International journal of surgery最新文献

{"title":"Biomechanical Study of Osteochondral Lesions of the Talus and Autologous Osteochondral Transplantation.","authors":"Ruihan Wang, Shiqin Yin, Jiabin Liu, Wenjing Luo, Zhiqiang Yong, Minglingzi Cheng, Wei Wang, Menglang Peng, Lei Zhang","doi":"10.1097/JS9.0000000000003605","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003605","url":null,"abstract":"<p><strong>Background: </strong>Osteochondral lesions of the talus (OLT) frequently result in limited ankle joint functionality, necessitating prompt intervention. For large-area OLT, autologous osteochondral transplantation (AOT) is a prevalent treatment; however, standardized criteria for its implementation are lacking.</p><p><strong>Objective: </strong>This study aims to examine the influence of OLT on stress transmission within the talus, assess how OLT of varying sizes and depths affects the peak stress of talar cartilage, and identify the optimal timing for AOT to effectively restore the peak stress of talar cartilage, thereby offering guidance for AOT procedures.</p><p><strong>Methods: </strong>Initially, a finite element model of a healthy human ankle joint was developed, and OLT defect models of different sizes and depths were created in designated areas of the talar cartilage. The impact of OLT on talus stress transmission was analyzed through gait simulation. Subsequently, biomechanical experiments were performed to evaluate the variations in peak stress of the talar cartilage across OLT models with differing sizes and depths, as well as in the AOT repair model.</p><p><strong>Results: </strong>Finite element analysis indicated that OLT alters the distribution of stress within the talus. Biomechanical experiments demonstrated that OLT initially reduces the peak stress of the talar cartilage, which subsequently increases after reaching a critical threshold, with this variation remaining unaffected by the position of the ankle joint. The stress changes of talar cartilage mainly depend on the defect area rather than the depth. When the area reaches 120 mm2, AOT can effectively restore the stress level of talar cartilage.</p><p><strong>Conclusion: </strong>OLT affects the biomechanical properties of the ankle joint. When the defect area reaches 120 mm2, AOT can effectively restore the stress levels of the talar cartilage to normal.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286166","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":"Intraoperative evaluation of metastatic SLNs with NIRF imaging assisted by artificial intelligence in breast cancers.","authors":"Xue-Qi Fan, Jing-Wen Bai, Shi-Long Yu, Xiao Shen, Lei Niu, Wen-He Huang, Gui-Mei Wang, Zhi-Cheng Du, Xue Zhao, Fang-Hong Zhang, Chen-Hui Yang, Guo-Jun Zhang","doi":"10.1097/JS9.0000000000003547","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003547","url":null,"abstract":"<p><strong>Background: </strong>Near-infrared fluorescence (NIRF) imaging with indocyanine green is widely employed for sentinel lymph node (SLN) biopsy in breast cancer but cannot assess SLN metastatic status. Current intraoperative assessment relies on frozen section (FS) analysis, which is time-consuming, causes tissue loss, and suffers from limited sensitivity with a high false-negative rate (FNR).</p><p><strong>Materials and methods: </strong>Preclinical data included fluorescence images from 4T1-Luc and MDA-MB-231-Luc mouse lymph node metastasis models. Clinical data comprised 35 breast cancer patients in a prospective clinical trial (NCT.). Intraoperative ICG-based NIRF imaging was performed, and four convolutional neural networks (Vgg19, Efficientnet, Resnet, Densenet) were evaluated.</p><p><strong>Results: </strong>In the mouse test set, the proposed approach achieved an area under the receiver operating characteristic curve (AUC) of 0.799 (95%CI: 0.787-0.810) for cohort 1 and 0.804 (95% CI: 0.793-0.816) for cohort 2. In the clinical cohort comprising 35 patients and 114 excised SLNs (16 metastatic, 98 non-metastatic), it demonstrated robust performance in detecting metastatic SLNs, with an AUC of 0.898 (95% CI: 0.892-0.903). The LymphNet approach, which aggregates predictions from multiple SLN images, yielded an FNR of 18.75%, comparable to FS analysis (FNR: 13.5-31.3%). LymphNet avoids tissue loss and streamlines the workflow, with the model's prediction process requiring less than 10 seconds. For the first time, we observed a marked reduction or complete absence of fluorescence in metastatic SLNs infiltrated by breast cancer cells.</p><p><strong>Conclusion: </strong>This study establishes a novel, efficient tool for intraoperative SLN metastatic assessment.