Weight Loss Procedures Can Double Blood Alcohol Absorption

MedicalResearch.com Interview with:

“Alcohol” by Takahiro Yamagiwa is licensed under CC BY 2.0


Marta Yanina Pepino PhD

Department of Food Science and Human Nutrition
College of Agricultural, Consumer and Environmental Sciences
University of Illinois
Urbana, IL 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our study is not the first to look at whether sleeve gastrectomy affects alcohol absorption and metabolism. Before our study, there were three published studies in the literature on this issue. However, findings from these studies were discrepant. Two of the studies found that sleeve gastrectomy did not affect blood alcohol levels and one of the studies did found that peak blood alcohol levels were higher when people drink after having a sleeve gastrectomy. All these three studies used a breathalyzer to estimate blood alcohol levels.

Our study tested the following two related hypothesis.

First, that similar to Roux-en-Y- gastric bypass (RYGB), sleeve gastrectomy accelerates alcohol absorption, which cause peak blood alcohol levels to be higher and much faster than before surgery. Because the breathalyzer requires a 15 min of waiting time between drinking the last sip of alcohol and the time that you can read a good estimate of blood alcohol levels from the breath, we hypothesized that the breathalyzer was not a good technique to estimate peak blood alcohol levels in people who may reach a peak blood alcohol level before those 15 min have passed, such as people who underwent sleeve gastrectomy or RYGB.

We found these two hypothesis to be truth:

1) Sleeve gastrectomy, similar to RYGB, can double blood alcohol levels; and

2) The breathalyzer technique is invalid to assess effects of gastric surgeries on pharmacokinetics of ingested alcohol (it underestimate blood alcohol levels by ~27% and it may miss peak blood alcohol levels).

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Bariatric Surgery Can Reduce Number Of Medications Needed To Control Blood Pressure

MedicalResearch.com Interview with:
“Blood Pressure” by Bernard Goldbach is licensed under CC BY 2.0Dr.
Carlos Aurelio Schiavon
Research Institute, Heart Hospital
São Paulo, Brazil 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Obesity and hypertension are highly prevalent diseases and when they are associated,  cardiovascular risk is almost double over patients with obesity alone. 60-70% of hypertension in adults may be attributable to adiposity.

To address both problems, we designed the GATEWAY TRIAL to evaluate the efficacy of Gastric Bypass in the reduction of antihypertensive medications in obese patients using at least 2 medications at maximum doses.

After 1 year, results were very consistent. 83.7 % of the patients submitted to Gastric Bypass reduced at least 30% of the total number of medications maintaining a controlled blood pressure (<140/90 mm Hg) and 51% remitted from hypertension, defined by controlled blood pressure without medications. When we evaluated the reduction of the medication maintaining the Systolic blood pressure below 120 mmHg (SPRINT TARGET), 22.4% of the patients showed remission of hypertension.

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No Clear Guidelines To Manage Pain After Surgical Procedures

MedicalResearch.com Interview with:
“Surgery” by mrpbps is licensed under CC BY 2.0
Sagar Patel MD
Facial Plastic Surgeon
Board Certified Otolaryngology, Head and Neck Surgeon
Facial Plastic Surgery Associates, Houston, Texas

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: While the majority of diverted opioids that are abused originate from pills prescribed for chronic conditions, with 214,000 rhinoplasties performed in the US in 2015, assessing opioid usage after rhinoplasty is an important view into prescription practices for acute pain after surgical procedures. Opioid use, pain control, and adverse effects were examined and opioid use was compared across patient demographic and surgical procedure characteristics, including rhinoplasty and septoplasty, open vs closed techniques, revision vs primary operations, reduction of turbinates, and use of osteotomies. Opioid use was self-reported as the number of prescribed tablets containing a combination of hydrocodone bitartrate (5 mg) and acetaminophen (325 mg) that were consumed. We them mathematically analyzed.

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Keyhole vs Open Surgery For Ruptured Abdominal Aortic Aneurysm

MedicalResearch.com Interview with:

ruptured Abdominal Aortic Aneurysm as seen on CT- Wikipedia James Heilman, MD

A ruptured abdominal aortic aneurysm  as seen on CT

 

 

Professor JT Powell PhD, MD, FRCPath
Faculty of Medicine,
Department of Surgery & CancerImperial College London

 

 

 

MedicalResearch.com: What is the background for this study?

Response: The mortality from ruptured abdominal aortic aneurysm (AAA) remains very high causing about 6000 deaths each year in the UK.  The only hope for survival is an emergency operation to repair the burst aorta.  Even so the mortality may be as high as 45% within a month of repair using open surgery.

It has been suggested that minimally invasive repair using keyhole or endovascular techniques would lower the mortality to about 25% within a month of repair.  However not all shapes of aorta are suitable for endovascular repair (also called EVAR).

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FDG-PET Scans of Lung Nodules Should Be Interpreted With Caution

MedicalResearch.com Interview with:

PET Scan Vanderbilt Health

PET Scan Vanderbilt Health

Amelia W. Maiga, MD MPH
Vanderbilt General Surgery Resident
VA Quality Scholar, TVHS

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Positron emission tomography (PET) combined with fludeoxyglucose F18 (FDG) is currently recommended for the noninvasive diagnosis of lung nodules suspicious for lung cancer. Our investigation adds to growing evidence that FDG-PET scans should be interpreted with caution in the diagnosis of lung cancer. Misdiagnosis of lung lesions driven by FDG-PET avidity can lead to unnecessary tests and surgeries for patients, along with potentially additional complications and mortality.

To estimate FDG-PET diagnostic accuracy, we conducted a multi-center retrospective cohort study. The seven cohorts originating from Tennessee, Arizona, Massachusetts and Virginia together comprised 1188 nodules, 81 percent of which were malignant. Smaller nodules were missed by FDG-PET imaging. Surprisingly, negative PET scans were also not reliable indicators of the absence of disease, especially in patients with smaller nodules or who are known to have a high probability of lung cancer prior to the FDG-PET test.

Our study supports a previous meta-analyses that found FDG-PET to be less reliable in regions of the country where fungal lung diseases are endemic. The most common fungal lung diseases in the United States are histoplasmosis, coccidioidomycosis and blastomycosis. All three fungi reside in soils. Histoplasmosis and blastomycosis are common across much of the Mississippi, Ohio and Missouri river valleys and coccidioidomycosis is prevalent in the southwestern U.S. These infections generate inflamed nodules in the lungs (granulomas), which can be mistaken for cancerous lesions by imaging.

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Matching Time of Day To Patient’s Biorhythm May Improve Surgical Outcomes

MedicalResearch.com Interview with:
Prof David Montaigne MD

Faculté de Médecine de Lille H Warembourg
Lille, France

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It is well known for many decades that cardiovascular diseases exhibit a diurnal variation with for instance higher incidence of myocardial infarction in the early morning as opposed to the evening. Although studies on circadian gene knock-out and mutant mice argue for a biorhythm in myocardial ischemia-reperfusion tolerance, whether a biorhythm in the myocardial tolerance to ischemia, exists in humans was unclear because of conflicting reports in the context of myocardial infarction.

We demonstrated for the first time in humans that the myocardial tolerance to ischemia-reperfusion is different along the day, in line with rodent experiments performed in the early 2010s.

We demonstrated that this biorhythm is clinically meaningful and that it can be targeted as a cardioprotective strategy.

In this topic, Rever-alpha is of specific interest. It belongs at the same time to circadian genes and nuclear receptor families: being a nuclear receptor, it is a feasible pharmacological target, conversely to other circadian genes.

