Racial Variation of Donor-Derived Cell-Free DNA in Kidney Transplant Recipients.

Introduction: There is a need for a noninvasive, affordable, sensitive, and specific biomarker to diagnose early acute rejection, to negate the need for frequent biopsies. Dd-cfDNA is a powerful adjunct yet there is limited data on the ethnic differences in its values. There is anecdotal evidence that dd-cfDNA values at rejection may be higher in Black as compared to non-Black recipients.

Pancreatic Exocrine Secretion and Weight Gain After Pancreas Transplantation.

Introduction: Weight gain after pancreas transplant is a poorly understood phenomenon thought to be related to increased posttransplant insulin production, immunosuppressive medications, and appetite changes. No study has investigated the effect of increased exocrine secretion posttransplant.

Aims And Hypothesis: We hypothesized that exocrine function, measured by fecal elastase-1 (FE-1), was normal posttransplant and not correlated with weight gain.

Ursodiol Prescriptions Following Bariatric Surgery: National Prescribing Trends and Outcomes.

Background: Rapid weight loss after bariatric surgery is a risk factor for gallstone development. Numerous studies have shown that ursodiol after surgery decreases rates of gallstone formation and cholecystitis. Real-world prescribing practices are unknown.

Refractory Immune Thrombocytopenic Purpura with Abdominal Splenosis: A Complex Case.

Immune thrombocytopenia (ITP) is an acquired thrombocytopenia resulting from immune-mediated platelet destruction via antiplatelet antibodies and T cells. Medical management of ITP includes corticosteroids and multiple other adjunct therapies, with splenectomy generally being reserved for severe, refractory cases. In this clinical case report, we describe the evaluation of a 35-year-old male with a history of prior traumatic splenic injury who presented to the emergency department endorsing easy bruising and a petechial rash, ultimately found to have severe thrombocytopenia.

Laser Ablation of Pilonidal Sinus Disease: A Pilot Study.

Background: Pilonidal disease is classically treated with wide local excision, although a number of minimally invasive approaches are currently under investigation. We aimed to determine the safety and feasibility of laser ablation of pilonidal sinus disease.

Impact Of Innovation: Laser ablation provides a minimally invasive means of obliterating pilonidal sinus tracts without a need for excessive tract dilation.

Prophylactic antireflux procedures are not necessary in neurologically impaired children undergoing gastrostomy placement.

Purpose: Fundoplication is frequently used in children with neurologic impairment even in the absence of reflux due to concerns for future gastric feeding intolerance, but supporting data are lacking. We aimed to determine the incidence of secondary antireflux procedures (fundoplication or gastrojejunostomy (GJ)) post gastrostomy tube (GT) placement in children with and without neurologic impairment.

Methods: Children under 18 undergoing a GT placement without fundoplication between 2010 and 2020 were identified utilizing the PearlDiver Mariner national patient claims database.

Accuracy of Surgeon and Patient Estimated Cost and Reimbursement for Common General Surgical Operations and Benefit of Centers for Medicare and Medicaid Services Price Transparency Rules.

Background: On January 1, 2021, the Centers for Medicare and Medicaid Services implemented a hospital price transparency rule. Consumerism as a means of reducing healthcare expenditure is predicated on informed consumers making discrete choices.

Study Design: For 10 months, immediately after a preoperative clinic visit at an academic medical center, patients and their surgeons were surveyed regarding their estimation of hospital cost and hospital reimbursement for the upcoming operation.

Effect of Operative Time on Outcomes of Minimally Invasive Versus Open Pancreatoduodenectomy.

Objective: To evaluate how operative time interacts with outcomes among different approaches to pancreaticoduodenectomy (PD). Minimally invasive PDs (MIPD), which include laparoscopic (LPD) and robotic (RPD) approaches, are increasingly performed in the USA. MIPD are generally associated with longer operative times (OT) compared to open PD (OPD).

Identifying individual social risk factors using unstructured data in electronic health records and their relationship with adverse clinical outcomes.

Objective: To determine the prevalence of individual-level social risk factors documented in unstructured data from electronic health records (EHRs) and the relationship between social risk factors and adverse clinical outcomes.

Study Setting: Inpatient encounters for adults (≥18 years) at the University of Virginia Medical Center during a 12-month study period between July 2018 and June 2019. Inpatient encounters for labor and delivery patients were excluded, as well as encounters where the patient was discharged to hospice, left against medical advice, or expired in the hospital.

