Abstract Background: Osteosarcoma is the most common malignant primary neoplasm of bone. Amputation was the primary treatment modality for osteosarcoma before the advent of limb salvage. However, the limb salvage procedure for osteosarcoma in long bones presents challenges to orthopedists because of the large diaphyseal bone defect. Case presentation: A 13-year-old girl presented with a two-month history of mild pain in the distal diaphysis of her left femur. The physical examination at admission was recorded as follows: the local skin appeared normal, without redness or venous engorgement; there was an apparent tenderness in her left distal thigh, but no palpable mass. In our hospital, relevant examinations were performed. Computed tomography (CT) revealed that the soft tissue density can be seen in the medullary cavity. The adjacent cortex was involved. Magnetic resonance imaging (MRI) showed an irregular, abnormal signal measuring approximately 16cm × 4.2cm. Positron emission tomography-computed tomography (PET/CT) excluded the metastasis. The needle biopsy was also carried out, which confirmed an osteosarcoma. Accordingly, we performed an individualized treatment for this patient, which included the wide resection of osteosarcoma, secondary bone transport, and postoperative chemotherapy. During the five-year follow-up period, no local recurrence or distant metastasis occurred in the patient. Highlights: Large femoral bone defects are difficult to manage. A unifocal bone transport was successfully performed for the reconstruction of a massive bone defect of 18cm in an adolescent. Good outcome and function at 5 years of follow-up. Bone transport is a proper reconstructive technique. Conclusion: For the young patient with osteosarcoma, after the wide resection of the tumor, the use of distraction osteogenesis proves to be a remarkable option in reconstructing massive limb bone loss. The successful reconstruction in this case, with no local recurrence or distant metastasis during the five years of follow-up, demonstrates the effectiveness and potential of this technique.
Abstract Background: Intraoperative frozen section consultation serves as an essential tool for guiding optimal surgical management. This study investigated generational changes in the utilization of intraoperative frozen section over the past two decades in a tertiary healthcare center. Material and Methods: Pathology reports of patients who underwent intraoperative frozen section analysis at Kaohsiung Medical University Hospital between 2001 and 2020 were reviewed and categorized according to anatomic site. The number and distribution of intraoperative frozen section cases across various anatomic sites were analyzed over the past two decades. The proportions of frozen section for each anatomical site were compared between the periods 2001–2010 and 2011–2020. Result: In the first decade, 8,958 frozen sections were evaluated, accounting for 3.8% of all surgical specimens. Breast tissue constituted the most common specimen submitted for frozen section analysis, followed by tissues from the central nervous system and lungs. In the second decade, 12,156 frozen sections were obtained, accounting for 4.4% of all surgical specimens. Breast tissue remained the most frequently analyzed sample, followed by tissues from the lung and female genital system. Between the two decades, the proportion of frozen section significantly decreased for the thyroid, urinary tract, and soft tissue/bone. Conversely, the proportion significantly increased for specimens from the lung, oral cavity, female genital system, and skin. Conclusion: Regular evaluations are essential to prevent overuse and ensure adherence to current evidence-based practices. Further improvements in diagnostic accuracy, revision of practice guidelines, resource allocation, and adjustment of training programs are warranted.
Abstract Objective: To assess the combined effects of health insurance type and travel distance to the cancer center on outcomes after robotic-assisted pulmonary lobectomy for lung cancer. Summary of Background Data: Social determinants of health are predictors of surgical and cancer outcomes, but their intersectional effects have not been examined in lung cancer patients. Methods: We retrospectively analyzed 711 consecutive patients who underwent robotic-assisted pulmonary lobectomy (RAPL) from September 2010 to March 2022 by one surgeon. Patients were stratified by distance of primary residence ZIP code < or ≥ 160 kilometers from the cancer center and by public, private, or combination insurance type. Univariate analyses, multivariable logistic regression, and Cox regression survival analysis were performed. Results: Of our study patients, 514 patients lived <160 km of the cancer center (28.6% private, 20.4% public, 51.0% combination insurance) and 197 patients lived ≥160 km from the cancer center (26.9% private, 19.8% public, 53.3% combination insurance). Patients with combination insurance traveling <160 km had the highest average age (p <0.0001) and more comorbidities than any other group. Nonetheless, those with public insurance living ≥160 km from the cancer center had higher proportions of intraoperative and postoperative complications. Having public health insurance and traveling ≥160 km was the only combination that independently predicted worse 10-year overall survival in multivariable analysis ( p =0.0003). Conclusions: Higher travel burden and public health insurance type had a compounding disadvantage, highlighting the importance of an intersectional approach to understanding the social determinants of outcomes in surgical oncology.
