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.

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 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.

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.

Objective To explore the effects of drug-coated balloons (DCB) on the patency rate of target lesion vessels, coagulation function and vascular endothelial function in patients with in-stent restenosis (ISR) after percutaneous endovascular angioplasty (PTA) for lower extremity arteriosclerosis obliterans (ASO).Methods A total of 62 patients with ISR and ASO admitted to the hospital were retrospectively enrolled between March 2020 and March 2022.According to different treatment methods,they were divided into DCB group (n=38) and common balloon (SAB) group (n=24).All were followed up for 12 months after surgery.The changes in primary patency rate of target lesion vessel,clinically driven-target lesion revascularization (CD-TLR) rate,late loss of values in the lumen (LLL),ankle-brachial index (ABI),coagulation function indexes [prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (FIB),D-dimer (D-D)] and vascular endothelial function indexes [serum endothelin-1 (ET-1),nitric oxide (NO),flow-mediated dilatation (FMD)] were observed,and the occurrence of postoperative complications in the two groups was recorded.Results At 12 months after surgery,primary patency rate of target lesion vessels in DCB group was higher than that in SAB group (86.84% vs 50.00%),CD-TLR rate,LLL and ABI were lower than those in SAB group[13.16%,(1.39±0.52)mm,(0.76±0.12) vs 50.00%,(1.79±0.64) mm,(0.62±0.11);P<0.05].At 24h and 2 weeks after surgery,there was no significant difference in PT,APTT,FIB or D-D between the two groups (P>0.05).At 24h and 2 weeks after surgery,levels of serum ET-1 in DCB group were lower than those in SAB group [(66.65±7.12)pg/ml,(65.58±6.98)pg/ml vs (71.74±6.92)pg/ml,(68.84±6.51)pg/ml)],while NO levels were higher than those in SAB group [(32.21±4.17)pg/ml,(34.62±3.32)pg/ml vs (28.53±5.23)pg/ml,(31.21±4.19)pg/ml;P<0.05].At 2 weeks after surgery,FMD in DCB group was higher than that in SAB group [(12.49±5.33)% vs (9.14±4.42)%,P<0.05].There was no significant difference in the total incidence of complications between the two groups (21.50% vs 12.50%,P>0.05).Conclusion Compared with SAB,DCB can effectively protect vascular endothelial function and improve the primary patency rate of ISR after PTA in patients with lower extremity ASO.

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 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 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 To evaluate the effects of thoracoscopic intercostal nerve block and incision infiltration block on postoperative recovery quality and analgesia in patients with partial pulmonary resection.Methods From July 2023 to December 2023, 60 patients scheduled for elective thoracoscopic partial lung resection were divided into two groups by random number table method, with 30 cases in each group.The observation group underwent thoracoscopic vision intercostal nerve block,and the control group underwent incision local infiltration block.Intravenous patient-controlled analgesia was adopted in all cases after the operation.The 15-item Recovery Quality Scale (QOR-15) score was recorded 1 day before surgery,24 hours and 48 hours after surgery.The visual analogue pain scores (VAS) at rest and cough at 2,4,8,24,and 48 hours after surgery,consumption of sufentanil within 24 hours and 48 hours after surgery,remedial analgesia and related adverse reactions were recorded.Results The QOR-15 scores of the observation group at 24 hours and 48 hours after operation were (103.4±14.2) and (111.2±6.9),which were higher than those of the control group (91.3±21.4) and (101.8±14.8),and the differences were statistically significant (P<0.05).At rest,the VAS scores of the observation group at 2,4,8 and 24 hours after surgery were (2.0±0.9),(2.1±0.9),(2.5±1.2) and (2.4±1.2).Compared with the control group (3.1±1.2),(3.4±1.7),(3.5±1.7) and (3.2±1.3),the differences were statistically significant (P<0.05).When coughing,the VAS scores of the observation group at 2,4 and 8 hours after operation were (2.4±0.6),(2.5±0.6) and (3.0±1.2),which were lower than (3.2±1.2),(3.7±1.7) and (4.0±2.1) of the control group.The difference was statistically significant (P<0.05).The consumption of sufentanil within 24 hours and 48 hours after surgery in the observation group was (58.1 ± 7.5)μg and (116.5 ± 14.9)μg,respectively,which were lower than those in the control group (63.2 ± 8.5)μg and (125.0 ± 16.7)μg,and the difference was statistically significant (P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).Conclusion Compared with incision infiltration block,thoracoscopic intercostal nerve block has better postoperative analgesic effect and higher postoperative recovery quality.

