Objective To investigate the effect of preoperative non-biliary drainage related invasive procedures on postoperative complications of pancreaticoduodenectomy, and to evaluate the benefits of preoperative non-biliary drainage related invasive procedures on patients.  Methods From January 2016 to July 2020, 163 patients with ampullary mass underwent pancreaticoduodenectomy. The patients were divided into the invasive operation group and the control group according to whether they underwent non-biliary drainage related invasive procedures before operation. Both groups underwent open or laparoscopic pancreaticoduodenectomy. The incidence of postoperative complications and its relationship with clinical factors were analyzed.  Results The incidence of postoperative complications in invasive group was 59.70% (40/67), including pancreatic leakage 52.24% (35/67), bile leakage 11.94%(8/67), intra-abdominal or gastrointestinal bleeding 17.91% (12/67), intra-abdominal infection 13.43% (9/67). The incidence of Clavien-Dindo grade Ⅰ~Ⅱ minor complications was 46.27% (31/67), and the incidence of Clavien-Dindo gradeⅢ~Ⅴ severe complications was 13.43% (9/67). The incidence of postoperative complications in the control group was 57.29% (55/96), including pancreatic leakage (52.08%, 50/96), bile leakage (12.50%, 12/96), abdominal or gastrointestinal bleeding (19.79%, 19/96), and abdominal infection (14.58%, 14/96). The incidence of Clavien-Dindo gradeⅠ~Ⅱ minor complications was 42.71% (41/96), and the incidence of Clavien-Dindo gradeⅢ~Ⅴ severe complications was 14.58% (14/96). There were no significant differences in the incidence of pancreatic leakage, bile leakage, intra-abdominal or gastrointestinal bleeding, intra-abdominal infection, minor and severe complications between the two groups.  Conclusion  Preoperative non-biliary drainage related invasive procedures have no significant effect on postoperative complications of pancreaticoduodenectomy. It is safe and feasible to perform preoperative non-biliary drainage related invasive procedures in patients with ampullary space occupying lesions.

Objective To investigate the results of bacteria from bile culture with obstructive jaundice patients without clinical infection. Methods 136 cases from bile culture with obstructive jaundice patients without clinical infection were reviewedfrom January 2015 to December 2020.Bacterial culture was performed on bile retained during endoscopic retrograde cholangiopanchography (ERCP), percutaneous hepatic bile drainage (PTCD), and univariate and multivariate Logistic regression to analyse risk factors of positive bile culture. Results The total positive rate was 60.3%(82/136),in which malignant obstructive jaundice accounted 67.8%(59/87)and benign obstructive jaundice accounted 46.9%(23/49).14 strains bacteria were detected in 136 patients,which consisted of 6 strains of Gram-negative bacteria and 7 strains of Gram-positive bacteria,and 1 strain of fungus(candida albicans).The most common bacteria were Escherichia Coli,Enterococcus faecalis.The nature, site, time and degree of biliary obstruction were the risk factors for positive culture of bile bacteria(P<0.05). Conclusion The rate of positive bile culture was higher in obstructive jaundice patients without clinical infection,so it was necessary to use preventive antibiotics.

Objective To investigate the clinical effect of laparoscopic chole-cystectomy(LC),laparoscopic forward intubation through cystic duct combined with duodenoscope and intraoperative ultrasound in the one-stage treatment of cholecysto-lithiasis and thining choledocholithiasis. Methods Retrospective cohort study was performed to analyze the clinical data of 108 cases of cholecystolithiasis complicated with thining choledocholithiasis from June 2019 to August 2020.The 34 patients who underwent laparoscopic intubation through the the cystic duct duct during laparoscope,duodenoscope and intraoperative ultrasound were allocated into the study group,and the remaining 74 patients received treatment by laparoscope combined with duodenoscope were assigned to the control group. Results Both groups underwent laparoscopic cholecystectomy successfully.The intubated was successfully inserted via cystic duct into the duodenal papilla.Eight patients in the control group were failed to ERCP treatment.Instead,they were successfully treated with the study group treatment.Seven patients in the control group developed mild pancreatitis,while no pancreatitis was found in the study group.In the control group,3 cases possessed residual stones and the study group had 1 case.There was 1 case of duodenal perforation in the control group,and which was improved through surgical treatment.All 108 patients were followed up for 2-14 months, with a median follow up time of 7 months. No stone recurrence or death occurred. Conclusion Laparoscopic cholecystectomy,laparoscopic forward intubation through cystic duct combined with duodenoscope and intraoperative ultrasound for the one-stage treatment of cholecystolithiasis and thining choledocholithiasis are safe,effective and feasible.

