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An integrated mini-CEX and OSCE assessment model for optimizing standardized training in department of hepatobiliary surgery 优化肝胆外科标准化培训的mini-CEX和OSCE综合评估模型
IF 1.7 Q3 SURGERY Pub Date : 2026-03-01 Epub Date: 2026-01-31 DOI: 10.1016/j.sopen.2026.01.008
Hucheng Ma MD , Haozhen Ren MD , Xingyu Wu MD , Decai Yu MD

Background

Standardized residency training in China requires robust evaluation mechanisms, yet significant disparities exist due to lacking standardized criteria. Current tools like OSCE (simulation-based) and Mini-CEX (workplace-based) have limitations: Mini-CEX excludes surgical skills, while OSCE lacks authentic clinical context. Combining them offers holistic assessment potential but is understudied in hepatobiliary surgery.

Methods

A prospective cohort study randomized 36 hepatobiliary surgery residents into: Experimental group (n = 18): Monthly Mini-CEX assessments (evaluating medical interviewing, physical exam, clinical judgment, communication, treatment planning, patient-centered care, and overall competence via 9-point scale) followed by final OSCE. Control group (n = 18): Monthly traditional written/procedural assessments followed by final OSCE.
The OSCE (100-point max) comprised stations for history-taking, physical exam, hepatobiliary procedural skills, case analysis and doctor-patient communication. Intergroup comparisons used Student's t-tests and chi-square tests (SPSS 26.0, p < 0.05 significant).

Results

Baseline characteristics showed no significant differences between groups. The experimental group achieved significantly higher final OSCE total scores (p < 0.05), with notable improvements in physical examination and doctor-patient communication. No significant differences were found in history-taking, hepatobiliary procedural skills, or case analysis. Satisfaction was significantly higher in the experimental group (1/18 vs. 6/18 dissatisfied in controls). Trainees valued Mini-CEX's real-time feedback and competency mapping.

Conclusions

Integrating Mini-CEX and OSCE creates an effective dual-modality system for hepatobiliary surgery residents. It significantly enhances overall clinical competency (especially physical exam and communication) and trainee satisfaction compared to traditional methods. This combined approach provide both formative feedback (Mini-CEX) and summative validation (OSCE), establishing a promising specialty-specific framework. Future multi-center studies are recommended.
背景中国住院医师培训的标准化需要健全的评估机制,但由于缺乏标准化的标准,存在着很大的差异。目前的工具,如OSCE(基于模拟的)和Mini-CEX(基于工作场所的)都有局限性:Mini-CEX不包括手术技能,而OSCE缺乏真实的临床背景。将它们结合起来提供了全面评估的潜力,但在肝胆外科手术中尚未得到充分研究。方法一项前瞻性队列研究将36名肝胆外科住院医师随机分为:实验组(n = 18):每月进行Mini-CEX评估(通过9分制评估医学访谈、体格检查、临床判断、沟通、治疗计划、以患者为中心的护理和整体能力),随后进行最终的OSCE评估。对照组(n = 18):每月进行传统的书面/程序评估,然后进行最终的欧安组织评估。欧安组织考试(满分100分)包括记录病史、体格检查、肝胆手术技能、病例分析和医患交流。组间比较采用学生t检验和卡方检验(SPSS 26.0, p <; 0.05显著)。结果两组患者基线特征无显著差异。实验组最终OSCE总分显著高于对照组(p < 0.05),体检和医患沟通均有显著改善。在病史记录、肝胆手术技巧或病例分析方面没有发现显著差异。实验组的满意度明显高于对照组(1/18比6/18)。学员们对Mini-CEX的实时反馈和能力映射非常重视。结论Mini-CEX与OSCE的整合为肝胆外科住院医师创建了一个有效的双模系统。与传统方法相比,它显著提高了整体临床能力(特别是体检和沟通)和学员满意度。这种组合方法提供了形成性反馈(Mini-CEX)和总结性验证(OSCE),建立了一个有前途的特定专业框架。建议未来进行多中心研究。
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引用次数: 0
Digital quantification of stroma percentage enhances prognostic stratification in pancreatic cancer 数字量化间质百分比可提高胰腺癌的预后分层
IF 1.7 Q3 SURGERY Pub Date : 2026-03-01 Epub Date: 2026-01-19 DOI: 10.1016/j.sopen.2026.01.002
Axel Bengtsson MD, Roland Andersson MD, PhD, Bodil Andersson MD, PhD, Daniel Ansari MD, PhD

Background

Pancreatic ductal adenocarcinoma (PDAC) is characterized by a prominent desmoplastic stroma, which plays a crucial role in tumor biology and treatment resistance. While the stromal compartment is a defining histopathological feature of PDAC, its prognostic significance remains incompletely understood. This study aimed to quantify the stromal content in PDAC using digital pathology and evaluate its association with patient outcomes.

