BACKGROUND: Postoperative adhesive small bowel obstruction (ASBO) is a common surgical complication. Conservative management is often attempted, but success varies. This study assessed the success rate and factors associ...BACKGROUND: Postoperative adhesive small bowel obstruction (ASBO) is a common surgical complication. Conservative management is often attempted, but success varies. This study assessed the success rate and factors associated with conservative management of ASBO in Central Ethiopia. METHODS: A retrospective cross-sectional study was conducted among patients managed from January 2017 to December 2024 at Wchemo University NigistEleni Mohammed Memorial Comprehensive Specialized Hospital (WCUNEMMCSH), WCSH (Worabe Comprehensive Specialized Hospital), and Wolkite University Comprehensive Specialized Hospital (WKUCSH). Data were collected using Kobo Collect and analyzed in SPSS v26. Variables with p < 0.25 in bivariable logistic regression were included in multivariable analysis, with p < 0.05 considered significant. RESULTS: Of 336 patients (response rate 97.94%), 63.4% (95% CI: 58.0-68.6) had successful conservative management. Multivariable analysis identified factors negatively associated with success: vomiting (AOR = 0.476; p = 0.024), abdominal distension (AOR = 0.301; p = 0.001), guarding/rebound tenderness (AOR = 0.354; p = 0.022), obstruction 13-60 months (AOR = 0.427; p = 0.037) and >60 months post-surgery (AOR = 0.327; p = 0.028), non-distended/gasless colon (AOR = 0.341; p = 0.001), and air-fluid levels >5 mm (AOR = 0.338; p = 0.001). Generalized tenderness was positively associated with success (AOR = 1.903; p = 0.034). CONCLUSION: Conservative management of ASBO was successful in 63.4% of patients. Clinical symptoms, physical examination, duration since surgery, and plain abdominal X-ray findings can help predict patients at risk of conservative treatment failure, supporting timely surgical intervention.
BACKGROUND: This retrospective multi-center study investigated whether radiomics features extracted from contrast-enhanced computed tomography (CECT) images could distinguish between the two most common pathological subt...BACKGROUND: This retrospective multi-center study investigated whether radiomics features extracted from contrast-enhanced computed tomography (CECT) images could distinguish between the two most common pathological subtypes of retroperitoneal sarcoma (RPS): dedifferentiated liposarcoma (DDLPS) and well-differentiated liposarcoma (WDLPS), as well as differentiate histological grading in DDLPS. MATERIALS AND METHODS: Patients with localized RPS who underwent surgery with curative intent between 2009 and 2021 were identified, along with their preoperative CECT images, which were obtained from two tertiary hospitals. Volumes of interest (VOIs) were constructed by segmenting tumor regions on CT images to extract radiomics features. In the training set, univariate logistic regression analysis and the least absolute shrinkage and selection operator (LASSO) algorithm were employed to identify the optimal radiomics features and construct the models. These models were then validated using internal and external validation sets. The models' utility was evaluated using the area under the receiver operating characteristic (ROC) curve, accuracy, the calibration curve, and decision curve analysis (DCA). RESULTS: Compared with multi-phase radiomics model, venous-phase radiomics model exhibits comparable predictive performance in differentiating WDLPS and DDLPS (AUCs: 0.848-0.852), as well as sclerosing WDLPS and DDLPS (AUCs: 0.811-0.838), with higher diagnostic accuracy than radiologists. In cases with discordant biopsy and final pathology (n = 5), the model demonstrated 80% accuracy. The analysis of calibration curves and DCA shows that the model is well calibrated and has significant clinical advantages. However, the venous-phase radiomics model shows only moderate predictive performance in distinguishing DDLPS grade 2 and 3. CONCLUSION: The venous-phase radiomics model has strong predictive ability in preoperative differentiation between WDLPS and DDLPS, as well as between sclerosing WDLPS and DDLPS. This makes it a promising imaging biomarker that could facilitate personalized management and precision medicine.
