Single Center Research Articles

Barbed suture in neck dissection: a randomized clinical study on efficacy, safety and aesthetic outcome.

The resection of lymph nodes/neck dissection is a typical part of the surgical treatment of head and neck malignancies. The aim of this study was to compare subcutaneous closure using single knotted, braided suture (VicrylTM, standard arm) with continuous self-locking, monofilament barbed suture (V-LocTM, experimental arm). Neck Lock was a randomized clinical trial at a single tertiary referral center. It was conducted from 2016 till 2022 with a follow-up period of 3months. Assessment of safety and aesthetic outcome was double-blinded. 68 patients were randomized after application of exclusion criteria. Subcutaneous wound closure was performed in an intrapatient randomized fashion for suture technique. The primary endpoint was the duration of subcutaneous sutures. Wound healing and scar formation were recorded at multiple postoperative intervals as secondary endpoints. The median age was 61years, 89.7% were male. 92.6% suffered from a squamous cell carcinoma. There was a significant difference in median subcutaneous suture time (p = 0.024) between the experimental (6:11 ± 2:30min) and standard (7:01 ± 2.42min) arms. There was no significant difference in safety when assessing adverse events (AEs). At least one AE occurred in 14.7% vs. 5.9%, for barbed and smooth sutures respectively (p = 0.16). For neck dissection of head and neck malignancies, subcutaneous wound closure with self-locking sutures offers significant time savings over the single knot technique with similar safety and aesthetic results. The trial was registered with WHO acknowledged primary registry "German Clinical Trials Register" under the ID DRKS00025831 ( https://drks.de/search/de/trial/DRKS00025831 ).

A new method with C-means segmentation for non-uniform image coordinate system definition in panoramic imaging employing Ladybug2 camera

A panorama ensures a stunning wide-angle field of view up to 360° representation of a scene, exceeding the limits of a normal photograph. Panoramic cameras satisfy the single-viewpoint characteristic. There are several types of panoramic cameras for 360-degree imaging. Multi-camera panoramic imaging systems pose a difficulty in obtaining a single projection center for the cameras. In a variety of practical implementations of panoramic cameras, it is possible to calculate three-dimensional coordinates from a panoramic image, especially using the Direct Linear Transformation (DLT) method. In this study, not only a defining method of the non-uniform image coordinate system is presented by utilizing the C-Means algorithm for a single panoramic image, captured with a Ladybug2 panoramic camera in a panoramic calibration room but also the use of an elliptical panoramic projection coordinate system is defined by the Singular Value Decomposition method in a panoramic view. The results of the suggested method have been compared with the DLT algorithm for a single panoramic image which defined a conventional photogrammetric image coordinate system. It has been observed that the proposed method provides more accurate results for the 3D coordinate definition.

Analysis of apheresis outcomes in a cohort of Chilean patients treated with autologous stem cell transplantation: a single center real-world experience.

Adequate stem cell harvesting is required for autologous hematopoietic transplantation. In deficient mobilizer patients, the collection of stem cells can be challenging because of the impossibility of achieving satisfactory CD34 cell counts with GCSF +- chemotherapy. Plerixafor is a potent and expensive drug that promotes the release of stem cells from the medullary niche to the peripheral blood and allows satisfactory harvests. We performed a retrospective analysis of 370 patients with myeloma and lymphoma harvested at our institution. 99% of patients achieved satisfactory apheresis using Plerixafor in 45%. Satisfactory harvests were obtained in patients mobilized with GCSF or plerixafor. In patients who used plerixafor, it was necessary to perform fewer apheresis procedures (P = 0.05). In multivariate analysis, the only factor that predicted the need for plerixafor was the presence of less than 30,000 CD34 / ul on the day of apheresis (OR 0.3. p <0.001). Since we adopted the plerixafor protocol guided by CD34 counts, the number of patients with harvest failure has decreased. In conclusion, the rational and standardized use of plerixafor favors satisfactory harvest in patients who require autologous transplantation in South-American patients.

