ObjectiveTo explore the predictive value of microRNA-215 (miR-215) and microRNA-7-5p (miR-7-5p) expression levels in gastric cancer tissues for recurrence after endoscopic submucosal dissection (ESD) based on restricted cubic spline (RCS). MethodsA total of 200 patients with early gastric cancer who underwent ESD in Yibin Second People’s Hospital from August 2020 to August 2022 were prospectively selected. The patients were followed up for 2 years, and the postoperative recurrence was counted. RCS was used to analyze the predictive value of miR-215 and miR-7-5p expression levels in gastric cancer tissues for recurrence after ESD and the dose-response relationship with recurrence after ESD. Helicobacter pylori (HP) infection, tumor maximum diameter, depth of invasion, carbohydrate antigen 724 (CA724) level, and neutrophils to lymphocytes ratio (NLR) were included to construct a basic nomogram prediction model, expression levels of miR-215 and miR-7-5p, HP infection, tumor maximum diameter, depth of invasion, CA724 level, and NLR were included to construct a new nomogram prediction model. The value of the two models in predicting recurrence after ESD was compared. The clinical data of 84 patients with early gastric cancer who underwent ESD in Deyang People’s Hospital from September 2022 to September 2023 were retrospectively collected for external validation. ResultsDuring the follow-up period, 5 of 200 patients with early gastric cancer were lost to follow-up, and 195 patients were included and analyzed. The recurrence rate after ESD was 11.28% (22/195). The expression level of miR-215 in gastric cancer tissues of recurrence group and non-recurrence group [recurrence group: (0.67±0.15) vs. (0.97±0.24); non-recurrence group: (0.84±0.19) vs. (0.98±0.26)], miR-7-5p [recurrence group: (0.45±0.12) vs. (1.59±0.36); non-recurrence group:(0.68±0.20) vs. (1.61±0.37)] were lower than those in adjacent tissues (P<0.05). The expression levels of miR-215 (OR=0.850, P=0.008) and miR-7-5p (OR=0.798, P=0.005) in gastric cancer tissues were the influencing factors of recurrence after ESD. There was a linear dose-response relationship between the expression levels of miR-215 and miR-7-5p in gastric cancer tissues and the recurrence after ESD (Poverall=0.009, Poverall<0.001; Pnonlinear=0.923, Pnonlinear=0.786). The area under curve (AUC) of the new nomogram prediction model including expression levels of miR-215 and miR-7-5p, HP infection, tumor maximum diameter, depth of invasion, CA724 level, and NLR for predicting recurrence after ESD was 0.964 [95%CI (0.900, 0.981)], which was greater than 0.857 [95%CI (0.796, 0.892)] of the basic nomogram prediction model, Z=2.158, P=0.032. The new nomogram prediction model has a high degree of calibration in predicting recurrence after ESD, and the clinical effect was good. External validation showed that the AUC of the new nomogram prediction model for predicting recurrence after ESD was 0.945 [95%CI (0.886, 0.978)], and the calibration degree for predicting recurrence after ESD was high and the clinical utility was good. ConclusionsThe expression levels of miR-215 and miR-7-5p in gastric cancer tissues of patients with early gastric cancer are lower than those in adjacent tissues, and there is a linear dose-response relationship with recurrence after ESD. The nomogram prediction model based on the expression levels of miR-215 and miR-7-5p in gastric cancer tissues can provide a reliable clinical basis for clinical prediction of postoperative recurrence.
