Transcatheter Closure of Postinfarct VSD With the Amplatzer PIVSD Occluder: Results of a US Study.

Background: A postinfarct ventricular septal defect (PIVSD) is associated with high mortality and morbidity, particularly in patients with hemodynamic instability who are not suitable candidates for surgical repair. The Amplatzer PIVSD Occluder (Abbott) is indicated for transcatheter PIVSD closure in patients who are not satisfactory candidates for surgical repair. The objective of this study was to evaluate associated clinical outcomes.

Gene-environment interactions: Epstein-Barr virus infection and risk of pediatric-onset multiple sclerosis.

Background And Objective: Prior Epstein-Barr virus (EBV) infection is associated with an increased risk of pediatric-onset multiple sclerosis (POMS) and adult-onset multiple sclerosis (MS). It has been challenging to elucidate the biological mechanisms underlying this association. We examined the interactions between candidate human leukocyte antigen (HLA) and non-HLA variants and childhood EBV infection as it may provide mechanistic insights into EBV-associated MS.

Thrombectomy With the pRESET vs Solitaire Stent Retrievers as First-Line Large Vessel Occlusion Stroke Treatment: A Randomized Clinical Trial.

Importance: Stent retriever-based thrombectomy is highly beneficial in large vessel occlusion (LVO) strokes. Many stent retriever designs are currently available, but comparison of these technologies in well-conducted studies is lacking.

Objective: To determine whether thrombectomy for LVO stroke with the pRESET stent retriever is noninferior to treatment with the Solitaire stent retriever.

An unusual response to 5-azacitidine by a patient with chronic myelomonocytic leukemia.

Key Clinical Message: Hypomethylating agents may be useful in some but not all cases of myelodysplastic syndromes. In some versions of these conditions, this treatment may yield deleterious results.

Abstract: Chronic myelomonocytic leukemia (CMML) is considered to be a heterogeneous group of hematopoietic neoplasms.

A Novel Interventional Approach to LV Pseudoaneurysm Compressing on LAD by Utilizing LAA Closure Device.

We describe the novel transcatheter approach, with off-label application of LAA closure device, coiling, and concurrent left anterior descending stenting in the setting of left ventricular (LV) pseudoaneurysm. This case underlines collaboration among interventional cardiology, cardiothoracic, and neurosurgery teams in a challenging, nonsurgical candidate with high risk of LV pseudoaneurysm rupture, and death. ().

Gene-environment interactions increase the risk of pediatric-onset multiple sclerosis associated with ozone pollution.

Background: We previously reported a relationship between air pollutants and increased risk of pediatric-onset multiple sclerosis (POMS). Ozone is an air pollutant that may play a role in multiple sclerosis (MS) pathoetiology. is the only non-HLA gene associated with POMS for which expression on antigen-presenting cells (APCs) is changed in response to ozone exposure.

A pilot study of radiation-induced bystander effect in radio-adapting frogs at a radiologically contaminated site located on the chalk river laboratories property.

Purpose: To measure medium borne bystander effects, to study the influence of radioadaptive response (RAR) on bystander response, and to discover reliable radioresponsive biomarkers in radio-adapting frogs from Duke Swamp contaminated with an above-background radiation level and in naïve frogs from Twin Lake as the background control site.

Materials And Methods: Frogs were captured at Duke Swamp and Twin Lake and brought to the lab at the Canadian Nuclear Laboratories facility. Half of the frogs from each site were irradiated with 4 Gy while the other half of the frogs were left with no further radiation treatment.

Decreasing the Surgical Errors by Neurostimulation of Primary Motor Cortex and the Associated Brain Activation via Neuroimaging.

Acquisition of fine motor skills is a time-consuming process as it is based on learning via frequent repetitions. Transcranial electrical stimulation (tES) is a promising means of enhancing simple motor skill development via neuromodulatory mechanisms. Here, we report that non-invasive neurostimulation facilitates the learning of complex fine bimanual motor skills associated with a surgical task.

The Use of Periareolar Topical Lidocaine Jelly After Needle Localization May Reduce Pain of Subsequent Lymphoscintigraphy.

Purpose Technetium Tc-99m sulfur colloid (99mTc-SC) breast lymphoscintigraphy is commonly performed to identify the sentinel lymph node (SLN) in patients diagnosed with breast carcinoma undergoing lumpectomy. The purpose of this report is to describe how the use of 2% topical lidocaine jelly immediately after the completion of needle localization and prior to scintigraphy may substantially reduce pain associated with the injection of 99mTc-SC. Materials and methods This was a quality improvement project.

Intramarrow injection needle: a new technique to treat patients with haematological and non-haematological malignancies by directly injecting therapeutic agents into the bone marrow cavity.

