Frontiers in Surgery最新文献

{"title":"Changes in parent-rated attention-deficit/hyperactivity disorder symptom scores and sleep parameters during individualized multidisciplinary clinical management in children with comorbid obstructive sleep apnea: a prospective cohort study in Vietnam.","authors":"Mai Nguyen-Thi-Phuong, Mai Nguyen-Thi-Thanh, Robert Joel Goldberg, Hoa L Nguyen, Thang Dac Hoang","doi":"10.3389/fsurg.2026.1941040","DOIUrl":"10.3389/fsurg.2026.1941040","url":null,"abstract":"<p><strong>Objective: </strong>To describe changes in parent-rated attention-deficit/hyperactivity disorder (ADHD) symptom scores, respiratory-polygraphy-derived parameters, and sleep characteristics over 6 months in children with ADHD and comorbid obstructive sleep apnea (OSA) who received individualized multidisciplinary clinical management.</p><p><strong>Methods: </strong>This single-arm prospective cohort study was conducted at Vietnam National Children's Hospital from November 2022 to October 2024. Among 629 children with ADHD screened using the Pediatric Sleep Questionnaire (PSQ), 293 had at least 8 positive responses and underwent home respiratory polygraphy; 147 had clinical features consistent with pediatric OSA and met the prespecified respiratory-polygraphy criterion of a respiratory event index (REI) ≥ 1 event/hour, and 141 completed follow-up. Parent-rated Vanderbilt ADHD Diagnostic Rating Scale (VADRS) scores were assessed at baseline, 3 months, and 6 months. Respiratory-polygraphy and sleep-diary measures were assessed at baseline and 6 months.</p><p><strong>Results: </strong>The mean age was 7.8 years, and 85.8% were boys. After 6 months, mean REI decreased from 11.8 to 4.4 events/hour, and the lowest nocturnal peripheral oxygen saturation (SpO₂) increased from 78.9% to 83.4% (both <i>p</i> < 0.001). Prespecified respiratory-polygraphy severity categories shifted toward less severe categories (McNemar-Bowker <i>χ</i> ²[6] = 70.80, <i>p</i> < 0.001); 73 children (51.8%) improved by at least one category, and 47 children (33.3%; 95% CI, 26.1-41.5%) no longer met the prespecified respiratory-polygraphy criterion for OSA at 6 months. Sleep-onset latency and daytime sleep duration decreased. Nighttime sleep duration increased from 8.4 ± 1.1 to 8.7 ± 0.6 h (mean change, +0.3 h; 95% CI, +0.14 to +0.46; <i>p</i> < 0.001), whereas total 24-h sleep duration decreased by 0.5 h (<i>p</i> < 0.001). Parent-rated ADHD symptom scores decreased across all VADRS domains.</p><p><strong>Conclusion: </strong>Respiratory-polygraphy-derived indices, selected sleep characteristics, and parent-rated ADHD symptom scores improved during 6 months of individualized multidisciplinary clinical management. The uncontrolled design and concurrent interventions preclude causal attribution of these changes to OSA-directed treatment.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1941040"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181589","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":"Research trends in minimally invasive partial splenectomy: a bibliometric mapping review with cross-database comparison.","authors":"Wei Tian, Xu Deng, Chunyuan Yang, Jianxing Tian, Zonglong Zhu, Rui Huang, Wei Pan","doi":"10.3389/fsurg.2026.1941549","DOIUrl":"https://doi.org/10.3389/fsurg.2026.1941549","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive partial splenectomy (MIPS) is used for hereditary hematologic disorders, splenic cysts, hydatid disease, benign tumors, and selected traumatic lesions. However, its literature remains dispersed across patient groups, indications, and surgical specialties. This study mapped the development, contributors, knowledge base, and thematic structure of MIPS research and examined the concordance of its principal patterns across databases.</p><p><strong>Methods: </strong>Articles and reviews published from 1 January 1995 to 29 August 2026 were retrieved from the Web of Science Core Collection (WoSCC), Scopus, and PubMed. WoSCC supported the primary bibliometric and knowledge-mapping analyses; Scopus and PubMed supported cross-database comparisons. Bibliometrix, VOSviewer, and CiteSpace were used to analyze publication output, contributors, keywords, co-cited references, and citation bursts. Database overlap, annual-output correlations, and journal and theme descriptive agreement were also assessed.