Superior Mesenteric Artery Syndrome

Portuguese study confirms use of HOPE provides demonstrably improved liver graft utilization with reduced rates of non-anastomatic biliary stricture (NAS); Italian study demonstrates increasing experience in managing DCD (donation after circulatory determination of death) results in greater utilization of more marginal donors and transplantation in recipients at higher risk CHICAGO, April 18, 2024 /PRNewswire/ -- Two major presentations collectively representing the largest real-world data experience with HOPE are being presented during the European Liver and Intestine Transplant Association (ELITA) Summit meeting in Madrid, Spain. The first of the two presentations was delivered today by Dulce Diogo, MD, Unidade de Transplantação Hepática de Adultos - Serviço de Cirurgia Geral, Unidade Local de Saude de Coimbra, Coimbra, Portugal. The study, 100 Hypothermic Oxygenated Perfusion liver transplants in a Portuguese centre, was conducted by Júlio Constantino, MD et al. Dr. Constantino and colleagues concluded that hypothermic oxygenated machine perfusion of livers awaiting transplantation provides greater liver graft utilization, positive liver graft function during the immediate postoperative period, with reduced rates of non-anastomotic biliary stricture (NAS), according to the largest real-world study of this novel organ preservation technique. In the study, conducted between August 2020 and July 2023, HOPE was used effectively in 100 liver transplants. Data were used from the donor, graft and receptor, as well as data from the intraoperative and postoperative period. Study investigators also analyzed the development of non-anastomotic biliary stricture (NAS), after excluding arterial complication patients and biliary cast syndrome. NAS is defined as one or multiple strictures in the biliary tract system not related to the anastomotic region following liver transplantation. "In our study, HOPE allowed for more extended criteria grafts utilization, good graft function on the immediate postoperative period, and a decreased NAS rate," said Júlio Constantino, MD, lead investigator of the study. "NAS rate decreased to 6.98 percent in our centre. Previous non-anastomotic biliary strictures (NAS) incidence in our centre was 16.7 percent," he added. Machine perfusion (MP) is a novel method for organ graft preservation before transplantation. In hypothermic oxygenated perfusion (HOPE), donor livers are continuously perfused through the portal vein and hepatic artery with a cold (4 °C), acellular, oxygenated fluid at low vascular pressures. Non-anastomotic biliary stricture (NAS) is a blockage of biliary ducts frequently occurring postoperatively in liver transplant patients. Italian Study Demonstrates Higher Utilization of Marginal Organs and Greater Transplantation Success in Patients at Higher Risk Also presented at 2024 ELITA Summit, Single center evolution of DCD donor utilization for liver transplantation: from perceived marginality to routine and beyond, Matteo Ravaioli, MD et al, Hepatobiliary and Transplant Surgery, Policlinico Sant'Orsola – IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna (Italy), Bologna, Italy, demonstrated improved organ transplantation outcomes achieved with greater experience. In the single-centre study, Dr. Ravaioli et al showed that experience performing liver graft transplants over an extended period produced improved liver graft function and survival, as well as less surgical complications. Results were comparable over a period of several years from 2016 through 2023. "At our centre, we were pleased to observe that the greater the number of liver grafts from DCD donors we reviewed and prepared for transplantation, the greater the potential for utilizing more marginal donors and perform transplantation in recipients at higher risk, maintaining similar outcomes," said Dr. Ravaioli, lead investigator of the Italian study. "This means we can improve the ability to use organs that would have previously been discarded and treat patients who were not considered candidates for organ transplantation because of a higher risk of surgical complications," he added. Donation after circulatory determination of death (DCD) has raised concerns in the past due to adjunctive donor warm ischemia, which can have detrimental effects on liver graft function. In Italy, those grafts have been long considered marginal, as the legislation imposes 20 minutes of no-touch time before harvest. Reflecting on the outcomes, Don Webber, President and CEO of Bridge to Life, expressed optimism, stating, "We find great encouragement in the consistency between our real-world findings and the interim results previously published for our multicenter, randomized study in the US. When considering these clinical results alongside the system's seamless integration into existing clinical workflows, it becomes evident that it holds significant disruptive potential in the field." About Bridge to Life Ltd Bridge to Life Ltd is a market leader in organ preservation solutions, offering premier products such as Belzer UW, EasiSlush and the VitaSmart1 hypothermic oxygenated perfusion system. With a strong focus on product quality, innovation and accessibility, the company serves and partners with leading Transplant Centers and Organ Procurement Offices (OPO) globally. 1 VitaSmart is CE Marked and available for sale in several markets outside of the United States. VitaSmart is not approved for sale in the US. The company successfully completed its pivotal, multicenter, randomized clinical study in the US in 2023 and expects to submit its Premarket Approval submission to FDA later this year. SOURCE Bridge to Life Ltd.

