Surgery Commons^™

Terror Medicine As Part Of The Medical School Curriculum, L. A. Cole, K. Wagner, S. Scott, N. D. Connell, A. Cooper, C. A. Kennedy, B. Natal, S. Lamba

Journal Articles

Terror medicine, a field related to emergency and disaster medicine, focuses on medical issues ranging from preparedness to psychological manifestations specifically associated with terrorist attacks. Calls to teach aspects of the subject in American medical schools surged after the 2001 jetliner and anthrax attacks. Although the threat of terrorism persists, terror medicine is still addressed erratically if at all in most medical schools. This paper suggests a template for incorporating the subject throughout a 4-year medical curriculum. The instructional framework culminates in a short course for fourth year students, such as one recently introduced at Rutgers New Jersey Medical School, …

Athletic Pubalgia And Associated Rehabilitation, A. A. Ellsworth, M. P. Zoland, T. F. Tyler

Journal Articles

BACKGROUND: Evaluation and treatment of groin pain in athletes is challenging. The anatomy is complex, and multiple pathologies often coexist. Different pathologies may cause similar symptoms, and many systems can refer pain to the groin. Many athletes with groin pain have tried prolonged rest and various treatment regimens, and received differing opinions as to the cause of their pain. The rehabilitation specialist is often given a non-specific referral of "groin pain" or "sports hernia." The cause of pain could be as simple as the effects of an adductor strain, or as complex as athletic pubalgia or inguinal disruption. The term …

Aicar Attenuates Organ Injury And Inflammatory Response After Intestinal Ischemia And Reperfusion, J. P. Idrovo, W.L. Yang, A. Jacob, M. Aziz, Jeffrey Nicastro, Gene Coppa, P. Wang

Journal Articles

Intestinal ischemia and reperfusion (I/R) is encountered in various clinical conditions and contributes to multiorgan failure and mortality as high as 60% to 80%. Intestinal I/R not only injures the intestine, but affects remote organs such as the lung leading to acute lung injury. The development of novel and effective therapies for intestinal I/R are critical for the improvement of patient outcome. AICAR (5-aminoimidazole-4-carboxyamide ribonucleoside) is a cell-permeable compound that has been shown to possess antiinflammatory effects. The objective is to determine that treatment with AICAR attenuates intestinal I/R injury and subsequent acute lung injury (ALI). Male Sprague Dawley rats …

Arterio-Enteric Fistula In Failed Enteric-Drained Pancreas Transplants: An Impending Danger, M. Villa, E. Siskind, N. Jaimes, D. Eckstein, M. Bhaskaran, M. Sachdeva, K. Jhaveri, K. Calderon, C. Greben, L. Sharan, G. Coppa, K. Krishnasastry, E. Molmenti, J. Nicastro

Journal Articles

Enteric drainage is the preferred method of exocrine diversion in simultaneous kidney-pancreas transplantation. Because of improvements in immunosuppression, enteric drainage has become the preferred method of pancreas transplantation in general. Although associated with less potential complications than bladder-drained pancreas, potentially lethal arterio-enteric fistulas in the setting of nonfunctioning allografts represent a constant threat. We herein present a case report, a review of the literature, and a call for caution.

Brain Region-Specific Alterations In The Gene Expression Of Cytokines, Immune Cell Markers And Cholinergic System Components During Peripheral Endotoxin-Induced Inflammation, H. A. Silverman, M. Dancho, A. Regnier-Golanov, M. Nasim, M. Ochani, P. S. Olofsson, M. Ahmed, E. J. Miller, S. S. Chavan, E. Golanov, C. Metz, K. J. Tracey, V. A. Pavlov

Journal Articles

Inflammatory conditions characterized by excessive peripheral immune responses are associated with diverse alterations in brain function, and brain-derived neural pathways regulate peripheral inflammation. Important aspects of this bidirectional peripheral immune - brain communication, including the impact of peripheral inflammation on brain region-specific cytokine responses, and brain cholinergic signaling (which plays a role in controlling peripheral cytokine levels) remain unclear. To provide insight, we studied gene expression of cytokines, immune cell markers and brain cholinergic system components in the cortex, cerebellum, brainstem, hippocampus, hypothalamus, striatum, and thalamus in mice following an intraperitoneal lipopolysaccharide injection. Endotoxemia was accompanied by elevated serum levels …

Approaching The Next Revolution? Evolutionary Integration Of Neural And Immune Pathogen Sensing And Response, K. J. Tracey

Journal Articles

Mammalian immunity evolved by the process of natural selection that produced differential survival and reproduction advantages through combinations of hereditary traits underlying the response to pathogens. Primitive animals sense the presence of microbial pathogens through recognition of pathogen-derived molecules in their rudimentary immune and nervous systems. No molecular biological mechanism assigns primacy of pathogen sensing mechanisms to immune cells over neurons. Rather, in animals as diverse as Caenorhabditis elegans to mammals, neural reflexes are activated by the presence of pathogens and transduce neural mechanisms that control the development of immunity. A coming revolution in immunological thinking will require immunologists to …

