In clinical research on articular cartilage injury repair,traditional treatment modalities can improve patients’ symptoms to a certain extent,but these approaches have limitations in long-term functional maintenance.In recent years,cartilage organoids (CORG) have drawn extensive attention due to their demonstrated potential advantages in the field of cartilage regeneration.This article aims to introduce the construction technology of CORG,providing a more promising application paradigm for cartilage repair.

Objective To explore the clinical application effects of artificial dermis in the repair of traumatic finger skin defects with bone exposure.Methods From January 2022 to January 2024,10 patients with fingertip skin defects and bone exposure,totaling 10 fingers,were treated.The defect areas ranged from 0.5 cm×1.0 cm to 1.0 cm×1.5 cm.After debridement,the wounds were covered with artificial dermis,and regular dressing changes were performed postoperatively.The artificial dermis was removed 3-4 weeks post-surgery.The wound healing,skin appearance,and sensory recovery of the fingertip were evaluated.Results All 10 fingertip wounds healed successfully,with a healing time of 3 to 4 weeks.Patients were followed up for more than 3 months,and the wound healing was satisfactory.The finger pads appeared full,the skin was smooth and flat with no obvious scarring,and the texture was soft.Skin sensory ability recovered well,with no pain or hypersensitivity,and the two-point discrimination ability reached 3 to 8 mm.According to the upper limb function evaluation standards set by the Hand Surgery Society of the Chinese Medical Association,the sensory recovery of all 10 fingertips achieved an S3+ level,with a good to excellent rate of 100%.Conclusion The primary repair of fingertip skin defects with bone exposure using artificial dermis resulted in no donor site damage.The surgical procedure is safe and simple,and the appearance and sensory function of the fingers have recovered well,demonstrating reliable efficacy.

Objective To explore the application effect of personalized osteotomy guide plate in high tibial osteotomy for patients with knee osteoarthritis (KOA).Methods A total of 99 patients with KOA who underwent open wedge high tibial osteotomy (OWHTO) in our hospital from January 2022 to January 2023 were selected and randomly divided into a study group (50 cases) and a control group (49 cases) using a random number table method.The control group received traditional medial OWHTO treatment,and the study group received a combination of medial OWHTO and personalized osteotomy guide plate treatment.The indexes of operation and postoperative rehabilitation,serum inflammatory stress factor [C-reactive protein (CRP),tumor necrosis factor-α (TNF-α),cortisol (Cor),adrenocorticotropin (ACTH)],anatomical structure of knee joint [tibial plateau posterior Angle (PTSA),proximal medial tibial Angle (MPTA),hip knee ankle Angle (HKA)],knee function,ACL shape and function,postoperative complications were compared between the two groups.Results The amount of bleeding,the number of intraoperative fluoroscopy,and the postoperative drainage volume in the study group were (138.69±24.03) ml,(4.83±1.07) times,and (228.95±38.72) ml,respectively,which were all less than those in the control group (154.28±27.16) ml,(7.15±1.14) times,and (271.61±42.19) ml.In the study group,the operation time,incision length,and hospitalization time were (40.96±7.28) min,(8.96±0.85) cm,and (10.73±2.05) d,respectively,which were all shorter than those in the control group [(52.31±10.12) min,(9.51±1.03) cm,and (12.16±2.37) d],with statistically significant differences (P<0.05).The levels of serum CRP,TNF-α,Cor,and ACTH in the study group on the 3rd day after the operation were (31.36±4.68) mg/L,(26.71±3.84) ng/ml,(241.28±27.45) ng/ml,and (18.65±3.01) pmol/L,respectively,which were lower than those in the control group [(35.07±5.16) mg/L,(30.29±4.15) ng/ml,(279.65±30.12) ng/ml,and (21.73±3.28) pmol/L,respectively],and the differences were statistically significant (P<0.05).The Hospital for Special Surgery(HSS) knee score and Knee Society Score(KSS) of the study group at 12 months after surgery were (81.24±6.85) points and (78.26±6.14) points,respectively,which were higher than those of the control group [(78.08±6.42) points and (75.53±5.82) points,respectively],with statistically significant differences (P<0.05);at the 12th month after surgery,the width of the ACL body in the study group was (5.68±0.71) mm,which was greater than that in the control group [(5.12±0.64) mm].The amount of anterior tibial displacement was (5.81±0.43)mm,which was smaller than that in the control group (6.19±0.41)mm,and the differences were statistically significant (P<0.05);the incidence of postoperative complications in the study group was 4.00%,which was lower than that in the control group (18.37%),and the difference was statistically significant (P<0.05).Conclusion The combined treatment of medial OWHTO and personalized osteotomy guide plate can reduce surgical trauma in patients with KOA,lower the incidence of complications,facilitate patient recovery,while maintaining the morphology and function of the ACL,and improving prognosis.

