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World Journal of Gastrointestinal surgery 2024年第5期16卷 1259-1270页

作者： Gan-Bin Li Chen-Tong Wang Xiao Zhang Xiao-Yuan Qiu Wei-Jie Chen Jun-Yang Lu Lai Xu Bin Wu YiXiao Guo-Le Lin Department of General surgery Peking Union Medical College HospitalPeking Union Medical CollegeBeijing 100730China

BACKGROUND Intestinal flora disorder(IFD)poses a significant challenge after laparoscopic colonic surgery,and no standard criteria exists for its diagnosis and *** To analyze the clinical features and risk factors of *** Patients with colon cancer receiving laparoscopic surgery were included using propensity-score-matching(PSM)*** on the occurrence of IFD,patients were categorized into IFD and non-IFD *** clinical characteristics and treatment approaches for patients with IFD were *** regression analysis was performed to identify the risk factors of *** The IFD incidence after laparoscopic surgery was 9.0%(97 of 1073 patients).After PSM,97 and 194 patients were identified in the IFD and non-IFD groups,*** most common symptoms of IFD were diarrhea and abdominal,typically occurring on post-operative days 3 and *** patients were managed conservatively,including modulation of the intestinal flora(90.7%),oral/intravenous application of vancomycin(74.2%),and insertion of a gastric/ileus tube for decompression(23.7%).Multivariate regression analysis identified that preoperative intestinal obstruction[odds ratio(OR)=2.79,95%CI:1.04–7.47,P=0.041]and post-operative antibiotics(OR=8.57,95%CI:3.31–23.49,Poperative parenteral nutrition(OR=0.12,95%CI:0.06–0.26,Poperatively for patients with pre-operative obstruction or early use of antibiotics.

关键词： Colon cancer,Laparoscopy Intestinal flora disorder clinical characteristics Risk factors

Indications of pro-inflammatory cytokines in laparoscopic and open liver resection for early-stage hepatocellular carcinoma

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Hepatobiliary & Pancreatic Diseases International 2024年第3期23卷 257-264页

作者： Kevin Tak-Pan Ng Li Pang Jia-Qi Wang Wong Hoi She Simon Hing-Yin Tsang Chung Mau Lo Kwan Man Tan To Cheung Department of surgery HKU-SZH&School of Clinical MedicineLi Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina State Key Laboratory of Liver Research The University of Hong KongHong KongChina

Background:Our clinical practice of laparoscopic liver resection(LLR)had achieved better short-term and long-term benefits for patients with hepatocellular carcinoma(HCC)over open liver resection(OLR),but the underlying mechanisms are not *** study was to find out whether systemic inflammation plays an important ***:A total of 103 patients with early-stage HCC under liver resection were enrolled(LLR group,n=53;OLR group,n=50).The expression of 9 inflammatory cytokines in patients at preoperation,postoperative day 1(POD1)and POD7 was quantified by Luminex Multiplex *** relationships of the cytokines and the postoperative outcomes were compared between LLR and ***:Seven of the circulating cytokines were found to be significantly upregulated on POD1 after LLR or OLR compared to their preoperative *** to OLR,the POD1 levels of granulocytemacrophage colony-stimulating factor(GM-CSF),interleukin-6(IL-6),IL-8,and monocyte chemoattractant protein-1(MCP-1)in the LLR group were significantly *** POD1 levels of these cytokines were significantly correlated with longer operative time and higher volume of blood loss during *** levels of these cytokines were positively associated with postoperative liver injury,and the length of hospital ***,a high level of IL-6 at POD1 was a risk factor for HCC recurrence and poor disease-free survival after liver ***:Significantly lower level of GM-CSF,IL-6,IL-8,and MCP-1 after liver resection represented a milder systemic inflammation which might be an important mechanism to offer better short-term and long-term outcomes in LLR over OLR.

