Surgery open science最新文献_第3页

Thoracic surgery - An underestimated dream job? 胸外科--被低估的梦想工作？

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2024-11-23 DOI: 10.1016/j.sopen.2024.11.002

Romina Maria Roesch , Raffaella Griffo , Isabella Metelmann , Lena Brendel , Maria Ada Presotto , Katrin Welcker , Hauke Winter , Laura Valentina Klotz

Background

Thoracic surgery is an expanding surgical specialty, but a shortage of qualified and motivated thoracic surgery residents is expected. It is estimated that around 23 % of all surgical specialist jobs will be vacant by 2030. We therefore need to assess the current clinical situation and urgently improve the recruitment and training of our next generation of surgeons.

Methods

Using the online survey (Lime Survey), a questionnaire (28 questions) was created to analyze the current nationwide situation of residency in thoracic surgery. The survey was sent to all postgraduate trainees in thoracic surgery departments in Germany. The current status on residency-programs, scientific interest, the attractiveness of thoracic surgery, and the demographics of the participants were evaluated. The survey also evaluated specific ways to increase attractiveness.

The survey was conducted in collaboration with “Frauen in der Thoraxchirurgie” by the “Junges Forum der Deutschen Gesellschaft für Thoraxchirurgie”. The survey was sent to all residents and young specialists in Germany. A total of 187 participants responded.

Results

Out of 187 participants, 123 questionnaires (65.8 %) were completed. Mean age was 36.3 ± 6.9 years. 62.6 % of the participants were male. About 70 % work in an independent thoracic surgery department, while the rest is affiliated with another specialty department. 50 % have completed a doctorate in medicine.

Conclusion

The development of an objective and structured training plan could define the roles and responsibilities of the senior surgeon and the trainee, leading to improved training and, at the very least, ensuring good recruitment of junior thoracic surgeons.

背景胸外科是一个不断发展的外科专科，但预计合格且积极进取的胸外科住院医师将出现短缺。据估计，到 2030 年，大约 23% 的外科专家职位将空缺。因此，我们需要评估当前的临床状况，并紧急改进下一代外科医生的招聘和培训工作。方法利用在线调查（Lime Survey）制作了一份问卷（28 个问题），以分析当前全国胸外科住院医师的状况。调查对象为德国胸外科所有研究生学员。对住院医师培训项目的现状、科研兴趣、胸外科的吸引力以及参与者的人口统计学特征进行了评估。该调查由 "德国胸外科协会青年论坛"（Junges Forum der Deutschen Gesellschaft für Thoraxchirurgie）与 "胸外科中的女性"（Frauen in der Thoraxchirurgie）合作进行。调查问卷发送给了德国所有住院医师和年轻专家。结果在 187 名参与者中，123 人（65.8%）完成了问卷调查。平均年龄为 36.3 ± 6.9 岁。62.6%的参与者为男性。约 70% 的参与者在独立的胸外科部门工作，其余则隶属于其他专业部门。结论制定客观、结构化的培训计划可以明确资深外科医生和受训者的角色和责任，从而改善培训，至少可以确保招聘到优秀的初级胸外科医生。

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引用次数: 0

See one, teach yourself one, do one: Barriers and opportunities in self-administered training and assessment for global surgical education 看一遍，自学一遍，做一遍：全球外科教育自学培训和评估的障碍与机遇

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2024-11-16 DOI: 10.1016/j.sopen.2024.11.001

Olubunmi A. Fariyike , Jacqueline Yao , Mehdi Baqri , Peggy Liao , Catherine Mohr , George Korir , Taseer Feroze Din , Adam L. Kushner , Sherry M. Wren

Objective

We aimed to determine the most important perceived barriers to the implementation of self-administered training and assessment in surgical education according to subject matter experts. With these findings, design thinking was used to explore possible interventions and develop a theory of change for overcoming identified barriers. Specifically, implementation was focused on expanding the surgical skills of associate clinicians (ACs) in low-to-middle-income countries (LMICs).

