International journal of surgery最新文献

{"title":"The longitudinal relationship between interoceptive sensibility and self-management behavior in stroke patients: a cross-lagged panel network analysis.","authors":"Yunmei Guo, Zhonglan Tang, Xin Yan, Lianhong Wang","doi":"10.1097/JS9.0000000000004715","DOIUrl":"10.1097/JS9.0000000000004715","url":null,"abstract":"<p><strong>Background: </strong>Network modeling is considered an effective method for elucidating the complex relationships between emotional states and their symptoms. This study aimed to investigate the dynamic interaction between interoceptive sensibility and self-management behavior over time in patients with stroke, using longitudinal and cross-lagged network analyses.</p><p><strong>Methods: </strong>Data were obtained from three follow-up records of 417 patients with stroke at a tertiary hospital in XX City between July 2024 and June 2025. The Self-Management Behavior Scale and the Multidimensional Intrasensory Awareness Assessment Scale were used to evaluate patients' self-management behavior and interoceptive sensibility, respectively. Symptom-level interactions at each time point were analyzed using network analysis, and cross-lagged panel network analysis was used to investigate the temporal dynamics and bidirectional relationship between interoceptive sensibility and self-management behavior.</p><p><strong>Results: </strong>Network analysis revealed that the number of nonzero connections at time points T1, T2, and T3 was 62, 29, and 17, respectively. The core symptom \"attention regulation\" (IS4) was consistently and significantly stronger than the other symptoms. The key roles were determined using the cross-lagged symptom network analysis. In T1-T2, \"trust\" (IS8) was the most predictive variable. \"Trust\" (IS8) and \"body listening\" (IS7), \"social and interpersonal management\" (SEM7), and \"daily life management\" (SEM6) formed a negative feedback loop. In T2-T3, \"Trust\" (IS8) is the most predictive, positively associated with \"worrying\" (IS3), \"social and interpersonal management\" (SEM7), and \"noticing\" (IS1). It indirectly affects \"disease management\" (SEM1) via IS3. In T1-T3, \"social and interpersonal management\" (SEM7) was the most predictive, associated with \"diet management\" (SEM3), and indirectly affects \"self-regulation\" (IS6) and \"attention regulation\" (IS4) via SEM3.</p><p><strong>Conclusion: </strong>This study identified a dynamic bidirectional association between self-management behavior and interoceptive sensibility in patients with stroke, providing an important reference for the development of targeted interventions and public health strategies to improve self-management behavior in patients with stroke.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13105648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147283599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term efficacy of ursodeoxycholic acid for the prevention of gallstone formation after gastrectomy in patients with gastric cancer: a randomized clinical trial.","authors":"Dong Kee Jang, Moon-Won Yoo, Young Suk Park, Sun-Hwi Hwang, Young-Kyu Park, Oh Kyoung Kwon, Hoon Hur, Hong Man Yoon, Hyoung-Il Kim, Hye Seong Ahn, Han Hong Lee, Min-Gew Choi, Sang-Il Lee, Sang Hyub Lee, Do Joong Park","doi":"10.1097/JS9.0000000000004967","DOIUrl":"https://doi.org/10.1097/JS9.0000000000004967","url":null,"abstract":"<p><strong>Background: </strong>The optimal long-term strategy for preventing post-gastrectomy gallstone formation in gastric cancer (GC) remains unclear. This study evaluated the sustained efficacy of a 12-month course of ursodeoxycholic acid (UDCA) after gastrectomy for GC.</p><p><strong>Methods: </strong>We conducted a randomized, double-blind, placebo-controlled clinical trial at 13 institutions in the Republic of Korea. Patients who underwent total, distal, or proximal gastrectomy for GC were randomized 1:1:1 to receive either 300 mg UDCA, 600 mg UDCA, or placebo daily for 12 months. The primary outcome was the incidence of gallstone formation at least 5 years post-gastrectomy. Secondary outcomes were biliary pain, gallstone complications, and cholecystectomy.</p><p><strong>Results: </strong>A total of 431 participants (300 mg UDCA: n = 141; 600 mg UDCA: n = 150; placebo: n = 140) were analyzed. At 80 months post-gastrectomy, gallstone formation occurred in 10.00% of the 300 mg group, 12.83% of the 600 mg group, and 26.21% of the placebo group. UDCA significantly reduced the hazard of gallstone formation compared to placebo (hazard ratio: 0.33, 95% CI 0.18-0.63, P = 0.0014 for 300 mg; 0.43, 95% CI 0.25-0.75, P = 0.0064 for 600 mg). There were no significant differences among groups in the incidence of biliary pain, gallstone complications, or cholecystectomy.