Journal of the American College of Surgeons最新文献

{"title":"Advancing the Optimization of Indocyanine Green Administration Strategies for Fluorescence Cholangiography: In Reply to Toro and colleagues.","authors":"Wenjun Lin, Haisu Tao, Jian Yang","doi":"10.1097/XCS.0000000000001428","DOIUrl":"10.1097/XCS.0000000000001428","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"317-318"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invited Commentary: Beyond the Checkbox: Advancing Health Equity in American College of Surgeons Quality Programs.","authors":"Cara L Berkowitz, Elizabeth M De Jesus, Krystle L Collins, Oluwadamilola M Fayanju","doi":"10.1097/XCS.0000000000001470","DOIUrl":"10.1097/XCS.0000000000001470","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"229-231"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Idiopathic Subglottic Stenosis and the Epithelial Interface of Host and Environment.","authors":"Alexander Gelbard, Meghan H Shilts, Austin Hoke, Britton Strickland, Kevin Motz, Hsiu-Wen Tsai, Helen Boone, Wonder P Drake, Celestine Wanjalla, Paula Marincola Smith, Hunter Brown, Jason Powell, Marisol Ramirez-Solano, James B Atkinson, John Simpson, Seesandra V Rajagopala, Simon Mallal, Quanhu Sheng, Alexander T Hillel, Suman R Das","doi":"10.1097/XCS.0000000000001340","DOIUrl":"10.1097/XCS.0000000000001340","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic subglottic stenosis (iSGS) is a rare fibrotic disease of the proximal airway affecting adult White women nearly exclusively. Life-threatening ventilatory obstruction occurs secondary to pernicious subglottic mucosal scar. Disease rarity and wide geographic patient distribution have previously limited substantive mechanistic investigation into iSGS pathogenesis.</p><p><strong>Study design: </strong>Harnessing pathogenic mucosa from an international iSGS patient cohort and single-cell RNA sequencing, we provide an unbiased characterization of the cell subsets present in the proximal airway scar and detail their molecular phenotypes.</p><p><strong>Results: </strong>Airway epithelium in patients with iSGS is depleted of basal progenitor cells and the residual epithelial cells acquire a mesenchymal phenotype. Observed displacement of bacteria beneath the lamina propria provides functional support for the molecular evidence of epithelial dysfunction. Matched superficial and deep tissue microbiomes support displacement of the native microbiome into the lamina propria of patients iSGS rather than disrupted bacterial community structure. However, animal models confirm that bacteria are necessary for pathologic proximal airway fibrosis and suggest an equally essential role for host adaptive immunity. Human samples from iSGS airway scar demonstrate adaptive immune activation in response to the proximal airway microbiome of both matched patients with iSGS and healthy controls. Clinical outcome data from patients with iSGS suggests that surgical extirpation of airway scar and reconstitution with unaffected tracheal mucosa halts the progressive fibrosis.</p><p><strong>Conclusions: </strong>Our novel data support an iSGS disease model in which epithelial alterations facilitate microbiome displacement, dysregulated immune activation, and localized fibrosis. Overall, these results refine our understanding of iSGS and implicate shared pathogenic mechanisms with distal airway fibrotic diseases.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"180-192"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12266974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential Role of EBI3 in Gastric Cancer and Its Inductive Effects on T-Cell Exhaustion.","authors":"Yongjia Yan, Zexuan Shen, Yanghee Woo, Daohan Wang, Xin Liu, Wenxin Zhang, Zhaoxiong Zhang, Peiyao Wang, Weihua Fu","doi":"10.1097/XCS.0000000000001263","DOIUrl":"10.1097/XCS.0000000000001263","url":null,"abstract":"<p><strong>Background: </strong>Immunotherapy has achieved effective antitumor activity in advanced patients with gastric cancer (GC). However, the rate of response to immune checkpoint inhibitor therapy is disappointing, T-cell exhaustion may contribute to this phenomenon. EBI3 is an emerging immunosuppressive factor, and the association between EBI3 and T-cell exhaustion is not clear. In this study, we aimed to explore the expression of EBI3 in GC and reveal the function of EBI3 in T-cell exhaustion.</p><p><strong>Study design: </strong>The gene expression data and clinical data of patients with GC were downloaded from The Cancer Genome Atlas database to measure the expression of EBI3 in GC and explore the association between EBI3 and clinicopathologic features. Then, tumor specimens were collected, and immunohistochemistry was used to demonstrate the expression of EBI3 in GC tissues. Finally, we constructed a mouse model of orthotopic GC to examine the function of EBI3 in T-cell exhaustion.</p><p><strong>Results: </strong>The data from The Cancer Genome Atlas database showed that EBI3 is highly expressed in GC and the expression of EBI3 is associated with pTNM stage. We analyzed the expression of EBI3 in GC tissues, the results showed that expression of EBI3 is associated with age, T stage, N stage, pTNM stage, and degree of differentiation. After constructing the mouse model of orthotopic GC, we found EBI3 can lead to an increase in proportion of CD8 + PD-1 + T cells and CD8 + LAG3 + T cells; meanwhile, the secretion of IL-2 was significantly decreased.</p><p><strong>Conclusions: </strong>Our study indicated that EBI3 is an important cytokine in the development of GC, and EBI3 may promote the development of GC by inducing T-cell exhaustion in the tumor microenvironment.