International journal of surgery最新文献

{"title":"Diagnostic performance of artificial intelligence-based imaging and liquid biopsy combined with clinical evaluation for distinguishing benign and malignant pulmonary nodules: a diagnostic network meta-analysis.","authors":"Yifan Zhao, Guixue Yang, Miao Yang, Xufeng Deng, Zhuoxin Dai, Peng Dai, Kai Wang, Shuangqing Liao, Li Jiang, Jigang Dai, Quanxing Liu","doi":"10.1097/JS9.0000000000005144","DOIUrl":"10.1097/JS9.0000000000005144","url":null,"abstract":"<p><strong>Background: </strong>The incidence of pulmonary nodules is rising. In the United States alone, approximately 1.57 million cases are detected annually via low-dose CT screening. This growing number has created an urgent need for accurately differentiating malignant lesions. The current standard methods rely on radiologist interpretation. However, these methods show variable accuracy, with a sensitivity range of 62%-79%. Invasive biopsies, which are often used for further diagnosis, carry complication risks ranging from 15% to 28%. Emerging technologies, such as artificial intelligence (AI) imaging analysis and liquid biopsy platforms, show promising capabilities in pulmonary nodule characterization. Nevertheless, there is a lack of a rigorous methodology for their comparative evaluation.</p><p><strong>Methods: </strong>We systematically evaluated 20 comparative studies that were published between 2015 and 2024. These studies assessed AI-based imaging methods, which included deep learning architectures and radiomics analysis, as well as liquid biopsy methods, such as ctDNA mutation profiling and methylation-based assays, for the characterization of pulmonary nodules. Bayesian hierarchical modeling was employed to account for the interdependencies among different tests. Evidence certainty was assessed via the GRADE framework.</p><p><strong>Results: </strong>The CT-Deep approach, when integrated with clinical information, demonstrated the highest sensitivity, with a value of 97.1% and a 90.8%-99.6% credible interval. However, it showed relatively lower specificity, with a value of 67.4% and a 74.4%-92.9% credible interval. Stand-alone liquid biopsy exhibited more balanced operating characteristics, with a sensitivity of 63.1% and a specificity of 82.8%. The hybrid clinical-liquid biopsy strategy showed optimal performance in the summary receiver operating characteristic analysis, with an area under the curve of 0.903. Substantial heterogeneity was observed across studies, with an I² > 50%. Additionally, there were wide confidence intervals for some diagnostic odds ratio estimates, which means that the comparative performance should be interpreted with caution.</p><p><strong>Conclusions: </strong>AI-enhanced imaging techniques are particularly valuable for high-sensitivity screening applications, where the risk of false negatives is the greatest. On the other hand, liquid biopsy approaches or their combination with clinical assessment may be more suitable for situations that require high specificity. The findings highlight the need for standardized validation protocols and prospective evaluation of combined modality strategies to address the current limitations in pulmonary nodule characterization.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 7","pages":"13217-13227"},"PeriodicalIF":9.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874292","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":"The challenges of laparoscopic hepatectomy for bilateral hepatolithiasis.","authors":"Ke-Xi Liao, Rui Guo, Shu-Guo Zheng","doi":"10.1097/JS9.0000000000005032","DOIUrl":"10.1097/JS9.0000000000005032","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 7","pages":"13255-13256"},"PeriodicalIF":9.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874382","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":"Debate on momentum transfer in shock wave therapy and neurostimulation - reply to Mohana Sundaram et al.: correspondence.","authors":"Othmar Wess, Juergen Mayer","doi":"10.1097/JS9.0000000000004340","DOIUrl":"10.1097/JS9.0000000000004340","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 6","pages":"12940-12943"},"PeriodicalIF":9.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874026","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":"Letter to the Editor: \"Quality of life and functional outcomes after rectal sparing approaches following neoadjuvant therapy for rectal cancer: a prospective cohort multicentre study\".","authors":"Mingwen Jia, Muwen Qu, Zhen Liu","doi":"10.1097/JS9.0000000000005049","DOIUrl":"10.1097/JS9.0000000000005049","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 6","pages":"12949-12950"},"PeriodicalIF":9.