Pancreatic ductal adenocarcinoma (PDAC) is highly malignant with a poor prognosis, and the traditional "resectability" assessment based on radiological vascular invasion no longer meets clinical needs.With advances in perioperative treatment concepts, multidisciplinary collaboration, and technologies such as liquid biopsy, metabolic imaging, and molecular detection, the management of PDAC is shifting from an "anatomical resectability" model to a precision model oriented to "biological benefit".Preoperatively, risk stratification can be achieved through dynamic CA19-9 changes, staging laparoscopy, positron emission tomography (PET/CT), and circulating tumor DNA (ctDNA), supplemented by radiomics and artificial intelligence, to better identify patients who will benefit from surgery.Neoadjuvant therapy improves the R0 resection rate while also providing biological selection and optimizing surgical timing.Surgically, the focus is on rationally optimizing the extent of resection while ensuring R0 resection, involving vascular resection and reconstruction, lymph node dissection, and nerve plexus management.Postoperatively, stratification of adjuvant therapy and ctDNA-based monitoring of minimal residual disease offer new approaches to recurrence risk identification and dynamic management.This review summarizes the key surgical issues in the precision treatment of PDAC to provide a reference for clinical decision-making.

Postoperative pancreatic fistula (POPF) is one of the most challenging and dangerous complications in pancreatic surgery, significantly compromising patient recovery and contributing to excessive consumption of healthcare resources.Based on the similarities and differences between the two types of POPF——pancreatic stump/raw surface fistula and anastomotic fistula—this article systematically reviews the current status and difficulties of the perioperative prevention strategies for POPF.At present, preoperative prevention and prediction have focused on controlling high-risk factors and constructing multimodal prediction models, although the reliability of these models urgently requires breakthroughs through AI-driven data integration.Intraoperative prevention, as the core component, remains controversial: modified techniques for pancreaticojejunostomy and pancreaticogastrostomy continue to emerge, yet no consensus has been reached regarding which is superior; the effectiveness of stump closure reinforcement techniques still lacks high-level evidence; and the necessity of prophylactic drain placement is highly debated, with the omission of drains during pancreaticoduodenectomy being difficult to adopt as standard practice.Somatostatin is an important part of postoperative prevention, but the patient populations that truly benefit from it require further refinement.

Pancreatic cancer is insidious in onset, highly aggressive, and associated with an extremely poor prognosis.Currently, surgical resection remains the primary means of prolonging survival in patients with pancreatic cancer; however, the majority of patients lose the opportunity for surgery at the time of diagnosis.Irreversible electroporation (IRE) is a non-thermal ablation technique that not only achieves local tumor ablation but also reverses the highly immunosuppressive tumor microenvironment.The combination of IRE with chemotherapy and immunotherapy is expected to yield improved clinical outcomes.This paper systematically reviews the latest clinical evidence on IRE combined with chemotherapy and immunotherapy, with a focus on the potential mechanisms by which IRE remodels the immunosuppressive microenvironment of pancreatic cancer.It also explores future directions for optimizing combination treatment strategies, aiming to provide new perspectives and a theoretical foundation for the treatment of pancreatic cancer.

Intestinal autotransplantation (IATx) has emerged as a novel surgical strategy to achieve curative resection in patients with locally advanced pancreatic cancer (LAPC) involving complex vascular invasion of the mesenteric root.With advances in neoadjuvant therapy, organ-preserving techniques, vascular reconstruction, and hypothermic perfusion, IATx has gradually overcome the technical barriers that traditionally rendered these tumors unresectable, thereby improving the likelihood of R0 resection and enhancing long-term survival outcomes.Based on the latest domestic and international evidence, together with our institutional experience, this review systematically summarizes the indications for IATx in LAPC, patient selection following neoadjuvant therapy, individualized surgical planning, and the application of modified techniques such as in situ cold perfusion.In addition, the advantages of IATx in damage control, organ function preservation, and perioperative management are discussed.Current challenges, including optimal patient selection, perioperative risk management, long-term outcome evaluation, and future directions, are also addressed.As precision surgery, multidisciplinary team (MDT) management, and multimodal treatment strategies continue to evolve, IATx and its modified approaches are expected to further expand the indications for curative resection in patients with LAPC and other complex tumors involving the mesenteric root, ultimately leading to improved long-term prognosis.

Arterial involvement by pancreatic cancer remains a major obstacle to curative resection, and the role of arterial resection (AR) and reconstruction in pancreatic surgery has long been controversial.With the ongoing optimization of neoadjuvant therapy regimens and the attendant improvement in oncological outcomes, coupled with the overall enhancement of perioperative safety in pancreatic surgery, the value and indication of AR in borderline resectable and locally advanced pancreatic cancer warrant reappraisal.This review summarizes the historical controversies surrounding AR and, drawing on recent retrospective studies from highvolume centers and metaanalyses, evaluates its perioperative safety and oncological efficacy and discusses the technical feasibility of AR and the application of arterial divestment(AD) as an alternative strategy.

While the concept of "precision treatment" has been widely adopted in pancreatic cancer, its clinical understanding often diverges from the original vision of precision medicine, frequently reduced to genetic testing or molecularly targeted therapies, while overlooking the multidimensional nature of precision decision-making from a surgical perspective.In 2024, the Trans-Atlantic Pancreatic Surgery Consortium validated the ABC stratification system, upgrading resectability assessment from purely anatomical imaging to a three-dimensional framework incorporating Anatomy, Biology, and Condition.However, rapid advances, including KRAS G12D inhibitors, Claudin18.2-targeted antibody-drug conjugates, individualized mRNA neoantigen vaccines, liquid biopsy-guided minimal residual disease monitoring, and AI-assisted decision platforms, demand a more comprehensive framework.This review systematically examines the current status and recent breakthroughs across multiple dimensions of precision treatment from a surgical standpoint.And explore the application prospects of multi-factor data integration and artificial intelligence in precise surgical decision-making, with the aim of providing a practical path for individualized treatment of pancreatic cancer.

Objective To analyze the influencing factors for hyperamylasemia after endoscopic retrograde cholangiopancreatography (ERCP) in patients with common bile duct stones.Methods A total of 246 hospitalized patients with common bile duct stones who underwent ERCP in our hospital from January 2023 to December 2024 were retrospectively enrolled and divided into occurrence group and non-occurrence group according to whether hyperamylasemia occurred postoperatively.Logistic regression was used to identify the influencing factors for hyperamylasemia after ERCP in patients with common bile duct stones, and a logistic regression equation model was established.Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model.Receiver operating characteristic (ROC) curve, calibration curve, and decision curve were used to evaluate the model performance.Results Logistic regression analysis showed that female gender, history of alcohol consumption, triglycerides, common bile duct stenosis, difficult cannulation, and procedure time were risk factors for hyperamylasemia after ERCP in patients with common bile duct stones, while pancreatic duct stent was a protective factor (P<0.05).logit(P) =-6.406+1.094×female (yes=1, no= 0) + 0.866 × history of alcohol consumption (yes=1, no=0)+1.704×triglycerides (mmol/L)+0.863×common bile duct stenosis (yes=1, no=0)+1.009×difficult cannulation (yes=1, no=0) -1.042×pancreatic duct stent placement (yes=1, no=0)+0.075×procedure duration (min).The ROC curve showed that the area under the curve (AUC) of this model prediction was 0.848, with a specificity of 84.48% and a sensitivity of 73.61%.The concordance index after internal validation of the model obtained by Bootstrap method was 0.850.The calibration curve showed that the predicted values were close to the actual values.Hosmer-Lemeshow test showed χ2=3.344, P=0.911, indicating good consistency and goodness of fit.Decision curve analysis showed that the model had good standardized net benefit when the threshold probability value was 0.15-0.95.Conclusion Female gender, history of alcohol consumption, triglycerides, common bile duct stenosis, difficult cannulation, procedure time, and pancreatic duct stent are influencing factors for hyperamylasemia after ERCP in patients with common bile duct stones.The logistic regression prediction model constructed based on the above key parameters has excellent discriminative ability.

