Frontiers in Surgery最新文献

{"title":"Rate of cesarean section among breech deliveries in Ethiopia: a systematic review and meta-analysis.","authors":"Ibsa Mussa, Adera Debella, Lemma Demissie Regassa, Badhasa Ahamed, Usmael Jibro, Addis Eyeberu","doi":"10.3389/fsurg.2024.1283965","DOIUrl":"10.3389/fsurg.2024.1283965","url":null,"abstract":"<p><strong>Background: </strong>Breech deliveries are a significant public health concern in developing countries. The World Health Organization (WHO) declared that the cesarean section rate should not be higher than 10%-15%. As unnecessary C-sections may be associated with an increased risk of maternal and neonatal mortality, this meta-analysis was aimed at determining the rate of caesarean sections among breech deliveries in Ethiopia.</p><p><strong>Methods: </strong>All published and unpublished articles were obtained from legitimate databases and websites. The PRISMA guidelines were used to conduct this systematic review and meta-analysis. The meta-analysis of the primary and secondary outcomes was performed using STATA version 18. The overall effect size with a 95% CI was estimated using the random effect model with the Der Simonian Liard method. A sensitivity analysis using a leave-one-out meta-analysis was computed.</p><p><strong>Results: </strong>This meta-analysis included a total of 57,236 mothers who had breech deliveries. The pooled prevalence of breech deliveries among women in Ethiopia was 5% [95% CI: 4, 6]. The overall pooled cesarean section rate among breech deliveries in Ethiopia was 41% (95% CI: 29-54).</p><p><strong>Conclusions: </strong>In this review, the pooled prevalence of breech deliveries among women in Ethiopia was 5%, and the overall rate of caesarian section among the breech deliveries was 41%. This finding pointed out that two out of every five pregnant women with breech presentation gave birth by cesarean section in Ethiopia. Therefore, the finding implies that both the government and all the concerned stakeholders shall be given particular emphasis made on strengthening antenatal care services and ensure more women have access to skilled healthcare professionals during childbirth. This can help in providing appropriate interventions, support to women and reducing the need for emergency and unnecessary breech deliveries. The result of this research are a baseline data for future researchers to conduct further studies to better understand the reasons behind the high rates and identify potential interventions and solutions specific to the African context.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"11 ","pages":"1283965"},"PeriodicalIF":1.6,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Clinical awareness about the effect of laser interstitial thermal therapy on pediatric high-grade brain tumors after radiotherapy.","authors":"Sandra Fernandes Dias, Markus F Oertel, Ana Guerreiro Stücklin, Nicolas U Gerber, Elisa Colombo, Tristan P C van Doormaal, Niklaus Krayenbühl","doi":"10.3389/fsurg.2024.1462074","DOIUrl":"10.3389/fsurg.2024.1462074","url":null,"abstract":"<p><p>The use of magnetic resonance-guided laser interstitial thermal therapy (LITT) for the treatment of brain tumors and epileptic lesions has increased in the field of pediatric neurosurgery. However, very little is known about the effect of LITT on pediatric high-grade tumors that have been previously treated with radiotherapy. We report on two cases of children with an unexpected rapid brain tumor progression after LITT. The first case was an 11-year-old boy with a periventricular metastasis of a recurrent anaplastic ependymoma treated with proton-therapy and radiosurgery. The second case was a 6-year-old girl with a Lynch-syndrome and a recurrence of a mesio-temporo-occipital high-grade glioma admitted to gross total resection, proton-therapy, chemotherapy, bevacizumab and immune checkpoint inhibitor. Due to evidence of tumor progression in both cases, a decision was made to perform LITT. Shortly after the laser ablation, we observed a significant tumor growth along the trajectory of the LITT catheters, accompanied by clinical deterioration. The effect of LITT on pediatric ependymoma and high-grade glioma recurrence after radiotherapy is still unclear. The tumor expansion following LITT in these two patients should drive a deeper awareness of the effect of radiation and LITT on the tumor-environment. The breakage of the morphogenetic boundaries of the neuromeres, to which each tumor was initially confined, through the placement of the LITT catheters should be considered while trying to understand the disease spread mechanisms. Based on the experience of our center, we advise a careful implementation of this technique on pediatric high-grade central nervous system tumors, particularly in recurrent tumors that were previously treated with radiotherapy, until the underlying pathophysiologic mechanism has been better understood.