首页期刊导航|The Journal of surgical research.
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The Journal of surgical research.
Academic Press
The Journal of surgical research.

Academic Press

0022-4804

The Journal of surgical research./Journal The Journal of surgical research.
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    Identifying Causative Microorganisms in Left Ventricular Assist Device Infections as a Guide for Developing Bacteriophage Therapy

    Kamat, IshanLamba, HarveenHines-Munson, CaseyHudson, Samuel...
    9页
    查看更多>>摘要：Background: As more left ventricular-assist devices (LVADs) are implanted, multidrugresistant LVAD infections are becoming increasingly common, partly due to bacterial biofilm production. To aid in developing bacteriophage therapy for LVAD infections, we have identified the most common bacterial pathogens that cause LVAD driveline infections (DLIs) in our heart transplant referral center. Materials and methods: We studied a retrospective cohort of patients who received LVADs from November 2003 to August 2017 to identify the common causative organisms of LVAD infection. We also studied a prospective cohort of patients diagnosed with DLIs from October 2018 to May 2019 to collect bacterial strains from DLIs for developing bacteriophages to lyse causative pathogens. LVAD infections were classified as DLI, bacteremia, and pump/device infections in the retrospective cohort. Results: In the retrospective cohort of 582 patients, 186 (32.0%) developed an LVAD infection, with 372 microbial isolates identified. In the prospective cohort, 96 bacterial strains were isolated from 54 DLIs. The microorganisms causing DLIs were similar in the two cohorts; the most common isolate was Staphylococcus aureus. We identified 6 prospective S. aureus strains capable of biofilm formation. We developed 3 bacteriophages that were able to lyse 5 of 6 of the biofilm-forming S. aureus strains. Conclusions: Similar pathogens caused LVAD DLIs in our retrospective and prospective co- horts, indicating our bacterial strain bank will be representative of future DLIs. Our banked bacterial strains will be useful in developing phage cocktails that can lyse >= 80% of the bac- teria causing LVAD infections at our institution. Published by Elsevier Inc.
      原文链接:
    • NSTL
    • Elsevier

    All Politics Are Local: A Single Institution Investigation of the Educational Impact of Residents and Fellows Working Together

    Selby, Luke V.Woelfel, Ingrid A.Eskander, MariamChen, Xiaodong...
    9页
    查看更多>>摘要：Background: Most general surgery residents pursue fellowship; there is limited understanding of the impact residents and fellows have on each other's education. The goal of this exploratory survey was to identify these impacts. Materials and Methods: Surgical residents and fellows at a single academic institution were surveyed regarding areas (OR assignments, the educational focus of the team, roles and responsibilities on the team, interpersonal communication, call, "other") hypothesized to be impacted by other learners. Impact was defined as "something that persistently affects the clinical learning environment and a trainee's education or ability to perform their job". Narrative responses were reviewed until dominant themes were identified. Results: Twenty-three residents (23/45, 51%) and 12 fellows (12/21, 57%) responded. Responses were well distributed among resident year (PGY-1:17% [4/23], PGY-2, 35% [8/23], PGY-3 26% [6/23], PGY-4 9% [2/23%], PGY-5 13% [3/23]). Most residents reported OR assignment (14/23, 61%) as the area of primary impact, fellows broadly reported organizational categories (Roles and responsibilities 33%, educational focus 16%, interpersonal communication 16%). Senior residents reported missing out on operations to fellows while junior residents reported positive impacts of operating directly with fellows. Residents of all levels reported that fellows positively contributed to their education. Fellows, senior residents, and junior residents reported positive experiences when residents and fellows operated together as primary surgeon and assistant. Conclusions: Residents and fellows impact one another's education both positively and negatively. Case allocation concerns senior residents, operating together may alleviate this, providing a positive experience for all trainees. Defining a unique educational role for fellows and delineating team expectations may maximize the positive impacts in this relationship. (C) 2021 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    The Windlass Tourniquet: Is It Taking the Wind Out of the "Stop the Bleed" Sails?

