Wangcheng Zhao, Zhi Yang, Quanming Fei, Xinhang Hu, Yifan Ouyang, Xuyang Yi, Shouzhi Xie, Li Wang, Xingchun Huang, Yu He, Juan Luo, Ye Xiao, Zhe Zhang, Fenglei Yu
{"title":"Treatment-related adverse events, immune-related adverse events and discontinuation in patients with solid tumors adding adjuvant immune checkpoint blockade: a meta-analysis of 38 randomized controlled trials.","authors":"Wangcheng Zhao, Zhi Yang, Quanming Fei, Xinhang Hu, Yifan Ouyang, Xuyang Yi, Shouzhi Xie, Li Wang, Xingchun Huang, Yu He, Juan Luo, Ye Xiao, Zhe Zhang, Fenglei Yu","doi":"10.1097/JS9.0000000000002480","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002480","url":null,"abstract":"<p><strong>Background: </strong>The safety profile of immune checkpoint blockade (ICB) in the adjuvant setting has not been well characterized. This study aims to summarize the incidences of adverse events (AEs) in patients with solid tumors receiving ICB in adjuvant setting, and evaluate the effect of ICB addition on incidences of these adverse events.</p><p><strong>Methods: </strong>We searched public databases and relevant international conference proceedings up to 20 September 2024, to identify eligible randomized controlled trials evaluating the ICB-based treatments in adjuvant setting for patients with solid tumors. The primary outcomes included treatment-related death, treatment-related adverse events (TrAEs), immune-related adverse events (IrAEs), serious AEs, and discontinuation due to AEs. The GRADE approach was used to evaluate the certainty of evidence for primary outcomes.</p><p><strong>Results: </strong>Thirty-eight trials with 25 852 participants were included. Single-arm meta-analysis showed that combination therapies had higher grade 3-4 TrAEs than PD-1/PD-L1 monotherapy, while anti-CTLA-4-based therapies exhibited greater discontinuation rates (49.7% [39.4-60.0] for anti-CTLA-4 monotherapy) versus other ICB strategies. Treatment-related death was rare, occurring in 63 of 16 272 participants receiving adjuvant ICB-based treatments. The pairwise meta-analysis revealed that the addition of ICB was associated with increased treatment-related deaths (OR [95% CI]: 1.713 [1.117-2.628]), although this association was observed only in the CTLA-4 blockade and not in the PD-1 or PD-L1 blockade. ICB addition also increased incidences of TrAEs, IrAEs, serious AEs, and discontinuations, with consistent results across blockade types. Additionally, ICB addition was associated with higher incidences of 37 types of AEs, including 20 grade 3-4 events. Most results had moderate evidence quality.</p><p><strong>Conclusion: </strong>Adding ICB in adjuvant setting was associated with increased AEs, but the toxicity profile was largely similar to that in the advanced setting.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110838","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}
Huihui Chai, Wenwen Yue, Liping Sun, Ling Zhang, Ji-Hoon Kim, Wei-Che Lin, Jie Yu, Mingan Yu, Ningning Wang, Hong Wang, Shurong Wang, Ying Che, Qiang Lu, Jie Ren, Fangyi Liu, Yang Liu, Erjiao Xu, Hui Xu, Min Xu, Jinge Zhu, Litao Ruan, Xinping Sun, Desheng Sun, Xiaolong Li, Changbin Li, Meng Yang, Songsong Wu, Fei Yu, Songyuan Yu, Yongwu Yu, Yifeng Zhang, Chun Ouyang, Bo Zhang, Xiaoliang Zhang, Lina Zhang, Jun Luo, Zhengbiao Ji, Jianqiao Zhou, Li Zhou, Yumin Zheng, Lin Fang, Qiyu Zhao, Binghui Zhao, Xinju Zhao, Pengcheng Hu, Shengxiang Rao, Hong Jiang, Qingqing He, Linxue Qian, Dong Xu, Junyue Huang, Hongli Cui, Tianan Jiang, Hong Han, Zhijiang Han, Jingning Cheng, Youben Fan, Jung Hwan Baek, Ping Liang, Huixiong Xu, Chengzhong Peng
