Digital Commons Network^™

Fluoroscopic Demonstration Of Thoracic Tumor Immobilization With High Frequency Percussive Ventilation, Ina M Sala, Beverly Maurer, Cristian Solano, Ronald Levitin, Thomas M Guerrero

Articles

Purpose: The purpose of this first-in-man study is to directly measure thoracic tumor immobilization by high frequency percussive ventilation (HFPV).

Methods: In an IRB approved protocol (IRB # 2017-046) we screened patients with conspicuous lung tumors that exhibited motion >10 mm to undergo kV fluoroscopy with HFPV. Two sets of consecutive AP (anterior posterior) fluoroscopy frames were acquired during multiple breathing cycles for free- and HFPV- breathing. All images were acquired using our kV source/panel of the therapeutic linear accelerator. Percussions were delivered via the intrapulmonary percussive ventilation device (IPV-2C) and phasitron (Percussionaire Corp., Sagle, Idaho). The baseline settings for …

A Review Of Bleeding Risk With Impella-Supported High-Risk Percutaneous Coronary Intervention, George W. Vetrovec, Amir Kaki, Thom G. Dahle

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Complex, high-risk percutaneous coronary intervention (HR-PCI) is increasingly being performed, often with mechanical circulatory support (MCS), though to date, there are limited randomised data on the efficacy of MCS for HR-PCI. The majority of MCS is provided by intra-aortic balloon pumps, but increasingly Impella® (Abiomed, Danvers, MA, USA) heart pumps are being used. While the Impella pumps provide greater increases in cardiac output, these devices require large bore access, which has been associated with an increased risk of bleeding and vascular complications. Decisions regarding the use of Impella are often based on risk–benefit considerations, with Impella-related bleeding risk being a …

Association Of Metabolomic Biomarkers With Sleeve Gastrectomy Weight Loss Outcomes, Wendy Miller, Kathryn Ziegler, Stewart Graham, Michael Maddens, Matthew Sims

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Background: Factors influencing weight loss variability following sleeve gastrectomy (SG) are not well understood. We evaluated the correlation of metabolomic biomarkers with weight loss outcomes. Methods: This prospective study evaluated the metabolomic profile of feces and serum prior to SG and three months post-SG, along with weight loss outcomes at three months post-SG (N=45). Serum and fecal samples were quantitatively profiled using a combination of 1H NMR and DI-LC-MS/MS (AbsoluteIDQ P180 kit (Biocrates, Innsbruck)). Results: Percent total weight loss (%TWL) for the lowest versus the highest weight loss tertiles (T1 vs T3) was 11.1 + 0.8% and 17.0 + 1.3%, …

A Reference Data Set For Image Registration Of The Pelvis Using Combinatorial Rigid Registration Optimization (Corro)., Afua A Yorke, David Solis Jr, Thoas Guerrero

Articles

Purpose Clinical image pairs provide the most realistic test data for image registration evaluation. However, the optimal registration is unknown. Using combinatorial rigid registration optimization (CORRO) we demonstrate a method to estimate the optimal alignment for rigid-registration of clinical image pairs.

Methods Expert selected landmark pairs were selected for each CT/CBCT image pair for six cases representing head and neck, thoracic, and pelvic anatomic regions. Combination subsets of a k number of landmark pairs (k-combination set) were generated without repeat to form a large set of k-combination sets (k-set) for k = 4,8,12. The rigid transformation between the image pairs …

A Population-Based Analysis Of Outcomes In Patients With Enteropathy-Associated T-Cell Lymphoma (Eatl), Nwabundo Anusim, Bana Antonios, Ruby Gupta, Vishal Jindal, John Khoury, Ishmael Jaiyesimi

Articles

Background: EATL is very rare and accounts for less than 1 percent of all non-Hodgkin lymphomas. EATL occurs most commonly in patients with celiac disease and carries a uniformly poor prognosis. The optimal treatment for EATL is unclear and the data is limited to case reports and small retrospective studies.

Methods: ICD-O-3 (9717) histological code was used to identify cases of EATL from the population-based cancer registries of the Surveillance Epidemiology and End Results program (SEER) between 2006 and 2016. Frequency, demographics, and survival data were assessed using SPSS statistical software.

