Intercostal neuralgia is a clinically relevant complication after percutaneous vertebroplasty (PVP) in postmenopausal patients with osteoporotic vertebral compression fracture (OVCF), and its risk remains difficult to predict using conventional approaches. Perioperative serum markers are generally used as indicators of metabolic and nutritional status; however, their systematic association with the risk of post-PVP intercostal neuralgia has not been well established. This study aims to evaluate the predictive value of perioperative serological indicators and clinical factors for intercostal neuralgia after PVP in postmenopausal OVCF patients, to provide a reference for clinical risk stratification and individualized intervention. A total of 122 postmenopausal OVCF patients who underwent PVP from December 2023 to June 2025 were enrolled in this single-center retrospective cohort study. According to the occurrence of postoperative intercostal neuralgia, patients were divided into the intercostal neuralgia group (52 cases) and the non-intercostal neuralgia group (70 cases). Serum indexes were collected preoperatively and on postoperative day 1. Preoperative indicators included 25-hydroxyvitamin D (25(OH)D), alkaline phosphatase (ALP), serum calcium (Ca), and serum phosphorus (P). Postoperative indicators collected on postoperative day 1 included albumin (Alb) and fasting blood glucose (Glu). Univariate and multivariate logistic regression analyses were performed to identify independent predictors, and a combined predictive model was constructed. Model discrimination was assessed using the receiver operating characteristic (ROC) curve, while calibration was evaluated using a bootstrap method for assessing the model's predictive consistency. Multivariate logistic regression analysis showed that elevated postoperative Glu (odds ratio [OR] = 2.25, 95% confidence interval [CI]: 1.22-4.15) was an independent risk factor for postoperative intercostal neuralgia, while higher levels of postoperative albumin (OR = 0.90, 95% CI: 0.84-0.96), preoperative 25(OH)D (OR = 0.91, 95% CI: 0.85-0.98), and bone mineral density (BMD) T-score (OR = 0.18, 95% CI: 0.05-0.59) were protective factors. Fracture location (lower thoracic) was also independently associated with neuralgia risk (OR = 0.28, 95% CI: 0.11-0.73). The area under the receiver operating characteristic curve (AUC) of the combined predictive model constructed with these five indicators was 0.82 (95% CI: 0.75-0.89). The calibration curve demonstrated good agreement between predicted and observed risk (mean absolute error = 0.048), indicating satisfactory model discrimination and calibration. BMD T-score, fracture location, postoperative Glu, postoperative Alb, and 25(OH)D can be used as independent predictors to predict intercostal neuralgia after PVP in postmenopausal OVCF patients. The combined model integrating BMD T-score, fracture location, postoperative Glu, postoperative Alb, and preoperative 25(OH)D demonstrates good predictive performance and may facilitate early risk stratification and individualized perioperative management of postoperative neuralgia.
The integration of radiomics and radiogenomics in the prognostication of head and neck cancer represents a rapidly evolving field within precision oncology. This systematic review aims to appraise advanced methods in radiomics and radiogenomics concerning prognostication in head and neck cancer, with a particular focus on methodological developments and clinical applications. A systematic literature search was conducted across seven major electronic databases: PubMed/MEDLINE, Embase, Web of Science, Scopus, Cochrane Library, CINAHL, and Google Scholar from January 2013 to December 2023. The search strategy incorporated database-specific syntax, controlled vocabulary such as Medical Subject Headings (MeSH) and Emtree terms, and supplementary free-text terms. Twelve studies were included in the review, and the qualitative analysis revealed three distinct research clusters: prognostic applications, development of predictive models, and molecular-immunological characterization. In all scenarios, studies employing multi-modality modelling were significantly more competent than those relying on single-modality analyses. The area under the curve values of machine learning ranged across 0.71-0.86, outperforming traditional statistical approaches. Larger cohort studies exhibited superior validation metrics. While predictions of molecular characteristics varied, the prediction of immune phenotypes was superior to that of specific genetic alterations. Studies incorporating external validation provided stronger evidence supporting clinical usability. Although some studies presented moderate risk due to early-phase methodological variability, nearly half demonstrated low overall bias. Our findings indicate significant advances in the prognostication of head and neck cancer through radiomics and radiogenomics approaches. Combined modelling strategies that integrate clinical, radiomic, and genomic features yielded enhanced performance. Despite the development of newer studies with greater methodological rigor and robust validation, variability in feature extraction, processing pipelines, and reporting metrics necessitates further consolidation of methodologies in this field.
