Table of Content

20 December 2024, Volume 24 Issue 06

Previous Issue    Next Issue

Original Articles and Clinical Research

Risk factors in delayed post-pancreaticoduodenectomy hemorrhage： a meta-analysis

YANG Guang, WU Jian-wu, JIANG Xin-wei

2024, 24(06):  335-346.  DOI: 10.3969/j.issn.1009-976X.2024.06.001

Asbtract ( )   PDF (11406KB) ( )  

References | Related Articles | Metrics

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.

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

2024, 24(06):  347-353.  DOI: 10.3969/j.issn.1009-976X.2024.06.002

Asbtract ( )   PDF (1262KB) ( )  

References | Related Articles | Metrics

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.

Therapeutic effect and mechanism of colonic flap reconstruction in a rat model of short bowel syndrome

TANG Zong-yi, DENG Gao-yan

2024, 24(06):  354-359.  DOI: 10.3969/j.issn.1009-976X.2024.06.003

Asbtract ( )   PDF (22418KB) ( )  

References | Related Articles | Metrics

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.

Clinical application value of indocyanine green fluorescence tracing, methylene blue tracing, and their combined use in sentinel lymph node biopsy for breast cancer

FANG Qin, CHEN Shu-ru, PENG Hong-bin, HUANG Yu-kang

2024, 24(06):  360-365.  DOI: 10.3969/j.issn.1009-976X.2024.06.004

Asbtract ( )   PDF (1162KB) ( )  

References | Related Articles | Metrics

Objective We aimed to assess the efficacy, safety, and practicality of indocyanine green （ICG）, methylene blue （MB）, and their combination in sentinel lymph node biopsy （SLNB）. Methods From August 2021 to August 2022, a total of 180 early-stage female breast cancer patients were enrolled and randomly assigned to three groups： the indocyanine green （ICG group, 60 cases）, the methylene blue （methylene blue group, 60 cases）, and the combination of indocyanine green and methylene blue （combination group, 60 cases） for sentinel lymph node biopsy. The primary endpoint of the study was the success rate of sentinel lymph node biopsy among the three groups. Results In the ICG group, sentinel lymph node biopsy was successful in 58 cases （success rate of 96.67%, 95% CI： 88.47-99.59）; in the methylene blue group, biopsy was successful in 56 cases （success rate of 93.33%, 95% CI： 83.80-98.15）; and in the combination group, biopsy was successful in all 60 cases （success rate of 100%, 95% CI： 94.04-100.00）. This study demonstrates that the success rates of sentinel lymph node biopsy are high in all groups-ICG, methylene blue, and combination-and there is no significant difference in success rates among the groups （P=0.168）. Conclusion The detection rate of sentinel lymph nodes （SLNs） achieved with ICG fluorescence tracing is comparable to that attained with methylene blue tracing. However, the dual-tracing technique that integrates ICG with methylene blue demonstrates an even higher detection rate. Consequently, both single ICG fluorescence tracing and the combined approach of ICG and methylene blue dual-tracing are viable options for sentinel lymph node biopsy （SLNB） in patients diagnosed with early-stage breast cancer.

Comparison study of ultrasound-guided vacuum-assisted biopsy and open surgical biopsy for breast calcifications

LUO Yi-zhong, WANG Yong-nan, YU Hai-yun, ZOU Su-wen, YANG Jian-min

2024, 24(06):  366-370.  DOI: 10.3969/j.issn.1009-976X.2024.06.005

Asbtract ( )   PDF (1085KB) ( )  

