首页期刊导航|The Journal of surgical research.
期刊信息/Journal information
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.
正式出版
收录年代

    Functional Characterization of Neutrophils Allows Source Control Evaluation in a Murine Sepsis Model

    Salyer, Christen E.Bergmann, Christian B.Hotchkiss, Richard S.Crisologo, Peter A....
    8页
    查看更多>>摘要：Introduction: Current surgical guidelines for the treatment of intra-abdominal sepsis recommend interventional source control as the key element of therapy, alongside resuscitation and antibiotic administration. Past trials attempted to predict the success of interventional source control to assess whether further interventional therapy is needed. However, no predictive score could be developed. Materials and methods: We utilized an established murine abdominal sepsis model, the cecal ligation and puncture (CLP), and performed a successful surgical source control interven-tion after full development of sepsis, the CLP-excision (CLP/E). We then sought to evaluate the success of the source control by characterizing circulating neutrophil phenotype and functionality 24 h postintervention. Results: We showed a significant relative increase of neutrophils and a significant absolute and relative increase of activated neutrophils in septic mice. Source control with CLP/E restored these numbers back to baseline. Moreover, main neutrophil functions, the acidi-fication of cell compartments, such as lysosomes, and the production of Tumor Necrosis Factor-alpha (TNF-a), were impaired in septic mice but restored after CLP/E intervention. Conclusions: Neutrophil characterization by phenotyping and evaluating their functionality indicates successful source control in septic mice and can serve as a prognostic tool. These findings provide a rationale for the phenotypic and functional characterization of neutro-phils in human patients with infection. Further studies will be needed to determine whether a predictive score for the assessment of successful surgical source control can be established. (c) 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    General Surgery Residents' Retention of Knowledge After an Anorectal Skills Workshop

    Ginesi, MeridithOfshteyn, AsyaBliggenstorfer, JonathanBingmer, Katherine...
    6页
    查看更多>>摘要：Introduction: Studies have demonstrated suboptimal resident exposure to anorectal pathology. A workshop was developed at an academic general surgery residency. This study assesses durability of learning from the workshop. Methods: Thirty-six residents participated in a skills laboratory addressing diagnosis and management of anorectal complaints. The skills laboratory was broken into didactic and hand-on skills stations. Residents completed pre-, post-and 6-mo after workshop assessments to evaluate knowledge and confidence. Knowledge and confidence-based scores pre-, post-and 6-mo after workshop were compared. Results: Scores demonstrated retention of information. Knowledge-based question median scores improved from 63.2% pre-workshop to 73.7% post-workshop and 76.3% at 6 mo (P = 0.0005). Median confidence scores improved from 31 pre-workshop to 40 post workshop, and were stable at 6 mo (P = 0.0001). Conclusions: Knowledge and confidence gained from an anorectal skills workshop was stable or improved at 6 mo. These results suggest that an anorectal curriculum is effective at improving general surgery resident background knowledge and confidence when managing anorectal complaints. (c) 2021 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    The Aerosolization of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): Phase I

    Ayuso, Sullivan A.Soriano, Ian S.Augenstein, Vedra A.Shao, Jenny M....
    8页
    查看更多>>摘要：Introduction: The degree to which Severe Acute Respiratory Syndrome Coronavirus 2 (SARSCoV-2) is aerosolized has yet to be determined. The aim of this study is to prove methods of detection of aerosolization of SARS-CoV-2 in hospitalized patients in anticipation of testing for aerosolization in procedural and operative settings. Methods: In this prospective study, inpatients with SARS-CoV-2 were identified. Demographic information was obtained, and a symptom questionnaire was completed. Polytetrafluoroethylene (PTFE) filters, which were attached to an air pump, were used to detect viral aerosolization and placed in four locations in each patient's room. The filters were left in the rooms for a three-hour period. Results: There were 10 patients who enrolled in the study, none of whom were vaccinated. Only two patients were more than a week from the onset of symptoms, and half of the patients received treatment for COVID with antivirals and steroids. Among ten RT-PCR positive and hospitalized patients, and four filters per patient, there was only one positive SARS-CoV-2 aerosol sample, and it was directly attached to one of the patients. Overall, there was no correlation between symptoms or symptom onset and aerosolized test result. Conclusions: The results of this suggest that there is limited aerosolization of SARS-CoV-2 and provided proof of concept for this filter sampling technique. Further studies with increased sample size should be performed in a procedural and operative setting to provide more information about SARS-CoV-2 aerosolization. (c) 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Transparent and Reproducible Research Practices in the Surgical Literature

