bluuebunny/crossref_metadata_2025 huggingface dataset:
Total pancreatectomy with islet autotransplantation in diabetic and pre-diabetic patients with intractable chronic pancreatitis
Authors: Bachul Piotr J. , Grybowski Damian J. , Anteby Roi , Basto Lindsay , Perea Laurencia , Golab Karolina , Wang Ling-Jia , Tibudan Martin , Gutierrez Angelica P. , Komorniczak Michal , Nagpal Sajan , Lucander Aaron , Fung John , Matthews Jeffrey B. , Witkowski Piotr
Published: May 2020

Total pancreatectomy with islet autotransplantation (TPIAT) is an effective treatment option for non-diabetic patients with intractable chronic pancreatitis. The outcome and potential benefits for pre-diabetic and diabetic patients are less well established. Thirty-four patients underwent TPIAT were retrospectively divided into 3 groups according to pre-operative glycemic control: diabetes mellitus (DM) (n = 5, 15%), pre-DM (n = 11, 32%) and non-DM (n = 18, 54%). Pre-operative fasting c-peptide was detectable and similar in all 3 groups. Islet yield in the DM group was comparable to pre-DM and non-DM groups (median islet equivalents [IEQ] was 191,800, 111,800, and 232,000 IEQ, respectively). Patients received islet mass of over the target level of 2000 IEQ/kg in pre-DM and DM at lower but clinically meaningful rates compared to the non-DM group: 45% (5/11) and 60% (3/5) for a combined 50% (8/16) rate, respectively, compared to 83% (15/18) for the non-DM group. At 1 year, fasting c-peptide and HbA1c did not differ between DM and pre-DM groups but c-peptide was significantly higher in non-DM. Islet transplantation failed (negative c-peptide) only in 1 patient. Pre-operatively, all patients experienced pancreatic pain with daily opioid dependence in 60% to 70%. Pancreatic-type pain gradually subsided completely in all groups with no differences in other painful somatic symptoms. Diabetic patients with measurable pre-operative c-peptide can achieve similar benefit from TPIAT, with comparable outcomes to pre-diabetic and non-diabetic patients including pain relief and the metabolic benefit of transplanted islets. Not surprisingly, endocrine outcomes for diabetic and pre-diabetics patients are substantially worse than in those with normal pre-operative glucose control.
Early drain removal after major pancreatectomy reduces postoperative complications: a single-center, randomized, controlled trial
Authors: Dai Menghua , Liu Qiaofei , Xing Cheng , Kleeff Jorg , Liao Quan , Guo Junchao , Han Xianlin , Xu Qiang , Wang Shunda
Published: May 2020

Objectives:

Timing of drain removal and its effects on complications after major pancreatectomy remain controversial. We designed this study to assess whether early drain removal after major pancreatectomy influences the incidence of complications in the patients with low risk of postoperative pancreatic fistula (POPF).

Methods:

This is a single-center randomized controlled trial (RCT). A total of 144 patients undergoing pancreaticoduodenectomy (PD) and distal pancreatectomy (DP) who met the criteria, including drain amylase on postoperative day (POD) 1 and 3 less than 5000 U/L and drain output within POD 3 less than 300 mL/d, were randomly assigned to early drain removal (POD 3) or standard drain removal (≥POD 5). The primary outcome was major complications (Clavien-Dindo grades 2–4), and the secondary outcome was POPF, reintervention treatment, readmission, and total medical expense within 3 months after surgery.

Results:

A total of 5 patients in early drain removal group had at least 1 major complications (grades 2–4), compared to 15 patients in standard drain removal group (P = .028). The incidence of grade B/C pancreatic fistula was not significantly different (2.8% vs 0%). Multivariate analysis demonstrated that early drain removal was an independent factor associated with a reduced risk of major complications (P = .039, odds ratio = 0.314). Majority of major complications occurred in PD patients, and only very few cases occurred in DP patients. Stratified analysis showed that early drain removal significantly reduced the major complications only in the patients undergoing PD.

Conclusion:

This single-center RCT shows early drain removal on POD 3 is safe for both DP and PD patients, under our criteria. Early drain removal could reduce the incidence of major complications in patients undergoing PD.
Training and learning curves in minimally invasive pancreatic surgery: from simulation to mastery
Authors: Haney Caelán M. , Karadza Emir , Limen Eldridge F. , de Santibanes Martin , Kinny-Köster Benedict , Müller Philip C. , Bintintan Vasile V. , Kulu Yakub , Hackert Thilo , Müller-Stich Beat-Peter , Nickel Felix
Published: May 2020

Background:

Minimally invasive pancreatic surgery (MIPS) has developed over the last 3 decades and is nowadays experiencing an increased interest from the surgical community. With increasing awareness of both the public and the surgical community on patient safety, optimization of training has gained importance. For implementation of MIPS we propose 3 training phases. The first phase focuses on developing basic skills and procedure specific skills with the help of simulation, biotissue drills, video libraries, live case observations, and training courses. The second phase consists of index procedures, fellowships, and proctoring programs to ensure patient safety during the first procedures. During the third phase the surgeons aim is to safely implement the procedure into standard practice while minimizing learning curve related excess morbidity and mortality. Case selection, skills assessment, feedback, and mentoring are important methods to optimize this phase. The residual learning curve can reach up to 100 cases depending on the surgeons’ previous experience, selection of cases, and definition of the parameters used to assess the learning curve. Adequate training and high procedural volume are key to implementing MIPS safely.
Pedagogy for Effective Learning of Clinical Skills: An Integrated Laboratory Model
Authors: Reilly Michelle , Beran-Shepler Kimberly , Paschal Karen A.
Published: May 2020

Background and Purpose.

