Journal of Investigative Surgery最新文献

Background: For papillary thyroid cancer (PTC) patients, no consensus has been reached for the impact of diagnosis-to-treatment interval (DTI) on patient survival outcomes. We evaluated the impact of DTI on prognosis among patients with PTC.

Methods: Patients diagnosed as PTC were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2019. The initial treatment strategies include surgery, radiation therapy, chemotherapy, hormone, immunotherapy, and/or active surveillance according to the SEER. Patients were grouped as follows: (I) DTI 0 (interval < 1 month or immediate treatment), (II) DTI 1-3 months, (III) DTI 4-5 months, and (IV) DTI ≥6 months.

Results: A total of 168,969 patients with PTC were included in this cohort study. Median follow-up time was 84.0 months. No significant overall survival (OS) difference was observed between patients with immediate treatment and DTI 1-3 months. However, DTI 4-5 months and ≥6 months were associated with poorer OS compared to patients with immediate treatment. Although Kaplan-Meier analysis suggested slight TCSS differences between the delayed and immediate treatment groups, these disappeared after adjusting for tumor characteristics and treatment factors.

Conclusions: A short-term delay (1-3 months) had no significant impact on OS, whereas more than 3 months of DTI resulted in poorer OS. Notably, delayed treatment had no impact on TCSS. These findings suggest that short-term delays are unlikely to affect survival, supporting decision-making flexibility for patients with low-risk PTC within three months of diagnosis.

Background: In order to ascertain the safety and therapeutic efficacy of preoperative simulation in conjunction with three-dimensional (3D) printing modalities for the surgical management of tibiofibular diaphyseal fractures. We postulate that preoperative simulation and three-dimensional (3D) printing techniques have a significant impact on reducing the mean operative time, diminishing intraoperative blood loss, and decreasing the frequency of fluoroscopic.

Material and methods: Sixty patients with tibiofibular diaphyseal fracture were divided into the conventional surgery group (n = 30) and the 3D printing group (n = 30). In the 3D printing group, preoperative equal-ratio fracture models prepared using the 3D printing technique were used to perform preoperative simulation, guide the real surgical operation, examine implant reduction and placement as well as preoperative plate/screw size. The operation time, intraoperative bleeding, frequency of fluoroscopies, Visual Analog Scale (VAS), and Johner-Wruhs Scale were recorded.

Results: The operation time, blood loss, and the frequency of fluoroscopy during operation in the group with preoperative simulation and 3D printing were less than that in the conventional surgery group (p < 0.001). Meanwhile, the Visual Analog Scale (VAS) and Johner-Wruhs Scale were also improved in both groups.

Conclusion: The findings indicated that preoperative simulation and three-dimensional (3D) printing may facilitate the treatment of tibiofibular diaphyseal fractures, potentially enhancing preoperative planning and contributing to the precision and personalization of the surgical procedure. Thus, the application of this technology possesses considerable promise for future utilization in clinical practice.

Trial registry: Name of the registry: This study was registered in the Chinese Clinical Trial Registry; Trial registration number: ChiCTR2100052379.

Background: To investigate the influence of preoperative noninvasive indexes on surgical outcomes of benign prostatic hyperplasia (BPH) patients and to establish a clinical prediction model.

Methods: A total of 250 BPH patients treated with transurethral resection of the prostate (TURP) in our center from December 2020 to June 2023 were included. The evaluation was completed by detailed history questionnaire, an international prostate symptom score (IPSS) assessment, and a urological ultrasonography.

Results: Among included patients, 185 had effective outcomes, and 65 had ineffective outcomes, with an effective rate of 74%. Univariate and multivariate analyses identified IPSS-voiding/storage (IPSS-V/S) ratio, postvoid residual urine ratio (PVR-R), disease duration, intravesical prostatic protrusion (IPP), history of diabetes, history of urinary retention as independent predictive factors of surgical outcomes, which were further subjected to construct the prediction model. The receiver operating characteristic curve indicated an area under the curve of 0.894. The sensitivity and specificity of the model were 79.46% and 87.69%, respectively. Internal validation and the calibration curve indicated good agreement between the predicted and actual outcomes. Clinical decision curves found that the model had a more significant net clinical benefit than the "all-intervention" and "no-intervention" scenarios.

Conclusion: The results suggested that BPH patients with a shorter disease duration, a larger IPSS-V/S, a larger IPP, a smaller PVR-R, and no history of diabetes or urinary retention were more likely to have a better outcome after TURP.

Objective: We aimed to explore the efficacy of guided tissue regeneration (GTR) combined with microscrew implant anchorage technique in treating patients with periodontitis and malocclusion.

