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

Since the emergence of thoracoscopic surgery in the 1990s,innovations in surgical approaches for thoracic surgery have never ceased.During this process,the subxiphoid approach has gradually stood out due to its distinctive perspective advantages,superior cosmetic outcomes,and significant reduction in postoperative pain.After entering the 21st century,multi-center research teams,both domestically and internationally,have continuously expanded the application scope of the subxiphoid approach,transforming it from an early exploratory technique into one of the conventional surgical methods in thoracic surgery.Currently,the subxiphoid approach has demonstrated its unique value in clinical settings,including mediastinal tumor resection,lung surgery,chest wall surgery and diverse biopsies.This article aims to provide a systematical elaboration on the latest progress in the application of the subxiphoid approach and explore its future development trends.

With the widespread implementation of lung cancer screening among high-risk populations,the detection rate of peripheral pulmonary nodules has been steadily increasing,posing higher demands for precise diagnosis and minimally invasive treatment.Robotic-assisted bronchoscopy(RAB) technology integrates high-precision navigation,stable control,and advanced imaging fusion capabilities,significantly enhancing the targeting accuracy and biopsy efficiency of peripheral lung lesions.This review systematically examines the technical principles,system innovations,and clinical applications of the major RAB platforms,as well as their exploratory use in preoperative localization and local therapy.Robotic bronchoscopy holds great promise as a key platform for the diagnosis and treatment of peripheral pulmonary nodules,heralding a new era of precision and minimally invasive interventional pulmonology.

The widespread implementation of low-dose computed tomography screening has led to a substantial rise in the detection of pulmonary nodules,with multiple pulmonary nodules(MPNs) now representing a common clinical presentation.Conventional diagnostic and therapeutic paradigms,characterized by sequential,multi-site processes,are often limited by inefficiency,safety concerns,and suboptimal patient outcomes.In contemporary thoracic surgery,a transformative "one-stop" precision management strategy has emerged within hybrid operating theaters.This integrated approach synergizes intraoperative imaging,advanced navigation,and surgical intervention to address these limitations.Cone-beam CT plays a pivotal role in this model by leveraging its maneuverability,low radiation,and high spatial resolution to greatly facilitate the development of precise diagnosis and treatment for MPNs.

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

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

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

Idiopathic Pulmonary Fibrosis(IPF) is a progressive disease characterized by declining respiratory function and high mortality.Macrophages play a pivotal role in its pathogenesis.Through polarization into pro-inflammatory M1 and pro-fibrotic M2 phenotypes,they contribute to a complex immunoregulatory network.In the early disease stages,M1 macrophage-mediated inflammation causes lung tissue injury,while M2 macrophages drive fibrogenesis by releasing pro-fibrotic factors such as TGF-β.Recent research has revealed that exosomes derived from macrophages serve as carriers for miRNAs,with specific miRNAs (e.g.,miR-328,miR-142-3p) demonstrating significant roles in pulmonary fibrosis.miR-328 promotes fibroblast proliferation and accelerates collagen deposition,whereas miR-142-3p attenuates fibrosis by modulating the TGF-β signaling pathway.Targeted intervention against these macrophage-associated miRNAs shows potential for clinical translation,potentially offering novel approaches for the early diagnosis and targeted therapy of IPF.However,translating these strategies into clinical practice requires overcoming challenges related to production and delivery systems.In conclusion,a deeper understanding of the mechanisms and translational applications of macrophage-derived miRNAs in IPF holds promise for ultimately improving patient prognosis and clinical outcomes.

