American journal of surgery最新文献_第6页

Tumor molecular signatures: bridging the bench and the operating room 肿瘤分子特征：架起手术台与手术台的桥梁

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-05-07 DOI: 10.1016/j.amjsurg.2025.116393

Iakovos N. Nomikos , Christos Kosmas , Vasiliki Gkretsi

{"title":"Tumor molecular signatures: bridging the bench and the operating room","authors":"Iakovos N. Nomikos , Christos Kosmas , Vasiliki Gkretsi","doi":"10.1016/j.amjsurg.2025.116393","DOIUrl":"10.1016/j.amjsurg.2025.116393","url":null,"abstract":"<div><div>Contemporary diagnostic and therapeutic strategies for many solid tumors rely on understanding the Mismatch Repair (MMR) system, a fundamental DNA repair mechanism responsible for correcting errors introduced during DNA replication. Pathology reports written for tumors excised in surgery, often indicate the expression status of MMR proteins. This is of significant clinical value, as loss of MMR protein expression is associated with the accumulation of DNA replication errors.</div><div>The MMR system recognizes and replaces mismatched nucleotides, particularly in microsatellite regions. These are short, repetitive non-coding DNA sequences prone to replication errors. When MMR proteins are inactivated by genetic or epigenetic alterations, MMR deficiency (dMMR) occurs, preventing repair and leading to microsatellite instability (MSI). MSI is a hallmark of Lynch syndrome, which is commonly associated with colorectal cancer (CRC) and endometrial cancer.</div><div>This work highlights the clinical utility of MMR protein and MSI status as molecular signatures and discusses diagnostic, prognostic, and therapeutic implications. Understanding these molecular changes supports clinicians in making informed therapeutic decisions and may improve patient outcomes by providing personalized treatments to fit individual tumor profiles.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"246 ","pages":"Article 116393"},"PeriodicalIF":2.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144068059","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}

引用次数: 0

Thin air, thick blood: High altitude trauma centers have increased deep venous thrombosis rates 空气稀薄，血液粘稠：高海拔创伤中心深静脉血栓发生率增高

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-05-07 DOI: 10.1016/j.amjsurg.2025.116365

Franklin L. Wright , Thomas J. Schroeppel , Michael R. Bronsert , Shane Urban , Stephanie A. Vega , Michael W. Cripps , Warren C. Dorlac , Whitney R. Jenson , Jennifer E. Baker , Robert C. McIntyre Jr.

{"title":"Thin air, thick blood: High altitude trauma centers have increased deep venous thrombosis rates","authors":"Franklin L. Wright , Thomas J. Schroeppel , Michael R. Bronsert , Shane Urban , Stephanie A. Vega , Michael W. Cripps , Warren C. Dorlac , Whitney R. Jenson , Jennifer E. Baker , Robert C. McIntyre Jr.","doi":"10.1016/j.amjsurg.2025.116365","DOIUrl":"10.1016/j.amjsurg.2025.116365","url":null,"abstract":"<div><h3>Background</h3><div>Patients undergoing elective procedures at altitudes >4000 ft have higher deep venous thrombosis (DVT) rates compared to those performed at ≤ 1000 ft.</div></div><div><h3>Design</h3><div>We reviewed the American College of Surgeons Trauma Quality Improvement Program (TQIP) database from 2014 to 2019. Adults are divided into LOW (<1001 ft) or HIGH (>4000 ft) altitude treatment with DVT rates compared by multivariable regression analysis as well as using a 2:1 propensity matched model.</div></div><div><h3>Results</h3><div>Risk-adjusted odds ratio (OR) for DVT at high altitude was 1.53 [95 % CI 1.42–1.64]. In patients with an Injury Severity Score (ISS) ≥ 16, the DVT rate was 1.10 % (LOW) vs 1.59 % (HIGH); risk-adjusted OR for DVT at high altitude with ISS ≥ 16 was 1.67 [1.53–1.83]. Under the propensity matched model, DVT rates at higher altitude had an OR of 1.59 [1.46–1.74].</div></div><div><h3>Conclusion</h3><div>Following traumatic injury, DVT rates are increased in higher altitude treatment facilities compared to their low elevation peers.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"246 ","pages":"Article 116365"},"PeriodicalIF":2.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143936937","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}

引用次数: 0

Total thyroidectomy does not improve survival for all patients with unilateral papillary thyroid cancer exceeding 4 cm 甲状腺全切除术并不能提高所有单侧甲状腺乳头状癌超过4厘米患者的生存率

