confounders. A logistic regression examined the relationship between subjective measures and exhaled carbon monoxide (CO) verified 7-day abstinence at week 8 after adjustment for potential confounders.

Results: Following Holm's p-value adjustment, e-cigarette liking and desire were associated with increased e-cigarette use (adjusted p < 0.01) and decreased cigarette use (adjusted p < 0.05). Measures of psychological reward and drug liking were associated with 7-day abstinence, however this association was no longer significant following p-value adjustment.

Conclusions: Initial subjective responses were related to cigarette and e-cigarette use at weeks 6-8, but not smoke-free days or CO-verified 7-day abstinence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.drugalcdep.2020.107999DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315796PMC
July 2020

Robot-assisted laparoscopic pyelotomy and ileal ureter substitution: video demonstration.

J Pediatr Urol 2020 04 20;16(2):255. Epub 2020 Feb 20.

Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, USA. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpurol.2020.01.013DOI Listing
April 2020

The effect of metformin on the risk of recurrent nonmelanoma skin cancers.

Int J Dermatol 2020 Aug 11;59(8):e303-e305. Epub 2020 Mar 11.

Departments of Medicine and Dermatology, University of Minnesota, Minneapolis, MN, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ijd.14829DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7673232PMC
August 2020

High School Youth and E-cigarettes: The Influence of Modified Risk Statements and Flavors on E-cigarette Packaging.

Am J Health Behav 2020 03;44(2):130-145

Department of Psychiatry, University of Minnesota, Minneapolis, MN.

In this paper, we test variations of e-cigarette warning labels on high school youth, alone, and alongside modified risk statements (MRS) and/or flavors, to determine how perceptions of and intentions toward use of e-cigarettes are influenced by these package elements. An experiment (N = 715 high school youth) varied the warning label participants viewed (FDA warning label/ MarkTen warning label/ abstract warning label) and whether they viewed the label alone or alongside MRS and/or flavors. Drawing upon the Heuristic Systematic Model, we found that youth who view an MRS with any of the warning labels are more likely to engage in counterarguing (compared to the FDA warning label alone), which increases risk perceptions. Additionally, the greater youth perceive the risks associated with e-cigarettes, the lower their intentions of using them, even if they have tried an e-cigarette in the past. Tobacco education and public health messages should encourage youth to evaluate the tobacco industry messages they receive, as counterarguing is associated with higher risk perceptions. Furthermore, fostering increased awareness of the risks associated with e-cigarette use by youth can reduce intentions to use them.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5993/AJHB.44.2.2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266646PMC
March 2020

Endoscopic-assisted robotic pyelolithotomy: a viable treatment option for complex pediatric nephrolithiasis.

J Pediatr Urol 2020 Apr 19;16(2):192.e1-192.e5. Epub 2019 Dec 19.

Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN, 46202, USA.

Introduction And Objective: Endourological and percutaneous approaches are the standard of care for treatment of pediatric urolithiasis. However, in certain situations, an endoscopic-assisted robotic pyelolithotomy (EARP) can be an acceptable alternative. Limited data exist on pediatric EARP; thus, the authors describe their experience.

Methods: Patient selection: The authors retrospectively analyzed the records of all robotic procedures performed at five institutions from 7/09-10/17 to identify patients who underwent EARP. The authors collected demographics data, indications, operative time, and postoperative complications. Stone composition was reported as the majority composition (≥50%), unless any uric acid or struvite was noted, and those stones were classified as such.

Technique: Through a traditional or hidden incision endoscopic surgery (HIdES) robot pyeloplasty approach, the authors are able to easily pass a flexible endoscope through a robotic trocar and into the renal collecting system to perform pyeloscopy or ureteroscopy. Stones were primarily retrieved via the pyelolotomy and, if indicated, treated with laser lithotripsy.

Results: The authors identified 26 patients who underwent EARP in 27 renal units. Median patient age was 12.2 years (interquartile range [IQR] 6.1-14.5 years), and body mass index was 17.5 kg/m (IQR 16.5-25.4 kg/m). The median pre-operative dimension of the largest stone was 9.0 mm (IQR 5.8 mm-15.0 mm). Reasons for EARP: 21 (77.8%) concomitant pyeloplasty, four (14.8%) altered anatomy precluding other techniques, and two (7.4%) multiple large stones. Multiple stones were present in 20 renal units (74.1%). Stones were located in the renal pelvis in nine (33.3%), lower pole in 10 (37.0%), ureter in one (3.7%), and multiple locations in seven (25.9%). Hidden incision endoscopic surgery approach was used in 14 (51.9%), and the median operative time was 237.5 min (IQR 189.8-357.8 min) with a median length of stay 1.0 day (IQR 1.0-2.0 days). Stone composition included calcium oxalate in 14 (51.9%), calcium phosphate in five (18.5%), cysteine in two (7.4%), struvite in two (7.4%), and unknown in four (14.8%). Overall stone free status was 19 (70.4%); of the eight (29.6%) renal units with residual stones, four underwent ureteroscopy, two extracorporeal shockwave lithotripsy (ESWL), one spontaneously passed, and one underwent percutaneous nephrolithotomy (PCNL). After secondary treatment, final stone free rate was 96.3%. Complications included stent migration and admission for urosepsis. At a median follow-up of 12 months (IQR 6.2-19.2 months), five (18.5%) had stone recurrence.

