T HE 31 ST A NNUAL R ESEARCH D AY S YMPOSIUM |T HE D EPARTMENT O F S URGERY J UNE 23, 2020 | P AGE 1 E VENT A GENDA |J UNE 23 RD , 2020 7:15 AM - 7:30 AM B REAKFAST &R EGISTRATION 7:30 AM - 7:45 AM W ELCOME &I NTRODUCTION O RAL P RESENTATION S ESSION 1-L ECTURE H ALL 2222 M ODERATORS –D R .S EPIDEH G HOLAMI &D R .K ATHLEEN R OMANOWSKI 7:45 AM - 8:00 AM A LICIA G INGRICH - Comparative transcriptomics of canine and human natural killer cells as immunotherapy target in translational osteosarcoma model 7:45 AM - 8: 00 AM M ELISSA G RIGSBY - Upregulation of human glucocorticoid receptor isoform expression by gram-positive bacterial cell wall components 8:15 AM - 8:30 AM H ILA S HIMSHI -S WINDELL - Extracellular matrix mediated local delivery of placental mesenchymal stem cell derived exosomes for spinal cord regeneration 8:30 AM - 8:45 AM J AMES C LARK - A prospective trial of intraoperative liposomal bupivacaine (Exparel) versus bupivacaine/lidocaine for thoracoscopic surgery 8:45 AM - 9:00 AM K ATE D OYLE - The neonatal intensive care unit as a source of deceased donor kidneys for transplantation: initial experience and 5-year data reviewed 9:00 AM - 9:15 AM C HRISTINA T HEODOROU - Increased mortality in very young children with traumatic brain injury due to child abuse (presented by Laura Galganski) 9:15 AM - 9:30 AM B REAK O RAL P RESENTATION S ESSION 1-L ECTURE H ALL 2222 M ODERATORS :K ENT L LOYD &D R .A MANDA K IRANE 9:30 AM - 9:45 AM K AELI J O Y AMASHIRO - Fetal tolerance of maternal partial resuscitative endovascular balloon occlusion of the aorta in an ovine model 9:45 AM - 10:00 AM L ALITHASRI R AMASUBRAMANIAN - Engineering synthetic extracellular vesicle mimics for vascular regeneration 10:00 AM - 10:15 AM S EAN J UDGE - Immune phenotype of tumor infiltrating t and nk cells in soft tissue sarcomas are associated with clinical outcome 10:15 AM - 10:30 AM D ATTESH R. D AVE - Geriatric age confers increased risk of post-operative complications following open reduction internal fixation for distal radius fracture: A NSQIP analysis 10:30 AM - 10:45 AM L AUREN P ERRY - The role of radiation therapy in addition to lumpectomy and hormone therapy in men 70 years of age and older with early breast cancer: A NCDB analysis 10:45 AM - 11:00 AM M ATTHEW Z EIDERMAN - The Omnimax MMF system: A cohort study for clinical evaluation
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ORALPRESENTATIONSESSION1 - LECTUREHALL2222MODERATORS – DR . SEPIDEHGHOLAMI & DR . KATHLEENROMANOWSKI
7:45AM-8:00AM ALICIA G INGRICH - Comparative transcriptomics of canine and human naturalkillercellsasimmunotherapytargetintranslationalosteosarcomamodel
7:45AM-8:00AM MELISSA GRIGSBY - Upregulation of human glucocorticoid receptor isoformexpressionbygram-positivebacterialcellwallcomponents
8:15AM-8:30AM H ILA SHIMSHI-SWINDELL - Extracellular matrix mediated local delivery ofplacentalmesenchymalstemcellderivedexosomesforspinalcordregeneration
8:30AM-8:45AM JAMES CLARK - A prospective trial of intraoperative liposomal bupivacaine(Exparel)versusbupivacaine/lidocaineforthoracoscopicsurgery
8:45AM-9:00AM KATE DOYLE - The neonatal intensive care unit as a source of deceased donorkidneysfortransplantation:initialexperienceand5-yeardatareviewed
9:00AM-9:15AM CHRISTINA THEODOROU - Increased mortality in very young children withtraumaticbraininjuryduetochildabuse(presentedbyLauraGalganski)
10:15AM-10:30AM DATTESHR. DAVE - Geriatricageconfersincreasedriskofpost-operativecomplicationsfollowingopenreductioninternalfixationfordistalradiusfracture:ANSQIPanalysis
WelcomefromDr.DianaFarmer,ChairofSurgery,andDr.TinaPalmieri,ViceChairofResearchWelcome to the31st AnnualDepartment of SurgeryResearch Symposiumat theUniversity ofCalifornia,Davis.Thecurrentpandemichasprovidedustheopportunitytodevelopnewresearchinitiatives,technologies,andcollaborations.ThisSymposiumcelebratesourresearchsuccessesandprovidesanopportunityfortraineestohonetheirresearchpresentationsastheysharetheirwork.ResearchisacorevalueoftheDepartmentofSurgeryandismadepossiblebythehardworkofthefacultybythehardworkofourfaculty,staff,andtrainees.Ourprogramincludesoralpresentationsandquick-shotoralposterpresentationsthathighlightthediverseresearchintheDepartment of Surgery. We will award prizes for the top clinical and basic science oralpresentationsaswellasthebestquick-shotoralpresentationtonight.ThankyouforjoiningustodaytocelebrateresearchintheDepartmentofSurgery!Sincerely,
Introduction: Natural killer (NK) cells are key effectors of the innate immune system, but majordifferencesbetweenhumanandmurineNKcellshavebeenabarriertotranslation.OutbreddogsareanimportantlinkforNK-basedcancerimmunotherapystudies.WeusedRNAseqtocomparegeneexpressionprofilesofexvivodogNKcellstoinvivoNKsignaturesfromdogswithpulmonarymetastasesreceivinginhaledrecombinanthuman(rh)IL-15inaphaseIclinicaltrial.
Methods:Eightdogswithpulmonarymetastaseswereenrolledonan IACUCandclinical trials reviewboard-approvedPhaseIclinicaltrialofinhaledrhIL-15usinga3+3cohortdesignwithescalatingdosesofinhaledrhIL-15.Bloodwascollectedfromstudysubjectsimmediatelypre-treatmentandondays7,14and21 after initiation of treatment for isolation of NK cells and RNAseq.We performed differential geneexpression(DGE)comparingsubjectstohealthydonorpurifiedNKpopulations(resting),exvivoactivateddogNKcellsusingIL-15andfeederlineco-culture.Weassessedglobaltranscriptionalprofileandprincipalcomponentanalysis(PCA)forvariationbetweentreatmentgroups(FDR<0.05).
Results:Of8dogs,2demonstrated>100daysurvivalwith1stablediseaseand1partialresponsebasedonRECISTcriteria.DGErevealeddistincttranscriptionalprofilesbetweentheexvivoresting,IL-15andco-culturedcanineNKcells.Amongtreatedpatients,hierarchicalclusteringandPCArevealedinvivoNKcelltranscriptionalsignaturesgroupedbyindividualdog,andnotamountoftimeexposedtotreatment.This suggests response to therapycouldbedeterminedbybaselineNKcell characteristics rather thanchangesovertime.Keygenesinducedinvivo(>20X)postinhalationofrhIL-15includeDLA-DRA,B2M,andthymosinbeta4,whilekeygenesinducedexvivopostrhIL-15exposureincludeCD96,KLRB1,andSPP1/OPN.
Introduction:Patients’variableresponsestosteroidtreatmentduringsepsismayberelatedtoalteredregulationofhumanglucocorticoid(hGR)isoformsbybacterialelements.Wepreviouslyidentifiedthatlipopolysaccharide (LPS) increased the activity of several splice variant isoforms of the humanglucocorticoidreceptor(hGR).Theseisoforms(hGR-B)containcrypticexonsinintronB,betweenexons2and3,thatresultinearlystopcodonsandtruncatedproteins.Wehypothesizethatgram-positivebacterialcellwallcomponentswillsimilarlyincreasetheactivityofthesehGRisoforms.
Methods:Peripheralbloodmononuclearcells(PMBCs)wereisolatedfromLeukopaksandtreatedwithlipoteichoicacid(LTA)orpeptidoglycan(PepG)for1,3,or13hours.RNAwasextractedfromthebuffycoats,andtheactivityof the targetedhGR isoformswasevaluatedbyqualitativeRT-PCR.Protein fromsimilarly treatedPMBCswas subjected toWesternblot analysis. The gelswere immunolabeledwith arabbitpolyclonalantibodythatrecognizedtheN-terminusofhGR.
Results: After 3 hours of treatmentwith 10 µg/mL of LTA, themRNA expression of hGR-B (54)wasincreased. Similarly, after3hoursof treatmentwith10µg/mLofPepG, expressionofhGR-B (77)wasincreased.TheexpressionofhGR-B(93)appearedtofollowasimilartrendwithbothLTAandPepG.Inpreliminaryanalysis,WesternblotshowedaprogressiveincreaseintheamountoflikelyhGRsplicevariantproteindetectedafter13hoursoftreatmentwithincreasingconcentrationsofPepG:1,10,and50µg/mL.LPSalsoincreasedtheamountofproteindetectedforwhatwebelievetobehGRsplicevariantisoforms.
Conclusions: We found that cell wall components of both gram-positive and gram-negative bacteriaincrease expression of several hGR splice variant isoforms. Both types of bacteria are responsible forcausing a septic response in patients, but the severity, timing, and length of the response often differbetweenpatients.ThepatternofhGRisoformexpressioninresponsetobacterial,viralorfungalelementsmaydetermineboththecourseofapatient’ssepticepisodeandtheroleofsteroidtreatmentinmitigatingtheinflammatorymechanism.
