World Journal of Gastrointestinal Surgery最新文献

{"title":"Logistic regression analysis of pathological features of bone metastasis in colorectal cancer and related influencing factors after surgery.","authors":"Qiu-Yan Tang, Wei Yu","doi":"10.4240/wjgs.v17.i4.100851","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.100851","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer (CRC) is a common malignant tumor in the digestive system, whose main treatment comprises surgical resection, radiotherapy and chemotherapy, and targeted drug therapy. At present, the radical resection of CRC is the main way of achieving an early cure.</p><p><strong>Aim: </strong>To investigate the logistic regression analysis of bone metastasis after CRC surgery and related influencing factors.</p><p><strong>Methods: </strong>We selected 100 patients who underwent surgery for CRC and were admitted from February 2018 to February 2024, collected the general data of bone metastasis, and collected the pathological characteristics of patients with bone metastasis. Next, we divided them into groups with and without bone metastasis (Bone metastases group, <i>n</i> = 44; no bone metastases group, <i>n</i> = 56), compared the clinical data of the two groups, and analyzed the risk factors of bone metastasis using logistic regression analysis.</p><p><strong>Results: </strong>Among the 100 patients, the mean age was 54.33 ± 8.45 years, and most were male (54.55%). The proportion of patients with lytic bone changes was 43.18%. The most common location of combined bone metastasis was the pelvis, whereas only 5 patients had limb transfer. There was a higher incidence of lung than of pancreatic or liver metastases. Regression analysis showed that the primary location of the cancer was rectal cancer. Lymph node involvement, lung metastasis, and no postoperative chemotherapy were the risk factors for postoperative bone metastasis in patients who underwent surgery for CRC (<i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Rectal cancer, lymph node involvement, complicated pulmonary metastasis, and no postoperative chemotherapy treatment can help predict high risk of bone metastasis in CRC.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"100851"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-nucleus RNA sequencing and spatial transcriptomics reveal the mechanism by which Xiaozhiling injection treats internal hemorrhoids.","authors":"Min-Hui Ke, Shu-Yan Huang, Wei-Gan Lin, Zhen-Guo Xu, Xia-Xia Zheng, Xian-Bao Liu, You-Min Cheng, Zuan-Fang Li","doi":"10.4240/wjgs.v17.i4.103494","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.103494","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Hemorrhoids, a prevalent chronic condition globally, significantly impact patients' quality of life. While various surgical interventions, such as external stripping and internal ligation, procedure for prolapse and hemorrhoids, and tissue selecting technique, are employed for treatment, they are often associated with postoperative complications, including unsatisfactory defecation, bleeding, and anal stenosis. In contrast, Xiaozhiling injection, a traditional Chinese medicine-based therapy, has emerged as a minimally invasive and effective alternative for internal hemorrhoids. This treatment offers distinct advantages, such as reduced dietary restrictions, broad applicability, and minimal induction of systemic inflammatory responses. Additionally, Xiaozhiling injection effectively eliminates hemorrhoid nuclei, prevents local tissue necrosis, preserves anal cushion integrity, and mitigates postoperative complications, including bleeding and prolapse. Despite its clinical efficacy, the molecular mechanisms underlying its therapeutic effects remain poorly understood, warranting further investigation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To investigate the molecular mechanism underlying the therapeutic effect of Xiaozhiling injection in the treatment of internal hemorrhoids.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;An internal hemorrhoid model was established in rats, and the rats were randomly divided into a modeling group [control group (CK group)] and a treatment group. One week after injection, Stereo-seq and electron microscopy were used to study the changes in gene expression and subcellular structures in fibroblasts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Single-cell sequencing revealed differences in the expression and transcript levels of the genes collagen 3 alpha 1, decorin, and actin alpha 2 in fibroblasts between the CK group and the treatment group. Spatial transcriptome analysis revealed that genes of the sphingosine kinase 1 (Sphk1)/sphingosine-1-phosphate (S1P) pathway spatially