Objective To analyze the risk factors of primary liver cancer complicated with sarcopenia and its impact on the prognosis of patients.Methods A retrospective analysis was conducted on the clinical data of 112 patients with primary liver cancer who were hospitalized in our hospital from November 2017 to June 2019.The patients were divided into the sarcopenia group(33 cases) and the non-sarcopenia group(79 cases) according to whether they were complicated with sarcopenia.The related factors affecting the occurrence of sarcopenia in primary liver cancer were evaluated by Multivariate Logistic regression.All subjects were followed up for 5 years, and the survival curves were plotted using the Kaplan-Meier method to compare the 5-year survival rates among the groups.Results The incidence of sarcopenia in 112 patients with primary liver cancer was 29.46%.The proportions of patients aged ≥ 60 years, smoking history, drinking history, combined underlying diseases, NRS 2002 score ≥3, tumor stage Ⅲ-Ⅳ, and Child-Pugh grade B in the sarcopenia group were all higher than those in the non-sarcopenia group, while the body mass index and albumin level were lower than those in the non-sarcopenia group (P<0.05).In addition, there was a significant difference in skeletal muscle mass index between the two groups, and this difference remained significant even after stratification by gender (P<0.05).Multivariate analysis showed that age ≥60 years (OR=1.941), Child-Pugh grade B (OR=2.683), and nutrition risk screening 2002(NRS2002) score ≥3 (OR=3.404) were all risk factors affecting sarcopenia in primary liver cancer (P<0.05).BMI (OR=0.296) was a protective factor (P<0.05).Kaplan-Meier survival analysis and Log-rank test showed that the median survival time in the sarcopenia group was 36.5 months (95%CI: 28.4-44.6), which was lower than 58.0 months (95%CI: 49.1-66.9) in the non-sarcopenia group.There was a statistically significant difference between the two groups (P<0.05).The 5-year survival rate was also significantly lower (24.24% vs.44.30%), and the Log-rank test for comparing the survival curves of the two groups showed statistically significant differences (χ2=3.961, P<0.05).Univariate analysis showed that, in addition to sarcopenia, age ≥60 years old, lower body mass index, tumor stage Ⅲ-Ⅳ and Child-Pugh grade B were also significantly associated with overall survival (P<0.05).The final model of multivariate Cox regression analysis shows that Sarcopenia (HR=2.861), decreased body mass index (HR=1.268), age ≥60 years old (HR=1.727), tumor stage Ⅲ-Ⅳ (HR=1.980), and Child-Pugh grade B (HR=2.119) were risk factors for overall survival (P<0.05).Conclusion Sarcopenia has a high incidence among patients with primary liver cancer.Its occurrence is related to factors such as age, nutritional status and liver function, and its existence is an independent risk factor for shortening the overall survival period of patients.

Objective To construct a predictive model for the risk of postoperative cerebral edema in patients with meningioma based on preoperative radiomics and to evaluate its predictive value for the occurrence of postoperative cerebral edema.Methods A prospective study was conducted on 500 patients with meningioma who underwent surgical treatment in our hospital from May 2021 to March 2025.The patients were randomly divided into a training set (350 cases) and a validation set (150 cases) at a ratio of 7∶3.All patients underwent preoperative MRI examination.According to the presence or absence of postoperative cerebral edema, patients were divided into an occurrence group and a non-occurrence group.General data, laboratory examination results, and preoperative MRI radiomics features were analyzed between the two groups.Multivariate Logistic regression was used to analyze the influencing factors for postoperative cerebral edema in meningioma patients.A nomogram prediction model for postoperative cerebral edema was constructed and validated based on the influencing factors.The receiver operating characteristic (ROC) curve was used to evaluate the performance and clinical value of the prediction model, and internal validation of the nomogram was performed.Results In the training and validation sets, the occurrence group showed a higher proportion of irregular tumor morphology, absence of peritumoral brain edema, presence of dural tail sign, unclear tumor-brain interface, tumor located in the parasagittal/parafalcine region, tumor lesion>5 cm, and presence of feeding arteries compared to the non-occurrence group (P<0.05).The feature values of original_glszm_Gray Level Non Uniformity, wavelet-HLL_glszm_Gray Level Non Uniformity, exponential_glszm_Gray Level Non Uniformity, and log-sigma-3D_glszm_zone Entropy were significantly higher in the occurrence group than in the non-occurrence group(P<0.05).Multivariate Logistic regression analysis showed that regular tumormorphology, non-parasagittal/parafalcine tumor location, and tumor size (<5 cm) were independent protective factors against postoperative brain edema, while unclear tumor-brain interface, original_glszm_Gray Level Non Uniformity, wavelet-HLL_glszm_Gray Level Non Uniformity, exponential_glszm_Gray Level Non Uniformity, and log-sigma-3D_glszm_zone Entropy were independent risk factors for postoperative brain edema(P<0.05).The concordance index (C-index) of the nomogram model for predicting brain edema in the training set was 0.802.The calibration curve showed that the predicted probability of brain edema by the nomogram model was in good agreement with the actual incidence in the training set.Decision curve analysis (DCA) indicated that the prediction model had high net benefit when the threshold probability ranged from 20% to 60%, demonstrating certain clinical applicability.The receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) of radiomic features for predicting postoperative brain edema in the validation set was 0.785 (95%CI: 0.671-0.874) (P<0.05).Conclusion The nomogram prediction model based on preoperative MRI radiomics features can effectively predict the risk of postoperative cerebral edema in patients with meningioma, providing strong support for clinical decision-making in patients with meningioma.

