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Article ; Online: Bowel Obstruction from an Incidentally Ingested Foreign Body.

Lin, Erica / Heffernan, Daithi S

Rhode Island medical journal (2013)

2023 Volume 106, Issue 5, Page(s) 34–37

Abstract: Small bowel obstructions are common surgical presentations that are most often caused by adhesions following abdominopelvic surgeries. However, in patients with no history of abdominal surgical interventions, assessment of the cause of a small bowel ... ...

Abstract	Small bowel obstructions are common surgical presentations that are most often caused by adhesions following abdominopelvic surgeries. However, in patients with no history of abdominal surgical interventions, assessment of the cause of a small bowel obstruction is more complex, and such patients frequently require operative intervention. We present a case of a 65-year-old man who presented with a small bowel obstruction caused by an inadvertent ingestion of a bread tag that was not identified on preoperative imaging. The sharp end of the bread tag had eroded through the small bowel leading to a walled-off perforation of the small bowel. Surgical resection was required.
MeSH term(s)	Male ; Humans ; Aged ; Intestinal Perforation/diagnostic imaging ; Intestinal Perforation/etiology ; Intestinal Perforation/surgery ; Foreign Bodies/complications ; Foreign Bodies/diagnostic imaging ; Foreign Bodies/surgery ; Intestine, Small/diagnostic imaging ; Intestine, Small/surgery ; Intestinal Obstruction/diagnostic imaging ; Intestinal Obstruction/etiology ; Intestinal Obstruction/surgery ; Tomography, X-Ray Computed
Language	English
Publishing date	2023-06-01
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	419430-5
ISSN	2327-2228 ; 0363-7913
ISSN (online)	2327-2228
ISSN	0363-7913
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Article ; Online: Severity of critical illness correlates with CD3-low expression on iNKT-cells among septic surgical patients.

Heffernan, Daithi S / Chung, Chun-Shiang / Ayala, Alfred

Inflammation research : official journal of the European Histamine Research Society ... [et al.

2023 Volume 73, Issue 1, Page(s) 1–4

Abstract: Background: iNKT-cells are innate regulatory lymphocytes capable of directing immune and inflammatory responses to sepsis. Repeat stimulation of iNKT-cells leads to the induction of anergy with the emergence of a hyporesponsive CD3: Methods: iNKT- ... ...

Abstract	Background: iNKT-cells are innate regulatory lymphocytes capable of directing immune and inflammatory responses to sepsis. Repeat stimulation of iNKT-cells leads to the induction of anergy with the emergence of a hyporesponsive CD3 Methods: iNKT-cells were isolated from critical ill surgical patients with sepsis and phenotyped for CD3 expression. This was correlated with degree of severity of illness, as denoted by APACHE-II score. Results: Comparing healthy volunteers to critically ill septic patients, it was noted that increasing severity of sepsis was associated with increasing frequency of circulating CD3 Conclusion: The emergence of CD3
MeSH term(s)	Humans ; Critical Illness ; Sepsis ; Lymphocytes
Language	English
Publishing date	2023-12-26
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	1221794-3
ISSN	1420-908X ; 1023-3830
ISSN (online)	1420-908X
ISSN	1023-3830
DOI	10.1007/s00011-023-01795-z
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Article ; Online: Influenza and the Surgeon.

Heffernan, Daithi S

Surgical infections

2019 Volume 20, Issue 2, Page(s) 119–128

Abstract: Background: The influenza virus is a pathogenic virus responsible for large numbers of deaths and long-term disabilities worldwide. Although the very young, the very old, and immunocompromised individuals are most susceptible, the effects of the ... ...