Objective To analyze the application effect of anterolateral femoral free flap transplantation based on three-dimensional reconstruction in CT angiography in the treatment of chronic osteomyelitis of the foot and ankle complicated with soft tissues defect.Methods A retrospective analysis was conducted on the clinical data of 105 patients with chronic osteomyelitis of the foot and ankle complicated with soft tissues defect who were admitted to Suining Central Hospital in Sichuan Province from January 2020 to January 2023.Patients enrolled were divided into the control group (n=52) and the observation group (n=53) according to different perforating blood vessel examination methods before surgery.The control group underwent anterolateral femoral free flap transplantation based on handheld Doppler ultrasound,while the observation group underwent anterolateral femoral free flap transplantation based on CTA three-dimensional reconstruction technology.Comparison between the groups was made on inflammatory factors (CRP,TNF-α and IL-6),skin flap repair effect,foot and ankle function (AOFAS) score,flap sensation,survival rate of skin flaps,and the incidence of adverse events.Results On day 14 after operation,serum CRP,TNF-α and IL-6 levels in the observation group were lower than those in the control group (P<0.05).Six months after operation,the effect of flap repair in observation group was better than that in control group,and the survival rate of flap was higher than that in control group (100.00% vs 92.31%) (P<0.05).Twelve months after operation,AOFAS score and flap sensation score of the observation group were higher (P<0.05).The incidence of adverse events was lower in the observation group than in the control group (3.77% vs.15.38%) (P<0.05).Conclusion Anterolateral femoral free flap transplantation based on CTA 3D reconstruction technique can repair soft tissue defect and reduce the risk of adverse events while can cure chronic osteomyelitis.

Objective To examine the causes of incision infections following lower extremity open fractures and develop a predictive model for assessing the risk.Methods A total of 104 patients with open fractures of the lower extremity,who received internal fixation from January 2022 to August 2023.According to whether there was incision infection after the operation,the patients were divided into infection group and non-infection group.The aim of the study was to analyze the distribution of pathogenic bacteria causing postoperative incision infections.Single-factor and multifactor Logistic regression analyses were employed to examine the factors influencing postoperative incisional infections.Subsequently,a risk prediction model for these infections was developed.The predictive capacity of this model was assessed using ROC curves.Results In the cohort of 104 patients with open fractures of the lower limb,the occurrence rate of postoperative incision infections was 19.23%.A total of 45 non-repeated pathogenic bacteria were isolated,among which gram-positive bacteria accounted for 53.33%,gram-negative bacteria 42.22%,fungi 4.44%.Gram-positive bacteria showed 100% resistance to ampicillin/sulbactam and penicillin,while resistance rates for erythromycin and clindamycin exceeded 90%.Among gram-negative bacteria,resistance rates to cefazolin,sulfamethoxazole/trimethoprim,levofloxacin,ampicillin/sulbactam,ciprofloxacin,and gentamicin were all above 67%.Notably,resistance rates for cefazolin,sulfamethoxazole,and trimethoprim surpassed 90%.Univariate and multifactorial Logistic stepwise regression analysis highlighted that time elapsed from injury to surgery,duration of surgery,length of hospital stay,perioperative prophylactic medication,and Gustilo classification were significant risk factors for postoperative incisional infections in patients with the condition (P<0.05).The ROC curves illustrated that the risk prediction model accurately forecasted the incidence of postoperative incisional infections in patients with open fractures of the lower extremity,with an area under the curve of 0.861 (95%CI:0.811 to 0.911),boasting a sensitivity of 90.50% and a specificity of 72.92%.Conclusion The main pathogen of wound infection after open fracture of lower extremity is Gram-negative,the time from injury to operation,operation time,hospitalization time,prophylactic medication during perioperative period and GUSTILO classification were the influencing factors of postoperative wound infection.In addition,the establishment of risk prediction model has a good prediction effect on the incidence of postoperative wound infection in patients with this disease.

