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Editorial: Brain metastasis and systemic target therapy: implications for neurosurgeons. 社论:脑转移和全身靶向治疗:对神经外科医生的启示。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2026-01-19 eCollection Date: 2026-01-01 DOI: 10.3389/fsurg.2026.1761513
Cleiton Formentin, Maira Cristina Velho, Erion Junior de Andrade, Guilherme Finger
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引用次数: 0
The role of medium-frequency pulsed electrotherapy in patients with postoperative ileus after gynecological surgery. 中频脉冲电疗在妇科术后肠梗阻患者中的作用。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2026-01-19 eCollection Date: 2025-01-01 DOI: 10.3389/fsurg.2025.1699446
Jiazhen Ji, Haixia Wu, Xiaopei Huang, Shouhua Yang

Objective: To investigate whether medium-frequency pulse electrical therapy can effectively shorten the duration of postoperative ileus in gynecological patients.

Methods: Clinical data from 126 eligible gynecological surgery patients from January 2024 to June 2024 were analyzed. Patients were grouped based on whether they received medium-frequency pulse electrical therapy and the initiation time of the therapy. Postoperative time to first flatus was compared between groups.

Results: There was no statistically significant difference in the time to first anal exhaust between patients who received medium-frequency pulsed electrotherapy and those who did not (P = 0.36). Similarly, no significant difference was observed based on the timing of initiation of medium-frequency pulsed electrotherapy (P = 0.70).

Conclusion: Medium-frequency pulse electrical therapy shows no significant effect in shortening the duration of postoperative ileus in gynecological patients.

目的:探讨中频脉冲电疗是否能有效缩短妇科患者术后肠梗阻持续时间。方法:对我院2024年1月~ 2024年6月126例符合条件的妇科手术患者的临床资料进行分析。患者根据是否接受中频脉冲电疗和治疗开始时间进行分组。比较两组术后首次排气时间。结果:中频脉冲电疗组与非中频脉冲电疗组首次肛门排气时间比较,差异无统计学意义(P = 0.36)。同样,基于中频脉冲电疗的开始时间,没有观察到显著差异(P = 0.70)。结论:中频脉冲电疗对缩短妇科患者术后肠梗阻持续时间无明显效果。
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引用次数: 0
Excess risk and resource utilization in dialysis-dependent patients undergoing total hip arthroplasty: insights from a nationally representative database. 透析依赖患者接受全髋关节置换术的过度风险和资源利用:来自全国代表性数据库的见解。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2026-01-16 eCollection Date: 2025-01-01 DOI: 10.3389/fsurg.2025.1704799
David Maman, Yaniv Steinfeld, Yaron Berkovich

Background: Total hip arthroplasty (THA) reliably restores function and quality of life in patients with end-stage hip disease. Individuals with end-stage renal disease (ESRD) requiring dialysis are vulnerable to perioperative complications due to immune dysfunction, hemodynamic instability, and impaired wound healing. Evidence on risk-adjusted outcomes remains limited.

Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample (2016-2022). Dialysis dependence was identified using ICD-10-CM Z99.2. Primary outcomes included in-hospital mortality, length of stay (LOS), and hospital charges; secondary outcomes were major complications. Propensity score matching (10:1 nearest neighbour) balanced baseline demographics and comorbidities. Survey weights were used for national estimates. Post-matching outcomes were compared using risk ratios (RR) with 95% CIs.

Results: Among 1,957,284 THA patients, 2,730 (0.1%) were dialysis dependent. In unmatched analysis, dialysis dependence was associated with substantially increased in-hospital mortality (1.3% vs. 0.03%; crude RR: 31.9, 95% CI: 22.7-44.9). After 10:1 propensity-score matching, dialysis-dependent patients had 62.5% longer LOS (3.9 vs. 2.4 days, p < 0.01), 95.8% higher hospital charges ($98,454 vs. $60,741, p < 0.01), and persistently elevated in-hospital mortality (matched RR: 10.1, 95% CI: 6.3-16.2). Major complications were significantly more frequent.

Conclusion: Dialysis dependence is a strong independent predictor of higher perioperative morbidity, mortality, and cost following THA. Targeted multidisciplinary optimization and enhanced perioperative care pathways are warranted.

