World Journal of Pediatric Surgery最新文献_第6页

Fibrotic liver injury in biliary atresia: long-term implications. 胆道闭锁的纤维化肝损伤：长期影响。

IF 1.3 4区医学

World Journal of Pediatric Surgery Pub Date : 2025-12-30 eCollection Date: 2025-01-01 DOI: 10.1136/wjps-2025-001098

Maria Hukkinen, Mikko P Pakarinen

{"title":"Fibrotic liver injury in biliary atresia: long-term implications.","authors":"Maria Hukkinen, Mikko P Pakarinen","doi":"10.1136/wjps-2025-001098","DOIUrl":"10.1136/wjps-2025-001098","url":null,"abstract":"Normalization of serum bilirubin after Kasai portoenterostomy (KPE) is a prerequisite for long-term native liver (NL) survival. Following a successful KPE, fibrotic liver injury progresses variably, although a significant proportion of patients show decreasing histological liver fibrosis during follow-up. Eventually, the great majority of patients develop cirrhosis and clinical manifestations of portal hypertension (PH), while liver malignancies and pulmonary complications of PH occur infrequently. Accurate prediction of liver fibrosis remains challenging. Development of reliable noninvasive biomarkers of liver fibrosis would improve patient management and benefit performance of interventional trials. Although successful KPE modifies liver gene expression profile, molecular signature of active fibrogenesis and ductular reaction (DR) persists. Successful KPE reduces the abundance of activated myofibroblasts and macrophages, whereas cholangiocytes tend to increase. Progression of long-term fibrotic liver injury is tightly connected with DR, which is associated with serum bile acids. While serum bile acids are predictive of portal fibrosis and NL survival, there are ongoing randomized clinical trials evaluating the efficacy of bile acids lowering therapies on KPE outcomes. A better understanding of disease mechanisms underpinning progression of liver injury and clinical complications following successful KPE is needed for the development of novel adjuvant therapies, improvement of follow-up, and optimizing outcomes.","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 6","pages":"e001098"},"PeriodicalIF":1.3,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12766845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical decision-making in neonatal gastrointestinal surgical emergencies: comparison between ChatGPT and human clinicians. 新生儿胃肠外科急诊的临床决策：ChatGPT与人类临床医生的比较

IF 2.1 4区医学

World Journal of Pediatric Surgery Pub Date : 2025-12-25 eCollection Date: 2025-01-01 DOI: 10.1136/wjps-2025-001117

Seyoon Kim, Dongho Choi, Joonhyuk Son

{"title":"Clinical decision-making in neonatal gastrointestinal surgical emergencies: comparison between ChatGPT and human clinicians.","authors":"Seyoon Kim, Dongho Choi, Joonhyuk Son","doi":"10.1136/wjps-2025-001117","DOIUrl":"10.1136/wjps-2025-001117","url":null,"abstract":"Background: Neonatal gastrointestinal surgical emergencies (NGSEs) require rapid decisions to prevent morbidity and mortality. This study assessed the potential use of ChatGPT in supporting clinical decision-making for NGSEs.Methods: The challenging NGSE cases (ileal atresia, midgut volvulus, Hirschsprung disease, meconium ileus, and pseudo-obstruction) were converted into structured short-answer questions including histories and radiologic images. Questions covered differential diagnosis, diagnostic plan, management plan, final diagnosis, and surgical plan. Each case was scored out of 10 (maximum 50). Scenarios were presented to 10 general surgery (GS) residents, 10 GS attendings, and 10 pediatric surgery (PS) attendings. GPT-4o was tested with 10 iterations per case. Group scores were compared using appropriate statistical tests.Results: A total of five cases were involved. GPT-4o achieved a mean score of 44.95 (89.9%), higher than GS residents (27.05, p<0.001) and GS attendings (28.35, p<0.001), but lower than PS attendings (47.70, p=0.021). Subgroup analysis showed GPT-4o matched PS attendings in management, final diagnosis, and surgical planning, but scored lower in differential diagnosis (87.8% vs. 92.8%, p=0.0479) and diagnostic plan (75.0% vs. 93.8%, p<0.001). Compared with GS residents and attendings, GPT-4o performed significantly better across all categories except diagnostic plan.Conclusions: GPT-4o demonstrated performance comparable to PS attendings in key management domains, while clearly surpassing GS residents and attendings overall. These findings suggest that GPT-4o may have potential as a supplementary decision-support tool for NGSEs, although clinical use requires further validation in real-world settings.","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 6","pages":"e001117"},"PeriodicalIF":2.1,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12742057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145850870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Laparoscopic management of congenital gastric muscular layer defect and gastric perforation: a case series. 腹腔镜治疗先天性胃肌层缺损和胃穿孔：一个病例系列。

