A S Highet

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Whether the volume of pediatric inguinal hernia cases a surgeon performs each year affects recurrence rates is an important quality question. This multi-institutional study found that higher-volume surgeons had significantly lower hernia recurrence rates in children. Channeling complex or at-risk patients to high-volume surgeons—or tracking volume as a quality metric—could reduce the need for repeat operations.

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Helmet use in bicycle, scooter, and skateboard crashes protects children from head injuries, but adoption is uneven. This retrospective study found that children from neighborhoods with greater social disadvantage were significantly less likely to be wearing helmets when they were injured. Helmet promotion programs need to target socioeconomically disadvantaged communities where the protection gap is largest.

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Childhood cholecystectomy was historically rare, but pandemic-era lifestyle changes and health care delays may have shifted that. This multi-institutional retrospective study found that cholecystectomy volume in children increased substantially after the COVID-19 pandemic, with cases also becoming more complex. Surgeons and hospitals should be prepared for a sustained increase in pediatric gallbladder disease.

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Bar displacement after the Nuss procedure for pectus excavatum is a known complication that often requires reoperation. This study evaluated the effect of medial stabilizer chest placement on preventing dislocation and found specific positioning strategies that significantly reduced displacement rates. Optimizing stabilizer placement is a modifiable factor that can reduce a major complication of pectus repair.

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Children with anorectal malformations often struggle to achieve continence by school age, but social and economic factors that influence these outcomes are poorly understood. This single-center study found that neighborhood-level disadvantage was independently associated with worse continence outcomes at school age. Addressing social determinants of health should be part of the care plan for children with complex anorectal conditions.

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Women surgeons are known to receive fewer and less remunerative referrals than men, but the structural barriers behind this disparity are not well understood. This qualitative study identified specific social and institutional barriers to clinical practice growth for early-career surgeons, with greater barriers reported by women. The findings provide an evidence base for targeted interventions to improve equity in surgical practice development.

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Surgery demands sustained physical postures that cause ergonomic strain, contributing to musculoskeletal injury. This pilot study used a sensorless AI app to assess residents' ergonomics during simulated laparoscopic tasks before and after an educational module, and found improvement in ergonomic scores after training. AI-assisted ergonomic feedback tools are feasible, scalable, and could reduce occupational injury in surgical trainees.

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Staple-line reinforcement during sleeve gastrectomy is marketed to reduce bleeding, but it adds cost. This cost-effectiveness analysis found that the benefit in bleeding reduction did not justify the added expense in most scenarios. Routine use of staple-line reinforcement is not cost-effective and should be reserved for high-risk patients.

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Research mentorship is essential to academic surgical careers, but surgeon-scientists face time constraints that make effective mentoring difficult. This paper offers concrete, pragmatic mentoring strategies tailored to the realities of a busy surgical practice. Accessible mentorship frameworks could improve mentoring quality and help retain more surgeon-scientists in academic medicine.

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Split-liver transplantation allows one deceased donor liver to benefit two recipients, which is especially valuable for children. This U.S. national analysis found that split-liver grafts had comparable long-term recipient outcomes to reduced-size grafts, and that more segments were discarded from reduced-size procurements. The results support prioritizing split-liver over reduced-size transplantation to maximize liver utilization.

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Building research skills takes time and mentorship that general surgery training rarely prioritizes. This paper describes the Transplant Research, Education, and Engagement (TREE) group—a multi-level collaborative research program for trainees and faculty—and its outcomes in developing research competency from medical school through faculty level. Intentional research training programs embedded in clinical environments can create a pipeline of surgeon-scientists.

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Public Health Service increased-risk donor kidneys are discarded at higher rates than other organs despite equivalent outcomes, partly because of how risk is communicated to patients and providers. This paper introduces the Best-Case/Worst-Case framework as a structured tool for transplant decision-making conversations about these organs. Framing organ quality decisions within outcome scenarios rather than labels could reduce unnecessary discard of viable kidneys.

