The surgical treatment of early-stage lung cancer isundergoing a profound paradigm shift from standardized resection to precision,individualized resection.In 2026,the Chinese Medical Association and the Chinese Society of Clinical Oncology updated their clinical guidelines for early-stage lung cancer.The surgical updates focus on three dimensions.First,the indications for sublobar resection have been significantly expanded.Based on a triple-screening criterion of tumor diameter ≤2 cm,consolidation-to-tumor ratio ≤0.5,and intraoperative frozen section confirmation of adenocarcinoma in situ or minimally invasive adenocarcinoma,sublobar resection has been upgraded from a “compromised choice” to a preferred procedure for selected populations.Second,mediastinal lymph node dissection has been adjusted from systematic dissection to a risk-stratified strategy based on imaging characteristics and pathological assessment,representing a critical transition from “sweeping” to “selective” dissection.Third,a standardized intraoperative frozen pathology decision-making pathway has been established,requiring an efficient intraoperative multidisciplinary collaboration between thoracic surgery and pathology departments.This article systematically interprets the evidence basis for these updates,reviews long-term follow-up data from key studies including JCOG0802,CALGB140503,and ACOSOG Z0030,analyzes controversial issues in clinical practice,and discusses future directions including AI assisted decision-making and liquid biopsy-guided precision surgery.

Esophageal squamous cell carcinoma (ESCC) withsupraclavicular lymph node metastasis exhibits features of both locoregional progression and potential systemic dissemination,representing a distinct and clinically controversial disease setting with respect to staging and treatment decision-making.The classification of supraclavicular nodal involvement varies across staging systems,which may influence the selection between curative-intent treatment and systemic therapy.Current evidence,largely derived from retrospective cohort studies,suggests that selected patients with ESCC and supraclavicular lymph node metastasis may achieve long-term survival through multidisciplinary management and aggressive local treatment following systemic therapy.With advances in immunotherapy and contemporary radiotherapy techniques,the feasibility of aggressive curative-intent surgical treatment for ESCC with supraclavicular lymph node metastasis is gradually increasing.This article provides an expert commentary on the anatomical basis of supraclavicular lymph node metastasis,controversies in staging,evidence supporting surgery and radiotherapy,multimodal treatment strategies,and future research directions.It emphasizes that treatment decisions should be individualized through multidisciplinary assessment based on disease burden,response to therapy,patient condition,and institutional expertise.

Thymic carcinoma is a rare and aggressive thymic epithelial tumor with high metastatic potential and poor prognosis.Due to its low incidence,relevant clinical studies are relatively limited,and perioperative treatment strategies remain controversial.In recent years,with the promotion of multidisciplinary diagnosis and treatment models and the emergence of novel therapeutic approaches,significant progress has been made in the perioperative management of thymic carcinoma.Based on the latest NCCN guidelines and relevant clinical research evidence,this article systematically reviews the latest advances in perioperative treatment of thymic carcinoma,including preoperative assessment,surgical treatment,neoadjuvant therapy,postoperative adjuvant therapy,and multidisciplinary management.

Esophageal squamous cell carcinoma dominates esophageal cancer cases in China,with a high proportion of patients diagnosed at locally advanced stages.Conventional neoadjuvant chemotherapy or chemoradiotherapy combined with surgery yields limited efficacy,and the 5-year overall survival rate remains merely 30%-40%.Perioperative immunotherapy centered on PD-1/PD-L1 inhibitors has remarkably broken through therapeutic bottlenecks and evolved into a potential therapeutic strategies for locally advanced esophageal cancer.Phase Ⅲ trials including CheckMate 816 and ESCORT-NEO have validated that neoadjuvant immunotherapy combined with chemotherapy markedly raises the pathological complete response (pCR) rate by 14%-24% compared with conventional chemotherapy,significantly increases the R0 resection rate and improves event-free survival;this regimen has been granted category Ⅰ,1A recommendation as m explanatory in clinical guidelines.Neoadjuvant immunotherapy plus chemoradiotherapy further elevates the pCR rate to 55%-60% for high-risk patients yet carries a higher risk of adverse events.Postoperative adjuvant immunotherapy substantially prolongs disease-free survival among patients failing to achieve pCR after neoadjuvant treatment and serves as a vital consolidation strategy.Radical surgical resection constitutes the cornerstone of perioperative immunotherapy,undertaking core functions including lesion eradication,pathological evaluation and synergizing anti-tumor immune responses.The standardized workflow covers MDT assessment,neoadjuvant therapy,surgery scheduled 4-6 weeks after the last immunotherapy dose,risk-stratified postoperative adjuvant immunotherapy and long-term surveillance.Current challenges involve escalated surgical difficulty,immune-related adverse events,insufficient predictive biomarkers and immune resistance.Future research will focus on novel combinatorial immunotherapies,biomarker-guided precision treatment and standardized multidisciplinary management to further improve long-term survival of patients with locally advanced esophageal cancer.

Post-esophagectomy chylothorax is uncommon but may cause substantial nutritional,immunologic,and hemodynamic impairment.Whether prophylactic thoracic duct ligation reduces chylothorax and whether it affects long-term outcomes remain controversial.This expert review evaluates thoracic duct anatomy,early recognition,and risk-adapted management of chylothorax,with emphasis on the evolving evidence regarding prophylactic ligation.Although early studies suggested a preventive benefit,recent meta-analyses and propensity-score analyses have not demonstrated consistent improvement,and the effects of ligation,resection,and extended lymphadenectomy remain difficult to separate.Current evidence does not support routine ligation of the thoracic duct when neither ductal injury nor tumor invasion is identified.Precise intraoperative identification and selective repair or ligation of an injured duct or tributary are more appropriate.Postoperative management should escalate from nutritional support to lymphatic intervention or therapeutic ligation according to output trajectory and systemic effects.

