Journal of Investigative Surgery最新文献

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.

Background: The superior mesenteric artery (SMA) approach aids laparoscopic right colectomy but relies on one landmark. The modified SMA (M-SMA) adds the ligament of Treitz as a second reference to improve safety and efficiency in complex anatomy.

Methods: This retrospective analysis included 306 patients who underwent totally laparoscopic radical resection for right-sided colon cancer, divided into the SMA group (n = 147) and the M-SMA group (n = 159). Propensity score matching was applied to balance baseline characteristics. Intraoperative outcomes-including operative time, blood loss, and postoperative complications-were compared between groups.

Results: The M-SMA group demonstrated significantly shorter operative times and reduced intraoperative blood loss (p < .05). The overall postoperative complication rate was also significantly lower in the M-SMA group (11.3% vs. 23.8%, p = .004), with the most notable reduction observed in the incidence of chylous fistula. No significant differences were found in lymph node yield, length of hospital stay, or overall recovery.

Conclusions: The M-SMA approach demonstrates clear perioperative advantages over the traditional SMA technique, including reduced blood loss and a lower complication rate. It may represent a safer and more effective option for patients with complex vascular anatomy undergoing laparoscopic right hemicolectomy.

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.

Objective: To explore the optimal management strategies for small-sized nonfunctional pancreatic neuroendocrine tumors (NF-PanNETs) and to assess the rationale for the 'wait and see' approach.

Methods: This retrospective study analyzed data from 2,052 patients with small-sized NF-PanNETs (tumor size ≤20 mm) diagnosed between 2004 and 2019. Patients were further divided into two groups: those with tumors ≤10 mm (n = 573) and those with tumors 11-20 mm (n = 1,479). Demographic information, clinical characteristics, and survival outcomes were obtained and compared using the Surveillance, Epidemiology, and End Results (SEER) database.

Results: Tumors ≤10 mm were less likely to exhibit adjacent structure invasion (p = 0.005), lymph node involvement (p = 0.028), or distant metastasis (p < 0.001). Among T1N0M0 patients, both surgery and surveillance yielded similar cancer-specific survival (CSS) for those with tumors ≤10 mm, while surgery was significantly associated with better CSS for patients with tumors in the 11-20 mm range (p = 0.040). Multivariate analyses identified age >65 years, poor differentiation, T4 stage, and M1 stage as independent predictive factors for worse outcomes (all p < 0.001).

Conclusions: Compared to NF-PanNETs ≤10 mm, tumors sized between 11 and 20 mm are associated with higher risks of adjacent structure invasion, lymph node involvement, and distant metastasis. Tumors ≤10 mm can be safely monitored with active surveillance.

Objective: Non-small cell lung cancer (NSCLC) remains a major health concern due to its high incidence and mortality rates. This study aimed to investigate the role and underlying mechanism of the long non-coding X inactivation-specific transcript (lncRNA XIST)/microRNA-329-3p (miR-329-3p)/transmembrane BAX Inhibitor Motif-6 (TMBIM6) axis in the proliferation, migration, and invasion of NSCLC, and its potential as a therapeutic target.

Methods: The expression levels of XIST, miR-329-3p, and TMBIM6 in NSCLC tissues and cell lines were assessed using quantitative real-time PCR (qRT-PCR), and their correlations with clinicopathological characteristics were examined. Dual-luciferase reporter assays and RNA immunoprecipitation (RIP) were used to validate the binding interactions among XIST and miR-329-3p, and TMBIM6. The malignant phenotypes of NSCLC cells, including proliferation, migration, invasion, and apoptosis, were assessed using CCK-8, Transwell assays, and flow cytometry.

Results: Silencing XIST significantly suppressed the proliferation, migration, and invasion of NSCLC cells while promoting apoptosis. Mechanistically, XIST functioned as a competitive endogenous RNA (ceRNA), sponging miR-329-3p and thereby downregulating its expression. Overexpression of miR-329-3p counteracted the oncogenic effects of XIST in NSCLC cells. Additionally, miR-329-3p downregulated TMBIM6 expression, while TMBIM6 overexpression counteracted the tumor-suppressive effects of miR-329-3p.

Conclusion: Silencing XIST upregulates miR-329-3p, leading to the suppression of TMBIM6 expression and inhibition of NSCLC progression. These findings suggest that the XIST/miR-329-3p/TMBIM6 axis could serve as a promising molecular target for therapeutic strategies in NSCLC.

Background: The prognostic value of tumor regression grade (TRG) after neoadjuvant chemoradiotherapy for rectal cancer is inconsistent in the literature. Both TRG and post-therapy lymph node (ypN) status could reflect the efficacy of neoadjuvant therapy. Here, we explored whether TRG combined with ypN status could be a prognostic factor for MRI-based lymph node-positive (cN+) rectal cancer following neoadjuvant chemoradiotherapy.

Methods: 671 cN + rectal cancer patients who received neoadjuvant chemoradiotherapy followed by radical resection were enrolled. Patients were innovatively divided into three groups based on TRG and ypN status: TRG0-1N0, TRG2-3N0 or TRG0-1N+, TRG2-3N+. Kaplan-Meier method and log-rank test were used to compare the disease-free survival (DFS) and overall survival (OS) among three groups. Univariate and multivariate analyses were performed to explore the prognostic value of the modified TRG in cN + rectal cancer following neoadjuvant chemoradiotherapy.

Results: The mean duration of follow-up was 30.4 months. Significant survival differences were observed among the three groups. The 3-year DFS were 83.0%, 69.2% and 55.9%, respectively. The 5-year OS were 83.5%, 80.4% and 57.8%, respectively. TRG combined with ypN status was an independent predictor for both DFS and OS in multivariate analysis.

Conclusion: TRG combined with ypN status is a novel prognostic factor in cN + rectal cancer following neoadjuvant chemoradiotherapy, which assists clinicians make appropriate decisions regarding postoperative treatment and surveillance.