Ben E Biesterveld

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This review synthesizes the evidence on who gets access to living donor kidney transplants in the U.S., which produce better long-term outcomes than transplants from deceased donors. White patients are far more likely to receive a living donor transplant than Black or Hispanic patients, and higher income and private insurance further increase access. Closing this gap requires coordinated action at the patient, provider, institutional, and policy levels.

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This multi-center study examined outcomes for patients who had their livers transplanted and later developed tumors in the transplanted organ requiring surgical removal. Among 54 patients at 12 centers, hepatocellular carcinoma was the most common tumor, and surgical removal—often as the only treatment—was associated with acceptable survival and recurrence rates comparable to those seen in patients with native livers. Hepatic resection is a viable and underutilized option for selected patients in this setting.

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Patients being evaluated for kidney transplants sometimes have pre-cancerous lesions discovered incidentally, but there is little guidance on how to manage these rarer findings. This review covers conditions like intraductal papillary mucinous neoplasms, gastrointestinal stromal tumors, thymomas, and pancreatic neuroendocrine tumors in the transplant candidate population. Because high-quality evidence is sparse, management decisions should involve multidisciplinary oncology teams and be individualized.

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Nodular regenerative hyperplasia is a rare liver condition where the liver tissue becomes nodular without the scarring seen in cirrhosis, sometimes causing dangerous complications from high blood pressure in the liver's portal vein. This systematic review found that it accounts for about 1% of liver transplants and can develop in nearly 3% of transplant recipients—often without an identifiable cause and sometimes requiring re-transplantation. Both transplanting for this condition and developing it after transplant are described, with reasonable long-term survival.

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This study combined electronic health record data with physiologic waveform signals from cardiac ICU monitors to predict when post-cardiac-surgery patients would deteriorate. Models using both data types outperformed either alone, with waveform data being the primary driver of accuracy. However, performance dropped in a later test period, a known challenge called dataset shift that limits how well such models hold up over time in real clinical settings.

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Researchers trained a machine learning model on cardiac surgery patients and tested it on different surgical populations to predict life-threatening complications hours before they occurred. The best models achieved very high accuracy even when applied to vascular and general surgery patients the model had never seen. This cross-cohort generalizability is an important step toward building clinical decision support tools that work broadly.

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This large study linked data from trauma registries and patient complaint records to ask whether having a doctor with a history of unprofessional behavior on your care team affects your odds of dying or having complications. Patients treated by at least one high-risk service—defined by a high proportion of physicians with patient complaints—had a 24% greater risk of death or complications. Professional behavior in trauma care is not just a cultural concern; it has measurable patient safety consequences.

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Researchers gave a single dose of stem-cell-derived extracellular vesicles to pigs that had suffered a severe traumatic brain injury combined with hemorrhagic shock, then analyzed gene expression in the brain a week later. Treated animals showed dramatically different gene activity: pro-inflammatory and cell-death pathways were suppressed, while genes supporting neuron growth, brain repair, and synaptic function were upregulated. These molecular changes help explain the previously observed reduction in brain damage with this treatment.

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This study compared patient-reported quality of life and fear of recurrence between lung cancer patients who had a lobe removed by traditional video-assisted thoracoscopic surgery versus the newer robotic approach. Patients in the video-assisted group reported better quality of life scores, less shortness of breath, and lower fear of recurrence at multiple time points up to one year after surgery. The findings suggest the robotic approach does not improve patient-reported outcomes and may be worse on some measures.

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In pigs that received an isolated traumatic brain injury—without the blood loss often present in research models—a single dose of valproic acid given one hour after injury reduced brain lesion size by 75% and dramatically improved neurological recovery scores the next day. Pharmacokinetic data showed adequate drug levels in the blood and brain tissue. This sets the stage for a clinical trial of valproic acid in isolated TBI, which is a more common real-world scenario.

