Thyroid-stimulating hormone (TSH) suppression therapy is an important adjuvant treatment following surgery for differentiated thyroid cancer (DTC).However,with the continuous rise in DTC incidence and the accumulation of long-term follow-up evidence,the traditional treatment model of "continuous,fixed,and deep suppression" is facing challenges.The 2025 update to the American Thyroid Association (ATA) guidelines for adult DTC marks a fundamental shift in the management philosophy of postoperative TSH:transitioning from "continuous suppression" to "individualized and moderate reduction or cessation" based on dynamic therapeutic response assessments.The new guidelines remove fixed TSH target recommendations during the initial treatment phase,emphasize risk-stratified management based on treatment response,and explicitly advise avoiding long-term suppression in low- to intermediate-risk patients without evidence of recurrence.By reviewing key studies cited in the guidelines that both support and question the benefits of TSH suppression,it becomes evident that current evidence remains controversial in many aspects.This article further explores TSH management strategies for low-risk DTC patients,long-term disease-free survivors,patients undergoing active surveillance,and those after thermal ablation,pointing out that "reducing or discontinuing treatment" is a viable strategy for patients with favorable therapeutic outcomes.

Papillary thyroid carcinoma(PTC) has a high incidence of lateral cervical lymph node metastasis,and several issues persist in its diagnosis and treatment.When preoperative cytological diagnosis of lateral cervical lymph nodes is indeterminate,there is no unified standard for determining positivity based on thyroglobulin measurement in needle washout fluid.For T_1-2 PTC with ipsilateral lateral cervical lymph node metastasis but without high-risk factors,the optimal extent of gland resection remains controversial.Furthermore,the appropriate range of neck dissection for PTC with lateral cervical lymph node metastasis has not reached a consensus.This article analyzes and discusses these issues by integrating international guidelines and the current situation in China,aiming to provide references for domestic colleagues.

Thyroid cancer is the fastest-growing solid malignant tumor in China over the past decade,with bottlenecks of missed diagnosis and overtreatment throughout its diagnosis and treatment.Artificial intelligence(AI) has been deeply integrated into the full process.In diagnosis,AI enhances ultrasound and contrast-enhanced cervical CT,bridging physicians' clinical experience gaps and improving diagnostic accuracy.During surgery,AI combined with endoscopic navigation protects key intraoperative structures and assists frozen section diagnosis to increase lymph node metastasis prediction accuracy.In prognosis management,AI-based models enable precise drug delivery,real-time monitoring,and optimized treatment outcomes with 3D printing and wearable devices.AI is transforming from an "auxiliary tool" to a "diagnostic and therapeutic collaborative partner".To address AI limitations,future measures including multi-center databases and technology translation will advance diagnosis and treatment toward a "precision,individualization,and intelligence" paradigm,improving patients' survival rates and quality of life.

Ultrasonography is the primary imaging modality for evaluating thyroid nodules and cervical lymph nodes.However,traditional diagnostic approaches heavily rely on physician expertise,presenting limitations such as inconsistent results and operator-dependent variability.The application of artificial intelligence(AI),particularly deep learning,in thyroid and cervical lymph node ultrasonography is advancing the field toward automation and standardization.AI-assisted diagnostic systems demonstrate remarkable performance in differentiating benign from malignant thyroid nodules,achieving accuracy comparable to or surpassing that of senior physicians,with some products already implemented in clinical practice.Nevertheless,diagnostic accuracy for cervical lymph node metastasis requires further improvement,and dedicated products remain under development.Additionally,the clinical translation of AI faces challenges including data limitations,insufficient model interpretability,suboptimal human-computer collaboration,and regulatory-ethical concerns.Future directions will focus on model optimization,multimodal integration,and enhanced human-AI collaboration to drive comprehensive advancements in diagnostic and therapeutic standards.

Active surveillance(AS) has become one of the management strategies for low-risk papillary thyroid carcinoma(T_1aN₀M₀ papillary thyroid carcinoma,low-risk PTC).The key is to identify patients who are suitable for AS.Conventional Ultrasonography(CUS) is the main evaluation method at present,but it has limitations in detecting indicators such as occult lymph node metastasis.Ultrasonic Elastography(UE) provides a new method for risk assessment by quantifying tissue stiffness,although it still has limitations when used alone.Artificial Intelligence(AI) has shown high diagnostic performance in identifying pathological features including lymph node metastasis.However,most models are established based on high-risk surgical cohorts,leading to low generalizability when applied to AS decision-making for low-risk PTC.Future research should focus on establishing and validating a multi-technique prediction model combining conventional ultrasonography,elastography and AI.Meanwhile,standardized data collection and model transparency can further improve the clinical applicability and generalizability of the model,thus contributing to more accurate identification of low-risk PTC.

