Journal of Surgical Research最新文献_第8页

Characterizing a Common Phenomenon: Why do Trauma Patients Re-Present to the Emergency Department? 描述一种常见现象：创伤患者为何再次到急诊科就诊？

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-10-18 DOI: 10.1016/j.jss.2024.09.068

Wang Pong Chan MS , Sophia M. Smith MD, MS , Cara Michael BA , Kendall Jenkins MS , Yorghos Tripodis PhD , Dane Scantling DO, MPH , Crisanto Torres MD, MPH , Sabrina E. Sanchez MD, MPH

Introduction

Trauma patients return to the emergency department (ED) at alarmingly high rates, despite not all patients requiring hospital resources. Reasons for ED re-presentation and associated risk factors have not been fully investigated.

Methods

Retrospective cohort study of adult trauma admissions at an urban safety net level 1 trauma center (1/12018-12/312021). Risk factors for ED re-presentation were identified using purposeful selection and modeled using multivariable logistic regression.

Results

Of 2491 patients, 19% returned within 30 d (N = 475). Most patients presented for uncontrolled pain (37%, N = 175), medical concerns (25%, N = 119), and infection (10%, N = 49). The readmission rates varied as follows: 18% for uncontrolled pain (N = 32), 42% for medical concerns (N = 50), and 67% for infection (N = 33). Risk factors for uncontrolled pain included depression/anxiety (adjusted odds ratio [aOR] 2.06, 95% confidence interval [CI] 1.39-3.05), substance use disorder (SUD) (aOR 1.65, 95% CI 1.12-2.43), and penetrating mechanism of injury (aOR 2.25, 95% CI 1.59-3.18). Risk factors for medical concerns included number of medical comorbidities (aOR 1.34, 95% CI 1.18-1.52), depression/anxiety (aOR 1.97, 95% CI 1.28-3.01), SUD (aOR 2.48, 95% CI 1.65-3.74), and nonhome discharge disposition (aOR 1.56, 95% CI 1.07-2.28). Risk factors for infection included non-English primary language (aOR 3.41, 95% CI 1.82-6.39), SUD (aOR 2.00, 95% CI 1.03-3.88), and nonhome discharge disposition (aOR 2.06, 95% CI 1.15-3.67).

Conclusions

Uncontrolled pain was the most common reason for re-presentation, although only a small fraction required readmission. Patients with penetrating injury may benefit from improved pain control. Primary care provider follow-up may help mitigate risk of medical disease exacerbation, and wound care instructions for non–English speaking patients may decrease re-presentation for infection.

导言：尽管并非所有患者都需要医院资源，但创伤患者重返急诊科（ED）的比例却高得惊人。急诊科再次就诊的原因及相关风险因素尚未得到充分调查：方法：对城市安全网一级创伤中心收治的成人创伤患者进行回顾性队列研究（1/12018-12/312021）。通过有目的的选择确定了急诊室再次就诊的风险因素，并使用多变量逻辑回归建立了模型：结果：在 2491 名患者中，19% 的患者在 30 天内再次就诊（N = 475）。大多数患者因疼痛无法控制（37%，175 人）、医疗问题（25%，119 人）和感染（10%，49 人）而再次就诊。再入院率变化如下疼痛失控率为 18%（32 人），医疗问题率为 42%（50 人），感染率为 67%（33 人）。疼痛无法控制的风险因素包括抑郁/焦虑（调整后比值比 [aOR]2.06，95% 置信区间 [CI]1.39-3.05）、药物使用障碍 (SUD)（aOR 1.65，95% CI 1.12-2.43）和穿透性损伤（aOR 2.25，95% CI 1.59-3.18）。医疗问题的风险因素包括合并症数量（aOR 1.34，95% CI 1.18-1.52）、抑郁/焦虑（aOR 1.97，95% CI 1.28-3.01）、SUD（aOR 2.48，95% CI 1.65-3.74）和非家庭出院处置（aOR 1.56，95% CI 1.07-2.28）。感染的风险因素包括非英语母语（aOR 3.41，95% CI 1.82-6.39）、SUD（aOR 2.00，95% CI 1.03-3.88）和非家庭出院处置（aOR 2.06，95% CI 1.15-3.67）：疼痛无法控制是再次就诊的最常见原因，但只有一小部分患者需要再次入院。改善疼痛控制可使穿透伤患者受益。初级保健提供者的随访可能有助于降低内科疾病恶化的风险，对不会说英语的患者进行伤口护理指导可能会减少因感染而再次就诊的情况。

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引用次数: 0

Piloting an Assessment Tool to Organize Surgical Care in Armed Conflicts: Findings From Cameroon 试行评估工具以组织武装冲突中的外科护理：喀麦隆的研究结果。

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-10-18 DOI: 10.1016/j.jss.2024.09.061

Kevin Gianaris BA , Ghyslaine Bruna Djeunang Dongho PhD , Nkengafac Nyiawung Fobellah MD , Ronald M. Gobina MD , Denis A. Foretia MD, MPH, MBA, FACS

Introduction

Armed conflict is increasing globally and is dramatically disrupting surgical care more than ever before. To address this, the PIPESS (Personnel, Infrastructure, Procedures, Equipment, Supplies, and Standard) tool was designed to facilitate assessment of hospital capacity. It assesses 6 key categories at 3 timepoints: preconflict, during conflict, and postconflict. This tool was piloted to assess the impact of conflict and COVID-19 on surgical care delivery at the Buea Regional Hospital in Cameroon.

