As the core functional units of weight-bearing and walking in the human body,the foot and ankle possess intricate structures and complex functions.Foot and ankle deformities often result from disorders of bones,muscles,tendons,and neurovascular structures.Their correction requires attention to both morphological reconstruction and dynamic functional balance.External fixation,with its advantages of minimal invasiveness,adjustability,and tissue regeneration,has become an important treatment modality for complex foot and ankle deformities.This article systematically elaborates the core principles of external fixation for correcting foot and ankle deformities-tissue distraction and regeneration based on the tension-stress principle along with stress control,as well as three derived treatment principles:the overall balance principle targeting a plantigrade foot,the individualized configuration principle guided by the apex of deformity,and the sequential regulation principle involving the time dimension.The article focuses on discussing the principles of external fixation for foot and ankle deformity correction,and the key roles of osteotomy and soft tissue balancing procedures in deformity correction.It systematically introduces clinical application strategies for soft tissue distraction correction,osteotomy and orthoplasty,and the Ilizarov external fixator.Treatment characteristics for foot and ankle deformities of different etiologies are specifically categorized and elaborated.The importance of the sequential treatment model of external fixation-orthosis-orthopedic insole and standardized postoperative rehabilitation is emphasized.The external fixation strategy for foot and ankle orthopedics,developed on the basis of Qin Sihe's concept of natural reconstruction,the Ilizarov technique,Paley's principles of orthopedic surgery,and traditional Chinese medicine theory of tendons and bones,provides a reference for standardized clinical application and serves as an important foundation for ensuring treatment efficacy.

Calcaneal fractures are the most common fractures of the foot,and approximately 75% are intra-articular injuries involving the subtalar joint.Compared with traditional open surgery,percutaneous minimally invasive treatment has shown several clinical advantages,including reduced soft-tissue trauma,a lower risk of wound-related complications,and faster postoperative recovery.From a practical clinical perspective,this article summarizes the key technical aspects of percutaneous minimally invasive treatment for calcaneal fractures,with particular attention to preoperative imaging evaluation and surgical planning,reduction strategies,selection of internal fixation,and postoperative management.In addition,it reviews the major challenges associated with this technique in current practice,including the difficulty of achieving anatomical reduction under limited visualization,radiation exposure related to repeated intraoperative fluoroscopy,and the relatively demanding learning curve for surgeons.On this basis,the article further outlines several targeted quality-control measures that may improve the consistency and safety of treatment,including precise preoperative assessment,standardized intraoperative procedures,and systematic postoperative follow-up and evaluation.Establishing a relatively complete quality control process may help improve surgical quality,reduce complications,and optimize patient outcomes.This article aims to provide a practical reference for clinicians and to support the standardized clinical application of this technique.

In recent years,minimally invasive surgery for hallux valgus (MIS-HV) has evolved rapidly,moving beyond the stage of technical exploration intobroader clinical practice.Available evidence indicates that third-generation minimally invasive Chevron-Akin techniques (MICA/PECA) can achieve radiographic and clinical outcomes comparable to those of conventional open procedures in the short to medium term,while also offering potential advantages in postoperative recovery and early pain control.Despite this progress,several issues continue to limit the wider adoption of MIS-HV,including the lack of clearly defined indications,inconsistency in the criteria used to define recurrence,and concerns regarding reoperation and hardware-related complications.Future advances should therefore focus on three-dimensional correction strategies,standardized outcome assessment,stratified patient selection,and the development of structured training pathways,with the ultimate aim of improving the reproducibility of clinical practice and the durability of long-term outcomes.

Charcot-Marie-Tooth (CMT) disease is the most common inherited peripheral neuropathy,mainly manifested by symmetrically progressive distal extremity muscle weakness,atrophy,and sensory abnormalities,and often accompanied by deformities such as pes cavovarus foot.Its diagnosis depends on medical history,physical examination,electrophysiological testing,and genetic testing.Whole-exome sequencing is helpful for determining the molecular subtypes.The treatment of CMT features multidisciplinary collaboration,precision,a step-by-step approach,and individualization,mainly focusing on symptomatic and supportive treatments,including pain management,rehabilitation training,psychological support,and the use of orthotics.The diagnosis and treatment of CMT involve a comprehensive treatment system.Currently,there is no radical cure for this disease,but specific drugs such as PXT3003 have shown certain efficacy in clinical trials.Gene and stem-cell therapies are still in the basic research stage.

Objective To compare the efficacy,safety and effects on postoperative inflammation,shoulder function and complications of dual-endoscope combined (arthroscopy + mini-incision) and conventional arthroscopic rivet fixation for rotator cuff injury.Methods Ninety patients (Jan 2023-Jan 2025) were prospectively randomized into two groups (n=45 each).The control group received conventional arthroscopic rivet fixation,and the observation group received dual-endoscope combined fixation.The levels of serum inflammatory factors,shoulder joint range of motion,shoulder joint function-related scores(UCLA,ASES,CMS),supraspinatus muscle occupancy rate and the occurrence of complications were compared between the two groups of patients before treatment (preoperative) and after treatment (6 months after surgery).Results The levels of serum tumor necrosis factor (TNF)-α,C-reactive protein (CRP),interleukin (IL)-6,and IL-8 in the observation group were(17.32±3.16)ng/ml,(13.27±2.49)mg/L,(12.06±3.48)H/L and (10.47±3.12)ng/L,respectively,which were all lower than those in the control group [(21.06±3.94)ng/ml,(19.06±3.17)mg/L,(20.16±4.92)H/L,and (15.32±2.49)ng/L],with statistically significant differences between the two groups (P<0.05).After treatment,the ranges of shoulder joint forward flexion,backward extension,external rotation,and abduction in the observation group were (147.32±16.94)°,(39.86±3.15)°,(49.35±4.32)°,and(119.58±19.45)°,respectively,which were all higher than those in the control group[(129.48±15.23)°,(34.16±4.35)°,(41.64±5.11)°,and(101.49±21.58)°],with statistically significant differences between the two groups (P <0.05).After treatment,the pain score,function score,active forward flexion score,forward flexion strength score,and subjective satisfaction score in the UCLA score of the observation group were (5.97±1.02),(6.01+1.03),(4.77+0.94),(3.12±0.56),and(3.65±0.65),respectively,which were all higher than those in the control group [(4.99±1.07),(5.16±1.08),(3.73±0.65),(2.56±0.42),and (3.09±0.58)],with statistically significant differences between the two groups (P<0.05).After treatment,the ASES score of the observation group was (14.46±1.28),which was higher than (13.16± 1.58) in the control group,with a statistically significant difference between the two groups (P<0.05).After treatment,the pain,muscle strength,activities of daily living,and limb mobility scores in the CMS of the observation group were (12.23±1.16),(24.05±3.44),(16.88±2.05),and(27.77±3.94),respectively,which were all higher than those in the control group [(10.12±1.06),(19.04±3.11),(13.36±1.65),and (23.76±3.15)],with statistically significant differences between the two groups (P <0.05).After treatment,the occupation rate of the supraspinatus muscle in the observation group was higher than (78.65±10.15)% in the control group (P <0.05).The incidence of complications in the observation group was 8.89%,which was lower than 24.44% in the control group,with a statistically significant difference between the two groups(P<0.05).Conclusion Dual-endoscope combined fixation for rotator cuff injury reduces postoperative inflammation,improves shoulder function and supraspinatus occupation rate,lowers complications,and has better medium-term efficacy than conventional arthroscopic rivet fixation.

