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Development of a multimodal artificial intelligence diagnostic model for bladder cancer based on ultrasound imaging and urine cytology WU Shao-cong, SHEN Run-nan, WANG Liang-yu, WU Shao-xu Lingnan Modern Clinics In Surgery    2024, 24 (03): 175-182.   DOI: 10.3969/j.issn.1009-976X.2024.03.005 Abstract （132）      PDF（pc） （3258KB）（302）       Knowledge map    Save Objective The aim of this study was to investigate whether a multimodal artificial intelligence diagnostic model can be constructed based on ultrasound images and urinary cytology to improve diagnostic sensitivity and assist in reducing the use of cystoscopy. Methods This was a single-center retrospective study that included 2056 patients who underwent both bladder ultrasound examination and urinary cytology examination from January 2018 to September 2023 for model training and validation. The gold standard was determined based on the patients' histopathological results, and patients with negative results needed to be followed up for 6 months to confirm non-cancer. Firstly, we constructed an AI diagnostic model for bladder cancer based on ResNet model and ultrasound images. We used pre-trained weights on ImageNet as the initialization of model weights. Random gradient descent and cross-entropy loss were used for network weight adjustment and algorithm optimization. After the ultrasound AI model output the diagnostic score, we combined it with the results of urinary cytology diagnosis and clinical risk factors based on Logistic regression to construct a multimodal diagnostic model, and output the final diagnostic probability for each individual. The effectiveness of the model was then validated in the validation set and subgroups （including different stages, grades, and clinical scenarios）. The final multimodal model was named BCaUSNet. Results The BCaUSNet model had a diagnostic sensitivity of 0.896（95%CI： 0.839-0.938） and an area under the curve of 0.917（95%CI： 0.891-0.942） in the validation set. In the scenario of recurrence monitoring, the model's sensitivity could reach 0.821（95%CI： 0.631-0.939）, and the negative predictive value could reach 0.896（95%CI： 0.773-0.965）, which could assist in reducing the use of cystoscopy with a high degree of certainty. In tumors with low malignant potential and low-grade tumors where urinary cytology is difficult to diagnose, the BCaUSNet model increased their sensitivity to 71.4% and 93.3%, respectively. In non-muscular invasive tumors and small tumors （<1.5 cm） that are easily missed by ultrasound, the BCaUSNet model increased their sensitivity to 89.5% and 87.5%, respectively. Conclusion The construction of a multimodal artificial intelligence diagnostic model for bladder cancer based on ultrasound images and urinary cytology has high diagnostic sensitivity, which helps to reduce missed diagnosis of bladder cancer, reduce the use of cystoscopy, and has good clinical utility and innovative significance. Reference | Related Articles | Metrics

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Prediction of prognosis of pancreatic cancer patients after operation by enhanced CT extracellular volume fraction LIU Li-qiang, LI Wen-bin, YE Hui-lin Lingnan Modern Clinics In Surgery    2024, 24 (03): 141-149.   DOI: 10.3969/j.issn.1009-976X.2024.03.001 Abstract （117）      PDF（pc） （5878KB）（154）       Knowledge map    Save Objective To explore the prognostic value of extracellular volume fraction （ECVf） in patients with pancreatic cancer after operation. Methods A total of 66 patients with pancreatic cancer who underwent surgical treatment in Sun Yat-Sen Memorial Hospital of Sun Yat-sen University from January 2014 to December 2022 were selected. The multi-detectorrow CT scanner was used for multi-phase enhanced CT scanning, and the images of the non-contrasted phase and equilibration phase were obtained. The ECVf of pancreatic cancer lesions was calculated by formula. According to the median ECVf, the patients were divided into high ECVf group and low ECVf group. The prognosis of the two groups was analyzed, and a nomogram model was established to predict the prognosis of patients with pancreatic cancer treated after operation. Results The high ECVf group had longer OS （P=0.002） and DFS （P=0.024） than the low ECVf group. The median OS of high ECVf group and low ECVf group were 32.0 months and 20.3 months respectively, and the median DFS were 20.7 months and 12.3 months, respectively. The area under curve （AUC） of nomogram model for predicting 1-year, 2-year and 3-year survival rates were 0.854, 0.802 and 0.707, respectively. Conclusion ECVf can be used as a prognostic indicator for patients with pancreatic cancer after operation. Reference | Related Articles | Metrics

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AI-based pathological image analysis for predicting BRAF-V600E mutation in thyroid cancer YU Ting-ting, ZHU Xiao-tong, GUO Li-fen, LI Li Lingnan Modern Clinics In Surgery    2024, 24 (05): 308-313.   DOI: 10.3969/j.issn.1009-976X.2024.05.007 Abstract （104）      PDF（pc） （2201KB）（137）       Knowledge map    Save Objective To investigate the application value of a deep learning model based on whole-slide imaging （WSI） in predicting the BRAF-V600E mutation status in thyroid cancer and to analyze the correlation between this mutation and patients' clinical characteristics. Methods A deep learning model based on a pre-trained ResNet50 network was developed using data from The Cancer Genome Atlas （TCGA）. The model employed a self-attention mechanism to extract key features from WSI and constructed a single-task binary classification model to predict the BRAF-V600E mutation status. A total of 305 papillary thyroid carcinoma （PTC） cases were used for model training, and 131 cases were used for validation. The model's performance was evaluated using the area under the receiver operating characteristic curve （AUC）. Additionally, the association between BRAF-V600E mutation and clinical characteristics such as gender, age, and tumor staging were analyzed. Results The model achieved AUC values of 0.972 and 0.904 on the training and validation datasets, respectively, demonstrating high predictive accuracy. Clinical characteristic analysis revealed that the BRAF-V600E mutation was more common in females, patients under 55 years of age, and those with advanced-stage tumors. The mutation was significantly associated with higher tumor stages and lymph node metastasis. Conclusion The deep learning-based WSI model performed excellently in predicting BRAF-V600E mutation status in thyroid cancer, providing support for personalized diagnosis and treatment. Future studies should integrate multi-center datasets to further validate the model's clinical applicability and generalizability. Reference | Related Articles | Metrics

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Exploring the causal relationship between MMPs and breast cancer risk： a Mendelian randomization study HAN Zhi-ren, ZHU Xiang-ping, HAN Bei-nan, WENG Hai-yan, YANG Qiong Lingnan Modern Clinics In Surgery    2024, 24 (03): 162-174.   DOI: 10.3969/j.issn.1009-976X.2024.03.004 Abstract （102）      PDF（pc） （7940KB）（13）       Knowledge map    Save Objective To explore the causal relationships between various subtypes of matrix metalloproteinases （MMPs） and the risk of developing breast cancer. Methods Using 501 428 genetic variants related to plasma MMPs levels from 990 Europeans in the publicly available MRC-IEU database as instrumental variables for exposure, and 19 674 639 genetic variants from 201 633 breast cancer patients in the FinnGen version 10 database as instrumental variables for outcome, we conducted a two-sample bidirectional Mendelian randomization analysis. The inverse variance weighted method was used as the primary analysis, with MR-Egger regression, simple mode method, weighted median method, and weighted mode method as secondary complementary regression models. Sensitivity analysis was performed using Cochran's Q test to verify the reliability of the results, MR-Egger test to assess the horizontal pleiotropy of instrumental variables, and leave-one-out analysis to evaluate the potential influence of single nucleotide polymorphisms on the results. Results Impact of MMPs on breast cancer： The inverse variance weighted method detected a reverse causal relationship between MMP-7 expression levels and the risk of breast cancer （OR=0.95, 95%CI： 0.92-0.99, P<0.05）; no statistically significant association was found between the expression levels of other MMPs and the risk of breast cancer. Meta-analysis showed no statistically significant association between overall plasma MMPs and the risk of breast cancer. Impact of breast cancer on MMPs： The inverse variance weighted method showed no statistically significant association between the risk of breast cancer and the expression levels of MMPs. Conclusion The overall effect of MMPs does not have a significant impact on the occurrence and development of breast cancer. However, there is a negative causal relationship between MMP-7 expression levels and the risk of breast cancer. As MMP-7 expression levels decrease, the risk of breast cancer increases. MMP-7 may be a protective factor closely related to the occurrence and progression of breast cancer among MMPs and should be paid more attention. Reference | Related Articles | Metrics

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Tumor microenvironment-mediated metabolic reprogramming in prostate cancer：from mechanisms to therapeutics LI Dong-quan, HUANG Shan-he, HUANG Hai, XIE Rui-hui Lingnan Modern Clinics In Surgery    2024, 24 (06): 398-409.   DOI: 10.3969/j.issn.1009-976X.2024.06.011 Abstract （102）      PDF（pc） （1160KB）（299）       Knowledge map    Save Metabolic reprogramming plays a key role in the progression of prostate cancer. In addition to tumor DNA mutation and epigenetics， the complicated crosstalk between tumor microenvironment and tumor cells is an important factor driving metabolic reprogramming of prostate cancer， leading to cancer progression and treatment failure. The continuous interaction between tumor cells and immune cells （such as macrophages， lymphocytes and natural killer cells）， non⁃immune cells （such as fibroblasts and endothelial cells）， extracellular matrix components and soluble factors in the tumor microenvironment leads to metabolic competition and symbiosis， inducing metabolic reprogramming of tumor cells， and remodeling the metabolic characteristics of neighboring cells at the same time， which ultimately leads to the development of prostate cancer. Targeting metabolic reprogramming of prostate cancer in microenvironment is a promising strategy to improve prostate cancer treatment dilemmas. In this review， we focus on the current studies of microenvironment⁃mediated metabolic reprogramming in prostate cancer， which can improve the understanding of the mechanisms that metabolic reprogramming regulates prostate cancer progression， and may shed light on new therapeutic strategies targeting metabolic reprogramming for prostate cancer patients. Reference | Related Articles | Metrics

