E-Only Articles
Is the Power Threshold of 0.8 Applicable to Surgical Science?—Empowering the Underpowered Study [Journal of Surgical Research 241 (2019) 235–239]
The original version of this article went online on 28 April 2019 and was erroneously updated on 12 June 2019 with the supplementary files removed. The original version was restored on 28 June 2019. The Publisher apologizes for the removal of the supplementary files, which was done without the permission of the Editor.Violent reinjury risk assessment instrument (VRRAI) for hospital-based violence intervention programs
Violent injury is the second most common cause of death among 15- to 24-year olds in the US. Up to 58% of violently injured youth return to the hospital with a second violent injury. Hospital-based violence intervention programs (HVIPs) have been shown to reduce injury recidivism through intensive case management. However, no validated guidelines for risk assessment strategies in the HVIP setting have been reported. We aimed to use qualitative methods to investigate the key components of risk assessments employed by HVIP case managers and to propose a risk assessment model based on this qualitative analysis.State-level geographic variation in prompt access to care for children after motor vehicle crashes
Motor vehicle crashes (MVCs) are a principal cause of death in children; fatal MVCs and pediatric trauma resources vary by state. We sought to examine state-level variability in and predictors of prompt access to care for children in MVCs.Then we all fall down: fall mortality by trauma center level
Ground-level falls (GLFs) are the predominant mechanism of injury in US trauma centers and accompany a spectrum of comorbidities, injury severity, and physiologic derangement. Trauma center levels define tiers of capability to treat injured patients. We hypothesized that risk-adjusted observed-to-expected mortality (O:E) by trauma center level would evaluate the degree to which need for care was met by provision of care.An anatomic risk model to screen post endovascular aneurysm repair patients for aneurysm sac enlargement
Follow-up computed tomography angiography (CTA) scans add considerable postimplantation costs to endovascular aneurysm repairs (EVARs) of abdominal aortic aneurysms (AAAs). By building a risk model, we hope to identify patients at low risk for aneurysm sac enlargement to minimize unnecessary CTAs.Musculoskeletal occupational injury among surgeons: effects for patients, providers, and institutions
The aim of this study was to determine the risk of occupational musculoskeletal injury during a surgeon's career and the effects of these injuries for patients, providers, and institutions. We hypothesized that surgeons have occupational injuries, which affect work performance.Pretreatment with sildenafil alleviates early lung ischemia-reperfusion injury in a rat model
Lung ischemia-reperfusion (I/R) injury plays an important role in lung transplantation. Less well known is the role of sildenafil in lung I/R injury; therefore, we attempted to determine whether sildenafil could alleviate lung apoptosis and tissue injury in a rat model.Repeatability of anorectal manometry in healthy volunteers and patients
Anorectal manometry is used extensively in the assessment of patients with disorders of the pelvic floor. The present study investigated the repeatability of anorectal manometry in healthy volunteers and patients.Pepsin concentrations are elevated in the bronchoalveolar lavage fluid of patients with idiopathic pulmonary fibrosis after lung transplantation
Aspiration of gastroesophageal refluxate has been implicated in the pathogenesis of idiopathic pulmonary fibrosis (IPF) and the progression of bronchiolitis obliterans syndrome after lung transplantation. The goals of the present study were to identify lung transplant patients at the greatest risk of aspiration and to investigate the causative factors.Hypercoagulability in response to elevated body temperature and central hypovolemia
Coagulation abnormalities contribute to poor outcomes in critically ill patients. In trauma patients exposed to a hot environment, a systemic inflammatory response syndrome, elevated body temperature, and reduced central blood volume occur in parallel with changes in hemostasis and endothelial damage. The objective of this study was to evaluate whether experimentally elevated body temperature and reduced central blood volume (CBV) per se affects hemostasis and endothelial activation.CCN2 is transiently expressed by keratinocytes during re-epithelialization and regulates keratinocyte migration in vitro by the ras-MEK-ERK signaling pathway
CCN2 (previously known as connective tissue growth factor) is a multifunctional matricellular protein that has numerous effects on cell life and cell interactions with the connective tissue. Although the importance of CCN2 for the fibrotic process in wound healing has been well studied, the involvement of CCN2 in keratinocyte function has not yet been explored. Therefore, the aim of the present study was to investigate the role of CCN2 in the epidermis during wound healing.Characterizing lobular carcinoma of the male breast using the SEER database
