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    Interpretation of the 5th edition of WHO classification of endocrine and neuroendocrine tumors: update and progress on follicular cell-derived thyroid tumors
    LU Shanshan, JI Yuan
    Journal of Surgery Concepts & Practice    2025, 30 (01): 27-33.   DOI: 10.16139/j.1007-9610.2025.01.06
    Abstract324)   HTML6)    PDF(pc) (934KB)(28)       Save

    The 2022 WHO classification of endocrine and neuroendocrine tumors (5th edition) categorizes thyroid follicular cell-derived tumors into benign, low-risk, and malignant types. Benign tumors now include thyroid follicular nodular lesions. A newly added category previously termed "borderline tumors" have been revised to low-risk follicular cell-derived tumors, which encompass non-invasive follicular thyroid neoplasm with papillary-like nuclear features, thyroid tumors of uncertain malignant potential, and hyalinizing trabecular tumors. The new WHO classification stratifies malignant follicular cell-derived tumors based on molecular characteristics and invasiveness: papillary thyroid carcinoma (PTC) with various histological subtypes represents BRAF-like malignancies; invasive encapsulated follicular variant PTC and follicular thyroid carcinoma represent RAS-like malignancies. Oncocytic carcinoma is now recognized as a distinct entity, specifically referring to tumors composed of ≥75% oncocytic follicular cells lacking PTC nuclear features and high-grade characteristics (necrosis and mitotic figures ≥3/2 mm²). A new category termed "high-grade follicular cell-derived thyroid carcinoma" has been added, encompassing traditional poorly differentiated thyroid carcinoma and differentiated high-grade thyroid carcinoma. Anaplastic thyroid carcinoma(ATC) remains the most undifferentiated type, with thyroid squamous cell carcinoma now classified as a subtype of ATC. The term "papillary thyroid microcarcinoma" is no longer recommended as a distinct subtype. Cribriform-morular thyroid carcinoma is no longer classified as a subtype of PTC, but is instead categorized as a tumor of uncertain histogenesis.

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    Mechanism, clinical manifestations, prevention, and treatment of air embolism during ERCP
    CHEN Junzong, LIU Kai, TANG Di
    Journal of Surgery Concepts & Practice    2024, 29 (06): 537-543.   DOI: 10.16139/j.1007-9610.2024.06.14
    Abstract318)   HTML5)    PDF(pc) (3370KB)(10)       Save

    Endoscopic retrograde cholangiopancreatography (ERCP) is a pivotal endoscopic technique for hepatobiliary and pancreatic diseases. Although rare, air embolism during ERCP carries a high risk of mortality and disability, with significant challenges in timely recognition. Current understanding of its pathogenesis, clinical manifestations, and emergency management remains insufficient. Air embolism requires two prerequisites: an open vascular pathway​and abnormal pressure gradients. It can be classified into venous, arterial, and paradoxical​subtypes based on the embolized vasculature. Clinical presentations are nonspecific and heterogeneous, often​masked by sedation or anesthesia, leading to delayed diagnosis. Key risk factors include prior biliary surgery, sphincterotomy, biliovenous fistula formation, and biliary stent placement. Diagnosis relies on integrating intraoperative vital sign monitoring, imaging​examination, and ​cardiocirculatory/neurological assessments. Timely recognition and intervention are critical, including​procedure termination, 100% oxygen therapy, positional adjustment, and hemodynamic stabilization. Preventive strategies involve strict adherence to ERCP indications, preoperative screening of high-risk patients, CO₂ insufflation ​instead of air, and ​enhanced intraoperative real-time monitoring. Clinicians should maintain a high alert for air embolism, optimize procedural protocols, implement surveillance, and establish emergency response plans ​to mitigate this life-threatening complication.