Objective To explore the correlation between serum inflammatory indicators and short-term prognosis in patients with single-segment lumbar intervertebral disc protrusion (LDH) treated by transforaminal endoscopic discectomy (TELD).Methods From January 2015 to June 2022,137 patients with single-segment LDH received TELD treatment.The levels of serum inflammatory factors such as C-reactive protein (CRP),white blood cell count (WBC),erythrocyte sedimentation rate (ESR),and procalcitonin (PCT) of the patients before the operation and 3 days after the operation,as well as surgical data such as anesthesia methods,operation time,and blood loss were collected.The time for patients to resume work was collected,and the pain relief and functional recovery of the patients were evaluated by using the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI).Pearson or Spearman rank correlation analysis was used to explore the correlations between demographic characteristics,inflammatory indicators,surgical data and short-term prognosis.Results The average time for patients to return to work was (3.55±2.13) months.There were statistically significant differences in the pain and functional scores at each time point compared with those at the previous time point (P<0.05).The CRP,WBC and PCT of the patients after the operation were significantly increased compared with those before the operation,and the difference was statistically significant (P<0.05).The levels of CRP and PCT in patients 3 days after surgery were significantly positively correlated with VAS 6 months after surgery.The duration of symptoms and the CRP level 3 days after surgery were significantly positively correlated with ODI 6 months after surgery.BMI was significantly positively correlated with the time to return to work (P<0.05).Conclusion There is a certain correlation between the levels of serum inflammatory indicators in patients with single-segment LDH treated with TELD and the short-term prognosis.The increase of CRP and PCT 3 days after the operation may affect the rehabilitation process of the patients.

Objective To explore a better surgical approach for the surgical treatment of avulsion fractures of the posterior cruciate ligament of the tibial plateau.Methods From July 2014 to May 2024,A total of 29 cases of avulsion fractures at the insertion point of the posterior cruciate ligament of the tibial platform were admitted to our department.They were divided into two groups according to different surgical approaches.There were 16 cases in group A,which adopted the modified posterior approach,and 13 cases in group B,which adopted the conventional posterior approach.The therapeutic effects of the two groups of patients were evaluated by using the Lysholm knee score scale after surgery and the KOOS knee injury and osteoarthritis outcome scoring system.Results All patients were followed up for 12 to 14 months,with an average of (12.6 ±0.3) months.No serious adverse complications such as non-healing of the surgical site occurred in group A.In group B,there was 1 case of delayed wound healing and 8 cases of knee joint pain during movement.The Lysholm knee joint score and KOOS knee joint outcome score of patients in group A at 12 months after the operation were (88.65±9.23) points and (90.48±6.84) points respectively,and those in group B were (63.98±10.77) points and (69.37±9.01) points respectively.Both groups in group A were more satisfied than those in group B,and the difference was statistically significant（P＜0.05）.Conclusion For patients with avulsion fractures of the insertion point of the posterior cruciate ligament of the tibial platform,the modified minimally invasive penetrating muscle approach on the posterior side of the knee joint can reduce related complications such as excessive intraoperative bleeding,internal relaxation of the knee joint,and poor postoperative wound healing,enabling early functional exercise for patients and achieving a better prognosis.

Objective To investigate the effects of super early enteral nutrition support on postoperative serum miR-124 levels,inflammatory markers,immune function,nutritional status,and short-term and long-term rehabilitation outcomes in patients with severe traumatic brain injury(STBI).Methods A total of123 STBI patients admitted to our hospital from January 2021 to December 2022 were selected.According to the start time of enteral nutrition,patients were divided into super early enteral nutrition group,late enteral nutrition group and parenteral nutrition group.We collect clinical data from each group and detected serum miR-124 and inflammatory factors,immune indicator,nutritional indicators levels before and after treatment,as well as postoperative complications and prognosis.Results Compared with the parenteral group and the late intestinal group,the levels of miR-124,inflammatory factors and the proportion of CD8⁺T cells in the super early intestinal group were significantly reduced,while the proportion of CD4⁺/CD8⁺ cells was significantly increased,with statistical differences(all P＜0.05).Compared with the parenteral group,the levels of albumin,prealbumin,and transferrin in intestinal groups were significantly increased with statistical differences(both P＜0.05).Compared with the late intestinal group,the levels of albumin and prealbumin in the super early intestinal group were significantly increased,with statistical differences(both P＜0.05),while there was no significant difference in transferrin levels between two groups(P＞0.05).There was no significant difference in the incidence of various complications during hospitalization among all groups(all P＞0.05).The total incidence of complications in the super early intestinal group was significantly lower than that in the parenteral group and late intestinal group with statistical differences(both P＜0.05).During the follow-up period,there was no significant difference in prognosis,disability,and mortality among three groups(all P＞0.05).Compared with the parenteral group,the GOS scores of the intestinal groups were significantly reduced with statistical differences(P＜0.05).There was no statistically significant difference in GOS scores between two groups(P＞0.05).Conclusion Super early enteral nutrition support is effective in treating patients with STBI,which can effectively improve the patient’s nutritional status,enhance immune function,suppress inflammatory reactions,help repair nerve injuries,and enhance rehabilitation effects.

