ObjectiveTo build a radiomics model based on preoperative B mode ultrasound (BMUS) and shear wave elastography (SWE) characteristics for predicting clinically relevant postoperative pancreatic fistula (CR-POPF) following radical pancreatectomy.MethodsA total of 138 patients who underwent radical surgery for pancreatic cancer at Zhongshan Hospital Affiliated to Fudan University from February 2021 to February 2022 and received pancreatic ultrasound examination and ultrasound SWE elasticity assessment within one week before surgery were included in this retrospective study. There were 60 cases of pancreaticoduodenectomy and 78 cases of distal pancreatectomy. The patients were divided into CR-POPF positive group (39 cases) and CR-POPF negative group (99 cases). Based on preoperative BMUS images and quantitative shear wave velocity (SWV) values of the pancreatic lesion and the surrounding normal pancreatic parenchyma in ultrasound elastography, the radiomics features were extracted using the minimum redundancy maximum relevance algorithm (mRMR) and the modified logistic regression algorithm with the selection operator (LASSO). A radiomics model for prediction of CR-POPF was constructed through multivariate logistic regression analysis. The diagnostic efficacy of the clinical prediction model (CM) based on potential clinical risk factors of CR-POPF, the radiomics model (lesRS) based on two-dimensional gray-scale ultrasound images of pancreatic lesions, the radiomics model (panRS) based on two-dimensional gray-scale ultrasound images of normal pancreatic parenchyma, the radiomics model (LT-RS) based on ultrasound images of pancreatic lesions and normal parenchyma, and the CR-POPF prediction model (C-LT-RS) combining clinical parameters and radiomics features were evaluated and compared through ROC curve analysis.ResultsThe SWV value of normal pancreatic tissue in the CR-POPF positive group was significantly lower than that in the CR-POPF negative group ([0.94±0.28] m/s vs. [1.18±0.50] m/s, P<0.001). The SWV ratio of the lesion center to normal pancreatic tissue in the CR-POPF positive group was significantly higher than that in the CR-POPF negative group ([1.60±0.71] m/s vs. [1.29±0.57] m/s, P=0.016). The results of univariate logistic regression analysis showed that the quantitative SWV value of normal pancreatic tissue by ultrasound elastography was significantly negatively correlated with the occurrence of CR-POPF after surgery (OR=－1.686, 95%CI: －3.288 to －0.085, P=0.039). The results of multivariate logistic regression analysis showed that the SWV value of normal pancreatic tissue was an independent risk factor for the occurrence of CR-POPF after surgery (OR=－1.892, 95%CI: －3.956 to 0.115, P=0.021). In the training set of CM, the accuracy rate of preoperative prediction of CR-POPF by the SWV value of normal pancreatic tissue was 50.54%, with a sensitivity of 0.885 and a specificity of 0.358; in the test set, the accuracy rate was 68.29%, with a sensitivity of 0.833 and a specificity of 0.621. In the training set of lesRS, the accuracy rate of preoperative prediction of CR-POPF was 67.74%, with a sensitivity of 0.615 and a specificity of 0.702; in the test set, the accuracy rate was 70.73%, with a sensitivity of 0.833 and a specificity of 0.966. In the training set of panRS, the accuracy rate of preoperative prediction of CR-POPF was 68.65%, with a sensitivity of 0.525 and a specificity of 0.751; in the test set, the accuracy rate was 70.36%, with a sensitivity of 0.833 and a specificity of 0.602. In the training set of LT-RS, the accuracy rate of preoperative prediction of CR-POPF was 69.89%, with a sensitivity of 0.577 and a specificity of 0.746; in the test set, the accuracy rate was 68.29%, with a sensitivity of 0.734 and a specificity of 0.621. In the training set and test set of C-LT-RS, the accuracy rate of preoperative prediction of CR-POPF was 62.37% and 80.49%, respectively, with a sensitivity of 0.962 and 0.667, and a specificity of 0.493 and 0.862. In the training set and test set of C-LT-RS, the area under the ROC (AUROC) for predicting the occurrence of CR-POPF after surgery was higher than those of CM, lesRS, panRS and LT-RS.ConclusionModified prediction model based on BMUS radiomics characteristics and quantitative SWE values of pancreas displays potential value in non-invasive and quantitative assessment of CR-POPF risk before radical surgery for pancreatic cancer.

