Medical Specialties Commons^™

Bassini Inguinal Hernia Repair: Obsolete Or Still A Viable Surgical Option? A Single Center Cohort Study, Wayne Tse, William Johns, James Maher, Jeannie Rivers, Thomas Miller

Department of Orthopaedic Surgery Faculty Papers

Background: Most inguinal hernias are presently repaired using some type of mesh technique. This mesh can be placed through an inguinal incision or positioned through a laparoscopic approach. Either way, results have been impressive including a low recurrence rate, minimal pain and a rapid return to work and normal activity compared to tissue based approaches. Notwithstanding these results, there is still a subset of patients who, for various reasons, are strongly opposed to having a mesh repair. This study summarizes our 13 year experience with such patients and why the Bassini hernia repair is a viable surgical option in these …

No Effect Of Hypercholesterolemia On Elastase-Induced Experimental Abdominal Aortic Aneurysm Progression, Toru Ikezoe, Takahiro Shoji, Jia Guo, Fanru Shen, Hong S. Lu, Alan Daugherty, Masao Nunokawa, Hiroshi Kubota, Masaaki Miyata, Baohui Xu, Ronald L. Dalman

Saha Cardiovascular Research Center Faculty Publications

Objective: Epidemiological studies link hyperlipidemia with increased risk for abdominal aortic aneurysms (AAAs). However, the influence of lipid-lowering drugs statins on prevalence and progression of clinical and experimental AAAs varies between reports, engendering controversy on the association of hyperlipidemia with AAA disease. This study investigated the impact of hypercholesterolemia on elastase-induced experimental AAAs in mice. Methods: Both spontaneous (targeted deletion of apolipoprotein E) and induced mouse hypercholesterolemia models were employed. In male wild type (WT) C57BL/6J mice, hypercholesterolemia was induced via intraperitoneal injection of an adeno-associated virus (AAV) encoding a gain-of-function proprotein convertase subtilisin/kexin type 9 mutation (PCSK9) followed by …

Management Of Coincident Pituitary Macroadenoma And Cavernous Carotid Aneurysm: A Systematic Literature Review., Keenan J. Piper, Michael Karsy, Blair Barton, Mindy Rabinowitz, Marc R. Rosen, Gurston G. Nyquist, James J. Evans, Stavropoula Tjoumakaris, Christopher J. Farrell

Department of Neurosurgery Faculty Papers

Introduction

Pituitary adenomas are a common intracranial pathology with an incidence of 15 to 20% in the population while cerebral aneurysms are less common with a prevalence of 1:50 patients. The incidence of aneurysms in patients with pituitary adenoma has been estimated at 2.3 to 5.4% of patients; however, this remains unclear. Equally, the management of concomitant lesions lacks significant understanding.

Methods

A case report is presented of a concomitant cerebral aneurysm and pituitary adenoma managed by minimally invasive endovascular and endoscopic methods, respectively. A systematic review of the literature for terms "pituitary adenoma" and "aneurysm" yielded 494 studies that …

Cardiac Tamponade On Ecpella: A Case Report Of A Unique Hemodynamic Picture, Naveed Akhtar, Parth Savsani, Maya Guglin, Roopa Rao

The VAD Journal

Extracorporeal membrane oxygenation is rapidly becoming a preferred therapy for short-term hemodynamic support in cardiogenic shock, along with the use of devices such as Impella (Abiomed, Andover, MA). The two together can create unique hemodynamics resulting in altered presentation of common hemodynamic conditions such as tamponade. We present a case of a patient with fulminant myocarditis requiring veno-arterial extracorporeal membrane oxygenation and Impella support. The patient later developed a pericardial effusion with atypical tamponade physiology which masked the left ventricular systolic function recovery. We further highlight the complex hemodynamics of cardiac tamponade in patients with such mechanical circulatory support and …

Current Evidence On Potential Of Adipose Derived Stem Cells To Enhance Bone Regeneration And Future Projection, Quang Le, Vedavathi Madhu, Joseph M Hart, Charles R Farber, Eli R Zunder, Abhijit S Dighe, Quanjun Cui