Lobular carcinoma of the male breast is rare. We sought to investigate the clinical characteristics, treatment, and outcomes of men and women with lobular breast cancer, using a population-based database.Protective effects of hydrogen sulfide in a rat model of traumatic brain injury via activation of mitochondrial adenosine triphosphate–sensitive potassium channels and reduction of oxidative stress
Hydrogen sulfide (H2S) is considered an important neuromodulator in the central nervous system. We designed the present study to investigate the effects of exogenous H2S in a rat model of traumatic brain injury (TBI) and the mechanism(s) that underlie this effect.Satellite cell functional alterations following cutaneous burn in rats include an increase in their osteogenic potential
Significant consequences of severe burn include skeletal muscle atrophy and heterotopic ossification (HO). The cellular mechanisms underlying either of these conditions are not known. Whether the functionality of satellite cells stem cells resident in skeletal muscle is affected by changes in circulatory factors following burn was determined to better understand their role in atrophy and HO.Meta-analysis of studies comparing single-incision laparoscopic appendectomy and conventional multiport laparoscopic appendectomy
There is no consensus that single-incision laparoscopic appendectomy (SILS-A) is on a par with conventional multiport laparoscopic appendectomy (CMLA). The aim of this meta-analysis was to assess feasibility, safety, and potential benefits of SILS-A when compared with CMLA.Sewed revascularization for arterialized liver transplantation in mice
Mouse models of liver transplantation are powerful tools for biomedical research. The cuff method is currently the most popular approach for revascularization of mouse liver grafts, as it is relatively easy to perform hence reducing the anhepatic time. However, the use of cuffs may induce a tissue reaction, causing chronic obstruction of anastomosed vessels, leading to portal hypertension. Here, we applied the suture technique for arterialized liver transplantation in mice.Extracorporeal membrane oxygenation for resuscitation of deceased cardiac donor livers for hepatocyte isolation
Deceased cardiac donors (DCDs) have become a useful source of organs for liver transplantation; nevertheless, there are concerns about the longevity of these grafts. The aim of this study was to evaluate the use of extracorporeal membrane oxygenation (ECMO) to resuscitate DCD porcine livers as a preclinical model using hepatocyte isolation and viability as a marker to assess whole-graft preservation.Eritoran attenuates tissue damage and inflammation in hemorrhagic shock/trauma
Severe injury and associated hemorrhagic shock lead to an inflammatory response and subsequent increased tissue damage. Numerous reports have shown that injury-induced inflammation and the associated end-organ damage is driven by Toll-like receptor 4 (TLR4) activation via damage-associated molecular patterns. We examined the effectiveness of Eritoran tetrasodium (E5564), an inhibitor of TLR4 function, in reducing inflammation induced during hemorrhagic shock with resuscitation (HS/R) or after peripheral tissue injury (bilateral femur fracture, BFF).Linalool: a novel natural anti-inflammatory agent?: Commentary on “Anti-inflammatory effects of linalool in RAW 264.7 macrophages and lipopolysaccharide-induced lung injury model”
Proinflammatory states are widely implicated in both acute and chronic disease processes. Severe acute systemic inflammation is at least partially responsible for shock and acute lung injury, and therapeutic options to curb the proinflammatory responses are limited. Sustained release of proinflammatory mediators by macrophages and other leukocyte subtypes is the hallmark of autoimmune illnesses. In addition to nonspecific immunosuppressants, targeted therapies to reduce inflammation via inhibition of cytokine release are available for some of these illnesses, including Crohn disease and rheumatoid arthritis.An in vitro study assessing the infection risk of low-cost polyethylene mosquito net compared with commercial hernia prosthetics
The innovative use of sterilized mosquito net as a cheaper alternative to commercial mesh for hernia repair has gained increasing recognition. Developing health care systems have inherently higher surgical site infection rates, and concerns regarding the introduction of untested prosthetic hernia meshes have been raised. This in vitro study assesses the infection risk of polyethylene (PE) mosquito net mesh compared with commercial hernia prosthetics by assessing the essential (first) step in the pathogenesis of mesh infections.A novel rat model of osteonecrosis of the femoral head induced by periarticular injection of vascular endothelial growth factor receptor 2 antibody
Traditional methods to establish animal model of osteonecrosis of the femoral head (ONFH) are not satisfactory because of the undefined underlying mechanism, low rate of the disease, and high incidence of mortality. The present study was to induce ONFH in a rat model through periarticular injection of vascular endothelial growth factor (VEGF) receptor 2 antibody.Effects of glycine, pyruvate, resveratrol, and nitrite on tissue injury and cytokine response in endotoxemic rats
