Journal of Investigative Surgery最新文献

Objective: Extant imaging methods used for the proper identification of the parathyroid glands to prevent post-operative hypothyroidism associated with the resection of differentiated thyroid cancer (DTC) are limited by factors such as low specificity, high cost, and technical complexity. This study, therefore, sought to investigate the efficacy of the immunocolloidal gold strip method combined with nanocarbon negative imaging tracing technology for parathyroid gland imaging during radical resection of DTC in elderly patients.

Methods: A total of 100 elderly patients with DTC were enrolled and randomly divided into two groups: the control group and the observation group. The control group underwent conventional radical thyroidectomy with bilateral cervical lymph node dissection, while the observation group received the immunocolloidal gold strip method combined with nanocarbon negative imaging tracing technology for parathyroid gland imaging during the surgery. The baseline characteristics, intraoperative findings, postoperative parathyroid hormone (PTH), and serum calcium levels, as well as postoperative complications, were compared between the two groups.

Results: There were no significant differences in age, gender, body mass index, comorbidities, or smoking history between the two groups. The observation group had a significantly higher number of parathyroid glands identified during surgery compared with the control group. The postoperative PTH and serum calcium levels at postoperative days 1 and 3 and at 6 months were significantly higher in the observation group than those in the control group. The incidence of postoperative hypoparathyroidism was significantly lower in the observation group.

Conclusion: The immunocolloidal gold strip method combined with nanocarbon negative imaging tracing technology is effective in identifying and preserving parathyroid glands during radical resection of DTC in elderly patients.

Objective: Obesity is a risk factor for joint arthroplasty complications. With this systematic review and meta-analysis, we assessed whether a positive history of bariatric surgery influences postoperative outcomes in patients undergoing various types of joint arthroplasty.

Methods: We conducted a comprehensive search database such as Scopus, PubMed, Medline Ovid, CNKI, and CENTRAL for studies comparing outcomes between patients undergoing arthroplasty with and without a history of bariatric surgery. We extracted data on short-term medical complications, venous thromboembolism (VTE), periprosthetic infections, superficial wound infections, hospital stay length, and operative time. We used the data to conduct meta-analyses using random-effects models and subgroup analyses based on the type of arthroplasty.

Results: Overall, 15 studies with nearly 150,000 participants were included. The analysis showed that prior bariatric surgery did not significantly affect overall medical complications post-arthroplasty, with OR of 0.968 (95%CI, 0.706-1.327). For VTE, the results similarly indicated no substantial difference, with an OR of 0.912 (95%CI, 0.644-1.291). In assessing periprosthetic infections, the OR was 0.754 (95%CI, 0.535-1.064), showing comparable rates between patients with and without a history of bariatric surgery.Regarding superficial wound infections, the analysis produced an OR of 2.390 (95%CI, 0.723-7.897), indicating variability but not statistical significance. Hospital stay length was reduced in patients with a history of bariatric surgery, reflected by SMD of -0.113 (95%CI, -0.221 to -0.005). Lastly, operative time also showed a significant reduction, with an SMD of -0.462 (95%CI, -0.865 to -0.059).

Conclusions: Prior bariatric surgery does not reduce the risk of short-term complications post-arthroplasty, but it seems to reduce the hospital stay length and operative time. The effects vary significantly across different types of joint arthroplasty, suggesting a need for tailored preoperative assessments and care protocols.

Protocol registration: This systematic review and meta-analysis was registered at PROSPERO, with the number: CRD42024539052.

Background: The incidence of lumbar disk herniation (LDH) is usually caused by lumbar disk degeneration. Surgery is a common treatment strategy for LDH, but it can recur, resulting in recurrent disk herniation (RDH).

Purpose: To explore the predictive value of hsa-miR-4741 and LILRB2 in the prognosis of LDH surgery and the mechanism of nucleus pulposus senescence.

Method: The ROC curves of RDH based on hsa-miR-4741 and LILRB2 were constructed to evaluate their predictive values in the prognosis of LDH surgery. Human nucleus pulposus cells (NPC) was treated by TNF-α to construct a cell senescence model, studying the senescence mechanism. Oxidative stress and senescence markers were detected after overexpression of hsa-miR-4741 and LILRB2 to evaluate their effects on the senescence of NPC. Dual luciferase assay and the transfection of hsa-miR-4741 mimics or inhibitor were used to investigate the targeted regulation of it to LILRB2.

Results: The combination of hsa-miR-4741 and LILRB2 showed higher accuracy in predicting the outcome of RDH (AUC = 0.9367), compared with a single molecule. Overexpression of hsa-miR-4741 enhanced TNF-α-induced oxidative stress and senescence, while LILRB2 overexpression had the opposite effect. Hsa-miR-4741 mimics attenuated the luciferase activity of NPC transfected with wt-LILRB2 vector and significantly down-regulated LILRB2 expression. In addition, the antioxidant NAC reversed the promotion of hsa-miR-4741 on NPC senescence.

