Emil Theodor Kocher, M.D., and his Nobel Prize (1841-1917).

Major contributions to the advancement of surgery occurred at the turn of the 20th century. Theodor Billroth was in the midst of revolutionizing abdominal surgery, whereas Louis Pasteur and Joseph Lister were making landmark strides in antisepsis, forever changing the foundations of surgical thinking. Undoubtedly, Theodor Kocher’s (Fig. 1) exposure to these and other giants had a major influence on his career and contributed to his success and ascent as the first, and one of only 10, surgeons ever to be awarded the Nobel Prize in Medicine

Christian Albert Theodor Billroth, M.D., founding father of abdominal surgery (1829-1894).

In the 1800s, the field of surgery was in its infancy, somewhat primitive and embryonic. The technical nature of surgery was the basis for the dividing line between the disciplines of surgery and internal medicine. Sterilization was not a common practice. Radical surgical resections and experimentation in medicine were shunned. With his boldness equaled only by his innovation and resourcefulness, Theodor Billroth would become a pioneer not only in the development of modern surgery, but also in the advancement of its cultural and historical significance

Edoardo Bassini (1844-1924): father of modern-day hernia surgery.

According to Roman scripture, it was Celsus who attempted the first inguinal hernia repair in history during the first century A.D. His attempts were unsuccessful and resulted in an early recurrence of the hernia, which eventually led to the patient’s death.1 Over the next two millennia, little understanding was gained regarding the anatomy of the inguinal canal. It was only in the last 100 years that major advancements in herniorrhaphy were established, thanks in large part to the work of Edoardo Bassini, who revolutionized the surgical treatment of the inguinal hernia with a technique which has become the basis of modern-day herniorrhaphy

A Genetic Algorithm Approach for Model Reference Adaptive Control of Ionic Polymer Metal Composites

Electroactive polymers undergo physical deformation to external voltage stimuli. These electrically activated polymers possess extraordinary features making them capable as lightweight sensors and actuators in manifold applications. The characteristics of applied voltage and environmental conditions, especially the moisture content surrounding the polymer, have a combined influence on the dynamical behavior of these polymers. In order to characterize these polymers under varying environmental conditions, this paper discusses the experimental procedure and modeling techniques used to derive a representative model. Ionic polymer metal composite polymers are used for this humidity relative electrodynamical study. Insight on the numerous applications of electroactive polymers as actuators and the built model enabled a controller is designed for a typical tracking problem. The control architecture includes a model reference adaptive scheme along with pole-placement control strategies to achieve the goal of tracking. A genetic algorithm approach is implemented to carryout an optimized control action. Tracking control of ionic polymer metal composites as actuator resembling that of a real-world scenario is simulated and reveals promising results

The Effects of Total Intravenous Versus Inhalational Anesthesia on Fluid Balance for Patients Undergoing Pancreaticoduodenectomy

Introduction: Pancreaticoduodenectomy (PD), the most common surgical treatment for pancreatic cancer, is a complex procedure with a morbidity of 45-60%. Recent studies indicate that intraoperative use of total intravenous anesthesia (TIVA) may reduce post-operative complications for PD patients, when compared to inhalational anesthesia (INHA). We hypothesized that patients who receive TIVA may have a more favorable fluid balance, which is known to reduce postoperative complications in PD patients. Methods: We carried out a retrospective analysis of patients who underwent PD at Thomas Jefferson University Hospital and were administered TIVA or INHA during surgery between April 2017 and January 2019. We analyzed intraoperative net fluid balance, complication rates, length of stay (LOS), and readmission rates. Statistical significance was determined using Fisher’s exact test or t-test as appropriate. Results: In the study period we found 50 patients who underwent PD (34 TIVA, 16 INHA). Intraoperative net fluid balance was not significantly different (ns) between groups (TIVA=4127mL, INHA=3458.5mL). Complication rates (TIVA=52.9%, INHA=56.3%, ns) and median LOS (TIVA=5.5, INHA=6.0, ns) were comparable between groups. Readmission rates were similar (TIVA=44.1%, INHA=37.5%, ns). Discussion: In the study comparing TIVA to INHA we found no differences in fluid balance, complication rates, LOS, or readmission rates. Given the ease of using an alternative surgical anesthetic, determining whether PD patients who receive TIVA have reduced morbidity, as compared to INHA, is an important potential avenue to improve patient outcomes. While we did not find significant differences, we were limited by a small sample size at the time of analysis