</p><p><strong>Conclusion: </strong>Twelve months of UDCA administration was associated with sustained reduction in gallstone formation for up to 80 months after gastrectomy in GC patients.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147283514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Device-measured physical activity and long-term outcomes in IBD: promise, plausibility, and clinical translation.","authors":"Xiaohong Xu","doi":"10.1097/JS9.0000000000004971","DOIUrl":"https://doi.org/10.1097/JS9.0000000000004971","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147283401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive assessment of postoperative metachronous liver metastasis risk in colon cancer based on inflammatory indicators: a multicenter prospective study.","authors":"Boyu Kang, Yihuan Qiao, Shuai Liu, Yiqian Wang, Xuechun Bai, Yunlong Li, Ke Ni, Qi Wang, Jun Zhu, Jipeng Li","doi":"10.1097/JS9.0000000000004984","DOIUrl":"https://doi.org/10.1097/JS9.0000000000004984","url":null,"abstract":"<p><strong>Objective: </strong>Insidiousness is a hallmark of metachronous liver metastasis. Owing to the absence of a comprehensive machine-learning model integrating systemic inflammatory indicators for predicting metachronous liver metastasis after colon cancer surgery, and to the lack of prospective validation and interpretability, this study aimed to develop and validate a machine-learning model for predicting postoperative metachronous liver metastasis in patients with colon cancer.</p><p><strong>Methods: </strong>The variable pool of risk factors was determined through meta-analysis combined with three distinct screening approaches. The model was developed retrospectively and validated prospectively. The retrospective cohort comprised patients who underwent radical colectomy for colon cancer at X Hospital, S Hospital, and the P Hospital between 1 January 2012 and 1 January 2023. The prospective cohort included patients at X Hospital between 1 March 2023 and 1 August 2024. In the retrospective cohort, patients were randomly allocated to a training set and an internal validation set in a 7:3 ratio. Feature selection was performed using Lasso regression, multivariable logistic regression, and the Boruta random forest algorithm. The performance of ten machine-learning models was assessed using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and F1 score. AUC, calibration curves, and decision curve analysis were employed to elucidate clinical utility. Model interpretability was achieved through SHapley Additive exPlanations. This study strictly adhered to the TRIPOD + AI statement.</p><p><strong>Results: </strong>In retrospective cohort of 3938 patients, 11.2 % developed metachronous liver metastasis within 1 year; in prospective cohort of 724 patients, the corresponding proportion was 7.5 %. Following three feature-selection procedures and two multicollinearity assessments, 18 basic clinical variables and nine immune-inflammatory indices were selected for model development. Gradient boosting machine (GBM) demonstrated the highest overall performance, with an AUC of 0.964 (95 % CI: 0.944-0.983); compared with other models, decision-curve analysis revealed superior clinical utility. In the prospective cohort, the model maintained robust performance, achieving an AUC of 0.939.</p><p><strong>Conclusion: </strong>The GBM model demonstrated strong predictive performance and favorable clinical utility for identifying colon-cancer patients undergoing curative resection who are at risk of developing metachronous liver metastasis within 1 year. Multicenter model development followed by prospective validation underscored the clinical value of an integrated immunological signature. Early identification of high-risk patients permits intensified surveillance, timely intervention, and more efficient allocation of finite health care resources.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147283031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transoral robotic surgery in head and neck cancer: an umbrella review of meta-analyses.","authors":"Chuan-Lu Shen, Zi-Yue Fu, Yan-Qiang Zhang, Shu Wang, Si-Yue Yin, Yun-Xia Ma, Yi-Wei Liu, Liang Zhang, Shan-Wen Chen, Yan-Xun Han, Yu-Chen Liu, Kai-Le Wu","doi":"10.1097/JS9.0000000000004717","DOIUrl":"10.1097/JS9.0000000000004717","url":null,"abstract":"<p><strong>Background: </strong>The aim of this umbrella review is to investigate the advantages of primary transoral robotic surgery (TORS) over other treatments such as open surgery (OS), transoral laser microsurgery (TLM) and primary radiotherapy in the diagnosis management of head and neck cancer (HNC).