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Distribution and drug resistance analysis of pathogenic bacteria in abdominal infections in patients with primary liver cancer after liver resection, transarterial chemoembolization（TACE） and liver transplantation PENG Xu-jian, LUO Ling, LIN Xiang-hua, WANG Xiao-chen, ZHONG Run-qiang, CAI Meng-shan Lingnan Modern Clinics In Surgery    2025, 25 (03): 156-161.   DOI: 10.3969/j.issn.1009-976X.2025.03.002 Abstract （165）      PDF（pc） （984KB）（5）       Knowledge map    Save Objective To investigate the distribution and drug resistance analysis of pathogenic bacteria in abdominal infection after liver resection, transarterial chemoembolization（TACE） and liver transplantation in primary liver cancerpatients. Methods The clinical data of 158 primary liver cancer patients with abdominal infection after liver resection, TACE or liver transplantation in our hospital from Jan 2018 to May 2023 were retrospectively analyzed, to investigate their pathogenic bacteria distribution and drug resistance. Results From samples of patients with abdominal infection after liver resection, TACE, and liver transplantation, 204, 69, and 34 strains of pathogenic bacteria were cultured, respectively. Gram-negative bacteria accounted for 51.96%, 62.32% and 52.94%; Gram-positive bacteria for 40.20%, 30.43%, and 32.35%; and fungi for 7.84%, 7.25%, 14.71%, respectively. The most common pathogenic bacteria were Escherichia coli（14.71%）, Escherichia coli（18.84%） and Klebsiella pneumoniae（11.76%） among primary liver cancer patients with abdominal infection after liver resection, TACE and liver transplantation. According to the results of drug susceptibility, Escherichia coli and Klebsiella pneumoniae had a high rate of resistance to Cephalosporins, Quinolones and Sulfonamides. Among Escherichia coli and Klebsiella pneumoniae, the detection rate of strains producing extended-spectrum beta-lactamases （ESBLs） were 56.8% and 27.8% and meanwhile, the detection rate of strains with carbapenem resistance were 2.3% and 16.2%. Conclusion Among the primary liver cancer patients with abdominal infection after liver resection, TACE or liver transplantation, the main pathogenic bacteria is enterobacteriaceae and the multi-drug resistance strains have a high rate of detection. While choosing the postoperative prophylactic antibiotics, the antibiotics which are effective to the enterobacteriaceae are the first choice. Reference | Related Articles | Metrics

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Application of small dose of esketamine on patient-controlled intravenous analgesia in children after concealed penile correction surgery GAO Ning-yang, YUAN Chao, ZHOU Lin, ZHANG Li-bin Lingnan Modern Clinics In Surgery    2025, 25 (03): 190-195.   DOI: 10.3969/j.issn.1009-976X.2025.03.008 Abstract （162）      PDF（pc） （995KB）（0）       Knowledge map    Save Objective To investigate the effect of low-dose esketamine combined with sufentanil on patient-controlled intravenous analgesia （PCIA） in children after allergic penile correction surgery. Methods In this study, a total of 90 children aged 4 to 12 years who were scheduled to undergo corrective surgery for concealed penis were selectedand divided equally into SE0, SE1 and SE2 groups. All children received anethesia induction with sufentanil and esketamine, while a sacral block was performed under ultrasound guidance and intraoperative anaesthesia was maintained with 1.3 MAC sevoflurane. The postoperative self-administered intravenous analgesia regimen was： 1 μg/（kg·24 h） of sufentanil in group SE0, 1 μg/（kg·24 h）of sufentanil + esketamine 0.5 mg/（kg·24 h）in group SE1 and 1 μg/kg of sufentanil + esketamine 1 mg/kg in group SE2, all diluted with 0.9% saline to 200 ml. Heart rate, mean arterial pressure, delirium score during anesthesia awakening, Wong-Baker analgesia score, Ramsay sedation score, number of postoperative analgesic pump presses, sufentanil dosage and occurrence of adverse effects were recorded in the three groups of children. Results The SE1 and SE2 groups experienced fewer postoperative analgesic pump presses and less sufentanil than the SE0 group （P<0.0165）. The SE2 group achieved fewer analgesic pump presses and less sufentanil consumption than the SE1 group, and had higher Ramsay sedation scores at T4 than the SE1 and SE0 groups （P<0.05）. At remaining moments, there were no significant differences between the groups in terms of delirium scores, analgesia, sedation scores, heart rate, mean arterial pressure and incidence of adverse reactions during the awakening period of paediatricanaesthesia （P>0.05）. Conclusion Low-dose esketamine combined with sufentanil PCIA achieves satisfactory postoperative analgesia in children undergoing hidden penis correction surgery, reduces total sufentanil dosage, and avoids emergence delirium or other significant adverse reactions. Reference | Related Articles | Metrics

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Clinical retrospective analysis of non-drainage in transoral endoscopic thyroidectomy vestibular approach AI Qing, HUANG Zhi-heng, JIANG Jiang, WENG Yu-jing Lingnan Modern Clinics In Surgery    2025, 25 (03): 168-173.   DOI: 10.3969/j.issn.1009-976X.2025.03.004 Abstract （155）      PDF（pc） （1038KB）（10）       Knowledge map    Save Objective To investigate the feasibility and safety of not placing a drainage tube during transoral endoscopic thyroidectomy vestibular approach （TOETVA）. Methods A retrospective analysis was conducted on 416 cases of TOETVA performed at our hospital from August 2021 to April 2024. After exclusions, 386 cases were included and divided into two groups based on the presence or absence of drainage： the no-drainage group （145 cases） and the drainage group （241 cases）. Postoperative hospital stays, pain scores, postoperative bleeding, seroma, and infection rates were compared between the two groups. Results No significant differences were observed in surgery time or postoperative pain scores.Postoperative complications, including bleeding, seroma, infection, hoarseness, and permanent hypoparathyroidism, showed no significant differences between the two groups. The proportion of patients who underwent total thyroidectomy was significantly higher in the drainage group than in the no-drainage group （25/241 vs. 1/145, P=0.01）. Intraoperative predicted bleeding was higher in the drainage group than in the no-drainage group [10（5,10） mL vs. 5（5,5） mL, P<0.01]. Postoperative hospitalization was significantly shorter in the no-drainage group than in the drainage group [2（2,2） vs. 3（2,3） d; P<0.01]. After excluding total thyroidectomy patients, when comparing only unilateral lobectomy cases, significant differences were found in intraoperative blood loss and hospital stay. In the no-drainage group, intraoperative bleeding was less （P<0.001） and postoperative hospitalization was shorter （P<0.001）, while other indicators showed no statistical differences. Conclusion Routine non-drainage in TOETVA is safe and feasible, not increasing the risk of postoperative bleeding, seroma, or infection. Reference | Related Articles | Metrics

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Clinical efficacy of longitudinal fixation with a single Kirschner pin in closed reduction for severely displaced juxta-epiphyseal fracture of the proximal phalanx in children WANG Shuai-yin, HUANG Zi-long, LI Jia-hui, LIU Shi-zhe, FU Gui-bing Lingnan Modern Clinics In Surgery    2025, 25 (03): 174-178.   DOI: 10.3969/j.issn.1009-976X.2025.03.005 Abstract （151）      PDF（pc） （1729KB）（3）       Knowledge map    Save Objective To explore the clinical efficacy of longitudinal fixation with a single Kirschner pin in closed reduction for severely displaced juxta-epiphyseal fracture of the proximal phalanx in children. Methods A retrospective analysis of 24 cases of juxta-epiphyseal fracture of the proximal phalanx in children were performed, in whom treated with closed-displacement single Kirschner pin longitudinal fixation from January 2018 to December 2020. All of them were acute closed fractures, diagnosed by X-ray before operation, and of them were severely displaced （type Ⅱ） juxta-epiphyseal fracture according to the Campbell's line, all were successfully closed-displaced and single Kirschner pin longitudinally fixated, and followed up regularly after operation. The function and growth of the affected fingers were observedduring regular follow-up after operation. Results The follow-up period ranged from 40 to 69 months, with an average of 51.23 months. All the children had healed the fracture at outpatient review, and the average healing time was 3.5 weeks. All cases were rated as excellent according to the hand function evaluation criteria in the trial standards for upper limb functional assessment by the Hand Surgery Society of the Chinese Medical Association, with no complications such as infection, skin necrosis, nonunion, premature physeal closure, or severe malunion of fingers. Conclusion Close dreduction longitudinal fixation with a single Kirschner pin can achieve satisfactory results in treating severely displaced juxta-epiphyseal fracture of the proximal phalanx in children. Reference | Related Articles | Metrics

