Abstract Background The role of acellular dermal matrix (ADM) in abdominal wall reconstruction (AWR) is unclear. The aim of this study was to review the management, complications, and long-term ...outcomes of AWR using ADM in a large surgical cohort. Methods Retrospective chart review of patients undergoing AWR using ADM from 2004 to 2007 was performed. Demographic data, comorbidities, complications, and long-term outcomes were collected. Results There were 77 cases in 68 patients with mean age of 61.1 ± 1.4 years. The most common indication was infected fascia (n = 19 25%). Wound closure was achieved in 75% of the cases via primary (n = 26 45%), secondary intention (n = 17 29%), or skin graft (n = 15 26%). Nonprimary closure was achieved in 5.7 ± .7 months. There were 32 perioperative (39%) and 33 long-term (43%) complications. Over a mean follow-up period of 13.2 ± 1.5 months, the hernia recurrence rate was 27% (n = 21). Conclusion Although ADM is a viable option in AWR, the high hernia recurrence rate warrants a continued search for alternative biologic materials to improve outcomes.
Mechanisms causing facial fractures have evolved over time and may be predictive of the types of injuries sustained. The objective of this study is to examine the impact of mechanisms of injury on ...the type and management of facial fractures at our Level 1 Trauma Center. The authors performed an Institutional Review Board-approved review of our network's trauma registry from 2006 to 2010, documenting age, sex, mechanism, Injury Severity Score, Glasgow Coma Scale, facial fracture patterns (nasal, maxillary/malar, orbital, mandible), and reconstructions. Mechanism rates were compared using a Pearson χ2 test. The database identified 23,318 patients, including 1686 patients with facial fractures and a subset of 1505 patients sustaining 2094 fractures by motor vehicle collision (MVC), fall, or assault. Nasal fractures were the most common injuries sustained by all mechanisms. MVCs were most likely to cause nasal and malar/maxillary fractures (P < 0.01). Falls were the least likely and assaults the most likely to cause mandible fractures (P < 0.001), the most common injury leading to surgical intervention (P < 0.001). Although not statistically significant, fractures sustained in MVCs were the most likely overall to undergo surgical intervention. Age, number of fractures, and alcohol level were statistically significant variables associated with operative management. Age and number of fractures sustained were associated with operative intervention. Although there is a statistically significant correlation between mechanism of injury and type of facial fracture sustained, none of the mechanisms evaluated herein are statistically associated with surgical intervention. Clinical Question/Level of Evidence: Therapeutic, III.
Megalopyge opercularis (Smith) (Lepidoptera: Megalopyridae) is a nocturnal moth of medical importance because it causes adverse immunological reactions in humans. In this study, we determined the ...microbiota composition of M. opercularis at the larval (caterpillars) and adult (moths) stages by next-generation sequencing. DNA was extracted from the caterpillars and moths, and the 16S rRNA prokaryote gene was then amplified and sequenced with next-generation sequencing to assess bacterial richness. Comparison of the microbiota of the caterpillars and adults revealed variation in species composition and diversity. The microbiota of the caterpillars of M. opercularis was composed of 259 species, dominated by the families Geodermatophilaceae (12%), Propionibacteriaceae (10.41%), Clostridiaceae (9.63%), and Nitriliruptoraceae (7.72%). In the adult moths, we found 138 species, and the most abundant families were Nostocaceae (24%) and Methylobacteriaceae (21%). Species richness in M. opercularis was higher in the caterpillars compared to adults. We determined that only some groups of bacteria could persist from 1 stage to another. The results obtained are essential to know about the ecology of M. opercularis and contribute to our understanding of the impact that microorganisms have on the physiological mechanisms of poisonous lepidopterans.