Methods

This was a cross-sectional, qualitative study combining in-depth interviews and on-site observations of the surgical care unit. The data collected during the interviews were then applied to the modified PIPESS tool to calculate a preconflict score based on recall and a during conflict score to quantify differences before and during conflict.

Results

We interviewed 12 key informants: 6 patients, 3 doctors, and 3 other staff. The themes extracted from the preconflict period highlight major barriers including rudimentary prehospital care and referral limitations from remote areas, lack of funding and training, and a demand exceeding the supply of care. COVID-19 resulted in an influx of resources into the region and did not disrupt care to the extent of the conflict. Quantitatively, the PIPESS score for preconflict was 110, and the PIPESS score during conflict was 115, showing an increase in resources, specifically in personnel and infrastructure during conflict.

Conclusions

The conflict increased the burden on existing health centers and strained resources for trauma care. Paradoxically, surgical resources increased during the conflict likely because of increased international support along with local displacement of staff toward the hospital. Further data should be collected during the postconflict setting.

导言：武装冲突在全球范围内愈演愈烈，对外科护理造成了前所未有的严重破坏。为解决这一问题，我们设计了 PIPESS（人员、基础设施、程序、设备、用品和标准）工具，以促进对医院能力的评估。该工具在冲突前、冲突中和冲突后 3 个时间点对 6 个关键类别进行评估。我们试用了这一工具，以评估冲突和 COVID-19 对喀麦隆布埃亚地区医院外科医疗服务的影响：这是一项横断面定性研究，结合了深入访谈和对外科护理单元的现场观察。然后将访谈中收集到的数据应用于修改后的 PIPESS 工具，根据回忆计算冲突前得分，并计算冲突期间得分，以量化冲突前和冲突期间的差异：我们采访了 12 位关键信息提供者：结果：我们采访了 12 名关键信息提供者：6 名患者、3 名医生和 3 名其他工作人员。从冲突前时期提取的主题突出了主要障碍，包括院前急救条件简陋、偏远地区的转诊限制、缺乏资金和培训以及医疗服务供不应求。COVID-19 事件导致大量资源涌入该地区，但并没有像冲突期间那样中断医疗服务。从数量上看，冲突前的 PIPESS 得分为 110，冲突期间的 PIPESS 得分为 115，这表明资源有所增加，特别是冲突期间人员和基础设施的增加：冲突加重了现有医疗中心的负担，并使创伤护理资源更加紧张。矛盾的是，在冲突期间，外科手术资源有所增加，这可能是因为国际社会增加了支持，同时当地工作人员也向医院转移。应在冲突后环境中收集更多数据。

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引用次数: 0

The Thermal Signature of Wound Healing 伤口愈合的热信号

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-10-18 DOI: 10.1016/j.jss.2024.09.043

Haggai Benvenisti MD , Omer Cohen Msc , Eti Feldman NP , Dan Assaf MD , Moran Jacob Bsc , Eran Bluestein MBA , Gal Strechman Msc , Boris Orkin MD , Hezi Nachman-Farchy Msc , Aviram Nissan MD

Background

Despite major efforts in prevention, surgical site infections (SSIs) remain a burden on patients and the healthcare system and are associated with significant morbidity. SSIs are one of the costliest healthcare-associated infections. The diagnosis of SSIs is based mainly on clinical assessment, which may result in a delay in detection. The ability to detect SSIs in subclinical phase and initiate effective therapy earlier may reduce morbidity and hospital stay. In this study, we attempted to utilize long-wave infrared (LWIR) imaging to define the healing process of the surgical site and to detect abnormal healing.

Methods

In this prospective study, 50 patients undergoing elective abdominal surgery had LWIR images of their incision obtained at determined intervals from their operation to discharge. Images were processed with proprietary algorithms to create a thermal topograph used to define the healing process.

Results

Images of 45 patients were available for a final review. Of these 45 patients, 10 patients developed SSIs. Using the thermal topograph, 10 criteria for image analysis were defined, yielding a prediction of six out of the 10 SSIs and 35 out of the 35 normal healing wounds. Sensitivity was 60%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 90.1%, with 92% accuracy. A preliminary program was created that allows trained users to methodically evaluate images providing them with a risk estimate.

Conclusions

In this preliminary study, LWIR analysis of surgical wounds was able to identify normal and abnormal wound healing. Further large-scale studies are needed to validate results.

