International journal of surgery最新文献

{"title":"Effectiveness of ERAS program on postoperative recovery after gastric cancer surgery: a randomized clinical trial.","authors":"Ho-Jin Lee, Jeesun Kim, Soo-Hyuk Yoon, Seong-Ho Kong, Won Ho Kim, Do Joong Park, Hyuk-Joon Lee, Han-Kwang Yang","doi":"10.1097/JS9.0000000000002328","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002328","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have reported the effectiveness of the \"enhanced recovery after surgery\" program in patients who underwent gastric cancer surgery, mostly based on the 2014 gastrectomy guidelines. Therefore, based on subsequent advancements in perioperative management, this randomized, controlled, open-label, single-center study aimed to assess the impact of a recent evidence-based multimodal enhanced recovery after surgery program on the quality of early recovery after gastric cancer surgery.</p><p><strong>Materials and methods: </strong>This study included adult patients scheduled to undergo elective laparoscopic or robotic distal gastrectomy for gastric cancer. Patients were randomly assigned to the enhanced recovery after surgery or conventional group. The primary outcome was the total Quality of Recovery-15 score assessed 24, 48, and 72 h postoperatively. Differences between both groups were evaluated using a linear mixed-effects model. We hypothesized that an increase of at least 8 points in the Korean version of Quality of Recovery-15 scores would indicate a clinically significant improvement, consistent with the minimal clinically important difference (≥8) for Quality of Recovery-15. Secondary outcomes included pain scores at rest and during coughing, cumulative fentanyl consumption through intravenous patient-controlled analgesia, postoperative nausea/vomiting incidence, and gastrointestinal dysfunction as measured using the I-FEED score - all assessed 24, 48, and 72 h postoperatively.</p><p><strong>Results: </strong>For the 92 patients examined (enhanced recovery after surgery, n = 45; conventional, n = 47), the estimated difference in the postoperative Quality of Recovery-15 total scores between the two groups during the first days was significantly larger than the minimal clinically important difference of Quality of Recovery-15 (mean difference: 16.0, 95% confidence interval: 8.9-23.0, P < 0.001). Therefore, excluding the incidence of postoperative nausea/vomiting, the enhanced recovery after surgery group demonstrated significant improvements in other secondary outcomes.</p><p><strong>Conclusions: </strong>Our evidence-based multimodal enhanced recovery after surgery program significantly improved the quality of early postoperative recovery after minimally invasive distal gastrectomy.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605071","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 and safety of preoperative biliary drainage in patients with Hilar Cholangiocarcinoma: a systematic review and meta-analysis.","authors":"Xiuwen Chen, Xueyi Wei, Liqing Yue, Yao Xiao","doi":"10.1097/JS9.0000000000002324","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002324","url":null,"abstract":"<p><strong>Background: </strong>Preoperative biliary drainage (PBD) has been proposed as a strategy to manage the complications associated with biliary obstruction in hilar cholangiocarcinoma patients. However, the efficacy and safety of PBD in remain controversial, even in clinical guidelines. This meta-analysis aimed to provide a comprehensive evaluation of the efficacy and safety of PBD in patients with hilar cholangiocarcinoma.</p><p><strong>Methods: </strong>PubMed, Medline, Embase, Cochrane Library and registers were screened to investigated the efficacy and safety of preoperative biliary drainage in patients with hilar cholangiocarcinoma. The search timeframe was set before December 2024. Mortality, morbidity and postoperative infection served as the primary outcomes, while the secondary outcomes included transfusion, operative time, operative bloody loss, intraabdominal abscess, intraabdominal bleeding, leakage (bile leake or anastomotic leakage), hepatic insufficiency, renal insufficiency, second laparotomy, total hospital stay, cholangitis. Studies were evaluated for quality by Newcastle-Ottawa scale. Data were pooled as odds ratio (OR) or standard mean difference (SMD).