Surgery Commons^™

National Trends In Pectus Excavatum Repair: Patient Age, Facility Volume, And Outcomes, Shale J. Mack, Brian M. Till, Charles Huang, Darshak Thosani, Uzma Rahman, Tyler Grenda, Nathaniel R. Evans Iii, Olugbenga Okusanya

Department of Surgery Faculty Papers

Background: There is limited data on the adult repair of pectus excavatum (PE). Existing literature is largely limited to single institution experiences and suggests that adults undergoing modified Nuss repair may have worse outcomes than pediatric and adolescent patients. Using a representative national database, this analysis is the first to describe trends in demographics, outcomes, charges, and facility volume for adults undergoing modified Nuss procedure.

Methods: Because of a coding change associated with ICD-10, a retrospective cohort analysis using the National Inpatient Sample (NIS) for patients 12 or older undergoing modified Nuss repair between 2016-2018 was possible. Pearson's χ2 and …

A Standardized Diagnostic Pathway For Suspected Appendicitis In Children Reduces Unnecessary Imaging, Roshan J. D'Cruz, Allison F. Linden, Courtney L. Devon, Jillian Savage, Arezoo Zomorrodi, Kirk W. Reichard, Arabinda Choudhary, Loren Berman

Department of Surgery Faculty Papers

Introduction:

Ultrasound (US) for the diagnosis of acute appendicitis is often nondiagnostic, and additional imaging is required. A standardized approach may reduce unnecessary imaging.

Methods:

We retrospectively analyzed all patients who had imaging for appendicitis in our emergency department in 2017 and evaluated patient characteristics associated with nondiagnostic US. Using these results, we developed a pediatric appendicitis score (PAS)-based imaging pathway and compared imaging trends prepathway and postpathway implementation.

Results:

A total of 971 patients received imaging for suspected appendicitis prepathway in 2017. Female sex, obesity, and low/intermediate PAS were significantly associated with nondiagnostic US, but not magnetic resonance imaging …

Detection Of Lung Carcinoma Arising From Ground Glass Opacities (Ggo) After 5 Years - A Retrospective Review, Elissa Herskovitz, Charalamobos Solomides, Julie Barta, Nathaniel R. Evans Iii, Gregory C. Kane

Department of Surgery Faculty Papers

Pure ground glass opacities (GGO) may indicate pre-invasive subtypes of lung carcinoma. These neoplasms typically demonstrate indolent patterns of growth; Fleischner Society guidelines recommend up to five years of serial imaging. Our aim was to determine the frequency of diagnosed carcinoma arising from GGO detected beyond 5 years of surveillance. We reviewed pathologic diagnoses of lung carcinoma (n = 442) between 2016 and 2018 of a tertiary academic hospital and National Cancer Institute-designated cancer center to identify all cancers that arose from ground glass opacities detected on CT scan. Of the 442 cases of lung carcinoma, 32 (7%) were found …

Rare Occurrence Of Pseudomyxoma Peritonei (Pmp) Syndrome Arising From A Malignant Transformed Ovarian Primary Mature Cystic Teratoma Treated By Cytoreductive Surgery And Hipec: A Case Report, Francesca Ponzini, Luke Kowal, Mariam Ghafoor, Allison F Goldberg, Joanna Chan, Ryan Lamm, Shawnna Cannaday, Scott D. Richard, Avinoam Nevler, Harish Lavu, Wilbur Bowne, Norman G Rosenblum

Department of Surgery Faculty Papers

Background: Pseudomyxoma peritonei (PMP) syndrome is a disease process that typically occurs from ruptured appendiceal mucocele neoplasms. PMP syndrome arising from malignant transformation of an ovarian primary mature cystic teratoma (MCT) is a pathogenesis rarely encountered.

