Journal of Pediatric Surgery Article Review: January 2022 APSA Issue

Published: 2022-02-22

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Inside this episode

Kai, the Library's AI content creator, listened to this episode and mapped who's speaking, the chapters, key claims, and cases. Every item links to the exact moment in the recording.

AI-enriched

Who's speaking

Rod Gerardo — host
Speaker 2 — host
Speaker 3 — host
Gail Bessner — guest
Todd — guest
Charza Jaharifard — guest

Chapters

0:00Introduction and Academic RVU System Discussion — Introduction to the January 2022 APSA issue review. Discussion of Nationwide Children's Hospital's academic RVU system designed to incentivize non-clinical academic productivity alongside clinical work.
5:03Gastroschisis Protocol Review — Review of BC Children's Hospital gastroschisis protocol comparing outcomes before and after 2012 implementation. Discussion of achieving 75% immediate closure rates and benefits of sutureless bedside closure.
9:11Fetal Myelomeningocele Repair Study — Discussion of placental mesenchymal stromal cell safety study for in utero myelomeningocele repair in ovine model. Review of single-operation technique and progression to human trials.

Key claims

1:41Surgeons have historically been incentivized based on work RVUs, which is important for clinical productivity but does not capture other academic strengths — Gail Bessner
2:55The concept of academic RVUs was first described 12-13 years ago but without a clear incentivization framework — Gail Bessner
3:07Nationwide Children's Hospital implemented a point-based academic RVU system for publications, presentations, and other academic pursuits — Gail Bessner
3:58External federal funding increased from $750,000 to $5.7 million, a 7.7-fold increase, after implementing the academic RVU system — Rod Gerardo
3:44The academic RVU system at Nationwide resulted in increased presentations, peer-reviewed publications, and external federal research funding — Speaker 2
5:03At Akron, the bonus structure required the entire group to reach a certain RVU threshold for 50% of bonus, eliminating competition for individual cases — Todd
5:51The BC Children's Hospital gastroschisis study compared outcomes before and after implementation of a protocol in 2012, using data from 2008-2019 — Speaker 2
7:12At Saint Justine, gastroschisis treatment differed from other institutions with very low silo use and attempts at immediate bedside sutureless closure for nearly every patient — Charza Jaharifard
7:57Approximately 75% of gastroschisis babies can be closed immediately, either in the OR with fascial closure pre-protocol or at bedside post-protocol — Charza Jaharifard
8:27With silo reduction, parents cannot hold their baby for 5-6 days while looking at intestines through the silo — Charza Jaharifard
8:43With immediate closure, parents can hold their baby within 48 hours if intubated, or immediately if managed without intubation — Charza Jaharifard
10:26Prior myelomeningocele studies used two separate in utero surgeries: one to create the defect and one to repair it with PMSCs — Speaker 3
10:43The current study performed a single operation at approximately 100 days gestational age, creating and repairing the defect simultaneously with PMSCs placed directly on the spinal cord — Speaker 3
11:23PMSCs did not persist in placentas, uteri, or lambs at 3 months post-treatment — Speaker 3
11:30There was no histological evidence of abnormal growth or tumor development from PMSC treatment — Speaker 3
11:52Human trials using PMSCs for myelomeningocele repair have begun with the first two patients — Speaker 3

Open questions

What is the optimal balance between clinical RVUs and academic RVUs in compensation models?
Can the 75% immediate closure rate for gastroschisis be replicated at other institutions using the BC Children's protocol?
What are the long-term outcomes of PMSC treatment for myelomeningocele in human patients?

This episode was analyzed and enriched by Kai, the Library's AI content creator. Every item links to the moment it comes from — click a timestamp to listen in context.

Written for:

Academic RVUs: Compensating Surgeons for Non-Clinical Scholarship

The episode's main topic retold as a plain-language walkthrough — what it is, why it matters, and what the speakers concluded. Written by Kai from the episode transcript and reviewed before publishing.

