The Effects of Leukocyte Filtration on Cell Salvaged Autologous Blood Transfusion on Lung Function and Lung Inflammatory and Oxidative Stress Reactions in Elderly Patients Undergoing Lumbar Spinal Surgery

Background: This study was designed to investigate the effects of leukocyte filtration of autologous salvaged blood on lung function, lung inflammatory reaction, and oxidative stress reaction in elderly patients undergoing lumbar spinal surgery. Materials and Methods: Sixty elderly patients undergoing lumbar spinal surgery were randomly divided into 2 groups: Leukocyte Filter group and Control group. Serum levels of inflammatory markers including white blood cell and polymorphonuclear count, neutrophil elastase, serum surfactant protein A, methane dicarboxylic aldehyde, superoxide dismutase, interleukin (IL)-6, IL-8, tumor necrosis factor-α, and respiratory function markers including dynamic respiratory system compliance, oxygenation index, and respiratory index were measured immediately before induction of anesthesia (T0), immediately before blood transfusion (T1), and 1 (T2), 6 (T3), and 12 hours (T4) after end of blood transfusion. Results: The Leukocyte Filter group had higher dynamic respiratory system compliance at T2, oxygenation index at T2 and T3, respiratory index and superoxide dismutase at T2, T3, and T4 than those in the Control group (P

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Protecting the Brain With Xenon Anesthesia for Neurosurgical Procedures

Xenon possesses some, but not all, of the clinical features of an ideal anesthetic agent. Besides well-known advantages of rapid awakening, stable hemodynamics and lack of biotransformation, preclinical data lead to the expectation of xenon's advantageous use for settings of acute ongoing brain injury; a single randomized clinical trial using an imaging biomarker for assessing brain injury corroborated xenon's preclinical efficacy in protecting the brain from further injury. In this review, we discuss the mechanisms and hence the putative applications of xenon for brain protection in neurosurgery. Although the expense of this rare monoatomic gas will likely prevent its widespread penetration into routine clinical neurosurgical practice, we draw attention to the theoretical benefits of xenon anesthesia over other anesthetic regimens for awake craniotomy and for neurosurgery in older, high-risk, and sicker patients. M.M. is a cofounder and Board Member of NeuroproteXeon, a spinout company formed by Imperial College, London on the basis of patents that were filed when he was employed at that institution. NeuroproteXeon's mission is to develop xenon for clinical use to prevent acute ongoing neurological injury. M.M. has an equity stake in NeuroproteXeon through (i) founder status, (ii) exercised stock options, and (iii) personal investment. M.M is neither an employee of NeuroproteXeon nor does he have an executive role in the company. A.R. declares no funding or conflict of interest to disclose. Address correspondence to: Mervyn Maze, MB, ChB, Department of Anesthesia and Perioperative Care University of California San Francisco, 1001 Potrero Avenue, P.O. Box 1363, San Francisco, CA 94143 (e-mail: mervyn.maze@ucsf.edu). Received June 2, 2017 Accepted December 31, 2017 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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Impact of 3D virtual planning on reconstruction of mandibular and maxillary surgical defects in head and neck oncology

Purpose of review This review describes the advances in 3D virtual planning for mandibular and maxillary reconstruction surgical defects with full prosthetic rehabilitation. The primary purpose is to provide an overview of various techniques that apply 3D technology safely in primary and secondary reconstructive cases of patients suffering from head and neck cancer. Recent findings Methods have been developed to overcome the problem of control over the margin during surgery while the crucial decision with regard to resection margin and planning of osteotomies were predetermined by virtual planning. The unlimited possibilities of designing patient-specific implants can result in creative uniquely applied solutions for single cases but should be applied wisely with knowledge of biomechanical engineering principles. Summary The high surgical accuracy of an executed 3D virtual plan provides tumor margin control during ablative surgery and the possibility of planned combined use of osseus free flaps and dental implants in the reconstruction in one surgical procedure. A thorough understanding of the effects of radiotherapy on the reconstruction, soft tissue management, and prosthetic rehabilitation is imperative in individual cases when deciding to use dental implants in patients who received radiotherapy. Correspondence to Max J.H. Witjes, Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands. Tel: +31 50 3613841; e-mail: m.j.h.witjes@umcg.nl Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Impact of 3D virtual planning on reconstruction of mandibular and maxillary surgical defects in head and neck oncology