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-05-07 DOI: 10.1016/j.amjsurg.2025.116395

Ying Ding , Ziyang Feng , Ke Cao

{"title":"Total thyroidectomy does not improve survival for all patients with unilateral papillary thyroid cancer exceeding 4 cm","authors":"Ying Ding , Ziyang Feng , Ke Cao","doi":"10.1016/j.amjsurg.2025.116395","DOIUrl":"10.1016/j.amjsurg.2025.116395","url":null,"abstract":"<div><h3>Background</h3><div>Total thyroidectomy (TT) is recommended for papillary thyroid cancer (PTC) over 4 cm, but its universal benefit is uncertain. This study evaluates whether TT offers a significant advantage over lobectomy (LT) in improving overall survival (OS) and cancer-specific survival (CSS) for patients with unilateral PTC exceeding 4 cm.</div></div><div><h3>Methods</h3><div>The study included 8862 patients from the Surveillance, Epidemiology, and End Results (SEER) database (2004–2021) with unilateral PTC larger than 4 cm. The relationship between age and survival was assessed using the restricted cubic splines (RCS) model. The effects of LT and TT on OS and CSS across age groups were analyzed using Cox regression and Kaplan-Meier (KM) methods, with and without age stratification. Propensity score matching (PSM) and sensitivity analyses were conducted to assess the robustness of the results.</div></div><div><h3>Results</h3><div>TT did not improve OS (<em>P</em> = 0.888) or CSS (<em>P</em> = 0.907) compared to LT in the overall cohort. However, TT significantly improved OS (HR = 0.54, <em>P</em> = 0.004) and CSS (HR = 0.55, <em>P</em> = 0.018) in high-risk patients (T4, N1, or M1 stage), but not in low-risk patients. Age-stratified analysis showed TT benefited only young (18–55 years) high-risk patients, enhancing OS (HR = 0.29, <em>P</em> = 0.001) and CSS (HR = 0.35, <em>P</em> = 0.035). Older patients did not gain significant survival advantages from TT, regardless of risk status. These results were consistent in the PSM and sensitivity analyses.</div></div><div><h3>Conclusions</h3><div>TT may not be the best approach for all unilateral PTC patients over 4 cm in terms of OS and CSS. It improves survival outcomes in young patients with advanced TNM stages but does not confer a significant OS or CSS advantage over LT for older or low-risk patients.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"246 ","pages":"Article 116395"},"PeriodicalIF":2.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143936938","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}

引用次数: 0

A match like no other: Lessons from a pandemic application cycle 独一无二的匹配：大流行应用周期的经验教训。

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-05-06 DOI: 10.1016/j.amjsurg.2025.116384

Autumn Beavers MD, Andrea Gillis MD

引用次数: 0

From the editor – in – chief 总编辑的信。

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-05-06 DOI: 10.1016/j.amjsurg.2025.116392

Herbert Chen MD (Editor-in-Chief)

引用次数: 0

A call to (Frequent) action: A reminder that residents value more feedback 号召（经常）行动：提醒居民重视更多的反馈。

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-05-06 DOI: 10.1016/j.amjsurg.2025.116364

Jennifer E. Hrabe MD , Muneera R. Kapadia MD, MME

引用次数: 0

Corrigendum to "Role of endovascular management on outcomes in patients with traumatic inferior vena cava injuries" [Am J Surg 238 (2024) 115836]. “血管内处理对外伤性下腔静脉损伤患者预后的影响”[J].中华外科杂志，238(2024):1158 - 1158。

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-05-05 DOI: 10.1016/j.amjsurg.2025.116358

Devin O'Connor, Omar Hejazi, Christina Colosimo, Collin Stewart, Hamidreza Hosseinpour, Muhammad Haris Khurshid, Adam C Nelson, Bellal Joseph, Sai Krishna Bhogadi, Tanya Anand, Audrey L Spencer, Louis J Magnotti

引用次数: 0

The value of identity-based affinity group conferences in advancing professional growth and equity in surgery. 基于身份的亲和团体会议在促进外科专业成长和公平中的价值。

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-05-03 DOI: 10.1016/j.amjsurg.2025.116391

Rajika Jindani, Minerva A Romero Arenas, Mara B Antonoff

引用次数: 0

The bidirectional interplay between gut dysbiosis and surgical complications: A systematic review 肠道生态失调与手术并发症之间的双向相互作用：一项系统综述

