Two-Center Validation of a Novel Quality Improvement Protocol to Avoid Postileostomy Morbidity Using Home Intravenous Fluids and Structured Daily Calls.

Background: New ileostomates have higher rates of dehydration and readmission compared to patients undergoing other colorectal procedures.

Objective: We aimed to show the efficacy of a novel ileostomy-specific quality improvement protocol at an academic center with subsequent validation at another academic center.

Design: Prospective cohort study.

Evaluating the Impact of Preoperative Nutritional Status on Surgical Outcomes and Public Health Implications in General Surgery Patients.

Background: Malnutrition is linked to more postoperative problems, a longer recovery period, and a higher death rate; preoperative nutritional condition is a critical factor in surgical outcomes.

Objective: This study aimed to evaluate the impact of preoperative nutritional status on surgical outcomes in general surgery patients and explore its broader public health implications.

Methodology: A two-year observational research with 440 adult patients undergoing general surgery was carried out between January 2022 and December 2023.

Prevalence of Obesity in Abdominal Surgery Patients at a Tertiary Care Hospital: A Cross-Sectional Study.

Background Obesity significantly impacts surgical outcomes, increasing the risk of postoperative complications, especially in abdominal surgery. Objective To determine the prevalence of obesity among patients undergoing abdominal surgery and to explore its association with postoperative complications. Methodology A cross-sectional study was conducted from January 2022 to December 2023.

EXPLORING THE IMPACT OF RISK FACTORS, PREVENTIVE MEASURES, AND MANAGEMENT STRATEGIES ON SURGICAL SITE INFECTIONS IN GENERAL SURGERY: A COMPREHENSIVE ASSESSMENT.

Background: Surgical site infections (SSIs) pose significant challenges in healthcare, leading to prolonged hospital stays, increased morbidity, and economic burden. Understanding the interplay between risk factors, preventive measures, and management strategies is crucial for effective infection control in general surgery. This study aimed to comprehensively assess the impact of various risk factors, preventive measures, and management strategies on surgical site infections in the context of general surgery.

OPTIMIZING POSTOPERATIVE OUTCOMES: ASSESSING THE EFFECT OF ENHANCED RECOVERY AFTER SURGERY (ERAS) PROTOCOLS IN GENERAL SURGICAL PATIENTS.

Background: Enhanced Recovery After Surgery (ERAS) protocols were progressively implemented to advance postoperative results in various surgical specialties. However, their effectiveness in general surgical patients remains underexplored. This study intended to assess impact of ERAS protocols on postoperative results in general surgical patients at Jinnah International Hospital Abbottabad (JIHA).

A high voltage gain solid-state transformer for integration of renewable energy and AC sources.

This paper introduces a novel high-voltage gain topology for a solid-state transformer, integrating a DC-DC converter and dual active bridge converters. The proposed design features three DC links operating at different voltage levels. The first DC link connects to a single-switch high step-up DC-DC converter, while the second DC link interfaces with an AC source via a rectifier, allowing the use of both DC and AC inputs.

Deciphering the key pathway for triterpenoid biosynthesis in A. Juss.: a comprehensive review of omics studies in nature's pharmacy.

Since ancient times, , or Neem, has been a well-known species of plant that produces a broad range of bioactive terpenoid chemicals that are involved in a variety of biological functions. Understanding the molecular mechanisms that are responsible for the biosynthesis and control of terpenoid synthesis is majorly dependent on successfully identifying the genes that are involved in their production. This review provides an overview of the recent developments concerning the identification of genes in that are responsible for the production of terpenoids.

Detecting Cotton Leaf Curl Virus Resistance Quantitative Trait Loci in and iCottonQTL a New R/Shiny App to Streamline Genetic Mapping.

Cotton leaf curl virus (CLCuV) causes devastating losses to fiber production in Central Asia. Viral spread across Asia in the last decade is causing concern that the virus will spread further before resistant varieties can be bred. Current development depends on screening each generation under disease pressure in a country where the disease is endemic.

Validation of a pelvic surgery difficulty risk model to predict difficult pelvic dissection and poor outcomes.

Background: We previously developed the Pelvic Surgery Difficulty Index for predicting intraoperative events and postoperative outcomes associated with rectal mobilization with or without proctectomy ("deep pelvic dissection"). The aim of this study was to validate the scoring system as a prognostic tool for outcomes of pelvic dissection, regardless of the cause of dissection.

Methods: Consecutive patients who underwent elective deep pelvic dissection at our institution from 2009 to 2016 were reviewed.

A novel hybrid methodology to secure GOOSE messages against cyberattacks in smart grids.

IEC 61850 is emerging as a popular communication standard for smart grids. Standardized communication in smart grids has an unwanted consequence of higher vulnerability to cyber-attacks. Attackers exploit the standardized semantics of the communication protocols to launch different types of attacks such as false data injection (FDI) attacks.

The Impact of a Narcotic-Sparing Enhanced Recovery Protocol on Postoperative Narcotic Use Following Colectomy.

Background: In the United States, 37% of all opioids are prescribed in the surgical setting, many of which report initial exposure in the postoperative period.

Objective: This study aimed to assess the impact of a narcotic-sparing enhanced recovery after surgery protocol on postoperative narcotic use by patients and to assess its impact on the narcotic-prescribing practices of physicians.

Design: Data regarding consecutive narcotic-naïve patients who underwent a surgical procedure from January 2013 to August 2017 were retrospectively reviewed.

Utility of Restaging MRI Following Neoadjuvant Chemoradiotherapy for Stage II-III Rectal Adenocarcinoma.

