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Utilizing Instilling Negative Pressure Wound Therapy with Vashe Wound Solution for an Infected Sternal Dehiscence: A Case Report

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Surgical Science 2023年第3期14卷 231-239页

作者： Linnea T. Mauro Courtney M. Janowski Mariah J. Janowski Adalberto C. Gonzalez Eugene J. Sidoti Luis G. Fernandez Paul J. Kim Marc R. Matthews Valleywise medical Center Department of Surgery Phoenix Arizona department of Surgery Division of Trauma Surgery/Surgical Critical Care University of Texas Health Science Center Tyler Texas The university of texas Tyler School of Medicine Endowed Chair in Trauma Surgery Tyler Texas Trauma Wound Care UT Health East Tyler Texas department of Surgery University of Texas Medical Branch Galveston Texas Medicine and Nursing University of Texas Arlington Texas department of medical Education Health Science Center Tyler Texas department of Physician Assistant Studies School of Health Professions University of North Texas Fort Worth Texas ACS National Committee on Trauma Chicago USA Plastic Surgery Department of Surgery University of Texas Southwestern Dallas Texas university of Arizona & Creighton university Schools of Medicine The Arizona Burn Center Phoenix Arizona

Utilization of negative pressure wound therapy with instillation (NPWTi) for sternal dehiscence wounds secondary to sternal wound infection after surgery has become an accepted therapy. NPWTi accelerates wound healing through macrostrain, microstrain, and cyclic fluid instillation. Wounds benefit from additional superficial infection control with the removal of microorganisms, the release of proinflammatory mediators, stimulation of angiogenesis, as well as mechanical debridement. However, very few cases of utilizing NPWTi in the treatment of sternal wound infections have been reported in the literature. This case study describes the use of NPWTi with hypochlorous acid for the treatment of a sternal wound infection.

关键词： Negative Pressure Wound Therapy with Instillation NPWT NPWTi NPWT with Dwell Hypochlorous Acid Vashe Wound Solution Sternal Dehiscence

Current Practices in Prescribing Auto-Injectable Epinephrine during Immunotherapy amongst Otolaryngic Allergists

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International Journal of Otolaryngology and Head & Neck Surgery 2021年第4期10卷 258-267页

作者： Kareem B. Haroun Duncan C. Watley Farrah N. Siddiqui department of Otolaryngology University of Texas Medical Branch Galveston TX USA

Purpose: Allergen immunotherapy (AIT) while usually safe, is not without risk. Both sublingual (SLIT) and subcutaneous immunotherapy (SCIT) have the potential for systemic reactions including anaphylaxis. Materials and Methods: A short survey was distributed to fellows of the American Academy of Otolaryngic Allergy (AAOA) (n = 553) in July of 2019 to determine current prescribing practices. Results: A total of 103/553 surveys were completed, giving a response rate of 18.6%. Prescribing patterns for SCIT showed 79.6% prescribed auto-injectable epinephrine (AIE) to all patients, 11.7% prescribed only to high risk patients, while 1.9% did not prescribe AIE at all. SLIT showed similar patterns with 71.8% prescribing AIE to all, 11.7% to high risk or letting patient choose, and 6.8% did not prescribe to anyone. Just under half of the physicians responded affirmatively to giving a written anaphylaxis plan to patients on immunotherapy. 48.5% physicians reported treating in-office anaphylaxis due to SCIT or skin testing in the past year, while 6% reported anaphylaxis due to SLIT. Conclusions: A majority of otolaryngic allergists are still prescribing AIE for both SCIT and SLIT. With the recent higher costs attributed to AIE as well as drug shortages, some physicians are risk-stratifying patients. While SCIT has a higher risk for treatment related systemic reactions, anaphylaxis does occur with SLIT, thus making it imperative to counsel patients on a clear anaphylaxis protocol in all forms of AIT.