overlapped with key genes of the transforming growth factor beta 1 pathway, namely, &lt;i&gt;Sphk1&lt;/i&gt;, S1P receptor, and transforming growth factor beta 1, in the treatment group. The proportion of fibroblasts was lower in the treatment group than in the CK group, and Xiaozhiling treatment had a significant effect on the proportion of fibroblasts in hemorrhoidal tissue. Immunohistochemistry revealed a significant increase in the expression of a fibroblast marker. Electron microscopy showed that the endoplasmic reticulum of fibroblasts contained a large amount of glycogen, indicating cell activation. Fibroblast activation and the expression of key genes of the Sphk1-S1P pathway could be observed at the injection site, suggesting that after Xiaozhiling intervention, the Sphk1-S1P pathway could be activated to promote fibrosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Xiaozhiling injection exerts its therapeutic effects on internal hemorrhoids by promoting collagen","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"103494"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of modified pancreatic duct stent drainage during endoscopic retrograde cholangiopancreatography for common bile duct stones.","authors":"Li-Jia Qian, Chen Xu, Jian-Rong Wang, Jun Quan","doi":"10.4240/wjgs.v17.i4.101295","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.101295","url":null,"abstract":"<p><strong>Background: </strong>Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated. However, there is still no optimal treatment approach.</p><p><strong>Aim: </strong>To investigate the clinical efficacy of modified pancreatic duct stent drainage in endoscopic retrograde cholangiopancreatography (ERCP) for treating common bile duct stones.</p><p><strong>Methods: </strong>This retrospective study included 175 patients with common bile duct stones treated at Taizhou Fourth People's Hospital between January 1, 2021, and November 30, 2023. The patients were divided into three groups-the modified pancreatic duct stent drainage group (59 cases), the nasobiliary drainage group (58 cases), and the standard biliary drainage group (58 cases). Preoperative general clinical data, laboratory indicators, and the visual analog scale (VAS) at two time points (24 hours before and after surgery) were compared, along with postoperative complications across the three groups.</p><p><strong>Results: </strong>Serum levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyltransferase, total bilirubin, direct bilirubin, C-reactive protein, and amylase were significantly lower in the modified pancreatic duct stent drainage group and the standard biliary drainage group than those in the nasobiliary drainage group (<i>P</i> < 0.05). However, no statistically significant differences were observed in white blood cells, hemoglobin, or neutrophil levels among the three groups (<i>P</i> > 0.05). The standard biliary drainage group had significantly lower VAS scores [(4.36 ± 1.18) points] than those for the modified pancreatic duct stent drainage group [(4.92 ± 1.68) points] (<i>P</i> = 0.033), and the nasobiliary drainage group [(5.54 ± 1.24) points] (<i>P</i> = 0.017). There were no statistically significant differences in complication rates across the three groups (<i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>Compared to standard biliary drainage and nasobiliary drainage, the modified pancreatic duct stent used during ERCP for patients with bile duct stones significantly reduced hepatocyte injury, improved liver function parameters, alleviated inflammation and pain, enhanced patient comfort, and demonstrated superior safety.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"101295"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Construction of a risk prediction model for postoperative cognitive dysfunction in colorectal cancer patients.","authors":"Zhen-Ping Zheng, Yong-Guo Zhang, Ming-Bo Long, Kui-Quan Ji, Jin-Yan Peng, Kai He","doi":"10.4240/wjgs.v17.i4.104459","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.104459","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Colorectal cancer (CRC) is one of the most prevalent and lethal malignant tumors worldwide. Currently, surgical intervention was the primary treatment modality for CRC. However, increasing studies have revealed that CRC patients may experience postoperative cognitive dysfunction (POCD).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To establish a risk prediction model for POCD in CRC patients and investigate the preventive value of dexmedetomidine (DEX).