Medicine and Health Sciences Commons^™

Prevalence And Antimicrobial Susceptibility Pattern Of Coagulase-Negative Staphylococci (Cons) Isolated From Clinical Specimens In Northern Of Jordan, Ibrahim Ali Al Tayyar, Mazhar Salim Al-Zoubi, Emad Hussein, Salih Khudairat, Konrad Sarosiek

Department of Surgery Faculty Papers

No abstract provided.

Enos Transfection Of Adipose-Derived Stem Cells Yields Bioactive Nitric Oxide Production And Improved Results In Vascular Tissue Engineering., Stephen Mcilhenny, Ping Zhang, Thomas Tulenko, Jason Comeau, Sarah Fernandez, Aleksandra Policha, Matthew Ferroni, Elizabeth J Faul, Gabor Bagameri, Irving Shapiro, Paul J. Dimuzio

Department of Surgery Faculty Papers

This study evaluates the durability of a novel tissue engineered blood vessel (TEBV) created by seeding a natural vascular tissue scaffold (decellularized human saphenous vein allograft) with autologous adipose-derived stem cells (ASC) differentiated into endothelial-like cells. Previous work with this model revealed the graft to be thrombogenic, likely due to inadequate endothelial differentiation as evidenced by minimal production of nitric oxide (NO). To evaluate the importance of NO expression by the seeded cells, we created TEBV using autologous ASC transfected with the endothelial nitric oxide synthase (eNOS) gene to produce NO. We found that transfected ASC produced NO at levels …

Migrated Avalon Veno-Venous Extracorporeal Membrane Oxygenation Cannula: How To Adjust Without Interruption Of Flow., Daizo Tanaka, Harrsion T. Pitcher, Nicholas C. Cavarocchi, Hitoshi Hirose

Department of Surgery Faculty Papers

The Avalon dual lumen cannula is presently the cannula of choice for veno-venous extracorporeal membrane oxygenation (VV-ECMO) via right internal jugular cannulation. This cannula establishes VV-ECMO with a single cannulation; however, it requires appropriate positioning to gain adequate oxygenation. Malposition of this cannula can cause inadequate ECMO flow, hypoxia, and structural injury. We have experienced two cases of migration: one into the hepatic vein and the other into the right ventricle. The former was repositioned using echocardiographic guidance without using a guidewire. The latter was repositioned using a guidewire from the femoral vein under fluoroscopy, without antegrade wire placement into …

Saving Life And Brain With Extracorporeal Cardiopulmonary Resuscitation: A Single-Center Analysis Of In-Hospital Cardiac Arrests., Graham Peigh, Nicholas C. Cavarocchi, Hitoshi Hirose

Department of Surgery Faculty Papers

OBJECTIVE: Despite advances in medical care, survival to discharge and full neurologic recovery after cardiac arrest remains less than 20% after cardiopulmonary resuscitation. An alternate approach to traditional cardiopulmonary resuscitation is extracorporeal cardiopulmonary resuscitation, which places patients on extracorporeal membrane oxygenation during cardiopulmonary resuscitation and provides immediate cardiopulmonary support when traditional resuscitation has been unsuccessful. We report the results from extracorporeal cardiopulmonary resuscitation at the Thomas Jefferson University.

METHODS: Between 2010 and June 2014, 107 adult extracorporeal membrane oxygenation procedures were performed at the Thomas Jefferson University. Patient demographics, survival to discharge, and neurologic recovery of patients who underwent extracorporeal …

A Consortium Level Approach To Reducing Ventilator Dependence, Adam P. Johnson, Md, Mph, Vanessa Thompson, Phd, Randi E. Altmark, Rn, Bsn, Scott W. Cowan, Md, Henry A. Pitt, Md, Vanita Ahuja, Md

Department of Surgery Faculty Papers

Significance Statement

We found that all but two institutions in our consortium were poor performing outliers for ventilator dependence, defined as on the ventilator greater than 48 hours. Ventilator dependence is a rare occurrence, so our goal was to identify those patients at highest risk and develop best practices to share for the region.