Objective To explore the correlation between serum V-set and immunoglobulin domain containing 4 (VSIG4),the protein encoded by the multiple endocrine neoplasia type 1 gene (menin) with immune infiltration in patients with papillary thyroid carcinoma (PTC),and their impact on prognosis.Methods From February 2019 to February 2022,168 PTC patients treated with thyroidectomy (PTC group),168 patients with benign thyroid lesions (benign nodules group),and 168 healthy individuals with normal thyroid function (healthy group) in our hospital were considered as the study subjects.According to whether there was recurrence or death within 3 years after thyroidectomy,the 168 PTC patients were included into 138 cases in the good prognosis group and 30 cases in the poor prognosis group.ELISA method was used to detect serum VSIG4 and menin.Bioinformatics (TISDIB database) was used to explore the correlation between VSIG4,menin,and five types of tumor infiltrating immune cells in PTC patients.Kaplan-Meier survival curves were plotted to explore the relationship between high/low VSIG4,menin levels and disease-free survival.Multifactorial COx method was used to explore the factors influencing the recurrence/death.ROC curve was plotted to evaluate the predictive value of VSIG4 and menin for recurrence/death.Results Serum VSIG4 levels in PTC group,benign nodule group,healthy group were （6.59±1.42）ng/ml,（5.14±1.20）ng/ml,（3.29±0.86）ng/ml respectively,and it was higher in PTC group than the benign nodule group and the healthy group (P<0.05).Serum menin levels in PTC group,benign nodule group,healthy group were （5.02±1.34）ng/ml,（6.47±1.67）ng/ml,（8.15±1.88）ng/ml respectively,and it was lower in PTC group than the benign nodule group and the healthy group (P<0.05).The analysis results of TISDIB database showed that the VSIG4 and menin were correlated with five types of tumor infiltrating immune cells in PTC patients,and the correlation of VSIG4 with immune infiltration in PTC patients was higher than the correlation of menin (P<0.05).The poor prognosis group had prominently higher proportion of lymph node dissection,VSIG4,and proportion of TNM stage Ⅲ,and prominently lower menin than the good prognosis group (P<0.05).The disease-free survival rate of PTC patients with VSIG4 ≥ 6.50ng/ml was greatly lower than that of patients with VSIG4<6.50ng/ml,and the disease-free survival rate of PTC patients with menin ≤ 5.11ng/ml was greatly higher than that of patients with menin>5.11ng/ml (χ2=9.217,16.407,P<0.05).TNM stage Ⅲ and VSIG4 were risk factors for recurrence/death in PTC patients,while menin and lymph node dissection were protective factors (P<0.05).The combined prediction of VSIG4 and menin had an AUC of 0.919 (95%CI 0.868-0.970) for predicting recurrence/death in PTC patients,which was superior to the single prediction of VSIG4 (Z=2.206,P<0.05) and menin (Z=2.376,P<0.05).Conclusion Serum VSIG4 is elevated and menin is reduced in patients with PTC .Both are correlated with five types of tumor infiltrating immune cells in PTC patients.The combined prediction of VSIG4 and menin has a high value in predicting the prognostic recurrence/death in PTC patients.

Objective  To investigate the risk factors for deep vein thrombosis of lower extremities (LEDVT) in patients with traumatic rib fractures,construct a nomogram prediction model,and validate its performance.Methods A retrospective study was conducted on 211 patients with traumatic rib fractures admitted to Putian 95th Hospital from January 2020 to February 2025.Clinical data were collected.Variables were first screened using LASSO regression,followed by multivariate Logistic- regression analysis.A nomogram prediction model was constructed based on independent risk factors,and its predictive performance was validated.Result The postoperative incidence of lower extremity deep vein thrombosis (LEDVT) in the enrolled patients was 18.96% (40/211).The non-LEDVT group had significantly lower body mass index (BMI) than the LEDVT group[(23.10±2.55) kg/m2 vs.(24.17±2.63) kg/m2].The proportion of patients with >10 rib fractures were 13.45% and 30.00%,respectively.The proportion of patients with concomitant fractures at other sites were 42.69% and 65.00%,respectively.The operation time were (98.17±15.71) min and (105.50±14.72) min,respectively.There was a statistically significant difference between the two groups (P<0.05).The prothrombin time (PT) in the non-LEDVT group and the LEDVT group was (13.17±2.50) seconds and (12.30±2.00) seconds,respectively.There was a statistically significant difference between the two groups (P<0.05).LASSO regression analysis identified 8 key variables.Multivariate Logistic regression analysis revealed that >10 rib fractures (OR=4.070,95%CI:1.561-10.611),concomitant fractures at other sites (OR=2.871,95%CI:1.267-6.506),operation time > 110min (OR=2.986,95%CI:1.313-6.790),and D-dimer (D-D) > 2mg/L (OR=3.812,95%CI:1.655-8.778) were independent risk factors for LEDVT in patients with traumatic rib fractures (P<0.05).Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) was 0.764 (95%CI:0.665-0.864) for the training set and 0.731 (95%CI:0.634-0.828) for the test set.Calibration curve analysis demonstrated no significant differences between the predicted and actual probabilities in both the training and test sets.Decision curve analysis indicated that within the highrisk threshold range of 0.1-0.75,prophylactic intervention guided by the nomogram model yielded higher standardized net benefits compared with universal intervention or no intervention.Conclusion Postoperative LEDVT in patients with traumatic rib fractures is closely associated with the number of rib fractures,concomitant fractures at other sites,operation time,and DD levels.The nomogram prediction model constructed based on these indicators can accurately predict the occurrence of LEDVT,providing a reference for formulating early prevention and treatment strategies for clinical LEDVT.

