Surgery open science最新文献

{"title":"Collagenolytic Enterococcus faecalis induces DDR1 signaling, proliferation and altered immune infiltrate in colorectal peritoneal metastases","authors":"Richard Jacobson ,&nbsp;Sean Dineen ,&nbsp;John Mullinax ,&nbsp;Ryan Martin ,&nbsp;Sidharth Mishra ,&nbsp;Michelle Maurin ,&nbsp;Ramani Soundararajan ,&nbsp;Timothy Nywening ,&nbsp;Andreas Karachristos ,&nbsp;Hariom Yadav ,&nbsp;Timothy Yeatman ,&nbsp;Jason Fleming","doi":"10.1016/j.sopen.2025.10.011","DOIUrl":"10.1016/j.sopen.2025.10.011","url":null,"abstract":"<div><h3>Background</h3><div>Intratumoral pathogens are an emerging paradigm in metastatic colorectal cancer (CRC). Overgrowth of <em>Enterococcus faecalis</em> was shown to promote local recurrence in the colon, in a fashion dependent on collagenolytic virulence factors. The role of intratumoral enterococci in metastatic CRC is presently unknown.</div></div><div><h3>Methods</h3><div>We screened resected human metastatic CRC from the liver, lungs, and peritoneal surface for intratumoral bacteria with 16 s rRNA sequencing. We probed the effects of <em>E. faecalis</em> on CRC biology in vitro<em>,</em> with a focus on collagenolysis and the putative receptor for cleaved collagen, discoidin domain receptor 1 (DDR1) in CT26 CRC cells. We used a syngeneic, orthotopic mouse model of colorectal peritoneal metastases to measure the impact of <em>E. faecalis</em> on tumor bulk and immune infiltrate.</div></div><div><h3>Results</h3><div>Resected metastatic CRC from 70 patients were screened for intratumoral bacteria. <em>Enterococcus</em> species were identified in 10/13 patients with CRC peritoneal metastases and were enriched in peritoneal compared to non-peritoneal metastases. <em>E. faecalis</em> and CRC cells demonstrated cooperative collagenolysis in a fashion dependent on the secreted virulence factors GelE and SprE<em>.</em> Bacterial-induced collagenolysis led to increased DDR1 phosphorylation and downstream effects, specifically proliferation and endocytosis of cleaved collagen. In the mouse model, cell counts indicate intratumoral <em>E. faecalis</em> altered the immune compartment of the tumor microenvironment.</div></div><div><h3>Discussion</h3><div>Collagenolytic <em>E. faecalis</em> induce DDR1 pathway activation in CRC cells, alter the immune landscape in mouse models, and are enriched in human CRC peritoneal metastases. Further work is required to determine whether eradication of intratumoral bacteria can change tumor biology.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 65-72"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145528539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Female department chairs and diversity among general surgery applicants and entering residents","authors":"Alexander L. Ren MPhil ,&nbsp;Jeff Choi MD, MSc ,&nbsp;Sherry M. Wren MD","doi":"10.1016/j.sopen.2025.10.008","DOIUrl":"10.1016/j.sopen.2025.10.008","url":null,"abstract":"<div><h3>Purpose</h3><div>Academic surgical department chairs play a critical role in guiding the missions of their departments. One understudied aspect of chairs' influence is their effect on trainee recruitment and diversity. This study explores whether the appointment of female surgical chairs is associated with an increase in the proportion of female and underrepresented-in-medicine applicants and entrants to academic general surgery residency programs.</div></div><div><h3>Method</h3><div>Academic programs in which a female chair was appointed to replace a male chair were identified. Male-led programs were identified and matched 2:1 to each female-led program based on similar geographic location and time span. Data on applicant and entrant demographics for all included programs was obtained from the Association of American Medical Colleges. A difference-in-difference analysis of applicants and entrants was performed comparing female and underrepresented-in-medicine proportions between the pre-chair appointment and post-appointment years.</div></div><div><h3>Results</h3><div>No significant changes were found in the proportions of female or underrepresented-in-medicine applicants/entrants following the appointment of a female chair.</div></div><div><h3>Conclusions</h3><div>Our study found that the appointment of new female chairs is not associated with the gender or racial/ethnic composition of residency applicants/entrants in the immediate post-appointment period. This indicates that increasing diversity among surgical trainees likely relies on the combined efforts of multiple department leaders and faculty members, as well as broader advocacy and outreach efforts in the surgical community.