背景：尽管在预防方面做出了巨大努力，但手术部位感染（SSI）仍然是患者和医疗系统的负担，并与严重的发病率相关。SSI 是医疗成本最高的相关感染之一。SSI 的诊断主要基于临床评估，这可能导致检测延迟。如果能在亚临床阶段检测到 SSI 并尽早启动有效治疗，则可降低发病率和缩短住院时间。在这项研究中，我们尝试利用长波红外成像（LWIR）来确定手术部位的愈合过程并检测异常愈合：在这项前瞻性研究中，50 名接受择期腹部手术的患者从手术到出院期间，每隔一段时间就会采集切口的长波红外图像。采用专有算法对图像进行处理，以创建用于确定愈合过程的热地形图：共有 45 名患者的图像可供最终审核。在这 45 名患者中，有 10 名患者出现了 SSI。通过热地形图，确定了 10 项图像分析标准，预测出 10 例 SSI 中的 6 例和 35 例正常愈合伤口中的 35 例。灵敏度为 60%，特异性为 100%，阳性预测值为 100%，阴性预测值为 90.1%，准确率为 92%。我们还创建了一个初步的程序，让经过培训的用户有条不紊地评估图像，为他们提供风险估计：在这项初步研究中，手术伤口的长波红外分析能够识别正常和异常的伤口愈合。需要进一步的大规模研究来验证结果。

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引用次数: 0

The Initial Experience After Pediatric Firearm Injury: A Multifaceted Qualitative Approach 小儿枪伤后的最初经历：多方面定性方法。

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-10-18 DOI: 10.1016/j.jss.2024.09.057

Jennifer M. Schuh MD , Christina Georgeades MD , Taylor Schleusner BS , Carisa Bergner PhD , Samantha Leonard MD , Patricia Marik PsyD , Matthew Jandrisevits PhD , David Gourlay MD, FAAP, FACS , Katherine Flynn-O’Brien MD, MPH, FAAP, FACS

Introduction

Firearm victims sustain a disproportionate mental health burden. Inpatient pediatric psychology consult liaison (CL) services provide comprehensive evaluation after injury. We aim to explore CL documentation qualitatively to better understand the initial psychological experience after firearm injury in children compared to motor vehicle crash (MVC) injury. We hypothesized that meaningful differences between the cohorts would be evident by thematic, sentiment, and word cloud analyses of CL notes.

Materials and methods

This single-institution, retrospective study at a level I pediatric trauma center identified 5-17-y-old children who sustained firearm injuries and were admitted for ≥48 h from January 1, 2016 to March 31, 2021. Firearm-injured children were propensity score-matched to MVC-injured children. Thematic, sentiment, and word cloud analyses were completed for all CL notes.

Results

98 firearm-injured children were identified. The CL service evaluated 71% of firearm-injured children and 65% of MVC-injured children. Domains of resources, encountering the medical system, prior psychological and legal influences, immediate cognitive reactions, and social influences were identified based on extracted themes. Sentiment analysis revealed more negative than positive words for both firearm- (3318 versus 2190 words) and MVC-injured children (2225 versus 1994 words). Word cloud showed that firearm-injured child notes more frequently mentioned “trauma”, while MVC-injured child notes more frequently mentioned “family” and “support”.

Conclusions

The pediatric CL note analysis suggests that the experience after firearm injury differs from that after MVC injury in reference to family and support. CL notes covered a breadth of topics beyond the psychological impact alone. Understanding the experiences of injured children in relation to injury mechanism offers opportunity for focused intervention strategies.

导言：枪伤受害者承受着过重的心理健康负担。住院儿科心理咨询联络（CL）服务可提供受伤后的全面评估。我们旨在对 CL 文档进行定性研究，以便更好地了解与机动车碰撞 (MVC) 伤害相比，儿童在枪支伤害后最初的心理体验。我们假设，通过对CL记录进行主题、情感和词云分析，可以明显看出组群之间存在有意义的差异：这项在一级儿科创伤中心进行的单一机构回顾性研究确定了 2016 年 1 月 1 日至 2021 年 3 月 31 日期间遭受枪伤且入院时间≥48 小时的 5-17 岁儿童。枪伤儿童与机动车交通事故受伤儿童进行了倾向得分匹配。对所有CL记录进行了主题、情感和词云分析：结果：确定了 98 名枪伤儿童。CL服务评估了71%的枪伤儿童和65%的机动车碰撞受伤儿童。根据提取的主题，确定了资源、遇到医疗系统、先前的心理和法律影响、即时认知反应和社会影响等领域。情感分析显示，枪伤儿童（3318 字对 2190 字）和机动车碰撞受伤儿童（2225 字对 1994 字）的负面词语多于正面词语。词云显示，枪伤儿童的记录中更多地提到了 "创伤"，而车祸受伤儿童的记录中更多地提到了 "家庭 "和 "支持"：儿科 CL 笔记分析表明，在提及家庭和支持时，枪支伤害后的经历与机动车碰撞伤害后的经历有所不同。CL记录涉及的主题非常广泛，不仅仅是心理影响。了解受伤儿童在受伤机制方面的经历为制定有针对性的干预策略提供了机会。

