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"Smith, Brian R."
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The impact of the novel coronavirus pandemic on gastrointestinal operative volume in the United States
BackgroundIn March 2020, the Surgeon General recommended limiting elective procedures to prepare for the COVID-19 surge. We hypothesize a consequence of COVID-19 is reduced operative volume across the country. We aim to examine changes in volume of common gastrointestinal operations during COVID-19, including elective, urgent/emergent, and cancer operations. We also evaluate if hospitals with more COVID-19 admissions were most impacted.MethodsThe Vizient database was used to determine monthly operative volume from November 2019 to June 2020 for elective operations (hiatal hernia repairs, bariatric surgery), urgent operations (cholecystectomies, appendectomies, inguinal hernia repairs), and cancer operations (colectomies, gastrectomies, esophagectomies). COVID-19 admissions per hospital were also determined. November 2019–January 2020 was defined as “pre-COVID.” The monthly reduction in volume from pre-COVID was calculated for each operation. The top quartile (25%) of hospitals with the most COVID admissions were also evaluated separately from hospitals with fewer COVID cases. Data were analyzed using analysis of variance.ResultsData from 559 hospitals were analyzed. The volumes of all operations evaluated were significantly reduced during the pandemic except gastrectomies and esophagectomies for cancer. The greatest reduction in all operations was in April. In April, the volume of bariatric surgery reduced by 98% (P < 0.001), hiatal hernia repairs by 96% (P < 0.001), urgent cholecystectomies by 42% (P < 0.001), urgent inguinal hernia repairs by 40% (P < 0.001), urgent appendectomies by 24% (P < 0.001), and colectomies for cancer by 39% (P < 0.001). Hospitals with the most COVID-19 admissions had greater reductions in all operations than hospitals with fewer COVID cases.ConclusionsThe coronavirus pandemic led to a significant reduction in volume of all gastrointestinal operations evaluated except gastrectomies and esophagectomies. While elective, non-cancer operations were most affected, urgent and some cancer operations also declined significantly. As COVID-19 continues to surge, Americans may suffer continued limited access to surgical care and a significant operative backlog may be forthcoming.
Journal Article
Serum HER2 testing in patients with HER2-positive breast cancer: the death knell tolls
Determination of the human epidermal growth factor receptor 2 (HER2; also known as ERBB2) status of breast tumours is emphasised in various national guidelines as a necessary step for the diagnosis of breast cancer. As an alternative to tissue-based diagnostic methods, there has been substantial interest in the establishment of an easily accessible serum-based alternative that could be used for prognosis and diagnosis. Detection of serum-soluble-HER2 extracellular domain (ECD) and establishment of its potential clinical usefulness has created much debate. We assessed whether identification of circulating concentrations of HER2 ECD have clinical usefulness for management of patients with HER2-positive breast cancer. We examined data from 63 studies of patients with breast cancer. Prevalence of increased concentrations varied greatly between studies. Some studies showed significant associations between raised concentrations and poor prognosis, poor response to treatments including trastuzumab, or tumour characteristics associated with aggressive disease, whereas others did not. Examination of existing data showed that concentrations of HER2 ECD are not consistently related to patient outcomes; therefore, there is insufficient evidence to support the clinical use of serum HER2 ECD testing. Design and execution of future large-scale trials to investigate the clinical use of HER2 ECD testing, in view of the progressive non-supportive evidence, is not recommended. Oncologists should continue to adhere to national guidelines for determining HER2 status. Furthermore, oncologists should continue to use clinical parameters when making decisions about initiation, continuation, and discontinuation of HER2-targeted treatments.
