Journal of the American College of Surgeons
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The Appalachian region of the United States (US) extends from the Mississippi delta to southern New York. Although disparities in Appalachian cancer outcomes have long been observed, recent rates and trends have not been assessed. ⋯ While cancer incidence and mortality rates are declining in Appalachia, they remain substantially higher and demonstrate slower progress than elsewhere in the US-particularly in the Central Appalachian subregion-indicating the need for targeted research to delineate and address the factors driving these cancer health disparities.
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Obesity is directly correlated with wound complications and recurrence following open ventral hernia repair (OVHR). Preoperative weight loss (WL) mitigates these risks, improves overall health, and reduces intraabdominal volume. For patients successful in losing weight, it is unclear whether this WL is maintained. ⋯ Prehabilitation-induced WL averaged 26lbs. With 3.5years follow-up, patients weighed an average of 24lbs less than their initial consult weight. Nearly half of patients continued WL postoperatively, and more than 70% maintained at least half of their WL, demonstrating longevity to preoperative optimization.
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Anastomotic conversions and revisions remain crucial in addressing complications or sub-optimal outcomes following primary bariatric procedures. Preoperative malnutrition, proxied by hypoalbuminemia, has traditionally been considered a risk factor for postoperative morbidity. This study investigates the validity of this association in revisional and conversion metabolic/bariatric surgery (MBS). ⋯ Following adjustment for confounding patient factors, hypoalbuminemia alone did not arise as an independent predictive factor for the 30-day major complications such as leak, reoperation, or re-intervention after revisional and anastomotic conversion MBS, although there maybe increase in SSI and readmission rates.
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Idiopathic subglottic stenosis (iSGS) is a rare fibrotic disease of the proximal airway affecting adult Caucasian women nearly exclusively. Life-threatening ventilatory obstruction occurs secondary to pernicious subglottic mucosal scar. Disease rarity and wide geographic patient distribution has previously limited substantive mechanistic investigation into iSGS pathogenesis. ⋯ Our novel data support an iSGS disease model where epithelial alterations facilitate microbiome displacement, dysregulated immune activation, and localized fibrosis. Overall, these results refine our understanding of iSGS and implicate shared pathogenic mechanisms with distal airway fibrotic diseases.