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.

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 compare the clinical efficacy of neuroendoscopic intracranial hematoma evacuation and stereotactic minimally invasive puncture in the treatment of hypertensive intracerebral hemorrhage.Methods A total of 111 patients with hypertensive intracerebral hemorrhage admitted from January 2019 to November 2023 were divided into the puncture group(58 cases) and the endoscopy group(53 cases) according to the surgical method. The puncture group was treated with stereotactic minimally invasive puncture, and the endoscopy group was treated with neuroendoscopic surgery. The perioperative indicators, activity of daily living(ADL), prognosis quality, and complications were compared between the two groups.Results The operation time of the endoscopy group and the puncture group was (90.19±20.18) minutes and (55.43±16.39) minutes, the intraoperative blood loss was (102.55±29.58)ml and (14.76±8.27)ml, and the hematoma evacuation rate was (95.98±5.50)% and (72.16±6.97)%, respectively. The differences were statistically significant(P＜0.05). There was no significant difference in ADL score between the two groups before surgery(P＞0.05). After surgery, the ADL scores of both groups increased, and the endoscopy group was higher than the puncture group [(81.59±9.34) points vs.(72.63±8.47) points], with a statistically significant difference(P＜0.05). The overall prognosis quality of the endoscopy group was higher than that of the puncture group, and the difference was statistically significant(P＜0.05). The total complication rate of the endoscopy group(5.66%) was lower than that of the puncture group(12.07%), but there was no significant difference between the two groups(P＞0.05).Conclusion Compared with stereotactic minimally invasive puncture, neuroendoscopic intracranial hematoma evacuation has better efficacy in the treatment of hypertensive intracerebral hemorrhage, with higher hematoma evacuation rate and better prognosis.

Objective To explore the surgical treatment experience of primary giant gastrointestinal stromal tumors（GIST）(with isolated lesions with a maximum diameter ＞ 10cm).Methods A retrospective analysis was conducted on the clinical and pathological data of 67 patients with primary giant GIST admitted from January 2018 to December 2024.Among them, 35 cases underwent surgical operations after preoperative neoadjuvant therapy (25 effective cases and 10 ineffective cases) (neoadjuvant therapy group).Due to the initial diagnosis assessment expecting radical (R0) resection (13 cases), or preoperative complications (12 cases), or difficulty in obtaining a pathological diagnosis through puncture biopsy (7 cases), 32 cases underwent direct surgery without neoadjuvant therapy (direct surgery group).Compare the general information,tumor condition,surgical condition,postoperative recovery,postoperative pathology,postoperative adjuvant therapy,and recurrence between two groups.Results Comparative analysis revealed that there was no statistically significant difference(P>0.05) between the neoadjuvant therapy group and the direct surgery group in terms of gender,age,primary tumor location,initial maximum diameter,growth type,localized or locally advanced stage,and postoperative follow-up time.The maximum diameters of the tumors before surgery in the neoadjuvant therapy group and the direct surgery group were (12.4±7.1)cm and (18.2±5.0) cm respectively, and the operation times were (125.4±30.6) minutes and (153.0±31.7) minutes respectively. The intraoperative blood loss was (228.3±76.4)ml and (300.3±67.2)ml, respectively. The postoperative hospital stay was (9.1±2.6) days and (11.1±3.2) days, respectively. There was a statistically significant difference between the two groups (P < 0.05).The proportion of laparoscopic surgery in the neoadjuvant therapy group was 17.1%, which was higher than that in the direct surgery group (0), and the difference was statistically significant (P < 0.05). There was no statistically significant difference between the two groups in terms of the proportion of tumor rupture, combined organ resection, postoperative complications and postoperative recurrence (P>0.05).Conclusion Primary giant gastrointestinal stromal tumors can mostly be reduced in size and progression through neoadjuvant therapy,improving the chances of minimally invasive surgery.However,there is also a risk of tumor progression during neoadjuvant therapy leading to increased surgical difficulty or even loss of curative surgical opportunities.

