The '2023 practical guideline for the management of obesity in patients with gastrointestinal and liver diseases' was jointly issued by the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Society of Gastroenterology（UEG）.It focuses on clinical management issues related to patients with chronic gastrointestinal diseases (such as Inflammatory Bowel Disease,Irritable Bowel Syndrome,Gastroesophageal Reflux Disease,etc.) and chronic liver diseases (CLD) combined with obesity.The guidelines provide guidance for practitioners in internal medicine,gastroenterology,surgery,and nutrition.Following the ESPEN standard process,the guidelines formulated 100 recommendations with a consensus exceeding 90% (3 Level A,33 Level B,24 Level 0,and 40 GPP level).They emphasize the bidirectional association between obesity and gastrointestinal diseases,systematically integrating disease-specific screening,assessment,and intervention strategies for the first time,paying attention to sarcopenic obesity,and setting a special chapter for the management of bariatric surgery patients.In disease-specific management,inflammatory bowel disease is recommended to undergo a three-tiered screening (nutritional risk,obesity-related indicators,sarcopenia).During remission,weight loss of 5%-10% is achieved through lifestyle interventions;orlistat is contraindicated;and weight-loss surgery preserving the small intestine may be selected in specific situations.For irritable bowel syndrome,regular nutritional screening is emphasized,with weight loss prioritized through lifestyle adjustments;weight-loss medications should be used cautiously;and specific probiotics are recommended.Gastroesophageal reflux disease is assessed by combining body mass index,waist circumference with esophageal pH monitoring.Lifestyle-induced weight loss is prioritized,and Roux-en-Y gastric bypass may be considered for severe obesity.For CLD (particularly NAFLD/NASH),specialized tools are used to screen nutritional status;liver steatosis is graded using ultrasound,CAP,and MRI-PDFF;a Mediterranean diet and specific medications[such as glucagon-like peptide-1(GLP-1) receptor agonists] are recommended;and Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy may be considered for severe obesity.In addition,the guidelines standardize the full-cycle management of weight-loss surgery,including preoperative assessment from multiple dimensions of nutrition,function,and psychology,and postoperative focus on protein supplementation to maintain muscle mass and standardized prevention and control of postoperative hypoglycemia.The guidelines also propose structural requirements,including clinical doctors following relevant guidelines,encouraging patient participation,primary healthcare collaboration,and utilization of electronic health tools,to ensure effective implementation of the guidelines.

The textbook outcome is a novel surgical concept introduced in recent years,integrating various indicators such as postoperative complications,ICU and hospital stays,short-term readmissions,perioperative mortality,and radical resection.It provides a more comprehensive and objective reflection of surgical quality and patient prognosis.For patients at nutritional risk or with malnutrition,a holistic nutritional management approach spanning the entire perioperative period——preoperative,intraoperative,postoperative,and post-discharge——can effectively improve nutritional status,enhance 〖JP3〗physiological tolerance,promote postoperative recovery,reduce complications,and improve clinical outcomes.Perioperative nutritional therapy plays a crucial role in achieving textbook outcomes in surgical patients.

Clinical nutritional therapy plays a crucial role in the treatment for critical ill patients in Neurosurgery,however,there are a few misunderstanding of theoretical knowledge and deficiencies in clinical practice.To prioritize standardized nutritional therapy for critically ill patients in Neurosurgery,we must strive in the following aspects:establishing multidisciplinary team(MDT) for nutritional therapy;performing assessments for nutritional risk and malnutrition;emphasizing stepwise nutritional therapy to improve the compliance rate of nutritional treatment;advocating protective feeding practices to avoid overfeeding and applying syndrome differentiation and treatment to improve immune-modulating effects of nutritional therapy.

Gastric surgery inevitably alter gastrointestinal anatomy and function.This can lead to maldigestion,malabsorption,nutrient deficiencies,and metabolic disturbances.Perioperative nutritional status is closely linked to postoperative convalescence,immune competence,complication rates,and overall survival.Evidence-based and individualized nutritional support is therefore crucial,as it not only improves the metabolic milieu and promotes the recovery of gastrointestinal function but also accelerates overall rehabilitation,shortens hospital stays,and reduces complication and readmission rates.

Malnutrition is highly prevalent in patients with pancreatic cancer,substantially compromising treatment tolerance and clinical outcomes.Nutritional management should commence upon diagnosis and be maintained continuously throughout the preoperative,postoperative,and long-term follow-up phases.Core components include early nutritional screening and assessment,preferential utilization of enteral nutrition， as well as reasonable and effective nutritional supplementation strategy.At the same time, attention should be paid to the identification of exocrine pancreatic insufficiency and pancreatic enzyme replacement therapy.Through personalized nutritional interventions with dynamic adjustments,integrated with multidisciplinary collaboration and longitudinal follow-up,significant improvements in nutritional status,treatment adherence,and quality of life can be achieved.