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Value of MR-DWI combined with PSAD on differentiation degree of prostate cancer ZHANG Li-hua, ZHANG Ke, YUAN Jia-jun Lingnan Modern Clinics In Surgery    2025, 25 (03): 196-201.   DOI: 10.3969/j.issn.1009-976X.2025.03.009 Abstract （131）      PDF（pc） （1214KB）（0）       Knowledge map    Save Objective To investigate the value of 3.0T magnetic resonance diffusion weighted imaging （MR-DWI） parameters combined with prostate-specific antigen density （PSAD） on predicting the differentiation degree of prostate cancer. Methods 80 patients with prostate cancer in the hospital from August 2021 to August 2024 were included in this study. According to the results of clinical and pathological examination, they were divided into 32 cases in highly differentiated group （Gleason score<7 points） and 48 cases in moderately and poorly differentiated group （Gleason score≥7 points）. The MR-DWI signs, apparent diffusion coefficient （ADC） under different b values （0 s/mm2, 1000 s/mm2） and PSAD were analyzed and compared. The correlation between ADC, PSAD and Gleason score was analyzed. Receiver operating characteristic （ROC） curve was used to analyze the evaluation value of ADC and PSAD on differentiation degree of prostate cancer. Results Compared with highly differentiated group, the proportions of cases with blurred lesion boundary and lesion located in peripheral zone by MR-DWI were more in moderately and poorly differentiated group （P<0.05）. The ADCs under different b values in moderately and poorly differentiated group were smaller than those in highly differentiated group, and PSAD was higher than that in highly differentiated cancer group （P<0.05）. ADC was negatively correlated with Gleason score （P<0.05）, and PSAD was positively correlated with Gleason score （P<0.05）. The results of the ROC curve analysis for assessing the risk of low-to-intermediate-grade prostate cancer showed that the areas under the curve （AUCs） for the ADC value （b=50 s/mm2）, the ADC value （b=1200 s/mm2）, the PSAD level, and the combined model were 0.747, 0.704, 0.700, and 0.890, respectively. Statistical comparison indicated no significant difference in diagnostic performance among the three individual indicators （P>0.05）. However, the diagnostic performance of the combined model was significantly superior to that of any single indicator （Z-scores=2.662, 3.190, and 2.593, respectively; all P<0.05）. Among all assessment models, the combined model demonstrated the highest diagnostic efficacy, with a sensitivity of 66.67% and a specificity of 96.87%. Conclusion Both ADC values and PSAD levels are effective biomarkers for assessing the differentiation grade of prostate cancer. A multiparametric model, constructed by combining MR-DWI-derived ADC values with serum PSAD levels, demonstrates superior diagnostic performance in the preoperative prediction of low-to-intermediate-grade prostate cancer risk compared to each individual indicator. Reference | Related Articles | Metrics

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Study on the feasibility of improving the timeliness of diagnosis and treatment of tumors through multi-project and multi-sample hybrid gene sequencing technology HUANG Jing-hua, LUO Jia-huan, SUN Xi, XIAO Xiao-qin, JIANG Yuan-ling, HUANG Yong-sheng, LIAO Jian-wei Lingnan Modern Clinics In Surgery    2025, 25 (03): 184-189.   DOI: 10.3969/j.issn.1009-976X.2025.03.007 Abstract （130）      PDF（pc） （993KB）（2）       Knowledge map    Save Objective To conduct a retrospective analysis of multi-project and multi-sample sequencing in tumor samples, and to explore the feasibility of improving the timeliness of clinical tumor diagnosis and treatment. Methods This study mainly verified the feasibility of improving the timeliness of tumor diagnosis and treatment through multi-project mixed gene sequencing by analyzing the sequencing quality control data and detection results when WES libraries and tumor gene sequencing libraries were sequenced on the NovaSeq 6000dx sequencing platform. Results In 24 batches of pooled sequencing, the average cluster pass rate was 77.92%, the average expected data output was 633.22 Gb, and the average Q30 was 91.33%, all of which met the quality control standards. For the 753 whole exome sequencing （WES） libraries and 164 tumor multi-gene sequencing libraries, the individual sample data volume, average sequencing depth, and the proportion of sequencing depth >20× all met the quality control standards. No statistically significant differences were found in the detection results of the same sample in different batches of hybrid sequencing （P=0.125）. The turnaround time for clinical gene test reports was significantly shortened after adopting hybrid gene sequencing, mainly characterized by a reduced sequencing frequency. Conclusion Multi-project and multi-sample libraries can be sequenced using hybrid sequencing to improve the timeliness of gene testing reports in tumor diagnosis and treatment. Reference | Related Articles | Metrics

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The predictive value of serum choline acetyltransferase combined with DCE-MRI parameters for postoperative femoral head necrosis in patients with femoral neck fractures LI De, CHEN Wu-lin, SUN Rui-bo, LIU You-wen Lingnan Modern Clinics In Surgery    2025, 25 (03): 179-183.   DOI: 10.3969/j.issn.1009-976X.2025.03.006 Abstract （118）      PDF（pc） （1099KB）（0）       Knowledge map    Save Objective To analyze the predictive value of serum choline acetyltransferase（ChAT） combined with dynamic contrast-enhanced magnetic resonance imaging（DCE-MRI） parameters for postoperative femoral head necrosis in patients with femoral neck fractures. Method 120 patients with femoral neck fractures who underwent surgery at Luoyang Orthopedic Hospital Luoyang district, Henan Province from January 2020 to June 2023 were selected as the research subjects.They were divided into an occurrence group and a non-occurrence group based on whether they developed femoral head necrosis after surgery. Both groups underwent DCE-MRI examination, and the relevant examination parameters and serum ChAT levels were compared between the two groups. The receiver operating characteristic（ROC） curve was used to analyze the value of serum ChAT and DCE-MRI parameters in the prognosis of femoral neck fractures. Results The serum ChAT level in the occurrence group was lower than that in the non-occurrence group, and the volume transfer constant（Ktrans）, rate constant（Kep）, and area under the initial time concentration curve（iAUC） values were all higher than those in the non-occurrence group（P<0.05）. The range of serum ChAT, DCE-MRI parameters, and area under the curve（AUC） values for combined examination was 0.765~0.962, indicating high sensitivity and specificity. Conclusion The combination of serum ChAT and DCE-MRI parameters has certain predictive value for postoperative femoral head necrosis in patients with femoral neck fractures. The use of a combined examination plan is expected to provide a basis for clinical treatment selection. Reference | Related Articles | Metrics

