Journal of the American College of Surgeons
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Obese patients are more prone to post-injury multiple organ failure (MOF). Obesity pathophysiology includes an adipose-tissue-derived, renin-angiotensin-aldosterone system affecting inflammatory responses via leukocyte angiotensin receptors. We hypothesized that obese patients receiving pre-injury angiotensin-converting enzyme inhibitor (ACE) or angiotensin receptor blocker (ARB) therapy would have decreased MOF and differences in immune cell frequencies. ⋯ Obese patients receiving preinjury ACE/ARB therapy demonstrate post-injury MOF scores similar to nonobese patients; obese patients not receiving these medications have greater post-injury MOF. Leukocyte analysis demonstrates improved immune regulation. Modulation of the renin-angiotensin-aldosterone system pathway might represent a novel therapeutic target in severely injured obese patients.
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Comparative Study
Racial and Regional Disparities in the Effect of the Affordable Care Act's Dependent Coverage Provision on Young Adult Trauma Patients.
Disparities in trauma outcomes based on insurance and race are especially pronounced among young adults who have relatively high uninsured rates and incur a disproportionate share of trauma in the population. The 2010 Dependent Coverage Provision (DCP) of the Affordable Care Act (ACA) allowed young adults to remain on their parent's health insurance plans until age 26 years, leading to >3 million young adults gaining insurance. We investigated the impact of the DCP on racial disparities in coverage expansion among trauma patients. ⋯ Although the DCP increased insurance coverage for young adult trauma patients of all races, both absolute and relative racial disparities in insurance coverage widened. The extent of these racial disparities also differed by geographic region. Although this policy produced overall progress toward greater coverage among young adults, its heterogeneous impact by race has important implications for future disparities research in trauma.
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The aim of this study was to investigate the messenger RNA and protein expressions of SET and MYND domain-containing protein 3 (SMYD3) and transforming growth factor-β1 (TGF-β1) in gastric cancer (GC) and to explore the correlations between these proteins and the biologic behavior of GC. ⋯ SET and MYND domain-containing protein 3 expression and TGF-β1 expression in GC tissues were significantly and positively correlated. High expression levels of SMYD3 and TGF-β1 can indicate poor prognoses for GC patients.
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Comparative Study
Extended Intervals after Neoadjuvant Therapy in Locally Advanced Rectal Cancer: The Key to Improved Tumor Response and Potential Organ Preservation.
Many rectal cancer patients experience tumor downstaging and some are found to achieve a pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT). Previous data suggest that there is an association between the time interval from nCRT completion to surgery and tumor response rates, including pCR. However, these studies have been primarily from single institutions with small sample sizes. The aim of this study was to examine the relationship between a longer interval after nCRT and pCR in a nationally representative cohort of rectal cancer patients. ⋯ An nCRT-surgery interval time >8 weeks results in increased odds of pCR, with no evidence of associated increased surgical complications compared with an interval of 6 to 8 weeks. These data support implementation of a lengthened interval after nCRT to optimize the chances of pCR and perhaps add to the possibility of ultimate organ preservation (nonoperative management).
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Controlled Clinical Trial
Effects of Fatigue on Residents' Performance in Laparoscopy.
The influence of fatigue on residents' performance in laparoscopy was prospectively assessed through a computer-based virtual reality simulation (VRS) model. ⋯ In this prospectively controlled study we observed reduced efficiency and safety in the performance of residents after sleep deprivation. Using an innovative study design, we eliminated the learning curve bias. Compared with novices, experienced residents performed relatively better after a night shift, and this may be attributed to better adaptation to sleep deprivation.