Electronic cigarette (e-cigarette) usage in the USA has drastically increased in the past 5 years due to age restrictions on conventional cigarettes, aggressive marketing and a perception that e-cigarettes are a healthy alternative. E-cigarettes contain nicotine, water, glycerol, propylene glycol and optional flavouring. On inhalation, the device heats the ingredients into a vapour [1]. While tobacco cigarette smoke is known to cause deleterious effects on the cardiovascular system, angiogenesis and skin capillary perfusion by causing direct injury to blood vessel walls, increased platelet aggregation, microvascular thrombosis [2-4] and inflammation [5], the consequences of e-cigarette vapour exposure on the lung are still largely unexplored [6, 7]. Recently, LERNER et al. [8] reported that vapours produced by e-cigarettes and e-cigarette fluids with flavourings induced toxicity, oxidative stress and inflammatory response in human bronchial airway epithelial cells (H292) and fetal lung fibroblasts (HFL1) as well as mouse lung. GARCIA-ARCOS et al. [9] showed that the aerosolised nicotine-containing e-cigarette fluid increased airway hyperreactivity, distal airspace enlargement, mucin production, and cytokine and protease expression in mice, implying potential dangers of nicotine inhalation during e-cigarette use. The inflammatory response to e-cigarette use involved increased neutrophil activation and mucus production [10], and decreased mucociliary clearance [11]. In human embryonic and mouse neural stem cells, human pulmonary fibroblasts [12], and skin and lung cells [13], cytotoxicity of e-cigarette vapour was correlated with the number and concentration of chemicals used to flavour the fluids. We recently showed in the skin flap survival model in vivo that nicotine-containing e-cigarette vapour is just as harmful to the microcirculation as tobacco cigarette smoke [4]. In the present study, we examined whether long-term exposure to e-cigarette vapour or nicotine produce the same damaging effect on lung structure and vasculature as tobacco smoke in a rat model in vivo. 6-week-old, male Sprague Dawley rats (Envigo Laboratories, Denver, CO, USA) were divided into four groups of eight animals per group and exposed for 5 weeks as follows. 1) Room air. 2) Subcutaneous injections of (−)-nicotine ditartrate (Sigma Aldrich, St Louis, MO, USA) 2 mg•kg −1 twice daily; the amount of nicotine for injections was based on that known from previous studies to produce stable plasma nicotine levels of approximately 25 ng•mL −1 , which is compatible with plasma levels in habitual smokers [14, 15]. 3) Blu E-cigs (Classic Tobacco Flavour (Blu, Charlotte, NC, USA), containing 12 mg•mL −1 nicotine) vapour produced in a TE-2E e-cigarette smoking machine (Teague Enterprises, Davis, CA, USA); the coil temperature of the e-cigarettes was within the normal range usually used by vapers (200-250°C). Rats in this group were exposed to 48 mg nicotine per day [4]. Our experimental design, by subjecting rats to e-cigarette vapour, is a major imp...

Background:Robotic approaches have become increasingly used for colorectal surgery. The aim of this study is to examine the safety and efficacy of robotic colorectal procedures in an adult population.Study Design:A systematic review of articles in both PubMed and Embase comparing laparoscopic and robotic colorectal procedures was performed. Clinical trials and observational studies in an adult population were included. Approaches were evaluated in terms of operative time, length of stay, estimated blood loss, number of lymph nodes harvested, and perioperative complications. Mean net differences and odds ratios were calculated to examine treatment effect of each group.Results:Two hundred eighteen articles were identified, and 17 met the inclusion criteria, representing 4,342 patients: 920 robotic and 3,422 in the laparoscopic group. Operative time for the robotic approach was 38.849 minutes longer (95% confidence interval: 17.944 to 59.755). The robotic group had lower estimated blood loss (14.17 mL; 95% confidence interval: –27.63 to –1.60), and patients were 1.78 times more likely to be converted to an open procedure (95% confidence interval: 1.24 to 2.55). There was no difference between groups with respect to number of lymph nodes harvested, length of stay, readmission rate, or perioperative complication rate.Conclusions:The robotic approach to colorectal surgery is as safe and efficacious as conventional laparoscopic surgery. However, it is associated with longer operative time and an increased rate of conversion to laparotomy. Further prospective randomized controlled trials are warranted to examine the cost-effectiveness of robotic colorectal surgery before it can be adopted as the new standard of care.