背景:全髋关节置换术(THA)可以可靠地恢复终末期髋关节疾病患者的功能和生活质量。需要透析的终末期肾病(ESRD)患者易因免疫功能障碍、血流动力学不稳定和伤口愈合受损而出现围手术期并发症。关于风险调整后结果的证据仍然有限。方法:采用2016-2022年全国住院患者样本进行回顾性队列研究。采用ICD-10-CM Z99.2进行透析依赖鉴定。主要结局包括住院死亡率、住院时间(LOS)和医院收费;次要结局为主要并发症。倾向评分匹配(10:1最近邻)平衡了基线人口统计学和合并症。调查权重用于国家估计。配对后结果采用95% ci的风险比(RR)进行比较。结果:在1,957,284例THA患者中,2,730例(0.1%)依赖透析。在非匹配分析中,透析依赖与住院死亡率显著增加相关(1.3%对0.03%;粗RR: 31.9, 95% CI: 22.7-44.9)。在10:1倾向评分匹配后,透析依赖患者的LOS延长了62.5%(3.9天vs 2.4天,p)。结论:透析依赖是THA术后围手术期发病率、死亡率和成本较高的一个强有力的独立预测因素。有针对性的多学科优化和加强围手术期护理途径是必要的。
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引用次数: 0
Effect of tidal volume on gastric insufflation during laparoscopic cholecystectomy: a strictly retrospective observational study. 腹腔镜胆囊切除术中潮汐量对胃充气的影响:一项严格回顾性观察性研究。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2026-01-16 eCollection Date: 2025-01-01 DOI: 10.3389/fsurg.2025.1708814
Xiaolong Zhao, Jinyang Zhao, Chengjiang Zhang

Background: Laparoscopic cholecystectomy (LC) is the gold-standard minimally invasive gallbladder removal procedure. Optimal ventilation during LC requires positive end-expiratory pressure (PEEP) and low tidal volumes (TV) to prevent gastric insufflation (GI), which may cause regurgitation and cardiopulmonary complications.

Method: This strictly retrospective observational study analyzed routine collected data from 60 patients undergoing laparoscopic cholecystectomy between January 2022 and December 2023. Patients were categorized into three groups based on anesthesia records of delivered tidal volumes (6, 8, or 10 mL/kg) during facemask ventilation. While group assignment was performed retrospectively, ventilation parameters were standardized per institutional protocol, ensuring consistent clinical delivery. Patients were divided into Group 1 (6 mL/kg), Group 2 (8 mL/kg), and Group 3 (10 mL/kg). Gastric insufflation was assessed via ultrasonography, and respiratory parameters end-tidal carbon dioxide (PetCO2), end-tidal oxygen (ETO2), and peak inspiratory pressure (PIP) were recorded.

Result: GI incidence was significantly higher in Group 3 (60%) vs. Group 1 (15%, p = 0.0079) and Group 2 (20%, p = 0.0225). Group 3 showed greater antral area expansion post-ventilation (504.1 ± 109.8 mm2 vs. 420.1 ± 47.1 mm2, p = 0.001). PetCO2 and ETO2 levels differed significantly across groups (p < 0.001).

Conclusion: The study reveals that Group 2's facemask ventilation may improve preoxygenation and minimize gastric insufflation during laparoscopic cholecystectomy anesthesia induction. Further research is needed due to the small sample size, ultrasonography accuracy issues, and a single-center scenario.

背景:腹腔镜胆囊切除术(LC)是金标准的微创胆囊切除手术。LC期间的最佳通气需要呼气末正压(PEEP)和低潮气量(TV),以防止胃充盈(GI),胃充盈可能导致反流和心肺并发症。方法:这项严格回顾性观察性研究分析了2022年1月至2023年12月期间60例腹腔镜胆囊切除术患者的常规收集数据。根据面罩通气时的麻醉记录将患者分为三组(6、8、10 mL/kg)。回顾性分组时,通气参数按机构方案标准化,确保一致的临床交付。患者分为1组(6 mL/kg)、2组(8 mL/kg)、3组(10 mL/kg)。超声检查胃内注入量,记录呼吸参数潮末二氧化碳(PetCO2)、潮末氧气(ETO2)和吸气峰值压力(PIP)。结果:3组胃肠道发生率(60%)明显高于1组(15%,p = 0.0079)和2组(20%,p = 0.0225)。第3组通气后心房面积扩张较大(504.1±109.8 mm2 vs. 420.1±47.1 mm2, p = 0.001)。结论:在腹腔镜胆囊切除术麻醉诱导过程中,第2组面罩通气可改善预充氧,减少胃内灌气。由于样本量小、超声准确性问题和单中心方案,需要进一步研究。
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引用次数: 0
In situ split liver transplantation with celiac trunk allocation: technical evolution and outcomes supporting right-sided preservation. 腹腔干分配原位肝移植:支持右侧保存的技术演变和结果。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2026-01-16 eCollection Date: 2025-01-01 DOI: 10.3389/fsurg.2025.1737518
Fahim Kanani, Naheel Mahajna, Aviad Gravetz, Micheal Gurevich, Nir Lubezky, Ronli Ovadya, Eviatar Nesher

Background: Split liver transplantation (SLT) expands the donor pool, but optimal arterial configuration remains debated. We report outcomes of right-sided in situ SLT with systematic celiac trunk preservation with the right graft.