</p><p><strong>Results: </strong>The final datasets comprised 150 WoSCC, 154 Scopus, and 161 PubMed publications. WoSCC output increased after 2015 and reached 15 publications in 2024, the highest total among complete years. China contributed the most publications (<i>n</i> = 53), while the United States had the highest country-level total link strength. <i>Surgical Endoscopy</i>, <i>Journal of Pediatric Surgery</i>, and <i>Journal of Laparoendoscopic & Advanced Surgical Techniques</i> were the leading sources. Keyword analysis identified eight moderately coherent clusters (Q = 0.4383; mean silhouette = 0.6477), covering partial splenectomy, laparoscopic surgery, hydatid disease, hereditary spherocytosis, pediatric surgery, and operative techniques. Cross-database linkage identified 183 unique publications; 122 (66.7%) occurred in all three databases. Annual publication counts were strongly correlated for 1995-2025 (Spearman's <i>ρ</i> = 0.960-0.979) and after inclusion of partial-year 2026 data (<i>ρ</i> = 0.963-0.978; all <i>P</i> < 0.001). Eight journals appeared in all three database-specific Top-10 lists, and the leading thematic distributions were broadly similar across databases.</p><p><strong>Conclusion: </strong>MIPS research has expanded but remains relatively small, institutionally dispersed, and focused on operative feasibility, technical refinement, and perioperative outcomes. These broad patterns were consistent across the three databases, although the comparisons do not constitute independent external validation. Disease-stratified multicenter studies with standardized long-term assessment of splenic function are needed.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1941549"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192537","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":"Local infiltration anesthesia (anterior field block) vs. general anesthesia for thyroidectomy: effects on operative time, complications, and cost-a GRADE-assessed systematic review and meta-analysis with subgroup analysis.","authors":"Khadeeja Ali Hamzah, Hassan H Eladl, Shehab Elfiqi, Ahmed Abdelkader Saad Elsehsah, Amr E Zeweta, Ahmed Nabil Ali, Mohamed Wagdy, Yousif Hameed Kurmasha, Yasmeen Jamal Alabdallat","doi":"10.3389/fsurg.2026.1697921","DOIUrl":"https://doi.org/10.3389/fsurg.2026.1697921","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Thyroidectomy involves the removal of part or all of the thyroid gland, commonly performed for goiters, hyperthyroidism, or carcinomas, with 450,000-500,000 procedures performed annually in the United States. General anesthesia is traditionally used, providing optimal surgical conditions but associated with risks such as cardiovascular complications and longer hospital stays. Local anesthesia is gaining interest for high-risk patients, offering potentially similar outcomes to general anesthesia, while reducing postoperative complications and costs. The choice of anesthetic technique impacts patient safety, healthcare costs, and overall experience, yet no meta-analysis has previously compared local and general anesthesia for thyroidectomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;This systematic review and meta-analysis aimed to compare surgical and perioperative outcomes of general anesthesia vs. local anesthesia in thyroidectomy, focusing on operative time, complications, cost, and postoperative recovery, to inform clinical practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search of PubMed/MEDLINE, Embase, Web of Science, and Scopus was performed from database inception to August 2025. We included randomized controlled trials, cohort studies, and case-control studies comparing local infiltration anesthesia with general anesthesia in patients with thyroidectomy. Key outcomes included operative time, intraoperative and postoperative complications, hospital stay length, pain scores, patient satisfaction, and cost. Data were extracted independently by two authors. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool for randomized trials and the Risk of Bias In Non-Randomized Studies of Interventions tool for non-randomized studies. Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation framework. Statistical analysis was performed using Review Manager (RevMan), calculating mean differences and risk ratios under a random-effects model, with heterogeneity assessed using the &lt;i&gt;I&lt;/i&gt; &lt;sup&gt;2&lt;/sup&gt; statistic. Statistical significance was set at &lt;i&gt;p&lt;/i&gt; &lt; 0.05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The systematic search identified 1,785 studies, of which 252 duplicates were removed. After screening, 1,508 studies were excluded, leading to a full-text review of 25 studies and ultimate inclusion of 5 studies comprising 508 patients undergoing thyroid surgery with either local or general anesthesia. Local anesthesia was associated with a shorter operative time than general anesthesia (mean difference -18.32 min, 95% CI: -27.31 to -9.15), but heterogeneity was high (&lt;i&gt;I&lt;/i&gt; &lt;sup&gt;2&lt;/sup&gt; = 95%), and the effect was significant only in cohort studies and not in randomized