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective analysis was conducted on clinical data from 140 CRC patients who underwent surgery at the People's Hospital of Qian Nan from February 2020 to May 2024. Patients were allocated into a modeling group (&lt;i&gt;n&lt;/i&gt; = 98) and a validation group (&lt;i&gt;n&lt;/i&gt; = 42) in a 7:3 ratio. General clinical data were collected. Additionally, in the modeling group, patients who received DEX preoperatively were incorporated into the observation group (&lt;i&gt;n&lt;/i&gt; = 54), while those who did not were placed in the control group (&lt;i&gt;n&lt;/i&gt; = 44). The incidence of POCD was recorded for both cohorts. Data analysis was performed using statistical product and service solutions 20.0, with &lt;i&gt;t&lt;/i&gt;-tests or &lt;i&gt;χ&lt;/i&gt; &lt;sup&gt;2&lt;/sup&gt; tests employed for group comparisons based on the data type. Least absolute shrinkage and selection operator regression was applied to identify influencing factors and reduce the impact of multicollinear predictors among variables. Multivariate analysis was carried out using Logistic regression. Based on the identified risk factors, a risk prediction model for POCD in CRC patients was developed, and the predictive value of these risk factors was evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Significant differences were observed between the cognitive dysfunction group and the non-cognitive dysfunction group in diabetes status, alcohol consumption, years of education, anesthesia duration, intraoperative blood loss, intraoperative hypoxemia, use of DEX during surgery, intraoperative use of vasoactive drugs, surgical time, systemic inflammatory response syndrome (SIRS) score (&lt;i&gt;P&lt;/i&gt; &lt; 0.05). Multivariate Logistic regression analysis identified that diabetes [odds ratio (OR) = 4.679, 95% confidence interval (CI) = 1.382-15.833], alcohol consumption (OR = 5.058, 95%CI: 1.255-20.380), intraoperative hypoxemia (OR = 4.697, 95%CI: 1.380-15.991), no use of DEX during surgery (OR = 3.931, 95%CI: 1.383-11.175), surgery duration ≥ 90 minutes (OR = 4.894, 95%CI: 1.377-17.394), and a SIRS score ≥ 3 (OR = 4.133, 95%CI: 1.323-12.907) were independent risk factors for POCD in CRC patients (&lt;i&gt;P&lt;/i&gt; &lt; 0.05). A risk prediction model for POCD was constructed using diabetes, alcohol consumption, intraoperative hypoxemia, non-use of DEX during surgery, surgery duration, and SIRS score as factors. A receiver operator characteristic curve analysis of these factors revealed the model's predictive sensitivity (88.56%), specificity (70.64%), and area under the curve (AUC) (AU","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"104459"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early prediction of anastomotic leakage after rectal cancer surgery: Onodera prognostic nutritional index combined with inflammation-related biomarkers.","authors":"Zi-Yi Zhang, Ke-Jin Li, Xiang-Yue Zeng, Kuan Wang, Subinur Sulayman, Yi Chen, Ze-Liang Zhao","doi":"10.4240/wjgs.v17.i4.102862","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.102862","url":null,"abstract":"<p><strong>Background: </strong>Anastomotic leakage (AL) is a serious complication following rectal cancer surgery and is associated with increased recurrence, mortality, extended hospital stays, and delayed chemotherapy. The Onodera prognostic nutritional index (OPNI) and inflammation-related biomarkers, such as the neutrophil-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), have been studied in the context of cancer prognosis, but their combined efficacy in predicting AL remains unclear.</p><p><strong>Aim: </strong>To investigate the relationships between AL and these markers and developed a predictive model for AL.</p><p><strong>Methods: </strong>A retrospective cohort study analyzed the outcomes of 434 patients who had undergone surgery for rectal cancer at a tertiary cancer center from 2016 to 2023. The patients were divided into two groups on the basis of the occurrence of AL: One group consisted of patients who experienced AL (<i>n</i> = 49), and the other group did not (<i>n</i> = 385). The investigation applied logistic regression to develop a risk prediction model utilizing clinical, pathological, and laboratory data. The efficacy of this model was then evaluated through receiver operating characteristic curve analysis.</p><p><strong>Results: </strong>In the present study, 11.28% of the participants (49 out of 434 participants) suffered from AL. Multivariate analysis revealed that preoperative levels of the OPNI, NLR, and PLR emerged as independent risk factors for AL, with odds ratios of 0.705 (95%CI: 0.641-0.775, <i>P</i> = 0.012), 1.628 (95%CI: 1.221-2.172, <i>P</i> = 0.024), and 0.994 (95%CI: 0.989-0.999, <i>P</i> = 0.031), respectively. These findings suggest that these biomarkers could effectively predict AL risk. Furthermore, the proposed predictive model has superior discriminative ability, as demonstrated by an area under the curve of 0.910, a sensitivity of 0.898, and a specificity of 0.826, reflecting its high level of accuracy.