</p><p><strong>Materials and methods: </strong>A comprehensive search for meta-analyses of comparisons between TORS of HNC and other treatments such as OS, TLM and primary radiotherapy was conducted in the PubMed, Embase, and Cochrane library databases. The primary outcomes assessed include oncological outcomes, surgical outcomes, function outcomes and complicates. The AMSTAR-2 tool was used to assess the quality, which consists of 16 entries, with final quality outcomes categorized as \"critically low quality,\" \"low quality,\" \"moderate quality,\" and \"high quality.\"</p><p><strong>Results: </strong>Of the 1424 articles retrieved, 14 studies were eventually included for the comprehensive umbrella meta-analysis. TORS was superior to OS in terms of survival rate, length of hospital stay, cosmetic outcome, quality of life, surgical efficacy, and recognition of HNC with unknown primary lesion, but no significant difference was seen between them and TLM or radiation therapy.</p><p><strong>Conclusion: </strong>There are few studies on head and neck tumors other than oropharyngeal cancer, and there is a lack of studies on specific tumor stages or HPV status of the population, which does not allow for the provision of personalized treatment recommendations based on the patient's own situation, and there is a need to carry out more randomized controlled trials on the specific type and status of the patient in future.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13105643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147283535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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 of tumor-associated macrophages in colorectal cancer: a bibliometric analysis.","authors":"Yuxin Long, Xiangxu Wang, Xiaoting Chao, Yue Yang, Shou Jin, Hongmei Zhang","doi":"10.1097/JS9.0000000000004422","DOIUrl":"10.1097/JS9.0000000000004422","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer (CRC) represents the third most prevalent malignancy worldwide and accounts for the second-highest cancer-related mortality rate. Accumulating evidence over the past decade has established the pivotal role of tumor-associated macrophages (TAMs) in CRC tumorigenesis and disease progression. This study employs bibliometric analysis to delineate the research landscape and emerging frontiers in CRC TAMs investigation.</p><p><strong>Methods: </strong>We systematically retrieved publications indexed in the Web of Science Core Collection from database inception through 14 April 2025, applying predefined inclusion and exclusion criteria. Using VOSviewer and CiteSpace, we conducted comprehensive visual analyses of the CRC TAMs research domain, including country contributions, institutional productivity, annual publication trends, and journal distributions.</p><p><strong>Results: </strong>Our bibliometric analysis identified 2861 publications on CRC TAMs worldwide, with a consistent upward publication trend since 2018. Geospatial analysis revealed that China and the United States are the predominant contributing nations, with Sun Yat-sen University being the most productive institution. Keyword co-occurrence mapping identified five predominant research clusters: CRC biology, TAMs characterization, patient survival outcomes, disease progression mechanisms, and metastatic processes. Four key research directions emerged: (1) single-cell RNA sequencing for TAMs heterogeneity analysis, (2) PD-1/PD-L1 checkpoint interactions with TAMs, (3) molecular mechanisms underlying macrophage polarization, and (4) chemotherapeutic modulation of TAMs functionality (particularly irinotecan). These advances provide mechanistic insights into CRC TAMs biology and may facilitate (1) the discovery of novel diagnostic biomarkers, (2) precision therapeutic strategies, and (3) personalized prognostic frameworks.</p><p><strong>Conclusion: </strong>Bibliometric analysis has highlighted the global landscape of research on CRC TAMs. Future research directions in CRC TAMs are likely to center on the integration of multi-omics, in-depth investigation of the tumor microenvironment, targeting TAMs, application of machine learning and artificial intelligence, and the development of personalized treatment strategies for CRC.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13105662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147283566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SPP1+ neutrophil and exhausted CD8⁺ T cells infiltration predicting the early recurrence of hepatocellular carcinoma patients after R0 resection.","authors":"Kai Luo, Tao Song, Xin Zheng, Cheng Guo, Shaoshan Han","doi":"10.1097/JS9.0000000000004998","DOIUrl":"https://doi.org/10.1097/JS9.0000000000004998","url":null,"abstract":"<p><strong>Background: </strong>Early recurrence of liver cancer is significantly associated with poor prognosis. Further dissection of the cellular heterogeneity in the tumor microenvironment (TME) of patients at high risk of early recurrence after liver cancer surgery is highly necessary.