Reconstruction of severe lower extremity trauma with extensive soft tissue defects remains a major microsurgical concern. Unlike elective procedures, emergency reconstruction is plagued by higher rates of necrosis and failure. Current preoperative assessments predominantly focus on local vascular patency, often neglecting systemic physiological disturbances. This gap in the assessment process highlights the need to incorporate whole-body resuscitation indicators. This study aimed to evaluate the predictive value of combining a modified computed tomography angiography (CTA) Run-off Score with systemic resuscitation indices-specifically Central Venous Oxygen Saturation (ScvO2) and preoperative lactate (Lac_Pre)-for emergency flap prognosis. A retrospective cohort study was conducted on 180 patients undergoing emergency free flap transfer for high-energy lower limb trauma between February 1, 2022, and March 31, 2025. Systemic monitoring involved ScvO2 measurement via central venous catheterization and serial lactate analysis. Anatomical assessment included a modified CTA Run-off Score and the measurement of the distance from injury zone to anastomosis site (Dist_Anastomosis). The dataset was divided into the training and validation sets at a 6:4 ratio, which does not represent random clinical allocation. A multivariate logistic regression model was built in the training cohort, with candidate predictors selected based on univariable analyses, collinearity assessment and the clinical relevance supported by previous literature. The model's performance was evaluated through discrimination (Area Under the Curve [AUC]), calibration (calibration curve), and clinical utility (decision curve analysis). For the secondary aesthetic analysis, a total of 163 patients were ultimately included in the 6-month VISIA/Vancouver Scar Scale (VSS)-based analysis after excluding patients with complete flap failure, for whom scar-based assessment was not applicable. Multivariate logistic regression analysis identified three variables independently associated with flap failure: CTA Run-off Score (p < 0.001), Dist_Anastomosis (Odds Ratio [OR] 0.76, p = 0.006), and preoperative lactate (Lac_Pre; OR 1.54, p = 0.014). The combined prognostic model demonstrated acceptable to good discrimination, with an Area Under the Curve (AUC) of 0.89 (95% Confidence Interval [CI]: 0.82-0.97) in the training set and 0.79 (95% CI: 0.66-0.92) in the validation set. Calibration analysis, assessed via the Brier Score, yielded values of 0.103 for the training set and 0.165 for the validation set, indicating acceptable predictive error and robust model calibration. Secondary analysis revealed that flaps experiencing early adverse events showed significantly higher VISIA-7 Complexion Analysis System-derived "Redness Index" scores at 6 months after surgery (p = 0.006). Integrating anatomical characteristics and perioperative physiological indicators may provide a useful approach for risk stratification in emergency reconstruction. In this internally validated retrospective cohort, preoperative lactate demonstrated a significant association with adverse acute flap outcomes and should be interpreted as a stratification marker rather than a definitive predictor. Further prospective studies with external validation are required to confirm these findings and evaluate functional recovery outcomes.
The study aimed to investigate the influence of Billroth II combined with Braun anastomosis on perioperative stress indicators and pepsinogens in patients undergoing laparoscopic gastric cancer surgery. This study is a single-center retrospective research design. This study included 148 patients who underwent laparoscopic radical distal gastrectomy for gastric cancer between March 2021 and June 2024, with all surgical procedures performed by the same surgical team. According to the digestive tract reconstruction methods, participants were divided into a Billroth II group (n = 63) and a Billroth II+Braun group (n = 85). The short-term efficacy outcomes included perioperative stress indicators, pepsinogen I to pepsinogen II ratio (PGR), Gastrin-17 (G-17), and postoperative complications. Moreover, the long-term efficacy outcomes comprised bile reflux rate, incidence rate of reflux residual gastritis and 1-year survival rate. The C-reactive protein (CRP) showed a gradual increase preoperatively (T0) and at postoperative day 1 (T1) and day 2 (T2) (F interaction = 2.74, p = 0.064; F time-point = 757.8, p < 0.001; F between-group = 2.50, p = 0.114). However, norepinephrine (NE) and cortisol (COR) initially increased and then declined at these time points (F interaction = 0.90, 0.58, p = 0.407, 0.559; F time-point = 1628, 466.4, both p < 0.001; F between-group = 0.83, 0.70, p = 0.36, 0.40). Furthermore, no statistical differences in CRP, NE and COR were observed between the Billroth II+Braun group and the Billroth II group at the three time points (p > 0.05). Compared with preoperative levels (T0), PGR increased in both groups, whereas G-17 decreased at postoperative day 30 (T3) (p < 0.01). Additionally, PGR was significantly higher in Billroth II+Braun group (p < 0.001) while there was no statistical difference in G-17 between the two groups at T3 (p = 0.943). Similarly, the anastomotic leakage (Fisher's exact test, p = 0.312), anastomotic stenosis (Fisher's exact test, p = 1.000), duodenal stump bleeding (Fisher's exact test, p = 0.426), duodenal stump leakage (Fisher's exact test, p = 0.180), and intestinal obstruction rate (Fisher's exact test, p = 0.402) also showed no statistical differences between the two groups. The bile reflux rate was substantially lower in the Billroth II+Braun group (p = 0.005), while no statistical differences were observed in residual food (p = 0.097), reflux residual gastritis (Fisher's exact test, p = 0.312) and survival rate (Fisher's exact test, p = 0.700) between groups. This study demonstrates that Billroth II+Braun anastomosis and Billroth II anastomosis are equally safe and effective during radical distal gastrectomy for gastric cancer. There is no significant difference in the influence of two digestive tract reconstruction methods on perioperative stress indicators in this cohort. Additionally, Billroth II+Braun anastomosis can improve PGR level and reduce bile reflux rate.
