Table of Content

20 June 2024, Volume 24 Issue 03

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Original Articles and Clinical Research

Prediction of prognosis of pancreatic cancer patients after operation by enhanced CT extracellular volume fraction

LIU Li-qiang, LI Wen-bin, YE Hui-lin

2024, 24(03):  141-149.  DOI: 10.3969/j.issn.1009-976X.2024.03.001

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Objective To explore the prognostic value of extracellular volume fraction （ECVf） in patients with pancreatic cancer after operation. Methods A total of 66 patients with pancreatic cancer who underwent surgical treatment in Sun Yat-Sen Memorial Hospital of Sun Yat-sen University from January 2014 to December 2022 were selected. The multi-detectorrow CT scanner was used for multi-phase enhanced CT scanning, and the images of the non-contrasted phase and equilibration phase were obtained. The ECVf of pancreatic cancer lesions was calculated by formula. According to the median ECVf, the patients were divided into high ECVf group and low ECVf group. The prognosis of the two groups was analyzed, and a nomogram model was established to predict the prognosis of patients with pancreatic cancer treated after operation. Results The high ECVf group had longer OS （P=0.002） and DFS （P=0.024） than the low ECVf group. The median OS of high ECVf group and low ECVf group were 32.0 months and 20.3 months respectively, and the median DFS were 20.7 months and 12.3 months, respectively. The area under curve （AUC） of nomogram model for predicting 1-year, 2-year and 3-year survival rates were 0.854, 0.802 and 0.707, respectively. Conclusion ECVf can be used as a prognostic indicator for patients with pancreatic cancer after operation.

Dynamic contrast-enhanced MRI based on GRASP technique for the assessment of liver fibrosis

ZENG Kun-jie, DUAN Xiao-hui, YAN Zhuo-heng, ZENG Jia-le, LAI Chao-qi, SU Yun

2024, 24(03):  150-156.  DOI: 10.3969/j.issn.1009-976X.2024.03.002

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Objective To investigate the value of dynamic contrast-enhanced MRI （DCE-MRI） based on golden-angle radial sparse parallel （GRASP） acquisition technique in assessing the degree of liver fibrosis staging. Methods This was a prospective enrollment of patients who underwent resection for localized liver lesions at Sun Yat-sen Memorial Hospital, Sun Yat-sen University, between September 2022 and December 2023, with subsequent assessment of fibrosis staging in the peritumoral liver tissue. All patients underwent preoperative DCE-MRI examination using the GRASP technique. Quantitative DCE-MRI parameters including arterial flow （Fa）, portal venous flow （Fv）, total blood flow （Ftotal）, arterial flow fraction （AF）, mean extracellular transit time （MTT）, and extracellular volume （ECV） were measured in all patients. Parameter comparisons for different liver fibrosis stages were performed using t-tests. Spearman's rank correlation test method was used to assess the correlation between each DCE parameter and the liver fibrosis staging. The efficacy of the model was evaluated using Receiver Operating Characteristic （ROC） curve analysis. Results DCE-MRI parameters were analyzed in 76 participants （64 males）. Compared to non-late （S≤2） patients, late patients （S≥3） showed a decrease in Fv （125.1 vs. 104.26 ml/100 ml/min, P=0.013）, an increase in AF （45.24 % vs. 51.89 %, P=0.013）, and an increase in ECV （35.46 vs. 40.44 ml/100 ml, P<0.001）. Across fibrosis stages, Fv（r=-0.326,P=0.004） decreased with increasing stages, and AF （r=0.317,P=0.005）and ECV （r=0.569,P<0.001）increased with increasing stages. The cut-off value for Fv was 145.13 mL/100 mL/min with an AUC of 0.651 （95% CI：0.524~0.778, P=0.026）, and the cut-off value for AF was 42.97% with an AUC of 0.652 （95% CI： 0.521~0.782, P=0.025）, and a cut-off value of 37.72 mL/100 mL for ECV, with an AUC of 0.776 （95% CI： 0.664~0.888, P<0.001）. Conclusion Quantitative GRASP-based DCE-MRI parameters can be employed to diagnose and stage the liver fibrosis.

