Surgery最新文献

Background: Regional lymph node involvement impacts prognosis for patients with pancreatic neuroendocrine tumors and may influence management decisions for small tumors. Conventional cross-sectional imaging modalities have low sensitivity in detecting regional lymph node metastases, but the diagnostic performance of somatostatin receptor positron emission tomography for this is unknown.

Methods: Patients with pancreatic neuroendocrine tumors who underwent preoperative gallium 68 DOTATATE positron emission tomography followed by resection with lymphadenectomy from 2017 to 2022 were reviewed. Preoperative gallium 68 DOTATATE positron emission tomography was retrospectively reviewed by radiologists. The presence of suspicious regional lymph nodes was correlated with pathologic reports to determine diagnostic accuracy.

Results: Among 130 patients who met inclusion criteria, DOTATATE positron emission tomography detected suspicious lymph nodes in 24%, whereas pathologic evaluation demonstrated lymph node involvement in 42%. Overall, sensitivity was 46% and specificity was 92%, with a positive predictive value of 81% and negative predictive value of 29%. Among patients with lymph node involvement confirmed on pathologic review, 92% of patients with true-positive results had a Krenning score of 4 compared with 59% of patients with false-negative results (P = .013), and 58% of patients with true-positive results had lymph nodes >1 cm on preoperative cross-sectional imaging compared with 8.7% of patients with false-negative results (P < .001).

Conclusion: Gallium 68 DOTATATE positron emission tomography has limited sensitivity but high specificity for preoperative diagnosis of regional pancreatic neuroendocrine tumor lymph node metastases. Detection rate improves with higher Krenning score and larger lymph node size. This study has important implications for preoperative planning, particularly for patients with small tumors who may be candidates for either observation or resection.

Background: The early progression of burn wounds poses a significant clinical challenge. Although inflammatory cell death is thought to be involved, the role of the newly discovered integrated cell death pathway PANoptosis in burn injuries has not yet been studied. Baicalin is a natural compound with anti-inflammatory properties and has therapeutic potential, but its impact on burn progression and PANoptosis is unknown.

Methods: A rat comb burn model was established. PANoptosis activation was assessed in the zone of stasis via Western blot, immunohistochemistry, and immunofluorescence for key markers (ZBP1, pMLKL, cleaved GSDMD, cleaved caspase-3, and ASC). In the intervention study, baicalin (100 mg/kg) or vehicle was administered for 7 days. PANoptosis markers, inflammatory cytokines (interleukin 1β, interleukin 6, interleukin 18, tumor necrosis factor α), myeloperoxidase activity, and histopathologic wound progression were evaluated.

Results: Burn injury induced time-dependent PANoptosis activation, characterized by coordinated upregulation of ZBP1, pMLKL, cleaved GSDMD, and cleaved caspase-3. Immunofluorescence confirmed PANoptosome assembly via ASC/cleaved caspase-3 colocalization. Baicalin treatment significantly suppressed all 3 PANoptosis executers, disrupted complex formation, reduced proinflammatory cytokines, and myeloperoxidase activity. Importantly, baicalin treatment significantly reduced the progression of burn wounds at day 7, as evidenced by diminished tissue necrosis and improved tissue architecture.

Conclusion: Our study identifies PANoptosis as a novel pathogenic mechanism contributing to burn wound progression. We further demonstrate that baicalin is an effective therapeutic agent that alleviates tissue damage possibly by inhibiting the PANoptosis pathway and its associated inflammatory cascade. These findings provide a new mechanistic understanding and highlight the therapeutic potential of baicalin for preventing burn wound deepening.

Background: Symptomatic recurrence after hiatal hernia repair poses several challenges, particularly as surgical options are limited. The use of mesh during hiatal hernia repair is controversial, as it is associated with long-term complications and a higher morbidity rate in case of redo surgery. Nevertheless, proponents of this technique argue that its use might reduce the risk of recurrence.

Methods: A retrospective analysis of hiatal hernia repair from 2011 to 2022 performed at our clinic was conducted. All hiatus defects were closed using barbed nonresorbable sutures without mesh. Univariate and multivariate logistic regression analyzed patient and operative characteristics for associations with early symptomatic recurrence in patients with ≥12-month follow-up. Early symptomatic recurrence was defined as redo surgery within 1-year post-primary repair. Kaplan-Meier estimator and log-rank test assessed cumulative recurrence rate.

Results: Of 1,226 patients with hiatal hernia repair, 74.1% (n = 908) were female, median age was 65 years (interquartile range 54, 72), and median body mass index was 28 kg/m² (interquartile range 25, 33). Of repairs, 99.6% (n = 1,221) were laparoscopic and 14.4% (n = 177) were redo surgery, of which 43 had a previous mesh placement. Reoperation and mortality rates at 30 days were 2.6% (n = 32) and 0.1% (n = 1), respectively. Median follow-up was 12 months (interquartile range 1, 44). Symptomatic recurrences requiring reoperation were observed in 47 (3.8%) cases. In the univariate and multivariate logistic regression of 610 patients with ≥12-month follow-up, 2.5% (n = 15) experienced symptomatic recurrences. Open repair (odds ratio 5.37, P = .008) and redo surgery with previous mesh (odds ratio 7.69, P = .013) were independent risk factors for early recurrence with an area under the curve of 0.64. The cumulative recurrence rate at 1 year was significantly impacted by mesh use in previous repair (7.3%) compared with no mesh (2.9%) or no previous repair (1.4%) (P = .024).

Conclusion: Barbed nonresorbable suture closure during hiatal hernia repair is safe and effective in the short term. Open repair and redo surgery with previous mesh placement were associated with higher 1-year recurrence rates, underscoring the need for careful consideration in surgical planning.

Background: High-fidelity trauma simulation offers a unique opportunity to improve teamwork, communication, and crisis management in the operating room. Beyond technical skill acquisition, such simulations may foster interprofessional respect, self-reflection, and systems-level quality improvement awareness.

Methods: A post-simulation survey was completed by 90 participants following 2 high-fidelity trauma surgery scenarios conducted in a simulated operating room at an academic level 1 trauma center. Respondents included surgeons, surgical residents, anesthesiologists, circulating nurses, and scrub technicians from 8 institutions. Confidence in communication, teamwork, and role appreciation were measured using 5-point Likert scales and analyzed with paired-samples t tests and repeated-measures analysis of variance. Qualitative and quantitative items assessed perceived impact on communication practices and opportunities for process improvement.

Results: Confidence in communication improved from 3.67 ± 0.97 at baseline to 4.15 ± 0.81 after scenario 1 and 4.51 ± 0.61 after scenario 2 (P < .001 for all paired comparisons). Eighty-eight percent reported that participation in the simulation influenced how they would communicate in the operating room in the future, with the most common intended changes including enhanced name recognition (70%), closed-loop communication (70%), active listening (67%), and more frequent updates on patient status (47%). Participants emphasized the value of simulation as a quality-improvement tool, citing increased awareness of latent system issues, and the importance of interdisciplinary readiness. Perceived role importance increased most for circulating nurses (59%), anesthesiologists (49%), and scrub technicians (48%).

Conclusion: High-fidelity trauma simulation improved communication, strengthened teamwork, and promoted a culture of reflection and quality improvement across operating room disciplines. These findings support routine integration of immersive simulation into surgical and interprofessional training.