    Niemann, AndrewTritz, DanielBoyer, KrystonRobbins, Hal...
    9页
    查看更多>>摘要：Introduction: Previous studies have established a baseline of minimal reproducibility in the social science and biomedical literature. Clinical research is especially deficient in factors of reproducibility. Surgical journals contain fewer clinical trials than non-surgical areas of medicine, suggesting that it should be easier to reproduce the outcomes of surgical litera-ture. Methods: In this study, we evaluated a broad range of indicators related to transparency and reproducibility in a random sample of 387 articles published in Surgery journals between 2014 and 2018. Results: A small minority of our sample made available their materials (5.3%, 95% C.I. 2.4%-8.2%), protocols (1.2%, 0-2.5%), data (2.5%, 0.7%-4.2%), or analysis scripts (0.04%). Four studies were adequately pre-registered. No studies were explicit replications of previous literature. Most studies (58%), declined to provide a funding statement, while conflicts of interest were declared in a small fraction (9.3%). Most have not been cited by systematic reviews (83%) or meta-analyses (87%), and most were only accessible to paying subscribers (59%). Conclusions: The transparency of the surgical literature could improve with adherence to baseline standards of reproducibility. (c) 2021 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Telemedicine During COVID-19 Pandemic: Endocrine Surgery Patient Perspective

    Jeraq, Mohammed W.Mulder, Michelle B.Kaplan, DinaLew, John I....
    11页
    查看更多>>摘要：Introduction: In response to the COVID-19 pandemic, many medical providers have turned to telemedicine as an alternative method to provide ambulatory patient care. Perspectives of endocrine surgery patients regarding this mode of healthcare delivery remains unclear. The purpose of this study is to evaluate the opinions and perspectives of endocrine surgery patients regarding telemedicine. Methods: The first 100 adult patients who had their initial telemedicine appointment with two endocrine surgeons were contacted at the conclusion of their visit. The survey administered assessed satisfaction with telemedicine, the provider, and whether attire or video background played a role in their perception of the quality of care received using a 5-point Likert scale. Differences in responses between new and returning patients were also evaluated. Results: Telemedicine endocrine surgery patients stated excellent satisfaction with their visit (4.89 out of 5) and their provider (4.96 out of 5). Although there was less consensus that telemedicine was equivalent to in-person or face-to-face clinic visits (4.15 out of 5), patients would recommend a telemedicine visit to others and most agreed that this modality made it easier to obtain healthcare (4.7 out of 5). Attire of the provider and video background did not influence patient opinion in regard to the quality of care they received. Returning patients were more likely to be satisfied with this modality (4.94 versus 4.73, P = 0.02) compared to new patients. Conclusions: This study shows that telemedicine does not compromise patient satisfaction or healthcare delivery for patients and is a viable clinic option for endocrine surgery. (C) 2021 Published by Elsevier Inc.
      原文链接:
    • NSTL
    • Elsevier

    Show Me the Money, I'll Show You My Complications: Impacts of Incentivized Incident Self-Reporting Among Surgeons

