Journal of Investigative Surgery最新文献

Background and purpose: The optimal surgical approach for inguinal hernia (IH) repair in adolescents has not been established. This study aimed to analyze and compare the perioperative results and long-term outcomes of adolescent patients with IH treated with laparoscopic (LHR) versus open hernia repair (OHR).

Methods: This study retrospectively reviewed the clinicopathological data of adolescent patients with IH who underwent LHR or OHR as initial treatment from March 2012 to February 2018 at Xinxiang Central Hospital. Clinicopathological factors associated with the prognosis of patients were identified using univariate and multivariate Cox regression analysis. Recurrence-free survival (RFS) curves between different cohorts of patients were generated using the Kaplan-Meier method and compared using the log-rank test. Propensity score matching (PSM) analysis was used to match patients of the LHR and OHR groups in a 1:1 ratio.

Results: Adolescent patients with IH were enrolled, including 243 patients in the LHR group and 252 patients in the OHR group. After PSM, 189 patients were matched in each of the study group. Compared with the OHR group, the LHR group had a shorter hospitalization, less blood loss, fewer overall postoperative complications and lower rates of recurrence and chronic pain. The LHR group had a significantly better RFS than the OHR group before and after PSM.

Conclusions: Laparoscopic inguinal hernia repair for adolescent patients with IH can be safely performed with favorable perioperative and long-term outcomes.

Background: Temporary stoma formation is common in Crohn's disease (CD), while stoma reversal is associated with postoperative morbidity. This study aimed to evaluate the postoperative outcomes of split stoma reversal, SSR (i.e., exteriorization of proximal and distal ends of the stoma through a small common opening) and end stoma closure, ESC (i.e., the proximal stump externalized, and distal end localized abdominally.

Methods: Patients with CD who underwent stoma reversal surgeries between January 2017 and December 2021 were included. Demographic, clinical, and postoperative data were collected and analyzed to evaluate outcomes of reversal surgery.

Results: A total of 255 patients who underwent stoma reversal surgeries met the inclusion criteria. SSR was superior to ESC in terms of operative time (80.0 vs. 120.0, p = 0.0004), intraoperative blood loss volume (20.0 vs. 100.0, p = 0.0002), incision length (3.0 vs. 15.0, p < 0.0001), surgical wound classification (0 vs. 8.3%, p = 0.04), postoperative hospital stay (7.0 vs. 9.0, p = 0.0007), hospital expense (45.6 vs. 54.2, p = 0.0003), and postoperative complications (23.8% vs. 44.3%, p = 0.0040). Although patients in the ESC group experienced more surgical recurrence than those in the SSR group (8.3% vs. 3.2%) during the follow-up, the Kaplan-Meier curve analysis revealed no statistical difference (p = 0.29).

Conclusions: The split stoma can be recommended when stoma construction is indicated in patients with Crohn's disease.

Objective: This study harnesses the power of text mining to quantitatively investigate the causative factors of falls in adult inpatients, offering valuable references and guidance for fall prevention measures within hospitals.

Methods: Employing KH Coder 3.0, a cutting-edge text mining software, we performed co-occurrence network analysis and text clustering on fall incident reports of 2,772 adult patients from a nursing quality control platform in a particular city in Jiangsu Province, spanning January 2017 to December 2022.

Results: Among the 2,772 patients who fell, 80.23% were aged above 60, and 73.27% exhibited physical frailty. Text clustering yielded 16 distinct categories, with four clusters implicating patient factors, four linking falls to toileting processes, four highlighting dynamic interplays between patients, the environment, and objects, and another four clusters revealing the influence of patient-caregiver interactions in causing falls.

Conclusion: This study highlights the complex, multifactorial nature of falls in adult inpatients. Effective prevention requires a collaborative effort among healthcare staff, patients, and caregivers, focusing on patient vulnerabilities, environmental factors, and improved care coordination. By strengthening these aspects, hospitals can significantly reduce fall risks and promote patient safety.

Background: The high invasion and heterogeneity of head and neck squamous cell carcinoma (HNSCC) commonly leads to poor clinical outcomes. Identification of reliable biomarkers for HNSCC is imperative.