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Bioinformatic exploration of key genes in sepsis induced acute-on-chronic liver failure based on GEO database YI Xiao-ling, GU Yang, LI Li, YU Tao Lingnan Modern Clinics In Surgery    2024, 24 (03): 157-161.   DOI: 10.3969/j.issn.1009-976X.2024.03.003 Abstract （100）      PDF（pc） （6835KB）（20）       Knowledge map    Save Objective The aim of the present study was to compare the Gene expression profiling of chronic acute Liver failure （ACLF） patients with and without sepsis, and identify the differential expressed genes （DEGs） in acute-on-chronic liver failure （ACLF） patients with sepsis. Methods The gene chip datasets were obtained from the Gene Expression Omnibus （GEO） database. Then the common differential genes were carried out for later analyses according to the occurrence of sepsis in acute-on-chronic liver failure （ACLF） patients. The genes were analyzed by Gene ontology （GO）, pathway enrichment analysis （KEGG, GSEA） for screening out key genes. Results A total of 883 DEGs were identified, with 371 up-regulated genes and 512 down-regulated genes compared with acute-on-chronic liver failure （ACLF） patients without sepsis. Further bioinformatics analysis revealed that the GO, KEGG, GSEA were mainly enriched in humoral immune response, complement activation, Natural killer cell mediated cytotoxicity, lymphocyte mediated immunity and Notch signaling pathway. Conclusion Bioinformatics analysis identified the differential genes of ACLF induced by sepsis, which lead to the occurrenceand development of diseases through humoral immunity response, complement activation and Notch signal pathway in immune response, and may be used as potential indicators for diagnosis and therapy of sepsis-related ACLF in the future. Reference | Related Articles | Metrics

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Summary of successful treatment and manage experience of refractory Crohn′s disease anal fistula complicated with severe infection （1 case report） RUAN Jian-Min, LI Yong-Jie, LIN Jie-mei, LIU Li Lingnan Modern Clinics In Surgery    2024, 24 (03): 199-205.   DOI: 10.3969/j.issn.1009-976X.2024.03.009 Abstract （100）      PDF（pc） （2332KB）（435）       Knowledge map    Save Objective To introduce the successful treatment and management experience of a severe patient with perianal fistulizing Crohn's disease （pfCD） and perianal abscess. Methods The clinical data of a patient with pfCD complicated with perianal abscess admitted to the Gastroenterology Dept. of Sun Yat-sen Memorial Hospital of Sun Yat-sen University were retrospectively analyzed. Results The patient's condition was improved and discharged after 65 days of disease management. Conclusion pfCD with perianal abscess is clinically challenging to treat. The key to successful treatment lies in multidisciplinary team （MDT） combined treatment and individualized management measures. Reference | Related Articles | Metrics

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Comparison of clinical efficacy between percutaneous and wiltse approach for the internal fixation of single-segment thoracolumbar AO Type A3 fractures ZHENG Chao-shun, CHEN Tai-qiu, GUO Yue-yue, HE Xu-hui, LIN Yi-hui, CHEN Bin-yong, LIN Chu-chun Lingnan Modern Clinics In Surgery    2024, 24 (03): 187-192.   DOI: 10.3969/j.issn.1009-976X.2024.03.007 Abstract （84）      PDF（pc） （2246KB）（305）       Knowledge map    Save Objective To compare the clinical efficacy of percutaneous and wiltse approach for the internal fixation of single-segment thoracolumbar AO Type A3 fractures. Methods A retrospective analysis was conducted on 74 patients with single-segment thoracolumbar Type A3 fractures treated at Jieyang People's Hospital from January 1, 2021, to December 31, 2022. The patients were divided into two groups based on different surgical methods： percutaneous screw fixation group（n=38） and transmuscular approach group（wiltse group, n=36）. The clinical outcomes and radiological indicators of the two groups were compared. Results All cases were followed up for one year. There were no significant statistical differences in intraoperative blood loss, incision length, postoperative hospital stay, and hospitalization costs between the two groups. The surgical time for the percutaneous screw group was 121.6±19.4 min, while for the intermuscular interval group it was 91.7±19.3 min （P<0.05）. The number of intraoperative radiation exposures for the percutaneous screw group（15.0±2.1） was higher than for the intermuscular interval group （5.1±1.1） （P<0.05）. Both groups effectively improved vertebral angle, vertebral height, and clinical scores such as VAS, ODI after surgery. The wiltse group showed better results in vertebral angle and Cobb's angle （P<0.05）. One case of poor incision healing occurred in the percutaneous screw group, and there were no serious complications in either group. Conclusion Both percutaneous and wiltse approach for pedicle screw internal fixation are effective in treating single-segment thoracolumbar AO Type A3 fractures. The wiltse group had fewer intraoperative radiation exposures, shorter surgical time, and better postoperative vertebral height recovery, making it more suitablefor use in primary hospitals. Reference | Related Articles | Metrics

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The relationship between preoperative serum hepatitis B virus DNA load and postoperative liver function in patients with hepatocellular carcinoma resection TAN Yong, LIU Hui, WU Li-ming, LIU Wen-ying, OU-YANG Zai-xing, HU Le-sheng, SONG Hao, HUANG Cong-yun, WU Qing-song Lingnan Modern Clinics In Surgery    2024, 24 (04): 209-214.   DOI: 10.3969/j.issn.1009-976X.2024.04.001 Abstract （81）      PDF（pc） （875KB）（104）       Knowledge map    Save Objective The purpose of this study was to explore the effect of preoperative serum hepatitis B virus DNA（HBV-DNA） load on postoperative liver function in patients with hepatocellular carcinoma （HCC）. Methods Ninety-one patients were divided into high replication group （30 cases in Group A, preoperative serum HBV-DNA load ≥104 IU/ml）, medium replication group（23 cases in Group B, preoperative serum HBV-DNA load ≥500 IU/ml and <104 IU/ml）, and low replication group （38 cases in Group C, preoperative serum HBV-DNA load <500 IU/ml）based on preoperative serum HBV-DNA load. The operating time, intraoperative blood loss, liver function indexes, postoperative hospital stay of patients were analyzed and compared between the three groups. Results The group A demonstrated a longer operating time compared with the group B and Group C（P<0.05）. The vakues of alanine aminotransferase （ALT） and aspartate aminotransferase （AST） of three groups achieved peak on the 1st day after operation. The values of ALT and AST of patients on the 1st day after operation, group A>group B>group C（P<0.05）. The ALT values of patients on the 3rd day after operation, group A>group B>group C（P<0.05）. The prothrombin time （PT） of Group C was significantly shorter than the Group A and group B on the 1st day after operation（P<0.05）. However, there was no significant difference in intraoperative blood loss, postoperative hospital stay, albumin （ALB） and total bilirubin （TBIL） after operation, and the AST on the 3rd day after operation among the groups（P>0.05）. The group A, the group B and the group C were divided into smaller groups according to preoperative antiviral therapy for 10 days. The operating time, the ALT and AST of patients on the 1st day after operation in the group that the preoperative serum HBV-DNA load ≥104 IU/ml and the preoperative antiviral therapy less than 10 days were significantly higher than those in other groups（P<0.05）. There were two patients in the group that the preoperative serum HBV-DNA load ≥104 IU/ml and the preoperative antiviral therapy was less than 10 days experienced postoperative liver failure, of which one died. Conclusion The HCC patients with highly preoperative serum HBV-DNA load who experienced more severely liver injury after operation, and properly prolonging the time of antiviral therapy before operation may help reduce the occurrence of postoperative liver failure and death. Reference | Related Articles | Metrics

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Analysis of safety and effectiveness of middle meningeal artery embolization combined with external drainage in the treatment of chronic subdural hematoma in hybrid operating room LIANG Xiao-long, LI Ai-guo, YANG Yu-min, LONG Xiao-dong, HAN Yang-yun Lingnan Modern Clinics In Surgery    2024, 24 (04): 238-243.   DOI: 10.3969/j.issn.1009-976X.2024.04.006 Abstract （78）      PDF（pc） （1166KB）（132）       Knowledge map    Save Objective To evaluate the safety and effectiveness of combined middle meningeal artery （MMA）embolization and external drainage in the treatment of chronic subdural hematoma （cSDH） under hybrid operating room. Methods Eighty patients with cSDH who received surgical intervention from September 2021 to October 2023 in our hospital, were included in the study. Among them, 41 cases received external drainage, 39 patients received MMA embolization combined with external drainage. One patient had a collateral anastomosis between the middle meningeal artery and the ophthalmic artery branch and did not receive embolization. In another case, the embolization was terminated due to severe arteriosclerosis and tortuousness which led to microcatheter being unable to bein place. The clinical symptoms, hematoma absorption, recurrence and related complications were observed within 3 months after operation. Results The successful rate of operation was 100% in all 80 cSDH patients. The hematoma was cleared well in all patients, and there were no surgical related complications. Fourty-ome patients were treated with external drainage. Only 7 patients （8.7%） recrudesced, and 37 patients received middle meningeal artery embolization combined with external drainage for 30 patients with primary cSDH and 7 patient with recurrence. No recurrence was found during the follow-up period and the mRS score was≤2.There were statistically significant differences in the thickness of cSDH and the first and last follow-up results of mRS （P<0.01）. Conclusion Middle meningeal artery embolization combined with external drainage is safe, effective and economical for the treatment of chronic subdural hematoma in hybrid operating room, especially for the treatment of refractory chronic subdural hematoma. Reference | Related Articles | Metrics

