International journal of surgery最新文献

{"title":"Effect of parecoxib on postoperative delirium in patients with hyperlipidemia: a randomized, double-blind, single-center, superiority trial.","authors":"Zeng Daojun, Tang Yuling, Xu Yingzhe, Ana Kowark, Mark Coburn, Zhao Yue, Zhang Qixin, Zhang Daiying, Peng Tao, Duan Xiaoxia","doi":"10.1097/JS9.0000000000002286","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002286","url":null,"abstract":"<p><strong>Background: </strong>Hyperlipidemia has been implicated in the higher risk of developing postoperative delirium. Prostaglandin endoperoxide synthase-2 mediates neuroinflammatory processes in postoperative delirium. This study aims to investigate whether preoperative administration of parecoxib is more efficient than a placebo in averting postoperative delirium in patients with hyperlipidemia.</p><p><strong>Materials and methods: </strong>In this randomized, double-blind, superiority trial, participants with hyperlipidemia were randomized in a 1:1 ratio to receive parecoxib (40 mg parecoxib administered intravenously before anesthesia induction) or placebo (normal saline). The primary outcome was postoperative delirium incidence within three days, with a 5.4% difference set as the superiority threshold. Secondary outcomes were cumulative incidences of emergence delirium and prostaglandin endoperoxide synthase-2 levels, inflammatory cell counts, and pain score on postoperative day 1 and postoperative adverse events.</p><p><strong>Results: </strong>This trial conducted between August 2023 and August 2024 at a tertiary hospital in China included 452 adults with hyperlipidemia, with 226 in the parecoxib group and 226 in the placebo group. The incidence of postoperative delirium in the parecoxib group was 13.72%, a reduction of 12.39% compared to the placebo group (hazard ratio, 0.491; 95% confidence interval: 0.318 to 0.759; P < 0.001). The parecoxib group also had a lower incidence of emergence delirium, prostaglandin endoperoxide synthase-2 levels, white blood cell counts and neutrophil, and pain scores on postoperative day 1. The occurrence of adverse events was comparable between the two groups. Prostaglandin endoperoxide synthase-2 expression levels, white blood cell counts, and pain scores mediated the reduction of postoperative delirium incidence by parecoxib.</p><p><strong>Conclusion: </strong>Parecoxib may help in reducing the hyperlipidemia-related postoperative delirium incidence. The effective anti-inflammatory activity of prostaglandin endoperoxide synthase-2 inhibition by parecoxib and postoperative pain control may be important mechanisms for preventing postoperative delirium.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189067","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":"Iatrogenic nerve injury following pelvic ring injury: a network meta-analysis.","authors":"Yu-Cheng Su, Yung-Heng Hsu, Ying-Chao Chou, I-Jung Chen, Chih-Yang Lai, Yi-Hsun Yu","doi":"10.1097/JS9.0000000000002272","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002272","url":null,"abstract":"<p><strong>Background: </strong>Pelvic ring injuries are common in multi-trauma patients and can be life-threatening, necessitating prompt surgical intervention to improve outcomes. However, surgery can lead to complications such as iatrogenic nerve injury. This network meta-analysis aimed to improve outcomes in multi-trauma patients with pelvic ring injuries by evaluating the incidence of iatrogenic nerve injuries, identifying vulnerable nerves, and comparing different fixation methods.</p><p><strong>Materials and methods: </strong>A systematic search of MEDLINE, EMBASE, and Scopus from inception to 5 December 2023, revealed 29 comparative studies on the incidence of iatrogenic nerve injury in 1561 adult patients with pelvic ring injuries. Data were extracted on study and patient characteristics, iatrogenic nerve injury incidences, and specific nerve injuries. A random-effects model assessed treatment effects, with subgroup analysis and meta-regression. The main outcomes included odds ratios (ORs) and confidence intervals (CIs) for iatrogenic nerve injuries.