Startseite Medizin Intraoperative temperature management and its effect on surgical outcomes in elderly patients undergoing lichtenstein unilateral inguinal hernia repair
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Intraoperative temperature management and its effect on surgical outcomes in elderly patients undergoing lichtenstein unilateral inguinal hernia repair

  • Xiawei Zheng ORCID logo und Min Zhang ORCID logo EMAIL logo
Veröffentlicht/Copyright: 17. Dezember 2025
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Open Medicine
Aus der Zeitschrift Open Medicine Band 20 Heft 1

Abstract

Objectives

Unilateral inguinal hernia repair is common in elderly patients, but postoperative complications and recurrence remain concerns. Intraoperative factors such as body temperature, surgical duration, and blood loss may influence outcomes. This study evaluated the impact of intraoperative temperature, surgical duration, and blood loss on postoperative complications and recurrence in elderly patients undergoing Lichtenstein unilateral inguinal hernia repair.

Methods

We retrospectively analyzed clinical data from 368 patients treated between 2018 and 2023. Intraoperative hypothermia was defined as body temperature<36 °C. Postoperative outcomes, including complications and recurrence, were assessed. Predictive performance was evaluated using receiver operating characteristic (ROC) curves.

Results

Intraoperative hypothermia was strongly associated with postoperative wound infections, hematomas, and recurrence, and was identified as an independent prognostic factor. Patients with hypothermia showed longer operative times, greater inflammatory responses, and higher recurrence rates compared with normothermic patients. Excessive blood loss and prolonged surgical duration also increased complication risk. ROC analysis confirmed intraoperative temperature as the strongest predictor of poor outcomes, with an optimal cutoff of 36.25 °C.

Conclusions

Normothermia maintenance, shortened operative time, and minimized blood loss are critical to improving outcomes in elderly patients. Temperature control represents a key modifiable factor to reduce complications and recurrence.

Keywords: unilateral inguinal herni repair; intraoperative temperature; postoperative complications; recurrence; elderly patients

Introduction

Inguinal hernia is one of the most common conditions in general surgery [1]. Its incidence increases with aging, as abdominal muscle atrophy and metabolic decline predispose elderly individuals to a higher risk compared with younger patients [2], [3], [4]. Elderly patients account for over 30 % of all cases, with a prevalence of approximately 1.15 % in those aged 60 years or older [5]. In China, approximately 1.5 million repairs are performed annually. Although surgery is effective, complication rates in elderly patients reach 4.2 %, significantly higher than in younger groups [6], 7]. Clinically, inguinal hernia is predominantly unilateral, with most series reporting a higher proportion of unilateral cases [1], 8]. These features underscore the importance of perioperative risk control in elderly patients with unilateral inguinal hernia.

Evidence indicates that intraoperative factors such as body temperature, surgical duration, and blood loss are strongly associated with complications and recurrence after inguinal hernia repair. Although postoperative hematoma is relatively uncommon, it correlates with these intraoperative variables and may predispose to infection and recurrence, underscoring the need for strict control of operative time and bleeding in unilateral repairs [9]. Perioperative temperature is another critical determinant: normothermia supports metabolic and immune function, whereas hypo- or hyperthermia worsens outcomes [10]. Open hernia repair carries a higher risk of hypothermia, particularly in elderly patients with impaired thermoregulation [11], 12]. Hypothermia suppresses immunity and induces inflammatory responses, thereby increasing the risk of infection [13]. Inflammatory markers, such as the white blood cell count (WBC) and the neutrophil-to-lymphocyte ratio (NLR), reflect systemic inflammation [14], 15]. Additionally, neutrophils further exacerbate postoperative inflammation through the release of cytokines and chemokines [16].

Although evidence from meta-analyses and systematic reviews supports surgical decision-making in unilateral hernia repair, limitations persist. Comparative studies of Lichtenstein and TAPP in unilateral, primary hernias have focused on perioperative outcomes across techniques, without addressing intraoperative modifiable factors such as temperature, duration, and blood loss [17]. Furthermore, while meta-analyses include data on unilateral primary inguinal hernia [18], 19], subgroup analyses specific to elderly unilateral patients are lacking, and systematic evaluations of intraoperative variables as independent predictors of complications and recurrence are absent. These gaps underscore the need to clarify how intraoperative temperature, surgical duration, and blood loss collectively impact postoperative outcomes in elderly patients with unilateral inguinal hernias.

This study aims to determine the effects of intraoperative temperature, surgical duration, and blood loss on postoperative complications and recurrence in elderly patients undergoing unilateral inguinal hernia repair. By leveraging large-sample retrospective data and conducting multifactorial linkage analysis, this research seeks to elucidate the relationship between modifiable intraoperative factors and adverse outcomes, thereby addressing existing evidence gaps. Such work has important implications for expanding the mechanistic understanding of intraoperative risks in unilateral inguinal hernia repair and for providing evidence-based guidance to optimize perioperative management, ultimately reducing complications and recurrence while improving long-term outcomes in elderly patients.

Materials and methods

Clinical data collection and sources

This retrospective study included patients who underwent unilateral inguinal hernia repair at our institution between January 2018 and December 2023, with follow-up through December 2024. Demographic data (age, sex, and comorbidities such as hypertension and diabetes) were extracted from electronic medical records. Intraoperative variables were obtained from the surgical management system, including procedure code, surgical approach (Lichtenstein tension-free repair with mesh plug), body temperature, operative time, and blood loss. Postoperative outcomes were collected from institutional follow-up records, including length of stay, complications (e.g., wound infection, hematoma), and recurrence within 12 months. Complications were classified using the Clavien-Dindo system. Hernia recurrence was uniformly evaluated through outpatient physical examination combined with groin ultrasonography, while equivocal cases underwent postoperative re-examination or confirmation at reoperation. Body temperature was continuously monitored using standardized devices throughout the pre-, intra-, and postoperative phases to ensure consistency. The operating room temperature was maintained at 22–24 °C with controlled humidity; however, active warming devices were not routinely applied, as they are not standard in general surgery at our center and are limited by cost and workflow considerations. Thus, intraoperative hypothermia, when present, occurred without deliberate intervention. All data were de-identified before analysis. This study was approved by the institutional ethics committee (Approval No. KY2024506) and adhered to relevant ethical standards, ensuring strict protection of patient confidentiality.

Inclusion and exclusion criteria

The inclusion criteria were patients surgically confirmed to have a unilateral inguinal hernia during the study period who underwent Lichtenstein tension-free repair, completed at least 12 months of follow-up, and had complete electronic medical records. To reduce surgical complexity and ensure consistency of intraoperative variables (e.g., operative time and blood loss), cases of bilateral inguinal hernia were excluded.

Exclusion criteria were: (1) incomplete data, such as missing operative records or intraoperative temperature measurements; (2) uncertain diagnosis or lack of confirmation by both surgery and imaging; (3) failure to complete postoperative follow-up; (4) unstable comorbidities or very short disease duration, which might exert extreme effects on postoperative recovery; and (5) complex hernias, including irreducible, incarcerated, recurrent hernias, EHS grade≥L3 large hernias, or hernias involving multiple organs, to ensure clinical homogeneity and minimize confounding factors (Figure S1).

Surgical method

All patients underwent standardized unilateral inguinal hernia repair using the Lichtenstein tension-free mesh plug technique, performed by senior attending surgeons to ensure procedural consistency. Intraoperative body temperature was continuously monitored using electronic devices, but temperature management remained observational, without active warming interventions.

Anesthesia

All patients received spinal anesthesia. Inguinal hernia repair is commonly performed under spinal anesthesia, as it exerts minimal effects on respiratory function, provides greater hemodynamic stability, and is particularly suitable for elderly patients [20], 21]. In this study, 0.5 % hyperbaric bupivacaine (1.5–2.0 mL) was administered via lumbar puncture to achieve a sensory block at the T10-T12 level. All procedures were conducted by senior anesthesiologists, with continuous intraoperative monitoring of vital signs to ensure standardization and patient safety.

