American Surgeon最新文献_第4页

A Novel Microbe, Immunization Deaths, and Vaccination on Trial: BCG and the Lübeck Disaster of 1930. 一种新的微生物、免疫死亡和疫苗试验：卡介苗和1930年的l<s:1>贝克灾难。

IF 1 4区医学

American Surgeon Pub Date : 2025-01-09 DOI: 10.1177/00031348251313994

Don K Nakayama

{"title":"A Novel Microbe, Immunization Deaths, and Vaccination on Trial: BCG and the Lübeck Disaster of 1930.","authors":"Don K Nakayama","doi":"10.1177/00031348251313994","DOIUrl":"https://doi.org/10.1177/00031348251313994","url":null,"abstract":"Today's controversies of gain-of-function virological research and mRNA COVID vaccination policies had an antecedent nearly a century ago in an event often referred to as \"the Lübeck disaster.\" From April through September 1930, 77 newborn infants in Lübeck, Germany, died after receiving oral BCG immunizations tainted with active human Mycobacterium tuberculosis. The tragedy threatened to end BCG immunizations. BCG and its originators, the French scientists Albert Calmette and Camille Guérin, were exonerated from liability. An inquest uncovered careless laboratory practices that contaminated doses of the vaccine with a human pathogen. The calamity underscored the necessity for exacting standards when handling dangerous infective microbes. The physician and bacteriologist responsible for the immunization program in Lübeck were tried and convicted for negligence, a concrete example of the civic responsibility expected of scientists when an experimental venture inflicts harm on an unwitting public. The example of Lübeck stands as an object lesson on the necessity of an informed, measured approach to any novel treatment. Controversies continue whether BCG vaccination is the preferred public health strategy against tuberculosis. Calmette and Guérin's lasting scientific achievement is the creation of a microbe that over a century has kept its essential features of inciting a vigorous immunological reaction that was tolerated by its host and never regaining its pathogenicity. The features form the basis of modern cancer immunotherapy, where intravesical BCG is first-line therapy against non-muscle invasive bladder cancer.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251313994"},"PeriodicalIF":1.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

Socioeconomic Deprivation and Risk of Operative Mortality After Emergency Laparotomy: A Systematic Review and Meta-Analysis. 紧急剖腹手术后社会经济剥夺与手术死亡风险：系统回顾和荟萃分析。

IF 1 4区医学

American Surgeon Pub Date : 2025-01-09 DOI: 10.1177/00031348251314151

Olivia Ambler, Shahin Hajibandeh, Shahab Hajibandeh

{"title":"Socioeconomic Deprivation and Risk of Operative Mortality After Emergency Laparotomy: A Systematic Review and Meta-Analysis.","authors":"Olivia Ambler, Shahin Hajibandeh, Shahab Hajibandeh","doi":"10.1177/00031348251314151","DOIUrl":"https://doi.org/10.1177/00031348251314151","url":null,"abstract":"Aims: The aim was to determine the effect of socioeconomic deprivation on operative mortality after emergency laparotomy.Methods: A PRISMA-compliant systematic review and meta-analysis (random-effects modeling) was performed searching for studies comparing operative mortality between the least and the most socioeconomically deprived patients undergoing emergency laparotomy. Both unadjusted and adjusted odds ratio (OR) were calculated as summary measure. Risk of bias was assessed using the Quality In Prognosis Studies tool, and certainty of evidence was assessed using the GRADE system.Results: Four studies comprising 87,690 patients were included. There was no difference in the risk of operative mortality between the most and least deprived groups (unadjusted OR: 1.57, 95% CI .92, 2.68, P = .100) and when adjusted for other predictors (adjusted OR: 1.11, 95% CI .93, 1.32, P = .230). Subgroup analysis showed consistency of the findings in the United Kingdom (unadjusted OR: 1.36, 95% CI .92, 2.01, P = .130; adjusted OR: 1.15, 95% CI .92, 1.43, P = .230) and in the United States (unadjusted OR: 1.75, 95% CI .75, 4.06, P = .190; adjusted OR: 1.01, 95% CI .79, 1.29, P = .940). Sensitivity analyses showed inconsistency in favor of higher mortality risk in the most deprived patients. The GRADE certainty was moderate.Conclusions: Socioeconomic deprivation may have minor effect on operative mortality after emergency laparotomy; however, such effect fades away once adjusted for other predictors of mortality. Although independent research is required, it may be reasonable to predict that incorporation of socioeconomic deprivation into preoperative risk assessment tools may not improve their predictive performance.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251314151"},"PeriodicalIF":1.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

