OtoRhinoLaryngology News: 04/22/18

Κυριακή 22 Απριλίου 2018

Attitude Towards End of Life Communication of Austrian Medical Students

Abstract

Medical students have to acquire theoretical knowledge, practical skills, and a personal attitude to meet the emerging needs of palliative care. The present study aimed to assess the personal attitude of Austrian medical students towards end of life communication (EOLC), as key part of palliative care. This cross-sectional, mono-institutional assessment invited all medical students at the Medical University of Vienna in 2015. The assessment was conducted web-based via questionnaire about attitudes towards EOLC. Additional socio-demographic and medical education-related parameters were collected. Overall, 743 medical students participated in the present report. Differences regarding the agreement or disagreement to several statements concerning the satisfaction of working with chronically ill patients, palliative care, and health care costs, as well as the extent of information about palliative disease, were found for age, gender, and academic years. The overall attitude towards EOLC in the present sample can be regarded as quite balanced. Nevertheless, a considerable number of medical students are still reluctant to inform patients about their incurable disease. Reservations towards palliative care as part of the health care system seem to exist. The influence of the curriculum as well as practical experiences seems to be important but needs further investigation.

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Sociocultural Barriers Related to Late-Stage Presentation of Breast Cancer in Morocco

Abstract

Breast cancer is the most prevalent cancer affecting women globally and in Morocco, where more than one fourth of patients are diagnosed at advanced stages. This study aimed to investigate sociocultural barriers that contribute to delayed presentation and diagnosis of breast cancer among women in Marrakesh, Morocco. Qualitative interviews were conducted with 25 breast cancer patients who received care at the CHU Mohammed VI Hospital in Marrakesh to elicit barriers to diagnosis and treatment and ease of access to care. Interviews with breast cancer patients revealed several themes regarding structural and sociocultural barriers to initial diagnosis and treatment. Structural barriers included high treatment-associated costs for patients and their families, burden of transportation to central treatment centers, and limited access to appropriate health care resources. Sociocultural barriers included perceived attack on one's identity associated with breast cancer diagnosis and treatment, influence of the local community, and ideas of faith, spirituality, and conception of death. Findings from this study can help identify areas for improved access and education of patients in order to improve breast cancer diagnostic and treatment efforts and enhance opportunities for early detection.

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AAA 2018 Explores New Frontiers in Music Perception of Cochlear Implant Users

It was a full house at the Judith S. Gravel Annual Vanderbilt Lecture by Charles Limb, MD, at this week's American Academy of Audiology coneference in Nashville, TN. Limb is the Francis A. Sooy Professor of Otolaryngology-Head and Neck Surgery and the chief of the Division of Otology, Neurotology, and Skull Base Surgery at University of California in San Francisco.

Limb gave a fascinating presentation on the challenges affecting children with cochlear impants in the area o musicperception. Despite the adavcen in CIs, Limb's research has sound significant limitations of this technology in enabling users to have extensive epxerience of sound. However, he presented his creative an donoging work so identifu new frontiers in improving the music percenption of this patient popylation.

"I'm most excited that were starting to identify things that could be improved. We've spent the last 10 to 15 years of the field just showing how bad everyhing was without actually being able to improve anything," Limb told The Hearing Journal after his presentation. "So we're starting to find things that might actually imporive music perception—and that's pretty exciting to me."

At the lecture, Limb showed videos of CI users with music abilities—testaments to the musicality of children who may have hearing difficulties but benefit from the use of CIs.

Limb cited some exciting areas of advancement. "For example, some of the sutides on tuning in cochlear implant is starting to show some promise in temrs sof pitch percepton, and others have worked on on pitch processing strategies that are promising so maybe we're getting closer to more accurate pitch."

But to optimize this progress in research, it's important to address critical issues like access to CIs.

"Sadly, there are still many people who need our services but dont get access to them, and the system thatd in place to give people access to these services is pretty daunting," Limb stated.

"I think that we to acceot as a comunity, as a people, as a goverment that hearig loss is not acceptable to just persist in our world world. if tehre treatments out there, it should be our right to get that treatment. So all of us need to get better."

Published: 4/20/2018 10:14:00 AM

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mRECIST criteria to assess recurrent thyroid carcinoma treatment response after radiofrequency ablation: a prospective study

Abstract

Purpose

Surgical removal is recommended for recurrent thyroid carcinomas (RTCs) unable to uptake radioiodine and/or not responsive to chemotherapy. However, repeated neck dissection is difficult for surgeons. Thus, radiofrequency ablation (RFA) was proposed for RTCs. The aim of this prospective study is to assess RTC treatment response after RFA, according to well-established criteria.

Methods

Sixteen lesions in 13 patients were treated by RFA. All patients refused/were excluded from repeated surgery or other conventional therapy. CT and US examinations were performed before RFA to evaluate lesion volume and vascularization. All RFA procedures were performed under US-guidance by an 18-gauge, electrode. Treatment response was evaluated by CT, according to RECIST 1.1 and to mRECIST guidelines; CT examinations were performed during follow-up (6–18 months); the volume of residual vital tumour tissue and the percentage of necrotic tissue were estimated by contrast enhanced CT.

Results

RFA was well tolerated by all patients; in two cases laryngeal nerve paralysis was observed. Mean pre-treatment volume was 4.18 ± 3.53 ml. Vital tumour tissue and percentage of necrosis at 6, 12 and 18 months were 0.18 ± 0.25, 0.11 ± 0.13, 0.29 ± 0.40 ml and 91.9 ± 11.1, 90.4 ± 13.3, 80.8 ± 23.1%. According to RECIST 1.1, target lesion response was classified as complete response (CR) in one case, partial response (PR) in 11/16, stable disease in 4/16 cases. According to mRECIST, 11/16 cases were classified as CR and the remaining 5 as PR.

Conclusion

RFA is a safe procedure to treat the viable tumour tissue and to reduce the RTC volume; as to the criteria to assess treatment response, mRECIST appears to be more accurate.

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Noninvasive follicular thyroid neoplasm with papillary‐like nuclear features (NIFTP) in thyroid tumor classification

Pathology International, EarlyView.

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Loss of SWI/SNF complex expression in undifferentiated renal carcinoma in acquired cystic kidney

Pathology International, EarlyView.

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Application of Passive Sampler for Ammonia Gas in Soil

Abstract

The emissions of ammonia (NH₃) from soil have accelerated rapidly and have affected both vegetation and the atmosphere. It is thus necessary to investigate not only the amounts of NH₃ gas released from the soil surface but also the dynamics of NH₃ gas in the soil. Active sampling and diffusive sampling have been adopted to measure the components of soil air. However, gas aspiration for active sampling inevitably collects a wide range of soil gases. We examined the application of passive sampling to NH₃ gas measurements in soil and compared the outcome to active sampling results. In laboratory experiments, the performance of the present passive sampler in moist soil was investigated. When immersed in solution, the passive sampler collected gas released from the solution, depending on the vapor pressure of the volatile substance. In laboratory experiments measuring NH₃ gas in soil, there were no significant differences among the values measured by passive sampler at each measurement point. Thus, we concluded that the passive sampler can accurately measure NH₃ gas in soil. In field experiments, the average NH₃ gas concentrations were 43 ppb in urea-added soil and 1 ppb in control soil. The relative standard deviation of NH₃ concentrations in urea-added soil was large. This result is expected because soil characteristics can change under the influence of ambient environmental factors such as wind, rain, and temperature. In other words, the spatial differences in NH₃ emissions were reflected in the passive sampler measurements.

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Attitude Towards End of Life Communication of Austrian Medical Students

Abstract

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Gene Expression Profiles in Chemokine (C-C Motif) Ligand 21-Overexpressing Pancreatic Cancer Cells

Abstract

Chemokine (C-C Motif) ligand 21 (CCL21) plays an important role in tumor immunity. However, the molecular mechanisms by which CCL21 regulates tumor immunity remain largely unknown. In this study, we successfully generated a lentiviral vector expressing human CCL21 (Lenti-hCCL21), which was confirmed by biological assays. The Lenti-hCCL21 was transduced into PANC-1 cells, a chemokine (C-C motif) receptor 7 (CCR7)-positive human pancreatic cancer cell line. We used the scratch wound and transwell assays to measure cell migration of the CCL21-overexpressing PANC-1 cells. A DNA microarray assay was performed to determine gene expression profiles. The results showed that CCL21 lentiviral transduction significantly up- or down-regulated a panel of tumor-associated genes, although CCL21 appeared to have no effect on PANC-1 cell migration. Importantly, CCL21 promoted matrix metallopeptidase-9 (MMP-9) expression in PANC-1 cells. CCL21 regulates pancreatic cancer immunity possibly through governing the expression of a panel of tumor-associated genes, including MMP-9.

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Sociocultural Barriers Related to Late-Stage Presentation of Breast Cancer in Morocco

Abstract

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mRECIST criteria to assess recurrent thyroid carcinoma treatment response after radiofrequency ablation: a prospective study

Abstract

Purpose

Methods

Results

Conclusion

RFA is a safe procedure to treat the viable tumour tissue and to reduce the RTC volume; as to the criteria to assess treatment response, mRECIST appears to be more accurate.

