Journal of Surgical Research最新文献

{"title":"A National Analysis of the Economic Impact Associated With Fatal Injuries and Trauma Centers' Distribution","authors":"Hazem Nasef BS ,&nbsp;Nikita Nunes Espat MS ,&nbsp;Sanjan Kumar BS ,&nbsp;Ruth Zagales BS ,&nbsp;Brevin O'Connor BS ,&nbsp;Logan Rogers BS ,&nbsp;Quratulain Amin BS ,&nbsp;Adel Elkbuli MD, MPH, MBA","doi":"10.1016/j.jss.2025.09.032","DOIUrl":"10.1016/j.jss.2025.09.032","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aims to examine the epidemiological and economic impact of trauma centers’ distribution at the national level to achieve more equitable and cost-effective access to quality trauma care.</div></div><div><h3>Methods</h3><div>A cross-sectional study evaluating the epidemiological and economic impact of trauma centers’ distribution in the United States from 2018 to 2022, using the Web-based Injury Statistics Query and Reporting System, as well as state-level income data obtained from the United States Census Bureau. Study outcomes included the total cost of traumatic injuries and fatalities, associated personal income loss, state tax revenue loss, years of potential life lost (YPLL), and potential cost savings from increased access to advanced trauma care.</div></div><div><h3>Results</h3><div>The Midwest had the highest number of level I and II trauma centers, while the South had the lowest. Economic analysis showed that regions with higher trauma center density had lower per capita medical and life loss costs. Specifically, the Northeast had the lowest burden of fatal injuries and YPLL, while the South had the highest, associated with the lowest trauma center density. Within the South region, the lowest distribution of trauma centers was associated with the highest amount of lost state income tax revenue.</div></div><div><h3>Conclusions</h3><div>Regions with higher access to advanced trauma care were associated with lower costs of fatal injuries, including reduced personal income loss, state tax revenue loss, and YPLL, than regions with lower access. These findings underscore the economic and public health benefits of optimizing trauma center allocation, particularly in underserved regions.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 407-416"},"PeriodicalIF":1.7,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280681","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":"Comprehensive Review and Management Strategies of Airway Complications Post-lung Transplantation","authors":"Ming Yin MS ,&nbsp;Yu Liang MS ,&nbsp;Shixiong Wei PhD ,&nbsp;Anling Zhang PhD","doi":"10.1016/j.jss.2025.09.028","DOIUrl":"10.1016/j.jss.2025.09.028","url":null,"abstract":"<div><h3>Introduction</h3><div>Airway complications following lung transplantation are a major cause of morbidity (2%-18%) and mortality (2%-4%). These complications include necrosis, dehiscence, granulation tissue, bronchial stenosis, tracheobronchomalacia, fistulas, and infections. Donor bronchial ischemia, aggravated by poor graft preservation, prolonged mechanical ventilation, and donor–recipient size mismatch, is the primary driver. Although advances in bronchoscopic surveillance and endobronchial therapies have improved outcomes, airway complications remain a significant clinical challenge.</div></div><div><h3>Materials and Methods</h3><div>We performed a comprehensive review of the literature focusing on classification systems, risk factors, pathophysiology, diagnostic strategies, and management of airway complications post–lung transplantation. Emphasis was placed on recent innovations in surgical and bronchoscopic interventions, as well as consensus recommendations such as the International Society for Heart and Lung Transplantation classification system.</div></div><div><h3>Results</h3><div>Airway complications have decreased substantially in incidence compared to earlier decades, yet they continue to contribute to early and late post-transplant morbidity and mortality. Advances in organ preservation, refined surgical techniques, and early bronchoscopic surveillance have reduced ischemia-related complications. Endoscopic interventions such as balloon dilation, cryotherapy, and stenting remain cornerstones of management, while newer strategies including biodegradable stents, tissue-engineered scaffolds, and novel adhesives offer promise but require further validation. Despite these improvements, the absence of standardized bronchoscopic grading and the risk of stent-related complications remain key limitations.</div></div><div><h3>Conclusions</h3><div>Effective management of airway complications requires early detection and a multidisciplinary approach integrating surgery, interventional pulmonology, and optimized immunosuppression. While recent innovations have improved patient outcomes, consensus on standardized diagnostic systems and long-term strategies remains lacking. Continued research is essential to further reduce complication rates and improve the quality of life of lung transplant recipients.