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Editorial: Advances in surgical management of abdominal and retroperitoneal sarcoma: where do we stand, and where do we go? 社论:腹部和腹膜后肉瘤手术治疗的进展:现状与未来?
IF 1.6 4区 医学 Q2 SURGERY Pub Date : 2024-09-13 eCollection Date: 2024-01-01 DOI: 10.3389/fsurg.2024.1488404
Luit Penninga, Louise Preisler, Jens Georg Hillingsø
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引用次数: 0
Robotic thoracic surgery: lessons learned from the first 1,000 procedures 机器人胸腔手术:从最初的 1,000 例手术中汲取的经验教训
IF 1.8 4区 医学 Q2 SURGERY Pub Date : 2024-09-12 DOI: 10.3389/fsurg.2024.1417787
Marion Durand, Lee S. Nguyen, Frankie Mbadinga, Maksim Pryshchepau, Hadrien Portefaix, Nouha Chaabane, Stanislas Ropert, Naziha Khen-Dunlop
IntroductionThe aim of this study was to evaluate the impact of the thoracic robotic approach in a high-volume center regarding procedures and clinical outcomes after 1,000 procedures.MethodsIn a single-center subset of the Epithor® database, a prospective cohort database of French thoracic surgery, we analyzed procedural characteristics and clinical outcomes from February 2014 to April 2023. A surgical technique for lung surgery was conducted with a four-arm closed chest with the port access approach and vascular sewing and knotting were preferred over stapling. Statistical analysis was performed using the Chi-2 test for discontinuous variables and the Mann–Whitney–Wilcoxon test for continuous variables. Tests were considered significant for a p-value <0.05.ResultsRobotic thoracic surgery was used in anatomical lung resection in 85% of the cases. Over the study period, 1,067 patients underwent robotic surgery, of which 509 had lobectomies and 391 segmentectomies. In the segmentectomy group vs. lobectomy group we observed a shorter length of stay (9 ± 7 vs. 7 ± 5.6 days, p < 0.001), a shorter surgery time (99 ± 24 vs. 116 ± 38 min, p < 0.001) a lower conversion rate (n = 2 vs. n = 17, p = 0.004), and a lower complication rate (28% vs. 40%, p = 0.009, mainly Clavien–Dindo II, 18% and 28%, respectively). For cancer treatment surgery, we found more previous cancer in the segmentectomy group (48% vs. 26%, p < 0.001). We also observed a progressive change of lobectomy vs. segmentectomy from 80%/20% to 30%/70% over the 9 years.DiscussionA robotic platform is an appropriate tool to perform anatomical lung resection and especially to develop a safe and systematic approach to lung-sparing sub-lobar resection.
方法在法国胸外科前瞻性队列数据库 Epithor® 数据库的单中心子集中,我们分析了 2014 年 2 月至 2023 年 4 月期间的手术特征和临床结果。肺部手术采用四臂胸腔闭合式手术技术,采用端口入路,血管缝合和打结优于缝合。对不连续变量采用Chi-2检验,对连续变量采用Mann-Whitney-Wilcoxon检验进行统计分析。P值为<0.05的检验被认为是有意义的。结果85%的病例在解剖肺切除术中使用了机器人胸腔镜手术。在研究期间,1,067 名患者接受了机器人手术,其中 509 人进行了肺叶切除术,391 人进行了肺段切除术。在分段切除术组与肺叶切除术组中,我们观察到住院时间更短(9±7天 vs. 7±5.6天,pamp &;lt;0.001),手术时间更短(99±24分钟 vs. 116±38分钟,pamp &;lt;0.001),转换率更低(n = 2 vs. n = 17,p = 0.004),并发症发生率更低(28% vs. 40%,p = 0.009,主要是Clavien-Dindo II,分别为18%和28%)。在癌症治疗手术方面,我们发现分段切除术组的既往癌症发生率更高(48% 对 26%,p < 0.001)。讨论机器人平台是进行肺部解剖切除术的合适工具,尤其适用于开发安全、系统的保肺肺叶下切除术。
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引用次数: 0
Special contoured pelvic brim reconstruction titanium plate combined with trans-plate buttress screws (quadrilateral screws) for acetabular fractures with quadrilateral plate involvement through the anterior ilioinguinal approach 通过髂腹股沟前入路,将特殊轮廓骨盆边缘重建钛钢板与经钢板支撑螺钉(四边形螺钉)相结合,用于治疗四边形钢板受累的髋臼骨折
IF 1.8 4区 医学 Q2 SURGERY Pub Date : 2024-09-12 DOI: 10.3389/fsurg.2024.1438036
Wei Wang, Xianhua Cai, Ximing Liu, Guodong Wang, Hui Kang, Shenglong Qian
