Annals of surgery最新文献

{"title":"A Randomized Controlled Trial Evaluating Negative Pressure Therapy (NPT) to Reduce Wound Complications Following Major Lower Extremity Amputation.","authors":"Paul J DiMuzio, Cara M Staley, Federico Biscetti, Dawn M Salvatore, Babak Abai, Michael J Nooromid, Roberto G Aru, Scott Keith, Romeo B Mateo, Nii-Kabu Kabutey, Ellen D Dillavou","doi":"10.1097/SLA.0000000000007209","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007209","url":null,"abstract":"<p><strong>Objective: </strong>This study hypothesizes that negative pressure therapy (NPT) reduces wound-healing complications following major amputation.</p><p><strong>Background: </strong>Major lower extremity amputation carries a high incidence of incisional complications. NPT reduces these complications in other areas of the body, suggesting a benefit following amputation.</p><p><strong>Methods: </strong>Patients undergoing above- or below-knee amputation (AKA, BKA) were randomized in this multi-institution study into receiving NPT versus standard dressing. The primary endpoint was any wound complication within 30 days of surgery; secondary endpoints included reoperation, readmission, and length of stay. Post hoc analyses were performed in patients considered high risk for wound complications.</p><p><strong>Results: </strong>The overall 30-day mortality rate was 3.4%. The wound complication rate for the NPT group was 19.4% (n=134) compared with 24% for controls (n=129; RR=0.80; 95% CI: 0.51, 1.26; P=0.339). No significant difference was observed for reoperation (3.7% vs. 8.5%, RR=0.83), readmission (9% vs. 11.6%, RR=0.77), or length of stay (10 vs. 9.3 d, RR=1.1). Post hoc analyses suggested a reduction in complications using NPT in people without diabetes (9.8% vs. 27.6%, RR=0.36), those with end-stage renal disease (ESRD; 23.1% vs. 37.5%, RR=0.66), patients with obesity (18.2% vs. 26.7%, RR=0.65), and those presenting without tissue loss (3.6% vs. 35.5%, RR=0.10).</p><p><strong>Conclusions: </strong>Wound complications remain a significant problem following major lower extremity amputation, leading to reoperation, readmission, and increased length of stay. NPT does not significantly reduce the overall wound complication rate. Future studies should focus on high-risk subgroups that may benefit from this therapy.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The International Medical Graduate Paradox.","authors":"Christian Miguel de Virgilio, Leigh A Neumayer, R Matthew Walsh, Raul Rosenthal, Kamal Mf Itani, Anthony Charles, Mary E Klingensmith, Jeffrey B Matthews","doi":"10.1097/SLA.0000000000007149","DOIUrl":"10.1097/SLA.0000000000007149","url":null,"abstract":"<p><strong>Background: </strong>International medical graduates (IMGs) play a critical role in the United States physician workforce and are essential to sustaining access to surgical care, particularly in underserved communities. Despite their contributions, IMGs pursuing surgical training continue to face significant systemic, financial, cultural, and institutional barriers.</p><p><strong>Objective: </strong>To examine the historical role, workforce contributions, challenges, and future implications of IMGs within the U.S. surgical workforce and identify opportunities to better support their integration into surgical training and practice.</p><p><strong>Summary of background data: </strong>IMGs comprise a substantial portion of the U.S. physician workforce but remain underrepresented in many surgical specialties. Persistent barriers include licensing requirements, financial burden, limited access to clinical and research opportunities, visa restrictions, bias within training environments, and reduced match success rates compared with U.S. medical graduates.</p><p><strong>Methods: </strong>This article synthesizes presentations from the American Surgical Association Inclusive Excellence Forum and incorporates current literature regarding IMG participation in U.S. surgical education, workforce trends, residency training, and professional advancement.</p><p><strong>Results: </strong>IMGs contribute significantly to clinical care, academic medicine, health care leadership, and culturally competent patient care. However, structural barriers within recruitment, credentialing, residency training pathways, and immigration processes continue to limit equitable access to surgical careers. Preliminary surgical positions, visa-related constraints, and cultural bias remain major challenges affecting IMG trainees and practicing surgeons.