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Research progress of Mendelian randomized analysis of osteonecrosis PANG Yin-quan, YANG Xi-cheng, ZHAO Li-li Lingnan Modern Clinics In Surgery    2025, 25 (03): 210-215.   DOI: 10.3969/j.issn.1009-976X.2025.03.012 Abstract （112）      PDF（pc） （1000KB）（14）       Knowledge map    Save Mendelian randomization analysis is a data analysis technique used to evaluate etiological inference in epidemiological studies. It uses genetic variation strongly correlated with disease-related exposure factors as instrumental variables to evaluate the causal relationship between disease exposure factors and outcomes, aiming to reduce the interference of confounding factors and improve the accuracy of causal inference. There is a causal relationship between osteonecrosis and inflammatory cytokines, immunocyte phenotype, telomere length, intestinal flora and micronutrients, while there is no causal relationship between diabetes and osteonecrosis. This can more accurately reveal the etiology and pathogenesis of osteonecrosis in clinical practice, and provide new ideas and directions for the prevention and treatment of osteonecrosis. The literature of Mendelian randomization analysis of osteonecrosis was extensively reviewed in recent years, and the causal association between osteonecrosis and inflammatory cytokines, immunocyte phenotype, telomere length, intestinal flora, micronutrients and diabetes was analyzed and summarized. Reference | Related Articles | Metrics

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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 Lingnan Modern Clinics In Surgery    2025, 25 (06): 352-359.   DOI: 10.3969/j.issn.1009-976X.2025.06.002 Abstract （109）      PDF（pc） （1024KB）（7）       Knowledge map    Save 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. Reference | Related Articles | Metrics

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Study on the significance of PCT combined with amylase measurement of peritoneal drainage fluid in the early diagnosis and prognosis evaluation of intestinal fistula after colorectal cancer surgery LIN Liang-xue, DENG Hai-mei, CAI Hai-jing, PANG Shao-chun, DENG Zhi-an, LI Yi-ting, WANG Guan, WU Guo-zhong Lingnan Modern Clinics In Surgery    2025, 25 (03): 162-167.   DOI: 10.3969/j.issn.1009-976X.2025.03.003 Abstract （108）      PDF（pc） （1103KB）（3）       Knowledge map    Save Objective To analyze the application value of serum procalcitonin（PCT） combined with amylase measurement of peritoneal drainage fluid in the early diagnosis and prognosis evaluation of intestinal fistula after colorectal cancer surgery. Methods Patients who underwent surgical treatment for colorectal cancer at the hospital from March 2023 to October 2024 were selected for the study. Peritoneal drainage tubes were inserted post-operation, and serum PCT and amylase levels in the peritoneal drainage fluid were measured on the 1st, 3rd, 5th, and 7th days post-surgery. The patients were categorized into the intestinal fistula group and the non-intestinal fistula group based on the presence of an intestinal fistula, and a cohort observational study was conducted to compare and analyze the serum PCT and amylase levels in the peritoneal drainage fluid between the two groups. Results There were significant differences （P<0.05） in serum PCT and amylase levels in peritoneal drainage fluid between the intestinal fistula group and the non-intestinal fistula group at different postoperative time periods. ROC curve analysis revealed that the AUC and sensitivity of the combined diagnosis of serum PCT and peritoneal drainage amylase were relatively high. There were significant differences （P<0.05） in serum PCT levels between the micro-fistula group and the non-micro-fistula group on postoperative days 1, 3, 5, and 7. ROC curve analysis revealed that serum PCT had an AUC of 0.907 and a sensitivity of 86.67% for predicting the prognosis of postoperative intestinal fistula in colorectal cancer. Conclusion The combined detection of amylase in peritoneal drainage fluid and serum PCT can improve the early diagnostic efficiency of postoperative intestinal fistula in colorectal cancer, and changes in serum PCT levels can be used to evaluate the prognosis of patients. Reference | Related Articles | Metrics

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Clinicopathological features of gastric cancer with familial aggregation: a single-center retrospective study LI Sen-mao, HE Xuan, WANG Peng-liang, WU Xian-rui, LIAO Yi Lingnan Modern Clinics In Surgery    2025, 25 (05): 281-287.   DOI: 10.3969/j.issn.1009-976X.2025.05.001 Abstract （104）      PDF（pc） （1110KB）（6）       Knowledge map    Save Objective To investigate the clinicopathological characteristics of familial clustering gastric cancer and compare the differences among probands with different types of family history, providing clues for exploring the unique genetic background of familial gastric cancer in Chinese, particularly East Asian populations. Methods Data from 282 gastric cancer patients who underwent surgery at the Sixth Affiliated Hospital of Sun Yat-sen University between January 1 and December 31, 2018, were retrospectively collected. Valid family history of malignant tumors was obtained via telephone follow-up, with 184 patients ultimately included in the analysis. Probands were divided into five cohorts based on family history： overall positive/negative family history, positive/negative family history of gastric cancer, positive/negative family history of colorectal cancer, HDGC/non-HDGC （according to 2015 IGCLC criteria）, and FIGC/non-FIGC （according to 1999 IGCLC criteria）. The epidemiological and clinicopathological characteristics of probands across cohorts were compared. Results Among the 184 probands, 58 （31.5%） had a positive family history of malignant tumors. Gastric cancer was the most commonly clustered malignancy within these families （15/58, 25.9%）. Cohort analysis revealed that probands in the overall positive family history group （P=0.026）, the positive gastric cancer family history group （P=0.011）, and families meeting the FIGC criteria （P=0.004） had a significantly higher rate of HER2 positivity on immunohistochemistry compared to their respective negative or non-FIGC groups. Additionally, the positive gastric cancer family history group had a higher number of tumor deposits （P=0.042）. Probands from HDGC families exhibited characteristics including younger age and a higher proportion of poorly differentiated and diffuse-type gastric cancers. Conclusion Significant familial clustering of gastric cancer exists in the patient population from Southern China. Probands with a family history of gastric cancer, particularly those meeting FIGC criteria, exhibit a distinct feature of HER2 protein overexpression. This suggests that the underlying genetic mechanism may differ from the CDH1 mutation-associated HDGC common in Western populations or Lynch syndrome. The HER2-related signaling pathway may play an important role in the pathogenesis of familial clustering gastric cancer in the Chinese population. Reference | Related Articles | Metrics

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Effect of simultaneous bi-atrial bipolar radiofrequency ablation during heart valve replacement in the treatment of valvular heart disease complicated with atrial fibrillation and the impact on echocardiographic parameters ZHAI Shao-feng, WANG Yong-sheng, AN Zhuo-yi Lingnan Modern Clinics In Surgery    2025, 25 (05): 312-317.   DOI: 10.3969/j.issn.1009-976X.2025.05.005 Abstract （103）      PDF（pc） （889KB）（1）       Knowledge map    Save Objective To compare the effects of simultaneous bi-atrialbipolar radiofrequency ablation and simultaneous unipolar radiofrequency ablation during heart valve replacement in the treatment of patients with valvular heart disease complicated with atrial fibrillation, and the impact on echocardiographic parameters. Methods Using random number table method, 90 patients with valvular heart disease complicated with atrial fibrillation who were scheduled to undergo surgical treatment in the hospital from February 2022 to January 2025 were assigned to the bipolar group and the unipolar group, with 45 cases in each group.Both groups underwent heart valve replacement, and bi-atrial bipolar radiofrequency ablation and unipolar radiofrequency ablation were performed in the same period, respectively. The situation of sinus rhythm conversion at different time points after surgery was compared between the two groups. Echocardiographic parameters [left atrial diameter （LAD）, left ventricular ejection fraction （LVEF）, left ventricular fractional shortening （LVFS）and right atrial diameter （RAD）] of the two groups before surgery and at 3 months after surgery were compared. Postoperative complications observed in the two groups were recorded. Results The ablation time in the monopolar group was shorter than that in the bipolar group （P<0.05）; the sinus rhythm conversion rate in the bipolar group was higher than that in the monopolar group at 1 and 3 months post-operation （both P<0.05）; at 3 months post-operation, there was no statistically significant difference in left ventricular fractional shortening （LVFS） between the two groups （P>0.05）; the bipolar group had lower left atrial diameter （LAD） and right atrial diameter （RAD） than the monopolar group, and higher left ventricular ejection fraction （LVEF） than the monopolar group （all P<0.05）; the postoperative complication rate in the bipolar group was lower than that in the monopolar group （P<0.05）. Conclusion Concomitant biatrial bipolar radiofrequency ablation during cardiac valve replacement surgery can significantly improve cardiac function in patients with valvular heart disease combined with atrial fibrillation, reduce postoperative complications, and increase the postoperative sinus rhythm conversion rate. Reference | Related Articles | Metrics