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Dynamic contrast-enhanced MRI based on GRASP technique for the assessment of liver fibrosis ZENG Kun-jie, DUAN Xiao-hui, YAN Zhuo-heng, ZENG Jia-le, LAI Chao-qi, SU Yun Lingnan Modern Clinics In Surgery    2024, 24 (03): 150-156.   DOI: 10.3969/j.issn.1009-976X.2024.03.002 Abstract （78）      PDF（pc） （2000KB）（194）       Knowledge map    Save Objective To investigate the value of dynamic contrast-enhanced MRI （DCE-MRI） based on golden-angle radial sparse parallel （GRASP） acquisition technique in assessing the degree of liver fibrosis staging. Methods This was a prospective enrollment of patients who underwent resection for localized liver lesions at Sun Yat-sen Memorial Hospital, Sun Yat-sen University, between September 2022 and December 2023, with subsequent assessment of fibrosis staging in the peritumoral liver tissue. All patients underwent preoperative DCE-MRI examination using the GRASP technique. Quantitative DCE-MRI parameters including arterial flow （Fa）, portal venous flow （Fv）, total blood flow （Ftotal）, arterial flow fraction （AF）, mean extracellular transit time （MTT）, and extracellular volume （ECV） were measured in all patients. Parameter comparisons for different liver fibrosis stages were performed using t-tests. Spearman's rank correlation test method was used to assess the correlation between each DCE parameter and the liver fibrosis staging. The efficacy of the model was evaluated using Receiver Operating Characteristic （ROC） curve analysis. Results DCE-MRI parameters were analyzed in 76 participants （64 males）. Compared to non-late （S≤2） patients, late patients （S≥3） showed a decrease in Fv （125.1 vs. 104.26 ml/100 ml/min, P=0.013）, an increase in AF （45.24 % vs. 51.89 %, P=0.013）, and an increase in ECV （35.46 vs. 40.44 ml/100 ml, P<0.001）. Across fibrosis stages, Fv（r=-0.326,P=0.004） decreased with increasing stages, and AF （r=0.317,P=0.005）and ECV （r=0.569,P<0.001）increased with increasing stages. The cut-off value for Fv was 145.13 mL/100 mL/min with an AUC of 0.651 （95% CI：0.524~0.778, P=0.026）, and the cut-off value for AF was 42.97% with an AUC of 0.652 （95% CI： 0.521~0.782, P=0.025）, and a cut-off value of 37.72 mL/100 mL for ECV, with an AUC of 0.776 （95% CI： 0.664~0.888, P<0.001）. Conclusion Quantitative GRASP-based DCE-MRI parameters can be employed to diagnose and stage the liver fibrosis. Reference | Related Articles | Metrics

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The infection of Trichosporon effectively treated with isavuconazole during the perioperative period for liver transplantation：two cases report and experience sharing MAI Han-tao, ZHANG Ke-lin, GUO Rui-lian, ZHUANG Su-yuan, HE Qing Lingnan Modern Clinics In Surgery    2024, 24 (05): 330-334.   DOI: 10.3969/j.issn.1009-976X.2024.05.011 Abstract （76）      PDF（pc） （4631KB）（202）       Knowledge map    Save Objective To explore the feasibility of isavuconazole in the treatment of Trichosporon infection and share clinical experience. Methods Through a retrospective analysis of the treatment process of two cases of pneumonia caused by Trichosporon during the perioperative period of liver transplantation at our hospital, combined with the study of relevant literature, we summarize the characteristics and treatment points of trichosporonosis, as well as the evaluate the feasibility of using isavuconazole to treat trichosporonosis. Results Two patients underwent liver transplantation for “liver failure,” and the lung trichosporonosiswas detected earlier through metagenomic next-generation sequencing technology before the operation. After treatment with amphotericin B failed, two patients were treated with isavuconazole in combination. Case 1 was also complicated with pulmonary Aspergillus fumigatus infection after surgery. The treatment of isavuconazolefor nearly 10 months showed improvement in both pulmonary lesions on imaging and negative results of fungal etiology for many times. Case 2 was treated with isavuconazole for 2 weeks and finally cured. As of the submission date, case 1 patient had died and Case 2 patient was still alive. Conclusion Isavuconazole is a potentially effective drug for trichosporonosis. Reference | Related Articles | Metrics

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Application of critical view of safety （CVS） concept in laparoscopic cholecystectomy in southern Xinjiang Region ZHANG Ji-hao, SALAMU Mi-ji-ti, CAO Yan-long, TANG Hao-ze, KAHAER Tu-er-xun, LIAO Hao, CHEN Ya-jin, CHEN Jie Lingnan Modern Clinics In Surgery    2024, 24 (04): 215-219.   DOI: 10.3969/j.issn.1009-976X.2024.04.002 Abstract （75）      PDF（pc） （4491KB）（122）       Knowledge map    Save Objective To investigate the impact of the critical view of safety （CVS） concept on the safety and prognosis of laparoscopic cholecystectomy （LC） in the southern Xinjiang region. Methods A retrospective analysis was conducted on the clinical data of 104 LC cases performed at the First People's Hospital of Kashgar from May 2023 to August 2023, designated as the control group. Starting in September 2023, the CVS concept was introduced to the clinical doctors performing LC, and 67 LC patients meeting the inclusion criteria from the same period and center were designated as the CVS group. Perioperative indicators of the CVS group were collected, and the safety and postoperative recovery between the control group and the CVS group were compared and analyzed. Results There was no statistically significant difference in the general preoperative conditions between the two groups （P>0.05）. The incidence of intraoperative bile duct injury and delayed postoperative bile duct injury was lower in the CVS group compared to the control group. Additionally, blood loss and postoperative AST and ALT levels were significantly lower in the CVS group, with the differences being statistically significant （P<0.05）. Conclusion The CVS concept can significantly enhance the safety of LC procedures in primary regions like southern Xinjiang and effectively improve prognosis and prevent bile duct injuries. Reference | Related Articles | Metrics

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Clinical observation on the postoperative impact of PPH and MMH on sexual function in the treatment of severe mixed hemorrhoids LIU Fan, YU Zhi-tao, WEN Sheng-rong Lingnan Modern Clinics In Surgery    2024, 24 (04): 249-253.   DOI: 10.3969/j.issn.1009-976X.2024.04.008 Abstract （74）      PDF（pc） （858KB）（126）       Knowledge map    Save Objective To investigate the impact of Procedure for Prolapse and Hemorrhoids （PPH） and Milligan-Morgan hemorrhoidectomy （MMH） on sexual function in patients with severe mixed hemorrhoids. Methods The data from 81 patients who underwent surgery for severe mixed hemorrhoids in our hospital from October 2022 to June 2023 were collected. The PPH group consisted of 41 patients who underwent PPH, while the MMH group consisted of 40 patients who underwent MMH. The International Index of Erectile Function （IIEF-5; score： ≥22 indicates no impairment） was used to evaluate male sexual function, and the Female Sexual Function Index（FSFI; score： >26.55 indicates no impairment） was used to evaluate female sexual function. A total of 62 patients completed the sexual function assessment questionnaires before and after surgery. The impact of the two most commonly used surgical methods on patients′ sexual function was assessed based on the scales. Results There was no statistically significant difference in the baseline data between the two groups. In the PPH group, the preoperative male sexual function score was 22.0 （3.5）, and the postoperative score was 22.0 （5.0）, P>0.05; the preoperative female score was 21.4 （8.1）, and the postoperative score was 23.6 （6.8）, P>0.05. In the MMH group, the preoperative male sexual function score was 22.5 （4.0）, and the postoperative score was 23.0 （5.0）, P>0.05; the preoperative female score was 24.6±7.5, and the postoperative score was 22.4±8.0, P>0.05. The median IIEF-5 scores of male patients before and after surgery in both groups were ≥22, and there were no statistically significant differences in the six dimensions of the FSFI scores for female patients before and after surgery. Conclusion PPH and MMH treatments for severe mixed hemorrhoids do not result in significant changes in patients′ sexual function, indicating that the surgeries are safe in terms of their impact on sexual function. Reference | Related Articles | Metrics