Background Magnetic resonance imaging (MRI) is currently utilized for the pretreatment staging of locally advanced rectal cancer; however, there is no consensus regarding the utility of repeat MRI for restaging following neoadjuvant chemoradiotherapy (CRT). In this study, we aimed to investigate the clinical utility of restaging MRI after CRT in patients with clinical stage II-III rectal cancer. Methodology We performed a retrospective observational study at a tertiary care hospital.

Impact of Early Exposure to Robotic Surgery Among Pre-clinical Medical Students on Career Choice and Simulation Skills.

We aimed to assess whether early exposure of medical students to robotic surgery training influences their interest in a surgical career and improves scores on objective simulation tasks. Medical students were invited to participate in robotic online training modules, robotic simulation exercises followed by a hands-on robotic dry-lab session. Pre- and post-simulator scores were recorded.

Effects of Patient and Surgery Characteristics on Persistent Postoperative Pain: A Mediation Analysis.

Objective: Acute postoperative pain intensity is associated with persistent postsurgical pain (PPP) risk. However, it remains unclear whether acute postoperative pain intensity mediates the relationship between clinical factors and persistent pain.

Materials And Methods: Participants from a mixed surgical population completed the Brief Pain Inventory and Pain Catastrophizing Scale before surgery, and the Brief Pain Inventory daily after surgery for 7 days and at 30 and 90 days after surgery.

Analysis of Outcomes in Adolescents and Young Adults With Pilonidal Disease.

Numerous definitive surgical techniques exist for the treatment of pilonidal disease with varied recurrence rates and wound complications. Due to the wide array of techniques and lack of consensus on the best approach, we proposed to study our experience treating pilonidal disease in adolescents and young adults. A retrospective analysis was conducted of patients 10-24 years old treated at a tertiary medical center from 2011 to 2016.

Activity of Sorafenib Plus Capecitabine in Previously Treated Metastatic Colorectal Cancer.

Lessons Learned: Treatment for patients with metastatic colorectal cancer (mCRC) typically involves multiple lines of therapy with eventual development of treatment resistance. In this single-arm, phase II study involving heavily pretreated patients, the combination of sorafenib and capecitabine yielded a clinically meaningful progression-free survival of 6.2 months with an acceptable toxicity profile.

Comprehensive literature review of randomized clinical trials examining novel treatment advances in patients with colon cancer.

The treatment of colon cancer has had numerous recent advances, in terms of surgical approach, adjuvant therapies, and more. In this review, the authors examine randomized clinical trials comparing open surgery to laparoscopic surgery (including total mesocolic excision), and also examine the role of robotic surgery. Novel surgical techniques including the no-touch technique, side-to-side anastomosis, suture technique, complete mesocolic excision (CME) with central vascular ligation (CVL), and natural orifice transluminal endoscopic surgery (NOTES) are outlined.

A Comprehensive Review of Randomized Clinical Trials Shaping the Landscape of Rectal Cancer Therapy.

Colorectal carcinoma is the second leading cause of cancer-related deaths in the United States, with rectal cancer accounting for approximately one third of newly diagnosed cases. Surgery remains the cornerstone of curative therapy, with total mesorectal excision being the standard of care. Although minimally invasive procedures might be appropriate for a subset of patients with early-stage, superficial tumors, the standard of care for medically operable patients with nonmetastatic rectal cancer includes a comprehensive multimodality approach of neoadjuvant chemoradiotherapy, surgery with total mesorectal excision, and systemic chemotherapy.

ctDNA applications and integration in colorectal cancer: an NCI Colon and Rectal-Anal Task Forces whitepaper.

An increasing number of studies are describing potential uses of circulating tumour DNA (ctDNA) in the care of patients with colorectal cancer. Owing to this rapidly developing area of research, the Colon and Rectal-Anal Task Forces of the United States National Cancer Institute convened a panel of multidisciplinary experts to summarize current data on the utility of ctDNA in the management of colorectal cancer and to provide guidance in promoting the efficient development and integration of this technology into clinical care. The panel focused on four key areas in which ctDNA has the potential to change clinical practice, including the detection of minimal residual disease, the management of patients with rectal cancer, monitoring responses to therapy, and tracking clonal dynamics in response to targeted therapies and other systemic treatments.

Genotypic Variant and Increased Tyrosine Phosphorylation of STAT3 in IL-23 Responsive Innate Lymphoid Cells during Pathogenesis of Crohn's Disease.

Crohn's disease (CD) results from dysregulated immune responses to gut microbiota in genetically susceptible individuals, affecting multiple areas of the gastrointestinal tract. Innate lymphoid cells (ILCs) are tissue-resident innate effector lymphocytes which play crucial roles in mucosal immune defense, tissue repair, and maintenance of homeostasis. The accumulation of IFN--producing ILC1s and increased level of proinflammatory cytokines produced by ILCs has been observed in the inflamed terminal ileum of CD patients.

Gender differences among surgical fellowship program directors.

Background: Although women are increasingly represented in American surgery, data regarding sex and academic rank of the leadership of fellowship programs are lacking.

Methods: Demographics and academic ranks for fellowship program directors were analyzed for 811 surgery fellowship programs across 14 specialties. Associations between academic rank and sex were assessed using a χ independence test.

Sigmoido-rectal intussusception.

Rectal prolapse is usually of benign etiology. Rarely, sigmoido-rectal intussusception results from a malignant lead-point. We report the case of a patient with a partially obstructing sigmoid cancer causing a full thickness rectal prolapse requiring surgical intervention.