{"title":"The Initial Experience After Pediatric Firearm Injury: A Multifaceted Qualitative Approach","authors":"Jennifer M. Schuh MD , Christina Georgeades MD , Taylor Schleusner BS , Carisa Bergner PhD , Samantha Leonard MD , Patricia Marik PsyD , Matthew Jandrisevits PhD , David Gourlay MD, FAAP, FACS , Katherine Flynn-O’Brien MD, MPH, FAAP, FACS","doi":"10.1016/j.jss.2024.09.057","DOIUrl":"10.1016/j.jss.2024.09.057","url":null,"abstract":"<div><h3>Introduction</h3><div>Firearm victims sustain a disproportionate mental health burden. Inpatient pediatric psychology consult liaison (CL) services provide comprehensive evaluation after injury. We aim to explore CL documentation qualitatively to better understand the initial psychological experience after firearm injury in children compared to motor vehicle crash (MVC) injury. We hypothesized that meaningful differences between the cohorts would be evident by thematic, sentiment, and word cloud analyses of CL notes.</div></div><div><h3>Materials and methods</h3><div>This single-institution, retrospective study at a level I pediatric trauma center identified 5-17-y-old children who sustained firearm injuries and were admitted for ≥48 h from January 1, 2016 to March 31, 2021. Firearm-injured children were propensity score-matched to MVC-injured children. Thematic, sentiment, and word cloud analyses were completed for all CL notes.</div></div><div><h3>Results</h3><div>98 firearm-injured children were identified. The CL service evaluated 71% of firearm-injured children and 65% of MVC-injured children. Domains of resources, encountering the medical system, prior psychological and legal influences, immediate cognitive reactions, and social influences were identified based on extracted themes. Sentiment analysis revealed more negative than positive words for both firearm- (3318 <em>versus</em> 2190 words) and MVC-injured children (2225 <em>versus</em> 1994 words). Word cloud showed that firearm-injured child notes more frequently mentioned “trauma”, while MVC-injured child notes more frequently mentioned “family” and “support”.</div></div><div><h3>Conclusions</h3><div>The pediatric CL note analysis suggests that the experience after firearm injury differs from that after MVC injury in reference to family and support. CL notes covered a breadth of topics beyond the psychological impact alone. Understanding the experiences of injured children in relation to injury mechanism offers opportunity for focused intervention strategies.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 519-531"},"PeriodicalIF":1.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468445","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

Mental and Physical Readiness for Weight Loss After Abdominal Organ Transplant 腹腔器官移植后减肥的心理和生理准备

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-10-18 DOI: 10.1016/j.jss.2024.09.009

Maria P. Cote MD, Srilakshmi Atthota MD, Anne MacDonald BS, Jennie Cataldo MS, RD, Anushi Shah MD, Flor Flores BS, MS, Ruby Singh MD, MPH, Nahel Elias MD, Leigh Anne Dageforde MD, MPH

Introduction

Readiness to incorporate healthy lifestyle practices is not studied in posttransplant patients. We evaluate physical and mental readiness for a weight-loss guided lifestyle intervention.

Methods

12 kidney and 12 liver transplant patients were given a Fitbit and weighing scale for 12 mo. Twelve patients received group sessions on lifestyle modifications. Mental readiness was assessed using Patient Activation Measurement-13, Physical Activity, Process of Change, and Weight Stages of Change. Physical readiness was assessed using Fatigue, Resistance, Ambulation, Illness, and Loss of Weight, and Short Physical Performance Battery questionnaires. Weight change, group session attendance, device usage, and readiness were analyzed.

Results

23 patients (12 kidney, 11 liver), 57 y (46.2-67.5), 75% male, 24.9 (15.7-43.2) months posttransplant) completed the study. Twenty-two patients had robust physical readiness, and high Fitbit usage (>80%). Ten patients (43%) lost ≥2.5% (moderate) of body weight, including 4 (17.3%) losing >5% total weight (high). 13 patients lost ≤2.5% or gained weight (maintenance). High loss and target group session attendance groups had the highest use of Processes of Change.

Conclusions

Posttransplant patients are physically ready for a weight-loss guided lifestyle intervention and show high usage of the Fitbit device. Higher mental readiness associates with higher weight loss.

导言：目前尚未对移植后患者纳入健康生活方式的准备情况进行研究。我们对体重减轻指导下的生活方式干预的身体和心理准备情况进行了评估。12 名患者接受了有关生活方式调整的小组课程。心理准备情况通过患者激活测量-13、体育活动、变化过程和体重变化阶段进行评估。使用疲劳、阻力、行走、疾病、体重减轻和短期体能测试问卷对患者的体能准备情况进行评估。结果23名患者（12名肾脏患者，11名肝脏患者）完成了研究（年龄57岁（46.2-67.5），75%为男性，移植后24.9个月（15.7-43.2））。22名患者身体状况良好，Fitbit使用率高（80%）。10名患者（43%）体重下降≥2.5%（中度），其中4名患者（17.3%）总重量下降>5%（高度）。13名患者的体重下降≤2.5%或增加（维持）。高减重组和目标小组会议出席组对 "改变过程 "的使用率最高。心理准备程度越高，体重减轻的幅度越大。

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引用次数: 0

Cardiothoracic Surgery Interviews and Selection in a Pandemic Era – Lessons to Learn 大流行时代的心胸外科面试和选拔--值得借鉴的经验。

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-10-18 DOI: 10.1016/j.jss.2024.09.039

Naima A. Alver MD , Jay D. Pal MD, PhD , Castigliano M. Bhamidipati DO, PhD, MSc, FACS, FACC

Introduction

Candidate selection for cardiothoracic surgery (CTS) training programs is challenging. The recent pandemic has impacted a program's ability to meet matriculants in-person. We hypothesized that a central venue at the CTS annual meeting could prove as a favorable supplement for programs and applicants.

