查看更多>>摘要：? 2022 Elsevier Inc.Introduction: Frequency of PD-L1 expression and the role of immunotherapy in malignant peritoneal mesothelioma (MPM) have not been well characterized. The purpose of this study was to determine PD-L1 expression in patients with MPM and perform an exploratory analysis for associations between PD-L1 and its biological behavior in MPM. Methods: Tumor samples were collected from patients undergoing surgical interventions between January 2018 and June 2020. Specimens were stained with anti-PD-L1 antibodies (Dako 22c3) and positivity was determined by tumor proportion score (TPS) or combined positive score (CPS) being ≥1%. Results: Twenty one samples were obtained from 21 patients. Sixteen of 21 (76%) samples were CPS positive and 9 of 21 (43%) were TPS positive. Three samples had more aggressive biphasic/sarcomatoid histology and a high CPS and TPS (CPS: 3, 75, 95%; TPS: 2, 60, 90%). On an exploratory analysis, as the CPS or TPS threshold increased, there was a trend towards worse survival. Conclusions: MPM has a high frequency of PD-L1 expression, which may be associated with more aggressive tumor biology. These data provide the foundation for continued evaluation of checkpoint inhibition in patients with MPM.
查看更多>>摘要：? 2022 Elsevier Inc.Introduction: Surgery resident mental health, burnout, and overall well-being are constantly scrutinized, and improving surgery resident well-being programs continuously requires refinement. We sought to evaluate the effectiveness of human-centered design (HCD) sprints to enhance our surgery resident well-being program. Methods: An HCD sprint was conducted with 34 surgery residents in a single session using seven separate domains, including Mental Health/Reflection and Therapy; Mentoring or Faculty Engagement; Physical Well-being; Retreats; Scheduled Breaks or Free Time; Social Connection; and Well-being Lectures, Emails, or Curriculum. Responses were characterized as: “How might we”, Suggestions, Useful, and Not Useful. Results: Well-being Lectures, Emails, or Curriculum were overwhelmingly viewed, as Not Useful (77%), as was Mental Health/Reflection and Therapy (42%). Scheduled Breaks or Free Time was viewed as the most Useful (42%). This category also had the most suggestions and “How might we” ideas for improvement (41%). Lastly, Suggestions and “How might we” ideas were also common for improving Mentoring or Faculty Engagement (31% and 29%, respectively). These results were incorporated into multiple strategies to improve surgery resident well-being and also shared in a Department of Surgery Grand Rounds. Conclusions: Surgery resident well-being and a targeted approach by a well-being program are critical to a residency program, particularly with the arduous nature of surgical training during the pandemic resulting in periods of prolonged social isolation. HCD sprints are an effective means to refine a surgery resident well-being program and to involve the residents themselves in that process.
查看更多>>摘要：? 2022 The Author(s)Introduction: Since March 2020, the coronavirus disease 2019 pandemic has affected healthcare systems worldwide. It is largely unknown how acutely ill surgical patients and their next of kin have perceived the hospital care during the ongoing pandemic. Therefore, we aimed to explore their experiences. Material and methods: We performed 12 interviews with patients who had undergone acute abdominal surgery in a public acute care hospital in Sweden during March to June 2020. In addition, we interviewed 10 of the patients’ next of kin. We analyzed the interviews using content analysis. Results: Our analysis resulted in two themes: “Worries about seeking acute care” and “The surgical care worked adequately, even though the system was overloaded.” The participants experienced that the hospital maintained its functionality during the ongoing pandemic. Both the patients and their next of kin experienced insufficient information by the hospital, especially during the initial acute phase and at discharge, which led to a perceived loss of control. The implemented ban on visitors was found to have had both positive and negative effects for the patients, whereas the next of kin's experiences focused on the difficulties with not being able to visit. Conclusions: Our findings indicate that the challenges of communication with patients and their next of kin are exacerbated during a crisis such as a pandemic. In addition, a ban on visitors might have both positive and negative aspects. Therefore, we propose individualized routines for visits to acute surgical patients when possible.
查看更多>>摘要：? 2022 Elsevier Inc.Introduction: The prospective registration of systematic reviews represent an effective strategy for reducing the selective reporting of outcomes. However, the relationship between registration and the reporting quality of systematic reviews on surgical interventions remains unclear. Methods: MEDLINE was searched for relevant systematic reviews of randomized controlled trials investigating surgical interventions published in 2020. Data concerning general characteristics and registration information were independently extracted. The reporting quality was evaluated in accordance with pre-established evaluation criteria. Univariate and multivariate linear regression were performed to identify factors associated with improved reporting quality. Results: A total of 135 systematic reviews were analyzed, of which 50 (37%) were registered. Registered systematic reviews achieved a significantly higher compliance rate on all items compared with non-registered reviews. Registered reviews also demonstrated significantly higher proportions of the reporting of seven items. Multivariate regression analysis showed that registration status and funding support were associated with better reporting quality. Conclusions: Although prospective registration associates with higher reporting quality in systematic reviews, the number of prospective registrations remains low. Therefore, prospective registration should be encouraged among authors, peer reviewers, and journal editors, as well as institutions, to enhance the value of systematic reviews in evidence-based surgical practice.