</p><p><strong>Conclusions: </strong>IMGs are indispensable to the future of the U.S. surgical workforce. Institutional support, mentorship, equitable recruitment practices, expanded residency opportunities, and immigration policy reform are necessary to strengthen IMG integration and ensure continued access to high-quality surgical care.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"451-457"},"PeriodicalIF":7.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital-level Variation in Inferior Vena Cava Filter Insertion in Trauma Patients: An Opportunity for a National Appropriateness Quality Improvement Initiative.","authors":"Cody Lendon Mullens, Anne H Cain-Nielsen, Scott C Levy, Jamila K Picart, Elizabeth A Alore, John W Scott, Lena M Napolitano, Mark R Hemmila","doi":"10.1097/SLA.0000000000007118","DOIUrl":"10.1097/SLA.0000000000007118","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate inferior vena cava (IVC) filter utilization among trauma patients with regard to national trends, interhospital variation, and association with outcomes.</p><p><strong>Background: </strong>IVC filters can be placed for therapeutic or prophylactic indications. Current clinical guidelines recommend IVC filter placement only for trauma patients with a proximal deep vein thrombosis (DVT) or pulmonary embolism (PE) and contraindication to anticoagulation.</p><p><strong>Methods: </strong>We performed a study using American College of Surgeons Trauma Quality Improvement Program data from 2017 to 2024. Inclusion criteria were adult patients, admitted to a level I or II trauma center, with blunt or penetrating injury, hospital length of stay ≥3 days, and an Injury Severity Score ≥9. Hospital-level IVC filter insertion rates were calculated, and trauma centers were classified as low (<1%) or high (≥1%) utilizers. Risk-adjusted hospital-level outcomes were generated using mixed-effects logistic regression with empirical Bayes shrinkage. Associations between hospital-level IVC filter utilization and mortality, DVT, PE, and venous thromboembolism were evaluated using Pearson correlation coefficients.</p><p><strong>Results: </strong>Among 2,277,066 patients, at 427 trauma centers, 18,415 (0.81%) underwent IVC filter placement. Utilization declined from 1.15% in 2017 to 0.59% in 2024 ( P < 0.001). Substantial interhospital variation was found, with 96 trauma centers (22.5%) demonstrating rates of IVC filter insertion ≥1% (range, 0% to 11.5%). Higher hospital-level IVC filter use was not associated with risk-adjusted in-hospital mortality ( r = 0.01, P = 0.77) but was associated with increased rates of DVT ( r = 0.28), PE (r = 0.20), and venous thromboembolism ( r = 0.30; all P < 0.001).</p><p><strong>Conclusions: </strong>Although rates of IVC filter use in trauma patients have declined, marked interhospital variation exists. A higher rate of IVC filter utilization was not associated with improved survival. This suggests an opportunity to measure and optimize appropriate IVC filter use across trauma centers.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"546-555"},"PeriodicalIF":7.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148262928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is 5.5 cm Still the Optimal Size Threshold to Treat AAA in Men? A Contemporary Cost-utility Analysis.","authors":"Jesse A Columbo, Salvatore T Scali, Anders Wanhainen, Dan Neal, Aravind S Ponukumati, Thomas S Huber, Sebastian Debus, Rebecca E Scully, Michol Cooper, Philip P Goodney, Gilbert Upchurch, David H Stone","doi":"10.1097/SLA.0000000000007134","DOIUrl":"10.1097/SLA.0000000000007134","url":null,"abstract":"<p><strong>Objective: </strong>To determine the contemporary cost per quality-adjusted life year (QALY) gained for abdominal aortic aneurysm (AAA) repair in current practice and assess the optimal threshold for intervention.</p><p><strong>Summary background data: </strong>The widely accepted 5.5 cm threshold for elective AAA repair in men remains largely consensus-based. However, contemporary evidence suggests that size-associated rupture risk may be lower than previously assumed, calling into question whether this threshold is cost-effective.