International journal of surgery最新文献

{"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}

{"title":"Letter to the Editor on the Article \"Epineurectomy of Extracranial Facial Nerve Trunk for Non-flaccid Sequelae Following Bell's Palsy: a Single-arm Trial\".","authors":"Orlando Guntinas-Lichius","doi":"10.1097/JS9.0000000000002310","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002310","url":null,"abstract":"<p><p>Zhao H, Cai X, Zhang Z, Ying T, Tang Y, Wang H, Wang B, Li S. Epineurectomy of extracranial facial nerve trunk for non-flaccid sequelae following Bell's palsy: A single-arm trial. Int J Surg. 18 September 2024;111(1):536-42. doi: 10.1097/JS9.0000000000002080. Epub ahead of print. PMID: 39 291 959; PMCID: PMC11745721.</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":"143673790","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":"Intrawound vancomycin powder for prevention of surgical site infections in primary joint arthroplasty: an umbrella review of systematic reviews and meta-analyses.","authors":"Zhong Zhu, Tao-Hsin Tung, Yongwei Su, Yimin Li, Hua Luo","doi":"10.1097/JS9.0000000000002316","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002316","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this umbrella review is to explore the effect of intrawound vancomycin on the incidence of infection and wound complications in patients undergoing primary joint arthroplasty.</p><p><strong>Methods: </strong>Two authors conducted a systematic search of PubMed, EMBASE, Medline, and the Cochrane Central Register of Controlled Trials from inception to 15 October 2023. All systematic reviews and meta-analyses examining the effect of intrawound vancomycin on the incidence of infection and wound complications in primary joint arthroplasty were included. Two authors independently screened and extracted the data from the studies, evaluated the methodological quality of the included studies using the Assessment of Multiple Systematic Reviews scale, and assessed the publication bias and small-sample effects.</p><p><strong>Results: </strong>Our umbrella review includes a total of five systematic reviews, comprising 16 retrospective studies. The pooled results indicate that intrawound vancomycin significantly reduces overall infection rates (OR: 0.41; 95% CI: 0.30-0.54, P < 0.001), superficial infections (OR: 0.51; 95% CI: 0.26-0.97, P = 0.04), and periprosthetic joint infection (PJI) rates (OR: 0.38; 95% CI: 0.28-0.52, P < 0.001) among patients undergoing primary joint arthroplasty. However, vancomycin did not increase the risk of aseptic wound complications (OR: 1.34; 95% CI: 0.88-2.04, P = 0.17) and prolong wound healing (OR: 1.40; 95% CI: 0.87-2.26, P = 0.17).</p><p><strong>Conclusions: </strong>Based on the available research, our umbrella review demonstrates that intrawound vancomycin significantly reduces infection rates in primary joint arthroplasty, including periprosthetic joint and superficial infections, without increasing wound complications. However, given the inclusion of studies with varying quality, these findings should be interpreted with caution. Further high-quality studies are needed to better confirm its long-term safety, cost-effectiveness, and overall clinical utility.</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":"143541927","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: the incidence and outcomes of hyperacute cardiovascular dysfunction following isolated traumatic brain injury: an observational cohort study.","authors":"Yu Chang, Kuan-Yu Chi, Hany Atwan","doi":"10.1097/JS9.0000000000002314","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002314","url":null,"abstract":"","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":"143541929","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":"Clinical value of aortic arch morphology in transfemoral TAVR: artificial intelligence evaluation.","authors":"Yu Mao, Yang Liu, Mengen Zhai, Ping Jin, Fangyao Chen, Yuhui Yang, Guangyu Zhu, Tingting Yang, Gejun Zhang, Kai Xu, Xiaoke Shang, Yuan Zhao, Buqing Ni, Hongxin Li, Min Tang, Zhao Jian, Yining Yang, Haibo Zhang, Lai Wei, Jian Liu, Timothée Noterdaeme, Ruediger Lange, Yingqiang Guo, Xiangbin Pan, Yongjian Wu, Jian Yang","doi":"10.1097/JS9.0000000000002232","DOIUrl":"10.1097/JS9.0000000000002232","url":null,"abstract":"<p><strong>Background: </strong>The impact of aortic arch (AA) morphology on the management of the procedural details and the clinical outcomes of the transfemoral artery (TF)-transcatheter aortic valve replacement (TAVR) has not been evaluated. The goal of this study was to evaluate the AA morphology of patients who had TF-TAVR using an artificial intelligence algorithm and then to evaluate its predictive value for clinical outcomes.