Journal of Investigative Surgery最新文献

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.

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: 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.

Objective: This investigation was to determine the relationship between changes in the expression levels of miR-134 and the E2F transcription factor 6 (E2F6) in mediating control of apoptosis in N-methyl-D-aspartate (NMDA)-induced glaucomatous mice.

Methods: Morphological and structural changes were quantitatively analyzed along with apoptosis in the retinal ganglion cell (RGC) layer, internal plexiform layer and RGCs. Glaucomatous RGCs were transfected, and cell viability and apoptosis were examined. The targeting relationship between miR-134 and E2F6 was analyzed, as well as their expression pattern.

Results: Intravitreal injection of NMDA induced a significant reduction in the number of RGCs and thinning of IPL thickness. miR-134 was highly expressed and E2F6 was lowly expressed in glaucoma mice. Suppression of miR-134 or E2F6 overexpression inhibited apoptosis in the glaucomatous RGCs and instead their proliferative activity. MiR-134 targeted inhibition of E2F6 expression. Suppressing rises in E2F6 expression reduced the interfering effect of miR-134 on glaucomatous RGC development.

Conclusion: Depleting miR134 expression increases, in turn, E2F6 expression levels and in turn reduces glaucomatous RGC apoptosis expression.

Background: Superior mesenteric artery syndrome (SMAS) is a rare condition, for which laparoscopic surgery was successfully performed safely and with long-term efficacy.

Methods: This single center retrospective clinical study comprised 66 patients with SMAS, surgically treated between January 2010 and January 2020, who were allocated to three different surgical groups according to their medical history and symptoms (Laparoscopic duodenojejunostomy, n = 35; Gastrojejunostomy, n = 16; Duodenojejunostomy plus gastrojejunostomy, n = 15). Patient demographics, surgical data and postoperative outcomes were retrieved from the medical records.

Results: All operations were successfully completed laparoscopically, and with a median follow-up of 65 months, the overall symptom score was significantly reduced from 32 to 8 (p < 0.0001) and the BMI was increased from 17.2 kg/m² to 21.8 kg/m² (p < 0.0001).

Conclusions: When conservative measures failed in the treatment of SMAS, laparoscopic surgery proved to be a safe and effective method. The specific surgical technique was selected according to the history and symptoms of each individual patient. To our knowledge, this study represents the largest number of laparoscopic procedures at a single center for the treatment of superior mesenteric artery syndrome.

Objective: The main purpose of the study was to explore the clinicopathological features and survival outcomes of patients with cervical cancer (CC) and adenomyosis and without the latter and to gain insight into the timely association between adenomyosis and CC.

Methods: 991 patients with CC and adenomyosis and 3964 patients without the latter were included in this retrospective cohort study. The clinicopathological characteristics including tumor size, depth of stromal invasion, presence of lymphovascular space invasion (LVSI), infiltration into vagina or uterine body, status of surgical vaginal margin, parametrial involvement, and pelvic or para-aortic lymph nodes metastasis were compared between the CC patients with/without coexisting adenomyosis by Student's t-tests, chi-square or Fisher's exact tests. The Cox proportional hazards model was employed to evaluate potential risk factors. Survival curves were constructed using the Kaplan-Meier method.

Results: Among the cervical cancer cohort, the coexistence of adenomyosis is associated with a lower likelihood of deep stromal invasion (50.2% vs 54.6%, p < 0.0001) and vaginal infiltration (25.8% vs 29.1%, p = 0.041) compared with CC patients without adenomyosis. There were no significant differences in tumor size, presence of LVSI, uterine body infiltration, status of surgical vaginal margin, parametrial involvement, and pelvic or para-aortic lymph nodes metastasis between both groups. However, adenomyosis did not remain as an independent prognostic factor for CC (HR 0.938, 95% CI: [0.72-1.22], p = 0.636) and did not reach statistical significance in the survival analysis (log rank test, p = 0.587).

Conclusion: CC patients with coexistent adenomyosis were associated with less aggressive tumor behavior including deep stromal invasion and vaginal infiltration. However, adenomyosis was not a prognostic factor for CC survival.

Background: Fracture healing can be impeded or even compromised by various factors, resulting in a growing number of patients suffering. The lncRNA LINC-PINT has garnered attention for its latent role in enhancing fracture healing, but its specific functions in this process remain unclear.

Objectives: The primary objective of this study is to investigate the clinical relevance and underlying molecular mechanisms of LINC-PINT in delayed fracture healing (DFH), while also assessing its potential as an early diagnostic biomarker.

Materials and methods: The expression levels of LINC-PINT were measured in the serum of DFH patients and those with normal fracture healing using RT-qPCR. In MC3T3-E1 cells, the study investigated the influence on the expression of differentiation-related protein, cell viability, and apoptosis through the modulation of LINC-PINT and miR-324-3p. To elucidate the targeting relationship between LINC-PINT, miR-324-3p, and BMP2, a dual-luciferase reporter assay was employed.

Results: The findings revealed a significant downregulation of LINC-PINT expression in DFH patients. LINC-PINT showed high sensitivity and specificity as a diagnostic marker for DFH. In MC3T3-E1 cells, LINC-PINT overexpression markedly enhanced the expression levels of ALP, OCN, Runx2, and OPN, improved cell viability, and inhibited apoptosis. LINC-PINT negatively regulated miR-324-3p, and the effects of LINC-PINT were counteracted by miR-324-3p. LINC-PINT was found to regulate BMP2 by targeting miR-324-3p.

Conclusion: LINC-PINT could serve as an early diagnostic biomarker for DFH and slow the progression of DFH by modulating BMP2 through the targeted regulation of miR-324-3p. This research presents new molecular targets for the diagnosis and treatment of DFH.

Objective: This study aimed to observe the safe use of intraspinal anesthesia in geriatric orthopedic surgery and its effect on coagulation factors.

Methods: The anesthesia indices, cognitive functions, hemodynamic indicators, along with coagulation function indices were compared. The duration of anesthesia was compared between the two groups. Adverse reactions occurring in the two groups of patients were compared.

Results: The time to awaken, time to open eyes, time to the verbal statement, the onset of anesthesia, duration of sensory blockade, and duration of motor nerve blockade were shorter while the duration of analgesia was longer in the observation group than in the control group. The observation group's postoperative Mini-Mental State Examination scores were higher than those of the control group. Heart rate and mean arterial pressure of the patients in the observation group at 10 min after anesthesia and at the end of surgery were lower versus those in the control group. The observation group had lower levels of von Willebrand factor (%) and fibrinogen at 10 min after anesthesia and at the end of surgery than the control group, and lower levels of the thrombin-antithrombin complex at the end of surgery than the control group. The observation group exhibited a lower incidence of adverse reactions in contrast to the control group.

Conclusion: The application of intraspinal anesthesia in geriatric orthopedic surgery has a significant and remarkable effect, with less impact on patients' hemodynamics and postoperative cognitive function, and can improve patients' blood hypercoagulability.