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Salimi-Jazi F, Wood L, Rafeeqi T, Yamada N, Fuerch J, Wall J. Novel Umbilical Catheter Securement and Protection Device for Umbilical Line Securement during Laparotomy. Am J Perinatol 2023. [PMID: 37758205 DOI: 10.1055/a-2182-4221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Umbilical catheter malposition rate is high. We compared a Novel Umbilical Securement Device (NUSD) to standard methodologies for neonatal invasive care unit patients undergoing laparotomy. STUDY DESIGN Retrospective study was performed on infants undergoing laparotomy from April 2019 to January 2023. Two neonatologists compared position of umbilical arterial catheter/umbilical venous catheter (UVC) on perioperative chest X-ray (CXRs) in patients with or without NUSD. RESULTS Eighteen patients underwent laparotomy, of which 8 patients had NUSD (9 lines) and 10 patients did not (14 lines). In NUSD group, mean gestational age was 37 ± 4 weeks and mean birth weight was 2.3 ± 0.9 kg compared with 31 ± 8 weeks and 2.1 ± 1.4 kg in non-NUSD group, respectively. The mean age at surgery was 5 ± 7 and 5 ± 3 days, respectively. No malposition was seen in NUSD group, while 57% of UVCs (28% of lines) were malpositioned postoperatively in non-NUSD group (p = 0.048). CONCLUSION NUSD is an umbilical catheter securement device with low malposition rate, specifically during perioperative period with heightened risk for dislodgement. KEY POINTS · Umbilical catheters provide reliable access for neonates but have a high rate of malpositioning.. · NUSD is an umbilical catheter securement device with low malposition rate.. · NUSD can be kept in place during laparotomy and can decrease the risk of malpositioning..
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Affiliation(s)
- Fereshteh Salimi-Jazi
- Division of Pediatric Surgery, Department of Surgery, Stanford University, California
| | - Lauren Wood
- Division of Pediatric Surgery, Department of Surgery, Stanford University, California
| | - Talha Rafeeqi
- Division of Pediatric Surgery, Department of Surgery, Stanford University, California
| | - Nicole Yamada
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, California
| | - Janene Fuerch
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, California
| | - James Wall
- Division of Pediatric Surgery, Department of Surgery, Stanford University, California
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Salimi-Jazia F, Wood LSY, Jones RE, Chandler J, Rafeeqi T, Dutta S, Steinberg G, Bruzoni M. Corrigendum to: "Ten-Year Experience With Laparoscopic Pedicled Omental Flap for Cerebral Revascularization in Patients With Moyamoya Disease" J Pediatr Surg 57 (2022) 710-715. J Pediatr Surg 2023; 58:2268. [PMID: 37500373 DOI: 10.1016/j.jpedsurg.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
| | - Lauren S Y Wood
- Lucile Packard Children's Hospital at Stanford University, United States
| | - R Ellen Jones
- Lucile Packard Children's Hospital at Stanford University, United States
| | - Julia Chandler
- Lucile Packard Children's Hospital at Stanford University, United States
| | - Talha Rafeeqi
- Lucile Packard Children's Hospital at Stanford University, United States
| | - Sanjeev Dutta
- Lucile Packard Children's Hospital at Stanford University, United States
| | - Gary Steinberg
- Lucile Packard Children's Hospital at Stanford University, United States
| | - Matias Bruzoni
- Lucile Packard Children's Hospital at Stanford University, United States.