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Balloon-borne tropospheric CO2 observations over the equatorial eastern and western Pacific

Publication date: July 2018
Source:Atmospheric Environment, Volume 184
Author(s): Yoichi Inai, Shuji Aoki, Hideyuki Honda, Hiroshi Furutani, Yutaka Matsumi, Mai Ouchi, Satoshi Sugawara, Fumio Hasebe, Mitsuo Uematsu, Masatomo Fujiwara
Vertical profiles of carbon dioxide (CO2) mixing ratio in the equatorial eastern and western Pacific were measured by newly developed balloon-borne CO2 sondes in February 2012 (two soundings) and February–March 2015 (four soundings), respectively. The 1–10 km vertically averaged CO2 mixing ratios lie between the background surface values in the Northern Hemisphere (NH) and those in the Southern Hemisphere (SH) monitored at ground-based sites during these periods. A backward trajectory analysis, taking account of convective mixing processes using geostationary satellite cloud-image data, is applied to the measured CO2 profiles to estimate the origin of the observed air masses. Air masses originating in the SH show low CO2 mixing ratios that are similar to the background values in the SH. This relationship is confirmed by a positive correlation (∼0.6) between the CO2 mixing ratio and the latitude of air mass origin which is found from trajectory calculations. This result suggests that the CO2 distribution in the troposphere over the equatorial Pacific is controlled by monthly time-scale, large-scale CO2 distribution and weekly time-scale atmospheric transport processes. Furthermore, this study shows that the combination of CO2 sonde measurements and trajectory analysis, taking account of convective mixing, is a useful tool in investigating CO2 transport processes.

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Meta-modeling of ADMS-Urban by dimension reduction and emulation

Publication date: July 2018
Source:Atmospheric Environment, Volume 184
Author(s): Vivien Mallet, Anne Tilloy, David Poulet, Sylvain Girard, Fabien Brocheton
ADMS-Urban is a non-linear, static, urban air quality model, with high-dimensional outputs. A simulation of NO2 and PM10 concentrations every hour during a full year and over an entire city can take dozens of days of computations, which greatly limits the range of methods that can be applied to the model, especially for uncertainty quantification. This work presents a method to replace the complete model, ADMS-Urban, with a meta-model or surrogate model, i.e., a reasonably close approximation of ADMS-Urban whose computational cost is negligible. When the emissions are formulated as a function of the day and the hour, the complete-model inputs essentially contain a few scalar values, to describe the meteorological conditions, the background pollution and the target date. The complete-model outputs are first projected onto a reduced subspace. The relations between the projection coefficients and the low-dimensional inputs are then emulated by a fast statistical emulator, based on Kriging or radial basis functions (RBF). The mean error between the meta-model and ADMS-Urban is 22% with Kriging and 27% with RBF for NO2, and 14% with Kriging and 20% with RBF for PM10. The meta-model performs as well as ADMS-Urban when compared to the observations. Its computational cost is almost negligible to compute the concentrations at a given hour and date for an entire city: 50 ms with RBF and 150 ms with Kriging to simulate 1 h on one core, while the complete model requires 8 min on 16 cores.

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The effect of heat recovery on near-source plume dispersion of a simple cycle gas turbine

Publication date: July 2018
Source:Atmospheric Environment, Volume 184
Author(s): Bo Yang, Jiajun Gu, K. Max Zhang
The waste heat recovery (HR) systems are employed to increase the overall thermal efficiency of electric generation units (EGUs). Although the emission factors (in terms of gram of pollutants per unit of thermal energy consumed or electric energy generated) generally decreases after installing HR systems, the emission rates in terms of grams of pollutants per unit of time remain unchanged. However, HR systems reduce stack exit temperature, resulting in lower effective emission heights, which lead to higher near-source ground level concentrations (GLCs) of air pollutants. In order to comprehensively evaluate the near-source air quality impact from deploying HR systems, we proposed a new modeling framework by integrating a computationally efficient Gaussian-based dispersion model (AERMOD) and a (relatively) more accurate computational fluid dynamics (CFD) model. As a demonstration of the proposed framework, we investigated the HR impact on NOx concentrations near a simple cycle gas turbine located in Brentwood, NY. Specifically, we applied the AERMOD modeling system to screen the hourly GLCs over five years, and highest values (and the corresponding hours) were shown to cluster into two main meteorological conditions: the stable atmospheric boundary layer with relatively high wind speed (Stable, HW) and the unstable atmospheric boundary layer with relatively low wind speed (Unstable, LW). These two conditions were further simulated using a CFD model that have been extensively evaluated previously for detailed analysis. By setting different stack exit temperatures, the near-source air quality impact of different waste heat conversion rates was evaluated. We introduced a concept called the heat recovery amplified factor (HRAF), defined as the ratio between the maximum GLC with HR system and that without HR system, as an indicator of HR impact. HRAF was shown to be much more sensitive to temperature in the Unstable, LW condition than in the Stable, HW condition. Although the results were limited to a specific simple cycle gas turbine, the proposed modeling framework and HRAF can be used for evaluating the HR systems impact for other emission sources.

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Evaluating EDGARv4.tox2 speciated mercury emissions ex-post scenarios and their impacts on modelled global and regional wet deposition patterns

Publication date: July 2018
Source:Atmospheric Environment, Volume 184
Author(s): Marilena Muntean, Greet Janssens-Maenhout, Shaojie Song, Amanda Giang, Noelle E. Selin, Hui Zhong, Yu Zhao, Jos G.J. Olivier, Diego Guizzardi, Monica Crippa, Edwin Schaaf, Frank Dentener
Speciated mercury gridded emissions inventories together with chemical transport models and concentration measurements are essential when investigating both the effectiveness of mitigation measures and the mercury cycle in the environment. Since different mercury species have contrasting behaviour in the atmosphere, their proportion in anthropogenic emissions could determine the spatial impacts. In this study, the time series from 1970 to 2012 of the EDGARv4.tox2 global mercury emissions inventory are described; the total global mercury emission in 2010 is 1772 tonnes. Global grid-maps with geospatial distribution of mercury emissions at a 0.1° × 0.1° resolution are provided for each year. Compared to the previous tox1 version, tox2 provides updates for more recent years and improved emissions in particular for agricultural waste burning, power generation and artisanal and small-scale gold mining (ASGM) sectors. We have also developed three retrospective emissions scenarios based on different hypotheses related to the proportion of mercury species in the total mercury emissions for each activity sector; improvements in emissions speciation are seen when using information primarily from field measurements. We evaluated them using the GEOS-Chem 3-D mercury model in order to explore the influence of speciation shifts, to reactive mercury forms in particular, on regional wet deposition patterns. The reference scenario S1 (EDGARv4.tox2_S1) uses speciation factors from the Arctic Monitoring and Assessment Programme (AMAP); scenario S2 ("EPA_power") uses factors from EPA's Information Collection Request (ICR); and scenario S3 ("Asia_filedM") factors from recent scientific publications. In the reference scenario, the sum of reactive mercury emissions (Hg-P and Hg²⁺) accounted for 25.3% of the total global emissions; the regions/countries that have shares of reactive mercury emissions higher than 6% in total global reactive mercury are China+ (30.9%), India+ (12.5%) and the United States (9.9%). In 2010, the variations of reactive mercury emissions amongst the different scenarios are in the range of −19.3 t/yr (China+) to 4.4 t/yr (OECD_Europe). However, at the sector level, the variation could be different, e.g., for the iron and steel industry in China reaches 15.4 t/yr. Model evaluation at the global level shows a variation of approximately ±10% in wet deposition for the three emissions scenarios. An evaluation of the impact of mercury speciation within nested grid sensitivity simulations is performed for the United States and modelled wet deposition fluxes are compared with measurements. These studies show that using the S2 and S3 emissions of reactive mercury, can improve wet deposition estimates near sources.

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Resolution of Metastatic Colon Cancer upon Withdrawal of Anti-TNF Therapy for Crohn’s Disease

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Progress in preventive therapy for cancer: a reminiscence and personal viewpoint

Progress in preventive therapy for cancer: a reminiscence and personal viewpoint

Progress in preventive therapy for cancer: a reminiscence and personal viewpoint, Published online: 23 April 2018; doi:10.1038/s41416-018-0039-4

Progress in preventive therapy for cancer: a reminiscence and personal viewpoint

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Impact of NICE guidance on tamoxifen prescribing in England 2011–2017: an interrupted time series analysis

Impact of NICE guidance on tamoxifen prescribing in England 2011–2017: an interrupted time series analysis

Impact of NICE guidance on tamoxifen prescribing in England 2011–2017: an interrupted time series analysis, Published online: 23 April 2018; doi:10.1038/s41416-018-0065-2

Impact of NICE guidance on tamoxifen prescribing in England 2011–2017: an interrupted time series analysis

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Generation and characterization of a paclitaxel-resistant human gastric carcinoma cell line