Objective To investigate the clinical efficacy of three-port gasless intermuscular approach endoscopic surgery for cN0 stage papillary thyroid carcinoma(PTC).Methods A retrospective analysis was conducted on the clinical data of 120 patients with cN0 stage papillary thyroid carcinoma who underwent endoscopic-assisted unilateral radical thyroidectomy between January 2023 and March 2025.Patients were divided into the three-port group(48 cases) and the trans-subclavian group(72 cases) based on the surgical approach.The cumulative sum(CUSUM) method was used to analyze the learning curve for the trans-subclavian group.Based on the curve's inflection point，the group was divided into a learning phase（trans-subclavian group in the learning phase，30 cases） and a technically mature phase（trans-subclavian group in the technically mature phase,42 cases）.Perioperative data，incidence of postoperative complications,incision length，and cosmetic satisfaction were compared between the two groups.Perioperative data，postoperative complication rate，incision length，and cosmetic satisfaction were then compared between the three-port group and the trans-subclavian group in the technically mature phase.Results The trans-subclavian group reached the technically mature phase after the 31rd case.No statistically significant differences were found between the three-port group and the technically mature trans-subclavian group regarding maximum tumor diameter，number of dissected lymph nodes，length of hospital stay，and postoperative complication rate(P>0.05).However，the operative time for the three-port group was significantly shorter than that of the technically mature trans-subclavian group [73.5(64.3，85.8) min vs.90.0(82.8，105.0) min，P<0.01].The three-port group demonstrated superior outcomes in incision length [2.5（2.4，3.0）cm vs 4.4（4.1，5.0）cm]，wound pain score [2.0（2.0，3.0）points vs 3.0（2.0，3.0）points]，and proportion of patients whic were all satisfied with cosmetic(91.67% vs 73.81%) compared to the overall trans-subclavian group(P<0.05).Conclusion The three-port gasless intermuscular approach endoscopic surgery offers distinct advantages in treating cN0 stage papillary thyroid carcinoma，further enhancing cosmetic outcomes and surgical efficiency.

Objective To explore the diagnostic value of serum galectin-3 and stromal cell-derived factor-1 (SDF-1) combined with ultrasound elastography (UE) for papillary thyroid carcinoma (PTC).Methods Ninety PTC patients admitted to our hospital from January 2023 to May 2024 were used as the observation subjects (PTC group).Another 95 patients with benign thyroid tumors during the same period in our hospital were regarded as the control group.ELISA was applied to detect the expression levels of galectin-3 and SDF-1 in the serum of subjects.All patients underwent UE examination and general information was collected.Four grid table method was applied to analyze the diagnostic value of serum galectin-3,SDF-1,and UE for PTC.The diagnostic value of serum galectin-3, SDF-1 and UE for PTC was analyzed by the four-grid table method.The consistency Kappa test was applied to compare the consistency between serum galectin-3,SDF-1,and UE alone and in combination in diagnosing PTC and pathological results.ROC curve was used to analyze the diagnostic value of serum galectin-3,SDF-1,UE alone and in combination for PTC.Results There was no statistically obvious difference in lesion diameter,age,BMI,and gender between the control group and the PTC group (P>0.05).Compared with the control group [(2.03±0.34) ng/ml,(10.66±1.40) pg/ml],the serum levels of galectin-3 [(2.41±0.41) ng/ml] and SDF-1 [(12.42±2.02) pg/ml] in the PTC group increased (P<0.05).The AUC of serum galectin-3 for diagnosing PTC was 0.732,with a sensitivity of 83.33% and a specificity of 62.11%.The AUC of serum SDF-1 for diagnosing PTC was 0.775,with a sensitivity of 63.33% and a specificity of 86.32%.The UE diagnosis results showed 31 false positives and 18 false negatives,with moderate consistency compared to the pathological diagnosis results,the Kappa value was 0.472 (P<0.05),the diagnostic AUC was 0.737,the specificity was 67.37%,and the sensitivity was 80.00%.The results of combined diagnosis of serum galectin-3 and SDF-1 with UE showed 4 false positives and 9 false negatives,with high consistency compared to pathological diagnosis,the Kappa value was 0.859 (P<0.05),the diagnostic AUC was 0.929,the specificity was 95.79%,and the sensitivity was 90.00%.The combined diagnosis of serum galectin-3,SDF-1,and UE for PTC showed higher specificity and accuracy,and lower misdiagnosis rate than the single indicator diagnosis (P<0.05).Conclusion Serum galectin-3 and SDF-1 levels are elevated in patients with PTC,and serum galectin-3,SDF-1,and UE have certain diagnostic value for PTC.The combined diagnosis of the three has higher value.

Objective To analyze the relationship of thyroid hormone responsive spot 14 protein (THRSP),plasminogen activator urokinase (PLAU),E26 transformation-specific variant 4 (ETV4) and cervical lymph node metastasis and prognostic of papillary thyroid carcinoma (PTC).Methods Totally 108 PTC patients who received treatment in our hospital between July 2017 and June 2021 were gathered.Immunohistochemistry was used to detect the expression of THRSP,PLAU,and ETV4 in cancer tissues and adjacent tissues.Kaplan-Meier method was used to analyze the relationship between THRSP,PLAU,and ETV4 with the survival rate of PTC.Cox regression was used to analyze the influencing factors of poor prognosis in PTC.Results The positive expression rates of THRSP,PLAU,and ETV4 in PTC cancer tissues (60.19%,62.04%,56.48%) were manifestly higher than those in adjacent tissues (37.04%,39.81%,37.96%) (P<0.05).PTC patients with lymph node metastasis had manifestly higher positive expression rates of THRSP,PLAU,and ETV4 (80.77%,80.77%,76.92%) than non lymph node metastasis (53.66%,56.10%,50.00%) (P<0.05).The results of Kaplan-Meier analysis showed that the 3-year progression free survival rate of the THRSP,PLAU,and ETV4 positive expression groups (60.00%,59.70%,60.66%) was manifestly lower than that of the negative expression groups (88.37%,90.24%,85.11%) (P<0.05).The good prognosis group had manifestly lower rates of lymph node metastasis,THRSP,PLAU,and ETV4 expression (12.99%,50.65%,51.95%,48.05%) than the poor prognosis group (51.61%,83.87%,87.10%,77.42%) (P<0.05).Cox analysis found that lymph node metastasis (HR=3.736,95%CI=1.669-8.361),THRSP,PLAU and ETV4 were factors affecting poor prognosis in PTC (P<0.05).Conclusion THRSP,PLAU,and ETV4 are positively expressed in PTC cancer tissues.The 3-year survival rate of PTC patients with positive THRSP (HR=3.218,95%CI=1.366-7.578),PLAU (HR=3.567,95%CI=1.548-8.221) and ETV4 (HR=4.103,95%CI=1.348-12.491) expression is relatively low.These three factors are associated with cervical lymph node metastasis and prognosis.