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 417-425"},"PeriodicalIF":1.7,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280312","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":"Fibrinogen in Resuscitation of Older Adult Trauma Patients: Are They Too Old to Receive New Adjuncts?","authors":"Muhammad Haris Khurshid MD,&nbsp;Mohammad Al Ma'ani MD,&nbsp;Omar Hejazi MD,&nbsp;Francisco Castillo Diaz MD,&nbsp;Adam Nelson MD, FACS,&nbsp;Tanya Anand MD, MPH, FACS,&nbsp;Christina Colosimo DO, MS, FACS,&nbsp;Stanley E. Okosun MD, MS, FACS,&nbsp;Louis J. Magnotti MD, MS, FACS,&nbsp;Bellal Joseph MD, FACS","doi":"10.1016/j.jss.2025.09.045","DOIUrl":"10.1016/j.jss.2025.09.045","url":null,"abstract":"<div><h3>Introduction</h3><div>Trauma-induced coagulopathy occurs in a quarter of injured patients and increases the risk of mortality. Recent studies suggest that fibrinogen supplementation (FS), when used as an adjunct for resuscitation, is associated with improved outcomes. There is a lack of data on the role of pharmacologic adjuncts in hemorrhaging older adult (OA) trauma patients. The aim of our study was to compare the outcomes of patients receiving FS as an adjunct to the standard of care among OA <em>versus</em> young adult (YA) trauma patients.</div></div><div><h3>Methods</h3><div>We performed a 4-y (2017-2020) retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program database. All adult (age ≥18 y) trauma patients with a shock index &gt; 1 who received early (≤4 h) FS, including fibrinogen concentrate (FC) or cryoprecipitate (Cryo), were included. We excluded patients dead on arrival, those transferred from other facilities, those with bleeding disorders or chronic liver disease, and those on preinjury anticoagulation. Patients were stratified into YA (18-64 y) and OA (≥ 65 y). Primary outcomes were 6-h and 24-h mortality. Secondary outcomes were included in-hospital mortality, major complications, and 4-h blood transfusion requirements. Multivariable regression analyses were performed to identify the independent association of age on the outcomes.</div></div><div><h3>Results</h3><div>A total of 7103 patients were identified, of which 999 (14.06%) were OA. On presentation, the mean shock index was 1.4, and both study groups had comparable median Injury Severity Score. The median time to FC and Cryo administration was 59 and 120 min, respectively. Overall, the rates of 6-h, 24-h, and in-hospital mortality were 11.1%, 20.6%, and 38.9%, respectively. On multivariable regression analysis, age was not associated with 6-h mortality (adjusted odds ratio [aOR]: 1.20, 95% confidence interval [CI] [0.95-1.52], <em>P</em> = 0.125), 24-h mortality (aOR: 1.12, 95% CI [0.87-1.43], <em>P</em> = 0.379), and major complications (aOR: 0.79, 95% CI [0.83-1.27], <em>P</em> = 0.125). However, OA had independently higher risk-adjusted odds of in-hospital mortality (aOR: 1.96, 95% CI [1.59-2.41], <em>P</em> &lt; 0.001). Notably, older age was associated with a 5.27-unit decrease in packed red blood cell, 2.82-unit decrease in fresh frozen plasma , and 1.63-unit decrease in platelet requirements at 4 h. A subanalysis of patients receiving Cryo (<em>n</em> = 6409) or FC (<em>n</em> = 694) showed the same trend of outcomes.</div></div><div><h3>Conclusions</h3><div>FS was associated with early outcomes that were broadly comparable between OA and YA. Despite higher in-hospital mortality, older age was associated with a reduction in blood product transfusion compared with younger patients.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 426-434"},"PeriodicalIF":1.7,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280487","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":"Intraoperative Indocyanine Green Angiography Use for Perfusion Assessment in Immediate Breast Reconstruction Is Associated With Reduced Reoperation and Takeback","authors":"Artur Manasyan BS,&nbsp;Jacqueline Stoneburner MD MBA,&nbsp;Erin M. Wolfe MD,&nbsp;Idean Roohani BS,&nbsp;Michael I. Kim BS,&nbsp;Eloise W. Stanton MD,&nbsp;Emma Koesters MD,&nbsp;David A. Daar MD MBA","doi":"10.1016/j.jss.2025.09.048","DOIUrl":"10.1016/j.jss.2025.09.048","url":null,"abstract":"<div><h3>Background</h3><div>Immediate breast reconstruction has higher rates of complications than delayed breast reconstruction, in part due to the risks of mastectomy flap necrosis and adequate flap perfusion in implant-based and autologous reconstruction. This study analyzes the impact of indocyanine green (ICG) on 30-d surgical outcomes among patients who underwent immediate breast reconstruction on a national scale.</div></div><div><h3>Methods</h3><div>A retrospective review was performed using the National Surgical Quality Improvement Program data sets from 2005 to 2022. Multivariable logistic regressions were performed to assess the impact of ICG angiography on surgical outcomes. All regression models demonstrated adequate fit (all <em>P</em> &lt; 0.001).