Journal of Surgical Research最新文献

{"title":"Polyvinyl Alcohol Sponges Reduce Intraperitoneal Adhesions After Abdominal Surgery","authors":"Donna C. Koo MD ,&nbsp;P. Nina Scalise MD ,&nbsp;Claire A. Ostertag-Hill MD ,&nbsp;Abbie E. Naus MD ,&nbsp;Jonathan M. Durgin MD ,&nbsp;Megan Z. Chiu MD ,&nbsp;Melissa Mejia Bautista MD ,&nbsp;Kamila Moskowitzova MD ,&nbsp;Steven J. Staffa MS ,&nbsp;Gabriel Ramos Gonzalez MD ,&nbsp;Alyaa Al-Ibraheemi MD ,&nbsp;Eliza J. Lee MD ,&nbsp;Farokh R. Demehri MD ,&nbsp;Heung Bae Kim MD","doi":"10.1016/j.jss.2025.02.005","DOIUrl":"10.1016/j.jss.2025.02.005","url":null,"abstract":"<div><h3>Introduction</h3><div>The use of cotton sponges in the operating room has been linked to intraperitoneal adhesion formation. Inert, nonlinting polyvinyl alcohol (PVA) sponges have been used as an alternative to reduce intraoperative tissue trauma and particle remnants in other surgical fields. We investigate the effect of PVA sponges on reducing postoperative intraperitoneal adhesions in a murine model.</div></div><div><h3>Methods and methods</h3><div>In total, 189 C57BL/6 mice were randomly divided into three groups by abdominal packing intervention. Following laparotomy on day 0, the abdominal cavity was packed with cotton gauze (<em>n</em> = 53), PVA wipe (<em>n</em> = 54), or no packing (sham; <em>n</em> = 58) for three rounds of 10 min each before packing was removed. Mice were euthanized, and necropsies were performed between postoperative days 13-15. Adhesions were graded by two blinded observers using a validated system composed of adhesion extent, tenacity, and density. Adhesion scores were compared between the three groups.</div></div><div><h3>Results</h3><div>Compared to adhesions in gauze-packed mice, adhesions in PVA-packed mice were significantly less extensive, less tenacious, and less dense (<em>P</em> &lt; 0.001 for all), which equated to lower total adhesion scores in PVA-packed mice (0 [0, 3] <em>versus</em> 5 [2, 7], <em>P</em> &lt; 0.001). The adhesion scores for sham group mice were significantly lower than PVA and gauze mice in all categories.</div></div><div><h3>Conclusions</h3><div>This is the first study to directly compare postoperative intra-abdominal adhesion formation following the use of gauze and PVA sponges in an animal model. PVA sponges significantly reduce postoperative adhesions when compared to standard cotton gauze sponges. PVA should be further explored as a useful alternative to reduce postoperative adhesion-related morbidity.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"308 ","pages":"Pages 183-192"},"PeriodicalIF":1.8,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628805","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":"The COVID-19 Pandemic and Delays in Melanoma Treatment: A National Cancer Database Study","authors":"Sophie H. Chung MD,&nbsp;Jacob L. Leung BA,&nbsp;Kelsey S. Romatoski MD,&nbsp;Gordana Rasic MD, MS,&nbsp;Anna J. Kobzeva-Herzog MD,&nbsp;Jennifer F. Tseng MD, MPH, FACS,&nbsp;Kelly Kenzik MS, PhD,&nbsp;Teviah E. Sachs MD, MPH, FACS","doi":"10.1016/j.jss.2025.02.018","DOIUrl":"10.1016/j.jss.2025.02.018","url":null,"abstract":"<div><h3>Introduction</h3><div>Timely treatment for patients with melanoma is critical. This study evaluated associations between the COVID-19 pandemic and time to treatment for patients with melanoma and delineated factors associated with delayed treatment.</div></div><div><h3>Methods</h3><div>Using the National Cancer Database, patients with cutaneous melanoma were categorized using year of diagnosis: COVID era (2020) versus pre-COVID era (2018-2019). Multivariable logistic regression was used to estimate the odds of delayed time to surgery (DTS) and/or chemoimmunotherapy (DTC), defined as &gt;30 d.</div></div><div><h3>Results</h3><div>Among 72,590 patients with melanoma, 71.2% were diagnosed in the pre-COVID era (25,210 in 2018; 26,471 in 2019) compared to 28.8% diagnosed in the 2020 COVID era. Of the COVID era patients, 40.4% received COVID-19 testing, with 5.7% having a positive result. COVID era patients were diagnosed at a later stage (3 and 4), 7.4% <em>versus</em> 6.6%. While overall DTS decreased for COVID era patients, a higher proportion of patients tested for COVID experienced longer DTS. In multivariable logistic analysis, male sex, Black race, Hispanic ethnicity, uninsured or underinsured status, less education, stage &gt; 1, and treatment locations in the Northeast, West, and South were associated with DTS. COVID era diagnosis was not associated with DTC; however, uninsured or underinsured status and treatment in the South were associated with DTC.