Journal of Surgical Research最新文献

{"title":"Limited Axillary Dissection for Substantial Breast Cancer Axillary Tumor Burden","authors":"Yaniv Berger MD ,&nbsp;Hila Meiri MD ,&nbsp;Nora Balint-Lahat MD ,&nbsp;Ronny Maman MD ,&nbsp;Yael Weksler MD ,&nbsp;Danny Rosin MD ,&nbsp;Ido Nachmany MD ,&nbsp;Mordechai Gutman MD ,&nbsp;Einav Nili Gal-Yam MD ,&nbsp;Roi Anteby MD ,&nbsp;Orit Kaidar-Person MD","doi":"10.1016/j.jss.2025.11.015","DOIUrl":"10.1016/j.jss.2025.11.015","url":null,"abstract":"<div><h3>Introduction</h3><div>The axillary surgical management in breast cancer is de-escalating but level 1 + 2 axillary lymph node dissection (ALND) remains the standard of care for substantial axillary tumor burden (SATB). We explored the outcomes of limited axillary dissection (LAD, defined as sentinel lymph node (SLN) sampling or level 1 ALND) for SATB.</div></div><div><h3>Methods</h3><div>We retrospectively identified SATB patients who underwent LAD between 2011 and 2020. SATB was defined as gross extracapsular extension, ≥3 positive SLNs, palpable lymphadenopathy, or ≥3 suspected nodes on preoperative imaging. Those who received neoadjuvant chemotherapy or had follow-up &lt;1 y were excluded.</div></div><div><h3>Results</h3><div>We reviewed 4904 breast cancer cases and identified 33 women with SATB (tumor size 19.0 ± 9.8 mm, infiltrating ductal carcinoma 78.8%, estrogen receptor positive 100%, cN+ 66.7%) undergoing LAD during which 2(1-6) positive nodes out of 5(1-11) total nodes were resected. The intended axillary surgery was SLN sampling in 66.7%. During a median follow-up of 6.1(1.2-9.9) years, two cases of distal recurrence occurred; the 5-y disease-, metastasis-, and locoregional-free survival rates were 95.7%, 95.7%, and 100%, respectively. Survival probabilities for two control groups—a matched group of SATB patients undergoing ALND (<em>n</em> = 50) and those presenting with low axillary tumor burden (LATB, <em>n</em> = 137) did not differ significantly (all <em>P</em> &gt; 0.3) when compared to SATB patients undergoing LAD. Higher KI67, larger tumor size, and omission of adjuvant radiotherapy correlated independently with disease recurrence among all node-positive patients (<em>n</em> = 249) undergoing axillary surgery.</div></div><div><h3>Conclusions</h3><div>Survival outcomes of LAD for SATB were comparable to ALND and to LATB patients, meriting further prospective investigation.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 217-225"},"PeriodicalIF":1.7,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734722","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}

{"title":"Human Doctors or AI? Evaluating Patient Satisfaction in Urinary Stone Disease Consultations","authors":"Hüseyin Alperen Yıldız MD","doi":"10.1016/j.jss.2025.11.026","DOIUrl":"10.1016/j.jss.2025.11.026","url":null,"abstract":"<div><h3>Introduction</h3><div>Artificial intelligence (AI) chatbots are increasingly used in health care, yet their effectiveness in patient consultations remains uncertain. This study aimed to compare patient satisfaction levels between AI chatbot consultations and human doctor consultations for urinary stone disease.</div></div><div><h3>Methods</h3><div>A prospective, randomized controlled trial was conducted with 100 patients newly diagnosed with urinary stone disease. Patients were randomly assigned to one of the five consultation methods: human doctors, ChatGPT, Gemini, Perplexity, or Copilot. Satisfaction was assessed using the Client Satisfaction Questionnaire-8 (CSQ-8), and consultation duration and the number of questions asked were recorded.</div></div><div><h3>Results</h3><div>There was no significant difference in CSQ-8 scores among the groups (<em>P</em> = 0.618), indicating comparable satisfaction levels. However, human doctor consultations lasted significantly longer (15.1 ± 4.9 min) than chatbot consultations (8.4 ± 1.3 min, <em>P</em> &lt; 0.001). Patients in the doctor group asked more questions (5.0 ± 1.4) than those consulting chatbots (2.76 ± 0.5). Higher education levels were associated with lower satisfaction scores (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>AI chatbots provided consultations with satisfaction levels similar to human doctors but in shorter interactions. These findings highlight the potential of AI chatbots as a complementary or alternative consultation tool in specific medical contexts. Future research should explore ways to optimize chatbot interactions to better meet patient expectations.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 181-188"},"PeriodicalIF":1.7,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734806","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}

