Journal of Investigative Surgery最新文献

Objective: This review examines the diagnostic criteria, incidence rates, risk factors, preventive strategies and therapeutic approaches for post-cement augmentation vertebral recollapse, aiming to establish standardized preventive protocols.

Methods: A systematic literature search was conducted through databases such as PubMed, Web of Science, Embase, and Cochrane, identifying 78 studies meeting predefined criteria. Eligibility criteria focused on imaging outcomes and risk stratification.

Results: The incidence of secondary vertebral recollapse after cement augmentation varies widely (8.5-63.3%) due to inconsistent diagnostic standards. Major risk factors include procedure-related (e.g., low cement volume), anatomical (e.g., thoracolumbar location), and patient-specific (e.g., low bone mineral density) factors. Effective prevention strategies encompass standardized diagnostic protocols combining radiological and clinical assessments, precise cement application techniques, and aggressive anti-osteoporosis therapy. Innovative materials, like mineralized collagen-modified bone cement, and tailored postoperative rehabilitation can further reduce recollapse rates. Management is tiered by severity: conservative treatment for minor collapses and surgical interventions for severe cases.

Conclusion: Vertebral recollapse is a significant post-PVA complication impacting OVCF patient prognosis. Comprehensive risk assessment, optimized cement use, and ongoing anti-osteoporosis therapy are crucial for reducing incidence. Advancements in cement formulation, technique, and standardized therapeutic frameworks are vital for improving long-term patient outcomes.

Background: This study aimed to retrospectively compare the efficacy of transarterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) and conventional agents (microcoils, polyvinyl alcohol [PVA], or gelatin sponge) in the treatment of patients with late postpancreatectomy hemorrhage (late-PPH).

Methods: From June 2012 to June 2022, this retrospective study enrolled 130 consecutive patients who underwent TAE treatment due to late-PPH at one institution. Of these patients, 56 were treated with NBCA-mixed conventional agents (NBCA-MA group), and 74 were treated with mixed conventional agents alone (MA group). The patients' clinical characteristics and TAE details were gathered. The clinical outcomes in the two groups were compared. Using univariate and multivariate logistic regression analyses, prognostic factors were evaluated for clinical success and 30-day mortality rates.

Results: The clinical success in the NBCA-MA group was 80.4% higher than that in the MA group (60.8%). Rebleeding was significantly more common in the MA group (29.7% vs. 8.9%). The 30-day mortality rate of the NBCA-MA group was lower than that of the MA group (16.1% vs. 33.8%). NBCA use was a significant prognostic factor associated with clinical success, while age and NBCA use were significant factors associated with the 30-day mortality rate.

Conclusion: In conclusion, we found that TAE with NBCA is a safe and effective method for treating late-PPH.

Background: Hemorrhoids refer to a common anorectal disorder that is usually associated with vascular proliferation. The present study investigated the role of miR-143-3p in the development of hemorrhoids and postoperative wound healing, aiming to provide novel ideas for the study of the pathogenesis of hemorrhoids and their clinical treatment.

Methods: Hemorrhoid tissues and normal perianal tissues were collected from 42 patients who underwent hemorrhoid surgery. The expressions of miR-143-3p, vascular endothelial markers (CD31, vWF, and VEGFR2), and inflammatory factors (TNF-α, IL-1β, and IL-6) in these tissues were determined using RT-qPCR. The correlation of miR-143-3p with CD31, vWF, and VEGFR2 was analyzed using Pearson's method. The proliferation of HUVEC and HaCaT cells was detected using the CCK-8 assay. The migration of HUVEC and HaCaT cells was detected using Transwell assay. The apoptosis of HUVEC cells was detected using flow cytometry.

Results: Reduced expression of miR-143-3p in hemorrhoid tissues was negatively correlated to the mRNA levels of CD31, vWF, and VEGFR2. The mRNA levels of CD31, vWF, and VEGFR2 in the HUVEC cells were reduced after miR-143-3p overexpression. Overexpression of miR-143-3p inhibited the proliferation and migration of HUVEC cells while promoting apoptosis in these cells. Upregulation of miR-143-3p decreased the mRNA levels of TNF-α, IL-1β, and IL-6 in HaCaT cells while promoting cell proliferation and migration in these cells.

Conclusions: Downregulation of miR-143-3p was noted in hemorrhoids, which could be linked to the regulation of angiogenesis. MiR-143-3p might have an anti-inflammatory role in postoperative wound healing.