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"11 ","pages":"1462074"},"PeriodicalIF":1.6,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous unilateral biportal endoscopic discectomy for symptomatic lumbar disc herniation in geriatric patients.","authors":"Rongqing Qin, Anhong Guan, Min Zhu, Pin Zhou, Bing Zhou, Ruihua Zhou, Zaiyong Guan","doi":"10.3389/fsurg.2024.1519952","DOIUrl":"10.3389/fsurg.2024.1519952","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study is to investigate the surgical efficacy and safety of percutaneous unilateral biportal endoscopic discectomy (UBED) for symptomatic lumbar disc herniation (LDH) in geriatric patients.</p><p><strong>Methods: </strong>Seventy-two geriatric patients, aged 65-86 years (mean age: 73.2 years), with single or two-level LDH who underwent UBED from January 2020 to September 2022 were retrospectively analyzed. Clinical outcomes were evaluated based on operation time, total blood loss, hospital stay, visual analog scale (VAS) scores for leg pain, Oswestry disability index (ODI) scores, modified MacNab criteria, and postoperative magnetic resonance imaging findings.</p><p><strong>Results: </strong>Surgery was successfully performed on all geriatric patients, with a mean operation time of 46 min (range: 32-68 min). All patients were followed up for an average duration of 14.2 ± 1.9 months (range: 12-16 months). The leg pain VAS score decreased from 8.37 ± 1.21 preoperatively to 2.03 ± 0.61 immediately after surgery, 1.56 ± 0.32 at 1 month postoperatively, 1.16 ± 0.45 at 6 months postoperatively, and 0.91 ± 0.26 at 12 months postoperatively. Similarly, the ODI score also decreased from 61.21 ± 11.06 preoperatively to 27.52 ± 10.41 immediately after surgery, 19.12 ± 7.05 at 1 month postoperatively, 12.17 ± 5.21 at 6 months postoperatively, and 8.56 ± 4.32 at 12 months postoperatively. Statistically significant differences were observed in both VAS and ODI scores at each follow-up time point when compared with preoperative parameters (<i>P</i> < 0.01). Also, there were 53 excellent cases, 12 good cases, and 7 fair cases based on the modified MacNab criteria at 12 months postoperatively, resulting in an excellent and good rate of 90.2%. Only three cases were found to be complicated by low extremity numbness, all of which were recovered via conservative treatment in 3 weeks. No infections or iatrogenic neurological deficits occurred in all patients.</p><p><strong>Conclusions: </strong>We concluded that UBED achieved satisfactory results and provided a minimally invasive, effective, and safe alternative for the treatment of symptomatic LDH in geriatric patients.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"11 ","pages":"1519952"},"PeriodicalIF":1.6,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management of benign tumors of the parotid gland: the advantages of extracapsular dissection compared to traditional surgical techniques.","authors":"Antonio Zanghì, Andrea Cavallaro, Martine Marchi, Marcello Marchi, Luigi La Via, Filippo Sanfilippo, Alessandro Cappellani, Simone Di Majo","doi":"10.3389/fsurg.2024.1415485","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1415485","url":null,"abstract":"<p><strong>Introduction: </strong>Salivary gland tumors represent only 3%-6% of all head and neck neoplasms, and approximately 70% of these tumors are located in the parotid gland. Most of these tumors are found in the more abundant superficial portion of the parotid gland, lateral to the facial nerve (FN). For many years, the location of the facial nerve between the superficial and deep segments of the parotid gland hindered adequate tumor extirpation. Several surgical options are available for the treatment of benign tumors in the parotid gland, but there remains no universal agreement on what the optimal surgical treatment is. In the early twentieth century, tumor enucleation