International journal of surgery最新文献

{"title":"Mechanical injury after tracheal intubation is the main factor in obstructive fibrinous tracheal pseudomembrane.","authors":"Qian Liu, Qing Zhong, Yating Zeng, Guoqiang Tang","doi":"10.1097/JS9.0000000000003473","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003473","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029686","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":"A commentary on \"The role of coagulopathy and subdural hematoma thickness at admission in predicting the prognoses of patients with severe traumatic brain injury: a multicenter retrospective cohort study from China\".","authors":"Ling Chen, Hongjie Chen","doi":"10.1097/JS9.0000000000003420","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003420","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029820","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":"Commentary: beyond PLR-rethinking biomarkers in fracture healing.","authors":"Kun Zhang, Fan Yang","doi":"10.1097/JS9.0000000000003424","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003424","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029857","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":"Comment on \"Exploring the complex relationship between Vitamin K, gut microbiota, and warfarin variability in cardiac surgery patients\".","authors":"Jun Chen, Jianhao Li, Guoqin Chen","doi":"10.1097/JS9.0000000000003357","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003357","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029871","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":"Association of preoperative cerebrospinal fluid sTREM2 concentration with postoperative delirium and three-year mortality in patients total knee or hip arthroplasty: a prospective cohort study.","authors":"Bin Wang, Xiao Wang, Yizhi Liang, Jiahan Wang, Shuhui Hua, Jian Kong, Shanling Xu, Yunchao Yang, Yanan Lin, Chuan Li, Hongyan Gong, Xu Lin, Yanlin Bi","doi":"10.1097/JS9.0000000000003465","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003465","url":null,"abstract":"<p><strong>Background: </strong>As a common postoperative neurological complication, postoperative delirium (POD) can lead to poor postoperative recovery in patients, prolonged hospitalization, and even increased mortality. However, POD's mechanism remains undefined and there are no reliable molecular markers of POD to date. The present work examined the associations of cerebrospinal fluid (CSF) sTREM2 with CSF POD biomarkers, and investigated whether the effects of CSF sTREM2 on POD were modulated by the core pathological indexes of POD (Aβ42, tau, and ptau). The association of presurgical CSF sTREM2 with 3-year mortality in POD cases administered total knee or hip arthroplasty was assessed.</p><p><strong>Methods: </strong>We enrolled 545 Chinese Han patients undergoing total knee or hip arthroplasty (aged 50-95, weighing 50-80 kg, and using ASA II-III) combined with epidural anesthesia between October 2020 and March 2022. In these participants, POD was identified using the Confusion Assessment Method (CAM) and the severity of POD was evaluated using the Memorial Delirium Assessment Scale (MDAS) at 1-7 days postoperatively (or before discharge) by an anesthesiologist. The levels of cerebrospinal fluid (CSF) POD biomarkers were measured by ELISA. Next, logistic regression models were used to analyze the association between sTREM2and POD, as well as between cerebrospinal fluid (CSF) biomarkers and POD. We used Stata MP16.0. to examine whether the association between sTREM2 and POD was mediated by CSF POD biomarkers. We also used potential predictive factors to built 5 models, including Logistic Regression (LR), Support Vector Machine (SVM), K Nearest Neighbours (KNN), AdaBoost and CatBoost to assess the predictive abilities of sTREM2. After that, we verified the performance of the 5 models in the set, plotting receiver operating characteristic (ROC) curve analysis and precision recall curve (PRC) were used to further evaluate whether the machine learning (ML) models were effective in supporting clinical decision-making. All POD patients were followed up for three years, and Kaplan-Meier (K-M) survival analysis was used to compare the 3-year mortality rates of high sTREM2 group and low sTREM2 group in patients with POD.</p><p><strong>Results: </strong>Finally, a total of 545 patients (122patients in POD group and 423in NPOD group) were included in our study. sTREM2 and CSF levels of tau and ptau in the POD group were higher than those in the NPOD group. CSF Aβ42, Aβ42/ tau, and Aβ42/ ptau in the POD group were lower than those in the NPOD group. CSF sTREM2 was negatively associated with Aβ42 (r = - 0.445, P < 0.001), Aβ42/ tau (r = - 0.350, P < 0.001) and Aβ42/ ptau (r = - 0.429, P < 0.001), CSF sTREM2 was positively associated with tau (r = 0.179, P = 0.048) and ptau (r = 0.311, P < 0.001). The relationship between sTREM2 and POD was partially mediated by tau and ptau, with the mediation proportion of 17.91% and 22.09%, respectively. The following","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029890","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":"Commentary on \"DeepSeek-R1 and GPT-4 are comparable in a complex diagnostic challenge: a historical control study\".","authors":"Hanzhe Lv, Longhao Chen, Zhizhen Lv, Lijiang