</p><p><strong>Materials and methods: </strong>A total of 1480 consecutive patients undergoing TF-TAVR using a new-generation transcatheter heart valve at 12 institutes were included in this retrospective study. The AA measurements were evaluated by deep learning, and then the approach index (I A ) was determined. The machine learning algorithm was used to construct the predictive model and was validated externally.</p><p><strong>Results: </strong>The area under the curve of the I A model using random forest and logistic regression was 0.675 [95% confidence interval (CI): 0.586-0.764] and 0.757 (95% CI: 0.665-0.849), respectively. The I A model was validated externally, and consistent distinctions were obtained. After we used a generalized propensity score matching method for continuous exposure, the I A was the strongest correlation factor for major procedural events (odds ratio: 3.87; 95% CI: 2.13-7.59, P < 0.001). When leaflet morphology or transcatheter heart valve type was an interactive item with I A , neither of them was statistically significant in terms of clinical outcomes.</p><p><strong>Conclusion: </strong>I A may be used to identify the impact of AA morphology on procedural and clinical outcomes in patients having TF-TAVR and to help to predict the procedural complications.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2338-2347"},"PeriodicalIF":12.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046560","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":"Induction of M1 polarization in BV2 cells by propofol intervention promotes perioperative neurocognitive disorders through the NGF/CREB signaling pathway: an experimental research.","authors":"Ting Ye, Yiwei Fan, Xiangye Zeng, Xiaojing Wang, Huaping Xiao","doi":"10.1097/JS9.0000000000002257","DOIUrl":"10.1097/JS9.0000000000002257","url":null,"abstract":"<p><p>Nerve growth factor (NGF) is critical in regulating the homeostasis of microglial cells. It activates various signaling pathways that mediate the phosphorylation of cAMP response element-binding protein (CREB) at key regulatory sites. The decrease in phosphorylated CREB (p-CREB) expression is linked to neuroinflammatory responses. The exact molecular mechanism by which propofol regulates microglial polarization and induces neuroinflammation via the NGF/CREB signaling axis remains unclear. This study aims to investigate the specific mechanisms by which propofol induces perioperative neurocognitive disorders through microglial M1 polarization and neuroinflammation via the NGF/CREB signaling pathway. We demonstrated that propofol impairs neurocognitive function in mice, as evidenced by behavioral deficits. It reduces NGF expression in hippocampal microglia and BV2 cells, where protein-protein interactions between NGF and CREB suggest that NGF primarily regulates neurocognitive function by modulating p-CREB. Propofol intervention and inhibition of the NGF/CREB pathway promote M1 polarization in hippocampal microglia and BV2 cells, leading to reduced cell proliferation, increased apoptosis, elevated oxidative stress, and higher levels of the inflammatory marker TNF-α. Exogenous NGF does not alter the expression of NGF or total CREB but significantly upregulates p-CREB, indicating its regulatory role in signaling pathways associated with microglial activation. Moreover, exogenous NGF mitigates propofol-induced cognitive impairments and M1 polarization, reducing apoptosis and oxidative stress levels. Our findings suggest that propofol downregulates the expression of NGF and CREB, subsequently reducing p-CREB levels. This downregulation induces M1 polarization of microglia, promoting the progression of neuroinflammation and contributing to the development of perioperative neurocognitive disorders.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2439-2452"},"PeriodicalIF":12.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046711","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":"Small pulmonary nodule localization techniques in the era of lung cancer screening: a narrative review.","authors":"Hao Zhang, Chi Zhang, Lin Li, Jun Qi, Guo-Huan Yang, Ying-Qiang Li, Chang-Qi Gong","doi":"10.1097/JS9.0000000000002247","DOIUrl":"10.1097/JS9.0000000000002247","url":null,"abstract":"<p><p>The widespread adoption of high-resolution computed tomography (CT) screening has led to increased detection of small pulmonary nodules, necessitating accurate localization techniques for surgical resection. This review examines the evolution, efficacy, and safety of various localization methods for small pulmonary nodules. Studies focusing on localization techniques for pulmonary nodules ≤30 mm in diameter were included, with emphasis on technical success rates and complication profiles. Preoperative CT-guided techniques, including hook-wire (success rate 94-98%) and anchored needle localization (success rate >99%, dislodgement rate 0%) demonstrate high technical success