Fecal microbiotabased therapy,which treats diseases by restoring intestinal microbiota balance,is an emerging strategy that has attracted considerable attention in gastrointestinal surgery and related fields.The American Gastroenterological Association(AGA) recently issued clinical practice guidelines focusing on fecal microbiota transplantation(FMT) and two U.S.Food and Drug Administration(FDA)approved commercial microbiotabased preparations.These guidelines propose seven core recommendations for managing recurrent Clostridioides difficile infection,inflammatory bowel disease,and irritable bowel syndrome.This article systematically reviews the key recommendations of the guidelines,discusses the indications,methodologies,efficacy,and safety evidence supporting such therapies across different conditions,and analyzes current controversies and future research directions,with the aim of providing a scientific reference for surgical and gastroenterological clinical practice.

Postoperative complications after colorectal surgery are important issues affecting patient recovery and quality of life.Recent studies have revealed that gut dysbiosis plays a critical role in the development and progression of these complications.Factors such as surgical trauma,anesthesia,antibiotics,and fasting can lead to reduced microbial diversity,depletion of beneficial bacteria,and enrichment of opportunistic pathogens.Through various mechanisms including activation of Tolllike receptor signaling pathways,alterations in metabolites such as shortchain fatty acids and bile acids,and induction of collagenase secretion by pathogenic bacteria that degrades the extracellular matrix,dysbiosis participates in the pathological processes of postoperative ileus (POI),diarrhea,anastomotic leakage,and low anterior resection syndrome (LARS).Microbiotabased therapeutic strategies include perioperative antibiotic stewardship,probiotic and prebiotic supplementation,metabolitebased interventions,and fecal microbiota transplantation (FMT).Current evidence suggests that rational antibiotic use,perioperative supplementation with specific probiotics,butyrate enemas,and autologous reinfusion of stoma discharge show promise in improving postoperative complications,although some findings remain inconsistent.Future largescale randomized controlled trials are needed to identify specific microbial biomarkers,explore combination therapies,and develop novel microbiotamodulating drugs.

The comorbidity of depression and constipation in adolescents has emerged as a critical public health challenge.These two conditions interact bidirectionally via the gutbrain axis,thereby significantly exacerbating the overall disease burden.Conventional therapies frequently fail to overcome the therapeutic bottleneck of this comorbidity due to their limited efficacy and potential gastrointestinal adverse effects.Driven by the core pathophysiology of gut microbiota dysbiosis,fecal microbiota transplantation (FMT) offers a novel approach to concurrently ameliorating mood disorders and restoring intestinal function by reestablishing microecological homeostasis.Although FMT in the neuropsychiatric domain remains in the clinical investigational phase,it is rapidly evolving toward standardized and personalized clinical paradigms.This transition is profoundly accelerated by artificial intelligence (AI)assisted donor screening,multiomicsdriven precise colonization,and the optimization of standardized preparation protocols.Ultimately,this strategy holds great promise for overcoming the therapeutic hurdles of refractory comorbidities,providing adolescent patients with a safe,durable,and novel microbiotatargeted therapeutic regimen.

In severe intestinal diseases,malnutrition and gut microbiota dysbiosis can reinforce each other and form a vicious cycle.Fecal microbiota transplantation (FMT) is an effective strategy for restoring gut microbial homeostasis.It may also act synergistically with clinical nutritional therapy.The combined use of FMT and enteral nutrition (EN) can improve EN tolerance.This approach has shown potential clinical value in Crohn’s disease,severe malnutrition,refractory diarrhea,and intestinal dysfunction in the intensive care unit (ICU).For patients requiring longterm parenteral nutrition (PN),FMT may alleviate PNassociated complications.It may also help patients transition to physiological EN.

Fecal Microbiota Transplantation (FMT),a therapy that transplants gut microbiota from healthy donors into patients,has evolved from an ancient folk remedy into a cuttingedge field of modern biomedicine.Its remarkable success in treating recurrent Clostridioides difficile infection (rCDI) provides a disruptive strategy for microbiomebased interventions in major chronic diseases.Based on current research evidence,this article systematically reviews the clinical application status of FMT and,drawing on the practical experience of Suzhou Municipal Hospital,delves into the pathways for constructing a standardized,interdisciplinary "Microbiome Medicine" system.It distills a replicable discipline development model centered on comprehensive disciplinary coverage,a multiomics technology platform,standardized procedures,highlevel platform and talent development,and an industryacademiaresearch closed loop.

This article combines the research data of the proposed version officially released by the AJCC Colon Cancer Expert Panel and relevant literature to interpret the key updates of the proposed AJCC 9th Edition TNM staging system for colon cancer,analyzing its update methods,main changes,and their impacts on clinical and pathological practices.It should be particularly noted that the current version is only a proposed scheme put forward by the expert panel and has not been officially approved and released by the AJCC.The proposed staging system is based on largescale realworld data from the National Cancer Database (NCDB) in the United States,using recursive partitioning and regression tree analysis to make structural adjustments for the nonhierarchical survival outcomes existing in the 8th edition.The main updates include:moderately increasing the weight of T stage in prognostic stratification;listing tumor deposits (TDs) as an independent prognostic variable;scientifically adjusting N staging so that it can more reasonably reflect prognostic value in coordination with T stage and TDs.The new proposed staging framework has more biological significance and clearer prognostic hierarchy,and also puts forward higher requirements for the accuracy of pathological reports and clinical individualized treatment.The proposed AJCC 9th Edition TNM staging system for colon cancer is based on realworld prognostic data and is expected to solve the nonhierarchical problem existing in previous staging systems,marking that colon cancer staging is expected to evolve from a mainly anatomybased model to a new stage that integrates tumor biological behavior.