This study aimed to investigate the predictive value of preoperative radiographic indices, demographic characteristics, and psychological factors for mandibular third molar extraction difficulty, to develop a nomogram, and to interpret feature contributions using SHapley Additive exPlanations (SHAP) analysis. In this retrospective cohort study of 250 patients, demographic characteristics, including age, sex, and body mass index (BMI), together with radiographic indices such as root morphology and psychological factors assessed using the Modified Dental Anxiety Scale (MDAS), were analyzed in relation to surgical difficulty, defined as operative time exceeding 45 minutes. Multivariate logistic regression was used to construct a nomogram, which was validated through receiver operating characteristic (ROC) curves and decision curve analysis (DCA). Feature importance was explored using SHAP analysis, and the association between operative time and perioperative outcomes was assessed. Multivariate logistic regression identified age, root morphology, Winter's angulation, and preoperative dental anxiety (MDAS score) as key predictors of high surgical difficulty (p < 0.05). The resulting nomogram demonstrated excellent discrimination, with an area under the curve (AUC) of 0.91. SHAP analysis illustrated that age and Winter's angulation contribute more to the model's predictions, followed by root morphology. Longer operative time was independently associated with a higher risk of perioperative complications (odds ratio = 1.03, p < 0.05) and showed a positive correlation with pain intensity on postoperative day 1 (Spearman's ρ = 0.712, p < 0.001). Bulbous or curved root morphology, advanced age, high dental anxiety, Winter's angulation, and male sex were associated with the difficulty of mandibular third molar extraction. The developed nomogram serves as a precise, clinically interpretable tool for preoperative risk stratification. Integrating psychological evaluation with anatomical assessment facilitates a holistic approach to surgical planning.
Craniofacial disorders are complex and debilitating conditions that require personalized treatment approaches. Various technologies in the field of bioprinting have developed into promising methods for the production of patient-specific implants for the aforementioned disorders. This review evaluates the ability of the bioprinting methods used to produce patient-specific implants for improved patient outcomes. A comprehensive search strategy was designed to gather pertinent research from databases of PubMed, Scopus, Web of science, Cochrane Library, Embase, ProQuest and Science Direct, published till July 2024. The search approach was developed by mixing Boolean operators, Medical Subject Heading (MeSH) terms, and free-form terms to guarantee an exhaustive and accurate search. After a thorough screening process for duplicates and compliance with eligibility criteria, seven studies met our exacting inclusion criteria, out of the initial 312 studies. The collective findings of the studies demonstrated the efficacy and feasibility of bioprinting techniques in creating patient-specific implants for craniofacial disorders. The studies were grouped into three categories based on their similarities and dissimilarities, highlighting the high success rates and low complication rates of bioprinting techniques in craniofacial reconstruction, the feasibility and effectiveness of bioprinting techniques in specific craniofacial applications, and the use of custom-made implants as a successful treatment option. Majority (five out of seven) reporting a 100% success rate, minor complication rates averaging less than 5%, and patient satisfaction rates over 90% across a range of craniofacial applications, the reviewed studies collectively showed the excellent efficacy of bioprinting techniques. The synthesised evidence from the seven studies included for the review concluded that bioprinting methods were efficient in producing custom or individual specific implants for craniofacial disabilities. Though the results are promising, multicentric, prospective studies are needed to validate long term outcomes.
To compare perioperative outcomes and short-term safety of endoscopic retrograde appendicitis therapy (ERAT) assisted by a single-use small-caliber digital cholangioscope (digital cholangioscope) and laparoscopic appendectomy (LA) in patients with acute uncomplicated appendicitis. This study utilized a direct-vision technique in which a digital cholangioscope was advanced over a guidewire through the colonoscope working channel into the appendiceal lumen, enabling intraluminal evaluation and intervention under direct visualization. A total of 60 patients with acute uncomplicated appendicitis treated at Hangzhou Ninth Hospital between January 2023 and December 2024 were retrospectively included and allocated, based on the actual treatment received, to an ERAT group (n = 32) or an LA group (n = 28). In the ERAT group, a digital cholangioscope was advanced over a guidewire through the colonoscope working channel into the appendiceal lumen, and intraluminal evaluation and treatment were performed under direct vision. Perioperative outcomes, inflammatory and pain-related parameters within 48 h postoperatively, and in-hospital complications were compared between the groups. Continuous perioperative outcomes were analyzed using multivariable linear regression, adjusted for prespecified covariates, whereas in-hospital complications were compared using a two-sided Fisher's exact test. Compared with the LA group, the ERAT group demonstrated shorter operative time, reduced intraoperative blood loss, shorter postoperative bed rest, and a shorter length of hospital stay (all p < 0.001). Total in-hospital costs were significantly higher in the ERAT group than in the LA group (p < 0.001). At 48 hours postoperatively, levels of inflammatory markers (interleukin-6 [IL-6], tumor necrosis factor-α [TNF-α], C-reactive protein [CRP], and procalcitonin [PCT]) and pain-related mediators (dopamine [DA], substance P [SP], 5-hydroxytryptamine [5-HT], and prostaglandin E2 [PGE2]) were significantly lower in the ERAT group than in the LA group (all p < 0.05). A lower crude in-hospital complication rate was observed in the ERAT group than in the LA group (two-sided Fisher's exact p < 0.05). In this single-center retrospective cohort study of patients with acute uncomplicated appendicitis, digital cholangioscope-assisted ERAT was associated with improved perioperative recovery and reduced short-term inflammatory and pain responses compared with LA, without evidence of an increased in-hospital complication rate. These findings suggest that ERAT may represent a feasible appendiceal-preserving minimally invasive treatment option. However, given the retrospective, non-randomized design, the results should be interpreted cautiously as associative rather than causal.
