<p>Table S1: Treatments undertaken with timing of imaging; S2: Changes in CgA at first post-treatment time-point (3-5 weeks) compared to baseline and effect on OS.</p>

BACKGROUND Studies have reported sex differences in outcomes following implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy-defibrillator (CRT-D) implantation. How-ever, little is known about sex differences with regard to mode of death or device efficacy following ICD or CRT-D implantation. OBJECTIVES The purpose of this study was to investigate whether sex influenced mode of death or device efficacy in ICD and CRT-D subjects enrolled in the MADIT (Multicenter Automatic Defibrillator Implantation Trial) studies (MADIT-II, MADIT-CRT, and MADIT-RIT). METHODS The combined MADIT cohort consisted of 3038 men and 1000 women with ischemic cardiomyopathy (ICM) or nonischemic cardiomyopathy (NICM), left ventricular ejection fraction <30%; New York Heart Association functional class I-III heart failure who received ICD or CRT-D. Mode of death was divided into cardiac and noncardiac causes, reviewed by independent adjudication com-mittees. RESULTS A total of 295 men and 66 women died (9.7% vs 6.6%; P =.003) during 26 months. The most common cause of death was nonarrhythmic cardiac death in men (n = 121 [41%]) and noncar-diac death in women (n = 22 [33%]). All-cause mortality and car-diac deaths were 1.5-to 2.0-fold higher in men vs women with ICM but similar for those with NICM after adjustment for covariates. ICD efficacy was similar in men and women, resulting in a 50% reduction in all-cause mortality. CRT-D was more effective at reducing all-cause and cardiac death in women than men.CONCLUSION Mode of death differs between sex and is dependent on the underlying cardiac substrate. Compared to women, cardiac death is higher in men with ICM but similar in those with NICM. ICDs are equally effective at reducing mortality in both men and women. However, CRT-D may be more effective at reducing mortal-ity in women.

Importance:Acuity circles (AC) liver allocation policy was implemented to eliminate donor service area geographic boundaries from liver allocation and to decrease variability in median Model of End-stage Liver Disease (MELD) score at transplant and wait list mortality. However, the broader sharing of organs was also associated with more flights for organ procurements and higher costs associated with the increase in flights.Objective:To determine whether the costs associated with liver acquisition changed after the implementation of AC allocation.Design, Setting, and Participants:This single-center cost comparison study analyzed fees associated with organ acquisition before and after AC allocation implementation. The cost data were collected from a single transplant institute with 2 liver transplant centers, located 30 miles apart, in different donation service areas. Cost, recipient, and transportation data for all cases that included fees associated with liver acquisition from July 1, 2019, to October 31, 2020, were collected.Exposures:Primary liver offer acceptance with associated organ procurement organization or charter flight fees.Main Outcomes and Measures:Specific fees (organ acquisition, surgeon, import, and charter flight fees) and total fees per donor were collected for all accepted liver donors with at least 1 associated fee during the study period.Results:Of 213 included donors, 171 were used for transplant; 90 of 171 (52.6%) were male, and the median (interquartile range) age of donors was 41.0 (30.0-52.8) years in the pre-AC period and 36.9 (24.0-48.8) years in the post-AC period. There was no significant difference in the post-AC compared with pre-AC period in median (range) MELD score (24 [8-40] vs 25 [6-40]; P = .27) or median (range) match run sequence (15 [1-3951] vs 10 [1-1138]; P = .31), nor in mean (SD) distance traveled (155.83 [157.00] vs 140.54 [144.33] nautical miles; P = .32) or percentage of donors requiring flights (58.5% [69 of 118] vs 56.8% [54 of 95]; P = .82). However, costs increased significantly in the post-AC period: total cost increased 16% per accepted donor (mean [SD] of $52 966 [13 278] vs $45 725 [9300]; P < .001) and 55% per declined donor (mean [SD] of $15 865 [3942] vs $10 217 [4853]; P < .001). Contributing factors included more than 2-fold increases in the proportions of donors incurring import fees (31.4% [37 of 118] vs 12.6% [12 of 95]; P = .002) and surgeon fees (19.5% [23 of 118] vs 9.5% [9 of 95]; P = .05), increased acquisition fees (10% increase; mean [SD] of $43 860 [3266] vs $39 980 [2236]; P < .001), and increased flight expenses (43% increase; mean [SD] of $12 904 [6066] vs $9049 [5140]; P = .002).Conclusions and Relevance:The unintended consequences of implementing broader sharing without addressing organ acquisition fees to account for increased importation between organ procurement organizations must be remedied to contain costs and ensure viability of transplant programs.

