Journal of Investigative Surgery最新文献

Purpose: This study evaluated the clinical effectiveness of combined treatment of sevoflurane with propofol or remimazolam in decreasing hemodynamic changes and postoperative pain in pediatric patients undergoing laparoscopic inguinal hernia repair (LIHR).

Methods: This study prospectively recruited 287 children with hernia admitted to our hospital from September 2020 to October 2023. These children were allocated into the sevoflurane plus remimazolam and sevoflurane plus propofol groups using the random number table method. General clinical data at admission were collected. Clinical outcomes were compared between the two groups. The primary outcomes included anesthesia quality, intraoperative hemodynamic indicators at different time points (MAP, SpO₂, HR), and the postoperative FLACC score, while the secondary outcomes included the PAED score of the children and the incidence of postoperative adverse reactions.

Results: No remarkable difference occurred between these two groups regarding general clinical data. Compared to the sevoflurane plus propofol group, the sevoflurane plus remimazolam group resulted in significantly lower MAP and HR at T1, T2, T3, and T4 (p < .05), shorter postoperative awakening time (mean difference: 2.9 min, p < .01), lower FLACC pain scores at 0.5, 1, and 2 h postoperatively (p < .05), and lower PAED scores at 5, 15, and 30 min postoperatively (p < .05). Adverse effects were lower in the sevoflurane + remimazolam group (5% vs. 12%, p = .076).

Conclusion: Sevoflurane plus remimazolam in children receiving LIHR has minimal impact on hemodynamics, reduces pain levels within 4 h postoperatively, lowers PAED and agitation scores, and demonstrates high safety.

Purpose: To investigate outcome and local treatment strategy for extranodal mucosa-associated lymphoid tissue (MALT) lymphoma patients.

Methods: Retrospectively collected patients using the data from the Surveillance, Epidemiology, and End Results database, including tumor sites with over 200 cases.

Results: The cohort comprised 3842 patients, with the gastric region being the most prevalent site (34.9%), followed by salivary gland (16.8%), cutaneous (16.5%), pulmonary (13.3%), intestinal (13.2%), and head and neck (5.4%). The 10-year cancer-specific survival (CSS) was 88.1%, 92.6%, 86.5%, 87.7%, 89.7%, and 97.7% in patients with tumors located in the gastric, salivary gland, pulmonary, head and neck, intestinal, and cutaneous, respectively (p < 0.001). Compared to gastric MALT lymphoma, the cutaneous site exhibited superior CSS (p < 0.001), whereas other sites showed comparable outcomes (all p ≥ 0.05). In gastric MALT lymphoma cases, radiotherapy was associated with better CSS than surgery alone (p < 0.001), while no significant difference was observed between surgery plus radiotherapy versus surgery alone (p = 0.561). Treatment outcomes were similar across the three therapeutic modalities for non-gastric sites.

Conclusions: Our findings underscore the biological and clinical heterogeneity of extranodal MALT lymphoma. While localized treatments provide equivalent results across most non-gastric sites, radiotherapy is recommended as the primary noninvasive treatment option.

Objective: Obesity is a risk factor for joint arthroplasty complications. With this systematic review and meta-analysis, we assessed whether a positive history of bariatric surgery influences postoperative outcomes in patients undergoing various types of joint arthroplasty.

Methods: We conducted a comprehensive search database such as Scopus, PubMed, Medline Ovid, CNKI, and CENTRAL for studies comparing outcomes between patients undergoing arthroplasty with and without a history of bariatric surgery. We extracted data on short-term medical complications, venous thromboembolism (VTE), periprosthetic infections, superficial wound infections, hospital stay length, and operative time. We used the data to conduct meta-analyses using random-effects models and subgroup analyses based on the type of arthroplasty.