Methods

Tissue microarrays (TMAs) were constructed from resected PDAC specimens (n = 142). Digital analysis of tumor stroma percentage (TSP) was performed on tissue sections labeled with CA19–9. Cases were stratified into low and high TSP groups based on an optimized threshold of 44.2%. Associations between TSP and clinicopathological variables were assessed, and survival outcomes were analyzed using Kaplan-Meier and Cox proportional hazards models.

Results

Digital quantification revealed wide intertumoral variability in TSP. A total of 127 (89%) patients were categorized into the high TSP group (>44.2% stroma). A high TSP was significantly associated with anatomic location of the tumor in the head of the pancreas. Patients with high TSP exhibited significantly prolonged overall survival (median: 27.8 months vs 12 months, p < 0.001). In multivariable analysis, high TSP remained an independent predictor of favorable prognosis (HR = 0.26, 95% CI: 0.13–0.52, p < 0.001).

Conclusion

A high TSP is independently associated with improved survival in PDAC. These findings challenge traditional views of the stroma as purely tumor-promoting and suggest a potential protective role of the stromal compartment in certain contexts.
胰腺导管腺癌(pancreatic ductal adencarcinoma, PDAC)的特点是具有显著的间质增生,在肿瘤生物学和治疗耐药性中起着至关重要的作用。虽然间质室是PDAC的组织病理学特征,但其预后意义仍不完全清楚。本研究旨在利用数字病理学量化PDAC基质含量,并评估其与患者预后的关系。方法利用142例PDAC切除标本构建组织微阵列(tma)。在CA19-9标记的组织切片上进行肿瘤间质百分比(TSP)的数字分析。以44.2%为优化阈值,将病例分为高、低TSP组。评估TSP与临床病理变量之间的关系,并使用Kaplan-Meier和Cox比例风险模型分析生存结果。结果数字量化显示TSP在肿瘤间具有广泛的差异性。高TSP组127例(89%)(44.2%)。高TSP与肿瘤在胰腺头部的解剖位置显著相关。高TSP患者的总生存期明显延长(中位:27.8个月vs 12个月,p < 0.001)。在多变量分析中,高TSP仍然是良好预后的独立预测因子(HR = 0.26, 95% CI: 0.13-0.52, p < 0.001)。结论高TSP与PDAC患者生存率的提高独立相关。这些发现挑战了传统的观点,即基质纯粹是促进肿瘤的,并表明基质室在某些情况下具有潜在的保护作用。
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引用次数: 0
Surgery for colorectal liver metastases: Predictive factors of biliary fistula 结直肠肝转移手术:胆道瘘的预测因素
IF 1.7 Q3 SURGERY Pub Date : 2026-03-01 Epub Date: 2026-01-31 DOI: 10.1016/j.sopen.2026.01.006
Mohamed Guelbi , Mohamed Hajri , Zied Hadrich , Aziz Atallah , Sofiene Gabsi , Rached Bayar , Lassad Gharbi , Sahir Omrani

Background

Colorectal liver metastases (CRLM) are the most common secondary site of colorectal cancer. Hepatic resection remains the potentially curative standard treatment, but postoperative morbidity remains substantial, with biliary fistula representing the most frequent and clinically significant specific complication. This study aimed to identify predictive factors of biliary fistula following CRLM surgery.

Methods

A retrospective single-center study was conducted including 129 patients who underwent surgery for CRLM at Mongi Slim Hospital, La Marsa, between January 2020 and December 2024. The primary endpoint was postoperative biliary fistula according to ISGLS criteria. Univariate and multivariate logistic regression analyses were performed to determine independent predictive factors.