Cardiovascular disease remains the most common cause of death in the developed world, with heart failure (HF) increasing in prevalence. In the HF disease state, the left ventricle (LV) manifests a robust plasticity response called remodeling. Cardiac remodeling is a dynamic process that can lead to myocardial fibrosis, which is associated with an increased risk of sudden cardiac death. The extracellular matrix (ECM) is a dynamic support structure that is remodeled following cardiac injury and HF. All of the ECM constituents are vulnerable to the diverse stresses on the heart. Within the ECM, matrix metalloproteinases (MMPs), a key family of proteolytic enzymes, alter the interactions between different structural and metabolically active interstitial molecules and play a major role in the structure and function of the ECM.After obtaining Institutional Animal Care and Use Committee (IACUC) approval, Yorkshire swine (N=10) were paced for 3 to 5 weeks with implanted devices at 200 beats per minute. Prior to termination, all 10 paced swine had left ventricular shortening fraction <16%. Ten additional healthy swine served as controls.The results demonstrated differences between control and HF animals consistent with the HF state. Early biomarkers of HF extracellular‐signal regulated kinase 1 and 2 (ERK1/2) (32%), galectin‐3 (25%), Membrane Type 1 MMP (MMP‐14) (68%) and Tissue Inhibitor of Metallo‐Proteinase‐1 (TIMP‐1) (45%) were elevated (by the percentages shown) in the HF animals (p≤0.05) compared to controls. Oxidative stress may have a key role in the transition from compensated hypertrophy to heart failure. In this study, elevated expression of key transcription factors NFκ‐B p65 (39%) and NRF‐2 (62%) (p≤0.05) was seen in HF animals, which is consistent with elevated ROS and inflammation in the myocardium, thus supporting the idea that oxidative stress may have an adverse effect on the heart.Fluorescent staining of left ventricular myocardial tissue sections demonstrated an increase in all collagens of HF animals relative to controls. The overall increase in ECM fibrosis in HF was clearly demonstrated on Masson’s trichrome histology, including the changes in the ratios of structural collagens in the heart. The control tissue shows a small percentage of collagen, whereas HF tissue shows visible increases in Types I, III and VI collagens. Furthermore, the HF tissue also demonstrated a shifting of the Type I/Type III ratio, with Type III, a more elastic collagen, becoming more preponderant and thus allowing for the structural and functional changes consistent with typical HF. Additional exploration into the mechanisms of cardiac remodeling, may lead to treatments to prevent adverse ECM changes and slow the progression of adverse remodeling and ultimately reduce the risk of progression to lethal HF.Support or Funding InformationUniformed Services University Early Career Scientist Award, USU Grant # R089354417

Background: To assess the impact of participation of multiorgan procurement (MP) by general surgery (GS) residents on surgical knowledge and skills, a prospective cohort study of GS residents during transplant surgery rotation was performed. Methods: Before and after participation in MPs, assessment of knowledge was performed by written pre and post tests and surgical skills by modified Objective Structured Assessment of Technical Skill (OSATS) score. Thirty-nine residents performed 84 MPs. Results: Significant improvement was noted in the written test scores (63.3% vs 76.7%; P < 0.001). Better surgical score was associated with female gender (15.4 vs 13.3, P = <0.01), prior MP experience (16.2 vs 13.7, P = 0.03), and senior level resident (15.1 vs 13.0, P = 0.03). Supraceliac aortic dissection (P = 0.0017) and instrument handling (P = 0.041) improved with more MP operations. Conclusions: Participation in MP improves residents' knowledge of abdominal anatomy and surgical technique. (C) 2017 Elsevier Inc. All rights reserved.

