Journal of Investigative Surgery最新文献

Objective: The study aimed to investigate the clinical effect of the Simple Bidirectional Counter-Traction Frame (SBCTF) at the bedside on preventing lower limb DVT in patients with distal tibial and fibular fractures.

Methods: This study adopted a retrospective cohort study method and included 310 patients with unilateral closed distal tibial and fibular fractures. Among them, 204 cases that accepted conventional calcaneal traction comprised the control group, and the other 106 ones that accepted the SBCTF comprised the observation group. The DVT incidence, D-Dimer concentrations of D-Dime, activated partial thromboplastin time (APTT), fibrinogen (Fib), and adverse events in both groups were compared.

Results: In total of 21 patients experienced a DVT; 19 cases (9.3%) in the control group and 2 cases (1.9%) in the SBCTF group (p < 0.05). Significant lower post-treatment concentrations were observed in the SBCTF group than the control group (0.66 vs. 0.84, p < 0.05). At admission, there was no significant difference in activated partial thromboplastin time (APTT) levels between the two groups, and no significant improvement was observed post-treatment (p > 0.05). No significant complications were reported within either group. The median hospitalization cost in the control group was significantly lower than that of the observation group (24,879.50 yuan vs. 25,513.00 yuan, p = 0.024).

Conclusion: SBCTF effectively reduces the incidence of lower limb DVT in patients with distal tibial and fibular fractures, improves the hypercoagulable state of the blood, and has good safety. It is worth investigating through randomized controlled trial testing in a long-term observation.

Objective: This study examined the feasibility and effectiveness of utilizing the single-person reset fixed system (RFS) for treating pediatric supracondylar humeral fractures (SHFs) to enhance surgical efficiency and reduce manpower requirements.

Methods: A retrospective analysis of 10 pediatric SHF cases treated with the Single-Person RF was conducted from 2022 to 2023. The primary variables of interest were surgical time, fluoroscopy frequency, postoperative outcomes, and complication rates.

Results: All patients achieved successful single-stage surgical reduction and fixation without additional surgeries. The surgical time was 55 min, with an average fluoroscopy frequency of 11.8 times. Postoperatively, Baumann's Angle ranged from 64 to 81 degrees, indicating restoration of normal joint mobility as Range of Motion (ROM) exceeded 90%. The meta-analysis highlighted the significant advantage of the Single-Person RFS in improving the excellent treatment rate with low heterogeneity.

Conclusion: The single-person RFS demonstrates remarkable effectiveness in pediatric SHF treatment, evident through reduced surgical times, decreased fluoroscopy frequency, minimal complications, and positive functional recovery for patients. The findings emphasize the superiority of the single-person RFS in enhancing treatment outcomes, suggesting future optimization and potential broader applications in fracture management.

Background: Venous waveform analysis is an emerging technique to estimate intravascular fluid status by fast Fourier transform deconvolution. Fluid status has been shown proportional to f₀, the amplitude of the fundamental frequency of the waveform's cardiac wave upon deconvolution. Using a porcine model of distributive shock and fluid resuscitation, we sought to determine the influence of norepinephrine on f₀ of the central venous waveform.

Methods: Eight pigs were anesthetized, catheterized and treated with norepinephrine after precipitation of endotoxemic hypotension, and subsequent fluid resuscitation to mimic sepsis physiology. Hemodynamic parameters and central venous waveforms were continually transduced throughout the protocol for post-hoc analysis. Central venous waveform f₀ before, during and after norepinephrine administration were determined using Fourier analysis.

Results: Heart rate increased, while central venous pressure, pulmonary capillary wedge pressure and stroke volume decreased throughout norepinephrine administration (p < 0.05). Mean f₀ at pre-norepinephrine, and doses 0.05, 0.10, 0.15, 0.20 and 0.25 mcg/kg/min, were 2.5, 1.4, 1.7, 1.7, 1.6 and 1.4 mmHg², respectively (repeated measures ANOVA; p < 0.001). On post-hoc comparison to pre-norepinephrine, f₀ at 0.05 mcg/kg/min was decreased (p = 0.04).

Conclusions: As the performance of f₀ was previously characterized during fluid administration, these data offer novel insight into the performance of f₀ during vasopressor delivery. Central venous waveform f₀ is a decreased with norepinephrine, in concordance with pulmonary capillary wedge pressure. This allows contextualization of the novel, venous-derived signal f₀ during vasopressor administration, a finding that must be understood prior to clinical translation.

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.