Results

Postoperative biliary fistulas occurred in 31 patients (24%). They were detected through surgical drainage in 61%, through abdominal collections in 29%, and as biliary peritonitis in 9.7%. Most fistulas were grade A (71%), followed by grades B (16%) and C (13%). Spontaneous resolution occurred in 67.7% of cases, while 19.4% required percutaneous drainage and 12.9% required surgical re-intervention. Univariate analysis identified several factors associated with biliary fistula: low BMI, elevated preoperative PAL and GGT levels, preoperative cholestasis, and sinusoidal obstruction syndrome. In multivariate analysis, three independent predictors were retained: low BMI (OR = 0.818; p = 0.04), postoperative hyperleukocytosis (OR = 4.001; p = 0.028), and postoperative cholestasis (OR = 8.382; p = 0.041). Overall postoperative morbidity reached 43.4%, with no postoperative mortality.

Conclusion

Biliary fistula remains a major complication after CRLM resection. Identifying high-risk patients may improve postoperative surveillance and outcomes.
结直肠癌肝转移(colorectal liver metastasis, CRLM)是结直肠癌最常见的继发部位。肝切除术仍然是潜在的治愈性标准治疗,但术后发病率仍然很高,胆道瘘是最常见和临床显著的特定并发症。本研究旨在确定CRLM术后胆道瘘的预测因素。方法对2020年1月至2024年12月在La Marsa Mongi Slim医院接受CRLM手术的129例患者进行回顾性单中心研究。根据ISGLS标准,主要终点是术后胆道瘘。采用单因素和多因素logistic回归分析确定独立预测因素。结果术后发生胆道瘘31例(24%)。61%通过手术引流发现,29%通过腹腔收集发现,9.7%通过胆道性腹膜炎发现。大多数瘘管为A级(71%),其次是B级(16%)和C级(13%)。67.7%的病例自发消退,19.4%需要经皮引流,12.9%需要手术再干预。单因素分析确定了与胆瘘相关的几个因素:低BMI、术前PAL和GGT水平升高、术前胆汁淤积和窦状窦梗阻综合征。在多变量分析中,保留了三个独立的预测因子:低BMI (OR = 0.818; p = 0.04)、术后白细胞增多(OR = 4.001; p = 0.028)和术后胆汁淤积(OR = 8.382; p = 0.041)。术后总发病率为43.4%,无术后死亡率。结论胆瘘仍是CRLM术后的主要并发症。识别高危患者可以改善术后监测和预后。
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引用次数: 0
Surgery for adrenal gland disease. Experience of a tertiary center 肾上腺疾病的外科手术。有高等教育中心的工作经验。
IF 1.7 Q3 SURGERY Pub Date : 2026-03-01 Epub Date: 2026-02-10 DOI: 10.1016/j.sopen.2026.01.009
Gaia Cicioni , Immacolata Iannone , Daniele Crocetti , Mariarita Tarallo , Paolo Sapienza , Giuseppe Cavallaro , Giorgio De Toma , Luigi Petramala , Claudio Letizia , Maria Irene Bellini

Introduction

Laparoscopic adrenalectomy and robotic adrenalectomy are increasingly accepted methods for removing adrenal lesions, especially for benign conditions. This study investigated the evolution of surgical techniques and patient characteristics at a tertiary centre during the transition from open to minimally invasive surgery.

Patients and methods

The analysis included all adrenal surgery cases referred to our institution between January 2009 and June 2025. The following were recorded for each patient: demographics, diagnosis, surgical approach, intraoperative blood loss, histology, length of hospital stays, and complications.

Results

A total of 292 adrenalectomies were performed (56% female; mean age 54.5 ± 12.6 years). The left adrenal was more frequently affected (59%), and the mean tumor size was 46.8 ± 25.1 mm. Indications included primary hyperaldosteronism (37%), Cushing's syndrome (28%), pheochromocytoma (15%), adrenal cysts or myelolipomas (17%), adrenocortical carcinomas (4%), and adrenal metastases (2%). Laparoscopy was the most common approach (76%), followed by open (10%) and robotic adrenalectomy (9%); overall 7 (2%) patients required conversion to open surgery and postoperative morbidity was 7%. Minimally invasive procedures were associated with shorter operative times, less blood loss, and shorter in-hospital stays when compared to open surgery (p < 0.05). Robotic adrenalectomy had the lowest intraoperative blood loss, while laparoscopy had the fastest operative time.