查看更多>>摘要：? 2022 Elsevier Inc.Introduction: The precise mechanism through which excessive tension confers poor outcomes in nerve gap repair is yet to be elucidated. Furthermore, the effect of tension on gene expression in regenerating nerves has not been characterized. This study investigated differential gene expression in transected nerves repaired under high and minimal tension. Methods: Male Lewis rats underwent right sciatic nerve transection with either minimal-tension or high-tension repair. Fourteen weeks postoperatively, segments of the right sciatic nerves were harvested along with equal-length segments from the contralateral, healthy nerve to serve as internal controls (na?ve nerve). Differentially expressed genes (DEGs) and differentially regulated biochemical pathways between the samples were identified. Results: Seventeen animals were studied. The gene expression profiles of na?ve nerve and minimal-tension repair demonstrated minimal within-group variation, whereas that of high-tension repair demonstrated heterogeneity. Relative to na?ve nerve, high-tension repair samples had 4276 DEGs (1941 upregulated and 2335 downregulated) and minimal-tension repair samples had 3305 DEGs (1479 upregulated and 1826 downregulated). High-tension repair samples had 360 DEGs relative to minimal-tension repair samples (68 upregulated and 292 downregulated). Upregulated biological pathways in all repaired nerves included steroid biosynthesis, extracellular matrix–receptor interaction, and ferroptosis. Finally, upregulated pathways in high-tension repair samples relative to minimal-tension repair samples included tumor necrosis factor signaling, interleukin-17 signaling, cytokine-cytokine receptor interaction, and mitogen-activated protein kinase signaling. Conclusions: The improved outcomes achieved with minimal-tension nerve repair may take root in a favorable gene expression profile. Future elucidation of biochemical pathways in nerve regeneration may identify potential therapeutic targets to optimize primary nerve repair outcomes.
查看更多>>摘要：? 2022 The Author(s)Introduction: The aging process places the elderly, a worldwide increasing age group, at an increased risk for trauma. This study aims to explore changes over time in admission rates, sociodemographical, clinical, and injury-related data in elderly patients (aged ≥65 y) admitted to the Puerto Rico Trauma Hospital (PRTH) during 2000-2019. Materials and methods: A time-series analysis was conducted. Admission rates were analyzed by fitting an exponential growth curve model. Trends were assessed using the Cochrane-Armitage and Cuzick tests for categorical and continuous data, respectively. Results: Elderly admission rates to the PRTH have shown growth over the past 2 decades, from 6.2 cases per 100 overall admissions in 2000 to 18.2 in 2019. This trend is projected to continue with estimated 24.8 (95% CI: 21.7-27.8) cases per 100 overall admissions in 2023. Trends for mechanisms of injury such as motor vehicle accidents and pedestrians showed a significant decrease, whereas falls presented a clear positive trend, showing an increase from 25.6% in 2000-2004 to 46.2% in 2015-2019. Both Injury Severity Score ≥25 and Glasgow Coma Scale ≤8 declined significantly through time. Finally, in-hospital mortality presented a decreasing trend from 31.7% in 2000-2004 to 21.5% in 2015-2019. Conclusions: Our analysis demonstrates an increase over time in elderly admissions, especially fall-related trauma. Also, it projects this upward trend will continue. This imposes new challenges for PRTH and other healthcare services and is a gateway for the implementation of adapted clinical management.
查看更多>>摘要：? 2022 Elsevier Inc.Introduction: The minimally invasive step-up approach to pancreatitis improves outcomes. Multidisciplinary working groups may best facilitate this approach. However, support for these working groups requires funding. We hypothesize that patients requiring surgical debridement generate sufficient revenue to sustain these working groups. Furthermore, patients selected for surgical debridement by the working group will have a higher rate of percutaneous and endoscopic intervention in adherence to the step-up approach. Methods: We conducted an observational cohort study of all patients with severe acute and/or necrotizing pancreatitis whose care was overseen by our multidisciplinary working group (October 2015 through January 2019). Patient demographics, hospital treatments, and outcomes data were compared between those who underwent surgical debridement and those who did not. Hospital billing data were also collected from those who are undergoing surgical debridement and compared to institutional benchmarks for financial sustainability. Results: A total of 108 patients received care overseen by the working group, 10 of which progressed to surgical debridement. The mean contribution margin percentages for each patient in the surgical debridement group were higher than the threshold value for financial sustainability, 39% (60.34% ± 16.66%; P = 0.004). Patients in the surgical debridement group were more likely to undergo intervention by interventional radiologist (odds ratio, 1.58; P = 0.005). The mortality was higher in the nonsurgical debridement group (odds ratio, 15; P = 0.008). Conclusions: Our multidisciplinary working group delivered step-up care to patients with pancreatitis. Patients requiring surgical debridement generated a significantly positive contribution margin that could be used to help support the costs associated with providing multidisciplinary care.