The teaching, learning, and assessment of clinical skills is a critical component of entry-level physical therapy education. The intention of this article was to describe a successful model for teaching clinical skills in the context of the patient and client management model across the domains of physical therapist education with emphasis on motor learning principles, experiential learning, and clinical reasoning.

Method/Model Description and Evaluation.

The model describes a cohesive laboratory learning environment that integrates skills from the clinical science courses that coincide each semester. A laboratory director coordinates with faculty teaching clinical sciences in a given semester to ensure the necessary psychomotor content is included, creates experiential learning opportunities that integrate skills across content areas, and promotes clinical reasoning in the context of the patient and client management model. Success of this model was measured through student outcomes on skills competency tests (SCTs), Clinical Competence Performance Examinations (CCPEs), American Physical Therapy Association (APTA) Clinical Performance Instrument (CPI) benchmarks, and the National Physical Therapy Examination (NPTE).

Outcomes.

Each student passed SCTs administered during semesters 1–6 given a maximum of 3 trials. Every student passed the CCPE administered at the end of each semester in one of 3 trials except for one student in semester 6. Each student met expectations for performance as measured on the CPI for 4 clinical education experiences including entry-level performance for the final 2terminal experiences. All students were successful on the NPTE.

Discussion and Conclusion.

Implementation of this model has prepared students for authentic physical therapy practice by promoting integration of curriculum content and has fostered faculty collaboration. While initial student and curricular outcomes have been positive, assessment of the model is ongoing.
Influence of noninvasive central blood pressure devices for afterload monitoring with aortic velocity-pressure Loop in anesthetized patients
Authors: Leve Charlotte , Hong Alex , Millasseau Sandrine , Joachim Jona , Touchard Cyril , Mateo Joaquim , Serrano José , Mebazaa Alexandre , Gayat Etienne , Vallee Fabrice
Published: May 2020

Background

Global afterload angle (GALA) is a parameter derived from velocity-pressure loop (VP Loop), for continuous assessment of cardiac afterload in the operating room. It has been validated with invasive measure of central pressure. The aim of this study was to evaluate the feasibility of noninvasive VP Loop obtained with central pressure measured with two different noninvasive tonometers.

Methods

A prospective, observational, monocentric study was conducted in 51 patients under general anesthesia. Invasive central pressure (cPINV) was measured with a fulfilled intravascular catheter, and noninvasive central pressure signals were obtained with two applanation tonometry devices: radial artery tonometry (cPSHYG: Sphygmocor tonometer) and carotid tonometry (cPCOMP: Complior tonometer). Three VP Loops were built: VP LoopINV, VP LoopSPHYG and VP LoopCOMP. Patients were separated according to cardiovascular risk factors.

Results

In the 51 patients under general anesthesia, cPSHYG was adequately obtained in 48 patients (89%) but, compared to cPINV, SBP was underestimated (−4 ± 6 mmHg, P < 0.0001), augmentation index (AIXSPHYG) and a GALASPHYG were overestimated (+13 ± 19%, P = 0.0077 and +4 ± 8°, P = 0.0024, respectively) with large limit of agreement (LOA) (−21 to 47% and −13 to 21° for AIXSPHYG and GALASPHYG, respectively). With the Complior, the failure rate of measurement for cPCOMP was 41%. SBP was similar (3 ± 17 mmHg, P = 0.32), AIXCOMP was underestimated (−11 ± 19%, P = 0.0046) and GALACOMP was similar but with large LOA (−50 to 26% and −20 to 18° for AIXCOMP and GALACOMP, respectively).

Conclusion

In anesthetized patient, the reliability of noninvasive central pressure monitoring by tonometry seems too limited to monitor cardiac afterload with VP Loop.
Dynamic Change of β to α Ratio in Islets of Chinese People With Prediabetes and Type 2 Diabetes Mellitus
Authors: Liu Tengli , Liang Rui , Wang Le , Zou Jiaqi , Wang Guanqiao , Liu Na , Sun Peng , Liu Yaojuan , Ding Xuejie , Lu Chenxi , Liang Xue , Wang Shusen , Shen Zhongyang
Published: May 2020

Objectives

The present study aimed to investigate the dynamic change of α cells and β cells, and their ratios in prediabetes and type 2 diabetes in the Chinese population.

Methods

Pancreata from 27 nondiabetic (ND), 8 prediabetic (PreD), and 19 type 2 diabetic (T2D) organ donors were subjected to immunofluorescence staining with insulin and glucagon.

Results

The β to α ratio in islets (β/α) in PreD was significantly higher than that in ND, resulting from an increase of β cells and a decrease of α cells per islet, but that in T2D was significantly lower than that in ND, resulting from a decrease of β cells and an increase of α cells per islet. The β-cell percentage and β/α ratio positively correlated and α-cell percentage negatively correlated with HbA1c (glycated hemoglobin) in ND and PreD, but these correlations disappeared when T2D subjects were included.