Objective To analyze the risk factors of delayed bleeding after colonic polyp resection.Methods 700 patients with colonic polyps admitted to General medical treatment Hanzhong 3201 hospital from January 2022 to May 2023 were included as the research object,and all patients were treated with colonoscopy polypectomy.According to whether Post-procedural bleeding (PPB) occurred after operation,they were divided into two groups:the group with PPB occurrence (n=85 cases) and the group without PPB occurrence (n=615 cases).The general data,clinical data and operation related data of the two groups were analyzed by univariate analysis.Multivariate Logistic regression was used to analyze the risk factors of postoperative PPB,and receiver operating characteristic curve was drawn to analyze the predictive value of risk factors.Results 700 patients in this study were all treated by colon polypectomy,and 85 patients (12.14%) developed PPB within 30 days after operation,that is,the incidence of PPB in this study was 12.14%.There was significant difference in sex,age,hypertension and treatment history of thrombosis between the two groups (P<0.05).There was significant difference in the morphology,diameter and surgical methods between the two groups (P<0.05).Multivariate Logistic regression analysis showed that polyp morphology (stalk),polyp diameter (>1cm),Endoscopic mucosal resection(EMR) and Endoscopic submucosal dissection(ESD) were the risk factors for postoperative PPB (P<0.05).The ROC curve showed that the area under curve of polypoid-shaped is 0.653,95%CI is 0.616-0.688,the AUC of polyp-diameter is 0.741,95%CI is 0.707-0.773;and in the way of operation,the AUC of argon plasma coagulation/ESD is 0.730,95%CI is 0.713-0.802,the AUC of EMR/ESD is 0.541,95%CI is 0.498-0.584,the AUC of APC/EMR is 0.604 and 95%CI is 0.565-0.641.Conclusion Polyp pedicled,diameter > 1cm,EMR and ESD are the risk factors for postoperative PPB.

Objective  To analyze the efficacy of the expression of POK erythroid myeloid carcinogenic factor (Pokemon),mitochondrial autophagy receptor protein FUNDC1,and p27 in predicting the 5-year tumor free survival of non-small cell lung cancer (NSCLC) patients after surgery.Methods A prospective study was conducted on 189 patients with NSCLC who underwent surgical treatment in our hospital from January 2018 to September 2019.According to whether there was tumor free survival after 5 years,patients were divided into tumor-free group and non-tumor-free group.The propensity score matching (PSM) method using the nearest neighbor matching method was applied to reduce selection bias between groups.The general information,surgical specimens Pokemon,FUNDC1,and p27 expression were compared between the two groups before and after PSM.Multivariate Logistic regression analysis was used to analyze the factors associated with 5-year tumor free survival after surgery in NSCLC.The value of the receiver operating characteristic (ROC) curve analysis of the expression of Pokemon,FUNDC1,and p27 in surgical specimens for predicting 5-year tumor free survival in NSCLC patients was investigated.The Kappa value was used to test the consistency between the combined prediction results and the actual clinical results.Results There were significant differences in clinical stage,lymph node metastasis,and vascular tumor thrombus between the first two groups of PSM (P＜0.05),while there were no significant differences in age,gender,BMI,family history of cancer,past medical history,tumor diameter,tumor location,and pathological type (P>0.05),there were no significant differences in baseline data between the two groups after PSM (P>0.05),making them comparable.The expression of Pokemon and FUNDC1 in non-tumor group was higher than that in tumor group,while the expression of p27 was lower than that in tumor group (P＜0.001).Multivariate Logistic regression analysis showed that after correcting for clinical data such as age and gender,Pokemon and FUNDC1 were still independent risk factors for 5-year tumor free survival after NSCLC surgery,while p27 was an independent protective factor for 5-year tumor free survival after NSCLC surgery (P＜0.05).The ROC curve shows that the AUC of Pokemon,FUNDC1,p27,and the combined prediction of 5-year tumor free survival after NSCLC surgery are 0.744,0.783,0.755,and 0.907,respectively (P＜0.001).Comparing the AUC of different schemes,the combined AUC is higher than that of Pokemon,FUNDC1,and p27 (Z=3.297,2.673,3.100,P=0.001,0.008,0.002).The external dataset test showed that the consistency between the joint prediction and the actual clinical results was 90.00%,with a Kappa value of 0.769 (P＜0.001).Conclusion The expression of Pokemon,FUNDC1,and p27 in surgical specimens is associated with 5year tumor free survival after NSCLC surgery,showing a certain predictive ability.Combined detection can further improve the prognosis after NSCLC resection.

