bluuebunny/crossref_metadata_2025 huggingface dataset:
Distribution, composition, and activity of airway-associated adipose tissue in the porcine lung
Authors: Wang Carolyn J. , Noble Peter B. , Elliot John G. , Choi Yu Suk , James Alan L. , Wang Kimberley C. W.
Published: November 2022

Patients with comorbid asthma-obesity experience greater disease severity and are less responsive to therapy. We have previously reported adipose tissue within the airway wall that positively correlated with body mass index. Accumulation of biologically active adipose tissue may result in the local release of adipokines and disrupt large and small airway function depending on its anatomical distribution. This study therefore characterized airway-associated adipose tissue distribution, lipid composition, and adipokine activity in a porcine model. Airway segments were systematically dissected from different locations of the bronchial tree in inflation-fixed lungs. Cryosections were stained with hematoxylin and eosin (H&E) for airway morphology, oil red O to distinguish adipose tissue, and Nile blue A for lipid subtype delineation. Excised airway-associated adipose tissue was cultured for 72 h to quantify adipokine release using immunoassays. Results showed that airway-associated adipose tissue extended throughout the bronchial tree and occupied an area proportionally similar to airway smooth muscle within the wall area. Lipid composition consisted of pure neutral lipids (61.7 ± 3.5%), a mixture of neutral and acidic lipids (36.3 ± 3.4%), or pure acidic lipids (2.0 ± 0.8%). Following tissue culture, there was rapid release of IFN-γ, IL-1β, and TNF-α at 12 h. Maximum IL-4 and IL-10 release was at 24 and 48 h, and peak leptin release occurred between 48 and 72 h. These data extend previous findings and demonstrate that airway-associated adipose tissue is prevalent and biologically active within the bronchial tree, providing a local source of adipokines that may be a contributing factor in airway disease.
Pectic polysaccharides derived from Hainan Rauwolfia ameliorate NLR family pyrin domain-containing 3-mediated colonic epithelial cell pyroptosis in ulcerative colitis
Authors: Yuan Wei , Tian Yuanyuan , Lin Cheng , Wang Yuxuan , Liu Zhanju , Zhao Ye , Chen Fengying , Miao Xinpu
Published: November 2022

Pectic polysaccharides (PPs) could exert functions on ulcerative colitis (UC), which is classified as a nonspecific inflammatory disorder. This study investigated the molecular mechanism of PPs derived from Rauwolfia in UC. First, the dextran sodium sulfate (DSS)-induced mouse colitis models and lipopolysaccharide (LPS)-treated colonic epithelial cell (YAMC) models were established and treated with PP. Subsequently, the effects of PPs on mucosal damages in DSS mice were detected, and the levels of inflammatory cytokines, pyroptosis-related factors, oxidative stress-related markers, and the tight junction-related proteins in the tissues or cells were examined, and the results suggested that PPs ameliorated colonic mucosal damages and cell pyroptosis in DSS mice, and limited colonic epithelial cell pyroptosis in in vitro UC models. Subsequently, the binding relations of retinol-binding protein 4 (RBP4) to miR-124-3p and NLR pyrin domain-containing 3 (NLRP3) were analyzed. miR-124-3p targeted RBP4 and reduced the binding of RBP4 to NLRP3, thus inhibiting NLRP3-mediated pyroptosis. Finally, functional rescue experiments revealed that miR-124-3p suppression or RBP4 overexpression promoted colonic epithelial cell pyroptosis. Collectively, Rauwolfia-derived PPs limited miR-124-3p and targeted RBP4 and reduced the binding potency of RBP4 to NLRP3 to inhibit NLRP3-mediated pyroptosis, resulting in the alleviation of colonic epithelial cell pyroptosis and mucosal damages in UC.
Two-Agent Single Machine Scheduling with Deteriorating Jobs and Rejection
Authors: Li Dawei , Li Ganggang , Cheng Fangzheng
Published: November 2022

We consider two two-agent scheduling problems with deteriorating jobs and rejection. Two agents

A

and

B

compete for the usage of a single machine. The actual processing time of job

J
j
X

is

p
j
X

=

b
j
X

a
+
b
t

,

X
∈

A
,
B

, where

b
j
X

is the normal processing time of

J
j
X

,

a
≥
0

,

b
≥
0

and

t

denotes the starting time of

J
j
X

. A job is either rejected by paying a rejection penalty, or accepted and processed on the machine. The objective is to minimize the sum of the completion time of the accepted

A

-jobs and total rejection penalty of the rejected

A

-jobs subject to an upper bound on the sum of the given objective function

f

B

of the accepted

B

-jobs and total rejection penalty of the rejected

B

-jobs, where

f

B

∈

C

max

B

,
∑

C
j
B

. We give dynamic programming algorithms for them, respectively. When

f

B

=

C

max

B

, we present a fully polynomial-time approximation scheme (FPTAS) for the case

a
=
0

and

b
=
1

. When

f

B

=
∑

C
j
B

, a fully polynomial-time approximation scheme is also presented.
Associating Immunotherapy and Targeted Therapies: Facts and Hopes
Authors: Ladoire Sylvain , Rébé Cédric , Ghiringhelli François
Published: November 2022

