Implementing a Labor and Delivery Cell Salvage Protocol in Patients at Increased Risk of Hemorrhage: A Pilot Study.

Background: Postpartum hemorrhage (PPH) contributes significantly to maternal morbidity and mortality. The use of cell salvage has been implemented in operating rooms across the world, but only a limited number of institutions have protocols for use of cell salvage during vaginal hemorrhage at the time of vaginal delivery. Observations suggest that blood salvaged from vaginal delivery is comparable to blood salvaged during cesarean delivery.

Improving outcomes in emergency general surgery: Construct of a collaborative quality initiative.

Background: Emergency general surgery conditions are common, costly, and highly morbid. The proportion of excess morbidity due to variation in health systems and processes of care is poorly understood. We constructed a collaborative quality initiative for emergency general surgery to investigate the emergency general surgery care provided and guide process improvements.

Petascale pipeline for precise alignment of images from serial section electron microscopy.

The reconstruction of neural circuits from serial section electron microscopy (ssEM) images is being accelerated by automatic image segmentation methods. Segmentation accuracy is often limited by the preceding step of aligning 2D section images to create a 3D image stack. Precise and robust alignment in the presence of image artifacts is challenging, especially as datasets are attaining the petascale.

"Winged" Eagle's syndrome: neurophysiological findings in a rare cause of spinal accessory nerve palsy. Illustrative cases.

Background: Eagle's syndrome (ES) classically describes dysphagia, globus sensation, and otalgia from an elongated and calcified styloid process or stylohyoid ligament. Compression of the spinal accessory nerve (SAN) has not been reported as an associated feature of ES or related variants.

Observations: The authors describe two cases of an atypical "winged" variant with SAN palsy resulting from compression by a posteriorly angulated or calcified styloid process.

Development of a Tool to Assess Surgical Resident Competence On-Call: The Western University Call Assessment Tool (WUCAT).

Background: A central tenet of competency-based medical education is the formative assessment of trainees. There are currently no assessments designed to examine resident competence on-call, despite the on-call period being a significant component of residency, characterized by less direct supervision compared to daytime. The purpose of this study was to design a formative on-call assessment tool and collect valid evidence on its application.

Gender Equality in Plastic Surgery Training: A Canadian Nationwide Cross-sectional Analysis.

One of the important factors in achieving gender equity is ensuring equitable surgical training for all. Previous studies have shown that females get significantly lower surgical exposure than males in certain surgical specialties. Gender gap in surgical exposure has never been assessed in plastic surgery.

CAVE: Connectome Annotation Versioning Engine.

Advances in Electron Microscopy, image segmentation and computational infrastructure have given rise to large-scale and richly annotated connectomic datasets which are increasingly shared across communities. To enable collaboration, users need to be able to concurrently create new annotations and correct errors in the automated segmentation by proofreading. In large datasets, every proofreading edit relabels cell identities of millions of voxels and thousands of annotations like synapses.

Neuronal wiring diagram of an adult brain.

Connections between neurons can be mapped by acquiring and analyzing electron microscopic (EM) brain images. In recent years, this approach has been applied to chunks of brains to reconstruct local connectivity maps that are highly informative, yet inadequate for understanding brain function more globally. Here, we present the first neuronal wiring diagram of a whole adult brain, containing 5×10 chemical synapses between ~130,000 neurons reconstructed from a female .

NEURD offers automated proofreading and feature extraction for connectomics.

We are now in the era of millimeter-scale electron microscopy (EM) volumes collected at nanometer resolution. Dense reconstruction of cellular compartments in these EM volumes has been enabled by recent advances in Machine Learning (ML). Automated segmentation methods produce exceptionally accurate reconstructions of cells, but post-hoc proofreading is still required to generate large connectomes free of merge and split errors.

Cell-type-specific inhibitory circuitry from a connectomic census of mouse visual cortex.

Mammalian cortex features a vast diversity of neuronal cell types, each with characteristic anatomical, molecular and functional properties. Synaptic connectivity powerfully shapes how each cell type participates in the cortical circuit, but mapping connectivity rules at the resolution of distinct cell types remains difficult. Here, we used millimeter-scale volumetric electron microscopy to investigate the connectivity of all inhibitory neurons across a densely-segmented neuronal population of 1352 cells spanning all layers of mouse visual cortex, producing a wiring diagram of inhibitory connections with more than 70,000 synapses.

The Evaluation of a Flexor Digitorum Profundus-to-Volar Plate Zone I Repair Versus Button Repair: An In Vitro Biomechanics Study.