Methods: Sixty patients with periodontitis accompanied by malocclusion were randomly assigned to either the control group (n = 30, receiving GTR combined with traditional orthodontic treatment) or the observation group (n = 30, receiving GTR combined with microscrew implant anchorage technique). Periodontal indicators [gingival index (GI), sulcus bleeding index (SBI), plaque index (PLI), probing depth (PD), and clinical attachment level (CAL)], chewing function (biting force, chewing efficiency), dental esthetics [pink esthetic score (PES)], as well as interleukin-6 (IL-6), matrix metalloproteinase-8 (MMP-8), and transforming growth factor-β (TGF-β) levels in gingival crevicular fluid (the gingival crevicular fluid was collected from three non-adjacent periodontitis sites) were measured in both groups. The efficacy and complications were also compared.

Results: Six months after treatment, the observation group exhibited lower GI, SBI, PLI, PD, and CAL values, and improved bit force, chewing efficiency, and PES than the control group (p < .05). Six weeks after treatment, the observation group showed reduced IL-6 and MMP-8 levels in gingival crevicular fluid and increased TGF-β levels than the control group (p < .05). Additionally, the observation group exhibited higher overall treatment efficacy than the control group (p < .05).

Conclusion: GTR combined with microscrew implant anchorage yields superior therapeutic outcomes in patients with periodontitis and malocclusion. This approach effectively improves periodontal health, optimizes the local periodontal microenvironment, enhances masticatory function, and promotes dental esthetic outcomes.

Objective: This study analyzed the therapeutic effects of cyclosporine A (CsA) plus Zishen Yutai Pill (ZYP) in the treatment of patients with recurrent pregnancy loss (RPL).

Methods: This study prospectively included 150 RPL patients who were randomized into CsA and CsA + ZYP groups (n = 75 patients/group). The serum levels of hormones estradiol (E2), human chorionic gonadotropin (HCG), progesterone (P), Th1-type cytokines, and Th2-type cytokines were detected by ELISA. Additionally, we compared the proportions of immune cell subsets (T lymphocytes, Th1, Th2), the incidence of adverse reactions, and live birth rates between the two groups. Furthermore, patients treated with CsA plus ZYP were categorized into appropriate age and elderly age groups based on their age to ascertain the therapeutic effects of CsA plus ZYP on RPL patients of different ages.

Results: CsA plus ZYP resulted in markedly higher E2, HCG, and P levels and live birth rates than CsA alone. After treatment with either CsA or CsA plus ZYP, the Th1 cell subset, Th1-type cytokines, and Th1/Th2 ratio significantly decreased but Th2 cell subset and Th2-type cytokines were greatly elevated in both groups, with more pronounced changes induced by CsA plus ZYP. There was no significant difference in the incidence of adverse reactions between the two groups. Furthermore, the therapeutic effect of CsA plus ZYP was better in RPL patients of appropriate age.

Conclusion: CsA plus ZYP significantly improved Th1/Th2 balance and increased live birth rates in RPL patients and was more effective in RPL patients of appropriate age.

Background: The microvascular invasion (MVI) score evaluates the presence of MVI in patients with hepatocellular carcinoma (HCC) by integrating multiple factors associated with MVI. We aimed to establish a MVI scoring system for HCC based on the clinical characteristics and serum biomarkers of patients with HCC.

Methods: A total of 1027 patients with HCC hospitalized at Shandong Provincial Hospital from January 2016 to August 2021 were included and randomly divided into the development group and validation group at a ratio of 3:1. Univariable and multivariable logistic regression analyses were conducted to identify independent risk factors for MVI in HCC patients. Based on these independent risk factors, the preoperative MVI scoring system (diagnostic model) for HCC was established and verified. The receiver operating characteristic (ROC) curves, calibration curves and decision curve analyses (DCA) were employed to evaluate the discrimination and clinical application of the diagnostic model.

Results: Independent risk factors for MVI of HCC involved Hepatitis B virus infection (HBV), large tumor diameter, higher logarithm of Alpha-fetoprotein (Log AFP), higher logarithm of AFP-L3% (Log AFP-L3%), higher logarithm of protein induced by vitamin K absence or antagonist-II (Log PIVKA-II) and higher logarithm of Carbohydrate antigen 125 (Log CA125). The diagnostic model incorporating these six independent risk factors was finally established. The areas under the ROC curve (AUC) assessed by the nomogram in the development cohort and validation cohort were 0.806 (95% CI, 0.773-0.839) and 0.818 (95% CI, 0.763-0.874) respectively. The calibration curve revealed that the results predicted by our diagnostic model for MVI in HCC were highly consistent with the postoperative pathological outcomes. The DCA further indicated promising clinical application of the diagnostic model.

Conclusion: An effective preoperative diagnostic model for MVI of HCC based on readily available tumor markers and clinical characteristics has been established, which is both clinically significant and easy to implement for diagnosing MVI.

Background: Current prognostic tools lack precision for small hepatocellular carcinoma (HCC) (≤5 cm) and fail to capture tumor heterogeneity. This study aimed to construct a nomogram to predict survival in patients with isolated small HCC.