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Impact of diabetes mellitus on pathogenic bacteria resistance, disease severity, and clinical outcomes among septic patients： a retrospective cohort study MAI Lan, QIN Wei-qiang, XU Chang-qin, WU Na Lingnan Modern Clinics In Surgery    2024, 24 (04): 231-237.   DOI: 10.3969/j.issn.1009-976X.2024.04.005 Abstract （68）      PDF（pc） （1052KB）（35）       Knowledge map    Save Objective The aim of this study was to investigate in depth the effect of diabetes mellitus （DM）on pathogenic bacterial resistance and its correlation with the severity of the disease by retrospectively analyzing the clinical data of patients with sepsis. Methods Adult patients diagnosed with sepsis from January 2020 to December 2021 were retrospectively collected. Patients' clinical data, laboratory data, infection indicator data, and clinical diagnosis and treatment data were collected. According to whether the patients were accompanied by type 2 diabetes mellitus or not, the patients were categorized into two groups, DM group and non-DM group, and the clinical data, laboratory data, infection index data, and clinical diagnosis and treatment data of the two groups were compared. In addition, multifactorial analysis was performed to explore the independent risk factors affecting clinical mortality outcomes in the DM group compared with the non-DM group. Results A total of 189 patients with sepsis were included, with a mean age of 70.9±9.7 years. Compared with patients in the non-DM group, patients in the DM group had significantly higher levels of glucose （224.6±64.3 vs. 84.9±7.1, P<0.001） and glycosylated hemoglobin （8.2±2.0 vs. 6.7±0.9, P<0.001） and significantly lower levels of albumin （40.2±3.7 vs. 41.6±2.7, P=0.006） on admission. were significantly lower. Moreover, a significantly higher proportion of patients in the DM group had drug-resistant drug sensitization results compared to the non-DM group （86.7% vs. 49.5%, P<0.001）. In addition, patients in the DM group had higher SOFA scores （16.3±5.4 vs. 11.8±3.9, P<0.001）, APACHE Ⅱ scores （38.4±8.9 vs. 16.8±12.9, P<0.001） compared to those in the non-DM group.A higher percentage of patients died of clinical outcomes in the DM group （41.8% vs. 14.3%, P<0.001）. Finally, only glucose on admission （OR=9.711, 95% CI：2.889~32.639, P<0.001） was found to be independently associated with clinical outcome （death）. Conclusion Patients with sepsis combined with diabetes had a higher proportion of bacterial resistance; more severe disease severity and a higher proportion of clinical outcome （death）. And high glucose on admission was an independent risk factor for patient death. Reference | Related Articles | Metrics

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Expression of RAD54B in liver hepatocellular carcinoma and its influence on clinical prognosis ZHENG Biao, CHEN Xu, QIAN Junlin, XU Baoshi, ZHEN Chaohui, LIANG Rui Lingnan Modern Clinics In Surgery    2024, 24 (04): 225-230.   DOI: 10.3969/j.issn.1009-976X.2024.04.004 Abstract （66）      PDF（pc） （3958KB）（97）       Knowledge map    Save Objective To explore the significance of RAD54B expressionin liver hepatocellular carcinoma （LIHC）, and the difference of RAD54B expression level between LIHC and normal tissues, analyze its influence on patient prognosis. Methods Analyze the mRNA expression of RAD54B in LIHC and its impact on survival by using the TCGA online database. By using the human liver cancer tissue microarray （TMA）, evaluate the expression of RAD54B in LIHC by using immunohistochemical staining, and explore the impact of RAD54B on patient prognosis and its correlation with clinical pathological characteristics.Chi-square test was performed according to the correlation between antibody expression and clinical indicators of patients with LIHC, and univariate COX regression analysis and multivariate COX regression analysis were performed to screen out independent prognostic factors. The TCGA database was used to construct the nomogram and prognostic risk score model for RAD54B. Results TCGA database analysis showed that the expression level of RAD54B mRNA in LIHC tissues was higher than that in normal liver tissues. Immunohistochemical staining results also showed that the level of RAD54B protein expressed in LIHC tissue was significantly higher than that in normal liver tissue. The bioinformatics analysis of TCGA database and survival analysis of immunohistochemistry staining showed that the overall survival of the RAD54B high expression group was significantly reduced compared to the low expression group. Moreover, the expression of RAD54B is significantly correlated with multiple clinical features such as tumor size, TNM staging, and tumor grade in LIHC patients. Conclusion RAD54B as a prognostic factor for LIHC, is correlated with the size, stage, and differentiation of the patient's tumor. RAD54B may provide a new therapeutic target for LIHC treatment. Reference | Related Articles | Metrics

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A retrospective study of HAIC in combination with lenvatinib and PD-1 antibody versus HAIC in combination with lenvatinib for the translational treatment of hepatocellular carcinoma HUANG Dong-dong, TIAN Feng, FANG Yu-hui, QIU Yi-lin, HE Kun Lingnan Modern Clinics In Surgery    2024, 24 (05): 284-290.   DOI: 10.3969/j.issn.1009-976X.2024.05.003 Abstract （66）      PDF（pc） （1161KB）（65）       Knowledge map    Save Objective To retrospectively analyze the efficacy and prognosis of HAIC combined with lenvatinib and PD-1 antibody in the treatment of hepatocellular carcinoma in patients with intermediate and advanced hepatocellular carcinoma in our center. Methods Sixty-five patients admitted to Zhongshan People′s Hospital from March 2020 to March 2023 were retrospectively collected and divided into a combination group （HAIC combined with lenvatinib and PD-1 antibody） and a control group （HAIC combined with lenvatinib） according to the different treatment regimens, and the overall survival （OS）, disease progression-free survival （PFS）, and treatment-related adverse effects of the patients in the two groups were statistically analyzed. Results Sixty-five patients with hepatocellular carcinoma were evaluated for treatment according to RECIST 1.1 and mRECIST criteria, respectively, According to the mRECIST criteria, there were 29 cases （74.4%） of PR, 35 cases （89.7%） of ORR, and 37 cases （94.9%） of DCR in the combined group; In the control group, there were 9 cases of PR （74.4%）, 17 cases of ORR （65.4%）, and 24 cases of DCR （92.3%）; the overall median survival time was about 36 months, and the overall median relapse-free survival was about 28 months. The median survival time for patients in the combination group was 40 months, and the median relapse-free survival was 32 months. Patients in the control group had a median survival time of 29 months and a median relapse-free survival of 25 months. The PR, ORR, OS and RFS of the combination group were significantly higher than those of the control group, which were statistically different. Conclusion HAIC combined with lenvatinib and PD-1 antibody can bring more significant survival advantages for patients with intermediate and advanced HCC, effectively prolonging the survival of intermediate and advanced patients and improving the quality of patients′ survival. Reference | Related Articles | Metrics

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Exploration of the effect of applying nanocarbon suspension injection in thyroid cancer surgery ZHANG Yang-yi, DING Luo-zhou, LUO Hong-li, LIU Ce, REN Jia, MA Sheng-hui Lingnan Modern Clinics In Surgery    2024, 24 (03): 183-186.   DOI: 10.3969/j.issn.1009-976X.2024.03.006 Abstract （64）      PDF（pc） （908KB）（51）       Knowledge map    Save Objective To analyze Analysis of the effect of intraoperative application of nanocarbon-mixed injection in patients with differentiated thyroid cancer. Methods The clinical data of 92 cases of patients with total thyroidectomy + unilateral central zone lymphatic dissection admitted to Chengde City Central Hospital in Hebei Province from January 2021 to December 2023 were retrospectively collected and divided into the nanocarbon group （nanocarbon suspension injection treatment, n=46） and the control group （conventional surgical treatment, n=46） according to the different treatment methods. The treatment effects of the two groups were compared. Results The number of cervical lymph nodes cleared in the nanocarbon group （6.37±4.44） was more than that in the control group （t=3.919, P<0.001）. The rate of cervical lymph node metastasis （56.5%） was higher than that of the control group （χ2=10.172, P=0.001）, and the misdissection of parathyroid gland rate （6.5%） was lower than that of the control group （χ2=4.389, P=0.036）. The incidence of hypocalcemic symptoms in the nanocarbon group within 7 d postoperatively （8.7%） was lower than that in the control group （χ2=4.842, P=0.028）, and the incidence of total associatedcomplications in the postoperative period within 7 d （13.0%） was lower than that in the control group （χ2=5.974, P=0.015）. Conclusion The intraoperative application of nanocarbon-mixed injection in patients with differentiated thyroid cancer was able to improve the detection rate of cervical lymph node metastasis, increase the number of cervical lymph nodes cleared as well as reduce the rate of misdissection of the parathyroid glands, and also reduce the incidence of complications related to the patients in the postoperative period of 7 d. It also had a significant impact on the reduction of the incidence of hypocalcemic symptoms in the patients within seven days after surgery. Reference | Related Articles | Metrics

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Comparative analysis of laparoscopic sleeve gastrectomy and sleeve gastrectomy combined with jejunal bypass in the treatment of non-alcoholic fatty liver disease TONG Si-yu, CAO Guan-yi, WANG Shi-ping, LIU Guo-dong Lingnan Modern Clinics In Surgery    2024, 24 (04): 254-259.   DOI: 10.3969/j.issn.1009-976X.2024.04.009 Abstract （62）      PDF（pc） （877KB）（84）       Knowledge map    Save Objective To analyze the effect of laparoscopic sleeve gastrectomy （LSG） and sleeve gastrectomy combined with jejunal bypass （LSG-JJB） in the treatment of non-alcoholic fatty liver disease（NAFLD. Methods The clinical data and postoperative follow-up data of eligible bariatric patients in our hospital from January 2018 to December 2022 were analyzed. A historical cohort study was conducted, patients were divided into LSG group and LSG+JJB group according to different surgical methods. Two groups were matched 1∶1 using the PSM method. The general data of the two groups before and after PSM were compared, and the NAFLD indexes remission of the two groups after PSM were compared at 6 months and 12 months after operation. Results Seventy-five pairs of patients in the two groups were successfully matched by PSM. There was no significant difference in preoperative clinical data between the two groups after matching （P>0.05）. 6 months after operation, There was no significant difference in BMI, body weight, EWL% and LSM between the two groups （P>0.05）. Compared with LSG+JJB group,ALT（P<0.001）, AST （P<0.001）,GGT （P<0.001） and CAP （P=0.017） in LSG group were superior to LSG+JJB group, with statistical significance. TC （P<0.001） and TG （P=0.002） in the LSG group were inferior to those in the LSG+JJB group. Twelve months after surgery： There were no significant differences in ALT、AST、GGT、LSM and CAP between the two groups. LSG+JJB group were superior to LSG group in BMI （P=0.007）, EWL% （P=0.004）, body weight （P=0.001）, TC （P=0.004） and TG（P<0.001）. Conclusion There is no significant difference in ameliorating hepatic steatosis and fibrosis between the two surgical methods at 1 year after operation. LSG has advantage on ameliorating steatosis in the early postoperative period, LSG+JJB is superior to LSG in total cholesterol （TC） and triglyceride （TG） remission. Reference | Related Articles | Metrics

