Journal of Investigative Surgery最新文献

Purpose: To introduce a modified intrascleral suture technique (MIST) for repairing iridodialysis combined with phacoemulsification cataract surgery and evaluate its efficacy.

Methods: We retrospectively analyzed the clinical characteristics and surgical outcomes of patients undergoing iridodialysis repair and cataract surgery (2018-2023). Twelve eyes received MIST, and eleven received the modified sewing-machine technique (MSMT). Both techniques utilized the closed-chamber sewing-machine principle of suture loop formation. MIST utilized a 10-0 polypropylene suture with long straight and short curved needles, guided by a 26-gauge syringe tip for intrascleral suturing. MSMT involved creating a partial-thickness scleral tunnel, through which a prethreaded needle with 10-0 polypropylene suture was passed for fixation.

Results: Iridodialysis was successfully repaired in all patients. The median procedure time was significantly shorter in the MIST group (25 min, IQR: 24.0-27.5) than in the MSMT group (34 min, IQR: 29.0-35.0; p < 0.0001). Although postoperative day 1 best-corrected visual acuity (BCVA) did not differ significantly between groups (p = 0.08), the median BCVA was better in the MIST group (0.1 logMAR, IQR: 0.0-0.4) than the MSMT group (0.4 logMAR, IQR: 0.1-0.6). Complication rates were comparable between groups.

Conclusion: The MIST technique provides a minimally invasive alternative for iridodialysis repair by eliminating the need for conjunctival or scleral dissection. This approach significantly reduces operative time while maintaining surgical efficacy and safety, making it a valuable option for combined iridodialysis and cataract surgery.

Background: Malignant anorectal melanoma (AM) is a rare tumor characterized by its aggressive behavior. To date, there has been no comprehensive investigation into the association between the log odds of positive lymph nodes (LODDS) and the prognosis of patients with malignant AM who have undergone surgical intervention.

Methods: Data were extracted from the Surveillance, Epidemiology and End Results (SEER) database for patients diagnosed with primary malignant AM who have undergone surgical intervention between 2000 and 2021. The Kaplan-Meier (KM) method with the log-rank test was used to compare survival curves between different LODDS groups. Multivariate Cox models were employed to evaluate the independent association between LODDS and overall survival (OS). An analysis to explore the potential influence of unmeasured confounders on the relationship between LODDS and OS was conducted using the E value.

Results: The study included a total of 126 eligible patients. KM analysis revealed that patients with low LODDS exhibited significantly improved OS compared to those with high LODDS (p < 0.001). The multivariate Cox analysis demonstrated that LODDS was independently associated with OS. The calculated E value suggested that the potential impact of unmeasured confounders on the association between LODDS and OS was likely minimal.

Conclusion: The findings indicate that LODDS is independently associated with the prognosis of patients with AM undergoing surgical intervention. These results may enhance clinicians' understanding of the prognosis of this rare malignancy and provide a basis for guiding therapeutic decisions.

Objective: The correlation between atrial fibrillation (AF) and atherosclerosis remains inadequately elucidated. This study sought to examine the correlation between AF and atherosclerosis risk in patients with acute lower limb ischemia (ALLI).

Methods: This retrospective cohort study involved 175 patients with ALLI admitted to our hospital from May 2015 to May 2023, all of whom underwent CT angiography (CTA). We gathered data on patient demographics, risk factors, ischemic sites, and CTA results to explore the correlation between AF and atherosclerosis.

Results: AF was present in 46 out of 175 patients (26.3%). In the AF group, 25 patients (54.3%) were rated as IIb according to the Rutherford classification. According to the Trans-Atlantic Inter-Society Consensus II (TASC II) classification, 4 patients (9.3%) were classified as Grade D in the aorto-iliac lesions, while 19 patients (41.9%) were classified as Grade D in the femoral-popliteal lesions. The median calcification score was 1.3 ± 1.3 for the aorto-iliac lesions and 0.5 ± 0.8 for the femoral-popliteal lesions. Multiple logistic analyses showed a significant negative correlation between AF and atherosclerosis in the aorto-iliac and femoral-popliteal lesions.

Conclusions: This retrospective study indicates that AF is linked to a decreased risk of aorto-iliac and femoral-popliteal atherosclerosis in patients with ALLI, with significant variations in these associations upon adjustment for confounding factors. This finding contests established assumptions and requires validation through extensive, prospective cohort studies and fundamental research to clarify the underlying mechanisms.

Background: This study aimed to compare the operative outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and total laparoscopic hysterectomy (TLH). We also aimed to determine the feasibility of performing vNOTES hysterectomy in primary hospitals.

Methods: This prospective cohort study enrolled 54 patients with indications for hysterectomy related to benign uterine disease without prolapse, between September 1, 2020, and November 30, 2024. The patients were categorized into two groups: vNOTES hysterectomy and TLH (n = 27 each). Surgical outcomes, including operative time, blood loss, recovery parameters, and complications, were assessed.