BackgroundManaging complicated acetabular fractures involving the quadrilateral plate (QLP) can be challenging for surgeons, especially when complicated by comminution and osteoporosis. Traditional implants do not provide sufficient fixed strength or a proper match. The new-type pre-contoured infrapectineal buttress plates may have drawbacks, such as inaccurate fitting on the medial surface of QLP and an inability to apply reversed compression force to resist medial displacement of femoral head. Therefore, the primary purpose of this study is to introduce a novel technique that utilizes a special contoured pelvic brim reconstruction titanium plate combined with quadrilateral screws to reduce and stabilize acetabular fractures involving the QLP through the ilioinguinal approach. Additionally, the secondary purpose is to evaluate both clinical effectiveness and radiological outcomes of this technique for QLP fractures.MethodsWe conducted a retrospective analysis of prospectively collected data from 48 patients (31 males and 17 females) who suffered from acute displaced fractures of the QLP and were treated between January 2012 and December 2019 using a special contoured plate combined with quadrilateral screws. The patients' mean age was 47.56 ± 11.31 years (range: 19–73 years). Fracture patterns included 20 both-column fractures, 12 anterior column and posterior hemitransverse fractures, eight T-type fractures, five transverse fractures and three anterior column fractures with the QLP affected, all of which had femoral head protrusion. Immediate postoperative reduction quality was evaluated according to Matta's criteria. Final clinical functions were assessed during follow-up using the modified Merle d’Aubigné and Harris Hip scores (HHS).ResultsThe patients were followed up for an average of 48.36 ± 12.94 months (ranging from 24 to 84 months). The mean operative time was 246.08 ± 54.30 min (ranging from 178 to 397 min), and the average blood loss was 715.16 ± 263.84 ml (ranging from 400 to 2000ml). The radiological grading at postoperative stage showed anatomical reduction in 30 patients (62.50%), satisfactory reduction in 14 patients (29.17%), and poor reduction in four patients (8.33%). At the final follow-up, no re-protrusion of the femoral head was observed. In terms of functional outcome, the mean modified Merle d’Aubigné-Postel score was excellent in 26 patients (54.17%), good in 17 patients (35.42%), fair in four patients (8.33%), and poor in one patient (2.08%). The HHS was excellent in 23 patients (47.92%), good in 20 patients (41.67%), fair in four patients (8.33%), and poor in one patient (2.08%). The average HHS was 87.38 ± 7.86 (ranging from 52 to 98). Postoperative complications included lateral femoral cutaneous nerve injury in two patients, delayed wound healing and subsequent development of an inguinal hernia in one patient. Late complications were observed in two patients, with one case of heterotopic ossification and another cas
背景处理涉及四边形钢板(QLP)的复杂髋臼骨折对外科医生来说是一项挑战,尤其是在合并粉碎和骨质疏松症的情况下。传统的植入物不能提供足够的固定强度或适当的匹配。新型预塑形髋臼下托板可能存在一些缺陷,如与 QLP 内侧表面的配合不准确,无法施加反向压缩力以抵抗股骨头向内侧移位。因此,本研究的主要目的是引入一种新技术,利用特殊轮廓的骨盆边缘重建钛板和四边形螺钉,通过髂腹股沟入路减少和稳定涉及 QLP 的髋臼骨折。方法我们对前瞻性收集的 48 例 QLP 急性移位骨折患者(男性 31 例,女性 17 例)的数据进行了回顾性分析,这些患者在 2012 年 1 月至 2019 年 12 月期间接受了特殊轮廓钢板结合四边形螺钉的治疗。患者的平均年龄为 47.56±11.31 岁(范围:19-73 岁)。骨折类型包括20例双柱骨折、12例前柱和后半横断骨折、8例T型骨折、5例横断骨折和3例影响QLP的前柱骨折,所有骨折均伴有股骨头突出。术后即刻的还原质量根据 Matta 标准进行评估。随访期间使用改良的 Merle d'Aubigné 和 Harris 髋关节评分(HHS)评估最终临床功能。平均手术时间为(246.08±54.30)分钟(178-397分钟不等),平均失血量为(715.16±263.84)毫升(400-2000毫升不等)。术后阶段的放射学分级显示,30 例患者(62.50%)解剖学缩小,14 例患者(29.17%)缩小效果满意,4 例患者(8.33%)缩小效果不佳。在最后的随访中,未发现股骨头再次突出。在功能结果方面,26 名患者(54.17%)的平均改良 Merle d'Aubigné-Postel 评分为优(54.17%),17 名患者(35.42%)为良(35.42%),4 名患者(8.33%)为中(8.33%),1 名患者(2.08%)为差(2.08%)。23 名患者的 HHS 为优(47.92%),20 名患者的 HHS 为良(41.67%),4 名患者的 HHS 为一般(8.33%),1 名患者的 HHS 为差(2.08%)。平均 HHS 为 87.38 ± 7.86(范围从 52 到 98)。术后并发症包括两名患者的股外侧皮神经损伤,一名患者的伤口延迟愈合,随后出现腹股沟疝。结论:我们的研究结果表明,在治疗涉及 QLP 的移位性髋臼骨折时,采用专为 QLP 损伤设计的轮廓钢板,并通过髂腹股沟入路使用四边形螺钉,可以取得良好的疗效。这种简单高效的技术为外科医生处理复杂的髋臼骨折提供了一种可行的选择。
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引用次数: 0
Surgical management of anastomotic leakage related to ovarian cancer surgery: a narrative review 与卵巢癌手术相关的吻合口漏的外科处理:叙述性综述
IF 1.8 4区 医学 Q2 SURGERY Pub Date : 2024-09-11 DOI: 10.3389/fsurg.2024.1434730