Objective To analyze the influence of blood flow restriction training on postoperative muscle strength and joint function in patients with distal radius fractures.Methods This study was a prospective one,taking 60 postoperative patients with distal radius fractures as the research subjects.All of them received rehabilitation treatment in our hospital from October 2021 to October 2024.The research subjects were divided into the control group and the observation group according to the simple randomization method,with 30 cases in each group.The former was given conventional rehabilitation treatment,while the latter was given blood flow restriction training on the basis of the control group.Both groups were treated continuously for 4 weeks,and both were followed up for 3 months after the treatment.The Visual Analogue Scale (VAS),the circumference of the forearm and wrist joint,muscle strength,the score of the Patient Assessment Scale for Wrist Function (PRWE),the score of the Disability Assessment Scale for Arm,Shoulder and Hand (DASH),serum D-dimer,Fracture Healing Imaging (RUSS) score and safety assessment were compared between the two groups of patients.Results At both 2 weeks and the end of treatment,the VAS scores in the observation group were 1 (0,2) and 0 (0,1),respectively,significantly lower than those in the control group [3 (1,4) and 1 (0,2)] (all P<0.05).Three-point pinch strength,grip strength,wrist palmar flexion,and wrist dorsal extension in the observation group were (0.46±0.11) and (0.70±0.13),(0.40±0.12) and (0.72±0.14),(0.52±0.13) and (0.71±0.15),and (0.51±0.14) and (0.73±0.15),respectively,all significantly higher than those in the control group [(0.40±0.09) and (0.63±0.12),(0.34±0.10) and (0.64±0.13),(0.39±0.11) and (0.53±0.14),(0.36±0.12) and (0.53±0.13)] (all P<0.05).Serum D-dimer levels in the observation group were at the two time points,which did not differ significantly from those in the control group (both P>0.05).At the end of treatment,the differences in wrist joint and forearm circumference in the observation group were (0.58±0.15) cm and (0.21±0.06) cm respectively,which were lower than those in the control group [(1.45±0.42) cm and (0.48±0.14) cm] (P<0.05).At the end of treatment and at the final follow-up,the PRWE scores in the observation group were (7.85±2.54) and (2.14±0.68),and the DASH scores were (11.35±4.08) and (3.45±1.02),all significantly lower than those in the control group [(14.45±3.25) and (4.18±1.05) for PRWE;(19.65±4.12) and (7.36±2.43) for DASH] (all P<0.05).No significant between-group difference was observed in RUSS scores at either time point (P>0.05).Conclusion For patients with distal radius fractures,the application of blood flow restriction training combined with traditional rehabilitation training after surgery is more conducive to improving their muscle strength and joint function,reducing the degree of pain and limb swelling,and the fracture healing is good.

Objective To explore the influencing factors of infection after internal fixation of traumatic pelvic fractures and establish a nomogram model.Methods A prospective study design wasused to conveniently select 246 patients with traumatic pelvic fractures who were treated at Hebei Medical University Third Hospital from October 2022 to February 2024 as the research subjects.Patients were divided into an infected group and a Non-infected group based on the infection status after open reduction and internal fixation.The difference between the two groups of covariates was balanced by 1∶1 propensity score matching.Logistic regression equations were used to analyze the factors that contribute to infection after internal fixation for traumatic pelvic fractures.R4.3.2 software was used to establish the nomogram model,and the receiver operating characteristic curve (ROC),calibration curve and decision curve were drawn to test the predictive efficacy of the nomogram model.Another 100 patients with traumatic pelvic fractures who were treated from March 2024 to December 2024 were selected for external validation of the nomogram model.Results After matching,the ISS score,IL-23,IL-17 and TLR7 in the infection group were (16.11±1.34) scores,(735.59±213.75) pg/ml,(542.42±160.66) pg/ml and (72.55±10.24) ng/ml,respectively,the incidence of acetabular fracture was 30.00%.The data in the non-infected group were (15.18±1.46) scores,(568.81±166.71) pg/ml,(400.03±118.86) pg/ml,(66.43±9.27) ng/ml and 10.00%,respectively(P<0.05).ISS score (OR:1.597),acetabular fracture (OR:2.296),IL-23 (OR:1.544),IL-17 (OR:1.512) and TLR7 (OR:1.384) were the influencing factors of infection after internal fixation in patients with traumatic pelvic fracture (P<0.05).The AUC of nomogram model for predicting infection after internal fixation of traumatic pelvic fractures was 0.885 and 0.886,respectively.The predicted probability was close to the actual observed probability.When the threshold probability was between 0.1 and 0.8,or between 0.0 and 0.8,the net patient benefit was high.Conclusion The nomogram model constructed based on ISS score,acetabular fracture,IL-23,IL-17,and TLR7 has good predictive performance and can provide a reliable tool for early screening of infection after internal fixation of traumatic pelvic fractures,assisting clinical treatment decisions.