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Chan KS, Martin N, Rafeeqi T, Salimi-Jazi F, Chao S. Complications Associated with Subsequent Vascular Access in Pediatric ECMO Patients. J Pediatr Surg 2023; 58:2201-2205. [PMID: 37599195 PMCID: PMC10592097 DOI: 10.1016/j.jpedsurg.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/25/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Following ECMO decannulation, intensivists and surgeons must consider whether to reuse the cannulation site for central venous catheters (CVC) or seek remote access. This study investigates the risk of infectious complication associated with the reuse of peripheral ECMO cannulation sites for subsequent central venous access. METHODS A retrospective review was conducted for patients aged 0-18 years, who underwent peripheral ECMO cannulation between 2009 and 2021 at a single children's hospital. RESULTS Of the 227 charts reviewed, after ECMO decannulation, 53 patients received a CVC at the same location, 25 received a CVC at a different location, 62 received a peripherally inserted central catheter (PICC), and 87 had no subsequent vascular access placed within 30 days of decannulation. Patients with secondary access placed at the same site experienced 1 CLABSI, or 0.94 CLABSIs per 1000 line days. Patients with PICC lines after ECMO decannulation had 1 CLABSI, or 0.43 CLABSIs per 1000 line days. In comparison, the institution's hospital-wide CLABSI rate was 1.46 per 1000 line days during this same period. Although the rate of CLABSI among patients with secondary access at the site of decannulation was higher than the rate among patients with PICC lines (p = 0.79) it was lower than the institutional rate (p = 0.54), these differences did not rise to the level of statistical significance. CONCLUSION Compared with ECMO patients with subsequent CVCs placed at an alternative access site or via PICC after decannulation, patients with contemporaneous CVC placement at the site of decannulation do not experience a significantly higher rate of CLABSIs. LEVEL OF EVIDENCE Level III. TYPE OF STUDY Retrospective comparative study.
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Affiliation(s)
- Katelyn S Chan
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA; Department of Surgery, University of Washington, Seattle, WA 98195, USA.
| | - Nolan Martin
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA; Eastern Virginia Medical School, Norfolk, VA 23507, USA
| | - Talha Rafeeqi
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA; Department of Surgery, Valley Health System, Las Vegas, NV 89119, USA
| | - Fereshteh Salimi-Jazi
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA; Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Stephanie Chao
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
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Salimi-Jazi F, Rafeeqi T, Cunningham A, Park KT, Goyal A, Rosen MJ, Bruzoni M. Total colectomy in severe Crohn's colitis in children: Is permanent ileostomy necessary? Journal of Pediatric Surgery Open 2023; 3:100043. [DOI: 10.1016/j.yjpso.2023.100043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Rafeeqi T, Salimi-Jazi F, Cunningham A, Wall J. The utility of Endoscopic Functional Luminal Imaging (EndoFLIP) in the diagnosis and management of children with achalasia. J Pediatr Surg 2023; 58:639-642. [PMID: 36683001 DOI: 10.1016/j.jpedsurg.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Per-oral endoscopic myotomy (POEM) has is an alternative treatment to laparoscopic Heller myotomy for children with achalasia. The EndoFLIP functional luminal imaging system is used to measure esophagogastric junction (EGJ) distensibility pre- and post-POEM. Previous adult studies have established a correlation between obstructive symptoms and Distensibility Index (DI). Here we analyze the utility of EndoFLIP in diagnosis and management of achalasia in the largest study on pediatric POEM patients and hypothesize that DI may aid diagnosis and treatment of pediatric achalasia. METHODS Demographics, preoperative basal and residual pressures measured on manometry, and EndoFLIP measurements pre- and post-POEM were recorded for children that underwent POEM. Pearson correlation coefficient and T-scores were used to assess for correlation between manometry measurements and pre-POEM DI. Linear regression was conducted to analyze the relationship between pre-POEM DI, Eckardt scores, and manometry pressures. RESULTS Of 33 patients that underwent POEM and EndoFLIP since 2014 (21 male, 12 female), the median pre-POEM Eckardt score decreased from 7 to 1 post-POEM. The median basal pressure was 50 ± 25 mmHg, pre-POEM DI was 0.9 (0.8-1.6) mm2/mmHg and the post-POEM DI was 3.8 (3.2-4.4) mm2/mmHg. There was no correlation between DI and basal pressure or residual pressure, though there was a strong negative correlation between Eckardt scores and DI. CONCLUSION The EndoFLIP system is a valuable tool in adult patients in diagnosing achalasia and defining the endpoint of the POEM procedure. We find that there is a role for EndoFLIP in the pediatric population in diagnosis and management of the disease. TYPE OF STUDY & LEVEL OF EVIDENCE Study of diagnostic test; Level IV.