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Fewer Patients Receiving Opioids Alone Following Hip or Knee Replacement

MedicalResearch.com Interview with:
Philipp Gerner

MD Candidate – Class of 2018
University of Massachusetts Medical School

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Over 1 million patients undergo total joint replacement surgery in the United States alone every year, with many experiencing significant pain postoperatively. These procedures often require large amounts of pain medication to keep patients comfortable, which historically has been treated with opioids. Currently, increasing awareness of safe opioid prescribing has created an increased interest in other ways to effectively treat post-operative pain without the dangers and side-effects of opioids.

As part of an analysis of the impact of multimodal pain management (i.e. multiple drug classes or procedures to treat post-operative pain) and opioid usage, we conducted this study to considered how trends have changed over the last 10 years. Our data shows that opioid use for post-operative pain has declined substantially in patients undergoing total hip and knee arthroplasty (THA & TKA), two very common and often painful orthopedic procedures. Patients being treated with opioids alone for THA decreased from 47.6% in 2006 to 7.5% in 2016, with similar trends being seen in TKA patients.

Importantly, our data also showed that patients are increasingly being treated with a multimodal approach to pain control; especially patients being treated with 3 or more different pain modalities increased sharply in the last 10 years for both procedures in our study. This allows patients the benefit of managing their pain without many of the side-effect associated with large doses of a single pain medication. This trend was found to be especially true in small and medium sized hospitals, compared to larger hospitals. With increasing emphasis on limiting opioid use, this data shows us that the medical community is actively pursuing alternate possibilities for successfully treating post-operative pain.

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Early Surgery for Drug Resistant Epilepsy May Limit Cognitive Disabilities

MedicalResearch.com Interview with:
Dr. Manjari Tripathi Professor, Epileptology, Neurology
Dr. P Sarat Chandra, Chief epilepsy Neurosurgeon
AIIMS, New Delhi

MedicalResearch.com: What is the background for this study?:

  1. Surgery for drug resistant epilepsy (DRE) is an accepted procedure for children and there have been multiple surgical series and surgical techniques published in literature. However, till date there are no randomized controlled trials (RCT) available to objectively demonstrate the safety and efficacy of surgical therapy in children with DRE. There are till date only 2 randomized trials for adult patients with drug resistant epilepsy (both for mesial temporal sclerosis only, Wiebe S et al, New Eng J Med, 2001 & Engel J et al, JAMA, 2012).
  2. Children constitute a significant proportion of patients undergoing surgical therapy for DRE (close to 50% in tertiary centers). They have unique problems associated due to uncontrolled epilepsy and some of these include epileptic encephalopathy and status epilepticus. In addition, surgery is also associated with problems like hypothermia, issues related to blood loss etc. Thus the senior author (Manjari Tripathi) and her team felt that a RCT would be very important to objectively assess the role of surgery and hence designed this study.

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Robotic-Assisted Radical Nephrectomy: No Difference in Outcomes But Takes Longer and Costs More

MedicalResearch.com Interview with:
In Gab Jeong, MD

Associate Professor
Department of Urology, Asan Medical Center
University of Ulsan College of Medicine
Seoul, Korea

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Use of robotic surgery has increased in urological practice over the last decade especially for the surgery that was difficult to perform with laparoscopic techniques such as radical prostatectomy for prostate cancer or partial resection of kidney cancer. However, the use, outcomes, and costs of robotic nephrectomy are unknown.

We examined the trend in use of robotic-assisted operations for radical nephrectomy in the United States and compared the perioperative outcomes and costs with laparoscopic radical nephrectomy. The proportion of radical nephrectomies using robotic-assisted operations increased from 1.5% in 2003 to 27.0% in 2015. Although there was no significant difference between robotic-assisted vs laparoscopic radical nephrectomy in major postoperative complications, robotic-assisted procedures were associated with longer operating time and higher direct hospital costs. The rate of prolonged operating time (>4 hours) for patients undergoing the robotic-assisted procedure was higher than for patients receiving the laparoscopic procedure (46.3% vs 25.8%; risk difference, 20.5%; 95% CI, 14.2% to 26.8%). Robotic-assisted radical nephrectomy was associated with higher mean 90-day direct hospital costs ($19530 vs $16851; difference, $2678; 95% CI, $838 to $4519).

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Virtual Cartoon Technology Can Ease Pediatric Anxiety in OR Before Anesthesia

MedicalResearch.com Interview with:
Dr. Sunghee Han
Professor
Seoul National Unversity College of Medicine
Seoul National University Hospital
Department of Anesthesia and Pain Medicin

What is the background for this new technology and study? What are the main findings?

Response: The time from patient arrival in the operating theatre to induction of general anesthesia is one of the most stressful moments for children undergoing surgery. Various strategies such as ‘pre-operative guided operating room tour’ or ‘therapeutic play intervention’ have been developed in order to reduce children’s pre-operative anxiety. Although these existing simulation-based approaches may be effective, they have not been widely used in real clinical settings with limited budget and resources such as manpower and space.

Virtual Reality(VR), a relatively new technology in the field of healthcare, can allow the user to experience an immersive environment. In this study, using VR technology, we provided the children with a realistic trip to the operating theatre accompanied by ‘My best friend’ Pororo. “Pororo, The Little Penguin” is a very famous cartoon character in Korea and Asia. Most children in Korea watch Pororo in TV, play with Pororo toys since early yeas and perceive Pororo as a ‘close friend’. In the VR content used in this study, Pororo acts as a patient and is subjected to anesthesia and surgery himself. Pororo kindly brings his friend(the viewer; paediatric patient) to the theatre and shows all that is going on in there.

Intervention with the VR content was able to reduce the level of anxiety in paediatric patients and promote collaborative behavior and acceptance of the invasive procedures, especially general anesthesia. Parental satisfaction level was also relatively higher in the VR group.

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Modifiable Surgical Outcomes in ENT Cancer Surgery That May Improve Survival

MedicalResearch.com Interview with:
David Schoppy, MD PhD
Resident, Division of Head and Neck Surgery
Department of Otolaryngology
Stanford University School of Medicine
Stanford, Palo Alto, California

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There is a growing focus in healthcare on quality, and one component of this focus is the development of robust measures of quality. Currently, there are relatively few validated metrics of performance in oncologic surgery, and several of these indicators are relatively static metrics (such as hospital case volume and institution type).

This study examined the relationship between overall survival (one surrogate of quality cancer surgery) and two modifiable variables in Head and Neck surgery – achieving negative surgical margins around a primary tumor and 18 or more lymph nodes from a concurrent neck dissection. After controlling for multiple other patient variables, data collected from the National Cancer Database (NCDB) showed that treatment at hospitals where a high percentage of patients had a surgery with negative margins and 18 or more lymph nodes removed from their neck was associated with improved survival. Importantly, this survival benefit was independent of the individual, patient-level survival benefit conferred by having either of these surgical process measures reached.

This study therefore highlights two modifiable measures of institutional performance in Head and Neck surgery that may serve as targets for quality improvement programs.

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Does Gender Bias Play A Role in Cardiovascular Surgery in Women?

MedicalResearch.com Interview with:

Habib Jabagi B.Sc., M.Sc., M.D. Department of Surgery University of Ottawa , Ottawa

Dr.  Jabagi

Habib Jabagi B.Sc., M.Sc., M.D.
Department of Surgery
University of Ottawa , Ottawa

MedicalResearch.com: What is the background for this study? What are the main findings

Response: Women with coronary artery disease (CAD) are at a significant disadvantage compared to men, as they do not consistently receive the same intensive treatment. For example, when surgery is done in men, it is more common to use arteries, as opposed to saphenous veins from the leg to complete the bypass graft. Arteries, such as the left internal thoracic artery, appear to have much better long-term patency than veins, which translates into improved outcomes.

