Gland surgery最新文献

Background: Primary hyperparathyroidism (pHPT) is the third most common endocrine disease, affecting predominantly postmenopausal women. About 85% of cases are caused by a solitary parathyroid adenoma which leads to a hypersecretion of the parathyroid hormone (PTH) and consequently to elevated serum calcium concentrations. Parathyroidectomy is the only curative treatment. While a very low recurrence rate of 0.4-1.3% was previously thought, recent long-term studies have shown significantly higher recurrence rates at longer follow-up intervals of more than 6 months to several years, posing new challenges for surgeons. In addition, laboratory dynamics may occur in the early postoperative period that cannot yet be adequately explained in terms of long-term outcomes. Therefore, the aim of this study was to evaluate the long-term outcome after parathyroidectomy for pHPT at the Department of General Surgery at the University Medical Center Rostock with regard to late recurrences.

Methods: This retrospective long-term follow-up evaluated the postoperative course after parathyroidectomy for pHPT. Based on 111 patients who underwent surgery at the Department of General Surgery at the University Medical Center Rostock between 2007 and 2017, 65 patients were followed for a median postoperative period of 41 months.

Results: In addition to normocalcemic PTH fluctuations in the early postoperative period, which is a well-known phenomenon, the result shows an elevated calcium or PTH concentration during a follow-up of more than 10 years. These results may predict late recurrence. Furthermore, it is not the preoperative PTH and calcium, but rather the preoperative serum creatinine that plays a role in late follow-up, contrary to expectations.

Conclusions: The results emphasise the importance of long-term follow-up of patients who have undergone parathyroidectomy and may help to guide the development of institutional postoperative surveillance.

Background: Breast cancer is the most common malignant tumor among women, with an increasing incidence each year. The subtypes of human epidermal growth factor receptor 2 (HER2)-negative breast cancer, classified as HER2-low and HER2-zero based on HER2 receptor expression, show differences in clinical characteristics, therapeutic approaches, and prognoses. Distinguishing between these subtypes is clinically valuable as it can impact treatment strategies, including the use of next-generation antibody-drug conjugates (ADCs) targeting HER2-low tumors. This study aimed to develop a nomogram based on dynamic magnetic resonance imaging (MRI) and clinical indicators to differentiate between HER2-low and HER2-zero subtypes in HER2-negative breast cancer patients.

Methods: This study included 214 breast cancer patients from two centers, Hospital A (Affiliated Hospital of Jining Medical University, n=178) and Hospital B (Ningyang No. 1 People's Hospital, n=36). HER2 status was determined by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). Among the participants, 112 cases were identified as HER2-low and 102 as HER2-zero. Patients from Hospital A were split into a training set and an internal test set in an 8:2 ratio, while the 36 patients from Hospital B were used as an external test set. Regions of interest (ROI) were delineated on phase 2 enhanced scans and diffusion weighted imaging (DWI) images, with features selected via Pearson correlation coefficients and least absolute shrinkage and selection operator (LASSO) regression. A K-Nearest Neighbor (KNN) model was employed to calculate the rad score, and clinical predictors (tumor maximum diameter and CA153) were identified through logistic regression analysis. These predictors, combined with the rad score, were incorporated into the final nomogram model. The model's accuracy was evaluated using area under curve (AUC) values in both the internal and external validation sets.

Results: The nomogram achieved AUC values of 0.873 and 0.859 in the internal and external validation sets, respectively, demonstrating superior performance over single-feature models. Decision curve analysis (DCA) indicated substantial net clinical benefits, and calibration curves displayed strong alignment between the model's predictions and actual outcomes in both sets.

Conclusions: This nomogram shows high accuracy and stability in differentiating HER2-low and HER2-zero subtypes among HER2-negative breast cancer patients, suggesting potential clinical utility in refining treatment decisions and identifying candidates for ADC therapy in HER2-low cases.

Background: Pheochromocytoma is a rare neuroendocrine tumor, and bilateral pheochromocytomas is even less common. Due to the limited experience with such cases, this study aims to explore the optimal surgical strategy, assess the potential advantages of robotic surgery, and evaluate surgical outcomes for managing bilateral pheochromocytomas.