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Multivariate analysis of MVI-positivity in hepatocellular carcinoma HU Xiao, PENG Lin-hui Lingnan Modern Clinics In Surgery    2025, 25 (05): 297-301.   DOI: 10.3969/j.issn.1009-976X.2025.05.003 Abstract （101）      PDF（pc） （1037KB）（4）       Knowledge map    Save Objective To investigate the influencing factors of postoperative microvascular invasion （MVI） in hepatocellular carcinoma （HCC） patients and provide a theoretical basis for neoadjuvant therapy. Methods Clinical data of 995 HCC patients who underwent surgery at Sun Yat-sen Memorial Hospital between January 2020 and December 2023 were retrospectively analyzed. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for MVI positivity. Results A total of 995 patients were included, with an MVI positivity rate of 38.4% （382/995）. Univariate analysis revealed significant differences between MVI-positive and MVI-negative groups in tumor stage （P<0.001）, differentiation grade （P<0.001）, and proportion of preoperative adjuvant therapy （P=0.044）. Multivariate analysis demonstrated that advanced tumor stage （OR=3.171） and absence of preoperative adjuvant therapy （OR=3.312） were independent risk factors for MVI positivity, while well-differentiated tumors served as a protective factor （OR=0.275） （all P<0.05 ）. Conclusion Higher tumor stage, poorer differentiation, and absence of preoperative adjuvant therapy significantly increase the risk of postoperative MVI in HCC patients. Individualized preoperative adjuvant therapy based on tumor stage and differentiation grade may reduce MVI risk. Reference | Related Articles | Metrics

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Analysis of factors affecting stigma in patients with breast cancer wounds and construction of a prediction model LIN Ai-yi, WANG Xiu, LI Ling, QIU Liang-zhi, WU Xian-rong Lingnan Modern Clinics In Surgery    2025, 25 (05): 330-336.   DOI: 10.3969/j.issn.1009-976X.2025.05.008 Abstract （100）      PDF（pc） （911KB）（2）       Knowledge map    Save Objective To explore the factors influencing stigmatization in patients with malignant breast cancer wounds, identify its core predictive factors, and construct and validate a clinical predictive model for stigmatization. Methods A cross-sectional survey was conducted on 67 patients using the following instruments： general information questionnaire, Stigma Scale for Chronic Illnesses 8-item version （SSCI-8）, Toronto Wound Symptom Assessment System-Wounds（TSAS-W）, Self-Rating Anxiety Scale （SAS）, Self-Rating Depression Scale （SDS）, Social Support Rating Scale （SSRS）, and Quality of Life Instruments for Cancer Patients-Breast Cancer（QLICP-BR）. Data analysis was performed using univariate analysis, Pearson correlation, and multiple linear regression analysis. Results The overall score for stigmatization was 13.3±5.76 points. Correlation analysis showed that stigmatization was significantly positively correlated with anxiety （r=0.537） and depression （r=0.464）, and wound symptoms （r=0.389） （all P<0.05）, strongly negatively correlated with quality of life （r=-0.718, P<0.01）, and marginally significantly negatively correlated with social support （r=-0.229, P=0.062）. Multivariate linear regression analysis showed that： Quality of life （β=-0.666, P<0.01） was the strongest negative predictor of stigma, while anxiety （β=0.234, P=0.088） and depression （β=-0.251, P=0.095） had marginal predictive effects. The final model explained 51.5% of the variance in stigmatization （adjusted R3=0.515, F=15.003, P<0.01）. Conclusion Stigmatization in patients with breast cancer wounds has a significant statistical association with quality of life, and a marginally significant association with anxiety and depression levels. Wound management can be combined with a focus on enhancing patient quality of life and alleviating anxiety and depression, in order to reduce patients' level of stigmatization. Reference | Related Articles | Metrics

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CT hypoperfusion intensity ratio before endovascular thrombectomy is associated with clinical prognosis in patients with anterior circulation large vessel occlusion RUAN Xin-lei, CHEN Rui, HUANG Zhong-run, XIANG Chun, CHEN Pei-sheng, SHI Zhong-song Lingnan Modern Clinics In Surgery    2025, 25 (05): 318-324.   DOI: 10.3969/j.issn.1009-976X.2025.05.006 Abstract （93）      PDF（pc） （2854KB）（2）       Knowledge map    Save Objective Parenchymal hematoma （PH） is a severe type of hemorrhagic transformation and is associated with poor outcomes in patients with acute ischemic stroke after endovascular thrombectomy treatment. This study explores the relationship between hypoperfusion intensity ratio （HIR） from CT perfusion imaging with postoperative PH and clinical outcomes. Methods We analyzed the clinical and imaging data of patients with acute anterior circulation large vessel occlusion treated with endovascular intervention in our stroke center from December 2020 to December 2022. HIR was calculated as the ratio of severe hypoperfusion area volume （Tmax>10 seconds） to hypoperfusion area volume （Tmax>6 seconds） from head CT perfusion imaging. The type of hemorrhagic transformation after endovascular thrombectomy treatment was determined according to Heidelberg grading criteria. We analyzed the relationship between clinical, and imaging data with postoperative HT and clinical outcomes at discharge. Results Fifty-five patients with acute anterior circulation large vessel occlusion were included in the study. Twenty-one patients （38.2%） developed HT after thrombectomy treatment, including nine with PH. HIR at admission was significantly higher in the PH group than in the non-PH group （0.58 vs. 0.33, P=0.010）. HIR was significantly higher in the poor clinical outcome group （modified Rankin Scale 3~6 points） than in the good outcome group （0.47 vs. 0.25, P<0.001）. In addition, atrial fibrillation, NIHSS score at admission, blood glucose, neutrophil-to-platelet ratio, cerebral blood flow <30%, Tmax>10 seconds, and PH after endovascular thrombectomy were significantly associated with poor clinical outcomes. HIR（OR=1132.791, 95%CI： 7.979~160 828.706, P=0.005）was one ofthe independent factors for poor clinical outcomes. Conclusion HIR at admission is significantly associated with PH after endovascular thrombectomy, and it is an effective imaging marker for poor clinical outcomes after endovascular thrombectomyfor patients with acute anterior circulation large vessel occlusion. Reference | Related Articles | Metrics

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Quercitrin promotes M2 macrophage polarization after myocardial infarction in mice through the JAK2/STAT3 signaling pathway LIU Cong-yong, FU Yuan, LI Jing-wen, CENG Hui, ZHENG Jun-meng, GAO Min-nan Lingnan Modern Clinics In Surgery    2025, 25 (05): 302-311.   DOI: 10.3969/j.issn.1009-976X.2025.05.004 Abstract （92）      PDF（pc） （6163KB）（13）       Knowledge map    Save Objective To investigate the effects of quercitrin on ventricular remodeling after myocardial infarction in mice and its underlying mechanisms,providing a basis for the application of quercitrin in cardiovascular diseases. Methods In the in vivo experiment,a mouse model of myocardial infarction was established. Single-cell RNA sequencing technology was used to analyze the immune cell and macrophage subtypes in the myocardial tissue of mice treated with quercitrin. In the in vitro experiment, mouse bone marrow macrophages were isolated and cultured. The polarization state of macrophages was detected after treatment with quercitrin. Western Blot and qPCR were used to detect the protein and gene expression of the JAK2/STAT3 signaling pathway,and the role of the pathway was verified using the JAK inhibitor Ruxolitinib. Results In the in vivo experiment, single-cell RNA sequencing revealed that quercitrin altered the composition of immune cells in the myocardium of mice with myocardial infarction. The total proportion of macrophages increased, with an increase in M2-type macrophage subtypes（such as Macro_Chil1, Macro_Cd163）and a decrease in M1-type（such as Macro_Cd86）. In the in vitro experiment, flow cytometry showed that quercitrin increased the proportion of M2-type macrophages（P<0.05）and decreased M1-type（P<0.01）. Western Blot and qPCR results indicated that the expression of TGF-β1,TGF-β2, VEGF-A,and VEGF-B in mouse macrophages was upregulated after quercitrin treatment（all P<0.001）, and this upregulation was reversed by the JAK inhibitor Ruxolitinib. Conclusion Quercitrin promotes M2 macrophage polarization by activating the JAK2/STAT3 signaling pathway,inhibits inflammatory responses,and promotes angiogenesis,thereby improving ventricular remodeling after myocardial infarction. Reference | Related Articles | Metrics