Objective To investigate the clinical manifestations,risk factors,treatment strategies and clinical prevention feasibility of diabetic ketoacidosis (DKA) after coronary artery bypass transplantation (CABG).Methods Clinical data of 9 patients with ketoacidosis after CABG surgery treated and treated by CICU in the Intensive Care Unit of Cardiac Surgery in Nanjing Gulou Hospital from January 2022 to January 2024 were retrospectively analyzed,and the diagnosis and treatment process and short-term postoperative follow-up were conducted to evaluate the causes of ketoacidosis in order to obtain clinical characteristics.To provide early warning information for follow-up diagnosis and treatment,and to evaluate the effect of perioperative corrective treatment strategy on the short-term prognosis of patients.Results The median duration of DKA in the 9 patients was 2.6 days after surgery,and the clinically suggestive symptoms were tachyarrhythmia (8/9),hypotension (4/9),polyuria (6/9),intractable hyperglycemia (3/9),and derangation (5/9).Analysis of concomitant manifestations or risk factors were mainly the perioperative use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) (9/9),age> 60 years old.The main diagnosis was based on abnormal blood ketone and urine ketone.Blood gas analysis suggested metabolic acidosis,and BE showed serious negative performance.After early diagnosis,8 patients took the volumetric surplus strategy,and the average correction time was 5.6 days.One patient was slow to correct and eventually died from other types of severe complications.Conclusion Perioperative use of SGLT2-i drugs in CHD patients with heart failure and type 2 diabetes is a high risk factor for DKA.The strategy of early diagnosis and parallel capacity surplus is an important way to correct DKA.

Objective To compare the application effects of bronchial blocker (BB) and double-lumen endotracheal tube (DLT) in pediatric thoracoscopic lobectomy.Methods A total of 80 pediatric patients who underwent thoracoscopic lobectomy at Xuzhou Children’s Hospital from February 2020 to February 2023 were randomly divided into the DLT group (n=40) and the BB group (n=40) by envelope drawing.The DLT group received treatment with double-lumen endotracheal tubes,while the BB group was treated with bronchial blockers.Perioperative indicators,mean arterial pressure (MAP),heart rate (HR) at different times,airway pressure,pre- and post-operative recovery quality scores (QoR-15),intraoperative lung collapse (LCS) scores,modified Aldrete recovery scores,and adverse reactions were compared between the two groups.Results The comparison of single-lung ventilation time,intubation positioning time,and anesthesia time between the two groups showed no statistically significant differences (P>0.05);however,the operation time of the BB group was (68.37±6.28) minutes and the hospital stay was (4.56±0.35) days,while those of the DLT group were (76.87±8.34) minutes and (5.97±0.70) days,respectively.There was a statistically significant difference between the two groups (P<0.05).There were no significant differences in the mean arterial pressure (MAP) and heart rate (HR) before induction (T0) between the two groups (P>0.05).The MAP of the BB group immediately after intubation (T1),2 minutes after intubation (T2),immediately after extubation (T3),and 2 minutes after extubation (T4) was (91.53±8.28)mmHg,(89.58±8.72)mmHg,(89.33±8.97)mmHg,and (95.40±9.86)mmHg,respectively.The HRS were (72.74±6.35) times/minute,(72.83± 6.82) times/minute,(71.19±6.57) times/minute,and (73.63±7.46) times/minute respectively.The MAP in the DLT group was (83.88±7.29)mmHg,(83.40±7.66)mmHg,(85.17±7.91)mmHg,and (89.42±9.15)mmHg,respectively.HR was (66.68± 6.17) times/minute,(64.27±6.19) times/minute,(65.97±6.28) times/minute,and (68.80±6.27) times/minute,respectively.There was a statistically significant difference between the two groups (P<0.05).The airway pressures of the BB group at 5 minutes of bilateral lung ventilation (T5),5 minutes of unilateral lung ventilation (T6),and 5 minutes of recovery of bilateral lung ventilation (T7) were (14.36±2.46)cmH₂O,(17.34±2.75)cmH₂O,and (15.30 ± 2.32)cmH₂O,respectively.The values in the DLT group were (17.77±2.85)cmH₂O,(21.35±3.17)cmH₂O,and (18.49±2.99)cmH₂O,respectively.There was a statistically significant difference between the two groups (P<0.05).There was no statistically significant difference in QOR-15 score and modified Aldrete recovery score one day before the operation between the two groups (P>0.05).One day after surgery,the QOR-15 score of the BB group was (119.33±12.20) points,and the intraoperative LCS score was (7.70±0.61) points,while those of the DLT group were (107.60±10.10) and (6.31±0.57) points,respectively.There was a statistically significant difference between the two groups (P<0.05).The incidence of adverse reactions was 10.0% in the BB group and 27.5% in the DLT group.There was a statistically significant difference between the two groups (P< 0.05).Conclusion The application of bronchial blockers in pediatric thoracoscopic lobectomy shows better results compared to double-lumen endotracheal tubes.