Abstract Purpose: To investigate posttreatment circulating tumor cell (CTC) counts in patients with neuroendocrine neoplasms (NENs) as a predictive biomarker for disease progression and overall survival (OS). Experimental Design: Patients with metastatic NENs commencing therapy were prospectively recruited (n = 138). Blood samples were obtained for evaluation of CTCs using the CellSearch platform and for chromogranin A (CgA) at baseline, three to five (median, 4.3) weeks and 10 to 15 (median 13.7) weeks after commencing therapy. Radiologic response and OS data were collected. Results: There was a significant association between first posttreatment CTC count and progressive disease (PD; P < 0.001). Only 8% of patients with a favorable “CTC response” (0 CTCs at baseline and 0 at first posttreatment time-point; or ≥50% reduction from baseline) had PD compared with 60% in the unfavorable group (<50% reduction or increase). Changes in CTCs were strongly associated with OS (P < 0.001), the best prognostic group being patients with 0 CTCs before and after therapy; followed by those with ≥50% reduction in CTCs [hazard ratio (HR), 3.31]; with those with a <50% reduction or increase in CTCs (HR, 5.07) having the worst outcome. In multivariate analysis, changes in CTCs had the strongest association with OS (HR, 4.13; P = 0.0002). Changes in CgA were not significantly associated with survival. Conclusions: Changes in CTCs are associated with response to treatment and OS in metastatic NENs, suggesting CTCs may be useful as surrogate markers to direct clinical decision making. Clin Cancer Res; 22(1); 79–85. ©2015 AACR.

IMAGING FINDINGS The biopsy was performed with an 18-gauge Biopense needle to obtain a core sample of liver, with one pass, and no complications were noted following the procedure. No histopathologic diagnosis was found on the liver biopsy. Imaging demonstrated a noncirrhotic liver, conventional hepatic arterial anatomy, trifurcation of intrahepatic bile ducts, fat quantification of 4.2% to 4.7%, and an adequate liver volume (Figure 1). She was deemed an appropriate living donor candidate and underwent an exploratory laparotomy, cholecystectomy, and intraoperative cholangiogram. The intraoperative cholangiogram demonstrated reflux of contrast from the right posterior hepatic duct into the adjacent liver parenchyma and subsequent appearance of the contrast in an adjacent peripheral right hepatic vein branch (Figure 2). A repeat cholangiogram demonstrated a similar finding, with slightly decreased flow of contrast into the right hepatic vein branch (Figure 3).

Introduction: the neck and chest are the most common sites of ectopic thyroid tissues. Ectopic thyroid tissue is infrequently encountered in the liver or gallbladder. this is a rare presentation of an incidental portal hepatis mass consistent with ectopic thyroid. case report: A 69-yearold female with a medical history significant for hypothyroidism and multiple thyroid nodules, had undergone a total thyroidectomy. On subsequent ultrasound an incidental 3.6 cm porta hepatis mass was noted, with enlargement on computed tomography (ct) scan and magnetic resonance imaging (MrI) scan to 4.6 cm. A complete resection of the porta hepatis mass was performed. Pathology of the porta hepatis mass was consistent with benign ectopic thyroid tissue with nodular hyperplasia. conclusion: this case describes the rare presentation of a porta hepatis mass consistent with an ectopic thyroid. the presence of ectopic thyroid in the porta hepatis is especially rare, and required surgical resection due to increasing size. 1