Journal of Surgical Research最新文献

{"title":"Association of Neoadjuvant Therapy on Pathologic and Clinical Outcomes for Pancreatic Adenocarcinoma","authors":"Nicholas Galouzis MD, MBA,&nbsp;Maria Fotinos BS,&nbsp;Evelyn V. Alexander MD,&nbsp;Forrest Bethel DO,&nbsp;Mohammad R. Khreiss MD,&nbsp;Lusine Mesropyan DO,&nbsp;Carrie Luu MD,&nbsp;Taylor S. Riall MD, PhD","doi":"10.1016/j.jss.2025.11.065","DOIUrl":"10.1016/j.jss.2025.11.065","url":null,"abstract":"<div><h3>Introduction</h3><div>The use of total neoadjuvant chemotherapy (TNC) for pancreatic adenocarcinoma (PDAC) is increasing. This study evaluated the association between chemotherapy timing [TNC, perioperative (PERIOP), adjuvant (ADJ)] and total duration of chemotherapy on survival in PDAC.</div></div><div><h3>Methods</h3><div>Single-institution, retrospective study (2020-2023) of PDAC patients that underwent surgical resection and chemotherapy with an intended 6-mo course. We compared overall survival and chemotherapy completion rates between TNC, PERIOP, and ADJ groups.</div></div><div><h3>Results</h3><div>Of 115 patients, 10 received TNC, 69 PERIOP, and 36 ADJ chemotherapy. Pancreaticoduodenectomy was performed in 64.4% of patients. Resectable disease was more common in the ADJ group (97.2%) compared to PERIOP (47.8%) or TNC (30.0%, <em>P</em> &lt; 0.01) groups, with vascular resection more common in TNC compared to PERIOP or ADJ groups (40.0% <em>versus</em> 7.2% <em>versus</em> 8.3%, <em>P</em> = 0.02). The TNC group was more frequently node negative (70.0% <em>versus</em> 43.5% PERIOP <em>versus</em> 36.1% ADJ, <em>P</em> = 0.02). Median survival from first treatment was similar between the groups (TNC 43 <em>versus</em> PERIOP 40 <em>versus</em> ADJ 38 mo, <em>P</em> = 0.70). By definition, all TNC patients completed 6 mo of chemotherapy. Completion of chemotherapy was much less common in the in the PERIOP group (40.6%) and the ADJ group (36.1%, <em>P</em> &lt; 0.01), as patients were unable to tolerate chemotherapy after surgery. Patients who completed 6 mo of chemotherapy, regardless of timing relative to surgery, had a median overall survival of 43 mo compared to 35 mo in those who did not (hazard ratio 0.37, 95% confidence interval: 0.19-0.73; <em>P</em> &lt; 0.01).</div></div><div><h3>Conclusions</h3><div>Completion of 6 mo of chemotherapy was associated with improved survival, regardless of timing. As postoperative completion rates remain low, TNC may facilitate higher chemotherapy completion rates.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 64-74"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Status, Advances, and Challenges in Pediatric Liver Transplantation in Africa: A Scoping Review","authors":"Brian Kasagga MBChB ,&nbsp;Joseph Thaimye MBChB ,&nbsp;Daniel Lawal MBChB ,&nbsp;Boma Esther Jacks MD ,&nbsp;Benjamin Chukwunonso Okonkwo MBBS ,&nbsp;Obieze Nwanna-Nzewunwa MD","doi":"10.1016/j.jss.2025.12.011","DOIUrl":"10.1016/j.jss.2025.12.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Pediatric liver diseases are a significant mortality burden in low-income countries particularly in Africa, where access to life-saving pediatric liver transplantation (PLT) is limited. We aimed to determine the current state of PLT in Africa based on the available literature, identify key barriers to access, and propose solutions.</div></div><div><h3>Methods</h3><div>We conducted a comprehensive search of peer-reviewed articles, reports, and gray literature from databases such as Google Scholar, PubMed Central, Web of Science, and African Journal Online. We included studies on PLT between January 2000 and July 2024. Data were extracted, collated, and summarized following the Arksey, O'Malley, and Joanna Briggs Institute frameworks.