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Competing Interests: Competing interests: MCG: Speaker fees: Novartis, Knight Therapeutics. GB: AstraZeneca, GSK and MSD. MS: Speaker fees and/or honoraria for consulting or advisory functions: MSD, AstraZeneca, Libbs, GSK, Zodiac, Roche, Orentt, MDHealth, Sanofi, Gilead, Amgen, Sophia genetics. YRS and AJR have no competing interests to declare.

Background: Acute esophageal necrosis (AEN) is a rare clinical condition characterized by diffuse, circumferential, black mucosal discoloration of the distal esophagus. The cause is multifactorial, frequently seen as a sequela to a large physiologic stressor such as trauma, multisystem organ failure, or sepsis. Mortality from AEN has previously been documented as high as 32%. Cases of AEN have been described in the post-operative period, however the etiology has not clearly been defined., Methods: A review of AEN was performed, predominately through case reports and small series. In combination of clinical experience and review, emphasis was placed on identification of shared risk factors, signs and symptoms and efficacious management., Key Content and Findings: Patients diagnosed with AEN frequently have a documented history of diabetes, hypertension, and chronic kidney disease. Additional risk factors include duodenal and/or gastric ulcer disease, reflux anemia and malignancy. While more common in patients with multiple comorbidities, AEN is seen otherwise healthy post-operative patients. Surgery can act as a trigger for AEN, documented after transplants, oncologic operations, and routine cholecystectomies. The most common presenting symptom was hematemesis. Management focused on early diagnosis with upper endoscopy, supportive care and reversal of underlying stressors can mitigate morbidity and mortality., Conclusions: AEN is a rare and life-threatening condition that requires early identification and intervention to prevent severe morbidity and mortality. It not only occurs in patients with multiple comorbidities but also in otherwise healthy patients in response to a large stressor, such as surgery., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-22-1763/coif). The authors have no conflicts of interest to declare., (2024 AME Publishing Company. All rights reserved.)

Species with different ecological niches will likely exhibit distinct responses to a changing environment. Differences in the magnitude of niche specialization may also indicate which species may be more vulnerable to environmental change, as many life-history characteristics are known to affect climate change vulnerability. We characterized the niche space of three sympatric high-elevation ground-dwelling squirrels, yellow-bellied marmot ( Marmota flaviventer ), Belding's ground squirrel ( Urocitellus beldingi ), and golden-mantled ground squirrel ( Callospermophilus lateralis ), in the alpine and upper subalpine regions of the Sierra Nevada in California. We used 5879 observations of individual squirrels, collected from 4 years (2009-2012) of transect survey data, to quantify which ecogeographical variable types (climate, topography, or landcover) were most important in defining the niche of each species. We conducted Ecological Niche Factor Analysis to quantify the niche and generate indices of "marginality" (magnitude of selection) and "specialization" (narrowness of niche space). All three species demonstrated differential use of niche space when compared to the available niche space. Moreover, the relative importance of the variables shaping the niche differed among these species. For example, the presence of meadows was important in defining the niche for U. beldingi and M. flaviventer , but the presence of conifers was important to C. lateralis . Precipitation was important in defining the niche for all three species, positively so for U. beldingi , and negatively for the other two species. The niche breadth of these three species was also positively associated with geographic range size. Mammals in high-elevation mountain systems often are perceived as vulnerable to climate shifts, but our results underscore the importance of also including non-climate-based factors in defining the niche. The overall magnitude of niche selection for all three species was driven by a combination of topographic, climatic, and landcover factors; thus, efforts to forecast areas where these species can persist in the future need to evaluate from more than just a climatic perspective., (© 2023 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