Results: Preoperative baseline characteristics were comparable between the two groups. The vNOTES group had a longer mean operative time (187.6 vs. 154.4 min, p < 0.05) and greater median blood loss (100 vs. 30 mL, p < 0.05) compared to the TLH group. However, there were no significant differences in conversion rates, uterine weights, complications, 24-h pain scores, hospital stay, costs, or readmission rates. The vNOTES group demonstrated shorter times to postoperative ambulation, earlier return of bowel function (anal exhaust), and reduced urinary catheter insertion duration (p < 0.05).

Conclusion: vNOTES hysterectomy is feasible in primary hospitals, with surgical outcomes comparable to those of TLH. Patients who underwent vNOTES experienced faster recovery, indicating that it serves as a potential minimally invasive alternative to TLH. However, the small sample size warrants further studies to validate these findings.

Background: Total hip arthroplasty (THA) in elderly patients is often associated with significant perioperative pain. This study aimed to evaluate the analgesic efficacy of fascia iliaca compartment block (FICB) and pericapsular nerve group block (PENGB) in elderly patients undergoing THA.

Methods: This retrospective study included two patient groups: the PENGB group (n = 62) and the FICB group (n = 64). The primary outcome was the analgesic efficacy, assessed using Visual Analog Scale (VAS) pain scores at multiple postoperative time points. Secondary outcomes included motor blockade, the time to first rescue analgesia, postoperative analgesia quality and systemic inflammatory responses.

Results: PENGB provided significantly superior analgesia at 6 and 12 h postoperatively, as evidenced by lower VAS pain scores compared to the FICB group. Motor blockade was also less pronounced in the PENGB group at 3 and 6 h post-surgery. The time to first rescue analgesia was significantly longer in the PENGB group, indicating more sustained pain control. Additionally, PENGB was associated with reduced use of patient-controlled analgesia pumps and lower total sufentanil consumption. At 24 h postoperatively, interleukin-6 levels were significantly lower in the PENGB group, suggesting an attenuated inflammatory response.

Conclusions: Compared to FICB, PENGB provided superior analgesia in elderly patients undergoing THA.

Background: Ischemia-reperfusion injury is a well-recognized challenge in reconstructive flap surgery, often leading to partial or total tissue necrosis. In this experimental study, we aimed to evaluate the protective effects of lutein-a non-provitamin A carotenoid known for its antioxidant and anti-inflammatory actions-against ischemia-reperfusion -induced damage in a rat epigastric flap model.

Methods: Sixteen Sprague-Dawley rats were randomized to receive either intraperitoneal lutein (0.5 mg/kg) or saline prior to inducing 10 h of ischemia. Flap viability was assessed macroscopically on postoperative day 10, and biochemical and histopathological analyses were conducted to explore underlying mechanisms.

Results: Compared to controls, lutein-treated animals demonstrated significantly larger flap survival areas (21.18 ± 0.88 cm² vs. 8.42 ± 1.15 cm², p < 0.05), lower malondialdehyde levels (p < 0.01) and myeloperoxidase levels (p < 0.05), and higher glutathione (p < 0.05) and nitric oxide concentrations (p < 0.01), suggesting reduced oxidative stress and improved vascular function. Histological examination revealed less necrosis, edema, and neutrophil infiltration in the Lutein group, alongside enhanced fibroblast activity, collagen deposition, and neovascularization. Additionally, increased epidermal thickness and a notable rise in lymphocyte infiltration indicated the potential modulation of the adaptive immune response during repair.

Conclusion: Taken together, our findings suggest that lutein exerts a multifaceted protective effect on ischemic flap tissue and may serve as a useful adjunct in reconstructive surgery, particularly in settings with high risk of ischemia-reperfusion injury. Given its safety and supplement status, these preclinical findings support further exploration in human studies.

Background: In patients with newly diagnosed metastatic prostate cancer (mPCa), the appropriate population for radical prostatectomy (RP) remains unclear.

Patients and methods: Newly diagnosed mPCa patients were identified from the Surveillance, Epidemiology, and End Results (SEER) database and divided into no local therapy (NLT) and RP groups. Propensity score matching (PSM) was used to balance baseline characteristics. Kaplan-Meier curves were used to estimate cancer-specific survival (CSS).

Results: A total of 9,215 patients were included, with 8,844 receiving NLT and 371 undergoing RP. After PSM, 321 patients in each group were included. RP was associated with significantly better CSS (HR = 0.38, 95% CI, 0.27-0.54, p < 0.001). Subgroup analyses showed consistent survival benefit of RP except in patients with M1c disease (HR = 0.55, 95% CI, 0.21-1.46, p = 0.229) or PSA ≥60 ng/ml (HR = 1.19, 95% CI, 0.53-2.86, p = 0.673). An exploratory classification defined low tumor burden as PSA <60 ng/ml and M1a/M1b disease, and high tumor burden as PSA ≥60 ng/ml or M1c. RP significantly improved CSS in the low tumor burden group (HR = 0.30, 95% CI, 0.20-0.46, p < 0.001), but not in the high tumor burden group (HR = 0.98, 95% CI, 0.53-1.84, p = 0.961).

