China is among the countries with a high incidence of cholangiocarcinoma (CCA),and its incidence has been increasing annually.CCA arising at different anatomical sites presents distinct clinical features and requires differentiated diagnostic and therapeutic approaches.In 2015,the Chinese Chapter of the International Hepato-Pancreato-Biliary Association and the Hepatic Surgery Group of Surgical Branch of Chinese Medical Association jointly developed the "Diagnosis and treatment of cholangiocarcinoma:surgical expert consensus".Over the past decade,substantial progress has been made in the diagnosis and management of CCA.To better guide clinicians in addressing the challenges of CCA,the Chinese Chapter of the International Hepato-Pancreato-Biliary Association and the Hepatic Surgery Group of Surgical Branch of Chinese Medical Association convened a multidisciplinary committee of experts to revise and update the 2015 consensus,resulting in the present guideline.

Objective To explore the risk factors and possible preventive measures of delayed postoperative intestinal paralysis (PPOI) in elderly (aged ≥75 years) patients with colorectal cancer.Methods This retrospective study included 333 patients with CRC who underwent laporascopic resection in General Department of Beijing Chaoyang Hospital from June 2016 to August 2023.There were 126 patients were enrolled in PPOI group and 207 patients were enrolled in non-PPOI group.The perioperative clinical characteristics of the patients were compared between PPOI group and non-PPOI group,and the risk factors of PPOI and potential preventive measures for them were investigated using-Logistic-regression.Results The incidence of PPOI after laparoscopic surgery in elderly patients with colorectal cancer was 37.84%. The ages of the PPOI group and the non-PPOI group were (82.60±3.587) years and (80.38±3.847) years respectively. The rates of primary enterostomy during the operation were 20.63% and 9.66%,respectively, and the preoperative combined nutritional risks were 53.97% and 20.77%,respectively.The preoperative serum albumin levels were lower, which were (35.32±3.77) g/L and (38.36±3.91) g/L,respectively, and the preoperative hemoglobin levels were (104.47±20.31) g/L and (110.33 ±20.27) g/L,respectively. The intraoperative blood loss was (140.48±130.65) ml and (98.26±56.45) ml,respectively. The patients who received enhanced recovery after surgery (ERAS) measures during the perioperative period were 14.29% and 75.85%,respectively. There was a statistically significant difference between the two groups (P<0.05).The Logistic analysis showed that the risk factors for elderly patients with PPOI including increased age ,preoperative nutritional risk ,low preoperative albumin ,increased intraoperative blood loss.Moreover,the implementation of ERAS protocols  including preoperative nutritional support ,multimodal low-opioid anesthesia,gastric tube removal  and ground activity  early after surgery may be the protective factors of PPOI.Conclusion The risk factors of PPOI for colorectal patients older than 75 years including increased age,preoperative nutritional risk,low preoperative albumin,increased intraoperative blood loss.The ERAS protocols including preoperative nutritional support,multimodal low-opioid anesthesia,gastric tube removal and ground activity early after surgery may be useful to prevent the occurrence of PPOI for elderly patients with colorectal cancer.

Hepatectomy has become the most important treatment method for hepatobiliary diseases.The perioperative management of hepatectomy is closely related to its safety and efficacy.Perioperative management includes systematic evaluation and management of the patient′s condition before,during,and after surgery,and its principles and methods have developed rapidly in recent years.In 2017,the Group of Liver Surgery of Surgical Society of Chinese Medical Association released the "Expert Consensus on Perioperative Management of Hepatectomy".On this basis,the editorial committee has reviewed existing evidence-based medicine research evidence,combined with the latest clinical practice experience of numerous liver surgery centers at home and abroad,organized a multidisciplinary expert team in relevant fields in China for discussion,and revised to formulate the guideline.This guideline covers a systematic assessment,treatment principles,and methods for relevant conditions before,during,and after hepatectomy,and provides specific recommendations.The revision of the guidelines aims to promote the standardization and refinement of clinical practice in this field,improve the safety and clinical efficacy of liver resection,and provide guidance and reference for clinical professionals related to liver surgery.

Objective To investigate the effect of pectointercostal fascial block（PIFB)PECSⅡ block-general anesthesia on hemodynamics and stress response in patients undergoing modified radical mastectomy for breast cancer.Methods A total of 95 patients with breast cancer who underwent modified radical mastectomy in the hospital from November 2021 to November 2023 were enrolled in this study.They were divided into the control group (n=46) and the observation group (n=49) according to the anesthesia mode.The control group received PECS Ⅱ block general anesthesia and the observation group received PIFB-PECS Ⅱ block-general anesthesia.The dosage of remifentanil,the dosage of cisatracurium,recovery time,tracheal extubation time,postoperative analgesia pump compression times,VAS scores,hemodynamics (HR,MAP),oxidative stress response (SOD,CAT,MDA),and hyperthermia were compared between the two groups Susceptibility to MMSE score and adverse reactions.Results The dosage of remifentanil,dosage of cisatracurium,effective pressing times of analgesia pump within 48 h,wake-up time,tracheal extubation time and time to postoperative first pressing in the observation group were lower and shorter than those in the control group (P<0.05).The observation group had lower VAS scores than the control group after surgery (P<0.05).The HR of after anesthesia induction (T1),at tracheal intubation (T2),at the beginning of surgery (T3) and at the end of surgery (T4) in the observation group was (78.45±6.12) times /min,(100.28±11.54) times /min,(103.90±14.82) times /min and (93.66±9.17) times /min,respectively,which were lower than the control group [(84.66±7.04) times /min,(112.33±13.28) times /min,(122.44±17.06) times /min and (106.26±11.03) times /min,respectively].MAP of T1,T2,T3 and T4 in the observation group were (67.73±4.09) mmHg,(75.22±9.51) mmHg,(90.76±10.77) mmHg and (82.50±8.63) mmHg,respectively,the control groups were (70.10±5.66) mmHg, (82.62±10.17) mmHg, (96.43±12.59) mmHg and (90.82±11.04) mmHg,respectively.There was a statistically significant difference between the two groups (P<0.05). The levels of SOD, CAT and MDA in both groups at 24 hours and 72 hours after the operation were all higher than those before the operation (P<0.05).The SOD levels in the observation group were (83.22±15.44) nU/ml and (77.41±10.39) nU/ml at 24h and 72h after operation.It was lower than that of the control group, which was (90.40±18.23) nU/ml and (82.80±13.18) nU/ml.The CAT scores of observation group were (16.20±5.03) kU/L and (14.12±3.27) kU/L at 24h and 72h after operation,which were lower than those of control group [(20.75±6.57) kU/L and (17.06±4.35) kU/L].The MDA levels in the observation group were (5.12±1.33) mmol/L and (3.23±0.76) mmol/L at 24h and 72h after surgery,which were lower than those in the control group [(6.03±2.24) mmol/L and (4.88±1.05) mmol/L],and the differences were statistically significant (all P<0.05).The MMSE scores of the observation group were (28.01±1.35) and (28.46±1.39),which were higher than those of the control group [(26.44±1.08) and (27.36±1.23)] (P<0.05).Conclusion Applying PIFB-PECS Ⅱ block-general anesthesia in modified radical mastectomy for breast cancer can maintain hemodynamic stability,reduce oxidative stress and alleviate the damage to cognitive function,with high safety.