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Affiliation(s)
- Talha Rafeeqi
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Palo Alto, CA, USA
| | - Fereshteh Salimi-Jazi
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Palo Alto, CA, USA
| | - Aaron Cunningham
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Palo Alto, CA, USA
| | - James Wall
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Palo Alto, CA, USA.
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Rafeeqi T, Abrajano C, Salimi-Jazi F, Garza D, Hartman E, Hah K, Wilcox M, Diyaolu M, Chao S, Su W, Hui T, Mueller C, Fuchs J, Chiu B. Adoption of a standardized treatment protocol for pilonidal disease leads to low recurrence. J Pediatr Surg 2023; 58:532-536. [PMID: 35868880 DOI: 10.1016/j.jpedsurg.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/10/2022] [Accepted: 06/20/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pilonidal disease may present as acute abscesses or chronic draining sinuses. There is no standardized treatment and recurrence rates can be as high as 30%. Within our five-hospital network we have established a standardized treatment protocol including minimally invasive surgical trephination and aggressive epilation. We hypothesize that such a treatment protocol can be established across different hospital settings and lead to low overall recurrence. METHODS Patients with pilonidal disease were enrolled in the study on presentation to our hospital network. Those that underwent initial surgery outside our hospital system or were noncompliant with our treatment protocol were excluded. Patients were grouped based on surgeon and treating facility. Frequency of recurrence per surgeon and per hospital was calculated and compared. RESULTS Out of 132 patients, 80 patients were included (45 female, 35 male) while 52 were excluded because of initial surgery at a non-network hospital or for protocol noncompliance. Median age was 17 (16-19) years and median length of follow-up was 352 (261-496) days. There were 6 patients who experienced at least one recurrence. There was an overall 8% recurrence rate with no significant difference noted between surgeons or hospitals (p = 0.15, p = 0.64, respectively). CONCLUSIONS We have successfully implemented a standardized treatment protocol for pilonidal disease across different hospital settings and by different surgeons, with an overall low recurrence rate. Our findings suggest that adoption of a standardized protocol for treatment of pilonidal disease can lead to low recurrence. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Talha Rafeeqi
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Claire Abrajano
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Fereshteh Salimi-Jazi
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Deanna Garza
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Emi Hartman
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Kira Hah
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Melissa Wilcox
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Modupeola Diyaolu
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Stephanie Chao
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Wendy Su
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Thomas Hui
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Claudia Mueller
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Julie Fuchs
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Bill Chiu
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States.
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Salimi-Jazi F, Abrajano C, Yousefi R, Garza D, Dalusag KS, Sabapaty A, Rafeeqi T, Hui T, Su W, Mueller C, Fuchs J, Chiu B. Increasing Amount of Hair Reduction Using Laser Correlates With Lower Probability of Recurrence in Patients With Pilonidal Disease. J Pediatr Surg 2023:S0022-3468(23)00174-4. [PMID: 36934004 DOI: 10.1016/j.jpedsurg.2023.02.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 03/20/2023]
Abstract
BACKGROUND Hair at the gluteal cleft plays a key role in the development and recurrence of pilonidal disease (PD). We hypothesized that more hair reduction achieved using laser could correlate with lower chance of PD recurrence. METHODS PD patients who underwent laser epilation (LE) were categorized by Fitzpatrick skin type, hair color, and hair thickness. Photos taken at LE sessions were compared to determine hair reduction amount. LE sessions completed prior to the recurrences were recorded. Groups were compared using multivariate T-test. RESULTS 198 PD patients had mean age 18.1 ± 3.6 years. 21, 156, and 21 patients had skin types 1/2, 3/4, and 5/6, respectively. 47 patients had light- and 151 had dark-colored hair. 29 patients had fine hair, 129 medium, and 40 thick. Median follow-up was 217 days. 95%, 70%, 40%, and 19% of patients reached 20%, 50%, 75%, and 90% hair reduction after mean LE sessions of 2.6, 4.3, 6.6, 7.8 sessions, respectively. To reach 75% hair reduction, patients require a mean of 4.8-6.8 LE sessions, depending on different skin/hair characteristics. PD recurrence rate was 6%. Probability of recurrence after 20%, 50%, 75% hair reduction was decreased by 50%, 78%, 100%, respectively. Dark hair and skin type 5/6 were associated with higher recurrence rates. CONCLUSION Patients with dark-color and thick hair require more LE sessions to achieve certain degree of hair reduction. Patients with dark hair and skin type 5/6 were more likely to recur; more hair reduction correlated with lower chance of recurrence. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Fereshteh Salimi-Jazi
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | - Claire Abrajano
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | - Razie Yousefi
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX, USA
| | - Deanna Garza
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | - Kyla Santos Dalusag
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | - Akanksha Sabapaty
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | - Talha Rafeeqi
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | - Thomas Hui
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | - Wendy Su
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | - Claudia Mueller
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | - Julie Fuchs
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | - Bill Chiu
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Stanford, CA, USA.