Objective To analyze the expression levels of long non-coding RNA(lncRNA) XIST and microRNA(miR)-186-5p in non-small cell lung cancer(NSCLC) tissues and their relationship with pathological features and prognosis.Methods From September 2020 to March 2022,92 NSCLC patients who underwent diagnosis and surgical treatment in our hospital were collected.Cancer tissues(study group) and adjacent tissues(control group) of NSCLC patients were collected during surgery,and real-time quantitative reverse transcription polymerase chain reaction(qRT-PCR) was employed to detect the expression levels of lncRNA XIST and miR-186-5p in both cancerous and adjacent non-cancerous tissues.A 2-year follow-up was conducted after surgery.NSCLC patients were separated into survival group and death group.Pearson method was applied to analyze the correlation between lncRNA XIST and miR-186-5p in cancer tissue.Cox regression was applied to analyze the factors affecting the prognosis of patients.Kaplan-Meier was applied to analyze the relationship between lncRNA XIST,miR-186-5p expression and prognosis in patients.Results The expression level of lncRNA XIST in cancer tissues of NSCLC patients was obviously higher than that in adjacent tissues(1.44±0.43 vs 1.03±0.16),and the expression level of miR-186-5p was obviously lower than that in adjacent tissues(0.76±0.18 vs 0.97±0.21)(P<0.05).There was a targeted binding site between lncRNA XIST and miR-186-5p in cancer tissue of NSCLC patients,and their expression levels were negatively correlated(r=0.416,P<0.05).TNM staging,lymph node metastasis,and degree of differentiation had a obvious impact on the expression of lncRNA XIST and miR-186-5p in NSCLC patients(P<0.05).TNM staging,lymph node metastasis,degree of differentiation,and lncRNA XIST were risk factors for the prognosis of NSCLC patients.miR-186-5p was a protective factor for the prognosis of NSCLC patients(P<0.05).The 2-year survival rate of NSCLC patients with low expression of lncRNA XIST(92.16%) was higher than that of high expression of lncRNA XIST(73.17%).The 2-year survival rate of NSCLC patients with high expression of miR-186-5p(91.23%) was higher than that of low expression of miR-186-5p(71.43%).Conclusion In cancer tissues of NSCLC patients,the expression level of lncRNA XIST is increased,while the expression level of miR-186-5p is reduced.lncRNA XIST and miR-186-5p are related to the prognosis of NSCLC patients.

Objective To study the relationship between the expression of long non-coding RNA lung adenocarcinoma metastasis-associated transcript 1 (lncRNA MALAT1) and microRNA (miR)-181a-5p in lung adenocarcinoma tissues and the signal pathway of Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3),clinicopathological features and prognosis.Methods 218 patients with lung adenocarcinoma who had surgical resection at our institution between January 2018 and May 2021 had their cancer tissues and nearby normal lung tissues collected,the levels of lncRNA MALAT1,miR-181a-5p and key factors of JAK2/STAT3 signaling pathway (JAK2 mRNA,STAT3 mRNA) in lung adenocarcinoma tissues and adjacent tissues were detected by reverse transcription polymerase chain reaction (RT-PCR).The correlation between the expression levels of lncRNA MALAT1 and miR-181a-5p in cancer tissues of lung adenocarcinoma patients and the levels of key factors in JAK2/STAT3 signaling pathway were analyzed by Pearson test.The relationship between the expression levels of lncRNA MALAT1 and miR-181a-5p and the clinicopathological features of lung adenocarcinoma patients were analyzed.Patients with lung adenocarcinoma were followed up for 3 years,and their prognosis was counted,the 3-year overall survival rate of lncRNA MALAT1 and miR-181a-5p low/high expression groups were analyzed by Kaplan-Meier method.The prognostic factors were analyzed by univariate and multivariate Cox risk proportional regression models.Results In lung adenocarcinoma tissues,the expression levels of lncRNA MALAT1,JAK2,and STAT3 mRNA were substantially greater (P<0.05) than in neighboring normal lung tissues,whereas the expression level of miR-181a-5p was significantly lower (P<0.05) in compared to nearby normal lung tissues.Pearson test results showed that,lncRNA MALAT1 was positively correlated with JAK2 and STAT3 mRNA expression levels in cancer tissues of patients with lung adenocarcinoma(P＜0.05,r=0.526、0.483),and miR-181a-5p was negatively correlated with JAK2 and STAT3 mRNA expression levels in cancer tissues of patients with lung adenocarcinoma(P＜0.05,r=-0.430、-0.493).lncRNA MALAT1 had a considerably greater expression rate and miR-181a-5p had a significantly lower expression rate in patients with TNM stage Ⅲa,lymph node metastasis and poorly differentiated lung adenocarcinoma than in patients with TNM stage Ⅰ-Ⅱ,without lymph node metastasis and moderately well differentiated lung adenocarcinoma (P<0.05).Three patients were lost during the 3-year follow-up of 218 patients with lung adenocarcinoma,and the 3-year overall survival rate was 58.14% (125/215).The 3-year overall survival rate of the lncRNA MALAT1 high expression group was considerably lower than that of the lncRNA MALAT1 low expression group.The miR-181a-5p high expression group had a substantially greater (P<0.05) .Lymph node metastasis,TNM stage Ⅲa,decreased expression level of miR-181a-5p,and increased expression level of lncRNA MALAT1 are risk factors for the prognosis of patients with lung adenocarcinoma(P<0.05).Conclusion The low expression of miR-181a-5p and the high expression of lncRNA MALAT1 in lung adenocarcinoma tissues are related to TNM stage IIIa,lymph node metastasis and poor prognosis,which may promote the progression of lung adenocarcinoma and cause poor prognosis by activating JAK2/STAT3 signaling pathway.