Objective To explore the influence of external fixation brace combined with lower limb rehabilitation robot system on fracture healing and function recovery in patients with traumatic lower limb fractures.Methods From June 2021 to December 2022,30 patients with traumatic lower limb fractures who were treated with external fixation brace were collected as control group.From January 2023 to June 2024,32 patients with traumatic lower limb fractures who received external fixation brace combined with lower limb rehabilitation robot system were included in observation group.The fracture healing status,pain score,lower limb function recovery [Holden functional ambulation category (FAC) grading,Berg balance scale (BBS),Fugl-Meyer lower limb motor function score scale (FMA-LL) score],knee range of motion and complications were compared between groups.Results After treatment,the lower limb weight-bearing time and fracture healing time in observation group with (35.37±5.96) days and (87.95±9.76) days were shorter compared with (39.25±6.62) days and (95.14±11.63) days in control group (P<0.05).The pain scores at 1 month and 3 months after treatment in observation group with (2.94±0.72) points and (1.23±0.29) points were lower than (3.34±0.77) points and (1.96±0.51) points in control group (P<0.05).The FAC grading,BBS score and FMA-LL score with (3.96±0.48) grade,(36.25±5.46) points and (25.17±3.28) points after treatment in observation group were higher than (3.59±0.51) grade,(32.81±5.14) points and (21.86±3.02) points in control group (P<0.05).The knee flexion and abduction in observation group with (88.22±14.25) ° and (79.37±12.23) ° were higher than 79.93±11.58) ° and (71.34±10.64) ° in control group (P<0.05).The total incidence rate of complications in observation group (3.13%) was lower compared to control group (20.00%) (P<0.05).Conclusion External fixation brace combined with lower limb rehabilitation robot system can accelerate lower limb weight-bearing,promote fracture healing,reduce pain,and enhance lower limb function,and it has few complications.

This article presents a case of HER-2 positive breast cancer that occurred after polyacrylamide hydrogel (PAAG) injection for breast augmentation.Due to the hard injection gel covering the breast,it is analyzed that PAAG injection may alter the microenvironment of the breast and increase the risk of HER-2 positive breast cancer.Therefore,early detection of breast cancer is very difficult.It is suggested to strengthen breast monitoring for such patients and provide early diagnosis and treatment.

Objective To explore the dynamic changes in gut microbiota structure and immunologic function in patients with cranial trauma under enteral nutritional support.Methods 106 patients with traumatic brain injury who were treated in the hospital from January 2023 to October 2024 were retrospectively analyzed.They were divided into tolerance group and intolerance group,and 50 patients with traumatic brain injury who received parenteral nutrition at the same time were selected as the control group.The laboratory indexes and adverse reactions of the three groups were compared.Results After treatment,the levels of Escherichia coli in the tolerance group,intolerance group and control group were (7.02 ±1.23) copies/g and (9.31±1.61) copies/g and (12.21±2.16) copies/g,respectively.Before treatment,they were (12.06±1.91) copies/g,(11.82±2.05) copies/g and (11.63±1.81) copies/g,respectively.After treatment,there was a statistically significant difference between the tolerance group and the intolerance group and before treatment (P<0.05),compared with the control group,the difference was statistically significant (P<0.05),the difference between the tolerance group and the intolerance group was statistically significant (P<0.05).After treatment,the levels of trimethylamine oxide (TMAO) in the tolerance group,intolerance group and control group were (2.25±0.37)ng/ml,(2.60±0.35)ng/ml and (2.81±0.32)ng/ml,respectively.Before treatment,they were (3.92±0.41)ng/ml,(3.95±0.37)ng/ml and (4.05±0.42)ng/ml,respectively,and the difference was statistically significant (P<0.05),the tolerance group was lower than the intolerance group,both were lower than the control group,and the difference was statistically significant (P<0.05).After treatment,the Lactobacillus levels in the tolerance group,intolerance group and control group were (10.28±1.32) copies/g,(9.71±1.19) copies/g and (5.42±1.05) copies/g,respectively.Before treatment,they were (7.09±1.17) copies/g,(7.14±1.21) copies/g and (7.21±1.20) copies/g,respectively.There was a statistically significant difference before and after treatment in the same group (P<0.05).After treatment,the tolerance group was higher than the intolerance group,both were higher than the control group,and the difference was statistically significant (P<0.05).After treatment,the bifidobacterium levels in the tolerance group,intolerance group and control group were (13.67±1.80) copies/g,(10.91±1.31) copies/g and (9.11±1.23) copies/g,respectively.Before treatment,they were (8.15±0.71) copies/g,(8.34±0.90）copies/g and (8.27±0.83) copies/g,respectively.Before and after treatment in the same group,the difference was statistically significant (P<0.05).After treatment,the tolerance group was higher than the intolerance group,both were higher than the control group,and the difference was statistically significant (P<0.05).After treatment,the butyric acid levels in the tolerance group,intolerance group and control group were (3.39±0.65) μg/ml,(3.15±0.62) μg/ml and (2.89±0.57) μg/ml,respectively.Before the treatment,they were (2.26±0.34)μg/ml,mu g/ml (2.29±0.30)μg/ml and (2.17±0.31)μg/ml,respectively.Before and after treatment in the same group,the difference was statistically significant (P<0.05).After treatment,the tolerance group was higher than the intolerance group and both were higher than the control group,and the difference was statistically significant (P<0.05).Compared with before treatment,the levels of plasma albumin,serum prealbumin and hemoglobin in the three groups increased after treatment.The levels in the tolerance group were higher than those in the intolerance group and were all higher than those in the control group.The differences were statistically significant (P<0.05).After treatment,the proportions of neutrophils,white blood cell count,CRP and PCT in the three groups decreased.The tolerance group was lower than the intolerance group and all were lower than the control group,and the differences were statistically significant (P<0.05).The counts of CD4⁺T cells in the tolerance group,intolerance group and control group were 34.02±4.15,31.71±4.08 and 28.19±4.11,respectively,and those of IgA were 3.36±0.49,3.08±0.52 and 2.86±0.34,respectively.The IgG values were 12.89±1.31,11.15±1.04 and 10.13±1.07,respectively.Compared with before treatment,the counts of CD4⁺T cells,the ratio of CD4⁺/CD8⁺,IgA,IgM and IgG in the three groups increased after treatment,and the differences were statistically significant (P<0.05); After treatment,the tolerance group was higher than the intolerance group,both were higher than the control group,and the difference was statistically significant (P<0.05).The incidences of diarrhea and pneumonia in the tolerance group were lower than those in the intolerance group and the control group,and the difference was statistically significant (P<0.05).Conclusion Early enteral nutrition support helps regulate the gut microbiota in patients with cranial trauma,enhance immune function,and reduce the risk of infection,with better outcomes observed in patients with gastrointestinal tolerance.