trials, and therefore, this finding should be interpreted with caution. No si","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1697921"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192513","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: Distal tibial physeal injury secondary to conservative treatment of acute hematogenous osteomyelitis resulting in ankle deformity - highlighting the necessity of regular follow-up.","authors":"Tuo Cheng, Jie Li","doi":"10.3389/fsurg.2026.1827366","DOIUrl":"https://doi.org/10.3389/fsurg.2026.1827366","url":null,"abstract":"<p><p>Ankle deformities most commonly result from physeal injuries following major trauma; those secondary to occult physeal injury without significant antecedent trauma are rarely documented. We report a case of ankle deformity in a 13-year-old boy resulting from distal tibial physeal injury following conservative treatment for acute hematogenous osteomyelitis(AHO) four years earlier; despite initial clinical improvement, the patient was subsequently lost to follow-up. At his return visit, significant ankle discomfort severely compromised daily activities. Following combined distal tibial osteotomy and distal fibular epiphysiodesis, the patient regained normal quality of life. This case highlights a frequently overlooked aspect of AHO in children: despite initial symptom resolution with conservative treatment, regular follow-up is essential to detect occult physeal injury and prevent irreversible deformity. Early diagnosis facilitates timely intervention and may obviate the need for osteotomy. In managing ankle deformity secondary to AHO, combined distal tibial osteotomy and epiphysiodesis effectively corrects the deformity while preserving subsequent growth balance, representing a reliable therapeutic option.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1827366"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192518","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":"Recommendations for microbiological sampling in infected hard-to-heal wounds: an Italian association for cutaneous ulcers (AIUC) perspective.","authors":"Sara Carella, Barbara De Angelis, Barbara Nardi, Francesco Branda, Diego Ceci, Caterina Borghetti, Alessandra Mercuri, Marino Cordellini, Cosimo Maglio, Monica Gonnelli, Riccardo Garcea, Giancarlo Ceccarelli","doi":"10.3389/fsurg.2026.1908843","DOIUrl":"10.3389/fsurg.2026.1908843","url":null,"abstract":"<p><p>Chronic and hard-to-heal wounds represent a significant and growing healthcare burden, frequently complicated by infection and impaired healing. Despite the availability of international guidelines, microbiological assessment in clinical practice remains highly heterogeneous, with substantial variability in sampling techniques, timing, and interpretation of results. This variability occurs within a broader One Health context, where antimicrobial resistance and microbial ecology are shaped by interconnected human, environmental, and healthcare factors. The present recommendations, developed by the Italian Association for Cutaneous Ulcers (AIUC), aim to provide a structured and operational framework for microbiological sampling in infected hard-to-heal wounds. A multidisciplinary expert panel conducted a structured review of the literature and developed consensus-based recommendations through iterative discussion. The resulting framework addresses key aspects of the diagnostic pathway, including indications for sampling, selection of techniques (swab, tissue biopsy, and fine needle aspiration), standard operating procedures, and principles for the interpretation of microbiological findings. The recommendations emphasise a context-driven approach to sampling, recognising the complementary roles of different techniques according to clinical presentation and depth of infection. Particular attention is given to the distinction between colonisation and infection, the limitations of quantitative thresholds, and the impact of biofilm, polymicrobial interactions, and host-related factors on diagnostic accuracy and antimicrobial response. The document also highlights the importance of integrating microbiological data with clinical assessment to support appropriate antimicrobial stewardship. By translating existing evidence into practical and reproducible procedures, these recommendations aim to reduce variability in clinical practice and improve the quality of microbiological diagnostics in wound care. Within a One Health perspective, standardised and reliable microbiological data may also support surveillance of antimicrobial resistance and inform more integrated infection control strategies. The proposed framework supports more consistent clinical decision-making and may contribute to optimising antimicrobial use and patient outcomes across diverse healthcare settings.