Transcriptomic Effects on the Mouse Heart Following 30 Days on the International Space Station.

Efforts to understand the impact of spaceflight on the human body stem from growing interest in long-term space travel. Multiple organ systems are affected by microgravity and radiation, including the cardiovascular system. Previous transcriptomic studies have sought to reveal the changes in gene expression after spaceflight. However, little is known about the impact of long-term spaceflight on the mouse heart in vivo. This study focuses on the transcriptomic changes in the hearts of female C57BL/6J mice flown on the International Space Station (ISS) for 30 days. RNA was isolated from the hearts of three flight and three comparable ground control mice and RNA sequencing was performed. Our analyses showed that 1147 transcripts were significantly regulated after spaceflight. The MAPK, PI3K-Akt, and GPCR signaling pathways were predicted to be activated. Transcripts related to cytoskeleton breakdown and organization were upregulated, but no significant change in the expression of extracellular matrix (ECM) components or oxidative stress pathway-associated transcripts occurred. Our results indicate an absence of cellular senescence, and a significant upregulation of transcripts associated with the cell cycle. Transcripts related to cellular maintenance and survival were most affected by spaceflight, suggesting that cardiovascular transcriptome initiates an adaptive response to long-term spaceflight.

Which eligible breast conservation patients choose mastectomy in the setting of newly diagnosed breast cancer?

PURPOSE: Breast conserving therapy (BCT) and mastectomy offer equivalent survival for women with newly diagnosed breast cancer (BrCa). Despite this, many women eligible for BCT elect mastectomy. Herein, we identify factors associated with choosing ipsilateral mastectomy instead of BCT when mastectomy is not required. METHODS: Between July 2007 and June 2010, 520 women with BrCa were treated by a single surgeon who prospectively documented patient eligibility for BCT. For patients who did not require mastectomy (n=392), we evaluated associations between treatment choice and potential predictors using odds ratios (ORs) obtained from multivariable logistic regression models. P values≤0.0029 were significant after correction for multiple testing. RESULTS: Of 392 women eligible for BCT, 106 (27%) chose mastectomy and 286 (73%) chose BCT. Multivariate analysis found an increased likelihood of electing mastectomy over BCT for patients with no comorbidities (OR 5.4; P<0.001) and those with previous mastectomy (OR 23.2; P<0.001). MRI and biopsy findings were associated with treatment choice because patients who had a second-site biopsy positive for cancer in the same quadrant as the index tumor were more likely to elect mastectomy compared with patients with no additional MRI abnormalities (OR 4.3; P=0.0027). No association existed on multivariate analysis between choice of mastectomy and patient age, family history, or tumor stage. CONCLUSIONS: One in four eligible BCT patients chooses mastectomy. Factors independently associated with choosing mastectomy over BCT include findings of second-site biopsy, previous mastectomy, and absence of comorbidities but not primary tumor characteristics. Further study into a patient's choice for mastectomy is warranted.

Preliminary experience and development of an algorithm for the optimal use of the laparoscopic component separation technique for myofascial advancement during ventral incisional hernia repair.

BACKGROUND: Component separation technique (CST) enables rectus abdominus medialization, but may cause wound complications. Few published outcomes exist involving laparoscopic CST. Our aim was to examine feasibility and outcomes involving open and laparoscopic (lap) CST during ventral incisional hernia repair (VIHR) and present an algorithm for ventral herniorrhaphy. STUDY DESIGN: Our design was a retrospective cohort study. Over 22 months, 28 patients underwent one of the following: (i) unilateral (U-) lap CST with open VIHR [n = 5], (ii) bilateral (B-) lap CST with open VIHR [n = 7], (iii) B-lap CST with lap VIHR [n = 8], or (iv) B-open CST with open VIHR [n = 8]. Indications for open VIHR included mesh removal, concomitant visceral procedure, wound revision, thin/ulcerated skin, abdominal wall tumor, frozen abdomen, and/or off-midline hernia. During open VIHR, CST was performed in the Ramirez fashion. Lap CST was performed before intraperitoneal access in lap VIHR and after retrorectus dissection in open VIHR. Patient surveillance consisted of clinical encounters and telephone interviews. RESULTS: Groups were similar regarding age, body mass index, American Society of Anesthesiologists classification, hernia width, operative time, and hospital stay. Six of the 20 patients who underwent open VIHR developed wound complications, and two required early reoperation. Four of the six with concomitant visceral procedures had wound complications. No laparoscopic VIHR patients had a wound complication. Based on 11 months' follow-up, one open VIHR patient has concern for recurrence. CONCLUSIONS: Laparoscopic CST is feasible during open and laparoscopic VIHR, but it appears most beneficial for wound healing after laparoscopic VIHR. During open VIHR, laparoscopic CST may not substantially reduce wound complications.

Hiatal mesh is associated with major resection at revisional operation.

BACKGROUND: Mesh-assisted hiatal closure during foregut surgery is increasing. Our aim was to evaluate the complications that follow revisional foregut surgery. Specifically, we compared surgical indications and perioperative outcomes between patients with and without prior hiatal mesh (PHM). METHODS: We conducted an institutional review board (IRB)-approved retrospective cohort study from a single tertiary-care referral center. Over 37 months, 91 patients underwent revisional foregut surgery. We excluded 13 cases including operations performed primarily for obesity or achalasia. Of the remaining 78 patients, 10 had PHM and 68 were nonmesh patients (NM). RESULTS: The groups were similar in terms of age, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, and rates and types of anatomic failure. Compared with NM patients, PHM patients had increased estimated blood loss (410 vs. 127 ml, p < 0.01) and operative time (4.07 vs. 2.89 h, p < 0.01). The groups had no difference in perioperative blood transfusion or length of stay. Complete fundoplication was more commonly created in NM patients (2/10 vs. 42/68, p = 0.03). Three of the 10 PHM patients and 3 of the 68 NM patients required major resection. Therefore, PHM patients had 6.8-fold increased risk of major resection compared with NM patients [95% confidence interval (CI) = 1.585, 29.17; p = 0.05]. The NM patients with multiple prior hiatal operations had 4.6-fold increased risk of major resection compared with those with one prior operation (95% CI = 2.919, 7.384; p = 0.03). In PHM patients, however, the number of prior hiatal operations was not associated with major resection. CONCLUSIONS: PHM is associated with increased risk of major resection at revision. The pattern of failure was not different in patients with hiatal mesh, suggesting that hiatal mesh does not eliminate the potential for revision. When performing hiatal herniorrhaphy, the increased risk of recurrence without mesh must be weighed against the potential risk for subsequent major resection when using mesh.