Immune-checkpoint inhibitors (ICI), particularly inhibitors of the PD-1/PD-L1 (Programmed Death 1/Programmed Death-Ligand 1) axis, have modified the management of many types of cancer over the last 10 years. However, both intrinsic and acquired resistance are major clinical issues with these therapies, and only a few patients are cured by ICI monotherapy. To overcome resistance, the concept of combining ICIs with other therapies is emerging and supported by many preclinical trials. Besides associations of ICIs with chemotherapy or radiotherapy, now used in clinical practice, some targeted therapies have also been reported to influence immune response of patients against cancer cells, thus showing potential synergy with ICIs. In this review, we describe the preclinical and clinical advances to date in the use of these combination strategies.
COMMD3-Mediated Endosomal Trafficking of HER2 Inhibits the Progression of Ovarian Carcinoma
Authors: Wang Shiqing , Liu Yuxin , Li Siyu , Chen Yanan , Liu Yanhua , Yan Jie , Wu Jiayi , Li Jia , Wang Longlong , Xiang Rong , Shi Yi , Qin Xuan , Yang Shuang
Published: November 2022

The dysregulated endocytic traffic of oncogenic receptors, such as the EGFR family especially HER2, contributes to the uncontrolled activation of the downstream oncogenic signaling and progression of various carcinomas, including 90% of ovarian carcinoma. However, the key regulators in the intracellular trafficking of HER2 and their impacts for cancer progression remain largely unknown. In this study, through a genome-wide CRISPR/Cas9 screening for key genes affecting the peritoneal disseminated metastasis of ovarian carcinoma, we identified a member of COMMD family, that is, COMMD3, as a key regulator in the endosomal trafficking of HER2. In the patients with high-grade serous ovarian carcinoma (HGSOC), the expression of COMMD3 is dramatically decreased in the peritoneal disseminated ovarian carcinoma cells comparing with that in the primary ovarian carcinoma cells. COMMD3 greatly inhibits the proliferation, migration, and epithelial–mesenchymal transition (EMT) of HGSOC cells, and dramatically suppresses the tumor growth, the formation of malignant ascites, and the peritoneal dissemination of cancer cells in the orthotopic murine model of HGSOC. Further transcriptome analysis reveals that silencing COMMD3 boosts the activation of HER2 downstream signaling. As a component in the Retriever-associated COMMD/CCDC22/CCDC93 complex responsible for the recognition and recycling of membrane receptors, COMMD3 physically interacts with HER2 for directing it to the slow recycling pathway, leading to the attenuated downstream tumor-promoting signaling.

Implications:

Collectively, this study reveals a novel HER2 inactivation mechanism with a high value for the clinic diagnosis of new ovarian carcinoma types and the design of new therapeutic strategy.
MUC1-C Dictates PBRM1-Mediated Chronic Induction of Interferon Signaling, DNA Damage Resistance, and Immunosuppression in Triple-Negative Breast Cancer
Authors: Yamashita Nami , Morimoto Yoshihiro , Fushimi Atsushi , Ahmad Rehan , Bhattacharya Atrayee , Daimon Tatsuaki , Haratake Naoki , Inoue Yuka , Ishikawa Satoshi , Yamamoto Masaaki , Hata Tsuyoshi , Akiyoshi Sayuri , Hu Qiang , Liu Tao , Withers Henry , Liu Song , Shapiro Geoffrey I. , Yoshizumi Tomoharu , Long Mark D. , Kufe Donald
Published: November 2022

The polybromo-1 (PBRM1) chromatin-targeting subunit of the SWI/SNF PBAF chromatin remodeling complex drives DNA damage resistance and immune evasion in certain cancer cells through mechanisms that remain unclear. STAT1 and IRF1 are essential effectors of type I and II IFN pathways. Here, we report that MUC1-C is necessary for PBRM1 expression and that it forms a nuclear complex with PBRM1 in triple-negative breast cancer (TNBC) cells. Analysis of global transcriptional (RNA-seq) and chromatin accessibility (ATAC-seq) profiles further demonstrated that MUC1-C and PBRM1 drive STAT1 and IRF1 expression by increasing chromatin accessibility of promoter-like signatures (PLS) on their respective genes. We also found that MUC1-C, PBRM1, and IRF1 increase the expression and chromatin accessibility on PLSs of the (i) type II IFN pathway IDO1 and WARS genes and (ii) type I IFN pathway RIG-I, MDA5, and ISG15 genes that collectively contribute to DNA damage resistance and immune evasion. In support of these results, targeting MUC1-C in wild-type BRCA TNBC cells enhanced carboplatin-induced DNA damage and the loss of self-renewal capacity. In addition, MUC1-C was necessary for DNA damage resistance, self-renewal, and tumorigenicity in olaparib-resistant BRCA1-mutant TNBC cells. Analysis of TNBC tumors corroborated that (i) MUC1 and PBRM1 are associated with decreased responsiveness to chemotherapy and (ii) MUC1-C expression is associated with the depletion of tumor-infiltrating lymphocytes (TIL). These findings demonstrate that MUC1-C activates PBRM1, and thereby chromatin remodeling of IFN-stimulated genes that promote chronic inflammation, DNA damage resistance, and immune evasion.

