586 results on '"J McCormick"'
Search Results
2. Lateralisation of subcortical functional connectivity during and after general anaesthesia
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Joshua S. Mincer, Stacie Deiner, Tommer Nir, Patrick J. McCormick, Yael Jacob, Inbar Meningher, Helen Ahn, Julia Scarpa, Jess W. Brallier, Arthur E. Schwartz, Kuang-Han Huang, Abigail Livny, Cheuk Y. Tang, Prantik Kundu, Reut Raizman, Mark G. Baxter, Bradley N. Delman, and Mary Sano
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Adult ,Male ,Deep brain stimulation ,medicine.medical_treatment ,Thalamus ,Anesthesia, General ,Reticular formation ,Arousal ,Sevoflurane ,Neuroscience and Neuroanaesthesia ,Functional neuroimaging ,medicine ,Humans ,Aged ,Aged, 80 and over ,Resting state fMRI ,business.industry ,Functional Neuroimaging ,Brain ,Awareness ,Middle Aged ,Magnetic Resonance Imaging ,Anesthesiology and Pain Medicine ,Anesthetics, Inhalation ,Female ,Brainstem ,business ,Neuroscience ,Reticular activating system - Abstract
Background Arousal and awareness are two important components of consciousness states. Functional neuroimaging has furthered our understanding of cortical and thalamocortical mechanisms of awareness. Investigating the relationship between subcortical functional connectivity and arousal has been challenging owing to the relatively small size of brainstem structures and thalamic nuclei, and their depth in the brain. Methods Resting state functional MRI scans of 72 healthy volunteers were acquired before, during, 1 h after, and 1 day after sevoflurane general anaesthesia. Functional connectivity of subcortical regions of interest vs whole brain and homotopic functional connectivity for assessment of left–right symmetry analyses of both cortical and subcortical regions of interest were performed. Both analyses used high resolution atlases generated from deep brain stimulation applications. Results Functional connectivity in subcortical loci within the thalamus and of the ascending reticular activating system was sharply restricted under anaesthesia, featuring a general lateralisation of connectivity. Similarly, left–right homology was sharply reduced under anaesthesia. Subcortical bilateral functional connectivity was not fully restored after emergence from anaesthesia, although greater restoration was seen between ascending reticular activating system loci and specific thalamic nuclei thought to be involved in promoting and maintaining arousal. Functional connectivity was fully restored to baseline by the following day. Conclusions Functional connectivity in the subcortex is sharply restricted and lateralised under general anaesthesia. This restriction may play a part in loss and return of consciousness. Clinical trial registration NCT02275026.
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- 2022
3. Functional outcomes after lateral pelvic lymph node dissection for rectal cancer: a systematic review and meta-analysis
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Joseph C Kong, Alexander G. Heriot, Satish K Warrier, Jacob J McCormick, and Benjamin Cribb
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medicine.medical_specialty ,Colorectal cancer ,business.industry ,Urinary system ,Gastroenterology ,medicine.disease ,Surgery ,Dissection ,Sexual dysfunction ,medicine.anatomical_structure ,Meta-analysis ,medicine ,Rectal Adenocarcinoma ,Observational study ,medicine.symptom ,business ,Lymph node - Abstract
PURPOSE Lateral pelvic lymph node dissection (LPLND) may improve oncological outcomes for select patients with rectal cancer, though functional outcomes may be adversely impacted. The aim of this study is to assess the functional outcomes associated with LPLND for rectal cancer and compare these outcomes with standard surgical resection. METHODS A systematic search was undertaken to identify relevant studies reporting on urinary dysfunction (UD), sexual dysfunction (SD), and defecatory dysfunction (DD) for patients who underwent LPLND for rectal cancer. Studies comparing functional outcomes in patients who underwent surgery with and without LPLND were assessed. In addition, a comparison of functional outcomes in patients who underwent LPLND before and after the year 2000 was performed. RESULTS Twenty-one studies of predominantly non-randomised observational data were included. Ten were comparative studies. Male SD was worse in patients who underwent LPLND compared with those who did not (RR 1.68 (95% CI 1.41-1.99, P
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- 2021
4. Carnitine palmitoyltransferase-II deficiency: case presentation and review of the literature
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Benjamin J. Mccormick and Razvan M. Chirila
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Pediatrics ,medicine.medical_specialty ,Signs and symptoms ,Disease ,Case presentation ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Carnitine ,Myopathy ,Exercise ,Carnitine O-Palmitoyltransferase ,business.industry ,carnitine palmitoyltransferase-ii deficiency ,Middle Aged ,medicine.disease ,RC31-1245 ,rhabdomyolysis ,Treatment strategy ,Carnitine palmitoyltransferase II deficiency ,medicine.symptom ,business ,Rhabdomyolysis ,Metabolism, Inborn Errors ,030217 neurology & neurosurgery ,myopathy ,medicine.drug - Abstract
Carnitine palmitoyltransferase-II deficiency, an autosomal recessive disorder, is the most common cause of recurrent rhabdomyolysis in adults. Recognition and avoidance of triggers, such as heavy exercise and stress, is key in prevention of further episodes; however, even with preventative measures, many patients will continue to experience periodic symptoms, including rhabdomyolysis. Avoidance of renal failure, correction of electrolyte disturbances and halting further muscle breakdown are the goals of treatment. It is essential for clinicians to recognize the signs and symptoms of acute disease in CPT-II deficiency. We present a case of recurrent rhabdomyolysis requiring hospitalization in a patient with CPT-II deficiency and review the literature for common clinical manifestations, diagnostics, and treatment strategies.
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- 2021
5. Enhanced Recovery Programs in an Ambulatory Surgical Oncology Center
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Geema Masson, Rebecca S Twersky, Hanae K. Tokita, Vincent P. Laudone, Patrick J. McCormick, Anoushka M. Afonso, Kara Barnett, Elizabeth Rieth, Melissa Assel, and Brett A Simon
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medicine.medical_specialty ,Hysterectomy ,Featured Articles ,Prostatectomy ,business.industry ,medicine.medical_treatment ,Thyroidectomy ,Confidence interval ,Surgery ,Anesthesiology and Pain Medicine ,Acute care ,Ambulatory ,medicine ,medicine.symptom ,Original Clinical Research Report ,business ,Postoperative nausea and vomiting ,Mastectomy - Abstract
Background We describe the implementation of enhanced recovery after surgery (ERAS) programs designed to minimize postoperative nausea and vomiting (PONV) and pain and reduce opioid use in patients undergoing selected procedures at an ambulatory cancer surgery center. Key components of the ERAS included preoperative patient education regarding the postoperative course, liberal preoperative hydration, standardized PONV prophylaxis, appropriate intraoperative fluid management, and multimodal analgesia at all stages. Methods We retrospectively reviewed data on patients who underwent mastectomy with or without immediate reconstruction, minimally invasive hysterectomy, thyroidectomy, or minimally invasive prostatectomy from the opening of our institution on January 2016 to December 2018. Data collected included use of total intravenous anesthesia (TIVA), rate of PONV rescue, time to first oral opioid, and total intraoperative and postoperative opioid consumption. Compliance with ERAS elements was determined for each service. Quality outcomes included time to first ambulation, postoperative length of stay (LOS), rate of reoperation, rate of transfer to acute care hospital, 30-day readmission, and urgent care visits ≤30 days. Results We analyzed 6781 ambulatory surgery cases (2965 mastectomies, 1099 hysterectomies, 680 thyroidectomies, and 1976 prostatectomies). PONV rescue decreased most appreciably for mastectomy (28% decrease; 95% confidence interval [CI], -36 to -22). TIVA use increased for both mastectomies (28%; 95% CI, 20-40) and hysterectomies (58%; 95% CI, 46-76). Total intraoperative opioid administration decreased over time across all procedures. Time to first oral opioid decreased for all surgeries; decreases ranged from 0.96 hours (95% CI, 2.1-1.4) for thyroidectomies to 3.3 hours (95% CI, 4.5 to -1.7) for hysterectomies. Total postoperative opioid consumption did not change by a clinically meaningful degree for any surgery. Compliance with ERAS measures was generally high but varied among surgeries. Conclusions This quality improvement study demonstrates the feasibility of implementing ERAS at an ambulatory surgery center. However, the study did not include either a concurrent or preintervention control so that further studies are needed to assess whether there is an association between implementation of ERAS components and improvements in outcomes. Nevertheless, we provide benchmarking data on postoperative outcomes during the first 3 years of ERAS implementation. Our findings reflect progressive improvement achieved through continuous feedback and education of staff.
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- 2021
6. Intraoperative opioid exposure, tumour genomic alterations, and survival differences in people with lung adenocarcinoma
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Joshua S. Mincer, Joseph Dycoco, Raul Caso, Gregory D. Jones, Hersh Gupta, Brooke Mastrogiacomo, James M. Isbell, Takeshi Irie, Francisco Sanchez-Vega, Kay See Tan, James G. Connolly, David R. Jones, Patrick J. McCormick, Gregory W. Fischer, Prasad S. Adusumilli, Gaetano Rocco, Joseph R. Scarpa, and Matthew J. Bott
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Male ,Oncology ,medicine.medical_specialty ,Lung Neoplasms ,medicine.drug_class ,Adenocarcinoma of Lung ,CDKN2A ,Opioid receptor ,Internal medicine ,medicine ,Humans ,Ketamine ,Clinical Investigation ,Prospective Studies ,Aged ,Retrospective Studies ,Pain, Postoperative ,Intraoperative Care ,business.industry ,Hazard ratio ,Cancer ,Genomics ,Middle Aged ,medicine.disease ,Analgesics, Opioid ,Survival Rate ,Anesthesiology and Pain Medicine ,Opioid ,Morphine ,Adenocarcinoma ,Female ,Neoplasm Recurrence, Local ,business ,medicine.drug - Abstract
Background Opioids have been linked to worse oncologic outcomes in surgical patients. Studies in certain cancer types have identified associations between survival and intra-tumoural opioid receptor gene alterations, but no study has investigated whether the tumour genome interacts with opioid exposure to affect survival. We sought to determine whether intraoperative opioid exposure is associated with recurrence-specific survival and overall survival in early-stage lung adenocarcinoma, and whether selected tumour genomics are associated with this relationship. Associations between ketamine and dexmedetomidine and outcomes were also studied. Methods Surgical patients (N=740) with pathological stage I–III lung adenocarcinoma and next-generation sequencing data were retrospectively reviewed from a prospectively maintained database. Results On multivariable analysis, ketamine administration was protective for recurrence-specific survival (hazard ratio = 0.44, 95% confidence interval 0.24–0.80; P=0.007), compared with no adjunct. Higher intraoperative oral morphine milligram equivalents were significantly associated with worse overall survival (hazard ratio=1.09/10 morphine milligram equivalents, 95% confidence interval 1.02–1.17; P=0.010). Significant interaction effects were found between morphine milligram equivalents and fraction genome altered and morphine milligram equivalents and CDKN2A, such that higher fraction genome altered or CDKN2A alterations were associated with worse overall survival at higher morphine milligram equivalents (P=0.044 and P=0.052, respectively). In contrast, alterations in the Wnt (P=0.029) and Hippo (P=0.040) oncogenic pathways were associated with improved recurrence-specific survival at higher morphine milligram equivalents, compared with unaltered pathways. Conclusions Intraoperative opioid exposure is associated with worse overall survival, whereas ketamine exposure is associated with improved recurrence-specific survival in patients with early-stage lung adenocarcinoma. This is the first study to investigate tumour-specific genomic interactions with intraoperative opioid administration to modify survival associations.