Observation indicators

The primary outcome measures included postoperative complications (e.g., wound infection, hematoma, recurrence), length of hospital stay, postoperative recovery, and recurrence within 12 months after surgery. Postoperative complications were graded using the Clavien-Dindo classification. Hernia recurrence was evaluated through outpatient physical examination and groin ultrasonography, with equivocal cases confirmed at reoperation. Intraoperative temperature was analyzed as a key factor influencing postoperative recovery, complications, and recurrence. Additionally, secondary clinical indicators such as intraoperative blood loss and surgical duration were recorded to further evaluate their potential impact on surgical prognosis (Table 1).

Table 1:

Comparison of clinical data.

Clinical data Hypothermia group Normal temperature group χ 2 /t p-Value
Number of cases 40 338
Age (years, Mean ± SD) 72.50 ± 5.46 74.53 ± 7.05 −1.262 0.208
Gender [cases, %] 3.363 0.067
 Male 24 (60.0) 263 (77.8)
 Female 16 (40.0) 75 (22.2)
BMI (kg/m2, Mean ± SD) 23.88 ± 3.34 25.20 ± 3.49 −1.648 0.100
Comorbidity [cases, %] 3.186 0.074
 Yes 18 (45.0) 90 (26.6)
 No 22 (55.0) 248 (73.4)
ASA grade 3.490 0.062
 I/II grade 28 (70.0) 289 (85.5)
 III/IV grade 12 (30.0) 49 (14.5)
Preoperative WBC level (×109 L−1) 7.39 ± 1.69 7.93 ± 1.42 −1.626 0.105
Preoperative NLR 1.73 ± 0.30 1.62 ± 0.24 1.904 0.058
Operation time (min, Mean ± SD) 98.45 ± 12.31 90.87 ± 13.61 2.431 0.016
Blood loss (ml, Mean ± SD) 82.00 ± 14.03 75.98 ± 13.79 1.895 0.059
Intraoperative temperature (°C, Mean ± SD) 35.46 ± 0.26 36.52 ± 0.23 −19.975 <0.001
Postoperative WBC level (×109 L−1) 12.67 ± 1.33 11.94 ± 1.40 2.301 0.022
Postoperative NLR 4.29 ± 0.95 3.69 ± 0.88 2.932 0.004
Complications [cases, %] 9.50 0.0021
 Yes 4 (10.0) 4 (1.18)
 No 36 (90.0) 334 (98.82)

  1. BMI, body mass index; WBC, postoperative peripheral blood leukocyte count; NLR, neutrophil to lymphocyte ratio.

Sample size calculation

To ensure the statistical reliability of the study results, we performed a power analysis using R software. Based on an expected effect size (Cohen’s d=0.5, indicating a moderate effect), the significance level was set at 0.05, with a target statistical power of 80 %. The analysis determined that a sample size of 40 patients in the hypothermia group and 338 patients in the normothermia group would achieve 80 % power to detect significant differences between groups. It confirms that the current sample size is sufficient to meet standard statistical requirements, ensuring the robustness and reliability of the study findings.

Statistical analysis

Data analysis was conducted using R software (version 4.0.3). Continuous variables were presented as mean ± standard deviation (Mean ± SD), with group differences assessed using independent sample t-tests or the Mann-Whitney U test, depending on the data distribution. Categorical variables were expressed as frequencies and percentages, with comparisons made using chi-square tests. Changes in postoperative immune response indicators, such as WBC and NLR, were analyzed using paired t-tests. A one-way analysis of variance (ANOVA) was performed to compare multiple groups. Multiple linear regression analysis was conducted to evaluate the independent effect of intraoperative temperature on postoperative recovery, while adjusting for potential confounding variables, including age, sex, and comorbidities. Receiver operating characteristic (ROC) curve analysis was further applied to assess the predictive ability of intraoperative temperature, postoperative WBC, and NLR for poor prognosis, with the area under the curve (AUC), optimal cutoff values, sensitivity, and specificity calculated. All statistical tests were two-tailed, and a p-value < 0.05 was considered statistically significant.

Ethical statement

This study was approved by the Clinical Ethics Committee of The Affiliated Hospital of Southwest Medical University (No. KY2024506).

Results

Patient characteristics

This study included 368 patients who underwent unilateral inguinal hernia repair, with 40 patients (10.8 %) in the hypothermia group and 328 (89.2 %) in the normothermia group. The cohort comprised 263 male patients (77.8 %) and 75 female patients (22.2 %). The age range was 65–85 years, with an average age of 72.5 ± 5.46 years in the hypothermia group and 74.53 ± 7.05 years in the normothermia group, with no significant difference between groups (p=0.208). Additionally, there were no significant differences in sex distribution, body weight, height, or BMI between the two groups (p>0.05). In the hypothermia group, the median duration of intraoperative hypothermia (<36 °C) was 42 min (IQR: 35–52 min).

Preoperative WBC was 7.39 ± 1.69 × 109/L in the hypothermia group and 7.93 ± 1.42 × 109/L in the normothermia group (p=0.105). The NLR was 1.73 ± 0.30 in the hypothermia group and 1.62 ± 0.24 in the normothermia group (p=0.058). Regarding surgical parameters, the mean surgical duration was 98.45 ± 12.31 min in the hypothermia group and 90.87 ± 13.61 min in the normothermia group, with a statistically significant difference (p=0.016). The mean intraoperative blood loss was 82.00 ± 14.03 mL in the hypothermia group and 75.98 ± 13.79 mL in the normothermia group, though this difference did not reach statistical significance (p=0.059).

Intraoperative temperature was significantly different between the two groups, with a mean temperature of 35.46 ± 0.26 °C in the hypothermia group and 36.52 ± 0.23 °C in the normothermia group (p<0.001).

Postoperative WBC was significantly higher in the hypothermia group (12.67 ± 1.33 × 109/L) compared to the normothermia group (11.94 ± 1.40 × 109/L, p=0.022). Similarly, the NLR was elevated in the hypothermia group (4.29 ± 0.95) compared to the normothermia group (3.69 ± 0.88, p=0.004).

The hypothermia group showed longer operative times, elevated postoperative WBC and NLR, and a median hypothermia duration of 42 min, indicating its potential to exacerbate inflammation and increase complication risk.

Independent risk factors for poor prognosis in elderly patients undergoing inguinal hernia repair

Multivariate logistic regression identified postoperative NLR≥1.665 (OR=3.116, 95 % CI: 1.665–5.833, p<0.001), intraoperative blood loss (per mL, OR=1.060, 95 % CI: 1.010–1.113, p=0.019), and age (per year, OR=1.085, 95 % CI: 1.001–1.175, p=0.048) as independent predictors of poor prognosis after unilateral inguinal hernia repair in elderly patients (Table 2). Hypothermia (<36 °C) was also associated with increased risk (OR=6.865, 95 % CI: 1.131–41.661, p=0.036). Other factors, including sex, BMI, comorbidities, ASA classification, preoperative WBC, and surgical duration, were not significant (Figure 1). These results highlight NLR, blood loss, age, and perioperative hypothermia as critical variables influencing postoperative outcomes, underscoring the need for targeted intraoperative management.

Table 2:

Multivariate logistic regression analysis of prognostic factors for elderly inguinal hernia repair outcomes.