Yoshida CT, Higgins MG, Leslie SE
… +12 more, Durden JA, Adams M, Vemuru S, Parris H, Huynh VD, Goode J, DeWitt A, Arkema A, Becker N, Davis N, Helmkamp LJ, Tevis SE
BACKGROUND: Quality of life is assessed using patient-reported outcome measures (PROMs), but is rarely utilized in patients at high risk for breast cancer despite greater distress. We evaluated PROMs in this population....BACKGROUND: Quality of life is assessed using patient-reported outcome measures (PROMs), but is rarely utilized in patients at high risk for breast cancer despite greater distress. We evaluated PROMs in this population. METHODS: Participants completed the BREAST-Q, measuring Satisfaction with Breasts (SB), Physical Wellbeing (PhW), Psychosocial Wellbeing (PsyW), and Sexual Wellbeing (SW) from 08/2020-02/2025. Additional questions assessed worry. Responses were compared to published normative controls using descriptive statistics and two-sample t-tests. RESULTS: 83 high-risk participants (average age 41 years ± 10) reported significantly higher SB score (p = 0.018) and significantly lower PhW score (p = 0.039). There were no statistically significant differences for PsyW and SW. Most participants reported screenings increased their sense of control over breast cancer risk-reduction. CONCLUSIONS: Differences observed in SB and PhW suggest that high-risk screening may positively influence body image but negatively impacts PhW. Further work is needed to elucidate factors leading to these differences.
OBJECTIVE: To characterize trends and specialty-specific variation in gender-based salary disparities. DESIGN: Secondary analysis of Association of American Medical Colleges Faculty Salary Reports from 2013 to 2023 using...OBJECTIVE: To characterize trends and specialty-specific variation in gender-based salary disparities. DESIGN: Secondary analysis of Association of American Medical Colleges Faculty Salary Reports from 2013 to 2023 using descriptive and nonparametric methods to assess gender distribution, leadership representation, and salary differences across specialties. SETTING AND PARTICIPANTS: The 2013 cohort included 63,463 full-time faculty (34% women); the 2023 cohort included 88,646 faculty (43% women). RESULTS: Pay gaps narrowed between 2013 and 2023 but persisted across specialties and ranks. Women's representation increased across specialties and leadership. Pay gaps varied by specialty, with larger disparities in surgical fields. Median pay gaps were significantly greater in surgical versus non-surgical specialties in 2013 (35.0% vs 21.0%; p = 0.020) and 2023 (32.0%vs 18.4%; p = 0.028). No association was identified between female workforce or leadership representation and pay gaps. CONCLUSIONS: Gender pay inequities persist, particularly in surgical specialties, suggesting ongoing structural and specialty-specific drivers.
BACKGROUND: Small intestinal malignancies contribute increasingly to cancer mortality. This study evaluates US mortality trends and disparities from 1999 to 2023 to address limited data on long-term patterns. METHODS: Mo...BACKGROUND: Small intestinal malignancies contribute increasingly to cancer mortality. This study evaluates US mortality trends and disparities from 1999 to 2023 to address limited data on long-term patterns. METHODS: Mortality data for adults ≥25 years were obtained from CDC WONDER. Joinpoint regression was used to estimate temporal trends in age-adjusted mortality rates (AAMRs) and calculate annual percent changes (APCs). RESULTS: The overall AAMR increased (AAPC = 0.91%), accelerating significantly after 2010 (APC = 2.03%). Crude rates rose continuously in adults ≥85 years (APC = 2.07%) but declined in the 35-44 group. Women experienced a steeper mortality acceleration after 2013 than men. Non-Hispanic Blacks sustained the highest steady mortality, while Hispanics exhibited a rapid rise after 2015 (APC = 4.70%). Geographically, the South showed marked acceleration after 2012. CONCLUSION: Mortality increased significantly with accelerating trends and marked sociodemographic disparities. These findings highlight the urgent need for targeted prevention and equitable access to care.