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Exploring the relationship between ETV4 and colorectal cancer LIU Jin-yu, GUO Qiang, MA Xing-yue, CHEN Hui-wen, XU Hong-chao Lingnan Modern Clinics In Surgery    2025, 25 (05): 288-296.   DOI: 10.3969/j.issn.1009-976X.2025.05.002 Abstract （91）      PDF（pc） （9430KB）（25）       Knowledge map    Save Objective To explore the relationship between ETS transcription factor 4 （ETV4） and colorectal cancer. Methods Colorectalcancer tissues and adjacent tissues from 40 cancer patients were collected. RT-qPCR and immunohistochemistry were used to detect ETV4 expression levels. Bioinformatics methods were applied： cBioPortal for ETV4 mutation analysis, String to extract its protein-protein interaction network, UALCAN to analyze the correlation between ETV4 expression and clinical data like cancer stage, lymph node metastasis, age, and gender, and Kaplan-Meier Plotter to analyze the relationship between ETV4 expression and patient prognosis. Results RT-qPCR and immunohistochemistry showed that ETV4 expression was significantly higher in cancer tissues than in adjacent tissues （P<0.01）. cBioPortal showed that ETV4 mutations in colorectal cancer mainly included missense and splice mutations. UALCAN analysis indicated that ETV4 expression was correlated with TNM stage, histological subtype, and TP53 mutation status （P<0.05）, but not with age, gender, race, or weight （P>0.05）. Kaplan-Meier analysis demonstrated that high ETV4 expression was associated with significantly improved overall survival （OS; Logrank P=0.031, HR=0.8, 95%CI： 0.66~0.98） and post-progression survival （PPS; Logrank P=0.05, HR=0.64, 95%CI： 0.47~0.88） in colorectal cancer patients. Conclusion The upregulation of ETV4 in colorectal cancer tissues correlates with a better prognosis, indicating its potential as a promising prognostic biomarker and a novel therapeutic target. Reference | Related Articles | Metrics

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Lingnan Modern Clinics In Surgery    2025, 25 (06): 345-351.   DOI: 10.3969/j.issn.1009-976X.2025.06.001 Abstract （90）      PDF（pc） （11947KB）（25）       Knowledge map    Save Reference | Related Articles | Metrics

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A case of intrahepatic cholangiocarcinoma treated with radical surgery after conversion therapy and literature review ZHANG Ke-cheng, LUO Shu-li, XIA Jing, ZHAO Yong-yang, XING Xiang-lei, YANG Xin-wei Lingnan Modern Clinics In Surgery    2025, 25 (05): 337-340.   DOI: 10.3969/j.issn.1009-976X.2025.05.009 Abstract （87）      PDF（pc） （3428KB）（3）       Knowledge map    Save This paper presents a case of a 43-year-old male diagnosed with left lobe intrahepatic cholangiocarcinoma following the detection of a left hepatic mass during a routine physical examination. Imaging evaluations confirmed tumor invasion into the middle hepatic vein, inferior vena cava, and hilar lymph nodes, leading to an initial assessment of unresectable disease. Following a multidisciplinary team （MDT） discussion, the patient was initiated on neoadjuvant therapy consisting of Gemcitabine/Cisplatin/Albumin-bound paclitaxel chemotherapy combined with sintilimab immunotherapy. Following four cycles of conversion therapy, the tumor significantly shrank, and the tumor marker CA19-9 markedly decreased, creating an opportunity for curative surgery.Subsequently, the patient successfully underwent extended left hepatectomy, caudate lobectomy,and regional lymph node dissection. Postoperative pathological examination confirmed an R0 resection. The patient recovered well postoperatively and continued adjuvant therapy. Over a follow-up period exceeding 24 months, no evidence of tumor recurrence was identified, and the patient maintained a favorable quality of life. This case suggests that chemotherapy combined with immunotherapy as a neoadjuvant approach can effectively convert initially unresectable locally advanced intrahepatic cholangiocarcinoma, providing patients with an opportunity for curative surgery and survival benefits. Reference | Related Articles | Metrics

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Ectopic adrenal chromaffinoma misdiagnosed as liver metastasis from rectal cancer： a case report and literature reviews LIU Jian, MO Dai-jing, LEI Shao-hui, ZHAO Bing-cheng, FAN Mei-da Lingnan Modern Clinics In Surgery    2025, 25 (05): 341-345.   DOI: 10.3969/j.issn.1009-976X.2025.05.010 Abstract （86）      PDF（pc） （2885KB）（11）       Knowledge map    Save Rectal cancer with liver metastasis is a common clinical condition, yet misdiagnosis remains a challenge. This article reports a rare case of hepatic paraganglioma that was initially misdiagnosed as rectal cancer with liver metastasis, leading to surgical exploration. The aim of presenting this case is to enhance clinical awareness of paragangliomas, particularly in atypical locations, and to minimize the incidence of misdiagnosis and underdiagnosis. Reference | Related Articles | Metrics

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Lingnan Modern Clinics In Surgery    2025, 25 (03): 151-155.   DOI: 10.3969/j.issn.1009-976X.2025.03.001 Abstract （84）      PDF（pc） （3981KB）（6）       Knowledge map    Save Reference | Related Articles | Metrics

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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 Lingnan Modern Clinics In Surgery    2025, 25 (06): 382-387.   DOI: 10.3969/j.issn.1009-976X.2025.06.006 Abstract （84）      PDF（pc） （1104KB）（5）       Knowledge map    Save 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. Reference | Related Articles | Metrics

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A case report of transoral endoscopic surgery via vestibular approach in treating benign mediastinal teratoma YUE Ning, YU Xing Lingnan Modern Clinics In Surgery    2025, 25 (03): 206-209.   DOI: 10.3969/j.issn.1009-976X.2025.03.011 Abstract （79）      PDF（pc） （8811KB）（2）       Knowledge map    Save This study reports a case of mediastinal benign teratoma treated with endoscopic resection via the transoral vestibular approach. We retrospectively analyzed the patient's clinical data, diagnostic and therapeutic process, intraoperative findings, and treatment outcomes. As a benign germ cell tumor, mediastinal teratoma is most effectively managed by surgical excision. We presented the case of a 16-year-old female patient with a preoperative diagnosis of an upper mediastinal benign tumor. Given the patients strong preference for cosmetic outcomes, a multidisciplinary team opted for an endoscopic transoral vestibular approach for tumor resection. The procedure was successfully completed with complete tumor removal. Intraoperative nerve monitoring effectively preserved critical structures such as the recurrent laryngeal nerve. Histopathology confirmed a benign teratoma, and no significant postoperative complications occurred. The patient expressed satisfaction with both the therapeutic and cosmetic results. The transoral vestibular approach may be considered a viable surgical option for mediastinal teratoma. Reference | Related Articles | Metrics