Comparison of clinical and serological features in thrombotic antiphospholipid syndrome patients, with and without associated systemic lupus erythematosus, followed for up to 42 years: A single centre retrospective study.

To assess the impact of concomitant systemic lupus erythematosus (SLE) on the clinicopathological manifestations of thrombotic antiphospholipid syndrome (APS). This single-centre, retrospective study compared clinical and antiphospholipid antibody (aPL) data from 118 patients, 58 with SLE-associated APS (SLE-APS), and 60 with primary APS. Median follow-up was 13.9 (IQR 7.7-19.3) and 8.6years (3.5-10.6) for the SLE-APS cohort and PAPS cohort, respectively. Age at diagnosis of APS was lower in the SLE-APS cohort (mean 35.9 vs PAPS: 46.7years; p < 0.05). Distribution of aPL subtypes was similar across cohorts. 198 thrombotic events were identified overall (index plus recurrent), with venous thromboembolism (VTE) and arterial thrombosis each occurring in just over half of patients in both cohorts. Microvascular thrombosis (12.1% vs 0%), and a mixed (any combination of venous, arterial and microvascular) thrombotic phenotype (19.0% vs 6.7%, p = 0.05) were more prevalent in SLE-APS patients. Recurrent thrombosis incidence rates (∼0.5 events/10-patient years), and Kaplan-Meier recurrence-free survival after index thrombosis, were similar. In the PAPS cohort, only: (i) triple-aPL-positivity was associated with a significantly higher recurrent thrombosis event rate (incidence rate ratio 2.22, p = 0.03) and lower recurrence-free survival after first thrombosis (log-rank test p = 0.01); (ii) lupus anticoagulant (LA)-positivity was associated with higher prevalance of arterial thrombosis (RR 2.69, p = 0.01), and lower prevlance of VTE (RR 0.48, p < 0.001), versus LA-negativity. Concomitant SLE does not appear to modify long-term recurrent thrombosis risk, or aPL phenotypes, in patients with APS. Triple-aPL-positivity and LA-positive status may have less influence on thrombotic outcomes in patients with SLE-APS compared to PAPS.

Endomyocardial biopsy through the left internal jugular vein in heart transplant recipients: a single center experience.

Endomyocardial biopsies for rejection monitoring after heart transplantation are generally performed through the right internal jugular vein. We aimed to assess the feasibility and safety of using the left internal jugular vein approach as a valid alternative to a femoral vein for endomyocardial biopsies whenever thrombosis of the right internal jugular vein precludes insertion of a bioptome. We have reviewed our experience with heart transplantation in the last 2 decades to identify patients in whom surveillance endomyocardial biopsy was performed through the left internal jugular vein. We herein describe the step-by-step procedure and report the preliminary results. From May 1, 2000 to January 31, 2024, 561 orthotopic heart transplants have been performed in our unit. In 49 patients (8.7%), the right internal jugular vein access was found to be unsuitable or occluded at eco-Doppler evaluation; in 15 of them (30%) a total of 206 endomyocardial biopsies have been performed, using the left internal jugular vein, without complications. Our experience demonstrates that the left internal jugular vein is a valid alternative approach for endomyocardial biopsies when the right internal jugular vein is not available. This technique is feasible, safe and reproducible and allows adequate rejection monitoring after heart transplantation.

Antibiotic-impregnated envelopes reduce the rate of surgical site infection in deep brain stimulation pulse generators: a comparative study.