Crohn's disease(CD) is a chronic,relapsing inflammatory bowel disease.Despite continuous advances in medical therapy,a subset of patients still requires surgical intervention.Postoperative nutritional management is crucial for promoting recovery,preventing complications,and reducing the risk of recurrence.This article systematically delineates four pivotal strategies for postoperative nutritional management in CD:the initiation and implementation of early postoperative enteral nutrition(EN),bridging therapy with biologics,the application of Supplemental Enteral Nutrition（SEN）,the management of anemia and trace element deficiency following ileal resection.By integrating early EN to restore intestinal function,combining it with biologics to prevent recurrence,and supplementing with long-term nutritional support alongside systematic monitoring,prevention,and treatment of anemia and trace element deficiencies,a comprehensive strategy for postoperative nutritional management in CD is established.This approach aims to improve long-term patient outcomes and enhance quality of life.

Short bowel syndrome(SBS) is a severe clinical condition resulting from extensive intestinal resection,leading to a significant reduction in functional small bowel length(typically≤200 cm).The core pathophysiological change is a severe insufficiency of the effective absorptive surface area,which subsequently causes malabsorption of macronutrients and micronutrients,as well as fluid and electrolyte imbalances.Primary clinical manifestations include refractory diarrhea,progressive malnutrition,and specific nutrient deficiencies.The management of SBS requires a multidisciplinary team to implement personalized,comprehensive treatment strategies.These strategies encompass stepwise nutritional support therapy,meticulous fluid and electrolyte management,targeted pharmacological interventions,and for some patients,the use of glucagon-like peptide（GLP）-2 analogs to promote intestinal adaptation.Surgical treatments,such as intestinal reconstruction or transplantation,are reserved for specific cases.Long-term management should focus on monitoring and preventing complications.The ultimate goals are to achieve intestinal autonomy and improve the patient's quality of life.

Surgical management of chronic radiation enteritis(CRE) had replaced home parenteral nutrition(HPN) as the most a critical component.The era of function preservation surgery,surgical management of CRE has also advanced from mitigating severe complications to preserving intestinal function.Malnutrition had been shown to be a risk factor for poor perioperative outcomes of CRE patients.The prevalence of malnutrition in CRE patients was higher and severer malnutrition was more common.The patients needed more long-term MNT than guidelines recommendations in surgery and the ratio of parenteral nutrition or combination of enteral nutrition was higher.The short bowel syndrome patients underwent extensive intestinal resection should be considered to continue MNT after discharge.Immunonutrition has the effect of suppressing excessive inflammation,however,its effects in improving nutritional status and enhancing postoperative recovery of gastrointestinal motility need to investigate in qualitative research.

Objective To explore the predictive value of preoperative C-reactive protein albumin lymphocyte(CALLY) index on prognosis of surgical treatment in esophageal cancer(EC) patients.Methods From January 2020 to June 2024, 120 patients with EC underwent radical resection.Collect the patient's whole blood cell count,albumin,total lymphocyte count,CRP level,and tumor markers one week before surgery,and calculate the CALLY index.Analyze its correlation with disease-free survival(DFS),overall survival(OS),and surgical site infection(SSI).Results Elderly patients(≥69 years old),patients receiving neoadjuvant chemotherapy,patients with lymphatic infiltration,patients with advanced T stage(T3/4), patients with lymph node metastasis had lower preoperative CALLY index,and the difference was statistically significant（P<0.05).Multivariate analysis showed that low preoperative CALLY index was an independent risk factor for decreased OS and DFS in EC patients;low preoperative CALLY index was an independent risk factor for postoperative SSI in EC patients（P<0.05).Conclusion The preoperative CALLY index can serve as a predictive factor for the prognosis of esophageal cancer patients undergoing surgical treatment.

Objective To investigate the correlation between serum thyroid globulin antibody (TgAb),thyroid stimulating hormone (TSH) levels and clinical pathological features of differentiated thyroid cancer (DTC) patients,and their predictive value for postoperative metastasis.Methods From June 2022 to June 2023,103 DTC patients treated in our hospital were included as the diseased group.They were separated into a metastasis group (26 cases) and a non metastasis group (77 cases) based on whether they had postoperative metastasis.Another 103 patients with benign thyroid lesions were included as the control group.The levels of TgAb and TSH in serum were compared.Multivariate Logistic regression was applied to analyze the influencing factors of postoperative metastasis in DTC patients.ROC curve was applied to analyze the predictive value of serum TgAb and TSH levels for postoperative metastasis in DTC patients.Results Compared with the control group[(54.65±6.68)IU/ml,(1.24±0.36）mIU/L],the serum TgAb and TSH levels in the cancer group[(110.56±13.42）IU/ml,（5.28±1.73)mIU/L)] were significantly increased (P<0.05).Patients with low differentiation,TNM stage Ⅲ+Ⅳ,and tumor infiltration had obviously higher levels of serum TgAb and TSH than patients with medium to high differentiation,TNM stage Ⅰ+Ⅱ,and no tumor infiltration (P<0.05).Compared with the non metastasis group,the serum TgAb and TSH levels,and the proportions of low differentiation and tumor infiltration were obviously higher in the metastasis group (P<0.05).TgAb and TSH were influencing factors for postoperative metastasis in DTC patients (P<0.05).The area under the curve (AUC) for predicting postoperative metastasis in DTC patients based on serum TgAb and TSH levels was 0.778 and 0.756,respectively,with a combined predicted AUC of 0.889.The AUC predicted by the combination of the two indicators was obviously higher than that predicted by a single indicator (Z_{combination-TgAb}=2.200,Z_{combination-TSH}=1.950,P=0.028,0.046),the sensitivity and specificity of the combined prediction of the two were 76.81% and 94.81%,respectively.Conclusion Serum TgAb and TSH levels in DTC patients are obviously upregulated,and there is a certain correlation between changes in TgAb and TSH levels and clinical pathological features.The combination of the two has high predictive value for postoperative metastasis in patients.