Objective To investigate the effect of spread through air spaces (STAS) of lung adenocarcinoma on the selection of lobectomy and sublobar resection and postoperative survival outcomes.Methods A retrospective analysis was performed on 196 patients with lung adenocarcinoma admitted to our hospital from October 2018 to October 2022.According to the STAS diagnostic criteria,they were divided into a STAS-positive group (121 cases) and a STAS-negative group (75 cases).The clinical data,surgical methods,and follow-up data of the patients were collected,and the clinical characteristics,surgical selection,and survival outcomes of the two groups were compared.The effect of STAS status on prognosis under different surgical methods was further compared.Results Compared with the STAS-negative group,patients in the STAS-positive group presented with larger tumor diameters,higher rates of vascular,pleural,perineural,and lymphovascular infiltration and tumor necrosis,higher pathological stages,and a higher rate of lobectomy (P<0.05).Multivariate Logistic regression analysis showed that STAS status,maximum tumor diameter,vascular invasion,lymphovascular invasion,and pathological stage were independent factors affecting the surgical procedure selection (lobectomy vs sublobar resection) in patients with lung adenocarcinoma (P<0.05).The recurrence rate and mortality rate in the STAS-positive group were 40.50% (49/121) and 16.53% (20/121),respectively,which were significantly higher than those in the STAS-negative group (14.67% (11/75) and 5.33% (4/75)) (P<0.05).In the STAS-positive group,the recurrence rate and mortality rate of patients undergoing sublobar resection were significantly higher than those undergoing lobectomy (both P<0.05);while in the STAS-negative group,there was no statistically significant difference in recurrence rate and mortality between the two surgical procedures (P>0.05).Conclusion For the STAS-negative patients,there is no difference in prognosis between lobectomy and sublobar resection;however,for the STAS-positive patients,lobectomy offers a better prognosis than sublobar resection.

Objective To explore the diagnostic value of DSA-guided precision catheterography technique in gastroduodenal diseases.Methods Clinical data from 139 patients with gastroduodenal diseases treated at the Third People's Hospital of Xinjiang Uygur Autonomous Region and Shufu County People's Hospital in Kashgar Prefecture between January 2016 and October 2024 were included in this study.Disease classifications included:38 cases of gastroduodenal obstruction;60 cases of gastroduodenal wall disruption (23 microgastric perforations,9 duodenal ruptures,17 gastroenteric anastomotic leaks,11 cholecystoduodenal fistulas);12 cases of superior mesenteric artery compression syndrome;16 cases of duodenal diverticulum;and 13 cases of gastroparesis.All patients underwent both CT examination (CT group) and DSA-guided precise cannulation radiography (DSA group).Using discharge diagnoses and clinical cure as evaluation standards,the disease diagnosis accuracy of the two methods was compared.Results Both the diagnostic accuracy for individual diseases (gastroduodenal obstruction,gastroduodenal wall disruption,superior mesenteric artery compression syndrome,duodenal diverticulum,and gastroparesis) and the overall diagnostic accuracy,as well as the accuracy in localizing lesions within gastroduodenal wall disruption cases,were significantly superior in the DSA group compared to the CT group.These differences were statistically significant (P<0.05).Conclusion DSA-guided precise cannulation radiography significantly improves the diagnostic accuracy for gastroduodenal obstruction,gastroduodenal wall disruption,superior mesenteric artery compression syndrome,duodenal diverticulum,and gastroparesis,as well as the accuracy in localizing lesions within gastroduodenal wall disruption cases.It could serve as an auxiliary diagnostic tool.

Objective To construct a dehydration risk prediction model for ileostomy patients based on machine learning algorithms and conduct internal validation.Methods A retrospective study was conducted including 520 ileostomy surgery patients admitted to our hospital from June 2020 to June 2023 as study subjects.Patients were divided into modeling set and testing set at a 1∶1 ratio,and postoperative dehydration was statistically observed.Based on clinical data from the modeling set,univariate and multivariate Logistic regression analyses were used to identify independent influencing factors for dehydration after ileostomy surgery.Random forest model,XGBoost model,and decision tree model were constructed to predict postoperative dehydration in patients.The predictive efficacy of the models was evaluated,the optimal model was selected,and internal validation was performed.Results In the total cohort,74 patients (14.23%) developed dehydration within 30 days postoperatively,with 38 patients (14.62%) in the modeling set and 36 patients (13.85%) in the validation set developing postoperative dehydration.The dehydration group had lower body mass index than the non-dehydration group,while age,diabetes,American Society of Anesthesiologists (ASA) classification,diuretic use,postoperative chemotherapy proportion,and postoperative day 1 C-reactive protein levels were higher than the non-dehydration group (P<0.05).Multivariate Logistic regression model showed that age,diabetes,diuretic use,postoperative chemotherapy,and postoperative day 1 C-reactive protein were all risk factors for postoperative dehydration in ileostomy surgery patients (P<0.05).Receiver operating characteristic (ROC) curve analysis showed that the predictive AUCs of the random forest model,XGBoost model,and decision tree model were 0.913,0.905,and 0.832,respectively,with the random forest model having the highest predictive efficacy.Calibration curve and decision curve analysis showed that the random forest model had good consistency and clinical net benefit.Random forest feature importance ranking showed that the importance ranking of independent influencing factors for postoperative dehydration in patients was postoperative day 1 C-reactive protein,age,diuretic use,diabetes,and postoperative chemotherapy,in that order.Additionally,internal validation showed that the predictive sensitivity,specificity,and accuracy of the random forest model were 86.11%,87.05%,and 86.92%,respectively.Conclusion The random forest model constructed based on age,diabetes,diuretic use,postoperative chemotherapy,and postoperative day 1 C-reactive protein has the best performance in predicting postoperative dehydration in ileostomy surgery patients.Importance ranking based on this model can provide support for formulating targeted clinical intervention strategies.