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Salimi-Jazi F, Abrajano C, Garza D, Rafeeqi T, Yousefi R, Hartman E, Hah K, Wilcox M, Diyaolu M, Chao S, Su W, Hui T, Mueller C, Fuchs J, Chiu B. Burden of pilonidal disease and improvement in quality of life after treatment in adolescents. Pediatr Surg Int 2022; 38:1453-1459. [PMID: 35842877 DOI: 10.1007/s00383-022-05175-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Pilonidal Disease (PD) affects adolescents in different aspects. We hypothesized that patients with different gender, ethnicity, and age have different quality of life (QOL) measurements which could improve with minimally invasive treatment (MIT). METHODS 131 PD patients underwent MIT (laser epilation ± trephination) from 2019 to 2021. Patients' demographics were recorded. Before and after MIT, patients received QOL questionnaire consisting of four categories: daily activities, sports participation, school/work attendance, and socializing. Data were analyzed using Student and multivariate t test. P < 0.05 was considered statistically significant. RESULTS 101 (51 male, 50 female) patients were included. 30 patients with incomplete data were excluded. 54% of patients were < 18 years old. 47.5% were Hispanic. Median symptom duration prior to presentation was 5.4 (1.3-15) months. Prior to MIT, patients' ability to perform daily activities, participate in sports, attend school/work, and socialize was moderately or severely impacted in 66%, 57%, 45%, and 23% of respondents, respectively; after MIT, only 7%, 8%, 2%, and 4% were affected (p < 0.01). Recurrence rate was 6%. Pre-MIT, older patients and non-Hispanics reported worse impact on their QOL. Symptom duration or PD recurrence did not correlate with patient's pre- or post-MIT QOL. CONCLUSION Patients' ethnicity and age impacted QOL in PD. All patients' QOL significantly improved with MIT. Considering the importance of socializing, playing sports, and school/work attendance in adolescents, our study highlights importance of early treatment of PD.
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Affiliation(s)
- Fereshteh Salimi-Jazi
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Palo Alto, CA, 94304, USA
| | - Claire Abrajano
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Palo Alto, CA, 94304, USA
| | - Deanna Garza
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Palo Alto, CA, 94304, USA
| | - Talha Rafeeqi
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Palo Alto, CA, 94304, USA
| | - Razie Yousefi
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX, USA
| | - Emi Hartman
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Palo Alto, CA, 94304, USA
| | - Kira Hah
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Palo Alto, CA, 94304, USA
| | - Melissa Wilcox
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Palo Alto, CA, 94304, USA
| | - Modupeola Diyaolu
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Palo Alto, CA, 94304, USA
| | - Stephanie Chao
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Palo Alto, CA, 94304, USA
| | - Wendy Su
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Palo Alto, CA, 94304, USA
| | - Thomas Hui
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Palo Alto, CA, 94304, USA
| | - Claudia Mueller
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Palo Alto, CA, 94304, USA
| | - Julie Fuchs
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Palo Alto, CA, 94304, USA
| | - Bill Chiu
- Division of Pediatric Surgery, Department of Surgery, Stanford University, Palo Alto, CA, 94304, USA.