was the standard treatment for parotid tumors to preserve the facial nerve, but high recurrence rates were the main downside of this procedure. To improve the outcome, superficial parotidectomy (SP) was implemented, which involves excision of the entire lateral segment of the parotid gland, superficial to the facial nerve. However, this surgical procedure may lead to severe postoperative complications, including facial nerve paralysis, in a significant number of patients. In recent years, more gland-preserving techniques were developed to reduce complication rates and improve the safety of procedures and patients' satisfaction, without increasing the risk of recurrence.</p><p><strong>Materials and method: </strong>This study compares our surgical experience with extracapsular dissection gland-sparing surgery (ECD) to traditional superficial parotidectomy in 56 patients who underwent surgery performed by the same surgical team.</p><p><strong>Results: </strong>The superiority of ECD procedures compared to SP procedures was shown as far as total complication rates are concerned. In this case, Fisher's exact test statistic value was 0.0043 (significant at <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>ECD should be applied in properly selected cases and further prospective studies are needed to clarify the optimal indications.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"11 ","pages":"1415485"},"PeriodicalIF":1.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: First use of dental bisphenol A-glycidyl methacrylate composite without UV light polymerization for repair of iatrogenic CSF leak following a frontal craniotomy plus tumor resection.","authors":"Haman Nassourou Oumarou, Ndome Toto Orlane","doi":"10.3389/fsurg.2024.1436361","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1436361","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the efficacy and safety of bisphenol A-glycidyl methacrylate (bis-GMA) without UV light polymerization for the repair of refractory iatrogenic cerebrospinal fluid (CSF) leaks with large skull base defects.</p><p><strong>Background: </strong>CSF leakage remains a common complication after neurosurgical interventions with a substantial resultant impact on morbidity and increased healthcare costs. The management of refractory CSF leaks with large skull base defects remains challenging. Radiological investigations are highly contributive as they visualize the defect and assess the herniated content. Optimal treatment depends on the breach parameters and the consequent hernia. Surgery, when indicated, consists of exposure of the defect and its reconstruction using different grafts. The dental composite bis-GMA has been investigated and has shown effectiveness for the repair of anterior skull base defects. This is due to its compactible mechanical properties, long-term stability, and good osteo-integration. Hence, it presents a promising solution for refractory CSF leaks not responding to extradural endoscopic techniques.</p><p><strong>Case report: </strong>We describe the case of a 40-year-old female with persistent CSF rhinorrhea following a left frontal craniotomy performed 4 years before. A high-resolution cerebral CT scan and MRI revealed a bilateral fronto-ethmoidal osteo-meningeal breach and a hyperintense T2 signal in the ethmoidal sinus interrupting the hypo-intensity of the bone, respectively. In our patient, surgical treatment involved a bifrontal craniotomy and osteo-meningeal reconstruction with the use of bis-GMA without UV light polymerization. This reconstruction gave rigid structural support and watertight closure of the defect. Postoperatively, the CSF rhinorrhea ceased and there were no perceivable associated complications.</p><p><strong>Conclusion: </strong>Given the favorable outcome, the composite bis-GMA without UV light polymerization can be used as a reliable material for the repair of iatrogenic CSF leaks.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"11 ","pages":"1436361"},"PeriodicalIF":1.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hidden blood loss and risk factors after percutaneous endoscopic transforaminal lumbar interbody fusion.","authors":"Meng Ge, Fangbing Zhu, Weibin Du, Zhengcong Ye, Zhenfei Xiong, Lukai Zhang, Hua Zhou, Jun Yang","doi":"10.3389/fsurg.2025.1490038","DOIUrl":"10.3389/fsurg.2025.1490038","url":null,"abstract":"<p><strong>Purpose: </strong>In this study, we aimed to assess the occurrence of hidden blood loss (HBL) and its associated risk factors in patients with lumbar degenerative diseases who underwent percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF).</p><p><strong>Methods: </strong>Sex, age, height, weight, body mass index, and medical history including hypertension, diabetes, and osteoporosis were recorded. The duration of symptoms, preoperative lumbar subcutaneous fat tissue thickness (measured using midsagittal T2-weighted magnetic resonance imaging), lumbar disc degeneration grade, and other basic patient information were also documented. The levels of fibrinogen, activated partial thromboplastin time, prothrombin time, thrombin time, and platelet count as well as the pre- and postoperative hematocrit and hemoglobin levels were collected. In addition, the number of fusion levels, surgical time, and intraoperative blood loss were recorded. Total blood loss (TBL) was calculated using the gross formula, and HBL was calculated based on the TBL and visible blood loss. The risk factors were analyzed using single-factor correlation and multivariate linear regression analyses.</p><p><strong>Results: </strong>Of the 83 patients, there were 42 males and 41 females. Hypertension (<i>P</i> = 0.003), fusion level (<i>P</i> < <i>0.001</i>), and surgery time (<i>P</i> < <i>0.001</i>) were significantly correlated with HBL via a single-factor correlation analysis. Multiple linear regression analysis showed that the fusion level (<i>P</i> < <i>0.001</i>) and surgery time (<i>P</i> < <i>0.001</i>) were independent risk factors for HBL.</p><p><strong>Conclusion: </strong>In patients with lumbar degenerative diseases treated with Endo-TLIF, HBL accounts for a large proportion of TBL. A large number of fusion segments and prolonged operation time are risk factors for increased perioperative HBL during Endo-TLIF. Increased attention should be paid to the presence of HBL to ensure the safety of perioperative patients.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1490038"},"PeriodicalIF":1.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and radiological outcomes of lumbar endoscopic decompression for treating lumbar spinal stenosis and degenerative lumbar scoliosis: a retrospective study at mean 4.4 years follow-up.","authors":"Ning Fan, Aobo Wang, Shuo Yuan, Peng Du, Tianyi Wang, Lei Zang","doi":"10.3389/fsurg.2024.1525843","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1525843","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the clinical and radiological outcomes of lumbar endoscopic decompression for the treatment of lumbar spinal stenosis (LSS) with concurrent degenerative lumbar scoliosis (DLS).</p><p><strong>Methods: </strong>This study retrospectively reviewed 97 patients with LSS and DLS who underwent lumbar endoscopic decompression between 2016 and 2021. The average follow-up duration was 52.9 months. Another 97 LSS patients without DLS were selected as the control group. The pre- and postoperative visual analog score (VAS) and the Oswestry disability index (ODI) were recorded and analyzed to compare clinical outcomes. Radiological findings, such as coronal balance and intervertebral disc height, have also been reported.</p><p><strong>Results: </strong>Both groups' mean VAS scores for back pain, leg pain, and ODI were significantly improved two weeks after surgery and at the final follow-up (<i>p</i> < 0.001). There was no significant difference in the prevalence of surgical complications or patient satisfaction rates. However, patients in the DLS group reported more severe back pain at the final follow-up than those in the LSS group (<i>p</i> = 0.039). Radiological follow-up revealed no significant deterioration in coronal imbalance or loss of disc height in either group.</p><p><strong>Conclusion: </strong>Lumbar endoscopic decompression can be a safe and effective surgical technique for treating LSS with DLS, particularly in elderly patients with poor general conditions.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"11 ","pages":"1525843"},"PeriodicalIF":1.