</div></div><div><h3>Results</h3><div>Only two African countries have PLT programs, located in South Africa and Egypt. Approximately 548 PLTs were performed, with 388 in South Africa and 160 in Egypt. Biliary atresia is the leading indication (43.1%). Sixty-six percent of patients wait longer than a year for a transplant. Living donors are predominantly used, with deceased donor programs primarily located in South Africa. Compared to global 1-y and 5-y survival rates of 86.6% and 77.7%, survival in Africa is at 79.4% and 67.4%, respectively. PLT complications include biliary (41%), vascular (16%), and enteric (10%). Major challenges include limited access and infrastructure, donor shortages, late referrals, diagnostic delays, financial and socioeconomic barriers, clinical and postoperative complications, and policy bottlenecks.</div></div><div><h3>Conclusions</h3><div>PLT in Africa has limited access and poorer outcomes compared to global trends. Addressing these requires increasing resources, improved early diagnosis, expanded deceased donor programs, policy development, education, and resource allocation.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 52-63"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Particulate Matter Exposure and Prolonged Length of Stay After Surgery—A Novel Association","authors":"Wendelyn M. Oslock MD, MBA, MSPH ,&nbsp;Lauren Wood MPH ,&nbsp;Arundhati Sawant MBBS ,&nbsp;Nathan C. English MBChB ,&nbsp;Bayley A. Jones MD, MSPH ,&nbsp;Victor Perim MD ,&nbsp;Colin Martin MD ,&nbsp;Daniel I. Chu MD, MSPH ,&nbsp;Ruzmyn Vilcassim MS, PhD","doi":"10.1016/j.jss.2025.12.035","DOIUrl":"10.1016/j.jss.2025.12.035","url":null,"abstract":"<div><h3>Introduction</h3><div>Air pollution negatively impacts health outcomes for chronic conditions and has been linked to the development of surgically managed diseases. Its impact on surgical outcomes, however, is not well understood.</div></div><div><h3>Methods</h3><div>In this cross-sectional study, we linked institutional American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data to publicly available air pollutant data from 2006 to 2021. We compared the length of stay (LOS), 30-day complications, and readmission for patients undergoing colorectal surgery based on patient home county exposure to particulate matter &lt;2.5 μm in diameter (PM_2.5) during the year of their operation. Patient demographics, comorbidities, procedural characteristics, as well as social vulnerability were included. Statistical analysis included chi-square tests, Kruskal–Wallis rank sum, Pearson correlation, as well as logistical and linear regression modeling.</div></div><div><h3>Results</h3><div>A total of 1892 surgical encounters were linked to PM_2.5. Overall, patients were a median 58.7 years of age, 53% female, 35% Black, 45% had private insurance, and 71% came from areas with a high Social Vulnerability Index. Most procedures were elective (77%) and open (54%). The median LOS was 5 days (interquartile range, 3-9) with a 30-day readmission rate of 12% and 30% of patients experiencing at least one complication. On multivariable analysis, PM_2.5 exposure was associated with LOS. Compared to patients from areas with low PM_2.5, those from moderately elevated and high PM_2.5 had an incidence rate ratio of 1.08 [95% confidence interval: 1.04-1.13] and 1.08 [1.02-1.15], respectively.</div></div><div><h3>Conclusions</h3><div>Air pollution is associated with longer LOS following colorectal surgery. Although readmission and complication rates were not found to be statistically significant, the limited sample size warrants larger study populations.