Conclusions: Endoscopic-assisted robotic pyelolithotomy is a reasonable treatment option for select pediatric patients with concomitant ureteropelvic junction obstruction and nephrolithiasis or pediatric patients with stones inaccessible by standard methods.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpurol.2019.12.007DOI Listing
April 2020

Effects of 6-Week Use of Very Low Nicotine Content Cigarettes in Smokers With Serious Mental Illness.

Nicotine Tob Res 2019 12;21(Suppl 1):S38-S45

Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC.

Introduction: The US Food and Drug Administration is considering implementing a reduced-nicotine standard for cigarettes. Given the high rate of smoking among people with serious mental illness (SMI), it is important to examine the responses of these smokers to very low nicotine content (VLNC) cigarettes.

Methods: This trial compared the effects of VLNC (0.4 mg nicotine/g tobacco) and normal nicotine content cigarettes (15.8 mg/g) over a 6-week period in non-treatment-seeking smokers with schizophrenia, schizoaffective disorder, or bipolar disorder (n = 58). Linear regression was used to examine the effects of cigarette condition on cigarettes per day, subjective responses, nicotine and tobacco toxicant exposure, craving, withdrawal symptoms, and psychiatric symptoms.

Results: At week 6, participants in the VLNC condition smoked fewer cigarettes per day, had lower breath carbon monoxide levels, lower craving scores, and rated their study cigarettes lower in satisfaction, reward, enjoyment, and craving reduction than those in the normal nicotine content condition (ps < .05). Week 6 psychiatric and extrapyramidal symptoms did not differ by condition, except for scores on a measure of parkinsonism, which were lower in the VLNC condition (p < .05). There were no differences across conditions on total nicotine exposure, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol, withdrawal symptoms, or responses to abstinence.

Conclusions: These results suggest that a reduced-nicotine standard for cigarettes would reduce smoking among smokers with SMI. However, the lack of effect on total nicotine exposure indicates VLNC noncompliance, suggesting that smokers with SMI may respond to a reduced-nicotine standard by substituting alternative forms of nicotine.

Implications: Results from this trial suggest that a reduced-nicotine standard for cigarettes would reduce smoking rates and smoke exposure in smokers with SMI, without increasing psychiatric symptoms. However, noncompliance with VLNC cigarettes was observed, suggesting that these smokers might respond to a reduced-nicotine standard by substituting alternative forms of nicotine.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ntr/ntz133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6939771PMC
December 2019

A Randomized Clinical Trial Examining the Effects of Instructions for Electronic Cigarette Use on Smoking-Related Behaviors and Biomarkers of Exposure.

Nicotine Tob Res 2020 08;22(9):1524-1532

James Cancer Center, The Ohio State University, Columbus, OH.

Introduction: Electronic cigarettes (e-cigarettes) have the potential to significantly reduce exposure to harmful constituents associated with cigarette smoking when smokers completely substitute cigarettes with e-cigarettes. This study examined patterns of e-cigarette and cigarette use, and extent of toxicant exposure, if smokers were instructed and incentivized to completely switch to e-cigarettes compared to instructions to use the product ad libitum.

Aims And Methods: US adult daily smokers (n = 264; 49.2% female; Mage = 47.0), uninterested in quitting smoking immediately, were recruited from Minneapolis, MN, Columbus, OH, and Buffalo, NY. Participants were randomized to 8 weeks of instructions for (1) ad libitum use of e-cigarettes (AD-E), (2) complete substitution of cigarettes with e-cigarettes (CS-E), (3) complete substitution of cigarettes with nicotine gum or lozenge (CS-NRT), or (4) continue smoking of usual brand cigarettes (UB). Participants were incentivized for protocol compliance, including complete switching in the CS-E and CS-NRT groups. Outcome variables were cigarette smoking rate and tobacco-related biomarkers of exposure.

Results: Smokers in the CS-E and CS-NRT groups showed lower rates of smoking and lower exposure to carbon monoxide, tobacco carcinogens, and other toxicants than smokers in the AD-E group. In general, no significant differences were observed between CS-E versus CS-NRT or between AD-E versus UB for most biomarkers. Significantly higher 7-day point prevalence smoke-free rates were observed for CS-E versus CS-NRT.