Stefano Restaino, Sofia Schierano, Martina Arcieri, Barbara Costantini, Alice Poli, Sara Pregnolato, Giovanni Terrosu, Sergio Calandra, Marco Petrillo, Giulia Pellecchia, Alessandro Lucidi, Marko Klarić, Lorenza Driul, Vito Chiantera, Alfredo Ercoli, Cristina Taliento, Francesco Fanfani, Anna Fagotti, Giovanni Scambia, Giuseppe Vizzielli
This narrative review describes the state of the art in the management of anastomotic leakage in ovarian cancer. Multiple surgical procedures, including bowel resection, are often required to achieve “optimal” cytoreduction in locally advanced ovarian cancer. Intestinal anastomosis is currently the most common way to restore bowel continuity. However, in some patients, a temporary protective stoma is indicated to prevent anastomotic leakage. This is an important issue to improve surgical outcomes and until recently there has been a lack of objective data to clarify the risk factors for anastomotic leakage. This review describes the risk factors for AL associated with surgery and compares the results of recent studies. We also review the current indications for placement of a protective ileostomy and treatment options for conservative management of AL. We present two examples of practical clinical AL risk calculators, in addition to the most assessed AL risk factor. To date, the decision-making processes that lead surgeons to perform a protective ileostomy are quite heterogeneous and based on the personal experience of the surgeon, mainly depending on individual training. Three different management options after colorectal anastomosis in OC are described: conservative management, diversion ileostomy and ghost ileostomy.
这篇叙述性综述介绍了卵巢癌吻合口漏的最新治疗技术。局部晚期卵巢癌患者通常需要进行包括肠道切除在内的多种手术,才能达到 "最佳 "的细胞减灭术。肠吻合术是目前恢复肠道连续性最常用的方法。然而,有些患者需要临时保护性造口,以防止吻合口渗漏。这是改善手术效果的一个重要问题,但直到最近,仍缺乏客观数据来明确吻合口漏的风险因素。本综述描述了与手术相关的 AL 风险因素,并比较了近期的研究结果。我们还回顾了目前放置保护性回肠造口术的适应症以及保守治疗 AL 的治疗方案。除了评估最多的 AL 风险因素外,我们还介绍了两种实用的临床 AL 风险计算器。迄今为止,导致外科医生实施保护性回肠造口术的决策过程是多种多样的,主要基于外科医生的个人经验和个人培训。本文介绍了 OC 结肠直肠吻合术后的三种不同处理方案:保守处理、转流回肠造口术和幽闭回肠造口术。
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引用次数: 0
Knowledge mapping and bibliometric analysis of medical knee magnetic resonance imaging for knee osteoarthritis (2004–2023) 膝关节骨关节炎医学膝关节磁共振成像的知识图谱和文献计量分析(2004-2023 年)
IF 1.8 4区 医学 Q2 SURGERY Pub Date : 2024-09-11 DOI: 10.3389/fsurg.2024.1387351
Juntao Chen, Hui Xu, Hang Zhou, Zheng Wang, Wanyu Li, Juan Guo, Yunfeng Zhou
ObjectivesMagnetic resonance imaging (MRI) is increasingly used to detect knee osteoarthritis (KOA). In this study, we aimed to systematically examine the global research status on the application of medical knee MRI in the treatment of KOA, analyze research hotspots, explore future trends, and present results in the form of a knowledge graph.MethodsThe Web of Science core database was searched for studies on medical knee MRI scans in patients with KOA between 2004 and 2023. CiteSpace, SCImago Graphica, and VOSviewer were used for the country, institution, journal, author, reference, and keyword analyses.ResultsA total of 2,904 articles were included. The United States and Europe are leading countries. Boston University is the main institution. Osteoarthritis and cartilage is the main magazine. The most frequently cocited article was “Radiological assessment of osteoarthrosis”. Guermazi A was the author with the highest number of publications and total references. The keywords most closely linked to MRI and KOA were “cartilage”, “pain”, and “injury”.ConclusionsThe application of medical knee MRI in KOA can be divided into the following parts: (1). MRI was used to assess the relationship between the characteristics of local tissue damage and pathological changes and clinical symptoms. (2).The risk factors of KOA were analyzed by MRI to determine the early diagnosis of KOA. (3). MRI was used to evaluate the efficacy of multiple interventions for KOA tissue damage (e.g., cartilage defects, bone marrow edema, bone marrow microfracture, and subchondral bone remodeling). Artificial intelligence, particularly deep learning, has become the focus of research on MRI applications for KOA.