Conclusions

The islet β to α ratio increased in PreD individuals because of a relative α-cell loss and β-cell compensation and decreased after T2D onset because of both β-cell loss and α-cell reexpansion.
Positive and Useful Voices in Patients With Schizophrenia
Authors: Lorente-Rovira Esther , Grasa Eva , Ochoa Susana , Corripio Iluminada , Peláez Trinidad , López-Carrillero Raquel , Morano-Guillén María , Gutiérrez-Gea Ángela , Villagrán José M. , Llácer Blanca , Sanjuán Julio
Published: May 2020

Auditory verbal hallucinations (AVHs) in schizophrenia have been characterized by their negative emotional valence. However, positive hallucinations have also been described. The objective of the current study is to explore the prevalence, course, characteristics, and associations of positive and useful voices. The Positive and Useful Voices Inquiry and some clinical and functioning instruments were administered to a sample of 68 patients with schizophrenia or schizoaffective disorder presenting with AVHs. Both the lifetime and current prevalences of positive and useful voices were high. Although AVHs tended to remain stable, there was a trend to decrease over time. The strongest positive attributions of such voices were that they help patients to feel important, amuse them, and help them to conduct their studies and carry out their profession. They seem to be mainly related to more grandiosity and to worse general functioning. Interference with biological and psychological treatments and the need for personalized formulations in patients with auditory hallucinations are discussed.
Chief Nurse Executive Readiness for the Here and Now
Authors: Boston-Fleischhauer Carol
Published: May 2020

The significant role of the chief nurse executive in leading healthcare innovation has been widely discussed in the literature, including the importance of monitoring market disruptors and determining how to best respond. Critical to implementing and sustaining innovation is attention to leadership competencies, organizational enablers, and cultural transformation throughout the entire nursing enterprise. Chief nurse executives are challenged to examine personal and organizational readiness.
Designing for Efficiency
Authors: Fay Lindsey , Santiago Joshua E. , Real Kevin , Isaacs Kathy
Published: May 2020

OBJECTIVE

This study examined the impact of centralized and decentralized unit designs on an interdisciplinary team's perceptions of efficiency through the use of a preoccupancy and postoccupancy evaluation of a cardiovascular unit.

BACKGROUND

During the premove study, the service line was housed across 4 separate locations, each with a centralized nurses' station. The postmove design was housed on 1 floor with decentralized stations.

METHODS

For this qualitative study, 14 focus groups and 1 interview were conducted. Analysis of the data was guided by a developed framework for efficiency classified into 7 categories.

RESULTS

Outcomes reveal that efficiency was impacted by issues including walking, access to supplies and equipment, proximity to staff, and overall unit configuration and size.

CONCLUSIONS

Although the design of the decentralized unit positions staff members closer to patients, many feel isolated while the centralized units seemed to better promote staff proximity and access to supplies.
Exome Sequencing and Its Emerging Role in Prenatal Genetic Diagnosis
Authors: Hopkins Maeve K. , Dugoff Lorraine , Kuller Jeffrey A.
Published: May 2020

Importance

Prenatal genetic diagnosis can guide pregnancy management and decision making. Genetic diagnosis has advanced rapidly, and chromosomal microarray has become widely used, in addition to conventional karyotype. Exome sequencing may provide an even higher detection rate of genetic anomalies and may be more commonly applied in the future.

Objective

The objectives of this manuscript are to review current practices in prenatal genetic diagnosis, define exome sequencing, identify scenarios in which exome sequencing may be indicated, identify potential concerns regarding exome sequencing, and review the importance for the general obstetrician-gynecologist to understand exome sequencing technology and its uses.

Evidence Acquisition

A MEDLINE search of “prenatal genetic testing,” “chromosomal microarray,” “conventional karyotype,” or “exome sequencing” in the review was performed.

Results

The evidence cited in this review includes 6 medical society committee opinions and 17 additional peer-reviewed journal articles that were original research or expert opinion summaries.

Conclusions and Relevance

Exome sequencing may be a useful prenatal genetic diagnostic tool in cases with ultrasound anomalies with previously normal chromosomal microarray and/or karyotype. As more data become available, technology improves, and costs fall, exome sequencing may become more widely used in prenatal genetic diagnosis.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, the learner should be better able to identify indications for prenatal genetic diagnosis; compare available methods of prenatal genetic diagnosis; define exome sequencing; refer patients for whom exome sequencing may be considered; and explain the benefits and limitations of exome sequencing for prenatal genetic diagnosis.
Exposure and Confidence With Critical Nonairway Procedures
Authors: Craig Simon S. , Auerbach Marc , Cheek John A. , Babl Franz E. , Oakley Ed , Nguyen Lucia , Rao Arjun , Dalton Sarah , Lyttle Mark D. , Mintegi Santiago , Nagler Joshua , Mistry Rakesh D. , Dixon Andrew , Rino Pedro , Kohn Loncarica Guillermo , Dalziel Stuart R. ,   for the Pediatric Emergency Research Networks
Published: May 2020

Background

Children rarely experience critical illness, resulting in low exposure of emergency physicians (EPs) to critical procedures. Our primary objective was to describe senior EP confidence, most recent performance, and/or supervision of critical nonairway procedures. Secondary objectives were to compare responses between those who work exclusively in PEM and those who do not and to determine whether confidence changed for selected procedures according to increasing patient age.