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- 2021
7. Meta‐analysis of direct‐to‐surgery lateral pelvic lymph node dissection for rectal cancer
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Alexander G. Heriot, Benjamin Cribb, Satish K Warrier, Joseph C Kong, and Jacob J McCormick
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medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,medicine ,Humans ,Neoadjuvant therapy ,Randomized Controlled Trials as Topic ,Retrospective Studies ,Clinical Trials as Topic ,Rectal Neoplasms ,business.industry ,Gastroenterology ,Retrospective cohort study ,medicine.disease ,Total mesorectal excision ,Neoadjuvant Therapy ,Surgery ,Dissection ,Treatment Outcome ,Meta-analysis ,Lymph Node Excision ,Lymphadenectomy ,Lymph Nodes ,Neoplasm Recurrence, Local ,business ,Chemoradiotherapy - Abstract
AIM: Direct-to-surgery rectal resection with lateral pelvic lymph node dissection (LPLND) is a treatment strategy commonly employed in Japan to improve oncological outcomes for rectal cancer. The aim of this study was to assess oncological outcomes in the literature for patients with low rectal cancer who underwent direct-to-surgery resection and LPLND compared with those who underwent total mesorectal excision (TME) alone. METHOD: A literature search of Medline, Embase and PubMed databases was performed to identify relevant studies published between 1989 and 2020. The primary outcomes were 5-year overall survival (OS) and 5-year disease-free survival (DFS). The secondary outcomes were cancer recurrence (local, distant and total) and operative burden (operative time and blood loss). Pooled relative risk (RR) of oncological outcomes was performed using the DerSimonian-Laird method random-effect model. RESULTS: Twenty-one studies fulfilled inclusion criteria, including 19 nonrandomized studies of interventions and two studies from one randomized controlled trial. No differences were observed in 5-year OS or 5-year DFS. Local recurrence in nonrandomized studies was worse in patients who underwent LPLND [RR 1.41 (95% CI 1.21-1.64, p
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- 2021
8. Infrarenal aortic balloon-expandable stent graft deployment using the sheath control technique in a patient with hemorrhagic shock secondary to an aortoenteric fistula
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Benjamin J. Mccormick, John Moss, Johnathan M. Sheele, Beau Toskich, Young Erben, Hollie Saunders, and Cameron J. Overfield
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Balloon-expandable stent graft ,medicine.medical_specialty ,RD1-811 ,Fistula ,Aortoenteric fistula ,Femoral artery ,030204 cardiovascular system & hematology ,Balloon ,030218 nuclear medicine & medical imaging ,Balloon exchange ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Case report ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Surgical repair ,Aorta ,medicine.diagnostic_test ,business.industry ,Vasospasm ,medicine.disease ,Surgery ,surgical procedures, operative ,RC666-701 ,Angiography ,Endoprosthesis ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,business ,Sheath control technique - Abstract
A 40-year-old man presented with hemorrhagic shock owing to an aortoduodenal fistula. Angiography demonstrated vasospasm of the right common femoral artery to 2 mm. Treatment using a balloon-expandable stent graft was chosen given the smaller sheath diameter requirement when compared to self-expandable aortic stent graft. Given the undersized 11 mm delivery balloon for the patient's aorta, a sheath control technique was utilized. The stent graft was partially expanded within the sheath and the delivery balloon was exchanged for a 16-mm balloon to complete expansion of the stent graft apposition to the aortic wall, bridging the patient to definitive surgical repair.
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- 2021
9. Patient and provider characteristics associated with retention in HIV medical care and viral suppression among in care patients in Hawaii
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Alan R. Katz, Fenfang Li, Timothy J. McCormick, Peter M Whiticar, and Glenn M Wasserman
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medicine.medical_specialty ,Anti-HIV Agents ,Human immunodeficiency virus (HIV) ,HIV Infections ,Dermatology ,medicine.disease_cause ,Medical care ,Hawaii ,White People ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Viral suppression ,030505 public health ,business.industry ,Public Health, Environmental and Occupational Health ,Middle Aged ,Viral Load ,Retention in care ,United States ,Infectious Diseases ,Family medicine ,0305 other medical science ,business - Abstract
The percentages of retention in care and viral suppression among persons living with HIV (PLWH) in the United States from 2015 to 2018 were far below the 2020 national goals. This study aims to examine disparities in retention in care and viral suppression. The study population included PLWH diagnosed through 2016, residing in Hawaii at year-end 2016 and 2017, and who were in care in 2017 defined as having ≥1 CD4/viral load tests in 2017. Care providers were categorized as “very frequent” (≥50 patients), “frequent” (25–49 patients), “occasional” (10–24 patients), and “infrequent” (
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- 2021
10. Robotic complete mesocolic excision versus conventional robotic right colectomy for right-sided colon cancer: a comparative study of perioperative outcomes
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Julie Flynn, Alexander G. Heriot, Timothy Wright, José Tomás Larach, Philip Smart, Amrish Rajkomar, Joseph C Kong, Satish K Warrier, and Jacob J McCormick
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medicine.medical_specialty ,business.industry ,Colorectal cancer ,Cancer ,Perioperative ,Hepatology ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Internal medicine ,Right Colectomy ,medicine ,030211 gastroenterology & hepatology ,Robotic surgery ,business ,Lymph node ,Abdominal surgery - Abstract
This study aims to compare the short-term outcomes of robotic complete mesocolic excision (RCME) versus conventional robotic right colectomy (RRC) for right-sided colon cancer. Consecutive patients who underwent robotic surgery for right-sided colon cancer in a public quaternary and a private tertiary healthcare centre between November 2018 and June 2020 were included. Clinical, perioperative and histopathological variables were collected and analysed. Fifty-one patients were included; 25 (49%) of them had an RCME. The groups were evenly distributed in terms of demographic characteristics and tumour location. Operative time was similar between both groups, and no patients required conversion to open surgery. There were no differences in overall complications (16% in RCME vs. 26.9% in RRC; p = 0.499) or their profile between groups. There were no anastomotic leaks recorded, and the reoperation rates were similar (0% for RCME versus 3.8% for RRC; p = 1). In addition, the median length of hospital stay was similar in between the RCME and the RRC groups (4 [4–6] days versus 5 [3–8.5] days, respectively; p = 0.891). Whilst there were no differences in the TNM staging, the mean number of lymph nodes harvested with RCME was 37.7 (±12.9) compared to 21.8 (±7.5) with RCC (p
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- 2021
11. Significant variations in surgical construct and return to sport protocols with syndesmotic injuries: an ISAKOS global perspective
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Jonathan Bartolomei, Annunziato Amendola, Kenneth J. Hunt, Shanthan Challa, Pieter D’Hooghe, Michael I. Tuffiash, and Jeremy J. McCormick
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Syndesmosis ,medicine.medical_specialty ,medicine.medical_treatment ,Deltoid curve ,High ankle sprain ,Bone Screws ,Deltoid ligament ,medicine ,Humans ,Orthopedics and Sports Medicine ,Ankle Injuries ,Fixation (histology) ,Rehabilitation ,biology ,Athletes ,business.industry ,Evidence-based medicine ,medicine.disease ,biology.organism_classification ,United States ,Return to Sport ,medicine.anatomical_structure ,Physical therapy ,Surgery ,business ,Lateral Ligament, Ankle ,Ankle Joint - Abstract
Although the body of literature on syndesmosis injuries is growing with regard to both the biomechanics and clinical outcomes for various fixation constructs, there is little consensus on the optimal treatment and return to sport strategy for these injuries. We endeavoured to assess the current approaches to managing syndesmotic injuries through a Research Electronic Data Capture survey.The survey consisted of 27 questions, including respondent demographics, indications for treatment of syndesmotic injuries, preferred treatment and technique, and postoperative management. Responses were generated through six different athlete scenarios: moderate impact, high impact, and very high impact athletes with/without complete deltoid injury. Frequencies and percentages were calculated for all categorical responses.A total of 742 providers responded to the survey, including 457 American surgeons and 285 members of various international societies. Flexible devices were the preferred fixation construct (47.1%), followed by screws (29.6%), hybrid fixation (e.g. combination of flexible device and screw, 18%), and other (5.3%). Sixty-four percent of respondents noted that their rehabilitation protocols would not change for each athlete scenario. Considerable variability was present in anticipated return to full participation, largely dependent on the presence or absence of a deltoid ligament injury.The most common elements used as surgical indications were syndesmosis widening2 mm on x-ray, an anterior inferior talofibular ligament injury in combination with a posterior inferior talofinular ligament or deltoid ligament involvement on magnetic resonance imaging, and widening of the distal tibiofibular joint during arthroscopic evaluation. Overall, flexible fixation (e.g. suture button) was the preferred device choice for the repair of an injured syndesmosis. Most respondents did not alter their rehab protocol or anticipated return to play timeline based on the injury severity. However, there was considerable variability between respondents on the time to weight-bearing, running, and full participation. Further pragmatic outcomes data are necessary to guide safe return to play protocols for syndesmotic injuries.Level IV.
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- 2022
12. Fellowship training in robotic colorectal surgery within the current hospital setting: an achievable goal?
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Michael Flood, Peadar S Waters, Alexander G. Heriot, Julie Flynn, Satish K Warrier, José Tomás Larach, Diharah Fernando, Jake D. Foster, Jacob J McCormick, and Oliver Peacock
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medicine.medical_specialty ,Hospital setting ,Training course ,education ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,Robotic Surgical Procedures ,Blood loss ,medicine ,Humans ,Robotic surgery ,Fellowships and Scholarships ,Fellowship training ,business.industry ,General surgery ,Significant difference ,General Medicine ,Hospitals ,Colorectal surgery ,030220 oncology & carcinogenesis ,Operative time ,Laparoscopy ,Surgery ,business ,Colorectal Surgery ,Goals - Abstract
BACKGROUND: Although currently limited, the requirement for colorectal trainees to attain skills in robotic surgery is likely to increase due to further utilization of robotic platforms globally. The aim of the study is to describe the training programme utilized and assess outcomes of fellowship training in robotic colorectal surgery. METHODS: A structured robotic training programme was generated across a tertiary hospital setting. Review of four prospectively maintained fellow operative logbooks was performed to assess caseload and skill acquisition. Operative and patient-related outcomes were compared with consultant trainer performed cases. Data were analysed using R with a P
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- 2021
13. Management of lateral pelvic lymph nodes by Australasian colorectal surgeons: An insight from the west
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Benjamin Cribb, Alexander G. Heriot, Joseph C Kong, Satish K Warrier, and Jacob J McCormick
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medicine.medical_specialty ,Colorectal cancer ,Context (language use) ,03 medical and health sciences ,0302 clinical medicine ,Rectal Adenocarcinoma ,Humans ,Medicine ,030212 general & internal medicine ,Lymph node ,Surgeons ,Response rate (survey) ,Rectal Neoplasms ,business.industry ,General surgery ,General Medicine ,medicine.disease ,Pelvic lymph nodes ,Neoadjuvant Therapy ,Dissection ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Lymph Node Excision ,Lymph Nodes ,business ,Colorectal surgeons - Abstract
Purpose Lateral pelvic lymph node dissection (LPLND) for locally advanced low rectal cancer is a common practice in Japan. However, it is not widely performed in western countries. The aim of this survey study is to assess the current practice and management of lateral pelvic lymph nodes by colorectal surgeons in Australasia. Methods The authors developed a survey to assess surgeons' assessment and management of lateral pelvic lymph nodes in patients with rectal cancer. The survey was run through the online RedCap® platform in 2019. An electronic link and request to complete the survey was sent to specialist surgeons of the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). Results Ninety-two colorectal surgeons completed the online survey (32% response rate). Eighty percent of participants consider malignant lateral pelvic lymph nodes to represent locoregional and resectable disease. In patients with clinically malignant lateral pelvic lymph nodes on preoperative imaging the majority of respondents (92%) recommend neoadjuvant chemoradiotherapy and 86% would also recommend LPLND. Over half of the surgeons (57%) had no exposure to LPLND during fellowship training and approximately two thirds (62%) do not perform LPLND in their current practice. Conclusion This study highlights the challenges in the management of the lateral pelvic lymph nodes in a western context. The majority of the participating Australasian colorectal surgeons consider malignant lateral pelvic lymph nodes to represent locoregional and resectable disease. The majority also recommend LPLND for clinically malignant lateral pelvic nodes. However, adequate training and experience with LPLND is limited.
