Journal of Investigative Surgery最新文献

{"title":"Sonographic Endometrial Characteristics Associated with Subsequent Surgical Intervention After Medical Termination of Early Pregnancy Loss: A Single-Center Retrospective Cohort Study.","authors":"Heng-Kien Au, Meng-Chen Tsai, Li-Wei Chien, Hao-Sheng Fu","doi":"10.1080/08941939.2025.2596165","DOIUrl":"https://doi.org/10.1080/08941939.2025.2596165","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to identify factors of surgical intervention following medical termination of pregnancy (MTOP) of early pregnancy loss (EPL), using gestational age determined by transvaginal ultrasonography.</p><p><strong>Methods: </strong>A retrospective study was conducted of women who underwent MTOP for EPL at a single tertiary hospital between 2010 and 2019. The treatment protocol consisted of oral mifepristone (600 mg), followed by oral misoprostol (600 mcg) 48 h later. A transvaginal ultrasound was performed 14-16 days after mifepristone administration to evaluate endometrial morphology. Patients were classified into three groups according to ultrasound-determined gestational age. MTOP failure was defined as the need for surgical evacuation.</p><p><strong>Results: </strong>Among the 534 patients, 39 (7.3%) required surgical management. Gestational age ≤7+ weeks was not associated with MTOP outcomes. All women exhibiting a linear endometrial midline or homogeneous endometrium appearance achieved complete uterine evacuation (<i>p</i> < 0.001). Multivariate logistic regression identified increased endometrium thickness (adjusted odds ratio [aOR]: 1.43, 95% CI: 1.25-1.62, <i>p</i> < 0.001) and non-clear endometrial-myometrial margin (aOR: 8.88, 95% CI: 3.26-24.15, <i>p</i> < 0.001) as factors associated with MTOPs failure.</p><p><strong>Conclusions: </strong>Sonographic endometrial assessment approximately two weeks after MTOP provides clinically relevant indicators of treatment success.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":"39 1","pages":"2596165"},"PeriodicalIF":3.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145850128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Ferritin on Weight Loss in Patients Undergoing Bariatric Surgery: A Prospective Cohort Study.","authors":"Yu Wang, Meng Zhang, Shibo Bian, Peirong Tian, Jia Liu, Peng Zhang, Bingjie Ding","doi":"10.1080/08941939.2026.2656836","DOIUrl":"10.1080/08941939.2026.2656836","url":null,"abstract":"<p><strong>Background: </strong>Weight loss may cause nutrient deficiencies that hinder further weight loss. This study aimed to assess serum ferritin, folate, and vitamin B12 levels and examine their roles in weight loss after bariatric surgery (BS).</p><p><strong>Methods: </strong>In 135 obese patients, serum ferritin, folate, and vitamin B12 levels were measured from baseline to 12 months post-BS. Weight loss was measured by percentage of total weight loss (%TWL) and excess weight loss (%EWL) using linear regression.</p><p><strong>Results: </strong>The median %TWL and %EWL were 30.66 (26.63-35.30) and 88.44 (76.12-108.17), respectively. Ferritin, folate, and vitamin B12 deficiencies were recorded in 6.67%, 0.74%, and 8.15% at baseline and 27.61%, 5.19%, and 18.52% at 12 months post-BS, respectively. Serum ferritin at 12 months post-BS was positively correlated with %EWL (<i>β</i> 0.07, 95% CI 0.00-0.14, <i>p</i> = 0.041). The difference in ferritin levels (baseline subtracted from 12 months post-BS) was negatively correlated with %TWL (<i>β</i> -0.02, 95% CI -0.04 to -0.01, <i>p</i> = 0.010) and %EWL (<i>β</i> -0.11, 95% CI -0.18 to -0.05, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Serum ferritin levels were positively associated with weight loss after BS. Monitoring and appropriate iron supplementation are recommended in patients undergoing BS.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":"39 1","pages":"2656836"},"PeriodicalIF":2.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148016034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaginal Natural Orifice Transluminal Endoscopic Surgery for High Uterosacral Ligament Suspension: Initial Experience in Advanced Pelvic Organ Prolapse Repair.","authors":"Gizem Boz İzceyhan, Gizem Berfin Uluutku Bulutlar, Eralp Bulutlar, Ayşe Betül Albayrak Denizli, Resul Karakuş, Çetin Kılıççı","doi":"10.1080/08941939.2026.2673283","DOIUrl":"10.1080/08941939.2026.2673283","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the feasibility and short-term outcomes of Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) High Uterosacral Ligament Suspension (USLS) in patients with advanced apical pelvic organ prolapse (POP).