Conclusion: The combination of hsa-miR-4741 and LILRB2 was a good predictor of LDH prognosis. Hsa-miR-4741 promoted oxidative stress-induced NPC senescence by negatively regulating LILRB2.

Background: Venous waveform analysis is an emerging technique to estimate intravascular fluid status by fast Fourier transform deconvolution. Fluid status has been shown proportional to f₀, the amplitude of the fundamental frequency of the waveform's cardiac wave upon deconvolution. Using a porcine model of distributive shock and fluid resuscitation, we sought to determine the influence of norepinephrine on f₀ of the central venous waveform.

Methods: Eight pigs were anesthetized, catheterized and treated with norepinephrine after precipitation of endotoxemic hypotension, and subsequent fluid resuscitation to mimic sepsis physiology. Hemodynamic parameters and central venous waveforms were continually transduced throughout the protocol for post-hoc analysis. Central venous waveform f₀ before, during and after norepinephrine administration were determined using Fourier analysis.

Results: Heart rate increased, while central venous pressure, pulmonary capillary wedge pressure and stroke volume decreased throughout norepinephrine administration (p < 0.05). Mean f₀ at pre-norepinephrine, and doses 0.05, 0.10, 0.15, 0.20 and 0.25 mcg/kg/min, were 2.5, 1.4, 1.7, 1.7, 1.6 and 1.4 mmHg², respectively (repeated measures ANOVA; p < 0.001). On post-hoc comparison to pre-norepinephrine, f₀ at 0.05 mcg/kg/min was decreased (p = 0.04).

Conclusions: As the performance of f₀ was previously characterized during fluid administration, these data offer novel insight into the performance of f₀ during vasopressor delivery. Central venous waveform f₀ is a decreased with norepinephrine, in concordance with pulmonary capillary wedge pressure. This allows contextualization of the novel, venous-derived signal f₀ during vasopressor administration, a finding that must be understood prior to clinical translation.

Background: For papillary thyroid cancer (PTC) patients, no consensus has been reached for the impact of diagnosis-to-treatment interval (DTI) on patient survival outcomes. We evaluated the impact of DTI on prognosis among patients with PTC.

Methods: Patients diagnosed as PTC were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2019. The initial treatment strategies include surgery, radiation therapy, chemotherapy, hormone, immunotherapy, and/or active surveillance according to the SEER. Patients were grouped as follows: (I) DTI 0 (interval < 1 month or immediate treatment), (II) DTI 1-3 months, (III) DTI 4-5 months, and (IV) DTI ≥6 months.

Results: A total of 168,969 patients with PTC were included in this cohort study. Median follow-up time was 84.0 months. No significant overall survival (OS) difference was observed between patients with immediate treatment and DTI 1-3 months. However, DTI 4-5 months and ≥6 months were associated with poorer OS compared to patients with immediate treatment. Although Kaplan-Meier analysis suggested slight TCSS differences between the delayed and immediate treatment groups, these disappeared after adjusting for tumor characteristics and treatment factors.

Conclusions: A short-term delay (1-3 months) had no significant impact on OS, whereas more than 3 months of DTI resulted in poorer OS. Notably, delayed treatment had no impact on TCSS. These findings suggest that short-term delays are unlikely to affect survival, supporting decision-making flexibility for patients with low-risk PTC within three months of diagnosis.

Background: In order to ascertain the safety and therapeutic efficacy of preoperative simulation in conjunction with three-dimensional (3D) printing modalities for the surgical management of tibiofibular diaphyseal fractures. We postulate that preoperative simulation and three-dimensional (3D) printing techniques have a significant impact on reducing the mean operative time, diminishing intraoperative blood loss, and decreasing the frequency of fluoroscopic.

Material and methods: Sixty patients with tibiofibular diaphyseal fracture were divided into the conventional surgery group (n = 30) and the 3D printing group (n = 30). In the 3D printing group, preoperative equal-ratio fracture models prepared using the 3D printing technique were used to perform preoperative simulation, guide the real surgical operation, examine implant reduction and placement as well as preoperative plate/screw size. The operation time, intraoperative bleeding, frequency of fluoroscopies, Visual Analog Scale (VAS), and Johner-Wruhs Scale were recorded.

Results: The operation time, blood loss, and the frequency of fluoroscopy during operation in the group with preoperative simulation and 3D printing were less than that in the conventional surgery group (p < 0.001). Meanwhile, the Visual Analog Scale (VAS) and Johner-Wruhs Scale were also improved in both groups.

Conclusion: The findings indicated that preoperative simulation and three-dimensional (3D) printing may facilitate the treatment of tibiofibular diaphyseal fractures, potentially enhancing preoperative planning and contributing to the precision and personalization of the surgical procedure. Thus, the application of this technology possesses considerable promise for future utilization in clinical practice.