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The value of rapid contrast ⁃ enhanced MRI in the preoperative imaging evaluation of brain tumors WANG Zhi-hui, LI Yong, BAI Zhi-qiang Lingnan Modern Clinics In Surgery    2025, 25 (05): 325-329.   DOI: 10.3969/j.issn.1009-976X.2025.05.007 Abstract （78）      PDF（pc） （1304KB）（3）       Knowledge map    Save Objective To explore the feasibility of reducing the number of signal averages （NSA） to shorten MRI scanning time in patients with brain tumors. Methods Imaging data from 46 patients who were suspected of brain tumors and underwent contrast-enhanced brain MRI scans at Sun Yat-sen Memorial Hospital of Sun Yat-sen University were retrospectively analyzed between March 2015 and October 2024. The number of lesions detected, signal-to-noise ratio （SNR）, contrast-to-noise ratio （CNR）, overall image quality, and subjective scores of lesion boundaries were compared between the contrast-enhanced axial T1-weighted sequences with NSA=1 and those with NSA=2 for each patient. Results The SNRs, CNRs, and overall image quality scores of the contrast-enhanced sequence with NSA=2 were 310.78± 248.05, 112.80± 151.63, and 4.74± 0.58, respectively. In contrast, those of the contrast-enhanced sequence with NSA=1 were 237.40± 159.74, 89.29± 110.18, and 4.5± 0.59, respectively. The SNRs, CNRs, and overall image quality scores of the sequence were all significantly higher than the latter （P< 0.001, P=0.002, and P=0.028, respectively）. There were no statistically significant differences in the number of lesions detected or lesion boundary scores （both were 4.67± 0.56） between the contrast-enhanced sequences with NSA=2 and those with NSA=1 （P=0.564 and P=1.000, respectively）. Conclusion Reducing NSA of the contrast-enhanced sequence from 2 to 1 significantly shortened scanning time while maintaining the samediagnostic performance. Thus, reducing NSA of the contrast-enhanced sequence from 2 to 1 to shorten the scanning time of brain tumor patients is feasible. Reference | Related Articles | Metrics

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Research Progress of Metabolomics in Surgical Precision Medicine CEN Mei-feng, PAN Wen-feng, WANG Xiao-juan Lingnan Modern Clinics In Surgery    2025, 25 (06): 399-409.   DOI: 10.3969/j.issn.1009-976X.2025.06.009 Abstract （76）      PDF（pc） （2823KB）（2）       Knowledge map    Save 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. Reference | Related Articles | Metrics

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A clinicopathological report of hepatic alveolar echinococcosis in a low-incidence area HUANG Wen-qing, YONG Juan-juan Lingnan Modern Clinics In Surgery    2025, 25 (03): 202-205.   DOI: 10.3969/j.issn.1009-976X.2025.03.010 Abstract （73）      PDF（pc） （4306KB）（2）       Knowledge map    Save Objective To investigate the clinicopathological features of hepatic alveolar echinococcosis. Methods The clinical, pathological, and imaging data of one case of hepatic alveolar echinococcosis were retrospectively analyzed. HE （hematoxylin-eosin） staining slides were observed for surgical resection, and the pathological tissue morphological characteristics were analyzed, and relevant literature was reviewed. Results The Gross examination showed cystic mass in the liver. Histologically, the liver tissue was purulent, and large necrosis and granuloma formation were seen, some vesicular larvae vesicles of different sizes were seen in the necrotic tissue, and the vesicular larvae vesicles were only seen in the corneal cortex, which showed that there was no structure in the red staining uniform, and no germinal layer was seen. Conclusion Hepatic alveolar echinococcosis is rare in low-incidence areas, and most of the lesions are atypical when erythrotic vesicle-like structures can be seen in the background of hepatic necrotizing granulomatous inflammation, is necessary to be vigilant against the possibility of hepatic alveolar echinococcosis in combination with epidemiological history, imaging, and laboratory examination results, to avoid missed diagnosis and misdiagnosis. Reference | Related Articles | Metrics

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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 Lingnan Modern Clinics In Surgery    2025, 25 (06): 367-374.   DOI: 10.3969/j.issn.1009-976X.2025.06.004 Abstract （69）      PDF（pc） （3114KB）（0）       Knowledge map    Save 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. Reference | Related Articles | Metrics

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Comparative clinical efficacy of primary excision with primary closure versus rhomboid flap reconstruction in the treatment of sacrococcygeal pilonidal Sinus LU Zhilin, LIN Yikun, CAI Shihuai Lingnan Modern Clinics In Surgery    2026, 26 (01): 22-26.   DOI: 10.3969/j.issn.1009-976X.2026.01.003 Abstract （65）      PDF（pc） （1745KB）（8）       Knowledge map    Save Objective To compare the efficacy of primary resection and suture versus rhomboid flap transfer in the treatment of sacrococcygeal pilonidal sinus. Methods We retrospectively analyzed 61 patients with sacrococcygeal pilonidal sinus. They were divided into a resection group （n=25） and a flap group （n=36）. Operative time, length of hospital stay, complication rate, recurrence rate, and postoperative aesthetic satisfaction were compared between the two groups. Logistic regression was used to analyze risk factors for postoperative complications and recurrence. Results The two groups were comparable in terms of baseline characteristics, including sex, age, and disease duration. Operative time was significantly shorter in the resection group than in the flap group （P< 0.05）. In contrast, the length of hospital stay was significantly shorter in the flap group （P< 0.05）. Recurrence and complication rates were significantly lower in the flap group （P< 0.05）, whereas postoperative aesthetic satisfaction was higher in the resection group （P< 0.05）. Length of hospital stay was a risk factor for postoperative complications（OR=1.551,P=0.019）. Conclusion Compared with primary resection and suture, rhomboid flap transfer is associated with lower rates of postoperative complications and recurrence, and a shorter hospital stay, making it an effective treatment for sacrococcygeal pilonidal sinus.However, it is associated with a higher risk of scar formation and a longer operative time. Reference | Related Articles | Metrics

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Long-term efficacy of parenchymal-sparing anatomical hepatectomy： a propensity score-matched study based on the SEER database KOU Chunwei, DUAN Yufan, ZHU Hongtao, JI Ren Lingnan Modern Clinics In Surgery    2026, 26 (01): 1-9.   DOI: 10.3969/j.issn.1009-976X.2026.01.001 Abstract （64）      PDF（pc） （2101KB）（7）       Knowledge map    Save Objective To compare the long-term outcomes between formal anatomical hepatectomy （FAH, left or right hepatectomy） and parenchymal-sparing anatomical hepatectomy （PSAH, resection of 1, 2, or 3 liver segments） based on the SEER database. Methods A retrospective analysis was conducted on patients diagnosed with hepatocellular carcinoma （HCC） between 2000 and 2021 in the SEER database. Patients were divided into two groups according to surgical approach： PSAH group （n=2348） and FAH group （n=2450）. Propensity score matching （PSM） was used to balance intergroup differences. Demographic and tumor characteristics, overall survival （OS）, and cancer-specific survival （CSS） were compared between the two groups. Results Before PSM, compared with the FAH group, the PSAH group had a lower proportion of male patients （71% vs. 74.2%, P=0.012）, a higher proportion of patients aged ≥ 60 years （72.2% vs. 68.2%, P=0.004）, a longer interval from diagnosis to treatment （41.0 vs. 37.0 days, P< 0.001）, a higher proportion of patients with Ishak 5~6 liver fibrosis （53.5% vs. 36.3%, P< 0.001）, smaller tumor size （42.0 mm vs. 66.0 mm, P< 0.001）, earlier AJCC TNM stage （P< 0.001）, fewer patients receiving radiotherapy （P=0.044） and chemotherapy （P< 0.001）, and significantly better OS （P< 0.001） and CSS （P< 0.001）. After PSM, although the PSAH group still had a higher proportion of patients with Ishak 5~6 liver fibrosis compared with the FAH group （50.6% vs. 39.7%, P< 0.001）, OS （P=0.030） and CSS （P=0.032） remained significantly better in the PSAH group. Subgroup analysis results indicated that after balancing key prognostic factors, there were no significant differences in OS and CSS between the PSAH and FAH groups in the small HCC subgroup or the giant HCC subgroup. However, in the large HCC subgroup, the PSAH group demonstrated significantly better CSS （P= 0.004） and OS （P=0.002） compared to the FAH group. Conclusion This study demonstrates that after balancing key prognostic factors such as tumor size, tumor stage, and degree of liver fibrosis, the efficacy of PSAH in patients with HCC is not inferior to that of FAH, and may even be superior in patients with large liver tumors. Therefore, PSAH may be prioritized when tumor characteristics and technical conditions permit. Reference | Related Articles | Metrics