Objective To investigate the feasibility, safety and efficacy of self-controlled physical rehabilitation therapy of chest (SPRC) in alleviating acute pain in hospitalized patients with multiple rib fractures of non-flail chest caused by blunt chest trauma.Methods From January 2023 to December 2024, 180 patients with multiple rib fractures due to blunt thoracic trauma were admitted.They were divided into the observation group(91 cases) and the control group(89 cases) based on the treatment methods.There was no significant difference in the basic conditions between the two groups (P>0.05).Starting from the second day after admission, the observation group received systematic rehabilitation treatment according to the SPRC method, while the control group received treatment according to the conventional method.Compare the number of patients who received additional analgesic drugs, the daily resting VAS score and the maximum VAS score, the number of patients who stopped observation and chose to undergo internal fixation surgery for rib fractures, as well as the complications.Results The number of patients who received additional analgesic drugs on the second day of admission was significantly lower in the observation group than in the control group[16 cases(17.6%)vs.28 cases(31.5%)] (P<0.05).The resting VAS scores of the observation group and the control group on the third day of admission were (2.85±0.71) points and (3.16± 0.69) points respectively, and on the fourth day, they were (2.27±0.65) points and (2.56±0.85) points respectively.The heaviest VAS scores on the third day of admission in the observation group and the control group were (6.53 ±0.94) points and (6.87±0.89) points respectively, and the heaviest VAS scores on the fourth day of admission were (5.49±1.02) points and (6.00±1.15) points respectively.There was a statistically significant difference between the two groups (P<0.05).The number of patients who underwent internal fixation for rib fractures in the observation group and the control group was 14 cases (15.4%) and 23 cases (25.8%), respectively.There was no statistically significant difference between the two groups (P>0.05).There was no statistically significant difference in complications between the two groups (P>0.05).Conclusion The SPRC method is feasible, safe and effective in alleviating acute pain in patients with multiple rib fractures of non-flail chest caused by blunt thoracic trauma, and is superior to conventional treatment methods.

Objective To investigate the effects of long non-coding RNA LAMTOR5-AS1 (LncRNA LAMTOR5-AS1) on the malignant biological behaviors of colorectal cancer (CRC) cells through targeted regulation of the microRNA-28-5p (miR-28-5p)/agmatinase (AGMAT) signaling axis. Methods The expression levels of LncRNA LAMTOR5-AS1, miR-28-5p, and AGMAT mRNA were detected in CRC tissues, adjacent non-tumor tissues, CRC cell lines (HCT116, SW480, Lo Vo), and human normal colonic epithelial cells (NCM460).HCT116 cells were divided into the si-NC, si-LAMTOR5-AS1, miR-NC, miR-28-5p mimics, si-LAMTOR5-AS1+inhibitor NC, and si-LAMTOR5-AS1+miR-28-5p inhibitor.In each group, the expression levels of LncRNA LAMTOR5-AS1, miR-28-5p and AGMAT mRNA were detected by real-time quantitative reverse transcription PCR (RT-qPCR); cell viability was assessed by CCK-8 assay; cell migration and invasion were evaluated by wound healing assay and Transwell assay, respectively; cell apoptosis was measured by flow cytometry; and the protein expression levels of AGMAT, Ki67, Cleaved caspase-3, E-cadherin and MMP9 were determined by Western blot.The targeted relationships between miR-28-5p and LncRNA LAMTOR5-AS1 or AGMAT were verified.A subcutaneous xenograft tumor model in nude mice was established, and the animals were divided into si-NC and si-LAMTOR5-AS1 groups.Tumor growth and the expression levels of LncRNA LAMTOR5-AS1, miR-28-5p and AGMAT mRNA were examined. Results LncRNA LAMTOR5-AS1 and AGMAT mRNA were upregulated, while miR-28-5p was downregulated in CRC tissues and cell lines.Silencing LncRNA LAMTOR5-AS1 or overexpressing miR-28-5p significantly reduced HCT116 cell viability, proliferation, migration, and the protein expression of AGMAT, Ki67 and MMP9, while increasing the apoptosis rate and the protein expression of Cleaved caspase-3 and E-cadherin (P<0.05).Simultaneous silencing of LncRNA LAMTOR5-AS1 and downregulation of miR-28-5p reversed the effects of si-LAMTOR5-AS1, as evidenced by increased protein expression of AGMAT, Ki67 and MMP9, decreased apoptosis rate and reduced Cleaved caspase-3 and E-cadherin expression, thereby attenuating the inhibitory effects of si-LAMTOR5-AS1 on HCT116 cell viability, proliferation and migration (P<0.05).In vivo experiments demonstrated that silencing LncRNA LAMTOR5-AS1 suppressed the growth of xenograft tumors in nude mice. Conclusion Silencing LncRNA LAMTOR5-AS1 inhibits HCT116 cell proliferation, migration and tumor growth through targeted regulation of the miR-28-5p/AGMAT signaling axis.

Objective To study the effect of "anal pushing" method on distal intestinal disconnection and reinforced suture anastomosis and closure in endoscopic assisted resection of low rectal cancer.Methods From December 2022 to December 2024, 85 patients who underwent endoscopic assisted anterior resection of rectum (Dixon) in our department were reviewed.The patients were divided into two groups according to whether to give "anal pushing" when the distal intestinal canal of the tumor was broken and the anastomoses and closures were reinforced during the operation.There were 41 cases in the observation group, who were treated with the "anal pushing" method, and 44 cases in the control group, who were treated with the traditional method.The number of anastomoses and closures, perioperative related indicators, postoperative laboratory test results, postoperative complications and so on were compared between the two groups.Results In the observation group, there were 27 cases(65.85%) of patients with abdominal reinforcement suture anastomosis and closure, which were significantly more than those in the control group[17 cases(38.64%)] (P<0.05).In the observation group, the number of times the linear cutting closure device was used to sever the distal tumor was 32 times, the time to reinforce the anastomosis was (9.89±1.88) minutes, the operation time was (188.66±26.32) minutes, the postoperative ventilation time was (3.93±4.98) days, and 7 cases (17.07%) underwent prophylactic ileostomy.The control groups were 21 times, (13.45±3.76) minutes, (209.50±19.45) minutes, (4.98±1.87) days and 16 cases (36.36%) respectively.There was a statistically significant difference between the two groups (P < 0.05).Conclusion The "anal pushing" is conducive to the exposure of the distal bowel of low rectal cancer, reducing the number of times of using the closure device, better exposing the anastomotic and closure in the surgical field, accelerating the speed of reinforcement and suture, and promoting the rehabilitation of patients.