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    Treatment strategies for subacute lower extremities deep vein thrombosis
    LI Xinqing, PAN Jie, SANG Hongfei
    Journal of Surgery Concepts & Practice    2024, 29 (06): 477-480.   DOI: 10.16139/j.1007-9610.2024.06.03
    Abstract289)   HTML1)    PDF(pc) (803KB)(10)       Save

    In this article we primarily explored the treatment strategies for subacute lower extremity deep vein thrombosis (LEDVT). We introduced the definition, incidence, and clinical stage of DVT, emphasized the pathological changes following thrombosis and the lag in the clinical course, discussed diagnostic methods for subacute DVT, including venous ultrasound examination, super-microvascular imaging (SMI), two-dimensional shear-wave elastography(2D-SWE),and venography, highlighting the importance of these techniques in determining the property and stage of the thrombus. In terms of treatment, we underscored the fundamental role of anticoagulant therapy and mentioned the adjuvant effects of vasoactive drugs and heparinoid antithrombotic drugs. We recommended interventional thrombectomy techniques, such as catheter-directed thrombolysis (CDT), percutaneous mechanical thrombectomy (PMT), and large-bore catheter manual aspiration (MAT). In this article we cited results from multiple clinical studies, demonstrating the effectiveness and safety of these techniques in the treatment of subacute DVT. Finally, we looked forward to future research directions in the diagnosis and treatment of subacute DVT, including the development of new molecular imaging technologies, the establishment of a correlation model between the degree of thrombus organization and treatment outcomes, the exploration of the effects of anticoagulant combined with vasoactive drugs, and the use of artificial intelligence for prognosis prediction. We emphasized that with the advancement of precision medicine, the diagnosis and treatment of subacute DVT are expected to shift from an empirical model to a stratified management approach based on thrombus biological characteristics, in order to improve patients’ long-term prognosis.

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    Advances of antibody-drug conjugates in the treatment of metastatic triple-negative breast cancer
    TONG Yiwei, CHEN Xiaosong
    Journal of Surgery Concepts & Practice    2024, 29 (06): 533-536.   DOI: 10.16139/j.1007-9610.2024.06.13
    Abstract283)   HTML3)    PDF(pc) (819KB)(15)       Save

    Triple-negative breast cancer (TNBC) is insensitive to endocrine therapy or anti-human epidermal growth factor receptor(HER)-2 targeted therapy due to its lack of expression of hormone receptors and HER-2. Antibody-drug conjugates(ADCs) recognize specific antigens on the surface of cancer cells through specific antibodies, form antigen-antibody complexes that are then internalized, and subsequently release their payloads to kill cancer cells, which offering a novel therapeutic option for metastatic TNBC. Currently, ADCs undergoing research and clinical application in metastatic TNBC include sacituzumab govitecan, datopotamab deruxtecan (Dato-DXd), SKB264, and trastuzumab deruxtecan (T-DXd). This article summarized the targets and structural characteristics of ADCs in metastatic TNBC, systematically reviewed the efficacy and safety of ADCs from relevant clinical studies, and discussed the issues of the clinical application of ADCs.

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    Recent advances in ultrasound diagnosis of thyroid follicular neoplasms
    SU Yixuan, YING Tao
    Journal of Surgery Concepts & Practice    2025, 30 (01): 21-26.   DOI: 10.16139/j.1007-9610.2025.01.05
    Abstract268)   HTML6)    PDF(pc) (4475KB)(12)       Save

    Conventional ultrasonography often struggles to accurately differentiate between benign and malignant thyroid follicular tumors, which relying heavily on postoperative pathological diagnosis. Recent advancements in novel ultrasound technologies and artificial intelligence(AI) have shown significant potential in improving diagnostic accuracy, reducing unnecessary surgeries, and decreasing misdiagnosis rates. Emerging ultrasound modalities, such as superb microvascular imaging, contrast-enhanced ultrasound, and ultrasound elastography, provide new approaches for preoperative differentiation of thyroid follicular tumors. This review summarized and discussed the application value of these novel ultrasound techniques and various AI-based modeling methods in the preoperative diagnosis of thyroid follicular tumors, aiming to provide a scientific basis for clinical decision-making.

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    Expanded application of superior standard recurrent laryngeal nerve and superior laryngeal nerve monitoring techniques in endoscopic and robotic thyroid surgery
    Zhao Wenxin, Huang Qijian, Zhang Liyong, Cai Shaojun
    Journal of Surgery Concepts & Practice    2025, 30 (01): 13-16.   DOI: 10.16139/j.1007-9610.2025.01.03
    Abstract267)   HTML2)    PDF(pc) (7268KB)(16)       Save

    The standardized implementation of intraoperative nerve monitoring technology significantly minimizes surgical injury risks. Its application in endoscopic and robotic thyroid surgeries enhances procedural safety. Building upon standardized protocols, our team has innovated technical extensions through accumulated clinical experience, systematically formulated as operational guidelines. This article elucidated these technical extensions through pictures and videos, aiming to improve the safety and procedural fluency of endoscopic and robotic thyroidectomies.

