Lumbar disc herniation (LDH) is a common clinical spinal disorder, with the L5/S1 segment being a frequently affected site due to its unique anatomical and biomechanical characteristics. Conventional minimally invasive spinal endoscopic techniques, such as percutaneous transforaminal endoscopic discectomy (PTED), percutaneous endoscopic interlaminar discectomy (PEID), and unilateral biportal endoscopy (UBE), have inherent limitations in treating L5/S1 LDH. These include difficulty bypassing the high iliac crest (for PTED), a steep learning curve (for PEID), and potential impairment of spinal stability (for UBE). To address these challenges, this study applied Arthroscopic-assisted uni-portal spine surgery (AUSS) via a modified interlaminar approach combined with 4-0 absorbable suture annular repair for L5/S1 LDH, reporting its short-term clinical outcomes and detailing key technical points. A 45-year-old male patient presented with a 1-year history of low back pain, which worsened over 1 month with persistent right lower limb radicular pain, unresponsive to conservative treatment. Preoperative lumbar MRI and CT confirmed L5/S1 disc herniation, with T2-weighted MRI showing low signal intensity of the herniated disc and axial CT demonstrating direct compression of the right S1 nerve root by the herniated nucleus pulposus. The patient underwent the modified procedure: during surgery, a portion of the ligamentum flavum was excised to expose the herniated nucleus pulposus, while the remainder was retracted and preserved. After complete removal of the herniated nucleus pulposus, full-thickness annular suturing was performed using 4-0 absorbable sutures, with knot tying performed extracanalicularly and pushed into place using a dedicated knot pusher. At 1, 3, and 12 months postoperatively, the incision healed well without complications such as infection, nerve injury, or cerebrospinal fluid leakage. Imaging re-evaluation showed no recurrence of L5/S1 disc herniation and a smooth posterior annular margin. The patient experienced significant relief of low back and leg pain, resuming normal daily activities within 1 month postoperatively. The visual analogue scale (VAS) score decreased from 7 preoperatively to 1, the Japanese Orthopaedic Association (JOA) score reached 25, and the Oswestry Disability Index (ODI) decreased from 68% preoperatively to 12%. Arthroscopic-assisted uni-portal spine surgery via the modified interlaminar approach combined with annular suturing is a safe, feasible, and effective treatment for L5/S1 LDH. Its core advantages include bypassing anatomical barriers such as the high iliac crest, maximizing the preservation of spinal osseous and ligamentous structures, ease of operation, high surgical efficiency, and a low short-term recurrence rate. This procedure is a targeted optimization of the traditional interlaminar approach, providing a valuable treatment option for L5/S1 LDH, especially in cases where conventional endoscopic techniques are limited. However, the results of this single-case study cannot be generalized to long-term efficacy, and large-sample, multi-center follow-up studies are needed for further validation.
To construct an artificial intelligence (AI) model based on Computed Tomography (CT) imaging and evaluate its efficacy in preoperatively predicting infected upper urinary tract calculi. Clinical data from December 2023 to February 2025 for patients diagnosed with urinary tract calculi at the Affiliated Hospital of Hebei University were collected. Postoperative analysis of stone composition defined stones containing more than 25% struvite and/or carbonate apatite as infectious stones, with the remainder being non-infectious stones. Labelimg software was utilized to annotate the stone locations in CT images by manually outlining the stone contours. Stratified random sampling was performed at the patient level to divide the 465 enrolled patients into training, validation, and test sets at a 7:1:2 ratio (326, 47 and 92 patients, respectively), with all CT images of each patient assigned to the corresponding dataset to avoid data overlap. We documented the model's Average Precision (AP), Mean Average Precision (mAP), and Mean Recall (mR). Additionally, CT images from patients diagnosed with urinary tract calculi from December 2021 to February 2023 at our hospital were randomly selected to evaluate the model's clinical efficacy. Of the 465 patients enrolled, 134 were classified in the infectious stone group and 331 in the non-infectious stone group. The model's mAP for infectious stones in the training and validation sets was 95.3% and 95.0%, respectively. The mAP was lower at 62.4% for stones smaller than 32 × 32 pixels, and 81.3% for stones larger than this size. Of the 935 CT images analyzed from December 2021 to February 2023, the RetinaNet model achieved an accuracy of 85.17%, sensitivity of 72.78%, specificity of 93.09%, and positive and negative predictive values of 87.04% and 84.27%, respectively for predicting infectious stones. The kappa test demonstrated significant consistency between the model and infrared spectroscopy analysis (kappa value of 0.679). The RetinaNet model based on CT imaging shows high specificity for predicting infectious upper urinary tract calculi, supporting its clinical value in identifying suspected cases preoperatively. However, its moderate sensitivity precludes reliable standalone ruling-out of infectious stones. When combined with routine laboratory tests (e.g., urine routine and culture), this AI model acts as a valuable complementary preoperative tool, providing auxiliary guidance for treatment strategy formulation and surgical decision-making in patients with urinary tract calculi.