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Salimi-Jazi F, Thomas AL, Rafeeqi T, Diyaolu M, Wood LSY, Axelrod S, Navalgund A, Axelrod L, Dunn JCY. Gastrointestinal Myoelectric Measurements via Simultaneous External and Internal Electrodes in Pigs. J Surg Res 2022; 279:119-126. [PMID: 35759929 DOI: 10.1016/j.jss.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/20/2022] [Accepted: 05/22/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Currently, there is no accurate noninvasive measurement system to diagnose gastrointestinal (GI) motility disorders. Wireless skin patches have been introduced to provide an accurate noninvasive measurement of GI myoelectric activity which is essential for developing neuro-stimulation devices to treat GI motility disorders. The aim of this study is to compare the external and internal electrical signal measurements in ambulatory pigs. METHODS Yucatan pigs underwent placement of internal electrodes on the stomach, small intestine, and colon. Wires were brought through the abdominal wall. Signals were collected by a wireless receptor. Four external patches were placed on the abdominal skin to record the signals simultaneously. Pigs were kept for 6 d while the sensors were continuously recording the data from both systems. RESULTS Internal sensors detected rich signals from each organ. The stomach had a dominant frequency that ranged from 4 to 4.5 cpm, with occasional higher frequencies at 2, 3 and 4 times that. Small intestine signals had their primary energy in the 12-15 cpm range. Colon signals primarily displayed a dominant broad peak in the 4-6 cpm region. External skin patches detected a substantial fraction of the activities measured by the internal electrodes. A clear congruence in the frequency spectrum was observed between the internal and external readings. CONCLUSIONS Internally measured myoelectrical signals confirmed different patterns of rhythmic activity of the stomach, small intestine, and colon. Skin patches provided GI myoelectric measurement with a range of frequencies that could be useful in the diagnosis and treatment of motility disorders.
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Affiliation(s)
- Fereshteh Salimi-Jazi
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Anne-Laure Thomas
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Talha Rafeeqi
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Modupeola Diyaolu
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Lauren S Y Wood
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Steve Axelrod
- G-Tech Medical, Fogarty Innovation, Mountain View, California
| | - Anand Navalgund
- G-Tech Medical, Fogarty Innovation, Mountain View, California
| | - Lindsay Axelrod
- G-Tech Medical, Fogarty Innovation, Mountain View, California
| | - James C Y Dunn
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California; Department of Bioengineering, Stanford University, Stanford, California.
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Abstract
Enhanced recovery after surgery (ERAS) is a systematic approach to optimize a patient's health and improve clinical outcomes, increase patient satisfaction and decrease healthcare costs. Enhanced recovery protocols have been used across a variety of surgical disciplines and patient groups to improve patient safety and reduce hospital length of stay without increasing return visits to the system. ERAS involves the application of clinical decision making throughout the patient experience with interventions in the preoperative, perioperative and post operative phases. In addition, ERAS is multidisciplinary and the success of an ERAS program is dependent on the effort and integration of stakeholders across the healthcare system. Utilization of ERAS systems have grown across the global adult surgical community over the last three decades and adoption in pediatric surgery has only occurred recently. Hospitals in both adult and pediatric surgery have found that implementation of ERAS systems lead to a shortened length of stay and reduced complications without increasing patient returns to the system. Importantly patients who have surgery within an ERAS program experience less pain, less opioid utilization, a quicker recovery and increased satisfaction. In pediatric surgery ERAS has successfully been employed across most all disciplines from congenital cardiac surgery to colorectal surgery. The evolution of ERAS continues as a paradigm of quality and safety.
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Affiliation(s)
- Talha Rafeeqi
- Department of Surgery, Valley Health System, Las Vegas, NV, USA
| | - Erik G Pearson
- Department of Pediatric Surgery, Sunrise Children's, Las Vegas, NV, USA
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Rafeeqi T, Kaul G. Isolation and enrichment of type A spermatogonia from pre-pubertal buffalo (Bubalus bubalis) testis. Andrologia 2012; 45:195-203. [DOI: 10.1111/j.1439-0272.2012.01331.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2012] [Indexed: 11/30/2022] Open
Affiliation(s)
- T. Rafeeqi
- Department of Biochemistry; National Dairy Research Institute; I.C.A.R.; Karnal; Haryana; India
| | - G. Kaul
- Department of Biochemistry; National Dairy Research Institute; I.C.A.R.; Karnal; Haryana; India
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