The main aim of this study was to establish a novel paclitaxel (PTX)-resistant human gastric carcinoma cell line and to investigate its biological significance. A cell line, MGC803/PTX, was established by gradually increasing PTX density on the basis of MGC803 over a period of 10 months. In addition, a pair of resistant cell lines (SW620 and SW620/PTX) were added to further explain the resistant mechanism of PTX. The drug resistance index and stability of MGC803/PTX cells were detected using the Cell Counting Kit-8 method. The morphological features were observed using inverted microscopy. Apoptosis was measured by flow cytometry (FCM) and Hoechst 33258 fluorescence staining. The distribution of the cell cycle was determined by FCM, and protein expressions of P-gp, Bcl-2, Bax, and PARP were detected by western blot analysis. When characterizing the resistance in vitro, we found that MGC803/PTX cells were 10.3-fold more resistant to PTX compared with MGC803 cells. In addition, MGC803/PTX cells showed cross-resistance to 5-fluorouracil and adriamycin. FCM and Hoechst 33258 fluorescence staining indicated that MGC803/PTX cells had a significantly lower percentage of apoptotic cells after treatment with PTX compared with MGC803 cells. Other differences between parental cells and resistant cells included morphology, proliferation rate, doubling time, cell cycle distribution, and colony-formation rate. Western blot analysis indicated that P-gp, Bcl-2, and PARP protein were more abundant in MGC803/PTX and SW620/PTX cells compared with MGC803 and SW620 cells, whereas Bax protein levels were lower in resistant cells. Furthermore, MGC803/PTX cells showed obvious resistance to PTX in vivo. To our knowledge, this is the first report on the establishment of a PTX-resistant MGC803 cell line, which is an important tool to explore the resistance of anticancer drugs and to overcome tumor drug resistance. * Ling Fu, Fen Yin and Xiao-Rui Li contributed equally to the writing of this article. Correspondence to Dr Hong-Min Liu, Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou 450001, Henan Province, China Tel: +86 371 6778 1908; fax: +86 371 6778 1890; e-mail: liuhm@zzu.edu.cn Received September 27, 2017 Accepted January 11, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Evidence of the homeostatic regulation with the combination of transcranial direct current stimulation and physical activity

Transcranial direct current stimulation (tDCS) can optimize beneficial effects induced by motor practice in patients with neurological disorders. However, possibly due to homeostatic regulation, the conditioning effects of tDCS are often imprecise and variable, limiting its therapeutic application. Objective to explore the magnitude and direction of the after-effects induced by physical activity (PA) on tDCS-preconditioned cortical excitability (CE). Design First, a crossover experiment was performed with 12 subjects to determine whether a single session of low-, moderate- and high-intensity PA on a treadmill modulates the motor cortical excitability measured by transcranial magnetic stimulation. In a second crossover experiment, we investigated long-lasting changes (until 90 min) of the effects induced by PA (with intensities defined by the first experiment) on motor cortical excitability after the subject had been preconditioned by tDCS (using different polarities). Results and conclusion In Experiment 1, we found that high and moderate-intensity PA modulate the CE. Experiment 2 demonstrated that preconditioning the CE using tDCS homeostatically changes the direction and magnitude of after-effects induced by subsequent PA plasticity caused by motor activity. In conclusion, the results suggest that the direction of after-effects induced by the combination of physical exercise with tDCS on the cortical excitability is regulated within a physiologically defined range. Contact information: Katia Monte-Silva; Applied Neuroscience Laboratory, Universidade Federal de Pernambuco, Department of Physical Therapy. Av. Prof. Moraes Rego s/n 50670-900 Recife, Brazil., phone: +55 81-2126 7579/FAX: +55 81-2126 8491. Funding: Monte-Silva K receives a grant from CNPq (308291/2015-8) Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Progress in preventive therapy for cancer: a reminiscence and personal viewpoint

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Impact of NICE guidance on tamoxifen prescribing in England 2011–2017: an interrupted time series analysis

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Outcomes of Anesthesia Selection in Endovascular Treatment of Acute Ischemic Stroke

Background: The association between anesthesia type and outcomes in patients with acute ischemic stroke undergoing endovascular treatment (EVT) remains a subject of ongoing debate. Methods: This prospective nonrandomized controlled trial included 149 consecutive patients with acute anterior circulation stroke who underwent EVT. The primary outcome was functional independence assessed by the modified Rankin Scale (mRS) after 3 months. Results: A total of 105 (70.5%) and 44 (29.5%) patients undergoing EVT who received conscious sedation (CS) and general anesthesia (GA), respectively. The patients who received GA had similar demographics and basic National Institute of Health Stroke Scale scores (17 vs. 16, P>0.05) as the patients who received CS. The recanalization time (304 vs. 311 min, P=0.940) and the recanalization rate (86.4% vs. 84.1%, P=0.170) did not differ between the patients receiving the different types of anesthesia. The National Institute of Health Stroke Scale at 24 hours was lower in the patients who received CS than in those who received GA (β=−2.26, 95% confidence interval, −5.30 to 0.79). The independence (modified Rankin Scale score 0 to 2) at 3 months was equal between patients who received GA and those who received CS (odds ratio=0.73, 95% confidence interval, 0.32-1.68). The mortality and the morbidity rates did not differ. Conclusions: The data indicated that the selection of GA or CS during EVT had no impact on the independent outcomes of patients with anterior circulation occlusion. Z.M. and R.H. contributed equally. Y.P., Z.M., and R.H.: helped with the study design and manuscript preparation. Y.W., J.L., and F.L.: helped with the data collection and manuscript preparation. X.H. helped with the patient recruitment. X.L. and Y.Z.: helped with the data collection. P.W. and Y.P.: helped with the data analyses. Clinical Trial Registration: www.clinicaltrials.gov (NCT02350283). The trial was funded by the 'Youth Program' (QML20150508) and Hospitals Clinical Medicine Development of Special Funding Support (ZYLX201708) from the Beijing Municipal Administration of Hospitals and programs from National Science and Technology Major Project of China (2011BAI08B02, 2015BAI12B04, and 2015BAI12B02). The authors have no conflicts of interest to disclose. Address correspondence to: Ruquan Han, MD, PhD, Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Dongcheng District, Beijing 100050, PR China (e-mail: ruquan.han@gmail.com). Received November 28, 2017 Accepted March 12, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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Effect of Dexmedetomidine on Cerebral Vasospasm and Associated Biomarkers in a Rat Subarachnoid Hemorrhage Model

Background: The α2 adrenergic agonist dexmedetomidine (DEX) has huge potential for protecting against cerebral vasospasm, a leading cause of death and disability after subarachnoid hemorrhage (SAH). Biomarker assays for SAH have recently emerged as tools for predicting vasospasm and outcomes. We investigated the effects of DEX on vasospasm and assessed relevant biomarkers in a rat SAH model. Methods: Male Wistar rats were randomly assigned to sham (n=10), vehicle (n=10), SAH (n=10), or SAH+ DEX (n=10) groups. The SAH and SAH+DEX groups received 0.3 mL injections of autologous blood into the cisterna magna, followed by intraperitoneal injections of normal saline or 10 μg/kg DEX. Forty-eight hours later, neurological deficits as well as the basilar artery (BA) wall thickness and cross-sectional area were measured. Cerebrospinal fluid (CSF) and blood samples were obtained to assess concentrations of interleukin (IL)-6, C-reactive protein (CRP), endothelin-1, and S100-β using enzyme-linked immunosorbent assays. Results: The SAH and SAH+DEX groups exhibited deteriorated neurological function as well as structural and morphological BA vasospasm. The SAH+DEX group showed an improved neurological function score (ie, a 52% decrease), a 10% reduction in wall thickness, and a BA cross-sectional area enlarged by 157%. Compared with the sham group, CSF levels of IL-6 and CRP in the SAH and SAH+DEX groups, as well as serum IL-6 and CRP levels in the SAH group, were significantly elevated. The SAH+DEX group showed significantly lower CSF IL-6 levels than the SAH group. Serum and CSF levels of endothelin-1 and S100-β were similar across all groups. Conclusions: DEX administration reduced the severity of cerebral vasospasm and improved neurological function in SAH rats; this may be closely linked to reduced CSF IL-6 levels. This study was supported by special research grant funded by the Korean Society of Neuroscience in Anesthesiology and Critical Care (KSNACC-2016) for Young Song. The remaining authors have no conflicts of interest to disclose. Address correspondence to: Dong Woo Han, MD, PhD, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul 06273, Republic of Korea (e-mail: hanesth@yuhs.ac). Received November 22, 2017 Accepted March 27, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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Intracranial Space–occupying Lesion Inducing Intracranial Hypertension Increases the Encephalographic Effects of Isoflurane in a Swine Model