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Distribution and significance of hepatic artery variation in liver surgery WU Hai-feng, HUANG Ya-zhen, LI Fen, YAO Pei-xu Lingnan Modern Clinics In Surgery    2024, 24 (04): 220-224.   DOI: 10.3969/j.issn.1009-976X.2024.04.003 Abstract （61）      PDF（pc） （3200KB）（111）       Knowledge map    Save Objective To investigate the anatomical variations of hepatic artery, to direct the operation, to reduce the incidence of hepatic artery injury and surgical complications. Methods A retrospectively analyze the data of patients who underwent liver operation in Jieyang People′s Hospital in recent 5 years, and analyze the variations of hepatic artery. Results There were 229 cases with normal anatomical structure of hepatic artery and 49 cases with anatomical variations of hepatic artery in 278 patients. Conclusion The variations of hepatic artery are common and complex. Hepatic arterial injury can be significantly reduced by increased familiarity with the variation of hepatic artery and making a plan before operation. Reference | Related Articles | Metrics

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Timing and outcome of thoracic endovascular aortic repair in the acute phase of uncomplicated type B aortic dissection LI Jing-wen, SHI Zhan-yue, FU Yuan, MA Tian-jiao, ZENG Zhao-pei, LI Gen, ZHENG Jun-meng Lingnan Modern Clinics In Surgery    2024, 24 (05): 276-283.   DOI: 10.3969/j.issn.1009-976X.2024.05.002 Abstract （61）      PDF（pc） （1202KB）（110）       Knowledge map    Save Objective To provide evidence-based medicine support for clinical decision-making in the acute phase of uncomplicated type B aortic dissection. Methods This study enrolled 598 consecutive patients diagnosed with uncomplicated type B aortic dissection treated with TEVAR from January 2015 to December 2020 at a single center. With a threshold of 48 hours between onset and TEVAR, the patients were termed the Acute-Early group and Acute-Delayed TEVAR group. Descriptive and inferential statistics and Survival Analysis Methods were performed to explore the clinical features between the two groups. Results The mean age was 54.00 （45.25, 61.00） years old and 503 （84.1%） patients were men. The most common symptom was chest pain （86.3%） which is statistically different （92% vs 79.6%, P<0.001） between the two groups. The most common in-hospital complication is the formation of internal leakage in 59（9.9%）. There was no significant difference between the Acute-Early and Acute-Delayed groups in the number of total deaths （20 patients, 6.2% vs 18 patients, 6.5%, P=0.993） and aortic-related events （14 patients, 4.3% vs 7 patients, 2.5%, P=0.336）. The overall 1,3 and 5-year survival rates after TEVAR were 97.5%, 94.7%, and 91.1% respectively, which was also no statistical difference between the two groups. Conclusion The early or delayed TEVAR （threshold of 48 hours between onset and TEVAR） for selected uncomplicated TBADs did not affect the postoperative incidence of hospital complications, aortic-related complications, and ultimate survival. Therefore, patients of this kind can undergo TEVAR either immediately or after a waiting period following the onset of the condition but efforts should be paid to identify the high-risk subgroups of acute uncomplicated TBADs who may benefit from early or delayed TEVAR intervention. Reference | Related Articles | Metrics

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The biomechanical role of the fibula in lower limbs： a fracture mechanics analysis CHEN Xin-rong, XING Jian-qiang, WANG Da-wei, LI Peng, SHAO Bin Lingnan Modern Clinics In Surgery    2024, 24 (06): 371-377.   DOI: 10.3969/j.issn.1009-976X.2024.06.006 Abstract （60）      PDF（pc） （4813KB）（115）       Knowledge map    Save Objective Fibular grafting is widely used in the treatment of various bone nonunions and defects because of its good therapeutic effects. However, the fibula plays important roles in the biomechanics of the lower limbs. In this study, the biomechanical effects of the fibula in lower limbs were researched through mechanics analysis. Methods We randomly collected knee joint computed tomography （CT） scans from ten adults with normal bone mass（T≥-1）, including six left knee and four right knees. None of the volunteers had bone pathologies. The CT scan images in DICOM format were imported into Mimics software, and the three-dimensional models of tibia and fibula were extracted in Mimics software. Each model was imported into 3-MATIC and LS-DYNA software for model processing and operation condition setting, and the changes of load and fracture time in the two models were calculated to evaluate the biomechanical role of the fibula in the lower limbs. Results The validity of the model was verified, and the fibular load condition was similar to those previously reported. In the model with fibular support, the fracture load of the tibia was 10.92±0.45 kN, the initial fracture time was 0.65±0.15 s, and the complete fracture time was 0.69±0.16 s. In the fibular defect model, the fracture load of the tibia was 9.60±0.37 kN （P<0.05）, the initial fracture time was 0.49±0.11 s （P<0.05）, and the complete fracture time was 0.54±0.12 s （P<0.05）. Conclusion The fibula plays an essential biomechanical role in lower limb load-bearing and therefore is worthy of clinical attention. Reference | Related Articles | Metrics

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A case report of cribriform morular thyroid carcinoma and literature review LIU Huo-lian, YONG Juan-juan Lingnan Modern Clinics In Surgery    2024, 24 (06): 388-391.   DOI: 10.3969/j.issn.1009-976X.2024.06.009 Abstract （60）      PDF（pc） （3135KB）（95）       Knowledge map    Save This study retrospectively analyzed the clinical data, pathological findings, immunohistochemical results, and genetic test outcomes of a patient diagnosed with Cribriform Morular Thyroid Carcinoma （CMTC）. Postoperative histological examination showed the cribriform and morular patterns. Immunohistochemistry demonstrated that TTF-1, estrogen receptor （ER）, and progesterone receptor （PR） were positively expressed in cribriform structures, while absent in the morular structures. β-catenin showed diffuse positivity in the nucleus and cytoplasm, and the Ki-67 proliferation index was consistently below 5%。CMTC, a rare variant of thyroid carcinoma, is distinguished by its unique pathological features and typically favorable prognosis. Accurate morphological assessment and immunohistochemical profiling are essential for diagnosis. Additionally, screening for Familial Adenomatous Polyposis （FAP） and regular follow-up of affected patients and their families hold significant clinical relevance. Reference | Related Articles | Metrics

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Application research of using cyanoacrylate in cranial fixation following microvascular decompression MA Wen-chao, ZOU Lin-bo, YE Feng, WU Xiao-ming, YANG Yu-min, LONG Xiao-dong Lingnan Modern Clinics In Surgery    2024, 24 (05): 296-300.   DOI: 10.3969/j.issn.1009-976X.2024.05.005 Abstract （59）      PDF（pc） （3819KB）（136）       Knowledge map    Save Objective To investigate the efficacy and safety of cyanoacrylate using in cranial fixation following microvascular decompression （MVD）. Methods The clinical data of patients, who were used cyanoacrylate in cranial fixation following MVD, was retrospectively analyzed. The efficacy of cranial fixation and incidence of postoperative complications was summarized. Results A total of 198 patients were included, and the median follow-up time was 24.50 （14.00,47.75） months. The postoperative head CT showed no obvious absorption and displacement of the bone flap, and achieved good fixation. None of the patients had any adverse reactions such as allergy or toxicity. Eight patients had postoperative complications, including 2 patients （1.01%） underwent re-operation due to the recurrence of trigeminal neuralgia, 5 patients （2.53%） of cerebrospinal fluid leakage, and 1 patient （0.51%） of surgical wound infection. Conclusion The application of cyanoacrylate in cranial fixation following MVD has definite efficacy and good safety. Due to its advantages of safety, cheap, simple, rapid, no retained foreign body, and no influence on imaging, it is worthy of clinical application. Reference | Related Articles | Metrics

