Annals of surgery
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Evaluate the current status of Hepatopancreatobiliary (HPB) Surgery workforce in North America. ⋯ A cohesive strategy for responsibly responding to the HPB surgical workforce requirements of North America is needed. Elevation of training standards, standardization of requirements for certification, and careful modeling that accounts for regionalization of care should be pursued to prevent overtraining and decentralization of HPB surgical care in the future.
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Our objective was to determine the fetal in vivo microRNA signature in hypoplastic lungs of human fetuses with severe isolated congenital diaphragmatic hernia (CDH) and changes in tracheal and amniotic fluid of fetuses undergoing fetoscopic endoluminal tracheal occlusion (FETO) to reverse severe lung hypoplasia due to CDH. ⋯ Human fetal hypoplastic CDH lungs have a specific miR-200/miR-10a signature. Survival after FETO is associated with increased miR-200 family expression. miR-200b overexpression in CDH lungs results in decreased TGF-β/SMAD signaling.
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To investigate the legitimacy of 90-day mortality as a measure of hepatopancreatobiliary quality. ⋯ The 99- and 118-day definitions of postoperative mortality optimally reflected surgery-related mortality after hepatobiliary and pancreatic operations, respectively. However, among commonly reported metrics, the 90-day overall mortality rate represents a legitimate measure of surgical quality.
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Biography Historical Article
Samuel D. Gross and the Writing of American Surgical History.
To explore the details of Samuel D. Gross's achievements as America's foremost historian of medicine in the mid-nineteenth century. ⋯ Although Gross's accomplishments as a medical historian have been overlooked, it is undeniable that he was America's pioneer surgical historian and, as such, afforded surgeons their earliest measure of self-esteem, a critical attribute that was indispensable for the rise of surgery as a distinguished profession.
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Reframing healthcare delivery in terms of the principles of complex adaptive systems has practical implications for addressing the challenges in improving surgical care. In an Integrated Practice Unit (IPU) - such as a surgical service line, a surgical in-patient floor, or an acute care unit - a diverse group of caregivers must interact in a highly interdependent fashion in an environment characterized by ambiguity, uncertainty, and time constraints. Understanding of the concept of teaming and the tenets of relational coordination are crucial to the promotion of a successful patient-centric approach to surgical care.