Two unique cases of Bouveret syndrome with review of literature.

Bouveret syndrome is a rare form of gallstone ileus in which a proximally lodged gallstone in the duodenum causes a gastric outlet obstruction. It is a rare condition that can be challenging to manage. Although endoscopic management remains first line, a surgical approach can be needed.

Associations of Race, Ethnicity, and Social Determinants of Health With Colorectal Cancer Screening.

Background: Racial and ethnic disparities in receipt of recommended colorectal cancer screening exist; however, the impact of social determinants of health on such disparities has not been recently studied in a national cohort.

Objective: This study aimed to determine whether social determinants of health attenuate racial disparities in receipt of colorectal cancer screening.

Design: This was a cross-sectional telephone survey of self-reported race and ethnicity and up-to-date colorectal cancer screening.

Early Experience Using Donor-derived Cell-free DNA for Surveillance of Rejection Following Simultaneous Pancreas and Kidney Transplantation.

Background: Allograft biopsy is the gold standard for diagnosing graft rejection following simultaneous pancreas and kidney (SPK) transplant. Intraperitoneal biopsies are technically challenging and can be burdensome to patients and the healthcare system. Donor-derived cell-free DNA (dd-cfDNA) is well-studied in kidney transplant recipients; however, it has not yet been studied in the SPK population.

A Pro-Endocrine Pancreatic Islet Transcriptional Program Established During Development Is Retained in Human Gallbladder Epithelial Cells.

Background & Aims: Pancreatic islet β-cells are factories for insulin production; however, ectopic expression of insulin also is well recognized. The gallbladder is a next-door neighbor to the developing pancreas. Here, we wanted to understand if gallbladders contain functional insulin-producing cells.

Can Donor-Derived Cell-Free DNA Detect Graft-Versus-Host Disease in Solid Organ Transplantation: A Case Report.

Graft-versus-host disease (GVHD) is a rare complication after solid organ transplant. We present a case of GVHD after simultaneous pancreas kidney transplant. The patient was diagnosed with a cutaneous biopsy after developing the classic symptoms of maculopapular rash, diarrhea, and pancytopenia.

Mediating Factors Between Race and Time to Treatment in Colorectal Cancer.

Background: Previous disparities research has demonstrated that underrepresented racial minority patients have worse colorectal cancer outcomes and that they experience unnecessary delays in time to treatment. These delays may explain worse colorectal cancer outcomes for minority patients and serve as a marker of inequalities in our healthcare system.

Objective: This study aims to quantify the mechanisms that contribute to this disparity in treatment delay.

Variation in bariatric surgery utilization by state from 2010 to 2019: analysis of the PearlDiver Mariner database.

Background: Bariatric surgery is the most effective treatment for severe obesity and its associated complications, but it remains underutilized. The degree to which bariatric surgery utilization varies by state is unclear.

Objectives: The aim of this study was to quantify variation in bariatric surgery utilization across U.

The effect of bariatric surgery on ischemic stroke risk.

Background: Metabolic and bariatric surgery (MBS) has demonstrated improvements in diabetes and cardiovascular health. The effect of MBS on the risk of ischemic stroke remains unclear.

Objectives: The goal of this study was to determine the risk of stroke following MBS compared with patients with obesity who qualified for but did not undergo MBS.

100 Disruptive Publications in Breast Cancer Research.

Background: Breast cancer has a rich history of research over the past 75 years. Many studies have had disruptive influences on the field itself. Our study employs a new, validated measurement to determine the most disruptive publications within the field of breast cancer.

Outcomes of Laparoscopic Versus Open Resection of Meckel's Diverticulum.

Background: Meckel's Diverticulum (MD) is a common congenital anomaly accounting for half of pediatric gastrointestinal bleeds. No large-scale studies exist comparing open and laparoscopic surgery and conversion rates remain high. We sought to compare postoperative outcomes associated with each approach and to determine risk factors for conversion.

The specialist cadre of the Royal Army Dental Corps.

The specialist cadre of the Royal Army Dental Corps (RADC) came to fruition at the start of World War II, with the speciality of maxillofacial surgery being born during World War I. The cadre has followed developments within the speciality, and building on the experience of forebears, has become capable of not only providing a secondary care service to the RADC but also being competent in the management of complex war injuries.