Conclusions: Smokers instructed and incentivized to completely switch to e-cigarettes resulted in lower smoking rates and greater reductions in exposures to harmful chemicals than smokers instructed to use the product ad libitum.

Implications: Smokers instructed to completely substitute e-cigarettes for cigarettes displayed significantly lower levels of smoking and biomarkers of exposure to carcinogens and toxicants, compared to smokers instructed to use e-cigarettes ad libitum and similar levels as smokers instructed to completely substitute with nicotine replacement therapies. Furthermore, a higher rate of complete switching was achieved with e-cigarettes versus nicotine replacement therapies. Approaches to maximize complete substitution with e-cigarettes are an important area for future research.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ntr/ntz233DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7443587PMC
August 2020

Smoking Topography Characteristics During a 6-Week Trial of Very Low Nicotine Content Cigarettes in Smokers With Serious Mental Illness.

Nicotine Tob Res 2020 07;22(8):1414-1418

Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI.

Introduction: A nicotine-reduction policy could have major benefits for smokers with serious mental illness (SMI). However, potential unintended consequences, such as compensatory smoking, should be considered to ensure that such a policy does not negatively affect this population. The purpose of this secondary analysis was to examine the impact of smoking very low nicotine content (VLNC) cigarettes for 6 weeks on smoking topography characteristics, indicators of compensatory smoking, among smokers with SMI.

Aims And Methods: After a baseline usual brand smoking phase, smokers with SMI (N = 58) were randomly assigned under double-blind conditions to receive either VLNC (0.4 mg nicotine per g tobacco) or normal nicotine content (NNC; 15.8 mg nicotine per g tobacco) research cigarettes for 6 weeks. During two study visits scheduled 6 weeks apart, participants smoked either their usual brand (baseline) or assigned study cigarettes (postrandomization) through a handheld smoking topography device. Univariate analysis of variance compared smoking topography indices with cigarette condition (VLNC vs. NNC) as the between-subjects factor with corresponding baseline topography results included as covariates.

Results: At week 6, participants in the VLNC condition smoked fewer puffs per cigarette and had shorter interpuff intervals compared to participants in the NNC condition (ps < .05). There were no differences between research cigarette conditions at week 6 for cigarette volume, puff volume, puff duration, peak flow rate, or carbon monoxide boost.

Conclusions: Findings are consistent with acute VLNC cigarette topography studies and indicate that a nicotine-reduction policy is unlikely to lead to compensation among smokers with SMI.

Implications: Given the high smoking rates among people with SMI, understanding how a nicotine-reduction policy may affect this population is critically important. When considering the smoking topography results as a whole, smokers with SMI did not engage in compensatory smoking behavior when using VLNC cigarettes during a 6-week trial. Study findings suggest that compensatory smoking is not likely to occur among smokers with SMI if nicotine content is lowered to minimally addictive levels.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ntr/ntz198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364846PMC
July 2020

A Randomized Clinical Trial of Snus Examining the Effect of Complete Versus Partial Cigarette Substitution on Smoking-Related Behaviors, and Biomarkers of Exposure.

Nicotine Tob Res 2020 04;22(4):473-481

Masonic Comprehensive Cancer Center, University of Minnesota, Minneapolis, MN.

Introduction: This 8-week multisite, randomized controlled trial of snus examined the differential effects of instructions on (1) snus use, (2) smoking and smoking-related measures, and (3) exposure to tobacco-related constituents.

Method: US adult daily cigarette smokers (n = 150; 43.3% female; Medianage = 43.5) were recruited from Minneapolis, Minnesota; Columbus and Coshocton, Ohio; and Buffalo, New York. Following a 1-week sampling phase of snus, participants who used at least 7 pouches were randomized to either (1) partial substitution (PS; "use snus as you like with your cigarettes"), (2) complete substitution (CS; "avoid cigarettes"), or (3) usual brand cigarettes (UB). Analyses included between-group analyses (eg, PS vs. CS) using Wilcoxon rank sum test of cigarettes per day and snus pouches per day, and a linear mixed model (biomarkers).

Results: Compared to the PS and UB groups, smokers assigned to CS reported greater reductions in cigarettes per day (ps < .001), using more snus pouches per day (p = .02), and more smoke-free days (CS median = 14.5, PS and UB medians = 0, p < .001). In addition, results demonstrated reductions in carbon monoxide (p < .001), total nicotine equivalents (p = .02), and four out of five measured volatile organic compounds (ps < .01) over time among the CS group. Exposure to N'-nitrosonornicotine increased by trial end only among the PS group (p < .04). Phenanthrene tetraol increased among all groups by trial end (p = .02) with no difference between groups.