Glycine, pyruvate, resveratrol, and nitrite are well-known protective compounds among others in ischemic tissue injury. Here, we compared their effects in acute lipopolysaccharide (LPS)-induced shock in rats to assess whether inhibition of the proinflammatory cytokine response is a prerequisite for their protective actions.17β-Estradiol attenuates secondary injury through activation of Akt signaling via estrogen receptor alpha in rat brain following subarachnoid hemorrhage
Apoptosis is implicated in vasospasm and the long-term sequelae of subarachnoid hemorrhage (SAH). This study tested the hypothesis that attenuation of SAH-induced apoptosis after 17β-estradiol (E2) treatment is associated with an increase in phosphorylation of Akt via estrogen receptor-α (ER-α) in rats.Intestinal alkaline phosphatase prevents the systemic inflammatory response associated with necrotizing enterocolitis
Necrotizing enterocolitis (NEC) represents a heterogeneous group of pathologic processes in the intestines of neonates who are commonly premature with very low birth weights. It is characterized by an intense inflammatory response and has mortality rates as high as 20%–40% [1,2]. Despite the established relationship between necrotizing enterocolitis and a proinflammatory cascade, the pathophysiology is still not completely understood. The involvement of enteral feedings, compromised intestinal perfusion, and bacterial invasion are commonly accepted factors [3].Importance of erythropoietin in septic encephalopathy
Erythropoietin (EPO) is a 31-kDa glycoprotein that has long been studied for its role in hematopoiesis. However, more recent evidence suggests that in addition to its biological functions in the hematopoietic system, EPO may have significant activity in the brain [1–3]. More specific functions in the brain have been proposed, including EPO as a neuroprotective agent against excitotoxicity and apopotosis, as well as EPO enhancing the proliferation and mobilization of neuronal stem cells [4,5].The Iliad and the Odyssey of metallic foreign body extraction: commentary on “Novel methods of removing metallic foreign body from human soft tissue: a report of 7390 cases”
Surgeons have been extracting metallic foreign bodies (MFB) for centuries. Perhaps the earliest literary account comes from Homer's epic poem The Iliad (ca BC 800), based on events of the Trojan War from Greek mythology. Makaon operated on an arrow wound to the abdomen of King Menelaus by extracting the arrow, sucking blood from the wound to remove poison, and applying a salve [1]: The shaft he drew, but left the head behind. Straight the broad belt with gay embroidery graced, He loosed; the corslet from his breast unbraced; Then suck'd the blood, and sovereign balm infused, Which Chron gave, and Aesculapius used [2].Radicicol, a Hsp90 inhibitor, inhibits intestinal inflammation and leakage in abdominal sepsis
Sepsis complex syndromes remain active challenges in critical care medicine because of a deficiency in understanding the molecular basis and cellular signaling network of such infections. We hope that the 21st century will witness a revolution in discovering and targeting the cellular and molecular roots of this clinical entity. Severe sepsis with multiple organ dysfunction remains the most common cause of mortality in noncardiac intensive care units and is ranked as the 10th leading cause of death in the US [1].The long and winding road to immune tolerance
No matter how many new immunosuppressive medications reach the market, the “Holy Grail” of transplantation has always been (and according to some will continue to “always” be) the induction of donor-specific immunologic tolerance. In this effort to modulate the immune system, there have been a multitude of different approaches and candidates at the cellular or molecular level. Dendritic cells (DC), as possibly the most effective antigen presenting cells, appear to play a critical role in moderating the immune response.Strategies to prevent sepsis-induced intensive care unit–acquired weakness: are there any options? Commentary on “Comparison of melatonin and oxytocin in the prevention of critical illness polyneuropathy in rats with surgically induced sepsis”
Intensive care unit-acquired weakness (ICUAW) is one of the leading causes of morbidity in critically ill patients and a significant risk factor for the development of chronic critical illness. In 2008, 727,000 patients were hospitalized for sepsis, with mortality rate of 17% at an estimated cost of $14.6 billion [1]. The risk of critical illness neuromuscular abnormalities in patients with sepsis, multiorgan failure, or prolonged mechanical ventilation is reported to be as high as 46% [2].Efficient selection of Gal-knockout pig cells for somatic cell nuclear transfer
The process of selecting transgenic cells has been one of the bottlenecks in the generation of transgenic animals by somatic cell nuclear transfer (SCNT). In particular, selection for the Gal double-knockout (Gal-DKO) genotype has been time consuming and inefficient. The objective of this work was to generate a highly efficient system to select Gal-DKO cells to be used in SCNT without affecting the efficiency in production of Gal-null pigs.Anti-inflammatory effects of linalool in RAW 264.7 macrophages and lipopolysaccharide-induced lung injury model