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- 2021
14. Intraoperative Ketorolac is Associated with Risk of Reoperation After Mastectomy: A Single-Center Examination
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Jonas A. Nelson, Hanae K. Tokita, Kimberly J. Van Zee, Melissa Assel, Patrick J. McCormick, Brett A Simon, Rebecca S Twersky, Andrew J. Vickers, and Monica Morrow
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medicine.medical_specialty ,business.industry ,Narcotic ,medicine.medical_treatment ,Odds ratio ,Perioperative ,Single Center ,Surgery ,body regions ,Ketorolac ,03 medical and health sciences ,0302 clinical medicine ,Oncology ,030220 oncology & carcinogenesis ,Ambulatory ,Medicine ,030211 gastroenterology & hepatology ,Breast reconstruction ,business ,Mastectomy ,medicine.drug - Abstract
Although ketorolac is an effective adjunct for managing pain in the perioperative period, it is associated with a risk of postoperative bleeding. This study retrospectively investigated the association between ketorolac use and both reoperation and postoperative opioid use among mastectomy patients. The study identified all women undergoing mastectomy (unilaterally or bilaterally) at our ambulatory surgery cancer center from January 2016 to June 2019. The primary outcome was reoperation for bleeding on postoperative day 0 or 1, and the secondary outcome was postoperative opioid use. The association between ketorolac and outcomes was assessed using multivariable regression models. The covariates were age, body mass index, breast reconstruction, bilateral surgery, peripheral nerve block, and preoperative antiplatelet and/or anticoagulation medication. A cohort of 3469 women were identified. Ketorolac was given to 1549 (45%) of the women, with 922 women (60%) receiving 30 mg and 627 women (40%) receiving 15 mg. The overall reoperation rate for bleeding was 3.1% (1.8% without ketorolac vs 4.8% with ketorolac). In the multivariable analysis, ketorolac was associated with a higher risk of reoperation [odds ratio (OR) 2.43; 95% confidence interval (CI) 1.60–3.70; P < 0.0001]. Ketorolac also was associated with a lower proportion of patients receiving any postoperative narcotic within 24 h (15 mg: OR 0.73; 95% CI 0.57–0.94; P = 0.014 vs 30 mg: OR 0.52; 95% CI 0.42–0.66; P < 0.0001). Ketorolac use decreased postoperative opioid use, but this benefit was outweighed by the increased risk of bleeding requiring reoperation. This finding led to a change in practice at the authors’ center, with ketorolac no longer administered in the perioperative care of the mastectomy patient.
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- 2021
15. Identifying Clear Cell Renal Cell Carcinoma Coexpression Networks Associated with Opioid Signaling and Survival
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Takeshi Irie, Joshua S. Mincer, Roy Mano, Joseph R. Scarpa, Gregory W. Fischer, Fengshen Kuo, A. Ari Hakimi, Renzo G. DiNatale, Patrick J. McCormick, and Andrew W. Silagy
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Adult ,Male ,0301 basic medicine ,Cancer Research ,Angiogenesis ,Analgesic ,(+)-Naloxone ,Disease ,Bioinformatics ,Article ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Gene Regulatory Networks ,Mortality ,Carcinoma, Renal Cell ,Aged ,Cell Proliferation ,Aged, 80 and over ,business.industry ,Gene Expression Profiling ,Cancer ,Epistasis, Genetic ,Middle Aged ,Prognosis ,medicine.disease ,Survival Analysis ,Kidney Neoplasms ,Analgesics, Opioid ,Gene Expression Regulation, Neoplastic ,Clear cell renal cell carcinoma ,030104 developmental biology ,Oncology ,Opioid ,Case-Control Studies ,030220 oncology & carcinogenesis ,Cancer cell ,Female ,business ,Signal Transduction ,medicine.drug - Abstract
While opioids constitute the major component of perioperative analgesic regimens for surgery in general, a variety of evidence points to an association between perioperative opioid exposure and longer term oncologic outcomes. The mechanistic details underlying these effects are not well understood. In this study, we focused on clear cell renal cell carcinoma (ccRCC) and utilized RNA sequencing and outcome data from both The Cancer Genome Atlas, as well as a local patient cohort to identify survival-associated gene coexpression networks. We then projected drug-induced transcriptional profiles from in vitro cancer cells to predict drug effects on these networks and recurrence-free, cancer-specific, and overall survival. The opioid receptor agonist, leu-enkephalin, was predicted to have antisurvival effects in ccRCC, primarily through Th2 immune- and NRF2-dependent macrophage networks. Conversely, the antagonist, naloxone, was predicted to have prosurvival effects, primarily through angiogenesis, fatty acid metabolism, and hemopoesis pathways. Eight coexpression networks associated with survival endpoints in ccRCC were identified, and master regulators of the transition from the normal to disease state were inferred, a number of which are linked to opioid pathways. These results are the first to suggest a mechanism for opioid effects on cancer outcomes through modulation of survival-associated coexpression networks. While we focus on ccRCC, this methodology may be employed to predict opioid effects on other cancer types and to personalize analgesic regimens in patients with cancer for optimal outcomes. Significance: This study suggests a possible molecular mechanism for opioid effects on cancer outcomes generally, with implications for personalization of analgesic regimens.
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- 2021
16. Beyond transanal total mesorectal excision: short‐term outcomes of transanal total mesorectal excision in locally advanced rectal cancer requiring resection beyond total mesorectal excision
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Alexander G. Heriot, Jacob J McCormick, Amrish Rajkomar, Philip Smart, Satish K Warrier, and José Tomás Larach
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Male ,medicine.medical_specialty ,Rectum ,Transanal Endoscopic Surgery ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Humans ,Medicine ,Laparoscopy ,Retrospective Studies ,Mesorectal ,medicine.diagnostic_test ,Rectal Neoplasms ,business.industry ,Gastroenterology ,medicine.disease ,Total mesorectal excision ,Surgery ,Bowel obstruction ,Dissection ,Treatment Outcome ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Presacral fascia ,Neoplasm Recurrence, Local ,business - Abstract
AIM: The aim of this work was to define the role of transanal total mesorectal excision (taTME) in locally advanced rectal cancer (LARC) requiring resection beyond the mesorectal plane. METHOD: We performed a retrospective review of the outcomes of a case series of patients undergoing taTME for rectal cancer with mesorectal fascia or adjacent organ involvement. RESULTS: Eleven patients (six men) underwent taTME for LARC requiring resection beyond total mesorectal excision (TME). All had a restorative procedure. The transabdominal approach was open in five and minimally invasive in six cases. All patients required the resection of at least one adjacent structure, including presacral fascia, internal iliac vessels, nerve roots, uterus, vagina or seminal vesicles. Four patients required a pelvic side-wall lymph node dissection and four had intraoperative radiotherapy. In all cases, the transanal approach was useful to disconnect the rectum distally, resect adjacent organs or control the R1 risk-point. Three patients had a complication of Clavien-Dindo grade III or above (one mechanical bowel obstruction, one pelvic collection and one urine sepsis). There were no anastomotic complications. Ten patients had an R0 resection. During a median follow-up of 11 (8.6-16) months there were no local recurrences, but two patients had distant metastases. During the study period, eight patients underwent closure of their stoma whilst the remaining three have had normal anastomotic assessments and will be closed in the future. CONCLUSION: This early series shows that implementation of taTME for resections beyond TME may be feasible and safe in a highly selected setting.
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- 2020
17. Preeclamptic Women Have Decreased Circulating IL-10 (Interleukin-10) Values at the Time of Preeclampsia Diagnosis
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Daniel J. McCormick, Meryl C. Nath, Natasa Milic, Vesna D. Garovic, and Hajrunisa Cubro
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medicine.medical_specialty ,Pregnancy ,030219 obstetrics & reproductive medicine ,business.industry ,medicine.medical_treatment ,Subgroup analysis ,030204 cardiovascular system & hematology ,medicine.disease ,Gastroenterology ,Pathophysiology ,3. Good health ,Preeclampsia ,03 medical and health sciences ,Interleukin 10 ,0302 clinical medicine ,Cytokine ,Blood pressure ,Meta-analysis ,Internal medicine ,Internal Medicine ,medicine ,business - Abstract
A key immunomodulatory cytokine, IL-10 (interleukin-10), has been shown to be dysregulated in preeclampsia, a pregnancy-specific hypertensive disorder, further characterized by multi-system involvement. However, studies have reported inconsistent findings about circulating IL-10 levels in preeclamptic versus normotensive pregnancies. The aim of the present systematic review and meta-analysis was to assess circulating IL-10 levels in preeclamptic and normotensive pregnancies at 2 time points: before, and at the time of preeclampsia diagnosis. PubMED, EMBASE, and Web of Science databases were searched to include all published studies examining circulating IL-10 levels in preeclamptic and normotensive pregnancies. Differences in IL-10 levels were evaluated by standardized mean differences. Of 876 abstracts screened, 56 studies were included in the meta-analysis. Circulating IL-10 levels were not different before the time of active disease (standardized mean differences, −0.01 [95% CI, −0.11 to 0.08]; P =0.76). At the time of active disease, women with preeclampsia (n=1599) had significantly lower IL-10 levels compared with normotensive controls (n=1998; standardized mean differences, −0.79 [95% CI, −1.22 to −0.35]; P =0.0004). IL-10 levels were lower in both early/severe and late/mild forms of preeclampsia. Subgroup analysis revealed that IL-10 measurement methodology (ELISA or multiplex bead array) and the sample type (plasma or serum) significantly influenced the observed differences, with the use of sera paired with ELISA technology providing the best distinction in IL-10 levels between preeclamptic and normotensive pregnancies. These findings support the role of decreased IL-10 levels in the pathophysiology of preeclampsia. Future studies should address the therapeutic potential of IL-10 in preeclampsia.
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- 2020
18. Resting-state functional connectivity in early postanaesthesia recovery is characterised by globally reduced anticorrelations
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Kuang-Han Huang, Tommer Nir, Prantik Kundu, Helen Ahn, Mary Sano, Yael Jacob, Patrick J. McCormick, Arthur E. Schwartz, Stacie Deiner, Cheuk Y. Tang, Mark G. Baxter, Joshua S. Mincer, Bradley N. Delman, and Jess W. Brallier
- Subjects
Adult ,Male ,Anesthesia, General ,Sevoflurane ,03 medical and health sciences ,0302 clinical medicine ,Neuroscience and Neuroanaesthesia ,030202 anesthesiology ,medicine ,Humans ,General anaesthesia ,Aged ,Aged, 80 and over ,Resting state fMRI ,business.industry ,Functional connectivity ,Age Factors ,Brain ,Cognition ,Middle Aged ,Magnetic Resonance Imaging ,Oxygen ,Anesthesiology and Pain Medicine ,Anesthesia ,Anesthesia Recovery Period ,Female ,Cognition Disorders ,business ,medicine.drug - Abstract
Background A growing body of literature addresses the possible long-term cognitive effects of anaesthetics, but no study has delineated the normal trajectory of neural recovery attributable to anaesthesia alone in adults. We obtained resting-state functional MRI scans on 72 healthy human volunteers between ages 40 and 80 (median: 59) yr before, during, and after general anaesthesia with sevoflurane, in the absence of surgery, as part of a larger study on cognitive function postanaesthesia. Methods Region-of-interest analysis, independent component analysis, and seed-to-voxel analysis were used to characterise resting-state functional connectivity and to differentiate between correlated and anticorrelated connectivity before, during, and after general anaesthesia. Results Whilst positively correlated functional connectivity remained essentially unchanged across these perianaesthetic states, anticorrelated functional connectivity decreased globally by 35% 1 h after emergence from general anaesthesia compared with baseline, as seen by the region-of-interest analysis. This decrease corresponded to a consistent reduction in expression of canonical resting-state networks, as seen by independent component analysis. All measures returned to baseline 1 day later. Conclusions The normal perianaesthesia trajectory of resting-state connectivity in healthy adults is characterised by a transient global reduction in anticorrelated activity shortly after emergence from anaesthesia that returns to baseline by the following day. Clinical trial registration NCT02275026.
