Frontiers in Surgery最新文献

Objective: Asian females with ovarian cancer have different clinicopathological characteristics compared with other races. However, an effective prognostic prediction tool is lacking. The goal of our study was to develop and evaluate nomograms for estimating overall survival and cancer-specific survival in Asian patients with ovarian cancer.

Methods: We extracted data from 2010 to 2018 in the Surveillance, Epidemiology, and End Results database, focusing on Asian/Pacific Islander females that had been diagnosed with epithelial ovarian cancer. To find prognostic factors, least absolute shrinkage and selection operator Cox regression and multivariate Cox regression analyses were used. Based on the outcomes, nomograms were then constructed. Numerous techniques, such as the C-index, calibration plots, decision curve analysis, and risk subgroup stratification, were used to assess the performance of the nomograms.

Results: Nomograms were created to evaluate overall survival and cancer-specific survival rates over three and five years. The C-indices for overall survival and cancer-specific survival in the training cohort were 0.768 and 0.778, respectively. The C-indices for overall survival and cancer-specific survival in the validation cohort were 0.804 and 0.812, respectively. The calibration plots showed that the nomogram forecasts and actual survival results agreed. Additionally, the decision curve analysis curves indicated that the nomogram outperformed the American Joint Commission on Cancer staging system in terms of predictive accuracy.

Conclusion: Nomograms and a risk classification system were created to forecast the overall survival and cancer-specific survival of Asian females with ovarian cancer. The nomograms and risk stratification system have the potential to provide valuable assistance in making future clinical decisions.

Background: Open surgery is the treatment of choice for verrucous venous malformation (VVM) and capillary arteriovenous malformation (CAVM) with overgrowth. The study aimed to report an innovative endoscopic resection technique for subcutaneous vascular malformations with superficial lesions at our center.

Methods: We retrospectively reviewed the medical records of patients who underwent endoscopic resection for VVM or CAVM between September 2019 and July 2024.

Results: The current cohort includes 14 female and 4 male patients, with ages ranging from 1 year to 8 years. Diagnoses included classic VVM (n = 10), VVM-subcutaneous variant (n = 4), and CAVM (n = 4). Endoscopic surgery uses two or more small ports in a gas-inflated manner. Surgery included radical resection, partial resection of the subcutaneous mass, and debulking of adipose overgrowth. Technical success was achieved in all patients. Local skin necrosis (area <1 cm²) occurred in two patients. No recurrence was observed during follow-up.

Conclusion: Endoscopic resection is a minimally invasive, feasible, and safe technique for VVMs in selected CAVM. Better cosmetic results can be expected in patients with superficial lesions using this endoscopic surgical technique.

Talar fractures represent less than 1% of all fractures, and combined fractures involving the posteromedial and posterolateral talar processes along with a lateral process fracture are exceptionally rare. These fractures are considered severe injuries that may lead to prolonged disability and persistent pain. The intricate anatomical configuration and the proximity of nerves and blood vessels surrounding the talus present substantial challenges in the management of posterior talar process fractures. Surgical procedures in this area are rare, and inadequate treatment may lead to significant discomfort and limitations in daily functioning for patients. In this case report, we describe a 45-year-old male who experienced a fall from a 2-meter height, leading to persistent right ankle swelling for 6 days. Radiographs, CT scans, and 3D-CT reconstructions identified fractures involving the posteromedial and posterolateral talar processes, as well as an avulsion fracture at the calcaneofibular ligament attachment site. To the best of our knowledge, there are no previously documented reports of this combined injury. We conducted arthroscopically assisted reduction and internal fixation through a posterior approach utilizing Herbert screw. The patient underwent a 4-year postoperative follow-up, during which favorable fracture healing was observed. The objective of this report is to demonstrate that arthroscopy offers a well-defined surgical field, aids in reduction and internal fixation, and to suggest a novel treatment approach for this uncommon fracture pattern.

Objective: To compare the safety and efficacy of four different surgical approaches for the treatment of complex non-hydronephrotic renal stones.