Objective To analyze the relationship between serum forkhead box protein O1 (FOXO1) and myeloid cell trigger receptor 2 (TREM2) levels and brain edema volume and nerve function in patients with cerebral hemorrhage.Methods Clinical data of 150 patients with cerebral hemorrhage (test group) who received treatment in our hospital from January 2021 to January 2023 were retrospectively collected,and 60 healthy patients who came to our hospital for physical examination during the same period were selected as the control group.The levels of FOXO1 and TREM2 were compared between the two groups.Using the median FOXO1 and TREM2 as nodes,the patients were divided into high level and low level observation groups,and the differences of edema volume and National Institutes of Health Stroke Scale (NIHSS) scores were compared among different groups at admission,3 days after admission and 5 days after admission.Pearson analyzed the correlation of serum FOXO1 and TREM2 levels with edema volume and nerve function.Results The levels of FOXO1 and TREM2 in the observation group were (10.45±1.17) ng/ml and (23.96±1.57) ng/L,respectively,while those in the control group were (8.15±1.06) ng/L and (20.70±0.65) ng/L,respectively. There was a statistically significant difference between the two groups (P<0.05).The brain edema volume and NIHSS score in patients with different FOXO1 level and TREM2 level were compared at F_{time point},F_interaction,and F_{among groups}(P<0.05).The brain edema volume and NIHSS score showed a trend of change with time,and there were differences between groups.Higher FOXO1 and TREM2 level group had higher cerebral edema volume at admission,3 days after admission and 5 days after admission,and higher FOXO1 and TREM2 level group had higher scores at 3 days after admission and 5 days after admission (P<0.05).The levels of FOXO1 and TREM2 were positively correlated with cerebral edema volume at admission,3 d and 5 d,and were positively correlated with 3 d and 5 d NIHSS scores at admission (P<0.05).Conclusion Patients with cerebral hemorrhage have abnormal FOXO1 and TREM2 high expression,and FOXO1 and TREM2 levels are significantly positively correlated with brain edema volume and nerve function impairment.

Objective To investigate the expression levels and clinical significance of serum long chain non coding RNA cancer susceptibility candidate 11(lncRNA CASC11) and Testis-associated highly-conserved oncogenic long non-coding RNA(lncRNA THOR) in esophageal cancer patients.Methods Esophageal cancer patients diagnosed in our hospital from January 2017 to January 2021 were selected as the observation group(n=129),and healthy individuals who underwent physical examination in our hospital(n=129) were as the control group.Serum lncRNA CASC11 and lncRNA THOR expression levels were detected by RT-qPCR;the 3-year survival rate was analyzed by Kaplan-Meier method;and the diagnostic value was analyzed by ROC curve.Results The expression levels of serum lncRNA CASC11(1.48±0.35 vs 1.01±0.20) and lncRNA THOR(1.54±0.28 vs 1.11±0.15) in the observation group were obviously higher than those in the control group(P＜0.05).The proportions of high expression of serum lncRNA CASC11 and lncRNA THOR in patients with infiltration depth of T3~T4,tumor diameter>4cm,TNM staging of Ⅲ-Ⅳ,and lymph node metastasis were obviously higher than those in patients with infiltration depth T1~T2,tumor diameter ≤ 4cm,TNM staging Ⅰ-Ⅱ,and no lymph node metastasis(P＜0.05).After 3-year of follow-up,52 out of 129 esophageal cancer patients died and 77 survived.The 3-year survival rate of patients with high expression of lncRNA CASC11(32.20% vs 82.86%) and lncRNA THOR(36.07% vs 80.88%) was obviously lower than that of patients with low expression of lncRNA CASC11 and lncRNA THOR(P＜0.05).The area under the curve(AUC) of serum lncRNA CASC11 and lncRNA THOR levels for diagnosing esophageal cancer was 0.888 and 0.914,respectively,with cutoff value of 1.29 and 1.32.The AUC of the combined diagnosis of the two was 0.946,and the combined diagnosis of the two was superior to their individual diagnosis(Z_{combination-lncRNA CASC11}=2.410,Z_{combination-lncRNA THOR}=2.167,P=0.010,0.040).Conclusion The serum levels of lncRNA CASC11 and lncRNA THOR in patients with esophageal cancer are upregulated,they are obviously associated with the 3-year survival rate of patients,and the combination of the two has higher efficacy in the diagnosis of esophageal cancer.

