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Awards & Distinctions ?

American College of Surgeons

Publications & Research

Dr. Roach has contributed to 8 publications.
Title Advances in the Understanding and Treatment of Biliary Atresia.
Date July 2008
Journal Current Opinion in Pediatrics

PURPOSE OF REVIEW: The purpose of this study is to review both the basic science and clinical advancements in the last 12 months that have furthered our understanding of biliary atresia. RECENT FINDINGS: Early diagnosis and further understanding of the disease process may be the next major step in advancement. Stool color cards have been shown to be an accurate screening tool. Basic science developments have focused on defects in morphogenesis, immunologic dysregulation, and viral infection as the major theories of causes. There have been initial reports of minimally invasive approaches to hepatic portoenterostomy but there has been little comparative study. Postoperative corticosteroid therapy remains an area of debate without definitive data. Early postoperative testing of serum bilirubin levels and hepatobiliary scintigraphy are showing strong correlation with long-term outcomes. The comparison of regions with decentralization policies compared with those with central referral policies is providing a good forum to monitor real-time outcome data. SUMMARY: Biliary atresia continues to represent a major challenge with many unanswered questions. The establishment of multicentered collaboration in both basic science and clinical research interests has been an important step in improving outcomes for this disease.

Title Gelsolin is Depleted in Post-shock Mesenteric Lymph.
Date December 2007
Journal The Journal of Surgical Research

BACKGROUND: Gelsolin is a plasma protein that functions to depolymerize actin filaments preventing capillary plug formation following tissue injury. It also functions to mediate the inflammatory response by binding proinflammatory lipids such as lysophosphatidic acid, sphingosine-1-phosphate and phosphoinositides. Clinically, reduced gelsolin concentrations have been associated with increased mortality in critically ill, trauma, and burn patients. We have previously shown that following hemorrhagic shock with splanchnic hypoperfusion, mesenteric lymph contains lipid components that cause neutrophil and EC activation and that protein concentrations are severely diluted due to resuscitation. We hypothesized that lipid binding proteins such as gelsolin may be depleted after trauma/hemorrhagic shock leading to increased lipid bioactivity. METHODS: Shock was induced in SD rats by controlled hemorrhage and the mesenteric duct cannulated for lymph collection. Resuscitation was performed by infusing 2x SB volume in NS over 30 min, followed by 1/2 SB volume over 30 min, then 2x SB volume in NS over 60 min. Pre and post-shock lymph was loaded at equal protein concentrations on 2D-gels, followed by trypsin digestion and identification with mass spectrometry (MS-MS). Proteomics data were confirmed with Western blotting then quantitated by densitometry. Analysis of variance was used evaluate statistical data. RESULTS: Gelsolin decreased in mesenteric lymph following hemorrhagic shock. CONCLUSIONS: Gelsolin is found at high levels (comparable to plasma) in mesenteric lymph. Following hemorrhagic shock, gelsolin levels decrease significantly, possibly due to consumption by the actin scavenging system. The magnitude of this change in concentration could release lipid bioactivity and predispose the lung and other organs to capillary injury.

Title Complicated Appendicitis in Children: a Clear Role for Drainage and Delayed Appendectomy.
Date December 2007
Journal American Journal of Surgery

INTRODUCTION: Children presenting with complicated appendicitis represent a common and challenging problem. Conflicting data exist concerning optimal treatment of these patients with primary versus delayed appendectomy. METHODS: A retrospective review of all children undergoing appendectomy over a 5-year period was performed. RESULTS: We identified 1,106 children: 360 had evidence of perforation and 92 had an intra-abdominal abscess or right lower quadrant phlegmon. Of these 92, 60 underwent primary appendectomy and 32 underwent drainage and/or antibiotic therapy with delayed appendectomy. Children undergoing delayed appendectomy had a longer prodrome of symptoms (6.9 vs 4.6 days, P = .002), slightly higher presenting white blood cell count (19.3 vs 16.6, P = .08), and had the same hospital length of stay, yet had a lower complication rate requiring readmission to the hospital (0% vs 10%) compared to those undergoing immediate appendectomy. CONCLUSION: In children presenting with prolonged symptoms and a discrete appendiceal abscess or phlegmon, drainage and delayed appendectomy should be the treatment of choice.

Title Minimization of Ion Suppression in Lc-ms/ms Analysis Through the Application of Strong Cation Exchange Solid-phase Extraction (scx-spe).
Date July 2005
Journal Journal of Pharmaceutical and Biomedical Analysis

Ion suppression of drug response is a major source of imprecision for bioanalytical analysis using LC-MS/MS. Endogenous phospholipids cause ion suppression in both positive ESI and negative ESI modes and must be removed or resolved chromatographically. Three types of ion-exchange solid-phase extraction mediums were evaluated to determine their abilities to remove phospholipids. It was determined that although mixed mode phases fulfills the requirements of retaining both analytes and diverse metabolites, reverse phase retention mechanisms are detrimental in eliminating ion suppression caused by late eluting phospholipids. If an analyte and its metabolites can be retained using an ion-exchange mechanism alone, mixed mode extraction phases should be avoided.