Abstract Objective: This study aimed to investigate the predictive value of heparin-binding protein (HBP) combined with extravascular lung water index (EVLWI) for the prognosis of patients with sepsis-related acute respiratory distress syndrome (ARDS). Methods: A total of 156 patients with sepsis-related ARDS admitted from October 2019 to December 2021 were selected and divided into a survival group and a death group based on clinical outcomes. The predictive value of HBP and EVLWI was analyzed using the receiver operating characteristic (ROC) curve. The optimal subset of prognostic predictors was obtained by LASSO regression with 10-fold cross-validation, and independent risk factors were determined via logistic regression analysis. A nomogram prediction model was then established, and its performance was evaluated in terms of discrimination and calibration. Results: After adjusting for confounders, the risk of poor prognosis increased by 14% for each 2 mg/L rise in HBP when HBP was ≥28.56 mg/L (OR=0.92, 95%CI: 0.88-0.98, P<0.05), and by 17% for each 1 mL/kg increase in EVLWI when EVLWI was ≥12.91 mL/kg (OR=0.80, 95%CI: 0.68-0.94, P<0.05). The AUCs of HBP and EVLWI for predicting poor prognosis were 0.805 and 0.785, respectively, while their combination demonstrated superior diagnostic efficacy. Furthermore, EVLWI, PVPI, hs-CRP, PCT and HBP were identified as independent risk factors (P<0.05). The nomogram prediction model exhibited high discrimination and accuracy. Conclusions: The combination of HBP and EVLWI serves as a sensitive and reliable prognostic indicator in patients with sepsis-related ARDS, with high predictive value for clinical outcomes
Abstract Background: Clinically relevant postoperative pancreatic fistula (CR-POPF) occurs in 20–40% of distal pancreatectomy cases. Predicting POPF is important for appropriate postoperative management. This study aimed to examine risk factors for CR-POPF and evaluate the no-compression dissection method performed at our institution. Methods: We retrospectively analyzed 53 patients who underwent laparoscopic distal pancreatectomy between August 2018 and December 2024. Pancreatic transection was performed using a powered stapler (Echelon 60 Green) using the no-compression method. Patient demographics, clinical factors, pancreatic thickness, and pathological findings were compared between patients with and without CR-POPF. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were used to identify predictors and cutoff values. Results: CR-POPF (ISGPS grade B or higher) developed in seven patients (13.2%). Multivariate analysis identified pancreatic thickness as an independent predictor, with a cutoff value of 12.7 mm on ROC analysis. Conclusions: Pancreatic thickness is a significant risk factor for CR-POPF after laparoscopic distal pancreatectomy. Thus, evaluating pancreatic thickness may aid the selection of appropriate transection methods, including the no-compression technique.
Objective To explore the features, benefits, and challenges of digital health platforms in oncology care based on literature published from 2015 to 2025. Summary of Background Data Digital health tools, such as mobile applications, wearable devices, and electronic patient-reported outcomes (ePRO) systems, are increasingly used in oncology. These platforms aim to support symptom management, patient education, and communication between patients and providers, particularly in the context of chronic and complex cancer care. The COVID-19 pandemic further accelerated the adoption of digital health technologies, highlighting their role in maintaining continuity of care. Methods This narrative review synthesized findings from peer-reviewed studies published between 2015 and 2025, focusing on the design, implementation, and clinical impact of digital platforms for cancer patients. Results Digital health interventions demonstrated improvements in patient quality of life, treatment adherence, and reductions in emergency department visits. Remote monitoring and teleconsultation were particularly effective during the COVID-19 pandemic. However, persistent barriers include digital literacy gaps among older adults, concerns about data privacy and security, and a lack of robust long-term outcome data. Conclusions Digital platforms offer meaningful benefits in oncology care but face implementation and equity challenges. Future development should prioritize user-centered design, integration of emerging technologies ( e.g. , artificial intelligence, blockchain, digital twins), and comprehensive policy frameworks. Large-scale studies are needed to evaluate long-term effectiveness, cost-efficiency, and equitable access.