Objective To investigate the predictive value of the fibrinogen-to-albumin ratio (FAR) for deep vein thrombosis (DVT) in patients following chronic subdural hematoma (CSDH) evacuation.Methods We conducted a retrospective cohort study of CSDH patients who underwent surgical evacuation at Shiyan Taihe Hospital (June 2015-June 2025).DVT was diagnosed via Doppler ultrasonography during hospitalization.Baseline characteristics including serological parameters,imaging findings,medical history,and anesthesia techniques were collected upon admission.The association between FAR and DVT was assessed using multivariate Logistic regression and restricted cubic spline (RCS) analyses.We performed hierarchical regression to identify effect modifiers and constructed receiver operating characteristic (ROC) curves to evaluate FAR's predictive performance.Results Among 238 enrolled CSDH patients,29 (12.2%) developed postoperative DVT.Elevated FAR showed a significant positive association with DVT risk (adjusted OR 1.33,95%CI 1.18-1.49).After multivariable adjustment,the ROC analysis demonstrated good discrimination (AUC=0.85),with the highest FAR quartile showing significantly increased DVT risk (OR 7.05,95%CI 1.24-68.3) versus the lowest quartile.The RCS curve showed a linear relationship between FAR and DVT (P-value=0.035,P-Nonlinear=0.512),and the threshold effect analysis was used to determine that the predicted critical value of FAR was 12.6%.Conclusion In patients with chronic subdural hematoma,the FAR ratio is associated with the risk of DVT,and further study of the FAR ratio may be helpful for the prevention and treatment of DVT.

Objective To investigate the relationship between the expression levels of serum monoacylglycerol esterase (MAGL),glycerol 3 phosphate dehydrogenase 1 (GPD1),human pre circulating gastrin (hPG80) and molecular typing and prognosis in breast cancer patients.Methods A total of 121 breast cancer patients from May 2019 to May 2021 were included as the cancer group.The molecular typing was Luminal A (62 cases),Luminal B (31 cases),HER2 positive (19 cases) and triple negative (9 cases) breast cancer.According to the prognosis,there were 82 cases in the good prognosis group and 39 cases in the poor prognosis group.121 patients with benign breast lesions were selected as the benign lesion group,and another 121 healthy volunteers who underwent physical examination were included as the control group.Enzyme linked immunosorbent assay (ELISA) was applied to detect the expression levels of MAGL,GPD1,and hPG80 in all personnel serum samples.Multivariate Logistic analysis was applied to analyze the adverse prognostic factors of breast cancer patients.ROC curve was drawn to analyze the predictive value of serum MAGL,GPD1,hPG80 levels for poor prognosis of breast cancer patients.Results Compared with the control group [MAGL=(10.74±2.35)μg/L,GPD1=(6.31±1.32)μg/L,hPG80=(2.41±0.56)pmol/L],the expression level of serum hPG80 in patients of the cancer group [MAGL=(5.93±1.12)μg/L,GPD1=(4.07±0.81)μg/L,hPG80=(5.34±1.25)pmol/L] and the benign lesion group [MAGL=（7.36±1.42）μg/L，GPD1=（4.89±0.99）μg/L，hPG80=（4.75±0.82）pmol/L] increased,while the expression levels of MAGL and GPD1 decreased. The serum hPG80 in the cancer group was higher than that in the benign lesion group, while MAGL and GPD1 were lower than those in the benign lesion group, and the differences were statistically significant (P < 0.05).Serum MAGL in different molecular subtypes of breast cancer patients [Luminal A=(6.34±1.15)μg/L,Luminal B=(5.11±1.02)μg/L,HER2 positive=(7.48±1.52)μg/L,Triple negative breast cancer=(2.62±0.72)μg/L],GPD1[Luminal A=(4.15±0.83)μg/L,Luminal B=(3.87±0.79)μg/L,HER2 positive=(5.05±1.07)μg/L,Triple negative breast cancer=(2.14±0.48)μg/L],hPG80[Luminal A=(5.03±1.10)pmol/L,Luminal B=(5.86±1.40)pmol/L,HER2 positive=(4.65±1.32)pmol/L,Triple negative breast cancer=(7.13±1.35)pmol/L] showed different expression levels.The expression levels of serum MAGL and GPD1 in triple negative breast cancer patients were the lowest,and the expression level of hPG80 was the highest(P<0.05).With the increase of TNM stage,the serum levels of MAGL[Ⅰ-Ⅱ stage=(6.36±1.29)μg/L,Ⅲ-Ⅳ stage=(5.64±1.06)μg/L] and GPD1[Ⅰ-Ⅱ stage=(4.34±0.86)μg/L,Ⅲ-Ⅳ stage =(3.76±0.74)μg/L] in the cancer group gradually decreased,and the level of hPG80[Ⅰ-Ⅱ stage=(4.99±0.98)pmol/L,Ⅲ-Ⅳ stage =(5.57±1.39)pmol/L] gradually increased(P<0.05).Compared with the good prognosis group[MAGL=（6.52±1.23）μg/L，GPD1=（4.42±0.83）μg/L，hPG80=（4.96±1.05）pmol/L],the expression level of serum hPG80 in the poor prognosis[MAGL=（4.69±0.89）μg/L，GPD1=（3.34±0.67）μg/L，hPG80=（6.16±1.14）pmol/L] group was higher,and the expression levels of MAGL and GPD1 were lower(P<0.05).Multivariate Logistic analysis showed that hPG80 was a risk factor for poor prognosis of breast cancer patients,MAGL and GPD1 were protective factors(P<0.05).ROC curve revealed that the area under the curve (AUC) value of serum MAGL,GPD1 and hPG80 levels for predicting poor prognosis of breast cancer patients was 0.911,obviously higher than that of MAGL,GPD1 and hPG80 alone.Conclusion The expression level of serum hPG80 in breast cancer patients increases,while the expression level of MAGL and GPD1 decrease.The three levels are related to the molecular typing and prognosis of breast cancer patients.

