Uncovering protein-protein interactions through a team-based undergraduate biochemistry course.

How can we provide fertile ground for students to simultaneously explore a breadth of foundational knowledge, develop cross-disciplinary problem-solving skills, gain resiliency, and learn to work as a member of a team? One way is to integrate original research in the context of an undergraduate biochemistry course. In this Community Page, we discuss the development and execution of an interdisciplinary and cross-departmental undergraduate biochemistry laboratory course. We present a template for how a similar course can be replicated at other institutions and provide pedagogical and research results from a sample module in which we challenged our students to study the binding interface between 2 important biosynthetic proteins. Finally, we address the community and invite others to join us in making a larger impact on undergraduate education and the field of biochemistry by coordinating efforts to integrate research and teaching across campuses.

Standardized measures of frailty predict hospital length of stay following orthotopic liver transplantation for hepatocellular carcinoma.

Frailty in liver transplant (LT) waitlisted patients has been shown to predict waitlist mortality. While not currently used to allocate organs, the relationship between preoperative frailty and postoperative outcomes following orthotopic LT needs further elucidation. We determined the frailty status of 50 OLT candidates listed for hepatocellular carcinoma (HCC) and examined relationships between frailty and outcomes on the waitlist and, if transplanted, 30-day mortality, hospital length of stay (LOS), ICU LOS, and several other secondary outcomes. The overall prevalence of frailty was 30%, and the median natural MELD score for patients was 13. The overall hospital LOS for the frail group was longer (14.5 days [IQR 12-19]) as compared to the non-frail group (8 days [IQR 7-13]); P = .015. Groups also differed in the time to their first PT session (6 days [IQR 4-15] for the frail vs 4 days [IQR 3-7] for the non-frail patients; P = .042). There was no statistically significant difference in other outcomes measures, including ICU LOS and 30-day mortality. Frailty in OLT patients with diagnosed HCC is a predictor of longer hospital stay and longer time to the first completed PT session independent of preoperative MELD scores.

Dental clearance and postoperative heart infections: Observations from a preoperative evaluation clinic for day-admission surgery.

Every year, two-million hospitalised patients develop healthcare-associated infections with a consequent mortality eclipsing 90,000. The literature suggests that dental infections are one of many potential sources of these infections and may be associated with an increased risk of endocarditis in surgical patients, especially those undergoing cardiac procedures, though some studies have conversely shown no heightened risk of cardiac infections in patients forgoing pre-surgical dental screenings. We sought to elucidate whether patients seen at our preoperative evaluation clinic who obtained pre-surgical dental clearance experienced improved outcomes compared to those who did not receive dental clearance prior to their surgical interventions. The medical records of 196 consecutive patients were reviewed who were seen at the pre-anaesthesia evaluation prior to elective cardiac surgery from July 2017 to February 2018. Of this cohort, 102 patients had pre-surgical dental clearance, while 94 did not have dental clearance. Preoperative demographic and comorbidity data were analysed using independent t-tests. We found no significant differences between these group in terms of post-operation infections (zero instances versus four instances, p > 0.05), length of intensive care unit stay (two days versus two days, p = 0.815), or mortality associated with elective cardiac procedures (zero instances). Further evaluation of preoperative dental clearance and its potential to prevent morbidity (e.g. postoperative infections) is warranted.

Anesthetic Management of a Patient With Tracheal Dehiscence Post-Tracheal Resection Surgery.

We present a case of a patient with complete tracheal dehiscence and multiple false passages after recent tracheal resection and anastomosis. Loss of tracheal continuity after disruption of anastomosis with distal stump retraction presents a unique anesthetic challenge given lack of access to the trachea and the need for adequate anesthesia and analgesia for surgical neck dissection. Traditional airway management, including awake fiberoptic intubation, intubation via direct laryngoscopy, needle cricothyrotomy, and awake tracheostomy are not viable options. Using total intravenous anesthesia with spontaneous ventilation, surgeons dissected the neck, retrieved the distal tracheal stump, repaired the trachea, and formalized the tracheostomy. We highlight the importance of recognizing the symptoms of a tracheal rupture, understanding the extreme limitation of securing the airway with traditional techniques, and discuss the alternative techniques including use of extracorporeal membrane oxygenation to avoid airway management. Awareness of increased mortality risk with tracheal reoperation and the significance of close communication between the anesthesiologists, the surgeons, and the patient is necessary for successful management.