Objective To explore the correlation between DNA damage and inflammatory responses in diabetic foot ulcer wounds.Methods From March 2024 to February 2025, 25 patients with diabetic foot ulcers were admitted as the experimental group, and 25 patients without diabetic trauma were taken as the control group.Skin tissue samples were collected from wounds of both groups for fixation, immunofluorescence assessed γ-H2A.X and cGAS expression, ELISA measured IL-6 and TNF-α levels, RT-PCR determined NF-κB p65 and IkB-α mRNA levels, whilst Western blotting evaluated γ-H2A.X and cGAS expression.Results The expression levels of γ-H2A.X and cGAS in the wound tissue of the patients in the experimental group were (63.0±4.36) and (32.7±6.43), respectively, which were significantly enhanced compared with those in the control group (49.3±5.13 and18.3±2.89).The expression levels of IL-6 in the experimental group and the control group were (4.50±0.64)pg/ml and (3.11 ±0.47)pg/ml, respectively.The expression levels of TNF-α were (224.67±24.06)pg/ml and (205.60±20.44)pg/ml, respectively.There was a statistically significant difference between the two groups (P<0.05).RT PCR results suggest The expression levels of NF-κB p65 in the wounds of the experimental group and the control group were (0.056±0.011)pg/ml and (0.036±0.006)pg/ml respectively, and the expression levels of IkB-α were (0.030±0.008)pg/ml and (0.017±0.006)pg/ml, respectively.There was a statistically significant difference between the two groups (P<0.05).The results of Western blotting suggest The expression levels of γ-H2A.X in the experimental group and the control group were 0.89±0.040 and 0.69±0.046 respectively, and the expression levels of cGAS were 0.48±0.035 and 0.26±0.048 respectively.There was a statistically significant difference between the two groups (P<0.05).Conclusion DNA damage is closely linked to inammatory responses in diabetic foot ulcer woundss. [Key Words] DNA damage; diabetic foot ulcers; inflammatory response 糖尿病足溃疡(DFU)是糖尿病病人晚期严重并发症之一, 2型糖尿病病人出现DFU风险高达25%^[1]. 目前, DFU的治疗效果仍不满意, 15%~20%的中重度感染最终引起病人下肢截肢^[2-3]. 有研究表明, 过量炎症反应是导致DFU伤口难愈的重要原因之一^[1]. Weigelt等^[4]研究发现, 糖尿病足伤口组织中白细胞介素(IL)-6等炎症介质水平明显升高. 本团队前期研究发现, DFU伤口NOD 样受体蛋白 3(p65NLRP3), 核因子(NF)-κB p65含量明显高于对照组^[5-6]. 典型的炎症反应可分为炎症诱导物, 炎症反应传感器, 诱导的炎症介质以及下游靶组织^[7]. DNA损伤是内外源性刺激如致病菌毒性代谢产物等威胁细胞基因组的稳定性, 引起包括DNA双链断裂(DSBs)在内的损伤, DSBs是DNA损伤后果最严重的一种^[8]. H2A.X是染色质核小体的核心成分之一, 在DSBs早期, H2A.X可被共济失调-毛细血管扩张突变蛋白(ATM)及ATM-Rad3 相关蛋白(ATR)磷酸化为γ-H2A.X, 并大量募集于DNA损伤位点, 被认为是DSBs发生的重要标志^[9]. 本研究检测糖尿病足病人伤口皮肤组织炎症因子以及DNA损伤标志物, 探讨DNA损伤在糖尿病足伤口炎症反应发生发展中的机制. 对象与方法 一, 对象 2024年3月~2025年2月收治的DFU病人25例为试验组, 25例无糖尿病开放伤口病人(车祸伤, 下肢开放性伤口以及骨折术后未愈伤口等)为对照组. 纳入标准: (1)年龄18~80岁; (2)明确诊断为糖尿病足溃疡; (3)伤口Wagner分级为2~4级. 排除标准: 严重心脑肺功能异常; 下肢静脉性溃疡; C反应蛋白(CRP)>100mg/L和踝肱指数(ABI)<0.4; 有精神类疾病等或无法合作. 本研究经过医院伦理委员会批准(青医2021-20), 所有病人均签署入组知情同意书. 二, 方法 1.临床资料收集: 包括性别, 年龄, 身体质量指数(BMI), 丙氨酸氨基转移酶(ALT), 肌酐, CRP, 创面大小, 溃疡时间, 空腹血糖, 当前吸烟, 当前饮酒, ABI, 动脉硬化指数[(总胆固醇mmol/L-高密度脂蛋白胆固醇mmol/L)／高密度脂蛋白胆固醇mmol/L]和高血压既往史. 入院后进行伤口细菌培养, 根据培养和药敏结果, 采用合适抗生素. 2.标本采集: 入院时采集两组病人的伤口周围肉芽组织(大小约1.0cm×0.5cm×0.5cm), 一半伤口组织通过福尔马林固定液保存, 另一半伤口组织置于-80℃冰箱保存. 3.HE染色及免疫荧光: 取伤口组织进行包埋切片, 然后进行苏木精-伊红染色(HE)和免疫荧光染色, 观察伤口组织炎症反应. 为观察γ-H2A.X和环磷酸鸟苷-腺苷合成酶(cGAS)的表达定位, 取组织切片, 4%多聚甲醛固定, 血清孵育15分钟后加入一抗(γ-H2A.X或cGAS), 37℃孵育过夜, PBS冲洗, 加入二抗(抗兔IgG), 室温孵育1小时, PBS冲洗, 加入DAPI染色5分钟, 封片后免疫荧光显微镜观察, 定量两组之间的荧光强度表达差异. 4.酶联免疫吸附试验(ELISA)检测: 伤口组织匀浆加入PBS, 离心取上清液, 通过ELISA试剂盒(e Bioscience公司)检测伤口组织IL-6和TNF-α水平, 利用酶标仪测定450nm处吸光度值, 计算IL-6和TNF-α含量. 5.蛋白印迹法(Western blotting)检测: 提取伤口组织总蛋白, 使用BCA试剂盒计算蛋白浓度, 丙稀酰胺凝胶电泳后(SDS-PAGE), 转膜后TBST缓冲液洗膜后封闭. 加入γ-H2A.X或cGAS一抗, 4℃孵育过夜, 加二抗, 孵育50分钟, 显色剂显色, Image J软件分析电泳带灰度值. 6.逆转录聚合酶链反应(RT-PCR): Trizol法提取两组病人伤口组织总RNA, 紫外-可见光分光光度计定量RNA浓度. 选取标本RNA后, 通过反转录试剂盒步骤, 将RNA反转录合成cDNA. 利用软件设计PCR引物(表1). 检测伤口皮肤核因子-κB p65(NF-κB p65)和κB抑制蛋白 α(IkB-α)的mRNA表达量. 表1 本研究使用的PCR引物 项目5’- 3’ NF-κB p65 FGAATGGCTCGTCTGTAGTG RTGGTATCTGTGCTCCTCCTC NF-κB IkB-α FGGAGAAGTTCGGTTTAGTAGCC RTTTATTCCTGTTTCACGCTCA GAPDH FATGGGGAAGGTGAAGGTCGGAGTC RGCTGATGATCTTGAGGCTGTTGTC 三, 统计学方法 采用SPSS 20.0软件分析数据. 计量资料以均数±标准差(±s)表示, 采用独立样本t检验; 计数资料以例(%)表示, 采用χ2检验. P<0.05为差异有统计学意义. 结果 1.两组病人一般资料比较: 两组病人年龄, BMI, ALT, 肌酐, CRP, 创面大小, 溃疡时间, 当前吸烟, 当前饮酒, ABI和合并高血压比例比较, 差异无统计学意义(P>0.05), 入院时病人随机血糖比较, 差异有统计学意义. 见表2. 表2 两组病人入院一般资料比较 一般资料对照组 (25例)试验组 (25例)t/χ²P 年龄(岁)54.7±9.4456.8±9.370.7970.430 性别(例, %) 男16(64.0)14(56.0)0.3330.564 女9(36.0)11(44.0)0.3330.564 BMI(kg/m2)23.1±3.7623.5±3.810.3300.743 ALT(U/L)36.4±9.8333.3±8.781.1980.237 肌酐(mmol/L)58.1±15.2764.4±17.771.3490.184 CRP(mg/L)72.6±26.9064.1±31.131.0350.306 创面大小(cm²)17.5±8.9215.2±8.910.9040.370 溃疡时间(天)40.1±25.5734.6±22.250.8140.419 随机血糖(mmol/L)9.4±1.617.5±4.52.9380.042 当前吸烟(例, %)6(24.0)10(40.0)1.4710.225 当前饮酒(例, %)10(40.0)16(64.0)2.8550.089 ABI0.6±0.130.8±0.140.5690.572 动脉硬化指数4.9±0.175.1±0.181.0820.340 合并高血压(例, %)10(40.0)13(52.0)0.7250.395 A: 对照组(HE×40); B: 对照组(HE×100); C: 对照组(HE×400); D: 试验组(HE×40); E: 试验组(HE×100); F: 试验组(HE×400) 图1 两组病人伤口组织的HE染色结果 表3 两组病人伤口组织炎症介质蛋白和炎症信号通路基因表达水平 组别例数IL-6(pg/ml)TNF-α(pg/ml)NF-κB p65 mRNANF-κB IkB-α mRNA 对照组253.11±0.47205.60±20.440.036±0.0060.030±0.008 试验组254.50±0.64224.67±24.060.056±0.0110.017±0.006 t6.7982.3396.0283.660 P0.0010.0270.0010.001 2.HE染色情况: 两组病人伤口组织中均有不同程度炎细胞浸润, 以中性粒细胞为主, 且试验组伤口组织中性粒细胞的浸润较对照组更加明显, 差异有统计学意义(400倍视野中, 随机中性粒细胞计数735±65 vs.448±82, P＜0.05), 见图1. 3.免疫荧光染色情况: 两组病人伤口组织免疫荧光染色结果提示, 试验组伤口组织和对照组γ-H2A.X表达水平分别为63.0±4.36 和 49.3±5.13, cGAS表达水平分别为32.7±6.43 和 18.3±2.89, 两组比较差异有统计学意义(P＜0.05). 绿色荧光显示为γ-H2A.X和cGAS, 蓝色荧光显示为细胞核(图2). 4.ELISA检测情况: 结果显示, 试验组病人伤口组织中IL-6和TNF-α表达水平明显高于对照组, 差异有统计学意义(P<0.05). 见表3. 5.PCR检测结果: 试验组病人伤口组织中NF-κB p65及NF-κB IkB-α mRNA相对表达量均高于对照组, 两组比较差异有统计学意义(P<0.05). 见表3. 6.伤口组织γ-H2A.X和cGAS含量比较: Western blotting结果显示, 试验组病人伤口γ-H2A.X和cGAS表达水平明显高于对照组, 差异有统计学意义(P<0.05). 见图3. 讨论 目前, 糖尿病足伤口不愈合以及延迟愈合机制仍 A: 对照组γ-H2A.X表达情况; B: 对照组细胞核染色情况; C: 对照组γ-H2A.X及细胞核染色组合图; D: 试验组γ-H2A.X表达情况; E: 试验组细胞核染色情况; F: 试验组γ-H2A.X及细胞核染色组合图; G: 对照组cGAS表达情况; H: 对照组细胞核染色情况; I: 对照组cGAS及细胞核染色组合图; J: 试验组cGAS表达情况; K: 试验组细胞核染色情况; L: 试验组cGAS及细胞核染色组合图 图2 两组伤口组织γ-H2A.X和cGAS胞内表达分布情况 A: γ-H2A.X和cGAS蛋白条带显色结果; B: γ-H2A.X蛋白灰度值结果; C: cGAS蛋白灰度值结果. a为P<0.05 图3 两组病人入院伤口组织γ-H2A.X和cGAS蛋白表达水平 不清楚. 在正常伤口愈合过程的早期, 炎症细胞以及介质趋化至伤口组织, 通过杀灭并清除细菌等有害物质促进伤口愈合^[10]. 过量炎症因子在伤口聚集, 降解伤口组织基质金属蛋白酶, 影响新鲜肉芽组织形成及伤口愈合^[11]. 本课题组前期研究发现, 糖尿病足伤口存在炎症因子的过量表达并引起创面的延迟愈合或不愈合^[5-6]. 本研究结果提示, 试验组糖尿病足病人伤口炎症细胞浸润程度高于对照组, 与Grant等^[12]和Lee等^[13]研究结果一致. 因此糖尿病病人机体组织长期处于慢性炎症反应状态, 一旦皮肤溃破, 炎性细胞浸润增多, 加剧伤口局部炎症反应, 并贯穿伤口创面愈合过程, 导致糖尿病足创面的延迟愈合或不愈合. IL-6由活化的单核巨噬细胞分泌, 主要功能是活化T淋巴细胞, 合成CRP. TNF-α是单核细胞分泌的一种细胞因子, 参与感染, 创伤, 自身免疫等炎症性疾病的发生发展^[14]. 本研究结果表明, 糖尿病病人IL-6及TNF-α的水平高于对照组, 说明高糖环境可诱发炎症反应, 激活单核巨噬细胞, 提高伤口局部组织炎症因子水平. Weigelt等^[4]研究发现, 糖尿病足病人伤口中CRP和IL-6炎症介质分子水平明显升高. 因此, 过量的IL-6及TNF-α可能是影响糖尿病足伤口愈合的关键因素. cGAS是识别胞质内DNA的重要识别器之一, 在炎症反应中具有重要的调节作用^[15]. cGAS在识别胞质DNA损伤后, 产生活化的环鸟苷酸-腺苷酸(cGAMP), 介导STING信号通路上调NF-κB水平, 启动大量促炎因子, 趋化因子, 参与炎症反应的调节^[16]. 本研究免疫荧光以及Western blotting结果显示, 试验组伤口组织DNA损伤感应器cGAS和DSBs标志物γ-H2A.X含量高于对照组. Jiang等^[17]报道, LPS刺激可导致单核细胞中DSBs以及感应器cGAS表达增加, 且参与炎症因子如TNF-α等的转录和合成调节. 有研究发现, 正常情况下 cGAS存在于细胞质中, 有丝分裂中高糖环境可能导致cGAS被募集至细胞核中, 参与DNA损伤的应答反应, 调节伤口组织的炎症反应^[18], 与Gluck等^[19]研究结果一致, 以上结果提示DNA损伤加重糖尿病足溃疡伤口炎症反应, 延迟伤口愈合. 综上所述, 糖尿病足病人伤口创面存在过量炎症反应, DNA损伤及其感应器cGAS在糖尿病足伤口的过量炎症中扮演着重要作用, 可为DFU的治疗提供新的治疗靶点. DNA损伤具体通过何种路径加重糖尿病足伤口炎症反应作用机制仍需进一步验证. 参考文献 [1] Mc Dermott K, Fang M, Boulton AJM, et al.Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers[J].Diabetes Care, 2023, 46(1): 209-221. [2] Petersen BJ, Linde-Zwirble WT, Tan TW, et al.Higher rates of all-cause mortality and resource utilization during episodes-of-care for diabetic foot ulceration[J].Diabetes Res Clin Pract, 2022, 184(1): 109182-109191. [3] Armstrong DG, Tan TW, Boulton AJM, et al.Diabetic Foot Ulcers: A Review[J].JAMA, 2023, 330(1): 62-75. [4] Weigelt C, Rose B, Poschen U, et al.Immune mediators in patients with acute diabetic foot syndrome[J].Diabetes Care, 2009, 32(8): 1491-1496. [5] Wang T, Li X, Fan L, et al.Negative Pressure Wound Therapy promoted wound healing by suppressing Inflammation via down-regulating MAPK-JNK signaling pathway in diabetic patients[J].Diabetes Res Clin Pract, 2019, 150(1): 81-89. [6] 汪涛, 范隆华, 陈斌, 等.NLRP3-NF-κB炎症信号通路在糖尿病足伤口细胞焦亡中的作用研究[J].中国普外研究进展杂志, 2022, 25(10): 795-799 [7] 汪涛, 范隆华, 陈斌, 等.NLRP3炎症小体与下肢静脉性溃疡创面炎症反应的相关性分析[J].中国普外基础与临床杂志, 2021, 28(10): 1287-1293. 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[13]Lee HM, Kim JJ, Kim HJ, et al.Upregulated NLRP3 inflammasome activation in patients with type 2 diabetes[J].Diabetes, 2013, 62(1): 194-204. [14]Cebeci E, Katirci E, Karhan M, et al.The immunomodulator effect of Stevia rebaudiana Bertoni mediated by TNF-alpha and IL-1beta in peripheral blood in diabetic rats[J].Food Sci Nutr, 2024, 12(10): 7581-7590. [15]Sun X, Zhang J, Li X, et al.Fenofibrate inhibits activation of cGAS-STING pathway by alleviating mitochondrial damage to attenuate inflammatory response in diabetic dry eye[J].Free Radic Biol Med, 2025, 235(8): 364-378. [16]Chen Z, Lai X, Li J, et al.BRG1 Deficiency Promotes Cardiomyocyte Inflammation and Apoptosis by Activating the cGAS-STING Signaling in Diabetic Cardiomyopathy[J].Inflammation, 2025, 48(1): 299-315. [17]Jiang Z, He R, Zhong Y, et al.Fumarate Hydratase Restrains mtDNA Attenuates LPS-Induced Acute Lung Injury Through cGAS-STING Pathways[J].J Inflamm Res, 2025, 18(4): 5399-5413. 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Objective To investigate the effect of preserving the left colic artery (LCA) in radical rectal cancer surgery on the incidence of postoperative anastomotic fistula and short-term prognosis.Methods The clinical data of 113 patients who underwent radical rectal cancer surgery in our hospital from March 2020 to December 2024 were retrospectively analyzed, and the patients were divided into the preserved group (n=42) and the non-preserved group (n=71) based on whether the LCA was preserved or not.The non-preserved group carried out the direct high ligation of the inferior mesenteric artery (IMA), and the preserved group carried out the preserved LCA low ligation.The clinical data, perioperative indexes, and the incidence of anastomotic fistula and postoperative complications within 3 months after surgery were compared between the two groups.The risk factors for postoperative anastomotic fistula events in the two groups were analyzed by Logistic regression, and their predictive efficacy was analyzed by ROC curves.Results The number of patients with complicated chronic diseases in the non-preserved group(26.76%, 19 cases) was higher than that in the preserved group(9.52%, 4 cases) (P<0.05), while the comparison of the rest of the general clinical data was not statistically significant(P＞0.05).The length of postoperative hospitalization in the nonpreserved group was significantly higher than that in the preserved group (P<0.05), whereas there was no significant difference in the length of surgery, laparoscopic surgery, intraoperative bleeding, and the number of lymphatic dissections between the two groups.The postoperative CRP, leukocyte level, and the incidence of postoperative complications were significantly higher in the non-preserved group than in the preserved group (P<0.05).The regression results showed that tumor length diameter, distance from the anal verge, leukocytes, preserved LCA, and TNM stage were risk factors for the development of anastomotic fistula.The results of the ROC curve showed that the AUC of tumor length diameter, distance from the anal verge, leukocytes, preserved LCA, TNM staging, and combined index were 0.80, 0.75, 0.86, 0.65, 0.64, and 0.89, respectively, and the predictive efficacy of the combined index was better than that of the single index (P<0.05).Conclusion Preservation of LCA reduces the risk of complications and anastomotic fistula after radical surgery for rectal cancer, and tumor length diameter, distance from the anal verge, leukocytes, TNM stage, and failure to preserve LCA are risk factors for anastomotic fistula, and the combined index prognostic efficacy is better.

