Hilar cholangiocarcinoma (HCCA) is a common malignant tumor of the biliary system.Radical HCCA resection with combined vascular resection and reconstruction can help achieve R0 re section,improve tumor resectability,and enhance patient outcomes.With the increasing popularity of minimally invasive surgical techniques such as laparoscopy and robotic surgery,more and more centers are beginning to experiment with minimally invasive HCCA resection with combined vascular resection and reconstruction.However,due to the complex anatomy of the hilum and the limitations of minimally invasive techniques,completing HCCA revascularization and reconstruction under minimally invasive conditions is particularly challenging.The author has accumulated considerable experience in minimally invasive HCCA vascular resection and reconstruction.This article will discuss the technical challenges of minimally invasive HCCA vascular resection and reconstruction,indication selection,established revascularization techniques,reconstructive skills,and remedial measures after reconstruction failure.

Recent innovations in endoscopic techniques have dramatically transformed the landscape of biliary and pancreatic disease management,particularly through the synergistic integration of peroral choledochoscope-assisted cholangioscopy and endoscopic retrograde cholangiopancreatography (ERCP).This article delves into the clinical utility of peroral choledochoscope within the ERCP framework,highlighting its pivotal role in enhancing diagnostic precision.

Gallbladder cancer (GBC) is a relatively rare malignant tumor with poor prognosis,which is usually diagnosed in the late stage due to the lack of obvious early symptoms and specific clinical manifestations.Surgery is the only possible cure for gallbladder cancer,but the choice of surgical approach and scope is still controversial.In recent years, the application of targeted therapy and immunotherapy in advanced gallbladder cancer has brought new hope to patients.This article reviews the epidemiologic features,risk factors,pathologic characteristics,and current diagnostic and therapeutic strategies of gallbladder cancer,and discusses several controversial topics,aiming to provide a reference for clinical management.

Objective To investigate the prognostic value of lectin galactoside binding soluble 3 binding protein (LGALS3BP) and growth differentiation factor-15 (GDF-15) in patients with severe acute pancreatitis (SAP).Methods Ninety patients with SAP (SAP group) and 90 patients with mild pancreatitis (MAP) and moderately severe acute pancreatitis (MSAP) (non-SAP group) who attended the First Affiliated Hospital of Xi'an Medical College from January 2021 to January 2024 were foresight selected.The SAP group was separated into a good group(47 cases) and a bad group(43 cases) according to prognosis.Clinical data and relevant testing indicators were collected from the researchers.Compare the levels of serum LGALS3BP and GDF-15 in the SAP group and the non-SAP group; conduct Pearson correlation analysis; perform multivariate Logistic analysis to identify the influencing factors for the prognosis of SAP patients; and use ROC curve analysis to evaluate the value of serum LGALS3BP and GDF-15 in predicting the prognosis of SAP patients.Results Compared with the non-SAP group group,the serum LGALS3BP and GDF-15 levels in the SAP group were greatly increased (65.26ng/ml vs. 118.63ng/ml,1763.46ng/ml vs.2534.83pg/ml,P<0.05).There was a positive correlation between serum LGALS3BP and GDF-15 (r=0.479,P<0.05).The expression levels of LGALS3BP and GDF-15 were lower in SAP patients at 48 h and 72 h after admission than at 24 h after admission,and the expression levels of LGALS3BP and GDF-15 were lower in SAP patients at 72 h after admission than at 48 h after admission (P<0.05).Compared with the poor group,the serum levels of LGALS3BP and GDF-15 in the good group were greatly reduced (135.13ng/ml vs. 103.53ng/ml,2879.63pg/ml vs. 2219.37pg/ml,P<0.05).Compared with the poor group,the C-reactive protein and BISAP scores of SAP patients in the good group were greatly reduced (P<0.05).LGALS3BP and GDF-15 were risk factors affecting the prognosis of SAP (P<0.05).The AUC of serum LGALS3BP for predicting the prognosis of SAP patients was 0.897,with sensitivity and specificity of 81.40% and 93.62%,respectively.The AUC of serum GDF-15 in predicting the prognosis of SAP patients was 0.897,with sensitivity and specificity of 76.74% and 93.62%,respectively.The AUC for predicting the prognostic effect in SAP patients with serum LGALS3BP and GDF-15 combination was 0.974,with sensitivity and specificity of 95.35% and 89.36%,respectively.The Zcombination-LGALS3BP and Zcombination-GDF-15 was 2.194 and 2.227,respectively,with P<0.05.Conclusion Serum LGALS3BP and GDF-15 expression levels are elevated in SAP patients and have a poor prognosis SAP patients have higher serum LGALS3BP and GDF-15 expression levels.Elevated serum LGALS3BP and GDF-15 are detrimental to patient prognosis,and the combination of the two may be used in the future for prognostic assessment of patients with SAP.