Objective To investigate the impacts of long non-coding RNA 662(LINC00662) on the malignant biological behavior of thyroid cancer cells by targeting microRNA(miR)-195-5p/checkpoint kinase 1 (CHEK1).Methods Tpc-1 cells in good condition were transfected with interfering LINC00662 siRNA (si LINC00662),negative control (si NC),co-transfected with miR-195-5p inhibitor and si LINC00662,co-transfected with inhibitor NC and si LINC00662,and were successively recorded as si NC group,si LINC00662 group,si LINC00662+miR-195-5p inhibitor group,si LINC00662+inhibitor NC group,and untreated cells were recorded as control group.Double luciferase assay,MTT and Transwell assay were used to verify the targeting relationship,cell proliferation,migration and invasion,respectively.Western blot and qRT-PCR were used to detect the expression of proliferating protein CyclinD1,matrix metalloproteinase (MMP) -2,CHEK1 protein and gene (LINC00662,miR-195-5p,CHEK1) in TPC-1 cells.Results The expression of LINC00662 and CHEK1 mRNA in human thyroid carcinoma cell lines (BCPAP,BHP5-16,TPC-1 and CGTH-W3) was obviously higher than that in Nthy-ori3-1 cells,the expression of miR-195-5p decreased obviously (P<0.05);miR-195-5p had targeted binding sites with LINC00662 and CHEK1,respectively.Compared with the control group[ (100±0.00）%,（163.56±16.36）cells,(245.27±24.53)cells,1.03±0.11,0.85±0.09,2.14±0.22,2.55±0.26,0.93±0.10,0.33±0.04] and the si NC group [(90.01±9.01)%,(164.35±16.44)cells,(247.24±24.73)cells,1.07±0.11,0.88±0.09,2.16±0.22,2.57±0.26,0.97±0.10,0.35±0.04],the si LINC00662 group showed significantly decreased cell proliferation rate [(43.55±4.36)%],migration number [(73.24±7.33) cells],invasion number [(113.27±11.33) cells],CyclinD1 (0.43±0.05),MMP-2 (0.37±0.04),LINC00662 (1.37±0.14),CHEK1 mRNA（1.66±0.17）and protein（0.55±0.06）（P<0.05）,while the expression of miR 195 5p (0.77 ± 0.08) was significantly upregulated（P<0.05）.Inhibition of miR-195-5p or overexpression of CHEK1 reversed the inhibitory effect of interfering LINC00662 on the malignant biological behavior of thyroid cancer cells.Conclusion Interfering LINC00662 can inhibit the malignant biological behavior of thyroid cancer cells,which may be achieved by regulating miR-195-5p/CHEK1.

Objective To detect the expression of serum hyaluronic acid synthetase 2 (HAS2),carcinoembryonic antigen (CEA) and cytokeratin 19 (CK-19) in different pathologic types of thyroid carcinoma,and to explore their diagnostic value and prediction value for postoperative recurrence.Methods A total of 202 patients who received surgical treatment for thyroid cancer in our hospital from January 2017 to January 2022 were selected and divided into differentiated group (164 cases) and undifferentiated group (38 cases).All patients were followed up for a minimum of 3 months,a maximum of 85 months,and a median of 38 months.In the differentiated group,157 patients survived,of whom 66 had recurrent thyroid cancer and 91 did not.In the undifferentiated group, 37 cases died and 1 case survived. The surviving patients relapsed during the follow-up period.Clinical data of patients were collected,serum HAS2,CEA and CK-19 levels were detected,and the correlation between serum HAS2,CEA and CK-19 levels in different types of thyroid cancer was analyzed.Receiver operating characteristic curve (ROC) was used to analyze the value of serum HAS2,CEA and CK19 levels in the diagnosis of thyroid cancer classification and the prediction value of differentiated thyroid cancer recurrence.Results The proportion of females in the differentiated group was higher than that in the undifferentiated group.The proportion of TNM stage Ⅳ patients,mean age,serum CEA and CK-19 levels were lower than those in undifferentiated group (P<0.05).Serum CEA and CK-19 levels were positively correlated with undifferentiated thyroid cancer (r=0.593,r=0.150,P<0.05).The area under the curve (AUC) of HAS2,CEA,CK19 in the combined evaluation of undifferentiated thyroid cancer was 0.609,0.859,0.595,0.879,and the Yoden index was 0.278,0.625,0.195,0.619,respectively.The combined prediction AUC of HAS2,CEA,CK19 and three indexes for the recurrence of differentiated thyroid cancer was 0.712,0.819,0.671 and 0.870,respectively,and the Yoden index was 0.374,0.557,0.311 and 0.616,respectively.Conclusion Serum HAS2,CEA and CK-19 have certain values for the classification diagnosis of undifferentiated thyroid and the recurrence of differentiated thyroid cancer, and can be used as auxiliary predictive indicators.