Methods

Surveys were sent to adult cardiothoracic and congenital cardiac surgery training program directors (PD) and department chairs or division chiefs. Separately, surveys were sent to applicants from the 2018 through 2023 electronic residency application service match process.

Results

A total of 166 individuals (PDs and department chairs or division chiefs) were contacted. This represented 94 unique programs, and 45 programs responded. The majority of these programs (88.9%) felt that social gatherings were valuable in evaluating applicants and 86.7% would be interested in a social event at an Society of Thoracic Surgery annual meeting. 54% of applicants did not get an accurate impression of the programs to inform their rank list through virtual interviews, 70% would not be able to accept the same number of interviews in-person versus virtual, and 94% would be interested in attending an annual conference to meet program faculty.

Conclusions

A centralized in-person interview event allows for fiscal and scheduling efficiencies, while creating an opportunity for an equitable exchange between potential candidates and PDs in an efficient manner. Such an event would cost a fraction of what our profession has been incurring, could diversify our workforce, would create early mentoring linkages, and perhaps remodel the way we select trainees.

导言：心胸外科（CTS）培训项目的候选人遴选工作极具挑战性。最近的大流行影响了培训项目与预科生面对面交流的能力。我们假设，在 CTS 年会上设立一个中心会场可以证明是对项目和申请人的有利补充：我们向成人心胸外科和先天性心脏外科培训项目主任（PD）、系主任或科主任发送了调查问卷。另外，还向2018年至2023年住院医师电子申请服务匹配过程中的申请人发送了调查问卷：共联系了 166 人（项目主任和科主任或科主任）。这代表了 94 个独特的项目，其中 45 个项目做出了回应。其中大多数项目（88.9%）认为社交聚会对评估申请人很有价值，86.7%的项目对胸外科学会年会上的社交活动感兴趣。54%的申请者无法通过虚拟面试获得对项目的准确印象，从而影响他们的排名，70%的申请者无法接受相同数量的现场面试和虚拟面试，94%的申请者有兴趣参加年会与项目教师会面：集中的面对面面试活动可以提高财政和时间安排的效率，同时为潜在候选人和项目主任之间以高效的方式进行公平交流创造机会。这样的活动所花费的成本仅为我们专业所花费成本的一小部分，可以使我们的劳动力多样化，建立早期的指导联系，或许还能重塑我们选择受训者的方式。

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引用次数: 0

Amitriptyline Decreases Mouse Lung Endothelial Cell Inflammatory Responses to Packed Red Blood Cell Microparticles 阿米替林可降低小鼠肺内皮细胞对包装红细胞微粒的炎症反应

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-10-18 DOI: 10.1016/j.jss.2024.09.042

Lindsey Wattley MD, Ryan Chae MD, Christopher Nguyen BS, Rebecca Schuster MS, Alex Lentsch PhD, Charles Caldwell PhD, Michael Goodman MD, Timothy A. Pritts MD, PhD

Introduction

Large-volume packed red blood cell (pRBC) transfusion is associated with lung injury and worsened outcomes. Amitriptyline reduces lung injury and inflammation in a murine sepsis model. We hypothesized that red cell microparticles (MP) activate endothelial cells, leading to lung injury and that treatment with amitriptyline would blunt the inflammatory response MPs through inhibition of acid sphingomyelinase (ASM).

Methods

Murine pRBCs were obtained from C57Bl/6 mice and stored in AS3 for 14 d. The MPs were isolated from pRBCs by serial centrifugation. Mouse lung endothelial cells (MLECs) were pretreated with amitriptyline (0, 2.5, 25, 27 μM, n = 5) for 30 min prior to MP treatment. Chemokine secretion and adhesion molecule shedding was assessed. ASM activity was measured from cell lysates.

Results

MPs increased the secretion of chemokines and shedding of adhesion molecules in MLECs at both four and 24 h. Amitriptyline treatment of MLECs decreased ASM activity in the setting of MPs. Amitriptyline pretreatment decreased the secretion of chemokines and shedding of adhesion molecules in response to MPs at 4 h but did not decrease adhesion molecule shedding at 24 h

Conclusions

Endothelial cell treatment with MPs induces secretion of chemokines responsible for chemotaxis (keratinocyte chemoattractant, regulated upon activation normal T cell expressed and presumably secreted, and G-granulocyte colony-stimulating factor) as well as many downstream proinflammatory effects (interleukin-6). Additionally, MPs induce adhesion molecule shedding (vascular cell adhesion molecule-1, intracellular adhesion molecule-1, P-selectin, and E-selectin), which has been shown to be associated with endothelial cell activation. Amitriptyline pretreatment decreases MLEC inflammatory response and ASM activity is decreased. These data suggest that ASM inhibition in MLECs is a potential strategy to blunt the inflammatory response to the red blood cell storage lesion.

