Successful application of the innovation process to a case of Floyd Type I tracheal agenesis.

Background: Innovation is broadly defined as the act of introducing a new product, idea, or process. The field of surgery is built upon innovation, revolutionizing technology, science, and tools to improve patient care. While most innovative solutions are aimed at problems with a significant patient population, the process can also be used on orphan pathologies without obvious solutions. We present a case of tracheal agenesis, a rare congenital anomaly with an overwhelming mortality and few good treatment options, that benefited from the innovation process and achieved survival with no ventilator dependence at three years of age. Methods: Utilizing the framework of the innovation process akin to the Stanford Biodesign Program, 1) the parameters of the clinical problem were identified, 2) previous solutions and existing technologies were analyzed, newly invented solutions were brainstormed, and value analysis of the possible solutions were carried out using crowd wisdom, and 3) the selected solution was prototyped and tested using 3D modeling, iterative testing on 3D prints of actual-sized patient parts, and eventual implementation in the patient after regulatory clearance. Results: A 3D-printed external bioresorbable splint was chosen as the solution. Our patient underwent airway reconstruction with "trachealization of the esophagus": esophageotracheal fistula resection, esophagotracheoplasty, and placement of a 3D-printed polycaprolactone (PCL) stent for external esophageal airway support at five months of age. Conclusions: The innovation process provided our team with the guidance and imperative steps necessary to develop an innovative device for the successful management of an infant survivor with Floyd Type I tracheal agenesis. Article summary: We present a case of tracheal agenesis, a rare congenital anomaly with an overwhelming mortality and few good treatment options, that benefited from the innovation process and achieved survival with no ventilator dependence at three years of age.The importance of this report is to reveal how the innovation process, which is typically used for problems with significant patient population, can also be used on orphan pathologies without obvious solutions.

Targeting cholesterol transport in circulating melanoma cells to inhibit metastasis.

Despite recent breakthroughs in targeted- and immune-based therapies, rapid development of drug resistance remains a hurdle for the long-term treatment of patients with melanoma. Targeting metastatically spreading circulating tumor cells (CTCs) may provide an additional approach to manage melanoma. This study investigates whether targeting cholesterol transport in melanoma CTCs can retard metastasis development. Nanolipolee-007, the liposomal form of leelamine, reduced melanoma metastasis in both a novel in vitro flow system mimicking the circulating system and in experimental as well as spontaneous animal metastasis models, irrespective of the BRAF mutational status of the CTCs. Leelamine led to cholesterol trapping in lysosomes, which subsequently shut down receptor-mediated endocytosis, endosome trafficking, and inhibited the major oncogenic signaling cascades important for survival such as the AKT pathway. As pAKT is important in CTC survival, inhibition by targeting cholesterol metabolism led to apoptosis, suggesting this approach might be particularly effective for those CTCs having high levels of pAKT to aid survival in the circulation system.

Unicompartmental tibial hemiarthroplasty: early results of the UniSpacer knee.

An intra-articular metallic spacer is evaluated for the treatment of isolated medial compartment OA. It is proposed that this implant can provide axial correction for a varus deformity, eliminate the pseudolaxity of the MCL, improve knee function, maintain ROM, and provide pain relief. One-and 2-year data are presented on 71 UniSpacer Knee System implants that were implanted in 67 patients (four had bilateral surgeries). The mean age and weight of these patients was 54 years and 94 kg (207 lb), respectively. The heaviest patient in the group weighed 168 kg (370 lb). All knees were evaluated using the Knee Society clinical rating system, Lysholm scoring scale, radiographic limb alignment, and ROM. The mean Knee Society knee score improved 169% in the 1-year group and 193% in the 2-year group. The mean Knee Society function score improved 31% and 65%, respectively. The mean Lysholm score improved 88% and 140%, respectively. Five implants (7%) were revised to total knee arthroplasty (TKA) and 10 implants (14%) were revised to another UniSpacer Knee System implant. The early results suggest that an intra-articular metallic spacer is a viable treatment option for OA in the younger patient.