</p><p><strong>Methods: </strong>A Markov chain estimated the cost-utility of endovascular AAA repair (EVAR) and open surgical repair (OSR) compared with surveillance. Social Security Administration life tables informed survival, while Vascular Quality Initiative and Medicare data informed complication rates, reinterventions, and late rupture. Quality-adjusted life years (QALYs) were derived from published estimates. Two willingness-to-pay (WTP) thresholds were evaluated: $100,000/QALY (US) and $40,000/QALY (UK NICE equivalent). Given uncertainty in size-specific rupture risk, a range of annual rupture probabilities was modeled. The base-case analysis considered a 70-year-old man over a 10-year time horizon.</p><p><strong>Results: </strong>At a WTP threshold of $100,000/QALY, immediate EVAR became cost-effective when annual rupture risk was ≥2.2%, whereas OSR became cost-effective at ≥3.4%. At a $40,000/QALY threshold, the rupture risk thresholds were ≥5.0% for EVAR and ≥6.8% for OSR. Assuming an annual rupture risk of 0.4% (as reported in a contemporary study), the cost per QALY gained with EVAR was $1,233,000, while OSR was associated with a loss of QALYs.</p><p><strong>Conclusions: </strong>The cost-effectiveness of AAA repair is highly dependent on rupture risk. Given that contemporary data suggest lower rupture rates than previously assumed, the current 5.5 cm repair threshold in men may not be optimally cost-effective from a population health perspective.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"582-595"},"PeriodicalIF":7.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148262987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combining Commercial Cancer Protein Biomarkers and Benign Fungal Antibodies Improves Diagnostic Accuracy in Pulmonary Nodules.","authors":"Hudson M Holmes, Kevin C McGann, Sheau-Chiann Chen, Cole Welch, Yong Zou, Sanja Antic, Yency J Forero, Samson A Argaw, Heidi Chen, Alex Kaizer, Anna Baron, Robert Meguid, Fabien Maldonado, Stephen A Deppen, Eric L Grogan","doi":"10.1097/SLA.0000000000007116","DOIUrl":"10.1097/SLA.0000000000007116","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether adding cancer and histoplasma biomarkers to existing clinical prediction models improves diagnostic accuracy for malignancy in indeterminate pulmonary nodules (IPNs).</p><p><strong>Summary background data: </strong>IPNs remain a diagnostic challenge, particularly in regions where granulomatous disease exists. Clinical prediction models such as the Mayo model perform moderately well but only use clinical and radiographic information. Blood-based biomarkers for cancer proteins and fungal exposure may enhance diagnostic discrimination.</p><p><strong>Methods: </strong>Two geographically distinct cohorts with 6-30 mm IPNs were studied from the Ohio River Valley (ORV) and the Mountain West (MW). Mayo scores, serum levels of 4 cancer proteins (CYFRA 21‑1, CEA, CA‑125, and HE‑4), and histoplasma IgG and IgM antibodies were measured. Area under the receiver operating curve (AUC) and 95% confidence intervals were calculated for individual components and combinations. Multivariable logistic regression models were built for pairwise combinations and for all variables together (full model). Risk reclassification was assessed in each cohort.</p><p><strong>Results: </strong>We studied 366 patients: 282 from the ORV cohort and 84 from the MW cohort. Mayo model AUCs were 0.74 (0.67-0.80) and 0.68 (0.59-0.78), respectively. Combining cancer biomarkers with fungal antibodies yielded AUCs of 0.74 (0.68-0.80) and 0.76 (0.64-0.86). The full model achieved AUCs of 0.80 (0.75-0.87) and 0.79 (0.70-0.88). In intermediate-risk nodules, the full model correctly upgraded malignancy risk in 46.3% and 42.9% of patients in each cohort.</p><p><strong>Conclusions: </strong>Integrating cancer biomarkers, fungal antibodies, and clinical prediction tools improves diagnostic performance for IPNs across distinct geographic regions. A combined biomarker-clinical model offers a feasible strategy to better differentiate benign from malignant nodules.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"638-646"},"PeriodicalIF":7.