目的磁共振成像(MRI)越来越多地用于检测膝关节骨性关节炎(KOA)。在本研究中,我们旨在系统研究全球应用医用膝关节磁共振成像治疗 KOA 的研究现状,分析研究热点,探索未来趋势,并以知识图谱的形式呈现研究结果。方法在 Web of Science 核心数据库中检索 2004 年至 2023 年间有关医用膝关节磁共振成像扫描治疗 KOA 患者的研究。CiteSpace、SCImago Graphica 和 VOSviewer 用于国家、机构、期刊、作者、参考文献和关键词分析。美国和欧洲是主要国家。波士顿大学是主要研究机构。骨关节炎与软骨》是主要杂志。最常被引用的文章是 "骨关节病的放射学评估"。Guermazi A 是发表文章数量和参考文献总数最多的作者。与核磁共振成像和 KOA 关系最密切的关键词是 "软骨"、"疼痛 "和 "损伤"。利用 MRI 评估局部组织损伤和病理变化特征与临床症状之间的关系。(2)通过 MRI 分析 KOA 的危险因素,确定 KOA 的早期诊断。利用MRI评估多种干预KOA组织损伤(如软骨缺损、骨髓水肿、骨髓微骨折和软骨下骨重塑)的疗效。人工智能,尤其是深度学习,已成为 KOA 核磁共振成像应用研究的重点。
{"title":"Knowledge mapping and bibliometric analysis of medical knee magnetic resonance imaging for knee osteoarthritis (2004–2023)","authors":"Juntao Chen, Hui Xu, Hang Zhou, Zheng Wang, Wanyu Li, Juan Guo, Yunfeng Zhou","doi":"10.3389/fsurg.2024.1387351","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1387351","url":null,"abstract":"ObjectivesMagnetic resonance imaging (MRI) is increasingly used to detect knee osteoarthritis (KOA). In this study, we aimed to systematically examine the global research status on the application of medical knee MRI in the treatment of KOA, analyze research hotspots, explore future trends, and present results in the form of a knowledge graph.MethodsThe Web of Science core database was searched for studies on medical knee MRI scans in patients with KOA between 2004 and 2023. CiteSpace, SCImago Graphica, and VOSviewer were used for the country, institution, journal, author, reference, and keyword analyses.ResultsA total of 2,904 articles were included. The United States and Europe are leading countries. Boston University is the main institution. Osteoarthritis and cartilage is the main magazine. The most frequently cocited article was “Radiological assessment of osteoarthrosis”. Guermazi A was the author with the highest number of publications and total references. The keywords most closely linked to MRI and KOA were “cartilage”, “pain”, and “injury”.ConclusionsThe application of medical knee MRI in KOA can be divided into the following parts: (1). MRI was used to assess the relationship between the characteristics of local tissue damage and pathological changes and clinical symptoms. (2).The risk factors of KOA were analyzed by MRI to determine the early diagnosis of KOA. (3). MRI was used to evaluate the efficacy of multiple interventions for KOA tissue damage (e.g., cartilage defects, bone marrow edema, bone marrow microfracture, and subchondral bone remodeling). Artificial intelligence, particularly deep learning, has become the focus of research on MRI applications for KOA.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparative study of acute kidney injury in pararenal aortic aneurysm: open surgical versus endovascular repair 主动脉瘤旁急性肾损伤的比较研究:开放手术与血管内修复术
IF 1.8 4区 医学 Q2 SURGERY Pub Date : 2024-09-10 DOI: 10.3389/fsurg.2024.1457583
Sherif Sultan, Yogesh Acharya, Wael Tawfick, William Wijns, Osama Soliman
BackgroundPararenal abdominal aortic aneurysms (PR-AAA), constituting around 15%-20% of AAA patients, are defined as having no neck between the aneurysm and the renal arteries. Due to an insufficient sealing zone, open surgical repair (OSR) is the gold standard, while EVAR is reserved for those unfit for surgery. Renal outcomes disturb long-term survival, and they have massive socioeconomic and quality of life implications, especially if patients require dialysis.MethodsThis study aims to elucidate any difference between EVAR and OSR of PR-AAA, excluding suprarenal aneurysms, with specific emphasis on renal dysfunction over the short and long term. An existing database of PR-AAA between 2002 and 2023 was used to glean information regarding the therapeutic option used. Renal events were defined by the RIFLE criteria. Out of 1,563 aortic interventions, we identified 179 PR-AAA, of which 99 high-risk patients had an aortic neck of less than 10 mm with complete follow-up. We excluded patients with fenestrated EVAR (FEVAR), branched EVAR (BEVAR), or chimney EVAR (Ch-EVAR) and any patients requiring visceral artery reimplantation.ResultsIn total, 63 patients underwent EVAR, and 36 required OSR. 17.46% of patients who underwent EVAR experienced acute kidney injury (AKI) compared with 36.11% of the OSR group (P = 0.037). The mean post-op creatinine for OSR was 109.88 µmol/L, and for EVAR was 127.06 µmol/L (P = 0.192). The mean difference between long-term (9–12 years) creatinine values in OSR was 14.29 µmol/L (P = 0.191), and the mean difference for EVAR was 25.05 µmol/L (P = 0.024). Furthermore, 27.8% of OSR patients who underwent Left Renal Vein Division and Ligation (LRVDL) experienced an AKI, while 50% who did not undergo LRVDL experienced an AKI (P = 0.382). Thirty-day morbidity in the EVAR group (20.97%) was significantly lower than in the OSR group (42.62%) (P = 0.022). Moreover, 3.17% in EVAR group and 7.14% in OSR group had aneurysm-related mortality (P = 0.584).ConclusionThe rate of renal events for OSR is higher, while the rate of endovascular renal events was lower. Our study shows that PR-AAA undergoing OSR may benefit from endovascular repair.
背景arenal腹主动脉瘤(PR-AAA)约占 AAA 患者的 15%-20%,其定义是动脉瘤与肾动脉之间没有颈部。由于密封区不足,开放手术修补术(OSR)是金标准,而 EVAR 仅适用于不适合手术的患者。本研究旨在阐明除肾上动脉瘤以外的 PR-AAA 的 EVAR 和 OSR 之间的差异,重点关注短期和长期的肾功能障碍。我们利用现有的 2002 年至 2023 年 PR-AAA 数据库来收集有关所用治疗方案的信息。肾功能事件根据 RIFLE 标准定义。在 1,563 例主动脉介入手术中,我们发现了 179 例 PR-AAA,其中 99 例高风险患者的主动脉颈小于 10 毫米,并进行了完整的随访。我们排除了栅栏式 EVAR(FEVAR)、分支式 EVAR(BEVAR)或烟囱式 EVAR(Ch-EVAR)患者以及任何需要内脏动脉再植的患者。接受EVAR的患者中有17.46%出现急性肾损伤(AKI),而OSR组中有36.11%(P = 0.037)。OSR 术后肌酐平均值为 109.88 µmol/L,EVAR 术后肌酐平均值为 127.06 µmol/L(P = 0.192)。OSR 长期(9-12 年)肌酐值的平均差异为 14.29 µmol/L(P = 0.191),EVAR 的平均差异为 25.05 µmol/L(P = 0.024)。此外,接受左肾静脉分割和结扎术(LRVDL)的 OSR 患者中有 27.8% 出现了 AKI,而未接受 LRVDL 的患者中有 50% 出现了 AKI(P = 0.382)。EVAR组的30天发病率(20.97%)明显低于OSR组(42.62%)(P = 0.022)。此外,EVAR 组和 OSR 组分别有 3.17% 和 7.14% 出现动脉瘤相关死亡率(P = 0.584)。我们的研究表明,接受OSR的PR-AAA可能会从血管内修复中获益。
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引用次数: 0
Paneth-like cells disruption and intestinal dysbiosis in the development of enterocolitis in an iatrogenic rectosigmoid hypoganglionosis rat model 类盘状细胞破坏和肠道菌群失调在先天性直肠乙状结肠发育不全大鼠肠炎发病过程中的作用
IF 1.8 4区 医学 Q2 SURGERY Pub Date : 2024-09-09 DOI: 10.3389/fsurg.2024.1407948
Iskandar Rahardjo Budianto, Kusmardi Kusmardi, Andi Muh. Maulana, Somasundaram Arumugam, Rejina Afrin, Vivian Soetikno
BackgroundHypoganglionosis resembles Hirschsprung disease (HSCR) which is characterized by severe constipation. Enterocolitis due to hypoganglionosis or Hirschsprung-associated enterocolitis (HAEC) is a life-threatening complication of both diseases. This study investigated the role of Paneth-like cells (PLCs) and gut microbiota in the development of enterocolitis in an iatrogenic rectosigmoid hypoganglionosis rat model.MethodsThe rectosigmoid serosa of male Sprague-Dawley rats were exposed to 0.1% benzalkonium chloride (BAC). The rats were then sacrificed after 1, 3, 5, 8, and 12 weeks. A sham group was sacrificed on Week 12. With hematoxylin-eosin staining, the ganglionic cells were quantified, the degree of enterocolitis was analyzed, and the PLCs was identified. Intestinal barrier function was assessed for the anti-peripherin, occludin, and acetylcholinesterase (AChE)/butyrylcholinesterase (BChE) ratio. qRT-PCR was used as reference for the evaluation of antimicrobial peptide (AMP) of PLCs using cryptdins, secretory Phospholipase A2, and lysozyme levels. 16S rRNA high-throughput sequencing on fecal samples was performed to analyze the changes in the intestinal microbiota diversity in each group.ResultsAfter 1 week of intervention, the ganglion cells were fewer in all sacrificial 0.1% BAC groups at varying times than those in the sham group. Occludin and peripherin were decreased, while the AChE/BChE ratio was increased. At Week 5 postintervention, the number of α-defensins-positive PLCs increased in the sigmoid colon tissues from BAC-treated rats. Conversely, PLCs-produced AMP decreased from Week 5 to Week 12. The sham group demonstrated increased Lactobacillus and decreased Bacteroides, while the 0.1% BAC group exhibited reciprocal changes, indicating dysbiosis. Enterocolitis occurred from Week 1 postintervention.ConclusionApplication with BAC influences the disruption of PLCs in Week 5 postintervention, and dysbiosis exacerbate the occurrence of enterocolitis. Further research on Paneth cells involvement in HAEC development is warranted.