Methods

Survey of senior EPs working in 96 emergency departments (EDs) affiliated with the Pediatric Emergency Research Networks. Questions assessed training, performance, supervision, and confidence in 11 nonairway critical procedures, including cardiopulmonary resuscitation (CPR), vascular access, chest decompression, and cardiac procedures.

Results

Of 2446 physicians, 1503 (61%) responded to the survey. Within the previous year, only CPR and insertion of an intraosseous needle had been performed by at least 50% of respondents: over 20% had performed defibrillation/direct current cardioversion. More than 50% of respondents had never performed or supervised ED thoracotomy, pericardiocentesis, venous cutdown, or transcutaneous pacing. Self-reported confidence was high for all patient age groups for CPR, needle thoracocentesis, tube thoracostomy, intraosseous needle insertion, and defibrillation/DC cardioversion. Confidence levels increased with increasing patient age for central venous and arterial line insertion. Respondents working exclusively in PEM were more likely to report being at least somewhat confident in defibrillation/DC cardioversion, intraosseous needle insertion, and central venous line insertion in particular age groups; however, they were less likely to be at least somewhat confident in ED thoracotomy and transcutaneous pacing.

Conclusions

Cardiopulmonary resuscitation and intraosseous needle insertion were the only critical nonairway procedures performed by at least half of EPs within the previous year. Confidence was higher for these procedures, and needle and tube thoracostomy. These data may inform the development of continuing medical education activities to maintain pediatric procedural skills for emergency physicians.
Point-of-Care Ultrasound Training Programs Across Italian Pediatric Residency Schools: A National Survey
Authors: Buonsenso Danilo , Malamisura Monica , Musolino Anna Maria
Published: May 2020

Introduction

The role of point-of-care ultrasound (POCUS) in routine clinical practice is rapidly growing, whereas adult specialties have already included training programs regarding this topic; pediatric residency schools are still late on this topic, particularly in Italy.

Methods

We performed an online anonymous survey to Italian residents. The online survey has been submitted to the resident representatives of each pediatric residency school in Italy by the Italian Observatory of Pediatric Residents; each representative in turn distributed it to the pediatric residents of his own school.

Results

Three sixty-one residents responded to the survey. Only 7.8% of residents declared that in their residency school, an official training program on POCUS exists, although more than 95% of respondents declared that such a training would be of primary importance for their future practice. Most residents do not know how to use an ultrasound machine nor the differences between different probes.

Conclusions

Our results demonstrate that POCUS training is still missing in Italy. Given the growing number of evidences of the benefits from including POCUS in clinical practice and patient evaluation, efforts are needed to fill this gap, in Italy and, probably, in most European countries. Such a training will definitely help the new generation of pediatricians improve their curriculum and, therefore, child health.
COVID-19 Prevention and Control Public Health Strategies in Shanghai, China
Authors: Zhang Ni , Shi Tianqin , Zhong Heng , Guo Yijia
Published: May 2020

Context:

COVID-19 was characterized as a pandemic by the World Health Organization on March 11, 2020. This research aims to analyze the public health strategies to prevent and control COVID-19 in Shanghai, China, and provide recommendations for public health policy and interventions in the United States.

Program:

Based on the Social-Ecological Model, this research collected information for public health strategies from the Shanghai Municipal Health Commission and various Chinese websites.

Evaluation:

The daily confirmed new cases of COVID-19 decreased from 27 to 0 in 53 days since the first case of COVID-19 was confirmed in Shanghai on January 20, 2020.

Discussion:

The pattern of daily confirmed new cases suggests the effectiveness of public health strategies. This research also provides recommendations on the development and improvements of public health strategies in the U.S. by acknowledging the differences in political and social systems between the two countries.
Improving Early Discharges With an Electronic Health Record Discharge Optimization Tool
Authors: Perry Michael F. , Macias Charlie , Chaparro Juan D. , Heacock Allison C. , Jackson Kenneth , Bode Ryan S.
Published: May 2020

Introduction:

Delays in hospital discharge can negatively impact patient care, bed availability, and patient satisfaction. There are limited studies examining how the electronic health record (EHR) can be used to improve discharge timeliness. This study aimed to implement an EHR discharge optimization tool (DOT) successfully and achieve a discharge before noon (DBN) percentage of 25%.

Methods:

We conducted a single-center quality improvement study of patients discharged from 3 pediatric hospital medicine teaching service teams at a quaternary care academic children’s hospital. The multidisciplinary team created a DOT centrally embedded within the care team standard workflow to communicate anticipated time until discharge. The primary outcome was the monthly percentage of patients discharged before noon. Secondary outcomes included provider utilization of the DOT, tool accuracy, and patient length of stay. Balancing measures were 7- and 30-day readmission rates.

Results:

The DBN percentage increased from 16.4% to an average of 19.3% over the 13-month intervention period (P = 0.0005). DOT utilization was measured at 87.2%, and the overall accuracy of predicting time until discharge was 75.6% (P < 0.0001). Median length of stay declined from 1.75 to 1.68 days (P = 0.0033), and there was no negative impact on 7- or 30-day readmission rates.

