Objective To evaluate the significance and reasonability of select in various types of circumcision in children of different ages.
Methods A retrospective analysis was performed for 1 440 children of different ages(3-15 years) between Jan 2019 and Sep 2019 in urological ward and ambulatory surgery area of our hospital.280 were preschool children,620 were school-age children,240 were adolescent children.In different ages,divide them into 4 groups by different types of circumcision：traditional circumcision group,circumcision group with ligation device,circumcision group with anastomoses device,circumcision group with stitching instrument.The indications such as blood loss、operating time、  pain duration、 shedding time、 short-term complication and long-term complication were compared.
Result Among the 4 surgical procedures,preschoolers had the shortest pain duration,shedding time and fewer short-term complication.School-age children had the lowest operative time and blood loss by circumcision with ligation device.Adolescent children had lower operative time,blood loss and the fewer long-term complication by circumcision with stitching instrument.
Conclusion With the development of circumcision apparatus,different surgical methods should be adopted for children's  circumcision in combination with different age.Traditional circumcision should be recommended for preschoolers,circumcision with ligation device for school-age children,circumcision with stitching instrument for adolescent children.

Objective To investigate the mechanism of aquaporin 4（AQP4）in the development of breast cancer.Methods The expression of aquaporin 4 in the T47D and MCF-7 cell lines of breast cancer cells was downregulated by siRNA interference，and the effect of this down regulation on the invasion and metastasis of breast cancer cells was detected.Results Decreased expression of AQP4 inhibits invasion and metastasis of breast cancer cells.Conclusion The expression level of AQP4 is correlated with the development of breast cancer，and it can further develop into a new target.

Biliary tract cancer is one of the digestive system malignances with very poor prognosis.Majority of patients belongs to the advanced stage when diagnosed.Currently,systemic chemotherapy is the standard first-line treatment option for advanced biliary tract cancer.However,the clinical efficacy is not satisfactory.A new era has been coming while the immunotherapy is introduced in the treatment of hepatobiliary cancers.Many clinical studies have been conducted in the treatment of biliary tract cancer with immune checkpoint inhibitor drugs,and the clinical efficacy and safety are acknowledged by the clinicians.Meanwhile,further studies should focus on how to treat biliary tract cancer with immunotherapy drugs more precisely.

Objective To compare the therapeutic effect of silver ion antibacterial dressing and povidone iodine gauze on the incision and drainage of the abscess.
Methods From March 2019 to November 2019,62 patients were included in this study,and divided randomly into the observation group and the control group with 31 cases in each group.The patients in the observation group were treated with silver ion antibacterial dressing,while the patients in the control group were treated with povidone iodine gauze.The patients in the two groups were recorded in detail.The infection control time of abscess incision was compared before treatment,the third day and the second week after the first treatment,the number of dressing changes and wound healing time of the two groups,and the clinical effect of the patients was evaluated.
Results .The time of wound control in the observation group was (13.9±1.81)d,shorter than that in the control group (23.4±2.32)d(P<0.05);the BWATBWAT(Bates-Jensen Wound  assessment tool，BWAT) score of the observation group in the second week after the first treatment was (14.98±1.51),lower than that in the control group (19.78±2.46)(P<0.05);the times of drug change and wound healing in the Observation group were significantly shorter than that in the control group(P<0.05).
Conclusion Compared with the traditional povidone iodine gauze,the silver ion antibacterial dressing can control the wound infection and improve the wound healing more quickly,and the dressing change times are less,the wound healing time is obviously shortened.

Articular cartilage is a major tissue distributed at the joint surface;it plays a role in loadbearing and lubricating.The articular cartilage of the joints in the extremities mainly consists of hyaline cartilage composed of collagen II.Fibrocartilage formation is easily observed when the cartilage is injured or degenerated,which has abundant type I collagen.In this study,a new viewpoint and concept,focusing on the modification of fibrocartilage in situ approach and regeneration of hyaline cartilage,namely “fibrocartilage hyalinization”,was proposed as a practical clinical strategy.We conducted preliminary discussions and prospects on the feasibility and potential mechanisms of fibrocartilage hyalinization.It is hoped that the strategy will be helpful to the development and clinical transformation of cartilage regeneration research.

Pancreatic cancer is a highly malignant disease in the digestive system.So far,surgical resection is still the primary treatment for pancreatic cancer,but only about 20% of pancreatic cancer patients can be treated with surgery.Even with comprehensive treatment measures such as surgery,radiotherapy and chemotherapy,biological therapy,and targeted therapy,the overall survival rate of pancreatic cancer patients has not been significantly improved in the past ten years.In recent years,immunotherapy has made breakthroughs in tumor treatment.Cancer immunotherapy has now been recognized as the fourth pillar of cancer treatment alongside surgery,radiotherapy,and chemotherapy.There are also many studies in the treatment of pancreatic cancer,but the results are not satisfactory.This article reviews the current status and possible prospects of immunotherapy for pancreatic cancer.

When the elderly patients with hip fracture receive surgical treatment,they often face a high risk of unfavorable prognosis due to the influence of multiple complications,which reduces their quality of life and also brings certain economic burden to the society.Therefore,minimally invasive treatment techniques for elderly hip fracture have been developing to improve the prognosis of elderly hip fracture patients.Based on the epidemiology of elderly hip fracture and the results of domestic and foreign literature review and expert investigation,this consensus summarizes the classification,surgical path and rehabilitation measures of elderly hip fracture,to provide a reasonable and standard treatment plan for minimally invasive surgical treatment of elderly hip fracture.

