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Background: Rheumatic heart disease (RHD) is a major challenge to global health, primarily in low- and middle-income countries. Even though RHD is rare in high-income countries, it still poses a health challenge, yet there is a lack of data on its impact within the highest-income regions. Objectives: The purpose of this study was to compare the epidemiology of RHD in the United States of America (USA) and the European Union (EU). Methods: Data on RHD burden were collected using the Global Disease Burden Study 2021 using the Global Health Data Exchange query tool. Age-standardized rates of incidence (ASIR), prevalence (ASPR), death (ASDR), disability-adjusted life years (ASDALY), years lived with disability (ASYLD), and years of life lost (ASYLL) were collected. Estimated annual percentage change (EAPC) was calculated. Results: In USA in 2021, the ASPR was 123.4/100,000 with a decreasing annual trend of 0.32% since 1993. Between 2021 and 1993, the ASIR decreased from 10.6 to 10.0/100,000 cases. In the EU in 2021, the ASPR was 49.7/100,000 cases, with an annual decreasing trend of 1.6% between 2021 and 1993. Between 2021 and 1993, the ASIR decreased from 7.43 to 4.6/100,000 cases. The changing prevalence and incidence in the US was primarily driven by Florida, Nevada, and Tennessee. There has been a reversal in the burden of RHD since 2007 in the USA. In both regions, there was a significant gender disparity with female predominance. The EU reported higher age-standardized disability-adjusted life years and age-standardized years of life losts than the USA. Conclusions: The varied trends underscore the complexity of RHD epidemiology and the need for region-specific strategies to address this persistent health challenge.

Neurofibromatosis 1 (NF1) is a rare genetic syndrome that leads to the development of neurofibromas and increases the risk of malignancy, including malignant peripheral nerve sheath tumors. Patients with NF1 often have other orthopaedic manifestations, including short stature, osteopenia, and dysplasia. A 47-year-old patient with a history of NF1 and multiple neurofibromas of the right lower extremity presented with a severe valgus deformity, instability, and osteoarthritis of the right knee that was debilitating to daily life. Over time, the patient lost proprioception and potentially some sensation to the right knee with neurofibroma formation, leading to the development of Charcot arthropathy of the right knee with secondary osteoarthritis. The preoperative workup consisted of a magnetic resonance imaging of the knee to confirm no malignancy was present and templating to ensure the standard implant size was amenable for the patient. A primary total knee arthroplasty was performed with a cemented-stemmed hinged knee implant. At 6 months post-surgery, the patient had a dramatic improvement in her pain and quality of life.

Purpose: Few studies have evaluated the methodology by which radiation therapy (RT) for thyroid eye disease and compressive optic neuropathy is performed. The objective of this study was to retrospectively review our experience from a radiation planning standpoint and to determine whether current treatment methods provide adequate dose to target and collateral structures. Methods: A retrospective review of 52 patients (104 orbits) with bilateral thyroid eye disease and compressive optic neuropathy treated with RT (20 Gy in 10 fractions) at our institution. RT plans were analyzed for target volumes and doses. Visual fields, color plates, and visual acuity were assessed pretreatment and at last available follow-up post RT. A standardized, anatomic contour of the retro-orbital space was applied to these retrospective plans to determine dose to the entire space, rather than the self-selected target structure. Results: Compared with the anatomic retro-orbital space, the original contour overlapped by only 68%. Maximum and mean dose was 2134 cGy and 1910 cGy to the anatomic retro-orbital space. Consequently, 39.8% of the orbits had a mean dose 21 Gy 5%). There was no significant association of improvement in color plates (P = .07), visual fields (P = .77), and visual acuity (P = .62), based on these dose differences. When beam placement was retrospectively adjusted to include a space of 0.5 cm between the lens and the anterior beam edge, there was a 39.4% and 20.3% decrease in max and mean dose to the lens. Conclusions: Without a standardized protocol for contouring in thyroid eye disease, target delineation was found to be rather varied, even among the same practitioner. Differences in dose to the anatomic retro-orbital space did not affect outcomes in the follow-up period. Although precise contouring of the retro-orbital space may be of little clinical consequence overall, a >0.5 cm space from the lens may significantly reduce or delay cataractogenesis.