</p><p><strong>Results: </strong>Our meta-analysis of 21 studies (3,059 patients) showed that PBD reduced hepatic insufficiency(OR = 0.38, 95% CI = 0.16-0.90, P = 0.03, I2 = 69%) but increased risks of long term follow up mortality (OR = 1.90, 95% CI = 1.02-3.56, P = 0.04, I2 = 0%), morbidity (OR = 1.47, 95% CI = 1.12-1.92, P = 0.01, I2 = 52%), postoperative infection(OR = 2.46, 95% CI = 1.17-5.18, P = 0.02, I2 = 69%), transfusion(OR = 1.39, 95% CI = 1.06-1.81, P = 0.02, I2 = 49%), leakage(OR = 1.67, 95% CI = 1.08-2.60, P = 0.02, I2 = 44%), cholangitis (OR = 6.40, 95% CI = 1.75-23.48, P = 0.01, I2 = 51%), and prolonged hospital stay(SMD = 0.53, 95% CI = 0.06-0.99, P = 0.03, I2 = 87%). There was no difference in overall mortality, operative time, blood loss, or other complications (P > 0.05). Subgroup analysis showed that differences in some outcomes lost significance with higher bilirubin levels, fewer PBD cases, studies published after 2010, and strictly select PBD patients (P < 0.05).</p><p><strong>Conclusions: </strong>Routine PBD cannot be recommended but it tends to be a better choice in patients with average initial bilirubin above 218.75 μmol/l, portal vein embolization and malnutrition. Further multicenter randomized studies should address the potential advantages of PBD over NPBD, identify clear patient selection criteria, and determine the optimal bilirubin threshold for PBD.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605072","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":"Management of high-surgical risk patients with acute cholecystitis following percutaneous cholecystostomy. results of an international Delphi consensus study.","authors":"Antonio Pesce, Camilo Ramirez-Giraldo, Nikolaos-Achilleas Arkoudis, George Ramsay, Georgi Popivanov, Kurinchi Gurusamy, Natalia Bejarano, Maria Irene Bellini, Massimiliano Allegritti, Jacopo Tesei, Alessandro Gemini, Augusto Lauro, Matteo Matteucci, Antonio La Greca, Valerio Cozza, Federico Coccolini, Marco Cannistra', Carlo Boselli, Piero Covarelli, Gianluca Costa, Paolo Bruzzone, Giovanni Domenico Tebala, Simona Meneghini, Vito D'Andrea, Andrea Mingoli, Eugenio Cucinotta, Antonia Rizzuto, Mauro Zago, Paolo Prosperi, Massimo Buononato, Gioia Brachini, Roberto Cirocchi","doi":"10.1097/JS9.0000000000002325","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002325","url":null,"abstract":"<p><strong>Background: </strong>The management of high-surgical risk patients with moderate to severe acute cholecystitis is challenging in clinical practice. Early laparoscopic cholecystectomy is considered the gold standard for patients who do not respond to conservative treatment. However, for those unfit for surgery due to high-surgical risk, alternative treatment options such as percutaneous cholecystostomy (PC) are available. There are no clear guidelines regarding the management of patients following PC. The primary aim of this study was to propose indications for PC in high-surgical risk patients with acute cholecystitis and to establish management strategies for gallbladder drainage, either as a bridge to surgery or as definitive treatment, according to available literature data.</p><p><strong>Materials and methods: </strong>After a targeted literature review, International and XXX experts in the field from the XXXXX and the XXXXX were consulted to provide their evidence-based opinions on the topic. Statements were proposed during subsequent rounds using Delphi methodology. Ten statements were provided and the final agreement is presented in this study.</p><p><strong>Results: </strong>Patients with moderate acute cholecystitis, a Charlson Comorbidity Index (CCI) ≥ 6, and American Society of Anesthesiologists-Performance Status (ASA-PS) ≥ 3 who fail conservative treatment should undergo laparoscopic cholecystectomy as the first choice. For patients with severe acute cholecystitis who are at high-surgical risk, percutaneous cholecystostomy is recommended to relieve symptoms within 24-48 hours. Once the infection is controlled, we should assess which patients may be candidates for interval laparoscopic cholecystectomy. For patients selected for surgery, laparoscopic cholecystectomy is recommended at least six weeks after PC placement. In patients not suitable for surgery, such as those with CCI ≥6 and ASA-PS ≥4, percutaneous cholecystostomy should remain in place for at least three weeks, after which, following radiographic confirmation of biliary tree patency, the tube may be removed.