Objective To study the clinical efficacy of  laparoscopic cholecystectomy under different time windows in the treatment of  mild biliary pancreatitis. Methods A total of  80 patients who were admitted with a diagnosis of mild biliary pancreatitis and underwent laparoscopic cholecystectomy at Nanjing Tongren hospital affiliated medical college of southeast university between February 2012 and February 2020 were selected randomly by digital random table method.After admission,Patients were divided into early surgery group and late surgery group according to operation time,with 40 cases in each group abdominal pain symptoms.Among them,LC treatment was performed after partial relief of abdominal pain in patients in the early surgery group,and LC treatment was performed after complete relief of abdominal pain in patients in the late surgery group.The clinical efficacy of the two groups was compared. Results The mean preoperative onset time between the two groups [(3.73±0.78) days vs.(6.88±1.07) days],and the difference was statistically significant(P<0.05).The conversion rate of open operation(5.0% vs.7.5%),operation time [(72.92±10.48) minutes vs.(74.02±9.94) minutes] and incidence of postoperative complications(5.0% vs.2.5%),there was no statistical significance between the two groups(P>0.05).Compared with the early surgery group,patients in the late surgery group had less intraoperative blood loss[(42.13±12.90)ml vs.(35.25±13.01)ml] and longer hospital stay [(7.73±0.78) days vs.(10.88±1.07) days]and increased hospitalization costs [(24 553.91±3 946.91) yuan vs.(27 617.96±4 276.29) yuan](all P<0.05).Although the difficulty of gallbladder triangle anatomy increased between the two groups,there was no significant difference in the rate of conversion to open surgery(P>0.05). Conclusion Early surgery for mild biliary pancreatitis does not  increase the perioperative complications and the conversion rate to open surgery,but it can significantly shorten the length of hospital stay,and reduce the economic burden of patients.

Objective To investigate the biological role and the potential mechanisms of LINC00221 in proliferation,migration and invasion of hepatocellular carcinoma(HCC) through ERK signaling pathway. Methods qRT-PCR was used to detect the expression of LINC00221 in HCC cell lines.MHCC-LM3 cell were divided into Blank control group,Negative control group,siRNA-LINC00221 group and siRNA-LINC00221+ERK activator group.The cell proliferation,migration and invasion capabilities were detected by Cell Counting Kit-8(CCK-8),wound-healing assay and Transwell assay.The expressions of MEK1/2 and p-ERK1/2 were examined by Western blot. Results LINC00221 expression were highly expressed in HCC cell lines(P＜0.05).Compared with negative control group,the proliferation,migration and invasion abilities of siRNA-LINC00221 group were inhibited(P＜0.01).Rescue experiments showed that the proliferation,migration and invasion of siRNA-LINC00221+ERK activator group were promoted as compared with siRNA-LINC00221 group(P＜0.01).Compared with Negative control group,the expressions of MEK1/2 and p-ERK1/2 were decreased in siRNA-LINC00221 group(P＜0.01).While MEK1/2 and p-ERK1/2 expression of siRNA-LINC00221+ERK activator group were increased as compared with siRNA-LINC00221 group(P＜0.01). Conclusion LINC00221 promotes HCC development via increasing activity of ERK/MEK pathway.LINC00221 may serve as a promising,novel therapeutic target in HCC.

Objective To investigate the relationship of plant homeodomain finger protein 2(PHF2) expression with clinicopathological features and prognosis in hepatocellular carcinoma. Methods 121 patients with hepatocellular carcinoma in our hospital from January 2015 to January 2019 were enrolled,their hepatocellular carcinoma tissues and para-carcinoma tissues were taken,and their clinical data were collected.PHF2 expression in cancer tissues was detected,and 3-year survival time was recorded.Then the correlation of PHF2 expression with clinicopathological parameters and prognosis of patients with hepatocellular carcinoma was discussed.Multivariate Cox regression was used to analyze the prognostic risk factors of hepatocellular carcinoma. Results The positive expression rate of PHF2 in adjacent normal tissues(104/121，86.00%) was significantly higher than that in cancer tissues(26/121,21.49%)(P＜0.05).PHF2 positive expression was not associated with age,gender,smoking history,or alcohol consumption history(P>0.05),while was associated with tumor diameter,pathological grade,serum hepatitis B surface antigen(HBsAg) and cirrhosis(P＜0.05).The mean survival time for patients with negative PHF2 expression was(16.24±2.11) months,which was significantly shorter than the patients with positive PHF2 expression[(21.29±2.18) months,P＜0.05].PHF2 expression level was an independent risk factor affecting the prognosis of patients with hepatocellular carcinoma. Conclusion The expression of PHF2 in hepatocellular carcinoma is associated with clinicopathological features and prognosis,and patients with negative expression may suffer a poor prognosis.