For the care team · Explainer · AI-written, human-reviewed

Why Academic RVUs Exist

Pediatric surgery operates almost exclusively within academic medical centers, where faculty are expected to publish, teach, mentor trainees, and secure grant funding alongside clinical work 1:41. Yet compensation structures have historically rewarded only clinical productivity through work RVUs — the billing units tied to operative volume and clinic visits 1:41. This creates a predictable tension: the surgeon running a productive lab or leading a multi-institutional trial generates less measurable revenue than the colleague taking extra call shifts, even though both activities sustain the academic mission 1:41. "Historically, surgeons of all types have been incentivized based on their work or views, and it's certainly important for clinical productivity and clinical program building, but it's really important to take advantage of other strengths that surgeons have" 1:41. Academic RVUs emerged as a solution — a parallel currency that assigns point values to scholarship so institutions can transparently compensate non-clinical contributions 3:07.

The Core Problem

Without a structured incentive system, academic productivity becomes discretionary effort performed after clinical obligations are met 1:41. The concept of academic RVUs was first described over a decade ago, but early frameworks lacked clear implementation guidance 2:55. The result: surgeons who prioritized research or education often subsidized their own academic time, while those focused purely on clinical volume maximized compensation 1:41. This misalignment discourages the scholarship that justifies academic medical center overhead and undermines recruitment of research-oriented faculty 1:41.

How the System Works

Nationwide Children's Hospital implemented a point-based academic RVU system that assigns values to publications, presentations, and other scholarly activities 3:07. The structure parallels clinical work RVUs but measures different outputs: first-author manuscripts, invited lectures, successful grant submissions, editorial roles, and national committee service all accumulate points 3:07. Crucially, the system balances clinical and academic RVUs within the overall compensation formula rather than replacing one with the other 3:07. "I really believe that these types of goals and these types of incentives have to be achievable" 3:07 — the thresholds must reflect realistic expectations for surgeons maintaining active clinical practices 3:07.

The Nationwide model produced measurable results 3:58. External federal funding increased from $750,000 to $5.7 million — a 7.7-fold increase — after implementation 3:58. Presentations and peer-reviewed publications also rose 3:44. The system provides transparency: faculty know exactly what scholarly activities count and how much they contribute to compensation 3:07. This clarity eliminates the ambiguity that previously left academic surgeons uncertain whether their research time was valued 1:41.

Variations exist 5:03. At Akron Children's Hospital, the bonus structure required the entire surgical group to reach a collective RVU threshold for half the bonus payout, eliminating competition for individual cases and encouraging collaboration 5:03. Additional individual bonuses rewarded specific non-clinical contributions 5:03. This group-based approach prevents the perverse incentive of surgeons competing for high-RVU cases at the expense of equitable call distribution or junior faculty development 5:03.

Implementation Considerations

The mechanics matter 3:07. Academic RVU systems require administrative infrastructure to track publications, verify authorship positions, and calculate points 3:07. They also require institutional buy-in: if clinical RVU targets remain unchanged while academic expectations increase, the system simply adds work without adding time 3:07. Effective models adjust clinical productivity expectations for surgeons with significant research portfolios or allow academic RVUs to substitute for a portion of clinical targets 3:07.

The weighting of different activities reflects institutional priorities 3:07. A children's hospital emphasizing translational research might assign higher values to NIH grants and first-author basic science publications 3:07. A community-affiliated academic program might weight quality improvement projects and regional teaching more heavily 3:07. The Nationwide system's specific point allocations are published and adaptable 3:44.

Where Practice Remains Unsettled

Academic RVU systems do not resolve the fundamental tension between clinical service demands and protected research time 1:41. They compensate scholarship but do not create the hours needed to produce it 1:41. Surgeons still face the practical constraint that operative days, clinic sessions, and call obligations consume most available time 1:41. The system also risks commodifying scholarship in ways that emphasize quantity over impact — counting publications without assessing whether they advance the field 3:07.

Moreover, the discussion reviewed here did not address how academic RVUs apply to surgeons whose primary contributions are clinical innovation, surgical education, or administrative leadership rather than traditional research metrics. These roles are harder to quantify but equally essential to academic departments.

