International journal of surgery最新文献

Background: Robotic pancreaticoduodenectomy (RPD) is used more commonly, but high-level evidence is still scarce. This meta-analysis aimed to compare the short-term outcomes between RPD and laparoscopic pancreaticoduodenectomy (LPD) using data collected from propensity score-matched (PSM) studies.

Materials and methods: We searched PubMed, Cochrane Library, Embase, and Web of Science databases for PSM studies comparing RPD and LPD. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals were calculated.

Results: Ten PSM studies were included, encompassing 8106 patients (RPD group: 3695 patients; LPD group: 4411 patients). Compared with LPD, RPD was associated with a lower conversion rate (RR, 0.56) and blood transfusion rate (RR, 0.49), as well as a higher number of harvested lymph nodes (MD, 2.15). There were no significant differences observed in 30-day readmission (RR, 1.02), 90-day mortality (RR, 1.01), overall morbidity (RR, 0.94), major complications (RR, 1.06), operative time (MD, -8.00 min), blood loss (MD, -19.37 mL), reoperation (RR, 0.95), bile leak (RR, 0.93), chylous leak (RR, 1.40), postoperative pancreatic fistula (RR, 1.06), delayed gastric emptying (RR, 0.92), wound infection (RR, 1.12), length of stay (MD, -0.32 days), and R0 resection (RR, 0.98) between the groups.

Conclusions: Although LPD and RPD had similar surgical outcomes, RPD had the perioperative advantage over LPD in decreasing conversion rates and blood transfusion rates and increasing the number of lymph nodes harvested. Further randomized controlled trials evaluating the potential advantages of RPD over LPD are warranted.

Background: Major adverse cardiovascular events (MACEs) within 30 days following noncardiac surgery are prognostically relevant. Accurate prediction of risk and modifiable risk factors for postoperative MACEs is critical for surgical planning and patient outcomes. We aimed to develop and validate an accurate and easy-to-use machine learning model for predicting postoperative MACEs in geriatric patients undergoing noncardiac surgery.

Materials and methods: The cohort study was conducted at an academic medical center between June 2019 and February 2023. The outcome was postoperative MACEs within 30 days after surgery. Significant predictors were selected using permutation-shuffling. Ten machine learning models were established and compared with the Revised Cardiac Risk Index (RCRI). The SHapley Additive exPlanations algorithm was used to interpret the models.

Results: Of the 18,395 patients included, 354 (1.92%) experienced postoperative MACEs. Eighteen predictors were included in model development. The AutoGluon model outperformed other models and the RCRI with an AUROC of 0.884 (95% CI: 0.878-0.890), an accuracy of 0.976 (95% CI: 0.973-0.978), and a Brier score of 0.023 (95% CI: 0.020-0.026). In interpretability analyses, the hemoglobin level was the most important predictor. We identified the relationships between predictors and postoperative MACEs and interaction effects between some predictors. The AutoGluon model has been deployed as a web-based tool for further external validation ( https://huggingface.co/spaces/MDC2J/Predicting_postoperative_MACEs ).

Conclusion: In this prospective study, the AutoGluon model could accurately predict MACEs after noncardiac surgery in geriatric patients, outperforming existing models and the RCRI. Subsequent interpretability analysis can provide insight into how our model works and help personalize surgical strategies.

Background: Intra-leaflet hemorrhage (IH) plays a well-recognized detrimental role in calcified aortic valve disease (CAVD). However, IH-induced fibro-osteogenic responses in valvular interstitial cells (VICs) appear to be triggered under specific pathological conditions. Iron deficiency (ID), a common co-morbidity in CAVD, may influence these responses. This study investigated the relationship between ID and pathological changes associated with CAVD, and its effects on IH-mediated fibro-osteogenic differentiation of VICs.