Inflammation, characterized by redness, swelling, pain and a sensation of heat, is one of the body’s self-defense systems. Although the inflammation response has an important role in host survival, it also leads to chronic inflammatory diseases. Linalool is a natural compound of the essential oils in several aromatic plants species. It possesses anti-inflammatory, antinociceptive, and other bioactive properties. In the present study, we investigated the protective effects of linalool on inflammation in lipopolysaccharide (LPS)-stimulated RAW 264.7 cells and an LPS-induced in vivo lung injury model.Participation of autophagy in lung ischemia–reperfusion injury in vivo
In response to stress, autophagy is activated and may present as a cell survival mechanism or lead to cell death. Although there has been some progress in studying the function of autophagy in the ischemia–reperfusion (I/R) injury of other organs, little is known about the role autophagy plays in lung I/R injury.Intraoperative stress in cardiac surgery: Attendings versus residents
Performing cardiac surgery is associated with stress for surgeons. We investigated stress levels of experienced surgeons and trainees during coronary artery bypass graft teaching procedures.Predictive value of pleural and serum interleukin-6 levels for pneumonia and hypo-oxygenations after esophagectomy
Pulmonary complications after esophagectomy continue to be a significant cause of morbidity and mortality. Although several factors have been implicated to be associated with pulmonary complications after esophagectomy, the prediction of pulmonary complications remains a challenge. The purpose of this study was to evaluate the predictive value of cytokine levels in sera and pleural drainage fluid for pneumonia and hypo-oxygenations following esophagectomy.Force recovery and axonal regeneration of the sternomastoid muscle reinnervated with the end-to-end nerve anastomosis
End-to-end nerve anastomosis (EEA) is a commonly used nerve repair technique. However, this method generally results in poor functional recovery. This study was designed to determine the correlation of functional recovery to the extent of axonal reinnervation after EEA procedure in a rat model.Alpha tocopherol treatment reduces the expression of Nogo-A and NgR in rat brain after traumatic brain injury
Neurite outgrowth inhibitor-A (Nogo-A), myelin-associated glycoprotein, and oligodendrocyte myelin glycoprotein are three myelin-associated proteins that act as inhibitors to central nervous system regeneration. Neurite outgrowth inhibitor-A imposes the strongest effect on inhibiting axonal regeneration after traumatic brain injury. Alpha-tocopherol, a member of the vitamin E family, is recognized as an active antioxidative substance. Its use has not been well studied in brain injury research, especially in axonal regeneration research.Corrigendum for the paper “Platonin mitigates acute lung injury induced by bilateral lower limb ischemia-reperfusion in rats”
The authors would like to correct an error printed in our article on the effects of platonin against lung injury induced by bilateral lower limb ischemia-reperfusion in rats [1]. The correct Figure 2 is shown below. We wish to express our sincere apology for this error.Commentary on “Defining and predicting surgeon utilization at Forward Surgical Teams in Afghanistan”
In a recently published paper in the Journal of Surgical Research, Remick et al. [1] discuss contrasts between two Forward Surgical Teams deployed to Afghanistan during Operation Enduring Freedom during two separate time periods. Forward Surgical Teams are currently the smallest unit available to the US Army to provide resuscitative surgery in the field. These units, and variations, have been pushed farther afield in an effort to provide far-forward resuscitative capacity for our injured service members in the conflict in the Middle East.Inhibition of hydrogen sulfide generation contributes to lung injury after experimental orthotopic lung transplantation
Lung injury induced by ischemia or reperfusion significantly accounts for the risk of early mortality of lung transplantation (LT). Recent studies have demonstrated that hydrogen sulfide (H2S) and its endogenous synthase cystathionine-γ-lyase (CSE) confer protection against injury induced by ischemia or reperfusion in various organs. This prompted us to define the role of CSE/H2S pathway in transplantation-induced lung injury.Bone marrow–derived cells participate in the long-term remodeling in a mouse model of esophageal reconstruction
The default response of the esophagus to injury includes inflammation and scar tissue formation often leading to stricture. Biologic scaffolds composed of extracellular matrix (ECM) have been associated with the reconstitution of functional esophageal tissue in preclinical studies and clinical case reports of esophageal mucosal resection, anastomotic reinforcement, and full circumferential replacement. However, the mechanisms responsible for this change in the default response to esophageal injury are not fully understood.Angiotensin II as a limiting agent to intracellular calcium signaling in inflammatory states