Introduction:Researchsuggeststhatregenerationofthespinalcordcanoccurifthemicroenvironmentatthelesionsiteispro-regenerative.Mesenchymalstemcells(MSCs)possessregenerativepotentialfortissuerepairandwoundhealing.ThecurrentrationalisthatMSCselicittheirtherapeuticeffectsprimarilyviaparacrinemechanisms.Exosomeswerefoundtobevaluableparacrinesignalingfactorsfordeliveringpro-regenerativemolecules. Exosomes adhere to extracellularmatrix (ECM) in an integrin-dependentmanner and influence cell migration, proliferation, apoptosis, differentiation and other physiologicalactivities.ArecentproteomicandRNAsequencinganalysisofplacentalMSC-derivedexosomes(PMSC-exos)revealedseveralproteinsandRNAsknowntobeinvolvedinneuronalsurvivalanddevelopment.Thus, inthisstudy,weconstructeddeliverysystemsbyusingtwotypesofscaffolds for localsustainedreleaseofPMSC-exostoserveasastemcell-derived,cell-freetherapytoprotectandregenerateneurons.Methods:We isolated and immobilized PMSC-exos onto two representative ECM scaffolds, injectablecollagenhydrogelandsmallintestinalsubmucosa(SIS)patchmaterial.WepreviouslyidentifiedLLP2A,anintegrinα4β1ligandbyone-beadone-compoundcombinatorialtechnologyandshowedthatLLP2Acanspecifically bind to PMSCs and PMSC-exos. We couple a collagen-binding peptide, SILY, to LLP2A togenerate a bifunctional peptide SILY-LLP2A, and use this bifunctional peptide to conjugate LLP2A tocollagen-based scaffolds to thus immobilize PMSC-exosomes to the scaffolds via their α4β1 integrin.Binding affinity of PMSC-exos on SILY-LLP2Amodified scaffolds were examined in vitro via scanningelectronmicroscopy(SEM).Thecontrolledreleaseofexosomeswasanalyzedusingnanotrackinganalysis(NTA).NeurorescueandneurogenesisassayswillbefurtherconductedtotestthefunctionofimmobilizedPMSC-exos.Results:SEMshowedspecificmechanismofexosomesbindingwhenmodifiedwithSILY-LLP2Aligand.Acontrolreleaseanalysisshowedastrongerbindingaffinityandslowerreleaseofexosomesfromcollagen-basedscaffoldsmodifiedwithSILY-LLP2A.Conclusion:Inthisstudywedevelopedascaffoldbasedcontrolledreleasesystemtoprovidesustainedreleaseofexosomeswhichholdspromisingforneurorescueandneurodegenerationandcanbewidelyusedforothertissueregenerationapplications.
Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health,Sacramento,CA
Introduction:Given theworsening opioid crisis, enhanced recovery protocols utilizing intraoperativeliposomal bupivacaine (LipoB) have been implemented in a variety of surgical specialties to improvepatientrecovery.NostudytodatehasexaminedtheeffectofLipoBonpatientreportedoutcomes(PROMs),andthereisapaucityofdataontheeffectoflong-termopioidusageupto2monthspostoperatively.Method: Through a prospective cohort trial we enrolled 20 patients to receive 1:1 0.25%bupivacaine:1.0%lidocaine(control)followedby20patientstoreceiveLipoBviaintraoperativeposteriorintercostalnerveblock.Eligiblepatientswerethoseundergoingplannedvideo-assistedorrobot-assistedthoracoscopic lung resection, lung biopsy, or pleural biopsy. Patient postoperative opioid usage inmorphineequivalentdoses(MEDs)wascalculated,andPROMswererecordedviaavalidatedsurveyinthepreoperativearea,ondayofdischarge,atpostoperativemonth1,andatpostoperativemonth2.Results:Therewerenodemographicdifferencesbetweentreatmentgroups.Controlpatientshada2.3xhigher opioid need postoperatively while inpatient compared to LipoB patients (MEDs 296±227 vs130±123mg,p=0.006),andweremorelikelytostillrequireopioidsattimeofdischarge(65.0vs30.0%,p=0.03).Onmultivariable analysis, use of LipoB compared to Control decreased inpatient opioidMEDrequirementsby125mg(β-125,95%CI-222to-29,p=0.013).Eachadditional10mgofinpatientMEDsrequiredpostoperatively increased theoddsof continuedopioidusageatdischargeby6.6%(OR1.07,95%CI1.01to1.13,p=0.03)andat1monthby10.4%(OR1.10,95%CI1.02to1.20,p=0.02).PROMsdidnotdifferatdischarge,1month,or2monthspostoperatively.Conclusion: LipoB significantly reduces the need for postoperative inpatient opioids after thoracicsurgery,andmayreducetheneedforopioidprescriptionsatthetimeofdischarge.TherewasnodifferenceinlongtermpostoperativePROMs,suggestingthatLipoBisnotmaskingshorttermsymptomsbutprovidesdurablelong-termpainreliefandpatientrecovery.Accordingly,theUCDavisPharmacyandTherapeuticsCommitteehasapprovedLipoBforuseinthoracicsurgeryproceduresinclinicalsettings.
Methods:Aretrospectiveanalysiswasperformedofallrecipientsofkidneysfromneonataldonorsfrom2011to2014atasinglecenter.AllkidneyswereprocuredenblocandimplantedintotheiliacfossawiththedonoraortaandIVCanastomosedtorecipient iliacvessels. Recipientswereprimarilysmalladultswithlowimmunologicrisk.Patientandallograftoutcomeswerereviewed.Results:28patientswere included in the studywith 64% (19/28) female, average age of 50.7 years;averageweightof54.7kgandaveragepercentreactiveantibodyof2.9±1.3%.Donoragewas9days,andweight3.4±0.2kg(range:1.9-5.0kg).71%weredonorsaftercardiacdeath(DCD)and96%wereimportedfromoutsideourlocalorganprocurementarea.Allkidneyswerepreservedwithhypothermicpulsatileperfusion.Patientsurvivalwas96%withonefatalitywithafunctioninggraftafter2years.One-yeargraftsurvivalwas86%with4earlygraftfailures.Therewerenoothergraftlossesafterthefirstyear.Allgraftshadearlyhematuriaandproteinuria;mostresolvedwithin1year.5-yearfollowupdatawasavailablefor22patientsandshowedprogressiveimprovementofkidneyfunction.Serumcreatinineat6months,1,2,3,4,and5yearswasasfollows:1.26±0.14,1.0±0.09,0.90±0.08,0.88±0.09,0.82±0.07,and0.75±0.07mg/dL,respectively.EstimatedGFRnormalizedinallpatients.Conclusion:Successfulneonatalkidneytransplantationisfeasiblewiththeknownrisksofhigherearlygraft failure rateanduniversal evidenceof earlyhyperfiltration injury.However,kidney functiondoesrecover and improves up to 5 years.Morewidespread experiencewith these graftswill undoubtedlyimprovetheseoutcomes.Webelieveneonatalkidneydonationshouldbeconsideredasaviableoptiontoaddressthenationalorganshortage.
Introduction:Hemorrhageistheleadingcauseofmaternalmortality.Resuscitativeendovascularballoonocclusion of the aorta (REBOA) is used to decrease post-partum hemorrhage only after the fetus isdelivered.PartialREBOA(pREBOA)priortodeliverymayimproveoutcomesbuttheeffectsonthefetusareunknown.WeaimedtoevaluatehowprogressivelevelsofpREBOAeffectthefetus.Methods:AREBOAcatheterwasplacedinZone3ingravidewesattermandfetalcarotidarterialaccesswasobtained.TheREBOAballoonwasinflatedtoattenuatemeanarterialpressureattheplacenta(pMAP)by5-10mmHgin10minintervalsuntilafetalSaO2of<15%.Thefetuswasrecoveredfor10minandthiswasrepeatedtwice.Fetalarterialbloodgasses,heartrate(HR)andmeanarterialpressure(MAP)wereobtained.Results:Duringthefirstround,fetal(n=3)changesfrombaselinefirstoccurredatpMAP40mmHgwithadecreaseinSaO2(59.0±12.1vs37.6±14.8%,p=0.0009),followedbyadecreaseinfetalMAPandpHatpMAP35mmHg(51.3±5.8vs56.1±10.1mmHg,p=0.04and7.20±0.08vs7.17±0.07,p=0.01)andanincreaseinlactateatpMAP30mmHg(2.0±0.5vs2.4±0.4mmol/L,p=0.02).HRdidnotdifferfrombaseline,evenatthelowestpMAPof25mmHg.ThebaselineSaO2improvedfromround1toround2(59.0±12.1vs70.6±6.6,p=0.02),lactateworsenedbyround(2.0±0.5vs4.7±0.4vs5.6±0.9,p=0.007)andtherewasnodifferenceinfetalMAPorHRbetweentherounds.Conclusion:PhysiologicchangesinthefetusfrommaternalpREBOAfirstoccurredatpMAP40mmHg.ThefetustoleratedhighlevelsofpREBOAanddemonstratedanabilitytorecover.pREBOApriortodeliverymaybepossiblewithoutinjuringthefetus.
Introduction:Extracellular vesicles (EVs) derived from endothelial progenitor cells (EPCs) have beenshowntofacilitatevascularizationviadeliveryofmiRNA-126(miR126).However,therapeutictranslationhasbeengreatlyhinderedby the inherentdisadvantages inEV isolationandstandardization.Here,wesoughttoovercometheseshortcomingsbyengineeringabiomimeticsyntheticEVthatcanrecapitulatetheproangiogenic properties of native EPC EVs and can also bemass producedwith a greater degree ofstandardizationandspecification.WeproposethatEPCEVmimics(EMs)canbesynthesizedbycoatingamiR126-loaded poly (lactic-co-glycolic acid) (PLGA) core with SILY (a collagen-binding peptide)-conjugatedEPC-plasmamembrane(PM)shellinordertomimicthefunctionalcharacteristicsofnativeEPCEVs.
