Journal of surgery and research最新文献

Heart transplantation is the definitive treatment for end-stage heart failure, yet the persistent scarcity of donor organs has necessitated expanded criteria for donor selection, particularly the inclusion of donors after brain death (DBD) and circulatory death (DCD). These two mechanisms of donor death result in distinct pathophysiological alterations that impact myocardial viability, inflammatory activation, and immune recognition. DBD is characterized by a catecholamine surge, hormonal collapse, and systemic inflammation, contributing to endothelial dysfunction and immunologic priming. In contrast, DCD grafts are subjected to warm ischemia and reperfusion injury, elevating the risk of primary graft dysfunction and delayed recovery. These physiological differences may differentially influence graft performance, immunologic rejection, infection risk, and long-term survival. This review presents a detailed analysis of how the cause of donor death influences clinical outcomes in heart transplantation. It explores the mechanistic underpinnings of DBD- and DCD-associated injury, assesses their impact on post-transplant complications, and evaluates emerging strategies such as ex vivo perfusion, donor-derived cell-free DNA monitoring, and gene expression profiling. Additionally, it discusses how donor physiology intersects with recipient characteristics, the selective use of heterotopic transplantation, and evolving approaches in immunosuppression and risk stratification. These insights support the development of precision-guided protocols that integrate donor and recipient profiles to optimize graft utilization and improve outcomes.

The timing of surgical intervention and prosthesis selection in mildly symptomatic aortic and mitral valve disease remain an area of clinical uncertainty. Symptom-based referral often occurs after the onset of adverse ventricular remodeling, whereas earlier surgery may improve long-term outcomes but introduces procedural risk. This article synthesized contemporary evidence to delineate optimal strategies in this intermediate-risk population. In aortic stenosis, randomized trials including RECOVERY and AVATAR demonstrate that early surgical aortic valve replacement reduces heart failure events and may improve survival. In aortic and mitral regurgitation, observational data associate early intervention, triggered by mild symptoms or subclinical ventricular dysfunction, with improved survival and preservation of cardiac function. Emerging modalities such as global longitudinal strain and natriuretic peptide biomarkers enhance risk stratification in asymptomatic individuals. Prosthesis selection is primarily informed by patient age, comorbidity burden, and anticoagulation tolerance. Mechanical valves confer superior durability and lower reoperation risk in younger patients. Bioprosthetic valves are increasingly favored in older adults due to compatibility with transcatheter valve-in-valve reintervention and avoidance of lifelong anticoagulation. Comparative cohort studies and meta-analyses suggest a survival benefit for mechanical valves up to approximately 65-to-70 years of age, beyond which the benefit diminishes due to competing mortality risks. Evidence supports timely surgical referral in mildly symptomatic patients, particularly in the presence of early imaging or biomarker evidence of ventricular dysfunction. Individualized decision-making through multidisciplinary heart team evaluation remains essential. Further investigations are warranted to define long-term prosthetic durability and the role of early surgery in valvular regurgitation.

Introduction: Bleeding is a major concern while using antithrombotic therapy. While Thromboelastography with Platelet Mapping (TEG-PM) predicts postoperative bleeding and platelet dysfunction in trauma, its utility in peripheral artery disease (PAD) remains unclear. Hence, this study aimed to evaluate whether platelet inhibition (PI) and maximum amplitude of adenosine diphosphate (MA ADP) can predict bleeding risk in PAD.

Methods: Patients with PAD undergoing lower extremity revascularization between 2021-2025 were prospectively evaluated and monitored for one year to identify bleeding events. Bleeding events were defined as clinically significant hemorrhages that required medical intervention or transfusion. Patients were stratified based on the occurrence of bleeding, and descriptive statistics characterized each group. The Mann-Whitney U test assessed differences in platelet function, while receiver operating characteristic (ROC) analysis determined the optimal TEG-PM cutoff values for predicting increased bleeding risk.

Results: A total of 234 patients were analyzed, of whom 14 (5%) experienced a bleeding event. The bleeding cohort exhibited higher platelet inhibition (94.5% vs. 24.1%; p<0.0001) and lower MA ADP (22.4 vs. 52; p<0.0001), suggesting reduced platelet aggregation and clot strength. ROC analysis revealed platelet inhibition >86.4% (AUC: 0.89, sensitivity: 71%, specificity: 92%) and MA ADP <31.9 (AUC: 0.85, sensitivity: 79%, specificity: 85%) as predictive thresholds for bleeding risk.

Conclusion: High platelet inhibition (>86.4%) and low MA ADP (<31.9%) may serve as indicators of bleeding risk in PAD patients on antiplatelets, highlighting the potential utility of TEG-PM in guiding personalized antithrombotic management.

