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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    Preoperative and Postoperative Cognitive Assessment in Geriatric Patients Following Acute Traumatic Injuries: Towards Improving Geriatric Trauma Outcomes

    Selvakumar S.Das S.Newsome K.Chan K....
    13页
    查看更多>>摘要：? 2022 Elsevier Inc.Introduction: A growing percentage of the US population is over the age of 65, and geriatrics account for a large portion of trauma admissions, expected to reach nearly 40% by 2050. Cognitive status is important for operative management, especially in elderly populations. This study aims to investigate preoperative and postoperative cognitive function assessment tools in geriatric patients following acute trauma and associated outcomes, including functional status, postdischarge disposition, mortality, and hospital length of stay (H-LOS). Methods: A literature search was conducted using Medline/PubMed, Google Scholar, Embase, JAMA Networks, and Cochrane databases for studies investigating the use of cognitive assessment tools for geriatric patients with acute trauma. The last literature search was conducted on November 13, 2021. Results: Ten studies were included in this review, of which five focused on preoperative cognitive assessment and five focused on postoperative. The evidence suggests patients with preoperative cognitive impairment had worse functional status, mortality, and postdischarge disposition along with increased LOS. Acute trauma patients with postoperative cognitive impairment also had worse functional status, mortality, and adverse postdischarge disposition. Conclusions: Preoperative and postoperative cognitive impairment is common in geriatric patients with acute trauma and is associated with worse outcomes, including decreased functional status, increased LOS, and adverse discharge disposition. Cognitive assessment tools such as MMSE, MoCA, and CAM are fast and effective at detecting cognitive impairment in the acute trauma setting and allow clinicians to address preoperative or postoperative cognitive impairments to improve patient outcomes.
      原文链接:
    • NSTL
    • Elsevier

    Predictors of Readmission Following Treatment for Traumatic Hemothorax

    Kirchberg T.N.Costantini T.W.Santorelli J.Doucet J.J....
    7页
    查看更多>>摘要：? 2022 Elsevier Inc.Introduction: Retained-hemothorax after trauma can be associated with prolonged hospitalization, empyema, pneumonia, readmission, and the need for additional intervention. The purpose of this study is to reduce patient morbidity associated with retained-hemothorax by defining readmission rates and identifying predictors of readmission after traumatic hemothorax. Methods: The Nationwide Readmission Database for 2017 was queried for patients with an index admission for traumatic hemothorax during the first 9 mo of the year. Deaths during the index admission were excluded. Data collected includes demographics, injury mechanism, outcomes and interventions including chest tube, video-assisted thoracoscopic surgery, and thoracotomy. Chest-related readmissions (CRR) were defined as hemothorax, pleural effusion, pyothorax, and lung abscess. Univariate and multivariate analysis were used to identify predictors of readmission. Results: There were 13,903 patients admitted during the study period with a mean age of 53 ± 21, 75.2% were admitted after blunt versus 18.3% penetrating injury. The overall 90-day readmission rate was 20.8% (n = 2896). The 90-day CRR rate was 5.7% (n = 794), with 80.5% of these occurring within 30 d. Of all CRR, 62.3% (n = 495) required an intervention (chest tube 72.7%, Thoracotomy 26.9%, video-assisted thoracoscopic surgery 0.4%). Mortality for CRR was 6.2%. Predictors for CRR were age >50, pyothorax or pleural effusion during the index admission and discharge to another healthcare facility or skilled nursing facility. Conclusions: Majority of CRR after traumatic hemothorax occur within 30 d of discharge and frequently require invasive intervention. These findings can be used to improve post discharge follow-up and monitoring.
      原文链接:
    • NSTL
    • Elsevier

