American Surgeon最新文献

The rise of England as a global empire in the Seven Years' War (1756-1763) depended on the health of the seamen in the Royal Navy. Under constant danger from combat and manning a sailing battleship in open water, their greatest risk were contagious disease and dietary deficiencies, notably scurvy. During the conflict disease and desertion resulted in nearly 100 times the deaths from direct contact with the enemy. Tasked with the treatment of grievous injuries far from land, ship's surgeons had the greater responsibility of maintaining the general health and nutrition of the crew. Reformists like James Lind, Sir Gilbert Blane, and Thomas Trotter led to improvements in nutrition, especially the general issue of antiscorbutic fruit, fruit juice, and fresh vegetables; smallpox vaccination; and improved cleanliness of clothing and berths. The better overall health of its seamen was an important factor in the Royal Navy's decisive victory over France at the Battle of Trafalgar (1805).

Background: Adolescent trauma patients (ATPs) with traumatic brain injury (TBI) are a population with challenges to standardizing treatment practices and optimizing outcomes. Adult trauma centers (ATCs) and pediatric trauma centers (PTCs) may have different care practices and outcomes for ATPs with severe TBI. Methods: A retrospective analysis was performed querying the 2020-2022 Trauma Quality Improvement Program database, observing treatments and outcomes for ATPs aged 10-19 years old with head Abbreviated Injury Scale (AIS) 3-5 and TBI diagnosis. Multivariable logistic regression (MLR) was performed for tracheostomy, neurosurgical interventions, and mortality. Results: 28,527 ATPs were included in the study. 3,744 (13%) and 24,783 (87%) were treated at PTCs and ATCs, respectively. Most patients (73%) were male and had a blunt mechanism (89%). Patients at ATCs had lower Glasgow Coma Scale scores (p<.0001), higher head AIS scores (p<.0001), and higher mortality (10% vs 6%, p<.0001). Pediatric trauma centers utilized less venous thromboembolism (VTE) prophylaxis (32% vs 15%, p<.0001), which was evident across all ages 10-19, and had fewer VTE events (p=.001). Adult trauma centers were more likely to perform intracranial pressure monitoring, tracheostomy, long-term enteral access device (LTEAD), and craniotomy (all p<0.0001). Adult trauma centers had shorter median times to tracheostomy and LTEAD. Multivariable logistic regression for tracheostomy and neurosurgical interventions were associated with ATCs, after controlling for severity of TBI and other covariates. Both tracheostomy and neurosurgical interventions were less likely in the uninsured (p<.0001). Discussion: Care for ATPs with severe TBI varies between ATCs and PTCs. Pathways are needed to optimize outcomes for all ATPs with TBI.

ObjectiveTo study the effectiveness of primary sutures after laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) in treating elderly patients with gallbladder stones and common bile duct stones.MethodsA retrospective study was conducted on 127 elderly patients with common bile duct stones who were enrolled between January 2019 and December 2023. Based on the suture method of the common bile duct, the patients were divided into the primary suture and T-tube drainage groups. The preoperative, intraoperative, and postoperative recovery rates of the 2 groups were compared and analyzed.ResultsThere were 67 and 60 patients in the primary and T-tube drainage groups, respectively. There was no statistically significant difference in the preoperative data between the 2 groups (P > 0.05). Moreover, the operation time, postoperative drainage time, first exhaust time, time to get out of bed, hospital stay, and hospital costs in the primary suture group were significantly shorter than those in the T-tube drainage group (P < 0.05). Additionally, there was no statistically significant difference in intraoperative blood loss, postoperative liver function, or total postoperative complications between the 2 groups (P > 0.05).ConclusionLC + LCBDE + primary suture is a safe and effective treatment for elderly patients with gallbladder and common bile duct stones. It may promote recovery, but further research is needed to confirm its superiority over T-tube drainage.