</div></div><div><h3>Conclusions</h3><div>The pandemic was not associated with overall delays in treatment for melanoma; however, vulnerable populations and certain geographic areas experienced disproportionate differences in treatment timing. The potential long-term associations between delayed treatment and outcomes warrant further investigation, especially for marginalized populations.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"308 ","pages":"Pages 141-152"},"PeriodicalIF":1.8,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628807","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":"Small Bite Fascial Closure Technique Associated With Reduction in Fascial Dehiscence","authors":"Jinman Cai MD ,&nbsp;James G. Kwok BS ,&nbsp;Catherine A. Buck MS ,&nbsp;Andrew T. King BS ,&nbsp;Mamata R. Tokala BS ,&nbsp;Katie L. Bower MD ,&nbsp;Joshua D. Stodghill DO ,&nbsp;Bryan R. Collier DO ,&nbsp;Jacob R. Gillen MD","doi":"10.1016/j.jss.2025.02.013","DOIUrl":"10.1016/j.jss.2025.02.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Abdominal fascial dehiscence (FD) is a postoperative complication with significant morbidity and mortality. The incidence of FD exceeded the national average at our institution. As small bite fascial closure technique has been shown to decrease dehiscence rate compared with traditional 10 mm bites in elective low-risk populations, we hypothesized that a 5 mm bite and 5 mm travel fascial closure technique would be associated with a lower FD rate in patients undergoing both elective and emergent laparotomy at our institution.</div></div><div><h3>Methods</h3><div>Patients undergoing an operation requiring a midline laparotomy were identified. Cohort periods were defined as preintervention (January 6, 2019, to May 31, 2021) and postintervention (April 1, 2022, to June 30, 2023). Intervention consisted of simulation laboratory education and training for surgical residents and faculty regarding small bite fascial closure technique. Demographics and outcomes were compared. The primary outcome was FD as identified by Patient Safety Indicator 14 or International Classification of Diseases, Tenth Revision, code and confirmed via chart review. Statistical comparisons were performed using either Kruskal–Wallis analysis of variance or Fisher's exact test (<em>P</em> &lt; 0.05). Regression analysis was performed to estimate the effects of various predictors on the log odds of the outcome.</div></div><div><h3>Results</h3><div>There were 1611 patients in the preintervention cohort and 906 patients in the postintervention cohort. Demographics and outcomes were similar between the two cohorts. The average body mass index was 29 kg/m² in both groups. The dehiscence rate significantly decreased from preintervention to postintervention based on the both International Classification of Diseases, Tenth Revision (2.05% <em>versus</em> 0.88%, <em>P</em> = 0.029) and Patient Safety Indicator 14 definitions (0.99% <em>versus</em> 0.22%, <em>P</em> = 0.028).</div></div><div><h3>Conclusions</h3><div>This study demonstrated that the small bite and small travel fascial closure technique was associated with a significant reduction in the rate of FD in patients undergoing laparotomy at our institution in an overweight patient population. This technique offers a teachable and low-cost method to mitigate this complication.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"308 ","pages":"Pages 153-160"},"PeriodicalIF":1.8,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628808","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":"Prevention of Open Surgical Treatment Complications of Patients with Occlusive Lesions of the Aortoiliac Segment","authors":"Merey Imanbayev MSc ,&nbsp;Zhassulan Kozhakhmetov MSc ,&nbsp;Yerlan Salmenbayev MSc ,&nbsp;Dina Toleutayeva PhD ,&nbsp;Yernur Kazymov MSc","doi":"10.1016/j.jss.2025.02.006","DOIUrl":"10.1016/j.jss.2025.02.