Table of Content

20 December 2025, Volume 25 Issue 06

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Original Articles and Clinical Research

Breast cancer screening in Guangdong： efficacy assessment and management optimization for ultrasound BI-RADS 0/3 categories

XIE Si-mei, CHEN Guo-zhen, ZHU Cai-xia, WU Cai-xia, OU Qiao-yan, YANG Jian-min, ZHANG An-qin

2025, 25(06):  352-359.  DOI: 10.3969/j.issn.1009-976X.2025.06.002

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Objective To evaluate the implementation efficiency of the screening program, and to focus on the incremental diagnostic value of X-ray examination in people classified by ultrasound BI-RADS into 0 and 3 categories. Methods The data were collected from the Guangdong Women and Children Information Platform and finally included 683 765 women aged 35-64 who participated in the free breast cancer screening project in Guangdong Province in 2024 for analysis. Results There were significant differences in the distribution of basic characteristics among different age groups （P<0.001）. This study revealed no significant differences in histopathology biopsy rates across age groups. Overall, the biopsyrate was 67.97%, with a breast cancer detection rate of 120.66 per 100,000. In 2024, the detection rate of breast cancer in Guangdong Province increased with age （χ²=169.549, P<0.001）. Taking the results of histopathological examination as the gold standard, the sensitivity of ultrasound examination was the highest （79.88%）, the sensitivity of clinical examination and X-ray examination was low （20.36%, 22.06%）, and the specificity of the three methods was high （99.04%~99.94%）. In the ultrasound category 0/3 population, X-ray examination downgraded 50.23% to category 1/2, and upgraded 3.76% to category 4/5. The overall detection rate of extra cancer was 26.62 per 100 000. Conclusion Ultrasound examination, as the main method of breast cancer screening, has the core diagnostic value in screening, and its sensitivity is significantly higher than other screening methods. X-ray examination provides definite incremental value for the ultrasound category 0/3 population, which can not only avoid unnecessary biopsy, but also identify additional cancer cases.

Exploring the optimal dosage of indocyanine green in real-time fluorescence imaging during laparoscopic surgery for acute cholecystitis （Grade Ⅱ）

CHEN Qia-ming, LI Zhen-pan, HUANG Dan-na, ZHANG Zhuo-min, WANG Li-yong, YAO Le-zhao, ZHENG Zhong

2025, 25(06):  360-366.  DOI: 10.3969/j.issn.1009-976X.2025.06.003

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Objective To investigate the optimal intravenous dosage of indocyanine green （ICG） during laparoscopic cholecystectomy （LC）. Methods Eighty patients scheduled for fluorescence-guided laparoscopic cholecystectomy （LC） in the Department of General Surgery, Puning People's Hospital, from January 2024 to December 2024 were enrolled as research subjects. They were randomly divided into four groups with 20 cases each using the envelope method. Different doses of indocyanine green （ICG） were intravenously injected intraoperatively in each group： 0.125 mg, 0.25 mg, 0.5 mg, and 5 mg. The extrahepatic bile duct visualization time, visualization rate, and fluorescence intensity of the liver and bile duct were observed in the four groups. Additionally, the fluorescence intensity ratio between the two （bile duct-to-liver ratio, BLR） was analyzed to evaluate the effect of cholangiography. Results The 0.5 mg group exhibited a superior visualization rate, with a statistically significant difference among the four groups （P=0.01）. There was no statistically significant difference in the common bile duct visualization time across the four groups （P=0.162）. For the stratified analysis of the bile duct-to-liver ratio （BLR）, we counted the number of eligible cases with BLR≥1, BLR≥1.5, BLR≥2, and BLR≥2.5, respectively. The results showed that under the above four BLR stratification criteria, the number of eligible cases in the 0.5 mg group was the highest among the four groups, and there were statistically significant overall differences among the four groups （all P<0.05）. Conclusion Intravenous injection of 0.5 mg ICG during LC provides optimal fluorescence imaging for the extrahepatic biliary tract.