关键词： Laparoscopic liver resection Open liver resection Hepatocellular carcinoma Postoperative cytokines Inflammatory responses

Transcriptomic and machine learning analyses identify hub genes of metabolism and host immune response that are associated with the progression of breast capsular contracture

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Genes & Diseases 2024年第3期11卷 427-437页

作者： Yukun Mao Xueying Hou Su Fu Jie Luan Breast Plastic and Reconstructive surgery Center Plastic Surgery HospitalChinese Academy of Medical SciencesPeking Union Medical CollegeBeijing 100144China

Capsular contracture is a prevalent and severe complication that affects the post-operative outcomes of patients who receive silicone breast *** present,prosthesis replacement is the major treatment for capsular contracture after both breast augmentation procedures and breast reconstruction following breast cancer ***,the mecha-nism(s)underlying breast capsular contracture remains *** study aimed to identify the biological features of breast capsular contracture and reveal the potential underlying mechanism using RNA *** tissues from 12 female patients(15 breast capsules)were divided into low capsular contracture(LCC)and high capsular contracture(HCC)groups based on the Baker ***,41 lipid metabolism-related genes were identified through enrichment analysis,and three of these genes were identified as candidate genes by SVM-RFE and LASSO *** then compared the proportions of the 22 types of im-mune cells between the LCC and HCC groups using a CIBERSORT analysis and explored the Cor-relation between the candidate hub features and immune ***,PRKAR2B was positively correlated with the differentially clustered immune cells,which were M1 macro-phages and follicular helper T cells(area under the ROC=0.786).In addition,the expression of PRKAR2B at the mRNA or protein level was lower in the HCC group than in the LCC *** molecular mechanisms were identified based on the expression levels in the high and low PRKAR2B *** findings indicate that PRKAR2B is a novel diagnostic biomarker for breast capsular contracture and might also influence the grade and progression of capsularcontracture.

关键词： Biomarker Breastcapsular contracture Immune infiltration Machinelearning algorithms PRKAR2B

Utility of plasma D-dimer for diagnosis of venous thromboembolism after hepatectomy

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World Journal of clinical Cases 2024年第2期12卷 276-284页

作者： Taiichiro Miyake Hiroaki Yanagimoto Daisuke Tsugawa Masayuki Akita Riki Asakura Keisuke Arai Toshihiko Yoshida Shinichi So Jun Ishida Takeshi Urade Yoshihide Nanno Kenji Fukushima Hidetoshi Gon Shohei Komatsu Sadaki Asari Hirochika Toyama Masahiro Kido Tetsuo Ajiki Takumi Fukumoto Division of Hepato-Biliary-Pancreatic surgery Department of SurgeryKobe University Graduate School of MedicineKobe 650-0017HyogoJapan

BACKGROUND Venous thromboembolism(VTE)is a potentially fatal complication of *** use of postoperative prophylactic anticoagulation in patients who have undergone hepatectomy is controversial because of the risk of postoperative ***,we hypothesized that monitoring plasma D-dimer could be useful in the early diagnosis of VTE after *** To evaluate the utility of monitoring plasma D-dimer levels in the early diagnosis of VTE after *** The medical records of patients who underwent hepatectomy at our institution between January 2017 and December 2020 were retrospectively *** were divided into two groups according to whether or not they developed VTE after hepatectomy,as diagnosed by contrast-enhanced computed tomography and/or ultrasonography of the lower *** factors,including demographic data and perioperative D-dimer values,were compared between the two *** operating characteristic curve analysis was performed to determine the D-dimer cutoff *** and multivariate analyses were performed using logistic regression analysis to identify significant *** In total,234 patients who underwent hepatectomy were,of whom(5.6%)were diagnosed with VTE following hepatectomy.A comparison between the two groups showed significant differences in operative time(529 vs 403 min,P=0.0274)and blood loss(530 vs 138 mL,P=0.0067).The D-dimer levels on postoperative days(POD)1,3,5,7 were significantly higher in the VTE group than in the non-VTE *** the multivariate analysis,intraoperative blood loss of>275 mL[odds ratio(OR)=5.32,95%confidence interval(CI):1.05-27.0,P=0.044]and plasma D-dimer levels on POD 5≥21μg/mL(OR=10.1,95%CI:2.04-50.1,P=0.0046)were independent risk factors for VTE after *** Monitoring of plasma D-dimer levels after hepatectomy is useful for early diagnosis of VTE and may avoid routine prophylactic anticoagulation in the

关键词： Hepatectomy Malignant tumor Postoperative complication D-dimer Early diagnosis Venous thromboembolism

Construction of a nomogram model to predict technical difficulty in performing laparoscopic sphincter-preserving radical resection for rectal cancer

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World Journal of Gastroenterology 2024年第18期30卷 2418-2439页