    Schlanser, Victoria L.Tatebe, Leah C.Karalius, Vytas P.Liesen, Erik...
    7页
    查看更多>>摘要：Background: Civilians are often first-line responders in hemorrhage control; however, wind-lass tourniquets are not intuitive. Untrained users reading enclosed instructions failed in 38.2% of tourniquet applications. This prospective follow-up study replicated testing following Stop the Bleed (STB) training. Materials and Methods: One and six months following STB, first-year medical students were randomly assigned a windlass tourniquet with enclosed instructions. Each was given one minute to read instructions and two minutes to apply the windlass tourniquet on the TraumaFX HEMO trainer. Demographics, time to read instructions and stop bleeding, blood loss, and simulation success were analyzed. Results: 100 students received STB training. 31 and 34 students completed tourniquet testing at one month and six months, respectively. At both intervals, 38% of students were unable to control hemorrhage (P = 0.97). When compared to the pilot study without STB training (median 48 sec, IQR 33-60 sec), the time taken to read the instructions was shorter one month following STB (P < 0.001), but there was no difference at 6 months (P = 0.1). Incorrect placement was noted for 19.4% and 23.5% of attempts at 1 and 6 months. Male participants were more successful in effective placement at one month (93.3% versus 31.3%, P = 0.004) and at six months (77.8% versus 43.8%, p = 0.04). Conclusions: Skills decay for tourniquet application was observed between 1 and 6 months following STB. Instruction review and STB produced the same hemorrhage control rates as reading enclosed instructions without prior training. Training efforts must continue; but an intuitive tourniquet relying less on mechanical advantage is needed. (C) 2021 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Variations in Discharge Destination Following Severe TBI across the United States

    Stanley, Samuel P.Truong, Evelyn I.DeMario, Belinda S.Ladhani, Husayn A....
    8页
    查看更多>>摘要：Background: Discharge destination after traumatic brain injury (TBI) may be influenced by non-patient factors such as regional or institutional practice patterns. We hypothesized that non-patient factors would be associated with discharge destination in severe TBI patients. Methods: All patients in the ACS Trauma Quality Improvement Program 2016 data set with severe TBI, defined as head Abbreviated Injury Scale >= 3, were categorized by discharge destination. Logistic regression was used to assess factors associated with each destination; odds ratios and 95% confidence level are reported. Regressions were adjusted for age, gender, race, insurance, GCS, ISS, polytrauma, mechanism, neurosurgical procedure, geographic region, teaching status, trauma center level, hospital size, and neurosurgeon group size. Results: 75,690 patients met inclusion criteria. 51% were discharged to home, 16% to rehab, 14% to SNF, and 11% deceased. Mortality was similar across geographic region, teaching status, and hospital size. Southern patients were more likely to be discharged to home while Northeastern patients were more likely to be discharged to rehab. Treatment by groups of 3 or more neurosurgeons was associated with SNF discharge as was treatment at community or non-teaching hospitals. Patients treated at larger hospitals were less likely to be discharged to rehab and more likely to go to SNF. Conclusions: Geographic region, neurosurgeon group size, teaching status, and hospital size are significantly associated with variation in discharge destination following severe TBI. Regional and institutional variation in practice patterns may play important roles in recovery for some patients with severe TBI. (C) 2021 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Vision-based Tracking of Surgical Motion during Live Open-Heart Surgery

    Stenmark, MajOmerbasic, EdinMagnusson, MansAndersson, Viktor...
    11页
    查看更多>>摘要：Background: Motion tracking during live surgeries may be used to assess surgeons' intraoperative performance, provide feedback, and predict outcome. Current assessment protocols rely on human observations, controlled laboratory settings, or tracking technologies not suitable for live operating theatres. In this study, a novel method for motion tracking of live open-heart surgery was developed, and evaluated. Materials and methods: Three-D-printed 'tracking die' with miniature markers were fitted to DeBakey forceps. The surgical field was recorded with a video camera mounted above the operating table. Software was developed for tracking the die from the recordings. The system was tested on five open-heart procedures. Surgeons were asked to report subjective system related concerns during live surgery and assess the weight of the die on blind test. The accuracy of the system was evaluated against ground truth generated by a robot. Results: The 3D-printed die weighed 6 g and tolerated sterilization with hydrogen peroxide, which added approximately 13% to the mass of the forceps. Surgeons sensed a shift in the balance of the instrument but could on blind test not correctly verify changes in weight. When two or more markers were detected, the 3D position estimate was on average within 2-3 mm, and 1.1-2.6 degrees from ground truth. Computational time was 30-50 ms per frame on a standard laptop. Conclusions: The vision-based motion tracking system was applicable for live surgeries with negligible inconvenience to the surgeons. Motion data was extracted with acceptable accuracy and speed at low computational cost. (C) 2021 The Authors. Published by Elsevier Inc.
      原文链接:
    • NSTL
    • Elsevier