A multiparametric MRI-based radiomics model for the preoperative prediction of histological differentiation in hepatocellular carcinoma

ZENG Jia-le, FENG Xin, XU Qi-ye, WANG Zhi-hui

2025, 25(06):  367-374.  DOI: 10.3969/j.issn.1009-976X.2025.06.004

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Objective To develop a multiparametric MRI-based radiomics model for the preoperative noninvasive prediction of histological differentiation in hepatocellular carcinoma （HCC）. Methods A total of 206 patients with pathologically confirmed HCC who underwent surgical resection at Sun Yat-sen Memorial Hospital between September 2022 and December 2024 were retrospectively enrolled. Patients were classified into high-grade （n=57） and low-grade （n=149） groups based on the Edmondson-Steiner grading system and were then randomly assigned to training （n=144） and validation （n=62） cohorts at a ratio of 7∶3. Clinical predictors were identified through univariate and multivariate logistic regression analysis. Radiomics features were extracted from multiparametric MRI images and selected by applying univariate logistic regression analysis, maximum relevance minimum redundancy （mRMR）, and least absolute shrinkage and selection operator （LASSO） algorithms. Predictive models were developed using logistic regression. Model performance was evaluated by the receiver operating characteristic （ROC） curves and area under the curve （AUC）. The DeLong test was employed to compare AUC values. Calibration curves and the Hosmer-Lemeshow test were used to evaluate the model's calibration. Results The combined radiomics model （Comb_Rad） achieved AUCs of 0.904 and 0.886 in the training and validation cohorts, significantly outperformed all single-parameter radiomics models in the validation cohort （all P<0.05, DeLong test）. The radiomics-clinical combined model （Rad_Clin） achieved the best performance, with AUCs of 0.933 in the training cohort and 0.902 in the validation cohort. The Rad_Clin model demonstrated significantly better performance than the Comb_Rad model in the training cohort （P=0.047）, while both models significantly outperformed the clinical model （Clin） in both cohorts （all P<0.05）. Additionally, the Rad_Clin model demonstrated good fit （training cohort P=0.905, test cohort P=0.853）. Conclusion A multiparametric MRI-based radiomics model can effectively predict the histological differentiation of HCC, and the integration of clinical factors further improves predictive performance.

Observation on effect and complications of LCA preservation during total mesorectal excision in the treatment of middle and low rectal cancer

ZENG Yue-yue, XIA Yue-ming, YANG Xiao-feng, WU Shu-tao, WU Jin-cheng, CHEN Zhao-wu

2025, 25(06):  375-381.  DOI: 10.3969/j.issn.1009-976X.2025.06.005

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Objective To investigate the influence of presence or absence of preservation of left colonic artery （LCA） during laparoscopic total mesorectal excision （TME） on the therapeutic effect and complications in patients with middle and low rectal cancer. Methods Patients with middle and low rectal cancer who underwent TME in the hospital from January 2019 to December 2024 were selected. According to different LCA treatment methods, they were divided into preservation group and non-preservation group. After excluding the influence of baseline data confounding factors by propensity score matching method, 58 cases were finally obtained in preservation group and 53 cases in non-preservation group. The baseline data of the two groups after matching were balanced and comparable. The surgical indexes, complications, blood perfusion time, urination function, gastrointestinal function indexes and inflammatory factors were analyzed and compared between the two groups, and the prognosis of the two groups was followed up and counted. Results The first postoperative anal exhaust time, incidence rates of complications and blood perfusion time after anastomosis in preservation group were shorter or lower than those in non-preservation group （P<0.05）, while marginal arterial arch pressure was higher （P<0.05）. At 1 month after surgery, the International Prostate Symptom Scale （IPSS） score was lower in preservation group than those in non-preservation group （P<0.05）. At 3 days after surgery, the motilin and gastrin levels in preservation group were higher （P<0.05） while the levels of interleukin-1β （IL-1β）, IL-6 and tumor necrosis factor-α were lower than those in non-preservation group （P<0.05）. At 6-month follow-up, no deaths occurred in either group. There were no significant differences between groups in short-term complications, local recurrence rate and metastasis rate （P>0.05）. Conclusion Preservation of LCA during laparoscopic TME for patients with middle and low rectal cancer is conducive to postoperative recovery, with low risk of perioperative complications and low incidence rate of postoperative urination disorders.

