Pheochromocytomas and paragangliomas (PPGLs) are a type of neuroendocrine tumors characterized by strong hereditary and metastatic potential,whose pathogenesis is closely associated with signaling pathways such as the pseudohypoxia signaling and the kinase signaling.Based on differences in driver gene mutation profiles,PPGLs can be classified into distinct molecular subtypes,each with unique clinical phenotypes,biological behaviors,and prognostic features.Clinically,plasma free metanephrines measurement and imaging examinations are the primary diagnostic methods for PPGLs,while surgical resection remains the preferred treatment.Currently,there is still lacking standard treatment for locally advanced and metastatic PPGLs,and management of these patients remains challenging.Clinical trials of targeted agents have initially demonstrated therapeutic potential,thereby offering novel treatment avenues for this patient population.

Cushing's syndrome is an endocrine disorder caused by excessive levels of cortisol in the body,most commonly resulting from abnormalities of the adrenal glands or the pituitary gland.Its clinical manifestations are diverse and involve multiple organ systems,leading to a marked decline in patients’ quality of life.With the deepening understanding of this disease and continuous advances in diagnostic techniques and therapeutic approaches,early diagnosis and timely intervention have become increasingly important.This article aims to comprehensively review the etiology,diagnostic methods,and intervention strategies of Cushing’s syndrome,in order to provide a reference for clinical practice.

Adrenal Genital Syndrome (AGS) is a rare endocrine disorder characterized by impaired adrenalsteroid hormone synthesis.It primarily encompasses two subtypes:congenital adrenal hyperplasia (CAH) and adrenocortical tumors that secrete sex hormones,both of which exhibit significant genetic heterogeneity and phenotypic variability.Over 95% of CAH cases are attributed to 21-hydroxylase deficiency (21OHD CAH),resulting from mutations in the CYP21A2 gene.In the East Asian population,c.293-13C/A>G and c.955C>T represent prevalent mutation hotspots.These mutations disrupt cortisol and aldosterone biosynthesis,leading to elevated adrenocorticotropic hormone (ACTH) levels and excessive adrenal androgen production.Clinically,this manifests as either the classic form-presenting with neonatal salt wasting crisis and disorders of sex development or the non-classic form,associated with symptoms of hyperandrogenism.Sex hormone secreting adrenal tumors are typically driven by oncogene activation and tumor suppressor gene inactivation,characterized by autonomous sex hormone secretion.Diagnosis relies on a comprehensive approach integrating hormonal assessments (e.g.,17 hydroxyprogesterone,11-oxygenated androgens),molecular genetic testing (including sequencing of genes such as CYP21A2),and imaging studies.Conventional management includes glucocorticoid and mineralocorticoid replacement therapy for CAH and surgical resection for tumors;however,challenges persist,including suboptimal mimicry of physiological hormone rhythms and difficulties in dose titration.Recent advances have enabled more individualized therapeutic strategies,including modified-release hydrocortisone (Efmody),pediatric-specific formulations (Alkindi),hypothalamic-pituitary-adrenal (HPA) axis modulators (e.g.,CRF-1 receptor antagonists),CYP17A1 inhibitors (e.g.,abiraterone acetate),and emerging curative approaches such as cell-based and gene therapies.Bilateral adrenalectomy may be considered for patients refractory to medical treatment.

Objective To analyze the application effect of intradermal suturing combined with modified chest tube placement in single-port video-assisted thoracoscopic lobectomy for lung cancer and its impact on wound healing.Methods Clinical data of 222 lung cancer patients who underwent single-port thoracoscopic lobectomy at the Thoracic Surgery Department,Wuhan University People's Hospital Guanggu Branch between July 2020 and August 2023 were retrospectively analyzed.Patients were sequentially assigned by admission time to the control group (n=93,interrupted sutures + conventional tube placement) and the study group (n=129,intradermal sutures + modified tube placement).Follow-up lasted 1 month postoperatively to compare wound healing,postoperative pain,and scar cosmesis.Results The unplanned extubation rates of thoracic tubes in the study group and the control group were 3.10% and 7.53% respectively,and there was no statistically significant difference between the two groups (P>0.05).The postoperative catheter insertion time of the study group and the control group was (5.10±2.00) days and (6.80±1.72) days respectively,the postoperative hospital stay was (11.45±5.53) days and (13.91±6.82) days respectively,and the incision healing time was (6.81±2.51) days and (9.11±2.38) days respectively.The incision fat liquefaction rates were 2.33% and 11.83% respectively,and the incision infection rates were 2.33% and 13.98% respectively.There was a statistically significant difference between the two groups (P<0.05).The pain scores of the study group and the control group on the 3rd day after surgery were (7.06±1.75) points and (7.46±1.62) points respectively.There was a statistically significant difference between the two groups (P>0.05).One month after the operation,the scar score of the study group was lower than that of the control group.Among them,the Vancouver Scar Scale scores of the study group and the control group were (4.73±2.13) points and (9.55±2.20) points respectively,and the scar Scale scores of the patients and the observers were (12.54±4.32) points and (25.22±3.08) points respectively.There was a statistically significant difference between the two groups (P<0.05).Conclusion Intradermal suturing combined with modified chest tube placement facilitates wound healing,improves scar cosmesis,and enhances postoperative aesthetic outcomes in single-port thoracoscopic lobectomy for lung cancer.