Ischemia-reperfusion (I/R) injury remains a principal biological determinant of partial or total flap failure in reconstructive microsurgery. Reperfusion paradoxically initiates a coordinated cascade involving reactive oxygen species generation, lipid peroxidation, neutrophil activation, endothelial dysfunction, and microvascular obstruction, ultimately propagating progressive tissue necrosis. Despite extensive experimental investigation, effective translation into perioperative free flap salvage strategies remains limited. A structured translational synthesis was conducted integrating institutional experimental flap I/R studies performed over two decades with systematically mapped external literature published between 2000 and February 2026. Study identification followed PRISMA-informed search principles to ensure methodological transparency. Data extraction adhered to ARRIVE 2.0 domains to standardize experimental quality assessment. Given predefined biological heterogeneity in flap type, ischemia duration, intervention timing, and outcome definitions, quantitative meta-analysis was not pursued. Instead, biologically stratified comparative analyses were performed, and biologically contextualized viability changes were descriptively evaluated within comparable severe ischemia subgroups to preserve mechanistic interpretability. Across experimental platforms, effective interventions demonstrated a reproducible biological signature characterized by attenuation of lipid peroxidation, suppression of neutrophil-mediated inflammation, restoration of endogenous antioxidant defenses, and preservation of nitric oxide bioavailability. In a comparable severe ischemia epigastric island flap paradigm, trimetazidine, propionyl-L-carnitine, and lutein each demonstrated improved survival area relative to ischemic controls within their respective experimental contexts. Surgical conditioning strategies exhibited robust protection, with venous flap pre-arterialization and delay procedures achieving survival rates approaching near-complete viability in the respective model. However, these conditioning strategies are not directly transferable to acute free flap salvage scenarios and are primarily applicable to planned or staged reconstructive settings. Flap I/R injury follows a reproducible oxidative stress-inflammation-microvascular dysfunction axis. Interventions targeting multiple components of this cascade appear to demonstrate a more reproducible protective pattern across severe ischemia conditions within their respective experimental contexts. These findings establish a translational mechanistic framework to guide rational adjunctive strategies in high-risk free flap protocols and support prospective clinical integration in microsurgical salvage scenarios. This synthesis is intended to guide mechanistic prioritization rather than imply direct interventional equivalence across models.
The clinical treatment of complex anal fistula faces the dual challenges of cure rate and preservation of sphincter function. This study aims to evaluate the application effect of a novel surgical method - internal opening downward displacement combined with external sphincter denudation and virtual hanging drainage - in the treatment of complex anal fistula. A total of 102 patients with complex anal fistula confirmed by MRI were included in this study and randomly divided into the treatment group (internal opening downward displacement combined with external sphincter denudation and virtual hanging drainage) and the control group (traditional incision and hanging thread surgery). The surgical outcomes, changes in anal function (Wexner score), quality of life (EQ-5D score), and postoperative recurrence were compared between the two groups. The follow-up period was 12 months. There were no significant differences in baseline data between the two groups. The treatment group had shorter operation time (69.22 ± 32.81 vs. 77.33 ± 40.66 min), shorter wound healing time (42.10 ± 3.65 vs. 47.54 ± 5.33 days), and shorter hospital stay (4.88 ± 1.84 vs. 9.94 ± 4.26 days) compared with the control group (all P < 0.001); the postoperative pain score was also significantly lower (2.88 ± 0.48 vs. 3.77 ± 0.83, P < 0.001). One month after surgery, the number of patients who recovered in the treatment group (40 cases) was more than that in the control group (37 cases, P < 0.05). The postoperative anal incontinence score in the treatment group was lower than that in the control group (1.35 ± 0.97 vs. 4.48 ± 1.23, P < 0.05). The complication rate in the treatment group was significantly lower than that in the control group (18.00% vs. 36.54%, P < 0.001). The recurrence rate at 1-year follow-up was only 2% in the treatment group and 7.69% in the control group (P < 0.05). The quality of life scores improved in both groups after surgery, but the improvement was more significant in the treatment group. The internal opening downward displacement combined with external sphincter denudation and virtual hanging drainage method shows good short-term and long-term efficacy in the treatment of complex anal fistula, balancing cure rate, fecal control function, and quality of life, and has a promising clinical application prospect.