Objective To explore the influencing factors of urinary dysfunction in patients with rectal cancer after laparoscopic surgery,and to construct and validate a column chart prediction model.Methods A retrospective analysis was conducted on the clinical data of 415 rectal cancer patients in our hospital from January 2021 to April 2024.According to the computer-generated allocation order,they were stochastically grouped into a modeling group of 311 cases and a validation group of 104 cases in a 3∶1 ratio.The modeling group was further separated into a urinary dysfunction group of 55 cases and a non urinary dysfunction group of 256 cases.The patient's sex, diabetes history, tumor diameter and other relevant data were collected; Multivariate-Logistic-regression analysis was used to screen for risk factors; R software was used to construct a column chart prediction model for predicting urinary dysfunction in patients with colorectal cancer after laparoscopic surgery; The Hosmer-Lemeshow test, ROC curve, calibration curve, and DCA curve were used to validate the predictive performance of the column chart model.Results Male [OR (95% CI)=3.512 (1.637~7.533), P=0.001], diabetes [OR (95% CI)=3.684 (1.639~8.280), P=0.002], tumor diameter ≥ 5 cm [OR (95% CI)=4.459 (1.993~9.979), P=0.000], large intraoperative bleeding [OR (95% CI)=1.018 (1.011~1.026), P=0.000], anterior resection of rectum combined with abdominal perineum resection [OR (95% CI)=3.885 (1.901~7.940), P=0.000] were Independent risk factors for postoperative urination dysfunction in rectal cancer patients after laparoscopic surgery.In internal and external validations,the Hosmer-Lemeshau test for the column chart model showed χ2=0.159,P=0.254>0.05,and χ2=5.991,P=0.648>0.05.The areas under the receiver operating characteristic curve were 0.846 and 0.828,respectively.The calibration curve indicated that the simulated curve had a similar trend to the actual curve,indicating good discrimination and calibration of the column chart prediction model.Clinical decision curve analysis results showed that when the high-risk threshold probability was between 0.05 and 0.98,the column chart prediction model could produce better clinical benefits.Conclusion The column chart model constructed by integrating independent risk factors for urinary dysfunction in rectal cancer patients after laparoscopic surgery has high predictive value.

Objective To investigate the clinical effect of hemorrhoidal artery ligation combined with ultrasonic knife resection,suture,ligature and suspension in the treatment of mixed hemorrhoids with annular prolapse.Methods A retrospective analysis was conducted to select 80 patients with annular prolapse mixed hemorrhoids admitted to the anorectal Department of our hospital from January 2022 to April 2023.According to different treatment plans,they were divided into control group(n=40 cases) who received external stripping and internal ligation combined with tape ligation,and study group(n=40 cases) who received hemorrhoidal artery ligation combined with ultrasonic knife resection,suture,ligation and suspension.The operative effect,operative status,postoperative anal pain,anal edema,stool blood score and quality of life were evaluated.Results The effective rate of the study group was 97.50%,which was higher than that of the control group(77.50%)(P＜0.05).The operation time, intraoperative blood loss, hospital stay and wound healing time of the research group were (25.03±10.00) minutes, (10.00±5.32)ml, (7.25±1.54) days and (12.21±2.00) days respectively. [is better than that of control group (29.85±14.00) minutes, ml (17.85±10.25), (11.87±2.35), (18.89±4.85) days], two groups of comparison, the difference was statistically significant (P< 0.05 ).The VAS scores of anal pain in the study group on 1 day, 3 days and 7 days after the operation were (4.25±0.85) points, (2.89±0.54) points and (2.00±0.30) points,respectively.The scores of perianal edema were (1.87±0.36) points, (1.41±0.30) points, and (1.00±0.20) points,respectively.The hematochezia scores were (1.85±0.21) points, (1.34±0.18) points, and (0.85±0.13) points,respectively.Which were better than that of control group [(7.56±1.10), (6.54±1.03), (4.87±1.00)] [(2.40±0.58), (2.03±0.49), (1.87±0.45)] [(2.45±0.55), (2.03±0.47),(1.88±0.25)], and the differences were statistically significant (P < 0.05).The recurrence rate was 2.50% in the study group and 17.50% in the control group(P＜0.05).The scores of SF,MH,PF and GH of the Modified Health Survey Summary Form(SF-36) in the study group were(88.54±10.22,87.87±10.58,88.97±10.00,89.95±10.05) higher than those of the control group(67.52±10.00,70.10±11.25,71.10±9.85,70.00±10.00)(P＜0.05).Conclusion Hemorrhoidal artery ligation combined with ultrasonic knife resection,suture,ligature and suspension in the treatment of patients with annular prolapse mixed hemorrhoids has ideal surgical effect and little trauma,which is beneficial to promoting postoperative rehabilitation,alleviating anal pain,improving anal edema and hematostoecium,and improving quality of life.

Objective  To investigate the value of serum micro ribonucleic acid-335-5p (miR-335-5p) and endothelial cell-specific molecule-1 (ESM1) in the early diagnosis and prognosis of patients with esophageal cancer.Methods A total of 81 patients diagnosed with esophageal cancer by pathological examination were selected from April 2019 to April 2023 as the esophageal cancer group,and 81 healthy volunteers who underwent physical examination in our hospital were selected as the control group.Real-time quantitative polymerase chain reaction (qRT-PCR) was used to detect the levels of miR-335-5p and ESM1.According to the follow-up results,46 cases were grouped into the good prognosis group and 35 cases in the poor prognosis group.Pearson correlation analysis was used to analyze the relationship between serum miR-335-5p and ESM1 in patients with esophageal cancer.Receiver operating characteristic (ROC) curve was plotted to analyze the value of serum miR-335-5p and ESM1 levels in diagnosing esophageal cancer and the value in evaluating the prognosis of esophageal cancer patients.Results Compared with the control group,the serum level of miR-335-5p in the esophageal cancer group was greatly reduced,the level of ESM1 was greatly increased (P<0.05).MiR-335-5p had binding sites with ESM1.Pearson correlation analysis showed that serum miR-335-5p was negatively correlated with ESM1 level in patients with esophageal cancer (r=-0.538,P<0.001).Compared with the individual diagnosis,the AUC of the combination of serum levels of miR-335-5p and ESM1 in the diagnosis of esophageal cancer was greatly higher (ZmiR-335-5p~miR-335-5p+ESM1=2.625,P=0.009;ZESM1~miR-335-5p+ESM1=4.156,P<0.001).The levels of miR-335-5p and ESM1 were correlated with TNM stage,lymph node metastasis and differentiation (P<0.05).Compared with the good prognosis group,the serum level of miR-335-5p in the poor prognosis group was greatly reduced,and the ESM1 level was greatly increased (P<0.05).Compared with the individual diagnosis,the AUC of combination of serum miR-335-5p and ESM1 levels in the prognostic assessment of esophageal cancer patients was greatly higher (ZmiR-335-5p~miR-335-5p+ESM1=2.128,P=0.033;ZESM1~miR-335-5p+ESM1=2.440,P=0.015).Conclusion MiR-335-5p is low expressed and ESM1 is highly expressed in the serum of esophageal cancer patients,they have certain clinical value for early diagnosis and prognostic evaluation of esophageal cancer patients.

Non-small cell lung cancer(NSCLC) is the leading cause of cancer-related mortality worldwide,with approximately 30% of patients initially presenting at stage Ⅱ-Ⅲ and thus potentially eligible for surgical resection.However,surgery alone is insufficient to control postoperative recurrence and distant metastasis effectively.Therefore,neoadjuvant treatment has gradually become a critical approach to improving patient prognosis.Conventional neoadjuvant chemotherapy has historically shown limited pathological complete response(pCR) rates,while neoadjuvant targeted therapy,despite enhancing objective response rates(ORR),still results in relatively low pCR.Recently,neoadjuvant immunotherapy combined with chemotherapy has demonstrated groundbreaking progress.Several large-scale international and domestic clinical trials have reported that this combination strategy significantly increases pCR rates to between 17% and 41% and notably prolongs event-free survival.However,neoadjuvant immunotherapy also introduces new surgical challenges,including increased intraoperative difficulty due to tissue fibrosis,expanded surgical resections resulting from inadequate preoperative prediction,and emerging concerns surrounding the perioperative management of immune-related adverse events(irAEs).Recent advancements in artificial intelligence(AI)-assisted imaging models,multi-omics integration,and dynamic ctDNA monitoring offer novel perspectives and tools for accurately predicting pathological responses preoperatively.Furthermore,intensive studies on mechanisms underlying immunotherapy resistance,such as exosomal PD-L1 regulatory pathways and oxidative stress pathways,alongside emerging strategies involving bispecific antibodies and metabolic interventions,provide theoretical foundations for further optimizing therapeutic approaches.Looking forward,the development of precise preoperative efficacy prediction systems,deep integration of AI technology,and the expansion of multi-modal combination strategies will represent primary directions in the evolution of neoadjuvant immunotherapy for NSCLC.

Hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) have a short survival time and an extremely poor prognosis,with more than half of all HCC cases complicated by PVTT.In the past,various local therapies or direct surgical strategies were often adopted for HCC patients with PVTT,but ideal outcomes were difficult to achieve.Currently,there is a general consensus on the efficacy and safety of immune checkpoint inhibitors combined with tyrosine kinase inhibitors as a conversion therapy regimen for advanced HCC.Our team has explored and developed a sequential surgical treatment protocol combining immune targeting and conversion.We believe that compared to existing treatment approaches,this strategy significantly prolongs the overall survival of HCC patients with PVTT and has the potential to become a new treatment paradigm.This article details the efficacy of the sequential surgical treatment protocol combining immune targeting and conversion for HCC patients with PVTT,as well as key surgical considerations,with the aim of sharing relevant experience.

Hepatic arterial infusion chemotherapy(HAIC) is a therapeutic strategy that delivers chemotherapy drugs directly to the liver through the hepatic arterial system,which enriches the concentration of the drug in the liver to 400 times of the systemic intravenous administration.It has the significant advantage of maximizing the concentration of liver local chemotherapy drugs,while reducing systemic side effects.HAIC plus intravenous chemotherapy has shown promising results in conversion to resection and survival rate for metastatic liver cancer,especially for initially unresectable colorectal liver metastasis.The primary tumor and liver metastasis can be simultaneously addressed by combined transcatheter arterial infusion chemotherapy with chemoembolization,which can rapidly reduce tumor burden,ameliorate clinical symptoms of gastrointestinal hemorrhage and incomplete intestinal obstruction.To date,though,there is no consensus on the definitive indication,medication regimen and multi-method combination therapy.This article discusses the basic principle,technical methods,clinical application and current research progress of HAIC.

Objective To investigate the application effect of the anterolateral thigh perforator flap (ALTPF) with end-to-side anastomosis of non-primary source vessels in repairing soft tissue defects in the hands and feet.Methods Ninety-six patients with soft tissue defects in the hands and feet of the Third People's Hospital of Xinjiang Uygur Autonomous Region from March 2021 to June 2023 were randomly divided into two groups using a random number table method,with 48 cases in each group.The control group was treated with a conventional subcutaneous artery perforator flap,while the observation group was treated with an end-to-side anastomosis of non-primary source vessels using an ALTF.The repair indicators of tissue defects,the recovery of sensory function,the recovery of hand and foot function,and the incidence of complications were compared between the two groups at 1 month and 3 months after surgery.Results The wound healing time in the observation group and the control group was (19.35±3.89) days and (23.72±4.76) days,respectively,with a statistically significant difference (P<0.05).There was no significant difference in the preparation time,survival rate,and stage I healing rate of the two groups of skin flaps (P>0.05).At 1 month and 3 months after surgery,the proportions of patients with pain sensation in the observation group and control group were 70.83% and 50.00%,respectively,and 100.00% and 79.17%,respectively.The proportions of patients with cold and hot sensation were 66.67% and 45.83%,respectively,and 97.92% and 72.92%,respectively.The distance of two-point discrimination was (30.69±6.10) mm and (34.40±7.36) mm,respectively,and (15.23±3.72) mm and (22.36±5.28) mm,respectively,with a statistically significant difference (P<0.05).There was no significant difference in the excellent and good rate of hand and foot function between the two groups 3 months after surgery (P>0.05).The incidence of complications in the observation group was 4.17%,which was lower than that in the control group (22.91%),and the difference was statistically significant (P<0.05).Conclusion ALTPF repair of soft tissue defects in the hands and feet with end-to-side anastomosis of non-primary source vessels can improve wound healing rates,improve sensory function,and reduce the incidence of complications.

Objective To observe the efficacy and safety of 3D video-assisted thoracoscopic segmentectomy in patients with stage Ⅰ lung cancer treated with indocyanine green (ICG) fluorescence reverse-staining.Methods A total of 132 patients with stage Ⅰ lung cancer who were admitted from May 2022 to September 2024 all underwent three-dimensional video-assisted thoracoscopic segmental resection of the lung. They were divided into the observation group (63 cases) and the control group (69 cases) according to the method of intersegmental plane exposure. The control group was treated with the modified expansion and collapse method, while the observation group was treated with the ICG fluorescence backstaining method. The surgical conditions, pulmonary function, postoperative pain degree, quality of life and complications of the two groups were compared. Results The postoperative chest tube retention time, surgical time, postoperative hospitalization time, total postoperative thoracic drainage volume,and inter-segmental plane exposure time in the observation group were as follows(2.13±0.37) d，(145.12±25.26) min，(5.21±0.95) d，(261.41±28.57) ml and (9.15±1.73) s,respectively.The data of the control groups were (3.29±0.48) d,(178.31±30.45) min,(6.34±1.36) d,(352.03±36.74) ml and (1 651.28±179.84) s,respectively.There was a statistically significant difference between the two groups (P<0.05). There was no statistically significant difference in the number of intraoperative blood loss and intraoperative lymph node dissections between the two groups (P>0.05).There was no statistically significant difference in the levels of maximal expiratory flow (PEF),forced expiratory volume in one second (FEV-1), and FEV-1/ forced vital capacity (FVC) between the two groups before the operation and one month after the operation (P>0.05).The Visual Analogue Scale (VAS) scores of the observation group at 12 hours, 48 hours and 72 hours after the operation were (3.25±0.46) points, (2.13±0.35) points and (1.02±0.24) points respectively. The control groups were (4.11±0.59) points, (2.98±0.42) points, and (1.73±0.30) points,respectively. There was a statistically significant difference between the two groups (P<0.05). There was no statistically significant difference in the scores of negative and positive items between the two groups before the operation and one month after the operation (P>0.05). There was no statistically significant difference in the total incidence of complications between the two groups (P>0.05).Conclusion The modified dilatation collapse method and ICG fluorescence reverse staining method have no significant effects on lung function and complications in patients with stage Ⅰ lung cancer,and both can improve the quality of life.Compared with the modified dilatation collapse method,ICG fluorescence reverse staining method can shorten the plane exposure time between segments and the operation time,promote postoperative rehabilitation and alleviate postoperative pain.

Pediatric chronic subdural effusion (PCE) is a prevalent neurosurgical condition in children,particularly among infants and young children.Classified into traumatic,infectious,and idiopathic types,it manifests clinically from asymptomatic to varying degrees of intracranial hypertension and neurological deficits.This systematic review examines diagnostic approaches,therapeutic strategies,and prognosis assessment for PCE,with particular focus on comparing conservative management versus surgical interventions (including burr hole drainage,subdural-abdominal shunt,and craniotomy) in terms of indications,technical nuances,and efficacy.Emerging modalities such as immunotherapy are also explored.

Objective To explore the influencing factors of postoperative defecation dysfunction in children with anorectal malformations(ARM),and to construct a risk prediction model of postoperative defecation dysfunction after ARM.Methods 150 cases ARM children who underwent surgery in our department of general surgery between March 2021 and April 2024 were enrolled.The children were divided into the training set (120 cases) and the internal validation set (30 cases) at a ratio of 8∶2 by the retention method..Children in the training set were collected and divided into obstacle groups (n=36,children with postoperative defecation dysfunction) and barrier-free group (n=84) according to whether postoperative defecation dysfunction occurred.The demographic data,clinical characteristics,surgical approaches,pelvic-floor muscle strength,and other variables were collected.influencingfactors were identified by univariate and multivariate logistic regression analyses.A nomogram was developed with R software.The discrimination (C-index),calibration curves,and decision-curve analysis were assessed in both the internal and external validation sets.Results The incidence of postoperative defecation dysfunction was 30.00 % (36/120) in the training set,33.33% (10/30) in the internal validation set,and 32.00 % (16/50) in the external validation set.There was no significant difference in 3 sets (χ2=0.261,P=0.877).In the training set,variables showing significant differences between the dysfunction and non-dysfunction groups were preterm birth,hypoglycaemia,irregular diet,artificial feeding,associated congenital anomalies,cardiac malformations,poor defecation habits,lower-extremity manual muscle testing(MMT) grade 3,lower-extremity MMT grade 5,Oxford pelvic-floor muscle grade 4,Oxford pelvic-floor muscle grade 5 and bowel function score(BFS)＜17.Stepwise Logistic regression revealed that BFS score < 17,preterm birth,Oxford pelvic-floor muscle grade,hypoglycaemia,cardiac malformations and poor defecation habits were independent predictors of postoperative defecation dysfunction (P＜0.05).The Oxford pelvic-floor muscle grade was a protective factor.In the training set,the area under the curve (AUC) was 0.69(0.60~0.77),accuracy 0.62(0.52~0.72),sensitivity 0.86(0.75~0.97),specificity 0.91(0.84~0.99) and a cutoff value of 0.223.AUC of the validation set 0.70(0.61~0.78),accuracy 0.62(0.52~0.72),sensitivity 0.89(0.79~0.99),specificity 0.93(0.86~0.99).Both the internal and external validation sets confirmed good predictive performance and stability of the model.Conclusion The risk prediction model,incorporating BFS＜17points,preterm birth,Oxford pelvic-floor muscle grade,hypoglycaemia,cardiac malformations,and poor defecation habits,accurately predicts the risk of postoperative defecation dysfunction in children with ARM and has been internally and externally validated.