Objective To construct and validate a predictive model  based on the physiological and surgical severity score (POSSUM) system and inflammatory factors for assessing the risk of postoperative complications in elderly patients with locally advanced esophageal squamous cell carcinoma(ESCC).Methods From January 2021 to September 2024,197 elderly patients with locally advanced ESCC were admitted,among whom 105 cases developed postoperative complications.Patients were divided into non-severe (n=65,grade 1-2) and severe (n=40,grade 3-5) complication groups based on Clavien-Dindo grading.Logistic regression identified independent risk factors for serious complications.ROC and AUC assessed diagnostic efficacy of POSSUM and inflammatory factors.Based on these factors,a nomogram risk prediction model was constructed,and the prediction efficacy,calibration degree and clinical utility of the model were evaluated by AUC,calibration curve and DCA.Results Multivariate analysis showed POSSUM score and inflammatory factors (TNF-α,IL-8) were independent risk factors for serious complications (P<0.05).ROC curve analysis showed that POSSUM score,TNF-α,IL-8 combined prediction of AUC was significantly higher than used alone POSSUM score(Z=2.515,P=0.012),TNF-α(Z=2.725,P=0.006) and IL-8(Z=3.579,AUC of P<0.001(P<0.05)).Compared to POSSUM alone,the joint model had NRI=0.35 (P<0.05) and IDI=0.12 (P<0.05).The nomogram model had good fit,threshold probabilities,and clinical net benefits.Conclusion The nomogram model based on POSSUM and inflammatory factors (TNF-α,IL-8) has high predictive value and clinical utility for postoperative complications in elderly locally advanced ESCC patients.

Objective To construct a predictive model for postoperative anastomotic leakage in esophageal cancer patients based on Cox regression combined with risk scoring.Methods A retrospective analysis was conducted on the data of 380 esophageal cancer patients who underwent surgery at our hospital from February 2023 to June 2024.The patients were divided into a training set (n=304) and a validation set (n=76) in an 8∶2 ratio.Based on the training set data,the patients were divided into an observation group (stomal leak,n=38) and a control group (no anastomotic leakage,n=266) according to the occurrence of postoperative anastomotic leakage.The demographic data,surgical methods,time of anastomotic fistula,time of gastrointestinal decompression,and number of lymph node dissection were collected from both groups.Univariate and Cox regression analysis was used to determine the relationship between each variable and postoperative anastomotic fistula,and a nomogram model was constructed using R software for internal verification to determine the discrimination and calibration for anastomotic leakage within 3 days and 5 days after the operation.Results A total of 49 patients (12.9%) with anastomotic leakage after surgery were included in this study.There were 38 cases (12.5%) of postoperative anastomotic leakage in the training set and 11 cases (14.5%) in the validation set.Univariate analysis showed that the differences in age,diabetes comorbidity,tumor diameter,pulmonary infection,preoperative chemoradiotherapy,preoperative targeted drug therapy,duration of gastrointestinal decompression,and number of lymph nodes dissected between the observation group and the control group were statistically significant (P＜0.05).Cox regression analysis revealed that pulmonary infection,age,preoperative targeted therapy,preoperative chemoradiotherapy,diabetes,duration of gastrointestinal decompression,and tumor diameter were influencing factors for postoperative anastomotic leak in esophageal cancer patients (P＜0.05).The area under the ROC curve of the training set prediction model was 0.94 (0.91~0.98),and the validation set was 0.97 (0.92~0.99),The two datasets prediction models show good model discrimination and calibration.Conclusion We constructed and validated the risk prediction model of anastomotic fistula after esophageal cancer based on Cox regression analysis,and systematically considered several clinically relevant factors including pulmonary infection,age,targeted therapy before surgery,preoperative chemoradiotherapy,diabetes,time of gastrointestinal decompression,and tumor diameter.The intuitive presentation of the nomogram model makes the risk assessment more understandable to both doctors and patients,thus contributing to the clinical decision making.

Objective To investigate the relationship between the expression level of chemokine ligand 9 (CXCL9) mRNA and clinicopathological features and prognosis of triple-negative breast cancer (TNBC).Additionally,this research aims to analyze the relationships of CXCL9 with infiltration degree of tumor-infiltrating lymphocytes and the expression of common immune checkpoints．Methobs The expression levels of CXCL9 mRNA in tissues obtained from TNBC and neighboring normal tissues was detected by real-time fluorescence quantitative PCR,and the correlation between the levels of CXCL9 mRNA expression and the clinical outcomes of patients with TNBC was investigated.The correlation between CXCL9 mRNA and the mRNA of Immune cells and common Immune checkpoints was analyzed by using Tumor Immune Estimation Resource (TIMER) database.Results The expression level of CXCL9 mRNA was higher in TNBC tissues and lower in paracancerous tissues（P<0.05）.The proportion of patients with tumor size ≤ 2 cm,no lymph node metastasis and TNM stage Ⅰ-Ⅱ  in patients with high expression of CXCL9 was higher than those with low CXCL9 expression (P<0.05).The prognosis of TNBC patients with high expression of CXCL9 mRNA is better than that of patients with low expression（P<0.05）.CXCL9 mRNA related genes were enriched in immune response related pathways.CXCL9 mRNA expression was positively correlated with B cells,neutrophils，dendritic cells,CD8+T cells and CD4+T cells,and negatively correlated with tumor purity.The mRNA levels of CXCL9 exhibited a positive correlation with the mRNA levels of CTLA4,PD-1，PD-L1,and LAG3.Conclusion High expression of CXCL9 mRNA in TNBC is a predictor of a good prognosis for patients. The immune microenvironment of TNBC with high expression of CXCL9 mRNA is more abundant．

