American Surgeon最新文献

On June 17, 1775, 250 years ago, the British Army assaulted American forces occupying Bunker Hill. Doctor and Major General Joseph Warren led the American army, both in rank and in spirit. In addition to his successful medical practice, his political activities alongside Sam and John Adams propelled him to the forefront of the Patriot movement. Treating casualties from the Boston Massacre, organizing the Boston Tea Party, and ordering Paul Revere's famous ride, Warren embodied and propelled America's independence from England. On the morning of 17 June, he asked to be placed in the center of American lines. Connecticut militia officer John Trumbull witnessed the attack, serving a short but distinguished career in the Continental Army. Pursuing his passion for painting, he trained with Benjamin West and completed a series of works that portrayed and later defined the American Revolution. His 1786 Death of General Warren, the first and arguably the greatest in his oeuvre, showcased the British Army overrunning the Americans on Bunker Hill, with Warren fatally falling to a British bullet. Relying on the contemporary realism West pioneered, Trumbull successfully captured the essence of the battle: the chaos of the moment, the courage of the participants, and the pathos of Warren's martyrdom.

IntroductionSocial media platforms, particularly X (formerly Twitter), play an influential role in professional networking and information dissemination. This study aimed to examine X usage trends among faculty in a single department of surgery at a large academic institution.MethodsFaculty X accounts were analyzed from January to June 2022. Metrics such as follower count, number of accounts followed, and post (formerly: tweets) types (original/quoted reposts) were studied. Themes of posts were categorized as personal, promotional, educational, or related to academic events/conferences. Associations between faculty rank, division, gender, and post metrics were explored using Mann-Whitney U and Kruskal-Wallis tests.ResultsOf 133 faculty members, 53 (39.85%) had X accounts, with 3 excluded due to privacy settings. A total of 3476 posts were analyzed, averaging 0-34 posts/month per faculty. Categories included professional (63%, n = 2174), educational (19%, n = 653), and personal (13%, n = 436). No significant associations were found between faculty gender/division and posting rates. However, faculty rank correlated significantly with primary post categories (P < 0.01). Associate professors, and professors posted more about academic events (2% and 1%) than instructors or assistant professors (1%). The most followed faculty actively promoted colleagues' work through reposting.ConclusionLess than half the faculty in a single department of surgery engaged with X. Those active predominantly used it for promotion, followed by education and personal use. Adoption remains limited, highlighting opportunities for growth in utilizing X for academic dissemination.

BackgroundApplication Programming Interfaces (APIs) enable seamless communication and data exchange between different software systems. In clinical research, APIs provide a powerful and efficient way to access large datasets, allowing researchers to develop reproducible workflows for data extraction and analysis.Methods and ResultsAPI calls were constructed using Python to extract data from 2 publicly available sources: NIH RePORTER and the CMS Medicare datasets. The NIH API was queried with a JSON payload to retrieve project-level funding data by year and keyword, while the CMS API was accessed via URL parameters to filter Medicare enrollment by state and year. Scripts were written to scale queries across multiple years and automate data collection, with outputs saved in CSV format for further analysis.ConclusionAPI-based data extraction is a scalable and reproducible method for accessing large clinical and research datasets. By leveraging NIH and CMS APIs, researchers can automate queries, customize filters, and retrieve longitudinal data to support health care analysis. Broader use of API workflows may enhance data accessibility and research efficiency across clinical disciplines.

Single-center retrospective studies remain a common form of surgical scholarship and often reflect careful clinical work addressing real problems. Despite this, many such studies fail to reach publication. The reason is rarely flawed data or poor execution. More often, the work does not move beyond local experience or articulate why its findings matter to surgeons outside the authors' own institution. This editorial outlines a practical framework for transforming a single-center retrospective study into a publishable article. Key elements include clarifying a focused and clinically relevant research question, defining the study population and time frame transparently, and using standardized outcomes and benchmarks to place results in context. Emphasis is placed on the unique strength of single-center studies: granular detail regarding operative decision making, technical nuance, workflow, and postoperative management that large administrative datasets and multicenter prospective studies often cannot capture. A thorough literature review establishes external validity and scope. When multiple similar retrospective series already exist, authors are encouraged to consider whether a reframed analysis or an updated PRISMA-compliant systematic review would better serve the field. Single-center retrospective studies become publishable when they offer more than results. When thoughtfully framed, they can contribute meaningfully to surgical knowledge and practice. Writing must be directed to practicing surgeons, which is the primary readership of the journal. The submission must emphasize interpretation and application rather than description alone, with a consistent focus on patient care.