</p><p><strong>Methods: </strong>This study integrated clinical data, single-cell RNA sequencing (scRNA-seq), spatial transcriptomics, and bulk RNA-seq data to reveal and verify a TME characteristic associated with high risk of early recurrence after liver cancer surgery.</p><p><strong>Results: </strong>Clinical analysis of 402 patients identified neutrophil-to-lymphocyte ratio ≥3, alpha-fetoprotein ≥400 ng/mL, and microvascular invasion as independent predictors of early recurrence. scRNA-seq of 28 hepatocellular carcinoma (HCC) samples revealed nine neutrophil subtypes, with SPP1⁺ neutrophils (enriched in TNFα/NF-κB, hypoxia, and TGF-β pathways) and exhausted CD8⁺ T cells (expressing PD-1 and CTLA-4) significantly infiltrating the TME of patients with early recurrence. These findings were corroborated in an independent validation cohort comprising scRNA-seq data from 17 HCC tissues and 7 matched peripheral blood samples. Spatial analysis demonstrated their co-localization at tumor margins, forming an immunosuppressive barrier. Ligand-receptor interaction analysis highlighted SPP1-CD44, TGFB1-TGFBR, and TNF-TNFRSF axes as key mediators of neutrophil-T cell crosstalk, inducing T cell dysfunction. Validation in The Cancer Genome Atlas-Liver Hepatocellular Carcinoma cohort comprising 365 patients confirmed that high infiltration of SPP1⁺ neutrophils and exhausted CD8⁺ T cells was significantly correlated with shorter recurrence-free (P < 0.0001) and overall survival (P < 0.0001).</p><p><strong>Conclusions: </strong>This study shows that the infiltration of SPP1⁺ neutrophils and exhausted CD8⁺ T cells is associated with a high risk of early recurrence in HCC. SPP1⁺ neutrophils may serve as key mediator of immune suppression through spatial interactions with exhausted CD8⁺ T cells, suggesting that they could be potential therapeutic targets to mitigate early recurrence in HCC.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147283563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of bariatric surgery and pharmacological treatments on cardiovascular risk factors for adults with overweight and obesity: a systematic review and network meta-analysis.","authors":"You Yang, Xiaohong Cheng, Siming Chen, Jiatong Xie, Gowen Chen, Lifa Li, Yue Feng, Yi Chen, Guanqun Liu, Yuan Yin, Tong Zhou, Rui Zhao","doi":"10.1097/JS9.0000000000004566","DOIUrl":"10.1097/JS9.0000000000004566","url":null,"abstract":"<p><strong>Background: </strong>To comprehensively evaluate the relative efficacy and safety of lifestyle interventions, pharmacological therapies (orlistat, liraglutide, and semaglutide), and bariatric surgeries [Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and biliopancreatic diversion (BPD)] on body weight and cardiovascular risk factors in adults with overweight and obesity. We conducted a systematic review and network meta-analysis of randomized controlled trials (RCTs).</p><p><strong>Materials and methods: </strong>Comprehensive searches were performed in PubMed, MEDLINE, Embase, and the Cochrane Library through 1 February 2025. The analysis focused on interventions in adults with overweight or obesity, assessing outcomes including changes in body mass index (BMI), glycated hemoglobin (HbA1c), lipids, blood pressure, and adverse events.</p><p><strong>Results: </strong>This network meta-analysis included 26 RCTs. Bariatric surgery was the most effective modality for improving body weight and the majority of cardiovascular risk factors. Among surgeries, BPD demonstrated the greatest reductions in weight, BMI, and low-density lipoprotein cholesterol, but was also associated with the highest risk of serious adverse events (SAEs). RYGB and SG produced comparable weight loss, though RYGB showed unique advantages in improving high-density lipoprotein cholesterol and metabolic outcomes. Among pharmacological agents, semaglutide was the most efficacious, achieving weight loss, BMI reduction, and blood pressure control comparable to RYGB and SG. While liraglutide showed strong effects on glycemic control, semaglutide consistently outperformed both liraglutide and orlistat across most other outcomes and had a lower risk of discontinuation than liraglutide. Importantly, pharmacological agents, particularly semaglutide, had a significantly lower risk of SAEs than surgery.</p><p><strong>Conclusion: </strong>Bariatric surgery provides the most potent efficacy for weight loss and cardiometabolic improvement, with BPD being the most effective but also highest-risk procedure. Semaglutide emerges as a formidable therapeutic alternative, offering a degree of efficacy comparable to RYGB and SG in many key domains but with a superior safety profile. These findings underscore the need to shift from a \"one-size-fits-all\" approach to an evidence-based, individualized strategy that aligns each intervention's distinct efficacy and safety profile with specific patient goals and risk tolerance.