Aims: The purpose of this report is to describe a new instrument designed for the injection of therapeutic agents directly into the bone marrow cavity as well as to aspirate bone marrow specimens for the diagnostic purposes.

Methods: The instrument consists of three parts: the needle, stilette and an adjustable guard. The overall length of the needle is 76 mm and has uniform external diameter except for the distal penetrating segment, which is sharp but short and safe to use on the sternum.

A machine learning approach to predict surgical learning curves.

Background: Contemporary surgical training programs rely on the repetition of selected surgical motor tasks. Such methodology is inherently open ended with no control on the time taken to attain a set level of proficiency, given the trainees' intrinsic differences in initial skill levels and learning abilities. Hence, an efficient training program should aim at tailoring the surgical training protocols to each trainee.

Clinical efficacy of gastric per-oral endoscopic myotomy (G-POEM) in the treatment of refractory gastroparesis and predictors of outcomes: a systematic review and meta-analysis using surgical pyloroplasty as a comparator group.

Background And Aims: Gastric peroral endoscopic myotomy (G-POEM) is a novel minimally invasive technique in endosurgery. Data is limited as to its efficacy, safety, and predictive factors. We conducted this meta-analysis to evaluate the clinical outcomes of G-POEM and used the outcomes of surgical pyloroplasty as a comparator group in the treatment of refractory gastroparesis.

Hypoplastic acute myeloid leukemia in an elderly patient. A long-term partial remission with low-dose prednisone and G-CSF.

Hypoplastic acute myeloid leukemia (AML) is a rare variant of AML that mainly affects the elderly and accounts for 5%-7% of de novo AML. Prognosis for this disease is poor, and there is no standard therapy. We have treated an elderly patient with hypoplastic AML with low-dose prednisone and G-CSF with good results.

Diagnostic value of preparing bone marrow smears from the small amount of material left within the aspiration needle following a dry tap.

Bone marrow aspirations are used in the diagnosis of patients with hematological disorders. Cytological diagnosis becomes difficult when aspiration is a dry tap. Smears produced from the material left in the needle following a dry tap can provide valuable information either to complement or even make an accurate diagnosis.

Urban air quality and associations with pediatric multiple sclerosis.

Background: We previously identified air quality as a risk factor of interest for pediatric multiple sclerosis. The purpose of this study is to more closely examine the association between the six criteria air pollutants and pediatric MS as well as identify specific areas of toxic release using data from the Toxic Release Inventory.

Methods: Pediatric MS cases ( = 290) and healthy controls ( = 442) were included as part of an ongoing case-control study.

Molecular Diagnostics in the Neoplasms of the Pancreas, Liver, Gallbladder, and Extrahepatic Biliary Tract: 2018 Update.

Pancreatic neoplasms, including ductal adenocarcinoma, solid pseudopapillary neoplasm, pancreatic endocrine neoplasms, acinar cell carcinoma, and pancreatoblastoma, are associated with different genetic abnormalities. Hepatic adenomas with beta-catenin exon 3 mutation are associated with a high risk of malignancy. Hepatic adenoma with arginosuccinate synthetase 1 expression or sonic hedgehog mutations are associated with a risk of bleeding.

Molecular Diagnostics in the Neoplasms of Small Intestine and Appendix: 2018 Update.

Neoplasms of the small intestine are rare in comparison with colorectal tumors. The most common tumor types arising in the small intestine are adenocarcinomas, well-differentiated neuroendocrine tumors, gastrointestinal stromal tumors, and lymphoma. Primary appendiceal neoplasms are rare and found in less than 2% of appendectomy specimens with an incidence of approximately 1.

Dysfunctional Closed Chest Drainage - Common Causative Factors and Recommendations for Prevention.

Introduction Dysfunctional closed chest drainage unit (CDU) dysfunction is a common but serious clinical problem associated with tube thoracostomy and results in a significant rise in morbidity, prolonged hospital stays, and increased economic burden. This observational study examines the proximate factors of closed CDU dysfunction in addition to their relative frequency. Based on our findings, we suggest logical recommendations for preventing the factors that contribute to closed chest drainage unit dysfunction.

The SAGES Fundamental Use of Surgical Energy program (FUSE): history, development, and purpose.

Background: Adverse events due to energy device use in surgical operating rooms are a daily occurrence. These occur at a rate of approximately 1-2 per 1000 operations. Hundreds of operating room fires occur each year in the United States, some causing severe injury and even mortality.

Examining the contributions of environmental quality to pediatric multiple sclerosis.

Background: Multiple sclerosis (MS) is a presumed autoimmune disease caused by genetic and environmental factors. It is hypothesized that environmental exposures (such as air and water quality) trigger the innate immune response thereby activating a pro-inflammatory cascade.

Objective: To examine potential environmental factors in pediatric MS using geographic information systems (GIS).