Conclusions

Minimally invasive adrenalectomy is safe and effective for adrenal tumors. In our series, robotic-assisted surgery is becoming increasingly prevalent and has excellent results; however, its implementation needs to be balanced with the associated costs.
导读:腹腔镜肾上腺切除术和机器人肾上腺切除术越来越多地被接受为切除肾上腺病变的方法,特别是对于良性病变。本研究调查了三级中心从开放手术到微创手术过渡期间手术技术和患者特征的演变。患者和方法:分析包括2009年1月至2025年6月间本院所有肾上腺手术病例。记录每位患者的以下信息:人口统计学、诊断、手术方式、术中出血量、组织学、住院时间和并发症。结果:共行肾上腺切除术292例(56%为女性,平均年龄54.5±12.6岁)。左肾上腺最常见(59%),平均肿瘤大小46.8±25.1 mm。适应症包括原发性醛固酮增多症(37%)、库欣综合征(28%)、嗜铬细胞瘤(15%)、肾上腺囊肿或骨髓脂肪瘤(17%)、肾上腺皮质癌(4%)和肾上腺转移瘤(2%)。腹腔镜是最常见的方法(76%),其次是开放(10%)和机器人肾上腺切除术(9%);总共有7例(2%)患者需要转开手术,术后发病率为7%。与开放手术相比,微创手术与更短的手术时间、更少的出血量和更短的住院时间相关(结论:微创肾上腺切除术对肾上腺肿瘤是安全有效的。在我们的系列中,机器人辅助手术正变得越来越普遍,并取得了良好的效果;但是,它的实施需要与相关费用相平衡。
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引用次数: 0
Race/ethnicity on firearm & self-injuries during COVID-19 using TQIP data 使用TQIP数据的COVID-19期间枪支和自伤的种族/民族
IF 1.7 Q3 SURGERY Pub Date : 2026-03-01 Epub Date: 2026-01-10 DOI: 10.1016/j.sopen.2026.01.001
Veronica Layrisse Landaeta M.D. , Shahenda Khedr B.A. , Victoria Yuan M.D. , Eshani Pareek M.B.S. , Debra D'Angelo M.S. , Elizabeth Zhao BS , Gala Cygiel M.D. , Konstantin Khariton D.O., F.A.C.S. , Steven Y. Chao M.D., F.A.C.S.

Introduction

The COVID-19 pandemic led to increased assaults, self-inflicted injuries, and firearm-related injuries across the nation, along with increased reports of depression and anxiety worldwide. Our study examines trends in these types of injuries among diverse racial and ethnic groups in the United States during this time.

Methods

Data was extracted from the ACS-TQIP database, including patients with assaults, self-inflicted injuries and firearm-related injuries from 2018 to 2021. Pre-COVID period was defined as 2018–2019, and COVID period as 2020–2021. We performed univariable and multivariable logistic regressions to identify associations between injury rates and COVID period, sex, race, and ethnicity.

Results

We identified 417,797 assaults (9.3% of traumas), 57,853 self-inflicted injuries (1.3%) and 208,882 firearm-related injuries (4.7%). Multivariable analysis revealed significant increase in assaults (OR: 1.02, 95% CI: [1.01, 1.03]; p < 0.001) and firearm-related injuries (1.28 [1.27, 1.29]; p < 0.001) and a significant decrease in self-inflicted injuries (0.98 [0.97, 0.99]; p = 0.039) during the COVID period.
Asian American Pacific Islanders (1.06 [1.02–1.10]; p < 0.005), American Indians (3.47 [3.35–3.60]; p < 0.001), Black or African American (5.32 [5.26–5.38]; p < 0.001, other races (1.23 [1.20–1.25]; p < 0.001) and Hispanics (1.71[1.65–1.74]; p < 0.001) had higher odds of assaults during COVID.
Asian American Pacific Islanders (1.12 [1.04–1.20]; p = 0.001) and American Indians (1.23 [1.12–1.35]; p < 0.001 had higher odds of self-inflicted injuries and Hispanic patients had lower odds (0.73 [0.70–0.76]; p < 0.001) during COVID.
American Indians (1.45 [1.36–1.55]; p < 0.001), Black or African Americans (6.42 [6.33–6.52]; p < 0.001), Hispanics (1.46 [1.43–1.50]; p < 0.001) and other races (1.11 [1.08–1.15]; p < 0.001) had higher odds of firearm related injuries during COVID.