Methods and results: Two independent studies were conducted, including 2495 patients in the discovery study and 34 in the validation study. Our data demonstrated that ID was associated with CAVD severity and progression, particularly in an age-dependent manner. Based on these clinical findings, immunofluorescence and Western blot analyses revealed that TFR1, a key iron import transporter, was significantly upregulated in human calcified aortic valves. Concurrently, iron accumulation was detected by Perl's staining in both calcific and non-calcific valve sections. In vitro , VICs cultured with human serum from ID patients showed red blood cell lysis-induced iron overload and fibro-calcific differentiation.

Conclusions: ID triggers TFR1-mediated intracellular iron overload, leading to fibrosis and calcification in human VICs, thereby contributing to IH-mediated valve remodeling and calcification. These findings supported the potential role of monitoring and correcting ID to slow or prevent the progression of valvular calcification.

Background: Pulmonary ischemia-reperfusion injury (PIRI) is a major cause of fatality post-lung transplantation. Though some long non-coding RNAs (lncRNAs) have been studied in acute lung injury (ALI), their effects on PIRI remain undefined. The present study aims to explore the underlying mechanism of small nucleolar RNA host gene 16 (SNHG16) in PIRI.

Methods: PIR mouse and oxygen-glucose deprivation/reoxygenation (OGD/R) cell models were established. Exosomes were extracted from human pulmonary microvascular endothelial cells (HPMECs). Functional and rescue experiments were conducted in OGD/R-exposed HPMECs, OGD/R-exposed pulmonary alveolar epithelial type II cells (AECs), and I/R model mice. The relationships among SNHG16, miR-372-3p/miR-373-3p, and MTCH2 were also verified using dual luciferase reporter assay, RNA pull-down and RIP assay.

Results: SNHG16 was downregulated in OGD/R-exposed HPMECs, and SNHG16 overexpression accelerated proliferation, angiogenesis, and ameliorated mitochondrial respiration in OGD/R-exposed HPMECs. HPMEC-derived exosomal SNHG16 suppressed OGD/R-induced type II AEC injury. SNHG16 ameliorated lung injury in PIR mice. Mechanistically, SNHG16 targeted and negatively regulated miR-372-3p and miR-373-3p expression, and MTCH2, a target gene of miR-372-3p/miR-373-3p. SNHG16 was found to upregulate MTCH2 expression not only in a miR-372-3p and miR-373-3p-dependent manner but also suppress ubiquitination induced MTCH2 degradation.

Conclusions: Our findings revealed that SNHG16 overexpression suppressed OGD/R-induced HPMEC apoptosis by promoting Warburg effect, and HPMEC-derived exosomal SNHG16 alleviated PIRI through the miR-372-3p/miR-373-3p/MTCH2 axis, suggesting that SNHG16 as a therapeutic target for PIRI.

Background: Despite complete resection, the recurrence rate of biliary tract cancer (BTC) remains high, leading to poor prognosis. Postoperative adjuvant chemotherapy (ACT) following radical resection may substantially reduce the recurrence risk by eradicating micrometastatic lesions. However, the benefits of postoperative ACT and the optimal ACT strategy are still unclear for BTC. The objectives of this study are to evaluate the prognostic value of ACT and compare the effectiveness of different ACTs among BTC patients after curative resection.

Methods: A comprehensive literature search was conducted across PubMed, Cochrane Library, Web of Science, and EMBASE databases to identify randomized controlled trials (RCTs) comparing the benefits of ACT versus no intervention or other ACTs in BTC patients after curative resection. A random-effects network meta-analysis was performed to compare overall survival (OS) and relapse-free survival (RFS). The quality of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation framework.

