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Background Surgical value is based on optimizing clinical and financial outcomes. The clinical benefits of laparoscopic surgery are well established; however, many patients are still not offered a laparoscopic procedure. Our objective was to compare the modern clinical and financial outcomes of laparoscopic and open colorectal surgery. Methods The Premier Perspective database identified patients undergoing elective colorectal resections from January 1, 2013 to December 31, 2013. Cases were stratified by operative approach into laparoscopic and open cohorts. Groups were controlled on all demographics, diagnosis, procedural, hospital characteristics, surgeon volume, and surgeon specialty and then compared for clinical and financial outcomes. The main outcome measures were length of stay (LOS), complications, readmission rates, and cost by surgical approach. Results A total of 6343 patients were matched and analyzed in each cohort. The most common diagnosis was diverticulitis ( p  = 0.0835) and the most common procedure a sigmoidectomy ( p  = 0.0962). The LOS was significantly shorter in laparoscopic compared to open (mean 5.78 vs. 7.80 days, p  < 0.0001). The laparoscopic group had significantly lower readmission (5.82 vs. 7.68 %, p  < 0.0001), complication (32.60 vs. 42.28 %, p  < 0.0001), and mortality rates (0.52 vs. 1.28 %, p  < 0.0001). The total cost was significantly lower in laparoscopic than in open (mean $17,269 vs. $20,552, p  < 0.0001). By category, laparoscopy was significantly more cost-effective for pharmacy ( p  < 0.0001), room and board ( p  < 0.0001), recovery room ( p  = 0.0058), ICU ( p  < 0.0001), and laboratory and imaging services (both p  < 0.0001). Surgical supplies ( p  < 0.0001), surgery ( p  < 0.0001), and anesthesia ( p  = 0.0053) were higher for the laparoscopic group. Conclusions Laparoscopy is more cost-effective and produces better patient outcomes than open colorectal surgery. Minimally invasive colorectal surgery is now the standard that should be offered to patients, providing value to both patient and provider.

Modified frailty index (mFI) has been proposed as a reliable tool in predicting postoperative outcomes after surgery. This study aims to evaluate whether mFI could be utilized to predict readmissions after colorectal resection for patients with cancer by using nationwide cohort. Patients undergoing elective abdominal colorectal resection for colorectal cancer were reviewed from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) procedure-targeted database (2010–2012). A previously described mFI was calculated. Demographics, comorbidities, and 30-day postoperative complications were compared between patients who were readmitted or not after colorectal surgery. A total of 7337 patients were identified with a mean age of 65.8(±13.6) years. Eight hundred seventy-one (11.8%) patients were readmitted at least once within 30 days. Age, gender, BMI, and other comorbidities were comparable between the groups. O approach, current smoking, mFI(>3/11), disseminating cancer, bleeding disorder and longer operative time were found to independently associated with readmission. An 11-point modified frailty index as measured in NSQIP correlates with readmissions after colorectal resection in patients with colon and rectal cancer. •mFI is a quick and simple tool that can predict readmissions after colorectal surgery.•Open approach, current smoking, disseminating cancer are associated with readmission.•Bleeding disorder and longer operative time are associated with readmission.

Blood-brain barrier (BBB) dysfunction is associated with worse epilepsy outcomes however the underlying molecular mechanisms of BBB dysfunction remain to be elucidated. Tight junction proteins are important regulators of BBB integrity and in particular, the tight junction protein claudin-5 is the most enriched in brain endothelial cells and regulates size-selectivity at the BBB. Additionally, disruption of claudin-5 expression has been implicated in numerous disorders including schizophrenia, depression and traumatic brain injury, yet its role in epilepsy has not been fully deciphered. Here we report that claudin-5 protein levels are significantly diminished in surgically resected brain tissue from patients with treatment-resistant epilepsy. Concomitantly, dynamic contrast-enhanced MRI in these patients showed widespread BBB disruption. We show that targeted disruption of claudin-5 in the hippocampus or genetic heterozygosity of claudin-5 in mice exacerbates kainic acid-induced seizures and BBB disruption. Additionally, inducible knockdown of claudin-5 in mice leads to spontaneous recurrent seizures, severe neuroinflammation, and mortality. Finally, we identify that RepSox, a regulator of claudin-5 expression, can prevent seizure activity in experimental epilepsy. Altogether, we propose that BBB stabilizing drugs could represent a new generation of agents to prevent seizure activity in epilepsy patients. The mechanisms underlying epilepsy development are not well understood. Here the authors show that loss of a key component of the so called blood-brain barrier drives seizures in mice and is also lost in humans with treatment resistant epilepsy