Methods:miR126-loadedPLGAcoresweresynthesizedusingamodifiednanoprecipitationmethodandmechanically coatedwithplasmamembrane fractions isolated fromEPCs.Clickchemistrywasused toconjugate SILY onto particle surfaces. Fluorescent microscopy and transmission electron microscopy(TEM) were used to visualize morphology and confirm coating. miR126 loading and release werequantifiedalongsideEMstabilityovertwoweeks.EPCmigrationandproliferationwereassessedusingascratchwoundassayandMTSassay,respectively,todeterminetheangiogenicpotentialoftheEMs.Progress:WesternblottingconfirmedretentionofEVsurfacemarkers(CD9,CD63,CD81,Alix)onisolatedPMwhile fluorescencemicroscopyandTEMshoweduniformPMcoatingonto thePLGAcores.SurfacemodificationofthePMwithSILYpeptideswassuccessfulviaClickchemistry.EMswereseentoexhibithigh stability (~115nm)over2weeks.miR126encapsulation efficiencywas46.4%±3.72,with~60%cumulativereleaseoveraweek.PreliminarystudiesshowthatboththemiRNA-126andPMcomponentsoftheEMsystemplayfunctionalrolesinpromotingEPCmigrationandproliferation.Conclusion: Thus far, a relatively stable biomimetic EV structure has been synthesized to broadlyrecapitulatethephysicalstructureofEPC-derivedEVsandpromoteangiogenicprocessesinEPCs.FutureworkwillfocusonassessingandoptimizingtheEMfunctionalpropertiesfordownstreaminvitroandinvivoangiogenicmodels.
DifferencesinNKandMemoryCD8T-cellresponsestoantigen-nonspecificstimulationbyinterleukin-15Sean J. Judge*, Cordelia Dunai, Catherine T. Le, Lam T. Khuat, Logan V. Vick, KevinM. Stoffel, ArtaM.Monjazeb,WilliamJ.Murphy,RobertJ.Canter*
*DivisionofSurgicalOncology,UniversityofCalifornia,Davis.Introduction:Naturalkiller(NK)cellsareinnatelymphoidcellsthatexertimmediatefunctionswhichcanbe further augmented and sustainedwith immunostimulatory cytokines. Memory CD8 T cells, due toexpressionofCD132andCD122,canbeactivatedbysimilarcytokinesintheabsenceofTCRengagement(termed“bystander”activation).Thisresultsinactivationandproliferationbutnecessitateshighamountsofcytokineashigh-affinityIL2Rcomplexes(CD25)arenotinduced.Interestingly,bothcelltypescanthenelicitsimilareffectorfunctionsviaNKG2D-mediatedtargetcellrecognition.Asthesecelltypescanfillasimilarimmunologicniche,wesetouttocompareNKandmemoryCD8TcellresponsesfollowingIL-15exposureinvitrofromhealthyhumandonors.
Methods:CellanalysiswasperformedbyflowcytometryandqRT-PCR.Atbaseline,CD25expressionwasnegligibleat<5%onbothhumanNKandmemoryCD8Tcells.CulturewithrhIL-15(10ng/mL)for4-6daysresultedinmarkedCD25upregulationonCD56+CD3-NKcellsbutnotbystander-activatedCD45RA-CD95+ CD8 T cells (72±9.2% vs 11±3.8%, P=0.003) despite comparable proliferation. Additionally,cytokine-activated NK cells expressed higher levels of inhibitory receptor TIGIT (85±4% vs 57±2%,P=0.01)andactivationmarkerCD69(99±1%vs27±9%,P=0.008).Functionally,NKcellshadincreasedexpressionofgranzymeBcomparedtobystanderactivatedCD8Tcells.Conclusion:AlthoughNKandbystanderCD8Tcellscanfillasimilarimmunologicnicheregardingtargetcellkilling,therearesignificantdifferencesinexpressionofcriticalmarkersfollowingactivation.Thesedifferencesmayhaveconsequences in theregulationof thesecell typesand impactanti-viralandanti-tumorresponses,aswellastheimmunopathologicresponseduringhighlyinflammatory,non-infectiousstates.
Introduction:Open reduction internal fixation of distal radius fractures is one of the most commonfracturesurgeriesforHandsurgeons.Fewstudieshaveevaluatedopenreductioninternalfixationwithinthegeriatricpopulation.Thisstudyhypothesizesthatgeriatricpatientsareatgreaterriskofpost-operativecomplicationsrelativetonon-geriatricsfollowingdistalradiusfracturefixation.
Methods: The American College of Surgeons National Surgical Quality Improvement Project (NSQIP)databasewasreviewedforopenreductioninternalfixation(ORIF)fordistalradiusfractures(DRFs)from2005 – 2017. Hypothesis testing for demographics, co-morbidities, and post-operative complicationsbetweengeriatricandnon-geriatricpatientswasperformed.Statisticallysignificantdifferenceswerethenevaluatedwithmulti-variatelogisticregressionanalysis.
Results:Atotalof17,097ORIFforDRFswerecollectedbyNSQIP2005-2017,with5,654patientsolderthan64years(33.2%).AverageageforgeriatricpatientsundergoingORIFforDRFwas73.7yearsversus46.7 years for non-geriatric patients. Rates of pre-operative risk factors including body mass index,albuminlevel,diabetes,dialysisdependence,smokingstatus,andoperativetimewerestatisticallydifferentbetween the groups (p<.001). Geriatric age confers a 1.5-times increased risk for any post-operativecomplicationfollowingORIFfordistalradiusfractureadjustingforpre-operativeriskfactors(ORa1.5p=.04). Within the geriatric cohort, dialysis dependence was singularly predictive of returning to theoperativeroomwitha14.5-timesincreasedrisk(ORa14.5p<.01).Predictorsforany30-daypost-operativecomplicationwithinthegeriatriccohortincludeprolongingoperativetimeby45-minuteincrementsafter80minutes(ORa1.3p<.001).Conclusion: Geriatric age confers an adjusted increased risk of 30-day post-operative complication.Geriatric patients who are dialysis dependent carry a significant increased risk for returning to theoperative room within 30 days. Prolonging operative time increased the risk for any post-operativecomplicationwithin the geriatric cohort.Hand surgeons can use these findings to guide pre-operativediscussionswiththeirgeriatricdistalradiusfracturepatients.
Theroleofradiationtherapyinadditiontolumpectomyandhormonetherapyinmen70yearsofageandolderwithearlybreastcancer:AnNCDBanalysisLaurenM.Perry,MD*,SarahB.Bateni,MD*,XiaoZhao,MD,MiliArora,MD,MeganE.Daly,MD,SusanL.Stewart,PhD,RichardJ.Bold,MD,RobertJ.Canter,MD,CandiceA.M.Sauder,MDDivisionofSurgicalOncology,DepartmentofSurgery*LaurenPerryandSarahB.Batenicontributedequallytothiswork.Introduction:Currenttreatmentguidelinesformalebreastcancerareguidedbyfemale-onlytrialsdespitedatasuggestingdistinctclinicopathologicdifferencesbetweensexes.Wesoughttoevaluate ifradiationtherapy(RT)afterlumpectomywasassociatedwithequivalentsurvivalamongmen>70yearsofagewithStageI,estrogenreceptor(ER)positivetumors,asseeninwomenfromtheCancerandLeukemiaGroupB(CALGB)9343trial.Methods:Weperformedaretrospectiveanalysisof752stageI,ER-positivemalebreastcancerpatients≥70yearswhoweretreatedwithhormonetherapyandsurgery,withorwithoutRT,fromtheNationalCancerDatabasebetween2004-2014.PatientswerecategorizedbasedonsurgeryandRT(lumpectomyalone,lumpectomywithRT,andmastectomyalone).MultivariableCoxproportionalhazardsregressionanalysiswasusedtocompareoverallsurvivalbetweentreatmentgroups.Results:Mostpatientsunderwenttotalmastectomy,withonly32.6%treatedwithlumpectomy.Ofthosewhounderwentlumpectomy,72.7%receivedadjuvantRT.Inmultivariateanalysis,therewasnostatisticaldifference in overall survival when comparing lumpectomy alone to lumpectomy with RT (aHR 0.72[95%CI0.38-1.37],p=0.31),orwhencomparing lumpectomy(aloneorwithRT)andmastectomy(aHR1.28[95%CI0.88-1.87],p=0.20).
Conclusion: In this national sample of elderlymenwith ER-positive early-stage disease treated withendocrinetherapy,therewerenosignificantdifferencesinoverallsurvivalwhencomparinglumpectomyalonetolumpectomywithRT,orlumpectomy(aloneorwithRT)tomastectomy.Theseresultssuggestthatlessaggressivetreatmentmaybeappropriateforasubsetofmalebreastcancerpatients.
Methods:Thismulti-center,prospective,uncontrolled,singlecohortstudyincluded39adultpatients(31males,8females) with one or more mandibular fractures repaired within10days usingtheOmniMaxMMFsystem.Open-reductioninternalfixationoffractureswerecompletedasindicatedandMMFplacedfor4-8weeks.Datawascollectedprospectivelyatbaseline,intra-operativedeviceplacement,and removal. Outcome measures included tooth root damage from screw insertion, time for deviceimplantationandremoval,incidenceofsurgeongloveperforationorsharpsexposure,incidenceofmucosalovergrowthandgingivalnecrosis,patientqualityoflifemetrics,andadverseevents.Results:AveragelengthofMMFwas49.6±11days.Averagetimefordeviceimplantationwas14.6±5.0minutes. All removalswere completedinanoutpatientsetting in an average 3.2±2.2 minutes.Meanpatient-reported pain score (0-10 scale) was 5.1±1.6beforedeviceapplication and 1.9±2.2priortoremoval.605rootsurfacescouldbeaffectedbyscrews.515(85.6%)hadnocontact,84(13.9%)hadminorcontact,6(1.0%)hadrootcontact.Noscrewcontactrequiredfurthertreatment.Adverseeventsatfinalvisitincluded3cases(7.7%)ofinjury/damagetoperiodontalstructure.38/39(97.4%)hadadequatefracture healing.37/39 (94.9%) had satisfactoryfinalocclusion.No glove perforations or accidentalpuncturesoccurred.Conclusion:ResultsofthisstudysupportsafeandeffectiveuseoftheOmniMaxMMFsystemfortreatinguncomplicatedmandibularfractures.