导言大容量包装红细胞（pRBC）输注与肺损伤和预后恶化有关。阿米替林能减轻小鼠败血症模型中的肺损伤和炎症反应。我们假设红细胞微颗粒（MP）能激活内皮细胞，导致肺损伤，而阿米替林能通过抑制酸性鞘磷脂酶（ASM）减轻MP的炎症反应。在处理 MP 之前，用阿米替林（0、2.5、25、27 μM，n = 5）预处理小鼠肺内皮细胞（MLECs）30 分钟。对趋化因子分泌和粘附分子脱落进行评估。结果 MPs 增加了 MLECs 在 4 小时和 24 小时内趋化因子的分泌和粘附分子的脱落。结论内皮细胞经 MPs 处理后会诱导分泌趋化因子（角质细胞趋化因子、角质细胞趋化因子、角质细胞趋化因子、角质细胞趋化因子、角质细胞趋化因子、角质细胞趋化因子、角质细胞趋化因子、角质细胞趋化因子、角质细胞趋化因子、角质细胞趋化因子、角质细胞趋化因子、角质细胞趋化因子、角质细胞趋化因子、角质细胞趋化因子、角质细胞趋化因子、角质细胞趋化因子）、和 G-粒细胞集落刺激因子）以及许多下游促炎效应（白细胞介素-6）。此外，MPs 还会诱导粘附分子脱落（血管细胞粘附分子-1、细胞内粘附分子-1、P-选择素和 E-选择素），这已被证明与内皮细胞活化有关。阿米替林预处理可减少 MLEC 的炎症反应，并降低 ASM 的活性。这些数据表明，抑制 MLECs 中的 ASM 是减轻红细胞储存病变炎症反应的一种潜在策略。

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引用次数: 0

Screening Mammography Adherence Improves After Bariatric Surgery 减肥手术后坚持乳腺放射摄影筛查的情况有所改善。

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-10-18 DOI: 10.1016/j.jss.2024.09.067

Abigail Alexander MD , Noah Brown MD , Joshua John Horns PhD , Sheetal Hardikar MBBS, PhD, MPH , Mary Playdon PhD, MPH , Rupam Das MS, MBA , Nathan Driggs BS , Niraj Paudel MS , Cindy Matsen MD, MS , Anna Ibele MD

Introduction

Poor adherence to mammography screening guidelines has been reported in women with obesity. However, bariatric surgery has been associated with lower incidence of breast cancer postoperatively. The mechanisms for this protective effect are unknown. We examined the relationship between bariatric surgery and screening mammography adherence.

Methods

Using a commercial health insurance claims database, all female patients between ages 40 and 64 who underwent bariatric surgery were identified and compared to three control groups who did not undergo bariatric surgery stratified across obesity-related billing codes. Screening mammography rates were calculated as the total number of screenings divided by the total person-years of follow-up. THe screening rate was standardized to a frequency of 1 exam every 2 y based on United States Preventative Services Taskforce guidelines. We ran multivariable Poisson regression models of the rate of mammography screening, adjusting for sociodemographic factors and comorbidities.

Results

The rates of screening were 0.91 of the recommended frequency in bariatric surgery patients prior to surgery and 1.22 of the recommended frequency after surgery (P < 0.001). In multivariable models, bariatric surgery patients had a significantly lower rate of mammogram screening in the presurgical period (incidence rate ratio 0.99, 95% CI 0.98-0.99, P = 0.025) and a significantly higher rate in the postsurgical period (incidence rate ratio 1.34, 95% CI 1.32-1.35, P < 0.001) relative to the “no obesity” control group.

Conclusions

The rate of adherence to recommended mammography screening for breast cancer increased following bariatric surgery. This suggests that women with obesity may experience improved mammography screening adherence following bariatric surgery.

导言：据报道，肥胖妇女对乳房 X 射线摄影筛查指南的依从性较差。然而，减肥手术与术后乳腺癌发病率较低有关。这种保护作用的机制尚不清楚。我们研究了减肥手术与乳腺放射摄影筛查依从性之间的关系：方法：利用商业健康保险理赔数据库，确定了所有接受减肥手术的 40 至 64 岁女性患者，并将其与未接受减肥手术的三个对照组进行比较，对照组按肥胖相关账单代码进行分层。乳腺放射摄影筛查率的计算方法是筛查总数除以总随访年数。根据美国预防服务工作组指南，筛查率标准化为每 2 年检查 1 次。我们对乳腺 X 线照相筛查率进行了多变量泊松回归模型计算，并对社会人口学因素和合并症进行了调整：结果：减肥手术患者在手术前的筛查率为推荐频率的 0.91，手术后为推荐频率的 1.22（P 结论：减肥手术患者的筛查率为推荐频率的 0.91，手术后为推荐频率的 1.22：减肥手术后，乳腺癌乳腺 X 射线照相筛查推荐频率的坚持率有所提高。这表明，肥胖妇女在接受减肥手术后，乳腺 X 线照相术筛查的坚持率可能会有所提高。