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286292","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":"Multi-omics dissection of high TWAS-active endothelial pathogenesis in pulmonary arterial hypertension: bridging single-cell heterogeneity, machine learning-driven biomarkers, and developmental reprogramming.","authors":"Zerong Li, Huayang Li, Wenmei Qiao, Siming Yu, Bin Fan, Ming Yang, Leyan Zhou, Fang Qiu, Zhongkai Wu, Jinping Wang","doi":"10.1097/JS9.0000000000003601","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003601","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary Arterial Hypertension (PAH) is a leading cause of cardiovascular-related mortality worldwide. The emergence of single-cell RNA sequencing (scRNA-seq) has enhanced the ability to dissect cellular heterogeneity in PAH at a granular level. Transcriptome-wide association studies (TWAS) leverage expression quantitative trait loci (eQTL) and genome-wide association study (GWAS) data to identify novel susceptibility genes whose genetically predicted expression correlates with disease risk. However, no study has systematically integrated TWAS with scRNA-seq to unravel the pathogenesis of PAH at single-cell resolution.</p><p><strong>Methods: </strong>Using TWAS analysis, we identified a set of candidate genes genetically associated with PAH. We then evaluated the differential activity of these genes across PAH cell types at single-cell resolution using AUCell, Ucell, ssGSEA, and AddModuleScore algorithms. A subset of endothelial cells exhibiting elevated TWAS activity was identified via quartile-based stratification and designated as the high TWAS activity state (HTS) group. Multi-dimensional analyses, including observed-to-expected ratio (RO/E), CellChat, CytoTRACE, and scMetabolism, were employed to characterize the functional and communicative properties of HTS cells. Machine learning algorithms were integrated to identify signature genes of the HTS subpopulation, and a benchmarked random forest model was trained to predict HTS status. We performed immunohistochemistry and qRT-PCR validation of the signature genes (KLF2, RASIP1 and DEPP1) in PAH and control lung tissues to support their expression patterns.</p><p><strong>Results: </strong>We demonstrated that HTS endothelial cells are strongly associated with PAH pathogenesis, exhibiting significant tissue tropism, enhanced roles in intercellular communication, and a progenitor-like function in endothelial differentiation. Machine learning-based feature selection revealed three robust signature genes: KLF2, RASIP1, and DEPP1. These genes demonstrated exceptional predictive power for identifying HTS cells, suggesting their potential as drivers of endothelial dysfunction in PAH. The random forest model, benchmarked against multiple algorithms, achieved high accuracy in predicting PAH progression using these genes. Immunohistochemical analysis of pulmonary artery and qRT-PCR result of lung tissues addressed the elevated expression of KLF2, RASIP1 and DEPP1 in arterial wall post-PAH.</p><p><strong>Conclusion: </strong>This study elucidates endothelial cell heterogeneity in PAH and establishes the central role of HTS cells in disease progression, cellular crosstalk, and developmental reprogramming. Our findings bridge the gap between GWAS and scRNA-seq methodologies and provide a transformative framework for understanding PAH mechanisms.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251225","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":"SPP1 in Notochord Cells Modulates Intervertebral Disc Degeneration Through CD44 Recognition by Macrophages Based on Single Cell Transcriptome Analysis.","authors":"Qiuwei Li, Peilin Jin, Chenhao Zhao, Renjie Zhang, Cailiang Shen","doi":"10.1097/JS9.0000000000003454","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003454","url":null,"abstract":"<p><strong>Background: </strong>Intervertebral disc degeneration (IVDD) is a major cause of spinal disorders, often leading to chronic pain and mobility issues. Mechanical stress is a key factor in IVDD progression, but the underlying mechanisms remain unclear. In this study, we improved a rat intervertebral disc pressure model to explore how mechanical stress affects IVDD, focusing on notochord cell populations and their interactions in the degenerative process.</p><p><strong>Methods: </strong>We developed a custom pressure device for rats, validated using imaging techniques. Following pressure application, single-cell transcriptomics was employed to analyze dynamic changes in notochord cells in both surgical and sham groups. Gene expression profiles were analyzed for immune regulation, matrix metabolism, and intercellular signaling. We also studied the SPP1 signaling pathway and its interaction with CD44.Finally, we combined Mendelian randomization(MR) and human GEO sequencing data to support our results.