{"title":"Infection control challenges of extrapulmonary tuberculosis in surgery: an overlooked risk.","authors":"Jiao Shan, Wei Huai, Yulong Cao","doi":"10.1097/JS9.0000000000003686","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003686","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145300606","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}
Jinlin Wu, Meng Xiao, Duanduan Chen, Jie Chen, Guangyun Zhang
{"title":"From overlooked metric to clinical action: ascending aortic length as a translational breakthrough in elective thoracic aneurysm surgery.","authors":"Jinlin Wu, Meng Xiao, Duanduan Chen, Jie Chen, Guangyun Zhang","doi":"10.1097/JS9.0000000000003685","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003685","url":null,"abstract":"<p><strong>Background: </strong>Ascending aortic length (AAL) has long been overlooked in assessing the risk of adverse aortic events (AAE) in patients with ascending thoracic aortic aneurysm (ATAA). Our team was among the first globally to investigate AAL's role, and this work contributed to the update of international guidelines. Further, this study aimed to provide mechanistic evidence for AAL as a surgical indicator.</p><p><strong>Methods: </strong>AAL was measured from the aortic annulus to the origin of the innominate artery along the centerline. Patient-specific FSI models were constructed, and hemodynamic parameters including time-averaged wall shear stress (TAWSS), maximum wall shear stress (WSS), average wall stress (WS), maximum WS, oscillatory shear index (OSI), and particle residence time (PRT) were analyzed.</p><p><strong>Results: </strong>Compared with the control group (AAL <11 cm), patients with elongated AAL (≥11 cm) showed significantly disturbed hemodynamics: decreased TAWSS (0.8 vs 1.1 Pa, p = 0.002), increased average WS (177 644.5 vs 158 342.8 Pa, p<0.001), increased maximum WS (876 760.0 vs 770 420.0 Pa, p = 0.013), increased average OSI (0.2 ± 0.0 vs 0.1 ± 0.0, p = 0.002), and increased average PRT (2.7 vs 1.9, p<0.001). A strong dose-response relationship was observed when AAL was divided into quartiles (Q1-Q4), with TAWSS decreasing and WS, OSI, PRT increasing progressively with longer AAL (all p<0.001).</p><p><strong>Conclusion: </strong>Elongated AAL is associated with worsening hemodynamics in a proportional manner, confirming its validity as a surgical indicator for ATAA.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145300567","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 massive abdominal bleeding in duodenal fistula patients with uncontrolled abdominal infection after delayed transfer to tertiary centers: a multicenter prospective study.","authors":"Fan Yang, Weiliang Tian, Juqiang Zhang, Wuhan Li, Zheng Yao, Shen Tao, Xin Xu, Risheng Zhao, Xinhao Chen, Jieyan Xu, Yunzhao Zhao, Qian Huang","doi":"10.1097/JS9.0000000000003297","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003297","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to develop and validate a nomogram for predicting massive abdominal bleeding in patients with duodenal fistulas and uncontrolled abdominal infection following delayed transfer to tertiary centers.</p><p><strong>Methods: </strong>This multicenter (A, B, C, and D) prospective cohort study included 389 patients from four centers. A nomogram was developed using Least Absolute Shrinkage and Selection Operator regression and multivariate logistic analysis on data from 240 patients (from center A), and validated on 149 patients (from center B, C, and D). The model's performance was assessed using concordance index, calibration plots, and decision curve analysis.</p><p><strong>Results: </strong>Six predictors were identified: output ≥1000 mL/day, Sequential Organ Failure Assessment score on admission, infection invading the retroperitoneum, laparotomy requirement, endoscopic fistula diameter ≥2 cm, and International Society on Thrombosis and Haemostasis score ≥5. The nomogram showed good predictive accuracy, with concordance indices (C-indices) of 0.87 (95% CI: 0.80-0.91) in the development cohort and 0.82 (95% CI: 0.74-0.88. Calibration plots showed good agreement between predicted and observed bleeding rates.</p><p><strong>Conclusion: </strong>The developed nomogram offers a tailored approach to risk stratification for massive abdominal bleeding in duodenal fistula patients delayed transfer to tertiary centers. This tool might enhance clinical decision-making and improve patient outcomes.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145300685","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 Regarding \"Comparison of oncological and functional outcomes in lower-limb osteosarcoma pediatric patients: a large single-center retrospective cohort study\".","authors":"Yuxuan Wu, Jianlan Wang","doi":"10.1097/JS9.0000000000003646","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003646","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145300663","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 prolonged versus short-term infusion of meropenem for the treatment of sepsis: a systematic review and meta-analysis.","authors":"Dandan Weng, Wanjun Ye, Jiansen Lv","doi":"10.1097/JS9.0000000000003679","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003679","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145300660","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 Association between the advanced lung cancer inflammation index and all-cause mortality in the US MASLD/MetALD patient population: a cohort study.","authors":"Ke Cao, Dandan Weng, Zhe Li","doi":"10.1097/JS9.0000000000003676","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003676","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145300656","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}
