Journal of Investigative Surgery最新文献

Objective: Gene mutations in tumor cells can lead to several unique metabolic phenotypes, which are crucial for the proliferation of cancer cells. EGFR mutation (EGFR-mt) is the main oncogenic driving mutation in lung adenocarcinoma (LUAD). HIF-1 α and PKM2 are two key metabolic regulatory proteins that can form a feedback loop and promote cancer growth by promoting glycolysis. Here, the linkage between EGFR mutational status and HIF-1α/PKM2 feedback loop in LUAD were evaluated.

Methods: Retrospective study were performed on LUAD patients (n = 89) undergoing first-time therapeutic surgical resection. EGFR mutation was analyzed by real-time PCR. Immunohistochemistry was used to measure the expressions of HIF-1α and PKM2.

Results: We found that the protein expressions of HIF-1α and PKM2 were significantly higher in LUAD than normal lung tissues. In adenocarcinomas, the two protein expressions were both correlated with worse pTNM stage. Moreover, the correlation between the proteins of HIF-1α/PKM2 feedback loop and the EGFR mutational status were also analyzed. We found that EGFR-mt tumors showed higher HIF-1α and PKM2 proteins compared to tumors with EGFR wild-type. Meanwhile, HIF-1α expression was significantly correlated with higher pTNM stage, and PKM2 showed a similar trend, only in EGFR-mutated tumors. The expression of HIF-1α was positively correlated with PKM2 in LUAD, furthermore, this correlation was mainly in patients with EGFR-mt.

Conclusion: Different expression and clinical features of HIF-1α/PKM2 feedback loop was existed between LUAD and normal lung tissues, especially in EGFR mutational tumors, supporting the relationship between EGFR mutation and the key related proteins of aerobic glycolysis (HIF-1α and PKM2) in lung adenocarcinomas.

Background and objectives: Fournier's gangrene (FG) is a polymicrobial-induced necrotizing fasciitis that affects the deep and superficial tissues of the perineal, perianal, scrotal, and genital regions. This study aimed to investigate the role of C-reactive protein (CRP)/lymphocyte and neutrophil/lymphocyte ratios, which are objective markers of inflammatory response, in predicting mortality in patients with FG.

Patients and methods: Seventy-one patients who underwent surgery for FG between 2019 and 2023 were evaluated retrospectively. Demographic and clinical characteristics, laboratory results, the FG severity index (FGSI) score, and the CRP/lymphocyte and neutrophil/lymphocyte ratios were analyzed for the patient groups with and without in-hospital mortality.

Results: The characteristics of the patients with and without mortality were compared. A total of 71 patients, 51 (71.8%) males and 20 (28.2%) females, were evaluated. Eight patients died during treatment. The median age was 67 (56-86) years in the mortality group and 58 (27-82) years in the non-mortality group. Statistically significant differences were observed between the two groups in terms of age, lymphocyte count, CRP/lymphocyte, neutrophil/lymphocyte, potassium, blood urea nitrogen, and FSGI. In the receiver operating characteristic analysis of the CRP/lymphocyte and neutrophil/lymphocyte ratios, the cutoff values were calculated as 183.3 and 19.93, respectively. By comparing the data between the mortality and non-mortality groups, the sensitivity and specificity rates of these ratios were also determined.

Conclusion: The CRP/lymphocyte and neutrophil/lymphocyte ratios may be important parameters in predicting mortality in patients with FG.

Background: To evaluate the new preoperative Changgung classification (CC) system of portal vein thrombosis (PVT) in choosing suitable operative procedures to reconstruct portal veins during liver transplantation (LT) in patients with portal vein cavernous transformation (PVCT).

Methods: This retrospective observational study analyzed data from allograft LTs performed for various liver diseases.