Objective To investigate the effects of recombinant human atrial natriuretic peptide(rhANP) on pulmonary immune suppression in sepsis and its underlying mechanisms.Methods A murine "second-hit" model was established by cecal ligation and puncture(CLP) followed by intratracheal LPS injection.Male C57BL/6 mice were randomized into the Sham operation group (Sham group, 6 mice), the CLP group (44 mice), and the CLP+rhANP (1 mg/kg) group (42 mice).Survival rate,lung wet-to-dry weight ratio,and histopathology were assessed.Proportions of regulatory T cells(Tregs) and myeloid derived suppressor cells(MDSCs) in lung tissue were analyzed by flow cytometry.Expression of inflammatory cytokines(IL-6,IL-17A,IL-10) and Wnt pathway components(Wnt5a,β-catenin,Lef1) was determined by Western blot.Results Compared with the sham group,CLP mice showed significantly increased proportions of Tregs and MDSCs,elevated IL-10 but decreased IL-6 and IL-17A levels,and downregulated Wnt signaling components(all P<0.05).rhANP treatment reversed these immune suppression indicators,improved survival,and activated the Wnt pathway in alveolar macrophages.Conclusion rhANP may alleviate sepsis-induced pulmonary immune suppression by activating the Wnt signaling pathway in alveolar macrophages.

Objective To explore the safety and feasibility of laparoscopic inguinal hernia day surgery in elderly patients（≥80 years old）.Methods Collect the clinical data of 235 elderly patients  who underwent laparoscopic inguinal hernia day surgery admitted to the Gastrointestinal Anorectal and Hernia Surgery Department of Nanchong Central Hospital from January 2020 to September 2023,and evaluate the curative effect of day surgery:operation time,intraoperative blood loss,hernia recurrence,incision infection,surgical area hematoma and effusion,urinary retention,chronic pain,and the incidence of mesh infection,spermatic cord and testicular complications,etc.All patients were followed up in the outpatient department and by phone on the day of discharge,and all patients were followed up after surgery for 3 days,1 month,and 3 months.Results All 235 elderly patients underwent laparoscopic inguinal hernia tension-free repair (TAPP/TEP) under general anesthesia,among which,80 patients used TAPP and 155 patients used TEP.The operation time of all patients was (35.0±6.0) minutes,the amount of intraoperative bleeding was (5.0±2.0) ml,there were 0 cases of postoperative delirium,0 cases of hernia recurrence,0 cases of incision infection,11 cases of surgical area hematoma and effusion,15 cases of urinary retention,8 cases of chronic pain,0 cases of mesh infection,and 0 cases of spermatic cord and testicular complications.Conclusion Laparoscopic inguinal hernia day surgery under general anesthesia in elderly patients（≥80 years old） is safe and feasible,with few perioperative complications,a high cure rate.

A 40-year-old male patient was admitted to the hospital due to left abdominal pain for one week.Physical examination revealed significant tenderness at the level of the umbilicus on the left side of the abdomen.CT scan indicated a wandering spleen with pedicle torsion and splenic infarction.Emergency surgery was performed.During the operation,the spleen was found to be located in the middle and lower abdomen,appearing dark and necrotic.The spleen was then removed.The patient's platelet count increased significantly after the operation.Therefore,hydroxyurea and aspirin were administered.Wandering spleen is rare.Approximately 20% of patients may experience splenic torsion,which can lead to splenic infarction.Surgery is the preferred treatment approach.

Objective To investigate the molecular mechanisms underlying the pathogenesis of juvenile polyposis syndrome (JPS) in a family.Methods Eight family members of a JPS family were enrolled,and polyp tissue samples were collected for HE staining and immunohistochemical analysis.Results SMAD4 mutation led to a significant reduction in protein expression,and the activity of phosphorylated SMAD3,a key molecule in the downstream TGF-β signaling pathway,was significantly weakened,resulting in glandular structural disorder,infiltration of inflammatory cells,and epithelial atypia.Moreover,Bax expression was upregulated in both the mutated tissue and the control group.Bcl-2 showed consistently elevated expression in the mutant group,while maintaining normal or decreased expression in the control group.Caspase3 exhibited reduced expression in the mutant group,with normal expression levels observed in the control group.Conclusion The SMAD4 mutation promotes the formation of JPS lesions through disruption of the TGF-β signaling pathway and apoptosis regulation imbalance.These findings provide new insights for the early diagnosis and targeted therapy of the disease.