Objective To evaluate the levels of Pre-S1 antigen(PreS1Ag),Hepatitis B surface antigen(HBsAg) and PreS1Ag/ HBsAg levels,and to explore the effect of PreS1Ag/HBsAg levels on the risk of hepatocellular carcinoma in patients with HBV-related cirrhosis. Methods From March 2019 to April 2021,61 HBV-related liver cirrhosis patients in First People's Hospital of Hefei and 61 HBV-related liver cirrhosis patients without liver cancer from March 2019 to April 2021 were retrospectively enrolled.PreS1Ag/HBsAg levels,a logistic regression prediction model was established to analyze the effects of PreS1Ag,HBsAg levels and PreS1Ag/HBsAg levels on the risk of liver cancer in patients with HBV-related cirrhosis,and the ROC curve and decision curve were used to evaluate the predictive efficacy and clinical practicability of the model. Results The levels of PreS1Ag,HBsAg and PreS1Ag/HBsAg in patients with HBV-related cirrhosis were(112.36±20.47) ng/ml,(3.67±0.29) log IU/ml,and 1.14±0.20,respectively;Logistic regression analysis showed that age ,HBsAg,PreS1Agand PreS1Ag/HBsAg were risk factors for the risk of liver cancer in patients with HBV-related cirrhosis.ROC curve analysis showed that a predictive model was established based on multivariate Logistic regression analysis results.The results showed that HBsAg,PreS1Ag,and PreS1Ag/HBsAg had clinical value in predicting the occurrence of liver cancer in patients with HBV-related cirrhosis. Conclusion Age,HBsAg,PreS1Ag,PreS1Ag/HBsAg are risk factors for the occurrence of liver cancer in patients with HBV-related liver cirrhosis.HBsAg,PreS1Ag,PreS1Ag/HBsAg have clinical value in predicting the occurrence of liver cancer in patients with HBV-related liver cirrhosis.

Objective To compare analysis of different operation timing of coronary artery bypass grafting (CABG) for acute ST segment elevation myocardial infarction (STEMI). Method We retrospectively analyzed the clinical data and results of 206 patients who underwent CABG from January 2009 to December 2017 in Qingdao Municipal Hospital.There were 30 emergency/urgent surgeries (group A).Stable STEMI patients who underwent CABG after acute myocardial infarction 1 week within 30 days had 66 cases (group B).Randomly selected 110 patients with non-myocardial infarction undergoing elective CABG in the same period(group C).Comparing the general clinical data,surgical methods,coronary artery lesions,transplantation materials,postoperative complications,perioperative mortality,time of ICU stay,and IABP application of the three groups of patients.To follow these patients in cardiac surgery clinic or by telephone,and recording the time from discharge to the last follow-up and general clinical data. Result There was no statistically significant difference in the number of transplanted blood vessels and materials among the three groups.There was a statistically significant difference between group A and group B or between group A and group C in mortality,postoperative complications (low cardiac output,multiple organ failure,arrhythmia) and the use of IABP (P<0.05).The difference between group B and group C was no significant (P>0.05).Significant differences among three groups(A、B、C) at ICU time.A total of 183 patients were followed up by a follow-up rate of 88.8% with a period ranged from 10 to 26 months (20.7±3.12 months).One patient died of cerebrovascular accident in group A,one patient died of a traffic accident in Group C and there was no death in group B during follow-up. Conclusion CABG is safe for stable STEMI patients after 7 days of myocardial infarction within 30days with full preoperative preparation and can improve the patients survival.The patients with cardiogenic shock,persistent myocardial ischemia and mechanical concurrency should receive the emergency CABG to save lives.

