International journal of surgery最新文献

{"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}

{"title":"Nomogram for predicting severe abdominal adhesions prior to definitive surgery in patients with anastomotic fistula post-small intestine resection: a cohort study.","authors":"Zheng Yao, Weiwei Shang, Fan Yang, Weiliang Tian, Guoping Zhao, Xin Xu, Risheng Zhao Md, Tao Tian, Wuhan Li, Ming Huang, Yunzhao Zhao, Qian Huang","doi":"10.1097/JS9.0000000000002191","DOIUrl":"10.1097/JS9.0000000000002191","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to develop and validate a nomogram for predicting the presence of severe intra-abdominal adhesions before definitive surgery (DS) for anastomotic fistula following small intestine resection (SIR).</p><p><strong>Methods: </strong>Patients were enrolled from January 2009 to October 2023 and were randomly divided (2:1) into development and validation cohorts. Predictors of severe adhesion were identified and integrated into a nomogram. The nomogram's performance was evaluated through calibration, discrimination, and clinical utility. Results : A total of 414 patients were included, with 276 in the development cohort and 138 in the validation cohort. Severe adhesion was diagnosed in 54 (13%) patients, including 37 (13.4%) in the development cohort and 17 (12.3%) in the validation cohort ( P = 0.76). Five predictors were identified: Sequential Organ Failure Assessment score, duration of early-stage abdominal infection, preoperative albumin (Alb) <35 g/L, visceral to subcutaneous fat area ratio, and preoperative C-reactive protein >10 mg/L. The nomogram demonstrated robust discrimination, with a concordance index (C-index) of 0.80 (95% CI, 0.76-0.90) in internal validation, and was well-calibrated. In the validation cohort, the model maintained good discrimination (C-index = 0.79; 95% CI, 0.67-0.94) and calibration. Decision curve analysis affirmed the nomogram's clinical utility.</p><p><strong>Conclusion: </strong>This study introduces a practical nomogram for assessing the risk of severe abdominal adhesion prior to DS in patients undergoing surgery for anastomotic fistula after SIR.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2046-2054"},"PeriodicalIF":12.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869460","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":"Efficacy of laparoscopic parenchyma-sparing hepatectomy using augmented reality navigation combined with fluorescence imaging for colorectal liver metastases: a retrospective cohort study using inverse probability treatment weighting analysis.","authors":"Xiaojun Zeng, Xinci Li, Wenjun Lin, Junfeng Wang, Chihua Fang, Mingxin Pan, Haisu Tao, Jian Yang","doi":"10.1097/JS9.0000000000002193","DOIUrl":"10.1097/JS9.0000000000002193","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic parenchyma-sparing hepatectomy (PSH) is an effective treatment for colorectal liver metastases (CRLMs), but ensuring the safety and radicality of the procedure, particularly for deep-seated tumors, remains challenging. Surgical navigation technologies such as augmented reality navigation (ARN) and indocyanine green fluorescence imaging (ICG-FI) are increasingly utilized to guide surgery, yet their efficacy for CRLMs is unclear. This study aims to evaluate the short-term and long-term outcomes of ARN combined with ICG-FI-guided (ARN-FI) laparoscopic PSH for CRLMs.</p><p><strong>Methods: </strong>Between January 2020 and December 2022, 89 consecutive patients who underwent laparoscopic PSH for CRLMs were included in the study. Patients were divided into an ARN-FI group ( n = 38) and a non-ARN-FI group ( n = 51) based on the use of ARN-FI. Inverse probability treatment weighting (IPTW) was used to balance baseline characteristics and minimize potential selection bias. Short-term and long-term outcomes were compared between the two groups. Cox regression analysis was conducted to identify risk factors associated with recurrence-free survival (RFS) and hepatic RFS.</p><p><strong>Results: </strong>After IPTW, there were 87 patients in the ARN-FI group and 89 patients in the non-ARN-FI group. Shorter parenchymal transection time, postoperative hospital stays, and wider margins were observed in the ARN-FI group. There was no significant difference in RFS or hepatic RFS between the groups. Mutant KRAS status was an independent risk factor for both RFS and hepatic RFS, while tumor diameter ≥ 5 cm and deep-seated location were risk factors for hepatic RFS. In the subgroup analysis of deep-seated tumors, the ARN-FI group also showed less intraoperative blood loss, a lower rate of strategy change, shorter postoperative recovery times, a higher R0 resection rate, and improved RFS and hepatic RFS.