Objective To explore the correlation between the expression of long non coding RNA nuclear paraspeckle assembly transcript 1(LncRNA NEAT1),microRNA(miR)-138-5p and prognosis in breast cancer.Methods 160 breast cancer patients undergoing surgical treatment from january 2022 to january 2023.QRT-PCR was used to detect the expression levels of LncRNA NEAT1 and miR-138-5p in breast cancer tissues and adjacent tissues.Pearson method was used to analyze the correlation between LncRNA NEAT1 and miR-138-5p levels in breast cancer tissues.The predictive efficacy of LncRNA NEAT1 and miR-138-5p levels on recurrence and metastasis of breast cancer patients was analyzed by establishing receiver operator characteristic (ROC) curve.Results Compared with the adjacent tissues,the expression level of LncRNA NEAT1 in breast cancer tissues increased (P<0.05),and the expression level of miR-138-5p decreased (P<0.05).The levels of LncRNA NEAT1 and miR-138-5p in breast cancer tissues with different lymph node metastasis,TNM stage and differentiation degree were statistically significant (P<0.05).TargetScanHuman website predicted that there was a targeted binding site between LncRNA NEAT1 and miR-138-5p,and the expression level of LncRNA NEAT1 and miR-138-5p in breast cancer tissue was negatively correlated (r=-0.529,P<0.05).Compared with the non recurrence and metastasis group,the expression level of LncRNA NEAT1 increased and the expression level of miR-138-5p decreased in the recurrence and metastasis group (P<0.05).The area under the curve (AUC) of LncRNA NEAT1 combined miR-138-5p in predicting the recurrence and metastasis of breast cancer patients was 0.928,which was better than that of LncRNA NEAT1 and miR-138-5p separately (Z_{combination-LncRNA NEAT1}=3.489,P=0.001,Z_{combination-miR-138-5p}=4.235,P<0.001).Conclusion The expression level of LncRNA NEAT1 in breast cancer tissue increases and the expression level of miR-138-5p decreases,which are closely related to the clinical pathological parameters.The combination of the two can better predict the recurrence and metastasis of breast cancer patients.

Objective To explore the influencing factors affecting the overall survival (OS) of thymic epithelial tumors（TETs） patients,draw a nomogram and evaluate the differentiation,calibration and clinical application value,to develop personalized postoperative diagnosis and treatment plans for monitoring and follow-up.Methods We extracted clinical data from the Surveillance,Epidemiology,and End Results (SEER) database,encompassing patients with pathologically confirmed thymic epithelial tumors (TETs) who had complete follow-up records.They were randomly divided into training set and validation set at a ratio of 7∶3.The Cox proportional hazards regression model (Cox analysis) was used to obtain the independent influencing factors affecting the prognosis of TETs patients,and a nomogram model was constructed.The model was evaluated from three aspects:discrimination,calibration and clinical application value.Results Multivariate Cox regression analysis was performed after univariate Cox analysis of the training set to determine that age,pathological type,Masaoka-Koga stage,surgery and chemotherapy were independent prognostic factors related to OS in TETs patients (all P<0.05).The C-index of the nomogram is 0.765.The Area Under the Curve of ROC for 3-year,5-year and 10-year OS were 0.791,0.81 and 0.803,respectively.Calibration plots were used to evaluate that the predicted values of the nomogram model were in good agreement with the actual OS,and decision curve analysis showed that the nomogram model had higher clinical net benefits at 3,5 and 10 years.The results of internal validation with the validation set are basically consistent.Conclusion The nomogram model constructed in this study has good discrimination,accuracy and good clinical application value,and can be used to predict the OS-related individualized survival time of TETs patients in clinical practice.