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-05-02 DOI: 10.1016/j.amjsurg.2025.116369

Lindsey Nichols , Omar El-Kholy , Ahmed Adham R. Elsayed , Marc D. Basson

{"title":"The bidirectional interplay between gut dysbiosis and surgical complications: A systematic review","authors":"Lindsey Nichols , Omar El-Kholy , Ahmed Adham R. Elsayed , Marc D. Basson","doi":"10.1016/j.amjsurg.2025.116369","DOIUrl":"10.1016/j.amjsurg.2025.116369","url":null,"abstract":"<div><h3>Background</h3><div>The gut microbiome critically influences diverse aspects of physiology and surgical recovery. Conversely, surgery alters the microbiome, potentially predisposing to complications. We aimed to clarify the bidirectional interaction between surgery and gut dysbiosis.</div></div><div><h3>Methods</h3><div>On December 22nd, 2024, a systematic search of the Cochrane Library, PubMed, VHL, and WOS was completed. Relevant studies were assessed for risk of bias using STROBE and CONSORT guidelines.</div></div><div><h3>Results</h3><div>Thirty studies, with 2500+ participants experiencing diverse procedures and complications, were incorporated. Although specifics varied, dysbiosis correlated with surgery and its complications. Patients with complications had more harmful bacteria and fewer beneficial bacteria. In some studies, probiotics reduced complications.</div></div><div><h3>Conclusion</h3><div>Gut dysbiosis is tied to postoperative complications in a complex, bidirectional relationship. Patients with surgical complications may have fewer beneficial and more pathogenic bacteria both before and after surgery. Early identification of dysbiosis and probiotic administration could predict or even reduce postoperative complications.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"245 ","pages":"Article 116369"},"PeriodicalIF":2.7,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143918385","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}

引用次数: 0

Novel electronic health records-based consultation workflow improves time to operating room for surgery patients in an acute setting 新颖的电子健康记录为基础的咨询工作流程，提高了时间到手术室的手术患者在急性设置

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-05-02 DOI: 10.1016/j.amjsurg.2025.116386

Micaella R. Zubkov , John Iguidbashian , Zhixin Lun , Kyle Bata , Lauren Gunn-Sandell , Derek Crosby , Kristin Stoebner , David Tharp , Linda Staubli , Ct Lin , Ethan Cumbler , Jennifer Wiler , Robert C. McIntyre Jr. , Jeniann Yi

{"title":"Novel electronic health records-based consultation workflow improves time to operating room for surgery patients in an acute setting","authors":"Micaella R. Zubkov , John Iguidbashian , Zhixin Lun , Kyle Bata , Lauren Gunn-Sandell , Derek Crosby , Kristin Stoebner , David Tharp , Linda Staubli , Ct Lin , Ethan Cumbler , Jennifer Wiler , Robert C. McIntyre Jr. , Jeniann Yi","doi":"10.1016/j.amjsurg.2025.116386","DOIUrl":"10.1016/j.amjsurg.2025.116386","url":null,"abstract":"<div><h3>Background</h3><div>A novel electronic health records (EHR)-based workflow was implemented at a quaternary referral center to improve the efficiency of inpatient surgical consultation processes for patients requiring trauma or acute care surgery (TACS) consultation.</div></div><div><h3>Methods</h3><div>The EHR-driven consultation workflow automated notifications, communication of patient information, and data-tracking. Timeliness of care was compared between pre-implementation (1/1/2020-1/31/2022), early post-implementation (2/1/2022-1/31/2023), and late post-implementation (2/1/2023-1/31/2024) cohorts.</div></div><div><h3>Results</h3><div>Of 5724 consultations, 2658 required surgery (733 pre-, 830 early post-, 1095 late post-implementation). Time between consult to OR was reduced overall by 27 % post-implementation (pre = 726 min; early post = 577; late post = 532; p < 0.001) and by 48 % (pre = 531 min; early post = 290; late post = 277; p < 0.001) for urgent/emergent cases. Length of stay decreased post-implementation with no difference in 30-day clinical outcomes.</div></div><div><h3>Conclusion</h3><div>Implementation of the novel EHR consultation workflow was safe and associated with decreased time-to-OR, which persisted throughout the post-implementation phase with greatest impact on patients requiring urgent/emergent operations.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"246 ","pages":"Article 116386"},"PeriodicalIF":2.7,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143936936","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}

引用次数: 0