Methods: The targeted gene with the highest mutation was screened out in cBioPortal database, and the interactive microRNAs (miRNAs) were identified by miRNA-mRNA co-expression analysis. CCK-8 and transwell assays were used to explore the proliferative, migrative, and invasive behaviors of HNSCC cells. The dual-luciferase reporter assay and cell transfection experiment were conducted. The role of miR-15a-5p was investigated in the in vivo xenograft mouse model.

Results: ATP binding cassette transporter 1 (ABCB1) had the highest mutation frequency and multiple mutation types in HNSCC, and the decreased ABCB1 was significantly related to better prognosis of HNSCC patients. MiR-15a-5p was a regulator for ABCB1, which was up-regulated after miR-15a-5p inhibition in vitro. Furthermore, the miR-15a-5p knockdown significantly suppressed HNSCC cell proliferation, migration, and invasion in vitro, and reduced the HNSCC tumor growth and migration capabilities in vivo, possibly through NF-κB signaling pathway.

Conclusion: Collectively, miR-15a-5p knockdown increased the ABCB1 level and abated the HNSCC progression via the NF-κB signaling pathway. ABCB1 and miR-15a-5p were underlying predictors for HNSCC therapeutic biomarkers.

Objective: To construct and internally validate a nomogram that predicts the likelihood of postoperative delirium in a cohort of elderly individuals undergoing hip arthroplasty.

Methods: Data for a total of 681 elderly patients underwent hip arthroplasty were retrospectively collected and divided into a model (n = 477) and a validation cohort (n = 204) according to the principle of 7:3 distribution temporally. The assessment of postoperative cognitive function was conducted through the utilization of The Confusion Assessment Method (CAM). The nomogram model for postoperative cognitive impairments was established by a combination of Lasso regression and logistic regression. The receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA) were used to evaluate the performance.

Results: The nomogram utilized various predictors, including age, body mass index (BMI), education, preoperative Barthel Index, preoperative hemoglobin level, history of diabetes, and history of cerebrovascular disease, to forecast the likelihood of postoperative delirium in patients. The area under the ROC curves (AUC) for the nomogram, incorporating the aforementioned predictors, was 0.836 (95% CI: 0.797-0.875) for the training set and 0.817 (95% CI: 0.755-0.880) for the validation set. The calibration curves for both sets indicated a good agreement between the nomogram's predictions and the actual probabilities.

Conclusion: The use of this novel nomogram can help clinicians predict the likelihood of delirium after hip arthroplasty in elderly patients and help prevent and manage it in advance.

Aim: This study aimed to evaluate the relationship between secreted frizzled-related protein 5 (SFRP5) expression and fluorine 18-fluoro-deoxyglucose (18 F-FDG) uptake imaged with positron emission tomography/tomography (PET/CT) in patients with non-small cell lung cancer (NSCLC). In addition, we sought to elucidate the potential role and mechanism of action of SFRP5 in NSCLC.Materials and methods: The maximum standardized uptake value (SUVmax) of the lesions was calculated. SFRP5 expression was analyzed using quantitative reverse transcriptase polymerase chain reaction (qRT-PCR). The correlation between SFRP5 expression and SUVmax was evaluated using Pearson's correlation analysis. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), flow cytometry, wound healing, and transwell assays were used to analyze cell viability, apoptosis, migration, and invasion, respectively.Results and conclusion: The results indicated that the SUVmax was higher in patients with NSCLC than that in healthy volunteers. Moreover, SFRP5 expression was lower in tissues from the four types of NSCLC than that in the adjacent normal tissues. SUVmax negatively correlated with SFRP5 expression in the four types of NSCLC. In addition, up-regulation of SFRP5 decreased the viability, migration, and invasion abilities, and increased apoptosis of NSCLC cells. Furthermore, SFRP5 inhibited the Wnt/β-catenin pathway in NSCLC cells. In conclusion, SFRP5 modulates the biological behaviors of NSCLC through Wnt/β-catenin pathway.

Objective: The influence of serum sodium level changes on septic patient survival after cardiopulmonary bypass surgery is not clear. We attempted to figure out the impact of serum sodium trajectory changes on the 30-day mortality rate of such patients.