Methods: Retrospective Multicentre analysis of 36 consecutive adult recipients of right-sided split grafts (2015-2025) with celiac trunk preservation. Primary outcomes included vascular complications, patient/graft survival, and comparison with published benchmarks.

Results: Recipients (mean age 54.0 ± 12.6 years, 53% male) underwent SLT for HCV (30.6%), NASH (19.4%), and other etiologies. Major vascular complications occurred in 12/36 (33%) of cases, though life-threatening events remained uncommon: HAT 2.8%, postoperative PVT 5.6%, arterial stenosis 5.6%. Biliary complications occurred in 25% (ischemic 8.3%, technical 17%). Patient survival was 86% at 1 year and 81% at 3 years. Reoperation rate was 47%, primarily for biliary complications (17%) and intra-abdominal abscess (14%). Retransplantation rate was 11%.

Conclusion: Right-sided SLT with celiac trunk preservation achieves excellent vascular outcomes, with both HAT (2.8%) and PVT (5.6%) rates meeting international benchmarks. These results strongly support this configuration as the preferred technical approach for in situ split liver transplantation.

背景:分裂肝移植(SLT)扩大了供体池,但最佳动脉配置仍存在争议。我们报告了右侧原位SLT与系统腹腔干保存和右侧移植物的结果。方法:回顾性多中心分析2015-2025年36例保留乳糜干的连续成人右侧劈裂移植物受者。主要结局包括血管并发症、患者/移植物存活以及与已发表基准的比较。结果:接受者(平均年龄54.0±12.6岁,53%男性)因HCV(30.6%)、NASH(19.4%)和其他病因接受了SLT治疗。12/36(33%)的病例发生了主要血管并发症,尽管危及生命的事件仍然罕见:HAT 2.8%,术后PVT 5.6%,动脉狭窄5.6%。胆道并发症发生率为25%(缺血性8.3%,技术性17%)。患者1年生存率为86%,3年生存率为81%。再手术率为47%,主要是胆道并发症(17%)和腹腔脓肿(14%)。再移植率为11%。结论:保留乳糜干的右侧SLT具有良好的血管预后,HAT(2.8%)和PVT(5.6%)的发生率均达到国际标准。这些结果有力地支持这种结构作为原位分裂肝移植的首选技术方法。
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引用次数: 0
Establishment of a long-term secondary lymphedema animal model in the rodent hindlimb. 鼠类后肢长期继发性淋巴水肿动物模型的建立。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2026-01-16 eCollection Date: 2025-01-01 DOI: 10.3389/fsurg.2025.1703868
Sung-Hwan Yoon, Hyun Suk Peter Suh, Jin-Hui Yoon, Hayeong Cho, Yujin Myung, Jae Yong Jeon

Introduction: Secondary lymphedema is a chronic swelling of the extremities caused by physical disruption of the lymphatic system, leading to impaired lymph drainage. It frequently develops in cancer patients after surgical removal of lymph nodes and vessels during tumor resection, when reconnection of lymphatic pathways fails. Current clinical therapies are mainly palliative or conservative, with limited therapeutic effects. Therefore, an animal model that closely mimics the chronic and severe characteristics of secondary lymphedema in patients is required to enable mechanistic and therapeutic research.

Methods: To establish a long-term secondary lymphedema model in the mouse hindlimb, a combination of surgical, radiological, and mechanical interventions was designed. A novel surgical procedure termed the folding suture technique was developed to disrupt both the superficial and deep lymphatic networks. Controlled radiation exposure was applied postoperatively to inhibit early-stage lymphangiogenesis, while hindlimb immobilization was introduced to suppress lymphatic pumping and enhance edema formation.

Results: The newly developed model showed a significant and persistent increase in hindlimb paw thickness, with edema sustained for over six weeks. Immunofluorescence analysis demonstrated a markedly reduced number and diameter of regenerated lymphatic vessels compared to previously established models. Functional lymphography using fluorescein isothiocyanate (FITC)-dextran and live indocyanine green (ICG) imaging confirmed diminished lymphangiogenesis and impaired lymphatic flow. Further evaluation using the leg dermal backflow (LDB) staging system-commonly applied in clinical assessment-showed consistently higher severity scores, indicating a robust and irreversible secondary lymphedema phenotype.