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 101-103"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feedback gap and strategies for handling criticism in early surgical career","authors":"Hanne Pedersen ,&nbsp;Alexander Tejera ,&nbsp;Christopher Mathieu ,&nbsp;Britt-Marie Johansson ,&nbsp;Magnus Anderberg ,&nbsp;Kristine Hagelsteen","doi":"10.1016/j.sopen.2025.11.005","DOIUrl":"10.1016/j.sopen.2025.11.005","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to explore experiences and challenges in handling feedback and criticism among early career surgeons.</div></div><div><h3>Design</h3><div>This study is part of a prospective, exploratory, longitudinal study evaluating surgical residents throughout residency. Semi-structured interviews were conducted with medical doctors applying to a locum or residency position in a surgical specialty. Analysis was performed using a cross-sectional thematic analysis.</div></div><div><h3>Setting</h3><div>Departments in general surgery, urology, and pediatric surgery at seven hospitals in Sweden.</div></div><div><h3>Participants</h3><div>Contact information to applicants interviewed for a locum or resident position at the included departments were forwarded to the research group. The research group contacted applicants for inclusion and 50 were included.</div></div><div><h3>Results</h3><div>Four themes were constructed in relation to the participants' management strategies and experiences: 1) reflection and processing of criticism, 2) emotional response to criticism, 3) cautious feedback culture, and 4) navigating criticism in a hierarchical system.</div></div><div><h3>Conclusion</h3><div>This study revealed barriers to an effective feedback culture in a pool of applicants for a residency or locum position in surgical disciplines. A culture of reluctance to give feedback was a strong and common denominator. A process of filtering feedback could possibly be a method of survival and thriving in the contemporary workplace. Suggestions and initiatives to change the feedback culture are proposed.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 81-88"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-axis versus long-axis ultrasound-guided thyroid nodule biopsy: A randomized controlled trial of diagnostic performance in Iraq","authors":"Mustafa Adnan Zaidan ,&nbsp;Hussein Ali Tawfeeq ,&nbsp;Ali Kamal Ghanim","doi":"10.1016/j.sopen.2025.11.003","DOIUrl":"10.1016/j.sopen.2025.11.003","url":null,"abstract":"<div><h3>Background</h3><div>Ultrasound guided fine needle aspiration cytology (US-FNAC) is the gold standard of evaluation of thyroid nodule. Two main approaches are available - short axis (perpendicular) and long axis (parallel), and each has theoretical clinical advantages. Evidence comparing the diagnostic performance of the two in Middle Eastern populations is limited. Objective: To compare the sensitivity, specificity, and accuracy of US-FNAC of short-axis versus long-axis in thyroid nodules with implications for patient care.</div></div><div><h3>Methods</h3><div>A prospective multi-center randomized controlled trial was performed in Pioneer Private Laboratory and Mustafa Hafez Specialized Laboratory, Baghdad, Iraq from March to December 2024. A total of 196 nodules from patients ≥18 years were randomized to undergo short-axis or long-axis US-FNAC. Cytological results by the Bethesda System were correlated with histopathology. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were the primary outcomes.</div></div><div><h3>Results</h3><div>Of 196 nodules (mean age 47.8 ± 13.5 years; 79.6 % female), patient and nodule characteristics did not differ between groups. Long-axis US-FNAC was 73.9 % sensitive, 100 % specific, 87.0 % accurate, 100 % positive predictive and 79.3 % negative predictive. Short-axis US-FNAC showed sensitivity of 76.7 %, specificity of 100 %, accuracy of 89.2 %, positive predictive value of 100 % and negative predictive value of 83.3 %. There were no differences in accuracy of diagnosis (<em>p</em> = 0.524).</div></div><div><h3>Conclusions</h3><div>Short-axis and long-axis US-FNAC offer similar diagnostic performance of thyroid nodules in Iraqi patients. Although there were no differences in accuracy between procedures, operator experience, nodule characteristics, and patient factors could be used to choose the technique that best suited the clinical situation, which would allow for flexibility in clinical practice and potential improvements in patient comfort and procedural efficiency.