Objective To discuss the short-term effectiveness of total hip arthroplasty (THA) for post-traumatic osteoarthritis secondary to acetabular fracture. Methods Between January 2004 and March 2012, the clinical data was analyzed retrospectively from 12 cases (13 hips) of post-traumatic osteoarthritis secondary to acetabular fracture undergoing THA. Of 12 patients, 6 were male and 6 were female, with an average age of 55.6 years (range, 40-68 years). The locations were the left hip in 5 cases, the right hip in 6 cases, and bilateral hips in 1 case. The interval between acetabular fracture and THA was 65.7 months on average (range, 12-240 months). The preoperative hip Harris score was 48.8 ± 9.5. Results The incisions healed by first intention. No deep vein thrombosis and infection occurred postoperatively. Ten cases were followed up 1-7 years (mean, 4.8 years). The hip Harris score was 86.5 ± 8.6 at last follow-up, showing significant difference when compared with preoperative score (t=10.520, P=0.006). X-ray films showed no acetabular prosthesis instability. Stem subsidence (2 mm) occurred in 1 case, peri-prosthetic osteolysis in 2 cases, and heterotopic ossification in 2 cases (Brooker type I and type II in 1 case, respectively). Conclusion THA has satisfactory short-term effectiveness for post-traumatic osteoarthritis secondary to acetabular fracture. The good effectiveness is based on strict case selection, pathological evaluation, and the proper acetabular reconstruction.
Objective To evaluate the impact of an integrated management mode of prenatal diagnosis-postnatal treatment for congenital heart disease (CHD) on perioperative and long-term outcomes of the arterial switch operation (ASO), and to analyze the efficacy of ASO in a single center. Methods This retrospective study analyzed the clinical data of 183 children who underwent ASO at Guangdong Provincial People’s Hospital from 2018 to 2024. The cohort included 106 (57.9%) patients of transposition of the great arteries with intact ventricular septum (TGA/IVS), 61 (33.3%) patients of transposition of the great arteries with ventricular septal defect (TGA/VSD), and 16 (8.7%) patients of Taussig-bing anomaly (TBA). Perioperative indicators were compared between 91 patients in the prenatal-postnatal integrated management group (an integrated group) and 92 patients in the traditional management group (a non-integrated group). Long-term survival and reoperation rates were analyzed using Kaplan-Meier curves. Results The overall perioperative mortality rate was 4.9% (9/183), showing a downward trend year by year. The primary cause of perioperative mortality was low cardiac output syndrome (LCOS), which occurred in 12 patients (6.6% incidence) with a mortality rate of 75.0%. The integrated group had a higher proportion of males (89.0% vs. 72.8%, P<0.05) and lower body weight [3.1 (2.7, 3.3) kg vs. 3.3 (3.0, 3.7) kg, P<0.05] compared to the non-integrated group. The age at surgery was significantly earlier in the integrated group [7 (3, 10) d vs. 14 (9, 48) d, P<0.05], and all children in the integrated group underwent ASO within the optimal surgical window (100.0% vs. 82.6%, P<0.05). Intraoperatively, cardiopulmonary bypass time [173 (150, 207) min vs. 186 (159, 237) min, P<0.05] and aortic cross-clamp time [100 (90, 117) min vs. 116 (97, 142) min, P<0.05] were significantly shorter in the integrated group. Although the integrated group had longer postoperative mechanical ventilation time [145 (98, 214) h vs. 116 (77, 147) h, P<0.05] and higher 48-hour maximum vasoactive inotropic score [15 (10, 21) points vs. 12 (8, 16) points, P<0.05], there was no statistically significant difference in the incidence of severe complications (LCOS, necrotizing enterocolitis, extracorporeal membrane oxygenation) or mortality rate (3.3% vs. 6.5%, P=0.51) between the two groups, despite earlier surgical intervention and a higher proportion of critically ill cases in the integrated group. The length of hospital stay in the emergency surgery group was significantly shorter than that in the elective surgery group [20 (15, 28) d vs. 25 (21, 30) d, P<0.05], suggesting that early surgery may be of potential benefit. A total of 163 patients were successfully followed up for a median of 4.7 years, with a 5-year survival rate of 95.1% and a freedom from reintervention survival rate of 95.1%. There were no late deaths, and the most common postoperative complication was pulmonary artery stenosis. Conclusion The integrated management model allowed critically ill children with lower body weights to safely undergo surgery, significantly optimizing the timing of surgery and shortening intraoperative times. The long-term risk of reoperation after ASO is primarily concentrated on pulmonary artery stenosis, necessitating long-term follow-up and monitoring.