Abstract. Antibiotic resistance remains a global public health concern with significant patient morbidity and tremendous associated health care costs. Drivers of antibiotic resistance are multifaceted and differ between developing and developed countries. Under evolutionary pressure, microbes acquire antibiotic tolerance through a variety of mechanisms at the cellular level. Patients after orthopaedic trauma are vulnerable to drug-resistant pathogens, particularly after open fractures. Traumatologists practicing appropriate antibiotic prophylaxis and treatment regimens mitigate infection and propagation of antibiotic resistance.

Category: Sports Introduction/Purpose: Navicular injuries are documented to have the potential for significant impairment of foot function. Regardless of treatment choice, these injuries can result in persistent pain, advanced osteoarthritis, and chronic dysfunction. A clearer understanding of their prevalence in collegiate athletes as well as their impact on their NFL career would help team physicians better counsel players and their teams, and perhaps also aid in defining optimal treatment. The purpose of this study was to 1) determine the epidemiology of navicular fractures in players participating in the NFL combine, 2) define positions that might be at higher risk for sustaining this injury, and 3) evaluate the impact of navicular injuries on NFL draft position and NFL game play compared to matched controls. Methods: Data was collected from the NFL combine website on all participating players who had sustained a navicular injury before entering the NFL between 2009 and 2015. Medical records, imaging, and treatments were reviewed on all individuals who met these criteria. The epidemiology of navicular injuries was determined by evaluating the number of injuries, surgeries, games missed, position played and draft position of each player. Available exam and imaging findings were reviewed for each player. Players from 2009 to 2013 with a navicular injury were compared to matched controls. Control groups consisted of players who missed less than 2 games in college, played the same position, and did not have a previous surgery. NFL performance outcomes were evaluated through analysis of draft position, career length ≥2 years, and number of games played and games started within their first 2 years. All NFL performance data was obtained from STATS.com. Odds ratios were calculated using logistic regression to assess the risk of sustaining a navicular injury by position. Two-sample, two-tailed T-tests were computed to assess games missed in college and draft position in players with a navicular injury and NFL career consisting of games played, and started in the NFL in the first 2 years of their career versus control players. Results: A total of 2285 foot players participated in the NFL combine between 2009 – 2015. There were 15 navicular injuries (14 players) with an incidence of 0.6% of NFL football players participating in the combine during this time frame. Defensive backs had a statistically significant increased odds ratio (Odds ratio = 3.0, p=0.03) of sustaining a navicular injury, however only 3 defensive backs had a navicular injury. Three players had nonunions or a refracture and 2 players required a revision surgery. Fifty-seven percent of players with navicular injuries (72.7% of fractures) were undrafted versus 30.9% in the control group (P< 0.001). Twenty-nine percent of players with navicular fractures played 2 years in the NFL compared to 69.6% in the control group (P< 0.01). Conclusion: While only a small percentage of players at the NFL combine had a navicular injury, there was a significant increase in percentage of players undrafted and a decreased percent of players who played two years in the NFL when compared to controls. This demonstrates the detrimental effect this injury may have to a player’s career.

Category: Sports Introduction/Purpose: Lisfranc injuries can have detrimental consequences to an athlete’s career. If left inadequately treated, these injuries can result in persistent pain and lead to advanced osteoarthritis. Understanding the prevalence of these injuries in collegiate athletes and their effect on NFL draft position can help team physicians counsel future players and determine optimal treatment. The purpose of this study was to determine the epidemiology of Lisfranc injuries in players participating in the NFL combine and to determine the positions that are at higher risk for sustaining these injuries. Methods: Data was collected from the NFL combine website on all players who participated in the combine and had sustained a Lisfranc injury before entering the NFL from 2009 to 2015. Medical records, imaging, and treatments were reviewed on players who were identified with these injuries. The epidemiology of Lisfranc injuries was determined by evaluating the number of injuries, surgeries, games missed, position played and draft position of each player. Odds ratios were calculated using logistic regression to assess the risk of sustaining each injury by position. Two-sample, two-tailed T-tests were computed to assess games missed and draft position in players with operative versus non-operative management. Players with a Lisfranc injury as well a second primary midfoot injury (n=3) were excluded from analysis. Results: Thirty-nine(1.7%) players at the NFL combine had an isolated Lisfranc injury during their collegiate football career. Of these players, 27(69.2%) required surgical intervention. The average number of collegiate football games missed for this injury was 3.0±5.0. The average number of games missed for players requiring operative fixation was statistically greater(4.2±5.7) than those in the non-operative group (0.3 ±0.9, p=0.02). The average NFL draft position was 141.7±69.4, and 13(33.3%) went undrafted. There was no statistical difference in the average draft position(p=0.84) and number of undrafted players(p=0.15) between the operative and non-operative groups. No position was found to be at increased risk for Lisfranc injury; however, as a whole, offensive players had a significantly increased risk(Odds ratio=2.7, p = 0.01) of having a Lisfranc injury when compared to all other players. Overall, 24(61.5%) of the players with a Lisfranc injury played on offense. Conclusion: The majority of players who reported a Lisfranc injury required operative intervention, and offensive players were at a higher risk for this injury. Lisfranc requiring operative management did not significantly change a player’s draft position or chance of being drafted.