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- 2020
19. Tumor-Infiltrating Lymphocyte Function Predicts Response to Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer
- Author
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Satish Warrier, Jayesh Desai, Rosemary Millen, Michael H. Kershaw, Joseph Cherng Huei Kong, Minyu Wang, William K. Murray, Michael Michael, David Shi Hao Liu, Robert G. Ramsay, Shienny Sampurno, Toan Duc Pham, Phillip K. Darcy, Kumar Visvanathan, Andrew Craig Lynch, Jacob J McCormick, Samuel Y Ngan, Sara Roth, Vignesh Narasimhan, Alexander G. Heriot, Huiling Xu, Catherine Mitchell, Jordane Malaterre, Glen R Guerra, Yu-Kuan Huang, Paul J Neeson, and Wayne A. Phillips
- Subjects
0301 basic medicine ,Oncology ,Cancer Research ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Colorectal cancer ,Tumor-infiltrating lymphocytes ,Cancer ,medicine.disease ,Blockade ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Clinical research ,030220 oncology & carcinogenesis ,Internal medicine ,Biopsy ,Medicine ,Cytotoxic T cell ,business ,Cytotoxicity - Abstract
Purpose The presence of tumor-infiltrating lymphocytes (TILs) in tumors is superior to conventional pathologic staging in predicting patient outcome. However, their presence does not define TIL functionality. Here we developed an assay that tests TIL cytotoxicity in patients with locally advanced rectal cancer before definitive treatment, identifying those who will obtain a pathologic complete response (pCR). We also used the assay to demonstrate the rescue of TIL function after checkpoint inhibition blockade (CIB). Patients and Methods Thirty-four consecutive patients were identified initially, with successful completion of the assay before surgery in those 17 patients who underwent full treatment. An in vitro cytotoxic assay of rectal cancer tumoroids cocultured with patient-matched TILs was established and validated. Newly diagnosed patients were recruited with pretreatment biopsy specimens processed within 1 month. Evaluation of TIL-mediated tumoroid lysis was performed by measuring the mean fluorescence intensity of cell death marker, propidium iodide. CIB (anti–programmed cell death protein 1 [anti–PD-1] antibody) response was also assessed in a subset of patient specimens. Results Six of the 17 patients achieved an objective pCR on final evaluation of the resected specimen after neoadjuvant chemoradiotherapy. Cytotoxic killing identified the pCR group with a higher mean fluorescence intensity (27,982 [95% CI, 25,340 to 30,625]) compared with the non-pCR cohort (12,428 [95% CI, 9,434 to 15,423]; p < .001). Assessment of the effectiveness of CIB revealed partial restoration of cytotoxicity in TILs with increased PD-1 expression with anti–PD-1 antibody exposure. Conclusion Evaluating TIL function can be undertaken within weeks of the diagnostic biopsy, affording the potential to alter patient management decisions and refine selection for a watch-and-wait protocol. This cytotoxic assay also has the potential to serve as a platform to assist in the additional development of CIB.
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- 2022
20. A Web-Based Perioperative Dashboard as a Platform for Anesthesia Informatics Innovation
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David B. Wax, Jia Huang, Matthew A. Levin, Thomas T. Joseph, Patrick J. McCormick, and Raymond Goldstein
- Subjects
Internet ,Decision support system ,Informatics ,Information Dissemination ,business.industry ,Vendor ,Dashboard (business) ,Internship and Residency ,Usability ,Article ,Perioperative Care ,Data warehouse ,Anesthesiologists ,User-Computer Interface ,Anesthesiology and Pain Medicine ,Workflow ,Anesthesiology ,Anesthesia ,Personal computer ,Electronic Health Records ,Humans ,Medicine ,Web application ,business - Abstract
Physician anesthesiologists have a long and storied history of using technical innovation to improve patient care. Initially, this innovation was focused on hardware. During the 1980s and 1990s, with the rise of the personal computer, the focus shifted to software. The electronic “anesthesia record keeper” was first described over thirty years ago1. This developed from a basic automated charting tool into the anesthesia information management system (AIMS)2, becoming comprehensive data warehouses used for clinical, administrative, and research purposes. AIMS add value beyond direct patient care by sharing anesthesia systems and data horizontally and vertically within the healthcare organization3. Yet as hospitals consolidate into large health systems, the standalone AIMS has become obsolete, increasingly replaced by proprietary enterprise electronic health record (EHR) systems. We contend this hinders innovation. Enterprise EHR vendors typically provide a monolithic “all-in-one” solution on a common platform for all functions – administration, billing, and clinical charting and decision support. This approach is claimed to reduce support, integration, development, and training costs. This is in marked contrast to the classic AIMS, which took a “best-of-breed” approach where the software was highly customized to the needs of the specific end-user. The billing office used billing software, the report writers used reporting software, and the clinicians used an interface often designed by fellow clinicians. The “all-in-one” approach has led to dissatisfaction among clinicians, with usability graded as unacceptable and a major contributor to physician burnout4,5. Ideally, EHR shortcomings could be quickly solved in response to user feedback. However, this idealism is at odds with the business model and development process of EHR vendors. When the AIMS is only one component of an enterprise EHR, the cost of migrating away from only the AIMS component is generally unjustifiably high from the health system perspective, so there is little financial incentive for the vendor to innovate. The ability to create custom solutions is necessary to support and drive research into improvement in AIMS functionality. We describe a custom web-based application, providing functionality absent in the enterprise EHR, that we use to streamline clinical and operational workflows. Our work is distinct from existing efforts focused on clinical decision support6,7. The focus is on supporting and enabling the call team and daily coordinator to most efficiently staff and coordinate the complex dance of scheduling activities that occurs in a busy anesthesia practice. Originally built to work with a standalone AIMS, its modular architecture allowed us to easily adapt it to an enterprise EHR system. The greater significance of this project is that it shows, in an era of monolithic enterprise EHR systems, the importance of open access to EHR data, without which innovation in anesthesia informatics could not occur.
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- 2020
21. Abdominoperineal excision in Australasia: clinical outcomes, predictive factors and recent trends of nonrestorative rectal cancer surgery
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Alexander G. Heriot, Oliver Peacock, Nicholas Smith, Joseph C Kong, Satish K Warrier, Peadar S Waters, Jacob J McCormick, and A. C. Lynch
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medicine.medical_specialty ,animal structures ,Colorectal cancer ,medicine.medical_treatment ,Perineum ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Neoadjuvant therapy ,Retrospective Studies ,Proctectomy ,Rectal Neoplasms ,business.industry ,Abdominoperineal resection ,Incidence (epidemiology) ,Rectum ,Gastroenterology ,Bowel resection ,medicine.disease ,Treatment Outcome ,030220 oncology & carcinogenesis ,Cohort ,T-stage ,Adenocarcinoma ,030211 gastroenterology & hepatology ,Neoplasm Recurrence, Local ,business - Abstract
AIM: The decision to perform an abdominoperineal excision (APR) rather than restorative bowel resection relies on a number of clinical factors. There remains great variability in APR rates internationally. The aim of this study was to demonstrate trends of APR surgery in low rectal cancer (
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- 2020
22. Robotic multivisceral pelvic resection: experience from an exenteration unit
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A. C. Lynch, Jacob J McCormick, Nicholas Smith, Satish K Warrier, N. Lawrentschuk, Alexander G. Heriot, and Declan G. Murphy
- Subjects
medicine.medical_specialty ,Blood transfusion ,Pelvic exenteration ,business.industry ,medicine.medical_treatment ,Gastroenterology ,Locally advanced ,Retrospective cohort study ,Perioperative ,Resection ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,medicine ,030211 gastroenterology & hepatology ,business ,Lymph node ,Pelvis - Abstract
Pelvic exenteration remains a viable and effective treatment option for the management of locally advanced or recurrent pelvic malignancy. The aim of this study was to present an early experience of robotic multivisceral resection of pelvic malignancy, and to compare this experience with similar series through a systematic review of the literature. A retrospective study was performed on patients who had robotic-assisted multi-visceral resection for pelvic malignancy at a single Colorectal Surgical unit based between two tertiary academic hospitals. Primary outcomes observed included operation type, operation time, perioperative complications, and hospital length of stay. Secondary outcomes included R0 resection status, lymph node harvest, and rate of recurrence at clinical follow-up. Eight cases of robotic multivisceral resection were performed for primary locally advanced pelvic malignancy involving a rectal resection as part of their operative management. The median age of patients undergoing resection was 56 years (range 29–83 years). The male:female ratio was 6:2. The mean total operating time was 8.3 h (range 6–10 h). Perioperative blood transfusion requirements were minimal. Mean hospital length of stay was 15 days (range 7–26 days). No patients experienced any serious postoperative morbidity or mortality. All patients had clear margins on histological assessment and no patients have recurrence at 12-month follow-up. Robotic multivisceral resection for malignant disease of the pelvis is a safe and feasible minimally invasive approach in highly selected cases.
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- 2020
23. Differences in Outcomes After Anesthesia-Related Adverse Events in Older and Younger Patients
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Christopher J. Curatolo, Patrick J. McCormick, Daniel Martin Katz, Jaime B. Hyman, Christopher W. Root, and Yaakov Beilin
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Adult ,Male ,medicine.medical_specialty ,Pediatrics ,media_common.quotation_subject ,New York ,MEDLINE ,Tertiary care ,Perioperative Care ,Article ,Cohort Studies ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Anesthesiology ,Odds Ratio ,medicine ,Humans ,Anesthesia ,030212 general & internal medicine ,Adverse effect ,Aged ,Retrospective Studies ,media_common ,Aged, 80 and over ,business.industry ,030503 health policy & services ,Health Policy ,Age Factors ,Public Health, Environmental and Occupational Health ,Retrospective cohort study ,Odds ratio ,Middle Aged ,Treatment Outcome ,Female ,0305 other medical science ,business ,Vigilance (psychology) ,Cohort study - Abstract
Because more older adults undergo surgical procedures, it is incumbent on us to learn how to provide them with the safest possible perioperative care. We conducted a retrospective cohort study at a large tertiary care center to determine whether outcomes after anesthesia-related adverse events differed between patients aged 65 years and older versus patients under age 65. One thousand four hundred twenty-four cases were referred to the Performance Improvement committee of the Department of Anesthesiology from the years 2007-2015. After exclusions of cases that were not anesthesia-related, could not be identified, or were duplicates, 747 cases with anesthesia-related adverse events were included in the study. Two hundred eighty-six were aged 65 years and older and 461 were under age 65. Anesthesia-related adverse events occurred more commonly in the postoperative period in older patients relative to younger patients (37.7% vs. 21.9%, p = .001), and older patients had a greater incidence of mortality compared with a propensity-matched group of younger patients (adjusted odds ratio 1.87 [1.14-3.12], p < .05). We concluded that older patients have a greater likelihood of mortality as a result of suffering an anesthesia-related adverse event and may benefit from increased vigilance in the postoperative period.
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- 2020
24. Sugammadex versus Neostigmine for Reversal of Neuromuscular Blockade and Postoperative Pulmonary Complications (STRONGER)
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Michael R. Mathis, Michelle T. Vaughn, Timur Dubovoy, Leif Saager, Karsten Bartels, Amit Bardia, Amy Shanks, Roy G. Soto, Sachin Kheterpal, Patrick J. McCormick, Robert B. Schonberger, Lori D. Bash, Nirav Shah, and Douglas A. Colquhoun
- Subjects
Neuromuscular Blockade ,Adult patients ,business.industry ,Pulmonary Complication ,medicine.disease ,Sugammadex ,3. Good health ,Neostigmine ,03 medical and health sciences ,Pneumonia ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,Matched cohort ,030202 anesthesiology ,Anesthesia ,medicine ,business ,030217 neurology & neurosurgery ,medicine.drug ,Cohort study - Abstract
Background Five percent of adult patients undergoing noncardiac inpatient surgery experience a major pulmonary complication. The authors hypothesized that the choice of neuromuscular blockade reversal (neostigmine vs. sugammadex) may be associated with a lower incidence of major pulmonary complications. Methods Twelve U.S. Multicenter Perioperative Outcomes Group hospitals were included in a multicenter observational matched-cohort study of surgical cases between January 2014 and August 2018. Adult patients undergoing elective inpatient noncardiac surgical procedures with general anesthesia and endotracheal intubation receiving a nondepolarizing neuromuscular blockade agent and reversal were included. Exact matching criteria included institution, sex, age, comorbidities, obesity, surgical procedure type, and neuromuscular blockade agent (rocuronium vs. vecuronium). Other preoperative and intraoperative factors were compared and adjusted in the case of residual imbalance. The composite primary outcome was major postoperative pulmonary complications, defined as pneumonia, respiratory failure, or other pulmonary complications (including pneumonitis; pulmonary congestion; iatrogenic pulmonary embolism, infarction, or pneumothorax). Secondary outcomes focused on the components of pneumonia and respiratory failure. Results Of 30,026 patients receiving sugammadex, 22,856 were matched to 22,856 patients receiving neostigmine. Out of 45,712 patients studied, 1,892 (4.1%) were diagnosed with the composite primary outcome (3.5% sugammadex vs. 4.8% neostigmine). A total of 796 (1.7%) patients had pneumonia (1.3% vs. 2.2%), and 582 (1.3%) respiratory failure (0.8% vs. 1.7%). In multivariable analysis, sugammadex administration was associated with a 30% reduced risk of pulmonary complications (adjusted odds ratio, 0.70; 95% CI, 0.63 to 0.77), 47% reduced risk of pneumonia (adjusted odds ratio, 0.53; 95% CI, 0.44 to 0.62), and 55% reduced risk of respiratory failure (adjusted odds ratio, 0.45; 95% CI, 0.37 to 0.56), compared to neostigmine. Conclusions Among a generalizable cohort of adult patients undergoing inpatient surgery at U.S. hospitals, the use of sugammadex was associated with a clinically and statistically significant lower incidence of major pulmonary complications. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
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- 2020
25. Predictors of overall survival following extended radical resections for locally advanced and recurrent pelvic malignancies
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Tim Eglinton, Satish K Warrier, Peadar S Waters, Christopher Wakeman, Oliver Peacock, Joseph C Kong, Jacob J McCormick, Frank A. Frizelle, and Alexander G. Heriot
- Subjects
Extended radical ,medicine.medical_specialty ,business.industry ,Locally advanced ,Disease ,030230 surgery ,Vascular surgery ,Cardiac surgery ,03 medical and health sciences ,0302 clinical medicine ,Cardiothoracic surgery ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,Rectal Adenocarcinoma ,Surgery ,business ,Abdominal surgery - Abstract
In an era of personalised medicine, there is an overwhelming effort for predicting patients who will benefit from extended radical resections for locally advanced pelvic malignancy. However, there is paucity of data on the effect of comorbidities and postoperative complications on long-term overall survival (OS). The aim of this study was to define predictors of 1-year and 5-year OS. Data were collected from prospective databases at two high-volume institutions specialising in beyond TME surgery for locally advanced and recurrent pelvic malignancies between 1990 and 2015. The primary outcome measures were 1-year and 5-year OS. A total of 646 consecutive extended radical resections were performed between 1990 and 2015. The majority were female patients (371, 57.4%) and the median age was 63 years (range 19–89 years). One-year OS, primary rectal adenocarcinoma had the best survival while recurrent colon cancer had the worse survival (p = 0.047). The 5-year OS between primary and recurrent cancers were 64.7% and 53%, respectively (p = 0.004). Poor independent prognostic markers for 5-year OS were increasing ASA score, cardiovascular disease, recurrent cancers, ovarian cancers, pulmonary embolus and acute respiratory distress syndrome. A positive survival benefit was demonstrated with preoperative radiotherapy (HR 0.55; 95% CI 0.4–0.75, p < 0.001). Patient comorbidities and specific complications can influence long-term survival following extended radical resections. This study highlights important predictors, enabling clinicians to better inform patients of the potential short- and long-term outcomes in the management of locally advanced and recurrent pelvic malignancy.