Title Assessment of Knowledge and Practice of High Risk Sexual Behavior at a Private Midwestern University.
Date September 2003
Journal South Dakota Journal of Medicine

In the United States, an estimated 15.3 million new cases of sexually transmitted infections (STIs) occur each year. Approximately two-thirds of people who acquire STIs in the U.S. are younger than 25 years of age. In addition, approximately 57% (3.1 million) of all pregnancies in the United States are classified as unintended. It is only logical that the consequences of high-risk sexual behavior (unintended pregnancy and contraction of an STI) would most affect those who exhibit high-risk sexual behavior. Thus, one would expect to find high-risk sexual behavior in the same populations that have high rates of STIs and unintended pregnancy. The purpose of this study was to survey freshman students living in the residence halls at a local college to assess their knowledge and the prevalence of high-risk sexual behavior, and give feedback to the participating institution about these results. The survey was designed to answer two questions: (1) What is the current level of high-risk sexual behavior at a small private Midwestern College? (2) What is the current level of knowledge about high-risk sexual behaviors of those surveyed? A total of 38 men and 131 women participated in the survey. Forty-seven percent of men and 41% of women respondents reported having sexual intercourse at least once in their lifetimes. Of those respondents who were sexually active, 67% of men and 54% of women reported that they "always use a condom" with sexual activity. Fifty-six percent of men and 51% of women that were sexually active reported that they were "not at all concerned" about contracting an STI. Twenty-two percent of men and 17% of women answered that they were "not at all concerned" about pregnancy. Three true/false questions about STIs were answered correctly over 95% of the time by those surveyed. Seventy-nine percent of respondents reported never having attended educational opportunities about STIs and safe sexual practices at the college.

Title Spontaneous Intraperitoneal Rupture of a Kidney in a Patient with Tuberous Sclerosis.
Date July 1986
Journal The Journal of Urology

A case is reported of spontaneous intraperitoneal rupture of a kidney in a patient with tuberous sclerosis who presented with left renal colic and left lower quadrant abdominal pain.

Title Physical Therapist Assistant in a California Home Health Agency.
Date October 1981
Journal Physical Therapy

A perpetual shortage of physical therapists qualified to provide home health care exists in Southern California. This paper presents one solution to the problem: the employment of a physical therapist assistant. The preparation, implementation, and evaluation of a program for employing a physical therapist assistant in a home health agency is presented and discussed. The use of the assistant increased the availability of physical therapy, and quality was not adversely affected. The assistant was accepted by staff and derived job satisfaction. We concluded that this assistant was a valuable adjunct to the home health team. Subsequently, The Visiting Nurse Association of Los Angeles employed two additional assistants in 1980.

Title Heme Oxygenase 1 Induction In Macrophages By A Hemoglobin-based Oxygen Carrier Reduces Endotoxin-stimulated Cytokine Secretion.
Journal Shock (augusta, Ga.)

The inflammatory response after an insult may provoke further tissue damage, and the macrophage is central in this pathophysiology. Induction of heme oxygenase 1 (HO-1) attenuates postshock organ dysfunction, although the mechanism remains unclear. We hypothesized that HO-1 induction modifies the cytokine profile of LPS-stimulated macrophages. Heme oxygenase 1 was induced in murine and human macrophages with varying concentrations of a hemoglobin-based oxygen carrier (HBOC). Heme oxygenase 1 expression was analyzed by Western blotting of whole cell lysates. Macrophages were pretreated with HBOC for 4 h, then media with LPS were added for up to 24 h. The specific HO-1 inhibitor zinc protoporphyrin (ZnPP) was used to inhibit the effects of HO-1. Supernatants were analyzed for IL-6, IL-10, TNF-alpha, and monocyte chemotactic protein 1 (MCP-1) by enzyme-linked immunosorbent assay. Incubation of cells with HBOC produced a dose-dependent expression of HO-1. Heme oxygenase 1 expression decreased LPS-stimulated secretion of MCP-1, IL-6, IL-10, and TNF-alpha at both 4 and 24 h in murine and human macrophages. The addition of ZnPP to inhibit HO-1 partially restored MCP-1 and IL-6 secretion in murine macrophages. Furthermore, immunofluorescent microscopy revealed HBOC-induced HO-1 inhibited LPS-stimulated nuclear translocation of the p65 subunit of nuclear factor-kappaB. In summary, HBOC incubation of macrophages induced HO-1 expression, which reduced LPS-mediated cytokine release, and that MCP-1 and IL-6 secretion could be partially restored with ZnPP. These data encourage continued investigation into the role of HO-1 in protecting against posttraumatic organ dysfunction and the clinical potential of HBOC for HO-1 induction.

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