Deep brain stimulation (DBS) is a surgical procedure that has been used to treat a variety of neurological disorders including Parkinson's disease, essential tremor, and dystonia. While DBS is generally considered safe and effective, surgical site infections (SSIs) are a potential complication that can lead to significant morbidity and mortality. Our objective was to investigate the use of antibiotic-impregnated envelopes (AIEs) encasing implantable pulse generators (IPGs) to reduce the rate of infection at IPG sites and the costs. We conducted a retrospective analysis at a single center encompassing all procedures involving the placement of Implantable Pulse Generators (IPG), including both initial insertions and replacement surgeries. The study period spanned from January 2017 to May 2024. Starting in 2020, the routine utilization of AIE became standard practice at our institute for both primary DBS implantation and IPG replacements. Surgical techniques remained consistent, pre- and post-operative antibiotic protocols were standardized throughout the study period and all cases were undertaken by a single surgeon. 178 patients were included and the overall incidence of IPG SSIs was found to be 1.7% (1 infection in 58 patients; 20 primary IPG/38 IPG replacements) among those who received an AIE compared to 5% (6 infections in 120 patients; 36 primary IPG/84 replacement IPG) in patients where no AIE was utilized. This resulted in an odds ratio for infection that was 2.9 times higher in the absence of AIE. The decrease in infection rates was observed in both primary and replacement IPG implants. Notably, over 80% of patients with IPG infection required surgical intervention. The use of AIE further resulted in significant cost savings. To our knowledge, this is the largest series reporting the efficacy of Antibiotic impregnated envelope (AIE) in modifying infection rates associated with both initial and replacement Deep Brain Stimulation (DBS) Implantable Pulse Generators (IPGs). The implementation of AIEs led to a decrease in the occurrence of IPG-related infections, observed across both primary implantations and replacement surgeries, with associated economic benefits.

Quantification of the Cellular Content of Platelet Rich Plasma Harvested After Injection of Filgrastim Versus Pegfilgrastim Biosimilars: A Prospective, Single Center, Crossover Study

BackgroundHematopoietic stem cells (HSCs) are primitive cells that often appear in peripheral blood (PB) following mobilization events from bone marrow due to stress, injury, exercise, or pharmaceutical agents like filgrastim and pegfilgrastim. These cells can be concentrated into platelet-rich plasma (PRP), widely used in orthopedics. Filgrastim requires consecutive daily doses, while pegfilgrastim requires a single dose. Hypothesis/PurposeThis crossover study aimed to compare the safety profiles of filgrastim and pegfilgrastim administration and quantify the cellular content of PRP derived from peripheral blood following drug administration. We hypothesized comparable rates and severity of adverse events among participants, along with similar cellular content in the PRP products. Study DesignProspective, single center, cross over and controlled laboratory study MethodsHealthy participants aged 19-39 years and weighing 50-100 kilograms were screened and enrolled. They underwent a crossover design with two interventions separated by a washout period: four days of 10mcg/kg filgrastim or a single 6mcg/kg pegfilgrastim injection. Peripheral blood samples were collected before and after each intervention to produce PRP samples for cellular comparison in vitro. Adverse events (AEs) were monitored for severity and frequency throughout the study. Results10 healthy male participants were included in this study. The mean ± (SD) age of the participants was 28.30 ± 6.48 years, with a mean ± (SD) BMI of 25.29 ± 3.80. The most common adverse events for filgrastim included fatigue (36%) myalgia (36%) and back pain (9.1%), and the most common adverse events for pegfilgrastim included myalgia (31%), fatigue (23%), and back pain (23%). There were no significant differences in safety data between filgrastim and pegfilgrastim in terms of adverse event occurrence (P=0.49) nor relationship to study drug (P>0.99). The baseline PRP samples had an average TNC count of mean ± (SD) 3,844.77 ± 1,326.71, the filgrastim PRP samples had 6,939.20 ± 6,252.24, and the pegfilgrastim PRP samples had 8,923.20 ± 3,258.09. The baseline PRP samples had an average TNC concentration of mean ± (SD) 1.33×107±4.60×106 cells/mL, the filgrastim PRP samples had 1.83×107±1.81×107 cells/mL, and the pegfilgrastim samples had 3.09×107±1.13×107cells/mL. Significant differences were found in both TNC count (P=0.010) and TNC concentration (P=0.004). Specifically, there were significantly higher average TNC counts in the pegfilgrastim PRP samples compared to control (P=0.0082), but there were no differences between the filgrastim and pegfilgrastim PRP samples (P=0.1515). There was also a significantly higher average TNC concentration in the pegfilgrastim PRP samples compared to control PRP (P=0.0082) and compared to filgrastim PRP (P=0.0197). White blood cells, basophils, and immature granulocytes were significantly higher in the pegfilgrastim PRP compared to control (P=0.0082, P=0.0002, and P=0.0272). Neutrophils were significantly higher in both the filgrastim PRP (P=0.0357) and pegfilgrastim PRP (P=0.0024) compared to control. There were no differences detected for these measures among the filgrastim and pegfilgrastim PRP groups. None of the cultured PRP samples produced CFU-Fs, however cellular growth was qualitatively observed after overnight incubation. All PRP products expressed high levels (>88%) of HPC/HSC-specific CD45+, CD34+, CD45dim+, and HPC/HSC+ markers. There were no statistically significant differences in cell-surface antigens between the PRP products. ConclusionsThis prospective, single center, cross over and controlled laboratory study demonstrated that filgrastim and pegfilgrastim administration appears safe and pegfilgrastim is equivalent to filgrastim for the mobilization of white blood cells and cells expressing hematopoietic cell-surface markers into the peripheral blood and consequently, into the derived platelet rich plasma product. Clinical RelevanceThis study presents pegfilgrastim as a single-injection alternative to filgrastim for the mobilization of HSCs into the PB and subsequent PB-derived PRP, which is more convenient and less invasive for patients.