The motivation for this study was to see if our centre, which has embraced the use of arteries quite aggressively, has suffered the same gender disparities with respect to the use of multiple arterial revascularization strategies in coronary artery bypass grafting (CABG).

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Surgical Delays For Melanoma Patients Are Common

MedicalResearch.com Interview with:
Adewole Adamson, MD, MPP
Department of Dermatology
UNC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Surgery is the primary intervention for the treatment of melanoma. Little is known about how delays for surgery, defined as the time between diagnosis and surgical treatment, among melanoma patient differ by insurance type. After adjustment of patient-level, provider-level, and tumor-level factors we found that Medicaid patients experience a 36% increased risk of delays in surgery for melanoma. These delays were 19% less likely in patients diagnosed and 18% less likely in patients surgically treated by dermatologists. Non-white patients also had a 38% increased risk of delays.

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Genetic Testing Reduces Risk Of Side Effects From Anticoagulation After Surgery

MedicalResearch.com Interview with:

Anne R. Bass, MD Associate Professor of Clinical Medicine Weill Cornell Medical College Rheumatology Fellowship Program Director Hospital for Special Surgery New York, NY 10021

Dr. Bass

Anne R. Bass, MD
Associate Professor of Clinical Medicine
Weill Cornell Medical College
Rheumatology Fellowship Program Director
Hospital for Special Surgery
New York, NY 10021

MedicalResearch.com: What is the background for this study?

Response: Blood thinners are used after orthopedic surgery to prevent blood clots from forming in the legs and traveling to the lungs. They are also used in patients with certain heart diseases to prevent strokes. Blood thinners, like warfarin, are effective but can be associated with serious bleeding complications, especially if the wrong dose is given. Genetic testing can help doctors predict the right warfarin dose to use in an individual patient.

In this trial, ≈1600 elderly patients undergoing hip or knee replacement were randomly assigned to receive warfarin dosing based on genetics plus clinical factors (like height, weight and gender), or based on clinical factors alone. The specific genes tested wereVKORC1, CYP2C9, and CYP4F2 which influence warfarin metabolism and the body’s ability to produce clotting factors.

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Appendicitis May Be More Common After Colonoscopy

MedicalResearch.com Interview with:

Marc D. Basson, MD, PhD, MBA Professor of Surgery, Pathology, and Biomedical Science Senior Associate Dean for Medicine and Research University of North Dakota School of Medicine & Health Sciences Grand Forks, ND 58202

Dr. Basson

Marc D. Basson, MD, PhD, MBA
Professor of Surgery, Pathology, and Biomedical Science
Senior Associate Dean for Medicine and Research
University of North Dakota School of Medicine & Health Sciences
Grand Forks, ND 58202 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: I and other surgeons have previously had the experience of caring for patients with appendicitis who had recently undergone colonoscopy, and wondered if there might be a connection.  However, colonoscopy and appendicitis are both common events, and so it would be difficult to tell whether they are linked or just coincidences from scattered occurrences.

After obtaining appropriate regulatory approvals, we identified almost 400,000 veterans from the US Department of Veterans Affairs database who had undergone screening colonoscopy and compared their rates of appendectomy and acute appendicitis in the week following colonoscopy to rates of appendectomy and appendicitis over each of the following 51 weeks.  We asked the question in several different ways and verified our results by examining surgical and pathology reports.  Depending on how the question was asked and appendicitis or appendectomy defined, rates of appendectomy and appendicitis were clearly 4-9 times higher in the first week after diagnostic colonoscopy.  This wasn’t true when we asked whether appendectomy was more common after several other procedures that also required sedation and contact with the medical system.

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Study Compares Three Types of Botulinum Injections For Involuntary Facial Movements

MedicalResearch.com Interview with:

P. Daniel Ward, MD, MS, FACS Facial Plastic Surgeon WardMD Form Medical SpaAdjunct Associate Professor, University of Utah School of Medicine Salt Lake City, Utah 84121

Dr. Ward

P. Daniel Ward, MD, MS, FACS
Facial Plastic Surgeon
WardMD Form Medical SpaAdjunct Associate Professor, University of Utah School of Medicine
Salt Lake City, Utah 84121

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: As a facial plastic surgeon with an interest in finding treatments for patients with facial paralysis, we are always looking for ways to improve the care that our patients receive. One of those treatments is to treat the effects of abnormal and asymmetric facial motion with botulinum, which decreases the deformity that results from facial nerve disorders by decreasing muscular hyperactivity.

This study was based on the fact that there are three commercially available types of botulinum available for treatment of the face. There have been studies that have compared the different types of botulinum for cosmetic purposes, but there have not been any studies that specifically looked to see if there were any differences between the different types of botulinum when used for treatment of facial nerve disorders.

The main finding of the study is that the three different types of botulinum are essentially equivalent with the exception being that one type of botulinum, incobotulinum toxin, was slightly less effective than the other two types of botulinum at the 4-week follow up point. Of note, all three types were equivalent at all other time points.

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Mild Hypothermia During Prolonged Surgery May Reduce Complications

MedicalResearch.com Interview with:

Brett A. Miles, DDS MD FACS Associate Professor of Otolaryngology Head and Neck Surgery Co-Chief Division Head and Neck Oncology Fellowship Director Head and Neck Oncologic and Microvascular Reconstructive Surgery Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York, NY 10029

Dr. Miles

Brett A. Miles, DDS MD FACS
Associate Professor of Otolaryngology Head and Neck Surgery
Co-Chief Division Head and Neck Oncology
Fellowship Director
Head and Neck Oncologic and Microvascular Reconstructive Surgery
Department of Otolaryngology Head and Neck Surgery
Icahn School of Medicine at Mount Sinai
New York, NY 10029 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The ideal core temperature for patients undergoing prolonged major head and neck surgery remains unknown. Previous data indicates the low temperatures may increase the risk of developing postoperative complications such as tissue loss, hematomas, or surgical infections.(1) Other studies have indicated that high temperatures may also influence outcomes and lead to increased complications such as bleeding.(2)

This study was a study of 519 patients who underwent major head and neck surgery at the Mount Sinai Hospital, New York, New York. The study looked at the core temperature of the patients during prolonged surgery for head and neck cancer in order to identify the optimal temperature range for these patients to prevent complications.

The study found that higher intraoperative temperatures were associated with worse outcomes in terms of tissue loss, wound complications, and infection. Our study suggests an optimal temperature range of 35.3C-37.6C. If patients were above or below that range for a significant period of time, their complications increased. Therefore maintaining this temperature range (mild hypothermia) may improve flap outcomes in this population.

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Gastric Bypass: Half of Diabetic Patients In Remission 12 Years After Surgery

MedicalResearch.com Interview with:
Ted Adams PhD
Adjunct Professor, Internal Medicine
Adjunct Associate Professor, Nutrition & Integrative Physiology
The University of Utah 

MedicalResearch.com: Why did you decide to conduct this study?

Response: The primary aim of the study was to determine the clinical outcomes in patients who underwent gastric bypass surgery.

As NIDDK/NIH continued to fund the study, the aim was extended to determining the durability) long-term outcomes) of gastric bypass surgery when compared to non-surgical, severely obese patients.

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48-Hours of Antibiotics Reduced Infection Rate After C-Section in Obese Women

MedicalResearch.com Interview with:

Dr. Carri R. Warshak, MD Associate Professor of Obstetrics & Gynecology University of  Cincinnati

Dr. Warshak

Dr. Carri R. Warshak, MD
Associate Professor of Obstetrics & Gynecology
University of  Cincinnati

MedicalResearch.com: What is the background for this study?

Response: Cesarean deliveries are the most common major surgical procedure performed in the United States.  A common complication of cesarean section is wound infections that can include infections in the skin and incision site, or infections in the uterus itself after delivery.  These complications can lead to prolonged hospitalization after delivery for antibiotics and even further surgery in severe infections.  Often these wound complications lead to delayed healing, wound opening which can sometimes take several weeks to heal. Studies have demonstrated as many as 12% of women experience a surgical site infection after delivery.