Abstract Purpose: This study aimed to assess the effect of the laparoscopic sleeve gastrectomy and the one anastomosis gastric bypass on fasting GLP-1 serum level, HbA1c, and T2D remission. Methodology: This prospective, non-randomized comparative study was conducted at KasrAlainy Teaching Hospital from August 2017 to September 2020. A total of 40 obese patients with T2D were enrolled and divided into two equal groups: 20 underwent LSG and 20 underwent OAGB. Preoperative assessments included HbA1c and fasting GLP-1 levels, along with standard laboratory and imaging studies. Postoperative follow-ups were conducted at 3 months and 1 year to reassess GLP-1 and HbA1c levels. Data were analyzed using SPSS version 26, with significance set at p < 0.05. Results: The study results revealed a significant increase in excess weight loss (%EWL) in the sleeve gastrectomy group over one-year, with a mean of 31. 24% three months postoperatively and 58.95% one year postoperatively. In the anastomosis gastric bypass group, the mean %EWL increased to 31.37% three months postoperatively and 64.86% one year postoperatively. Fasting GLP-1 serum levels increased significantly three months postoperatively, but this effect was not maintained one year postoperatively. The sleeve gastrectomy group showed a complete remission rate of 20% three months postoperatively, increasing to 60% one year postoperatively. Conclusion: The study found that OAGB was more effective than LSG in achieving type 2 diabetes remission and maintaining elevated fasting GLP-1 levels, highlighting the importance of weight loss and incretins in metabolic improvement.
Abstract Objective: This study aimed to evaluate the impact of concomitant cholecystectomy performed during laparoscopic sleeve gastrectomy (LSG) on percentage total weight loss (%TWL) and body mass index (BMI) reduction at 3, 6, 12, and 18 months. Summary of Background Data: Obesity is a major health concern in Saudi Arabia, boosting demand for LSG. Rapid postoperative weight loss can cause cholelithiasis, prompting debate on concomitant cholecystectomy for patients with gallstones in a Saudi cohort. LSG effectively promotes significant and sustained weight loss but heightens cholelithiasis risk. The impact of concomitant cholecystectomy on weight-related outcomes is debated, and data from the Middle East are limited. Methods: Retrospective analysis of 347 patients undergoing primary LSG (2010–2024) at King Abdulaziz University Hospital, Jeddah, with ≥18 months follow-up. Groups: LSG with concomitant cholecystectomy (n = 62; gallstones via preoperative ultrasound) and LSG alone (n = 285; ursodeoxycholic acid for 6 months). Propensity score matching for age, sex, BMI, comorbidities, and smoking created 62 pairs. Results: Concomitant cholecystectomy extended operative time (142 ± 28 vs. 118 ± 22 minutes; P < 0.001), but hospital stay and complications were comparable. At 18 months, %TWL was 28.3% ± 6.0% (concomitant cholecystectomy) vs. 28.7% ± 5.8% (LSG-only; P = 0.796; 95% confidence interval: −3.4% to 2.6%). BMI: 30.5 ± 4.8 vs. 30.2 ± 4.6 kg/m² (P = 0.712). Conclusions: Concomitant cholecystectomy with LSG is safe without hindering weight loss. In high-obesity regions, a protocol of preoperative ultrasound screening with concomitant cholecystectomy for confirmed gallstones and ursodeoxycholic acid prophylaxis for gallstone-free patients is a practical and safe approach.