Questionnaire-based screening of adolescents and young adult women can identify markers associated with endometriosis.

Do adolescents and young adult women (YAW) with histologically proven endometriosis present a specific clinical history? Questionnaire screening of adolescents and YAW can identify clinical markers associated with histologically proven endometriosis. Some validated questionaries can contribute to an earlier endometriosis diagnosis in adults. None of these scores, however, have been validated for adolescents or YAW. This was an observational cross-sectional study using prospectively recorded data performed between January 2005 and January 2020 in a single university tertiary referral centre for endometriosis diagnosis and management. After a thorough surgical examination of the abdomino-pelvic cavity, women with histologically proven endometriosis were allocated to the endometriosis group, and symptomatic women without evidence of endometriosis were allocated to the endometriosis-free control group. The endometriotic patients were allocated into two sub-groups according to their age: adolescent (≤20 years) and YAW (21-24 years). Adolescents and YAW ≤24 years of age were operated for a symptomatic benign gynaecological condition with signed informed consent. A standardized questionnaire was prospectively completed in the month before the surgery and included epidemiological data, pelvic pain scores, family history of endometriosis, and symptoms experienced during adolescence. The study searched for correlations by univariate analysis to determine clinical markers of endometriosis in adolescents and YAW compared with endometriosis-free control patients. Of the 262 study participants, 77 women were adolescents (≤20 years of age) and 185 patients (70.6%) were YAW. The endometriosis group included 118 patients (45.0%) and 144 (55.0%) were assigned to the control group. A family history of endometriosis, absenteeism from school during menstruation, history of fainting spells during menstruation, and prescription of oral contraceptive pills for intense dysmenorrhea were significantly more frequently observed in the endometriotic patients. The prevalence and mean pain scores for dysmenorrhea, deep dyspareunia, non-cyclic chronic pelvic pain and gastrointestinal and lower urinary tract symptoms were significantly greater in the endometriosis group, as was experienced rectal bleeding. The study was performed in a single referral centre that treats patients with potentially more severe disease. This questionnaire was evaluated on a population of patients with an indication for endometriosis surgery, which can also select patients with more severe disease. Women with asymptomatic endometriosis were not considered in this study. These factors can affect the external validity of this study. Patient interviews are relevant to the diagnosis of endometriosis in adolescents and YAW. Combined with imaging and clinical examination, this approach will enable earlier diagnosis and treatment, while remaining non-invasive and rapid. The study received no funding from external sources. There are no conflicts of interest. N/A.

