Table of Content

20 June 2025, Volume 25 Issue 03

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Original Articles and Clinical Research

Distribution and drug resistance analysis of pathogenic bacteria in abdominal infections in patients with primary liver cancer after liver resection, transarterial chemoembolization（TACE） and liver transplantation

PENG Xu-jian, LUO Ling, LIN Xiang-hua, WANG Xiao-chen, ZHONG Run-qiang, CAI Meng-shan

2025, 25(03):  156-161.  DOI: 10.3969/j.issn.1009-976X.2025.03.002

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Objective To investigate the distribution and drug resistance analysis of pathogenic bacteria in abdominal infection after liver resection, transarterial chemoembolization（TACE） and liver transplantation in primary liver cancerpatients. Methods The clinical data of 158 primary liver cancer patients with abdominal infection after liver resection, TACE or liver transplantation in our hospital from Jan 2018 to May 2023 were retrospectively analyzed, to investigate their pathogenic bacteria distribution and drug resistance. Results From samples of patients with abdominal infection after liver resection, TACE, and liver transplantation, 204, 69, and 34 strains of pathogenic bacteria were cultured, respectively. Gram-negative bacteria accounted for 51.96%, 62.32% and 52.94%; Gram-positive bacteria for 40.20%, 30.43%, and 32.35%; and fungi for 7.84%, 7.25%, 14.71%, respectively. The most common pathogenic bacteria were Escherichia coli（14.71%）, Escherichia coli（18.84%） and Klebsiella pneumoniae（11.76%） among primary liver cancer patients with abdominal infection after liver resection, TACE and liver transplantation. According to the results of drug susceptibility, Escherichia coli and Klebsiella pneumoniae had a high rate of resistance to Cephalosporins, Quinolones and Sulfonamides. Among Escherichia coli and Klebsiella pneumoniae, the detection rate of strains producing extended-spectrum beta-lactamases （ESBLs） were 56.8% and 27.8% and meanwhile, the detection rate of strains with carbapenem resistance were 2.3% and 16.2%. Conclusion Among the primary liver cancer patients with abdominal infection after liver resection, TACE or liver transplantation, the main pathogenic bacteria is enterobacteriaceae and the multi-drug resistance strains have a high rate of detection. While choosing the postoperative prophylactic antibiotics, the antibiotics which are effective to the enterobacteriaceae are the first choice.

Study on the significance of PCT combined with amylase measurement of peritoneal drainage fluid in the early diagnosis and prognosis evaluation of intestinal fistula after colorectal cancer surgery

LIN Liang-xue, DENG Hai-mei, CAI Hai-jing, PANG Shao-chun, DENG Zhi-an, LI Yi-ting, WANG Guan, WU Guo-zhong

2025, 25(03):  162-167.  DOI: 10.3969/j.issn.1009-976X.2025.03.003

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Objective To analyze the application value of serum procalcitonin（PCT） combined with amylase measurement of peritoneal drainage fluid in the early diagnosis and prognosis evaluation of intestinal fistula after colorectal cancer surgery. Methods Patients who underwent surgical treatment for colorectal cancer at the hospital from March 2023 to October 2024 were selected for the study. Peritoneal drainage tubes were inserted post-operation, and serum PCT and amylase levels in the peritoneal drainage fluid were measured on the 1st, 3rd, 5th, and 7th days post-surgery. The patients were categorized into the intestinal fistula group and the non-intestinal fistula group based on the presence of an intestinal fistula, and a cohort observational study was conducted to compare and analyze the serum PCT and amylase levels in the peritoneal drainage fluid between the two groups. Results There were significant differences （P<0.05） in serum PCT and amylase levels in peritoneal drainage fluid between the intestinal fistula group and the non-intestinal fistula group at different postoperative time periods. ROC curve analysis revealed that the AUC and sensitivity of the combined diagnosis of serum PCT and peritoneal drainage amylase were relatively high. There were significant differences （P<0.05） in serum PCT levels between the micro-fistula group and the non-micro-fistula group on postoperative days 1, 3, 5, and 7. ROC curve analysis revealed that serum PCT had an AUC of 0.907 and a sensitivity of 86.67% for predicting the prognosis of postoperative intestinal fistula in colorectal cancer. Conclusion The combined detection of amylase in peritoneal drainage fluid and serum PCT can improve the early diagnostic efficiency of postoperative intestinal fistula in colorectal cancer, and changes in serum PCT levels can be used to evaluate the prognosis of patients.