Results: The study included 22 males and 4 females with LT indications comprising cirrhosis (n = 9), hepatocellular carcinoma (n = 12), PVCT (n = 2), liver failure from fulminant hepatitis B (n = 1), dysfunction of transplanted liver (n = 1), and chronic rejection of transplanted liver (n = 1). Patients were classified according to Yerdel (21 Yerdel II and 5 Yerdel III) and CC (C1-C5). In total 16 simple operations were performed on C1-C3 cases and 9 complex operations on C4-C5 cases, with one additional simple operation. The distribution according to the Yerdel classification was 16 simple and 5 complex operations in Yerdel II cases and 1 simple and 4 complex operations in Yerdel III cases. The median follow-up time was 27.5 months with overall one-year and three-year OS rates of 88.1% and 83.9% for the cohort. Specifically, the one-year OS rates for patients classified as C1-3 vs. C4-5 were 93.3% and 80.0%, while the three-year OS rates were 86.7% and 80.0%, respectively (p = 0.526).

Conclusion: The CC proposed in this study shows comparable potential to the Yerdel classification in preoperatively identifying the need for complex surgical techniques in LT patients with PVCT and may also have predictive power for the survival benefits following LT.

Objective: Single-port laparoscopic surgery (SPLS) is an effective, minimally invasive, feasible, and promising surgical technique for the treatment of various benign and malignant gynecological diseases. This study aimed to evaluate the differences in surgical conditions, complications, and esthetic incisions between SPLS and traditional laparoscopic surgery (TLS) in benign gynecological surgeries.

Methods: Fifty-one eligible patients were included, and their general information (age, surgical approach), surgical conditions (surgical time, blood loss, postoperative first flatus), postoperative pain, and incision healing were collected.

Results: There was a significant difference in the results of hysterectomy between the two groups. The surgical time in the SPLS group was significantly shorter than that in the TLS group (p = 0.026). Furthermore, the SPLS group had less blood loss (p < 0.05) and earlier postoperative first flatus (p < 0.05) than the control group. There was no significant difference in postoperative conditions between the two groups. During the follow-up, it was found that the Vancouver Scar Scale score was 8.37 ± 2.30 in the control group and 6.81 ± 2.14 in the study group. The cosmetic effect and satisfaction were better in the SPLS group (p = 0.018). Subgroup analysis showed that in other benign gynecological diseases without uterine lesions, SPLS significantly improved surgical time, intraoperative blood loss, and postoperative first flatus (p < 0.05).

Conclusion: SPLS demonstrated good clinical efficacy in benign gynecological surgery, with shorter surgical time, less blood loss, earlier postoperative first flatus, fewer complications, and better cosmetic effects of scars.

Background: Transcutaneous Electrical Acupoint Stimulation (TEAS) is a technique that involves stimulating specific acupoints on the body with electrical currents. It may regulate nerve excitability and improve nerve function. This study aimed to assess the impact of TEAS on gastrointestinal motility, nutrition, and immune function in patients post cerebrovascular accident surgery in the intensive care unit (ICU).

Methods: A randomized controlled trial included 300 post-cerebrovascular surgery patients at Lishui Central Hospital (January 2021-June 2023). Patients were randomly assigned to TEAS or control groups in a 1:1 ratio. The TEAS group received TEAS at bilateral Zusanli (ST36), Shangjuxu (ST37), Tianshu (ST25), Neiguan (PC6), and Hegu (LI4) according to the International Acupuncture Point Code, plus standard care. The control group received routine enteral nutrition and sham TEAS. Nutritional, immune, and gastrointestinal motility indicators were compared.

Results: A randomized controlled trial involving 300 post-surgery patients compared TEAS to sham TEAS, demonstrating significant enhancements (p < 0.05) in immune function and gastrointestinal motility. Compared to the control group, the TEAS group showed significant improvements in the patient's serum nutritional levels (prealbumin, albumin, hemoglobin, and total protein), immune status (IgG, IgA, IgM, and CD4+/CD8+), gastrointestinal motility (daily gastric residual volume, time to achieve target feeding volume, time for nutritional fluid to meet standards, time to first bowel movement, time to first passage of activated charcoal stool, time to reach the defecation volume), and overall condition (the scores of clinical scales and ICU stay duration) (p < 0.05). The TEAS group also experienced a significantly lower incidence of adverse events (p < 0.05).