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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 Lingnan Modern Clinics In Surgery    2025, 25 (06): 388-394.   DOI: 10.3969/j.issn.1009-976X.2025.06.007 Abstract （63）      PDF（pc） （1006KB）（1）       Knowledge map    Save 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. Reference | Related Articles | Metrics

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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 Lingnan Modern Clinics In Surgery    2025, 25 (06): 375-381.   DOI: 10.3969/j.issn.1009-976X.2025.06.005 Abstract （63）      PDF（pc） （1003KB）（3）       Knowledge map    Save 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. Reference | Related Articles | Metrics

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Effects of common endocrine disrupting chemicals on hypospadias WU Xian, NIU Shuaiyu, TANG Jingyuan, WEI Yunfei Lingnan Modern Clinics In Surgery    2026, 26 (01): 62-67.   DOI: 10.3969/j.issn.1009-976X.2026.01.009 Abstract （51）      PDF（pc） （1033KB）（2）       Knowledge map    Save Hypospadias is a relatively common congenital malformation of the pediatric genitourinary system, and its incidence has been increasing worldwide in recent years. This disorder not only leads to abnormal micturition and penile developmental malformations, but may also have an adverse psychological effect on affected children due to penile morphological anomalies and the resulting social stress. In etiological research on hypospadias,epidemiological studies have shown that exposure to endocrine-disrupting chemicals （EDCs） is an important environmental factor that increases the risk of this disease. This paper systematically reviews the main categories of EDCs and their primary exposure routes, and focuses on exploring their pathogenic mechanisms from four aspects： interfering with hormonal signals, impairing the developmental microenvironment and molecular dynamics, affecting and affecting the progesterone receptorhypothesis and the regulation of key genes. It aims to provide a systematic reference for an in-depth understanding of the etiology of hypospadias. Reference | Related Articles | Metrics

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Identification and validation of a carbohydrate metabolism related key gene associated with fibroblast in abdominal aortic aneurysm LI Gen, ZHAO Ziniu, SHI zhanyue Lingnan Modern Clinics In Surgery    2026, 26 (01): 33-41.   DOI: 10.3969/j.issn.1009-976X.2026.01.005 Abstract （49）      PDF（pc） （23581KB）（0）       Knowledge map    Save Objective To explore the potential role of the （alcohol dehydrogenase 1B, ADH1B）ADH1B gene in abdominal aortic aneurysms （AAA）. Methods Utilizing bioinformatics techniques, we conducted a comprehensive analysis of transcriptome and single-cell data from human AAA and normal abdominal aorta tissue samples. The metabolism-related marker gene ADH1B was identified using logistic regression analysis of carbohydrate metabolism datasets. Results The fibroblast ADH1B gene may be involved in protecting against the development of AAA by modulating smooth muscle cell phenotypic changes. Conclusion The ADH1B gene appears to have a protective role in abdominal aortic aneurysms. Reference | Related Articles | Metrics

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Application of the integrated traditional Chinese and Western medicine health management model in percutaneous vertebroplasty for elderly patients with osteoporotic vertebral compression fractures LI Bifeng, SHI Jiacheng, YANG Lin, HU Rihe, HUANG Jiasheng, GUO Shun, LAN Guojian, HUANG Guoxing Lingnan Modern Clinics In Surgery    2026, 26 (01): 54-61.   DOI: 10.3969/j.issn.1009-976X.2026.01.008 Abstract （45）      PDF（pc） （1031KB）（0）       Knowledge map    Save Objective To investigate the application effect of the integrated traditional Chinese and Western medicine-enhanced recovery after surgery （ERAS） model in the perioperative period of Percutaneous Vertebroplasty （PVP） for elderly patients with osteoporotic vertebral fracture （OVF）. Methods A retrospective analysis was conducted on 50 elderly OVCF patients who underwent PVP at Qingyuan Hospital of Traditional Chinese Medicine, affiliated with Guangzhou University of Chinese Medicine from September 2021 to March 2022. These patients were designated as the control group and received interventions according to the conventional disease management pathway. Another 50 patients with OVF who underwent the same surgery from April 2022 to September 2022 were assigned to the observation group and received a health management intervention integrating traditional Chinese and Western medicine characteristics. Perioperative indicators such as operation time, bone cement volume, length of hospital stay, hospital costs, and complication rates were collected. Data from assessment scales, including the Patient Health Questionnaire-9 （PHQ-9）, Visual Analogue Scale （VAS）, Oswestry Disability Index （ODI）, and EuroQol-5 Dimensions （EQ-5D）, were collected preoperatively, on postoperative day 1, and at 6 months postoperatively. Vertebral body recovery was assessed by measuring the anterior vertebral height （AVH） and local kyphosis angle （LKA） of the injured vertebra. Results The time to ambulation and hospital stay length in the observation group were significantly shorter than those in the control group （P< 0.05）. Hospitalization costs were also significantly lower in the observation group compared to the control group （P< 0.05）. There were no significant differences in anesthesia time, bone cement volume, or operation time between the two groups （P> 0.05）. The pain level in the observation group was slightly lower than that in the control group on postoperative day 1, with a statistically significant difference in VAS score （P< 0.05）. There were no significant differences in ODI, AVH, or LKA between the two groups at preoperative, postoperative day 1, 3 months, and 6 months compared to preoperative values （P> 0.05）. The incidence of postoperative constipation in the observation group was lower than that in the control group （P< 0.05）, while no significant differences were found in other complications （P> 0.05）. In the quality-of-life scale, the dimensions of pain/discomfort and anxiety/depression had significantly better outcomes in the observation group compared to the control group （P< 0.05）. Conclusion The integrated traditional Chinese and Western medicine ERAS model is a reliable and effective perioperative management strategy. It helps in early pain relief, alleviates postoperative anxiety and depression, promotes rehabilitation after PVP, and improves patients' postoperative quality of life. Reference | Related Articles | Metrics