Clinical retrospective analysis of non-drainage in transoral endoscopic thyroidectomy vestibular approach

AI Qing, HUANG Zhi-heng, JIANG Jiang, WENG Yu-jing

2025, 25(03):  168-173.  DOI: 10.3969/j.issn.1009-976X.2025.03.004

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Objective To investigate the feasibility and safety of not placing a drainage tube during transoral endoscopic thyroidectomy vestibular approach （TOETVA）. Methods A retrospective analysis was conducted on 416 cases of TOETVA performed at our hospital from August 2021 to April 2024. After exclusions, 386 cases were included and divided into two groups based on the presence or absence of drainage： the no-drainage group （145 cases） and the drainage group （241 cases）. Postoperative hospital stays, pain scores, postoperative bleeding, seroma, and infection rates were compared between the two groups. Results No significant differences were observed in surgery time or postoperative pain scores.Postoperative complications, including bleeding, seroma, infection, hoarseness, and permanent hypoparathyroidism, showed no significant differences between the two groups. The proportion of patients who underwent total thyroidectomy was significantly higher in the drainage group than in the no-drainage group （25/241 vs. 1/145, P=0.01）. Intraoperative predicted bleeding was higher in the drainage group than in the no-drainage group [10（5,10） mL vs. 5（5,5） mL, P<0.01]. Postoperative hospitalization was significantly shorter in the no-drainage group than in the drainage group [2（2,2） vs. 3（2,3） d; P<0.01]. After excluding total thyroidectomy patients, when comparing only unilateral lobectomy cases, significant differences were found in intraoperative blood loss and hospital stay. In the no-drainage group, intraoperative bleeding was less （P<0.001） and postoperative hospitalization was shorter （P<0.001）, while other indicators showed no statistical differences. Conclusion Routine non-drainage in TOETVA is safe and feasible, not increasing the risk of postoperative bleeding, seroma, or infection.

Clinical efficacy of longitudinal fixation with a single Kirschner pin in closed reduction for severely displaced juxta-epiphyseal fracture of the proximal phalanx in children

WANG Shuai-yin, HUANG Zi-long, LI Jia-hui, LIU Shi-zhe, FU Gui-bing

2025, 25(03):  174-178.  DOI: 10.3969/j.issn.1009-976X.2025.03.005

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Objective To explore the clinical efficacy of longitudinal fixation with a single Kirschner pin in closed reduction for severely displaced juxta-epiphyseal fracture of the proximal phalanx in children. Methods A retrospective analysis of 24 cases of juxta-epiphyseal fracture of the proximal phalanx in children were performed, in whom treated with closed-displacement single Kirschner pin longitudinal fixation from January 2018 to December 2020. All of them were acute closed fractures, diagnosed by X-ray before operation, and of them were severely displaced （type Ⅱ） juxta-epiphyseal fracture according to the Campbell's line, all were successfully closed-displaced and single Kirschner pin longitudinally fixated, and followed up regularly after operation. The function and growth of the affected fingers were observedduring regular follow-up after operation. Results The follow-up period ranged from 40 to 69 months, with an average of 51.23 months. All the children had healed the fracture at outpatient review, and the average healing time was 3.5 weeks. All cases were rated as excellent according to the hand function evaluation criteria in the trial standards for upper limb functional assessment by the Hand Surgery Society of the Chinese Medical Association, with no complications such as infection, skin necrosis, nonunion, premature physeal closure, or severe malunion of fingers. Conclusion Close dreduction longitudinal fixation with a single Kirschner pin can achieve satisfactory results in treating severely displaced juxta-epiphyseal fracture of the proximal phalanx in children.

The predictive value of serum choline acetyltransferase combined with DCE-MRI parameters for postoperative femoral head necrosis in patients with femoral neck fractures