    Cook-Richardson, SharmaAddo, AlexKim, PaulTurcotte, Justin...
    9页
    查看更多>>摘要：Introduction: Trial and error have the propensity to generate knowledge. Near misses and adverse event reporting can improve patient care. Professional ridicule or litigation risks after an incident may lead to decreased reporting by physicians; however, the lack of incident reporting can negatively affect patient safety and halt scientific advancements. This study compares reporting patterns after distribution of financial incentives to surgeons for self-reporting quality incidents. Methods: Retrospective review of an internal incident reporting system, RL6, from September 2018 to September 2019 was performed. Incident reporting patterns after incentive distributions across professional classifications and surgical specialties were evaluated. Engagement surveys on incident reporting were completed by physicians. The primary outcomes were changes in reporting patterns and perceptions after distribution of incentives. Results: Two hundred and eighteen surgical patients were identified in the incidents reported. Financial incentives significantly increased incidents reported (35 to 183) by physicians (37.1% to 67.8%; P < 0.001) and physician assistants (2.9% to 18.6%; P < 0.001). Acute care surgery displayed the largest increase in incidents reported among surgical specialties (5.7% to 20.2%; P = 0.040). Surgeons exhibited an increase in reporting (60.0% to 94.5%; P < 0.001) compared with witnesses after incentivization (2.9% to 1.6%). Conclusions: Financial incentives were associated with increased incident reporting. After the establishment of incentives, physicians were more likely to report their incidents, which may dispel professional embarrassment and display incident ownership. Institutions must encourage reporting while supporting providers. Future quality-improvement studies targeting reporting should incorporate incentives aimed to engage and empower health-care providers. (C) 2021 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Protective Effect of Casticin on Experimental Skin Wound of Rats

    Sun, ChaoYan, HongmeiJiang, KejiaoHuang, Lei...
    8页
    查看更多>>摘要：Introduction: The wound is known as damage to the skin structure by external stimuli, such as cut, bruises, and burn, which typically leaves the internal tissue exposed. The wound repair process when hampered leads to an excessive burden on the healthcare setting. Therefore, there is an urgent need to develop effective agents that can promote the wound healing process. In the present study, we intended to investigate the pharmacological benefit of Casticin (CST), a polymethylflavone against wound. Methods: The wound in Wistar rats was induced by a surgical procedure. After surgery, the wound was examined for wound size over a period and for the expression of cyclooxygenase-2 and induced collagen III expressions. The effect of CST was examined on tumor necrosis factor a, interferon gamma, interleukin (IL)-10, transforming growth factor beta, and IL-7 by real-time polymerase chain reaction. The expression of matrix metalloproteinases (MMP)-2 and MMP-9 and its natural inhibitor (tissue inhibitors of metalloproteinases, TIMP1), level of macrophages, and lymphocytes were also quantified. The effect of CST was determined also on apoptosis of rats' splenocytes. Results: CST significantly enhances wound healing of rat postsurgery, with maximum activity achieved in the case of a 60 mM treated group. The expression of cyclooxygenase-2 was found reduced together with an increase in collagen III, tumor necrosis factor a, interferon gamma, IL-10, transforming growth factor beta, and IL-7 in the CST group. The levels of MMP-2 and MMP-9 were also found reduced together with an increase in TIMP1 level in CST-treated group. The levels of CD4+, CD8+, and CD11b+ cells at the wound site 24 and 120 h postsurgery was also found reduced in CST-treated group. However, it showed no apoptosis in murine splenocytes. Conclusions: Collectively, CST can promote the wound healing process by modulation of inflammation and immune response, which induces tissue remodeling. (c) 2021 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    The Case for Integrating Medical-Legal Partnerships Into Trauma Care

    Hall, Erin C.Current, J. J.Sava, Jack A.Rosen, Jennifer E....
    7页
    查看更多>>摘要：Introduction: Medical-legal needs are health-harming adverse social conditions with a legal remedy. Medical-legal partnerships in primary care settings have been proposed to address these needs for at-risk patients already seeking medical care. Our hypothesis is that trauma patients represent a unique population that may be more likely to have baseline medical-legal needs. Methods: A trauma-specific medical-legal needs survey was developed. Adult trauma patients who were able to give consent and were admitted to our urban Level I hospital were surveyed. Medical-legal needs were tabulated from the surveys. Those patients in the top decile of medical-legal needs were categorized as having a High Burden of medical-legal needs. Multivariate logistic regression was used to identify those independent risk factors for having a High Burden of medical-legal needs. Results: A total of 566 participants completed the survey (78.2% response rate). The mean number of medical-legal needs for our population was 2.5 (SD = 3.1). 73% of our respondents had at least one medical-legal need. The most common needs were Housing (n = 229, 40%) and Education/Employment (n = 223, 39%). Older age (aOR = 3.01, 95% CI 1.2-8.1, P = 0.02), being separated or divorced (aOR = 4.25, 95% CI 1.2-14.0, P = 0.02), self perceived poor health (aOR = 8.4, 95% CI 2.61-26.86, P < 0.001), penetrating mechanism of injury (aOR = 2.52, 95% CI 1.22-5.2, P = 0.01), and having been admitted to the hospital for a longer period of time (aOR = 5.48, 95% CI 1.55-19.4, P = 0.008) were all independently associated with a High Burden of medical-legal needs. Conclusions: Trauma patients have a high baseline burden of medical-legal needs. Medicallegal partnerships embedded in trauma teams may offer an innovative strategy to help address long-term health outcomes in a highly vulnerable population that would not otherwise have contact with the healthcare system. (c) 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Postoperative Respiratory Failure After Elective Abdominal Surgery: A Case-Control Study

