ObjectiveTo assess the causal relationship between cervical vertebra related disorders and essential hypertension using a bidirectional two-sample Mendelian randomization study approach. MethodsThe research data comes from the genome-wide association study dataset. Four types of cervical vertebra related disorders: cervicalgia, cervical disc disorders, cervical root disorders, injury of nerves and spinal cord at neck level, as well as data on essential hypertension, were selected for the study. Relevant single nucleotide polymorphisms were selected as instrumental variables to assess the causal relationship between cervical vertebra related disorders and essential hypertension mainly by inverse variance weighted model ratio. Cochran's Q test was used to detect heterogeneity, MR-Egger intercept term and MR-PRESSO was used to detect multiplicity, and leave-one-out method was used for sensitivity analysis. ResultsCervicalgia had a positive causal relationship with the essential hypertension (OR=1.01, 95%CI 1.00 to1.02, P=0.019). Essential hypertension had a positive causal relationship with the cervical disc disorders (OR=4.08, 95%CI 1.57 to10.61, P=0.004). There was no significant causal relationship between cervical root disorders, injury of nerves and spinal cord at neck level and essential hypertension. Reliability assessment indicates that the study results were reliable. ConclusionCervicalgia is a risk factor for essential hypertension; Essential hypertension is a risk factor for cervical disc lesions; There is no correlation between cervical root disorders, injury of nerves and spinal cord at neck level and essential hypertension.
ObjectiveTo investigate the short-term outcomes and the impact on postoperative peritoneal implantation after laparoscopic radical gastrectomy with natural orifice specimen extraction surgery (NOSES) compared with small incision specimen extraction. MethodsPatients who underwent standard laparoscopic radical gastrectomy with NOSES (NOSES group) admitted to The Second People’s Hospital of Yibin from September 2022 to October 2024 were retrospectively enrolled. Propensity score matching (PSM) at a 1∶1 ratio was performed to select patients receiving standard laparoscopic radical gastrectomy with small incision specimen extraction as controls (small incision group). Operative indicators, visual analogue scale (VAS) points at different postoperative time points (6 h, 12 h, 24 h, 72 h), oncological outcomes, complications, and patients’ satisfaction were compared between the two groups. ResultsA total of 252 patients were enrolled. After PSM, 102 patients were included in the NOSES group and the small incision group respectively, and the baseline characteristics were well balanced between the two groups (all standardized mean differences <0.2). There were no statistically significant differences in operation time and intraoperative blood loss between the NOSES group and the small incision group (P>0.05). The time to first postoperative flatus, first ambulation, first liquid diet intake, and postoperative hospital stay were significantly shorter in the NOSES group than those in the small incision group (P<0.05). Repeated-measures analysis of variance for postoperative VAS pain points at multiple time points revealed a significant group-by-time interaction effect (Finteraction=58.969, P<0.001). VAS pain points gradually decreased over postoperative time in both groups (Ftime=102.582, P<0.001), and the main effect of group was statistically significant (Fgroup=8.635, P<0.001). At all identical observation time points of 6 h, 12 h, 24 h and 72 h postoperatively, VAS pain points were consistently lower in the NOSES group than those in the small incision group (all P<0.05). No statistically significant differences were observed between the NOSES group and the small incision group (all P>0.05) in the number of harvested lymph nodes [(35.67±9.78) per case vs. (36.12±10.23) per case], proximal resection margin length [(4.23±1.56) cm vs. (4.05±1.78) cm], distal resection margin length [(6.89±2.34) cm vs. (7.11±2.45) cm], R0 resection rate (100% vs. 100%), local recurrence rate [1.96% (2/102) vs. 0.98% (1/102)], peritoneal implantation rate [1.96% (2/102) vs. 0.98% (1/102)], distant metastasis rate [0.98% (1/102) vs. 0.98% (1/102)], and overall complication rate [2.94% (3/102) vs. 2.94% (3/102)]. The overall satisfaction rate was significantly higher in the NOSES group as compared with the small incision group [98.04% (100/102) vs. 80.39% (82/102), P<0.001]. ConclusionsThe results of this study suggest that both NOSES and small incision specimen retrieval after laparoscopic radical gastrectomy can achieve favorable therapeutic efficacy and safety. In addition, NOSES specimen extraction can alleviate postoperative pain, accelerate the recovery process, and improve patients’ satisfaction.