{"title":"“Prophylactic dressing in the prevention of bedsore: A Network Meta-analysis”","authors":"Mohammed Al Jehani ,&nbsp;Fatimah Al Mazrou ,&nbsp;Anas Bafail ,&nbsp;Halah Alhwsawi ,&nbsp;Ibrahim Albalawi ,&nbsp;Ghaida Alanazi ,&nbsp;Ibrahim Halawani ,&nbsp;Fatima Alhije ,&nbsp;Rayan Alalola","doi":"10.1016/j.jss.2025.09.065","DOIUrl":"10.1016/j.jss.2025.09.065","url":null,"abstract":"<div><h3>Background</h3><div>Pressure sores, also known as pressure ulcers, present a critical health-care challenge, with a prevalence of 5%–20% in Western countries and annual costs exceeding $26.8 billion in the US. This study evaluates the effectiveness of various dressings in preventing pressure ulcers, aiming to improve patient care and reduce health-care expenditures.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted across Embase, PubMed, and Cochrane databases, spanning publications from 1974 to November 2023. Keywords related to pressure ulcers and dressing materials guided the search, resulting in 1041 articles initially screened, with 15 ultimately included in the analysis.</div></div><div><h3>Results</h3><div>The systematic review encompassed studies from diverse global locations, analyzing data from 5,324 patients to assess the effectiveness of prophylactic dressings. Silicone dressings were highlighted for their superior performance in preventing pressure ulcers. The network meta-analysis of 15 studies revealed a significant preference for silicone over polyurethane film (IV= 2.87, CI 95%, 1.01-8.13) and control (IV= 2.69, CI 95%, 1.65-4.39), showcasing very low heterogeneity. Silicone sheets emerged as the prophylactic dressing of choice with a 90.72% probability of being the most effective, outperforming polyurethane foam, fatty acid oils, control, polyurethane film, and hydrocolloid in surface under the cumulative ranking curve ranking.</div></div><div><h3>Conclusion</h3><div>The comparative effectiveness of prophylactic dressings highlights silicone dressings as the optimal choice for preventing pressure ulcers. This finding suggests a strategic shift toward using silicone-based dressings in clinical settings to enhance patient outcomes and reduce the burden of pressure ulcers on health-care systems.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 235-243"},"PeriodicalIF":1.7,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734721","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}

{"title":"Cesarean Section Ratio: A Practical Tool to Assess Surgical Access and Resource Availability in Low- and Middle-Income Countries","authors":"Arthur T. Johnson MD ,&nbsp;Karabo Ngwako MD ,&nbsp;Tlotlo Nthibo MD ,&nbsp;Maliha M.J. Shaikh MD ,&nbsp;Beatrice Mahlaya MD ,&nbsp;Adam L. Kushner MD MPH ,&nbsp;Sarah Jean Hanson MD","doi":"10.1016/j.jss.2025.11.024","DOIUrl":"10.1016/j.jss.2025.11.024","url":null,"abstract":"<div><h3>Introduction</h3><div>Access and availability of timely, quality surgical services remain a problem in low- and middle-income countries. Easily obtainable measures, such as the facilities cesarean section ratio and whether a facility can complete and care for a patient undergoing a damage control laparotomy, are needed to evaluate access to surgical services. This current study aims to evaluate surgical access and resource allocation at primary, district, and tertiary level facilities (public and private) throughout Botswana. These data have the potential to help guide future surgical resource allocation in other low- and middle-income countries throughout the world.</div></div><div><h3>Materials and Methods</h3><div>Cesarean section ratio was calculated based on the ratio of cesarean sections to total surgical procedures completed during the data collection timeframe (June 1, 2022-May 31, 2023). Total surgical procedures included all procedures performed in an operating theater requiring local, general, spinal, or regional anesthesia. Data were collected from a selection of primary, district, and tertiary facilities throughout Botswana.