Conclusion: In patients with newly diagnosed mPCa, the survival benefit of RP varies with tumor burden.

Background: CircRNA_0006393 was reported to promote osteogenesis in glucocorticoid-induced osteoporosis, but its role in male idiopathic osteoporosis (MIO) has not been revealed.

Aim: To explore circRNA_0006393's role in MIO.

Methods: Dual-luciferase reporter assay was performed to notarize the direct connection among circRNA_0006393, miR-375 and IGFBP4. Their value as biomarkers of MIO was confirmed by the ROC curve. The osteogenic induction was measured by detecting the ALP activity/expression and OCN/RUNX2 expression. The osteoclastic induction was evaluated by detecting TRAP activity and bone resorption capacity. The concentration of Fe²⁺, GSH, and ROS was detected to evaluate ferroptosis.

Results: MiR-375 was overexpressed in MIO patients, while circRNA_000639 and IGFBP4 presented low expression. CircRNA_0006393 promoted IGFBP4 expression by sponging miR-375. The AUC of circulating circRNA_0006393, miR-375, IGFBP4, or their combination in distinguishing unhealing and healing individuals with MIO-related fracture was 0.840, 0.851, 0.743, 0.960, respectively. CircRNA_0006393 reduced the ferroptosis process by regulating miR-375/IGFBP4. Iron overload inhibited the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSC) and promoted the osteoclastic differentiation of bone marrow-derived macrophage cells (BMMC).

Conclusion: CircRNA_000639 inhibited ferroptosis by regulating the miR-375/IGFBP4 axis, thereby promoting osteogenesis and hindering osteoclastic differentiation, and they are the biomarkers for MIO-related fracture healing.

Background: The aim of this study is to investigate the association between uterine septum and dysmenorrhea and to assess the effect of hysteroscopic resection on the severity of dysmenorrhea.

Method: The study group (N:50) consisted of women who underwent hysteroscopic septum resection, and the control group (N:74) consisted of women who underwent diagnostic hysteroscopy and had no significant uterine pathologies. The presence and severity of dysmenorrhea were assessed by using a 10 cm visual analog scale (VAS). The main outcome measurement was the difference between preoperative and postoperative dysmenorrhea VAS scores.

Results: The mean preoperative VAS score was significantly higher in the study group than the control group (4.6 ± 2.6 cm vs. 3.2 ± 2.4 cm, respectively; p = 0.023). The rates of moderate to severe dysmenorrhea were 52% in the study group and 17.5% in the control group (p = 0.025). The mean dysmenorrhea VAS score of women with uterine septum was significantly improved in postoperative 3rd and 6th months when compared to the preoperative period (3.4 ± 2.4 cm and 3.1 ± 2.3 vs. 4.6 ± 2.6 cm, respectively; P1 = 0.025 and P2 = 0.003).

Conclusions: Uterine septum seems to be an etiological factor for dysmenorrhea. Although there is no significant relationship between septum depth and dysmenorrhea severity, hysteroscopic resection of the uterine septum improves dysmenorrhea in the infertile study group.

Purpose: To compare the effects of laparoscopic sleeve gastrectomy (LSG) with antrum preservation (AP) and antrum resection (AR) on weight loss and postoperative complications.

Methods: A meta-analysis of randomized controlled trials (RCTs) followed PRISMA guidelines. The databases searched included PubMed, Web of Science, Embase Medline, and the Cochrane Library up to October 2022. Extracted data included operation time, hospital stay, excess weight loss, total weight loss, body mass index (BMI), weight, and complications.

Results: Eleven RCTs were included with 843 patients: 422 with AR and 421 with AP. The AR group exhibited higher total weight loss at 3 months (p = 0.02), 6 months (p < 0.001), and 1 year (p < 0.001) postoperatively. They also showed greater excess weight loss at 6 months (p < 0.001), 1 year (p < 0.001), and 2 years (p = 0.03). BMI reduction was more significant in the AR group at 3 (p = 0.007) and 6 months (p < 0.001). The AR group lost weight more rapidly at 3 months (p = 0.05), 6 months (p = 0.04), and 1 year (p < 0.001). No significant differences were found in operation time, hospital stay, bleeding, staple line disruption, Clavien-Dindo complications, or remission rates of diabetes, hypertension, arthritis/back pain, hyperlipidemia, or gastroesophageal reflux disease (p > 0.05).

Conclusion: LSG with AR offers better short-term weight loss than AP without increasing surgical complications, but the long-term effects and complications need further investigation in larger RCTs.