{"title":"Asian consensus statement of experts on thermal ablation for secondary hyperparathyroidism in chronic kidney disease.","authors":"Huihui Chai, Wenwen Yue, Liping Sun, Ling Zhang, Ji-Hoon Kim, Wei-Che Lin, Jie Yu, Mingan Yu, Ningning Wang, Hong Wang, Shurong Wang, Ying Che, Qiang Lu, Jie Ren, Fangyi Liu, Yang Liu, Erjiao Xu, Hui Xu, Min Xu, Jinge Zhu, Litao Ruan, Xinping Sun, Desheng Sun, Xiaolong Li, Changbin Li, Meng Yang, Songsong Wu, Fei Yu, Songyuan Yu, Yongwu Yu, Yifeng Zhang, Chun Ouyang, Bo Zhang, Xiaoliang Zhang, Lina Zhang, Jun Luo, Zhengbiao Ji, Jianqiao Zhou, Li Zhou, Yumin Zheng, Lin Fang, Qiyu Zhao, Binghui Zhao, Xinju Zhao, Pengcheng Hu, Shengxiang Rao, Hong Jiang, Qingqing He, Linxue Qian, Dong Xu, Junyue Huang, Hongli Cui, Tianan Jiang, Hong Han, Zhijiang Han, Jingning Cheng, Youben Fan, Jung Hwan Baek, Ping Liang, Huixiong Xu, Chengzhong Peng","doi":"10.1097/JS9.0000000000002510","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002510","url":null,"abstract":"<p><p>Secondary hyperparathyroidism (SHPT) is characterized by parathyroid hyperplasia, persistently elevated parathyroid hormone levels, and disturbances in mineral metabolism. Currently, a considerable amount of literature has consistently shown that thermal ablation is effective in maintaining parathyroid hormone levels within an appropriate range, normalizing calcium and phosphorus levels, improving clinical symptoms, and reducing the volume of parathyroid glands. However, there are currently no established guidelines regarding its utilization. The Asian consensus statement of experts on thermal ablation for SHPT in chronic kidney disease was jointly initiated by experts from China and Korea in the fields of nephrology, interventional ultrasound or radiology, thyroid surgery, ultrasound medicine, nuclear medicine, and diagnostic radiology-to formulate recommendations aimed at establishing standardized protocols for thermal ablation targeting the parathyroid glands. Based on the systematic review of literatures related to ultrasound-guided thermal ablation of parathyroid glands and the professional opinions of experts, the consensus statement covers the relevant content regarding thermal ablation treatment for SHPT, including indications, contraindications, pre-ablation evaluation, operational procedures, post-ablation follow-up, therapeutic effect evaluation, complications prevention and treatment. According to the Grading of Recommendations Assessment, Development and Evaluation, a total of 18 recommendations were given. This consensus statement will positively promote the standardization of ultrasound-guided thermal ablation of parathyroid glands.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110653","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":"Intrarenal pressure gradient in an ex-vivo porcine kidney model.","authors":"Xiaohui Liu, Zhenyuan Han, Baosen Wang, Yajie Zhou, Xiaoqing Luo, Dong Wang","doi":"10.1097/JS9.0000000000002499","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002499","url":null,"abstract":"<p><strong>Introduction: </strong>Intrarenal pressure (IRP) is challenging to measure during retrograde intrarenal surgery (RIRS). Distal end-mounted pressure sensors in flexible ureteroscope (fURS) or ureteral access sheath (UAS) offer real-time pressure measurement, which may address this issue. Pyelorenal reflux occurs in the renal calyces, particularly at the fornices. No study has yet investigated whether there is a pressure differential between the renal pelvis and the calyces. This research aims to examine this topic using the porcine kidney model developed at our institution.</p><p><strong>Materials and methods: </strong>Twelve adult porcine kidneys were used. Three pressure measuring catheters were inserted into upper, middle, and lower calyces. IRPs were studied using either conventional UAS (cUAS) or vacuum-assisted UAS (vaUAS) with a fourth measure monitor catheter inside and level with the tip of UAS and a 7.5F fURS. Incremental rate of irrigation was delivered through the fURS and IRPs were measured and recorded.</p><p><strong>Result: </strong>In cUAS, there were statistically significant reductions in pressure, ranging from small to moderate, observed in both the upper and lower calyces compared to the renal pelvis. These pressure differences disappeared when irrigation reached >90 c.c./minute. In vaUAS with vent closed: The IRP remained negligible even with irrigation up to 140 c.c./minute. Interestingly, there were very small but significantly less pressures in all three calyces as compared to the real pelvises when irrigation rate was ≧90 c.c./minute. There were no differences in pressure with irrigation below 90 c.c./minute.</p><p><strong>Conclusion: </strong>Real-time IRP measurement during RIRS with cUAS can provide valuable clinical insights. Porcine kidney studies show slightly less pressure in the calyces than the renal pelvis. vaUAS reduces high IRP and pressure gradients, potentially making real-time IRP measurement unnecessary.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110744","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}