Bioinformatic exploration of key genes in sepsis induced acute-on-chronic liver failure based on GEO database

YI Xiao-ling, GU Yang, LI Li, YU Tao

2024, 24(03):  157-161.  DOI: 10.3969/j.issn.1009-976X.2024.03.003

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Objective The aim of the present study was to compare the Gene expression profiling of chronic acute Liver failure （ACLF） patients with and without sepsis, and identify the differential expressed genes （DEGs） in acute-on-chronic liver failure （ACLF） patients with sepsis. Methods The gene chip datasets were obtained from the Gene Expression Omnibus （GEO） database. Then the common differential genes were carried out for later analyses according to the occurrence of sepsis in acute-on-chronic liver failure （ACLF） patients. The genes were analyzed by Gene ontology （GO）, pathway enrichment analysis （KEGG, GSEA） for screening out key genes. Results A total of 883 DEGs were identified, with 371 up-regulated genes and 512 down-regulated genes compared with acute-on-chronic liver failure （ACLF） patients without sepsis. Further bioinformatics analysis revealed that the GO, KEGG, GSEA were mainly enriched in humoral immune response, complement activation, Natural killer cell mediated cytotoxicity, lymphocyte mediated immunity and Notch signaling pathway. Conclusion Bioinformatics analysis identified the differential genes of ACLF induced by sepsis, which lead to the occurrenceand development of diseases through humoral immunity response, complement activation and Notch signal pathway in immune response, and may be used as potential indicators for diagnosis and therapy of sepsis-related ACLF in the future.

Exploring the causal relationship between MMPs and breast cancer risk： a Mendelian randomization study

HAN Zhi-ren, ZHU Xiang-ping, HAN Bei-nan, WENG Hai-yan, YANG Qiong

2024, 24(03):  162-174.  DOI: 10.3969/j.issn.1009-976X.2024.03.004

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Objective To explore the causal relationships between various subtypes of matrix metalloproteinases （MMPs） and the risk of developing breast cancer. Methods Using 501 428 genetic variants related to plasma MMPs levels from 990 Europeans in the publicly available MRC-IEU database as instrumental variables for exposure, and 19 674 639 genetic variants from 201 633 breast cancer patients in the FinnGen version 10 database as instrumental variables for outcome, we conducted a two-sample bidirectional Mendelian randomization analysis. The inverse variance weighted method was used as the primary analysis, with MR-Egger regression, simple mode method, weighted median method, and weighted mode method as secondary complementary regression models. Sensitivity analysis was performed using Cochran's Q test to verify the reliability of the results, MR-Egger test to assess the horizontal pleiotropy of instrumental variables, and leave-one-out analysis to evaluate the potential influence of single nucleotide polymorphisms on the results. Results Impact of MMPs on breast cancer： The inverse variance weighted method detected a reverse causal relationship between MMP-7 expression levels and the risk of breast cancer （OR=0.95, 95%CI： 0.92-0.99, P<0.05）; no statistically significant association was found between the expression levels of other MMPs and the risk of breast cancer. Meta-analysis showed no statistically significant association between overall plasma MMPs and the risk of breast cancer. Impact of breast cancer on MMPs： The inverse variance weighted method showed no statistically significant association between the risk of breast cancer and the expression levels of MMPs. Conclusion The overall effect of MMPs does not have a significant impact on the occurrence and development of breast cancer. However, there is a negative causal relationship between MMP-7 expression levels and the risk of breast cancer. As MMP-7 expression levels decrease, the risk of breast cancer increases. MMP-7 may be a protective factor closely related to the occurrence and progression of breast cancer among MMPs and should be paid more attention.

Development of a multimodal artificial intelligence diagnostic model for bladder cancer based on ultrasound imaging and urine cytology

