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Outcomes of early versus late irrigation and debridement of pediatric open long bone fractures

World Journal of Orthopedics 2024年第6期15卷 539-546页

作者： Riya Savla Yen-Hong Kuo Nasim Ahmed Department of Surgery and Trauma Hackensack Meridian School of MedicineNutleyNJ 07110United States Department of Medical Sciences Hackensack Meridian School of medicineNutleyNJ 08753United States Office of Research Administration Hackensack Meridian Health Research InstituteNutleyNJ 077110United States Department of Surgery Department of Trauma and Surgical Critical CareJersey Shore University Medical CenterNeptuneNJ 07754United States Department of Surgery Department of Trauma and Surgical Critical CareHackensack Meridian School of MedicineNutleyNJ 07110United States

BACKGROUND Open long bone fractures are a major concern for pediatric patients due to the risk of surgical site infection(SSI).Early studies have recommended irrigation and debridement of open fractures within 6 hours-8 hours for the prevention of *** to the American College of Surgeons(ACS)Best Practice Guidelines,in 2015,irrigation and debridement should be done within 24 *** To identify whether early irrigation and debridement,within 8 hours,vs late,between 8 hours and 24 hours,for pediatric open long bone fractures impacts rate of *** Using retrospective data review from the National Trauma Data Bank,Trauma Quality Improvement Project(TQIP)of *** database is own by the ACS and it is the largest database for trauma quality program in the *** matching analysis was performed for the *** There were 390 pediatric patients with open long bone fractures who were incl-uded in the *** completing propensity score matching,we had 176 patients in each category,irrigation and debridement within 8 hours and irrigation and debridement between 8 hours and 24 *** found no significant differences between each group for the rate of deep SSI which was 0.6%for patients who received surgical irrigation and debridement within 8 hours and 1.1%for those who received it after 8 hours[adjusted odd ratio(AOR):0.5,95%CI:0.268-30.909,P>0.99].For the secondary outcomes studied,in terms of length of hospital stay,patients who received irrigation and debridement within 8 hours stayed for an average of 3.5 days,and those who received it after 8 hours stayed for an average of 3 days,with no significant difference found,and there were also no sig-nificant differences found between the discharge dispositions of the *** Our findings support the recommendation for managing open long bone fractures from the ACS:Complete surgical irrigation and debridement within 24 hours.

关键词： Pediatric trauma Open tibia fracture Irrigation and debridement Timing of intervention Surgical site infection

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Role of buccal mucosa graft ureteroplasty in the surgical management of pyeloplasty failure

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Asian Journal of Urology 2024年第3期11卷 373-376页

作者： Matthew Lee Elizabeth Nagoda David Strauss Matthew Loecher Michael Stifelman Lee Zhao Department of Urology Lewis Katz School of MedicineTemple UniversityPhiladelphiaPAUSA Department of Urology Hackensack Meridian School of MedicineHackensack University Medical CenterHackensackNJUSA Department of Urology New York University Grossman School of MedicineNew York University Langone Health SystemNew YorkNYUSA

Objective:Secondary pyeloplasty for recurrent ureteropelvic junction obstructions may be a safe and feasible surgical option for *** study aimed to demonstrate outcomes of utilizing a non-transecting buccal mucosa graft ureteroplasty for management of recurrent ureteropelvic junction obstruction after prior failed ***:We performed a retrospective review of our Collaborative of Reconstructive Robotic Ureteral Surgery database for all consecutive patients who underwent buccal mucosa graft ureteroplasty between April 2012 and June 2022 for management of recurrent ureteropelvic junction obstructions after prior failed *** primary outcome included surgical success which was defined as the absence of flank pain and no obstruction on ***:Overall,ten patients were included in our *** median stricture length was 2.5(interquartile range[IQR]1.8-4.0)*** median operative time was 230.5(IQR 199.5-287.0)min and median estimated blood loss was 50.0(IQR 28.8-102.5)*** a median follow-up of 10.3(IQR 6.2-14.8)months,80%of patients were surgically successful and there were no major(ClavieneDindo Grade>2)***:Buccal mucosa graft ureteroplasty is a valuable non-transecting surgical option for patients with recurrent ureteropelvic junction obstructions who failed prior pyeloplasty and has comparable outcomes to the literature regarding standard transecting techniques.