Jing-Yu Chen, Da-Wei Zhao, Yi Yin, Li Gui, Xin Chen, Xiao-Mei Wang, Pang-Bo Wang, Cheng-Hai Zuo, Zhao-Pan Lai, Chong Li, Rui Wang, Ji-Shu Xian, Zhi Chen, Hua Feng, Rong Hu
{"title":"Deep cervical lymphovenous anastomosis (LVA) for Alzheimer's disease microsurgical procedure in a prospective cohort study.","authors":"Jing-Yu Chen, Da-Wei Zhao, Yi Yin, Li Gui, Xin Chen, Xiao-Mei Wang, Pang-Bo Wang, Cheng-Hai Zuo, Zhao-Pan Lai, Chong Li, Rui Wang, Ji-Shu Xian, Zhi Chen, Hua Feng, Rong Hu","doi":"10.1097/JS9.0000000000002490","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002490","url":null,"abstract":"<p><strong>Objectives: </strong>Alzheimer's disease (AD) is a prevalent neurodegenerative disorder, characterized by progressive cognitive decline. Current approved drugs merely relieve symptoms rather than halt or reverse disease progression. The role of the brain lymphatic system in clearing harmful substances in the brain has provided new insights for AD treatment. The goal of this study was to assess the efficacy and safety of deep cervical lymphovenous anastomosis (LVA) in treating AD patients.</p><p><strong>Materials and methods: </strong>A single-center, prospective, single-arm exploratory study was conducted on 26 AD patients who met the clinical and biomarker diagnostic criteria of the National Institute on Aging-Alzheimer's Association (NIA-AA). Deep cervical LVA was performed with modified technique from lymphatic vessel-vein to lymphatic flap-vein anastomosis. Preoperative and follow-up neuropsychological tests were carried out using Mini-Mental Status Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Neuropsychiatric Inventory (NPI) scores. Cerebrospinal fluid (CSF) biomarkers (Aβ42, Aβ40, p-Tau, T-Tau) were collected and analyzed via single-molecule immunoassay in the early postoperative period.</p><p><strong>Results: </strong>One month after surgery, about 60% of caregivers reported varying degrees of overall symptom improvement in patients. MMSE scores of patients significantly increased after surgery compared with before surgery (3 [0, 6] vs. 5 [0, 7], P = 0.022). Although, 15% of patients had increased MoCA scores, 42% had decreased NPI scores, both changes did not reach statistical difference. Quantitative analysis revealed a trend toward reduced AD biomarker levels following LVA, but the differences did not reach statistical significant. Only two patients experienced postoperative difficulty raising their arms, with gradual recovery during follow-up.</p><p><strong>Conclusion: </strong>This study demonstrates that deep cervical LVA is safe and feasible procedure, showing a significant cognitive improvement in AD patients (mainly in MMSE), which needs long-term follow-up and large-scale clinical trials to verify.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110663","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}
Gabriel Christian de Farias Morais, Guilherme Bastos Alves, Md Sarowar Hossain, Emad Rashad Sindi, Magdi E A Zaki, Jonas Ivan Nobre Oliveira
{"title":"Olaparib in pancreatic cancer: a computational study on safety and toxicological implications-research letter.","authors":"Gabriel Christian de Farias Morais, Guilherme Bastos Alves, Md Sarowar Hossain, Emad Rashad Sindi, Magdi E A Zaki, Jonas Ivan Nobre Oliveira","doi":"10.1097/JS9.0000000000002523","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002523","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110773","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":"Reevaluating biomarker selection: Enhancing the Rigor of Cuproptosis-Related HIRI Studies.","authors":"Wenpeng Jin, Xianqiang Liu","doi":"10.1097/JS9.0000000000002539","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002539","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110831","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}