IF 1.3 4区医学

World Journal of Pediatric Surgery Pub Date : 2025-12-17 eCollection Date: 2025-01-01 DOI: 10.1136/wjps-2025-001090

Ying Wu, Xin Guo, Xiaoxia Wu, Baohong Zhao, Yuanyuan Jin, Wenyue Liu, Hongxia Ren

{"title":"Laparoscopic management of congenital gastric muscular layer defect and gastric perforation: a case series.","authors":"Ying Wu, Xin Guo, Xiaoxia Wu, Baohong Zhao, Yuanyuan Jin, Wenyue Liu, Hongxia Ren","doi":"10.1136/wjps-2025-001090","DOIUrl":"10.1136/wjps-2025-001090","url":null,"abstract":"This study aimed to evaluate the feasibility and efficacy of laparoscopic management in neonates diagnosed with congenital gastric muscular layer defects and gastric perforation. A retrospective analysis was conducted on four male neonates (median gestational age: 36.79 weeks; median birth weight: 2460 g) who underwent laparoscopic repair at Shanxi Provincial Children's Hospital between January 2022 and October 2024. All neonates presented with symptoms of vomiting, feeding intolerance, and abdominal distension, with preoperative imaging confirming pneumoperitoneum. Laparoscopic surgery was successfully completed in all cases without conversion to open surgery. The median operative time was 102 min, and no surgery-related complications such as anastomotic leakage or hemorrhage were observed. One neonate was transferred to the department of internal medicine due to postoperative feeding difficulties, failure, and persistent oxygen dependence. The median hospital stay was 27.5 days. At the 6-month postoperative follow-up, three neonates exhibited satisfactory growth and development, while one exhibited mild growth delay. Our findings indicate that laparoscopic repair offers significant advantages, including mitigated surgical trauma, quicker recovery, and lower incidence of intestinal adhesion. Provided that surgical indications are strictly assessed and the surgeon possesses proficient laparoscopic skills, it is feasible for specialized surgeons to manage this disease using laparoscopy.","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 6","pages":"e001090"},"PeriodicalIF":1.3,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12716580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145805630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Transoral endoscopic thyroidectomy using the vestibular approach in pediatric patients: 5-year experience in a single center in Vietnam. 经口内窥镜甲状腺切除术采用前庭入路在儿科患者：5年经验在越南单一中心。

IF 1.3 4区医学

World Journal of Pediatric Surgery Pub Date : 2025-12-03 eCollection Date: 2025-01-01 DOI: 10.1136/wjps-2025-001085

Hau Xuan Nguyen, Minh Quang Pham, Nhat Tan Nguyen, Hien Xuan Nguyen, Luc Van Tieu, Chi Huyen Do, Lien Thi Dam, Quang Van Le

{"title":"Transoral endoscopic thyroidectomy using the vestibular approach in pediatric patients: 5-year experience in a single center in Vietnam.","authors":"Hau Xuan Nguyen, Minh Quang Pham, Nhat Tan Nguyen, Hien Xuan Nguyen, Luc Van Tieu, Chi Huyen Do, Lien Thi Dam, Quang Van Le","doi":"10.1136/wjps-2025-001085","DOIUrl":"10.1136/wjps-2025-001085","url":null,"abstract":"Objective: To evaluate the clinical and oncological outcomes of transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) in the management of pediatric patients with benign and malignant thyroid lesions in Vietnam.Methods: A cross-sectional study was performed on pediatric patients (≤18 years old) who underwent TOETVA for thyroid cancer and benign thyroid nodules between August 2019 to September 2024.Results: Of the 28 patients included in the study, 23 were female (82.1%), and 5 were male (17.9%) with a mean age of 15.86±2.45 years. Mean tumor size on ultrasound was 19.47±13.63 mm. TOETVA was completed successfully in all cases. Postoperative histopathological findings revealed benign lesions in 13 patients, differentiated thyroid carcinoma in 14 patients and non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in one patient; central neck dissection (CND) was performed in 15 patients; nine of them had occult lymph node metastasis. Postoperative complications included transient hypoparathyroidism (3.6%) and vocal cord palsy (7.1%), all of which resolved. No permanent complications or recurrences were observed over a median follow-up of 26.5 months.Conclusions: TOETVA appears feasible for the treatment of thyroid nodules in children. However, larger prospective studies are needed to confirm these findings.","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 6","pages":"e001085"},"PeriodicalIF":1.3,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12682162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145709839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

From adult centric to child specific: the Pediatric Scale for Quality of Recovery (PedSQoR) as a pioneering tool. 从以成人为中心到以儿童为中心：儿童康复质量量表（PedSQoR）是一个开创性的工具。

IF 1.3 4区医学

World Journal of Pediatric Surgery Pub Date : 2025-12-02 eCollection Date: 2025-01-01 DOI: 10.1136/wjps-2025-001104

