Journal of Surgical Research最新文献

英文中文

Pediatric Intussusception in Sub-Saharan Africa: A Systematic Review and Meta-Analysis of Surgical Outcomes 撒哈拉以南非洲儿童肠套叠：手术结果的系统回顾和荟萃分析

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-01 DOI: 10.1016/j.jss.2025.11.068

Yohannis Derbew Molla MD , Kidist Hunegn Setargew MD , Mekdes Tsegaye Alebel MD , Hirut Tesfahun Alemu MD

Introduction

Intussusception is a common cause of acute abdominal pain and intestinal obstruction in children worldwide. However, in areas with limited health-care resources, it is more frequently associated with severe complications and poor outcomes due to delays in diagnosis and treatment. Although nonsurgical treatments have improved outcomes worldwide, many children in Sub-Saharan Africa (SSA) still require surgery for this condition. This study reviews the available evidence on surgical outcomes for pediatric intussusception in SSA.

Methods

We conducted a systematic search across multiple databases including PubMed, Scopus, Web of Science, African Journals Online, and Google Scholar—for studies published from 1991 to 2024 that reported on surgical treatment of pediatric intussusception in SSA. From these studies, we extracted key details such as patient demographics, symptoms, diagnostic approaches, surgical procedures, complications, and mortality rates. Using random-effects meta-analysis, we calculated pooled prevalence estimates with 95% confidence intervals (CIs). Finally, we evaluated study quality with the Newcastle–Ottawa Scale.

Results

Twenty-four studies involving 2078 children from 11 SSA countries were included. The pooled mean age at presentation was 13.2 mo, with 64% of cases occurring in males. The classic triad (intermittent abdominal pain, vomiting, and bloody stools) was present in 50.4% (95% CI: 37.3–63.4), and the mean duration of symptoms before presentation was 3.45 d. Ultrasound was used in 58.3% (95% CI: 49.2–66.9), whereas clinical diagnosis alone accounted for 34.7%. Manual reduction was the most common surgical procedure (55.2%; 95% CI: 49.9–60.6), followed by resection with anastomosis (38.2%; 95% CI: 31.0–45.3). Postoperative complications occurred in 24.5% (95% CI: 18.5–30.5), with surgical site infection being the most frequent. The pooled mortality rate was 12.4% (95% CI: 9.2–15.6), substantially higher than global averages.

Conclusions

Pediatric intussusception in SSA is characterized by delayed presentation, high reliance on surgical management, and unacceptably high mortality and complication rates. Strengthening early diagnosis, expanding access to nonoperative reduction, and improving surgical capacity are essential to reduce the burden of this condition in the region.

肠套叠是全世界儿童急性腹痛和肠梗阻的常见原因。然而，在保健资源有限的地区，由于诊断和治疗的延误，它往往与严重并发症和不良结果有关。尽管非手术治疗改善了世界范围内的预后，但撒哈拉以南非洲（SSA）的许多儿童仍然需要手术治疗。本研究回顾了SSA患儿肠套叠手术结果的现有证据。方法系统检索PubMed、Scopus、Web of Science、African Journals Online和谷歌scholar等多个数据库，检索1991年至2024年发表的关于SSA患儿肠套叠手术治疗的研究。从这些研究中，我们提取了关键细节，如患者人口统计学、症状、诊断方法、外科手术、并发症和死亡率。使用随机效应荟萃分析，我们计算了95%置信区间（ci）的合并患病率估计值。最后，我们用纽卡斯尔-渥太华量表评估研究质量。结果共纳入24项研究，涉及来自11个SSA国家的2078名儿童。合并平均发病年龄为13.2个月，64%的病例为男性。典型的三联征（间歇性腹痛、呕吐和带血便）出现在50.4% (95% CI: 37.3-63.4)，症状出现前的平均持续时间为3.45 d。58.3% （95% CI: 49.2-66.9）使用了超声波，而单独的临床诊断占34.7%。手工复位是最常见的手术方法（55.2%;95% CI: 49.9-60.6），其次是吻合切除（38.2%;95% CI: 31.0-45.3）。术后并发症发生率为24.5% (95% CI: 18.5-30.5)，以手术部位感染最为常见。合并死亡率为12.4% (95% CI: 9.2-15.6)，大大高于全球平均水平。结论小儿SSA肠套叠表现迟缓，对手术治疗的依赖程度高，死亡率和并发症发生率高得令人无法接受。加强早期诊断、扩大非手术复位的可及性和提高手术能力对于减轻该地区这种疾病的负担至关重要。

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引用次数: 0

Letter Regarding: Racial and Sex Disparities in US Kidney Transplant Clinical Trials: A Comparative Analysis With National Transplant Registry Data 关于“美国肾移植临床试验中的种族和性别差异：与国家移植登记数据的比较分析”的信。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-01 DOI: 10.1016/j.jss.2025.10.050