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Surgical procedures on large arteries are associated with an increased likelihood of complications and a long rehabilitation period, making it extremely important to reduce the risks of such operations. The study aims to examine various aspects of preventing complications of surgical treatment, including preoperative preparation, intraoperative management, postoperative observation, and analysis of factors that determine treatment outcomes.</div></div><div><h3>Methods</h3><div>The present study used clinical data from 300 patients undergoing surgical treatment of aortoiliac segment occlusion to evaluate the effectiveness of preoperative correction. The study was conducted over 3 ys, from 2018 to 2023, at the university clinic of the nonprofit joint-stock company Semey Medical University.</div></div><div><h3>Results</h3><div>The study found that preoperative optimization, including medical correction of diabetes mellitus and chronic obstructive pulmonary disease, led to improved functional performance in patients. In the group of patients who underwent preoperative correction, intraoperative complications were recorded in only 12% of patients, while in the control group, where such correction was not performed, this figure reached 24%. A similar trend was observed concerning postoperative complications: 18% compared to 34% in the control group.</div></div><div><h3>Conclusions</h3><div>Multiple logistic analyses confirmed the critical role of diabetes mellitus and chronic obstructive pulmonary disease as risk factors for postoperative complications, emphasizing the need to address these conditions before surgery. The practical significance of the study is to confirm the need for preoperative drug correction to reduce the risk of intraoperative and postoperative complications and improve the outcomes of surgical treatment of aortoiliac segment occlusion.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"308 ","pages":"Pages 102-111"},"PeriodicalIF":1.8,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620781","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":"Treatment of Noncompressible Torso Hemorrhage With Thermoreversible Intra-abdominal Foam: A Dose-response Study in a Porcine Model","authors":"Ross I. Donaldson MD, MPH ,&nbsp;Aslam A. Akhtar MD, PhD ,&nbsp;Oliver J. Buchanan BSc ,&nbsp;Todd L. Graham MS ,&nbsp;Maja Engler BS ,&nbsp;Jonathan K. Armstrong PhD ,&nbsp;John S. Cambridge PhD ,&nbsp;Diane Goldenberg PhD ,&nbsp;Juliana Tolles MD, MHS ,&nbsp;David A. Tanen MD ,&nbsp;James D. Ross PhD","doi":"10.1016/j.jss.2025.02.003","DOIUrl":"10.1016/j.jss.2025.02.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Noncompressible torso hemorrhage (NCTH) leads to significant mortality in civilian settings where transport to a trauma center may be delayed and is also the leading cause of exsanguination on the battlefield. Fast Onset Abdominal Management (F.O.A.M.) is a medical device under development that deploys a rapidly expanding thermoreversible foaming agent from a prefilled pressurized canister via an autostopping needle inserted into the peritoneal cavity. Previous pilot and safety studies in porcine models of NCTH have shown that F.O.A.M. increased survival and reached desired intra-abdominal pressure endpoints without significant adverse effects. However, the optimal intra-abdominal deployment pressure for the foaming agent is yet to be determined.</div></div><div><h3>Methods</h3><div>In this prospective study, NCTH was modeled using a modified Ross–Burns swine model wherein a grade IV-V liver laceration was made in 40 animals. Each F.O.A.M. device was set to deliver agent to a preset intra-abdominal goal pressure. The pressure for the initial cohort was 60 mmHg and the experimental pressure for each subsequent cohort of animals was selected to be the pressure with the highest posterior probability of being the minimum effective pressure based on an ordinal Bayesian continual reassessment method.</div></div><div><h3>Results</h3><div>After the allocation of animals to various pressures delivered by the F.O.A.M. device ranging between 50 and 80 mmHg, 33/40 swine had interpretable outcomes (e.g., technically successful device deployments). Based on <em>a priori</em> exclusion criteria, 7 animals were excluded from the analysis, four based on prototype device failure, and three based on off-target needle administration. At the final analysis, two pressures (70 mmHg and 80 mmHg) remained in the 95% credible interval.