Factor β SE Wald 2 p-Value OR 95 % CI
Age 0.081 0.041 3.909 0.048 1.085 1.001 ∼ 1.175
Gender −0.653 0.604 1.169 0.280 0.521 0.159 ∼ 1.700
BMI 0.077 0.081 0.917 0.338 1.081 0.922 ∼ 1.266
Comorbidity 0.340 0.675 0.254 0.614 1.405 0.374 ∼ 5.272
ASA grade 0.985 0.924 1.138 0.286 2.679 0.438 ∼ 16.379
Preop WBC level 0.174 0.229 0.580 0.446 1.190 0.760 ∼ 1.864
Preop NLR 0.310 1.041 0.089 0.766 1.364 0.177 ∼ 10.493
Operation time 0.005 0.021 0.053 0.818 1.005 0.964 ∼ 1.048
Blood loss 0.058 0.025 5.513 0.019 1.060 1.010 ∼ 1.113
Postop WBC level 0.364 0.167 4.744 0.029 1.438 1.037 ∼ 1.995
Postop NLR 1.137 0.320 12.628 <0.001 3.116 1.665 ∼ 5.833
Group 1.926 0.920 4.385 0.036 6.865 1.131 ∼ 41.661
Figure 1: Multivariate logistic regression analysis of risk factors for poor prognosis in elderly patients undergoing unilateral inguinal hernia repair.
Figure 1:

Multivariate logistic regression analysis of risk factors for poor prognosis in elderly patients undergoing unilateral inguinal hernia repair.

Predictive performance of intraoperative temperature, postoperative WBC, and NLR for prognosis

ROC curve analysis demonstrated differential predictive performance among the three markers (Table 3). Postoperative WBC showed the lowest predictive value (AUC=0.678, 95 % CI: 0.616–0.741), although its relatively high specificity (72.9 %) suggests an association with infection or severe inflammation (Figure 2A). Postoperative NLR exhibited stronger predictive performance (AUC=0.730, 95 % CI: 0.675–0.786) with an optimal cutoff of 4.03 (sensitivity 58.9 %, specificity 74.5 %), consistent with its role as a systemic inflammatory marker (Figure 2B). Intraoperative temperature demonstrated the highest predictive efficacy (AUC=0.777, 95 % CI: 0.727–0.828) with an optimal cutoff of 36.25 °C (sensitivity 81.3 %, specificity 62.5 %), confirming hypothermia as a critical prognostic risk factor (Figure 2C). Overall, intraoperative temperature was the strongest predictor, followed by postoperative NLR, whereas WBC may serve as an auxiliary indicator in clinical risk assessment.

Table 3:

ROC curve of intraoperative temperature, postoperative WBC levels, and NLR in predicting surgical outcomes.

Factor AUC (95 % CI) SE value p-Value Cutoff valuea Sensitivity, % Specificity, %
Postoperative WBC level 0.716 (0.605, 0.827) 0.056 0.001 12.03 60.0 72.5
Postoperative NLR 0.804 (0.698, 0.910) 0.054 <0.001 4.03 80.0 75.7
Intraoperative temperature 0.812 (0.686, 0.937) 0.064 <0.001 36.25 75.0 88.8

  1. aThe ideal cutoff value is calculated based on the Youden Index.

Figure 2: ROC curves for intraoperative temperature, postoperative WBC levels, and NLR in predicting surgical prognosis. (A) ROC curve for postoperative WBC levels (AUC=0.678, 95 % CI: 0.616–0.741); (B) ROC curve for postoperative NLR (AUC=0.730, 95 % CI: 0.675–0.786); (C) ROC curve for intraoperative temperature (AUC=0.777, 95 % CI: 0.727–0.828).
Figure 2:

ROC curves for intraoperative temperature, postoperative WBC levels, and NLR in predicting surgical prognosis. (A) ROC curve for postoperative WBC levels (AUC=0.678, 95 % CI: 0.616–0.741); (B) ROC curve for postoperative NLR (AUC=0.730, 95 % CI: 0.675–0.786); (C) ROC curve for intraoperative temperature (AUC=0.777, 95 % CI: 0.727–0.828).

Relationship between intraoperative temperature and postoperative complications

Furthermore, this study analyzed the impact of intraoperative temperature on the incidence of postoperative complications, revealing a significant effect. The hypothermia group (intraoperative temperature<36 °C) exhibited a substantially higher rate of postoperative complications compared to the normothermia group (36.5°C–37.5 °C) (p<0.001). Specifically, the overall postoperative complication rate in the hypothermia group was 10.0 % (4/40), whereas in the normothermia group, it was 1.18 % (4/338). Among hypothermic patients, the incidence of surgical site infection and hematoma was 7.5 % (3/40) and 2.5 % (1/40), respectively, compared to 0.59 % (2/338) and 0.59 % (2/338) in the normothermia group. These findings indicate that low intraoperative temperature significantly increases the risk of postoperative complications, particularly surgical site infections and hematomas (Table 1).

Relationship between intraoperative temperature and length of hospital stay

Patients with intraoperative hypothermia (<36 °C) had significantly longer hospital stays compared with normothermia cases (8 ± 5 vs. 4 ± 1 days, p<0.01) (Figure 3A). Greater intraoperative temperature variability (SD>0.5 °C) was also associated with prolonged hospitalization (9 ± 6 vs. 4 ± 1.5 days, p<0.05) (Figure 3B). These findings suggest that hypothermia and temperature fluctuations are closely linked to extended hospital stay, potentially through mechanisms such as physiological stress, delayed immune recovery, and increased complication risk. Effective intraoperative temperature management and stability maintenance may therefore be essential for reducing hospitalization and improving recovery.

Figure 3: Impact of intraoperative temperature and temperature variability on length of hospital stay. (A) Box plot of intraoperative temperature and length of hospital stay; (B) Box plot of temperature variability and length of hospital stay.
Figure 3:

Impact of intraoperative temperature and temperature variability on length of hospital stay. (A) Box plot of intraoperative temperature and length of hospital stay; (B) Box plot of temperature variability and length of hospital stay.

Relationship between intraoperative temperature and postoperative recurrence rate

The association between intraoperative temperature and postoperative recurrence was further evaluated. The association between intraoperative temperature and postoperative recurrence was analyzed. The recurrence rate in the hypothermia group (<36 °C) was 5 %, significantly higher than the 3.25 % observed in the normothermia group (36–37 °C) (p<0.05). A greater proportion of recurrence cases was seen in the hypothermia group, as indicated by the larger dark blue segment in Figure 4, whereas the normothermia group showed a smaller recurrence proportion. These findings suggest that intraoperative hypothermia may increase the risk of recurrence after unilateral inguinal hernia repair, underscoring the importance of temperature management during surgery.

Figure 4: Bar chart of intraoperative temperature and postoperative recurrence rate. Comparison of postoperative recurrence rates between the hypothermia and normothermia groups. The bar chart illustrates the proportion of patients with recurrence (dark blue) and no recurrence (light blue) in each group. p<0.05 indicates a statistically significant difference between groups.
Figure 4:

Bar chart of intraoperative temperature and postoperative recurrence rate. Comparison of postoperative recurrence rates between the hypothermia and normothermia groups. The bar chart illustrates the proportion of patients with recurrence (dark blue) and no recurrence (light blue) in each group. p<0.05 indicates a statistically significant difference between groups.

Discussion

Unilateral inguinal hernia repair is a common surgical procedure; however, the occurrence of postoperative complications and recurrence remains a significant concern for patient health [22], [23], [24], [25]. While numerous studies have focused on surgical treatment and postoperative management of unilateral inguinal hernia, research on how intraoperative factors influence postoperative complications and recurrence rates remains limited. This study conducted a retrospective analysis to examine the relationship between intraoperative temperature, surgical duration, and blood loss with postoperative complications and recurrence following unilateral inguinal hernia repair. The findings indicate that intraoperative hypothermia, prolonged surgical duration, and excessive blood loss are significantly associated with an increased risk of postoperative complications and recurrence. Specifically, hypothermia not only elevates the risk of postoperative complications but also correlates positively with recurrence. Our findings align with previous research while addressing the knowledge gap regarding the impact of intraoperative temperature on recurrence mechanisms. This study offers new theoretical insights for optimizing clinical strategies in unilateral inguinal hernia repair by providing a detailed analysis of intraoperative factors, particularly temperature management. For elderly patients, effective intraoperative temperature control, reducing surgical duration, and minimizing blood loss may be crucial in improving surgical outcomes. This discovery holds significant clinical value and innovation, guiding future surgical practices and postoperative management.