Conclusions: Instructions to completely switch from cigarettes to snus resulted in the greatest reduction in cigarettes and exposure to harmful constituents.

Implications: Directly instructing smokers to switch completely to snus, rather than using ad libitum (with no instructions to avoid cigarettes), is necessary for reductions in smoking and subsequent exposure to harmful constituents.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ntr/ntz055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164575PMC
April 2020

Transitional care practices, services, and delivery in childhood cancer survivor programs: A survey study of U.S. survivorship providers.

Pediatr Blood Cancer 2019 08 16;66(8):e27793. Epub 2019 May 16.

Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Department of Pediatrics and Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.

Purpose: There are limited reports describing transition of young adult childhood cancer survivors (CCS) from pediatric to adult-focused survivorship care. The purpose of this study was to characterize current transitional care practices in the United States.

Project Description: An online survey was sent to one preselected respondent at 163 Children's Oncology Group member institutions in the United States. Data were collected about (i) the availability and type of long-term follow-up services for adult CCS and (ii) policies and procedures for transitioning. Logistic regression was used to evaluate factors related to care for CCS.

Results: The response rate was 60% (97/163). Eighty-one respondents (84%) represented centers with specialized pediatric-focused CCS programs. Thirty-nine percent (38/97) of programs delivered specialized transitional care for adult CCS. Adult-centered care was delivered in both pediatric (39%, 15/38) and adult oncology clinics (39%, 15/38). The most common perceived transition barriers were lack of available partnering adult providers and adult providers' lack of knowledge regarding CCS. The larger the program in terms of new diagnoses, the more likely they were to offer formal transitional care (<50 vs >200: odds ratios [OR] 20.0; 95% CI 3.2, 100.0, P = 0.004).

Conclusions: A variety of models are utilized for delivering care to adult CCS. Our results suggest that interventions to establish effective partnerships with adult providers on appropriate care of CCS may facilitate expanded availability of these services.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/pbc.27793DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7521144PMC
August 2019

Effect of chemotherapy on cancer stem cells and tumor-associated macrophages in a prospective study of preoperative chemotherapy in soft tissue sarcoma.

J Transl Med 2019 04 18;17(1):130. Epub 2019 Apr 18.

Masonic Cancer Center, University of Minnesota Medical School, Minneapolis, MN, USA.

Background: Cancer stem cells (CSC) may respond to chemotherapy differently from other tumor cells.

Methods: This study examined the expression of the putative cancer stem cell markers ALDH1, CD44, and CD133; the angiogenesis marker CD31; and the macrophage marker CD68 in soft tissue sarcomas (STS) before and after 4 cycles of chemotherapy with doxorubicin and ifosfamide in 31 patients with high-grade soft tissue sarcoma in a prospective clinical trial.

Results: None of the markers clearly identified CSCs in STS samples. Macrophages represented a prominent component in viable tumor areas in pre-treatment STS biopsies, ranging from < 5 to > 50%. Furthermore, macrophages expressed CD44 and ALDH1. Macrophage density correlated with baseline maximum standardized uptake value (SUVmax) on fluoro-deoxyglucose positron emission tomography (PET) imaging. Pre-chemotherapy CD68 staining correlated positively with the baseline SUVmax, and negatively with the percent of viable tumor cells in post-chemotherapy resection samples. In particular, cases with more CD68-positive cells at biopsy had fewer viable tumor cells at resection, suggesting a better response to chemotherapy.

Conclusions: In conclusion, ALDH1, CD44, and CD133 are not likely to be useful markers of CSCs in STS. However, our observation of infiltrating macrophages in STS specimens indicates that these immune cells may contribute significantly to STS biology and response to chemotherapy, and could provide a potential target of therapy. Future studies should investigate macrophage contribution to STS pathophysiology by cytokine signaling.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12967-019-1883-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6471853PMC
April 2019

Penetrating Colon Trauma Outcomes in Black and White Males.

Am J Prev Med 2018 11;55(5 Suppl 1):S5-S13

Department of Surgery, University of California, Los Angeles, California.

Introduction: Racial disparities have been both published and disputed in trauma patient mortality, outcomes, and rehabilitation. In this study, the objective was to assess racial disparities in patients with penetrating colon trauma.

Methods: The National Trauma Data Bank was searched for males aged ≥14years from 2010 through 2014 who underwent operative intervention for penetrating colon trauma. The primary outcomes for this study were stoma formation and transfer to rehabilitation; secondary outcomes were postoperative morbidity and mortality. Analyses were performed in 2016-2018.