Background and Objectives:Over the years, there has been a continual shift toward more minimally invasive surgical techniques, such as the use of laparoscopy in colorectal surgery. Recently, there has been increasing adoption of robotic technology. Our study aims to compare and contrast robot-assisted and laparoscopic approaches to colorectal operations.Methods:Forty patients undergoing laparoscopic or robotic colorectal surgery performed by 2 surgeons at an academic center, regardless of indication, were included in this retrospective review. Patients undergoing open approaches were excluded. Study outcomes included operative time, estimated blood loss, length of stay, complications, and conversion rate to an open procedure.Results:Twenty-five laparoscopic and fifteen robot-assisted colorectal surgeries were performed. The mean patient age was 61.1 ± 10.7 years in the laparoscopic group compared with 61.1 ± 8.5 years in the robotic group (P = .997). Patients had a similar body mass index and history of abdominal surgery. Mean blood loss was 163.3 ± 249.2 mL and 96.8 ± 157.7 mL, respectively (P = .385). Operative times were similar, with 190.8 ± 84.3 minutes in the laparoscopic group versus 258.4 ± 170.8 minutes in the robotic group (P = .183), as were lengths of hospital stay: 9.6 ± 7.3 and 6.5 ± 3.8 days, respectively (P = .091). In addition, there was no difference in the number of lymph nodes harvested between the laparoscopic group (14.0 ± 6.5) and robotic group (12.3 ± 4.2, P = .683).Conclusions:In our early experience, the robotic approach to colorectal surgery can be considered both safe and efficacious. Furthermore, it also preserves oncologically sufficient outcomes when performed for cancer operations.

SPECT/CT influences the location of incision and contributes most to identification of nodes in the supraclavicular region. It also detects additional SLN basins when compared with PL. Further studies are necessary to determine when these additional basins require sampling.

BackgroundThe application and appropriate use of imaging-based scoring instruments is usually based on passive learning from published manuscripts while real-time interaction with instrument developers is often non-feasible. Moreover, most instruments lack knowledge transfer tools that would facilitate attainment of pre-specified performance targets for reader reliability.Objectives1. To develop a web-based calibration module for the SPARCC MRI SIJ Inflammation Score based on consensus scores from these instrument developers, experiential game psychology, and real-time iterative feedback. 2. To test the feasibility and attainment of pre-specified performance targets for reader reliability.MethodsThe scoring of inflammatory lesions of the SIJ on MRI using the SPARCC method is based on SIJ quadrants and the calibration module is comprised of 50 DICOM cases, each with scans from baseline and 12 weeks after the start of TNF inhibitor therapy. Scans are scored blinded-to-time-point. Continuous visual real-time feedback regarding concordance/discordance of scoring per SIJ quadrant with expert readers is provided by a color-coding scheme. Reliability is additionally assessed by real-time intra-class correlation coefficient with the first ICC data being provided after 20 cases. Accreditation for SPARCC BME score is achieved with status and change score ICC of >0.8 and>0.7 and is based on the final 20 cases. 26 readers scored the SPARCC BME module (7 rheumatology fellows, 2 chiropracters, 1 undergraduate, 8 rheumatologists, 8 radiologists) with 21 having no prior experience. Feasibility was assessed by 8-item survey.ResultsThe majority of readers achieved accreditation for SPARCC BME score on the basis of sufficient reliability with instrument developers for both status and change scores, irrespective of prior experience (table 1). All readers who completed the module a second time, 6 months after the first exposure, achieved accreditation for SPARCC BME score. All readers rated the modules as easy and intuitive with average time for reading each case for SPARCC BME being 8 min.Abstract FRI0597 – Table 1*Proficiency targets for reader reliability**7 rheumatology fellows, 2 chiropractors, 1 undergraduateConclusionsExperiential web-based learning is an effective and feasible calibration tool to achieve proficiency targets in the scoring of MRI scans for SIJ inflammatory lesions.Disclosure of InterestW. Maksymowych Shareholder of: CaRE Arthritis, S. Krabbe: None declared, D. Biko: None declared, P. Weiss: None declared, M. Maksymowych: None declared, J. Cheah: None declared, G. Kröber: None declared, U. Weber: None declared, K. Danebod: None declared, P. Bird: None declared, P. Chiowchanwisawakit: None declared, J. Moeller: None declared, M. Francavilla: None declared, J. Stimec: None declared, T. Kogay: None declared, V. Zubler: None declared, M. Battish: None declared, N. Winn: None declared, D. Rumsey: None declared, R. Guglielmi: None declared, S. Pedersen: None declared, H. Boutrup: None declared, S. Shafer: None declare...

We found that in children undergoing routine preoperative UGI before GT placement (1) the risk of malrotation is less than 1%; (2) the decision to perform an antireflux procedure weakly correlates with the UGI findings of GER; and (3) one in five patients without radiographic GER still underwent concomitant fundoplication with or without confirmatory pH probe study. We conclude that the practice of routine UGI before laparoscopic gastrostomy placement in children is likely unnecessary.

Summary:Reconstruction of a composite maxillary defect is frequently performed with a fibular osteocutaneous free flap to address both the bony and mucosal defect. If during the harvest of the fibula a distal skin perforator is not present due to vascular variations, reconstruction can potentially be done using the soleus muscle for filling of the palatal mucosal defect. An additional challenge arises when the accompanying skin paddle that has been harvested is not perfused, but the fibula remains viable. This case report describes salvage following loss of the skin paddle in an osteocutaneous fibular free flap by designing a fibular flow-through flap using a proximal peroneal perforator free flap. The use of this second free flap allows a skin paddle to be positioned on the distal fibular segment, provides a surgical backup, and limits the donor sites to the same extremity.

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