Jeremy T. Aidlen

Slit and robo: expression patterns in lung development

First described as an axonal guidance cue through its repulsive effect on neurons expressing its receptor Roundabout (Robo), the Slit ligand has effects on cell migration, axon branching and elongation. Indirect evidence implicates Slit and Robo in lung development. We now demonstrate that Slit-2 and Slit-3 are developmentally regulated in embryonic murine lung. Immunohistochemistry demonstrates Slit-2 and Slit-3 expression by the pulmonary mesenchyme and airway epithelium. Robo-1 and Robo-2 are also expressed by the developing mesenchyme and airway epithelium. As lung development progresses, Robo-1 and Robo-2 expression localizes to only the airway epithelium. We conclude Slit/Robo are expressed in temporo-spatially adjacent domains suggesting interactive roles in pulmonary bronchiolar development.

Malrotation with midgut volvulus: CT findings of bowel infarction

Midgut volvulus, the most common serious complication of malrotation, can be diagnosed using conventional contrast fluoroscopy, US or CT. CT is a quick and comprehensive examination in the evaluation of complex acute abdominal pathology in children. Contrast-enhanced CT can readily help the radiologist recognize perfusion abnormalities of the bowel, which is vital for reducing morbidity and mortality in affected children. Our case emphasizes and demonstrates additional CT features of bowel infarction in a child with a proven malrotation with midgut volvulus.

Head-Motion-Controlled Video Goggles: Preliminary Concept for an Interactive Laparoscopic Image Display (i-LID)

BACKGROUND Light-weight, low-profile, and high-resolution head-mounted displays (HMDs) now allow personalized viewing, of a laparoscopic image. The advantages include unobstructed viewing, regardless of position at the operating table, and the possibility to customize the image (i.e., enhanced reality, picture-in-picture, etc.). The bright image display allows use in daylight surroundings and the low profile of the HMD provides adequate peripheral vision. Theoretic disadvantages include reliance for all on the same image capture and anticues (i.e., reality disconnect) when the projected image remains static, despite changes in head position. This can lead to discomfort and even nausea. MATERIALS AND METHODS We have developed a prototype of interactive laparoscopic image display that allows hands-free control of the displayed image by changes in spatial orientation of the operators head. The prototype consists of an HMD, a spatial orientation device, and computer software to enable hands-free panning and zooming of a video-endoscopic image display. The spatial orientation device uses magnetic fields created by a transmitter and receiver, each containing three orthogonal coils. The transmitter coils are efficiently driven, using USB power only, by a newly developed circuit, each at a unique frequency. The HMD-mounted receiver system links to a commercially available PC-interface PCI-bus sound card (M-Audiocard Delta 44; Avid Technology, Tewksbury, MA). Analog signals at the receiver are filtered, amplified, and converted to digital signals, which are processed to control the image display. RESULTS The prototype uses a proprietary static fish-eye lens and software for the distortion-free reconstitution of any portion of the captured image. Left-right and up-down motions of the head (and HMD) produce real-time panning of the displayed image. Motion of the head toward, or away from, the transmitter causes real-time zooming in or out, respectively, of the displayed image. CONCLUSIONS This prototype of the interactive HMD allows hands-free, intuitive control of the laparoscopic field, independent of the captured image.

Individualized Image Display Improves Performance in Laparoscopic Surgery

BACKGROUND Laparoscopic surgery has made great advances over the years, but it is still dependent on a single viewpoint. This single-lens system impedes multitasking and may provide suboptimal views of the operative field. We have previously developed a prototype of interactive laparoscopic image display to enable individualized manipulation of the displayed image by each member of the operating team. The current study examines whether the concept of individualized image display improves performance during laparoscopic surgery. MATERIALS AND METHODS Individualized display of the endoscopic image was implemented in vitro using two cameras, independently manipulated by each operator, in a Fundamental of Laparoscopic Surgery (Society of American Gastrointestinal and Endoscopic Surgeons) endotrainer model. The standardized bead transfer and endoloop tasks were adapted to a two-operator exercise. Each team of two was paired by experience level (novice or expert) and was timed twice: once while using a single camera (control) and once using two cameras (individualized image). RESULTS In total, 20 medical students, residents, and attending surgeons were paired in various combinations. Bead transfer times for the individualized image experiment were significantly shorter in the expert group (61.8 ± 14.8% of control, P=.002). Endoloop task performance time was significantly decreased in both novices (80.3 ± 44.4%, P=.04) and experts (69.5 ± 12.9%, P=.001) using the two-camera set-up. CONCLUSIONS Many advances in laparoscopic image display have led to an incremental improvement in performance. They have been most beneficial to novices, as experts have learned to overcome the shortcomings of laparoscopy. Using a validated tool of laparoscopic training, we have shown that efficiency is improved with the use of an individualized image display and that this effect is more pronounced in experts. The concept of individual image manipulation and display will be further developed into a hands-free, intuitive system and must be validated in a clinical setting.

Mass Forming Eosinophilic Cystitis in Pediatric Patients.