</div></div><div><h3>Conclusions</h3><div>Pressure is the gold standard for effective tamponade of bleeding. In this dose-finding study of the F.O.A.M. device for intra-abdominal tamponade of NCTH in a porcine model, we found a 95% posterior probability that either 70 mmHg or 80 mmHg is the minimum effective pressure as defined in our model. Future studies will be needed to assess long-term survival and adverse events at this pressure.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"308 ","pages":"Pages 95-101"},"PeriodicalIF":1.8,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors and Trends of Hemorrhage After Bariatric Surgery Using Two Large National Datasets: A Retrospective Observational Study","authors":"Charles M. Quinn BS ,&nbsp;Zachary D. Leslie ,&nbsp;Jeana Schafer BS ,&nbsp;Sayeed Ikramuddin MD MHA ,&nbsp;Eric S. Wise MD MA","doi":"10.1016/j.jss.2025.02.020","DOIUrl":"10.1016/j.jss.2025.02.020","url":null,"abstract":"<div><h3>Introduction</h3><div>The National Inpatient Sample (NIS) is a comprehensive representative database for inpatient hospitalizations; the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database aggregates surgical outcomes from nationally accredited bariatric surgical programs. There has been no comparison of postoperative hemorrhage rates nor a comparison of predictors of hemorrhage between the two databases. The aim of this study was to compare trends and predictors of significant hemorrhage after bariatric surgery using two national databases.</div></div><div><h3>Methods</h3><div>The core NIS files of the Healthcare Cost and Utilization Project and the MBSAQIP Participant Use Data Files from 2016 to 2021 were concatenated, and vertical sleeve gastrectomy and Roux-en-Y gastric bypass procedures were included. Trends in a 3-d postoperative hemorrhage requiring blood transfusion were derived from both datasets. Demographic, comorbidity, and other health factors were analyzed to construct multivariable logistic regression models.</div></div><div><h3>Results</h3><div>Briefly, 204,866 and 1,029,979 patients were identified in the NIS and MBSAQIP, respectively, and 3-d inpatient blood transfusion rates were 0.48% and 0.64%. Anticoagulants, Black race, diabetes, and increased age were associated with higher risk of a blood transfusion in both datasets. Vertical sleeve gastrectomy had a lower transfusion risk than Roux-en-Y gastric bypass (NIS: odds ratio: 0.62; 95% confidence interval [0.53, 0.71], <em>P</em> &lt; 0.05; MBSAQIP: odds ratio: 0.52 [0.49, 0.55], <em>P</em> &lt; 0.05). The NIS reported consistently lower annual 3-d transfusion rates relative to the MBSAQIP.</div></div><div><h3>Conclusions</h3><div>Health care professionals should be aware of the associated risk factors for blood transfusion after bariatric surgery. Most blood transfusions occurred during the initial hospitalization.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"308 ","pages":"Pages 86-94"},"PeriodicalIF":1.8,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620779","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":"Optimizing Efficacy of Vacuum Bell Therapy for Pectus Excavatum: Compliance is Key","authors":"Donna C. Koo MD ,&nbsp;P. Nina Scalise MD ,&nbsp;Megan Z. Chiu MD ,&nbsp;Erik Banda BS ,&nbsp;Gheed Murtadi MBBS ,&nbsp;Kelly Bartkus MSN ,&nbsp;John Gironda PA-C ,&nbsp;Samantha Pillen BSN ,&nbsp;Steven J. Staffa BS ,&nbsp;Konstantinos Papadakis MD ,&nbsp;Craig W. Lillehei MD ,&nbsp;Tom Jaksic MD ,&nbsp;Farokh R. Demehri MD","doi":"10.1016/j.jss.2025.02.012","DOIUrl":"10.1016/j.jss.2025.02.012","url":null,"abstract":"<div><h3>Introduction</h3><div>Pectus excavatum (PE) is the most common congenital chest wall deformity. The vacuum bell (VB) is a nonoperative alternative to surgical correction. We reviewed our center's experience with VB for PE to identify variables associated with improved therapeutic success, with a focus on compliance to prescribed VB therapy.