关键词： Allergy Immunotherapy Sublingual Immunotherapy Subcutaneous Immunotherapy Anaphylaxis Epinephrine Auto-Injectable Epinephrine

Single-Step Combined Laparoscopic Management of Hepatocellular Carcinoma with Simultaneous Radio Frequency Ablation and Trans-Arterial Embolization in Unresactable Lesions

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Journal of Cancer Therapy 2016年第13期7卷 979-985页

作者： Lukman Cheraghvandi Michael Silva Charlie Cheng Mauro Montalbano Ali Shirafkan Cristiana Rastellini Luca Cicalese department of Surgery University of Texas Medical Branch Galveston TX USA

Hepatocellular carcinoma (HCC) is a cancer with increasing incidence in the USA and high mortality rate. HCC is often difficult to treat due to underlying comorbidities such as cirrhosis. However, the application of loco-regional thermal ablation using radio frequency (RF) and trans-arterial embolization with chemotherapy (TACE) or without (TAE) has shown promising results in the treatment of patients not amenable to surgical resection or liver transplantation. Conventionally, RF and TAE are performed in two separated sessions or two steps and often RF ablation is performed percutaneously. However, no consensus has been reached regarding the ideal interval between the two treatments. In this article, we discuss the feasibility and benefits of a single-step TAE in combination with laparoscopic RF ablation in one operative session. We also present a case where this procedure has been successfully performed demonstrating its feasibility. We suggest that the use of laparoscopic RF ablation in the same surgical session as TAE is feasible and potentially offers several advantages over the two-step process that is usually performed with embolization followed by percutaneous RF with a long time interval. In this article we discuss such advantages.

关键词： Single Step Single Session Hepatocellular Carcinoma Laparoscopic Radiofrequency Ablation Trans-Arterial Embolization

Surgical Flap and Graft Reconstruction Workshop for Dermatology Residents

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Journal of Cosmetics, Dermatological Sciences and Applications 2015年第2期5卷 86-93页

作者： Brandon Goodwin Richard Wagner department of Dermatology The University of Texas Medical Branch Galveston TX USA

Background: Traditional models for teaching surgical principles focus primarily on the apprenticeship theory;however there has been a trend in surgical education to certifying competency in a simulation environment prior to working with patients. Many surgical models emphasize learning the technical and manual dexterity skills necessary to be a surgeon, yet few focus on obtaining the theoretical and abstract skills needed for planning complex cutaneous surgical repairs with flaps and grafts. We developed and evaluated a novel surgical flaps and grafts workshop for residents through the department of Dermatology. Methods: Participants received a 60 minute PowerPoint lecture focusing on the basic principles of cutaneous repair with flaps and grafts, with examples and explanation of each of the four main types of flaps and grafts. The participants then received nine photocopies of Mohs micrographic surgery defects with instructions to design three repairs, focusing on functional and aesthetic outcome. Hypothetical and actual repair designs were then discussed in an open forum format. Anonymous surveys administered to 11 dermatology residents assessed their knowledge level, confidence level, and likelihood of using flaps and grafts pre- and post-workshop using Likert scales. Overall experience was also assessed. A paired sample Wilcoxon Signed Rank Test was used for analysis, since the data was non-parametrically distributed. Results: There was a statistically significant increase in confidence performing flaps post workshop (p = 0.0469). There was also an increase in knowledge of flaps and grafts, confidence in planning flaps and grafts, and confidence in performing grafts post workshop, but these findings did not reach statistical significance. The workshop had no effect on expected future use of flaps and grafts. Conclusions: The surgical workshop is a novel simulation teaching tool for learning basic principles and design of flaps and grafts in cutaneous surgery.