Conclusion

The COVID period saw higher odds of assaults, self-inflicted injuries, and firearm-related injuries in certain racial/ethnic minorities. These findings highlight the need for targeted interventions to address the disproportionate impact on racial/ethnic minorities.
2019冠状病毒病大流行导致全国范围内袭击、自残和枪支相关伤害的增加,同时全球范围内抑郁和焦虑的报告也在增加。我们的研究调查了这段时间美国不同种族和民族群体中这些类型伤害的趋势。方法从ACS-TQIP数据库中提取数据,包括2018年至2021年发生袭击、自伤和枪支相关伤害的患者。预冠期定义为2018-2019年,新冠期定义为2020-2021年。我们进行了单变量和多变量logistic回归,以确定受伤率与COVID期间、性别、种族和民族之间的关系。结果共发现417,797起袭击(占创伤的9.3%),57,853起自残(1.3%)和208,882起涉枪伤害(4.7%)。多变量分析显示,在疫情期间,袭击事件(OR: 1.02, 95% CI: [1.01, 1.03]; p < 0.001)和枪支相关伤害(1.28 [1.27,1.29];p < 0.001)显著增加,自我伤害(0.98 [0.97,0.99];p = 0.039)显著减少。亚裔美国太平洋岛民(1.06 [1.02-1.10];p < 0.005)、美洲印第安人(3.47 [3.35-3.60];p < 0.001)、黑人或非裔美国人(5.32 [5.26-5.38];p < 0.001)、其他种族(1.23 [1.20-1.25];p < 0.001)和西班牙裔(1.71[1.65-1.74];p < 0.001)在COVID期间遭受袭击的几率更高。亚裔美国太平洋岛民(1.12 [1.04-1.20];p = 0.001)和美洲印第安人(1.23 [1.12 - 1.35];p < 0.001)在COVID期间自我伤害的几率较高,西班牙裔患者的几率较低(0.73 [0.70-0.76];p < 0.001)。美洲印第安人(1.45 [1.36-1.55];p < 0.001)、黑人或非裔美国人(6.42 [6.33-6.52];p < 0.001)、西班牙裔美国人(1.46 [1.43-1.50];p < 0.001)和其他种族(1.11 [1.08-1.15];p < 0.001)在COVID期间枪支相关伤害的几率更高。结论新冠肺炎疫情期间,某些少数民族发生袭击、自残和涉枪伤害的几率更高。这些发现突出表明,需要采取有针对性的干预措施,以解决对种族/族裔少数群体的不成比例的影响。
{"title":"Race/ethnicity on firearm & self-injuries during COVID-19 using TQIP data","authors":"Veronica Layrisse Landaeta M.D. ,&nbsp;Shahenda Khedr B.A. ,&nbsp;Victoria Yuan M.D. ,&nbsp;Eshani Pareek M.B.S. ,&nbsp;Debra D'Angelo M.S. ,&nbsp;Elizabeth Zhao BS ,&nbsp;Gala Cygiel M.D. ,&nbsp;Konstantin Khariton D.O., F.A.C.S. ,&nbsp;Steven Y. Chao M.D., F.A.C.S.","doi":"10.1016/j.sopen.2026.01.001","DOIUrl":"10.1016/j.sopen.2026.01.001","url":null,"abstract":"<div><h3>Introduction</h3><div>The COVID-19 pandemic led to increased assaults, self-inflicted injuries, and firearm-related injuries across the nation, along with increased reports of depression and anxiety worldwide. Our study examines trends in these types of injuries among diverse racial and ethnic groups in the United States during this time.</div></div><div><h3>Methods</h3><div>Data was extracted from the ACS-TQIP database, including patients with assaults, self-inflicted injuries and firearm-related injuries from 2018 to 2021. Pre-COVID period was defined as 2018–2019, and COVID period as 2020–2021. We performed univariable and multivariable logistic regressions to identify associations between injury rates and COVID period, sex, race, and ethnicity.</div></div><div><h3>Results</h3><div>We identified 417,797 assaults (9.3% of traumas), 57,853 self-inflicted injuries (1.3%) and 208,882 firearm-related injuries (4.7%). Multivariable analysis revealed significant increase in assaults (OR: 1.02, 95% CI: [1.01, 1.03]; <em>p</em> &lt; 0.001) and firearm-related injuries (1.28 [1.27, 1.29]; p &lt; 0.001) and a significant decrease in self-inflicted injuries (0.98 [0.97, 0.99]; <em>p</em> = 0.039) during the COVID period.</div><div>Asian American Pacific Islanders (1.06 [1.02–1.10]; <em>p</em> &lt; 0.005), American Indians (3.47 [3.35–3.60]; <em>p</em> &lt; 0.001), Black or African American (5.32 [5.26–5.38]; <em>p</em> &lt; 0.001, other races (1.23 [1.20–1.25]; p &lt; 0.001) and Hispanics (1.71[1.65–1.74]; p &lt; 0.001) had higher odds of assaults during COVID.</div><div>Asian American Pacific Islanders (1.12 [1.04–1.20]; <em>p</em> = 0.001) and American Indians (1.23 [1.12–1.35]; <em>p</em> &lt; 0.001 had higher odds of self-inflicted injuries and Hispanic patients had lower odds (0.73 [0.70–0.76]; <em>p</em> &lt; 0.001) during COVID.