Research investigating the role of paternal age in adverse birth outcomes is limited. This population-based retrospective cohort study used the Missouri maternally linked data set from 1989 to 2005 to assess whether paternal age affects fetal birth outcomes: low birth weight (LBW), preterm birth (PTB), stillbirth, and small size for gestational age (SGA). We examined these outcomes among infants across seven paternal age-groups (45 years) using the generalized estimating equation framework. Compared with infants born to younger fathers (25-29 years), infants born to fathers aged 40 to 45 years had a 24% increased risk of stillbirth but a reduced risk of SGA. A 48% increased risk of late stillbirth was observed in infants born to advanced paternal age (>45 years). Moreover, advanced paternal age (>45 years) was observed to result in a 19%, 13%, and 29% greater risk for LBW, PTB, and VPTB (very preterm birth) infants, respectively. Infants born to fathers aged 30 to 39 years had a lower risk of LBW, PTB, and SGA, whereas those born to fathers aged 24 years or younger had an elevated likelihood of experiencing these same adverse outcomes. These findings demonstrate that paternal age influences birth outcomes and warrants further investigation.

Background: Digital health technologies can improve health outcomes and the efficiency of healthcare delivery when used appropriately. Nevertheless, the human-computer interaction is a concern in compassionate patient care and nurses' professional well-being., Objective: To analyze the degree of technological acceptance and use within nurses in two Latin American university hospitals., Design: A mixed methods study design., Settings: Two Latin American university hospitals, one in Chile and the other in Colombia., Participants: A total of 53 nurses participated in the study. In phase 1, 31 nurses took part, with 15 from a Chilean hospital and 16 from a Colombian hospital. In phase 2, 22 nurses participated, with 14 in Chile and 8 in Colombia., Methods: : A mixed methods sequential study was conducted in inpatient services. It was developed in three phases. First, a quantitative one with a call to all nurses in two institutions, in Chile and Colombia. A scale of the unified theory of acceptance and use of technology, adapted to nursing in Spanish, was employed following expert validation both facial and content aspects. Second, a qualitative one with four focus groups with service coordinator nurses and in-depth interviews with nursing managers or supervisors. These sessions were recorded and transcribed verbatim. Quantitative data were analyzed using descriptive statistics and hypothesis testing for mean differences, while qualitative data underwent content analysis. Finally in the third phase, both qualitative and quantitative data were integrated to establish the acceptability and use of the technology., Results: Quantitative analysis revealed a statistically significant positive correlation between behavioural intention to use the system and facilitating conditions ( r ( 31 ) = 0.50 , p < . 01 ). Also, there is a positive correlation between behavioural intention to use the system and effort expectancy in Chile ( r ( 13 ) = 0.60 , p < . 05 ). Additionally, a statistically significant difference ( p < . 05 ) exists between the two institutions regarding social influence and facilitating conditions. Qualitative data confirmed these findings. Integration made it possible to specify the factors such as the performance expectancy, facilitating conditions, and anxiety determine the acceptability and use of technology by nurses in the studied institutions., Conclusions: The degree of technological adoption among nursing staff in two Latin American university hospitals is currently 3.7 ± 0.4 (scale from 1 to 5). Understanding the aspects that affect the acceptance and use of technologies paves the way for achieving their best use in support of nursing care., Registration: ING-256-2020, January 16, 2023., Tweetable Abstract: Nurses in Latin American show mixed tech acceptance. Understanding barriers is crucial for better care delivery #DigitalHealth #NurseTech., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2025 The Authors. Published by Elsevier Ltd.)