Discussion: This study demonstrates that the newly established mouse hindlimb lymphedema model successfully replicates the chronic, severe, and irreversible nature of clinical secondary lymphedema. The combination of the folding suture technique, radiation-induced inhibition of lymphangiogenesis, and immobilization effectively induces and maintains the pathology. This model provides a reliable preclinical platform for in-depth investigation of secondary lymphedema pathophysiology and for the development and validation of novel therapeutic strategies.

继发性淋巴水肿是由淋巴系统的物理破坏引起的四肢慢性肿胀,导致淋巴排水受损。它经常发生在肿瘤切除术中手术切除淋巴结和血管后,当淋巴管重新连接失败时。目前的临床治疗主要是姑息性或保守性,治疗效果有限。因此,需要一种密切模仿患者继发性淋巴水肿的慢性和严重特征的动物模型来进行机制和治疗研究。方法:建立小鼠后肢长期继发性淋巴水肿模型,采用手术、放射和机械干预相结合的方法。一种新颖的外科手术称为折叠缝合技术被开发破坏表面和深层淋巴网络。术后控制辐射照射抑制早期淋巴管生成,后肢固定抑制淋巴泵送,促进水肿形成。结果:新建立的模型后肢爪厚明显持续增加,水肿持续6周以上。免疫荧光分析显示,与先前建立的模型相比,再生淋巴管的数量和直径明显减少。使用异硫氰酸荧光素(FITC)-葡聚糖和活吲哚菁绿(ICG)成像的功能性淋巴造影证实淋巴管生成减少和淋巴血流受损。使用腿部真皮回流(LDB)分期系统(通常用于临床评估)进行进一步评估,结果显示严重程度评分始终较高,表明继发性淋巴水肿表型稳健且不可逆。讨论:本研究表明,新建立的小鼠后肢淋巴水肿模型成功复制了临床继发性淋巴水肿的慢性、重度和不可逆性。折叠缝合技术、放射诱导的淋巴管生成抑制和固定相结合,有效地诱导和维持了病理。该模型为深入研究继发性淋巴水肿病理生理以及开发和验证新的治疗策略提供了可靠的临床前平台。
{"title":"Establishment of a long-term secondary lymphedema animal model in the rodent hindlimb.","authors":"Sung-Hwan Yoon, Hyun Suk Peter Suh, Jin-Hui Yoon, Hayeong Cho, Yujin Myung, Jae Yong Jeon","doi":"10.3389/fsurg.2025.1703868","DOIUrl":"10.3389/fsurg.2025.1703868","url":null,"abstract":"<p><strong>Introduction: </strong>Secondary lymphedema is a chronic swelling of the extremities caused by physical disruption of the lymphatic system, leading to impaired lymph drainage. It frequently develops in cancer patients after surgical removal of lymph nodes and vessels during tumor resection, when reconnection of lymphatic pathways fails. Current clinical therapies are mainly palliative or conservative, with limited therapeutic effects. Therefore, an animal model that closely mimics the chronic and severe characteristics of secondary lymphedema in patients is required to enable mechanistic and therapeutic research.</p><p><strong>Methods: </strong>To establish a long-term secondary lymphedema model in the mouse hindlimb, a combination of surgical, radiological, and mechanical interventions was designed. A novel surgical procedure termed the folding suture technique was developed to disrupt both the superficial and deep lymphatic networks. Controlled radiation exposure was applied postoperatively to inhibit early-stage lymphangiogenesis, while hindlimb immobilization was introduced to suppress lymphatic pumping and enhance edema formation.</p><p><strong>Results: </strong>The newly developed model showed a significant and persistent increase in hindlimb paw thickness, with edema sustained for over six weeks. Immunofluorescence analysis demonstrated a markedly reduced number and diameter of regenerated lymphatic vessels compared to previously established models. Functional lymphography using fluorescein isothiocyanate (FITC)-dextran and live indocyanine green (ICG) imaging confirmed diminished lymphangiogenesis and impaired lymphatic flow. Further evaluation using the leg dermal backflow (LDB) staging system-commonly applied in clinical assessment-showed consistently higher severity scores, indicating a robust and irreversible secondary lymphedema phenotype.</p><p><strong>Discussion: </strong>This study demonstrates that the newly established mouse hindlimb lymphedema model successfully replicates the chronic, severe, and irreversible nature of clinical secondary lymphedema. The combination of the folding suture technique, radiation-induced inhibition of lymphangiogenesis, and immobilization effectively induces and maintains the pathology. This model provides a reliable preclinical platform for in-depth investigation of secondary lymphedema pathophysiology and for the development and validation of novel therapeutic strategies.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1703868"},"PeriodicalIF":1.6,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12855541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146104985","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
Learning curve in robotic surgery for ureteropelvic junction obstruction in children: how to best define a reliable learning process through CUSUM analysis. 儿童输尿管盂连接处梗阻机器人手术的学习曲线:如何通过CUSUM分析最好地定义一个可靠的学习过程。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2026-01-16 eCollection Date: 2025-01-01 DOI: 10.3389/fsurg.2025.1693109
Girolamo Mattioli, Maria Stella Cipriani, Maria Grazia Calevo, Martina Monti, Venusia Fiorenza, Marcello Carlucci