Obesity is a strong risk factor for increased surgical site infections.  Increasing maternal weight increases the risk of wound complications, with a two to five fold increase in risk, making surgical site infections and common and concerning complication of cesarean delivery in obese women.

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Which Is Better? Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke

MedicalResearch.com Interview with:

Prof. Jean-Louis MAS Université Paris Descartes INSERM UMR S 894 Service de Neurologie et Unité Neurovasculaire Hôpital Sainte-Anne Paris 

Prof. Jean Louis MAS

Prof. Jean-Louis MAS
Université Paris Descartes
INSERM UMR S 894
Service de Neurologie et Unité Neurovasculaire
Hôpital Sainte-Anne
Paris 

MedicalResearch.com: What is the background for this study?

Response: Stroke is a major cause of death, disability and dementia affecting 17 million people each year worldwide. About 80% of strokes are ischemic strokes due to occlusion of a cerebral artery by a thrombus, itself the consequence of various arterial or heart diseases. In 30 to 40% of cases, no definite cause of ischemic stroke can be identified. Cryptogenic stroke is the term used to refer to these strokes of unknown etiology.

The patent foramen ovale (PFO) is a defect between the upper two heart chambers (called atria) though which a thrombus of venous origin may reach the systemic circulation and cause a stroke. This mechanism is called paradoxical embolism. Several case-control studies have shown an association between PFO and cryptogenic ischemic stroke, particularly in patients less than 60 years old, in those who have an atrial septal aneurysm (defined as an abnormal protrusion of the interatrial septum in the right or the left atrium or both) in addition to a PFO, and in those who have a PFO with a large right-to-left shunt. These findings suggested that a PFO might be responsible for stroke and that PFO closure with a device may decrease the risk of stroke recurrence. However, the causative relationship between PFO and stroke and the best strategy to prevent stroke recurrence have long been a hot topic of debate. Three previous randomized clinical trials failed to demonstrate any superiority of PFO closure over antithrombotic therapy.

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Risk Factors For Reoperation and Readmission After Parathyroidectomy Identified

MedicalResearch.com Interview with:

Raymond L. Chai, MD Assistant Professor of Otolaryngology Icahn School of Medicine at Mount Sinai.

Dr. Rai

Raymond L. Chai, MD
Assistant Professor of Otolaryngology
Icahn School of Medicine at Mount Sinai. 

MedicalResearch.com: What is the background for this study?

Response: Primary hyperparathyroidism is a common endocrine disorder affecting up to 1% of the general population. Surgical intervention is the only known durable cure for the disease. Untreated primary hyperparathyroidism can lead to number of health problems, including progressive osteoporosis and kidney stones. Although parathyroidectomy is a commonly performed surgical procedure by otolaryngologists, limited data exists regarding risk factors and rates of reoperation and readmission following surgery.

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Delaying Reconstruction Did Not Increase Postoperative Complications in Moh’s Skin Cancer Surgery

MedicalResearch.com Interview with:
Matthew Q. Miller, MD
Department of Otolaryngology–Head and Neck Surgery
University of Virginia Health System, Charlottesville 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Skin cancer is the most common type of cancer worldwide. In the United States, 3.3 million people are diagnosed with a new skin cancer annually and many of these individuals will have more than one cancer. The face is the most common place for skin cancers to develop. Mohs micrographic surgery (often referred to as Mohs surgery) is the standard of care for some skin cancers on the face. Once the cancer is removed, the skin defect is usually repaired by the Mohs surgeon but many require referral to a reconstructive surgeon.

We were intrigued by a recent publication that noted an increased risk in complications when repair of Mohs defects is delayed beyond 2 days. While most patients that will require referral for reconstruction can be predicted and scheduled accordingly in concert with the Mohs surgery, it is not infrequent that a Mohs procedure requires multiple, unexpected passes to excise the entire cancer and the patient is then left with an unexpectedly large defect requiring reconstruction. These large defects often require more OR time and planning and, therefore, reconstruction cannot be easily completed within 2 days of the Mohs procedure.

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Adherence To Guidelines Reduces Mortality & Admissions For Patients With Severe Aortic Stenosis

MedicalResearch.com Interview with:

Mario Goessl, MD, PhD, FACC, FAHA, FESC, FSCAI Director, Research and Education, Center for Valve and Structural Heart Disease Director, LAAC/Watchman™ Program Program Director, Fellowship in Advanced Adult Structural and Congenital Heart Disease Interventions and Interventional Cardiology Fellowship Minneapolis Heart Institute | Abbott Northwestern Hospital, part of Allina Health

Dr. Goessl

Mario Goessl, MD, PhD, FACC, FAHA, FESC, FSCAI
Director, Research and Education, Center for Valve and Structural Heart Disease
Director, LAAC/Watchman™ Program
Program Director, Fellowship in Advanced Adult Structural and Congenital Heart Disease Interventions and Interventional Cardiology Fellowship
Minneapolis Heart Institute | Abbott Northwestern Hospital, part of Allina Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We wanted to investigate if asymptomatic patients with severe aortic stenosis benefit clinically from adherence to current national guidelines that suggest close follow up within 6-12 months.

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DNA Analysis Identifies Subtype of Pancreatic Cancer With Good Prognosis

MedicalResearch.com Interview with:

Nancy You, MD, MHSc, FACS Department of Surgical Oncology The University of Texas MD Anderson Cancer Center Houston

Dr. You

Nancy You, MD, MHSc, FACS
Department of Surgical Oncology
The University of Texas MD Anderson Cancer Center
Houston 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study was motivated by the emerging promise of precision medicine and the emerging evidence that immunotherapy may have phenomenal efficacy in particular molecular subtypes of cancers.  This specific molecular subtype shows deficiency in DNA mismatch repair mechanisms and therefore is thought to be more immunogenic.  DNA mismatch repair deficiency can arise from germline defects such as in the case of patients with Lynch Syndrome, an inherited cancer syndrome, or from epigenetic inactivation DNA mismatch repair genes.

Overall, pancreas cancer has seen limited success with conventional chemotherapy.  In our study, we demonstrated that there is a particular molecular subtype of pancreas cancer that is characterized by defect in DNA mismatch repair genes and by microsatelie instability that has a different prognosis than other pancreas cancers.  This subtype of pancreas cancer is suspected to also respond to immunotherapy.

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NEJM: On-Pump CABG Should Continue To Be Standard Surgical Treatment

MedicalResearch.com Interview with:

A. Laurie Shroyer, Ph.D., M.S.H.A. WOC Health Science Officer Northport VAMC Research and Development Office (151) Northport, NY 11768 Professor and Vice Chair for Research, Department of Surgery Stony Brook University, School of Medicine Stony Brook, NY

Dr. Shroyer

A. Laurie Shroyer, Ph.D., M.S.H.A.
WOC Health Science Officer
Northport VAMC
Research and Development Office (151)
Northport, NY 11768
Professor and Vice Chair for Research, Department of Surgery
Stony Brook University, School of Medicine
Stony Brook, NY 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Since the 1990’s, two different approaches have been commonly used by cardiac surgeons to perform an adult coronary artery bypass graft (CABG) procedure, these approaches have been referred to as  “on-pump” (with cardiopulmonary bypass) or “off-pump” (without cardiopulmonary bypass) procedures. The Department of Veterans Affairs (VA) Randomized On/Off Bypass Follow-up Study” (ROOBY-FS) compared the relative performance of off-pump versus on-pump approaches upon 5-year patients’ clinical outcomes including mortality and major adverse cardiovascular events.