{"title":"Screening Mammography Adherence Improves After Bariatric Surgery","authors":"Abigail Alexander MD , Noah Brown MD , Joshua John Horns PhD , Sheetal Hardikar MBBS, PhD, MPH , Mary Playdon PhD, MPH , Rupam Das MS, MBA , Nathan Driggs BS , Niraj Paudel MS , Cindy Matsen MD, MS , Anna Ibele MD","doi":"10.1016/j.jss.2024.09.067","DOIUrl":"10.1016/j.jss.2024.09.067","url":null,"abstract":"<div><h3>Introduction</h3><div>Poor adherence to mammography screening guidelines has been reported in women with obesity. However, bariatric surgery has been associated with lower incidence of breast cancer postoperatively. The mechanisms for this protective effect are unknown. We examined the relationship between bariatric surgery and screening mammography adherence.</div></div><div><h3>Methods</h3><div>Using a commercial health insurance claims database, all female patients between ages 40 and 64 who underwent bariatric surgery were identified and compared to three control groups who did not undergo bariatric surgery stratified across obesity-related billing codes. Screening mammography rates were calculated as the total number of screenings divided by the total person-years of follow-up. THe screening rate was standardized to a frequency of 1 exam every 2 y based on United States Preventative Services Taskforce guidelines. We ran multivariable Poisson regression models of the rate of mammography screening, adjusting for sociodemographic factors and comorbidities.</div></div><div><h3>Results</h3><div>The rates of screening were 0.91 of the recommended frequency in bariatric surgery patients prior to surgery and 1.22 of the recommended frequency after surgery (<em>P</em> < 0.001). In multivariable models, bariatric surgery patients had a significantly lower rate of mammogram screening in the presurgical period (incidence rate ratio 0.99, 95% CI 0.98-0.99, <em>P</em> = 0.025) and a significantly higher rate in the postsurgical period (incidence rate ratio 1.34, 95% CI 1.32-1.35, <em>P</em> < 0.001) relative to the “no obesity” control group.</div></div><div><h3>Conclusions</h3><div>The rate of adherence to recommended mammography screening for breast cancer increased following bariatric surgery. This suggests that women with obesity may experience improved mammography screening adherence following bariatric surgery.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 476-481"},"PeriodicalIF":1.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468434","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

Patient Neighborhood Adversity Associated With Access Not Wait Time to Parathyroidectomy 与甲状旁腺切除术就诊时间而非等待时间相关的患者周边环境不利因素。

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-10-18 DOI: 10.1016/j.jss.2024.09.029

Markayle Schears MPH , Courtney Balentine MD , Rebecca Sippel MD , David Schneider MD , Dawn Elfenbein MD , Kristin Long MD , Amy Kind MD, PHD , Alexander Chiu MD, MPH

Introduction

Delays to treatment of primary hyperparathyroidism (PHPT) escalates patient morbidity, which particularly affects individuals from under-resourced areas already facing health disparities. We hypothesized that PHPT patients from socially and economically deprived areas encounter longer waits to surgery.

Methods

Utilizing a prospectively maintained database, we identified PHPT patients aged ≥18 undergoing initial parathyroidectomy between 2013 and 2022 at an academic, tertiary care center. Patient's social and economic advantage levels were classified into deciles using the Area Deprivation Index (ADI), which accounts for 17 social determinants of health. The time from first hypercalcemic value to surgery was compared across ADI groups via linear regression, controlling for pertinent care process factors.

Results

Among 1132 patients, 68.9% were from low, 19.1% from medium, and 12.0% from high-disadvantage areas, diverging from the hospital's catchment population (55.2%, 26.6%, and 18.1%, respectively, P < 0.01). Patients from high-disadvantage areas exhibited higher comorbidity rates (55.2% versus 38.2%, P < 0.01) and were predominantly rural residents (66.2% vs. 5.8%, P < 0.01) compared to low-disadvantage areas. Similar biochemical and clinical features were shown across ADI groups. The median time from abnormal calcium to surgery was 648 d (IQR 543-753), with high-disadvantage patients experiencing a median treatment delay of 527 d, compared to 657 and 633 d for medium and low-disadvantage patients, respectively (P = 0.38). Linear regression analysis showed no association between ADI and treatment delay.

Conclusions

The high-disadvantage group underwent parathyroidectomy at lower rates than expected, but there were no significant delays in surgery among disadvantaged patients who were ultimately treated. This suggests that while social determinants may correlate to care access, they do not necessarily prolong treatment for those with established care.

导言：原发性甲状旁腺功能亢进症（PHPT）治疗的延误会增加患者的发病率，尤其会影响到那些来自资源匮乏地区、已经面临健康不平等问题的患者。我们假设，来自社会和经济贫困地区的原发性甲状旁腺功能亢进症患者等待手术的时间更长：利用前瞻性维护的数据库，我们确定了 2013 年至 2022 年期间在一家学术性三级医疗中心接受初次甲状旁腺切除术的年龄≥18 岁的 PHPT 患者。采用地区贫困指数（ADI）将患者的社会和经济优势水平划分为十等分，该指数包含 17 个健康的社会决定因素。通过线性回归比较了不同 ADI 组从首次高钙血症值到手术的时间，并控制了相关的护理过程因素：在1132名患者中，68.9%来自低度贫困地区，19.1%来自中度贫困地区，12.0%来自高度贫困地区，与医院的覆盖人群（分别为55.2%、26.6%和18.1%）存在差异：弱势人群接受甲状旁腺切除术的比例低于预期，但在最终接受治疗的弱势患者中，并没有出现明显的手术延迟现象。这表明，虽然社会决定因素可能与获得医疗服务有关，但并不一定会延长已接受治疗者的治疗时间。

