Surgery

BACKGROUND: Enhanced recovery pathways have been shown to improve clinical outcomes after surgery. Concerns exist about the feasibility of implementing enhanced recovery pathways in frail patients, who are at a greater risk for adverse postoperative outcomes. This study evaluated compliance and outcomes after enhanced recovery pathway implementation in high-risk, abdominal surgery patients. METHODS: Patients entered into the American College of Surgeons National Surgical Quality Improvement Program database who underwent abdominal surgery after enhanced recovery pathway implementation at two Johns Hopkins Medical Institutions were included...

BACKGROUND: The transition from fourth-year medical student to surgical intern is difficult. A lack of repetitions, experience, and knowledge is problematic. We report our experience using simulation-based technical and nontechnical skills to assess the competency of surgical interns in July and January of their intern year. DESIGN: As part of a larger assessment effort, our general surgery interns (2010-2016) have been tested on performing an emergent cricothyrotomy, interpreting 2 arterial blood gases, and reading 3 chest x-rays in fewer than 7 minutes...

BACKGROUND: Microvascular invasion is the strongest prognostic factor of survival in patients with hepatocellular carcinoma. We therefore developed a predictive model for microvascular invasion of hepatocellular carcinoma to help guide treatment strategies in patients scheduled for either hepatic resection or liver transplantation. METHODS: Patients with hepatocellular carcinoma who underwent hepatic resection or liver transplantation from 1994 to 2016 were divided into training and validation cohorts...

BACKGROUND: Interest is growing in simulation-based continuing medical education courses for practicing surgeons. However, little research has explored the instruction employed during these courses. This study examines instruction practices used during an annual simulation-based continuing medical education course. METHODS: Audio-video data were collected from surgeon instructors (n = 12) who taught a simulated laparoscopic hernia repair continuing medical education course across 2 years...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: Lymph node metastases from papillary thyroid cancer is believed to disseminate sequentially, first to the central neck and later to the lateral neck. Skip metastases of papillary thyroid cancer, however, are defined as lateral lymph node metastasis without central lymph node metastasis. The aim of this study was to investigate the risk factors for skip metastases and lateral lymph node metastasis of papillary thyroid cancer. METHODS: We reviewed 721 papillary thyroid cancer patients undergoing total thyroidectomy with central lymph node dissection and lateral lymph node dissection during 2013 to 2018...

BACKGROUND: Women are underrepresented in trauma research, and aggregated results of clinical trials may mask effects that differ by sex. It is unclear whether women respond differently to severe hemorrhage compared with men. We sought to evaluate sex-based differences in outcomes after severe trauma with hemorrhage. METHODS: We performed a secondary analysis of the Pragmatic Randomized Optimal Platelet and Plasma Ratios trial. Trauma patients predicted to require massive transfusion were randomized to a 1:1:1 vs 1:1:2 plasma to platelet to red blood cell transfusion ratio...

BACKGROUND: Morbidity and mortality after hepatectomy for perihilar cholangiocarcinoma are known to be high. However, reported postoperative outcomes vary, with notable differences between Western and Asian series. We aimed to determine morbidity and mortality rates after major hepatectomy in patients with perihilar cholangiocarcinoma and assess differences in outcome regarding geographic location and hospital volume. METHODS: A systematic review was performed by searching the MEDLINE and EMBASE databases through November 20, 2017...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: Mastery learning is an effective educational tool to assess basic procedural skill proficiency and may also be beneficial for more complex skills along the continuum of surgical training. In addition, anxiety and confidence have effects on cognitive and decision-making performance, both in educational and clinical settings. This study evaluates anxiety and confidence in a skills-level-appropriate mastery learning module for chest tube insertion in graduating medical students...

BACKGROUND: This study aimed to elucidate the impact of extranodal extension, pathologically assessed according to new diagnostic criteria, on the prognosis of esophageal squamous cell carcinoma. Extranodal extension has been shown to be a prognostic indicator for head and neck cancers; however, its utility in esophageal squamous cell carcinoma has not been demonstrated. METHODS: We enrolled 174 consecutive esophageal squamous cell carcinoma patients who had undergone esophagectomy with lymph node dissection in the three fields...

BACKGROUND: To investigate the prognostic values of the change of α-fetoprotein within 1 week after resection of hepatocellular carcinoma. METHODS: We retrospectively analyzed patients with hepatocellular carcinoma who underwent curative hepatectomy as primary therapy at Zhongshan Hospital, Fudan University (Shanghai, China) from 2009 to 2011. We measured serum α-fetoprotein before (α-fetoprotein0 ) and 1 week after (α-fetoprotein7 ) hepatectomy, calculated change of α-fetoprotein, namely the α-fetoprotein response by the formula: AR = lgAFP7 /lgAFP0 (lg = log10 ), analyzed the relationship between patient survival and α-fetoprotein response, and explored the potential clinical implications of the α-fetoprotein response...

BACKGROUND: Malignancy is a relative contraindication in transplant candidates, given the increased neoplastic risk accompanying posttransplant immunosuppression. However, the number of patients receiving a lung transplant despite pretransplant malignancy is rising, and their outcomes remain unclear. Our purpose was to examine the outcomes of lung transplant recipients with pretransplant malignancy in the modern era. METHODS: We evaluated the United Network for Organ Sharing registry for adult lung transplants that were completed between June 2005 and September 2016...

No abstract text is available yet for this article.

BACKGROUND: Lung ischemia-reperfusion injury is a complex pathophysiologic process associated with high morbidity and mortality. We have demonstrated elsewhere that diabetes mellitus aggravated ischemia-induced lung injury. Oxidative stress and mitochondrial dysfunction are drivers of diabetic lung ischemia-reperfusion injury; however, the pathways that mediate these events are unexplored. In this study using a high-fat diet-fed model of streptozotocin-induced type 2 diabetes in rats, we determined the effect of hydrogen sulfide on lung ischemia-reperfusion injury with a focus on Sirtuin3 signaling...

No abstract text is available yet for this article.

No abstract text is available yet for this article.