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"137-145"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Aging and Sex on Clot Formation, Structure, and Lysis in Trauma Patients.","authors":"Charoo Piplani, Andrew Gosselin, Christopher Bargoud, Marie Macor, Rachel L Choron, Joseph S Hanna, Valerie Tutwiler, Julie Goswami","doi":"10.1097/XCS.0000000000001347","DOIUrl":"10.1097/XCS.0000000000001347","url":null,"abstract":"<p><strong>Background: </strong>The dynamics of blood clotting are influenced by age and sex, potentially impacting treatment outcomes and susceptibility to complications in trauma patients. This study aimed to identify how age and sex impact clot formation and resolution kinetics, and network structure in trauma patients, exploring their potential implications for personalized treatment strategies.</p><p><strong>Study design: </strong>Trauma patients meeting the highest level of trauma designation had plasma isolated after emergency department admission before any resuscitative fluid administration. Thrombin generation kinetics, rheological clot mechanics, fibrin network properties, and optical density were measured in patient plasma.</p><p><strong>Results: </strong>Sixty-three patients were included in this study. The majority (76%) were male, and the age range was 18 to 87 years, with a median age of 38 years. Older patients had increased mortality at a similar Injury Severity Score as compared with younger patients while exhibiting greater clot stiffness and increased time to thrombin generation. Increasing patient age was associated with increased thrombin lag time, time to peak thrombin, and fibrinogen-normalized stiffness. Male and female patients had similar mortality rates and Injury Severity Scores but exhibited significant differences in clot stiffness and lysis with aging.</p><p><strong>Conclusions: </strong>This study suggests that aging in trauma patients correlates with a prolonged clot formation rate despite the presence of stiffer clots and reduced fibrinolysis in older men. Our findings highlight the importance of age and sex when developing resuscitation protocols and tailoring treatment strategies for acute traumatic coagulopathy in trauma patients. Further research is needed to effectively develop and implement such protocols to optimize clinical outcomes in this patient population.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"160-169"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12266973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invited Commentary: Impact of the Trends in Medical Education Debt and Surgeon Compensation.","authors":"Lindsay E Kuo","doi":"10.1097/XCS.0000000000001253","DOIUrl":"10.1097/XCS.0000000000001253","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"267-268"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatic Artery Reconstruction Using Splenic Artery During Pancreatoduodenectomy.","authors":"Milena Muzzolini, Alice Antier, Béatrice Aussilhou, Wei-Liang Loh, Mickael Lesurtel, Alain Sauvanet, Safi Dokmak","doi":"10.1097/XCS.0000000000001267","DOIUrl":"10.1097/XCS.0000000000001267","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"307-313"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Missing Race Data in NSQIP Pediatric: In Reply to Cohen and colleagues.","authors":"Kevin G Hu, Michael Alperovich","doi":"10.1097/XCS.0000000000001423","DOIUrl":"10.1097/XCS.0000000000001423","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"315"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Possible Artifactual Explanation for the Observed Relationship Between Race and Ethnicity Missingness and Postoperative Events.","authors":"Mark E Cohen, Melvin Coleman, Bruce L Hall, Vanessa Thompson, Clifford Ko","doi":"10.1097/XCS.0000000000001422","DOIUrl":"10.1097/XCS.0000000000001422","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"314"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgeon Decision-Making: A Contemporary, Qualitative Analysis of Urologists.","authors":"Brooke N Spratte, Katherine Poulos, Katy Reines, Susan Blalock, Antonia V Bennett, Kathryn H Gessner, Matthew E Nielsen, Daniel S Reuland, Ethan Basch, Hung-Jui Tan","doi":"10.1097/XCS.0000000000001498","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001498","url":null,"abstract":"<p><strong>Background: </strong>The decision to operate is one of the most complex and essential responsibilities surgeons hold yet remains poorly understood. Existing interventions often overlook the intuitive nature of surgical judgement, limiting their impact. This study explores how surgeons make the decision to operate and identifies factors that shape this process.</p><p><strong>Study design: </strong>Twenty-five interviews were performed with practicing urologic surgeons from June to July 2020. Participants were recruited from the 2019 American Urological Association Census, purposefully sampled to ensure diversity in experience, patient load, gender, geography, and practice type. Interviews focused on the decision-making processes, including information sources, risk assessment, and driving factors. Data were analyzed using inductive and deductive coding to identify key themes and patterns.</p><p><strong>Results: </strong>Surgeon decision-making is a dynamic, iterative process that includes evaluating the patient, assessing treatment options, matching surgeon assessment with patient preferences, and communicating with the patient and family. Often beginning before the patient encounter, surgeons integrate a range of input from visual, written, and verbal cues. While surgeons consider numeric data, decisions are largely driven by intuition and heuristics - honed by experience and shaped by patient, surgeon, work/environment, and external factors. This largely unconscious process aims to balance benefit and harm in pursuit of both patient and surgeon goals.</p><p><strong>Conclusion: </strong>Through qualitative interviews, this study found surgeon decision-making is predominantly intuitive, shaped by experience and subject to heuristics. Intervening early and designing tools that align with intuitive reasoning may enhance the effectiveness of decision support interventions.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}