Journal of the American College of Surgeons
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Randomized Controlled Trial Comparative Study
Comparison of Analgesic Efficacy of Laparoscope-Assisted and Ultrasound-Guided Transversus Abdominis Plane Block after Laparoscopic Colorectal Surgery: A Randomized, Single-Blind, Non-Inferiority Trial.
Transversus abdominis plane (TAP) block has been used as a component of multimodal analgesia after abdominal operation. We introduced a new laparoscope-assisted TAP (LTAP) block technique using intraperitoneal injection and compared its analgesic effect with that of an ultrasound-guided TAP (UTAP) block in terms of postoperative pain control. ⋯ These results show our new LTAP block technique was non-inferior to the ultrasound-guided technique in providing a TAP block after laparoscopic colorectal operation.
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Observational Study
Syndecan-1: A Quantitative Marker for the Endotheliopathy of Trauma.
Endothelial glycocalyx breakdown elicits syndecan-1 shedding and endotheliopathy of trauma (EoT). We hypothesized that a cutoff syndecan-1 level can identify patients with endothelial dysfunction who would have poorer outcomes. ⋯ A syndecan-1 level ≥40 ng/mL identified patients with significantly worse outcomes, despite admission physiology similar to those without the condition.
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Nipple-sparing mastectomy (NSM) has gained popularity for breast cancer treatment and prevention. There are limited data about long-term oncologic safety of this procedure. ⋯ Rates of locoregional and distant recurrence are acceptably low after nipple-sparing mastectomy in patients with breast cancer. No patient in our series has had a recurrence involving the retained nipple areola complex.
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Observational Study
External Validation of the HERNIAscore: An Observational Study.
The HERNIAscore is a ventral incisional hernia (VIH) risk assessment tool that uses only preoperative variables and predictable intraoperative variables. The aim of this study was to validate and modify, if needed, the HERNIAscore in an external dataset. ⋯ We have externally validated and improved the HERNIAscore. The revised HERNIAscore uses BMI, incision length, COPD, and earlier abdominal operation to predict risk of postoperative incisional hernia. Future research should assess methods to prevent incisional hernias in moderate-to-high risk patients.
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Compared with nonprocedural fields, procedural specialization requires longer training, less flexible schedules, and greater physical demands. The impact of these factors on pregnancy, maternity outcomes, and career satisfaction has not been well described. ⋯ Procedural trainees have higher rates of assisted reproduction, shorter maternity leave, and are ultimately more likely to express career dissatisfaction. These findings illustrate the need for adequate support for trainee mothers, particularly in procedural specialties.