Introduction:Polymericscaffoldshavebeenwidelyusedinregenerativemedicinetoprovidestructuralsupport to guide cell growth and tissue regeneration. Electrospun nanofibrous scaffold has a three-dimensional structure mimicking the native extracellular matrix (ECM) architecture, however, lackbiological motifs and surface cytocompatibility. Exosomes have immense potential to impact tissueengineering and regenerativemedicine applications due to themediation of intercellular informationtransferinnumerousbiologicalsystems.Vascularizationiscrucialtosupplycellsandtissuewithnutrientsand oxygen for tissue engineering and regeneration. Thus, in this study, we propose to improve thevascularizationandregenerationpotentialofthepolymericelectrospunscaffoldsbyloadingthescaffoldswithfunctionalexosomes.Methods:We isolated exosomes fromhuman chorionic villusmesenchymal stem cells (CV-MSCs) andcharacterizedthembynanoparticletrackinganalysis(NTA),transmissionelectronmicroscopy(TEM)andWestern-blot. We previously identified LLP2A, an integrin α4β1 ligand by One-Bead One-Compound(OBOC)technology.Weheredevelopedanapproachtoenable‘clickchemistry’toimmobilizeLLP2Aontothesurfaceofpolymericelectrospunscaffoldsasalinkertoimmobilizeexosome.Exosomeimmobilizationwasevaluatedbyscanningelectronmicroscope(SEM).Theendothelialcell(EC)functionsontheexosome-modifiedelectrospunscaffoldswereevaluatedbyMTS,RT-PCRandWestern-blot.Results: Exosomes derived from CV-MSCs significantly improved EC migration and endothelial geneexpression. LLP2A treated2Dculture surface significantly improvedexosomeattachment. SEMresultsshowed exosomes were successfully immobilized onto the surface of LLP2A modified electrospunnanofibrous scaffolds. Exosome modified electrospun scaffolds significantly improved EC attachment,survivalandphosphorylationofAKT,decreasedtheexpressionofapoptosis-relatedgenessuchascaspase9.Conclusion:Thisstudydemonstratesthatexosomesholdpromisingpotentialtofunctionalizebiomaterialconstructsandimprovethevascularizationandregenerationpotential.Theexosomemodifiedbiomaterialscaffoldscanbewidelyusedfordifferenttissueengineeringapplications
Postnataltreatmentofcaninespinabifidausingplacenta-derivedmesenchymalstem/stromalcells:ClinicaltrialupdateKaitlinClark1,2,MelissaVanover1,NicoleKreutzberg1,ConnorLong1,LeeLankford1PriyadarsiniKumar1,NaomiWalker2,RogérioMartinsAmorim2,DoriBorjesson2,BeverlySturges2,DianaL.Farmer1,AijunWang1,21SurgicalBioengineeringLaboratory,2VeterinaryInstituteforRegenerativeCuresIntroduction:Thecanineisincreasinglyrecognizedasavaluablepre-clinicallargeanimalmodelformanyhuman diseases. Canine spina bifida (SB) clinically presents very similarly to human SB, and EnglishbulldogsinparticularhaveahighincidenceofnaturallyoccurringSB.Placentalmesenchymalstemcells(PMSCs)arebeinginvestigatedasanadjuncttoprenatalrepairofSB;however,similartreatmentshavenotbeenexploredforpostnatalrepair.EnglishbulldogscouldserveasthefirstpostnatalanimalmodelofSB.ThegoalofthisstudyistoevaluatecaninePMSCs(cPMSCs)totesttheirefficacyasapostnataltherapyinanaturallyoccurringlargeanimaldiseasemodel.Methods: To date, we have enrolled six 10-week-old English bulldogs with SB defects confirmed byneurological evaluation andmagnetic resonance imaging (MRI). Each dog underwent amulti-segmentlaminectomyand4/6dog’s treatmentwas coupledwith transplantof allogeneic cPMSCsembedded inhydrogelandextracellularmatrixscaffold.One-yearfollow-uphasbeencompletedonfourstudyanimalsandtheremainingtwoanimalsarecurrentlybeingevaluated.Results:The first two dogs enrolled were initially ambulatory with notable abnormal gaits andincontinence. MRI revealed L7-S1 defects of varying severity. One MRI also showed a largesyringohydromyelnia involving the lumbar spinal cord.Electrophysiologic testing revealed low-normalconduction velocity for bothmotor and sensory hindlimbnerves. Both dogs recovered fromposteriorlaminectomy and cPMSC implantation uneventfully. At 8 weeks post-treatment both dogs showedimprovedambulatorygaits.MRIsperformedat8weeks showedonly syrinx recurrence.Nosignificantadverseeventsoccurredinanydogby12months.Theremainingfouranimals’evaluationsarecurrentlybeingcollectedand/oranalyzed.Conclusions:PostnataltreatmentofanaturallyoccurringcaninemodelofSBwithallogeneiccPMSCsisclinicallyfeasibleandappearssafe.Furtherstudiesarecurrentlybeingperformedtoevaluateefficacy.Thefindings fromthisstudysuggest thatnaturallyoccurringcanineSB isavaluable translationalmodel toevaluatePMSCpostnataltherapyandwillprovidecriticalinsightsforhumanclinicalstudies.
Background:Combinedburnandtraumaticbraininjury(TBI)treatmentprioritiesmaynotalignduetotheneedforhighvolumeburnresuscitationwhileattemptingtominimizecerebraledemaduetoTBI.WedevelopedaporcinemodelofcombinedthermalinjuryandTBIandcomparedan“aggressive”strategyusingtheParklandformulaanda“restrictive”strategyusingthemodifiedBrookeformula.Methods:28Yorkshirecrossswinewereanesthetizedandreceiveda40%totalbodysurfacearea fullthickness burn injury and TBI. Swine were then randomized to receive “restrictive” or “aggressive”resuscitation.Resuscitationcontinuedfor8hoursafterwhichtimeanimalswereeuthanizedandnecropsywasperformed.Thevolumeofbraininjurywasassessedafteranalyzingsegmentalslicesofbraintissue.Results:Swineintheaggressiveresuscitationgroupgainedsignificantlymoremassduringresuscitation(2.3±1.3kgvs1.1±1.1,pvalue0.01).Therewerenodifferencesbetweentherestrictiveandaggressiveresuscitation groups in MAP, heart rate, central venous pressure, or ICP. There were no significantelevationsinserumlactateforeithergroupcomparedtobaselinemeasurementsorbetweengroupsafter8 hours of resuscitation. UOPwas higher in the aggressive resuscitation group (7.3±1.8mL/kg/hr. vs5.3±1.8, p value <0.01). The restrictive group had a significantly higher serumBUN in comparison tobaselineandincomparison,totheaggressivegroup.Therewasnosignificantdifferenceinsizeofbraininjurybetweengroups.(1.4±0.5cm3vs1.6±0.8,pvalve0.51)Conclusions:Bywidelyusedclinicalassessmentsofresuscitation(MAP,serumlactate,andUOP),boththerestrictiveandaggressiveresuscitationgroupsappearedtodemonstrateadequateresuscitationat8hoursfrominjury.ElevationinserumBUNwereseenintherestrictivegroupandmaybeanindicatorofearlyacutekidneyinjury,eventhoughbothgroupshadUOPthatwasclinicallyadequate(>1mL/kg/hr.).ResuscitationstrategydidnotappeartoeffectICPlevelsorthesizeofbraininjury.
Introduction:SpinalCordInjury(SCI)isalife-alteringeventthatcanresultinirreversibledisabilities.Wehavesuccessfullyusedplacenta-derivedmesenchymalstem/stromalcells(PMSCs)asatherapyinanovinemodelofmyelomeningocele,acongenitalformofSCI.PMSCsarecurrentlyculturedinagrowthmediumcontainingfetalbovineserum.But,tolimittheriskofanyzoonotictransmissions,weproposeserum-freebasedexpansionofPMSCsusingHumanPlateletLysate(HPL)forthetreatmentofacquiredSCIs.Methods:PMSCswereisolatedfromdiscarded2nd-trimesterhumanplacentaviaanestablishedexplantculture method in HPL supplemented medium. PMSCs were evaluated for growth kinetics, trilineagedifferentiationpotential,MSCphenotypeby flow cytometry, andbasal concentrationsof brain-derivedneurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), and hepatocyte growth factor(HGF) by enzyme-linked immunosorbent assay (ELISA). The neuroprotective capability of PMSCswasstudied using a staurosporine-induced apoptotic human neuroblastoma cell line. PMSC angiogenicpotentialwasanalyzedusinganexvivoaorticringsproutingassayandtheimmunomodulatoryeffectwasobservedviaamixedleukocytereaction(MLR).Results:HPLcontaininggrowthmediumincreasedPMSCproliferationasevaluatedbytheirdoublingtime.PMSCs cultured inHPLcontainingmediumexpressed typicalMSCsurfacemarkersCD29,CD44,CD73,CD105andCD90anddidnotexpressendothelialmarkerCD31,orhematopoieticmarkersCD45andCD34.PMSCsmaintainedtheirdifferentiationpotentialintoadipogenic,chondrogenicandosteogeniclineages.The secretory profiles of the cells contained substantial amounts of BDNF, VEGF, and HGF. PMSCsdemonstrated robust neuroprotective capabilities based on increased neurite outgrowth. Improvedsprouting was seen in the aortic rings treated with PMSCs. The cells were also able to inhibit T-cellproliferationinanMLRassayasshownbyreducedBrdUincorporation.Conclusion:TheseresultsdemonstratedthatPMSCsculturedinHPLcontainingmediummaintaintheirtherapeuticpotential.OurnextaimistotestthecellsinvivoinaSCIratcontusionmodeltoestablishatherapyforAcquiredSpinalCordInjuries.