Keloids represent a pathological wound-healing process distinct from normal and hypertrophic scarring and characterized by invasion beyond wound borders, associated pain and pruritis, and high recurrence rate despite multimodal treatment. Current therapeutic options aim to target the mechanisms that underlie this aberrant immunological response. Conservative management, such as pressure therapy, silicone-based modalities, and topical agents, has historically been used as the first-line treatment option often in combination with steroid injections. More invasive approaches such as surgical excision, coupled with radiation therapy or other repurposed chemotherapeutic agents, are sometimes warranted if an inadequate clinical response persists. Despite a wide range of treatment options, keloids and hypertrophic scars remain difficult to manage, and response is generally dependent on patient-specific factors, scar location, or etiology. Novel therapies, including calcium-channel blockers and mesenchymal stem cells, have accelerated development in this field of study, though further investigation is needed to elucidate the most effective and accessible application of these investigative treatments. This review aims to provide a comprehensive summary of available treatment strategies and their shortcomings, including specific recommendations on dosage and duration when available.

Hemorrhage is the leading cause of preventable death in the United States and carries a disproportionately high mortality in pediatric patients. However, the literature surrounding pediatric trauma resuscitation, specifically massive transfusion protocol (MTP), is less robust than for adults. In this review, we assess the current state of the literature surrounding pediatric MTP (pMTP). Content experts in the field of trauma and pediatric surgery developed an algorithm to be used to identify cases requiring activation pMTP until a definitive scoring system that is both reliable and validated is created.

Rejection is a routine and expected part of surgical publishing. Many manuscripts that ultimately reach publication have been declined by at least one journal, most often not because of flawed data or poor execution, but because of misalignment between the work and a journal's scope, audience, or expectations. For many authors, particularly trainees and early-career surgeons, a rejected submission is experienced as an endpoint rather than an opportunity for reassessment. For papers that eventually succeed, the outcome depends less on persistence than on how thoughtfully the manuscript is revised and repositioned. This editorial presents a practical, editor-informed approach to reworking a rejected manuscript for resubmission. Key steps include reading reviews with distance, diagnosing the structural reasons for rejection, and selecting the next journal deliberately based on mission and readership. Successful resubmission usually requires reframing rather than polishing. Authors are encouraged to revise the abstract and discussion to emphasize clinical decision making, strengthen context through comparison with existing literature, and revise the manuscript itself rather than relying on a persuasive cover letter. Attention is also given to reassessing currency, redundancy, and scholarly contribution. When similar titles already exist or recent systematic reviews address the same topic, authors should reconsider scope and identify what the work truly adds or pursue a different scholarly product altogether. When approached with judgment and clarity, rejection often serves as redirection toward a more effective and ultimately successful contribution to surgical practice.

The association between prophylactic ureteral stents (PUS) and postoperative complications was evaluated. Five electronic databases were searched to identify studies involving patients undergoing colorectal surgery (CRS) with PUS. Primary outcomes were acute kidney injury (AKI), ureteral injury (UI), urinary tract infection (UTI) and hematuria. Risk ratios (RR) and mean differences (MD) were calculated using a random-effects model. Seventeen retrospective cohort studies involving 104 162 patients were analyzed. AKI incidence was not significantly different between PUS and non-PUS (P = .06). Subgroup analysis revealed no significant increase in AKI (P = .08). UI was similar (P = .74); UTI (P < .01) and hematuria (P < .01) were significantly higher with PUS. Operative time was longer (P < .01). PUS in CRS did not significantly reduce UI or increase AKI risk but was associated with higher UTI and hematuria.

BackgroundThe low survival rate among patients with advanced thyroid cancer implies a dearth of effective treatment strategies. Research on advanced thyroid cancer has focused on targeted drugs, while neglecting the prognostic prediction for patients with advanced thyroid cancer who are undergoing surgical treatment. Consequently, further investigation into the prognostic implications of surgery for patients with advanced thyroid cancer is of great significance.MethodsThis study retrieved and screened all stage IV thyroid cancer patients between 2010 and 2020 in the SEER database, and finally included 670 patients in the study. Independent risk factors, which were used to develop a nomogram model predicting prognosis, were screened using univariate and multivariate Cox regression analyses. Furthermore, the log-rank test was used to compare differences in the Kaplan-Meier curves of overall survival (OS) and cancer-specific death (CSS) in different risk factor groups.ResultSurvival analysis was performed based on the OS and TCSS of the surgical and non-surgical groups, and the Kaplan-Meier curves were statistically significant. Cox multivariate analysis showed statistical significance in grade, T stage, surgery, and radiotherapy. When statistically significant variables were incorporated into the construction of the prediction model, the C-index of the training group was 0.857, and the areas under the ROC curve of the modeling group were 0.927, 0.925, and 0.919, respectively. The areas under the ROC curve for the validation group were 0.934, 0.937, and 0.944, respectively. The calibration curves and DCA curves showed excellent prediction effect in the prediction model.ConclusionThe prognostic prediction model established in this study demonstrated higher predictive accuracy.