Comparison of short-term and long-term curative effects of hybrid surgery and open surgery on right-sided colon cancer with intestinal obstruction

YANG Yu-gang, LUO Li-xiong, ZHENG Zhi-zhong, HU Jin-hui

2025, 25(06):  382-387.  DOI: 10.3969/j.issn.1009-976X.2025.06.006

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Objective To explore and compare the short-term and long-term curative effects of hybrid surgery and open surgery on right-sided colon cancer with intestinal obstruction. Methods A total of 92 patients who underwent surgical treatment for right colon cancer with intestinal obstruction from June 2019 to June 2022 were selected and divided into an observation group （hybrid surgery, n=40） and a control group （open surgery, n=52）. Perioperative indicators, complication rates, inflammatory and nutritional markers on postoperative day 1 and day 4 were compared between the two groups. The overall survival rates at 3 years postoperatively were also followed up and compared. Results The surgical time in observation group was significantly longer than that in control group （P<0.05）, and the blood loss volume, pain level, first feeding time, exhaust time and hospitalization time were significantly less or shorter （P<0.05）. There were no statistical differences in the incidence rates of complications between the two groups （P>0.05）. At 4 days after surgery, the levels of serum inflammatory factors in observation group were significantly lower while the nutritional indexes levels were significantly higher compared to control group （P<0.05）. At 3 years of follow-up after surgery, no statistical difference was found in the overall survival rate between the two groups （P>0.05）. Conclusion Hybrid surgery takes a long time, and has fast postoperative recovery and improved postoperative inflammatory status and nutritional indexes, and there are no significant differences in the major complications at 30 days after surgery and long-term overall survival rate.

Clinical characteristics of excessive release of cytokines in patients undergoing extracorporeal circulation surgery in cardiovascular surgery

LI Jing-wen, FU Yuan, MA Tian-jiao, ZENG Zhao-pei, LI Ling, ZHENG Jun-meng

2025, 25(06):  388-394.  DOI: 10.3969/j.issn.1009-976X.2025.06.007

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Objective This study aimed to investigate the impact of persistent cytokine over-release on the 72-hour and 90-day prognosis after adult cardiac surgery. Methods A retrospective analysis was conducted on 571 consecutive patients with confirmed cardiovascular and great vessel diseases admitted to a single center between 2017 and 2024. Patients were divided into an over-release group （117 cases） based on high cytokine test indicators and a conventional group （454 cases） for the remaining patients. Surgical-related indicators before cardiopulmonary bypass, within 72 hours post-surgery, and 4~10 days post-surgery, as well as postoperative outcomes, were recorded. Related indicators of adverse prognosis and clinical outcomes after cardiac surgery were compared and analyzed between the two groups. Results A total of 571 cardiac surgery patients were included in the study, with 117 patients in the over-release group and 454 in the conventional group. Baseline data showed a significantly higher proportion of advanced age （≥75 years, P<0.0001）, renal insufficiency （P<0.0001）, and history of PCI （P=0.0003） in the over-release group. Intraoperative analysis revealed that the rates of ECMO support, David procedure, and median cardiopulmonary bypass time （P<0.0001） were significantly higher in the over-release group compared to the conventional group. Postoperative outcomes indicated a significantly increased risk of SIRS （adjusted OR=11.40, 95%CI： 4.14~31.39）, mortality （OR=23.45, 95%CI： 5.12~107.38）, and postoperative dialysis （OR=11.21, 95%CI： 5.92~21.24） in the over-release group. Furthermore, ICU length of stay was prolonged by 11 hours （23 h vs 12 h; HR=0.34, 95%CI： 0.27~0.42）, and total length of stay was prolonged by 8 days （19 d vs 11 d; HR=0.52, 95%CI： 0.40~0.66）, suggesting a close association between excessive inflammatory cytokine release and adverse prognosis. Conclusion Perioperative cytokine over-release in cardiac surgery patients undergoing cardiopulmonary bypass leads to increased ICU length of stay and total length of stay, an increased incidence of postoperative delirium, and exacerbated renal damage. Long aortic clamping time and massive transfusion of blood products during surgery are important risk factors for increased cytokine release. Additionally, elevated postoperative cytokine levels were more pronounced in patients with pre-existing chronic inflammatory conditions, those undergoing long-term dialysis, and elderly patients.