Unlike the majority of other tissues,cartilage is low in cellularity and basically avascular in nature,therefore,chondral lesions due to injury commonly result in the development of osteoarthritis,eventually leading to progressive total joint destruction.Current clinical treatment strategies for cartilage defects include microfracture,osteochondral autografts and allografts.Although they are often used clinically,significant drawbacks and limitations still exist.To solve these problems,cartilage tissue engineering has been recommended to promote more effective treatments.In this review,we discuss current clinical approaches for repairing cartilage,as well as cartilage tissue engineering approaches which are currently developing.We also describe potential future directions in cartilage regeneration.

Holmium laser is the most commonly used laser for minimally invasive treatment of urinary calculi.To understand the principle of the action of holmium laser and to reasonably set and optimize holmium laser parameters（pulse energy，frequency，pulse width）can improve the efficiency and effect of lithotripsy.We review the present status of laser lithotripsy technology and the recent advances in laser technology，such as Moses technology holmium laser，Laser Lithotripsy System with Automatic RealTime Urinary Stone Recognition and thulium fiber laser.

The complex anatomy of the distal radioulnar joint is the basis for its forearm rotation function and power transmission.It is important to research the anatomical structure and biomechanical mechanism of the distal radioulnar joint to understand the mechanism of the instability of the distal radioulnar joint.The instability of the distal radioulnar joint can be divided into primary instability，post-traumatic or postoperative instability.The combination of medical history，physical examination and imaging findings on the classification of instability of the distal radioulnar joint is helpful for the diagnosis and treatment of the disease.The treatments for the instability of the distal radioulnar joint are conservative treatment and surgical treatment.

Objective:To explore the clinical value of preoperative chest plain scan threedimensional reconstruction technique and enhanced CT threedimensional reconstruction technique in anatomical resection of pulmonary segments.Methods:The clinical data of 40 patients who underwent thoracoscopic anatomical segmentectomy from March 2019 to January 2021 were retrospectively analyzed.Among them,22 patients underwent preoperative plain CT,and 18 patients underwent preoperative enhanced CT.All the patients underwent preoperative threedimensional computed tomography bronchography and angiography(3DCTBA) using the Mimics software to show the anatomy of pulmonary segments,and the safe cutting edge of 2 cm from the pulmonary nodule was constructed.This study was divided into two groups:plain scan reconstruction group and enhanced reconstruction group.The general clinical characteristics,operation complexity,operation time and postoperative recovery of the two groups were compared.Results:There were no significant differences in operation complexity,operation time,intraoperative blood loss,postoperative total drainage volume,postoperative drainage tube indwelling time,postoperative hospital stay and postoperative pathological types(P＞0.05).Conclusion:Preoperative application of 3DCTBA with chest plain CT or enhanced CT can be used to guide anatomic segmentectomy to achieve accurate segmentectomy,which is safe and effective.

The deficiency disease of 5αreductase 2 is a common genetic disease of AR,which karyotype is 46,XY.As the boy patients were born,some abnormity in various degrees would occur on the majority of their external genitalia.Blurring of external genitalia or being similar to female phenotype is the most common phenomenon.Also,being close to normal external genitalia of male phenotype could be found.Some patients would visit a doctor on account of diminutive penis or maldevelopment of gonad.The boy patients who have the deficiency disease of 5αreductase 2 with diminutive penis would be inclined to be misdiagnosed or never diagnosed.Thus,the time for treatment would always be delayed.The article is a summary of genotype characteristics、pathogenesis、clinical feature、diagnostic basis and progress of treatment in allusion to the deficiency disease of 5αreductase 2 with diminutive penis.

In recent years the precise diagnosis and treatment of thyroid cancer have made great progress and widely applied clinically, which include the judgment of benign and malignant, malignant risk stratification, inheritance and target therapy. It provides new guidelines for the individualized management of thyroid cancer. We try to introduce the applications of molecular diagnosis in thyroid cancer from the above aspects.

Objective To explore the clinical practice of best evidence-based practice program for nasogastric tube insertion and evaluate its application.
Methods By referencing to Australia JBI model for evidence-based healthcare, we retrieved and summarized the best evidence for preoperative insertion of nasogastric tube, judged the position of nasogastric tube and alleviated the discomfort caused by the nasogastric tube insertion.Then we formed inspection indicators, maded baseline inspections before application of the best evidence on 29 medical staffs and 50 patients who met the inclusion criteria in department of hepatobiliary surgery, took transformative measures to boost application of the best evidence, and made post-application inspections to evlaute the effect.
Results After the application of the best evidence, the routine operation process of gastric tube insertion was improved; the awareness rate of audit indicators in medical staffs, audit indicators implementation rate, and the correct rate of gastric tube implantation were significantly improved (P<0.05 for all).
Conclusion The summarization and application of the best evidence for preoperative nasogastric tube insertion can improve medical staffs' operation level of nasogastric tube insertion,standardize the operation behaviors,reduce the patients' discomfort caused by the nasogastric tube insertion and improve their satisfaction.