</p><p><strong>Results: </strong>Compared with closed reduction internal fixation, robotic-assisted techniques had the highest, and open reduction internal fixation had the lowest ORs for iatrogenic nerve injuries. The robotic-assisted approach ranked best with an OR of 0.22 (95%CI: 0.02-2.16), while closed reduction internal fixation with the anterior approach (OR: 0.71; 95%CI: 0.21-2.48) and open reduction internal fixation with the anterior approach performed the worst. The lateral femoral cutaneous nerve was injured in all open reduction internal fixation with anterior approach procedures and in 66.7% of open reduction internal fixation with posterior approach procedures. Meta-regression showed a significantly lower OR for iatrogenic nerve injuries in patients aged >41.4 years in the open reduction internal fixation with anterior approach group (OR: 0.02; 95%CI: 0.001-0.63; p = 0.026) compared with younger patients.</p><p><strong>Conclusion: </strong>The robotic-assisted technique may result in the fewest iatrogenic nerve injuries during the treatment of pelvic ring injuries. The posterior approach may also reduce the risk of iatrogenic nerve injuries.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189146","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":"ChatGPT's role in alleviating anxiety in total knee arthroplasty consent process: a randomized controlled trial pilot study.","authors":"Wenyi Gan, Jianfeng Ouyang, Guorong She, Zhaowen Xue, Lingxuan Zhu, Anqi Lin, Weiming Mou, Aimin Jiang, Chang Qi, Quan Cheng, Peng Luo, Hua Li, Xiaofei Zheng","doi":"10.1097/JS9.0000000000002223","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002223","url":null,"abstract":"<p><strong>Background: </strong>Recent advancements in artificial intelligence (AI) like ChatGPT have expanded possibilities for patient education, yet its impact on perioperative anxiety in total knee arthroplasty (TKA) patients remains unexplored.</p><p><strong>Methods: </strong>In this single-blind, randomized controlled pilot study from April to July 2023, 60 patients were randomly allocated using sealed envelopes to either ChatGPT-assisted or traditional surgeon-led informed consent groups. In the ChatGPT group, physicians used ChatGPT 4.0 to provide standardized, comprehensive responses to patient queries during the consent process, while maintaining their role in interpreting and contextualizing the information. Outcomes were measured using Hospital Anxiety and Depression Scales (HADS), Perioperative Apprehension Scale-7 (PAS-7), Visual Analogue Scales for Anxiety and Pain (VAS-A, VAS-P), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and satisfaction questionnaires.</p><p><strong>Results: </strong>Of 55 patients completing the study, the ChatGPT group showed significantly lower anxiety scores after informed consent (HADS-A: 10.48 ± 3.84 vs 12.75 ± 4.12, P = .04, Power = .67; PAS-7: 12.44 ± 3.70 vs 14.64 ± 2.11, P = .01, Power = .85; VAS-A: 5.40 ± 1.89 vs 6.71 ± 2.27, P = .02, Power = .75) and on the fifth postoperative day (HADS-A: 8.33 ± 3.20 vs 10.71 ± 3.83, P = .01, Power = .79; VAS-A: 3.41 ± 1.58 vs 4.64 ± 1.70, P = .008, Power = .85). The ChatGPT group also reported higher satisfaction with preoperative education (4.22 ± 0.51 vs 3.43 ± 0.84, P<.001, Power = .99) and overall hospitalization experience (4.11 ± 0.65 vs 3.46 ± 0.69, P = .001, Power = .97). No significant differences were found in depression scores, knee function, or pain levels.</p><p><strong>Conclusions: </strong>ChatGPT-assisted informed consent effectively reduced perioperative anxiety and improved patient satisfaction in TKA patients. While these preliminary findings are promising, larger studies are needed to validate these results and explore broader applications of AI in preoperative patient education.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188839","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":"Comparison of percutaneous versus cutdown access in patients after endovascular abdominal aortic repair: a randomized controlled trial (SWEET-EVAR trial).","authors":"Yuhang Zhou, Jiarong Wang, Jichun Zhao, Ding Yuan, Chengxin Weng, Bin Huang, Tiehao Wang","doi":"10.1097/JS9.0000000000002233","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002233","url":null,"abstract":"<p><strong>Introduction: </strong>The optimal choice of either percutaneous or cutdown access for endovascular abdominal aortic repair (EVAR) remains uncertain due to insufficient evidence, particularly regarding patient-centered outcomes (PCOs). This study aimed at comparing both clinician-reported outcomes (ClinROs) and PCOs of percutaneous versus cutdown access in patients after EVAR.