Background: Patients with a brain tumor are susceptible to the hypnotic effect of anesthetics depending on the tumor's size. We investigated whether intracranial space–occupying lesions (ICSOLs) inducing intracranial hypertension increase isoflurane's effect on electroencephalographic (EEG) results. Materials and Methods: After anesthetic induction with isoflurane, 11 swine were studied with regard to isoflurane's effect on EEGs at 0.5% to 2.0% inhalational concentration at sequential stages: baseline 1, ICSOL 1, baseline 2, ICSOL 2, baseline 3. At each ICSOL stage, an intracranial epidural balloon catheter was inflated and the intracranial pressure maintained at twice the baseline pressure. The balloon was deflated after each ICSOL stage (baselines 2 and 3). A 95% spectral edge frequency (SEF), which correlates with anesthetic hypnosis, was used to measure isoflurane's effect. Pharmacodynamics was characterized using a sigmoidal inhibitory maximum effect model for the SEF versus end-tidal concentration. Results: ICSOL shifted the relations between SEF and the effect-site concentration (Ce) downward. Baseline and 50% of the maximum spectral edge effect levels significantly decreased during balloon inflation. The Ce that produced SEF=15 was 1.12 (1.04-1.20) (mean [95% confidence interval])% for baseline 1; 0.92 (0.81-1.03) for ICSOL 1; 1.02 (0.94-1.11) for baseline 2; 0.88 (0.82-0.94) for ICSOL 2; 1.05 (0.93-1.17) for baseline 3. Isoflurane's effect on EEGs increased during balloon inflation, with the alteration tending to recover after balloon deflation. Conclusions: ICSOLs inducing intracranial hypertension increase the EEG effect of isoflurane, and external compression from the brain surface enhances the anesthetic hypnosis despite minimum brain injury. Support was provided solely from institutional and/or departmental sources. The authors have no conflicts of interest to disclose. Address correspondence to: Tadayoshi Kurita, MD, Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan (e-mail: tadkur@hama-med.ac.jp). Received December 20, 2017 Accepted March 22, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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Correlation with lymphocyte infiltration, but lack of prognostic significance of MECA-79-positive high endothelial venules in primary malignant melanoma

High endothelial venules (HEVs) are specialized vessels in lymphoid organs, supporting lymphocyte trafficking from the blood. As the presence of these vessels was described recently in tumors, it was proposed that they could facilitate the development of antitumor immune response, resulting in improved prognosis. The aim of our study was to analyze the correlation of the density of HEVs with that of the different immune cell types as well as with the clinicopathologic parameters and the disease outcomes in patients with cutaneous melanoma. Primary melanoma samples of 118 patients were analyzed retrospectively by immunohistochemical labeling and quantitation of vessels stained with the MECA-79 antibody, as well as a panel of eight different immune cell types (CD8+ and CD45RO+ T cells, lymphocytes expressing the CD25, CD134, or CD137 activation markers, FOXP3+ regulatory T cells, CD20+ B cells, and DC-LAMP+ mature dendritic cells). Correlations of MECA-79+ vessel density with that of the immune cells, as well as with clinicopathologic parameters and disease outcomes were evaluated. We showed that the number of MECA-79+ vessels correlates strongly with the peritumoral density of B and T lymphocytes. Moreover, higher HEV numbers were detected in tumors hosting tertiary lymphoid structures as well as in those of axial location compared with the ones in the extremity and in men compared with women, whereas no association was found with patient age, tumor thickness, histologic type or ulceration, or with the survival of melanoma patients. The density of MECA-79+ HEVs in primary melanomas shows a correlation with B and T-lymphocyte density and differences according to the presence of tertiary lymphoid structures, tumor site, and the sex of the patient. However, it has no prognostic value. Correspondence to Andrea Ladányi, PhD, Department of Surgical and Molecular Pathology, National Institute of Oncology, 7–9. Ráth György u., Budapest H-1122, Hungary Tel: +36 12 248 600; e-mail: ladanyi@oncol.hu Received November 28, 2017 Accepted April 4, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Immediate Breast Reconstruction with Abdominal Free Flap and Adjuvant Radiotherapy.

No abstract available

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Transabdominal Breast Augmentation: A Review of 114 Cases Performed over 14 Years

No abstract available

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Reply to the letter: “Breast cleavage remodeling with fat grafting is a safe way to optimize symmetry and to reduce intermammary distance Several questions with regard to the research”

No abstract available

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Re: Clinical and qualitative isokinetic comparison of abdominal morbidity and dynamics following DIEP verses muscle sparing free TRAM flap breast reconstruction

No abstract available

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Textbook of Plastic, Reconstructive, and Aesthetic Surgery – Volume I: Principles and Advances in Plastic Surgery. By Karoon Agrawal and Surajit Bhattacharya. Pp. 614. Thieme Medical Publishers, New Delhi, India, 2017. Price Rs 5,395 ($84.11)

No abstract available

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Patient’s breast perception after mastectomy: analysis of outcomes in 208 patients with BREAST-Q following mastectomy alone, implant of tissue expander and definitive breast reconstruction

No abstract available

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“Transabdominal Breast Augmentation: A Review of 114 Cases Performed over 14 Years”

No abstract available

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“Evidence-Based Medicine: Current Evidence in the Diagnosis and Management of Carpal Tunnel Syndrome.”

No abstract available

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Reply to Letter to the Editor on " Transversus Abdominis Plane Blocks with Single-Dose Liposomal Bupivacaine in Conjunction with a Nonnarcotic Pain Regimen Help Reduce Length of Stay Following Abdominally Based Microsurgical Breast Reconstruction

No abstract available

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Spotlight in Plastic Surgery

No abstract available

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Breast cleavage remodeling with fat grafting is a safe way to optimize symmetry and to reduce intermammary distance: Several questions with regard to the research

No abstract available

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“Direct-to-Implant versus Two-Stage Tissue Expander/Implant Reconstruction: 2-Year Risks and Patient-Reported Outcomes from a Prospective, Multicenter Study”

No abstract available

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The Cost of Contralateral Prophylactic Mastectomy in Women with Unilateral Breast Cancer

Background: Contralateral prophylactic mastectomy (CPM) may be unnecessary from an oncologic perspective; therefore, the debate persists about the value of CPM in women with early stage unilateral breast cancer. Given finite healthcare resources, this study aims to evaluate the cost of contralateral prophylactic mastectomy and breast reconstruction. Study Design: Women with unilateral breast cancer undergoing either unilateral mastectomy or unilateral mastectomy with CPM and immediate breast reconstruction (IBR) were selected from the Truven MarketScan databases between 2009 and 2013. Demographic and treatment data were recorded, and over an 18-month follow-up period, the treatment cost was tallied. A log-transformed linear model was used to compare cost between the groups. Results: A total of 2,343 women were identified who met our inclusion criteria with 1,295 undergoing unilateral mastectomy and 1,048 undergoing CPM. Complication rates within 18 months were similar for women undergoing unilateral mastectomy and CPM (39% vs. 42%, p=0.17). Management with unilateral mastectomy with reconstruction required an adjusted cumulative mean cost of $33,557. CPM with reconstruction was an additional $11,872 in expenditure (p

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Sural Nerve Splitting in Reverse Sural Artery Perforator Flap: Anatomical Study in 40 Cadaver Legs

No abstract available

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Evolution in Monitoring of Free Flap Autologous Breast Reconstruction After Nipple-Sparing Mastectomy: Is There a Best Way?

Background: Free flap monitoring in autologous reconstruction after nipple-sparing mastectomy (NSM) remains controversial. We therefore examined outcomes in NSM with buried free flap reconstruction versus free flap reconstruction incorporating a monitoring skin paddle. Methods: Autologous free flap reconstructions with NSM performed from 2006 to 2015 were identified. Demographics and operative results were analyzed and compared between buried flaps and those with a skin paddle for monitoring. Results: 221 free flaps for NSM reconstruction were identified: 50 buried flaps and 171 flaps incorporating a skin paddle. Most common flaps used were deep inferior epigastric perforator (DIEP) (64%), profunda artery perforator (PAP) (12.1%), and muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps (10.4%). Autologous reconstructions with a skin paddle had significantly greater BMI (p=0.006). Mastectomy weight (p = 0.017) and flap weight (p

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Aseptic Freeze Dried vs. Sterile Wet-Packaged Human Cadaveric Acellular Dermal Matrix (ADM) in Immediate Tissue Expander Breast Reconstruction: A Propensity Score Analysis Study

Background: Although multiple acellular dermal matrix (ADM) sources exist, it is unclear how ADM processing impacts complication rates. We compared complications between two preparations of human cadaveric ADM (freeze dried [hADM-FD] and ready to use [hADM-RTU]) in immediate tissue expander (TE) breast reconstruction to analyze the effect of processing on complications. HADM-FD is aseptic while hADM-RTU is sterilized and wet-packaged. Methods: We retrospectively reviewed all TE breast reconstructions with hADM-FD or hADM-RTU at a single center between 2006 and 2016. The primary outcome measure was surgical site occurrence (SSO) before implant placement. SSO was defined as: seroma, skin dehiscence, surgical site infection (SSI), or reconstructive failure. The hADM-FD and hADM-RTU groups were compared before and after propensity-score (PS) matching. Results: We included 988 TE reconstructions (53.8% hADM-FD vs. 46.2% hADM-RTU). Analysis of 384 PS-pairs demonstrated a slightly higher rate of SSO (21.4% vs. 16.7%, p=0.10) and SSI (9.6% vs. 7.8%, p=0.13) in the hADM-FD group than hADM-RTU, but the difference was not significant. However, reconstructive failure was significantly higher for hADM-FD versus hADM-RTU (7.8% vs. 4.4%, p=0.050). Conclusions: This is the largest study comparing the outcomes of TE breast reconstruction using hADM materials prepared by different methods. We demonstrated higher early complications with aseptic hADM-FD than sterile hADM-RTU; reconstructive failure was the only outcome to achieve statistical significance. Additionally, there were significantly higher late complications with hADM-RTU compared to hADM-FD. We conclude that ADM preparation has an independent impact on patient outcomes in our comparison of one company's product. Financial Disclosure: Dr. Selber is a consultant for Integra Life Sciences (Plainsboro, NJ). Dr. Hassid is a consultant for Novadaq Technologies, Inc (Bonita Springs, FL). No other author has any disclosures related to this article. Financial Support: This research was supported in part by an Investigator Initiated Research Grant from LifeCell Corporation (Branchburg, NJ). Products mentioned: Alloderm Freeze Dried (LifeCell Corporation, Branchburg, NJ); Alloderm Ready to Use (Lifecell Corporation, Branchburg, NJ). Acknowledgements: The authors wish to acknowledge the Department of Scientific Publications at The University of Texas MD Anderson Cancer Center for review and assistance with this manuscript. Corresponding author: Summer E. Hanson, MD, PhD, Department of Plastic Surgery - Unit 1488, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, sehanson@mdanderson.org ©2018American Society of Plastic Surgeons