    Early Biomarker Signatures in Surgical Sepsis

    Madushani R.W.M.A.Patel V.Loftus T.Ren Y....
    12页
    查看更多>>摘要：? 2022Introduction: Sepsis has complex, time-sensitive pathophysiology and important phenotypic subgroups. The objective of this study was to use machine learning analyses of blood and urine biomarker profiles to elucidate the pathophysiologic signatures of subgroups of surgical sepsis patients. Methods: This prospective cohort study included 243 surgical sepsis patients admitted to a quaternary care center between January 2015 and June 2017. We applied hierarchical clustering to clinical variables and 42 blood and urine biomarkers to identify phenotypic subgroups in a development cohort. Clinical characteristics and short-term and long-term outcomes were compared between clusters. A na?ve Bayes classifier predicted cluster labels in a validation cohort. Results: The development cohort contained one cluster characterized by early organ dysfunction (cluster I, n = 18) and one cluster characterized by recovery (cluster II, n = 139). Cluster I was associated with higher Acute Physiologic Assessment and Chronic Health Evaluation II (30 versus 16, P < 0.001) and SOFA scores (13 versus 5, P < 0.001), greater prevalence of chronic cardiovascular and renal disease (P < 0.001) and septic shock (78% versus 17%, P < 0.001). Cluster I had higher mortality within 14 d of sepsis onset (11% versus 1.5%, P = 0.001) and within 1 y (44% versus 20%, P = 0.032), and higher incidence of chronic critical illness (61% versus 30%, P = 0.001). The Bayes classifier achieved 95% accuracy and identified two clusters that were similar to development cohort clusters. Conclusions: Machine learning analyses of clinical and biomarker variables identified an early organ dysfunction sepsis phenotype characterized by inflammation, renal dysfunction, endotheliopathy, and immunosuppression, as well as poor short-term and long-term clinical outcomes.
      原文链接:
    • NSTL
    • Elsevier

    Circ_0003423 Alleviates Oxidized Low-Density Lipoprotein-Induced Endothelial Cell Injury by Sponging miR-142-3p and Activating Sirtuin 3/Superoxide Dismutase 2 Pathway

    Wang P.Zhang H.Wang Y.
    14页
    查看更多>>摘要：? 2022 Elsevier Inc.Introduction: Atherosclerosis (AS) is a common cardiovascular disease with high morbidity and mortality globally. Circular RNAs (circRNAs) have been shown to regulate AS progression. However, the biological role of circ_0,003,423 in AS pathology and its associated mechanism is still unclear. Methods: Oxidized low-density lipoprotein (ox-LDL)–induced human umbilical vein endothelial cells (HUVECs) were used as an AS cell model in vitro. Reverse transcription–quantitative polymerase chain reaction (RT-qPCR) and Western blot assays were conducted to measure ribonucleic acid (RNA) and protein expression. Cell proliferation was analyzed by Cell Counting Kit-8 (CCK-8) and 5-ethynyl-2′-deoxyuridine (EdU) incorporation assays. Cell apoptosis, migration, and angiogenesis were analyzed by flow cytometry, wound healing, and Matrigel tube formation assays. The oxidative stress factors were detected using reactive oxygen species activity (ROS) assay kit, malondialdehyde (MDA) assay kit, and superoxide dismutase (SOD) assay kit. The interaction between microRNA-142-3p (miR-142-3p) and circ_0,003,423 or sirtuin 3 (SIRT3) was verified by dual-luciferase reporter assay and RNA immunoprecipitation (RIP) assay. Results: Ox-LDL exposure dose-dependently reduced circ_0,003,423 expression in HUVECs. Ox-LDL suppressed the proliferation, migration, and angiogenesis and induced the apoptosis and oxidative stress of HUVECs, which were offset by circ_0,003,423 overexpression. miR-142-3p is a direct target of circ_0,003,423, and circ_0,003,423 overexpression-mediated protective effects in ox-LDL–induced HUVECs were largely reversed by the addition of miR-142-3p mimic. miR-142-3p directly interacted with the 3′UTR of SIRT3 and SIRT3 knockdown reversed anti-miR-142-3p-mediated protective effects in HUVECs upon ox-LDL exposure. Circ_0,003,423 positively regulated SIRT3 expression by sponging miR-142-3p in HUVECs. In addition, circ_0,003,423 could regulate the SIRT3/SOD2 signaling pathway in HUVECs. Conclusions: Circ_0,003,423 protected HUVECs from ox-LDL–induced dysfunction by sponging miR-142-3p and activating SIRT3/SOD2 signaling, which provided new potential targets for AS intervention and treatment.
      原文链接:
    • NSTL
    • Elsevier