Department of Orthopaedic Surgery Faculty Papers

Injuries to the postnatal skeleton are naturally repaired through successive steps involving specific cell types in a process collectively termed “bone regeneration”. Although complex, bone regeneration occurs through a series of well-orchestrated stages wherein endogenous bone stem cells play a central role. In most situations, bone regeneration is successful; however, there are instances when it fails and creates non-healing injuries or fracture nonunion requiring surgical or therapeutic interventions. Transplantation of adult or mesenchymal stem cells (MSCs) defined by the International Society for Cell and Gene Therapy (ISCT) as CD105+-CD90+CD73+CD45-CD34-CD14orCD11b-CD79αorCD19-HLA-DR-is being investigated as an attractive therapy for bone regeneration throughout the …

Nursing Management Of The Bloodless Surgery Patient, Tiffany Achenbach Msn, Rn, Cmsrn

Posters

No abstract provided.

Neurotensin Regulates Proliferation And Stem Cell Function In The Small Intestine In A Nutrient-Dependent Manner, Stephanie A. Rock, Kai Jiang, Yuanyuan Wu, Yajuan Liu, Jing Li, Heidi L. Weiss, Chi Wang, Jianhang Jia, Tianyan Gao, B. Mark Evers

Surgery Faculty Publications

BACKGROUND & AIMS: Intestinal stem cells (ISCs) are sensitive to dietary alterations and nutrient availability. Neurotensin (NT), a gut peptide localized predominantly to the small bowel and released by fat ingestion, stimulates the growth of intestinal mucosa under basal conditions and during periods of nutrient deprivation, suggesting a possible role for NT on ISC function.

METHODS: Leucine-rich repeat-containing G-protein coupled receptor 5-Enhanced Green Fluorescent Protein (Lgr5-EGFP) NT wild type (Nt^+/+) and Lgr5-EGFP NT knockout (Nt^-/-) mice were fed ad libitum or fasted for 48 hours. Small intestine tissue and crypts were examined by gene …

Nsg-Pro Mouse Model For Uncovering Resistance Mechanisms And Unique Vulnerabilities In Human Luminal Breast Cancers, Yunguang Sun, Ning Yang, Fransiscus E Utama, Sameer S Udhane, Junling Zhang, Amy R Peck, Alicia Yanac, Katherine Duffey, John F Langenheim, Vindhya Udhane, Guanjun Xia, Jess F Peterson, Julie M Jorns, Marja T Nevalainen, Romain Rouet, Peter Schofield, Daniel Christ, Christopher J Ormandy, Anne Rosenberg, I Chervoneva, Shirng-Wern Tsaih, Michael J Flister, Serge Y Fuchs, Kay-Uwe Wagner, Hallgeir Rui

Department of Surgery Faculty Papers

Most breast cancer deaths are caused by estrogen receptor-α-positive (ER+) disease. Preclinical progress is hampered by a shortage of therapy-naïve ER+ tumor models that recapitulate metastatic progression and clinically relevant therapy resistance. Human prolactin (hPRL) is a risk factor for primary and metastatic ER+ breast cancer. Because mouse prolactin fails to activate hPRL receptors, we developed a prolactin-humanized Nod-SCID-IL2Rγ (NSG) mouse (NSG-Pro) with physiological hPRL levels. Here, we show that NSG-Pro mice facilitate establishment of therapy-naïve, estrogen-dependent PDX tumors that progress to lethal metastatic disease. Preclinical trials provide first-in-mouse efficacy of pharmacological hPRL suppression on residual ER+ human breast cancer …

Understanding Pediatric Surgery Cancellation: Geospatial Analysis, Lei Liu, Yizhao Ni, Andrew F Beck, Cole Brokamp, Ryan C Ramphul, Linda D Highfield, Megha Karkera Kanjia, J Nick Pratap

Faculty, Staff and Students Publications

BACKGROUND: Day-of-surgery cancellation (DoSC) represents a substantial wastage of hospital resources and can cause significant inconvenience to patients and families. Cancellation is reported to impact between 2% and 20% of the 50 million procedures performed annually in American hospitals. Up to 85% of cancellations may be amenable to the modification of patients' and families' behaviors. However, the factors underlying DoSC and the barriers experienced by families are not well understood.