LI De, CHEN Wu-lin, SUN Rui-bo, LIU You-wen

2025, 25(03):  179-183.  DOI: 10.3969/j.issn.1009-976X.2025.03.006

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Objective To analyze the predictive value of serum choline acetyltransferase（ChAT） combined with dynamic contrast-enhanced magnetic resonance imaging（DCE-MRI） parameters for postoperative femoral head necrosis in patients with femoral neck fractures. Method 120 patients with femoral neck fractures who underwent surgery at Luoyang Orthopedic Hospital Luoyang district, Henan Province from January 2020 to June 2023 were selected as the research subjects.They were divided into an occurrence group and a non-occurrence group based on whether they developed femoral head necrosis after surgery. Both groups underwent DCE-MRI examination, and the relevant examination parameters and serum ChAT levels were compared between the two groups. The receiver operating characteristic（ROC） curve was used to analyze the value of serum ChAT and DCE-MRI parameters in the prognosis of femoral neck fractures. Results The serum ChAT level in the occurrence group was lower than that in the non-occurrence group, and the volume transfer constant（K^trans）, rate constant（K_ep）, and area under the initial time concentration curve（iAUC） values were all higher than those in the non-occurrence group（P<0.05）. The range of serum ChAT, DCE-MRI parameters, and area under the curve（AUC） values for combined examination was 0.765~0.962, indicating high sensitivity and specificity. Conclusion The combination of serum ChAT and DCE-MRI parameters has certain predictive value for postoperative femoral head necrosis in patients with femoral neck fractures. The use of a combined examination plan is expected to provide a basis for clinical treatment selection.

Study on the feasibility of improving the timeliness of diagnosis and treatment of tumors through multi-project and multi-sample hybrid gene sequencing technology

HUANG Jing-hua, LUO Jia-huan, SUN Xi, XIAO Xiao-qin, JIANG Yuan-ling, HUANG Yong-sheng, LIAO Jian-wei

2025, 25(03):  184-189.  DOI: 10.3969/j.issn.1009-976X.2025.03.007

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Objective To conduct a retrospective analysis of multi-project and multi-sample sequencing in tumor samples, and to explore the feasibility of improving the timeliness of clinical tumor diagnosis and treatment. Methods This study mainly verified the feasibility of improving the timeliness of tumor diagnosis and treatment through multi-project mixed gene sequencing by analyzing the sequencing quality control data and detection results when WES libraries and tumor gene sequencing libraries were sequenced on the NovaSeq 6000dx sequencing platform. Results In 24 batches of pooled sequencing, the average cluster pass rate was 77.92%, the average expected data output was 633.22 Gb, and the average Q30 was 91.33%, all of which met the quality control standards. For the 753 whole exome sequencing （WES） libraries and 164 tumor multi-gene sequencing libraries, the individual sample data volume, average sequencing depth, and the proportion of sequencing depth >20× all met the quality control standards. No statistically significant differences were found in the detection results of the same sample in different batches of hybrid sequencing （P=0.125）. The turnaround time for clinical gene test reports was significantly shortened after adopting hybrid gene sequencing, mainly characterized by a reduced sequencing frequency. Conclusion Multi-project and multi-sample libraries can be sequenced using hybrid sequencing to improve the timeliness of gene testing reports in tumor diagnosis and treatment.

Application of small dose of esketamine on patient-controlled intravenous analgesia in children after concealed penile correction surgery

GAO Ning-yang, YUAN Chao, ZHOU Lin, ZHANG Li-bin

2025, 25(03):  190-195.  DOI: 10.3969/j.issn.1009-976X.2025.03.008

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Objective To investigate the effect of low-dose esketamine combined with sufentanil on patient-controlled intravenous analgesia （PCIA） in children after allergic penile correction surgery. Methods In this study, a total of 90 children aged 4 to 12 years who were scheduled to undergo corrective surgery for concealed penis were selectedand divided equally into SE₀, SE₁ and SE₂ groups. All children received anethesia induction with sufentanil and esketamine, while a sacral block was performed under ultrasound guidance and intraoperative anaesthesia was maintained with 1.3 MAC sevoflurane. The postoperative self-administered intravenous analgesia regimen was： 1 μg/（kg·24 h） of sufentanil in group SE₀, 1 μg/（kg·24 h）of sufentanil + esketamine 0.5 mg/（kg·24 h）in group SE₁ and 1 μg/kg of sufentanil + esketamine 1 mg/kg in group SE₂, all diluted with 0.9% saline to 200 ml. Heart rate, mean arterial pressure, delirium score during anesthesia awakening, Wong-Baker analgesia score, Ramsay sedation score, number of postoperative analgesic pump presses, sufentanil dosage and occurrence of adverse effects were recorded in the three groups of children. Results The SE₁ and SE₂ groups experienced fewer postoperative analgesic pump presses and less sufentanil than the SE₀ group （P<0.0165）. The SE₂ group achieved fewer analgesic pump presses and less sufentanil consumption than the SE₁ group, and had higher Ramsay sedation scores at T₄ than the SE₁ and SE₀ groups （P<0.05）. At remaining moments, there were no significant differences between the groups in terms of delirium scores, analgesia, sedation scores, heart rate, mean arterial pressure and incidence of adverse reactions during the awakening period of paediatricanaesthesia （P>0.05）. Conclusion Low-dose esketamine combined with sufentanil PCIA achieves satisfactory postoperative analgesia in children undergoing hidden penis correction surgery, reduces total sufentanil dosage, and avoids emergence delirium or other significant adverse reactions.