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    Treatment of iliac vein thrombotic diseases
    XIE Xinsheng, HUANG Yulong, WANG Lixin
    Journal of Surgery Concepts & Practice    2024, 29 (06): 463-471.   DOI: 10.16139/j.1007-9610.2024.06.01
    Abstract255)   HTML7)    PDF(pc) (978KB)(14)       Save

    Currently, the treatment strategy for iliac venous thromboembolic disease has evolved from early approaches such as simple anticoagulation therapy, surgical thrombectomy, and venous return improvement to encompass multiple minimally invasive modalities including pharmacologic thrombolysis, catheter-directed thrombolysis (CDT), and mechanical thrombectomy. These advancements have demonstrated enhanced therapeutic efficacy and safety profiles. With the diversification of treatment modalities, the therapeutic concepts for venous thromboembolism (VTE) continue to be updated, establishing higher standards for treatment outcomes and safety. This article explored recent progress in the management of iliac venous thromboembolic disease, aiming to clarify the roles and efficacy of various treatment approaches in clinical practice while providing evidence-based treatment recommendation for clinicians. We anticipated further standardization of diagnostic and therapeutic protocols, along with increased emphasis on preventive measures, to safeguard vascular health in the general population.

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    Risk factors of postoperative delirium in elderly patients undergoing noncardiac surgery under general anesthesia
    WU Xinwan, LI Xiang, ZHENG Minjia, YAO Junyan
    Journal of Surgery Concepts & Practice    2024, 29 (06): 510-517.   DOI: 10.16139/j.1007-9610.2024.06.09
    Abstract253)   HTML1)    PDF(pc) (968KB)(6)       Save

    Objective To investigate the incidence and related factors of postoperative delirium in elderly patients undergoing elective noncardiac surgery under general anesthesia. Methods Elderly patients aged ≥65 years old undergoing non-cardiac surgery under general anesthesia from December 31, 2017 to December 31, 2018 were retrospectively analyzed. The patients were divided into delirium group and control group according to whether delirium occurred after surgery. Paired t test was used to compare the laboratory test results between the delirium group and the control group. Logistic regression analysis was used to identify the independent risk factors for delirium after non-cardiac surgery in elderly patients. Results A total of 1 072 elderly patients undergoing elective non-cardiac surgery were enrolled in this study. Delirium occurred in 60 patients, and the incidence of delirium was 5.6%. Multivariate Logistic regression analysis showed that postoperative prothrombin time(PT), preoperative blood glucose, preoperative activated partial thromboplastin time(APTT) and postoperative C-reactive protein(CRP) were independent risk factors for delirium after non-cardiac surgery in elderly patients. Conclusions Postoperative PT, preoperative blood glucose, preoperative APTT and postoperative CRP are independent risk factors for POD in elderly patients undergoing non-cardiac surgery.

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    Comparative study of parenteral and enteral nutrition support after abdominal surgery in elderly patients with malnutrition diagnosed by GLIM criteria
    CAI Zhuowei, ZHU Dengfeng, CHEN Minggan, CAI Yiting, CHEN Dawei, GAO Ming
    Journal of Surgery Concepts & Practice    2024, 29 (06): 503-509.   DOI: 10.16139/j.1007-9610.2024.06.08
    Abstract249)   HTML1)    PDF(pc) (1010KB)(16)       Save

    Objective To observe the effects of postoperative complications, anal exhaust time, immune function and fatigue index of parenteral and enteral nutrition support after abdominal surgery in elderly patients with malnutrition diagnosed by GLIM criteria. Methods Ninty elderly abdominal surgery patients (more than 70 years old) who diagnosed as malnutrition by GLIM 2-step method were divided into enteral nutrition(EN) group and parenteral nutrition (PN) group randomly. The corresponding immune and fatigue indexes were tested on day 1 and day 7 of postoperation. Postoperative complications, anal exhaust time and mean time of hospitalization were observed and analyzed. Results The incidence of malnutritional risk was 61.0% (122/200) in elderly abdominal surgery patients and malnutrition incidence was 45.0% (90/200). IgA, IgM, IgG, CD3, CD4 and CD4/CD8 on postoperative day 7 increased significantly in EN group than those in PN group (P<0.05). The postoperative complications in EN group significantly lower than that in PN group (P<0.05). Anus exhaust time and hospitalization days of EN group were shorter than that of PN group (P<0.05). Fatigue index on postoperative day 7 of EN group was significantly better than that of PN group (P<0.05). Conclusions The malnutrition diagnosis of elderly patients based on GLIM crteria is a necessary prerequisite for nutritional intervention. Early EN support can reduce postoperative complications and hospitalization days in elderly patients, improve postoperative fatigue syndrome and immune status, and improve the patients with malnutrition recover from surgery.

