Frontiers in Surgery最新文献

Background: Ureteral injury is a severe complication in colorectal surgery, with an incidence up to 2.5%. Despite meticulous surgical technique, intraoperative ureter identification can be challenging, particularly in cases involving prior operations or extensive inflammation. Indocyanine green (ICG) fluorescence imaging has emerged as a promising adjunct to enhance ureter visualization. In parallel, novel fluorophores with renal excretion properties (e.g., CW800-CA, ZW800-1) are undergoing investigation to avoid routine ureteral catheterization. This systematic review evaluates the efficacy, safety, and clinical impact of ICG-based and emerging fluorescence approaches for ureter identification in colorectal surgery.

Methods: A systematic literature search was performed in PubMed and Embase, up to March 2025, following PRISMA 2020 guidelines. Studies assessing intraoperative ureter identification via ICG fluorescence or other near-infrared fluorophores during adult colorectal surgery were included. Exclusion criteria comprised pediatric populations, non-colorectal procedures, reviews, editorials, and animal experiments. Primary outcomes were ureter visualization rate and intraoperative ureteral injury rate, while secondary outcomes included procedure-related complications, operative time, adverse effects, and preliminary cost data.

Results: Ten studies comprising 716 patients undergoing colorectal surgery with ICG fluorescence imaging were analyzed. Ureter visualization rates ranged from 95.3% to 100%, with most studies reporting a rate of 100%. No ICG-related complications were documented. ICG administration was primarily via cystoscopy with intra-ureteral injection or ureteral catheterization, predominantly in laparoscopic and robot-assisted procedures. Mean duration of the cystoscopy varied from 7 to 29 min. Improved intraoperative ureter identification compared with conventional visualization was reported in available comparative studies.

Conclusion: ICG fluorescence imaging safely and effectively enhances intraoperative ureter visualization during colorectal surgery, potentially reducing the risk of ureteral injuries. However, the need for routine ureteral catheterization prolongs procedure duration. Emerging renally excreted fluorophores may eliminate the need for catheterization and should be prioritized in future clinical trials.

Systematic review registration: PROSPERO [CRD420250653992].

Objective: The aim of this study was to analyze the clinical value of biomechanics and magnetic resonance imaging (MRI) in the evaluation of knee osteoarthritis.

Methods: Sixty patients diagnosed with knee osteoarthritis from June 2020 to November 2023 in our hospital were retrospectively selected as the study group. Fifty healthy subjects who underwent annual health checkups in our hospital during the same period were selected as the control group. A three-dimensional finite element model was constructed based on knee MRI images. The MRI parameters and biomechanical parameters of knee joints were compared between the two groups.

Results: The mean Whole-Organ Magnetic Resonance Imaging Score (WORMS) of patients in the study group was (72.29 ± 16.92), significantly higher than that of (44.68 ± 16.95) in the control group. The contact area between the medial femoral cartilage and medial meniscus, the maximal von Mises stress on the medial meniscus, and the maximal von Mises stress on the femoral cartilage were significantly greater in the study group than in the control group. The area under the curves of MRI indicators and biomechanical indicators (contact area between the medial femoral cartilage and medial meniscus, the maximal von Mises stress on the medial meniscus, and the maximal von Mises stress on the femoral cartilage) for knee osteoarthritis were 0.8694, 0.7874, 0.6282, and 0.7650, respectively.

Conclusion: WORMS and biomechanical parameters (medial femoral-meniscal contact area and peak stress) demonstrate good diagnostic value in knee osteoarthritis, with the maximal von Mises stress on the medial meniscus showing discriminatory power for disease severity. The combination of MRI and biomechanical analysis facilitates the assessment of knee osteoarthritis from both structural and functional perspectives, providing objective evidence for clinical diagnosis and treatment.

Purpose: The aim of this study was to investigate and compare the clinical results of arthroscopic absorbable suture repair versus conservative treatment in the management of patients with Palmer type IIC central perforation of triangular fibrocartilage complex tears.