Objective To explore the effect of different genders on intestinal function in patients with rectal cancer after laparoscopic surgery.Methods The clinical and pathological data of patients who underwent laparoscopic anterior resection for rectal cancer in Tongji Hospital Affiliated to Huazhong University of Science and Technology and Enshi Tujia and Miao Autonomous Prefecture Central Hospital  from January 1,2012 to December 31,2020 were collected.The Chinese version of low anterior resection syndrome (LARS) questionnaire was used to evaluate the intestinal function of patients at 12 months after intestinal continuity recovery.Patients were grouped according to gender and the two groups were propensity-score matched using spss27.0 software at 1∶1 ratio with matching variables including age at surgery,distance from anastomosis to anal verge ,neoadjuvant therapy,length of removed bowel,ASA (American Society of Anesthesiologists classification),tumor staging,tumor diameter,history of preventive stoma,BMI (body mass index),hypertension,diabetes mellitus,TME (total mesorectal excision) /PME (partial mesorectal excision).Univariate binary Logistic regression was used to analyze the effect of gender on intestinal function of patients.ResultsAfter matching,a total of 1 278 eligible patients from the two centers were included in the study,1 124 from Tongji Hospital and 154 from Enshi Central Hospital.There were 639 males and 639 females,respectively.There was no significant difference in intestinal function between the two groups (OR:1.014;95%CI:0.803-1.281;P=0.905).Conclusion There is no significant correlation between male and female regarding low anterior resection syndrome after laparoscopic rectal cancer surgery.

Objective To explore the therapeutic efficacy of the modified separation of external anal sphincter and the external anal sphincter bareness in treating high-level horseshoe shaped anal fistula.Methods 152 patients with high-level horseshoe shaped anal fistula admitted to the hospital from February 2021 to March 2024 were selected and categorized into two groups based on the type of surgical method:an observation group with 82 cases and a control group consisting of 70 cases.The observation group received treatment the modified separation of external anal sphincter,while the control group received treatment the external anal sphincter bareness.Compare the clinical efficacy,pain,anal function,anal pressure,postoperative complications,and recurrence rate between the two groups.Results The intraoperative blood output of the observation group was lower than that of the control group (P<0.05).At 7 and 14 days after surgery,the pain level scores of the two groups gradually decreased,and there was no statistically significant difference between the groups (P>0.05).At 1 month and 3 months after surgery,the Wexner anal incontinence score of the observation group patients was lower than that of the control group (P<0.05).Three months after surgery,the resting pressure,maximum systolic pressure,and maximum tolerance of the anal canal decreased in both groups,with the observation group being higher than the control group (P<0.05).Both groups of patients did not experience postoperative complications such as bleeding or infection.Six months after surgery,the recurrence rate in the observation group was higher than that in the control group (P<0.05).Conclusion The modified separation of external anal sphincter treatment for high-level horseshoe shaped anal fistula can reduce the incidence of postoperative anal incontinence in patients,but the postoperative recurrence rate is higher compared to the external anal sphincter bareness.

Objective To explore the application effect of colonic anal anastomosis and intersphincterectomy in the treatment of low rectal cancer with anal preservation and their impact on postoperative defecation function.Methods A retrospective analysis was conducted on 108 patients who underwent anal sphincter preservation surgery for low rectal cancer in hospitals from February 2019 to January 2024.According to the treatment plan,they were divided into an observation group (n=56) and a control group (n=52).Compare the surgical outcomes,Wexner anal incontinence score,anal pressure,and tumor markers between two groups.Results The observation group [(7.02±2.14) d] had a shorter discharge time than the control group [(10.02±2.06) d] (P<0.05).At 6 and 12 months after surgery,the Wexner Fecal Incontinence Score（Wexner FIS） in the observation group [(3.58±0.92)points and (2.06±0.52) points] was lower than that in the control group [(4.86±0.71) points and (3.31±0.49) points] (P<0.05).After surgery,the resting pressure of the anal canal,maximum systolic pressure of the anal canal,and maximum tolerance of the rectum decreased in both groups (P<0.05),with the observation group [(32.07±6.61) mmHg,(120.81±9.06) mmHg and (120.54±14.38) ml] being higher than the control group [(29.19±5.73) mmHg,(115.73±8.75) mmHg and (112.47±15.96) ml] (P<0.05).After surgery,CEA and CA199 decreased in both groups (P<0.05),with the observation group [(17.53±2.19) ng/ml and (41.06±3.97) U/ml] being lower than the control group [(19.08±3.62) ng/ml and (45.82±4.15) U/ml](P<0.05).Conclusion Both intersphincterectomy and colorectal anastomosis can achieve anal preservation treatment for low rectal cancer,and colorectal anastomosis is more helpful in improving patients' postoperative defecation function.

