Journal of Surgical Research最新文献_第6页

Surgical Resection for Pulmonary Metastasis From Cholangiocarcinoma: A Retrospective Case Series 胆管癌肺转移的手术切除：回顾性病例系列

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-01 Epub Date: 2026-01-13 DOI: 10.1016/j.jss.2025.12.006

Yuhi Yoshizaki MD, PhD , Nobuyuki Takemura MD, PhD , Takashi Kokudo MD, PhD , Fuyuki Inagaki MD, PhD , Fuminori Mihara MD , Tatsuo Maeyashiki MD, PhD , Satoshi Nagasaka MD, PhD , Norihiro Kokudo MD, PhD

Introduction

Cholangiocarcinoma (CCA) is associated with a high incidence of recurrence and patients occasionally develop pulmonary metastases. Systemic chemotherapy is the first-line treatment for unresectable or recurrent CCA. However, we have occasionally encountered cases of favorable prognosis following pulmonary resection for CCA metastases.

Materials and methods

Data from patients undergoing surgery for CCA between 2012 and 2021 were obtained from a prospectively maintained database. We retrospectively reviewed patients with pulmonary metastases from CCA, including those who underwent pulmonary resection and those who did not. Additionally, we described a representative case of repeated pulmonary resection with long-term survival.

Results

Among 122 patients who underwent surgery for CCA with curative intent, 64 patients (52.5%) experienced recurrence, including 14 patients (11.5%) who developed pulmonary metastases. Of these, five underwent pulmonary resection, including 1 who received two resections. None of the patients experienced postoperative complications. With a median follow-up of 2.6 y, three patients remained alive without recurrence. A representative case achieved long-term survival after repeated pulmonary resections. The 5-y overall survival rates were significantly better in patients who underwent pulmonary resection than in those who did not (75.0% versus 0%, P = 0.011).

Conclusions

Pulmonary resection may represent a feasible treatment option for carefully selected patients with pulmonary metastases from CCA.

胆管癌（CCA）具有高复发率，患者偶尔会发生肺转移。全身化疗是不可切除或复发性CCA的一线治疗方法。然而，我们偶尔会遇到肺切除CCA转移灶后预后良好的病例。材料和方法从前瞻性维护的数据库中获得2012年至2021年接受CCA手术的患者的数据。我们回顾性分析了CCA肺转移患者，包括接受肺切除术和未接受肺切除术的患者。此外，我们描述了一个具有代表性的长期生存的反复肺切除病例。结果122例手术治疗CCA患者中，64例（52.5%）复发，其中14例（11.5%）发生肺转移。其中，5人接受了肺切除术，其中1人接受了两次切除术。所有患者均未出现术后并发症。中位随访时间为2.6年，3例患者存活且无复发。一例典型病例在多次肺切除术后获得长期生存。接受肺切除术的患者的5年总生存率明显优于未接受肺切除术的患者（75.0%对0%，P = 0.011）。结论肺切除术可能是一种可行的治疗方案，为精心挑选的肺转移患者的CCA。

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引用次数: 0

Associations of Hernia Sac Size, Serum Indicators, and Postoperative Complications After Laparoscopic Inguinal Hernia Repair 腹腔镜腹股沟疝修补术后疝囊大小、血清指标与并发症的关系

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-01 Epub Date: 2026-01-14 DOI: 10.1016/j.jss.2025.12.019

Fan Liu MD, Tao Kuang MD, Chao Chen MD, Guangyu Liu MD

Introduction

Inguinal hernia is a common surgical condition with a low rate of self-healing. This study aimed to analyze the associations of hernia sac size, serum indicators, and postoperative complications following laparoscopic inguinal hernia surgery.

Methods

Eighty-one patients with inguinal hernia who underwent laparoscopic surgery from January 2021 to July 2024 were enrolled and followed up at 2 weeks, 1 month, 3 months, and 6 months after surgery. Based on the presence or absence of postoperative complications, the patients were divided into a complication group (n = 30) and a noncomplication group (n = 51). The complication group was subdivided according to the type of complication into a seroma group/a nonseroma group, an incision infection group/a nonincision infection group, and a chronic pain group/a nonchronic pain group.

Results

The postoperative follow-up showed that 30 of the 81 patients had complications, with an incidence rate of 37.04%. Multivariate ridge regression analysis identified hernia sac size, body mass index, and age as significant positive predictors of postoperative complications, whereas serum Na⁺ level was inversely associated (P < 0.05). The combined ridge regression model had an area under the curve of 0.93 (95% confidence interval: 0.86-0.98), with a sensitivity of 91% and specificity of 88%, indicating good discriminatory ability. Subgroup analyses further demonstrated consistent predictive capacity for seroma, incision infection, and chronic pain.

Conclusions

Hernia sac size, body mass index, age, and serum Na⁺ are independently associated with postoperative complications following laparoscopic inguinal hernia repair. A combined predictive model incorporating these factors allows early risk stratification, which may guide targeted perioperative management.