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Repeated Breast-Conserving Surgeries Come With Significant Complications and Costs

MedicalResearch.com Interview with:

Dr. Lisa K. Jacobs MD Johns Hopkins School of Medicine Baltimore, Maryland

Dr. Jacobs

Dr. Lisa K. Jacobs MD
Johns Hopkins School of Medicine
Baltimore, Maryland

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Breast preservation is the preferred treatment for many women diagnosed with breast cancer.  The most common question that a patient will ask after the surgery is, “Did you get it all?” In the ideal case, this is accomplished in a single outpatient surgery with very good cosmetic results.  In our study, Beyond the Margins-Economic Costs and Complications Associated with Repeated Breast-Conserving Surgeries we evaluated the detrimental effects of an unsuccessful initial surgery due to positive surgical margins. Using private insurance claims data, we found that 16% of patients planning breast preservation required a second breast-conserving surgery and an additional 7% converted to mastectomy.  Of those patients that required additional surgery there was a 56% ($16,072) increase in cost and a 48% increase in complications.  Those complications include infection, hematoma, seroma, and fat necrosis.  This study demonstrates that repeated surgery has not only cosmetic consequences, but also has financial implications and increased risk.

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Long Acting Local Anesthetic Reduced Need For Opioids After Knee Replacement

MedicalResearch.com Interview with:

Michael A. Mont, MD Department of Orthopaedic Surgery Cleveland Clinic Cleveland, OH

Dr. Mont

Michael A. Mont, MD
Department of Orthopaedic Surgery
Cleveland Clinic
Cleveland, OH 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Postoperative pain after total knee arthroplasty (TKA) is a major hurdle for both the patients and the orthopaedists. Many analgesic modalities are currently in use, and can be used alone or in combination in order to augment their effect. Addition of local anesthetic analgesia has been shown to improve pain control and reduce opioid consumption during postoperative period. However, the effects of this analgesia tend to dissipate with time, with the longest duration of action (bupivacaine) of approximately 12 hours. Therefore, long acting local anesthetic (liposomal bupivacaine) has been developed in order to expand the duration of effectiveness of pain relief for up to 96 hours. Many studies evaluated the effectiveness of this anesthetic and demonstrated contradictory results, however, they did not use the same methods and infiltration technique. Therefore, we conducted a prospective, randomized, double-blind, controlled study at 16 hospitals using optimal infiltration techniques. Our study demonstrated significant improvement in pain, decreased opioid consumption, increased time to first opioid rescue, more opioid free patients in liposomal bupivacaine cohort. In addition, there were no unexpected safety concerns.

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Blood Biomarkers Signal Multiple Organ Dysfunction Syndrome After Critical Injuries

MedicalResearch.com Interview with:

Dr. Joanna Shepherd Centre for Trauma Sciences Blizard Institute Queen Mary, University of London

Dr. Shepherd

Dr. Joanna Shepherd
Centre for Trauma Sciences
Blizard Institute
Queen Mary, University of London

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Recent advances in resuscitation and treatment of life-threatening critical injuries means that patients with previously unsurvivable injuries are now surviving to reach hospital.  However, many of these patients develop Multiple Organ Dysfunction Syndrome (MODS), which is a failure of several organs including the lung, heart, kidney, and liver.

We studied immune cell genes in the blood of critically injured patients within the first few minutes to hours after injury, a period called the ‘hyperacute window’. We found a small and specific response to critical injury during this window that then evolved into a widespread immune reaction by 24 hours.  The development of MODS was linked to changes in the hyperacute window, with central roles for innate immune cells (including natural killer cells and neutrophils) and biological pathways associated with cell death and survival.  By 24 hours after injury, there was widespread immune activation present in all critically injured patients, but the MODS signal had either reversed or disappeared.

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TAVR Linked To Improved Quality of Life Even After Two Years

MedicalResearch.com Interview with:

Suzanne J. Baron, MD, MSc Saint Luke’s Mid America Heart Institute School of Medicine University of Missouri, Kansas City

Dr. Baron

Suzanne J. Baron, MD, MSc
Saint Luke’s Mid America Heart Institute
School of Medicine
University of Missouri, Kansas City

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Transcatheter Aortic Valve Replacement (TAVR) has emerged as a viable treatment option for patients with severe aortic stenosis in patients at high and intermediate surgical risk.  Prior studies have demonstrated that both TAVR and surgical AVR (SAVR) results in substantial quality of life benefit in patients at high surgical risk.

Whether these results applied to an intermediate risk population was unknown and so we performed a prospective study alongside the PARTNER 2A trial to compare both short- and long-term health status outcomes in intermediate-risk patients with AS treated with either TAVR or SAVR.   The analysis included 1833 patients (950 TAVR, 833 SAVR), who were evaluated at 1 month, 1 year and 2 years post procedure.  By 1 month, quality of life had improved in both the TAVR and SAVR groups, although the gain was significantly greater in patients treated with TAVR via the transfemoral approach as opposed to patients treated with SAVR or with TAVR via the transthoracic approach (i.e. direct aortic access or transapical access).   At 1 and 2 years, both TAVR (via either approach) and SAVR were associated with similarly large, clinically meaningful improvements from baseline in both disease-specific and generic health status scales at 2 years.

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Sweat Sensors Can Guage Surgical Residents’ Confidence With Procedures

MedicalResearch.com Interview with:

Jacob Quick, M.D.</strong> Assistant professor of acute care surgery University of Missouri School of Medicine Dr. Quick also serves as a trauma surgeon at MU Health Care.

Dr. Quick

Jacob Quick, M.D.
Assistant professor of acute care surgery
University of Missouri School of Medicine
Dr. Quick also serves as a trauma surgeon at MU Health Care.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: During five to seven years of surgical training, surgical faculty determine the level of clinical competency, confidence and decision-making skills of each resident physician through personal observations. This skill evaluation is based on a subjective assessment, which essentially is a gut feeling.

We monitored electrodermal activity, or EDA, using dermal sensors on the wrists of residents while they performed laparoscopic cholecystectomies. Our initial findings indicated that at crucial points during the procedures, residents’ EDA increased as much as 20 times more than experienced faculty performing the same surgery. However, over the course of the study, and as their proficiency developed, surgical residents’ EDA levels began to lower in accordance with their experience. Continue reading

Dramatic Increase in ACL Injuries and Surgery in Adolescent Girls

MedicalResearch.com Interview with:

Mackenzie M. Herzog, MPH PhD Candidate, Injury Epidemiology The University of North Carolina at Chapel Hill 

Mackenzie Herzog

Mackenzie M. Herzog, MPH
PhD Candidate, Injury Epidemiology
The University of North Carolina at Chapel Hill 

MedicalResearch.com: What is the background for this study?

Response: In 1999, a study by Arendt et al. reported that women were more likely to tear their ACL than men while playing the same sport. Since then, numerous studies have investigated this sex difference in ACL injury, and many prevention programs targeting youth athletes have been developed and tested. Although randomized trials have demonstrated the value of injury prevention programs in reducing the risk of ACL injury, the overall impact of these programs has not been examined in the general population. Our study investigated the net impact of research and prevention efforts over nearly 20 years in reducing ACL injuries by assessing time trends of ACL reconstruction, a consequence of ACL injury, among commercially-insured individuals in the United States.

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Wireless Monitoring Feasible Both Before and After Surgery

MedicalResearch.com Interview with:

Virginia Sun, RN, PhD Assistant Professor Division of Nursing Research and Education Department of Population Sciences Cancer Control and Population Sciences Program City of Hope Duarte, CA 91010

Dr. Sun

Virginia Sun, RN, PhD
Assistant Professor
Division of Nursing Research and Education
Department of Population Sciences
Cancer Control and Population Sciences Program
City of Hope Duarte, CA 91010 

MedicalResearch.com: What is the background for this study?