Abstract	Background: The influenza virus is a pathogenic virus responsible for large numbers of deaths and long-term disabilities worldwide. Although the very young, the very old, and immunocompromised individuals are most susceptible, the effects of the influenza virus can be observed across the entire spectrum of individuals. Discussion: Infection with the influenza virus induces a substantial inflammatory and immunologic response and induces marked pulmonary inflammation. Many aspects of influenza affect surgical patients directly. Vaccines are one of the most effective measures aimed at reducing the prevalence and severity of many infectious diseases, including the influenza virus. Vaccination programs remain one of the highest priorities across the spectrum of countries, research institutions such as the National Institutes of Health, international health agencies such as the World Health Organization (WHO), and major non-profit organizations. Conclusion: This review addresses aspects of the immune and inflammatory response to influenza, with a focus on the elderly population and healthcare providers who may act as reservoirs for virus transmission to the vulnerable surgical population.
MeSH term(s)	Cross Infection/prevention & control ; Disease Transmission, Infectious/prevention & control ; Humans ; Infection Control/methods ; Influenza Vaccines/administration & dosage ; Influenza Vaccines/immunology ; Influenza, Human/epidemiology ; Influenza, Human/prevention & control ; Influenza, Human/transmission ; Prevalence ; Surgeons ; Vaccination Coverage
Chemical Substances	Influenza Vaccines
Language	English
Publishing date	2019-02-06
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1440120-4
ISSN	1557-8674 ; 1096-2964
ISSN (online)	1557-8674
ISSN	1096-2964
DOI	10.1089/sur.2019.015
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Article ; Online: SPLENIC INVARIANT NATURAL KILLER T CELLS PLAY A SIGNIFICANT ROLE IN THE RESPONSE TO POLYMICROBIAL SEPSIS.

Heffernan, Daithi S / Chung, Chun-Shiang / Ayala, Alfred

Shock (Augusta, Ga.)

2023 Volume 60, Issue 3, Page(s) 443–449

Abstract: Abstract: Background: Sepsis is marked by a dysregulated immune response to an infection. Invariant natural killer T cells ( i NKT cells) are a pluripotent lymphocyte subpopulation capable of affecting and coordinating the immune response to sepsis. The ...

Abstract	Abstract: Background: Sepsis is marked by a dysregulated immune response to an infection. Invariant natural killer T cells ( i NKT cells) are a pluripotent lymphocyte subpopulation capable of affecting and coordinating the immune response to sepsis. The spleen is an important site of immune interactions in response to an infection. Splenic i NKT cells have emerged as important potential frontline mediators of chronic immune response. There are few data addressing the role splenic of i NKT cells in response to intra-abdominal polymicrobial sepsis. Methods: The cecal ligation and puncture model was used to create intra-abdominal sepsis in 8- to 12-week-old wild-type, i NKT -/- , or programmed cell death receptor-1 (PD-1) -/- mice. Twenty-four hours later, spleens were harvested. Flow cytometry was used for phenotyping using monoclonal antibodies. Cell sort was used to isolate i NKT cells. A macrophage cell line was used to assess i NKT cell-phagocyte interactions. Enzyme-linked immunosorbent assay was used for cytokine analysis. Results: Splenic i NKT-cell populations rapidly declined following induction of sepsis. Within i NKT-cell -/- mice, a distinct baseline hyperinflammatory environment was noted. Within wild type, sepsis induced an increase in splenic IL-6 and IL-10, whereas in i NKT -/- mice, there was no change in elevated IL-6 levels and a noted decrease in IL-10 expression. Further, following sepsis, PD-1 expression was increased upon spleen i NKT cells. With respect to PD-1 ligands upon phagocytes, PD-1 ligand expression was unaffected, whereas PD-L2 expression was significantly affected by the presence of PD-1. Conclusions: Invariant natural killer T cells play a distinct role in the spleen response to sepsis, an effect mediated by the checkpoint protein PD-1. Given that modulators are available in clinical trials, this offers a potential therapeutic target in the setting of sepsis-induced immune dysfunction.
MeSH term(s)	Animals ; Mice ; Natural Killer T-Cells ; Programmed Cell Death 1 Receptor ; Interleukin-10/metabolism ; Interleukin-6/metabolism ; Spleen ; Sepsis/metabolism
Chemical Substances	Programmed Cell Death 1 Receptor ; Interleukin-10 (130068-27-8) ; Interleukin-6
Language	English
Publishing date	2023-07-25
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1185432-7
ISSN	1540-0514 ; 1073-2322
ISSN (online)	1540-0514
ISSN	1073-2322
DOI	10.1097/SHK.0000000000002185
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Article ; Online: Management of Acute Appendicitis in HIV/AIDs Patients: A 19-year Review from the National In-Patient Sample.