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Clinical comparison between 3Fr ureteral catheter and zebra guidewire in guiding scope insertion during ureteroscopy WU Guanke, HUANG Weichao, CHEN Baizhuang, LI Zhizhen Lingnan Modern Clinics In Surgery    2026, 26 (01): 47-53.   DOI: 10.3969/j.issn.1009-976X.2026.01.007 Abstract （43）      PDF（pc） （2012KB）（0）       Knowledge map    Save Objective To compare the clinical effects of 3Fr ureteral catheter and zebra guidewire in guiding scope insertion duringureteroscopy. Methods A total of 161 patients who were scheduled to undergo ureteroscopy in the hospital from January 2022 to July 2025 were enrolled in this study. They were randomly divided into the 3Fr ureteral catheter group （n=81） and the zebra guidewire group （n=80） by the envelope method. The operation time of the two groups was compared, as well as the differences in C-reactive protein （CRP）, urine protein/creatinine ratio （UPCR） before and after the operation and the occurrence of complications. Results The operation time of the 3Fr ureteral catheter group was significantly longer than that of the zebra guidewire group （P< 0.05）. In all subgroups based on stone size （≤ 1.5 cm or > 1.5 cm） and stone location （upper or mid-lower segment）, the 3Fr catheter group also exhibited significantly longer operative times than the zebra guidewire group （P< 0.05）. Postoperatively, both groups showed elevated CRP and UPCR levels, with the 3Fr catheter group significantly higher than the zebra guidewire group, and this difference remained significant across all subgroups （P< 0.05）. The incidence of ureteral injury in the Fr ureteral catheter group was significantly lower than that in the Zebra guidewire group （4.94% vs. 15.00%）, while the incidence of stones returning to the kidney was significantly higher in the Fr ureteral catheter group than in the Zebra guidewire group （11.11% vs. 2.50%; P< 0.05）. The total incidence of complications between the two groups was not significantly different （P> 0.05）. Conclusion 3Fr ureteral catheter has more advantages in reducing ureteral mucosal injury, while zebra guidewire performs better in shortening operation time, reducing the risk of stone displacement, and alleviating postoperative stress response. It is recommended that the appropriate guidance method be chosen based on the patient′s condition and surgical requirements. Reference | Related Articles | Metrics

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SNF5 cooperates with RNA helicase DDX5 to resolve R-loop and maintain genome stability in tumor cells GAO Yuan, XIE Xiaojuan, HU Kaishun Lingnan Modern Clinics In Surgery    2026, 26 (01): 10-21.   DOI: 10.3969/j.issn.1009-976X.2026.01.002 Abstract （42）      PDF（pc） （8703KB）（3）       Knowledge map    Save Objective To investigate the role and molecular mechanism of the chromatin remodeling factor SNF5 in tumor cell proliferation and genome stability maintenance. Methods An SNF5-knockout HeLa cell line was generated using CRISPR-Cas9 technology. Cell proliferation and cell cycle distribution were analyzed by EdU incorporation and flow cytometry, respectively. Colony formation assays were performed to evaluate cellular sensitivity to IR, HU, CPT, and MMC treatments. DNA fiber assays were used to assess DNA replication dynamics, and R-loop accumulation was detected by S9.6 immunofluorescence. Potential SNF5-interacting proteins under replication stress were identified by IP-MS, followed by validation of SNF5-DDX5 interaction through co-immunoprecipitation （CoIP） and GST pull-down assay. Results Loss of SNF5 impaired DNA synthesis, increased the proportion of G1-phase cells, and markedly reduced proliferation of tumor cells, accompanied by enhanced sensitivity to DNA-damaging agents. DNA fiber assay revealed slowed replication fork progression in SNF5-deficient cells, while S9.6 staining indicated increased R-loop accumulation. Protein interaction assays confirmed that SNF5 physically associates with the RNA helicase DDX5, cooperating to alleviate R-loop accumulation under replication stress. Conclusion SNF5 promotes DNA replication and tumor cell proliferation by coordinating with DDX5 to resolve R-loop and maintain genomic stability. SNF5 deficiency leads to R-loop accumulation, replication impairment, and increased sensitivity to radio- and chemotherapy, supporting SNF5 as a potential tumor therapeutic target. Reference | Related Articles | Metrics

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Data volume optimization of pooled library sequencing enhances clinical application and validation of genetic testing efficacy in oncological surgery LUO Jiahuan, HUANG Jinghua, JIANG Yuanling, HUANG Yongsheng, YIN Xinke, FU Sha, OUYANG Nengtai, LIAO Jian-wei Lingnan Modern Clinics In Surgery    2026, 26 (01): 27-32.   DOI: 10.3969/j.issn.1009-976X.2026.01.004 Abstract （40）      PDF（pc） （997KB）（0）       Knowledge map    Save Objective To optimize data allocation strategies for tumor libraries of different lengths on the Illumina NextSeq 550 sequencing platform, ensuring detection quality while meeting the timeliness requirements of surgical diagnosis and treatment. Methods In 10 batches of experiments, the output ratio （output data volume/input data volume） of three library types （275 bp/300 bp amplicons, 350 bp hybrid capture） was quantified.This quantification was used to determine the cluster generation capability of different libraries. Further analysis was conducted to derive the adjustment range for the data volume ratio of libraries with different lengths. Based on this range, the concentration of each library was adjusted to regulate its final data volume. Results The data volume for 300 bp amplicon libraries should be adjusted to a range of 0.55× to 0.72×. The data volume of 275 bp amplicon libraries should be adjusted in the range of 0.56× to 0.79×. The data volume of 350 bp hybridization capture libraries can be adjusted according to the amount of redundant data on the flow cell to balance data output. Conclusion Adjusting library loading volumes based on output ratios quantifying clustering capabilities across libraries of varying lengths enables balanced output of tumor pooled sequencing data and optimal utilization of chip resources. Reference | Related Articles | Metrics

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Research of great saphenous vein trunk stripping using the Havst catheter LIN Xiaowen, HU Minxiang, PENG Xiangyu, LI Pengfei, HUANG Qingjin Lingnan Modern Clinics In Surgery    2026, 26 (01): 42-46.   DOI: 10.3969/j.issn.1009-976X.2026.01.006 Abstract （39）      PDF（pc） （1306KB）（0）       Knowledge map    Save Objective To compare the short-term outcomes of the Havst catheter-assisted stripping technique versus conventional stripping for trunk of great saphenous vein （GSV）. Methods We retrospectively analyzed clinical data from 80 consecutive patients with great saphenous vein （GSV） varicosities who underwent surgical treatment in our department between January 2025 and June 2025. Patients were equally allocated into two groups （n=40 each）： the external stripping group （high ligation of the great saphenous vein + trunk stripping in the thigh + stab phlebectomy in the calf） and the conventional stripping group （high ligation + trunk stripping in the thigh + stab phlebectomy in the calf）. The two groups were compared across multiple parameters： age and sex distribution, clinical severity （CEAP classification）, thigh-level incision length, GSV trunk stripping time （including tumescent anesthesia administration）, length of hospital stay, surgical pain score, and thigh ecchymosis area on postoperative Day 3. Results No statistically significant differences were observed between the external stripping group and conventional stripping group regarding age, gender distribution, clinical classification （CEAP）, length of hospital stay,surgical pain score,and thigh ecchymosis area on postoperative Day 3. （all P> 0.05）. The external stripping group demonstrated significantly shorter incision lengths and reduced stripping times compared to the conventional group （both P< 0.001）. Conclusion The Havst catheter system enables minimally invasive stripping of the great saphenous vein （GSV） trunk through a single small incision, with significantly improved procedural efficiency. Reference | Related Articles | Metrics

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Segmentectomy for early-stage non-small cell lung cancer： current applications and ongoing controversies SHI Shangzhe, SAI Xiyalatu Lingnan Modern Clinics In Surgery    2026, 26 (01): 68-74.   DOI: 10.3969/j.issn.1009-976X.2026.01.010 Abstract （37）      PDF（pc） （1021KB）（2）       Knowledge map    Save Lung cancer remains a leading cause of cancer-related mortality worldwide, and non-small cell lung cancer （NSCLC） accounts for approximately 85% of all lung cancer cases. For early-stage （stage I） NSCLC, surgical resection is the mainstay of treatment, with anatomical lobectomy having long been regarded as the standard procedure. In recent years, advances in imaging technologies and the wider implementation of early screening have renewed interest in segmentectomy, an anatomical sublobar resection that preserves more functional lung parenchyma. This review summarizes the evolution of segmentectomy, expansion of its indications, oncologic outcomes and recurrence risk, advantages in postoperative pulmonary function preservation, technical challenges, the impact of spread through air spaces （STAS） on procedure selection, current controversies, and future research priorities, with the aim of informing clinical decision-making. Reference | Related Articles | Metrics