In comparison to existing literature, this study validates previous findings and offers deeper insights into the impact of intraoperative factors on postoperative complications and recurrence. Prior research has widely recognized the association between intraoperative hypothermia and postoperative infections and complications [26], [27], [28]. However, this study is the first to establish that intraoperative hypothermia is linked not only to complication rates but also to an increased risk of postoperative recurrence, offering important clinical implications. Previous studies have primarily focused on hypothermia-induced immune suppression and heightened infection risk [13]. In contrast, this study further elucidates the potential connection between hypothermia and the recurrence of disease. A possible mechanism is that hypothermia exacerbates immune responses and cytokine release, thereby impairing postoperative wound healing and immune function, ultimately increasing recurrence risk. Additionally, this study confirms that surgical duration and blood loss significantly influence complication rates. Prolonged surgical duration and excessive blood loss are associated with a higher incidence of postoperative complications, aligning with conclusions from existing literature [29], 30]. However, research on the relationship between surgical duration and recurrence remains limited. Our findings highlight the long-term impact of surgical duration on recurrence risk, emphasizing the importance of minimizing unnecessary surgical delays and optimizing procedural efficiency in clinical practice.

Notably, beyond intraoperative parameters such as temperature, overall functional status and frailty play a critical role in postoperative recovery. Recent evidence indicates that sarcopenia and functional measures (e.g., handgrip strength) are stronger predictors of hospital stay and recovery trajectory after abdominal surgery than chronological age alone [31], suggesting that frailty serves as an independent risk stratification marker for identifying high-risk patients. In this study, prolonged hospitalization in hypothermic patients may reflect not only the physiological effects of low temperature but also underlying functional decline and frailty. Hypothermia may further exacerbate physiological stress in frail individuals, delaying recovery. Future research should incorporate functional indicators such as grip strength and gait speed into perioperative assessments, alongside temperature and other parameters, to establish more comprehensive risk prediction models.

In this study, the relationship between intraoperative hypothermia and postoperative recurrence emerged as an unexpected but significant finding. Previous research has primarily focused on the impact of intraoperative hypothermia on postoperative infections and other complications, with limited discussion on its role in recurrence. Our findings reveal that hypothermia not only increases the incidence of postoperative complications but also significantly elevates the recurrence rate. A possible explanation is that hypothermia enhances the release of inflammatory cytokines, such as interleukins and tumor necrosis factor, leading to immune dysfunction. This, in turn, impairs wound healing and the effectiveness of hernia repair, ultimately increasing recurrence risk. These findings provide a new perspective on the long-term prognostic implications of intraoperative temperature management, particularly for elderly patients undergoing unilateral inguinal hernia repair. Although previous studies have explored the association between intraoperative hypothermia and immune response, this study further integrates inflammatory biomarkers, such as peripheral blood WBC and NLR, to demonstrate that hypothermia may exacerbate systemic inflammatory responses, promoting postoperative complications. This discovery has significant clinical implications for intraoperative temperature management, emphasizing that temperature control helps prevent short-term complications and may also play a crucial role in reducing postoperative recurrence.

The findings of this study have important implications for clinical practice. First, intraoperative temperature management should be prioritized, particularly in elderly patients, where hypothermia should be avoided whenever possible. Effective warming strategies should be implemented to maintain intraoperative temperature above 36.25 °C, as this is crucial for reducing postoperative complications, including surgical site infections, seromas, and recurrence. Surgical duration and blood loss should also be carefully controlled to minimize the risk of adverse postoperative outcomes. Prolonged surgical duration and excessive blood loss have been linked to higher complication rates, making it essential to maintain these factors within an optimal range. For high-risk patients, personalized intraoperative management strategies should be employed, considering factors such as patient physiology, age, and comorbidities to optimize surgical planning and postoperative outcomes. Beyond intraoperative temperature control, comprehensive preoperative assessment is critical in reducing complications. This is particularly important for elderly patients and those with underlying conditions, where individualized anesthesia, surgical planning, and postoperative care protocols should be established to enhance recovery and minimize the risk of complications.

This study has several limitations. As a retrospective analysis, intraoperative hypothermia was not the result of deliberate intervention but rather reflected routine clinical practice, since active warming devices (e.g., Bair Hugger) were not regularly applied in general surgery at this institution due to workflow and cost constraints, particularly in shorter or lower-risk procedures. Consequently, the hypothermia group mainly represented unplanned events, which may have introduced selection bias and residual confounding. The relatively limited sample size and heterogeneity in case types may also restrict the generalizability of the findings. In addition, potential confounders such as comorbidity burden, frailty, and nutritional status were not systematically quantified. Although adjustments were made for age and sex, the absence of standardized indices such as the Charlson Comorbidity Index, frailty scales, or nutritional screening tools limited interpretability. Finally, although all operations were performed by experienced attending surgeons using standardized Lichtenstein repair, variations in surgical technique and operator experience could have influenced outcomes.

Future research should adopt large-scale, multicenter prospective designs with more comprehensive baseline assessments, incorporating comorbidities, frailty status, nutritional indicators, and surgeon-related variables to enhance robustness and generalizability. Intraoperative temperature management represents a critical area for refinement, with dynamic monitoring and precise control technologies offering potential to improve prognosis. Beyond temperature, perioperative factors such as anesthetic strategy, oxygenation, and fluid management also warrant systematic evaluation, with the aim of constructing integrated risk prediction models and advancing perioperative care for unilateral inguinal hernia repair toward greater precision and individualization.

Conclusions

This study conducted a retrospective analysis of clinical data from patients undergoing unilateral inguinal hernia repair to investigate the impact of intraoperative temperature and other surgical factors on postoperative complications and recurrence. The findings reveal that intraoperative hypothermia is closely associated with an increased risk of postoperative recurrence, while prolonged surgical duration and excessive blood loss significantly elevate the incidence of postoperative complications. Additionally, fluctuations in intraoperative temperature have a notable effect on postoperative wound infections and other complications, providing essential theoretical and data-driven support for optimizing unilateral inguinal hernia repair in clinical practice. The scientific significance of this study lies in its elucidation of the specific effects of intraoperative temperature, surgical duration, and blood loss on postoperative outcomes in unilateral inguinal hernia repair. Furthermore, it offers a novel perspective and foundation for future research on the relationship between these intraoperative factors, postoperative recurrence, and complications (Figure 5). From a clinical standpoint, optimizing intraoperative management – particularly temperature regulation – may effectively reduce postoperative complications and recurrence rates. Enhancing intraoperative temperature control could improve surgical outcomes and facilitate patient recovery.

Figure 5: Impact of intraoperative temperature, surgical duration, and blood loss on postoperative complications and recurrence following unilateral inguinal hernia repair.
Figure 5:

Impact of intraoperative temperature, surgical duration, and blood loss on postoperative complications and recurrence following unilateral inguinal hernia repair.

Corresponding author: Min Zhang, The Operating Room, The Affiliated Hospital of Southwest Medical University, No. 25, Taiping Street, Jiangyang District, 646100, Luzhou, Sichuan, Province, China, E-mail:

  1. Funding information: None.

  2. Author contribution: Xiawei Zheng contributed to data collection, statistical analysis, and drafting of the manuscript. Min Zhang conceived and designed the study, supervised data interpretation, and critically revised the manuscript for important intellectual content. Both authors approved the final version of the manuscript and agree to be accountable for all aspects of the work.

  3. Conflict of interest: The author declares no conflict of interest.

  4. Data availability statement: All data can be provided as needed.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/med-2025-1324).