Pressure injuries, also known as decubitus ulcers or bedsores, are a major source of preventable morbidity among individuals with impaired mobility, particularly those recovering from spinal cord injury, stroke, or traumatic brain injury. These wounds not only prolong hospital stays and increase healthcare costs but also significantly impair rehabilitation outcomes and quality of life. This paper provides a comprehensive review of the pathophysiology and risk factors underlying pressure injury development, emphasizing the unique vulnerabilities of patients with sensory loss, malnutrition, obesity, and incontinence. It synthesizes current best practices in prevention, including repositioning schedules, the use of pressure-redistributing support surfaces, moisture control, and nutritional optimization. The role of risk assessment tools such as the Braden Scale is examined alongside newer technologies like pressure mapping systems, Artificial intelligence-based prediction algorithms and biofeedback tools enhance individualization of care. Pharmacologic strategies and wound management principles, including debridement and antimicrobial use, are discussed in the context of multidisciplinary rehabilitation. Implementation challenges such as staffing constraints, variability across care settings, and financial limitations are addressed, and future directions are proposed to better integrate skin integrity metrics into functional outcome measures. Ultimately, this review advocates for a proactive, interdisciplinary approach that aligns preventive strategies with personalized care and emerging technology, positioning pressure injury prevention as a core component of high-quality, value-based medicine.

Rotator cuff injuries are prevalent and have a plethora of risk factors that play a role in both the incidence of injury and recovery from surgical repair. One of the major contributors is metabolic syndrome, which has a variety of different elements that affect the issue under discussion such as hypertension, hyperglycemia, hyperlipidemia, and obesity, which are highly prevalent in patients troubled with this injury. The purpose of this article is to critically review the information from various scientific reports on the underlying cellular and molecular mechanisms of metabolic syndrome increasing the rate of injury and delaying recovery after repair. After critical examination of the findings from many publications in this area, it can be concluded that the factors associated with the metabolic syndrome play a negative role and support the underlying thesis on prolonged recovery with poor outcome following tendon repair in the shoulder. Diabetes Mellitus with elevated insulin levels increases inflammation and cell apoptosis, decreasing healing factors post-surgery. The occurrence of hyperlipidemia and obesity can increase the deposition of xanthomas and the release of adipokines, respectively, which has been proven to delay wound healing as well as increase the risk of reinjury. Studies have also shown that patients with metabolic syndrome who have had a rotator cuff repair tend to have prolonged hospital stays, a higher incidence of reinjury, and increased instances of rehospitalization. The findings together further emphasize the negative effect of metabolic syndrome and how its actions can affect the outcome of the recovery process and lifestyle of a patient post-surgery. These findings further establish the critical consideration of such factors as a cause for incidence, reinjury/rehospitalization, and prolongation of surgical recovery.

Neuroinflammation plays a key role in the development of CNS pathologies. This event encompasses a series of mechanisms involving the immune system and its cellular and molecular components. While it is necessary to activate the innate immune system during the early response to pathogens or traumas, persistent inflammation hinders neuronal recovery and contributes to the development of long-term neuronal complications. In this way, the application of pharmacological and non-pharmacological treatments is crucial to achieving better recovery of patients. We recently observed that the application of a low frequency electromagnetic field (EMF) decreases the expression of pro-inflammatory markers in an animal model of Traumatic Brain Injury in swine. To characterize this effect in terms of individualized response of neurons and microglial cells, we performed an in vitro model of pro-inflammatory damage by treating two different cell lines with tumor necrosis factor-α and then stimulating the cells with two frequencies of EMF. Transcriptional expression of inflammatory mediators was analyzed 24 and 48 hours after. Our results showed that both cell lines are susceptible to EMF, responding to the treatment by reducing the levels of the target genes in study. These observations further support the anti-inflammatory effect of EMF in the function of neurons and microglial cells and thus enhancing the recovery following traumatic brain injury, as observed under in vivo conditions in both experimental animals and human. These findings lay the foundation and warrants further preclinical and clinical studies to determine the effective frequency and duration of EMF stimulation in the healing of brain injury.

Anesthetics and sedatives may cause long-term negative neurocognitive consequences in children. Many clinical reports on this subject have had a profound impact on the field of clinical pediatric anesthesiology. Findings from animal models suggest that early exposure to anesthesia might cause neurocognitive impairment and apoptotic cell death in the brain. Even though the findings from the experimental animals cannot be directly translated to the use of anesthesia in pediatric population due to many variable factors, parents and government regulatory bodies have become sensitive and attentive to the potential adverse effects of anesthesia in children. Multiple epidemiological investigations in human have added to the growing body of evidence showing neurological impairment and cognitive decline after early anesthetic exposure. This is supported by several outcome indicators, including validated neuropsychologic testing, educational interventions for neurodevelopmental or behavioral disorders, and academic performance or school readiness. These outcomes have been evaluated in clinical studies involving children who have been subjected to general anesthesia. The primary goal of this article is to critically review the clinical findings, perform systematic analyses of the evidence, discuss potential underlying mechanisms of neurotoxicity, the pathophysiology of anesthesia-induced developmental neurotoxicity involving mitochondria, endoplasmic reticulum, and lysosomes, and the ethical considerations of pediatric anesthesia. Although detailed well-controlled clinical studies are warranted, the evidence so far support that the potential adverse effects of surgical anesthesia to induce neurotoxicity in pediatric population are not exaggerated.