MaterialsandMethods:Acutely injuredpatients65yearsandolderwereenrolledandprospectivelyobserved.DemographicsandfrailtymeasuresusingFRAILScale,TraumaSpecificFrailtyIndex(TSFI),andCanadianFrailtyScale(CSHA-CFS)weredeterminedfromsurveysatenrollmentand3monthsintervalsfollowingdischargeforoneyear.Surveysqueriedthetotalnumberandtimingoffalls.Changesinfrailtyovertimewereassessedbylogisticregressionandareaunderthecurve(AUC).Results:Fifty-eightpatientswereenrolled.FRAILScaleandCSHA-CFSdidnotchangeovertime,butTSFIdid(F4,152=4.52,p=0.002).WorseningfrailtywasobservedbyTSFIat6(p=0.006)and12months(p=0.0001)relativetobaseline.Mortalitydidnotdifferbetweenfrailtysystems.Increasingfrailtyscoresandtimepost-dischargewasassociatedwithincreasedoddsofafall.AUCestimateswith95%CIwere0.722[0.641, 0.803], 0.813 [0.744, 0.881], and 0.761 [0.682, 0.841] for Frail Scale, TSFI, and CSHA-CFS,respectively.Conclusions: Risk of falls post-dischargewas associatedwith increased age, time post-discharge, andfrailty in our population. No scale appeared to significantly outperform the other by AUC estimation.Furtherstudyonthelongitudinaleffectsoffrailtyiswarranted.
Introduction: Technical innovation, including improved image quality, wristed movements, andinstrumentstabilityhavepromotedthegrowinguseofroboticsurgeryasanalternativetoVideo-AssistedThoracoscopicSurgery(VATS)lobectomyinpatientswithstage1lungcancer.Wesoughttocomparethequalityandsafetyofourfirst25Robot-Assistedlobectomy,toVATSandtestedthehypothesisthatnewandcomplexsurgicaltechnologycanbeintroducedwithoutsacrificingpatientsafetyoroutcomes.
Methods: Using the UC Davis Section of General Thoracic Surgery Database, we compared roboticlobectomy and VATS lobectomy cases, from 2/2017 to 2/2018 (the year before introducing the newroboticsystem)and3/2018to2/2019(theyearofintroductionofthenewroboticsystem).Wemeasuredperioperativemorbidity, 30-daymortality, nodal upstaging andweperformed a univariate analysis toobservedifferencesbetweenthethreecohorts:Robotic(3/2018-2/2019),VATS(3/2018-2/2019),andVATS(2/2017-2/2018).Results: We identified 25 robotic lobectomy and 28 contemporaneous VATS lobectomy cases from3/2018to2/2019(yearofintroductionoftheroboticsystem),and35VATSlobectomycasesfrom2/2017to2/2018(yearbeforeintroducingtheroboticsystem).RoboticlobectomyoperatingroomtimeswerelongercomparedtoVATS(median383versus295minutes,respectively;p<0.0001);allotheroperativemeasurementsweresimilar.Allpostoperativeoutcomesweresimilar,including30-daymortality(roboticlobectomy,0%versusVATS,0%)andperioperativecomplications.Medianlengthofstaywas4daysforallthreecohorts.Therewasnodifferenceinnodalupstaging(28%incidenceinrobotic,versus14.4%and10.7%inVATS2/17-2/18and3/18-2/19, respectively;p=0.377).Therewasadecreaseover time inroboticORtime.Conclusion: Patients undergoing robotic lobectomy had longer operative times, but otherwise nodifferenceinhospitallengthofstay,perioperativeoutcomes,mortality,andhadsimilarincidenceofnodalupstagingwhen compared toVATS lobectomy. These results suggest equipoisewhen comparing earlyexperienceofroboticlobectomywithVATSanddemonstratesthatnewandcomplexsurgicaltechnologycanbeintroducedwithoutsacrificingpatientoutcomes.
DivisionofTransplantSurgeryIntroduction:Patientswithend-stagerenaldiseasearefrequentlydeniedaccesstotransplantsurgeryduetoobesityandpoorfunctionalstatus.Thosewitha largepanniculusmaybedeclinedsecondarytoconcern for potential wound healing complications. To decrease post-transplant wound and graftcomplications,weimplementedaprogramwherepatientsunderwentpanniculectomytoregaincandidacyforrenaltransplant.Methods: We performed a retrospective review of all patients deemed high-risk for post-kidneytransplantwoundcomplicationswhounderwentpanniculectomyinpreparation forrenal transplantatourinstitutionfrom2008to2018.Aminimumof3monthsfollow-upisneededforinclusioninthestudy.Patient characteristics (age, BMI, medical comorbidities, maximum BMI and weight lost prior topanniculectomy)andsurgicaloutcomes(specimenweight,operationlength,timetodrainremoval,woundcomplications, time to treat complication) were analyzed after panniculectomy as well as aftertransplantation.Results:Atotalof65panniculectomiesinrenaltransplantcandidateswereincludedinourstudy.Overallcomplicationsoccurred in33patients (50.8%).Minor complications (woundseparation, cellulitis, skinnecrosis)occurredin23patients(35.4%);majorcomplications(hematoma,seroma,abscess,unplannedreturntotheoperatingroom)andmedicalcomplicationsoccurredin12patients(17%).32patientshavesince undergone renal transplant. No patients have experienced post-transplant wound healingcomplications.Conclusions:Panniculectomyinpreparationforrenaltransplantationcanbeperformedinpatientswithend-stagerenaldiseasewithahighbutmanageablecomplicationrate, convertingpreviously ineligiblepatientsintoeligiblecandidatesforkidneytransplantation.Thesewoundcomplicationsaremoreeasilymanagedpriortoinstitutionofimmunosuppressionrequiredforrenaltransplant.
Introduction:Handinfectionsarecommonlyencountered,withseverecasesoftennecessitatingsurgicalintervention and hospitalization. This study aims to characterize patient and hospital level factorsassociatedwithincreasedhospitalresourceutilization.Methods:Patientswithaprimarydiagnosisofhandinfectionandprimaryinterventionof incisionanddrainage were retrieved from the Healthcare Cost and Utilization Project National Inpatient SampleDatabase (2014-2015). A gamma regression with a log-link function was performed to adjust forconfoundersandtoidentifydriversofincreasedlengthofstay(LOS),hospitalcosts,aswellasproceduraldelay followingadmission.Referencegroups forregressionwere included,race,age<65years,privateinsurance,andElixhauserComorbidityIndex(ECI):0,Results:Therewere15,510identifiedpatients.SignificantdriversofincreasedLOSincludednon-Whiterace (Black: 0.190 days, Hispanic: 0.560 days), age >65 years, income in the 3rd quartile, non-privateinsurancestatus,andECI(1:0.219days,2:1.132days).Driversofincreasedhospitalcostsincludednon-White race, income quartile, non-private insurance, and ECI (1: $326.23; 2: $2049.26). Notably, suchdriverswereassociatedwithpatientswhoreceivedincisionanddrainageatasignificantlydelayedtimefollowingadmission.
Conclusions:Ourresultssuggestthatincreasedhospitalresourceutilizationforseverehandinfectionsrequiring incisionanddrainageandhospitalization is largelyassociated toracialminority,non-privateinsurancestatus,andincreasedcomorbiditystatus,ratherthanhospital-levelinfluences.
Introduction: Drowning is the leading cause of death in children under the age of 5 years. Despitepreventionefforts,drowningcontinuestodisproportionatelyaffectchildrenintheUS.Weexaminedthenationalincidenceofdrowningandnotedhigh-riskpopulations.Method: A retrospective analysis of a nationally representative sample of children ages 0-5 years,hospitalized for drowning between 2000 and 2016, was conducted using the Health Care Cost andUtilizationProjectKidInpatientDatabase.Results: The average annual incidence of drowning in the study period is 6.5 cases per 100,000hospitalizations. From 2000 to 2016, incidence decreased from 8.4 to 4.3 cases per 100,000hospitalizationsperyear(49%reduction).Casefatalitydecreasedfrom1.04to0.46per100,000casesperyear(56%reduction).Two-year-oldchildrenexperiencedthehighestincidence,witharateof15.3in2000and8.5in2016per100,000hospitalizationsperyear.Thecasefatalityratewasalsohighestin2-year-olds,13.1in2000and5.4in2016per100,000casesperyear(Figure1).Theaverageannualincidenceofdrowningper100,000hospitalizationswashigherinmales(7.9)versusfemales(4.9)andhospitalsintheWest(8.6)andSouth(7.9),comparedtoMidwest(3.8),andNorth(3.7).Conclusion:Preventionefforts toreducedrowning inchildrenhavebeeneffective,asevidencedbyanoverallreductionofcasesinthelastdecade.However,2-year-oldchildren,boysofallages,andchildreninhospitals intheWestandSouthcontinuetoexperienceratesthatexceednationalaverages.Preventioneffortstargetedtoreducedrowninginthesehigh-riskgroupsareneeded.