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 281-289"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Depression With Inferior Amputation-free Survival in Chronic Limb-threatening Ischemia","authors":"Ilse Torres Ruiz MD,&nbsp;Cuneyt Koksoy MD,&nbsp;Zachary S. Pallister MD,&nbsp;Ramyar S. Gilani MD,&nbsp;Joseph L. Mills MD,&nbsp;Jayer Chung MD, MSc","doi":"10.1016/j.jss.2025.12.005","DOIUrl":"10.1016/j.jss.2025.12.005","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Chronic limb-threatening ischemia (CLTI) is the most severe form of peripheral arterial disease) and can cause profound psychosocial distress, including depression. Depression in CLTI patients is often underdiagnosed and its impact on clinical outcomes remains unclear. This study aims to quantify the prevalence of depression in CLTI patients and quantify its impact on outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A single-center, retrospective analysis was conducted from December 2010 to January 2024. Demographics, comorbidities, ischemia metrics, limb-salvage, and survival were collected and analyzed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Over 14 y, 801 CLTI patients (median age, 66.7; interquartile range, 59.3-74.3 y; 62.5% male) underwent 1882 revascularizations. The first episode of revascularization procedures included 697 endovascular, 241 open surgical, and 56 hybrid procedures, while 73 extremities were managed without revascularization. During the follow-up, 288 (36.0%) patients underwent minor amputations and 156 (19.5%) underwent major amputations. A total of 255 (31.8%) patients had a history of depression. Binary logistic regression modeling revealed that age (odds ratio [OR], 0.96, 95% confidence interval [CI], 0.95-0.97), female sex (OR, 2.1; 95% CI, 1.5-2.9), congestive heart failure (OR, 1.6: 95% CI, 1.2-2.2), hypothyroidism (OR, 1.6; 95% CI, 1.2-2.8), and active smoking (OR, 1.6; 95% CI, 1.2-2.2) were independently associated with depression. At a 20-mo follow-up, depressed patients had higher rates of major amputation (25.5% &lt;em&gt;versus&lt;/em&gt; 16.7%; &lt;em&gt;P&lt;/em&gt; = 0.003), lower Kaplan–Meier-estimated amputation-free survival (OR, 49.3; 95% CI, 42.7-55.9 mo &lt;em&gt;versus&lt;/em&gt; 70.2, 95% CI, 64.1-76.6 mo; &lt;em&gt;P&lt;/em&gt; &lt; 0.001), and lower overall Kaplan–Meier-estimated survival compared to nondepressed patients (OR, 76.9; 95% CI, 65.5-88.5 &lt;em&gt;versus&lt;/em&gt; OR, 87.9; 95% CI, 81.9-93.9 mo, &lt;em&gt;P&lt;/em&gt; = 0.03). There were no significant differences between depressed and nondepressed patients in baseline symptoms, tissue loss, osteomyelitis, total number of procedures, reintervention rates, and bypass patency. However, depressed patients had higher percentages in Wound, Ischemia, and foot Infection (WIfI) classification ischemia grade I-0 (2.4% &lt;em&gt;versus&lt;/em&gt; 4.9%, &lt;em&gt;P&lt;/em&gt; &lt; 0.05) and I-2 (11.8% &lt;em&gt;versus&lt;/em&gt; 17.9%, &lt;em&gt;P&lt;/em&gt; &lt; 0.01), but a lower percentage in grade I-3 (69.7% &lt;em&gt;versus&lt;/em&gt; 59.8%, &lt;em&gt;P&lt;/em&gt; = 0.001). Depressed patients also had higher percentages in WIfI clinical stage 1 (5.1% &lt;em&gt;versus&lt;/em&gt; 9.8%, &lt;em&gt;P&lt;/em&gt; &lt; 0.01) and lower in stage 3 (23.2% &lt;em&gt;versus&lt;/em&gt; 16.5%, &lt;em&gt;P&lt;/em&gt; &lt; 0.05).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Depression is prevalent in almost one-third of CLTI patients and is associated with an increased risk of limb-loss. These findings underscore the opportunity for regimented depression screening and integrated psychosocial care in managing CLTI patients","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 146-153"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resveratrol Suppresses Sepsis-Induced Micro-vascular Hypo-Reactivity Through Rac1-MLCK Pathway","authors":"Yang Yang MS ,&nbsp;Jun-Chao Liu BS ,&nbsp;Zhen-Kui Liu MS ,&nbsp;Yu-Ping Zhang PhD ,&nbsp;Min Xi BS ,&nbsp;Hai-Ning Zheng MS ,&nbsp;Jing Wang PhD ,&nbsp;Zhen-Ao Zhao PhD ,&nbsp;Chun-Yu Niu PhD ,&nbsp;Zi-Gang Zhao PhD","doi":"10.1016/j.jss.2025.12.021","DOIUrl":"10.1016/j.jss.2025.12.021","url":null,"abstract":"<div><h3>Introduction</h3><div>Vascular hyporeactivity contributes to a high mortality rate in sepsis. Resveratrol (Res) exhibits anti-inflammatory properties and improves vascular reactivity in septic animals. However, the mechanism of action of Res in sepsis-induced vascular hyporeactivity is not fully understood.