Myxomatous mitral valve disease (MMVD) in dogs is a heart disease that is characterized by histopathologic changes in cardiomyocytes, which ultimately result in valve degeneration and blood regurgitation due to structural changes in the heart valves. A number of studies have been conducted with the objective of identifying prognostic factors that may influence the prognosis of dogs with MMVD. Nevertheless, there is a paucity of research examining the factors that predict MMVD stage progression as defined by the American College of Veteri-nary Internal Medicine. The objective of this study was to examine whether there are factors associated with stage progression within one year of diagnosis in dogs diagnosed with subclinical MMVD (stage B1 or B2) using physical examination findings, clinicopathologic bio-markers, and echocardiographic markers. This is a retrospective study of veterinary practiceperformed at Chungbuk National University Animal Hospital. The electronic medical recordof the hospital was searched to obtain clinical records of canine patients diagnosed with subclinical MMVD over an 11-year period. For each patient cohort, a logistic regression analysis was conducted. The variables were initially selected using the backward elimination method, and the optimal logistic regression model was determined by removing the independent vari-ables with the largest variance inflation factor. Among the independent variables examined in this study, heart murmur intensity was identified as a statistically significant predictor of stage progression within one year for subclinical MMVD, a finding that aligns with those of previous studies. No other independent variables were found to be significantly associated with sub-clinical MMVD stage progression. This is the inaugural exploratory study to concentrate onblood test results, a relatively straightforward and quantifiable test result that can be readilyobtained in primary care veterinary clinics, among the factors that may be associated with the progression of subclinical MMVD stages.

Myxomatous mitral valve disease (MMVD) in dogs is a heart disease that is characterized by histopathologic changes in cardiomyocytes, which ultimately result in valve degeneration and blood regurgitation due to structural changes in the heart valves. A number of studies have been conducted with the objective of identifying prognostic factors that may influence the prognosis of dogs with MMVD. Nevertheless, there is a paucity of research examining the factors that predict MMVD stage progression as defined by the American College of Veteri-nary Internal Medicine. The objective of this study was to examine whether there are factors associated with stage progression within one year of diagnosis in dogs diagnosed with subclinical MMVD (stage B1 or B2) using physical examination findings, clinicopathologic bio-markers, and echocardiographic markers. This is a retrospective study of veterinary practiceperformed at Chungbuk National University Animal Hospital. The electronic medical recordof the hospital was searched to obtain clinical records of canine patients diagnosed with subclinical MMVD over an 11-year period. For each patient cohort, a logistic regression analysis was conducted. The variables were initially selected using the backward elimination method, and the optimal logistic regression model was determined by removing the independent vari-ables with the largest variance inflation factor. Among the independent variables examined in this study, heart murmur intensity was identified as a statistically significant predictor of stage progression within one year for subclinical MMVD, a finding that aligns with those of previous studies. No other independent variables were found to be significantly associated with sub-clinical MMVD stage progression. This is the inaugural exploratory study to concentrate onblood test results, a relatively straightforward and quantifiable test result that can be readilyobtained in primary care veterinary clinics, among the factors that may be associated with the progression of subclinical MMVD stages.

Myxomatous mitral valve disease (MMVD) in dogs is a heart disease that is characterized by histopathologic changes in cardiomyocytes, which ultimately result in valve degeneration and blood regurgitation due to structural changes in the heart valves. A number of studies have been conducted with the objective of identifying prognostic factors that may influence the prognosis of dogs with MMVD. Nevertheless, there is a paucity of research examining the factors that predict MMVD stage progression as defined by the American College of Veteri-nary Internal Medicine. The objective of this study was to examine whether there are factors associated with stage progression within one year of diagnosis in dogs diagnosed with subclinical MMVD (stage B1 or B2) using physical examination findings, clinicopathologic bio-markers, and echocardiographic markers. This is a retrospective study of veterinary practiceperformed at Chungbuk National University Animal Hospital. The electronic medical recordof the hospital was searched to obtain clinical records of canine patients diagnosed with subclinical MMVD over an 11-year period. For each patient cohort, a logistic regression analysis was conducted. The variables were initially selected using the backward elimination method, and the optimal logistic regression model was determined by removing the independent vari-ables with the largest variance inflation factor. Among the independent variables examined in this study, heart murmur intensity was identified as a statistically significant predictor of stage progression within one year for subclinical MMVD, a finding that aligns with those of previous studies. No other independent variables were found to be significantly associated with sub-clinical MMVD stage progression. This is the inaugural exploratory study to concentrate onblood test results, a relatively straightforward and quantifiable test result that can be readilyobtained in primary care veterinary clinics, among the factors that may be associated with the progression of subclinical MMVD stages.