</div></div><div><h3>Results</h3><div>Among 11,574,114 patients in the National Surgical Quality Improvement Program database, 11,201 patients underwent immediate breast reconstruction, and 287 (2.6%) of whom underwent intraoperative ICG angiography. ICG angiography was more commonly used in implant-based <em>versus</em> autologous reconstruction (13.7% <em>versus</em> 9.4%, <em>P</em> = 0.035) and in patients with American Society of Anesthesiologists class III or higher (37.3% <em>versus</em> 26.6%, <em>P</em> &lt; 0.001). Multivariable regressions determined that using intraoperative ICG angiography was associated with reduced risk of operation room takebacks by 14.3-fold (odds ratio 0.07 [95% confidence interval 0.01-0.51], <em>P</em> = 0.008) and 30-d reoperation by 4.8-fold (odds ratio 0.21 [95% confidence interval 0.07-0.65], <em>P</em> = 0.007).</div></div><div><h3>Conclusions</h3><div>ICG angiography may be useful in immediate breast reconstruction, especially for patients of higher American Society of Anesthesia class. Surgeons may be more inclined to use this technology to assess mastectomy flap quality in immediate implant-based reconstruction rather than autologous reconstruction.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 376-380"},"PeriodicalIF":1.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268466","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":"Stitching the Story: Third-Y Clerkship Impact on Applicants to General Surgery Residency","authors":"Aaron L. Albuck BS ,&nbsp;Alison K. Mortemore BS, MS ,&nbsp;Ariel Kesick BS, MPP ,&nbsp;Jacquelyn Turner MD, FACS, FASCRS","doi":"10.1016/j.jss.2025.09.027","DOIUrl":"10.1016/j.jss.2025.09.027","url":null,"abstract":"<div><h3>Introduction</h3><div>Medical students' clerkship experiences play a crucial role in shaping specialty interests. Factors such as mentorship, autonomy, and meaningful patient care contribute to clerkship quality and career decisions. Previous studies suggest that positive interactions with residents and attendings significantly influence students' likelihood of pursuing a specialty. This study evaluates key clerkship factors associated with students' interest in general surgery, focusing on mentorship, clinical exposure, and academic performance.</div></div><div><h3>Methods</h3><div>This retrospective study was conducted at a single medical school, analyzing data from students who completed their third-year surgical clerkship between May 2023 and December 2024. A deidentified survey assessed students' specialty preferences, clerkship timing, service assignments, team structures, and subjective factors influencing specialty choice. Performance data from the surgery shelf exam and clerkship grades were analyzed for associations.</div></div><div><h3>Results</h3><div>Among 144 respondents (27.6% response rate), 23.7% applied to general surgery. At the start of the third y, 18.0% were not interested in surgery, 39.6% were open-minded, 36.8% were interested, and 4.9% were committed. Notably, students exposed to postgraduate year-1 residents had a significantly higher likelihood of applying (odds ratio 1.887, <em>P</em> = 0.046). Direct participation in cases (60.6%), interactions with residents (56.7%), and faculty mentorship (52.0%) were key factors, whereas long work hours negatively impacted the interest.</div></div><div><h3>Conclusions</h3><div>This study highlights that direct clinical exposure, mentorship from junior residents, and active case participation strongly influence medical students' interest in general surgery. Although academic performance did not significantly impact specialty selection, subjective experiences and the quality of interactions played a pivotal role.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 400-406"},"PeriodicalIF":1.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268562","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":"Presensitization Accelerates Antibody-Mediated Rejection in Mouse Intestinal Transplantation","authors":"Takuro Fujita MD,&nbsp;Hajime Matsushima MD, PhD,&nbsp;Taichiro Kosaka MD, PhD,&nbsp;Daisuke Miyamoto PhD,&nbsp;Akihiko Soyama MD, PhD,&nbsp;Takanobu Hara MD, PhD,&nbsp;Tomohiko Adachi MD, PhD,&nbsp;Kengo Kanetaka MD, PhD,&nbsp;Susumu Eguchi MD, PhD","doi":"10.1016/j.jss.2025.09.060","DOIUrl":"10.1016/j.jss.2025.09.060","url":null,"abstract":"<div><h3>Introduction</h3><div>The presence of donor-specific antibodies (DSAs) is a risk factor for antibody-mediated rejection (AMR) in the context of organ transplantation. However, the mechanisms and clinical characteristics of AMR in intestinal transplantation remain poorly understood, largely due to a lack of suitable animal models. In the present study, we performed intestinal transplantation in presensitized murine recipients as a model of AMR to better understand how this phenomenon contributes to graft rejection.