We aim to determine if an objective evidence-based threshold of operative volume associated with improvement in operative outcome for esophageal resections can be defined.
Methods: Retrospective analysis was performed on patients undergoing esophageal resection for cancer in the 1998 to 2005 Nationwide Inpatient Sample. A series of multivariable analyses were performed, changing the resection volume cutoff to account for the
range of annual hospital resections. The goodness of fit of each model was compared by pseudo r(2), the amount of data variance explained by each model.
Results: A total of 4080 patients underwent esophageal resection. The median annual hospital Transmembrane Transporters inhibitor resection volume was 4 (range: 1-34). The mortality rate of “”high-volume” centers ranged from 9.94% (>= 2 resection/year) to 1.56%(>= 30 resections/year). The best model was with an annual hospital resection Blasticidin S ic50 volume greater than or equal to 15 (3.87% of data variance explained). The difference in goodness of fit between the best model and other models with different volume cutoffs was 0.64%, suggesting that volume explains less than 1% of variance in perioperative death.
data do not support the use of volume cutoffs for defining centers of excellence for esophageal cancer resections. Although volume has an incremental impact on mortality, volume alone is insufficient for defining centers of excellence. Volume seems to function as an imperfect surrogate for other variables, which may better define centers of excellence. Additional work is needed to identify these variables.”
“Ultrasonic vocalization at 55 kHz (55 kHz-USVs) by rodents has been proposed to be a behavioral manifestation of affectively positive incentive Teicoplanin motivation. To examine the extent to which 55 kHz-USV emissions correlate with cocaine-induced locomotor activity, we measured cocaine-induced 55 kHz-USVs and their relationship to cocaine-induced locomotor sensitization in rats. We demonstrate that similar to locomotor responses, 55 kHz-USVs are also sensitized by exposure to
cocaine. Furthermore, we show that the magnitude of cocaine-induced 55 kHz-USV sensitization is positively correlated with that of locomotor sensitization. Moreover, we demonstrate that rats selectively bred for high rates of 55 kHz-USVs exhibit higher levels of cocaine-induced 55 kHz-USV sensitization than animals selectively bred for low levels of 55 kHz USVs. These results suggest that the neural circuits underlying 55 kHz-USV, which may directly reflect affective experience/motivation, can be sensitized by cocaine in a way that resembles locomotor sensitization. (C) 2009 Elsevier Ireland Ltd. All rights reserved.”
“Objective: Widespread application of computed tomographic scans has increased detection of asymptomatic pulmonary nodules. A dedicated clinic was established to encourage referral and manage large numbers of patients with such nodules.