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 73-79"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of pylorus preservation with outcomes of pancreaticoduodenectomy across the United States","authors":"Sona Mahrokhi MD ,&nbsp;Sara Sakowitz MD ,&nbsp;Esteban Aguayo MD ,&nbsp;Melissa Justo MD ,&nbsp;Robert Kropp MD ,&nbsp;Konmal Ali BS ,&nbsp;Barzin Badiee ,&nbsp;Timothy R. Donahue MD ,&nbsp;Peyman Benharash MD","doi":"10.1016/j.sopen.2025.10.005","DOIUrl":"10.1016/j.sopen.2025.10.005","url":null,"abstract":"<div><h3>Background</h3><div>Pylorus-preserving pancreaticoduodenectomy (PPPD) was developed to improve postoperative gastrointestinal function while maintaining oncologic adequacy. However, conflicting evidence and concerns persist regarding increased delayed gastric emptying, warranting a national-level investigation.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed 40,063 adult pancreaticoduodenectomy procedures from the ACS NSQIP database (2014–2023). Patients were stratified into pylorus-preserving and non-pylorus-preserving groups. Multivariable regression models evaluated independent associations between pylorus-preserving status and clinical outcomes including infectious complications, blood transfusions, delayed gastric emptying, and length of stay.</div></div><div><h3>Results</h3><div>Of 40,063 pancreaticoduodenectomy procedures, 13,882 (34.6 %) were pylorus-preserving. PPPD was associated with lower rates of infectious complications (25.9 vs 27.5 %, <em>P</em> = 0.01) and blood transfusions (13.6 vs 16.4 %, <em>P</em> &lt; 0.001), but higher delayed gastric emptying rates (17.1 vs 16.1 %, <em>P</em> = 0.02) and shorter length of stay (7 vs 8 days, <em>P</em> = 0.01). Readmission rates were similar (17.4 vs 17.9 %, <em>P</em> = 0.16). Following risk adjustment, PPPD remained associated with reduced infectious complications (AOR 0.94, 95 % CI 0.89–0.99) and blood transfusions (AOR 0.88, 95 % CI 0.82–0.95), but increased delayed gastric emptying (AOR 1.12, 95 % CI 1.04–1.21).</div></div><div><h3>Conclusion</h3><div>Despite declining utilization over the study period, PPPD offers significant advantages in reducing infectious complications and blood transfusion requirements while shortening operative times and hospital stay. However, the trade-off of increased delayed gastric emptying requires careful consideration in surgical decision-making. These findings support individualized approach selection based on patient complexity and surgeon expertise to optimize perioperative outcomes.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 36-42"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liquid biopsies for risk stratification of intraductal papillary mucinous neoplasms","authors":"Nicolas Jorek ,&nbsp;Ingmar F. Rompen ,&nbsp;Louisa Bolm ,&nbsp;Thomas Hank ,&nbsp;Martin Loos ,&nbsp;Christoph W. Michalski ,&nbsp;Nerma Crnovrsanin","doi":"10.1016/j.sopen.2025.10.003","DOIUrl":"10.1016/j.sopen.2025.10.003","url":null,"abstract":"","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 34-35"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why Transanal Opening of Intersphincteric Space (TROPIS) is effective in high complex anal fistula?","authors":"Pankaj Garg","doi":"10.1016/j.sopen.2025.09.005","DOIUrl":"10.1016/j.sopen.2025.09.005","url":null,"abstract":"","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 11-12"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of tracheostomy timing with outcomes following traumatic brain injury","authors":"Syed Shaheer Ali ,&nbsp;Troy Coaston ,&nbsp;Konmal Ali ,&nbsp;Giselle Porter ,&nbsp;Esteban Aguayo ,&nbsp;Areti Tillou ,&nbsp;Peyman Benharash ,&nbsp;Galinos Barmparas ,&nbsp;on behalf of the Academic Trauma Research Consortium (ATRIUM)","doi":"10.1016/j.sopen.2025.10.001","DOIUrl":"10.1016/j.sopen.2025.10.001","url":null,"abstract":"<div><h3>Introduction</h3><div>The optimal timing for tracheostomy among patients with traumatic brain injury (TBI) remains controversial. Earlier tracheostomy is hypothesized to reduce sedation requirements and allow for earlier mobility. We examined the association of tracheostomy timing with clinical endpoints among a national cohort of TBI patients.</div></div><div><h3>Methods</h3><div>All adult patients (≥18 years) with TBI, defined as head abbreviated injury scale ≥3, undergoing tracheostomy were identified in the 2018 to 2021 Trauma Quality Improvement Program (TQIP) database. Patients were stratified into groups labeled <em>Early</em> (≤10 days) and <em>Delayed</em> (&gt;10 days) using the median day of tracheostomy initiation of the study cohort. Multivariable regression models were developed to assess the association between tracheostomy timing and outcomes including in-hospital mortality, pneumonia, and total ventilator days.