</p><p><strong>Methods: </strong>The study was a single-blind, single-center, non-inferiority, randomized controlled trial. After eligibility screening, patients diagnosed with abdominal aortic diseases were randomly assigned to either the intervention group receiving percutaneous EVAR or the control group receiving cutdown EVAR. Primary ClinRO was access-related complications, and primary PCO was time return to normal life/work.</p><p><strong>Results: </strong>Overall, 120 patients (containing 240 accesses) were allocated to either intervention group (n = 62) or control group (n = 58). Percutaneous EVAR (10/124, 8.1%) was non-inferior and not superior to cutdown EVAR (17/116, 14.7%) regarding access-related complications (P = 0.110; OR: 0.521, 95% CI: 0.225-1.157). As for PCOs, the recovery time back to normal life or work was superior in percutaneous EVAR compared to cutdown EVAR (16 vs. 28 days, P = 0.025; median difference: 7 days, 95% CI: 0-13 days). Moreover, percutaneous access did better in other PCOs, including a reduction in the duration of access-related pain (4 vs. 8 days, P = 0.001), decreased use of analgesics for access-related pain (0/61, 0% vs. 6/55, 10.9%; P = 0.026), and improved quality of life scores at 2 weeks following EVAR (0.876 vs. 0.782; P = 0.022). Prespecified subgroup analyses demonstrated percutaneous access significantly reduced the incidence of access-related complications compared to cutdown access in patients with thick subcutaneous tissue (1/42, 2.4% vs. 7/32, 21.9%; P = 0.026).</p><p><strong>Conclusion: </strong>In patients without massive common femoral artery calcification, percutaneous access may accelerate postoperative recovery and enhance patient experience and quality of life following EVAR, but did not provide obvious advantages regarding access-related complications.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188964","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":"AI-driven evidence synthesis: data extraction of randomized controlled trials with large language models.","authors":"Jiayi Liu, Honghao Lai, Weilong Zhao, Jiajie Huang, Danni Xia, Hui Liu, Xufei Luo, Bingyi Wang, Bei Pan, Liangying Hou, Yaolong Chen, Long Ge","doi":"10.1097/JS9.0000000000002215","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002215","url":null,"abstract":"<p><p>The advancement of large language models (LLMs) presents promising opportunities to enhance evidence synthesis efficiency, particularly in data extraction processes, yet existing prompts for data extraction remain limited, focusing primarily on commonly used items without accommodating diverse extraction needs. This research letter developed structured prompts for LLMs and evaluated their feasibility in extracting data from randomized controlled trials (RCTs). Using Claude (Claude-2) as the platform, we designed comprehensive structured prompts comprising 58 items across six Cochrane Handbook domains and tested them on 10 randomly selected RCTs from published Cochrane reviews. The results demonstrated high accuracy with an overall correct rate of 94.77% (95% CI: 93.66% to 95.73%), with domain-specific performance ranging from 77.97% to 100%. The extraction process proved efficient, requiring only 88 seconds per RCT. These findings substantiate the feasibility and potential value of LLMs in evidence synthesis when guided by structured prompts, marking a significant advancement in systematic review methodology.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188766","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":"Daily physical activity habits influence surgeons' stress in the operating room: a prospective cohort study.","authors":"Sarah C Skinner, Jake A Awtry, Léa Pascal, Stéphanie Polazzi, Jean-Christophe Lifante, Antoine Duclos","doi":"10.1097/JS9.0000000000002258","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002258","url":null,"abstract":"<p><strong>Background: </strong>Exercise training improves heart rate variability, and evidence suggests it can mitigate the detrimental effects of stress. This study aims to evaluate the relationship between surgeons' physical activity habits and their stress, assessed as heart rate variability, at the start of surgery.