</div><div>American Indians (1.45 [1.36–1.55]; <em>p</em> &lt; 0.001), Black or African Americans (6.42 [6.33–6.52]; <em>p</em> &lt; 0.001), Hispanics (1.46 [1.43–1.50]; p &lt; 0.001) and other races (1.11 [1.08–1.15]; p &lt; 0.001) had higher odds of firearm related injuries during COVID.</div></div><div><h3>Conclusion</h3><div>The COVID period saw higher odds of assaults, self-inflicted injuries, and firearm-related injuries in certain racial/ethnic minorities. These findings highlight the need for targeted interventions to address the disproportionate impact on racial/ethnic minorities.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"30 ","pages":"Pages 1-7"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The role of negative pressure wound therapy—From the perspective of drainage fluid composition 负压伤口治疗的作用——从引流液成分的角度
IF 1.7 Q3 SURGERY Pub Date : 2026-03-01 Epub Date: 2026-01-19 DOI: 10.1016/j.sopen.2026.01.003
Muhaimaiti Abudurezhake , Yifei Huang , Hailong Wang , Gulinuer Aili , Yamei Xu , Yajun Tian , Zhanjun Ma
Negative pressure wound therapy (NPWT) accelerates wound healing processes by promoting angiogenesis and vascularization. However, the molecular mechanisms and biological effects underpinning these processes remain unclear, while drainage fluids (and associated components) extracted by negative pressure suction are rarely investigated. This study investigated these components and explored their relationship with wound healing. To this end, a diabetic wound rat model was established, and wound exudate was collected using negative pressure wound therapy (NPWT) equipment. Platelet-derived growth factor (PDFG-BB), transforming growth factor-β (TGF-β1), epidermal growth factor (EGF), vascular endothelial growth factor-A (VEGF-A), and stromal cell-derived factor-1 (SDF-1) expression levels were investigated using quantitative reverse transcription polymerase chain reaction (RT-qPCR) and western blotting. Circulating endothelial progenitor cells (EPCs), circulating fibrocytes, and mesenchymal stem cells (MSCs) were analyzed by flow cytometry. This study observed that during wound healing, the expression levels of platelet-derived growth factor (PDGF), transforming growth factor-β (TGF-β1), epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), and chemokine-1 (SDF-1) were significantly higher in the experimental group than in the control group. This expression pattern was similar to that observed in endothelial progenitor cells (EPCs), fibroblasts, and mesenchymal stem cells (MSCs). The data from this study indicate that NPWT significantly increases the clearance of drainage fluid and its related components (including growth factors, chemokines, and cells). Also, drainage fluid levels were proportional to wound healing.
负压伤口治疗(NPWT)通过促进血管生成和血管化来加速伤口愈合过程。然而,支持这些过程的分子机制和生物学效应仍不清楚,而通过负压吸入提取的排液(及相关成分)很少被研究。本研究研究了这些成分,并探讨了它们与伤口愈合的关系。为此,建立糖尿病创面大鼠模型,采用负压创面治疗仪(NPWT)收集创面渗出液。采用定量逆转录聚合酶链反应(RT-qPCR)和western blotting检测血小板源性生长因子(PDFG-BB)、转化生长因子-β (TGF-β1)、表皮生长因子(EGF)、血管内皮生长因子- a (VEGF-A)和基质细胞源性生长因子-1 (SDF-1)的表达水平。流式细胞术分析循环内皮祖细胞(EPCs)、循环纤维细胞和间充质干细胞(MSCs)。本研究发现,在创面愈合过程中,实验组血小板衍生生长因子(PDGF)、转化生长因子-β (TGF-β1)、表皮生长因子(EGF)、血管内皮生长因子(VEGF)和趋化因子-1 (SDF-1)的表达水平显著高于对照组。这种表达模式与内皮祖细胞(EPCs)、成纤维细胞和间充质干细胞(MSCs)中观察到的表达模式相似。本研究的数据表明,NPWT显著增加引流液及其相关成分(包括生长因子、趋化因子和细胞)的清除率。此外,引流液水平与伤口愈合成正比。
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引用次数: 0
Development of prediction models for perioperative opioid needs in laparoscopic cholecystectomy patients: A machine-learning approach 腹腔镜胆囊切除术患者围手术期阿片类药物需求预测模型的建立:一种机器学习方法
IF 1.7 Q3 SURGERY Pub Date : 2026-03-01 Epub Date: 2026-01-19 DOI: 10.1016/j.sopen.2026.01.005
Yongmei Huang MD, DrPH , Guohua Li MD, DrPH , Silvia S. Martins MD, PhD , Pia M. Mauro PhD , Ana I. Tergas MD, MPH , June Hou MD, MBA , Xiao Xu PhD , Elena B. Elkin PhD , Judith S. Jacobson DrPH, MBA , Jason D. Wright MD

