601 N 30Th St Creighton University - Dept Of Obstretrics & Gynecology
Omaha NE 68131
Medical School: Other - Unknown
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License #: TEP6786
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Characteristics of women who have had cosmetic breast implants that could be associated with increased suicide risk: a systematic review, proposing a suicide prevention model. - Archives of plastic surgery
Literature indicates an increased risk of suicide among women who have had cosmetic breast implants. An explanatory model for this association has not been established. Some studies conclude that women with cosmetic breast implants demonstrate some characteristics that are associated with increased suicide risk while others support that the breast augmentation protects from suicide. A systematic review including data collection from January 1961 up to February 2014 was conducted. The results were incorporated to pre-existing suicide risk models of the general population. A modified suicide risk model was created for the female cosmetic augmentation mammaplasty candidate. A 2-3 times increased suicide risk among women that undergo cosmetic breast augmentation has been identified. Breast augmentation patients show some characteristics that are associated with increased suicide risk. The majority of women reported high postoperative satisfaction. Recent research indicates that the Autoimmune syndrome induced by adjuvants and fibromyalgia syndrome are associated with silicone implantation. A thorough surgical, medical and psycho-social (psychiatric, family, reproductive, and occupational) history should be included in the preoperative assessment of women seeking to undergo cosmetic breast augmentation. Breast augmentation surgery can stimulate a systematic stress response and increase the risk of suicide. Each risk factor of suicide has poor predictive value when considered independently and can result in prediction errors. A clinical management model has been proposed considering the overlapping risk factors of women that undergo cosmetic breast augmentation with suicide.
Extended applications of gauze-based negative pressure wound therapy in hand surgery: a review of five cases. - Journal of wound care
Negative pressure wound therapy (NPWT) is an established treatment for a wide variety of acute and chronic wounds. Although the exact mechanism of action is still undefined, the proposed benefits of NPWT have been well described in the literature and include improved wound perfusion, granulation and reduction of oedema and bacteria. Here we describe a series of five challenging cases where NPWT dressings were applied for both elective and traumatic wounds of the upper limb. We describe the application of the dressing and the benefits seen in our patients. We believe the patients would have had inferior outcomes if managed by the best alternative conventional dressings.All named authors hereby declare that they have no conflicts of interest to disclose.
The association of crown-rump length discrepancy with birthweight discordance in spontaneous versus assisted conception dichorionic twins. - Prenatal diagnosis
This study aimed to compare the associations of crown-rump length (CRL) discrepancy with birthweight discordance in spontaneous versus vitro fertilization (IVF) conceived dichorionic twin pregnancies.A computerized retrospective study of women referred to our ultrasonographic unit for nuchal translucency examination between January 1997 and December 2011. The study group was subdivided into twins conceived after IVF, non-IVF fertility treatment and spontaneously conceived twins. Birthweight discordance was defined as a difference of birthweights of >20%.A total of 688 dichorionic twin pregnancies were included, all of them ending in live birth of both twins. IVF-conceived pregnancies were associated with a significant increased risk of extreme birthweight discordance compared with spontaneous-conceived twin pregnancies (ORâ€‰=â€‰2.3; CIâ€‰=â€‰1.4-3.8, Pâ€‰<â€‰0.001). A significant correlation was found between CRL discrepancy and birthweight discordance in spontaneous-conceived pregnancies (râ€‰=â€‰0.15, Pâ€‰<â€‰0.05). In contrast, there was no significant correlation between CRL discrepancy and birthweight discordance in both IVF and fertility treatment-conceived pregnancies.Because birthweight discordance in IVF-conceived twins did not correlate with CRL discrepancy, we assume that it emerges later in pregnancy, maybe related to maternal underplaying complications, for which IVF was indicated in the first place.Â© 2014 John Wiley & Sons, Ltd.