</p><p><strong>Conclusions: </strong>This study represents the first consensus on this specific topic, characterized by a unique multidisciplinary approach involving interventional radiologists, gastroenterologists, and surgeons who shared their opinions and experiences. We also believe this consensus may offer a straightforward and safe guide for clinicians when managing high-risk surgical patients with acute cholecystitis in daily clinical practice.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605074","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":"Effect of chewing gum on clinical outcomes and postoperative recovery in adult patients after gastrointestinal surgery: an umbrella review.","authors":"Shu Ling Lew, Ling Jie Cheng, Siat Yee Yap, Yi Qi Liaw, Jiyoung Park, Siew Tiang Lau","doi":"10.1097/JS9.0000000000002332","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002332","url":null,"abstract":"<p><strong>Background: </strong>Gastrointestinal surgery is crucial for many medical conditions but can lead to difficult recoveries. Chewing gum is proposed as a remedy, yet existing reviews offer conflicting results. This umbrella review aims to synthesize the effectiveness of chewing gum on time to first flatus, time to first bowel movement, length of stay and complication rates in adult patients.</p><p><strong>Methods: </strong>We conducted an umbrella review, searching seven databases up to 17 November 2023, with an updated search extending to 1 January 2025. The focus was on post-surgery chewing gum interventions. The quality and certainty of evidence were assessed using the AMSTAR-2 tool and umbrella review criteria.</p><p><strong>Results: </strong>Seventeen reviews, encompassing 26,672 participants from 264 primary studies, were included. Meta-analyses indicated reductions in time to first flatus by -0.36 days (95% CI = - 0.61, - 0.1) or -12.26 hours (95% CI = - 14.73, - 9.78), time to first bowel movement by -0.59 days (95% CI = - 0.94, - 0.23) or -19.29 hours (95% CI = - 23.79, - 14.79), and length of stay by -0.85 days (95% CI = - 1.22, - 0.48) or -20.08 hours (95% CI = - 28.62, - 11.54). Additionally, chewing gum was associated with fewer postoperative complications.</p><p><strong>Conclusion: </strong>Chewing gum may significantly aid postoperative care by reducing time to first flatus, time to first bowel movement, and length of stay. However, many included reviews were of low quality with weak evidence, highlighting the need for more rigorous studies to confirm these benefits. Integrating chewing gum into clinical practice could enhance recovery and optimise hospital bed turnover, making it a valuable addition to postoperative care protocols.</p><p><strong>Registration: </strong>PROSPERO Number: CRD4202451XXXX.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605070","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 risks of autoimmune inflammatory outcomes in patients infected with SARS-CoV-2: a longitudinal, population-based cohort study.","authors":"Lijun Zhang, Dong Chen, Yu Long, Lingyi Li, Yanlin Lyu, Meijun Meng, Yuying Ma, Yanjun Wu, Felix W Leung, Weihong Sha, Hao Chen, Yufeng Liu","doi":"10.1097/JS9.0000000000002333","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002333","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605075","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":"Breast neurotization along with breast reconstruction after nipple sparing mastectomy enhances quality of life and reduces denervation symptoms in patient reported outcome: a prospective cohort study.","authors":"Shiuan Shyu, Tommy Nai-Jen Chang, JohnnyChuieng-Yi Lu, Chia-Fang Chen, David Chon-Fok Cheong, Shu-Wei Kao, Wen-Ling Kuo, Jung-Ju Huang","doi":"10.1097/JS9.0000000000002331","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002331","url":null,"abstract":"<p><strong>Objective: </strong>Persistent postoperative sensory loss significantly limits breast reconstruction following mastectomy. In addition, the absence of sensation profoundly impacts patients' physical well-being and overall quality of life. New surgical techniques involving nerve autograft intercostal nerve elongation have been introduced to neurotize reconstructed breasts. However, patient quality of life after neurotization has not been well evaluated. This study aimed to investigate improvements in patient quality of life in association with breast neurotization.