Results: There were 7,324 patients identified (4,916 black, 2,408 white). Black and white patients underwent fecal diversion with stoma formation at a similar rate (19.6% vs 18.5%, p=0.28). Black patients were more likely than white patients to be uninsured (self-pay; 37.1% vs 29.9%) and more likely to be injured by firearms (88.3% vs 70.2%, p<0.001), but had a lower overall postoperative morbidity rate (52.6% vs 55.3%, p=0.04). The odds of stoma formation (OR=0.92, 95% CI=0.78, 1.09, p=0.35) and the odds of transfer to rehabilitation (OR=1.03, 95% CI=0.82, 1.30, p=0.78) were similar for black versus white patients.

Conclusions: Black patients experienced similar rates of stoma formation and transfer to rehabilitation as white patients with penetrating colon trauma. Multivariate analysis confirmed expected findings that trauma severity increased the odds of receiving an ostomy and rehabilitation placement. The protocol-based management approach to emergency trauma care potentially decreases the risk for the racial biases that could lead to healthcare disparities.

Supplement Information: This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amepre.2018.05.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7409984PMC
November 2018

Excessive inflammation portends complications: Wound cytokines and head and neck surgery outcomes.

Laryngoscope 2019 07 9;129(7):E238-E246. Epub 2019 Jan 9.

Department of Medicine, Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota, U.S.A.

Objectives/hypothesis: Postoperative wound-healing complications can be devastating after head and neck surgery. Whereas many patients are expected to have more complications, few objective indicators predict these poorer outcomes. We evaluated wound healing in this population by studying the association between biomarkers and surgical outcomes.

Study Design: Prospective cohort study.

Methods: A study was performed of head and neck surgery patients at our tertiary care center, from 2012 to 2015. Postsurgical drain fluid was collected 24 hours postoperatively. Biomarkers of wound healing were assayed. These included interleukin (IL)-1, -6, and -8; tumor necrosis factor (TNF)-α; transforming growth factor β; epidermal growth factor; fibroblast growth factor; C-reactive protein (CRP); vascular endothelial growth factor (VEGF); soluble fms-like tyrosine kinase-1; and placental growth factor. Patient characteristics and clinical outcomes were recorded. Two-sample, two-sided t tests evaluated differences in cytokine levels by clinical outcomes.

Results: Twenty-eight patients were enrolled with drain fluid collection. IL-1β, IL-8, and matrix metalloproteinase (MMP)-9 were significantly higher in the wound fluid of subjects with complications. Patients with longer length of stay in days had statistically higher levels of TNF-α (P = .011), IL-6 (P = .021), IL-8 (P = .004), IL-1β (P = .004), MMP-1 (P = .002), MMP-2 (P = .022), VEGF-A (P = .038), and CRP (P < .001), and longer length of stay was associated with malignancy. There were no statistically significant associations between baseline clinical characteristics and post-operative complications.

Conclusions: In this head and neck surgical cohort, higher IL-1β, IL-8, and MMP-9 levels in wound fluid were associated with postoperative complications, and elevation of multiple proinflammatory cytokines was associated with longer length of stay. These findings suggest excessive inflammation in early wound healing may portend poorer clinical outcomes after head and neck surgery.

Level Of Evidence: 2b Laryngoscope, 129:E238-E246, 2019.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/lary.27796DOI Listing
July 2019

Facial Rehabilitation as Noninvasive Treatment for Chronic Facial Nerve Paralysis.

Otol Neurotol 2019 02;40(2):241-245

Department of Otolaryngology and Facial Plastic Surgery, University of Minnesota, Minneapolis, Minnesota.

Objectives: This study aims to evaluate the effectiveness of facial rehabilitation (FR) in patients with chronic facial nerve paralysis (FNP) and describe factors that predict improved facial nerve function after FR in this patient population.

Study Design: Retrospective case review.

Setting: Tertiary referral center.

Patients: Around 241 patients were referred to a university hospital facial rehabilitation (FR) program for FNP between 1995 and 2016. Seventy-six patients met criteria, defined as diagnosis of FNP ≥12 months prior to initiation of FR.

Interventions: Each received at least two sessions of directed FR by a single therapist. Techniques employed: neuromuscular retraining, stretching/massage, and active exercise.

Main Outcomes: Variables affecting outcomes were analyzed to determine association with success of FR as measured by improvement in Facial Grading System (FGS) scale.

Results: Onset of FNP to initiation of FR ranged 12 to 384 months (mean latency = 64.7 months). All patients, age 20 to 89, showed improvement in FGS after FR (mean, 16.54 points, SD 9.35). Positive predictors of FGS improvement after therapy (p-values < 0.05): increased the number of therapy sessions, right side of face being treated for FNP, lower starting FGS score. When controlling for these important variables, time from diagnosis to initiation of therapy was not significantly associated with improvement in FGS score.

Conclusion: Facial rehabilitation was associated with improved FGS score regardless of patient age, gender, or latency to facial rehabilitation. As a noninvasive treatment option with positive outcomes, it should be offered to patients with facial nerve paralysis regardless of chronicity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MAO.0000000000002107DOI Listing
February 2019

Beliefs about E-cigarettes: A Focus Group Study with College Students.