Objective To analyze the correlation and interaction between peripheral blood neutrophil/lymphocyte ratio (NLR),Creactive protein (CRP)/albumin (ALB) and postoperative pulmonary infection in patients with traumatic brain injury (TBI). Methods A total of 210 TBI patients were selected from March 2022 to October 2024 in Red Cross Hospital Affiliated to Xi'an Jiaotong University.According to whether pulmonary infection occurred during postoperative hospitalization,they were divided into an infected group (nP=73) and a noninfected group (nP=137).The general data,preoperative peripheral blood NLR and CRP/ALB levels were compared between the two groups.The influencing factors of pulmonary infection after TBI were analyzed.The predictive value of preoperative peripheral blood NLR and CRP/ALB on pulmonary infection after TBI was analyzed.The conventional Logistic model was constructed according to the conventional influencing factors.The new Logistic model was constructed according to the conventional influencing factors and preoperative peripheral blood NLR and CRP/ALB.The value of the two models in predicting pulmonary infection after TBI was compared. Results The proportion of diabetes mellitus,preoperative serum procalcitonin (PCT),interleukin-6 (IL-6),peripheral blood NLR and CRP/ALB levels in the infected group were higher than those in the uninfected group,and the preoperative Glasgow Coma Scale (GCS) score was lower than that in the uninfected group (P<0.05).Diabetes mellitus,preoperative serum PCT,IL-6,peripheral blood NLR,CRP/ALB were independent risk factors for pulmonary infection after TBI,and preoperative GCS score was an independent protective factor (P<0.05).The area under the curve (AUC) of preoperative peripheral blood NLR and CRP/ALB in predicting pulmonary infection after TBI was 0.728 and 0.719,respectively (P<0.05).The AUC of conventional Logistic model and new Logistic model in predicting pulmonary infection after TBI were 0.827 and 0.912,respectively (P<0.05).Compared with the conventional Logistic model,the AUC of the new Logistic model in predicting pulmonary infection after TBI was significantly increased (P<0.05). Conclusion The increase of preoperative peripheral blood NLR and CRP/ALB levels can increase the risk of pulmonary infection after TBI.The establishment of a new Logistic model based on preoperative peripheral blood NLR and CRP/ALB can improve the predictive value of pulmonary infection after TBI.

Objective To evaluate the clinical value of interventricular shunt—a novel approach that avoids the implantation of a shunt pump and peritoneal catheter—as a salvage treatment for trapped temporal horn. Methods A retrospective analysis was conducted on two patients with trapped temporal horn who underwent interventricular shunt after failed endoscopic treatment.The efficacy of the procedure was assessed based on clinical and imaging outcomes. Results Two patients received ventricular shunt two years after the operation.The muscle strength of the left limb of Case 1 improved from grade 2 to grade 5,and the headache of Case 2 completely disappeared.The temporal Angle widths at the same level on the affected side of the two patients decreased by 32.5% and 51.1% respectively compared with those before the operation,and the modified Rankin Scale (MRS) scores of both improved from grade 4 to grade 0.No complications related to the interventricular shunt device occurred during the follow-up period. Conclusion For patients with trapped temporal horn complicating resection of lateral ventricular trigonal tumors,interventricular shunt represents an effective individualized salvage option when endoscopic intraventricular adhesiolysis yields suboptimal outcomes.

Objective Investigating the Clinical Significance of Serum LLGL2 （Lethal Giant Larvae Homolog 2）Protein and ferritin levels in early diagnosis and disease evaluation of Esophageal Squamous Cell Carcinoma (ESCC). Methods In this retrospective study,79 patients diagnosed with ESCC were enrolled as the observation group,and 100 healthy individuals were selected as the control group between June 2020 and December 2024.Clinical and pathological data were systematically collected,and serum levels of LLGL2 protein and ferritin were measured.Statistical analyses,including paired t> tests,χ² tests,Logistic regression analysis,and ROC curve analysis,were performed to assess the association of these biomarkers with ESCC and to evaluate their predictive performance. Results The levels of serum LLGL2 protein and serum ferritin in the observation group were (38.65±7.23) ng/ml and (420.56±85.32) ng/ml,respectively,which were significantly higher than those in the normal group[(15.42±4.15) ng/ml and (180.23±40.56) ng/ml].Both biomarkers demonstrated significant correlations with tumor size,TNM stage,and lymph node metastasis (P<0.05),but no significant associations were observed with gender,age,or tumor differentiation degree (P>0.05).Multivariate analysis identified LLGL2 protein level,serum ferritin level,TNM stage,and lymph node metastasis as independent risk factors for ESCC development (P<0.05).Notably,the combined detection of LLGL2 protein and serum ferritin achieved an AUC of 0.927 (95%CI:0.888-0.966),outperforming the predictive performance of either biomarker alone. Conclusion Serum levels of LLGL2 protein and ferritin exhibit a strong correlation with ESCC.The combined measurement of these biomarkers demonstrates significant predictive value for ESCC,highlighting their potential as a promising approach for early diagnosis.