Implications:

MUC1-C is necessary for PBRM1-driven chromatin remodeling in chronic activation of IFN pathway genes that promote DNA damage resistance and immunosuppression.
Focal Laser Photocoagulation for Central Serous Chorioretinopathy in Under-Represented Populations: A Retrospective Case Series
Authors: Sangal Kajal , Prasad Minali , Siegel Nicole H. , Chen Xuejing , Ness Steven , Subramanian Manju L.
Published: November 2022

This case series examines visual and anatomic outcomes of focal laser photocoagulation in the treatment of central serous chorioretinopathy (CSCR) with subretinal fluid (SRF) in under-represented populations. We reviewed records of 25 eyes with CSCR and SRF that underwent focal laser photocoagulation. Visual acuity (VA) and central macular thickness (CMT) were recorded prior to laser, after laser treatment, and at final follow-up and were all compared using Wilcox signed-rank tests after using Shapiro-Wilk tests to determine normality. The racial and ethnic breakdown of our cohort (n = 25) includes 64% Hispanic (n = 16), 20% black (n = 5), 12% Asian (n = 3), 4% other (n = 1). Patients were followed for a median of 15.5 months (range: 5.75–87 months) after treatment. The VA prior to laser compared to best-available VA significantly improved (p = 0.0003). Pre-laser CMT to post-laser CMT (p < 0.0001) and pre-laser CMT to final CMT (p < 0.0001) significantly improved. Excluding the one eye that developed a choroidal neovascular membrane, the pre-laser VA to final VA improved significantly (p = 0.0047) as well as the pre-laser CMT to final CMT (p < 0.0001). Of the 25 eyes, 4 had persistent SRF following laser, and of the 21 eyes with complete resolution of SRF, 2 developed recurrent SRF. Focal laser photocoagulation can significantly improve VA and CMT in CSCR with active SRF in patients who have been under-represented in prior clinical studies.
Procedural Outcomes After Percutaneous Coronary Interventions in Focal and Diffuse Coronary Artery Disease
Authors: Mizukami Takuya , Sonck Jeroen , Sakai Koshiro , Ko Brian , Maeng Michael , Otake Hiromasa , Koo Bon‐Kwon , Nagumo Sakura , Nørgaard Bjarne L. , Leipsic Jonathon , Shinke Toshiro , Munhoz Daniel , Mileva Niya , Belmonte Marta , Ohashi Hirofumi , Barbato Emanuele , Johnson Nils P. , De Bruyne Bernard , Collet Carlos
Published: November 2022

Background

Coronary artery disease (CAD) patterns play an essential role in the decision‐making process about revascularization. The pullback pressure gradient (PPG) quantifies CAD patterns as either focal or diffuse based on fractional flow reserve (FFR) pullbacks. The objective of this study was to evaluate the impact of CAD patterns on acute percutaneous coronary intervention (PCI) results considered surrogates of clinical outcomes.

Methods and Results

This was a prospective, multicenter study of patients with hemodynamically significant CAD undergoing PCI. Motorized FFR pullbacks and optical coherence tomography (OCT) were performed before and after PCI. Post‐PCI FFR >0.90 was considered an optimal result. Focal disease was defined as PPG >0.73 (highest PPG tertile). Overall, 113 patients (116 vessels) were included. Patients with focal disease were younger than those with diffuse CAD (61.4±9.9 versus 65.1±8.7 years,
P
=0.042). PCI in vessels with high PPG (focal CAD) resulted in higher post‐PCI FFR (0.91±0.07 in the focal group versus 0.86±0.05 in the diffuse group,
P
<0.001) and larger minimal stent area (6.3±2.3 mm
2
in focal versus 5.3±1.8 mm
2
in diffuse CAD,
P
=0.015) compared withvessels with low PPG (diffuse CAD). The PPG was associated with the change in FFR after PCI (
R
2
=0.51,
P
<0.001). The PPG significantly improved the capacity to predict optimal PCI results compared with an angiographic assessment of CAD patterns (area under the curve
PPG
0.81 [95% CI, 0.73–0.88] versus area under the curve
angio
0.51 [95% CI, 0.42–0.60];
P
<0.001).

Conclusions

PCI in vessels with focal disease defined by the PPG resulted in greater improvement in epicardial conductance and larger minimal stent area compared with diffuse disease. PPG, but not angiographically defined CAD patterns, distinguished patients attaining superior procedural outcomes.

Registration

URL:
https://clinicaltrials.gov/ct2/show/NCT03782688
Installation and monitoring of a canopy bridge connecting Atlantic Forest fragments containing endangered species in Northeastern Brazil
Authors: Buss Gerson , Ludwig Gabriela , Beltrão-Mendes Raone , Valença-Montenegro Mônica Mafra , Martins Amely Branquinho , Chein Alonso André
Published: November 2022

In 2019, a canopy bridge was built connecting two fragments of the Atlantic Forest separated by the Pacatuba unpaved road within the Pacatuba-Gargaú Corridor. This bridge was built as part of the Brazilian National Action Plan for the Conservation of Northeastern Primates (Plano de Ação Nacional para Conservação dos Primatas do Nordeste – PAN PRINE). The forest fragments contain a variety of mammal species, including the endangered primate species Alouatta belzebul and Sapajus flavius. Between September 2019 and March 2020, we monitored the canopy bridge continuously with a Bushnell camera trap; for a total of 204 days of sampling, resulting in evidence of 113 independent passage events. During the monitoring period, four mammal species used the canopy bridge, the Endangered Sapajus flavius (blond capuchin monkey), Callithrix jacchus (common marmoset), Marmosa demerarae (woolly mouse opossum), and Marmosa murina (murine mouse opossum). The common marmoset (Callithrix jacchus) used the bridge most frequently, representing 50.44% of the passage events (57), while the blond capuchin monkey (S. flavius) crossed the bridge in 30 events (26.5% of total crossings). All other mammals used the bridge less frequently than the primates (23% of crossings were of opossums). There was no record of crossings by the red-handed howler monkey (Alouatta belzebul) during the monitoring period. The construction of the canopy bridge within the Pacatuba-Gargaú forest corridor promoted structural and functional connectivity of the forest habitats, affecting the movement of the Endangered blond capuchin monkey and the common marmoset and benefiting other arboreal mammal species. The results indicate that monitoring the use of this canopy bridge provided important insights into the behaviour and ecology of the species studied (e.g., activity patterns, social interactions, group sizes, and reproduction, among many others). In addition, the use of the bridge decreases the risks of animal-vehicle collisions and electrocutions. Considering our results, we strongly recommend constructing and implementing canopy bridges as a strategy for the conservation of arboreal species living in fragmented forest areas.
A Targeted Abroach for Antiangiogenic Therapy of Metastatic Human Colon Cancer
Authors: Ellis Lee M.
Published: November 2022