Eosinophilic cystitis (EC) is an uncommon inflammatory disorder of uncertain etiology that has been described in adult and pediatric populations. We describe 3 recent cases of EC that presented as a mass lesion in pediatric patients from the New England region of the United States. All patients were initially suspected to have a malignancy, and biopsy was performed, which ultimately led to the diagnosis of EC. We propose the use of eosinophil density of >25 eosinophils per high-power field and myocyte degeneration as supportive histopathologic features to make this diagnosis. It is of utmost importance to consider EC in the differential diagnosis when approaching a pediatric patient with a bladder mass.

Enhanced image display to improve laparoscopic surgery: new and future developments

In its relatively short history, minimally invasive surgery has been characterized by rapid innovation and the sequential scientific application of ever-more sophisticated techniques. At first, the fledgling surgical subspecialty was seen by many as a mere fad driven partially by manufacturers of surgical instruments, and partially by patient expectations. However, the once popular adage ‘big surgeons make big incisions’ has long been replaced by a surgeon’s pride in performing operations more efficiently through smaller, less morbid approaches. Laparoscopy and thoracoscopy have become pervasive. The complexity of minimally invasive surgical procedures has increased dramatically since the first laparo scopic cholecystectomies more than 20 years ago (and the first laparoscopic appendectomies 30 years ago). Instrumentation has been miniaturized and the addition of robotics promises to compensate for human limitations. As a result, surgeons have successfully modified most open operations and found a minimally invasive option – an achievement that has been celebrated and advertised. Throughout the last two decades, the endoscopic image has greatly improved as well – from single-chip charge-coupled device (CCD) cameras to three-chip digital cameras, from low-luminosity cathode ray tube monitors to flatscreen panels, and from conventional to high-definition video [1]. These improvements have added up to an image quality that is unparalleled – even in conventional surgery. Positioning of the image display has also been recognized as an important component of successful laparo scopy and monitors that are placed in the same line of vision as the operator’s hands (i.e., directly in the operative field) have been shown to improve surgical performance [2]. However, each of these improvements has been marginal or incremental and has mostly benefited novice surgeons. Experienced physicians learn to overcome most of the constraints of laparoscopy, and there has been little clamor for a true overhaul of laparoscopic image display.

The risk of snow sport injury in pediatric patients

Purpose In 2015, approximately 13,436 snowboarding or skiing injuries occurred in children younger than 15. We describe injury patterns of pediatric snow sport participants based on age, activity at the time of injury, and use of protective equipment. Methods A retrospective analysis was performed of 10–17 year old patients with snow‐sport related injuries at a Level‐1 trauma center from 2005 to 2015. Participants were divided into groups, 10–13 (middle‐school, MS) and 14–17 years (high‐school, HS) and compared using chi‐square, Students t‐tests, and multivariable logistic regression. Results We identified 235 patients. The HS group had a higher proportion of females than MS (17.5% vs. 7.4%, p = 0.03) but groups were otherwise similar. Helmet use was significantly lower in the HS group (51.6% vs. 76.5%, p < 0.01). MS students were more likely to suffer any head injury (aOR 4.66, 95% CI: 1.70–12.8), closed head injury (aOR 3.69 95% CI: 1.37–9.99), or loss of consciousness (aOR 5.56 95% CI 1.76–17.6) after 4 pm. HS students engaging in jumps or tricks had 2.79 times the risk of any head injury (aOR 2.79 95% CI: 1.18–6.57) compared to peers that did not. HS students had increased risk of solid organ injury when helmeted (aOR 4.86 95% CI: 1.30–18.2). Conclusions Injured high‐school snow sports participants were less likely to wear helmets and more likely to have solid organ injuries when helmeted than middle‐schoolers. Additionally, high‐schoolers with head injuries were more like to sustain these injures while engaging in jumps or tricks. Injury prevention in this vulnerable population deserves further study. Level of evidence Level III (Retrospective Comparative Study).

Are "Goods for Guns" Good for the Community? An Update of a Community Gun Buyback Program

BACKGROUND Gun violence remains a leading cause of death in the United States. Community gun buyback programs provide an opportunity to dispose of extraneous firearms. The purpose of this study was to understand the demographics, motivation, child access to firearms, and household mental illness of buyback participants in hopes of improving the program’s effectiveness. METHODS A 2015 Injury Free Coalition for Kids gun buyback program which collaborated with local police departments was studied. We administered a 23-item questionnaire survey to gun buyback participants assessing demographic characteristics, motivation for relinquishing firearms, child firearm accessibility, and mental illness/domestic violence history. RESULTS A total of 186 individuals from Central/Western Massachusetts turned in 339 weapons. Participants received between US

Tunica vaginalis pedicle flap for repair of ruptured testis: A single-center experience with four patients

25 and US

Nitrofen induces a redox-dependent apoptosis associated with increased p38 activity in P19 teratocarcinoma cells

75 in gift cards dependent on what type of gun was turned in, with an average cost of