Faculty Bibliography

Previous studies have suggested favorable outcomes of hydrocortisone, ascorbic acid (vitamin C), and thiamine (HAT) therapy in patients with sepsis. However, similar results have not been duplicated in sequential studies. This meta-analysis aimed to reevaluate the value of HAT treatment in patients with sepsis. Electronic databases were searched up until October 2020 for any studies that compared the effect of HAT versus non-HAT use in patients with sepsis. Data from 15 studies (eight randomized controlled trials [RCTs] and seven cohort studies) involving 67,349 patients were included. The results from the RCTs show no significant benefit of triple therapy on hospital mortality (risk ratio [RR], 0.99; P=0.92; I2=0%); intensive care unit (ICU) mortality (RR, 0.77; P=0.20; I2=58%); ICU length of stay (weighted mean difference [WMD], 0.11; P=0.86; I2 =37%) or hospital length of stay (WMD: 0.57; P=0.49; I2=17%), and renal replacement therapy (RR, 0.64; P=0.44; I2=39%). The delta Sequential Organ Failure Assessment (SOFA) score favored treatment after a sensitivity analysis (WMD, -0.72; P=0.01; I2=32%). However, a significant effect was noted for the duration of vasopressor use (WMD, -25.49; P<0.001; I2=46%). The results from cohort studies have also shown no significant benefit of HAT therapy on hospital mortality, ICU mortality, ICU length of stay, length of hospital stay, the delta SOFA score, the use of renal replacement therapy, or vasopressor duration. HAT therapy significantly reduced the duration of vasopressor use and improved the SOFA score but appeared not to have significant benefits in other outcomes for patients with sepsis. Further RCTs can help understand its benefit exclusively.

BACKGROUND:The presence of necrotic collection in acute necrotizing pancreatitis (ANP) at intra-abdominal sites other than the retroperitoneum has not been systematically studied. AIM:To investigate unusual sites of necrotic collections at computed tomography (CT) and to evaluate association with pancreatic necrosis and clinical outcomes. METHODS:This retrospective study comprised of consecutive patients with ANP evaluated between January 2018 and March 2019. Based on CT findings, patients were divided into two groups: collections at unusual sites (small bowel mesentery, mesocolon, omentum, subcapsular collections along liver and spleen, pelvis, anterior abdominal wall, and inguinoscrotal regions) and collections at usual retroperitoneal locations (lesser sac, gastrosplenic location, anterior and posterior pararenal spaces, and paracolic gutters). The differences in CT findings and clinical outcomes (need for drainage, length of hospitalization, intensive care unit admission, surgery, and death) between the two groups were evaluated. RESULTS:A total of 75 patients with ANP were evaluated. There were 25 (33.3%) patients with collections in unusual locations. These included mesentery (n = 17), splenic subcapsular location (n = 7), omentum (n = 6), hepatic subcapsular location (n = 4), anterior abdominal wall (n = 3), pelvis (n = 2), and inguinoscrotal location (n = 1). Compared to patients with collections at usual locations (n = 50), there were no differences in the CT findings except complete parenchymal necrosis (32% vs. 0%, P = .001). There were no statistically significant differences in the clinical outcomes between the two groups. CONCLUSIONS:Mesenteric collections are frequent in ANP. The other non-retroperitoneal sites are infrequently involved. There is no association between unusual sites of collection and clinical outcomes.

Bone defects are often linked to congenital disorders, high impact traumas, tumors or oncological resections. Potential treatment options include autografts, allografts, or synthetic grafts, such as bioactive ceramic-based materials which have been successfully utilized in an effort to regenerate bone. β-tricalcium phosphate (β-TCP), is a commonly utilized bioactive ceramic for regenerative purposes with favorable osteoconductive properties. Alternatively, Synthetic Bone Mineral (SBM) has been previously utilized in in vivo experiments as a supplement for bone loss treatment. As a potential alternative to β-TCP, it is also a bioactive ceramic, which consists of a carbonate hydroxyapatite with ionic substitutions such as F^−, Zn²⁺ and Mg²⁺. The objective of this work was to characterize the physiochemical properties of the colloidal gel obtained from a formulation of SBM and compare the properties directly to β-TCP. Mechanical properties were evaluated for both materials in bulk, using Biaxial Flexural Strength tests. Scanning electron microscopy and micro-computed tomography were utilized to explore the structure of the bulk material and the three dimensionally (3D) printed scaffolds. Inductive coupled plasma (ICP), X-ray diffraction (XRD), and Fourier transform infrared spectrometry (FT-IR), were utilized to determine the calcium-phosphorous ratio (Ca:P), quantitative analysis of crystalline phases, and functional groups, respectively. Thermogravimetric analysis (TGA) was used to quantify the weight percent of water, organic components, carbonate and mineral in the SBM colloidal gel. Flexural strength of SBM discs sintered at 700°C were statistically analogous to β-TCP sintered at 900°C. The Ca:P ratio of the sintered SBM was found to be 1.47 ± 0.04, statistically different from β-TCP sintered at higher temperatures. The carbonate content of the SBM was determined to be ~2.8% ± 0.9. The novel SBM colloidal gel has hence been characterized chemically and physically for its potential use in 3D printing grafts to repair critical sized bone defects.

Current breast cancer care involves a multidisciplinary clinical approach for diagnosis and treatment including input from radiology, surgery, pathology, radiation, and medical oncology. Radiation is an integral part of the treatment for locoregionally confined breast cancer, and has well-recognized long-term risks of secondary malignancies, such as angiosarcomas. Basal cell carcinoma (BCC), a common skin malignancy, is not typically considered a radiation-induced carcinoma following breast cancer treatment. Our recent experience with 4 patients with vastly different presentations of BCC in previous radiation fields prompts the current report in order to alert clinicians to this entity.

Purpose: Although the number of older adults who might benefit from kidney transplantation continues to increase in the United states, little is known about older adults' lived experience of transplantation and the impact of transplant on their sense of embodied selfhood.
Method(s): Employing a phenomenological research design, this study explored the lived experience of 10 deceased donor kidney transplant recipients aged 65 to 72 years old. Participants completed one to two in-depth phenomenological interviews lasting approximately one hour each, for a total of 15 interviews. The sample was drawn from a transplant center in an urban location in the United States. Interview transcripts and field notes were analyzed following the processes of phenomenological reduction, imaginative variation and synthesis.
Result(s): Analyses illuminated older adults' perceptions of the impact of kidney transplantation on their sense of physical, psychological and social selfhood. Participants reported experiencing physical and psychosocial challenges as they adjusted to their transplants, yet they also constructed powerful narratives of resilience and coping that were rooted in a deeply held sense of identity developed over the life course. This sense of continuity of the embodied self over time enabled most participants to better navigate the corporeal disruption and re-integration of transplantation. Participants expressed profound appreciation for their transplants and reported substantial improvement in quality of life as compared to their pre-transplant experience on dialysis. Most participants perceived their older age as playing a protective role in the recovery process.
Conclusion(s): These findings shed light on benefits of older age for kidney transplant recipients that may not be fully integrated into standard approaches to patient selection and assessment of transplant outcomes. As such, findings may help to address age-related bias in transplant policy and clinical practice, with the ultimate goal of improving wellbeing and quality of life for older adults