腹股沟疝是一种常见的外科疾病，自愈率低。本研究旨在分析腹腔镜腹股沟疝手术后疝囊大小、血清指标与术后并发症的关系。方法选取2021年1月至2024年7月行腹腔镜手术的腹股沟疝患者81例，分别于术后2周、1个月、3个月、6个月进行随访。根据有无术后并发症将患者分为并发症组（n = 30）和无并发症组（n = 51）。并发症组按并发症类型细分为血清肿组/非血清肿组、切口感染组/非切口感染组、慢性疼痛组/非慢性疼痛组。结果81例患者术后随访，并发症30例，发生率为37.04%。多因素脊回归分析发现，疝囊大小、体重指数和年龄是术后并发症的显著阳性预测因素，而血清Na+水平呈负相关（P < 0.05）。联合脊回归模型的曲线下面积为0.93(95%可信区间为0.86 ~ 0.98)，灵敏度为91%，特异度为88%，具有较好的判别能力。亚组分析进一步证明了对血肿、切口感染和慢性疼痛的一致预测能力。结论疝囊大小、体重指数、年龄、血清Na+与腹腔镜腹股沟疝修补术后并发症独立相关。结合这些因素的联合预测模型允许早期风险分层，可以指导有针对性的围手术期管理。

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引用次数: 0

Assessing Racial Bias Within American Society of Anesthesiologists Classification 评估美国麻醉师协会分类中的种族偏见。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-01 Epub Date: 2026-01-20 DOI: 10.1016/j.jss.2025.12.040

Michael A. Jacobs MS , Brenna N. McKaig BS , Susanne Schmidt PhD , Paula K. Shireman MD, MBA, MS , James W. Ibinson MD, PhD , Jessica H. Maxwell MD, MPH , Daniel E. Hall MD, MDiv, MHSc

Introduction

The American Society of Anesthesiologists (ASA) classification system is widely used to evaluate surgical risk, make patient care decisions, and determine reimbursement. However, race/ethnicity bias in ASA class is largely unexplored, with potential ramifications for healthcare disparities.

Methods

In a retrospective cohort study of 350,187 Veterans Health Administration surgical cases and 4,051,185 non–Veterans Health Administration cases, race/ethnicity groups were matched on the components of the Risk Analysis Index, a surgical frailty measure, and preoperative acute serious conditions, conditions associated with urgent/emergent surgeries, to evaluate differences in ASA class.

Results

After matching, Black cases had higher ASA class versus White cases (adjusted odds ratios = 1.37 and 1.07, 95% confidence intervals = 1.37-1.38 and 1.04-1.09, P < 0.001). Hispanic cases had lower ASA class versus White cases (adjusted odds ratios = 0.96 and 0.96, 95% confidence intervals = 0.96-0.97 and 0.93-0.99, P < 0.001 and 0.008), though the effect changed sign in a sensitivity analysis.

Conclusions

ASA class varies by race/ethnicity, representing bias that could drive health disparities. Given the matching strategy used, such bias may have practical implications for patient outcomes and quality improvement. For Black patients, a higher ASA class may drive increased preoperative testing, surgical delays, and increased costs. For Hispanic patients, a lower ASA class may drive reduced preoperative screening and riskier outpatient procedures. For some purposes, the ASA class may need to be replaced with other measures of patient morbidity. For others, ASA class may need to be revised and assigned by automated systems with safeguards against race/ethnicity bias.

简介：美国麻醉医师学会（ASA）分类系统被广泛用于评估手术风险、制定患者护理决策和确定报销。然而，ASA类的种族/民族偏见在很大程度上未被探索，具有潜在的医疗差异后果。方法：对350,187例退伍军人卫生管理局手术病例和4,051,185例非退伍军人卫生管理局病例进行回顾性队列研究，在风险分析指数（一种手术虚弱指标）和术前急性严重情况（与紧急/紧急手术相关的情况）的组成部分上匹配种族/民族，以评估ASA等级的差异。结果：匹配后，黑人患者ASA等级高于白人患者（校正比值比分别为1.37和1.07,95%可信区间分别为1.37 ~ 1.38和1.04 ~ 1.09,P < 0.001）。西班牙裔患者的ASA等级低于白人患者（校正优势比= 0.96和0.96,95%可信区间= 0.96-0.97和0.93-0.99,P < 0.001和0.008），尽管在敏感性分析中效果改变了符号。结论：ASA等级因种族/民族而异，代表可能导致健康差异的偏见。考虑到所使用的匹配策略，这种偏差可能对患者结果和质量改进具有实际意义。对于黑人患者，ASA等级较高可能会导致术前检查增加、手术延误和费用增加。对于西班牙裔患者，较低的ASA等级可能会减少术前筛查和更危险的门诊手术。出于某些目的，ASA分级可能需要用其他衡量患者发病率的指标来代替。对其他人来说，ASA等级可能需要修改，并由自动化系统分配，以防止种族/民族偏见。

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引用次数: 0

Effectiveness and Validity of Informed Consent in Patients Undergoing Surgery in Cameroon: A Prospective Survey 喀麦隆手术患者知情同意的有效性和有效性：一项前瞻性调查

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-01 Epub Date: 2026-01-07 DOI: 10.1016/j.jss.2025.12.010

Robert Tchounzou MD , Obi Cyril Egbe MD , Mark T. Yost MD, MPH , Brandon Carl Monica Pouekoua MD , Pascal Nwandum MD , Mefire Alain Chichom MD

Introduction

The process of informed consent before surgery has not been evaluated in Cameroon. We hypothesized that the process of informed consent for patients operated on in the Southwest Region of Cameroon is not appropriate.