</p><p><strong>Conclusion: </strong>The risk of AL in rectal cancer surgery patients can be effectively predicted by assessing the preoperative levels of serum nutritional biomarkers and inflammatory indicators, emphasizing their importance in the preoperative evaluation process.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"102862"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visualizing global progress and challenges in esophagogastric variceal bleeding.","authors":"De-Xin Wang, Xue-Jie Wu, Jin-Zhong Yu, Jun-Yi Zhan, Fei-Fei Xing, Wei Liu, Jia-Mei Chen, Ping Liu, Cheng-Hai Liu, Yong-Ping Mu","doi":"10.4240/wjgs.v17.i4.102020","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.102020","url":null,"abstract":"<p><strong>Background: </strong>Esophageal and gastric variceal bleeding is a catastrophic complication of portal hypertension, most commonly caused by cirrhosis of various etiologies. Although a considerable body of research has been conducted in this area, the complexity of the disease and the lack of standardized treatment strategies have led to fragmented findings, insufficient information, and a lack of systematic investigation. Bibliometric analysis can help clarify research trends, identify core topics, and reveal potential future directions. Therefore, this study aims to use bibliometric methods to conduct an in-depth exploration of research progress in this field, with the expectation of providing new insights for both clinical practice and scientific research.</p><p><strong>Aim: </strong>To evaluate research trends and advancements in esophagogastric variceal bleeding (EGVB) over the past twenty years.</p><p><strong>Methods: </strong>Relevant publications on EGVB were retrieved from the Web of Science Core Collection. VOSviewer, Pajek, CiteSpace, and the bibliometrix package were then employed to perform bibliometric visualizations of publication volume, countries, institutions, journals, authors, keywords, and citation counts.</p><p><strong>Results: </strong>The analysis focused on original research articles and review papers. From 2004 to 2023, a total of 2097 records on EGVB were retrieved. The number of relevant publications has increased significantly over the past two decades, especially in China and the United States. The leading contributors in this field, in terms of countries, institutions, authors, and journals, were China, Assistance Publique-Hôpitaux de Paris, Bosch Jaime, and <i>World Journal of Gastroenterology</i>, respectively. Core keywords in this field include portal hypertension, management, liver cirrhosis, risk, prevention, and diagnosis. Future research directions may focus on optimizing diagnostic methods, personalized treatment, and multidisciplinary collaboration.</p><p><strong>Conclusion: </strong>Using bibliometric methods, this study reveals the developmental trajectory and trends in research on EGVB, underscoring risk assessment and diagnostic optimization as the core areas of current focus. The study provides an innovative and systematic perspective for this field, indicating that future research could center on multidisciplinary collaboration, personalized treatment approaches, and the development of new diagnostic tools. Moreover, this work offers practical research directions for both the academic community and clinical practice, driving continued advancement in this domain.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"102020"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between peripheral blood endotoxin, toll-like receptor 4 expression, and postoperative infection following surgery for acute appendicitis.","authors":"Wei Su, Tao Yang, Xiao-Jun Hu, Juan Song, Jing-Jing He, Dan Huang, Bo Zhang, Xiao-Ji Zhao, Fang Tang","doi":"10.4240/wjgs.v17.i4.104443","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.104443","url":null,"abstract":"<p><strong>Background: </strong>Acute appendicitis, a common condition with a higher prevalence among men, has shown an increasing incidence in recent years owing to lifestyle changes. It is characterized by right lower quadrant abdominal pain, rebound tenderness, and rapid onset. Its pathogenesis is complex and potentially linked to infection, environment, and genetics. Timely intervention is crucial to prevent complications. While surgery is the primary treatment, it carries risks, including postoperative infections that may necessitate re-operation. Gram-negative bacteria release endotoxin (ETX), which induces inflammation and is recognized by toll-like receptor 4 (TLR4). This study evaluated ETX and TLR4 levels in patients with acute appendicitis to assess the risk of postoperative incision infections, aiding in prevention and treatment.