Results: Overall, 15 studies with nearly 150,000 participants were included. The analysis showed that prior bariatric surgery did not significantly affect overall medical complications post-arthroplasty, with OR of 0.968 (95%CI, 0.706-1.327). For VTE, the results similarly indicated no substantial difference, with an OR of 0.912 (95%CI, 0.644-1.291). In assessing periprosthetic infections, the OR was 0.754 (95%CI, 0.535-1.064), showing comparable rates between patients with and without a history of bariatric surgery.Regarding superficial wound infections, the analysis produced an OR of 2.390 (95%CI, 0.723-7.897), indicating variability but not statistical significance. Hospital stay length was reduced in patients with a history of bariatric surgery, reflected by SMD of -0.113 (95%CI, -0.221 to -0.005). Lastly, operative time also showed a significant reduction, with an SMD of -0.462 (95%CI, -0.865 to -0.059).

Conclusions: Prior bariatric surgery does not reduce the risk of short-term complications post-arthroplasty, but it seems to reduce the hospital stay length and operative time. The effects vary significantly across different types of joint arthroplasty, suggesting a need for tailored preoperative assessments and care protocols.

Protocol registration: This systematic review and meta-analysis was registered at PROSPERO, with the number: CRD42024539052.

Objective: This study aim to investigate the oncological safety of neoadjuvant therapy (NAT) followed by breast-conserving surgery (BCS) for invasive ductal carcinoma (IDC) patients with the presence of ductal carcinoma in situ (DCIS) on pre-NAT biopsy.

Methods: The data of women with IDC who underwent radical surgery between January 2013 and December 2021 were retrospectively reviewed from two institutions. The study endpoints were 5-year disease-free survival (DFS) and local recurrence-fee survival (LRFS).

Results: Overall, 994 eligible patients were enrolled. Patients with IDC with DCIS (n = 277) and patients undergoing BCS (n = 285) were selected separately for prognostic analysis. For patients with IDC with DCIS, the 5-year DFS (p = 0.517) and 5-year LRFS (p = 0.397) rates of the patients undergoing BCS were similar to those of patients undergoing mastectomy after propensity score matching. In addition, the 285 patients who underwent BCS were divided into the IDC + DCIS and IDC groups. The 5-year DFS (p = 0.394) and 5-year LRFS (p = 0.341) rates were similar between the IDC and IDC + DCIS groups.

Conclusion: NAT followed by BCS combined with adjuvant radiotherapy is a safe and feasible treatment option in patients with IDC with DCIS under the premise of strict adherence to the surgical indications and adequate incision margins.

Background: Granulomatous mastitis (GM) is a rare benign inflammatory breast disease that may mimic carcinoma. Etiology remains unclear, but emerging evidence suggests a role for both breast and gut microbiota.

Methods: Between June 2022 and June 2024, 32 women with histopathology-confirmed GM and 44 non-GM controls (benign and non-granulomatous inflammatory conditions) were enrolled. Granulomatous tissue, adjacent normal breast tissue, and stool samples were collected. Microbiota composition was analyzed using 16S rRNA sequencing. Clinical variables were documented. Diversity analyses and receiver operating characteristic (ROC) curves assessed microbial differences and diagnostic potential.

Results: The GM cohort had a mean age of 36.8 years and BMI of 27.6 ± 3.9 kg/m²; 86.2% were postpartum, with no autoimmune or malignant conditions. GM lesions showed enrichment of Corynebacterium (notably C. kroppenstedtii), Staphylococcus, and Microbacterium, whereas Lactobacillus and Bifidobacterium were higher in normal tissue. Fecal samples exhibited reduced microbial diversity in GM compared with controls but did not replicate breast microbial profiles. ROC analysis indicated that Corynebacterium discriminated GM from controls with excellent accuracy (AUC = 0.87), while Staphylococcus was moderate (AUC = 0.78) and Lactobacillus inversely associated (AUC = 0.11).

Conclusions: GM demonstrates distinct microbial signatures, including pro-inflammatory taxa enrichment and protective commensal depletion, along with systemic dysbiosis. These findings support a microbiota-driven pathogenesis and highlight the potential of microbial biomarkers and therapeutic modulation.

Objective: This study aims to unravel the clinical effects of total intravenous anesthesia (TIVA) versus combined intravenous-inhalational anesthesia, each with ultrasound-guided transversus abdominis plane (TAP) block, in gynecologic laparoscopic surgery.