Response: Surgery is one of the most effective and important treatment strategies for cancer. Surgical procedures are by definition invasive, and patients are at risk for unpleasant symptoms, impaired functional status, and poor quality of life. Traditionally, mortality has been the sole measure to assess the risk of most surgical procedures. However, as surgical mortality has sharply declined, focus has shifted toward other endpoints, including patient-centered outcomes. There are critical gaps to assessing and integrating patient-centered outcomes into the surgical oncology workflow.

We conducted this proof-of-concept study to assess the feasibility and acceptability of a wireless monitoring approach for patient-centered outcomes before and after a major abdominal cancer surgery.

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Guidelines Linked to Reduced Surgery After Lumpectomy for Breast Cancer

MedicalResearch.com Interview with:

Monica Morrow, MD, FACS Chief, Breast Service Department of Surgery Anne Burnett Windfohr Chair of Clinical Oncology Memorial Sloan Kettering

Dr. Morrow

Monica Morrow, MD, FACS
Chief, Breast Service
Department of Surgery
Anne Burnett Windfohr Chair of Clinical Oncology
Memorial Sloan Kettering

MedicalResearch.com: What is the background for this study?

Response: Although we know that bigger surgery does not result in better patient outcomes in breast cancer, since 2005 rates of lumpectomy have been decreasing accompanied by an increase in bilateral mastectomy for unilateral cancer.

High rates of second surgery after initial lumpectomy are one deterrent for patients. In 2013 the SSO and ASTRO developed an evidence based consensus guideline endorsing no ink on tumor as the standard negative margin width for women with stage 1 and 2 cancer having breast conserving surgery with whole breast irradiation. The purpose of our study was to examine time trends in the use of additional surgery after lumpectomy before and after guideline dissemination and to determine the impact of these trends on final rates of breast conservation.

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Better Communication Linked To Reduced Racial Disparities in Breast Reconstruction Surgery

MedicalResearch.com Interview with:

Elham Mahmoudi, PhD, MS Section of Plastic Surgery, University of Michigan Medical School Ann Arbor, Michigan

Dr. Mahmoudi

Elham Mahmoudi, PhD, MS
Section of Plastic Surgery, University of Michigan Medical School
Ann Arbor, Michigan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: About one-third of all women diagnosed with breast cancer undergo mastectomy. In recent years, owing to advancements in screening and treatment, life expectancy after being diagnosed with breast cancer has increased. Research has shown that for patients who undergo mastectomy, breast reconstruction offers many psychological benefits such as improved self-esteem, reduced sexual dysfunction, decreased anxiety, and overall improvement in quality of life. After the passage of the Women’s Health and Cancer Rights Act in 1998, the coverage of post-mastectomy breast reconstruction (PBR) by any type of health insurance became mandatory. However, there are large and widening racial and ethnic disparities in PBR, with White women having a higher rate of PBR than women from other racial and ethnic groups.

In 2011, the State of New York enacted a law mandating that surgeons advise their patients undergoing mastectomy about available breast reconstruction options, insurance coverage, and referral to a plastic surgeon. We evaluated the effect of this law on racial/ethnic disparities in immediate PBR.

Our results did not show any effect on the overall rate of immediate  post-mastectomy breast reconstruction or on disparities between white and African-American women; however, we found that White-Hispanic and White-other racial/ethnic group disparities in immediate PBR were reduced by 9 and 13 percentage points, respectively. This is a substantial reduction in disparity within only a year after the passage of the law, which demonstrates the importance of physician-patient communication.

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Modified Hospital Elder Life Program Reduces Post-Op Delirium and Length of Stay

MedicalResearch.com Interview with:
Cheryl Chia-Hui Chen, RN, DNSc

Vice Dean for Student Affairs
Professor of Nursing
National Taiwan University
Nurse Supervisor at National Taiwan University Hospital
Taipei, Taiwan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Older patients undergoing abdominal surgery often experience preventable delirium, which greatly influences their postoperative recovery and hospital length of stay. The modified Hospital Elder Life Program (mHELP) utilizes nurses to reduce postoperative delirium and LOS among older patients undergoing abdominal surgery for resection of malignant tumor. The mHELP consisted of 3 protocols: oral and nutritional assistance, early mobilization, and orienting communication, researchers say.

Researchers at the National Taiwan University Hospital randomly assigned 377 patients undergoing abdominal surgery for a malignant tumor to an intervention (n = 197) or usual care (n = 180).

Postoperative delirium occurred in 6.6 percent of mHELP participants vs 15.1 percent of control individuals (odds of delirium reduced by 56 percent). Intervention group participants received the mHELP for a median of 7 days, and they had a median LOS that was two days shorter (12 vs 14 days).

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Risks of Surgery For Thyroid Cancer Higher Than Expected

MedicalResearch.com Interview with:

Megan Rist Haymart MD Assistant Professor University of Michigan

Dr. Haymart

Megan Rist Haymart MD
Assistant Professor
University of Michigan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Thyroid cancer is typically treated with thyroid surgery. It is common practice for physicians to inform patients that the risk of vocal cord paralysis or hypoparathyroidism with thyroid surgery is 1-3%.

However, most of these estimates are based on single institution studies with high volume surgeons. In our study we evaluated surgical risks in a population-based cohort. Using the Surveillance, Epidemiology, and End Results-Medicare database, we found that 6.5% of thyroid cancer patients developed general post-operative complications (fever, infection, hematoma, cardiopulmonary and thromboembolic events) and 12.3% developed thyroid surgery specific complications (hypoparathyroidism/hypocalcemia, vocal cord/fold paralysis).

Older patient age, presence of comorbidities, and advanced stage disease were associated with the greatest risks of surgical complications.

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Re-Operations After Gastric Band Surgery Are Common and Costly

MedicalResearch.com Interview with:

Andrew Ibrahim, M.D., M.Sc</strong> Institute for HealthCare Policy and Innovation University of Michigan

Dr. Ibrahim

Andrew Ibrahim, M.D., M.Sc
Institute for HealthCare Policy and Innovation
University of Michigan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The laparoscopic gastric band was approved by the FDA in 2001 and widely adopted for the surgical treatment of morbid obesity. Reported rates of reoperation to revise or remove the device ranged from 4 to 60 percent in small scale studies, but no population estimates in the United States existed.

In a review of Medicare Claims data between 2006 and 2013, we observed that reoperation was common with 18% of patients requiring at least one reoperation. More over, we found that on average, patients who did need a reoperation often underwent an average of 3.8 additional procedures. Taken together, nearly half (47%) of the $470 million paid by Medicare for device related procedures was for reoperations.

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Vena Cava Filter Use in Trauma and Rates of Pulmonary Embolism, 2003-2015

MedicalResearch.com Interview with:
Alan Cook, MD, FACS
Director, Trauma Research Program
Chandler Regional Medical Center
Clinical Assistant Professor, Department of Surgery
University of Arizona College of Medicine – Phoenix
Chandler, AZ 85224 and
Frederick B. Rogers MD, MS, FACS
Trauma Surgeon
Lancaster General Health/Penn Medicine
Adjunct Professor of Surgery University of Pennsylvania College of Medicine
Department of Surgery

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The morbidity and mortality from pulmonary emboli (PE) are considerable. They range in severity from a problem amenable to outpatient medical management to fatal. Trauma patients are often ineligible for chemoprophylaxis due to the risk for life-threatening bleeding.

Yet traumatic injury can increase a person’s likelihood of having a pulmonary embolus via an array of mechanical and humoral pathways. The vena cava filter (VCF) offered the possibility of PE prophylaxis for patients otherwise vulnerable to PE risk. Use of VCF grew and the rate of use increased even more after the introduction of the retrievable VCF. Our study sought to determine if any temporal variation in VCF use has occurred and investigate if an contemporaneous change in the diagnosis of PE has taken place.