Received: 2025-03-18
Accepted: 2025-10-16
Published Online: 2025-12-17

© 2025 the author(s), published by De Gruyter, Berlin/Boston

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  218. EsoFLIP-assisted dilation for dysphagia in systemic sclerosis: Highlighting the role of multimodal esophageal evaluation
  219. Molecular hydrogen-rhodiola as an adjuvant therapy for ischemic stroke in internal carotid artery occlusion: A case report
  220. Coronary artery anomalies: A case of the “malignant” left coronary artery and its surgical management
  221. Combined VAT and retroperitoneoscopy for pleural empyema due to nephro-pleuric fistula in xanthogranulomatous pyelonephritis
  222. A rare case of Opalski syndrome with a suspected multiple sclerosis etiology
  223. Newly diagnosed B-cell acute lymphoblastic leukemia demonstrating localized bone marrow infiltration exclusively in the lower extremities
  224. Rapid Communication
  225. Biological properties of valve materials using RGD and EC
  226. A single oral administration of flavanols enhances short-term memory in mice along with increased brain-derived neurotrophic factor
  227. Repeat influenza incidence across two consecutive influenza seasons
  228. Letter to the Editor
  229. Role of enhanced external counterpulsation in long COVID
  230. Expression of Concern
  231. Expression of concern “A ceRNA network mediated by LINC00475 in papillary thyroid carcinoma”
  232. Expression of concern “Notoginsenoside R1 alleviates spinal cord injury through the miR-301a/KLF7 axis to activate Wnt/β-catenin pathway”
  233. Expression of concern “circ_0020123 promotes cell proliferation and migration in lung adenocarcinoma via PDZD8”
  234. Corrigendum
  235. Corrigendum to “Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism”
  236. Corrigendum to “Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis”
  237. Corrigendum to “The progress of autoimmune hepatitis research and future challenges”
  238. Retraction
  239. Retraction of “miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway”
  240. Retraction of: “LncRNA CASC15 inhibition relieves renal fibrosis in diabetic nephropathy through downregulating SP-A by sponging to miR-424”
  241. Retraction of: “SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways”
  242. Special Issue Advancements in oncology: bridging clinical and experimental research - Part II
  243. Unveiling novel biomarkers for platinum chemoresistance in ovarian cancer
  244. Lathyrol affects the expression of AR and PSA and inhibits the malignant behavior of RCC cells
  245. The era of increasing cancer survivorship: Trends in fertility preservation, medico-legal implications, and ethical challenges
  246. Bone scintigraphy and positron emission tomography in the early diagnosis of MRONJ
  247. Meta-analysis of clinical efficacy and safety of immunotherapy combined with chemotherapy in non-small cell lung cancer
  248. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part IV
  249. Exploration of mRNA-modifying METTL3 oncogene as momentous prognostic biomarker responsible for colorectal cancer development
  250. Special Issue The evolving saga of RNAs from bench to bedside - Part III
  251. Interaction and verification of ferroptosis-related RNAs Rela and Stat3 in promoting sepsis-associated acute kidney injury
  252. The mRNA MOXD1: Link to oxidative stress and prognostic significance in gastric cancer
  253. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part II
  254. Dynamic changes in lactate-related genes in microglia and their role in immune cell interactions after ischemic stroke
  255. A prognostic model correlated with fatty acid metabolism in Ewing’s sarcoma based on bioinformatics analysis
  256. Red cell distribution width predicts early kidney injury: A NHANES cross-sectional study
  257. Special Issue Diabetes mellitus: pathophysiology, complications & treatment
  258. Nutritional risk assessment and nutritional support in children with congenital diabetes during surgery
  259. Correlation of the differential expressions of RANK, RANKL, and OPG with obesity in the elderly population in Xinjiang
  260. A discussion on the application of fluorescence micro-optical sectioning tomography in the research of cognitive dysfunction in diabetes
  261. A review of brain research on T2DM-related cognitive dysfunction
  262. Metformin and estrogen modulation in LABC with T2DM: A 36-month randomized trial
  263. Special Issue Innovative Biomarker Discovery and Precision Medicine in Cancer Diagnostics
  264. CircASH1L-mediated tumor progression in triple-negative breast cancer: PI3K/AKT pathway mechanisms
https://doi.org/10.1515/med-2025-1324
Schlagwörter für diesen Artikel
unilateral inguinal herni repair; intraoperative temperature; postoperative complications; recurrence; elderly patients
Creative Commons
BY 4.0