Objective To investigate the application effect of high flow humidified oxygen therapy combined with tracheotomy in elderly patients with cerebral hemorrhage and analyze the risk factors of pulmonary infection.Methods A total of 140 elderly patients with cerebral hemorrhage who underwent tracheotomy in our hospital from 2019 to 2023 were selected as the study objects,of which 93 patients receiving high-flow humidified oxygen therapy were selected as the observation group,and 47 patients receiving conventional low-flow oxygen therapy were selected as the control group during the same period.The changes of PaO₂,SpO₂,heart rate and mean arterial pressure were compared,and patients in the observation group were divided into infected group (n=26) and non-infected group (n=67) according to whether pulmonary infection occurred during hospitalization.The risk factors affecting pulmonary infection during hospitalization in elderly patients with cerebral hemorrhage were analyzed,and a nematographic prediction model was built to predict the risk of pulmonary infection.Results The PaO₂ and SpO₂ levels in observation group were higher than those in control group at 24h and 72 h,but the respiratory rate was lower than that in control group (P<0.05).The improvement of sputum viscosity in the observation group (68 cases of grade Ⅰ sputum and 25 cases of grade Ⅱ sputum) was better than that in the control group (16 cases of grade Ⅰ sputum,17 cases of grade Ⅱ sputum and 14 cases of grade Ⅲ sputum).The rate of phlegm scab formation (0) and the number of sputum aspiration (5.15±1.08) times were lower than those in the control group [14.87%,(8.17±1.82) times] (P<0.05).There were significant differences in tracheotomy time,smoking history,bed rest time,mechanical ventilation time and nasal feeding tube retention time between infected and non-infected groups (P<0.05).Logistic regression analysis showed that tracheotomy time > 5d,smoking history,bed time > 10d,mechanical ventilation time ≥24h,nasal feeding tube retention time ≥10d were the risk factors for pulmonary infection in elderly patients with cerebral hemorrhage during treatment (P<0.05).The AUC,sensitivity and specificity were 0.696,0.565 and 0.889 in elderly patients with cerebral hemorrhage complicated by pulmonary infection during treatment.Conclusion High-flow humidification oxygen therapy combined with tracheotomy can improve the oxygenation status in elderly patients with cerebral hemorrhage,but the time of tracheotomy,smoking history,bed rest time,mechanical ventilation time,and nasal feeding tube retention time will affect the pulmonary infection during treatment.The construction of a nomogram model based on these risk factors has higher predictive efficacy in evaluating the pulmonary infection.

Objective To explore the risk factors for pain after puncturing localization using Hookwire needles for preoperative pulmonary nodules resections, providing theoretical evidences for reducing post-localization complications in patients.Methods For cross-sectional analysis,141 patients undergoing preoperative CT-guided localization using Hookwire needles for preoperative single pulmonary nodule resections in Nanjing Chest Hospital from February 2024 to May 2024.The pain levels of the patients after localization were recorded according to the numerical rating scales(NRS).Comparions the pain levels between patients' genders,ages,BMI,sides,number of intercostals at the puncture point,depths of puncture needle penetration through the chest wall,depths of puncture needle penetration in the lungs,whether the needles were inserted tightly against the ribs,and whether the needle were inserted tightly against the scapula.The influencing factors causing pain were explored by univariate analysis as well as ordered Logistic analysis.Results All 141 patients were successfully localized without serious complications,and the results of univariate analysis showed that BMI,depth of penetration within the thoracic wall of the puncture needle,whether or not the needle was inserted tightly against the ribs,and whether or not it was inserted tightly against the scapula were correlated with the post-positioning pain,and the differences were statistically significant from each other(P<0.1).Ordered Logistic regression analysis showed that the depth of penetration within the chest wall of the puncture needle (OR=1.484,95%CI=0.033~0.758,P＜0.05),and whether or not the needle was inserted tightly against the rib cage (OR=9.440,95%CI= 1.434~3.056,P＜0.05) and tight scapular entry (OR=9.994,95%CI=0.957~3.646,P＜0.05) were risk factors for pain after positioning.Conclusion The deepth of localization needle penetrating in the chest wall and puncturing close to the edge of scapula and ribs are the risk factors for pain after puncturing localization using a Hookwire needle for preoperative pulmonary nodules resection.