Objective To explore the influencing factors of 5-year recurrence in mixed hemorrhoid patients after Milligan-Morgan hemorrhoidectomy (MMH) and to construct a machine learning based predictive model for recurrence risk,evaluating its performance.Methods Retrospective analysis of 684 patients with Milligan-Morgan surgery for mixed hemorrhoids admitted to Gaochun Hospital Affiliated to Jiangsu University from 2018 to 2020.Patients were followed up for 5 years and divided into a recurrence group (n=139) and a non-recurrence group (n=545).The dataset was split into a training set and a validation set at a 7∶3 ratio,with 29 patient characteristics as independent variables.Clinical features and laboratory indicators were compared between the two groups.LASSO regression and XGBoost algorithms were used for feature selection,followed by multivariate logistic regression to identify independent risk factors.A nomogram prediction model was constructed based on the selected key factors,and its performance was evaluated using calibration curves,decision curve analysis (DCA),and receiver operating characteristic (ROC) curves to assess calibration,clinical utility,and discriminative ability.Results Analysis of preoperative clinical parameters from 684 patients revealed that LASSO regression identified 13 significant factors associated with recurrence:disease duration,age,smoking history,lesion diameter,postoperative infection,foreign body reaction,postoperative constipation,spicy diet,diabetes,postoperative psychological distress,anesthesia recovery time,triglycerides (TG),and white blood cell count (WBC).A Venn diagram was used to identify overlapping variables from both algorithms,and logistic regression analysis further refined the selection to 7 key parameters:spicy diet,postoperative constipation,postoperative infection,foreign body reaction,lesion diameter,postoperative psychological distress,and WBC.Multivariate logistic regression confirmed these as independent risk factors (P<0.05).The nomogram prediction model demonstrated good calibration in the calibration curve,high clinical net benefit in DCA,and excellent discriminative ability in ROC analysis (AUC=0.896,95%CI=0.860-0.931),with an accuracy of 81.0%,sensitivity of 80.4%,and specificity of 83.5%.ConclusionThe machine learning-based predictive model exhibits strong performance in assessing recurrence risk after MMH for mixed hemorrhoids,providing a theoretical reference for recurrence prediction.

Objective To investigate the efficacy and safety of choledochoscopic dual-frequency dual-pulse（DFDP） laser lithotripsy for the treatment of postoperative biliary tract stone remnants.Methods A total of 112 patients with residual stones after biliary tract surgery admitted from August 2014 to December 2022 were divided into two groups according to treatment modalities.The observation group (n=63) received choledochoscopic DFDP laser lithotripsy,while the control group (n=49) underwent conventional basket extraction.We compared stone clearance rates,complications,perioperative indicators,and surgical outcomes between the two groups.ResultsThe stone extraction rate of the observation group was significantly higher than that of the control group（95.2% vs.73.5% ，P＜0.05）,and the difference was statistically significant.Compared with the control group,the observation group had fewer average stone removals（two times vs three times，P＜0.05）and shorter average operation time(22.8 min vs.24.1 min，P＜0.05）.The postoperative gamma glutamyl transferase (GGT) level of the observation group was lower than that of the control group（63 U/L vs.109.0 U/L，95%CI:-63～-9，P＜0.05）,and the degree of postoperative GGT reduction in the observation group was greater than that in the control group（-40.8 U/L vs.-28.0 U/L，95%CI：-23.5～-0.8，P＜0.05）,the differences were both statistically significant.The observation group demonstrated a statistically significant reduction in complication rate compared to control group（1.6% vs.14.2%，P＜0.05）.Conclusion DFDP laser lithotripsy under choledochoscopy for the treatment of residual stones after biliary surgery has the advantages of high efficiency,safety and convenience.

Objective To compare the clinical efficacy of laparoscopic-assisted common bile duct exploration (LCBDE) one-stage suture and laparoscopic-assisted common bile duct exploration T-tube drainage in young and middle-aged patients with extrahepatic bile duct stones.Methods A total of 99 patients with extrahepatic bile duct stones were admitted from January 2021 to December 2024.According to the treatment methods,they were divided into two groups.There were 55 cases in the observation group,who were given primary suture after LCBDE,and 44 cases in the control group,who were given T-tube drainage after LCBDE.The operation time,intraoperative blood loss,postoperative drainage time,postoperative self-care ability score,postoperative intestinal function recovery time,total hospitalization cost,length of hospitalization,changes in liver function indexes,inflammatory indexes and postoperative pain score were compared between the two groups.Results The gender (male/female),age,number of stones,stone size and common bile duct inner diameter of the patients in the observation group were 27/28 cases,(58.33±3.68) years old,(2.36±1.43),(0.79±0.38) cm and (1.17±0.31) cm,respectively.The control groups were 23/21 cases,(56.44±8.79) years,(2.45±1.57) individuals,(0.88±0.54)cm and (1.29± <s:1> 0.38 cm)cm respectively.There was no statistical significance between the two groups (P>0.05).The operation time,hospital stay,abdominal drainage tube placement time and total cost of the observation group were (125.10±36.27) minutes,(9.58±2.58) days,(5.22±1.47) days and (22167.39±3569.69) yuan,respectively.The control groups were (161.45±37.24) minutes,(12.59±3.76) days,(6.79±2.55) days and (26479.88±5556.30) yuan respectively.There was a statistically significant difference between the two groups (P<0.05).The average postoperative self care ability score,average postoperative pain score and average postoperative intestinal function recovery time of the observation group were (1.89±0.88) points,(93.09±4.42) points and (2.98±0.82) days respectively.The control groups were (4.23±1.06) points,(82.50±9.97) points and (4.98±1.23) days respectively.There was a statistically significant difference between the two groups (P<0.05).There was no statistically significant difference in liver function indicators between the two groups before and 3 days after the operation (P>0.05).Conclusion One-stage suture has shown good clinical results in the treatment of extrahepatic bile duct stones in young and middle-aged patients.