</div></div><div><h3>Methods</h3><div>Skin from donor B6 mice was grafted onto the backs of recipient C3H mice. The presensitized C3H mice then received intestinal allografts from B6 mice 14 ds later. The presensitized and nonsensitized mice were compared in terms of their circulating DSAs levels and their intestinal allograft characteristics at various time points.</div></div><div><h3>Results</h3><div>Flow cytometric analysis showed that circulating DSA levels increased over time in the presensitized recipients. Moreover, the presensitized recipients exhibited more severe intestinal graft rejection at day 4 post-transplantation than the nonsensitized mice. Although immunostaining revealed no significant difference in the numbers of infiltrating CD4⁺ and CD8⁺ cells between the groups post-transplantation, the numbers of infiltrating CD20⁺ and CD68⁺ cells were significantly higher in the presensitized recipients. Furthermore, C3 and C4 deposition on the microvascular endothelium of intestinal allografts and capillaritis were observed after transplantation.</div></div><div><h3>Conclusions</h3><div>We successfully established a presensitized mouse model of AMR in the context of intestinal transplantation. Our model will be valuable in elucidating the mechanisms underlying AMR and exploring strategies for managing this phenomenon to improve the outcomes of intestinal transplantation.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 390-399"},"PeriodicalIF":1.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268070","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":"Under Pressure: Rapid Infusion of Stored Whole Blood Alters Coagulation Parameters","authors":"Ellen R. Becker MD,&nbsp;Ryan C. Chae MD,&nbsp;Adam D. Price MD,&nbsp;Lindsey J. Wattley MD,&nbsp;Rebecca M. Schuster MS,&nbsp;Michael D. Goodman MD,&nbsp;Timothy A. Pritts MD, PhD","doi":"10.1016/j.jss.2025.07.067","DOIUrl":"10.1016/j.jss.2025.07.067","url":null,"abstract":"<div><h3>Introduction</h3><div>The use of normothermic rapid transfusers to deliver high volumes of warmed blood products to hemorrhaging patients is common practice. However, the effects of these transfusers on the coagulation profile of stored compared to fresh whole blood has not been studied.</div></div><div><h3>Methods</h3><div>Units of fresh whole blood and blood stored for 21 days were acquired from our local blood bank. Rapid infusion was simulated using a Level 1 H-1200 at 42°C and 300 mmHg of pressure. Samples were taken preinfusion and postinfusion and examined for cell counts, biochemical changes, viability, viscoelastic properties, and microvesicle concentrations.</div></div><div><h3>Results</h3><div>Fresh whole blood was unaffected by rapid infusion in all end points. In contrast, rapid infusion of stored whole blood resulted in significantly higher levels of free hemoglobin (63 ± 25 mg/mL preinfusion to 101 ± 41 mg/mL postinfusion, <em>P</em> = 0.0025), decreased platelet contribution to clot (73 ± 5% to 66 ± 6%, <em>P</em> = 0.0075), decreased platelet aggregation (10.1 ± 5.5 to 6.0 ± 3.7 area under the curve with arachidonic acid, <em>P</em> = 0.03), and increased platelet derived microvesicles (164 ± 151 to 260 ± 163 events/μL, <em>P</em> = 0.01). Platelet and platelet microvesicle concentrations expressing CD62 in stored whole blood remained unchanged postinfusion (<em>P</em> &gt; 0.05).</div></div><div><h3>Conclusions</h3><div>Infusion of stored whole blood via a rapid infuser resulted in hemolysis, platelet dysfunction, and increased platelet-derived microvesicles. We suspect that platelet destruction due to pressurized infusion leads to an increase in microvesicle concentration and a subsequently altered coagulation profile.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 381-389"},"PeriodicalIF":1.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268966","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":"Response to \"Letter Regarding: The Performance of ChatGPT-4.0 and ChatGPT-4omni on Answering Thyroid Question: A Multicenter Study\".","authors":"Siyin Guo, Genpeng Li, Juxiang Gou, Yanping Gong, Wanjun Zhao, Zhiqiang Li, Xianwei Yang, Zhenni Liu, Zhihui Li, Jianyong Lei","doi":"10.1016/j.jss.2025.09.030","DOIUrl":"https://doi.org/10.1016/j.jss.2025.09.030","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275013","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":"Quality of Life and Functional Outcomes After Watch-and-Wait for Locally Advanced Rectal Cancer: A Meta-Analysis","authors":"Racquel S. Gaetani MD, MSc,&nbsp;Sowmya Sharma MD,&nbsp;Tasneem Zaihra Rizvi PhD,&nbsp;Jonathan S. Abelson MD, MSc","doi":"10.1016/j.jss.2025.09.019","DOIUrl":"10.1016/j.jss.2025.09.019","url":null,"abstract":"<div><h3>Introduction</h3><div>Watch-and-wait (W&amp;W), which involves total neoadjuvant therapy followed by close observation, has emerged as an alternative to total mesorectal excision for patients with locally advanced rectal cancer who achieve a clinical or near-complete response. This approach aims to preserve bowel function and avoid the morbidity associated with radical surgery.