Methods: Between September 2022 and February 2023, 50 patients with Palmer type IIC central perforation of triangular fibrocartilage complex tears at our hospital were retrospectively enrolled and included in this study, with a 1-year follow-up. Patients were classified into two groups for different treatment methods: 25 patients received conservative treatment and 25 patients received arthroscopic absorbable suture repair. Preoperative magnetic resonance imaging, intraoperative arthroscopic findings, and postoperative complications were recorded. Outcome measures were assessed using the visual analog scale (VAS) and the Modified Mayo Wrist Score (MMWS).

Results: All patients completed the 1 year follow-up. In the conservative treatment group, the average VAS score was 3 ± 0.7 and the average MMWS was 83.3 ± 4.8. In the surgical group, the average VAS score was 2 ± 0.7 and the average MMWS was 85.1 ± 3.9. The two groups showed no statistically significant difference in MMWS values. On the other hand, statistically significant differences were demonstrated in VAS scores. Postoperative complications, including surgical site infection and wrist joint stiffness, were observed in four patients of the 25.

Conclusion: There were no statistically significant differences in the clinical outcomes between the absorbable repair and conservative treatment groups. However, absorbable repair surgery could effectively alleviate patients' pain symptoms.

Background: There is a severe shortage of healthcare professionals, emphasized in a stark manner by the recent COVID-19 pandemic, where the mortality rate was primarily a consequence of medical professionals lacking the technical know-how for conducting specialized procedures. Therefore, this systematic review and meta-analysis aimed to evaluate the success rates of nurse-performed emergency surgeries, focusing on trauma care (e.g., cricothyrotomy), rural obstetric emergencies (e.g., caesarean section, hysterectomy), and general procedures (e.g., laparotomy, appendectomy).

Methods: A systematic search was conducted across eight major databases (PubMed, Embase, CINAHL, Scopus, Web of Science, PsycINFO, Cochrane Library, ProQuest) following PRISMA guidelines. Four eligible studies were identified, and data were pooled using a fixed-effects model.

Results: The synthesis of data across the four selected studies revealed a pooled relative risk (RR) of 0.88 (95% CI: 0.78, 1.00) and odds ratio (OR) of 0.80 (95% CI: 0.65, 0.99) about the efficacy in emergency surgeries conducted by nurses. These four studies were the only ones meeting our strict inclusion criteria of reporting outcome data on nurse-performed emergency procedures. An analysis of heterogeneity demonstrated minimal variability among the studies, with a Chi² value of 1.54, df = 3, P = 0.67, and I² = 0%. The test for overall effect yielded a statistically significant Z statistic of 2.03 (P = 0.04), indicating a meaningful finding. The observed inferences also showed that the surgical procedures exhibited minimal complications.

Conclusion: This study suggests that trained nurses can safely and effectively perform selected emergency surgical procedures. While encouraging, the limited number of studies highlights the need for further research to confirm these findings and guide clinical practice.

Introduction: Free anterolateral thigh perforator flap (ALTPF) reconstruction is a conventional approach for the treatment of diabetic foot ulcers (DFU), whereas tibial cortex transverse transport (TTT) represents an emerging alternative. However, direct comparative studies evaluating their therapeutic efficacy remain limited.

Methods: A retrospective analysis was performed on patients with DFU treated at the First Affiliated Hospital of Guangxi Medical University between January 2016 and December 2022. All patients underwent either TTT or ALTPF reconstruction. Treatment and follow-up data were obtained from the hospital's Computer Information Center and the outpatient follow-up system. Patient demographics and wound-related information were collected. Ulcer healing status was assessed using wound photographs and follow-up records, with healing time, recurrence, and amputation events documented. Foot sensory function was evaluated using the Semmes-Weinstein monofilament test (SWMT) and nerve conduction velocity measurements, while postoperative foot function was assessed according to the Maryland Foot Score.