</p><p><strong>Aim: </strong>To explore ETX and TLR4 expression in the blood of patients with acute appendicitis and its association with in postoperative incision infection.</p><p><strong>Methods: </strong>A total of 153 patients with acute appendicitis treated at our hospital between April 2022 and March 2024 (<i>n</i> = 153) were included in the study. Patients were categorized into infected (<i>n</i> = 36) and uninfected (<i>n</i> = 117) groups according to the development of postoperative incision infections. General characteristics and blood levels of ETX and TLR4 were compared, and the factors influencing postoperative infection were identified using multivariate logistic regression. ETX and TLR4 predictive values were analyzed using receiver operating characteristic curves.</p><p><strong>Results: </strong>No statistically significant differences were observed between the two groups in terms of sex, age, or other general characteristics (<i>P</i> > 0.05). Compared to the uninfected group, the infected group had a higher proportion of patients with suppurative or gangrenous appendicitis, longer surgical times, longer incision lengths, and elevated ETX and TLR4 levels (<i>P</i> < 0.05). Multivariate logistic regression analysis identified pathological type, surgical method, surgical time, and incision length as factors influencing postoperative incision infection in acute appendicitis. Receiver operating characteristic curve analysis revealed that both ETX and TLR4 levels were predictive factors for postoperative incision infection, with higher prediction efficiency when combined.</p><p><strong>Conclusion: </strong>Pathological type, surgical method, surgical time, and incision length significantly influence postoperative incision infection risk in patients with acute appendicitis. Elevated ETX and TLR4 levels serve as valuable predictors of post-appendectomy infections.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"104443"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transjugular intrahepatic portosystemic shunt and non-selective beta-blockers act as friends or foe in decompensated cirrhosis: A comparative review.","authors":"Eyad Gadour, Syed A Gardezi","doi":"10.4240/wjgs.v17.i4.103395","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.103395","url":null,"abstract":"<p><p>The management of portal hypertension and its complications, such as variceal bleeding, in patients with cirrhosis often involves the use of nonselective beta-blockers (NSBBs) and a transjugular intrahepatic portosystemic shunt (TIPS). Both treatment modalities have demonstrated efficacy; however, each presents distinct challenges and benefits. NSBBs, including propranolol, nadolol, and carvedilol, effectively reduce portal pressure, but are associated with side effects such as bradycardia, hypotension, fatigue, and respiratory issues. Additionally, NSBBs can exacerbate conditions such as refractory ascites, hepatorenal syndrome, and hepatic encephalopathy. In contrast, TIPS effectively reduces the incidence of variceal rebleeding, controlling refractory ascites. However, it is associated with a significant risk of hepatic encephalopathy, shunt dysfunction, and procedure-related complications including bleeding and infection. The high cost of TIPS, along with the need for regular follow-up and potential re-intervention, poses additional challenges. Furthermore, patient selection for TIPS is critical, as inappropriate candidates may experience suboptimal outcomes. Future studies comparing NSBBs and TIPS should focus on refining the patient selection criteria, enhancing procedural techniques, optimising combination therapies, and conducting long-term outcome studies. Personalised treatment approaches, cost-effectiveness analyses, and improved patient education and support are essential for maximising the use of these therapies.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"103395"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nursing care for patients with liver cirrhosis undergoing surgery for esophageal variceal bleeding in an integrated healthcare system.","authors":"Wen-Xiu Su, Yun-Fei Li, Yi-Jun Zhu, Di-Wen Li","doi":"10.4240/wjgs.v17.i4.100400","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.100400","url":null,"abstract":"<p><strong>Background: </strong>Globally, Liver cirrhosis is the 14th leading cause of death and poses a significant threat to human health.</p><p><strong>Aim: </strong>To investigate the effects of a multidisciplinary collaboration model on postoperative recovery and psychological stress in patients with liver cirrhosis undergoing esophageal variceal bleeding (EVB) surgery within an integrated healthcare system.