Postoperative pancreatic fistula (POPF) is a potentially fatal complication of distal pancreatectomy (DP) but the optimal prevention method is unknown. The standard methodology for DP is to dissect the pancreas using a stapler alone. This pilot study evaluated post-DP remnant closure by stapling plus a PGA felt patch and examined the predictors of POPF. We prospectively enrolled and analyzed 26 patients scheduled for DP in which the remnants were closed with staples and a PGA felt patch. Primary disease included 17 pancreatic adenocarcinomas, 3 pancreatic neuroendocrine neoplasms, 2 mucinous cystic neoplasms, 2 solid pseudopapillary neoplasms, and 2 other disorders. The mean main pancreatic duct diameter at the excision site was 2.3 mm. The mean pancreatic parenchyma thickness was 12.3 mm. The mean pancreatic dissected line was 0.5 mm to the left from the left edge of the portal vein. We observed nine biochemical leaks and the formation of nine grade B POPFs. We found significant differences in the BMI, pancreatic parenchymal thickness, and pancreatic dissection line between patients with and without POPF. Although stapling and applying PGA felt did not show efficacy in preventing POPF, the pancreatic dissecting line was suggested as a risk factor.
Objective Helicobacter pylori (Hp) infection affects half of the global population, with rising antibiotic resistance causing >20% treatment failure. Clinically, gastric biopsy is routinely performed in patients with gastrointestinal symptoms. On hematoxylin and eosin (H&E)-stained histological images, lesion characteristics can be assessed to guide therapy, whereas Hp can also be identified. Methods We promote the development of precise augmentation and counting of Hp (PAC-Hp), a deep learning framework combining density-based population counting algorithms with synthetic data augmentation using deep convolutional generative adversarial networks (DCGANs). The system automates Hp identification and quantification directly from histological images. We trained and validated PAC-Hp using whole-slide images (WSIs) from 114 patients, using immunohistochemistry (IHC) and multiplex immunofluorescence (mIF) as the gold standard for Hp detection. Results PAC-Hp achieved superior performance (88.6% sensitivity, 89.4% specificity) compared to manual microscopic diagnosis (82.4% sensitivity, 88.1% specificity). The framework demonstrated robust accuracy in quantifying Hp density while mitigating challenges like staining variability and overlapping bacteria. Conclusions Our artificial intelligence (AI)-driven approach provides a cost-effective, scalable solution for Hp detection, reducing reliance on labor-intensive manual methods. PAC-Hp’s high accuracy could aid in guiding therapy, particularly in resource-limited settings, and warrants further validation in multicenter studies.
Introduction Leiomyosarcoma is a rare malignant mesenchymal tumor that may contribute to the development of an inferior vena cava (IVC) tumor thrombus. Herein, we report a life-saving case of resection of a massive pulmonary thromboembolism (PTE) associated with an IVC tumor thrombus from renal leiomyosarcoma, performed under veno-arterial extracorporeal membrane oxygenation (V-A ECMO) circulation support. Case presentation A 72-year-old woman was transferred to the emergency department with dyspnea. Contrast-enhanced computed tomography (CT) detected a 53-mm large mass in the right kidney with an IVC tumor thrombus, right iliac vein thrombosis, and bilateral PTE. Although intravenous heparin infusion was initiated, V-A ECMO circulation support was also initiated because of circulatory collapse. A follow-up CT scan revealed no reduction in PTE. The multidisciplinary team concluded that the patient’s critical condition could only be improved by addressing the right heart failure through thrombus removal, necessitating emergency surgical intervention to save the patient’s life. Emergency surgery, including right nephrectomy, IVC tumor thrombectomy, and bilateral pulmonary artery thrombectomy, was performed under V-A ECMO using heparin. The final diagnosis was leiomyosarcoma with an IVC tumor thrombus and a fresh thrombus in the pulmonary artery. After 11 months of follow-up, the patient is alive with no clinical or radiological evidence of recurrence. Conclusions We experienced a life-saving resected case of massive PTE associated with IVC tumor thrombus of renal leiomyosarcoma under V-A ECMO circulation support.