Survival Outcome According To Kras Mutation Status In Newly Diagnosed Patients With Stage Iv Non-Small Cell Lung Cancer Treated With Platinum Doublet Chemotherapy., Anna K Brady, Jonathan D Mcneill, Brendan Judy, Joshua Bauml, Tracey L Evans, Roger B Cohen, Corey Langer, Anil Vachani, Charu Aggarwal

Department of Surgery Faculty Papers

INTRODUCTION: Mutations (MT) of the KRAS gene are the most common mutation in non-small cell lung cancer (NSCLC), seen in about 20-25% of all adenocarcinomas. Effect of KRAS MT on response to cytotoxic chemotherapy is unclear.

METHODS: We undertook a single-institution retrospective analysis of 93 consecutive patients with stage IV NSCLC adenocarcinoma with known KRAS and EGFR MT status to determine the association of KRAS MT with survival. All patients were treated between January 1, 2008 and December 31, 2011 with standard platinum based chemotherapy at the University of Pennsylvania. Overall and progression free survival were analyzed using Kaplan-Meier and …

Segment And Fit Thresholding: A New Method For Image Analysis Applied To Microarray And Immunofluorescence Data., Elliot Ensink, Jessica Sinha, Arkadeep Sinha, Huiyuan Tang, Heather M. Calderone, Galen Hostetter, Jordan M. Winter, David Cherba, Randall E. Brand, Peter J. Allen, Lorenzo F. Sempere, Brian B. Haab

Department of Surgery Faculty Papers

Experiments involving the high-throughput quantification of image data require algorithms for automation. A challenge in the development of such algorithms is to properly interpret signals over a broad range of image characteristics, without the need for manual adjustment of parameters. Here we present a new approach for locating signals in image data, called Segment and Fit Thresholding (SFT). The method assesses statistical characteristics of small segments of the image and determines the best-fit trends between the statistics. Based on the relationships, SFT identifies segments belonging to background regions; analyzes the background to determine optimal thresholds; and analyzes all segments to …

Simple New Risk Score Model For Adult Cardiac Extracorporeal Membrane Oxygenation: Simple Cardiac Ecmo Score., Graham Peigh, Nicholas Cavarocchi, Scott W. Keith, Hitoshi Hirose

Department of Surgery Faculty Papers

BACKGROUND: Although the use of cardiac extracorporeal membrane oxygenation (ECMO) is increasing in adult patients, the field lacks understanding of associated risk factors. While standard intensive care unit risk scores such as SAPS II (simplified acute physiology score II), SOFA (sequential organ failure assessment), and APACHE II (acute physiology and chronic health evaluation II), or disease-specific scores such as MELD (model for end-stage liver disease) and RIFLE (kidney risk, injury, failure, loss of function, ESRD) exist, they may not apply to adult cardiac ECMO patients as their risk factors differ from variables used in these scores.

METHODS: Between 2010 and …

Relationships Between Cancer Pattern, Country Income And Geographical Region In Asia., Chirk Jenn Ng, Chin Hai Teo, Nurdiana Abdullah, Wei Phin Tan, Hui Meng Tan

Department of Surgery Faculty Papers

BACKGROUND: Cancer incidence and mortality varies across region, sex and country's economic status. While most studies focused on global trends, this study aimed to describe and analyse cancer incidence and mortality in Asia, focusing on cancer site, sex, region and income status.

METHODS: Age-standardised incidence and mortality rates of cancer were extracted from the GLOBOCAN 2012 database. Cancer mortality to incidence ratios (MIRs) were calculated to represent cancer survival. The data were analysed based on the four regions in Asia and income.

