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The esophagus is derived from the anterior portion of the foregut endoderm, which also gives rise to the respiratory system. As it develops, the esophageal lining is transformed from a simple columnar epithelium into a stratified squamous cell layer, accompanied by the replacement of unspecified mesenchyme with layers of muscle cells. Studies in animal models have provided significant insights into the roles of various signaling pathways in esophageal development. More recent studies using human pluripotent stem cells (hPSCs) further demonstrate that some of these signaling pathways are conserved in human esophageal development. In addition, a combination of mouse genetics and hPSC differentiation approaches have uncovered new players that control esophageal morphogenesis. In this Review, we summarize these new findings and discuss how the esophagus is established and matures throughout different stages, including its initial specification, respiratory-esophageal separation, epithelial morphogenesis and maintenance. We also discuss esophageal muscular development and enteric nervous system innervation, which are essential for esophageal structure and function. [ABSTRACT FROM AUTHOR]

The purpose of this study was to better define an ideal tendon transfer suture construct to allow for early active range of motion. A side-to-side tendon construct was used to test suture technique (cross stich vs. Krackow stitch), number of suture throws, and calibre of suture. A minimum load to failure of 100 N was used to comfortably allow early motion while minimizing rupture risk. All constructs tested, except the 4-0 Krackow construct, were strong enough to withstand 100 N of load. The choice of suture should be based on surgeon preference, patient compliance, and specific surgery, and 3-0 non-absorbable suture may be more suitable for tendon transfers from a yield force standpoint. [ABSTRACT FROM AUTHOR]

Purpose: Endourologic procedures such as percutaneous nephrolithotomy (PCNL) employ the use of foot pedals in low-light operating room (OR) settings. These pedals can be especially difficult to locate or distinguish when several pedals are present during a single operation. Improper instrument activation in the OR has led to serious complications ranging from unintentional electrocautery to patient burns and even an intraoperative explosion. This study evaluates the impact of color-coded illumination on speed and efficiency of foot pedal activation. Materials and Methods: During a simulated PCNL procedure, the foot pedals for a C-arm, laser, and ultrasonic lithotripter (USL) were placed in random positions. Ten participants performed pedal activation in a randomized sequence. Objective outcomes included time to instrument activation, number of attempted pedal presses, number of incomplete pedal presses, and number of incorrect pedal presses. Subjective preferences for pedal illumination were also determined. Data were analyzed using Mann–Whitney U, Wilcoxon signed-rank, and Chi-square tests with p  < 0.05 indicating statistical significance. Results: Illuminated foot pedals were associated with decreases in the average activation time for all instruments collectively (3.95 seconds vs 6.49 seconds; p  = 0.017) and individually (C-arm: 3.07 seconds vs 4.21 seconds; p  = 0.006; laser: 13.04 seconds vs 15.18 seconds; p  < 0.001; USL: 3.28 seconds vs 4.91 seconds; p  < 0.001) compared with nonilluminated pedals. Illuminated pedals were associated with fewer attempted pedal presses (33.5 vs 39.5; p  = 0.007) and incomplete pedal presses (1.5 vs 8.5; p  = 0.002). The number of incorrect pedal presses decreased with illumination, but this did not reach statistical significance (0 vs 0.5; p  = 0.08). Participants reported that illumination simplified pedal activation and recommended its use ( p  < 0.01). Conclusion: Color-coded illumination improved the speed and efficiency of foot pedal activation during simulated PCNL. Participants subjectively preferred using illuminated foot pedals for endourologic procedures and felt that they improved safety and efficiency. [ABSTRACT FROM AUTHOR]

An outbreak of influenza A(H7N2) virus in cats in a shelter in New York, NY, USA, resulted in zoonotic transmission. Virus isolated from the infected human was closely related to virus isolated from a cat; both were related to low pathogenicity avian influenza A(H7N2) viruses detected in the United States during the early 2000s. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of laser fiber stripping on stone fragmentation and laser fiber power output. Materials and Methods: In a benchtop simulation of laser lithotripsy, 20 BegoStone phantoms were positioned within a ureteral model and irradiated for 10 minutes at 8 Hz and 0.8 J. A freshly cleaved 365 μm laser fiber was used for all trials, with half of the fibers also undergoing stripping. Power output was measured at 1-minute intervals, beginning with an initial prelithotripsy recording at 0 minutes. Fiber tips were imaged with scanning electron microscopy. In a single-blinded manner, final masses of residual stone fragments were measured and used to quantify stone breakdown. Independent-sample Mann-Whitney U tests were performed with significance set at p < 0.05, comparing stripped and unstripped fiber tips with respect to power output and fraction of stone fragmentation. Results: Mean power output after 1 minute of lasing was significantly greater in unstripped laser fibers ( p = 0.015), while fibers, whether stripped or not, demonstrated no significant output differences prelithotripsy or at any time from 2 to 10 minutes. However, stripped laser fibers achieved significantly increased stone breakdown compared to unstripped fibers ( p = 0.004), fragmenting 63 mg (25%) more of the initial stone mass per trial. Conclusions: Although unstripped laser fibers provided superior power output at 1 minute, output at all other time points was similar between stripped and unstripped fibers. However, despite similar optical output, stripped laser fibers achieved greater stone fragmentation, possibly due to improved contact between stone and fiber tip. [ABSTRACT FROM AUTHOR]

Objective: To compare the outcomes between laparoendoscopic single-site (LESS) and a novel percutaneous externally assembled laparoscopic (PEAL) nephrectomy in an in vivo porcine model. Materials and Methods: Ten female farm pigs were randomized to LESS nephrectomy (5) or PEAL nephrectomy (5). Operative times, estimated blood loss, and intraoperative and postoperative complications were compared. The surgeons used a Likert scale to grade difficulty of peritoneal access, port placement, tool assembly, hilar dissection, closure, and overall difficulty of surgery. Scar assessment was performed by a blinded plastic surgeon using the Vancouver Scar Scale. Descriptive statistics were reported as median and range. The Mann-Whitney U test was used for continuous and ordinal variables. A p value <0.05 was considered significant. Results: Median operative time was significantly shorter in the PEAL group vs the LESS group (85 minutes vs 127 minutes, p = 0.03). Median Likert scores showed overall hilar dissection and nephrectomy to be significantly easier using PEAL compared with LESS (2 vs 9, p < 0.01 for both). The PEAL instruments left no visible scar at 5 feet in any animal, and only 1 out of 10 scars could be identified on physical examination. Conclusions: The PEAL surgical paradigm demonstrates nearly scarless outcomes while providing shorter operative times and easier performance than LESS nephrectomy in a porcine model. [ABSTRACT FROM AUTHOR]