Methods

A qualitative study with 10 field experts representing surgeons, educators, and engineers from the US, South America, and East and West Africa was conducted. Interviewees were selected through purposeful snowball sampling until thematic saturation. Semi-structured interviews were conducted over video conference or in-person. Open-ended responses were synthesized, coded, and used to identify key barriers for scaling simulation-based learning and self-administered training and assessment in low-resource settings.

Results

We identified four major barriers to widespread implementation of self-administered training and assessment: demonstration of the safety and quality of surgical care provided after self-administered training; validation of the principle of self-administered training and assessment; translation of simulation skills to surgical knowledge; and integration into existing task shifting and task sharing legal landscapes.

Discussion

Increasing surgical capacity in LMICs is an urgent need that could be expanded with carefully developed self-administered training and assessment for ACs. The implementation process will be variable depending on local culture and regulations but is dependent on an international community of local champions to first produce a common body of evidence supporting the technology's utility and then to generate local excitement for its integration into existing systems.

目的我们旨在根据学科专家的意见，确定在外科教育中实施自我管理培训和评估的最主要障碍。根据这些发现，我们采用设计思维来探索可能的干预措施，并为克服所发现的障碍制定了一套变革理论。具体来说，实施的重点是扩大中低收入国家（LMIC）准临床医师（ACs）的外科技能。研究方法对来自美国、南美、东非和西非的 10 名外科医生、教育工作者和工程师领域专家进行了定性研究。受访者是通过有目的的滚雪球式抽样选出的，直到主题饱和为止。半结构式访谈通过视频会议或面对面的方式进行。对开放式回答进行了综合、编码，并用于确定在低资源环境中推广基于模拟的学习和自我管理的培训与评估的主要障碍。结果我们确定了广泛实施自控培训和评估的四大障碍：证明自控培训后提供的外科护理的安全性和质量；验证自控培训和评估的原则；将模拟技能转化为外科知识；以及融入现有的任务转移和任务分担的法律环境中。讨论提高低收入国家和地区的外科能力是一项迫切需求，可以通过为助理医师精心设计的自控培训和评估来扩大这一需求。实施过程将因当地文化和法规而异，但有赖于由当地拥护者组成的国际团体首先提供支持该技术实用性的共同证据，然后在当地激发将该技术融入现有系统的热情。

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引用次数: 0

Management of Colorectal Cancer with Synchronous Liver Metastases: A systematic review of national and International Clinical Guidelines (CoSMIC-G) 大肠癌同步肝转移的管理：国家和国际临床指南系统回顾 (CoSMIC-G)

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2024-10-31 DOI: 10.1016/j.sopen.2024.10.009

Anthony K.C. Chan PhD FRCS, Ajith K. Siriwardena MD FRCS

Introduction

The contemporary management of patients with colorectal cancer and synchronous liver metastases is complex. This study appraises the recommendations made by national/international guidelines for the diagnosis and management of patients with synchronous liver metastases from colorectal cancer.

Methods

A systematic review of national and international guidelines published between 2011 and 2024 was carried out using PubMed, OvidSP and Guidelines International Network databases. The quality of guidelines was evaluated using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. Guidelines were assessed for the quality of advice for specific scenarios. The protocol was registered with PROSPERO (CRD42021243744).

Results

The search strategy returned ninety unique articles with 11 guidelines eligible for inclusion. Of these, one (9 %) guideline defined ‘synchronous disease’ at outset, eight (73 %) recommended neoadjuvant chemotherapy as first intervention. Seven (64 %) guidelines supported synchronous hepatic resection with colectomy. One (9 %) recommended against synchronous surgery.

Conclusions

This study demonstrates important variations between international clinical guidelines on diagnostic workup and management of synchronous liver metastases in colorectal cancer. [167 words].