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13492203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148209915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated Assessment of Surgical Quality in Distal Gastrectomy: Development of a Novel Computer Vision Model Based on the Critical View of Quality (CVQ).","authors":"Jeesun Kim, Dotan Asselmann, Tamir Wolf, Seong-Ho Kong, Do Joong Park, Hyuk-Joon Lee, Gerald Fried, Han-Kwang Yang","doi":"10.1097/SLA.0000000000007130","DOIUrl":"10.1097/SLA.0000000000007130","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical validity of the critical view of quality (CVQ) as a measure of lymphadenectomy quality in minimally invasive distal gastrectomy and to develop a computer vision model for automated CVQ assessment.</p><p><strong>Background: </strong>Objective intraoperative assessment of lymphadenectomy quality in gastric cancer surgery remains limited, relying largely on postoperative surrogate markers such as lymph node yield.</p><p><strong>Methods: </strong>This retrospective study included 260 patients who underwent laparoscopic or robotic distal gastrectomy with complete intraoperative video recordings. CVQ was defined as an anatomy-based scoring system reflecting the completeness of lymph node dissection across five stations. Associations between CVQ and lymph node yield were evaluated using correlation and multivariable linear regression analyses. A computer vision model was developed to classify CVQ components as complete or incomplete using temporally contextualized video segments.</p><p><strong>Results: </strong>CVQ demonstrated a moderate positive correlation with lymph node yield (Pearson r =0.485, P <0.001; Spearman ρ=0.484, P <0.001) and remained independently associated after adjustment for clinical covariates (β=4.79, 95% CI: 3.83-5.74, P <0.001). Lymph node retrieval increased across CVQ quartiles (28.9 vs. 47.6 nodes, P <0.001). Lower CVQ scores were associated with older age, higher BMI, higher ASA classification, male sex, and surgeon-related variability (all P <0.05). CVQ was not associated with short-term postoperative outcomes. Automated CVQ classification achieved an average precision of up to 91.5%.</p><p><strong>Conclusions: </strong>CVQ is a clinically meaningful measure of lymphadenectomy quality that correlates with lymph node yield while capturing operative difficulty and surgeon-related variability. Automated assessment using surgical video is feasible and may enable scalable evaluation of intraoperative performance.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"607-617"},"PeriodicalIF":7.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148275685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GLP-1 Receptor Agonists versus Bariatric Surgery in Breast Cancer: A Comparative Study of Oncologic Outcomes.","authors":"Jennifer Den, Raj Vaghjiani, Matthew Hutter, V Suzanne Klimberg","doi":"10.1097/SLA.0000000000007121","DOIUrl":"10.1097/SLA.0000000000007121","url":null,"abstract":"<p><strong>Background: </strong>Obesity contributes to chronic inflammation and estrogen dysregulation, mechanisms linked to increased breast cancer (BC) risk and recurrence, particularly in postmenopausal women. Bariatric surgery and glucagon-like peptide-1 receptor agonists (GLP-1RAs) are effective weight-loss interventions, but their comparative impact on BC outcomes remains unclear. This study compared long-term overall survival (OS) and locoregional recurrence (LRR) among postmenopausal BC patients with obesity treated with GLP-1RAs, bariatric surgery, or both.</p><p><strong>Methods: </strong>Using the TriNetX Network, a real-world federated research database of de-identified electronic records from multiple health care organizations, we identified women aged ≥50 years with BMI ≥30 kg/m² and stage 0-III BC. Study 1 compared patients who initiated GLP-1RA therapy ≥6 months after BC diagnosis with those who underwent bariatric surgery during the same interval. Study 2 compared patients who received both bariatric surgery and GLP-1RA therapy with those who underwent surgery alone. Propensity score matching (1:1) was performed for age, BMI, tumor stage, receptor status, adjuvant therapy, other cancers, and comorbidities. Outcomes included OS and LRR, assessed from 30 days to 10 years after the index event (bariatric surgery or GLP-1RA initiation). Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards models.</p><p><strong>Results: </strong>In Study 1, 22,532 GLP-1RA users and 3468 bariatric surgery patients were identified; 3438 were matched in each cohort. 