</p><p><strong>Materials and methods: </strong>This multispecialty prospective cohort study included surgeons from fourteen cardiac, endocrine, digestive, gynecologic, orthopedic, thoracic, and urologic surgical departments of four university hospitals. Surgeons wore accelerometers 24/7 from 1 November 2020 to 31 December 2021 to quantify the mean daily step counts and daily sedentary time for 7 days prior to each operation. RMSSD, the root mean square of successive differences between normal heart beats, is a heart rate variability (HRV) metric that reflects cardiac vagal tone. We evaluated RMSSD during the first 5 minutes of surgeries performed over five 15-day periods. Data were analyzed using a multivariable linear mixed model with a random effect for surgeons.</p><p><strong>Results: </strong>We analyzed 722 surgeries performed by 37 surgeons (median age = 47 (IQR 42-55); 29 (78.4%) male). On average (SD), surgeons walked 9762 (2447) steps and were sedentary 391 (102) minutes daily. The model showed a positive relationship between steps and cardiac vagal tone, with an increase in lnRMSSD (0.028, 95% CI 0.003 to 0.053, P = 0.026) for every 1000 more steps per day, but not for sedentary behavior. Senior surgeons presented lower lnRMSSD (-0.437, -0.749 to -0.126, P = 0.006), as did surgeons who spent less total time operating over the study period (-0.337, -0.646 to -0.027, P = 0.033), compared to their counterparts.</p><p><strong>Conclusions: </strong>Higher daily step counts the week before surgery were associated with increased cardiac vagal tone, indicating lower stress levels at the beginning of surgery. This relationship highlights the influence of physical activity on surgeons' stress in the operating room.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189048","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":"Exercise-based cardiac rehabilitation for patients with coronary artery operation: a systematic review and meta-analysis based on current randomized controlled trials.","authors":"Yan Shi, Huiqing Xu, Jige Dong","doi":"10.1097/JS9.0000000000002268","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002268","url":null,"abstract":"<p><strong>Background: </strong>Currently, exercise-based cardiac rehabilitation (CR) has been given increasing interest for its potentially beneficial effects on the health related quality of life (HRQoL) and outcomes of patients with coronary heart disease (CHD). The aim of this study was to evaluate the effect of exercise-based CR on patients after coronary artery bypass graſt (CABG) and percutaneous coronary interventions (PCI).</p><p><strong>Methods: </strong>We searched PubMed, Embase, Cochrane Library and Web of Science from inception to 1 December 2023 for relevant studies that evaluated the effect of exercise-based CR on patients after CABG and PCI. Our primary outcomes included the mortality, complications, hospital admissions and HRQoL between patients receiving exercise-based CR and usual care. All statistical analyses were performed using the standard statistical procedures provided in Review Manager 5.2 and Stata 12.0.</p><p><strong>Results: </strong>We finally indicated and included 25 randomized controlled trials (RCTs) with 4106 participants for the present analysis. Our pooled results indicated that, compared to usual care, exercise-based CR did not increasing the all-cause (RR 0.84; 95% CI 0.54 ‒ 1.31) and cardiovascular (RR 0.98; 95% CI 0.38 ‒ 2.54) mortality for patients after coronary artery operation. Similarly, exercise-based CR had equal effect on coronary artery complications for patients after coronary artery surgery, including CABG (RR 0.60; 95% CI 0.32 ‒ 1.15) and PCI (RR 0.92; 95% CI 0.55 ‒ 1.54). It was indicated that exercise-based CR significantly reduced the incidence of myocardial infarction (MI) by half with a RR of 0.50 (95% CI 0.28 ‒ 0.90). In addition, exercise-based CR also significantly reduced all-cause hospital admissions with a RR of 0.74 (95% CI 0.62 ‒ 0.88). Compared with usual care, exercise-based CR obviously improved HRQoL of patients after coronary artery operation evaluated with SF-36 summary scores (SMD 0.24; 95% CI 0.11 ‒ 0.38) and SF-36 8 domains (SMD 0.35; 95% CI 0.24 ‒ 0.46) respectively.