V C Deivayanai, Pavithra Swaminaathan, A S Vickram, A Saravanan, Shabana Bibi, Navidha Aggarwal, Virender Kumar, Albaraa H Alhadrami, Zuhair M Mohammedsaleh, Rawan Altalhi, May Nasser Bin-Jumah, Amany A Sayed, Amirah Albaqami, Hitesh Chopra, Talha Bin Emran, Mohamed M Abdel-Daim
{"title":"Transforming healthcare: the impact of artificial intelligence on diagnostics, pharmaceuticals and ethical considerations - a comprehensive review.","authors":"V C Deivayanai, Pavithra Swaminaathan, A S Vickram, A Saravanan, Shabana Bibi, Navidha Aggarwal, Virender Kumar, Albaraa H Alhadrami, Zuhair M Mohammedsaleh, Rawan Altalhi, May Nasser Bin-Jumah, Amany A Sayed, Amirah Albaqami, Hitesh Chopra, Talha Bin Emran, Mohamed M Abdel-Daim","doi":"10.1097/JS9.0000000000002481","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002481","url":null,"abstract":"<p><p>Interpretability of results remains challenging in most health industries since patients may suffer life-threatening consequences from an inaccurate diagnosis. Artificial Intelligence (AI) integration has arisen as a prominent technology in the healthcare sector, transforming the field by advancing early diagnostics, surgeries, and ethical concerns. The present review analyses the multidimensional impact of AI on the health sector through enhancements in medical accuracy and diagnosis outcomes. Implementing AI techniques and machine learning algorithms in predictive analytics enables disease identification at a nascent stage, boosting decision-making accuracy. Advancements in genomics have demanded the employment of AI in decoding genetic information supporting personalized and targeted treatments. The review comprehensively examines the application of AI-based diagnostics addressing the impact on heart-associated diseases, cancer pathogenesis, and other general disease prediction. Different machine learning algorithms aid in identifying tumor behavior, risk factors, and tailored therapy in cancer treatment. In the context of cardiovascular disorders, AI-driven methodologies aid in assessing the patient data, risk factors, and forecasting the probable complications in preventative care. AI-based surgeries employing the da Vinci system highlight the use of AI in increasing the prediction of surgical success rate. Robotic automation in orthopedics advances spine and joint replacement surgeries, offering real-time guidance and enhancing patient recovery outcomes. Broader improvements in AI integration in healthcare have been discussed, focusing on refining algorithms for improved application.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110837","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}
Jianpeng Liu, Shufan Jiang, Yanfei Wu, Ruoyao Zou, Yifang Bao, Na Wang, Jiaqi Tu, Ji Xiong, Ying Liu, Yuxin Li
{"title":"Deep learning-based radiomics and machine learning for prognostic assessment in IDH-wildtype glioblastoma after maximal safe surgical resection: a multicenter study.","authors":"Jianpeng Liu, Shufan Jiang, Yanfei Wu, Ruoyao Zou, Yifang Bao, Na Wang, Jiaqi Tu, Ji Xiong, Ying Liu, Yuxin Li","doi":"10.1097/JS9.0000000000002488","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002488","url":null,"abstract":"<p><strong>Background: </strong>Glioblastoma (GBM) is a highly aggressive brain tumor with poor prognosis. This study aimed to construct and validate a radiomics-based machine learning model for predicting overall survival (OS) in IDH-wildtype GBM after maximal safe surgical resection using magnetic resonance imaging.