Am J Health Behav 2019 01;43(1):76-87

Director, Tobacco Research Programs, University of Minnesota, Minneapolis, MN.

In this study, we consider how best to prevent recreational uptake of e-cigarettes among tobacco nonusers; it is important to investigate the underlying beliefs that young adults have about e-cigarettes and package elements. Using the focus group method of belief elicitation, we explore underlying belief structures that undergraduate students at a large Midwestern public university have about e-cigarettes. Beliefs are analyzed using the constantcomparative approach and categorized using the theory of planned behavior. Participants describe a dual view, wherein e-cigarettes are a cool and causal item to use at a party, while holding a negative stigma toward everyday use. They acknowledged confusion over nicotine and focused on the flavors and smoke tricks as attractions to the product. In response to package elements, participants describe the flavors and modified risk statement as undermining the health warning. Findings suggest it may be useful to supplement the required warning labels with a public education campaign that improves understanding of nicotine and to regulate the amount of nicotine permissible in e-cigarettes in order to prevent addiction in recreational users, while at the same time supporting use of the product for smoking cessation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5993/AJHB.43.1.7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7015258PMC
January 2019

Robot-Assisted Laparoscopic Reoperative Repair for Failed Pyeloplasty in Children: An Updated Series.

J Urol 2019 05;201(5):1005-1011

Department of Urology, Northwestern University , Chicago , Illinois.

Purpose: Reoperative pyeloplasty is commonly used in children with recurrent obstruction after pyeloplasty. We previously reported on reoperative robot-assisted laparoscopic repair for failed pyeloplasty in 16 children and concluded that short-term and intermediate outcomes were comparable to open reoperative repair. In this updated series we describe longer term outcomes from an extended study.

Materials And Methods: We retrospectively reviewed outcomes of consecutive children with prior failed primary pyeloplasty who underwent robot-assisted laparoscopic reoperative repair at a single institution from January 2008 to June 2018.

Results: Overall, 36 children 0.6 to 15.2 years old (median 3.7) underwent robot-assisted laparoscopic reoperative repair (pyeloplasty in 31, ureterocalicostomy in 5) at a median of 24.3 months (range 3.9 to 136.7) after primary repair. Median reoperative time was 285.0 minutes (range 207 to 556) and median length of stay was 1 day (1 to 8). Crossing vessels were present in 8 of 30 children (26.7%) with prior open repair and in 0 of 6 with prior minimally invasive repair. Clavien-Dindo grade 1 to 2 perioperative complications occurred in 4 children (11.1%) and grade 3 to 5 complications in 2 (5.6%). Median followup was 35.3 months (range 1.4 to 108.3), with 18 children (50.0%) being followed for more than 3 years. Postoperative ultrasound in 34 children revealed improvement in 31 (91.2%), stability in 2 (5.9%) and worsening hydronephrosis in 1 (2.9%). All 11 children undergoing preoperative and postoperative diuretic renography demonstrated stable or improved differential renal function. All children were symptom-free at last followup.

Conclusions: To our knowledge, this is the largest series of robot-assisted laparoscopic reoperative repair for failed pyeloplasty in children. Our results indicate the feasibility, efficacy, safety and durability of this procedure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.juro.2018.10.021DOI Listing
May 2019

Assessing the Impact of Conflicting Health Warning Information on Intentions to Use E-Cigarettes -An Application of the Heuristic-Systematic Model.

J Health Commun 2018 25;23(10-11):874-885. Epub 2018 Oct 25.

c Department of Psychiatry and Director, Tobacco Research Programs , University of Minnesota , Minneapolis , MN , USA.

The purpose of this study is to determine how nonsmokers perceive conflicting information when a modified risk statement is included along with a warning label on e-cigarette packages. We propose an application of the heuristic-systematic model to test whether this conflicting information leads to more or less active processing. As part of a larger inquiry into e-cigarette labeling, we present an experiment (n = 303) in which we test this model with nonsmokers, measuring ambiguity perceptions, counter-arguing, reduced effectiveness of the message, and behavioral intentions. Results demonstrate that the addition of a modified risk statement on the package with the warning label increases ambiguity perceptions which can lead to reduced effectiveness of warning labels and reduced behavioral intentions to avoid using e-cigarettes among nonsmokers. While the systematic and heuristic pathways are both explanatory, heuristic processing provides the better fit.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/10810730.2018.1533052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988485PMC
November 2019

E-cigarettes Warning Labels and Modified Risk Statements: Tests of Messages to Reduce Recreational Use.

