Nelson Andrew Royall

Background: Surgeons work in a progressive field where communicating research is vital to advancing health care and enabling meaningful interactions among clinicians. It also contributes to societal impact, increases access to information, and reduces misinformation. Additionally, there can be barriers to accessing papers. Social media enhances research impact through sharing scholarly work and improving its translation into clinical practice, but little is known about how to design specific posts to maximize research impact through language. Objective: The purpose of this study was to determine the linguistic cues that optimize research impact among surgeons through Twitter (subsequently rebranded X). Additionally, this research combines the linguistic features of the posts and article access to determine their unique contributions. Methods: An exploratory linguistic analysis of 84 posts extracted from Twitter was conducted, which shared scholarly activity by 17 of the most-followed surgeons. The linguistic cues were measured on a continuous scale, computed from the percentage of each linguistic cue used in the text, and reported as mean (SD). Regression analysis and analysis of covariance were conducted to determine which cues influenced research impact and to estimate the potential association with study accessibility (open vs restricted access). Results: Analyzed tweets were highly analytic (mean 94.77, SD 9.00), moderate in clout (mean 42.69, SD 19.84), low in tone (mean 20.06, SD 33.91), suggesting negative tone use, and low in authenticity (mean 19.52, SD 24.50). Results suggest that a high use of formal language negatively impacts readership and citations. Analytical language was indirectly associated with readership (β=−0.296, 95% CI −423.57 to −59.95; P =.01) and citations (β=−0.524, 95% CI −0.442 to −0.187; P <.001). Linguistic clout had a positive association with readership (β=0.260, 95% CI 8.58-186.91; P =.03), and tone in tweets had a negative association with readership (β=−0.317, 95% CI −138.52 to −5.39; P =.04). Negative language tone was found to increase the impact of research. With respect to linguistic cues and study accessibility, the results also suggest that the number of citations was impacted by readership ( F _1,66 =4.11, 95% CI 2.459E -06 to 0.003; P =.047) and analytic linguistic cues ( F _1,66 =18.77, 95% CI −0.402 to −0.149; P <.001) used in the post, but the association of open (mean 3.04, SE 1.062) versus restricted access (mean 1.83, SE 0.716) was not statistically significant ( F _1,66 =0.877, 95% CI 0.405-3.266; P =.352). Conclusions: This research is the first to explore article accessibility and linguistic cues used in creating posts that share research on social media to determine their influence on research impact, making this study both innovative and unique relative to existing studies in the surgery field. Through language, the medical field can expand its impact and encourage dialogue between scientists and the public, thereby increasing scientific and societal contributions while reducing the negative effects of limited article access.

Background/Objectives: Prediabetes is characterized by insulin resistance and systemic inflammation, which may increase susceptibility to acute pancreatitis (AP). However, limited data exist on how prediabetes influences in-hospital outcomes in AP patients. This study aimed to evaluate the prevalence and clinical outcomes of hospitalized AP patients with prediabetes using the National Inpatient Sample (NIS) database. Methods: We conducted a retrospective cohort study using NIS data from 2016 to 2018, identifying adult patients hospitalized with a primary diagnosis of AP. Patients were stratified based on the presence or absence of prediabetes; those with type 1 or 2 diabetes were excluded. The primary outcome is the association of prediabetes with developing acute pancreatitis and its influence on in-hospital mortality, length of stay, and total hospital cost. Results: Among 193,617 patients hospitalized with AP, 1639 had prediabetes. No statistically significant difference was found in in-hospital mortality, length of stay, or hospitalization costs between patients with or without prediabetes. The in-hospital mortality was 1.22% in prediabetic patients versus 2.01% in non-prediabetic patients (p = 0.0225). The length of stay was shorter in prediabetic patients (4.93 vs. 5.37 days, p = 0.0021), and hospitalization costs were similar (USD55,351.56 vs. USD57,106.83, p = 0.195). Furthermore, prediabetes was not an independent predictor of mortality (OR 0.50, 95% CI 0.31–0.82, p = 0.0063). Significant predictors of mortality included acute kidney injury (OR 12.98, 95% CI 11.96–14.09, p < 0.001) and severe sepsis with shock (OR 5.89, 95% CI 5.27–6.59, p < 0.001). Conclusions: Prediabetes was not associated with an increased in-hospital mortality in AP patients. However, complications such as AKI and septic shock significantly predicted mortality, underscoring the importance of early recognition and management.