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The use of surgical delay for partial mastectomy reconstruction in the previously irradiated breast: a matched-control case series

No abstract available

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Supratrochlear Artery Based Periosteal Flaps: A New Alternative Technique for Nasal Lining Reconstruction

No abstract available

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Commentary on: Supratrochlear Artery Based Periosteal Flaps A New Alternative Technique for Nasal Lining Reconstruction

No abstract available

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Adipose Tissue–Preserved Skin Graft: Applicability and Long-Term Results

No abstract available

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Sensorimotor cortex atrophy in patients with cervical spondylotic myelopathy

Previous studies have shown compensatory adaptive changes in cerebral functions before surgery in patients with cervical spondylotic myelopathy (CSM), especially in the sensorimotor cortices. However, the structural changes in the sensorimotor cortices in patients with CSM remain poorly understood. The aim of this study was to assess the volumetric changes in the sensorimotor cortices using morphological MRI and to correlate these changes with clinical scales. We hypothesize that CSM causes atrophy in the sensorimotor cortices, which results in functional changes during CSM progression. The study participants included 30 CSM patients and 25 matched healthy controls. The patients underwent brain morphological MRI before surgery. Compared with the healthy controls, the patients with CSM showed significant atrophy in the primary somatosensory cortex (S1), the primary motor cortex (M1), the somatosensory association cortex, and the supplementary motor area. The gray matter volumes in the S1 and M1 were correlated positively with the motor scores of the Japanese Orthopedic Association in patients with CSM. The change in supplementary motor area correlated with the sphincter scores of the Japanese Orthopedic Association in CSM patients. Our findings provide new insights into the compensatory reaction in CSM patients. Correspondence to Qiyong Guo, MD, Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China Tel: +86 249 6615, fax: +86 242 392 9902; e-mail: guoqiyongcmu@163.com Received December 5, 2017 Accepted April 2, 2018 © 2018 Wolters Kluwer Health | Lippincott Williams & Wilkins

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Isosteviol sodium injection improves outcomes by modulating TLRs/NF-κB-dependent inflammatory responses following experimental traumatic brain injury in rats

Previous studies have shown that isosteviol sodium (STVNa) protects against permanent cerebral ischemia injury by inhibition of the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB)-mediated inflammatory responses. Overwhelming evidence shows that toll-like receptors (TLRs) are the upstream regulators of NF-κB. On the basis of the similarity of the pathology caused by traumatic brain injury (TBI) and stroke, we speculated that STVNa may have a therapeutic effect against TBI through regulation of the TLRs/NF-κB signaling-mediated inflammatory response. Thus, we studied the potential therapeutic effects of STVNa and the underlying mechanisms. Male rats, subjected to controlled cortical impact (CCI) injury, were injected intraperitoneally with STVNa (5, 10, 20, 40, and 80 mg/kg, daily for 3 or 7 days) after trauma. Neurobehavioral scores, relative numbers of cortical lesions, and histology were examined. We also measured the mRNA and protein expression levels of TLRs/NF-κB signaling pathway-related genes including TLR2, TLR4, and NF-κB by quantitative real-time-PCR and western blotting, respectively, and concentrations of tumor necrosis factor-α and interleukin-1β by an enzyme-linked immunosorbent assay. The results indicated that STVNa (20 mg/kg) showed significant neuroprotective effects 3 and 7 days after TBI, including the reduction of cortical lesions, improvement of the neurological severity score, significantly increased number of restored neurons, decreased number of astrocytes, and lower concentrations of tumor necrosis factor-α and interleukin-1β. Results from quantitative real-time-PCR and western blotting also show that the mRNA and protein expression levels of TLR2, TLR4, and NF-κB were significantly lower in STVNa-treated rats compared with the vehicle-treated rats. The administration of STVNa attenuates the TLR/NF-κB signaling pathway-mediated inflammatory responses in the injured rat brain, and this may be the mechanism by which STVNa improves the outcome following TBI. * Jie Zan and Hao Zhang contributed equally to the writing of this article. Correspondence to Wen Tan, MD, PhD, Institute of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou 510006, China Tel: +86 139 2895 4505; e-mail: went@gdut.edu.cn Received January 13, 2018 Accepted March 20, 2018 © 2018 Wolters Kluwer Health | Lippincott Williams & Wilkins

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Surveying the Literature: Synopsis of Recent Key Publications

No abstract available

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A Randomized Trial Comparing the Effect of Fiberoptic Selection and Guidance Versus Random Selection, Blind Insertion, and Direct Laryngoscopy, on the Incidence and Severity of Epistaxis After Nasotracheal Intubation

BACKGROUND: Epistaxis, or nasal bleeding, is a common complication after nasotracheal intubation (NTI). Because such bleeding is likely related to trauma during intubation, use of fiberoptic visualization and guidance rather than direct laryngoscopy may affect the incidence and severity of epistaxis. We compared the incidence of epistaxis after NTI using a fiberoptic versus a direct laryngoscopy approach. METHODS: Seventy patients who were able to breathe easily through unobstructed nostrils and required NTI as part of their anesthetic management were recruited. Exclusion criteria included unequal nasal airflow, nostril obstruction, previous nasal trauma or surgery, and coagulation abnormalities as determined by history. Patients were randomly assigned to undergo NTI with thermosoftened Mallinckrodt nasal Ring-Adair-Elwyn (RAE) tubes via either traditional direct laryngoscopy using a Macintosh blade or fiberoptic nasal intubation. All patients first underwent anesthetic induction and were randomized to blind or fiberoptic groups. Patients in the blind insertion/direct laryngoscopy group were then intubated via a randomly selected nostril. Patients in the fiberoptic group underwent an asleep nasal fiberoptic examination to determine the most patent nostril, followed by tube insertion under fiberoptic guidance. Ten minutes after NTI, the incidence and severity of epistaxis were evaluated and graded by the surgeon, who was blinded to the intubation method. RESULTS: Initial nasal fiberoptic endoscopy identified asymptomatic nasal pathology in 51% of patients: inferior turbinate hypertrophy (28.6%) and deviation of the nasal septum in (22.8%). The incidence of epistaxis was higher in the blind insertion/direct laryngoscopy group (88%) than in the fiberoptic group (51%; relative risk, 0.55; 95% confidence interval, 0.38–0.79; P = .0011). The severity of bleeding was also greater in the blind tube insertion/direct laryngoscopy cohort (Wilcoxon Mann-Whitney odds, 3.5; 95% confidence interval, 1.8–11.1). CONCLUSIONS: Fiberoptic nostril selection and guidance during NTI reduced the incidence and severity of epistaxis when compared with NTI performed via blind insertion and direct laryngoscopy. Accepted for publication March 14, 2018. Funding: None. Conflicts of Interest: See Disclosures at the end of the article. Reprints will not be available from the authors. Address correspondence to Jeffrey Leighton Tong, MD, FRCA, Department of Anesthesia and Critical Care, University of Chicago, 5841 S Maryland Ave, MC4028, Chicago, IL 60637. Address e-mail to jtong4@dacc.uchicago.edu. © 2018 International Anesthesia Research Society

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Caution When Dosing Anesthetic Medications: Are We Putting Too Much Weight on Patient Weight?

No abstract available

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Comprehensive Pain Management in the Rehabilitation Patient

No abstract available

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Can Lung Ultrasound Be the First-Line Tool for Evaluation of Intraoperative Hypoxemia?

No abstract available

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Hyperchloremic Intravenous Fluids Should Be Abandoned

No abstract available

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Practical Anesthetic Management: The Art of Anesthesiology

No abstract available

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In Response

No abstract available

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Harmful or Physiologic: Diagnosing Fibrinolysis Shutdown in a Trauma Cohort With Rotational Thromboelastometry

BACKGROUND: Despite its central role in early trauma coagulopathy, abnormal fibrinolysis continues to be poorly understood. Excessive fibrinolysis is a known contributor to mortality. Recent studies with thromboelastography (TEG) suggest decreased fibrinolysis (or shutdown) may be just as harmful. Considering the broad use of 2 different viscoelastic assays, which are not interchangeable, we proposed for the first time to define and characterize fibrinolysis shutdown using rotational thromboelastometry (ROTEM). METHODS: Retrospective cohort study of severely injured patients with admission ROTEM. Shutdown was defined by the best Youden index value of the maximum lysis. Fibrinolysis phenotypes were physiologic, hyperfibrinolysis, and shutdown. Multivariable logistic regression evaluated association between Injury Severity Score and the fibrinolysis phenotypes, and the association among shutdown phenotype with mortality, blood transfusion, and thrombotic events. RESULTS: Five hundred fifty patients were included. Maximum lysis

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In Response

No abstract available

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Pharmacological Basis of Anesthesia: How to Overcome Stagnation?