关键词： Ureteral obstruction Buccal mucosa graft Pyeloplasty Robotic Stricture

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Surgical management of facial dog bite trauma:A contemporary perspective and review

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2023年第2期9卷 123-130页

作者： Tiffany Chen Maria Karim Zachary T.Grace Andrew R.Magdich Eric C.Carniol Brian E.Benson Peter F.Svider hackensack meridian School of Medicine NutleyNew JerseyUSA Carniol Plastic Surgery SummitNew JerseyUSA hackensack meridian health Hackensack University Medical CenterHackensackNew JerseyUSA Bergen Medical Associates EmersonNew JerseyUsA

Objective:To perform a review evaluating management of and complications stemming from dog bite trauma sustained to the head and neck over the past *** Sources:PubMed and Cochrane ***:The authors searched the PubMed and Cochrane Library databases for relevant published literature.A total of 12 peer-reviewed canine-exclusive series inclusive of 1384 patient cases describing facial dog bite trauma met inclusion *** including fractures,lacerations,contusions,and other soft-tissue injuries were *** related to clinical course and management,operating room requirements,and antibiotic usage were compiled and *** trauma and surgical management complications were also ***:75.5%of patients sustaining dog bites required surgical *** these patients,7.8%suffered from postsurgical complications,including hypertrophic scarring(4.3%),postoperative infection(0.8%),or nerve deficits and persistent paresthesias(0.8%).Prophylactic antibiotics were administered to 44.3%of patients treated for facial dog bites and the overall infection rate was 5.6%.Concomitant fracture was present in 1.0%of ***:Primary closure,often in the OR may be necessary,with few cases requiring grafts or *** should be aware that the most common complication is hypertrophic *** research is needed to elucidate the role of prophylactic antibiotics.

关键词： bite canine dog face facial injury laceration trauma

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Overview of juvenile localized scleroderma and its management

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World Journal of Pediatrics 2020年第1期16卷 5-18页

作者： Suzanne C.Li Rong-Jun Zheng Department of Pediatrics Division of Pediatric RheumatologyJoseph M.Sanzari Children's HospitalHackensack University Medical Center30 Prospect AvenueImus 337Hackensack 07601NJUSA Department of Pediatrics Hackensack Meridian School of Medicine at Seton Hall UniversityClifton 07110NJUSA Department of Rheumatology Immunologyand AllergyChildren's HospitalZhejiang University School of MedicineHangzhou 310003China

Background Juvenile localized scleroderma(JLS)is a rare pediatric disease characterized by inflammation and skin thick *** is associated with deep tissue and extracutaneous involvement that often results in functional impairment and growth *** article provides an overview of the disease with a focus on active features and *** sources We searched databases including PubMed,Elsevier and MedLine and Wanfang,reviewing publications from 2013 to *** earlier publications were also *** Linear scleroderma is the most common JLS *** lines of evidence suggest that JLS is an autoimmune *** involvement is common and can present before the onset of skin *** skin features are associated with disease activity,and activity can also manifest as arthritis,myositis,uveitis,seizures,and growth *** immunosuppressive treatment,commonly methotrexate with or without glucocorticoids,greatly improves outcome and is recommended for treating JLS patients with active disease and moderate or higher *** term monitoring is needed because of the disease's chronicity and the high frequency of relapses off of *** JLS is associated with a risk for disabling and disfiguring morbidity for the growing *** active disease is important for guiding treatment,but often difficult because of the paucity of markers and lack of a universal skin activity *** studies of JLS pathophysiology are needed to allow the identification of biomarkers and therapeutic *** effectiveness treatment studies are also needed to work towards optimizing care and outcome.