Background/Objectives: Prediabetes is characterized by insulin resistance and systemic inflammation, which may increase susceptibility to acute pancreatitis (AP). However, limited data exist on how prediabetes influences in-hospital outcomes in AP patients. This study aimed to evaluate the prevalence and clinical outcomes of hospitalized AP patients with prediabetes using the National Inpatient Sample (NIS) data-base. Methods: We conducted a retrospective cohort study using NIS data from 2016 to 2018, identifying adult patients hospitalized with a primary diagnosis of AP. Patients were stratified based on the presence or absence of prediabetes; those with type 1 or type 2 diabetes were excluded. The primary outcome is the association of prediabetes in developing acute pancreatitis and its influence on in-hospital mortality, length of stay, total hospital cost. Results: Among 193,617 patients hospitalized with AP, 1,639 had prediabetes. In-hospital mortality was 1.22% in prediabetic patients versus 2.01% in non-prediabetic patients (p = 0.0225), though this was not statistically significant. LOS was shorter in prediabetic patients (4.93 vs. 5.37 days, p = 0.0021), and hospitalization costs were similar ($55,351.56 vs. $57,106.83, p = 0.195). Prediabetes was not an independent predictor of mortality (OR 0.50, 95% CI 0.31–0.82, p = 0.0063). Significant predictors of mortality included acute kidney injury (AKI) (OR 12.98, 95% CI 11.96–14.09, p < 0.001) and severe sepsis with shock (OR 5.89, 95% CI 5.27–6.59, p < 0.001). Conclusions: Prediabetes was not associated with increased in-hospital mortality in AP patients. However, complications such as AKI and septic shock significantly predicted mortality, underscoring the importance of early recognition and management.

Introduction Gallbladder adenocarcinoma is the most common histologic subtype of gallbladder malignancies. In contrast, gallbladder neuroendocrine carcinomas are rare and poorly studied. This study aims to identify the demographic variables that may be associated with each histologic subtype. Methods A retrospective analysis was conducted on 53,447 patients diagnosed with gallbladder neoplasms using data from the National Cancer Database (NCDB) between 2011 and 2020. Associations between demographic variables and the incidence of gallbladder adenocarcinoma and neuroendocrine carcinoma were compared using chi-square tests and post hoc analyses. Results A total of 51,694 (96.7%) patients had adenocarcinoma, and 1753 (3.3%) had neuroendocrine histologic subtypes. The comparative analysis revealed significant associations with age, gender, and race (p < 0.05). Neuroendocrine carcinoma patients were diagnosed at a younger age compared to those with adenocarcinoma (z = 14.7). Moreover, patients with privately managed insurance had a higher likelihood of neuroendocrine carcinoma (z = 5.7), while those with Medicare were less likely (z = − 4.7). Gender differences were also notable; males were more predisposed to neuroendocrine carcinoma (z = 4.4, OR = 1.3), while females were less so (z = − 3.1). A significant increase in neuroendocrine cases was observed after 2016 (z = 2.4), while the incidence of adenocarcinoma subtypes was stable. Notable racial disparities in the diagnosis of gallbladder cancer were identified with black patients more likely to have neuroendocrine carcinoma. Conclusion This study highlights the differences in demographic and clinical characteristics of patients diagnosed with gallbladder neuroendocrine carcinomas compared to adenocarcinoma tumors. These findings highlight potential opportunities for targeted screening programs to enhance early detection efforts.