The realization that the growth and spread of tumors are dependent on angiogenesis has created new avenues of research designed to help us to better understand cancer biology and to facilitate the development of new therapeutic strategies. However, the process of angiogenesis consists of multiple sequential and interdependent steps with a myriad of positive and negative regulators of angiogenesis being involved. The survival of tumors and thus their metastases are dependent on the balance of endogenous angiogenic and antiangiogenic factors such that the outcome favors increased angiogenesis. Several growth factors have been identified that regulate angiogenesis in colon cancer; the most important of these is vascular endothelial growth factor. In addition, specific integrins such as αvβ3 and α5β1 mediate endothelial cell survival and have been shown to be overexpressed on the endothelium of colon cancer. These angiogenic mediators thus serve as targets for therapy of metastatic colon cancer and have shown promise in preclinical trials.
Radiofrequency Ablation of Breast Cancer
Authors: Singletary S. Eva
Published: November 2022

Radiofrequency ablation (RFA) is currently under study as a candidate for nonsurgical removal or destruction of breast tumors. RFA of solid tumors is produced by frictional heating caused when ions in the tissue attempt to follow the changing directions of a high-frequency alternating current. The radiofrequency probe is typically placed into the tumor under ultrasound guidance, and the ablation is performed with real-time ultrasound monitoring. Preliminary studies in which RFA was followed by standard surgical resection have indicated that this technique is effective for the surgical ablation of small (≤2 cm) primary breast tumors. A new study at the University of Texas M.D. Anderson Cancer Center will use RFA as the sole local treatment of breast tumors ≤1.5 cm in size to determine whether this technique is oncologically and cosmetically appropriate for the local treatment of primary breast cancer. Twenty patients with small tumors that are clearly identifiable and measurable by ultrasound will be enrolled in the study. Local control will be assessed by core and fine-needle biopsies, and long-term outcomes will be assessed using imaging studies and quality-of-life measurement scales for 5 years after treatment.
Acute Infectious Purpura Fulminans: A 15-Year Retrospective Review of 28 Consecutive Cases
Authors: Childers Ben J. , Cobanov Brando
Published: November 2022

Acute infectious purpura fulminans (AIPF) is a rare syndrome of hemorrhagic infarction of the skin, extremity loss, and intravascular thrombosis. It progresses rapidly and is accompanied by disseminated intravascular coagulation and vascular collapse. The victims often succumb to the disease. Our objective was to investigate the clinical manifestations, outline the clinical course, and delineate factors related to mortality among the patients with AIPF. Patients diagnosed with AIPF over a 15-year period were reviewed retrospectively for patient history, comorbid conditions, progression of clinical course, and medical and surgical management. The vast majority of the patients were under the age of 7; however, the disease process can be seen in adults. The overall mortality rate was 43 per cent. The major predisposing factors were history of recent upper respiratory infection, recent surgery or childbirth, young age, and absence of a spleen. The most common clinical manifestations were skin discoloration, disseminated intravascular coagulation, fever, and septic shock. The most common bacteria cultures were Neisseria meningitidis, Hemophilus influenzae, and Streptococcus pneumoniae. There appears to be a higher mortality in patients who did not undergo a surgical intervention. Compartment syndrome needs to be evaluated early on in the presentation. Rapid diagnosis, intensive care unit management, and prompt surgical consultation and debridement may decrease the mortality.
Effect of the Learning Curve on the Early Outcomes of Laparoscopic Roux-en-Y Gastric Bypass
Authors: Kligman Mark D. , Thomas Chadwick , Saxe Jonathan
Published: November 2022

Open gastric bypass has been demonstrated to provide durable weight loss in morbidly obese patients. As laparoscopic techniques have evolved surgeons are offering patients such an approach for performance of gastric bypass. The purpose of this study was to evaluate the relationship between increasing experience and outcome for this technically challenging operation. A retrospective analysis was performed on the initial 160 consecutive patients undergoing laparoscopic gastric bypass by a single surgeon over a 24-month period. Patients were divided into quartiles for data analysis. Duration of surgery decreased significantly between quartiles: 324 ± 124, 225 ± 70, 190 ± 47, and 168 ± 40 minutes, respectively ( P < 0.01). However, the conversion rate (3.1%) and mean hospital length of stay (2.1 ± 2.4 days) were unaffected by surgeon experience. The early and late postoperative complication rates were 9.4 and 3.1 per cent, respectively. Early complications included: leak (1.3%), bleeding (3.8%), obstruction (1.9%), acute gastric distention (0.6%), subphrenic abscess (0.6%), and wound infection (0.6%). Late complications include: obstruction (1.3%), anastomotic stricture (1.3%), and marginal ulcer (0.6%). The complication rates did not change statistically between quartiles. The excess weight loss at one year was 77.4 ± 16.7 per cent. These data suggest that throughout the learning curve laparoscopic gastric bypass can be accomplished with acceptable complication rates, conversion rates, and hospital length of stay. Duration of surgery improves with experience. Early weight loss results compare favorably with those of open gastric bypass.
The Clinical Significance of an Isofunctioning Thyroid Nodule
Authors: Hedayati Nasim , McHenry Christopher R.
Published: November 2022