RESULTS: Cancer incidence rate is lower in Asia compared to the West but for MIR, it is the …

Implementation Of Resident-Driven, Quality-Based Improvement Projects At A Single Academic Institution: Resident Value And Institutional Outcomes, Kathleen M. Lamb, Md, Randi E. Altmark, Rn, Bsn, Cnor, Adam P. Johnson, Md, Mph, Richard A. Burkhart, Md, Karen A. Chojnacki, Md, Facs, Scott W. Cowan, Md, Facs

Department of Surgery Faculty Papers

Significance

Finding a viable and sustainable methodology for resident involvement in surgical quality improvement is not only a GME requirement, but also imperative to patient care.

Declaring A Patient Brain Dead On Extracorporeal Membrane Oxygenation (Ecmo): Are There Guidelines Or Misconceptions, Kristin J. Kreitler, Nicholas C. Cavarocchi, Hitoshi Hirose, Sharon West, Richard Hasz, Michelle Ghobrial, Rodney D. Bell

Department of Surgery Faculty Papers

Objectives:

• To review the clinical practice variations and trends with declaring patients brain dead on ECMO
• To highlight the need for the development of consensus guidelines to assist clinicians in the accurate diagnosis of brain death in this specific patient population

Transplantation Of Kidneys From Donors With Acute Renal Failure Five-Year Results From Double Center Experience, Ahmad Safra, Md, Ashesh P. Shah, Md, Cataldo Doria, Md, Phd, Warren R Maley, Md, Adam M. Frank, Md, Chad Gorn, Laurel Lerner, Rn, Marie Manley, Carlo B Ramirez, Md

Department of Surgery Faculty Papers

Background:

Transplantation of kidneys from deceased donors with acute renal failure (ARF) has been described and represents an underutilized source of renal grafts. We reviewed retrospectively our double center experience with transplantation of ARF donor kidneys.

Methods:

Between January 2009 and June 2014, we performed a total of 397 kidney transplants at the two hospitals. Of which, 65 came from donors with ARF. The outcome was compared with 62 expanded criteria donor kidneys and 270 standard criteria donor kidneys. ARF was defined as donor terminal creatinine higher than 2. All kidneys from ARF donors had acceptable biopsies and were pumped. …

A Cost-Reducing Extracorporeal Membrane Oxygenation (Ecmo) Program Model: A Single Institution Experience., Nicholas C. Cavarocchi, S Wallace, E Y. Hong, A Tropea, J Byrne, Harrsion Pitcher, Hitoshi Hirose

Department of Surgery Faculty Papers

BACKGROUND: The worldwide demand for ECMO support has grown. Its provision remains limited due to several factors (high cost, complicated technology, lack of expertise) that increase healthcare cost. Our goal was to assess if an intensive care unit (ICU)-run ECMO model without continuous bedside perfusionists would decrease costs while maintaining patient safety and outcomes.

METHOD: A new ECMO program was implemented in 2010, consisting of dedicated ICU multidisciplinary providers (ICU-registered nurses, mid-level providers and intensivists). In year one, we introduced an education platform, new technology and dedicated space. In year two, continuous bedside monitoring by perfusionists was removed and new …

A Resource Planning Analysis Of District Hospital Surgical Services In The Democratic Republic Of The Congo., Melanie K. Sion, Md, Dheepa Rajan, Hyppolite Kalambay, Jean-Pierre Lokonga, Joseph Bulakali, Mathias Mossoko, Dieudonne Kwete, Gerard Schmets, Edward Kelley, Tarcisse Elongo, Luis Sambo, Meena Cherian

Department of Surgery Faculty Papers

BACKGROUND: The impact of surgical conditions on global health, particularly on vulnerable populations, is gaining recognition. However, only 3.5% of the 234.2 million cases per year of major surgery are performed in countries where the world's poorest third reside, such as the Democratic Republic of the Congo (DRC).

METHODS: Data on the availability of anesthesia and surgical services were gathered from 12 DRC district hospitals using the World Health Organization's (WHO's) Emergency and Essential Surgical Care Situation Analysis Tool. We complemented these data with an analysis of the costs of surgical services in a Congolese norms-based district hospital as well …