Social Media, Misinformation, and Online Patient Education in Emergency General Surgical Procedures.

INTRODUCTION: Patients use the internet to learn about diagnoses and treatment options. These sources vary in quality and accuracy of medical information. Thus, utilization of social media may lead to misinformation regarding treatment for patients in need of emergent general surgery procedures. METHODS: YouTube was searched with keywords "cholecystectomy," "cholecystitis," and "gallbladder surgery" and "appendectomy," "appendicitis," and "appendix surgery." For each procedure, the 100 videos with the greatest views were reviewed. Videos were assessed by four surgical trainees using validated instruments, DISCERN and the Patient Education Materials Assessment Tool (PEMAT), and Likert scales for patient education and misinformation. After appendectomy or cholecystectomy, patients completed a survey assessing use of social media preoperatively. RESULTS: The median DISCERN score was 28.0 of 75. The median PEMAT scores were 66.7% for understandability and 0% for actionability. Nearly half (49%) of videos provided no patient education and only 22% provided moderate or more. More than a third (35%) of videos contained misinformation. Doctors, medical education, and healthcare systems published videos with less misinformation, whereas patients, health/wellness groups published more misinformation (P < 0.001). Videos discoverable with colloquial terms "appendix surgery" and "gallbladder surgery" were more likely to contain misinformation (45.3%) compared to 20.5% of videos with misinformation discoverable using medical search terms only (P < 0.001). CONCLUSIONS: There is a range of video quality online with most videos of poor quality and provide little patient education. Understanding information available to patients online can tailor surgeon-patient discussions to combat misinformation and improve the informed consent process for patients.

Acute Arthroscopic Removal of a Bullet Embedded in the Glenoid: A Case Report.

INTRODUCTION: Retained bullets in joint spaces have been shown to cause both mechanical and chemical damage to the joint surfaces, leading to the risk of arthritis if untreated. CASE REPORT: A case of arthroscopic treatment for a gunshot to the shoulder with a retained bullet embedded in the glenoid is presented. The patient presented with multiple gunshots to his back and extremities, including gunshot to the left leg with popliteal vein injury, gunshot to the back with lumbar level laminar fractures and acute spinal cord injury, and gunshot to the left shoulder with a retained bullet in the posterior superior glenoid. CONCLUSION: Shoulder arthroscopy can be successfully employed to retrieve larger embedded bullet or foreign body with the help of tools such as laparoscopic graspers. Even with significant glenoid bone defect, the stability of the shoulder joint does not get compromised if the bone defects are located posterosuperiorly.

[Evaluation of patients with humeral midshaft fractures treated with DCP plate vs. intramedullary nail UHN]. / Evaluación de los pacientes con fracturas diafisiarias de húmero tratadas con placa DCP frente a clavo centro medular UHN.

BACKGROUND: Humeral midshaft fractures should be surgically managed, so the knowledge of functionality, bone healing and pain of these treatments is required to obtain the expected results. The aim of this paper is to compare the results of patients with humeral midshaft fracture operated with intramedullary nails UHN vs. DCP plate. METHODS: Comparative study, conducted during the period of June 2014 to June 2015, in patients with humeral midshaft fracture, incidents, operated with intramedullary nails UHN vs. DCP plate. Pain, functional and radiographic assessment were conducted by Andersen, UCLA and simple X ray test, respectively. RESULTS: There were 40 patients, 57.5% with DCP plate, 67.5% male, mean age was 42.38 years, mean operative time was 73.3 minutes, side affected 50% right, 87% had complete consolidation with DCP plate against 70.6% of the patients treated with intramedullary nails UHN. Radiographic consolidation was good for both treatments, functionality and pain patients had presented no statistically significant differences in both groups (p ≥ 0.05). Complications are in the range described worldwide for both treatments. CONCLUSIONS: Both treatments are effective for humeral diaphyseal lesions, however should be cautious and try to avoid the complications that can be serious is recommended.

Introducción: las fracturas diafisiarias de húmero deben de ser manejadas quirúrgicamente, por lo que se requiere el conocimiento de la funcionalidad, consolidación ósea y dolor de estos tratamientos para poder obtener los resultados esperados. El objetivo de este trabajo es comparar la evolución de los pacientes con fractura diafisiaria de húmero operados con clavo centro medular UHN frente a aquellos operados con placa DCP. Métodos: estudio comparativo, realizado durante el periodo de junio 2014 a junio 2015, en pacientes con fractura diafisiaria de húmero, incidentes, operados con clavo UHN y placa DCP. La evaluación funcional, del dolor y la radiográfica se llevaron a cabo por las escalas UCLA, Andersen y por personal del departamento de radiodiagnóstico, respectivamente. Resultados: se seleccionaron 40 pacientes, 57.5% con placa DCP, 67.5% hombres, promedio de edad 42.38 años, tiempo quirúrgico promedio 73.3 minutos, lado afectado 50% derecho, 87% tuvieron consolidación completa con placa DCP contra 70.6% de los manejados con clavo centro medular UHN. La consolidación radiográfica fue buena para ambos tratamientos, la funcionalidad de los pacientes y el dolor presentado no tuvo diferencias estadísticamente significativas para ambos grupos (p > 0.05). Las complicaciones están en el rango descrito a nivel mundial para ambos tratamientos. Conclusiones: ambos tratamientos son eficaces para las lesiones diafisiarias del húmero, sin embargo se debe de tener precaución y tratar de evitar las complicaciones que pueden llegar a ser graves.

The role of Cdk5 in neuroendocrine thyroid cancer.

Medullary thyroid carcinoma (MTC) is a neuroendocrine cancer that originates from calcitonin-secreting parafollicular cells, or C cells. We found that Cdk5 and its cofactors p35 and p25 are highly expressed in human MTC and that Cdk5 activity promotes MTC proliferation. A conditional MTC mouse model was generated and corroborated the role of aberrant Cdk5 activation in MTC. C cell-specific overexpression of p25 caused rapid C cell hyperplasia leading to lethal MTC, which was arrested by repressing p25 overexpression. A comparative phosphoproteomic screen between proliferating and arrested MTC identified the retinoblastoma protein (Rb) as a crucial Cdk5 downstream target. Prevention of Rb phosphorylation at Ser807/Ser811 attenuated MTC proliferation. These findings implicate Cdk5 signaling via Rb as critical to MTC tumorigenesis and progression.