Objective To investigate the clinical efficacy of tracing with mitoxantrone hydrochloride in patients undergoing total thyroidectomy combined with bilateral central compartment lymph node dissection.Methods Patients with differentiated thyroid carcinoma who underwent total thyroidectomy combined with bilateral central compartment lymph node dissection between June 2021 and June 2024 at a single medical institution were included.They were randomly assigned to either the mitoxantrone hydrochloride tracer group (MHI group) or the blank control group (control group) in a 1∶1 ratio.The lymph node dissection count,postoperative parathyroid gland (PG) resection count in gross specimens,and postoperative parathyroid hormone (PTH) levels on postoperative days 1d,5d,30d and 6 months were compared between the two groups. Results All 132 patients underwent successful surgery,with 69 in the MHI group and 63 in the control group.There were no cases of bleeding,infection,or permanent recurrent laryngeal nerve injury（P>0.05）.The baseline characteristics and operative time showed no statistically significant differences between the two groups.The mean number of metastatic lymph nodes was 1.93 ± 1.66 in the MHI group and 1.63 ± 1.59 in the control group,with no statistically significant difference (P> 0.05).Intraoperative parathyroid autotransplantation was performed in 12 patients (17.39%) in the MHI group and 6 patients (9.52%) in the control group,with no statistically significant difference (P > 0.05).The number of lymph nodes dissected was 12.55 ± 3.05 in the MHI group and 10.41 ± 2.90 in the control group,showing a statistically significant difference (P< 0.05).Postoperative pathological examination revealed inadvertent parathyroid gland (PG) excision in 3 patients (4.35%) in the MHI group and 11 patients (17.46%) in the control group,with a statistically significant difference (P < 0.05).The proportion of patients with low parathyroid hormone (PTH) levels on postoperative day 1 did not differ significantly between the two groups (P>0.05).In the MHI group,7 (10.14%),3 (4.35%),and 1 (1.45%) patients exhibited low PTH levels on postoperative days 5,30,and at 6 months,respectively.In the control group,the numbers were 15 (23.81%),10 (15.87%),and 6 (9.52%),respectively,showing statistically significant differences (P<0.05).Conclusion The use of mitoxantrone hydrochloride tracing in patients undergoing total thyroidectomy for papillary thyroid carcinoma can enhance the thoroughness of neck lymph node dissection,diminish parathyroid missection,and mitigate the occurrence of parathyroid dysfunction.

Objective To investigate the anesthetic effect of ultrasound-guided pectoral nerve block (PECS) and thoracic paravertebral block (TPVB) in breast cancer patients undergoing radical surgery. Methods A total of 102 breast cancer patients admitted to our hospital from April 2021 to April 2024 were selected and all received radical mastectomy for breast cancer.They were randomly divided into Group A and Group B by the random number table method,with 51 cases in each group.Group A used PECS,and Group B used TPVB.The perioperative indicators,postoperative pain,stress response indicators,inflammatory response indicators,cognitive function,and untoward reactions of both groups were compared. Results There was no statistically significant difference in intraoperative infusion，blood loss volume，operation and hospital stay between group A and group B (P>0.05).The visual analogue scale (VAS) scores of group A at different time points after surgery were prominently lower than those of group B (P<0.05).After surgery,tumor necrosis factor-α (TNF-α),adrenaline (E),interleukin-6 (IL-6),and norepinephrine (NE) in group A were prominently lower than those in group B (P<0.05).The Mini Mental State Examination (MMSE) score in group A was prominently higher than that in group B (P<0.05).Moreover,there was no statistically significant difference in the incidence of hypotension,vomiting,etc(P>0.05).Conclusion Ultrasound guided PECS for breast cancer patients undergoing radical mastectomy has less postoperative pain response,less stress injury,and ideal analgesic effect.

Objective To discuss the relationship between serum progranulin (PGRN),citrullinated histone H3 (CitH3),and secreted frizzled-related protein 1 (SFRP1) with postoperative infection in patients with chest trauma. Methods From January 2024 to January 2025,122 patients with chest trauma who underwent surgical treatment in our hospital were selected as the study group,and 124 healthy individuals who passed the health examination were selected as the control group.According to the postoperative infection assessment results,the study group was classified into an infected group of 46 cases and an uninfected group of 76 cases.ELISA method was used to measure serum PGRN,CitH3,and SFRP1.Multivariate Logistic regression was used to explore the risk factors for postoperative infections in patients with chest trauma.ROC curve was used to explore the diagnostic value of serum PGRN,CitH3,and SFRP1 for postoperative infections in patients with chest trauma. Results Compared with the control group,patients in the study group showed significantly elevated levels of serum PGRN [(22.19±2.27) ng/ml vs. (11.75±1.19) ng/ml],CitH3 [(75.10±7.59) pg/ml vs. (37.54±3.78)pg/ml],and SFRP1 [(42.18±4.33)ng/ml vs. (21.62±2.21)ng/ml] were significantly elevated (P<0.05).The neutrophil to lymphocyte ratio(NLR) in the infected group and the non-infected group was 3.07±0.33 and 2.89±0.29 respectively,and the tumor necrosis factor-α(TNF-α) was (45.71±4.59)pg/ml and (48.62±4.89) pg/ml respectively.There was a statistically significant difference between the two groups (P<0.05).The serum PGRN in the infection group and the non-infection group was (23.91±2.42) ng/ml and (21.15±2.18) ng/ml respectively.The CitH3 was (80.81±8.11) pg/ml and (71.64±7.19) pg/ml respectively,and the SFRP1 was (45.41±4.58) ng/ml and (40.23±4.06) ng/ml respectively.There was a statistically significant difference between the two groups (P<0.05).Serum levels of PGRN,CitH3,and SFRP1 in patients with chest trauma were positively correlated with NLR (r=0.431,0.512,0.489) and TNF-α (r=0.426,0.508,0.477) (P<0.05);serum PGRN and CitH3 are positively correlated with SFRP1 (r=0.582,0.376,P<0.05);and serum PGRN is positively correlated with CitH3 (r=0.503,P<0.05).Elevated serum PGRN,CitH3,and SFRP1 were independent risk factors for postoperative infections in patients with chest trauma (P<0.05).The combined diagnostic AUC of serum PGRN,CitH3,and SFRP1 for detecting postoperative infections in patients with chest trauma was superior to that of individual markers (Z=3.520,3.044,3.862,P<0.05). Conclusion Serum PGRN,CitH3,and SFRP1 expression is upregulated in patients with chest trauma and correlates with postoperative infection.The combined use of these three markers holds high diagnostic value for identifying postoperative infection secondary to chest trauma.