Objective To investigate the effects of long non coding RNA MAGI2 antisense chain RNA3 (LncRNA MAGI2-AS3) on the migration,invasion,and epithelial mesenchymal transition (EMT) of gastric cancer (GCa) cells by regulating the miR-194-5p/caveolin-1 (CAV1) axis.Methods Fifty-two GCa patients who underwent surgical resection in our hospital from August 2022 to December 2023 were selected.Cancer and adjacent tissues were collected,and AGS,MKN45,HGC-27,and GES1 cells were cultured in vitro.The expression of MAGI2-AS3,miR-194-5p,and CAV1 in tissue samples and cell lines was analyzed.AGS cells were randomly separated into AGS group,sh-AGS group sh-MAGI2-AS3 group,miR-NC group,and in miR-194-5p group.The proliferation,apoptosis,migration,and invasion of cells in each group were compared.Immunoblotting was applied to analyze the expression of E-cadherin,CAV1,proliferating cell nuclear antigen (PCNA),N-cadherin,Bax,matrix metalloproteinase 2 (MMP2),and vimentin of cells in each group.Dual luciferase assay was applied to analyze the relationship between MAGI2-AS3 and miR-194-5p,and between miR-194-5p and CAV1.Results The expression of MAGI2-AS3 mRNA,CAV1 mRNA,and positive expression rate of CAV1 protein in GCa tissue increased,while the expression of miR-194-5p mRNA decreased (P<0.05).The expression of MAGI2-AS3 mRNA,CAV1 mRNA,and CAV1 protein in HGC-27,MKN45,and AGS cells was higher than that of GES1 cells,the expression of miR-194-5p mRNA was lower than that of GES1 cells (P<0.05).Compared with the AGS and sh-AGS groups,the cell absorbance,number of clones,invasion and migration,expression of CAV1,PCNA,N-cadherin,MMP2,and vimentin in sh-MAGI2-AS3 group decreased,the apoptosis rate,expression of E-cadherin,and Bax increased (P<0.05).Compared with the miR-NC group and sh-MAGI2-AS3 group,the cell absorbance,number of clones,invasion and migration,expression of CAV1,PCNA,N-cadherin,MMP2,and vimentin in in-miR-194-5p group increased,the apoptosis rate,expression of E-cadherin,and Bax reduced (P<0.05).ENCORI database found that there were multiple binding sites between MAGI2-AS3 and miR-194-5p,and between miR-194-5p and CAV1.Compared with the WT-MAGI2-AS3+miR-NC group,the luciferase activity in the WT-MAGI2-AS3+miR-194-5p group decreased (P<0.05),while compared with the WT-CAV1+miR-NC group,the luciferase activity in the WT-CAV1+miR-194-5p group decreased (P<0.05).Conclusion LncRNA MAGI2-AS3 silencing can target miR-194-5p to downregulate CAV1,thereby inhibiting GCa cell migration,invasion,and EMT.