</p><p><strong>Conclusions: </strong>In laparoscopic PSH for CRLMs, ARN-FI may improve surgical efficiency and accuracy. Especially for deep-seated tumors, it has the potential to reduce blood loss and attain higher R0 resection rates.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"1749-1759"},"PeriodicalIF":12.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882104","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":"Predicting early recurrence in locally advanced gastric cancer after gastrectomy using CT-based deep learning model: a multicenter study.","authors":"Xinyu Guo, Mingzhen Chen, Lingling Zhou, Lingyi Zhu, Shuang Liu, Liyun Zheng, Yongjun Chen, Qiang Li, Shuiwei Xia, Chenying Lu, Minjiang Chen, Feng Chen, Jiansong Ji","doi":"10.1097/JS9.0000000000002184","DOIUrl":"10.1097/JS9.0000000000002184","url":null,"abstract":"<p><strong>Background: </strong>Early recurrence in patients with locally advanced gastric cancer (LAGC) portends aggressive biological characteristics and a dismal prognosis. Predicting early recurrence may help determine treatment strategies for LAGC. The goal is to develop a deep learning model for early recurrence prediction (DLER) based on preoperative multiphase computed tomography (CT) images and to further explore the underlying biological basis of the proposed model.</p><p><strong>Materials and methods: </strong>In this retrospective study, 620 LAGC patients from January 2015 to March 2023 were included in three medical centers and The Cancer Image Archive (TCIA). The DLER model was developed using DenseNet169 and multiphase 2.5D CT images, and then crucial clinical factors of early recurrence were integrated into the multilayer perceptron (MLP) classifier model (DLER MLP ). The area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity were applied to measure the performance of different models. The log-rank test was used to analyze survival outcomes. The genetic analysis was performed using RNA-sequencing data from TCIA.</p><p><strong>Results: </strong>Using the MLP classifier combined with clinical factors, DLER MLP showed higher performance than DLER and clinical models in predicting early recurrence in the internal validation set (AUC: 0.891 vs. 0.797, 0.752) and two external test sets: test set 1 (0.814 vs. 0.666, 0.808) and test set 2 (0.834 vs. 0.756, 0.766). Early recurrence-free survival, disease-free survival, and overall survival can be stratified using the DLER MLP (all P < 0.001). High DLER MLP score is associated with upregulated tumor proliferation pathways (WNT, MYC, and KRAS signaling) and immune cell infiltration in the tumor microenvironment.</p><p><strong>Conclusion: </strong>The DLER MLP based on CT images was able to predict early recurrence of patients with LAGC and served as a useful tool for optimizing treatment strategies and monitoring.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2089-2100"},"PeriodicalIF":12.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882133","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":"The efficacy and safety of robot-assisted surgery in cancer patients: a systematic review of randomized controlled trials.","authors":"Kai Yu, Baoqi Zeng, Qingxin Zhou, Feng Sun","doi":"10.1097/JS9.0000000000002205","DOIUrl":"10.1097/JS9.0000000000002205","url":null,"abstract":"<p><strong>Background: </strong>The utilization of robot-assisted surgery (RAS) has been increasing among cancer patients. However, evidence supporting the use of RAS remains uncertain. The availability of randomized controlled trials (RCTs) for each surgical procedure is limited. This study aimed to assess the safety and efficacy of RAS in cancer patients.</p><p><strong>Materials and methods: </strong>A comprehensive search was performed in Embase, PubMed, the Cochrane Library, and ClinicalTrials.gov from the inception of the databases until 1 April 2023. We included RCTs of RAS in cancer patients compared with laparoscopic, thoracoscopic, or open surgery, and random-effects meta-analyses were performed.</p><p><strong>Results: </strong>A total of 32 trials (6092 patients) met the eligibility criteria. Among these, 22 trials had a low risk of bias, seven trials had some concerns, and three trials were at high risk. Most trials were conducted for bladder cancer ( n = 8), rectal cancer ( n = 5), prostate cancer ( n = 4), and endometrial cancer (n = 4). In all cancers, RAS likely resulted in a slight reduction in the length of hospital stay (31 comparisons; mean difference [MD], - 0.91 days; 95% CI, - 1.33 to - 0.49), but resulted in little to no difference in overall survival (11 comparisons; hazard ratio [HR], 0.96; 95% CI, 0.78 to 1.17). Compared with open surgery, RAS was found to reduce estimated blood loss (MD, - 239.1 mL; 95% CI, - 172.0 to - 306.2) and overall complication (relative risk [RR] 0.88; 95% CI, 0.81 to 0.96), but increase total operative time (MD, 55.4 minutes; 95% CI, 30.9 to 80.0). Additionally, RAS seemed to be not associated with positive surgical margin, any recurrence, disease-free survival, and quality of life.