Simon, Kiran / Cournoyer, Lauren / Nwaiwu, Chibueze / Stephen, Andrew H / Heffernan, Daithi S

Rhode Island medical journal (2013)

2023 Volume 106, Issue 4, Page(s) 46–51

Abstract: Background: Acute Appendicitis (AA), one of the most common surgical emergencies, is usually managed operatively. There is a paucity of data addressing how HIV/AIDS affects management of acute uncomplicated appendicitis.: Methods: A retrospective ... ...

Abstract	Background: Acute Appendicitis (AA), one of the most common surgical emergencies, is usually managed operatively. There is a paucity of data addressing how HIV/AIDS affects management of acute uncomplicated appendicitis. Methods: A retrospective review of HIV/AIDS positive (HPos) versus negative (HNeg) patients with acute, uncomplicated appendicitis over a 19-year period. The primary outcome was undergoing appendectomy. Results: Among 912,779 AA patients, 4,291 patients were HPos. HIV rates increased from 3.8/1,000 in 2000 to 6.3 per 1,000 appendicitis cases in 2019 (p<0.001). HPos patients were older, less likely to have private insurance, and more likely to have psychiatric illnesses, hypertension, and a history of prior malignancy. HPos AA patients underwent operative intervention less often than HNeg AA patients (90.7% versus 97.7%;p<0.001). Overall, comparing HPos to HNeg patients, there was no difference in post-operative infections or mortality. Conclusion: HIV-positive status should not deter surgeons from offering definitive care for acute uncomplicated appendicitis.
MeSH term(s)	Humans ; Appendicitis/epidemiology ; Appendicitis/surgery ; Appendicitis/drug therapy ; Acquired Immunodeficiency Syndrome/drug therapy ; Acquired Immunodeficiency Syndrome/surgery ; Appendectomy ; Postoperative Complications ; Acute Disease ; Retrospective Studies ; Treatment Outcome ; Anti-Bacterial Agents/therapeutic use ; Laparoscopy
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2023-05-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	419430-5
ISSN	2327-2228 ; 0363-7913
ISSN (online)	2327-2228
ISSN	0363-7913
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Article ; Online: A Case of Recurrent Malignant Melanoma of the Left Foot with In-Transit Metastases.

Olivieri, Daniel J / Heffernan, Daithi S / Koness, R James

Rhode Island medical journal (2013)

2021 Volume 104, Issue 7, Page(s) 42–45

Abstract: We report a 73-year-old male with recurrent amelanotic malignant melanoma of the left foot with in-transit metastases to the left thigh. In-transit metastatic melanoma can often represent a diagnostic and therapeutic challenge for physicians. This ... ...

Abstract	We report a 73-year-old male with recurrent amelanotic malignant melanoma of the left foot with in-transit metastases to the left thigh. In-transit metastatic melanoma can often represent a diagnostic and therapeutic challenge for physicians. This patient was treated with talimogene laherparepvec injections (T-VEC; Imlygic) in the left inguinal and the left plantar region every two weeks for one year as oncolytic viral therapy for advanced non- operable malignant melanoma. He then received consistent follow-up including blood work and PET scans every four months, and he also required further lymph node surgical dissection. To date, our patient has survived 3 years and 11 months, which is 27 months longer than the esti- mated median survival of 1 year 8 months for patients diagnosed with in-transit metastatic melanoma.
MeSH term(s)	Aged ; Humans ; Male ; Melanoma/therapy ; Oncolytic Virotherapy ; Skin Neoplasms/therapy
Language	English
Publishing date	2021-09-01
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	419430-5
ISSN	2327-2228 ; 0363-7913
ISSN (online)	2327-2228
ISSN	0363-7913
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Article ; Online: The Impact of Protective Devices Across the Spectrum of Trauma Care and Across Racial Groupings.

Montas, Genevieve / Nwaiwu, Chibueze / Stephen, Andrew H / Heffernan, Daithi S

The American surgeon

2022 Volume 89, Issue 12, Page(s) 5140–5146

Abstract: Introduction: Protective devices such as seat belts and helmets save lives. Most studies only address one aspect of the injury profile - compliance or mortality - not the entire spectrum of trauma care, and little attention is paid to racial differences ...