Journal Article
Wireless Power Transfer to Millimeter-Sized Gastrointestinal Electronics Validated in a Swine Model
Electronic devices placed in the gastrointestinal (GI) tract for prolonged periods have the potential to transform clinical evaluation and treatment. One challenge to the deployment of such gastroresident electronics is the difficulty in powering millimeter-sized electronics devices without using batteries, which compromise biocompatibility and long-term residence. We examined the feasibility of leveraging mid-field wireless powering to transfer power from outside of the body to electronics at various locations along the GI tract. Using simulations and
ex vivo
measurements, we designed mid-field antennas capable of operating efficiently in tissue at 1.2 GHz. These antennas were then characterized
in vivo
in five anesthetized pigs, by placing one antenna outside the body, and the other antenna inside the body endoscopically, at the esophagus, stomach, and colon. Across the animals tested, mean transmission efficiencies of −41.2, −36.1, and −34.6 dB were achieved
in vivo
while coupling power from outside the body to the esophagus, stomach, and colon, respectively. This corresponds to power levels of 37.5 μW, 123 μW and 173 μW received by antennas in the respective locations, while keeping radiation exposure levels below safety thresholds. These power levels are sufficient to wirelessly power a range of medical devices from outside of the body.
Journal Article
Single-Laparoscopic Incision Transabdominal Surgery Sleeve Gastrectomy
Laparoscopic sleeve gastrectomy has recently been added to the list of appropriate weight loss operations presently performed by bariatric surgeons. The sleeve gastrectomy is routinely performed using five and up to seven laparoscopic trocars with enlargement of one of the trocar sites for extraction of the gastric specimen. We describe a case of laparoscopic sleeve gastrectomy performed through a single laparoscopic incision.
Journal Article
Lisocabtagene Maraleucel for Richter's Transformation—A Case Series
Introduction Richter's transformation (RT) from chronic lymphocytic leukemia (CLL) to lymphoma carries poor prognosis. This case series examines the efficacy of lisocabtagene maraleucel (liso‐cel) in six RT patients, highlighting the impact of concurrent ibrutinib therapy. Methods Six patients were with RT who received liso‐cel from were included in this single institution case series. Clinical data related to efficacy, safety, CAR‐T expansion kinetics, and measurable residual disease were collected. Results The best overall response was 83.3%. The four patients who received ibrutinib concurrent with liso‐cel therapy continue to show MRD‐negative complete response till date. None experienced severe (grade 3+) cytokine release syndrome while 1 had severe (grade 3+) immune‐effector cell‐associated neurotoxicity syndrome (ICANS). All patients were noted to have in vivo CAR expansion. Conclusion This series of real cases suggests liso‐cel with concurrent ibrutinib may be a promising treatment for RT, warranting further exploration.
Journal Article
Golden
[...]they shared that within our silence, they saw in me a willing listener and a safe space to unload their burdens. Data Availability No datasets were generated or analyzed during the current study. Disclosures The author states that there is no conflict of interest.
Journal Article
A comparison of outcomes of emergent, urgent, and elective surgical treatment of diverticulitis
There is a controversy regarding the best urgent surgical treatment of colonic diverticulitis. We sought to compare outcomes of patients who underwent surgery for diverticulitis by the type of admission.
The National Surgical Quality Improvement Program databases were used to examine the clinical data of patients who underwent colorectal resection for diverticulitis during 2012 to 2013. Multivariate regression analysis was performed to identify outcomes of patients.
We sampled a total of 13,510 patients admitted for diverticulitis who underwent colorectal resection, of which 7.8% had emergent and 19.7% had urgent operation. Patients with perforation (adjusted odds ratio [AOR] 188.56, P < .01) and preoperative sepsis (AOR 28.17, P < .01) had significantly higher rates of emergent surgery. Patients who underwent emergent operation had higher mortality (AOR 4.08, P = .04) and morbidity (AOR 2.14, P < .01). Emergent operations had a significantly higher risk of anastomosis leakage compared with elective operation (AOR 3.92, P = .02).
Emergent treatment of diverticulitis is associated with a high morbidity and mortality. In the setting of emergent treatment of diverticulitis, colonic anastomosis without a stoma has a high risk of anastomosis leakage.
•Emergent treatment of diverticulitis is associated with high mortality rate.•Most of emergent diverticulitis patients undergo Hartmann’s procedure.•Outcome of patients operated on emergently/urgently is still suboptimal.•Patients with colonic perforation and preoperative sepsis have high risk to treat emergently.•Emergent treatment without a stoma has a high risk of anastomosis leakage.•Laparoscopic approach can decrease mortality and morbidity risks of emergent/urgent operations.
Journal Article