Veno-Arterial Extracorporeal Membrane Oxygenation and Thrombectomy for Massive Pulmonary Embolism.

Massive pulmonary embolism (PE) is associated with high mortality rates. Pulmonary Embolism Response Team (PERT) collaboration with prompt access to veno-arterial extracorporeal membrane oxygenation (VA ECMO) during mechanical or aspiration thrombectomy for massive PE can be life-saving; ECMO stand-by should be considered for high-risk cases. We describe a case of massive PE treated with intraprocedural VA ECMO during the catheter-directed intervention.

Empirical determination of explosive vapor transport efficiencies.

The transport efficiency of 2,4-dinitrotoluene (2,4-DNT), 2,4,6-trinitrotoluene (TNT) and 1,3,5-trinitro-1,3,5-triazinane (RDX) trace vapors through tubing materials that commonly constitute vapor handling infrastructures have been determined for a variety of tubing dimensions and sampling conditions. Using a programmable temperature vaporization inlet coupled with a gas chromatography mass spectrometer (PTV-GC-MS), the explosive vapors were quantified both with and without a length of tubing of a specific material in the sampling flow path. At vapor temperatures of 30 °C and 66 °C, minimal attenuations were observed for 2,4-DNT and TNT vapor concentrations when the tubing material was in-line with the sampling flow path, indicating that the transport is largely unaffected by interactions with the surface of the tubing materials.

Trace vapor generator for Explosives and Narcotics (TV-Gen).

The Trace Vapor Generator for Explosives and Narcotics (TV-Gen) is a portable and compact instrument designed to deliver a continuous source of trace-level vapors and vapor mixtures. It provides a tool to assist in the independent validation and verification of new materials and sensors under development for the vapor detection of explosives and narcotics. The design was conceived for use with a broad range of analytes, detection systems, materials, and sensors and to switch easily between the clean and analyte vapor streams.

A Spectroscopic Study of Xanthene Dyes on a Polystyrene Surface: an Investigation of Ion-π Interactions at Polymer Interfaces.

Thin films of three differently charged xanthene dyes: rhodamine 6G (Rh6G, cationic), fluorescein 27 (F27, neutral), and disodium fluorescein (DSF, anionic) were cast onto a polystyrene (PS) coated glass substrate to investigate ion-π interactions. Absorbance spectroscopy was used to determine the aggregation state of the dyes on the PS surface. Deconvolution of the spectra of films revealed multiple peaks for all dyes assigned to isolated monomers, aggregates, and complexes between the dye and the polymer substrate.

Combined secondary electrospray and corona discharge ionization (SECDI) for improved detection of explosive vapors using drift tube ion mobility spectrometry.

Secondary electrospray corona discharge ionization (SECDI) combines the principles of secondary electrospray ionization (SESI) and corona discharge (CD) to achieve higher sensitivity, which is demonstrated through the detection of 2,4,6-trinitrotoluene (TNT) and 2,6-dinitrotoluene (2,6-DNT) vapors using ion mobility spectrometry (IMS). Using SECDI, enhancements in the IMS signal for TNT and 2,6-DNT vapors at trace concentrations are as much as 2-26 times that observed with CD or SESI alone. The enhancement in sensitivity is hypothesized to result from an increase in ionization efficiency driven by a higher number of reactant ions associated with SECDI compared to either technique individually.

Part per quadrillion quantitation of pentaerythritol tetranitrate vapor using online sampling gas chromatography-mass spectrometry.

The development of an online sampling method using programmable temperature vaporization gas chromatography with a mass spectrometer detector (PTV-GC/MS) for the analysis of trace pentaerythritol tetranitrate (PETN) vapor is presented. PETN degradation was minimized by optimizing the temperature and flow rates of the vapor sampling infrastructure. Validation of the online method was done using a previously published technique, vapor sampling with Tenax-TA thermal desorption tubes followed by analysis with a thermal desorption system coupled to a programmable temperature vaporization gas chromatograph with a micro-electron capture detector (TDS-PTV-GC/μECD).