Introduction: Robot-assisted laparoscopic pyeloplasty (RALP) is the most common robotic procedure performed in children. The aim was to evaluate the LC of a pediatric urologist experienced in open and laparoscopic surgery, using CUSUM analysis of both operative times and outcomes, to provide a more comprehensive understanding of the learning process.

Methods: This single-centre prospective study included children who underwent RALP for ureteropelvic junction obstruction (UPJO) between February 2021 and October 2024. Demographic, operative and postoperative data were collected. The parameters assessed through CUSUM analysis were total operative time (TOT), plotted using three different reference means; console operative time (COT); and a composite parameter (CP) combining TOT, urological complications, and success.

Results: Twenty-two patients were included. Median age at surgery was 2.1 years, and mean weight 17.1 kg. Mean TOT was 158.1 min, and mean COT was 109.2 min. Median follow-up was 8.8 months. CUSUM-TOT and CUSUM-COT curves, based on the operating surgeon's mean values, identified three phases: introductory (4 cases), proficiency (6 cases), and mastery (12 cases). In contrast, the CUSUM-CP curve revealed only two phases: an introductory phase of 17 patients and a proficiency phase of 5.

Discussion: This study highlights how CUSUM LC analysis in RALP varies depending on both the parameter evaluated and the reference value used. Composite metrics revealed a longer LC than operative time alone, highlighting the influence of postoperative outcomes in assessing surgical competency. These findings emphasize the need for standardized, multidimensional LC assessments in pediatric RALP to better capture the complexity of the learning process.

机器人辅助腹腔镜肾盂成形术(RALP)是儿童中最常见的机器人手术。目的是评估有开放和腹腔镜手术经验的儿科泌尿科医生的LC,使用CUSUM对手术时间和结果进行分析,以提供对学习过程更全面的了解。方法:这项单中心前瞻性研究纳入了2021年2月至2024年10月期间因肾盂输尿管连接处梗阻(UPJO)接受RALP治疗的儿童。收集人口统计学、手术和术后数据。通过CUSUM分析评估的参数是总手术时间(TOT),使用三种不同的参考方法绘制;控制台操作时间(COT);以及综合TOT、泌尿系统并发症和成功率的综合参数(CP)。结果:纳入22例患者。手术时的中位年龄为2.1岁,平均体重为17.1公斤。平均TOT 158.1 min,平均COT 109.2 min。中位随访时间为8.8个月。CUSUM-TOT和CUSUM-COT曲线基于手术医生的平均值,确定了三个阶段:入门(4例)、熟练(6例)和熟练(12例)。相比之下,CUSUM-CP曲线只显示了两个阶段:17例患者的入门期和5例患者的熟练期。讨论:本研究强调了CUSUM LC分析在RALP中的变化如何取决于所评估的参数和使用的参考值。综合指标显示LC比单独手术时间更长,突出了术后结果对评估手术能力的影响。这些发现强调了在儿童RALP中进行标准化、多维的LC评估的必要性,以更好地捕捉学习过程的复杂性。
{"title":"Learning curve in robotic surgery for ureteropelvic junction obstruction in children: how to best define a reliable learning process through CUSUM analysis.","authors":"Girolamo Mattioli, Maria Stella Cipriani, Maria Grazia Calevo, Martina Monti, Venusia Fiorenza, Marcello Carlucci","doi":"10.3389/fsurg.2025.1693109","DOIUrl":"10.3389/fsurg.2025.1693109","url":null,"abstract":"<p><strong>Introduction: </strong>Robot-assisted laparoscopic pyeloplasty (RALP) is the most common robotic procedure performed in children. The aim was to evaluate the LC of a pediatric urologist experienced in open and laparoscopic surgery, using CUSUM analysis of both operative times and outcomes, to provide a more comprehensive understanding of the learning process.</p><p><strong>Methods: </strong>This single-centre prospective study included children who underwent RALP for ureteropelvic junction obstruction (UPJO) between February 2021 and October 2024. Demographic, operative and postoperative data were collected. The parameters assessed through CUSUM analysis were total operative time (TOT), plotted using three different reference means; console operative time (COT); and a composite parameter (CP) combining TOT, urological complications, and success.</p><p><strong>Results: </strong>Twenty-two patients were included. Median age at surgery was 2.1 years, and mean weight 17.1 kg. Mean TOT was 158.1 min, and mean COT was 109.2 min. Median follow-up was 8.8 months. CUSUM-TOT and CUSUM-COT curves, based on the operating surgeon's mean values, identified three phases: introductory (4 cases), proficiency (6 cases), and mastery (12 cases). In contrast, the CUSUM-CP curve revealed only two phases: an introductory phase of 17 patients and a proficiency phase of 5.</p><p><strong>Discussion: </strong>This study highlights how CUSUM LC analysis in RALP varies depending on both the parameter evaluated and the reference value used. Composite metrics revealed a longer LC than operative time alone, highlighting the influence of postoperative outcomes in assessing surgical competency. These findings emphasize the need for standardized, multidimensional LC assessments in pediatric RALP to better capture the complexity of the learning process.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1693109"},"PeriodicalIF":1.6,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12855502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105070","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
Development and validation of a frailty risk prediction model in patients with peripheral artery disease. 外周动脉疾病患者虚弱风险预测模型的建立与验证
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2026-01-16 eCollection Date: 2025-01-01 DOI: 10.3389/fsurg.2025.1682178
Qingmei Fang, Fengwang Xue, Xueshuang Chen, Xia Qing, Feng Liu, Shengmin Guo

