Not just a BLiP: early experience with a novel multidisciplinary case conference for benign hepatopancreatobiliary disease at a tertiary Canadian healthcare center.

Background: Benign Liver and Pancreas (BLiPs) rounds, implemented in 2022 at our Canadian tertiary care center, are a novel concept of a multidisciplinary case conference (MCC) for discussion of benign hepatopancreatobiliary (HPB) disease. BLiPs Rounds are a monthly virtual meeting of surgeons, gastroenterologists, and interventional radiologists experienced in biliary and pancreatic disease.

Methods: This case series was completed to review the patient cases discussed over the first year of BLiPs rounds, and to evaluate the effect of the multidisciplinary discussion on patient management plans.

Point of care biliary ultrasound in the emergency department (BUSED) predicts final surgical management decisions.

Objectives: Gallstone disease is a common reason for emergency department (ED) presentation. Surgeons often prefer radiology department ultrasound (RUS) over point of care ultrasound (POCUS) because of perceived of unreliability. Our study was designed to test the hypothesis that POCUS is sufficient to guide the management of surgeons treating select cases of biliary disease as compared to RUS.

Surgical trauma is associated with renal immune cell activation in rats: A microarray study.

Acute kidney injury (AKI) is a common perioperative complication that is associated with increased mortality. This study investigates the renal gene expression in male Long-Evans rats after prolonged anesthesia and surgery to detect molecular mechanisms that could predispose the kidneys to injury upon further insults. Healthy and streptozotocin diabetic rats that underwent autoregulatory investigation in an earlier study were compared to rats that were sacrificed quickly for mRNA quantification in the same study.

Data Driven Competitive Motivation Strategies in a Longitudinal Simulation Curriculum for Trauma Team Training.

Objective: A novel approach to trauma team simulation was used to enhance team performance in a cohort of general surgical residents. We implemented data driven debriefing using performance report cards and video footage of the simulations. We wanted to evaluate the technical and nontechnical skills developed by teams using this approach.

Transplantation of pediatric renal allografts from donors less than 10 kg.

Few transplant programs use kidneys from donors with body weight (BW) < 10 kg. We hypothesized that pediatric en bloc transplants from donors with BW < 10 kg would provide similar transplant outcomes to larger grafts. All pediatric en bloc renal transplants performed at our center between 2001 and 2017 were reviewed (N = 28).

A gap junction inhibitor, carbenoxolone, induces spatiotemporal dispersion of renal cortical perfusion and impairs autoregulation.

Renal autoregulation dynamics originating from the myogenic response (MR) and tubuloglomerular feedback (TGF) can synchronize over large regions of the kidney surface, likely through gap junction-mediated electrotonic conduction and reflecting distributed operation of autoregulation. We tested the hypotheses that inhibition of gap junctions reduces spatial synchronization of autoregulation dynamics, abrogates spatial and temporal smoothing of renal perfusion, and impairs renal autoregulation. In male Long-Evans rats, we infused the gap junction inhibitor carbenoxolone (CBX) or the related glycyrrhizic acid (GZA) that does not block gap junctions into the renal artery and monitored renal blood flow (RBF) and surface perfusion by laser speckle contrast imaging.

Detecting Interactions between the Renal Autoregulation Mechanisms in Time and Space.

Objective: Our objective is to identify localized interactions between the renal autoregulation mechanisms over time.

Methods: A time-varying phase-randomized wavelet bicoherence detector for quadratic phase coupling between tubuloglomerular feedback and the myogenic response is presented. Through simulations we show its ability to interrogate quadratic phase coupling.

Transient impairment of dynamic renal autoregulation in early diabetes mellitus in rats.

Renal autoregulation is impaired in early (1 wk) diabetes mellitus (DM) induced by streptozotocin, but effective in established DM (4 wk). Furthermore nitric oxide synthesis (NOS) inhibition with N(G)-nitro-L-arginine methyl ester (L-NAME) significantly improved autoregulation in early DM but not in established DM. We hypothesized that autoregulation is transiently impaired in early DM because of increased NO availability in the kidney.

Laser speckle contrast imaging reveals large-scale synchronization of cortical autoregulation dynamics influenced by nitric oxide.

Synchronization of tubuloglomerular feedback (TGF) dynamics in nephrons that share a cortical radial artery is well known. It is less clear whether synchronization extends beyond a single cortical radial artery or whether it extends to the myogenic response (MR). We used LSCI to examine cortical perfusion dynamics in isoflurane-anesthetized, male Long-Evans rats.

Segmentation of renal perfusion signals from laser speckle imaging into clusters with phase synchronized dynamics.

Renal perfusion signals contain dynamics arising from the renal autoregulation feedback mechanisms as the contraction and dilation of vessels alter flow patterns. We can capture the time-varying dynamics at points across the renal surface using laser speckle imaging. We segment an imaged area of the renal cortex into clusters with phase synchronized dynamics.

Detecting physiological systems with laser speckle perfusion imaging of the renal cortex.

Laser speckle perfusion imaging (LSPI) has become an increasingly popular technique for monitoring vascular perfusion over a tissue surface. However, few studies have utilized the full range of spatial and temporal information generated by LSPI to monitor spatial properties of physiologically relevant dynamics. In this study, we extend the use of LSPI to analyze renal perfusion dynamics over a spatial surface of ~5 × 7 mm of renal cortex.