Value of MR-DWI combined with PSAD on differentiation degree of prostate cancer

ZHANG Li-hua, ZHANG Ke, YUAN Jia-jun

2025, 25(03):  196-201.  DOI: 10.3969/j.issn.1009-976X.2025.03.009

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

Case Report

A clinicopathological report of hepatic alveolar echinococcosis in a low-incidence area

HUANG Wen-qing, YONG Juan-juan

2025, 25(03):  202-205.  DOI: 10.3969/j.issn.1009-976X.2025.03.010

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Objective To investigate the clinicopathological features of hepatic alveolar echinococcosis. Methods The clinical, pathological, and imaging data of one case of hepatic alveolar echinococcosis were retrospectively analyzed. HE （hematoxylin-eosin） staining slides were observed for surgical resection, and the pathological tissue morphological characteristics were analyzed, and relevant literature was reviewed. Results The Gross examination showed cystic mass in the liver. Histologically, the liver tissue was purulent, and large necrosis and granuloma formation were seen, some vesicular larvae vesicles of different sizes were seen in the necrotic tissue, and the vesicular larvae vesicles were only seen in the corneal cortex, which showed that there was no structure in the red staining uniform, and no germinal layer was seen. Conclusion Hepatic alveolar echinococcosis is rare in low-incidence areas, and most of the lesions are atypical when erythrotic vesicle-like structures can be seen in the background of hepatic necrotizing granulomatous inflammation, is necessary to be vigilant against the possibility of hepatic alveolar echinococcosis in combination with epidemiological history, imaging, and laboratory examination results, to avoid missed diagnosis and misdiagnosis.

A case report of transoral endoscopic surgery via vestibular approach in treating benign mediastinal teratoma

YUE Ning, YU Xing

2025, 25(03):  206-209.  DOI: 10.3969/j.issn.1009-976X.2025.03.011

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This study reports a case of mediastinal benign teratoma treated with endoscopic resection via the transoral vestibular approach. We retrospectively analyzed the patient's clinical data, diagnostic and therapeutic process, intraoperative findings, and treatment outcomes. As a benign germ cell tumor, mediastinal teratoma is most effectively managed by surgical excision. We presented the case of a 16-year-old female patient with a preoperative diagnosis of an upper mediastinal benign tumor. Given the patients strong preference for cosmetic outcomes, a multidisciplinary team opted for an endoscopic transoral vestibular approach for tumor resection. The procedure was successfully completed with complete tumor removal. Intraoperative nerve monitoring effectively preserved critical structures such as the recurrent laryngeal nerve. Histopathology confirmed a benign teratoma, and no significant postoperative complications occurred. The patient expressed satisfaction with both the therapeutic and cosmetic results. The transoral vestibular approach may be considered a viable surgical option for mediastinal teratoma.

Review

Research progress of Mendelian randomized analysis of osteonecrosis

PANG Yin-quan, YANG Xi-cheng, ZHAO Li-li

2025, 25(03):  210-215.  DOI: 10.3969/j.issn.1009-976X.2025.03.012

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Mendelian randomization analysis is a data analysis technique used to evaluate etiological inference in epidemiological studies. It uses genetic variation strongly correlated with disease-related exposure factors as instrumental variables to evaluate the causal relationship between disease exposure factors and outcomes, aiming to reduce the interference of confounding factors and improve the accuracy of causal inference. There is a causal relationship between osteonecrosis and inflammatory cytokines, immunocyte phenotype, telomere length, intestinal flora and micronutrients, while there is no causal relationship between diabetes and osteonecrosis. This can more accurately reveal the etiology and pathogenesis of osteonecrosis in clinical practice, and provide new ideas and directions for the prevention and treatment of osteonecrosis. The literature of Mendelian randomization analysis of osteonecrosis was extensively reviewed in recent years, and the causal association between osteonecrosis and inflammatory cytokines, immunocyte phenotype, telomere length, intestinal flora, micronutrients and diabetes was analyzed and summarized.