Nuchal translucency in twins according to mode of assisted conception and chorionicity. - Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
The impact of nuchal translucency (NT) screening in twins conceived after use of assisted reproduction technology (ART) has not been addressed properly in the literature. The aim of the current study was to assess, in a large cohort from a single center, NT in twins following various modes of ART as compared with NT in spontaneously-conceived twins and to differentiate results with regard to chorionicity.Retrospective data from 825 twin pregnancies were available for this study. All pregnant women underwent NT screening and chorionicity determination between 11â€‰+â€‰0 and 13â€‰+â€‰6 weeks' gestation in our center. Information about mode of conception and pregnancy outcome was obtained from hospital records and by telephone interviews. Twins were classified as having been conceived after in-vitro fertilization (IVF) with the woman's own or a donated embryo, after non-IVF ART or spontaneously. NT distribution in subgroups of fetuses was compared on the basis of the multiple of the normal median (MoM), SD of log10 MoM estimated by the 90(th) -10(th) centile range divided by 2.563 and the proportion of NT values exceeding the normal 95(th) centile which was 1.641 MoM in the singletons.NT values were statistically significantly higher in ART pregnancies as compared with spontaneously-conceived pregnancies (Wilcoxon rank-sum test, Pâ€‰<â€‰0.05) with medians of 1.073 and 1.038 MoM, respectively, but the proportion with values above the normal 95(th) percentile did not differ (chi-square test, Pâ€‰=â€‰0.89). Among the ART twins, NT values were significantly higher for those conceived using IVF methods (Pâ€‰<â€‰0.005), with a median of 1.082 MoM, compared with a median of 1.022 MoM using other methods. However, although a greater proportion exceeded the 95(th) centile (7.3% compared with 4.8%) this difference did not reach statistical significance (Pâ€‰=â€‰0.17). There were no differences in NT values according to chorionicity (Wilcoxon rank-sum test, Pâ€‰= 0.75). The standard deviation of log10 NT was similar for all subgroups of twins. The correlation coefficient between fetuses in ART pregnancies was statistically significantly lower than that in spontaneously-conceived pregnancies (Pâ€‰<â€‰0.05) but no significant differences were found between types of ART or according to chorionicity.There was a small but significant increase in NT levels among ART pregnancies, which appeared to be confined to those conceived using IVF, and a small reduction in the correlation between fetuses. These effects probably have little impact on the estimated risk based on algorithms in use today.Copyright Â© 2013 ISUOG. Published by John Wiley & Sons Ltd.
Detection of perforators using thermal imaging. - Plastic and reconstructive surgery
Perforator flaps are commonly used in reconstructive surgery and require accurate vascular anatomy navigation. Several imaging methods help surgeons, including hand-held Doppler, color Doppler ultrasound, computed tomography, and magnetic resonance angiography. A growing literature supports the efficacy of thermal imaging in identifying perforators. This study assessed the efficacy of thermal imaging and perforator anatomy in four body regions.Twenty volunteers had their abdomen, sacrum, and both anterolateral thighs assessed for cutaneous perforators using thermal imaging. Key surface landmarks were marked with black crosshairs centered on the umbilicus, superior natal cleft, and traditional anterolateral thigh flap markings. All thermal imaging-identified perforators were marked by red crosses, immediately checked with a hand-held Doppler device, and marked with blue circles if not confirmed. A color digital photograph taken of each region was analyzed.Thermal imaging identified a total of 757 "hotspots," of which 732 (97.0 percent) were confirmed by hand-held Doppler. In 40 anterolateral thighs, the mean number of perforators identified was 1.3 within 2.5 cm and 4.6 within 5 cm of traditional landmarks. In the abdomen, the mean number of perforators was 0.7 and 3.7 within 2.5 cm and 5 cm of the umbilicus, respectively. In the sacral region, there was a mean number of 0.3 and 2.3 perforators within 2.5 cm and 5 cm, respectively, of the superior natal cleft.Thermal imaging is a quick, easy method of assessing cutaneous perforators. It should be considered a useful adjunct, and further investigated, to determine its best role among the established perforator imaging methods.Diagnostic, II.
Brachial plexus palsy following a training run with a heavy backpack. - Journal of the Royal Army Medical Corps
A 23-year-old male British soldier developed a progressive sensory loss and weakness in his right arm during a 12â€…km training run with a load of approximately 70â€…kg. There was no recovery of his symptoms within 3â€…months and both MRI and USS did not demonstrate a site of compression within the brachial plexus. An infraclavicular brachial plexus exploration was performed 11â€…months after injury that indicated an ischaemic neuropathy with post-injury fibrosis. Injuries of the brachial plexus secondary to carrying a heavy backpack during prolonged periods of exercise are rare, particularly in the infraclavicular region. Cases such as this highlight that training regimens within the military population should be appraised due to the risk of similar injuries occurring.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
A sticky situation: methaemaglobinaemia in a hand trauma patient. - BMJ case reports
We describe a case of methaemoglobinaemia (MtHb) in a previously healthy 39-year-old gentleman who presented with a traumatic glass laceration to his right wrist that required emergency surgery to control bleeding and repair his ulnar artery. The MtHb was noted on blood gas analysis by the anaesthetist after the patient had a drop in arterial oxygen saturation under general anaesthetic. We initially suspected the lidocaine local anaesthetic injected proximal to his wound for pain control in the emergency department an hour preoperatively, but then discovered that the patient was a recreational user of 'poppers' and had in fact been using these drugs just before his injury and hospitalisation. The patient's condition stabilised overnight with conservative management. Given how commonly hand surgeons and other clinical staff use local anaesthetics, we reviewed the literature on this uncommon, but potentially fatal, complication, its causes and evidence-based management.