Conclusions: Early TEAS intervention positively impacted recovery, shortened ICU stay, and improved outcomes in patients post cerebrovascular accident surgery.

Objective: This study developed a nomogram combining longitudinal and transverse ultrasound radiomics with clinical factors to identify human epidermal growth factor receptor 2 (HER2) status in invasive breast cancer (BC).

Materials and methods: We analyzed 537 invasive BC patients from two hospitals: 436 in the training cohort (Hospital A) and 101 in the test cohort (Hospital B). From longitudinal and transverse ultrasound planes, 788 radiomics features were extracted, with dimensionality reduced using least absolute shrinkage and selection operator regression. A radiomics nomogram integrating clinical predictors and radiomics scores (Rad-scores) was constructed.

Results: Fifteen and sixteen features from longitudinal and transverse ultrasound planes, respectively, were selected to generate Rad-scores, which differed significantly between HER2-positive and HER2-negative groups in both cohorts (p < 0.05). The combined radiomics model outperformed individual models with AUCs of 0.783 and 0.762 in the training and external test cohorts, respectively. Tumor size was an independent clinical predictor. The nomogram, incorporating Rad-scores and tumor size, achieved AUCs of 0.790 (training cohort) and 0.774 (test cohort). Decision curve analysis demonstrated its potential clinical utility.

Conclusion: A biplanar ultrasound radiomics nomogram effectively predicts HER2 status in invasive BC, potentially reducing the need for biopsies and supporting personalized treatment strategies.

Purpose: Limited attention was paid to focus on rectal melanomas (RM). This study aimed to evaluate the survival rate and prognostic factors of RM.

Methods: The data for patients with RM from Surveillance, Epidemiology, and End Results (SEER) database were used to analyze tumor survival. Kaplan-Meier method and log-rank test were employed to estimate cancer-specific survival (CSS) and overall survival (OS). A nomogram was established based on the risk factors of survival by the forest plot for multivariate Cox regression analysis. Receiver operating characteristic (ROC) and calibration curve were conducted for validation.

Results: A total of 187 patients with RM were selected to perform survival analyses. The median survival time of OS was 12 months (range: 0-146 months), and the median survival time of CSS was 12 months (range: 0-74 months). Patients' age, tumor size, stage, the number of nodes examined, surgery, and radiation were identified as prognostic indicators for CSS by the forest plot for multivariate Cox regression analysis. The nomogram was validated as a reliable model for CSS.

Conclusion: Clinicopathologic relevance with tumor prognosis was confirmed in this study. Our nomogram can provide a relatively accurate prediction of the survival rate of patients with RM.

Purpose: Readmission is one of the measures of quality of care and potential costs. This study aimed to determine whether lactate dehydrogenase (LDH) is associated with an increased risk of 30-day readmission in gastric cancer.

Methods: We performed a retrospective study of patients who underwent radical gastrectomy for gastric cancer at our institution between July 2014 and May 2018. Balanced cohorts were created by propensity score matching (PSM) with a 1:1 ratio to generate the elevated LDH (ELDH) group (n = 151) and the low LDH group (Control) (n = 302). To determine the incidence, causes, and risk factors of 30-day readmission, subgroup analyzes were performed and used to develop an efficient prediction model.

Results: A total of 788 patients met the criteria to be included in the study. The cutoff value for serum LDH was 215.5. After PSM, a total of 302 patients were matched in pairs (ELDH group, n = 151, Control group, n = 151). ELDH levels had a higher risk of readmission (p = 0.005, Odds ratio 3.768, 95% confidence interval 1.493-9.510). The pre-match 30-day readmission rate was 7.2 percent, and common causes of post-match readmission included infection-related symptoms, gastrointestinal symptoms, and gastrointestinal bleeding.

Conclusions: Patients with preoperative ELDH levels, postoperative complications, and high preoperative American Society of Anesthesiologists Scores had a higher risk of readmission 30 days after surgery.