</p><p><strong>Methods: </strong>A prospective cohort study of 132 patients treated at (blinded for review) between January 2018 and December 2022 was conducted. Two groups of patients who underwent nipple-sparing mastectomy (NSM) and breast reconstruction were compared: those with (n = 67) and without (n = 65) breast neurotization. Patient-reported outcomes were assessed via the BREAST-Q reconstruction module questionnaire and an additional questionnaire measuring sensation, nipple satisfaction, and breast symptoms. Objective measurements were conducted via the Semmes-Weinstein monofilaments test.</p><p><strong>Results: </strong>With respect to patient-reported outcomes, the innervated group had significantly higher scores for nipple sensation and on the BREAST-Q domains of psychosocial well-being (71.6 ± 18.1 vs. 62.8 ± 18.6, P = 0.006), sexual well-being (56.9 ± 22.1 vs. 47.3 ± 20.7, P = 0.015), satisfaction with the medical team, as well as less frequent post-operative breast symptoms. In the subgroup analysis, the innervated group demonstrated higher scores in both autologous flap and implant-based reconstruction. Linear regression revealed a statistically significant relationship between objectively measured monofilament value and subjectively examined patient-reported outcomes: nipple sensation, breast sensation, and BREAST-Q score for the psychosocial well-being domain (coefficient: - 4.922, P = 0.033).</p><p><strong>Conclusion: </strong>Breast reconstruction with autologous nerve graft neurotization yields improved sensory outcomes and has a statistically significant positive impact on the quality of life of breast reconstruction patients.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605069","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":"Higher life's essential 8 score is associated with reduced risk of related surgery and all-cause mortality among 3,232 individuals with inflammatory bowel disease in a longitudinal cohort study.","authors":"Fangmin Jing, Yuxuan Cao, Qijia Gong, Lintao Dan, Yuexin Zhu, Fernando Magro, Tian Fu, Jie Chen, Xiaoyan Wang","doi":"10.1097/JS9.0000000000002335","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002335","url":null,"abstract":"<p><strong>Background: </strong>Previous studies indicated discrete lifestyle health metrics that benefit cardiovascular health are associated with better prognosis in inflammatory bowel disease (IBD), while evidence regarding the comprehensive impact of cardiovascular health remains limited. This study aimed to investigate the association between the overall cardiovascular health indicator, Life's Essential 8 (LE8), and the adverse outcomes of IBD.</p><p><strong>Materials and methods: </strong>We included 3,232 IBD participants recruited from the UK Biobank between 2006 and 2010. LE8 encompasses 8 metrics, including physical activity, diet, sleep health, nicotine exposure, body mass index, blood glucose, blood lipids, and blood pressure. The adverse outcomes studied in our study included IBD-related surgery and all-cause mortality. Hazard ratios (HRs) with 95% confidence intervals (CIs) for the strength of the associations between LE8 score and IBD-related surgery as well as all-cause mortality were calculated using Cox proportional hazard models.</p><p><strong>Results: </strong>Over a mean (standard deviation) follow-up of 12.60 (2.74) years and 13.17 (1.89) years, 282 IBD-related surgery and 259 death events were recorded. UC patients with a high LE8 score showed decreased risk of IBD-related surgery (HR 0.47, 95% CI 0.26, 0.87) and all-cause mortality (HR 0.47, 95% CI 0.25, 0.87), in comparison to those with a low LE8 score. No significant associations were observed between LE8 score and the risk of IBD-related surgery and all-cause mortality among CD in the primary analyses.</p><p><strong>Conclusion: </strong>Participants with a higher LE8 score showed decreased risk of IBD-related surgery and all-cause mortality among UC, but not CD, underscoring the significance of implementing LE8 as a management approach in improving the prognosis of UC.