Journal of Investigative Surgery最新文献

Objective: This study aimed to observe the safe use of intraspinal anesthesia in geriatric orthopedic surgery and its effect on coagulation factors.

Methods: The anesthesia indices, cognitive functions, hemodynamic indicators, along with coagulation function indices were compared. The duration of anesthesia was compared between the two groups. Adverse reactions occurring in the two groups of patients were compared.

Results: The time to awaken, time to open eyes, time to the verbal statement, the onset of anesthesia, duration of sensory blockade, and duration of motor nerve blockade were shorter while the duration of analgesia was longer in the observation group than in the control group. The observation group's postoperative Mini-Mental State Examination scores were higher than those of the control group. Heart rate and mean arterial pressure of the patients in the observation group at 10 min after anesthesia and at the end of surgery were lower versus those in the control group. The observation group had lower levels of von Willebrand factor (%) and fibrinogen at 10 min after anesthesia and at the end of surgery than the control group, and lower levels of the thrombin-antithrombin complex at the end of surgery than the control group. The observation group exhibited a lower incidence of adverse reactions in contrast to the control group.

Conclusion: The application of intraspinal anesthesia in geriatric orthopedic surgery has a significant and remarkable effect, with less impact on patients' hemodynamics and postoperative cognitive function, and can improve patients' blood hypercoagulability.

Background: Fracture healing can be impeded or even compromised by various factors, resulting in a growing number of patients suffering. The lncRNA LINC-PINT has garnered attention for its latent role in enhancing fracture healing, but its specific functions in this process remain unclear.

Objectives: The primary objective of this study is to investigate the clinical relevance and underlying molecular mechanisms of LINC-PINT in delayed fracture healing (DFH), while also assessing its potential as an early diagnostic biomarker.

Materials and methods: The expression levels of LINC-PINT were measured in the serum of DFH patients and those with normal fracture healing using RT-qPCR. In MC3T3-E1 cells, the study investigated the influence on the expression of differentiation-related protein, cell viability, and apoptosis through the modulation of LINC-PINT and miR-324-3p. To elucidate the targeting relationship between LINC-PINT, miR-324-3p, and BMP2, a dual-luciferase reporter assay was employed.

Results: The findings revealed a significant downregulation of LINC-PINT expression in DFH patients. LINC-PINT showed high sensitivity and specificity as a diagnostic marker for DFH. In MC3T3-E1 cells, LINC-PINT overexpression markedly enhanced the expression levels of ALP, OCN, Runx2, and OPN, improved cell viability, and inhibited apoptosis. LINC-PINT negatively regulated miR-324-3p, and the effects of LINC-PINT were counteracted by miR-324-3p. LINC-PINT was found to regulate BMP2 by targeting miR-324-3p.

Conclusion: LINC-PINT could serve as an early diagnostic biomarker for DFH and slow the progression of DFH by modulating BMP2 through the targeted regulation of miR-324-3p. This research presents new molecular targets for the diagnosis and treatment of DFH.

Objectives: Hypermetabolism is associated with clinical prognosis of cancer patients. The aim of this study was to explore the association between basal metabolic rate (BMR) and postoperative clinical outcomes in gastric cancer patients.

Methods: We collected data of 958 gastric cancer patients admitted at our center from June 2014 to December 2018. The optimal cutoff value of BMR (BMR ≤1149 kcal/day) was obtained using the X-tile plot. Logistic and Cox regression analyses were then performed to evaluate the relevant influencing factors of clinical outcomes. Finally, R software was utilized to construct the nomogram.

Results: A total of 213 patients were defined as having a lower basal metabolic rate (LBMR). Univariate and multivariate analyses showed that gastric cancer patients with LBMR were more prone to postoperative complications and had poor long-term overall survival (OS). The established nomogram had good predictive power to assess the risk of OS in gastric cancer patients after radical gastrectomy (c-index was 0.764).

Conclusions: Overall, LBMR on admission is associated with the occurrence of postoperative complications in gastric cancer patients, and this population has a poorer long-term survival. Therefore, there should be more focus on the perioperative management of patients with this risk factor before surgery.