Background and Objective Pterygium excision with conjunctival flap transplantation is a common ophthalmic surgery. Due to the eye fragility property, patients are prone to fear and anxiety, and there is tonic and disorderly movement of the eyeball during surgery, which affects the surgical progress and postoperative rehabilitation. The aim of this study was to explore the influence on preoperative anxiety and postoperative rehabilitation status in patients undergoing pterygium excision after preoperative health education based on the theory of enhanced recovery after surgery (ERAS). Methods Ninety patients who received elective pterygium excision with conjunctival flap transplantation in the hospital from March 2023 to December 2023 were randomized into two groups. There were 45 patients in the control group were given routine intervention guidance, and on this basis, the remaining 45 patients in the observation group adopted preoperative health education based on ERAS theory. The intervention effect was evaluated according to Generalized Anxiety Disorder Scale-7 (GAD-7), Self-Perceived Burden Scale (SPBS), Numerical Rating Scale (NRS), wound healing time, uncorrected visual acuity (UCVA), and nursing satisfaction. Results After intervention, the observation group had lower GAD-7 score and SPBS score before surgery than the control group ( P < 0.05). The NRS scores in the observation group at 1 and 2 days after surgery were lower than those in the control group ( P < 0.05). The wound healing time in the observation group was shorter compared to the control group ( P < 0.05), but the UCVA revealed no obvious difference between both groups at 4 weeks after surgery ( P > 0.05). The nursing satisfaction was higher in the observation group ( P < 0.05). Conclusion Preoperative health education based on ERAS theory has obvious advantages in improving preoperative anxiety and postoperative rehabilitation of patients with pterygium excision, and its clinical application value is high.
Purpose The primary objective of this study is to evaluate the predictive value of pan-immune inflammation value (PIV) in determining the pathological severity in patients undergoing appendectomy for acute appendicitis. Secondary objective is to compare the predictive performance with other inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI). Methods This retrospective observational study included 2334 adult patients who underwent appendectomy between 2012 and 2024. Patients were classified into noncomplicated (lymphoid hyperplasia, acute appendicitis) and complicated (phlegmonous, perforated, gangrenous appendicitis) groups based on postoperative histopathological findings. Preoperative hematological and biochemical data were collected to calculate inflammatory indices including NLR, PLR, SII, SIRI, and PIV. Receiver operating characteristics (ROC) analysis and logistic regression were performed to evaluate diagnostic performance and independent predictors of complicated appendicitis. Results Of the 2334 patients, 1574 (67.4%) patients had noncomplicated and 760 (32.6%) had complicated appendicitis. Neutrophil count had the highest area under curve (0.655), followed by white blood cell (0.651), SIRI (0.631), NLR (0.619), and PIV (0.615). The optimal PIV cut-off of 643.2 showed a sensitivity of 70% and specificity of 48%. In multivariate logistic regression, PIV was significantly associated with complicated appendicitis (odds ratio = 2.32; 95% confidence interval: 1.72–3.16; P < 0.001). Conclusion PIV is a novel and independent marker with moderate predictive value for predicting pathological severity of acute appendicitis in adults. Clinical utility should be supported with prospective studies.
Introduction Potential complications of long-term use of a central venous port include catheter-related bloodstream infection, thrombus formation, and vena cava occlusion. Here, we report an extremely rare case of a patient with Crohn disease in whom a central venous port was removed under cardiopulmonary bypass because of intimal adhesion of the superior vena cava. Case presentation A 58-year-old man with a history of Crohn disease since the age of 17 required emergency hospitalization because of disease exacerbation. A central venous port was implanted, and the patient was started on home parenteral nutrition at 30 years of age. At 58 years of age, he was scheduled for elective surgery because of abscess formation and stenosis around the colostomy site. He had remittent fever, and we suspected catheter-related bloodstream infection. We encountered strong resistance and postponed central venous port removal; we suspected an adhesion in the thoracic cavity. An endovascular procedure would have been difficult because of the presence of sepsis and the lack of available information about the implanted central venous port. The following day, the patient underwent central venous port removal under cardiopulmonary bypass. Catheter tip cultures obtained during surgery were positive. After the removal of the central venous port, the fever resolved steadily. Conclusion Regular assessment or replacement may be advisable after several years of use and removed as soon as possible when unnecessary.