Single-photon emission computed tomography/computed tomography (SPECT/CT) technology is a promising imaging tool for the detection of postoperative residual and recurrent lesions in differentiated thyroid cancer (DTC). However, existing studies presented mixed results, and the overall diagnostic efficacy of this technology remains unclear. Therefore, this meta-analysis was conducted to systematically evaluate the diagnostic value of 131I-SPECT/CT for identifying residual or recurrent disease in patients with DTC. A systematic literature search was conducted across PubMed, Web of Science, EMBASE, and Cochrane Library from inception to 4 December 2025. The search strategy incorporated relevant keywords and MeSH terms, such as "differentiated thyroid cancer", "thyroidectomy", "SPECT", "SPECT/CT", "SPECT-CT", "metastasis", "recurrence", and "residual". Study selection, data extraction, and risk-of-bias assessment were performed independently by two investigators. The overall diagnostic performance was assessed by calculating the pooled sensitivity (SENS), specificity (SPEC), and summary receiver operating characteristic (SROC) curve. Sensitivity analyses were performed by excluding individual studies to assess the robustness and stability of the pooled results. Subgroup analysis was used to determine the source of heterogeneity. Six studies involving 800 patients were included. Pooled analysis showed that lesion-level 131I-SPECT/CT had a pooled SENS of 0.59 (0.33-0.81) and a pooled SPEC of 0.92 (0.85-0.96). The pooled diagnostic odds ratio (DOR) was 18 (3-91), and the area under the curve (AUC) was 0.92. Based on patient-level 131I-SPECT/CT, the pooled SENS was 0.89 (0.63-0.98), the pooled SPEC was 0.95 (0.70-0.99), and the DOR was 166 (7-4126). The AUC of the SROC curve was 0.97. The overall diagnostic accuracy of 131I-SPECT/CT was confirmed, regardless of whether it was conducted at the patient or lesion level. To avoid potential patient overlap, we excluded an earlier study for a sensitivity analysis. The results after exclusion remained within reasonable limits, supporting the robustness of the main findings. Subgroup analyses indicated that patient type may be a potential source of heterogeneity in the non-threshold effect. No publication bias was statistically suggested through Deeks' funnel plot. 131I-SPECT/CT demonstrates efficacy for the targeted detection of postoperative residual and recurrent lesions in DTC, showing high diagnostic accuracy. However, existing evidence is subject to high heterogeneity, and clinical application should be carefully interpreted in combination with the specific characteristics of patients. Future higher-quality studies conducted using unified standards are needed to further verify its clinical value.
Postoperative recovery after heart valve surgery is an important topic in the realm of nursing care. This study aimed to evaluate the effect of individualized positioning care on cardiac function recovery and comfort in patients after heart valve surgery. A single-center, retrospective cohort study was conducted, continuously enrolling patients who underwent heart valve surgery at Affiliated Hospital of Xuzhou Medical University from June 2022 to June 2025. A total of 150 patients were included. The patients were divided into a control group (conventional positioning care, n = 76) and an experimental group (individualized positioning care, n = 74) according to the nursing method received. The primary outcome measures were changes in cardiac function indicators, such as left ventricular ejection fraction (LVEF) and N-terminal pro-brain natriuretic peptide (NT-proBNP) before and after nursing, as well as postoperative comfort scores measured using the Visual Analog Scale for Comfort (VAS-Comfort). Secondary outcomes included postoperative pain scores (Numeric Rating Scale [NRS]), sleep quality (Richards-Campbell Sleep Questionnaire [RCSQ]), pulmonary complications, pressure ulcer incidence, intensive care unit (ICU) length of stay, and postoperative hospital days. Group comparisons were performed using t-test, Mann-Whitney U test, Chi-square test, or Fisher's exact test. Postoperative NT-proBNP was analyzed using analysis of covariance (ANCOVA), adjusting for baseline levels. Baseline characteristics were balanced and comparable between the two groups (all p > 0.05). Compared to the control group receiving conventional care, the experimental group receiving individualized positioning care showed more significant improvement in cardiac function: the change in LVEF (ΔLVEF) was significantly higher in the experimental group (0.85 ± 3.98% vs. -3.15 ± 4.20%, p < 0.001); NT-proBNP levels on postoperative day 7 were significantly lower in the experimental group (median: 685.00 pg/mL vs. 1003.50 pg/mL, p < 0.001), and the difference remained statistically significant after adjusting for preoperative values (F = 12.13, p < 0.001). The VAS-Comfort score at 72 h postoperatively was significantly higher in the experimental group (p < 0.001). For secondary outcomes, the experimental group had significantly lower NRS pain scores at 72 h postoperatively (p < 0.001), significantly higher RCSQ sleep scores (69.26 ± 9.87 vs. 59.86 ± 12.02, p < 0.001), a lower incidence of pulmonary complications (9.46% vs. 23.68%, p = 0.019), and significantly shorter ICU stay and postoperative hospital days (both p < 0.001). There were no statistically significant differences between the two groups in the incidence of pressure ulcers or adverse events (p > 0.05). Individualized positioning care can significantly promote cardiac function recovery, enhance comfort, and improve clinical outcomes in patients after heart valve surgery without increasing safety risks.