The rotator cuff is a crucial group of muscles and tendons in the shoulder complex that plays a significant role in the stabilization of the glenohumeral joint and enabling a wide range of motion. Rotator cuff tendon tears can occur due to sudden injuries or degenerative processes that develop gradually over time, whether they are partial or full thickness. These injuries are common causes of shoulder pain and functional impairment, and their complex nature highlights the essential role of the rotator cuff in shoulder function. Scar formation is a crucial aspect of the healing process initiated following a rotator cuff tendon tear, but excessive fibrous tissue development can potentially lead to stiffness, discomfort, and movement limitations. Age is a critical risk factor, with the prevalence of these tears increasing among older individuals. This comprehensive review aims to delve deeper into the anatomy and injury mechanisms of the rotator cuff. Furthermore, it will inspect the signaling pathways involved in fibrous tissue development, evaluate the various factors affecting the healing environment, and discuss proactive measures aimed at reducing excessive fibrous tissue formation. Lastly, this review identifed gaps within existing knowledge to advance methods for better management of rotator cuff tendon injuries.

Purpose: We assessed the frequency of emergency department (ED) visits by transgender individuals, examined whether these visits were related to gender transition healthcare, and identified longitudinal trends in relevant International Classification of Disease (ICD) codes.

Methods: We conducted a retrospective review of aggregated patient records using the California Office of Statewide Health Planning and Development database. ED visits from 2012-2021 that involved ICD-9(2012 to Q3 2015) or ICD-10(Q4 2015 to 2021) codes commonly associated with transgender patients were identified, examining trends in ICD code usage.

Results: We identified 393 relevant ED visits (0.0037% of all visits) in 2012, compared to 2642 visits (0.021% of all visits) in 2021. This represents a 570% increase in ED visits by transgender individuals, despite only a 22% increase in ED visits overall. Gender identity disorders were the primary reason for seeking care in 0.76% of relevant visits in 2012, compared to 3.0% in 2019. The use of diagnosis codes for "transsexualism" decreased from 93% of visits in 2012 to 52% in 2021; the use of codes for "gender identity disorder" increased from 43% of visits in 2016 to 47% in 2021.

Conclusions: This is the first attempt to assess transgender healthcare needs using a non-LGBT-specific database, providing insights for clinical and policy decision-making. The significant increase in the usage of gender-identity disorder diagnosis codes suggests that the prevalence of gender dysphoria is severely under-estimated. Better documentation practices are needed to improve care and track health and epidemiologic outcomes for transgender patients.

Objectives: Nicotine usage is known to increase postoperative complications; however, studies show that the general population believes that non-tobacco nicotine delivery devices are a safer option compared to tobacco-based nicotine products. This study evaluates postoperative complications between non-tobacco nicotine dependent and non-nicotine dependent patients for intramedullary nailing in intertrochanteric femur fractures.

Methods: Utilizing the TriNetX database, we retrospectively examined postoperative outcomes in patients aged 18 to 90 who underwent intramedullary nailing for intertrochanteric femur fractures between November 21, 2013, and November 21, 2023. Two cohorts were analyzed: Cohort A comprised nicotine-dependent patients without tobacco product usage (e.g. cigarettes or chewing tobacco) and Cohort B consisted of patients without any nicotine dependence. Propensity matching was performed for BMI, type 2 diabetes, alcohol/substance abuse, socioeconomic status, and demographic factors. Outcomes assessed included mortality, sepsis, pneumonia, revision, dehiscence, pulmonary embolism, nonunion, and deep vein thrombosis within 1 day to 6 months post-treatment.

Results: A total of 2,041 non-tobacco nicotine dependent patients were matched with 22,872 non-nicotine dependent patients. Non-tobacco nicotine dependent patients experienced higher associated risk for numerous postoperative complications compared to non-nicotine dependent patients including increased risk for mortality within 6 months postoperatively (RR 1.386, 10.7% vs 7.7%, P = 0.001), sepsis (RR 1.459, 4.4% vs 3.0%, P = 0.027), and pneumonia (RR 1.751, 5.8% vs 3.3%, P = 0.001).

Conclusions: Non-tobacco nicotine dependence increases postoperative complications for patients undergoing intramedullary nailing for intertrochanteric femur fractures. Our findings support the need for development of perioperative nicotine cessation guidelines for non-tobacco nicotine users.

Level of evidence: Level III, Prognostic.