Objective To compare the effects of two surgical methods (duodenal papillary reconstruction and small duodenal papillary incision+large balloon dilation) on Oddi’s sphincter function in patients with common bile duct stones.Methods From January 2021 to December 2022,64 patients with large common bile duct stones underwent endoscopic retrograde cholangiopancreatography (ERCP) stone removal surgery,which were randomly divided into two groups using a lottery method (32 cases each).Group A underwent ECPP,while Group B underwent limited EST plus EPLBD.Before the procedure,immediately after procedure,and one month after procedure,duodenal pressure measurements (Oddi sphincter basal pressure,maximum systolic pressure,and systolic frequency) were conducted to observe changes in various measurement indicators,and to compare the incidence of short-term and long-term complications between the two groups.Results The basal pressure,maximum systolic pressure and systolic frequency of the Oddi sphincter in both groups immediately after the operation and one month after the operation showed a trend of first decreasing and then increasing,and were all lower than those before the operation,and the differences were statistically significant(P<0.05).There were no statistically significant differences in the basic pressure,maximum systolic pressure and systolic frequency of the Oddi sphincter immediately after surgery between the two groups (P>0.05).One month after the operation,the basal pressure,maximum systolic pressure and systolic frequency of the Oddi sphincter in group A were (21.12±4.08) mmHg,(113.60±12.07) mmHg and (6.10±0.96) times/minute,respectively.The values in group B were (16.28± 1.64) mmHg,(104.19±19.25) mmHg,and (5.68±1.02) beats/minute,respectively.The values in group A were all higher than those in group B,and the differences were statistically significant(P<0.05).The incidences of gas reflux in group A at 1 week,6 months and 12 months after surgery were 6.25%,3.13% and 0 respectively,while those in group B were 21.88%,15.63% and 12.50% respectively.The incidences of barium reflux in group A were 3.13%,0 and 0 respectively,and those in group B were 12.50%,9.38% and 6.25% respectively.There were statistically significant differences between the two groups (P<0.05).The total incidence of short-term and long-term complications after surgery was close (34.38% and 31.25%),and there was no statistically significant difference between the two groups (P>0.05).Conclusion Compared with limited EST plus EPLBD,ECPP is more helpful for the recovery of Oddi’s sphincter function,and this surgical procedure is simple to operate without increasing the risk of postoperative complications.

Objective To explore the application value of manual purse-string suture in esophageal jejunum tubular anastomosis in total laparoscopic total gastrectomy.Methods A retrospective cohort study was conducted to collect the clinical data of 41 patients with gastric cancer who underwent laparoscopic total gastrectomy in the Department of Gastrointestinal Surgery,Jingmen Central Hospital from January 2020 to December 2023.Among them,22 cases underwent total laparoscopic radical total gastrectomy with manual purse-string suture (total laparoscopic group),Nineteen patients underwent traditional laparoscopic-assisted total gastrectomy (laparoscopic-assisted group).Results 41 patients were successfully completed surgery,no conversion to laparotomy,no perioperative death.The operation time of the total laparoscopic group and laparoscopic-assisted group was 397.50 (310-540) minutes and 350 (250-440) minutes.The intraoperative blood loss was 50 (10-400) ml and 100 (20-200) ml.The incision length was 5 (4-5) cm and 8 (6-10) cm.The duration of postoperative analgesic use was 4 (3-5) days and 5 (3-5) days.The hospitalization days were 23 (18-37) days and 26 (13-34) days,respectively,and the difference was statistically significant (P<0.05).There was no significant difference in the number of lymph node dissection,postoperative abdominal bleeding,postoperative anastomotic leakage,postoperative anastomotic stenosis,postoperative pulmonary infection,postoperative first exhaust time and postoperative ambulation time between the two groups (P> 0.05).Conclusion It is safe and feasible to perform esophagojejunostomy by hand purse-string suture in totally laparoscopic total gastrectomy.Compared with traditional laparoscopic-assisted total gastrectomy,it has smaller incision,less intraoperative blood loss,less postoperative pain,shorter hospitalization time,but longer operation time.