</div></div><div><h3>Results</h3><div>A total of eight primary, three district, and two tertiary facilities were included. Most facilities (11 of 13) were public. More surgical procedures were completed at tertiary compared to primary and district level facilities, 4889 (785) <em>versus</em> 162 (962), and median (range), respectively. The median (range) cesarean section ratio among all facilities was 66.1 (85). The two private facilities (Kanye Seventh-day Adventist and Bokamoso Private hospitals) had lower cesarean section ratios than all public facilities, 20.7% and 6.4%, respectively. Only tertiary level facilities were able to complete damage control laparotomies.</div></div><div><h3>Conclusions</h3><div>The cesarean section ratio can be easily obtained and dynamically followed to provide feedback on surgical resource utilization. The high cesarean section ratio seen in public facilities demonstrates an unmet surgical need, with resources asymmetrically devoted to perinatal care. Tertiary level facilities can complete damage control laparotomies, showing that surgical resources are available in Botswana.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 199-207"},"PeriodicalIF":1.7,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734672","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}

{"title":"Traumatic Brain Injury Care and Use of a Standardized Trauma Intake Form in Ghana","authors":"Adam Gyedu MD MPH ,&nbsp;Frank Nketiah Boakye MBChB ,&nbsp;Samuel Mensah MBChB ,&nbsp;Peter Donkor MDsc ,&nbsp;Charles Mock MD PhD","doi":"10.1016/j.jss.2025.11.022","DOIUrl":"10.1016/j.jss.2025.11.022","url":null,"abstract":"<div><h3>Introduction</h3><div>Care of patients with traumatic brain injury (TBI) is limited in many low- and middle-income countries because of constraints in expensive resources, including computerized tomography and neurosurgeons. Improving TBI care and outcomes should nonetheless be feasible by strengthening initial care to prevent secondary brain injury.</div></div><div><h3>Methods</h3><div>We conducted a post hoc analysis of a prior randomized trial at eight nontertiary hospitals in Ghana. The intervention was a quality-improvement tool, a standardized trauma intake form (TIF) with built-in real-time clinical decision support prompts. Outcomes were achievement of key performance indicators (KPIs) of trauma care and in-hospital mortality. In this post hoc analysis, we evaluated the association of the intervention with TBI care and outcomes.</div></div><div><h3>Results</h3><div>A total of 4077 trauma patients were included. Of these, 252 had a head injury with abbreviated injury score (AIS) ≥ 2. TIF was associated with increased KPI achievement. In the before phase (<em>n</em> = 142), only three of 20 key KPIs were performed ≥ 90% of the time. After TIF introduction (<em>n</em> = 110), 18 of 20 KPIs were performed ≥ 90% of the time. For example, airway assessment rose from 79% to 98% (<em>P</em> = 0.015) and chest examination rose from 69% to 100% (<em>P</em> &lt; 0.001). Similar patterns pertained to a subgroup with head AIS ≥ 3 (<em>n</em> = 79 before, <em>n</em> = 68 after). Mortality in the head AIS ≥ 3 group decreased from 34% to 19% (<em>P</em> = 0.009).</div></div><div><h3>Conclusions</h3><div>Many KPIs were suboptimal for TBI. The simple quality-improvement intervention, the TIF, was associated with increased KPI completion and with decreased mortality among more seriously head-injured patients (head AIS ≥ 3).</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 226-234"},"PeriodicalIF":1.7,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734717","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}

{"title":"Learning Curve for Rat Intestinal Transplantation: Milestones From a Single Surgeon's Perspective","authors":"Antoine Dubois MD ,&nbsp;Javier Serradilla MD ,&nbsp;Ane M. Andres MD, PhD ,&nbsp;Francisco Hernandez MD, PhD ,&nbsp;Jacques Pirenne MD, PhD ,&nbsp;Laurens J. Ceulemans MD, PhD ,&nbsp;Eliano Bonaccorsi-Riani MD, PhD","doi":"10.1016/j.jss.2025.10.052","DOIUrl":"10.1016/j.jss.2025.10.052","url":null,"abstract":"<div><h3>Introduction</h3><div>The rat intestinal transplant (ITx) model is associated with a steep and challenging learning curve (LC) due to the microsurgical skills it requires. Although benchmark values are well-defined in the literature, clear milestones guiding progression along this curve are lacking, which limits its widespread use. Here, we present our methodology for assessing LC progression and achievement.