CRISPR knockout screening identifies combinatorial drug targets in pancreatic cancer and models cellular drug response.

Predicting the response and identifying additional targets that will improve the efficacy of chemotherapy is a major goal in cancer research. Through large-scale in vivo and in vitro CRISPR knockout screens in pancreatic ductal adenocarcinoma cells, we identified genes whose genetic deletion or pharmacologic inhibition synergistically increase the cytotoxicity of MEK signaling inhibitors. Furthermore, we show that CRISPR viability scores combined with basal gene expression levels could model global cellular responses to the drug treatment.

Neoadjuvant Chemotherapy Is Associated with Lower Lymph Node Counts in Colon Cancer.

Adequate lymphadenectomy is associated with improved survival in patients who undergo oncologic resection of colorectal cancer and has been identified as a quality metric. Neoadjuvant chemotherapy has been found to be associated with collection of <12 lymph nodes in patients with rectal cancer. The purpose of this study was to evaluate patient and operative risk factors for inadequate lymph node retrieval during oncologic colectomy.

A propensity matched analysis of robotic, minimally invasive, and conventional mitral valve surgery.

Objectives: Institutional studies suggest robotic mitral surgery may be associated with superior outcomes. The objective of this study was to compare the outcomes of robotic, minimally invasive (mini), and conventional mitral surgery.

Methods: A total of 2300 patients undergoing non-emergent isolated mitral valve operations from 2011 to 2016 were extracted from a regional Society of Thoracic Surgeons database.

Open Surgical Incisions After Colorectal Surgery Improve Quality Metrics, But Do Patients Benefit?

Background: Surgical site infection is a frequent cause of morbidity after colorectal resection and is a quality measure for hospitals and surgeons. In an effort to reduce the risk of postoperative infections, many wounds are left open at the time of surgery for secondary or delayed primary wound closure.

Objective: The purpose of this study was to evaluate the impact of delayed wound closure on the rate of surgical infections and resource use.

Ureteral stents increase risk of postoperative acute kidney injury following colorectal surgery.

Background: Ureteral stents are commonly placed before colorectal resection to assist in identification of ureters and prevent injury. Acute kidney injury (AKI) is a common cause of morbidity and increased cost following colorectal surgery. Although previously associated with reflex anuria, prophylactic stents have not been found to increase AKI.

CD47 Blockade as an Adjuvant Immunotherapy for Resectable Pancreatic Cancer.

Patients with pancreatic ductal adenocarcinoma (PDAC) who undergo surgical resection and adjuvant chemotherapy have an expected survival of only 2 years due to disease recurrence, frequently in the liver. We investigated the role of liver macrophages in progression of PDAC micrometastases to identify adjuvant treatment strategies that could prolong survival. A murine splenic injection model of hepatic micrometastatic PDAC was used with five patient-derived PDAC tumors.

Adoption of robotics in a general surgery residency program: at what cost?

Background: Robotic technology is increasingly being utilized by general surgeons. However, the impact of introducing robotics to surgical residency has not been examined. This study aims to assess the financial costs and training impact of introducing robotics at an academic general surgery residency program.

Unplanned Reoperation Following Colorectal Surgery: Indications and Operations.

Aim: Prior studies have demonstrated a reoperation rate ranging from 5.8 to 7.6% following colorectal surgery.

Risk Associated With Complications and Mortality After Urgent Surgery vs Elective and Emergency Surgery: Implications for Defining "Quality" and Reporting Outcomes for Urgent Surgery.

Importance: Given the current climate of outcomes-driven quality reporting, it is critical to appropriately risk stratify patients using standardized metrics.

Objective: To elucidate the risk associated with urgent surgery on complications and mortality after general surgical procedures.

Design, Setting, And Participants: This retrospective review used the American College of Surgeons National Surgery Quality Improvement Program database to capture all general surgery cases performed at 435 hospitals nationwide between January 1, 2013, and December 31, 2013.

Patient Reported Outcomes 10 years After Roux-en-Y Gastric Bypass.

Background: Following weight-loss surgery, patients who failed to achieve or sustain weight loss have nevertheless reported high satisfaction with their long-term bariatric experience. Understanding this phenomenon better will likely improve patients' experiences.