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Valproic acid, already known to improve survival in animal models of severe trauma, was tested specifically for its ability to protect the kidneys after hemorrhage and polytrauma in pigs. Treated animals had significantly lower creatinine levels—a key marker of kidney injury—in both a hemorrhage-only model and a full polytrauma model. Protein analysis of kidney tissue pointed to metabolic pathways as the main mechanism of protection.

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This study asked whether physician professionalism affects outcomes for elderly patients with hip fractures, using national trauma and complaint databases. Patients treated by services with a high rate of physician complaints had greater odds of delayed surgery and worse outcomes. The findings reinforce that professional behavior and team culture have direct implications for patient care quality.

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Researchers compared protein changes in the blood of healthy volunteers who received either a high dose (140 mg/kg) or a standard clinical dose (30 mg/kg) of valproic acid, aiming to understand why higher doses seem to protect trauma patients better. The higher dose activated pathways involved in protecting cells from oxygen deprivation, regulating energy production, and reducing cell death—changes not seen at the standard dose. These molecular signatures may explain the dose-dependent survival benefits seen in animal trauma models.

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This study analyzed brain tissue proteins from pigs given valproic acid after traumatic brain injury to understand how the drug protects the brain at a molecular level. Hundreds of proteins changed in expression, with the drug appearing to reduce inflammation, support neurotransmitter balance, and shift the brain toward cell survival rather than cell death. This mechanistic work helps explain why valproic acid reduces lesion size in prior studies.

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When intravenous access is unavailable in emergencies, drugs can sometimes be delivered through bone marrow (intraosseous route). This study showed that intraosseous delivery of valproic acid achieved blood levels equivalent to intravenous delivery in pigs with severe polytrauma, and both routes produced identical 100% survival versus 0% in controls. Intraosseous valproic acid is a viable emergency option when IV access fails.

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This study built and validated a machine learning model to predict hemodynamic deterioration in post-cardiac-surgery patients using physiological signals from ICU monitors. Models combining multiple signal types predicted adverse events several hours in advance with high accuracy. This work establishes that multimodal monitoring data can be computationally integrated to give clinicians earlier warning of patient decline.

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The authors developed and refined a large-animal model in pigs that combines severe polytrauma with intra-abdominal infection (sepsis), a combination that kills more than half of affected trauma patients. Through multiple iterations testing different colon injuries to create reproducible bacterial infection, they arrived at a model that is lethal but potentially treatable. Such a model is essential for testing new therapies for trauma complicated by sepsis.

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Resuscitative endovascular balloon occlusion of the aorta is used to control life-threatening hemorrhage, but blocking all blood flow to the lower body causes serious ischemia and reperfusion injury. This study tested a new device designed to allow partial rather than complete aortic occlusion, providing hemorrhage control while still permitting some blood flow distally. Animals in the partial occlusion group had less organ damage, needed less vasopressor support, and had lower lactate levels—demonstrating the device's potential clinical advantage.

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A survey of over 350 surgical providers during the COVID-19 pandemic revealed that 80% had received no formal telehealth training, yet were using it extensively. Providers expressed satisfaction with video visits overall but identified physical examination limitations and rapport-building as the biggest weaknesses. The study identifies training gaps that need to be addressed to optimize surgical telehealth.

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This study tested whether a dose of valproic acid within the range already approved for human use can still protect the brain after traumatic brain injury combined with hemorrhagic shock in pigs. Both a 50 mg/kg and a 150 mg/kg dose significantly reduced brain lesion size and improved neurological recovery compared to saline, with no meaningful difference between the two doses. The finding that clinically approved doses are sufficient supports moving this treatment toward human trials.

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Based on institutional experience with surgical telehealth, this practical guide outlines early steps to identify and address common barriers before they disrupt patient care. Key strategies include setting clear expectations, assessing patients' technology access and comfort, and evaluating social support. The focus is on proactive identification rather than reactive problem-solving.