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- 2020
26. Robotic transanal minimally invasive surgery – technical, oncological and patient outcomes from a single institution
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Alexander G. Heriot, Oliver Peacock, Craig Lynch, Jacob J McCormick, Peadar S Waters, Vignesh Narasimhan, Tomas Larach, Satish K Warrier, and Emily J Baker
- Subjects
Male ,medicine.medical_specialty ,Anal Canal ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Robotic Surgical Procedures ,medicine ,Humans ,Minimally Invasive Surgical Procedures ,Robotic surgery ,Rectal Polyp ,Aged ,Transanal Endoscopic Surgery ,medicine.diagnostic_test ,Rectal Neoplasms ,business.industry ,Rectum ,Gastroenterology ,Bleed ,medicine.disease ,Endoscopy ,Surgery ,Lithotomy position ,Treatment Outcome ,030220 oncology & carcinogenesis ,Anal verge ,Adenocarcinoma ,Female ,030211 gastroenterology & hepatology ,medicine.symptom ,business - Abstract
Aim Robotic transanal minimally invasive surgery (R-TAMIS) is gaining traction around the globe as an alternative to laparoscopic conventional TAMIS for local excision of benign and early malignant rectal lesions. The aim was to analyse patient and oncological outcomes of R-TAMIS for consecutive cases in a single centre. Methods A prospective analysis of consecutive R-TAMIS procedures over a 12-month period was performed. Data were collated from hospital databases and theatre registers. Results Eleven patients (six men, five women), mean age 69.81 years (51-92 years), underwent R-TAMIS over 12 months utilizing a da Vinci Xi platform. The mean lesion size was 36 mm (20-60 mm) with a mean distance from the anal verge of 7.5 cm (3-14 cm). Five lesions were posterior in anatomical location, four anterior, one right lateral and one left lateral. All procedures were performed in the lithotomy position using a GelPOINT Path Platform. Mean operative time was 64 min (40-100 min). Complete resection was achieved in 10/11 patients with two patients being upgraded to a diagnosis of adenocarcinoma. Nine patients were diagnosed with dysplastic lesions. Four patients had a false positive diagnosis of an invasive tumour on MRI. Six patients required suturing for full-thickness resections. One patient had a postoperative bleed requiring repeat endoscopy and clipping. One patient (full-thickness resection of T3 tumour) proceeded to a formal resection without difficulty with no residual disease (T0N0, 0/22). One patient with a fully resected T2 tumour is undergoing a surveillance protocol. The mean length of stay was 1 day with two patients having a length of stay of 2 days and one patient of 4 days. Conclusion R-TAMIS could potentially represent a safe novel approach for local resection of rectal lesions.
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- 2020
27. Substantial and sustained reduction in under-5 mortality, diarrhea, and pneumonia in Oshikhandass, Pakistan: evidence from two longitudinal cohort studies 15 years apart
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C. L. Hansen, B. J. J. McCormick, S. I. Azam, K. Ahmed, J. M. Baker, E. Hussain, A. Jahan, A. F. Jamison, S. L. Knobler, N. Samji, W. H. Shah, D. J. Spiro, E. D. Thomas, C. Viboud, Z. A. Rasmussen, and for the Oshikhandass Diarrhea and Pneumonia Project
- Subjects
Male ,Rural Population ,Diarrhea ,medicine.medical_specialty ,Community-based healthcare ,Infant mortality ,Under-5 mortality ,Risk Factors ,Environmental health ,Epidemiology ,medicine ,Humans ,Pakistan ,Longitudinal Studies ,Prospective Studies ,Mortality ,business.industry ,Incidence ,Public health ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,Infant ,lcsh:RA1-1270 ,Pneumonia ,medicine.disease ,Verbal autopsy ,Social Class ,Child, Preschool ,Population Surveillance ,Community health ,Female ,Bloody diarrhea ,medicine.symptom ,business ,Research Article - Abstract
Background Oshikhandass is a rural village in northern Pakistan where a 1989–1991 verbal autopsy study showed that diarrhea and pneumonia were the top causes of under-5 mortality. Intensive surveillance, active community health education and child health interventions were delivered in 1989–1996; here we assess improvements in under-5 mortality, diarrhea, and pneumonia over this period and 15 years later. Methods Two prospective open-cohort studies in Oshikhandass from 1989 to 1996 (Study 1) and 2011–2014 (Study 2) enrolled all children under age 60 months. Study staff trained using WHO guidelines, conducted weekly household surveillance and promoted knowledge on causes and management of diarrhea and pneumonia. Information about household characteristics and socioeconomic status was collected. Hurdle models were constructed to examine putative risk factors for diarrhea and pneumonia. Results Against a backdrop of considerable change in the socioeconomic status of the community, under-5 mortality, which declined over the course of Study 1 (from 114.3 to 79.5 deaths/1000 live births (LB) between 1989 and 1996), exceeded Sustainable Development Goal 3 by Study 2 (19.8 deaths/ 1000 LB). Reductions in diarrhea prevalence (20.3 to 2.2 days/ Child Year [CY]), incidence (2.1 to 0.5 episodes/ CY), and number of bloody diarrhea episodes (18.6 to 5.2%) seen during Study 1, were sustained in Study 2. Pneumonia incidence was 0.5 episodes /CY in Study 1 and 0.2/CY in Study 2; only 5% of episodes were categorized as severe or very severe in both studies. While no individual factors predicted a statistically significant difference in diarrhea or pneumonia episodes, the combined effect of water, toilet and housing materials was associated with a significant decrease in diarrhea; higher household income was the most protective factor for pneumonia in Study 1. Conclusions We report a 4-fold decrease in overall childhood mortality, and a 2-fold decrease in childhood morbidity from diarrhea and pneumonia in a remote rural village in Pakistan between 1989 and 2014. We conclude that significant, sustainable improvements in child health may be achieved through improved socioeconomic status and promoting interactions between locally engaged health workers and the community, but that continued efforts are needed to improve health worker training, supervision, and the rational use of medications. Trial registration Not Applicable.
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- 2020
28. Outcomes of extended radical resections for locally advanced and recurrent pelvic malignancy involving the aortoiliac axis
- Author
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Francis Cheung, Satish K Warrier, Alexander G. Heriot, Timothy Wagner, Peadar S Waters, Nicholas Smith, Jacob J McCormick, and Oliver Peacock
- Subjects
Adult ,Extended radical ,medicine.medical_specialty ,medicine.medical_treatment ,Locally advanced ,Malignancy ,medicine ,Humans ,Prospective Studies ,Vascular resection ,Thrombus ,Aged ,Pelvic Neoplasms ,Retrospective Studies ,Pelvic exenteration ,business.industry ,Gastroenterology ,Middle Aged ,medicine.disease ,Pelvic Exenteration ,Surgery ,Treatment Outcome ,Pelvic malignancy ,Female ,Neoplasm Recurrence, Local ,Complication ,business - Abstract
AIM Currently, there is no clear consensus on the role of extended pelvic resections for locally advanced or recurrent disease involving major vascular structures. The aims of this study were to report the outcomes of consecutive patients undergoing extended resections for pelvic malignancy involving the aortoiliac axis. METHODS Prospective data were collected on patients having extended radical resections for locally advanced or recurrent pelvic malignancies, with aortoiliac axis involvement, requiring en bloc vascular resection and reconstruction, at a single institution between 2014 and 2018. RESULTS Eleven patients were included (median age 60 years; range 31-69 years; seven women). The majority required resection of both arterial and venous systems (n = 8), and the technique for vascular reconstruction was either interposition grafts or femoral-femoral crossover grafts. The median operative time was 510 min (range 330-960 min). Clear resection margins (R0) were achieved in nine patients. The median length of stay was 25 days (range 7-83 days). Seven patients did not suffer an early complication. There was one serious complication (Clavien-Dindo ≥ 3), an arterial graft occlusion secondary to thrombus in the immediate postoperative period, requiring a return to theatre and thrombectomy. The median length of follow-up in this study was 22 months (range 4-58 months). CONCLUSION This series demonstrates that en bloc major vascular resection and reconstruction can be performed safely and can achieve clear resection margins in selected patients with locally advanced or recurrent pelvic malignancy at specialist surgery centres.
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- 2020
29. Outcome of Lesser Metatarsophalangeal Joint Interpositional Arthroplasty With Tendon Allograft
- Author
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Sandra E. Klein, Eugene F. Stautberg, Jeremy J. McCormick, Amber Salter, and Jeffrey E. Johnson
- Subjects
Adult ,Metatarsophalangeal Joint ,Lesser toe ,medicine.medical_specialty ,Degeneration (medical) ,Arthroplasty ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,medicine ,Humans ,Orthopedics and Sports Medicine ,Metatarsal head ,Joint (geology) ,Collapse (medical) ,Aged ,Pain Measurement ,Retrospective Studies ,030222 orthopedics ,Interpositional arthroplasty ,business.industry ,Hamstring Tendons ,Interposition arthroplasty ,030229 sport sciences ,Middle Aged ,Allografts ,Tendon ,Surgery ,medicine.anatomical_structure ,Patient Satisfaction ,Joint Diseases ,medicine.symptom ,business - Abstract
Background: Lesser toe metatarsal head degeneration and collapse can cause significant pain and disability. In the setting of global metatarsal head collapse, there are limited operative options. The purpose of our study was to evaluate clinical and radiographic outcomes after lesser toe metatarsophalangeal (MTP) joint interpositional arthroplasty with a tendon allograft and to describe the operative technique. Methods: We retrospectively reviewed a consecutive series of patients treated by 3 fellowship-trained foot and ankle surgeons at one institution. We created a phone survey to evaluate satisfaction, pain, and likelihood to repeat the surgery. Foot and Ankle Ability Measure (FAAM) scores were reviewed before and after surgery. Preoperative and postoperative radiographs were evaluated for preservation of metatarsal length. The procedure was performed through a dorsal midline approach. The metatarsal head was reamed to a concave shape. A tendon allograft was fashioned into a ball and secured to the metatarsal with an anchor. Fifteen feet in 14 patients underwent lesser MTP joint interposition arthroplasty, with the average age of 49 years (range, 24-69), and an average follow-up of 4.2 years. Results: Eighty percent (12/15) reported they would have the procedure again. Visual analog scale pain scores showed a decrease in pain from 7 to 1. FAAM sports subscale improved from 56% to 85%. Radiographically, the ratio of the affected metatarsal length to the adjacent metatarsal remained constant before and after surgery, suggesting preservation of the metatarsal cascade. Conclusion: Interpositional arthroplasty of the lesser MTP joints with a rolled tendon allograft provided a unique solution, as it allows the surgeon to fill a large void without harvesting an autograft. This study showed improved patient-reported outcomes, high patient satisfaction, and good radiographic outcomes. Lesser metatarsophalangeal joint allograft interposition arthroplasty was a viable solution as a salvage procedure in the setting of global metatarsal head collapse. Level of Evidence: Level IV, retrospective case series.