The management of an “isofunctioning” thyroid nodule—defined by radioiodine uptake equivalent to normal thyroid tissue—is often a dilemma. Our goal was to determine the percentage of thyroid nodules that were isofunctioning and the frequency with which carcinoma occurred in an isofunctioning nodule. Patients referred for evaluation of a thyroid nodule from 1990 to 2002 were reviewed and those with an iodine-123 thyroid scintiscan were identified. Nodule size, serum thyrotropin, fine-needle aspiration biopsy, pathology, and follow-up were determined for patients with an isofunctioning, hypofunctioning, or hyperfunctioning thyroid nodule. Of the 562 patients with a thyroid nodule 273 (49%) had a thyroid scan. Nodules were hypofunctioning in 232 (85%), isofunctioning in 29 (11%), and hyperfunctioning in 12 (4%) patients. Mean nodule size and serum thyrotropin level were respectively 2.49 ± 0.23 cm and 1.73 ± 0.26 μIU/mL for isofunctioning, 2.47 ± 0.31 cm and 0.83 ± 0.21 μIU/mL for hyperfunctioning, and 3.94 ± 0.13 cm and 1.86 ± 0.28 μIU/mL for hypofunctioning nodules. Seventeen patients with an isofunctioning nodule underwent thyroidectomy and 12 patients were followed for a mean 27 months without an increase in nodule size. No patient with a hyperfunctioning nodule, six patients (21%) with an isofunctioning nodule, and 44 patients (19%) with a hypofunctioning nodule had a carcinoma. We conclude that the risk of malignancy in an isofunctioning nodule is similar to that of a hypofunctioning nodule and therefore the management should be based on routine fine-needle aspiration biopsy.
Management of Ovarian Cysts in Women Undergoing Restorative Proctocolectomy for Ulcerative Colitis
Authors: Thakur Anjani , Yang Isaac , Lin Albert , Buchmiller-Crair Terry , Fonkalsrud Eric W.
Published: November 2022

More than half of all patients undergoing restorative proctocolectomy (RP) for ulcerative colitis (UC) are women, yet there is a paucity of information regarding the frequency, management, and outcome of ovarian cysts. A single surgeon's (E.W.F.) experience with female patients (N = 165) who underwent RP for UC at an academic medical center was retrospectively evaluated for postoperative complications and overall outcome. Patients with large ovarian cysts (LOCs), defined as being greater than 5 cm in diameter, were further segregated for subanalysis. All results were analyzed using the Student's t test and Fisher's exact test. Patients were 29.3 ± 13 years (mean) at the time of RP; 34 patients were less than 16 years old (21%), 113 patients (68%) were between the ages of 17 and 46 years, and 18 patients were over 46 years old (11%). All patients underwent total colectomy, mucosal proctectomy ileal pouch-anal anastomosis, and temporary end ileostomy. The ileostomy was closed 3 months later. Fifty-five of the 165 patients had ovarian cysts (33%) identified at operation, 46 had unilateral cysts, and nine had bilateral cysts. Mean ovarian cyst size was 4.6 ± 2.7 cm (range <1–13 cm); 14 were LOCs. Patients with cysts <3 cm in diameter at operation were treated by observation with hormonal manipulation. Seventeen patients with cysts 3 to 5 cm in diameter required partial resection of one or both ovaries. Six of 14 patients with LOC underwent unilateral oophorectomy (cyst size range 10–13 cm). Twelve patients presented within 3 years after RP with malfunction of the pouch because of adhesions or minimal and uncontrolled passage of fecal material (soiling), partial obstruction due to LOC compression of the ileoanal pouch (n = 6), or adhesions. When evaluated on the basis of ovarian cyst size those without cysts and those with small cysts were significantly more likely to have children than those with LOC: 54 of 110 patients without cysts (49%), 18 of the 41 with cysts less than 5 cm in diameter (44%), and two of the 14 patients with LOC (14%) have had children ( P = 0.047). Ovarian cysts are common in women undergoing RP for UC. Ovarian cysts often complicate postoperative intestinal function and are best treated by cyst resection or oophorectomy at the time of RP or ileostomy closure. Cysts under 3 cm in diameter may often be managed conservatively with few complications. Women with LOC after RP for UC have decreased fertility compared with those without cysts.
Pneumatosis Cystoides Intestinalis with Free Intraperitoneal Air: A Case Report
Authors: Hwang Joanna , Reddy V. Sreenath , Sharp Kenneth W.
Published: November 2022

Pneumatosis cystoides intestinalis (PCI) is a rare disorder of the medical management and clinical outcome of which largely depend on the severity of its clinical manifestation. A limited number of cases have been reported in the literature although it is suggested that the true incidence of this disorder is higher than observed in clinical practice. This is the case of a 76-year-old woman with a past medical history of Crohn's disease found to have PCI. The patient initially complained of abdominal pain, distention, and weight loss. Chest and abdominal radiographs demonstrated free intraperitoneal air. CT scans revealed characteristic air-filled cysts in the intestinal wall, which established the diagnosis of PCI. Because the patient did not have an acute abdomen or findings requiring emergency laparotomy she was treated nonoperatively with supportive care. Her symptoms resolved gradually over several days. The patient was discharged home in stable condition tolerating a regular diet and was doing well at follow-up. The sole finding of free air with PCI does not mandate exploratory laparotomy.
An Unusual Complication after Hyaluronate-Based Bioresorbable Membrane (Seprafilm) Application
Authors: Remzi Feza H. , Oncel Mustafa , Church James M. , Senagore Anthony J. , Delaney Conor P. , Fazio Victor W.
Published: November 2022