</div></div><div><h3>Methods</h3><div>We conducted a single-center retrospective review of patients with PE who initiated VB therapy from August 2020 to August 2023. Patients who were fully compliant with therapy (defined as 28 h/week) were compared to patients who were noncompliant (&lt;27 h/week). Multivariable linear regression was used to identify factors predictive of pectus excavatum depth (PED) correction.</div></div><div><h3>Results</h3><div>Fifty-seven patients (86% male) initiated VB therapy. Of these, 22 patients (38.6%) were compliant with prescribed VB usage and 35 (61.4%) were noncompliant. There was a significant difference in PED correction between compliant and noncompliant groups (28.0% <em>versus</em> 16.0%, <em>P</em> &lt; 0.001). Hours of VB usage per week was the strongest predictor of PED correction (<em>P</em> = 0.023). Days of treatment and lower initial Haller index also significantly predicted PED correction (<em>P</em> = 0.036 and <em>P</em> = 0.043, respectively), while height, weight, age, sex, and initial PED were not significant predictors.</div></div><div><h3>Conclusions</h3><div>Although age and initial PED are thought to affect VB efficacy, our data demonstrates that when compliance with therapy is factored, these variables do not significantly predict therapeutic success. Therefore, for a highly compliant patient, VB therapy can be effective regardless of age or severity.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"308 ","pages":"Pages 112-121"},"PeriodicalIF":1.8,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620780","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":"The Impact of a Surgical Career on the Relationship, Family, and Personal Well-being of Surgeons’ Partners","authors":"Christina M. Stuart MD ,&nbsp;Nicole M. Mott MD, MSCR ,&nbsp;Alison Halpern Mungo MD ,&nbsp;Zachary P. Asher PA-C ,&nbsp;Robert A. Meguid MD, MPH ,&nbsp;Elizabeth A. David MD, MAS","doi":"10.1016/j.jss.2025.02.019","DOIUrl":"10.1016/j.jss.2025.02.019","url":null,"abstract":"<div><h3>Babckground</h3><div>The demands of a surgical career have known impacts on surgeons’ well-being; however, the impact on their partners is unknown.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional survey of the partners of faculty and housestaff in a single department of surgery. Participants responded to questions assessing the impact of their partner's career on their relationship, family, and personal well-being adapted from the Stanford “Impact of Work on Personal Relationships” survey.</div></div><div><h3>Results</h3><div>There were 36 responses (response rate 55%). The majority were women (67%) with partners who are men (64%) and a relationship length of 10+ y (56%). The greatest impact was on the direct surgeon-partner relationship, with a median [interquartile range] impact score of 4 [3-4], indicating moderately severe impact, followed by 3 [2-4] for both family life and emotional well-being, indicating moderate impact. Nevertheless, 64% of partners agreed or strongly agreed that they would want their partner to choose a surgical career again.</div></div><div><h3>Conclusions</h3><div>A surgical career has significant impact on surgeons' partners. Future work should explore strategies to mitigate this impact on surgeons’ relationships and family life.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"308 ","pages":"Pages 37-44"},"PeriodicalIF":1.8,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143611444","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":"Surviving not Thriving After Gunshot Wound: Prospective Study of Quality of Life, PTSD, and Employment","authors":"Isaac W. Howley MD, MPH, FACS ,&nbsp;Diana S. Arthur BS ,&nbsp;Brian R. Czarkowski MD ,&nbsp;Alexis B. Hess MD ,&nbsp;Allison M. Stokes MD ,&nbsp;Saskya Byerly MD, FACS ,&nbsp;Andrew J. Kerwin MD, FACS ,&nbsp;Karen J. Derefinko PhD","doi":"10.1016/j.jss.2025.01.028","DOIUrl":"10.1016/j.jss.2025.01.028","url":null,"abstract":"<div><h3>Introduction</h3><div>Psychosocial morbidity, including posttraumatic stress disorder (PTSD), depression, and failure to return to work, is common following gunshot wounds (GSWs). GSW victims with retained bullets experience increased rates of elevated blood lead, putting patients at risk for toxic effects on cognition and mood. This pilot study was performed to examine associations between retained bullets and employment and psychosocial outcomes after GSW.