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- 2020
30. Pelvic Exenteration for Anal and Urogenital Squamous Cell Carcinoma: Experience and Outcomes from an Exenteration Unit Over 12 Years
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Orla McNally, Alexander G. Heriot, Nicholas Smith, Satish K Warrier, Jacob J McCormick, A. C. Lynch, Peadar S Waters, Oliver Peacock, and Joseph C Kong
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,03 medical and health sciences ,0302 clinical medicine ,Surgical oncology ,medicine ,Humans ,Basal cell ,Pathological ,Aged ,Retrospective Studies ,Aged, 80 and over ,Pelvic exenteration ,Genitourinary system ,business.industry ,Significant difference ,Palliative procedure ,Middle Aged ,Anus Neoplasms ,Pelvic Exenteration ,Surgery ,Treatment Outcome ,Oncology ,030220 oncology & carcinogenesis ,Carcinoma, Squamous Cell ,T-stage ,Female ,030211 gastroenterology & hepatology ,Neoplasm Recurrence, Local ,business ,Urogenital Neoplasms - Abstract
Pelvic exenteration has increasingly been shown to improve disease-free and overall survival for patients with locally advanced pelvic malignancies. Squamous cell carcinoma (SCC) is the second most common pelvic malignancy requiring exenteration. The aim of this study was to report the clinical and oncological outcomes from patients treated with pelvic exenteration for anal and urogenital SCC from a single, high-volume unit. A review of a prospectively maintained database from 1991 to 2018 at a high-volume specialised institution was performed. Primary endpoints included R0 resection rates, local recurrence and overall survival (OS) rates. From January 1999 to July 2018, 361 patients underwent pelvic exenteration of which 31 patients were identified with SCC (15 anal SCC, 16 urogenital SCC). The majority of patients were females (n = 24, 77.4%). Median age was 59 (range 35–81). Twenty-seven patients underwent resection with curative intent with an R0 resection rate of 81.5%. Four patients underwent a palliative procedure [R1 = 3 (8%), R2 = 1 (3.3%)]. Mean hospital length of stay was 32 days (range 8–122 days). Disease-free survival was significantly increased in anal SCC with no significant difference in OS compared to urogenital SCC (p = 0.03, p = 0.447 respectively). Advanced pathological T stage was associated with decreased OS (p = 0.023). In the curative intent group the disease-free survival and OS rate was 59.3% and 70% at 24 months, respectively. Complete R0 resection is achievable in a high proportion of patients. Urogenital SCC is associated with significantly worse disease-free survival, and advanced T-stage was a significant prognostic factor for OS.
- Published
- 2020
31. Complications and 5-year survival after radical resections which include urological organs for locally advanced and recurrent pelvic malignancies: analysis of 646 consecutive cases
- Author
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Oliver Peacock, Joseph C Kong, Jacob J McCormick, Satish K Warrier, Declan G. Murphy, Christopher Wakeman, Alexander G. Heriot, Frank A. Frizelle, Peadar S Waters, and Tim Eglinton
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Urinary Diversion ,030230 surgery ,Anastomosis ,Pelvis ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Humans ,Medicine ,Pelvic Neoplasms ,Aged ,Retrospective Studies ,Aged, 80 and over ,Pelvic exenteration ,Rectal Neoplasms ,business.industry ,Urinary diversion ,Gastroenterology ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Colorectal surgery ,Pelvic Exenteration ,Surgery ,Pulmonary embolism ,Treatment Outcome ,Female ,030211 gastroenterology & hepatology ,Neoplasm Recurrence, Local ,business ,Abdominal surgery - Abstract
Extensive multi-visceral resection, including components of the urinary tract, is often required to achieve clear resection margins, which is now well established as a key predictor of long-term survival for locally advanced pelvic tumours. The aims of this study were to analyse major morbidity and factors predicting complications and long-term outcomes following a urological procedure within extended radical resections. Data were collected from prospective databases at two high-volume institutions specialising in extended radical resections for locally advanced and recurrent pelvic malignancies between 1990 and 2015. The primary endpoints were general major complications (Clavien–Dindo ≥ 3) and factors influencing complications and overall survival after urological resection. A total of 646 consecutive patients requiring an extended radical resection for locally advanced or recurrent pelvic malignancies were identified. The median age was 63 years (range 19–89 years) and the majority were female (371; 57.4%). A urological resection was performed as part of the resection in 226 patients (35.0%). The overall 30-day major complication rate was significantly higher in the urological intervention group (23%; n = 52) compared to the non-urological group (12.9%; n = 54 patients; p = 0.001). Intestinal anastomotic leak (p = 0.001) and intra-abdominal collections (p = 0.001) were more common in the urological cohort. Ileal conduit formation was an independent predictor of major morbidity (OR 1.95; 95% CI 1.24–3.07; p = 0.004). Independent prognostic markers for poor 5-year survival following urological procedures were recurrent tumour, cardiovascular disease, previous thromboembolic event and postoperative pulmonary embolism. Extended radical resections which include a urological resection are associated with significantly more major morbidity than those without urological resection. Ileal conduit formation is independently associated with the development of major morbidity. Five-year overall survival is no different for patients who had or did not have urological resection as part of extended radical surgery for locally advanced or recurrent pelvic malignancy.
- Published
- 2020
32. Using taTME to maintain restorative options in locally advanced rectal cancer: A technical note
- Author
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Alexander G. Heriot, Satish K Warrier, Philip Smart, Jacob J McCormick, Peadar S Waters, and José Tomás Larach
- Subjects
medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,Locally advanced ,taTME ,Vaginal wall ,Article ,R0 resection ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Rectal cancer ,En-bloc vaginal wall resection ,business.industry ,General surgery ,Vaginectomy ,Technical note ,medicine.disease ,Total mesorectal excision ,Dissection ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Vagina ,030211 gastroenterology & hepatology ,Surgery ,Transanal total mesorectal excision ,business ,Extended resection - Abstract
Highlights • The safe adoption of transanal total mesorectal excision (taTME) has occurred in many countries worldwide. • Planes beyond TME can be utilised in more advanced cases to achieve negative margins during transanal dissection. • In this case, the transanal technique allowed the surgeons to ensure organ preservation and control the R1 risk point during dissection. • An R0 resection was achieved. • This technical note highlights that in experienced hands, taTME can be safely implemented to maintain restorative options in locally advanced rectal cancer requiring resection beyond the mesorectal plane., Background The safe adoption of transanal total mesorectal excision (taTME) has occurred in Australasia as previously reported by the current authors. Planes beyond TME can be utilised in more advanced cases to achieve negative margins during transanal dissection. Methods In this article we describe how taTME is used to perform an en-bloc partial vaginectomy and aid restore intestinal and vaginal continuity in a young female with a locally advanced rectal cancer and posterior vaginal wall involvement in the pre-treatment magnetic resonance imaging. Results The transanal technique allowed the surgeons to remove a disc of vagina, ensure organ preservation and control the main R1 risk point. An R0 resection was achieved. Conclusion This technical note highlights that in experienced hands, taTME may be safely implemented to maintain restorative options in locally advanced rectal cancer requiring resection beyond the total mesorectal excision plane.
- Published
- 2020
33. Utilization of a Transanal TME Platform to Enable a Distal TME Dissection En Bloc with Presacral Fascia and Pelvic Sidewall with Intraoperative Radiotherapy Delivery in a Locally Advanced Rectal Cancer: Advanced Application of taTME
- Author
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Alexander G. Heriot, Tomas Larach, Jacob J McCormick, Jordan D Lee, Sarat Chander, Peadar S Waters, Oliver Peacock, and Satish K Warrier
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Operative Time ,Pelvis ,Transanal Endoscopic Surgery ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Intraoperative radiation therapy ,Mesorectal ,Radiotherapy ,Rectal Neoplasms ,business.industry ,Dissection ,Margins of Excision ,Middle Aged ,Sacrum ,Total mesorectal excision ,Fasciotomy ,Surgery ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,Resection margin ,Lymph Node Excision ,Female ,030211 gastroenterology & hepatology ,Presacral fascia ,Lymph Nodes ,business - Abstract
Introduction: The safe introduction of transanal total mesorectal excision (taTME) has been documented by the Australasian group previously. The most important prognostic indicator for rectal cancer is the ability to achieve a clear resection margin. By utilizing false planes for taTME surgery, the endopelvic fascia and or presacral fascia can be resected en bloc. Technique: This case highlights the utilization of a taTME platform to perform a distal taTME with presacral fascial stripping and a lateral pelvic sidewall transanal-assisted dissection in a 53-year-old otherwise healthy woman with a mid-rectal tumor. Radiologically the tumor was staged as a T3c/T4 rectal cancer with an N1c deposit extending beyond mesorectal fascia abutting the left piriformis muscle. An extramural venous invasion positive tumor was evident with a positive circumferential resection margin at 4 o' clock. In addition, the taTME platform was used to allow transanal intraoperative radiotherapy (IORT) delivery to the sacrum. An R0 resection was achieved and the patient recovered well without incident. Results: Total operative time was 250 minutes with the patient being discharged on day 7 postoperatively without complication. Macroscopic evaluation revealed a grade III mesorectal excision with en bloc removal of presacral fascia. On microscopic evaluation, revealed a T3N1b tumor with 2 of 14 positive lymph nodes (0/5 pelvic sidewall nodes). Conclusion: The case highlights a novel application of taTME and is to the authors' best knowledge the first described use of a transanal platform to deliver intraoperative radiation therapy in the literature.
- Published
- 2020
34. Evolution of pelvic exenteration surgery– resectional trends and survival outcomes over three decades
- Author
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Oliver Peacock, Jacob J McCormick, Alexander G. Heriot, Christopher Wakeman, A. C. Lynch, Peadar S Waters, Frank A. Frizelle, Satish K Warrier, and Tim Eglinton
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Adult ,Male ,medicine.medical_specialty ,Blood transfusion ,Ileus ,Endpoint Determination ,medicine.medical_treatment ,030230 surgery ,Anastomosis ,Digestive System Neoplasms ,Malignancy ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Survival rate ,Aged ,Retrospective Studies ,Aged, 80 and over ,Pelvic exenteration ,business.industry ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Pelvic Exenteration ,Surgery ,Survival Rate ,Oncology ,030220 oncology & carcinogenesis ,Cohort ,Female ,business ,Urogenital Neoplasms - Abstract
To examine the changes in exenterative surgery over three decades analysing oncological outcomes and whether changes in surgical approach have led to improved patient outcomes.Advances in surgical technology, perioperative care and pattern of disease recurrence have coincided with an evolutionary change in exenterative surgery.A review of a prospectively maintained databases of pelvic exenteration surgery from 1988 to 2018 at two high volume specialised institutions. The total cohort was divided into three major time points (1988-2004, 2005-2010 and 2011 to 2018) to allow comparative analysis. Primary endpoints were overall survival in primary and recurrent disease at each time point. Secondary endpoints included anastomotic leak, blood transfusion, ileus, wound infection rates and evolution of case complexity. Data were analysed using R with a p 0.05 considered significant.Six hundred and seventy patients underwent exenterative surgery. In 2011-2018 there was an increase in resection of recurrent malignancy with a continuous increase in GI malignancies resected over each time period(p 0.001,0.01) and a reduction in gynaecological malignancy(p 0.001). A significant increase in sacrectomy, pelvic sidewall resection and ileal conduit reconstruction was observed (p 0.01,0.001).In 2005-2010 patients had increased rates of ileus and anastomotic leak(p 0.05). Patients undergoing resection for primary disease had improved overall survival at time points 1988-2004 and 2011-2018 compared to those with recurrent disease(p = 0.007,0.001). Overall survival was significantly improved in patients with primary versus recurrent disease(p = 0.022).There has been a significant improvement in survival in patients undergoing pelvic exenteration surgery from primary disease. Case complexity has increased without significant morbidity.