Objective To explore the application value of artificial intelligence assisted imaging in evaluating the effect of neoadjuvant chemotherapy for locally advanced breast cancer.Methods A total of 107 patients with locally advanced breast cancer were admitted from February 2023 to February 2025.107 patients with locally advanced breast cancer who were treated with EC-T (Epirubicin+Cyclophosphamide sequential Taxotere) sequential neoadjuvant chemotherapy were examined by magnetic resonance imaging (MRI) before and after chemotherapy.According to the Miller-Payne pathological evaluation system,patients were divided into an effective group and an ineffective group.The MRI parameters between the two groups after chemotherapy was compared,and the relationship between MRI parameters and ineffective neoadjuvant chemotherapy was investigated using multiple Logistic regression analysis.The MRI imaging evaluation model based on artificial intelligence was constructed,and this model was used to evaluate the effectiveness of neoadjuvant chemotherapy.Results 76 patients (71.03%) were effective in chemotherapy and 31 (28.97%) were ineffective among the 107 patients.The maximum tumor diameter,apparent diffusion coefficient (ADC),volume transfer constant (Ktrans),extracellular space volume percentage (Ve),rate constant (Kep),maximum enhancement ratio (Emax),maximum enhancement rate (Vmax),contrast enhancement rate (CER) and peak time (Tmax) in the effective group were (3.96±0.83)cm,(1.21±0.28)×10-3mm2/s,(0.41±0.07)min-1,(0.79±0.14)%,(0.52±0.15)min-1,(91.25±25.64)%,(0.55±0.12)SI/S,(1.48±0.32) and (301.36±40.78)s respectively，which in the ineffective group were (6.95±1.03)cm,(0.88±0.16)×10-3mm2/s,(0.88±0.19)min-1,(1.03±0.12)%,(0.85±0.23)min-1,(153.78±32.03)%,(0.91±0.24)SI/S,(1.64±0.35) and (169.92±34.71)s respectively,and the differences between the two groups were statistically significant (P<0.05).Multivariate logistic regression analysis showed that the maximum tumor diameter,Ktrans,Ve,Kep,Emax,Vmax and CER were risk factors for the ineffectiveness of neoadjuvant chemotherapy for locally advanced breast cancer (P<0.05),and ADC and CER were protective factors (P<0.05).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of the imaging evaluation model based on artificial intelligence to evaluate the effect of neoadjuvant chemotherapy for locally advanced breast cancer were 93.55%,94.74%,87.88%,97.30% and 94.39% respectively,and the evaluation result of this model was extremely strong consistency with pathological evaluation (Kappa=0.866,P<0.05).Conclusion Artificial intelligence assisted imaging has good application value in evaluating the effect of neoadjuvant chemotherapy for locally advanced breast cancer.

Objective To investigate the clinical features,diagnostic approaches,and selection of surgical treatments for pediatric magnetic foreign bodies in the digestive tract.Methods Clinical data of 17 children who ingested magnetic foreign bodies,admitted to our hospital between January 2018 and June 2025,were retrospectively analyzed.Data included demographics,clinical presentation,imaging findings,treatment,and outcomes.Results Among the 17 children (11 males,6 females),median age was 4.0 years (range,1.0-11.0).Common symptoms were abdominal pain,vomiting,and abdominal distension.All cases were diagnosed via abdominal X-ray or CT.Fifteen patients underwent surgery (7 laparotomy,5 laparoscopy,3 endoscopylaparoscopy combined).All children were discharged uneventfully.Conclusion Magnetic foreign bodies in the pediatric digestive tract can lead to severe complications.Early diagnosis and individualized treatment are crucial.Combined endoscopic and laparoscopic surgery minimizes trauma and improves outcomes.Prevention and education are vital for reducing incidence.

Objective To evaluate the predictive value of preoperative hemoglobin,albumin,lymphocyte,and platelet (HALP) scores for postoperative complications following laparoscopic cholecystectomy in patients with acute cholecystitis (AC).Methods A total of 160 patients with acute cholecystitis  AC who underwent laparoscopic cholecystectomy from May 2021 to May 2024 were selected as the research subjects.The preoperative HALP scores of AC patients with different disease severity and postoperative complications were compared to analyze the predictive value of preoperative HALP scores for postoperative complications in AC patients.The relationship between  preoperative HALP scores and the occurrence of postoperative complications in AC patients was analyzed.The independent correlation between postoperative complications in AC patients and preoperative HALP scores was also analyzed.Results As the condition worsened,the preoperative HALP score gradually decreased.(P<0.001);the preoperative HALP score of patients with poor prognosis in AC was significantly lower than that of patients with good prognosis (P<0.001);the preoperative HALP score had a high predictive value for the occurrence of postoperative complications in AC patients (P<0.001);a low preoperative HALP score was an independent risk factor for postoperative complications in AC patients.Conclusion The reduction in preoperative HALP score is closely related to disease progression and postoperative complications of AC patients.Moreover,the preoperative HALP score can effectively predict the occurrence of postoperative complications in AC patients,and it holds significant clinical importance for the prognosis assessment and reatment  of AC patients.

Objective To evaluate the clinical efficacy of the Masquelet induced membrane technique in treating Wagner grade 3-4 diabetic foot with bone defect or osteomyelitis and compare the prognostic differences between patients with different Wagner grades.Methods Clinical data of 21 patients with Wagner grade 3-4 diabetic foot who underwent the Masquelet technique at Xiantao First People's Hospital from January 2022 to October 2024 were retrospectively analyzed,including 11 cases of Wagner grade 3 and 10 cases of Wagner grade 4.All patients underwent thorough debridement and antibiotic-loaded bone cement spacer implantation in the first-stage surgery,followed by autologous or composite bone grafting reconstruction within the induced membrane in the second stage.Limb salvage rate,deep infection control,bone healing,and wound healing were compared between the two groups.Perioperative indicators and functional recovery during follow-up were recorded,with a follow-up period of 12-18 months.Results The overall limb salvage rate was 85.7% (18/21),with 90.9% for Wagner grade 3 and 80.0% for Wagner grade 4 (P>0.05).The overall bone healing rate was 81.0% (17/21),with 90.9% in Wagner grade 3 and 70.0% in Wagner grade 4 (P>0.05).The bone healing time was (14.2±3.1) weeks,slightly shorter in grade 3 compared to grade 4 (P＞0.05).All wounds ultimately healed,with an overall wound healing time of (9.3±2.7) weeks.Recurrent infection occurred in 4 cases (19.0%),with no statistically significant difference between the two groups（P＜0.05）.Wagner grade 4 patients had significantly larger debridement range in the first stage and greater bone graft volume in the second stage compared to grade 3 (all P<0.05),but no significant differences were observed in hospitalization duration,complications,or functional recovery（P＜0.05）.Conclusion The Masquelet induced membrane technique is safe and feasible for Wagner grade 3-4 diabetic foot,achieving high infection control,bone reconstruction,and limb salvage rates.Although some prognostic indicators showed a negative trend in Wagner grade 4 patients,the overall differences were not significant,suggesting that this technique can serve as an important limb salvage strategy for severe diabetic foot under strict indication selection and comprehensive management.