Living-donor kidney transplantation (LDKT) is the gold standard for end-stage renal disease. Traditionally, the left kidney is preferred for its longer vein. However, the "donor safety first" principle, combined with the transition to laparoscopic and robotic donor nephrectomy, has increased the frequency of using right-sided grafts or encountering "iatrogenically" shortened veins due to mechanical stapling. In this study, we report our preliminary experience evaluating the efficacy of cryopreserved vascular grafts for renal vein lengthening in LDKT to overcome anatomical vascular length limitations. All LDKT in this series were performed using a robotic-assisted laparoscopic approach. All procedures were carried out by a dedicated and experienced surgical team thanks to a cross-institutional partnership involving two regional University Hospitals. When necessary, cryopreserved venous allografts were employed to ensure adequate renal vein length. All transplants were carried out using a standard retroperitoneal approach in the iliac fossa. From June 2024 to October 2025, nine living-donor kidney transplants were performed. The donor cohort included 7 females and 2 males with a median age of 58 years (IQR 51-69), while the recipient cohort included 4 females and 5 males with a median age of 39 years (IQR 23-55). Cryopreserved venous allografts were used in 5/9 LDKT (55.5%), following right kidney procurement. Cold ischemia time was higher in grafts requiring vascular extension than in those without elongation (median 139 min [IQR 130-141] vs. 115 min [IQR 107-121], respectively; p < 0.05). Rewarming time was also longer in the vessel extension group (median 38 min [IQR 37-40] vs. 33.5 min [IQR 31-35], respectively; p = 0.6). No intraoperative or high-grade postoperative complications were observed. At a median follow-up of 10 months (IQR 8-17), there were no deaths or graft losses. The median serum creatinine level at last follow-up was 1.6 mg/dL (IQR 1.2-1.7). Renal vein lengthening with cryopreserved vascular grafts is a valuable tool in modern transplantation, addressing short veins-common in right-sided grafts and after laparoscopic or robotic stapling-and complex recipient venous anatomy. By enabling safer anastomoses, this technique supports excellent graft function while preserving donor safety.
Surgical site infection (SSI) is a serious complication of spinal surgery, including minimally invasive unilateral biportal endoscopic (UBE) procedures. Staphylococcus aureus (S. aureus) is a leading cause of such infections. This report analyses two cases of S. aureus SSI following UBE surgery. Two patients (one male and one female) aged 56 underwent elective UBE surgery. Both patients had inadequate preoperative skin preparation. The cases were complicated by intraoperative fluid leakage, which led to soaked surgical drapes. The second case also involved prolonged operative time and failure of postoperative wound care, with the patient performing unsterile dressing changes at home. Both patients developed deep SSIs caused by S. aureus, as confirmed by culture. This required readmission, endoscopic debridement and targeted antibiotic therapy. The differences in the antibiotic susceptibility profiles of the two cases suggest that the SSIs were likely caused by the patients' own colonising flora. Key risk factors identified include inadequate skin preparation, intraoperative fluid leakage, prolonged surgery and breaches in postoperative care. These factors likely facilitated bacterial ingress and infection. In response, the institution implemented three key measures: direct nurse-led preoperative skin cleansing; increased surgical draping layers to prevent fluid saturation; and exclusive physician-performed postoperative dressings. Following these interventions, no new SSI cases were observed for over a year. SSI after UBE surgery is multifactorial. A comprehensive strategy that addresses preoperative, intraoperative and postoperative protocols is crucial for prevention. The simple, targeted interventions described here effectively mitigated the risk of infection in our subsequent practice.
Laparoscopic appendectomy is the standard treatment for acute appendicitis; however, postoperative acute pain remains a significant challenge. This study aimed to identify risk factors and develop an externally validated nomogram to predict moderate-to-severe acute pain following the procedure. A retrospective study was conducted, including a training cohort (n = 430) and an independent external validation cohort (n = 124). Postoperative pain intensity was quantified using the peak numeric rating scale (NRS) score recorded within the first 24 h (assessed at 1, 3, 7, 9, 12, and 24 h). Patients were categorized into mild (NRS ≤ 3) and moderate-to-severe (NRS > 3) pain groups. Potential risk factors were identified via univariate analysis, and multivariable binary logistic regression was performed to determine independent predictors after assessing multicollinearity using the variance inflation factor. A nomogram-based predictive model was then developed and rigorously evaluated using the area under the curve (AUC), calibration plots, and decision curve analysis (DCA) in both cohorts. Multivariable binary logistic regression identified three independent predictors of moderate-to-severe acute postoperative pain: surgical approach [three-port laparoscopic appendectomy (TPLA) vs. single-port laparoscopic appendectomy (SPLA); P < 0.01, odds ratio (OR) = 5.504; 95% CI 3.423-8.852], preoperative total delay (P = 0.005, OR = 1.496; 95% CI 1.129-1.983), and admission body temperature (P = 0.008, OR = 1.797; 95% CI 1.168-2.763). The developed nomogram exhibited robust discriminative performance, with an AUC of 0.762 (95% CI 0.716-0.808) in the training set and 0.785 in the external validation set. Calibration curves for both cohorts demonstrated optimal agreement between predicted and observed outcomes. In the validation cohort, DCA confirmed significant clinical net benefits across threshold ranges of 10%-14% and 16%-95%. Surgical approach, preoperative total delay, and admission body temperature were identified as independent predictors of acute pain following laparoscopic appendectomy. Compared with TPLA, the SPLA approach was associated with a significantly lower risk of moderate-to-severe acute pain. The externally validated nomogram provides a reliable clinical tool with high discriminative power and practical applicability, facilitating the identification of high-risk patients and supporting the optimization of individualized perioperative pain management strategies.