Objective  To explore the factors associated with complete resolution of sentinel lymph node metastasis (pCR) after neoadjuvant chemotherapy in breast cancer and to establish a predictive model.Methods The medical records of 136 female patients with breast cancer who received neoadjuvant chemotherapy in the First Hospital of Lanzhou University from January 2022 to February 2024 were retrospectively analyzed.According to the 80/20 rule,the patients were randomly divided into a training set (108 cases) and a validation set (28 cases).Based on the pathological examination results of axillary lymph node dissection (ALND) after neoadjuvant chemotherapy in breast cancer patients,they were classified into the sentinel lymph node pCR group and non-pCR group.Multivariate logistic regression analysis was used to screen the independent risk factors of sentinel lymph nodes failing to reach pCR.Build a nomogram prediction model based on the screened risk factors.By drawing the receiver operating characteristic(ROC) curve calculation curve, the area under ROC curve, sensitivity and specificity are used to evaluate the discrimination of the model.Results Among the 108 breast cancer patients,46 cases achieved pCR in the sentinel lymph nodes,accounting for 42.59% (46 cases/108 cases).In addition,33 cases (30.56%) achieved pCR in the primary tumor lesion.The non-pCR group showed a higher proportion of stage Ⅲ clinical staging,lymph node short-axis reduction of less than 50% before and after treatment,tumor maximum diameter reduction of less than 50% before and after treatment,lymph node type Ⅲ classification,and blood flow grade Ⅲ compared to the pCR group (P<0.05).Multivariate logistic regression analysis showed that Clinical staging (OR=3.593,95%CI:1.276~10.121),lymph node short-axis reduction of less than 50% before and after treatment (OR=4.272,95%CI:1.517~12.032),tumor maximum diameter reduction of less than 50% before and after treatment (OR=3.710,95%CI:1.317~10.449),lymph node type (OR=3.827,95%CI:1.359~10.779),and blood flow grade (OR=4.764,95%CI:1.691~13.418) were identified as risk factors for not achieving pCR in the sentinel lymph nodes after neoadjuvant chemotherapy in breast cancer patients (P<0.05).The sensitivity of the risk model for predicting non-achievement of pCR in the sentinel lymph nodes after neoadjuvant chemotherapy in the training set of breast cancer patients was 0.826 (95%CI:0.705~0.943),with a specificity of 0.826 (95%CI:0.712~0.919) and an area under the ROC curve of 0.847 (95%CI:0.738~0.952).In the validation set,the sensitivity for predicting non~achievement of pCR in the sentinel lymph nodes after neoadjuvant chemotherapy in breast cancer patients was 0.731 (95%CI:0.608~0.904),with a specificity of 0.827 (95%CI:0.713~0.941) and an area under the ROC curve of 0.834 (95%CI:0.729~0.951).Conclusion Clinical staging,changes in lymph node short-axis before and after treatment,changes in tumor maximum diameter before and after treatment,lymph node type,and blood flow grade are associated with pCR in the sentinel lymph nodes after neoadjuvant chemotherapy in breast cancer patients.Constructing a predictive model can help evaluate the pCR status of sentinel lymph nodes after neoadjuvant chemotherapy.

Objective To investigate the predictive value of plasma four and a half LIM domains protein 2 (FHL2),pulmonary surfactant-associated glycoprotein A1 (SFTPA1),and solute carrier family 31 member 1 (SLC31A1) for diagnosis and prognosis of lung cancer.Methods From January 2018 to June 2022,96 lung cancer patients treated in our hospital were included as the lung cancer group.Another 108 patients with benign lung diseases and 120 healthy subjects who underwent physical examinations were regarded as the benign lesion group and control group,respectively.QRT-PCR was applied to detect the expression level of FHL2.ELISA was applied to detect SFTPA1 and SLC31A1 levels.ROC curve was applied to analyze the diagnostic value of FHL2,SFTPA1,and SLC31A1 for lung cancer.Kaplan-Meier method was applied for survival analysis.COX regression was applied to analyze the influencing factors of poor prognosis in lung cancer patients.Results The levels of FHL2 and SLC31A1 gradually decreased in the control group,benign lesion group,and lung cancer group,while the level of SFTPA1 gradually increased (P＜0.05).The Area Under the Curve (AUC) of the combined diagnosis of lung cancer by was 0.940,which was better than their individual diagnoses (all P＜0.05).The expression of FHL2,SFTPA1,and SLC31A1 was correlated with TNM staging,distant metastasis,and differentiation degree (P＜0.05).The 2 year cumulative survival rates of FHL2 and SLC31A1 high expression groups were 92.31% and 89.09%,respectively,which were higher than those of the low expression groups (63.64% and 65.85%).The 2 year cumulative survival rate of SFTPA1 high expression group was 67.39%,which was lower than that of the low expression group (90.00%) (both P＜0.05).TNM staging,distant metastasis,and levels of FHL2,SFTPA1,and SLC31A1 were influencing factors for mortality in lung cancer patients (P＜0.05).Conclusion The levels of FHL2 and SLC31A1 in the plasma of lung cancer patients are decreased,while SFTPA1 is increased.These three factors have certain value for diagnosis of lung cancer.Low expression of FHL2 and SLC31A1,and high expression of SFTPA1 are influencing factors for mortality of lung cancer patients.

Non-small cell lung cancer（NSCLC） remains the leading cause of cancer-related mortality globally. In recent years,the advent of molecular targeted therapies and immune checkpoint inhibition has profoundly reshaped the therapeutic landscape of NSCLC. As these advanced modalities shift from treating advanced-stage disease toward earlier-stage presentations,perioperative intervention (including neoadjuvant and adjuvant therapy) has risen to the forefront of NSCLC research. To comprehensively address the integration of targeted and immunotherapeutic strategies in the perioperative management of NSCLC research,this review synthesizes the core findings from landmark phase Ⅲ randomized controlled trials such as NeoADAURA and CheckMate 816. Additionally,it presents a succinct summary and analysis of the principal prognostic endpoints used to evaluate perioperative efficacy. Drawing on current evidence related to both efficacy and safety,the review advocates for an individualized precision-oncology approach as a pivotal direction for optimizing perioperative treatment strategies in NSCLC research.

Objective To explore the predictive value of D-dimer (D-D)/platelet count (PLT) ratio (DPR) for lower extremity deep vein thrombosis (DVT) after radical resection of colon cancer.Methods The clinical data of 366 cases who underwent radical resection of colon cancer in our hospital from January 2021 to December 2023 were selected and divided into DVT group (n=63) and non-DVT group (n=303) according to the presence or absence of lower extremity DVT after colon cancer surgery.The clinical data of all subjects were collected and the DPR at admission was calculated.The predictive value of DPR for lower extremity DVT after radical resection of colon cancer was evaluated by ROC.The influencing factors of lower extremity DVT after radical resection of colon cancer were explored by multivariate Logistic stepwise regression analysis.Results D-D and DPR in DVT group were higher than those in non-DVT group,PLT was lower than that in non-DVT group (P<0.05).ROC analysis showed that the AUC (95%CI) of D-D,PLT and DPR in predicting lower extremity DVT after radical resection of colon cancer were 0.811(0.762~0.853),0.723(0.675~0.770),0.919(0.872~0.969),respectively.Preoperative adjuvant chemotherapy,operation time > 3 h,postoperative continuous bed time > 2 d,and blood transfusion history were significantly higher in the DVT group than in the non-DVT group (P<0.05).Operation time > 3 h (OR=2.347,95%CI:1.424~3.868),history of blood transfusion (OR=1.937,95%CI:1.217~3.082),DPR≥0.60 (OR=4.707,95%CI:2.099~10.554) were risk factors for lower extremity DVT after radical resection of colon cancer (P<0.05).Conclusion DPR has significant predictive value in predicting the risk of lower extremity DVT after radical resection of colon cancer.It is an effective preoperative evaluation index.