Objective To evaluate the efficacy of respiratory-guided ankle pump exercise combined with low molecular weight heparin (LMWH) in preventing DVT after radical resection of perihilar cholangiocarcinoma.Methods From January 2020 to December 2023, 114 patients who underwent radical resection of hilar cholangiocarcinoma were randomly divided into two groups by a random number table. There were 57 patients in the control group, who were treated with conventional intervention and LMWH. There were 57 cases in the observation group,which was combined breathing guided ankle pump exercise therapy was adopted on the basis of the control group.The hemorheological indicators, D-dimer levels, Caprini scores and the incidence of DVT were compared between the two groups at 1 week and 4 weeks after surgery. The incidence of complications of drug anticoagulation therapy such as bleeding at the surgical incision site, gastrointestinal bleeding and subcutaneous ecchymosis within 4 weeks after surgery was also statistically compared between the two groups.Results One week after surgery, the plasma viscosity, hemocytogene, fibrinogen and D-dimer of observation group and control group in turn were (1.25±0.06) mPa·s VS (1.38±0.08) mPa·s, (42.5±3.4)% VS (45.5±3.8)%, (3.0±0.4) g/L VS (3.3±0.5) g/L, and (0.50±0.16) mg/L VS (0.65±0.18) mg/L with statistically significant differences between the two groups (all P<0.05). Within four weeks after surgery, the DVT incidence of observation group and control group was 3.5% VS 14.0%, with statistically significant difference (P<0.05). Four week after surgery, the Caprini scores of observation group and control group was (7.96±2.20) points VS (9.07±1.81) points, with statistically significant difference (P<0.05). Within four weeks after surgery, there were no significant differences in these incidences of complication of drug anticoagulation therapy such as bleeding at the incision site, gastrointestinal bleeding and subcutaneous ecchymosis between the two groups (P>0.05）.Conclusion Combined intervention can effectively reduce the incidence of DVT and has good safety.

Objective To compare short-term outcomes between self-expanding metal stents (SEMS) and emergency surgery (ES) for left-sided colonic tumor complicated with acute intestinal obstruction.Methods From January 2022 to December 2024, 37 patients with left-sided colonic tumor complicated with acute intestinal obstruction were admitted to Renmin Hospital of Wuhan University and Xishui County People's Hospital.According to the treatment methods, they were divided into the SEMS group (21 cases) and the ES group (16 cases).The laparoscopic resection rate,defunctioning stoma rate,postoperative complications,and length of postoperative hospital stay were analyzed.Results The SEMS group demonstrated a significantly higher laparoscopic resection rate than the ES group (85.7% vs.12.5%,P<0.05).In addition,the SEMS group exhibited markedly lower rates of stoma creation (4.8% vs.93.7%,P<0.05) and shorter postoperative hospital stays [(9.6±2.7)d vs.(16.0±3.9)d,P<0.05].There was no significant difference in the incidence of postoperative complications (surgical-site infection,pulmonary infection,cardiovascular/cerebrovascular events) between the two groups（P＞0.05）.Conclusion SEMS is used as a "bridging surgery" to treat left-sided colonic tumor complicated with acute intestinal obstruction,which can increases minimally invasive resection rates,reduces the need for stoma,and shortens hospital stay without increasing complications.

Objective To investigate the relationship between the levels of high mobility group protein A2 (HMGA2) and insulin like growth factor II mRNA binding protein 3 (IMP3) in colorectal cancer tissue with the clinical pathological characteristics of patients,and their diagnostic value for lymph node metastasis.Methods This study focused on 123 patients with colorectal cancer admitted to Qingdao Central Hospital,University of Health and Rehabilitation Dciencesour from December 2022 to March 2024.Real-time fluorescence quantitative polymerase chain reaction was used to detect the expression of HMGA2 and IMP3 mRNA in cancer tissues and adjacent tissues.Immunohistochemical SP method was applied to detect the expression of HMGA2 and IMP3 proteins in different tissues.Multivariate Logistic regression was applied to analyze the influencing factors of lymph node metastasis in colorectal cancer patients.Receiver operating characteristic (ROC) curve was applied to analyze the diagnostic value of HMGA2 and IMP3 in patients with lymph node metastasis.Results Compared with adjacent tissues,the expression of HMGA2 and IMP3 mRNA in cancer tissues of colorectal cancer patients was obviously increased (P<0.05).The positive expression rates of HMGA2 (χ²=36.390,P=0.000) and IMP3 (χ²=54.877,P=0.000) proteins in cancer tissues were higher than those in adjacent tissues.The expression of HMGA2 and IMP3 showed obvious differences in different tissue differentiation,tumor diameter,T staging,and lymph node metastasis (P<0.05).Compared with patients without lymph node metastasis,patients with lymph node metastasis exhibited statistically significant increases in both HMG-A2 and IMP3 mRNA levels in their cancer tissues (P<0.05).HMGA2 and IMP3 were both risk factors for lymph node metastasis in colorectal cancer patients (P<0.05).The area under the curve (AUC) of the combined diagnosis of HMGA2 and IMP3 was 0.940,which was obviously larger than the AUC for the individual diagnosis of HMGA2 (Z=2.168,P=0.030) and IMP3 (Z=2.355,P=0.019).Conclusion The high expression of HMGA2 and IMP3 in colorectal cancer patients is correlated with clinicopathological features,and their combination has high diagnostic value for lymph node metastasis in colorectal cancer patients.