Conclusion:

This initiative demonstrated that a highly utilized and accurate discharge tool could be created in the EHR to assist medical care teams with improving DBN percentage on busy, academic teaching services.
Human Hair as a Possible Surrogate Marker of Retained Tissue Gadolinium
Authors: Hasegawa Makoto , Duncan Brianne R. , Marshall Desiree A. , Gonzalez-Cuyar Luis F. , Paulsen Michael , Kobayashi Masahiro , Simpson Christopher , Maravilla Kenneth R.
Published: May 2020

Objectives

We used laser ablation inductively coupled plasma mass spectrometry to quantify gadolinium in hair samples from autopsy cases with gadolinium-based contrast agent (GBCA) exposure. Hair gadolinium data were correlated with gadolinium concentrations in brain, skin, and bone tissues from the same case to investigate a potential noninvasive method for gadolinium quantification and monitoring.

Materials and Methods

Medical records from autopsy cases at our institution were screened for history of GBCA exposure. Cases with exposure to a single type of GBCA with the most recent injection occurring within 1 year were identified and included in the study. The concentration of gadolinium in hair samples was analyzed by laser ablation inductively coupled plasma mass spectrometry, and brain (globus pallidus, dentate nucleus, white matter), bone, and skin tissues were analyzed by bulk inductively coupled plasma mass spectrometry. The mean of the maximum value in the hair samples was used to generate a representative measurement of the hair gadolinium concentration for each case. A linear regression analysis between each tissue type and hair was conducted to assess for possible correlation.

Results

Tissue and hair samples from 18 autopsies (16 cases with exposure to GBCA, 2 controls) were included in the study. Comparing the different tissues revealed good correlation between some tissue types. The best model fit occurred between white matter and hair (R
2 = 0.83; P < 0.0001) followed by the comparison between dentate nucleus and hair (R
2 = 0.72; P < 0.0001) and dentate nucleus and skin (R
2 = 0.70; P < 0.0001).

Conclusions

A significant correlation in this study between hair gadolinium concentrations and brain and skin gadolinium concentrations suggests that hair may serve as a safe and effective biomonitoring tissue for patients who receive GBCA injections.
FDG PET/CT in a Pregnant Woman With Breast Cancer
Authors: Drouet Clément , Vrigneaud Jean-Marc , Desmoulins Isabelle , Cochet Alexandre
Published: May 2020

This 37-year-old woman was diagnosed with breast cancer during pregnancy. After multidisciplinary meeting, she was referred to our department for an FDG PET/CT for staging, and chemotherapy with weekly infusion of paclitaxel was initiated before childbirth. We estimated the fetal dose from the PET/CT procedure, and our results show that, if deemed necessary, this examination can reasonably be performed during pregnancy. The patient gave birth vaginally at term to an apparently healthy girl.
18F-FDG PET/CT in Sporadic Creutzfeldt-Jakob Disease
Authors: Zizi Ghali , Berger Henri , Lalire Paul , Dejust Sébastien , Morland David
Published: May 2020

We report the case of a 64-year-old man referred for optic ataxia, constructional apraxia, and spatial orientation disorders evolving for 2 months. Benson syndrome (posterior cortical atrophy) was initially suspected. Brain 18F-FDG PET/CT depicted an asymmetric decreased uptake pattern consistent with Creutzfeldt-Jakob disease. 14-3-3 proteins were detected in the cerebrospinal fluid. Clinical evolution was quickly unfavorable. The patient died 1 month after the PET/CT, and Creutzfeldt-Jakob disease was confirmed on postmortem examination of brain tissue.
Is It Time to Introduce PET/CT in Colon Cancer Guidelines?
Authors: Maffione Anna Margherita , Rubello Domenico , Caroli Paola , Colletti Patrick M. , Matteucci Federica
Published: May 2020

International colon cancer guidelines suggest 18F-FDG PET/CT in a few circumstances: (1) at disease presentation in case of suspected or proven metastatic synchronous adenocarcinoma; (2) in the workup of recurrent colon cancer with metachronous metastases documented by CT, MRI, or biopsy and in case of serial CEA elevation with negative colonoscopy and negative CT; and (3) in case of contraindication to iodine- and gadolinium-based contrast agents. However, review of the literature has shown that PET/CT can also be used in other scenarios with significant levels of diagnostic advantage. This review aims to emphasize differences between guidelines and scientific literature for the use of PET/CT in colon cancer.
Egested Feces Revealed Massive Protein Loss in 99mTc-HSA-D Scintigraphy
Authors: Matsusaka Yohji , Nakahara Tadaki , Iwabuchi Yu , Owaki Yoshiki , Narimatsu Hidetoshi , Jinzaki Masahiro
Published: May 2020

A 66-year-old man with severe diarrhea and severe hypoproteinemia was referred for 99mTc-DTPA-human serum albumin (HSA-D) scintigraphy. The scintigraphy at 24 hours postinjection showed strong accumulation of 99mTc-HSA-D in not only the colon but also all his diapers containing his egested feces. The ratio of the diapers counts to the total counts was 17.0%, and a considerable amount of protein loss was confirmed. 99mTc-HSA-D scintigraphy has an important role in diagnosing protein-losing enteropathy, but the abdomen is the only routinely scanned area. Additional scanning of egested radiotracer and the whole body can be useful for evaluating the disease severity.
Hepatobiliary Scintigraphy in Cholecystocolonic Fistula
Authors: Philip Justin T. , Noor Muhammad , Leyva Alexander , Contreras Francisco
Published: May 2020