No abstract available

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Transesophageal Lung Ultrasound Should Be the First-Line Tool to Evaluate Intraoperative Hypoxia

No abstract available

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Gender Distribution of the American Board of Anesthesiology Diplomates, Examiners, and Directors (1985–2015)

To understand the potential role of women in leadership positions, data from the American Board of Anesthesiology (ABA) were analyzed to explore the impact of women in the specialty of anesthesiology. The number of newly certified ABA diplomates, oral examiners, and directors from 1985 to 2015 was obtained from the ABA database. The percentages of women in each group were calculated for each year. Because it took an average of 10 years for a diplomate to become an oral examiner and an average of 7 years for an oral examiner to be elected as a director during the study period, the following percentages were compared: women oral examiners versus newly certified women diplomates 10 years prior and women directors versus women oral examiners 7 years prior. The correlation coefficients between the percentages of women oral examiners and of newly certified women diplomates 10 years prior and between the percentages of women directors and women oral examiners 7 years prior were calculated. From 1985 to 2015, the percentage of newly certified women diplomates increased from 15% to 38% with an average annual increase of 0.74%, percentage of women oral examiners increased from 8% to 26% with an average annual increase of 0.63%, and percentage of women directors increased from 8% to 25% with an average annual increase of 0.56%. The percentage of women examiners consistently lagged behind the percentage of women diplomates who were certified 10 years earlier; the average difference over 21 years from 1995 to 2015 was −3.7% with a standard deviation of 2.1%. The correlation coefficient between the percentages of women examiners and newly certified women diplomates 10 years earlier from 1995 to 2015 was 0.86 (P

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The Brachiocephalic Vein as a Safe and Viable Alternative to Internal Jugular Vein for Central Venous Cannulation

BACKGROUND: Although many studies have compared success and complication rates for central line insertion sites with and without ultrasound, few have examined the use of the brachiocephalic vein for central venous access. The aim of this study was to describe the brachiocephalic vein as an alternative site for elective ultrasound vascular cannulation in adults, and to compare it with the more commonly used internal jugular vein site in terms of procedural difficulties, first pass failure rate, overall failure rate, and safety. METHODS: In this single-center, retrospective cohort study, clinical data from consecutive adult patients undergoing elective ultrasound-guided central venous catheterization of upper body were retrieved from the department database. All of these central venous catheters were requested by department team, none was positioned for surgery. Seven hundred nine patients underwent central venous catheterization via the internal jugular approach and 285 patients via the brachiocephalic route. Patients catheterized via the brachiocephalic vein approach were then compared with those catheterized via the internal jugular vein in terms of ease of catheterization, success rate, and complications. Differences between approaches were assessed by univariate analyses and multivariable analysis. RESULTS: Overall, 994 patients underwent central venous catheterization. A total of 87% had a successful catheter implantation at the first attempt, 6.7% of insertions were difficult, 5.7% were complicated, and 3.4% failed. Procedural difficulty was more frequent with the internal jugular than with the brachiocephalic approach (odds ratio, 0.38; 95% confidence interval, 0.19–0.76; P = .007) after correction for potential confounders. Differences between groups in complication rate (6.3% vs 4.1%) or failure rate (3.4% vs 3.5%) were not significant. CONCLUSIONS: Brachiocephalic cannulation is a reasonable alternative to ultrasound-guided internal jugular vein catheterization. Accepted for publication February 26, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Paolo Federico Beccaria, MD, Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132 Italy. Address e-mail to beccaria.paolo@hsr.it. © 2018 International Anesthesia Research Society

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Prognostic Significance of Nodal Location and Ratio in Stage IIIC Endometrial Carcinoma Among a Multi-Institutional Academic Collaboration

Purpose/Objective(s): Stage IIIC endometrial carcinoma (EC) represents pathologically heterogenous patients with single/multiple pelvic (stage IIIC1) or paraaortic (stage IIIC2) lymph nodes (LNs). There is an increasing trend to offer adjuvant chemotherapy (CT) +/− radiation (RT) uniformly to these patients, regardless of substage. We investigate the prognostic significance of positive LN (pLN) number, ratio (%pLN), location (IIC1 vs. IIC2), and adjuvant treatment on patterns of failure and survival in a large collaborative multi-institutional series. Materials and Methods: Clinical data for stage III EC patients such as patient characteristics, surgery/pathologic details, adjuvant therapies (including CT, RT, and chemotherapy and radiation), and outcomes (including pelvic control [PC], disease-free survival [DFS], distant DFS, and overall survival [OS]) were collected from 3 academic institutions. Log-rank analyses, Cox regression univariate and multivariate analyses were performed. Results: Of the 264 patients queried for stage III disease, 237 (73%) had pLN, and complete LN sampling for analysis. The mean number of pLN in the combined data were 3.9, with 26.1% of all LN sampled positive; 121 patients (51%) staged IIIC1, and 116 patients (49%) staged IIIC2. There was a significant difference in number of pLN (P=0.0006) and total LN sampled by institution (range, 13 to 35; P=0.0004), without a difference in %pLN (P=0.35). Ninety-seven of 220 (44.1%) have ≥20% pLN. While controlling for substage and institution, a decrease in DFS (hazard ratio [HR], 1.1; P=0.007), and OS (HR, 1.1; P=0.01) was observed with every increase of 10% in the pLN ratio. There was a significant difference in DFS (HR, 1.8; P=0.003), PC (HR, 1.9; P=0.004), and distant DFS (HR, 1.6; P=0.03), as well as a trend for decreased OS (HR, 1.6; P=0.08) for substage IIIC2 versus IIIC1 disease; 5 years DFS 40% versus 45%, OS 50% versus 57%. Patients received no adjuvant therapy (10%), CT alone (27%), RT alone (16%), or chemotherapy and radiation (47%). There was no significant difference in PC, DFS, or OS between the various treatment regimens. On univariate analysis, while pLN was significant, treatment type did not impact DFS or OS. On multivariate analysis for DFS, patient age, race, and IIIC1 versus IIIC2 substage retained significance (HR, 0.56; P=0.01). Conclusions: Stage III EC patients with substage IIIC2 disease have a significantly increased risk of local and distant disease recurrence and death from EC. A decrease in DFS and OS was observed with every increase of 10% in the pLN ratio. Stage IIIC2 patients represent a high-risk subpopulation for whom clinical trials, or targeted regimens should be explored to achieve improved oncologic outcomes. The authors declare no conflicts of interest. Reprints: Jyoti Mayadev, MD, Department of Radiation Oncology, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093. E-mail: jmayadev@ucsd.edu. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Multi-modal 3D Simulation Makes the Impossible Possible

Summary: B.Y. was born full term after a large vertex encephalocele was diagnosed prenatally. The unique challenge to repairing B.Y.'s encephalocele was a microcephalic skull and large proportion of likely functional extracranial brain tissue, which would need to be preserved. At Boston Children's Hospital, a simulation-based collaborative presurgical planning and rehearsal process, using both digital and 3D printed models, enabled successful technical completion and outcome of an otherwise inoperable case. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 20 April 2018. Received for publication October 16, 2017; accepted January 30, 2018. Accepted for presentation at the International Society of Craniofacial Surgery annual conference, October 2017, Cancun, Mexico. This study was approved by the Boston Children's Hospital international review board under IRB-P00022491. Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Ingrid M. Ganske, MD, MPA, Department of Plastic & Oral Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, Email: Ingrid.ganske@childrens.harvard.edu Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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“Blue-Blood”- Infused Chicken Thigh Training Model for Microsurgery and Supermicrosurgery

No abstract available

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What Drives Patient Choice: Preferences for Approaches to Surgical Treatments for Breast Cancer Beyond Traditional Clinical Benchmarks

