Journal of Investigative Surgery最新文献

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.

Background: To evaluate the prognostic effect of endovascular treatment (EVT) in patients with acute base artery occlusion (ABAO) within 24 h of onset, and analyze the factors related to prognosis.

Methods: A retrospective analysis was conducted on all ABAO patients who received EVT within 24 h of onset in the neurology department of Baotou Central Hospital in Inner Mongolia from May 2016 to October 2022. Good prognosis was defined as a Modified Rankin Scale (mRS) score of 0-3 and poor prognosis mRS score of 4-6 at 90 day follow-up, and factors related to prognosis were analyzed.

Results: Among the 77 patients included in the analysis, 68 patients (88.3%) achieved recanalization (modified thrombolysis in cerebral infarction, mTICI 2b/3 grade). Thirty eight patients (49.4%) achieved an overall good prognosis. In univariate analysis, age, baseline Glasgow Coma Scale (GCS), baseline National Institutes of Health Stroke Scale (NIHSS), posterior circulation Acute Stroke Prognostic Early CT score (pc ASPECTS), preoperative intravenous thrombolysis, and mTICI2b-3 were factors affecting good prognosis. Multivariate analysis showed that shorter onset to puncture time (OR 0.069; 95% CI, 0.009-0.519; p = 0.009), lower NIHSS (OR 1.179; 95% CI, 1.019-1.364; p = 0.027), and higher pc ASPECTS (OR 0.489, 95% CI, 0.250-0.959, p = 0.037) were factors influencing good prognosis in this study.

Conclusions: In summary, endovascular treatment for patients with acute basilar artery occlusion is safe and effective, but EVT may achieve better prognosis within 6 h of onset. The shorter time from onset to puncture at admission, lower baseline NIHSS score, and higher baseline pc-ASPECTS are factors affecting the good prognosis of patients at 90 days.

Background: This study explored the prognostic role of GPR27 and its predictive value to platinum-based therapy in ovarian cancer.

Material and methods: A survival analysis of GPR27, and the therapeutic response to platinum in ovarian cancer was investigated using data from the cancer genome atlas (TCGA) and Gene Expression Omnibus (GEO) databases. GPR27 expression was assessed using reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry.

Results: Database analysis and RT-PCR revealed over-expression of GPR27 mRNA in ovarian cancer tissues compared to normal ovarian tissues. Ovarian cancer patients with up-regulated GPR27 transcription were associated with better overall survival and disease-free survival compared to those with downregulated GPR27 mRNA in the TCGA dataset and Kaplan-Meier plot database (N = 1656). GPR27 demonstrated good predictive value for pathological response in patients with ovarian cancer receiving platinum-based therapy. The predictive performance for 6-month relapse-free survival was higher in endometrioid ovarian cancer (AUC:0.804) than that in serous ovarian cancer. GPR27 protein levels were significantly up-regulated in ovarian cancer tissues compared with normal ovarian tissue, and high GPR27 protein expression correlated with early-stage TNM. ROC analysis revealed that the GPR27 protein, quantified by the immunohistochemistry score, effectively predicted the response to platinum-based therapy response with an AUC of 0.7479 in our cohort.

Conclusion: GPR27 was up-regulated in ovarian cancer, compared with that of normal ovarian tissue, and was strongly correlated with survival outcomes and response to platinum-based therapy. GPR27 may serve as a reliable biomarker for platinum -based therapy in ovarian cancer patients.

Objective: To develop a porcine model for laparoscopic intersphincteric resection (ISR) targeting ultra-low rectal cancer.

Methods: Six Bama mini-pigs underwent a standard laparoscopic ISR procedure: (1) Ligation and transection of the inferior mesenteric vessels; (2) Exposure and sparing of the pelvic autonomic nerves; (3) Dissection of the rectum; (4) Dissection and transection of hiatal ligament and rectourethralis muscle; (5) Transanal dissection of the anal canal; (6) Dissection of the intersphincteric space (ISS); (7) End-to-end handsewn coloanal anastomosis (CAA). Pathological evaluations were conducted to ascertain the precision of the ISR. Furthermore, postoperative fecal incontinence scores were systematically assessed on a weekly basis throughout a 12-week post-surgery follow-up period.