Tob Regul Sci 2017 Oct;3(4):445-458

Tobacco Research Programs Director, Department of Psychiatry Professor, Associate Director of Cancer Prevention and Control, Masonic Cancer Center, University of Minnesota, Minneapolis, MN.

Objectives: We tested how variations of the warning message on e-cigarette packages influenced risk and ambiguity perceptions, and whether including a modified risk statement on the package influenced how the warning label was perceived.

Method: A 4 (warning text) × 2 (modified risk statement), plus control, experiment (N = 451) was conducted.

Results: Smoking status, sex, and the language used in the warning statements interacted to influence risk perceptions. For example, non-smoking women perceived e-cigarettes with the FDA text at 30% of the package as riskier than the FDA text at 12-point type. Additionally, including a modified risk statement on the package increased ambiguity among non-smokers, as did an abstract warning label.

Conclusions: When evaluating the effectiveness of warning label text, it is important to consider smoking status and sex. Additionally, including modified risk statements on the package with the warning label could potentially increase ambiguity among non-smokers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.18001/TRS.3.4.6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6141046PMC
October 2017

Linking Pediatrics Patients and Nurses With the Pharmacy and Electronic Health Record System Through the Inpatient Television: A Novel Interactive Pain-Management Tool.

Hosp Pediatr 2018 09 16;8(9):588-592. Epub 2018 Aug 16.

Pediatrics,

Objectives: Implement a novel pain-management interface that is used to bring real-time, patient-reported pain assessments to the inpatient television and evaluate the impact of implementation on the pain-management clinical workflow, patient engagement, and nursing pain reassessments.

Methods: We developed a pain-management tool interfacing 4 stand-alone technologies: a television-based, interactive patient care system; electronic health record system; nursing call system; and pharmacy inventory-management system. The workflow is triggered when pain medications are dispensed by sending an automatic pain assessment rating question via the patient's television at a predefined time. To measure the effects of implementation, we calculated patient and/or parent use rates and pain reassessment timely documentation rates. Data were extracted from the electronic health record for a period of 22 months and covered pre- and postimplementation.

Results: A total of 56 931 patient records were identified during the study period, representing 2447 unique patients. In total, 608 parents and/or patients reported their pain through the tool. Use rates were 6.5% for responding to the pain rating prompt and 13.3% for the follow-up prompt, in which additional nonpharmacologic strategies to eliminate pain were offered. A modest increase was found in the mean timely documentation rates on the basis of nursing documentation standards (26.1% vs 32.8%, a percentage increase of 25.7%; < .001) along with decreased median time to pain reassessment documentation (29 minutes versus 25 minutes, a percentage decrease of 13.8%; < .001).

Conclusions: With this novel tool, we offer a potentially scalable approach in supporting the pain-management clinical workflow, integration of technologies, and promoting of patient and/or parent engagement in the inpatient setting.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1542/hpeds.2018-0096DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6226310PMC
September 2018

Mapping three guanine oxidation products along DNA following exposure to three types of reactive oxygen species.

Free Radic Biol Med 2018 06 25;121:180-189. Epub 2018 Apr 25.

Department of Medicinal Chemistry and Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA. Electronic address:

Reactive oxygen and nitrogen species generated during respiration, inflammation, and immune response can damage cellular DNA, contributing to aging, cancer, and neurodegeneration. The ability of oxidized DNA bases to interfere with DNA replication and transcription is strongly influenced by their chemical structures and locations within the genome. In the present work, we examined the influence of local DNA sequence context, DNA secondary structure, and oxidant identity on the efficiency and the chemistry of guanine oxidation in the context of the Kras protooncogene. A novel isotope labeling strategy developed in our laboratory was used to accurately map the formation of 2,2-diamino-4-[(2-deoxy-β-D-erythropentofuranosyl)amino]- 5(2 H)-oxazolone (Z), 8-oxo-7,8-dihydro-2'-deoxyguanosine (OG), and 8-nitroguanine (8-NO-G) lesions along DNA duplexes following photooxidation in the presence of riboflavin, treatment with nitrosoperoxycarbonate, and oxidation in the presence of hydroxyl radicals. Riboflavin-mediated photooxidation preferentially induced OG lesions at 5' guanines within GG repeats, while treatment with nitrosoperoxycarbonate targeted 3'-guanines within GG and AG dinucleotides. Little sequence selectivity was observed following hydroxyl radical-mediated oxidation. However, Z and 8-NO-G adducts were overproduced at duplex ends, irrespective of oxidant identity. Overall, our results indicate that the patterns of Z, OG, and 8-NO-G adduct formation in the genome are distinct and are influenced by oxidant identity and the secondary structure of DNA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.freeradbiomed.2018.04.561DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858621PMC
June 2018

The Correlation between Serial Ultrasound and Diuretic Renography in Children with Severe Unilateral Hydronephrosis.