Background Although enhanced recovery pathways (ERPs) may permit early recovery and discharge after laparoscopic colorectal surgery (LC), most publications report that the mean hospital stay is 4 and 6 days. This study evaluates the addition of a transversus abdominis plane (TAP) block to the standard ERP. Methods In this study, 35 consecutive elective patients received a TAP block at the end of LC. The patients were matched by operation, diagnosis, age, gender, and body mass index (BMI) with 35 recent cases and followed in a prospective institutional review board (IRB)-approved database. All the patients were managed with a standardized ERP. The surgeon placed TAP blocks under laparoscopic guidance that infiltrated 15 ml of 0.5 % Marcaine on both sides of the abdomen. Results The cases included 8 low pelvic anastomoses, 4 proctectomies with or without an ileal pouch anal anastomosis, 5 sigmoid/left colectomies, 13 ileocolic/right colectomies, 1 total colectomy, and 5 others. The mean age was 59 years for the TAP group and 64.1 years for the control group ( p  = 0.21). The mean hospital stay was 2 days for the TAP patients and 3 days for the control patients ( p  = 0.000013). Of the 35 TAP patients, 13 went home on postoperative day (POD) 1 (37 %), 12 on POD 2 (34 %), 8 on POD 3 (23 %), and the remainder on POD 4. Of the 35 control patients, 1 went home on POD 1 (3 %), 10 on POD 2 (29 %), 10 on POD 3 (29 %), 11 on POD 4 (31 %), and the remainder on POD 5 to 8. The TAP patients required fewer narcotics postoperatively than the control patients (respective mean morphine equivalents, 31.08 vs. 85.41; p  = 0.01). Discussion A bilateral TAP block significantly improved the results of an established ERP for patients undergoing LC. Surgeon-administered TAP blocks may be an economical and efficient method for improving the results of LC.

Laparoscopic colorectal procedures require specimen extraction. It is unclear whether extraction site affects the incidence of incisional hernia (IH). Patients undergoing laparoscopic colectomy over a 6-year period were identified. Outcomes were compared between patients to evaluate the incidence of hernia. Among 480 laparoscopic colorectal procedures, extraction sites were midline (n = 305), muscle splitting (n = 128), Pfannenstiel (n = 26), and ostomy (n = 21). Average follow-up was 3.5 years. Age, gender, diagnosis, extraction incision length, and hospital stay were similar. The mean body mass index for all patients was 28 kg/m2 and for those with IHs was 31 kg/m2 (P = .008). The overall IH rate was 7%. Midline IHs accounted for 84% of all hernias, occurring in 8.9% of midline extractions (P < .05 vs nonmidline extractions). Hernia rates for muscle-splitting, Pfannenstiel, and ostomy site extractions were 2.3%, 3.8%, and 4.8%, respectively. Although midline hernia rates were lower than traditionally reported with open surgery, midline extraction sites have a higher chance of IH than nonmidline sites.

Single‐cell transcriptomic studies are identifying novel cell populations with exciting functional roles in various in vivo contexts, but identification of succinct gene marker panels for such populations remains a challenge. In this work, we introduce COMET, a computational framework for the identification of candidate marker panels consisting of one or more genes for cell populations of interest identified with single‐cell RNA‐seq data. We show that COMET outperforms other methods for the identification of single‐gene panels and enables, for the first time, prediction of multi‐gene marker panels ranked by relevance. Staining by flow cytometry assay confirmed the accuracy of COMET's predictions in identifying marker panels for cellular subtypes, at both the single‐ and multi‐gene levels, validating COMET's applicability and accuracy in predicting favorable marker panels from transcriptomic input. COMET is a general non‐parametric statistical framework and can be used as‐is on various high‐throughput datasets in addition to single‐cell RNA‐sequencing data. COMET is available for use via a web interface ( http://www.cometsc.com/ ) or a stand‐alone software package ( https://github.com/MSingerLab/COMETSC ). Synopsis COMET is a computational tool for marker‐panel selection from single‐cell RNA‐seq data. It generates ranked predictions of single‐ and multiple‐gene marker panels for a cell population of interest. COMET is a computational tool for combinatorial prediction of marker panels from single‐cell transcriptomic data. COMET's statistical framework enables controlling for specificity and sensitivity in predicted marker panels. Staining by flow‐cytometry validates that COMET identifies novel and favorable single‐ and multi‐gene marker panels for cellular subtypes. COMET is available via a web interface ( http://www.cometsc.com/ ) or downloadable software package ( https://github.com/MSingerLab/COMETSC ). Graphical Abstract COMET is a computational tool for marker‐panel selection from single‐cell RNA‐seq data. It generates ranked predictions of single‐ and multiple‐gene marker panels for a cell population of interest.