- Published
- 2019
35. Total Neoadjuvant Therapy in Locally Advanced Rectal Cancer: A Systematic Review and Metaanalysis of Oncological and Operative Outcomes
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Jeanne Tie, Samuel Y Ngan, Michael Michael, Mikael L Soucisse, Jacob J McCormick, Joseph C Kong, Alexander G. Heriot, Satish K Warrier, and Trevor Leong
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Oncology ,medicine.medical_specialty ,Colorectal cancer ,business.industry ,medicine.medical_treatment ,Rectum ,Induction chemotherapy ,medicine.disease ,Total mesorectal excision ,Settore MED/18 ,Radiation therapy ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,Resection margin ,030211 gastroenterology & hepatology ,Surgery ,business ,Neoadjuvant therapy ,Chemoradiotherapy - Abstract
Total neoadjuvant therapy in rectal cancer refers to the administration of chemoradiotherapy plus chemotherapy before surgery. Recent studies have shown improved pathological complete response and disease-free survival with this approach. However, survival benefits remain unproven. Our objective is to present a metaanalysis of oncological outcomes of total neoadjuvant therapy in locally advanced rectal cancer. A comprehensive search was performed on PubMed, Medline, and Google Scholars. Studies comparing total neoadjuvant therapy with standard neoadjuvant chemoradiotherapy were included. Data extracted from the individual studies were pooled and a metaanalysis performed. The outcomes of interest are the rate of complete pathological response, nodal response, resection margin, anal preservation, anastomotic leak, local recurrence, distant recurrence, disease-free survival, and overall survival. There were 15 comparative studies with 2437 patients in the neoadjuvant chemoradiotherapy group and 2284 in the total neoadjuvant therapy group. The pooled complete pathological response was 22.3% in the total neoadjuvant therapy group, compared with 14.2% in the standard neoadjuvant chemoradiotherapy group (p
- Published
- 2021
36. Cabergoline treatment in human primary non-functioning pituitary adenomas
- Author
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Marta Korbonits, Joaquin Botta, Oniz Suleyman, Danyal Z. Khan, Federica Begalli, David Collier, Tatsuya Komagata, Kesson Magid, Koji Shinozaki, Peter J. McCormick, Neil L. Dorward, Ramesh Nair, Joan Grieve, Angelos G. Kolias, Thomas Rice, Hani J Marcus, and Nigel Mendoza
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Oncology ,medicine.medical_specialty ,Primary (chemistry) ,business.industry ,Internal medicine ,Cabergoline ,medicine ,business ,medicine.drug - Published
- 2021
37. Status and Distribution: A Key to Bird Identification
- Author
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Andrew J. McCormick
- Subjects
Computer science ,business.industry ,Key (cryptography) ,Distribution (economics) ,Identification (biology) ,Data mining ,computer.software_genre ,business ,computer ,Ecology, Evolution, Behavior and Systematics - Published
- 2021
38. 35 Intravascular lithotripsy-assisted PCI for severe calcific coronary disease: evaluating the impact on quality of life and outcomes
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Ross T. Murphy, J Carey, M Hensey, Andrew O. Maree, S O’Connor, J Cosgrave, J McCormick, Caroline Daly, I Pearson, A Buckley, and R Armstrong
- Subjects
medicine.medical_specialty ,Quality of life (healthcare) ,business.industry ,medicine.medical_treatment ,Conventional PCI ,medicine ,Lithotripsy ,Coronary disease ,business ,Intensive care medicine - Published
- 2021
39. Are we doing enough to assess surgical quality in advanced colon and rectal cancer?
- Author
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Satish K Warrier, Alexander G. Heriot, Peadar S Waters, Jacob J McCormick, José Tomás Larach, Joseph C Kong, and Philip Smart
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medicine.medical_specialty ,Colon ,Rectal Neoplasms ,business.industry ,Colorectal cancer ,General surgery ,General Medicine ,medicine.disease ,Acs nsqip ,Text mining ,Colonic Neoplasms ,Humans ,Medicine ,Surgery ,business - Published
- 2021
40. Pre-emptive femoral-femoral crossover and subsequent resection of locally recurrent colon cancer with multiorgan involvement including the common iliac vessels
- Author
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Alexander G. Heriot, Satish K Warrier, Timothy Wagner, Peadar S Waters, Jacob J McCormick, Natalie Guiney, Mikael L Soucisse, and José Tomás Larach
- Subjects
medicine.medical_specialty ,business.industry ,Recurrent colon cancer ,General Medicine ,Iliac Artery ,Surgery ,Resection ,Pelvis ,Femoral Artery ,Colonic Neoplasms ,medicine ,Humans ,Iliac vessels ,Neoplasm Recurrence, Local ,business - Published
- 2021
41. The Association Between Modifiable Perioperative Parameters and Renal Function After Nephrectomy
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Jonathan A. Coleman, A. Ari Hakimi, Gregory W. Fischer, Amy Tin, Chun Huang, Samuel Haywood, Paul Russo, Joshua S. Mincer, Patrick J. McCormick, Nicole Benfante, Roy Mano, Andrew W. Silagy, and Andrew J. Vickers
- Subjects
Male ,Urology ,medicine.medical_treatment ,Renal function ,Hypothermia ,Kidney ,Nephrectomy ,Article ,Postoperative Complications ,Medicine ,Humans ,Clinical significance ,Renal Insufficiency, Chronic ,Carcinoma, Renal Cell ,Retrospective Studies ,business.industry ,Acute kidney injury ,Perioperative ,Odds ratio ,Acute Kidney Injury ,medicine.disease ,Confidence interval ,Kidney Neoplasms ,Anesthesia ,Female ,Hypotension ,business ,Kidney disease ,Glomerular Filtration Rate - Abstract
OBJECTIVE To evaluate the association between intraoperative anaesthetic parameters, primarily intraoperative hypotension, and postoperative renal function in patients undergoing nephrectomy. PATIENTS AND METHODS We reviewed data from 3240 consecutive patients who underwent nephrectomy between 2010 and 2018. Anaesthetic parameters evaluated included duration of hypotension, tachycardia, hypothermia, volatile anaesthetic use and mean arterial pressure in the post-anaesthesia care unit. Outcomes included acute kidney injury (AKI) and estimated glomerular filtration rate (eGFR) within the first year after nephrectomy. Associations between anaesthetic parameters and outcomes were evaluated with multivariable logistic regression and generalised estimating equation, respectively, adjusted for predictors of renal function after nephrectomy. RESULTS Before nephrectomy, 677 (21%) patients had moderate-severe chronic kidney disease. A quarter of patients (n = 809) had postoperative AKI and 35% (n = 746) had Stage ≥3 chronic kidney disease 12-months after surgery. Only 12% of patients (n = 386) had >5 min of intraoperative hypotension. While not statistically significant, longer duration of intraoperative hypotension was associated with slightly higher rates of AKI (odds ratio [OR] per 10-min 1.14, 95% confidence interval [CI] 0.98, 1.32). Prolonged hypothermia was associated with increased rate of AKI (OR per 10-min 1.02, 95% CI 1.00, 1.04), and decreased eGFR (change in eGFR per 10-min -0.19, 95% CI -0.27, -0.12); however, these results have limited clinical significance. CONCLUSIONS Under current practice, intraoperative anaesthetic parameters are tightly maintained, restricting the significance of their effect on postoperative renal function. Future studies should evaluate whether haemodynamic parameters during the early postoperative period, when they are monitored less frequently, are associated with renal functional outcome.
- Published
- 2021
42. Trends in peripheral nerve block usage in mastectomy and lumpectomy: Analysis of a national database from 2010 to 2018
- Author
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Stephanie Lam, Anoushka M. Afonso, Patrick J. McCormick, Helena Qu, Hanae K. Tokita, Kay See Tan, and Margaret Hannum
- Subjects
Adult ,Male ,medicine.medical_specialty ,Databases, Factual ,medicine.medical_treatment ,Breast surgery ,Mastectomy, Segmental ,Logistic regression ,Article ,Odds ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Reward ,030202 anesthesiology ,Anesthesiology ,Epidemiology ,Humans ,Medicine ,Peripheral Nerves ,Registries ,Mastectomy ,Motivation ,business.industry ,Lumpectomy ,Middle Aged ,Confidence interval ,Surgery ,Anesthesiology and Pain Medicine ,Data Interpretation, Statistical ,Cohort ,Female ,business ,030217 neurology & neurosurgery ,Autonomic Nerve Block - Abstract
BACKGROUND: Compared to general anesthesia, regional anesthesia confers several benefits including improved pain control and decreased postoperative opioid consumption. While the benefits of peripheral nerve blocks (PNB) have been well studied, there is little epidemiological data on PNB usage in mastectomy and lumpectomy procedures. The primary objective of our study was to assess national trends of the annual proportion of PNB use in breast surgery from 2010 to 2018. We also identified factors associated with PNB use for breast surgery. METHODS: We identified lumpectomy and mastectomy surgical cases with and without PNB between 2010 and 2018 using the Anesthesia Quality Institute National Anesthesia Clinical Outcomes Registry (AQI NACOR). We modeled the nonlinear association between year of procedure and PNB use with segmented mixed-effects logistic regression clustered on facility identifier. The association between PNB use and year of procedure, age, sex, American Society of Anesthesiologists Physical Status (ASA PS), facility type, facility region, weekday, and tissue expander use was also modeled using mixed-effects logistic regression. RESULTS: Of the 189,854 surgical cases from 2010 to 2018 that met criteria, 86.2% were lumpectomy cases and 13.8% were mastectomy cases. The proportion of lumpectomy cases with PNB was
- Published
- 2021
43. Exploring the Growing Role of Cyanobacteria in Industrial Biotechnology and Sustainability
- Author
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Xuefeng Lu, Daniel C. Ducat, David J. Lea-Smith, Tina C. Summerfield, Alistair J. McCormick, and Saul Purton
- Subjects
Microbiology (medical) ,Cyanobacteria ,Engineering ,biology ,business.industry ,Natural resource economics ,protein turnover ,Industrial biotechnology ,chemical production ,biology.organism_classification ,Microbiology ,cyanobacteria ,QR1-502 ,Chemical production ,Synthetic biology ,Editorial ,Sustainability ,synthetic biology ,business ,biotechnology - Published
- 2021
44. Impact of intraoperative opioid and adjunct analgesic use on renal cell carcinoma recurrence: role for onco-anaesthesia
- Author
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Paul Russo, Julian Marcon, Jonathan A. Coleman, Kyrollis Attalla, Andrew W. Silagy, Joshua S. Mincer, Margaret Hannum, A. Ari Hakimi, Kay See Tan, Patrick J. McCormick, Roy Mano, Joseph R. Scarpa, Gregory W. Fischer, and Renzo G. DiNatale
- Subjects
Male ,medicine.medical_treatment ,Analgesic ,Cohort Studies ,Renal cell carcinoma ,Correspondence ,medicine ,Humans ,Anesthesia ,Carcinoma, Renal Cell ,Aged ,Aged, 80 and over ,Analgesics ,Intraoperative Care ,business.industry ,Cancer ,Middle Aged ,medicine.disease ,Kidney Neoplasms ,Progression-Free Survival ,Adjunct ,Nephrectomy ,Analgesics, Opioid ,Treatment Outcome ,Anesthesiology and Pain Medicine ,Opioid ,Female ,Neoplasm Recurrence, Local ,business ,Follow-Up Studies ,medicine.drug - Published
- 2020
45. Influences on catch-up growth using relative versus absolute metrics: evidence from the MAL-ED cohort study
- Author
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Stephanie A, Richard, Benjamin J J, McCormick, Laura E, Murray-Kolb, Pascal, Bessong, Sanjaya K, Shrestha, Estomih, Mduma, Tahmeed, Ahmed, Gagandeep, Kang, Gwenyth O, Lee, Jessica C, Seidman, Erling, Svensen, Margaret N, Kosek, Laura E, Caulfield, and Tor, Strand
- Subjects
Male ,medicine.medical_specialty ,030309 nutrition & dietetics ,Catch-up growth ,Permeability ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Linear regression ,Epidemiology ,medicine ,Humans ,Underweight ,030212 general & internal medicine ,Child ,Socioeconomic status ,Growth Disorders ,Stunting ,0303 health sciences ,business.industry ,Body Weight ,Public Health, Environmental and Occupational Health ,Infant ,Anthropometry ,Micronutrient ,Body Height ,Benchmarking ,Child, Preschool ,Cohort ,Enteric dysfunction ,Female ,Public aspects of medicine ,RA1-1270 ,medicine.symptom ,business ,Research Article ,Demography ,Cohort study - Abstract
Background Poor growth in early childhood has been considered irreversible after 2–3 years of age and has been associated with morbidity and mortality over the short-term and with poor economic and cognitive outcomes over the long-term. The MAL-ED cohort study was performed in eight low-income settings with the goal of evaluating relationships between the child’s environment and experience (dietary, illness, and pathogen exposure, among others) and their growth and development. The goal of this analysis is to determine whether there are differences in the factors associated with growth from 24 to 60 months using two different metrics. Methods Across six MAL-ED sites, 942 children had anthropometry data at 24 and 60 months, as well as information about socioeconomic status, maternal height, gut permeability (lactulose-mannitol z-score (LMZ)), dietary intake from 9 to 24 months, and micronutrient status. Anthropometric changes were in height- or weight-for-age z-score (HAZ, WAZ), their absolute difference from the growth standard median (HAD (cm), WAD (kg)), as well as recovery from stunting/underweight. Outcomes were modeled using multivariate regression. Results At 24 months, almost half of the cohort was stunted (45%) and 21% were underweight. Among those who were stunted at 24 months (n = 426), 185 (43%) were no longer stunted at 60 months. Most children increased their HAZ from 24 to 60 months (81%), whereas fewer (33%) had positive changes in their HAD. Linear regression models indicate that girls improved less than boys from 24 to 60 months (HAZ: -0.21 (95% CI -0.27, -0.15); HAD: -0.75 (-1.07, -0.43)). Greater intestinal permeability (higher LMZ) at 0–24 months was associated with lower relative and absolute changes from 24 to 60 months (HAZ: -0.10 (-0.16, -0.04); HAD: -0.47 (-0.73, -0.21)). Maternal height (per 10 cm) was positively associated with changes (HAZ: 0.09 (0.03, 0.15); HAD: 0.45 (0.15, 0.75)). Similar relationships were identified for changes in WAZ and WAD. Conclusions The study children demonstrated improved growth from 24 to 60 months of age, but only a subset had positive changes in HAD and WAD. The same environmental factors were associated with growth from 24 to 60 months regardless of metric used (change in HAZ or HAD, or WAZ and WAD).