Objective To explore the clinical efficacy of the modified Bacon procedure and low anterior resection in the treatment of patients with middle and low rectal cancer.Methods A retrospective analysis was conducted on the clinical data of 130 patients with mid to low rectal cancer who underwent surgical treatment in the Colorectal and Anal Surgery Department of our hospital from January 2023 to December 2024.They were divided into Group A (laparoscopic anterior resection group,109 cases) and Group B (laparoscopic modified Bacon surgery group,21 cases) according to different anastomosis methods.The baseline data,surgical related indicators,postoperative pathological related indicators,and postoperative recovery of the two groups of patients were compared.The recovery function of the anus of the postoperative patients was evaluated by using the LARS scoring scale and the Wexner scoring scale at 1,3,6,9 and 12 months after the operation respectively.Results There was no statistically significant difference (P>0.05) between the two groups of patients in terms of surgical time,intraoperative blood loss,tumor gross classification,tumor circumferential length,and postoperative complications at 30 days.The distances from the lower edge of the tumor to the dentate line in group A and group B were (5.31±1.21)cm and (2.41±0.65)cm,respectively.The proportions of patients with stage T3-T4 tumors were 80% and 57%,respectively.The lengths of hospital stay were (9.35±4.83) days and (21.38±4.33) days,respectively.There was a statistically significant difference between the two groups (P<0.05).The incidences of severe LARS in group A and group B at 1 month,3 months and 6 months after surgery were 54% and 86%,41% and 76%,27% and 62%,respectively,and the Wexner scores were (10.12±2.01) points and (14.57±2.39) points,(7.05±1.33) points and (9.71±1.58) points,(3.23±1.24) points and (5.43±1.66) points,respectively.There was a statistically significant difference between the two groups (P<0.05).There was no significant statistical difference in the incidence of severe LARS and Wexner score between the two groups of patients at 9 and 12 months after surgery (P>0.05).Conclusion Compared with traditional low anterior resection,the modified Bacon procedure does not significantly increase early postoperative complications,and postoperative anal function is not inferior to that of patients undergoing low anterior resection.

Objective To compare the therapeutic outcomes of transanal total mesorectal excision (taTME) with primary anastomosis versus taTME combined with modified Bacon procedure in low rectal cancer patients.Methods From January 2021 to January 2024,123 patients with low rectal cancer were enrolled and divided into two groups:the control group (n=73) underwent taTME with primary anastomosis,while the study group (n=50) received taTME combined with modified Bacon procedure.To compare the two groups in terms of perioperative indicators,specimen outcomes,anal function,inflammatory factors,quality of life,and complications.Results No significant differences were observed in operative time,intraoperative blood loss,prophylactic stoma rate,or conversion to laparotomy (P>0.05).The length of hospital stay in the study group was (10.42±4.27) days,which was shorter than that in the control group [(12.68±4.18) days],and the difference was statistically significant (P<0.05).One month after the operation,the scores of the anal incontinence Scale (Wexner) and low anterior rectal resection syndrome (LARS) in both groups were increased compared with those before the operation,and the difference was statistically significant (P<0.05).The levels of interleukin-6,high-sensitivity C-reactive protein and interferon-γ in the study group 3 days after the operation were (49.47±8.15) pg/ml,(19.23±2.21) mg/L and (115.87±15.93) ng/L,respectively.The control groups were (54.38±7.19) pg/ml,(22.42±2.49) mg/L and (124.19 ±18.21) ng/L respectively.There was a statistically significant difference between the two groups (P<0.05).One month after the operation,the scores of emotional status,social/family status,physical status and functional status in both groups were increased compared with those before the operation,and the differences were statistically significant (P<0.05).The scores of emotional status,social/family status,physical status and functional status of the research group one month after the operation were (23.21±2.18) points,(25.49±2.41) points,(24.33±2.24) points and (24.66±2.28) points respectively.The control groups were (19.66±2.28) points,(21.33±2.25) points,(20.28±2.49) points and (20.28±2.41) points respectively.There was a statistically significant difference between the two groups (P<0.05).The incidence rates of complications in the study group and the control group were 6.00% and 19.18% respectively.There was a statistically significant difference between the two groups (P<0.05).Conclusion For low rectal cancer patients,taTME combined with modified Bacon procedure demonstrates advantages in reducing postoperative inflammation,decreasing complications,shortening recovery time,and improving quality of life compared to taTME with primary anastomosis.

Objective The aim of this study was to develop a predictive model for early recurrence and distant metastasis in patients with early-onset colorectal cancer (EOCRC) following surgery,and to validate its predictive value.Methods A retrospective analysis was conducted on the clinical data of 256 patients with EOCRC who underwent surgery at the 900th Hospital of PLA Joint Logistics Support Force from December 2014 to December 2020,with a follow-up period of three years post-surgery.Patients were divided into a recurrence and metastasis group (n=121) and a non-recurrence and metastasis group (n=135) based on the occurrence of recurrence and distant metastasis after surgery.Preoperative peripheral blood indicators and postoperative pathological characteristics were analyzed and compared between the two groups.Univariate and multivariate Logistic regression analyses were performed using R software (version 4.4.3) to identify potential risk factors.A nomogram prediction model was constructed based on the results of multivariate analysis.Receiver Operating Characteristic (ROC) curves,calibration curves,and Decision Curve Analysis (DCA) curves were plotted to evaluate and validate the predictive performance of the model.Results Of the 256 patients,121 experienced early recurrence and distant metastasis post-surgery,with a recurrence and metastasis rate of 47.3%.Multivariate Logistic regression analysis revealed that T stage,N stage,vascular/neural invasion,other histological types (mucinous adenocarcinoma/signet ring cell carcinoma),CEA,HRR,TyG,and PNI were independent risk factors for early recurrence and distant metastasis after EOCRC surgery.The area under the ROC curve of the model was 0.858(95%CI0.812~0.904).Based on the area under the ROC curve,calibration curves,and DCA curves,the model demonstrated good predictive performance.The web-based dynamic nomogram is accessible via this link:https://eocrc.shinyapps.io/dynnomapp/.Conclusion The nomogram can accurately predict the risk of early recurrence and distant metastasis within three years after EOCRC surgery,providing individualized clinical decision-making for future clinical diagnosis and treatment of EOCRC.