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1908843"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181853","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":"A \"stepped\" flexible vacuum-assisted ureteral access sheath improves stone clearance efficiency: experimental results from an <i>ex vivo</i> porcine model.","authors":"Daibing Lv, Ming Jin, Xi Meng, Weizhong Zhang, Shanfang Yuan, Yang Ding, Weixi Wang, Jianghua Yang, Xiaoxing Liao","doi":"10.3389/fsurg.2026.1959554","DOIUrl":"https://doi.org/10.3389/fsurg.2026.1959554","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of a novel \"stepped\" flexible vacuum-assisted ureteral access sheath (SFV-UAS) on stone clearance efficiency during flexible ureteroscopy lithotripsy (f-URL).</p><p><strong>Methods: </strong>Human upper urinary tract stone fragments (< 4 mm) were placed into <i>ex vivo</i> porcine renal pelves. We simulated f-URL stone extraction under continuous irrigation and vacuum suction, comparing the SFV-UAS (ureteral segment 12/14 Fr, cystourethral segment 16/18 Fr) with a conventional flexible vacuum-assisted ureteral access sheath (FV-UAS)(12/14 Fr). With intrarenal pressure strictly controlled (< 30 mmHg) and constant vacuum suction (01 step), irrigation flow rates were evaluated at 40 mL/min, 50 mL/min, 60 mL/min, 70 mL/min, 80 mL/min, and 90 mL/min. Stone evacuation times were recorded.</p><p><strong>Results: </strong>(1) Sheath type and irrigation flow rate exhibited significant main effects on clearance time [F(1,408) = 189.231, <i>P</i> < 0.01, effect size 31.7%; and F(5,408) = 38.721, <i>P</i> < 0.01, effect size 32.2%, respectively]. A significant two-way interaction was also observed [F(5,408) = 8.372, <i>P</i> < 0.01, effect size 9.3%]. (2) Simple main effects revealed: First, across all corresponding irrigation rates, the SFV-UAS group achieved significantly shorter clearance times than the FV-UAS group (mean differences: MD = -21.598, -18.099, -8.172, -11.129, -9.762, -4.883; all <i>P</i> < 0.05). Second, within the SFV-UAS group, rates ≥ 70 mL/min resulted in significantly shorter clearance times vs. the 40 mL/min baseline (mean differences:MD = -9.393, -9.771, -9.084; all <i>P</i> < 0.05). Although comparisons between 60 mL/min and higher rates were non-significant, 70 mL/min was the lowest evaluated irrigation rate that demonstrated a statistically significant reduction in clearance time compared to the 40 mL/min baseline. Third, within the FV-UAS group, clearance times at ≥ 60 mL/min were significantly shorter than at 40 and 50 mL/min (mean differences:MD = -19.664, -12.370; all <i>P</i> < 0.001), with no significant differences among the ≥ 60 mL/min groups, indicating its plateau at ≥ 60 mL/min.</p><p><strong>Conclusion: </strong>Within the parameters of this <i>ex vivo</i> model,the SFV-UAS significantly reduces the measured stone clearance time during f-URL compared to the FV-UAS under identical irrigation conditions. For the SFV-UAS group, targeting an irrigation flow rate of ≥ 70 mL/min consistently optimizes stone extraction efficiency relative to baseline conditions.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1959554"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192520","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":"Delayed giant thoracic pseudomeningocele presenting as enlarging painless paraspinal swelling followed by postural dizziness: a case report.","authors":"Zhi-Jun Lu, Chao-Yang Guo, Fei-Xiang Lin","doi":"10.3389/fsurg.2026.1954854","DOIUrl":"https://doi.org/10.3389/fsurg.2026.1954854","url":null,"abstract":"<p><strong>Introduction: </strong>Pseudomeningocele (PMC) is an uncommon but recognized complication of spinal surgery. In this report, we present a rare case of delayed thoracic PMC presenting as a progressively enlarging, painless paraspinal swelling followed by postural dizziness, occurring 8 months after thoracic laminectomy performed for thoracic ossification of the ligamentum flavum (tOLF).</p><p><strong>Case presentation: </strong>A 46-year-old woman underwent T9-L1 laminectomy with posterior instrumentation and fusion for tOLF associated with incomplete paraplegia. During the initial surgery, no dural tear or CSF leakage was identified, including during the Valsalva manoeuvre. MRI at 3 months showed no evidence of PMC. At 8 months postoperatively, she developed a progressively enlarging, painless, fluctuant thoracic paraspinal mass followed by postural dizziness, without postural headache or signs of infection. Cranial MRI showed no evidence of spontaneous intracranial hypotension (SIH), and cardiac and carotid examinations revealed no cause for the dizziness. Revision surgery confirmed a PMC with a 2.0 mm × 2.0 mm dural defect, which was repaired using a dural patch with reinforced fascial closure. At 1-year follow-up, the PMC and postural dizziness had completely resolved, with no evidence of recurrence.