American journal of surgery
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Microvascular hyperpermeability that occurs in hemorrhagic shock and burn trauma is regulated by the apoptotic signaling pathway. We hypothesized that tumor necrosis factor-α (TNF-α)-related apoptosis-inducing ligand (TRAIL) would promote hyperpermeability directly or by interacting with other signaling pathways. ⋯ TRAIL-induced microvascular hyperpermeability is phosphatidylinositol 3-kinase (PI3K)-dependent and may be mediated by caspase-3 cleavage of the endothelial adherens junctional complex.
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Comparative Study
Accuracy of magnetic resonance cholangiopancreatography for diagnosing stones in the common bile duct in patients with abnormal intraoperative cholangiograms.
Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive method for diagnosing choledocholithiasis. It is said to be as accurate as the gold standard endoscopic retrograde cholangiopancreatography (ERCP) for detecting common bile duct (CBD) stones. A study was needed to look at the accuracy of MRCP compared with intraoperative cholangiography (IOC) for detecting stones in the CBD. The aim of this study was to evaluate the diagnostic accuracy of MRCP in patients with choledocholithiasis diagnosed with IOC. ⋯ MRCP has a high rate of false normal results compared with IOC and is not as accurate as more invasive techniques. There is no need for preoperative MRCP in patients with suspected choledocholithiasis caused by stones.
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Performance feedback or debriefing in surgery is increasingly recognized as an essential means to optimize learning in the operating room (OR). However, there is a lack of evidence regarding the current practice and barriers to debriefing in the OR. ⋯ There is a disparity between what the surgical community views as effective debriefing and actual debriefing practices in the OR. Improvements to the current debriefing culture and practice within the field of surgery should be considered to facilitate learning from clinical practice.
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Previous observations suggest that intraoperative blood transfusion (IBT) is a risk factor for adverse postoperative outcomes. IBT alters immune function and may predispose to systemic inflammatory response syndrome (SIRS). ⋯ There is a significant association between IBT and the development of SIRS. IBT may induce SIRS, and reductions in IBT may decrease the incidence of postoperative SIRS.