WU Shao-cong, SHEN Run-nan, WANG Liang-yu, WU Shao-xu

2024, 24(03):  175-182.  DOI: 10.3969/j.issn.1009-976X.2024.03.005

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Objective The aim of this study was to investigate whether a multimodal artificial intelligence diagnostic model can be constructed based on ultrasound images and urinary cytology to improve diagnostic sensitivity and assist in reducing the use of cystoscopy. Methods This was a single-center retrospective study that included 2056 patients who underwent both bladder ultrasound examination and urinary cytology examination from January 2018 to September 2023 for model training and validation. The gold standard was determined based on the patients' histopathological results, and patients with negative results needed to be followed up for 6 months to confirm non-cancer. Firstly, we constructed an AI diagnostic model for bladder cancer based on ResNet model and ultrasound images. We used pre-trained weights on ImageNet as the initialization of model weights. Random gradient descent and cross-entropy loss were used for network weight adjustment and algorithm optimization. After the ultrasound AI model output the diagnostic score, we combined it with the results of urinary cytology diagnosis and clinical risk factors based on Logistic regression to construct a multimodal diagnostic model, and output the final diagnostic probability for each individual. The effectiveness of the model was then validated in the validation set and subgroups （including different stages, grades, and clinical scenarios）. The final multimodal model was named BCaUSNet. Results The BCaUSNet model had a diagnostic sensitivity of 0.896（95%CI： 0.839-0.938） and an area under the curve of 0.917（95%CI： 0.891-0.942） in the validation set. In the scenario of recurrence monitoring, the model's sensitivity could reach 0.821（95%CI： 0.631-0.939）, and the negative predictive value could reach 0.896（95%CI： 0.773-0.965）, which could assist in reducing the use of cystoscopy with a high degree of certainty. In tumors with low malignant potential and low-grade tumors where urinary cytology is difficult to diagnose, the BCaUSNet model increased their sensitivity to 71.4% and 93.3%, respectively. In non-muscular invasive tumors and small tumors （<1.5 cm） that are easily missed by ultrasound, the BCaUSNet model increased their sensitivity to 89.5% and 87.5%, respectively. Conclusion The construction of a multimodal artificial intelligence diagnostic model for bladder cancer based on ultrasound images and urinary cytology has high diagnostic sensitivity, which helps to reduce missed diagnosis of bladder cancer, reduce the use of cystoscopy, and has good clinical utility and innovative significance.

Exploration of the effect of applying nanocarbon suspension injection in thyroid cancer surgery

ZHANG Yang-yi, DING Luo-zhou, LUO Hong-li, LIU Ce, REN Jia, MA Sheng-hui

2024, 24(03):  183-186.  DOI: 10.3969/j.issn.1009-976X.2024.03.006

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Objective To analyze Analysis of the effect of intraoperative application of nanocarbon-mixed injection in patients with differentiated thyroid cancer. Methods The clinical data of 92 cases of patients with total thyroidectomy + unilateral central zone lymphatic dissection admitted to Chengde City Central Hospital in Hebei Province from January 2021 to December 2023 were retrospectively collected and divided into the nanocarbon group （nanocarbon suspension injection treatment, n=46） and the control group （conventional surgical treatment, n=46） according to the different treatment methods. The treatment effects of the two groups were compared. Results The number of cervical lymph nodes cleared in the nanocarbon group （6.37±4.44） was more than that in the control group （t=3.919, P<0.001）. The rate of cervical lymph node metastasis （56.5%） was higher than that of the control group （χ²=10.172, P=0.001）, and the misdissection of parathyroid gland rate （6.5%） was lower than that of the control group （χ²=4.389, P=0.036）. The incidence of hypocalcemic symptoms in the nanocarbon group within 7 d postoperatively （8.7%） was lower than that in the control group （χ²=4.842, P=0.028）, and the incidence of total associatedcomplications in the postoperative period within 7 d （13.0%） was lower than that in the control group （χ²=5.974, P=0.015）. Conclusion The intraoperative application of nanocarbon-mixed injection in patients with differentiated thyroid cancer was able to improve the detection rate of cervical lymph node metastasis, increase the number of cervical lymph nodes cleared as well as reduce the rate of misdissection of the parathyroid glands, and also reduce the incidence of complications related to the patients in the postoperative period of 7 d. It also had a significant impact on the reduction of the incidence of hypocalcemic symptoms in the patients within seven days after surgery.