Methods: A total of 5187 eligible patients from the SEER database were randomized into training and internal validation cohorts, while 180 patients from Zhongnan Hospital of Wuhan University served as an external validation cohort. Cox regression analysis identified factors affecting cancer-specific survival (CSS), which were used to construct the nomogram. Performance was evaluated using the consistency index (C-index), area under the curve (AUC), calibration curve, and decision curve analysis (DCA). Finally, we used Kaplan-Meier curves for survival analysis.

Results: We identified eleven independent risk factors influencing CSS in isolated small HCC patients. In the training, internal validation, and external validation cohort, the C-index of the nomogram was 0.702, 0.717, and 0.729, respectively. AUC, calibration curves, and DCA curves showed good predictive accuracy and clinical utility. Kaplan-Meier curves revealed significant CSS differences between high- and low-risk groups. Additionally, we developed an online prediction tool.

Conclusions: The nomogram effectively predicts CSS in isolated small HCC patients and may aid in individualized clinical decision-making.

Methods: A total of 6626 patients with CRC who were initially referred for endoscopic polypectomy were enrolled from the Surveillance Epidemiology and End Results Database.

Results: Most enrolled patients (6557/6626, 99.0%) were at T0-T1 stage (American Joint Committee on Cancer staging system). Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to reduce selection bias, which resulted in balanced groups of patients with and without lymphadenectomy, with no difference in CSS (p = .99 and .074, respectively). In the subgroup analysis, insufficient lymphadenectomy (lymph node yield [LNY] < 12) was associated with poor CSS compared with no lymphadenectomy. The multivariate analysis identified adequate lymphadenectomy with an LNY ≥ 12 as an independent favorable prognostic factor. However, nearly half of the patients (59/127, 46.5%) referred for lymph node resection did not undergo adequate lymphadenectomy.

Conclusions: The prognosis of CSS cannot be improved by lymphadenectomy for most patients (T0-T1) who are referred for endoscopic therapy because of the low rate of lymph node metastasis. Nonetheless, adequate lymphadenectomy should be performed instead of diagnostic lymph node resection if lymph node involvement is suspected.

Purpose: This study aimed to assess the safety of dexmedetomidine administration to mothers, fetuses, and neonates during general anesthesia in cesarean section (CS).

Patients and methods: A total of 60 parturients scheduled for elective CS under general anesthesia were randomly divided into anesthesia in groups (DEX1 and DEX2) and control (C) groups. Groups DEX1 and DEX2 were induced with dexmedetomidine (induction, 0.4 µg/kg; maintenance, 0.4 µg/kg·h) and dexmedetomidine (induction, 0.6 µg/kg; maintenance, 0.6 µg/kg·h), respectively, until birth. Equivalent volumes of normal saline were administered in group C. Anesthesia was induced with propofol and rocuronium in all groups. The mean arterial blood pressure (MAP) and heart rate (HR) of parturients were monitored and recorded; fetal HR was monitored using color doppler ultrasound. The blood gas analysis from the umbilical artery (UA) and umbilical vein (UV), along with the HR, Apgar score and Neurologic Adaptive Capacity Scores (NACS) of neonates, were recorded.

Results: Maternal MAP at intubation/skin incision, maternal HR at intubation/skin incision and delivery were significantly lower in groups DEX1 and DEX2 than in group C, no significant differences were observed between groups DEX1 and DEX2. No significant differences were observed in fetal HR, UA and UV blood gas analyses, Apgar score and NACS of neonates in the three groups.

Conclusion: Intravenous 0.4 or 0.6 µg/kg doses of dexmedetomidine with propofol for general anesthesia in CS is beneficial for inhibiting the maternal stress response induced by intubation/skin incision and delivery without significant adverse effects on fetuses or neonates. Our findings suggest that dexmedetomidine is safe for mothers, fetuses, and neonates in obstetric general anesthesia.

Objective: This paper focuses on the efficacy of low energy ultrapulsed CO₂ fractional laser (LEUCO₂FL) combined with autologous platelet-rich plasma (PRP) in periorbital rejuvenation treatment.

Methods: Eighty patients with periorbital wrinkles and eyelid laxity were randomly assigned to a laser group (n = 40) receiving LEUCO₂FL or a combination group (n = 40) receiving additional autologous PRP. Both groups received treatment once per month for a total of three sessions. Cosmetic outcomes were assessed at three months post-treatment using the Global Esthetic Improvement Scale (GAIS). VISIA (wrinkles, texture), SOFT (skin elasticity, moisture), upper eyelid depression, and infraorbital hollowing were evaluated before and at 1, 3, and 6 months post-treatment. Adverse reactions and patient satisfaction were recorded.

Results: The combination group exhibited higher overall effective rate of GAIS, greater improvements in wrinkles, texture, skin elasticity, and moisture at all time points, and lower upper eyelid depression and infraorbital hollowing scores than the laser group. While both treatments were well tolerated, patient satisfaction was higher in the combined group than the laser group.

Conclusion: LEUCO₂FL combined with autologous PRP demonstrates favorable cosmetic effects in periorbital rejuvenation, significantly improving periorbital wrinkles and texture, enhancing skin elasticity and hydration, and reducing periorbital hollowness.