Pediatric intracranial non-germinoma Tous germ cell tumors (NGGCTs) are a group of rare,highly heterogeneous malignant tumors,encompassing subtypes such as immature teratoma,embryonal carcinoma,yolk sac tumor,choriocarcinoma,and mixed germ cell tumors.The management of NGGCTs requires the integration of multidisciplinary approaches including surgery,chemotherapy,and radiotherapy;however,significant controversies persist regarding treatment sequence,surgical timing,and the selection of chemoradiotherapy regimens.Currently,most international mainstream strategies recommend platinum-based chemotherapy combined with postoperative radiotherapy.In contrast,Asian researchers have proposed an individualized surgery-prioritized strategy based on clinical practice,emphasizing that tumors containing teratomatous components or measuring ≤3 cm should undergo direct surgical resection.

Objective To investigate the expression of N-acetyltransferase 10 (NAT10),serine hydroxymethyltransferase 2 (SHMT2) and YTH domain family protein 1 (YTHDF1) in lung cancer tissues and their correlation with clinicopathological characteristics and prognosis. Methods A total of 98 lung cancer patients admitted to our hospital from April 2020 to April 2021 were regarded as the observation subjects.The cancerous tissues and adjacent tissues of the patient during surgery were collected.Immunohistochemistry was used to detect the expression levels of NAT10,SHMT2 and YTHDF1.The patients were followed up for 3 years and divided into the survival group and the death group according to their prognosis.The data of general clinicopathological characteristics were collected and analyzed.The relationship between NAT10,SHMT2 and YTHDF1 with the prognosis of patients were analyzed.Multivariate Cox- regression was used to analyze the influencing factors of lung cancer patients.Results The high expression ratios of NAT10,SHMT2 and YTHDF1 in cancer tissues were obviously higher than those in adjacent tissues (P<0.05).The expression of NAT10 and YTHDF1 was related to clinical stage,degree of differentiation and lymph node metastasis (P<0.05),and the expression of SHMT2 was correlated with clinical stage,degree of differentiation,tumor diameter,and lymph node metastasis (P<0.05).There were statistically significant differences in tumor diameter, clinical stage, degree of differentiation, lymph node metastasis, and expressions of NAT10, SHMT2, and YTHDF1 between the survival group and the death group (P<0.05). NAT10, SHMT2, YTHDF1 patient survival rates significantly below the low of high expression patients (χ2=6.354, P=0.012, χ 2 =8.512, P=0.004, χ2=4.791, P=0.029).Lymph node metastasis, high expression of NAT10, SHMT2 and YTHDF1 are all risk factors affecting the prognosis of patients (P < 0.05 ).Conclusion NAT10,SHMT2,and YTHDF1 are all highly expressed in the tissues of lung cancer,and have a certain correlation with clinical pathological characteristics and prognosis.They may serve as relevant evaluation indicators for the prognosis of lung cancer patients.

Objective To explore the advantages of high-frequency ultrasound-guided “cross-shaped” positioning method in accurate positioning and surgical effect in open reduction and internal fixation of rib fractures.Methods Retrospective analysis of 97 cases of multiple rib fractures treated surgically in our department from october 2019 to october 2024.Patients were divided into three groups based on different localization methods.The control group designed the surgical incision according to the results of chest three-dimensional reconstruction,the ultrasound group determined the incision based on the control group combined with high-frequency ultrasound,and Based on the method used in the ultrasound group,the “cross-localization” technique was combined to determine the incision in the cross-shaped group.The comparison of surgical-related data included fracture positioning accuracy,incision length of per singer rib,postoperative drainage volume,duration of drainage tube retention,postoperative pain score,operative time,intraoperative blood loss,length of hospital stay and incision infection rate.Additionally,commonly used inflammatory markers (white blood cell count,neutrophil percentage,CRP,IL-6,NF-κB) and pain-related biomarkers (PGE2,5-HT) were also included in the comparative analysis.Results In the control group,ultrasound group,and crossover group,aside from wound infections,the respective accuracies of fracture localization were 68.97% vs 87.50% vs 97.22%,the length of single rib incision was (3.50±1.23) cm vs (2.70±0.62) cm vs (2.45±0.58) cm,the volume of drainage on the day of surgery was (170.55±27.85) ml vs (150.69±24.67) ml vs (120.34±18.45) ml,the duration of drainage tube retention was (4.17±1.12) days vs (3.67±0.95) days vs (3.12±0.65) days,the postoperative pain scores were (6.86±2.15) vs (5.54±1.15) vs (4.89±1.53),the operation times were (75.84±15.62) minutes vs (67.74±11.85) minutes vs (57.35±9.36) minutes,the intraoperative blood loss was (85.78±11.78) ml vs (72.65±8.92) ml vs (62.23±9.63) ml,and the length of hospital stay was (8.42±1.47) days vs (7.12±1.14) days vs (6.56±1.32) days.The crossover group showed superior results in all metrics compared to the other two groups,with statistically significant differences (P<0.05).The inflammatory and pain stress indicators for the control,ultrasound,and crossover groups were as follows:white blood cell counts [(16.39±4.15)×109/L vs (13.25±2.45)×109/L vs (12.02±2.77)×109/L],neutrophil percentages [(80.14±12.21) vs (72.36±10.34) vs (65.73±8.83)],CRP [(31.86±6.87) mg/L vs (27.72±5.65) mg/L vs (24.69±4.11) mg/L],IL-6 [(46.35±11.42) pg/L vs (41.42±8.75) pg/L vs (35.53±9.51) pg/L],NF-B [(22.55±4.98) pg/L vs (17.34±3.62) pg/L vs (15.91±3.84) pg/L],PGE2 [(240.37±21.65) ng/L vs (209.45±23.24) ng/L vs (180.21±18.72) ng/L],and 5-HT [(290.62±34.37) ng/L vs (270.85±26.98) ng/L vs (210.62±19.64) ng/L].The crossover group demonstrated statistically significant differences compared to both the control and ultrasound groups (P<0.05).There was no statistically significant difference in incision infection among the three groups (P > 0.05).Conclusion The ultrasound-guided “cross” positioning method for rib fracture open reduction and internal fixation can more accurately locate the incision,shorten the incision length and hospitalization time,reduce postoperative inflammatory response and patient pain,and facilitate rapid recovery after surgery.

Objective  Traditional classification systems for skull base lesion surgeries fail to accurately reflect the differences in surgical difficulty.This study aims to establish and validate a multi-dimensional grading sclae for skull base tumor surgical difficulty,to guide clinical decision-making and resource optimization.Methods A total of 131 patients with skull base tumors who underwent surgery at West China Hospital of Sichuan University in 2018 were included in this study.Based on the selfdeveloped “grading scheme for surgical difficulty of skull base tumors” (encompassing nine dimensions such as involved regions,arteries,nerves,and tumor characteristics),patients were categorized into grades Ⅰ-Ⅳ.The baseline data,imaging features,surgical indicators and postoperative outcomes of each group were analyzed to verify the clinical applicability of the scale.Results The surgical difficulty increased progressively from grade Ⅰ to Ⅳ,with significant differences observed in core dimensions such as involved regions,arteries,and nerves (all P<0.05).As the difficulty level increased,the intraoperative blood transfusion rate (0→38.1%),operation time [(1.6±1.5)h →(7.3±4.2)h],hospital stay [(7.6±2.7)d→(15.9±15.2)d],and postoperative complication rates (15.5→52.4%) also increased significantly (all P<0.05).Conclusion This system enables quantitative evaluation-based surgical difficulty gradient classification,compensating for the limitations of the traditional classification system.It provides a scientific foundation for personalized surgical approach selection,DRG-based fine payment,physician training,and promotes the standardized development of the skull base subspecialty.