- Published
- 2021
46. Nephrectomy After High-Grade Renal Trauma is Associated With Higher Mortality: Results From the Multi-Institutional Genitourinary Trauma Study (MiGUTS)
- Author
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Rachel Moses, Kaushik Mukherjee, Ian Schwartz, Michael E. Rezaee, Bryan B. Voelzke, Reza Askari, S. Mitchell Heiner, Matthew M. Carrick, Nima Baradaran, Sarah Majercik, Sorena Keihani, Sean P. Elliott, Erik S. DeSoucy, Brandi Miller, Benjamin N. Breyer, Joshua A. Broghammer, Raminder Nirula, Jeremy B. Myers, Christopher M. Dodgion, Judith C. Hagedorn, Clara M. Castillejo Becerra, J. Patrick Selph, Alexander P. Nocera, Chirag S. Arya, Elisa Fang, Scott Zakaluzny, Brian P. Smith, Shubham Gupta, Bradley A. Erickson, Richard A. Santucci, Katie Glavin, Benjamin J. McCormick, Margaret Higgins, Rachel L. Sensenig, Frank Burks, and Scott H. Norwood
- Subjects
Adult ,Male ,medicine.medical_specialty ,Urology ,medicine.medical_treatment ,Renal Hemorrhage ,Kidney ,Nephrectomy ,Young Adult ,Injury Severity Score ,medicine ,Humans ,Retrospective Studies ,Genitourinary system ,business.industry ,Mortality rate ,Head injury ,Middle Aged ,medicine.disease ,Surgery ,Blood pressure ,Shock (circulatory) ,Wounds and Injuries ,Female ,medicine.symptom ,business - Abstract
To test the hypothesis that undergoing nephrectomy after high-grade renal trauma is associated with higher mortality rates.We gathered data from 21 Level-1 trauma centers through the Multi-institutional Genito-Urinary Trauma Study. Patients with high-grade renal trauma were included. We assessed the association between nephrectomy and mortality in all patients and in subgroups of patients after excluding those who died within 24 hours of hospital arrival and those with GCS≤8. We controlled for age, injury severity score (ISS), shock (systolic blood pressure90 mmHg), and Glasgow Coma Scale (GCS).A total of 1181 high-grade renal trauma patients were included. Median age was 31 and trauma mechanism was blunt in 78%. Injuries were graded as III, IV, and V in 55%, 34%, and 11%, respectively. There were 96 (8%) mortalities and 129 (11%) nephrectomies. Mortality was higher in the nephrectomy group (21.7% vs 6.5%, P.001). Those who died were older, had higher ISS, lower GCS, and higher rates of shock. After adjusting for patient and injury characteristics nephrectomy was still associated with higher risk of death (RR: 2.12, 95% CI: 1.26-2.55).Nephrectomy was associated with higher mortality in the acute trauma setting even when controlling for shock, overall injury severity, and head injury. These results may have implications in decision making in acute trauma management for patients not in extremis from renal hemorrhage.
- Published
- 2021
47. Intraoperative ketorolac may interact with patient-specific tumour genomics to modify recurrence risk in lung adenocarcinoma: an exploratory analysis
- Author
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Raul Caso, Hersh Gupta, Gaetano Rocco, Gregory W. Fischer, James M. Isbell, Takeshi Irie, Patrick J. McCormick, Joseph Dycoco, Prasad S. Adusumilli, Brooke Mastrogiacomo, Kay See Tan, David R. Jones, Francisco Sanchez-Vega, Joshua S. Mincer, James G. Connolly, Gregory D. Jones, Joseph R. Scarpa, and Matthew J. Bott
- Subjects
Oncology ,medicine.medical_specialty ,Lung Neoplasms ,Time Factors ,NF-E2-Related Factor 2 ,Genomics ,Adenocarcinoma of Lung ,Risk Assessment ,Recurrence risk ,Risk Factors ,Internal medicine ,Correspondence ,medicine ,Biomarkers, Tumor ,Humans ,Gene Regulatory Networks ,Pneumonectomy ,Lung ,Intraoperative Care ,business.industry ,Anti-Inflammatory Agents, Non-Steroidal ,Proto-Oncogene Proteins c-mdm2 ,Exploratory analysis ,Patient specific ,medicine.disease ,Ketorolac ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Treatment Outcome ,Adenocarcinoma ,Neoplasm Recurrence, Local ,business ,medicine.drug - Published
- 2021
48. Delayed Haemorrhage Following Pelvic Side Wall Excision With Internal Iliac Vessel Resection in Locally Recurrent Rectal Cancer
- Author
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Tomas Larach, Satish K Warrier, Jacob J McCormick, Jordan M. Hamilton, and Alexander G. Heriot
- Subjects
medicine.medical_specialty ,Rectal Neoplasms ,business.industry ,Rectum ,Hemorrhage ,General Medicine ,Pelvic Exenteration ,Pelvis ,Surgery ,Resection ,Humans ,Medicine ,Neoplasm Recurrence, Local ,business ,Recurrent Rectal Cancer - Published
- 2020
49. Advanced Application of TaTME Platform For a T4 Anterior Rectal Tumor
- Author
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Emily J Baker, Peadar S Waters, Alexander G. Heriot, Jacob J McCormick, Oliver Peacock, and Satish K Warrier
- Subjects
Adult ,Male ,medicine.medical_specialty ,Endoscopic Mucosal Resection ,Colorectal cancer ,Operative Time ,Locally advanced ,Adenocarcinoma ,Anastomosis ,Malignancy ,Proctoscopy ,Patient Positioning ,03 medical and health sciences ,0302 clinical medicine ,Preoperative Care ,Humans ,Minimally Invasive Surgical Procedures ,Medicine ,Neoplasm Invasiveness ,Stage (cooking) ,Contraindication ,Neoplasm Staging ,Postoperative Care ,Rectal Neoplasms ,business.industry ,Anastomosis, Surgical ,Chemoradiotherapy ,Prognosis ,medicine.disease ,Magnetic Resonance Imaging ,Total mesorectal excision ,Neoadjuvant Therapy ,Surgery ,Treatment Outcome ,Positron-Emission Tomography ,030220 oncology & carcinogenesis ,Operative time ,030211 gastroenterology & hepatology ,Tomography, X-Ray Computed ,business - Abstract
Transanal total mesorectal excision (TaTME) is a rapidly progressing technique in the management of both benign and malignant rectal disease. It is a technical advance to the current gold-standard approach to rectal cancer, the transabdominal total mesorectal excision. Until now, T4 stage cancers have been considered a relative contraindication to TaTME due to the perceived technical difficulty and increased complication rate. This case describes the TaTME operative technique for a T4b locally advanced, mid rectal anterior tumor in a young male postneoadjuvant chemoradiation. Employing a dual team hybrid TaTME (Cecil approach) with laparoscopic abdominal assistance, this case highlights the ability of TaTME to be successfully utilized in more advanced malignancy and technically difficult patients without an increase in complications, operative time, or hospital length of stay.
- Published
- 2019
50. Preoperative Anxiety Effect on Patient-Reported Outcomes Following Foot and Ankle Surgery
- Author
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Sandra E. Klein, Kevin A. Schafer, Jeffery E Johnson, Jeremy J. McCormick, Brian Cusworth, and Devon C. Nixon
- Subjects
Adult ,Male ,medicine.medical_specialty ,Joint arthroplasty ,Anxiety ,03 medical and health sciences ,0302 clinical medicine ,Spine surgery ,Emotional distress ,medicine ,Humans ,Orthopedic Procedures ,Orthopedics and Sports Medicine ,Patient Reported Outcome Measures ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Pain, Postoperative ,030222 orthopedics ,Foot ,business.industry ,Foot and ankle surgery ,Middle Aged ,medicine.anatomical_structure ,Preoperative Period ,Physical therapy ,Female ,Surgery ,Ankle ,medicine.symptom ,business ,Foot (unit) - Abstract
Background: Preoperative emotional distress has been shown to negatively influence joint arthroplasty and spine surgery, but limited data exist for foot and ankle outcomes. Emotional distress can be captured through modern tools like the Patient-Reported Outcomes Instrument Measurement System (PROMIS) anxiety domain. We hypothesized that patients with greater preoperative PROMIS anxiety scores would report greater pain and less function after foot and ankle surgery than patients with lower preoperative anxiety levels. Methods: Elective foot and ankle surgeries from May 2016 to December 2017 were retrospectively identified. PROMIS anxiety, pain interference (PI), and physical function (PF) scores were collected before and after surgery. Patients were grouped based on preoperative PROMIS scores greater or less than 59.4. A cutoff of PROMIS anxiety above 59.4 was selected as the threshold that corresponds to traditional measures of anxiety. Results: Compared to patients with less preoperative anxiety (average: 47.2, n=146), patients with higher preoperative anxiety (average: 63.9, n=59) had greater preoperative pain (PROMIS PI: 63.5 vs 59.1, P < .001) and lower physical function (PROMIS PF: 37.9 vs 42.0, P = .001). Postoperatively, patients with higher preoperative anxiety had more residual pain and greater functional disability as compared to patients with less preoperative emotional distress (PROMIS PI: 58.6 vs 52.9, P < .001; PROMIS PF: 39.8 vs 44.4, P < .001; respectively). Conclusion: Our evidence showed that preoperative emotional anxiety predicted worse pain and function at early operative follow-up. Measures of preoperative anxiety could be useful in identifying patients at risk for poorer operative outcomes, but continued study is necessary. Level of Evidence: Level III, retrospective comparative study.
- Published
- 2019
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