While endoscopic resection techniques such as endoscopic submucosal excavation (ESE) or endoscopic full-thickness resection (EFTR) enable the removal of gastrointestinal muscularis propria-originating submucosal tumors (MP-SMTs), these procedures still present certain limitations, including risks of perforation and hemorrhage. Therefore, we developed a novel embryonic-natural orifice transluminal endoscopic surgery (E-NOTES) approach designed to achieve complete resection of MP-SMTs while preserving mucosal integrity. This study evaluated its feasibility in beagle model. Twelve healthy beagles underwent E-NOTES using a gastric endoscope. Simulated lesions were created on the serosal surface of the gastric anterior wall. The muscularis propria and serosal layers were resected while maintaining mucosal integrity. Simulated lesion size, operative time, intraoperative hemorrhage, intra-/ postoperative complications were recorded and analyzed. Postoperative endoscopy at 60 days and histopathological examination were performed to assess outcomes. All procedures were successfully completed without conversion to laparoscopy. The mean simulated lesion diameter was 28.1 ± 7.7 mm, and mean operative time was 64.3 ± 5.5 min. Minor intraoperative bleeding (< 5 mL) occurred in 7/12 (58.3%) dogs and was controlled endoscopically. No severe complications (perforation, peritonitis, or major bleeding) occurred. All animals resumed oral intake within 24 h. Endoscopy on postoperative day 60 confirmed complete mucosal healing, and histopathology verified the complete excision of the targeted full-thickness muscularis propria and the preservation of mucosal layers. In this preclinical canine model, E-NOTES enabled safe and complete resection of gastric MP-SMTs with intact mucosa in a beagle model, demonstrating minimal invasiveness, low complication rates, and rapid recovery. These findings support further technical refinement and cautious evaluation in subsequent translational studies.
Navigation-assisted spinal instrumentation is increasingly used in modern spine surgery, offering improvements in accuracy, workflow efficiency, and radiation safety. However, real-world implementation and the transition from fluoroscopy to navigation in high-volume trauma centers remain insufficiently described. This retrospective single-center study reviewed all dorsal spinal instrumentation procedures performed between 2015 and 2025 at a Level I trauma center. A total of 557 patients were analyzed: 119 navigated and 438 fluoroscopic procedures. Demographics, ASA classification, operative time, screw count, radiation parameters, anatomical distribution, and revision rates were compared, with specific focus on changes after the introduction of navigation in 2020. Navigation use increased steadily and expanded from lumbar to more anatomically demanding regions. Navigated cases involved older patients with higher ASA scores. Although operative times were longer in navigated procedures, this was explained by higher screw counts, and time per screw did not differ significantly. A clear learning curve was observed, with time per screw improving from 27 (±22) to 19 (±7) minutes (p = 0.03). Radiation time was significantly lower in the navigated group, while total dose was comparable. Screw misplacement-related revisions were less frequent with navigation (1% vs. 5%), whereas wound-related revisions were more common, reflecting higher comorbidity and a greater proportion of open procedures. Navigation substantially altered clinical practice, leading to its predominant use in complex anatomies and higher-risk patients. It improved screw accuracy and reduced radiation exposure while maintaining procedural efficiency after the learning curve. With ongoing advances such as robotics, augmented reality, and markerless registration, the role of navigation in spinal trauma surgery is expected to expand further.
Adolescent idiopathic scoliosis (AIS) affects 0.5%-5% of the adolescent population, representing the most common spinal deformity in this age group. This systematic review and meta-analysis aimed to determine optimal exercise prescription parameters for Schroth training in AIS by examining dose-response relationships between exercise frequency, duration, and clinical outcomes. Systematic searches of PubMed, Scopus, Web of Science, and SPORTDiscus were conducted following PRISMA 2020 guidelines. Randomized controlled trials examining Schroth interventions in adolescents aged 10-18 years with idiopathic scoliosis were included. Network meta-analysis was performed using MetaInsight platform for Cobb angle outcomes, with traditional pairwise meta-analyses conducted for all outcomes using standardized mean differences with 95% confidence intervals. 15 randomized controlled trials encompassing 620 participants were included. The overall meta-analysis demonstrated Schroth exercises produced statistically significant Cobb angle improvements (SMD = -0.52, p < 0.0001; I2 = 0%). Subgroup analysis revealed dose-response relationships favouring moderate exercise frequencies (3-4 sessions/week), which showed the largest pooled effect (SMD = -0.58, I2 = 3%). Duration analysis demonstrated medium duration interventions (46-75 min) provided the most precise improvements (MD = -2.92°), while optimal frequency was the moderate (MD = -2.79°, 95% CI: -4.05, -1.48). Combined subgroup analysis identified moderate frequency plus medium duration as the most robust combination (SMD = -0.65, I2 = 10%). Health-related quality of life outcomes showed non-significant improvements with substantial heterogeneity (SMD = 0.52, p = 0.43; I2 = 93%). Secondary outcomes showed statistically significant improvements in trunk rotation (SMD = -0.86, p = 0.002; I2 = 22%) and cosmetic appearance perception (SMD = -0.73, p = 0.01; I2 = 0%), while postural stability measures showed non-significant effects (SMD = 0.08; p = 0.81; I2 = 68%). Publication bias assessment using Egger's test shows no statistically significant funnel plot asymmetry (p = 0.745). Exploratory subgroup and network meta-analyses suggest that moderate frequency Schroth exercises (3-4 sessions/week) combined with medium duration sessions (46-75 min) may represent optimal parameters for Cobb angle improvement in AIS. Non-linear dose-response patterns show diminishing returns at higher frequencies, challenging conventional exercise prescription assumptions. These findings require validation through prospective studies with pre-specified dose-stratification examining long-term effectiveness, cost-effectiveness, and patient adherence across diverse healthcare contexts before broad clinical implementation.