</p><p><strong>Methods: </strong>Between January 2022 and March 2024, a total of 180 patients with cirrhosis and EVB were admitted and randomly assigned to either a control group (standard care) or an observation group (standard care plus the multidisciplinary collaboration model), with 90 patients in each group. Postoperative recovery indicators (time to symptom improvement, time to start eating, time to bowel sound recovery, time to first flatus, and hospital stay), psychological stress responses [self-rating anxiety scale (SAS); self-rating depression scale (SDS)], subjective well-being, and incidence of complications were compared between the two groups.</p><p><strong>Results: </strong>Compared to the control group, the observation group showed earlier symptom improvement, earlier return to eating, bowel sound recovery, first flatus, and a shorter hospital stay. Pre-intervention SAS and SDS scores were not significantly different between the groups, but post-intervention scores were significantly lower in the observation group. Similarly, there was no significant difference in the subjective well-being scores before the intervention between the two groups. After the intervention, both groups showed improved scores, with the observation group scoring significantly higher than the control group.</p><p><strong>Conclusion: </strong>The observation group also had a lower incidence of complications. Therefore, for patients with liver cirrhosis undergoing EVB surgery, a multidisciplinary collaboration model within an integrated healthcare system can promote early postoperative recovery, reduces psychological stress, improves subjective well-being, and reduces complications and rebleeding.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"100400"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nomogram for predicting survival after transjugular intrahepatic portosystemic shunt in portal hypertension patients with bleeding.","authors":"Zhi-Bin Wang, Bing Zhu, Ming-Ming Meng, Yi-Fan Wu, Yu Zhang, Dong-Ze Li, Hua Tian, Fu-Chuan Wang, Yi-Fan Lv, Qiu-Xia Ye, Fu-Quan Liu","doi":"10.4240/wjgs.v17.i4.104884","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.104884","url":null,"abstract":"<p><strong>Background: </strong>Portal hypertension (PHT) is a life-threatening complication of cirrhosis, often resulting in gastrointestinal bleeding that requires transjugular intrahepatic portosystemic shunt (TIPS). While TIPS effectively reduces portal pressure, predicting long-term survival remains challenging due to the multifactorial nature of patient outcomes. Accurate survival prediction tools are lacking, and existing models often omit critical factors such as portal vein diameter. This study aimed to develop and validate a nomogram incorporating key clinical and biochemical variables to predict 1-year and 2-year survival following TIPS in PHT patients. We hypothesized that this model would provide improved risk stratification and guide clinical decisions.</p><p><strong>Aim: </strong>To develop and validate a nomogram for predicting 1-year and 2-year survival in PHT patients post-TIPS.</p><p><strong>Methods: </strong>This retrospective cohort study included 848 TIPS-treated PHT patients with gastrointestinal bleeding from two tertiary hospitals (2013-2021). Mortality was the primary endpoint. Predictive variables were selected using least absolute shrinkage and selection operator regression, and a nomogram was developed with Cox regression to predict 1-year and 2-year survival. Model performance was evaluated through receiver operating characteristic curves, calibration plots, and decision curve analysis.</p><p><strong>Results: </strong>The mean age of the included (848) patients was 53.00 years ± 12.51, where 69.58% were men. Results showed that portal vein diameter, serum creatinine, potassium, and alpha-fetoprotein were the independent predictors of post-TIPS survival. Besides, the model showed strong discriminatory ability (C-index, 0.816 in the training set; 0.827 in the validation set) and good calibration. The area under the curve for 1-year and 2-year survival in the training set were 0.890 [95% confidence interval (CI): 0.802-0.948] and 0.838 (95%CI: 0.803-0.869), respectively. The area under the curve for 1-year and 2-year survival in the validation set were 0.934 (95%CI: 0.815-0.987) and 0.864 (95%CI: 0.811-0.907), respectively.</p><p><strong>Conclusion: </strong>The developed nomogram could reliably predict 1-year and 2-year survival in patients undergoing TIPS for PHT-induced gastrointestinal bleeding.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"104884"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}