OBJECTIVE: This study aims to conduct a geospatial analysis of patient-specific variables from electronic health records (EHRs) of Cincinnati Children's Hospital Medical Center (CCHMC) and of Texas Children's Hospital (TCH), …

Real-World Evaluation Of Universal Germline Screening For Cancer Treatment-Relevant Pharmacogenes, Megan L. Hutchcraft, Nan Lin, Shulin Zhang, Catherine Sears, Kyle Zacholski, Elizabeth A. Belcher, Eric B. Durbin, John L. Villano, Michael J. Cavnar, Susanne M. Arnold, Frederick R. Ueland, Jill M. Kolesar

Pathology and Laboratory Medicine Faculty Publications

The purpose of this study was to determine the frequency of clinically actionable treatment-relevant germline pharmacogenomic variants in patients with cancer and assess the real-world clinical utility of universal screening using whole-exome sequencing in this population. Cancer patients underwent research-grade germline whole-exome sequencing as a component of sequencing for somatic variants. Analysis in a clinical bioinformatics pipeline identified clinically actionable pharmacogenomic variants. Clinical Pharmacogenetics Implementation Consortium guidelines defined clinical actionability. We assessed clinical utility by reviewing electronic health records to determine the frequency of patients receiving pharmacogenomically actionable anti-cancer agents and associated outcomes. This observational study evaluated 291 patients with …

Rupture Of A Superficial Temporal Artery Pseudoaneurysm Following Craniotomy, Jessica A. Shields, Jared M. Robichaux, Kevin Morrow, Clifford Crutcher, Gabriel Tender

School of Medicine Faculty Publications

Pseudoaneurysm of the superficial temporal artery (STA) is a rare entity that has been reported in the literature after trauma or iatrogenic injuries. We describe a unique case of STA pseudoaneurysm rupture and the clinical sequelae associated with its rupture. We report a case of pseudoaneurysm rupture of the STA that occurred 14 days after craniotomy for cerebrospinal fluid leak repair. We also review the literature, diagnosis and treatment of external carotid artery aneurysms. Rupture of a STA pseudoaneurysm is a previously unreported and serious complication that must be quickly recognized in order to control hemorrhage that may have life …

Activity-Dependent Modulation Of Synapse-Regulating Genes In Astrocytes, Isabella Farhy-Tselnicker, Matthew M Boisvert, Hanqing Liu, Cari Dowling, Galina A Erikson, Elena Blanco-Suarez, Chen Farhy, Maxim N Shokhirev, Joseph R Ecker, Nicola J Allen

Department of Neurosurgery Faculty Papers

Astrocytes regulate the formation and function of neuronal synapses via multiple signals, however, what controls regional and temporal expression of these signals during development is unknown. We determined the expression profile of astrocyte synapse-regulating genes in the developing mouse visual cortex, identifying astrocyte signals that show differential temporal and layer-enriched expression. These patterns are not intrinsic to astrocytes, but regulated by visually-evoked neuronal activity, as they are absent in mice lacking glutamate release from thalamocortical terminals. Consequently, synapses remain immature. Expression of synapse-regulating genes and synaptic development are also altered when astrocyte signaling is blunted by diminishing calcium release from …

Redo Surgical Mitral Valve Replacement Versus Transcatheter Mitral Valve In Valve From The National Inpatient Sample, Muhammad Zia Khan, Salman Zahid, Muhammad U Khan, Asim Kichloo, Shakeel Jamal, Abdul Mannan Khan Minhas, Waqas Ullah, Yasar Sattar, Sudarshan Balla

Department of Medicine Faculty Papers

Background

Redo mitral valve surgery is required in up to one-third of patients and is associated with significant mortality and morbidity. Valve-in-valve transcatheter mitral valve replacement (ViV TMVR) is less invasive and could be considered in those at prohibitive surgical risk. Studies on comparative outcomes of ViV TMVR and redo surgical mitral valve replacement (SMVR) remain limited. Our study aimed to investigate the real-world outcomes of the above procedures using the National Inpatient Sample database.

Methods and Results

We analyzed National Inpatient Sample data using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD‐10‐CM) from September 2015 …

Outcomes Of Implant Removal And Capsulectomy For Breast Implant Illness In 248 Patients., Jacob Y. Katsnelson, Joseph R. Spaniol, Joshua C. Buinewicz, Frederick V. Ramsey, Brian R. Buinewicz

Abington Jefferson Health Papers

Background: Breast implant illness (BII) is a term popularized by social media to describe systemic symptoms that patients ascribe to their breast implants. Though the concept of implants as an underlying cause for a systemic illness remains controversial, few studies have delineated the implant characteristics, capsular histology, and outcomes of patients who undergo explantation for BII.