</p><p><strong>Results: </strong>Pressure application resulted in significant structural damage and abnormal changes in matrix components, worsening over time. Single-cell analysis revealed differences in notochord cell populations between surgical and sham groups, with increased immune regulation and matrix metabolism activity. The SPP1-CD44 signaling pathway was activated in degenerated discs, especially in CD44-expressing cells, underscoring its role in matrix remodeling and inflammation.MR and human GEO sequencing data also support these ideas.</p><p><strong>Conclusion: </strong>This study provides insights into IVDD mechanisms, focusing on the role of the SPP1-CD44 pathway in disc degeneration. We suggest that targeting this pathway may offer potential therapeutic strategies for degenerative spinal diseases.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251297","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":"Letter to the editor about'duration of surgical antibiotic prophylaxis and surgical site infection in orthopaedic surgery: a prospective cohort study'.","authors":"Jiayi Dou, Zhongcheng An, Tongfu Luo","doi":"10.1097/JS9.0000000000003535","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003535","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251199","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":"Risk factors for morbidity in both donor and recipient following minimally invasive donor hepatectomy: a systematic review.","authors":"Sang-Hoon Kim, Ki-Hun Kim, Surendran Sudhindran, Dieter C Broering","doi":"10.1097/JS9.0000000000003524","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003524","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive donor hepatectomy (MIDH), including laparoscopic, laparoscopic-assisted, and robotic donor hepatectomy, is an evolving technique in living donor liver transplantation, but its technical complexity presents potential risks for both donors and recipients. This study purposes to systematically review and identify key risk factors for donor and recipient morbidity after MIDH.</p><p><strong>Methods: </strong>A systematic search of electronic databases was performed to identify studies published between January 2001 and December 2024 that reported significant risk factors for donor and recipient complications after MIDH. Risk factors for overall or major complications, biliary complications (bile leak or biliary stricture), or open conversion were summarized using odds ratios or hazard ratios with 95% confidence intervals derived from multivariate analysis.</p><p><strong>Results: </strong>In total, eight studies reported significant risk factors for donor or recipient after MIDH. Risk factors for donor complications included unfavorable anatomical characteristics (short hepatic ducts, multiple hepatic ducts/arteries/veins, and large graft) and operative factors (increased operative time and blood loss). Conversion from laparoscopic to open was related to high BMI. Recipient risk factors included biliary variations, portal vein thrombosis, hepaticojejunostomy, prolonged operative time, massive transfusion, and high MELD scores. Robotic surgery was linked to favorable donor and recipient outcomes.</p><p><strong>Conclusion: </strong>Risk factors for donor and recipient morbidity after MIDH include anatomical, operative, procedural, donor, and recipient factors. Notably, biliary variation of graft is key contributor for both donor and recipient morbidity. Given the limited studies on risk factors, multicenter studies with larger sample sizes are essential to validate these findings.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251208","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":"Letter to the editor comments on the manuscript entitled: surgical technique of laparoscopic mini-gastric bypass with obstructive stapleless pouch creation: a case series.","authors":"Galymjan Duysenov","doi":"10.1097/JS9.0000000000003155","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003155","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251237","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":"Letter to the editor:\"Deep learning-driven multi-hierarchical granularity integration for surgical scene understanding: experimental study\".","authors":"Zuomin Wang, Qinwei Liu, Wangdong Deng","doi":"10.1097/JS9.0000000000003532","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003532","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251277","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":"Total thymectomy is oncologically superior to partial thymectomy in patients with thymic carcinoma: insights from a multicenter real-world data analysis.","authors":"Tatsuya Hayashi, Mikio Okazaki, Toshiharu Mitsuhashi, Hidetaka Yamamoto, Tomohiro Habu, Kazuhiko Shien, Ken Suzawa, Hiromasa Yamamoto, Tomoaki Otsuka, Mototsugu Watanabe, Takeshi Kurosaki, Eiji Yamada, Eisuke Matsuda, Tatsurou Hayashi, Toshiya Fujiwara, Makio Hayama, Hiroyuki Tao, Masaomi Yamane, Hidetoshi Inokawa, Yuji Hirami, Kazuhiro Washio, Takahiko Misao, Motohiro Yamashita, Yoshifumi Sano, Masao Nakata, Osamu Kawamata, Shinishi Toyooka","doi":"10.1097/JS9.0000000000003600","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003600","url":null,"abstract":"<p><strong>Background: </strong>Although total thymectomy has been the standard surgical approach for thymic epithelial tumors, an increasing number of recent reports suggest that partial thymectomy for early-stage thymomas may yield outcomes comparable to those of total thymectomy. However, whether partial thymectomy is a viable alternative for thymic carcinoma remains unclear.