We used three databases to allow a telescoping window of observation from a single state, Pennsylvania (PTOS), to a convenience of sample of trauma centers across the country (NTDB), and finally a national, population-based sample of all hospital discharges in the US (NIS).

A temporal trend was observed in all three datasets with differing magnitudes and time points of change. The variation of vena cava filter use was most pronounced in the PTOS and least dramatic in the NIS, The rate of PE was essentially unchanged during the same period.

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After PCI, Two Anticoagulants May Be As Effective As Three

MedicalResearch.com Interview with:

Nayan Agarwal MD Intervention Cardiology Fellow, University of Florida, Gainesville, FL

Dr. Agarwal

Nayan Agarwal MD
Intervention Cardiology Fellow,
University of Florida,
Gainesville, FL

MedicalResearch.com: What is the background for this study?

Response: Long term anticoagulation is indicated in patients with mechanical heart valves, prior thromboembolic events, atrial fibrillation etc, to prevent recurrent thrombo-embolic episodes. About 20-30% of these patients also have concomitant ischemic heart disease requiring percutaneous coronary intervention (PCI).

Post PCI, patients require treatment with dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor (clopidogrel, prasugrel, ticagrelor) to prevent stent thrombosis. Thus, these patients may end up needing triple antithrombotic therapy with oral anticoagulant (OAC) and DAPT, which increases the bleeding risk.

Both American College of Cardiology(ACC) and European Society of Cardiology (ESC), currently recommend triple therapy in these patients. Recently new evidence has emerged that such patients can be managed with dual therapy of a single antiplatelet (SAPT) and OAC. Hence, we decided to do a systematic review of these studies to evaluate safety and efficacy of dual therapy of SAPT and OAC against triple therapy of DAPT and OAC.

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How Do Patients With Compromised Kidney Function Do After TAVR?

MedicalResearch.com Interview with:

Nirat Beohar, MD Vice-Chief of Cardiology Director Cardiac Catheterization Laboratory Director Structural Heart Disease Program Director Interventional Cardiology Fellowship program Cardiac Catheterization Laboratory Columbia University Division of Cardiology, Mount Sinai Medical Center Miami Beach, Miami, FL 33140

Dr. Beohar

Nirat Beohar, MD
Vice-Chief of Cardiology
Director Cardiac Catheterization Laboratory
Director Structural Heart Disease Program
Director Interventional Cardiology Fellowship program
Cardiac Catheterization Laboratory
Columbia University Division of Cardiology,
Mount Sinai Medical Center
Miami Beach, Miami, FL 33140

MedicalResearch.com: What is the background for this study?

Response: Nirat Beohar MD, Director of the Cardiovascular Catheterization Laboratory and Vice-Chief of Cardiology at the Columbia University Division of Cardiology at the Mount Sinai Medical Center and co-authors report the effect of trans-catheter aortic valve replacement (TAVR) on subsequent renal function and outcomes in high-risk and inoperable patients presenting with baseline renal dysfunction (eGFR < 60 ml/min/1.73 m2). This was a sub-study of patients undergoing TAVR in the PARTNER 1 trial and continued access registry that was conducted in 25 centers in the United States and Canada.

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Post-Surgical Medications Are Major Cause Of New Chronic Opioid Use

MedicalResearch.com Interview with:

Chad M. Brummett, M.D. Associate Professor Director, Clinical Anesthesia Research Director, Pain Research Department of Anesthesiology Division of Pain Medicine University of Michigan Medical School Ann Arbor, MI  48109

Dr. Brummett

Chad M. Brummett, M.D.
Associate Professor
Director, Clinical Anesthesia Research
Director, Pain Research
Department of Anesthesiology
Division of Pain Medicine
University of Michigan Medical School
Ann Arbor, MI  48109 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The opioid epidemic has received tremendous attention in recent years, but most of the focus has been on chronic pain, opioid abuse and overdose. Far less attention has been paid to the importance of acute care prescribing (e.g. surgical pain) in patients that are not chronic opioid users.

We found that 5-6% of patients not using opioids prior to surgery continued to fill prescriptions for opioids long after what would be considered normal surgical recovery. Moreover, the rates of new chronic use did not differ between patients having major and minor surgeries, suggesting that patients continue to use these pain medications for something other than simply pain from surgery. Building on other work by our group, and the few additional studies done on the topic to date, these data suggest that pain medications written for surgery are a major cause of new chronic opioid use for millions of Americans each year.

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Carotid Artery Stenting vs Endarterectomy: Similar Efficacies, Different Safety Profiles

MedicalResearch.com Interview with:
Jay S. Giri, MD, MPH
Director, Peripheral Intervention
Assistant Professor of Clinical Medicine
Penn Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We analyzed data from 6,526 patients in the 5 most recent randomized trials comparing carotid artery stenting to carotid endarterectomy.  These procedures are performed to prevent long-term stroke in patients with severe narrowings of their carotid arteries.  We learned that the procedures are equally effective in preventing stroke over the long-term.  However, the procedures have quite different safety profiles, defined as adverse events that the patients experienced within 30 days of their procedure.

Carotid artery stenting was associated with a higher risk of stroke in the initial 30 days after the procedure.  Carotid endarterectomy was associated with greater risks of myocardial infarction (heart attack) and cranial nerve palsy, a variable condition that most often results in difficulty with swallowing or speaking, over this timeframe.

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Myocardial Injury Not Uncommon After Non-Cardiac Surgery

MedicalResearch.com Interview with:

Dr. PJ Devereaux MD, PhD, FRCP(C)</strong> Director of the Division of Cardiolog Scientific Leader of the Anesthesiology, Perioperative Medicine and Surgical Research Group at the Population Health Research Institute Professor and University Scholar in the Departments of Health Research Methods, Evidence, and Impact and Medicine McMaster University

Dr. Devereaux

Dr. PJ Devereaux MD, PhD, FRCP(C)
Director of the Division of Cardiolog
Scientific Leader of the Anesthesiology, Perioperative Medicine and
Surgical Research Group at the Population Health Research Institute
Professor and University Scholar in the Departments of Health Research Methods, Evidence, and Impact and Medicine
McMaster University
MedicalResearch.com: What is the background for this study?

Response: Although the majority of patients undergoing noncardiac surgery benefit from surgery and do well, even when a small proportion of these patients have a serious complication it represents a major population issue. A recent publication in JAMA Cardiology established that >5 million Americans age ≥45 years undergo major in-patient noncardiac surgery annually, and 1.3% of these patients die in the hospital. This means 65,000 of these patients die, and cardiovascular causes are a dominant cause.

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Rate of Law Enforcement Associated Injuries Has Remained Stable Over Time

MedicalResearch.com Interview with:
Elinore J. Kaufman, MD, MSHP

Department of Surgery, New York
Presbyterian Hospital Weill Cornell Medicine
New York, New York

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Deaths of civilians in contact with police have recently gained national public and policy attention. However, we know very little about nonfatal injuries, which far outnumber deaths.

MedicalResearch.com: What should readers take away from your report?

Response: Nonfatal injuries are much more pervasive than law enforcement-associated deaths, and rates have remained stable over several years, at approximately 51,000 emergency department visits and hospitalizations each year.

These injuries primarily affect young men, and mental illness is a common theme. As a physician, my goal is always to get to zero preventable injuries.