Purpose of review This review describes the advances in 3D virtual planning for mandibular and maxillary reconstruction surgical defects with full prosthetic rehabilitation. The primary purpose is to provide an overview of various techniques that apply 3D technology safely in primary and secondary reconstructive cases of patients suffering from head and neck cancer. Recent findings Methods have been developed to overcome the problem of control over the margin during surgery while the crucial decision with regard to resection margin and planning of osteotomies were predetermined by virtual planning. The unlimited possibilities of designing patient-specific implants can result in creative uniquely applied solutions for single cases but should be applied wisely with knowledge of biomechanical engineering principles. Summary The high surgical accuracy of an executed 3D virtual plan provides tumor margin control during ablative surgery and the possibility of planned combined use of osseus free flaps and dental implants in the reconstruction in one surgical procedure. A thorough understanding of the effects of radiotherapy on the reconstruction, soft tissue management, and prosthetic rehabilitation is imperative in individual cases when deciding to use dental implants in patients who received radiotherapy. Correspondence to Max J.H. Witjes, Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands. Tel: +31 50 3613841; e-mail: m.j.h.witjes@umcg.nl Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Mucosa-associated invariant T cells in malignancies: a faithful friend or formidable foe?

Abstract

Mucosa-associated invariant T (MAIT) cells are a subset of innate-like T lymphocytes known for their ability to respond to MHC-related protein 1 (MR1)-restricted stimuli and select cytokine signals. They are abundant in humans and especially enriched in mucosal layers, common sites of neoplastic transformation. MAIT cells have been found within primary and metastatic tumors. However, whether they promote malignancy or contribute to anticancer immunity is unclear. On the one hand, MAIT cells produce IL-17A in certain locations and under certain circumstances, which could in turn facilitate neoangiogenesis, intratumoral accumulation of immunosuppressive cell populations, and cancer progression. On the other hand, they can express a potent arsenal of cytotoxic effector molecules, NKG2D and IFN-γ, all of which have established roles in cancer immune surveillance. In this review, we highlight MAIT cells' characteristics as they might pertain to cancer initiation, progression, or control. We discuss recent findings, including our own, that link MAIT cells to cancer, with a focus on colorectal carcinoma, as well as some of the outstanding questions in this active area of research. Finally, we provide a hypothetical picture in which MAIT cells constitute attractive targets in cancer immunotherapy.

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Dermatology hospitalists: a multicenter survey study characterizing the infrastructure of consultative dermatology in select American hospitals

Abstract

Background

Although considered an outpatient specialty, dermatology plays an important role in inpatient medicine. We characterized the activity and structure of dermatology consultation services in select U.S. hospitals.

Methods

In this cross sectional study, a 31-question survey was distributed in person to 32 board-certified dermatologists at the 2017 Society of Dermatology Hospitalists meeting.

Results

Thirty participants completed the survey (yield 93.8%). Most dermatology hospitalists spend 41–52 weeks on service (50%), with 37% spending between 11 and 30 weeks. Coverage was organized by continuous weeks (68%) or months (21%). While on service, hospitalists staffed an average of 4 outpatient clinics per week. Consultative teams also included internal medicine residents (43%), medical students (47%), pediatric residents (10%), and fellows from other specialties (27%). Consultation services saw approximately 3.7 new inpatients and 4.2 follow-up inpatients per day, with daily rounds lasting approximately 2.6 hours.

Conclusions

The results suggest that hospital dermatologists in the U.S. consider inpatient care their niche and devote a majority of their time staffing consults over clinic. The diverse composition of inpatient teams and the number of academic duties held by these physicians suggests they play an important role in medical education.

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Migratory Fish Bone in the Thyroid Gland: Case Report and Literature Review

Introduction. Foreign body stuck in the throat is a common emergency case, which can be removed by the endoscopic treatment. Fish bones are one of the common observed foreign bodies in the pharynx or cervical esophagus. Fish bones have a risk of damaging the mucosa when lodged in the upper digestive tract. Foreign bodies of fish bones located outside the laryngopharyngeal tissue are relatively unusual, and it is even more rare that they remain in the thyroid. It may cause local infection, abscess formation, large blood vessels rupture, and other serious life-threatening complications when the position of the fish bone migrates to the neck. We present a unique case of a 31-year-old woman in whom a fish bone was found in the thyroid. The fish bone had been removed successfully two months after the onset of symptoms. The relevant literature is reviewed and summarized. Case Presentation. A foreign body which is located in the neck area by swallowing is usually found in the emergency case. One of the commonest foreign bodies is the fish bone. The common presenting symptoms include foreign body (FB) sensation and or a sharp pain during swallowing. But we report a rare case in which a migratory fish bone stuck in the thyroid gland was found after 3 months. We retrieved previous literature and made a summary. Conclusions. Fish bones are not easy to be found as a foreign body. Surgeons should be aware that fish bones can become lodged in the thyroid gland. Combined with the history should be a wary fish bone to migrate to the case of the thyroid, to avoid misdiagnosis. To confirm the diagnosis, we can take ultrasound, computerized tomographic scanning (CT), and other tests.

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