Dong-Won Kang, Shouhao Zhou, Chanhyun Park, Russell Torres, Abhinandan Chowdhury, Suman Niranjan, Charles Vining, Colette Pameijer, Chan Shen
{"title":"Advancing postoperative mortality prediction in gastrectomy: a machine learning approach using NSQIP data.","authors":"Dong-Won Kang, Shouhao Zhou, Chanhyun Park, Russell Torres, Abhinandan Chowdhury, Suman Niranjan, Charles Vining, Colette Pameijer, Chan Shen","doi":"10.1097/JS9.0000000000003688","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003688","url":null,"abstract":"<p><strong>Background: </strong>Accurate prediction of mortality risk in gastrectomy is critical to optimize surgical management and improve patient outcomes. This study aims to develop machine learning (ML) models for predicting 30-day postoperative mortality following gastrectomy and identify key predictors.</p><p><strong>Methods: </strong>We utilized the NSQIP Participant Use Data File from 2017 to 2022 to develop ML models: (1) random forest, (2) gradient-boosted tree, and (3) XGBoost model. A simple logistic regression model was further developed to compare the model prediction. We trained each model using a comprehensive set of variables available in the NSQIP data (Model C) or 17 variables included in the existing ACS NSQIP risk calculator (Model L). We used the area under the receiver operating characteristics curve to evaluate the model performance and employed SHapley Additive exPlanations algorithms on the best performing model to identify the most impactful predictors.</p><p><strong>Results: </strong>Of 7,954 patients who underwent gastrectomy, approximately 4.3% of patients died within 30 days following gastrectomy. In both Model C and Model L, the XGBoost model showed the best performance, followed by the random forest. The Model C outperformed the Model L, and all ML models outperformed simple logistic regression. In XGBoost model, preoperative blood urea nitrogen was the most important predictor, followed by age.</p><p><strong>Conclusion: </strong>The XGBoost model demonstrated the highest predictive performance for 30-day postoperative mortality following gastrectomy. Preoperative laboratory variables and age were key predictors. Incorporating ML-based models into clinical practice has the potential to enhance perioperative decision-making and improve patient outcomes after gastrectomy.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145300834","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--Supervising the recurrence of pancreatic ductal adenocarcinoma using CtDNA-based MIR129-2 methylation detection.","authors":"Man Sun, Dan Zang, Jun Chen","doi":"10.1097/JS9.0000000000003627","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003627","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286239","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}
Yining Lan, Luqi Guo, Dedi Tong, Jiuzuo Huang, Nanze Yu, Fengzhou Du, Xiao Long
{"title":"Optimizing limb salvage in critical mangled extremities: one-step acute repair with bilateral anterolateral thigh perforator flaps.","authors":"Yining Lan, Luqi Guo, Dedi Tong, Jiuzuo Huang, Nanze Yu, Fengzhou Du, Xiao Long","doi":"10.1097/JS9.0000000000003612","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003612","url":null,"abstract":"<p><strong>Background/objectives: </strong>Complex distal extremity trauma often involves both extensive soft tissue loss and vascular injury. While the anterolateral thigh (ALT) free flap is a mainstay for limb salvage, large defects may exceed the capacity of a single flap and are associated with higher complication rates. We report a one-stage bilateral ALT free-flap reconstruction strategy designed to provide stable wound coverage and improve functional outcomes.</p><p><strong>Methods: </strong>In six patients with severe distal extremity trauma (affecting upper or lower limbs) treated from 2018 to 2020, one-stage reconstruction was performed using bilateral ALT free flaps. Flaps were inset via tandem or parallel vascular configurations based on recipient vessel status. Functional outcomes were assessed by DASH scores (upper limbs) or LEFS (lower limbs) with 5 years of follow-up. Four patients had postoperative photon-counting CT (PCCT) angiography to assess anastomotic patency.</p><p><strong>Results: </strong>All flaps survived without major complications. By final follow-up, all patients had achieved stable soft-tissue coverage and satisfactory functional recovery. Functional outcome scores improved in every case, and notably the pediatric patient attained normal gait and limb development after reconstruction. The four patients underwent PCCT angiography were confirmed patent anastomoses and robust perfusion.</p><p><strong>Conclusions: </strong>One-stage bilateral ALT free-flap reconstruction is a safe and feasible approach for complex distal extremity trauma. It provides reliable wound coverage and facilitates timely functional recovery while avoiding the morbidity of staged procedures. Long-term outcomes demonstrate sustained flap viability and functional gains, supporting this approach to avoid staged procedures and improve limb salvage.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145300673","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 on \"Association between post-trauma platelet-lymphocyte ratio and nonunion in patients with extremity fractures: a multicenter retrospective cohort study\".","authors":"Yongmei Jiang, Yunxia Du","doi":"10.1097/JS9.0000000000003636","DOIUrl":"https://doi.org/10.1097/JS9.0000000000003636","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286225","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}