Methods: In this prospective randomized controlled trial, 100 patients undergoing gynecologic laparoscopic surgery were randomly assigned to either a control group (balanced inhalation anesthesia + TAP block) or an observation group (TIVA + TAP block) (n = 50 each). Postoperative recovery, pain scores (VAS at 2, 6, 12, 24, and 48 h), hemodynamics (SpO₂, heart rate, SBP) at key surgical stages, and stress markers (cortisol, PGE₂), and complications were recorded.

Results: Baseline characteristics were comparable. The observation group showed faster spontaneous respiration recovery, awakening, and extubation (all p < 0.05), though ambulation, flatus, and hospital stay did not differ (p > 0.05). VAS scores were lower in the observation group at all time points (p < 0.05). Hemodynamics remained stable in both groups. Postoperative cortisol and PGE₂ rose in both groups but were lower in the observation group (p < 0.05). Nausea/vomiting incidence was reduced with TIVA (p < 0.05).

Conclusion: TIVA combined with ropivacaine TAP block accelerates early recovery, improves analgesia, attenuates surgical stress, and reduces nausea/vomiting.

Objective: This systematic review and meta-analysis aimed to evaluate the efficacy and safety of radiofrequency ablation (RFA) in the management of papillary thyroid cancer (PTC).

Methods: A comprehensive literature search was conducted in the PubMed, Embase, Cochrane Library, Web of Science and CNKI databases. Studies reporting outcomes of RFA for PTC were included. Random-effects models were used for meta-analysis, and heterogeneity was assessed using I² statistics.

Results: Fifteen retrospective studies involving 1,844 patients were included. The meta-analysis revealed a pooled standardized mean difference of -1.11 (95% CI: -1.39 to -0.84) for volume reduction at 12 months, corresponding to an approximate 88.9% mean volume reduction, with moderate heterogeneity (I² = 55.4%). The pooled risk ratio (RR) for complete disappearance was 1.08 (95% CI: 0.99-1.18), with significant heterogeneity among studies (I² = 71.4%). The local recurrence rate was 0.62% (95% CI: 0.32%-1.21%), with no significant heterogeneity (I² = 0.0%). The RFS analysis showed a pooled RR of 1.00 (95% CI: 0.93-1.08), with no significant heterogeneity (I² = 0.0%). The local tumor progression rate was 1.42% (95% CI: 0.81%-2.48%), also with no significant heterogeneity (I² = 0.0%).

Conclusion: This meta-analysis suggests that RFA is an effective and safe treatment for PTC, demonstrating high volume reduction rates, satisfactory complete disappearance rates and low local recurrence rates.

Background: The neurocentral cartilage (NCC) is crucial for vertebral development and spinal canal shape, with its peak activity occurring around ages 5-6. The objective of this experimental animal study was to investigate whether bilateral epiphysiodesis of the NCC using pedicle screws can induce spinal canal narrowing in the thoracolumbar spine.

Methods: Twenty-four domestic pigs were divided into four groups based on the level of NCC blockage: low thoracic, thoracolumbar transitional hinge, upper lumbar spine, and caudal lumbar levels below L5. The animals were monitored for 8-9 months, during which morphological, morphometric, and radiological parameters were analyzed and compared to those of 14 control pigs.

Results: No asymmetrical growth or coronal deformities were observed (p > 0.05). NCC caused a significant reduction in sagittal pedicle length (-2.94 mm, 32.6%) in lower lumbar segments (L₃-L₆) and a 3.11 mm (29.6%) decrease in the anteroposterior canal diameter, leading to segmental stenosis most pronounced caudally. The transverse diameter of the canal remained largely unchanged. Morphologically, slight lumbar hyper lordosis and compensatory thoracic kyphosis were observed.

Conclusions: Symmetrical NCC growth arrest using pedicle screws induces spinal canal narrowing through decreased sagittal diameter, linked to insufficient development of vertebral pedicles. These findings suggest caution in employing thoracolumbar pedicle screws in skeletally immature patients with an open NCC.