Objective To investigate the expressions of cyclin B2(CCNB2) and cyclin E1(Cyclin E1) in hepatocellular carcinoma(HCC) and their significance for the prognosis of HCC.Methods Sixty HCC patients were admitted and treated from October 2013 to October 2016.The expressions of CCNB2 and Cyclin E1 in 60 HCC tissues and adjacent normal tissues were detected by immunohistochemistry,and the relationship between the two and the clinicopathological characteristics of HCC patients was analyzed;Spearman method was performed to analyze the correlation of CCNB2 and Cyclin E1 expression;Kaplan-Meier was performed to analyze the relationship between CCNB2,Cyclin E1 expression and clinical prognosis;and univariate and multivariate Cox regression were performed to analyze the influencing factors of clinical prognosis of HCC patients.Results The positive expression rates of CCNB2 and Cyclin E1 in HCC(61.67%,56.67%) were significantly higher than those in adjacent normal tissues(20.00%,13.33%,P<0.05);the positive expressions of CCNB2 and Cyclin E1 were positively correlated with serum AFP level,liver cirrhosis status,tumor thrombus and recurrence(P<0.05).The expressions of CCNB2 and Cyclin E1 in HCC tissues were positively correlated(r=0.487,P=0.000).The positive expressions of CCNB2 and Cyclin E1 in HCC tissues predicted a lower survival time(χ²=7.104,7.140,P=0.008,0.008).In addition,the positive expressions of CCNB2 and Cyclin E1 were independent factors affecting the prognosis of HCC patients(P<0.05).Conclusion CCNB2 and Cyclin E1 are highly expressed in HCC and are associated with serum AFP level,cirrhosis status,tumor thrombus and recurrence,and can be used as independent prognostic markers.

Objective To investigate the effect of extracorporeal shock wave lithotripsy (ESWL) and transurethral ureteroscopic holmium laser lithotripsy (URLL) in the treatment of urinary calculi.Methods From January 2021 to December 2023,162 patients with urinary calculi were admitted and divided into a control group and an observation group according to the lithotripsy method,with 81 cases in each group.The patients in the control group and in the observation group received ESWL and URLL respectively.The stone clearance effect,postoperative recovery and postoperative complications of the two 〖CM(41*3/4〗groups were compared,and the VAS score for pain before and after treatment was measured.Results The total effective rates of stone removal in the observation group and the control group were 96.30% and 86.42% respectively. There was a statistically significant difference between the two groups (P<0.05).The time of first getting out of bed for activities in the observation group and the control group was (25.15±4.37) hours and (31.74±5.12) hours respectively,the hospital stay was (8.59±3.13) days and (11.62±3.84) days respectively,and the incidence of postoperative complications was 11.11% and 23.46% respectively. There was a statistically significant difference between the two groups (P<0.05).The VAS scores of pain in both groups at 4 hours,12 hours,24 hours and 7 days after treatment were lower than those before treatment,and the VAS scores of patients in the observation group at 4 hours,12 hours and 24 hours after treatment were significantly lower than those in the control group,and the differences were statistically significant (P<0.05).Conclusion Transurethral ureteroscopic holmium laser lithotripsy is effective in removing urinary calculi,reducing postoperative pain compared with extracorporeal shock wave lithotripsy and fewer postoperative complications.