Shifan Zhu, Qian Chen, Daqing Ma

引用次数: 0

Application of artificial intelligence in conjunction with clinical laboratory indicators to aid decision-making for surgical or conservative treatment of pediatric intestinal obstruction. 应用人工智能结合临床实验室指标，辅助小儿肠梗阻手术或保守治疗决策。

IF 1.3 4区医学

World Journal of Pediatric Surgery Pub Date : 2025-11-05 eCollection Date: 2025-01-01 DOI: 10.1136/wjps-2025-001079

Min Zhan, Ting Xiong, Ming Luo, Manxin Hu, Leifeng Chen, Dan Nie, Mengjie Yu, Shouhua Zhang

{"title":"Application of artificial intelligence in conjunction with clinical laboratory indicators to aid decision-making for surgical or conservative treatment of pediatric intestinal obstruction.","authors":"Min Zhan, Ting Xiong, Ming Luo, Manxin Hu, Leifeng Chen, Dan Nie, Mengjie Yu, Shouhua Zhang","doi":"10.1136/wjps-2025-001079","DOIUrl":"10.1136/wjps-2025-001079","url":null,"abstract":"Background: Management of pediatric intestinal obstruction remains clinically challenging, particularly regarding the selection between surgical and conservative approaches. This study aimed to develop artificial intelligence (AI) models to support treatment decision-making.Methods: A retrospective analysis was conducted on clinical data from pediatric intestinal obstruction patients. The dataset was split via stratified sampling (70% training/ 30% test), preserving outcome distribution. Predictive models incorporating clinical indicators were developed using machine learning, with evaluation metrics including accuracy, F1-score, Kappa value, positive predictive value (PPV), negative predictive value (NPV), precision-recall curves, calibration plots and decision curve analysis (DCA).Results: Among 765 pediatric patients, 425 responded to conservative treatment while 340 required surgery. The Random Forest model demonstrated optimal performance in the test cohort (area under the curve: 0.953; sensitivity: 0.879; specificity: 0.901; accuracy: 0.892; F1-score: 0.878; Kappa value: 0.780; PPV: 0.878; NPV: 0.905). Calibration, precision-recall, and DCAs indicated favorable clinical applicability.Conclusion: Machine learning integration with clinical indicators shows potential as a decision-support tool for selecting surgical or conservative treatment in pediatric intestinal obstruction.","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 5","pages":"e001079"},"PeriodicalIF":1.3,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12593502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Artificial intelligence and electronic health records: a narrative review of current applications and challenges in pediatric surgery. 人工智能和电子健康记录：儿科外科当前应用和挑战的叙述性回顾。

IF 1.3 4区医学

World Journal of Pediatric Surgery Pub Date : 2025-10-31 eCollection Date: 2025-01-01 DOI: 10.1136/wjps-2025-001100

Javeria Javed, Saleem Islam

{"title":"Artificial intelligence and electronic health records: a narrative review of current applications and challenges in pediatric surgery.","authors":"Javeria Javed, Saleem Islam","doi":"10.1136/wjps-2025-001100","DOIUrl":"10.1136/wjps-2025-001100","url":null,"abstract":"Application of artificial intelligence (AI) within electronic health record (EHR) systems is influencing clinical care, research, education, and quality improvement in pediatric surgical practice. In clinical settings, these technologies organize and structure patient information, enable predictive analytics, and support decision-making tools that enhance awareness and facilitate interventions.Longitudinal datasets in EHR create opportunities for data-driven research ranging from modeling and outcome prediction to clinical trial recruitment. Educational applications of AI-enabled EHR extend to healthcare professionals, trainees, patients, and caregivers. For professionals, case-based learning and simulation resources strengthen decision-making skills and clinical judgment. For patients and caregivers, personalized guidance and accessible health records foster understanding of disease, encourage active participation in care, and improve adherence to management plans. Quality improvement initiatives benefit from AI-assisted audit systems, automated tracking of outcomes, and identification of workflow inefficiencies. These benefits are accompanied by challenges, including the risk of overreliance on automated alerts, limited representativeness of training data, lack of external validation, workflow misalignment, and concerns about privacy and transparency. Addressing these issues through rigorous validation, inclusive datasets, user-focused design, and informatics education will be essential to ensure that AI-enabled EHR systems enhance rather than replace clinician expertise, while promoting safe, equitable, and patient-centered care.","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 5","pages":"e001100"},"PeriodicalIF":1.3,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12581078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Risk factors for and outcomes of intraoperative desaturation in neonates undergoing non-cardiac surgery: a retrospective study. 非心脏手术新生儿术中去饱和的危险因素和结果：一项回顾性研究。

IF 1.3 4区医学

World Journal of Pediatric Surgery Pub Date : 2025-10-31 eCollection Date: 2025-01-01 DOI: 10.1136/wjps-2025-001036

