International journal of surgery最新文献

Introduction: With an estimated 2.1 million hip and knee replacements performed annually in developed countries, orthopaedic surgeries can result in complications such as postoperative pain and cognitive dysfunctions. Dexmedetomidine shows potential for reducing pain and opioid use and improving cognitive outcomes, but its efficacy in orthopaedic settings needs further evaluation.

Methods: A comprehensive literature search was performed across electronic databases (e.g. PubMed) up to 1 June 2024, to identify relevant randomised controlled trials (RCTs) investigating the use of dexmedetomidine for orthopaedic surgeries. The primary outcomes included visual analogue scale (VAS), opioid consumption, incidence of postoperative cognitive dysfunction (POCD) and postoperative delirium (POD). The meta-analysis was conducted via RevMan 5.3 and Stata 16.0, with statistical significance set at p < 0.05. Sensitivity analyses, along with trial sequential analysis (TSA), were used to evaluate the robustness of the findings.

Results: The meta-analysis included 59 RCTs with 7,713 participants and demonstrated that dexmedetomidine significantly reduced postoperative VAS score [mean difference (MD) - 0.50, P = 0.0003] and opioid consumption (MD -11.91, P<0.0001) and decreased the incidence of POCD [risk ratio (RR) 0.59, P = 0.006] and POD (RR 0.49, P<0.0001). Dexmedetomidine also prolonged motor (MD: 1.70, P<0.0001), sensory block durations (MD: 1.80, P<0.0001), and delayed the time to first rescue analgesics (MD: 1.51, P<0.0001). TSA and sensitivity analysis confirmed the robustness and reliability of the results, whereas meta-regression revealed no significant effect of variables on primary outcomes.

Conclusion: Our study demonstrates that intravenous dexmedetomidine significantly improved postoperative pain and neurocognitive functions in orthopaedic surgery patients.

Background: Limited stem cells, low vascularization efficiency and weak osteoinductive activity plague the repair and reconstruction of bone defects with cell-free scaffolds.

Methods: Herein, injectable platelet-rich fibrin (i-PRF) was loaded into a methacrylated alginate/gelatin-methylcellulose (AGM) bioink system and constructed a porous hydrogel scaffold by three-dimensional bioprinting. The addition of nanosilicate-laponite (Lap) further enhanced this scaffold and synergized with i-PRF to promote efficient and personalized cranial regeneration.

Results: At the biochemical level, Lap significantly enhanced the ability of the scaffold to retard growth factor release, and multiple physiologically proportional growth factors in the scaffold synergistically promoted rapid neoangiogenesis and concomitantly recruited endogenous BMSCs. More importantly, the bioactive ions released by Lap markedly promoted the proliferation of BMSCs and consistently induced the osteogenic differentiation of BMSCs; At the immunological level, iPRF-AGM@Lap significantly attenuates the inflammatory response by promoting macrophage M2 polarization. Mechanistically, miRNA sequencing and functional validation experiments demonstrated that bioactive ions released by Lap could synergize with growth factors in iPRF to promote osteogenic differentiation of BMSC through the miR-21 and miR-125a-mediated TGF-β/Smads signaling pathway.

Conclusion: The results of this study provide a new idea for the personalized treatment of bone defects.

Objectives: The aim of this umbrella review is to explore the effect of intrawound vancomycin on the incidence of infection and wound complications in patients undergoing primary joint arthroplasty.

Methods: Two authors conducted a systematic search of PubMed, EMBASE, Medline, and the Cochrane Central Register of Controlled Trials from inception to 15 October 2023. All systematic reviews and meta-analyses examining the effect of intrawound vancomycin on the incidence of infection and wound complications in primary joint arthroplasty were included. Two authors independently screened and extracted the data from the studies, evaluated the methodological quality of the included studies using the Assessment of Multiple Systematic Reviews scale, and assessed the publication bias and small-sample effects.