    Influence of Race, Insurance, and Rurality on Equity of Breast Cancer Care

    Markey, ChadWeiss, Julie E.Loehrer, Andrew P.
    8页
    查看更多>>摘要：Background: Considerable gaps in knowledge remain regarding the intersectionality between race, insurance status, rurality, and community-level socioeconomic status that contribute in concert to disparities in breast cancer care delivery. Methods: Women age 18-64 y old with either private, Medicaid, or no insurance coverage and a diagnosis of breast cancer from the North Carolina Central Cancer Registry (20102015) were identified and reviewed. Logistic regression models examined the impact of race, insurance status, rurality, and the Social Deprivation Index (SDI) on advanced stage disease at diagnosis (III, IV) and receipt of cancer directed surgery (CDS). Models tested two-way interactions between race, insurance status, rurality, and SDI. Results: Of the study population (n = 23,529), 14.6% were diagnosed with advanced stage disease (III, IV), and 97.1% of women with non-metastatic breast cancer (n = 22,438) received cancer directed surgery (CDS). Twenty percent of women were non-Hispanic Black (NHB), 3.0% Hispanic, 10.9% Medicaid insured, 5.9% uninsured, 20.0% of women resided in rural areas, and 20.0% resided in communities of the highest quartile SDI. NHB race, Medicaid or uninsured status, and residence in rural or socially deprived areas were associated with advanced stage breast cancer at diagnosis. NHB and Medicaid or uninsured women were significantly less likely to receive CDS. There were no statistically significant interactions found influencing stage at diagnosis or receipt of cancer directed surgery. Conclusions: In a heterogeneous population across the state of North Carolina, non-Hispanic Black race, Medicaid or uninsured status, and residence in rural or high social deprivation communities are independently associated with advanced stage breast cancer at diagnosis,
      原文链接:
    • NSTL
    • Elsevier

    Evaluating Discrimination of ACS-NSQIP Surgical Risk Calculator in Thyroidectomy Patients

    Hsiao, VivianElfenbein, Dawn M.Pitt, Susan C.Long, Kristin L....
    8页
    查看更多>>摘要：Background: The ACS-NSQIP surgical risk calculator (SRC) often guides preoperative counseling, but the rarity of complications in certain populations causes class imbalance, complicating risk prediction. We aimed to compare the performance of the ACS-NSQIP SRC to other classical machine learning algorithms trained on NSQIP data, and to demonstrate challenges and strategies in predicting such rare events. Methods: Data from the NSQIP thyroidectomy module ys 2016 - 2018 were used to train logistic regression, Ridge regression and Random Forest classifiers for predicting 2 different composite outcomes of surgical risk (systemic and thyroidectomy-specific). We implemented techniques to address imbalanced class sizes and reported the area under the receiver operating characteristic (AUC) for each classifier including the ACS-NSQIP SRC, along with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) at a 5% - 15% predicted risk threshold. Results: Of 18,078 included patients, 405 (2.24%) patients suffered systemic complications and 1670 (9.24%) thyroidectomy-specific complications. Logistic regression performed best for predicting systemic complication risk (AUC 0.723 [0.658 - 0.778]); Random Forest with RUSBoost performed best for predicting thyroidectomy-specific complication risk (0.702; 0.674 - 0.726). The addition of optimizations for class imbalance improved performance for all classifiers. Conclusions: Complications are rare after thyroidectomy even when considered as composite outcomes, and class imbalance poses a challenge in surgical risk prediction. Using the SRC as a classifier where intervention occurs above a certain validated threshold, rather than citing the numeric estimates of complication risk, should be considered in low-risk patients. (C) 2021 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Is Axillary Assessment of Ductal Carcinoma In Situ of the Breast Necessary in All Cases?

    Ripoll, FranciscoAdrianzen, MarcosBermejo, BegonaBurgues, Octavio...
    9页
    查看更多>>摘要：BACKGROUND: Staging of the axilla in women with ductal carcinoma in situ (DCIS) is a point of controversy. We aimed to assess whether there is a group of patients in whom axillary assessment can be avoided and whether the likelihood of underdiagnosis of infiltrating carcinoma is sufficient to justify this evaluation. MATERIALS AND METHODS: This was a multicenter, prospective, observational study of patients who were operated on between 2008 and 2018 in three Spanish hospitals, with a diagnosis by radiological or excisional biopsy of DCIS and clinically and radiologically negative axilla. RESULTS: A total of 530 patients with a preoperative diagnosis of DCIS were studied. An axillary assessment was performed in 77% of the patients. In 397 patients, selective sentinel lymph node biopsy was performed. Axillary involvement was found in 7.2% of all patients, which dropped to 2.15% if we only included DCIS diagnosed after a definitive anatomical pathology analysis. Underdiagnosis was correlated with the type of biopsy performed: the risk was 1.34 times as high if the biopsy was performed with a core needle. The risk of lymph node metastasis was higher when there was lymphovascular invasion and when mastectomy was performed. CONCLUSIONS: We propose an axilla management algorithm in patients with a preoperative diagnosis of DCIS. The patients who would benefit from sentinel lymph node biopsy would be those who are not candidates for breast-conserving surgery, those with a BIRADS 5 lesion biopsied by core-needle biopsy, and those whose definitive diagnosis is lymphovascular invasion. (C) 2021 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    PTGES3 is a Putative Prognostic Marker in Breast Cancer

