Journal of the American College of Surgeons
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Prolonged field care is a military adaptation of tactical combat casualty care providing extended prehospital management during delayed extrication. Effects of addition of valproic acid (VPA) to fresh-frozen plasma (FFP) in a prolonged field care model of hemorrhagic shock and traumatic brain injury are not known. We hypothesized that VPA is associated with decreased neurological impairment, and its protective changes are detected at the transcriptomic level. ⋯ The addition of FFP to the resuscitation protocol resulted in a significant reduction in crystalloid requirements. Both the NS + FFP and NS + FFP + VPA groups showed improved neurological recovery compared with NS alone and had distinctive transcriptomic profiles in injured brains at 72 hours. The mitochondrially encoded ATP synthase membrane subunit 8 gene, involved in worsening ischemia following brain injury, was downregulated in VPA-treated animals.
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Overall, 3% to 12% of opioid-naive patients develop persistent opioid use after surgery. It is still unclear whether persistent opioid use after transabdominal surgery is associated with adverse surgical outcomes. We aimed to assess if new persistent opioid use after transabdominal surgery is associated with increased long-term mortality and readmission rates. ⋯ New persistent opioid use after transabdominal surgery was associated with higher rates of mortality and readmission rates. This calls for increased postoperative support for at-risk patients and increased support during transitions of care for these patients.
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The success of parathyroidectomy in primary hyperparathyroidism depends on the intraoperative differentiation of diseased from normal glands. Deep learning can potentially be applied to digitalize this subjective interpretation process that relies heavily on surgeon expertise. In this study, we aimed to investigate whether diseased vs normal parathyroid glands have different near-infrared autofluorescence (NIRAF) signatures and whether related deep learning models can predict normal vs diseased parathyroid glands based on intraoperative in vivo images. ⋯ Normal and diseased parathyroid glands in primary hyperparathyroidism have different intraoperative NIRAF patterns that could be quantified with intensity and heterogeneity analyses. Visual deep learning models relying on these NIRAF signatures could be built to assist surgeons in differentiating normal from diseased parathyroid glands.