Objective To analyze the incidence,influencing factors,and predictive efficacy of postoperative pulmonary complications in patients with congenital scoliosis (CS).Methods Clinical data of 280 patients with CS who successfully underwent scoliosis correction surgery in our hospital from January 2021 to February 2026 were retrospectively collected.According to the occurrence of postoperative pulmonary complications (PPCs) within 30 d after surgery,the patients were divided into a PPCs group and a non-PPCs group.Clinical data were collected.Logistic regression analysis was used to analyze the influencing factors for PPCs in patients with CS,and a Logit(P) regression prediction model was constructed.Receiver operating characteristic (ROC) curves,the Hosmer-Lemeshow (H-L) test,and Bootstrap internal validation were used to evaluate the predictive value of the model for PPCs.Results The incidence of PPCs among the 280 patients with CS was 22.14% (62/280).Univariate analysis showed that there were statistically significant differences between the two groups in age,preoperative Cobb angle,preoperative SII level,preoperative respiratory disease,number of fused segments,mid-thoracic screw placement,allogeneic red blood cell transfusion,thoracoplasty,operative time,and Cobb angle correction rate (P<0.05).Logistic regression analysis showed that increased preoperative Cobb angle,high preoperative SII level,preoperative respiratory disease,allogeneic red blood cell transfusion,thoracoplasty,and prolonged operative time were risk factors for PPCs in patients with CS (P<0.05).The regression equation was as follows:Logit(P) =-17.851+0.047×preoperative Cobb angle (°)+0.006×preoperative SII level+1.299×preoperative respiratory disease (no=0,yes=1)+0.942×allogeneic red blood cell transfusion (no=0,yes=1)+0.932×thoracoplasty (no=0,yes=1)+0.024×operative time (min).ROC curve analysis showed that the area under the curve (AUC) of this regression prediction model for predicting PPCs was 0.889.The calibration curve showed that the corrected curve was close to the ideal curve.Bootstrap internal validation showed that the C-index was 0.893.Conclusion Patients with CS have a relatively high risk of PPCs.Preoperative Cobb angle,preoperative SII level,preoperative respiratory disease,allogeneic red blood cell transfusion,thoracoplasty,and operative time can all affect the occurrence of PPCs.The prediction model constructed based on these factors has good predictive value and can be used for early clinical risk assessment and management.

Objective To evaluate the clinical application value of unilateral biportal endoscopy (UBE) in the management of adjacent segment disease (ASD) following posterior lumbar fusion.Methods Between January 2022 and April 2024,a total of 28 patients with symptomatic adjacent segment lesions after prior posterior lumbar fusion underwent UBE surgery for either endoscopic discectomy or unilateral laminotomy for bilateral decompression (ULBD) via the contralateral approach.Intraoperative and postoperative outcomes,including operative duration,length of hospital stay,drainage volume,and complications,were recorded.The visual analogue scale (VAS) scores for back and leg pain,as well as the Oswestry Disability Index (ODI),were assessed preoperatively and at 1,6,and 12 months postoperatively,with additional evaluation at the final follow-up.Results All procedures were successfully completed in the 28 patients.The mean follow-up period was (19.3±3.5)months (range:16-24 months).The mean operative time was (68±30)minutes (range:54-98 minutes).Postoperative computed tomography confirmed adequate neural decompression,with preservation of more than 50% of the facet joint on the operated side.VAS scores for low back pain,leg pain,and ODI values at 1,6,and 12 months postoperatively,as well as at final follow-up,showed significant improvement compared to preoperative levels (P<0.05).At the final followup,functional outcomes based on the modified MacNab criteria revealed 21 excellent,4 good,3 fair,and 0 poor results,yielding an excellent and good rate of 89.3%.One patient experienced a dural tear,which was managed endoscopically with suture repair and external compression;the drainage tube was removed after 7 days.Another patient developed a postoperative hematoma with transient radiculopathy,which resolved following conservative treatment with corticosteroids and mannitol.Follow-up MRI one week later confirmed hematoma absorption without evidence of spinal instability.Conclusion Unilateral biportal endoscopy demonstrates favorable outcomes in the treatment of adjacent segment disease following posterior lumbar fusion,offering minimal invasiveness,and promising early clinical efficacy.It represents a viable minimally invasive option for revision surgery in this patient population.

Objective To analyze the relationship between preoperative serum cystatin 6 (CST6),centromere protein A (CENPA),C-type lectin domain family 3 member B (CLEC3B) and clinical features and prognosis in bladder cancer.Methods From January 2020 to December 2021,160 patients with bladder cancer who were treated in our hospital were collected for research (cancer group),and 160 healthy people were served as control group.The levels of serum CST6,CENPA and CLEC3B were detected by enzymelinked immunosorbent assay.The receiver operating characteristic (ROC) curve was used to analyze the value of serum CST6,CENPA and CLEC3B in predicting the prognosis of bladder cancer.The relationship between serum CST6,CENPA,CLEC3B and prognosis was analyzed using the Kaplan-Meier-method.Results The levels of CST6 and CENPA in the cancer group were (7.65±1.59) ng/ml and (15.41±4.67) ng/ml respectively,which were higher than those in the control group [(3.24±0.97) ng/ml and (8.92±2.63) ng/ml].The CLEC3B in the cancer group was (67.29±13.25) ng/ml,which was lower than that in the control group [(95.35±15.96) ng/ml],and the difference between the two groups was statistically significant (P<0.05).The serum CST6,CENPA,and CLEC3B was statistically clearly different among different differentiation,T staging,and lymph node metastasis (P<0.05).The poor prognosis group had higher CST6 and CENPA,and lower CLEC3B than good prognosis group (P<0.05).The ROC curve showed that the area under the curve (AUC) of the combined prediction of patient prognosis by CST6,CENPA and CLEC3B was 0.926,which was significantly higher than that of the individual predictions of the three.Kaplan-Meier analysis showed that there were significant differences in cumulative survival rates among those with high and low expressions of serum CST6,CENPA,and CLEC3B (Log Rankχ2=11.102,15.817,36.612,all P<0.001).Conclusion CST6,CENPA and CLEC3B are all related to the clinical characteristics and prognosis of patients with bladder cancer.The combination of the three has a high value in predicting the prognosis of bladder cancer and is related to the overall survival rate after bladder cancer surgery.