Objective To investigate the risk factors and significance of catheter dislocationat the venipuncture site after the implantation of a totally implantable venous access port (TIVAP) in patients with breast cancer.Methods From January 2019 to September 2021,1003 patients who underwent vein approach transfusion port implantation were divided into the catheter dislocation group(7 cases) and the non-catheter dislocation group(996 cases).Risk factors for post operative recurrence of catheter dislocationwere analyzed through univariate analysis and logistic regression analysis.Results The results of the univariate analysis indicated that the incidence of catheter dislocation in the group with age≥60 years, axillary vein approach, and left-side puncture was higher than that in the control group, and the difference was statistically significant (P< 0.05). The BMI of the dislocation group [(27.06 ± 2.16)kg/m²] was higher than that of the non-dislocation group [(25.09 ± 3.33)kg/m²],there was a statistically significant difference between the two groups (P=0.05).The multivariate Logistic regression analysis showed that the catheterization approach and puncture side had no significant effect on catheter dislocation (P>0.05); high BMI and age≥ 60 years were independent risk factors for catheter dislocation complications (P<0.05).Conclusion Axillary vein approach transfusion port implantation is relatively safe and reliable.Age≥ 60years old and high BMI are independent risk factors affecting the complication of catheter dislodgement.

Hip joint cysts are a type of cystic lesion involving the hip joint and its surrounding soft tissues,mainly caused by degenerative changes or abnormal synovium.In imaging examinations, MRI and ultrasound examinations are crucial for the diagnosis of cysts.The clinical manifestations of hip joint cysts mainly include pain, swelling and compression symptoms. The treatment strategy depends on the size of the cyst, the severity of the symptoms and the nature of the primary disease.Conservative treatment can be adopted for asymptomatic patients,while symptomatic patients may require puncture aspiration or surgical treatment.In surgical treatment,hip arthroscopy has gradually become the preferred treatment due to its minimally invasive and high-precision characteristics.

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.

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.

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 explore the influencing factors of postoperative pancreatitis in elderly patients with common bile duct stones undergoing endoscopic retrograde cholangiopancreatography (ERCP).Methods 304 elderly patients with common bile duct stones treated with ERCP in our hospital from February 2021 to June 2023 were selected as the study subjects.They were divided into a group with concurrent pancreatitis (n=22) and a group without concurrent pancreatitis (n=282) based on whether postoperative pancreatitis occurred.And the levels of serum lipase,whole blood PLR,and serum CRP were measured before surgery and 3,6,and 24 hours after surgery,respectively.At the same time,the differences in other relevant clinical data between the two groups of patients were compared.Binary Logistic regression was used to analyze the risk factors of pancreatitis after ERCP.Results The serum lipase levels in the concurrent pancreatitis group at 3, 6, and 24 hours after the operation were (1060.48±131.23) U/L, (1137.45±126.34) U/L, and (1152.87±135.05) U/L, respectively. The levels of PLR in whole blood were 192.24±29.26, 216.45±30.24, and 243.62±38.22 respectively, all of which were higher than those in the group without concurrent pancreatitis during the same period. There was a statistically significant difference between the two groups (P<0.05).The serum CRP level in the group with pancreatitis was significantly higher than that in the group without pancreatitis at 6 and 24 h after operation (P<0.05).Body mass index,Oddi sphincter dysfunction,difficulty in intubation,pancreatic development,ERCP operation time >60 min,multiple entry of the catheter into the pancreatic duct were associated with postoperative pancreatitis after ERCP in elderly patients (P<0.05).Multivariate Logistic regression analysis showed that after adjusting for confounding factors such as gender,age,BMI,course of disease,and number of stones,Serum lipase at 3 h after surgery,whole blood PLR at 3 h after surgery,serum CRP level at 6 h after surgery,difficulty in intubation and pancreatic development were independent risk factors for pancreatitis after ERCP in elderly patients (P<0.05).Conclusion Serum lipase,whole blood PLR levels 3 hours after surgery,and serum CRP levels 6 hours after surgery are independent risk factors for pancreatitis after ERCP in the elderly with common bile duct stones.