Results: Our umbrella review includes a total of five systematic reviews, comprising 16 retrospective studies. The pooled results indicate that intrawound vancomycin significantly reduces overall infection rates (OR: 0.41; 95% CI: 0.30-0.54, P < 0.001), superficial infections (OR: 0.51; 95% CI: 0.26-0.97, P = 0.04), and periprosthetic joint infection (PJI) rates (OR: 0.38; 95% CI: 0.28-0.52, P < 0.001) among patients undergoing primary joint arthroplasty. However, vancomycin did not increase the risk of aseptic wound complications (OR: 1.34; 95% CI: 0.88-2.04, P = 0.17) and prolong wound healing (OR: 1.40; 95% CI: 0.87-2.26, P = 0.17).

Conclusions: Based on the available research, our umbrella review demonstrates that intrawound vancomycin significantly reduces infection rates in primary joint arthroplasty, including periprosthetic joint and superficial infections, without increasing wound complications. However, given the inclusion of studies with varying quality, these findings should be interpreted with caution. Further high-quality studies are needed to better confirm its long-term safety, cost-effectiveness, and overall clinical utility.

Pancreatic surgery is a complex and challenging field, with patients facing a high risk of postoperative complications. In recent years, indocyanine green (ICG) has gained prominence as a valuable tool used in various aspects of pancreatic surgery. ICG is a fluorescent dye thatoffers real-time imaging capabilities that enhance the surgeon's ability to accurately localise tumours and critical anatomical structures, thereby improving surgical precision and potentially reducing operative time and complications. One of the most significant advantages of ICG is its ability to provide enhanced visualisation of the biliary tract and vascular structures, which is particularly beneficial in complex pancreatic resections, in which the anatomy can be highly variable and challenging to navigate. Furthermore, ICG can be instrumental in ensuring the adequate perfusion of anastomoses, thereby reducing the risk of postoperative leaks and associated morbidity. This comprehensive review aims to provide an in-depth analysis of the current applications, advantages, and limitations of ICG in pancreatic surgery.

Background: Shock waves in medicine have gained enormous importance and have spread since 1980, and the first kidney stone was successfully fragmented in a patient in Munich. Meanwhile, the spectrum of medical applications of shock waves ranges from powerful fragmentation of kidney stones to diverse indications such as wound healing, chronic pelvic pain, spasticity, erectile dysfunction, and others, to neuro-stimulation in the context of Alzheimer's disease. A comprehensive working mechanism for this diverse field of medical indications are still missing.

Objective: Investigation of the physical basis of the working mechanism of shock waves in medical applications.

Methods: We developed a model based on the mechanical forces generated by the momentum transfer at the acoustic interfaces of different layers of biological tissue. The generated forces are strong enough to crash brittle material and provide an adequate mechanical stimulus to activate mechano-transduction and mechano-sensory-transduction with nerve stimulation, thereby affecting the neural memory function of the central nervous system.

Results: The key to generating appropriate forces in the millisecond range is the mechanism of momentum transfer at the interfaces between tissue layers with different acoustic impedances. According to Newton´s laws of motion, a change in momentum (momentum transfer) generates force F = dP/dt. The inherent shear forces can stretch biological membranes to release biomolecules such as VEGF and NO. A most favourable feature of this mechanism is the selective effect on soft tissue interfaces and small tissue inhomogeneities to generate small forces in the range of few (≤ 10) Newton to stimulate tissue and nerve cells, while the same shock wave can generate forces ≥ 200 Newton and more on hard tissue interfaces such as bones or stones.

Conclusion: The mechanism of momentum transfer is the basis for mechano-transduction and mechano-sensory transduction. It offers the opportunity to stimulate peripheral nerves and modify the motor reflex patterns of "pathologic" reflexes by hyper stimulation. The new technique of transcranial pulse stimulation (TPS) may be based on direct stimulation and reactivation of neurons in the brain. Momentum transfer is the basic physical mechanism and the initiator for successive biological processes in medical shock wave therapy.