Objective To analyze the influencing factors of negative pressure drainage volume after transabdominal preperitoneal prosthesis（TAPP） for scrotal hernia.Methods The clinical data of 80 patients who underwent TAPP at the Department of General Surgery,Jiangsu Province Hospital of Traditional Chinese Medicine from January 2021 to December 2023 were retrospectively analyzed.According to the total drainage volume within 3 days after operation,the patients were divided into high drainage group and low drainage group,with 40 cases in each group.Univariate analysis and multivariate Logistic regression analysis were used to analyze the influencing factors of high drainage volume,and factors with significant differences were included to analyze .Plot receiver operating characteristic (ROC) curve and calculate area under curve (AUC).Results The median drainage volume was 100.00 ml (range 45.00-170.00 ml) in the first 3 days after operation,and the daily drainage volume decreased gradually.Univariate analysis showed that the diameter of hernia ring,operation time,intraoperative blood loss,albumin,and transection hernia sac(P<0.05).Logistic regression analysis showed that large hernia ring diameter,more blood loss and albumin were independent risk factors for high drainage volume(P<0.05).Hernia ring diameter >2.75 cm,blood loss >12.50 ml,albumin <31.5 g/L had high predictive value for high induced flow,and AUC was 0.916,0.908,0.904,respectively.Conclusions Large diameter of hernia ring,more intraoperative bleeding and hypoalbuminemia are independent risk factors for high drainage volume after TAPP.Negative pressure drainage tube can be placed during operation to prevent postoperative seroma.

Objective To explore the value of combined detection of serum soluble human myeloid cell trigger receptor-1 (sTREM-1),stromal cell derived factor-1 (SDF-1) and tumor necrosis factor-α (TNF-α) in predicting the risk of early postoperative infection in patients with rib fracture.Methods A total of 196 patients with rib fractures treated in our hospital from April 2020 to November 2022 were retrospectively selected as the research objects.According to the presence or absence of early postoperative infection,the patients with rib fractures were divided into infected group (n=28) and non-infected group (n=168).The serum levels of sTREM-1,SDF-1 and TNF-α were detected by enzyme-linked immunosorbent assay (ELISA).Multivariate Logistic regression analysis and receiver operating characteristic curve (ROC) were used to evaluate the application value of the three in early postoperative infection of rib fracture.Results The serum sTREM-1 in the infection group and the non-infection group was (115.70±24.93)pg/ml and (82.34±18.83)pg/ml respectively, and the SDF-1 was (220.38±39.86)pg/ml and (175.63±28.59)pg/ml respectively. TNF-α was (58.99±14.78)pg/ml and (40.60±9.89)pg/ml respectively. There was a statistically significant difference between the two groups(all P＜0.05).The AUC of serum sTREM-1,SDF-1 and TNF-α combined prediction was 0.952,which was significantly better than that of the three alone.Conclusion The combined detection of serum sTREM-1,SDF-1,and TNF-α levels has a good predictive effect on early infection after rib fracture surgery.

Objective The study was aimed at evaluating the efficacy of manipulative reduction under over-extension traction device combined with percutaneous kyphoplasty (PKP) in the treatment of elderly patients with simple thoracolumbar osteoporotic vertebral compression fracture (OVCF).Methods 86 elderly patients with simple thoracolumbar OVCF admitted from October 2019 to November 2023 were divided into an observation group (44 cases) and a control group (42 cases) according to the treatment method. The control group received PKP treatment, while the observation group received manual reduction with an over extension traction device before PKP treatment. Pain visual analog scale (VAS) was used to assess the patient's pain status before surgery, 1 day after surgery, and 30 days after surgery. Oswestry Disability Index (ODI) was used to assess the patient's lower back pain/functional impairment. The Japanese Orthopaedic Association Treatment Score (JOA) was used to assess functional impairment in the human body, and the Cobb angle and anterior edge height of the injured vertebra were measured.Results The VAS scores of the observation group and the control group one day after the operation were (2.52±0.78) points and (2.71±0.82) points respectively, and the VAS scores 30 days after the operation were (1.97±0.64) points and (2.10±0.69) points respectively.The ODI scores of the observation group and the control group one day after the operation were (25.37±7.39) % and (27.69±7.81) %, respectively, and 30 days after the operation were (21.65±6.54) % and (23.14±6.91) %, respectively.The JOA scores of the observation group and the control group one day after the operation were (23.97±1.97) points and (23.32±2.01) points respectively, and 30 days after the operation were (24.68±1.95) points and (23.91±1.98) points respectively.ompared with those before the operation, the differences were statistically significant (P<0.05), but there was no statistically significant difference between the groups (P> 0.05).The Cobb angles of kyphosis of the injured vertebrae in the observation group and the control group were (9.41±2.23) degrees and (10.89±2.40) degrees respectively one day after the operation, and (10.03±2.19) degrees and (11.36±2.21) degrees respectively 30 days after the operation. The Angle of kyphosis in the observation group was lower than that in the control group, and the difference was statistically significant (P<0.05).The anterior height of the injured vertebrae in the observation group and the control group was (23.46±2.65)mm and (21.98±2.72)mm respectively one day after the operation, and (24.05±2.71)mm and (22.24±2.70)mm respectively 30 days after the operation. Both were higher in the observation group than in the control group, and the difference was statistically significant (P<0.05).Conclusion Manipulative reduction under over-extension traction device combined with PKP treatment has a good effect on improving the spinal function of elderly OVCF patients,reducing the kyphosis deformity of the injured vertebra,increasing the height of the anterior edge of the injured vertebra and improving the level of serum indicators in bone metabolism.