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 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.

Adipocytic tumors are the most common type of soft tissue tumors, which can be divided into lipomas and liposarcomas. Studies have found that benign lipomas resected from the same site can transform into liposarcomas,especially atypical lipomatous tumors(ALT), suggesting an underlying biological association. In this case, the patient underwent resection of a right neck mass in our hospital in 2017, and the pathology showed fibrolipoma. One year later, the mass recurred at the original site but was not treated. By 2023, the mass had significantly enlarged and extended deeply. MRI showed that the lesion had an unclear boundary with the surrounding fat, suggesting liposarcoma. Puncture and molecular pathology showed MDM2 gene amplification, and the diagnosis of ALT was made, which was confirmed by pathology after complete surgical resection. It can be seen that adipocytic tumors have great differences in biological behavior, and benign lipomas can transform into liposarcomas (especially ALT). Clinically, it is necessary to combine imaging, pathology and molecular detection (such as MDM2/CDK4) for differentiation to formulate treatment plans.

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.

Obejective  To explore whether it is possible to detect the ¹²³I prostate-specific membrane antigen(PSMA) radiation value of the puncture tissue during prostate biopsy to achieve real-time,rapid,and accurate identification of benign and malignant prostate tissues,so as to improve the current clinical biopsy strategy and achieve  accurate diagnosis of prostate cancer during operation with fewer puncture needles.Method In this prospective,diagnostic trial,we included 29 patients with suspected prostate cancer.All patients underwent transperineal biopsy guided by ultrasound within 24 hours after injection of ¹²³I PSMA，a total of 435 punctures were performed.The radiation value of punctured tissue was measured in real-time with a gamma counter.〖JP2〗Pearson test is used to correlate radiation value with histopathology.Result The median radiation value of prostate cancer tissue (1906.50cpm) was significantly higher than that of benign prostate tissue (415.00cpm).The optimal cut-off value for distinguishing benign and malignant prostate tissues was 828.50cpm.The median radiation value of clinically significant prostate cancer tissue (2652.50cpm) was significantly higher than that of clinically insignificant prostate cancer (1386.00cpm).The optimal cut-off value for distinguishing clinically significant and clinically insignificant prostate cancer tissues was 1767.00cpm.In additional,there was a significant positive correlation between the radiation value of puncture tissue and ISUP pathological grade (r=0.834).Conclusion It is preliminarily confirmed that detection of ¹²³I PSMA radiation value of prostate puncture tissue can realize real-time,rapid and accurate identification of benign and malignant prostate tissues during operation.

Objective To explore the influence of Da Vinci robot-assisted different approaches of laparoscopic partial nephrectomy (LPN) on the renal function and intestinal function recovery in the treatment of central renal tumors.Methods Totally 100 patients with central renal tumors who received Da Vinci robot-assisted LPN in the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture were selected from November 2022 to March 2024.According to the consent of the patients,they were divided into transperitoneal group and retroperitoneal group by envelope drawing method,with 50 cases in each group.The transperitoneal group adopted transperitoneal approach,while the retroperitoneal group received retroperitoneal approach.The surgical status and postoperative recovery status,renal function [serum creatinine (Scr),glomerular filtration rate (GFR) and blood urea nitrogen (BUN)],intestinal function recovery status [restore exhaust time,plasma diamine oxidase (DAO),D-lactic acid and urinary lactulose/mannose (L/M)] and complications were compared between groups.Results The surgical time,intraoperative blood loss,renal warm ischemia time,restore exhaust time,urinary catheter indwelling time and hospitalization time with (126.76±23.89) h,(115.86±6.93) ml,(25.41±6.57) min,(2.29±0.56) d,(4.89±0.93) d and (11.08±1.92) d in transperitoneal group were longer or more than the retroperitoneal group [(111.58±21.86) h,(86.27±6.71) ml,(17.08±5.16) min,(1.73±0.43) d,(3.16±0.62) d and (9.29±2.07) d,all P<0.05].1 month after surgery,the SCr level in transperitoneal group with (83.04±10.13) μmol/L was lower than (88.55±9.16) μmol/L in retroperitoneal group while the GFR value with (58.27±6.19) ml/min was higher than (54.36±6.05) ml/min in retroperitoneal group (P<0.05).The levels of DAO,D-lactic acid and the value of urine L/M with (3.39±0.57) mg/L，(2.09±0.31) mg/L and (0.08±0.02) in transperitoneal group at 24 hours after surgery,which were higher than the retroperitoneal group[(3.07±0.46) mg/L，(1.72±0.25) mg/L and (0.05±0.02),P<0.05].The total incidence rates of postoperative complications in transperitoneal group and retroperitoneal group were 12.00% and 8.00% (P>0.05).Conclusion The two approaches of LPN assisted by Da Vinci robot have their own advantages in the treatment of central renal tumors.Transperitoneal approach is more conducive to improving renal function,but retroperitoneal approach is more conducive to shortening the postoperative recovery time and promoting the intestinal function recovery and has lower incidence rates of complications.