Objective To explore the effect of thoracoscopic-assisted tricuspid valve surgery with minimally invasive right thoracotomy after left heart valve replacement. Methods A retrospective analysis of 28 patients with tricuspid valve surgery with minimally invasive right thoracotomy after left heart valve replacement was conducted in the First Affiliated Hospital with Nanjing Medical University from May 2018 to July 2020.Nine patients underwent tricuspid valve repair and 19 patients underwent tricuspid valve replacement.All the patients underwent double-lumen tracheal intubation under general anesthesia,with the right chest elevated,the main operating hole of 5cm from the right midclavicular line to the right midaxillary line at the 4th intercostal space,and the observation hole of 1cm at the 5th intercostal incision at the right midaxillary line.Cardiopulmonary circulation was established through right femoral artery and vein cannulation,and tricuspid valve surgery was completed under heart beating. Results Only one patient died during the perioperative period,the patient developed acute renal failure combined with pulmonary infection,and the rest patients recovered well after the operation.All the operations were performed under cardiopulmonary bypass with continuous heart beating,no patients were converted to sternotomy,and there was no intraoperative complication.The cardiopulmonary bypass time was (78±15)min,postoperative ICU extubation time (20.3±8.6)h,postoperative hospital stay (8.5±3.0)days,no postoperative third-degree atrioventricular block,postoperative echocardiography showed no paravalvular leakage.The patients were followed up for 12 to 30 months,no death was found,and the cardiac function was improved compared with that before the operation. Conclusion Tricuspid valve surgery with thoracoscopic-assisted minimally invasive right thoracotomy after left heart valve replacement is a safe and feasible surgical method,which can significantly simplify the surgical process and reduce postoperative mortality and complications.

Objective To compare the puncture needle type grab clamp three hole laparoscopic assisted laparoscopic and conventional double holes clinical effect in the treatment of acute appendicitis. Methods June 2019-September 2020 in our hospital of 60 patients with acute appendicitis,were randomly divided into normal group and the three hole piercing forceps group,30 cases each,regular conventional three out of three hole hole laparoscopic appendectomy,piercing,scratching clamp group adopted needle type pliers auxiliary double hole laparoscopic appendectomy,postoperative follow-up of 6 months,compared two groups of operation time,intraoperative blood loss,puncture time,incision length,cut suture time,postoperative complications such as index. Results Two groups of operation time,intraoperative blood loss comparison differences had no statistical significance(P>0.05).Biopsy forceps group in puncture time[(40.86±10.45)s vs (60.75±11.45)s],incision[(20.15±3.41)mm vs (27.61±3.12mm)], incision suture time[(4.22±0.86)s vs (5.35±0.75)s] was less than the conventional three hole group,difference had statistical significance(P<0.05).Two groups of anal exhaust time,postoperative hospitalization days there was no significant difference(P>0.05).Biopsy forceps group in 24 hours of postoperative incision pain score(2.11±0.25 vs 2.27±0.30),3 months after surgery scar length[(22.15±3.42)mm vs (33.24±4.32)mm] and the degree of postoperative incision(4.75±0.34 vs 4.33±0.48) was superior to the conventional three hole group,difference had statistical significance(P<0.05).Followed up for 6 months,two groups of postoperative complication such as infection,abdominal cavity infection in Trocar hole had no obvious difference,no statistical significance(P>0.05). Conclusion Needle type grab clamp auxiliary double hole laparoscopic appendectomy operation is simple,practical strong,does not increase operation difficulty and operation time,clinical feasibility is strong,reduce incision length,reduce postoperative pain,achieve more beautiful effect.