Results: A total of 174 patients with DFU were included in this study, of whom 88 underwent TTT and 86 received ALTPF reconstruction. The TTT group had significantly shorter operative time, less intraoperative blood loss, and a lower transfusion rate than the ALTPF group (P < 0.05). The ulcer healing rate was higher in the TTT group (98% vs. 88%, P = 0.015), whereas the recurrence and major amputation rates were significantly lower (both P < 0.05). The TTT group also showed a higher rate of positive SWMT and faster nerve conduction velocity compared with the ALTPF group (P < 0.05), along with better Maryland Foot Scores. Two cases of pin-tract infection occurred in the TTT group, while flap necrosis developed in nine cases in the ALTPF group.

Conclusions: TTT demonstrated superior therapeutic efficacy to ALTPF in the management of severe DFU. TTT offered advantages including shorter operative time, reduced blood loss, lower transfusion and complication rates, higher healing rate, and better functional recovery. However, further randomized controlled trials are warranted to validate these findings.

Objectives: The analysis of prognostic regression of patients in the regional treatment programme for severe trauma can improve the survival rate and quality of life of patients. The aim of this study is to construct an accurate and effective prognostic prediction model for the optimization and development of the regional trauma care network.

Methods: We firstly extracted the clinical data of patients admitted to the regional treatment programme for severe trauma in our hospital during the period from January 2020 to December 2022. The criterion weighting method was adopted to comprehensively evaluated the AIS scores of the cumulative patients in different parts of the body. Based on the regression, the patients were divided into cured group, improved group and poor prognosis group. Based on the dependent variables, the included influencing factors were subjected to univariate analysis, multivariate analysis, and prediction model construction and comparison study. Genetic algorithm was used to solve the planning model; combined with the results of unifactorial analysis and Xgboost, RF was used to screen the features, and the interpretable model (SHAP) and column charts were used to verify the effectiveness of the screened features.

Results: After feature screening and interpretable model validation, 11 indicators such as the main diagnostic score, AIS score and albumin were ultimately included as the important influencing factors of outcome variables, among which albumin was the more important protective factor, and the diagnostic score and AIS score were the more important risk factors. In the comparative study of categorical prediction models, the RF-Transformer-LSTM model achieved the most excellent prediction effect, the accuracy rate of the model test set was 0.9556, the precision rate was 0.9615, the TPR was 0.9474, the TNR was 0.9619, F1 value of 0.9544 as well as AUC value of 0.9271, and in the construction of the three-classification model, the accuracy of the model test set reached 0.9310.

Conclusion: We constructed RF-Transformer-LSTM prediction model has high prediction accuracy and good interpretability in practical applications, which can provide strong support for the optimisation of regional trauma treatment strategies.

Background: Minimally invasive surgery has gained widespread popularity in clinical practice. Among spinal surgeries, percutaneous pedicle screw placement (PPS) is one of the most widely performed procedures. However, it necessitates high-frequency fluoroscopic guidance to ensure accuracy, resulting in substantial radiation exposure. Therefore, it is crucial to develop a technique that is fast, safe, and minimizes radiation exposure.

Objective: We aimed to describe a novel three-step fluoroscopy-guided technique for PPS and preliminarily evaluate the technical feasibility, procedural efficiency, and short-term safety.

Methods: This study prospectively enrolled consecutive patients who underwent PPS using either the three-step fluoroscopy-guided technique or the conventional method from December 2024 to February 2025, while data analysis was performed retrospectively. Data collected included operative time, fluoroscopy frequency, screw placement accuracy, and postoperative complications.

Results: The three-step fluoroscopy-guided technique required an average of 4 ± 1.12 fluoroscopic exposures per screw, with an average screw placement time of 5.05 ± 0.923 min. In contrast, the conventional method required an average of 18.33 ± 2.89 fluoroscopic exposures per screw and an average placement time of 15.84 ± 4.11 min. And no significant complications, such as neural or vascular injuries, were reported.

Conclusion: This pilot study suggests that the three-step fluoroscopy-guided PPS technique is technically feasible and may reduce fluoroscopy usage while maintaining short-term procedural safety, making it a feasible and efficient alternative that warrants further validation in larger cohorts.