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.

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.

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 evaluate the clinical efficacy of anterior versus posterior surgical approaches in the treatment of thoracic spinal tuberculous kyphosis.Methods From January 2018 to January 2023,a total of 67 patients with thoracic spinal tuberculous kyphosis were treated.According to the surgical approach,patients were divided into an anterior group(30 cases) and a posterior group(37 cases).The operation time, blood loss, Cobb Angle before the operation, 6 months after the operation, and at the last follow-up (12 months after the operation), visual analog scale (VAS) score, and oswestry disability index (ODI) were compared between the two groups.Results The anterior group had significantly longer operative time and greater intraoperative blood loss compared to the posterior group(P<0.05).At 6 months postoperatively,the Cobb angle in the anterior group was significantly lower than that in the posterior group(P<0.05).Subgroup analysis showed no significant differences between the anterior and posterior groups in preoperative,6 months,and 12 months Cobb angles,correction degree,correction loss for single-segment cases(P>0.05).However,in multi-segment cases,the anterior group had significantly higher Cobb angles at both preoperative and 6-month postoperative time points compared to the posterior group(P<0.05),while no significant differences were observed at 12 months,including in correction degree and loss(P>0.05).The VAS score and ODI of the anterior approach group and the posterior approach group at 6 months after surgery were lower than those before surgery, and the VAS score and ODI at 12 months after surgery were lower than those at 6 months after surgery. The differences were statistically significant (P<0.05). During the follow-up period, no recurrence of tuberculosis, failure of internal fixation or significant loss of correction was observed.Conclusion Both anterior and posterior surgical approaches can effectively treat single-segment tuberculous thoracic kyphosis,with comparable efficacy.The anterior approach is more suitable for patients with localized lesions requiring anterior decompression,whereas the posterior approach offers advantages in deformity correction and spinal stability reconstruction,especially in cases involving multi-segmental lesions.

