Surgery Commons^™

Management Of Primary Spontaneous Pneumothorax: A Single Institution Protocol Analysis, Shai Stewart Md, James A. Fraser, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Tolulope A. Oyetunji, Shawn D. St.Peter

Posters

Management of Primary Spontaneous Pneumothorax in Children: A Single Institution Protocol Analysis

Background: The Midwest Pediatric Surgery Consortium (MWPSC) has suggested a management algorithm to include simple aspiration of primary spontaneous pneumothorax (PSP), failing which, Video-Assisted Thoracoscopic Surgery (VATS) should be considered. We describe our outcomes in patients who have been managed with this suggested protocol.

Methods: An Institutional Review Board (IRB) approved, single institution retrospective analysis was conducted on all patients between 12 and 18 years who were diagnosed with PSP from 2016 to 2022. Initial management consisted of aspiration alone with a 12F Thal-Quick chest tube followed by …

Time For Reintroducing Hpv Vaccine In Pakistan For Primary Prevention Of Cervical Cancer, Uzma Shamsi, Afshan Anwar, Zainab Samad

Community Health Sciences

No abstract provided.

Association Between Fetal Abdominal Growth Trajectories, Maternal Metabolite Signatures Early In Pregnancy, And Childhood Growth And Adiposity: Prospective Observational Multinational Interbio-21st Fetal Study, Jose Villar, Roseline Ochieng, Robert B. Gunier, Aris T. Papageorghiou, Stephen Rauch, Rose Mcgready, Julia M. Gauglitz, Fernando C. Barros, Manu Vatish, Shama Munim

Department of Obstetrics & Gynaecology

Background: Obesity predominantly affects populations in high-income countries and those countries facing epidemiological transition. The risk of childhood obesity is increased among infants who had overweight or obesity at birth, but in low-resource settings one in five infants are born small for gestational age. We aimed to study the relationships between: (1) maternal metabolite signatures; (2) fetal abdominal growth; and (3) postnatal growth, adiposity, and neurodevelopment.
Methods: In the prospective, multinational, observational INTERBIO-21st fetal study, conducted in maternity units in Pelotas (Brazil), Nairobi (Kenya), Karachi (Pakistan), Soweto (South Africa), Mae Sot (Thailand), and Oxford (UK), we enrolled women (≥18 years, …

Endoscopic Retrograde Cholangiography Using A Colonoscope In A Pediatric Liver Transplant Patient With Roux-En-Y Biliary Anastomosis, Nadia Ibrahimi, Thomas M. Attard, Ryan T. Fischer, Voytek Slowik, Richard J. Hendrickson, Bhargava Mullapudi, Moises Alatorre-Jimenez, Syed Jafri

Posters

Introduction: Biliary ducal sequelae including occlusions, strictures, leaks, or necrosis frequently complicate pediatric liver transplantation. The underlying etiology includes prolonged intraoperative ischemia or postoperative arterial inflow obstruction. In adult patients the role of endoscopic retrograde cholangiography (ERC) is well established in the management of biliary complications post-liver transplantation. In contrast, in the pediatric population, due to the combination of small patient size and the complexity of Roux-en-Y anastomotic techniques, ERC has been described as difficult or virtually impossible. This limits the options available for managing biliary duct complications to percutaneous techniques Endoscopic management of biliary complications in pediatric patients with …

Automated Extraction Of Anatomical Measurements From Temporal Bone Ct Imaging, Andy S Ding, Alexander Lu, Zhaoshuo Li, Deepa Galaiya, Masaru Ishii, Jeffrey H Siewerdsen, Russell H Taylor, Francis X Creighton

Faculty, Staff and Student Publications

OBJECTIVE: Proposed methods of minimally invasive and robot-assisted procedures within the temporal bone require measurements of surgically relevant distances and angles, which often require time-consuming manual segmentation of preoperative imaging. This study aims to describe an automatic segmentation and measurement extraction pipeline of temporal bone cone-beam computed tomography (CT) scans.

STUDY DESIGN: Descriptive study of temporal bone measurements.

SETTING: Academic institution.