Basal cell carcinoma (BCC) represents the most common cutaneous malignancy, with tumors located in high-risk anatomical regions presenting significant challenges due to elevated recurrence rates and functional constraints. This retrospective cohort study investigated the relationship between surgical margin status and tumor recurrence in patients with BCC at high-risk sites. We analyzed clinical and pathological data from patients who underwent surgical excision, focusing on margin status classification, margin distance measurements, and recurrence outcomes during follow-up periods. Univariate analyses examined associations between margin status and various clinicopathological features, while multivariate Cox regression identified independent prognostic factors for recurrence. Kaplan-Meier survival analysis compared recurrence-free survival between margin-negative and margin-positive groups. Our findings demonstrated that positive surgical margins significantly increased recurrence risk in high-risk anatomical locations. Margin distance showed a dose-response relationship with recurrence probability, with specific threshold values correlating with optimal oncological outcomes. Histological subtypes and tumor size also influenced the relationship between margin status and recurrence. These results emphasize the critical importance of achieving adequate surgical margins during BCC excision at high-risk sites and provide evidence-based guidance for determining appropriate margin distances based on anatomical location and tumor characteristics.

Knee osteoarthritis (KOA) is a highly prevalent degenerative joint disease characterized by osteophyte formation at joint margins, subchondral bone sclerosis, and progressive degeneration of the articular cartilage. In advanced stages, it can result in severe functional impairment of the knee joint, imposing a substantial burden on patients' quality of life and on healthcare systems. Conventional intra-articular treatments, such as hyaluronic acid and corticosteroid injections, provide temporary pain relief but fail to achieve true tissue repair or regeneration. In recent years, several novel biological agents with regenerative potential have been introduced, yet their efficacy and safety remain debated. Exosomes, nanoscale vesicles secreted by cells, play essential roles in the pathophysiology of OA by mediating intercellular communication and regulating inflammatory and metabolic processes within the joint microenvironment. Exosomes derived from various cellular sources have been shown to promote chondrocyte proliferation and survival, suppress inflammation, maintain cartilage matrix homeostasis, and modulate subchondral bone remodeling and angiogenesis, demonstrating significant therapeutic promise for KOA. This review systematically summarizes current research on the mechanisms and therapeutic potential of exosomes derived from diverse cell types in KOA, highlighting recent advances and ongoing challenges. It aims to provide a theoretical foundation and reference framework for future basic studies and clinical translation of exosome-based therapies.

Nonunion (non-osteogenic healing) remains a major challenge in fracture management, particularly due to its diagnostic complexity and unpredictable occurrence in clavicle and femoral fractures. This study aimed to investigate the potential association between plasma fibrinogen concentration and the incidence of nonunion in fracture patients, with the objective of identifying a potential biomarker for clinical prediction. Based on retrospective data from Shandong Provincial Hospital Affiliated to Shandong First Medical University (January 2010 to May 2019), we analyzed a cohort of 338 fracture cases, among which 23 (6.8%) developed nonunion. Fibrinogen concentration (AUC = 0.635, 95% CI 0.517-0.752) showed moderate discriminative capability for nonunion. Using smoothing curve fitting techniques and multivariable logistic regression models, the study systematically assessed the dose-response relationship between fibrinogen levels and the risk of nonunion risk, adjusting for confounding factors such as age, sex, injury mechanism, and ASA classification. The results indicated that for every 1 g/L increase in fibrinogen concentration, the risk of nonunion increased significantly by 48% [adjusted odds ratio [OR] = 1.48, 95% confidence interval [CI] not explicitly reported but implied statistical significance]. This association remained statistically significant even after controlling for traditional risk factors such as trauma severity and baseline patient status, suggesting that fibrinogen may influence bone healing through independent pathways. Smoothing curve fitting revealed a nonlinear, dose-dependent increase in nonunion risk with higher fibrinogen levels, potentially guiding the establishment of clinical threshold settings. The study found that elevated plasma fibrinogen levels are independently associated with an increased risk of nonunion, and routine monitoring of fibrinogen concentrations may serve as a promising adjunct tool for early identification of at-risk patients. Future research should focus on elucidating the underlying mechanisms-such as inflammation regulation and extracellular matrix deposition-and validating the predictive value of fibrinogen across different types of fractures to support the development of personalized treatment strategies.