</p><p><strong>Conclusion: </strong>RAS has demonstrated small favorable effects on short-term outcomes, particularly when compared to open surgery. However, these effects may vary across different cancers. Additionally, RAS may not impact long-term survival, oncological outcomes, or quality of life in cancer patients.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2227-2239"},"PeriodicalIF":12.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882156","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":"Vacuum suction catheter semi-rigid ureteroscopic laser lithotripsy for impacted upper ureteral stones: randomized controlled trial.","authors":"Xing-Huan Wang, Zhong-Hua Wu, Tong-Zu Liu, Bing Li, Sheng Li, Yong-Zhi Wang, Ping Chen","doi":"10.1097/JS9.0000000000002202","DOIUrl":"10.1097/JS9.0000000000002202","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effectiveness and safety of an upgraded integrated vacuum suction catheter in semi-rigid ureteroscopic laser lithotripsy (VC-URSL) compared to traditional methods for treating impacted upper ureteral stones.</p><p><strong>Patients and methods: </strong>This prospective, randomized controlled trial was conducted from September 2022 to March 2024 at a single center, enrolling 95 patients aged 18-70 years with a single radiopaque impacted upper ureteral stone. Participants were randomized into two groups: the VC-URSL group used an integrated vacuum suction catheter featuring a stainless steel stabilizing tube and a narrowed distal end to prevent obstruction, while the T-URSL group underwent standard ureteroscopic lithotripsy without vacuum assistance. Both groups utilized a holmium-YAG laser under general anesthesia. Primary outcomes included operative time, stone-free rates on the first postoperative day and after one month, and complication rates, specifically fever and stone retropulsion.</p><p><strong>Results: </strong>The VC-URSL group achieved significantly shorter operative times (37.60 ± 3.87 min vs. 46.21 ± 7.54 min, P < 0.001) and higher initial stone-free rates (91.7% vs. 74.5%, P = 0.025) compared to T-URSL. Additionally, the VC-URSL group had fewer complications, with lower rates of fever (2.1% vs. 17.0%, P = 0.015) and stone retropulsion (6.3% vs. 21.3%, P = 0.033).</p><p><strong>Conclusions: </strong>VC-URSL offers a more effective, safer, and efficient alternative to T-URSL, enhancing outcomes while reducing complications. Further multicenter trials with larger populations are recommended for broader validation.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2031-2036"},"PeriodicalIF":12.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894392","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":"Current advance in comprehensive management of hilar cholangiocarcinoma and navigation in surgery: non-systematic reviews.","authors":"Man Luo, Jiapeng Yang, Kai Zhang, Ji Sun, Zhiyu Lu, Zhihao Wang, Yaowei Hu, Jianxin Zhai, Peng Xie, Tana Siqin, Mengran Lang, Xuan Meng, Hongguang Wang","doi":"10.1097/JS9.0000000000002206","DOIUrl":"10.1097/JS9.0000000000002206","url":null,"abstract":"<p><p>Hilar cholangiocarcinoma (h-CCA) originates from the epithelial cells, which characters as longitudinal growth along the bile ducts and invasion of peripheral vascular nerves. Due to the tumors insidious progression and usually become advanced stage disease at presentation, patients' mortality could parallel incidence rates. For patients who are not amenable to resection, systemic therapy and palliative treatment become the way to go. Dawn of the immunotherapy era offers new opportunity for patients with advanced tumors. Numbers of successful clinical trials have been conducted these years, giving us the chance to optimize multiple treatment modalities. Although liver transplantation is worth to be considered, there is no high-level evidence to support it better outcomes over surgical resection. Given the poor prognosis of h-CCA, radical resection (R0) undoubtfully becomes the only irreplaceable treatment to prolonged survival. Thus, tumors free boundary assessment along the bile duct hit the crucial point. Over the years, numerous imaging techniques leveraging computed tomography, MRI, intraoperation ultrasound and endoscopy with the aim of guiding operation to eliminating cancers. Novel fiberscopes utilizing the second near-infrared region light (NIR-II) offer the potential to assist surgeon visualize tumors precisely. In this review, we summarize the clinical palliative care for advanced h-CCA patients and new opportunities for medications, discussing liver transplantation and other available treatment that not widely disseminated. In addition, we mainly focus on the novel technique of real-time intraoperation imaging navigation to achieve R0 resection and potential molecule prognosis development in the intractable disease.