</div></div><div><h3>Methods</h3><div>A rat model of sepsis was established by intraperitoneal injection of fecal filtrate. Rats were divided into sham, sham + Res, sepsis, and sepsis + Res groups. Hemodynamic parameters, intestinal microcirculation (assessed by laser speckle contrast imaging and <em>in vivo</em> microcirculation imaging), and histopathological changes in intestinal and pulmonary tissues were evaluated. Vascular reactivity of isolated mesenteric micro-arteries was measured using a wire myograph system. The effects of serum from septic rats (SS) and Res-treated septic rats (SS-Res) on vascular smooth muscle cell viability and contractility were assessed <em>in vitro</em>. Protein expression of phosphorylated Ras-related C3 botulinum toxin substrate 1 and myosin light-chain kinase (p-MLCK) in vascular tissues were analyzed by western blotting. The roles of Ras-related C3 botulinum toxin substrate (Rac1) and MLCK were further verified using specific pharmacological activators and inhibitors.</div></div><div><h3>Results</h3><div>Res improved the general health status, alleviated lung and intestinal injuries, and restored intestinal hemoperfusion and vessel distribution in SS. In addition, Res suppressed sepsis-induced intestinal microvascular hyporeactivity to norepinephrine <em>in vitro</em>, whereas treatment with Res-treated septic rats increased the cellular viability and contractility of vascular smooth muscle cells compared to SS. Furthermore, Res reversed the upregulated Ras-related C3 botulinum toxin substrate 1 and downregulated p-MLCK expressions in the mesenteric artery tissue of SS. The Rac1 activator platelet-derived growth factor and inhibitor NSC 27366 partially inhibited vascular reactivity in SS, whereas the effect of NSC 27366 was blocked by the MLCK inhibitor ML-7.</div></div><div><h3>Conclusions</h3><div>Res suppressed sepsis-induced microvascular hyporeactivity through the Rac1-MLCK pathway, providing insights into the treatment of vascular hyporeactivity during sepsis.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 98-109"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatial Analysis in Surgical Research","authors":"Hongke Wu MD, MS, MPH ,&nbsp;Ye Liu MD, MPH, DrPH","doi":"10.1016/j.jss.2025.11.071","DOIUrl":"10.1016/j.jss.2025.11.071","url":null,"abstract":"<div><h3>Introduction</h3><div>Spatial analysis helps to understand geographic influences on surgical outcomes, healthcare access, and resource allocation.</div></div><div><h3>Materials and methods</h3><div>This commentary reviews spatial methods, including Kernel Density Estimation, indicators of spatial autocorrelation, spatial autoregression models, and Bayesian spatial modeling.</div></div><div><h3>Results</h3><div>Kernel Density Estimation and Local Moran's Index effectively identify geographic clusters of surgical complications. Spatial autoregression models quantify direct and indirect (spillover) effects, and Bayesian approaches provide stable estimates, especially for small-area studies. Despite these advantages, careful consideration of methodological challenges and limitations is crucial for accurate interpretation and application of spatial analytical findings in surgical research.</div></div><div><h3>Conclusions</h3><div>Spatial analysis provides powerful tools for examining geographic disparities in surgical care, but thoughtful application and interpretation are essential to ensure valid and actionable insights.