Comparison of clinical efficacy between percutaneous and wiltse approach for the internal fixation of single-segment thoracolumbar AO Type A3 fractures

ZHENG Chao-shun, CHEN Tai-qiu, GUO Yue-yue, HE Xu-hui, LIN Yi-hui, CHEN Bin-yong, LIN Chu-chun

2024, 24(03):  187-192.  DOI: 10.3969/j.issn.1009-976X.2024.03.007

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Objective To compare the clinical efficacy of percutaneous and wiltse approach for the internal fixation of single-segment thoracolumbar AO Type A3 fractures. Methods A retrospective analysis was conducted on 74 patients with single-segment thoracolumbar Type A3 fractures treated at Jieyang People's Hospital from January 1, 2021, to December 31, 2022. The patients were divided into two groups based on different surgical methods： percutaneous screw fixation group（n=38） and transmuscular approach group（wiltse group, n=36）. The clinical outcomes and radiological indicators of the two groups were compared. Results All cases were followed up for one year. There were no significant statistical differences in intraoperative blood loss, incision length, postoperative hospital stay, and hospitalization costs between the two groups. The surgical time for the percutaneous screw group was 121.6±19.4 min, while for the intermuscular interval group it was 91.7±19.3 min （P<0.05）. The number of intraoperative radiation exposures for the percutaneous screw group（15.0±2.1） was higher than for the intermuscular interval group （5.1±1.1） （P<0.05）. Both groups effectively improved vertebral angle, vertebral height, and clinical scores such as VAS, ODI after surgery. The wiltse group showed better results in vertebral angle and Cobb's angle （P<0.05）. One case of poor incision healing occurred in the percutaneous screw group, and there were no serious complications in either group. Conclusion Both percutaneous and wiltse approach for pedicle screw internal fixation are effective in treating single-segment thoracolumbar AO Type A3 fractures. The wiltse group had fewer intraoperative radiation exposures, shorter surgical time, and better postoperative vertebral height recovery, making it more suitablefor use in primary hospitals.

Effect of intrathecal application of different doses of dexmedetomidine on postoperative comfort treatment of PPH

QIN Fu-xing, HUANG Ze-han

2024, 24(03):  193-198.  DOI: 10.3969/j.issn.1009-976X.2024.03.008

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Objective To explore the effect of intrathecal application of different doses of dexmedetomidine on postoperative analgesia during procedure for prolapse and hemorrhoids （PPH）. Methods 380 patients undergoing PPH under combined spinal and epidural anesthesia were selected and randomly divided into 4 groups： C group （intrathecal 0.5% ropivacaine 15 mg）, LDA group （intrathecal 0.5% ropivacaine 15 mg + dexmedetomidine 5 μg）, LDB group（intrathecal 0.5% ropivacaine 15 mg + dexmedetomidine 7.5 μg） and LDC group（intrathecal 0.5% ropivacaine 15 mg + dexmedetomidine 10 μg）, 95 cases in each group. Record the time when patients first used analgesics, spinal anesthesia analgesia time, and differential analgesia time after surgery, and the visual analog scale （visual analogue scale, VAS） score. Results The first postoperative analgesic time, spinal anesthesia analgesia time, and differential analgesia time in the LDA group, LDB group, and LDC group were all longer than those in the C group, and the differences were statistically significant （P<0.05）. The VAS scores of the LDA group, LDB group, and LDC group at rest and during activity at 6 h, 12 h, and 24 h after surgery and immediately after taking analgesics were lower than those in the C group, and the difference was statistically significant （P<0.05）. Conclusion Dexmedetomidine is an intrathecal safe and effective adjuvant, which can enhance the effect of postoperative analgesia and reduce the dosage and frequency of postoperative analgesics. It is an effective scheme to realize comfortable medical treatment after PPH,Intrathecal application of 7.5 μg dexmedetomidine can achieve more satisfactory differential analgesia time.

Case Report

Summary of successful treatment and manage experience of refractory Crohn′s disease anal fistula complicated with severe infection （1 case report）

RUAN Jian-Min, LI Yong-Jie, LIN Jie-mei, LIU Li

2024, 24(03):  199-205.  DOI: 10.3969/j.issn.1009-976X.2024.03.009

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Objective To introduce the successful treatment and management experience of a severe patient with perianal fistulizing Crohn's disease （pfCD） and perianal abscess. Methods The clinical data of a patient with pfCD complicated with perianal abscess admitted to the Gastroenterology Dept. of Sun Yat-sen Memorial Hospital of Sun Yat-sen University were retrospectively analyzed. Results The patient's condition was improved and discharged after 65 days of disease management. Conclusion pfCD with perianal abscess is clinically challenging to treat. The key to successful treatment lies in multidisciplinary team （MDT） combined treatment and individualized management measures.