METHODS: A propagation template composed of 16 temporal bone CT scans was formed with relevant anatomical structures and landmarks manually segmented. Next, 52 temporal bone CT scans were autonomously segmented using deformable registration techniques from the Advanced Normalization Tools …

Cardiovascular Outcomes And Trends Of Transcatheter Vs. Surgical Aortic Valve Replacement Among Octogenarians With Heart Failure: A Propensity Matched National Cohort Analysis, Yasar Sattar, David Song, Talal Almas, Mohamed Zghouzi, Usama Talib, Abdul-Rahman M Suleiman, Bachar Ahmad, Junaid Arshad, Waqas Ullah, Muhammad Zia Khan, Christopher M Bianco, Rodrigo Bagur, Muhammad Rashid, Mamas A Mamas, M Chadi Alraies

Division of Cardiology Faculty Papers

Background: Heart failure (HF) is a complex clinical syndrome with symptoms and signs that result from any structural or functional impairment of ventricular filling or ejection of blood. Limited data is available regarding the in-hospital outcomes of TAVR compared to SAVR in the octogenarian population with HF.

Methods: The National Inpatient Sample (NIS) database was used to compare TAVR versus SAVR among octogenarians with HF. The primary outcome was in-hospital mortality. The secondary outcome included acute kidney injury (AKI), cerebrovascular accident (CVA), post-procedural stroke, major bleeding, blood transfusions, sudden cardiac arrest (SCA), cardiogenic shock (CS), and mechanical circulatory support (MCS). …

A Hydrogen-Sulfide Derivative Of Mesalamine Reduces The Severity Of Intestinal And Lung Injury In Necrotizing Enterocolitis Through Endothelial Nitric Oxide Synthase, Brian D Hosfield, Chelsea E Hunter, Hongge Li, Natalie A Drucker, Anthony R Pecoraro, Krishna Manohar, W Christopher Shelley, Troy A Markel

Faculty, Staff and Student Publications

Necrotizing enterocolitis (NEC) remains a devastating disease that affects preterm infants. Hydrogen sulfide (H2S) donors have been shown to reduce the severity of NEC, but the optimal compound has yet to be identified. We hypothesized that oral H2S-Mesalamine (ATB-429) would improve outcomes in experimental NEC, and its benefits would be dependent on endothelial nitric oxide synthase (eNOS) pathways. NEC was induced in 5-day-old wild-type (WT) and eNOS knockout (eNOSKO) pups by formula feeding and stress. Four groups were studied in both WT and eNOSKO mice: 1) breastfed controls, 2) NEC, 3) NEC + 50 mg/kg mesalamine, and …

The Impact Of Covid-19 Pandemic Upon Non-Elective Admissions And Surgery At A Safety-Net Hospital: A Retrospective Cohort Study, Artem Boyev, Srinivas Sanjeevi, Martha M Estrada, Tien C Ko, Curtis J Wray

Faculty, Staff and Student Publications

Introduction: In response to the COVID-19 pandemic, hospitals reported decreased admissions for acute surgical diagnoses, but scant data was available to quantify the decrease and its consequences. The objective of this study was to examine the incidence of acute care surgery encounters before and during the COVID-19 pandemic.

Materials and methods: A retrospective cohort study was performed at a single, urban, United States safety-net hospital. Emergency room encounters, admissions, non-elective surgical procedures, patient acuity, and surgical complications were compared before and after the start of the COVID-19 pandemic. The primary outcome of the study was the incidence rate (IR) and …

Comparative Safety And Effectiveness Of Roux-En-Y Gastric Bypass And Sleeve Gastrectomy For Weight Loss And Type 2 Diabetes Across Race And Ethnicity In The Pcornet Bariatric Study Cohort, Karen J Coleman, Robert Wellman, Stephanie L Fitzpatrick, Molly B Conroy, Callie Hlavin, Kristina H Lewis, R Yates Coley, Kathleen M Mctigue, Jonathan N Tobin, Corrigan L Mcbride, Jay R Desai, Jeanne M Clark, Sengwee Toh, Jessica L Sturtevant, Casie E Horgan, Meredith C Duke, Neely Williams, Jane Anau, Michael A Horberg, Marc P Michalsky, Andrea J Cook, David E Arterburn, Caroline M Apovian, Pcornet Bariatric Study Collaborative

Faculty, Staff and Student Publications

IMPORTANCE: Bariatric surgery is the most effective treatment for severe obesity; yet it is unclear whether the long-term safety and comparative effectiveness of these operations differ across racial and ethnic groups.

OBJECTIVE: To compare outcomes of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) across racial and ethnic groups in the National Patient-Centered Clinical Research Network (PCORnet) Bariatric Study.

DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective, observational, comparative effectiveness cohort study that comprised 25 health care systems in the PCORnet Bariatric Study. Patients were adults and adolescents aged 12 to 79 years who underwent a primary (first nonrevisional) RYGB …

American Association Of Endocrine Surgeons Guidelines For Adrenalectomy: Executive Summary, Linwah Yip, Quan-Yang Duh, Heather Wachtel, Camilo Jimenez, Cord Sturgeon, Cortney Lee, David Velázquez-Fernández, Eren Berber, Gary D Hammer, Irina Bancos, James A Lee, Jamie Marko, Lilah F Morris-Wiseman, Marybeth S Hughes, Masha J Livhits, Mi-Ah Han, Philip W Smith, Scott Wilhelm, Sylvia L Asa, Thomas J Fahey, Travis J Mckenzie, Vivian E Strong, Nancy D Perrier

Faculty, Staff and Student Publications

IMPORTANCE: Adrenalectomy is the definitive treatment for multiple adrenal abnormalities. Advances in technology and genomics and an improved understanding of adrenal pathophysiology have altered operative techniques and indications.

OBJECTIVE: To develop evidence-based recommendations to enhance the appropriate, safe, and effective approaches to adrenalectomy.

EVIDENCE REVIEW: A multidisciplinary panel identified and investigated 7 categories of relevant clinical concern to practicing surgeons. Questions were structured in the framework Population, Intervention/Exposure, Comparison, and Outcome, and a guided review of medical literature from PubMed and/or Embase from 1980 to 2021 was performed. Recommendations were developed using Grading of Recommendations, Assessment, Development and Evaluation methodology …

Large Retroperitoneal Mass, Ryan Lamm, Wilbur B. Bowne

Department of Surgery Faculty Papers

No abstract provided.

The Impact Of Intraoperative Glucagon On The Diagnostic Accuracy Of Intraoperative Cholangiogram For The Diagnosis Of Choledocholithiasis: Experience From A Large Tertiary Care Center, Artem Boyev, Srinivas Sanjeevi, Martha M Estrada, Tien C Ko, Curtis J Wray

Faculty, Staff and Student Publications

INTRODUCTION: In response to the COVID-19 pandemic, hospitals reported decreased admissions for acute surgical diagnoses, but scant data was available to quantify the decrease and its consequences. The objective of this study was to examine the incidence of acute care surgery encounters before and during the COVID-19 pandemic.

MATERIALS AND METHODS: A retrospective cohort study was performed at a single, urban, United States safety-net hospital. Emergency room encounters, admissions, non-elective surgical procedures, patient acuity, and surgical complications were compared before and after the start of the COVID-19 pandemic. The primary outcome of the study was the incidence rate (IR) and …

Intra-Aortic Balloon Pump May Attenuate Adverse Hemodynamic Effects Of Negative Intrathoracic Pressure In Cardiogenic Shock, Faris Araj

The VAD Journal

High negative intrathoracic pressure (NIP), as occurs during obstructive sleep apnea or hiccups, results in adverse hemodynamic consequences, specifically a decrease in left ventricle (LV) performance. These untoward effects can potentially be catastrophic in the case of an already compromised LV in cardiogenic shock. The interplay of intra-aortic balloon pump counter pulsation during abrupt high NIP in cardiogenic shock is described.

Hypoglossal Nerve Injury With C1 Lateral Mass Screw Placement: A Case Report And Review Of The Literature, Maria De Abreu Pineda, Elias Atallah, John Wainwright, Joseph Schaefer, Aria Mahtabfar, James S Harrop, Srinivas Prasad, Joshua Pelta-Heller, Ashwini Sharan, Ahilan Sivaganesan, Jack Jallo

Department of Neurosurgery Faculty Papers

We report the case of a 62-year-old man who presented with a progressive myelopathy secondary to spinal cord compression from an odontoid process fracture and subaxial central canal stenosis. The patient underwent a C1-T2 posterior decompression and instrumented fusion (PCDF) and did well immediately postoperatively. However, on POD1, he developed a right hypoglossal nerve (HN) palsy attributed to direct mechanical compression or injury from the C1 lateral mass screw (LMS), which improved following a revision and screw replacement. While HN injury is a known complication of high anterior and anterolateral cervical spine approaches as well as transcondylar screw fixation, this …

Analysis Of The Efficacy Of Autologous Peripheral Blood Stem Cell Transplantation In High-Risk Neuroblastoma, Jin Yan, Li Jie, Yang Jiaxing, Cao Yanna, Li Zhanglin, Li Zhongyuan, Wang Daowei, Zhao Guangzong, Zhong Benfu, Yan Jie, Zhao Qiang

Faculty, Staff and Student Publications

Objective: This study aimed to analyze the efficacy of autologous peripheral blood stem cell transplantation for high-risk neuroblastoma in China.