Methods: We retrospectively reviewed the demographics, presenting symptoms, outcomes, capsular histology, and culture results of all women who presented to the senior author with symptoms attributed to BII and underwent breast implant removal with capsulectomy from August 2016 to February 2020. Chi-square and logistic …

Mechanisms Of Reducing Joint Stiffness By Blocking Collagen Fibrillogenesis In A Rabbit Model Of Posttraumatic Arthrofibrosis, Andrzej Steplewski, Jolanta Fertala, Ryan Tomlinson, Mark L. Wang, Allison Donahue, William V Arnold, Michael Rivlin, Pedro K Beredjiklian, Joseph A Abboud, Surena Namdari, Andrzej Fertala

Department of Orthopaedic Surgery Faculty Papers

Posttraumatic fibrotic scarring is a significant medical problem that alters the proper functioning of injured tissues. Current methods to reduce posttraumatic fibrosis rely on antiinflammatory and anti-proliferative agents with broad intracellular targets. As a result, their use is not fully effective and may cause unwanted side effects. Our group previously demonstrated that extracellular collagen fibrillogenesis is a valid and specific target to reduce collagen- rich scar buildup. Our previous studies showed that a rationally designed antibody that binds the C-terminal telopeptide of the α2(I) chain involved in the aggregation of collagen molecules limits fibril assembly in vitro and reduces scar …

Long-Term Treatment With Senolytic Drugs Dasatinib And Quercetin Ameliorates Age-Dependent Intervertebral Disc Degeneration In Mice, Emanuel J Novais, Victoria Tran, Shira N Johnston, Kayla R Darris, Alex J Roupas, Garrett A Sessions, Irving Shapiro, Brian O Diekman, Makarand V Risbud

Department of Orthopaedic Surgery Faculty Papers

Intervertebral disc degeneration is highly prevalent within the elderly population and is a leading cause of chronic back pain and disability. Due to the link between disc degeneration and senescence, we explored the ability of the Dasatinib and Quercetin drug combination (D + Q) to prevent an age-dependent progression of disc degeneration in mice. We treated C57BL/6 mice beginning at 6, 14, and 18 months of age, and analyzed them at 23 months of age. Interestingly, 6- and 14-month D + Q cohorts show lower incidences of degeneration, and the treatment results in a significant decrease in senescence markers p16INK4a, …

Hip Replacement For Femur Neck Fracture In The Elderly, Effects Of Delayed Surgical Intervention On Morbidity And Mortality, A Retrospective Comparative Study, Ahmed Habib, Shah Fahad, Muhammad Atif, Javeria Saeed, Pervaiz Hashmi, Mujahid Jamil Khattak

Section of Orthopaedic Surgery

Hip fracture is one of the most common injuries in the elderly population. Delay in operating on patients with hip fracture is associated with greater mortality and morbidity. A retrospective review of medical charts of patients who underwent primary total hip replacement (THR) for neck of femur fractures at our tertiary care level 1 trauma was carried out. Data was collected from the patients' charts and analysed for 30-day mortality and morbidity. A total of 96 patients were included in the study. Out of the 36 patients in the delayed THR group, mortality within 30 days was observed in 4 …

Spontaneous Closure Of Full Thickness Macular Hole In The Presence Of An Epiretinal Membrane In A Vitrectomised Eye: A Case Report, Rehman Siddiqui, Muhammad Umar Fawad, Nida Ahsan

Section of Ophthalmology

We report the case of a spontaneous closure of full thickness macular hole (FTMH) in the presence of an epiretinal membrane (ERM) in a previously vitrectomised eye. The patient had undergone vitrectomy for rhegmatogenous retinal detachment and developed an ERM two weeks after the surgery, which converted into a FTMH after one week. Eight months after the vitrectomy, spontaneous closure of FTMH was observed with an improvement in best-corrected visual acuity (BCVA) from 20/200 to 20/40. The patient was followed up for four years, and the FTMH remained closed. Spontaneous closure of FTMH is possible even in the presence of …