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    Use of transnasal ileus catheter combined with surgery in malignant bowel obstruction:one case report
    JIN Yifeng, CHEN Shiyu, CUI Rong, XIA Yufeng, ZHOU Yong
    Journal of Surgery Concepts & Practice    2024, 29 (06): 523-528.   DOI: 10.16139/j.1007-9610.2024.06.11
    Abstract247)   HTML0)    PDF(pc) (3970KB)(11)       Save

    Malignant bowel obstruction(MBO) is a common complication of advanced ventral-pelvic tumors, with poor overall prognosis and seriously affecting the quality of life of these patients. Numerous factors are involved in the pathogenesis of MBO and there is no standard treatment. Most MBO patients were not suitable for surgery. The use of chemotherapy and total parenteral nutrition(TPN) is also controversial. The best treatment is still supportive treatment, including drug treatment and gastrointestinal decompression. Here we reported a case diagnosed as MBO. Transnasal ileus cathete was inserted immediately when hospitalizated after diagnosed 5 days. The symptom was partial relieved after conservative treatment. The abdomen CT scan suggested the sign of closed-loop obstruction. Then, an exploratory laparotomy was performed and found proximal small intestine obviously decompressed with transnasal ileus catheter. However, the tumor caused the closed-loop obstruction of terminal ileum and colon, then the transverse colostomy and terminal ileostomy were performed. After treatment, the patient recovered and was discharged from the hospital. In conclusion, the use of transnasal ileus catheter combined with surgery in MBO, could improve the accuracy of condition judgment, increase the feasibility and safety of surgery, and achieved the goals of treatment expected, and might be a potential treatment regimen for MBO.

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    Minimally invasive thyroid surgery: development and future
    CHEN Lingxie, ZHAO Qiwu, QIU Weihua
    Journal of Surgery Concepts & Practice    2025, 30 (01): 7-12.   DOI: 10.16139/j.1007-9610.2025.01.02
    Abstract241)   HTML4)    PDF(pc) (855KB)(25)       Save

    Since the 90s of the 20th century, thyroid endoscopic surgery has undergone the development from multi-port to single-site, from endoscopy to robot. In recent years, the emergence of da Vinci single-port robots and domestic single-port robots have further promoted the technological innovation of minimally invasive thyroid surgery. This article reviewed the development process of minimally invasive thyroid surgery from the development of endoscopic thyroid surgery, the breakthrough of single-site endoscopic surgery, and the realization of robotic thyroid surgery and single-port robotic thyroid surgery, and discussed the future of thyroid surgery in the era of artificial intelligence.

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    Application, innovation, and quality control of endoscopic thyroidectomy by gasless unilateral axillary approach
    GUO Yawen, ZHENG Chuanming, GE Minghua
    Journal of Surgery Concepts & Practice    2025, 30 (01): 1-6.   DOI: 10.16139/j.1007-9610.2025.01.01
    Abstract238)   HTML5)    PDF(pc) (852KB)(29)       Save

    The endoscopic thyroidectomy by gasless unilateral axillary approach (GUA) represents a significant advancement in the field of endoscopic thyroid surgery, offering notable aesthetic and clinical therapeutic benefits. This paper reviewed the current clinical application, core technological innovations, quality control systems, and future developmental directions of GUA. Research indicated that GUA achieved surgical outcomes comparable to traditional open surgery in the treatment of benign thyroid tumors and thyroid cancer, while substantially enhancing cosmetic results and patient satisfaction. By optimizing the surgical approach design, enhancing cavity construction equipment, and standardizing the operational process, GUA markedly reduced the incidence of postoperative complications, preserved the anterior cervical functional area, and improved patients' postoperative quality of life. Furthermore, multidisciplinary collaboration and thorough pre-operative evaluation were fundamental to surgical success, while intraoperative quality control measures and a comprehensive postoperative follow-up system ensured the safety and efficacy of the procedure. In the future, the integration of robotic technology and advancements in single-site devices are anticipated to enhance the role of GUA in endoscopic thyroid surgery, thereby offering patients more minimally invasive and aesthetically favorable treatment options.