Case Report

Invasive mixed signet ring cell carcinoma of the breast： a case report and literature review

YU Miao, ZHANG Meng, WANG Ze, JIA Jian-dong

2025, 25(06):  395-398.  DOI: 10.3969/j.issn.1009-976X.2025.06.008

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Objective To report a rare case of primary invasive mixed signet ring cell carcinoma （SRCBC） of the breast, and to investigate its clinical characteristics, diagnostic criteria, differential diagnosis, and treatment and prognosis for improve understanding of this rare disease. Methods Clinical data, imaging findings, pathological results （core-needle biopsy and postoperative）, and treatment course （right total mastectomy with low axillary lymph node dissection） of an 83-year-old female patient were retrospectively analyzed with a comprehensive literature review. Results The patient presented with a painless right breast mass. Preoperative imaging suggested malignancy （BI-RADS 4C）. Both biopsy and postoperative pathology confirmed invasive mixed carcinoma composed predominantly of mucinous carcinoma （90%） and signet ring cell carcinoma （>20%）, with a minor component of grade Ⅱ invasive ductal carcinoma （10%）. Immunohistochemistry demonstrated strong ER positivity （90%）, low PR expression （<5%）, Her-2 negativity, and Ki-67 （15%）, supporting mammary origin （E-Cadherin+, GATA-3+）. Axillary lymph nodes showed no metastasis （0/16）. Perioperative management integrated Traditional Chinese Medicine （herbal decoction, auricular acupuncture, micro-acupuncture） with conventional therapy （surgery + supportive care）. Metastatic disease was excluded through imaging and clinical history, confirming primary mixed SRCBC （T2N0M0）. Conclusion This mixed-pathology case exhibited relatively favorable prognosis due to early pathological stage （T2N0M0） and node-negative status.

Review

Research Progress of Metabolomics in Surgical Precision Medicine

CEN Mei-feng, PAN Wen-feng, WANG Xiao-juan

2025, 25(06):  399-409.  DOI: 10.3969/j.issn.1009-976X.2025.06.009

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Metabolomics is an important branch of systems biology, mainly studying the composition and dynamic changes of endogenous small molecules in organisms. Due to its ability to reflect the phenotype of the body and its rapid response to physiological and pathological changes, it provides an important strategy for the diagnosis and treatment of the surgical precision medicine. This article briefly describes the core concepts, mainstream methods, standard experimental procedures and quality control principles of metabolomics technology, and focuses on summarizing its main research progress in the fields of tumor and non-tumor surgery, including risk assessment, lesion identification, prognosis monitoring and perioperative management. It also analyzes the challenges that metabolomics technology currently faces in the process of clinical transformation, such as the standardization of samples and databases, the verification of result repeatability, and the complexity of deep integration of multi-omics data. In the future, with the development of nanosensors and artificial intelligence analysis technology, metabolomics technology is expected to promote the transformation of the predictive model of precision medicine in surgery.

Research progress on partial-thickness rotator cuff tear

Qiu Yu, Xie Zi-kang

2025, 25(06):  410-415.  DOI: 10.3969/j.issn.1009-976X.2025.06.010

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Partial-thickness rotator cuff tear （PTRCT） is a common clinical disease that causes shoulder pain and limited movement. Age-related degenerative changes and acute trauma are the main causes of PTRCT. Ultrasonography, MRI, and MRA can assist in the diagnosis of PTRCT, while arthroscopy is considered the “gold standard” for diagnosis. Treatment options for PTRCT include non-surgical and surgical methods. Surgery may be considered when non-surgical treatments fail. Surgical treatments mainly involve arthroscopic debridement and arthroscopic PTRCT repair. In addition, biotechnology and biological scaffold techniques may offer good clinical outcomes in treating PTRCT, but further research is needed to clarify their mechanisms of action, long-term efficacy, and to refine operation standards for standardized application.