Background: DuraMatrix-Onlay® Plus is a collagen dura membrane derived from purified bovine Achilles tendon. The matrix provides a scaffold for collagen synthesis and is intended to be used as an onlay without the need for dural sutures. The study aims to describe our experience with 33 consecutive patients who underwent a duraplasty procedure using the novel DuraMatrix-Onlay® Plus collagen dura membrane. Methods: This is a retrospective case series of 33 patients who underwent a duraplasty proce-dure at a single academic hospital in Los Angeles, CA, USA between May 2016 and March 2017. The primary outcome was the incidence rate of cerebrospinal fluid (CSF) leak. Secondary outcomes included rates of patient infection, dural substitute complication, and removal. Results: Thirty-three patients underwent a duraplasty procedure using the DuraMatrix-Onlay® Plus material. The average age of the patients was 41.12±7.34 years (range 2–75 years). There were 18 (54.5%) females and 15 (45.5%) males. The majority of procedures were elective operations for the resection of a lesion (n=19, 58%), and the average graft size was 17.69±4.73 cm2 . At an average follow-up of 3 months, there were no postoperative CSF leaks. The rates of patient infection, dural substitute complication, and removal were 6%, 6%, and 3%, respectively. Conclusion DuraMatrix-Onlay® Plus is associated with a low rate of postoperative CSF leakage and an acceptable complication profile. This result supports the use of collagen matrices for dural closure in general neurosurgical procedures.

Purpose: Medical schools have faced various challenges in preparing their clinical students for the frontlines of a pandemic. This study investigated medical students’ satisfaction with their institutions during the coronavirus disease 2019 (COVID-19) pandemic with the intention of guiding educators in future public health crises. Methods: In this cross-sectional study surveying students in clinical rotations, the primary outcome was overall satisfaction regarding medical schools’ responses to the pandemic, and the four secondary outcomes were school communication, exposure to COVID-19, availability of personal protective equipment, and access to COVID-19 testing. Results: The survey was distributed to ten medical schools, of which 430 students responded for a response rate of 13.0%. While most students were satisfied (61.9%, n=266) with their schools’ response, more than one in five (21.9%, n=94) were dissatisfied. Among the four secondary outcomes, communication with students was most predictive of overall satisfaction. Conclusion In future crises, schools can best improve student satisfaction by prioritizing timely communication.

Abstract During the yellow fever epidemic in Angola in 2016, cases of yellow fever were reported in China for the first time. The 11 cases, all Chinese nationals returning from Angola, were identified in March and April 2016, one to two weeks after the peak of the Angolan epidemic. One patient died; the other 10 cases recovered after treatment. This paper reviews the epidemiological characteristics of the 11 yellow fever cases imported into China. It examines case detection and disease control and surveillance, and presents recommendations for further action to prevent additional importation of yellow fever into China.

BACKGROUND: Racial differences in American patients undergoing brain tumour surgery remain poorly characterized within urban medical centres. Our objective was to assess racial differences in operative brain tumour patients at a single academic hospital in Los Angeles, California. METHODS: We reviewed medical records of adult patients undergoing craniotomy for tumour resection from March 2013 to January 2017 at UCLA Medical Centre. Patients were categorized as Asian, Hispanic, Black, or White. Racial cohorts were matched on demographic variables for comparisons. Our primary outcome was post-operative length of stay (LOS). Secondary outcomes included hospital mortality and discharge disposition. RESULTS: In this study, 462 patients identified as Asian (15.1%), Hispanic (8.7%), Black (3.9%), or White (72.3%). After cohort matching, non-White patients had elevated risk of prolonged LOS [odds ratio (OR)=2.62 (1.44, 4.76)]. No differences were observed in hospital mortality or non-routine discharge. Longer LOS was positively correlated with non-routine discharge [r(pb) (458)=0.41, p<0.001]. Black patients with government insurance had average LOS 2.84 days shorter than Black patients with private insurance (p=0.04). Among Hispanics, government insurance was associated with non-routine discharge [OR=4.93 (1.03, 24.00)]. CONCLUSION: Racial differences manifested as extended LOS for non-White patients, with comparable rates of hospital mortality and non-routine discharge across races. Prolonged LOS loosely reflected complicated clinical course with greater risk of adverse discharge disposition. Private insurance coverage predicted markedly lower risk of non-routine discharge for Hispanic patients, and LOS of three additional days among Black patients. Further research is needed to elucidate the basis of these differences.
Adult ; Asian Continental Ancestry Group ; Brain ; Brain Neoplasms ; California ; Cohort Studies ; Continental Population Groups ; Craniotomy ; Hispanic Americans ; Hospital Mortality ; Humans ; Insurance ; Insurance Coverage ; Length of Stay ; Medical Records ; Socioeconomic Factors