Objective To explore the expression pattern and molecular function of ubiquitin-like containing PHD and RING finger domains 1(UHRF1) gene in soft tissue sarcoma(STS),as well as its correlation with clinical characteristics and prognosis of STS.Methods RNA data and related clinical data of 263 STS tissues were obtained from Cancer Genome Atlas (TCGA).Wilcoxon rank-sum test was used to analyze correlation between two groups of data;Spearman correlation coefficient analyzed the top 35 co-expressed genes positively and negatively correlated with UHRF1 expression in STS database,ggplot2 statistical package displayed co-expressed gene heatmap,Pearson correlation coefficient showed correlation between UHRF1 expression and expression of the top 10 genes in the heatmap;different UHRF1 gene expression groups in STS were analyzed using DESeq2 package,ggplot2 package was used to draw volcano plots,gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyzed differentially expressed genes (DEGs) and protein functions,ggplot2 package for visualization,and cluster Profiler package for statistical analysis;STRING web was used to establish PPI network of DEGs,and the MCC algorithm in CytoHubba of Cytoscape was used to analyze hub genes.Results In STS,UHRF1 gene was significantly correlated with its histological type (liposarcoma 22.2%,synovial sarcoma 3.8%,leiomyosarcoma 40.7%,malignant peripheral nerve sheath tumor 3.8%,myxofibrosarcoma 9.6%,pleomorphic sarcoma 19.9%,P＝0.001),tumor necrosis (none 38.8%,focal necrosis 20.8%,moderate necrosis 33.8%,extensive necrosis 6.6%,P＝0.010),and tumor metastasis (no metastasis 67%,metastasis 33%,P＜0.001).In different clinical subgroups (age,gender,histological type,residual tumor,tumor necrosis,tumor depth,margin status,tumor multifocality,radiotherapy),high expression of UHRF1 led to poor prognosis of overall survival (OS),disease-specific survival (DSS),and progression-free interval (PFI);Three prognostic factors above were simultaneously shortened in the following five subgroups:namely residual tumor R0 and R1,tumor necrosis extensive,focal and moderate,tumor depth deep,positive margin status,tumor without multifocality.Analysis of the top 10 co-expressed genes associated with UHRF1 expression revealed that the associated positive genes were PAGE5,LINC01425,LCEP3,SERPINB7,AC074031.1,LCE3A,LCE2A,PAGE2B,MYF5,and AC037486.1(P＜0.05);the associated negative genes were CDH19,CSN1S1,TAC3,AC103563.7,SAA1,CHST8,PRLHR,MIR202HG,IGHV1-24,and ART4(P＜0.05).A total of 3029 DEGs of UHRF1 in STS were obtained with a threshold of |log2 fold-change (FC)| > 1.0 and adjusted P value < 0.05,in which 1 228 genes were up-regulated and 1801 genes were down-regulated;GO enrichment analyed primary biological processes (BP),original cellular components (CC),and original molecular functions (MF),and KEGG enrichment analyed signaling pathways.A total of 343 DEGs including 133 up-regulated genes and 210 down-regulated genes,were obtained with a threshold of |log2 fold-change (FC)| > 2.0 and adjusted P value < 0.05.The top 10 hub genes were analyzed. The top 3 hub genes were GCG, SST and SHH,respectively.Conclusion UHRF1 is significantly correlated with histological type,tumor necrosis,metastasis,OS,DSS,and PFI events in STS.In co expressed genes model and molecular functions of related positive and negative genes involved in multiple biological processes;The network of differentially expressed genes and protein product interactions involved in mechanisms of occurrence and development of the disease,and provided new ideas for in-depth researches on STS.

Objective To explore the impact of Video-Assisted Protrusion Treatment with Endoscope (VPTED) on red blood cell immunity,complications,and lumbar extensor muscle groups in patients with lumbar disc herniation (LDH).Methods A total of 103 LDH patients in our hospital from March 2021 to March 2023 were prospectively selected. Among them, 6 cases were lost to follow-up, and 97 cases were included in the study. They were divided into the observation group (49 cases) and the control group (48 cases) by random number table method, and VPTED and microscopic minimally invasive channel technique (MITM) were performed respectively.The perioperative indicators, complications, and excellent and good rates of the two groups were statistically analyzed. The tissue trauma indicators interleukin-6 (IL-6),IL-8,IL-17, red blood cell immune indicators, Oswestry disability index (ODI), and biomechanical indicators of the lumbar and dorsal extensor muscle group (peak moment, average power, and lumbar and dorsal flexion and extension ratio in the lumbar and dorsal extension state) before and after the operation were compared between the two groups.Results The surgical time,mobilization time,and hospitalization time of the observation group were (68.62±5.59) minutes,(1.44±0.31) days,and (7.24±1.08) days,respectively,which were shorter than those of the control group [(94.11±10.34) minutes,(2.38±0.46) days,and (9.26±1.23) days].The intraoperative blood loss and VAS scores at 3 and 5 days after surgery were (12.68±2.37) ml,(2.78±0.34)points and (1.45±0.33) points,respectively.Which were lower than those of the control group [(50.54±4.49) ml,(3.31±0.36)points and (2.12±0.40) points](P<0.05).The incision length of the observation group was (0.87±0.21)cm, which was shorter than that of the control group [(1.23±0.26)cm]. There was a statistically significant difference between the two groups (P < 0.05).From pre-operation to 7 days post-operation,the levels of IL-6,IL-17,IL-8,and RBC-ICR in both groups exhibited an increase-decrease trend,while RBC-C3bRR and RBC-NTFR showed a decrease-increase trend (P<0.05).From pre-operation to 12 months post-operation,the ODI index and lumbar back flexion-extension ratio in both groups decreased with time,while peak torque and average power in lumbar back extension increased with time (P<0.05).At 12 months post-operation,there were no statistically significant differences in complication rates (2.04% vs 6.25%) and surgical excellence rates (89.80% vs 87.50%) between the two groups (P>0.05).Conclusion VPTED is safe and effective in the treatment of LDH,and has unique advantages in the improvement of perioperative indexes.