</p><p><strong>Methods: </strong>This retrospective case series included 20 patients with Stage III or IV apical prolapse who underwent vNOTES High USLS. Primary outcomes were surgical feasibility, anatomical success defined as postoperative POP-Q Stage 0 or I, and symptomatic improvement defined as absence of bulge sensation or pelvic pressure. Secondary outcomes included operative time, estimated blood loss, and 30-day complications. All procedures were performed under direct endoscopic visualization with ureteral lateralization before suture placement.</p><p><strong>Results: </strong>Anatomical and symptomatic success rates were both 100%. Mean patient age was 62.35 years and mean BMI was 25.2 kg/m². Mean operative time was 128.05 min, including a mean USLS duration of 54 min. Mean blood loss was 86 ml. No intraoperative or postoperative complications, including ureteral injury or hemorrhage, were observed. All patients were discharged within 48 h.</p><p><strong>Conclusions: </strong>vNOTES High USLS appears to be a feasible and safe mesh-free alternative for advanced apical prolapse. Larger prospective studies are needed to confirm long-term outcomes.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":"39 1","pages":"2673283"},"PeriodicalIF":2.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148055000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Ketamine and Esketamine for Enhanced Recovery After Surgery (ERAS): A Systematic Review.","authors":"Muhan Xu, Rongjie Zhu, Yong-Jun She, Yuyu Sun, Li Xu, Richard Rosenquist, Ming Yao, Xudong Han, Jijun Xu","doi":"10.1080/08941939.2026.2637241","DOIUrl":"10.1080/08941939.2026.2637241","url":null,"abstract":"<p><strong>Background: </strong>Enhanced recovery after surgery (ERAS) protocol optimizes perioperative care and accelerates recovery. Ketamine and esketamine are increasingly incorporated into ERAS strategies.</p><p><strong>Objectives: </strong>This systematic review critically examines the evidence of perioperative ketamine and esketamine use within ERAS, focusing on postoperative pain, opioid consumption, nausea and vomiting, cognitive function, depression, and sleep quality.</p><p><strong>Methods: </strong>Randomized controlled trials, meta-analyses, systematic reviews, and relevant clinical guidelines were identified. Evidence for each outcome was graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.</p><p><strong>Results: </strong>Perioperative ketamine or esketamine consistently reduces postoperative pain and opioid consumption, particularly within the first 24-48 h after surgery. Both agents were associated with reductions in early postoperative depressive symptoms, especially among patients with preexisting depression. Evidence regarding postoperative neurocognitive disorders, including delirium and cognitive dysfunction, remains insufficient. Moderate-certainty evidence supports esketamine-associated improvements in postoperative nausea and vomiting and early postoperative sleep quality, particularly within 72 h after surgery.</p><p><strong>Discussion: </strong>Perioperative ketamine and esketamine are valuable adjuncts to ERAS multimodal analgesia, with evidence also supporting their effects on depressive and sleep disorders. However, evidence is limited by high heterogeneity, small sample sizes, underpower, inconsistent or non-standardized outcome assessment tools, and short follow-up durations. Optimal dosing strategies remain undetermined.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":"39 1","pages":"2637241"},"PeriodicalIF":2.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Oliceridine on the Incidence of Postoperative Nausea and Vomiting in High-Risk Patients Stratified Using Apfel Score After General Anesthesia: A Prospective, Randomized Controlled Clinical Study.","authors":"Xinyang Heng, Aina Xu, Yajing Xiong, Rumei Ding, Jiangfeng Zhao","doi":"10.1080/08941939.2026.2698141","DOIUrl":"10.1080/08941939.2026.2698141","url":null,"abstract":"<p><strong>Background: </strong>As a typical complication, postoperative nausea and vomiting (PONV) usually occurs among patients undergoing general anesthesia surgery, diminishing postoperative satisfaction and recovery.</p><p><strong>Objective: </strong>Herein, we applied a new G-protein-biased μ-opioid receptor agonist, oliceridine, to compare its management with fentanyl on PONV among high-risk patients receiving general anesthesia with transversus abdominis plane block (TAP).</p><p><strong>Methods: </strong>In this prospective, double-blind, randomized controlled study, a total of 280 patients were enrolled for general anesthesia surgery, including laparoscopic cholecystectomy and laparoscopic gynecological surgery. Participants were randomly divided into either the oliceridine group or the fentanyl group at a 1: 1 ratio. Afterwards, the primary outcome was the rate of nausea and vomiting on postoperative day 2. The secondary outcomes comprised the visual analogue scale (VAS) score of PONV, intraoperative analgesic effect, rescue antiemetic treatment, hemodynamic parameters during T1-T5, postoperative pain assessment, hospitalization period, gut function, time of drink and food intake, drainage tube removal, hospitalizations, and perioperative complications.