Recent developments in adhesion prevention have led to the introduction of a sodium hyaluranate-based bioresorbable membrane into clinical practice. Its application has been regarded as safe and efficient. We present three cases of postoperative acute aseptic peritonitis without an obvious etiology, which might have been related to this bioresorbable membrane during recent surgery. Surgeons should be aware of this kind of a complication that might be attributed to this product.
Laparoscopic Adrenalectomy and Splenectomy are Safe and Reduce Hospital Stay and Charges
Authors: Heslin Martin J. , Winzeler Ashley H. , Weingarten Jill O. , Diethelm Arnold G. , Urist Marshall M. , Bland Kirby I.
Published: November 2022

The proposed benefits of laparoscopy for certain surgical procedures have been decreased postoperative pain and hospital stay balanced against the proposed deficits of increased costs. We have reviewed our data to evaluate factors associated with patient, procedure, and hospital charges for patients undergoing open versus laparoscopic adrenalectomy and splenectomy during the same time period. Eighty-seven patients underwent adrenalectomy (n = 47) or splenectomy (n = 40) from October 30, 1995 to June 6, 2001 and were retrospectively reviewed. Patient and operative factors were analyzed by intent to treat; the major endpoints were operating room (OR) time in minutes, blood loss in cm3, length of hospital stay in days, and charges broken down by anesthesia/operation [OR/recovery room (RR)] and total charges in dollars x 1000. Comparisons of means were analyzed by unpaired t test; data are presented as mean ± SEM, and significance is defined as P < 0.05. Median age of the group was 47 years (range 20–77). Forty-five patients underwent a laparoscopic approach of which two were converted to open (4%) as compared with 42 undergoing an open operation; one patient from each group was excluded from outcome analyses because of prolonged hospitalization (>3 weeks). Operative mortality of the whole group was one per cent. There were no differences between the groups with respect to age, gender, or comorbidity. The laparoscopic group had significantly longer operative times and OR/RR charges. However, the length of hospital stay and the total charges for the patient undergoing a laparoscopic approach were significantly less ( P < 0.05). We conclude that a laparoscopic approach for adrenalectomy or splenectomy can be accomplished in approximately 95 per cent of patients selected for this procedure. Despite prolonged OR time and increased OR/RR charges the laparoscopic procedures resulted in significantly decreased length of hospital stay and overall patient charges. Laparoscopy is a safe and cost-effective approach and should be strongly considered in patients requiring adrenalectomy or splenectomy.
Subcuticular Closure versus Dermabond: A Prospective Randomized Trial
Authors: Switzer Erin F. , Dinsmore Robert C. , North James H.
Published: November 2022

2-Octylcyanoacrylate tissue adhesive (Dermabond™, Ethicon, Inc, Somerville, NJ) is being used successfully for closure of minor lacerations. To date, however, there have been no studies evaluating its use in the operating room for surgical incisions. We conducted a prospective randomized trial to compare the closure of inguinal herniorrhaphy incisions using 2-octylcyanoacrylate tissue adhesive (Dermabond) with closures using 4–0 Monocryl (Ethicon, Inc) in a running subcuticular closure. A total of 46 incisions were randomized at the time of closure. Of these incisions 24 were randomized to Dermabond closure (TA) and 22 were randomized to subcuticular closure (SC). Performance measures included: time for closure, wound complications, and cosmesis. Cosmesis was evaluated by blinded evaluation of photographs of the incisions taken 4 weeks after surgery. Closure times for the TA group were faster than in the SC group (mean of 155 vs 286 seconds; P < 0.001). Wound complications were higher in the TA group ( P = 0.045). Cosmesis was also felt to be better in the SC group with a score of 4.2 versus 3.88, but this did not reach statistical significance. Although the use of Dermabond did result in faster wound cultures it also resulted in an increase in wound complications. The difference in mean cosmetic score for each group was not statistically significant but trended toward better scores in the SC group. Based on these findings we do not feel Dermabond is an acceptable alternative to subcuticular suture closure in inguinal herniorrhaphy incisions.
Comparison of Tissue Integration between Polyester and Polypropylene Prostheses in the Preperitoneal Space
Authors: Gonzalez Rodrigo , Ramshaw Bruce J.
Published: November 2022

Tissue integration and implant characteristics of various biomaterials commonly used for inguinal hernia repair have not been studied extensively. The aim of this study is to compare behavior and tissue response between two new polyester prostheses and a commonly used polypropylene (PP) mesh. The polyester prostheses utilized were polyester flat (PF) and polyester soft three-dimensional (PS); the PP mesh utilized was Marlex®. Eight randomly assigned 4 x 4-cm2 pieces of two different meshes were fixed in the preperitoneal space with a centrally placed single suture. Gross evaluation included shrinkage and stiffness. Histological evaluation included amount of fibrous and fat encapsulation, connective tissue, foreign-body reaction, neovascularization, hemorrhage, necrosis, and exudate. Evaluations were graded on a zero to four scale. The area and the area ratio were measured using a calibrated micrometer. PP mesh resulted in more fibrous encapsulation and stiffness than PF and PS prostheses. PP also resulted in less connective tissue formation and foreign-body reaction than PF and PS prostheses. There was no difference in fat encapsulation, necrosis, hemorrhage, or exudate between prostheses. Both polyester prostheses (PF and PS) have better tissue integration than the PP mesh, as evidenced by the higher amount of connective tissue and lower extent of fibrous encapsulation.
Experienced Scintigraphers Contribute to Success of Minimally Invasive Parathyroidectomy by Skilled Endocrine Surgeons
Authors: Clark Paige B. , Case Doug , Watson Nat E. , Morton Kathryn A. , Perrier Nancy D.
Published: November 2022