作者： Xiao-Cong Zhou Shi-Wei Guan Fei-Yue Ke Gaurav Dhamija Qiang Wang Bang-Fei Chen Medical University(Wenzhou Central Hospital) Wenzhou 325000Zhejiang ProvinceChina Department of Hepatobiliary surgery The Dingli Clinical Institute of Wenzhou Medical University(Wenzhou Central Hospital)Wenzhou 325000Zhejiang ProvinceChina Postgraduate Training Base Alliance of Wenzhou Medical University Wenzhou Central HospitalWenzhou 325000Zhejiang ProvinceChina School of International Studies Wenzhou Medical UniversityWenzhou Central HospitalWenzhou 325000Zhejiang ProvinceChina Department of Radiology The Dingli Clinical Institute of Wenzhou Medical University(Wenzhou Central Hospital)Wenzhou 325000Zhejiang ProvinceChina Department of Colorectal surgery The Affiliated Zhejiang HospitalZhejiang University School of Medicine(Zhejiang Hospital)Hangzhou 310000Zhejiang ProvinceChina

BACKGROUND Colorectal surgeons are well aware that performing surgery for rectal cancer becomes more challenging in obese patients with narrow and deep pelvic ***,it is essential for colorectal surgeons to have a comprehensive understanding of pelvic structure prior to surgery and anticipate potential surgical *** To evaluate predictive parameters for technical challenges encountered during laparoscopic radical sphincter-preserving surgery for rectal *** We retrospectively gathered data from 162 consecutive patients who underwent laparoscopic radical sphincterpreserving surgery for rectal ***-dimensional reconstruction of pelvic bone and soft tissue parameters was conducted using computed tomography(CT)*** difficulty was categorized as either high or low,and multivariate logistic regression analysis was employed to identify predictors of operative difficulty,ultimately creating a *** Out of 162 patients,21(13.0%)were classified in the high surgical difficulty group,while 141(87.0%)were in the low surgical difficulty *** logistic regression analysis showed that the surgical approach using laparoscopic intersphincteric dissection,intraoperative preventive ostomy,and the sacrococcygeal distance were independent risk factors for highly difficult laparoscopic radical sphincter-sparing surgery for rectal cancer(Poperative preventive ostomy,the sacrococcygeal distance,and the anterior-posterior diameter of pelvic inlet/sacrococcygeal distance could help to predict the difficulty of laparoscopic radical sphincter-preserving surgery.

关键词： Nomogram Rectal cancer Laparoscopic operation Sphincter-preserving surgery Technical difficulty

Strategy and technique for surgical treatment of Ebstein’s anomaly

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Chinese Medical Journal 2024年第10期137卷 1218-1224页

作者： Qingyu Wu Xiaoya Zhang Mingkui Zhang Hongyin Li Dongya Zhang Lianyi Wang Qingfeng Wu Cardiac Center Division of Cardiac SurgeryThe First Hospital of Tsinghua UniversityBeijing 100016China

Background:Ebstein’s anomaly(EA)is a rare and complex congenital heart anomaly,and the effect of surgical treatment is not *** study aims to introduce our experience in management strategies,surgical techniques,and operative indications for patients with Ebstein’s ***:A retrospective study of 258 operations was performed in 253 patients by the same cardiac surgeon in The First Hospital of Tsinghua University between March 2004 and January 2020.32 patients had previously received cardiac surgery in other *** clinical data including diagnosis,operative indications,techniques,pathological changes,and survival rates were collected and ***:Anatomical correction was performed in 203(78.7%)operations,1½ventricle repair in 38(14.7%)operations,tricuspid valve repair only in four operations(1.6%),tricuspid valve replacement in ten(3.9%),total cavopulmonary connection(TCPC)in two(0.8%),and Glenn operation in one operation(0.4%).Reoperation was performed in five patients(2.0%)during *** them,tricuspid valve replacement was performed in one patient,1½ventricle repair in two patients,and tricuspid valve annulus reinforcement in two *** patients died with an early mortality rate of 2.0%.Complete atrioventricular conduction block was complicated in one patient(0.4%).A total of 244 patients was followed up(four in the 253 patients lost)with a duration of 3.0-168.0(87.6±38.4)*** function of 244 patients improved significantly with mean New York Heart Association(NYHA)functional class recovery from 3.5 to *** mean grade of tricuspid valve regurgitation improved from 3.6 to *** late deaths(1.2%)*** survival rates at five and ten years after surgery were 98.6%and 98.2%,*** was performed in five patients(2.0%)during the follow-up ***:Based on our management strategies and operative principles and techniques,anatomical correction of EA is capable of achiev