Case description: This report presented a case of a 33-year-old woman with bilateral pheochromocytomas related to multiple endocrine neoplasia type 2a (MEN2A), who was successfully managed by synchronous transperitoneal robotic-assisted bilateral cortical-sparing adrenalectomy. This strategy reduced blood loss, improved cosmetic outcomes, preserved adrenal function, and gradually reduced the need for hormone replacement, ultimately leading to discontinuation of hydrocortisone therapy. The surgery was performed without significant complications. The patient recovered well and had normal blood pressure and hormone level at the 1-year postoperative follow-up.

Conclusions: Synchronous transperitoneal robotic-assisted bilateral cortical-sparing adrenalectomy is a safe, effective, and efficient approach for bilateral pheochromocytomas, and is favorable for rapid recovery and cosmetic demand. This treatment is more advantageous when dealing with multiple neuroendocrine tumors.

Background: Multifocality is a distinctive feature of papillary thyroid carcinoma (PTC); however, the biological behavior of PTC and its optimal management strategy remain unclear. The aim of this study was to analyze the clinical features and prognostic differences of multifocal papillary carcinoma and to guide the precise treatment of multifocal papillary carcinoma.

Methods: The medical records of 1,139 patients with PTC who had undergone total or hemi-thyroidectomy between April and October 2013 at the Tianjin Medical University Cancer Institute and Hospital were reviewed. The number of central compartment lymph node metastasis (LNM), as well as the size, number, and laterality of each tumor focus, along with other possible risk factors were recorded. Patients were followed up until May 2024.

Results: According to univariate and multivariable analyses, PTC, multifocality, and male sex were risk factors for level VI LNM. Moreover, the central compartment LNM rate increased proportionally with the number of foci. The LNM rates for patients with unilateral papillary thyroid microcarcinoma (PTMC) having one, two, three, and four foci were 27.8% (146/525), 37.3% (55/142), 40% (14/35), and 57.1% (4/7), respectively; conversely, the LNM rates for patients with bilateral PTC having two, three, four, five, and six foci were 50% (15/30), 62.5% (15/24), 70% (7/10), 83.3% (5/6), and 100% (2/2), respectively. Notably, the LNM rates were comparable for multifocal PTMCs (largest tumor diameter: 6-10 mm) and unilateral unifocal PTCs [44.0% (55/125) vs. 60.8% (59/97); P=0.43 (0.42-0.93)]. Meanwhile, the survival rates and risk of recurrence were comparable for multifocal and unifocal PTCs.

Conclusions: Multifocality is indicative of a heightened risk of LNM in PTC but does not increase the risk of recurrence or mortality. Multifocal PTMCs with a tumor diameter of 6-10 mm should undergo thorough preoperative evaluation of the regional lymph nodes as they have a higher risk of developing LNM.

Background: Breast cancer-related lymphedema (BCRL) is one of the common complications after breast cancer surgery. It can easily lead to limb swelling, deformation and upper limb dysfunction, which has a serious impact on the physical and mental health and quality of life of patients. Previous studies have mostly used statistical methods such as linear regression and logistic regression to analyze the influencing factors, but all of them have certain limitations. Machine learning (ML) is an important branch of artificial intelligence, which can effectively overcome the problems of multivariate interaction and collinearity. This study aimed to explore the influencing factors for the occurrence of BCRL in breast cancer patients, and construct a predictive model with ML algorithms and validate its predictive value on this basis.

Methods: Clinical data of breast cancer patients admitted to Hainan Cancer Hospital from September 2018 to May 2024 were retrospectively collected. BCRL was considered as the outcome measurement, and the data were divided into training and validation sets in a ratio of 7:3. In the training set, random forest (RF), support vector machine (SVM), and eXtreme Gradient Boosting (XGBoost) algorithms were used to construct predictive models. The discrimination accuracy of the models was evaluated with receiver operating characteristic (ROC) curve analysis, sensitivity, specificity, and F1 score. The calibration of the models was assessed using calibration curves and the Hosmer-Lemeshow (H-L) Chi-squared test.