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874121","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":"Therapeutic effects of Icariside II on radiation cystitis: revealing the mechanistic role of the FN1/Itgαvβ6-PI3K/AKT signaling pathway using single-cell RNA sequencing","authors":"Juntao Sun, Wanqi Wang, Hongwei Li, Yinglu Yan, Xiaoying Pan, Yang Liu, Chenli Pan, Shuangyan He, Zhuo Wang, Yueyue Zang, Yinhui Mao, Mingxing Wang, Yong Yang, ZhitaoWei","doi":"10.1097/js9.0000000000005212","DOIUrl":"https://doi.org/10.1097/js9.0000000000005212","url":null,"abstract":"Objectives: Radiation cystitis (RC) is a common complication of pelvic radiotherapy and is characterized by persistent bladder inflammation that can ultimately progress to fibrosis. However, the specific cell types involved in RC and targeted molecular therapies remain poorly understood, hindering the development of effective treatment strategies. This study focused on the molecular complexity of RC, aiming to elucidate the effects of radiation on bladder cells via single-cell RNA sequencing (scRNA-seq) and to investigate the protective role and underlying mechanisms of Icariside II (ICA II) in RC treatment. Materials and methods: A rat model of RC was established, and single-cell RNA sequencing (scRNA-seq) was performed to analyze the molecular impact of radiation on different bladder cell types. Intercellular communication analysis was conducted to identify key signaling pathways involved in RC progression. The findings from scRNA-seq were validated through in vitro experiments. Additionally, coimmunoprecipitation and molecular dynamics (MD) simulations were used to assess the effect of ICA II on the binding affinity between fibronectin 1 (FN1) and Integrin alpha v beta 6 (Itgαvβ6). Results: ScRNA-seq analysis revealed 16 distinct cell types within the bladder, including epithelial cells, fibroblasts, smooth muscle cells, endothelial cells, and immune cells, revealing substantial cellular heterogeneity in RC. Intercellular communication analysis revealed that FN1 expression was markedly upregulated following radiation exposure. FN1 binds to its receptor Itgαvβ6, activating the PI3K/AKT signaling pathway and promoting fibrosis. MD simulations and in vitro assays further confirmed that ICA II effectively disrupted the FN1-Itgαvβ6 interaction, inhibited the activation of the PI3K/AKT pathway, and downregulated markers associated with fibrosis and epithelial‒mesenchymal transition (EMT). Conclusions: This study identified the FN1-Itgαvβ6 interaction as a critical driver of fibrosis in RC. These findings suggest that ICA II may serve as a promising therapeutic agent for RC by targeting the FN1/Itgαvβ6-PI3K/AKT signaling axis to mitigate fibrosis progression.","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147879119","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":"Variable sensitivity despite high detection rates: is sentinel node navigation surgery feasible following non-curative gastric ESD?","authors":"Zimeng Wang, Zhi Zheng, Jun Zhang","doi":"10.1097/JS9.0000000000005139","DOIUrl":"10.1097/JS9.0000000000005139","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 7","pages":"13314-13317"},"PeriodicalIF":9.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874460","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":"An interpretable whole-stream video based deep learning framework for surgical skill assessment of basic procedural elements.","authors":"Ke Chen, Ying Weng, Yiming Zhang, Boding Wang, Zhenzhu Li, Kai Tang","doi":"10.1097/JS9.0000000000005082","DOIUrl":"10.1097/JS9.0000000000005082","url":null,"abstract":"<p><strong>Background: </strong>Conventional surgical skill assessment, conducted by expert surgeons in operating rooms, is often time-consuming and subjective. An automated and objective system capable of differentiating surgeon expertise levels (novice, intermediate, and expert) and providing feedback would significantly enhance surgical training. However, most existing automated frameworks prioritize deep learning performance over interpretability.</p><p><strong>Materials and methods: </strong>We propose I3D-SAP, an interpretable video-based surgical skill assessment framework of basic procedural elements using a 3D convolutional neural network. The model processes surgical videos and classifies surgeons into three expertise levels. Experiments are conducted on the public JIGSAWS dataset, evaluating performance across suturing, needle passing, and knot tying tasks.</p><p><strong>Results: </strong>Our method has achieved high accuracy: 100% (suturing), 96.3% (needle passing), and 97.2% (knot tying), comparable to the state-of-the-art models. Our framework's interpretability is demonstrated through Class Activation Map (CAM) visualization and snippet-wise analysis, offering dual perspectives to explain classification decisions. However, evaluation under a more rigorous Leave-One-User-Out (LOUO) protocol revealed a significant performance drop, and testing on an external dataset (ROSMA) resulted in near-chance-level accuracy, indicating that the current model's ability to generalize to entirely unseen surgeons is limited.</p><p><strong>Conclusion: </strong>I3D-SAP provides both high accuracy and interpretability, addressing a critical gap in automated surgical assessment of basic procedural elements. By visualizing the model decisions, it enhances transparency and trust, paving the way for practical adoption in surgical training. Moreover, the model's current generalizability challenges should be addressed through future work involving larger, more diverse datasets and techniques for surgeon-invariant feature learning before practical clinical deployment can be considered.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 6","pages":"12565-12578"},"PeriodicalIF":9.