</p><p><strong>Conclusion: </strong>We present an uncommon case of delayed thoracic PMC presenting with an enlarging, painless paraspinal swelling followed by postural dizziness, but without postural headache, 8 months after spinal decompression and fusion for tOLF. Follow-up MRI at 3 months after surgery had shown no evidence of PMC, and there was no antecedent trauma. Cranial MRI showed no imaging evidence of SIH. MRI plays a crucial role in establishing the diagnosis. Given the recognised association between tOLF and intraoperative dural tears, delayed PMC should be considered when a painless, progressively enlarging paraspinal swelling develops after surgery for tOLF, even in the absence of postural headache, worsening paraparesis, or imaging evidence of SIH.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1954854"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192585","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":"Editorial: The emerging role of biomarker mutations in early stage non-small cell lung cancer (NSCLC) management.","authors":"Riya Aggarwal, Adrian Valderrama, Shreya Guha, Ivana Vasic, Jeffrey B Velotta","doi":"10.3389/fsurg.2026.1978192","DOIUrl":"https://doi.org/10.3389/fsurg.2026.1978192","url":null,"abstract":"","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1978192"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192509","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":"Restrictive hypertonic saline resuscitation is associated with less intestinal injury after hemorrhagic shock in rats and with coordinated changes in MALAT1, miR-145-5p, and BNIP3 expression.","authors":"Hongfei Ma, Yang Zhang, Jie Yang, Tianshan Wu, Gongbing Zhu, Xinwen Yang","doi":"10.3389/fsurg.2026.1920366","DOIUrl":"https://doi.org/10.3389/fsurg.2026.1920366","url":null,"abstract":"<p><strong>Background: </strong>Intestinal ischemia-reperfusion contributes to barrier failure and secondary organ injury after hemorrhagic shock. It is not known whether restrictive hypertonic saline resuscitation alters the resulting intestinal injury or the accompanying non-coding RNA response.</p><p><strong>Methods: </strong>One hundred male Sprague-Dawley rats were allocated to normal control, hemorrhagic shock, conventional 0.9% saline resuscitation (CFR), restrictive 7.5% hypertonic saline resuscitation (RFR), or superior mesenteric artery ischemia-reperfusion control groups. Hemorrhagic shock was induced by controlled blood withdrawal to maintain mean arterial pressure (MAP) at 35-40 mmHg for 60 min. CFR targeted an MAP of approximately 80 mmHg, whereas RFR targeted an MAP of approximately 60 mmHg. Three-hour survival was recorded. Coagulation, serum IL-6 and TNF-α, qRT-PCR, Western blotting, H&E staining, and TUNEL were assessed in assay-specific subsets. Public GEO datasets were analyzed for exploratory transcriptomic context.</p><p><strong>Results: </strong>Three-hour survival was 75% in RFR and 60% in CFR (two-sided Fisher exact test, <i>P</i> = 0.501). In the coagulation cohort, prothrombin time (PT) and thrombin time (TT) were shorter in RFR than in CFR after Dunn-Holm adjustment; no differences were observed for activated partial thromboplastin time (APTT), international normalized ratio (INR), and prothrombin activity (PA). RFR had lower serum IL-6 and TNF-α, better-preserved ileal morphology, and lower TUNEL positivity in representative fields than CFR. MALAT1 was lower, while miR-145-5p and Bnip3/BNIP3 were higher in RFR. Exploratory analyses of public datasets confirmed that Malat1 and Bnip3 are expressed in the intestinal cell populations relevant to ischemia-reperfusion injury.</p><p><strong>Conclusion: </strong>Under the present experimental conditions, restrictive hypertonic saline resuscitation was associated with a less severe acute intestinal injury phenotype than conventional isotonic resuscitation. The coordinated changes in MALAT1, miR-145-5p, and BNIP3 do not establish a linear regulatory axis and require functional validation.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1920366"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192576","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":"Editorial: Regenerative liver surgery.","authors":"Ivan Romic, Gregor A Stavrou, Branko Bakula, Ante Bogut","doi":"10.3389/fsurg.2026.1993956","DOIUrl":"10.3389/fsurg.2026.1993956","url":null,"abstract":"","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1993956"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181640","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}