Developmental dysplasia of the hip (DDH) associated with an acute proximal femoral fracture on the same side is uncommon, and performing a one-stage total hip arthroplasty (THA) with concurrent fracture stabilization in such cases poses significant technical challenges. We present a case involving a 57-year-old female with a long history of right-sided DDH who was involved in a vehicular accident, leading to acute pain in her right hip, shortening of the limb, and restricted movement. Imaging studies indicated Hartofilakidis type II DDH along with a comminuted intertrochanteric fracture of the proximal femur and a pseudoacetabulum. Utilizing thin-slice computed tomography, we created a customized three-dimensional (3D) printed model of the pelvis and proximal femur, which allowed for detailed preoperative planning. This included evaluating the acetabular bone quality, identifying the true center of the acetabulum, selecting the appropriate cup size and orientation, and strategizing the femoral osteotomy and fixation with plates and cables. A one-stage cementless THA was executed through a posterolateral approach, featuring a small hemispherical cup securely placed in the true acetabulum and a size-16 biological femoral stem anchored distally across the fracture site, followed by the application of a lateral plate and titanium cable to stabilize the proximal femoral fracture. The patient began ambulation with the assistance of a walker on postoperative day 1. At 2 months after surgery, the pain score had decreased to 1/10 on the visual analog scale (VAS), and radiographic evaluation demonstrated ongoing fracture healing. By 3 months postoperatively, the patient was pain-free (VAS 0/10), had achieved a Harris Hip Score of 92, and showed restoration of lower-limb length. Imaging confirmed fracture union and stable prosthesis positioning, and the patient had returned to work independently. This case suggests that individualized 3D printing-assisted preoperative planning may improve the feasibility and early safety of one-stage cementless total hip arthroplasty combined with internal fixation for adult DDH with an ipsilateral proximal femoral fracture, and may provide a useful reference for preoperative decision-making in similarly complex cases.
Penetrating trauma in children is relatively uncommon but is associated with significant morbidity and mortality, particularly when major vascular or visceral structures are involved. Owing to anatomical and physiological differences, as well as limited paediatric-specific evidence, surgical decision-making remains challenging and often relies on extrapolation from adult data. This study aimed to describe the surgical decision-making strategies for haemodynamically stable paediatric patients with penetrating injuries, highlighting the roles of clinical assessment, imaging, and multidisciplinary management. We report a retrospective case series of three paediatric patients with penetrating trauma who were managed at two tertiary paediatric referral centres. The clinical presentation, diagnostic workup, surgical approach, and outcomes were analysed. All patients were haemodynamically stable on admission but presented with penetrating injuries involving high-risk anatomical regions. Contrast-enhanced computed tomography played a key role in the preoperative assessment of extremity injuries, whereas surgical exploration was deemed mandatory in the presence of abdominal evisceration, despite stable vital signs. A tailored surgical approach based on clinical and radiological findings allowed safe foreign body removal or exploratory surgery without major complications. No vascular or visceral injuries requiring repair were observed. The postoperative course was uneventful, and no early or late complications occurred during follow-up. Penetrating trauma in haemodynamically stable paediatric patients requires individualised decision-making, supported by careful clinical evaluation, appropriate imaging, and multidisciplinary collaboration. Selective surgical exploration guided by injury pattern and anatomical risk can result in favourable outcomes while avoiding unnecessary procedures.