Objective To systematically identify independent risk factors for postoperative pleural effusion (PE) following video-assisted thoracoscopic surgery (VATS), develop a risk prediction model, and evaluate the protective effect of preoperative paravertebral block (PVB).Methods This study integrated multicenter retrospective and prospective cohorts, including 2 141 patients who underwent thoracoscopic surgery in the Department of Thoracic Surgery at Tongji Hospital, Wuhan, between August 25, 2024 and December 31, 2024.Postoperative pleural effusion was assessed using chest CT, and relevant biomarkers were measured.Multivariable ordinal Logistic regression was used to identify independent predictors of postoperative PE.To explore the association between different analgesic modalities including PVB, intercostal nerve block (INB), and local infiltration analgesia (LIA) and inflammatory or metabolic markers were further analyzed.Results Multivariable analysis identified older age, lower postoperative albumin, surgical type, extent of intraoperative lymph node dissection, and analgesic modality as independent predictors of postoperative PE(P＜0.05).PVB provided significant protective effects compared with LIA or INB.A nomogram incorporating these factors demonstrated good discrimination and calibration in both the training cohort (AUC=0.704) and the validation cohort (AUC=0.692).Further analyses indicated that PVB significantly reduced postoperative elevations in C-reactive protein and fasting plasma glucose(P＜0.05).Conclusions Perioperative PVB independently reduces the risk of postoperative PE after VATS, potentially via anti-inflammatory and antioxidative mechanisms.The nomogram effectively stratifies patient risk, supporting individualized perioperative management.