Wastewater surveillance allows severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection levels to be tracked in a community. Here, we present a protocol to longitudinally quantify SARS-CoV-2 RNA in wastewater using quantitative reverse-transcription PCR (RT-qPCR) and pepper mild mottle virus (PMMoV) normalization. We describe steps for the pasteurization of wastewater samples, solids separation, supernatant filtration, viral precipitation and concentration, and RNA extraction. We then detail procedures for RT-qPCR, viral concentration extrapolation, PMMoV normalization, and longitudinal analysis. This protocol has the potential to be used for surveillance of other microorganisms. For complete details on the use and execution of this protocol, please refer to Sanchez Jimenez et al. 1 ., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Acute viral bronchiolitis is the major cause of hospital admissions in children under 2 years of age, and respiratory syncytial virus (RSV) can be responsible for up to 80% of these infections. We aimed to describe RSV dynamics among hospitalized children with bronchiolitis. Upper respiratory samples of 101 hospitalized patients were collected and submitted to RSV detection by a quantitative real-time RT-PCR to assess viral load (Log 10 RNA copies/mL). Seventy-two patients were positive for RSV infection, of which 38 (52.7%) could be followed up until RSV was no longer detected. The first RSV RT-qPCR was carried out on average on the 5th day of symptom onset. Thirty-six patients (94.7%) were still shedding RSV after 7 days, and 9 (23.6%) after 14 days of symptoms onset. Only 2 patients (5.2%) were still shedding RSV after 21 days. Only 7 of the followed patients (18.9%) were submitted to intubation. There was no difference between the viral load of the first collected sample and the viral persistence of patients with comorbidities, who needed intensive care unit and who needed intubation. These data could help understand RSV dynamics and future studies and treatments to come., (© 2022. The Author(s) under exclusive licence to Sociedade Brasileira de Microbiologia.)

Anterior abdominal cutaneous nerve entrapment syndrome (ACNES) is a chronic neuropathic abdominal pain that can radiate dorsally and occurs as a result of entrapment of the thoracic intercostal nerves in the abdominal muscles. This pain increases with the contraction of the abdominal muscles and is not related to meals or bowel habits. Its diagnosis is based on history and physical examination without the need for additional tests. The treatment of this pathology consists of the infiltration of a local anesthetic together with corticosteroids at the point of greatest pain, which achieves an immediate resolution of the pain., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Family Medicine and Primary Care.)

The first European Vasculitis Society (EUVAS) meeting report was published in 2017. Herein, we report on developments in the past 5 years which were greatly influenced by the pandemic. The adaptability to engage virtually, at this critical time in society, embodies the importance of networks and underscores the role of global collaborations. We outline state-of-the-art webinar topics, updates on developments in the last 5 years, and proposals for agendas going forward. A host of newly reported clinical trials is shaping practice on steroid minimization, maintenance strategies, and the role of newer therapies. To guide longer-term strategies, a longitudinal 10-year study investigating relapse, comorbidity, malignancy, and survival rates is at an advanced stage. Disease assessment studies are refining classification criteria to differentiate forms of vasculitis more fully. A large international validation study on the histologic classification of anti-neutrophil cytoplasmic antibody (ANCA) glomerulonephritis, recruiting new multicenter sites and comparing results with the Kidney Risk Score, has been conducted. Eosinophilic granulomatosis with polyangiitis (EGPA) genomics offers potential pathogenic subset and therapeutic insights. Among biomarkers, ANCA testing is favoring immunoassay as the preferred method for diagnostic evaluation. Consolidated development of European registries is progressing with an integrated framework to analyze large clinical data sets on an unprecedented scale., (© 2022 Published by Elsevier, Inc., on behalf of the International Society of Nephrology.)