Objective To observe the clinical efficacy of continuous negative pressure closed drainage technology in promoting wound healing after anal fistula surgery.Methods From June 2022 to December 2024,60 patients with anal fistula and surgery admitted to our proctology department were randomly divided into an experimental group (30 cases) using continuous negative pressure closure drainage technology and a control group (30 cases) not using continuous negative pressure closure drainage technology.All patients underwent anal fistula resection surgery.Compare the clinical efficacy,wound healing rate,preoperative and postoperative inflammatory indicators [prostaglandin E2 (PGE2),high-sensitivity C-reactive protein (hs CRP),interleukin-6 (IL)],and wound healing time between the two groups.Results The postoperative experimental group had a wound area of (14.5±2.3) cm²,while the control group had a wound area of （12.8±3.6) cm².The observation course was 10 weeks.There was no statistically significant difference in age,disease duration,disease complexity,preoperative related examinations,postoperative wound area,and other data between the two groups of patients（P>0.05）.The effective rates of treatment in both groups were 100%.The wound healing rates of the experimental group at 2,3,6,and 10 weeks after surgery were (30.69±1.14)%,(45.59±3.25)%,(87.32±1.93)% and (100.00±0.00)%,respectively,while those of the control group were (15.78±0.15)%,(26.12±1.01)%,(65.31±0.32)% and (95.29±0.29)%,respectively.The difference between the two groups was statistically significant (P<0.05).On the third day after surgery,the experimental group had PGE2 levels of (142.13±12.85) ng/L,hs CRP levels of (8.13±0.92) ng/L,and IL-6 levels of (10.19±0.89) ng/L,respectively,while the control group were (180.23±15.21) ng/L,hs CRP levels of (14.15±1.35) ng/L,and IL-6 levels of (13.12±1.34) ng/L,respectively.The difference between the two groups was statistically significant (P<0.05).The average wound healing time in the experimental group was (40.5±10.6) days,while in the control group it was (65.5±4.5) days.The difference between the two groups was statistically significant (P<0.05).Conclusion After anal fistula surgery,negative pressure closed drainage treatment is adopted,which reduces the inflammatory response of the wound,speeds up the wound healing and shortens the wound healing time.

Objective To observe the clinical effect of the "Z"-shaped single purse-string suture method for the treatment of severe hemorrhoids with mucosal resection and nailing of hemorrhoids.Methods A total of 114 patients with stage Ⅲ or Ⅳ internal hemorrhoids,and mixed hemorrhoids who underwent hemorrhoidal mucosal resection and nailing surgery between March 2020 and February 2024 were selected and randomly divided into three groups using a random number table method,with 38 cases in each group.Single purse-string suture method was used for the patients of control group A,double purse-string suture method was used for the patients of control group B,and "Z" - shaped single purse-string suture method was used for the patients of observation group.The intraoperative conditions (surgical time,tissue resection width,incidence of intraoperative hematoma),incidence of postoperative complications (pain,heavy bleeding,anal prolapse,anal stenosis),and recurrence of hemorrhoids within 6 months after surgery were compared among three groups.Results The surgical time of the observation group was (25.34±6.61) minutes,which was significantly lower than that of the control group B [(32.13±6.51) minutes] (P<0.05),and there was no significant difference between the observation group and control group A [(24.47±5.76) minutes] (P>0.05).The width of the excised tissue in the observation group [(2.53±0.35) cm] was significantly larger than that of the control group A[(2.13±0.36) cm] (P<0.05),and there was no significant difference between the observation group and control group B [(2.62±0.40)cm] (P>0.05).The incidence of intraoperative hematoma in the observation group was 15.79% (5/38),which was significantly lower than that of the control group B [42.11 (16/38)] (P<0.05),and there was no significant difference between the observation group and control group A [13.16% (5/38)] (P>0.05).There was no statistically significant difference (P>0.05) in the incidence of postoperative pain,heavy bleeding,anal prolapse,and anal stenosis among the three groups.Follow up until 6 months after surgery,there were no recurrence cases in the observation group and control group B,which was significantly lower than that in control group A [5.71% (2/35)](P<0.05).Conclusion The "Z" - shaped single purse-string suture method is simple to operate,has a short surgical time,removes wide tissue,and does not increase complications.

Objective To investigate the efficacy of tube feeding enteral nutrition combined with vascular interventional therapy in treating acute occlusive mesenteric ischemia (AOMI).Methods A retrospective analysis was conducted on the clinical data of 29 patients with AOMI who underwent vascular interventional therapy from January 2022 to June 2025.Patients were divided into two groups based on whether they received tube feeding enteral nutrition:general treatment+supplemental parenteral nutrition+oral enteral nutrition group(R1 group,11cases) and general treatment+supplemental parenteral nutrition+tube feeding enteral nutrition group(R2 group,18 cases).Clinical data from both groups,including nutritional indicators,inflammatory markers,diarrhea occurrence,weight changes,and the length of surgically resected intestinal segments,were collected and analyzed.Results After 7 days of nutritional support,the white blood cell count (WBC) was (16.68±3.76)×10^*