Objective To investigate the expression of ubiquitin specific protease (USP) 10,28,and 35 in lung cancer (LC) tissues and their relationship with clinical pathological characteristics and prognosis. Methods 154 patients with LC admitted to Baoji Third Hospital from June 2018 to June 2021 were selected.During the operation,tumor tissue and normal residual lung tissue adjacent to the cancer (≥2 cm from the tumor margin) were collected.Immunohistochemistry was used to detect the expression of USP10,USP28,and USP35 in tumor tissue and normal residual lung tissue adjacent to the cancer.The relationship between the three and the clinical pathological characteristics of LC was analyzed.The expression of USP10,USP28,and USP35 in patients who did not experience recurrence/metastasis and those who experienced recurrence/metastasis were compared.Kaplan Meiercurves were used to analyze the 3-year disease-free survival rate of USP10,USP28,and USP35 negative/positive expression groups. Results The positive expression rates of USP10,USP28,and USP35 in the normal residual lung tissue and LC tissue adjacent to the cancer were 10.39% and 63.64%,12.99% and 71.43%,and 14.94% and 66.88%,respectively.The positive expression rates of USP10,USP28,and USP35 in LC tissue were significantly higher than those in the normal residual lung tissue adjacent to the cancer (P<0.05).Compared with TNM stage Ⅰ+Ⅱ and those without lymph node metastasis,the positive expression rates of USP10,USP28,and USP35 in cancer tissues of TNM stage Ⅲa and those with lymph node metastasis were significantly increased (P<0.05).The median follow-up time for 154 patients was 29.23 months,with 4 lost to follow-up and 150 completed follow-up,resulting in a follow-up rate of 97.40% (150/154).Among them,98 cases experienced recurrence/metastasis,and 75 cases died due to recurrence/metastasis.The tumor recurrence/metastasis rate was 65.33% (98/150),and the disease-free survival rate was 34.67% (52/150).Kaplan Meiersurvival curve analysis showed that the 3-year disease-free survival rate of the USP10,USP28,and USP35 positive expression groups was significantly shorter than that of the negative expression group (P<0.05).The positive expression rates of USP10,USP28,and USP35 in cancer tissues of patients with recurrence/metastasis were significantly higher than those of patients without recurrence/metastasis (P<0.05). Conclusion The high expression of USP10,USP28,and USP35 in lung cancer tissues is associated with lymph node metastasis,high TNM staging,and low 3-year disease-free survival rate.

Objective To explore the effectiveness and feasibility of multi-dimensional rehabilitation during the perioperative period in the postoperative recovery of patients with heart valve disease during hospitalization. Methods From January 2023 to June 2024,a total of 67 patients with elective valvular heart disease were randomly assigned to the experimental(nP=34) or control group(nP=33).Patients in the control group received routine physiotherapy care,whereas the experimental protocol consisted of an additional respiratory and musculoskeletal exercise.Patients in the control group received routine physiotherapy care,whereas the experimental protocol consisted of an additional respiratory and musculoskeletal exercise.Data on hospital stay,inspiratory muscle strength,and 6-min walking distance were retrospectively analyzed. Results There was no significant difference in demographic and clinical characteristics between the two groups.The inspiratory muscle strength of the 0patients in the experimental group and the control group at discharge was (51.8±18.0) and (41.9±18.4),respectively.The 6-minute walking distances were (418.9±65.1) meters and (355.8±62.2) meters respectively.There was a statistically significant difference between the two groups (P<0.05).The left ventricular ejection fraction at discharge was (61.4±7.6)%,which was higher than that of the control group[(51.3±10.2)%],and the difference between the two groups was statistically significant (P<0.05);The left ventricular end-systolic diameter was (48.2±12.1)mm,which was lower than that of the control group [(53.5±7.7)mm],and the difference between the two groups was statistically significant (P<0.05);The postoperative hospital stay of patients in the experimental group was (13.6±4.4) days,and that in the control group was (15.8±4.5) days.There was a statistically significant difference between the two groups (P<0.05).No adverse events occurred during the intervention period in both groups. Conclusion Perioperative multi-dimensional rehabilitation during the perioperative period can improve the motor function level and cardiac function indicators of patients scheduled for elective heart valve disease surgery at discharge,and reduce the postoperative hospital stay.

Objective To analyze the feasibility of immediate intraperitoneal hyperperfusion chemotherapy (HIPEC) after laparoscopic radical resection of sigmoid carcinoma. Methods Selecting 80 patients with sigmoid colon cancer admitted to the Second Affiliated Hospital of Qiqihar Medical College from January 2021 to January 2023 as the research subjects,all patients underwent laparoscopic radical resection of sigmoid colon cancer (CME).The patients were divided into two groups according to whether they were combined with HIPEC after surgery.Observation group (40 cases) received CME combined with loplatin HIPEC immediately after surgery.The control group (40 cases) received CME combined with intravenous chemotherapy.Blood routine indexes before and after chemotherapy were compared between the two groups ,liver and kidney function indexes and Postoperative recovery indicators (exhaust recovery time,defecation recovery time,general food recovery time) The total complication rate of the two groups was analyzed,and the recurrence rate in the two groups was analyzed after 1 year follow-up. Results There was no significant difference in white blood cell count (WBC),platelet count (PLT) and hemoglobin (HGB) between the observation group and the control group before and after chemotherapy (P>0.05).Compared with before chemotherapy,WBC and PLT levels were increased after chemotherapy,while HGB levels were decreased (P<0.05).There were no statistically significant differences in Aspartate aminotransferase(AST),alanine aminotransferase(ALT),serum creatinine (Scr) and urea (BUN)) between the observation group and the control group before and after chemotherapy (P>0.05).There were no significant differences in liver and kidney function indexes between the observation group and the control group before and after chemotherapy (P>0.05).The recovery times of exhaust gas, defecation and normal diet in the observation group were (3.62±0.71) days, (4.11±0.56) days and (3.86±0.72) days respectively, while those in the control group were (4.24±0.80) days, (5.16±0.72) days and (4.64±0.66) days respectively. The comparison between the two groups was statistically significant (P < 0.05).There was no statistically significant difference in the total incidence of complications between the observation group and the control group (P>0.05).During the 1-year follow-up,the number of relapsed patients in the observation group and the control group was 2 (5.00%) and 8 (20.00%) respectively.The recurrence rate in the observation group was lower than that in the control group (P<0.05). Conclusion CME combined with immediate postoperative HIPEC in the treatment of patients with sigmoid colon cancer has a relatively small impact on blood routine indicators and liver and kidney function indicators.It can effectively promote the recovery of gastrointestinal function in patients,reduce the postoperative recurrence rate of patients,and has good safety.