The natural orifice specimen extraction surgery (NOSES) procedure is an innovative approach to treating colorectal cancer that offers several advantages. First, the NOSES technique is minimally invasive, reducing the incidence of postoperative complications such as wound infection and fat liquefaction. Second, it provides excellent pain relief and improves cosmetic outcomes by requiring fewer abdominal incisions, thereby increasing patient satisfaction. Additionally, NOSES provides all of the advantages of minimally invasive surgery and enables patients to recover quickly, helping patients return to their normal lives faster. This approach aligns with the concept of patient-centered care and significantly improves patient quality of life. The positive results noted at both short- and long-term postoperative follow-up indicate that NOSES is a valuable option in cancer care. Despite its many benefits, NOSES has also been challenged by bacteriology, oncology, and ethics. This paper presents a review of recent research progress regarding NOSES in the treatment of colorectal cancer. In this article, we examined the advantages and disadvantages of NOSES in clinical practice and discussed potential issues and solutions.

Objective: T cell-mediated rejection (TCMR) is a major concern following liver transplantation (LT), and identifying its predictors could help improve post-transplant prognosis. This study aimed to develop a model to predict the risk of TCMR in children and adults after LT.

Method: Pre-transplant demographic characteristics, intraoperative parameters, and especially early post-transplant laboratory data for 1221 LT recipients (1096 adults and 125 children) were obtained from the Hospital, University, between 1 January 2015, and 1 January 2022. These data were analyzed to develop the prediction model.

Result: The incidence of TCMR was higher in pediatric LT recipients than in adults (17.6% vs. 6.4%, P < 0.001). In adult recipients, seven predictors were identified: donor sex, recipient age, recipient height, and post-transplant levels of serum direct bilirubin, urea, platelets, and neutrophil-to-lymphocyte ratio. In pediatric recipients, four predictors were identified: post-transplant levels of serum monocyte percentage, direct bilirubin, albumin, and gamma-glutamyl transferase. The area under the model's curve incorporating these variables for predicting TCMR after LT was 0.713 (95% confidence interval, CI: 0.655-0.770) in adults and 0.786 (95% CI: 0.675-0.896) in children. Decision curve analyses demonstrated the clinical significance of the model.

Conclusion: This study developed a prediction model that may be useful in identifying high-TCMR-risk populations in both adult and pediatric LT recipients.

Background: To evaluate outcomes of intracorporeal (IOJ) versus extracorporeal (EOJ) oesophagojejunostomy following laparoscopic total gastrectomy (LTG) for the treatment of gastric cancer.

Methods: A comprehensive search of various electronic databases was conducted. Comparative studies of IOJ versus EOJ following LTG in patients with gastric malignancy were included. Primary outcomes were anastomotic leak, anastomotic bleeding, and anastomotic stricture formation. Secondary outcomes included operative time, length of hospital stay (LOS), volume of intra-operative haemorrhage, number of harvested lymph nodes, time to flatus, time to soft diet, intra-abdominal infection, pulmonary infection, surgical site infection (SSI), duodenal stump leak, pancreatic fistula occurrence, postoperative ileus, re-operation, and mortality. Combined overall effect sizes were calculated using the random-effects model, and the Newcastle-Ottawa Scale was used to assess risk of bias.

Results: Seventeen non-randomised studies enrolling 2,960 patients divided between an IOJ (n = 1430) and EOJ (n = 1530) group were included. IOJ was associated with significantly lower risk of anastomotic stricture (P = 0.01), volume of intra-operative bleeding (P = < 0.001), and SSI (P = 0.04) compared to EOJ. No difference was found in anastomotic leak (P = 0.93); anastomotic bleeding (P = 0.35); operative time (P = 0.63); LOS (P = 0.30); lymph node yield (P = 0.17); time to first flatus (P = 0.77); time to resumption of soft diet (P = 0.32); intra-abdominal infection (P = 0.22); pulmonary infection (P = 0.45); duodenal stump leak (P = 0.46); pancreatic fistula occurrence (P = 0.16); and paralytic ileus (P = 0.59), re-operation (P = 0.50), and mortality (P = 0.23) between the two groups.

Conclusions: LTG for gastric malignancy with IOJ may be associated with lower risk of anastomotic stricture and SSI compared to the extracorporeal approach. However, future adequately powered randomized studies are needed to compare the two techniques.