</div></div><div><h3>Methods</h3><div>We describe the experience of a single surgeon developing the rat ITx model without prior microsurgical training. The LC was divided into 3 stepwise milestones: (1) acquisition of microsurgical skills, (2) development of intestinal graft procurement, and (3) development of intestinal graft implantation. LC progression was assessed using surgical times (milestones 2 and 3) and survival rate (milestone 3), according to the number of procedures performed. Based on anastomosis time, a cumulative sum chart analysis was used to determine the number of procedures required to reach LC proficiency.</div></div><div><h3>Results</h3><div>After initial microsurgical training, chicken thighs and rat cadavers were used to practice the key steps of the ITx model. Subsequently, intestinal procurement and implantation in living rats were performed to ultimately complete the 3 defined milestones. Analysis of the cumulative sum chart indicated that 34 ITx procedures were required to reach anastomosis time targets (linear regression adjusted R² = 0.95), which was directly associated with an increased 7-day survival rate.</div></div><div><h3>Conclusions</h3><div>Our methodology, based on stepwise milestones, enabled the development of the rat ITx model. Following the completion of milestones 1 and 2, 34 ITx procedures were required to complete the LC.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 189-198"},"PeriodicalIF":1.7,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734676","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}

{"title":"Multimetric Analysis of Online Health Resources for Oncoplastic Breast Surgery Patients","authors":"Maria J. Escobar-Domingo MD ,&nbsp;James E. Fanning BS ,&nbsp;Agustin Posso MD ,&nbsp;Khoa Nguyen BS ,&nbsp;Charlotte Thomas BS ,&nbsp;Sarah J. Karinja MD ,&nbsp;Samuel J. Lin MD, MBA ,&nbsp;David W. Mathes MD ,&nbsp;Bernard T. Lee MD, MBA, MPH ,&nbsp;Christodoulos Kaoutzanis MD","doi":"10.1016/j.jss.2025.11.023","DOIUrl":"10.1016/j.jss.2025.11.023","url":null,"abstract":"<div><h3>Introduction</h3><div>Oncoplastic breast surgery (OBS) has gained attention for improving breast cancer patients’ satisfaction and quality of life. This study aims to address the readability of online English and Spanish language patient education materials (PEMs) in oncoplastic breast surgery.</div></div><div><h3>Methods</h3><div>A de-identified online search using the terms \"oncoplastic breast surgery\" or \"cirugía oncoplástica de seno\" was performed. English and Spanish websites were selected and categorized by academic or private centers. Readability scores were generated using established tests: Simple Measure of Gobbledygook (SMOG), Fry Graph, Patient Education Materials Assessment Tool (PEMAT) for Understandability and Actionability, and Cultural Sensitivity and Assessment Tool (CSAT). Fisher's exact tests assessed group differences.</div></div><div><h3>Results</h3><div>The most common location of origin of online resources was the United States (53%), followed by Europe (23%). The specialties performing OBS included breast surgery (48%), plastic surgery (44%), and obstetric and gynecological surgery (8%). All PEMs failed to meet the recommended readability levels. The average Simplified Measure of Gobbledygook and Spanish Orthographic Length reading level corresponded to that of a university freshman for both academic and private materials, with English websites being more difficult to read than Spanish resources. The average understandability score was slightly higher for academic centers compared to private institutions (63% <em>versus</em>. 61%; <em>P</em> = 0.661). The average actionability score was significantly higher for English websites compared to their Spanish counterparts (35% <em>versus</em> 21%; <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Patient information found through an online search for OBS is too difficult for the average American adult to read. As patient interest in OBS grows, access to appropriately written educational material is crucial to support informed decision-making, enhance patient satisfaction, reduce decisional regret, and ultimately promote equity in health care.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 208-216"},"PeriodicalIF":1.7,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734807","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}