Results: Eight RCTs comprising 1803 patients were included in the meta-analysis. ACT was associated with significant improvements in 5-year all-cause mortality [four RCTs, hazard rate (HR) 0.93; 95% confidence interval (CI), 0.87-1.00, marginally significant; low-certainty evidence], RFS (five RCTs, HR 0.87; 95% CI, 0.78-0.98; moderate-certainty evidence), and OS (7 studies, HR 0.85; 95% CI, 0.75-0.96; low-certainty evidence) compared with observation. ACT had significantly better survival benefits on patients with negative margins (R0), lymph node-positive (N+), and tumor node metastasis classification (TNM) stage I/II ( P < 0.05). Further network meta-analysis demonstrated that fluorouracil-based ACT was significantly inferior to gemcitabine-based ACT (HR 1.20; 95% CI, 1.10-1.25) in improving RFS. However, both were superior to observation ( P < 0.05). No statistical difference in OS was observed between gemcitabine-based and fluorouracil-based chemotherapy (HR 1.00; 95% CI, 0.86-1.20). In subgroup analysis, fluorouracil-based ACT but not gemcitabine-based ACT achieved significantly better OS benefits on patients with N+ (HR 0.67; 95% CI, 0.52-0.86) and R0 (HR 0.69; 95% CI, 0.54-0.88).

Conclusion: Compared with observation, ACT should be routinely recommended to improve survival outcomes in BTC patients after curative resection, especially for those with R0, N+, and TNM stage I/II. Gemcitabine-based ACT performed better than other chemotherapies in improving RFS. This network meta-analysis provides precise information for determining the best adjuvant treatment for resected BTC. Further thorough and high-quality RCTs are needed.

Adipose-derived stem cell exosomes (ADSC-exos) are promising for nerve regeneration; however, their precise mechanisms remain unclear. This study employed fluorescent labeling and spatial transcriptomics to track the effects of ADSC-exos on crushed sciatic nerves in mice. Labeled exosomes were detected in spinal neurons and proximal nerve segments after application. Spatial transcriptomics revealed significant changes in gene expression, with an upregulation of neurons and Schwann cells and the downregulation of oligodendrocytes. The key pathways affected were prosaposin, pleiotrophin, fibroblast growth factor, secreted phosphoprotein 1, SLIT and NTRK-like family, member, vascular endothelial growth factor, and growth arrest-specific protein. ADSC-exo treatment enhanced cell-cell interactions, particularly between Schwann cells and astrocytes, thereby promoting a regenerative environment. Gene ontology analysis suggested improvements in metabolic activity, cell communication, and structural support. This study highlights the complex interplay between multiple cell types and signaling pathways involved in the nerve regeneration response to ADSC-exos. This comprehensive approach offers new perspectives on the role of ADSC-exos in nerve regeneration and paves the way for advanced regenerative strategies for peripheral nerve injuries.

Background: Aneurysmal subarachnoid hemorrhage (aSAH) can lead to cognitive impairment (CI), but underlying neural mechanisms remain to be elucidated.

Materials and methods: To predict long-term CI after aSAH, resting electroencephalography (EEG) was measured in 112 patients hospitalized with a diagnosis of aSAH ( n = 66) or unruptured intracranial aneurysms (controls) ( n = 46). A neuropsychological battery was administered 8-24 months after discharge.

Results: Power spectrum analysis in the parietal-occipital lobe showed significantly higher power theta vs. alpha oscillations in patients with CI after aSAH. The power of theta and alpha oscillations were significantly correlated with multiple cognitive scale scores on the neuropsychological battery. A neural model was established, which showed that connectivity between inhibitory and excitatory neurons in neural circuits contributed to changes in theta and alpha oscillations and CI in aSAH.

Conclusion: The data collection, analysis, and computational model established in this study can serve as a new paradigm for other clinical studies investigating CI.

Background: Hand-foot syndrome (HFS) and oral mucositis (OM) are common adverse events during cancer chemotherapy and can significantly decrease patients' quality of life and chemotherapy adaptation, however, prevention strategies of these complications yet to be established.

Methods: Patients with stages I-III breast cancer, who had surgery and needed pegylated liposomal doxorubicin (PLD)-based adjuvant chemotherapy were screened, recruited and randomly assigned to receive either probiotics or placebo (three capsules, twice/day) treatment during the course of chemotherapy from November 2019 to August 2020. The incidence and severity of PLD related HFS and OM, and patients' quality of life were assessed. Their plasma biomarkers, metabolites and fecal microbiota compositions were measured. And the results were further verified in animal experiments.