rates, though with varying complication profiles. Microcoil localization (97-98% success) shows comparable efficacy with lower complication rates. Dye-based methods offer simplicity but can be limited by rapid diffusion. Newer techniques like medical adhesive localization (success rate up to 100%) and electromagnetic navigation bronchoscopy (97.2% success) show promise in reducing complications and improving accuracy. Intraoperative methods such as ultrasound and hybrid operating room approaches provide real-time guidance but may be limited by nodule characteristics and available expertise. This review presents a radar chart analysis comparing techniques across key parameters and introduces an innovative decision-making algorithm that considers nodule characteristics, patient factors, and institutional resources, providing practical guidance and serving as a reference for clinicians. While no single method is universally superior, the trend towards minimally invasive, precise, and flexible approaches is evident. Future research should focus on large-scale comparative studies and the integration of artificial intelligence for optimized technique selection and improved patient outcomes.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2624-2632"},"PeriodicalIF":12.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046717","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":"Could less be enough: sublobar resection vs lobectomy for clinical stage IA non-small cell lung cancer patients with visceral pleural invasion or spread through air spaces.","authors":"Zhang-Yi Dai, Cheng Shen, Xinwei Wang, Fu-Qiang Wang, Yun Wang","doi":"10.1097/JS9.0000000000002249","DOIUrl":"10.1097/JS9.0000000000002249","url":null,"abstract":"<p><strong>Background: </strong>While recent randomized controlled trials have demonstrated that sublobar resection (SLR) is non-inferior to lobectomy, the comparative efficacy of these procedures remains uncertain for early-stage non-small cell lung cancer (NSCLC; ≤3 cm) exhibiting invasive features postoperatively, such as visceral pleural invasion (VPI) or spread through air spaces (STAS).</p><p><strong>Materials and methods: </strong>To identify eligible studies, a comprehensive search of PubMed, Embase, MEDLINE, the Cochrane Library, and Web of Science was conducted through 25 July 2024. Studies were screened according to predefined criteria in accordance with PRISMA guidelines. The primary endpoints were 5-year overall survival (OS) and recurrence-free survival (RFS). Hazard ratios (HR) and 95% confidence intervals (CI) were used to perform a meta-analysis.</p><p><strong>Results: </strong>The final analysis included 14 retrospective studies and 1 randomized controlled trial, encompassing a total of 8054 patients with NSCLC (tumors ≤3 cm) exhibiting VPI or STAS. The meta-analysis revealed that SLR was associated with impaired 5-year OS (HR: 1.25; 95% CI: 1.10-1.41) and slightly inferior RFS (HR: 1.25; 95% CI: 0.99-1.58) compared to lobectomy for pT2a (VPI) NSCLC patients with tumor ≤3 cm. Similarly, SLR was associated with significantly worse 5-year OS (HR: 2.58; 95% CI: 1.92-3.45) and 5-year RFS (HR: 2.42; 95% CI: 1.69-3.46) compared to lobectomy for stage IA NSCLC patients with STAS. Subgroup analysis revealed that statistically significant differences in 5-year OS (HR: 1.13; 95% CI: 0.92-1.38) and 5-year RFS (HR: 0.87; 95% CI: 0.56-1.36) were not observed between the SLR and lobectomy groups for pT2a (VPI) NSCLC patients with tumor ≤2 cm. Additionally, no statistically significant survival difference was observed between the segmentectomy and lobectomy groups for NSCLC patients (≤3 cm) with VPI (5-year OS: HR: 1.16; 95% CI: 0.89-1.52; 5-year RFS: HR: 1.07; 95% CI: 0.88-1.30) or STAS (5-year OS: HR: 3.88; 95% CI: 0.82-18.31; 5-year RFS: HR: 1.64; 95% CI: 0.70-3.80).</p><p><strong>Conclusions: </strong>For early-stage (≤3 cm) NSCLC with VPI or STAS, SLR was associated with worse survival outcomes compared to lobectomy. However, segmentectomy achieved survival outcomes comparable to those of lobectomy. For pT2a (VPI) NSCLC patients with tumor ≤2 cm, the differences in survival outcomes between SLR and lobectomy were not statistically significant.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2675-2685"},"PeriodicalIF":12.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059069","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":"Quantitative tissue analysis reveals AK2, COL1A1, and PLG protein signatures: targeted therapeutics for meningioma: Erratum.","authors":"","doi":"10.1097/JS9.0000000000002319","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002319","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"111 3","pages":"2763"},"PeriodicalIF":12.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630397","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}