Chunyi Jin, Jialian Zhao, Bin Bin Cai, Hao Xie, Cuicui Sun, Lingli Yu, Yaoqin Hu, Yue Jin

{"title":"Risk factors for and outcomes of intraoperative desaturation in neonates undergoing non-cardiac surgery: a retrospective study.","authors":"Chunyi Jin, Jialian Zhao, Bin Bin Cai, Hao Xie, Cuicui Sun, Lingli Yu, Yaoqin Hu, Yue Jin","doi":"10.1136/wjps-2025-001036","DOIUrl":"10.1136/wjps-2025-001036","url":null,"abstract":"Objective: The aim of this study was to determine the prevalence, outcomes and risk factors for intraoperative desaturation in neonates undergoing non-cardiac surgery.Methods: This retrospective study included neonates who underwent non-cardiac surgery between April 2020 and October 2022. Patients were classified as normal or reduced oxygenation based on a review of their medical records and whether they experienced intraoperative desaturation. The incidence of intraoperative desaturation, as well as postoperative outcomes and other characteristics, was recorded.Results: A total of 1005 neonates were included, of whom 118 (11.74%) experienced intraoperative desaturation. Intraoperative desaturation was significantly associated with increased postoperative mortality (16.95% vs. 4.62%, p<0.001) and postoperative outcomes including pulmonary complications, acidosis, anemia, thrombocytopenia, unplanned surgery and intubation along with prolonged hospital and intensive care unit stay (all p<0.05). After conducting both univariate and multivariate analyses, 10 preoperative and surgical factors were identified to be significantly associated with intraoperative desaturation. These included six preoperative disease and treatment factors (pneumonia, pulmonary arterial hypertension, anemia, acidosis, pulmonary surfactant treatment and oxygen therapy), two surgical factors (duration of surgery and thoracic surgery) along with the American Society of Anesthesiologists physical status and low weight.Conclusions: The incidence of intraoperative desaturation among neonatal patients is relatively high, and it may be associated with a multitude of serious adverse complications. Several perioperative factors are significantly associated with the occurrence of intraoperative desaturation.","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 5","pages":"e001036"},"PeriodicalIF":1.3,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12581081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pulmonary vascular complications in children who survive long-term after Kasai portoenterostomy for biliary atresia: a narrative review. Kasai门肠造口术治疗胆道闭锁后长期存活儿童的肺血管并发症：一项叙述性回顾。

IF 1.3 4区医学

World Journal of Pediatric Surgery Pub Date : 2025-10-31 eCollection Date: 2025-01-01 DOI: 10.1136/wjps-2025-001067

Jie Zhang, Gong Chen

引用次数: 0

Ambient AI-assited clinical documentation in surgical outpatient care: a preliminary study of usability, workflow, and patient experience. 外科门诊护理环境人工智能辅助临床文件：可用性、工作流程和患者体验的初步研究。

IF 2.1 4区医学

World Journal of Pediatric Surgery Pub Date : 2025-10-23 eCollection Date: 2025-01-01 DOI: 10.1136/wjps-2025-001073

Cameron J Harvey, Victor Wong, William Huynh, Jerome P Lee, Russell K Woo

{"title":"Ambient AI-assited clinical documentation in surgical outpatient care: a preliminary study of usability, workflow, and patient experience.","authors":"Cameron J Harvey, Victor Wong, William Huynh, Jerome P Lee, Russell K Woo","doi":"10.1136/wjps-2025-001073","DOIUrl":"10.1136/wjps-2025-001073","url":null,"abstract":"Ambient artificial intelligence (AI) scribes offer promise for reducing documentation burden, yet their effects on surgical practice have not been well defined. We conducted a pilot study of an ambient AI scribe across 79 ambulatory providers (three surgeons) in a multihospital system from December 2024 to February 2025. Surgeon adoption of the AI scribe ranged from 58% to 90% of visits. We evaluated workload via pre- and post-intervention surveys (NASA-TLX mental demand and perceived rush), burnout rates, scheduling capacity, and Epic Signal metrics (note length, time per note) and compared billing data for high utilizers between August and October 2024 and the pilot period. Average \"pajama time\" did not change significantly (p=0.55). NASA-TLX mental demand decreased from 14 to 5 (p=0.08) and perceived rush from 15 to 5 (p=0.06). Burnout declined from 67% to 33%. Two surgeons reported the capacity to add three patients per clinic. The billing metric showed no significant changes. Undivided attention scores improved from 3.5 to 4.1 (p<0.0001). This preliminary data shows promise that ambient AI scribes in surgical clinics may reduce documentation burden and burnout, with potential gains in efficiency and throughput. Larger studies are warranted to further confirm these findings.","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 5","pages":"e001073"},"PeriodicalIF":2.1,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12551534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145379080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0