This study aimed to evaluate the impact of injectable nicotinic acid as adjuvant therapy on microcirculatory perfusion and digit survival rate after digital replantation. This single-center retrospective cohort study included 200 patients who underwent digital replantation. Based on the treatment regimen, patients were divided into two groups: the nicotinic acid group (n = 102) and the control group (n = 98). The primary outcome was the relative perfusion ratio (PU ratio), calculated by normalizing the perfusion value of the replanted digit to that of an intact and uninjured reference digit from the same patient, measured using a laser Doppler flowmeter. Secondary outcomes included the incidence of vascular crisis, digit survival rate, postoperative hospital stay, and adverse reactions. On postoperative day 1, the perfusion ratio did not differ between the two groups. However, on postoperative days 3, 5, and 7, the perfusion ratios in the nicotinic acid group were significantly higher than those in the control group (all p < 0.001). In the nicotinic acid group, the total incidence of vascular crisis was significantly lower (p = 0.029), and the digit survival rate was significantly higher (p = 0.030), along with shorter postoperative hospital stay compared with the control group (p < 0.001). Subgroup analysis indicated that the therapeutic benefit of nicotinic acid was particularly pronounced in the subgroup with more severe "crush/avulsion" injuries. The incidence of facial flushing was higher in the nicotinic acid group (p < 0.001). Adjuvant use of injectable nicotinic acid, in addition to conventional therapy, was associated with improved microcirculatory perfusion, reduced incidence of vascular crisis, and increased digit survival rate. The treatment was generally well tolerated with no serious safety concerns identified. Due to the retrospective and non-randomized nature of this study, these findings should be interpreted as associations rather than definitive treatment effects.
This study aimed to systematically evaluate the independent predictive value and diagnostic performance of quantitative indices derived from early postoperative computed tomography (CT) imaging for predicting major complications (Clavien-Dindo grade ≥II) within 30 days after pulmonary segmentectomy. A total of 231 patients who underwent Video-Assisted Thoracoscopic Surgery (VATS) segmentectomy were retrospectively enrolled. On CT images obtained within 2-3 days postoperatively, the depth of pleural effusion, pneumothorax rate, lung re-expansion ratio, and maximum subcutaneous air thickness were measured. The primary outcome was the occurrence of Clavien-Dindo grade ≥II complications within 30 days. Univariate and multivariate logistic regression analyses were performed, and predictive performance was evaluated using the area under the curve (AUC). Major complications occurred in 42 patients (18.2%). Multivariate analysis identified depth of pleural effusion (odds ratio [OR] = 1.213, 95% confidence interval [CI]: 1.107-1.329, p < 0.001), pneumothorax rate (OR = 1.201, 95% CI: 1.081-1.333, p < 0.001), lung re-expansion ratio (OR = 0.872, 95% CI: 0.809-0.940, p < 0.001), and maximum subcutaneous air thickness (OR = 1.438, 95% CI: 1.248-1.656, p < 0.001) as independent predictors. Receiver operating characteristic (ROC) analysis demonstrated that maximum subcutaneous air thickness had the highest predictive performance (AUC = 0.850), followed by pneumothorax rate (AUC = 0.831), lung re-expansion ratio (AUC = 0.785), and depth of pleural effusion (AUC = 0.783). Quantitative indices derived from early postoperative CT scans may serve as reliable imaging biomarkers for predicting major complications after pulmonary segmentectomy, thereby facilitating early identification of high-risk patients and guiding individualized postoperative management.
To present the diagnostic approach, surgical management, and early outcomes of patients with mediastinal ectopic parathyroid adenoma (MEPA) causing primary hyperparathyroidism. Between January 2015 and January 2025, patients with mediastinal ectopic parathyroid adenoma identified among 458 patients who underwent surgery for a solitary parathyroid adenoma were retrospectively reviewed, and five cases were identified (1%; n = 5). Diagnostic evaluation included cervical ultrasonography, technetium-99m sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT), and CT. The surgical strategy was individualized according to lesion location and proximity to major vascular structures. Intraoperative confirmation was achieved using radioguided surgery, frozen section analysis, and intraoperative parathyroid hormone (ioPTH) monitoring. Patients were followed for one year with serial serum calcium and parathyroid hormone (PTH) measurements. The median age was 62 years (range, 40-70 years), and three patients were female. Bone pain and fatigue were the most common presenting symptoms, whereas one patient was asymptomatic. Preoperative albumin-corrected serum calcium levels ranged from 11.24 to 13.43 mg/dL, and PTH levels ranged from 161 to 1493 pg/mL. Lesion size ranged from 8 × 8 mm to 35 × 22 mm, and four lesions were located in the anterior mediastinum. Four patients underwent J-shaped partial median sternotomy, and one underwent a transcervical approach. The 10-minute ioPTH decline ranged from 48.3% to 85.5%. No major surgical complications occurred. All patients remained normocalcemic and clinically stable at the 1-year follow-up. In patients with MEPA, the combined use of functional and anatomical imaging, supported by multiple intraoperative confirmation modalities, may facilitate curative resection with low morbidity through an individualized surgical strategy.