Objective To explore its application value of LNM in patients with gastric adenocarcinoma based on the construction of a radiomic nomogram prediction model for preoperative lymph node metastasis in gastric adenocarcinoma using enhanced CT imaging features and parameters.Methods 131 patients with gastric adenocarcinoma who underwent radical gastric cancer surgery(Billroth Ⅱ) + lymph node dissection in our hospital from August 2019 to October 2023 were retrospectively analysed,and the preoperative enhancement CT extracted lesions,histological features of lymph node images,and pathological examination of LNM were recorded respectively,and the statistically significant Enhanced CT image histological features and parameters,multifactorial Logistic regression to analyse the independent risk factors of gastric adenocarcinoma LNM(+) and construct a column-line diagram,and evaluate its performance.The performance and clinical value of the prediction model were evaluated using subject work characteristic(ROC) curves,and the column-line diagram was internally validated.Results The results of univariate analysis showed that the maximum diameter of the tumour,the lymph node status,the short-axis length and volume of the largest lymph node in the lymph node group and the sum of the short-axis lengths of all the lymph nodes were associated with the occurrence of LNM,and the difference was statistically significant(P<0.05);multifactorial Logistic regression analysis suggested that the maximum diameter of the tumour was ≥15mm and the lymph node status was positive in the enhanced CT imaging examination,maximum lymph node short-axis length ≥7mm in the lymph node group,the sum of short-axis lengths of all lymph nodes ≥11mm,and the maximum lymph node short-axis volume ≥300mm³ in the lymph node group were the independent risk factors for gastric adenocarcinoma patients with LNM(+)(P<0.05);the area under the curve of the model was plotted using a ROC curve with an AUC=0.816(95%CI 0.810-0.939),with the sensitivity of 0.91 and the specificity of 0.86.Model validation was performed using the BOOTSTRAP method containing 500 resamples,and the results suggested that the differences between the fitted curves and the ideal curves of the constructed column-line graphical model were not significant,and the validity and reliability were good.Conclusion The radiomic nomogram prediction model based on enhanced CT imaging features and parameters can effectively predict preoperative lymph node metastasis in gastric adenocarcinoma,providing strong support for clinical decision-making in gastric adenocarcinoma patients.

Objective To explore prognostic factors of patients with distant metastatic hepatocellular carcinoma (DMHCC) and construct a survival prognosis nomogram to predict cancer-specific survival (CSS) for DMHCC patients.Methods A total of 619 patients from the SEER database (2000-2018) were included after strict inclusion and exclusion criteria.They were randomly divided into two groups at a ratio of 7〖DK〗∶3,among which there were 433 cases in the training set and 186 cases in the validation set.Cox regression analysis was used to screen out the independent risk factors affecting the prognosis of patients with DMHCC,and a nomogram was constructed.The predictive accuracy of the nomogram was determined by concordance index (C-index),receiver operating characteristic(ROC) and calibration curves.The clinical net benefit of the nomogram was assessed using decision curve analysis (DCA).Kaplan-Meier survival curves and Log-rank tests were performed for examining survival differences between high and low-risk groups.Results Multivariate Cox regression analysis revealed that tumor size,degree of tumor differentiation,T stage,whether or not surgery,chemotherapy or radiotherapy were independent risk factors influencing the prognosis of DMHCC patients.The nomogram,based on these factors,demonstrated good predictive performance in the training set with a C-index of 0.720 (95%CI:0.693-0.747),and area under the ROC curve at1,2,and3 years was 0.790,0.778,and 0.795,respectively.In the validation set,the C-index was 0.673 (95%CI:0.626-0.720),and area under the ROC curve at 1,2,and 3 years was 0.741,0.782,and 0.824,respectively.Risk stratification was performed with the nomogram.Kaplan-Meier survival curve indicated that for both training and validation sets,low-risk group had a significantly better prognosis than high-risk group.Conclusion This prediction model exhibits good predictive efficacy,providing valuable support for clinical decision-making and personalized treatment strategies in DMHCC patients.

Objective Construct a risk model for postoperative recurrence of hepatolithiasis and validate it.Methods From January 2020 to December 2021,237 patients undergoing hepatobiliary duct stone surgery were selected.All patients underwent liver lobectomy by the same team and were divided into two groups according to whether there was recurrence during the 2-year postoperative follow-up period.Among them,there were 34 cases in the recurrence group and 203 cases in the non-recurrence group.Using binary Logistic regression analysis to identify risk factors for postoperative recurrence of liver and bile duct stones,and constructing a predictive model based on the results of binary Logistic regression.Using ROC curve analysis to evaluate the diagnostic efficacy of the predictive model,and verifying its validity.Results Univariate analysis showed that age,BMI,course of disease,gender,common bile duct exploration,cholecystectomy,hypertension,diabetes,hepatitis and cirrhosis,smoking,drinking history in the recurrence group were not statistically significant compared with those in the non recurrence group (P>0.05),while the size of stones in the liver,diameter of common bile duct,number of stones,biliary inflammation,biliary stricture,diverticulum near the nipple,residual stones,hypercholesterolemia in the recurrence group were statistically significant compared with those in the non recurrence group (P<0.05).Logistic multiple regression analysis showed that intrahepatic stone size ≥ 10mm,number of stones>1,biliary inflammation,biliary stricture,and diverticulum adjacent to the nipple were risk factors for postoperative recurrence of hepatobiliary stones [OR values (95%CI) were 5.032 (1.812-13.977),2.585 (1.007-6.632),2.512 (1.013-6.230),4.571 (1.775-11.72),2.925 (1.023-8.363),P<0.05].Based on the risk factors,a prediction model was constructed.The Hosmer-Lemeshow fitting test showed that χ²=3.506,P=0.743.Receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve (AUC) of the prediction model for recurrence after hepatobiliary calculi surgery was 0.828,the Youden index was 0.489,and the sensitivity and specificity were 76.5% and 72.4%,respectively.95%CI was (0.756,0.906).The accuracy was 88.2%.Conclusion The risk prediction model for postoperative recurrence of liver and gallbladder stones constructed in this study has certain predictive value.