Case presentation: Herein, we report a 28-year-old patient evaluated and treated for a right ovarian mass and large volume symptomatic abdominopelvic mucinous ascites. Molecular profiling and genetic analysis revealed mutations in ATM, GNAS, and KRAS proteins while IHC demonstrated gastrointestinal-specific staining for CK20, CDX2, CK7, and SATB2. Peritoneal cytology showed paucicellular mucin. Diffuse peritoneal adenomucinosis (DPAM) variant of PMP arising from a ruptured ovarian …

Acute Occlusion Of Aortic Endovascular Aneurysm Repair Stent Graft With Bilateral Limb Ischemia, Min Choi, Dawn Salvatore, Paul J Dimuzio, Michael Nooromid, Babak Abai

Department of Surgery Faculty Papers

Endovascular aneurysm repair has dramatically changed the management of abdominal aortic aneurysms as an alternative to open repair. However, complications can occur, including stent graft migration, kinking, and occlusion, leading to compromise of the excluded aneurysm walls and acute limb ischemia. In the present report, we have described a case of migration and kinking of an abdominal aortic stent graft in the main body that led to occlusion of the abdominal aorta and bilateral acute limb ischemia. The patient required emergent explantation of the stent graft and open repair of the abdominal aneurysm with a rifampin-soaked Dacron graft, which achieved …

Burnout: Exploring The Differences Between U.S. And International Medical Graduates., Joan E St Onge, Heidi Allespach, Yvonne Diaz, Alexandria Poitier, Leonardo Tamariz, Charles Paidas, Ana Palacio

Department of Surgery Faculty Papers

Background: International medical graduates (IMGs) have less burnout than U. S. medical school graduates (USMGs) during residency training. This study evaluates possible correlates of differences in burnout rates between USMGs and IMGs.

Methods: We surveyed 375 first-year residents at orientation in June/July 2017. We assessed burnout using the Copenhagen Burnout Inventory (CBI) and used validated scales to measure stress, quality of life (QoL), mastery, and spirituality. We collected data on gender, place of graduation, language fluency, and specialty. We compared CBI scores between USMGs and IMGs, performed a multivariate linear regression analysis of relationships between covariates and CBI subscales, and …

Giant Abdominal Aortic Aneurysms, Joshua I Ng, Tuong Nguyen, Anand Tarpara, Dawn Salvatore, Paul J Dimuzio, Babak Abai

Department of Surgery Faculty Papers

Giant abdominal aortic aneurysms (AAAs) are defined as AAAs >10 to 13 cm in the maximum transverse diameter. We have described a case of a patient who had presented for open repair of an 18-cm AAA and a review of reported cases of giant AAAs >10 cm in the maximum transverse diameter. Forty cases were compiled. The average maximum AAA diameter was 14.5 ± 4.1 cm. The AAA was ruptured on presentation in 12 patients (30%). Of the 40 cases, 34 (85%) were repaired with open surgery. The reported mortality was 15%. Despite the case complexity, five endovascular repairs were …

A Systematic Review Of Health State Utility Values In The Plastic Surgery Literature, Adrienne Christopher, Martin P Morris, Viren Patel, Kevin Klifto, John P Fischer

Department of Surgery Faculty Papers

Cost-utility analyses assess health gains acquired by interventions by incorporating weighted health state utility values (HSUVs). HSUVs are important in plastic and reconstructive surgery (PRS) because they include qualitative metrics when comparing operative techniques or interventions. We systematically reviewed the literature to identify the extent and quality of existing original utilities research within PRS.

Methods: A systematic review of articles with original PRS utility data was conducted in accordance with the Preferred Reporting Items for a Systematic Review and Meta-Analysis guidelines. Subspecialty, survey sample size, and respondent characteristics were extracted. For each HSUV, the utility measure [direct (standard gamble, time …

Postoperative Outcomes In Oesophagectomy With Trainee Involvement., Oesophago-Gastric Anastomosis Study Group (Ogaa) On Behalf Of The West Midlands Research Collaborative

Department of Surgery Faculty Papers

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting.

METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed …

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 …

Tumor Metabolism And Associated Serum Metabolites Define Prognostic Subtypes Of Asian Hepatocellular Carcinoma., Yotsawat Pomyen, Anuradha Budhu, Jittiporn Chaisaingmongkol, Marshonna Forgues, Hien Dang, Mathuros Ruchirawat, Chulabhorn Mahidol, Xin Wei Wang

Department of Surgery Faculty Papers

Treatment effectiveness in hepatocellular carcinoma (HCC) depends on early detection and precision-medicine-based patient stratification for targeted therapies. However, the lack of robust biomarkers, particularly a non-invasive diagnostic tool, precludes significant improvement of clinical outcomes for HCC patients. Serum metabolites are one of the best non-invasive means for determining patient prognosis, as they are stable end-products of biochemical processes in human body. In this study, we aimed to identify prognostic serum metabolites in HCC. To determine serum metabolites that were relevant and representative of the tissue status, we performed a two-step correlation analysis to first determine associations between metabolic genes and …

