Journal of the American College of Surgeons
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Historical Article
The American College of Surgeons publications: a brief history.
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Secretory immunoglobulin A (sIgA) is the principle antibody produced at the respiratory surface. Respiratory sIgA levels are increased early after injury in both human and laboratory animals; the mechanisms are uncertain. Stress hormones, including epinephrine (Epi) and norepinephrine (NE), increase early after injury. In addition, respiratory epithelial cells are known to be responsive to β2-agonists. We therefore studied the effect of Epi, NE, and albuterol on IgA transport in vitro. ⋯ Epinephrine is likely an early upstream signal in the enhanced IgA response at respiratory surfaces after injury.
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Multicenter Study Comparative Study
Portal vein resection in borderline resectable pancreatic cancer: a United Kingdom multicenter study.
Until recently, in the United Kingdom, borderline resectable pancreatic cancer with invasion into the portomesenteric veins often resulted in surgical bypass because of the presumed high risk for complications and the uncertainty of a survival benefit associated with a vascular resection. Portomesenteric vein resection has therefore remained controversial. We present the second largest published cohort of patients undergoing portal vein resection for borderline resectable (T3) adenocarcinoma of the head of the pancreas. ⋯ This study, the second largest to date on borderline resectable pancreatic cancer, demonstrates no significant difference in perioperative mortality in the 3 groups and a similar overall survival between PD and PDVR; significantly better compared with SB.
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Randomized Controlled Trial
Adjuvant radiotherapy in centrally located hepatocellular carcinomas after hepatectomy with narrow margin (<1 cm): a prospective randomized study.
Although radiotherapy (RT) provides potential benefits for patients with hepatocellular carcinomas (HCCs) that are unsuitable for operation, the specific role of adjuvant RT in HCC after hepatectomy remains ill defined. The current study's aim was to evaluate the safety and efficacy of adjuvant RT for centrally located HCCs after narrow-margin (<1 cm) hepatectomy. ⋯ Adjuvant RT for centrally located HCCs after narrow-margin hepatectomy was technically feasible and relatively safe. No significant between-group difference was observed in recurrence-free and overall survival. The post-hoc subgroup comparison showed that adjuvant RT improved recurrence-free survival considerably, but not overall survival, in patients with small HCCs (≤5 cm). More in-depth studies are needed to validate this finding.
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Trauma resuscitations without pre-arrival notification are often initially chaotic, which can potentially compromise patient care. We hypothesized that trauma resuscitations without pre-arrival notification are performed with more variable adherence to ATLS protocol and that implementation of a checklist would improve performance. ⋯ Trauma resuscitations without pre-arrival notification are associated with a decreased adherence to key components of the ATLS primary survey protocol. The addition of a checklist improves protocol adherence and reduces the effect of notification on task performance.