American journal of surgery最新文献

Background: Breast atypia increases overall breast cancer risk, potentially necessitating future interventions. This study examines the frequency and outcomes of additional percutaneous biopsies after an atypia diagnosis.

Methods: Adult patients with breast atypia (atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ) at a single institution were reviewed for subsequent core needle biopsies (CNBs) and corresponding malignant outcomes.

Results: Among 432 patients, median age at diagnosis was 54.8 ​y. Seventy-one (71/432, 16.4 ​%) patients developed a breast malignancy. During a median follow-up of 7.4 ​y, 113 patients underwent 149 additional CNBs. Twenty-six patients (26/113, 23.0 ​%) had >2 additional CNBs. Approximately half (79/149, 53.0 ​%) of all additional CNBs occurred within 5 years after breast atypia diagnosis.

Conclusion: A considerable number of patients with breast atypia undergo additional percutaneous biopsies, especially within 5 years post-atypia diagnosis. Our study highlights the significant burden of surveillance and the need for tailored follow-up strategies.

Objective: Breast cancer (BC) is the leading cause of female cancer death in the world and the second leading cause of female cancer death in the U.S, Mortality from breast cancer is even higher in individuals with schizophrenia. The aim of our project was to evaluate the incidence of breast cancer in women with schizophrenia and to compare outcomes between breast cancer patients who were or were not on antipsychotics prior to diagnosis.

Methods: This retrospective study used data from the TriNetX database. Women ≥18 years old diagnosed with schizophrenia were identified. The incidence of primary BC diagnosis between January 2011 and December 2023 was evaluated and stratified by ethnicity. We then conducted a retrospective cohort study to compare outcomes of women ≥18 years who did or did not use antipsychotics one year before BC diagnosis. Patients' propensity score was matched based on age, obesity, tobacco use, socioeconomic status, cancer stage, chemoradiation, axillary lymph node dissection (ALND), sentinel lymph node biopsy (SLNB), and hormone therapy use. Outcomes of interest were 5-year overall survival, recurrence, chemotherapy need, and lymphedema.

Results: 1,398,475 women ≥18 years old with schizophrenia were identified. Breast cancer incidence in these patients was 0.53 ​% in 2011 and 0.53 ​% in 2022, with a peak in 2017 (1.29 ​%). Non-Hispanic patients were diagnosed with BC approximately 1.3 times more than Hispanic patients. The outcomes study included 183,062 matched patients, with 91,531 per cohort. 5-year survival with the Kaplan-Meier analysis was significantly greater in women not on antipsychotics (72 ​%) compared to those on antipsychotics (60 ​%), log-rank test p-value <0.0001. The risk of local recurrence (13.4 ​% versus 22.6 ​%, p-value <0.0001), chemotherapy need (41.2 ​% versus 48.4 ​%, p-value <0.0001), and lymphedema (7.7 ​% versus 11.5 ​%, p-value <0.0001) were also significantly lower in women who did not take antipsychotics.

Conclusion: Breast cancer incidence in patients with schizophrenia identified through TriNetX has not experienced a significant uptrend or downtrend over the past decade. Non-Hispanic patients with schizophrenia have a higher incidence of BC than Hispanic patients. Matched breast cancer patients on antipsychotics at least one year prior to diagnosis had higher mortality, recurrence, chemotherapy need, and risk of lymphedema.

Background: Transplantation is a rapidly evolving field, reflecting advances in medical science and changing healthcare needs. This study aims to elucidate shifts in research focus over a decade, providing insights into emerging trends in transplant research.

Methods: We conducted a comprehensive analysis of 9,250 articles published in five high-impact transplant journals from 2012 to 2021. Article titles were processed to extract keywords using R Studio (v. 4.3.0). STATA 18 was used for t-tests and logistic regressions, with significance set at p ​< ​0.05.

Results: Emerging topics over the decade included outcomes and survival, surgical innovations, and lung transplantation. There was a downward trend in research on immunosuppression, genetics, and immunology. Over the decade, the odds of women's first authorship were higher for subjects such as public health, pediatric transplantation, infectious diseases, renal transplantation, and psychological aspects. Similarly, there were lower odds for women as first authors on surgical innovations, organ preservation, living donor transplantation, liver and lung transplantation, and multiorgan transplantation. Senior women authors had higher odds of publishing on the same topics as first author, plus immunology, kidney and heart transplantation. There were lower odds that a woman would be last author of regenerative medicine and xenotransplantation. Over the decade, there were higher odds of funding for research published on xenotransplantation, regenerative medicine, and immunology. Living donor, infectious diseases, and liver transplantation had lower odds of being funded over time.

Conclusion: This cross-sectional study highlights the dynamic nature of transplant research, underscoring the importance of continuous observation of trends to anticipate future directions and needs in the field. The emergence of new focal areas, especially those related to technological advancements and social issues, reflects a broader trend in medical research responding to evolving challenges and opportunities. Notably, women's authorship was more prevalent in public health but less in surgical innovation. These insights can guide future research priorities, funding allocation, and clinical practices in transplantation.

Background: This study investigated the outcomes before and after initiation of a postoperative care pathway for carotid endarterectomy (CEA) patients.

Methods: A CEA pathway was developed with stakeholders. We compared in-hospital outcomes and charges (USD) for patients undergoing CEA 18 months before (11/2019-04/2021) vs. after (05/2021-11/2022) implementation.

Results: 149 patients (mean age 70.2 ​± ​10.9 years, 60.4 ​% male, 75.7 ​% white) underwent CEA (83 pre-initiative, 66 post-initiative). There was significant reduction in intensive care unit (ICU) care (90.4 ​% vs.46.2 ​%; P ​< ​0.001) but no changes in stroke (3.6 ​% vs. 0 ​%), death (0 ​% vs. 0 ​%), or median length-of stay (1.0 vs. 1.0 days) following implementation (all, P ​> ​0.12). After risk adjustment, the pathway was associated with charge reductions of $1631/patient/day (95%CI -$3,008, -$254).

Conclusions: Initiation of a CEA pathway was associated with lower ICU rates and reduction in hospital charges without compromising patient outcomes.

Background: Through online health portals, patients receive complex medical reports without interpretation from their healthcare provider. This study evaluated the usability of MedEd, a patient engagement tool providing definitions of medical terminology in breast pathology and radiology reports.

Methods: Individuals who underwent a normal screening mammogram were invited to complete semi-structured interviews where they downloaded MedEd and discussed their download experience. Acceptability, appropriateness, and feasibility of MedEd were evaluated.

Results: 143 individuals were invited to participate, and 14 semi-structured interviews were completed. Participants reported ease of downloading and navigating MedEd with concerns about privacy and others' abilities to download. Participants demonstrated high acceptability (mean 4.48/5, SD 0.95), appropriateness (mean 4.66/5, SD 0.83), and feasibility (mean 4.48/5, SD 1.04) scores.

Conclusion: Participants expressed excitement for future use of MedEd and provided suggestions for improvements. Next steps include evaluating comprehension of real breast reports while using MedEd and expanding patient access.