Lv","doi":"10.1097/JS9.0000000000003335","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003335","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029801","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":"Guideline adherence in surgical decisions for T1 colorectal cancer after endoscopic resection: large language models vs clinicians.","authors":"Liangtang Zeng, Cao Qinxing, Junyuan Deng, Junnan Hu, Minghui Pang, Feng Liu","doi":"10.1097/JS9.0000000000003492","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003492","url":null,"abstract":"<p><strong>Background: </strong>Patients with T1 colorectal cancer (CRC) often show poor adherence to guideline-recommended treatment strategies after endoscopic resection. To address this challenge and improve clinical decision-making, this study aims to compare the accuracy of surgical management recommendations between large language models (LLMs) and clinicians.</p><p><strong>Methods: </strong>This retrospective study enrolled 202 patients with T1 CRC who underwent endoscopic resection at three hospitals. We compared the decision-making accuracy of two representative LLMs (ChatGPT-4o and DeepSeek) with that of 29 clinicians in determining whether additional surgery was required after endoscopic resection of T1 CRC. To optimize the inputs for the LLMs, we applied a prompt-engineering strategy that combined role prompting, in-context learning, and few-shot learning.</p><p><strong>Results: </strong>In clinical practice, we found that the guideline adherence rate after endoscopic resection for T1 CRC was below 80%. We analyzed the pathology reports of 200 patients with T1 CRC, and the results showed that both ChatGPT-4o and DeepSeek significantly outperformed clinical physicians. Subgroup analyses demonstrated that LLMs outperformed doctors regardless of years of experience or professional background. Additionally, the use of Chinese or English input had no significant impact on the performance of the LLMs.</p><p><strong>Conclusion: </strong>This study highlights the potential of LLMs to improve guideline adherence in the post-endoscopic resection management of T1 CRC.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029852","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":"Tumor-phrenic nerve spatial relationship and intraoperative traction-induced injury during mediastinal tumor resection: implications for real-time protective strategies.","authors":"Lei Zhu, Ziming Wang, Hongdou Ding, Fugui Yang, Minwei Bao, Jiaoyu Yi, Bo Tao","doi":"10.1097/JS9.0000000000003399","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003399","url":null,"abstract":"<p><strong>Background: </strong>Phrenic nerve injury during mediastinal tumor resection can lead to significant postoperative diaphragmatic dysfunction. Current intraoperative protection techniques are imprecise and lack real-time feedback. We aimed to develop and validate a quantifiable, multimodal neuroprotective strategy.</p><p><strong>Methods: </strong>A total of 370 patients undergoing minimally invasive mediastinal tumor resection were enrolled in a two-phase cohort. Tumor-nerve spatial parameters, traction force, and intraoperative temperature were measured. The intervention group received automated cold saline irrigation and pharmacologic protection triggered by predefined thresholds.</p><p><strong>Results: </strong>Phrenic nerve injury occurred in 8.1% of the intervention group versus 18.4% in controls (P = 0.009). Median time to diaphragmatic excursion recovery ≥1.5 cm was significantly shorter (5.2 vs 8.6 weeks, P < 0.001). LOESS curves revealed sharp inflection points in injury probability at tumor-nerve distance <4 mm, traction >10 min, and local temperature >39.5°C. Multivariate Cox analysis confirmed all three as independent predictors (HRs: 2.17, 1.88, and 2.04, respectively). At 90 days, patients in the intervention group demonstrated superior pulmonary function (FEV₁: 2.04 vs 1.83 L), longer 6-minute walk distance (442 vs 388 m), and higher QOL scores (77.0 vs 69.4; all P < 0.01). Cost-effectiveness analysis showed average savings >$3,000 and QALY gains in all tumor subtypes.</p><p><strong>Conclusion: </strong>This study demonstrates that real-time, threshold-guided modulation of intraoperative mechanical and thermal stress can reduce phrenic nerve injury and enhance recovery, particularly in anatomically preserved but functionally vulnerable nerves. Rather than replacing surgical judgment, the proposed strategy provides a quantifiable, replicable adjunct for nerve preservation in technically challenging thoracic procedures.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029785","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 editor about prediction of sepsis among patients with major trauma using artificial intelligence: a multicenter validated cohort study.","authors":"Yiran Yuan, Xuewen Jia, Bo Qi","doi":"10.1097/JS9.0000000000003353","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003353","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033248","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: \"Dynamic CtDNA monitoring in adjuvant therapy and recurrence for colorectal liver metastases (PKUCRLM-01): a prospective study\".","authors":"Kehang Dai, Ping Chen, Chengting Zheng","doi":"10.1097/JS9.0000000000003468","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003468","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033318","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}