Reconsidering Perioperative Antibiotic Use In Elective Laparoscopic Cholecystectomy, Kayla B. Briggs, James Fraser, Wendy Jo Svetanoff, Charles L. Snyder, Pablo Aguayo, David Juang, Rebecca M. Rentea, Jason D. Fraser, Shawn D. St. Peter Md, Tolulope A. Oyetunji

Posters

Introduction: Prophylactic preoperative antibiotics (PPA) are questionable in cases with a low rate of surgical site infection (SSI). We report institutional PPA usage and SSI rates after elective laparoscopic cholecystectomy in a children’s hospital. Methods: Children <18 years old who underwent outpatient laparoscopic cholecystectomy between 7/2010 and 8/2020 were included. SSI was defined as clinical signs of infection, requiring antibiotics, within 30 days of surgery. Results: 502 patients met inclusion criteria; 50% were pre-operatively diagnosed with symptomatic cholelithiasis, 47% biliary dyskinesia, 2% hyperkinetic gallbladder, and 1% gallbladder polyp(s). The majority were female (78%) and Caucasian (80%). 60% (n=301) of patients received PPA while 40% (n=201) did not; 1.3% (n=4) of those who received PPA developed SSI compared to 5.5% (n=11) of those who did not (p=0.01). Though PPA use was associated with an 84% reduction in risk of SSI on multivariate analysis (p=0.01), all SSIs were superficial. One child required readmission for intravenous antibiotics while the remainder were treated with outpatient antibiotics. Gender, age, BMI, ethnicity, and preoperative diagnosis did not influence the likelihood of receiving PPA (Table 1). Conclusion: Given the relatively low morbidity of the superficial SSI, conservative use of PPA should be carefully considered in outpatient laparoscopic cholecystectomy to avoid contributing to antibiotic-related complications.

Indications For A "Surgery First" Approach For The Treatment Of Lower Extremity Arterial Disease, Mohineesh Kumar, Steven D. Rimar, Graham W. Long, Diane M. Studzinski, O W. Brown

Conference Presentation Abstracts

No abstract provided.

Umbilical Access In Laparoscopic Surgery In Infants Less Than 3 Months: Single Institution Retrospective Review, James Fraser, Kayla B. Briggs, Wendy Jo Svetanoff, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Shawn D. St Peter, Tolulope A. Oyetunji

Presentations

PURPOSE: Umbilical access in laparoscopic surgery has been cited as a potential factor for increased complications in low birth weight infants and those less than three months old. Previous series noted a self-reported complication rate of 10.6% among 329 pediatric surgeons via anonymous survey, citing carbon dioxide (CO2) embolism as the most common complication. We report four-year outcomes with blunt transumbilical laparoscopic access to examine the safety of this technique. METHODS: Following IRB approval, a retrospective database of patients less than three months of age who underwent laparoscopic pyloromyotomy or inguinal hernia repair from 2016-2019 at a tertiary care academic …

Endoleaks: Current Concepts And Treatments - A Narrative Review, Zia Ur Rehman

Department of Surgery Docs

Endoleaks are the most common complications following endovascular aneurysm repair. Depending upon their origin, there are five types of endoleaks, types I-V, which can also be classified as direct and indirect endoleaks. Direct endoleaks (type I and III) have higher risk of aneurysm rupture due to rapid sac expansion, and require immediate correction. Indirect endoleaks ( type II, IV and V) have a relatively benign course compared to direct endoleaks. Most of them resolve with time and very few need interventions upon sac enlargement. Type V endotension is a special situation where there is sac enlargement despite no demonstrable endoleak. …

Management And Outcomes For Long-Segment Hirschsprung Disease: A Systematic Review From The Apsa Outcomes And Evidence Based Practice Committee, Akemi L Kawaguchi, Yigit S Guner, Stig Sømme, Alexandria C Quesenberry, L Grier Arthur, Juan E Sola, Cynthia D Downard, Rebecca M Rentea, Patricia A Valusek, Caitlin A Smith, Mark B Slidell, Robert L Ricca, Roshni Dasgupta, Elizabeth Renaud, Doug Miniati, Jarod Mcateer, Alana L Beres, Julia Grabowski, Shawn D St Peter, Ankush Gosain, American Pediatric Surgical Association Outcomes And Evidence-Based Practice (Oebp) Committee

Faculty, Staff and Student Publications

OBJECTIVE: Long-Segment Hirschsprung Disease (LSHD) differs clinically from short-segment disease. This review article critically appraises current literature on the definition, management, outcomes, and novel therapies for patients with LSHD.