背景扁桃体功能减退症(Hypoganglionosis)与以严重便秘为特征的赫氏病(Hirschsprung disease,HSCR)相似。低位小肠结肠症引起的小肠结肠炎或赫氏相关性小肠结肠炎(HAEC)是这两种疾病的一种危及生命的并发症。本研究探讨了类潘氏细胞(PLCs)和肠道微生物群在先天性直肠乙状结肠下垂症大鼠模型中肠结肠炎发生过程中的作用。方法将雄性 Sprague-Dawley 大鼠的直肠乙状结肠浆膜暴露于 0.1% 的苯扎氯铵(BAC)中。大鼠分别在 1、3、5、8 和 12 周后被处死。假组在第 12 周牺牲。通过苏木精-伊红染色,对神经节细胞进行量化,分析肠炎的程度,并确定 PLC。利用隐球蛋白、分泌型磷脂酶 A2 和溶菌酶水平的 qRT-PCR 作为参考,评估 PLC 的抗菌肽 (AMP)。对粪便样本进行了 16S rRNA 高通量测序,以分析各组肠道微生物群多样性的变化。闭锁素和外周素减少,而 AChE/BChE 比率增加。干预后第 5 周,BAC 处理大鼠乙状结肠组织中的α-防御素阳性 PLC 数量增加。相反,从第 5 周到第 12 周,PLCs 产生的 AMP 有所减少。假结肠组显示乳酸杆菌增加,而嗜酸乳杆菌减少,而 0.1% BAC 组则显示出相反的变化,表明菌群失调。结论应用 BAC 会影响干预后第 5 周 PLC 的破坏,而菌群失调会加剧肠炎的发生。有必要对 Paneth 细胞参与 HAEC 发育的情况进行进一步研究。
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引用次数: 0
Frontiers | Retrospective analysis of immediate and long-term results of NOSES technique and conventional laparoscopic-assisted resection in patients with colorectal cancer 前沿 | NOSES技术和传统腹腔镜辅助切除术对结直肠癌患者近期和远期效果的回顾性分析
IF 1.8 4区 医学 Q2 SURGERY Pub Date : 2024-09-09 DOI: 10.3389/fsurg.2024.1444942
Sergei Malev, Hao Zhang, Ziming Yuan, Qingchao Tang, Guiyu Wang, Giorgi Oganezov, Rui Huang, Wang Xishan
IntroductionThe aim of research was to study the feasibility and safety of surgery providing specimen extraction through natural orifices in patients with colorectal cancer.Materials and methodsThis study is a comparative retrospective analysis of findings obtained from 265 patients who underwent surgical treatment using NOSES technique and 275 patients who underwent laparoscopic-assisted (LA) resection. Data included preoperative patients’ information, intraoperative findings, results of postoperative pathological examination of surgical specimens, early postoperative period analysis, and follow-up.ResultsBoth groups were comparable in terms of gender, age and BMI. The duration of surgery was similar in both groups (p = 0.94). Intraoperative blood loss under NOSES interventions was slightly lower than in laparoscopic-assisted surgeries (p < 0.001). There was no significant difference in the number of lymph nodes removed and anal function scores between the two groups (p > 0.05). It was revealed that in the NOSES group, the function of the gastrointestinal tract normalized at an earlier time, slightly the time to start liquid food intake and the duration of postoperative hospital stay were reduced (p < 0.001). A statistically significant difference between groups was found in complications, such as pneumonia (p = 0.03). The absolute number of complications was observed more often in the LA surgery group (10.4%) than in the NOSES group (5.8%). Local recurrence was less common in the NOSES group (p = 0.01). There were no statistically significant differences in disease progression (p = 0.16). When analyzing disease-free and overall survival rate in this study, there was no statistically significant difference between the two surgical techniques in terms of their effect on postoperative survival (p > 0.05).ConclusionThe results of this study demonstrate that NOSES technique is a relatively safe and effective surgical option in patients with colorectal cancer. It has high surgical efficiency providing no increased risk of surgical intervention, reducing total number of postoperative complications, reducing duration of postoperative hospital stay, reducing the time for gastrointestinal function recovery and the start of food intake. This study supports that NOSES has clear advantages over conventional laparoscopic-assisted surgery.