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 193-199"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual-Mode Ventilation Promotes Diaphragm Function Recovery in Rats With Ventilator-Induced Diaphragmatic Dysfunction by Upregulating Insulin-Like Growth Factor-1","authors":"Xiao-Zhuo Zheng MD ,&nbsp;Lei Wu MD ,&nbsp;Qi Chen MM ,&nbsp;Xiao-Feng Lei MM ,&nbsp;Shu-Liang Guo MD","doi":"10.1016/j.jss.2025.12.024","DOIUrl":"10.1016/j.jss.2025.12.024","url":null,"abstract":"<div><h3>Introduction</h3><div>Ventilator-induced diaphragmatic dysfunction (VIDD) is associated with diaphragm atrophy and decreased contractility, leading to difficult weaning. Respiratory muscle training could prevent diaphragmatic dysfunction. IGF-1 is correlated with the enhancement of muscle mass and strength. The aim of this study was to investigate the effect of dual-mode ventilation (DMV) on diaphragm function recovery in VIDD rats, and to explore the role of insulin-like growth factor-1 (IGF-1) as an underlying mechanism.</div></div><div><h3>Methods</h3><div>Adult male Sprague–Dawley rats were used to establish the VIDD model and randomly divided into seven groups. Diaphragm morphology, myofiber cross-sectional area, diaphragm contractility, reactive oxygen species production, superoxide dismutase activity, IGF-1 expression and protein levels related to muscle differentiation and protein synthesis were examined. Adeno-associated virus transfection was used to downregulate IGF-1 expression. Overexpression of IGF-1 was performed by subcutaneous injection of rhIGF-1 to explore the possible mechanism.</div></div><div><h3>Results</h3><div>DMV increased myofiber cross-sectional area, improved diaphragm contractility, reduced reactive oxygen species production, enhanced superoxide dismutase activity, and upregulated the expression of Myod, Myogenin, MyHC, and a-actinin. DMV also upregulated the protein level of IGF-1 in the diaphragm of VIDD rats. <em>In vivo</em>, IGF-1 knockdown aggravated diaphragmatic dysfunction, increased oxidative stress injury, reduced protein synthesis and muscle differentiation, and decreased p-protein kinase B (Akt)/AKT and p-mammalian target of rapamycin (mTOR)/mTOR expression, while overexpression of IGF-1 reversed these changes.</div></div><div><h3>Conclusions</h3><div>DMV is beneficial for diaphragm function recovery. And IGF-1 plays an important role in DMV to enhance diaphragm mass and strength of VIDD rats, which may promote protein synthesis and muscle differentiation through activating Akt/mTOR signaling pathway.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 346-358"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146034671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re-evaluation of Blood Product Wastage From Massive Transfusion Protocol at a Level 1 Trauma Center: A Retrospective Cohort Study","authors":"Sandra M. Farach MD, MSPH ,&nbsp;Nathan Santiago ,&nbsp;Milad Behbahaninia MD ,&nbsp;Joby J. Chandy MD ,&nbsp;Emma Joiner MSc ,&nbsp;Jose J. Diaz MD ,&nbsp;Enrico Camporesi MD","doi":"10.1016/j.jss.2025.11.053","DOIUrl":"10.1016/j.jss.2025.11.053","url":null,"abstract":"<div><h3>Introduction</h3><div>Massive transfusion protocols (MTPs) are essential in the management of traumatic hemorrhage, enabling timely and standardized blood product delivery. This study evaluated whether blood component wastage after MTP activation has decreased compared with previously published institutional data.</div></div><div><h3>Materials and Methods</h3><div>We retrospectively reviewed 5072 trauma patients ≥18 y between January 2022 and September 2023, identifying 89 (1.8%) with MTP activation. Demographic and clinical data were analyzed. Wastage rates for packed red blood cells, fresh frozen plasma, and platelets were compared to 2015-2018 institutional data. Transfusion documentation discrepancies between the blood bank and the electronic medical record were also assessed. Continuous variables were analyzed with the Mann–Whitney <em>U</em> test and categorical variables with the chi-square or Fisher's exact test, with significance set at <em>P</em> &lt; 0.05.