Objective To analyze the effects of end-to-side ileocolon and side-to-side ileocolon on diarrhea after radical resection of right colon cancer.Methods Total 90 right colon cancer subjects from Jingzhou First People's Hospital between June 2019 and June 2021 were recruited.According to different surgical anastomosis methods,patients were divided into group A(30 cases):ileocolonic anastomosis was performed by end-to-side anastomosis with A 25 mm circular stapler,and the colon stump was 5 cm;Group B(30 cases):ileocolonic anastomosis was performed end-to-side anastomosis with a 25 mm circular stapler,and the colon stump was 10 cm;Group C(30 cases):ileocolon anastomosis was performed side-to-side with a 75 mm linear cutter and closure device.Multivariate Logistic regression was used to analyze the risk factors of postoperative diarrhea and compare the effects of different surgical anastomosis methods. Results The results showed that 35 patients developed postoperative diarrhea, univariate analysis showed that age(P=0.033)，club ratio(P=0.015)，anastomosis(P=0.014)，recovery time(P=0.024)，postoperative antibiotic time(P=0.033) had statistical significance between diarrhea group and non-diarrhea group.Multivariate analysis showed that club ratio(P=0.012,OR=0.195) was an independent factor influencing the occurrence of diarrhea after right colon cancer.There were statistically significant differences between group A and group C(P<0.01,OR=0.181) and group B and group C(P=0.021,OR = 2.243).There was no statistical significance in group A compared with group B(P=0.661,OR=1.339).Therefore,the anastomosis method is also an independent factor influencing the occurrence of postoperative diarrhea in right colon cancer.There were statistical differences in the number of postoperative daily diarrhea(P=0.028),duration of postoperative diarrhea(P=0.045),intestinal sIgA(P=0.018) and blood D-lactic acid(P= 0.019) between the end-to-side anastomosis group and the side-to-side anastomosis group.
 Conclusion 1.Age,club ratio,anastomosis method,recovery time of liquid food and postoperative antibiotic time were correlated with the occurrence of diarrhea after right colon cancer radical resection.2.Club ratio and anastomosis were independent risk factors for diarrhea after radical resection of right colon cancer.3.The incidence and degree of postoperative diarrhea were both lower in the end-to-side anastomosis group than in the side-to-side anastomosis group,and the effects of simulated cecum 5 cm and simulated cecum 10 cm on postoperative diarrhea were similar.4.The changes of intestinal sIgA and blood D-lactic acid may be the mechanism of end-to-side anastomosis and side-to-side anastomosis affecting postoperative diarrhea.

Objective To study the clinical efficacy of transabdominal rectus abdominis preperitoneal combined with the intraperitoneal approach in the treatment of incarcerated femoral hernia. Method A prospective study was conducted on 56 cases of incarcerated femoral hernia admitted to the Surgery Department of Gastroenterology and Hernia from May 2019 to January 2022.The experimental group(30 cases) was treated with transabdominal rectus abdominis preperitoneal combined with intraperitoneal approach,and the control group(26 cases) was treated with traditional Mcvay repair.The operative time,wound length,postoperative length of stay,expenses,postoperative complications(wound infection rate,chronic discomfort and postoperative recurrence) were observed and compared between the two groups. Result Shorter operative time,shorter length of wound and less chronic discomfort in the experimental group were found than those in the control group(P＜0.05).There were no statistically significant differences in length of stay,expenses,wound infection rate,seroma severity and postoperative recurrence(P＞0.05). Conclusion Compared with McVay repair,the transabdominal rectus abdominis preperitoneal combined with the intraperitoneal approach has the characteristics of simple operation, short time and low incidence of chronic discomfort in the operative area.

Objective To investigate the effect of Lightweight Stereoscopic 3D Patch on complications,pain and quality of life followed up for one year in elderly patients with inguinal hernia treated with laparoscopic TAPP. Methods The clinical data of 203 elderly patients with inguinal hernia admitted and diagnosed in our hospital from September 2018 to August 2020 were retrospectively analyzed.All patients were treated with laparoscopic TAPP,and were included in the control group(105 cases) and the treatment group(98 cases) according to the different hernia patches in the data.The control group was given ordinary patch,and the treatment group was given Lightweight Stereoscopic 3D Patch.Postoperative pain was assessed by visual analogue scale(VAS),and quality of life before and after surgery was assessed by the Comprehensive Quality of Life Questionnaire-74(GQOLI-74).The surgery-related conditions,complications,postoperative pain,and quality of life before and after surgery were compared in two groups. Results The operation time[(57.34±4.69)min],postoperative ambulation time[(27.53±5.46)h] and hospital stay[(7.85±1.12)d] in the control group were longer than those in the treatment group[(50.65±4.31)min、(20.39±5.26)h、(5.76±0.73)d](P<0.05).The incidence of postoperative complications in the treatment group(3.06%) was significantly lower than that in the control group(11.43%)(P<0.05).The VAS scores of the control group at 1 day(3.89±0.84),4 days(3.47±0.74),7 days(2.82±0.64) ，1 month(1.74±0.46)after operation were higher than those in the treatment group[(3.01±0.57),(2.63±0.55),(2.09±0.52),(1.12±0.41)](P<0.05).One year after the operation,the scores of mental health(74.13±5.67),material life status(70.49±6.44),physical health(71.56±6.43) and social function(75.86±4.21) in the treatment group were significantly higher than those in the control group [(62.39±4.39),(61.53±4.35),(60.93±5.76),(62.82±3.24)](P<0.05). Conclusion Lightweight Stereoscopic 3D Patch combined with laparoscopic TAPP in the treatment of elderly patients with inguinal hernia has fewer postoperative complications,and at the same time can effectively relieve postoperative pain and improve the quality of life.