Importance: Understanding what drives breast cancer (BC) patient's surgical decision-making and why, as survival continues to improve, are women continuing to choose mastectomy in increasing numbers. Objective: We sought to understand better what drives patient choice in surgical decision-making regarding BC treatment options. Design: We used a dynamic model, adaptive conjoint–based survey experiment, to assess multiple factors concurrently impacting patient choice, conducted from December 2016 to January 2017 using the Army of Women. Setting: Army of Women, is a U.S.–based nation-wide registry of women, both healthy and previous BC patients. Participants: An e-mail invitation was sent to the AWOL's 108,933 members, with 1,233 signing up to participate and 858 responding (548 healthy, 310 previous BC). Two hundred thirty-nine BC patients who underwent treatment > 5 years were excluded due to potential recall bias and changes in BC treatment paradigms. All subjects who did not complete the adaptive conjoint–based survey were also excluded due to inability to calculate preferences. The final sample consisted of 522 healthy women and 71 previous BC patients. Interventions or Exposures: Study of patient preference and decision drivers, without, interventions or exposures. Main Outcome(s) and Measure(s): Shares of preferences for various surgical treatment options were calculated using the highest-ranked factors, by the importance that drove patient decision-making. Results: Survey response rate was 69.5%. Among healthy women, the most important of the 9 factors in making a surgical choice were doctor's recommendation at 21.4% (SD, 13.6%) and overall survival (OS) at 20.5% (SD, 9.8%) while among previous BC patients, the most important factor was OS at 19% (SD, 9%) and doctor's recommendation at 17.2% (SD, 10.3%). Conclusion and Relevance: While OS accounted for the largest single driver of patient choice at ~20 %, it is notable that 80% of patient decision-making was driven by factors unrelated to survival such as cost, intensity and recovery time, and breast image. By understanding what drives choice, we can provide better patient-centric education and treatments. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 20 April 2018. Received for publication November 19, 2017; accepted February 12, 2018. Disclosure: This study was sponsored by LifeCell Corporation (an Allergan affiliate), Bridgewater, N.J. All authors met the ICMJE authorship criteria. Neither honoraria nor payments were made for authorship. Dr. Toni Storm-Dickerson is a speaker for Allergan and a consultant for Invuity. Dr. Allen Gabriel is a consultant for Allergan and Acelity. Dave Macarios is an employee of Allergan and owns stock or stock options. Lopamudra Das, Matthew Gitlin, and Jorge Farias received research funding from LifeCell Corporation (an Allergan affiliate). The Article Processing Charge was paid for by the authors. Supplemental digital content is available for this article. Clickable URL citations appear in the text. Allen Gabriel, MD, FACS, Department of Plastic Surgery, 505 NE, 87th Avenue, Suite 250, Vancouver, WA 98664, E-mail: gabrielallen@yahoo.com Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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Ultrasonography-guided Cannula Method for Hyaluronic Acid Filler Injection with Evaluation using Laser Speckle Flowgraphy

Summary: Hyaluronic acid (HA) is present in the connective tissues of the skin and decreases with age. HA fillers are popular as facial rejuvenation treatments. They are generally considered safe; however, complications, such as cutaneous necrosis and blindness due to vascular embolism, sometimes occur. Because vascular embolisms are likely associated with the deep placement of HA fillers, a strategy that involves injection into superficial regions (the conventional method) is commonly used to reduce risks. However, deep injections to achieve revolumization are becoming common, even in high-risk areas for intravascular infusion. We aimed to study the usefulness of the ultrasonography-guided cannula method for preventing intravascular infusion of HA fillers. An HA filler was injected into the region just under the dermis on the left side of the face of a 38-year-old man using the conventional method, and another HA filler was injected into the periosteum on the right side using the ultrasonography-guided cannula method. The skin blood flow on both sides was compared using laser speckle flowgraphy (LSFG). The ultrasonography-guided method was successful in detecting the cannula and the blood vessel, and the HA filler was safely injected into a deep region. Using LSFG, a difference in skin blood flow between the 2 methods was detected. The ultrasonography-guided cannula method was effective in aiding the safe injection of an HA filler in a deep high-risk area and maintained skin blood flow. LSFG may be adopted to evaluate skin blood flow after HA filler injections. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 20 April 2018. Received for publication December 5, 2017; accepted March 13, 2018. Disclosure:Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Takeshi Fukumoto, MD, PhD, Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan, E-mail: fuku@med.kobe-u.ac.jp Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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Prepectoral Versus Subpectoral Tissue Expander Placement: A Clinical and Quality of Life Outcomes Study

Background: Traditionally, tissue expanders (TEs) for breast reconstruction have been placed beneath the pectoralis major muscle with or without acellular dermal matrix. More recently, full acellular dermal matrix coverage has been described for prepectoral TE placement. Our study aims to explore differences in clinical and quality-of-life (QOL) outcomes for prepectoral versus subpectoral TE breast reconstruction. Methods: We identified patients who underwent postmastectomy breast reconstruction with prepectoral or subpectoral TE placement between 2011 and 2015 and completed QOL surveys. Primary outcomes were postoperative pain and QOL scores. Secondary outcomes were clinical outcomes. We used Wilcoxon rank-sum test, chi-square test, and linear regression to compare outcomes. Postoperative follow-up for each patient was at least 60 days, except that of pain scores, which were at least 30 days. Mean age was 49 ± 10 years. Results: Twenty-six prepectoral TE patients and 109 subpectoral TE patients met inclusion criteria. Pain scores were significantly lower at 12 hours, 1 day, 7 days, and 30 days postoperatively for the prepectoral group, compared with the subpectoral group, even after adjusting for confounding variables [PO12H: Sub-Pectoral (SP) median (interquartile range), 7 (5–8), Pre-Pectoral (PP), 5 (2.5–7.5), P value = 0.004; PO1D: SP, 5 (4–6), PP 3 (2–4), P value =

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Goldilocks Mastectomy with Bilateral In Situ Nipple Preservation Via Dermal Pedicle

Summary: Patients who don't want or can't have formal breast reconstruction after mastectomy surgery can be considered for a Goldilocks mastectomy, where the breast fullness is recreated from what is left behind after the gland tissue is removed from underneath the skin in a breast reduction pattern. A Goldilocks mastectomy does not require the use of implants or tissue transfer from other parts of the body and may be completed in a single surgery. This is best suited for larger breasted women who are willing to have much smaller breasts as a result. Previously, it was a challenge to be able to preserve the nipples when this operation was performed; however, this article describes a patient who had a bilateral Goldilocks mastectomy for right breast cancer who was able to save her nipples by keeping the blood flow in place from the surrounding skin. Conventional breast reconstruction after mastectomy is a challenge for larger breasted women. The Goldilocks mastectomy technique was designed to make best use of the redundant lower pole skin and subcutaneous fat to recreate a breast mound without a prosthetic implant or autologous tissue transfer. In its original description, the Goldilocks mastectomy did not include a means for nipple preservation. In this report, we describe the further refinement of the Goldilocks procedure that preserves the nipple areolar complex using a dermal pedicle. A patient with large pendulous breasts and right breast carcinoma underwent a bilateral Goldilocks nipple-sparing mastectomy and immediate reconstruction without an implant or flap. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 20 April 2018. Received for publication December 28, 2017; accepted February 13, 2018. Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Heather Richardson, MD, Bedford Breast Center, 436 N. Bedford Drive, Suite #105, Beverly Hills, CA 90210 Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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Caring for the person with cancer: Information and support needs and the role of technology

Psycho-Oncology, EarlyView.

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Assessing cognitive function in patients treated with immune checkpoint inhibitors: A feasibility study

Psycho-Oncology, EarlyView.

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Vascular targeting of LIGHT normalizes blood vessels in primary brain cancer and induces intratumoural high endothelial venules

The Journal of Pathology, EarlyView.

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FOXO1 regulates VEGFA expression and promotes angiogenesis in healing wounds

The Journal of Pathology, EarlyView.

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Understanding deregulated cellular and molecular dynamics in the haematopoietic stem cell niche to develop novel therapeutics for bone marrow fibrosis

The Journal of Pathology, EarlyView.

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The effect of preoperative exercise on upper extremity recovery following breast cancer surgery: a systematic review

Prehabilitation benefits among patients undergoing various oncological surgeries have been demonstrated. However, the effects of presurgical exercise and fitness on postoperative ipsilateral upper extremity recovery outcomes in patients with breast cancer surgery are less evident. A systematic review was performed to assess the effects of preoperative exercise and fitness on postmastectomy recovery. Systematic literature search was performed in 12 electronic databases. Study eligibility was accessed using the PICOS (Participants, Interventions, Comparison, Outcome and Study Design) criteria. Six eligible studies were found: three cohort–control and three prospective observational studies. One randomized-controlled trial showed that prehabilitation was beneficial in shoulder range of motion (ROM) and upper extremity functional recovery. One cohort–control study demonstrated that preoperative exercises reduced postoperative pain without increasing the risk of developing a seroma. A prospective cohort study showed that preoperatively active individuals had a significantly better chance of feeling recovered physically at 3 weeks after surgery. Baseline ipsilateral grip strength, shoulder flexion, and abduction ROM were reliable predictors of shoulder flexion and abduction ROM and grip strength improvements at 1 month following breast cancer surgery. One study showed that preoperative conditioning alone without postoperative rehabilitation was insufficient to aid recovery. Implementing exercise program and optimizing preoperative fitness, especially shoulder ROM, before breast cancer surgery in conjunction with individualized rehabilitation program may benefit postmastectomy ipsilateral upper extremity recovery. Correspondence to Ajax Yang, MD, Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA Tel: +1 212 824 8361; fax: +1 212 348 5901; e-mail: yang.ajax@gmail.com Received February 11, 2018 Accepted March 21, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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HDAC5–LSD1 axis regulates antineoplastic effect of natural HDAC inhibitor sulforaphane in human breast cancer cells

International Journal of Cancer, EarlyView.

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PLOD2 as a potential regulator of peritoneal dissemination in gastric cancer

International Journal of Cancer, EarlyView.

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Issue Information

International Journal of Cancer, Volume 142, Issue 12, Page 2625-2626, 15 June 2018.

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Issue Information

International Journal of Cancer, Volume 142, Issue 12, Page 2407-2413, 15 June 2018.