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

Objective To study the application value of the supraclavicular and anterior sternocleidomastoid space approach in open thyroid cancer surgery.Methods A retrospective study of 65 patients with thyroid cancer from January 2023 to December 2023 was conducted,the patients were divided into experimental group (30 cases) and control group (35 cases),which received thyroid cancer operation via supraclavicular and Sternocleidomastoid muscle anterior space approach and conventional open thyroid cancer operation respectively.The perioperative period,quality of life,pain and complications were compared between the two groups.Results The incision length, the number of lymph nodes removed, the operation time, the blood loss, the drainage volume, the drainage time and the hospital stay in the observation group were (4.00±0.76) cm, (6.41±0.73), (66.32±2.93) minutes, (37.14±6.69) mL, (1.41±0.59) days and (16.68±1.9), respectively 1) ml and (5.14±1.25) days.The control groups were (5.54±1.03) cm, (4.31±0.68) pieces, (80.42±2.96) minutes, (55.54±2.67) ml, (3.15±0.67) days, (31.19±1.96) ml and (7.88±1.28) days respectively. There was a statistically significant difference between the two groups (P<0.001).Under the effects of interaction, time point effect and inter-group effect, the EQ-5D-5L scale and NRS score will change with the time point variation due to different surgical methods. The incidences of choking cough when drinking water, neck tightness sensation and total adverse events in the observation group were lower than those in the control group, and the difference was statistically significant (P<0.001).Conclusion The supraclavicular and anterior sternocleidomastoid approach can reduce the length of incision,shorten the operation time,reduce postoperative pain and complications,and improve the quality of life of patients with thyroid cancer.

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

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

Objective To analyze the efficacy of autologous tissue repair for rectocele through the perineal approach in treating constipation and fecal incontinence in patients.Methods From January 2021 to November 2022, 23 female patients with symptomatic rectal protrusion were treated with perineal autologous tissue repair.Preoperatively and at 12 months postoperatively,the Cleveland Clinic Constipation Score (CCCS), Cleveland Clinic Incontinence Score (CCIS), and Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaires were used to assess postoperative outcomes and quality of life.Results Among the 23 patients,with a median follow-up time of 12.6 months,CCCS decreased from 17.09±1.68 to 3.96±2.08 (P<0.05);CCIS decreased from 1.52±4.15 to 0.52±1.41 (P>0.05);PAC-QOL:physical discomfort decreased from 13.00±1.51 to 4.74±1.98 ;psychological discomfort decreased from 20.96±3.27 to 5.74±2.67 ;concern and anxiety decreased from 26.13±4.37 to 8.78±3.14 ;satisfaction decreased from 15.39±2.35 to 4.60±1.59 (P<0.05).All patients showed significant improvement in constipation and incontinence symptoms postoperatively,with no serious postoperative complications and a marked improvement in postoperative quality of life.Conclusion Rectocele repair with perineal approach using autologous tissue is an effective and safe method,avoiding potential potential complications associated with grafts.