Clinical Characteristics and Disease Burden of African, Caribbean, and Black People with Multiple Sclerosis in Toronto, Canada

Background:Different racial and ethnic groups have demonstrated heterogeneity in the clinical course of multiple sclerosis(MS).Objective:We aimed to evaluate disease characteristics in African, Caribbean, and Black PwMS(ACB-MS) followed at a single centre in Toronto, Canada.Methods:ACB-MS were compared with age- and sex-matched PwMS of European descent(EUR-MS) identified through the clinic registry.Results:344 PwMS were included(n=172 ACB-MS,n=172 EUR-MS; mean age 43 years, 68% female). Baseline mean EDSS scores (ACB-MS 2.3±2.3 vs. EUR-MS 2.2±2.0,p=0.38) and subsequent clinical and radiological measures of disease activity were similar between groups, including ARR(ACB-MS 0.47±0.47 vs. EUR-MS 0.41±0.34,p=0.2) and most recent EDSS (ACB-MS 2.7±2.2 vs. EUR-MS 2.3±2.1,p=0.10). However, the proportion of MRI brain demonstrating new disease activity was higher(37% vs. 26%,p<0.05) and disability progression greater in ACB-MS vs. EUR-MS(43% vs. 33%,p<0.05) but measures of disease severity including MS Severity Score(3.17 vs. 2.58,p=0.3) and Progression Index(PI)(0.27 vs. 0.30,p=0.5) were comparable.Conclusion:Disability progression was seen more commonly in ACB-MS, though clinical disease activity and severity were generally comparable between ACB-MS and EUR-MS patients in Toronto, Canada. These findings partially differ from prior studies demonstrating more overtly aggressive MS disease courses in Black and African American PwMS, necessitating further studies to understand how structural determinants of health drive these disparities.

The effect of tranexamic acid on blood transfusion in lower gastrointestinal bleeding-A double blind prospective randomised controlled trial.

Acute gastrointestinal bleeding is a common emergency. Tranexamic acid (TXA) reduces clot breakdown by inhibiting the action of plasmin and has been shown to reduce the need for blood transfusion in trauma, surgical procedures, and upper gastrointestinal bleeding. This study examined the efficiency of intravenous TXA in patients with acute lower gastrointestinal bleeding. Eighty-one patients aged >18years with lower GI hemorrhage, presenting as active rectal bleeding and anemia (hemoglobin lower than 11g/dL or a decrease of 2 gr/dl from the patient's base level), were enrolled in this single center, double blind prospective research. Patients were randomly assigned to receive intravenous TXA or placebo from admission until colonoscopy took place. The need for transfusion of packed red blood cells (PRBC) and number of units was recorded and compared between the two groups. Eighty-one patients were randomized in this study, thirty-nine in the TXA arm, and forty-two in the placebo arm. Patient characteristics did not differ between the groups. Forty-three out of the 81 patients received blood transfusion; twenty-two were on the placebo arm and twenty-one on the TXA arm (p=0.89). Twenty-nine patients required 2 or more units, 14 in the TXA arm and 15 in the placebo arm (p=0.98). Intravenous TXA has no significant effect on blood requirement in patients with lower GI bleeding. There was no difference in the consumption of PRBC units among the patients in the placebo and TXA groups. It seems that tranexamic acid has no significant effect on transfusion of PRBC units in lower GI bleeding.

Diagnostic Performance of 18F-FDG PET/CT According to Delay After Treatment to Detect Subclinical Recurrence of Head and Neck Squamous Cell Carcinoma.