</div></div><div><h3>Methods</h3><div>This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane guidelines. Eligible studies included randomized trials and observational studies of patients with locally advanced rectal cancer treated with total neoadjuvant therapy, followed by either W&amp;W or total mesorectal excision. The primary outcome was quality of life (QoL), assessed using validated instruments (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30, Quality of Life Questionnaire-CR29, Fecal Incontinence Quality of Life). Secondary outcomes included bowel function among patients without an ostomy, using validated measures such as Cleveland Clinic Florida Fecal Incontinence Scores, Vaizey, Memorial Sloan Kettering Cancer Center, and low anterior resection syndrome scores. A comprehensive search of PubMed, EMBASE, Medline, and Web of Science (Sept 2023-May 2025) was performed without language or date restrictions. Abstract/full-text screening, data extraction, and risk of bias assessments were conducted independently by two reviewers. Meta-analyses used inverse-variance weighting under a random-effects model. Data unsuitable for meta-analysis were synthesized narratively.</div></div><div><h3>Results</h3><div>Of 617 screened studies, 28 were reviewed in full and 9 met inclusion criteria (total 923 patients). Meta-analysis of five studies (<em>n</em> = 601) with no statistically significant difference in overall QoL between groups (pooled mean difference = 0.10, 95% confidence interval: −0.19 to 0.39, <em>P</em> = 0.49). However, pooled analysis of fecal incontinence scores from four studies (<em>n</em> = 384) showed a significant advantage for W&amp;W (pooled mean difference = −1.10, 95% confidence interval: −1.50 to −0.73, <em>P</em> &lt; 0.001). Qualitative synthesis of low anterior resections syndrome scores outcomes favored W&amp;W.</div></div><div><h3>Conclusions</h3><div>W&amp;W, offers a functional advantage without compromising QoL. The decision to pursue W&amp;W should be individualized, considering both the potential functional benefits and the oncological risks.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 362-375"},"PeriodicalIF":1.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268563","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":"Effects of Irrigation With Normal Saline on Traumatic Brain Injury Combined With Seawater Immersion in Rats.","authors":"Yang Yang, Li Chen, Pengwei Hou, Xia Yu, Tianshun Feng, Yuhui Chen, Yongjun Xu, Shousen Wang","doi":"10.1016/j.jss.2025.09.017","DOIUrl":"https://doi.org/10.1016/j.jss.2025.09.017","url":null,"abstract":"<p><strong>Introduction: </strong>With the integrated development of the global economy, various economic activities in marine environments are also expanding, along with the number of offshore employees. However, the increased risk of accidental falling and collisions at sea may lead to traumatic brain injury (TBI) accompanied by seawater immersion (SI). The high permeability and alkalinity of seawater increase the risk of TBI and damage to the blood-brain barrier (BBB), which can indirectly result in excessive neuroinflammation, brain edema, and neuronal cell death.</p><p><strong>Methods: </strong>A well-characterized rat model of TBI + SI induced by controlled cortical impact combined with SI was established. After successful modeling, three different concentrations of sodium chloride (NaCl) solutions were used to irrigate the wound site to assess the effects on rats with early TBI complicated with SI.</p><p><strong>Results: </strong>The results showed that irrigation with 0.9% NaCl (normal saline [NS]) significantly reduced neurological dysfunction, reduced brain edema, and inhibited neuroinflammatory response in rats with TBI combined with SI. However, irrigation with 3% NaCl (3% hypertonic saline) aggravated the injury, whereas 0.45% NaCl (half-NS) had no obvious improvement. Irrigation with NS can neutralize the high alkalinity of seawater and prevent further damage to the BBB. Irrigation with NS caused fewer morphological changes to the neuronal mitochondria and prevented further damage, suggesting that NS was the most suitable rinse solution.</p><p><strong>Conclusions: </strong>SI can cause damage to the BBB, neuroinflammation, and neuronal cell death after TBI. Restoration of the injured BBB is a promising strategy for the treatment of TBI combined with SI.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275064","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}