As far as we know, no report uses the Swenson transanal endorectal pull-through technique in an animal model. Our objective is to describe the use of this technique as an experimental model for training and research purposes. Ten Norfolk hybrid rabbits were randomly selected from our experimental laboratory, with a mean weight of 3539.3 (± 678.4) g. Neither colon preparation nor fast were used before the procedures. The surgical technique was based on the description performed by Levitt et al. (2013, J Pediatr Surg. 2013;48(11):2289-2295). Information related to the surgical procedures and the clinical evolution in the postoperative period were recorded and analyzed. There were no deaths or severe complications. The anesthetic and the surgical times were significantly higher for the first three animals of the experiment. Our animal model proved adequate to perform the transanal endorectal Swenson pull-through technique, allowing the training of surgical skills through a model similar to the human, with few anesthetic complications and good postoperative evolution, including postoperative follow-up. We believe that it will serve as a learning tool in many institutions that are continuously searching for improved new techniques and will support new researches in this area.

Objective: This investigation was to determine the relationship between changes in the expression levels of miR-134 and the E2F transcription factor 6 (E2F6) in mediating control of apoptosis in N-methyl-D-aspartate (NMDA)-induced glaucomatous mice.

Methods: Morphological and structural changes were quantitatively analyzed along with apoptosis in the retinal ganglion cell (RGC) layer, internal plexiform layer and RGCs. Glaucomatous RGCs were transfected, and cell viability and apoptosis were examined. The targeting relationship between miR-134 and E2F6 was analyzed, as well as their expression pattern.

Results: Intravitreal injection of NMDA induced a significant reduction in the number of RGCs and thinning of IPL thickness. miR-134 was highly expressed and E2F6 was lowly expressed in glaucoma mice. Suppression of miR-134 or E2F6 overexpression inhibited apoptosis in the glaucomatous RGCs and instead their proliferative activity. MiR-134 targeted inhibition of E2F6 expression. Suppressing rises in E2F6 expression reduced the interfering effect of miR-134 on glaucomatous RGC development.

Conclusion: Depleting miR134 expression increases, in turn, E2F6 expression levels and in turn reduces glaucomatous RGC apoptosis expression.

Background: Superior mesenteric artery syndrome (SMAS) is a rare condition, for which laparoscopic surgery was successfully performed safely and with long-term efficacy.

Methods: This single center retrospective clinical study comprised 66 patients with SMAS, surgically treated between January 2010 and January 2020, who were allocated to three different surgical groups according to their medical history and symptoms (Laparoscopic duodenojejunostomy, n = 35; Gastrojejunostomy, n = 16; Duodenojejunostomy plus gastrojejunostomy, n = 15). Patient demographics, surgical data and postoperative outcomes were retrieved from the medical records.

Results: All operations were successfully completed laparoscopically, and with a median follow-up of 65 months, the overall symptom score was significantly reduced from 32 to 8 (p < 0.0001) and the BMI was increased from 17.2 kg/m² to 21.8 kg/m² (p < 0.0001).

Conclusions: When conservative measures failed in the treatment of SMAS, laparoscopic surgery proved to be a safe and effective method. The specific surgical technique was selected according to the history and symptoms of each individual patient. To our knowledge, this study represents the largest number of laparoscopic procedures at a single center for the treatment of superior mesenteric artery syndrome.

Objective: The main purpose of the study was to explore the clinicopathological features and survival outcomes of patients with cervical cancer (CC) and adenomyosis and without the latter and to gain insight into the timely association between adenomyosis and CC.

Methods: 991 patients with CC and adenomyosis and 3964 patients without the latter were included in this retrospective cohort study. The clinicopathological characteristics including tumor size, depth of stromal invasion, presence of lymphovascular space invasion (LVSI), infiltration into vagina or uterine body, status of surgical vaginal margin, parametrial involvement, and pelvic or para-aortic lymph nodes metastasis were compared between the CC patients with/without coexisting adenomyosis by Student's t-tests, chi-square or Fisher's exact tests. The Cox proportional hazards model was employed to evaluate potential risk factors. Survival curves were constructed using the Kaplan-Meier method.

Results: Among the cervical cancer cohort, the coexistence of adenomyosis is associated with a lower likelihood of deep stromal invasion (50.2% vs 54.6%, p < 0.0001) and vaginal infiltration (25.8% vs 29.1%, p = 0.041) compared with CC patients without adenomyosis. There were no significant differences in tumor size, presence of LVSI, uterine body infiltration, status of surgical vaginal margin, parametrial involvement, and pelvic or para-aortic lymph nodes metastasis between both groups. However, adenomyosis did not remain as an independent prognostic factor for CC (HR 0.938, 95% CI: [0.72-1.22], p = 0.636) and did not reach statistical significance in the survival analysis (log rank test, p = 0.587).

