Research Spotlight

Heimbach, J.K., Trotter, J.F., Pomposelli, J., Cafarella, M. and Noreen, S.M. (2021). “A Tale Full of Sound and Fury.” Liver Transpl 27(5): 624-626.

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In the current issue of Liver Transplantation, Chyou et al. present an analysis of the new acuity circle (AC) distribution model for liver transplantation in the United States.(1) The authors analyzed Organ Procurement and Transplantation Network (OPTN) data from the 6-month period prior to the adoption of the policy (August 8, 2019 to February 3, 2020) compared with the 6 months after the policy began (March 5, 2020 to August 31, 2020), excluding status 1A, pediatric, living donor transplants, and transplants performed within the month of February to allow for a 1-month “adjustment period.” They examined the number of transplants performed in the 2 periods, the variance in the median Model for End-Stage Liver Disease at transplant (MMaT) across donor service areas (DSAs), which is one of the metrics used to assess differences in access to transplantation based on geography, and the number of liver procurements that would be anticipated to require a flight (distance >100 miles between donor and transplant hospitals). [No abstract; excerpt from article].

Malek, A.J., Stafford, S.V., Papaconstantinou, H.T. and Thomas, J.S. (2021). “Initial Outcomes of A Novel Irrigating Wound Protector for Reducing the Risk of Surgical Site Infection in Elective Colectomies.” J Surg Res 265: 64-70.

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BACKGROUND: Surgical site infection (SSI) rates in elective colorectal surgery remain high due to intraoperative exposure of colonic bacteria at the surgical site. We aimed to evaluate 30-day SSI outcomes of a novel wound retractor that combines barrier protection with continuous wound irrigation in elective colorectal resection. MATERIALS AND METHODS: A retrospective single-center cohort-matched analysis included all patients undergoing elective colorectal resection utilizing the novel irrigating wound protector (IWP) from April 2015 to July 2019. A control cohort of patients who underwent the same procedures with a standard wound protector over the same time period were also identified. Patients from both groups were matched for procedure type, procedure approach, pathology requiring operation, age, sex, race, body mass index, diabetes, smoker status, hypertension, presence of disseminated cancer, current steroid or immunosuppressant use, wound classification, and American Society of Anesthesiologist classification. SSI frequency, SSI subtype (superficial, deep, or organ space), hospital length of stay (LOS) and associated procedure were tabulated through 30 postoperative days. Fisher’s exact test and number needed to treat (NNT) were used to compare SSI rates and estimate cost between both groups. RESULTS: The IWP group had 41 patients. The control group had 82 patients. Control-matched variables were similar for both groups. 30-day SSI rates were significantly lower in the IWP group (P=0.0298). length of stay was significantly shorter in the IWP group (P=0.0150). The NNT for the IWP to prevent one episode of SSI was 8.2 patients. CONCLUSIONS: The novel IWP device shows promise to reducing the risk of SSI in elective colorectal surgery.

Testa, G. and Johannesson, L. (2021). “The Value of a Nulliparous Uterus.” Transplantation 105(5): 958-959.

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One of the recommendations for both deceased and living uterus donors has been previous completion of an uncomplicated pregnancy.2 The reason for being cautious is the risk that the uterus might have undiagnosed pathologies that might impede a successful pregnancy. In the available literature, the prevalence of primary female infertility is calculated as 1.9% of women aged 20–44 y.5 If normal uterine anatomy is verified, the likelihood of transplanting a uterus unable to implant an embryo and carry a pregnancy is slim. [No abstract; excerpt from article].

Swanson, G.P., Trevathan, S., Hammonds, K.A.P., Speights, V.O. and Hermans, M.R. (2021). “Gleason Score Evolution and the Effect on Prostate Cancer Outcomes.” Am J Clin Pathol 155(5): 711-717.

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OBJECTIVES: We evaluated how the changes in Gleason grading affected the long-term outcomes of a large prostatectomy cohort. METHODS: We obtained long-term follow-up (16.7 years) in 581 patients having undergone radical retropubic prostatectomy between 1985 and 1995. We excluded those with seminal vesicle and/or lymphatic involvement. We regraded the specimens according to contemporary guidelines and compared how this affected outcomes compared with their original (pre-1995) Gleason scoring. In total, 499 patients were evaluable. RESULTS: A Gleason score of 6 or less declined from 73% to 29%, and the number increased from 25% to 63% for a Gleason score of 7 and from 5% to 8% for a Gleason score of 8 to 9. As a result, for a Gleason score less than 7, biochemical failure decreased from 28% to 23%, metastatic disease 5% to 2%, and prostate cancer death from 5% to 3%. The same results were 50% to 37%, 11% to 7%, and 10% to 6% for a Gleason score of 7 and 86% to 71%, 43% to 32%, and 29% to 26% for a Gleason score more than 7, respectively. With the most recent grade grouping, for groups 1 to 5, biochemical failure occurred in 23%, 32%, 45%, 69%, and 78%, respectively. Metastatic disease occurred in 2%, 4%, 12%, 24%, and 56%, respectively. Prostate cancer-related death occurred in 2%, 4%, 9%, 21%, and 44%, respectively. CONCLUSIONS: The revised Gleason scores improved the outcomes in all risk groups. Based on Gleason score, patients with prostate cancer will appear to have better outcomes than they did before 2005, making any comparison tenable. The current grading system shows a consistent increased risk in biochemical failure, metastatic disease, and prostate cancer-related death with each successive grade.

Shearin, S., Medley, A., Trudelle-Jackson, E., Swank, C. and Querry, R. (2021). “Differences in predictors for gait speed and gait endurance in Parkinson’s disease.” Gait Posture 87: 49-53.

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INTRODUCTION: Both gait speed and gait endurance directly impact independence and community engagement for individuals with Parkinson’s disease (PD). However, factors accounting for variability in gait speed and gait endurance performance are unclear. The purpose of this study was to investigate whether key factors associated with gait speed in individuals with PD also predicted gait endurance. METHODS: Community dwelling ambulatory individuals with PD were recruited for a single session. Key measures included 10 Meter Walk Test (10MWT) and 6 Minute Walk Test (6MWT) and key factors: age, disease severity [Movement Disorders Society United Parkinson’s Disease Rating Scale (motor scale only) (MDS-UPDRS motor)], plantar flexor strength [Calf Raise Senior (CRS)], fatigue [Fatigue Severity Scale (FSS)], cognition [Montreal Cognitive Assessment (MoCA)], and balance [Four Square Step Test (FSST)]. Multiple linear regression analyses were conducted to determine clinical relationships. RESULTS: Seventy-two individuals with PD (mean (standard deviation) (age = 70.83 (7.91) years; 50 males; MDS-UPDRS motor = 30.67 (13.50)) completed all assessments. The model predicting gait speed was significant, F(6, 65) = 15.143, p <.001, accounting for 54 % of the variance. Of the predictor variables age, MDS-UPDRS motor, CRS, MoCA and FSST scores were significant predictors. The model predicting gait endurance was significant, F(6, 65) = 15.608, p <.001, accounting for 55 % of the variance. Of the predictor variables, age, MDS-UPDRS motor scale, and CRS scores were significant predictors. DISCUSSION: Gait speed and gait endurance are similarly influenced by age, motor impairment, and plantarflexion strength. However, cognition and balance were predictors only of gait speed, which may suggest unique task differences exist between gait speed and gait endurance.