关键词： Disease activity Extracutaneous involvement Juvenile localized scleroderma Morphea Pediatric scleroderma Treatment

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Gastric Perforation after Cesarean Delivery: An Unintended Consequence of the Opioid Epidemic

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Open Journal of Obstetrics and Gynecology 2021年第5期11卷 563-568页

作者： Tesia A. McKenzie Eugene Zurkovsky Jonathan D. Baum Department of Obstetrics and Gynecology Departments Affiliated with Jersey Shore University Medical Center Hackensack Meridian Health System Neptune USA Department of General Surgery Departments Affiliated with Jersey Shore University Medical Center Hackensack Meridian Health System Neptune USA

30 year old female now para 1 presented to the Emergency Department with nausea, vomiting, and abdominal pain 6 days after an uncomplicated primary cesarean delivery. She did not respond to conservative management and underwent exploratory laparotomy for worsening pain, pneumoperitoneum and intraabdominal fluid collections. Gastric perforations required repair via gastrojejunostomy. Postoperative course was unremarkable. The anti-opioid campaign has altered the approach to postoperative pain management in both positive and negative ways. It has sparked new interest in alternative approaches to postoperative pain management, which include an increased role for non-steroidal anti-inflammatory drugs (NSAIDs). We present a case of a woman who had a significant complication due to the reliance of non-opioid pain medications after cesarean delivery.

关键词： Opioid Opioid Epidemic Gastric Perforation Gastrojejunostomy Cesarean Delivery

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Traumatic Lower Extremity Reconstruction in a Patient with Significant Vascular Comorbidities

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Modern Plastic Surgery 2024年第4期14卷 113-121页

作者： Natalia Da Fonte Richard Winters hackensack meridian School of Medicine Nutley NJ USA Department of Plastic Surgery Hackensack University Medical Center Hackensack NJ USA

Limb salvage after devastating traumatic injuries, cancer extirpation, and intrinsic disease is a complex decision-making process. Although several scoring and evaluation tools have been created to attempt to apply algorithmic decision-making to the process, thoughtful clinical decision-making remains the most important standard. When limb salvage is deemed appropriate, selection of a tissue flap for limb reconstruction is dependent on the size and location of the defect, patient comorbidities, nicotine dependence, mechanism of injury to the limb, patient lifestyle, occupation, and ambulatory status. This case involves a male trauma patient with significant comorbidities and a large lower extremity wound requiring multiple operations to attempt limb reconstruction with a rectus abdominis free flap. This patient’s complex injury and comorbidities made the risk of flap failure high, illustrating that the importance of patient- and case-specific factors cannot be overstated when planning for a limb reconstruction. This extreme resort of limb reconstruction, where limb loss is the only other option and a likely consequence of even heroic efforts, is aptly called “limb salvage”.

关键词： Free Flap Limb Reconstruction Limb Salvage

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SRSF1 plays a critical role in invariant natural killer T cell development and function

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Cellular & Molecular Immunology 2021年第11期18卷 2502-2515页

作者： Jingjing Liu Menghao You Yingpeng Yao Ce Ji Zhao Wang Fang Wang Di Wang Zhihong Qi Guotao Yu Zhen Sun Wenhui Guo Juanjuan Liu Shumin Li Yipeng Jin Tianyan Zhao Hai-Hui Xue Yuanchao Xue Shuyang Yu State Key Laboratory of Agrobiotechnology College of Biological SciencesChina Agricultural UniversityBeijingChina Key Laboratory of RNA Biology Institute of BiophysicsChinese Academy of SciencesBeijingChina Clinical Department College of Veterinary MedicineChina Agricultural UniversityBeijingChina Center for Discovery and Innovation Hackensack Meridian HealthNutleyNJUSA