Conclusion: CC patients with coexistent adenomyosis were associated with less aggressive tumor behavior including deep stromal invasion and vaginal infiltration. However, adenomyosis was not a prognostic factor for CC survival.

The human intestinal epithelium has an impressive ability to respond to insults and its homeostasis is maintained by well-regulated mechanisms under various pathophysiological conditions. Nonetheless, acute injury and inhibited regeneration of the intestinal epithelium occur commonly in critically ill surgical patients, leading to the translocation of luminal toxic substances and bacteria to the bloodstream. Effective therapies for the preservation of intestinal epithelial integrity and for the prevention of mucosal hemorrhage and gut barrier dysfunction are limited, primarily because of a poor understanding of the mechanisms underlying mucosal disruption. Noncoding RNAs (ncRNAs), which include microRNAs (miRNAs), long ncRNAs (lncRNAs), circular RNAs (circRNAs), and small vault RNAs (vtRNAs), modulate a wide array of biological functions and have been identified as orchestrators of intestinal epithelial homeostasis. Here, we feature the roles of many important ncRNAs in controlling intestinal mucosal growth, barrier function, and repair after injury-particularly in the context of postoperative recovery from bowel surgery. We review recent literature surrounding the relationships between lncRNAs, microRNAs, and RNA-binding proteins and how their interactions impact cell survival, proliferation, migration, and cell-to-cell interactions in the intestinal epithelium. With advancing knowledge of ncRNA biology and growing recognition of the importance of ncRNAs in maintaining the intestinal epithelial integrity, ncRNAs provide novel therapeutic targets for treatments to preserve the gut epithelium in individuals suffering from critical surgical disorders.

Objective: This article aimed to ascertain the application of problem-based learning (PBL) combined with micro-video teaching in burn surgery teaching and its impact on satisfaction with teaching.

Methods: Fifty clinical medical students who were interns at our hospital from November 2022 to October 2023 were selected as the study subjects and randomly separated into the control group (n = 25) and the observation group (n = 25). The control group adopted traditional teaching methods. The observation group employed PBL combined with micro-video teaching mode. The scores of theory tests and skill tests, the critical thinking capability, the students' evaluation of teaching methods, the scores of teachers for teaching methods, and the scores of interns for teaching satisfaction were compared.

Results: The observation group possessed higher scores on theory tests and skill tests, greater critical thinking ability after teaching, higher evaluation of teaching methods and more satisfaction with their internships versus the control group (all p < 0.05).

Conclusion: The application of PBL combined with micro-video teaching in the teaching of burn surgery can improve students' thinking ability and their satisfaction with teaching.

Background: This project aims to shed light on how various treatment approaches affect RCC patients' chances of survival and create a prediction model for them.

Methods: Data from the Surveillance, Epidemiology, and End Results database were used in this investigation. OS and RCSS after radiation, chemotherapy, and surgery were investigated using the Kaplan-Meier approach. Fourteen factors, including gender, age, race, and others, were subjected to univariate and multivariate COX analyses. Predicting RCSS at three, five, or ten years is the main goal. Predicting OS at three, five, or ten years is the secondary endpoint. Cox analyses, both univariate and multivariate, were used to identify prognostic factors. Furthermore, a nomogram was developed to precisely forecast patient survival rates at 3-, 5-, and 10-year intervals. DCA, calibration curves, and ROC were used to assess the nomogram's efficacy.

Results: Kaplan-Meier analysis revealed that PN was associated with better survival compared to RN for tumors ≤10 cm. Cox analysis identified 10 independent prognostic factors. These variables included gender, age, race, histological type, histological grade, AJCC stage, N stage, T stage, M stage, and surgical type. Based on these variables, a nomogram for OS and RCSS prediction was created.

Conclusion: PN is advised over RN for RCC patients whose tumors are less than 10 cm in diameter since it offers more advantages. The combined nomogram model, which is based on clinicopathological characteristics, therapy data, and demographic variables, may be used to predict the survival of RCC patients and perform prognostic and survival analysis with accuracy.