Narrative Review Of Socioeconomic And Racial Disparities In The Treatment Of Early Stage Lung Cancer, Nathaniel R. Evans Iii, Tyler Grenda, Nkosi H. Alvarez, Olugbenga Okusanya

Department of Surgery Faculty Papers

Background: To review and discuss the current literature regarding socio-economic and racial disparities in the treatment of early-stage non-small cell lung cancer (NSCLC). Background: Lung cancer is the most lethal solid organ malignancy in the United States, with the second-highest incidence of new malignances for both men and women. While overall survival for lung cancer is improving, significant socioeconomic and racial disparities in outcomes for lung cancer persist. Methods: Narrative review of peer reviewed literature synthesizing findings retrieved from searches of computerized databases, primary article reference lists, authoritative texts and expert options. Results: The current incidence of lung cancer appears …

Forward-Thinking Design Solutions For Mechanical Circulatory Support: Multifunctional Hybrid Continuous-Flow Ventricular Assist Device Technology., Amy Throckmorton, Ellen Garven, Matthew Hirschhorn, Steven Day, Randy Stevens, Vakhtang Tchantchaleishvili

Department of Surgery Faculty Papers

No abstract provided.

Development Of Malignancies And Their Outcomes In Patients Supported On Continuous-Flow Left Ventricular Assist Devices-A Systematic Review., Elizabeth J. Maynes, Jonathan S. Gordon, Matthew P. Weber, Thomas J. O'Malley, Tyler M. Bauer, Chelsey T. Wood, Rohinton J. Morris, Louis E. Samuels, John W. Entwistle, H. Todd Massey, Vakhtang Tchantchaleishvili

Department of Surgery Faculty Papers

Background: With increased use of continuous-flow left ventricular assist devices (CF-LVAD), development of malignant tumors in this population is not uncommon. We sought to evaluate malignancies in CF-LVAD patients and evaluate the outcomes of treatment strategies.

Methods: Overall, 18 articles consisting of 28 patients were identified who developed malignancies after CF-LVAD placement. Patient-level data were extracted for systematic review.

Results: Median patient age was 60 years [59-67] and 85.7% (24/28) were male. CF-LVAD was placed as bridge-to-transplant (BTT) in 60.9% (14/23) of patients. The three most common malignancy types were GI in 35.7% (10/28) of patients, lung in 21.4% (6/28) …

Impact Of Mechanical Circulatory Support On Donor Heart Allocation: Past, Present, And Future., Robert T Tatum, H Todd Massey, Vakhtang Tchantchaleishvili

Department of Surgery Faculty Papers

The United Network for Organ Sharing (UNOS) recently revised its heart allocation policy to address numerous shortcomings of the previous system. Implemented in 2018, the changes sought to reduce waiting list mortality, clearly define urgency status based on objective physiologic variables, decrease exemption requests, and introduce geographic modifications to ensure organ distribution favors the highest urgency candidates. In large part, UNOS policy revisions were driven by the growing use of continuous flow left ventricular assist devices (CF-LVADs) and the relevant device complications that led to an unacceptably high number of status exemptions. The new 6-tiered system assigns a comparatively lower …

Minimally Invasive Transhiatal Esophagectomy, Tyler Grenda, Md, Jules Lin, Andrew C. Chang, Rishindra M. Reddy

Department of Surgery Faculty Papers

While traditionally performed through an open approach, the role of minimally invasive technologies has evolved in its application to esophageal resection. Esophagectomy is associated with significant morbidity, which has led to interest in developing minimally invasive esophagectomy (e.g., laparoscopic/thoracoscopic approaches) to address this issue. As a result, the role of minimally invasive approaches for esophageal resection has evolved, with a growing body of literature describing these techniques. Minimally invasive approaches have been applied to transhiatal esophagectomy, with application of both laparoscopic and robotic-assisted techniques. Although minimally invasive esophagectomy approaches are well-described in the literature for esophageal malignancies, the efficacy of …

Declining Intensive Care Unit Mortality Of Covid-19: A Multi-Center Study, Sohaib Roomi, Syed Omar Shah, Waqas Ullah, Shan Abedin, Karyn L. Butler, Chiers, Kelly, Benjamin A. Kohl, Erika J. Yoo, Matthew Vibbert, Jack Jallo