Head and neck squamous cell carcinoma (HNSCC) remains a malignancy with high rates of locoregional recurrence and poor prognosis for recurrent cases. Early detection of subclinical lesions is challenging but critical for effective patient management. Imaging surveillance after treatment, particularly 18F-FDG PET/CT, has shown promise in the diagnosis of HNSCC recurrence. The aim was to evaluate the diagnostic performance of 18F-FDG PET/CT according to delay after treatment in detecting subclinical recurrence (SCR) in HNSCC patients. Methods: In this retrospective study, all 18F-FDG PET/CT scans were performed at a single center. All adults with histologically proven HNSCC who were treated with curative intent between January 1, 2006, and December 31, 2021, were included. They had a normal clinical examination before each scan. Patients who underwent an intensive follow-up strategy after treatment had 18F-FDG PET/CT with an intravenous contrast agent at 3-6 mo and annually thereafter for 5 y. The primary endpoint was diagnostic performance (positive and negative predictive values, sensitivity, specificity, and accuracy). Results: In total, 2,566 18F-FDG PET/CT scans were performed among 852 patients, with an average of 3 scans per patient. The overall diagnostic performance measures were as follows: positive predictive value (88%), negative predictive value (98%), sensitivity (98%), specificity (89%), and accuracy (93%). There were no significant differences in diagnostic performance over time. The scans detected 126 cases of SCR (14.8%) and 118 cases of metachronous cancer (13.8%). The incidence of SCR decreased over time, with the highest detection rate in the first 2 y after treatment. Positive predictive value improved over time, reaching 90% for the digital Vision 600 system (third period) compared with 76% for the analog Gemini GXLi system (first period, P < 0.001). Multivariate analysis identified advanced stage, high body mass index, and initial PET/CT upstaging as predictive factors for detection of SCR. Conclusion: Our study demonstrates that 18F-FDG PET/CT has high diagnostic performance in detecting SCR during follow-up after treatment of HNSCC, especially in the first 2 y. Advanced tumor stage, initial PET/CT upstaging, and high body mass index were associated with a higher likelihood of SCR detection. The routine use of 18F-FDG PET/CT during follow-up seems justified for patients with HNSCC.

Efficacy of the Different Statins and Combination Therapies With Non-Statin Agents on Serum Lipid Profiles in a Cohort With Established Atherosclerotic Cardiovascular Disease: A Comparative Cross-Sectional Study in a Single Centre

Efficacy of the Different Statins and Combination Therapies With Non-Statin Agents on Serum Lipid Profiles in a Cohort With Established Atherosclerotic Cardiovascular Disease: A Comparative Cross-Sectional Study in a Single Centre

Long-term outcomes of percutaneous transluminal renal artery intervention: a retrospective study at a single center

BackgroundThe indications, benefits, and outcomes of percutaneous transluminal renal artery intervention (PTRI) remain controversial. The study purpose was to evaluate the long-term outcomes of PTRI in clinical practice.MethodsA retrospective review of 217 subjects (254 renal arteries; mean age, 59.8 years) who underwent PTRI based on medical database.ResultsThe most common cause of renal artery stenosis was atherosclerosis in 217 (85.4%), followed by Takayasu arteritis (TA) in 23 (9.1%), fibromuscular dysplasia in five (2.0%) and others in nine (3.5%). Mean follow-up duration was 5.7 ± 3.7 years. The first restenosis rate was 7.5% (n = 19; highest in TA: n = 9, 47.4%) and second restenosis occurred in six arteries (five TAs, one fibromuscular dysplasia). Follow-up blood pressure improved from 142.0/83.5 to 122.8/73.5 mmHg (P < 0.001). There was no change within 5 years’ follow-up in estimated glomerular filtration rate (P = 0.44), whereas TA changed from 69.8 ± 20.5 to 84.2 ± 17.9 mL/min/1.73 m² (P = 0.008). Progressive renal dysfunction was related to diabetes mellitus, chronic kidney disease, and peripheral artery obstructive disease on multivariate analysis with hazard ratios (95% confidence intervals) of 2.24 (1.21–4.17), 2.54 (1.33–4.84), and 3.93 (1.97–7.82), respectively.ConclusionsPTRI was associated with a blood pressure reduction. Despite a higher rate of restenosis, patients with TA showed significant improvement in estimated glomerular filtration rate. Diabetes mellitus, chronic kidney disease, and peripheral artery obstructive disease were related with progressive renal dysfunction after PTRI.

Radiological predictors of outcomes in hip arthroscopy for femoroacetabular impingement.