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Risk factors in delayed post-pancreaticoduodenectomy hemorrhage： a meta-analysis YANG Guang, WU Jian-wu, JIANG Xin-wei Lingnan Modern Clinics In Surgery    2024, 24 (06): 335-346.   DOI: 10.3969/j.issn.1009-976X.2024.06.001 Abstract （57）      PDF（pc） （11406KB）（9）       Knowledge map    Save Objective Through meta-analysis of risk factors related to delayed post-pancreaticoduodenectomy hemorrhage （DPPDH） at home and abroad, to provide theoretical basis for prevention and treatment of delayed hemorrhage after pancreaticoduodenectomy. Methods Previous studies on the risk factors of delayed hemorrhage after pancreaticoduodenectomy were searched by computer in medical literature databases, including PubMed, Cochrane Library, Embase, Web of science, CNKI, Wanfang, VIP and other resources. RevMan 5.4 and STATA were used in this meta-analysis. The heterogeneity and publication bias of the research is included in analysis to ensure the reliabity of this meta-analysis. Results A total of 16 retrospective studies were included. Meta-analysis showed thatthere was no significant differences between diabetes mellitus, hypertension, preoperative albumin, preoperative biliary drainage or not, tumor character, delayed gastric emptying and delayed hemorrhage after pancreaticoduodenectomy （P>0.05）. And the results showed that the elderly （SMD=0.16, 95%CI： 0.02-0.29, P=0.02）, male （OR=1.77, 95%CI： 1.43-2.18, P<0.001）, preoperative total bilirubin （OR=0.28, 95%CI： 0.04-0.51, P=0.02）, vascular reconstruction（OR=1.75, 95%CI： 1.08-2.84, P=0.02）, soft pancreas texture （OR=0.39, 95%CI： 0.23-0.66, P=0.0005）, pancreatic duct diameter <3 mm（OR=0.53, 95%CI： 0.35-0.81, P=0.004）, pancreatic leakage （OR=4.04, 95%CI： 3.19-5.13, P<0.001）, bile leakage （OR=4.04, 95%CI： 2.83-5.76, P<0.001） and abdominal infection （OR=6.61, 95%CI： 4.60-9.51, P<0.001） was closely related to the occurrence of delayed hemorrhage after pancreaticoduodenectomy. Conclusion There was no significant association between the DPPDH anddiabetes mellitus, hypertension, preoperative albumin, preoperative biliary drainage or not, tumor character, delayed gastric emptying. Age, gender, preoperative total bilirubin, vascular reconstruction, pancreas texture, pancreatic duct diameter, pancreatic leakage, bile leakage, abdominal infection are factors associated with DPPDH. Reference | Related Articles | Metrics

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Application of non-invasive skin closure disposable device after excision of medium or small facial nevus of children CHEN Chen, SHI Fen, ZHANG Jia-qi Lingnan Modern Clinics In Surgery    2024, 24 (04): 260-263.   DOI: 10.3969/j.issn.1009-976X.2024.04.010 Abstract （56）      PDF（pc） （3315KB）（147）       Knowledge map    Save Objective To summarize the effect of one-stage application of single-use non-invasive skin closure disposable device on the wounds of the children after medium or small facial nevus excision. Methods From July 2019 to September 2023, 67 children ged 1~9 years old with medium or small facial nevus, a. The nevus was located on the face, with the longest diameter of 15 mm~50 mm. Using tension-reducing suture when the nevus was excised, then single-use non-invasive skin closure disposable device was used for external wound tension-reducing. disposable device on the wounds of the children after medium or small facial nevus excision. Results All of 67 children healed well after surgery, no bleeding, infection, dehiscence or other complication, wound scars were linear, no obvious scar widening, scar hyperplasia during follow-up. Conclusion The rational application of single-use non-invasive skin closure disposable device on the wounds of the children after medium or small facial nevus excision has good effects on reducing wound tension, promoting wound healing and alleviating postoperative scar. Reference | Related Articles | Metrics

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Lingnan Modern Clinics In Surgery    2024, 24 (03): 206-208.   DOI: 10.3969/j.issn.1009-976X.2024.03.010 Abstract （55）      PDF（pc） （6071KB）（71）       Knowledge map    Save Reference | Related Articles | Metrics

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Relationship between glomerular filtration rate and clinical stage and prognosis of primary gastric adenocarcinoma REN Xue-kang, ZHU Shao-gong, XIA Yun-zhan Lingnan Modern Clinics In Surgery    2024, 24 (04): 244-248.   DOI: 10.3969/j.issn.1009-976X.2024.04.007 Abstract （54）      PDF（pc） （1176KB）（94）       Knowledge map    Save Objective To explore the relationship between estimated glomerular filtration rate （eGFR） and clinical stage and prognosis of primary gastric adenocarcinoma （GA）. Methods A total of 102 patients with GA in Zhengzhou People's Hospital from June 2020 to June 2023 were retrospectively selected as the research objects. Clinical data such as age, gender, tumor location, maximum diameter, histological differentiation, lymph node metastasis, distant metastasis, and clinical stage were recorded. The results of related indicators of renal function within 1 week before surgery were recorded. The eGFR levels and their correlation in patients with different clinical stages were compared. Patients were divided into metastasis group and non-metastasis group according to the presence or absence of distant metastasis, and eGFR levels were compared between the two groups. The diagnostic efficacy of eGFR was analyzed by ROC curve. Kaplan-Meier method and Cox proportional hazard model were used for survival analysis to evaluate the relationship between eGFR level and prognosis. Results There were significant differences in eGFR levels between patients with different clinical stages （P<0.001）, eGFR level was negatively correlated with clinical stage （r=-0.862,P<0.001）. The level of eGFR in patients with metastasis was lower than that in patients of non-metastasis （P<0.001）. The AUC of eGFR in the diagnosis of tumor metastasis was 0.940. By eGFR stratification, the results showed that the survival time of the higher stratification group was longer than that of the lower stratification group. Cox proportional hazards regression analysis showed that eGFR level（P=0.021）, distant metastasis （P=0.038）, and degree of differentiation （P=0.009） were independent factors affecting the prognosis of GA. Conclusion The level of eGFR is closely related to the clinical stage of patients, and it is an independent factor affecting the prognosis of patientsandhas important predictive value in evaluating the metastasis and prognosis of GA. Reference | Related Articles | Metrics

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Effect of intrathecal application of different doses of dexmedetomidine on postoperative comfort treatment of PPH QIN Fu-xing, HUANG Ze-han Lingnan Modern Clinics In Surgery    2024, 24 (03): 193-198.   DOI: 10.3969/j.issn.1009-976X.2024.03.008 Abstract （54）      PDF（pc） （934KB）（96）       Knowledge map    Save Objective To explore the effect of intrathecal application of different doses of dexmedetomidine on postoperative analgesia during procedure for prolapse and hemorrhoids （PPH）. Methods 380 patients undergoing PPH under combined spinal and epidural anesthesia were selected and randomly divided into 4 groups： C group （intrathecal 0.5% ropivacaine 15 mg）, LDA group （intrathecal 0.5% ropivacaine 15 mg + dexmedetomidine 5 μg）, LDB group（intrathecal 0.5% ropivacaine 15 mg + dexmedetomidine 7.5 μg） and LDC group（intrathecal 0.5% ropivacaine 15 mg + dexmedetomidine 10 μg）, 95 cases in each group. Record the time when patients first used analgesics, spinal anesthesia analgesia time, and differential analgesia time after surgery, and the visual analog scale （visual analogue scale, VAS） score. Results The first postoperative analgesic time, spinal anesthesia analgesia time, and differential analgesia time in the LDA group, LDB group, and LDC group were all longer than those in the C group, and the differences were statistically significant （P<0.05）. The VAS scores of the LDA group, LDB group, and LDC group at rest and during activity at 6 h, 12 h, and 24 h after surgery and immediately after taking analgesics were lower than those in the C group, and the difference was statistically significant （P<0.05）. Conclusion Dexmedetomidine is an intrathecal safe and effective adjuvant, which can enhance the effect of postoperative analgesia and reduce the dosage and frequency of postoperative analgesics. It is an effective scheme to realize comfortable medical treatment after PPH,Intrathecal application of 7.5 μg dexmedetomidine can achieve more satisfactory differential analgesia time. Reference | Related Articles | Metrics

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Preoperative indirect bilirubin to total bilirubin ratio： a novel rognostic factor for gastric cancer based on competing risk model MA Ming-zhe, YUAN Shu-qiang, MIN Xiao-hui Lingnan Modern Clinics In Surgery    2024, 24 (06): 347-353.   DOI: 10.3969/j.issn.1009-976X.2024.06.002 Abstract （54）      PDF（pc） （1262KB）（131）       Knowledge map    Save Background Besides its adverse effect, bilirubin, especially indirect bilirubin, also serves as a potent antioxidant and could influence the formation and development of carcinoma. The correlation between bilirubin with clinical outcome has been widely validated in several malignancies, nevertheless, whether bilirubin is capable of being a prognosis indicator in gastric cancer remains disputable. Methods We retrospectively reviewed 1245 gastric cancer （GC） patients who received radical or palliative gastrectomy at Sun Yat-Sen University Cancer Center and Shenshan Medical Center,Sun Yat-Sen Memorial Hospital from 2008 to 2023. Fine and Gray competing risk model was conducted to evaluate prognostic significance of clinicopathological factors and bilirubin. Results We derived a novel index, Indirect Bilirubin to Total Bilirubin Ratio （ITR） and explored its role in predicting prognosis of GC patients with curative/palliative surgery by utilizing competing risk regression model. At first time, we found patients with ITR>0.69 had relatively better prognosis （HR, 0.72; 95%CI, 0.61-0.84; P<0.001）. Conclusion Our study indicated that preoperative ITR could act as an independent prognostic factor in GC. Reference | Related Articles | Metrics