Results: A total of 138 cases were found. The …

Mast Cells As A Surrogate Marker For Diagnosis Of Persistent Eosinophilic Esophagitis., Subhashree Mallika Krishnan, Ping Zhang, Zhenhong Qu

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Context: Histologically, the hallmark of active eosinophilic esophagitis (EoE) is the presence of intraepithelial eosinophils (iEos). Recently, studies have evaluated the etiologic role of intraepithelial mast cells (iMCs) in pathogenesis of EoE and residual disease. We aimed to evaluate diagnostic and prognostic value of iMCs in EoE by its prevalence in esophageal biopsy cases in association with presence of iEos and/or lymphocytes. Design: Esophageal biopsy cases were prospectively reviewed for presence of iEos, lymphocytes, and/or iMCs. An experienced gastroenterology pathologist at our institution quantitated the number of inflammatory cells. Immunohistochemistry (CD117) was used to highlight iMCs. Unpaired Student t test …

Not All Free Air In The Nicu Is Necrotizing Enterocolitis., Paul Holtrop, Paras Khandar, Nathan Novotny

Articles

When a tiny preterm baby in our neonatal intensive care unit (NICU) has an intestinal perforation, it is always necrotizing enterocolitis (NEC), right? Not so fast, my friend. Many of these preterm infants who perforate have free air from spontaneous intestinal perforation (SIP) and not NEC. As it turns out, not all free air in the NICU is NEC. How can you tell the difference and does it matter?

It can be challenging to tell the difference, but SIP tends to occur earlier in life, often within the first week, whereas NEC usually occurs slightly later. One analysis of a …

High Flow Nasal Cannula In The Surgical Patient, Morta Lapkus, Paras Khandhar

Articles

No matter how much they want it, airway management and the decision to place a surgical patient on a ventilator should not just be for the PICU physicians to decide. The type of ventilation a patient receives can affect the surgical patient both positively and negatively. Could High Flow Nasal Cannula in the surgical patient be beneficial? Imagine a patient with an esophageal anastomosis that is extubated to CPAP. Now imagine the tears that would flow from the surgeon when they discover bilateral pneumothoraces and a blown-out anastomosis. Tragic. Therefore, we must weigh the risks and benefits of intubation versus …

Post-Op Day 1 Fever Is Never Atelectasis, Elizabeth Boudiab, Paras Khandhar

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Postop day 1 fever is never atelectasis. It has been blamed for decades while even the latest editions of surgical textbooks disseminate this myth1. Whilst both fever and atelectasis are extraordinarily common after surgery – occurring in up to 40% and 90% of patients, respectively2 this is NOT the cause on Day 1. It is time that we exonerate this myth.

Postop day 1 fever is never atelectasis, it is due to inflammation and trauma of surgery. The concept that atelectasis was causing fever was derived principally from a study showing that alveolar macrophages sampled from an atelectatic rat lung …

The Coronavirus And The Risks To The Elderly In Long-Term Care, William Gardner, David States, Nicholas Bagley

Articles

The elderly in long-term care (LTC) and their caregiving staff are at elevated risk from COVID-19. Outbreaks in LTC facilities can threaten the health care system. COVID-19 suppression should focus on testing and infection control at LTC facilities. Policies should also be developed to ensure that LTC facilities remain adequately staffed and that infection control protocols are closely followed. Family will not be able to visit LTC facilities, increasing isolation and vulnerability to abuse and neglect. To protect residents and staff, supervision of LTC facilities should remain a priority during the pandemic.

National Trends For Intra-Operative Radiation Therapy In Favorable, Early-Stage Breast Cancer: A Propensity Scoring Analysis Of The National Cancer Database, Mohamad Sebai, Muayad F. Almahariq, Joshua Dilworth, Patrick Karabon, Rachel Kalthoff, Sayee Kiran, Jayant Vaidya, Kyle J Feldmann, Nayan Dekhne

Articles

No abstract provided.