    Orabi, DannyNaples, RobertBrundidge, DominiqueSnyder, Karen...
    9页
    查看更多>>摘要：Introduction: Postoperative respiratory failure (PRF) contributes significantly to morbidity and mortality. We sought to identify patient characteristics and perioperative risk factors associated with PRF in patients undergoing elective abdominal surgery to improve patient outcomes. Methods: We retrospectively reviewed patients undergoing elective abdominal surgery from 2011 to 2016 at our institution. An experimental group consisting of adult patients with the Patient Safety Indicator 11 diagnosis of PRF was compared with a time-matched control group. Results: Each group consisted of 233 patients. Comorbidities associated with PRF included ascites, coronary artery disease, chronic kidney disease, chronic obstructive pulmonary disease, diabetes mellitus type II, hypertension, and hypoalbuminemia (P < 0.05). American Society of Anesthesiologists score IV (20.2% versus 3.95%; P < 0.001), operative time (4.13 versus 2.55 h; P < 0.001), laparotomy with open operation (77.7% versus 45.5%; P < 0.001), and net intraoperative fluid balance (3635 versus 2410 mL; P < 0.001) were higher in patients with PRF. On multivariate analysis, age, American Society of Anesthesiologists score, chronic obstructive pulmonary disease, diabetes mellitus type II, laparotomy, and net intraoperative fluid balance maintained significance (P < 0.05). Conclusions: We identified contributing pre- and intra-operative risk factors for PRF undergoing elective abdominal surgery. These findings may help identify those at increased risk for respiratory failure and mitigate complications. (c) 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Assessing Factor V Antigen and Degradation Products in Burn and Trauma Patients

    Keyloun, John W.Le, Tuan D.Orfeo, ThomasBrummel-Ziedins, Kathleen E....
    9页
    查看更多>>摘要：Introduction: Proposed mechanisms of acute traumatic coagulopathy (ATC) include decreased clotting potential due to factor consumption and proteolytic inactivation of factor V (FV) and activated factor V (FVa) by activated protein C (aPC). The role of FV/FVa depletion or inactivation in burn-induced coagulopathy is not well characterized. This study evaluates FV dynamics following burn and nonburn trauma. Methods: Burn and trauma patients were prospectively enrolled. Western blotting was performed on admission plasma to quantitate levels of FV antigen and to assess for aPC or other proteolytically derived FV/FVa degradation products. Statistical analysis was performed with Spearman's, Chi-square, Mann-Whitney U test, and logistic regression. Results: Burn (n = 60) and trauma (n = 136) cohorts showed similar degrees of FV consumption with median FV levels of 76% versus 73% (P = 0.65) of normal, respectively. Percent total body surface area (TBSA) was not correlated with FV, nor were significant differences in median FV levels observed between low and high TBSA groups. The injury severity score (ISS) in trauma patients was inversely correlated with FV (r = -0.26; P = 0.01) and ISS > 25 was associated with a lower FV antigen level (64% versus. 93%; P = 0.009). The proportion of samples showing proteolysis-derived FV was greater in trauma than burn patients (42% versus. 16%; P = 0.0006). Conclusions: Increasing traumatic injury severity is associated with decreased FV antigen levels, and a greater proportion of trauma patient samples exhibit proteolytically degraded FV fragments. These associations are not present in burns, suggesting that mechanisms underlying FV depletion in burn and nonburn trauma are not identical. 2022 Published by Elsevier Inc.
      原文链接:
    • NSTL
    • Elsevier