材料和方法 本研究是一项回顾性对比分析,研究对象是265名接受NOSES技术手术治疗的患者和275名接受腹腔镜辅助(LA)切除术的患者。数据包括术前患者信息、术中发现、术后手术标本病理检查结果、术后早期分析和随访。两组患者的手术时间相似(P = 0.94)。NOSES 介入手术的术中失血量略低于腹腔镜辅助手术(P 0.05)。研究结果表明,NOSES 组胃肠道功能恢复正常的时间较早,开始进食流质食物的时间和术后住院时间略有缩短(P 0.05)。它具有很高的手术效率,不会增加手术干预的风险,减少术后并发症总数,缩短术后住院时间,缩短胃肠功能恢复和开始进食的时间。这项研究证明,与传统的腹腔镜辅助手术相比,NOSES 具有明显的优势。
{"title":"Frontiers | Retrospective analysis of immediate and long-term results of NOSES technique and conventional laparoscopic-assisted resection in patients with colorectal cancer","authors":"Sergei Malev, Hao Zhang, Ziming Yuan, Qingchao Tang, Guiyu Wang, Giorgi Oganezov, Rui Huang, Wang Xishan","doi":"10.3389/fsurg.2024.1444942","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1444942","url":null,"abstract":"IntroductionThe aim of research was to study the feasibility and safety of surgery providing specimen extraction through natural orifices in patients with colorectal cancer.Materials and methodsThis study is a comparative retrospective analysis of findings obtained from 265 patients who underwent surgical treatment using NOSES technique and 275 patients who underwent laparoscopic-assisted (LA) resection. Data included preoperative patients’ information, intraoperative findings, results of postoperative pathological examination of surgical specimens, early postoperative period analysis, and follow-up.ResultsBoth groups were comparable in terms of gender, age and BMI. The duration of surgery was similar in both groups (p = 0.94). Intraoperative blood loss under NOSES interventions was slightly lower than in laparoscopic-assisted surgeries (p < 0.001). There was no significant difference in the number of lymph nodes removed and anal function scores between the two groups (p > 0.05). It was revealed that in the NOSES group, the function of the gastrointestinal tract normalized at an earlier time, slightly the time to start liquid food intake and the duration of postoperative hospital stay were reduced (p < 0.001). A statistically significant difference between groups was found in complications, such as pneumonia (p = 0.03). The absolute number of complications was observed more often in the LA surgery group (10.4%) than in the NOSES group (5.8%). Local recurrence was less common in the NOSES group (p = 0.01). There were no statistically significant differences in disease progression (p = 0.16). When analyzing disease-free and overall survival rate in this study, there was no statistically significant difference between the two surgical techniques in terms of their effect on postoperative survival (p > 0.05).ConclusionThe results of this study demonstrate that NOSES technique is a relatively safe and effective surgical option in patients with colorectal cancer. It has high surgical efficiency providing no increased risk of surgical intervention, reducing total number of postoperative complications, reducing duration of postoperative hospital stay, reducing the time for gastrointestinal function recovery and the start of food intake. This study supports that NOSES has clear advantages over conventional laparoscopic-assisted surgery.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142257966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Surgery paradigm for locally advanced breast cancer following neoadjuvant systemic therapy 新辅助系统疗法后局部晚期乳腺癌的手术范例
IF 1.8 4区 医学 Q2 SURGERY Pub Date : 2024-09-06 DOI: 10.3389/fsurg.2024.1410127
Ziyue Sun, Kexin Liu, Yanru Guo, Nanyuan Jiang, Meina Ye
Locally advanced breast cancer (LABC) remains a significant clinical challenge, particularly in developing countries. While neoadjuvant systemic therapy (NST) has improved the pathological complete response (pCR) rates, particularly in HER2-positive and triple-negative breast cancer patients, surgical management post-NST continues to evolve. The feasibility of omitting surgery and the increasing consideration of breast-conserving surgery, immediate reconstruction in LABC patients are important areas of exploration. Accurate assessment of tumor response to NST through advanced imaging and minimally invasive biopsies remains pivotal, though challenges persist in reliably predicting pCR. Additionally, axillary lymph node management continues to evolve, with emerging strategies aiming to minimize the extent of surgery in patients who achieve nodal downstaging post-NST. Minimizing axillary lymph node dissection in favor of less invasive approaches is gaining attention, though further evidence is needed to establish its oncological safety. The potential for personalized treatment approaches, reducing surgical morbidity, and improving quality of life are key goals in managing LABC, while maintaining the priority of achieving favorable long-term outcomes.
