Purpose of reviewComputing advances over the decades have catalyzed the pervasive integration of digital technology in the medical industry, now followed by similar applications for clinical nutrition. This review discusses the implementation of such technologies for nutrition, ranging from the use of mobile apps and wearable technologies to the development of decision support tools for parenteral nutrition and use of telehealth for remote assessment of nutrition.Recent findingsMobile applications and wearable technologies have provided opportunities for real-time collection of granular nutrition-related data. Machine learning has allowed for more complex analyses of the increasing volume of data collected. The combination of these tools has also translated into practical clinical applications, such as decision support tools, risk prediction, and diet optimization.SummaryThe state of digital technology for clinical nutrition is still young, although there is much promise for growth and disruption in the future.

The aim of this review is to summarize and sum up the recent evidence on the topic of abdominal wall reconstruction post oncologic resection, comparing the use of mesh versus autologous reconstruction. Recent findings show a more accepting approach towards more complex reconstructions that aim at a dynamic and robust abdominal wall reconstruction. Musculocutaneous free flaps using the anterolateral thigh flap, with a vastus lateralis, or the latissimus dorsi flap are being used more for replacing musculo-fascial and full-thickness defects to restore abdominal domain. Those autologous reconstructions are best combined with a mesh for robust musculo-fascial layer closure. Different mesh options are available for different cases depending on defect and the contamination status of the wound. Post-oncologic abdominal wall reconstruction is a complex procedure that should be well planned in multidisciplinary teams. The surgical options should be set up on a case-by-case basis weighing the different benefits and risks of autologous, mesh, or combined reconstruction. The more robust the reconstruction, the less complications encountered, especially with hernia formation rates.

Enterocutaneous Fistula (ECF) management remains a complex medical problem. Under best circumstances morbidity and mortality remains high. Best practice for nutrition management has remained stagnant since the development of parenteral nutrition by the late Stanley Dudrick in the 1960–1970s. This manuscript proposes that the old paradigm of exclusive parenteral nutrition for high output fistulas (> 500 cc/day) is antiquated and should be aborted based on contemporary evidence. Through the development of modern management protocols for nutritional optimization, pre-habilitation of this patient population may become more efficient and impact morbidity and mortality in a positive manner. A review of the literature and inferences from other bodies of surgical management helps impact ECF care. Enhanced recovery after surgery will likely be the future for ECF patient, but outcomes of more randomized control trials studying ECF management must help guide the future.

In this review, we will discuss the recent advances in the identification of landmark gene signatures in cutaneous melanoma and in the discovery of those relevant to cutaneous squamous cell carcinoma (cSCC). Melanoma and cSCC are the most important cutaneous malignancies when considering morbidity and mortality. They are responsible for the greatest number of skin cancer related deaths. Over the past several years, a number of gene signatures have been identified showing great promise in terms of tumor molecular classification and risk stratification of patients to anticipate best therapeutic modalities. These gene signatures have allowed a personalized medicine approach to a comprehensive decision-making process for these patients. Prediction of the prognosis and therapeutic response of patients with melanoma and high-risk cSCC will be aided by the elucidation and utilization of these gene signatures.

Breast cancer research has long focused on breast epithelium in cancer development. This traditional view is being challenged by more recent work which suggests that stromal components such as fibroblasts, immune cells, endothelial cells, and others may play a central role in cancer development. The purpose of this review is to investigate the elements of the breast stroma and their interaction with the epithelium in creating the necessary pro-tumorigenic environment. Several studies have revealed that breast cancer stroma differs significantly from normal breast stroma, with altered cellular and molecular factors that may serve as potential therapeutic targets in breast cancer treatment. Studies of the complex interactions within the cancer ecosystem have revealed tumor-associated stromal changes that promote cell growth and invasiveness. They also reveal specific targets for novel strategies to inhibit inflammation, immunosuppression, angiogenesis, and distant invasion.

This review intends to discuss the current status of childhood and adolescent bariatric surgery, including short- and mid-term outcomes, complications, and controversies. Additionally we will highlight potential future directions of pediatric weight loss procedures specifically in regard to procedures. To date, adolescent bariatric surgery appears to be the most effective way to treat adolescent and pediatric obesity in the short term. Not only does surgery offer the benefit of significant weight loss that is sustainable based on adult literature and the short-term data that we have in pediatric and adolescent literature, but there are significant improvements and resolutions to obesity-associated comorbidities. The recent literature converge on the importance and necessity of further studies which follow patients into adulthood in order to provide a better understanding of the long-term effects of surgery on the adolescent population, resolution of comorbidities, the benefits to the patient, and the impact on life expectancy. Adolescent surgical outcomes and comorbidities appear to mimic adult data, and some studies show that children and adolescents respond better to bariatric surgery with better results than the adults in regard to comorbidities. Effective management of overweight and obese pediatric and adolescent patients requires early identification and surgery for those patients who would most benefit from surgical treatment. To date, pharmacotherapy, behavior modification, and dietary changes do not have long-term sustainability in regard to maintaining a healthy weight in these children. Appropriate utilization of bariatric surgery among the pediatric and adolescent population is important in preventing obesity transmission, and its complications, into adulthood. Long-term data will address many questions and concerns of parents, patients, and primary care physicians. Until effective non-surgical options become available, weight loss surgery is the only viable option. Future endeavors and new research favor creation and use of less invasive safer procedures that incur less risk with maximum benefit, and study of the patients’ unique physiology in a search for different treatments as well as prevention options.

This report is intended to review the principals of US trauma system design and to examine the theorized and observed effects of trauma center over designation in a regional trauma system. Quality trauma care is predicated on concentrating resources and experience in major trauma centers. Nearly all major US urban areas have at least one major trauma center. New techniques are available to measure a region's geospatial demand that better predict the optimal placement of system resources and the impact of new major trauma center designations in areas already served. Although concerns that over designation may decrease quality through dilution of experience, increased costs from duplication of services and variation in economic practices pose a larger threat to trauma system’s value. Recent changes in patient populations, health care economics, and policy have made trauma center designations more financially desirable shifting the trauma system’s center of gravity from public health towards industry. New tools are available to aid in trauma system planning which should help designating authorities optimize regional major trauma center allocation.

The goal of this paper is to review the surgical techniques for the correction of sternal cleft in children. Various surgical techniques have been developed for the correction of sternal cleft since 1949, when the first successful repair was reported. Sternal cleft is an uncommon congenital chest wall deformity. The optimal correction can be achieved by primary repair of the defect in patients younger than 1 year of age, especially during the neonatal period, mostly with an easy technique. In older children, more extensive techniques are applied, using either autologous tissues or synthetic prosthetic materials, with satisfactory functional and aesthetic results.

This review summarizes the literature from the last 5 years regarding atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), classic lobular carcinoma in situ (C-LCIS), and non-classic LCIS (NC-LCIS). ADH, ALH, and C-LCIS are well-established markers of increased breast cancer risk. Recent studies suggest the possibility of observation for select cases of ADH diagnosed on core biopsy; however, guidelines support routine excision. In contrast, accumulating data support observation for ALH and C-LCIS on core biopsy with radiographic–pathologic concordance. Data on the natural history of pure NC-LCIS remain limited; however, when NC-LCIS is diagnosed on core biopsy, routine excision is warranted. ALH and C-LCIS on core biopsy should be reviewed for concordance to determine the need for excision; independent of surgical excision, all warrant counseling regarding increased future breast cancer risk. Current guidelines support routine excision for ADH and NC-LCIS on core biopsy. The natural history of NC-LCIS remains poorly defined.