</p><p><strong>Conclusions: </strong>Our analysis indicated that exercise-based CR had significant effect on the improvement of HRQoL of patients after coronary artery operation without increasing the mortality or incidence of re-intervention with operation.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189025","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":"Development, validation, and clinical evaluation of a machine-learning based model for diagnosing early infection after cardiovascular surgery (DEICS): a multi-center cohort study.","authors":"Tuo Pan, Haitao Zhang, Chuangshi Wang, Hanghang Wang, Yusanjian Matniyaz, Zhi-Kang Lv, Tong Tong Zhu, Ya-Peng Wang, Zhi-Zhao Song, Yu-Xian Tang, He Zhang, Hao-Dong Pan, Chen Li, Lin-Shan Yang, Shi-Yu Guan, Wen Bian, Xiateke Hafu, Xiang Li, Yang Li, Xiao-Ting Wu, Zhi-Wei Fan, Yuan-Xi Luo, Yi Jiang, Ya-Xuan Gao, Wen-Zhe Wang, Yun-Xing Xue, Fu-Dong Fan, Jun Pan, Qing Zhou, Bo-Min Zhang, Wei Wang, Qiang Wang, Guo-Liang Fan, Dong-Jin Wang","doi":"10.1097/JS9.0000000000002287","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002287","url":null,"abstract":"<p><strong>Background: </strong>This study addresses the critical need for timely and accurate diagnosis of early postoperative infection (EPI) following cardiac surgery. EPI significantly impacts patient outcomes and healthcare costs, making its early detection vital.</p><p><strong>Objectives: </strong>To develop, validate, and clinically implement a machine-learning-based model for diagnosing EPI post-cardiac surgery, enhancing postoperative care.</p><p><strong>Methods: </strong>In this multi-center cohort study spanning 2020 to 2022, data from four medical centers involved 2001 participants. Of these, 1400 were used for trainingand 601 for validation. Several machines-learning algorithms, including XGBoost, random forest, support vector machines, least absolute shrinkage and selection operator, and single-layer neural networks, were applied to develop predictive models. These were compared against a traditional logistic regression model. The model with the highest area under the receiver operating characteristic curve (AUROC) was deemed optimal. Implemented across four centers since 1 January 2023, a retrospective real-world study assessed its clinical applicability. Among 400 patients with an estimated EPI risk above 10%, identified by the optimal model, 55 followed its antibiotic upgrade recommendations (DEICS group). The remaining 345 patients upgraded antibiotics empirically, with 55 in the control group, matched 1:1 with the DEICS group. Clinical utility was evaluated through antibiotic use density (AUD), hospital costs, and ICU stay duration.</p><p><strong>Results: </strong>The XGBoost model achieved the highest performance with an AUROC of 0.96 (95% CI: 0.93-0.98). The calibration curve exhibited strong agreement with Brier scores of 0.02. According to the XGBoost model, the DEICS group significantly demonstrated reduced AUD (P < 0.01) in the matched cohort, along with decreased ICU stay time (median: 5 vs. 6 days, P = 0.01) and hospital costs (median: ¥150 000 vs. median: ¥200 000, P = 0.01) in the EPI cohort.</p><p><strong>Conclusion: </strong>The successful implementation of the XGBoost model facilitates accurate EPI diagnosis, improves postoperative recovery, and lowers hospital costs.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189061","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":"Comparison of thoracoscopic-guided intercostal nerve block and ultrasound-guided intercostal nerve block in postoperative analgesia of uniportal video-assisted lobectomy: a pilot randomized controlled trial.","authors":"Yan Li, Luyao Wei, Jian-Hui Du, Jin-Xian He, Xia Xu, Li-Hong Hu","doi":"10.1097/JS9.0000000000002165","DOIUrl":"10.1097/JS9.0000000000002165","url":null,"abstract":"<p><strong>Background: </strong>Ultrasound-guided intercostal nerve block (UINB) and thoracoscopic-guided intercostal nerve block (TINB) are often used for analgesia after thoracic surgery. Herein, we compared the application of TINB and UINB for analgesia after uniportal video-assisted lobectomy.