Annika Gompers MPhil, Jessica L. Harding PhD

引用次数: 0

Cover 1: Update 封面一：更新

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-01 DOI: 10.1016/S0022-4804(26)00005-3

引用次数: 0

On The Cover 封面上

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-01 DOI: 10.1016/S0022-4804(26)00004-1

引用次数: 0

Response Regarding: Predicting Acute Cholecystitis on Final Pathology to Prioritize Surgical Urgency: An Evaluation of the Tokyo Criteria and Development of a Novel Predictive Score 关于：预测急性胆囊炎的最终病理优先手术紧迫性：东京标准的评估和一种新的预测评分的发展。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-01 DOI: 10.1016/j.jss.2025.11.014

Lilly Groszman MD, Brent Hopkins MD, MSc, FRCSC, Nawaf AlShahwan MBBS, FRCSC, DABS, Shannon Fraser MD, MSc, FRCSC, Simon Bergman MD, MSc, FRCSC, Jean-Sebastien Pelletier MD, FRCSC, Tsafrir Vanounou MD, MBA, Evan G. Wong MD, MPH, FRCSC, FACS

引用次数: 0

Letter Regarding: Predicting Acute Cholecystitis on Final Pathology to Prioritize Surgical Urgency: An Evaluation of the Tokyo Criteria and Development of a Novel Predictive Score 关于：“预测急性胆囊炎的最终病理优先手术紧迫性：东京标准的评估和一种新的预测评分的发展”。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-01 DOI: 10.1016/j.jss.2025.10.049

Tirayut Veerasatian MD, Schawanya K. Rattanapitoon MD, Chutharat Thanchonnang PhD, Nathkapach K. Rattanapitoon PhD

引用次数: 0

Automating Injury Severity Score Calculation Using Large Language Models: A Feasibility Study With Large Language Model–Assisted Trauma Scoring 使用大型语言模型自动计算损伤严重程度评分：大型语言模型辅助创伤评分的可行性研究。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-01 DOI: 10.1016/j.jss.2025.11.064

Sheng-Yu Chan MD , Pang-Chun Liao , Albert Jow , Ying-Jia Lin PhD , Kuan-Yueh Fang , Chi-Tung Cheng MDPhD , Chien-Hung Liao MDFACSFICS , Chih-Chi Chen MD , David A. Spain MDFACS

Introduction

The injury severity score (ISS) is a crucial tool for trauma severity assessment, but its calculation relies on registrars manually assigning the scores, a process prone to human error and time constraints. This study evaluates the feasibility of using a large language model (LLM) to assist in ISS calculation based on trauma patients’ diagnoses.

Methods

A retrospective study was conducted at a level I trauma center. Training data from trauma patients hospitalized in 2022 were used, and we retrieved the final diagnoses, abbreviated injury scale scores, and ISS values assigned by experienced registrars. The LLM was trained with structured prompts detailing trauma scoring principles. The model was validated using 100 randomly selected trauma cases from 2022, comparing LLM-generated ISS (LLM ISS) with registrar-calculated ISS. The correlation was evaluated using Pearson correlation, and the agreement was evaluated using the intraclass correlation coefficient (ICC) and Bland-Altman analysis.

Results

Among the 100 trauma patients, the ISS distribution showed 34 patients with ISS <9, 33 with ISS 9–16, and 33 with ISS >16. The intraclass correlation coefficient between LLM ISS and registrar-calculated ISS was 0.981 (95% confidence interval: 0.97, 0.99), with an accuracy of 0.91. Bland-Altman analysis showed a mean bias of −0.03 indicating strong consistency.

Conclusions

LLM ISS demonstrated high reliability and accuracy, offering a promising approach to automate trauma scoring. Future research should explore its integration into real-time clinical workflows and its expansion to other trauma severity scores.

简介：损伤严重程度评分（ISS）是创伤严重程度评估的重要工具，但其计算依赖于注册员手动分配分数，这一过程容易出现人为错误和时间限制。本研究评估了基于创伤患者诊断使用大语言模型（LLM）辅助ISS计算的可行性。方法：在某一级创伤中心进行回顾性研究。我们使用了2022年住院的创伤患者的训练数据，并检索了最终诊断、简略损伤量表评分和由经验丰富的登记员分配的ISS值。法学硕士接受结构化提示，详细说明创伤评分原则。该模型使用2022年随机选择的100例创伤病例进行验证，将LLM生成的ISS （LLM ISS）与注册者计算的ISS进行比较。使用Pearson相关评价相关性，使用类内相关系数（ICC）和Bland-Altman分析评价一致性。结果：100例外伤患者中，ISS分布为34例，ISS为16。LLM ISS与注册者计算ISS的类内相关系数为0.981(95%可信区间：0.97,0.99)，准确率为0.91。Bland-Altman分析显示，平均偏差为-0.03，表明一致性强。结论：LLM ISS具有较高的可靠性和准确性，为创伤自动评分提供了一种有前景的方法。未来的研究应探索将其整合到实时临床工作流程中，并将其扩展到其他创伤严重程度评分中。