Objective To retrospective analysis summarized the effectiveness and safety of the “triple” conversion therapy regimen combining immune,targeted and local therapy.Methods From February 2019 to June 2023,52 patients with advanced liver cancer from February 2019 to June 2023 in XI,an Jiao Tong university medicine college affiliated 3201 hospital were admitted and received conversion treatment regimens combining sintilimab with bevacizumab and combined with local treatment,analyzed the surgical resection rate and pathological complete response rate (pCR),complete response rate (CR),partial response rate (PR),progression of disease (PD),stable disease (SD),objective response rate (ORR) and disease control rate(DCR).To evaluated the effect of conversion therapy and adverse reactions.Results 21 cases had recived operative resection in the 52 patients with primary liver cancer receiving sintilimab and bevacizumab.The postoperative resection rate was 40.4% (21/52),pCR 42.9% (9/21).The other 31 cases have complete response 5.8%(3/52),PR 25.0%(13/52),PD 11.5%(6/52),SD 17.3%(9/52).The overall objective response rate (ORR) was71.2% (37/52),and the disease control rate (DCR) was 88.5% (46/52).Adverse reactions manifest as Grade 1-2 skin-related damage primarily affecting the epidermis.Conclusion For patients with potentially resectable primary liver cancer in middle and advanced stage,the “triple” conversion therapy with sintilimab combined with bevacizumab as systematic treatment and combined with local therapy can achieve good conversion treatment effect with controllable safety.

Objective To investigate the glucose and lipid metabolism,Mayo adhesion probability (MAP) score and perirenal function in patients with laparoscopic partial nephrectomy The relationship between fat adhesion and prognosis.Methods A total of 84 patients who underwent laparoscopic resection in our hospital from December 2019 to December 2022 were retrospectively selected as the research subjects.According to whether perirenal fatty adhesion (APF) occurred during the operation,the patients were divided into APF group (44 cases) and non-APF group (40 cases).The results of 1-year follow-up were divided into good prognosis group (68 cases) and poor prognosis group (16 cases) The patient’s gender,age,body mass index (BMI),fasting blood glucose (FPG),serum triglyceride (TG),high-density lipoprotein cholesterol (HDL-C) and MAP score were recorded before surgery.All patients underwent laparoscopic partial nephrectomy,and the receiver operating curve (ROC) was used to analyze the evaluation value of glucose and lipid metabolism and MAP score for APF.Multivariate Logistic regression was used to analyze the influencing factors of LPN.Results There were statistically significant differences in gender,age,BMI,APF,FPG,TG,HDL-C and MAP scores between the APF group and the non-APF group (P<0.05);ROC curve analysis showed that FPG,TG,HDL-C and MAP Scoring APF has certain evaluation value,and the overall performance of the combined evaluation of the four was better.There were significant differences in gender,age,BMI,FPG,TG,HDL-C and MAP scores between the good prognosis group and the poor prognosis group (P<0.05).Multivariate Logistic regression analysis showed that FPG,TG,HDL-C and MAP scores,APF were all risk factors for ineffective LPN surgery.Conclusion FPG,TG,HDL-C and MAP scores have a certain value for APF evaluation,with high sensitivity and specificity,and the overall efficiency of the combined evaluation is better.FPG,TG,HDL-C and MAP scores were all risk factors for ineffective LPN surgery.

Objective To compare the clinical effects of posterior suprapubic median incision approach and anterior hernia incision approach in the treatment of adult incarcerated inguinal hernia.Methods From 2019 to 2024,94 adult patients with inguinal hernia who underwent emergency surgery were divided into two groups according to the surgical approach.There were 47 cases in the observation group,and the approach was adopted after the suprapubic median incision.In the control group of 47 cases,the traditional anterior approach of hernia incision was adopted.The basic data,surgery-related indexes and surgery-related complication indexes of the two groups were compared.Results Compared with the control group,the resetting time of incarcerated organs in the observation group was shorter (P＜0.05),the incidence of incision complications and the rate of unplanned reoperation were lower than those in the control group,and the differences were statistically significant(both P＜0.05).The operation time,operation completion,intestinal complications and postoperative testicular atrophy rate in the study group were similar to those in the control group,with no statistical significance (P>0.05).Conclusion The use of posterior suprapubic median incision for emergency inguinal hernia surgery in adults has the advantages of fast resetting of incarcerated organs,fewer incision complications,and low rate of unplanned second operation.