</p><p><strong>Methods: </strong>Sixty patients were randomly allocated into two groups: UINB and TINB. The surgical time of intercostal nerve block (INB), the success rate of the first needle, visual analog scale (VAS) scores, the time of the first patient-controlled intravenous analgesia (PCIA) press, the time for removing the thoracic drainage tube, consumption of sufentanil and the number of PCIA presses within 24 hours postoperatively, and adverse reactions (ARs) were compared between the two groups.</p><p><strong>Results: </strong>The surgical time of INB was significantly shorter in the TINB group than in the UINB group ( P < 0.001). The time of the first press of PCIA was significantly earlier in the TINB group than in the UINB group ( P < 0.001). The success rate of the first needle was significantly higher in the TINB group than in the UINB group ( P < 0.001). No significant differences were observed between the two groups regarding VAS scores, time for removing the thoracic drainage tube, the consumption of sufentanil, the number of PCIA presses within 24 hours postoperatively, and ARs.</p><p><strong>Conclusion: </strong>TINB and UINB have similar analgesic effects after uniportal video-assisted lobectomy. However, TINB demonstrates shorter surgical time and a higher success rate than UINB.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"1995-2001"},"PeriodicalIF":12.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869453","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":"Loss of RPN1 promotes antitumor immunity via PD-L1 checkpoint blockade in triple-negative breast cancer - experimental studies.","authors":"Mengxue Wang, Xunjia Li, Yushen Wu, Long Wang, Xue Zhang, Meng Dai, Yang Long, Deyu Zuo, Shengwei Li, Xuedong Yin","doi":"10.1097/JS9.0000000000002164","DOIUrl":"10.1097/JS9.0000000000002164","url":null,"abstract":"<p><strong>Background: </strong>RPN1, also known as ribophorin I (RPN1), is a type I transmembrane protein that plays an important role in glycosylation. However, the effects of RPN1 on cancer progression and immune evasion in breast cancer (BC) have not been identified.</p><p><strong>Materials and methods: </strong>The expression of RPN1 was evaluated using RT-qPCR and immunohistochemistry (IHC). The effects of RPN1 on tumor cells were assessed using RT-qPCR, western blotting, flow cytometry, Cell Counting Kit 8 (CCK-8), colony formation assays, and in vivo experiments. The mechanism by which RPN1 modifies programmed death ligand-1 (PD-L1) and the tumor microenvironment was examined by RT-qPCR, western blotting, co-immunoprecipitation (Co-IP), and flow cytometry. The influence of the transcription factor YY1 on RPN1 expression was revealed using bioinformatics analysis, RT-qPCR, and dual-luciferase reporter and chromatin immunoprecipitation (ChIP) assays.</p><p><strong>Results: </strong>RPN1 is aberrantly expressed in triple-negative breast cancer (TNBC) cells, correlating with increased proliferation and poor prognosis. RPN1 mediates the post-translational modification of PD-L1, enhancing its glycosylation and stability, thus facilitating PD-L1-mediated immune escape and tumor growth. The deletion of RPN1 improves the TNBC microenvironment and enhances the efficacy of anti-PD-1 therapy. Additionally, we uncovered a novel regulatory axis involving YY1/RPN1/YBX1 in PD-L1 regulation, affecting TNBC growth and metastasis.</p><p><strong>Conclusions: </strong>Our preliminary study reveals that targeting RPN1 promotes immune suppression, providing a new potential immunotherapy strategy for TNBC. However, further research is necessary to fully elucidate and understand the specific mechanisms of RPN1 in TNBC and its potential for clinical application.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"1801-1813"},"PeriodicalIF":12.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869459","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}