Megalopyge opercularis (Smith) (Lepidoptera: Megalopyridae) es una especie de polilla nocturna perteneciente a la familia Megalopyridae de importancia médica debido a las reacciones inmunológicas causadas en humanos por sustancias urticantes ubicadas en sus estructuras espinosas. En este estudio, determinamos el microbioma de M. opercularis en su estado larval y en su estado adulto. Se extrajo el ADN de larvas y adultos y se amplificó el gen rRNA 16S mediante tecnologías de secuenciación de nueva generación. Las comparaciones del microbioma larval contra el microbioma adulto revelaron variación tanto en la composición como en la diversidad de especie. El microbioma larval de M. opercularis está compuesto de 259 especies, dominado por las familias Geodermatophilaceae (12%), Propionibacteriaceae (10.41%), Clostridiaceae (9.63%), y Nitriliruptoraceae (7.72%). En el microbioma adulto encontramos 138 espcies, las familias más abundantes fueron Nostocaceae (24%) y Methylobacteriaceae (21%). La riqueza de especies encontradas en M. opercularis fue mayor en las orugas en comparación con los adultos. Determinamos que solo algunos grupos de bacterias podían persistir de una etapa a otra. Los resultados obtenidos son importantes para conocer la ecología de esta polilla y contribuyen a comprender el impacto que tienen los microorganismos en los mecanismos fisiológicos de los lepidópteros venenosos.
Upper extremity aneurysms are relatively infrequent when compared to other vessels in the body. However, a combination of factors occurring following arteriovenous fistula (AVF) ligation can lead to ...dilation of the brachial artery. Periodic follow-up after AVF creation can help prevent complications. We report a case of an immunosuppressed, patient with renal transplant who presented with delayed onset digital ischemia following ligation of a remotely created brachial artery-cephalic vein fistula.
Understanding how the electronic conductivity of metal oxides used as electrode materials in Li-ion batteries (LIBs) evolves as a function of the degree of lithiation/delithiation is relevant to try ...to prolong the battery lifetime, which affects, among others, the sustainability of LIBs. We propose the use of ion-gated transistors (IGTs) employed as transistor channel material films of Li4Ti5O12 (LTO) and TiO2 interfaced to the ionic liquid 1-ethyl-3-methylimidazolium bis(trifluoromethylsulfonyl)imide (EMIMTFSI) including the salt LiTFSI, to study the evolution of the doping mechanism, charge carrier density and mobility with the advancement of lithiation/delithiation in the films. The process of lithiation/delithiation is controlled by the electrical bias applied at the gate electrode, made of carbon paper coated with high surface area activated carbon. The sweeping rate of the gate bias affects the kinetics of Li intercalation/deintercalation and, consequently, the electronic doping of the transistor channel. We discuss how different doping mechanisms, namely electrostatic, “purely” electrochemical, or electrochemical possibly associated with structural changes in the transistor channel are possible for the metal oxide films. We consider such a discussion relevant to contribute to the optimal use of the electrode materials in LIBs.
Abstract
Introduction: Enhanced recovery after surgery (ERAS) pathways strive to minimize surgical stress and restore normal physiological function through the implementation of standardized and ...streamlined protocols. ERAS pathways have shown benefits in many surgical populations including cardiac, colorectal, urology and general surgery by aiming to accelerate recovery and reduce post-operative morbidity. As microsurgical breast reconstruction continues to become more popular, study objectives aim to determine possible benefits of ERAS pathway implementation during abdominal-based free flap breast reconstruction related to post-operative narcotic use and health-care resource utilization.
Methods: A retrospective analysis of consecutive patients undergoing abdominal-based free flap breast reconstruction from Nov 2015 to April 2018 was performed. Study populations were defined relative to uniform implementation of an ERAS pathway, which included preoperative counseling, optimization of nutrition, perioperative fluid management, early mobilization, and multimodal analgesia. Patient age, medical comorbidities, and BMI were recorded preoperatively. Procedural characteristics and immediate postoperative morbidity were recorded along with length of hospitalization. Utilization of narcotics was standardized for the entire hospitalization by determining morphine milligram equivalents.