BackgroundCirculating tumor DNA (ctDNA) has been proposed as a surrogate for solid tumor tissue biopsies. Our study evaluated trends of clinical trials that assess the role of ctDNA in surgical oncology.MethodsThe ClinicalTrials.gov database was queried for clinical trial that evaluated the use of ctDNA in the management of patients who underwent curative resections for solid tumor malignancies. Studies were categorized based on the phase of operative care were ctDNA was assessed and further stratified based on surgical application. Descriptive statistics were utilized to describe trends of included trials.ResultsOf 382,298 clinical trials, our study identified 68 trials (2014-2021). The majority of these trials were phase 2 (82.4%) and actively recruiting (63.2%). The most commonly studied malignancies were breast (20.0%), colon (17.1%) and lung (14.3%) cancers. Majority of trials assessed ctDNA utility in preoperative prognostication (52.9%) and in postoperative adjuvant therapy candidacy (16.2%).DiscussionThere have been significant strides in the use of ctDNA in surgical oncology including preoperative prognostication, postoperative surveillance, and risk stratification for adjuvant therapy. In recognizing the dynamic landscape of clinical trials, multidisciplinary oncology teams can be better informed to anticipate the clinical implications of ctDNA within their practice.

BackgroundColorectal cancer is a leading cause of cancer-related deaths in the United States Hesitancy toward colonoscopy and long wait times have led to increased interest in DNA stool-based testing. Access to timely colonoscopy after positive stool-based tests may be challenging, particularly for rural populations. This study aimed to evaluate the timeliness of diagnostic colonoscopies following positive stool-based tests in rural and non-rural patients.MethodsThis was an observational case-control study of patients aged ≥18 years who had a positive DNA-based stool test and underwent diagnostic colonoscopy between January 2018 and December 2023. Participants were classified as rural or non-rural based on Rural-Urban Commuting Area (RUCA) codes. The primary outcome was the number of days from a positive stool test to diagnostic colonoscopy. Statistical analyses were performed using Wilcoxon rank-sum and Pearson's Chi-squared tests.ResultsOf 1316 patients, 668 (50.8%) were from rural areas. The median time to colonoscopy was 35 days for rural patients and 37 days for non-rural patients (P = .6). There was no significant difference in follow-up times. Rural patients were more likely to undergo colonoscopy at an external facility (25% vs 3.1%, P < .001).ConclusionBoth rural and non-rural patients received timely follow-up colonoscopies after positive stool-based tests, indicating that stool-based testing is an effective and accessible method for CRC screening. This supports the continued use of stool-based DNA testing in reducing the burden on health care systems and enhancing screening accessibility for all patients.

IntroductionTraditionally peritoneal dialysis (PD) is initiated >3 weeks post-placement for tract maturation. The pandemic spurred a need for earlier initiation. We hypothesized that there is no significant difference between outcomes of early start (<2 weeks) vs standard (>2 weeks).MethodsA retrospective review was conducted between 2020 to 2022 at a safety-net hospital and included patients who received a PD catheter ("PDC"). Demographics, technique, dialysate volume, and outcomes were analyzed.Results83 patients met criteria. 47/83 (56.6%) were male, the average age was 49.9 [41-60] years, and average BMI was 30.7 [26-34.6]. Average dialysate volume was 2.13 L (±1.31). There were no significant differences in readmissions, reoperations, or catheter issues between the two groups. Patients with higher BMI and catheter-related issues were more likely to be readmitted (P = 0.0003) and undergo reoperation (P = 0.0021).ConclusionsEarly initiation of PD was not associated with significant differences in complications compared to standard start. Our study demonstrates the feasibility and safety of early PD initiation.