Objective To investigate the effects of intermediate frequency therapeutic instrument combined with exposure therapy on blood circulation disorders,collagen synthesis,and skin barrier system after skin flap transplantation in the limbs. Methods Clinical data of 83 patients after skin flap transplantation in the limbs in our hospital from October 2020 to October 2023 were retrospectively collected and categorized into a control group (41 ceses,exposure therapy) and an observation group (42 cases,exposure therapy+intermediate frequency therapeutic instrument) according to the treatment methods. The clinical efficacy,skin flap swelling,pain score,collagen synthesis related indicators,skin barrier system related indicators,wound healing effect and complications of the two groups were statistically analyzed. Results The total effective rate of treatment in the observation group was 92.86%,which was higher than that in the control group (75.61%) (P＜0.05). One week and two weeks after the operation in the observation group, the flap pain was (2.04±0.36) points and (1.33±0.30) points respectively, and the flap swelling scores were (2.22±0.34) points and (1.69±0.31) points respectively. The flap pain scores of the control group at 1 week and 2 weeks after the operation were (3.12±0.40) points and (1.60±0.33) points respectively, and the flap swelling scores were (2.51±0.36) points and (1.87±0.32) points respectively. There was a statistically significant difference between the two groups (P < 0.05).One week after the operation in the observation group, the expression levels of type Ⅰ collagen mRNA and protein in mononuclear cells were 2.56±0.38 and 0.49±0.15 respectively, and the expression levels of type Ⅲ collagen mRNA and protein were 2.89±0.34 and 0.26±0.13 respectively. Two weeks after the operation in the observation group, the expression levels of type Ⅰ collagen mRNA and protein in mononuclear cells were 4.03±0.52 and 0.65±0.16 respectively, and the expression levels of type Ⅲ collagen mRNA and protein were 4.07±0.46 and 0.35±0.15 respectively. One week after the operation, the expression levels of type Ⅰ collagen mRNA and protein in mononuclear cells of the control group were 1.78±0.36 and 0.40±0.14, respectively, and the expression levels of type Ⅲ collagen mRNA and protein were 2.02±0.36 and 0.19±0.12, respectively.Two weeks after the operation, the expression levels of type Ⅰ collagen mRNA and protein in mononuclear cells of the control group were 3.49±0.50 and 0.53±0.20 respectively, and the expression levels of type Ⅲ collagen mRNA and protein were 3.37±0.44 and 0.26±0.20 respectively. There was a statistically significant difference between the two groups (P < 0.05). One week after the operation in the observation group, the sebum secretion volume, stratum corneum water content and pH value were 47.48±4.36, 34.94±4.12 and 5.71±0.23 respectively, and two weeks after the operation, the sebum secretion volume, stratum corneum water content and pH value were 40.21±3.88, 40.12±4.36 and 5.15±0.14 respectively. In the control group, the sebum secretion volume, stratum corneum water content and pH value one week after the operation were 50.53±5.11, 32.03±3.55 and 6.02±0.33 respectively, and the sebum secretion volume, stratum corneum water content and pH value two weeks after the operation were 45.50±4.12, 36.88±4.27 and 5.58±0.20 respectively. There was a statistically significant difference between the two groups (P < 0.05).The number of dressing changes, wound healing time and antibiotic usage time in the observation group were (12.21±2.34) times/month, (12.60±1.87) days and (6.20±1.33) days respectively. The number of dressing changes, wound healing time and antibiotic use time in the control group were (15.58±2.71) times/month, (19.33±2.25) days and (7.68±1.42) days respectively. There was a statistically significant difference between the two groups (P < 0.05). There was no statistically significant difference in blood circulation disorder, wound infection, scar hyperplasia contracture and effusion between the two groups (P > 0.05).Conclusion The effect of intermediate frequency therapeutic instrument combined with exposure therapy in the treatment of skin flap transplantation in the limbs is obvious,which can not only alleviate the degree of postoperative pain and swelling,but also improve collagen synthesis and skin barrier function,which is conducive to postoperative wound healing.