Invariant natural killer T(iNKT)cells are highly conserved innate-like T lymphocytes that originate from CD4^(+)CD8^(+)double-positive(DP)***,we report that serine/arginine splicing factor 1(SRSF1)intrinsically regulates iNKT cell development by directly targeting Myb and balancing the abundance of short and long *** ablation of SRSF1 in DP cells led to a substantially diminished iNKT cell pool due to defects in proliferation,survival,and TCRα*** transition from stage 0 to stage 1 of iNKT cells was substantially blocked,and the iNKT2 subset was notably diminished in SRSF1-deficient ***1 deficiency resulted in aberrant expression of a series of regulators that are tightly correlated with iNKT cell development and iNKT2 differentiation,including Myb,PLZF,Gata3,ICOS,and *** particular,we found that SRSF1 directly binds and regulates pre-mRNA alternative splicing of Myb and that the expression of the short isoform of Myb is substantially reduced in SRSF1-deficient DP and iNKT ***,ectopic expression of the Myb short isoform partially rectified the defects caused by ablation of ***,we confirmed that the SRSF1-deficient mice exhibited resistance to acute liver injury uponα-GalCer and Con A *** findings thus uncovered a previously unknown role of SRSF1 as an essential post-transcriptional regulator in iNKT cell development and functional differentiation,providing new clinical insights into iNKT-correlated disease.

关键词： Invariant natural killer T cell SRSF1 Development Function Alternative splicing

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Post-traumatic thrombotic microangiopathy: What trauma surgeons need to know?

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Chinese Journal of Traumatology 2021年第2期24卷 69-74页

作者： Mohammad A.Hossain Nasim Ahmed Varsha Gupta Ravneet Bajwa Marjan Alidoost Arif Asif Tushar Vachharajani Department of Medicine Hackensack Meridian Health Jersey Shore University Medical CenterNeptuneNJ07753USA Department of Surgery Division of Trauma SurgeryHackensack Meridian Health Jersey Shore University Medical CenterNeptuneNJ07753USA Global Nephrology Glickman Urological&Kidney InstituteCleveland ClinicClevelandOH44103USA

Thrombotic microangiopathy(TMA)is characterized by systemic microvascular thrombosis,target organ injury,anemia and *** thrombocytopenic purpura,atypical hemolytic uremic syndrome and Shiga toxin E-coli-related hemolytic uremic syndrome are the three common forms of ***,TMA is encountered during pregnancy/postpartum period,malignant hypertension,systemic infections,malignancies,autoimmune disorders,***,the patients presenting with trauma have been reported to suffer from *** carries a high morbidity and mortality,and demands a prompt recognition and early intervention to limit the target organ *** trauma surgeons are the first line of defense for patients presenting with trauma,the prompt recognition of TMA for these experts is critically *** treatment of post-traumatic TMA can help improve the patient outcomes,if the diagnosis is made *** treatment of TMA is also different from acute blood loss anemia namely in that plasmapheresis is recommended rather than platelet *** article familiarizes trauma surgeons with TMA encountered in the context of ***,it provides a simplified approach to establishing the diagnosis of *** trauma patients can require multiple transfusions,the development of disseminated intravascular coagulation must be ***,the article also provides different features of disseminated intravascular coagulation and ***,the article suggests practical points that can be readily applied to the management of these patients.

关键词： Trauma Microangiopathy Complement amplifying condition

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Impact of liver cirrhosis on ST-elevation myocardial infarction related shock and interventional management,a nationwide analysis

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World Journal of Hepatology 2022年第4期14卷 766-777页

作者： Sophia Haroon Dar Mehek Rahim Davood K Hosseini Khurram Sarfraz Internal Medicine Hackensack University Medical CenterHackensackNJ 07601United States