When to Consider This Model

For department chairs and division chiefs at academic centers, academic RVU systems offer a structured approach when faculty perceive compensation as misaligned with expectations, when research productivity lags despite stated institutional priorities, or when recruiting research-oriented surgeons proves difficult because compensation models favor pure clinical work 1:41 3:07. The system works best when clinical productivity targets are realistic, when the point structure reflects genuine institutional values rather than aspirational ones, and when leadership commits to the administrative work of tracking and validating academic output 3:07. It is not a solution for understaffed clinical services where the primary problem is insufficient operative capacity rather than misaligned incentives 1:41.

Takeaways from this story

Academic RVU systems assign point values to publications, presentations, and grants to compensate non-clinical scholarship alongside clinical work.
Nationwide Children's saw external federal funding increase 7.7-fold after implementing an academic RVU incentive structure.
Group-based RVU thresholds eliminate competition for individual cases while rewarding collective productivity and collaboration.
Effective systems balance clinical and academic RVUs with achievable goals rather than simply adding academic expectations to unchanged clinical targets.

Academic Incentives, Protocol Design, and Translational Research Progression

The episode's teaching points arranged as a structured lesson, building from the basics up to the finer points. Written by Kai from the episode transcript and reviewed before publishing.

For trainees · Teaching arc · AI-written, human-reviewed

Aligning compensation with academic mission

Academic productivity requires explicit incentivization. Traditional work RVU systems reward clinical volume but ignore the research, teaching, and scholarship that define academic surgery 1:41. The academic RVU concept emerged over a decade ago, but early descriptions lacked implementation frameworks 2:55. Nationwide Children's Hospital built a point-based system assigning values to publications, presentations, and grants alongside clinical RVUs 3:07. The results were not incremental: external federal funding increased 7.7-fold, from $750,000 to $5.7 million 3:58. Presentations and peer-reviewed publications rose in parallel 3:44. The lesson is not that any particular point allocation is correct — it is that making academic work visible in compensation makes it happen.

Group-based thresholds eliminate destructive competition. At Akron, the bonus structure required the entire surgical group to reach a collective RVU threshold for half the bonus, with individual bonuses tied to non-clinical value-added work 5:03. This design removes the incentive to compete for individual cases while preserving accountability for contribution. The structure matters as much as the total dollars — a system that rewards one surgeon's productivity at another's expense will fracture a division.

Protocol papers that actually change practice

The protocol itself may matter less than having one. BC Children's Hospital compared gastroschisis outcomes before and after implementing a 2012 protocol favoring immediate bedside sutureless closure over silo placement 5:51. At Saint Justine, silo use was exceptionally low, with nearly every patient receiving an attempt at immediate closure 7:12. Approximately 75% of infants achieved immediate closure, whether by OR-based fascial closure pre-protocol or bedside closure post-protocol 7:57. The consistency of approach — not necessarily the specific technique — drove the outcome. A protocol that all surgeons follow is more valuable than an optimal protocol that half the group ignores.

Parent experience is a clinical outcome. With silo reduction, parents cannot hold their infant for five to six days while viewing exteriorized bowel 8:27. With immediate closure, holding is possible within 48 hours if the infant requires intubation, or immediately if not 8:43. One of the discussants noted, "I think for those of us in pediatric surgery, that might not really seem like a big deal, but from the parents' perspective, that's a really big deal" [q6]. The point is not sentimental — delayed bonding has measurable effects on feeding, maternal mental health, and long-term attachment. If 75% of infants can be closed immediately without compromising safety, the default should shift.

Moving stem cell therapy from efficacy to safety to humans

Translational progression requires answering different questions at each stage. Prior ovine studies of placental mesenchymal stem cells for myelomeningocele repair used two separate in utero surgeries: one to create the defect, one to repair it with PMSCs 10:26. The current study collapsed this into a single operation at approximately 100 days gestational age, creating and repairing the defect simultaneously with cells placed directly on the spinal cord 10:43. This was not an efficacy study — efficacy had been shown. This was a safety study. The critical findings: PMSCs did not persist in placentas, uteri, or lambs at three months 11:23, and there was no histological evidence of abnormal growth or tumor formation 11:30. Only after demonstrating that the cells do not engraft long-term and do not cause neoplasia could human trials begin 11:52. The lesson is that demonstrating efficacy alone does not justify human application — safety must be established through studies designed to detect harms not yet looked for.