Effectiveness of a Dedicated Rural General Surgery Residency Track: A 13-Year Analysis of the First ACGME Designated Rural Track. 专门的农村普外科住院医师轨道的有效性：第一个ACGME指定的农村轨道的13年分析。

IF 1 4区医学

American Surgeon Pub Date : 2025-01-08 DOI: 10.1177/00031348251313992

Jude C Barber, David R Velez, Stefan W Johnson, Robert P Sticca

{"title":"Effectiveness of a Dedicated Rural General Surgery Residency Track: A 13-Year Analysis of the First ACGME Designated Rural Track.","authors":"Jude C Barber, David R Velez, Stefan W Johnson, Robert P Sticca","doi":"10.1177/00031348251313992","DOIUrl":"https://doi.org/10.1177/00031348251313992","url":null,"abstract":"Background: The shortage of general surgeons in rural America is well documented. The North Dakota community-based general surgery residency program initiated a unique approach to training for rural practice through a dedicated rural track. The rural track included 9 months of rotations in specialty rotations beneficial for rural practice. This study analyzed practice patterns and satisfaction of residents completing rural track training.Methods: An anonymous voluntary survey was sent to rural track graduates between 2010 and 2022 via the Qualtrics Web site.Data collection included: Specialty rotations completed, specialty procedures currently performing, satisfaction with rural track training, and recommended specialty rotations for future rural track graduates.Results: Twelve of fifteen graduates (80%) responded. Eighty-three percent of respondents chose the rural track because they desired practice in rural areas and/or desired broad-spectrum surgical practice. One hundred percent of the graduates were satisfied with their training. Seventy-five percent of the graduates came from a rural background, and 75% either previously practiced or currently practice in a rural community. Procedural data demonstrated that 67% of the graduates performed endoscopy procedures, 42% performed hand procedures, and 47% performed C-sections. Rural track graduates desired more experience in urology (50%), ENT, OBGYN, and advanced endoscopy (33%). Experience in plastic surgery, GI, hand surgery, dermatology, and IR was cited as beneficial.Conclusion: The rural track graduates found significant value in their rural track training that benefited them in practice. Three quarters of the graduates entered rural surgery practice, performing a broad spectrum of procedures.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251313992"},"PeriodicalIF":1.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

Retained Surgical Sponge Expelled Through a Rectal Fistula With Spontaneous Passage Per Rectum. 通过直肠瘘管排出的手术海绵，经直肠自动通过。

IF 1 4区医学

American Surgeon Pub Date : 2025-01-07 DOI: 10.1177/00031348251313526

Seyit Murat Aydın, Aziz Mutlu Barlas, Tayfun Bayraktar

引用次数: 0

Care Fragmentation Following Bariatric Operations: A National Analysis. 减肥手术后护理碎片化：一项全国分析。

IF 1 4区医学

American Surgeon Pub Date : 2025-01-06 DOI: 10.1177/00031348251313525

Konmal Ali, Troy Coaston, Ayesha P Ng, Lavender Micalo, Sara Sakowitz, Amulya Vadlakonda, Barzin Badiee, Syed Shaheer Ali, Peyman Benharash

{"title":"Care Fragmentation Following Bariatric Operations: A National Analysis.","authors":"Konmal Ali, Troy Coaston, Ayesha P Ng, Lavender Micalo, Sara Sakowitz, Amulya Vadlakonda, Barzin Badiee, Syed Shaheer Ali, Peyman Benharash","doi":"10.1177/00031348251313525","DOIUrl":"https://doi.org/10.1177/00031348251313525","url":null,"abstract":"Background: Although existing work has evaluated outcomes associated with care fragmentation (CF), these adverse consequences may be accentuated in patients undergoing bariatric operations. This retrospective study examined the association of CF with clinical and financial outcomes among patients receiving bariatric surgery.Methods: All adult (≥18 years) records for bariatric operations were tabulated from the 2016-2021 Nationwide Readmissions Database. Patients with nonelective rehospitalization at a non-index facility within 30 days of index discharge comprised the CF cohort (others: No-CF). Multivariable linear and logistic models were developed to assess the association of care fragmentation with outcomes of interest.Results: Of an estimated 38,842 patients, 5591 (17.0%) comprised the CF cohort. Compared to No-CF, CF was older, less likely to be female, and more frequently insured by Medicare. Following comprehensive risk adjustment, CF demonstrated increased odds of respiratory (adjusted odds ratio [AOR] 1.61, 95% CI 1.37-1.90), renal (AOR 1.56, 95% CI 1.38-1.76), and thromboembolic (AOR 2.03, 95% CI 1.71-2.41) complications. Additionally, those who experienced CF demonstrated increased odds of non-home discharge (AOR 2.03, 95% CI 1.70-2.42).Conclusions: Care fragmentation is associated with increased mortality, complications, non-home discharge, and hospitalization costs. Initiatives such as patient education, harmonizing postoperative care, and facilitating returns to the index hospitals may minimize the adverse effects of CF to improve the continuation of care following bariatric operations.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251313525"},"PeriodicalIF":1.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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 Prehospital Time and Tractor Injuries: A Nebraska State Trauma Registry Analysis. 院前总时间和牵引车损伤：内布拉斯加州创伤登记分析。