Methods: The data of 90 high-risk neuroblastoma patients treated with the CCCG-NB 2015 regimen were reviewed. The baseline clinicopathological characteristics and prognosis were analyzed and compared. In addition, the prognoses of tandem autologous stem cell transplantation and single autologous stem cell transplantation groups were compared.

Results: The results of survival analysis showed that autologous peripheral blood stem cell transplantation based on this pretreatment regimen significantly improved the prognosis of children in the high-risk group. The 3-year event-free survival (EFS) and …

Routine Use Of Closed Suction Drains Following Revision Arthroplasty May Not Be Necessary, Farideh Najafi, Jonah M. Stein, Nicholas V. Peterson, Michael Meghpara, Matthew B. Sherman, Camilo Restrepo, Javad Parvizi

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: There are numerous studies demonstrating that closed suction drainage (CSD) usage after primary total joint arthroplasty (TJA) has little to no benefit. There are little data on the role of CSDs after revision TJA. The purpose of our study was to evaluate whether there is any clinical advantage to CSD usage after revision TJA.

METHODS: This retrospective study evaluated the clinical records of 2,030 patients undergoing revision TJA between 2007 and 2021. CSD was used in 472 patients and not used in 1,558 patients. Primary outcome was blood transfusion rate and secondary outcomes included total blood loss (TBL), as …

Case Report: The Promising Application Of Dynamic Functional Connectivity Analysis On An Individual With Failed Back Surgery Syndrome, Jingya Miao, Isaiah Ailes, Laura Krisa, Kristen Fleming, Devon Middleton, Kiran Talekar, Peter Natale, Feroze B. Mohamed, Kevin Hines, Caio M. Matias, Mahdi Alizadeh

Department of Neurosurgery Faculty Papers

Failed back surgery syndrome (FBSS), a chronic neuropathic pain condition, is a common indication for spinal cord stimulation (SCS). However, the mechanisms of SCS, especially its effects on supraspinal/brain functional connectivity, are still not fully understood. Resting state functional magnetic resonance imaging (rsfMRI) studies have shown characteristics in patients with chronic low back pain (cLBP). In this case study, we performed rsfMRI scanning (3.0 T) on an FBSS patient, who presented with chronic low back and leg pain following her previous lumbar microdiscectomy and had undergone permanent SCS. Appropriate MRI safety measures were undertaken to scan this subject. Seed-based functional …

Sterile Setup Table In The Operating Room Is Not So Sterile, Farideh Najafi, Diana Fernández-Rodríguez, Javad Parvizi

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: One of the important factors for surgical site infection prevention is the implementation of an ultraclean operating room. This study was designed to evaluate back-table sterility during total joint arthroplasty.

METHODS: This prospective study includes 52 patients undergoing primary total joint arthroplasty between November 2021 and January 2022. A total of 4 swabs (2 air swabs and 2 table swabs) were obtained for each case, at the conclusion of surgery and prior to the takedown of drapes. One swab from each set was sent for culture, and the other was sent for next-generation sequencing (NGS) analysis.

RESULTS: Among 104 …

Gender Dysphoria And Its Non-Surgical And Surgical Treatments, Danyon Anderson, Himasa Wijetunge, Peyton Moore, Daniel Provenzano, Nathan Li, Jamal Hasoon, Omar Viswanath, Alan D. Kaye, Ivan Urits

School of Medicine Faculty Publications

Gender dysphoria is defined by severe or persistent distress associated with an incongruence between one’s gender identity and biological sex. It is estimated that 1.4 million Americans and 25 million people worldwide identify as transgender and that 0.6% of Americans experience gender dysphoria. The pathophysiology of gender dysphoria is multifactorial and incompletely understood. Genetics, androgen exposure, neuroanatomy, brain connectivity, history of trauma, parents with psychological disorders, and being raised by less than two parents are associated with gender dysphoria. Gender dysphoria most frequently presents in early teenage years but can present earlier or later. Anxiety and depression are the two …

Failure Factors For Carpal Tunnel Syndrome Surgical Treatment: When And How To Perform A Revision Carpal Tunnel Decompression Surgery, Carlos Henrique Fernandes, João Baptista Gomes Santos, Francisco Schwartz-Fernandes, A. Lee Ostermann, Flávio Faloppa