Objective: To investigate the current status and risk factors of frailty among patients with peripheral artery disease, and to develop a risk prediction model to inform targeted clinical interventions.

Methods: Patients were consecutively recruited for this investigation from August 2024 to May 2025. The study included 499 individuals with peripheral artery disease who were hospitalized in the vascular surgery department of a tertiary hospital in Southwest China. Data were collected using a general information questionnaire, laboratory test results, the Barthel Index, and the Social Support Rating Scale. The Tilburg Frailty Indicator was used to classify patients into a non-frailty group and a frailty group. The dataset was randomly split in a 7:3 ratio into a training set and a validation set. Independent predictors of frailty were identified through univariate and multivariate logistic regression analyses. The risk prediction model was developed using R software. Discrimination of the model was evaluated by plotting receiver operating characteristic (ROC) curves and calculating the area under the curve (AUC), sensitivity, and specificity in both the training and validation sets. Model calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test and calibration curves. Clinical utility was evaluated using decision curve analysis.

Results: Age, hemoglobin level, number of comorbidities, and activities of daily living were identified as independent risk factors for frailty. In the training set, the AUC was 0.771 (95% CI: 0.721-0.821), with a sensitivity of 0.788 and a specificity of 0.808. In the validation set, the AUC was 0.704 (95% CI: 0.620-0.788), with a sensitivity of 0.743 and a specificity of 0.682. The Hosmer-Lemeshow test indicated good calibration in both the training set (χ 2 = 7.967, P = 0.435) and the validation set (χ 2 = 9.642, P = 0.291). DCA showed that the model provided net clinical benefit within threshold probability ranges of 10%-80% in the training set and 20%-74% in the validation set.

Conclusion: The developed risk prediction model exhibited predictive performance and can assist clinical healthcare providers in identifying populations at high risk of frailty among patients with PAD, thereby providing a reference for developing intervention strategies targeting relevant risk factors.