Objective To explore the influencing factors for adverse cardiovascular events after radical surgery in colon cancer patients and construct a nomogram prediction model. Methods A total of 150 colon cancer patients admitted to our hospital from January 2022 to January 2025 were selected,all of whom underwent radical surgery.They were divided into occurrence group and non-occurrence group according to whether adverse cardiovascular events occurred within 30 days after surgery.Logistic regression analysis was used to analyze the influencing factors of adverse cardiovascular events after radical surgery in colon cancer patients.The nomogram prediction model for adverse cardiovascular events after radical surgery in colon cancer patients was constructed using R software.Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model.receiver operating characteristic（ROC）curve,calibration curve,and decision curve were used to evaluate the efficacy of the nomogram prediction model. Results Among 150 colon cancer patients who underwent radical surgery,21 cases (14.0%) developed adverse cardiovascular events within 30 days after surgery.There were statistically significant differences between the two groups in age,coronary heart disease,arrhythmia,old myocardial infarction,chronic renal insufficiency,Revised Cardiac Risk Index(RCRI) score,preoperative NT-proBNP level,D-dimer,and NLR level (P<0.05).Logistic regression analysis showed that age,RCRI score (≥2 points),preoperative NT-proBNP,and NLR level were all risk factors for adverse cardiovascular events after radical surgery in colon cancer patients (P<0.05).The area under the ROC curve of the nomogram model for predicting adverse cardiovascular events after radical surgery in colon cancer patients was 0.988 (95%CI 0.975-1.000).Hosmer-Lemeshow goodness of fit test χ?su2> =4.472,P=0.812.The results of calibration curve and decision curve showed that the model had high predictive efficacy and clinical application value. Conclusions Adverse cardiovascular events after radical surgery in colon cancer patients are influenced by age,RCRI score,preoperative NT-proBNP,and NLR level.A nomogram model constructed accordingly can predict the risk of postoperative adverse cardiovascular events.

Objective To explore the effects of different suture methods in anastomotic stoma in laparoscopic radical resection of middle-low rectal cancer and their influences on complications. Methods From February 2020 to November 2024,84 patients with middle-low rectal cancer were selected and divided into two groups according to different reinforcement methods of the anastomosis.44 cases in the observation group were treated with full-thickness reinforcement suture of the anastomotic stoma,while 40 cases in the control group were treated with continuous reinforcement suture of the anterior wall of the anastomotic stoma.The surgical related indexes,inflammation levels on the third postoperative day,and postoperative complications of the two groups were compared. Results There was no statistical difference in operation time,intraoperative blood loss,first exhaust time,anal canal removal time and hospital stay between the two groups (P>0.05).The operation time of the observation group was (126.36±25.82) minutes,which was longer than that of the control group (116.38±22.76) minutes.There was a statistically significant difference between the two groups (P<0.05).There was no significant difference in inflammatory indexes such as c-reactive protein (CRP),white blood cells (WBC),lymphocytes (Lym) and interleukin -6(IL-6) between the two groups (P>0.05).There was no statistical difference in the incidence of postoperative complications between the two groups,such as anastomotic leakage,anastomotic bleeding,incision infection,urinary retention and anastomotic stenosis（all P＞0.05）,but the incidence of anastomotic stenosis in the observation group was significantly higher than that in the research group (9.09% vs. 0). Conclusion For patients undergoing laparoscopic radical resection of middle and low rectal cancer,the operation of reinforcing and suturing the anterior wall of anastomosis is relatively simple,which can not only shorten the operation time appropriately,but also reduce the occurrence of anastomotic stenosis without increasing other complications,and is safe and effective.

Objective To explore the clinical efficacy of rectal drainage combined with ulinastatin in the prevention of low rectal anastomotic leakage (AL). Methods A prospective randomized controlled study was conducted,100 patients with low rectal cancer scheduled for radical resection in our hospital from March 2022 to October 2024 were enrolled,and they were divided into two groups used random number table method.The experimental group (50 cases) received rectal drainage combined with ulinastatin ,while the control group (50 cases) received conventional basic treatment.The incidence of AL,surgery time,intestinal anastomosis time,intraoperative blood loss,postoperative bleeding,postoperative gastrointestinal function recovery time,average hospital stay,postoperative complications,and changes in inflammatory response and hemorheology indices before and after treatment were compared between the two groups. Results The incidence of AL and complications in the experimental group were lower than those in the control group (P<0.05),and the postoperative gastrointestinal function recovery time and hospital stay were shorter than those in the control group (P<0.05).Serum levels of procalcitonin（PCT）,C-reactive protein（CRP）,tumor necrosis factor-α（TNF-α）,interleukin（IL）-6 at 3 days (M₂) and 7 days (M₃) postoperatively and plasma viscosity,erythrocyte aggregation index,and whole blood viscosity at immediate anastomosis (M₀) and 1 day (M₁) postoperatively decreased(P < 0.05).And serum levels of PCT,CRP,TNF-α,IL-6,plasma viscosity,red blood cell aggregation index,and whole blood viscosity in experimental group at M_2-3were lower than those in the control group (P<0.05). Conclusion Rectal drainage combine with ulinastatin can effectively inhibit inflammatory response,improve hemorheology,reduce the incidence of AL and infection after radical resection of low rectal cancer,and accelerate postoperative recovery.

Objective To compare the efficacy of Delta large-channel endoscopic surgery versus anterior cervical discectomy and fusion (ACDF) in the treatment of cervical spondylotic radiculopathy (CSR). Methods A retrospective analysis was conducted on 75 patients with single-level CSR treated between April 2022 and May 2024,according to the surgical methods,they were divided into two groups.There were 32 cases in the Delta group,which underwent Delta large-channel endoscopic surgery.There were 43 cases in the ACDF group,and anterior cervical discectomy and fusion were performed.Perioperative indicators,visual analog scale (VAS),Japanese Orthopaedic Association (JOA) scores,and neck disability index (NDI) scores (preoperatively and at 3 days,3 months,and 12 months postoperatively) were compared.Radiographic parameters (preoperatively and 12 months postoperatively) and MacNab excellent-good rates at the final follow-up were also evaluated. Results The Delta group showed significantly less operative time[(62.34±7.35)min vs. (70.05±8.69)min],less intraoperative blood loss [(31.09±2.86)ml vs. (65.14±7.27) ml] and shorter hospital stay [(5.69±0.75)days vs. (9.44±1.80)days] than the ACDF group(all P<0.01).VAS,JOA,and NDI scores improved significantly at all postoperative time points in both groups (P<0.01).The VAS scores of the Delta group and the ACDF group at 3 days after surgery were (2.19±0.93) points and (2.88±0.79) points respectively,and at 3 months after surgery were (1.41±0.50) points and (2.12±0.79) points respectively.There was a statistically significant difference between the two groups (P<0.05).There was no statistically significant difference in VAS scores between the two groups at 12 months (P>0.05).No significant intergroup differences were found in JOA or NDI scores(P＞0.05) .The cervical curvature (Cobb Angle) of the ACDF group 12 months after the operation and before the operation was (18.54±0.28)° and (14.24±0.57)° respectively,and the intervertebral space height was (5.19±0.21)mm and (3.87±0.21)mm respectively.The range of motion of the adjacent segments of the upper segment was (10.06±0.90)° and (12.54±1.18)° respectively,and that of the adjacent segments of the lower segment was (8.67±0.94)° and (12.04±1.29) ° respectively.Compared with those before the operation,they increased,and the difference was statistically significant (P<0.05).There was no change in the Delta group (P>0.05).The excellent and good rates of MacNab in the two groups were 92.0% and 90.7% respectively,and there was no statistically significant difference between the two groups (P>0.05). Conclusion Delta large-channel endoscopic surgery is a safe and effective treatment for CSR,with clinical outcomes comparable to ACDF,while offering advantages in reduced intraoperative trauma and faster postoperative recovery.

Objective To explore the risk factors of joint stiffness after rotator cuff suture and construct a prediction model based on anatomical indicators. Methods 227 patients who underwent rotator cuff suture in our hospital from January 2018 to January 2024 were retrospectively included and were divided into the stiffness group (47 cases) and the non-stiffness group (180 cases) based on whether joint stiffness occurred 6 months after surgery or not.Use single factor and multi factor methods to analyze independent risk factors for joint stiffness after rotator cuff suturing surgery.Construct corresponding prediction models for predictive performance analysis. Results Compared with the non-stiff group (24.44%,0.71±0.02,and 75.09±5.95° respectively),the stiff group showed statistically significant differences in the preoperative shoulder joint stiffness rate (74.47%),postoperative acromial index (0.73±0.02),and postoperative lateral acromial angle (68.94±5.37)°,with all P-values less than 0.05.Multivariate analysis revealed that preoperative shoulder joint stiffness (OR=0.107,95%CI 0.045~0.256),a higher postoperative acromial index (OR=7.064,95%CI 4.764~10.475),and a smaller postoperative lateral acromial angle (OR=0.835,95%CI 0.775~0.900) were all independent risk factors for postoperative joint stiffness (all P<0.05).A nomogram model was constructed based on the above factors,and the areas under the ROC curve (AUC) for internal validation (nP=227) and external validation (nP=50) were 0.894 and 0.776,respectively. Conclusion Patients undergoing rotator cuff suture who have shoulder joint stiffness before the operation,excessive acromial index or smaller lateral acromial angle in the early postoperative period are more likely to develop joint stiffness after surgery.The column chart prediction model constructed using the above factors has shown good performance in predicting joint stiffness in patients.

Objective To explore the clinical outcomes of biological extended-stem versus cemented long-stem femoral head replacement in patients with intertrochanteric femoral fractures. Methods A total of 96 patients with intertrochanteric femoral fractures who were admitted to Shangluo Central Hospital from June 2021 to June 2023 were selected.Based on the type of femoral stem used,the patients were divided into an observation group (48 cases,treated with a biotype extended stem) and a control group (48 cases,treated with a cemented long stem).Perioperative indicators,hip joint function,pain level,fracture healing outcomes,and the incidence of complications during hospitalization were compared between the two groups.Results The observation group had significantly shorter time to first ambulation,operation time,and hospital stay compared to the control group [(1.07±0.26) days vs.(3.21±0.41) days,(55.27±7.52) min vs. (62.15±7.79) min,and (13.59±2.44) days vs. (18.25±4.68) days,respectively;P<0.05].However,the intraoperative blood loss in the observation group was significantly higher than that in the control group [(274.13±32.48) ml vs. (98.15±32.63) ml,P<0.05].The HHS scores of the observation group at 1 month and 3 months after the operation were (75.79±4.25) points and (89.29±4.31) points respectively,while those of the control group were (68.19±5.28) points and (82.35±5.84) points respectively.There was a statistically significant difference between the two groups (P<0.05).The VAS scores of the observation group at 1 month and 3 months after the operation were (4.23±1.33) points and (1.89±0.61) points respectively,while those of the control group were (3.63±1.08) points and (1.52±0.37) points respectively.There was a statistically significant difference between the two groups (P<0.05).There was no statistically significant difference in HHS and VAS scores between the two groups at 6 months and 12 months after surgery (P>0.05).No significant differences were observed in the incidence of postoperative complications between the two groups (P>0.05). Conclusion The biotype extended stem can promote early postoperative functional recovery and shorten hospital stay,but is associated with greater intraoperative blood loss and slower early pain relief compared to the cemented long stem.By 6 and 12 months postoperatively,there is no significant difference in functional recovery or pain relief between the two,suggesting that the choice of femoral stem should be made based on the specific conditions of the patient.