导言当代结直肠癌同步肝转移患者的管理非常复杂。本研究评估了国家/国际指南对结直肠癌同步肝转移患者的诊断和管理提出的建议。方法利用PubMed、OvidSP和指南国际网络数据库对2011年至2024年间发布的国家和国际指南进行了系统性回顾。使用研究与amp; 评估指南鉴定 II (AGREE II) 工具对指南质量进行评估。对指南进行了评估，以确定针对特定情况提出的建议的质量。该方案已在 PROSPERO（CRD42021243744）上注册。其中，1 份（9%）指南从一开始就定义了 "同步疾病"，8 份（73%）指南建议将新辅助化疗作为首次干预。七份（64%）指南支持同步肝切除和结肠切除术。结论这项研究表明，国际临床指南在结直肠癌同步肝转移的诊断和管理方面存在重大差异。[167字]。

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引用次数: 0

Primary delayed gastric emptying after pylorus-resecting pancreatoduodenectomy: A matched-pair comparison of Roux-en-Y vs. Billroth-II reconstruction 幽门切除胰十二指肠术后原发性胃排空延迟：Roux-en-Y重建与Billroth-II重建的配对比较

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2024-10-31 DOI: 10.1016/j.sopen.2024.10.005

Felix O. Hofmann , Victoria S. Engelstädter , Ughur Aghamaliyev , Mathilda M. Knoblauch , Elise Pretzsch , Maximilian Weniger , Jan G. D'Haese , Bernhard W. Renz , Jens Werner , Matthias Ilmer

Background

After pylorus-resecting pancreatoduodenectomy (PrPD), delayed gastric emptying (DGE) might partially be attributed to biliary reflux. We investigated whether the incidence of primary DGE is reduced after Roux-en-Y instead of Billroth-II reconstruction.

Methods

Patients undergoing PrPD from 2016 to 2019 at a high-volume center were identified. Excluding causes of secondary DGE, we matched patients with Roux-en-Y and Billroth-II reconstruction in a 1:2 ratio and compared primary DGE.

Results

In 24 vs. 48 (Roux-en-Y vs. Billroth-II) patients, DGE (grade B/C) incidence (20.8 % vs. 18.8 %; P = 1.000), nasogastric tube requirement (median 2 vs. 2 days; P = 0.844) and time to solid food intake (7 vs. 7 days; P = 0.933) were comparable. Univariable logistic regression showed no association between DGE and Roux-en-Y reconstruction (OR 1.47; P = 0.524), in contrast to age (1.08; P = 0.030) and pancreatic biochemical leak (4.98; P = 0.007).

Conclusions

Primary DGE did not differ between Roux-en-Y and Billroth-II reconstruction after PrPD. Instead, age and postoperative pancreatic biochemical leak were associated with higher DGE risk.

背景幽门切除胰十二指肠切除术（PrPD）后，胃排空延迟（DGE）可能部分归因于胆汁反流。我们研究了 Roux-en-Y 代替 Billroth-II 重建后是否会降低原发性 DGE 的发生率。结果在24例与48例（Roux-en-Y与Billroth-II）患者中，DGE（B/C级）发生率（20.8% vs. 18.8%；P = 1.000）、鼻胃管需求（中位2天 vs. 2天；P = 0.844）和固体食物摄入时间（7天 vs. 7天；P = 0.933）相当。单变量逻辑回归显示，DGE与Roux-en-Y重建（OR 1.47；P = 0.524）之间没有关联，而与年龄（1.08；P = 0.030）和胰腺生化漏（4.98；P = 0.007）之间有关联。相反，年龄和术后胰腺生化漏与较高的 DGE 风险相关。

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引用次数: 0

Immersive collaborative virtual reality for case-based graduate student teaching in thoracic surgery: A piloting study 用于胸外科研究生病例教学的沉浸式协作虚拟现实技术：试点研究

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2024-10-30 DOI: 10.1016/j.sopen.2024.10.008

Philipp Feodorovici , Nils Sommer , Philipp Bergedieck , Philipp Lingohr , Jörg C. Kalff , Joachim Schmidt , Jan C. Arensmeyer

Background

In medical education various non-digital teaching methods are established. However, studies have proven that the immersive character of virtual reality (VR) applications positively impact the understanding of spatial relationships.