Results: Two hundred and forty patients who met the inclusion criteria were screened, and they were randomly divided into a training set (168 patients) and a validation set (72 patients) in a 7:3 ratio. In the training set, 44 cases developed BCRL, while 124 did not. There were statistically significant differences (P<0.05) in hypertension history, number of dissected lymph nodes, postoperative complications, postoperative functional exercises, chemotherapy, radiotherapy, tumor node metastasis (TNM) stage, and level of axillary lymph node dissection between the BCRL and non-BCRL groups. Among the four models, the XGBoost model showed the best predictive performance, with an area under the curve (AUC) of 0.99 in the training set and 0.89 in the validation set. The XGBoost model demonstrated good calibration in both the training and validation sets, showing good consistency with the ideal model.

Conclusions: The ML-based XGBoost model for predicting BCRL exhibits excellent performance and assists healthcare professionals in rapidly and accurately assessing the risk of BCRL occurrence.

Background: The selection and extent of application for both total adrenalectomy (TA) and partial adrenalectomy (PA) within this surgical approach continue to be matters of debate. This paper compares the postoperative efficacy and functional indicators of PA and TA to provide comprehensive insights for clinicians to consider the best surgical treatment options.

Methods: Systematic review on PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure (CNKI) was conducted. We compared several key factors between TA and PA, including operating time (OT), blood loss, length of hospital stay, serum aldosterone levels, plasma renin activity, postoperative aldosterone to renin ratio (ARR), systolic and diastolic blood pressure, early postoperative complications, and blood potassium concentration. Data were collected by the Cochran-Mantel-Haenszel method, and Review Manager software (RevMan) version 5.3 was used.

Results: The results showed that compared to TA, PA had a shorter OT [weighted mean difference (WMD) =-12.16; 95% confidence interval (CI): -19.42, -4.89; I²=96%; P=0.001]. Compared with PA, TA had a better recovery of diastolic blood pressure (WMD =2.12; 95% CI: 0.42, 3.81; I²=0%; P=0.01). Regarding serum aldosterone, plasma renin activity, postoperative ARR, systolic blood pressure, early postoperative complications, length of hospital stay, and blood potassium, there was no significant difference between PA and TA (P>0.05). In subgroup analysis, results indicated that there was currently no significant difference in most results between PA and TA (P>0.05). For patients aged 50 years or younger, PA had a shorter OT compared to TA (WMD =-19.71; 95% CI: -35.99, -3.42; I²=95%; P=0.02). For tumor size ≤2.0 cm, the intraoperative blood loss of PA was greater than that of TA (WMD =16.76; 95% CI: 3.62, 29.90; I²=37%; P=0.01).

Conclusions: The OT was shorter in PA than in TA, and shorter in younger patients. The recovery of diastolic blood pressure after TA was better than that of PA. When the tumor was 2 cm or small, TA had less blood loss than PA. There was no significant difference in functional indexes between PA and TA. PA offers advantages in surgical outcomes compared to TA. However, for tumors ≤2 cm, TA may provide greater benefits to patients. Additionally, TA demonstrates superior recovery of diastolic blood pressure compared to PA according to functional indicators.

Background: Infertility is a special reproductive health defect. For women, congenital uterine malformations, extensive adhesions in the uterine cavity, and hysterectomy are associated with infertility. Uterine transplantation is technically feasible, but its clinical application and development are limited by donor shortages and immune rejection. Thus, uterine tissue engineering research has promising prospects. This study sought to explore the ideal perfusion strategy and evaluation process for successfully preparing natural uterine decellularized scaffolds using decellularized perfusion technology to provide a good platform for uterine tissue engineering research.

Methods: Female Sprague-Dawley rats were selected. Eluents, including TritonX-100 supplemented with sodium dodecyl sulfate, were perfused into the uterus through the uterine artery after physical freezing, thawing, and enzymatic hydrolysis. After decellularization, each scaffold was evaluated by general observation, methylene blue staining, hematoxylin and eosin staining, immunohistochemical staining, quantitative analysis of genomic DNA, collagen detection and identification, cytokine content determination, transmission electron microscopy (TEM), and scanning electron microscopy (SEM).

Results: After perfusion, a transparent uterine scaffold was established, and the histological examination and TEM showed that it contained no cell residue. The DNA content was shown to be less than 5% that of the normal uterus. Methylene blue staining and SEM showed that the vascular network and spatial structure were intact. Immunohistochemical staining and collagen quantification showed that the extracellular matrix components of the scaffold were completely preserved. In addition, the enzyme-linked immunosorbent assay results showed that the cytokines, including epidermal growth factor, basic fibroblast growth factor, and transforming growth factor beta, had been retained in the decellularized scaffold, and still showed some biological activity.