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Construction of teaching system on surgery-ideological and political integration LI Deng, CHEN Mei-yi, XU Jie, LIU Zhuo-jie, ZHANG Lin, YU Zhen-yan, LI Chun-hai Lingnan Modern Clinics In Surgery    2024, 24 (06): 392-397.   DOI: 10.3969/j.issn.1009-976X.2024.06.010 Abstract （54）      PDF（pc） （1006KB）（49）       Knowledge map    Save Moral cultivation is the center of medical education, and the integration of ideology and politics into the course of Surgery is an important path to train surgeons with both virtue and ability. The reform of Surgery-Ideological and Political integration teaching system includes two parts： the construction of the teaching team and the construction of the curriculum. Exploring ideological and political elements and integrating them into the course of surgery is the key and difficult point of teaching reform. The three education goals of “politics”, “virtue” and “Ability”, can guild young teachers to understanding of ideology and politics and help them master teaching methods. Reference | Related Articles | Metrics

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Progress in the treatment of high and complex anal fistulas by transanal opening of intersphincteric space GUO Shuo-hao, SONG Shun-xin Lingnan Modern Clinics In Surgery    2025, 25 (1): 70-78.   DOI: 10.3969/j.issn.1009-976X.2025.01.012 Abstract （52）      PDF（pc） （963KB）（34）       Knowledge map    Save Surgical treatment of anal fistulas faces the dual challenge of achieving wound healing while preserving anal function. High or complex anal fistulas represent a closed-space, non-functional cavity within the perianal musculature, predominantly occurring in the posterior deep space of the anal sphincter complex. Effective management requires complete opening of this space and ensuring adequate drainage to control infection and promote healing. Traditional fistulotomy with seton placement is primarily suitable for simple fistulas, but its application in complex cases often results in high incontinence rates. In the era of sphincter-preserving techniques, surgeons must select appropriate surgical approaches that prioritize the anatomical integrity of the anal sphincter system. Current literature and guidelines propose multiple therapeutic options, including mucosal advancement flap （MAF）, laser therapy, video-assisted anal fistula treatment （VAAFT）, ligation of intersphincteric fistula tract （LIFT）, over-the-scope clip closure （OTSC）, and radiofrequency ablation （RAF）, however, up to the present moment, no single method has demonstrated substantial and promising potential. The transanal opening of intersphincteric space （TROPIS） technique, introduced in recent years, offers a unique approach. Instead of closing the internal fistula opening, TROPIS enlarges it by incising the fistula tract along the intersphincteric plane. This method fully preserves the external anal sphincter （EAS） and facilitates secondary healing through sustained drainage. Transanal opening of intersphincteric space （TROPIS） is a novel technique developed in recent years for high or complex anal fistulas. Instead of closing the internal fistula opening, it enlarges the opening by incising the fistula tract along the intersphincteric plane, completely preserving the external anal sphincter （EAS） and allowing secondary healing through drainage. First reported in 2017, TROPIS has demonstrated good efficacy and safety in treating complex high anal fistulas and is gaining wider adoption. This article reviews the clinical outcomes and future prospects of TROPIS. Reference | Related Articles | Metrics

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IL-17A as a potential prognostic biomarker in communicating hydrocephalus patients LIN Hai, YE Zhong-xing, LIN Ling, HU Yu-ling, WANG Rui, ZHANG Wen-jing, TANG Wen-long Lingnan Modern Clinics In Surgery    2024, 24 (06): 378-383.   DOI: 10.3969/j.issn.1009-976X.2024.06.007 Abstract （51）      PDF（pc） （1263KB）（90）       Knowledge map    Save Objective This study aimed to explore the predictive value of preoperative cerebrospinal fluid （CSF） interleukin-17a （IL-17A） levels for the clinical prognosis of patients with communicating hydrocephalus. Methods This study retrospectively analyzed the clinical data of 54 patients with communicating hydrocephalus admitted to the Department of Neurosurgery of the Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine from January 2019 to December 2023. All selected patients underwent lumbar puncture before surgery to collect CSF samples for IL-17A level detection. The clinical efficacy of the patients was evaluated using the National Institutes of Health Stroke Scale （NIHSS） at 4 weeks and 3 years after surgery, and the potential relationship between CSF IL-17A levels and clinical efficacy was analyzed. Results The study data showed that patients with more severe preoperative symptoms had higher IL-17A expression levels in CSF. In the efficacy assessment at 4 weeks after surgery, 90.7% of the patients showed significant improvement in symptoms, but the association between CSF IL-17A levels and immediate postoperative efficacy was not significant. However, in the long-term efficacy assessment at 3 years after surgery, the NIHSS scores of the patients were significantly lower than those before surgery, and the CSF IL-17A levels of patients with better treatment efficacy were significantly lower than those with poorer efficacy （P < 0.05）. Additionally, the study indicated that patients with adverse reactions had significantly higher IL-17A expression levels in CSF than those without adverse reactions. Conclusion This study demonstrated that the expression level of IL-17A in CSF can serve as an effective indicator for predicting the long-term clinical prognosis of patients with communicating hydrocephalus. This finding provides a new perspective and potential intervention target for the clinical treatment of communicating hydrocephalus. Reference | Related Articles | Metrics

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Pan-cancer analysis of tripartite motif 5 and its validation in promoting malignant phenotypes of pancreatic cancer LI Wei-fan, HUANG Song-yin Lingnan Modern Clinics In Surgery    2024, 24 (05): 263-275.   DOI: 10.3969/j.issn.1009-976X.2024.05.001 Abstract （51）      PDF（pc） （11943KB）（20）       Knowledge map    Save Objective To evaluate the expression level of TRIM5 in pan-cancer and its relationship with prognosis, clinical stage, and immune micro-environment. Methods TRIM5 pan-oncogene expression profile, somatic mutation data, and clinically relevant information were obtained from TCGA, TARGET, and GTEx databases. Use R software package to analyze the relationship between TRIM5 and the prognosis, clinical pathological characteristics, and genomic heterogeneity of cancer patients. The relationship between TRIM5 and immune cell infiltration and immune regulatory genes in pan-cancer was analyzed by ESTIMATE and EPIC algorithms. The GO and KEGG enrichment analysis of TRIM5 related genes was further carried out, and the effect of TRIM5 on the proliferation and migration of pancreatic cancer was verified through in vitro experiments. Results TRIM5 was up-regulated in glioma, low-grade glioma, pancreatic cancer and other tumor tissues. The abnormal expression of TRIM5 was associated with poor prognosis in gliomas, low-grade brain gliomas, and pancreatic cancer, etc. TRIM5 promotes malignant progression of glioma, low-grade glioma of brain and pancreatic cancer. TRIM5 expression was associated with microsatellite instability, homologous recombination defects, tumor neoantigens, and tumor mutation burden. The expression of TRIM5 was positively correlated with the infiltration of various immune cells in pan cancer, such as T cells, macrophages, and cancer-related fibroblasts. TRIM5 was significantly correlated with immune regulatory genes in pan cancer, with most of them positively correlated with immune checkpoint genes such as PDCD1 and CTLA4. Gene enrichment results show that TRIM5 was closely related to signaling pathways such as cell adhesion and cancer-related signals. The in vitro experimental results showed that knocking down the TRIM5 gene significantly reduced the proliferation and migration ability of PANC-1 cells. Conclusion TRIM5 is abnormally expressed in various tumor tissues, and its expression is closely related to patient prognosis, clinical pathological characteristics, tumor immune infiltration, immune regulatory genes, genomic heterogeneity, etc. These results suggest that TRIM5 may be a new and promising tumor treatment target and prognostic biomarker. Reference | Related Articles | Metrics

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Clinical application of tubeless laparoscopic adrenalectomy LIAN Wen-qing, HUANG Ya-qiang, HUANG Hong-xing, ZHONG Rui, CAO Bin Lingnan Modern Clinics In Surgery    2024, 24 (05): 291-295.   DOI: 10.3969/j.issn.1009-976X.2024.05.004 Abstract （49）      PDF（pc） （921KB）（29）       Knowledge map    Save Objective To explore the feasibility and safety of tubeless laparoscopic adrenalectomy. Methods A retrospective analysis was conducted on the clinical data of 102 patients who underwent laparoscopic adrenalectomy by the same surgical team at our hospital from June 2022 to July 2024. Among them, 43 patients （tubeless group） did not have drainage tubes placed, and the urethral catheter was removed immediately or within 1 day after surgery. The remaining 59 patients （control group） underwent conventional drainage tube placement and urethral catheterization. The differences in surgical time, intraoperative bleeding, postoperative feeding time, postoperative hospital stay, postoperative pain visual analog score （VAS）, and postoperative complications between the two groups were compared. Subgroup analysis was then performed based on surgical approach （transperitoneal vs. retroperitoneal） to compare perioperative clinical indicators. Results Both groups completed the surgery successfully without conversion to open surgery. The tubeless group had shorter postoperative hospital stays, lower VAS pain scores at 2 hours and 24 hours after surgery, compared to the control group （all P values less than 0.05）. There were no significant differences in operative time, intraoperative bleeding, postoperative feeding time, and postoperative complications （fever, pulmonary infection, abdominal distension, and urinary retention） between the two groups （all P values more than 0.05）. Subgroup analysis based on surgical approach revealed that in the transperitoneal approach subgroup, the tubeless group showed significantly shorter operation times, lower VAS pain scores at 2 and 24 hours postoperatively, and shorter hospital stays compared to the control group （P<0.05）. In the retroperitoneal approach subgroup, the tubeless group also showed significantly lower VAS pain scores at 24 hours postoperatively and shorter hospital stays （P<0.05）. Conclusion Tubeless laparoscopic adrenalectomy can significantly accelerate postoperative recovery, improve patient comfort, and shorten hospital stays, making it a safe and feasible fast-track surgical approach. Reference | Related Articles | Metrics