Organ and tissue transplantation has transformed the management of end-stage organ failure, yet graft rejection remains a major barrier. Rejection arises from complex immune mechanisms involving MHC mismatch, T-cell allorecognition, and antibody-mediated injury. Advances in immunosuppressive therapy have improved graft survival, but significant challenges persist. This scoping review synthesizes current insights into the immunological basis of graft rejection and evaluates conventional, biologic, and emerging immunosuppressive strategies. Particular attention is given to organ-specific differences and newer fields such as vascularized composite allografts (VCA) and xenotransplantation. A systematic literature search was conducted across PubMed, Google Scholar, Cochrane, and ClinicalTrials.gov (updated June 2025) following PRISMA guidelines. Studies addressing mechanisms of rejection, therapeutic innovations, and clinical outcomes in solid organ transplantation were included. Rejection manifests in distinct forms: hyperacute rejection, though rare due to modern screening, remains catastrophic when pre-existing antibodies are present; acute rejection affects 10%-20% of patients within the first year, driven by both T-cell and antibody-mediated pathways; and chronic rejection, emerging months to years later, leads to progressive fibrosis, vasculopathy, and graft loss across organs. The degree of HLA mismatch consistently emerged as the strongest predictor of long-term survival. Conventional regimens of corticosteroids, calcineurin inhibitors, and antimetabolites remain foundational but are limited by nephrotoxicity, metabolic complications, and infection risk. Biologics such as basiliximab, belatacept, and rituximab have introduced more targeted suppression, while innovative approaches, including regulatory T-cell therapy, tolerogenic dendritic cells, gene-editing strategies, and nanotechnology-based drug delivery, show promise. Despite these advances, long-term therapy is challenged by 20%-70% patient non-adherence, heightened infection risk, and malignancy. Future strategies must emphasize personalized, biomarker-guided regimens, immune tolerance induction, and AI-driven diagnostics to achieve durable graft acceptance with minimal complications. Integration of consensus frameworks and precision medicine approaches will be essential to improving long-term graft survival and patient health.
To compare the short-term efficacy of robot-assisted and uniportal video-assisted thoracoscopic surgery (U-VATS) for right upper lobectomy in treating non-small cell lung cancer (NSCLC). 99 early-stage NSCLC patients from Nanxishan Hospital of Guangxi Zhuang Autonomous Region who underwent surgery between July 2022 and December 2024, were selected and grouped based on the surgical approach: patients undergoing da Vinci robot-assisted right upper lobectomy (da Vinci group) and patients undergoing U-VATS right upper lobectomy (U-VATS group). Clinical data were compared between the two groups, including baseline data, efficacy, surgical indicators, postoperative complications, and survival curves. There were no statistically significant differences in baseline data between the two groups (P > 0.05). The efficacy between the two groups showed no statistical significance (P > 0.05); however, the R0 was higher in the da Vinci robot group at 86.00% compared to 73.47% in the U-VATS group. There were no statistically significant differences in terms of surgical time, intraoperative blood loss, chest tube drainage, duration of drainage tube placement, and length of postoperative hospital stay between the two groups (P > 0.05). The da Vinci robot group had a higher number of lymph node dissections than the U-VATS group (P < 0.05). The incidence of postoperative complications showed no statistically significant difference between the two groups (P > 0.05). There were no cases of loss to follow-up among the 99 patients. The survival rate was 89.80% in the U-VATS group and 96.00% in the da Vinci robot group, with no statistical significance (P > 0.05). Compared to U-VATS, da Vinci robot-assisted right upper lobectomy for early-stage NSCLC patients demonstrates similar safety and operability, with a significantly higher number of lymph node dissections. There were no significant differences in surgical time, intraoperative blood loss, postoperative chest tube drainage, duration of drainage tube placement, length of postoperative hospital stay, and incidence of postoperative lung infections between the two approaches.
The field of abdominal wall hernia surgery is transitioning from a traditional focus on anatomical repair to a more comprehensive model centered on functional reconstruction. This paradigm shift expands the primary goal from mere defect closure to the restoration of abdominal wall integrity, dynamic stability, and physiological function. This perspective article examines this progression and highlights the critical role of integrating functional reconstruction with structured perioperative management to enhance long-term surgical outcomes and patient quality of life. We explore the clinical impact of technical innovations-including minimally invasive component separation, advanced prosthetic materials, and robotic-assisted techniques-alongside the implementation of individualized perioperative care pathways. Multidisciplinary collaboration is emphasized as a foundational framework for delivering personalized treatment. Several challenges remain, including optimal material selection, comparative evaluation of surgical approaches, and health economic assessments. Addressing these issues requires robust prospective studies to strengthen the evidence base. Future directions should prioritize the development of standardized functional assessment tools, the integration of artificial intelligence in surgical planning, and the incorporation of function-oriented principles into surgical education and practice. Through these advancements, abdominal wall hernia surgery can fully evolve into a patient-centered specialty focused on achieving sustainable, long-term benefits.