Objective To explore the efficacy of flexible suction sheath (FSS) combined with disposable flexible ureteroscope (fURL) in the treatment of non-lower calyx renal calculi ≤ 3cm.Methods A total of 112 patients with non-lower calyx renal stones who underwent surgical treatment at Lishui People's Hospital,Nanjing,from April 2020 to February 2023,were divided into two groups according to the surgical method:percutaneous nephrolithotomy (PCNL) group (54 patients) and FSS-fURL group (58 patients).The PCNL group received PCNL treatment,while the FSS-fURL group underwent FSS combined with disposable fURL treatment.Postoperative stone clearance rate,24-hour urinary calcium,24-hour urinary uric acid,24-hour urinary creatinine,and renal cortex thickness changes were compared between the two groups.A 24-month follow-up was performed to record the recurrence rate of renal stones.Results The stone clearance rate in the FSS-fURL group (96.55%) was higher than that in the PCNL group (85.19%) (P<0.05).At 1 week after surgery,the 24-hour urinary calcium in the FSS-fURL group [(8.09±0.61) mmol] was higher than that in the PCNL group [(7.84±0.59) mmol] (P<0.05).At 1 month after surgery,the 24-hour urinary calcium in the FSS-fURL group [(6.86±0.65) mmol] was lower than that in the PCNL group [(7.12±0.48) mmol] (P<0.05).At 1 week and 1 month after surgery,the 24-hour urinary creatinine in the FSS-fURL group [(19.81±3.75) mg/kg and (20.83±3.62) mg/kg] was higher than that in the PCNL group [(17.32±2.89) mg/kg and (18.96±3.05）mg/kg] (P<0.05).At 1 month,6 months,and 12 months post-surgery,the renal cortex thickness in the FSS-fURL group [(14.06±0.53),(14.05±0.57) and (13.92±0.53)] was higher than that in the PCNL group [(13.75±0.48),(13.02±0.69) and (12.77±0.85)] (P<0.05).Postoperatively,the FSS-fURL group had lower levels of C-reactive protein,interleukin-6,procalcitonin,norepinephrine,and cortisol [(1.41±0.37) mmol/L,(50.81±11.03) ng/L,(0.97±0.23) ng/L,(291.63±47.29) μg/L and (227.18±40.92) μg/L] than the PCNL group [(1.02±0.25) mmol/L,(45.05±12.96) ng/L,(0.75±0.19) ng/L,(256.31±39.26) μg/L and (205.32±50.19) μg/L] (P<0.05).At the end of the follow-up,15 cases of recurrence were recorded in the PCNL group,with a recurrence rate of 27.78%,while 6 cases of recurrence were recorded in the FSS-fURL group,with a recurrence rate of 10.34%.The recurrence rate in the FSS-fURL group was lower than that in the PCNL group (P<0.05).Conclusion FSS combined with disposable fURL for the treatment of 3cm non-lower calyx renal stones can improve postoperative stone clearance rate,reduce postoperative renal function damage,lower the long-term recurrence rate of stones,and has good safety.

Objective To analyze the clinical application value of MR-TRUS image artificial intelligence (AI) fusion-assisted prostate biopsy in prostate cancer screening.Methods This study enrolled 212 prostate cancer patients undergoing prostate biopsy at our hospital from January 2023 to May 2025.They were randomly divided into a fusion group (106 cases,using Venus ultrasound with MR-TRUS image AI fusion guidance) and a traditional group (106 cases,using conventional transrectal ultrasound (TRUS) guidance).The following parameters were compared between the two groups:biopsy positive rate,false-negative rate,detection rate of tumors with different Gleason scores (GS),number of biopsy cores,targeting error,and incidence of postoperative complications (rectal bleeding,urinary tract infection,urinary retention).Results The biopsy positive rate of fusion group was 62.26% (66/106),significantly higher than 43.40% (46/106) in the traditional group (P<0.01).The false-negative rate in the fusion group was 1.89% (2/106),significantly lower than 9.43% (10/106) the traditional group (P<0.01).In the fusion group,the detection rates for tumors with GS≤6、GS=7and GS≥8 26.42％、29.24％and 6.60％，respectively．In the traditional group，these rates were 18.87％、16.98％and 7.55％，respectively.The difference in detection rate for low-to-intermediate-risk differentiated adenocarcinoma was statistically significant (P<0.01).The fusion group had a lower average number of biopsy cores (7.9±1.2) compared to the traditional group (13.2±1.6) (P<0.05) and a smaller targeting error [(1.1±0.3)mm VS (4.0±0.8)mm](P<0.05).The total incidence of postoperative complications in the fusion group was 5.66% (6/106),lower than the 19.81% (21/106) in the traditional group (P<0.05).Conclusion MR-TRUS image AI fusion can improve the detection rate of low-to-intermediate-risk differentiated prostate cancer,reduce the prostate cancer missed diagnosis rate,and decrease biopsy-related trauma and complications.

Objective To explore the influence of immersive virtual reality (VR) interaction systems on acute and chronic pain and quality of life in patients after thoracic surgery.Methods A total of 118 patients who underwent thoracic surgery and were admitted to the hospital from December 2023 to December 2024 were selected and randomly divided into two groups.The control group (59 cases) was given patient-controlled intravenous analgesia after the operation,while the observation group (59 cases) was additionally given immersive VR interaction technology on the basis of the control group.The pain degree,sleep time,hospital stay,dosage of analgesic drugs,heart rate,mean arterial pressuree,blood oxygen saturation,quality of life score and chronic pain conditions of the two groups of patients were compared.Results After intervention,the degree of pain in the observation group at rest (painless 39),cough (painless 35),and activity (painless 31) was all lower than that in the control group [at rest (painless 26),cough (painless 19),activity (painless 20)] (P<0.05).The hospitalization time and the dosage of analgesic drugs in the observation group were both lower (P<0.05).After intervention,the sleep duration and blood oxygen saturation in both groups increased,and observation group were higher (P<0.05).The heart rate and mean arterial pressuree in both groups decreased,and observation group were lower (P<0.05).After intervention,the scores of physiology,psychology,environment and social relationship of patients in both groups increased,and the observation group were higher (P<0.05).Three months after the operation,the incidence of chronic pain in the observation group and the control group was 16.95% (10/59) and 37.29% (22/59),respectively,the incidence in the observation group was lower (P<0.05).Conclusion The immersive VR interaction system for patients after thoracic surgery can relieve pain,increase sleep time,improve heart rate,mean arterial pressuree and blood oxygen saturation,enhance the quality of life and reduce the incidence of chronic pain.