Methods: A total of 88 patients with complex non-hydronephrotic renal stones, who underwent surgical treatment at Xiangtan Central Hospital from January 2022 to December 2023, were included in this study. The patients were divided into two groups based on their CT values. Group 1 (CT ≥ 1,000) included 22 patients who underwent puncture-assisted single standard percutaneous nephrolithotomy (PCNL) with a laser for stone fragmentation and retrieval (experimental group), and 12 patients who underwent multi-standard percutaneous nephrolithotomy (control group). Group 2 (CT < 1,000) included 21 patients who underwent puncture-assisted single standard PCNL combined with ureteroscopic laser lithotripsy (experimental group), and 33 patients who underwent transurethral ureteroscopic laser lithotripsy (control group). The surgical variables including intraoperative blood loss, operative time, hospital stay, stone clearance rate, and postoperative complications were recorded. Statistical analysis was performed using chi-square test or Fisher's exact test for categorical data, and t-test for continuous data.

Results: The two groups were comparable in terms of age, sex, BMI, hypertension, coronary heart disease, diabetes, and preoperative white blood cell count (P > 0.01). In both CT ≥ 1,000 and CT < 1,000 groups, the experimental group had significantly less intraoperative blood loss, shorter operative time, and shorter hospital stay compared to the control group (P < 0.01). In the CT ≥ 1,000 control group, the stone clearance rate was higher, and two cases of postoperative bleeding (considered arteriovenous fistula) were managed with interventional embolization. In the CT < 1,000 control group, the stone clearance rate was lower, and three cases of postoperative fever (with a maximum temperature of 39.5°C) required an extended antibiotic course for 7 days before discharge.

Conclusion: For complex non-hydronephrotic renal stones, a CT value ≥ 1,000 should be treated with single standard PCNL using a puncture-assisted method; a CT value < 1,000 is better treated with a combination of puncture-assisted single standard PCNL and ureteroscopic laser lithotripsy, with higher safety and efficacy.

This study aims on establishing and validate a deep learning signature based on magnetic resonance imaging (MRI) to predict postoperative anxiety in patients receiving lung cancer surgery. In the current study, 202 patients receiving lung cancer surgery were included. Preoperative MRI-T1WI images were collected to train the deep learning signature utilized the ResNet-152 algorithm. The relationships between clinical variables and postoperative anxiety were explored via Logistic regression and the predictive performances of the developed deep learning signature were evaluated via receiver operating characteristic analysis. Larger tumor size [odds ratio (OR), 2.044; 95% confidence interval (CI), 1.736-3.276; p = 0.002] and occurrence of lymph node metastasis (OR, 2.078; 95% CI, 1.023-3.221; p = 0.043) were revealed as independent predictors for postoperative anxiety. With the increase of deep learning scores, more patients experiencing postoperative anxiety were identified. Moreover, our deep learning signature yielded areas under the curve of 0.865 (95% CI, 0.800-0.930) and 0.822 (95% CI, 0.695-0.950) to predict postoperative anxiety. Therefore, our deep learning signature could help identify lung cancer patients with high risks of postoperative anxiety.

Introduction: The minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) technique has become a popular and effective option for treating lumbar degenerative spondylolisthesis, especially in elderly patients. This systematic review and meta-analysis is to evaluate the long-term results of MIS-TLIF for patients with degenerative spondylolisthesis.

Methods: We thoroughly reviewed and analyzed studies from databases like PubMed, Web of Science, Scopus, and Google Scholar, covering research published from 2015-2024. We used random-effects models to estimate overall prevalence, and we conducted sensitivity analyses and assessed publication bias to understand the variability in results. All analyses were done using the "meta" and "metafor" packages in RStudio.

Results: According to the random-effects model, the pooled standardized mean difference of the VAS back score dynamics at 12 months post-operative in geriatric MIS-TLIF patients was -4.30, 95% CI [-10.02; 1.42]; the VAS leg pain score dynamics at 12 months post-operative was -2.46, 95% CI [-5.61; 0.68]; the ODI score dynamics at 12 months post-operative was -3.01, 95% CI [-6.02; -0.01]. The VAS back pain score dynamics at 24 months post-operative was -1.77, 95% CI [-2.33; -1.21]; the VAS leg pain score dynamics at 24 months post-operative was -2.29, 95% CI [-3.22; -1.37]; and the ODI score dynamics at 24 months post-operative was -1.92, 95% CI [-2.57; -1.27].

Conclusion: Our study provides compelling evidence supporting the long-term efficacy of MIS-TLIF for managing lumbar spondylolisthesis in geriatric patients. The findings suggest that MIS-TLIF is associated with significant reductions in back and leg pain, as well as improvements in disability scores over 12 months post-operatively. However, these improvements in pain and functional disability decline at 24 months postoperatively, which could be explained by the physiological nature of degenerative changes in the geriatric population.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024538220, PROSPERO (CRD42024538220).