Central Cholinergic Activation Of A Vagus Nerve-To-Spleen Circuit Alleviates Experimental Colitis, H. Ji, M. F. Rabbi, B. Labis, V. A. Pavlov, K. J. Tracey, J. E. Ghia

Journal Articles

The cholinergic anti-inflammatory pathway is an efferent vagus nerve-based mechanism that regulates immune responses and cytokine production through alpha 7 nicotinic acetylcholine receptor (alpha 7nAChR) signaling. Decreased efferent vagus nerve activity is observed in inflammatory bowel disease. We determined whether central activation of this pathway alters inflammation in mice with colitis and the mediating role of a vagus nerve-to-spleen circuit and alpha 7nAChR signaling. Two experimental models of colitis were used in C57BL/6 mice. Central cholinergic activation induced by the acetylcholinesterase inhibitor galantamine or a muscarinic acetylcholine receptor agonist treatments resulted in reduced mucosal inflammation associated with decreased major histocompatibility …

High-Mobility Group Box 1 Protein Initiates Postoperative Cognitive Decline By Engaging Bone Marrow-Derived Macrophages, S. Vacas, V. Degos, K. J. Tracey, M. Maze

Journal Articles

Background: Aseptic trauma engages the innate immune response to trigger a neuroinflammatory reaction that results in postoperative cognitive decline. The authors sought to determine whether high-mobility group box 1 protein (HMGB1), an ubiquitous nucleosomal protein, initiates this process through activation and trafficking of circulating bone marrow-derived macrophages to the brain. Methods: The effects of HMGB1 on memory (using trace fear conditioning) were tested in adult C57BL/6J male mice; separate cohorts were tested after bone marrow-derived macrophages were depleted by clodrolip. The effect of anti-HMGB1 neutralizing antibody on the inflammatory and behavioral responses to tibial surgery were investigated. Results: A single …

Lymphocyte Called Home: Beta2-Adreneric Neurotransmission Confines T Cells To Lymph Nodes To Suppress Inflammation, K J. Tracey

Journal Articles

No abstract provided.

Mapping Human Brain Networks With Cortico-Cortical Evoked Potentials, C. J. Keller, C. J. Honey, P. Megevand, L. Entz, I. Ulbert, A. D. Mehta

Journal Articles

The cerebral cortex forms a sheet of neurons organized into a network of interconnected modules that is highly expanded in humans and presumably enables our most refined sensory and cognitive abilities. The links of this network form a fundamental aspect of its organization, and a great deal of research is focusing on understanding how information flows within and between different regions. However, an often-overlooked element of this connectivity regards a causal, hierarchical structure of regions, whereby certain nodes of the cortical network may exert greater influence over the others. While this is difficult to ascertain non-invasively, patients undergoing invasive electrode …

Nanocomposite Scaffold For Chondrocyte Growth And Cartilage Tissue Engineering: Effects Of Carbon Nanotube Surface Functionalization, N. O. Chahine, N. M. Collette, C. B. Thomas, D. C. Genetos, G. G. Loots

Journal Articles

The goal of this study was to assess the long-term biocompatibility of single-wall carbon nanotubes (SWNTs) for tissue engineering of articular cartilage. We hypothesized that SWNT nanocomposite scaffolds in cartilage tissue engineering can provide an improved molecular-sized substrate for stimulation of chondrocyte growth, as well as structural reinforcement of the scaffold's mechanical properties. The effect of SWNT surface functionalization (-COOH or -PEG) on chondrocyte viability and biochemical matrix deposition was examined in two-dimensional cultures, in three-dimensional (3D) pellet cultures, and in a 3D nanocomposite scaffold consisting of hydrogels + SWNTs. Outcome measures included cell viability, histological and SEM evaluation, GAG …

Targeting A Heterogeneous Tumor: The Promise Of The Interleukin-13 Receptor Alpha2, I. Bodhinayake, M. Ottenhausen, J. A. Boockvar

Journal Articles

No abstract provided.