关键词： “Dermatology” Grafts” “Flaps “Surgical Skills Workshop” “Resident Education”

Estrogen augmented visceral pain and colonic neuron modulation in a double-hit model of prenatal and adult stress

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World Journal of Gastroenterology 2021年第30期27卷 5060-5075页

作者： Jing-Hong Chen Ying Sun Pei-Jun Ju Jin-Bao Wei Qing-Jie Li John H Winston Shanghai Key Laboratory of Psychotic Disorders Shanghai Mental Health CenterShanghai Jiao Tong University School of MedicineShanghai 200030China department of Internal Medicine University of Texas Medical BranchGalvestonTX 77555United States

BACKGROUND Chronic stress during pregnancy may increase visceral hyperalgesia of offspring in a sex-dependent *** adult stress in offspring will increase this *** on the evidence implicating estrogen in exacerbating visceral hypersensitivity in female rodents in preclinical models,we predicted that chronic prenatal stress(CPS)+chronic adult stress(CAS)will maximize visceral hyperalgesia;and that estrogen plays an important role in colonic *** The aim was to illuminate the role of estrogen in colonic hyperalgesia and its underlying *** We established a CPS plus CAS rodent model in which the balloon was used to distend the *** single-fiber recording in vivo and patch clamp experiments in vitro were used to monitor the colonic neuron’s *** reverse transcription-polymerase chain reaction,western blot,and immunofluorescence were used to study the effects of CPS and CAS on colon primary afferent *** used ovariectomy and letrozole to reduce estrogen levels of female rats respectively in order to assess the role of estrogen in female-specific enhanced primary afferent *** Spontaneous activity and single fiber activity were significantly greater in females than in *** enhanced sensitization in female rats mainly came from lowthreshold *** significantly increased single-unit afferent fiber activity in L6-S2 dorsal roots in *** was further enhanced by *** addition,the excitability of colon-projecting dorsal root ganglion(DRG)neurons increased in CPS+CAS rats and was associated with a decrease in transient Atype K+*** with ovariectomy,treatment with the aromatase inhibitor letrozole significantly reduced estrogen levels in female rats,confirming the gender ***,mice treated with letrozole had decreased colonic DRG neuron *** intrathecal infusion of estrogen increased brain-derived neurotrophic factor(BDNF)p

关键词： Chronic prenatal stress Estrogen Visceral pain Neuronal sensitization Excitability Letrozole

Efficacy of Nd:YAG Laser for the Treatment of Hidradenitis Suppurativa

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Journal of Cosmetics, Dermatological Sciences and Applications 2012年第2期2卷 83-87页

作者： Neda Nosrati Lindsey Hunter Erica Kelly department of Dermatology University of Texas Medical Branch Galveston USA

Hidradenitis suppurativa (HS) is an inflammatory skin disease that involves sebaceous glands and hair follicles of intertriginous areas, including axillary and inguinal regions. It is often chronic, painful, disabling, and can worsen over time. Besides surgically excising affected areas, effective treatments are currently lacking. The long-pulsed neodymium:yttrium-aluminium-garnet (Nd:YAG) laser is a device that has traditionally been used for hair removal, but has recently shown promise in clearing old lesions of HS and preventing new eruptions. In accordance with studies in the current literature, we hypothesize that the Nd:YAG laser will significantly improve subjects with hidradenitis suppurativa compared to standard, uninvasive treatment with topical antibiotics [1,2]. Study aims include: to treat subjects with hidradenitis suppurativa with Nd:YAG laser therapy once monthly for 3 consecutive months, with a one month follow-up;to compare the effectiveness of Nd:YAG treatment on one side of the subject (e.g., right) to treatment with topical antibiotics on the subject’s other side (e.g., left);to assess treatment response using a visual analogue scale;to assess subject satisfaction with treatment using a questionnaire;and to photodocument treatment response at each visit.

关键词： Hidradenitis Suppurativa Nd:YAG Laser Acne Inverse Follicular Disease

Contrast-enhanced endoscopic ultrasonography

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World Journal of Gastroenterology 2011年第1期17卷 42-48页

作者： Nischita K Reddy Ana Maria Ioncicǎ Adrian Sǎftoiu Peter Vilmann Manoop S Bhutani department of Medicine University of Texas Medical BranchGalvestonTX 77555-0144United States department of Gastroenterology and Hepatology University of Medicine and Pharmacy CraiovaCraiova 200349Romania department of Surgical Gastroenterology Gentofte and Herlev University Hospital2730 HerlevCopenhagenDenmark department of Gastroenterology Hepatology and Nutrition-Unit 1466University of TexasMD Anderson Cancer CenterHoustonTX 77030-4009United States