METHODS: Four questions regarding the definition, management, and outcomes of patients with LSHD were generated. English-language articles published between 1990 and 2018 were compiled by searching PubMed, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar. A qualitative synthesis was performed.

RESULTS: 66 manuscripts were included in this systematic review. Standardized nomenclature and preoperative evaluation for LSHD are recommended. Insufficient evidence exists to recommend a single method …

Extracorporeal Membrane Oxygenation Rescue For Severe Aspiration Pneumonitis In Two Patients After Roux-En-Y Gastric Bypass Procedure, Melissa M Felinski, Daniyal Abbas, Peter A Walker, John A Primomo, Tanyaradzwa M Kajese, Biswajit Kar, Igor D Gregoric, Igor Banjac, Lisa Janowiak, Sriram Nathan, Rahat Hussain, Sheilendra S Mehta, Kulvinder S Bajwa, Shinil K Shah, Bindu Akkanti

Faculty, Staff and Student Publications

Roux-en-y gastric bypass (RYGB) is one of the most common weight loss surgical procedures performed in the United States. Early post-operative small bowel obstruction is a rare but potentially morbid, complication of RYGB. We report two patients who underwent RYGB and required subsequent treatment for a post-operative small bowel obstruction. Their post-operative course was complicated by severe aspiration pneumonitis leading to hypoxemic respiratory failure requiring rescue with femoral veno-venous extracorporeal membrane oxygenation (V-V ECMO). Both patients were successfully extubated, weaned off V-V ECMO support, and discharged to home. These cases highlight the potential role of V-V ECMO for patients who …

First-In-Human Segmental Esophageal Reconstruction Using A Bioengineered Mesenchymal Stromal Cell-Seeded Implant, Johnathon M Aho, Saverio La Francesca, Scott D Olson, Fabio Triolo, Jeff Bouchard, Laura Mondano, Sumati Sundaram, Christina Roffidal, Charles S Cox, Louis M Wong Kee Song, Sameh M Said, William Fodor, Dennis A Wigle

Faculty, Staff and Student Publications

INTRODUCTION: Resection and reconstruction of the esophagus remains fraught with morbidity and mortality. Recently, data from a porcine reconstruction model revealed that segmental esophageal reconstruction using an autologous mesenchymal stromal cell-seeded polyurethane graft (Cellspan esophageal implant [CEI]) can facilitate esophageal regrowth and regeneration. To this end, a patient requiring a full circumferential esophageal segmental reconstruction after a complex multiorgan tumor resection was approved for an investigational treatment under the Food and Drug Administration Expanded Access Use (Investigational New Drug 17402).

METHODS: Autologous adipose-derived mesenchymal stromal cells (Ad-MSCs) were isolated from the Emergency Investigational New Drug patient approximately 4 weeks before …

Multicenter Outcomes After Hip Arthroscopy: Comparative Analysis Of Patients Undergoing Concomitant Labral Repair And Ligamentum Teres Debridement Versus Isolated Labral Repair, Blake Bodendorfer, Thomas Alter, Steven Defroda, Andrew Wolff, Dominic Carreira, John Cristoforetti, Dean Matsuda, John Salvo, Benjamin Kivlan, Shane Nho

Department of Orthopaedic Surgery Faculty Papers

Background: Increased attention has been directed toward the ligamentum teres (LT) and its association with acetabular coverage, labral pathology, and hip microinstability; however, few studies have evaluated whether LT pathology influences the rate of clinically significant outcome improvement after hip arthroscopy. Purpose: To determine if patients with femoroacetabular impingement syndrome (FAIS) undergoing labral repair and concomitant LT debridement achieve outcomes similar to patients without LT pathology undergoing labral repair. Study Design: Cohort study; Level of evidence, 3. Methods: We conducted a retrospective review of a prospectively maintained multicenter database for hip arthroscopy. Included were patients with FAIS who underwent primary …

Expandable Intravertebral Implants: A Narrative Review On The Concept, Biomechanics, And Outcomes In Traumatology., Diogo L Moura, Josue P Gabriel