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2131-2147"},"PeriodicalIF":12.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142948932","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":"Laennec approach for anatomical liver resection assisted by laparoscopy or robotics: a multicenter cohort study.","authors":"Binghua Li, Dalong Yin, Qifan Zhang, Lei Qin, Jianwei Li, Zhixian Hong, Peng Zhu, Guangyu Ding, Zhitian Shi, Changhe Zhang, Kai Zhang, Jin Peng, Yang Yue, Chaobo Chen, Lianxin Liu, Shuguo Zheng, Xiaoping Chen, Qiang Gao, Bixiang Zhang, Decai Yu","doi":"10.1097/JS9.0000000000002212","DOIUrl":"10.1097/JS9.0000000000002212","url":null,"abstract":"<p><strong>Introduction: </strong>Laennec's capsule serves as a critical anatomical landmark in liver resection. Despite its potential, a lack of large-scale prospective studies limits the widespread use of the Laennec approach for minimally invasive hepatectomy. This multicenter cohort study aimed to compare the outcomes of the traditional and Laennec approaches in minimally invasive anatomical hepatectomy across multiple centers in China.</p><p><strong>Methods: </strong>A total of 445 patients from 11 centers were included, with 339 undergoing the Laennec approach and 106 receiving the traditional approach. Intraoperative parameters such as the duration of hepatic pedicle isolation, hepatic vein exposure, parenchymal transection, and liver mobilization were analyzed. Postoperative outcomes, including recurrence-free survival and R0 resection rates, were also assessed. Additionally, a series of subgroup analyses were conducted to evaluate the efficacy of the Laennec approach.</p><p><strong>Results: </strong>The Laennec approach demonstrated notable intraoperative advantages, including reduced durations for hepatic pedicle isolation, liver mobilization, hepatic vein exposure, and parenchymal transection. Robotic-assisted procedures, in particular, showed superior outcomes when compared with laparoscopic platform. The Laennec approach proved highly effective across various liver diseases, particularly hepatocellular carcinoma, hemangioma, and hepatolithiasis. The Laennec gap, a distinct gap between the liver parenchyma and surrounding vasculature, played a key role in identifying candidates for the Laennec approach. Subgroup analysis revealed that although the Laennec approach provides significant intraoperative benefits, these advantages do not seem not to translate into substantial postoperative improvements.</p><p><strong>Conclusions: </strong>The Laennec approach offers clear intraoperative advantages over the traditional approach when utilizing laparoscopic or robotic systems. These findings support the Laennec approach as a standardized technique for anatomical liver resection.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"1929-1938"},"PeriodicalIF":12.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949006","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":"Large-scale network mechanisms underlying postoperative cognitive improvement after spine surgery.","authors":"Daria Antonenko, Sophie Leroy, Jonas Müller, Frederik Behr, Anna E Fromm, Falk von Dincklage, Robert Fleischmann","doi":"10.1097/JS9.0000000000002210","DOIUrl":"10.1097/JS9.0000000000002210","url":null,"abstract":"<p><strong>Background: </strong>The outcome of major surgery is determined not only by the success of the procedure itself but also by its neurocognitive effects. We previously reported improved cognition following spine surgery (Müller et al. 2023 Spine ), but the mechanisms underlying these changes remain unknown.</p><p><strong>Materials and methods: </strong>We analyzed resting-state functional magnetic resonance images of 79 patients (mean/SD age: 71/7 years) acquired at baseline in this previously published trial. For 26 patients, data was additionally available at 3-months follow-up visits. To delineate large-scale connectivity, we calculated functional connectivity (FC) within and between three core neural networks, the central executive network (CEN), the salience network (SAL), and the default mode network (DMN).</p><p><strong>Results: </strong>FC between CEN and SAL predicted cognitive improvement (beta = 0.36, 95%-CI 0.28 to 0.45, P = 0.033). Average FC between all nodes of the CEN showed changes toward an increase after surgery (beta = 0.057, 95%-CI -0.01 to 0.123, P = 0.086). Further seed-based FC analyses revealed that this increase was most pronounced in the functional coupling between left dorsolateral prefrontal and right posterior parietal cortex (beta = 0.10, T(24) = 2.73, Punc  = 0.012, PFDR  = 0.035). The increase of CEN-FC correlated with individual enhancements of executive scores (beta = 0.34, 95%-CI 0.32 to 0.36, P = 0.034).