BACKGROUND Critical care is rapidly evolving with significant innovations to decrease hospital stays and *** our knowledge,there is limited data on factors that affect the length of stay and hospital charges in cirrhotic patients who present with STelevation myocardial infarction-related cardiogenic shock(SRCS).AIM To identify the factors that increase inpatient mortality,length of stay,and total hospital charges in patients with liver cirrhosis(LC)compared to those without *** This study includes all adults over 18 from the National Inpatient Sample 2017 *** study consists of two groups of patients,including SRCS with LC and without *** mortality,length of stay,and total hospital charges are the primary outcomes between the two *** used STATA 16 to perform statistical *** Pearson's chi-square test compares the categorical ***-matched scoring with univariate and multivariate logistic regression generated the odds ratios for inpatient mortality,length of stay,and resource *** This study includes a total of 35798453 weighted hospitalized patients from the 2017 National Inpatient *** two groups are SRCS without LC(n=758809)and SRCS with LC(n=11920).The majority of patients were Caucasian in both groups(67%vs 72%).The mean number of patients insured with Medicare was lower in the LC group(60%vs 56%)compared to the other group,and those who had at least three or more comorbidities(53%vs 90%)were significantly higher in the LC group compared to the non-LC *** mortality was also considerably higher in the LC group(28.7%vs 10.63%).Length of Stay(LOS)is longer in the LC group compared to the non-LC group(9 vs 5.6).Similarly,total hospital charges are higher in patients with LC($147407.80 vs$113069.10,P≤0.05).Inpatient mortality is lower in the early percutaneous coronary intervention(PCI)group(OR:0.79<0.11),however,it is not statistically *** early Impella(OR:1.73<0.

关键词： Gastroenterology Hepatology Liver ST-elevation myocardial infarction Cardiogenic Shock Percutaneous coronary intervention Impella Extracorporeal membrane oxygenation

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Management of gastrointestinal bleed in the intensive care setting,an updated literature review

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World Journal of Critical Care Medicine 2025年第1期14卷 20-41页

作者： Vignesh K Nagesh Sai Priyanka Pulipaka Ruchi Bhuju Emelyn Martinez Shruthi Badam Gomathy Aarthy Nageswaran Hadrian Hoang-Vu Tran Daniel Elias Charlene Mansour Jaber Musalli Sanket Bhattarai Lokeash Subramani Shobana Tannishtha Sethi Ritvik Sethi Namrata Nikum Chinmay Trivedi Amer Jarri Colin Westman Nazir Ahmed Shawn Philip Simcha Weissman Jonathan Weinberger Ayrton I Bangolo Department of Internal Medicine Palisades Medical CenterNorth BergenNJ 07047United States Department of Internal Medicine University of Arkansas for Medical SciencesLittle RockAR 72205United States Department of Internal Medicine Hackensack Palisades Medical CenterNorth BergenNJ 07047United States Department of Gastroenterology Hackensack University Medical CenterHackensackNJ 07061United States Department of Pulmonology and Critical Care HCA Florida Bayonet Point HospitalHudsonFL 34667United States Department of Hematology&Oncology John Theurer Cancer Center at Hackensack University Medical CenterHackensackNJ 07601United States

Gastrointestinal(GI)bleeding is a critical and potentially life-threatening condition frequently observed in the intensive care unit(ICU).This literature review consolidates current insights on the epidemiology,etiology,management,and outcomes of GI bleeding in critically ill *** bleeding remains a significant concern,especially among patients with underlying risk factors such as coagulopathy,mechanical ventilation,and renal *** GI bleeding in the ICU requires a multidisciplinary approach,including resuscitation,endoscopic intervention,pharmacologic therapy,and sometimes surgical *** with enhanced management strategies,GI bleeding in the ICU is associated with considerable morbidity and mortality,particularly when complicated by multi-organ *** review reiterates the need for adequate resuscitation and interventions in managing GI bleeding in critically ill patients,aiming to enhance survival rates and improve the quality of care within the ICU setting.

关键词： Gastrointestinal bleed Varices Variceal bleeding Diverticular bleed Angiodysplasia Ulcer Hemorrhoids Endoscopy Enteroscopy Embolization

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