A female in her 60s with vague abdominal symptoms was found to have a pancreatic mass in her CT scan. A core needle biopsy done endoscopically demonstrated a poorly differentiated adenocarcinoma. The patient completed nine cycles of neoadjuvant systemic mFOLFIRINOX. Repeat staging demonstrated a partial radiographic response. She underwent an open pylorus-preserving pancreatoduodenectomy with segmental superior mesenteric vein resection with primary reconstruction (ISGPS Type 3). The final pathology demonstrated a poorly differentiated adenosquamous carcinoma, R1 margin status. The case report demonstrates the effect of mFOLFIRINOX on pancreatic adenosquamous (PASC) carcinoma with a review of the microscopic pictures following the neoadjuvant therapy. It can be postulated that glandular component being the major component in a PASC has a good response to mFOLFIRINOX like that seen in pancreatic ductal adenocarcinoma with some presumed effect on the squamous component as well. From the above case report, we are proposing that mFOLFIRINOX can be an effective chemotherapy regime in the management of PASC.

Objectives: Many medical specialties have adopted the use of ultrasound, creating demands for higher‐quality ultrasound training at all levels of medical education. Little is known about the long‐term benefit of integrating ultrasound training during undergraduate medical education. This study evaluated the effect of a longitudinal fourth‐year undergraduate medical education elective in ultrasound and its impact on the future use of ultrasound in clinical practice.Methods: A cross‐sectional survey of medical graduates from The Ohio State University College of Medicine (2006–2011) was done, comparing those who participated and those who did not participate in a rigorous ultrasound program for fourth‐year medical students. A 38‐item questionnaire queried graduates concerning ultrasound education in residency, their proficiency, and their current use of ultrasound in clinical practice.Results: Surveys were completed by 116 respondents, for a return rate of 40.8% (116 of 284). The participants of the undergraduate medical education ultrasound elective (n = 61) reported more hours of ultrasound training after graduation (hands‐on training, bedside scanning, and number of scans performed; P < .001), higher ultrasound proficiency (proficiency in using ultrasound for clinical decision making, use in emergency settings, and use of novel techniques; P< .001), and higher rates of ultrasound use in clinical practice (P < .001).Conclusions: The longitudinal undergraduate medical education ultrasound elective produced physicians who were more likely to seek additional training in residency, evaluate themselves as more proficient, and use ultrasound in their clinical practice. Early training in bedside ultrasound during undergraduate medical education yields physicians who are better prepared for integration of ultrasound into clinical practice.

Currently, sleeve gastrectomy is most commonly performed laparoscopically. However, robot-assisted approach for sleeve gastrectomy is increasing in number among bariatric surgeons. The aim of our study is to compare perioperative outcomes of robot-assisted (RA-LSG) and laparoscopic sleeve gastrectomy (LSG). Between June 2008 and December 2014, 647 patients underwent LSG and RA-LSG at our institution. A retrospective review was performed for 379 LSG and 268 R-LSG patients, noting the outcomes and complications of the procedure. The first 100 LSG and RA-LSG cases were separated to reflect the influence of learning curve. Mean length of hospital stay (LOS) was longer in RA-LSG patients at 1.3 ± 0.6 days (range, 1–4), while it was 1.1 ± 0.3 days (range, 1–2) in LSG patients. Thirty-day readmission rate was similar in both groups, 5.0 % in LSG and 6.0 % in RA-LSG group. One mortality (1.0 %) occurred in the RA-LSG group. In patients after 100 cases, mean LOS was still longer in RA-LSG patients at 1.7 ± 1.8 days (range, 1–21), while it was 1.2 ± 0.5 days (range, 1–5) LSG patients. Thirty-day readmission rate and 30-day reoperation rate did not show a significant difference between the two groups. Overall leak rate was 3.2 % (n = 9) in LSG group, and 1.9 % (n = 5) in RA-LSG group, and the difference was not statistically significant. Our study showed similar 30-day readmission and reoperation rate between LSG and RA-LSG during the learning curve and after the proficiency has been achieved.