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

Objective To investigate the influencing factors and predictive efficacy of joint function recovery in patients with tibial plateau fracture with intercondylar spine.Methods Fifty-eight patients with tibial plateau fracture with intercondylar spine admitted to the hospital from May 2020 to July 2022 were selected,all of whom were treated by surgery.The patients were followed up for 12 months after surgery,at the last follow-up,the patients were divided into two groups:poor prognosis group and good prognosis group according to Hospital for Special Surgery (HSS) score,and the clinical data of the two groups were compared.R software was used to build a nomogram prediction model based on the risk factors affecting the poor prognosis of postoperative joint function.Goodness of fit test,receiver operating characteristic (ROC) curve to assess risk nomogram model calibration and differentiation.Results All 58 patients were followed up for 12 months after operation.The HSS score at the last follow-up was 40-95 points,of which 19 were <59 points.The results of univariate analysis showed that BMI,osteoporosis,preoperative ASA grade,skin and soft tissue injury,intercondylar spine fracture block free,and postoperative functional training may be correlated with poor prognosis of postoperative joint function (P＜0.05).Multivariate logistic regression analysis showed that BMI≥23 kg/m²,osteoporosis,preoperative ASA grade Ⅲ to Ⅳ,skin and soft tissue injury,intercondylar spine fracture mass free and non-adherence to postoperative functional training were independent risk factors for poor prognosis of postoperative joint function(P＜0.05),there was no interaction among the risk factors (deviation=1.02,Pearson χ²=0.98,r²=0.34,P＞0.05).A nomogram model was constructed based on BMI,osteoporosis,preoperative ASA grading,skin and soft tissue injury,intercondylar spine fracture block free,and postoperative functional training.Calibration results showed that the measured values were basically consistent with the predicted values.The results of the Bootstrap internal validation method showed that the sensitivity,specificity,and area under the ROC curve of this nomogram model for predicting poor postoperative joint function recovery in patients with tibial plateau fractures with intercondylar spinous fractures were 86.50%,72.40%,and 0.885,respectively.Conclusion BMI≥23 kg/m²,osteoporosis,preoperative ASA grade,skin and soft tissue injury,intercondylar spine fracture fragment free,and non-adherence to postoperative functional training are risk factors for poor prognosis of postoperative joint function in patients with tibial plateau fracture with intercondylar spine fracture.The nomogram model constructed based on this has good accuracy and discrimination.

Objective To analyze the efficacy of vascularized lymph node transplantation (VLNT) combined with lymphatic venous anastomosis (LVA) in the treatment of secondary lower extremity lymphedema assisted by super microsurgical techniques.Methods A retrospective analysis was performed for 15 patients with secondary lower limb lymphedema who underwent VLNT+LVA surgery in the Department of Reconstructive and Reconstructive Microsurgery of Ruikang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine from July 2021 to July 2023,and compared the circumference and volume of each segment of the lower limb between the preoperative and postoperative 90 days.LVA according to the results of ICG examination,3-5 parts of the lower limb were selected for “Z” shaped surgery,and the lymphatic vessels and venules were anastomosed under the microscope in the subcutaneous fat layer.VLNT confirmed and labeled the saphenous branch of the descending knee artery and its accompanying veins in the popliteal fossa,and the latissimus dorsi lymph node flap was incised,and the flap vessels were anastomosed with the saphenous branch of the descending knee artery and its accompanying veins.Postoperative observation of flap vascularization.The circumference and volume of the affected limb were measured before surgery and 90 days after surgery.Results A total of 15 patients with lower extremity lymphedema were included without serious complications.Statistical analysis showed that the circumference of all levels of the affected limb and the volume of the affected limb were improved 90 days after operation compared with those before surgery.Among them,the limb circumference and volume at each level from the highest point of the dorsum of the foot to 52cm above the ankle improved 90 days after the operation compared with those before the operation.Conclusion LNT+LVA treatment for secondary lower extremity lymphedema can effectively control edema and improve the function of the affected limb.

With advances in minimally invasive techniques,non-intubated video-assisted thoracoscopic surgery (NIVATS) is increasingly applied in the treatment of early-stage non-small cell lung cancer (NSCLC).NIVATS preserves the patient's spontaneous breathing,avoiding laryngeal injury,airway edema,and pulmonary complications associated with mechanical ventilation and double-lumen endotracheal intubation,demonstrating significant advantages in postoperative recovery.Studies indicate that NIVATS is particularly suitable for NSCLC patients with good lung function and smaller tumors.However,the application of NIVATS in complex cases remains limited,such as in cases requiring extensive lymph node dissection,tumors close to major blood vessels,and severe pleural adhesions,where patients may need to switch to intubated anesthesia mid-procedure.Additionally,in obese patients or those with severe cardiopulmonary disease,the safety and efficacy of NIVATS are reduced due to inadequate respiratory function.

Thyroid cancer is the most common endocrine malignancy.This report describes a rare case of giant follicular thyroid carcinoma (FTC) in a patient presenting with hyperthyroidism and multiple metastases involving the lungs,bones,and mediastinal lymph nodes.Such a presentation is extremely uncommon in FTC cases.The patient's treatment primarily involved surgery supplemented by radioactive iodine therapy and targeted therapy.The clinical course was complex,and therapeutic outcomes were limited.This case aims to provide diagnostic and therapeutic insights and offer relevant references for future research on such rare cases.