a-translational-surgical-porcine-model-for-postoperative-intra

A Translational Surgical Porcine Model for Postoperative Intra-Abdominal Adhesion Formation

A porcine model of postoperative intra-abdominal adhesion formation was established using Yucatan mini pigs. The protocol combines midline laparotomy, ...

Stanford University School of Medicine

Fatigue is a common adverse effect of external beam radiation therapy in cancer patients. Mechanisms causing radiation fatigue remain unclear, although linkage to skin irradiation has been suggested. β-Endorphin, an endogenous opioid, is synthesized in skin following genotoxic ultraviolet irradiation and acts systemically, producing addiction. Exogenous opiates with the same receptor activity as β-endorphin can cause fatigue. Using rodent models of radiation therapy, exposing tails and sparing vital organs, we tested whether skin-derived β-endorphin contributes to radiation-induced fatigue. Over a 6-week radiation regimen, plasma β-endorphin increased in rats, paralleled by opiate phenotypes (elevated pain thresholds, Straub tail) and fatigue-like behavior, which was reversed in animals treated by the opiate antagonist naloxone. Mechanistically, all these phenotypes were blocked by opiate antagonist treatment and were undetected in either β-endorphin knockout mice or mice lacking keratinocyte p53 expression. These findings implicate skin-derived β-endorphin in systemic effects of radiation therapy. Opioid antagonism may warrant testing in humans as treatment or prevention of radiation-induced fatigue.

β-Endorphin mediates radiation therapy fatigue.

To quantify liver fibrosis in infants with biliary atresia (BA) through automated analysis of collagen extracellular matrix (ECM) ultrastructure in index liver biopsies and use a composite fibrosis architecture score to predict native liver survival.

BA-ECM Score: Automated Quantification of Liver Fibrosis Architecture in Biliary Atresia with Potential for Prognostic Value - A Pilot Study.

Pediatric Metabolic and Bariatric Surgery and Antiobesity Medications: Weighing Efficacy, Risks, and Future Directions.

Metabolic and bariatric surgery (MBS) is a highly durable, safe and effective treatment for severe obesity in adults. However, MBS remains underutilized in the pediatric and adolescent population, likely due to safety concerns of elective surgery in children.

Metabolic and bariatric surgery in adolescents compared to young adults: an MBSAQIP database analysis.

 Wound healing in pediatric patients is affected by physiology, growth, and development considerations unique from those in adults. In the following report, we review the primary literature on aging and wound healing and highlight clinical wound healing applications for the pediatric patient across age ranges from neonates and infants in the first year of life to adolescents (aged 10-19 years by World Health Organization definition).  We characterize the differences in wound healing biology between infants, adolescents, and adults and discuss wound care strategies for pediatric surgical patients, highlighting evidence-based guidelines for wound management. We discuss relevant animal models and review the multidisciplinary aspects of providing wound care for children.  Pediatric surgical patients have specialized wound care needs. Optimizing wound care outcomes for infants, children, and adolescents relies on an understanding of their wound-healing biology and unique physiological, psychological, and social considerations.  Future directions in pediatric wound care will focus on validating and optimizing emerging technologies through pediatric-specific clinical trials, while also addressing key knowledge gaps in topical agent pharmacokinetics and advancing regenerative approaches like mesenchymal stem cell therapies tailored to the unique biology of infants and children.

Wound Healing and Management Considerations in the Pediatric Surgical Patient.

Prior research has shown higher rates of complications across a broad spectrum of surgeries in pediatric patients with higher Social Vulnerability Index (SVI).

The impact of social determinants of health on adolescent metabolic and bariatric surgical outcomes.

Pediatric obesity is a growing epidemic associated with serious long-term health consequences, including diabetes, cardiovascular disease, and reduced life expectancy. Metabolic and bariatric surgery (MBS) is a safe, effective, and durable treatment for adolescents with severe or refractory obesity; however, it remains significantly underutilized. As a consequence, children with severe obesity and associated comorbidities progress to an advanced stage of disease that can be even more challenging to treat than in adults. Current evidence demonstrates that MBS in adolescents achieves comparable or even superior weight loss and comorbidity resolution compared to adults, with favorable long-term safety profiles. In select cases, GLP-1 receptor agonists (GLP-1RAs), may be used as an adjunct to MBS. Current evidence for GLP-1RA use in the preoperative period is limited, although when reinitiated early in the postoperative period, they may be associated with improved weight loss outcomes. Despite strong guideline support, <0.05 % of eligible children undergo MBS, likely due to poor access to adolescent MBS centers, limited insurance coverage, and a lack of awareness or misinformation surrounding MBS, among other causes. Multidisciplinary support including preoperative teaching, mental health services, and long-term postoperative follow-up is essential to the success of the procedure. Further research is needed to better characterize the disparities in access, improve outreach and education efforts, combat the stigma associated with adolescent MBS, and address this growing public health crisis.

Article	Year
β-Endorphin mediates radiation therapy fatigue. Science advances\| PubMed ID: 36525492	2022
BA-ECM Score: Automated Quantification of Liver Fibrosis Architecture in Biliary Atresia with Potential for Prognostic Value - A Pilot Study. Annals of surgery\| PubMed ID: 40109267	2025
Pediatric Metabolic and Bariatric Surgery and Antiobesity Medications: Weighing Efficacy, Risks, and Future Directions. The Journal of pediatrics\| PubMed ID: 40252955	2025
Metabolic and bariatric surgery in adolescents compared to young adults: an MBSAQIP database analysis. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery\| PubMed ID: 40946077	2025
Wound Healing and Management Considerations in the Pediatric Surgical Patient. Advances in wound care\| PubMed ID: 41192826	2025
The impact of social determinants of health on adolescent metabolic and bariatric surgical outcomes. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery\| PubMed ID: 41339175	2026
Pediatric metabolic and bariatric surgery: When is the right time to operate? Current problems in pediatric and adolescent health care\| PubMed ID: 41344950	2025

Gillian L. Fell

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