关键词： Ebstein’s anomaly Anatomical repair Surgical treatment Long-term result

Unicompartmental knee arthroplasty vs high tibial osteotomy for knee osteoarthritis:A comparison of clinical and radiological outcomes

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World Journal of Orthopedics 2024年第5期15卷 444-456页

作者： Frederick William Wyatt Oday Al-Dadah Translational and clinical Research Institute Faculty of Medical SciencesNewcastle UniversityNewcastle Upon Tyne NE24HHUnited Kingdom Department of Trauma and Orthopaedic surgery South Tyneside District HospitalSouth Shields NE340PLUnited Kingdom

BACKGROUND Unicompartmental knee arthroplasty(UKA)and high tibial osteotomy(HTO)are well-established operative interventions in the treatment of knee ***,which intervention is more beneficial to patients with knee osteoarthritis remains unknown and a topic of much ***,there is a paucity of research assessing the relationship between radiographic parameters of knee joint alignment and patient-reported clinical outcomes,preoperatively and following HTO or *** To compare UKAs and HTOs as interventions for medial-compartment knee osteoarthritis:Examining differences in clinical outcome and investigating the relationship of joint alignment with respect to *** This longitudinal observational study assessed a total of 42 patients that had undergone UKA(n=23)and HTO(n=19)to treat medial compartment knee ***-reported outcome measures(PROMs)were collected to evaluate clinical *** included two disease-specific(Knee Injury and Osteoarthritis Outcome Score,Oxford Knee Score)and two generic(EQ-5D-5L,Short Form-12)*** radiographic parameters of knee alignment assessed were the:Hip-knee-ankle angle,mechanical axis deviation and angle of Mikulicz *** Statistical analyses demonstrated significant(Poperative to postoperative,improvements in the PROM scores of both *** were,however,no significant inter-group differences in the postoperative PROM scores of the UKA and HTO *** significant correlations associated a more distolaterally angled Mikulicz line with worse knee function and overall health preoperatively(Poperatively,two clusters of significant correlations were observed between the disease-specific PROM scores and knee joint alignment parameters(hip-knee-ankle angle,mechanical axis deviation)within the HTO group;yet no such associations were observed within the UKA *** UKAs and HTOs are both efficacious operations that provide a comp

关键词： Arthroplasty Osteotomy Medial compartment Osteoarthritis Knee alignment Patient reported outcome measures

Cardiac surgery at Yaoundé General Hospital by a Local Team: Activity Report from September 2022 to January 2024

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World Journal of Cardiovascular surgery 2024年第6期14卷 87-94页

作者： Laurence Carole Ngo Yon Charles Mve Mvondo Hermann Nestor Tsague Kengni Zephanie Kobe Fokalbo Sépolin Lowe Mireille Dakleu Alain Patrick Menanga William Ngatchou Djomo Vincent De Paul Djientcheu Department of Cardiothoracic and Vascular surgery Yaound General Hospital Yaound Cameroon Department of surgery and Specialities Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Department of clinical Sciences Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Department of clinical Sciences Faculty of Medicine and Biomedical Sciences University of Yaound Yaound Cameroon Department of surgery and Specialities Faculty of Medicine and Biomedical Sciences University of Yaound Yaound Cameroon

Introduction: The practice of cardiac surgery (CS) in sub-Saharan Africa faces a number of challenges. We report on the surgical activities of the first 17 months of the program launched at the Yaoundé General Hospital (YGH), describing the types of interventions and the early results. Patients and Methods: This was a descriptive cross-sectional study including patients who underwent CS from September 2022 to January 2024 at the YGH. clinical, operative and postoperative data were collected and analysed retrospectively by R software. Results: A total of 37 patients underwent CS during the study period, divided into 23 (62.2%) open-heart and 14 (37.8%) closed-heart cases. Males predominated (sex ratio 1.17). The median age and interquartile range (IQR) were 36 years (9 - 51). Isolated valve surgery, in 15 (40.5%) cases, was the most common procedure in open-heart surgery cases. Closed-heart surgery involved closure of the patent ductus arteriosus in 9 (24.3%) cases, coronary artery bypass grafting in 3 (8.1%) cases, and pericardectomy in 2 (5.4%) cases. The median duration of extracorporeal circulation and aortic cross-clamping was 101 min (IQR 84 - 143) and 74 min (IQR 54 - 112) respectively. The median duration of mechanical ventilation was 2 hours (IQR 2 - 3). The median intensive care unit stay and median hospital stay were 2 days (IQR 2 - 3) and 7 days (IQR 5 - 8) respectively. operative mortality was 2 (5.4%). Conclusion: Cardiac surgery remains a major challenge for African populations. The early results achieved by the local team are satisfactory. An increase in surgical activity should be strongly encouraged to facilitate local training and ensure the sustainability of the activity.