Surgery Articles

Expandable intravertebral implants are self-expanding devices applied percutaneously by the posterior transpedicular approach. These devices introduce the concept of anatomical restoration of vertebral body endplates and direct anatomical reduction performed from the interior of the vertebral body with a compression fracture. This paper aims to provide a narrative review on the concept, indications, biomechanical characteristics, as well as functional and radiographic outcomes of the main expandable intravertebral implants currently available, in terms of their application to thoracolumbar spine traumatology. To this end, we performed a search in July 2021 on the MEDLINE/PubMed platform with the words "expandable intravertebral implant", "armed …

A Rare Entity: Case Report Of Recurrent Hypertrophic Pyloric Stenosis, Astrid A. Gleaton, Kartikey Pandya

Journal of Maine Medical Center

Introduction: Hypertrophic pyloric stenosis (HPS) is well known in pediatric surgery and has good outcomes after pyloromyotomy.1 Emesis in the immediate postoperative period occurs in 40% of patients with HPS and is attributed to gastroparesis from prolonged gastric distention.2 Emesis presenting weeks to months after pyloromyotomy prompts an evaluation that often yields pathology unrelated to HPS. Because recurrent HPS is rare, making this diagnosis highlighted the importance of practicing broad differential diagnoses, ruling out most common causes, and including obscure etiologies.

Clinical Findings: A 3-week-old male born after full-term gestation with a history of HPS underwent an uncomplicated laparoscopic pyloromyotomy. …

Implementing A Clinical Practice Guideline For Pediatric Appendicitis Safely Reduced Health Care Use And Improved Antimicrobial Stewardship, Jack Vernamonti, Robin Cotter, Jennifer Jubulis, Kartikey Pandya

Journal of Maine Medical Center

Introduction: Appendicitis is the most common emergency surgical disease in children. Those with perforated appendicitis have a more complicated and varied course. Through a clinical practice guideline (CPG), we sought to reduce computed tomography scans, laboratory draws, and exposure to broad-spectrum antibiotics without adversely affecting length of stay, hospital readmission, or repeat antibiotic administration.

Methods: Electronic records were retrospectively reviewed before and after CPG implementation, and data was collected in REDCap.

Results were reported as mean or percent incidence, and statistical analysis was done using a Student’s t-test, Mann-Whitney U test, or Pearson’s χ2 with P < .05 considered significant. Results: One hundred patients with a perforated appendix (50 before and 50 after CPG implementation) were included in our analysis. Length of stay (4.98 vs 4.46 days; P = .25), hospital readmission rate (10% vs 14%; P = .54), and additional antibiotic administration (2% vs 4%; P = .56) did not change. We observed no difference in the Pediatric Appendicitis Score (9 vs 9; P = .48) and a trending increase in evaluation at an outside hospital (56% vs 74%; P = .06). Rates of computed tomography scans did not differ overall (50% vs 40%; P = .31), but showed a decreasing trend at our institution (30% vs 12%; P = .06). We also found fewer post-operative laboratory studies (90% vs 38%; P < .01) and patients who received broad-spectrum intravenous antibiotics (92% vs 18%; P < .01).

Discussion: Through implementing the …

Innate Immune Activation By Checkpoint Inhibition In Human Patient-Derived Lung Cancer Tissues, Teresa W. M. Fan, Richard M. Higashi, Huan Song, Saeed Daneshmandi, Angela L. Mahan, Matthew S. Purdom, Therese J. Bocklage, Thomas A. Pittman, Daheng He, Chi Wang, Andrew N. Lane

Center for Environmental and Systems Biochemistry Faculty Publications

Although Pembrolizumab-based immunotherapy has significantly improved lung cancer patient survival, many patients show variable efficacy and resistance development. A better understanding of the drug’s action is needed to improve patient outcomes. Functional heterogeneity of the tumor microenvironment (TME) is crucial to modulating drug resistance; understanding of individual patients’ TME that impacts drug response is hampered by lack of appropriate models. Lung organotypic tissue slice cultures (OTC) with patients’ native TME procured from primary and brain-metastasized (BM) non-small cell lung cancer (NSCLC) patients were treated with Pembrolizumab and/or beta-glucan (WGP, an innate immune activator). Metabolic tracing with ¹³C₆-Glc/ …