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In hospital emergencies requiring rapid redeployment of clinical staff, matching residents and fellows to appropriate roles based on their skills is challenging. This study developed and validated a rapid assessment tool to quickly identify the clinical capabilities of trainees during mass casualty or surge events. A standardized rapid competency assessment enables safer and more effective use of trainees in emergency horizontal care situations.

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Donation after circulatory death livers require surgeons to travel further to procure organs that carry more uncertainty and complexity. This study found that DCD liver procurement required significantly greater travel distance than brain-death liver procurement, without proportional reimbursement. Revising reimbursement structures could reduce a financial disincentive for surgeons to procure DCD livers and increase organ utilization.

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Competency committees assess whether medical students meet educational milestones, but implementing them in undergraduate medical education creates institutional tensions around faculty judgment and standardization. This paper uses a polarity management framework to reframe these tensions not as problems to solve but as ongoing dynamics to manage. The approach provides practical guidance for medical schools building competency-based assessment structures.

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Tuberculosis in children is a major global health challenge, especially in settings where HIV is also endemic. This study characterized the epidemiology of pediatric TB in Harare, Zimbabwe, comparing children with and without HIV co-infection, and identified risk factors and diagnostic gaps. The findings highlight where clinical and public health resources should be directed to reduce pediatric TB mortality in high-burden countries.

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Embryos cultured outside the body develop less efficiently than embryos in the uterus, partly because they lack growth factors present in the reproductive tract. This mouse study found that adding IGF2 combined with urokinase plasminogen activator and plasminogen to embryo culture media significantly improved blastocyst development and pregnancy rates. The supplement combination could improve outcomes in assisted reproduction by better mimicking the natural uterine environment.

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Trophoblast cells from the placenta can form tube-like structures in the lab on Matrigel, mimicking blood vessel formation. This study profiled the gene expression of trophoblasts during this tube-forming process and found it closely resembles a blood vessel development program. This model may help researchers study how the placenta establishes its blood supply and what goes wrong in conditions like preeclampsia.

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During early pregnancy, the placenta forms in a low-oxygen environment that shapes trophoblast cell behavior. This study found that low oxygen activates HIF transcription factors in trophoblast cells, altering gene expression in ways that promote invasion of maternal blood vessels. Understanding how oxygen tension controls placental invasion helps explain why trophoblast dysfunction in preeclampsia disrupts spiral artery remodeling.

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IGF1 and IGF2 are growth factors that support placental development and fetal growth, but whether they interact with the renin-angiotensin system (which regulates blood pressure) during pregnancy is not fully understood. In guinea pig pregnancy experiments, IGF1 and IGF2 had distinct effects on the renin-angiotensin system, with IGF1 showing more acute effects on blood pressure-related hormones. These findings illuminate a potential pathway linking placental growth signaling to maternal blood pressure changes in pregnancy.

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The bacterial communities colonizing the gut of infants may play a role in SIDS, but how they differ from healthy babies is unclear. This study compared gut microbiome composition in SIDS cases versus healthy controls and found distinct differences, including microbes that produce gases in the prone (face-down) sleeping position—a known SIDS risk factor. This provides a plausible biological mechanism linking prone sleeping to SIDS through bacterial gas production.

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Recessive dystrophic epidermolysis bullosa causes severe skin fragility and chronic wounds. This study showed that cord blood-derived stem cells could be induced to express skin cell markers and, when applied to wounds, accelerated healing in laboratory and animal models. These stem cells represent a potential cellular therapy for this devastating skin condition.

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SIDS risk factors at the population level are well studied, but comprehensive analysis of maternal and perinatal complications linked to SIDS is less common. Using state pregnancy outcome records matched to SIDS cases, this study identified maternal complications and delivery factors that significantly increased SIDS risk. These findings point to pregnancy health as a window for identifying infants at elevated SIDS risk.

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The HTR8/SVneo trophoblast cell line is widely used to study placental function, but results often vary between labs because of inconsistent use of Matrigel substrate. This study systematically measured how Matrigel culture conditions change cell shape, gene expression, and invasive behavior in HTR8/SVneo cells. The findings call for standardized Matrigel use protocols to improve reproducibility of trophoblast research.