Takeaways from this story

Academic RVU systems that assign point values to publications and grants can increase federal research funding 7.7-fold.
Group-based RVU thresholds for bonuses eliminate competition for individual cases while preserving individual accountability.
Approximately 75% of gastroschisis infants can achieve immediate closure when a standardized protocol is followed.
Immediate gastroschisis closure allows parent-infant contact within 48 hours versus 5-6 days with silo reduction.
Translational stem cell research requires demonstrating cells do not persist or cause tumors before human trials begin.

Gastroschisis Closure: From Routine Silo Reduction to Immediate Bedside Repair

How thinking and practice on this topic have changed over time, as told in this episode. Written by Kai from the episode transcript and reviewed before publishing.

For specialists · How the thinking changed · AI-written, human-reviewed

The Silo Era

For decades, the standard approach to gastroschisis was serial silo reduction 7:12. The logic was straightforward: eviscerated bowel is often dilated, matted, or both, and forcing immediate closure risks abdominal compartment syndrome 7:12. A spring-loaded silo allowed gradual reduction over 5-6 days, giving the bowel time to decompress and the abdominal wall time to accommodate the viscera without dangerous intra-abdominal pressure 7:12. The approach was considered safer and gentler 7:12. Most institutions placed the majority of gastroschisis patients in silos as the default pathway 7:12.

The practice was reasonable. It avoided the perceived risk of forcing a tight closure in the operating room, and it worked — babies survived, bowels functioned, and the technique was reproducible across different surgeon skill levels.

What Changed

BC Children's Hospital implemented a protocol in 2012 that inverted the default 5:51. Rather than assuming most babies needed serial reduction, the protocol directed an attempt at immediate bedside sutureless closure for nearly every patient 7:12. The shift was driven by accumulated experience at Saint Justine, where fellows rotating through noticed that gastroschisis was managed very differently than at other institutions where they had trained — with very low silo use and routine attempts at immediate closure 7:12.

The key insight was empirical: when you actually try immediate closure systematically, approximately 75% of gastroschisis babies can be closed right away, either in the OR with fascial closure pre-protocol or at bedside post-protocol 7:57. The assumption that most babies could not tolerate immediate closure "because of extrinsic causes, you know, bowel dilatation or matting or whatever" did not hold when tested against a structured protocol [q5] 7:12.

The protocol itself mattered less than the discipline of having one 5:51. The value was not in the specific technical steps but in the commitment that all surgeons in the group would follow the same pathway, eliminating variation in approach 5:51.

Current Practice

Immediate closure is now achievable in three-quarters of cases without compromising closure success or early clinical outcomes 7:57. The benefits extend beyond surgical metrics 8:27 8:43. Parents can hold their baby within 48 hours if the infant is intubated, or immediately if managed without intubation, rather than waiting 5-6 days while "looking at their intestines through a silo" 8:27 8:43. One of the discussants noted: "I think for those of us in pediatric surgery, that might not really seem like a big deal, but from the parents' perspective, that's a really big deal" [q6].

The shift required recognizing that what seemed like a patient limitation — bowel too dilated, fascia too tight — was often a practice pattern limitation 7:12. When immediate closure became the default attempt rather than the exception, it became routine 7:12.

What Remains Unsettled

Some patients cannot be closed immediately and still require silos 7:57. The decision point — when to abandon the attempt at immediate closure and place a silo — remains a judgment call, and the protocol does not specify the threshold 7:57. Intra-abdominal pressure, bladder pressure, ventilatory parameters, and surgeon gestalt all factor in, but the exact combination that should trigger conversion to silo reduction is not standardized.

Whether sutureless bedside closure is truly equivalent to formal fascial closure in the OR for long-term outcomes also remains unknown 7:57. The study compared outcomes before and after protocol implementation, but the pre-protocol cohort received OR closures with fascial repair while the post-protocol cohort received bedside sutureless closures 7:57. Both achieved 75% immediate closure rates, but whether the two techniques are interchangeable over years of follow-up — hernia rates, bowel function, cosmesis — is not yet clear 7:57.