Objective To investigate the efficacy of BEIS combined with compound betasone in the treatment of lumbar disc herniation (LDH) and its influence on serum prostaglandin E2 (PGE2), tissue inhibitor of metalloproteinase-2 (TIMP-2) and tumor necrosis factor (TNF)-α levels.Methods Totally 116 LDH patients who received treatment in our hospital were served as the research subjects and stochastically grouped into intervertebral group and compound group through random number table.The intervertebral group used the BEIS technique via interlaminar endoscopy, while the compound group additionally received an injection of compound betamethasone.Two groups were compared in terms of 基金项目: 沧州市科学技术局研究课题(23244102059) 作者单位: 061000 河北沧州, 沧州市人民医院骨科 通信作者: 金忠军, Email: gnhs65@163.com [17]Wei W, Zheng X, Gu Y, et al.Effect of general anesthesia with thoracic paravertebral block on postoperative delirium in elderly patients undergoing thoracoscopic lobectomy: a randomized-controlled trial [J].BMC Anesthesiol, 2022, 22(1): 1. [18]Zhu J, Wei B, Wu L, et al.Effect of Thoracic Paravertebral Block on Postoperative Pulmonary Complications After Video-Assisted Thoracoscopic Surgery: A Dual-Center Randomized Clinical Trial [J].Ther Clin Risk Manag, 2025, 21: 691-703. [19]Hassan J, Khan S, Zahra R, et al.Role of Procalcitonin and C-reactive Protein as Predictors of Sepsis and in Managing Sepsis in Postoperative Patients: A Systematic Review [J].Cureus, 2022, 14(11): e31067. [20]Xu W, Yu P, Wang X, et al.Comparative analysis of CRP and PCT as biomarkers for early diagnosis of pediatric septic arthritis: superior performance of CRP [J].Front Pediatr, 2025, 13: 1582978. [21]Zeng L, Yu X, Yang T, et al.The effect of ultrasound-guided thoracic paravertebral nerve block combined with hydromorphone on postoperative analgesia and inflammatory response in thoracoscopic surgery: a randomized controlled trial [J].Front Med (Lausanne), 2025, 12: 1587477. [22]GonzáLez P, Lozano P, Ros G, et al.Hyperglycemia and Oxidative Stress: An Integral, Updated and Critical Overview of Their Metabolic Interconnections [J].Int J Mol Sci, 2023, 24(11): 352. (收稿日期: 2025-12-28) (本文编辑: 孙清源 杨泽平) therapeutic effect, pain, lumbar spine function, stress response, serum inflammatory factors, and complications.Results The total effective rate of the compound group was 94.83%, which was higher than the 81.03% of the intervertebral group (P<0.05).At 1 week and 3 months after surgery, both groups showed a decrease in pain scores, and the compound group had a lower pain score than the intervertebral group.Both groups showed an increase in lumbar spine function scores, and the compound group had a higher JOA score than the intervertebral group (P<0.05).On the day and 3 days after surgery, the compound group had lower adrenocorticotropic hormone (ACTH), cortisol (Cor), and norepinephrine (NE) than the intervertebral group (P<0.05).One week after surgery, the compound group had lower serum PGE2, TIMP-2, and TNF-α than the intervertebral group (P<0.05).The compound group and the intervertebral group had no great difference in complications (P>0.05).Conclusion The transforaminal endoscopic BEIS technique combined with compound betamethasone and compound betamethasone has good short-term curative effect in treating LDH patients.It can greatly reduce pain, improve lumbar spine function, inhibit stress response, downregulate inflammatory factors such as PGE2 and TIMP-2, control disease progression in a short period of time, and has high safety.