Background and Aims: The incorporation of normothermic regional perfusion (NRP) to donors after cardiac death (DCD) allows the recovery of liver grafts without the deleterious effects on graft survival the super-rapid technique may cause. The aim of the present report is to determine if the use of NRP in Maastricht type III DCD donors achieves short- and medium-term results comparable to donors after brain death (DBD)., Patients and Methods: This is an observational cohort study including 117 liver transplants executed between November 2016 and April 2021, divided into NRP (n = 39) and DBD (n = 78)., Results: Donors were younger in the NRP group (NRP 52 vs DBD 59.4 years; P < .005). Liver recipients in each study group were of similar age and severity of liver disease, although the predominant transplant indication in the NRP group was hepatocellular carcinoma. No differences in ischemia times were found. The incidence of early allograft disfunction and primary nonfunction was balanced between NRP and DBD. Eight patients required retransplant, all of them in the DBD group. No differences were found in biliary complications (NRP 12% vs DBD 5%; P = .104). Ischemic cholangiopathy affected a single DBD patient. Graft survival's Kaplan Meier curve shows a better outcome in the NRP group, although the difference did not reach significance (P = .075)., Conclusions: The incorporation of perfusion machines, and specifically the NPR in situ, converts suboptimal liver grafts such as DCD into organs comparable to DBDs., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Multimodal rehabilitation allows optimization of functional recovery in surgery patients by reducing the postoperative stress and hospital stay duration, without increasing the morbidity and mortality. It is reportedly successful in other surgical disciplines, and guidelines for its application to gynecological surgery are available; however, most evidence for these guidelines is derived from observational and/or retrospective studies. Therefore, this study aimed to investigate the applicability of an enhanced recovery after surgery (ERAS) protocol in laparoscopic gynecological surgery and its influence on the postoperative stay, morbidity, mortality, and readmission, through a prospective approach., Methods: This prospective cohort study was performed on 90 patients who underwent laparoscopic hysterectomy for benign causes from October 2017 to October 2019. Patients in whom the ERAS (ERAS group, n = 30) and traditional (control group, n = 60) protocols were implemented were compared. All patients were followed for 6 months., Results: The groups were homogeneous and did not differ significantly with respect to the demographic characteristics (age, ASA score, body mass index), surgical indications, and surgery types. Adherence to the ERAS protocol was over 99%. The postoperative hospital-stay durations were 1.73 days (r = 1-3) and 2.97 days (r = 2-6) in the ERAS and control groups, respectively (p = 0.000). No significant intergroup differences were observed in the rates of complications and readmissions., Conclusions: The ERAS protocol is applicable in laparoscopic gynecological surgery and can be implemented with good adherence. This can allow optimization of patient recovery by reducing the hospital stay duration, without increasing the rates of morbidity, mortality, or readmission., (© 2021. The Author(s).)

SARS-CoV-2 infection is mediated by the interaction of the spike glycoprotein trimer via its receptor-binding domain (RBD) with the host's cellular receptor. Vaccines seek to block this interaction by eliciting neutralizing antibodies, most of which are directed toward the RBD. Many protein subunit vaccines require powerful adjuvants to generate a potent antibody response. Here, we report on the use of a SARS-CoV-2 dimeric recombinant RBD combined with Neisseria meningitidis outer membrane vesicles (OMVs), adsorbed on alum, as a promising COVID-19 vaccine candidate. This formulation induces a potent and neutralizing immune response in laboratory animals, which is higher than that of the dimeric RBD alone adsorbed on alum. Sera of people vaccinated with this vaccine candidate, named Soberana01, show a high inhibition level of the RBD-ACE2 interaction using RBD mutants corresponding to SARS-CoV-2 variants of concern and wild-type expressed using the phage display technology. To our knowledge, this is the first time that the immunostimulation effect of N. meningitidis OMVs is evaluated in vaccine candidates against SARS-CoV-2., Competing Interests: The authors declare no financial conflicts of interest. Some of the authors are co-inventors on a provisional SARS-CoV-2 vaccine patent (Cu 2020-57) based on these results., (This journal is © The Royal Society of Chemistry.)

The acquired von Willebrand Syndrome (AvWS) is a bleeding disorder with laboratory findings similar to those of the congenital form. Its presentation is more common in adults than in children and is mainly associated with lymphoproliferative and myeloproliferative diseases and rarely with autoimmune diseases including systemic lupus erythematosus (SLE). Here, we report the case of a girl with SLE and AvWS with mucosal bleeding and low plasma levels of von Willebrand factor and factor VIII (FVIII) with failure to respond to treatment with first- and second-line therapies. The patient finally responded to rituximab. To our knowledge this is the first reported case of SLE associated with AvWS, that responded to rituximab.