Purpose: The purpose of the study was to evaluate joint kinematics and tendon work of flexion (WOF) following a flexor digitorum profundus (FDP)-to-volar plate (VP) repair technique relative to a pullout button for zone I flexor tendon injuries.

Methods: Fourteen digits were tested using an in vitro active finger motion simulator under 3 repaired conditions following a simulated zone I avulsion: button, FDP-VP, and "no slack" FDP-VP (corrected for additional VP length). Outcome metrics included active joint range of motion (ROM), fingertip strength, FDP and flexor digitorum superficialis tensile loads, and WOF.

Strength Comparison of Fibrin Glue and Suture Constructs in Upper Extremity Peripheral Nerve Coaptations: An In Vitro Study.

Purpose: To compare in vitro failure loads of nerve coaptations using fibrin glue alone, a suture alone, and a combination of fibrin glue and a suture.

Methods: The median, radial, and ulnar nerves of 15 fresh-frozen cadaveric upper extremity specimens (45 nerves in total) were dissected in vitro and transected 5 cm proximal to the wrist crease to simulate an injury requiring coaptation. Three coaptation techniques were used: fibrin glue alone, a suture alone, and a suture augmented with fibrin glue.

The Effect of Flexor Digitorum Profundus Repair Position Relative to Camper Chiasm on Tendon Biomechanics.

Purpose: The purpose of this study was to investigate the impact of repairing a zone II flexor digitorum profundus (FDP) laceration anatomically versus extra-anatomically on tendon loads and work of flexion (WOF).

Methods: Twenty digits from 5 cadaveric specimens were tested using an in vitro active finger motion simulator under 2 FDP tendon repair conditions: anatomic and extra-anatomic. Tensile loads in FDP and flexor digitorum superficialis (FDS), WOF, and total active finger range of motion (ROM) were measured using in-line load cells and electromagnetic tracking, respectively.

Hoarding and obsessive-compulsive behaviours in frontotemporal dementia: Clinical and neuroanatomic associations.

Background: Hoarding and obsessive-compulsive behaviours (OCB) are well documented symptoms in frontotemporal dementia (FTD). While contemporary models consider hoarding and obsessive-compulsive disorder distinct, the related behaviours have not been separately examined in patients with FTD, and the neuroanatomical correlates of hoarding in patients with FTD have not been previously examined (American Psychiatric Association, 2013; Grisham and Baldwin, 2015; Mataix-Cols et al., 2010).

Esophagectomy in Patients with Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome: A Viable Option.

The objective of this study was to assess the outcomes for patients with human immunodeficiency virus (HIV) and acquired immune deficiency virus (AIDS) who had esophagectomy done for both benign and malignant conditions. A retrospective chart review of patients with HIV and AIDS undergoing esophagectomy at a rural referral hospital was done for the period of 2009-2014. Patient postoperative complications, outcomes, and follow-up data were charted.

Alu repeats as transcriptional regulatory platforms in macrophage responses to M. tuberculosis infection.

To understand the epigenetic regulation of transcriptional response of macrophages during early-stage M. tuberculosis (Mtb) infection, we performed ChIPseq analysis of H3K4 monomethylation (H3K4me1), a marker of poised or active enhancers. De novo H3K4me1 peaks in infected cells were associated with genes implicated in host defenses and apoptosis.

Comparison of stapling techniques and management of the mesoappendix in laparoscopic appendectomy.

Many techniques for laparoscopic appendectomy have been proposed with few comparative studies. We performed a retrospective review of all patients undergoing laparoscopic appendectomy for uncomplicated appendicitis from 2006 to 2011. Techniques were: (1) transection of the mesoappendix and appendix with a single staple line (SSL); (2) transection of the mesoappendix and appendix with multiple staple lines (MSL); and (3) transection of the mesoappendix with ultrasonic shears and the appendix with a single staple line (USSL).

Selective laparoscopic approach in suspected gallbladder malignancy.

Background And Objectives: We examined patients with clinical findings that are concerning for gallbladder malignancy to determine the incidence of pathology-confirmed malignancy and to discover factors that may be used to determine which patients may be initially treated with a laparoscopic approach.

Methods: All patients referred to a surgical oncologist with preoperative findings that are concerning for gallbladder malignancy who had not undergone previous surgical resection from 2005 to 2011 were reviewed. Variables collected included demographics, imaging, operative findings, and final pathology.

Anomalous origin of the right coronary artery from the pulmonary artery: evaluation with use of 64-slice multidetector computed tomography.

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