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    Predictive factors of pathological complete response after neoadjuvant therapy for locally advanced rectal cancer
    LI Hao, LUO Yang, WANG Tingfeng, LIN Haiping, GONG Tingyue, ZHAO Yongheng, ZHONG Ming
    Journal of Surgery Concepts & Practice    2025, 30 (01): 47-53.   DOI: 10.16139/j.1007-9610.2025.01.09
    Abstract235)   HTML2)    PDF(pc) (1113KB)(22)       Save

    Objective To analyze the tumor characteristics associated with achieving pathological complete response(pCR) and tumor prognosis in the patients undergoing laparoscopic rectal cancer surgery after neoadjuvant chemoradiotherapy(nCRT). Methods A retrospective review was conducted on clinical and pathological data of locally advanced rectal cancer(LARC) patients who underwent nCRT at Renji Hospital from January 2017 to January 2024. Factors influencing the achievement of pCR were analyzed, and the patients prognosis of pCR group and non-pCR group was compared. Results Univariate analysis, multivariate Logistic regression analysis, and receiver operating characteristic (ROC) curve analysis showed that tumor length less than 5 cm(cutoff value 5.24 cm) and baseline carcinoembryonic antigen(CEA) less than 5 μg/L(cutoff value 5.33 μg/L) were independent predictors of achieving pCR after nCRT in LARC patients. Prognostic survival analysis showed that the 3-year overall survival(OS) rate for pCR group and non-pCR group were 92.86% and 82.46%, respectively (P=0.193), and the 3-year disease-free survival (DFS) rate were 85.71% and 70.18%, respectively (P=0.141), with no statistically significant differences between the two groups. Conclusions Tumor length and baseline CEA level are independent predictors for achieving pCR after nCRT in LARC patients. Additionally, there were no statistically significant differences in 3-year OS and DFS between pCR group and non-pCR group.

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    Establishment of an evaluation system for conversion to laparotomy in laparoscopic cholecystectomy and exploration of surgical grading management
    ZHANG Nannan, GUO Jinxing, WU Gang, YI Hui, ZHOU Yuanhang, LIAO Zhiwei, HUANG Qi, DONG Jian
    Journal of Surgery Concepts & Practice    2025, 30 (01): 54-60.   DOI: 10.16139/j.1007-9610.2025.01.10
    Abstract231)   HTML13)    PDF(pc) (958KB)(11)       Save

    Objective To develop and validate a scoring system to predict the possibility of laparoscopic cholecystectomy (LC) conversion to laparotomy based on preoperative clinical data, and to establish a grading management model of surgery. Methods A retrospective analysis was conducted on the clinical data of 9 414 patients who underwent LC at Renhe Hospital and Huashan Hospital from June 2013 to June 2018. The patients were divided into two groups: the LC group (9 246 patients who successfully underwent LC) and the conversion to laparotomy group (168 patients who required conversion to open surgery). The data of two groups were compared, and the risk factors affecting conversion to laparotomy were screened out by single factor analysis of Chi-square test. Then, the risk factors were analyzed by multiple Logistic regression, and the pre-coefficient of each variable of the risk factors was assigned according to the established conversion to laparotomy possibility function. After calculating the score of each case, the difference in the actual conversion rate of each group was compared. The area under receiver operating characteristic (ROC) curve was calculated to evaluate the performance of the scoring system. According to the scoring system, LC surgical grading management model was created and verified. Results The following factors were identified as significant risk factors for conversion to laparotomy (P < 0.001): body temperature ≥ 38.5℃, frequency of acute cholecystitis ≥3 times, maximum thickness of gallbladder wall ≥ 5 mm, gallbladder neck stone incarceration, diameter of common bile duct ≥8 mm, and surgical experience ≤50 cases were the risk factors for conversion to laparotomy (P < 0.001). A score >3 points was associated with a high risk of conversion to laparotomy. Conclusions The LC scoring system and surgical grading management are reliable and effective tools for predicting and reducing the conversion rate of LC to laparotomy.