Background: Latissimus dorsi myocutaneous (LDM) pedicled flaps are a well-established method for breast reconstruction in women with inadequate soft tissue coverage following mastectomy for breast cancer. The robust nature of the latissimus blood supply can accommodate immediate implant placement to increase breast volume; however, a known risk factor with this technique is implant malposition. By utilizing an acellular dermal matrix (ADM) in subpectoral implant-based LDM reconstruction, it is hypothesized that patients will experience a lower incidence of implant malposition. This 13-year retrospective review aims to evaluate the effectiveness of breast reconstruction using this technique., Methods: A retrospective review was conducted to identify all patients who underwent breast reconstruction following mastectomy with a LDM flap, subpectoral implant, and an ADM from 2007 to 2020 by a single surgeon at a single institution. Demographic and clinical data were collected and analyzed., Results: A total of 40 patients (LDM flaps, N = 51) were identified. Mean participant age was 50.25 ± 9.67 years and mean body mass index (BMI) was 30.85 ± 6.15 kg/m 2 . Comorbidities included hypertension (40.0%), diabetes mellitus (17.5%), and current smoking (25.0%). Mean follow-up was 31.52 ± 29.51 months. The most common complication was seroma formation (9.8%). No patients experienced implant malposition or flap necrosis., Conclusions: The use of a LDM flap and an ADM in implant-based breast reconstruction are each well described in the literature. This 13-year series supports the efficacy of these techniques utilized in combination to provide an aesthetic result while mitigating implant malposition during breast reconstruction of oncologic patients., Competing Interests: Disclosures: This study received no means of outside funding. The authors report no known or perceived conflicts of interest regarding the material presented in this manuscript., (© 2022, HMP Global. All rights reserved. Reproduction in whole or in part prohibited. Content may not be reproduced in any form without written permission. Rights, Permission, Reprint, and Translation information is available at www.hmpglobal.com.)

Wild-type KIT and PDGFRA gastrointestinal stromal tumors (GIST) are rare tumors with limited treatment options. We sought to determine the clinicopathologic features of wild-type GIST and identify factors that influence overall survival (OS) using a large national database. Retrospective evaluation of patients with wild-type GIST in the National Cancer Database (NCDB) was performed. Demographic, clinicopathologic, and treatment data were analyzed. Features associated with OS were investigated using Kaplan-Meier analysis and Cox proportional hazards model. 244 patients with median diagnosis age of 59 years (95% CI 57-63) were identified. The stomach was the most common primary site (57%) followed by the small intestine (35%). Surgical resection was performed on 85% of patients and 53% of patients received systemic therapy. Factors associated with decreased OS on multivariable analysis included small intestine primary (HR 2.72, 95% CI 1.13-6.69, P = 0.026) and > 5 mitoses per 50 HPF (HR 4.77, 95% CI 1.86-13.2, P = 0.001). Wild-type GISTs may be identified in older patients, with most arising in the stomach and small bowel. Surgery remains the principal treatment modality. Small intestine primary site and high mitotic count were associated with abbreviated OS., (© 2022. The Author(s).)

Background: Telemedicine is an evolving field of interactions between physicians and patients remotely. Health care delivery, patient satisfaction, adherence, earlier diagnosis, increased access, and cost reduction are all areas that telemedicine has potential influence. One focus involves the use of photos in wound assessment. Today, many patients' smartphones can capture high-quality digital photographs, which can easily be transmitted. Postoperative patients are an ideal population for this, as they have a certain level of uncertainty with regard to the healing course, which can often lead to patients seeking out care in unnecessarily costly settings. These visits can lead to inefficient use of health care resources, especially when a telesurgical assessment (TSA) could provide appropriate care more efficiently. Objective: We present data collected from a series of patients who received a TSA to demonstrate the potential benefits of incorporating TSA into postoperative wound care. Methods/Clinical Presentation: Patients who underwent a procedure and contacted their surgeon within 2 weeks with concerns received a TSA, which included a discussion as well as photographs through smartphone. Their surgeon then determined further treatment steps, if any. Results: We experienced that 85% of patients did not require emergent treatment for their concerns, 46% were prescribed medications, whereas 39% of patients did not require any intervention. Conclusion: Our results show that TSAs alleviated patient concerns and provide resolutions, while saving resources and increasing satisfaction. Incorporating aspects of telemedicine into outpatient practice could be valuable, especially with postoperative wound checks.