Incisional hernia (IH) and especially postoperative recurrences of IH persist as a common and extremely costly problem to treat and manage. In case of suspected recurrence, radiological studies are frequently misleading and/or inconclusive. With our case report, we aim to define the diagnostic and therapeutic role of a diagnostic laparoscopic approach. We report a case of a pseudo-recurrence of a ventral IH in a patient who had undergone IH Intraperitoneal Onlay Mesh (IPOM) repair. Recurrent IH was suspected due to the occurrence of an abdominal bulge and the findings of the abdominal wall Computed Tomography (CT) scan. CT showed an abdominal wall mass over the fascia containing a fluid-air level at the site of the mesh, highly suggestive of recurrent IH with bowel loop entrapment. At diagnostic laparoscopy, the prosthesis was shown to be well-positioned and no recurrent IH was detected. Conversely, a subcutaneous encapsulated hematoma was identified at the abdominal incision over the bulge. The patient experienced a fast and smooth postoperative recovery and was discharged symptom-free in good general conditions. In cases of suspected recurrent IH and in the presence of inconclusive imaging studies, diagnostic laparoscopy can play an important role, ensuring a minimally invasive approach and avoiding overtreatment.
Laparoscopic appendectomy has emerged as the preferred surgical approach for treating acute appendicitis, one of the most common abdominal emergencies. This review explores the key indications, technical benefits and ongoing controversies surrounding laparoscopic appendectomy. While diagnosing acute appendicitis is typically straightforward, atypical presentations due to variable appendix locations can complicate management. Advances in imaging and scoring systems have improved diagnostic accuracy, yet timely surgical intervention remains crucial. Compared to open appendectomy, laparoscopic appendectomy offers several advantages, including reduced postoperative pain, a shorter hospital stay, quicker recovery and better cosmetic outcomes. However, concerns persist regarding intra-abdominal abscess formation, operative time, and cost effectiveness, particularly in complicated or atypical cases. Additionally, debates continue on whether to remove a macroscopically normal appendix and the appropriateness of laparoscopic appendectomy in certain patient populations. This review synthesizes the current evidence to clarify the evolving role of laparoscopic appendectomy in managing both routine and complex cases of acute appendicitis.
To investigate the alleviating effects of perioperative psychological intervention combined with distraction therapy on discomfort in patients undergoing combined minimally invasive treatment for lower limb varicose veins. In this retrospective study, 150 patients with lower limb varicose veins who underwent combined minimally invasive treatment at The Affiliated Hospital of Xuzhou Medical University from January 2023 to June 2024 were included. The patients were divided into an observation group (73 cases) and a control group (77 cases) according to the type of perioperative nursing treatments received. Both groups of patients received routine intravenous analgesics during the procedure. The control group received routine intraoperative care, while the observation group underwent perioperative psychological intervention and distraction therapy on the basis of routine care. The Visual Analog Scale (VAS) pain scores were compared between the two groups at key procedural time points, including great saphenous vein trunk closure, local vein excision, and sclerosant injection. The Self-Rating Anxiety Scale (SAS) scores at multiple time points, heart rate, blood pressure fluctuations, and postoperative patient satisfaction were evaluated and compared. The VAS scores at each time point in the observation group were significantly lower than those in the control group (p < 0.001). The SAS scores at the pre- and post-operatively were significantly lower in the observation group than in the control group (p < 0.05). The heart rate, systolic blood pressure, and diastolic blood pressure fluctuation during the surgery were smaller in the observation group than in the control group (p < 0.001). The patient satisfaction rate in the observation group significantly exceeded that in the control group (97.26% vs 83.12%, p < 0.05). Perioperative psychological intervention combined with distraction therapy provides a potential strategy to alleviate preoperative anticipatory anxiety in patients with lower limb varicose veins undergoing combined minimally invasive treatment. By employing various intraoperative methods to divert patients' attention from pain, this approach may further alleviate overall discomfort. These findings suggest that this strategy is associated with favorable outcomes and may warrant further investigation for clinical application.
