Publications by authors named "Rosa Hwang"
Background And Objectives: Diagnosis of adnexal torsion is challenging due to variable clinical presentations and often inconclusive imaging results. We hypothesized that diagnostic delays are common, leading to prolonged ischemia and subsequent tissue loss. We aimed to identify factors associated with diagnostic delays in pediatric patients with adnexal torsion.
View Article and Find Full Text PDFUnlabelled: In pancreatic ductal adenocarcinoma cancer (PDAC) drug resistance is a severe clinical problem and patients relapse within a few months after receiving the standard-of-care chemotherapy. One contributing factor to treatment resistance is the desmoplastic nature of PDAC; the tumours are surrounded by thick layers of stroma composing up to 90% of the tumour mass. This stroma, which is mostly comprised of extracellular matrix (ECM) proteins, is secreted by cancer-associated fibroblasts (CAFs) residing in the tumour microenvironment.
View Article and Find Full Text PDFBackground: Blunt hollow viscus injuries (HVIs) are relatively rare and difficult to diagnose. Whether a delay in operative intervention impacts outcomes for pediatric patients with blunt HVI has not been investigated via analysis of multicenter databases.
Methods: We queried the Trauma Quality Improvement Program database from 2016 to 2020 for patients younger than 18 years who underwent an operation of the stomach, small intestine, large intestine, or rectum within 72 hours of emergency department arrival after blunt injury.
Article Synopsis
- Advanced pancreatic ductal adenocarcinomas (PDACs) have a poor response to all existing therapies, making effective treatment a significant challenge for patients with late-stage disease.
- Researchers discovered a new chemo-induced signaling network that contributes to chemoresistance in PDAC, highlighting Yap1 in cancer cells and Cox2 in stromal fibroblasts as critical components.
- Co-targeting both Yap1 and Cox2 markedly increased the effectiveness of Gemcitabine treatment in mice, and patient data suggested that combining statins and Cox2 inhibitors with Gemcitabine could enhance survival rates for PDAC patients.
Introduction: Pediatric patients with ileocecal Crohn's Disease (CD) refractory to medical management frequently require ileocecectomy. However, risk factors for post-operative ileocecal recurrence and appropriate management strategies are poorly defined in the pediatric literature in the biologic era.
Methods: We queried our institutional database from 1/1/2012-12/31/2022 for patients aged 1-21 who underwent primary ileocecectomy for CD.
Article Synopsis
- Intestinal malrotation is a rare condition that can cause serious complications like duodenal obstruction and midgut volvulus, traditionally treated with an open Ladd's operation, but laparoscopic methods are becoming more common.
- A study analyzed data from 226 patients under 18 who had Ladd's operation, finding that laparoscopic surgery led to significantly fewer cases of post-operative adhesive small bowel obstruction (SBO) compared to open surgery, with similar rates of volvulus between the two groups.
- While laparoscopic patients had a lower incidence of SBO, they faced a potential risk of needing re-operation due to duodenal issues, suggesting that although laparoscopic surgery may have specific benefits, these must be considered against possible complications.
Background: Postoperative maintenance fluids are traditionally provided via hypotonic dextrose containing fluids administered intravenously by continuous infusion. We hypothesized that scheduled weight-based boluses of balanced salt solution would be more physiologic, reduce fluid volumes, and improve patient comfort.
Methods: As part of an IRB-approved randomized controlled trial (Boluses of Ringer's in Surgical Kids, BRiSK), we randomized patients aged 1-21 years undergoing elective abdominal or thoracic surgery to post-operatively receive weight-based D0.
Introduction: Among premature infants, the incidence of inguinal hernias (IH) has been reported to be as high as 10-30%. We performed this study to characterize the association between individual and systemic variables that may affect diagnosis to definitive operative repair of the premature neonatal IH in the outpatient setting.
Methods: A single center cohort retrospective review analyzing IH repair in the premature neonatal (<37 GA) population was performed.
Rationale And Objectives: Recent ICE3 trial of breast cryoablation for breast cancer demonstrated 98% success rate, similar to breast-conserving surgery. However, ICE3 and other published studies did not differentiate curative from palliative treatment nor define patient-specific treatment objectives. We sought to define treatment success of curative and palliative breast cryoablation for breast cancer in meeting procedure objectives and patient-specific treatment objectives.
View Article and Find Full Text PDFIntroduction: Recent quality improvement (QI) initiatives indicate that pediatric patients with uncomplicated ileocolic intussusception can be safely discharged from the emergency department (ED) after fluoroscopic reduction. These programs improve patient experience and reduce cost. We sought to build on these efforts by developing a QI initiative at our own institution that included patients transferred from a satellite campus and focused on iterative improvement of our treatment pathway based on continual reassessment of our processes and data.
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- Axillary dissection is commonly performed for breast cancer patients with positive sentinel lymph nodes after receiving neoadjuvant therapy, but there is limited data on using frozen section in clinically node-negative cases.
- A study involving 662 patients with non-inflammatory, clinically node-negative HER2-positive or triple-negative breast cancer found a 6.6% prevalence of positive sentinel lymph nodes, with a modest sensitivity of frozen section testing at 57.6%.
- The study concludes that since positive sentinel lymph nodes are rare in these patients, it might be reasonable to rely on final pathology instead of intraoperative frozen section for decisions regarding axillary dissection.
Article Synopsis
- Sacrococcygeal teratomas (SCT) can recur, especially those with microscopic deposits of yolk sac tumor (YST), which may indicate a higher recurrence risk.