Objective To explore the effect of intraoperative hypothermia on early pulmonary complications (PPCs) after thoracoscopic lobectomy under thoracic paravertebral nerve block (TPVB) anesthesia in elderly patients.Methods The clinical data of 126 elderly patients who underwent thoracoscopic lobectomy in our hospital from May 2022 to February 2025 were retrospectively collected.They were divided into the PPCs group and the non-PPCs group based on whether PPCs occurred during postoperative hospitalization.Logistic regression was used to analyze the relationship between intraoperative hypothermia and PPCs.The ROC curve was used to evaluate the predictive value of intraoperative hypothermia for PPCs.Results Among the 126 elderly patients who underwent thoracoscopic lobectomy included,21 cases developed PPCs within one week after the operation,with an incidence rate of 16.67%.The age,smoking history,diabetes,preoperative frailty,intraoperative hypothermia,duration of hypothermia,hypoalbuminemia and C-reactive protein (CRP) concentration in the PPCs group were all higher than those in the non-PPCS group (P<0.05).Univariate Logistic regression analysis showed that age,smoking history,diabetes,preoperative frailty,intraoperative hypothermia,duration of hypothermia,hypoalbuminemia,and CRP concentration were all associated with early PPCs after thoracoscopic lobectomy under TPVB anesthesia in elderly patients (P<0.05).Further multivariate Logistic regression analysis showed that age,preoperative frailty,intraoperative hypothermia,duration of hypothermia,hypoalbuminemia,and CRP concentration were independent risk factors for early PPCs after thoracoscopic lobectomy under TPVB anesthesia in elderly patients (P<0.05).The ROC curve showed that the AUC of intraoperative hypothermia and the duration of intraoperative hypothermia alone in predicting early PPCs after thoracoscopic lobectomy under TPVB anesthesia in elderly patients was 0.776 (95%CI:0.651-0.902) and 0.739 (95%CI:0.631-0.848),respectively,the combined AUC of the two was 0.920 (95%CI:0.857-0.983),which was greater than the AUC predicted separately for intraoperative hypothermia and the duration of intraoperative hypothermia (Z=2.064,P=0.039;Z=1.979,P=0.045).Conclusion Intraoperative hypothermia and its duration are important independent risk factors for early PPCs after thoracoscopic lobectomy under TPVB anesthesia in elderly patients.The combined detection of the two can improve the predictive efficacy for PPCs.

Objective To explore the clinical characteristics,early diagnosis and treatment strategies of arterial massive hemorrhage following the tension-free vaginal tape (TVT) procedure for stress urinary incontinence (SUI).Methods A retrospective analysis was conducted on the clinical data of a 54-year-old female patient with SUI who suffered from arterial massive hemorrhage after TVT.Meanwhile,a systematic search of relevant literature was performed to summarize the incidence rate,high-risk factors,and core points of clinical diagnosis and treatment for arterial hemorrhage after TVT.Results The patient developed sudden hemorrhagic shock two hours after the operation,accompanied by lower abdominal distension,hypotension and a significant decrease in hemoglobin level.Iliac artery angiography identified a branch of the right internal pudendal artery as the responsible lesion for bleeding,and emergency hemostasis was performed via coil combined with gelatin sponge particle embolization.Postoperative CT examination indicated the formation of a large pelvic hematoma,and the patient’s condition stabilized after subsequent symptomatic and supportive treatment.A 6-month follow-up showed complete absorption of the pelvic hematoma,complete relief of urinary incontinence symptoms,and the therapeutic effect of the TVT procedure remained unaffected.Conclusion Arterial massive hemorrhage after TVT is a rare but acute and life-threatening complication that can rapidly progress to hemorrhagic shock.Clinicians should be highly alert to the possibility of arterial hemorrhage when patients present with shock combined with lower abdominal distension after TVT.Emergency angiography combined with interventional embolization can quickly identify the bleeding site and achieve effective hemostasis,while maximizing the preservation of the therapeutic effect of the sling procedure,which can be recommended as the first-choice diagnosis and treatment plan for this complication.

Pituitary adenomas are common tumors of the endocrine system,most of which are benign.However,despite surgical or medical treatment,some patients experience residual or recurrent tumors,inadequate control of tumor growth,or endocrine dysfunction,presenting significant challenges to clinicians.This article reviews the latest advances in the treatment of recurrent pituitary adenomas,including surgical treatment,medical oncology,and radiotherapy.It focuses on radiotherapy,covering radiotherapy methods,adverse reactions and complications after radiotherapy,protection against radiation damage,and future prospects.

Congenital diaphragmatic hernia (CDH) in adults is rare and often misdiagnosed,leading to delayed treatment.A 29-year-old male patient was admitted on November 21,2024,with progressive dyspnea.CT imaging revealed a left diaphragmatic defect with massive herniation of abdominal organs into the thoracic cavity.On the sixth day of hospitalization,the patient underwent laparoscopic tension-free repair of the left diaphragmatic hernia.Intraoperatively,a 5cm diaphragmatic defect was observed,and the herniated contents were successfully reduced into the abdominal cavity and secured with a mesh.The postoperative recovery was good,with full lung re-expansion and no significant complications.No recurrence was observed during the 3-month follow-up.

bdominal cocoon syndrome is a clinically rare abdominal disease,also known as idiopathic sclerosing peritonitis,congenital intestinal incarceration,etc.Its etiology remains unclear,preoperative diagnosis is difficult,clinical misdiagnosis is common,and treatment is subject to considerable controversy .Our hospital recently admitted a patient in whom dense adhesions caused by abdominal cocoon syndrome were found during surgery to have compressed an intra-abdominal cyst against the gastric fundus,leading to a preoperative misdiagnosis as a gastric fundus mass.

An intestinal fistula is defined as an abnormal passage that connects the intestine to another intra-abdominal organ,the abdominal cavity,or the body surface.Due to the presence of intestinal contents,digestive enzymes,bacteria,and fecal matter,intestinal fistulas can lead to severe complications such as sepsis and short bowel syndrome (manifested by dehydration,electrolyte imbalances,and malnutrition).The etiology of intestinal fistulas can be broadly classified into four categories:postoperative,traumatic,disease-related,and congenital.Among these,the first three are more commonly encountered,whereas congenital intestinal fistulas are relatively rare.

This paper reports the diagnosis and treatment of a 12-year-old male child with paraduodenal hernia complicated by small bowel obstruction.The child was admitted for persistent severe left abdominal colic,and abdominal CT suggested internal hernia.Emergency laparoscopic exploration was performed,and left paraduodenal hernia was confirmed.The surgical procedures included intestinal reduction,closure of the hernia defect,and mesenteric fixation.The child recovered well after symptomatic treatment and had no discomfort during 3-month follow-up.Combined with literature review,the clinical characteristics,diagnosis,and treatment of paraduodenal hernia were discussed.It is emphasized that the disease is rare in children with non-specific clinical manifestations,abdominal CT is an important diagnostic method,laparoscopic surgery is the first choice of treatment.