Artikel in diesem Heft

  1. Research Articles
  2. Network pharmacological analysis and in vitro testing of the rutin effects on triple-negative breast cancer
  3. Impact of diabetes on long-term survival in elderly liver cancer patients: A retrospective study
  4. Knockdown of CCNB1 alleviates high glucose-triggered trophoblast dysfunction during gestational diabetes via Wnt/β-catenin signaling pathway
  5. Risk factors for severe adverse drug reactions in hospitalized patients
  6. Analysis of the effect of ALA-PDT on macrophages in footpad model of mice infected with Fonsecaea monophora based on single-cell sequencing
  7. Development and validation of headspace gas chromatography with a flame ionization detector method for the determination of ethanol in the vitreous humor
  8. CMSP exerts anti-tumor effects on small cell lung cancer cells by inducing mitochondrial dysfunction and ferroptosis
  9. Predictive value of plasma sB7-H3 and YKL-40 in pediatric refractory Mycoplasma pneumoniae pneumonia
  10. Antiangiogenic potential of Elaeagnus umbellata extracts and molecular docking study by targeting VEGFR-2 pathway
  11. Comparison of the effectiveness of nurse-led preoperative counseling and postoperative follow-up care vs standard care for patients with gastric cancer
  12. Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis
  13. Adhered macrophages as an additional marker of cardiomyocyte injury in biopsies of patients with dilated cardiomyopathy
  14. Association between statin administration and outcome in patients with sepsis: A retrospective study
  15. Exploration of the association between estimated glucose disposal rate and osteoarthritis in middle-aged and older adults: An analysis of NHANES data from 2011 to 2018
  16. A comparative analysis of the binary and multiclass classified chest X-ray images of pneumonia and COVID-19 with ML and DL models
  17. Lysophosphatidic acid 2 alleviates deep vein thrombosis via protective endothelial barrier function
  18. Transcription factor A, mitochondrial promotes lymph node metastasis and lymphangiogenesis in epithelial ovarian carcinoma
  19. Serum PM20D1 levels are associated with nutritional status and inflammatory factors in gastric cancer patients undergoing early enteral nutrition
  20. Hydromorphone reduced the incidence of emergence agitation after adenotonsillectomy in children with obstructive sleep apnea: A randomized, double-blind study
  21. Vitamin D replacement therapy may regulate sleep habits in patients with restless leg syndrome
  22. The first-line antihypertensive nitrendipine potentiated the therapeutic effect of oxaliplatin by downregulating CACNA1D in colorectal cancer
  23. Health literacy and health-related quality of life: The mediating role of irrational happiness
  24. Modulatory effects of Lycium barbarum polysaccharide on bone cell dynamics in osteoporosis
  25. Mechanism research on inhibition of gastric cancer in vitro by the extract of Pinellia ternata based on network pharmacology and cellular metabolomics
  26. Examination of the causal role of immune cells in non-alcoholic fatty liver disease by a bidirectional Mendelian randomization study
  27. Clinical analysis of ten cases of HIV infection combined with acute leukemia
  28. Investigating the cardioprotective potential of quercetin against tacrolimus-induced cardiotoxicity in Wistar rats: A mechanistic insights
  29. Clinical observation of probiotics combined with mesalazine and Yiyi Baitouweng Decoction retention enema in treating mild-to-moderate ulcerative colitis
  30. Diagnostic value of ratio of blood inflammation to coagulation markers in periprosthetic joint infection
  31. Sex-specific associations of sex hormone binding globulin and risk of bladder cancer
  32. Core muscle strength and stability-oriented breathing training reduces inter-recti distance in postpartum women
  33. The ERAS nursing care strategy for patients undergoing transsphenoidal endoscopic pituitary tumor resection: A randomized blinded controlled trial
  34. The serum IL-17A levels in patients with traumatic bowel rupture post-surgery and its predictive value for patient prognosis
  35. Impact of Kolb’s experiential learning theory-based nursing on caregiver burden and psychological state of caregivers of dementia patients
  36. Analysis of serum NLR combined with intraoperative margin condition to predict the prognosis of cervical HSIL patients undergoing LEEP surgery
  37. Commiphora gileadensis ameliorate infertility and erectile dysfunction in diabetic male mice
  38. The correlation between epithelial–mesenchymal transition classification and MMP2 expression of circulating tumor cells and prognosis of advanced or metastatic nasopharyngeal carcinoma
  39. Tetrahydropalmatine improves mitochondrial function in vascular smooth muscle cells of atherosclerosis in vitro by inhibiting Ras homolog gene family A/Rho-associated protein kinase-1 signaling pathway
  40. A cross-sectional study: Relationship between serum oxidative stress levels and arteriovenous fistula maturation in maintenance dialysis patients
  41. A comparative analysis of the impact of repeated administration of flavan 3-ol on brown, subcutaneous, and visceral adipose tissue
  42. Identifying early screening factors for depression in middle-aged and older adults: A cohort study
  43. Perform tumor-specific survival analysis for Merkel cell carcinoma patients undergoing surgical resection based on the SEER database by constructing a nomogram chart
  44. Unveiling the role of CXCL10 in pancreatic cancer progression: A novel prognostic indicator
  45. High-dose preoperative intraperitoneal erythropoietin and intravenous methylprednisolone in acute traumatic spinal cord injuries following decompression surgeries
  46. RAB39B: A novel biomarker for acute myeloid leukemia identified via multi-omics and functional validation
  47. Impact of peripheral conditioning on reperfusion injury following primary percutaneous coronary intervention in diabetic and non-diabetic STEMI patients
  48. Clinical efficacy of azacitidine in the treatment of middle- and high-risk myelodysplastic syndrome in middle-aged and elderly patients: A retrospective study
  49. The effect of ambulatory blood pressure load on mitral regurgitation in continuous ambulatory peritoneal dialysis patients
  50. Expression and clinical significance of ITGA3 in breast cancer
  51. Single-nucleus RNA sequencing reveals ARHGAP28 expression of podocytes as a biomarker in human diabetic nephropathy
  52. rSIG combined with NLR in the prognostic assessment of patients with multiple injuries
  53. Toxic metals and metalloids in collagen supplements of fish and jellyfish origin: Risk assessment for daily intake
  54. Exploring causal relationship between 41 inflammatory cytokines and marginal zone lymphoma: A bidirectional Mendelian randomization study
  55. Gender beliefs and legitimization of dating violence in adolescents
  56. Effect of serum IL-6, CRP, and MMP-9 levels on the efficacy of modified preperitoneal Kugel repair in patients with inguinal hernia
  57. Effect of smoking and smoking cessation on hematological parameters in polycythemic patients
  58. Pathogen surveillance and risk factors for pulmonary infection in patients with lung cancer: A retrospective single-center study
  59. Necroptosis of hippocampal neurons in paclitaxel chemotherapy-induced cognitive impairment mediates microglial activation via TLR4/MyD88 signaling pathway
  60. Celastrol suppresses neovascularization in rat aortic vascular endothelial cells stimulated by inflammatory tenocytes via modulating the NLRP3 pathway
  61. Cord-lamina angle and foraminal diameter as key predictors of C5 palsy after anterior cervical decompression and fusion surgery
  62. GATA1: A key biomarker for predicting the prognosis of patients with diffuse large B-cell lymphoma
  63. Influencing factors of false lumen thrombosis in type B aortic dissection: A single-center retrospective study
  64. MZB1 regulates the immune microenvironment and inhibits ovarian cancer cell migration
  65. Integrating experimental and network pharmacology to explore the pharmacological mechanisms of Dioscin against glioblastoma
  66. Trends in research on preterm birth in twin pregnancy based on bibliometrics
  67. Four-week IgE/baseline IgE ratio combined with tryptase predicts clinical outcome in omalizumab-treated children with moderate-to-severe asthma
  68. Single-cell transcriptomic analysis identifies a stress response Schwann cell subtype
  69. Acute pancreatitis risk in the diagnosis and management of inflammatory bowel disease: A critical focus
  70. Effect of subclinical esketamine on NLRP3 and cognitive dysfunction in elderly ischemic stroke patients
  71. Interleukin-37 mediates the anti-oral tumor activity in oral cancer through STAT3
  72. CA199 and CEA expression levels, and minimally invasive postoperative prognosis analysis in esophageal squamous carcinoma patients
  73. Efficacy of a novel drainage catheter in the treatment of CSF leak after posterior spine surgery: A retrospective cohort study
  74. Comprehensive biomedicine assessment of Apteranthes tuberculata extracts: Phytochemical analysis and multifaceted pharmacological evaluation in animal models
  75. Relation of time in range to severity of coronary artery disease in patients with type 2 diabetes: A cross-sectional study
  76. Dopamine attenuates ethanol-induced neuronal apoptosis by stimulating electrical activity in the developing rat retina
  77. Correlation between albumin levels during the third trimester and the risk of postpartum levator ani muscle rupture
  78. Factors associated with maternal attention and distraction during breastfeeding and childcare: A cross-sectional study in the west of Iran
  79. Mechanisms of hesperetin in treating metabolic dysfunction-associated steatosis liver disease via network pharmacology and in vitro experiments
  80. The law on oncological oblivion in the Italian and European context: How to best uphold the cancer patients’ rights to privacy and self-determination?
  81. The prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and prognostic nutritional index for survival in patients with colorectal cancer