Materials and methods

We conducted a prospective, cross-sectional study in three health institutions in the Southwest region of Cameroon. A pretested questionnaire was administered to patients in the postoperative period to assess the basic components of the informed consent process. Patient's satisfaction and the overall validity of the process were measured.

Results

We included 468 consenting patients in this study. Their mean age was 31.41 ± 8.6 y. The majority of patients (58.5%) underwent an elective procedure. The informed consent process was administered on the day of surgery, sometimes on the operative table for 53.4% of patients. Over half of the patients did not receive specific information on the surgical procedure. Though most of them (64.5%) received information about anesthesia, none were ever given the opportunity to choose the type of anesthesia. A total of 268 (57.3%) patients were informed about the potential risks of the surgical and anesthetic procedures. The majority (86.54%) were never informed that the surgery could possibly not yield the expected results. Over 70% of patients never read the consent form, and the overall process was considered fully valid in 1.1% of patients.

Conclusions

Though the process of informed consent is now widespread, it is still inadequate as some basic components are not fulfilled and patients’ participation in the final decision is poor.

在喀麦隆，手术前知情同意的过程尚未得到评估。我们假设在喀麦隆西南地区手术的患者知情同意的过程是不合适的。材料和方法我们在喀麦隆西南地区的三家卫生机构进行了一项前瞻性横断面研究。在术后对患者进行预测问卷，以评估知情同意过程的基本组成部分。测量了患者的满意度和整个过程的有效性。结果我们纳入了468名同意的患者。他们的平均年龄为31.41±8.6岁。大多数患者（58.5%）接受了选择性手术。53.4%的患者在手术当天，有时在手术台上进行知情同意程序。超过一半的患者没有得到手术过程的具体信息。虽然他们中的大多数（64.5%）获得了麻醉的信息，但没有人有机会选择麻醉的类型。共有268例（57.3%）患者被告知手术和麻醉过程的潜在风险。大多数患者（86.54%）从未被告知手术可能达不到预期效果。超过70%的患者从未阅读同意书，1.1%的患者认为整个过程完全有效。结论虽然知情同意的程序已经广泛应用，但仍存在一些基本组成部分未得到履行，患者参与最终决策的程度较差等不足。

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引用次数: 0

Establishing a Mass Casualty Threshold in a Resource-Limited Hospital Setting: A Retrospective Analysis of a Trauma Registry From Malawi 在资源有限的医院环境中建立大规模伤亡阈值：马拉维创伤登记的回顾性分析

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-01 Epub Date: 2026-01-08 DOI: 10.1016/j.jss.2025.12.013

Tori Hester MPH , Selena J. An MD, MSPH, MA , Jotham Gondwe , Anthony Charles MD, MPH , Jared Gallaher MD, MPH

Introduction

Mass casualty incidents (MCIs) easily overwhelm hospitals in resource-limited settings. Unfortunately, limited data exists on this problem, and few hospitals are prepared to deal with these events. We hypothesized that excessive patient volume would be associated with worse outcomes at a tertiary hospital in Lilongwe, Malawi, and that these data would provide a foundation for targeted interventions and improvement.

Materials and methods

We retrospectively analyzed the Kamuzu Central Hospital Trauma Registry from 2010 to 2021. Using arrival data, we characterized patient co-arrival volume trends. We a priori set the mass casualty threshold at 2 standard deviations above the mean number of patient co-arrivals in 1 h. We performed bivariate and multivariable logistic regression analyses to investigate the relationship between mortality and the number of co-arrivals above the threshold.

Results

A total of 161,383 patients were analyzed. The median age was 24 y, and 73.8% were male. Crude mortality was 2.4%. A total of 3007 patients (1.9%) presented above the mass casualty threshold of 11 patients. Mortality for this group was 4.2% compared to 2.4% for those below the threshold. Those who have an arrival status above the MCI threshold of 11 patient arrivals in 1 h have 1.70 (95% confidence interval: 1.36, 2.12, P value < 0.001) times the odds of mortality than patients below the MCI threshold when adjusting for sex, age, primary injury type, and arrival time.

Conclusions

Overwhelming and sudden patient volume is associated with higher odds of mortality in a resource-limited setting. Our results will inform a mass casualty protocol to maximize efficient resource use in similar settings.