Abstract	Introduction: Protective devices such as seat belts and helmets save lives. Most studies only address one aspect of the injury profile - compliance or mortality - not the entire spectrum of trauma care, and little attention is paid to racial differences in the use or impact of protective devices. Methods: Patients with blunt mechanisms where using protective devices would be expected were included and were divided into utilizing (P) vs not utilizing protection (Non-P). Chart review included demographics, injuries sustained, hemodynamics, and blood alcohol level. Outcomes included need for emergent operation, complications and death. Results: Non-P patients were more likely male, presented at night and intoxicated. Highest risk behavior (intoxicated Non-P) presented at night (25.7% of nighttime presentations), and rarely during daytime (6.7% daytime presentations). Non-P were more likely hypotensive and sustain a traumatic brain injury. No race related differences were noted among young patients. Among older (>/=50 years) patients, White patients were least likely Non-P and least likely presented at night. Non-P required more emergent operative intervention, ICU admission, and longer hospital stay. Overall, Non-P was associated with increased risk of death (OR = 1.6 (95% CI = 1.28 - 2.11). Conclusion: Given unique age and racial differences, we advocate for culturally and age specific public service campaigns.
MeSH term(s)	Humans ; Male ; Accidents, Traffic ; Seat Belts ; Blood Alcohol Content ; Length of Stay ; Head Protective Devices ; Emergency Medical Services
Chemical Substances	Blood Alcohol Content
Language	English
Publishing date	2022-11-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348221135783
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Article ; Online: Long-Term Outcomes of Veterans With a Diagnosis of Heart Failure After COVID-19.

Khetpal, Vishal / Berkowitz, Julia / Jiang, Lan / Menon, Anupama / Shah, Nishant / Heffernan, Daithi S / Choudhary, Gaurav / Rudolph, James L / Wu, Wen-Chih / Erqou, Sebhat

JACC. Advances

2023 , Page(s) 100381

Language	English
Publishing date	2023-06-07
Publishing country	United States
Document type	Journal Article
ISSN	2772-963X
ISSN (online)	2772-963X
DOI	10.1016/j.jacadv.2023.100381
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Article: Lymphocyte HVEM/BTLA co-expression after critical illness demonstrates severity indiscriminate upregulation, impacting critical illness-induced immunosuppression.

Wakeley, Michelle E / Armstead, Brandon E / Gray, Chyna C / Tindal, Elizabeth W / Heffernan, Daithi S / Chung, Chun-Shiang / Ayala, Alfred

Frontiers in medicine

2023 Volume 10, Page(s) 1176602

Abstract: Introduction: The co-regulatory molecule, HVEM, can stimulate or inhibit immune function, but when co-expressed with BTLA, forms an inert complex preventing signaling. Altered HVEM or BTLA expression, separately have been associated with increased ... ...

Abstract	Introduction: The co-regulatory molecule, HVEM, can stimulate or inhibit immune function, but when co-expressed with BTLA, forms an inert complex preventing signaling. Altered HVEM or BTLA expression, separately have been associated with increased nosocomial infections in critical illness. Given that severe injury induces immunosuppression, we hypothesized that varying severity of shock and sepsis in murine models and critically ill patients would induce variable increases in HVEM/BTLA leukocyte co-expression. Methods: In this study, varying severities of murine models of critical illness were utilized to explore HVEM Results: Higher severity murine models resulted in minimal change in HVEM Discussion: While HVEM increased on leukocytes after critical illness in mice and patients, changes in co-expression did not relate to degree of injury severity of murine model. Rather, co-expression increases were seen at later time points in lower severity models, suggesting this mechanism evolves temporally. Increased co-expression on CD3
Language	English
Publishing date	2023-05-25
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2775999-4
ISSN	2296-858X
ISSN	2296-858X
DOI	10.3389/fmed.2023.1176602
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Article ; Online: Unmasking Unique Immune Altering Aspects of the Microbiome as a Tool to Correct Sepsis-Induced Immune Dysfunction.

Heffernan, Isabella M / McGeary, John E / Chung, Chun-Shiang / Ayala, Alfred / Heffernan, Daithi S

Surgical infections

2020 Volume 22, Issue 4, Page(s) 400–408

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Bacteroides fragilis ; Gastrointestinal Microbiome ; Humans ; Microbiota ; Probiotics ; Sepsis
Language	English
Publishing date	2020-09-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	1440120-4
ISSN	1557-8674 ; 1096-2964
ISSN (online)	1557-8674
ISSN	1096-2964
DOI	10.1089/sur.2020.233
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