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873759","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":"A multicenter parallel-group double-blind randomized placebo-controlled phase III clinical trial of generic aprepitant QLG2174 for the prevention of postoperative nausea and vomiting.","authors":"Peng Li, Shiyong Li, Wenya Du, Yanjuan Huang, Benfa Zhang, Kai Wang, Zhendong Xu, Yuanhao Qin, Hao Wang, Xia Xu, Shaoxing Liu, Min Zhang, Tiantian Zou, Wei Gao, Foquan Luo, Zhonghua Chen, Furong Huang, Chun Ma, Chunling Wang, Shu'An Jin, Chun Chen, Jun Jing, Ling Zhao, Junqing Li, Huiyu Luo, Changming Yang, Chan Wang, Yanzhuo Zhang, Xiaoling Hu, Yalan Li, Xiaoyi Ning, Yang Yan, Yunfei Ju, Juan Wang, Mengchang Yang, Yuelan Wang, Ailin Luo","doi":"10.1097/JS9.0000000000005149","DOIUrl":"10.1097/JS9.0000000000005149","url":null,"abstract":"<p><strong>Background: </strong>Postoperative nausea and vomiting (PONV), a common gastrointestinal disorder following surgery, primarily occurs within 6-24 hours postoperatively, with an incidence rate of approximately 30% in general surgical patients. QLG2174 (generic aprepitant) is a neurokinin-1 (NK-1) receptor antagonist exerting antiemetic effects by blocking the binding of substance P to NK-1 receptors. This study aimed to evaluate the efficacy and safety of QLG2174 for preventing PONV in Chinese patients.</p><p><strong>Materials and methods: </strong>This was a multi-center, parallel-group, double-blind, randomized, placebo-controlled, phase 3 clinical trial. Patients with ≥2 PONV risk factors and scheduled for elective laparoscopic gynecologic or abdominal surgery under general anesthesia were randomized 1:1 to receive either QLG2174 32 mg or placebo via intravenous injection within 30 seconds before anesthesia induction. The primary efficacy endpoint was the proportion of patients achieving complete response (CR, defined as no vomiting and no rescue therapy use) within 24 hours postoperatively.</p><p><strong>Results: </strong>A total of 515 patients were enrolled. The CR rate within 24 hours postoperatively was significantly higher in the QLG2174 group compared with that in the placebo group [70.7% (181/256) versus 44.0% (114/259); adjusted rate difference 26.6% (95% confidence interval, 18.4-34.7), <i>P</i> < 0.0001]. The incidence of treatment-emergent adverse events (TEAEs) were similar between the QLG2174 group (80.5%) and the placebo group (76.8%). The incidences of grade ≥3 TEAEs and serious TEAEs were similar between the two groups.</p><p><strong>Conclusion: </strong>QLG2174 significantly increased CR rate compared with placebo and demonstrated promising efficacy in preventing PONV in patients scheduled for elective laparoscopic surgery under general anesthesia.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 7","pages":"13132-13140"},"PeriodicalIF":9.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874165","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":"Computer-Assisted Detection (CADe) of colonic polyps during colonoscopy reduces cancer-related healthcare costs - a single Singaporean institution cost effectiveness analysis.","authors":"Gabrielle E Koh, Jayden W Yap, Tan J Han, Fung-Joon Foo, Juinn Huar Kam, Baldwin Yeung Po Man, James W Li, Clarence Kwan, Frederick H Koh","doi":"10.1097/JS9.0000000000005080","DOIUrl":"10.1097/JS9.0000000000005080","url":null,"abstract":"<p><strong>Background and aims: </strong>Colonoscopy remains as an invaluable diagnostic and therapeutic tool used for the screening and evaluation of colonic pathologies. Periodic endoscopic screening allowing for early detection and removal of pre-malignant lesions, resulting in significant overall decreased incidence and mortality from colorectal cancer. Despite its added costs, artificial intelligence (AI) has been increasingly utilized in the field of endoscopy, boasting benefits of improving adenoma detection rates while reducing endoscopists' mental fatigue intra-procedurally. As such, further evaluation of the financial impact of such AI-usage in screening colonoscopies was performed to assess if routine use of AI-guidance in screening colonoscopies was justifiable.</p><p><strong>Methods: </strong>This study conducted a cost effectiveness analysis of the GI Genius™ CADx Intelligent Endoscopy Module (US-DG-2000309, 2021 Medtronic) system in our local Singaporean tertiary public healthcare institution. A decision tree model was used to calculate Incremental Cost Effectiveness Ratio (ICER), comparing cancer-related costs for patients who underwent conventional colonoscopy versus colonoscopy with AI guidance.</p><p><strong>Results: </strong>With a calculated ICER value of 0.72, our study suggests that AI-assisted colonoscopy was indeed cost effective. Quality-Adjusted Life Years (QALY) values derived for each subgroup of patients further demonstrated overall improved quality of life reported by patients who underwent AI-assisted colonoscopy, as compared to conventional colonoscopy.</p><p><strong>Conclusion: </strong>Our study supports the incorporation of AI guidance into routine colonoscopic evaluation in view of increased cost effectiveness and improved overall quality of life achieved. However, further studies and analysis must be undertaken before reliably determining the cost-effectiveness of AI on regional or international scales.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 6","pages":"12742-12748"},"PeriodicalIF":9.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874028","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":"Comment on the clinical trial landscape of artificial intelligence applications in gastrointestinal endoscopy.","authors":"Xin Chen, Yuren Zhang, Wanli Deng","doi":"10.1097/JS9.0000000000005098","DOIUrl":"10.1097/JS9.0000000000005098","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 6","pages":"12981-12982"},"PeriodicalIF":9.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873954","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}