Objective To investigate the current status of postoperative dietary behavior in patients undergoing weight loss surgery and analyze its influencing factors.Methods From July 2021 to August 2023,187 patients who underwent weight loss surgery in our hospital were included.This study conducted a survey on patients using the Dutch Eating Behavior Questionnaire (DEBQ) and a self-made clinical data collection form for weight loss surgery patients.The weight loss and DEBQ score changes before and 1 year after surgery were observed.According to the DEBQ evaluation results after 1 year,the patients were assigned into a successful restriction group and a non successful restriction group,and their general conditions were compared between the two groups.Logistic regression model was used to screen the influencing factors of postoperative dietary behavior in patients undergoing weight loss surgery.Results One year after surgery,the BMI,extrinsic eating score,and emotional eating score were all lower than those before surgery (P<0.05),and the restrictive eating score was higher than that before surgery (P<0.05).142 cases (75.94%) were successfully restricted in diet after surgery,and 45 cases (24.06%) were not successfully restricted in diet.There were statistically obviously differences in the residential status,impulse control score,resistance to temptation score,perceived social support scale（PSSS) score,and depression status between the successful restriction group and the non successful restriction group(P<0.05).Logistic regression analysis showed that depression was a risk factor for postoperative non successful restrictive diet in patients,while impulse control ,resistance to temptation ,and high PSSS score were protective factors(P<0.05).Conclusion Patients undergoing weight loss surgery experience a obviously decrease in postoperative weight and an improvement in dietary behavior.But there are still some patients who have non restrictive or failed restrictive eating habits,which are related to impulse control,resistance to temptation,social support,and depression.

Objective To investigate the predictive value of preoperative serum lymphocyte count to C-reactive protein (CRP) ratio (LCR) and forkhead box protein A1 (FOXA1) for prognosis in patients with primary liver cancer after transcatheter arterial chemoembolization (TACE).Methods From June 2021 to June 2022,107 primary liver cancer patients who underwent TACE surgery and 107 primary liver cancer patients who did not undergo TACE surgery were selected as the observation group and control group in our hospital.The observation group was assigned into a survival group and a death group based on the 2-year survival status.Record the preoperative lymphocyte count and serum CRP,and LCR was calculated.Enzyme linked immunosorbent assay was applied to detect preoperative serum FOXA1 level.Kaplan-Meier survival curve was applied to analyze the relationship between LCR,FOXA1,and the two-year survival rate of patients after TACE surgery.ROC curve was plotted to analyze the predictive value of preoperative serum LCR and FOXA1 for the prognosis of patients after TACE.Multivariate Cox regression was applied to analyze the influencing factors of postoperative prognosis.Results There was no statistically significant difference in baseline data,preoperative lymphocyte count,CRP,LCR,and FOXA1 levels between the observation group and the control group (P>0.05).Patients with high preoperative LCR had a higher 2-year survival rate than those with low LCR,while patients with high FOXA1 had a lower 2-year survival rate than those with low FOXA1 (P<0.05).The area under the curve (AUC) of the combination of preoperative LCR,and FOXA1 in predicting the prognosis of primary liver cancer patients after TACE was higher than that predicted by preoperative LCR and FOXA1 alone (Z=4.313,3.500,P<0.05).Clinical TNM stage Ⅲ,tumor number ≥ 2,preoperative serum CRP and FOXA1 level were risk factors for postoperative prognosis in patients with primary liver cancer undergoing TACE,while preoperative lymphocyte count and LCR were protective factors for postoperative prognosis (P<0.05).Conclusion Preoperative LCR is lower and FOXA1 level is higher in patients who died after TACE for primary liver cancer.Preoperative LCR and FOXA1 levels are closely related to the postoperative prognosis of TACE for primary liver cancer.