Constipation is a common functional gastrointestinal disorder with a global prevalence of approximately 10% to 20%.Its causes include functional disorders,organic diseases,and drug factors,with the majority being functional constipation.In recent years,driven by advancements in biomedicine,artificial intelligence (AI),and microbiome research,significant progress has been made in the diagnosis and treatment of constipation.This review systematically explores the latest developments in constipation treatment,including the role of the gut microbiota in constipation,the metabolic regulatory effects of short-chain fatty acids (SCFAs),the impact of mental factors on intestinal motility.Additionally,it discusses future development directions such as AI-assisted diagnosis,AI-based consultation systems,personalized microbiota transplantation,and minimally invasive neuromodulation,providing new insights for precision medicine in constipation.

Non-small cell lung cancer(NSCLC) continues to exhibit a high incidence and mortality worldwide,posing a serious threat to human health.In recent years,the rapid advancement of immunotherapy has profoundly reshaped the therapeutic paradigm for NSCLC,particularly by improving long-term outcomes in the perioperative period.However,with its increasingly widespread clinical use during this period,several critical issues have emerged,including the precise identification of patients most likely to benefit,optimization of therapeutic strategies,evaluation of pathological value,formulation of adjuvant therapy strategies for patients with complete pathological response after surgery,and the management of immune-related adverse events.This review will systematically discuss these key challenges and aims to provide insights that may facilitate the standardized application of perioperative immunotherapy in NSCLC.

Objective To construct and validate a multimodal imagebased prediction model for the efficacy of neoadjuvant chemotherapy in breast cancer.Methods  The 121 patients with breast cancer with ipsilateral axillary lymph node metastasis admitted to the hospital from January 2020 ~ April 2024 were reviewed.The patient underwent surgical resection after neoadjuvant chemotherapy and the pathological complete response (pCR) was counted.High-resolution MRI,breast ultrasound and mammography were performed before and after neoadjuvant chemotherapy.Logistic regression was used to analyze the influencing factors of the neoadjuvant chemotherapy effect in breast cancer patients,and a multimodal imaging based on multimodal imaging was constructed to predict the effect of neoadjuvant chemotherapy for breast cancer,and the model was verified and evaluated for efficacy.Results  Twenty-eight cases achieved pCR.Logistic regression analysis showed that tumor stage (OR=4.899,95%CI:2.016~11.909),△apparent diffusion coefficient (ADC) (OR=4.419,95%CI:1.818~10.741),and △ time to peak (TTP) (OR=3.644,95%CI:1.499~8.855) were the factors affecting the effect of neoadjuvant chemotherapy in breast cancer patients (P<0.05).The nomogram prediction model was established with the above influencing factors as predictors,and the risk rate ranged from 0.56~0.68.The results of nomogram model validation showed that the calibration curve for predicting the effect of neoadjuvant chemotherapy for breast cancer was close to the ideal curve (P>0.05).The ROC curve showed that the nomogram model had a sensitivity of 78.57%,a specificity of 83.87%,and an AUC of 0.851 (95%CI:0.767~0.927) in predicting the effect of neoadjuvant chemotherapy in breast cancer.Conclusion Tumor stage,△ADC and △TTP are closely related to the effect of neoadjuvant chemotherapy in breast cancer patients,and the prediction model of neoadjuvant chemotherapy effect based on multimodal imaging has good predictive performance.

Objective To explore the correlation between preoperative airway preparation and postoperative day 1 drainage volume in patients undergoing radical esophagectomy and the occurrence of postoperative pulmonary complications.Methods Analyzing the clinical data of esophageal cancer 147 patients who underwent thoracoscopic and laparoscopic radical surgery from January 2022 to June 2024,they were divided into PPCs group and non-PPCs group based on whether PPCs occurred postoperatively.Clinical data of the two groups were compared.Multivariate logistic regression analysis was applied to analyze the influencing factors for the occurrence of PPCs after radical resection of esophageal cancer,and a decision tree prediction model for postoperative PPCs was constructed.Receiver operating characteristic(ROC) curve was used to analyze the value of related factors in predicting the occurrence of PPCs after radical resection of esophageal cancer.Results Univariate analysis showed that age,albumin/fibrinogen ratio,neutrophil/lymphocyte ratio,preoperative respiratory preparation,and drainage volume on the first day after surgery were associated with the occurrence of PPCs after radical resection of esophageal cancer(P<0.05).Multivariate logistic regression analysis indicated that age,albumin/fibrinogen ratio and drainage volume on the first day after surgery were independent influencing factors for the occurrence of PPCs after radical resection of esophageal cancer(P<0.05).The decision tree model identified drainage volume on the first day after surgery,albumin/fibrinogen ratio,age and neutrophil/lymphocyte ratio as predictive factors.The incidence rate of PPCs in the group without preoperative respiratory preparation was significantly higher than that in the group with preoperative respiratory preparation (62.5% vs. 37.5%,P<0.05).A drainage volume of 246.59ml on the first day after surgery was the optimal cutoff value for predicting the occurrence of PPCs after radical resection of esophageal cancer,and specificity was 93.04%,sensitivity was 87.5%,area under ROC curve(AUC) was 0.958,95%CI was 0.911-0.984.Moreover,the incidence rate of PPCs in patients with a drainage volume≤246.59ml on the first day after surgery was significantly higher than that in patients with a drainage volume >246.59ml (77.78% vs.3.60%,P<0.01).Conclusion Preoperative airway preparation and postoperative drainage volume are closely related to the occurrence of postoperative pulmonary complications (PPCs) after thoracoscopic radical surgery for esophageal cancer.Therefore,targeted measures should be taken for airway preparation before surgery,and changes in the patient's condition should be closely monitored after surgery to accurately determine the timing of drainage tube removal,which plays an important role in effectively preventing and treating PPCs.

Surgical resection remains the primary option for achieving radical cure and long-term survival in the treatment of liver cancer.In recent years,profound changes have taken place in the field of liver surgery:the surgical concept of liver resection for liver cancer has been constantly updated;Significant progress has also been made in many aspects such as liver imaging technology,liver resection techniques and equipment,and perioperative management.Liver resection for liver cancer has gradually developed into a more precise,minimally invasive and safer treatment model.However,liver resection for liver cancer still faces many new challenges up to now:the prevention strategies for recurrence and metastasis are limited;There is a lack of predictive indicators for the efficacy of targeted immunotherapy.Insufficient precision in individualized treatment,etc.

Objective  To analyze the clinical effect of conservative treatment of 218 cases of simple epidural hematoma (SEDH) in children and establish the prediction model of hematoma absorption.Methods The clinical data of 218 children with SEDH who were treated conservatively in our hospital from August 2023 to March 2025 were analyzed retrospectively.According to the status of hematoma absorption after conservative treatment,the patients were divided into slow hematoma absorption group (n=82) and fast hematoma absorption group (n=136).The clinical data of children with slow hematoma absorption group and fast hematoma absorption group were compared.Logistic regression analysis was used to explore the risk factors of hematoma absorption in children with conservative treatment of SEDH.A nomogram model based on the prediction of hematoma absorption in children with SEDH treated conservatively was constructed and verified internally by Bootstrap method.To analyze the predictive efficacy of risk nomogram model for hematoma absorption in children with SEDH treated conservatively.Results 21 days after injury,37.61%（82/218） of SEDH patients had a hematoma absorption rate of < 0.62ml/d after conservative treatment.The  slow hematoma absorption  group had an average age of (10.43±1.93)years,hematoma volume of (22.09±3.96 )ml,maximum hematoma thickness of (5.92±1.48) mm,admission Glasgow Coma Scale (GCS) score of (13.33±0.55),activated partial thromboplastin time (APTT) of （30.96±8.94） seconds,and fibrinogen level of （2.14 ± 0.58 ）g/L.In contrast,the fast absorption group showed corresponding values of （7.60±1.53 ）years,（12.30±4.13 ）ml,（3.18±1.06） mm,（14.48±0.48）,（28.63±7.46） seconds,and （2.33±0.62 ）g/L.The differences between the two groups were statistically significant (P<0.05).Logistic regression analysis identified age,hematoma volume,and maximum hematoma thickness as risk factors influencing hematoma absorption (P<0.05).According to the results of multi-factor analysis,the nomogram model was constructed,and the calibration curve shows that the model has good fitting degree.The sensitivity of the nomogram model for predicting hematoma absorption in children with SEDH was 89.02% (95%CI:79.71%94.55%),the specificity was 91.91% (95%CI:85.65%~95.69%),and the area under curve (AUC) was 0.958 (95%CI:0.923~0.981).Conclusion The nomogram model based on factors such as age,hematoma volume,and maximum hematoma thickness of hematoma has a good predictive effect on hematoma absorption in SEDH children.