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Study on the effect of changes in stool frequency in early enteral nutrition of ICU patients on tolerance assessment QIU Yu-ru, CAI Min, LI Zi-ying, WANG Ji-wen Lingnan Modern Clinics In Surgery    2024, 24 (05): 320-325.   DOI: 10.3969/j.issn.1009-976X.2024.05.009 Abstract （49）      PDF（pc） （934KB）（143）       Knowledge map    Save Objective To investigate the efficacy of assessment of early enteral nutrition （EN） tolerance in ICU patients and the role of abnormal stool frequency monitoring. Methods The basic data of patients who met the inclusion criteria from January 1, 2021 to May 30, 2023, and the GRV, stool frequency, abdominal circumference, and bladder pressure on the 1st to 7th day before and after EN were retrospectively collected and grouped into groups. The change trend of each observation index, the occurrence time and incidence of abnormalities, and the percentage as the earliest basis for determining tolerance were analyzed and compared. Results The incidence of EN intolerance in ICU patients was 85.9%, the most common was abnormal stool, 91.1% had no stool for a day, 40.3% had no stool for more than 3 days, and 47.6% had diarrhea. In the intolerance group, the incidence of abnormal stool was 90.2%, the average occurrence time was 4.0 days, and the incidence of diarrhea was the highest on the 4th day with more than 3 days absence. As the basis for the earliest determination of intolerance, the percentage from high to low was diarrhea, increased bladder pressure, no stool for more than 3 days, GRV, increased abdominal circumference, and abdominal distension. Conclusion The incidence of early EN intolerance in ICU patients was 85.9%. As a method for early identification of EN intolerance, both no stool and diarrhea showed good evaluation value, and should be paid attention to in ICU EN management. Reference | Related Articles | Metrics

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Therapeutic effect and mechanism of colonic flap reconstruction in a rat model of short bowel syndrome TANG Zong-yi, DENG Gao-yan Lingnan Modern Clinics In Surgery    2024, 24 (06): 354-359.   DOI: 10.3969/j.issn.1009-976X.2024.06.003 Abstract （47）      PDF（pc） （22418KB）（9）       Knowledge map    Save Objective To investigate the protective effect and potential mechanism of colonic flap reconstruction on colonic tissue in rats with short bowel syndrome （SBS） by upregulating Wnt3a and β-catenin expression. Methods Rats were randomly divided into sham operation （Sham）, SBS model （Model）, and colonic flap reconstruction treatment （Surgery） groups, with 10 rats in each group. Serum Wnt3a levels were detected by ELISA. The mRNA and protein expression of Wnt3a and β-catenin in colonic tissue were analyzed by qPCR and Western blot. Immunohistochemistry was used to observe the expression and distribution of α-amylase and bile salt transport protein in proximal and distal epithelial cells of the colonic flap. Immunohistochemistry was also used to detect the expression and localization of Wnt3a, β-catenin, α-amylase, and bile salt transport protein in colonic tissue. Results Compared with the Sham group, there was no significant difference in serum Wnt3a levels in the Model group （P>0.05）, while Wnt3a levels in the Surgery group were significantly higher than those in the Sham and Model groups （P<0.05）. Compared with the Sham group, the mRNA and protein expression of Wnt3a and β-catenin in colonic tissue were significantly downregulated in the Model group （P<0.05）. The expression of Wnt3a and β-catenin in the Surgery group was significantly higher than that in the Model group （P<0.05）. Immunohistochemical staining showed that there were differences in the expression and distribution of α-amylase and bile salt transport protein in proximal and distal epithelial cells of the colonic flap. Conclusion Colonic flap reconstruction can alleviate pathological changes in SBS rats to a certain extent by upregulating the expression of Wnt3a and β-catenin, which may be one of the potential mechanisms of its therapeutic effect. Reference | Related Articles | Metrics

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A case report of mixed medullary-papillary carcinoma of the thyroid with medullary carcinoma metastasis in the cervical lymph nodes and review of the literature AI Qing, HUANG Zhi-heng, WENG Yu-jing, CHEN Wei-chun Lingnan Modern Clinics In Surgery    2024, 24 (05): 326-329.   DOI: 10.3969/j.issn.1009-976X.2024.05.010 Abstract （46）      PDF（pc） （1613KB）（100）       Knowledge map    Save This paper reviewed the diagnosis and treatment process of a patient with mixed medullary-papillary thyroid carcinoma, to review and analyse the clinical data, pathology and immunohistochemistry results of the patient, and to analyse and discuss the disease with the domestic and international literature to provide reference for clinical diagnosis and treatment. A summary of case data reported in the literature showed that mixed medullary-papillary thyroid carcinoma is rare in incidence, is pathologically characterised by the presence of a mixture of medullary and papillary carcinoma, is treated in the same way as medullary thyroid carcinoma, and has an overall prognosis inferior to that of papillary thyroid carcinoma but superior to that of medullary thyroid carcinoma. Theer should be alert to this type of disease when preoperative FNA is considered papillary carcinoma and serum calcitonin is elevated, a cytological and tumour marker inconsistency. Reference | Related Articles | Metrics

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Construction and validation of a predictive model for prolonged postoperative length of stay after spinal discectomy and fusion LIANG Xia, LI Yong-xing, LIU Xiao-qing, JIANG Sha-sha, FU Yan-ni Lingnan Modern Clinics In Surgery    2024, 24 (05): 301-307.   DOI: 10.3969/j.issn.1009-976X.2024.05.006 Abstract （44）      PDF（pc） （2009KB）（97）       Knowledge map    Save Objective The aim of this study was to develop a clinical model for predicting prolonged postoperative length of stay （PLOS） after spinal discectomy and fusion. Methods Retrospective analysis was conducted based on the relevant data of 434 patients who underwent spinal discectomy and fusion which was extracted from the electronic medical record system. The main outcome variables of the study were prolonged PLOS. Cases that meet the inclusion criteria were randomly divided into a model training cohort and an internal validation cohort. LASSO regression was used to screen variables, and multivariate Logistic regression analysis was used to construct a prediction model and visualize it using nomogram. The discriminability, calibration, and clinical effectiveness of the model were evaluated through receiver operating characteristic curve （ROC curve）, calibration curve, and decision curve analysis （DCA）. Results The final prediction model included five variables： intraoperative blood transfusion, intraoperative neuroelectrophysiological monitoring, postoperative ICU admission, postoperative complications and postoperative drainage tube removal time. The area under the operating characteristic curve （AUC） of the training set and the validation set were 0.899 （95%CI：0.859-0.838） and 0.864 （95%CI：0.794-0.934） respectively, suggesting that the model has good discrimination. The calibration curve and DCA curve indicate that the model has good calibration and clinical practicality. Conclusion We have developed and validated a new predictive model for prolonged PLOS after spinal discectomy and fusion. The model has excellent comprehensive performance, which can better predict the risk of prolonged PLOS, guide clinical intervention as early as possible to shorten the length of stay, and provide data support for reducing hospitalization costs and implementing rapid recovery after spine surgery. Reference | Related Articles | Metrics

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Surgical patients infect PVL-positive Staphylococcus aureus correlation study of neutrophils and lymphocytes ZHANG Le, WANG Yue-ling, BAI Yuan-yuan, SONG Zhen, LU Xing-lun, WU Yu-long Lingnan Modern Clinics In Surgery    2024, 24 (05): 314-319.   DOI: 10.3969/j.issn.1009-976X.2024.05.008 Abstract （43）      PDF（pc） （946KB）（118）       Knowledge map    Save Objective To understand the prevalence and resistance of Staphylococcus aureus （S. aureus）carrying the Panton-Valentine leukocidin （PVL） gene in surgical patients at the Shandong Provincial Hospital Affiliated to Shandong First Medical University in 2023. The clinical application values of white blood cell （WBC）, C-reactive protein （CRP）, and neutrophil-to-lymphocyte ratio （NLR） in the diagnosis of PVL-positive S. aureus infection were investigated. Methods 100 strains of S. aureus were isolated. The presence of the mecA gene and genes encoding PVL were ditermined using PCR, and the drug resistance of the isolates were analyzed. Groups were grouped according to the mecA and PVL gene test results. Contemporaneous 100 subjects undergoing healthy physical examination were selected as the control group. The levels of WBC, CRP, and NLR of each group were collected, and the clinical application values of WBC, CRP, and NLR for PVL-positive S. aureus infection were compared. Results Among the 100 strains of S. aureus, 47 isolates were Methicillin-resistant Staphylococcus aureus（MRSA）. Of the 49 S. aureus strains tested, the PVL gene was detected in most of them, which were mainly methicillin-sensitive Staphylococcus aureus （MSSA）. The levels of WBC, CRP, and NLR increased significantly during S. aureus infection, and the level of NLR in the PVL-positive group was significantly higher than that in the PVL-negative group （Z=-2.26, P=0.02）. Still, the levels of WBC, and CRP were rarely different between the PVL-positive group and PVL-negative group. Conclusion Compared with WBC and CRP, NLR had a higher clinical application value for PVL-positive S. aureus, and NLR can be used as a predictor of PVL-positive S. aureus infection. Reference | Related Articles | Metrics