{"title":"Patient Neighborhood Adversity Associated With Access Not Wait Time to Parathyroidectomy","authors":"Markayle Schears MPH , Courtney Balentine MD , Rebecca Sippel MD , David Schneider MD , Dawn Elfenbein MD , Kristin Long MD , Amy Kind MD, PHD , Alexander Chiu MD, MPH","doi":"10.1016/j.jss.2024.09.029","DOIUrl":"10.1016/j.jss.2024.09.029","url":null,"abstract":"<div><h3>Introduction</h3><div>Delays to treatment of primary hyperparathyroidism (PHPT) escalates patient morbidity, which particularly affects individuals from under-resourced areas already facing health disparities. We hypothesized that PHPT patients from socially and economically deprived areas encounter longer waits to surgery.</div></div><div><h3>Methods</h3><div>Utilizing a prospectively maintained database, we identified PHPT patients aged ≥18 undergoing initial parathyroidectomy between 2013 and 2022 at an academic, tertiary care center. Patient's social and economic advantage levels were classified into deciles using the Area Deprivation Index (ADI), which accounts for 17 social determinants of health. The time from first hypercalcemic value to surgery was compared across ADI groups via linear regression, controlling for pertinent care process factors.</div></div><div><h3>Results</h3><div>Among 1132 patients, 68.9% were from low, 19.1% from medium, and 12.0% from high-disadvantage areas, diverging from the hospital's catchment population (55.2%, 26.6%, and 18.1%, respectively, <em>P</em> < 0.01). Patients from high-disadvantage areas exhibited higher comorbidity rates (55.2% <em>versus</em> 38.2%, <em>P</em> < 0.01) and were predominantly rural residents (66.2% vs. 5.8%, <em>P</em> < 0.01) compared to low-disadvantage areas. Similar biochemical and clinical features were shown across ADI groups. The median time from abnormal calcium to surgery was 648 d (IQR 543-753), with high-disadvantage patients experiencing a median treatment delay of 527 d, compared to 657 and 633 d for medium and low-disadvantage patients, respectively (<em>P</em> = 0.38). Linear regression analysis showed no association between ADI and treatment delay.</div></div><div><h3>Conclusions</h3><div>The high-disadvantage group underwent parathyroidectomy at lower rates than expected, but there were no significant delays in surgery among disadvantaged patients who were ultimately treated. This suggests that while social determinants may correlate to care access, they do not necessarily prolong treatment for those with established care.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 439-445"},"PeriodicalIF":1.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468431","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

Are Adolescents With Chest Wall Deformity Potential Primary Spontaneous Pneumothorax Patients? 有胸壁畸形的青少年是潜在的原发性自发性气胸患者吗？

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-10-17 DOI: 10.1016/j.jss.2024.09.050

Busra Ozdemir Ciflik MD , Kadir Baturhan Ciflik MD , Anil Gokce MD , Suleyman Anil Akboga MD , Yucel Akkas MD

Introduction

Chest wall deformities often become apparent with growth spurts during adolescence. Alterations in the structure of the chest wall can result in the development of pulmonary bullae and blebs, which may lead to spontaneous pneumothorax. There are limited data on this subject in the literature. In this study, it is aimed to investigate the presence of bullae and bleb in patients with anterior and posterior chest wall deformities.

Methods

Computed tomography scans of adolescent idiopathic scoliosis, pectus carinatum, and pectus excavatum patients were analyzed. The presence of bullae and/or bleb (BB) was recorded as “present” or “absent.”

Results

One hundred fifty patients with chest wall deformity have been included in the study. BB has been detected in 55 (36.7%) of the patients. Surgical procedures were performed in 45 (30%) of the patients due to chest wall deformity. BB was present in 12 (26.7%) of these patients. A statistically significant difference has been found between the presence of complications and the presence of BB in surgical patients (P < 0.001). In patients who developed complications, there was a statistically significant difference between the presence of BB and the duration of chest tube follow-up (P = 0.031), as well as between the presence of BB and the length of hospitalization (P = 0.006).

Conclusions

A significant proportion (36.7%) of patients with chest wall deformity had BB. Chest wall deformities and primary spontaneous pneumothorax (PSP) may have common etiologic factors. It should be kept in mind that patients with chest wall deformities may be potential PSP patients. Medical counseling about PSP should be considered for these patients.

导言：胸壁畸形通常会随着青春期的生长发育而变得明显。胸壁结构的改变可导致肺大泡和肺出血，从而引发自发性气胸。这方面的文献资料非常有限。本研究旨在调查前胸壁和后胸壁畸形患者是否存在肺大泡和肺出血。结果研究共纳入 150 名胸壁畸形患者。55名患者（36.7%）发现了BB。45名（30%）患者因胸壁畸形而接受了手术治疗。其中 12 例（26.7%）患者存在 BB。在手术患者中，并发症的出现与 BB 的出现在统计学上存在明显差异（P < 0.001）。在出现并发症的患者中，出现 BB 与胸管随访时间（P = 0.031）以及出现 BB 与住院时间（P = 0.006）之间存在统计学意义上的显著差异。胸壁畸形和原发性自发性气胸（PSP）可能有共同的致病因素。胸壁变形患者可能是潜在的原发性自发性气胸患者，这一点应牢记在心。应考虑为这些患者提供有关 PSP 的医疗咨询。

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引用次数: 0