Objective To investigate the effects of Esketamine (S-KET) on the proliferation,migration,invasion,and Wnt/β-catenin signaling pathway of liver cancer cells.Methods Hep G2 liver cancer cells were separated into Control group,low,medium,and high concentration treatment groups (S-KET-L,S-KET-M,S-KET-H groups),and high concentration treatment group (S-KET-H+LiCl group);Edu was applied to detect cell proliferation;scratch experiment was applied to detect cell migration;Transwell experiment was applied to detect cell invasion.Western blot was applied to detect the expression of nuclear proliferation antigen markers (Ki-67),Cyclin D1,matrix metalloproteinase 2 (MMP-2),matrix metalloproteinase 9 (MMP-9),Wnt1,and β-catenin proteins;nude mouse transplanted tumor was applied to detect the effect of Esketamine on the growth of liver cancer transplanted tumors;immunohistochemistry was applied to detect the expression of Wnt1 and β-catenin proteins.Results Compared with the Control group,the Edu positive rate,Ki-67,Cyclin D1,scratch healing rate,number of cell invasions,the expression of MMP-2,MMP-9,Wnt1,and β-catenin proteins in Hep G2 cells in the S-KET-L,S-KET-M,and S-KET-H groups were obviously reduced (P<0.05);compared with the S-KET-H group,the Edu positive rate,Ki-67,Cyclin D1,scratch healing rate,number of cell invasions,the expression of MMP-2,MMP-9,Wnt1,and β-catenin proteins in Hep G2 cells in Hep G2 cells in the S-KET-H+LiCl group were significantly increased (P<0.05);the results of nude mouse tumor transplantation experiment showed that compared with the Control group,the S-KET group mice showed slow tumor growth,reduced tumor mass and volume,and significantly reduced expression of Wnt1 and β-catenin proteins (P<0.05).Conclusion Esketamine can inhibit the proliferation,migration,and invasion of liver cancer cells by inhibiting the Wnt/β-catenin signaling pathway.

Developmental dysplasia of the hip (DDH) is a common orthopedic disorder characterized by insufficient acetabular development and inadequate coverage of the femoral head,leading to joint instability,chronic pain,and early osteoarthritis,which severely impacts patients’ quality of life.Traditional diagnostic and treatment methods rely on imaging and clinical experience,and are limited by high subjectivity,inadequate individualized therapy,and delayed postoperative rehabilitation monitoring.In recent years,artificial intelligence (AI) has made breakthroughs in medical image processing,machine learning,and robot-assisted surgery.By leveraging deep learning,AI enables automatic segmentation and quantitative analysis of multimodal images,effectively enhancing diagnostic accuracy and the scientific basis for treatment decision-making.Meanwhile,3D reconstruction,virtual surgical simulation,and remote rehabilitation monitoring provide robust support for surgical planning and dynamic management.This review summarizes the progress and challenges of applying AI in the diagnosis,treatment decision-making,surgical planning,and rehabilitation management of DDH,and outlines future directions for technological innovation and clinical practice optimization.

Severe acute pancreatitis (SAP) is one of the common surgical acute abdomen conditions,often accompanied by systemic or local complications.It is characterized by rapid onset,fast progression,and severe condition.Early detection and early treatment remain important ways to reduce the mortality rate of SAP.In clinical practice,personalized early intervention treatments tailored to patients with different etiologies and symptoms can achieve certain therapeutic effects in controlling the disease.With the updating of treatment concepts and techniques,minimally invasive surgery has replaced traditional open surgery and is widely applied in SAP,bringing about breakthrough changes in surgical methods.There are certain differences in the application of different surgical procedures in SAP.

Inguinal hernia is a common general surgical non-oncological condition,with more than 20 million inguinal hernia surgeries performed annually worldwide.Surgery is the only treatment for inguinal hernias in adults due to the lack of spontaneous healing and ineffective pharmacological treatment,as well as the risk of life-threatening intestinal necrosis due to herniorrhaphy.The incidence of inguinal hernia is on the rise,and there may be an association between its pathogenesis and the mechanism of sarcopenia,as well as the adverse effects of sarcopenia on various postoperative conditions.This paper aims to investigate the relationship between the recognition,diagnosis,treatment,pathogenesis,early postoperative clinical recovery and recurrence of sarcopenia in patients with inguinal hernia.