Journal of Investigative Surgery最新文献

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.

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.

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.

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.

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.