Conclusions: A decellularized uterine scaffold was successfully established, and its physical and chemical properties were preserved; consequently, it may be used as an alternative platform for uterine tissue engineering research.

Background: When papillary thyroid carcinoma (PTC) is accompanied by Hashimoto's thyroiditis (HT), it is often challenging for preoperative ultrasound to distinguish between central lymph node enlargement caused by PTC metastasis and inflammatory reaction due to HT. However, central lymph node metastasis (CLNM) is closely associated with the risk of PTC recurrence after surgery. In this study, we developed a model to predict in patients with PTC combined with HT, based on conventional ultrasound characteristics and shear wave elastography (SWE) quantitative parameters of the primary lesion. We aimed to evaluate its predictive value to provide a useful reference for clinical decisions regarding central lymph node dissection.

Methods: This retrospective study included ultrasound data for 181 PTC patients with concurrent HT (totaling 215 nodules), confirmed by surgical pathology at our hospital and routinely undergoing central neck lymph node dissection. All enrolled PTC patients were randomly divided into training and test groups at a 7:3 ratio. Then, patients in each group were further segregated into two distinct cohorts: the CLNM group and the non-CLNM group as per the gold standard of pathology assessment. Subsequent statistical analysis of conventional ultrasound characteristics pertaining to primary foci alongside quantitative parameters derived from SWE, facilitated the identification of independent risk factors associated with CLNM. Then, a nomogram model was constructed, and its predictive value was evaluated. The test group was used for internal validation.

Results: Univariate analysis results in the training group indicated that nodule size, multiplicity, location, capsular invasion, and Emax were significantly associated with CLNM (all P<0.05). Multivariate analysis further identified nodule size, multiplicity, location, capsular invasion, and Emax as independent risk factors for CLNM (all P<0.05). Based on the multivariate analysis results, a nomogram model was developed to predict the occurrence of CLNM in PTC patients with HT. Receiver operating characteristic (ROC) curve analysis showed high predictive accuracy for CLNM, with an area under the ROC curve (AUC) of 0.837 in the training group and 0.882 in the test group. Calibration curves demonstrated good fit, closely aligning with the diagonal, indicating strong consistency in predicting CLNM.

Conclusions: The nomogram model, based on primary lesion ultrasound characteristics and SWE quantitative parameters in PTC patients with HT, may aid clinicians in preoperatively predicting the likelihood of CLNM in PTC patients.

Background: Endoscopic thyroidectomy (ET) offers superior cosmetic outcomes compared to traditional open thyroidectomy but is associated with higher postoperative drainage volumes (DV) and potential complications. Although ET via the areola approach (ETAA) has been used, the factors influencing DV after ETAA remain poorly understood. Therefore, this study aimed to identify clinical parameters that can objectively evaluate the factors influencing drainage volume after ETAA.

Methods: This retrospective cohort study enrolled consecutive patients with thyroid disease who underwent ETAA at The First Affiliated Hospital of Jinan University between February and September 2016. After adjusting for potential confounders, univariate and ordinal logistic regression analyses determined the association between DV and clinical variables.

Results: We identified hyperthyroidism, operation time, and male gender as independent risk factors for increased DV. Specifically, hyperthyroidism was linked to higher DV across the first and second 24-hour periods [odds ratio (OR) =2.97, P=0.049], while longer operation times and male gender also significantly influenced DV (≤100 min: OR =0.11, P=0.02; >100, ≤150 min: OR =0.39, P=0.049; male gender OR =0.23, P=0.02). Notably, high DV in the second 24 hours predicted even higher DV in the third 24 hours (<30 mL: OR =0.04, P<0.001; 30-60 mL: OR =0.22, P=0.01). These findings suggest that patients with these risk factors should be closely monitored during ETAA, and postponing drain removal in patients with large DV in the early postoperative period may be warranted.

Conclusions: This study enhances our understanding of the factors affecting DV after ETAA and highlights the need for tailored postoperative care strategies.