</p><p><strong>Results: </strong>Among the enrolled 279 patients, oliceridine effectively reduced the occurrence of nausea (26.4% versus 12.9%, <i>p</i> = 0.005) and vomiting (24.3% versus 6.5%, <i>p</i> < 0.001). In addition, the postoperative nausea VAS score showed significantly lower in the oliceridine group compared with the fentanyl group (1.40 ± 1.31 versus 2.01 ± 1.79, <i>p</i> = 0.013), accompanied by reduced rescue antiemetic rate (17.1% versus 7.2%, <i>p</i> = 0.011), with stable hemodynamic condition and comparable postoperative recovery.</p><p><strong>Discussion: </strong>According to our study, oliceridine may be a viable substitute for general anesthesia to ameliorate postoperative incidence of PONV, along with its impressive pain control during anesthesia induction and maintenance.</p><p><strong>Clinical trial registration: </strong>Chinese Clinical Trial Registry (ChiCTR2400089121).</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":"39 1","pages":"2698141"},"PeriodicalIF":2.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascular and Wound-Healing Implications of Single-Stage Versus Multistage Repair of Anorectal Malformations: A Systematic Review and Meta-Analysis.","authors":"Yu Du, Yiwei Wang, Wenjing Wang, Jingming Zhao","doi":"10.1080/08941939.2026.2666959","DOIUrl":"10.1080/08941939.2026.2666959","url":null,"abstract":"<p><strong>Background: </strong>Anorectal malformations (ARMs) are managed using either single-stage or multistage surgical repair. However, concerns persist regarding wound-related complications and long-term functional outcomes, which remain inconsistently reported across surgical approaches.</p><p><strong>Objective: </strong>To compare wound-related complications and long-term functional outcomes following single-stage versus multistage repair of ARMs, with emphasis on wound perfusion, dehiscence, and vascular healing dynamics.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251006245). PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for studies published between 2000 and 2024 comparing single-stage and staged ARM repair in neonates and infants. Outcomes included wound dehiscence, surgical site infection (SSI), stenosis, prolapse, redo surgery, constipation, soiling, and voluntary bowel movements. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS).</p><p><strong>Results: </strong>Nineteen studies involving 1,972 patients were included. Single-stage repair was associated with a significantly higher risk of wound dehiscence (OR 3.31; 95% CI 1.90-5.79; <i>p</i> < 0.0001), while no significant differences were observed for SSI, stenosis, prolapse, redo surgery, constipation, soiling, or voluntary bowel movements. Moderate to high heterogeneity was noted for selected outcomes.</p><p><strong>Conclusions: </strong>Single-stage repair provides comparable infection rates and long-term functional outcomes to multistage surgery but carries an increased risk of wound dehiscence. Optimizing tissue perfusion and minimizing tension are essential to improve outcomes.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":"39 1","pages":"2666959"},"PeriodicalIF":2.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation Between the Extent of Lateral Neck Lymph Node Dissection and Postoperative Parathyroid Function in Papillary Thyroid Carcinoma.","authors":"Yi Shen, Xiaoen Li, Yupan Chen, Xujie Han","doi":"10.1080/08941939.2026.2716448","DOIUrl":"https://doi.org/10.1080/08941939.2026.2716448","url":null,"abstract":"<p><strong>Background: </strong>The graded effect of lateral neck dissection on parathyroid function in papillary thyroid carcinoma (PTC) is unclear. We compared outcomes across three progressively extensive dissection schemes.</p><p><strong>Methods: </strong>We retrospectively analysed 347 PTC patients who underwent total thyroidectomy with lateral neck dissection (2019-2023). Groups A (selective, levels II-IV) and B (modified comprehensive, levels II-V) had lateral-only dissection, whereas Group C (comprehensive plus ipsilateral central, levels II-V+VI) added central dissection; Group A-vs-B isolated pure lateral effect. Serum parathyroid hormone (PTH) and calcium were measured at five time points. Transient hypoparathyroidism: day-1 PTH<15 pg/mL recovering by 6 months; permanent: <15 pg/mL at 6 months. Analyses used linear mixed models, Kruskal-Wallis, and multivariable logistic regression.