关键词： Cardiac surgery Sub-Saharan Africa Cameroon

First experience in laparoscopic surgery in low and middle income countries: A systematic review

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World Journal of Gastrointestinal surgery 2024年第2期16卷 546-553页

作者： Rebekka Troller Jasmine Bawa Olivia Baker James Ashcroft Department of surgery Medway Maritime HospitalGillingham ME75NYKentUnited Kingdom Department of surgery University Hospital CambridgeCambridge CB20QQUnited Kingdom

BACKGROUND Laparoscopic surgery has reduced morbidity and mortality rates,shorter post-operative recovery periods and lower complication rates than open *** is routine practice in high-income countries and is becoming increasingly common in countries with limited ***,introducing laparoscopic surgery in low-and-middle-income countries(LMIC)can be expensive and requires resour-ces,equipment,and *** To report the challenges and benefits of introducing laparoscopic surgery in LMIC as well as to identify solutions to these challenges for countries with limited finances and *** MEDLINE,EMBASE and Cochrane databases were searched for studies reporting first experience in laparoscopic surgery in *** studies were published between 1996 and 2022 with full text available in *** criteria were studies considering only open surgery,ear,nose,and throat,endoscopy,arthro-scopy,hysteroscopy,cystoscopy,transplant,or bariatric *** Ten studies out of 3409 screened papers,from eight LMIC were eligible for inclusion in the final analysis,totaling 2497 *** reported challenges were related to costs of equipment and training programmes,equipment pro-blems such as faulty equipment,and access to surgical ***-related challenges were reliance on foreign trainers and lack of locally trained surgeons and theatre *** benefits of introducing laparoscopic surgery were economic and clinical,including a reduction in hospital stay,complications,and morbidi-ty/*** introduction of laparoscopic surgery also provided training opportunities for junior *** Despite financial and technical challenges,many studies emphasise the overall benefit of introducing laparoscopic surgery in LMICs such as reduced hospital stay and the related lower cost for *** many of the clinical centres in LMICs have proposed practical solutions to the challenges reported,more support is critical

关键词： Laparoscopic surgery Low and middle income country First experience Training in laparoscopic surgery

Optimal timing for plastic surgical procedures for common congenital anomalies:A review

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World Journal of clinical Pediatrics 2024年第2期13卷 38-61页

作者： Aakanksha Goel Arun Goel Divine Aesthetic surgery New Delhi 110048India Department of Plastic surgery Lok Nayak Hospital and Associated Maulana Azad Medical CollegeNew Delhi 110002India

Apart from listening to the cry of a healthy newborn,it is the declaration by the attending paediatrician in the labour room that the child is normal which brings utmost joy to *** global incidence of children born with congenital anomalies has been reported to be 3%-6%with more than 90%of these occurring in low-and middle-income group *** exact percentages/total numbers of children requiring surgical treatment cannot be estimated for several *** children are operated under several surgical disciplines,viz,paediatric-,plastic reconstructive,neuro-,cardiothoracic-,orthopaedic surgery *** conditions may be life-threatening,e.g.,trachea-oesophageal fistula,critical pulmonary stenosis,*** require immediate surgical ***,e.g.,hydrocephalus,may need intervention as soon as the patient is fit for ***,e.g.,patent ductus arteriosus need‘wait and watch’policy up to a certain age in the hope of spontaneous *** extremely important category is that of patients where the operative intervention is done based on their *** all the congenital anomalies coming under care of a plastic surgeon are operated as elective surgery(many as multiple stages of correction)at appropriate *** are advantages and disadvantages of intervention at different *** this article,we present a review of optimal timings,along with reasoning,for surgery of many of the common congenital anomalies which are treated by plastic ***,paediatricians and general practitioners/family physicians,who most often are the first ones to come across such children,must know to guide the parents appropriately and convincingly impress upon the them as to why their child should not be operated immediately and also the consequences of too soon or too late.

关键词： Plastic surgery Congenital anomalies Pediatric plastic surgery Facial cleft Microtia Vascular anomalies Syndactyly Hypospadias Optimal timing Pediatric surgery