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Infliximab suppresses the immune system to treat inflammatory conditions like pyoderma gangrenosum, but its effect on pre-existing blood cancers is unknown. This case report describes a patient with pyoderma gangrenosum and a pre-malignant blood condition (MGUS) who developed full myeloma after infliximab treatment. The case raises concern that TNF-blocking drugs may accelerate progression from pre-malignancy to active blood cancer.

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Nicorandil is a heart medication known to cause ulcers on mucosal surfaces, but its ability to cause skin ulcers alone—without mucosal involvement—is rarely reported. This case describes a non-healing leg ulcer that resolved completely when nicorandil was stopped, with no mucosal ulcers present. Nicorandil should be considered as a cause of unexplained leg ulcers even when classic mucosal symptoms are absent.

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Newborn screening cards store dried blood samples from millions of infants and could be a valuable archive for detecting viral infections around the time of birth. This study compared four DNA extraction methods from small newborn card punch samples to identify which could reliably detect low copy numbers of viral DNA. The optimized extraction method makes retrospective viral research from newborn cards more feasible.

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CD14 is an immune receptor for bacterial toxins, and a common polymorphism that affects its expression has been hypothesized to contribute to SIDS by altering response to bacterial infections. This large case-control study found no association between the CD14 (C-260T) polymorphism and SIDS in a South Australian cohort. The CD14 gene variant is unlikely to be a meaningful genetic risk factor for SIDS.

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The IL-1 receptor antagonist regulates inflammatory responses, and variants in its gene may influence susceptibility to overwhelming infection. This case-control study found that specific IL-1RN gene variants were significantly more common in SIDS infants than matched controls. The finding supports a model where genetic differences in immune regulation increase an infant's vulnerability to a fatal inflammatory response.

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A toxin receptor variant (TCRBV3S1 allele 2) has been proposed to increase susceptibility to staphylococcal toxic shock in infants. This study tested whether this allele was more common in SIDS and unexplained sudden unexpected infant deaths (uSUDI) and found no significant association. The TCRBV3 variant does not appear to contribute meaningfully to the staphylococcal toxic shock hypothesis of SIDS.

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IL-1 receptor antagonist gene variants that amplify inflammatory responses could increase SIDS risk by making infants more vulnerable to bacterial toxins. This study found that allele 2 of the IL-1RN tandem repeat polymorphism was more frequent in unexplained SUDI cases than in infectious or non-infectious infant deaths. The finding supports a genetic predisposition to uncontrolled inflammatory responses as a contributor to unexplained infant deaths.

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Staphylococcus aureus in the infant gut can produce toxins that enter the bloodstream and may cause fatal shock. This study catalogued which enterotoxin genes were present in S. aureus isolated from the gut of SIDS and healthy infants and found that genes for several toxins, including newer ones, were prevalent in both groups. Toxin gene presence alone is not sufficient to explain SIDS, suggesting host susceptibility factors determine outcome.

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Several studies have found pathogenic bacteria in normally sterile body sites in SIDS cases, suggesting some deaths may be triggered by unrecognized bacteremia. This hypothesis paper reviews those findings in the context of SIDS pathology and epidemiology and proposes that a proportion of unexplained infant deaths result from rapidly progressing bacterial infections. If correct, this would shift part of SIDS prevention toward infection control and vaccination strategies.

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E. coli colonizes all infant guts and produces multiple toxins, some of which have been linked to SIDS. This study measured the frequency of specific E. coli virulence genes in gut bacteria from SIDS cases, other infant deaths, and healthy infants and found no significant differences. E. coli virulence gene carriage does not distinguish SIDS cases from other infants and is unlikely to be a primary driver.

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SIDS remains poorly understood, but consistent autopsy findings—including immune activation and inflammation markers—suggest infection plays a role. This review synthesizes evidence for an infectious etiology of SIDS, including epidemiological and genetic data pointing to interactions between environmental pathogens and immune gene variants. The review supports a multifactorial model where infection, combined with vulnerable developmental windows and susceptible immune genotypes, triggers SIDS.