Objective: The purpose of this study was to explore patients' long-term experiences following bariatric surgery.

The Influence of Interfacial Effects on the Photophysics of Rhodamine 6G Thin Films on a Poly(vinylidene fluoride) Surface.

The spectral response of ultrathin films of rhodamine 6G (Rh6G) cast onto polyvinylidenefluoride (PVDF) coated glass slides is studied to investigate a perceived fluorescence emission enhancement. Varying the thickness of the Rh6G layer (submonolayer to multiple layers) on the PVDF layer revealed the existence of multiple Rh6G species on the surface, similar to previous reports on glass. Excitation spectra show that J-type excitons are not responsible for an emission enhancement.

Neuroendocrine liver metastasis: The chance to be cured after liver surgery.

Background And Objective: Neuroendocrine liver metastasis tumors (NELM) are a heterogeneous group of neoplasms with varied histologic features and a wide range of clinical behaviors. We aimed to identify the fraction of patients cured after liver surgery for NELM.

Methods: Cure fraction models were used to analyze 376 patients who underwent hepatectomy with curative intent for NELM.

Access to Quaternary Care Surgery: Implications for Accountable Care Organizations.

Background: Accountable care organizations (ACOs) attempt to provide the most efficient and effective care to patients within a region. We hypothesized that patients who undergo surgery closer to home have improved survival due to proximity of preoperative and post-discharge care.

Study Design: All (17,582) institutional American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) patients with a documented ZIP code and predicted risk, who underwent surgery at our institution (2005 to 2014), were evaluated.

Early dysfunction and progressive degeneration of the subthalamic nucleus in mouse models of Huntington's disease.

The subthalamic nucleus (STN) is an element of cortico-basal ganglia-thalamo-cortical circuitry critical for action suppression. In Huntington's disease (HD) action suppression is impaired, resembling the effects of STN lesioning or inactivation. To explore this potential linkage, the STN was studied in BAC transgenic and Q175 knock-in mouse models of HD.

Declining Operative Experience for Junior-Level Residents: Is This an Unintended Consequence of Minimally Invasive Surgery?

Introduction: Our group has previously demonstrated an upward shift from junior to senior resident participation in common general surgery operations, traditionally performed by junior-level residents. The objective of this study was to evaluate if this trend would correct over time. We hypothesized that junior resident case volume would improve.

A Multi-institutional Analysis of Duodenal Neuroendocrine Tumors: Tumor Biology Rather than Extent of Resection Dictates Prognosis.

Introduction: Duodenal neuroendocrine tumors (NETs) are rare neoplasms with poorly defined management. We sought to evaluate the outcomes of patients undergoing resection of duodenal NETs.

Methods: Using a multi-institutional database, 146 patients who underwent resection for duodenal NETs between 1993 and 2015 were identified.

The Progression of Cholelithiasis to Gallstone Ileus: Do Large Gallstones Warrant Surgery?

Gallstone ileus is a rare cause of small bowel obstruction, classically occurring in patients with recurrent cholecystitis. The incidence of biliary enteric fistula and gallstone ileus in patients with large, asymptomatic gallstones is not known. We report a case of gallstone ileus, which occurred in the setting of a large, asymptomatic gallstone.

Evaluating and mitigating fracture risk in established rheumatoid arthritis.

Patients with rheumatoid arthritis are predisposed to systemic bone loss, and they are at an increased risk of fractures. Although there are similarities in the patient demographics between rheumatoid arthritis patients and the general population of osteoporosis patients, there are factors, particularly the use of glucocorticoids, which are specific to rheumatoid arthritis. These factors can lead to an increased risk of bone loss and fracture.

Ileal J-Pouch Volvulus Following Total Proctocolectomy for Ulcerative Colitis.

Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) allows restoration of continence in select patients with ulcerative colitis but is associated with significant morbidity. Well-known complications following IPAA include pouchitis, anastomotic leak, and small bowel obstruction. Obstruction secondary to ileal pouch volvulus is exceedingly rare.