查看更多>>摘要：? 2022 Elsevier Inc.Introduction: Surgical excision of substernal thyroid goiters (STG) can be challenging while minimizing postoperative morbidity. Postoperative complication rates associated with transcervical and transthoracic approaches (i.e., partial or total sternotomy) for STG compared to multinodular goiters (MNG) limited to the neck (i.e., non-substernal) remains unclear. This study examines postoperative morbidity related to surgical approaches in the removal of STG and MNG. Methods: A retrospective review of prospectively collected data of 988 patients with STG and non-substernal MNG from a single institution between 2010 and 2021 was performed. Patients were stratified by STG and conventional non-substernal MNG limited to the neck excised by transcervical and transthoracic approach. Postoperative complications including neck hematoma requiring return to the operating room, permanent recurrent laryngeal nerve injury and hypocalcemia, and transient or temporary recurrent laryngeal nerve injury and hypocalcemia were identified. Demographics including age, sex, and race, among others, were analyzed. Results: Of the 988 cases, there were 887 (90%) MNG and 101 (10%) STG. Of the STG cohort, 11 (11%) required a partial sternotomy and 4 (4%) required a total sternotomy. Permanent complication rates for non-substernal MNG and STG patients were 1.5% and 0.9%, respectively. Only transient or temporary hypocalcemia rates were statistically different between the STG and MNG cohorts (9.9% versus 3.8%, P < 0.001). Conclusions: Regardless of transcervical or transthoracic approach, postoperative complications associated with the surgical removal of STG are low in the hands of experienced, high-volume thyroid surgeons.
查看更多>>摘要：? 2022 Elsevier Inc.Introduction: The role of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with extraperitoneal disease (EPD) is controversial. Methods: Among patients with peritoneal metastases from appendiceal cancer (AC) and colorectal cancer (CRC) who underwent CRS-HIPEC, those with EPD (liver, lung, or retroperitoneal lymph nodes [RP LN]) were retrospectively compared to those without EPD. Overall (OS) and recurrence-free survival (RFS) analyses were performed before/after propensity score matching (PSM). Results: Among 1341 patients with AC (64%) or CRC (36%) who underwent CRS ± HIPEC, 134 (10%) had EPD whereas 1207 (90%) did not. EPD was located in the lungs (47%), RP LN (28%), liver (18%), or multiple (6%). Patients with EPD experienced worse median OS (34 versus 63 mo; P = 0.002) and RFS (12 versus 19 mo; P < 0.001). On a multivariable analysis, EPD was associated with worse RFS (P = 0.003), but not OS (P = 0.071). After PSM, the association of EPD with OS (P = 0.204) and RFS (P = 0.056) was no longer significant. In the multivariable analysis of the PSM cohort, EPD was not associated with OS (P = 0.157) or RFS (P = 0.110). Conclusions: The findings of this large retrospective multi-institutional study suggest that EPD alone, while a negative prognostic indicator, should not be considered an absolute contraindication to CRS ± HIPEC for otherwise well-selected patients with peritoneal surface malignancies. Further research is needed to delineate whether location of EPD influences OS and RFS following CRS-HIPEC.
查看更多>>摘要：? 2022 Elsevier Inc.Introduction: Traumatic injury is the leading cause of pediatric mortality and morbidity in the United States. Pediatric trauma survivors requiring inpatient rehabilitation (IPR) require coordinated, multispecialty follow-up. Knowledge of the nature and level of disability is necessary for planning this continued care that is specific to the needs of pediatric trauma patients. This study aims to describe the outcomes of pediatric and adolescent trauma patients using measures of functional progression. Materials and methods: A retrospective review of trauma patients aged ≤18 y admitted to IPR between January 2018 and December 2020 at the only certified pediatric rehabilitation center in the region was performed. Results: Ninety five children and adolescents were admitted to IPR after traumatic injury with diagnoses of multitrauma (MT, N = 18), traumatic brain injury (TBI, N = 59), and spinal cord injury (SCI, N = 18). School aged children returned to school at high rates for all injury types (MT: 86.7%, TBI: 97.4%, SCI: 93.8%, P = ns). All groups had similar hospital and rehabilitation length of stay, and most patients required a durable medical equipment at discharge (79%). Using pediatric functional independence measure scoring progression from admission to discharge from IPR, SCI patients made significant improvement in bladder function and the least improvement in stair function. Patients sustaining a TBI made significant improvement in memory and comprehension tasks. Conclusions: Pediatric and adolescent trauma patients admitted to IPR had a positive progression during their therapy but required variable ongoing care depending on the mechanism of injury. Excellent rates of returning to school were seen across the three injury types.
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