Robotic Approach to Colon Resection

Robotic surgical techniques are being increasingly adopted as a tool in the minimally invasive armamentarium of the colorectal surgeon. These platforms present numerous potential advantages in visualization, precise dissection, and tissue manipulation while potentially reducing operator fatigue. They may also reduce the learning curve and rate of conversion, though the short- and long-term benefits of this approach in non-pelvic colorectal surgery, and the cost–benefit balance remain an ongoing debate. Adherence to established principles of laparoscopic colon surgery, a robust understanding of the operative anatomy, and proper patient preparation and setup are critical for the efficient and effective utilization of a robotic approach for colon resection

Use of rectal mucosal grafts in substitution urethroplasty: an early series

Background: To evaluate the feasibility of use of rectal mucosal grafts for augmentation urethroplasty. Methods: A series of five patients who underwent rectal mucosal graft urethroplasty for urethral stricture disease were identified. Descriptive statistics were used to describe these patients. Primary endpoints were recurrence of stricture and perioperative morbidity. Results: Five patients underwent rectal mucosal graft augmentation urethroplasty. Four had a history of prior buccal mucosal graft (BMG) urethroplasty and one had a history of head and neck cancer. Rectal mucosa was noted to be thinner and required more tailoring than buccal mucosa. All patients had patent urethras at time of postoperative retrograde urethrogram. A small diverticulum was noted in one patient with no further sequelae. No complications from rectal mucosal graft harvest were noted. All patients with prior buccal grafting subjectively preferred the rectal graft due to fewer side effects. Subjectively, patients with prior buccal grafts preferred the post-operative recovery following rectal mucosal graft urethroplasty. Conclusions: Rectal mucosal graft augmentation urethroplasty is a safe alternative in patients with contraindications to buccal grafting with limited morbidity

Laparoscopic Colectomy: Does the Learning Curve Extend Beyond Colorectal Surgery Fellowship?

Colorectal fellowship training adequately surpasses the learning curve with regard to safety and outcome; however, the surgeon continues to increase operative efficiency during the first year of practice

Pancreatic Cysts Identification Using Unstructured Information Management Architecture

poster abstractPancreatic cancer is one of the deadliest cancers, mostly diagnosed at late stages. Patients with pancreatic cysts are at higher risk of developing cancer and surveillance of these patients can help with early diagnosis. Much information about pancreatic cysts can be found in free text format in various medical narratives. In this retrospective study, a corpus of 1064 records from 44 patients at Indiana University Hospital from 1990 to 2012 was collected. A natural language processing system was developed and used to identify patients with pancreatic cysts. The input goes through series of tasks within the Unstructured Information Management Architecture (UIMA) framework consisting of report separation, metadata detection, sentence detection, concept annotation and writing into the database. Metadata such as medical record number (MRN), report id, report name, report date, report body were extracted from each report. Sentences were detected and concepts within each sentence were extracted using regular expression. Regular expression is a pattern of characters matching specific string of text. Our medical team assembled concepts that are used to identify pancreatic cysts in medical reports and additional keywords were added by searching through literature and Unified Medical Language System (UMLS) knowledge base. The Negex Algorithm was used to find out negation status of concepts. The 1064 reports were divided into sets of train and test sets. Two pancreatic-cyst surgeons created the gold standard data (Inter annotator agreement K=88%). The training set was analyzed to modify the regular expression. The concept identification using the NegEx algorithm resulted in precision and recall of 98.9% and 89% respectively. In order to improve the performance of negation detection, Stanford Dependency parser (SDP) was used. SDP finds out how words are related to each other in a sentence. SDP based negation algorithm improved the recall to 95.7%

Four new T dwarfs identified in PanSTARRS 1 commissioning data

A complete well-defined sample of ultracool dwarfs is one of the key science programs of the Pan-STARRS 1 optical survey telescope (PS1). Here we combine PS1 commissioning data with 2MASS to conduct a proper motion search (0.1--2.0\arcsec/yr) for nearby T dwarfs, using optical+near-IR colors to select objects for spectroscopic followup. The addition of sensitive far-red optical imaging from PS1 enables discovery of nearby ultracool dwarfs that cannot be identified from 2MASS data alone. We have searched 3700 sq. deg. of PS1 y-band (0.95--1.03 um) data to y$\approx$19.5 mag (AB) and J$\approx$16.5 mag (Vega) and discovered four previously unknown bright T dwarfs. Three of the objects (with spectral types T1.5, T2 and T3.5) have photometric distances within 25 pc and were missed by previous 2MASS searches due to more restrictive color selection criteria. The fourth object (spectral type T4.5) is more distant than 25 pc and is only a single-band detection in 2MASS. We also examine the potential for completing the census of nearby ultracool objects with the PS1 3$\pi$ survey.Comment: 25 pages, 8 figures, 5 table, AJ accepted, updated to comply with Pan-STARRS1 naming conventio