Non-intubated uniportal video-assisted thoracoscopic surgery (NI-UVATS) has emerged as an alternative to conventional intubated approaches, yet its applicability across diverse patient populations and procedure types remains undefined. We evaluated perioperative outcomes of NI-UVATS vs. intubated UVATS (I-UVATS) in an unrestricted cohort. This retrospective cohort study analyzed 289 consecutive VATS procedures (January 2017-June 2025) at a single center. Patients underwent either I-UVATS (n = 166) or NI-UVATS (n = 123) based on surgeon and anesthesiologist preference. Primary outcome was serious complications (composite of mortality, reintubation, pneumonia, or reoperation). Secondary outcomes included 30-day mortality, length of stay, and procedure-specific complications. Propensity score matching (1:1) was performed to address baseline imbalances. Post-hoc stratification by procedural complexity was conducted. After propensity score matching, 98 patients in each group were analyzed. Despite matching, significant procedural heterogeneity persisted: anatomical resections comprised 36.7% of I-UVATS vs. 5.1% of NI-UVATS procedures (p < 0.001). For low-complexity procedures (n = 118), serious complications occurred in 10.8% I-UVATS vs. 7.4% NI-UVATS (p = 0.545). For medium-complexity procedures (decortications, n = 37), serious complications were comparable (16.0% I-UVATS vs. 16.7% NI-UVATS, p = 0.959). The limited number of NI-UVATS anatomical resections (n = 5) precluded meaningful comparison for high-complexity procedures. Operative time was longer in NI-UVATS (median 52 vs. 37 min, p = 0.042). Overall serious complications occurred in 14.3% I-UVATS vs. 11.2% NI-UVATS patients (p = 0.522). Thirty-day mortality was 12 (12.2%) in I-UVATS vs. 7 (7.1%) in NI-UVATS (p = 0.240), and surgery-related mortality at 1 year was 10 (10.2%) vs. 15 (15.3%), respectively (p = 0.291). NI-UVATS demonstrated safety and feasibility for low-to-medium complexity thoracic procedures within current real-world selection patterns. The marked procedural imbalance (36.7% vs. 5.1% anatomical resections) reflects contemporary practice where surgeons reserve NI-UVATS for lower-complexity interventions. These findings support NI-UVATS implementation for appropriately selected patients undergoing diagnostic and pleural procedures, while anatomical resections remain predominantly performed under intubation. Procedure-specific randomized trials are needed to define the role of NI-UVATS in complex resections.
To compare the degree of kyphosis among patients with old thoracolumbar fracture kyphosis (OTFK) in various positions and to assess kyphosis flexibility. A total of 32 patients with OTFK who met the inclusion criteria were retrospectively included between February 2017 and August 2022. The cohort consisted of 4 males and 28 females with a mean age of 66.47 years (range, 55-88 years). All patients underwent preoperative standing full-length spine x-ray, prone full-length spine CT scout view (FLS-CT), and supine MRI. Among them, 29 patients had single-segment fractures and 3 had double-segment fractures. The local kyphosis Cobb angle (LKCA) was measured on all imaging modalities. The LKCA measured on standing x-ray and FLS-CT were recorded as LKCAX and LKCAFLSCT, respectively. On MRI, LKCA was measured on three sagittal slices (left parasagittal, midsagittal, and right parasagittal), recorded as LKCALMR, LKCAMMR, and LKCARMR, respectively. Kyphosis flexibility (KF) was calculated based on these measurements. Pairwise comparisons were performed using the Wilcoxon signed-rank test with Bonferroni correction after an overall Friedman test. Equivalence analysis between prone FLS-CT and supine MRI was performed using a prespecified margin of ±5°. Interobserver reliability was assessed using the intraclass correlation coefficient (ICC). The mean standing LKCA was 39.58 ± 9.00°. The LKCA measured on prone FLS-CT was 29.61 ± 6.96°. On supine MRI, the LKCA values were 28.34 ± 6.37° (LKCALMR), 27.64 ± 6.18° (LKCAMMR), and 28.97 ± 5.92° (LKCARMR). The mean LKCA of the three MRI planes was 28.32 ± 5.91°. The corresponding KF values were 24.45% ± 10.86% for prone FLS-CT, 27.36% ± 11.08% for the left parasagittal slice, 29.16% ± 10.89% for the midsagittal slice, 25.52% ± 11.20% for the right parasagittal slice, and 27.35% ± 10.16% for the mean of the three MRI planes. LKCA was significantly lower in the prone and supine positions than in the standing position (all adjusted p < 0.001). No significant differences were found between prone FLS-CT and any supine MRI measurement (all adjusted p > 0.05). In equivalence analysis, all 95% confidence intervals of the paired mean differences between prone FLS-CT and supine MRI measurements were entirely within the prespecified equivalence margin of ±5°. Interobserver reliability was excellent across all imaging modalities, with ICC values ranging from 0.985 to 0.992. Kyphosis severity was significantly reduced in the preoperative recumbent position in patients with OTFK. Prone FLS-CT and supine MRI provided clinically comparable estimates of positional kyphosis correction, suggesting that both modalities may be useful for preoperative assessment of kyphosis flexibility in OTFK.