Finally, the protocol's success at BC Children's and Saint Justine does not guarantee transportability 5:51 7:12. The institutions that developed this approach had surgeons comfortable with bedside closure and neonatal teams experienced in managing these infants without routine intubation 7:12. Whether the same immediate closure rate is achievable at centers where silo reduction has been standard for decades, and where the muscle memory and team coordination are built around that pathway, is an open question 5:51. The value of having a protocol is clear; whether this specific protocol works everywhere is not 5:51.

Takeaways from this story

Immediate closure is achievable in 75% of gastroschisis cases when attempted systematically, challenging the default silo approach.
Parents can hold their baby within 48 hours with immediate closure versus 5-6 days with silo reduction.
Protocol adherence across all surgeons matters more than the specific technical components of the protocol itself.
The threshold for converting from attempted immediate closure to silo placement remains unstandardized.

Topic overview

A journal club discussion reviewing three articles from the January 2022 APSA issue of the Journal of Pediatric Surgery. The panel examines an academic RVU compensation system from Nationwide Children's Hospital that increased external federal funding 7.7-fold, a gastroschisis protocol from BC Children's Hospital achieving 75% immediate closure rates, and a safety study of placental mesenchymal stromal cells for in utero myelomeningocele repair that has progressed to human trials.

Key takeaways

Academic RVU system at Nationwide increased external federal funding 7.7-fold, from $750K to $5.7M, incentivizing research output. (3:58)
BC Children's protocol achieves 75% immediate gastroschisis closure, enabling parent-infant contact within 48h vs 5-6 days with silo. (7:57)
Single-stage PMSC application for fetal myelomeningocele repair shows no tumor growth or cell persistence at 3 months in lamb model. (10:43)
PMSC therapy for in utero myelomeningocele repair has progressed to human trials with first two patients enrolled. (11:52)

Keywords

gastroschisis myelomeningocele congenital diaphragmatic hernia bowel atresias Hirschsprung's disease sutureless closure silo placement serial reduction fascial closure laminectomy in utero repair Nationwide Children's Hospital Mass General for Children BC Children's Hospital Saint Justine

Hashtags

#PediatricSurgery #AcademicMedicine #JPSReview #APSA

Transcript

Click "Show Transcript" to view the full text (12924 characters)