Results: During the study period, 409 patients met inclusion criteria. The pre-ERAS group was comprised of 205 patients, while 204 patients were managed via ERAS pathway. Mean age, laterality (unilateral vs. bilateral), timing (immediate vs. delayed) of reconstruction, and number of previous abdominal surgeries were similar (p > 0.05) between both groups. Mean BMI (30.4 ± 4.8 vs. 29 ± 5.1) and incidence of autoimmune disease (3.9% vs. 0%) were significantly higher (p < 0.05) in the pre-ERAS group. Mean operative time (minutes) between both groups (450.1 ± 92.7 vs. 440.7 ± 93.5) was similar (p > 0.05). Incidence of vascular thrombosis (6 (2.9%) vs. 5 (2.5%)), hematoma (4 (2%) vs.4 (2%)), flap loss (1 (0.5%) vs. 4 (2.%), or return to OR for any reason (10 (4.9%) vs. 8 (3.9%)) was similar (p > 0.05) between pre-ERAS and ERAS groups, respectively. Mean intra-operative (58.9 ± 32.5 vs. 31.7 ± 23.4) and post-operative (129.5 ± 80.1 vs. 90 ± 93.9) morphine milligram equivalents used were significantly (p < 0.001) higher in the pre-ERAS group. Mean length of stay (days) was significantly (p < 0.001) longer in the pre-ERAS group (4.5 ± 0.8 vs. 3.2 ± 0.6). Bivariate linear regression analysis demonstrates operative time is positively associated with total narcotic requirements slope (95% CI)=0.217 (0.114, 0.320), p < 0.001 and length of stay slope (95% CI) =0.00177 (0.0008, 0.0028), p < 0.001.
Conclusion: Without detrimental effects on operative morbidity, ERAS pathways in microsurgical breast reconstruction promote reduction in intraoperative and postoperative narcotic utilization with concomitant decrease in hospital length of stay. In the current study, patients managed via ERAS pathways required 46% less intraoperative and 31% less postoperative narcotics with a 29% reduction in length of stay.
Citation Format: Oscar Ochoa, Meenakshi Rajan, Minas Chrysopoulo, Steven Pisano, Peter Ledoux, Gary Arishita, Ramon Garza III, Chet Nastala. Enhanced recovery after surgery (ERAS) pathway reduces hospital stay and narcotic use in microsurgical breast reconstruction abstract. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr PD6-2.
BACKGROUNDManagement of positive margins after nonmelanoma skin cancer (NMSC) excision is debated in the literature. The purpose of this study is to determine the rate of residual tumor in reexcised ...NMSC specimens after previous excision with positive margins, to determine the rate of recurrence in patients who had positive margins but did not undergo reexcision, and to define the financial burden of negative reexcisions.
METHODSAn Institutional Review Board-approved retrospective review was conducted on all patients with NMSC excision over a 15-year period. Patients who met inclusion criteria and underwent initial NMSC excision with negative frozen section margins, but had positive permanent section margins were divided into 2 groupsthose who underwent reexcision for clearance of tumor (n = 161) or those who did not undergo further reexcision (n = 105). Variables collected include demographics, previous skin cancer, tumor location, cancer subtype, excision measurements, and time between first and second excisions. For those patients who did not undergo reexcision, charts were examined for recurrence.
RESULTSTwo hundred sixty-six patients met inclusion criteria with mean follow-up of 60 months. Eighty-three (52%) of 161 patients with positive margins on initial excision had no evidence of residual cancer upon reexcision. Residual tumor on permanent section was confirmed in 48% of patients. Patients with a previous history of basal cell carcinoma were more likely to have a true-positive margin after reexcision (P = 0.02). Larger reexcisions were more likely to harbor residual cancer (5.9 cm, P = 0.04). Patients with positive margins that did not undergo reexcision, only 7 of 105 patients (6.6%) had recurrence. No mortalities were reported from NMSC recurrence. US $247,672 was spent in reexcision for negative margins in 98 patients for an average cost of US $2984 per case.
CONCLUSIONSForty-eight percent of NMSC patients with positive margins had residual tumor upon reexcision. There were 6.6% of the patients who did not undergo resection after positive margins developed recurrence of disease at 5 years. Patients requiring larger reexcisions or those with a prior history of BCC were more likely to have residual cancer upon reexcision. This study suggests that observation is an appropriate option of care for certain patients with residual NMSC on permanent pathology.
