Metabolic dysfunction-associated steatotic liver disease (MASLD) has become the most prevalent chronic liver disease worldwide, affecting approximately 25%-30% of the adult population and closely linked to obesity and type 2 diabetes mellitus.Conventional lifestyle interventions suffer from poor long-term adherence, and pharmacological treatment options remain extremely limited.Against this backdrop, bariatric surgery, as a therapeutic modality capable of achieving significant and durable weight loss along with substantial metabolic improvements, has garnered increasing attention in the management of MASLD.This review systematically summarizes the epidemiological burden and pathological mechanisms of MASLD, examines the clinical and histological evidence for the improvement of hepatic steatosis, inflammation, and fibrosis following bariatric surgery, analyzes its weight-dependent and weight-independent mechanisms of action, and compares the efficacy differences between various surgical procedures.

Metabolic and bariatric surgery (MBS) provides durable weight loss and metabolic benefits, but maintaining the lowest postoperative weight should not be the sole criterion for long-term success.The weight-loss plateau may represent either a new healthy homeostatic state or an early warning sign of weight regain, sarcopenia, loss of control over eating, or psychological and sleep disturbances.Based on domestic and international research over the past five years, the consensus on domestic plateau and postoperative follow-up management in 2025, as well as the latest evidence on anti-obesity drugs and body composition from 2024 to 2026, this paper suggests shifting the long-term postoperative follow-up from a single weight threshold to a domain monitoring framework encompassing body weight, waist circumference, metabolic status, body composition, bone health, psychological and behavioral health, and physical function.Then, search for the dominant mechanisms by anatomical type, hungery-metabolic type, sarcopenia-low function type, eating behavior type and psychological-sleep type.Thresholds for recurrent weight gain should therefore serve as triggers for clinical reassessment rather than definitive indicators of treatment failure.The re-evaluation during the plateau period should take into account multiple signals such as weight trend, waist circumference, medication for metabolic diseases, muscle strength, bone density, nutritional intake and follow-up dropout.Nutrition, resistance exercise, micronutrient monitoring and active follow-up form a common foundation.Anti-obesity drugs, cognitive behavioral therapy, endoscopic treatment and corrective surgery should be combined in parallel based on the cause, rather than being remedied step by step after a large amount of recurrence.Potent enterotropin drugs and endoscopic/corrective treatments have provided new tools for relapse management, but they need to simultaneously protect protein intake, lean body mass, bone health and psychological safety, and strictly distinguish between observational evidence, randomized trial evidence and expert opinions.Long-term success should be understood as continuous benefits in fat mass, muscle function, bone health, metabolic health, mental state and quality of life, rather than permanently remaining at the minimum body mass.

Single-incision bariatric surgery was developed to further reduce visible abdominal wall trauma and improve scar concealment while preserving the established metabolic and weight-loss benefits of conventional laparoscopy.This expert commentary reviews the evolution, clinical evidence, technical advances, and unresolved issues of single-incision bariatric surgery, with particular emphasis on single-incision laparoscopic sleeve gastrectomy.International and Chinese guidelines, systematic reviews, meta-analyses, comparative cohorts, large institutional series, and recent technical studies were narratively synthesized.Current evidence suggests that, in appropriately selected patients and experienced centers, single-incision sleeve gastrectomy achieves weight loss, remission of obesity-related comorbidities, and overall perioperative safety comparable to conventional multiport surgery.Its most consistent advantage is improved scar concealment and cosmetic satisfaction.By contrast, reductions in postoperative pain, length of stay, and time to functional recovery are small, heterogeneous, or clinically uncertain.The umbilical approach for incisional hernia, operational conflicts, learning curves, the cost of specialized instruments and evidence bias still restrict its promotion.Complex single-port surgical methods are still in the exploratory stage.The standardized development of single-port technology should adhere to safety priority, anatomical stratification, standardized operation, timely addition of auxiliary ports, and full-process quality assessment.Moreover, the true beneficiary population should be identified through multi-center prospective studies and long-term follow-up registration.

Metabolic syndrome (MetS) is a clinical syndrome characterized by the clustering of central obesity, abnormalities in glucose and lipid metabolism, and hypertension.Endoscopic bariatric interventions are distinguished by minimal invasiveness, reversibility, and a low complication profile, and have been rapidly adopted in clinical practice in China in recent years.The domestically developed gastric bypass stent, approved in 2024 as the first marketed endoscopic bariatric device in China, has seen rapid clinical expansion; however, its own evidence base is still being established.Endo Barrier, a device based on the same principle, has accumulated multi-level evidence—including multicenter randomized controlled trials and national registries—and its experience regarding evolving clinical positioning, efficacy divergence, safety governance, implantation duration, and baseline population characteristics offers important reference value for the domestic stent.Drawing on more than a decade of evidence-based experience with Endo Barrier and integrating the latest full-text data from domestic multicenter randomized controlled trials, real-world cohorts, and randomized studies, this article systematically reviews the efficacy, clinical positioning, implantation duration, and safety management of the domestic gastric bypass stent.