Background: Researchers proposed mechanical ventilators (MVs) based on the automated compression of a self-inflating bag (SIB) to save lives during the pandemic caused by the SARS-CoV-2 virus. Many proposals had problems with continuous use time, repeatability of ventilatory variables, high partial pressure of carbon dioxide (PaCO₂) values, and a decreasing fraction of inspired oxygen (FiO₂) for high respiratory rates.

Objective: This study aimed to demonstrate that our technology, based on automated compression of an SIB, can operate for several days, is repeatable in its ventilatory variables, and is safe in the ventilator-patient interaction.

Materials and methods: Ehecatl-4T (EHT) MV was based on SIB. We first validated the repeatability of the ventilatory variables using a lung simulator for different compliances (0.01 up to 0.05 L/cmH₂O) and resistances (5 up to 50 cmH₂O·s/L). Subsequently, we conducted a long-term durability test to maintain the ventilatory parameters. Finally, the EHT was tested in a preclinical study using 12 York-Landrace × Pietrain-Duroc pigs weighing 87 ± 5 kg. Six pigs were assigned to the experimental group and six were assigned to the reference group.

Results: The EHT presented a relative error within the allowed margin for both pressure and volume modes. The EHT was operated for over 32 days without affecting the ventilatory variables. In the preclinical study, the PaCO₂ and FiO₂ values were close to the reference levels.

Conclusion: The EHT showed potential for continuous use, demonstrating repeatability for ventilatory variables in bench testing. Clinical parameters were maintained according to the industry safety standards.

Objective: This study aims to evaluate the biomechanical and clinical performance of a new anti-backout TLIF device compared to a traditional device.

Methods: This study involved a rat model, with biomechanical tests including static axial compression, static and dynamic settlement, and blade-cutting torque tests. Pain behavior in rats (n = 6) and material compatibility through cell toxicity and hemolysis tests were also assessed.

Results: The modified anti-backout interbody fusion cage demonstrated a yield load of 7747.36 ± 274.96 N in static axial compression testing, significantly higher than the traditional TLIF cage's 6933.36 ± 65.00 N (p < 0.05), indicating superior load resistance. In static settlement testing, the modified cage's yield load was 1020.87 ± 13.22 N, also notably higher than the traditional cage's 939.06 ± 8.03 N (p < 0.05). In static pullout testing, the maximum pullout force of the modified cage with the blade extended reached 534.02 ± 21.24 N, exceeding the 476.97 ± 24.45 N without the blade (p < 0.05), showing advantages in maximum pullout force and stiffness. Biocompatibility tests revealed lower cytotoxicity and a hemolysis rate of less than 5% for the modified cage material, significantly better than the traditional material's 8% (p < 0.05).

Conclusion: The new anti-backout TLIF device provides enhanced stability, reduced pain, and improved material compatibility, supporting its potential for clinical application.

Purpose: To compare the outcomes between mastectomy (MAST) and breast-conserving surgery (BCS) in patients with de novo metastatic breast cancer (dnMBC).

Methods: Patients diagnosed with dnMBC between 2010 and 2020 were retrospectively included. The chi-square test, binomial logistic regression, propensity score matching (PSM), Kaplan-Meier method, and multivariate Cox proportional analysis were used for statistical analyses.

Results: A total of 7880 patients were identified, including 2248 (28.5%) patients who underwent BCS and 5632 (71.5%) had achieved MAST. Although no statistically significant difference was found (p = 0.182), patients receiving MAST had a decreasing trend in later years. There were 74.3% (n = 629) of patients receiving MAST in 2010 and 68.5% (n = 366) in 2020. Younger age, advanced tumor stage, and advanced nodal stage were independent predictors of receiving MAST. There were 466 pairs of patients who were completely matched using PSM. The 3-year breast cancer-specific survival (BCSS) was 72.4% and 73.0% in patients treated with BCS and MAST, respectively (p = 0.509). The 3-year overall survival (OS) was 68.4% and 70.5% in patients treated with BCS and MAST, respectively (p = 0.702). The multivariate prognostic analyses showed that MAST had a similar BCSS (p = 0.996) and OS (p = 0.784) than those in BCS group.

Conclusions: Our study suggests that BCS and MAST yield similar survival outcomes in dnMBC.

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.

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.

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.