</div></div><div><h3>Results</h3><div>Of 24,517 patients, 51.1 % underwent tracheostomy within 10 days of admission (<em>Early)</em>. Compared to <em>Delayed</em>, <em>Early</em> were more commonly younger (42 [28–59] vs 48 years [31–63]; <em>p</em> &lt; 0.001) and privately insured (42.9 vs 41.1 %, p &lt; 0.001). Following multivariable adjustment, factors associated with increased likelihood of early tracheostomy included penetrating trauma (AOR 1.53, 95 % CI 1.37–1.72; ref.: Blunt) and severe facial injury (AOR 1.55, 95 % CI 1.39–1.72.) While early tracheostomy did not alter mortality (AOR 1.10, 95 % CI 0.99–1.24), patients had reduced pneumonia (AOR 0.66, 95 % CI 0.62–0.21) and reduced ventilator days (β −7.05 days, 95 % CI -7.35- -6.75).</div></div><div><h3>Conclusion</h3><div>Early tracheostomy is associated with reduced complications without altering mortality. These findings suggest the safety and potential benefits of early tracheostomy. Further prospective studies are warranted to explore the underlying mechanisms.</div></div><div><h3>Two sentence summary</h3><div>Although the optimal timing for tracheostomy among patients with traumatic brain injury remains controversial, previous literature has shown timely tracheostomy to reduce sedation requirements and allow for earlier mobility. Our findings found early tracheostomy to be linked with reduced time on the ventilator, length of stay, and risk of complications.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 28-33"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking operative approach metrics in hepatic resection: Toward functional and precision outcomes","authors":"Tirayut Veerasatian ,&nbsp;Schawanya K. Rattanapitoon ,&nbsp;Nav La ,&nbsp;Nathkapach K. Rattanapitoon","doi":"10.1016/j.sopen.2025.11.004","DOIUrl":"10.1016/j.sopen.2025.11.004","url":null,"abstract":"","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Page 80"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"S-EMR: A first experience with stalked endoscopic mucosal resection in thick and high-risk pedunculated polyps","authors":"Mojgan Forootan ,&nbsp;Alessandro Repici ,&nbsp;Mohsen Rajabnia ,&nbsp;Ali Jahanian ,&nbsp;Mahsa Mohammadi ,&nbsp;Mohammad Reza Zali ,&nbsp;Hamidreza Bolhasani","doi":"10.1016/j.sopen.2025.07.005","DOIUrl":"10.1016/j.sopen.2025.07.005","url":null,"abstract":"<div><h3>Background</h3><div>Post-polypectomy bleeding (PPB) is a relatively common event after polypectomy of large polyps using conventional methods, and the likelihood of malignant tissue remaining remains. The aim of this study was to investigate the efficacy of stalked endoscopic mucosal resection (S-EMR) as a potential solution to PPB in large pedunculated and semi-pedunculated colonic polyps and to reduce the need for repeat endoscopic intervention and surgery for malignant polyps.</div></div><div><h3>Methods</h3><div>This prospective, single-arm, open-label study was conducted on patients in whom screening colonoscopy was indicated. All patients who were found to have pedunculated and semi-pedunculated polyps (Paris class Ip and Ips) with a thick stalk (&gt;10 mm), a polyp head ≥20 mm in size, giant polyps leading to bowel obstruction, or large polyps with JNET type 2B or type3 were included in this study. These polyps were treated with S-EMR method, instead of conventional current methods like utilizing endoloops and clips in the base of stalks: Lift-and-cut technique after formation of adequate submucosal cushion in the base of the pedicle and subsequent prophylactic cauterization of the underlying blood vessels. After the procedure, patients were monitored for vital signs and symptoms of immediate complications for 6 h post-procedure and up to 48 h after discharge.</div></div><div><h3>Results</h3><div>A total of 48 patients were included in the study. The mean age of the patients was 62.24 years and 41.6 % of them were male. Ten patients had pedunculated and 38 patients had semi-pedunculated polyps. The most common localization of polyps was sigmoid (45.8 %). After S-EMR, no patient had early or late PPB. Four large semi-pedunculated polyps were diagnosed as adenocarcinoma. All had clear margins and no signs of neoplastic submucosal invasion on histologic evaluation.</div></div><div><h3>Conclusion</h3><div>S-EMR is a safe method for removing thick-stalked, giant, high-risk, and malignant, pedunculated, and semi-pedunculated polyps. It may reduce the risk of PPB and assist in achieving clear margins in malignant polyps.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"Pages 99-103"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144781467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}