All right. Welcome back. This is the January episode of our series on the Journal of Pediatric Surgery article review. Uh, we highlight articles chosen by the editors of JPS and then we talked to the editor, we talked to the authors. This episode is special because Society issue for APSA, the American Pediatric Surgical Association, we have some really great articles chosen by Doctor Kelleher. I'm Casey Kelleher. I'm a pediatric surgeon at Mass General for Children in Boston. I am the chair of the ABSA Publications Committee. I'm Rod Gerardo. I'm Ellen Ancisco. I'm Em Tombash, and Em is another junior research fellow. The team is growing, and she's been behind the scenes editing stuff for several months now, and I think we finally convinced her to put her voice on the podcast here. Thanks for joining us, Em, and we're gonna jump right in with the first. Article. If you want to read along with us, scroll down under the media player, click on the link, we're gonna give you the links to all of these articles so you can read them. So, the first article is called Development of an Academic RBU System to promote Pediatric surgical academic Productivity. This one's out of Nationwide Children's Hospital. Yeah, and we were lucky enough to talk to the senior author, Doctor Gail Bessner. I'm Gail Bessner. I'm the chief of pediatric surgery at Nationwide Children's Hospital in Columbus, Ohio. I think a lot of pediatric surgeons are inherently academic surgeons as well. So academic hospitals then. are pressured to figure out ways to compensate these surgeons in variable ways. Historically, surgeons of all types have been incentivized based on their work or views, and it's certainly important for clinical productivity and clinical program building, but it's really important to take advantage of other strengths that surgeons have. Because some of them are operating around the clock, and they don't do a whole lot of research. Some of them are doing research around the clock, and they maybe don't operate as much. And both parties seem to think, I am the one financially holding up this institution. Doctor Bessner wanted to look at an idea that has been used in other surgical subspecialties in the past. The Question is, how do we promote academic productivity amongst our partners? Partners, if we're only incentivizing them for clinical productivity, this idea of an academic RVU or a reimbursement value unit, is that what it's called? Relative, totally wrong, relative value unit. But the, the concept is simple. You have a, a type of RVU for academic work. You have a type of RVU for clinical surgical work, and she talks about how they implemented that at nationwide and And the results. The concept of academic RVUs was probably first put out there about 12 or 13 years ago, but it wasn't described how to incentivize people for that. So, one of the first things that we did was to come up with a point-based academic RVU system whereby people can accumulate points based on the number of publications that They have the same for presentations, and the same for all of the academic pursuits that we're involved in. We kept work RVUs as part of the incentivization plan, and there are also other goals. And I really believe that these types of goals and these types of incentives have to be achievable. Then to figure out the balance. Yeah, it sounds like overall very positive results they had. An increase in the number of presentations and peer-reviewed publications, uh, and they had an increase in the external federal funding for research. Right, like they go from $750,000 to $5.7 million. That's a 7.7-fold increase. Super impressive. They have this table that they show exactly how they at Nationwide broke down the RVUs. Anyone can pull this table and use for their hospitals because the most The important thing is to find some way how to credit your surgeons for their academic work. I think that a lot of people are trying to figure out just how to weight productivity that's not clinical. Like, how do we look at grant support? How do we look at publications? How do we look at teaching? Like, how do those things come out and how do we be transparent about the way we pay people for those things? Because historically, people just got a salary and it wasn't really based on anything, it was based on how the chief, if the chief liked you or if you worked hard. In addition to Having some sort of value assigned to your academic work so that it doesn't just get end up on the back burner. It's also nice to have this for the transparency. Todd has been a pediatric surgeon at 5 different hospitals, and here were his thoughts. In Akron, Bob Perry, the way that he structured the bonus was that the entire group has to get a certain RVU, not a single person. So if the whole group gets to this RVU, you all get 50% of your bonus just because the group. That way, there was no competition like trying to steal cases and stuff, because the whole group rose as a group. And then everyone had to have their project and depending on how well you did in your project, you would get incentivized part of your bonus. It just said you have to add value to the group in something other than just clinical. The next one is implementing a standardized gastroschisis protocol significantly increases the rate of primary sutureless closure. Without compromising closure, success, or early clinical outcomes. And this was a retrospective review of patients between 2008 and 2019 where they compared the outcomes before and after the implementation of a protocol in 2012. And we were able to talk with the first author of this article. I'm Charza Jaharifard. I'm a pediatric surgeon and assistant clinical professor of surgery at BC Children's Hospital in Vancouver. Canada. I thought this is cool because here, they are giving you not only the outcomes, but they're giving you the actual protocol that they use to hopefully increase the number of sutureless closure that your institution could do for gastroschisis. The thing that they did really well, which we don't always see in other protocol papers, is that they really explained what the protocol was, and they measured a before and after period very well and were very specific. Specific and candid about the things that they measured, the things that they would have done differently. So I think the neat thing about training in general, um, in surgical training is that you get to experience several different