Objective This study aimed to compare the clinical efficacy of double-notch procedure for prolapse and  hemorrhoids and traditional procedure for prolapse  and hemorrhoids (PPH) in the treatment of prolapsed circular hemorrhoids combined with internal rectal prolapse.Methods From June 2023 to June 2024,80 patients diagnosed with prolapsed circular hemorrhoids accompanied by internal rectal prolapse who were admitted to our department and elected surgical intervention were randomly assigned to either a treatment group or a control group,with 40 patients in each.The treatment group underwent double-notch PPH,whereas the control group underwent conventional PPH.Outcomes assessed included overall postoperative clinical efficacy,incidence of anal stenosis,pre-and postoperative Wexner constipation scores,intraoperative blood loss,postoperative anal pain measured by the visual analogue scale (VAS),operative duration,length of hospital stay,and the occurrence of postoperative complications.Results One month after surgery,the overall clinical effective rate was marginally higher in the treatment group compared to the control group;however,this difference did not reach statistical significance.At one-year follow-up,the total effective rate was significantly higher in the treatment group than in the control group (P<0.05),and the incidence of postoperative anal stenosis was significantly lower in the treatment group (P<0.05).Although the total incidence of postoperative complications was lower in the treatment group,the difference was not statistically significant (P>0.05).No significant difference was observed in baseline Wexner constipation scores between the two groups (P>0.05).At 12 months postoperatively,the reduction in Wexner constipation scores was significantly greater in the treatment group compared to the control group (P<0.05).Conclusion In the management of patients with prolapsed circular hemorrhoids complicated by internal rectal prolapse,double-notch PPH demonstrates superior longterm clinical effectiveness and a reduced risk of anal stenosis compared to conventional PPH.Both procedures effectively alleviate constipation symptoms to some extent.Overall,doublenotch PPH exhibits more favorable long-term outcomes and holds promise for broader clinical application.

Objective To explore the clinical efficacy of modified incision and suture of anal fistula in patients with high complex anal fistula (CAF) and the influencing factors of anal fistula healing.Methods A total of 104 patients with CAF who visited our hospital from January 2021 to March 2024 were selected as the research objects.They were divided into the observation group and the control group by the random number table method,with 52 cases in each group.The observation group was treated with the modified anal fistula incision and suture technique,while the control group was treated with the traditional anal fistula incision and suture technique.The perioperative indicators and the wound bleeding score,wound exudate score,anal distension score and wound pain score at 1,3 and 7 days after the operation were compared between the two groups of patients.The Wexner anal incontinence score,anal canal resting pressure (ARP) and anal canal maximum systolic pressure (AMCP) levels of the two groups of patients before the operation and at 7 days,1 and 3 months after the operation were also compared.The clinical efficacy and postoperative complications of the two groups of patients were compared.The Cox regression analysis was used to analyze the effect of the modified incision and suture of anal fistula on the non-healing of anal fistula in patients.Results The hospitalization time [(8.05±1.12)d],wound healing time [(27.26±4.38)d] and intraoperative blood loss [(28.29±4.47)ml] of the observation group were significantly lower than those of the control group [(11.24±2.06)d,(32.07±5.21 )d and (34.18±5.61)ml,respectively)] (P<0.05).The wound bleeding score,wound exudate score,anal distension score and wound pain score of the observation group and the control group 7 days after the operation were (1.61±0.25) points and (1.75±0.33) points,(1.52±0.24) points and (1.66±0.29) points,(1.47±0.44) points and (1.65±0.46) points,(3.46±0.35) points and (4.27±0.43) points,respectively.There was a statistically significant difference between the two groups (P<0.05)
At 7-days,1 month and 3 months after the operation,the Wexner anal incontinence scores of both groups showed an increasing and decreasing trend.The scores of the observation group at each time point were lower than those of the control group (P<0.05).At 7 days,1 month and 3 months after the operation,AMCP and ARP of both groups of patients showed a decreasing trend (P<0.05).There was no statistically significant difference in the total effective rate between the two groups (P>0.05).The total incidence of adverse reactions in the observation group (7.69%) was significantly lower than that in the control group (25.00%) (P<0.05).The results of Coxregression analysis showed that the modified incision and suture of anal fistula could reduce the risk of unhealed anal fistula in patients ,and the results were consistent in different subgroups.Conclusion The modified incision and suture surgery for anal fistula has a good clinical effect on CAF,with a low incidence of postoperative complications.It has obvious advantages in rapid pain relief,accelerated wound healing and maintenance of anal function after surgery.

Objective To analyze the predictive value of serum prostaglandin E2 (PGE2),central nervous system specific protein (S100β) combined with regional cerebral oxygen saturation (rScO2) for postoperative delirium (POD) in elderly patients with colorectal cancer (CRC) frailty.Methods Totally 203 elderly patients with CRC who underwent surgical treatment in our hospital (January 2025 June 2025) were served as the study subjects.ELISA method was used to detect serum PGE2 and S100β in patients.Pearson method was performed to explore the correlation between serum PGE2,S100β,and rScO2.Multivariate Logistic- regression was performed to analyze the factors affecting the occurrence of POD in elderly patients with CRC frailty.The receiver operating characteristic (ROC) curve was used to analyze the predictive value of the combination of serum PGE2,S100β,and rScO2 for POD in elderly patients with CRC frailty.Results The proportions of patients over 75 years old in the POD group and the non-POD group were 64.29% and 44.90% respectively,the serum PGE2 was (364.28±37.42) pg/ml and (329.76±33.65) pg/ml respectively,S100β was (258.64±26.93) pg/ml and (233.37±23.50) pg/ml respectively,and rScO2 was (57.34±5.22) % and (63.36±6.19) % respectively (P<0.05),there was a statistically significant difference between the two groups (P < 0.05).Serum PGE2 and S100β were negatively correlated with rScO2 (r=-0.365,-0.413,both P<0.05).Age (OR=1.994),PGE2 (OR=2.314),S100β (OR=2.426),and rScO2 (OR=0.498) levels were factors that affected the occurrence of POD in elderly patients with CRC frailty (P<0.05).The AUC values of serum PGE2,S100β,and rScO2 alone in predicting POD in elderly patients with CRC frailty were 0.778,0.786,and 0.790,respectively.The  area under curve （AUC） of the combined prediction of the three was 0.930,and their predictive value was conspicuously higher than that of single prediction (ZcombinationPGE2=4.801,Zcombination-S100β=4.417,Zcombination-rScO2=4.362,all P<0.001).The results of 100 internal Bootstrap validations show that the model has good calibration performance,and the calibration curve closely matches the ideal curve.The Hosmer-Lemeshow test results indicate that the model has good goodness of fit (χ2=13.120，degree of freedom=8，P=0.108).Conclusion The combination of serum PGE2,S100β,and rScO2 has a high predictive value for the occurrence of POD in elderly CRC frailty patients.