</p><p><strong>Materials and methods: </strong>A total of 106 patients with thymic carcinoma underwent curative intended resection at 19 institutions between January 2010 and December 2021. Excluding 14 patients with incomplete resection, 92 patients with thymic carcinoma who underwent total (n = 73) or partial thymectomy (n = 19) were compared. Overall survival (OS) and recurrence-free survival (RFS) were analyzed using Kaplan-Meier curves and Cox proportional hazard models. Overlap weighting was applied to adjust for potential confounding factors.</p><p><strong>Results: </strong>Among patients with clinical-stage I disease, 79.3% were upstaged to stage II or higher postoperatively. Unadjusted analyses revealed no statistically significant differences in OS and RFS between the total and partial thymectomy groups, although a trend toward poorer outcomes in the partial thymectomy group was observed. After overlap weighting, partial thymectomy was associated with significantly poorer OS (p = 0.0027) and higher recurrence risk (p < 0.0001). Early postoperative recurrence occurred more frequently in the partial thymectomy group.</p><p><strong>Conclusion: </strong>Partial thymectomy was associated with significantly worse survival and recurrence outcomes in thymic carcinoma. Given the limitations of preoperative diagnosis, total thymectomy should remain the preferred surgical approach for undiagnosed thymic epithelial tumors to achieve optimal oncologic control and minimize the risk of recurrence.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286035","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 safety and effectiveness between endoscopic ultrasound-guided and ultrasound-guided pancreatic biopsy in focal pancreatic disease: a multi-center, retrospective, propensity score analysis.","authors":"Weilu Chai, Qiang Lu, Dong Xu, Kai Li, Weina Wan, Li Yu, Ran Li, Tian'an Jiang","doi":"10.1097/JS9.0000000000003591","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003591","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic ultrasound (EUS) and ultrasound (US) are the two primary imaging modalities used to guide pancreatic needle biopsy. This study aimed to compare the diagnostic performance and complications associated with EUS- and US-guided pancreatic biopsies.</p><p><strong>Methods: </strong>A total of 2517 consecutive patients who underwent 2583 cases of EUS- or US-guided pancreatic biopsy for focal pancreatic disease between January 2017 and December 2023 at seven university teaching hospitals were included. The endpoints evaluated were diagnostic inaccuracy, complications, and repeat biopsies for each method. The propensity score matching (PSM) method was used for the analysis.</p><p><strong>Results: </strong>For the entire cohort, diagnostic inaccuracies were observed in 7.0% of cases in the EUS-guided biopsy group compared to 3.5% in the US-guided biopsy group, representing a statistically significant difference (p = 0.001). The rates of major (p = 1.000) and minor complications (p = 0.309) were similar between the two groups. The rate of repeat biopsies was significantly higher in the EUS-guided biopsy group than in the US-guided biopsy group (5.0% vs. 2.8%, p = 0.024). However, after balancing lesion characteristics using PSM, no significant differences were observed between the EUS- and US-guided biopsies in diagnostic inaccuracy (7.2% vs. 8.5%, p = 0.600), major complications (0.5% vs. 0%, p = 0.499), minor complications (1.7% vs. 0.2%, p = 0.069), or repeat biopsy rate (5.5% vs. 6.5%, p = 0.656). Subgroup analysis revealed that among patients with exophytic and backward growth pancreatic lesions, both diagnostic inaccuracy (7.1% vs. 33.3%, p = 0.001) and the repeat biopsy rate (10.7% vs. 27.8%, p = 0.029) were significantly lower in the EUS-guided biopsy group compared to the US-guided biopsy group.</p><p><strong>Conclusions: </strong>This study confirmed that both EUS-guided and US-guided pancreatic biopsies are safe and effective for patients with focal pancreatic disease. After PSM, diagnostic inaccuracy, repeat biopsy and complication rates were similar, but EUS-guided biopsy was preferred for lesions with exophytic and backward growth morphology.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251248","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}