Objective To explore the risk factors for the recurrence of choledocholithiasis after laparoscopy combined with choledochoscopy and to construct a predictive model.Methods A total of 296 patients with common bile duct stones who underwent laparoscopic combined with choledochoscopy for stone removal from January 2020 to October 2021 were selected for a 2-year follow-up.The patients were divided into a recurrence group and a non-recurrence group based on whether recurrence occurred.The clinical data of the two groups were compared. The factors with differences in the univariate analysis were subjected to Logistic multivariate analysis to obtain the risk factors for stone recurrence and construct a nomogram prediction model. The receiver operating characteristic curve (ROC), calibration curve and decision curve (DCA) were plotted for verification.Results After 2 years of follow-up,23 of the 296 patients (7.77%) had recurrence after laparoscopy combined with choledochoscopy, and 273 cases did not have recurrence (92.22%, non-recurrence group).The common bile duct diameter in the recurrence group (14.76±1.64)mm was longer than that in the non-recurrence group (12.32±1.41)mm. The proportion of history of biliary tract surgery in the recurrence group was 26.09%, and the proportion of hyperlipidemia was 39.13%, both higher than 3.30% and 15.38% in the non-recurrence group, and the differences were statistically significant (P < 0.05).Logistic regression analysis indicated that common bile duct diameter,history of biliary surgery,and hyperlipidemia were independent risk factors for recurrence of common bile duct stones (P<0.05).The Logistic regression equation and nomogram model were constructed as follows:Logit(P)=-16.614+1.008×common bile duct diameter+2.151×history of biliary surgery+1.361×hyperlipidemia.The ROC curve indicated that the model was reliable and stable (AUC=0.899,P<0.05),and the calibration and decision curves suggested that the model had good fit and clinical applicability.Conclusion The recurrence of choledocholithiasis after laparoscopy combined with choledochoscopy may be related to choledocholithiasis diameter,biliary duct operation history and hyperlipidemia.

Objective To investigate the risk factors of severe pancreatitis (SAP) and left portal hypertension (LPH),a nomogram prediction model was constructed based on the risk factors and verified.Methods The clinical data of 227 SAP patients admitted to our hospital from January 1,2019 to June 30,2022 were retrospectively collected,and the incidence of LPH was statistically analyzed.Multivariate Logistic regression was used to analyze the risk factors of LPH in SAP patients.Construct a Nomogram prediction model and evaluate its performance by C-index,calibration graph and decision curve analysis.Results During the follow-up period,66 patients were diagnosed with LPH,the incidence was about 29.07%.The proportions of men in LPH group,BMI≥28kg/m²,smoking history,hypertriglyceridemia,lesion location in pancreatic tail,splenic vein stenosis,diabetes mellitus and CT severity index（CTSI） score 9-10 points were higher than those in non-LPH group (P<0.05).Splenic vein stenosis,BMI≥28kg/m²,hypertriglyceridemia,diabetes mellitus and CTSI score 9-10 points were the risk factors for LPH in SAP patients (P<0.05).A nomogram prediction model based on Logistic regression risk factors was constructed,and it was verified that the prediction model showed good discrimination (area under the curve 0.892,P<0.05) and calibration (mean absolute error=0.029).Decision curve analysis showed that the prediction model could provide high clinical benefit.Conclusion Splenic vein stenosis,BMI≥28 kg/m²,hypertriglyceridemia,diabetes mellitus,acute fluid or necrotic accumulation are risk factors for SAP complicated with LPH.The prediction model based on risk factors has high predictive efficacy for LPH.

Objective To screen significantly differentially expressed genes in pancreatic cancer and establish a quantitative model to predict 1-year disease-free survival (DFS) of pancreatic cancer patients.Methods From January 2021 to January 2024,124 patients with pancreatic cancer pathologically confirmed and underwent radical resection into department of hepatobiliary and pancreatic surgery of the fifth affiliated hospital of Xinjiang medical university .They were followed up for 6~12 months and divided into DFS group (n=75) and recurrence group (n=49).Bioinformatics analysis was applied to screen differentially expressed genes.KRAS,TP53,CDKN2A,SMAD4,FKBP1A,PLD1,PSMA4,PES1,miR-320b and LncRNA MIR210HG in tumor tissues were detected by real-time PCR.The general datas,blood biochemistry,tumor pathological characteristics were compared between the two groups.Multivariate Cox regression analysis was used to identify predictors of DFS. A Nomogram was established using R software, and the receiver operating characteristic (ROC) curve was employed to evaluate the predictive performance of the Nomogram for DFS.Results Compared with DFS group,albumin decreased,maximum diameter≥4 cm,histological grade 3,TNM stage Ⅱb~Ⅲa and lymph node metastasis increased,the expressions of TP53,PES1 and LncRNA MIR210HG increased,and expressions of SMAD4 and miR-320b decreased in recurrence group (P<0.05).Multivariate Cox regression showed that Ⅱb~Ⅲa (HR=2.659),lymph node metastasis (HR=2.012),PES1 (HR=1.429),LncRNA MIR210HG (HR=1.758) and miR-320b (HR=1 659) were predictive factors to DFS.The nomogram was established by R software.ROC showed that AUC of nomogram for predicting DFS was 0.876 (95%CI=0.823~0.936,P<0.001).Conclusion The quantitative model established by combining tumor pathology and differential gene expressions has good application potential for predicting 1-year DFS after pancreatic cancer resection.