ObjectiveTo investigate the relationship between surgical risk factors and intraoperative blood loss in carotid body tumor resection.MethodsA retrospective analysis conducted. Clinical data of 227 patients who underwent carotid body tumor resection in the Department of Vascular Surgery at the First Affiliated Hospital of Naval Military Medical University and the Department of Gerneral Surgury at the Shanghai Seventh People's Hospital between November 2008 and October 2020 were retrospectively collected by the hospital's electronic medical record system. There were 130 males and 97 females, with a mean age of (43.55±13.30) years. Demographic data (age, sex, body mass index[BMI], systolic and diastolic blood pressures at admission, alcohol consumption, and smoking history), comorbidities (hypertension, diabetes, coronary artery disease, and cerebrovascular disease), and surgical variables (operation duration, intraoperative blood loss, covered stent implantation, artificial vascular replacement, and preoperative embolization) were compared among the three Shamblin classification groups. Univariate and multivariate regression analyses were performed to identify surgical risk factors influencing intraoperative blood loss.ResultsSignificant differences were observed among the three Shamblin types in BMI, operation duration, intraoperative blood loss, vascular reconstruction methods, and preoperative embolization (all P<0.05). Univariate logistic regression analysis revealed that intraoperative blood loss was negatively correlated with age (=－14.31, 95%CI: －20.65 to －7.97), BMI (=－29.47, 95%CI: －55.33 to －3.60) (P<0.01 or 0.05), while positively correlated with vascular reconstruction (=688.09, 95%CI: 452.23 to 923.95) and Shamblin type Ⅲ carotid body tumors (=627.38, 95%CI: 385.28 to 869.49) (both P<0.01). No significant association was found between intraoperative blood loss and preoperative laboratory parameters, including white blood cell count, lymphocyte percentage, neutrophil percentage, red blood cell count, hemoglobin, platelet count, D-dimer, thrombin time, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrin degradation products, or fibrinogen (all P>0.05). Factors demonstrating statistical significance (age, BMI, Shamblin classification of carotid body tumor, and surgical approach), along with preoperative carotid artery embolization, were incorporated into multivariate logistic regression analysis. As shown in Model 3, age (=－10.30, 95%CI: －17.41 to －3.20, P<0.01) was a protective factor for intraoperative blood loss, Shamblin type Ⅲ carotid body tumors (=573.93, 95%CI: 321.53 to 826.34) and vascular reconstruction (=361.64, 95%CI: 107.53 to 615.76) were identified as significant risk factors for intraoperative blood loss (all P<0.01), whereas preoperative embolization showed no significant effect (=－297.23, 95%CI: －651.11 to 56.66, P>0.05).ConclusionAge is a protective factor for intraoperative blood loss in carotid body tumor resection. Shamblin type Ⅲ carotid body tumor, and vascular reconstruction are risk factors for intraoperative blood loss in carotid body tumor resection.

ObjectiveTo investigate the therapeutic efficacy of dienogest in childbearing-age patients with recurrent endometriosis after conservative surgical treatment.MethodsA total of 81 patients who were admitted to our hospital due to recurrent endometriosis after laparoscopic surgery from January 2020 to December 2022 were selected and randomly divided into a study group and a control group. The study group received oral dienogest at a dose of 2 mg once daily, which could be started at any time during the menstrual cycle, with a treatment duration of 24 weeks. The control group was subcutaneously injected with gonadotropin-releasing hormone analogue (GnRH-a) of 3.75 mg on the first day of the menstrual cycle, once every 28 days, for a total of 24 weeks. Low-dose estrogen (0.5 mg/d) was given at the 18th week of treatment (regardless of the occurrence of hot flashes) or when experiencing uncomfortable symptoms such as hot flashes. The levels of follicle-stimulating hormone (FSH) and estradiol (E2) before and after treatment were compared between the two groups to evaluate the hormonal suppression. The levels of CA125 and the size of the cysts before and after treatment were compared to assess the disease control. Pain was evaluated using the Visual Analog Scale (VAS), and the pain reduction index (X) was used to assess the quality of life of the patients. The adverse reactions and the recurrence of dysmenorrhea after discontinuation of the medication were assessed.ResultsThere were 40 patients in the study group with a mean age of (42.00±3.84) years and a mean recurrence time of (16.00±4.42) months. There were 41 patients in the control group with a mean age of (45.00±1.96) years and a mean recurrence time of (14.00±3.88) months. There were no statistically significant differences in the levels of FSH, E2, or CA125 between the two groups before treatment, at 6 months of treatment, or at 6 months after treatment (all P>0.05). Transvaginal ultrasound showed that the cyst size was (7.37±2.40) cm3 in the study group and (7.39±2.14) cm3 in the control group before treatment (P>0.05). The cyst size decreased after treatment in both groups, but there was no significant difference in the cyst size between the two groups (P>0.05). There were no statistically significant differences in VAS scores between the two groups before treatment, at 6 months of treatment, or at 6 months after treatment (all P>0.05). The VAS scores at 6 months of treatment and at 6 months after treatment were significantly lower than those before treatment in both groups (all P<0.05). In the study group, the complete relief of pain was achieved in 28 patients, significant relief in 11, and partial relief in one; in the control group, 32 patients achieved complete relief of pain, and 9 had significant relief. The total effective rate of treatment was 100.00% in both groups (P>0.05). During the treatment period, 17 patients in the study group experienced irregular vaginal bleeding, while only 3 patients in the control group (P<0.05). Six patients had hot flashes and the symptom relieved after administration of estrogen in the control group, while no patient in the study group experienced such symptoms (P<0.05). The dysmenorrhea recurred in one patient in the study group and 3 patients in the control group (P>0.05). Follow-up results at 6 months after discontinuation of the medication showed no significant change in the cyst volume at 6 months after treatment as compared to that at 6 months of treatment in either group, and there was no statistically significant difference in cyst volume between the two groups at 6 months after treatment (P>0.05).ConclusionDienogest is safe and effective in the treatment of recurrent endometriosis in women of childbearing age and is suitable for long-term management of such patients.