Trends, Survival Outcomes, And Predictors Of Non-Adherence To Mastectomy Guidelines For Non-Metastatic Inflammatory Breast Cancer: Stage-Stratified Propensity Scoring Analysis Of Ncdb, Mohamad Sebai, Patrick Karabon, David Lee, Sayee Kiran, Nayana Dekhne

Articles

Background/Objective: Current National Comprehensive Cancer Network (NCCN) guidelines recommend modified radical mastectomy (MRM) as the surgical treatment of choice for nonmetastatic inflammatory breast cancer (IBC). Using data from the National Cancer Database (NCDB), our study compared the national trends and outcomes of breast-conserving surgery (BCS) vs. MRM for the treatment of IBC. Methods: NCDB data from 2004 to 2014 were retrospectively analyzed. Patients’ demographics, tumor characteristics, and overall mortality (OM) trends were compared between BCS and MRM cases of IBC. Univariate, multivariate, and propensity score weighted analyses were done to compare study groups and build a predictive model for undergoing …

Gender Differences And Survival Outcomes In Breast Cancer Patients: Stage Stratified Propensity Scoring Analysis Of The National Cancer Database, M Sebai, Pe Karabon, T Luan, S Kiran, N Dekhne

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Background: There is limited research examining breast cancer gender differences. This study compares the trends and survival outcomes over the years between male (MBC) and female (FBC) breast cancer patients using the National Cancer Database (NCDB). Methods: We retrospectively analyzed the NCDB registry for MBC and FBC cases diagnosed between 2004 and 2014. Patient demographics, tumor characteristics, overall mortality (OM), and trends were compared between MBC and FBC Patients. Univariate, multivariate, and propensity score weighted analyses were done to compare MBC and FBC. Results: 19,488 MBC patients (0.9%) and 2,138,730 FBC patients (99.1%) were identified. Median follow-up was 59.63 months. …

Effect Of Hemolysis On Fourier Transform Infrared And Raman Spectra Of Blood Plasma, Dinesh Medipally, Daniel Cullen, Valérie Untereiner, Jane Bryant, Ganesh D. Sockalingum, Thi Nguyet Que Nguyen, Emma Noone, Shirley Bradshaw, Marie Finn, Mary Dunne, Aoife M. Shannon, John Armstrong, Aidan Meade, Fiona Lyng

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Hemolysis is a very common phenomenon and is referred as the release of intracellular components from red blood cells to the extracellular fluid. Hemolyzed samples are often rejected in clinics due to the interference of hemoglobin and intracellular components in laboratory measurements. Plasma and serum based vibrational spectroscopy studies are extensively applied to generate spectral biomarkers for various diseases. However, no studies have reported the effect of hemolysis in blood based vibrational spectroscopy studies. This study was undertaken to evaluate the effect of hemolysis on infrared and Raman spectra of blood plasma. In this study, prostate cancer plasma samples (n …

Dynamic Blood-Brain Barrier Regulation In Mild Traumatic Brain Injury, Eoin O'Keeffe, Eoin Kelly, Yuzhe Liu, Chiara Giordano, Eugene Wallace, Mark Hynes, Stephen Tiernan, Aidan Meagher, Chris Greene, Stephanie Hughes, Tom Burke, John Kealy, Niamh Doyle, Alison Hay, Michael Farrell, Gerald A. Grant, Alon Friedman, Ronel Veksler, Michael G. Molloy, James F. Meaney, Niall Pender, David Camarillo, Colin P. Doherty, Matthew Campbell

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Whereas the diagnosis of moderate and severe traumatic brain injury (TBI) is readily visible on current medical imaging paradigms (magnetic resonance imaging [MRI] and computed tomography [CT] scanning), a far greater challenge is associated with the diagnosis and subsequent management of mild TBI (mTBI), especially concussion which, by definition, is characterized by a normal CT. To investigate whether the integrity of the blood-brain barrier (BBB) is altered in a high-risk population for concussions, we studied professional mixed martial arts (MMA) fighters and adolescent rugby players. Additionally, we performed the linear regression between the BBB disruption defined by increased gadolinium contrast …

Preoperative Exercise To Improve Fitness In Patients Undergoing Complex Surgery For Cancer Of The Lung Or Oesophagus (Pre-Hiit): Protocol For A Randomized Controlled Trial, Grainne Sheill, Emer Guinan, Linda O'Neill, Charles Normand, Suzanne Doyle, Sarah Moore, John Newell, Granne Mcdermott, Ronan Ryan, John V. Reynolds, Juliette Hussey