Sudden Unexpected Nocturnal Death In Chiari Type 1 Malformation And Potential Role Of Opioid Analgesics, F. Roohi, T. Gropen, R. W. Kula

Journal Articles

BACKGROUND: Chiari malformation type 1 (CM1) is a common congenital anomaly of the craniocervical junction. CM1 is reported to run a usually benign course and patients typically experience no symptoms or chronic, slowly progressive symptoms. However, recent reports indicate that a subset of patients with CM1 may present with acute deterioration and sudden unexpected death (SUD). We report a case of SUD during sleep in a young man with CM1, which we believe was related to the administration of common and therapeutic doses of narcotic analgesics for the management of pain. We will clarify the pathophysiology of acute deterioration and …

Traumatic Axillary Artery Pseudoaneurysm Treated With Intravascular Balloon Occlusion And Percutaneous Thrombin Injection, Maria Carratola, Priti Parikh, Kathryn M. Tchorz, Shannon Kauffman

Department of Surgery Faculty Publications

Axillary artery pseudoaneurysms are relatively rare, with few reported cases found in the literature. Furthermore, treatment with percutaneous thrombin injection has not yet been reported. We report the case of a 59-year-old man with a large (10 cm) post-traumatic pseudoaneurysm of the left axillary artery found five weeks after a motorcycle crash. The patient sustained multiple injuries, including fractures of the left scapula and clavicle. Edema was observed at the time of diagnosis. Arteriography with successful ultrasound-guided percutaneous thrombin injection was undertaken. The patient experienced no complications after the procedure.

Wound Healing In Peripheral Arterial Disease: Current And Future Therapy, Jon C. Henry, Laura Peterson, Richard E. Schlanger, Michael R. Go, Chandan K. Sen, Robert S.D. Higgins

Department of Surgery Faculty Publications

Wounds secondary to peripheral arterial disease (PAD) result in substantial morbidity and burden to the healthcare industry. To aid in the care of this patient population, knowledge of the disease process and current standards of therapy is paramount for healthcare providers.The future care of these patients and improvement from our existing standards hinges on the active translational research. To implement new technologies and advances in the treatment of PAD-induced wounds and ensure adequate utilization of our current therapies a PAD-wound team is necessary.

Middle Cerebral Artery Arrow Sign, Z. D. Levy, R. E. Temes, A. R. Dehdashti

Journal Articles

No abstract provided.

Central Muscarinic Cholinergic Activation Alters Interaction Between Splenic Dendritic Cell And Cd4(+)Cd25(-) T Cells In Experimental Colitis, P. Munyaka, M. F. Rabbi, V. A. Pavlov, K. J. Tracey, E. Khafipour, J. E. Ghia

Journal Articles

Background: The cholinergic anti-inflammatory pathway (CAP) is based on vagus nerve (VN) activity that regulates macrophage and dendritic cell responses in the spleen through alpha-7 nicotinic acetylcholine receptor (a7nAChR) signaling. Inflammatory bowel disease (IBD) patients present dysautonomia with decreased vagus nerve activity, dendritic cell and T cell over-activation. The aim of this study was to investigate whether central activation of the CAP alters the function of dendritic cells (DCs) and sequential CD4(+)/CD25(-)T cell activation in the context of experimental colitis. Methods: The dinitrobenzene sulfonic acid model of experimental colitis in C57BL/6 mice was used. Central, intracerebroventricular infusion of the M1 …

Effectiveness Of Treatments For Low Back Pain, Angela K. Salveson

Physician Assistant Scholarly Project Posters

Low back pain with or without radiculopathy symptoms is increasingly becoming a common complaint for patients. The purpose of this study is to evaluate the most effective treatment for patients experiencing low back pain with or without radiculopathy symptoms with the goal of pain reduction/elimination and positive long term results. The review of literature explores studies that discuss treatment options of surgical intervention or conventional treatment such as physical therapy. This information supplies health care providers with the tools to educate patients on treatment options and possible outcomes in hopes to offer the best treatment for the individual. Results show …

Building Research Capacity In Africa: Equity And Global Health Collaborations, Kathryn M. Chu, Sudha Jayaraman, Patrick Kyamanywa, Georges Ntakiyiruta

Surgery Publications

Summary Points

• Global health has increased the number of high-income country (HIC) investigators conducting research in low- and middle-income countries (LMICs).
• Partnerships with local collaborators rather than extractive research are needed.
• LMICs have to take an active role in leading or directing these research collaborations in order to maximize the benefits and minimize the harm of inherently inequitable relationships.
• This essay explores lessons from effective and equitable relationships that exist between African countries and HICs.

Dr. Seishu Hanaoka (1760-1835): Surgeon, Pharmacist, And Anesthesiologist., Drew L. Kotler, B.A., Hitoshi Hirose, Md, Charles J. Yeo, Md, Scott W. Cowan, Md

Department of Surgery Gibbon Society Historical Profiles

The notion of decreasing pain in surgery stretches back thousands of years with alcohol noted as one of the first anesthetics. Natural elements including coca and opium have been used by various civilizations in an attempt to mute the searing pain of surgery. By the 16th century, physicians around the world began to experiment with nitrous oxide and ether, providing the groundwork for the future of modern anesthesia. The successful application of general anesthesia in surgery was first documented in 1804 by Dr. Seishu Hanaoka (Fig. 1) in Wakayama, Japan, during a breast lumpectomy. During the case, Dr. Hanaoka served …