Patient Attitudes Toward a Physician Led Radiology Review: Improved Understanding of Medical Conditions and a Potential New Quality Metric

Objectives: We were interested in understanding patient perspectives regarding the importance of reviewing their imaging studies with a surgeon. Specific Aims: 1. What value do patients place on viewing their imaging? 2. Do patients have a better understanding of their disease and planned operation after a surgeon led review of imaging studies? 3. Do patients find viewing images an accessible educational tool?https://jdc.jefferson.edu/patientsafetyposters/1022/thumbnail.jp

Study of elliptically symmetrical two-dimensional digital filters possessing separable denominator transfer functions

Two-dimensional digital filters are being widely used in modern image processing software for various types of analysis. The main objective of this thesis has been to implement two-dimensional filter functions using simple design procedures such that the presence of elliptical symmetry in such designed filters are obtained by parameter modifications. In keeping with the simple design criteria, the two-dimensional filters studied in this thesis have been designed starting from a product of two one dimensional filters. Only IIR Filters have been considered for this purpose due to their flexibility in terms of altering filter parameters to obtain new filters. The filters have been checked for stability before analysis. The design has made use of the fact that varying the feedback factor ' k ' in an IIR filter produces a near-elliptical symmetric response for certain values of ' k 1 ' and ' k 2 ' having specific magnitude ranges. Considerable success has been achieved in obtained near-elliptical symmetry especially among the two-dimensional lowpass filters and also in other types of filters. It has also been found that there exists numerous possibilities to achieve near elliptical symmetry based on parameter modifications (values of k 1 and k 2 ) and magnitude range of the filter under study. (Abstract shortened by UMI.

Surgical Advances for Pancreas Cancer and Related Diseases

PowerPoint slides (no audio

A Sub-Type of Familial Pancreatic Cancer: Evidence and Implications of Loss-of-Function Polymorphisms in Indoleamine-2,3-Dioxygenase-2.

BACKGROUND: Variation in an individual\u27s genetic status can impact the development of pancreatic ductal adenocarcinoma; however, the majority of familial pancreatic cancers (FPC) cannot yet be attributed to a specific inherited mutation. We present data suggesting a correlation between loss-of-function single nucleotide polymorphisms (SNPs) in an immune regulator gene, indoleamine-2,3-dioxygenase-2 (IDO2), and an increased risk of FPC. STUDY DESIGN: Germline DNA from patients who underwent resection for pancreatic ductal adenocarcinoma (n = 79) was sequenced for the IDO2 SNPs R248W and Y359Stop. Genotypes resulting in inactivation of IDO2 (Y325X homozygous, R248W homozygous) were labeled as homozygous, and the other genotypes were grouped as wild-type or heterozygous. Genotype distributions of each SNP were analyzed for Hardy-Weinberg deviation. A genotype frequency set from the 1000 Genomes Project (n = 99) was used as a genetic control for genotype distribution comparisons. RESULTS: A significant 2-fold increase in the overall prevalence of the Y359Stop homozygous genotype compared with the expected Hardy-Weinberg equilibrium was noted (p \u3c 0.05). Familial pancreatic cancer was noted in 15 cases (19%) and comparison of the FPC cohort set to the genetic control set showed a 3-fold increase in Y359Stop homozygous rates (p = 0.054). Overall in our cohort, the homozygous genotype group was associated with increased risk of FPC (odds ratio 5.4; 95% CI 1.6 to 17.6; p \u3c 0.01). Sex, age at diagnosis, and history of tobacco use were not found to be significantly associated with FPC. CONCLUSIONS: Our preliminary data suggest a strong association between the IDO2 inactivating Y359Stop SNP and an increased risk of FPC when compared with the control group. Future studies will evaluate the value of IDO2 genotyping as a prognostic, early detection marker for pancreatic ductal adenocarcinoma and a predictive marker for novel immune checkpoint therapies