Angiotensin II, the end product of the renal angiotensin system, is well known for its role in increasing peripheral vascular resistance and subsequent elevation in blood pressure in a clinical setting. The regulatory effect of angiotensin II on growth factors and inflammatory cytokines in an immunologic setting is less known but equally important aspect of this protein molecule. In a recently published article in the Journal of Surgical Research, Lo et al. has expanded on this topic by exploring the role of angiotensin II.Infrared thermography of cutaneous melanoma metastases
Differentiating melanoma metastasis from benign cutaneous lesions currently requires biopsy or costly imaging, such as positron emission tomography scans. Melanoma metastases have been observed to be subjectively warmer than similarly appearing benign lesions. We hypothesized that infrared (IR) thermography would be sensitive and specific in differentiating palpable melanoma metastases from benign lesions.Commentary: Empiric antibiotics pending bronchoalveolar lavage data in patients without pneumonia significantly alters the flora but not the resistance profile if a subsequent pneumonia develops
Ventilator-associated pneumonia (VAP), defined as pneumonia that occurs within 48–72 h of endotracheal intubation, has been reported to occur in up to 52% of critically ill patients [1]. VAP is associated with increased morbidity, mortality, the length of hospital stay, and excess costs [2]. Given the magnitude of the problem, there has been an impetus to identify processes of care that are linked to outcome such as appropriate antibiotic coverage and timing in patients with suspected VAP. In 2005, the American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) published the consensus guidelines for the management of VAP.Radical gastrectomy with para-aortic lymphadenectomy for carcinoma? The controversy continues. Commentary on Risk Factors for Metastasis to Para-Aortic Lymph Nodes in Gastric Cancer: A Single Institution Study in China. Journal of Surgical Research
Gastric cancer is the fourth most common cancer worldwide and the second leading cause of cancer death. The highest incidence of gastric cancer is in Eastern Asia. China has 463,000 new cases a year, whereas the United States as an annual incidence of 21,000 cases [1]. Intestinal type gastric cancer is more prevalent in high-risk areas and is influenced by environmental factors. Because the incidence and histology are variable by region, there remains significant worldwide controversy regarding management of the disease.The dream: A leadership fable
R. Buckingham Daniels1—“Buck” to most people—was as cool as a cucumber as he was rolled down the hall to the operating room. Maybe it was the premedication. Maybe it was because he would not be under anesthesia for very long; the procedure was relatively minor, and he had great confidence in his surgeon. Maybe it was because he had been a practicing surgeon for 30 years and knew the drill. Maybe it was because he knew that, as head of the medical center, he would receive extra good care. Or, maybe it was because he had a lot on his mind: his hospital's growing number of uninsured patients, decreasing reimbursement, and disgruntled physicians—realities he did not want to deal with.Selective occlusion of the portal vein while maintaining hepatic artery blood flow during partial hepatectomy: a new method for preventing ischemia-reperfusion injury?
The liver is an essential multifunctional organ with diverse vital functions in nutrient metabolism, blood and bile formation, detoxification, and hormone production. Liver function can be impaired by drug and alcohol abuse, food and environmental toxins, metabolic disorders, viral infections, and congenital defects. Primary liver cancer and liver metastases, primarily from colorectal cancer, can also cause life-threatening damage to the liver [1]. Depending on comorbidities, tumor size, and the segmental distribution of tumors in the liver, the techniques of ablation, resection, or liver transplantation remain the most important and successful treatment modalities for primary and secondary liver cancer [2,3].Experimental study on the effect of controlled hypotension levels on rabbit CA1 neurons
The present study investigated the effect of controlled hypotension (CH) levels regulated by nitroprusside on hippocampal CA1 neurons.Early laparotomy wound failure as the mechanism for incisional hernia formation
Incisional hernia is the most common complication of abdominal surgery leading to reoperation. In the United States, 200,000 incisional hernia repairs are performed annually, often with significant morbidity. Obesity is increasing the risk of laparotomy wound failure.A blood test for acute rejection after renal transplantation? Commentary on “Osteopontin level correlates with acute cellular renal allograft rejection”
End-stage renal disease affects over 500,000 patients each year in the United States. Currently, over 92,000 people wait on the kidney transplant list in the United States alone, where approximately 16,000 transplants occur annually [1]. With such a discrepancy between supply and demand, graft survival is critical. Yet, even with advances in transplantation technique and immunosuppression, year one acute rejection rates remain between 10% and 20% [2]. Acute rejection begins subclinically and progression may lead to irreversible organ damage or graft loss.