BackgroundRectal cancer (RC) represents approximately one-third of all colorectal cancer, and its incidence has been increasing worldwide. Nectin-4 has demonstrated oncological effects on several human cancers and has attracted attention as a novel therapeutic target molecule. However, the clinical significance and underlying mechanism in RC remain largely unknown.MethodsTo investigate the prognostic impact of Nectin-4 in localized advanced RC, we first evaluated Nectin-4 expression in 135 tissues from patients with Stage II/III RC using immunohistochemistry. Patients were then categorized into 2 groups according to Nectin-4 status. Subsequently, we evaluated the clinical impact of Nectin-4 on oncological outcomes using survival calculations and uni-/multivariate analysis. Furthermore, we performed in-vitro assays to elucidate the underlying mechanisms of Nectin-4 in cell proliferation.ResultsPatients with high Nectin-4 expression exhibited worse postoperative prognosis than those with low (OS: P = 0.002, RFS: P = 0.002). Multivariate analysis revealed that Nectin-4 expression was a significant independent prognostic factor in RC (OS: P = 0.002, RFS: P = 0.002). In addition, the Nectin-4 status stratified post-recurrence survival in patients who received chemotherapy for postoperative relapse (P = 0.023). Nectin-4 silencing by siRNA significantly inhibited RC cell proliferation, furthermore, the combination of Nectin-4 silencing and 5-FU resulted in a synergistic antitumor effect.DiscussionWe have showcased the clinical impact and biological value of Nectin-4 in RC. Our findings could provide a guidepost for further clinical trials to establish individualized treatment for RC and act as a key to opening the door to genome-based precision medicine.

BackgroundOlder adult (OA) abuse affects the health and welfare of people ages 65 and older. Although previous research has shown that OA abuse impacts their well-being, there is limited understanding of the injury profiles and outcomes for OAs with or without reported abuse. This study compared OAs who reported abuse ((+)RA) to those who did not ((-)RA), hypothesizing OAs with (+)RA have increased mortality.MethodsThe 2017-2019 Trauma Quality Improvement Program (TQIP) was queried for all OAs ages 65 and older. The primary outcome was mortality. Bivariate analyses were performed to compare OAs with (+)RA and (-)RA. Separate multivariable analyses were performed to determine if (+)RA was associated with risk of complications or mortality.ResultsOut of 937 465 OAs, 1552 (0.2%) had (+)RA. OAs with (+)RA had increased rates of gunshot wounds (5.7% vs 0.7%, P < .001) and stab wounds (1.9% vs 0.4%, P < .001) compared to (-)RA patients. (+)RA patients also had increased mortality (6.7% vs 4.2%, P < .001), hospital LOS (5 vs 5, P < .001), and more often underwent surgical interventions (19.0% vs 14.3%, P < .001). On multivariable analysis, OAs with (+)RA had an increased associated risk of complications (OR 1.41, CI 1.16-1.71, P < .001) and mortality (OR 1.35, CI 1.06-1.70, P = .012) compared to OAs with (-)RA.DiscussionThis national analysis demonstrated that OAs with (+)RA had increased rates of penetrating trauma, surgical interventions, ventilator days, and death compared to (-)RA patients. Future prospective studies are needed to ascertain if primary prevention efforts can mitigate the increased morbidity and mortality seen in this vulnerable population.

PurposeBomb blast injuries in non-combat settings have seen a surge in the last two to three decades. Third-world countries like Pakistan have been at the receiving end of these attacks. However, the extent of the damage inflicted in these regions is not fully understood due to gross underreporting. We aim to assist radiologists in identifying common abdominopelvic injuries in bomb blast victims and highlighting specific injury patterns to guide more effective management.MethodsThis was a retrospective observational study designed to analyze abdominopelvic injuries among bomb blast victims treated at our institution. Data were retrieved from the hospital's electronic health records and included demographic information (age and sex), injury classification, imaging results, treatment received, and clinical outcomes.ResultsChi-square and t-tests showed no statistically significant difference in the gender or mean age distribution between patients who underwent abdominopelvic surgery and those who did not. The most common single injury category among the patients analyzed was secondary injury, while the most common combination of injuries observed was a combination of secondary and tertiary injuries. CT was the most frequently requested first-line radiological investigation, while US was most frequently requested as a second-line modality. Injuries to the liver were the most frequently observed solid-organ injury.ConclusionEfficient practices are essential in radiology departments to manage the surge in patient numbers seen after bomb blast incidents. Our study emphasizes the role of radiology scans and details the types of abdominopelvic injury patterns observed in bomb blast victims.