</div></div><div><h3>Results</h3><div>Of the 89 patients, 31 (34.8%) had wastage of at least one blood component. There were no significant demographic or clinical differences between patients with and those without wastage, including age, gender, injury type, Glasgow Comma Scale, injury severity score, MTP time, complications, discharge disposition, or mortality. Compared to previously published data, wastage significantly decreased for packed red blood cells (2.2% <em>versus</em> 1.2%), fresh frozen plasma (5.7% <em>versus</em> 2.3%), and platelets (13.7% <em>versus</em> 2.9%), all <em>P</em> &lt; 0.001. Documentation discrepancies occurred in 88.7% of activations, with 25.8% involving &gt;10-unit mismatches.</div></div><div><h3>Conclusions</h3><div>MTP blood product wastage has significantly decreased, reflecting sustained quality improvement. However, high documentation discrepancies highlight a critical target for process improvement.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 486-492"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limited Axillary Dissection for Substantial Breast Cancer Axillary Tumor Burden","authors":"Yaniv Berger MD ,&nbsp;Hila Meiri MD ,&nbsp;Nora Balint-Lahat MD ,&nbsp;Ronny Maman MD ,&nbsp;Yael Weksler MD ,&nbsp;Danny Rosin MD ,&nbsp;Ido Nachmany MD ,&nbsp;Mordechai Gutman MD ,&nbsp;Einav Nili Gal-Yam MD ,&nbsp;Roi Anteby MD ,&nbsp;Orit Kaidar-Person MD","doi":"10.1016/j.jss.2025.11.015","DOIUrl":"10.1016/j.jss.2025.11.015","url":null,"abstract":"<div><h3>Introduction</h3><div>The axillary surgical management in breast cancer is de-escalating but level 1 + 2 axillary lymph node dissection (ALND) remains the standard of care for substantial axillary tumor burden (SATB). We explored the outcomes of limited axillary dissection (LAD, defined as sentinel lymph node (SLN) sampling or level 1 ALND) for SATB.</div></div><div><h3>Methods</h3><div>We retrospectively identified SATB patients who underwent LAD between 2011 and 2020. SATB was defined as gross extracapsular extension, ≥3 positive SLNs, palpable lymphadenopathy, or ≥3 suspected nodes on preoperative imaging. Those who received neoadjuvant chemotherapy or had follow-up &lt;1 y were excluded.</div></div><div><h3>Results</h3><div>We reviewed 4904 breast cancer cases and identified 33 women with SATB (tumor size 19.0 ± 9.8 mm, infiltrating ductal carcinoma 78.8%, estrogen receptor positive 100%, cN+ 66.7%) undergoing LAD during which 2(1-6) positive nodes out of 5(1-11) total nodes were resected. The intended axillary surgery was SLN sampling in 66.7%. During a median follow-up of 6.1(1.2-9.9) years, two cases of distal recurrence occurred; the 5-y disease-, metastasis-, and locoregional-free survival rates were 95.7%, 95.7%, and 100%, respectively. Survival probabilities for two control groups—a matched group of SATB patients undergoing ALND (<em>n</em> = 50) and those presenting with low axillary tumor burden (LATB, <em>n</em> = 137) did not differ significantly (all <em>P</em> &gt; 0.3) when compared to SATB patients undergoing LAD. Higher KI67, larger tumor size, and omission of adjuvant radiotherapy correlated independently with disease recurrence among all node-positive patients (<em>n</em> = 249) undergoing axillary surgery.</div></div><div><h3>Conclusions</h3><div>Survival outcomes of LAD for SATB were comparable to ALND and to LATB patients, meriting further prospective investigation.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 217-225"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter Regarding: Gender Disparities in Career Longevity Among Surgeons and Physicians: A Decade-Long Analysis","authors":"Jordan Johnson BS,&nbsp;Georgios Karamitros MD, MS,&nbsp;Franklin R. Gergoudis MD,&nbsp;William C. Lineaweaver MD","doi":"10.1016/j.jss.2025.08.022","DOIUrl":"10.1016/j.jss.2025.08.022","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 602-603"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145687552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}