Hip arthroscopy has gained prominence as a primary surgical intervention for symptomatic femoroacetabular impingement (FAI). This study aimed to identify radiological features, and their combinations, that predict the outcome of hip arthroscopy for FAI. A prognostic cross-sectional cohort study was conducted involving patients from a single centre who underwent hip arthroscopy between January 2013 and April 2021. Radiological metrics measured on conventional radiographs and magnetic resonance arthrography were systematically assessed. The study analyzed the relationship between these metrics and complication rates, revision rates, and patient-reported outcomes. Out of 810 identified hip arthroscopies, 359 hips were included in the study. Radiological risk factors associated with unsatisfactory outcomes after cam resection included a dysplastic posterior wall, Tönnis grade 2 or higher, and over-correction of the α angle. The presence of acetabular retroversion and dysplasia were also significant predictors for worse surgical outcomes. Notably, over-correction of both cam and pincer deformities resulted in poorer outcomes than under-correction. We recommend caution in performing hip arthroscopy in patients who have three positive acetabular retroversion signs. Acetabular dysplasia with a lateral centre-edge angle of less than 20° should not be treated with isolated hip arthroscopy. Acetabular rim-trimming should be avoided in patients with borderline dysplasia, and care should be taken to avoid over-correction of a cam deformity and/or pincer deformity.

Leadless Pacemakers: A Retrospective Analysis of Efficacy, Safety, and Applicability in High-Risk Patients at a Single Centre in North Queensland

Leadless Pacemakers: A Retrospective Analysis of Efficacy, Safety, and Applicability in High-Risk Patients at a Single Centre in North Queensland

Nighttime/Weekend Venoarterial Extracorporeal Membrane Oxygenation Cannulation Is Not Associated With Increased 1-year Mortality for Non-ECPR Indications

ObjectivesThe process of placing a patient on venoarterial extracorporeal membrane oxygenation (VA-ECMO) is complex and requires the activation and coordination of numerous personnel from a variety of disciplines to achieve procedural success, initiate flow, and subsequently monitor the patient's condition. Existing literature suggests that nighttime cannulation for extracorporeal cardiopulmonary resuscitation (eCPR) is associated with adverse outcomes compared to daytime cannulation. Given the strain on personnel that this process can create, it is plausible that patients who are initiated on VA-ECMO for non-eCPR indications during the nighttime and on weekends, which are generally periods with reduced staffing as compared to weekday daytime hours, may also experience worse outcomes including decreased survival. Our objective was to determine whether nighttime/weekend VA-ECMO cannulations were associated with worse outcomes including decreased survival. Designretrospective cohort study SettingLarge quaternary academic medical center Participantspatients InterventionsVA-ECMO cannulation during the day versus night/weekends MeasurementsWe performed a retrospective review of patients at a single center who underwent VA-ECMO cannulation between 2011-2021. There were 468 patients included: 158 (33.8%) patients in the daytime cannulation cohort and 310 (66.2%) in the nighttime/weekend cannulation cohort. Nighttime and weekend VA-ECMO cannulations were not associated with increased 1-year mortality (64.2% vs 60.1%, P=0.42) or renal replacement therapy (25.4% vs 22.2%, P=0.49). ConclusionsWe conclude nighttime and weekend VA-ECMO cannulations can be performed safely at a large academic medical center.

A novel classification of senile dermatochalasis: insights from clinical and histological analysis.

Dermatochalasis is a common disorder of the elderly, often requiring upper blepharoplasty. Although it is mainly accepted as a process of aging, its clinical and histological findings vary among patients. The aim of this study was to classify types of dermatochalasis based on their clinical and histological findings. This retrospective study included patients with dermatochalasis who had undergone senile blepharoplasty at a single center. Clinical parameters such as margin-to-reflex distance 1 (MRD1), eyelid contour, visual field, and pre-existing medical conditions were assessed. Histological analysis was conducted of eyelid tissues stained with hematoxylin and eosin (H&E) and D2-40 to evaluate dermal edema, inflammation, lymphatic changes, and stromal depth. This study included 67 eyes of 35 patients. The mean age of the patients was 69.0 ± 8.3years, and the average MRD1 was 1.8 ± 1.3mm. In correlation analysis, two distinct types of dermatochalasis based on the histological findings were identified: lymphangiectasia-dominant and stromal edema-dominant types. The difference between nasal and temporal side MRD1(NT-MRD1) showed the area under the ROC curve of 0.718 of for distinguishing the two histological types of dermatochalasis was 0.718. Our novel classification of senile dermatochalasis based on morphological and histological analysis provides insights into the underlying pathology and may help to predict surgical outcomes and complications.