Objective To investigate the relationship between serum microRNA-217-5p (miR-217-5p) and microRNA-325-3p (miR-325-3p) expression with the occurrence and development of acute pancreatitis (AP).Methods From February 2021 to February 2024,127 patients with acute pancreatitis (AP) treated in our hospital were included as the AP group.AP was further separated into mild acute pancreatitis (MAP) group (n=44),moderate to severe acute pancreatitis (MSAP) group (n=42),and severe acute pancreatitis (SAP) group (n=41) according to the severity of the disease.During the same period,127 healthy volunteers who underwent physical examination in our hospital were included as the control group.qRT-PCR method was applied to detect the relative expression levels of serum miR-217-5p and miR-325-3p.Multivariate Logistic regression was applied to analyze the influencing factors of SAP.ROC curves were applied to investigate the diagnostic value of serum miR-217-5p and miR-325-3p for SAP.Results The relative expression level of serum miR-217-5p in the AP group was 1.52±0.16,which was significantly higher than that in the control group（1.02±0.13）.The relative expression level of miR-325-3p was 0.71±0.08,which was significantly lower than that in the control group（1.01±0.12） (P<0.05).The relative expression levels of miR-217-5p in the MAP group,MSAP group,and SAP group were 1.34±0.15,1.55±0.17 and 1.67±0.21,respectively,and the levels of C-reactive protein (CRP) were （27.07±6.31）mg/L,（35.37±7.58）mg/L and（51.04±8.14）mg/L,respectively,and the content of procalcitonin (PCT) was （0.16±0.03）ng/ml,（0.19±0.04）ng/ml and （0.26±0.04）ng/ml,respectively,which were significantly increased (P<0.05).MiR-217-5p was an independent risk factor affecting SAP (P<0.05).MiR-325-3p was an independent protective factor affecting SAP (P<0.05).The AUC of serum miR-217-5p and miR-325-3p for diagnosing SAP alone was 0.831 and 0.861,respectively.The AUC of their combined diagnosis was 0.941,which was better than the AUC of their combined diagnosis (Z_{miR-217-5p combination}=3.003,Z_{miR-325-3p combination}=2.725,both P<0.05).Conclusion Serum miR-217-5p expression is upregulated and miR-325-3p expression is downregulated in the serum of SAP patients,and they are associated with the occurrence and development of AP.Abnormal expressions of both are factors affecting SAP,and the combination of the two has higher diagnostic value for SAP.

Objective To investigate the effect of extraperitoneal drainage on incisional complications of laparoscopic-assisted median abdominal surgery.The risk factors related to incisional complications were also analysed separately and a prediction model was constructed.Methods Retrospective analysis included 200 patients with colorectal malignant tumours who were operated with laparoscopy from January 2017 to September 2023 at the Department of Abdominal Oncology of the People's Hospital of the Inner Mongolia Autonomous Region (all of whom were operated using laparoscopically-assisted median incision of the lower abdomen),and were divided into the group of extra-peritoneal negative pressure drain (120 cases) and the group of no negative pressure drain (80 cases),according to whether or not negative pressure drains were placed on the outer layer of the peritoneum intraoperatively.General,intraoperative and postoperative data of patients in the two groups were collected and analysed.Single-factor and multifactor Logistic regression models were used to analyse the influencing factors of laparoscopically assisted median abdominal incision complications,analyse the risk factors related to incision complications,and construct a prediction model.Sixty-three patients with colorectal malignancy in our department from October 2023 to January 2025 were collected as an external validation group according to the same criteria.The predictive model effect was assessed by C-index,receiver operating characteristic (ROC) curve,calibration curve,and decision curve in both modelling and external validation groups.Results There was no statistically significant difference between the two groups when comparing the general and intraoperative data (P>0.05).The results of univariate and multivariate Logistic regression analysis showed that extraperitoneal placement of negative pressure drainage reduced the absolute risk of surgical site infections (SSIs) rate by 6.7% and the relative risk by 53.6%;patients' combination of diabetes mellitus,history of previous abdominal surgeries,abdominal adhesions,and intestinal stomas were the risk of SSIs and fatty liquefaction factors (P<0.05).In the modelling and external validation groups,the C-index of the SSIs model was 0.857,95%CI 0.749 to 0.966,0.959,95% CI 0.909 to 1.008;and that of the fat liquefaction model was 0.868,95%CI 0.797 to 0.939,0.955,95%CI 0.895 to 1.016.The area under the ROC curve AOC of the SSIs The area under the ROC curve AUC for the model was 0.865,95%CI 0.756 to 0.975,0.967,95%CI 0.914-1.000,and for the fat liquefaction model was 0.876,95%CI 0.803 to 0.948,0.964,95%CI 0.904-1.000.The calibration curves of the two models passed the Spiegelhalter test (P>0.05).The clinical decision curve of both models showed a high threshold range.Conclusion Diabetes mellitus,history of previous abdominal surgery,abdominal adhesions,and enterostomy are risk factors for SSIs and fatty liquefaction,and for patients with colorectal malignancies treated with laparoscopically-assisted lower abdominal median incision,extraperitoneal drainage is recommended for the prevention of incisional infections;two columnar-line graphical models can more accurately predict the risk of SSIs and fatty liquefaction in the postoperative period,which has a certain clinical reference value.

