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

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

EXAMINING CAREGIVING-RELATED EFFECTS ON CAREGIVERS OF PATIENTS WITH PANCREATIC AND PERIAMPULLARY CANCER AFTER PANCREATECTOMY

Problem Statement: Patients with pancreatic and periampullary cancer may experience significant reduction in their quality of life and often rely on family and unpaid caregivers for assistance after surgery. However, little is known about who these caregivers are, what assistance they provide and struggle with, and what their experiences are like. As a result, little is known about how to better support them. This research aims to report on the profile of caregivers caring for patients with pancreatic and periampullary cancers post-pancreatectomy, assess the frequency and difficulty associated with specific assistances they provide as well as caregiving-related effects, and the quality of communication between caregivers and care providers. Methods: This study prospectively enrolled caregivers across 3 institutions accompanying patients with pancreatic and periampullary cancer during their 1-month post-pancreatectomy clinic visit. A questionnaire using elements of the National Study of Caregiving (NSOC) and the Caregiver Perceptions About Communication with Clinical Team Members (CAPACITY) instrument was administered to caregivers. Caregiver responses were linked to patient health status and outcomes from their electronic medical record. Results: Manuscript 1 reports on the characteristics of caregivers, as well as the frequency and difficulty of specific assistance they provide. Additionally, responses from open-ended questions were qualitatively analyzed to determine the most stressful time for the caregiver during the patient’s treatment, and what information or service would have been most helpful to the caregiver. Manuscript 2 identifies caregivers who work for pay as a vulnerable subgroup of caregivers and compared caregiving-related effects they may experience versus caregivers who did not work for pay. Specifically, the endpoints examined included physical and emotional wellbeing, financial stability, and work productivity. Finally, manuscript 3 examines the quality of communication between caregivers and care providers, and its association with patient- and caregiver-related outcomes. Conclusion: Caregivers of patients with pancreatic and periampullary cancer post-pancreatectomy expend significant amount of effort in providing care for their loved ones. Our study reports on caregiver characteristics, the assistances they provide, and their experiences. Additionally, our study highlights the critical need for family and medical leave policies to better support unpaid caregivers, and the potential for interventions that can improve communication between caregivers and care providers to improve both patient- and caregiver-related outcomes alike

Intraductal Papillary Mucinous Adenocarcinoma of the Pancreas: Clinical Outcomes, Prognostic Factors, and the Role of Adjuvant Therapy

Summary Background: Intraductal papillary mucinous adenocarcinoma (IPMCs) occur more frequently in main-duct intraductal papillary mucinous neoplasms. Methods: Review of the literature. Results: The prognosis of IPMCs depends on its histopathological subtype: colloid IPMCs have superior survival rates mainly secondary to more favorable pathological features, whereas tubular IPMCs have survival outcomes similar to that of conventional pancreatic adenocarcinomas. The epithelial background plays an equally important role in defining the biology of IPMCs: gastric IPMC subtypes demonstrate an overall worse survival outcome when compared to intestinal, pancreatobiliary, and oncocytic subtypes. Lymph node involvement is one of the strongest predictors of survival in IPMC, with a decreasing overall survival as the lymph node ratio increases. There is little evidence to support adjuvant chemoradiation in patients with IPMC. Conclusion: Our current understanding of IPMC biology based on histopathological and epithelial background subtypes as well as clinicopathological predictors should influence patient counseling and selection for adjuvant therapy

Liver transplantation utilizing a severely fractured graft: every organ counts

In our current era where shortage of liver grafts is commonplace, utilization of traumatic liver grafts may represent an opportunity to expand the organ donor pool without compromising graft survival. However, data on liver transplantation using a fractured liver allograft is scarce, with only small case series and reports found in the literature. In this report, we describe our experience with utilizing a liver graft with grade IV hepatic fracture for transplantation. At 12 months follow up, the recipient has excellent graft function and has regained an excellent quality of life. We demonstrate that the ability to safely use a fractured liver graft represents an additional avenue for expansion of the deceased donor population, especially in regions with prolonged waitlist times