10-year OS was similar (87% vs. 83%), yet GLP-1RA users experienced significantly lower instantaneous mortality risk (HR 0.57, 95% CI: 0.45-0.73), indicating fewer or delayed deaths over time. LRR occurred in 1.8% vs. 4.7% (HR 0.52, 95% CI: 0.39-0.70), also favoring GLP-1RA therapy.In Study 2, 1220 patients underwent both bariatric surgery and GLP-1RA therapy and 3468 underwent surgery alone; 1129 were matched per group. The combination group showed higher OS (91% vs. 80%; HR 0.44, 95% CI: 0.29-0.67) and lower LRR (2.5% vs. 5.8%; HR 0.52, 95% CI: 0.33-0.81).</p><p><strong>Conclusions: </strong>Among postmenopausal women with obesity and stage 0-III BC, GLP-1RA therapy was associated with improved OS and lower LRR compared with bariatric surgery alone. Combination therapy achieved the most favorable oncologic outcomes, suggesting a potential synergistic effect. The advantage observed with GLP-1RAs may reflect oncologic effects beyond weight loss, potentially through anti-inflammatory, insulin-modulating, or other metabolic pathways. These findings support further investigation into the underlying biological mechanisms and potential role of GLP-1RAs in oncology.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"534-545"},"PeriodicalIF":7.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148257126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A National Assessment of Well-being and Mistreatment Among Academic General Surgery Faculty.","authors":"Kellie A Brue, Sarah E Huber, Joshua S Eng, Brian Ruedinger, Daniela Amortegui, Natalia Mackiewicz, Yue-Yung Hu, Karl Y Bilimoria, Amy L Holmstrom","doi":"10.1097/SLA.0000000000007135","DOIUrl":"10.1097/SLA.0000000000007135","url":null,"abstract":"<p><strong>Objectives: </strong>To define the prevalence of poor faculty well-being and workplace mistreatment and investigate factors impacting surgical faculty well-being.</p><p><strong>Summary background data: </strong>Recent qualitative data suggests that faculty well-being has been largely unaddressed. Rates of poor faculty well-being are undefined and workplace factors influencing well-being are poorly characterized.</p><p><strong>Methods: </strong>A national cross-sectional survey was sent to all general surgery faculty through the ACGME in 2024. Multivariable logistic regression models evaluated associations of faculty and departmental characteristics with measures of well-being.</p><p><strong>Results: </strong>Responses from 3253 (30.0% response rate) surgical faculty from all 350 general surgery programs were analyzed. Weekly burnout symptoms were reported by 34.9% of faculty, thoughts of attrition were reported by 30.2%, and suicidal thoughts were reported by 4.4%. Mistreatment was reported by 66.2% of faculty (n= 2132), including bullying (54.4%), discrimination (46.3%), or sexual harassment (13.2%). Women reported significantly higher mistreatment (88.6% vs. 55.7%, P <0.001). Faculty were more likely to report burnout if they were women (OR 1.30, 95% CI: 1.06-1.60) or working >70 hours/week (aOR 2.09, 95% CI: 1.63-2.68) or >7 nights on call/month on average (aOR 1.58, 95% CI: 1.30-1.93). Faculty were more likely to consider leaving their job if they were non-White (aOR 1.25, 95% CI: 1.04-1.51), childless (aOR 1.32, 95% CI: 1.05-1.67), or making < $350K (aOR 2.00, 95% CI: 1.34-2.97). After adjusting for mistreatment, the association between gender and burnout was no longer observed (aOR 0.95, 95% CI: 0.77-1.18).</p><p><strong>Conclusions: </strong>Burnout and mistreatment are common, especially among female surgeons, which may be driven by differential workplace mistreatment. These results provide actionable targets for interventions within institutions to improve surgeon well-being.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"492-505"},"PeriodicalIF":7.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13440652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Swine Leukocyte Antigen DR Deletion is a Viable Option for Donor Pigs Used in Renal Xenotransplantation.","authors":"Andrew B Adams, Matt Tector, Christopher Burlak, Jose Estrada, Luz Reyes, Sabrina Copsel, Claudia Muniz, Victor Novara Gennuso, Melanie Martucci, Neal Iwakoshi, Michael Dryden, David Faber, Bryan Ray, Holly Haver, Jayasree Hariharan, Rodrigo Vianna, Alfred J Tector","doi":"10.1097/SLA.0000000000007095","DOIUrl":"10.1097/SLA.0000000000007095","url":null,"abstract":"<p><strong>Objective: </strong>Swine Leukocyte Antigen-DR knockout (SLA-DR KO) pigs were created and evaluated for safety/infectious profile and the ability to function in a preclinical model of xenotransplantation.