Objective To study the effect of intermittent alternating maintenance of propofol and sevoflurane on the clinical effect of patients with long-time general anesthesia.Methods A total of 90 patients with elective abdominal surgery from June 2023 to June 2024 were selected and divided into three groups (n=30) by computer random number table method,propofol intravenous maintenance group (group A),propofol combined with sevoflurane maintenance group ( group B) and intermittently maintenance of propofol and sevoflurane group (group C).All patients underwent tracheal intubation after routine intravenous induction, with 30 cases in each group.Group A was maintained by propofol and remifentanil,group B was maintained by propofol combined with sevoflurane and remifentanil,and group C was maintained by propofol alternate with sevoflurane and remifentanil.The dosage of each anesthesia drug,the recovery time of breathing,awareness time,extubation time and the total recovery time after the operation were recorded,and the restlessness at recovery (RS) score and Ramsay sedation score were evaluated.Adverse events and complications were recorded.Postoperative ICU stay,total hospital stay,and hospitalization expenses were also counted.Results The doses of propofol in groups A,B,and C were (1 740.3±385.6) mg,(1 243.2±278.5) mg and (1 055.1±245.8) mg,respectively,and the doses of sevoflurane in groups B and C were (39.83±9.20) mg and (28.33±4.25) mg,respectively.Compared with group A and B,group C used less propofol and sevoflurane (P<0.05).Postoperatively,patients in group C had shorter recovery times for spontaneous breathing [(15.43±14.90)min],consciousness awakening [(15.90±14.59)min],extubation [(42.82±37.23)min],and total recovery time [(44.03±12.68)min] than those in group A[（56.73±47.23）min,（57.03±47.83）min,（66.43±47.94）min and（93.80±48.68）min] and group B[（31.57±26.04）min,（31.17±26.06）min,（39.60±26.30）min and（65.43±34.18）min] (P<0.05).The RS scores for groups A,B,and C were (1.33±0.92),(0.83±0.70),and (0.33±0.55),respectively,and the Ramsay sedation scores were (2.87±0.94),(2.43±0.73),and (1.90±0.40),respectively,showing a gradual decrease (P<0.05).The incidences of postoperative choking cough, restlessness, nausea and vomiting, and hypotension in group A were 26.7%, 36.7%, 23.3%, and 30% respectively, and those in group C were 6.7%, 6.7%,3.3%,and 10% respectively. The incidences in group C were all lower than those in group A, and the differences were statistically significant (P < 0.05).Furthermore,compared with group A[（2.53±1.14）d,（25.53±13.17）d and（93 200±19 800）CNY],group C had shorter ICU stays [(1.50±0.68)d] and hospitalization durations [(20.37±6.67)d],and lower hospitalization costs [(84800±10700）CNY] (P<0.05).Conclusion Propofol and sevoflurane intermittently maintenance can be safely and effectively used for long-time anesthesia maintenance.Compared with traditional total intravenous and intravenous combined with inhalation anesthesia,the recovery is faster,the recovery quality is better,and the hospitalization time and cost can be optimized.

Perianal Paget's disease (PPD) is a type of extra-mammary Paget disease, and its essence is intrepithelial adenocarcinoma of the skin.The etiology and pathogenesis of PPD remain unclear,and its clinical features resemble non-malignant inflammatory disorders,often leading to delayed diagnosis and treatment.This report describes a rare case of primary perianal Paget's disease.The patient underwent local wide excision combined with modified V-Y flap reconstruction,achieving good postoperative recovery.

Objective To explore the pathogen characteristics and risk prediction model verification of urinary tract infection after transurethral bladder cancer tumor resection.Methods This study adopted a retrospective analysis method to conduct an in-depth analysis of the data from 150 bladder cancer patients collected by our hospital between January 2022 and December 2024.Patients were divided into two groups based on whether they developed urinary tract infections post-surgery:the non-infected group (n=127) and the infected group (n=23).A preliminary single-factor screening was conducted to identify potential factors that may influence the occurrence of urinary tract infections in bladder cancer patients after surgery.Based on the results of the single-factor screening,a multivariate logistics regression was performed to determine independent influencing factors.The R software was used to construct a predictive model for postoperative urinary tract infections in bladder cancer patients,and the area under the curve (AUC),sensitivity,and specificity were calculated to evaluate the performance of the predictive model.Results In 150 bladder cancer patients,23 cases developed urinary tract infections.Among these infected cases,Gram-negative bacteria accounted for 16 cases,representing as high as 69.57%.Univariate analysis showed that age,history of diabetes,pelvic radiation therapy,surgery duration,and catheter retention time were significantly associated with postoperative urinary tract infections (P<0.05).Variables with significant differences were included in a binary Logistic regression model,which identified diabetes,history of pelvic radiation therapy,older age,and longer catheter retention time as independent factors influencing urinary tract infections after transurethral resection of bladder tumors in bladder cancer patients（P＞0.05）.Additionally,based on these independent influencing factors,a logistic regression model was established with an C-index of 0.99,indicating excellent discrimination.There was no significant difference between the actual observed values and predicted values (χ²=8.999，P=0.342 4),suggesting good model fit.The AUC of the predictive model was 0.977,with a 95%CI ranging from 0.952 to 1.000,further confirming the accuracy of the model.Conclusion Patients with bladder cancer have a higher chance of developing urinary tract infections after transurethral resection of bladder tumors,primarily due to Gram-negative bacteria.Further analysis revealed that prolonged catheterization,age,history of pelvic radiation therapy,and diabetes are significant risk factors for urinary tract infections.Targeted preventive measures for these risk factors can reduce infection rates and improve patient outcomes.