  82. Factors affecting the measurements of peripheral oxygen saturation values in healthy young adults
  83. Comparison and correlations between findings of hysteroscopy and vaginal color Doppler ultrasonography for detection of uterine abnormalities in patients with recurrent implantation failure
  84. The effects of different types of RAGT on balance function in stroke patients with low levels of independent walking in a convalescent rehabilitation hospital
  85. Causal relationship between asthma and ankylosing spondylitis: A bidirectional two-sample univariable and multivariable Mendelian randomization study
  86. Correlations of health literacy with individuals’ understanding and use of medications in Southern Taiwan
  87. Correlation of serum calprotectin with outcome of acute cerebral infarction
  88. Comparison of computed tomography and guided bronchoscopy in the diagnosis of pulmonary nodules: A systematic review and meta-analysis
  89. Curdione protects vascular endothelial cells and atherosclerosis via the regulation of DNMT1-mediated ERBB4 promoter methylation
  90. The identification of novel missense variant in ChAT gene in a patient with gestational diabetes denotes plausible genetic association
  91. Molecular genotyping of multi-system rare blood types in foreign blood donors based on DNA sequencing and its clinical significance
  92. Exploring the role of succinyl carnitine in the association between CD39⁺ CD4⁺ T cell and ulcerative colitis: A Mendelian randomization study
  93. Dexmedetomidine suppresses microglial activation in postoperative cognitive dysfunction via the mmu-miRNA-125/TRAF6 signaling axis
  94. Analysis of serum metabolomics in patients with different types of chronic heart failure
  95. Diagnostic value of hematological parameters in the early diagnosis of acute cholecystitis
  96. Pachymaran alleviates fat accumulation, hepatocyte degeneration, and injury in mice with nonalcoholic fatty liver disease
  97. Decrease in CD4 and CD8 lymphocytes are predictors of severe clinical picture and unfavorable outcome of the disease in patients with COVID-19
  98. METTL3 blocked the progression of diabetic retinopathy through m6A-modified SOX2
  99. The predictive significance of anti-RO-52 antibody in patients with interstitial pneumonia after treatment of malignant tumors
  100. Exploring cerebrospinal fluid metabolites, cognitive function, and brain atrophy: Insights from Mendelian randomization
  101. Development and validation of potential molecular subtypes and signatures of ocular sarcoidosis based on autophagy-related gene analysis
  102. Widespread venous thrombosis: Unveiling a complex case of Behçet’s disease with a literature perspective
  103. Uterine fibroid embolization: An analysis of clinical outcomes and impact on patients’ quality of life
  104. Discovery of lipid metabolism-related diagnostic biomarkers and construction of diagnostic model in steroid-induced osteonecrosis of femoral head
  105. Serum-derived exomiR-188-3p is a promising novel biomarker for early-stage ovarian cancer
  106. Enhancing chronic back pain management: A comparative study of ultrasound–MRI fusion guidance for paravertebral nerve block
  107. Peptide CCAT1-70aa promotes hepatocellular carcinoma proliferation and invasion via the MAPK/ERK pathway
  108. Electroacupuncture-induced reduction of myocardial ischemia–reperfusion injury via FTO-dependent m6A methylation modulation
  109. Hemorrhoids and cardiovascular disease: A bidirectional Mendelian randomization study
  110. Cell-free adipose extract inhibits hypertrophic scar formation through collagen remodeling and antiangiogenesis
  111. HALP score in Demodex blepharitis: A case–control study
  112. Assessment of SOX2 performance as a marker for circulating cancer stem-like cells (CCSCs) identification in advanced breast cancer patients using CytoTrack system
  113. Risk and prognosis for brain metastasis in primary metastatic cervical cancer patients: A population-based study
  114. Comparison of the two intestinal anastomosis methods in pediatric patients
  115. Factors influencing hematological toxicity and adverse effects of perioperative hyperthermic intraperitoneal vs intraperitoneal chemotherapy in gastrointestinal cancer
  116. Endotoxin tolerance inhibits NLRP3 inflammasome activation in macrophages of septic mice by restoring autophagic flux through TRIM26
  117. Lateral transperitoneal laparoscopic adrenalectomy: A single-centre experience of 21 procedures
  118. Petunidin attenuates lipopolysaccharide-induced retinal microglia inflammatory response in diabetic retinopathy by targeting OGT/NF-κB/LCN2 axis
  119. Procalcitonin and C-reactive protein as biomarkers for diagnosing and assessing the severity of acute cholecystitis
  120. Factors determining the number of sessions in successful extracorporeal shock wave lithotripsy patients
  121. Development of a nomogram for predicting cancer-specific survival in patients with renal pelvic cancer following surgery
  122. Inhibition of ATG7 promotes orthodontic tooth movement by regulating the RANKL/OPG ratio under compression force
  123. A machine learning-based prognostic model integrating mRNA stemness index, hypoxia, and glycolysis‑related biomarkers for colorectal cancer
  124. Glutathione attenuates sepsis-associated encephalopathy via dual modulation of NF-κB and PKA/CREB pathways
  125. FAHD1 prevents neuronal ferroptosis by modulating R-loop and the cGAS–STING pathway
  126. Association of placenta weight and morphology with term low birth weight: A case–control study
  127. Investigation of the pathogenic variants induced Sjogren’s syndrome in Turkish population
  128. Nucleotide metabolic abnormalities in post-COVID-19 condition and type 2 diabetes mellitus patients and their association with endocrine dysfunction
  129. TGF-β–Smad2/3 signaling in high-altitude pulmonary hypertension in rats: Role and mechanisms via macrophage M2 polarization
  130. Ultrasound-guided unilateral versus bilateral erector spinae plane block for postoperative analgesia of patients undergoing laparoscopic cholecystectomy
  131. Profiling gut microbiome dynamics in subacute thyroiditis: Implications for pathogenesis, diagnosis, and treatment
  132. Delta neutrophil index, CRP/albumin ratio, procalcitonin, immature granulocytes, and HALP score in acute appendicitis: Best performing biomarker?
  133. Anticancer activity mechanism of novelly synthesized and characterized benzofuran ring-linked 3-nitrophenyl chalcone derivative on colon cancer cells
  134. H2valdien3 arrests the cell cycle and induces apoptosis of gastric cancer
  135. Prognostic relevance of PRSS2 and its immune correlates in papillary thyroid carcinoma
  136. Association of SGLT2 inhibition with psychiatric disorders: A Mendelian randomization study
  137. Motivational interviewing for alcohol use reduction in Thai patients
  138. Luteolin alleviates oxygen-glucose deprivation/reoxygenation-induced neuron injury by regulating NLRP3/IL-1β signaling
  139. Polyphyllin II inhibits thyroid cancer cell growth by simultaneously inhibiting glycolysis and oxidative phosphorylation
  140. Relationship between the expression of copper death promoting factor SLC31A1 in papillary thyroid carcinoma and clinicopathological indicators and prognosis
  141. CSF2 polarized neutrophils and invaded renal cancer cells in vitro influence
  142. Proton pump inhibitors-induced thrombocytopenia: A systematic literature analysis of case reports
  143. The current status and influence factors of research ability among community nurses: A sequential qualitative–quantitative study
  144. OKAIN: A comprehensive oncology knowledge base for the interpretation of clinically actionable alterations
  145. The relationship between serum CA50, CA242, and SAA levels and clinical pathological characteristics and prognosis in patients with pancreatic cancer
  146. Identification and external validation of a prognostic signature based on hypoxia–glycolysis-related genes for kidney renal clear cell carcinoma
  147. Engineered RBC-derived nanovesicles functionalized with tumor-targeting ligands: A comparative study on breast cancer targeting efficiency and biocompatibility
  148. Relationship of resting echocardiography combined with serum micronutrients to the severity of low-gradient severe aortic stenosis
  149. Effect of vibration on pain during subcutaneous heparin injection: A randomized, single-blind, placebo-controlled trial
  150. The diagnostic performance of machine learning-based FFRCT for coronary artery disease: A meta-analysis
  151. Comparing biofeedback device vs diaphragmatic breathing for bloating relief: A randomized controlled trial
  152. Serum uric acid to albumin ratio and C-reactive protein as predictive biomarkers for chronic total occlusion and coronary collateral circulation quality
  153. Multiple organ scoring systems for predicting in-hospital mortality of sepsis patients in the intensive care unit
  154. Single-cell RNA sequencing data analysis of the inner ear in gentamicin-treated mice via intraperitoneal injection
  155. Suppression of cathepsin B attenuates myocardial injury via limiting cardiomyocyte apoptosis
  156. Influence of sevoflurane combined with propofol anesthesia on the anesthesia effect and adverse reactions in children with acute appendicitis
  157. Identification of hub genes related to acute kidney injury caused by sevoflurane anesthesia and endoplasmic reticulum stress
  158. Efficacy and safety of PD-1/PD-L1 inhibitors in pancreatic ductal adenocarcinoma: a systematic review and Meta-analysis of randomized controlled trials
  159. The value of diagnostic experience in O-RADS MRI score for ovarian-adnexal lesions
  160. Health education pathway for individuals with temporary enterostomies using patient journey mapping
  161. Serum TLR8 as a potential diagnostic biomarker of coronary heart disease
  162. Intraoperative temperature management and its effect on surgical outcomes in elderly patients undergoing lichtenstein unilateral inguinal hernia repair
  163. Immunohistochemical profiling and neuroepithelial heterogeneity in immature ovarian teratomas: a retrospective digital pathology-based study
