The Journal of surgical research
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Blacks, Hispanics, and women are underrepresented in academic medicine. This study sought to identify recent trends in the academic appointments of underrepresented groups at all levels of academic medicine. ⋯ Minorities, including Asian Americans, and women remain grossly underrepresented in academic medicine. Blacks have shown the least progress during this 12-y period. The disparity is greatest at the highest levels (professor, chairperson, and dean) of our field. We must redouble our efforts to recruit, retain, and advance minorities in academic medicine.
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Hypothermic machine perfusion (HMP) of kidneys is intended to mitigate the deleterious effects of cold storage on organ quality, particularly when the cold ischemic time is prolonged or the donor is otherwise marginal. The use of HMP has remained controversial; however, a number of randomized controlled trials (RCTs) have recently been conducted to clarify its benefits. ⋯ There are few RCT comparing HMP and cold storage of kidneys in deceased donor kidney transplantation. Although these studies are small and heterogeneous in design, HMP appeared to be associated with a reduced incidence of DGF. No difference in the incidence of PNF, graft loss, or patient death at 1 y could be demonstrated.
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Sepsis remains a source of morbidity and mortality in the postoperative patient despite appropriate resuscitative and antimicrobial approaches. Recent research has focused upon additional interventions such as exogenous cell-based therapy. Mesenchymal stem cells (MSCs) exhibit multiple beneficial properties through their capacity for homing, attenuating the inflammatory response, modulating immune cells, and promoting tissue healing. Recent animal trials have provided evidence that MSCs may be useful therapeutic adjuncts. ⋯ Research utilizing animal models of sepsis has provided a greater understanding of the beneficial properties of MSCs. Their capacity to home to sites of injury and use paracrine mechanisms to change the local environment to ultimately improve organ function and survival make MSCs attractive in the treatment of sepsis. Future studies are needed to further evaluate the complex interactions between MSCs and host tissues.
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Review Comparative Study
Oxidative stress in laparoscopic versus open abdominal surgery: a systematic review.
Any form of trauma, including surgery, is known to result in oxidative stress. Increased intra-abdominal pressure during pneumoperitoneum and inflation-deflation may cause ischemia reperfusion and, hence, oxidative stress may be greater during laparoscopic surgery. The aim of this study was to systemically review the literature to compare oxidative stress in laparoscopic and open procedures. ⋯ Laparoscopic surgery seems to produce less systemic oxidative stress. However the effect of pneumoperitoneum on local oxidative stress and tissue hypoxia and its clinical significance need further investigation.
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Acute kidney injury (AKI) is a common complication of hospitalized patients, and clinical outcomes remain poor despite advances in renal replacement therapy. The accepted pathophysiology of AKI in the setting of sepsis has evolved from one of simple decreased renal blood flow to one that involves a more complex interaction of intra-glomerular microcirculatory vasodilation combined with the local release of inflammatory mediators and apoptosis. ⋯ These interactions are reflected by genomic changes and abnormal rates of cellular apoptosis in distant organs including the lungs, heart, gut, liver, and central nervous system. The purpose of this article is to review the influence of AKI, particularly sepsis-associated AKI, on inter-organ crosstalk in the context of systemic inflammation and multiple organ failure (MOF).