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of clinical efficacy of different internal fixation methods in older adult patients with osteoporotic fractures of proximal humerus.","authors":"Zongpu Wang, Tienan Wang, Song Qin, Jianchuan Wang","doi":"10.3389/fsurg.2024.1472054","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1472054","url":null,"abstract":"<p><strong>Objective: </strong>To compare the efficacy of three treatment methods for older adult patients with osteoporotic proximal humerus fractures: proximal humerus locking plate (PHILOS) combined with calcium sulfate injection, PHILOS plate alone, and artificial hemi-shoulder joint replacement.</p><p><strong>Methods: </strong>The clinical data of 48 older adult patients with osteoporotic proximal humerus fractures admitted to the Shoulder and Elbow Surgery Department of Zhongshan Hospital Affiliated with Dalian University from February 2018-August 2021 were retrospectively analyzed. The patients comprised 18 males and 30 females, with a mean age of (68.6 ± 5.8) years. The 48 patients were divided into three groups based on their treatment methods: Group A: 16 patients treated with PHILOS plate combined with calcium sulfate injection. Group B: 16 patients treated with the PHILOS plate alone. Group C: 16 patients treated with artificial hemi-shoulder joint replacement. Key parameters such as operation time, blood loss, incision length, operation cost, and shoulder joint motion at the final follow-up were recorded and compared. Shoulder joint function was evaluated using the American Shoulder and Elbow Surgeons (ASES) score, Visual Analogue Scale (VAS) for pain, University of California Shoulder Joint Score (UCLA), and Brief Shoulder Function Test (SST).</p><p><strong>Results: </strong>There were no statistically significant differences in the preoperative general data between the three groups (<i>P</i> > 0.05), indicating comparability. There was no significant difference in operation time, blood loss, and incision length among Groups A, B, and C (<i>P</i> > 0.05). However, Group C had significantly higher operation costs compared to the other two groups (<i>P</i> < 0.05). At the final follow-up, there were no significant differences in shoulder flexion and rotation among the three groups (<i>P</i> > 0.05). However, a statistically significant difference in abduction was observed between Group A and Group C (<i>P</i> < 0.05). No significant differences were found in ASES, VAS, UCLA, and SST scores among the three groups at the last follow-up (<i>P</i> > 0.05).Complications occurred in 1 patient (Group A), 3 patients (Group B), and 4 patients (Group C), showing a statistically significant difference among the groups (<i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>All three surgical methods are effective in treating older adult osteoporotic proximal humerus fractures, as they significantly alleviate pain and restore joint function. However, the use of a PHILOS plate combined with calcium sulfate injection (Group A) is particularly effective, demonstrating reliable clinical efficacy with fewer complications.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"11 ","pages":"1472054"},"PeriodicalIF":1.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mobile-based in-home telerehabilitation compared with in-hospital face-to-face rehabilitation for elderly patients after total hip arthroplasty in China's level 1 trauma center: a noninferiority randomized controlled trial.","authors":"Yang Zhou, Yiming Lyu, Qiaojie Wang, Yanhong Ma, Lihua Huang, Xin Zhang","doi":"10.3389/fsurg.2024.1536579","DOIUrl":"10.3389/fsurg.2024.1536579","url":null,"abstract":"<p><strong>Background: </strong>Telerehabilitation is gaining popularity in European and American countries, but whether it can be successfully implemented in China still lacks support from clinical studies.</p><p><strong>Objective: </strong>This trial aimed to determine if a home-based telerehabilitation method is clinically noninferior to standard in-hospital face-to-face rehabilitation for elderly patients with total hip arthroplasty (THA) in China.</p><p><strong>Methods: </strong>This multicenter randomized controlled trial was conducted from January 2021 to June 2022 at The First Rehabilitation Hospital in Shanghai, Shanghai Jiao Tong University affiliated Sixth People's Hospital and Shanghai Tongji University affiliated Tenth People's Hospital. Sixty-four patients were recruited for this two-arm, single-assessor blinded, randomized controlled trial. The participants were randomly assigned to the in-home telerehabilitation group (TELE group) and the in-hospital physical therapist in-person group (PT group). The intervention consisted of a 12-week home-based rehabilitation program with video instructions and remote coaching on a mobile APP (TELE group). The PT group received a standard in-hospital rehabilitation intervention assisted by a physical therapist for one month and outpatient clinic for the next two months. Patients were evaluated at baseline, 4 weeks, and 12 weeks postoperatively employing functional tests (Timed Up & Go test and Berg balance test) and self-reported questionnaires (Hip disability and Osteoarthritis Outcome Score (HOOS) and Short Form 12 (SF-12)).