Bladder management during the anesthesia recovery period is a crucial aspect that affects the safety and prognosis of postoperative patients.However,traditional assessment methods have limitations such as insufficient timeliness and high invasiveness.With the development of visualization technology,bedside ultrasound,with its real-time,non-invasive,and repeatable advantages,has become an important tool for comprehensive bladder management during the anesthesia recovery period.This article systematically elaborates on the multi-dimensional applications of bedside ultrasound in this field,including the determination of bladder volume by ultrasound to optimize catheterization decisions,the analysis of the causes and prevention strategies of catheter-related bladder irritation symptoms with ultrasound assistance,and the rapid diagnosis of bladder rupture by ultrasound.This article aims to review the progress of bedside ultrasound in bladder assessment and management during the anesthesia recovery period,providing visual decision-making basis for clinical practice and prevention and treatment methods for bladder-related complications during the recovery period.

Perianal Paget's disease is a relatively rare cutaneous malignancy, accounting for less than 1% of all perianal diseases. The clinical manifestations of this disease mainly include symptoms such as eczematous changes, scarring, and erythema on the local skin, which often leads to misdiagnosis as a chronic skin disease. Currently, there are no clear treatment guidelines for this disease, and surgical resection remains the mainstream treatment method.

Thyroglossal duct carcinoma is an extremely rare disease,with thyroglossal duct papillary carcinoma being the most common type.By reviewing the diagnosis and treatment processes of 2 cases of thyroglossal duct papillary carcinoma and combining with relevant domestic and foreign literature,the preoperative diagnosis and surgical methods of this disease are summarized.Ultimately,the research findings indicate that fine-needle aspiration can improve preoperative diagnostic efficacy,and surgery remains the preferred treatment for thyroglossal duct carcinoma at present.

This case report details the clinical presentation of a 55-year-old male with a 9-month history of swelling in the right mandible.Imaging studies identified osteolytic lesions in the jaw,while laboratory investigations revealed severe hypercalcemia (Ca2+3.75 mmol/L) and markedly elevated parathyroid hormone (PTH) levels (2 095.00 pg/ml).A suspicious mass in the parathyroid gland was detected.Subsequent parathyroidectomy and histopathological examination confirmed the diagnosis of parathyroid carcinoma,characterized by capsular and vascular invasion.Postoperative normalization of calcium and PTH levels was observed,accompanied by significant clinical improvement.This case underscores the importance of considering parathyroid carcinoma,albeit rare,in the differential diagnosis of patients presenting with severe hypercalcemia and skeletal manifestations.Surgical resection remains the definitive curative approach for this condition.

The patient had an 8-year history of breast mass showing rapid growth to 15cm×13cm within 1 year.Imaging suggested BI-RADS 4B cystic-solid mass,with postoperative pathology confirming borderline phyllodes tumor（PT） (14cm×13cm×8cm) showing ER/PR(-) and Ki-67 15%.Literature review indicates PT accounts for <1% of breast tumors,with core needle biopsy outperforming fine-needle aspiration.Surgical excision remains primary treatment,yet optimal margin width is debated .This case highlights the necessity of considering PT for rapidly growing breast masses and advocates triple assessment for accurate diagnosis.

Breast cancer is a common clinical malignancy,whereas heterotopic ossification at the surgical incision site is a rare postoperative complication.This article reports a case of heterotopic ossification that develop shortly after breast cancer surgery and lasted for one year.This condition was presumed to be associated with calcification and ossification of the surgical wound.The removal of calcified and ossified tissues was essential for wound healing.Potential contributing factors may include substances secreted by breast cancer cells and local infection.However,the exact cause warrant further investigation.

Metaplastic carcinoma of the breast is a rare type of breast cancer in which tumor cells can differentiate into squamous,spindle,or sarcomatoid mesenchymal components,with the sarcomatoid type being less than 0.1%.Clinically,it often presents as a rapidly growing painless mass,and imaging studies lack specificity,making it prone to misdiagnosis,often necessitating surgical biopsy for confirmation.It is predominantly triple-negative in phenotype,responds poorly to chemotherapy,and has a poor prognosis.Treatment mainly involves modified radical surgery,complemented by anthracyclines and platinum-based chemotherapy.This disease has a high risk of hematogenous metastasis and recurrence,with significant variability in lymph node metastasis rates;thus,the extent of dissection should be determined by sentinel lymph node biopsy,and close postoperative follow-up is required.

This article reports a case of a 52-year-old female who presented with a progressively enlarging left neck mass and had an 8-year history of targeted therapy for malignant small intestinal gastrointestinal stromal tumor (GIST).Imaging studies revealed a left thyroid lobe nodule suspicious for malignancy.The patient underwent left thyroid lobectomy with isthmusectomy and central lymph node dissection.Postoperative pathology,confirmed by immunohistochemical analysis,established the diagnosis of metastatic GIST to the thyroid.This case highlights the importance of comprehensive differential diagnosis between primary and metastatic thyroid tumors in patients with a history of malignancy,underscoring the need for careful therapeutic decision-making.