Background

Changes in opioid prescribing practices have evolved, including perioperative settings. However, computerized clinical decision support systems to guide opioid prescribing remain limited. This study aimed to develop and validate prediction models for perioperative opioid needs among patients undergoing laparoscopic cholecystectomy (LC) and to create a risk-scoring tool.

Methods

This was a retrospective cohort study. Using electronic medical records (EMR), we identified patients aged 18–64 years who underwent LC for benign conditions between October 2015 and December 2018. Demographic, clinical, and surgical data were collected. Perioperative opioid needs were classified as none/low (0–3 days), medium (4–6 days), or high (≥7 days), based on self-reported pain scores and prescription duration. The cohort was split into training (70%) and testing (30%) datasets. Prediction models were developed using random forest, Least Absolute Shrinkage and Selection Operator (LASSO), and subject-matter expertise, with performance evaluated by discrimination, calibration, accuracy, precision, recall, and F1 score.

Results

A total of 1136 patients were identified. In the training dataset (n = 803), 36.1% of patients were in the none/low group, 22.1% in the medium group, and 41.8% in the high group. In testing dataset (n = 333), LASSO outperformed random forest with better calibration. The revised LASSO model, incorporating subject-matter knowledge, improved interpretability, achieving an AUC of 0.64 and Brier score of 0.20. Key predictors included gender, pre-operative medication, emergency surgery, anesthesia type, and surgical indications. A nomogram was developed for visual prediction.