Articles

Patients with cancer of the lung or oesophagus, undergoing curative treatment, usually require a thoracotomy and a complex oncological resection. These surgeries carry a risk of major morbidity and mortality, and risk assessment, preoperative optimisation, and enhanced recovery after surgery (ERAS) pathways are modern approaches to optimise outcomes. Pre-operative fitness is an established predictor of postoperative outcome, accordingly, targeting pre-operative fitness through exercise prehabilitation has logical appeal. Exercise prehabilitation is challenging to implement however due to the short opportunity for intervention between diagnosis and surgery. Therefore, individually prescribed, intensive exercise training protocols which convey clinically meaningful improvements in cardiopulmonary fitness …

Pre-Clinical Models Of Small Cell Lung Cancer And The Validation Of Therapeutic Targets, Jane S.Y. Sui, Petra Martin, Steven G. Gray

Articles

Introduction: Small-cell lung cancer (SCLC) is an aggressive form of lung cancer that has a dismal prognosis. One of the factors hindering therapeutic developments for SCLC is that most SCLC is not surgically resected resulting in a paucity of material for analysis. To address this, significant efforts have been made by investigators to develop pre-clinical models of SCLC allowing for downstream target identification in this difficult to treat cancer.

Areas covered: In this review, we describe the current pre-clinical models that have been developed to interrogate SCLC, and outline the benefits and limitations associated with each. Using examples …

The Efficacy Of Warm Compresses In The Treatment Of Meibomian Gland Dysfunction And Demodex Folliculorum Blepharitis, Orla Murphy, Veronica O'Dwyer, Aoife Lloyd-Mckernan

Articles

Purpose: To investigate and compare the effect of warm compresses on meibomian gland dysfunction and Demodex folliculorum blepharitis.

Methods: Forty-two subjects (13 males, 29 females; mean age of 56.45 years) enrolled and completed the two-month warm compress treatment study. Three warm compress therapies were compared: Warm face cloth, MGDRx EyeBag® and OPTASETM Moist Heat Mask. Subjects attended for four visits: baseline, two weeks, four weeks, and eight weeks. Subjective symptoms, osmolarity, non-invasive tear break-up time, ocular surface staining, Schirmer I test, meibum expressibility and clarity, and eyelash manipulation and epilation to assess for the presence of Demodex folliculorum, …

Phenology Of Cupressaceae Urban Infrastructure Related To Its Pollen Content And Meteorological Variables, A. Monroy-Colín, J. M. Maya-Manzano, I. Silva-Palacios, R. Tormo-Molina, R. Pecero-Casimiro, Á. Gonzalo-Garijo, S. Fernández-Rodríguez

Articles

Cupressaceae pollen is one of the major airborne allergens of the Mediterranean region and in other regions around the world. Pollen production of these species causes considerable allergic problems during winter, being this type of pollen the most abundant in this period of the year. This work aims to relate phenology, meteorology and airborne pollen records in these species. Aerobiological sampling was carried out in Badajoz (SW Spain) from 2016 to 2018 using Hirst-type volumetric sampler. Pollination phenology was studied in 50 specimens, ten of Cupressus macrocarpa, ten of Cupressus arizonica, 15 of Cupressus sempervirens and 15 of …

Hysplit As An Environmental Impact Assessment Tool To Study The Data Discrepancies Between Olea Europaea Airborne Pollen Records And Its Phenology In Sw Spain, Alejandro Monroy-Colín, J. M. Maya-Manzano, Rafael Tormo-Molina, Raúl Pecero-Casimiro, María Ángeles Gonzalo-Garijo, Santiago Fernández-Rodríguez

Articles

The olive tree (Olea europaea) is a native evergreen tree in the Mediterranean region, being one of the most important causes of seasonal respiratory allergies in Mediterranean countries. This work aims to relate flowering phenology, source tree distribution, meteorology, and airborne pollen records for this species and to analyse the possible arrival of air masses from distant areas during days when differences between the phenological and pollen peaks. Aerobiological sampling was carried out in Badajoz (SW Spain) for 4 years (2016–2019) using a Hirst volumetric sampler. Trees were geolocalized in the city and surrounding areas. The pollination phenology of 15 …