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Using mass spectrometry to analyze brain tissue from pigs treated with valproic acid after traumatic brain injury and hemorrhagic shock, researchers found that the drug altered the brain's metabolic environment in protective ways. Notably, levels of the excitotoxic amino acid serine—which can worsen neuron damage—were significantly reduced in treated animals. This metabolomic evidence helps explain how valproic acid may preserve brain tissue in the critical early hours after injury.

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Adding valproic acid to fresh frozen plasma resuscitation after traumatic brain injury and hemorrhagic shock changed the expression of 800 genes in the brain. The combined treatment promoted cell proliferation and survival while suppressing inflammation and cell death pathways, suggesting the brain was shifted toward repair and recovery. Key transcription factors like TP53 and NF-kB appear to be central to how valproic acid exerts these effects.

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Sepsis triggers a cascade where certain enzymes cause neutrophils to release DNA traps that worsen organ damage. This study tested a drug that blocks these enzymes (Cl-amidine) in a rabbit model of septic shock. Treated rabbits had 72% survival versus 14% in controls and less kidney damage, supporting the potential of this approach for treating sepsis.

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This evidence-based review covers the full spectrum of gallstone disease—from mild biliary colic to life-threatening cholecystitis with sepsis—and synthesizes current best practices for diagnosis and treatment. Special populations and emerging endoscopic and percutaneous treatments are highlighted, alongside areas of ongoing uncertainty. The goal is to reduce unnecessary testing and delays in getting patients to definitive treatment.

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This study looked at which patients fail to show up for post-surgery follow-up visits in both in-person and telehealth settings. Patients in telehealth clinics were twice as likely to not show compared to traditional clinics, and Black patients and single patients had higher no-show rates regardless of setting. Geographic distance did not explain no-show rates, pointing instead to social and structural barriers.

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In pigs with isolated traumatic brain injury, a single dose of valproic acid given one hour after injury reduced brain lesion size by 50% and lowered blood levels of a brain injury marker. Mass spectrometry imaging showed the drug concentrated in injured blood vessel walls and readily penetrated damaged brain tissue. Pathway analysis of over 500 proteins revealed the drug activates calcium signaling and cell survival machinery in the brain.

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A review of 199 patients referred to a surgical electronic clinic found that over 21% failed to complete their visit. Non-White patients and those who were unmarried were significantly more likely to miss visits, while travel distance made no difference. The results reveal that technical barriers and social factors—not geography—drive underuse of surgical telehealth.

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Researchers gave pigs with traumatic brain injury and hemorrhagic shock a single dose of stem-cell-derived exosomes and then analyzed gene expression in the injured brain tissue. Exosome treatment increased activity of genes involved in neuron growth and synapse formation while reducing genes tied to inflammation and scar formation. These transcriptomic changes suggest exosomes may help the injured brain shift from damage response to recovery.

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In a pig model designed to simulate the austere conditions of prolonged military field care, valproic acid was added to dried plasma resuscitation after severe hemorrhage. Animals receiving valproic acid required 4.3 liters less resuscitation fluid to maintain target blood pressure over 72 hours. Reducing resuscitation requirements in resource-limited settings is a critical advantage when supplies are scarce.

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In a 7-day pig survival study of traumatic brain injury and hemorrhagic shock, a single early dose of stem-cell-derived exosomes significantly improved neurological scores, reduced brain lesion size, and modulated inflammatory and cell death markers. Treated animals had lower inflammatory cytokines, less apoptosis signaling, and higher levels of a brain growth factor. These results extend earlier short-term findings and establish lasting neuroprotection with a single exosome dose.

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A specific inhibitor of histone deacetylase 6 (ACY-1083) was tested in pigs with a combination of traumatic brain injury, severe hemorrhage, fracture, crush injury, and abdominal infection—a model designed to be uniformly lethal. All untreated animals died; 80% of those given ACY-1083 survived. This isoform-specific approach may offer the survival benefits of valproic acid with a more targeted mechanism and potentially fewer side effects.