IF 1 4区医学

American Surgeon Pub Date : 2025-01-05 DOI: 10.1177/00031348241312126

Curtis Rich, Stevin Lu, Joel R Narveson, Alex G Hall, Adrian Flores, Eric Kuncir

{"title":"Total Prehospital Time and Tractor Injuries: A Nebraska State Trauma Registry Analysis.","authors":"Curtis Rich, Stevin Lu, Joel R Narveson, Alex G Hall, Adrian Flores, Eric Kuncir","doi":"10.1177/00031348241312126","DOIUrl":"https://doi.org/10.1177/00031348241312126","url":null,"abstract":"Background: Agriculture is a hazardous industry, with tractor-related incidents being among the leading causes of traumatic injury and death. These injuries tend to take place far away from hospitals, thus leading to increased prehospital time to receive care. Understanding the relationship between prehospital time and outcomes such as hospital length of stay and mortality in the state of Nebraska could inform resource allocation for tractor related injuries.Study design: A 10-year retrospective study abstracting adults involved in tractor injuries using The Nebraska State Trauma Registry was performed. Mortality was evaluated using standard logistic regression, while length of stay outcomes were estimated using the negative binomial distribution. Adjusted model covariates included age, arrived from status, and Injury Severity Score.Results: A total of 100 tractor-related injuries were included. Extremity injuries made up the largest percentage of injury types (44%). Injury severity scores were considered low in most patients. The majority of injuries were experienced by a party not operating the tractor. After adjusting for age, the scene of patient arrival, and Injury Severity Score, total prehospital time was not a significant predictor of facility length of stay or mortality.Conclusion: Access to care is an ongoing problem for many communities in the United States, with the Midwest having some of the largest regions with poor access to care. We did not find a significant relationship between prehospital time and outcomes related to length of stay or mortality. Future studies should assess for differences in outcomes among accident types such as roll-over accidents vs collisions.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241312126"},"PeriodicalIF":1.0,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

Letter re: "Pathological Examination in Pilonidal Sinus Surgery: Evaluating Necessity and Cost-Effectiveness: A 10-Year Retrospective Analysis". 回复：“脊髓窦手术病理检查：评估必要性和成本-效果：10年回顾性分析”。

IF 1 4区医学

American Surgeon Pub Date : 2025-01-05 DOI: 10.1177/00031348241312122

Mhd Firas Safadi, Dietrich Doll

引用次数: 0

A Retrospective Study of Laparoscopic Distal Gastrectomy Guided by Carbon Nanoparticle Suspension Injection Lymphography for Gastric Cancer. 纳米碳悬浮液注射淋巴造影引导下腹腔镜胃癌远端切除术的回顾性研究。

IF 1 4区医学

American Surgeon Pub Date : 2025-01-04 DOI: 10.1177/00031348241309565

Jiayi Gu, Tao Liu, Bo Ni, Yile Huang, Yanying Shen, Yeqian Zhang, Yujing Guan, Long Bai, Haoyu Zhang, Muerzhate Aimaiti, Shuchang Wang, Ben Yue, Xiang Xia, Zizhen Zhang, Hui Cao