Results: Probiotics supplement during PLD treatment significantly decreased the incidence and the severity of HFS and OM ( P < 0.001), improved patients' life quality ( P < 0.001), increased the relative abundance of intestinal Enterococcus ( P = 0.025) and mitigated the changes of seven plasma metabolites. Among these metabolites, the changes of p-Mentha-1,8-dien-7-ol (MDO) ( B = - 0.441, P = 0.02) and L-arginine ( B = - 0.586, P = 0.002) were negatively correlated with the occurrence of severe HFS and OM. MDO can partly reproduce the preventive effects of probiotics on PLD-related skin cell proliferating inhibition, DNA damage, and local inflammation in rats.

Conclusion: Probiotics supplement during PLD-based chemotherapy prevents the incidence and severity of HFS and OM, which may be associated with modulating plasma metabolites including the MDO.

Artificial intelligence (AI) is significantly transforming surgery by enhancing precision, decision-making, and patient outcomes. This bibliometric analysis examines AI's impact on surgery, highlighting research trends, key contributors, and evolving themes from 1998 to 2024. Utilizing data from the Web of Science Core Collection and analyzed through the Bibliometrix tool, the study reviews publication trends, author impact, institutional contributions, country-specific research activities, and keyword frequency. A total of 821 articles were examined, revealing a 14.53% annual growth rate in publications, increasing from one in 1998 to 328 in 2023. Influential contributors include 10 157 authors, notably HASHIMOTO DA and ITO M. Prominent institutions such as Harvard University and Stanford University, along with leading countries like the USA and China, play major roles in this field. High-frequency keywords identify core research areas: surgery, artificial intelligence, classification, diagnosis, and outcomes. Thematic evolution shows a shift from foundational concepts to advanced applications and interdisciplinary collaborations. AI integration into surgical practices is revolutionizing the field, driving advancements in precision, efficiency, and patient care. The study underscores significant research growth, influential contributors, and key trends, emphasizing the importance of continued interdisciplinary collaboration and innovation. Future research should focus on enhancing AI applications, addressing data quality and security challenges, and expanding into diverse surgical contexts to further improve surgical outcomes and patient care. AI in surgery is a rapidly evolving and promising field for innovation, with its full potential reliant on enhanced collaboration across disciplines.

Background: The main reason restricting stroke patients from reintegrating into society is neurological deficits. Of particular interest is the potential vagus nerve stimulation (VNS) potentially offers for sustaining improvement in neurological deficits. The goal of the present study is to provide a summary of the findings from research that has been carried out to elucidate the mechanisms and demonstrate the efficacy and safety of the clinical application of VNS, as well as to identify research gaps in the field, in order to offer references for subsequent further research and application.

Methods: A systematic search was conducted in the PubMed, Web of Science, Embase, and Ovid MEDLINE databases (1866 publications). An initial screening of abstracts and titles was performed, followed by a thorough review and assessment of the full texts of 253 relevant papers.

Results: Ultimately, 62 studies that met the eligibility criteria were included. VNS may be performed either invasively or non-invasively. The modulation of brain function that is produced by VNS may improve cerebral function by one or more of the following means, namely stimulating the pathway that regulates synaptic plasticity, inhibiting inflammatory response, promoting vascular regeneration or protecting the blood-brain barrier. Application of invasive VNS has produced promising results in the treatment of moderate/severe upper limb dyskinesia in patients with ischemic stroke and has gradually entered clinical practice. Furthermore, transcutaneous auricular VNS has also demonstrated potential therapeutic effects (standardized mean differences 1.16, 95% CI = 0.02-2.30). However, further developments are required in many aspects, including preventing indications of dysfunction, optimization of parameters, timing and duration of stimulation and site of application.

Conclusions: The VNS as a promising therapeutic approach for stroke rehabilitation. The application of VNS in the treatment of hemorrhagic stroke is still unexplored and warrants attention in future studies.