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In a large-animal model of traumatic brain injury combined with hemorrhagic shock, a single early dose of mesenchymal stem cell-derived exosomes reduced brain swelling, cut lesion size, lowered intracranial pressure, and preserved the blood-brain barrier's integrity. Treated pigs also had lower blood markers of brain injury. Gene expression analysis confirmed that exosome treatment strengthened the barrier at the molecular level.

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Mice genetically engineered to lack the PAD2 enzyme—which converts certain proteins from arginine to citrulline—showed 100% survival after lethal hemorrhagic shock, while wild-type mice all died. In a cardiac ischemia model, PAD2 knockout mice also had smaller heart attacks and better cardiac function. These findings identify PAD2 as a potential drug target for improving survival after hemorrhage and cardiac ischemia.

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This qualitative study interviewed surgical residents about how they receive feedback on their leadership skills. Residents strongly wanted formal leadership feedback but reported that current systems rarely provided it meaningfully. Four themes emerged, including the importance of leadership feedback, inadequacy of current mechanisms, barriers to giving it, and resident-driven suggestions for improvement.

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Isoform-specific histone deacetylase inhibitors were compared to valproic acid for their ability to protect the intestine after hemorrhagic shock in rats. The isoform-specific drugs outperformed valproic acid in reducing intestinal inflammation and cell death markers, and worked even better when combined. These drugs may offer a more targeted way to protect the gut after severe blood loss.

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Researchers tested different doses of valproic acid in a pig model of lethal injuries to find the minimum effective dose. A 150 mg/kg dose given over three hours achieved 83% survival versus 17% for saline alone, while a 100 mg/kg dose only worked when delivered faster (over 2 hours rather than 3). This dose-optimization work provides critical information needed to design a safe and effective clinical trial.

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In a 72-hour pig model simulating prolonged military field care after lethal hemorrhage, adding a single dose of valproic acid to damage-control resuscitation improved survival from 20% to 80%. Treated animals also needed significantly less resuscitation fluid, maintained higher blood pressures, and showed better kidney and blood markers. The findings support valproic acid as a promising adjunct for prolonged field care in austere environments.

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This is a case report describing a rare patient who developed both an intercostal hernia and a diaphragmatic hernia simultaneously after a sneezing episode, an extremely uncommon combination of injuries. Surgical repair through the chest was performed successfully. The case illustrates that minor straining events can cause significant thoracic hernias in susceptible individuals.

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This study examined how varying the amount of IV fluid given to kidney donors during surgery affects outcomes for both the donor and the recipient. More aggressive fluid management slightly improved recipient kidney function on day 1 after transplant but made no difference at 6 months, while donor complications were significantly higher in the aggressive group. Standard fluid management appears to be the safest approach.

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This study examined whether a single dose of valproic acid given after traumatic brain injury and polytrauma in pigs continued to have protective effects 30 days later. Treated animals had significantly less neural apoptosis, less brain inflammation, fewer markers of neurodegeneration, and higher levels of a brain growth factor a month after injury. Valproic acid appears to shift the brain's long-term injury response toward protection and recovery.

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Partial aortic balloon occlusion (pREBOA) was tested in pigs that had both traumatic brain injury and hemorrhagic shock to see whether the combination worsened outcomes compared to hemorrhage alone. Mortality in the brain-injury plus pREBOA group was higher (40% vs. 0%), and those animals needed more fluid and vasopressors. The study cautions that the physiological effects of TBI may complicate pREBOA use and require careful monitoring.

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This review summarizes how drugs that inhibit histone deacetylase enzymes—including valproic acid—work as potential treatments for hemorrhagic shock, traumatic brain injury, polytrauma, and sepsis. These drugs modify gene expression to shift cells toward survival rather than death, offering a pharmacological approach to resuscitation that goes beyond replacing lost blood volume. With ongoing clinical translation work, they represent a promising adjunct to traditional trauma care.