Background This systematic investigation evaluates the clinical significance of circular RNA circHIPK3 in colorectal cancer (CRC) pathogenesis and prognostic outcomes. Methods A dual-phase analytical approach was implemented: (1) Systematic literature retrieval (inception-January 2025) across Embase, Web of Science, and PubMed identified clinical studies comparing CRC outcomes by circHIPK3 expression levels. Quantitative synthesis of dichotomous variables was performed using odds ratios (ORs) with 95% confidence intervals (CI), whereas survival outcomes were analyzed through hazard ratios (HRs). (2) Independent validation utilizing gene expression omnibus (GEO) and the cancer genome atlas (TCGA) datasets examined circHIPK3 expression patterns and survival correlations, supplemented by pathway enrichment analysis for mechanistic insights. Results A total of two publications were identified in this analysis. The high circHIPK3 expression group exhibited significant differences in regional lymph node metastasis (OR = 0.09; 95% CI = 0.04 to 0.17; P ＜0.001, I 2 = 45%), local invasion (OR = 0.43; 95% CI = 0.24 to 0.77; P = 0.005, I 2 = 44%), and distant metastasis (OR = 0.18; 95% CI = 0.08 to 0.40; P ＜0.001, I 2 = 0%) compared to the low circHIPK3 expression group. Additionally, a significant correlation was established between high circHIPK3 expression and decreased overall survival (OS) in CRC patients (HR = 0.30, 95% CI = 0.16 to 0.56; P = 0.0002, I 2 = 0%). No statistically significant differences were noted in gender (OR = 0.84; 95% CI = 0.50 to 1.42; P = 0.51, I 2 = 0%), tumor location (OR = 0.60; 95% CI = 0.35 to 1.02; P = 0.06, I 2 = 0%), and differentiation (OR = 0.99; 95% CI = 0.53 to 1.86; P = 0.98, I 2 = 0%). Bioinformatics analyses based on GEO and TCGA data further indicated that high circHIPK3 mRNA or protein expression correlates with shorter survival probabilities. Additional biological function predictions suggest that circHIPK3 plays a role in the onset and progression of CRC through multiple signaling pathways. Conclusion Our integrative analysis identifies circHIPK3 overexpression as a multimodal prognostic biomarker in CRC, associated with aggressive metastatic behavior and reduced survival. The mechanistic linkage to oncogenic pathways suggests its potential as both a therapeutic target and risk stratification tool.
Our goal is to evaluate the effectiveness and safety of lasers compared with mechanical staplers in pulmonary resections using a qualitative and systematic manner. The laser technique is effective in pulmonary resections among patients with pulmonary disease. However, systematic review of this technique needs to be made to ascertain its key role in the thoracosurgery domain. For randomized controlled trials (RCTs) published in Medline, Web of Science, Cochrane Controlled Trials Register, and clinical trial databases from June 1979 to October 2022, we identified and synthesized 3 studies to compare the efficacy and safety of lasers and mechanical staplers in pulmonary resections based on selection criteria. Two reviewers independently assessed trial bias and extracted data to make a useful qualitative systematic review. The 3 RCTs were obtained using a surgery approach of video-assisted thoracoscopic surgery. The operating time of the laser group was longer than that of the staple group in the Marulli study [weighted mean difference (WMD) = 12.00 minutes, 95% confidence interval (CI) -11.66 to 35.66 for McKenna; WMD = 39.00 minutes, 95% CI 21.82 to 56.18 for Marulli; and WMD = 2.00 minutes, 95% CI -15.10 to 19.10 for Scanagatta], whereas the hospital stay of the laser group was comparative with that of the staple group (WMD = -2.00 days, 95% CI -7.36 to 3.36 for McKenna; WMD = -3.00 days, 95% CI -6.29 to 0.29 for Marulli; and WMD = 0.00 days 95% CI -1.69 to 1.69 for Scanagatta). The risk ratio [RR (95% CI)], expressed as the persistent air leaks of the laser group versus the staple group, was RR = 0.68 (95% CI 0.38 to 1.22) for McKenna, RR = 0.67 (95% CI 0.12 to 3.61) for Marulli, and RR = 1.07 (95% CI 0.53 to 2.16) for Scanagatta, respectively, and expressed as pneumothorax, RR = 7.09 (95% CI 0.90 to 55.95) for McKenna, RR = 0.33 (95% CI 0.01 to 7.76) for Marulli, and RR = 6.28 (95% CI 0.34 to 117.39) for Scanagatta, respectively. At the 6-month follow-up, the mean postoperative forced expiratory volume in 1 second of the staple group was significantly improved compared with that of the laser group. The clinical symptoms and dyspnea index were improved by more than 1 grade 8 of 33 (24%) patients in the laser group and 26 of 39 (66%) patients in the staple group (p = 0.003). The lasers are effective and comparable with the mechanical stapler technique in pulmonary resections.