</p><p><strong>Conclusion: </strong>Integration of activity between the CEN and SAL networks predicted postoperative cognitive improvements, suggesting that less segregated large-scale functional networks may facilitate beneficial cognitive changes following surgery. Postoperative increases in functional coupling may serve as a biomarker for individual improvements in executive functions. These results indicate that surgery should not be routinely deferred in elderly patients due to concerns about postoperative neurocognitive complications. Moreover, our findings highlight potential targets for non-invasive brain stimulation interventions aimed at preventing neurocognitive complications.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2317-2320"},"PeriodicalIF":12.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949027","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":"Effects of continuous pecto-intercostal fascial block for management of post-sternotomy pain in patients undergoing cardiac surgery: a randomized controlled trial.","authors":"Yanfei Zhao, Dehao He, Wanqing Zhou, Cheng Chen, Zhuoyi Liu, Pingping Xia, Zhi Ye, Chunling Li","doi":"10.1097/JS9.0000000000002200","DOIUrl":"10.1097/JS9.0000000000002200","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Managing postoperative pain following median sternotomy has long been a notable challenge for anesthesiologists. The administration of postoperative analgesia traditionally relies on intravenous pumps for the delivery of opioids. With the development of regional block techniques and postoperative multimodal analgesia, pecto-intercostal fascial block (PIFB) has gained widespread utilization due to its distinctive advantages. However, its application is limited to a single block. This study aimed to indicate whether continuous PIFB analgesia in cardiac surgery via sternotomy could possess clinical advantages compared with intravenous analgesia in terms of postoperative pain management. If continuous PIFB analgesia was the priority, the secondary objective would involve determining the most effective administration method, making it a critical area of exploration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Totally, 114 patients were randomly allocated to three groups: the patient-controlled intravenous analgesia (PCIA) group, receiving intravenous opioid infusion exclusively via pump, and the constant infusion pecto-intercostal fascial block (C-PIFB) and intermittent infusion pecto-intercostal fascial block (I-PIFB) groups, where ultrasound-guided PIFB with a nerve-blocking pump was administered. The C-PIFB group received a constant basal infusion, while programmed intermittent boluses were administered in the I-PIFB group. The primary end point was postoperative visual analog scale (VAS) scores, and secondary outcomes included intraoperative sufentanil consumption, time to extubation, mobilization, length of stay in the intensive care unit (ICU) and hospital, and the incidence of postoperative complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The VAS scores at rest and during coughing were noticeably diminished in the two block groups relative to the intravenous pump group at 12, 24, 48, and 72 h postoperatively. Notably, intraoperative sufentanil consumption was significantly reduced in the C-PIFB group [3.12 (0.93) µg kg -1 ] and the I-PIFB group [3.42 (0.77) µg kg -1 ] compared with the PCIA group [4.66 (1.02) µg kg -1 , P &lt; 0.001]. Time to extubation, mobilization, length of stay in ICU and hospital, and use of rescue analgesics did not exhibit statistically significant differences among the three groups. However, the postoperative complication rates were markedly lower in the C-PIFB group (42.11%) and I-PIFB group (36.84%) relative to the PCIA group (81.58%, P &lt; 0.001). There were no significant differences between C-PIFB and I-PIFB groups regarding VAS score, secondary outcomes, and postoperative complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Continuous PIFB can provide satisfactory postoperative analgesia while reducing perioperative opioid consumption, diminishing the risk of postoperative complications, and accelerating postoperative recovery for patients undergoing median sternotomy in cardiac surgery. The constant ba","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2037-2045"},"PeriodicalIF":12.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869454","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}