Minimally invasive parathyroidectomy (MIP) has become the preferred surgical treatment for selected patients diagnosed with primary hyperparathyroidism (PHPT) at our tertiary-care center. Preoperative scintigraphy establishes the position of a parathyroid adenoma, dictates the incision site, and can minimize incision size and consequent tissue dissection. We reviewed our database and sought to identify factors that led to discordant preoperative imaging and operative findings and to assess the effect of experience on these findings. A retrospective review was performed on all patients with biochemically proven PHPT who underwent Tc-99m sestamibi scintigraphy and surgical intervention. Patient demographics, date of surgical intervention, scintigraphic localization, surgical findings, pre- and postoperative biochemical markers, histopathology, coexisting thyroid pathology, and 6-month follow up were recorded. Preoperative images that were discordant with operative findings were independently reviewed. Parathyroid scintigraphy was performed on 125 consecutive patients for PHPT between November 1999 and January 2002. Seventy-six patients had MIPs, 35 had standard cervical explorations, 11 had MIPs that were converted to standard cervical explorations, and three had surgery directed to an ectopic location. At 6-month follow-up 98.4 per cent were cured. Preoperative imaging and surgical findings were ipsilateral and concordant in 105 of 118 (89%) patients with parathyroid adenoma. The anatomic origin of an adenoma was predicted in only 83 of 118 (68%) patients. Most of the inaccurate scintigraphy readings occurred during the first 13 of the 26 months that MIPs were performed at our institution. Only two discordant cases occurred during the last 9 months of this period. Biochemical markers, prior neck operation, and concomitant thyroid pathology had no correlation with imaging sensitivity. Scintigraphic interpretation of smaller adenomas was less reliable; discordant cases were more common in small adenomas. Communication between endocrine surgeons and nuclear medicine physicians about the MIP technique and anatomic orientation of adenomas led to better scintigraphic localization as experience increased. Now that MIP by skilled endocrine surgeons is becoming the favored treatment for PHPT experienced nuclear medicine physicians may be the most important factor to achieve maximum success.
Bilateral Renal Rupture in a Patient on Hemodialysis
Authors: Carlson Chris C. , Holsten Steve J. , Grandas Oscar H.
Published: November 2022

This is a case presentation and discussion of a dialysis patient who presented to the surgical service with abdominal pain, hypotension, and tachycardia and in extremis who was found to have a contained retroperitoneal hematoma after rupture of his left kidney. Six months after an uneventful nephrectomy and postoperative recovery he again presented with hypotension and anemia and was found to have a contralateral retroperitoneal hematoma consistent with renal hemorrhage. After unsuccessful angioembolization, the patient underwent a right nephrectomy and recovered without sequelae. Bilateral spontaneous renal rupture is a rare event documented by only a few anecdotal reports in the literature and usually associated with acquired cystic kidney disease. Rupture of renal cysts is relatively common in renal cystic disease but usually presents as asymptomatic hematuria or flank pain. Trauma is the most common cause of renal rupture, but other causes of spontaneous renal rupture are rare and include polyarteritis nodosa and urothelial carcinoma. The diagnosis of acute abdominal pain in the dialysis patient is a challenging differential. While a rare complication the diagnosis of spontaneous renal rupture should not be excluded in a patient presenting with abdominal pain, hypotension, and anemia.
Bilateral Diaphragmatic Agenesis in an Adult Complicated by a Paraduodenal Hernia
Authors: Anderson Christopher D. , Eliason Jonathan , Roberts John R. , Sharp Kenneth W.
Published: November 2022

Diaphragmatic agenesis is an extremely rare clinical entity and has only been reported five previous times in the English literature. We report a patient with bilateral diaphragmatic agenesis complicated by a paraduodenal hernia. Diaphragmatic agenesis is rarely diagnosed preoperatively. Most diagnoses will likely be made during exploration for suspected bowel obstruction or other gastrointestinal emergency. When they are found repair seems warranted if contamination from associated procedures such as bowel resection is minimal. Repair of diaphragmatic agenesis can be approached much like the creation of a neodiaphragm after diaphragmatic resection. The diagnosis of paraduodenal hernia can usually be confirmed radiologically. Many cases of paraduodenal hernias have been reported and repair is uniformly recommended.
Hepatectomy in Children under Total Hepatic Occlusion
Authors: Liu Donald C. , Vogel Adam M. , Gulec Seza , Santore Matthew J. , Wu Yeming , Hill Charles B.
Published: November 2022

Major ablative hepatic resection is often indicated in children with solid liver tumors, and reduction of operative blood transfusion is a primary goal. Total hepatic occlusion (THO) is an effective method that is well established in adults, yet its role in children is less well described. We describe our preliminary experience with THO in children assessing surgical outcome. The charts of seven children (ages 5 months to 7 years, weight 6–30 kg) who underwent THO during hepatectomy (four right and three left lobectomies) for liver tumors (hepatoblastoma in three, metastatic Wilm's tumor in two, mesenchymal hamartoma in one, and angiosarcoma in one) between January 1997 and June 2002 were reviewed. THO was established in all cases by clamping the supra- and intrahepatic inferior vena cava and the porta hepatis. Surgical parameters assessed included: 1) warm ischemia time, 2) operative blood transfusion, 3) operative complications, and 4) tumor resection margins. THO was successful in six of the seven cases (85.7%). In one case systemic hypotension unresponsive to fluid resuscitation developed at the outset with THO requiring conversion to pedicle clamping to perform the hepatectomy. Mean warm ischemia time during THO was 26 minutes (range 18–45 minutes). Mean estimated blood loss was 221 cm3(range 50–800 cm3). Operative blood transfusion was required in one of six patients (15 cm3/kg). Excluding the “failed” THO case (intraoperative hypotension) there were no significant intraoperative or postoperative complications. All seven children had curative resections as indicated by “tumor-free” microscopic margins. We conclude that total hepatic occlusion can be performed safely and successfully for pediatric liver tumors. Operative blood transfusion appears to be minimized.
The Role of Vena Caval Filters in the Management of Venous Thromboembolism
Authors: Jacobs David G. , Sing Ronald F.
Published: November 2022