Department of Surgery Faculty Papers

Despite being a procedure widely used all over the world with high rates of symptom remission, surgical treatment of carpal tunnel syndrome may present unsatisfactory outcomes. Such outcomes may be manifested clinically by non-remission of symptoms, remission of symptoms with recurrence a time after surgery or appearance of different symptoms after surgery. Different factors are related to this unsuccessful surgical treatment of carpal tunnel syndrome. Prevention can be achieved through a thorough preoperative clinical evaluation of the patient. As such, the surgeon will be able to make differential or concomitant diagnoses, as well as determine factors related to patient dissatisfaction. …

A Novel Approach To Assessment Of Us Pediatric Trauma System Development., Mary E. Fallat, Colin Traeger, Sophie Humphrey, Lindsey Gumer, Kahir Jawad, Elissa Butler, Frederick B. Rogers, Frederick P. Rivara, Amelia T. Collings

Faculty and Staff Scholarship

Importance Mature trauma systems are critical in building and maintaining national, state, and local resilience against all-hazard disasters. Currently, pediatric state trauma system plans are not standardized and thus are without concrete measures of potential effectiveness.

Objective To develop objective measures of pediatric trauma system capability at the state level, hypothesizing significant variation in capabilities between states, and to provide a contemporary report on the status of national pediatric trauma system planning and development.

Design, Setting, and Participants A national survey was deployed in 2018 to perform a gap analysis of state pediatric trauma system capabilities. Four officials from each …

Microaxial Support After Orthotopic Heart Transplantation, Christopher D. Pritting, Danial Ahmad, Takuma Miyamoto, Taufiek Konrad Rajab, Indranee Rajapreyar, Howard Massey, Vakhtang Tchantchaleishvili

Department of Surgery Posters

Introduction and Objective

• Impella is a temporary ventricular support device intended for short term use (CP, and ≤ 6 days for Impella 5.0 and LD).
• There has yet to be a study investigating the outcomes of microaxial support for patients who previously underwent heart transplantation.
• We aimed to assess utilization patterns of microaxial mechanical circulatory support after heart transplantation in adults and adolescents.

Obstetric Complications And Wellbeing Among Us Surgical Residents, Ruojia Li, Joshua Eng, Darci C. Foote, Christine Wu, Julie Johnson, Sarah Easter, Karl Bilimoria, Yue-Yung Hu, Erika Rangel

Conference Presentation Abstracts

No abstract provided.

Dietary Risk Factors And Eating Behaviors In Peripheral Arterial Disease (Pad), Andrea Leonardo Cecchini, Federico Biscetti, Maria Margherita Rando, Elisabetta Nardella, Giovanni Pecorini, Luis H. Eraso, Paul J. Dimuzio, Antonio Gasbarrini, Massimo Massetti, Andrea Flex

Department of Surgery Faculty Papers

Dietary risk factors play a fundamental role in the prevention and progression of atherosclerosis and PAD (Peripheral Arterial Disease). The impact of nutrition, however, defined as the process of taking in food and using it for growth, metabolism and repair, remains undefined with regard to PAD. This article describes the interplay between nutrition and the development/progression of PAD. We reviewed 688 articles, including key articles, narrative and systematic reviews, meta-analyses and clinical studies. We analyzed the interaction between nutrition and PAD predictors, and subsequently created four descriptive tables to summarize the relationship between PAD, dietary risk factors and outcomes. We …

Bridging Thrombolysis In Atrial Fibrillation Stroke Is Associated With Increased Hemorrhagic Complications Without Improved Outcomes, Feras Akbik, Ali Alawieh, Laurie Dimisko, Brian M. Howard, C Michael Cawley, Frank C. Tong, Fadi Nahab, Owen B. Samuels, Ilko Maier, Wuwei Feng, Nitin Goyal, Robert M. Starke, Ansaar Rai, Kyle M. Fargen, Marios N. Psychogios, Pascal Jabbour, Reade De Leacy, Saleh G. Keyrouz, Travis M. Dumont, Peter Kan, Jan Liman, Adam S. Arthur, Stacey Q. Wolfe, J. Mocco, Roberto Javier Crosa, W Christopher Fox, Benjamin Gory, Alejandro M. Spiotta, Jonathan A. Grossberg

Department of Neurosurgery Faculty Papers

BACKGROUND: Atrial fibrillation (AF) associated ischemic stroke is associated with worse functional outcomes, less effective recanalization, and increased rates of hemorrhagic complications after intravenous thrombolysis (IVT). Conversely, AF is not associated with hemorrhagic complications or functional outcomes in patients undergoing mechanical thrombectomy (MT). This differential effect of MT and IVT in AF associated stroke raises the question of whether bridging thrombolysis increases hemorrhagic complications in AF patients undergoing MT.