[...]if you look at all of the developed countries, you can see their health care spending either per capita or as a percentage of GDP is so much less than in the U.S. And it truly is becoming unsustainable, such that total expenditures this year are going to be over $3 trillion. While the Affordable Care Act brought ACOs and more insured patients for us, it's made it into a much more aggressive marketplace for payers and reimbursement. [...]really, there can't be inaction. [...]the special thing isn't that four and a half thousand years ago they were able to work well enough as a team to build it with 20-ton stones, it is that they were able to create a light box above the door, which was designed such that the center of the tomb is lit by the sun at dawn, but only on the winter solstice.

Quantum computing leverages the quantum resources of superposition and entanglement to efficiently solve computational problems considered intractable for classical computers. Examples include calculating molecular and nuclear structure, simulating strongly interacting electron systems, and modeling aspects of material function. While substantial theoretical advances have been made in mapping these problems to quantum algorithms, there remains a large gap between the resource requirements for solving such problems and the capabilities of currently available quantum hardware. Bridging this gap will require a co-design approach, where the expression of algorithms is developed in conjunction with the hardware itself to optimize execution. Here we describe an extensible co-design framework for solving chemistry problems on a trapped-ion quantum computer and apply it to estimating the ground-state energy of the water molecule using the variational quantum eigensolver (VQE) method. The controllability of the trapped-ion quantum computer enables robust energy estimates using the prepared VQE ansatz states. The systematic and statistical errors are comparable to the chemical accuracy, which is the target threshold necessary for predicting the rates of chemical reaction dynamics, without resorting to any error mitigation techniques based on Richardson extrapolation.

BackgroundLimited data on the relationship between postoperative complications (POCs) after colorectal cancer resection and oncologic outcomes are available. We hypothesized that the increased severity of POCs is associated with progressively worse oncologic outcomes.MethodsPatients with pathological stages I–III colorectal adenocarcinoma undergoing elective curative resection in a single institution between 2000 and 2012 were identified from a prospectively collected database. The severity of POCs was determined using the Clavien–Dindo classification, and oncologic outcomes were assessed.ResultsOf 2266 patients, 669 (30%) had at least one POC. POCs were not associated with pathologic stage (p = 0.58) or use of adjuvant therapy (p = 0.19). With a mean follow-up of 5.3 years, POCs were associated with decreased 5-year overall survival (OS) (60% vs. 77%, p < 0.001), disease-free survival (DFS) (53% vs. 70%, p < 0.001), cancer-specific survival (CSS) (81% vs. 87%, p < 0.001), and increased overall recurrence rates (19% vs. 15%, p = 0.008). Increasing Clavien–Dindo scores from I to IV was significantly associated with progressively decreasing OS (71, 64, 60, 22%, p < 0.001), DFS (65, 58, 51, 19%, p < 0.001), CSS (88, 77, 79, 74%, p < 0.001), and increasing recurrence rates (12, 20, 26, 18%, p = 0.002). Multivariate analysis confirmed POCs as an independent factor associated with decreased OS [hazard ratio (HR) 0.63, 95% CI 0.52–0.76], DFS (HR 0.64, 95% CI 0.54–0.76), CSS (HR 0.73, 95% CI 0.56–0.97), and increased recurrence rates (HR 1.36, 95% CI 1.02–1.80).ConclusionsPOCs are associated with adverse oncologic outcomes, with increasing effect with higher Clavien–Dindo score. Efforts to reduce both the incidence and severity of complications should result in improved oncologic outcomes.

BackgroundThe surface morphology of colorectal polyps is well correlated with submucosal invasion in Eastern Countries but not in North America. We aimed to investigate associations between the Paris classification, surface morphology, and Kudo pit pattern to submucosal invasion in advanced endoscopic resection techniques.MethodsWe retrospectively analyzed prospectively collected data of consecutive advanced endoscopic procedures conducted by a single surgeon between August 2017 and October 2018. The data included patients’ demographics, the endoscopic finding of polyps (Paris, Kudo, and surface morphology), and pathology results.ResultsThe study consisted of 138 lesions, and the mean age was 67 ± 10 years. The most common polyp locations were cecum (n = 41, 30%) followed by ascending colon (n = 28, 20%), and sigmoid colon (n = 18, 13%).The median polyp size was 30 mm (25–40). The en-bloc resection rate was 96%, and 11 (8%) polyps had adenocarcinoma with submucosal invasion. Nine patients (6.5%) had late bleeding, and 3 (2.2%) perforation occurred. Polyps with pit pattern of Kudo IV (n = 4, 36.4%) and Kudo V (n = 6, 54.5%) were associated with submucosal invasion.ConclusionsSurface morphology and pit pattern can predict submucosal invasion in the North American patient population. Polyp morphology may aid polyp selection for advanced endoscopic interventions.