Objective  To evaluate the efficacy and safety of the Limberg flap transposition technique in the treatment of sacrococcygeal pilonidal sinus .Methods A total of 110 patients diagnosed with sacrococcygeal pilonidal sinus at our hospital between January 2022 and August 2023 were enrolled.They were divided into two groups according to the surgical procedure:50 patients in the control group underwent conventional pilonidal sinus excision,whereas 60 patients in the observation group received the Limberg flap transposition procedure.Postoperatively,recovery time,inflammatory indices,pain scores,and complications were compared between the two groups. Results The postoperative hospital stay of the observation group was (8.98±3.15) days,which was longer than that of the control group (7.24±3.54) days.The postoperative wound healing time of the observation group was (9.95±2.96) days,which was shorter than that of the control group (29.78±2.18) days.There was a statistically significant difference between the two groups (P<0.05).The white blood cell count (WBC) in the observation group was (6.34±0.38)×109/L,C-reactive protein (CRP) was (1.89-0.28 mg/L),which was lower than the control group[(7.56±0.54)×10⁹/L 、( 2.47±0.47)mg/L].There was a statistically significant difference between the two groups (P<0.05).The pain scores of the observation group at 24 hours and 36 hours after the operation were (5.32±1.03) points and (2.10±0.34) points respectively,which were lower than those of the control group [(6.29±1.13) points and (4.48±1.12) points] respectively.There was a statistically significant difference between the two groups (P<0.05).With respect to postoperative complications,the observation group experienced 5 cases of wound infection,8 cases of wound dehiscence,and 11 cases of tension blisters;no recurrence was observed during the follow-up period.In the control group,four patients developed recurrence,whereas no cases of wound infection,dehiscence,or tension blisters were recorded.The recurrence rate was significantly lower in the observation group,although the incidence of postoperative complications was higher;the difference between the groups (except for incision infection) was statistically significant (P<0.05).Conclusion The Limberg flap transposition technique for sacrococcygeal pilonidal sinus shortens postoperative recovery time,attenuates the inflammatory response,alleviates pain,and reduces the risk of recurrence.

Objective To investigate the effects of different concentrations (total doses) of ropivacaine in transversus abdominis plane block on inflammatory markers and short-term postoperative cognitive changes in elderly patients undergoing laparoscopic cholecystectomy.Methods A total of 242 elderly patients planned for laparoscopic cholecystectomy,admitted to our hospital between July 2021 and July 2024,were chosen and randomly allocated into Group A (0.25% ropivacaine concentration,n=80),Group B (0.375% ropivacaine concentration,n=81),and Group C (0.50% ropivacaine concentration,n=81) via the envelope technique.Observe the inflammatory indicators and cognitive functions of patients with different concentrations of ropivacaine.Results There were no statistically significant differences in awakening quality-related indicators among the three groups (P>0.05).Repeated-measures ANOVA showed a significant between-group effect for CRP (F=3.307,df=2,P=0.040);post-hoc tests indicated lower overall CRP in group B vs C (P=0.012).A significant time effect (F=1 505.179,df=3,P<0.001) reflected an immediate postoperative rise followed by a gradual decline.The interaction effect between groups and time was not statistically significant(F=0.981,df=6,P=0.434).It indicates that the CRP level of patients in group B was generally lower than that in group C,and the trends of CRP levels in groups A,B and C over time were consistent.For IL-6,the between-group effect was nonsignificant (F=2.852,df=2,P=0.062);the time effect was significant (F=699.598,df=3,P<0.001),showing an initial increase then decrease.The interaction became nonsignificant after correction (F=2.380,df=6,P=0.034).For TNF-α,the betweengroup effect was significant (F=21.421,df=2,P<0.001);both A and B had lower levels than C (both P<0.001).The time effect was significant (F=374.519,df=3,P<0.001),with levels declining over time,and the group×time interaction was also significant (F=4.084,df=6,P=0.001).For Mini-Mental State Examination (MMSE) scores,both time effect and inter-group effect were statistically significant (P<0.05).The LSDt test indicated that the MMSE scores in Group A and Group B were higher than those in Group C at all postoperative time points,and the differences were statistically significant (P<0.05).All three groups mainly presented with mild pain at different postoperative time points,and there were no statistically significant differences in pain intensity among the groups at different time points (P>0.05).The total incidence of adverse reactions in Group C was higher than that in Group A and Group B,but this difference was not statistically significant (18.52% vs.7.50% vs.8.64%,χ2=5.796,P=0.055).Conclusion 0.25% and 0.375% ropivacaine for transversus abdominis plane block provide superior suppression of inflammatory response and preservation of postoperative cognitive function compared with the 0.50% total dose,without increasing adverse-event risk.

