Aerosol and droplet generation from orbital repair: Surgical risk in the pandemic era

This article is made available for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.Introduction The highly contagious COVID-19 has resulted in millions of deaths worldwide. Physicians performing orbital procedures may be at increased risk of occupational exposure to the virus due to exposure to secretions. The goal of this study is to measure the droplet and aerosol production during repair of the inferior orbital rim and trial a smoke-evacuating electrocautery handpiece as a mitigation device. Material and methods The inferior rim of 6 cadaveric orbits was approached transconjunctivally using either standard or smoke-evacuator electrocautery and plated using a high-speed drill. Following fluorescein inoculation, droplet generation was measured by counting under ultraviolet-A (UV-A) light against a blue background. Aerosol generation from 0.300–10.000 μm was measured using an optical particle sizer. Droplet and aerosol generation was compared against retraction of the orbital soft tissue as a negative control. Results No droplets were observed following the orbital approach using electrocautery. Visible droplets were observed after plating with a high-speed drill for 3 of 6 orbits. Total aerosol generation was significantly higher than negative control following the use of standard electrocautery. Use of smoke-evacuator electrocautery was associated with significantly lower aerosol generation in 2 of 3 size groups and in total. There was no significant increase in total aerosols associated with high-speed drilling. Discussion and conclusions Droplet generation for orbital repair was present only following plating with high-speed drill. Aerosol generation during standard electrocautery was significantly reduced using a smoke-evacuating electrocautery handpiece. Aerosols were not significantly increased by high-speed drilling

A Novel Assay to Study Jagged-1 Trafficking

The Notch signaling pathway is an evolutionarily conserved cell-signaling system that plays an important role in cell differentiation and other processes. Notch signaling is activated when a ligand binds to the Notch protein at the cell surface, thereby initiating a series of events that leads to modification of gene expression. Notch and one of its ligands, Jagged-1, are found at elevated levels in metastatic prostate cancer, indicating that increased Notch signaling is responsible for metastasis of prostate cancer. If Jagged-1 were prevented from reaching the cell surface in the first place, prostate cancer metastasis could be averted. However, more knowledge about the trafficking of Jagged-1 is required to achieve that goal. This study hopes to develop a novel assay that could aid in the study of protein trafficking. A preliminary quantitative assay showed that the manufactured single chain variable fragment antibody bound to the Jagged-1 receptor at the cell surface and exhibited luciferase activity. Another qualitative assay showed that both receptor and antibody could be visualized fluorescently and that the internalization of the antibody could be tracked visually. These experiments will serve as a starting point for more extensive assays which will further optimize these techniques. This knowledge can then be utilized to combat cancer metastasis by blunting the expression of Jagged-1 at the cell surface.This research was supported by the Undergraduate Research Opportunities Program (UROP) and the University Honors Program (UHP)