Implementation of a Multi-component, Multi-disciplinary, Telehealth-based care package for Heart Failure patients in a Tertiary, Single Centre

Implementation of a Multi-component, Multi-disciplinary, Telehealth-based care package for Heart Failure patients in a Tertiary, Single Centre

The Vertical Profunda Artery Perforator Flap for Perineal Reconstruction.

Colorectal cancer is a significant cause of cancer-related death in the United States with abdominoperineal resection (APR) remaining a necessary procedure for many patients. The resultant defects of this radical operation are complex and characterized by significant tissue voids. Pedicled vertical profunda artery perforator flaps (vPAP) can be used to obliterate these defects in patients receiving minimally invasive APR or when the abdominal donor site is unavailable. After receiving local institutional review board approval, a single center, retrospective cohort study from January 2020 to December 2021 was performed assessing pedicled vPAP flap reconstruction of APR defects. Age, sex, body mass index, primary diagnosis, comorbidities, concomitant oncologic procedures, radiation, timing, incorporation of gracilis flaps, follow-up, and complications were compared. Ten patients (70% male) with an average age of 56.2 years and BMI of 27.6 were included in the study. Rectal adenocarcinoma (50%) was the most common indication for APR, followed by rectal squamous cell carcinoma (30%), vulvar squamous cell carcinoma (10%), and Crohn disease (10%). Eighty percent of the patients received radiation, and 70% of reconstructions were delayed after the initial resection. The average length of clinical follow-up was 26.1 months. Concerning major complications, 2 patients were required to return to the operating room due to venous congestion (20%), and 2 patients suffered partial flap failure (20%). Minor complications were perineal dehiscence (50%), abscess requiring percutaneous drainage by interventional radiology (30%), and infection requiring antibiotics (20%). Twenty percent of patients developed fistulas requiring surgical excision. There were no instances of donor site dehiscence, and there was no complete flap loss, indicating successful reconstruction in all included cases. vPAP flaps are a reliable method to reconstruct perineal defects with less donor-site morbidity than previous reconstructive options. vPAP flaps should be considered in the setting of delayed reconstruction, minimally invasive APRs, and when the abdominal donor site is unavailable.

Posttransplant Lymphoproliferative Disease Following Pancreas Transplantation: A 40 Year Single-Center Experience.

Chronic immunosuppression following pancreas transplantation carries significant risk, including posttransplant lymphoproliferative disease (PTLD). We sought to define the incidence, risk factors, and long-term outcomes of PTLD following pancreas transplantation at a single center. All adult pancreas transplants between February 1, 1983 and December 31, 2023 at the University of Minnesota were reviewed, including pancreas transplant alone (PTA), simultaneous pancreas-kidney transplants (SPK), and pancreas after kidney transplants (PAK). Among 2353 transplants, 110 cases of PTLD were identified, with an overall incidence of 4.8%. 17.3% were diagnosed within 1 year of transplant, 32.7% were diagnosed within 5 years, and 74 (67.3%) were diagnosed after 5 years. The overall 30-year incidence of PTLD did not differ by transplant type-7.4% for PTA, 14.2% for SPK, and 19.4% for PAK (p = 0.3). In multivariable analyses, older age and Epstein-Barr virus seronegativity were risk factors for PTLD, and PTLD was a risk factor for patient death. PTLD-specific mortality was 32.7%, although recipients with PTLD had similar median posttransplant survival compared to those without PTLD (14.9 year vs. 15.6 year, p = 0.9). PTLD following pancreas transplantation is associated with significant mortality. Although the incidence of PTLD has decreased over time, a high index of suspicion for PTLD following PTx should remain in EBV-negative recipients.