Objective To explore the occurrence and risk factors of referred pain (RP) in osteoporotic vertebral compression fracture (OVCF) after percutaneous vertebroplasty (PVP).Methods A retrospective analysis was performed on the clinical data of 198 patients with single-segment OVCF who underwent PVP in the hospital between January 2023 and December 2024.According to presence or absence of RP after PVP, patients were divided into RP group (36 cases) and non-RP group (162 cases).The occurrence of RP in OVCF patients after PVP was analyzed.The independent risk factors of RP after PVP were screened by univariate analysis and Logistic regression analysis.Results Among 198 OVCF patients after PVP, there were 36 cases cases (18.18%) with RP.The pain sites were mainly distributed in lumbar spinal cord, buttocks and lower extremities.The course of disease, proportions of thoracolumbar fracture, preoperative vertebral compression ≥25%, vacuum fissure sign, intraoperative use of lipidosome bupivacaine, asymmetry of bone cement diffusion and bone cement leakage in RP group were significantly higher than those in non-RP group, while preoperative BMD was significantly lower than that in non-RP group (P<0.05).Thoracolumbar fracture (OR=2.726, P=0.037), asymmetry of bone cement diffusion (OR=3.108, P=0.007) and bone cement leakage (OR=4.509, P=0.001) were all independent risk factors of RP in OVCF patients after PVP (P<0.05).Conclusion The incidence of RP is relatively higher in patients with OVCF after PVP.The thoracolumbar fracture, asymmetry of bone cement diffusion and bone cement leakage are all independent risk factors of postoperative RP.

Objective To investigate the predictive value of postoperative monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1β (MIP-1β), and neutrophil to lymphocyte ratio (NLR) levels for postoperative lumbar and leg pain in patients with lumbar disc herniation (LDH) after percutaneous endoscopic lumbar discectomy.Methods A total of 181 patients with LDH who underwent percutaneous transforaminal endoscopic surgery in our hospital from January, 2021 to October, 2024 were enrolled.The patients were divided into pain group and non-pain group according to whether they had residual lumbago and leg pain at 6 months after operation.The predictive value of serum MCP-1, MIP-1β and NLR alone and in combination was analyzed by receiver operating characteristic (ROC) curve.Multivariate Logistic regression analysis was used to screen the influencing factors of low back pain and leg pain after percutaneous transforaminal endoscopic discectomy in LDH patients.Results The serum MCP-1 levels of patients in the pain group (40.04±7.14) ng/L were higher than those in the non-pain group (32.72±5.59) ng/L, and the MIP-1β levels (37.21±6.23) ng/L were higher than those in the non-pain group (26.39±5.18) ng/L, and the NLR (2.80±0.61) was higher than that in the non-pain group (1.75±0.40) (P<0.05).The ROC results showed that the AUC of the three alone in predicting postoperative low back pain and leg pain in LDH patients were 0.778, 0.775 and 0.769, respectively.The combined predicted AUC was 0.917, which was higher than that of single diagnosis (P<0.001).The results of multiple factor analysis showed that age > 60 years old, no postoperative rehabilitation training, and elevated MCP-1, MIP-1β, and NLR after surgery were independent risk factors for postoperative lumbar and leg pain in LDH patients undergoing percutaneous transforaminal endoscopy (P<0.05).Conclusion Postoperative serum MCP-1, MIP-1β and NLR have certain predictive value for low back pain and leg pain after percutaneous transforaminal endoscopic discectomy in patients with LDH, and the combination of the three has a higher predictive value.

Objective To analyze the risk factors for refracture in elderly patients with osteoporotic spinal fractures after vertebral augmentation, and to construct a refracture risk prediction model and evaluate its predictive value.Methods A total of 91 elderly patients with osteoporotic spinal fractures who underwent vertebral augmentation in the Department of Orthopedics of our hospital from June 2022 to June 2024 were included.They were divided into the refracture group (n=21) and the non-refracture group (n=70) according to whether refracture occurred within 1 year after surgery.Univariate analysis was used to screen potential factors influencing refracture, followed by multivariate logistic regression analysis to identify independent risk factors and establish a prediction model.The receiver operating characteristic (ROC) curve was plotted to evaluate the predictive performance of the model.Results Univariate analysis showed that the single-segment bone cement injection volume, incidence of bone cement leakage, and thoracic kyphosis angle (TK) in the refracture group were significantly higher than those in the non-refracture group, while the proportion of spongy bone cement distribution, bone mineral density (BMD), local kyphosis angle (LKA), pelvic incidence (PI), and sacral slope (SS) were significantly lower, with statistically significant differences (P<0.05).Multivariate Logistic regression analysis confirmed that decreased BMD (OR=0.011, 95%CI: 0-0.940), decreased LKA (OR=0.627, 95%CI: 0.415-0.949), increased TK (OR=1.554, 95%CI: 1.062-2.273), decreased PI (OR=0.655, 95%CI: 0.443-0.969), and decreased SS (OR=0.691, 95%CI: 0.496-0.962) were independent risk factors for postoperative refracture (P<0.05).The area under the ROC curve (AUC) of the prediction model constructed based on the above indicators was 0.978 (95%CI: 0.952-1.000), with a sensitivity of 90.5% and a specificity of 94.3%, indicating excellent predictive performance.Conclusion Decreased BMD, LKA, PI, SS and increased TK are the core independent risk factors for refracture in elderly patients with osteoporotic spinal fractures after vertebral augmentation.The prediction model constructed based on these indicators has outstanding predictive efficacy, which can be used clinically to formulate personalized intervention plans and thereby reduce the occurrence of refracture.