This paper presents a background of the complicated biological and social contexts from early experimentation to consensus development, then focuses more in depth on advancements in systems of liver transplant. We addres...This paper presents a background of the complicated biological and social contexts from early experimentation to consensus development, then focuses more in depth on advancements in systems of liver transplant. We address 1) allocation - the evolution of the transplant recipient and development of allocation systems and 2) the donor-recipient imbalance - how these large-scale systems have attempted to meet demand. From the first transplant by Starzl, to self-imposed moratoriums, the beginnings of human liver transplant were controversial. Despite significant uncertainty, improving recipient outcomes prompted the acceptance of liver transplant as non-experimental. With increasing indications and a growing recipient pool, development of an appropriate allocation system became a priority. On the pursuit of objectivity, moral systems of utility, urgency and benefit intermingle. Recently, progress has surrounded expansion of the donor pool with organ preservation devices, use of extended grafts, and emphasis on living donor transplant. The following paper will highlight the sociological intricacies and collaborative thread throughout transplant history. While controversy persists, it is crucial in bringing forward the perspectives needed to drive innovation.
BACKGROUND: Antimicrobial resistance causes ∼700,000 deaths annually. Surgeons are essential to infection prevention but often misuse antibiotics due to limited antimicrobial stewardship (AMS) training. Educational AMS i...BACKGROUND: Antimicrobial resistance causes ∼700,000 deaths annually. Surgeons are essential to infection prevention but often misuse antibiotics due to limited antimicrobial stewardship (AMS) training. Educational AMS interventions may address limitations of traditional programs in the surgical context by empowering surgeons and trainees. This review synthesizes evidence on educational strategies to improve surgical antimicrobial prescribing. METHODS: A scoping review following Arksey and O'Malley's framework and PRISMA-Scr guidelines was registered on OSF. PubMed, Embase, Medline, and Web of Science were searched until June 5th, 2025. Studies evaluating educational antimicrobial stewardship interventions for surgeons and surgical trainees that reported on antimicrobial prescribing outcomes were included. Non-surgical populations, non-educational interventions, and non-original studies were excluded. RESULTS: Seventeen of 4338 articles were included, mostly from high-income countries, tertiary hospitals using pre-post designs. Common educational methods included lectures, guidelines, and posters, often in multimodal interventions. Significant improvements were most linked to antibiotic selection, timing, and duration. CONCLUSION: Educational AMS interventions improve surgical antimicrobial prescribing habits particularly regarding antibiotic selection, timing and duration.
BACKGROUND: This meta-analysis aimed to evaluate the operative safety of completion thyroidectomy (CT) following lobectomy compared with total thyroidectomy (TT) for differentiated thyroid cancer (DTC). METHODS: PubMed,...BACKGROUND: This meta-analysis aimed to evaluate the operative safety of completion thyroidectomy (CT) following lobectomy compared with total thyroidectomy (TT) for differentiated thyroid cancer (DTC). METHODS: PubMed, Ovid Embase, Cochrane Library, CINAHL, and Web of Science were searched from their respective inception dates to October 2025 (PROSPERO ID: CRD420251178003). RESULTS: A total of 43,362 patients from twelve studies were included, of whom 6810 (15.7%) underwent CT. CT was associated with lower odds of transient hypocalcemia (OR = 0.46; 95% CI: 0.34 - 0.63; I = 68%) compared with TT, while rates of permanent hypocalcemia (OR = 0.78; 95% CI: 0.61 - 1.01; I = 16%), transient recurrent laryngeal nerve injury (OR = 0.99; 95% CI: 0.78 - 1.26; I = 30%), permanent recurrent laryngeal nerve injury (OR = 1.12; 95% CI: 0.94 - 1.34; I = 0%), and hematoma (OR = 1.34; 95% CI: 0.56 - 3.21; I = 0%) were similar. CONCLUSIONS: Our analysis demonstrated that CT appears to have a similar safety profile when compared with upfront TT in selected DTC patients.
