The Effects of Rhodiola Crenulata Extract on Proliferation and Differentiation in Glioblastoma Multiforme

Purpose: Purpose of the study was to evaluate the effects of rhodiola crenulata plant extract on glioblastoma in vitro. Methods: U-87MG glioblastoma multiforme cell line was utilized for evaluation in this study. Cells were treated with 100ug/ml or 200ug/ml of rhodiola crenulata and compared to ethanol vehicle control. Proliferation was measured at 24, 48, 72, and 96 hours after treatment utilizing an MTS proliferation assay. To further assess proliferation a clonogenicity assay was conducted. These cells were treated with ethanol vehicle control, 100ug/ml of rhodiola, radiation, or combined rhodiola/radiation treatment. To evaluate differentiation the expression of glial fibrillary acidic protein (GFAP), a protein marker of differentiation, was assessed with immunocytochemistry. Results: Effects on proliferation were initially noted at 48hours after treatment and observed through the 96-hour period. The effects on proliferation were noted in both treatment groups. At 96-hours after treatment significant difference was noted between the 100ug/ml of rhodiola and control group (p=0.0065) and significant difference noted between the 200ug/ml of rhodiola and control group (p=0.0006). Cell clonogenicity was reduced in the cells treated with 100ug/ml of rhodiola. The decreased number of colonies was significant when comparing the radiation treated cells with 100ug/ml rhodiola treated cells (p=0.0030). GFAP was overexpressed in the rhodiola treatment group when compared to expression in the control group (Figure 1). Conclusion: Rhodiola crenulata extract effectively decreases proliferation and increases differentiation of glioblastoma cells in vitro. Further work is required to fully understand the extent and full effects rhodiola crenulata has glioblastoma cells

Quantitative temporal viromics: an approach to investigate host-pathogen interaction

A systematic quantitative analysis of temporal changes in host and viral proteins throughout the course of a productive infection could provide dynamic insights into virus-host interaction. We developed a proteomic technique called “quantitative temporal viromics” (QTV), which employs multiplexed tandem-mass-tag-based mass spectrometry. Human cytomegalovirus (HCMV) is not only an important pathogen but a paradigm of viral immune evasion. QTV detailed how HCMV orchestrates the expression of >8,000 cellular proteins, including 1,200 cell-surface proteins to manipulate signaling pathways and counterintrinsic, innate, and adaptive immune defenses. QTV predicted natural killer and T cell ligands, as well as 29 viral proteins present at the cell surface, potential therapeutic targets. Temporal profiles of >80% of HCMV canonical genes and 14 noncanonical HCMV open reading frames were defined. QTV is a powerful method that can yield important insights into viral infection and is applicable to any virus with a robust in vitro model

Considerations for the outpatient practice in pediatric surgery during the novel SARS-CoV-2 Pandemic

In the face of COVID-19 we can only hope for small victories, but small victories are what win wars. With the above strategies, and rolling out Telemedicine in our practice, we have recouped some of our outpatient service losses. We are now seeing patients at 42% utilization and the numbers are steadily rising. As a pediatric surgeon remaining flexible and adaptable to the needs of the community can help minimize disruption to your practice and maximize your contribution to the community. Pediatric surgery training provides the surgeon with a diverse skill set that makes them well suited to practice adaptation. COVID-19 has impacted most aspects of the health care system in the United States. Immediately visible are the tragic consequences from the overwhelming of health care systems with critically ill patients like in New York. However, the emotional and financial devastation on health care workers and their communities will likely far outlast the need for ventilators

Prehospital Transport Time and Outcomes for Pediatric Trauma: A National Study

Introduction: Historically, emergency medical services have aimed to deliver trauma patients to definitive care within the 60 min (min) Golden Hour to optimize survival. There is little evidence to support or refute this for pediatric trauma. The objective of this investigation was to describe national trends in prehospital transport time, in relation to the Golden Hour, and pediatric trauma outcomes. Methods: Retrospective cohort study of patients (\u3c15 y old) receiving emergency medical services trauma transport between 2017 and 2019. Transport time (less than or greater than 60 min) was the exposure variable, and analyses were adjusted for injury severity score (ISS). Continuous variables with a normal distribution were compared by t-test was and skewed variables were compared by Mann-Whitney U-test. Categorical variables were compared by Chi-Square test. Results: 54,489 patients met our criteria: 49,628 blunt and 4861 penetrating. Most patients (62.2%) had transport times less than 60 min: 30,389 (61.2%) blunt and 3479 (71.6%) penetrating. The overall mortality rate was 1.6%, 1.2% for blunt and 5.5% for penetrating. For blunt trauma, mortality was higher for transport times less than 60 min (1.5%). For penetrating trauma, mortality was lower for transport times less than 60 min (0.7%). Mean ISS was greater for blunt (7.9) compared to penetrating trauma (7.1), and greater for both trauma types with transport times less than 60 min. For both trauma types, mean length of stay was significantly longer for transport times greater than 60 min, when adjusting for ISS (P \u3c 0.001). Conclusions: We did not find evidence that prehospital transport within the Golden Hour had a substantial association with survival, though it may be associated with length of stay. There are many factors contributing to trauma outcomes, so efforts should continue to expand access and pediatric readiness. Keywords: Emergency medical services; Golden hour; Pediatric trauma; Prehospital transport