  164. Associated risk factors and prevalence of human papillomavirus infection among females visiting tertiary care hospital: a cross-sectional study from Nepal
  165. Comparative evaluation of various disc elution methods for the detection of colistin-resistant gram-negative bacteria
  166. Effect of timing of cholecystectomy on weight loss after sleeve gastrectomy in morbidly obese individuals with cholelithiasis: a retrospective cohort study
  167. Causal association between ceramide levels and central precocious puberty: a mendelian randomization study
  168. Novel predictive model for colorectal liver metastases recurrence: a radiomics and clinical data approach
  169. Relationship between resident physicians’ perceived professional value and exposure to violence
  170. Multiple sclerosis and type 1 diabetes: a Mendelian randomization study of European ancestry
  171. Rapid pathogen identification in peritoneal dialysis effluent by MALDI-TOF MS following blood culture enrichment
  172. Comparison of open and percutaneous A1 pulley release in pediatric trigger thumb: a retrospective cohort study
  173. Impact of combined diaphragm-lung ultrasound assessment on postoperative respiratory function in patients under general anesthesia recovery
  174. Development and internal validation of a nomogram for predicting short-term prognosis in ICU patients with acute pyelonephritis
  175. The association between hypoxic burden and blood pressure in patients with obstructive sleep apnea
  176. Promotion of asthenozoospermia by C9orf72 through suppression of spermatogonia activity via fructose metabolism and mitophagy
  177. Review Articles
  178. The effects of enhanced external counter-pulsation on post-acute sequelae of COVID-19: A narrative review
  179. Diabetes-related cognitive impairment: Mechanisms, symptoms, and treatments
  180. Microscopic changes and gross morphology of placenta in women affected by gestational diabetes mellitus in dietary treatment: A systematic review
  181. Review of mechanisms and frontier applications in IL-17A-induced hypertension
  182. Research progress on the correlation between islet amyloid peptides and type 2 diabetes mellitus
  183. The safety and efficacy of BCG combined with mitomycin C compared with BCG monotherapy in patients with non-muscle-invasive bladder cancer: A systematic review and meta-analysis
  184. The application of augmented reality in robotic general surgery: A mini-review
  185. The effect of Greek mountain tea extract and wheat germ extract on peripheral blood flow and eicosanoid metabolism in mammals
  186. Neurogasobiology of migraine: Carbon monoxide, hydrogen sulfide, and nitric oxide as emerging pathophysiological trinacrium relevant to nociception regulation
  187. Plant polyphenols, terpenes, and terpenoids in oral health
  188. Laboratory medicine between technological innovation, rights safeguarding, and patient safety: A bioethical perspective
  189. End-of-life in cancer patients: Medicolegal implications and ethical challenges in Europe
  190. The maternal factors during pregnancy for intrauterine growth retardation: An umbrella review
  191. Intra-abdominal hypertension/abdominal compartment syndrome of pediatric patients in critical care settings
  192. PI3K/Akt pathway and neuroinflammation in sepsis-associated encephalopathy
  193. Screening of Group B Streptococcus in pregnancy: A systematic review for the laboratory detection
  194. Giant borderline ovarian tumours – review of the literature
  195. Leveraging artificial intelligence for collaborative care planning: Innovations and impacts in shared decision-making – A systematic review
  196. Cholera epidemiology analysis through the experience of the 1973 Naples epidemic
  197. Risk factors of frailty/sarcopenia in community older adults: Meta-analysis
  198. Supplement strategies for infertility in overweight women: Evidence and legal insights
  199. Scurvy, a not obsolete disorder: Clinical report in eight young children and literature review
  200. A meta-analysis of the effects of DBS on cognitive function in patients with advanced PD
  201. Protective role of selenium in sepsis: Mechanisms and potential therapeutic strategies
  202. Strategies for hyperkalemia management in dialysis patients: A systematic review
  203. C-reactive protein-to-albumin ratio in peripheral artery disease
  204. Research progress on autophagy and its roles in sepsis induced organ injury
  205. Neuronutrition in autism spectrum disorders
  206. Pumilio 2 in neural development, function, and specific neurological disorders
  207. Antibiotic prescribing patterns in general dental practice- a scoping review
  208. Clinical and medico-legal reflections on non-invasive prenatal testing
  209. Smartphone use and back pain: a narrative review of postural pathologies
  210. Targeting endothelial oxidative stress in hypertension
  211. Exploring links between acne and metabolic syndrome: a narrative review
  212. Case Reports
  213. Delayed graft function after renal transplantation
  214. Semaglutide treatment for type 2 diabetes in a patient with chronic myeloid leukemia: A case report and review of the literature
  215. Diverse electrophysiological demyelinating features in a late-onset glycogen storage disease type IIIa case
  216. Giant right atrial hemangioma presenting with ascites: A case report
  217. Laser excision of a large granular cell tumor of the vocal cord with subglottic extension: A case report
  218. EsoFLIP-assisted dilation for dysphagia in systemic sclerosis: Highlighting the role of multimodal esophageal evaluation
  219. Molecular hydrogen-rhodiola as an adjuvant therapy for ischemic stroke in internal carotid artery occlusion: A case report
  220. Coronary artery anomalies: A case of the “malignant” left coronary artery and its surgical management
  221. Combined VAT and retroperitoneoscopy for pleural empyema due to nephro-pleuric fistula in xanthogranulomatous pyelonephritis
  222. A rare case of Opalski syndrome with a suspected multiple sclerosis etiology
  223. Newly diagnosed B-cell acute lymphoblastic leukemia demonstrating localized bone marrow infiltration exclusively in the lower extremities
  224. Rapid Communication
  225. Biological properties of valve materials using RGD and EC
  226. A single oral administration of flavanols enhances short-term memory in mice along with increased brain-derived neurotrophic factor
  227. Repeat influenza incidence across two consecutive influenza seasons
  228. Letter to the Editor
  229. Role of enhanced external counterpulsation in long COVID
  230. Expression of Concern
  231. Expression of concern “A ceRNA network mediated by LINC00475 in papillary thyroid carcinoma”
  232. Expression of concern “Notoginsenoside R1 alleviates spinal cord injury through the miR-301a/KLF7 axis to activate Wnt/β-catenin pathway”
  233. Expression of concern “circ_0020123 promotes cell proliferation and migration in lung adenocarcinoma via PDZD8”
  234. Corrigendum
  235. Corrigendum to “Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism”
  236. Corrigendum to “Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis”
  237. Corrigendum to “The progress of autoimmune hepatitis research and future challenges”
  238. Retraction
  239. Retraction of “miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway”
  240. Retraction of: “LncRNA CASC15 inhibition relieves renal fibrosis in diabetic nephropathy through downregulating SP-A by sponging to miR-424”
  241. Retraction of: “SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways”
  242. Special Issue Advancements in oncology: bridging clinical and experimental research - Part II
  243. Unveiling novel biomarkers for platinum chemoresistance in ovarian cancer
  244. Lathyrol affects the expression of AR and PSA and inhibits the malignant behavior of RCC cells
  245. The era of increasing cancer survivorship: Trends in fertility preservation, medico-legal implications, and ethical challenges
  246. Bone scintigraphy and positron emission tomography in the early diagnosis of MRONJ
  247. Meta-analysis of clinical efficacy and safety of immunotherapy combined with chemotherapy in non-small cell lung cancer
  248. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part IV
  249. Exploration of mRNA-modifying METTL3 oncogene as momentous prognostic biomarker responsible for colorectal cancer development
  250. Special Issue The evolving saga of RNAs from bench to bedside - Part III
  251. Interaction and verification of ferroptosis-related RNAs Rela and Stat3 in promoting sepsis-associated acute kidney injury
  252. The mRNA MOXD1: Link to oxidative stress and prognostic significance in gastric cancer
  253. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part II
  254. Dynamic changes in lactate-related genes in microglia and their role in immune cell interactions after ischemic stroke
  255. A prognostic model correlated with fatty acid metabolism in Ewing’s sarcoma based on bioinformatics analysis
  256. Red cell distribution width predicts early kidney injury: A NHANES cross-sectional study
  257. Special Issue Diabetes mellitus: pathophysiology, complications & treatment
  258. Nutritional risk assessment and nutritional support in children with congenital diabetes during surgery
  259. Correlation of the differential expressions of RANK, RANKL, and OPG with obesity in the elderly population in Xinjiang
  260. A discussion on the application of fluorescence micro-optical sectioning tomography in the research of cognitive dysfunction in diabetes
  261. A review of brain research on T2DM-related cognitive dysfunction
  262. Metformin and estrogen modulation in LABC with T2DM: A 36-month randomized trial
  263. Special Issue Innovative Biomarker Discovery and Precision Medicine in Cancer Diagnostics
  264. CircASH1L-mediated tumor progression in triple-negative breast cancer: PI3K/AKT pathway mechanisms
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Heruntergeladen am 4.2.2026 von https://www.degruyterbrill.com/document/doi/10.1515/med-2025-1324/html
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