    Adekeye, AdeseyeAgarwal, DivyanshNayak, AnupmaTchou, Julia...
    9页
    查看更多>>摘要：Background: The COX/prostaglandin (COX/PG) pathway plays a role in cancer pathogenesis via the production of prostaglandin E2 (PGE2). In breast cancer, the expression patterns of the COX/PG pathway enzymes involved in PGE2 synthesis are not well defined. Materials and methods: Using the Cancer Genome Atlas data, we analyzed the expression patterns of cyclooxygenases, COX1 (PTGS1) and COX2 (PTGS2), and four downstream enzymes of the COX/prostaglandin pathway - PTGS3 (PTGDS), PTGES1, PTGES2 and PTGES3 - in invasive breast cancer. The Clinical Proteomic Tumor Analysis Consortium database was used to determine the expression of these six genes at the protein level. Existing single-cell RNA sequencing data were used to evaluate the expression of the six COX/PG genes in luminal and basal epithelial cells from normal breast tissues. Cox regression Kaplan-Meier adjusted survival analyses were performed to evaluate the association of COX/PG pathway genes in overall survival using the TCGA data. Finally, we utilized the Tumor Immune Estimation Resource to correlate the expression of these six COX/PG genes with tumor infiltrating immune cell number. Results: COX1, COX2 and PTGES3 were significantly upregulated at the protein level in breast cancer compared to normal tissues (P < 0.005). However, only PTGES3 expression was elevated at both the mRNA and protein level in breast cancer (P = 0.0005). PTGES3 is the most highly expressed enzymes within the COX/PG pathway in both luminal and basal epithelial cells in normal breast tissues. Using Cox Regression Kaplan-Meier survival analysis, PTGES3 expression had a significant inverse prognostic association with breast cancer survival [HR 1.43, P = 0.0057]. Elevated PTGES3 expression within the tumor microenvironment significantly correlated with CD8+ T cell abundance, suggesting a possible immunomodulatory role of PTGES3 in the tumor microenvironment. Conclusions: PTGES3, a terminal synthetase in the COX/prostaglandin pathway, is a putative prognostic marker in breast cancer. (C) 2021 Published by Elsevier Inc.
      原文链接:
    • NSTL
    • Elsevier

    Sex Differences in Papillary Thyroid Cancer

    Remer, Lindsay F.Lee, Christina I.Picado, OmarLew, John I....
    8页
    查看更多>>摘要：Background: Papillary thyroid cancer (PTC) is three times more common in women than men. However, PTC in men appears to be associated with poorer outcomes than in women. This study compares the clinical presentation and pathologic features of men and women with PTC. Materials and methods: A retrospective review of prospectively collected data for patients with PTC who underwent fine needle aspiration (FNA) of a solitary thyroid nodule and thyroidectomy at a single institution was performed. Factors including age, ultrasound features, FNA results, extent of surgical operation and final histopathology were compared between male and female patients. Descriptive statistics using chi-square and t-test statistics compared outcomes by sex. Results: Of the 851 patients with PTC, 158 (19%) were men and 693 (81%) were women. Mean age and standard deviation (SD) of patients was 48 (+/- 14) years, and most were of Hispanic origin (69%). Men had a significantly higher rate of radiation exposure relative to women, respectively (8% vs. 2%, P < 0.01). There were no ultrasonographic or FNA cytologic differences among sexes. Men had more aggressive pathologic features including lymphovascular invasion (LVI) (47% vs. 34%, P < 0.01) and positive lymph nodes (LN) (36% vs. 27%, P < 0.05) compared to women. Thyroid lobectomy with isthmusectomy was more commonly performed among men compared to women (24% vs. 13%, P < 0.01). Conclusion: Men with PTC have higher rates of radiation exposure associated with more aggressive disease with LVI and LN involvement on final histopathology compared to women. Total thyroidectomy with possible central neck dissection should further be considered when counseling men with PTC. (C) 2021 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier