Biliary atresia (BA) is the leading cause of end-stage liver disease and pediatric liver transplantation worldwide.Although a timely Kasai portoenterostomy can significantly improve the natural history of the disease,achieving long-term complication-free native liver survival remains rare.Native liver survivors continually confront complex and lifelong challenges throughout the disease course,including cholangitis,progressive liver fibrosis,and portal hypertension.This article systematically reviews the latest advances in the diagnosis,treatment,and postoperative complication management of BA,with a particular focus on the challenges and future perspectives in the comprehensive,wholecourse management of this disease.

Intrahepatic bile lake is a common complication following Kasai portoenterostomy for biliary atresia.Its impact on the prognosis of biliary atresia has attracted increasing attention.Consensus has not yet been reached on its pathogenesis,diagnosis and classification methods,therapeutic strategies and other related issues.This article will summarize the abovementioned issues reported in existing literature combined with the experience of the author's team.

Objective To compare the perioperative and short-term outcomes of Da Vinci robotic-assisted surgery and traditional open surgery in the treatment of children with biliary atresia (BA).Methods A retrospective analysis was conducted on the clinical data of 46 children with biliary atresia admitted to Wuhan Children's Hospital from June 2015 to January 2025.All children underwent Kasai portoenterostom.Based on the surgical approach,they were divided into a Da Vinci robotic-assisted surgery group (Robotic-assisted Kasai portoenterostomy,RAKPE) and a traditional open surgery group (Open Kasai portoenterostomy,OKPE).The perioperative data,liver function indicators,and jaundice clearance rates at 6 months postoperatively were compared between the two groups.Results At the 6-month postoperative follow-up,the median values of total bilirubin and direct bilirubin in the RAKPE group were 22.3 (15.0,116.8)μmol/L and 11.8 (4.7,88.4)μmol/L,respectively.The OKPE groups were 34.5 (20.0,107.0)μmol/L and 15.5 (9.0,61.0)μmol/L respectively.There was a statistically significant difference between the two groups (P<0.05).The jaundice regression rate was 40.0% (8/20) in the RAKPE group.Among the 24 cases (2 lost to follow-up) in the OKPE group,7 cases had jaundice regression,with a jaundice regression rate of 29.2%.There was no statistically significant difference between the two groups (P>0.05).The postoperative hospital stay in the RAKPE group was 13.0 (11.0,15.0) days,and that in the OKPE group was 15.0 (13.0,18.0) days.There was a statistically significant difference between the two groups (P<0.01).The jaundice clearance rate (defined as serum total bilirubin ≤ 20 μmol/L) was 40.0% (8/20) in the RAKPE group and 29.2% (7/24,with 2 cases lost to follow-up) in the OKPE group,showing no statistically significant difference (P>0.05).The median postoperative hospital stay in the RAKPE group [13.0 (11.0,15.0) days] was significantly shorter than that in the OKPE group [15.0 (13.0,18.0) days] (P<0.01).Conclusion Robotic-assisted surgery can successfully achieve one-stage minimally invasive radical treatment for biliary atresia.Compared with traditional open surgery,it demonstrates advantages in terms of reducing bilirubin levels at 6 months postoperatively and shortening the length of postoperative hospital stay.The robotic surgical system is safe and feasible for complex pediatric hepatobiliary reconstructive surgery.However,the procedure is technically demanding,and widespread adoption requires further validation through multicenter studies.

Objective To investigate risk factors for portal vein stenosis (PVS) after liver transplantation in children with biliary atresia (BA) and summarize prevention and treatment strategies.Methods Clinical data of BA children who underwent liver transplantation from May 2018 to August 2025 were retrospectively analyzed.According to whether PVS occurred after the operation,the patients were divided into the PVS group (5 cases) and the control group (23 cases).Univariate and multivariate Logistic regression were used to analyze the risk factors of PVS in children with BA after liver transplantation.Results Univariate analysis showed that postoperative recipient portal vein diameter ≤5mm,body weight ≤7kg,GRWR between 2%-4%,preoperative Kasai procedure,and donor liver cold ischemia time were associated with PVS (P<0.05).Multivariate analysis identified postoperative recipient portal vein diameter ≤5mm ,body weight ≤7kg ,GRWR between 2%-4% ,preoperative Kasai procedure ,and donor liver cold ischemia time  as independent risk factors for PVS.Conclusion Recipient portal vein diameter ≤5mm,body weight ≤7kg,GRWR outside the 2%-4% range,preoperative Kasai procedure,and donor liver cold ischemia time are independent risk factors for PVS after liver transplantation in small infants with BA.

Objective To investigate the clinical efficacy of robotic-assisted laparoscopic colonic ureter in the repair and reconstruction of the upper urinary tract in children.Methods We retrospectively analyze the clinical data of 20 children with long-segment ureteral defects who underwent robotic-assisted laparoscopic ureteral replacement surgery at The Seventh Medical Center of PLA General Hospital from July 2017 to June 2024.All children underwent preoperative examinations,including urinary system ultrasound,magnetic resonance urography,diuretic nephrolinoscintigraphy and voiding cystourethrography,while some patients underwent retrograde ureteral catheterization.All children were treated with robotic-assisted laparoscopic colonic ureteral replacement to repair the long-segment ureteral defects.Three different techniques were employed for the colonic replacement:8 cases used the Yang-Monti colonic ureteral replacement,8 cases used the pedicled colonic patch technique (Onlay technique),and 4 cases used the modified Yang-Monti colonic ureteral replacement.Postoperative complications were evaluated using the ClavienDindo grading system.Results All surgeries were successfully completed under robotic-assisted laparoscopy without severe intraoperative complications or conversion to traditional laparoscopic or open surgery.The average length of ureteral defect was (6.10±2.13)cm,the average operation time was (308.0±24.5) minutes,the average intraoperative blood loss was (52.5±27.5)ml,and the average time to start oral feeding was (5.35±0.75) days.The average indwelling time of the drainage tube after the operation was (5.8±1.0) days,and the average postoperative hospital stay was (9.3±1.63) days.Eight children developed Clavien Dindo Ⅰ-Ⅱ complications,all of which were managed conservatively.Three children experienced ClavienDindo Ⅲ complications,all due to double-J stent obstruction leading to increased hydronephrosis on the affected side,which resolved after stent replacement or nephrostomy.All children had their internal stents removed approximately 8 weeks postoperatively,and ipsilateral ureteroscopy was performed simultaneously.Among them,19 cases showed well-healed anastomoses with patent lumens,while 1 case exhibited localized roughness and partial adhesion of the replaced ureteral segment,which was treated with one session of balloon dilation.The mean follow-up duration was (42±17) months.Postoperative urinary system ultrasound showed reduced or stable hydronephrosis on the affected side compared to preoperative levels,and diuretic renal scintigraphy revealed varying degrees of improvement in renal function,with no significant obstruction.Conclusion Robotic-assisted laparoscopic colonic ureteral replacement is a safe and feasible approach for repairing long-segment ureteral strictures or defects in children.It provides a novel option for the ultimate treatment of complex upper urinary tract repair or reconstruction in children.

We report 2 male pediatric patients who developed right-sided diaphragmatic hernia 4 months after liver transplantation for biliary atresia.Emergency repair of the diaphragmatic hernia was performed,and both patients recovered and were discharged following symptomatic and supportive treatment.A review of the Chinese and English literature over the past decade was conducted to systematically collate and comparatively analyze the incidence,onset timing,location,surgical methods,complications,and prognosis of post-liver transplantation diaphragmatic hernia in children,so as to provide evidence for clinical diagnosis and treatment.

Objective To explore the expression of CXCR4 and SDF1 in triple-negative breast cancer (TNBC).Methods A total of 88 cases of TNBC confirmed by surgical pathology in Xiangyang Central Hospital Affiliated to Wuhan University of Science and Technology from February 2016 to June 2018 were selected as the observation group,and 60 cases of normal breast tissues adjacent to the tumor resection specimens were selected as the control group.The expression of CXCR4 and SDF1 proteins in the two groups of specimens was detected by immunohistochemical staining.Bioinformatics was used to analyze the mRNA expression of CXCR4 and SDF1 in TNBC and normal tissues.The χ2 test was used to determine the correlation between the expression of CXCR4 and SDF1 and the clinicopathological characteristics of TNBC patients.Results The positive expression rates of CXCR4 and SDF1 in TNBC were 67.0% (59/88) and 73.8% (65/88),respectively,which were significantly higher than those in normal breast tissue adjacent to cancer (28.3% (17/60) and 41.7% (25/60),respectively),and the differences were statistically significant (P<0.05).The expression of CXCR4 and SDF1 was correlated with the clinical stage,ki-67 index,vascular tumor thrombus and lymph node metastasis of TNBC (P<0.05).Survival analysis showed that positive expression of CXCR4 was associated with poor overall survival (OS) and disease-free survival (DFS) in TNBC patients,while positive expression of SDF1 was associated with better OS and DFS.Cox proportional hazards model showed that positive expression of CXCR4,lymphatic metastasis and high expression of Ki-67 were independent risk factors for the prognosis of TNBC patients (P<0.05),while positive expression of SDF1 was a protective factor for prognosis (P<0.05,HR=0.427).Conclusion CXCR4 and SDF1 are highly expressed in TNBC,and CXCR4 and SDF1 may serve as potential prognostic markers for TNBC.

This paper reports the diagnosis and treatment of a 17-year-old male patient with idiopathic thrombocytopenic purpura complicated with acute gangrenous appendicitis.The patient was admitted for metastatic right lower abdominal pain with a platelet count of only 3×10⁹/L.Emergency preoperative preparation such as intravenous immunoglobulin infusion was given followed by appendectomy.Postoperatively,eltrombopag and thrombopoietin were combined for platelet elevation.During hospitalization,the white blood cell count and neutrophil ratio showed a continuous downward trend,while the platelet count rose rapidly from 3×10⁹/L to 530×10⁹/L at discharge.Inflammatory markers returned to normal and the patient was discharged successfully.This case suggests that such comorbidities are life-threatening.Rapid platelet elevation with intravenous immunoglobulin during the perioperative period and delicate vascular ligation during surgery are the key to treatment,and continuous platelet elevation and abdominal bleeding monitoring are needed postoperatively.

Objective To investigate the gain value of the combined expression of phospholipase C ε1 (PLCE1) mRNA,Src homology domain 3 protein 1 (LASP1) mRNA,and cyclindependent kinase 12 (CDK12) mRNA in predicting early disease progression after endoscopic submucosal dissection (ESD) for gastric cancer.Methods The clinical data of 184 patients diagnosed with gastric cancer in our hospital from January 2021 to May 2023 who underwent ESD surgery were retrospectively analyzed,Patients were divided into disease progression group（26 cases） and non-disease progression group（158 cases） according to whether their condition progressed one year after surgery.Real-time fluorescence quantitative PCR was used to detect and compare PLCE1 mRNA,LASP1 mRNA,and CDK12 mRNA in cancer tissues and paracancer tissues (2 cm away from the tumor lesions) of the two groups.The impact of PLCE1,LASP1,and CDK12 gene expression on early disease progression after ESD in gastric cancer was analyzed using a Multivariate logistic regression equation.The value of PLCE1 mRNA,LASP1 mRNA,CDK12 mRNA,and their combined prediction for early disease progression after ESD of gastric cancer was analyzed using receiver operating characteristic (ROC) curve analysis.Results The proportion of patients with superficial submucosal infiltration and ulceration in the disease progression group was higher than that in the non-disease progression group (P<0.05).The levels of PLCE1 mRNA,LASP1 mRNA,and CDK12 mRNA in the cancer tissues of both groups were higher than those in the tissues adjacent to the cancer (P<0.05).The levels of PLCE1 mRNA,LASP1 mRNA,and CDK12 mRNA in cancer tissues from the disease progression group were higher than those in the non-disease progression group (P<0.05).Multivariate analysis showed that the increase in PLCE1 mRNA,LASP1 mRNA,and CDK12 mRNA were independent factors associated with early disease progression after ESD in gastric cancer (P<0.001).Each increase of 1 unit in these three factors increased the risk of early disease progression by 1.318,1.226,and 1.352 times,respectively.In ROC analysis,the AUCs of PLCE1 mRNA,LASP1 mRNA,and CDK12 mRNA for predicting early disease progression after ESD in gastric cancer were 0.815,0.750,and 0.792,respectively.The AUC of PLCE1 mRNA + LASP1 mRNA + CDK12 mRNA for predicting early disease progression after ESD in gastric cancer was 0.935 (95%CI:0.889~0.966),which was higher than that of PLCE1 mRNA (Z=2.816,P=0.041).The sensitivity of combined prediction was 92.31%,and the specificity was 85.44%.Conclusion The gene expression of PLCE1,LASP1,and CDK12 in surgical specimens is independently associated with early disease progression after ESD of gastric cancer.Combined detection of the three genes can improve the gain value of early disease progression after ESD of gastric cancer.

Objective To investigate the relationship between serum C-X-C chemokine receptor 7 (C-X-CR7) and solute carrier family 7 member 11 (SLC7A11) with clinical pathological features and prognosis of gastric cancer.Methods From January 2021 to January 2024,108 gastric cancer patients diagnosed and treated in our hospital were considered as experimental group,while 50 healthy individuals admitted for physical examine were considered as control group.According to the prognosis,they were grouped into good prognosis group (n=48) and poor prognosis group (n=60).Detection of mRNA expression levels of serum CXCR7 and SLC7A11 by qPCR,The relationship between CXCR7 and SLC7A11 with the clinical pathological features of gastric cancer was discussed,and Cox regression was used to analyze the risk factors for poor prognosis in gastric cancer.The diagnostic value of CXCR7,SLC7A11,and their combination for the prognosis of gastric cancer patients was represented by the ROC curve.Results The CXCR7 mRNA and SLC7A11 mRNA in the experimental group were 1.80±0.56 and 1.71±0.48 respectively,which were higher than those in the control group (1.03±0.28 and 0.98±0.27).There was a statistically significant difference between the two groups (P<0.05).The CXCR7 mRNA and SLC7A11 mRNA in the poor prognosis group were 2.01±0.59 and 1.91±0.52 respectively,which were higher than those in the good prognosis group (1.53±0.32 and 1.45±0.32).There was a statistically significant difference between the two groups (P<0.05).In gastric cancer patients with high CXCR7 and SLC7A11,there were more patients with tumor diameter ≥ 5 cm,low differentiation degree,TNM stage (Ⅲ stage),and lymph node metastasis (P<0.05).Cox analysis showed that differentiation degree,TNM staging,lymph node metastasis,CXCR7,and SLC7A11 were risk factors for poor prognosis of gastric cancer (P<0.05).The AUC of combination of CXCR7 and SLC7A11 in diagnosing poor prognosis in gastric cancer was 0.925 (Z combination CXCR7=2.446,Z combination-SLC7A11=2.835,P＜0.05).Conclusion High expression of serum CXCR7 and SLC7A11 is associated with poor prognosis of gastric cancer patients,and the combined test is important for diagnosing the prognosis of patients.

Objective To investigate the predictive value of gastric fundus volume,nutritional status and pyloric obstruction for the risk of postgastrectomy syndrome (PGS) following radical gastrectomy for gastric cancer.Methods This study adopted a retrospective case-control design.A total of 35 gastric cancer patients who developed PGS after radical gastrectomy at the hospital from February 2023 to February 2025 were retrospectively enrolled as the PGS group.During the same period,70 patients who did not develop PGS after radical gastrectomy were selected by random sampling method at a ratio of 1∶2 as the control group.Preoperative gastric fundus volume,nutritional status,pyloric obstruction and other clinical data were collected from both groups.Univariate analysis was used to screen possible influencing factors for PGS following radical gastrectomy,and Logistic regression analysis was performed to determine independent influencing factors.Restricted cubic spline analysis was conducted to examine the relationship between gastric fundus volume,nutritional status,and the risk of PGS following radical gastrectomy.Receiver operating characteristic (ROC) curves were plotted and the area under the curve (AUC) was used to evaluate the predictive value of independent influencing factors and the regression model for PGS risk.The Cindex was obtained by the Bootstrap method for internal validation,and the Hosmer Lemeshow (H-L) test was used to evaluate model fitness.Results The PGS group had higher age (61.72±7.58 years),proportion of diabetes (25.71%),preoperative gastric fundus volume ratio (25.63±6.18)%,proportion of pyloric obstruction (22.86%),and modified Patient-Generated Subjective Global Assessment (mPG-SGA) score [5.00 (4.00,6.00) points] compared with the control group [(58.43±7.36 years),10.00%,(18.26±5.94)%,4.29%,3.00 (2.75,4.00) points],while preoperative albumin level (34.89±3.57 g/L) was lower than that of the control group (36.52±3.49 g/L) (P<0.05).Logistic regression analysis revealed that preoperative gastric fundus volume ratio (OR=1.107,95%CI=1.024~1.198),pyloric obstruction (OR=6.650,95%CI=1.176~37.613),and mPG-SGA score (OR=2.969,95%CI=1.799~4.897) were independent risk factors for PGS following radical gastrectomy (P<0.05).Restricted cubic spline analysis showed that as preoperative gastric fundus volume ratio and mPG-SGA score increased,the risk of PGS following radical gastrectomy significantly increased (P<0.05).ROC curve analysis showed that preoperative gastric fundus volume ratio,mPG-SGA score,and preoperative pyloric obstruction all had certain predictive value for the risk of PGS following radical gastrectomy.The combined prediction of the three indicators yielded an AUC of 0.903,demonstrating higher predictive value.Internal validation by the Bootstrap method showed a C-index of 0.906.The H-L test showed χ2=7.299,P=0.505.Conclusion Gastric fundus volume,nutritional status and pyloric obstruction have certain predictive value for the risk of PGS following radical gastrectomy for gastric cancer.Timely clinical prevention measures can be implemented to reduce the risk of PGS occurrence.

Objective To investigate the changes in the expression levels of serum monocyte chemotactic protein-1 (MCP-1) and NOD like receptor protein-3 (NLRP3) in patients with severe acute pancreatitis complicated by acute kidney injury,and the early predictive value of the combination of the two for diseases.Methods A total of 105 patients with severe acute pancreatitis from May 2022 to May 2024 were selected as the observation group.They were separated into a non concurrent group of 69 cases and a concurrent group of 36 cases based on whether acute kidney injury was present.According to the severity of acute kidney injury,they were further grouped into a mild group of 15 cases,a moderate group of 12 cases,and a severe group of 9 cases.Additionally,105 healthy volunteers who underwent physical examination were regarded as the control group.Enzyme linked immunosorbent assay (ELISA) was applied to detect the expression levels of serum MCP-1 and NLRP3.Multi factor Logistic analysis was applied to analyze the influencing factors of acute kidney injury in patients with severe acute pancreatitis.Receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of serum MCP-1 and NLRP3 levels in predicting acute kidney injury in patients with severe acute pancreatitis.Results Serum MCP-1 and NLRP3 expression levels in the control group were (118.24±24.68) μg/L and (267.42±61.24) μg/L,respectively,while those in the observation group were (407.46±101.73) μg/L and (603.23±164.51) μg/L,respectively,with statistically significant differences between the two groups (P<0.05).In the concurrent group,serum MCP-1 and NLRP3 levels were (482.59±102.99) μg/L and (755.33±143.73) μg/L,respectively,compared with (368.26±76.29) μg/L and (523.88±110.10) μg/L in the non concurrent group,showing statistically significant differences (P<0.05).As the severity of acute kidney injury progressed,the serum MCP-1 expression levels in the mild,moderate,and severe groups were (378.23±48.08) μg/L,(521.22±39.52) μg/L,and (605.03±26.20) μg/L,respectively;The expression levels of serum MCP-1 were (629.89±67.88) μg/L,(764.99±45.26) μ g/L,and (951.52±80.97) μg/L,respectively,all of which increased in sequence with statistically significant differences.Multivariate Logistic analysis showed that creatinine,MCP-1,and NLRP3 were risk factors for severe acute pancreatitis complicated with acute kidney injury (P<0.05).ROC results showed that the area under the curve (AUC) value of serum MCP-1 and NLRP3 levels combined to predict acute kidney injury in patients with severe acute pancreatitis was 0.943.Conclusion The expression levels of serum MCP-1 and NLRP3 are elevated in patients with severe acute pancreatitis complicated by acute kidney injury,and the combination of the two has a higher efficacy in early prediction of acute kidney injury.

Objective To investigate the expression and clinical significance of serum microRNA-451 (miR-451),miR-15a,miR-133b in patients with pancreatic cancer.Methods Between January 2021 and October 2024,195 patients with pancreatic cancer admitted to our hospital were regarded as the observation object,namely pancreatic cancer group,and 205 healthy volunteers who underwent physical examinations in our hospital during the same period were selected as the control group.The qRT-PCR method was performed to detect serum miR-451,miR-15a,and miR-13b.The general information of the subjects and the clinical features of the patients were recorded.Multivariate logistic regression was performed to analyze the factors affecting the occurrence of pancreatic cancer.ROC curve was used to analyze the diagnostic value of serum miR-451,miR-15a and miR-133b in pancreatic cancer.Results There was no prominent difference in BMI,drinking history,age,gender,and smoking history between control group and pancreatic cancer group (P>0.05).The levels of total cholesterol (TC) and triglycerides (TG) in the pancreatic cancer group were (1.92±0.28) mmol/L and (1.66±0.29) mmol/L respectively,which were higher than those in the control group [(1.85±0.22) mmol/L and (1.35±0.28) mmol/L].The difference was statistically significant (P<0.05).The levels of serum miR-451,miR-15a and miR-133b in the pancreatic cancer group were (0.84±0.12),(0.82±0.16),and (0.85±0.15),respectively,which were lower than those in the control group [(1.03±0.16),(1.01±0.19),and (1.02±0.16)].The difference was statistically significant (P<0.05).Elevated levels of serum miR-451,miR-15a and miR-133b are protective factors for pancreatic cancer (P<0.05);The AUCs of miR-451,miR-15a and miR-133b in the diagnosis of pancreatic cancer alone and in combination were 0.855,0.766,0.790,and 0.941,respectively.The combination of the three was superior to the individual diagnosis (Z=5.681、7.806、7.314，P＜0.001).There was no prominent difference in serum miR-451,miR-15a,and miR-133b among pancreatic cancer patients of different ages,tumor size,gender,and differentiation degree (P>0.05).In pancreatic cancer patients with lymph node metastasis,TNM stage Ⅲ-Ⅳ,and distant metastasis,the proportions of low expression of serum miR-451,miR-15a,and miR-133b were higher than the proportions of high expression (P<0.05).Conclusion Serum miR-451,miR-15a,miR-133b in patients with pancreatic cancer are decreased.The three factors have certain diagnostic value for pancreatic cancer,and are related to the clinical pathological features.

Objective To analyze the prevalence and main risk factors of secondary pleural effusion (PE) in patients with severe acute pancreatitis (SAP),then construct a quantitative risk nomogram predictive model to guide clinical practice.Methods A retrospective summary was conducted on 382 SAP patients into our hospital from July 2017 to July 2024.They were randomly divided into model group (n=255) and validation group (n=127) at 2∶1.The patients in model group were divided into PE group of 58 cases and non-PE group of 197 cases according to whether PE occurred during hospitalization.The clinical datas and clinical laboratory tests between the two groups were compared,then LASSO regression and multivariate Logistic regression analysis were used to screen the risk factors of PE and construct the nomogram model.The ROC was used for evaluation model prediction effect.Results It showed that the level of fibrinogen (FIB),Creactive protein (CRP),and blood amylase in the PE group were significantly higher than those in the non-PE group,while albumin (ALB) and fasting blood glucose (FBG) were significantly lower(P<0.05).The Logistic regression model showed that the acute physiology and chronic health assessment (APACHE Ⅱ) score,the sequential organ failure assessment (SOFA) score,FIB and CRP were the risk factors for secondary PE in SAP patients,while albumin was the protective factor.R software was used to establish the nomogram model,with total score of 200 points.ROC showed that the area under the curve (AUC) of the model for predicting PE in model and validation groups were 0.878 (95%CI：0.823~0.934,P<0.001) and 0.843(95%CI 0.801~0.922,P＜0.001),indicating that the model had good diagnostic performance.The calibration curve overlapped with the standard curve without obvious deflection,indicating that the model has good consistency.The decision curve analysis suggested that the model has potential clinical application value.Conclusion Higher of admission APACHE Ⅱ and SOFA scores,serum FIB and CRP levels,and lower of albumin suggest an increasing risk of PE;constructing a user-friendly nomogram model has great potential for guiding early and accurate identification of high-risk PE patients in clinical practice.

Objective To systematically investigate potential medical risk factors for surgical site infection (SSI) in patients undergoing general surgery and propose evidence-based preventive strategies.Methods This retrospective cohort study analyzed clinical data from 907 patients who underwent abdominal surgery at our institution between March 2021 and April 2022.Univariate and multivariate logistic regression analyses were employed to identify independent risk factors for postoperative SSI.A nomogram prediction model was constructed using the rms package in R 4.4.1.The discriminative ability and accuracy of the model were evaluated by calculating the Cindex,area under the receiver operating characteristic curve (AUC),and calibration curves.Results The incidence of SSI following abdominal surgery was 4.85%.The results of univariate analysis showed that age,ASA score,diabetes mellitus,hypertension,preoperative albumin,type of surgery,surgical procedure,type of incision,use of high-frequency electrocautery at the incision,and duration of surgery were correlated with combined surgical site infections after abdominal surgery (all P<0.05).Multivariate analysis revealed that diabetes mellitus,hypoalbuminemia,emergency surgery,open surgery,use of high-frequency electrocautery at the incision site,and prolonged operative duration were independent risk factors for SSI (all P<0.05).Subgroup analyses showed that diabetes mellitus,preoperative albumin <35g/L,and electrocautery use at the incision site were independent risk factors for SSI in laparoscopic or robotic surgery (all P<0.05),while emergency surgery,electrocautery use,and operative duration >3 hours were independent risk factors in open surgery (all P<0.05).The nomogram model for predicting SSI demonstrated a Cindex of 0.886 (95%CI:0.841~0.932),with a calibration curve closely aligned to the 45° reference line and an AUC of 0.886,indicating robust discriminative power and accuracy.Conclusion To effectively reduce SSI incidence in abdominal surgery patients,preoperative correction of malnutrition (e.g.,hypoalbuminemia),prioritization of minimally invasive procedures,strict control of operative duration,and minimization of high-frequency electrocautery use at incision sites (particularly in cases of wound bleeding) are strongly recommended.

Objective To explore whether young patients with peritoneal metastasis of colorectal cancer can achieve survival benefits through cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC).Methods From June 2019 to June 2023,140 patients with peritoneal metastasis of colorectal cancer who received CRS combined with HIPEC were included.The perioperative outcomes and survival results were observed.The patients were divided into the young group (age ≤50 years old) and the non-young group (age >50 years old) according to their age.Survival curves were plotted using the Kaplan-Meier method,and survival differences between groups were compared using logrank.The endpoint of the study was 3-year tumor-specific survival rate (CSS).Results Among the 140 patients,there were 46 cases in the young group and 94 cases in the non-young group.Patients in the young group were more prone to peritoneal metastasis than those in the non-young group (78.3% vs.51.1%),and the proportion of patients with histological type of mucinous adenocarcinoma/signet ring cell carcinoma in the young group was significantly higher than that in the non-young group (29.8% vs.60.9%),and the difference was statistically significant (P<0.05).The 3-year CSS of the two groups of patients was similar (51.4% vs.35.9%).Multi-factor  Cox  regression analysis showed that mucous adenocarcinoma/signet ring cell carcinoma (HR:2.22,95%CI:1.06~4.75;P=0.043) and rectal origin (HR:2.54,95%CI:1.14~5.70;P=0.023) are independent risk factors for adverse CSS.Conclusion Young patients with peritoneal metastasis of colorectal cancer are more likely to have synchronous peritoneal metastasis.Although young patients show stronger tumor invasiveness and poor histological types,they can still achieve similar survival benefits to non-young patients through CRS combined with HIPEC.

Objective To analyze and compare the evaluation efficacy of different tumor markers independently and in combination for the outcome of colorectal cancer surgery.Methods This study was a prospective observational study.197 cases of colorectal cancer patients who underwent radical resection in our hospital from January 2021 to February 2023 were selected as the research subjects.According to the clinical outcome within 2 year after surgery,the patients were divided into the group with good clinical outcome and the group with poor clinical outcome.The differences in clinical and disease characteristics,treatment characteristics,and preoperative tumor markers between the two groups of patients were compared.Multivariate logistic regression analysis was used to screen the independent influencing factors related to the poor outcome after radical resection of colorectal cancer patients.The efficacy of different tumor markers independently and in combination in predicting the poor outcome after radical resection of colorectal cancer patients was evaluated and compared through the receiver operating characteristic curve (ROC) and the area under the curve (AUC).Results A total of 197 patients who had undergone radical resection of colorectal cancer and completed at least 2 year of follow-up were finally selected in this study.The age,long diameter of the tumor,proportion of clinical stage Ⅲ,proportion of poor differentiation,operation time,proportion of positive surgical margin,preoperative carcinoembryonic antigen (CEA),carbohydrate antigen 199 (CA199),carbohydrate antigen 242 (CA242),carbohydrate antigen 724 (CA724),human epididymis protein 4 (HE4),count of circulating tumor cells (CTC),and proportion of positive circulating tumor DNA (ctDNA) in the group with poor outcome were all higher than those in the group with good outcome,and the proportion of adenocarcinoma was lower than that in the group with good outcome (all P<0.05).Multivariate logistic regression analysis showed that CEA ,CA199 ,CA242 ,CA724,HE4,CTC count and positive ctDNA  were all risk factors for death after radical resection of colorectal cancer patients (P<0.05).The DeLong test indicated that the area under the curve (AUC) for the combined prediction of CEA,CA199,CA242,CA724,HE4,CTC count,and positive ctDNA was 0.819 (95%CI: 0.718~0.861).This value was higher than the predictive values of each individual tumor marker (Z=3.976,3.856,3.601,3.663,3.525,3.850,3.847,all P<0.05),and at this time,the sensitivity of the combined prediction was 0.823 and the specificity was 0.782.Conclusion Positive CEA,CA199,CA242,CA724,HE4,CTC count,and ctDNA before radical resection of colorectal cancer patients are all risk factors for poor postoperative outcome,and the combined application of the above tumor markers has a higher predictive efficacy.

Objective To investigate the relationship between Fanconi anemia complementation group I (FANCI) expression in primary focus of colorectal cancer (CRC) and early postoperative recurrence and metastasis.Methods 183 patients with CRC admitted to Wuhan University of Science and Technology Affiliated Puren Hospital from January 2022 to February 2024 were selected for the study.All patients underwent 12-month postoperative follow-up.After excluding those lost to follow-up,they were categorised into a recurrence-free group (128 cases) and a recurrence-metastasis group (50 cases) based on the occurrence of recurrence or metastasis.The general data and the expression level of FANCI in the primary focus were compared between the two groups.The Cox proportional hazard model was used to analyze the risk factors of early postoperative recurrence and metastasis in CRC patients.Receiver operating characteristic curve (ROC) was used to evaluate the predictive value of FANCI expression level for recurrence and metastasis.ResultS The tumor diameter in the recurrence and metastasis group was (5.91±1.08) cm,which was larger than that in the non-recurrence and metastasis group [(4.29±0.85) cm].The number of lymph node metastases was (4.40±1.19),which was more than that in the non-recurrence and metastasis group [(2.94±0.87)].The proportion of patients in INM stage Ⅲ was 50.00%,the serum carcinoembryonic antigen (CEA) level was (9.18±2.79)ng/ml,the carbohydrate antigen 199(CA199) level was (29.71±9.47)U/ml,and the positive rate of FANCI was 94.00%.They were all higher than the non-recurrence and metastasis group[ 25.00%,(5.27±1.44)ng/ml,(21.65±8.51)U/ml,and 61.72%],and the differences were statistically significant (P<0.05).The Cox analysis showed that large tumor diameter,a large number of lymph node metastases,high serum CEA level,TNM stage III,and positive FANCI expression were risk factors affecting early postoperative recurrence and metastasis in CRC patients (P<0.05).ROC analysis showed that the AUC of FANCI(+),FANCI(++ )and FANCI(+++) in predicting early postoperative recurrence and metastasis of CRC patients were 0.716,0.865 and 0.725,respectively,and FANCI(++) predicted the highest AUC (P<0.05).Conclusion The positive expression of FANCI in the primary focus of CRC patients is a risk factor for early postoperative recurrence and metastasis.When FANCI(++) is taken as the cutoff value,the prediction efficiency of postoperative recurrence and metastasis is the strongest.

Objective To compare the perioperative outcomes and clinical prognoses of catheter enterostomy versus conventional enterostomy during laparoscopic anus-preserving surgery for low rectal cancer.Methods A total of 96 patients who underwent laparoscopic anus-preserving surgery for low rectal cancer in the First Hospital of Lanzhou University between January 2023 and December 2024 were enrolled,among whom 86 patients with complete data and follow-up were finally included.According to the different stoma methods,they were divided into two groups.Among them,there were 44 cases in the observation group,who underwent ileal intubation and stoma through the ileocecal valve using a No.24 balloon catheter.There were 42 cases in the control group,who underwent conventional terminal ileal stoma.The family members agreed to implement preventive stoma reduction 3 months after the operation.Perioperative indicators including intraoperative blood loss,operative duration,postoperative fasting time,time to first flatus,length of hospital stay,and total hospitalization cost of the two groups of patients were collected.The incidences of early and late stoma-related complications were recorded,and intestinal function recovery was followed up for 6 months postoperatively.Results The observation group had an operative duration of (80.2±12.0) minutes,intraoperative blood loss of (45.3±10.0) ml,length of hospital stay of (8.5±2.0) days,and total hospitalization cost of (1.8±0.3) ten thousand yuan;the control group had an operative duration of (120.6±15.0) minutes,intraoperative blood loss of (98.7±20.0) ml,length of hospital stay of (12.1±3.0) days,and total hospitalization cost of (3.2±0.5) ten thousand yuan.Statistically significant differences were observed between the two groups (all P<0.05).The incidence of early catheter-related complications was 31.8% in the observation group,slightly higher than 28.6% in the control group;the incidence of late stoma-related complications was 15.9% in the observation group,markedly lower than 88.1% in the control group.The overall complication rate was 23.9% in the observation group versus 58.3% in the control group.Conclusion The two preventive enterostomy methods have respective advantages and disadvantages.Ileal catheter enterostomy is associated with shorter hospital stay,lower medical costs,and benefits in reducing stoma-related complications and anastomotic stricture,while its stability and long-term efficacy are inferior to those of conventional enterostomy.

Objective To compare the clinical efficacy and feasibility of flexible front-end controllable negative pressure suction ureteral sheath and conventional ordinary ureteral sheath combined with disposable electronic flexible ureteroscope in the treatment of upper urinary calculi.Methods The clinical data of 187 patients with upper urinary calculi who underwent surgical treatment in urology department of the People’s Hospital of Wuchuan from January 2023 to May 2024 were analyzed retrospectively.They were divided into two groups according to the different ureteroscope sheaths used.Among them,there were 93 cases in the flexible front-end controllable negative pressure ureteroscope group (experimental group) and 94 cases in the conventional flexible ureteroscope group (control group).The general information,treatment cost,hospitalization days before and after operation,residual stone rate after operation,postoperative complications and secondary stone removal rate were compared between the two groups.Results Compared with the control group,at the age of patients,BMI,hospitalization expenses,stone load surface area,preoperative hospitalization day,total hospitalization days,gender,preoperative hydronephrosis,basic diseases,ureteral injury or (and) subcapsular hematoma,these differences are not statistically significant(P>0.05).The proportions of patients with postoperative fever in the experimental group and the control group were 4.3% and 14.89% respectively, the proportions of patients with postoperative gross hematuria were 4.3% and 13.83% respectively, the proportions of patients with postoperative residual stones > 4mm were 10.76% and 19.05% respectively, and the proportions of patients with postoperative adjuvant drug treatment were 19.98% and 32.98% respectively. The proportions of patients undergoing secondary stone removal surgery after the operation were 9.68% and 24.47% respectively. There was a statistically significant difference between the two groups (P<0.05).Conclusion In the treatment of upper urinary calculi with flexible and controllable negative pressure at the front end,compared with the conventional ordinary ureteral sheath,it can significantly improve the clearance rate of upper urinary calculi with flexible ureteroscopy,reduce the postoperative meaningful residual stone rate and reduce the incidence of postoperative infectious complications,and it does not increase the hospitalization time and treatment cost of patients.

Objective To explore the correlation between intraoperative parameters of somatic tissue oxygen saturation (SstO₂) and cerebral tissue oxygen saturation (SctO₂) and postoperative cognitive dysfunction (POCD) among patients undergoing spinal surgery in the prone position.Methods Clinical data of 126 patients who underwent prone-position open thoracic or lumbar spine surgery in our hospital from January 2021 to December 2024 were retrospectively analyzed.Patients were classified into POCD group and normal group according to the decrease in scores of the mini-mental state examination (MMSE) before and after surgery.Perioperative clinical data and intraoperative SctO₂ and SstO₂ parameters of the two groups were analyzed and compared.Pearson correlation was used to analyze the correlation between intraoperative SstO₂ and SctO₂ parameters and MMSE scores,and Logistic regression was performed to analyze whether intraoperative oxygenation parameters were risk factors for POCD.Results A total of 34 patients developed POCD and 92 patients had no POCD,the incidence of POCD was 26.98%.The absolute reduction value, relative reduction value, and the proportion of cases with the average value < 90% of the baseline value of Sst02 during the operation in the POCD group were (4.95 ± 1.16)%, (7.42 ± 2.03)% and 11 cases (32.35%), which were significantly higher than those in the normal group, which were (3.97 ± 1.21)%, (5.96 ± 1.38)% and 6 cases (6.52%), with statistically significant(P<0.05).Pearson correlation analysis showed that the intraoperative SctO₂ parameters was not correlated with the decrease of MMSE scores after surgery,and the absolute decrease value and relative decrease value of intraoperative SstO₂ were positively correlated with the decrease of MMSE scores after surgery (r=0.564 and 0.627,P<0.05).Logistic regression analysis showed that the absolute decrease,relative decrease,and mean value of <90% baseline of intraoperative SstO₂ were risk factors for the occurrence of POCD (P<0.05).Conclusion The SstO₂ parameter was superior to the SctO₂ parameter in predicting POCD during spinal surgery in the prone position.Monitoring of SstO₂ parameters may be considered during these surgery to prevent POCD.

Objective To explore the risk factors for the formation of lower extremity deep vein thrombosis (DVT) after surgery for proximal humeral fractures of Neer type Ⅲ and Ⅳ in the elderly,and to analyze the correlation between BMI stratification and anticoagulation strategies.Methods The clinical data of 200 elderly patients after surgery for proximal humeral fractures of Neer type Ⅲ and Ⅳ admitted from June 2022 to June 2024 were retrospectively analyzed.According to BMI,the patients were divided into a low BMI group (BMI < 18.5kg/m²),a normal BMI group (18.5kg/m² ≤ BMI < 24.0kg/m²),an overweight BMI group (24.0kg/m² ≤ BMI < 28.0kg/m²),and an obese BMI group (BMI ≥ 28.0kg/m²).The general data,comorbidity status,surgery-related indicators,anticoagulation strategies,and DVT occurrence were compared among patients in different BMI groups.Multivariate Logistic regression analysis was used to screen for risk factors for DVT formation and analyze the correlation between BMI stratification and anticoagulation strategies.Results Among the 200 patients,32 cases of DVT occurred,with a total incidence of 16.0%.There were differences in age,comorbidities (hypertension,diabetes,cardiovascular diseases),operation time,and hospital stay among patients in different BMI groups (P<0.05).Multivariate Logistic regression analysis showed that obese BMI (OR=3.25,95%CI:1.56~6.77),hypertension (OR=2.18,95%CI:1.12~4.24),operation time ≥ 2 hours (OR=2.36,95%CI:1.21~4.60),and non-standard anticoagulation (OR=3.87,95%CI:1.95~7.69) were independent risk factors for the formation of DVT after surgery for proximal humeral fractures of Neer type Ⅲ and Ⅳ in the elderly（P＜0.05）.In terms of anticoagulation strategies,the proportion of standardized anticoagulation in the obese BMI group was the lowest,and the difference was statistically significant compared with other groups (P<0.05).Conclusion The formation of DVT after surgery for proximal humeral fractures of Neer type Ⅲ and Ⅳ in the elderly is affected by multiple factors,and obese BMI is one of the important risk factors.There is a correlation between BMI stratification and anticoagulation strategies.The proportion of standardized anticoagulation in obeseBMI patients is low.Clinically,individualized anticoagulation strategies should be developed according to the patient's BMI stratification to reduce the risk of DVT.

