t is widely accepted that inhalation of smoke, specifically, the particulate matter (PM) found within smoke, can cause adverse effects on health. When diathermy devices, such as electrocauterization instruments, lasers, and ultrasonic scalpels, are used during surgery, surgical smoke, also called cautery smoke, surgical plume, laser plume, and diathermy plume, is released into the ambient environment. This process occurs in open surgery as well as laparoscopic surgery, as ports are often vented into the atmosphere. There is a lack of studies regarding the long-term effects of surgical smoke; findings from such studies may inform methods to prevent adverse outcomes on the health of operating room personnel. There are several other forms of smoke that the general population encounters, including secondhand smoke, cooking smoke, and environmental pollution. There have been more in-depth studies on these forms of smoke than of surgical smoke, and they can help bolster the present knowledge of the danger of surgical smoke.Although smoke evacuation devices exist, they are not often used in practice owing to inconvenience and lack of awareness. A study done in 2016 reported that 14% of operating room personnel always used local exhaust ventilation during electrosurgery. 1 These respon-dents were also more likely to report training and employer standard procedures regarding the hazards of surgical smoke. The largest difference in consistent use of local exhaust ventilation was attributed to knowledge and training on the hazards of surgical smoke. 1 Most operating room staff acknowledge adverse symptoms (eg, coughing, headache) from surgical smoke, yet few wear effective personal protection. 2 Although multiple health organizations, such as the Occupational Safety and Health Administration and the National Institute for Occupational Safety and Health, have created guidelines regarding exposure to surgical smoke, no laws mandate that protective measures be taken. 3,4 However, there has been increasing research and awareness of the harmful effects of surgical smoke on operating room personnel, leading to a push to increase regulation of surgical smoke exposure, for example, in the California legislature. 5 Signs regarding the dangers of surgical smoke can be found outside the operating room. 6 The medical community is becoming more sensitive to the possible hazards of surgical smoke exposure. 7 While emphasizing the importance of using current evacuation techniques is important, there are new modalities that could improve smoke evacuation beyond the simple vacuum and filter system. IMPORTANCE Smoke generated during surgical procedures has long been thought to be hazardous to hospital personnel; however, the degree of danger has yet to be determined.OBSERVATIONS The dangers of surgical smoke are associated with the composition of the plume. Small-particulate matter is found in the smoke that is easily inhaled. Particulates deposit in the lungs, circulatory system, and other organs, which may cause numerous health problems....

Importance A combined objective and subjective wireless monitoring program of patient-centered outcomes can be carried out in patients before and after major abdominal surgery. Objective To conduct a proof-of-concept study of a wireless, patient-centered outcomes monitoring program before and after major abdominal cancer surgery. Design Patients wore wristband pedometers and completed online patient-reported outcome surveys (symptoms, QOL) 3 to 7 days before surgery, through hospitalization, and for two weeks post-discharge. Alerts were generated for all moderate to severe scores for symptoms and QOL. Surgery-related data was collected via electronic medical chart and complications were calculated using the Clavien-Dindo classification. Setting The study was carried out in the inpatient and outpatient surgical oncology unit of one NCI designated comprehensive cancer center. Participants Eligible patients were scheduled to undergo curative resection for hepatobiliary and gastrointestinal malignancies, English-speaking, and 18 years or older. Twenty participants were enrolled over 4 months. Main Outcomes and Measures Outcomes included 1) adherence with wearing the pedometer; 2) adherence with completing the surveys (MDASI and EQ-5D-5L), and 3) satisfaction with the monitoring program. Results Pedometer adherence (88% pre-op versus 83% post-discharge) was higher than survey adherence (75% completed). The median number of steps at day 7 was 1689 (19% of steps at baseline). This correlated with the comprehensive complication index (CCI), for which the median was 15/100 (r = −0.64, p<0.05). Post-discharge overall symptom severity (2.3/10) and symptom interference with activities (3.5/10) were mild. Pain, fatigue, and appetite loss were moderate after surgery (4.4, 4.7, 4.0). QOL scores were lowest at discharge (66.6/100), but improved at week 2 (73.9/100). While patient-reported outcomes returned to baseline at 2 weeks, the number of steps was only one third of pre-operative baseline. Conclusions and Relevance Wireless monitoring of combined subjective and objective patient-centered outcomes can be carried out in the surgical oncology setting. Pre- and post-operative patient-centered outcomes have the potential of identifying high risk populations who may need additional interventions to support postoperative functional and symptom recovery.

Min/؊ adenomas displayed increased expression and association of E-cadherin, ␤-catenin, and ␣-catenin relative to Apc ؉/؉ controls. These data show that Apc plays a role in regulating adherens junction structure and function in the intestine. In addition, discovery of these effects in initiated but histologically normal tissue (Apc Min/؉ ) defines a pre-adenoma stage of tumorigenesis in the intestinal mucosa.

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The mechanism of monocyte deactivation in critically injured burn patients remains unresolved. Two functionally distinct F4/80+Gr-1+ and F4/80+Gr-1- monocyte subsets have been characterized based on their homing to inflammatory or noninflammatory tissues, respectively. We hypothesized that the posttraumatic milieu in the bone marrow (BM) blunts the production of "inflammatory" monocytes. C57Blk/J male mice were divided into sham (S), burn (B), and burn sepsis (BS) groups. B and BS received a 15% dorsal scald burn and BS was inoculated with 15K colony forming units Pseudomonas aeruginosa at the burn site. Animals were killed and blood and femoral BM were collected 48, 72, and 96 hours after injury. ER-MP20 monocyte progenitors were isolated from BM and differentiated into macrophage (MØ) or dendritic cells (DCs) and characterized by the cell surface expression of F4/80 and CD11c, respectively. In both cell types, TLR-4 agonist induced cytokine levels were determined. Results showed a 2-fold increase in the F4/80+Gr-1+ subset at 48 hours in BS that started to decline at 72 hours and remained low at 96 hours. ER-MP20 progenitors isolated at 48 hours exhibited robust MØ differentiation potential but a significant decline in the percentage of the F4/80+Gr-1+ subset (P < .05 vs S) with a concomitant decrease in tumor necrosis factor alpha production. DC development from ER-MP20 progenitors and LPS-stimulated tumor necrosis factor alpha production were impaired. Therefore, BM progenitor derived MØ will replace the transient hyper-responsive circulating monocytes later during the course of the septic insult. Hypo-reactivity of the developing monocytes and DC in the BM and their subsequent egress to the periphery provide a plausible explanation for the immunosuppression that ensues a critical burn injury and sepsis.