Objective To investigate the efficacy of unilateral dual-channel spinal endoscopic technique in the treatment of lumbar spinal stenosis. Methods A retrospective analysis was made of 68 patients with single-segment lumbar spinal stenosis who were treated in our hospital from January 2018 to March 2020.Among them,34 patients were treated with traditional hemilaminectomy and decompression(traditional group),34 patients Unilateral dual-channel spinal endoscopic technique(observation group) was used to compare the clinical efficacy and postoperative rehabilitation of the two groups of patients. Results Intraoperative blood loss [(84.53±13.62)ml],hospital stay [(11.36±3.51)d] and incision length [(8.53±1.53)cm] in the traditional group were significantly greater than those in the observation group[(37.82±10.27)ml,(7.40±2.67)d and (2.31±1.01)cm](P<0.05).The operation time of the observation group [(68.42±11.62)min] was longer than that of the traditional group[(52.27±10.89)min](P<0.05).At 3 months after operation,the JOA score,VAS score and ODI score of the traditional group were(20.24±3.43),(2.64±0.58),(19.54±4.21),respectively,while those of the control group were(22.58±3.61),(2.21±0.46),(16.41±5.11),the JOA score in the traditional group was significantly lower than that in the observation group(P<0.05),and the VAS score and ODI score in the observation group were significantly lower than those in the traditional group(P<0.05).The total incidence of complications in the observation group(11.76%) was slightly lower than that in the traditional group(17.65%)(P>0.05). Conclusion Compared with the traditional hemilaminectomy and decompression,the unilateral dual-channel spinal endoscopic technique for the treatment of lumbar spinal stenosis causes less trauma and better postoperative recovery effect.

Objective To investigate the feasibility and efficacy of the induced membrane technique combined with chimeric anterolateral thigh perforator leaf flap to cure limb exposed infection bone a nd multiple lacunar wounds. Methods From January 2016 to June 2019,28 patients with multiple lacunar wounds of limbs and bone exposure infection after internal fixation were treated in our hospital.The original internal fixation plate was retained, and the bone defect was occupied by antibiotic-loaded bone cement. The anterolateral femoral perforating branch lobular flap was used to repair the skin defect and wound, and the exposed bone space was filled with chimeric muscle flap.The wound area was from from 4cm×6cm to 8cm×14cm.Muscle flap resection range was about 3cm×6cm to 6cm×10cm.Direct closure of donor area or skin graft.Under the condition of bone infection control, bone cement was taken out 12 weeks after operation, and peanut sized granules were prepared by autologous iliac bone and fully implanted around the induction membrane.If the amount of autologous bone is insufficient, allogeneic bone should be added to repair the bone defect． Results All the 28 cases of flaps were survival well.And 22 cases of bone infection was cured at first intention,and the bone graft was clinical healed at second intention.6 cases of bone infection was cured after the second-stage expansion operation and antibiotic-containing bone cement implantation,then the bone graft was clinical healed.All patients were followed up for 12-24 months(mean 18 months).The color and texture of all flaps were good,the muscle strength of quadriceps femoris was normal,and the activity of knee joint was not affected. Conclusion Membrane induction technology combined with anterolateral femoral perforator and lobed chimeric tissue flap can simultaneously solve multiple wounds such as bone infection and bone exposed lacunar wounds.