--Findings suggest orthopaedic providers could improve opioid stewardship by recommending ibuprofen and acetaminophen instead of opioids after elbow and similar surgeries-- PHILADELPHIA, Oct. 23, 2023 /PRNewswire/ -- Children who take only ibuprofen or acetaminophen after routine elbow surgery report similar pain control to patients who take opioids, according to a new study by researchers at Children's Hospital of Philadelphia (CHOP). The study, published in the Journal of Bone and Joint Surgery, suggests surgeons can confidently recommend over-the-counter medications to patients after elbow and discontinue the routine prescription of opioids. Continue Reading Dr. Apurva Shah, Children's Hospital of Philadelphia "Pain is an important indicator of post-surgical recovery, and we want to make sure kids are not suffering needlessly, but we also want to make sure we are controlling pain in a responsible way," said senior author Apurva S. Shah, MD, MBA, an attending orthopaedic surgeon at CHOP. "This study provides support for recommending acetaminophen and ibuprofen to patients after elbow fracture surgery, which will improve opioid stewardship for this common surgery and potentially for others like it." Supracondylar humerus (SCH) fractures are the most common elbow fracture in children and are repaired through a procedure called closed reduction and percutaneous pinning (CRPP), which allows surgeons to repair the fracture without an incision. Multiple studies have questioned the need for opioids following this procedure, including a study by CHOP researchers that found patients used less than 25% of the opioids they were prescribed, raising a potential risk of opioid misuse, diversion into communities, and accidental poisonings. Promoting opioid stewardship without compromising patient comfort is key to ensuring safe, quality care, but prior to this study, there was little information on the efficacy of opioid versus non-opioid pain control in patients receiving orthopaedic procedures like CRPP. To help develop evidence-based guidelines for this population, the researchers enrolled 157 children from four tertiary hospitals in the United States between May 2021 and August 2022. The children, who were between the ages of 3 and 12, all had SCH fractures that were being repaired via CRPP. Approximately half (52%) of the patients enrolled in the study were prescribed the opioid oxycodone, as well as ibuprofen and acetaminophen, whereas the other half (48%) were prescribed only ibuprofen and acetaminophen. Using text messages, participants reported on the children's medication use and daily pain using the Pain FACES Scale for a week after the surgery, as well as on days 10, 14 and 21. The researchers found no significant differences in pain ratings between opioid and non-opioid groups at any timepoint. Notably, 35% of patients who were prescribed opioids never took them, and 49% took only one to three doses over the entire postoperative period. Patients who did take opioids rarely took them for more than two days after surgery. Only one patient in the non-opioid group (1%) asked for a prescription of opioids after presenting to the ED with postoperative cast discomfort. "Given that this study shows no significant benefit to opioid use in controlling pain in patients undergoing CRPP for elbow fractures, providers and institutions should consider discontinuing the routine prescription of opioids following this procedure – and potentially for other upper extremity fractures repaired using CRPP," Dr. Shah said. "Research into more invasive pediatric orthopaedic procedures and adolescent populations may demonstrate additional areas for opioid stewardship. Investment into these areas will ultimately improve the quality, safety, and value of surgical care in pediatric orthopaedics." Read the full study here: About Children's Hospital of Philadelphia: A non-profit, charitable organization, Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, the 595-bed hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. The institution has a well-established history of providing advanced pediatric care close to home through its CHOP Care Network, which includes more than 50 primary care practices, specialty care and surgical centers, urgent care centers, and community hospital alliances throughout Pennsylvania and New Jersey, as well as the Middleman Family Pavilion and its dedicated pediatric emergency department in King of Prussia. In addition, its unique family-centered care and public service programs have brought Children's Hospital of Philadelphia recognition as a leading advocate for children and adolescents. For more information, visit . Contact: Ashley Moore Children's Hospital of Philadelphia (267) 426-6071 [email protected] SOURCE Children's Hospital of Philadelphia

None A breast cancer specialist and a Mayo Clinic professor are the most influential oncology doctors on X, the platform formerly known as Twitter.  That’s according to a new report by analysts at GlobalData, who compiled a rundown of those they calculated to be the 20 top oncology influencers on the social media platform so far this year. Tatiana Prowell, M.D., an American medical oncologist and expert in the field of breast cancer, tied for the top spot with a score of 96 on GlobalData's social media analytics platform. The analysts determined this score by tracking conversations of influential accounts on X and then analyzing their influence through a series of algorithms and in-house tools. They assess their follower network, average engagements and propensity to influence on a topic. Prowell, who has more than 61,000 followers on X, predominately shared updates on topics like breast cancer, clinical trials, neoplasm and chemotherapy. Scoring 96 as well was Vincent Rajkumar, M.D., a professor of medicine at Mayo Clinic, who predominantly tweets to his 79,000 followers about topics such as multiple myeloma, chemotherapy, immunotherapy, myeloma cast nephropathy and neoplasm. The only other person to score in the 90s was Mark Lewis, M.D., the director of gastrointestinal oncology at Intermountain Health, with a score of 94. He has just under 81,000 followers on X. One of his most popular posts was about a stage 4 cancer patient who entered remission after receiving immunotherapy. All three were significant contributors to the conversation at the annual ASCO cancer conference in Chicago, which is the largest oncology meeting of the year. “Oncology related medical conferences have emerged as one of the key conversation drivers among the Twitter influencers,” said Shreyasee Majumder, a social media analyst at GlobalData, in a release.