This study intended to investigate the predictive value of C-reactive protein (CRP)/albumin ratio (CAR) and neutrophil/lymphocyte ratio (NLR) in elderly patients with acute kidney injury (AKI) following on-pump coronary artery bypass graft (CABG). The clinical information of elderly patients undergoing on-pump CABG admitted to Taizhou People's Hospital was collected for retrospective analysis (n = 150). The patients were divided into two groups based on their postoperative AKI status: injury group (n = 58, with AKI) and non-injury group (n = 92, without AKI). All patients with postoperative AKI were further divided into three groups based on AKI stage: stage 1 group (n = 40), stage 2 group (n = 12), and stage 3 group (n = 6). The CAR and NLR were calculated. Multivariate logistic regression analysis was utilized to explore the risk factors for AKI after on-pump CABG in elderly patients. Receiver operating characteristic (ROC) curve analysis was conducted to predict their diagnostic utility in AKI. Compared with the non-injury group, the injury group exhibited reduced lymphocyte count (p < 0.001) and higher European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) score, cardiopulmonary bypass (CPB) time, NLR, CRP, and CAR (p = 0.006, 0.002, <0.001, <0.001, and <0.001, respectively). Multivariate logistic regression analysis showed that CPB time (p = 0.005, odds ratio [OR] = 1.034, 95% confidence interval [CI] = 1.010-1.058), NLR (p = 0.003, OR = 1.476, 95% CI = 1.139-1.911), and CAR (p < 0.001, OR = 4.460, 95% CI = 2.237-8.890) were the independent influencing factors of AKI in elderly patients after on-pump CABG. The area under the curve (AUC) of CPB time, NLR, CAR, and the combination of NLR and CAR were 0.650, 0.787, 0.790, and 0.838, respectively. DeLong test demonstrated that the combined model incorporating NLR and CAR had significantly greater predictive performance than models using CAR alone (p = 0.011), NLR alone (p = 0.008), and CPB time alone (p = 0.001). Compared to stages 1 and 2, stage 3 patients had significantly higher EuroSCORE II scores (p < 0.05). CRP and CAR levels and age of patients were significantly higher in stage 3 than in stage 1 (p < 0.05), but the difference was not statistically significant compared to stage 2. NLR, CAR, and CPB time are identified as independent predictors of AKI in elderly patients undergoing on-pump CABG. The combined use of NLR and CAR demonstrates superior predictive performance for postoperative AKI compared with either indicator alone.
Diminished pulmonary function and psychological distress, which are common following lobectomy in lung cancer patients, represent a hindrance to the overall recovery. This study aimed to retrospectively explore the effects of preoperative mindfulness training combined with active breathing and circulation exercises on postoperative pulmonary function recovery in lung cancer patients undergoing lobectomy. A retrospective study was conducted on 160 patients who underwent lobectomy at Shaoxing People's Hospital. The samples were divided into two groups based on the type of nursing care received: the control group received standard care, whilst the experimental group received preoperative mindfulness training combined with active breathing and circulation exercises. Evaluation indicators included anxiety and depression levels, physiological parameters (peripheral capillary oxygen saturation [SpO2], forced vital capacity [FVC], forced expiratory volume in one second [FEV1], maximum voluntary ventilation [MVV], forced expiratory volume in one second, percent of predicted [FEV1%pred], forced vital capacity, percent of predicted [FVC%pred], FEV1/FVC, arterial oxygen pressure [PaO2], and arterial carbon dioxide pressure [PaCO2]), exercise tolerance, medication adherence and health-related quality of life (HRQoL). The depression score (2.00 [1.00, 3.00]) and anxiety score (2.00 [1.00, 4.00]) in the experimental group were significantly lower than those in the control group (p < 0.001). Compared with the control group, several physiological indicators showed significant improvement in lung function in the experimental group (p < 0.05), and the Borg scale score (1.00 [0.00, 2.00]) was significantly lower in the experimental group than in the control group (p < 0.001). Regarding exercise tolerance, the post-intervention six-minute walk distance (6MWD) was significantly higher in the experimental group than in the control group (382.10 ± 68.17 vs. 356.24 ± 87.46, p < 0.05). In the experimental group, the proportions of patients with poor, moderate, and good medication adherence after surgery were 5.95%, 26.19%, and 67.86%, respectively. In contrast, the corresponding proportions in the control group were 7.89%, 47.37%, and 44.74%. Medication adherence was significantly higher in the experimental group than in the control group (p < 0.05). Regarding quality of life, the experimental group showed significantly higher scores in the five functional dimensions and the overall healthy quality of life dimension compared to the control group (p < 0.05). Preoperative mindfulness training combined with active breathing and circulation exercises significantly improves the postoperative psychological well-being of patients undergoing lobectomy, enhances medication adherence and lung function recovery, and ultimately improves overall health-related quality of life.
To investigate factors influencing wound complications after cesarean section in women with gestational diabetes mellitus (GDM) and to develop a predictive model. A retrospective study was conducted, including 600 women with GDM who underwent cesarean delivery at The Maternal and Child Health Care Hospital of Tongxiang between January 2022 and February 2025. Participants were randomly divided into a training set (n = 420) and a validation set (n = 180) at a 7:3 ratio. Clinical variables for model development included age, body mass index (BMI), hypertension status, glycated hemoglobin (HbA1c), albumin level, and time to first postoperative ambulation. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors and establish the predictive model. The discriminative performance of the model was evaluated using the receiver operating characteristic (ROC) curve, while calibration curves and decision curve analysis (DCA) were applied to evaluate calibration and clinical utility, respectively. Wound complications occurred in 108 patients (18%). Multivariate analysis identified concurrent hypertension (odds ratio (OR) = 2.63, 95% CI: 1.30-5.33), elevated BMI (OR = 1.07, 95% CI: 1.01-1.15), increased HbA1c (OR = 1.76, 95% CI: 1.34-2.33), decreased albumin level (OR = 0.84, 95% CI: 0.78-0.91), and delayed time to first ambulation (OR = 1.17, 95% CI: 1.07-1.28) as independent risk factors for wound complications (all p < 0.05). The multivariable logistic regression model demonstrated good discrimination, with an area under the curve (AUC) of 0.78 (95% CI: 0.72-0.83) in the training set and 0.78 (95% CI: 0.69-0.87) in the validation set. Calibration and decision curve analyses indicated good agreement and clinical net benefit. This study developed and internally validated a predictive model incorporating five readily available clinical indicators. The model may assist in identifying women with GDM at increased risk of poor incision outcomes following cesarean section and support risk stratification and early clinical decision-making.