在资源有限的情况下，大规模伤亡事件（MCIs）很容易使医院不堪重负。不幸的是，关于这个问题的数据有限，很少有医院准备好处理这些事件。我们假设，在马拉维利隆圭的一家三级医院，过多的患者数量可能与较差的结果有关，并且这些数据将为有针对性的干预和改善提供基础。材料和方法回顾性分析2010年至2021年Kamuzu中心医院创伤登记。利用到达数据，我们描述了患者共同到达量的趋势。我们先验地将大规模伤亡阈值设置为高于1小时内共同到达的患者平均人数2个标准差。我们进行了双变量和多变量logistic回归分析，以调查死亡率与超过阈值的共同到达人数之间的关系。结果共分析161383例患者。中位年龄为24岁，男性占73.8%。粗死亡率为2.4%。共有3007例（1.9%）患者出现在11例的大规模伤亡阈值以上。这一组的死亡率为4.2%，而低于阈值组的死亡率为2.4%。在调整性别、年龄、原发损伤类型和到达时间后，到达状态高于MCI阈值（1 h内到达11例患者）的患者的死亡率是低于MCI阈值的患者的1.70倍（95%置信区间：1.36,2.12，P值<； 0.001）。结论在资源有限的情况下，患者数量过大和突然增加与较高的死亡率相关。我们的结果将为大规模伤亡协议提供信息，以便在类似情况下最大限度地有效利用资源。

{"title":"Establishing a Mass Casualty Threshold in a Resource-Limited Hospital Setting: A Retrospective Analysis of a Trauma Registry From Malawi","authors":"Tori Hester MPH , Selena J. An MD, MSPH, MA , Jotham Gondwe , Anthony Charles MD, MPH , Jared Gallaher MD, MPH","doi":"10.1016/j.jss.2025.12.013","DOIUrl":"10.1016/j.jss.2025.12.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Mass casualty incidents (MCIs) easily overwhelm hospitals in resource-limited settings. Unfortunately, limited data exists on this problem, and few hospitals are prepared to deal with these events. We hypothesized that excessive patient volume would be associated with worse outcomes at a tertiary hospital in Lilongwe, Malawi, and that these data would provide a foundation for targeted interventions and improvement.</div></div><div><h3>Materials and methods</h3><div>We retrospectively analyzed the Kamuzu Central Hospital Trauma Registry from 2010 to 2021. Using arrival data, we characterized patient co-arrival volume trends. We <em>a priori</em> set the mass casualty threshold at 2 standard deviations above the mean number of patient co-arrivals in 1 h. We performed bivariate and multivariable logistic regression analyses to investigate the relationship between mortality and the number of co-arrivals above the threshold.</div></div><div><h3>Results</h3><div>A total of 161,383 patients were analyzed. The median age was 24 y, and 73.8% were male. Crude mortality was 2.4%. A total of 3007 patients (1.9%) presented above the mass casualty threshold of 11 patients. Mortality for this group was 4.2% compared to 2.4% for those below the threshold. Those who have an arrival status above the MCI threshold of 11 patient arrivals in 1 h have 1.70 (95% confidence interval: 1.36, 2.12, <em>P</em> value < 0.001) times the odds of mortality than patients below the MCI threshold when adjusting for sex, age, primary injury type, and arrival time.</div></div><div><h3>Conclusions</h3><div>Overwhelming and sudden patient volume is associated with higher odds of mortality in a resource-limited setting. Our results will inform a mass casualty protocol to maximize efficient resource use in similar settings.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 89-97"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Structured Guide to Univariate Test Selection Based on Normality, Variance Homogeneity, and Graphical Data Exploration 基于正态性、方差同质性和图形数据探索的单变量测试选择的结构化指南。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-01 Epub Date: 2026-01-19 DOI: 10.1016/j.jss.2025.10.053

Javier Arredondo Montero MD, PhD

Introduction

The credibility of surgical research depends on appropriate statistical methodology. However, univariate statistical tests are frequently applied inconsistently, and key assumptions—particularly normality and variance homogeneity—are often misunderstood or inadequately assessed. These methodological shortcomings can distort inference, undermine internal validity, and compromise the clinical interpretability of research findings.

Methods

This article presents a structured, assumption-based framework to guide univariate statistical test selection in surgical research. The approach integrates visual data exploration (histograms, Q–Q plots, violin plots) with formal assumption testing, including the Shapiro-Wilk test for normality and Levene’s test for variance homogeneity, explicitly addressing the sample-size dependence of normality tests, which may lack power in small samples and overdetect trivial deviations in large datasets. The framework addresses common pitfalls related to distributional shape (including bimodality), outliers, data transformation, and the treatment of ordinal variables. When standard assumptions are violated, the framework discusses robust alternatives—such as Welch’s tests, nonparametric approaches, and modern robust estimators—to preserve valid and interpretable statistical inference.