METHODS: This international cohort study of 22 comprehensive stroke centers analyzed patients with large vessel occlusion (LVO) undergoing MT between June 1, 2015 and December 31, 2020. Patients were divided into …

Coexistence Of Cutaneous Squamous Cell Carcinoma And Basal Cell Carcinoma In A Renal Transplant Recipient: A Case Report., Diana Voloshyna, Tanveer Ahamad Shaik, Sunita Shrestha, Ajmat Ansari, Faraz Saleem, Muhammad Abu Zar Ghaffari

Faculty and Staff Scholarship

In solid organ transplant patients, non-melanoma skin cancer remains a leading cause of mortality. The most common skin malignancies in solid organ transplant patients are squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). In organ transplant patients, SCC is 100 times more prevalent, and BCC is 10 times more prevalent than in the general population. Many risk factors for developing such malignancies are equivalent to those in the general population. However, in the transplant population, such cancers occur at an earlier age, act more aggressively, and often appear at multiple locations. Thus, assiduousness on the patient's part and healthcare …

Retroperitoneal Ancient Neurilemmoma: A Nervous Rarity., Vaidehi Mendpara, Sweta Sahu, Devarsh N. Shaw, Subhangi Parmar, Tanveer Ahamad Shaik, Swastika Sadhai, Mukesh Pancholi

Faculty and Staff Scholarship

Neurilemmomas are tumors of neural origin that comprise Schwann cell proliferation in a characteristic pattern. They are benign in nature. Ancient neurilemmomas are usually longstanding growths that exhibit degenerative features that could be mistaken for malignancy. We report a case of ancient neurilemmoma in a 70-year-old male patient in the retroperitoneal area. Retroperitoneal schwannomas are extremely uncommon along with ancient neurilemmoma features making it worth reporting

Review: Management Of Midshaft Clavicle Fractures In Adolescents , Matthew B. Holloway

Longitudinal Scholar's Project

Clavicle fractures are common injuries that occur across all age ranges, but are largely seen in young, active males. The majority of these fractures (70-80%) occur in the midshaft of the clavicle. The purpose of this review was to compare non-operative treatment to operative treatment of midclavicular fractures and determine whether treatment for adolescent clavicle fractures more closely aligns with pediatric or adult management. Adolescent clavicle fractures are increasingly treated with open reduction and internal fixation, especially in the 15 to 19 age group. Nevertheless, there remains a lack of high-level studies comparing outcomes of operative and conservative treatment specifically …

Multiseptate Gallbladder Presenting With Biliary Colic., Peter Hopmann, Ellen Tan, David Lo

Surgery Articles

Common diagnoses associated with right upper quadrant and epigastric pain include cholecystitis, peptic ulcer disease (PUD), biliary colic, gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS). Multiseptate gallbladder is a rare congenital anomaly that can cause symptoms of biliary colic, however it may present with atypical symptoms, which can prolong definitive diagnosis and treatment. We present a case of multiseptate gallbladder in a 21-year-old female who initially presented with GERD and IBS. After multiple failed treatment regimens for IBS, she ultimately was found to have multiseptate gallbladder and was successfully treated with cholecystectomy.

An Enzymatically Cleavable Tripeptide Linker For Maximizing The Therapeutic Index Of Antibody-Drug Conjugates, Summer Y Y Ha, Yasuaki Anami, Chisato M Yamazaki, Wei Xiong, Candice M Haase, Scott D Olson, Jangsoon Lee, Naoto T Ueno, Ningyan Zhang, Zhiqiang An, Kyoji Tsuchikama

Faculty, Staff and Student Publications

Valine-citrulline is a protease-cleavable linker commonly used in many drug delivery systems, including antibody-drug conjugates (ADC) for cancer therapy. However, its suboptimal in vivo stability can cause various adverse effects such as neutropenia and hepatotoxicity, leading to dose delays or treatment discontinuation. Here, we report that glutamic acid-glycine-citrulline (EGCit) linkers have the potential to solve this clinical issue without compromising the ability of traceless drug release and ADC therapeutic efficacy. We demonstrate that our EGCit ADC resists neutrophil protease-mediated degradation and spares differentiating human neutrophils. Notably, our anti-HER2 ADC shows almost no sign of blood and liver toxicity in healthy …