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605073","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":"Comments on \"worldwide research trends on tumor burden and immunotherapy: a bibliometric analysis\".","authors":"Guangtao Han, Lijun Cai, Qin Wang, Shuo Sun, Pengde Kang","doi":"10.1097/JS9.0000000000001504","DOIUrl":"https://doi.org/10.1097/JS9.0000000000001504","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575597","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 perioperative dexmedetomidine on postoperative pain and neurocognitive functions in orthopaedic surgery: a systematic review and meta-analysis with trial sequential analysis of randomized controlled trials.","authors":"Xiang Zhang, Yu Leng, Xiurong Yuan, Yaoxin Yang, Cheng Zhou, Hao Liu","doi":"10.1097/JS9.0000000000002315","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002315","url":null,"abstract":"<p><strong>Introduction: </strong>With an estimated 2.1 million hip and knee replacements performed annually in developed countries, orthopaedic surgeries can result in complications such as postoperative pain and cognitive dysfunctions. Dexmedetomidine shows potential for reducing pain and opioid use and improving cognitive outcomes, but its efficacy in orthopaedic settings needs further evaluation.</p><p><strong>Methods: </strong>A comprehensive literature search was performed across electronic databases (e.g. PubMed) up to 1 June 2024, to identify relevant randomised controlled trials (RCTs) investigating the use of dexmedetomidine for orthopaedic surgeries. The primary outcomes included visual analogue scale (VAS), opioid consumption, incidence of postoperative cognitive dysfunction (POCD) and postoperative delirium (POD). The meta-analysis was conducted via RevMan 5.3 and Stata 16.0, with statistical significance set at p < 0.05. Sensitivity analyses, along with trial sequential analysis (TSA), were used to evaluate the robustness of the findings.</p><p><strong>Results: </strong>The meta-analysis included 59 RCTs with 7,713 participants and demonstrated that dexmedetomidine significantly reduced postoperative VAS score [mean difference (MD) - 0.50, P = 0.0003] and opioid consumption (MD -11.91, P<0.0001) and decreased the incidence of POCD [risk ratio (RR) 0.59, P = 0.006] and POD (RR 0.49, P<0.0001). Dexmedetomidine also prolonged motor (MD: 1.70, P<0.0001), sensory block durations (MD: 1.80, P<0.0001), and delayed the time to first rescue analgesics (MD: 1.51, P<0.0001). TSA and sensitivity analysis confirmed the robustness and reliability of the results, whereas meta-regression revealed no significant effect of variables on primary outcomes.</p><p><strong>Conclusion: </strong>Our study demonstrates that intravenous dexmedetomidine significantly improved postoperative pain and neurocognitive functions in orthopaedic surgery patients.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556942","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":"3D bioprinted functional scaffold based on synergistic induction of iprf and laponite exerts efficient and personalised bone regeneration via MiRNA-mediated TGF-β/Smads signaling.","authors":"Bojun Cao, Kunqi Zhang, Rongtai Zuo, Zhiyang Kang, Jieming Lin, Zhixuan Kang, Dinghao Luo, Yimin Chai, Jia Xu, Qinglin Kang, Shuo Qiu","doi":"10.1097/JS9.0000000000002312","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002312","url":null,"abstract":"<p><strong>Background: </strong>Limited stem cells, low vascularization efficiency and weak osteoinductive activity plague the repair and reconstruction of bone defects with cell-free scaffolds.</p><p><strong>Methods: </strong>Herein, injectable platelet-rich fibrin (i-PRF) was loaded into a methacrylated alginate/gelatin-methylcellulose (AGM) bioink system and constructed a porous hydrogel scaffold by three-dimensional bioprinting. The addition of nanosilicate-laponite (Lap) further enhanced this scaffold and synergized with i-PRF to promote efficient and personalized cranial regeneration.</p><p><strong>Results: </strong>At the biochemical level, Lap significantly enhanced the ability of the scaffold to retard growth factor release, and multiple physiologically proportional growth factors in the scaffold synergistically promoted rapid neoangiogenesis and concomitantly recruited endogenous BMSCs. More importantly, the bioactive ions released by Lap markedly promoted the proliferation of BMSCs and consistently induced the osteogenic differentiation of BMSCs; At the immunological level, iPRF-AGM@Lap significantly attenuates the inflammatory response by promoting macrophage M2 polarization. Mechanistically, miRNA sequencing and functional validation experiments demonstrated that bioactive ions released by Lap could synergize with growth factors in iPRF to promote osteogenic differentiation of BMSC through the miR-21 and miR-125a-mediated TGF-β/Smads signaling pathway.</p><p><strong>Conclusion: </strong>The results of this study provide a new idea for the personalized treatment of bone defects.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541924","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}