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    Diagnostic and treatment strategies for varicose veins of lower extremities combined with non-thrombotic iliac vein lesion
    DING Caiyou, WU Jingjin, ZHU Yuefeng
    Journal of Surgery Concepts & Practice    2024, 29 (06): 487-492.   DOI: 10.16139/j.1007-9610.2024.06.05
    Abstract218)   HTML0)    PDF(pc) (844KB)(8)       Save

    The co - existence of lower extremity varicose veins and non - thrombotic iliac vein lesions is not uncommon in clinical practice. The clinical manifestations of the two are similar, but there is no linear correlation between their severity. Therefore, a thorough examination is required to individually analyze the causes of patients, and then formulate treatment strategies. Treating the two diseases simultaneously can resolve both superficial and deep venous issues, accelerate the improvement of clinical symptoms, especially the healing of venous ulcers. However, the overall cost is high, and there are issues such as exceeding medical insurance limits. Treating the two diseases in stages allows for a decision on whether to treat the other disease after close follow - up, but there is a risk of disease progression. This article reviewed the literature on the etiology, diagnosis, grading, and treatment of lower extremity varicose veins and non - thrombotic iliac vein lesions, and explored the optimal treatment strategies.

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    How far are we from the ideal iliac vein stent
    LI Hanyu, XIAO Jianbin, ZHANG Zhihui
    Journal of Surgery Concepts & Practice    2024, 29 (06): 472-476.   DOI: 10.16139/j.1007-9610.2024.06.02
    Abstract216)   HTML2)    PDF(pc) (1782KB)(14)       Save

    The iliac vein plays a crucial role in the reflux of venous blood from the pelvic and lower extremity regions. Due to its unique anatomical characteristics, iliac vein is susceptible to iliac vein compression syndrome (May-Thurner syndrome) and post-thrombotic syndrome (PTS). Iliac vein stent placement has emerged as the preferred treatment for these conditions. Through the concerted efforts of clinicians and engineers, various types of iliac vein stents have been developed. This article aimed to elaborate on the physiological anatomy ofiliac vein and the characteristics of the iliac vein diseases, analyze the features of different iliac vein stents currently used in clinic, and explore potential future development direction of iliac vein stents.

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    Clinical application of circulating tumor cell in advanced gastric cancer
    WANG Yizhou, WEI Qi, JIN Huimin, CHEH Lei, LIANG Haibin, ZHOU Yunlan
    Journal of Surgery Concepts & Practice    2024, 29 (06): 549-554.   DOI: 10.16139/j.1007-9610.2024.06.16
    Abstract216)   HTML6)    PDF(pc) (876KB)(17)       Save

    Gastric cancer (GC) is one of the common malignant tumors globally. Its characteristics of high morbidity and mortality, high metastasis, low early diagnosis rate, low radical resection rate and low 5-year survival rate have seriously affected clinical treatment and patients’ prognosis. Circulating tumor cells (CTCs) are cancer cells that leave a solid tumor lesion and enter the bloodstream. Its diffusion and migration are important reasons for distant metastasis. In some solid tumors, enumeration of CTC has served as surrogate markers for overall survival (OS), progression-free survival (PFS) and chemotherapy effectiveness, and risk factors of relapse. Unfortunately, the study of CTC in GC is not sufficient. In this review, we collected relevant literatures and described the clinical significance of CTC for the patients with GC, especially advanced gastric cancer (AGC), including the biology, detection methods, and clinical applications of CTC, discussed the challenges and the future prospects in this field.

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    The incidence of PFO-RLS in patients with varicose veins of the lower extremities
    CEN Qing, TANG Mingjun, ZHU Yuefeng
    Journal of Surgery Concepts & Practice    2024, 29 (06): 493-497.   DOI: 10.16139/j.1007-9610.2024.06.06
    Abstract213)   HTML5)    PDF(pc) (962KB)(20)       Save