</div></div><div><h3>Methods</h3><div>Adult victims of interpersonal intentional GSW completed surveys using validated instruments to measure quality of life, PTSD, resilience, and substance use, and questions regarding employment during index hospitalization and at 1 and 3 mo. Survey data was linked to clinical records regarding injury severity and hospital course.</div></div><div><h3>Results</h3><div>Sixty-three patients completed the baseline survey; 43 completed all 3 surveys. Median age was 29 (interquartile range, 21-40), injury severity score 13 (9-17), and hospital length of stay 6 d (4-10). The patient population was overwhelmingly Black and male (both 87.3%). Laparotomy was performed in 28 patients (44%). Forty-nine patients (77.8%) were working prior to injury, 1 (2%) at 1 month, and 34 (54%) at 3 months. Eight (12.7%) screened PTSD + at baseline; 38 (60.3%) were PTSD + at 3 months. Three-month PTSD + patients were similar to PTSD-patients in all clinical and demographic variables. For 3-month PTSD + patients, all quality of life component scores were worse than for PTSD-patients. Presence of retained bullets was not associated with any differences in psychosocial outcome at 3 months.</div></div><div><h3>Conclusions</h3><div>GSW is associated with significant psychosocial morbidity, including a large decline in employment. PTSD affects approximately half of patients, consistent with prior reports. In this pilot study, PTSD + patients suffered from reduced quality of life.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"308 ","pages":"Pages 66-72"},"PeriodicalIF":1.8,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620866","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":"V-domain Ig Suppressor of T cell Activation Expression During Hemorrhage or Sepsis-Induced Acute Respiratory Distress Syndrome: Insights From a Mouse Model","authors":"Baoji Hu MD ,&nbsp;Jihong Jiang MD ,&nbsp;Wen Pan PhD ,&nbsp;Chun-Shiang Chung PhD ,&nbsp;Chyna Gray PhD ,&nbsp;Yaping Chen BS ,&nbsp;Jianrong Guo MD ,&nbsp;Alfred Ayala PhD","doi":"10.1016/j.jss.2025.02.001","DOIUrl":"10.1016/j.jss.2025.02.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute respiratory distress syndrome (ARDS) is a life-threatening pulmonary condition with significant mortality, largely due to a lack of therapeutic interventions grounded in its molecular pathophysiology. Immune checkpoint regulators, such as the V-domain Ig Suppressor of T cell Activation (VISTA), may provide novel immunotherapeutic strategies for ARDS by modulating the immune response, a concept extensively explored in cancer and autoimmune diseases. Investigating VISTA in the context of ARDS could unveil new therapeutic avenues.</div></div><div><h3>Methods</h3><div>We used a mouse model of indirect ARDS by subjecting C57BL/6J mice to hemorrhage followed by cecal ligation and puncture. Systemic and localized inflammatory conditions were assessed using samples from blood, lung, and peritoneal fluid. Lung pathology was quantified by scoring hematoxylin and eosin-stained sections. Flow cytometry, enzyme-linked immunosorbent assay, and reverse transcription-polymerase chain reaction analyses concentrated on macrophages, neutrophils, endothelial cells, and epithelial cells to elucidate VISTA expression patterns.</div></div><div><h3>Results</h3><div>Hemorrhage or cecal ligation and puncture–treated mice exhibited hallmark symptoms of indirect ARDS, including elevated levels of inflammatory cytokines and chemokines. Notably, VISTA expression was substantially upregulated on various cell types, including blood monocytes, lung macrophages, and both circulating and lung-infiltrating neutrophils, as well as on pulmonary epithelial cells and endothelial cells.</div></div><div><h3>Conclusions</h3><div>Our model replicates critical inflammatory and physiologic changes leading to ARDS, with the elevated expression of VISTA on immune and parenchymal cells suggesting its central involvement in lung injury. The findings propose VISTA as both a potential biomarker for lung damage and as a promising target for ARDS therapy.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"308 ","pages":"Pages 73-85"},"PeriodicalIF":1.8,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}