This systematic investigation evaluates the clinical significance of circular RNA circHIPK3 in colorectal cancer (CRC) pathogenesis and prognostic outcomes. A dual-phase analytical approach was implemented: (1) Systematic literature retrieval (inception-January 2025) across Embase, Web of Science, and PubMed identified clinical studies comparing CRC outcomes by circHIPK3 expression levels. Quantitative synthesis of dichotomous variables was performed using odds ratios (ORs) with 95% confidence intervals, while survival outcomes were analyzed through hazard ratios (HRs). (2) Independent validation utilizing GEO and TCGA datasets examined circHIPK3 expression patterns and survival correlations, supplemented by pathway enrichment analysis for mechanistic insights. A total of two publications were identified in this analysis. The high circHIPK3 expression group exhibited significant differences in regional lymph node metastasis (OR=0.09; 95% CI=0.04 to 0.17; P<0.001, I 2 =45%), local invasion (OR=0.43; 95% CI=0.24 to 0.77; P=0.005, I 2 =44%), and distant metastasis (OR=0.18; 95% CI=0.08 to 0.40; P<0.001, I 2 =0%) compared to the low circHIPK3 expression group. Additionally, a significant correlation was established between high circHIPK3 expression and decreased overall survival (OS) in CRC patients (HR=0.30, 95% CI=0.16 to 0.56; P=0.0002, I 2 =0%). No statistically significant differences were noted in gender (OR=0.84; 95% CI=0.50 to 1.42; P=0.51,I 2 =0%), tumor location (OR=0.60; 95% CI=0.35 to 1.02; P=0.06, I 2 =0%) and differentiation (OR=0.99; 95% CI=0.53 to 1.86; P=0.98, I 2 =0%). Bioinformatics analyses based on GEO and TCGA data further indicated that high circHIPK3 mRNA or protein expression correlates with shorter survival probabilities. Additional biological function predictions suggest that circHIPK3 plays a role in the onset and progression of CRC through multiple signaling pathways. Our integrative analysis identifies circHIPK3 overexpression as a multimodal prognostic biomarker in CRC, associated with aggressive metastatic behavior and reduced survival. The mechanistic linkage to oncogenic pathways suggests its potential as both a therapeutic target and risk stratification tool.