</p><p><strong>Background: </strong>SLA-DR is the dominant class II MHC antigen in pigs. It is unclear whether it is feasible/safe to delete SLA-DR in donor pigs to be used in kidney xenotransplantation.</p><p><strong>Methods: </strong>SLA DR KO pigs were created on the α-gal Sd a (GGTA1/B4GALNT2) deficient genetic background using CRISPR/Cas and somatic cell nuclear transfer. Pigs were evaluated for 55 potential zoonotic pathogens using digital droplet PCR assays. Four GGTA1/B4GALNT2/SLA-DR KO pig kidneys were transplanted into immunosuppressed rhesus monkeys. Renal function was monitored to evaluate whether these prototype kidneys could provide life-supporting renal function in a preclinical model.</p><p><strong>Results: </strong>SLA-DR KO pigs were produced and are healthy more than 16 months later, devoid of 55 pathogens with zoonotic infectious potential. Recipients survived 7, 126, >365, and >365 days. Serum creatinine was maintained in long-term survivors (Cr 0.8 mg/dL in both). Early graft losses (7 and 126 d) occurred because of donor-specific pretransplant SLA antibodies detected using a SLA bead crossmatch assay.</p><p><strong>Conclusions: </strong>SLA-DR KO pigs are viable and safe to consider as potential donors in clinical trials. The SLA DR KO pig kidneys provided good long-term graft function in a preclinical model if the donor was not sensitized to other SLA antigens present in the donor pig. The SLA-DR KO prototype is promising for evaluation in pig-to-human clinical xenograft trials.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"596-606"},"PeriodicalIF":7.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148161549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of Prophylactic Insulin in Surgical Patients Without Diabetes: A Pilot Randomized, Controlled Trial.","authors":"Jamie Schnuck, Ian A Jones, Robert H Schmicker, Bryan A Comstock, Armando E Rodriguez Martinez, Sara DePaoli, Erin E Fannon, Isaac A Knouff, Irl B Hirsch, E Patchen Dellinger, David R Flum","doi":"10.1097/SLA.0000000000007119","DOIUrl":"10.1097/SLA.0000000000007119","url":null,"abstract":"<p><strong>Objective: </strong>Determine the feasibility and proof-of-concept of using prophylactic insulin [glucose-insulin-potassium (GIK)] to improve outcomes in nondiabetic (NoDM) surgical patients.</p><p><strong>Summary background data: </strong>Perioperative hyperglycemia increases the risk of morbidity/mortality, and insulin is used to treat it. Prevention of hyperglycemia with prophylactic insulin may be better than using treatment insulin alone, but feasibility issues need to be addressed before developing a full-scale randomized controlled trial (RCT).</p><p><strong>Methods: </strong>A pilot RCT of GIK versus placebo among nondiabetic undergoing major abdominopelvic surgery. Feasibility (willingness to randomize, treatment completion) and clinical outcomes (glycemic control, neutrophil:lymphocyte ratio, and morbidity/mortality) were measured through 30 days.</p><p><strong>Results: </strong>Of 248 eligible patients, 103 were randomized (mean age 56, 54% female) to GIK (n=50) or placebo (n=53). Treatment was completed in 97% without episodes of severe hypoglycemia. Perioperative euglycemia (<125 mg/dL) was more common in the GIK arm (42%) versus the control (27%) ( P <0.01). Hyperglycemia (BG >140 mg/dL) was less common in the GIK arm (37% vs. 48%, P <0.05), as was the use of treatment insulin (26% vs. 45%, Absolute Risk Reduction (aRR) 0.6 [95% CI: 0.4, 0.9]). The rise in neutrophil:lymphocyte ratio from preoperative to postoperative day 1 was lower in the GIK group versus placebo (Delta 0.5, 95% CI: -6.23 to 3.32). Fewer complications were noted in the GIK arm (12%) versus control (21%) (aRR 0.5 [95% CI: 0.2, 1.5]), albeit with wide CIs.</p><p><strong>Conclusions: </strong>Prophylactic insulin improves glycemic outcomes and may improve clinical outcomes, possibly in part through anti-inflammatory mechanisms. A full-scale RCT focused on morbidity/mortality endpoints is feasible and would address an important evidence gap.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"527-533"},"PeriodicalIF":7.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148262632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}