Results

The proposed framework yields a practical decision algorithm, supported by summary tables and illustrative figures, that links data characteristics to appropriate univariate tests and summary measures. By emphasizing combined visual and statistical assessment, the framework clarifies when parametric, robust parametric, or nonparametric methods are most suitable and highlights frequent sources of misinterpretation in the surgical literature.

Conclusions

An assumption-driven approach to univariate test selection enhances statistical rigor, transparency, and reproducibility in surgical research. By aligning test choice and data summarization with underlying distributional properties, this framework supports more reliable statistical inference and clinically meaningful interpretation of univariate analyses.

引言：外科研究的可信度取决于适当的统计方法。然而，单变量统计检验的应用经常不一致，关键假设——特别是正态性和方差同质性——经常被误解或评估不充分。这些方法学上的缺陷会扭曲推理，破坏内部有效性，并损害研究结果的临床可解释性。方法：本文提出了一个结构化的、基于假设的框架来指导外科研究中单变量统计检验的选择。该方法将视觉数据探索（直方图、Q-Q图、小提琴图）与正式假设检验（包括Shapiro-Wilk正态性检验和Levene方差同质性检验）相结合，明确解决了正态性检验的样本量依赖性，这在小样本中可能缺乏能力，在大数据集中可能过度检测微不足道的偏差。该框架解决了与分布形状（包括双峰）、异常值、数据转换和有序变量处理相关的常见缺陷。当标准假设被违反时，该框架讨论健壮的替代方案，如韦尔奇检验、非参数方法和现代健壮估计，以保持有效和可解释的统计推断。结果：提议的框架产生了一个实用的决策算法，由汇总表和说明性数字支持，将数据特征与适当的单变量测试和汇总措施联系起来。通过强调视觉和统计评估的结合，该框架阐明了参数、稳健参数或非参数方法何时最合适，并强调了外科文献中常见的误解来源。结论：在外科研究中，假设驱动的方法可以提高统计严谨性、透明度和可重复性。通过将测试选择和数据汇总与潜在的分布特性结合起来，该框架支持更可靠的统计推断和对单变量分析有临床意义的解释。

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引用次数: 0

Xq28 Variants as Novel Male-Specific Susceptibility Factors for Hirschsprung Disease Xq28变异是先天性巨结肠疾病男性特异性易感因素

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-01 Epub Date: 2026-01-13 DOI: 10.1016/j.jss.2025.12.017

Xiaoli Xie MS , Xiaoyu Zuo PhD , Qiuming He MD , Wei Zhong MS , Liucheng Yang MD

Introduction

Hirschsprung's disease (HSCR) is a complex congenital digestive tract disease affected by multiple genes. Despite the identification of >20 risk loci, no susceptibility variants map to sex chromosomes—a striking gap given the 4- to 6-fold male predominance in short-segment HSCR. This study investigates the contribution of X-chromosomal variation to HSCR pathogenesis.

Methods

We conducted a large case-control study involving a South Chinese population. Four single nucleotide polymorphisms (SNPs) in a disease hotspot region spanning on Xq28 were genotyped through MassARRAY genotyping platform. Association analysis of the selected SNPs with HSCR were performed using PLINK1.9. RNA quantitative analysis, immunohistochemistry staining, and Western blot analysis were performed to observe the expression of the newly identified gene IRAK1 of colon tissues of HSCR patients.

Results

This study included 1470 HSCR patients and 1473 ethnically matched controls. Four SNPs (rs2071128, rs17422, rs1059702, and rs2734647) were identified as associated with HSCR in a male-specific manner, with odds ratios ranging from 1.20 to 1.52. These variants conferred an even higher risk for long-segment HSCR in males, with odds ratios between 1.75 and 2.53. We demonstrated higher expression of the newly identified gene IRAK1 in aganglionic colon samples compared with ganglionic colon tissues, especially in the males (P = 0.00046).

Conclusions

We identified a novel male-specific region Xq28 as associated with HSCR. The differential expression of the newly identified gene IRAK1 in HSCR patients suggests an important role for the HSCR-associated common variants in shaping the male-specific disease.

巨结肠病（hirschsprung 's disease， HSCR）是一种多基因影响的复杂先天性消化道疾病。尽管确定了20个风险位点，但没有易感性变异映射到性染色体上——考虑到短段HSCR中男性的4- 6倍优势，这是一个惊人的差距。本研究探讨了x染色体变异在HSCR发病中的作用。方法我们进行了一项涉及华南人群的大型病例对照研究。通过MassARRAY基因分型平台对跨越Xq28的疾病热点区域的4个单核苷酸多态性（snp）进行基因分型。使用PLINK1.9对选择的snp与HSCR进行关联分析。采用RNA定量分析、免疫组化染色、Western blot等方法观察新发现的IRAK1基因在HSCR患者结肠组织中的表达情况。结果本研究纳入1470例HSCR患者和1473例种族匹配的对照组。4个snp （rs2071128、rs17422、rs1059702和rs2734647）与男性特异性HSCR相关，比值比为1.20 ~ 1.52。这些变异使男性长段HSCR的风险更高，比值比在1.75到2.53之间。我们发现，新发现的IRAK1基因在神经节结结肠样本中的表达高于神经节结结肠组织，尤其是在男性中（P = 0.00046）。结论：我们发现了一个新的男性特异性区域Xq28与HSCR相关。新发现的基因IRAK1在HSCR患者中的差异表达表明，HSCR相关的常见变异在形成男性特异性疾病中起重要作用。