Conclusions

Prediction of perioperative opioid needs using EMR and machine-learning is feasible and may support individualized pain management, though further refinement of model performance is warranted.
阿片类药物处方实践发生了变化,包括围手术期环境。然而,指导阿片类药物处方的计算机化临床决策支持系统仍然有限。本研究旨在开发和验证腹腔镜胆囊切除术(LC)患者围手术期阿片类药物需求的预测模型,并创建一个风险评分工具。方法回顾性队列研究。使用电子病历(EMR),我们确定了在2015年10月至2018年12月期间因良性疾病接受LC治疗的18-64岁患者。收集了人口统计学、临床和手术数据。根据自我报告的疼痛评分和处方持续时间,围手术期阿片类药物需求分为无/低(0-3天)、中等(4-6天)或高(≥7天)。该队列被分为训练(70%)和测试(30%)数据集。使用随机森林、最小绝对收缩和选择算子(LASSO)和主题专业知识开发预测模型,并通过判别、校准、准确性、精密度、召回率和F1分数来评估其性能。结果共检出1136例患者。在训练数据集中(n = 803), 36.1%的患者为无/低组,22.1%为中组,41.8%为高组。在测试数据集(n = 333)中,LASSO优于随机森林,具有更好的校准。修正后的LASSO模型纳入了主题知识,提高了可解释性,AUC为0.64,Brier得分为0.20。主要预测因素包括性别、术前用药、急诊手术、麻醉类型和手术指征。开发了一种用于视觉预测的nomogram。结论使用EMR和机器学习预测围手术期阿片类药物需求是可行的,可能支持个性化疼痛管理,但需要进一步改进模型性能。
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引用次数: 0
Response to “Comment on the systematic review of TROPIS for anal fistula” 对“关于TROPIS治疗肛瘘的系统评价”的回复
IF 1.7 Q3 SURGERY Pub Date : 2026-03-01 Epub Date: 2025-10-14 DOI: 10.1016/j.sopen.2025.10.004
Yang-Tao Chen Doctor of Medicine , Rong Shi Bachelor of Medicine , Jing Wang Doctor of Medicine
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引用次数: 0
Postoperative ERCP as proxy for clinically significant retained stones in a population-based cohort? 在以人群为基础的队列中,术后ERCP作为临床显著结石残留的替代指标?
IF 1.7 Q3 SURGERY Pub Date : 2026-03-01 Epub Date: 2026-01-31 DOI: 10.1016/j.sopen.2026.01.007
Eyvind Liljegren , Lina Hedestig , Emma Sverdén , Johanna Österberg , Lars Enochsson , Gabriel Sandblom

Background

The rate of retained common bile duct stones (CBDS) following cholecystectomy can only be estimated if CBDS managed conservatively as well as CBDS treated with endoscopic retrograde cholangiopancreatography (ERCP) are identified. The aim was to explore the rate of retained CBDS and evaluate performance of ERCP as proxy for retained CBDS in a population-based setting.

Methods

Data were collected from The Swedish Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography Register (GallRiks) on patients who underwent cholecystectomy 2015–2020 with suspected CBDS at South General Hospital, Stockholm, Sweden. Medical records were reviewed to identify rate of patients with events raising suspicion of passage of retained CBDS and compare this to the rate of ERCP for retained CBDS.

Results

A total of 182 of 386 patients (47.2%) had CBDS on intraoperative cholangiography (IOC). During follow-up, 33 of the 182 presented with retained CBDS according to medical records. Of these, 24 had an ERCP registered in GallRiks with retained CBDS reported, whereas 9 had retained CBDS according to medical records only.

Conclusion

Postoperative ERCP found valid as proxy for retained stones following surgery for CBDS and can be a quality measure for management of patients undergoing gallstone surgery with suspicion of CBDS.
背景:胆囊切除术后保留的总胆管结石(CBDS)的比例只有在确定CBDS保守治疗和内窥镜逆行胆管造影(ERCP)治疗的情况下才能估计。目的是探索保留CBDS的比率,并评估ERCP在以人群为基础的环境中作为保留CBDS的代理的性能。方法数据来自瑞典斯德哥尔摩南方总医院2015-2020年行胆囊切除术的疑似CBDS患者的瑞典胆结石手术和内镜逆行胆管造影登记册(GallRiks)。回顾了医疗记录,以确定可疑的保留CBDS通过事件的患者比率,并将其与保留CBDS的ERCP比率进行比较。结果386例患者中182例(47.2%)出现术中胆道造影(IOC) CBDS。在随访期间,根据医疗记录,182例患者中有33例CBDS保留。其中,24人在GallRiks登记了ERCP,并报告了保留的CBDS,而9人仅根据医疗记录保留了CBDS。结论ERCP可作为CBDS术后结石残留的有效指标,可作为疑似CBDS的胆结石手术患者管理的质量指标。
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引用次数: 0
Comment on the systematic review of TROPIS for anal fistula TROPIS治疗肛瘘的系统综述
IF 1.7 Q3 SURGERY Pub Date : 2026-03-01 Epub Date: 2025-10-23 DOI: 10.1016/j.sopen.2025.10.002
Vipul D. Yagnik MS, FACS , Prema Ram Choudhary
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引用次数: 0
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Surgery open science
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