Objective To analyze the common complications after flap surgery and preliminarily summarize their management methods.Methods A total of 313 patients who underwent flap surgery from January 2021 to November 2023 were enrolled,including 18 males and 7 females,aged 3 to 70 years with a mean age of 48.1 years.The clinical data of patients with postoperative complications were analyzed.Results Among the 313 patients who underwent flap surgery,25 cases (8.0%) developed postoperative complications,including 8 cases of partial flap necrosis,11 cases of poor flap wound healing,3 cases of flap congestion,1 case of arterial insufficiency,1 case of donor-site infection,and 1 case of foreign body retention.No case of total flap necrosis was observed.The time of complication occurrence ranged from 1 day to 3 months after surgery.Mild complications could be improved by keeping warm,preventing compression,drug therapy and wound dressing change; severe complications required emergency exploration,wound debridement,skin grafting and even reoperation of flap.Conclusion Appropriate case selection,careful surgical planning,proficient flap surgery techniques and standardized postoperative management are important links to prevent postoperative complications of flap surgery.After the occurrence of complications,early and appropriate management can save most flaps,while a few severe complications need one or more remedial operations.

Objective To observe the effects of modified femoral intramedullary nail and dynamic hip screw (DHS) on perioperative indicators,joint function and prognosis in patients with femoral intertrochanteric fracture.Methods A total of 74 patients with femoral intertrochanteric fracture who underwent surgical treatment in the Shangluo Central Hospital from January 2020 to January 2024 were selected and divided into the control group and the observation group according to different treatment methods,with 37 cases in each group.The control group was treated with DHS and the observation group was treated with modified femoral intramedullary nail.The perioperative indicators,joint function,fracture reduction quality and prognosis were compared between the two groups.〖WTHZ〗Results〓〖WTBZ〗The surgical incision length [(5.04±1.07) cm],surgical time [(50.69±10.54) min],intraoperative blood loss [(138.36±20.15) ml],and postoperative drainage volume [(43.16±10.85) ml] in the observation group were significantly lower than those in the control group[（9.58±1.42）cm,（66.71±13.86）min,（251.82±40.62）ml and（100.73±18.46）ml] (P<0.05).Fracture healing time of the two groups was close (P>0.05).At 7 days after surgery,the HHS score of the observation group was significantly higher [(51.58±9.34)score] than that of the control group [(48.3±8.76) score](P<0.05),while there was no significant difference in HHS scores between the two groups before and at 3 and 6 months postoperatively (P>0.05).Comparison of fracture reduction quality between the two groups showed no statistically significant difference (P>0.05).The total incidence of complications in the observation group(10.81%) was significantly lower than that in the control group(29.73%) (P<0.05).〖WTHZ〗Conclusion〓〖WTBZ〗The use of modified femoral intramedullary nails and the application of DHS in the treatment of intertrochanteric fractures of the femur can effectively restore joint function,and the quality of fracture healing and reduction is good.However,the perioperative indicators of modified femoral intramedullary nails are better and the risk of complications is lower.

Objective To investigate the effect of lateral malleolus and lower tibiofibular joint fixation + triangular ligamentous anchor fixation on ankle fracture (AF) with inferior tibiofibular union separation.Methods A total of 103 patients with AF combined with inferior tibiofibular union separation treated in our hospital from September 2020 to June 2023 were retrospectively selected.Among them,51 patients with lateral malleolus and lower tibiofibular joint fixation + triangular ligament anchor repair were used as the fixed repair group,and 52 patients with lateral malleolus and lower tibiofibular joint fixation were used as the fixed group.The surgical status and complications were compared between the two groups,as well as the VAS score,ankle range of motion,AOFAS score,KAFS score,the excellent and good rate of AOFAS ankl-hind foot score before and after surgery.Results The operation time of the fixed repair group was (97.19±10.31) min,which was longer than (64.92±9.75) min of the fixed group,and the intraoperative blood loss was (104.00±15.48) ml,which was higher than (68.15±17.23) ml of the fixed group，the differences between the two groups were statistically significant (P<0.05).There was no significant difference in hospitalization time and fracture healing time between the two groups (P>0.05).The VAS scores of the fixed repair group at 1 month and 3 months after operation were (3.06±1.00) scores and (2.05±0.51) scores,which were lower than (4.14±0.76) scores and (2.72±0.69) scores of the fixed group，the differences between the two groups were statistically significant (P<0.05).The ankle joint mobility of the fixed repair group was (46.28±4.17)° and (54.24±3.18)° at 3 months and 6 months after operation,which was higher than that of the fixed group (41.59±3.88)° and (50.13±2.65)°,the AOFAS ankle-hind foot scores were (75.68±3.79) scores and (88.16 ± 2.52) scores,which were higher than those of the fixed group (70.04±4.25) scores and (83.15±2.70) scores,the KAFS scores were (74.99±4.23) scores and (87.13±3.00) scores,respectively,which were higher than (70.01±3.44) scores and (82.04±4.35) scores in the fixed group,the differences between the two groups were statistically significant (P<0.05).At 6 months after operation,48 cases were excellent and 3 cases were good of AOFAS ankle hindfoot score in the fixed repair group,34 cases were excellent,12 cases were good and 6 cases were fair in the fixed group,the fixed repair group was better than the fixed group,and the differences between the two groups were statistically significant (P<0.05).The incidence of complications in the fixed repair group was 1.96% lower than that in the fixed group (15.38%),and the difference between the two groups was statistically significant(P<0.05).At 6 months after operation,the AOFAS anklehind foot score was excellent in 48 cases and good in 3 cases in the fixed repair group,and excellent in 34 cases,good in 12 cases and fair in 6 cases in the fixed group.The fixed repair group was better than the fixed group (P<0.05);the incidence of complications in the fixed repair group was 1.96% lower than that in the fixed group (15.38%) (P<0.05).Conclusion Compared with lateral malleolus and lower tibiofibular joint fixation,lateral malleolus and lower tibiofibular joint fixation + triangular ligament anchor repair is used to treat AF patients with inferior tibiofibular union separation.Although it can prolong the operation time and increase the amount of bleeding,it can reduce the pain of patients,improve ankle function and reduce the risk of complications.