Objective To analyze the curative effect of traditional and retrograde insertion of talar process screws for calcaneal fracture. Methods From March 2019 to January 2021,80 patients with calcaneal fracture in our hospital were selected for the study.According to the surgical methods of patients,the subjects were divided into control group(traditional method of anterograde insertion of talar protrusion screws) and experimental group(retrograde insertion of talar protrusion screws),with 40 cases in each group.Surgical indicators(operative time,intraoperative blood loss,fracture healing time),Preoperative and postoperative Bohler Angle,Gissane Angle,VAS score,AOFAS score,QOL score,and the incidence of clinical complications in 2 groups were compared. Results The operation time of the control group(103.52±12.50) minwas higher than that of the experimental group(96.89±11.25)min.The amount of intraoperative blood loss in control group(79.58±9.13)ml was higher than that in experimental group(60.25±8.71)ml.The fracture healing time of the control group(15.52±2.51) weeks was higher than that of the experimental group(11.47±2.03) weeks,and the differences were statistically significant(P<0.05).After operation,Bohler Angle(31.08±4.22)°and Gissane Angle(125.99±4.38)°in experimental group were higher than those in control group(25.74±3.07)° and(110.48±5.12)°,with statistical significance(P<0.05).After operation,QOL score(80.04±5.29) and AOFAS score(82.55±7.46) of experimental group were higher than those of control group(68.17±4.79) and(64.03±6.14),VAS score of experimental group(1.28±0.42) was lower than that of control group(3.02±1.23).The differences were statistically significant(P<0.05).The incidence of complications in experimental group(7.50%) was lower than that in control group(15.00%),there was no statistical significance(P>0.05). Conclusion Retrograde insertion of talus process screws in the treatment of calcaneal fracture can significantly improve the condition of fracture,relieve pain,and improve the short-term quality of life of patients.

Objective To explore the roles of the basic leucine zipper ATF-like transcription factor (BATF) in the progression of kidney renal clear cell carcinoma (KIRC). Methods The expression levels of BATF in KIRC,and the roles of BATF in prognosis and immunity were analyzed using the UALCAN,TISIDB, Kaplan-Meier plotter,OncoLnc and Sangerbox databases. Results The expression level of BATF in KIRC tissues was significantly increased and correlated with the poor Overall survival.BATF overexpression was significantly associated with cancer stage,histological subtype,and lymph node metastasis in patients with KIRC.In addition,the methylation level of BATF in KIRC tissues was negatively correlated with tumor stage,tumor grade,and lymph node metastasis.BATF overexpression was positively correlated with the immune B cells,CD8+T cells,CD4+T cells,macrophages,and dendritic cells. Conclusion BATF was highly expressed in KIRC.BATF overexpression was associated with the poor prognosis in patients with KIRC,and was associated with KIRC immune infiltration cells,indicating that BATF was expected to be a biomarker and immune-related marker molecule for the poor prognosis of KIRC.

Objective  To report a case of renal clear cell carcinoma metastasis of ipsilateral adrenal after radical nephrectomy,and to analyze its symptoms,signs,diagnosis and treatment process,and discuss in accordance with the latest EUA and CSCO guidelines. Methods  The clinical data,diagnosis and treatment of a patient with renal clear cell carcinoma metastasis of ipsilateral adrenal more than one year after radical nephrectomy were retrospectively analyzed. Results The patient underwent laparoscopic radical left renal resection after renal cancer was found,and robot-assisted laparoscopic left adrenal resection after adrenal metastasis was found.Anti-infection,analgesia,hemostasis,fluid replacement and other treatments were given after the surgery,and the patient recovered well. Conclusion Adrenal metastasis of renal carcinoma is rare and difficult to detect in early stage,resulting in delayed treatment.Mastering comprehensive clinical features combined with authoritative guidelines for the diagnosis and treatment of renal carcinoma is helpful for early diagnosis and treatment of adrenal metastasis of renal carcinoma.

The onset of cholangiocarcinoma is insidious and the degree of malignancy is extremely high.Most of the patients are already in the advanced stage when they are first diagnosed and have lost the opportunity of radical surgery.The prognosis of patients is poor and the quality of life is low.Currently,the common treatment methods for unresectable cholangiocarcinoma include biliary stent,radiotherapy and chemotherapy,radiofrequency ablation,targeted therapy and immunotherapy,etc.However,due to the poor degree of malignancy of biliary duct tumor,radiotherapy and chemotherapy are not sensitive and prone to drug resistance,the existing treatment methods are limited in improving the survival time and quality of life of patients.Therefore,clinicians urgently need to explore new treatment strategies to overcome the current dilemma.Photodynamic therapy (PDT),as a new treatment for cholangiocarcinoma,has attracted attention due to its excellent local anti-tumor effect.In this paper,the research and development of photosensitizers,the molecular mechanism,and the clinical application of PDT in recent years are summarized.Combined with the corresponding clinical work carried out by the author's team,the spots and potential of PDT research are described,so as to provide references for clinical and scientific research.

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.