Association Between Community Social Vulnerability and Preventable Hospitalizations

Preventable hospitalizations are common and costly events that burden patients and our health care system. While research suggests that these events are strongly linked to ambulatory care access, emerging evidence suggests they may also be sensitive to a patient’s social, environmental, and economic conditions. This study examines the association between variations in social vulnerability and preventable hospitalization rates. We conducted a cross-sectional analysis of county-level preventable hospitalization rates for 33 states linked with data from the 2020 Social Vulnerability Index (SVI). Preventable hospitalizations were 40% higher in the most vulnerable counties compared with the least vulnerable. Adjusted regression results confirm the strong relationship between social vulnerability and preventable hospitalizations. Our results suggest wide variation in community-level preventable hospitalization rates, with robust evidence that variation is strongly related to a community’s social vulnerability. The human toll, societal cost, and preventability of these hospitalizations make understanding and mitigating these inequities a national priority

Space Environment Effects on Silicone Seal Materials

A docking system is being developed by the NASA to support future space missions. It is expected to use redundant elastomer seals to help contain cabin air during dockings between two spacecraft. The sealing surfaces are exposed to the space environment when vehicles are not docked. In space, the seals will be exposed to temperatures between 125 to -75 C, vacuum, atomic oxygen, particle and ultraviolet radiation, and micrometeoroid and orbital debris (MMOD). Silicone rubber is the only class of space flight-qualified elastomeric seal material that functions across the expected temperature range. NASA Glenn has tested three silicone elastomers for such seal applications: two provided by Parker (S0899-50 and S0383-70) and one from Esterline (ELA-SA-401). The effects of atomic oxygen (AO), UV and electron particle radiation, and vacuum on the properties of these three elastomers were examined. Critical seal properties such as leakage, adhesion, and compression set were measured before and after simulated space exposures. The S0899-50 silicone was determined to be inadequate for extended space seal applications due to high adhesion and intolerance to UV, but both S0383-70 and ELA-SA-401 seals were adequate

Compositional shifts within the denture-associated bacteriome in pneumonia – an analytical cross-sectional study

Introduction. Bacterial pneumonia is a common cause of morbidity and mortality in elderly individuals. While the incidence of edentulism is falling, approximately 19 % of the UK population wear a full or partial removable denture. Despite advances in denture biomaterials, the majority of dentures are fabricated using polymethyl-methacrylate. Growing evidence suggests that colonization of the oral cavity by putative respiratory pathogens predisposes individuals to respiratory infection, by translocation of these microorganisms along the respiratory tract.Hypothesis/Gap Statement. We hypothesized that denture surfaces provide a susceptible colonization site for putative respiratory pathogens, and thus could increase pneumonia risk in susceptible individuals.Aim. This study aimed to characterize the bacterial community composition of denture-wearers in respiratory health compared with individuals with a confirmed diagnosis of pneumonia.Methodology. This was an analytical cross-sectional study, comparing frail elderly individuals without respiratory infection (n=35) to hospitalized patients with pneumonia (n=26). The primary outcome was the relative abundance of putative respiratory pathogens identified by 16S rRNA metataxonomic sequencing, with quantitative PCR used to identified Streptococcus pneumoniae.Results. There was a statistically significant increase in the overall relative abundance of putative respiratory pathogens (P<0.0001), with a greater than 20-fold increase in the bioburden of these microorganisms. In keeping with these findings, there were significant shifts in bacterial community diversity (Chao index, P=0.0003) and richness (Inverse Simpson index P<0.0001) in the denture-associated microbiota of pneumonia patients compared with control subjects.Conclusion. Within the limitations of this study, our evidence supports the role of denture acrylic biomaterials as a potential colonization site for putative respiratory pathogens, which may lead to an increased risk of pneumonia in susceptible individuals. These findings support prior observational studies which have found denture-wearers to be at increased risk of respiratory infection. Further research is needed to confirm the sequence of colonization and translocation to examine potential causal relationships