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引用次数: 0

Letter Regarding: Nodal Metastases in Oncocytic Carcinoma of the Thyroid Are Associated With Decreased Survival 关于“甲状腺嗜瘤性癌淋巴结转移与生存率降低相关”的信函。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-01 DOI: 10.1016/j.jss.2025.10.025

Hooman Hadianfard MD, Mohammad Movahed MD, Nima Masoudi MD

引用次数: 0

Single-Arm Phase Ⅱ Study About a Tissue Oxygen Saturation Monitor in Gastric Tube Reconstruction 单臂期Ⅱ组织氧饱和度监测仪在胃管重建中的应用研究

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-12-30 DOI: 10.1016/j.jss.2025.12.002

Kenjiro Ishii MD, PhD , Yasuhiro Tsubosa MD, PhD , Shuhei Mayanagi MD, PhD , Keita Mori PhD , Masazumi Inoue MD, PhD , Kazunori Tokizawa MD , Ryoma Haneda MD

Introduction

Insufficient blood flow at the cervical anastomosis site can cause anastomotic leakage following radical esophagectomy. Previously, we reported the use of a tissue oxygen saturation monitor in a case series study, and we aimed to present the results of the prospective study.

Methods

This single-arm phase Ⅱ study involved patients who underwent radical esophagectomy with gastric tube reconstruction and cervical site anastomosis. Regional tissue oxygen saturation (rSO2) was measured at the tip and 2, 4, and 6 cm on the caudal side of the tip before gastric tube elevation through the retrosternal route. After elevating the gastric tube, rSO2 was measured at the same points: 3 cm above the edge of the sternal bone and the chest skin. The primary endpoint was the rate of having rSO2 > 45% 3 cm above the edge of the sternal bone, which was the anastomotic site. The secondary endpoint was the relationship between anastomotic leakage and the rate of change in rSO2 before and after gastric tube elevation. Based on the calculated sample size, 42 patients were enrolled.

Results

The rate of having rSO2 > 45% 3 cm above the edge of the sternal bone was 83.3%. Anastomotic leakage was found in seven patients. Only the rSO2 at the tip after gastric tube elevation was significantly lower in patients with anastomotic leakage.

Conclusions

Monitoring tissue oxygen saturation was a feasible indicator of blood flow insufficiency in the gastric tube during radical esophagectomy.

食管根治性切除术后，吻合口血流不足可引起吻合口漏。之前，我们报道了在一个病例系列研究中使用组织氧饱和度监测仪，我们的目的是呈现前瞻性研究的结果。方法单臂期Ⅱ研究纳入行根治性食管切除术合并胃管重建和颈部吻合的患者。在经胸骨后途径提升胃管前，在尖端和尖端尾侧2、4和6 cm处测量区域组织氧饱和度（rSO2）。抬高胃管后，在胸骨和胸部皮肤边缘以上3cm处测量rSO2。主要终点为吻合口胸骨边缘以上3cm处rSO2 >； 45%。次要终点为胃管抬高前后吻合口漏与rSO2变化率的关系。根据计算的样本量，纳入42例患者。结果胸骨缘以上3cm处病变发生率为83.3%；吻合口瘘7例。吻合口瘘患者只有胃管抬高后尖端的rSO2明显降低。结论监测组织血氧饱和度是根治性食管切除术中胃管血流不足的一个可行指标。

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引用次数: 0

P2Y12 Assay Identifies Patients at Risk for Blood Transfusion Following Cardiac Surgery P2Y12检测识别心脏手术后输血风险患者

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-12-27 DOI: 10.1016/j.jss.2025.10.039

Andrew D. Hawkins MD , Skylar C. Rodgers MD , Andrew M. Young MD , Raymond J. Strobel MD, MSc , Emily Kaplan BA , Steven Young MD , Katherine I. Foley MD MPH , Raza Ahmad MD , Nicholas R. Teman MD

Introduction

Timing of surgical intervention after administration of P2Y12 inhibitors remains a clinical challenge balancing ischemia and bleeding risks. This study assessed whether preoperative P2Y12 assay results correlate with perioperative transfusions, postoperative chest tube (CT) output, and reoperation for bleeding following cardiac surgery.