Success in the national care of pediatric trauma patients✰,✰✰

Background: Pediatric trauma patients should be treated at pediatric trauma centers, though not every patient can be transported to one. Our goal was to report outcomes for trauma patients at centers of varying levels of verification by the American College of Surgeons (ACS). Materials and Methods: Retrospective review of the ACS Trauma Quality Improvement Program trauma registry data of patients (<15 years old) receiving care at trauma centers in the United States. We compared level 1 and 2 pediatric trauma centers (PTC1 and PTC2) and level 1, 2 and 3 adult trauma centers (TC1, TC2, TC3). Main outcome measure was mortality. Secondary measures were injury severity score (ISS), length of stay (LOS), 30-day complications and race/ethnicity. We also stratified by trauma severity (non-severe vs severe ISS≥15), and age groups (0–3, 3–10, 10–15). Results: 41,399 patients met our inclusion criteria: 37,624 blunt, 3,775 penetrating. Of all patients, 66.7 % were treated at a PTC (69.9 % PTC1, 30.1 % PTC2), and 1.6 % of trauma resulted in mortality. Mortality rate (the percentage of cases treated that resulted in mortality) by trauma center varied more for penetrating trauma (range: 2.1–8.0) than for blunt trauma (range: 0.9–1.7). For blunt trauma, 46.6 % were treated at PTC1s and 1.3 % resulted in mortality. The highest mean ISS and length of stay were at TC1s. For penetrating trauma, 47.5 % were treated at PTC1s and 5.0 % resulted in mortality. Most traumas were non-severe and mortality rates for penetrating trauma were higher for the 10–15 age group, though still lower at pediatric trauma centers. Conclusion: The majority of pediatric trauma patients were treated at a PTC with slightly better outcomes than TCs. Overall, treatment at PTCs resulted in slightly lower mortality rates, shorter LOS, and lower/equivalent 30-day complication rates

Factors Associated with Successful Video-Assisted Thoracoscopic Surgery and Thoracotomy in the Management of Traumatic Hemothorax

Background: Few studies have identified factors associated with successful VATS or thoracotomy as the initial operative strategy among patients with traumatic hemothorax. Material and methods: We performed an exploratory analysis using the 2008 to 2017 TQP database. We identified all patients aged 18 to 89 years with traumatic hemothorax who were treated with tube thoracostomy alone in the first 24-hours of admission, followed by VATS or thoracotomy. Logistic regression was used to identify factors associated with successful VATS (no conversion or reoperation) or thoracotomy (no reoperation) as the initial operative strategy. Results: Among 2052 patients managed with initial VATS after chest tube drainage, 1710 (83%) were successful, while 263 (13%) were converted to thoracotomy and 79 (4%) required reoperation. On multivariable analysis, poor GCS (OR = 0.96 [95% CI = 0.94-0.99]), major injury (OR = 0.69 [95% CI = 0.53-0.90]), and diaphragmatic injury (OR = 0.42 [95% CI = 0.30-0.60]) were associated with lower odds of successful VATS, while rib fractures (OR=1.29 [95% CI=1.01-1.66]) were associated with higher odds of success of the initial operative plan. Among 3486 patients initially managed with thoracotomy after drainage with tube thoracostomy, 3118 (89.4%) were successful, while 11% (n = 368) required reoperation. Multivariable analysis revealed that major injury (OR = 0.68 [95% CI = 0.50-0.92]), blunt mechanism (OR = 0.63 [95% CI = 0.50-0.78]), and diaphragmatic injury (OR = 0.67, 95% CI = 0.53-0.84]) were associated with lower odds of successful thoracotomy as the initial operative plan. Conclusions: More severe injuries and diaphragmatic injuries have lower odds of successful of VATS or thoracotomy as the initial operative management strategy among patients with traumatic hemothorax. Rib fractures may be associated with higher odds of success of VATS as the initial management strategy. Keywords: Hemothorax; Thoracotomy; Trauma; VATS

Association Between the SARS-Cov2 Pandemic and Pediatric Surgical Consultations

Introduction: The purpose of this study was to evaluate changes to acute pediatric surgical needs during the early phase of the SARS-Cov2 (COVID-19) pandemic. Methods: We performed a retrospective cohort study of all in-hospital pediatric surgery consultations placed through the consult paging system at a single institution. We compared both median and absolute differences for emergency department (ED), operative, and hospital outcomes between March, April, and May of 2019 versus 2020. Results: There were 225 in-hospital pediatric surgery consults in 2019 and 123 in 2020. Overall, mean age was 8.4-y (standard deviation = 6.4) and 60% were male. Initial vitals were similar between years and a similar proportion of patients underwent laboratory and imaging tests. In 2020, children spent a median of 1.1-h fewer in the ED (95% confidence interval = -2.2, -0.1) and 0.9-h fewer in the ED before surgical consultation (95% confidence interval = -1.5, -0.3) compared to 2019. Patients required significantly more procedures in the ED in 2020 (n = 16, 14.3%) than 2019 (n = 13, 6.2%) (P = 0.02), most commonly laceration repairs. In 2019, 46 children (20.4% of all consults in 2019) presented with appendicitis and 27 children (22.0% of all consults in 2020) in 2020. Complicated appendicitis was more common in 2020 (n = 12, 44.4%) than 2019 (n = 9, 19.6%) (P = 0.02). Two children (7.4%) were managed nonoperatively with a drain in 2020 compared to none in 2019 (P = 0.13). Median time from surgical consultation to surgery, median operative time, and median time to discharge was similar for children with appendicitis in both years. Conclusions: The early phase of the pandemic was associated with more efficient triaging in the ED, but more ED procedures and more complex surgical pathology. Keywords: Acute surgery; Appendicitis; COVID-19; Pediatric