We report a case of a 50-year-old man diagnosed with cholecystocolonic fistula (CCF), confirmed by scintigraphy. After negative initial radiologic workup, a colonoscopy revealed findings of right-sided ischemic colitis. Soon after, a febrile episode prompted a repeat abdominal CT scan demonstrating a possible CCF, later confirmed with a nuclear medicine hepatobiliary scintigraphy and treated surgically. Less than 10% of CCFs are diagnosed preoperatively.
Vanishing Bone Metastases in 18F-FDG PET/CT
Authors: Ainouche Alida , Morland David , Durot Carole , Hoeffel Christine , Papathanassiou Dimitri
Published: May 2020

A 36-year-old woman with a history of large B-cell lymphoma was referred for the exploration of sclerotic bone thoracic vertebral metastases discovered on a contrast-enhanced CT examination. 18F-FDG PET showed no pathological uptake in the affected vertebrae, as well as normal vertebral density on the coupled unenhanced CT. After review of the initial contrast-enhanced CT, a left brachiocephalic vein stenosis was noted, leading to a retrograde contrast filling of the accessory hemiazygos vein and the capillary spaces within the vertebrae, mimicking sclerotic metastases.
Alternative Perforator Options for Insufficient Profunda Artery Perforators
Authors: Winters Harm , Tielemans Hanneke J. P. , van Wegen Marsha , Hupkens Pieter , Slater Nicholas J. , Ulrich Dietmar J. O.
Published: May 2020

Introduction

The profunda artery perforator (PAP) flap can be an alternative to the deep inferior epigastric artery flap. However, in some cases, the PAP may not be adequate to perfuse the whole flap. In this study, we describe 3 cases in which an alternative perforator was used for PAP flap perfusion. In addition, we describe an anatomical study to explore the perforasome of the PAP and alternative perforators.

Materials and Methods

Three cases are described in which an alternative perforator was used to successfully perfuse the pap flap. For the anatomical study, 7 PAP flaps were raised from cadavers. Ink was injected in the PAP, the gracilis perforator (GP) and the descending branch of the inferior gluteal artery perforator (DBIGA). Then, perfused area of the flap by each perforator was calculated.

Results

The 3 patients with alternative perforators recovered without complications, in addition, no signs of fat necrosis were observed. Concerning the anatomical study, mean perfusion area of the PAP pedicle was 204 ± 90 cm2 (range, 141–364 cm2). The GP and the DBIGA had a perfusion area of 182 ± 42 cm2 (range, 123–235 cm2) and 157 ± 22 cm2 (range, 136–192), respectively.

Conclusion

Although the PAP flap has considerable benefits over the more traditional inferior gluteal artery perforator and transverse upper gracilis flaps, a plastic surgeon might encounter a PAP flap perforator that is not deemed viable for flap perfusion. In these cases, the GP and DBIGA may be suitable “escape” alternatives to complete the reconstruction.
Reconstruction of Complex Abdominal Wall Defect With Autogenous Pedicled Demucosalized Seromuscular Flap
Authors: Asaad Malke , Vyas Krishna S. , Tran Nho V.
Published: May 2020

Abdominal wall reconstruction is indicated when 1 or more of the abdominal wall components (skin, fascia, or muscle) are either injured or absent. When faced with defects requiring flap reconstruction, the decision regarding flap choice should take into consideration the volume of soft tissue required, the extent of the defect, donor site morbidity, and prior surgical scars that affect flap vascularity. We present a case of an abdominal wall defect with limited reconstructive options in which a spare ileal bowel segment was filleted to create a seromuscular flap for improving the abdominal wall blood supply. The postoperative course was complicated by abdominal fluid collection, which resolved following an ultrasound-guided drain. The patient had normal wound healing and recovery without further postoperative complications at the 7-month follow-up. Seromuscular flaps are a practical option in the armamentarium of plastic surgeons performing abdominal wall reconstruction, especially when other alternatives are limited.
Thermoneutral Housing Temperature Improves Survival in a Murine Model of Polymicrobial Peritonitis
Authors: Carpenter Kelsey C. , Zhou Yesen , Hakenjos John M. , Fry Christopher D. , Nemzek Jean A.
Published: May 2020

Regulatory guidelines mandate housing for laboratory mice at temperatures below their thermoneutral zone, creating chronic cold stress. However, increases in housing temperature could alter immune responses. We hypothesized housing mice at temperatures within their thermoneutral zone would improve sepsis survival and alter immune responses. Male C57BL/6 mice were housed at 22°C or 30°C after cecal ligation and puncture (CLP) for 10 days. Survival of mice housed at 30°C (78%) after CLP was significantly increased compared with mice housed at 22°C (40%). Experimental groups were repeated with mice euthanized at 0, 12, 24, and 48 h post-surgery to examine select immune parameters. Raising housing temperature minimally altered systemic, peritoneal, or splenic cell counts. However, IL-6 levels in plasma and peritoneal lavage fluid were significantly lower at 12 h post-surgery in mice housed at 30°C compared with 22°C. Bacterial colony counts from peritoneal lavage fluid were significantly lower in mice housed at 30°C and in vivo studies suggested this was the result of increased phagocytosis by neutrophils. As previously demonstrated, adoptive transfer of fibrocytes significantly increased sepsis survival compared with saline at 22°C. However, there was no additive effect when adoptive transfer was performed at 30°C. Overall, the results demonstrated that thermoneutral housing improves survival after CLP by increasing local phagocytic activity and technical revisions may be necessary to standardize the severity of the model across different housing temperatures. These findings stress the pronounced impact housing temperature has on the CLP model and the importance of reporting housing temperature.
Fibrinogen Activates PAK1/Cofilin Signaling Pathway to Protect Endothelial Barrier Integrity
Authors: Wu Feng , Chipman Amanda , Dong Jing-Fei , Kozar Rosemary Ann
Published: May 2020