Results: All six pigs survived surgery without conversion to an open approach. There were no occurrences of incisional infection or any surgical complications, including anastomotic leakage, anastomotic bleeding, or ileus. Postoperatively, one pig manifested constipation and three exhibited anal redness, both conditions ameliorating within a week. No erosive ulcers were detected. Notably, all animals exhibited fecal staining on their tails within the first two weeks post-surgery, transitioning to formed feces by the third week. Improvement in defecation frequency was observed after 6 weeks, with a noticeable reduction in defecation areas after one month. Incontinence scores, evaluated three months post ISR surgery, revealed no significant abnormalities in anal function compared to preoperative assessments.

Conclusions: This study established a replicable porcine model for laparoscopic ISR, demonstrating its potential utility in clinical and fundamental research related to ultra-low rectal cancer treatment.

Objective: This study aimed to evaluate the relationship between neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) ratios and the occurrence and prognosis of progressive hemorrhagic injury (PHI) in patients with traumatic brain injury (TBI).

Methods: This retrospective study included 166 TBI patients. Clinical data were collected and NLR and PLR were assessed. Receiver operating characteristic (ROC) curve analysis was conducted to assess the predictive value of NLR and PLR for PHI occurrence in TBI patients. Logistic regression analysis was performed to identify risk factors influencing PHI development and poor neurological prognosis.

Results: The PHI group (n = 77) exhibited significantly higher NLR and PLR ratios than the non-PHI group (n = 89). Independent risk factors for PHI occurrence included higher Abbreviated Injury Scale scores, absent pupillary reflexes, lower Glasgow Coma Scale (GCS) scores, and elevated NLR and PLR ratios. The combined use of NLR and PLR ratios demonstrated superior predictive performance for PHI occurrence, with a higher area under the curve (AUC: 0.843) and sensitivity (77.9%, cutoff values: 17.19 for NLR and 196.33 for PLR) compared to NLR alone (AUC: 0.794, sensitivity: 53.2%, cutoff value: 21.78) or PLR alone (AUC: 0.665, sensitivity: 53.2%, cutoff value: 235.48). For poor neurological prognosis, higher AIS scores, lower GCS scores, and elevated NLR ratios were identified as independent risk factors.

Conclusion: TBI patients with elevated NLR and PLR ratios are at increased risk of developing PHI. In severe TBI cases, patients with high NLR ratios during the early stages tend to experience poor neurological outcomes.

Background: Standardized proximal gastrectomy for upper-third gastric cancer (UGC) is lacking due to the current methods' inability to prevent reflux and facilitate postoperative endoscopic monitoring surveillance. In this study, we provide a detailed description of proximal gastrectomy utilizing a new triangular muscle flap for esophagogastrostomy and evaluate the postoperative outcomes of this technique.

Method: A total of 17 patients diagnosed with early-stage primary UGC underwent laparoscopic proximal gastrectomy between May 2021 and May 2022. Subsequently, a new triangular muscle flap was used for esophagogastrostomy.

Results: No in-hospital deaths occurred during the study period. However, two patients experienced complications early in the study, including one case of pulmonary infection and another of abdominal abscess infection. Importantly, none of the patients exhibited any reflux symptoms. Postoperatively, 15 patients were diagnosed with grade N/M esophagitis, one with grade A, and one with grade B. All patients are currently alive without tumor recurrence.

Conclusions: This surgical technique can be safely performed and demonstrates excellent results in preventing gastroesophageal reflux. Further investigation through a multi-center clinical study is warranted to confirm its efficacy.

Objective: The efficacy and safety of optimized minimally invasive jejunoileal bypass (OM-JIB) compared to traditional minimally invasive jejunoileal bypass (TM-JIB) in the treatment of type 2 diabetes mellitus (T2DM) were evaluated.

Methods: The included patients were placed into two groups (TM-JIB group [n = 49] and OM-JIB group [n = 48]) based on the surgical method. The surgical parameters, basic information, the laboratory results, 1-y postoperative outcomes, and postoperative complication rates were compared.

Results: The operative time was longer for the OM-JIB group compared to the TM-JIB group (p < 0.05) with no differences in the intraoperative blood loss and length of hospital stay (p > 0.05). Both groups exhibited significant reductions in BMI, fasting plasma glucose, 2-hour plasma glucose, and glycated hemoglobin over time (p < 0.05). The OM-JIB group achieved a similar efficacy rate to the TM-JIB group at the 1-y follow-up evaluation (p > 0.05). However, the postoperative complication rate was significantly lower in the OM-JIB group than the TM-JIB group (2.08% vs. 16.33%, p < 0.05).

Conclusion: OM-JIB treatment of T2DM patients was shown to be as effective as TM-JIB, but with significantly fewer complications than TM-JIB, thus enhancing patient safety.