Objectives:Patientswith lowerextremitywounds fromdiabetesmellitusorperipheral arterydiseasehaveariskofamputationashighas25%.Inpatientswitharterialdisease,revascularizationdecreasestherisk of amputation. We aimed to determine if early assessment of arterial perfusion correlates withamputationrates.Methods:Weretrospectivelyreviewedpatientsreferredtothevascularclinicoveran18monthswithlower extremity wounds to determine when and who performed a complete pulse exam, and whendiagnosticstudiestoevaluateperfusionwereperformed.KaplanMeieranalysiswasusedtodetermineiftimingaffectedoutcomesfortreatmentanamputation.
PredictorsofunplannedreadmissionandmortalityafterbelowkneeamputationAvniSuri,LeoM.V.Andrada,AndrewM.Wishy,MatthewVuoncino,MatthewW.Mell,MimmieKwong.Division:VascularIntroduction:Perioperativemortalityandunplannedreadmissionsareconsideredqualityindicatorsforpatientcare.Publisheddatasuggests thatmajor lowerextremityamputationsareassociatedwithhighperioperativecomplicationratesandlowlong-termsurvival.Methods:Weconductedaretrospectivereviewofallpatientswhounderwentbelow-kneeamputation(BKA)betweenJuly2014andJune2019atourmedicalcenter.Patientdemographicsandpreoperativeconditions were collected and statistical analysis was performed to determine predictors of 30-daymortalityandunplanned30-dayreadmission.Results:128patientsunderwentbelowkneeamputationsduringthestudyperiod(52%right;48%left).69%ofpatientsweremale,31%werefemale,withameanageof62.7years.Therewerehighratesofmedicalcomorbidities,including48%ofpatientswithcoronaryarterydisease,48%withchronickidneydisease,and71%withdiabetes.Theoverall30-daymortalityratewas4.8%.27.3%ofpatientsexperienceda complication during the admission. The overall unplanned 30-day readmission rate was 29.8%.Independentpredictorsof30-daymortality includedcoronaryarterydisease (p=.01), congestiveheartfailure(p=.008),preoperativeclopidogreluse(p=.01),andcomplicationsduringtheindexadmission(p=0.046). The most significant predictor of unplanned 30-day readmission was wound complications(p=.002).Conclusion:PatientsundergoingBKAatourinstitutionhadhighratesofcomorbidconditions.Whiletheoverallperioperativemortalityratewaslow,nearly30%ofpatientswerereadmittedwithin30dayswithwoundbreakdownbeingtheprimarycontributingfactor forunplannedreadmissions.Futureeffortstoreducereadmissionsafterlowerextremityamputationshouldbeaimedtowardpreventionandoutpatienttreatmentofwoundbreakdown.
Introduction: Arterial involvement/encasement is a rare complication of advanced tumors, and theoptimalmanagementofthesepatientsisunclear.Limiteddatacurrentlyexistdescribingshort-andlong-term outcomes, including peri-operative morbidity/mortality and oncologic outcomes. We sought toevaluate surgical outcomes including vascular graft patency and long-termoncologic outcomes amongpatientsundergoingmajortumorresectionwithenblocarterialresectionandreconstruction.
Methods: From a prospective database, we identified and retrospectively analyzed 7 patients whounderwentoncologicsurgerywithvascularresectionandreconstructionforvariousneoplasmsinvolvingmajorbloodvesselsatUCDMedicalCentersince2010.Datawereabstractedonpatientandtreatmentfactorsaswellassurgicalandoncologicoutcomes.Descriptivestatisticswereevaluated.
Results:Inthiscohort,themeanagewas58.3±21.7yrsand86%werefemale.Medianlengthofstaywas14days [7,30].Diagnoseswereprimary sarcomas (4), recurrent carcinomas (2)andan inflammatorypseudotumorencasingtheaorta.Allpatientsunderwentarterialreconstructionofamajorvessel(2aortic,4iliac,and1femoral)usingcryopreservedallografts.Twopatientshadnopost-Opcomplicationsand3had complications unrelated to oncologic/vascular surgery. One patient developed fascial dehiscencerequiringre-operationand1wasreadmittedduetoacuteDVTs.Onepatientdevelopedcancerrecurrenceanddiedafter29mo.,and1isunderactivesurveillanceforpotentialrecurrence.Allgraftsarepatentatamedianfollow-upof1.2yrswith0%re-interventionrateforstenosis/occlusion.Conclusion: In this small series, vascular resection and reconstruction as part of the multi-modalitytreatmentofregionallyadvancedcancers isassociatedwithacceptableshort-andlong-termoutcomes,including excellent graft patency with cryopreserved allografts. In appropriately selected patients,involvementofmajorarterialstructuresshouldnotbeacontraindicationtoattemptedcurativesurgery.
2DivisionofPlasticandReconstructiveSurgery,UniversityofCalifornia,Davis,Sacramento,CABackground: Nipple-areola complex reconstruction (NACR) is a crucial step providing the visualappearanceofproceduralcompletionafterbreastreconstruction.However,thelong-termoutcomesafterNACRremainlessthansatisfactory.Weperformedthesereconstructionswithamodifiedskateflapandderma-fatgraftsandassessedpatientsatisfactionandsurgicaloutcomes.Surgicaltechnique:Aflapisdesignedbetween1-1.5cmandthediameterofthenewareolais3.8or4.2cmdependingontheexpectedfinalsizeandprojectionof thereconstructednipple.Toreconstruct theareola, a skin graft is harvested from common donor sites. Derma-fat graft is inserted into thereconstructednipplebeforefinalclosureforadditionalprojection.Completehealingisachievedbythreeweeks. If excess skin develops around the reconstructed nipple, de-epilthelization and skin-edge re-approximationareperformedtoimproveshapewithoutcompromisingvascularity.
Methods:30patientsunderwentunilateral(n=9)orbilateral(n=21)NACRspost implant-basedbreastreconstruction. Patient satisfaction (with respect to size, shape, and, projection of nipple) and post-operativecomplicationswerereviewedinpatientchartsandpost-operativephotography.Results:Reconstructednipplesshowedmaintenanceofadequateshape,sizeandprojection,withthefinalprojectionofeachnippleappearingtobemorethan5mm.24(80%)patientsreportedfullsatisfaction.6(20%)weresatisfiedwithsizeandprojection,butnotshapeduetoexcessskinaroundthereconstructednipple.Withrevision,allpatientsreportedfullsatisfaction.Therewerenosurgicalcomplicationsrequiringreoperation.
Conclusion: A modified skate flap with derma-fat grafts after implant-based breast reconstructionimproveslong-termpatientsatisfactionandmaymaintaingoodlong-termprojectionwithouttheneedforadditionalpatientdonorsites.
Introduction: Inperioperativepatients,magnesiumhasbeenshowntoreducepostoperativepainandanalgesicrequirements.However,magnesiumhasyettobeappliedsystematicallyoutsideoftheoperatingroom. Critically ill trauma patients often require opiate-based pain regimens and may benefit frommagnesiumasanadjuncttodecreaseopiaterequirementsandprovideadequatepaincontrol.
Methods: This double-blinded randomized, placebo-controlled trial will enroll 156 patients whencomplete.Patientsarerandomizedtoreceivea40mg/kgbolusfollowedbya24-hourinfusionofnormalsaline (placebo)ormagnesiumsulfate.Oralmorphineequivalents (OMEs)andpainscoresare trackedbefore, during, and after study drug infusion. Instances of bradycardia, dysrhythmia, over-sedation,agitation,andrespiratorydepressionarerecorded.Forthisinterimreport,thegroupsremainblindedandwerelabeled“GroupA”and“GroupB”bythepharmacyteamperformingrandomization.Results:Currently,22patients(32%female,meanage=48)havereceivedstudydruginfusion.MechanismofinjuryhasbeenMVC(50%),fall(27%),assault(9%),gunshotwound(9%),andmotorcyclecrash(5%).Commoninjurypatternsincludefractureofatleastonerib(64%),spine(55%),andatleastoneextremity(55%).Sevenpatientshavehadanintra-abdominalinjury(32%).ThemeanISSscoreofGroupAis21;GroupBis16.Bothgroupshavereceivedanaverageof23hoursof infusion;3patientsrequiredearlyterminationofinfusionduetoasurgery.OnepatientinGroupBexperiencedmildrespiratorydepression,notrequiringcessationofinfusion.Therehavebeennootherinstancesofsideeffectsineithergroup.ThereisnodifferenceinOMErequirementbetweengroupsduring(57vs.88p=0.28)orafterinfusion(50vs.69,p=0.45).TheinstancesofseverepainscoresduringinfusionhavebeenlowerinGroupA(p=0.01).Conclusion:Thusfar,infusionofmagnesiumsulfateforpaincontrolhasbeensafe;itsefficacyremainsunknown. Group A has had significantly fewer instances of severe pain during infusion, though OMErequirementsarenotdifferentbetweengroups.Patientaccrualcontinues,withagoalof156patients.