Postoperative bone nonunion is a critical complication following instrumented fusion for spinal tuberculosis. Preoperative prediction is essential for prevention. While clinical risk factors exist, current predictive tools lack validation in infected cohorts. This study developed and validated a multivariate nomogram, provided an individualized preoperative estimate of nonunion risk in spinal tuberculosis patients, incorporating key clinical and radiological predictors to guide preventative strategies. A retrospective cohort of 178 patients undergoing debridement and instrumented fusion for spinal tuberculosis (Shandong Public Health Clinical Center, January 2021-January 2024) was stratified by Bridwell classification into union (n = 120) and nonunion (n = 58) groups. Perioperative variables were compared between groups. Predictive features were selected via least absolute shrinkage and operator selection (LASSO) regression and incorporated into a multivariate logistic regression model. A nomogram was constructed based on the model. Calibration was assessed using the Hosmer-Lemeshow test with calibration curves, and discriminative ability was evaluated by the area under the ROC curve (AUC). Decision curve analysis (DCA)was performed to estimate the clinical usefulness of the prediction model by quantifying the net benefits at different threshold probabilities. The training cohort of this study comprised 178 patients, of which 120 presented with union and 58 with nonunion. Five predictor variables were screened by LASSO regression and plotted as a nomogram, including ALB, CRP normalization days, Bone graft materials, Psoas abscess, Jumping lesions. The nomogram showed strong discrimination and solid calibration, AUC = 0.947 (95% confidence 0.915-0.978). The calibration curves of the diagnostic models showed the optimal concordance between the predicted results and the actual observations. The DCA indicated that the substantial clinical net benefit across threshold probabilities. The study successfully developed a precise and effective nomogram for identifying postoperative bone nonunion in spinal tuberculosis patients. This nomogram aids early detection and prevention in postoperative bone nonunion, improving clinical decisions and treatment optimization.
The lipoma is a common benign tumor of the subcutaneous body, and it is commonly found on the surface of the skin. But, it can also involve any tissue or organ. Intraspinal lipomas are rare, which account for less than 1% of intraspinal tumors. Among these, intramedullary lipoma is an even rarer condition, compared to extramedullary subdural or epidural types. Intraspinal tumors were removed by the open surgery in common, due to its adequate intraoperative visualization and complete resection. But for intraspinal lipomas, it does not exhibit implantation metastasis, making minimally invasive spinal endoscopic surgery considered as an option. We performed a resection of a intramedullary lipoma, and the surgery was conducted under the guidance of spinal endoscopy. Compared with open surgery, minimally invasive spinal endoscopic surgery may be more advantageous in reducing soft tissue injury and bony structure destruction, allowing patients to achieve rapid recovery. The symptoms of numbness in the left limb and unsteady gait of the patient completely disappeared after the operation. It should be noted that continuous bleeding during the operation exacerbates the complexity of the surgery. When removing lipomas, patience and meticulousness are crucial for the operation.
The anterior clinoid process (ACP) is a critical anatomical landmark during skull base surgery. However, ACP pneumatization poses several risks during anterior clinoidectomy, including cerebrospinal fluid (CSF) leakage and optic nerve injury. Existing classification systems inadequately address clinically significant variations such as those involving the optic strut or planum sphenoidale. Therefore, this study aimed to determine the prevalence and morphological patterns of ACP pneumatization in a Thai population and propose a refined radiological classification system based on the route and extent of pneumatization. A retrospective computed tomography (CT)-based study was conducted on 400 ACPs from 200 patients aged ≥10 years. Pneumatization patterns were categorized into eight subtypes based on the pneumatization route (optic strut, planum sphenoidale, or both) and the degree of ACP involvement (≤50% or >50%). ACP morphometric data and associated bone variations were also assessed. ACP pneumatization was observed in 30.8% of ACPs, with bilateral involvement in 5% of cases. The most frequent subtype was isolated optic strut pneumatization (subtype 1, 16%), followed by limited ACP involvement via the optic strut (subtype 2a, 6%). Planum-based and combined subtypes (3a and 4b) were uncommon (<4%). Male patients demonstrated significantly greater ACP base width (9.09 ± 1.61 mm vs. 8.54 ± 1.39 mm; p = 0.015) and length (13.23 ± 1.72 mm vs. 12.61 ± 1.64 mm; p = 0.010) than females. Middle clinoid processes and interclinoid calcifications were present in 5.8% and 8.8% of patients, respectively. ACP pneumatization, particularly via the optic strut, is a common anatomical variation. The proposed eight-subtype classification provides a nuanced framework for preoperative imaging description and communication. Although prior classifications were largely discussed in the context of transcranial approaches, the observed pneumatization patterns may also be relevant to endoscopic endonasal anatomy, particularly regarding optic canal exposure and potential sinonasal communication. Prospective surgical correlation studies are warranted to determine concordance with intraoperative findings and to clarify clinical relevance.