Table of Content

20 October 2024, Volume 24 Issue 05

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Original Articles and Clinical Research

Pan-cancer analysis of tripartite motif 5 and its validation in promoting malignant phenotypes of pancreatic cancer

LI Wei-fan, HUANG Song-yin

2024, 24(05):  263-275.  DOI: 10.3969/j.issn.1009-976X.2024.05.001

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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.

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

2024, 24(05):  276-283.  DOI: 10.3969/j.issn.1009-976X.2024.05.002

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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.

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

2024, 24(05):  284-290.  DOI: 10.3969/j.issn.1009-976X.2024.05.003

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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.

Clinical application of tubeless laparoscopic adrenalectomy

LIAN Wen-qing, HUANG Ya-qiang, HUANG Hong-xing, ZHONG Rui, CAO Bin

2024, 24(05):  291-295.  DOI: 10.3969/j.issn.1009-976X.2024.05.004

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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.

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

2024, 24(05):  296-300.  DOI: 10.3969/j.issn.1009-976X.2024.05.005

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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.

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

2024, 24(05):  301-307.  DOI: 10.3969/j.issn.1009-976X.2024.05.006

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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.

AI-based pathological image analysis for predicting BRAF-V600E mutation in thyroid cancer

YU Ting-ting, ZHU Xiao-tong, GUO Li-fen, LI Li

2024, 24(05):  308-313.  DOI: 10.3969/j.issn.1009-976X.2024.05.007

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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.

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

2024, 24(05):  314-319.  DOI: 10.3969/j.issn.1009-976X.2024.05.008

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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.

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

2024, 24(05):  320-325.  DOI: 10.3969/j.issn.1009-976X.2024.05.009

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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.

Case Report

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

2024, 24(05):  326-329.  DOI: 10.3969/j.issn.1009-976X.2024.05.010

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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.

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

2024, 24(05):  330-334.  DOI: 10.3969/j.issn.1009-976X.2024.05.011

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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.