Objective To analyze the risk factors for hemothorax in multiple rib fractures and construct a nomogram prediction model.Methods From June 2022 to June 2024, 400 patients with multiple rib fractures in our hospital were randomly divided into the modeling group (280 cases) and the validation group (120 cases) at a ratio of 7∶3.Based on the presence or absence of concurrent hemothorax, patients with concurrent hemothorax in the modeling group were included in the concurrent hemothorax group (70 cases), and patients without concurrent hemothorax were included in the non-concurrent hemothorax group (210 cases).Patients with hemothorax in the validation group were included in the hemothorax group (33 cases), and those without hemothorax were included in the non-hemothorax group (87 cases).Clinical data were collected, and independent risk factors were screened through a multivariate logistic regression model.The nomogram prediction model was constructed using the rms package in R software.Results In both the modeling group and the validation group, there were statistically significant differences between the group with concurrent hemothorax and the group without concurrent hemothorax in terms of history of hypertension, number of fractures, bilateral fractures, severity score of chest trauma, chest tube placement, coexisting pulmonary contusion, flail chest, white blood cells, hemoglobin, and D-dimer (P<0.05).Thoracic catheterization, flail chest, leukocyte>8.04×109/L, hemoglobin>138.13 g/L, D-dimer>1.32 mg/L were independent risk factors of multiple rib fractures complicated with hemothorax (P<0.05), and the constructed logistic regression prediction model was validated accordingly.The Hosmer-Lemeshow goodness-of-fit test results indicate that the modeling group has a χ2=6.855 (P=0.552) and the validation group has a χ2=6.147 (P=0.631), demonstrating good consistency and fit of the model.Decision curve analysis shows that when the risk threshold in the modeling group ranges between 0.08-0.98 and in the validation group exceeds 0.08, the predictive model provides additional clinical net benefits.In the receiver operating characteristic curve, the area under the curve (AUC) of the modeling group was 0.861, with a 95%CI of 0.807-0.915, and the AUC of the validation group was 0.842, with a 95%CI of 0.757-0.926.This indicates that the predictive efficacy of the model is good.Conclusion The nomogram constructed using thoracic tube placement, flail chest, white blood cell count, hemoglobin level, and D-dimer provides crucial strategic guidance for predicting and evaluating complications such as hemothorax in patients with multiple rib fractures, as well as for clinical nursing interventions.

Case 1 was a 91-year-old male underwent appendectomy for acute appendicitis.Postoperative pathology revealed GCA.Due to advanced age and multiple comorbidities, no further radical surgery or adjuvant chemotherapy was performed.One-year postoperative follow-up showed no signs of recurrence.Case 2 was a 71-year-old male who underwent radical resection of the right colon combined with intraoperative intraperitoneal chemotherapy.Postoperative pathology showed negative margins and no lymph node metastasis.Immunohistochemical analysis demonstrated that both tumor cells expressed CK20, CDX-2, and SATB2, with Ki-67 proliferation indices of 30% and 80%, respectively, indicating significant differences in tumor proliferative activity.Comprehensive analysis indicates that GCA is highly prone to clinical misdiagnosis, requiring confirmation through combined intraoperative frozen section pathology and postoperative immunohistochemical staining.Treatment should emphasize individualized strategies: close follow-up may be considered for elderly patients with poor baseline health, while advanced-stage patients are recommended for radical surgery combined with adjuvant therapy.

This article reports a case of a 66-year-old female patient with hypertrophic obstructive cardiomyopathy who underwent thoracoscopic left upper lobectomy under continuous intraoperative transesophageal echocardiography (TEE) monitoring.The preoperative left ventricular outflow tract gradient was 65 mm Hg.Intraoperative TEE provided real-time monitoring of left ventricular volume, outflow tract velocity, and mitral valve motion, guiding anesthesia induction, fluid management, and the use of vasoactive agents.Inotropic drugs were avoided to maintain hemodynamic stability.The patient recovered smoothly postoperatively without cardiac complications.

This article presents a case of a 48-year-old male patient who underwent video-assisted thoracoscopic right upper lobectomy and intrathoracic lymph node dissection, and developed delayed thoracic hemorrhage 10 days postoperatively.The surgery proceeded smoothly, and the patient had a good early recovery; however, 10 days after the operation, he suddenly experienced chest pain and dyspnea.Surgical exploration confirmed the cause as active bleeding from the bronchial artery at the bronchial stump.Hemorrhage following video-assisted thoracoscopic lung resection is relatively common, while delayed hemorrhage occurring a relatively long time after surgery is rare..

Scoliosis can lead to anatomical variations of the inferior vena cava, increasing the difficulty of filter retrieval.This patient had longstanding kyphoscoliosis and underwent inferior vena cava filter placement for left lowerextremity deep vein thrombosis one year earlier, with subsequent failed retrieval attempts.Our hospital successfully retrieved the filter intact via a femoral approach using the combined “largesheath technique + guidewire snaring technique + Loop technique.” Postoperative angiography confirmed patency of the inferior vena cava.This case demonstrates that for patients with spinal deformity and challenging filter removal, a combined interventional strategy based on thorough imaging assessment can achieve safe and effective filter retrieval.

This article reports a case of giant congenital diaphragmatic hernia (CDH) in an adult.Preoperative CT showed a diaphragmatic defect with herniation of the stomach, transverse colon, spleen, and left kidney into the thoracic cavity, and the left diaphragm had a large defect (10 cm×10 cm).The patient underwent laparoscopic mesh repair and diaphragmatic repair.Postoperative pleural effusion occurred and recovered after multidisciplinary treatment.During the one-year follow-up, the patient’s symptoms disappeared completely, and CT showed no recurrence or other complications.

Two adult patients with intestinal duplication malformation admitted in the group did not show typical clinical symptoms.One of the patients was diagnosed with abdominal pain and was found to have pelvic space-occupying lesions by abdominal Computed Tomography, which could not be clearly diagnosed before surgery, and was finally diagnosed as intestinal duplication malformation by intraoperative exploration; the other patient was diagnosed with duplication of bowel after B-mode Ultrasonography of the uterus and bilateral adnexa revealed a cystic mass above the uterus, which was then considered as duplication of bowel by Magnetic Resonance Imaging of the pelvis and finally diagnosed with duplication of bowel by intraoperative exploration.Both patients underwent surgical treatments and recovered from the hospital successfully.Eventually Intestinal duplication malformation is a rare congenital malformation of the digestive tract, the treatment of which is mainly concentrated in childhood.Adult cases are not only rare, but also have complex clinical manifestations and lack of specificity.Currently, Computed Tomography and B-mode ultrasonography are the main preoperative diagnostic tools, but the accuracy is still unsatisfactory.Surgical resection is the treatment of choice after diagnosis.