Objective To explore the relationship between the prognosis of pediatric testicular torsion and the disease cognition in family and regionality. Methods A analysis was performed on the clinical data of 69 children with testicular torsion treated in Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2018 to December 2023,and the disease cognition in family was understood.Combined with the characteristics of the place of onset of the child,the analysis was performed. Results The cognition of testicular torsion in family was not related to age,occupation,and education level (P>0.05).The lack of prior knowledge about this condition among family members led to delayed initial medical consultation,and the necessity for referral,along with the location of symptom onset,resulted in a prolonged transfer time.The minimal time required for referral is significantly associated with the orchiectomy rate following testicular torsion (P<0.05).The ROC curve analysis of the shortest time required to reach Wuhan Children's Hospital suggested that the cutoff value for predicting testicular resection was 42 minutes,with the sensitivity of 70.7%,the specificity of 85.7%,and the AUC of 0.749. Conclusion Understanding the disease cognition level of the family members of the children with testicular torsion and the reasons for delayed medical treatment is of great significance for improving the salvage rate of the testicles.Grasping the opportunity of referral and improving the ability of regional diagnosis and treatment of testicular torsion can shorten the time of delayed diagnosis and treatment and improve the prognosis of children.

Objective To investigate the effects of opioid-free anesthesia (OFA) on the incidence of postoperative nausea and vomiting (PONV) and the quality of recovery in patients undergoing laparoscopic cholecystectomy.Methods A prospective,randomized,double-blind,single-center clinical trial was conducted.A total of 96 patients scheduled for elective laparoscopic cholecystectomy between May 2025 and November 2025 were randomly allocated to either the opioid-free anesthesia (OFA) group (nP=48) or the opioid-based anesthesia (OBA) group (nP=48).The primary outcomes were the incidence of PONV and Rhodes Index of Nausea and Vomiting scores at 6 and 24 hours postoperatively.Secondary outcomes included the Quality of Recovery-15 (QoR-15) score,Visual Analogue Scale (VAS) for pain,analgesic consumption,and patient satisfaction.Results The incidence of PONV within 24 hours postoperatively was 8.3% in the OFA group and 22.9% in the OBA group,and the incidence of nausea was 10.4% and 39.6%,respectively;the differences between the two groups were statistically significant (P<0.05).The Rhodes Index of Nausea and Vomiting scores at 6 hours postoperatively were (0.5±1.1) in the OFA group and (1.5±1.7) in the OBA group,and at 24 hours postoperatively were (0.2±0.5) and (0.9±1.3),respectively (P<0.05).The QoR-15 scores at 6 hours postoperatively were (145.4±2.6) in the OFA group and (138.7±7.7) in the OBA group,and at 24 hours postoperatively were (148.2±1.1) and (144.8±5.4),respectively (P<0.05).The VAS scores at 6 hours postoperatively were (1.2±1.4) in the OFA group and (1.9±1.2) in the OBA group,and at 12 hours postoperatively were (0.3±0.7) and (0.9±0.9),respectively (P<0.05).The number of rescue analgesia administrations in the OFA group and OBA group were (0.29±0.6) and (0.63±1.0),respectively,and patient satisfaction scores were (9.8±0.5) and (9.4±0.8),respectively (P<0.05).The awakening time,extubation time,and time to meet post-anesthesia care unit discharge criteria in the OFA group and OBA group were (13.9±4.3) min and (9.5±3.9) min,(2.4±1.8) min and (1.6±0.6) min,(24.5±5.0) min and (7.8±2.5) min,respectively (P<0.05).Conclusion The OFA regimen based on dexmedetomidine and esketamine significantly reduces the incidence and severity of PONV,provides effective analgesia,reduces opioid requirements,improves patient satisfaction,and does not increase serious adverse reactions in patients undergoing laparoscopic cholecystectomy.Although the time to awakening,extubation,and early postoperative recovery in the OFA group was slightly prolonged compared with the OBA group,the magnitude of the differences was small and remained within the clinically acceptable range.