This study outlines the development and pilot testing of a novel system for collaborative, case-based VR teaching, utilizing real-time volume rendered computed tomography (CT) data of thoracic cases among graduate students.

Methods

A system was configured and deployed to provide real-time volume rendered CT data in a collaborative, multiuser VR environment. A thoracic surgery VR course was implemented into the surgical graduate curriculum, which has subsequently been evaluated with questionnaires.

Results

Seventy students assessed the curriculum through a questionnaire. Usability was rated intuitive (77.14 %) while few students (5.71 %) reported cyber sickness.

A vast majority (98.57 %) agreed VR improved their understanding of anatomy compared to traditional methods and most students found learning more effective. (88.57 %) and joy during participation was rated high (97,14 %). A majority of the students (61.43 %) believed VR could partly replace traditional methods. They supported integrating VR into preclinical (81.43 %) and clinical teaching (94.29 %) as well as taking VR courses from home (78.57 %). Most participants (90,72 %) encouraged the expansion of VR infrastructure.

Conclusion

The concept of a collaborative real-time VR-based educational program in medical graduate teaching has proven its technical feasibility and positive acceptance with a desire for more VR integration in surgical curricula. A two-armed study will be conducted to evaluate the objective impact as the expansion of VR environments for teaching continues.

背景在医学教育中，有多种非数字化教学方法。然而，研究证明，虚拟现实（VR）应用的身临其境特性对空间关系的理解有积极影响。本研究概述了一种新型系统的开发和试点测试，该系统用于协作式、基于病例的 VR 教学，利用实时容积渲染的计算机断层扫描（CT）数据对研究生进行胸外科病例教学。结果70名学生通过问卷对课程进行了评估。绝大多数学生（98.57%）认为，与传统方法相比，VR 提高了他们对解剖学的理解，大多数学生认为学习更有效（88.57%）和更快乐。(绝大多数学生（98.57%）认为，与传统方法相比，虚拟现实技术提高了他们对解剖学的理解，大多数学生认为学习更有效（88.57%），参与过程中的愉悦程度很高（97.14%）。大多数学生（61.43 %）认为 VR 可以部分取代传统方法。他们支持将虚拟现实融入临床前教学（81.43 %）和临床教学（94.29 %），以及在家学习虚拟现实课程（78.57 %）。大多数参与者（90.72%）鼓励扩大 VR 基础设施。结论医学研究生教学中基于 VR 的协作式实时教育计划的概念已证明其技术可行性，并得到了积极的认可，人们希望在外科课程中融入更多的 VR 技术。随着 VR 教学环境的不断扩展，我们将开展一项双臂研究，以评估其客观影响。

{"title":"Immersive collaborative virtual reality for case-based graduate student teaching in thoracic surgery: A piloting study","authors":"Philipp Feodorovici , Nils Sommer , Philipp Bergedieck , Philipp Lingohr , Jörg C. Kalff , Joachim Schmidt , Jan C. Arensmeyer","doi":"10.1016/j.sopen.2024.10.008","DOIUrl":"10.1016/j.sopen.2024.10.008","url":null,"abstract":"<div><h3>Background</h3><div>In medical education various non-digital teaching methods are established. However, studies have proven that the immersive character of virtual reality (VR) applications positively impact the understanding of spatial relationships.</div><div>This study outlines the development and pilot testing of a novel system for collaborative, case-based VR teaching, utilizing real-time volume rendered computed tomography (CT) data of thoracic cases among graduate students.</div></div><div><h3>Methods</h3><div>A system was configured and deployed to provide real-time volume rendered CT data in a collaborative, multiuser VR environment. A thoracic surgery VR course was implemented into the surgical graduate curriculum, which has subsequently been evaluated with questionnaires.</div></div><div><h3>Results</h3><div>Seventy students assessed the curriculum through a questionnaire. Usability was rated intuitive (77.14 %) while few students (5.71 %) reported cyber sickness.</div><div>A vast majority (98.57 %) agreed VR improved their understanding of anatomy compared to traditional methods and most students found learning more effective. (88.57 %) and joy during participation was rated high (97,14 %). A majority of the students (61.43 %) believed VR could partly replace traditional methods. They supported integrating VR into preclinical (81.43 %) and clinical teaching (94.29 %) as well as taking VR courses from home (78.57 %). Most participants (90,72 %) encouraged the expansion of VR infrastructure.</div></div><div><h3>Conclusion</h3><div>The concept of a collaborative real-time VR-based educational program in medical graduate teaching has proven its technical feasibility and positive acceptance with a desire for more VR integration in surgical curricula. A two-armed study will be conducted to evaluate the objective impact as the expansion of VR environments for teaching continues.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"22 ","pages":"Pages 40-45"},"PeriodicalIF":1.4,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Engagement and learning approaches among medical students in an online surgical teaching programme: A cross-sectional study 在线外科教学计划中医科学生的参与度和学习方法：横断面研究