The Performance Effect Of Scheduled Carbohydrate And Caffeine Intake During Simulated Team Sport Match-Play, John Keane, Aidan Shovlin, Simon Devenney, Shane Malone, Damien Young, Giuseppe Coratella, Kieran Collins, Marcus Shortall

Articles

The aim of the current investigation was to identify the effects of scheduled carbohydrate (CHO) and caffeine (CAF) supplementation on simulated team sport match-play performance. Ten male hurling players completed three hurling match-play simulation protocols (HSP) performed 7 days apart in a double-blind, randomized design. Supplementation included CHO, CHO + CAF, and placebo (PLA). In a randomized order, participants ingested either a 6% CHO solution, a PLA solution of similar taste, or a combined intake of 6% CHO solution + 200 mg CAF capsule. At specific time points (Pre-0 min; half time (HT)-30 min; full time (FT)-60 min), participants completed …

Association Between Eccentric Knee Flexor Strength And Hamstring Injury Risk In 185 Elite Gaelic Football Players, Mark Roe, Eamonn Delahunt, Malachy Mchugh, Conor Gissane, Shane Malone, Kieran Collins, Catherine Blake

Articles

Hamstring strains are the most common time-loss injury in elite Gaelic football affecting over 20% of players per season. Thus, there is a need to identify factors contributing to the onset of hamstring injuries in order to inform injury risk management strategies. The current study investigated whether eccentric knee flexor strength and between-limb imbalances were associated with increased risk of sustaining a timeloss hamstring injury in elite Gaelic football players. A total of 185 elite male players (26.9 ± 2.7 years, 86.4 ± 6.2 kg, 183.4 ± 5.6) were prospectively followed for 12 weeks from the day of testing. Injury …

A Review Of The Influence Of Fathers On Children's Eating Behaviours And Dietary Intake, Stephanie Rahill, Aileen Kennedy, John Kearney

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The role of fathers in child rearing has changed in recent years due to an increase in maternal employment. Despite this, the majority of research has focused on maternal influences and behaviours in relation to child feeding. Therefore, the aims of the narrative review were: 1) to examine the role and responsibility of fathers in child feeding and the factors associated with paternal responsibility in child feeding; 2) to establish how paternal modelling, paternal diets, and paternal feeding practices relate to children's eating behaviours and dietary intake; and 3) to explore the role of maternal perceptions on paternal feeding roles, …

The Legal And Medical Necessity Of Abortion Care Amid The Covid-19 Pandemic, Greer Donley, Beatrice Chen, Sonya Borrero

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In response to the COVID-19 pandemic, states have ordered the cessation of non-essential healthcare. Unfortunately, many conservative states have sought to capitalize on those orders to halt abortion care. In this short paper, we argue that abortion should not fall under any state’s non-essential healthcare order. Major medical organizations recognize that abortion is essential healthcare that must be provided even in a pandemic, and the law recognizes abortion as a time-sensitive constitutional right. Finally, we examine the constitutional arguments as to why enforcing these orders against abortion providers should not stand constitutional scrutiny. We conclude that no public health purpose …

High Lymph Node Positive To Sampled Ratio As A Potential Indication For Postoperative Radiation Therapy In Patients With Pn2 Non-Small-Cell Lung Cancer, Nikhil P Mankuzhy, Muayad F Almahariq, Craig W Stevens, Thomas J Quinn

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Background: The role for postoperative radiation therapy (PORT) for patients with non–small-cell lung cancer (NSCLC) with mediastinal lymph node (LN) involvement (pN2 disease) is controversial. We performed a SEER analysis comparing surgery alone with PORT among patients with pN2 NSCLC. As we await the final results of the LUNG ART trial, a subset of patients with a high LN positive to sampled (LPR) ratio may benefit from PORT. Patients/methods: Patients with pN2 NSCLC, ranging from 1989-2016, were assessed from the Surveillance, Epidemiology and End Results (SEER) database. A propensity score (PS)-matched, inverse probability of treatment weighting (IPTW) analysis was conducted …