Tumor-associated hydrocephalus is one of the serious complications in patients with intracranial tumors,commonly seen in posterior cranial fossa tumors.Its pathogenesis is complex,clinical manifestations are diverse,and treatment strategies and prognosis vary greatly,which directly affects the treatment outcome and quality of life of patients.This article reviews the research progress of tumor-associated hydrocephalus from aspects such as pathogenesis,tumor types,treatment strategies,risk factors for hydrocephalus after tumor resection,and predictive models,aiming to provide ideas for  clinical research.

Objective To analyze the influencing factors of poor incision healing in postoperative patients with breast cancer.Methods The clinical data of 150 patients with breast cancer diagnosed by the Department of Nail Milk surgery of the Fifth affiliated Hospital of Xinjiang Medical University from January 2016 to December 2023 were retrospectively analyzed.According to the postoperative wound healing,the patients were divided into two groups:good healing group (n=94) and poor healing group (n=56).The general data,operation-related data and clinicopathological characteristics of the two groups were collected for univariate analysis,and the single-factor indexes with statistical significance were analyzed by multivariate Logistic analysis to screen the risk factors of poor incision healing after operation.The statistically significant indexes of regression analysis were analyzed by receiver operating characteristic (ROC) curve to further explore its predictive value in poor incision healing after breast cancer operation.Results The data of the two groups were compared and analyzed.Multivariate Logistic regression analysis showed that BMI,diabetes,age,axillary lymph node dissection and hemoglobin were independent risk factors for poor incision healing(P<0.05).ROC curve analysis of independent risk factors showed that when the age was more than 57.5,the area under the curve (AUC) was 0.635,the sensitivity was 55.4%,the specificity was 68.1%,and the critical value was 57.5.When BMI>24.9kg/m²,the area under the curve (AUC) was 0.735,the sensitivity was 87.5%,the specificity was 61.7%,and the critical value was 24.9 (P<0.001).When hemoglobin<101.5g/L,the area under the curve (AUC) was 0.829,the sensitivity was 57.1%,the specificity was 94.7%,and the critical value was 101.5g/L (P<0.001).Conclusion BMI,diabetes,hemoglobin,age and axillary lymph node dissection are independent risk factors for poor wound healing after breast cancer operation.When BMI>24.9kg/m²,age>57.5 years old and hemoglobin<101.5g/L,it can predict the occurrence of poor incision healing in patients with breast cancer.

Objective  To analyze the risk factors associated with intraoperative parathyroid injury during thyroid cancer surgery and develop a predictive model to evaluate its predictive efficacy.Methods A retrospective study was conducted involving 76 patients who experienced intraoperative parathyroid injury during thyroid cancer surgery between May 2021 and February 2024.These patients were included in the parathyroid injury group.For the control group,76 patients who underwent thyroid cancer surgery without intraoperative parathyroid injury during the same period were selected.Clinical data,complete blood count parameters,and other relevant variables were collected.Univariate analysis was performed to screen for potential risk factors,and Logistic regression analysis was used to identify independent risk factors.A regression predictive model was established,and the model's goodness-of-fit and predictive power were evaluated.Results Among the 76 patients, 75 had temporary parathyroid function impairment and 1 had permanent parathyroid function impairment. Univariate and multivariate Logistic regression analyses showed that bilateral lymph node dissection, bilateral total lobectomy, capsule invasion, and combined hashimoto's thyroiditis were independent risk factors (P< 0.05).A predictive regression model was developed based on these factors.The Hosmer-Lemeshow test showed a χ2 = 2.064,P=0.356,indicating good model fit.The receiver operating characteristic (ROC) curve revealed that the model had an area under the curve (AUC) of 0.713,with a 95% confidence interval (CI) of 0.639 to 0.787,suggesting good predictive efficacy.Conclusion Hashimoto's thyroiditis,capsular invasion,bilateral lymph node dissection,and bilateral total lobectomy are significant risk factors for intraoperative parathyroid injury during thyroid cancer surgery.The predictive model constructed based on these factors has good predictive efficacy.

Objective To investigate the compliance of hormone receptor-positive breast cancer patients with prolonged endocrine therapy and analyze its influencing factors.Methods This study was a retrospective cohort study.A total of 347 patients with breast cancer who received prolonged endocrine therapy in our hospital from June 2017 to March 2023 were selected. Relevant data of the patients were collected and they were divided into two groups according to whether they adhered to prolonged endocrine therapy: the compliance group and the non-compliance group.Using the χ² test to analyze the impact of patients' disease-related data on prolonging compliance with endocrine therapy.Use Logistic regression to analyze its influencing factors.Results Among 347 breast cancer patients who received extended endocrine therapy, during the median follow-up of 28 months (ranging from 12 to 60 months), 319 patients (91.9%) adhered to extended endocrine therapy (compliance group), and their treatment compliance was acceptable. Twenty-eight cases (8.1%) of patients did not adhere to prolonged endocrine therapy (non-compliance group).Multivariate analysis showed that the independent factors Influencing the compliance of breast cancer patients with prolonged endocrine therapy were comorbidities and radiotherapy(P＜0.05).Conclusion Based on the characteristics of influencing factors, behavioral interventions such as increasing follow-up frequency and strengthening health education content can be implemented for some patients without comorbidities and those who have not received radiation therapy,and to improve treatment compliance.

Objective To explore the relationship between fibrinogen to albumin ratio (FAR),prognostic nutritional index (PNI),systemic immune inflammation index (SII) and prognosis of patients with lung cancer undergoing thoracoscopic surgery.Methods The clinical data of 287 patients with lung cancer who underwent thoracoscopic lobectomy in the hospital from February 2018 to February 2020 were retrospectively collected.The FAR,PNI,and SII values were measured within one week before surgery.The 3-year survival after operation was counted.The relationship between clinical data,preoperative FAR,PNI,SII and 3-year survival prognosis was observed.The receiver operating characteristic curve (ROC) was used to determine the optimal cut-off values of preoperative FAR,PNI,and SII values for predicting the 3-year survival prognosis after surgery,and the prognostic value of single index and combination of each index was observed.Multivariate Logistic regression analysis was used to evaluate the influencing factors of prognosis.Pearson correlation analysis was used to explore the correlation between FAR,PNI and SII values.Results Finally,242 patients with lung cancer were included in the study,and 199 patients survived 3 years after operation,with an overall survival rate of 82.23 %.43 cases (17.77 %) died in 3 years.Age,serum carcinoembryonic antigen (CEA) level,lymph node metastasis,TNM stage,preoperative FAR,PNI and SII value were related to the 3-year survival prognosis of lung cancer patients after thoracoscopic lobectomy (P<0.05).The ROC curve showed that the preoperative FAR,PNI and SII values had certain predictive value for the 3-year survival prognosis of patients after operation.The combined prediction of the three showed better predictive efficacy,and the area under the curve (AUC) was 0.772.Multivariate Logistic regression analysis showed that lymph node metastasis,TNM stage,FAR value and SII value were independent risk factors for postoperative survival and prognosis.PNI was an independent protective factor (P<0.05).Pearson correlation analysis showed that there was a negative correlation between FAR and PNI,PNI and SII,and a positive correlation between FAR and SII (P<0.05).Conclusion The values of FAR,PNI and SII are independently related to the prognosis of patients with lung cancer undergoing thoracoscopic surgery.The combined application has a higher prognostic value.