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2024-10-30 DOI: 10.1016/j.sopen.2024.10.010

Sumayyah Ebrahim MMED Surgery (UKZN), MSc Epidemiology (Columbia University) , Jacqueline Marina Van Wyk PhD (UKZN)

Background

The COVID-19 pandemic prompted the transition of all teaching and learning of final-year General Surgery students to an online platform. Despite the utility of online methods, challenges exist such as a sense of impersonal learning, and poor student engagement. Student engagement with course content is important for deep learning. An Online Student Engagement Scale (OSE) and a revised Biggs Two-Factor Study Process Questionnaire (R-SPQ-2F) were used to evaluate student engagement and learning approaches respectively.

Methods

A cross-sectional study was conducted in 2021 at a South African university. The OSE and R-SPQ-2F online survey tools were administered to all final-year students (n = 325) enrolled in the surgical online module. Quantitative data was collected, and the data was analysed statistically using R-Statistical computing software. Results are presented in the form of descriptive and inferential statistics. The reliability of the tools was evaluated by Cronbach's alpha.

Results

The survey response rate was 35.4 % (115/325). Students were engaged at a high level, and the median (IQR) scores of the OSE tool were 71.0 (63.0–78.0). Overall, students adopted a deep approach (DA) to learning, with median (IQR) scores of 34.0 (30.0–39.0) on the R-SPQ-2F tool. There was a moderate positive correlation between the total OSE score and DA (0.53, p < 0.001). Both the OSE and R-SPQ-2F tools showed an acceptable level of internal consistency of 0.893 and 0.806 respectively.

Conclusions

Student engagement was associated with deep learning approaches. The OSE and R-SPQ-2F tools were reliable tools to measure student engagement and learning approaches among medical students.

背景COVID-19大流行促使普外科毕业班学生的所有教学和学习过渡到在线平台。尽管在线教学方法很有用，但也存在一些挑战，如学习缺乏人情味、学生参与度低等。学生对课程内容的参与对于深度学习非常重要。我们使用在线学生参与度量表（OSE）和修订版比格斯双因素学习过程问卷（R-SPQ-2F）来分别评估学生的参与度和学习方法。OSE和R-SPQ-2F在线调查工具的使用对象是所有参加外科在线模块学习的毕业班学生（n = 325）。收集了定量数据，并使用 R-Statistical 计算软件对数据进行了统计分析。结果以描述性和推论性统计的形式呈现。调查回复率为 35.4%（115/325）。学生的参与度很高，OSE 工具的中位数（IQR）为 71.0（63.0-78.0）。总体而言，学生采用了深度学习法（DA），R-SPQ-2F 工具的中位数（IQR）为 34.0（30.0-39.0）分。OSE 总分与 "深度学习 "之间存在中度正相关（0.53，p < 0.001）。OSE和R-SPQ-2F工具的内部一致性分别为0.893和0.806，都达到了可接受的水平。OSE和R-SPQ-2F工具是测量医学生参与度和学习方法的可靠工具。

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引用次数: 0

Gender and age specific dynamics of health-related postoperative outcome measures following the laparoscopic sleeve gastrectomy 腹腔镜袖带胃切除术后与健康相关的术后结果测量的性别和年龄特征动态变化

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2024-10-30 DOI: 10.1016/j.sopen.2024.10.007

Sevak Shahbazyan , Mushegh Mirijanyan , Zhorzheta Badalova , Zareh Ter-Avetikyan

Background

A variety of bariatric surgical techniques have been implemented to manage obesity, including the laparoscopic sleeve gastrectomy (LSG).

