Research Spotlight

Posted March 15th 2019

Time for a change and to adopt a novel molecular genomic approach in NETs.

Andrew S. Paulson M.D.

Andrew S. Paulson M.D.

Bodei, L., E. Liu, S. Paulson, A. Gulati, J. Freudman, W. Grosh, S. Kafer, P. C. Wickremesinghe and R. R. Salem (2019). “Time for a change and to adopt a novel molecular genomic approach in NETs.” Nat Rev Clin Oncol Feb 26. [Epub ahead of print].

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We read with interest the News and Views article by Rindi and Wiedenmann (Neuroendocrine neoplasia goes molecular — time for a change. Nat. Rev. Clin. Oncol. 16, 149–150 (2018)), two notable and eminent authorities in the field of genomic medicine. Despite the concerns raised by these experts, the registry study discussed in their article unequivocally demonstrated the clinical utility of the NETest liquid biopsy assay in the ‘real-world’ setting. NETest scores enabled accurate prediction (100%) of disease progression and had a 98% correlation with response to therapy, reducing the requirement to perform an imaging test in 40% of patients . . . The following factual inaccuracies were stated in the News and Views by Rindi and Wiedenmann: that the Response Evaluation Criteria in Solid Tumors (RECIST) always enable an accurate assessment of NET progression; that our data should be viewed cautiously owing to tumour heterogeneity; that we provided no sensitivity data; that patient management depends on a multidisciplinary team (MDT) approach; and that the cost–benefit ratio of NETest is unfavourable. (Excerpt from correspondence.)


Posted March 15th 2019

Acquisition of Fire Safety Knowledge and Skills With Virtual Reality Simulation.

Ganesh Sankaranarayanan Ph.D.

Ganesh Sankaranarayanan Ph.D.

Rossler, K. L., G. Sankaranarayanan and A. Duvall (2019). “Acquisition of Fire Safety Knowledge and Skills With Virtual Reality Simulation.” Nurse Educ 44(2): 88-92.

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BACKGROUND: Prelicensure nursing students seeking to enter perioperative nursing need preparatory fire safety knowledge and skills training to participate as a member of an operating room (OR) team. PURPOSE: This pilot study examined the effectiveness of the Virtual Electrosurgery Skill Trainer (VEST) on OR fire safety skills among prelicensure nursing students. METHODS: An experimental pretest-posttest design was used in this study. Twenty nursing students were randomized to a control or an intervention group. Knowledge and skills acquisition of OR fire safety were assessed. RESULTS: There were no statistically significant findings in knowledge for either group. Fisher exact test demonstrated significant relationships between the skills performance criteria of following emergency procedures for a fire and demonstrating PASS (pull-aim-squeeze-sweep) technique (P = .001). CONCLUSIONS: Academic and hospital educators may consider incorporating virtual reality simulation to teach fire safety education or reinforce general fire safety practices to nursing students and novice nurses.


Posted March 15th 2019

Hazards of Mitral Valve Replacement for Mitral Stenosis Caused by Massive Mitral Annular Calcium With or Without Aortic Valve Replacement for Aortic Stenosis.

William C. Roberts M.D.

William C. Roberts M.D.

Roberts, W. C. (2019). “Hazards of Mitral Valve Replacement for Mitral Stenosis Caused by Massive Mitral Annular Calcium With or Without Aortic Valve Replacement for Aortic Stenosis.” Am J Cardiol 123(4): 650-657.

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Mitral annular calcium (MAC) is common in older adults in the Western World and if extensive may cause mitral stenosis. The purpose of this report is to describe outcomes of 12 patients having mitral valve replacement for mitral stenosis secondary to massive MAC. Operatively excised deposits of calcium removed from the mitral annular area and the accompanying stenotic mitral valves were examined and then the patients’ medical records were examined to confirm the diagnosis and the degree of valvular dysfunction. A total of 12 patients with massive MAC causing mitral stenosis and receiving mitral valve replacement with or without aortic valve replacement for aortic stenosis were observed in 2013 to 2015. Of the 12 patients, 7 died from 5 to 44 days (mean 19) after the valve operation and all had “stormy” postoperative courses; one survived 150 days and another, 600 days; the remaining 3 were improved by the operation and are alive 22, 27, and 59 months postoperatively. In conclusion, the high mortality in these patients suggests that mitral valve replacement in the setting of massive MAC be considered with caution.


Posted March 15th 2019

From the Editor Pellagra, Osler, Roberts, Goldberger, the Atherosclerotic Diet, Niacin, the Beginning of the Atherosclerotic Epidemic, and the First Lipid-Altering Drug.

William C. Roberts M.D.

William C. Roberts M.D.E

Roberts, W. C. (2019). “From the Editor Pellagra, Osler, Roberts, Goldberger, the Atherosclerotic Diet, Niacin, the Beginning of the Atherosclerotic Epidemic, and the First Lipid-Altering Drug.” Am J Cardiol 123(4): 697-700

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[An appreciation of Drs. Joseph Goldberger, Conrad A. Elvehjem, and Tom Spies for their work in the etiology and treatment of pellagra during the period 1914-1938; no abstract available.]


Posted March 15th 2019

Volume-Based vs Rate-Based Enteral Nutrition in the Intensive Care Unit: Impact on Nutrition Delivery and Glycemic Control.

Susan Roberts D.C.N.

Susan Roberts D.C.N.

Roberts, S., R. Brody, S. Rawal and L. Byham-Gray (2019). “Volume-Based vs Rate-Based Enteral Nutrition in the Intensive Care Unit: Impact on Nutrition Delivery and Glycemic Control.” JPEN J Parenter Enteral Nutr 43(3): 365-375.

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BACKGROUND: Underfeeding with enteral nutrition (EN) is prevalent in intensive care units (ICUs) and associated with negative outcomes. This study evaluated the impact of volume-based EN (VBEN) vs rate-based EN (RBEN) on delivery of prescribed energy and protein, and glycemic control (GC). METHODS: This retrospective study included adult patients who require mechanical ventilation within 48 hours of ICU admission and with an RBEN (n = 85) or VBEN (n = 86) order for >/=3 consecutive days during the first 12 ICU days. RESULTS: Patients receiving VBEN, vs RBEN, received more prescribed energy (RBEN, 67.6%; VBEN, 79.6%; P < .001) and protein (RBEN, 68.6%; VBEN, 79.3%; P < .001). Multiple linear regression analyses confirmed VBEN was significantly associated with an 8.9% increase in energy (P = .002) and 7.7% increase in protein (P = .004) received, after adjusting for age, Acute Physiology and Chronic Health Evaluation II score, duration of and initiation day for EN, and ICU admission location. Presence of hyperglycemia (P = .40) and glycemic variability (GV) (P = .99) were not different between the 2 groups. After adjusting for age, body mass index, diabetes history, primary diagnosis, and percent of days receiving corticosteroids, GC outcomes (presence of hyperglycemia, P = .27; GV, P = .67) remained unrelated to EN order type in multivariable regression models. CONCLUSION: VBEN, compared with RBEN, was associated with increased energy and protein delivery without adversely affecting GC. These results suggest VBEN is an effective, safe strategy to enhance EN delivery in the ICU.