Objective To assess the sedative efficacy of low-dose remimazolam combined with remifentanil during awake tracheal intubation under surface anesthesia in patients with a predicted difficult airway.Methods From May to November 2024,a prospective,randomized controlled study was conducted involving 60 adult patients scheduled for awake tracheal intubation under general anesthesia due to anticipated difficult airway management.Participants were randomly allocated into three parallel groups based on the anesthetic regimen employed:Group A (control),receiving surface airway anesthesia followed by video laryngoscope-guided oral tracheal intubation;Group B (remifentanil),receiving remifentanil infusion in conjunction with surface anesthesia;and Group C (remimazolam-remifentanil),receiving remifentanil infusion plus a single intravenous bolus of remimazolam prior to surface anesthesia.Hemodynamic parameters—including mean arterial pressure (MAP),heart rate (HR),and peripheral oxygen saturation (SpO²)—were recorded at six predefined time points:baseline (T0),immediately before surface anesthesia (T1),during oropharyngeal and supraglottic anesthesia (T2),during subglottic anesthesia (T3),immediately after tracheal intubation (T4),and one minute post-intubation (T5).Sedation depth was assessed using the modified Observer’s Assessment of Alertness/Sedation (MOAA/S) scale.Patient and anesthesiologist satisfaction were quantified using a 5-point Likert scale.Secondary outcomes included total anesthesia duration,incidence of intraoperative coughing,frequency of bradycardia (HR<50 bpm) and apnea (SpO²<90% or respiratory pause>15 s),and occurrence of intubation-related adverse events (e.g.,laryngospasm,bronchospasm,hypoxemia,or airway trauma).Results The primary outcome:In group A (T4),SpO²,MAP and HR were (97.3±2.7) %,(118.4±28.2) mmHg and (111.6±18.7) beats per minute,respectively;In group B (T4),the data were (96.1±3.9) %,(105.3±26.1) mmHg and (102.8±22.5) beats per minute,respectively;In group C (T4),the data were (95.5±4.5) %,(96.2±24.5) mmHg and (95.3±15.3) beats per minute,respectively.Compared with group A,the levels of MAP and HR in groups B and C decreased after tracheal intubation,and the difference was statistically significant (P<0.05).Compared with group B,the MAP and HR levels in group C were lower,and the difference was statistically significant (P<0.05).SpO² values showed no statistically significant intergroup differences（P＞0.05）.Secondary outcomes:Compared with group A,groups B and C had higher MOAA/S sedation scores,higher patient satisfaction and anesthesiologist satisfaction,and the differences were statistically significant (P<0.05).The duration of anesthesia operation was shorter,and the incidence of choking cough in patients was lower,and the differences were statistically significant (P<0.05).Compared with group B,group C had a higher MOAA/S sedation score,higher patient satisfaction and anesthesiologist satisfaction,shorter duration of anesthesia operation,and lower incidence of choking cough in patients.The differences were statistically significant (P<0.05).None of the three groups of patients developed complications such as respiratory depression,bradycardia,hypoxemia,hypotension,or dental damage during anesthesia.Conclution Compared to simple surface anesthesia and surface anesthesia with remifentanil under awake sedation,a low-dose remimazolam and remifentanil combination for awake surface anesthesia during tracheal intubation provides superior sedation efficacy,attenuates stress responses associated with intubation,enhances patient satisfaction,and does not increase the incidence of anesthesia-related complications.

Objective To investigate the incidence of delayed emergence during the recovery period from general anesthesia and its associated factors in patients undergoing thoracoscopic lobectomy.Methods A retrospective study was conducted on 252 patients who underwent thoracoscopic lobectomy under general anesthesia at our institution between February 2022 and June 2025.Patients were divided into a delayed emergence group and a control group based on whether delayed emergence occurred during the recovery period from general anesthesia.Clinical data were collected from both groups.Independent influencing factors for delayed emergence during the recovery period from general anesthesia were identified,and a Logistic regression prediction model was established.Model discrimination was assessed using the area under the receiver operating characteristic (ROC) curve (AUC) and the concordance index (C-index) derived via the Bootstrap method,and model calibration was subsequently evaluated.Results Of the 252 patients who underwent thoracoscopic lobectomy under general anesthesia,51 (20.24%) experienced delayed emergence during the recovery period.Multivariate unconditional Logistic regression analysis revealed that preoperative frailty (OR=2.853),intraoperative hypothermia (OR=2.639),intraoperative fluid infusion volume (OR=1.002),intraoperative sufentanil dosage (OR=1.190),and anesthesia duration (OR=1.017) were all independent risk factors for delayed emergence during the recovery period from general anesthesia in patients undergoing thoracoscopic lobectomy (all P<0.05).A -Logistic regression prediction model was established as follows:Logit(P)=Logit(P)=-13.891+1.048×preoperative frailty (yes=1,no=0)+0.017×anesthesia duration (min)+0.002×intraoperative fluid volume (ml)+0.971×intraoperative hypothermia (yes=1,no=0)+0.174×intraoperative sufentanil dosage（μg）.ROC curve analysis demonstrated that the AUC of the regression prediction model for predicting delayed emergence during the recovery period from general anesthesia was 0.833 (95%CI:0.769-0.896).Internal validation using the Bootstrap method yielded a C-index of 0.836.The Hosmer-Lemeshow goodness of fit test indicated χ2=12.648,P=0.125.The calibration curve demonstrated good agreement between the predicted curve of the regression model and the ideal curve,with a mean absolute error of 0.012.Conclusion The incidence of delayed emergence during the recovery period from general anesthesia remains relatively high in patients undergoing thoracoscopic lobectomy.The associated factors include preoperative frailty,anesthesia duration,intraoperative hypothermia,intraoperative fluid infusion volume,and intraoperative sufentanil dosage.The Logistic regression prediction model constructed accordingly demonstrates satisfactory predictive performance.