References | Related Articles | Metrics

Objective To explore the advantages and disadvantages of high-frequency ultrasound-guided vacuum-assisted biopsy versus open surgical biopsy for breast calcifications. Methods A retrospective study analysis was conducted on the clinical and pathological data of 161 breast calcification cases （154 patients, including 7 cases of bilateral sides）. Based on the surgical approach, patients were divided into two groups： the vacuum-assisted biopsy group （93 cases with 97 lesions） and the open surgical biopsy group （61 cases with 64 lesions）. The vacuum-assisted group underwent vacuum-assisted stereotactic biopsy under high-frequency ultrasound guidance to remove the calcifications, while the open surgical biopsy group underwent traditional open surgical excisional biopsy. All specimens of the margins were subjected to intraoperative radiography and pathological examination. The two groups were compared in terms of success rate of single-attempt biopsy for target calcifications, incision size, postoperative infection rate, hospital stay, and hospitalization costs. Results The incision size in the vacuum-assisted biopsy group was 0.31±0.03 cm, while in the open surgical biopsy group, it was 4.15±0.72 cm, showing a statistically significant difference （P<0.01）. The success rate of single-attempt biopsy for target calcifications was 96.91% in the vacuum-assisted group and 96.88% in the open surgical biopsy group, with no statistically significant difference （P>0.05）. The postoperative infection rate was 0% in both groups. Among patients with benign pathology result, length of the hospital stay in the vacuum-assisted group was 2.20±1.30 days, compared to 5.80±1.97 days in the open surgical biopsy group, showing a statistically significant difference （P<0.05）. The hospitalization costs for patients with benign pathology result were 9303.87±4328.08 CNY in the vacuum-assisted group and 12 614.5±4055.85 CNY in the open surgical biopsy group, with a statistically significant difference （P<0.001）. Conclusion Both vacuum-assisted biopsy under high-frequency ultrasound guidance and traditional open surgical biopsy to remove target breast calcifications are safe and effective methods. Vacuum-assisted biopsy offers advantages of smaller incision size, shorter hospital stays, and lower hospitalization costs.

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

2024, 24(06):  371-377.  DOI: 10.3969/j.issn.1009-976X.2024.06.006

Asbtract ( )   PDF (4813KB) ( )  

References | Related Articles | Metrics

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.

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

2024, 24(06):  378-383.  DOI: 10.3969/j.issn.1009-976X.2024.06.007

Asbtract ( )   PDF (1263KB) ( )  

References | Related Articles | Metrics

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.

Comparison of intradermal and interrupted suture techniques for scalp closure in the frontolateral approach surgery

HE Shan, FU Tao, WANG Ji-wei, ZHANG Hai-hong

2024, 24(06):  384-387.  DOI: 10.3969/j.issn.1009-976X.2024.06.008

Asbtract ( )   PDF (1634KB) ( )  

References | Related Articles | Metrics

Objective To explore the differences between intradermal suturing and interrupted suturing techniques for scalp incision closure in the frontolateral approach surgeries, specifically regarding suturing speed, postoperative wound healing rates, maximum scar width, and average length of hospital stay. This study aims to provide a new strategy for incision closure in the frontolateral approach. Methods A total of 99 patients who underwent the frontolateral approach surgery at Tianjin Huanhu Hospital Neurosurgery Department from February 2020 to February 2024 were selected. Patients were divided into two groups based on the odd or even dates of their surgeries： the interrupted suture group （47 cases） and the intradermal suture group （52 cases）. Data were recorded, including intraoperative suturing time, incision length, postoperative wound healing outcomes, length of hospital stay, and maximum scar width at three months postoperatively. Results The suturing speeds for the interrupted and intradermal suture groups were （1.99±0.62） cm/min and （1.96±0.66） cm/min, respectively. Three months postoperatively, the maximum scar widths were （3.40±1.30） mm for the interrupted suture group and （1.96±0.90） mm for the intradermal suture group. The rates of excellent wound healing were 78.72% for the interrupted suture group and 96.15% for the intradermal suture group. The average length of hospital stay was （11.13±2.87） days for the interrupted suture group and （8.71±3.11） days for the intradermal suture group. Comparisons between the two groups revealed statistically significant differences in rates of excellent wound healing, maximum scar width, and average length of hospital stay （P<0.05）. Conclusion Compared to interrupted suturing, the use of intradermal suturing for closing incisions in the frontolateral approach surgeries can improve postoperative wound healing rates, shorten hospital stay durations, and does not increase surgical time. Additionally, it offers advantages of smaller and more aesthetically pleasing scars.

Case Report

A case report of cribriform morular thyroid carcinoma and literature review

LIU Huo-lian, YONG Juan-juan

2024, 24(06):  388-391.  DOI: 10.3969/j.issn.1009-976X.2024.06.009

Asbtract ( )   PDF (3135KB) ( )  

References | Related Articles | Metrics

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.

Surgical Teaching

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

2024, 24(06):  392-397.  DOI: 10.3969/j.issn.1009-976X.2024.06.010

Asbtract ( )   PDF (1006KB) ( )  

References | Related Articles | Metrics

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.

Review

Tumor microenvironment-mediated metabolic reprogramming in prostate cancer：from mechanisms to therapeutics

LI Dong-quan, HUANG Shan-he, HUANG Hai, XIE Rui-hui

2024, 24(06):  398-409.  DOI: 10.3969/j.issn.1009-976X.2024.06.011

Asbtract ( )   PDF (1160KB) ( )  

References | Related Articles | Metrics

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.