Achieving flying colours in surgical safety: audit of World Health Organization 'Surgical Safety Checklist' compliance. - The Journal of laryngology and otology
The World Health Organization 'Surgical Safety Checklist' has been adopted by UK surgical units following National Patient Safety Agency guidance. Our aim was to assess compliance with our local version of this Checklist.Otolaryngology trainee doctors prospectively assessed compliance with the local Checklist over a six-week period. A staff educational intervention was implemented and the audit was repeated 12 months later.A total of 72 cases were assessed. The initial audit found that: 44 per cent of procedures were undocumented at 'Sign in'; 'Time out' was inappropriately interrupted in 39 per cent of cases; the procedure started before Checklist completion in 33 per cent of cases; and the 'Sign out' was not read out in 94 per cent of cases and was not fully documented in 42 per cent of cases. Following education, re-audit indicated that overall compliance had improved from 63.7 per cent (Â± 8.9 per cent standard error of the mean) to 90.4 per cent (Â± 2.7 per cent standard error of the mean).Our completed audit cycle demonstrated a significant improvement in Checklist compliance following educational intervention. We discuss barriers to compliance, as well as strategies for quality improvement, and we call for other surgeons to similarly publish their Checklist experience and assess its impact on surgical outcomes.
Elucidation of the glucose transport pathway in glucose transporter 4 via steered molecular dynamics simulations. - PloS one
GLUT4 is a predominant insulin regulated glucose transporter expressed in major glucose disposal tissues such as adipocytes and muscles. Under the unstimulated state, GLUT4 resides within intracellular vesicles. Various stimuli such as insulin translocate this protein to the plasma membrane for glucose transport. In the absence of a crystal structure for GLUT4, very little is known about the mechanism of glucose transport by this protein. Earlier we proposed a homology model for GLUT4 and performed a conventional molecular dynamics study revealing the conformational rearrangements during glucose and ATP binding. However, this study could not explain the transport of glucose through the permeation tunnel.To elucidate the molecular mechanism of glucose transport and its energetic, a steered molecular dynamics study (SMD) was used. Glucose was pulled from the extracellular end of GLUT4 to the cytoplasm along the pathway using constant velocity pulling method. We identified several key residues within the tunnel that interact directly with either the backbone ring or the hydroxyl groups of glucose. A rotation of glucose molecule was seen near the sugar binding site facilitating the sugar recognition process at the QLS binding site.This study proposes a possible glucose transport pathway and aids the identification of several residues that make direct interactions with glucose during glucose transport. Mutational studies are required to further validate the observation made in this study.
Molecular dynamics simulation studies of GLUT4: substrate-free and substrate-induced dynamics and ATP-mediated glucose transport inhibition. - PloS one
Glucose transporter 4 (GLUT4) is an insulin facilitated glucose transporter that plays an important role in maintaining blood glucose homeostasis. GLUT4 is sequestered into intracellular vesicles in unstimulated cells and translocated to the plasma membrane by various stimuli. Understanding the structural details of GLUT4 will provide insights into the mechanism of glucose transport and its regulation. To date, a crystal structure for GLUT4 is not available. However, earlier work from our laboratory proposed a well validated homology model for GLUT4 based on the experimental data available on GLUT1 and the crystal structure data obtained from the glycerol 3-phosphate transporter.In the present study, the dynamic behavior of GLUT4 in a membrane environment was analyzed using three forms of GLUT4 (apo, substrate and ATP-substrate bound states). Apo form simulation analysis revealed an extracellular open conformation of GLUT4 in the membrane favoring easy exofacial binding of substrate. Simulation studies with the substrate bound form proposed a stable state of GLUT4 with glucose, which can be a substrate-occluded state of the transporter. Principal component analysis suggested a clockwise movement for the domains in the apo form, whereas ATP substrate-bound form induced an anti-clockwise rotation. Simulation studies suggested distinct conformational changes for the GLUT4 domains in the ATP substrate-bound form and favor a constricted behavior for the transport channel. Various inter-domain hydrogen bonds and switching of a salt-bridge network from E345-R350-E409 to E345-R169-E409 contributed to this ATP-mediated channel constriction favoring substrate occlusion and prevention of its release into cytoplasm. These data are consistent with the biochemical studies, suggesting an inhibitory role for ATP in GLUT-mediated glucose transport.In the absence of a crystal structure for any glucose transporter, this study provides mechanistic details of the conformational changes in GLUT4 induced by substrate and its regulator.
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601 N 30Th St Creighton University - Dept Of Obstretrics & Gynecology Omaha, NE 68131
601 N 30Th St Suite 1609
601 N 30Th St Cu Department Of Family Medicine
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601 N 30Th St Creighton University-Gme
601 N 30Th St Creighton University - Gme