Diabetic patients are at an increased risk for cataract and may experience delayed postoperative recovery due to diabetes-related ocular tissue vulnerability. However, the impact of preoperative glycemic control on early surgical outcomes and quality of life remains to be fully elucidated. This study aimed to investigate the effects of preoperative fasting blood glucose (FBG) control on postoperative corneal recovery, visual function, and vision-related quality of life in type 2 diabetic patients undergoing phacoemulsification. In this retrospective analysis, 197 cataract patients with type 2 diabetes who underwent phacoemulsification between March 2023 and March 2025 were included. Based on their preoperative FBG levels, they were divided into a well-controlled group (FBG <6.1 mmol/L, n = 83) and a poorly controlled group (FBG ≥6.1 mmol/L, n = 114). National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25), mean corneal astigmatism, corneal edema recovery, and best corrected visual acuity (BCVA) were compared between the two groups. Postoperatively, the well-controlled group had significantly higher total scores and scores on all dimensions of the NEI-VFQ-25 scale than the poorly controlled group (all p < 0.05). Regarding corneal recovery, the group with better control showed greater changes in mean corneal astigmatism on postoperative days 7 and 30 (p < 0.001). The corneal transparency ratio was higher on postoperative day 7 (p = 0.006), while there was no significant difference between the two groups on postoperative day 30. On postoperative day 7, the logarithm of the minimum angle of resolution (logMAR) BCVA of the well-controlled group was also significantly better than that of the poorly controlled group (p < 0.001). By postoperative day 30, the differences in corneal transparency and BCVA between the two groups became non-significant (p > 0.05). Good preoperative glycemic control in diabetic patients undergoing phacoemulsification is associated with faster early corneal edema resolution, better early visual recovery, and clinically meaningful improvements in vision-related quality of life. These findings underscore the importance of enhanced perioperative glycemic management to optimize short-term surgical outcomes and health-related quality of life in this population.
This study aims to explore the critical risk factors associated with surgical site infection (SSI) in patients with type 2 diabetes mellitus (T2DM) undergoing oral and maxillofacial surgery, and to develop a predictive model to support early risk stratification and guide targeted preventive approaches. This retrospective, case-control study enrolled patients with T2DM who underwent oral surgery at Nanjing Stomatological Hospital, Nanjing University between June 2022 and June 2025. A total of 110 patients who developed postoperative SSI were included in the infection group. A total of 110 patients without SSI were selected as the control group, matched 1:1 according to age and sex. Detailed demographic and clinical data, including patient history, perioperative blood glucose control levels, surgical type, oral environment, and antibiotic usage, were collected from both groups. Risk factors associated with SSI were analyzed and compared between groups, and a nomogram prediction model was developed. Internal validation was performed using 5000 bootstrap resamples, and model performance was assessed via the area under the receiver operating characteristic (ROC) curve (AUC) and calibration plots. Among the 110 patients who developed SSI after oral surgery, microbiological assessment identified Gram-negative bacteria as the predominant pathogens (62.73%), with Pseudomonas aeruginosa accounting for 18.18% and Klebsiella pneumoniae for 14.55% of the isolates. This was followed by Gram-positive organisms, which account for 34.55% of the pathogens, predominantly Staphylococcus aureus (10.91%). Multivariable logistic regression analysis showed that a surgical incision classified as Type II or III (vs Type I; Odds Ratio [OR] = 3.789), severe periodontal calculus in the oral environment (Grade III vs Grade I-II; OR = 4.092), poor blood glucose control (vs good; OR = 3.347), and elevated serum C‑reactive protein (CRP) levels (per unit increase; OR = 1.627) were independently associated with postoperative surgical site infection. A nomogram was constructed based on the equation: Logit (P) = 1.402 + 1.332 × (incision type) + 1.409 × (oral environment) + 1.208 × (blood glucose control) + 0.487 × (CRP). The maximum total score on the nomogram was 225 points, corresponding to a 90% predicted probability of postoperative SSI. The Hosmer-Lemeshow test (χ2 = 2.088, p = 0.230 > 0.05) demonstrated no significant difference between the observed and predicted outcomes of the nomogram model. The nomogram demonstrated excellent predictive performance, with an AUC of 0.897 (95% Confidence Interval [CI]: 0.855 to 0.939). The oral environment, perioperative glycemic control, CRP levels, and surgical incision type are independent risk factors associated with postoperative SSI. Establishing a prediction model based on these factors and implementing targeted interventions can effectively reduce infection in this high-risk cohort.