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In This Issue of JAMA Surgery
September 2018

Highlights

JAMA Surg. 2018;153(9):785. doi:10.1001/jamasurg.2017.3693
Research

Several national initiatives aim to empower laypersons to act as immediate responders to reduce preventable deaths from uncontrolled bleeding. In this randomized trial, Goralnick and colleagues demonstrated that in-person bleeding control training was superior to no training, flashcards, and audio kits. Fifty-five percent of participants retained tourniquet placement skills 3 to 9 months after training.

Invited Commentary

Continuing Medical Education

Nonbattle injuries are a potentially preventable drain on deployed military forces and the military health care system. Le and colleagues performed a retrospective analysis looking at the incidence and trend of nonbattle injuries among 29 958 US service members injured in Iraq and Afghanistan in the last 12 years. They found that nonbattle injuries accounted for one-third of total casualties and 11.5% of all deaths. Falls, car crashes, and other unintentional injuries were the most common types.

Invited Commentary

Continuing Medical Education

To determine the performance of the Genomic Sequencing Classifier in cytologically indeterminate thyroid nodules, Patel and colleagues performed a blinded clinical validation study in 191 fine-needle aspirate samples derived from a prospective, multicenter cohort. High sensitivity and negative predictive value results support the Genomic Sequencing Classifier as a cancer rule-out test to avoid unnecessary diagnostic surgery.

Invited Commentary

The association between perioperative red blood cell transfusions and postoperative venous thromboembolism within 30 days of a surgical procedure is unknown. In this prospective registry study of more than 750 000 surgical patients, perioperative red blood cell transfusions were significantly associated with 2-fold higher odds of venous thromboembolism, and the association was dose dependent. These findings should reinforce the importance of rigorous perioperative clinical blood management practices.

Because recent clinical studies have indicated an association between fluoroquinolone use and increased risk of aortic aneurysm and dissection, LeMaire and colleagues examined the association of ciprofloxacin with changes in the aortic wall in a mouse model of sporadic aortic aneurysm and dissection. Ciprofloxacin significantly increased elastic fiber destruction, smooth muscle cell injury, and susceptibility to aortic dissection and rupture. These findings are further substantiation that ciprofloxacin should be used with caution in patients with aortic dilatation and in those at high risk for aortic aneurysm and dissection.

Invited Commentary Continuing Medical Education

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