{"title":"Is Appendiceal Cancer a Risk of Nonoperative Management of Pediatric Uncomplicated Appendicitis?","authors":"Alexa G. Turpin MD ,&nbsp;Lindsey Asti PhD, MPH ,&nbsp;Carley Lutz BS ,&nbsp;Jacqueline M. Saito MD ,&nbsp;Grace Z. Mak MD ,&nbsp;Ronald B. Hirschl MD ,&nbsp;Samir Gadepalli MD, MBA ,&nbsp;Michael A. Helmrath MD ,&nbsp;Charles M. Leys MD ,&nbsp;Dave R. Lal MD ,&nbsp;Katherine T. Flynn-O’Brien MD, MPH ,&nbsp;Thomas T. Sato MD ,&nbsp;Matthew P. Landman MD ,&nbsp;Troy A. Markel MD ,&nbsp;Rashmi Kabre MD ,&nbsp;Mary E. Fallat MD ,&nbsp;Katherine J. Deans MD, MHSc ,&nbsp;Peter C. Minneci MD, MHSc","doi":"10.1016/j.jss.2025.11.030","DOIUrl":"10.1016/j.jss.2025.11.030","url":null,"abstract":"<div><h3>Introduction</h3><div>Nonoperative management (NOM) of pediatric uncomplicated appendicitis is becoming increasingly common. As most appendiceal cancer in children is incidentally diagnosed after appendectomy, there is a theoretical risk of missed appendiceal cancer with NOM. The objective of this study was to determine the incidence of appendiceal cancer in children who otherwise met the criteria for NOM.</div></div><div><h3>Methods</h3><div>This study is a secondary analysis of a multi-intuitional, nonrandomized interventional trial comparing surgery to NOM of uncomplicated appendicitis in children 7 to 17 y across ten tertiary children's hospitals between May 2015 and October 2018. Inclusion criteria for this study were (1) imaging confirmed uncomplicated appendicitis without evidence of abscess, fecalith, or phlegmon and appendiceal diameter ≤1.1 cm; (2) white blood cell count between 5000/μL and 18,000 μL; and (3) abdominal pain for less than 48 h before presentation. Pathology was reviewed for all children who underwent laparoscopic appendectomy, including those who chose primary appendectomy and those who failed NOM within 1 y. Appendiceal cancer was defined as any type of cancer, including carcinoid.</div></div><div><h3>Results</h3><div>A total of 826 patients (median age 12.5 y, interquartile range 10.4-14.8, 38% females) underwent an appendectomy during the study period, with 698 of these patients choosing upfront appendectomy and 128 patients undergoing appendectomy after failed NOM (242 of the 370 patients who chose NOM in the trial were successfully managed nonoperatively). Of the 128 patients who failed nonoperative management, 53 (41%) failed therapy and underwent laparoscopic appendectomy during initial admission, with pathology reports available for 52 patients, and 75 (59%) developed recurrent appendicitis and underwent appendectomy, 74 patients had available pathology reports. Among the 824 patients with available pathology reports, there were no appendiceal cancers (95% confidence interval 0%-0.36%).</div></div><div><h3>Conclusions</h3><div>In children with uncomplicated appendicitis who qualify for NOM, the incidence of appendiceal cancer is exceedingly rare. Therefore, the risk of appendiceal cancer should minimally factor into counseling and decision-making between surgery and NOM in uncomplicated appendicitis in children.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 161-166"},"PeriodicalIF":1.7,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734718","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}

{"title":"Educational Outcomes and Impact of HBCUs on the Pipeline of Minority Surgeons","authors":"Cassie P. Bowers BS ,&nbsp;Anna M. Lin MD ,&nbsp;Terrence M. Fullum MD, MBA ,&nbsp;Edward E. Cornwell III MD ,&nbsp;Debra H. Ford MD ,&nbsp;David A. Rose MD ,&nbsp;Daniel Tran MD ,&nbsp;Andrea Hayes Dixon MD, PhD (Hon) ,&nbsp;Christine E. Nembhard MD ,&nbsp;May C. Tee MD, MPH","doi":"10.1016/j.jss.2025.10.035","DOIUrl":"10.1016/j.jss.2025.10.035","url":null,"abstract":"<div><h3>Introduction</h3><div>We aim to examine the professional outcomes of graduates from a Historically Black College and University (HBCU) surgery residency program since inception.</div></div><div><h3>Materials and Methods</h3><div>A retrospective analysis using records of 378 graduates from a single HBCU general surgery residency program was queried from 1938 to 2025. Educational outcomes were captured and trends evaluated by univariable and multivariable analyses.