Objective To evaluate the effect of robotassisted partial nephrectomy (RAPN) and 4K ultra-high-definition laparoscopic partial nephrectomy (4K-LPN) in the treatment of localized renal cell carcinoma.Mtheods A retrospective analysis was conducted on 63 patients with localized renal cell carcinoma who underwent partial nephrectomy at Huanggang Central Hospital from April 2022 to August 2024.Based on the surgical approach,patients were divided into the RAPN group (n=31) and the 4K-LPN group (n=32).The preoperative baseline characteristics,perioperative data,tumor features,hospital stay,total hospitalization costs,and short-term postoperative complications were compared between the two groups.Results The intraoperative blood loss in the RAPN group and the 4K-LPN group was (151.2±13.5)ml and (184.6±14.0)ml respectively,and the warm ischemia time of the kidneys was (21.9±3.8) minutes and (24.3±3.5) minutes respectively.The operation times were (179.6±21.4) minutes and (196.4±31.6) minutes respectively.The increase in creatinine one day after the operation was (12.8±14.2 )μmol/L and (21.4±14.6)μmol/L respectively.There was a statistically significant difference between the two groups (P< 0.05).However,the total hospitalization cost was significantly higher in the RAPN group (38 798.1±10 609.3 CNY vs.27 925.9±5 793.9 CNY,P<0.05).No significant differences were observed in positive surgical margin rates (P>0.05).Additionally,there were no statistically significant differences between the two groups regarding intraoperative transfusion rates,drainage tube removal time,catheter removal time,postoperative hospital stay,or 2-week postoperative complication rates (P>0.05).Conclusion Compared with 4K-LPN,RAPN offers significant advantages,including reduced intraoperative blood loss,shorter renal warm ischemia time,shorter operative duration,and better renal function preservation.However,the high cost of robotic surgery remains a major limiting factor for its widespread adoption.

Objective To investigate the relationship between endothelial cell specific molecule-1 (ESM-1),cholinesterase (ChE),irisin and the recurrence of Non-muscle-invasive bladder cancer after bladder perfusion therapy.Methods A total of 86 patients with Non-muscle-invasive bladder cancer admitted to our hospital from December 2019 to December 2022were selected.All patients received bladder perfusion therapy.Serum levels of ESM-1,ChE and irisin were detected before treatment.After the treatment,they were followed up for 2 years and the recurrence was statistically analyzed.Multivariate COX proportional regression analysis was used to analyze the factors affecting recurrence in patients with Non-muscle-invasive bladder cancer after bladder perfusion therapy,and the value of ESM-1,ChE and irisin in predicting recurrence was analyzed by receiver operating characteristic (ROC) curve.ResultsThe serum ESM-1 level of Non-muscle-invasive bladder cancer patients at T1 stage of low differentiation and TNM stage was higher than that at Ta stage of middle and high differentiation and TNM stage,and the serum ChE and irisin levels were lower than that at Ta stage of middle and high differentiation and TNM stage (P<0.05).Three cases were lost to follow-up.Among the remaining 83 patients,11 relapsed and 72 did not relapse.Serum ESM-1 level in relapsed group was higher than that in non-relapsed group [(4.89±0.42)ng/ml vs. (4.17±0.53)ng/ml,P<0.05],ChE and irisin levels were lower than those in non-relapsed group [(4 618.35±531.29)U/L vs (5 663.27±502.71)U/L,(21.06±3.46)ng/ml vs (25.00±3.06 )ng/ml,P<0.05].TNM stage T1 and high ESM-1 were risk factors for recurrence of Non-muscleinvasive bladder cancer after bladder perfusion therapy (P<0.05),while high ChE and high irisin were protective factors (P<0.05).The area under the curve of ESM-1,ChE and irisin in predicting the recurrence of patients with Non-muscle-invasive bladder cancer after bladder perfusion therapy was 0.776,0.726 and 0.664,respectively,and the area under the curve of combined prediction was 0.871,which was higher than that of single prediction (P<0.05).Conclusion The increase of serum ESM-1 level and the decrease of ChE and irisin levels in patients with Non-muscle-invasive bladder cancer are related to the recurrence after bladder perfusion treatment,and the combination of the three is of high value in predicting the recurrence after bladder perfusion treatment.