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13105548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147283544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronal imbalance and intervertebral disc degeneration in degenerative scoliosis: an analysis using Hounsfield units measurement.","authors":"Ze-Yu Lu, Qing-Yin Xu, Peng-Bo Chen, Muradil Mardan, Bo Li, Sheng-Dan Jiang, Lei-Sheng Jiang, Xin-Feng Zheng","doi":"10.1097/JS9.0000000000004999","DOIUrl":"https://doi.org/10.1097/JS9.0000000000004999","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the relationship between coronal imbalance and the extent of intervertebral disc degeneration (IVDD) in cases of degenerative scoliosis.</p><p><strong>Methods: </strong>A comprehensive analysis was conducted on 102 patients diagnosed with degenerative scoliosis through a retrospective examination of relevant medical records. The patients were divided into two groups based on whether the scoliosis apex was located at the disc or vertebral body. The scoliosis was classified into three types (Types A, B, and C) according to the Nanjing classification. Coronal and sagittal parameters were measured on the standing radiographs of the whole spine. Hounsfield units (HU) values of the apical disc and the adjacent intervertebral discs (IVDs) of the apical body were obtained from computed tomography scans. The degeneration of the corresponding discs was also graded using the Pfirrmann classification on magnetic resonance imaging.</p><p><strong>Results: </strong>In the patients with the scoliosis apex at the disc or vertebral body level, the HU values of the IVDs were significantly lower in Type B and Type C patients compared to Type A patients. Additionally, the HU values of IVDs showed a negative correlation with coronal balance distance (CBD) and Pfirrmann grades, while CBD showed a positive correlation with Pfirrmann grades.</p><p><strong>Conclusions: </strong>Degenerative scoliosis patients with coronal imbalance exhibit more severe IVDD, which was evaluated using HU values of the IVDs. This suggests that IVDD is closely associated with the presence of coronal imbalance.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147283340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ischemia-free liver transplantation protects coagulation function via the HNF4α-coagulation factor axis: a post hoc analysis from the IFLT-DBD randomized controlled trial.","authors":"Yuqi Dong, Xiaoxiang Chen, Wei Xiong, Tao Zhang, Yuekun Shen, Bing Yang, Maogen Chen, Qiang Zhao, Weiqiang Ju, Anbin Hu, Dongping Wang, Lu Yang, Zhiyong Guo, Xiaoshun He","doi":"10.1097/JS9.0000000000004987","DOIUrl":"https://doi.org/10.1097/JS9.0000000000004987","url":null,"abstract":"<p><strong>Background: </strong>The liver is essential for coagulation-anticoagulation balance. Ischemia-free liver transplantation (IFLT) has been proven to prevent ischemia-reperfusion injury (IRI) and improve postoperative recovery. In this study, we explored protective effects of IFLT on the coagulation system.</p><p><strong>Materials and methods: </strong>Sixty-five liver transplant patients were enrolled in this post hoc analysis of the IFLT-DBD (ischemia-free transplantation of livers from donors after brain death) trial. Data of blood loss, blood product transfusion, intraoperative conventional coagulation tests, and rapid thromboelastography were evaluated. Transcriptome analysis was performed, and liver tissue specimens were collected for experimental validation.</p><p><strong>Results: </strong>Total blood loss was significantly lower in the IFLT group than in the conventional liver transplantation (CLT) group [1765.0 (565.0-2965.0) vs 2600.0 (595.0-4605.0) mL, P<0.001]. The IFLT group had fewer red blood cells (RBC), fresh frozen plasma (FFP), and platelet (PLT) transfusions than the CLT group [RBC: 4 (2-6) vs 7.25 (2.25-8) units, P = 0.026; FFP: 600 (0-600) vs 600 (400-987.5) ml, P = 0.031; PLT: 6(18.8%) vs 13(39.4%), P = 0.026]. Bulk transcriptome analysis showed that hepatocyte nuclear factor 4 alpha (HNF4α) expression was higher in the IFLT group. Real-time PCR revealed higher mRNA expression of HNF4α, factor II, and V in the IFLT group. Western blotting showed higher HNF4α protein expression in the IFLT group.</p><p><strong>Conclusion: </strong>Adopting IFLT significantly decreased intraoperative hemorrhage and blood product transfusion. IFLT facilitates the restoration of intraoperative coagulation homeostasis by preserving the HNF4α-mediated regulation of hepatic coagulation factor synthesis.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147283572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}