Objective To analyse the effect of ultrasound-guided femoral nerve block combined with esketamine on haemodynamics and analgesia in patients undergoing total knee arthroplasty (TKA).Methods A total of 82 patients who underwent TKA in our hospital from March 2024 to February 2025 were selected as the research objects.They were divided into two groups by random number table method,41 cases in each group,and both of them were anesthetized by lumbar-rigid combined anesthesia,the control group was anesthetized by intravenous self-controlled analgesia,and the observation group was anesthetized by ultrasound-guided femoral nerve block combined with esketamine.Recording hemodynamic indexes at baseline before anesthesia (T0),5min after skin cutting (T1),and 2h after the operation (T2);detecting stress indexes at T0,24 h after the operation (T5),and 48h after the operation (T6);and evaluating the patients' pain at rest and in motion using visual analog scoring (VAS) at T2,6h after the operation (T3),12h after the operation (T4),T5,and T6,respectively.and the adverse reactions of the two groups were counted.Results At T1-T2,compared with T0,the mean arterial pressure (MAP),heart rate (HR),diastolic blood pressure (DBP) and systolic blood pressure (SBP) of the two groups decreased,and the differences were statistically significant (P<0.05).The resting state VAS scores at T3,T4,T5 and T6 in the observation group were (1.64±0.39) points,(1.88±0.43) points,(1.73±0.37) points and (1.74±0.46) points,which were significantly lower than those in the control group [(2.74±0.55) points,(2.29±0.58) points,(2.01±0.38) points and (1.84±0.44) points],and the differences between the two groups were statistically significant (P < 0.05).The VAS scores of exercise state at T3,T4,T5 and T6 in the observation group were (2.86±0.76) points,(3.10±0.66) points,(2.43±0.24) points and (2.25±0.23) points,which were significantly lower than those in the control group [(4.65±0.80) points,(5.05±0.54) points,(3.79±0.59) points and (3.15±0.50) points],and the differences between the two groups were statistically significant (P<0.05).At T5 and T6,compared with T0,the indexes of adrenocorticotropic hormone (ACTH),cortisol (Cor),norepinephrine (NA) and epinephrine (AD) in the two groups increased,and the differences were statistically significant (P<0.05).The incidence of postoperative adverse reactions in the observation group (9.76 %) was higher than that in the control group (7.32 %).There was no significant difference between the two groups (P>0.05).Conclusion Ultrasound-guided femoral nerve block combined with esketamine has less impact on hemodynamics and physiological stress in patients undergoing TKA,and has superior analgesic effect,which can promote the recovery of patients' knee joint and quadriceps muscle strength,and has fewer postoperative adverse reactions.

The incidence of small gastrointestinal stromal tumors (GIST) is relatively low.However,thanks to the widespread application of endoscopic screening techniques and the continuous advancement of imaging modalities in recent years,their clinical detection rate has been steadily increasing.Small GIST exhibits biological behavioral heterogeneity,and its clinical management strategies remain controversial.This paper systematically analyzes the core controversial issues in small GIST,including biological behavioral heterogeneity,management of extremely low-risk lesions,selection of surgical approaches,and risk assessment systems.Additionally,it proposes future research directions to advance the precision and individualization of small GIST diagnosis and treatment.

Hepatocellular carcinoma and intrahepatic cholangiocarcinoma collision tumors are clinically rare and lack specific imaging features,making them prone to misdiagnosis.This article reports a case of a 42-year-old female patient diagnosed with a hepatic collision tumor through surgical pathology,with immunohistochemistry confirming the independent existence of the two carcinoma components.The pathogenesis,diagnosis,and differential diagnosis are discussed with reference to literature,aiming to improve understanding of this disease and reduce the rate of clinical misdiagnosis.

This report describes a 79-year-old male patient who underwent surgical treatment for clear cell renal cell carcinoma of the right kidney ten years ago.He was recently diagnosed with duodenal metastasis from the tumor,involving the junction of the bulb and descending portion.He received treatment with distal gastrectomy and partial duodenectomy followed by Billroth Ⅰ anastomosis,and was discharged from hospital.This case provides an overview of clinical symptoms,rare metastases,and treatment strategies to serve as a reference for future clinical practice.

Composite hemangioendothelioma is a rare vascular neoplasm of intermediate malignant potential,with an annual incidence of less than 0.1 per million,predominantly occurring in the deep soft tissues of the extremities and trunk.Clinically,it typically manifests as a slowly enlarging,painless mass.Magnetic resonance imaging reveals heterogeneous hyperintensity on T2-weighted images with infiltrative margins,while definitive diagnosis relies on histopathological examination.Histologically,the lesion is characterized by a composite admixture of at least two distinct vascular tumor components of varying differentiation.Immunohistochemically,the tumor cells commonly express CD34,CD31,ERG,and SMA.The disease exhibits locally aggressive behavior with rare distant metastasis,though splenic and osseous metastases have been documented.Wide local excision with a recommended surgical margin of ≥2cm remains the mainstay of treatment.Long-term postoperative surveillance with imaging is mandatory,focusing on the detection of local recurrence and regional lymph node involvement.At the time of this report,the patient remains free of recurrence and metastasis.

IP is a rare benign proliferative lesion characterized by fibrous tissue proliferation and chronic inflammatory cell infiltration.Named for its resemblance to an aggressive malignancy in clinical presentation,imaging,and histology,its etiology is unclear and may be related to infection,immune abnormalities,or trauma.Surgical resection is the only treatment.This article reports on a 78year-old male patient with low back pain,fever and malaise as the main symptoms and a past history of tuberculosis.Surgical resection was performed after ineffective anti-inflammatory treatment.The preoperative histologic examination of the perforated mass showed inflammatory lesions,and the postoperative pathology confirmed retroperitoneal IP.The patient was followed up for the first month and the CT examination revealed recurrence of the mass at the original surgical site,and the mass was found to have become slightly smaller in the second month,and the patient is currently being followed up for the next few months.Pathology is the gold standard for diagnosis,radical surgical resection is the primary treatment,and cure can be achieved by surgical resection in the case of recurrence.

Cervical vertebral arteriovenous fistula (CV-AVF) is a rare vascular malformation characterized by pathological communication between arteries and veins at the vertebral artery,leading to clinical symptoms.This paper reports a young female patient who presented with a pulsatile mass in the right neck.The diagnosis of right CV-AVF was confirmed by color Doppler ultrasound,computed tomography angiography (CTA),and digital subtraction angiography (DSA).The patient underwent interventional embolization and achieved a good postoperative recovery.DSA is of crucial value in the diagnosis of CV-AVF,and the main treatment methods include interventional embolization and surgical operation.Early diagnosis and intervention are essential.

This study reports the diagnosis and treatment of two pediatric cases of male pseudohermaphroditism complicated with inguinal hernia.Diagnosing male pseudohermaphroditism before puberty is challenging,and suspicion often arises during inguinal hernia surgery when testes are discovered.In cases complicated with hernia,the gonads can be reduced into the abdominal cavity followed by simple hernia repair.Further examinations are required to confirm the diagnosis before subsequent treatment is administered.