- A study of 56 patients treated for mature SCT showed that 16% had microscopic YST, and those with it had a significantly higher recurrence rate compared to those without.
- It’s suggested that patients with microscopic YST should undergo closer postoperative monitoring through alpha-fetoprotein tests and MRI to detect any recurrence early.
Background: Traditional posterolateral thoracotomy (PLT) is a painful and potentially morbid operation associated with an extensive recovery and a long, unsightly scar. In contrast, vertical thoracotomy (VT) is designed to spare muscles, avoid skin flaps, and minimize incision length, thereby limiting postoperative pain, hastening recovery, and improving scar cosmesis.
Methods: We reviewed children aged 1-21 that underwent PLT and VT at our institution from 1/1/2013-12/1/2023.
Importance: Premastectomy radiotherapy (PreMRT) is a new treatment sequence to avoid the adverse effects of radiotherapy on the final breast reconstruction while achieving the benefits of immediate breast reconstruction (IMBR).
Objective: To evaluate outcomes among patients who received PreMRT and regional nodal irradiation (RNI) followed by mastectomy and IMBR.
Design, Setting, And Participants: This was a phase 2 single-center randomized clinical trial conducted between August 3, 2018, and August 2, 2022, evaluating the feasibility and safety of PreMRT and RNI (including internal mammary lymph nodes).
Minimally invasive approaches to breast surgery have evolved from endoscopic techniques to recent developments in robotic-assisted mastectomies. Initial studies on robotic-assisted nipple-sparing mastectomy (RNSM) have shown improved patient satisfaction and aesthetic outcomes with similar complication rates and oncological outcomes in selected patients. This chapter reviews techniques used and available data on complications and clinical outcomes for RNSM.
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- Tumour cells rely on nutrients from their environment to survive, particularly in challenging conditions, and pancreatic cancer-associated fibroblasts (CAFs) play a key role in regulating this process by secreting acetate.* -
- The enzyme acetyl-CoA synthetase short-chain family member 2 (ACSS2) helps cancer cells utilize this acetate, impacting their gene expression and enhancing their survival in acidic conditions by stabilizing the transcription factor SP1.* -
- Disabling the ACSS2-SP1-SAT1 pathway in experimental mouse models leads to reduced tumour growth, emphasizing the importance of this metabolic interaction for cancer cell resilience under stress.*
Pediatric thoracic cage fractures-Mind the sternum: A retrospective analysis of the ACS-TQIP database.
J Trauma Acute Care Surg
September 2024
Background: The thoracic cage is an anatomical entity formed by the thoracic spine, ribs, and sternum. As part of this osteoligamentous complex, the sternum contributes substantially to the stability of the thoracic spine. This study investigates the influence of a concomitant sternal fracture (SF) on the treatment and hospital course of pediatric patients with a thoracic vertebral fracture (TVF).
View Article and Find Full Text PDFIntroduction: Pediatric patients with perianal Crohn's Disease (CD) suffer recalcitrant fistulas, abscesses, and strictures. Fecal diversion is a palliative last resort, but the expected clinical course and long-term management of the ostomy for this population is unclear. We sought to identify factors predictive of ostomy takedown and establish management recommendations for fistulizing and stenosing disease.
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- The study focuses on identifying factors that predict involvement of four or more positive axillary lymph nodes (ALNs) in postmenopausal women with early-stage breast cancer that initially shows no lymph node involvement (cN0).
- Researchers analyzed data from 2532 patients who underwent sentinel lymph node biopsy (SLNB) and completion axillary lymph node dissection (cALND) from 1993 to 2007, identifying key predictive factors like tumor size and lymphovascular invasion.
- The findings suggest that postmenopausal women with HR-positive, HER2-negative breast cancer and a single positive SLN have a low risk (5%) of having four or more positive nodes, indicating that aggressive treatments may not be necessary
Multiciliated cells contain hundreds of cilia whose directional movement powers the mucociliary clearance of the airways, a vital host defense mechanism. Multiciliated cell specification requires canonical Wnt signaling, which then must be turned off. Next, ciliogenesis and polarized ciliary orientation are regulated by noncanonical Wnt/planar cell polarity (Wnt/PCP) signaling.
View Article and Find Full Text PDFBackground: Completion axillary node dissection (CLND) is routinely omitted in cT1-2 N0 breast cancer treated with upfront, breast-conserving therapy and sentinel node biopsy (SLNB) showing one to two positive sentinel nodes (SLNs). The purpose of this study was to determine the incidence and impact of axillary treatment among patients treated with mastectomy in a contemporary cohort.
Methods: A prospective, institutional database was reviewed from 2006 to 2015 to identify patients with T1-2 breast cancer treated with upfront mastectomy and SLNB found to have one to two positive SLNs.
Introduction: Determine procedural outcomes and identify changing trends of utilization among patients undergoing histrelin implantation at a large pediatric tertiary care center over 15 y.
Methods: Retrospective review of all patients undergoing histrelin implantation between January 2008 and April 2022.
Results: A total of 746 patients underwent 1794 unique procedures (1364 placements/replacements, 430 removals).
Background: Pancreatic ductal adenocarcinoma (PDAC) is characterized by the presence of dense stroma that is enriched in hyaluronan (HA), with increased HA levels associated with more aggressive disease. Increased levels of the HA-degrading enzymes hyaluronidases (HYALs) are also associated with tumor progression. In this study, we evaluate the regulation of HYALs in PDAC.
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