Department of Surgery Faculty Papers

Background: Coronavirus disease 2019 (COVID-19) mortality has waned significantly over time; however, factors contributing towards this reduction largely remain unidentified. The purpose of this study was to evaluate the trend in mortality at our large tertiary academic health system and factors contributing to this trend. Methods: This is a retrospective cohort study of intensive care unit (ICU) patients diagnosed with COVID-19 between March and August 2020 admitted across 14 hospitals in the Philadelphia area. Collected data included demographics, comorbidities, admission risk of mortality score, laboratory values, medical interventions, survival outcomes, hospital and ICU length of stay (LOS) and discharge disposition. …

The Use Of Integra Dermal Regeneration Templates And Cortical Bone Fenestrations Over Exposed Tibia., Liam P Hughes, Steven Forman, James C Krieg, William Hughes

Department of Surgery Faculty Papers

We present the case of an 86-year-old woman who suffered full-thickness soft tissue loss secondary to degloving injury to the lower left limb, resulting in an exposed tibia. This patient underwent drilling to create artificial fenestrations in the cortical bone followed by placement of Integra dermal regeneration template. The technique of drilling fenestrations to expose underlying vasculature of cortical bone has not previously been described in its relationship with Integra dermal regeneration templates in large degloving injuries of the lower limb. This technique enabled us to perform earlier skin grafting and ultimately resulted in complete and timely wound closure. We …

International Evidence-Based Consensus Diagnostic And Treatment Guidelines For Unicentric Castleman Disease., Frits Van Rhee, Eric Oksenhendler, Gordan Srkalovic, Peter Voorhees, Megan Lim, Angela Dispenzieri, Makoto Ide, Sophia Parente, Stephen Schey, Matthew Streetly, Raymond Wong, David Wu, Ivan Maillard, Joshua Brandstadter, Nikhil Munshi, Wilbur Bowne, Kojo S Elenitoba-Johnson, Alexander Fössa, Mary Jo Lechowicz, Shanmuganathan Chandrakasan, Sheila K Pierson, Amy Greenway, Sunita Nasta, Kazuyuki Yoshizaki, Razelle Kurzrock, Thomas S Uldrick, Corey Casper, Amy Chadburn, David C Fajgenbaum

Department of Surgery Faculty Papers

Castleman disease (CD) includes a group of rare and heterogeneous disorders with characteristic lymph node histopathological abnormalities. CD can occur in a single lymph node station, which is referred to as unicentric CD (UCD). CD can also involve multicentric lymphadenopathy and inflammatory symptoms (multicentric CD [MCD]). MCD includes human herpesvirus-8 (HHV-8)-associated MCD, POEMS-associated MCD, and HHV-8-/idiopathic MCD (iMCD). The first-ever diagnostic and treatment guidelines were recently developed for iMCD by an international expert consortium convened by the Castleman Disease Collaborative Network (CDCN). The focus of this report is to establish similar guidelines for the management of UCD. To this purpose, …

Commentary: Coronavirus, Cysts, And Catheters, Olugbenga Okusanya, Ibrahim Sultan

Department of Surgery Faculty Papers

No abstract provided.

Nipple Sparing Mastectomy: A Review Of Outcomes At A 1 Single Institution, Steven Woodward, Md, Alliric Willis, Melissa Lazar, Adam C. Berger, Theodore Tsangaris

Department of Surgery Faculty Papers

Introduction

Nipple sparing mastectomy (NSM) offers patients who are not candidates for breast conserving treatment an aesthetically pleasing alternative to traditional mastectomy. Some studies have demonstrated its oncologic safety while others have demonstrated residual occult tumor cells at the nipple areolar complex (NAC). These data prompt further review of oncologic outcomes after NSM.