    Emotional Regulation in Surgery: Fostering Well-Being, Performance, and Leadership

    Greenberg A.L.Sullins V.F.Donahue T.R.Sundaram V.M....
    11页
    查看更多>>摘要：? 2022 The AuthorsEmotional regulation is increasingly gaining acceptance as a means to improve well-being, performance, and leadership across high-stakes professions, representing innovation in thinking within the field of surgical education. As one part of a broader cognitive skill set that can be trained and honed, emotional regulation has a strong evidence base in high-stress, high-performance fields. Nevertheless, even as Program Directors and surgical educators have become increasingly aware of this data, with emerging evidence in the surgical education literature supporting efficacy, hurdles to sustainable implementation exist. In this white paper, we present evidence supporting the value of emotional regulation training in surgery and share case studies in order to illustrate practical steps for the development, adaptation, and implementation of emotional regulation curricula in three key developmental contexts: basic cognitive skills training, technical skills acquisition and performance, and preparation for independence. We focus on the practical aspects of each case to elucidate the challenges and opportunities of introducing and adopting a curricular innovation into surgical education. We propose an integrated curriculum consisting of all three applied contexts for emotional regulation skills and advocate for the dissemination of such a longitudinal curriculum on a national level.
      原文链接:
    • NSTL
    • Elsevier

    Society of Asian Academic Surgeons Presidential Address: A Is for American. Asian. Ally

    Wang T.S.
    11页
      原文链接:
    • NSTL
    • Elsevier

    Leadership Development Among Junior Surgery Residents: Communication and Perception

    Shao C.C.Kennedy G.E.Rentas C.M.Chen H....
    7页
    查看更多>>摘要：? 2022 Elsevier Inc.Introduction: Leadership is necessary for effective health care teams, particularly for surgeons. Trainees similarly must acquire foundational leadership skills to maximize effectiveness. However, surgical leadership is rarely formally assessed, particularly for junior trainees. We aimed to establish themes of communication, perception and engagement styles, as well as strengths and weaknesses among junior surgical residents at a single institution. Methods: The Data Dome Inc. (datadome.com) DISC personality assessment was administered in 2018-2021 to junior residents at an academic general surgery training program at a single institution. Resident demographics were recorded, and themes from deidentified reports were analyzed by year (PGY-1 and PGY-2) using JMP 16 Pro Text Explorer. Results: PGY-1 communication was most frequently described as “accomplished best by well-defined avenues” with “duties and responsibilities of others who will be involved explained” in “friendly terms.” PGY-2 communication involved “deal [ing] with people,” “strong feelings about a particular problem,” and being “good at giving verbal and nonverbal feedback.” In ideal environments, PGY-1s self-perceived as “good listener [s],” “good-natured,” and “team player [s].” However, under stress, PGY-1s were perceived by others as “poor listener [s],” “self-promoter [s],” “detached,” and “insensitive.” In ideal environments, PGY-2s were also “good listener [s],” “good-natured,” and “team player [s].” However, under stress, PGY-2 external perception was “overly confident,” “poor listener [s],” and “self-promoter [s].” Conclusions: Clear expectations, friendly work environments, and opportunities to succeed are key to effectively train junior surgical residents. In environments where time is often a limited resource, surgical simulation, stress training, and standardized teaching methods from attending surgeons are needed to develop competent trainees.
      原文链接:
    • NSTL
    • Elsevier