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引用次数: 0

Performance of Postoperative Imaging for Leak Detection Following Repair of Upper Gastrointestinal Perforation 上消化道穿孔修补术后影像学检漏性能的研究

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-01 Epub Date: 2026-01-16 DOI: 10.1016/j.jss.2025.12.026

Mary Junak MD , Devashish Joshi MD , Victoria R. Rendell MD , Giuseppe V. Toia MD , Charles Patrick Shahan MD, MS

Introduction

Gastric and duodenal perforations are surgical emergencies with high morbidity and mortality. Postoperative leak is a serious complication, yet there are no guidelines for imaging modality or patient selection. This study compared fluoroscopic upper gastrointestinal series (fUGI) and computed tomography (CT) for postoperative leak detection following surgical repair.

Methods

This is a retrospective cohort study of patients who underwent repair of a gastric or duodenal perforation between 2011 and 2023. Surgical interventions, postoperative imaging (UGI vs CT), and clinical outcomes were assessed. Post repair leak was defined by radiographic evidence of contrast extravasation, change in drain character, and/or intraoperative findings. Performance of UGI and CT to identify post repair leak was assessed.

Results

A total of 168 patients were included; 142 underwent open repair and 26 laparoscopic. An omental patch was used in 87.5%, and drains were placed in 81.5%. Postoperative imaging was obtained in 85.7%, most often on postoperative day 5, with 95 fUGI and 49 CT studies. Postoperative leak occurred in 20.2% (34/168). All patients with leaks underwent imaging. For patients with confirmed leaks, fUGI demonstrated a sensitivity of 56.3% and negative predictive value (NPV) of 91.9%, while CT demonstrated a sensitivity of 44.4% and NPV of 75.6%. Discordant imaging results were frequent, and CT contrast protocols were not standardized.

Conclusions

Postoperative imaging after gastric or duodenal perforation repair is common but variable, often performed for surveillance. fUGI demonstrated modestly higher sensitivity and NPV compared with CT, suggesting greater reliability for ruling out early leaks. Both modalities showed limitations, underscoring the need for standardized imaging protocols.

胃和十二指肠穿孔是一种高发病率和死亡率的外科急症。术后渗漏是一种严重的并发症，但对于成像方式或患者选择尚无指导方针。本研究比较了透视上消化道系列（fUGI）和计算机断层扫描（CT）在手术修复后的术后泄漏检测中的应用。方法：这是一项回顾性队列研究，研究对象是2011年至2023年间接受胃或十二指肠穿孔修复术的患者。评估手术干预、术后影像（UGI vs CT）和临床结果。修复后渗漏的定义是通过造影剂外渗、引流特征改变和/或术中发现的影像学证据来确定的。评估UGI和CT识别修复后泄漏的性能。结果共纳入168例患者；142例行开腹修复，26例行腹腔镜修复。87.5%的患者使用网膜贴片，81.5%的患者放置引流管。术后影像学检查占85.7%，多见于术后第5天，fUGI检查95例，CT检查49例。术后发生渗漏的占20.2%（34/168）。所有有渗漏的患者都进行了影像学检查。对于确诊渗漏的患者，fUGI的敏感性为56.3%，阴性预测值（NPV）为91.9%，而CT的敏感性为44.4%，NPV为75.6%。不一致的成像结果是常见的，CT对比方案不标准化。结论胃或十二指肠穿孔修补术后的术后影像学是常见但不稳定的，常用于监测。与CT相比，fUGI显示出更高的灵敏度和NPV，表明排除早期泄漏的可靠性更高。这两种方式都显示出局限性，强调了标准化成像方案的必要性。

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引用次数: 0

Diagnostic Overshadowing: Delayed Management in Substance Use Disorder Patients With Splenic Injury 诊断阴影：物质使用障碍伴脾损伤患者的延迟处理

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-01 Epub Date: 2026-01-23 DOI: 10.1016/j.jss.2025.12.041

Yasmin Arda MD, Ikemsinachi C. Nzenwa MBChB, MSc, Vahe S. Panossian MD, Tiemen E.T. Holtrop MD, Haytham M.A. Kaafarani MD, MPH, John O. Hwabejire MD, MPH, George C. Velmahos MD, PhD, Michael P. DeWane MD

Introduction

Diagnostic overshadowing, a type of cognitive bias, happens when a pre-existing medical condition overshadows the evaluation of other potential diagnoses. This study aimed to explore diagnostic overshadowing in trauma due to the impact of substance and alcohol use disorder (SUD) on time to diagnosis and management in patients with blunt splenic injury.