The interaction between carboxylic acid-stabilised gold nanoparticles (AuNP) and pH-responsive microgels is shown. The microgel particles are a copolymer of N-[3-(dimethylamino)propyl]methacrylamide (DMAPMA) and N-isopropylacrylamide (NIPAM). The microgel properties are presented by their hydrodynamic diameter and electrophoretic mobility in response to pH. These microgel particles are pH-responsive under neutral conditions decreasing in diameter beyond pH 7. The dispersion characteristics of AuNP adsorbed onto the microgel network are shown with respect to adsorbed amount and the pH-responsive properties of the AuNP. This data is presented between pH 3 and 6 where the microgel properties remain constant. Asymmetric adsorption of AuNP onto poly(DMAPMA-co-NIPAM) microgels is achieved by adsorption of nanoparticles, from the aqueous phase, onto microgel-stabilised oil-in-water emulsions. These asymmetrically modified microgels display very different dispersion behaviour, in response to pH, due to their dipolar nature., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Background: The role of coronary atherosclerosis (CA+) in ventricular remodeling after aortic valve replacement (AVR) for isolated aortic stenosis (AS) is not well defined. We sought to evaluate the impact of not revascularized moderate coronary atherosclerosis in long-term left ventricular (LV) remodeling after AVR., Methods: We assessed by coronariography the coronary artery disease in 66 patients referred for AVR and evaluated morphological and functional LV data by echocardiography both preoperatively and postoperatively (3 ± 1.2 years)., Results: In patients without coronary atherosclerosis, hypertrophy regression was more intense and the absolute reverse remodeling was higher in LV mass index (-55.8 ± 36 g/m² vs -28.4 ± 34 g/m², p = 0.004), reduction of LV dimensions (LV end-diastolic diameter [LVEDD]: -4.1 ± 7.4 mm vs -2.2 ± 8.3 mm, p = 0.04), and regression of wall thickness (interventricular septum [IVS]: -3.3 ± 2.6 mm vs -1.6 ± 2.2 mm, p = 0.01; and posterior wall thickness [PWT]: -2.1 ± 2.1 mm vs 0.6 ± 2.1 mm, p = 0.012)., Conclusions: After AVR for AS, not revascularized moderate coronary atherosclerosis determines a long-term lesser degree of LV hypertrophy regression and a worse absolute reverse remodeling of LV mass index, LVEDD, IVS and PWT.

The cytotoxicity of doxorubicin bound to poly(butyl cyanoacrylate) nanoparticles (Dox-PBCA-NP) was investigated in the rat glioma cell lines GS-9L, F-98 and RG-2. MTT and LDH assays were used as cytotoxic assays. In general, the cytotoxicity of nanoparticle-bound doxorubicin (Dox) was enhanced compared to the free drug in solution. However, responses of the cell lines towards the drug effects were different. In the case of free Dox in solution, this difference correlated with different intracellular concentrations of Dox, which in turn, depended on the level of P-glycoprotein (P-gp) expression in these cell lines. Accordingly, the 9L gliosarcoma (GS-9L) cells, which appeared to be most resistant towards Dox, were characterized by the highest P-gp expression.Additionally, the influence of surfactants on the cytotoxic effect was investigated at different Dox concentrations. It was shown that the presence of polysorbate 80 (Tween 80) in the nanoparticle formulation significantly enhanced the cytotoxicity, whereas poloxamer 188 (Pluronic F68) and poloxamine 908 (Tetronic 908) had a negligible influence.

Background: Recent national efforts have focused on improving patient safety in surgical procedures including examining adverse events. An adverse event in laparoscopic Roux-en-Y gastric bypass (LRYGBP) which has not received much scrutiny involves orogastric tube complications during gastric pouch formation., Methods: Retrospective review was conducted of all LRYGBPs (n=727) performed by 5 surgeons over 5 years at 2 institutions. Cases with intraoperative orogastric tube (OGT) related complications (n=9) were identified., Results: 9 patients (1.2%) had preventable orogastric tube-related complications. Mean patient demographics were as follows: age 47 years, female 56%, pre-op BMI 52 kg/m(2), co-morbidities 3.5 and mortality 0%. 7 of 9 patients' cases were complicated by stapling of an orogastric tube during gastric pouch formation. The remaining 2 patients had complications involving suturing of the Levacuator tube during gastrojejunostomy formation. All complications required gastric pouch or anastomotic revision. 2 patients required conversion to an open procedure, 2 required re-operation for anastomotic leak, and 1 had respiratory failure and prolonged hospital stay., Conclusion: Orogastric tube complications can occur during laparoscopic RYGBP, but are seldom reported and can be associated with significant morbidity. Treatment options are dependent upon the situation. More importantly, prevention strategies must include constant communication with the anesthesiologist and removal or manipulation of an OGT prior to stapling or suturing, use of large bore OGTs for increased visual or tactile recognition, retraction of the OGT proximal to the anastomosis during gastrojejunal construction and employing alternatives to esophageal temperature probes (i.e. Foley temperature probes).