Methods: This single institution study included all BKA patients over a 5-year period. Patients withsubdermalclosureandtourniquetuse(TREATMENT)werecomparedwiththoseclosedwithstaples,skinsutures, or without tourniquet use (CONTROL). Demographics, preoperative conditions, andintraoperativefactorswererecorded.Theprimaryoutcomewas30-daywoundbreakdown.Results: 128 patients received BKA with complete data (101 [78.9%] TREATMENT and 27 [21.1%]CONTROL).Groupsweresimilarwithexceptionofrace,sex,andindicationforoperation.Medianlengthofstaywas 5 days (IQR 3-8 days).Wound breakdown occurred in 29 (24%) of patients. Of these, 83%happenedafterdischarge.TREATMENTpatientshadlesswoundbreakdown(18.6%vs.40.7%,p=.016).Onunivariateanalysis,surgicaltechnique,post-operativeantiplatelet(19.8%vs.44.4%,p=.022),andsex(male15.1%vs.female42.1%p=.001)wereassociatedwithlesswoundbreakdownwhilepost-operativeanticoagulationwasassociatedwithmorewoundbreakdown(40%vs.15.5%,p=.003).Afterstratifyingforsex,multivariatelogisticregressionshowedapersistentbenefitfortheTREATMENTinmen(OR.09,CI.016–.55,p=.009)butnobenefitinwomen(OR4.1,CI.36–46,p=.26).Surgicalrevisionwasrequiredin51.7%ofpatientswithwoundbreakdownvs.0%patientswithoutbreakdown(p<.0001).Discussion:SubdermalskinclosurewiththeuseoftourniquetsignificantlydecreasedwoundbreakdownandsubsequentsurgicalrevisionafterBKA.Thisbenefitwasseen formenbutnot forwomen.Factorsexplainingtheinteractionbetweensexandsurgicaltechniqueareunknownandmaybeatangibleareaforfurtherinvestigation.
ReducingopioiduseinendocrinesurgerythroughpatienteducationandproviderprescribingpatternsStephanieY.Kwan,MD,MTM;ElizabethLancaster,MD;AnjaliDixit,MD,MPH;ChristinaInglis-Arkell,MD;SolmazManuel,MD;InsooSuh,MD;WenT.Shen,MD,MA;CarolynD.Seib,MD,MASUniversityofCalifornia-SanFrancisco,GeneralSurgery,SectionofEndocrineSurgeryUniversityofCalifornia-SanFrancisco,AnesthesiaandPerioperativeCareIntroductionPostoperativeopioidusecanleadtodependence,contributingtotheopioidepidemicintheU.S. New persistent opioid use after minor surgeries occurs in 5.9% of patients. With increaseddocumentationofpersistentopioidusepostoperatively, surgeonsmustpursue interventions toreduceopioiduseperi-operatively.MethodWeperformedaprospectivecohortstudytoassessthefeasibilityofapre-operativeinterventionviapatienteducation/counselingandchangesinproviderprescribingpatternstoreducepost-operativeopioid use. We included adult patients undergoing thyroidectomy and parathyroidectomy from1/22/2019-2/28/2019 at a tertiary referral, academic endocrine surgery practice. Surveys wereadministered to assess pain and patient satisfaction post-operatively. Prescription, demographic, andcomorbiditydatawerecollectedfromtheelectronichealthrecord.
Results66patients(74.2%women,meanage58.6[SD14.9]years)underwentthyroidectomy(n=35),parathyroidectomy(n=24),andothercervicalendocrineoperations(n=7).Allpatientsreceivedapre-operativeeducationalinterventionintheformofapaperhandout.91%ofpatientsweredischargedwithprescriptions fornon-opioidpainmedicationsand8%weregivenanopioidprescriptionondischarge.Amongthosewhomreceivedanopioidprescription,themedianquantityofopioidsprescribedwas135(IQR 120-150) oral morphine equivalents. On survey, four patients (6%) reported any postoperativeopioid use and 94% of patients expressed satisfaction with their pre-operative education and post-operativepainmanagement.
Introduction:Extracellularvesicles(EVs)derivedfromplacentalmesenchymalstemcells(PMSCs)havebeenshowntoprovideneuroprotectionatsitesofinjury.However,aratelimitingstepinEVresearchislowyield,hightechnicaltime,andhighcostofcurrentisolationprocedures.Toaddressthisinefficiency,weculturedPMSCsonthePETmatrixofaunique3DbioreactorsystemtoincreasetheabsoluteyieldofEVspermLofmediaandpercell.Methods: PMSCs were cultured in this bioreactor system for 10 weeks. EV-conditioned media wascollectedweeklyandEVswereisolatedthroughdifferentialcentrifugation.Nanoparticletrackinganalysis(NTA)measuredEVsizeandconcentration.WesternblotswereperformedtoquantifynormalexpressionofEVmarkers (CD9, CD63, andCD81andCalnexin(-)). Enzyme-linked immunosorbent assays (ELISA)measured levels of characteristic growth factors including vascular endothelial growth factor (VEGF),brain-derivedneurotrophicfactor(BDNF),andhepatocytegrowthfactor(HGF).Results:EVmorphologicalfeaturesremainedunchangeduntilweek8,afterwhichadecreaseinbothEVsizeandconcentrationwasseen.WesternblotsrevealedtypicalexpressionoftheEVmarkersCD9,CD63,andCD81andnegativeexpressionofCalnexin.ConcentrationsofVEGF,BNDF,andHGF inconditionedmedia were comparable after 10 weeks. Cost analysis revealed an overall increase in EV yield whileshorteninglabortimeandmaterialcosts.FutureexperimentswillassessthepreservedneuroprotectivecapabilitiesofthePMSCEVs.
Conclusions:This initial study uses a new3D bioreactor system for a unique source of cells and hasbroughtusclosertooptimizingPMSCEVisolationprotocolsforincreasedyieldandmaintainedsamplepurity, while simultaneously lowering costs and time commitment. Future studies will assess theoptimization parameters using additional 3D culture systems including hollow fiber bioreactors,microspheres,andspheroidculture.
Aprospectivetrialofintraoperativeliposomalbupivacaine(Exparel)versusbupivacaine/lidocaineforthoracoscopicsurgeryMollieMustoe,JamesM.Clark,MD,LuisA.Godoy,MD,AnnaXue,MD,SarahHolmesPA-C,JohnAnconaPA-C,LisaM.Brown,MD,MAS,DavidT.Cooke,MDSection of General Thoracic Surgery, Department of Surgery, University of California, Davis Health,Sacramento,CA
Introduction:Given theworsening opioid crisis, enhanced recovery protocols utilizing intraoperativeliposomal bupivacaine (LipoB) have been implemented in a variety of surgical specialties to improvepatientrecovery.NostudytodatehasexaminedtheeffectofLipoBonpatientreportedoutcomes(PROMs),andthereisapaucityofdataontheeffectoflong-termopioidusageupto2monthspostoperatively.Method: Through a prospective cohort trial we enrolled 20 patients to receive 1:1 0.25%bupivacaine:1.0%lidocaine(control)followedby20patientstoreceiveLipoBviaintraoperativeposteriorintercostalnerveblock.Eligiblepatientswerethoseundergoingplannedvideo-assistedorrobot-assistedthoracoscopic lung resection, lung biopsy, or pleural biopsy. Patient postoperative opioid usage inmorphineequivalentdoses(MEDs)wascalculated,andPROMswererecordedviaavalidatedsurveyinthepreoperativearea,ondayofdischarge,atpostoperativemonth1,andatpostoperativemonth2.Results:Therewerenodemographicdifferencesbetweentreatmentgroups.Controlpatientshada2.3xhigher opioid need postoperatively while inpatient compared to LipoB patients (MEDs 296±227 vs130±123mg,p=0.006),andweremorelikelytostillrequireopioidsattimeofdischarge(65.0vs30.0%,p=0.03).Onmultivariable analysis, use of LipoB compared to Control decreased inpatient opioidMEDrequirementsby125mg(β-125,95%CI-222to-29,p=0.013).Eachadditional10mgofinpatientMEDsrequiredpostoperatively increased theoddsof continuedopioidusageatdischargeby6.6%(OR1.07,95%CI1.01to1.13,p=0.03)andat1monthby10.4%(OR1.10,95%CI1.02to1.20,p=0.02).PROMsdidnotdifferatdischarge,1month,or2monthspostoperatively.Conclusion: LipoB significantly reduces the need for postoperative inpatient opioids after thoracicsurgery,andmayreducetheneedforopioidprescriptionsatthetimeofdischarge.TherewasnodifferenceinlongtermpostoperativePROMs,suggestingthatLipoBisnotmaskingshorttermsymptomsbutprovidesdurablelong-termpainreliefandpatientrecovery.Accordingly,theUCDavisPharmacyandTherapeuticsCommitteehasapprovedLipoBforuseinthoracicsurgeryproceduresinclinicalsettings.
Introduction:Overthepast40years,theU.S.prisonpopulationhasincreasedbymorethan600%,butlittle has been previously described about this subpopulation of injured patients. Prisoners currentlyaccount for approximately 2-3% of hospitalized trauma patients at UCDMC. By improving ourunderstandingoftraumaticpatternsinprisonerswecanoptimizethecareofthismarginalizedpopulation.Methods:Themedical recordsof injuredadultprisonerswhopresented toUCDMCbetweenFebruary2011andApril2017werereviewed.Datafromthemedicalrecordwasthenlinkedtoour institution’straumaregistry.Weconducteddescriptiveanalysestosummarizecharacteristicsoftheinjuredprisonersandthecaretheyreceived.Results:Duringtheaforementionedperiod,14,461injuredadultswerehospitalizedatUCDMCandthehospitalizationsof299injuredprisonerswerereviewed.285(96%)patientsweremale,meanagewas40.5(SD=13)yearsandmedianlengthofhospitalstaywas3(IQ=5)days.67%sustainedbluntand42%sustainedpenetratingtrauma.43%wenttotheoperatingroomduringtheirhospitalization.70patients(23%) were victims of interpersonal violence between prisoners. 10% of those who were able tocommunicatewerenotedtonotbeforthcomingaboutcircumstancessurroundingtheirinjury.36cases(12%)involvedself-inflictedharmand33%ofpatientshadadocumentedhistoryofapsychiatricillness.However,psychiatrywasonlyconsultedin15%ofadmissions.Conclusion:A largenumberof injuredprisonerswhopresent toUCDMChaveahistoryofpsychiatricillness, are victims of interpersonal violence, and/or admit to self-harm. Clinicians who care for thispopulation should consider liberal psychiatric evaluation. Sincemany do not feel comfortable sharingdetailsabouttheirinjury,traumacenterswhocareforprisonersshouldconsidermechanismstobetterassureconfidentiality.