Surgical subspecialties have historically lacked diversity. Recently, surgical programs have begun to implement interventions for underrepresented in medicine (URiM) students to foster interest and provide mentorship for...Surgical subspecialties have historically lacked diversity. Recently, surgical programs have begun to implement interventions for underrepresented in medicine (URiM) students to foster interest and provide mentorship for a successful residency match. A comprehensive PubMed literature search of mentorship in surgical subspecialties (general surgery, cardiothoracic surgery, neurosurgery, orthopedics, otolaryngology, plastics, urology and vascular surgery) for URiM individuals published between 2012 and 2025 was conducted. Of 255 articles identified, only 18 discussed established URiM outreach/pipeline programs and were analyzed. A majority of programs were established at the medical school level (11), followed by high school (3), undergraduate (2), and residency (1). All subspecialties were represented except vascular. Outreach programs are effective in promoting interest in surgical subspecialties and hold the potential to increase diversity in the field when targeted toward URiM students. More programs are needed at all training levels and across all subspecialties.
Surgical site infection (SSI) remains a frequent complication after emergency surgery for colorectal perforation. We conducted an open-label randomized clinical trial comparing delayed primary closure (DPC) with intrawou...Surgical site infection (SSI) remains a frequent complication after emergency surgery for colorectal perforation. We conducted an open-label randomized clinical trial comparing delayed primary closure (DPC) with intrawound continuous negative pressure irrigation therapy and primary closure. Adults with colorectal perforation and generalized peritonitis were randomized. The primary outcome was the incidence of superficial and deep SSI within 30 days, analyzed using a modified intention-to-treat approach. Of 41 randomized patients, 38 were included in the analysis. DPC was not associated with a statistically significant reduction in superficial or deep SSI compared with primary closure (25% vs. 50%; odds ratio, 0.33; 95% CI, 0.08-1.27). A numerical reduction in total SSI was observed in the DPC group. ICU and hospital stays were longer with DPC. These findings suggest a potential trade-off between wound outcomes and resource utilization and warrant confirmation in adequately powered multicenter studies. Trial registration: UMIN Clinical Trials Registry (UMIN000032357).
BACKGROUND: Thyroid function may improve after bariatric surgery; however, predictors of postoperative TSH remission are not well defined. We investigated whether preoperative vitamin D and B12 levels could predict TSH r...BACKGROUND: Thyroid function may improve after bariatric surgery; however, predictors of postoperative TSH remission are not well defined. We investigated whether preoperative vitamin D and B12 levels could predict TSH remission after sleeve gastrectomy in patients with hypothyroidism. METHODS: This single-center retrospective cohort study included adults with preoperative hypothyroidism who underwent laparoscopic sleeve gastrectomy between February 2021 and December 2024 at our institution. The primary outcome was 6-month TSH remission, defined as a TSH level of 0.5-4.0 mIU/L without levothyroxine (LT4) dose increase. The secondary outcomes included 12-month remission and changes in the LT4 dose. Multivariate logistic regression was adjusted for age, sex, BMI, vitamin D, and vitamin B12; penalized (Firth) regression was applied to address separation. The predictive performance was evaluated using ROC analysis. RESULTS: Of 289 patients, 40 (13.9%) met the inclusion criteria (mean age 46.3 ± 7.4 years; 75% female). TSH remission occurred in 67.5% and 77.5% of patients at 6 and 12 months, respectively. Patients who achieved remission had significantly higher preoperative vitamin B12 and vitamin D levels at both time points (all p ≤ 0.007). No patient required LT4 dose escalation; dose reduction or withdrawal occurred in 70.0% of patients by 12 months. ROC analysis demonstrated strong discrimination at 6 months (vitamin B12 AUC 0.858; vitamin D AUC 0.826) and excellent discrimination at 12 months (vitamin B12 AUC 0.841; vitamin D AUC 0.898). Vitamin D showed a near-significant association with 12-month remission (OR 1.30 per 1 ng/mL; p = 0.051). CONCLUSIONS: Higher preoperative vitamin D and vitamin B12 levels strongly predicted TSH remission after sleeve gastrectomy, supporting routine micronutrient assessment and prospective validation of these findings.