Introduction:

We recently demonstrated that fibrinogen stabilizes syndecan-1 on the endothelial cell (EC) surface and contributes to EC barrier protection, though the intracellular signaling pathway remains unclear. P21 (Rac1) activated kinase 1 (PAK1) is a protein kinase involved in intracellular signaling leading to actin cytoskeleton rearrangement and plays an important role in maintaining endothelial barrier integrity. We therefore hypothesized that fibrinogen binding to syndecan-1 activated the PAK1 pathway.

Methods:

Primary human lung microvascular endothelial cells were incubated in 10% lactated Ringers (LR) solution or 10% fibrinogen saline solution (5 mg/mL). Protein phosphorylation was determined by Western blot analysis and endothelial permeability measured by fluorescein isothiocyanate (FITC)-dextran. Cells were silenced by siRNA transfection. Protein concentration was measured in the lung lavages of mice.

Results:

Fibrinogen treatment resulted in increased syndecan-1, PAK1 activation (phosphorylation), cofilin activation (dephosphorylation), as well as decreased stress fibers and permeability when compared with LR treatment. Cofilin is an actin-binding protein that depolymerizes F-actin to decrease stress fiber formation. Notably, fibrinogen did not influence myosin light chain activation (phosphorylation), a mediator of EC tension. Silencing of PAK1 prevented fibrinogen-induced dephosphorylation of cofilin and barrier integrity. Moreover, to confirm the in vitro findings, mice underwent hemorrhagic shock and were resuscitated with either LR or fibrinogen. Hemorrhage shock decreased lung p-PAK1 levels and caused significant lung vascular leakage. However, fibrinogen administration increased p-PAK1 expression to near sham levels and remarkably prevented the lung leakage.

Conclusion:

We have identified a novel pathway by which fibrinogen activates PAK1 signaling to stimulate/dephosphorylate cofilin, leading to disassembly of stress fibers and reduction of endothelial permeability.
Current Evidence for Minimally Invasive Surgery During the COVID-19 Pandemic and Risk Mitigation Strategies
Authors: Chadi Sami A. , Guidolin Keegan , Caycedo-Marulanda Antonio , Sharkawy Abdu , Spinelli Antonino , Quereshy Fayez A. , Okrainec Allan
Published: May 2020

Objective:

Our objective was to review the literature surrounding the risks of viral transmission during laparoscopic surgery and propose mitigation measures to address these risks.

Summary Background Data:

The SARS-CoV-2 pandemic has caused surgeons the world over to re-evaluate their approach to surgical procedures given concerns over the risk of aerosolization of viral particles and exposure of operating room staff to infection. International society guidelines advise against the use of laparoscopy; however, the evidence on this topic is scant and recommendations are based on the perceived most cautious course of action.

Methods:

We conducted a narrative review of the existing literature surrounding the risks of viral transmission during laparoscopic surgery and balance these risks against the benefits of minimally invasive approaches. We also propose mitigation measures to address these risks that we have adopted in our institution.

Results and Conclusion:

While it is currently assumed that open surgery minimizes operating room staff exposure to the virus, our findings reveal that this may not be the case. A well-informed, evidence-based opinion is critical when making decisions regarding which operative approach to pursue, for the safety and well-being of the patient, the operating room staff, and the healthcare system at large. Minimally invasive surgical approaches offer significant advantages with respect to both patient care, and the mitigation of the risk of viral transmission during surgery, provided the appropriate equipment and expertise are present.
The Role of SLAs in Xenotransplantation
Authors: Ladowski Joseph M. , Hara Hidetaka , Cooper David K.C.
Published: May 2020

Advances in genetic engineering, particularly CRISPR/Cas9, have resulted in the development of a triple glycan-knockout (TKO) pig. There is minimal human antipig antibody binding to TKO pig cells. The TKO background has decreased antibody binding to a sufficiently low level that any additional xenoantigens expressed on the cells can now be more easily detected. One of these xenoantigens is the swine major histocompatibility complex, termed swine leukocyte antigens (SLA). SLA are the homolog to HLAs, a protein complex expressed on human tissue capable of stimulating the development of new antibodies in allotransplantation. These antibodies can result in graft failure through hyperacute, acute, or chronic rejection. Our knowledge of SLA, particularly in the last 5 years, has grown considerably. The presence, cause, and methods to detect anti-SLA antibodies will need to be carefully considered for the first clinical trial of xenotransplantation. The focus of this review is to summarize the role of SLA in xenotransplantation and consider whether it will prove to be a major barrier. Techniques are now available to mutate target SLA amino acids to ensure that cross-reactive anti-HLA antibodies no longer bind to SLA on the cells of the organ-source pigs. While deletion of SLA expression is possible, it would render the pig at risk for infectious complications. The ideal organ-source pig for HLA highly sensitized recipients may therefore be 1 with site-specific mutations to eliminate cross-reactive binding.
Live Donor Liver Transplantation in the United States: Impact of Share 35 on Live Donor Utilization
Authors: Braun Hillary J. , Dodge Jennifer L. , Grab Joshua D. , Schwab Marisa E. , Liu Iris H. , Glencer Alexa C. , Stock Peter G. , Hirose Ryutaro , Roberts John P. , Ascher Nancy L.
Published: May 2020

Background.