局部晚期乳腺癌(LABC)仍然是一项重大的临床挑战,尤其是在发展中国家。虽然新辅助系统治疗(NST)提高了病理完全反应率(pCR),尤其是对 HER2 阳性和三阴性乳腺癌患者,但 NST 后的手术治疗仍在不断发展。省略手术的可行性以及越来越多的 LABC 患者开始考虑保乳手术和即刻重建,这些都是需要探索的重要领域。通过先进的成像技术和微创活检准确评估肿瘤对 NST 的反应仍然至关重要,但在可靠预测 pCR 方面仍然存在挑战。此外,腋窝淋巴结管理也在不断发展,新出现的策略旨在最大限度地减少 NST 后实现结节下移的患者的手术范围。尽量减少腋窝淋巴结清扫,转而采用创伤较小的方法正受到越来越多的关注,尽管还需要进一步的证据来确定其肿瘤安全性。个性化治疗方法的潜力、降低手术发病率和提高生活质量是治疗 LABC 的关键目标,同时也是实现良好的长期预后的首要任务。
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引用次数: 0
Early vs. interval approach to laparoscopic cholecystectomy for acute cholecystitis: a retrospective observational study from Pakistan 急性胆囊炎腹腔镜胆囊切除术的早期与间歇方法:巴基斯坦的一项回顾性观察研究
IF 1.8 4区 医学 Q2 SURGERY Pub Date : 2024-09-06 DOI: 10.3389/fsurg.2024.1462885
Sandesh Raja, Azzam Ali, Dileep Kumar, Adarsh Raja, Khursheed Ahmed Samo, Amjad Siraj Memon
BackgroundLaparoscopic cholecystectomy (LC) is the preferred treatment for acute cholecystitis (AC). However, the optimal timing for LC in AC management remains uncertain, with early cholecystectomy (EC) and interval cholecystectomy (IC) being two common approaches influenced by various factors.MethodsThis retrospective study, conducted at a tertiary care teaching hospital in Karachi, Pakistan, aimed to compare the outcomes of EC vs. IC for AC management. Patient data from January 2019 to September 2019 were analyzed with a focus on operative complications, duration of surgery, and postoperative hospital stay. The inclusion criteria were based on the Tokyo Guidelines, and patients underwent LC within 3 days of symptom onset in the EC group and after 6 weeks in the IC group.ResultsAmong 147 eligible patients, 100 underwent LC (50 in each group). No significant differences were observed in the sex distribution or mean age between the two groups. The EC group experienced fewer operative complications (12%) than the IC group (34%), with statistically significant differences observed. Nevertheless, no substantial variations in operative time or postoperative hospital stay were observed between the groups.ConclusionReduced complications in the EC group underscore its safety and efficacy. Nonetheless, further validation through multicenter studies is essential to substantiate these findings.
背景腹腔镜胆囊切除术(LC)是急性胆囊炎(AC)的首选治疗方法。然而,LC 治疗急性胆囊炎的最佳时机仍不确定,早期胆囊切除术(EC)和间歇性胆囊切除术(IC)是受各种因素影响的两种常见方法。方法这项回顾性研究在巴基斯坦卡拉奇的一家三级医疗教学医院进行,旨在比较 EC 与 IC 治疗急性胆囊炎的结果。研究分析了 2019 年 1 月至 2019 年 9 月的患者数据,重点关注手术并发症、手术持续时间和术后住院时间。纳入标准以《东京指南》为基础,EC组患者在症状出现后3天内接受LC治疗,IC组患者在6周后接受LC治疗。两组患者的性别分布和平均年龄无明显差异。EC组出现的手术并发症(12%)少于IC组(34%),差异有统计学意义。结论 EC 组并发症的减少凸显了其安全性和有效性。尽管如此,通过多中心研究进一步验证这些发现还是非常必要的。
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引用次数: 0
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Frontiers in Surgery
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