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Tracking single membrane targets of human autoantibodies using single nanoparticle imaging

Publication date: Available online 21 April 2018
Source:Journal of Neuroscience Methods
Author(s): Julie Jézéquel, Julien P. Dupuis, François Maingret, Laurent Groc
BackgroundOver the past decade, an increasing number of neurological and neuropsychiatric diseases have been associated with the expression of autoantibodies directed against neuronal targets, including neurotransmitter receptors. Although cell-based assays are routinely used in clinics to detect the presence of immunoglobulins, such tests often provide heterogeneous outcomes due to their limited sensitivity, especially at low titers. Thus, there is an urging need for new methods allowing the detection of autoantibodies in seropositive patients that cannot always be clinically distinguished from seronegative ones.New MethodHere we make a case for single nanoparticle imaging approaches as a highly sensitive antibody detection assay. Through high-affinity interactions between functionalized nanoparticles and autoantibodies that recognize extracellular domains of membrane neuronal targets, single nanoparticle imaging allows a live surface staining of transmembrane proteins and gives access to their surface dynamics.Results and Comparison with Existing Method(s)We show here that this method is well-suited to detect low titers of purified immunoglobulin G (IgG) from first-episode psychotic patients and demonstrate that these IgG target glutamatergic N-Methyl-D-Aspartate receptors (NMDAR) in live hippocampal neurons. The molecular behaviors of targeted membrane receptors were indistinguishable from those of endogenous GluN1 NMDAR subunit and were virtually independent of the IgG concentration present in the sample contrary to classical cell-based assays.ConclusionsSingle nanoparticle imaging emerges as a real-time sensitive method to detect IgG directed against neuronal surface proteins, which could be used as an additional step to rule out ambiguous seropositivity diagnoses.

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A comparison of seven different dti-derived estimates of corticospinal tract structural characteristics in chronic stroke survivors

Publication date: Available online 21 April 2018
Source:Journal of Neuroscience Methods
Author(s): Bokkyu Kim, Beth E. Fisher, Nicolas Schweighofer, Richard M. Leahy, Justin P. Haldar, Soyoung Choi, Dorsa B. Kay, James Gordon, Carolee J. Winstein
BackgroundDifferent diffusion tensor imaging (DTI) has been used to estimate corticospinal tract (CST) structure in the context of stroke rehabilitation research. However, there is no gold standard for the estimate of CST structure in chronic stroke survivors. This study aims to determine the most accurate DTI-derived CST estimate that is associated with a clinical motor outcome measure.MethodsWe obtained imaging and behavioral data from a phase-I stroke rehabilitation clinical trial. We included thirty seven chronic stroke survivors with mildtomoderate motor impairment. Imaging data were processed using BrainSuite16a software. We calculated mean FA for each of 7 different ROIs/VOIs that include manually drawn 2-D ROIs and 3-D VOIs of CST from individual tractography or standard atlas. We compared ipsi- and contralesional CST FA for each method. Partial correlation was conducted between each CST FA asymmetry index and a time-based motor outcome measure, controlling for age and chronicity.ResultsIpsilesional CST FA was significantly lower than contralesional CST FA for each of the 7 methods Only CST FA asymmetry from the 3-D individual CST tractography showed a significant correlation with the primary motor outcome (r = 0.46, p = .005), while CST FA from the other six methods did not.Comparison with existing methodsCompared to the six other methods, CST FA asymmetry from 3-D individual tractography is the most accurate estimate of CST structure in this cohort of stroke survivors.ConclusionWe recommend this method for future research seeking to understand brain-behavior mechanisms of motor recovery in chronic stroke survivors.

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Normothermic Ex Vivo Kidney Perfusion Reduces Warm Ischemic Injury of Porcine Kidney Grafts Retrieved After Circulatory Death (DCD)

Background: Cold storage is poorly tolerated by kidney grafts retrieved after Donation after Circulatory Death (DCD). It has been determined that normothermic ex vivo kidney perfusion (NEVKP) preservation decreases injury by minimizing cold ischemic storage. The impact of NEVKP on warm ischemic injury is unknown. Methods We compared pig kidneys retrieved after 30minutes warm ischemia and immediate transplantation (no-preservation) with grafts that were exposed to 30min of warm ischemia plus 8hr NEVKP or plus 8hr SCS. Results Following transplantation, the NEVKP group demonstrated lower daily serum creatinine levels indicating better early graft function compared with no-preservation (p=0.02) or static cold storage group (p

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Split liver transplantation and pediatric waitlist mortality in the United States: potential for improvement

Background In the United States, 1 in 10 infants and 1 in 20 older children die on the liver transplant waiting list. Increasing split liver transplantation could increase organ availability for these children, without decreasing transplants in adults. Methods Using UNOS STAR data, we identified livers transplanted 2010-2015 that could potentially have been used for split transplant, based on strict criteria. Livers not suitable for pediatric patients or allocated to high-risk recipients were excluded. Number and distribution of potentially "split-able" livers were compared to pediatric waitlist deaths in each region. Results Of 37 333 deceased donor livers transplanted, 6.3% met our strict criteria for utilization in split liver transplant. Only 3.8% of these were actually utilized for split liver transplantation. 96% were utilized for a single adult recipient. Of the 2253 transplanted as whole livers, 82% of their recipients were listed as willing to accept a segmental liver, and only 3% were listed as requiring a cold ischemia time less than 6 hours. Over the same 5 years, 299 children died on the waitlist. In every UNOS region, there were more potentially "split-able" livers than pediatric waitlist deaths. 37% of pediatric waitlist deaths occurred at transplant centers that averaged ≤1 pediatric split liver transplant annually during the study period. Conclusion This comparison, while not conclusive, suggests that we might be missing opportunities to reduce pediatric waitlist mortality without decreasing access for adults—using split liver transplant. Barriers are significant, but further work on strategies to increase split liver transplant is warranted. Corresponding Author: Emily R. Perito, MD MAS, Pediatric Gastroenterology, Hepatology, and Nutrition, 550 16th Street, 5th Floor, Box 0136; San Francisco, CA 94143, Email: emily.perito@ucsf.edu Authorship: Emily R. Perito, MD MAS: Led study design, IRB approval, data analysis and interpretation, writing and revision of the manuscript. Garrett Roll, MD: Participated in study design, data interpretation, writing and revision of the manuscript. Jennifer L. Dodge, MPH: Participated in study design, led data analysis and interpretation, participated in writing and revision of the manuscript Sue Rhee, MD: Participated in study design, data interpretation, writing and revision of the manuscript. John P. Roberts, MD: Participated in study design, data interpretation, writing and revision of the manuscript. Funding and acknowledgements: This work was supported in part by Health Resources and Services Administration contract 234-2005-37011C (UNOS Data), the NIH-NIDDK (Dr. Perito, K23 DK0990253-A101), the UCSF Liver Center (P30 DK026743), and the UCSF Department of Pediatrics (Clinical/Translational Pilot Study Grant). The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and should not be seen as an official policy of or interpretation by the SRTR or the US Government. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the NIH or the Department of Health and Human Services, nor does mention of trades names, commercial products, or organizations imply endorsement by the US Government. Disclosures: The authors of this manuscript have no conflicts of interest to disclose as described by Transplantation. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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One Hundred and Fifteen Cases of Pure Laparoscopic Living Donor Right Hepatectomy at a Single Center

Background The pure laparoscopic approach to donor hepatectomy is being taken more often. However, few centers perform pure laparoscopic donor right hepatectomy (PLDRH) because it requires a high level of surgical skill. Studies reporting initial outcomes of PLDRH may prompt further implementation of the technique and help reduce initial learning curves at other transplant centers. This study reports performance of PLDRH at a single center with extensive experience of adult living donor liver transplantation. Methods Data from 115 donors (and recipients) who underwent PLDRH between November 2015 and June 2017 were analyzed retrospectively. Subgroup analysis was performed to compare outcomes between the initial (November 2015 to October 2016) and more recent (November 2016 to June 2017) periods. Results During the initial period, three donors (2.6%) experienced complications greater than grade III on the Clavien-Dindo scale. By contrast, no donors developed complications during the recent period. The operative time (293.6 vs 344.4 minutes; P

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How Should Social Media Be Used in Transplantation? A Survey of The American Society of Transplant Surgeons

Background Social media platforms are increasingly used in surgery and have shown promise as effective tools to promote deceased donation and expand living donor transplantation. There is growing need to understand how social media-driven communication is perceived by providers in the field of transplantation. Methods We surveyed 299 members of the American Society of Transplant Surgeons (ASTS) about their use of, attitudes toward, and perceptions of social media and analyzed relationships between responses and participant characteristics. Results Respondents used social media to communicate with: family and friends (76%), surgeons (59%), transplant professionals (57%), transplant recipients (21%), living donors (16%), and waitlisted candidates (15%). Most respondents (83%) reported using social media for at least one purpose. While most (61%) supported sharing information with transplant recipients via social media, 42% believed it should not be used to facilitate living donor-recipient matching. Younger age (p=0.02) and fewer years of experience in the field of transplantation (p=0.03) were associated with stronger belief that social media can be influential in living organ donation. Respondents at transplant centers with higher reported use of social media had more favorable views about sharing information with transplant recipients (p

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Αρχειοθήκη ιστολογίου

Κυριακή 22 Απριλίου 2018

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