Methods

All patients undergoing cardiac surgery at a single institution with a preoperative P2Y12 assay value from 2012 to 2022 were included. The P2Y12 assay closest to surgery and relevant bleeding outcomes was obtained. A cutpoint analysis was used to determine a P2Y12 reaction unit (PRU) lab value that identified patients requiring >1 unit of postoperative blood transfusion. A risk-adjusted multivariable regression analyzed bleeding-related outcomes and operative mortality for patients stratified by the PRU cutpoint.

Results

There were 729 patients with a median P2Y12 level of 173.0 PRU, 89% of whom underwent coronary artery bypass grafting. Patients with PRU <194 had a greater decrease in postoperative hematocrit, postoperative day 1 CT output, and average daily CT output. A PRU cutpoint of 101 was selected that classified patients requiring postoperative transfusion of ≥1 unit of packed red blood cell (PRBC). In the risk-adjusted analysis, patients with PRU <101 were found to have higher odds of ≥1 unit postoperative PRBC administration (OR 3.2, 95% CI 1.95-5.44; P < 0.001).

Conclusions

Preoperative P2Y12 assay can help guide the estimation of postoperative bleeding risk. The cutpoint provided by the reference range may be too conservative, and a lower cutpoint can more accurately identify patients at risk of requiring postoperative PRBC transfusion.

应用P2Y12抑制剂后的手术干预时机仍然是平衡缺血和出血风险的临床挑战。本研究评估了术前P2Y12检测结果是否与围手术期输血、术后胸管（CT）输出和心脏手术后出血再手术相关。方法纳入2012 - 2022年在同一医院接受心脏手术且术前P2Y12测定值较高的患者。获得最接近手术和相关出血结果的P2Y12测定。切点分析用于确定P2Y12反应单位（PRU）实验室值，该值可识别需要1单位术后输血的患者。风险调整的多变量回归分析了按PRU切点分层的患者的出血相关结果和手术死亡率。结果729例患者P2Y12中位水平为173.0 PRU， 89%行冠状动脉旁路移植术。PRU <；194患者术后红细胞压积、术后第1天CT输出和平均每日CT输出均有较大下降。PRU切点为101，用于对需要术后输血≥1单位填充红细胞（PRBC）的患者进行分类。在风险调整分析中，PRU <；101患者术后给予≥1单位PRBC的几率更高（OR 3.2, 95% CI 1.95-5.44; P < 0.001）。结论术前P2Y12检测有助于指导术后出血风险的判断。参考范围提供的临界值可能过于保守，较低的临界值可以更准确地识别有术后输血风险的患者。

{"title":"P2Y12 Assay Identifies Patients at Risk for Blood Transfusion Following Cardiac Surgery","authors":"Andrew D. Hawkins MD , Skylar C. Rodgers MD , Andrew M. Young MD , Raymond J. Strobel MD, MSc , Emily Kaplan BA , Steven Young MD , Katherine I. Foley MD MPH , Raza Ahmad MD , Nicholas R. Teman MD","doi":"10.1016/j.jss.2025.10.039","DOIUrl":"10.1016/j.jss.2025.10.039","url":null,"abstract":"<div><h3>Introduction</h3><div>Timing of surgical intervention after administration of P2Y12 inhibitors remains a clinical challenge balancing ischemia and bleeding risks. This study assessed whether preoperative P2Y12 assay results correlate with perioperative transfusions, postoperative chest tube (CT) output, and reoperation for bleeding following cardiac surgery.</div></div><div><h3>Methods</h3><div>All patients undergoing cardiac surgery at a single institution with a preoperative P2Y12 assay value from 2012 to 2022 were included. The P2Y12 assay closest to surgery and relevant bleeding outcomes was obtained. A cutpoint analysis was used to determine a P2Y12 reaction unit (PRU) lab value that identified patients requiring >1 unit of postoperative blood transfusion. A risk-adjusted multivariable regression analyzed bleeding-related outcomes and operative mortality for patients stratified by the PRU cutpoint.</div></div><div><h3>Results</h3><div>There were 729 patients with a median P2Y12 level of 173.0 PRU, 89% of whom underwent coronary artery bypass grafting. Patients with PRU <194 had a greater decrease in postoperative hematocrit, postoperative day 1 CT output, and average daily CT output. A PRU cutpoint of 101 was selected that classified patients requiring postoperative transfusion of ≥1 unit of packed red blood cell (PRBC). In the risk-adjusted analysis, patients with PRU <101 were found to have higher odds of ≥1 unit postoperative PRBC administration (OR 3.2, 95% CI 1.95-5.44; <em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>Preoperative P2Y12 assay can help guide the estimation of postoperative bleeding risk. The cutpoint provided by the reference range may be too conservative, and a lower cutpoint can more accurately identify patients at risk of requiring postoperative PRBC transfusion.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 516-523"},"PeriodicalIF":1.7,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145837056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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