This work aims to evaluate the cytocompatibility of injectable and moldable restorative biomaterials based on granules of dense or porous biphasic calcium phosphates (BCPs) with human primary mesenchymal cells, in order to validate them as tools for stem cell-induced bone regeneration. Porous hydroxyapatite (HA) and HA/beta-tricalcium phosphate (β-TCP) (60:40) granules were obtained by the addition of wax spheres and pressing at 20 MPa, while dense materials were compacted by pressing at 100 MPa, followed by thermal treatment (1100°C), grinding, and sieving. Extracts were prepared by 24-h incubation of granules on culture media, with subsequent exposition of human primary mesenchymal cells. Three different cell viability parameters were evaluated on the same samples. Scanning electron microscopy analysis of the granules revealed distinct dense and porous surfaces. After cell exposition to extracts, no significant differences on mitochondrial activity (2,3-bis(2-methoxy-4-nitro-5-sulfophenly)-5-[(phenylamino) carbonyl]-2H-tetrazolium hydroxide) or cell density (Crystal Violet Dye Elution) were observed among groups. However, Neutral Red assay revealed that dense materials extracts induced lower levels of total viable cells to porous HA/β-TCP (P < 0.01). Calcium ion content was also significantly lower on the extracts of dense samples. Porogenic treatments on BCP composites do not affect cytocompatibility, as measured by three different parameters, indicating that these ceramics are well suited for further studies on future bioengineering applications., (© 2012, Copyright the Authors. Artificial Organs © 2012, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.)

Endotracheal intubation in rabbits is a formidable task and has led to the devising of a new endoscopic method. Sixty New Zealand White rabbits (2.0-3.5 kg) underwent experimental left thoracotomy requiring mechanical ventilation. After anaesthetic induction was achieved, the animal was placed in a supine position. A rigid 30 degrees endoscope was passed through a 4.5 mm endotracheal tube (ET) and then used to advance, under direct vision, through the oropharynx and vocal cords. Once passing the vocal cords, the ET was advanced into the trachea as the endoscope was withdrawn. All animals were successfully intubated within 30 s to 2 min and then ventilated. No complications or deaths occurred during or after intubation, or postoperatively. No instances of oesophageal intubation occurred. All animals survived long-term. Thirty animals underwent necropsy at 10 days and, 30 at 30 days, with no postoperative evidence of orotracheal injury. We have established a new method of endotracheal intubation in rabbits. It is reliable, effective, non-traumatic, safe, and expeditious.

We describe a case of thoracic myelopathy in a patient with renal osteodystrophy. The patient had chronic renal failure for longer than 20 years and had skeletal changes indicative of renal osteodystrophy, before the onset of myelopathy. Association between spinal stenosis and this entity has been documented only once before in the lumbar region. This is therefore the first case of thoracic myelopathy due to severe stenosis in just one vertebra in a patient with renal osteodystrophy, which was documented by computed tomography as well as magnetic resonance imaging and proven by histopathology.

Inadvertent tears to the atrial caval junction during open heart surgery can present as a disastrous complication. A method is described by which a flap of pericardium is mobilized and sutured over the caval laceration. Control of bleeding is facilitated and caval obstruction is minimized.

The authors investigated the pharmacological treatment of delusional depression by assigning patients on a random double-blind basis to amitriptyline alone, perphenazine alone, or a combination of the two. Fourteen (78%) of the 18 patients assigned to amitriptyline plus perphenazine were responders, compared with seven (41%) of 17 patients treated with amitriptyline alone and three (19%) of the 16 patients treated with perphenazine alone. The combination of amitriptyline and perphenazine was clearly superior (p less than .01).

Intraoperative reversible cryothermal mapping of recurrent ventricular tachycardia was performed in seven patients with left ventricular aneurysms with use of a 0 degrees C ice probe. A single, reproducible cryotermination site was found in each patient. The cryotermination site was uniformly located in an area where local electrograms obtained during ventricular tachycardia showed electrical activation during the diastolic portion of the surface electrocardiogram, and was different than the site of activation coincident with the onset of the QRS complex on the surface electrocardiogram (earliest reactivation site or ERS) by 4.5 +/- 2.7 cm (mean +/- SD) in five of seven patients. Sinus rhythm late potentials were recorded at the cryotermination site in five of six patients and from the ERS in one. In five patients, extensive subendocardial resection including both the ERS and cryotermination sites was performed. In two patients only the cryotermination site was excised. In six survivors, including one in whom only the cryotermination site was excised, ventricular tachycardia could not be induced 2 weeks after surgery and has not recurred during the follow-up period of 7 to 17 months (12 +/- 4.5 months, mean +/- SD). Reversible cryothermal mapping may provide additional important information not obtained by standard electrogram mapping of ventricular tachycardia that may help guide surgical therapy of recurrent ventricular tachycardia.