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Abstract Background Laparoscopic sleeve gastrectomy (SG) continues to grow in popularity as a primary bariatric procedure. The purpose of this study is to determine if leak rates and need for subsequent interventions are changed by the standardized use of a closed suction calibration system (CSCS) at a high-volume urban hospital.MethodsA retrospective review was conducted between January 1, 2016, and December 31, 2018, on SG patients. All cases performed in 2018 were completed with a closed suction calibration system. Patient demographics, comorbidities, operative variables, and outcomes were collected. Descriptive statistics and chi-squared test were used to compare the two groups. Logistic regression models were adjusted for patient- and procedure-specific factors.ResultsFour hundred ninety cases were performed before and 195 after institution of the CSCS. Groups were similar in most characteristics, including median body mass index (BMI) (46.4 vs 45.8 kg/m2, p = 0.79). Those in the closed suction cohort were more likely to have OSA requiring therapy (32.4% vs 46.6%, p < 0.01) and to have their cases performed robotically (55.4% vs 39.6%, p = 0.02). Post introduction of the CSCS, the overall leak rate was 0% (1.4% vs 0%, p = 0.09); overall need for postoperative interventions decreased (9.6% vs 2.6%, p = 0.009). After adjustment, a 69% decrease was observed in need for related additional intervention [aOR 0.31 (0.12–0.81), p = 0.017].ConclusionThe use of a standardized closed suction calibration system resulted in overall decreased leak rates, which was associated with a clinically significant decrease in additional interventions.

Quality improvement is central to improving the care of patients with cardiovascular disease; however, the optimum type of data feedback to support such efforts is unknown. Over 26 months, 149 eligible Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With The Guidelines hospitals were randomized to receive either standard (n = 76 control) or targeted (n = 73 intervention) performance feedback reports for acute myocardial infarction patient care. Each report summarized performance on identified metrics (providing hospitals with detailed data on their 3 lowest-performing quality metrics, relative to their peers). Intervention sites received 5 targeted feedback reports. Overall composite performance was compared between cohorts at end of study and as a change from baseline. Intervention (n = 60) and control (n = 64) hospitals that completed the study had similar baseline performance (median score 83.7% vs 84.2%). Over 26 months of follow-up, the change in overall composite score across hospitals was neutral (median 0.1% [interquartile range {IQR} −2.4% to 3.3%]). There was no difference in observed improvement in either the intervention (median −0.2% [IQR−2.6% to 3.3%]) or control (median 0.1% [IQR −2.2% to 3.4%]) hospitals. We were unable to demonstrate that targeted performance feedback reports lead to more rapid care improvements than standard reports. Future directions should explore the relationship between hospital self-selection of targeted metrics and the identification and promulgation of less common metrics—particularly those that reflect processes of care.

Background Malaria is a major world health issue and its continued burden is due, in part, to difficulties in the diagnosis of the illness. The World Health Organization recommends confirmatory testing using microscopy-based techniques or rapid diagnostic tests (RDT) for all cases of suspected malaria. In regions where Plasmodium species are indigenous, there are multiple etiologies of fever leading to misdiagnoses, especially in populations where HIV is prevalent and children. To determine the frequency of malaria infection in febrile patients over an 8-month period at the Regional Hospital in Bamenda, Cameroon, we evaluated the clinical efficacy of the Flourescence and Staining Technology (FAST) Malaria stain and ParaLens Advance TM microscopy system (FM) and compared it with conventional bright field microscopy and Giemsa stain (GS). Methods Peripheral blood samples from 522 patients with a clinical diagnosis of “suspected malaria” were evaluated using GS and FM methods. A nested PCR assay was the gold standard to compare the two methods. PCR positivity, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined. Results Four hundred ninety nine samples were included in the final analysis. Of these, 30 were positive via PCR (6.01%) with a mean PPV of 19.62% and 27.99% for GS and FM, respectively. The mean NPV was 95.01% and 95.28% for GS and FM, respectively. Sensitivity was 26.67% in both groups and specificity was 92.78% and 96.21% for GS and FM, respectively. An increased level of diagnostic discrepancy was observed between technicians based upon skill level using GS, which was not seen with FM. Conclusions The frequency of malarial infections confirmed via PCR among patients presenting with fever and other symptoms of malaria was dramatically lower than that anticipated based upon physicians’ clinical suspicions. A correlation between technician skill and accuracy of malaria diagnosis using GS was observed that was less pronounced using FM. Additionally, FM increased the specificity and improved the PPV, suggesting this relatively low cost approach could be useful in resource-limited environments. Anecdotally, physicians were reluctant to not treat all patients symptomatically before results were known and in spite of a negative microscopic diagnosis, highlighting the need for further physician education to avoid this practice of overtreatment. A larger study in an area with a known high prevalence is being planned to compare the two microscopy methods against available RDTs.

Idiopathic pulmonary fibrosis (IPF) is a progressive and fatal lung disease with limited treatment options. Although transforming growth factor beta 1 (TGFB1, TGFβ) is a key driver of fibrosis, additional signaling pathways, including wingless-type mammary tumor virus integration site (WNT)/β-catenin and yes-associated protein 1 (YAP), contribute to IPF pathogenesis. Clinical data indicate that inhibition of TGFβ alone provides limited efficacy or is associated with toxicity, underscoring the need for alternative therapeutic approaches. Tankyrase (TNKS) 1 and 2 are post-translational regulators of WNT/β-catenin and YAP signaling and therefore represent promising antifibrotic targets. OM-153, a potent and selective TNKS inhibitor, exhibits pharmacological properties suitable for preclinical development in IPF. Primary normal human lung fibroblasts (NHLF), Scar-in-a-Jar assays, lung-on-a-chip models, and precision-cut lung slices (PCLS) from non-pulmonary fibrosis (non-PF) tissue were stimulated with an IPF-relevant cytokine cocktail (IPF-RC) designed to accurately recapitulate the pro-fibrotic environment and compared to TGFβ. These models, with bleomycin-challenged mice and PCLS from end-stage pulmonary fibrosis (PF) patients, were treated with OM-153. Fibrosis markers, extracellular matrix (ECM) components, and signaling pathway-specific gene expression or protein markers were assessed by real-time qRT-PCR, RNA sequencing, immunoblotting, ELISA, and immunofluorescence. OM-153 stabilized the direct TNKS targets axin 1 (AXIN1) and angiomotin-like 1 (AMOTL1), suppressed WNT/β-catenin and YAP signaling. In parallel, it reduced profibrotic ECM expression across in vitro, in vivo, and ex vivo IPF models. Selective TNKS inhibition by OM-153 demonstrates broad antifibrotic activity in multiple preclinical models, supporting further development as a potential disease-modifying strategy for IPF. Our findings show that the potent and selective TNKS inhibitor OM-153 suppresses WNT/β-catenin and YAP signaling, reducing pro-fibrotic ECM expression in preclinical IPF models, supporting TNKS inhibition as a novel antifibrotic strategy.