The aim of the study was to compare the pre and postoperative features of patients undergoing LSG, analyze the dynamics of BMI and BAROS indices and to assess the impact of body appearance concern on the postoperative outcomes.

Methods

A total of 591 participants were divided into 3 age groups (20–39, 40–59 and over 60 years of age). The Charlson Comorbidity Index was used to assess comorbidity in patient groups. The rate of complications, assessment of psychological well-being and number of hospital days for patients were used to compare the features of postoperative recovery in different age groups.

Results

In the young and middle-aged groups, the BMI reduction speed was similar, and significantly higher than in the elder group with a faster rate of BMI reduction in female participants. Higher scores of BAROS were revealed in the young and middle-aged groups for the 0–1 and 1–6 month periods. The 12-month assessment revealed much higher BAROS scores for male subgroups, compared to female participants. The BAROS scores decreased gradually in female groups within the assessment periods and was the lowest in the third assessment.

Conclusions

The pattern of BAROS reduction can be the result of lower psychological and social well-being scores in female participants who reported significant weight reduction in 6–12 month period with paradoxically decreased quality of life scores explained by the impact of body appearance concern on the postoperative outcomes.

研究目的是比较接受腹腔镜袖带胃切除术（LSG）的患者的术前和术后特征，分析 BMI 和 BAROS 指数的动态变化，并评估对身体外观的关注对术后结果的影响。研究方法将 591 名参与者分为 3 个年龄组（20-39 岁、40-59 岁和 60 岁以上）。采用夏尔森合并症指数（Charlson Comorbidity Index）评估各组患者的合并症。结果在青年组和中年组中，BMI 下降速度相似，且明显高于老年组，女性参与者的 BMI 下降速度更快。年轻组和中年组在 0-1 个月和 1-6 个月期间的 BAROS 分数较高。在 12 个月的评估中，与女性参与者相比，男性亚组的 BAROS 分数要高得多。结论 BAROS 分数降低的模式可能是女性参与者的心理和社会幸福感分数降低的结果，她们在 6 至 12 个月期间体重明显减轻，但生活质量分数却下降，这是因为对身体外观的担忧影响了术后效果。

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引用次数: 0

Rapid liver graft implantation in canine: A preliminary study 犬类快速肝脏移植手术：初步研究

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2024-10-29 DOI: 10.1016/j.sopen.2024.10.006

Jie Hao , Jia-Wei Yu , Jing-Wen Xiao , Lin-Biao Xiang , Rong Peng , Jia-Qi Quan , Ya-Xu Dong , En-Hui Li , Juan-Juan Wang , Lu Ren , Yong Wan , Hong-Ke Zhang , Yi Lv , Qiang Lu

Background

The current method for liver graft implantation during the anhepatic phase is complex. Therefore, this study aimed to introduce a modified orthotopic liver transplantation (OLT) technique with major vascular reconstruction using cuff technique to simplify the process of liver graft implantation during the anhepatic phase.

Methods

Twenty-four canines were randomly assigned to two groups: the modified orthotopic liver transplantation group (M-OLT, n = 12) and the control group (n = 12). All animals were randomly assigned to the donor or recipient groups. The recipients received orthotopic liver transplantation using a modified technique in the M-OLT group, and OLT using traditional implantation technique without venovenous bypass was performed in the control group. The donor and recipient characteristics were compared between the two groups. Vascular anastomotic patency was evaluated using angiography immediately and one week after surgery.