institutions and several different ways of doing things. Um, so when I was at Saint Justin as a fellow, there were 3 of us fellows, and what we began to realize quite quickly in, in our training was that the way that gastroschisis was treated at Saint Justin was very different from other places that we collectively had trained. And what made it different was that there was very Low use of silos, whereas in other institutions where we trained, um, the majority of patients were placed in a silo and then serially reduced, um, until they had their ultimate closure. Whereas at Saint Justin, pretty much every single patient had an attempt at an immediate bedside sutures closure, and as we began to look into it, we understood that, uh, several years before a protocol had been developed and so that led to the idea of examining how practice had changed and how outcomes had changed before and after the implementation of the protocol. The outcomes were encouraging. Um, so most people will argue that a silo is safer and gentler, um, and that most babies can't be closed immediately because of extrinsic causes, you know, bowel dilatation or matting or whatever. But we found before and after protocol implementation that about 75% of babies can be closed immediately. Now, whether that was in the OR pre-implementation with fascial closure or at the bedside post, that's a pretty astonishing number. You know, maybe the protocol here isn't exactly what All institutions do, but having a protocol that theoretically all surgeons in the group follow is really one of the more valuable pieces of this, aside from the specific components of that protocol. First of all, it's a little less scary for the parents, to be honest. Um, if you have a newborn with gastroschisis and for 56 days, you're looking at their intestines through a silo, I think for those of us in pediatric surgery, that might not really seem like a big deal, but from the parents' perspective, that's a really big deal. And you can't hold your baby for that period until the the silo is completely reduced, versus if you close them immediately and then they're, you know, even if they're intubated, they're extubated within 48 hours, that means you can hold them within 48 hours. And of course, if you manage to do this without intubation at all, that means you can hold them immediately. Two main points. One, it seems like sutures closure for gastroschisis does not only seem to be good for the patient, but also seems to be very attainable if you follow a guideline like this. Anyway, so the last one, this is A long-term safety evaluation of placental mesenchymal stromal cells for in utero repair of myelomeningocele in a novel ovine model. And we got to talk to the first author, Doctor Sarah Stokes. She's a general surgery resident. My name is Sarah Stokes, and I am a PGY 6 resident at University of California, Davis. So this is a, a little bit different from a lot of the articles we've been reviewing on the podcast. This is a basic science paper. This one, I think, is really Pertinent to fetal care and that is something that I think we all wish we were better at. So I think that there are lots of people who wish we could intervene earlier and know that if we could intervene earlier on myelomeningocele and CDH and um maybe bowel atresias or Hirschsprung's disease, that babies have an amazing ability to heal and, and it might, you know, we might be able to cure disease rather than just temporize symptoms like we do in a lot of these things. And this is kind of a stepping stone. Paper. So they in a prior study shown that this treatment is efficacious in animal models. In all of the prior studies when we've been looking at the efficacy of placental mesenchymal stem cells for in utero repair of MMC, and here Dr. Stokes tells us how they did it. We had done two surgeries in these lambs. First, we did surgery where we created the defect, and then we did a surgery where we repaired the defect. Both were in utero, and when the repair was done, we used the PMSCs to repair them. MMC defect. In this study, we did a single operation around a gestational age of 100 days when these lambs were in utero. We created and repaired the defects simultaneously, and we put the PMSCs directly onto the spinal cord. They did laminectomies on these fetal lambs, then they basically put these stem cells onto the spinal cord and waited. You know, this was showing the safety of The intervention. Then when the babies were born, and they followed them for a few months, they got imaging on them, and then they tested the spinal cord in the brain of the lambs. Our results were pretty much what we expected. We found that the PMSCs did not persist in the placentas, in the uteri, or in the lambs at 3 months. Um, we also found that there was no histological evidence of any abnormal growth or tumor development. It sounds like they saw what they were expecting to find is that those Cells, there was no trace of those cells or that DNA, and they did not see tumor. And so that is one step forward in, in bringing them to the point of using these cells in human trials. And we have now started with our first two patients, um, and we'll be continuing to use this for more patients over this year. This is so cool. As an aspiring fetal surgeon, seeing those translational research come into real life and can be used in human trials is fascinating. The thing about this article is. That we on this podcast really focus on clinical research and it was really refreshing, get a basic science article, uh, that is way over my head. I'm not smart enough to understand this stuff, but we're happy to share this with, um, with you, with the listener. The articles this month were varied in terms of their scope, right? We had the administrative sort of article about academic RBUs, then we had the more clinical Practice article about a gastroschisis protocol for sutureless closure, and then we have this basic science article about addressing the repair of myeloma meningocele in fetuses. And that's APSA, baby, the diversity of the academic surgeon. If you like this episode, then make sure that you follow us on social media, subscribe to our YouTube channel, Download the Stay Current pediatric Surgery app. It's in the Apple App Store, it's in the Google Play Store. But until next time, I'm Rod, I'm Ellen, and I'm Em. Remember, knowledge should be free.

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