Methods

A single institution retrospective chart review of all NSMs performed by 4 breast surgeons at Thomas Jefferson University Hospital over a span of 2012-2019. In this cohort we review the reconstruction performed, axillary lymph node status, surgical margins, final pathology, loss of the NAC, recurrence rates, …

Orthopedic Principles To Facilitate Enhanced Recovery After Cardiac Surgery, Marc W Gerdisch, Keith B Allen, Yoshifumi Naka, Mark R Bonnell, Kevin P Landolfo, John Grehan, Kendra J Grubb, David J Cohen, T. Sloane Guy, Nirav C Patel, Vinod H Thourani

Department of Surgery Faculty Papers

Enhanced recovery after surgery (ERAS) protocols recognize early postoperative mobilization as a driver of faster postoperative recovery, return to normal activities, and improved long-term patient outcomes. For patients undergoing open cardiac surgery, an opportunity for facilitating earlier mobilization and a return to normal activity lies in the use of improved techniques to stabilize the sternal osteotomy. By following the key orthopedic principles of approximation, compression, and rigid fixation, a more nuanced approach to sternal precaution protocols is possible, which may enable earlier patient mobilization, physical rehabilitation, and recovery.

Hepatocellular Carcinoma-The Influence Of Immunoanatomy And The Role Of Immunotherapy, Keyur Patel, Ryan Lamm, Peter Altshuler, Hien Dang, Ashesh P. Shah, Md

Department of Surgery Faculty Papers

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related morbidity and mortality worldwide. Most patients are diagnosed with advanced disease, limiting their options for treatment. While current treatments are adequate for lower staged disease, available systemic treatments are limited, with marginal benefit at best. Chimeric antigen receptor (CAR) T cell therapy, effective in treating liquid tumors such as B-cell lymphoma, presents a potentially promising treatment option for advanced HCC. However, new challenges specific to solid tumors, such as tumor immunoanatomy or the immune cell presence and position anatomically and the tumor microenvironment, need to be defined and overcome. Immunotherapy currently …

A Multi-Institutional Analysis Of Sternoclavicular Joint Coverage Following Osteomyelitis, Sammy Othman, Omar Elfanagely, Saïd C Azoury, Geoffrey M Kozak, Jessica Cunning, Arturo J Rios-Diaz, Prashanth Palvannan, Patrick J. Greaney, Matthew Jenkins, Doraid Jarrar, Stephen J Kovach, John P Fischer

Department of Surgery Faculty Papers

BACKGROUND: Sternoclavicular joint (SCJ) osteomyelitis is a rare pathology requiring urgent intervention. Several operative approaches have been described with conflicting reports. Here, we present a multi-institutional study utilizing multiple surgical pathways for SCJ reconstruction.

METHODS: A multi-institutional retrospective cohort study was conducted to identify patients who underwent surgical repair for sternoclavicular osteomyelitis between 2008 and 2019. Patients were stratified according to reconstruction approach: single-stage reconstruction with advancement flap and delayed-reconstruction with flap following initial debridement. Demographics, operative approach, type of reconstruction, and postoperative outcomes were analyzed.

RESULTS: Thirty-two patients were identified. Mean patient age was 56.2±13.8 years and 68.8% were …

Hepatic Stellate Cells And Hepatocarcinogenesis, Anna E Barry, Rajkumar Baldeosingh, Ryan Lamm, Keyur Patel, Kai Zhang, Dana A Dominguez, Kayla J Kirton, Ashesh P. Shah, Hien Dang

Department of Surgery Faculty Papers

Hepatic stellate cells (HSCs) are a significant component of the hepatocellular carcinoma (HCC) tumor microenvironment (TME). Activated HSCs transform into myofibroblast-like cells to promote fibrosis in response to liver injury or chronic inflammation, leading to cirrhosis and HCC. The hepatic TME is comprised of cellular components, including activated HSCs, tumor-associated macrophages, endothelial cells, immune cells, and non-cellular components, such as growth factors, proteolytic enzymes and their inhibitors, and other extracellular matrix (ECM) proteins. Interactions between HCC cells and their microenvironment have become topics under active investigation. These interactions within the hepatic TME have the potential to drive carcinogenesis and create …

Characterization Of Initial North American Pediatric Surgical Response To The Covid-19 Pandemic, Martha-Conley E Ingram, Mehul V Raval, Christopher Newton, Monica E Lopez, Loren Berman, Md

Department of Surgery Faculty Papers

INTRODUCTION: The impact of COVID-19 pandemic on pediatric surgical care systems is unknown. We present an initial evaluation of self-reported pediatric surgical policy changes from hospitals across North America.

METHODS: On March 30, 2020, an online open access, data gathering spreadsheet was made available to pediatric surgeons through the American Pediatric Surgical Association (APSA) website, which captured information surrounding COVID-19 related policy changes. Responses from the first month of the pandemic were collected. Open-ended responses were evaluated and categorized into themes and descriptive statistics were performed to identify areas of consensus.