    Objective To study and evaluate the incidence of patent foramen ovale(PFO) and intracardiac right-to-left shunt(RLS)in the patients with varicose veins of the lower extremities. Methods From March 2023 to August 2024, 86 consecutive patients with varicose veins of the lower extremities were admitted to Cixi People’s hospital, and 57 of them who agreed to take foam sclerotherapy were selected for PFO-RLS test. Results Of the 57 patients, a total of 23 patients were positive for PFO with an incidence of 40.4% (95% CI: 27.2%-53.5%) and a total of 22 patients were positive for RLS with an incidence of 38.6% (95% CI: 25.6%-51.6%). The incidence of PFO was higher than the reported incidence in the general population, which is 26%. There were no serious complications such as pulmonary embolism or stroke occurred in all patients after surgery. Conclusions The incidence of PFO-RLS in patients with varicose veins of the lower extremities in this study was higher than that of expected in the general population. Patients with lower extremity varicose veins should be aware of the associated neurological complications when choosing sclerotherapy.

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    Trends analysis of pancreatic cancer mortality in Xuhui district, Shanghai from 1992 to 2021
    XU Jingshu, SHI Jianhua, GU Haiyan, CHEN Lei, QIAN Xiaolin, LU Lu, NIU Deng
    Journal of Surgery Concepts & Practice    2025, 30 (01): 34-40.   DOI: 10.16139/j.1007-9610.2025.01.07
    Abstract207)   HTML3)    PDF(pc) (1550KB)(9)       Save

    Objective To study the death status of pancreatic cancer among residents in Xuhui district, Shanghai, from 1992 to 2021, and analyze its trends of change, so as to provide evidence for the prevention and treatment of pancreatic cancer. Methods Based on the database of Shanghai death registration system from 1992 to 2021, the crude mortality rate, standardized mortality rate, age-specific mortality rate and other indicators of pancreatic cancer among registered residents in Xuhui district were calculated. The Joinpoint software was used to analyze the trends of average annual percent change (AAPC) of pancreatic cancer mortality rate, and the age-period-cohort model was used to analyze the age effect, period effect and birth cohort effect pairs significant changes in pancreatic cancer mortality. Results In 2021, the mortality rate of pancreatic cancer in Xuhui district, Shanghai, ranked fourth among malignant tumors, and the winning rate and world standard rate of the whole population, males and females were 8.34/100 000 (8.81/100 000, 7.98/100 000) and 7.28/100 000 (7.69/100 000, 6.96/100 000), respectively, with males higher than females. AAPC of crude mortality rate and the standardized (6) mortality rate were higher in males than that in females. The age-specific mortality rate increased with the increase of age, and the highest mortality rate was found in 60-84 years old group. The age-period-cohort model showed that from 1992 to 2021, the annual net shift of pancreatic cancer mortality among the whole population, male and female residents in Xuhui district, Shanghai, was 1.22%, 1.58%, 1.15% (P=0.20, 0.19, 0.45) respectively, and the time trend was not significant. From the perspective of age effect, the risk of death from pancreatic cancer in the whole population and with age deviation in males had an obvious trend with increasing age (P<0.05), while the age effect in females had no obvious trend. From the perspective of period effect, no period deviation was significant in the whole population, males and females (P>0.05). In terms of cohort effects, there were significant differences in the whole population and the male cohort deviations(P<0.05). No significant cohort effect was observed in the female population. Conclusions The mortality rate of pancreatic cancer among registered residents in Xuhui district, Shanghai from 1992 to 2021, was on the rise, especially in the 60-84 years old group and male. The prevention and control of pancreatic cancer needs to develop effective epidemic prevention measures for corresponding populations.

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    Role of biliary microbiota in the pathogenesis of bile duct stones: latest research progress
    WANG Xiaoning, WU Xiaodong, WU Shuodong, HAN Jinyan
    Journal of Surgery Concepts & Practice    2024, 29 (06): 544-548.   DOI: 10.16139/j.1007-9610.2024.06.15
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    The pathogenesis of bile duct stones (BDS) remains intricate and has not been fully elucidated to date. Emerging research has highlighted the biliary microbiota as a significant contributor to BDS. The diversity within the biliary microbiota correlates with stone formation, while bacterial metabolites and their self-protection mechanisms also exert pivotal roles in this process. Advanced technologies, such as high-throughput sequencing, offer fresh perspectives for in-depth exploration, and hold promise for novel strategies in the prevention and treatment of biliary tract diseases. This article comprehensively reviewed the recent advancements in research concerning the relationship and mechanisms between BDS and the biliary microbiota.

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