Methods

The 2017-2020 American College of Surgeons Trauma Quality Improvement Project database was used to identify patients ≥18 y with blunt splenic injury who underwent splenectomy. Patients were stratified into those with and without SUD. Delayed diagnosis (time to abdominal computed tomography scan >1 h) and delayed splenectomy (>2 h) were defined using median-based thresholds to measure distributional shifts in care timeliness between groups. Multivariable logistic regression examined the impact of SUD on delayed diagnosis, delayed splenectomy, and outcomes (e.g., mortality, postoperative complications). A sensitivity analysis was conducted by excluding patients with a positive alcohol screen on admission.

Results

Nine thousand two hundred thirty-seven patients were included: 1739 (19%) SUD and 7498 (81%) non-SUD. The median time to splenectomy was 2.4 h (interquartile range = 1.2-7.1) in SUD patients compared with 2 h (interquartile range = 1.1-4.9) in non-SUD patients (P < 0.001). On multivariable analyses, SUD patients were more likely to experience delayed diagnosis (adjusted odds ratio [aOR] = 1.13, 95% confidence interval [CI] = 1.04-1.23), delayed splenectomy (aOR = 1.25, 95% CI = 1.09-1.42), and composite complications (aOR = 1.14, 95% CI = 1.01-1.31) compared with non-SUD patients. After excluding intoxicated patients, those with SUD were still more likely to have delayed diagnosis and management, with a greater risk of delayed splenectomy compared with the overall cohort.

Conclusions

Diagnostic overshadowing, exemplified in blunt splenic injury patients with SUD, can be measured and can negatively impact patient care. Further studies are needed to explore the prevalence and impact of diagnostic overshadowing in trauma patients.

诊断掩盖是一种认知偏见，当已有的疾病掩盖了对其他潜在诊断的评估时，就会发生这种情况。本研究旨在探讨物质和酒精使用障碍（SUD）对钝性脾损伤患者诊断和治疗的影响。方法采用2017-2020年美国外科医师学会创伤质量改善项目数据库，筛选≥18岁的钝性脾损伤行脾切除术的患者。将患者分为有无SUD两组。延迟诊断（腹部计算机断层扫描时间>；1小时）和延迟脾切除术（>；2小时）采用基于中位数的阈值来衡量组间护理及时性的分布变化。多变量logistic回归分析了SUD对延迟诊断、延迟脾切除术和预后（如死亡率、术后并发症）的影响。通过排除入院时酒精筛查阳性的患者进行敏感性分析。结果共纳入92937例患者，其中SUD 1739例（19%），非SUD 7498例（81%）。SUD患者脾切除术的中位时间为2.4 h（四分位数范围= 1.2-7.1），而非SUD患者为2 h（四分位数范围= 1.1-4.9）（P < 0.001）。在多变量分析中，与非SUD患者相比，SUD患者更容易出现延迟诊断（调整优势比[aOR] = 1.13, 95%可信区间[CI] = 1.04-1.23）、延迟脾切除术（aOR = 1.25, 95% CI = 1.09-1.42）和复合并发症（aOR = 1.14, 95% CI = 1.01-1.31）。在排除了醉酒患者后，与整个队列相比，患有SUD的患者仍然更有可能延迟诊断和治疗，延迟脾切除术的风险更大。结论以钝性脾损伤合并SUD患者为例，诊断性阴影是可以测量的，并对患者的护理产生负面影响。需要进一步的研究来探讨创伤患者诊断阴影的患病率和影响。

{"title":"Diagnostic Overshadowing: Delayed Management in Substance Use Disorder Patients With Splenic Injury","authors":"Yasmin Arda MD, Ikemsinachi C. Nzenwa MBChB, MSc, Vahe S. Panossian MD, Tiemen E.T. Holtrop MD, Haytham M.A. Kaafarani MD, MPH, John O. Hwabejire MD, MPH, George C. Velmahos MD, PhD, Michael P. DeWane MD","doi":"10.1016/j.jss.2025.12.041","DOIUrl":"10.1016/j.jss.2025.12.041","url":null,"abstract":"<div><h3>Introduction</h3><div>Diagnostic overshadowing, a type of cognitive bias, happens when a pre-existing medical condition overshadows the evaluation of other potential diagnoses. This study aimed to explore diagnostic overshadowing in trauma due to the impact of substance and alcohol use disorder (SUD) on time to diagnosis and management in patients with blunt splenic injury.</div></div><div><h3>Methods</h3><div>The 2017-2020 American College of Surgeons Trauma Quality Improvement Project database was used to identify patients ≥18 y with blunt splenic injury who underwent splenectomy. Patients were stratified into those with and without SUD. Delayed diagnosis (time to abdominal computed tomography scan >1 h) and delayed splenectomy (>2 h) were defined using median-based thresholds to measure distributional shifts in care timeliness between groups. Multivariable logistic regression examined the impact of SUD on delayed diagnosis, delayed splenectomy, and outcomes (e.g., mortality, postoperative complications). A sensitivity analysis was conducted by excluding patients with a positive alcohol screen on admission.</div></div><div><h3>Results</h3><div>Nine thousand two hundred thirty-seven patients were included: 1739 (19%) SUD and 7498 (81%) non-SUD. The median time to splenectomy was 2.4 h (interquartile range = 1.2-7.1) in SUD patients compared with 2 h (interquartile range = 1.1-4.9) in non-SUD patients (<em>P</em> < 0.001). On multivariable analyses, SUD patients were more likely to experience delayed diagnosis (adjusted odds ratio [aOR] = 1.13, 95% confidence interval [CI] = 1.04-1.23), delayed splenectomy (aOR = 1.25, 95% CI = 1.09-1.42), and composite complications (aOR = 1.14, 95% CI = 1.01-1.31) compared with non-SUD patients. After excluding intoxicated patients, those with SUD were still more likely to have delayed diagnosis and management, with a greater risk of delayed splenectomy compared with the overall cohort.</div></div><div><h3>Conclusions</h3><div>Diagnostic overshadowing, exemplified in blunt splenic injury patients with SUD, can be measured and can negatively impact patient care. Further studies are needed to explore the prevalence and impact of diagnostic overshadowing in trauma patients.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 323-330"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146035046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Increased Prophylactic Enoxaparin Dosing is Associated With Improved Achievement of Target anti-Xa Levels; Implementation of the Western Trauma Association Venous-Thromboembolism Guidelines 增加预防性依诺肝素剂量与提高目标抗xa水平相关西方创伤协会静脉血栓栓塞指南的实施