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

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

Objective To investigate the clinical effect of percutaneous injection of calcitonin and methylprednone in the treatment of aneurysmal bone cyst in children.Methods From June 2020 to March 2023, 19 patients with aneurysmal bone cysts were admitted and all were treated with percutaneous puncture injection of calcitonin and methylprednisolone.After percutaneous puncture biopsy,200iu of calcitonin and 120mg of methylprednone were injected into the cyst of aneurysmal bone cyst.Compare the volume of the cyst cavity and the thinnest cortical bone thickness around the cyst cavity before and after the operation.All patients were followed up,while preoperative and postoperative tumor cavity and the thinnest peritumor cortical thickness were compared.Results 19 patients were followed up for an average of 16 months(12-52 months).Of the 19 patients,17 were effective,the effective rate was 89.5%,and no serious complications occurred in all cases.At the last follow-up,the volume of the tumor cavity was significantly lower than that before surgery[(37.05±21.17)cm³,(110.95±45.67)cm³],and the difference was statistically significant(P<0.05).The average thinnest cortical bone thickness around the tumor cavity was (0.71±0.37)mm before surgery and (1.87±0.60)mm after surgery.The difference was statistically significant(P<0.05).Conclusion Percutaneous injection of calcitonin and methylprednone in the treatment of aneurysmal bone cysts in children is minimally invasive,safe and effective.It can be used as the first-line treatment for aneurysmal bone cyst in children.

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

Objective To investigate the role of matrix GLA protein(MGP) in the pathogenesis of idiopathic calcium oxalate kidney stones(ICOS),and to find potential biomarkers for early diagnosis and disease evaluation.Methods A total of 120 patients admitted to our hospital from September 2021 to September 2023 were prospectively included,of which 60 patients with ICOS were in the calculus group and 60 patients without calculus were in the control group.Serum biochemical indexes and immunohistochemical scores of the two groups were detected,urinary MGP levels were determined by ELISA,and MGP mRNA and protein expression in renal papilla tissues were detected by qPCR and Western blot.The independent risk factors of ICOS were screened by Logistic regression analysis,and the prediction model was drawn by nomogram.Results Compared with control group,urinary MGP content in calculus group was decreased[(1805.91±244.44)pg/ml vs.(2014.79±252.14)pg/ml,P<0.05).Expression of MGP mRNA and MGP protein in renal papillae decreased(0.89±0.15 vs.1.00±0.00,P=0.001) and decreased(0.87±0.18 vs.1.00±0.00,P<0.05).MGP immunohistochemical scores of renal tissue were decreased [4(2-6) scores vs.6(4-8) scores,P<0.001].Multivariate analysis showed that urinary calcium(OR=1.370),urinary MGP(OR=1.127),renal papilla MGP relative expression level(OR=27.532) and renal tissue MGP immunohistochemical score(OR=1.359) were independent risk factors for ICOS.Area under ROC curve of the nomogram prediction model built based on the above factors is 0.839,indicating that the model has good differentiation ability in risk prediction.Conclusion MGP is closely related to the pathogenesis of ICOS.Urinary and renal tissue MGP levels may be potential biomarkers for early diagnosis and disease assessment of ICOS.