The recent surge in incretin-based pharmacotherapies for obesity is revolutionizing metabolic and bariatric Surgery (MBS) and redefining obesity care.The clinical focus has shifted from weight loss alone to the systemic improvement of overall metabolic health.This editorial aims to provide a systematic review of the key clinical and therapeutic advances in MBS in the era of potent anti-obesity pharmacotherapy, with a focus on the qualitative evolution and standardization of surgical techniques, the elevated role of surgery in obesity management, the emergence of combined therapeutic strategies, the growing body of evidence for MBS in treating obesity-related diseases, etc.Ultimately, standardized, precise, individualized, and combined approaches to obesity management strategy is recommended, so as to enhance therapeutic outcomes and maximize benefits for patients.

Novel anti-obesity medications, particularly glucagon-like peptide-1 receptor agonists and multi-agonist incretin-based therapies, have substantially improved the magnitude of nonsurgical weight loss and associated metabolic benefits.Meanwhile, the indications for metabolic and bariatric surgery have progressively expanded toward patients with lower body mass index values.Consequently, individuals with moderate obesity have become the population in whom the indications for pharmacotherapy and surgery overlap most prominently and in whom treatment decisions remain particularly controversial.Patients with moderate obesity frequently present with type 2 diabetes, metabolic dysfunction-associated steatotic liver disease, obstructive sleep apnea, hypertension, and reproductive or endocrine disorders.Nevertheless, obesity-related organ damage may still be partially reversible, making this stage a critical window for altering the course of disease.Treatment decisions should therefore not be based solely on body mass index, but should incorporate visceral adiposity, metabolic disease burden, the severity of organ impairment, previous weight-loss attempts, treatment adherence, affordability, accessibility, and patient preferences.Lifestyle intervention combined with pharmacotherapy may be prioritized in patients at relatively low risk, whereas metabolic and bariatric surgery should be discussed early in those with a high metabolic risk, progressive complications, or repeated failure of nonsurgical treatment.Pharmacotherapy and surgery should not be regarded as mutually exclusive alternatives.Anti-obesity medications may be used for preoperative optimization, as a strategy to delay or avoid surgery in selected patients, and as adjunctive treatment for insufficient weight loss or weight recurrence after surgery.Future obesity care should move toward an integrated “medication-surgery-follow-up” pathway based on risk stratification, multidisciplinary collaboration, dynamic treatment adjustment, and long-term clinical outcomes, thereby maximizing the complementary and sequential value of different therapeutic modalities.

Objective To investigate the outcomes and influencing factors of new-onset cerebral infarction after stent-assisted coil embolization for single intracranial aneurysms with Hunt-Hess grade 0-2.Methods A total of 116 patients with single intracranial aneurysms (Hunt-Hess grade 0-2) who underwent stent-assisted coil embolization and developed postoperative cerebral infarction in our hospital from January 2020 to January 2024 were selected as the research objects.Clinical outcomes were evaluated using the modified Rankin Scale (mRS) score after 1 year of follow-up: an mRS score < 3 indicated a good prognosis, while an mRS score ≥ 3 indicated a poor prognosis.Basic patient data were collected, and Logistic regression analysis was used to identify risk factors for poor prognosis of postoperative cerebral infarction.A nomogram prediction model was constructed, and the fitting effect of the model was evaluated.Results During the study period, a total of 813 cases of cerebral aneurysm treated with interventional therapy were admitted, among which 116 patients developed new-onset cerebral infarction after surgery.The proportion of aneurysm rupture was significantly higher in patients with cerebral infarction, and the difference was statistically significant (χ2=13.016, P＜0.001).Among the 116 patients with new-onset postoperative cerebral infarction, 23 (19.83%) had a poor prognosis.Logistic regression analysis showed that female gender, increased Hunt-Hess grade, prolonged operation time, irregular aneurysm, increased cerebral infarction volume, and intraoperative aneurysm rupture were independent risk factors for poor prognosis of postoperative cerebral infarction (P<0.05).The calibration curve showed that the corrected curve predicted by this model was close to the ideal curve.Conclusion Gender, Hunt-Hess grade, operation time, irregular aneurysm, cerebral infarction volume and intraoperative aneurysm rupture will affect the clinical outcomes of patients with new-onset cerebral infarction after stent-assisted coil embolization for single intracranial aneurysms with Hunt-Hess grade 0-2.