Contrast agents are increasingly being used to characterize the vasculature in an organ of interest,to better delineate benign from malignant pathology and to aid in staging and directing therapeutic *** review the mechanisms of action of first,second and third generation contrast agents and their use in various endoscopic procedures in the gastrointestinal *** applications of contrast-enhanced endoscopic ultrasonography include differentiating benign from malignant mediastinal lymphadenopathy,assessment of depth of invasion of esophageal,gastric and gall bladder cancers and visualization of the portal venous system and esophageal *** addition,contrast agents can be used to differentiate pancreatic *** use of color Doppler further increases the ability to diagnose and differentiate various pancreatic *** sensitivity of power Doppler sonography to depict tumor neovascularization can be increased by contrast ***-enhanced harmonic imaging is a useful aid in identifying the tumor vasculature and studying pancreatic *** the future,these techniques could potentially be used to quantify tumor perfusion,to assess and monitor the efficacy of antiangiogenic agents,to assist targeted drug delivery and allow molecular imaging.

关键词：多普勒超声内镜恶性肿瘤新生血管分子成像造影剂淋巴结肿大门静脉系统

Role of endoscopic ultrasound in liver disease: Where do we stand in 2017?

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World Journal of Hepatology 2017年第24期9卷 1013-1021页

作者： Hamzeh A Saraireh Mohammad Bilal Shailendra Singh department of Internal Medicine University of Texas Medical Branch Division of Gastroenterology and Hepatology University of Texas Medical Branch Division of Gastroenterology Hepatology and Nutrition Allegheny General Hospital

Endoscopic ultrasound(EUS) was first introduced into medical practice in 1980 s as a diagnostic imaging modality for pancreatic pathology. EUS has the unique advantage of combining ultrasound and endoscopy to obtain detailed information of the gastrointestinal tract. Over the past decade, the use of EUS in liver diseases has been increasing. EUS, which was initially used as a diagnostic tool, is now having increasing therapeutic role as well. We provide a review of the application of EUS in the diagnostic and therapeutic aspects of liver disease. We also look at the evolving future research on the role of EUS in liver diseases.

关键词：内视镜的超声肝疾病门高血压肝损害

Dermatology Procedural and Surgical Skills Workshop for medical and Physician Assistant Students

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Journal of Cosmetics, Dermatological Sciences and Applications 2013年第3期3卷 44-48页

作者： Julie Martin Sheila Z. Jalalat Richard F. Wagner The university of texas medical branch Galveston USA

Background: Evidence indicating the limited amount of hands-on experience in the current era of medical training has raised concern regarding students’ development and potential deficiencies in the performance of basic procedural skills. Studies have demonstrated the value of surgical workshops for medical students;however evaluation of improved student performance during future clerkships or residencies has yet to be assessed. We initiated and evaluated a resident-led surgical skills workshop for students through the department of Dermatology. Methods: Participants received instructions on surgical tools/techniques followed by hands-on practice. Anonymous surveys administered to 24 medical and physician assistant students assessed their skill level, confidence level, and likelihood of using surgical skills in future practice preand post-workshop using a 1 - 5 Likert scale. Overall experience was also assessed. Non-parametric bivariate tests were used for analysis to account for non-normal distribution of the data. Results: There was a statistically significant change in skill (p = 0.0001) and confidence (p = 0.0001) level post workshop. There was no significant difference in utility. There were also no statistically significant differences based on the year of medical student training, medical student versus physician assistant student responses, or number of procedures performed prior to the workshop. Estimated cost per participant was $5.65. Conclusions: Research supports our finding that workshop learning experiences increase students’ ability to perform common procedural skills, their confidence, and desire to practice such skills. Further studies are necessary to determine the impact of these skills workshops on long-term clinical performance in future clerkships and residencies.

关键词： Procedural Skills Workshop Dermatology Residents medical Students