Objective To explore the efficacy of transvaginal erbium laser treat combined with transvaginal tension-free urethral suspension (TVT) in the treatment of female stress urinary incontinence.Methods From September 2023 to September 2024,60 female patients with stress urinary incontinence were selected as the research object.The study subjects were randomly divided into a control group (n=30 cases) using TVT surgery for treatment and nursing care,and a study group (n=30 cases) using transvaginal erbium laser irradiation combined with TVT surgery treatment program followed by a combined targeted nursing care program,comparing the clinical efficacy of the two groups.The Chinese version of the urinary incontinence self-efficacy scale (GSE-UI) The clinical efficacy,Chinese version of the urinary incontinence self-efficacy scale (GSE-UI),anxiety self-assessment scale (SAS) and depression self-assessment scale (SDS),and urinary incontinence quality of life scale (I-QOL) were compared between the two groups.Results The treatment efficacy rate of the study group was 96.67% (29/30),significantly higher than the control group's 80% (24/30) (P<0.05).One month after the intervention,the GSE-UI score in the study group was 82.40±5.52,and three months later,it was 101.50±5.78,both significantly higher than the control group's scores of 66.10±4.45 and 75.56±5.00 (P<0.05).One month after the intervention,the SAS score in the study group was 48.00±1.21,and three months later,it was 37.11±1.00.One month after the intervention,the SDS score in the study group was 47.21±2.00,and three months later,it was 37.17±1.02,both significantly lower than the control group's SAS score of 58.85±4.22 and 52.00±2.05,and the SDS score of 56.63±5.21 and 50.00±2.25 (P<0.05).One month and three months after the intervention,the I-QOL score in the study group was 68.89±7.21 and 80.28±10.00,respectively,both significantly higher than the control group's scores of 55.87±6.03 and 70.00±7.52 (P<0.05).Conclusion Transvaginal erbium laser irradiation combined with TVT postoperative combined targeted nursing program has significant therapeutic effects on female stress urinary incontinence,and patients' negative emotions,self-efficacy,and quality of life were significantly improved after treatment.

A patient with severe liver abscess combined with endogenous endophthalmitis underwent ultrasound-guided percutaneous liver abscess puncture and drainage and received timely ophthalmologic treatment,which successfully controlled the condition and preserved her partial vision.This case reminds that in the treatment of pyogenic liver abscess,in addition to close monitoring of the patient's systemic condition,special vigilance is also required for possible local complications,especially serious complications such as endogenous endophthalmitis,to avoid misdiagnosis and delay in treatment.

Papillary thyroid carcinoma is the most common pathological type of thyroidcarcinoma,with a good prognosis and rare distant metastases.In this paper,we report a case of multiple brain metastases of papillary thyroid carcinoma,in which headache was the first symptom,and brain metastases redeveloped 28 months after thyroid palliative surgery and intracranial lesion resection,and the diagnosis and treatment of multiple brain metastases of thyroid cancer were discussed.

Fibrous dysplasia of bone is a skeletal disorder,characterized by the replacement of the bone marrow organ with a tissue formed by pre-osteogenic fibroblast-like cells and trabeculae of immature bone.The proximal femur is most commonly affected and prone to hip inversion with proximal femoral curvature,as well as "Coxa Vara" deformity,making surgical correction difficult.This article introduces a case of proximal femoral torsion caused by fibrous structural defects admitted to the Orthopedics Department of Kunming Children's Hospital.Fassier Duval extended intramedullary nail combined with Kirschner wire was used for one-stage osteotomy correction of the deformity.The case was followed up for 24 months after surgery,and the corrective effect remained good.

A retrospective analysis of a 63-year-old male patient with intussusception caused by small intestinal metastasis of lung cancer.The patient was admitted with aggravated abdominal pain and intestinal obstruction.Imaging examinations suggested small bowel intussusception and a lung mass.Emergency partial small bowel resection was performed.Postoperative pathology,combined with immunohistochemical findings,confirmed the diagnosis as small intestine metastasis from a SMARCA4-deficient undifferentiated carcinoma of pulmonary origin.The patient recovered well postoperatively and received tislelizumab immunotherapy.Follow-up for over 2 years showed the patient was still alive,although a later review indicated an increase in the size of the primary lung lesion.Small intestinal metastasis from lung cancer is clinically rare and challenging to diagnose.Surgical intervention can effectively manage acute complications,and combined with systemic therapy,may prolong patient survival.

This article presents the diagnosis and treatment of a patient with diffuse retroperitoneal emphysematous infection.Puncture drainage combined with antibiotic irrigation can effectively control the infection and shorten the treatment period,while also being convenient in operation and having definite therapeutic effects.

A 17-year-old male was admitted with intermittent right upper abdominal pain for more than 10 days accompanied by fever.He had no previous medical history.Imaging examinations suggested cholecystitis,and gallbladder torsion was not diagnosed preoperatively.Intraoperatively,the gallbladder was found to be twisted 180° clockwise with dark brown gangrenous changes,and laparoscopic retrograde cholecystectomy was performed.The patient recovered well postoperatively.Gallbladder torsion is clinically rare,mostly occurring in elderly females,and extremely uncommon in adolescents.It is easily misdiagnosed as acute cholecystitis preoperatively.This case indicates that for patients with imaging hints of gallbladder inflammation but atypical symptoms,gallbladder torsion should be suspected.Timely surgery can improve prognosis,and laparoscopic cholecystectomy is the preferred treatment.

Pancreas lymphatic epithepithetic cyst (PLEC) is a benign and rare lesion,characterized by a collection of benign keratinized squamous epithelial cells surrounded by lymphoid tissue,which is difficult to diagnose before surgery according to imaging studies.According to reports,the incidence of pancreas lymphatic epithepithesis cyst is about 0.5%,and its pathogenesis,clinical characteristics and diagnosis of PLEC are still unclear.The levels of PLEC tumor markers such as CEA and CA 199 May be elevated,with characteristics similar to malignant tumor lesions.