Head computed tomography (CT) is instrumental for managing patients of all ages. However, its low dose radiation may pose a low but non-zero risk of tumor induction in pediatric patients. Here, we present a systematic literature review on the estimated incidence of brain tumor induction from head CT exams performed on children and adolescents. MEDLINE was searched using an electronic protocol and bibliographic searches to identify articles related to CT, cancer, and epidemiology or risk assessment. Sixteen studies that predicted or measured head CT-related neoplasm incidence or mortality were identified and reviewed. Epidemiological studies consistently cited increased tumor incidence in pediatric patients (ages 0–18) exposed to head CTs. Excess relative risk of new brain tumor averaged 1.29 (95% confidence interval, 0.66–1.93) for pediatric patients exposed to one or more head CTs. Tumor incidence increased with number of pediatric head CTs in a dose-dependent manner, with measurable excess incidence even after a single scan. Converging evidence from epidemiological studies supported a small excess risk of brain tumor incidence after even a single CT exam in pediatric patients. However, refined epidemiological methods are needed to control for confounding variables that may contribute to reverse causation, such as patients with pre-existing cancer or cancer susceptibility. CT remains an invaluable technology that should be utilized so long as there is clinical indication for the study and the radiation dose is as small as reasonably achievable.
Adolescent ; Brain Neoplasms* ; Brain* ; Child ; Confounding Factors (Epidemiology) ; Epidemiologic Methods ; Epidemiologic Studies ; Epidemiology ; Head* ; Humans ; Incidence ; Mortality ; Patient Safety ; Pediatrics ; Radiometry ; Risk Assessment ; Tomography, X-Ray Computed

BACKGROUND: Worldwide, approximately 2% of new cancers are of the brain. Five-year survival rates among brain cancer patients have been reported as a little over a third. Differences in clinical outcomes between brain tumor patients of different races remain poorly understood. METHODS: A retrospective chart review was performed on brain tumor resection patients≥18 years old. Demographics, treatment variables, and survival outcomes were collected. Primary outcomes were length of stay, recurrence rate, progression-free survival (PFS), and overall survival (OS). RESULTS: A total of 452 patients were included in analysis. Females and males had nearly a 1:1 ratio (n=242 and n=220, respectively). Mean age was 54.8 years (SD: 14.5 range: 18–90). Females composed 69% (n=48) of Asian patients; males constituted 31% (n=22). Mean age of the Asian patients was 55.9 years (SD: 14.6 range: 26–89). Asian-only cohort tumor pathologies included glioblastoma (GBM) (n=14), high-grade glioma (n=7), low-grade glioma (n=4), meningioma (n=38), and metastases (n=7). Of the 185 meningioma patients, non-Asian patients comprised 79% of the group (n=146). Of the 65 GBM patients in total, non-Asian patients made up 89% of the GBM cohort (n=58). There were no statistically significant differences between these groups of both cohorts in recurrence (p=0.1580 and p=0.6294, respectively), PFS (p=0.9662 and p=0.4048, respectively), or OS (p=0.3711 and p=0.8183, respectively). CONCLUSION: Studies evaluating the survival between patients of different racial backgrounds against several tumor varieties are rare. Patients of certain racial backgrounds may need additional consideration when being attended to despite the same mutational composition as their counterparts. Repeated studies using national databases may yield more conclusive results.
Asian Continental Ancestry Group* ; Biomarkers ; Brain Neoplasms* ; Brain* ; Cohort Studies ; Continental Population Groups ; Demography ; Disease-Free Survival ; Female ; Glioblastoma ; Glioma ; Humans ; Length of Stay ; Male ; Meningioma ; Neoplasm Metastasis ; Pathology ; Recurrence ; Retrospective Studies ; Survival Rate

Central neurocytoma (CN) typically presents as an intraventricular mass causing obstructive hydrocephalus. The first line of treatment is surgical resection with adjuvant conventional radiotherapy. Stereotactic radiosurgery (SRS) was proposed as an alternative therapy for CN because of its lower risk profile. The objective of this systematic analysis is to assess the efficacy of SRS for CN. A systematic analysis for CN treated with SRS was conducted in PubMed. Baseline patient characteristics and outcomes data were extracted. Heterogeneity and publication bias were also assessed. Univariate and multivariate linear regressions were used to test for correlations to the primary outcome: local control (LC). The estimated cumulative rate of LC was 92.2% (95% confidence interval: 86.5-95.7%, p<0.001). Mean follow-up time was 62.4 months (range 3-149 months). Heterogeneity and publication bias were insignificant. The univariate linear regression models for both mean tumor volume and mean dose were significantly correlated with improved LC (p<0.001). Our data suggests that SRS may be an effective and safe therapy for CN. However, the rarity of CN still limits the efficacy of a quantitative analysis. Future multi-institutional, randomized trials of CN patients should be considered to further elucidate this therapy.
Brain Neoplasms ; Follow-Up Studies ; Humans ; Hydrocephalus ; Linear Models ; Neurocytoma* ; Particle Accelerators ; Population Characteristics ; Publication Bias ; Radiosurgery* ; Radiotherapy ; Tumor Burden