Objective To investigate the predictive factors for postoperative gastrointestinal function in patients undergoing laparoscopic radical rectectomy (LRR), and thereby construct a predictive model.Methods A total of 155 patients who underwent LRR at our hospital from February 2021 to April 2024 were selected for this study.Based on the postoperative intake-nausea-vomiting-examination-duration of symptoms (I-FEED) scoring system,patients were divided into postoperative gastrointestinal dysfunction (POGD) and non-POGD groups.Clinical data of the selected patients were collected,and Logistic regression analysis was used to identify factors influencing the occurrence of POGD in LRR patients.A predictive model for POGD was constructed,and its predictive performance was evaluated using the receiver operating characteristic (ROC) curve.The calibration ability of the model was assessed using the H-L test.Results Of the 155 LRR patients,2 were excluded due to intraoperative conversion to open surgery and 1 due to insufficient data,resulting in a total of 152 patients included in the analysis.The incidence of POGD in these 152 patients was 33.55% (51/152).Logistic regression analysis identified age (OR=2.687,95%CI=1.422-5.078,P=0.003),smoking history (OR=2.564,95%CI=1.395-4.713,P=0.004),preoperative albumin (Alb) level (OR=0.851,95%CI=0.781-0.927,P＜0.001),dexmedetomidine combined with general anesthesia (OR=0.382,95%CI=0.214-0.682,P=0.001), the location of the abdominal auxiliary incision (OR=2.992,95%CI=1.278-7.006,P=0.007) and ligation location of inferior mesenteric artery (OR=3.784,95%CI=1.624-8.815,P=0.001) as influencing factors for POGD in LRR patients.The ROC curve showed that the predictive model constructed using these factors had an area under the curve (AUC) of 0.905,indicating good predictive performance.The H-L goodness-of-fit test showed no significant difference between the predicted and observed values (P>0.05),indicating good calibration ability.Conclusion Age,smoking history,preoperative Alb level,dexmedetomidine combined with general anesthesia,the location of the abdominal auxiliary incision and ligation location of inferior mesenteric artery are influencing factors for POGD in LRR patients.The predictive model constructed based on these factors has good predictive value and calibration ability,providing a basis for targeted prevention and treatment to reduce the risk of POGD.

Objective  To investigate the effect of preoperative imaging combined with intraoperative Nice knot technique in the treatment of comminuted fractures of the lateral ankle.Methods  A total of 123 patients with comminuted fractures of the lateral ankle were admitted to our hospital from June 2021 to July 2023.62 patients who underwent routine reduction techniques were included in the control group,and 61 patients who underwent preoperative imaging combined with intraoperative Nice knot reduction were included in the observation group.The surgical indicators of surgery,intraoperative reduction quality and complication rate were compared between the two groups,as well as range of motion of talus calf angle and ankle joint before and 1 year after surgery,the affected and healthy sides of the talus calf angle,ankle joint range of motion,and functional prognosis at 1 year after surgery.Results The operation time in the observation group was (62.10±17.58) minutes,which was shorter than that in the control group (78.45±20.29) minutes.The intraoperative reduction time was (29.59±8.45) minutes,which was shorter than that in the control group (35.74±10.28) minutes.The length of the lateral malleolus incision was (10.02±2.88) cm,which was shorter than that in the control group (15.11±3.67) cm.The incision healing time was (11.30±2.16) days,which was shorter than that in the control group (14.88±2.48) days.The hospitalization time was (12.30±2.48) days,which was shorter than that in the control group (15.99±2.57) days.The intraoperative blood loss was (38.74±12.08) ml,which was lower than that in the control group (65.86±17.11) ml.The satisfaction rate of reduction was 95.08%,which was higher than that in the control group's 77.42% (P<0.05).One year after surgery,the talus-leg angle,ankle dorsiflexion,and ankle plantar flexion in the observation group were higher than those in the control group,while the talus-leg angle,ankle dorsiflexion,and ankle plantar flexion on the affected side in the control group were lower than those on the healthy side (P<0.05).The excellent and good rate of functional prognosis in the observation group was 95.08%,which was higher than that in the control group's77.42% (P<0.05).There was no significant difference in the total incidence of complications between the two groups (P＞0.05).Conclusion Preoperative imaging combined with intraoperative Nice knot technique can optimize the surgical process for patients with comminuted fractures of the lateral ankles,reduce tissue damage,promote perioperative recovery,and improve the reduction effect.

Objective To establish and test a 3-year prognosis model for elderly intertrochanteric fractures after intramedullary nail fixation.Methods A total of 205 elderly patients with intertrochoteric fracture of femur who underwent intramedullary nail fixation in our hospital from April 2019 to April 2021 were selected for observation study,followed up for 3 years after surgery,according to the Harris score, they were divided into the good group and the poor group.Univariate analysis was conducted to investigate the influencing factors of disease prognosis in the two groups 3 years after surgery.After the variables were screened by LASSO regression and cross-validation method,the independent influencing factors of the 3-year postoperative prognosis were analyzed by multi-factor Logistic-regression,and the prediction model of the nomogram was built,and the model was evaluated and validated.Results Among 205 elderly patients with intertrochanteric fractures of the femur who underwent intramedullary nailing fixation,201 were followed up for 3 years.Among them,148 patients had a Harris score of ≥70 points,while 53 patients had a score of <70 points.Univariate analysis results showed that the poor group had a higher proportion of patients with age,stroke,osteoporosis,Evans-Jensen type Ⅲ and Ⅳ fractures,poor intraoperative reduction,and a tip-apex distance of ≥30 mm compared to the good group,and had a lower lateral wall thickness than the good group,the difference was statistically significant (P < 0.05).LASSO regression analysis and cross-validation were used to screen variables.Multivariate Logistic regression analysis showed that stroke (OR=2.127,95%CI:1.478-3.061) and fracture Evans-Jensen classification Ⅲ (OR=1.149,95%CI:1.105-1.195) and type Ⅳ (OR=1.187,95%CI:1.143-1.233),intraoperative reduction was not good (OR=3.290,95%CI:2.319-4.668),apex distance ≥30mm (OR=1.413,95%CI:1.066-1.874) was an independent associated risk factor for disease outcome 3 years after surgery,the external wall thickness (OR=0.600,95%CI:0.4280.841) was an independent correlated risk factor for 3-year prognosis (P < 0.05).Based on the results of multiple factors,a nomogram prediction model was drawn,and the results showed that the model had certain predictive value for the disease outcome three years after surgery.The evaluation and verification results showed that when the threshold probability was 0-96%,the model had good clinical applicability and positive clinical net benefit.Conclusion Stroke,fracture Evans-Jensen classification Ⅲ and Ⅳ,poor intraoperative reduction,apical distance ≥30 mm,and lateral wall thickness are independent and relevant factors for 3-year prognosis of senile intertrochanteric fractures after intramedullary nail fixation.The establishment of a nematographic model has good predictive value for postoperative long-term prognosis and positive clinical net benefit.It can be used as an effective model to predict the long-term prognosis of postoperative disease.

Objective To compare the efficacy and safety of laparoscopic transabdominal preperitoneal mesh hernia repair (TAPP) and tension-free hernia repair (TFHR) in the treatment of inguinal hernia.Methods From January 2021 to June 2023,85 patients with inguinal hernia were treated in our hospital.They were grouped into TAPP group (n=42,with TAPP) and TFHR group (n=43,with open TFHR) based on the different surgical procedures.The surgical indicators,postoperative pain,serum testosterone levels of male,incidence of postoperative complications,and recurrence rate were compared between two groups.Results Intraoperative blood loss,postoperative exhaust time,and hospital stay in the TAPP group were lower than those in the TFHR group (P<0.05);there was a difference in postoperative numerical rating scale (NRS) scores between two groups (P<0.05),postoperative NRS scores in each group gradually decreased over time (P<0.05),and there was an interaction among groups and time (P<0.05),among them,TAPP group had lower scores than TFHR group at 12,24,and 48 hours after surgery (P<0.05);one month after surgery,there were no difference in serum testosterone levels between the two groups compared before surgery(P>0.05),and there was no difference between the two groups(P>0.05);the incidence of postoperative complications in the TAPP group was lower than that in the TFHR group (4.76% vs 18.60%) (P<0.05);there was no recurrence within 6 months after surgery in both groups.Conclusion The application of TAPP and open TFHR in the treatment of inguinal hernia has good results,and there is no influence on testicular function.However,compared to open TFHR,TAPP has lower intraoperative blood loss,lower postoperative pain and complications,and shorter recovery time.