目的:了解外周动脉疾病患者虚弱的现状及危险因素,建立风险预测模型,为有针对性的临床干预提供依据。方法:于2024年8月至2025年5月连续招募患者。本研究纳入西南地区某三级医院血管外科住院的499例外周动脉疾病患者。数据收集采用一般信息问卷、实验室测试结果、Barthel指数和社会支持评定量表。采用Tilburg衰弱指标将患者分为非衰弱组和衰弱组。数据集以7:3的比例随机分成训练集和验证集。通过单变量和多变量逻辑回归分析确定了衰弱的独立预测因子。利用R软件建立风险预测模型。通过绘制受试者工作特征(ROC)曲线并计算训练集和验证集的曲线下面积(AUC)、灵敏度和特异性来评估模型的判别性。使用Hosmer-Lemeshow拟合优度检验和校准曲线评估模型校准。采用决策曲线分析评价临床疗效。结果:年龄、血红蛋白水平、合并症数量和日常生活活动被确定为衰弱的独立危险因素。在训练集中,AUC为0.771 (95% CI: 0.721-0.821),敏感性为0.788,特异性为0.808。在验证集中,AUC为0.704 (95% CI: 0.620-0.788),敏感性为0.743,特异性为0.682。Hosmer-Lemeshow检验显示训练集(χ 2 = 7.967, P = 0.435)和验证集(χ 2 = 9.642, P = 0.291)均有良好的校准。DCA表明,该模型在训练集和验证集的阈值概率范围内分别为10%-80%和20%-74%,提供净临床效益。结论:建立的风险预测模型具有较好的预测效果,可帮助临床卫生保健人员识别PAD患者中脆弱的高危人群,从而为制定针对相关危险因素的干预策略提供参考。
{"title":"Development and validation of a frailty risk prediction model in patients with peripheral artery disease.","authors":"Qingmei Fang, Fengwang Xue, Xueshuang Chen, Xia Qing, Feng Liu, Shengmin Guo","doi":"10.3389/fsurg.2025.1682178","DOIUrl":"10.3389/fsurg.2025.1682178","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the current status and risk factors of frailty among patients with peripheral artery disease, and to develop a risk prediction model to inform targeted clinical interventions.</p><p><strong>Methods: </strong>Patients were consecutively recruited for this investigation from August 2024 to May 2025. The study included 499 individuals with peripheral artery disease who were hospitalized in the vascular surgery department of a tertiary hospital in Southwest China. Data were collected using a general information questionnaire, laboratory test results, the Barthel Index, and the Social Support Rating Scale. The Tilburg Frailty Indicator was used to classify patients into a non-frailty group and a frailty group. The dataset was randomly split in a 7:3 ratio into a training set and a validation set. Independent predictors of frailty were identified through univariate and multivariate logistic regression analyses. The risk prediction model was developed using R software. Discrimination of the model was evaluated by plotting receiver operating characteristic (ROC) curves and calculating the area under the curve (AUC), sensitivity, and specificity in both the training and validation sets. Model calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test and calibration curves. Clinical utility was evaluated using decision curve analysis.</p><p><strong>Results: </strong>Age, hemoglobin level, number of comorbidities, and activities of daily living were identified as independent risk factors for frailty. In the training set, the AUC was 0.771 (95% CI: 0.721-0.821), with a sensitivity of 0.788 and a specificity of 0.808. In the validation set, the AUC was 0.704 (95% CI: 0.620-0.788), with a sensitivity of 0.743 and a specificity of 0.682. The Hosmer-Lemeshow test indicated good calibration in both the training set (<i>χ</i> <sup>2</sup> = 7.967, <i>P</i> = 0.435) and the validation set (<i>χ</i> <sup>2</sup> = 9.642, <i>P</i> = 0.291). DCA showed that the model provided net clinical benefit within threshold probability ranges of 10%-80% in the training set and 20%-74% in the validation set.</p><p><strong>Conclusion: </strong>The developed risk prediction model exhibited predictive performance and can assist clinical healthcare providers in identifying populations at high risk of frailty among patients with PAD, thereby providing a reference for developing intervention strategies targeting relevant risk factors.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1682178"},"PeriodicalIF":1.6,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12857310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146104958","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
Group standardization of Chinese experts specification of operating techniques for facial embedded thread lift. 面埋螺纹提升作业技术规范中国专家小组标准化。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2026-01-16 eCollection Date: 2025-01-01 DOI: 10.3389/fsurg.2025.1750529
Bing Shi

Background: Despite the global popularity of minimally invasive thread lifts, the absence of standardized protocols has led to significant variations in outcomes. This study establishes China's first expert consensus (T/CAPA 009-2023) on facial thread lift techniques, addressing critical gaps in operator training, material selection, and anatomical precision.

Methods: A multidisciplinary panel analyzed 2,143 PPDO thread procedures (2018-2022) across 35 institutions. The consensus framework integrates: 1) Graded facility/operator requirements (Grade III device management), 2) Anatomical stratification (SMAS, fat layers, ligament anchoring), and 3) Region-specific protocols (upper/mid/lower face, neck) with 14 illustrated surgical designs.

Conclusion: Multicenter data and anatomical studies demonstrate that this consensus framework improves thread lift safety and efficacy, though further RCTs are warranted to confirm long-term outcomes The hierarchical protocol serves as a global benchmark for aesthetic training programs, particularly in Asian facial anatomy.