TheMotherInfantLactationQuestionnaire(MILQ):AssessingbreastfeedingperformanceJosephM.Firriolo,MD,LauraC.Nuzzi,BA,CatherineT.McNamara,BS,BrianI.Labow,MDIntroduction: Despiteagrowingfocusonbreastfeedingpromotionandresearch,therecurrentlyisnovalidatedmeasuretoassesslactationandbreastfeedingperformance.Methods:TheMotherInfantLactationQuestionnaire(MILQ)wasdevelopedbyourteaminconjunctionwithbiostatistics,nursing,andlactationsupportstafftoassesslactationandbreastfeedingperformanceacrossmultiplemotherandinfantdomains.TheMILQwaspilotedinasampleofmothersbetweentheagesof18-45yearswhowerebetween6months-5yearspostpartum.Results:FifteensubjectscompletedtheMILQ(meanage:31.8years).Allsubjectsproducedmilkwithinthefirstpostpartumweekand86.7%attemptedtobreastfeed. Twopatientsdidnotbreastfeedduetopreference or infection. Roughly one-third of breastfeedingmothers indicated having insufficientmilkproduction;ofwhich50%ofthesepatientsunderwentpriorsurgeryforfibroadenomaormacromastia.Ofmotherswhobreastfed,two-thirdsusedbreastmilktofeedtheirchildrenalmostexclusively.Thirty-eightpercentofbreastfeedingmothersnoted lackofemployersupportandspacetobreastfeedatworkasaconsiderablebarrier.Conclusion:TheMILQhasthepotentialtobecomeawidelyrecognizedtoolforcliniciansandresearcherstoquantifyandcomparebreastfeedingandlactationperformance.Ourfindingsindicatethatthemajorityofmothersinoursampleattempttobreastfeed,withmostexclusivelyusingbreastmilk.Allpatientsinoursamplewhounderwentpreviousbreastsurgerywereableto lactateandbreastfeed,althoughwithlimitedmilksupply.
2BurnsandPlasticSurgeryDepartment,TheThirdXiangyaHospitalofCentralSouthUniversityIntroduction:Diabetesisanimportantriskfactorofchronicwounds.Skininnervationandneuropeptidesmayplayan importantrole inwoundhealing.7,8-dihydroxyflavone(7,8-DHF),aselectiveagonist fortyrosinekinasereceptorB(TrkB)receptors,hasbeenwellstudiedforitsneurotrophicfunctions.However,itsroleinangiogenesisstillunknown.Since7,8-DHFisveryhydrophobicanditsbioavailabilityislow,wedesignedaliposomenanoformulationforeffectivedelivery.WefurtherengineeredtheliposomesurfacewithLXW7,aligandspecificallybindstointegrinαvβ3onendothelialcells(ECs).Wehypothesizethat7,8-DHF liposomes could possess adequate bioavailability and promote both skin innervation andangiogenesis and modification with LXW7 will further increase EC targeting and uptake efficiency,ultimatelyacceleratediabeticwoundhealing.Methods:Wedevelopedaprotocoltoproduce7,8-DHFliposomesandmodified7,8-DHFliposomesurfacewith LXW7 using Click chemistry.We characterized 7,8-DHF liposomes and tested their effects on ECfunctionandconfirmedtheactivationoftheTrkBpathwayinECs.Invivo,weusedb/dbdiabeticmouseexcisionalsplintwoundmodeltotesttheeffectof7,8-DHFonwoundhealing.WoundsweretreatedbyPBS, 7,8-DHF solution, 7,8-DHF liposomes or LXW7modified 7,8-DHF liposomes. The wound healingprocesswasdeterminedbyhistologicalanalysesandimmunohistochemistryoftheexcisionalwounds.Results:Wesuccessfullydevelopedaprotocoltoproduce7,8-DHFliposomeswithhighstability.Invitrofunctionofthe7,8-DHFliposomesonECsandneuronsandinvivofunctionfordiabeticwoundhealingarebeingevaluatedanddatawillbecollectedinthecomingweeks.Conclusion: The 7,8-DHF liposomes possess outstanding stability and bioavailability and represent apromisingnoveltreatmentfordiabeticwoundhealing.Futureworkwillfocusonthemechanismsofactionof7,8-DHFliposomesonbothtissueinnervationandneovascularization.
Introduction: Evidence regarding emergency department (ED) recidivism specific to violent injury issparse,butdatasuggestthispopulationhasahigherrateofre-visitation.Determiningtheeconomicimpactand identifying predictive factors for unnecessary utilization can be used to tailor population specificinterventions. We hypothesized that our violently injured population at UC Davis would have a highvolume,lowacuityEDutilization.Methods:Thestudywasdesignedasaretrospectivecohortreviewofviolentlyinjuredpatients(VIP)overthreeyearsfollowedfor90-dayspostdischarge.Demographicdata,followupinstructions,EDvisits,andtraumaclinicvisitswererecorded.AfinancialanalysiswascompletedonallEDvisitstodeterminehospitalandprofessionalchargesforeachencounter.
Conclusion: Preliminary data demonstrates violently injured patients have a high rate of low acuityemergencydepartmentvisitsafterdischarge.Thislevelofacuitysuggeststhemajorityofconcernswerenon-emergent and could be addressed in an outpatient setting. Future analysis will further classifypredictivefactorsincludingreasonsforEDvisitsandamoredetailedeconomiccomponent.
CausesandinjurypatternsofelderlyburnpatientsSamMiotkeMD,KathleenRomanowskiMD,TinaPalmieriMD,DavidGreenhalghMD,SomanSenMDIntroduction:Olderpatientsareavulnerablepopulationwithrespecttoburninjuries.TheAmericanBurnAssociation has invested resources in improving burn care and preventionwithin this age group. TheNational Electronic Injury Surveillance System (NEISS) ismaintained by the Consumer Product SafetyCommission to surveil for injury trends and is populated with data from a representative group ofapproximately100emergencydepartmentsintheUnitedStates.Thisdatabasecouldbeusefultoevaluateburninjurypatternsinelderlypatientswithaneyetowardtargetedpreventionmeasures.Methods:TheNEISSwasqueriedforpatientsaged55yearsandolderwithadiagnosisofscald,thermal,chemical,electrical,orunspecifiedburninjuriesfortheyears2008-2017.Eachinjurywasclassifiedbybodypart(s)burned,causativeproduct,gender,andagegroupofpatient (55-64,65-74,75-84,85andolder). The ten most commonly burned sites and the ten most common causative products weredeterminedforeachgenderandagegroupandinaggregate.Weightedestimateswereutilizedtocalculateinjurynumbersacrossthepopulation.
Results: The most common etiology of burn injuries for all patients was hot water. Men were mostcommonlyinjuredbygasoline,aproductwhichdidnotrankinthetoptenforwomeninanyagegroup.Cookwarewasthesecondmostcommoncauseamongwomenandthesixthmostcommoncauseamongmen. Forwomen, the combination of cookware and ranges/ovenswas among the top two causativeproductswithineachagegroup.Themostcommonlyinjuredbodypartforallpatientswastheface,holdingacrossmostageandgendergroupings.Menweremorelikelytoinjuretheirhandsthanwomen.Conclusions:Themostcommoncauseofburninjuriesinolderadultsishotwater,andthemostcommonbodypartaffectedistheface.Womenaremorelikelytobeinjuredbycookwareandranges/ovens.Menaremorelikelytobeinjuredsecondarytogasolineandaremorelikelytoinjuretheirhands.ApplicabilityofResearchtoPractice:NEISSdatacouldbeusefulinthedevelopmentoftargetedpreventioncampaigns,suchasfocusededucationaboutthedangersofhotliquids,cooking,andaccelerants.
Introduction: Post-operative closed suction drainage is a common practice in surgery to address thepotentialspacecreatedduringaprocedure.Asurgicaldrainiscomposedofanevacuatorwhichgeneratesthenegativepressure,tubingwhichpropagatesthisnegativepressuretothesurgicalsite,andanopenendinthesurgicalsitewhichpromotestissueappositionbyevacuatingairorfluid.Theliteraturecurrentlydemonstrates that drains generally reduce seroma formation however the decision to place a drain islargelyanecdotalandtherearenoguidelines for thenecessityofadrain.Ourstudyaimstodeterminewhetherthepotentialspacecreatedduringsurgery,usingexcisedtissueweightasasurrogate,toguidedrainplacementisavalidstrategy.Methods:Aretrospectivechartreviewofadultpatientsbetween2014to2018whohadanextirpativesurgery followed by reconstruction by a plastic surgeon at the University of California, DavisMedicalCenterwereincludedinthestudy.Weightoftissueremoved,placementofclosedsuctiondrain,and90-daypost-operativefollowupforclinicallysignificantseroma(seromarequiringdrainage)wererecorded.Criteriafordrainremovalwasoutputoflessthan30mLinthe24hoursprecedingremovalwherebynomorethan1drainwasremovedatatimeina24hourperiodifmorethan1drainwasplacedinthesamepotentialspace.Results: Of 276 patientswhichmet initial criteria, 142 patients had intra-operative specimenweightrecorded.6patientswerediagnosedwithaclinicallysignificantseromarequiringdrainagewithameantissueexcisionmassof800.3grams.Theremaining136patientswithoutseromarelatedcomplicationshadameantissueexcisionmassof1020.7grams(p=0.602).100%ofpatientsintheseromagrouphadatleast1drainplacedintra-operatively.Thenon-seromagrouphad69.9%drainplacementrate.Conclusions:Theamountofexcisedtissuedoesnotpredicttheriskofclinicallysignificantpost-operativeseromadespitedrainplacement.