</p><p><strong>Results: </strong>Day-1 PTH decreased stepwise. Transient hypoparathyroidism increased stepwise, while permanent rates did not differ. Adjusted ORs: B vs A=3.07 (95%CI 1.63-5.79), C vs A=6.15 (3.01-12.54); C estimate reflects combined lateral-plus-central. Day-1 PTH <13.4 pg/mL predicted permanent hypoparathyroidism (AUC 0.835, sensitivity 100%, specificity 74%).</p><p><strong>Conclusions: </strong>More extensive lateral dissection independently increases transient hypoparathyroidism, seen in purely lateral groups; the added increase with central dissection reflects central surgery. Permanent disease remained uncommon. Early day-1 PTH measurement shows promise as a triage tool for at-risk patients.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":"39 1","pages":"2716448"},"PeriodicalIF":2.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of Distal Chevron Biplanar Osteotomy Combined with Scarf or Proximal Lapidus Osteotomy in the Surgical Management of Moderate-to-Severe Hallux Valgus: A Retrospective Study.","authors":"Ning Zhang, Yibin Liu, Weiqi Yan, Zhixue Kang, Fei Liu","doi":"10.1080/08941939.2026.2702142","DOIUrl":"https://doi.org/10.1080/08941939.2026.2702142","url":null,"abstract":"<p><strong>Objective: </strong>This paper aims to assess the clinical effectiveness of combining distal first metatarsal biplanar Chevron osteotomy with either midshaft Scarf or proximal Lapidus osteotomy in treating moderate-to-severe hallux valgus.</p><p><strong>Methods: </strong>This retrospective study included patients with moderate-to-severe hallux valgus treated with Chevron + Scarf or Chevron + Lapidus osteotomy and followed for at least 6 months. Outcomes included VAS, HVA, IMA, DMAA, AOFAS score, SF-36, osteotomy healing time, full weight-bearing time, and complications.</p><p><strong>Results: </strong>Eighty-eight patients were included: 49 in the Chevron + Scarf group and 39 in the Chevron + Lapidus group. The Chevron + Scarf group had lower VAS scores at 1 week and 1 month postoperatively (<i>P</i> < 0.05), whereas the Chevron + Lapidus group achieved lower HVA and IMA at 3 and 6 months (<i>P</i> < 0.05). Healing time and time to full weight-bearing were shorter in the Chevron + Scarf group (<i>P</i> < 0.05). Improvements in DMAA, AOFAS, and SF-36 scores and complication rates were comparable between groups (<i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>Both osteotomy strategies effectively correct moderate-to-severe hallux valgus. Each combination has relative advantages, and surgical choice should be tailored to the patient's anatomical and functional needs.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":"39 1","pages":"2702142"},"PeriodicalIF":2.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction.","authors":"","doi":"10.1080/08941939.2026.2684192","DOIUrl":"10.1080/08941939.2026.2684192","url":null,"abstract":"","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":"39 1","pages":"2684192"},"PeriodicalIF":2.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intensive Care Unit Admissions Following Enhanced Recovery After Surgery for Laparoscopic Repair of Perforated Peptic Ulcer.","authors":"Kanglian Tan, Shaoqun Xu, Runsheng Xie, Hongming Li, Xinquan Lu, Jiaxin Lin, Haitao Yuan, Shirong Liu, Liaonan Zou","doi":"10.1080/08941939.2026.2652768","DOIUrl":"https://doi.org/10.1080/08941939.2026.2652768","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the incidence, causes, and risk factors of intensive care unit (ICU) admission in patients undergoing laparoscopic repair of perforated peptic ulcer (PPU) with enhanced recovery after surgery (ERAS) implementation.</p><p><strong>Methods: </strong>A retrospective cohort study included 342 patients undergoing laparoscopic PPU repair with ERAS protocols. Univariable and multivariable logistic regression were used to identify independent risk factors for ICU admission.</p><p><strong>Results: </strong>Of 279 included patients, 76 (27.2%) required ICU admission. The causes of admission were respiratory failure (44.7%), circulatory failure (23.7%), surgical complications (10.5%) and others (21.1%). Multivariable analysis revealed that age ≥ 65 years (odds ratio [OR] = 3.63, <i>p</i> = 0.002), ASA physical status III-IV (OR = 3.70, <i>p</i> = 0.002), heart failure (OR = 12.86, <i>p</i> = 0.008), COPD (OR = 16.28, <i>p</i> = 0.003), and kidney failure (OR = 9.42, <i>p</i> = 0.004) were independent risk factors for ICU admission.</p><p><strong>Conclusions: </strong>In the context of ERAS protocol implementation, the incidence of ICU admission following laparoscopic repair of PPU was 27.2%, accompanied by a 30-day ICU mortality rate of 6.6%. Among the causes of ICU admission, respiratory failure emerged as the leading factor.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":"39 1","pages":"2652768"},"PeriodicalIF":3.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148258325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}