背景:尽管微创螺纹提升术在全球范围内很流行,但由于缺乏标准化的方案,导致了结果的显著差异。本研究建立了中国首个关于面部螺纹提升技术的专家共识(T/CAPA 009-2023),解决了操作员培训、材料选择和解剖精度方面的关键差距。方法:一个多学科小组分析了35个机构的2143个PPDO线程程序(2018-2022)。共识框架包括:1)分级设备/操作人员要求(III级设备管理),2)解剖分层(SMAS,脂肪层,韧带锚定),以及3)区域特定方案(面部上/中/下,颈部)和14个手术设计说明。结论:多中心数据和解剖学研究表明,这一共识框架提高了螺纹提升术的安全性和有效性,尽管需要进一步的随机对照试验来确认长期结果。分层协议可作为审美训练计划的全球基准,特别是在亚洲面部解剖方面。
{"title":"Group standardization of Chinese experts specification of operating techniques for facial embedded thread lift.","authors":"Bing Shi","doi":"10.3389/fsurg.2025.1750529","DOIUrl":"10.3389/fsurg.2025.1750529","url":null,"abstract":"<p><strong>Background: </strong>Despite the global popularity of minimally invasive thread lifts, the absence of standardized protocols has led to significant variations in outcomes. This study establishes China's first expert consensus (T/CAPA 009-2023) on facial thread lift techniques, addressing critical gaps in operator training, material selection, and anatomical precision.</p><p><strong>Methods: </strong>A multidisciplinary panel analyzed 2,143 PPDO thread procedures (2018-2022) across 35 institutions. The consensus framework integrates: 1) Graded facility/operator requirements (Grade III device management), 2) Anatomical stratification (SMAS, fat layers, ligament anchoring), and 3) Region-specific protocols (upper/mid/lower face, neck) with 14 illustrated surgical designs.</p><p><strong>Conclusion: </strong>Multicenter data and anatomical studies demonstrate that this consensus framework improves thread lift safety and efficacy, though further RCTs are warranted to confirm long-term outcomes The hierarchical protocol serves as a global benchmark for aesthetic training programs, particularly in Asian facial anatomy.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1750529"},"PeriodicalIF":1.6,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12855474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105036","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
Comparative study on complications of screws versus plates for comminuted radial head and neck fractures with two or three fragments. 螺钉与钢板治疗桡骨头颈粉碎性骨折伴二、三碎片并发症的比较研究。
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2026-01-15 eCollection Date: 2025-01-01 DOI: 10.3389/fsurg.2025.1731596
Yuliang Fu, Yuan Cao, Zengzhen Cui, Liangyu Bai, Xiaoyu Norman Pan, Yang Lv

Background: This retrospective study aimed to compare the efficacy of internal fixation using headless compression screws (HCS) and radial head locking plate (RLP) for comminuted radial head and neck fractures with no more than 3 displaced fragments.

Methods: This retrospective study included 84 patients with radial head and neck fractures treated at Peking University Third Hospital between January 2013 and December 2022, with 38 and 46 patients in the HCS and RLP groups, respectively. The main outcome was the comparison of complications between the two groups. Demographic data, pre-operative time (POT), operation time (OT), and hospital stay time (HST) were also recorded. The Mayo Elbow Performance Score (MEPS), range of movement of the elbow and forearm, and reasons for re-operation were compared between the two groups.

Results: All patients were followed up for an average of 66.4 months (range, 20-135 months). One patient in each group underwent radial head replacement due to non-union, while the remaining patients achieved bone union. There was no statistically significant difference in the clinical outcomes between the two groups (p > 0.0023). Additionally, the re-operation rate due to symptomatic hardware was significantly higher in the RLP group (28.3%) than that in the HCS group (2.6%, p = 0.002).

Conclusion: For internal fixation of comminuted radial head and neck fractures with no more than three displaced fragments, both HCS and RLP achieved good outcomes. However, the RLP increased the incidence of complications and re-operation associated with internal fixation compared to HCS.

背景:本回顾性研究旨在比较使用无头加压螺钉(HCS)和桡骨头锁定钢板(RLP)内固定治疗不超过3个移位碎片的粉碎性桡骨头颈骨折的疗效。方法:回顾性研究北京大学第三医院2013年1月至2022年12月收治的84例桡骨头颈骨折患者,HCS组38例,RLP组46例。主要观察结果为两组并发症的比较。同时记录人口统计数据、术前时间(POT)、手术时间(OT)和住院时间(HST)。比较两组患者的Mayo肘关节功能评分(MEPS)、肘关节和前臂活动度、再手术原因。结果:所有患者平均随访66.4个月(20 ~ 135个月)。每组1例患者因骨不连行桡骨头置换术,其余患者实现骨愈合。两组临床结局比较,差异无统计学意义(p < 0.0023)。RLP组再手术率(28.3%)明显高于HCS组(2.6%,p = 0.002)。结论:对于不超过3块移位碎片的粉碎性桡骨头颈骨折内固定,HCS和RLP均可获得较好的疗效。然而,与HCS相比,RLP增加了与内固定相关的并发症和再手术的发生率。
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Frontiers in Surgery
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