Objective To investigate the clinical efficacy of combined application of 3D printing assisted anterolateral thigh perforator flap and vacuum sealing drainage (VSD) in treating hand or foot compound tissue defects.Methods A total of 104 patients with hand or foot compound tissue defects admitted to our hospital from January 2021 to January 2024 were regarded as the study sample.They were randomly assigned into control group and research group (52 cases each) via random number table.Both groups underwent anterolateral thigh perforator flap on top of VSD treatment.The control group measured the defect area to design skin flap,while the research group used 3D printing technology to assist in designing the skin flap.After surgery,the efficacy,hand or foot function[Michigan Hand Function Assessment Scale（MHQ）、American orthopedic foot and ankle society（AOFAS）],inflammatory factor levels[Tumor Necrosis Factor-α（TNF-α）、Interleukin-8（IL-8）、Interleukin-6（IL-6）],and postoperative complications were analyzed.Results The research group had unusually better clinical efficacy,and unusually lower dressing changes[（7.68±1.94) vs (3.47±0.75）],duration of antibiotic use[（10.54±2.87)d vs (6.24±1.74）d],and wound healing time[（27.64±3.85)d vs (19.64±2.91）d] than control group (P<0.05).After surgery,research group had unusually lower level of the TNF-α[（310.25±32.44）ng/ml vs (257.64±26.87）ng/ml],IL-6[（1.07±0.11）ng/ml vs (0.67±0.06）ng/ml],and IL-8[（0.97±0.09）ng/ml vs (0.57±0.05）ng/ml],and unusually higher MHQ scores[（66.87±7.71) vs (75.21±8.54）] and AOFAS scores[（74.58±8.57) vs (88.31±9.71）] than the control group (P<0.05).The postoperative complications were not unusually different between the two groups (P>0.05).Conclusion The combined application of 3D printing technology assisted anterolateral thigh perforator flap and VSD can effectively improve the clinical effect of patients with hand or foot compound tissue defects,promote their recovery,and reduce postoperative complications.

With the rapid advancement and widespread adoption of laparoscopic technology,laparoscopic surgery has become the predominant surgical approach for treating gastrointestinal tumors.However,higher requirements have been put forward for the accurate intraoperative localization of some tumors,especially smallsized lesions that do not invade the serosal surface and submucosal tumors that grow within the cavity.While intracavity anastomosis technology offers several advantages,such as minimal incisions and a clear field of vision,its limitations in accurately assessing the anastomosis restrict the broader application of fully laparoscopic anastomosis techniques.Intraoperative endoscopy not only facilitates precise lesion localization and accurate tumor resection but also enables the assessment of anastomosis integrity following gastrointestinal reconstruction.This reduces the incidence of postoperative anastomosisrelated complications and enhances the feasibility and safety of laparoscopic surgery for gastrointestinal tumors.

This article reports a case of medullary thyroid carcinoma (MTC) discovered during postoperative follow-up of a patient with triple-negative breast cancer (TNBC).The patient was diagnosed with TNBC (cT2N1M0,stage Ⅱb) in March 2019.After six cycles of neoadjuvant chemotherapy (TAC),the patient underwent "left breast cancer breast-conserving radical mastectomy" and completed radiotherapy (50 Gy/2.0 Gy,in 25 fractions) and adjuvant intensification chemotherapy.In March 2023,the patient presented with a right cervical mass,which was assessed as benign on imaging but ultimately diagnosed as MTC.This case is rare,suggesting that for breast cancer patients with thyroid nodules,the possibility of malignancies such as medullary carcinoma should be vigilant.

The clinical manifestations,pathological morphological features,immunohistochemical staining results and molecular pathological alterations of one case of recurrent intra-abdominal AF complicated with pancreatic SPN were analyzed,and the relevant literature was reviewed.AF was composed of long spindle-shaped tumor cells with relatively consistent size and shape,arranged in fascicular or woven structures.The results of immunohistochemical staining:β-catenin (nuclear +).Most cases of AF are sporadic and are related to mutations in exon 3 of the CTNNB1 gene;a few cases are related to APC gene mutations.SPN was composed of a solid area and a pseudopapillary area.The pseudopapillary structure was formed by cells loosely arranged around the fibrovascular axis.The results of immunohistochemical staining:CK (+),Vimentin (+),β-catenin (nuclear +),CD10 (+),PR (+),Syn (+).Most cases of SPN have mutations in exon 3 of the CTNNB1 gene;in rare cases,gene mutations such as CDKN2A,TP53,and LRP1B may also occur.The simultaneous occurrence of these two tumors is very rare,and only individual case reports can be found in domestic and foreign literatures.More cases need to be accumulated to further explore the treatment and prognosis.

This article reports a case of an intracranial aneurysm with a persistent trigeminal artery and an exceptionally challenging transfemoral access.Stable access was successfully established via a transradial approach,followed by uneventful endovascular embolization of the aneurysm.The patient recovered well postoperatively.In neurointerventional surgery, when difficult access is encountered, the radial artery approach can be used as an alternative.

This article reports a rare case of a 42-year-old male diagnosed with giant mesenteric cavernous lymphangioma (MCL) in adulthood.The patient was admitted to the hospital due to episodic abdominal pain.Imaging examinations (enhanced CT and color Doppler ultrasound) revealed a cystic lesion with clear boundaries and no enhancement,measuring approximately 11 cm×6 cm×9 cm in size,located in the right lower abdomen,which is consistent with the typical characteristics of MCL.Due to the large tumor size and the resulting compression symptoms,there were clear surgical indications.During the operation,it was found that the tumor was closely related to the mesentery and blood vessels,with mesenteric vessels running through the tumor,making it impossible to simply dissect them.Therefore,a combined mesenteric lesion resection and intestinal resection and anastomosis was ultimately performed.Postoperative pathology and immunohistochemical results confirmed the diagnosis of cavernous lymphangioma.The patient recovered well after surgery,was discharged smoothly,and showed no recurrence during short-term follow-up.