</div></div><div><h3>Results</h3><div>Overall, there were 300 (87%) Black, 78 (21%) female, 234 (62%) Black males, 293 (79.0%) male, and 12 (3.5%) Hispanic surgical graduates. Comparing early to late cohorts, we found that decreased Black graduates (122 (90%) <em>versus</em> 96 (80%), <em>P</em> = 0.029), decreased Black male graduates (100 (70%) <em>versus</em> 58 (47%), <em>P</em> &lt; 0.001), increased female graduates (22 (16%) <em>versus</em> 48 (39%), <em>P</em> &lt; 0.001), increased Hispanic graduates (1 (1%) <em>versus</em> 6 (5%), <em>P</em> = 0.045), increased graduates pursuing fellowships (65 (54%) <em>versus</em> 91 (77%), <em>P</em> &lt; 0.001), increased maintenance of board certification (96 (76%) <em>versus</em> 113 (91%), <em>P</em> = 0.001), increased fellowship of the American College of Surgeons distinction (58 (46%) versus 74 (60%), <em>P</em> = 0.026), and increased age at graduation (33 y old <em>versus</em> 34 y old, <em>P</em> = 0.0325). On multivariable analyses, the odds of board certification (adjusted odds ratio [aOR] = 3.75, <em>P</em> = 0.008), fellowship (aOR = 2.00, <em>P</em> = 0.028), and female sex (aOR = 4.15, <em>P</em> &lt; 0.001) were significantly associated with the late <em>versus</em> early group of graduates, whereas fellowship of the American College of Surgeons designation, pursuance of an academic position, US medical graduate, Black Race, and Hispanic Ethnicity were not.</div></div><div><h3>Conclusions</h3><div>Trends for surgical graduates of this HBCU program appear to mirror national trends. Such programs contribute to the diversification of surgeons, while maintaining excellent educational outcomes.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 154-160"},"PeriodicalIF":1.7,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734619","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}

{"title":"Pediatric Intracranial Gunshot Wounds: Lessons From the Newark Experience","authors":"Antonia M. Sames BS ,&nbsp;Arman Sawhney BS ,&nbsp;Tannishtha Som MS ,&nbsp;Travis R. Quinoa MD ,&nbsp;Esther A. Nimchinsky MD, PhD ,&nbsp;Joanelle A. Bailey MD, MPH ,&nbsp;Ziad C. Sifri MD ,&nbsp;Catherine A. Mazzola MD ,&nbsp;Nina E. Glass MD","doi":"10.1016/j.jss.2025.11.018","DOIUrl":"10.1016/j.jss.2025.11.018","url":null,"abstract":"<div><h3>Introduction</h3><div>Pediatric gunshot wounds to the head (GSWH) are among the most devastating injuries, with mortality rates ranging from 20% to 65%. Prognostic tools such as the St. Louis Score (SLS) and Rotterdam computed tomography (CT) Score have been studied, but data specific to pediatric populations are limited. This study aimed to identify factors predictive of mortality and functional outcomes in pediatric GSWH and evaluate the predictive accuracy of existing scoring systems.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed all 14 pediatric patients (≤18 y old) with GSWH at an urban, level 1 trauma center between 2010 and 2023. Patient demographics, injury characteristics, imaging findings, and outcomes were analyzed. Predictive tools were evaluated using receiver operator curve analysis, and statistical comparisons were conducted between survivors and nonsurvivors and between favorable (Glasgow Outcome Score ≥ 4) and unfavorable outcomes.</div></div><div><h3>Results</h3><div>The overall mortality rate was 65%. Survivors had significantly higher admission Glasgow Coma Scale (11 <em>versus</em> 4, <em>P</em> = 0.008), lower international normalized ratio (1.1 <em>versus</em> 1.7, <em>P</em> = 0.015), lower serum glucose (138 <em>versus</em> 225, <em>P</em> = 0.021), and lower Rotterdam CT Scores (3 <em>versus</em> 5, <em>P</em> = 0.038). SLS and Rotterdam CT Score demonstrated poor predictive accuracy for mortality.</div></div><div><h3>Conclusions</h3><div>Survivors of pediatric GSWH exhibited distinct clinical and laboratory profiles on admission, including higher Glasgow Coma Scale and lower international normalized ratio and glucose levels. While the Rotterdam CT Score performed better than the SLS, both prognostic tools were suboptimal to predict favorable outcomes for this cohort. Larger studies are needed to refine predictive models and improve management strategies in pediatric GSWH.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 173-180"},"PeriodicalIF":1.7,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734674","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}