</p><p><strong>Results: </strong>There was no significant difference between the two groups for the demographic and clinical characteristics. 61 participants were analyzed (PT group: <i>n</i> = 31, women: 48.4% of participants; TELE group: <i>n</i> = 30, 33.3% of participants) whose median age was 70 and 69 years, in PT group (IQR: 63-73) and TELE group (IQR: 66-72) respectively. At 12 weeks follow-up evaluation, the main differences between the two groups regarding the HOOS gains, adjusted for baseline values, were close to zero (<i>P</i> > 0.05). There was no significant difference in primary and secondary outcome measures between the two groups.</p><p><strong>Conclusion: </strong>Our results showed the noninferiority of in-home telerehabilitation and advocated its application as a reliable alternative to in-hospital face-to-face rehabilitation for patients who underwent THA.</p><p><strong>Clinical trial registration: </strong>https://www.chictr.org.cn/, Chinese Clinical Trial Registry (Number: ChiCTR1900025825).</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"11 ","pages":"1536579"},"PeriodicalIF":1.6,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing presurgical non-invasive spread through air spaces prediction in clinical stage IA lung adenocarcinoma using artificial intelligence and CT signatures.","authors":"Guanchao Ye, Guangyao Wu, Yiying Li, Chi Zhang, Lili Qin, Jianlin Wu, Jun Fan, Yu Qi, Fan Yang, Yongde Liao","doi":"10.3389/fsurg.2024.1511024","DOIUrl":"10.3389/fsurg.2024.1511024","url":null,"abstract":"<p><strong>Background: </strong>To accurately identify spread through air spaces (STAS) in clinical stage IA lung adenocarcinoma, our study developed a non-invasive and interpretable biomarker combining clinical and radiomics features using preoperative CT.</p><p><strong>Methods: </strong>The study included a cohort of 1,325 lung adenocarcinoma patients from three centers, which was divided into four groups: a training cohort (<i>n</i> = 930), a testing cohort (<i>n</i> = 238), an external validation 1 cohort (<i>n</i> = 93), and 2 cohort (<i>n</i> = 64). We collected clinical characteristics and semantic features, and extracted radiomics features. We utilized the LightGBM algorithm to construct prediction models using the selected features. Quantifying the contribution of radiomics features of CT to prediction model using Shapley additive explanations (SHAP) method. The models' performance was evaluated using metrics such as the area under the receiver operating characteristic curve (AUC), negative predictive value (NPV), positive predictive value (PPV), sensitivity, specificity, calibration curve, and decision curve analysis (DCA).</p><p><strong>Results: </strong>In the training cohort, the clinical model achieved an AUC value of 0.775, the radiomics model achieved an AUC value of 0.836, and the combined model achieved an AUC value of 0.837. In the testing cohort, the AUC values of the models were 0.743, 0.755, and 0.768. In the external validation 1 cohort, the AUC values of the models were 0.717, 0.758, and 0.765, while in the external validation 2 cohort, 0.725, 0.726 and 0.746. The DeLong test results indicated that the combined model outperformed the clinical model (<i>p</i> < 0.05). DCA indicated that the models provided a net benefit in predicting STAS. The SHAP algorithm explains the contribution of each feature in the model, visually demonstrating the impact of each feature on the model's decisions.</p><p><strong>Conclusion: </strong>The combined model has the potential to serve as a biomarker for predicting STAS using preoperative CT scans, determining the appropriate surgical strategy, and guiding the extent of resection.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"11 ","pages":"1511024"},"PeriodicalIF":1.6,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}