RESULTS: Responses from 38 hospitals were evaluated. Policy changes …

Risk Factors Of Recurrent Falls Among Older Adults Admitted To The Trauma Surgery Department., William Curran-Groome, Gary Klein, Stanton Miller, Azor Hui, Jordan S Wilson, Chol Kuoiloi, Venkata Masarapu, Andre Alabd, Toni Mascaro, Gideon Logan, Jonathan Lubeck

Department of Surgery Faculty Papers

Falls affect more than 29 million American adults ages ≥65 years annually. Many older adults experience recurrent falls requiring medical attention. These recurrent falls may be prevented through screening and intervention. In 2014 to 2015, records for 199 older adult patients admitted from a major urban teaching hospital’s emergency department were queried. Open-ended variables from clinicians’ notes were coded to supplement existing closed-ended variables. Of the 199 patients, 52 (26.1%) experienced one or more recurrent falls within 365 days after their initial fall. Half (50.0%) of all recurrent falls occurred within the first 90 days following discharge. A large proportion …

Hur/Elavl1 Drives Malignant Peripheral Nerve Sheath Tumor Growth And Metastasis, Marta Palomo-Irigoyen, Encarni Pérez-Andrés, Marta Iruarrizaga-Lejarreta, Adrián Barreira-Manrique, Miguel Tamayo-Caro, Laura Vila-Vecilla, Leire Moreno-Cugnon, Nagore Beitia, Daniela Medrano, David Fernández-Ramos, Juan José Lozano, Satoshi Okawa, José L Lavín, Natalia Martín-Martín, James D Sutherland, Virginia Guitiérez De Juan, Monika Gonzalez-Lopez, Nuria Macías-Cámara, David Mosén-Ansorena, Liyam Laraba, C Oliver Hanemann, Emanuela Ercolano, David B Parkinson, Christopher W. Schultz, Bs, Marcos J Araúzo-Bravo, Alex M Ascensión, Daniela Gerovska, Haizea Iribar, Ander Izeta, Peter Pytel, Philipp Krastel, Alessandro Provenzani, Pierfausto Seneci, Ruben D Carrasco, Antonio Del Sol, María Luz Martinez-Chantar, Rosa Barrio, Eduard Serra, Conxi Lazaro, Adrienne M Flanagan, Myriam Gorospe, Nancy Ratner, Ana M Aransay, Arkaitz Carracedo, Marta Varela-Rey, Ashwin Woodhoo

Department of Surgery Faculty Papers

Cancer cells can develop a strong addiction to discrete molecular regulators, which control the aberrant gene expression programs that drive and maintain the cancer phenotype. Here, we report the identification of the RNA-binding protein HuR/ELAVL1 as a central oncogenic driver for malignant peripheral nerve sheath tumors (MPNSTs), which are highly aggressive sarcomas that originate from cells of the Schwann cell lineage. HuR was found to be highly elevated and bound to a multitude of cancer-associated transcripts in human MPNST samples. Accordingly, genetic and pharmacological inhibition of HuR had potent cytostatic and cytotoxic effects on tumor growth, and strongly suppressed metastatic …

Reply: There Are Limits To Autonomy., John W C Entwistle, Kathleen N Fenton

Department of Surgery Faculty Papers

No abstract provided.

Global Kidney Exchange Should Expand Wisely., Alvin E Roth, Ignazio R. Marino, Obi Ekwenna, Ty B Dunn, Siegfredo R Paloyo, Miguel Tan, Ricardo Correa-Rotter, Christian S Kuhr, Christopher L Marsh, Jorge Ortiz, Giuliano Testa, Puneet Sindhwani, Dorry L Segev, Jeffrey Rogers, Jeffrey D Punch, Rachel C Forbes, Michael A Zimmerman, Matthew J Ellis, Aparna Rege, Laura Basagoitia, Kimberly D Krawiec, Michael A Rees

Department of Surgery Faculty Papers

We read with great interest and appreciation the careful consideration and analysis by Ambagtsheer et al. of the most critical ethical objections to Global Kidney Exchange (GKE). Ambagtsheer et al. conclude that implementation of GKE is a means to increase access to transplantation ethically and effectively.