Objective To explore the application value of volume and cardiac function assessment based on transthoracic ultrasound for emergency surgery and anesthesia management in elderly patients. Methods A total of 360 elderly patients scheduled for emergency surgery in our hospital from March 2022 to March 2025 were selected as the research subjects.They were divided into an observation group and a control group with 180 cases in each group using the computer random number table method.The observation group received volume and cardiac function assessment via transthoracic ultrasound and transesophageal ultrasound to guide anesthesia management,while the control group was given routine anesthesia management.The two groups were compared in terms of hemodynamic indicators at different time points [including mean arterial pressure (MAP) and heart rate (HR) before anesthesia induction,at the start of surgery and before leaving the operating room],clinical related indicators (including operation time,intraoperative fluid intake,intraoperative urine output and dosage of vasoactive drugs),imaging and ultrasound related indicators [including the detection rate of abnormalities such as pleural effusion,pneumothorax and abdominopelvic effusion,as well as parasternal left ventricular end-diastolic area (LVEDA),inferior vena cava diameter (IVC),right ventricular end-diastolic area (RVEDA) and tricuspid annular plane systolic excursion (TAPSE)],and postoperative related indicators (postoperative extubation time,ICU admission rate,complication rate and total hospitalization cost). Results There was no statistically significant difference in MAP and HR between the two groups before anesthesia induction (P>0.05).At the start of surgery and before leaving the operating room,the MAP of the observation group [(86.58±5.74) mmHg and (88.25±5.96) mmHg] was higher than that of the control group [(82.35±6.18) mmHg and (84.15±6.27) mmHg],and the HR [(98.65±8.74) beats/min and (102.36±9.12) beats/min] was lower than that of the control group [(105.82±9.21) beats/min and (108.75±9.58) beats/min],with statistically significant differences (P<0.05).The intraoperative fluid intake [(1 851.35±325.68) ml] and dosage of vasoactive drugs [5.23 (3.28,6.81) mg] in the observation group were lower than those in the control group [(2 140.73±358.24) ml and 8.65 (6.47,10.74) mg],while the urine output [(425.68±102.35) ml] was higher than that in the control group [(368.95±92.74) ml] (P<0.05).There was no statistically significant difference in operation time between the two groups (P>0.05).The total detection rate of abnormalities such as pleural effusion,pneumothorax and abdominopelvic effusion in the observation group was significantly higher than that in the control group (31.11% vs. 19.44%,P<0.05).There were no statistically significant differences in parasternal LVEDA,IVC,RVEDA and TAPSE at 5 minutes after intraoperative ultrasound monitoring and before leaving the operating room between the two groups(P>0.05).The postoperative extubation time [(6.35±2.18) h] of the observation group was shorter than that of the control group [(8.69±2.51) h],the postoperative ICU admission rate (6.67% vs. 15.56%) and complication rate (5.56% vs. 13.89%) were lower than those of the control group,and the total hospitalization cost [(35 291.74±5 242.27) yuan] was less than that of the control group [(43 918.80±6 215.58) yuan] (P<0.05). Conclusion The application of transthoracic ultrasound-based volume and cardiac function assessment for emergency surgery and anesthesia management in elderly patients can effectively maintain intraoperative hemodynamic stability,improve the detection rate of abnormalities,reduce intraoperative fluid intake and the use of vasoactive drugs,shorten postoperative extubation time,and decrease postoperative complication rate and hospitalization cost.

Objective To explore the therapeutic effect and application experience of Acostream thrombus aspiration system in acute lower extremity deep vein thrombosis. Methods A retrospective analysis was conducted on 36 patients with acute lower extremity deep vein thrombosis admitted to the vascular surgery department of the First Affiliated Hospital of Wannan Medical College from May 2022 to May 2024.All patients underwent Acostream thrombus aspiration treatment under DSA monitoring.Immediate angiography after surgery was performed to understand the thrombus clearance rate and venous patency degree.Outpatient follow-up was conducted for 3-6 months after discharge to understand the long-term patency rate and thrombus recurrence rate.Results Thrombus aspiration treatment was successfully implemented in all 36 patients.Two patients had hematoma at the puncture site,which was relieved after pressure bandaging.One patient had thrombus detachment to below the inferior vena cava filter during aspiration and was resolved after re-aspiration.Two patients showed more residual thrombus on immediate angiography after surgery and were given thrombolytic treatment with indwelling thrombolytic catheters.Six patients were diagnosed with iliac vein compression syndrome during the operation and improved after balloon dilation treatment.After treatment,the patient's lower limb swelling circumference difference improved,from （5.23±1.32）cm before treatment to （1.52±0.63）cm after treatment.The VAS score also improved,from 7.85±1.21 before treatment to 2.30±0.52 after treatment.with statistically significant differences (P<0.05).A follow-up lower limb venography at 24 hours post-surgery showed that among 36 patients,25 had complete recanalization (69.44%),8 had partial recanalization (22.22%),and 3 had no recanalization (8.33%),with a total recanalization rate of 91.67%.Conclusion The Acostream thrombus aspiration system can effectively remove acute stage thrombus in a short time,quickly open veins,and immediately improve clinical symptoms.It is safe and effective for the treatment of acute lower extremity deep vein thrombosis.

Intestinal stricture and fistula formation are severe and common complications of Crohn's disease,frequently accompanied by refractory malnutrition.This complex pathological condition directly impacts the surgical outcomes and quality of life of patients.This article reviews the recent research advances of exclusive enteral nutrition in Crohn's disease,focusing on its efficacy in inducing clinical remission,its perioperative application,and the underlying mechanisms of gut microbiota remodeling.

Papillary thyroid carcinoma (PTC) is the most common subtype of primary thyroid cancer.We herein present a case of predominantly cystic giant PTC coexisting with Hashimoto thyroiditis (HT).The multilocular cystic architecture and dense inflammatory infiltrate prompted us to conside r whether HT might represent a predisposing factor for PTC.The tumor was bulky and had invaded adjacent nerves;after palliative resection,the patient received adjuvant targeted therapy.The clinical course was complicated and the therapeutic benefit lim ited.

Paravertebral block has been successfully used for anesthesia management in percutaneous nephrolithotomy for renal and upper ureteral stones.We report a case of paravertebral block applied for anesthesia in a high-risk elderly patient with multiple comorbidities undergoing flexible ureteroscopic lithotripsy for upper ureteral stone on the right side.Two weeks prior to the surgery,a ureteral stent was placed for preoperative ureteral dilation.On the day of the procedure,ultrasound-guided multi-level (T8-9-10-11-12) paravertebral blocks were performed.The surgeon selected a small-diameter ureteral access sheath,and topical urethral anesthesia was additionally administered.A low dose of oxycodone was administered intravenously during the surgery for supplemental analgesia.The procedure was completed successfully.The patient was able to ambulate independently immediately after the surgery and was discharged two days postoperatively with an uneventful recovery.

Necrotizing fasciitis (NF) is a highly aggressive and severe soft tissue infection,pathologically characterized by the rapid and progressive necrosis of the subcutaneous deep fascial layer.Although relatively uncommon in clinical practice,it is a significant concern due to its substantial fatality rate.Its pathogenesis involves the rapid spread of bacteria along fascial planes with relatively poor blood supply,leading to secondary infection of the fascial tissue and adjacent structures,including the skin,subcutaneous tissue,and muscle.