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-01 Epub Date: 2026-01-22 DOI: 10.1016/j.jss.2025.12.032

Brian P. McKinzie PharmD, BCCCP , Natassha Ebert RN, BSN, PharmD, BCCCP , Felicia N. Williams MD, FACS, FABA , Ian Kratzke MD, MHPE , Jared Gallaher MD, MPH, FACS , Lauren Raff MD, FACS

Background

Evidence suggests that standard enoxaparin dosing for burn and trauma patients results in sub-optimal target thromboprophylactic plasma anti-Xa levels in up to 84% of the patients, potentially leading to increased incidence of venous thromboembolism (VTE). More intensive dosing regimens have been suggested; however, few studies have evaluated these protocols in trauma/burn patient populations.

Methods

A retrospective chart review of an American Burn Association–verified burn and American College of Surgeons–verified level 1 trauma center from June 2022 until July 2023 identified patients initiated on a higher dosing enoxaparin protocol for VTE prophylaxis in accordance with recent Western Trauma Association guidelines. Patients were included if they were at least 18 years of age, dosed according to protocol criteria, and received at least three sequential doses of enoxaparin with appropriately timed peak plasma anti-Xa levels to monitor efficacy.

Results

Two hundred forty five patients were screened with 196 patients included for analysis. 24.5% of the patients dosed according to the protocol did not reach target peak plasma anti-Xa levels (0.2-0.5 IU/mL). Burn patients were more likely to achieve target anti-Xa levels than trauma patients (81.1% versus 65.2%, P = 0.016). An association between severe burns and inability to meet anti-Xa goals was also noted.

Conclusions

Utilization of a higher dose enoxaparin protocol for VTE prophylaxis has an improved likelihood of achieving plasma anti-Xa targets compared to standard dosing strategies, however, almost 23% of the patients were still underdosed. Increased enoxaparin dosing targeted to peak plasma anti-Xa levels and the impact on VTE reduction in severe burn and trauma patients should be further evaluated.

有证据表明，烧伤和创伤患者的标准依诺肝素剂量导致高达84%的患者的靶血栓预防血浆抗xa水平低于最佳水平，这可能导致静脉血栓栓塞（VTE）的发生率增加。已经提出了更密集的给药方案；然而，很少有研究在创伤/烧伤患者群体中评估这些方案。方法对美国烧伤协会认证的烧伤和美国外科医师学会认证的1级创伤中心从2022年6月至2023年7月的回顾性图表进行回顾，确定了根据最近的西方创伤协会指南开始使用高剂量依诺肝素方案预防静脉血栓栓塞的患者。如果患者年龄在18岁以上，根据方案标准给药，并且接受了至少三次顺序剂量的依诺肝素，并有适当的血浆抗xa水平峰值来监测疗效。结果共筛选245例患者，纳入分析196例。24.5%的患者未达到血浆抗xa水平的目标峰值（0.2-0.5 IU/mL）。烧伤患者比创伤患者更容易达到目标抗xa水平（81.1%比65.2%,P = 0.016）。严重烧伤与无法达到抗xa目标之间的关联也被注意到。结论：与标准给药策略相比，采用高剂量依诺肝素方案预防静脉血栓栓塞的可能性更高，但仍有近23%的患者剂量不足。应进一步评估以血浆抗xa水平峰值为目标增加依诺肝素剂量以及对严重烧伤和创伤患者静脉血栓栓塞（VTE）降低的影响。

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引用次数: 0