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 effects of traditional laparoscopic surgery,natural orifice specimen extraction surgery(NOSES),and intersphincteric resection(ISR) on treatment outcomes and quality of life in patients with low rectal cancer.Methods A total of 152 patients with low rectal cancer who were admitted from January 2020 to June 2022,and they were divided into the traditional laparoscopic group(49 cases),the NOSES group(51 cases),and the ISR group(52 cases) according to the surgical method.The operation status,postoperative recovery status,pain,anal function recovery status,quality of life and complications were compared in the 3 groups.Results The operation time of the traditional laparoscopic group [(193.98±12.31) min] was lower than that of the NOSES group [(203.54±15.02) min] and the ISR group [(199.85±11.98) min](P<0.05),operation time of NOSES group and ISR group was no difference(P>0.05).The first exhaust time [(60.21±10.05) h],the first time of getting out of bed [(37.52±6.21) h],and the length of postoperative hospital stay [(12.51±1.47) d] in the traditional laparoscopic group were all higher than those in the NOSES group [(51.06±8.67) h,(30.13±4.92) h,and(11.27±) 1.23) d] and ISR group [(53.19±9.24) h,(28.97±4.71) h,(11.73±1.35) d](P<0.05),and there were no statistically significant differences in the first exhaust time,the first time to get out of bed,and the length of postoperative hospital stay between the NOSES and ISR groups(P>0.05). There was no statistically significant difference in the Visual Analogue Scale (VAS) scores for pain at 4 hours, 24 hours, and 48 hours after surgery among the three groups (P>0.05).The VAS scores of the three groups at 24 hours after surgery were higher than those at 4 hours and 48 hours after surgery, and the difference was statistically significant (P < 0.05).The VAS scores of the three groups at 48 hours after surgery were higher than those at 4 hours after surgery, and the difference was statistically significant (P< 0.05).The NOSES group’s Wexner score [(4.93±0.76) points] at 3 months after surgery and Wexner score [(3.21±0.42) points] at 6 months after surgery were lower than those of the ISR group [(6.32±0.93) points,(4.48±0.54) points] and the traditional laparoscopic group [(5.93±0.81) points,(4.01±0.53)points](P<0.05),and the Wexner score of the 3 groups at 3 months after surgery was lower than that at 1 month after surgery(P<0.05).The EORTC QLQ-C30 score of the NOSES group at 3 months after surgery was (74.82±4.01) points, and that at 6 months was (85.49±4.93) points, which were higher than those of the ISR group [(67.05±5.03) points and (71.64±4.21) points] and the traditional laparoscopic group [(70.42±3.92) points,(76.28±4.48) points](P<0.05),and the EORTC QLQ-C30 scores of the traditional laparoscopic group at 3 and 6 months after surgery were higher than those of the ISR group, and the difference was statistically significant (P < 0.05). The EORTC QLQ-C30 score of the 3 groups at 6 months after surgery was higher than that before surgery and 3 months after surgery(P<0.05),and the EORTC QLQ-C30 score of the 3 groups at 3 months after surgery was higher than that before surgery(P<0.05).There was no significant difference in the incidence of total complications among the three groups(P>0.05).Conclusion Compared with traditional laparoscopic surgery for low rectal cancer,the NOSES and ISR methods accelerate postoperative bowel function recovery,and the NOSES methods have advantages in anal function recovery and better and satisfactory quality of life.