Objective To investigate the effects and mechanisms of replication activating factor C2(RFC2) on the proliferation and migration of renal cell carcinoma(RCC) cells.Methods Western blotting was used to determine and compare the expression levels of RFC2 protein in human normal renal tubular epithelial cell lines HK-2 and RCC cell lines ACHN,786-O,Caki-1,KETR3,and OS-RC2.The KETR-3 cell line was transfected with Lipofectamine 3 000 using RFC2 small interfering RNA(siRNA) and control inhibitory sequence scaffold,respectively,and divided into RFC2 silenced expression group(si-RFC2) and inhibitory control group(si-NC).Transfect RFC2 overexpression plasmid(RFC2 plasmid) and blank control plasmid,and divide into RFC2 overexpression group(OE-RFC2) and overexpression control group(Vector).Cell proliferation ability was detected using Methylthiazolyldiphenyl-tetrazolium bromide(MTT) cell proliferation detection kit,cell migration ability was measured using cell scratch assay,and protein blotting assay was used to determine the expression levels of RFC2,p-PI3K,PI3K,p-Akt,and Akt proteins.Results Compared with the normal human renal tubular epithelial cell line HK-2,the RCC cell lines ACHN,786-O,Caki-1,KETR3,and OS-RC2 showed high expression of RFC2 protein(all P<0.001).MTT assay showed that the A_490nm values of the si-RFC2 group were lower than those of the si-NC group at 0,24,48,and 72h(all P<0.05),while the A_490nm values of the OE-RFC2 group were higher than those of the Vector group at 0,24,48,and 72h(all P<0.05).The scratch healing rate of the OE-RFC2 group was higher than that of the Vector group[(89.4±9.4)% vs(15.8±6.3)%,P<0.05].The cell scratch healing rate in the si-RFC2 group was lower than that in the si-NC group[(5.2±1.9)% vs(16.5±5.5)%,P<0.05].After upregulating RFC2 expression in KETR-3 cells,the relative expression level of RFC2 protein in the OE-RFC2 group was higher than that in the Vector group(1.04 ± 0.19 vs 0.25±0.03,P<0.05),the p-PI3K/PI3K ratio in the OE-RFC2 group was higher than that in the Vector group(1.15±0.23 vs 0.34±0.024,P<0.05),and the p-Akt/Akt ratio in the OE-RFC2 group was higher than that in the Vector group(1.26±0.25 vs 0.38± 0.022,P<0.05).After silencing the expression of RFC2,the relative expression level of RFC2 protein in the si-RFC2 group was lower than that in the si-NC group(0.16 ± 0.02 vs 1.08 ± 0.06,P<0.05),the p-PI3K/PI3K ratio in the si-RFC2 group was lower than that in the si-NC group(0.18 ± 0.04 vs 0.86±0.14,P<0.05),and the p-Akt/Akt ratio in the si-RFC2 group was lower than that in the si-NC group(0.10±0.01 vs 0.58±0.13,P<0.05).Conclusion RFC2 promotes the proliferation and migration of renal cell carcinoma cells,and the mechanism may be related to the activation of the PI3K/Akt signaling pathway.

Objective To investigate the clinical efficacy and aesthetic outcome of liposuction combined with mammary adenectomy through a periareolar small incision in the management of gynecomastia (GYN).Methods From January 2019 to June 2023, 18 patients with GYN were admitted. All of them were treated with small incision through the areola combined with liposuction. The postoperative aesthetic effect, occurrence of complications and patient satisfaction of the patients were evaluated.Results All 18 patients in this study were follwed up for a period of 3 to 18 months.No serious complications such as wound infection or necrosis of the nipple-areola occurred.Pathological examinations were consistent with the diagnosis of GYN.Except for one patient,who exhibited slight skin folds in the surgical area at the 12-month follow-up,the other patients all achieved symmetrical and smooth chest contours with noticeable aesthetic improvement,resulting in a 100% patient satisfaction rate.Conclusion The combined approach of liposuction combined with mammary adenectomy through a periareolar small incision for the treatment of GYN is straightforward,minimally invasive,and yields satisfactory therapeutic and aesthetic outcomes.