</p><p><strong>Methods: </strong>A total of 582 patients were retrospectively enrolled, comprising 301 in the training cohort, 128 in the internal validation cohort, and 153 in the external validation cohort. Volumes of interest (VOIs) from contrast-enhanced T1-weighted imaging (CE-T1WI) were segmented into three regions: contrast-enhancing tumor, necrotic non-enhancing core, and peritumoral edema using an ResNet-based segmentation network. A total of 4,227 radiomic features were extracted and filtered using LASSO-Cox regression to identify signatures. The prognostic model was constructed using the Mime prediction framework, categorizing patients into high- and low-risk groups based on the median OS. Model performance was assessed using the concordance index (CI) and Kaplan-Meier survival analysis. Independent prognostic factors were identified through multivariable Cox regression analysis, and a nomogram was developed for individualized risk assessment.</p><p><strong>Results: </strong>The Step Cox [backward] + RSF model achieved CIs of 0.89, 0.81, and 0.76 in the training, internal and external validation cohorts. Log-rank tests demonstrated significant survival differences between high- and low-risk groups across all cohorts (P < 0.05). Multivariate Cox analysis identified age (HR: 1.022; 95% CI: 0.979, 1.009, P < 0.05), KPS score (HR: 0.970, 95% CI: 0.960, 0.978, P < 0.05), rad-scores of the necrotic non-enhancing core (HR: 8.164; 95% CI: 2.439, 27.331, P < 0.05), and peritumoral edema (HR: 3.748; 95% CI: 1.212, 11.594, P < 0.05) as independent predictors of OS. A nomogram integrating these predictors provided individualized risk assessment.</p><p><strong>Conclusion: </strong>This deep learning segmentation-based radiomics model demonstrated robust performance in predicting OS in GBM after maximal safe surgical resection. By incorporating radiomic signatures and advanced machine learning algorithms, it offers a non-invasive tool for personalized prognostic assessment and supports clinical decision-making.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110681","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}
Tomas Nedelka, Jakub Katolicky, Jiri Nedelka, Paul Hobrough, Karsten Knobloch
{"title":"Efficacy of high energy, focused ESWT in treatment of lumbar facet joint pain - a randomized sham-controlled trial.","authors":"Tomas Nedelka, Jakub Katolicky, Jiri Nedelka, Paul Hobrough, Karsten Knobloch","doi":"10.1097/JS9.0000000000002538","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002538","url":null,"abstract":"<p><strong>Objective: </strong>Lumbar facet joints (FJ) are a common source of chronic low back pain (LBP). Focused extracorporeal shock wave therapy (ESWT) has demonstrated potential in the treatment of musculoskeletal disorders due to its deeper tissue penetration and safety profile. This study aimed to evaluate the efficacy and safety of ESWT in the management of lumbar facet joint pain.</p><p><strong>Methods: </strong>A prospective, randomized, sham-controlled trial was conducted in 128 patients with chronic lumbar facet syndrome confirmed by medial branch block. Patients were randomized to receive either focused ESWT (Group A, n = 64; 0.35 mJ/mm2, 1200 shocks/session = 600 shocks per segment, 5 weekly sessions) or sham therapy (Group B, n = 64). Pain intensity (VAS), disability (ODI), and neuropathic pain features (PainDETECT questionnaire) were assessed at 2, 6, and 12 months. Lumbar spine MRI was performed at baseline and 6 months post-treatment.</p><p><strong>Results: </strong>Group A showed significant reductions in VAS scores at 6 and 12 months (mean 64.4% reduction at 12 months, p<0.01), with an effect size (Cohen's d = 1.12). ODI decreased by 42.3% in Group A compared to 12.5% in the sham group. Neuropathic pain symptoms improved significantly only in Group A (PD-Q reduction from 18.3 ± 2.4 to 10.2 ± 1.9; p<0.01). MRI follow-up demonstrated resolution of bone marrow edema in 58.8% of ESWT-treated patients versus none in the control group. No adverse effects were reported.</p><p><strong>Conclusions: </strong>High-energy focused ESWT is a safe and effective non-invasive therapy for chronic lumbar facet joint pain, showing sustained improvements in pain, function, and neuropathic symptoms. MRI findings support its biological effect on joint-related bone marrow edema. ESWT represents a promising alternative to interventional pain procedures.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110720","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}