{"title":"A Retrospective Study of Laparoscopic Distal Gastrectomy Guided by Carbon Nanoparticle Suspension Injection Lymphography for Gastric Cancer.","authors":"Jiayi Gu, Tao Liu, Bo Ni, Yile Huang, Yanying Shen, Yeqian Zhang, Yujing Guan, Long Bai, Haoyu Zhang, Muerzhate Aimaiti, Shuchang Wang, Ben Yue, Xiang Xia, Zizhen Zhang, Hui Cao","doi":"10.1177/00031348241309565","DOIUrl":"https://doi.org/10.1177/00031348241309565","url":null,"abstract":"Background: The use of lymph node (LN) tracers can help obtain a complete dissection of the LNs and increase the detection rate of metastatic LNs. Carbon nanoparticle suspension injection (CNSI) has become increasingly used in radical gastrectomy procedures. This study is designed to evaluate the quality of LN dissection in gastric cancer patients with laparoscopic distal gastrectomy under the guidance of CNSI lymphography.Method: This was a retrospective cohort study including patients with a pathological biopsy diagnosis of resectable gastric cancer who underwent laparoscopic distal gastrectomy. Data was focused on patients at [Renji Hospital of Shanghai Jiaotong University] from July 2023 to January 2024. Patients were divided into the CNSI group and control group after 1:1 propensity score matching analysis. The median number of LNs harvested was compared between groups. Perioperative status and any complications that arose within 30 days were also analyzed.Result: After 1:1 propensity matching analysis, there were 49 patients each in the CNSI group and control group. The median number of harvested LNs was larger in the CNSI group than the control group (P = 0.01). A significant difference between 2 groups was observed in surgery time (P = 0.008). The morbidity of any short-term postoperative complications within 30 days after surgery revealed a similar outcome (P > 0.05).Discussion: CNSI-guided laparoscopic distal gastrectomy is less time-consuming and harvests more LNs. For laparoscopic distal gastrectomy, CNSI-guided lymphography can be an excellent adjuvant.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241309565"},"PeriodicalIF":1.0,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

Clinical Value of Abnormal Prothrombin and Carbohydrate Antigen 125 in the Diagnosis of Patients With Gallbladder Cancer. 凝血酶原和糖类抗原125异常在胆囊癌诊断中的临床价值。

IF 1 4区医学

American Surgeon Pub Date : 2025-01-04 DOI: 10.1177/00031348241312119

Yanguo Liu, Yanfang Wu, Shujie He

{"title":"Clinical Value of Abnormal Prothrombin and Carbohydrate Antigen 125 in the Diagnosis of Patients With Gallbladder Cancer.","authors":"Yanguo Liu, Yanfang Wu, Shujie He","doi":"10.1177/00031348241312119","DOIUrl":"https://doi.org/10.1177/00031348241312119","url":null,"abstract":"Objective: This study was aimed at ascertaining the application value of abnormal prothrombin (PIVKA-II) and carbohydrate antigen 125 (CA125) in gallbladder cancer (GBC) diagnosis.Methods: A total of 70 GBC patients, 70 patients with benign gallbladder diseases (gallbladder stones and gallbladder polyps), and 70 normal health examination people were selected as the malignant, benign, and normal groups, respectively. The differences in serum levels and positive rates of PIVKA-II and CA125 were compared. The correlation between serum PIVKA-II and CA125 levels and different clinicopathological characteristics (TNM stage and differentiation degree) of GBC patients was analyzed. The receiver operating characteristic curve was plotted to evaluate the diagnostic value of serum PIVKA-II and CA125 for GBC, and sensitivity, specificity, and Youden's index were calculated.Results: Serum PIVKA-II and CA125 levels and positive rates of patients in the malignant group were higher vs those in the benign and normal groups. Gallbladder cancer patients at stages III-IV had higher serum PIVKA-II and CA125 levels than those at stages I-II, and poorly differentiated GBC patients had higher serum PIVKA-II and CA125 levels than moderately differentiated and well-differentiated GBC patients. The AUC of serum PIVKA-II and CA125 alone and in combination were 0.771, 0.789, and 0.866, respectively, and the AUC of the two combined was higher vs that of the two alone.Conclusion: Serum PIVKA-II and CA125 levels in GBC patients are increased and have significant clinical application value in the diagnosis of GBC.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241312119"},"PeriodicalIF":1.0,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

Cost-Benefit Analysis of Various Management Algorithms for Suspected Choledocholithiasis. 疑似胆总管结石各种管理算法的成本效益分析。

IF 1 4区医学

American Surgeon Pub Date : 2025-01-04 DOI: 10.1177/00031348241312120

Jesse K Kelley, Jeremy Mormol, Mary Reiber, Avery Sena, Camille Joy Abutin, Jake Sypniewski, Charles Reed, Giuseppe M Zambito, Amy L Banks-Venegoni

引用次数: 0