Background: Long bone fractures, especially in the lower limbs, are highly prevalent in orthopedic practice. These fractures can significantly impair patients' mobility and quality of life. Intramedullary nails are a mainstay treatment, offering reliable fracture fixation. However, the addition of blocking screws has introduced an element of uncertainty regarding surgical outcomes. This meta-analysis evaluated the efficacy and complications of blocking screw fixation for lower limb long bone fractures (LLLBF).

Methods: A comprehensive and systematic search was conducted across eight databases, namely the Cochrane Library, PubMed, EMbase, Web of Science, CNKI, China Biomedical Literature Database (CBM), VIP, and WanFang, to identify relevant controlled trials. Before data analysis, the quality of each study was rigorously assessed. Subsequently, the data were analyzed using the Review Manager 5.3 (RevMan 5.3) software to ensure a reliable and accurate synthesis of the evidence.

Results: A total of 15 studies were incorporated into the analysis. Compared with the control group, the experimental group demonstrated a significantly shorter fracture healing time (standardized mean difference, SMD = -2.18; 95% confidence interval, CI: -3.17 to -1.20; P < 0.001), suggesting a substantial effect in favor of the intervention. Additionally, the experimental group had a longer operation time (SMD = 15.81, 95% CI: 4.28, 27.34, P = 0.007), less intraoperative bleeding (SMD = -75.60, 95% CI: -127.93, -23.27, P = 0.005), and fewer complications (odds ratio, OR = 0.51, 95% CI: 0.31, 0.84, P = 0.008). However, no significant difference was observed in the fracture healing rates between the two groups (OR = 1.09, 95% CI: 0.98, 1.20, P = 0.098).

Conclusion: The findings of this study suggest that the use of intramedullary nails in conjunction with blocking screws could potentially be an effective treatment option for patients with lower limb long bone fractures. However, to confirm this efficacy, additional high - quality research, preferably well-designed randomized controlled trials with large sample sizes and long-term follow - up, is warranted.

Background: Functional training after total knee arthroplasty (TKA) is of great significance for the recovery of knee function. However, the utility of applying an effective training modality, closed-chain isokinetic plyometric training, on top of the drug palonosetron, which is used to prevent nausea and vomiting, is unclear.

Objective: To investigate the effect of closed-chain isokinetic plyometric training combined with palonosetron-on-postoperative-knee-function in patients with TKA, aiming to provide an effective rehabilitation program for patients with TKA.

Methods: The results of the intervention were compared in 47 TKA patients who received closed-chain isokinetic plyometric training combined with palonosetron with 47 TKA patients who received conventional plyometric training combined with palonosetron. Knee function was evaluated using the Hospital for Specialty Surgery Knee (HSS), quadriceps muscle strength was assessed using real-time isometric plyometric testing with the BIODEX-sYs-tem 4-type system, walking ability was evaluated using the Timed Up-and-Go Test (TUGT), and proprioception was determined using the Biodex System 4-type multi-joint isometric system.

Results: After-the intervention,-the-HSS scores-of-the-experimental-group-were-higher-than-those-of-the-control-group-(P < 0.05); the peak moment values of the quadriceps (PT), the total quadriceps work values (STW), and the average power of the quadriceps (AP) were higher than those of the control group (P < 0.05); and the values of the reproduced deviation of the knee joint active joint angle and the TUGT time were lower than those of the control group (P < 0.05).

Conclusion: Closed-chain isokinetic plyometric training combined with palonosetron can strengthen their muscle strength and improve proprioception, which effectively promotes the recovery of postoperative knee function and walking ability in TKA patients.

Aneurysms of a persistent trigeminal artery (PTA) are exceptionally uncommon, and their rupture leading to a carotid-cavernous fistula (CCF) is even more extraordinary. The contemporary management of CCF predominantly revolves around endovascular approaches, with a variety of techniques such as detachable balloons or coils, coil embolization augmented with Onyx adhesive, and stent grafting. Herein, we report a successful intervention in a patient with a CCF instigated by a ruptured PTA aneurysm, employing a combination of detachable coils and endovascular electrothrombosis, yielding favorable outcomes.