Methods: The Medical Information Mart for Intensive Care (MIMIC)-IV database was searched to gather patients who developed sepsis after cardiopulmonary bypass surgery. A group-based trajectory model (GBTM) was employed to determine the serum sodium trajectory within 72 h of ICU admission. Patients' survival differences between different trajectory groups were compared using Kaplan-Meier (K-M) survival curves. Cox regression models were further employed to explore the correlation between survival status and serum sodium trajectory.

Results: 1,038 eligible patients were involved in this project. GBTM identified 3 serum sodium trajectories, all showing a trend of initial decrease followed by an increase. K-M curve analysis uncovered a notable difference in 30-day survival status between Class 1 and Class 2 (Log-rank p = 0.039), while no obvious differences were observed between other groups. Cox hazard analysis revealed that in the three models adjusting for different covariates, Class 2 was connected with the increased risk of survival (OR > 1, p < 0.05).

Conclusion: Higher serum sodium trajectory is linked with elevated 30-day death risk in septic patients following cardiopulmonary bypass surgery. Repressing high levels of serum sodium may be beneficial for patient survival.

Background: Malignant melanoma, a highly aggressive skin cancer, has remarkable incidence and mortality nowadays. This study aims to explore prognostic factors associated with nonmetastatic cutaneous melanoma of the limbs and to develop nomograms for predicting overall survival (OS) and cancer-specific survival (CSS).

Methods: The study cohort was derived from the Surveillance, Epidemiology, and End Results database. Univariate Cox regression, Lasso regression, and multivariate Cox regression analyses were conducted to identify prognostic factors and construct nomograms. The receiver operating characteristic (ROC) curve, time-dependent C-index, calibration curve, decision curve analysis (DCA) and Kaplan-Meier method were used to evaluate the accuracy and clinical applicability of the nomograms.

Results: A total of 15,606 patients were enrolled. Multivariate analysis identified several prognostic factors for OS and CSS including age, sex, histologic type, N stage, tumor thickness, depth of invasion, mitotic rate, ulceration, surgery of primary site, systemic therapy, race, and number of lymph nodes examined. A nomogram incorporating 12 independent predictors for OS was developed, with a C-index of 0.866 (95% confidence interval [CI]: 0.858-0.874) in the training cohort and 0.853 (95% CI: 0.839-0.867) in validation. For CSS, 10 independent predictors and one related factor were included, yielding a C-index of 0.913 (95% CI: 0.903-0.923) in the training cohort and 0.922 (95% CI: 0.908-0.936) in validation. The ROC curve, time-dependent C-index, calibration curve, DCA, and K-M plot demonstrated favorable discrimination, calibration, and clinical utility.

Conclusion: The developed nomograms provide a precise and personalized predictive tool for risk management of patients with nonmetastatic limb melanoma.

Purpose: To compare the clinical and radiological results of the anterior approach versus the posterior approach versus the anterior-posterior approach for the treatment of thoracolumbar burst fractures.

Methods: The network meta-analysis was performed in accordance with the PRISMA Statement. Electronic searches of PubMed and Embase were conducted up to June 22, 2023, for relevant randomized controlled trials. STATA13.0 was used to perform network meta-analysis. p < .05 was considered significant.

Results: Nine RCTs with a total of 550 patients receiving surgical treatment in at least two of the three approaches, including anterior, posterior and anterior-posterior approaches, were included. The surgical duration and intraoperative bleeding volume in the posterior approach were significantly lower than those in the anterior (SMD, -1.72; 95% CI, -2.82, -0.62) and anterior-posterior approaches (SMD, 3.33; 95% CI, 1.65, 5.00). The surgical duration in the anterior approach was significantly lower than that in the anterior-posterior approach (SMD, 1.61; 95% CI, 0.12, 3.10). The Cobb angle in the anterior-posterior approach was significantly lower than that in the anterior approach (MD, -4.83; 95% CI, -9.60, -0.05). The VAS score in the posterior approach was significantly higher than that in the anterior approach (MD, 0.85; 95% CI, 0.55, 1.16) and anterior-posterior approach (MD, -0.84; 95% CI, -1.12, -0.55). No significant difference was identified among the three surgical approaches in implant failure rate and infection rate.

Conclusion: All three approaches were safe approaches with advantages and disadvantages. The selection of surgical approaches for the treatment of thoracolumbar burst fractures may be individualized.