Background Prosthetic joint infection (PJI) is one of the most severe complications after joint replacement surgery, with the formation of bacterial biofilm being a primary cause. Chlorogenic acid (CGA) is a natural polyphenolic compound known for its antibacterial properties and its ability to inhibit biofilm formation. Objective This study aims to evaluate the inhibitory effects of two different concentrations of CGA on biofilm formation in methicillin-resistant Staphylococcus aureus (MRSA)-induced PJI by measuring the optical density at 492 nm (OD492) and analyzing the differences in the biofilm inhibitory effect at various concentrations of CGA during PJI. Methods The most common pathogen causing PJI, MRSA, was selected for this study. The experimental groups consisted of a control group with no intervention, a 256 μg/mL CGA group, and a 512 μg/mL CGA group, with 21 samples per group. Samples were cultured at 37°C and monoclonal TSB (tryptic soy broth) was used for bacterial amplification. Glass slides were placed in the culture and incubated in a 37°C shaking incubator for 48 hours to form biofilms, thus establishing an in vitro PJI human joint model. CGA was dissolved in dimethyl sulfoxide (DMSO) and diluted in TSB to final concentrations of 256 and 512 μg/mL. The OD492 values were determined using a microplate reader. Results The control group (no intervention) had an OD492 value of 0.461 ± 0.02, the 256 μg/mL CGA group had an OD492 value of 0.365 ± 0.04, and the 512 μg/mL CGA group had an OD492 value of 0.309 ± 0.03. The variance analysis for multiple samples showed P < 0.001. Independent sample t -test results between the 256 μg/mL and 512 μg/mL CGA groups showed P < 0.01. Conclusion Both 256 μg/mL and 512 μg/mL concentrations of chlorogenic acid can inhibit MRSA biofilm formation in the PJI process. The inhibitory effect of 512 μg/mL chlorogenic acid on MRSA biofilm formation is significantly stronger than that of 256 μg/mL.
Objective This study aimed to evaluate the effects of recombinant bovine basic fibroblast growth factor (rb-bFGF) intermittent flushing combined with vacuum sealing drainage (VSD) on acute infectious pressure ulcers. Summary of background data Pressure ulcers are common in elderly, bedridden, or critically ill patients and are prone to infection, complicating healing. Effective treatments are needed to promote healing and reduce infection rates. Methods Two hundred patients with acute infectious pressure ulcers were randomly divided into 2 groups: the control group (VSD only) and the research group (VSD combined with rb-bFGF flushing). We assessed wound healing time, dressing change frequency, drainage tube replacement frequency, length of hospital stay, granulation maturation rate, adverse reaction incidence, and serum levels of C-reactive protein (CRP), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF). Results The research group showed significantly better outcomes: higher total response rate (96.00% versus 82.00%), shorter wound healing time, lower dressing change and drainage tube replacement frequencies, and reduced length of stay (all P s < 0.05). Granulation maturation rate was higher in the research group (82.00% versus 56.00%, P < 0.05). After treatment, CRP levels decreased, and VEGF and EGF levels increased significantly in the research group ( P < 0.05). Adverse reaction incidence was similar between the groups ( P = 0.674). Conclusions Rb-bFGF flushing combined with VSD significantly enhances healing of acute infectious pressure ulcers, reducing inflammation and promoting granulation tissue formation with high safety.
Objective This study sought to examine how early mobilization combined with enteral nutrition suspension affects the nutritional status of patients with gastric cancer following surgery. Methods Ninety patients who underwent radical gastrectomy for gastric cancer at our hospital between December 2020 and May 2023 were randomly allocated to either an observation group or a control group. Both groups received standard postoperative care, including infection prevention, gastrointestinal decompression, and maintenance of fluid and electrolyte balance. The control group received enteral nutrition support starting from the first day after surgery, and outcomes were evaluated after 8 days of support. The observation group received early mobilization in addition to standard care. Recovery parameters, such as first defecation time, fluid intake time, first exhaust time, and hospital stay, were monitored along with serum nutrition indicators and incidence of adverse reactions during enteral nutrition support. Results The observation group had significantly shorter first defecation time, first exhaust time, fluid intake time, and hospital stay than the control group with statistically significant differences ( P < 0.05). On postoperative day 8, both groups demonstrated elevated prealbumin, albumin, and transferrin levels compared with postoperative day 1. Furthermore, the observation group had significantly higher levels than those of the control group with a statistically significant difference ( P < 0.05). The occurrence of adverse reactions between the 2 groups was 17.8% and 15.6%, respectively, but the difference was found to be not statistically significant ( P > 0.05). Conclusion Early mobilization combined with enteral nutrition suspension promotes early postoperative and nutritional recovery in gastric cancer patients undergoing radical gastrectomy. This approach is deemed safe and may offer valuable benefits in optimizing patient outcomes.