Share 35 was a policy implemented in 2013 to increase regional sharing of deceased donor livers to patients with model for end-stage liver disease ≥ 35 to decrease waitlist mortality for the sickest patients awaiting liver transplantation (LT). The purpose of this study was to determine whether live donor liver transplantation (LDLT) volume was impacted by the shift in allocation of deceased donor livers to patients with higher model for end-stage liver disease scores.

Methods.

Using Network for Organ Sharing/Organ Procurement and Transplantation Network Standard Transplant Analysis and Research files, we identified all adults who received a primary LT between October 1, 2008, and March 31, 2018. LT from October 1, 2008, through June 30, 2013, was designated as the pre-Share 35 era and July 1, 2013, through March 31, 2018, as the post-Share 35 era. Primary outcomes included transplant volumes, graft survival, and patient survival in both eras.

Results.

In total, 48 779 primary adult single-organ LT occurred during the study period (22 255 pre-Share 35, 26 524 post). LDLT increased significantly (6.8% post versus 5.7% pre, P < 0.001). LDLT volume varied significantly by region (P < 0.001) with regions 2, 4, 5, and 8 demonstrating significant increases in LDLT volume post-Share 35. The number of centers performing LDLT increased only in regions 4, 6, and 11. Throughout the 2 eras, there was no difference in graft or patient survival for LDLT recipients.

Conclusions.

Overall, LDLT volume increased following the implementation of Share 35, which was largely due to increased LDLT volume at centers with experience in LDLT, and corresponded to significant geographic variation in LDLT utilization.
Machine Perfusion of the Liver: Applications Beyond Transplantation
Authors: Hefler Joshua , Marfil-Garza Braulio A. , Dadheech Nidheesh , Shapiro A.M. James
Published: May 2020

Machine perfusion (MP) is at the forefront of innovation in modern liver transplantation. Several approaches, mainly varying the temperature at which the graft is perfused, have shown benefit in preclinical models and nonrandomized clinical trials. Given the recent randomized controlled trial by Nasralla et al demonstrating the efficacy of normothermic MP over static cold storage, MP is likely here to stay for the foreseeable future. We are only beginning to explore the possibilities of this technology, including the prediction of graft function and modification of suboptimal livers. This has the potential to both increase the donor pool and improve the quality of grafts provided to recipients. Beyond transplantation, there may be a role for MP in extracorporeal liver support, cancer research and therapeutics, and pharmaceutical testing. In this review, we provide the rationale and explore the relevant preclinical studies that support the use of ex situ liver perfusion for these extended applications.
Fitness benefits of male dominance behaviours depend on the degree of individual inbreeding in a polyandrous lizard
Authors: Piza-Roca Carmen , Schoeman David , Frere Celine
Published: May 2020

In polyandrous species, sexual selection extends beyond mating competition to selection for egg fertilization. As a result, the degree to which factors influencing mating success impact overall reproductive success becomes variable. Here, we used a longitudinal behavioural and genetic dataset for a population of eastern water dragons (Intellagama lesueurii) to investigate the degree to which male dominance, a pre-mating selection trait, influences overall reproductive success, measured as the number of surviving offspring. Moreover, we examine the interactive effects with a genetic trait, individual inbreeding, known to influence the reproductive success of males in this species. We found fitness benefits of male dominance, measured as body size and frequency of dominance behaviours displayed. However, individuals' propensity to display dominance behaviours had mixed effects, depending on the degree of inbreeding. While inbred males benefited from frequent displays, highly outbred males exhibited better reproductive outputs when displaying to a lesser extent. Given that outbred males have enhanced reproductive success in this species, the costs of displaying dominance behaviours may outweigh the benefits. Overall, our results demonstrate the fitness benefits of dominance in a polyandrous lizard, and suggest that these are modulated by an independent genetic trait. Our results may contribute to explaining the presence of alternative mating tactics in this species, owing to the variability in net fitness benefits of dominance. Our findings also reveal the challenges associated with investigating fitness traits in isolation, which may undermine the validity of results when important interactions are ignored.
Shift in ecological strategy helps marginal populations of shepherd's purse (Capsella bursa-pastoris) to overcome a high genetic load
Authors: Orsucci Marion , Milesi Pascal , Hansen Johanna , Girodolle Johanna , Glémin Sylvain , Lascoux Martin
Published: May 2020

The outcome of species range expansion depends on the interplay of demographic, environmental and genetic factors. Self-fertilizing species usually show a higher invasive ability than outcrossers but selfing and bottlenecks during colonization also lead to an increased genetic load. The relationship between genomic and phenotypic characteristics of expanding populations has, hitherto, rarely been tested experimentally. We analysed how accessions of the shepherd's purse,Capsella bursa-pastoris, from the colonization front or from the core of the natural range performed under increasing density of competitors. First, accessions from the front showed a lower fitness than those from the core. Second, for all accessions, competitor density impacted negatively both vegetative growth and fruit production. However, despite their higher genetic load and lower absolute performances, accessions from the front were less affected by competition than accessions from the core. This seems to be due to phenotypic trade-offs and a shift in phenology that allow accessions from the front to avoid competition.