Objective To conduct a bibliometric and visual analysis of the literature on targeted therapy for diabetic wounds over the past two decades,exploring research trends and hotspots in this field.Methods Literature on targeted therapy for diabetic wounds published between June 1,2005,and June 1,2025,was retrieved from the Web of Science Core Collection database.VOSviewer and CiteSpace software were used to perform visual analyses of publication trends,countries/regions,research institutions,journal distributions,author influence,and key words co-occurrence.Results A total of 605 articles were included.The annual publication volume in the field of targeted therapy for diabetic wounds generally showed an upward trend and is expected to continue increasing in the future.The country/region with the highest number of publications and total citations was China.The institution with the highest number of publications was Sun Yat-sen University.The journal with the highest number of publications was Diabetes.The author with the highest number of publications was Fu XB.Keyword co-occurrence cluster analysis indicated that research hotspots primarily focused on angiogenesis,inflammation,oxidative stress,diabetic foot ulcers,etc.Conclusion Research interest in targeted therapy for diabetic wounds continues to grow,with current studies mainly concentrated in basic research.Future efforts should foster inter-institutional collaboration across regions to enhance research quality and expedite the translation of basic research findings into clinical applications.

Objective To investigate the short-term and long-term effects of autologous fat grafting (AFG) combined with platelet-rich fibrin (PRF) in the treatment of diabetic foot ulcers (DFU).Methods This study was designed as a prospective randomized controlled trial (RCT).A total of 116 patients with DFU treated in our hospital from July 2020 to December 2023 were enrolled and divided into a fat grafting group and a combined treatment group with 58 patients in each group according to the randomized numerical table method.The fat grafting group received negative pressure suction and autologous fat grafting to treat the wound,while the combined treatment group received negative pressure suction,autologous fat grafting,and PRF to treat the wound.Clinical baseline data of the two groups were collected.The 50% ulcer healing time,30-day wound healing percentage,7-day granulation tissue score,and VAS score were evaluated in both groups.Follow-up was conducted for 3 months,and the ulcer surface of the patients was scored using the Pressure Ulcer Scale for Healing (PUSH) before treatment,at 7 days,1 month,2 months,and 3 months after treatment to assess the treatment effect.Results The healing time of 50% ulcer surface in the combined treatment group was (21.44±3.86) days, which was lower than that in the fat transplantation group [(26.39±3.79) days], and the difference between the two groups was statistically significant (P<0.05). The percentage of ulcer surface healing in the combined treatment group at 30 days was (66.39±6.92) %, and the granulation tissue score at 7 days was (3.96±0.47) points, which were higher than those in the fat transplantation group [(59.87±7.44) % and (3.58±0.44) points]. There was a statistically significant difference between the two groups (P<0.05).After 7 days of treatment, the vascular endothelial growth factor in the combined treatment group and the fat transplantation group was (6.52±0.76) ng/ml and (4.96±0.63) ng/ml respectively, and the transforming growth factor beta1 was (111.37±1.54) ng/ml and (9.04±1.18) ng/ml respectively. The interleukin (IL) -1β was (84.32±11.28) pg/ml and (113.15±15.32) pg/ml respectively, and the IL-10 was (40.39±6.87) pg/ml and (59.67 ±8.54) pg/ml respectively. There was a statistically significant difference between the two groups (P<0.05).The PUSH scores of the combined treatment group at 1 month, 2 months and 3 months after treatment were (7.58±1.44) points, (6.27±1.28) points and (2.44±0.72) points respectively, while those of the fat transplantation group were (8.62±1.39) points, (7.08±1.43) points and (4.12±0.93) points respectively. There was a statistically significant difference between the two groups (P<0.001).Conclusion AFG combined with PRF shows good short-term and long-term effects in the treatment of diabetic foot ulcers.

Department of Breast Surgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China

Cavernoushemangioma of the skull is a rare benign tumor of the skull.It usually has no typical clinical manifestations or only presents with focal tenderness.Occasionally,headache,nerve dysfunction and epilepsy can be seen.Head CT showed local swelling or lytic lesions with reduced internal density and sparse bone trabeculae,which was easily misdiagnosed as eosinophilic granuloma of the skull.The risk of intraoperative hemorrhage in cavernous hemangioma of skull is high,so preoperative differential diagnosis is very important.

Bronchogenic cysts are congenital benign lesions that predominantly occur in the mediastinum,with retroperitoneal cases being exceedingly rare.Preoperative diagnosis is challenging,and histopathological examination remains the definitive diagnostic method.This article presents a case of retroperitoneal bronchogenic cyst and analyzes its epidemiological characteristics,clinical manifestations,diagnostic evaluations,and management strategies,aiming to enhance clinicians' understanding of this condition.

Aggressive fibromatosis is a low-grade malignant tumor characterized by excessive proliferation of fibroblasts and myofibroblasts,featuring infiltrative growth and a propensity for recurrence,though it rarely metastasizes.Intra-abdominal aggressive fibromatosis is extremely uncommon.This case highlights the diagnostic challenges of intra-abdominal aggressive fibromatosis,the importance of multidisciplinary team) management,and the central role of surgical resection as the preferred treatment modality.

We report a case of Bouveret syndrome in a 78 year old woman presenting with 3 days of gastric distension,nausea and vomiting.CT showed an impacted high density lesion in the horizontal duodenum with suspected cholecystoduodenal fistula.Exploratory laparotomy revealed a contracted gallbladder adherent to the duodenal bulb;a firm 5.0cm×3.0cm stone was removed via a jejunal enterotomy approximately 20cm distal to the ligament of Treitz.Cholecystectomy and fistula repair were deferred due to dense adhesions.For large impacted stones or severe local inflammation,individualized surgical extraction with staged management of the gallbladder and fistula is a safe and effective strategy,and which can reduce the risk of complications.