Results

All recipients underwent successful liver transplantation. There were no significant differences between the two groups in terms of sex, body weight, or cold ischemia time of the donor liver. However, recipients in the M-OLT group had a shorter operation time, less intraoperative blood loss, shorter anhepatic phase, shorter vascular occlusion time, and shorter warm ischemia time than that in the control group (all p < 0.05). No anastomotic leakage or stenosis was detected in either group after liver transplantation. One recipient in the M-OLT group and three in the control group died within one week of transplantation.

Conclusions

This modified technique is safe and feasible for canine liver transplantation and can significantly simplify liver graft implantation procedures during the anhepatic period.

背景目前在无肝期植入肝脏移植物的方法较为复杂。方法将 24 只犬随机分为两组：改良正位肝移植组（M-OLT，n = 12）和对照组（n = 12）。所有动物都被随机分配到供体组或受体组。在M-OLT组中，受体接受改良技术的正位肝移植；在对照组中，受体接受不经静脉旁路的传统植入技术的OLT。比较了两组供体和受体的特征。结果所有受者都成功接受了肝移植手术。两组受者在性别、体重和供肝冷缺血时间方面没有明显差异。然而，与对照组相比，M-OLT 组受者的手术时间更短、术中失血量更少、无肝期更短、血管闭塞时间更短以及热缺血时间更短（均为 p <0.05）。两组肝移植术后均未发现吻合口漏或狭窄。结论这种改良技术在犬肝移植中安全可行，可大大简化无肝期的肝移植植入手术。

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引用次数: 0

A nomogram for cancer-specific survival of lung adenocarcinoma patients: A SEER based analysis 肺腺癌患者癌症特异性生存期提名图：基于 SEER 的分析

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2024-10-18 DOI: 10.1016/j.sopen.2024.10.003

Hong Guo Doctor of Medicine (M.D.) , Guole Nie Doctor of Medicine (M.D.) , Xin Zhao Master of Medicine (M.M.) , Jialu Liu Master of Medicine (M.M.) , Kaihua Yu Master of Medicine (M.M.) , Yulan Li Doctor of Medicine (M.D.)

Background

Non-small cell lung cancer (NSCLC) accounts for 85 % of lung cancer cases. Among NSCLC subtypes, lung adenocarcinoma (LUAD) stands as the most prevalent. Regrettably, LUAD continues to exhibit a notably unfavorable overall prognosis. This study's primary aim was to develop and validate prognostic tools capable of predicting the likelihood of cancer-specific survival (CSS) in patients with LUAD.

Methods

We retrospectively collected 21,099 patients diagnosed with LUAD between 2010 and 2015, and 8290 patients diagnosed between 2004 and 2009 from SEER database. The cohort of 21,099 patients served as the prognostic group for the exploration of LUAD-related prognostic risk factors. The cohort of 8290 patients was designated for external validation. We created a training set and an internal validation set in the prognostic group for the development and internal validation of CSS nomograms. CSS predictors were identified through the least absolute shrinkage and selection operator (Lasso) regression analysis. Prognostic model was constructed via Cox hazard regression analysis, presented in the form of both static and dynamic network-based nomograms.

Results

Several independent prognostic factors were incorporated into the construction of nomogram. The nomogram accurately predicted CSS at 1, 3, and 5 years, with respective AUC values of 0.769, 0.761, and 0.748 for the training group, and 0.741, 0.752, and 0.740 for the testing group. The study demonstrated a strong agreement between anticipated and actual CSS values, supported by decision curve analysis (DCA) and time-dependent calibrated curves. High-risk patients based on the nomogram exhibiting significantly lower survival rates compared to their low-risk counterparts according to Kaplan-Meier (K-M) curves. The nomogram demonstrates excellent predictive power in the external validation cohort.

Conclusions

A dependable and user-friendly nomogram has been developed, available in both static and online dynamic calculator formats, to facilitate healthcare professionals in accurately estimating the likelihood of CSS for patients diagnosed LUAD.