Deep venous thrombosis (DVT) and pulmonary embolism (PE) are important, and not infrequent, causes of morbidity and mortality in critically ill patients. Anticoagulation remains the treatment of choice for DVT and PE, but contraindications to, and complications from, anticoagulant therapy mandate the availability of alternate therapeutic and prophylactic strategies. The recent availability of safe and effective vena caval filters that can be inserted via a minimally invasive percutaneous approach has expanded the indications for, and acceptance of, these devices in selected patients at high risk for the development of PE. This article reviews both the established and the evolving indications for vena caval filters and discusses how improvements in filter design may impact future use.
Biopsy Needle Technique and the Accuracy of Diagnosis of Atypical Ductal Hyperplasia for Mammographic Abnormalities
Authors: Zhao Li , Freimanis Rita , Bergman Simon , Shen Perry , Perrier Nancy D. , Lesko Nadine , Pulaski Thomas , Pulaski Sherry , Carr J. Jeffrey , Levine Edward A.
Published: November 2022

The evaluation of mammographic abnormalities has become a substantial effort for surgeons and radiologists. The vacuum-assisted core biopsy (VACB) has been touted as a more accurate tool for the evaluation of mammographic lesions. Diagnosis of atypical ductal hyperplasia (ADH) from a percutaneous needle biopsy of the breast is associated with a significant risk of missing a significant breast lesion. We compared 2 methods of sampling with stereotactic-guided breast biopsy, 14-gauge automated gun core biopsy (AGCB) and VACB, on the accuracy of diagnosis of ADH at a single institution. All cases of ADH, without associated malignancy, found via image-guided breast biopsy of nonpalpable lesions between March 1996 and April 2002 were evaluated. VACB biopsy needles were utilized between July 1998 to April 2002 (686 patients) and 14-gauge AGCB from March 1996 to June 1998 (350 patients). The results of these biopsies were reviewed and compared to surgical biopsy and pathological records. ADH alone was found in 53 cases (5.1% of biopsies; mean age 57.9 years). Of these, 39 patients with ADH subsequently underwent wire-localized excisional biopsy. The other 14 patients were observed. VACB biopsy understaged 7 of 29 (24%) patients with ADH (all of which were DCIS), AGCB understaged 4 of 10 cases (40%) with one being invasive. Of the patients in the core biopsy group who were initially followed, 2 developed significant lesions within 3 years of follow-up in the same quadrant of the breast. If these cases are added to the AGCB group, then 50 per cent were understaged and significantly more invasive lesions were understaged than with VACB (17% vs. 0%; P = 0.018). The VACB resulted in less understaging of ADH than AGCB. However, there remains a significant risk of missing DCIS in this setting even with the VACB. Furthermore, the risk of understaging an invasive lesion is significantly lower in this setting with a VACB than an AGCB. Although the risk of understaging ADH is lower with the VACB, we continue to recommend excisional biopsy in a good-risk patient when a diagnosis of ADH is rendered via VACB biopsy.
Comparison of Outcomes in Noncomplicated and in Higher-Risk Donors after Standard versus Hand-Assisted Laparoscopic Nephrectomy
Authors: Mateo Rod B. , Sher Linda , Jabbour Nicolas , Singh Gagandeep , Chan Linda , Selby Robert R. , El-Shahawy Mohamed , Genyk Yuri
Published: November 2022

Hand-assisted techniques facilitated dissemination of the laparoscopic approach in live kidney donors and addressed concerns regarding potential procedural complications. We report our experience with both standard and hand-assisted laparoscopic nephrectomy in routine, complicated, and higher-risk donors. From July 1999 to September 2002, 47 donors underwent standard laparoscopic donor nephrectomy (SLDN; n = 29) or hand-assisted laparoscopic donor nephrectomy (HALDN; n = 18). Donors were “complicated” if they were >60 years of age, obese, refused blood-product transfusion, had multiple renal arteries or veins, or had right nephrectomies. “Higher-risk” donors had two or more risk factors. Results for SLDN and HALDN were compared for the overall groups and for the “complicated” and “higher-risk” groups. No donor required blood transfusion or reoperation. Warm-ischemia times were shorter in left nephrectomies (191 ± 72 seconds vs. 337 ± 95 seconds, P = 0.005), and blood loss was greater in patients with a body mass index ≥30 kg/m2 (296 ± 232 mL vs. 170 ± 139 mL, P = 0.03). Higher-risk donors had an increased operative blood loss and longer hospital stay than low-risk donors. Mean donor creatinine at discharge was 1.19 ± 0.2 mg/dL. Comparison of SLDN versus HALDN revealed shorter operating times for the latter, which approached statistical significance. Warm-ischemia time, operative blood loss, length of hospitalization, and donor and recipient discharge creatinines were similar for both groups. Laparoscopic donor nephrectomy can be applied to selected higher-risk donors with outcomes comparable to uncomplicated donors. Hand-assisted techniques facilitate the procedure during the learning curve, with advantages similar to standard laparoscopic techniques.