J Urol 2018 08 6;200(2):440-447. Epub 2018 Apr 6.

Division of Pediatric Urology, Department of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address:

Purpose: While serial renal ultrasound is often used as an alternative to functional renal imaging in children followed for hydronephrosis, it is unclear whether a lack of hydronephrosis progression safeguards against loss of renal function. In this study we characterize the association between findings on serial renal ultrasound and diuretic renography in children with severe unilateral hydronephrosis.

Materials And Methods: We retrospectively reviewed imaging among patients younger than 18 years old with a history of severe unilateral hydronephrosis, 2 renal ultrasounds and 2 diuretic renograms. Each pair of renal ultrasounds was interpreted by an independent blinded diagnostic radiologist and compared to a contemporaneous diuretic renogram. Change in hydronephrosis was considered as 1) a change in hydronephrosis grade or 2) any change by radiologist interpretation. A 5% or greater change in split differential function was considered significant. Chi-square and Spearman correlation analyses were performed.

Results: A total of 85 children were evaluated. Increased hydronephrosis was noted in 11.8% of children by grade and 32.9% by radiologist interpretation. Split differential renal function worsened by 5% or more in 17.6% of children. Overall, 13.3% of children with stable or decreased hydronephrosis demonstrated worsening split differential function at an average of 11.8 months. When renal ultrasound and diuretic renograms were directly compared, the Spearman correlation was poor (r = 0.24, 95% CI 0.03 to 0.43).

Conclusions: The overall correlation between imaging modalities was poor, and 13.3% of children with stable or decreased hydronephrosis had worsening of split differential renal function. These findings are important to consider when counseling nonoperatively managed children followed without diuretic renography.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.juro.2018.03.126DOI Listing
August 2018

Strong preference for mint snus flavor among research participants.

Addict Behav Rep 2017 Dec 31;6:51-55. Epub 2017 Jul 31.

Roswell Park Cancer Institute, Department of Health Behavior, Elm and Carlton Streets, Buffalo, NY 14263, United States.

Introduction: The Family Smoking Prevention and Tobacco Control Act of 2009 allows the US FDA to regulate tobacco products, including the banning of characterizing flavors, such as fruit and candy, cigarettes. The availability of mint flavored snus may facilitate the use of the product if consumers find it more palatable with respect to taste, odor, pleasantness, and intensity.

Methods: This study assessed product evaluation (PES), odor identification, odor intensity, and odor hedonics among 151 smokers enrolled in a clinical trial of snus substitution for cigarettes.

Results: Far more participants selected Winterchill (N = 110) than Robust (N = 41), regardless of their menthol cigarette smoking status. Nicotine dependence was higher among those who selected Winterchill (4 vs 3 on Fagerstrom scale, p = 0.017). Those who found Winterchill to be more satisfying, less aversive, and having a more intense, more pleasant odor than Robust were substantially more likely to select Winterchill for their one week trial.

Conclusions: Findings indicate that subjective effect measures such as the PES and DEQ are capable of differentiating products in terms of flavor preference, and that smokers express a strong preference for mint flavored snus.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.abrep.2017.07.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800582PMC
December 2017

Randomized Electronic Promotion of Lung Cancer Screening: A Pilot.

JCO Clin Cancer Inform 2017 11;1:1-6

All authors: University of Minnesota, Minneapolis, MN.

Purpose: Screening for lung cancer with low-dose computed tomography is endorsed by the US Preventive Services Task Force, but many eligible patients have yet to be offered screening. Major barriers to the implementation of screening are physician and system related-the requirement for a detailed smoking history, including pack-years, to determine eligibility. We conducted this pilot to determine the feasibility of lung cancer screening (LCS) promotion that would offer screening to eligible persons and patient completion of smoking history to estimate the size of the population of former smokers who may be eligible for LCS in a single health care system.

Patients And Methods: Two hundred participants were randomly selected from former smokers who were seen at the University of Minnesota Health in the past 2 years and assigned to control (usual care) and electronic promotion, stratified by age. Electronic messages to promote LCS were sent to an intervention group, including a link to complete a detailed smoking history in the electronic health record.

Results: Of 99 participants, 66 (67%) in the intervention group read the message, 24 (36%) of 66 responded, and 19 (79%) of 24 respondents completed the smoking history. Ten intervention participants and 13 usual care participants were eligible for screening on the basis of pack-year history. Four eligible participants underwent screening in the intervention group compared with one participant in the usual care group.

Conclusion: Electronic promotion may help identify patients who are eligible for LCS but will not reliably reach all patients because of low response rates. In this sample of former smokers, the majority are ineligible for LCS on the basis of pack-year history. Electronic methods can improve documentation of smoking history.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1200/CCI.17.00033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6874003PMC
November 2017