Trial registry: Name of the registry: This study was registered in the Chinese Clinical Trial Registry; Trial registration number: ChiCTR2100052379.

Background: To evaluate the prognostic effect of endovascular treatment (EVT) in patients with acute base artery occlusion (ABAO) within 24 h of onset, and analyze the factors related to prognosis.

Methods: A retrospective analysis was conducted on all ABAO patients who received EVT within 24 h of onset in the neurology department of Baotou Central Hospital in Inner Mongolia from May 2016 to October 2022. Good prognosis was defined as a Modified Rankin Scale (mRS) score of 0-3 and poor prognosis mRS score of 4-6 at 90 day follow-up, and factors related to prognosis were analyzed.

Results: Among the 77 patients included in the analysis, 68 patients (88.3%) achieved recanalization (modified thrombolysis in cerebral infarction, mTICI 2b/3 grade). Thirty eight patients (49.4%) achieved an overall good prognosis. In univariate analysis, age, baseline Glasgow Coma Scale (GCS), baseline National Institutes of Health Stroke Scale (NIHSS), posterior circulation Acute Stroke Prognostic Early CT score (pc ASPECTS), preoperative intravenous thrombolysis, and mTICI2b-3 were factors affecting good prognosis. Multivariate analysis showed that shorter onset to puncture time (OR 0.069; 95% CI, 0.009-0.519; p = 0.009), lower NIHSS (OR 1.179; 95% CI, 1.019-1.364; p = 0.027), and higher pc ASPECTS (OR 0.489, 95% CI, 0.250-0.959, p = 0.037) were factors influencing good prognosis in this study.

Conclusions: In summary, endovascular treatment for patients with acute basilar artery occlusion is safe and effective, but EVT may achieve better prognosis within 6 h of onset. The shorter time from onset to puncture at admission, lower baseline NIHSS score, and higher baseline pc-ASPECTS are factors affecting the good prognosis of patients at 90 days.

Background: Standardized proximal gastrectomy for upper-third gastric cancer (UGC) is lacking due to the current methods' inability to prevent reflux and facilitate postoperative endoscopic monitoring surveillance. In this study, we provide a detailed description of proximal gastrectomy utilizing a new triangular muscle flap for esophagogastrostomy and evaluate the postoperative outcomes of this technique.

Method: A total of 17 patients diagnosed with early-stage primary UGC underwent laparoscopic proximal gastrectomy between May 2021 and May 2022. Subsequently, a new triangular muscle flap was used for esophagogastrostomy.

Results: No in-hospital deaths occurred during the study period. However, two patients experienced complications early in the study, including one case of pulmonary infection and another of abdominal abscess infection. Importantly, none of the patients exhibited any reflux symptoms. Postoperatively, 15 patients were diagnosed with grade N/M esophagitis, one with grade A, and one with grade B. All patients are currently alive without tumor recurrence.

Conclusions: This surgical technique can be safely performed and demonstrates excellent results in preventing gastroesophageal reflux. Further investigation through a multi-center clinical study is warranted to confirm its efficacy.

Objective: Non-small cell lung cancer (NSCLC) remains a major health concern due to its high incidence and mortality rates. This study aimed to investigate the role and underlying mechanism of the long non-coding X inactivation-specific transcript (lncRNA XIST)/microRNA-329-3p (miR-329-3p)/transmembrane BAX Inhibitor Motif-6 (TMBIM6) axis in the proliferation, migration, and invasion of NSCLC, and its potential as a therapeutic target.

Methods: The expression levels of XIST, miR-329-3p, and TMBIM6 in NSCLC tissues and cell lines were assessed using quantitative real-time PCR (qRT-PCR), and their correlations with clinicopathological characteristics were examined. Dual-luciferase reporter assays and RNA immunoprecipitation (RIP) were used to validate the binding interactions among XIST and miR-329-3p, and TMBIM6. The malignant phenotypes of NSCLC cells, including proliferation, migration, invasion, and apoptosis, were assessed using CCK-8, Transwell assays, and flow cytometry.

Results: Silencing XIST significantly suppressed the proliferation, migration, and invasion of NSCLC cells while promoting apoptosis. Mechanistically, XIST functioned as a competitive endogenous RNA (ceRNA), sponging miR-329-3p and thereby downregulating its expression. Overexpression of miR-329-3p counteracted the oncogenic effects of XIST in NSCLC cells. Additionally, miR-329-3p downregulated TMBIM6 expression, while TMBIM6 overexpression counteracted the tumor-suppressive effects of miR-329-3p.

Conclusion: Silencing XIST upregulates miR-329-3p, leading to the suppression of TMBIM6 expression and inhibition of NSCLC progression. These findings suggest that the XIST/miR-329-3p/TMBIM6 axis could serve as a promising molecular target for therapeutic strategies in NSCLC.