Objective To observe the impact of low-dose oxycodone-nalbuphine on pain mediator release in patient-controlled intravenous analgesia (PCIA) following laparoscopic radical resection of rectal cancer.Methods 120 patients who underwent laparoscopic radical surgery for colorectal cancer in our hospital from October 2022 to September 2023 were selected and randomly divided into the control group and the experimental group（60 cases in each).PCIA was administered within 48h postoperatively,formulated as 10mg hydromorphone and 40mg nalbuphine diluted in saline to 100ml.No background dose was administered in the control group,and a background dose of 1ml/h was administered in the test group.Compare the number of effective PCIA compressions, the rate of remedial analgesia, the rate of remedial antiemesis, the dosage of analgesic pump, Visual Analogue Scale (VAS), Ramsay sedation score, the release of serum pain mediators and the occurrence of postoperative adverse reactions in patients within ≤24 hours and 24-48 hours.Results VAS Scores:The VAS scores during activity in the experimental group at 24h and 48h after surgery (2.21±0.25,1.78±0.44) were lower than those in the control group (2.58±0.23,2.12±0.27) (both P<0.05).The VAS scores at rest in the experimental group at 12h,24h,and 48h after surgery (2.52±0.28,2.14±0.26,1.75±0.32) were lower than those in the control group (3.17±0.39,2.68±0.33,2.04±0.21) (P<0.05).Pump Usage:The amounts of analgesic pump used in the experimental group at 24h and 48h after surgery [(27.64±0.28)ml,(49.11±0.25)ml] were higher than those in the control group [(12.06±0.33)ml,(20.15±0.36)ml)] (both P<0.001).PCIA Pressing Times:The effective pressing times of PCIA in the experimental group within ≤24h and 24-48h (5.89±0.31,4.73±0.28) were lower than those in the control group (7.28±0.38,6.21±0.37) (both P<0.001).Rescue Analgesia and Antiemesis Rates:The rescue analgesia rate (11.67% vs 28.33%,P=0.023) and rescue antiemesis rate (5.00% vs 18.33%,P=0.023) in the experimental group were both lower than those in the control group.Ramsay Sedation Scores:The Ramsay sedation scores in the experimental group at 12 h,24 h,and 48 h after surgery (2.18±0.31,1.74±0.42,1.46±0.14) were lower than those in the control group (2.43±0.48,2.12±0.32,2.03±0.38) (P<0.001).In the experimental group, substance P [(35.26±5.27)pg/ml, (26.37±4.17)pg/ml], neuropeptide Y[(147.28±27.43)pg/ml, (127.26± 18.49)pg/ml], and prostaglandin E2[(56.48±3.69) at 24 hours and 48 hours after the operation 9) The levels of pg/ml, (42.47±5.35)pg/ml and norepinephrine [(3.12±0.48)ng/ml, (1.57±0.19)ng/ml] were all lower than those of the control group [(41.27±6.48)pg/ml, (34.37±4.86)pg/ml, (35.26± 5.27 pg/ml, (26.37±4.17)pg/ml, (62.47±4.26) pg/ml, (53.95±4.73)pg/ml, (3.64±0.64) ng/ml, (2.16±0.26) ng/ml, (P < 0.001)].Conclusion Low-dose oxycodone-nalbuphine in patient-controlled intravenous analgesia following laparoscopic radical resection of rectal cancer can improve analgesic effects and reduce serum pain mediator release.

Biliary tract cancer (BTC) due to its subtle early symptoms,approximately 60%-70% of patients are diagnosed at an advanced stage,limiting the effectiveness of treatment.While traditional treatment methods such as surgery and chemotherapy remain the primary approaches,their efficacy is limited by the heterogeneity of the disease and the development of resistance.Recently,targeted therapies and immunotherapy have emerged as promising strategies,showing good prospects in clinical trials.Targeted drugs addressing common genetic mutations in BTC,such as FGFR2 gene fusion,IDH1 mutations,and HER2 amplification,have shown some therapeutic efficacy.In addition,the combination of immune checkpoint inhibitors with chemotherapy has shown potential in prolonging survival.However,targeted and immunotherapy for BTC still faces challenges,and future research should focus on personalized treatment,combining genetic testing and immunotherapy to further optimize therapeutic strategies and improve patient quality of life.

Complications such as pancreatic leakage,biliary leakage and abdominal infection may occur after pancreaticoduodenectomy.Previous surgeons have recommended routine preventive drainage for early detection and treatment of complications.In recent years,with the rise of the idea of accelerated rehabilitation,this view has been questioned and disputed.In this paper,five aspects of drainage tube placement after pancreaticoduodenectomy,drainage mode,drainage placement area,when to remove the drainage tube,and re-catheter drainage after surgery are reviewed.

Colorectal cancer has a high incidence and mortality rate,and some patients do not benefit from existing treatments.Intestinal inflammation is one of the major risk factors for colorectal cancer,and an abnormal tumor immune microenvironment plays a crucial role in its occurrence and progression.As a deubiquitinating enzyme,USP11 stabilizes target proteins by removing ubiquitin molecules,thereby exerting dual roles in the antitumor immunity of colorectal cancer.USP11 enhances the specific recognition and cytotoxic function of T cells,promotes the differentiation and regulation of CD4⁺ T cells,and induces macrophage polarization.Investigating the role and regulatory mechanisms of USP11 in colorectal cancer may provide new strategies and targets for its treatment.