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Study Compares Appendectomy Outcomes Between General Surgeons and Surgical Residents

MedicalResearch.com Interview with:
Haggi Mazeh, MD, FACS
Endocrine and General Surgery
Department of Surgery
Hadassah-Hebrew University Medical Center, Mount Scopus
Jerusalem, Israel 91240

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The level of operating room autonomy given to surgical residents varies greatly between different institutions and different countries. On one hand, providing residents the opportunity to operate alone augments their confidence and their sense of responsibility, possibly accelerating their learning process. On the other hand, it may be argued that the presence of a senior general surgeon in every operation is a safer approach.

Before 2012, a large proportion of appendectomies at our institution were performed by surgical residents alone. After 2012, our institutional policy changed to require the presence of a senior general surgeon in every appendectomy case. This unique situation provided us the opportunity to compare the outcomes of appendectomies performed by residents alone to those performed in the presence of a senior general surgeon.

Our study demonstrated no difference in the complication rates between the two groups of patients. However, surgeries performed in the presence of senior general surgeons were significantly shorter than those performed by residents.

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Study Evaluates Effects of Calcification of Occluded Coronary Arteries During PCI

MedicalResearch.com Interview with:

Emmanouil S. Brilakis, MD, PhD Director, Center for Advanced Coronary Interventions Minneapolis Heart Institute Minneapolis, Minnesota 55407 Adjunct Professor of Medicine University of Texas Southwestern Medical School at Dallas

Dr, Brilakis

Emmanouil S. Brilakis, MD, PhD
Director, Center for Advanced Coronary Interventions
Minneapolis Heart Institute
Minneapolis, Minnesota 55407
Adjunct Professor of Medicine
University of Texas Southwestern Medical School at Dallas

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Calcification in the coronary arteries might hinder lesion crossing, equipment delivery and stent expansion and contribute to higher rates of in-stent restenosis, as well as stent thrombosis. In this project we sought to examine the impact of calcific deposits on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in a contemporary, multicenter registry.

We analyzed the outcomes of 1,476 consecutive CTO PCIs performed in 1,453 patients between 2012 and 2016 at 11 US centers. Data collection was performed in a dedicated online database (PROGRESS CTO: Prospective Global Registry for the Study of Chronic Total Occlusion Intervention, Clinicaltrials.gov Identifier: NCT02061436).

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Some Breast Cancer Patients With Complete Response To Neoadjuvant Therapy Can Avoid Further Surgery

MedicalResearch.com Interview with:

Audree Tadros, MD, MPH Chief Administrative Fellow, Breast Surgical Oncology Training Program Department of Breast Surgical Oncology MD Anderson Cancer Center and

Dr. Tadros

Audree Tadros, MD, MPH
Chief Administrative Fellow, Breast Surgical Oncology Training Program
Department of Breast Surgical Oncology
MD Anderson Cancer Center and

Henry M. Kuerer, MD, PhD, FACS Executive Director, Breast Programs MD Anderson Cancer Network PH and Fay Etta Robinson Distinguished Professor in Cancer Research Department of Breast Surgical Oncology Director, Breast Surgical Oncology Training Program

Dr. Kuerer

Henry M. Kuerer, MD, PhD, FACS
Executive Director, Breast Programs
MD Anderson Cancer Network
PH and Fay Etta Robinson Distinguished Professor in Cancer Research
Dept of Breast Surgical Oncology
Director, Breast Surgical Oncology Training Program

MedicalResearch.com: What is the background for this study?

Response: Neoadjuvant chemotherapy (NCT) has the ability to confer a pCR (pathologic complete response-when no residual cancer is found) in both the breast and axillary lymph nodes. We know that this is most likely to occur in women with HER2 positive and triple negative disease. The high rate of pCR among these patients raises the question of whether surgery is still required, particularly among those who will receive adjuvant radiation therapy.

Until recently, we lacked the ability to pre-operatively predict patients who achieved a breast pCR. Recently, we completed a clinical feasibility trial examining the ability of image-guided biopsy to predict a pCR after neoadjuvant chemotherapy. Our biopsy technique was able to accurately predict a pCR in 98% of patients with only a 5% false negative rate. Based upon these findings, we believe we can accurately determine which patients achieve a breast pCR. This led us to develop a clinical trial to see if breast surgery is redundant in patients who achieve a pCR. An important question that remained was if we are going to omit breast surgery in these exceptional responders, can we also omit axillary surgery?

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Millions of Americans Become Chronic Opioid Users After Surgery

MedicalResearch.com Interview with:

Chad M. Brummett, MD Division of Pain Medicine, Department of Anesthesiology University of Michigan Medical School Ann Arbor, MI 48109

Dr. Brummett

Chad M. Brummett, MD
Division of Pain Medicine, Department of Anesthesiology
University of Michigan Medical School
Ann Arbor, MI 48109 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The opioid epidemic has received considerable attention, but most of the focus has been on chronic pain and primary care. However, surgeons prescribe ~40% of the opioids in the US, and little attention has been given to the importance of prescribing after surgery.

In this study, we found that among patients not using opioids in the year prior to surgery, ~6% of patients continued to use opioids long after what would be considered normal surgical recovery. Furthermore, there was no difference between patients undergoing minor and major surgeries, thereby suggesting that some patients continue to use opioids for reasons other than pain related to surgery.

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Determining the 2-Dimensional Threshold for Perception of Artificial-Appearing Lips

MedicalResearch.com Interview with:

Sang W. Kim, MD Diplomate, American Board of Facial Plastic and Reconstructive Surgery Diplomate, American Board of Otolaryngology - Head and Neck Surgery Natural Face Clinics East Syracuse, NY

Dr. Sang W. Kim

Sang W. Kim, MD
Diplomate, American Board of Facial Plastic and Reconstructive Surgery
Diplomate, American Board of Otolaryngology – Head and Neck Surgery
Natural Face Clinics
East Syracuse, NY

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There are extensive volume of studies and descriptions in literature describing ideal proportions and measurement of facial features, objective measurements for what constitute “artificial” and “overdone” facial appearance have not been studied extensively.

But as elective and cosmetic treatment for face become more mainstream and push its limits, we felt it is important to investigate objective measurement to determine when certain facial features appear to be “artificial” and “overdone”.

We decided to study the lips because compared to other features of the face, it is more practical to translate in 2-dimension and alter objective measurements such as the height of the lips or the shapes of the curvature.

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Effect of Centralization on Health Disparities in Lung and Bladder Cancer Surgery

MedicalResearch.com Interview with:

Emanuela Taioli MD PhD Professor, Population Health Science and Policy, and Thoracic Surgery Director, Institute for Translational Epidemiology Director, Center for the Study of Thoracic Diseases Outcome Director, Division of Social Epidemiology Icahn Medical Institute, New York, NY 10029

Dr. Taioli

Emanuela Taioli MD PhD
Professor, Population Health Science and Policy, and Thoracic Surgery
Director, Institute for Translational Epidemiology
Director, Center for the Study of Thoracic Diseases Outcome
Director, Division of Social Epidemiology
Icahn Medical Institute,
New York, NY 10029 

MedicalResearch.com: What is the background for this study?

Response: Extensive literature documenting the relationship between hospital volume and clinical outcomes has resulted in the centralization of cancer care advocating patients to seek cancer surgical procedures at high-volume (HV) hospitals. Lung resection and cystectomy have been specifically recommended for centralization, but improvements in outcomes are not shared equally among racial groups. It has also been reported that black patients more commonly undergo surgery at low-volume and lower-quality hospitals, despite living in close proximity to higher quality hospitals.

We investigated the effects of centralization on HV hospital utilization and surgical outcomes for lung (n = 28,047 White; n = 2,638 Black) and bladder (n = 7,593 White; n = 567 Black) cancer patients over a 15 year time span (1997-2011) in New York State. We hypothesized that centralization has improved utilization of HV hospitals and outcomes for both black and white patients, but significant disparities remain between black and white patients.

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