背景非小细胞肺癌（NSCLC）占肺癌病例的 85%。在 NSCLC 亚型中，肺腺癌（LUAD）最为常见。令人遗憾的是，肺腺癌的总体预后仍然不容乐观。本研究的主要目的是开发并验证能够预测LUAD患者癌症特异性生存（CSS）可能性的预后工具。方法我们从SEER数据库中回顾性地收集了2010年至2015年间确诊的21099例LUAD患者，以及2004年至2009年间确诊的8290例患者。21,099例患者作为预后组，探讨与LUAD相关的预后风险因素。8290例患者队列被指定为外部验证组。我们在预后组中创建了一个训练集和一个内部验证集，用于开发和内部验证 CSS 直方图。通过最小绝对收缩和选择算子（Lasso）回归分析确定了 CSS 预测因子。通过 Cox 危险回归分析建立了预后模型，并以基于静态和动态网络的提名图形式呈现。提名图能准确预测 1、3 和 5 年后的 CSS，训练组的 AUC 值分别为 0.769、0.761 和 0.748，测试组的 AUC 值分别为 0.741、0.752 和 0.740。研究结果表明，预期 CSS 值与实际 CSS 值之间具有很高的一致性，决策曲线分析 (DCA) 和随时间变化的校准曲线也证明了这一点。根据 Kaplan-Meier (K-M) 曲线，基于提名图的高风险患者的生存率明显低于低风险患者。结论我们开发出了一种可靠且用户友好的提名图，它既有静态计算器格式，也有在线动态计算器格式，可帮助医护人员准确估计确诊为 LUAD 患者的 CSS 可能性。

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引用次数: 0

Investigation and self-assessment of liver transplantation training physicians at Shanghai Renji Hospital: A preliminary study 上海仁济医院肝移植培训医师的调查与自我评估：初步研究

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2024-10-17 DOI: 10.1016/j.sopen.2024.10.004

Xiaochen Bo, Feng Xue, Qiang Xia, Kang He

Background

Continuing medical education in liver transplantation is pivotal in enhancing the proficiency of liver surgeons. The goal of this study is to obtain information on all aspects of the training, enable us to pinpoint the training's strengths, and address any shortcomings or challenges.

Method

We conducted an online questionnaire survey, which was comprised of 33 questions, offering response options in the form of “yes/no”, single choice, or multiple choice.

Results

A total of 59 liver surgeons actively participated in the questionnaire survey. The majority of them exhibited a comprehensive understanding of the liver transplant training program, encompassing its structure, content, and assessment format. It is noteworthy that all respondents expressed keen interest in novel course components such as medical humanities, interpersonal communication, full-process patient management, and scientific research and academic activities. The overall satisfaction with the diverse specialized training courses was notably high. Furthermore, there was a significant improvement in self-confidence among participants for performing relevant clinical practices post-training, signifying the effectiveness of the program. Notably, key determinants influencing physicians' confidence levels before and after training included accumulated clinical practice time, basic operation cases, and educational background.

Conclusion

This survey reveals that trainees possess a commendable grasp of the program, maintain a positive outlook, and gain substantial benefits from the training. Importantly, it underscores the need to enhance the pedagogical skills of professional training instructors, continually refine the curriculum, and serve as a foundation for informed decisions in the ongoing training of liver transplant physicians.

背景肝移植的继续医学教育对提高肝脏外科医生的水平至关重要。本研究的目的是获取有关培训各个方面的信息，使我们能够明确培训的优势，并解决任何不足或挑战。方法我们进行了在线问卷调查，其中包括 33 个问题，回答方式有 "是/否"、单选或多选。他们中的大多数人都对肝移植培训项目有了全面的了解，包括其结构、内容和评估形式。值得注意的是，所有受访者都对医学人文、人际沟通、全程患者管理、科研和学术活动等新颖的课程内容表现出浓厚的兴趣。对各种专业培训课程的总体满意度明显较高。此外，学员们在培训后开展相关临床实践的自信心也有了显著提高，这表明该项目卓有成效。值得注意的是，影响医生培训前后自信水平的主要决定因素包括累计临床实践时间、基本操作病例和教育背景。重要的是，它强调了提高专业培训导师的教学技能、不断完善课程设置的必要性，并为肝移植医生的持续培训提供了明智决策的基础。

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引用次数: 0