Objective To explore the relationship between serum interleukin-6 (IL-6), high mobility group protein A2 (HMGA2), stimulated by retinoic acid 6 (STRA6) with the clinical pathological features and postoperative lymph node metastasis of differentiated thyroid cancer (DTC) patients.Methods From March 2021 to July 2024, 84 DTC patients in our hospital were designated as the DTC group, and another 97 patients with benign thyroid diseases were designated as the benign group.The DTC patients was assigned into non metastatic group (n=60) and metastatic group (n=24) based on lymph node metastasis within 6 months after surgery.Enzyme-linked immunosorbent assay was used to detect serum IL-6, HMGA2, and STRA6.The correlation analysis was conducted using Spearman's method.Receiver operating characteristic (ROC) curve was used to explore the predictive efficacy of serum IL-6, HMGA2, and STRA6 for postoperative lymph node metastasis in DTC patients.Results Compared with the benign group, the levels of serum IL-6 [(188.47±31.14) vs (152.35±25.09) pg/ml], HMGA2 [(11.23±2.25) vs (6.07±1.34) ng/ml], and STRA6 [(95.09±14.89) vs (65.16±10.28) ng/ml] were higher in the DTC group (P < 0.05).Spearman analysis showed that serum IL-6, HMGA2, and STRA6 correlated with TNM staging in DTC patients (P<0.05).There was a statistically significant difference in the maximum tumor diameter and TNM stage between the metastasis group and the non-metastasis group (P<0.05).For the non metastatic group, the metastatic group had higher preoperative and postoperative serum IL-6, HMGA2, and STRA6 (P<0.05).ROC analysis showed that the joint of serum IL-6, HMGA2, and STRA6 had a higher area under the curve (AUC) (0.926) in predicting postoperative lymph node metastasis in DTC than the individual predictions of IL-6 (Z=2.514, P=0.012), HMGA2 (Z=2.089, P=0.037), and STRA6 (Z=2.008, P=0.045).Conclusion The levels of IL-6, HMGA2 and STRA6 in the serum of DTC patients are relatively high and are related to the TNM stage of the patients, and the combination of the three has a high predictive value for lymph node metastasis after surgery in DTC patients.

Objective To explore the influencing factors of fat liquefaction in the surgical incision of obese breast cancer, and to construct a risk early warning Nomogram model and verify its effectiveness.Methods The clinical data of 327 patients with obese breast cancer treated in our hospital from January 2021 to June 2024 were retrospectively analyzed, they were divided into the occurrence group (n=72) and the non-occurrence group (n=255) according to whether fat liquefaction occurred in the postoperative incision, and the influencing factors of fat liquefaction in the surgical incision of obese breast cancer were analyzed by multivariate Logistic regression model.The R software was applied to construct a risk early warning nomogram, and the receiver operating characteristic curve (ROC) and calibration curve were drawn to verify the predictive efficacy of the model for the risk of fat liquefaction in the surgical incision of obese breast cancer.Results The age, BMI, the proportion of diabetes mellitus, the proportion of intraoperative cutting instruments (electrotome), serum albumin and hemoglobin in occurrence group were (52.19±7.42) years old, (32.79±2.05)kg/m², 40.28%, 45.83%, (35.89±5.11) g/L and (110.49±12.88) g/L, respectively, and those in non-occurrence group were (46.45±6.25) years old, (30.47±1.93) kg/m², 20.39%, 27.45%, (40.71±4.14) g/L and (119.75±11.52) g/L], respectively.The difference between the two groups was statistically significant (P< 0.05).Age, BMI, diabetes, serum albumin were the influencing factors of fat liquefaction in the surgical incision of obese breast cancer (P< 0.05).The area under the curve, sensitivity and specificity of the the risk early warning Nomogram model for predicting fat liquefaction in the surgical incision of obese breast cancer were 0.926, 90.28%, 82.75%, respectively.The calibration curve showed that the prediction probability of the model was close to the actual probability, and the Hosmer-Lemeshow goodness of fit test showed that it was well fitted (χ²=1.891, P=0.329).Conclusion Age, BMI, diabetes, hemoglobin and intraoperative are the influencing factors of fat liquefaction in the surgical incision of obese breast cancer, the risk early warning Nomogram model has good prediction efficiency based on this.

Objective To explore the related factors for hypoxemia during anesthesia recovery period after thoracoscopic radical resection of lung cancer under general anesthesia and construct a nomogram prediction model.Methods A total of 227 patients who underwent thoracoscopic radical resection of lung cancer under general anesthesia in our hospital from May 2022 to May 2025 were retrospectively enrolled and divided into hypoxemia group and non-hypoxemia group according to whether hypoxemia occurred during postoperative anesthesia recovery period.Variables were screened by LASSO regression, and independent related factors were determined by multivariate Logistic regression analysis.A nomogram model was constructed and Bootstrap method was used for internal validation.Receiver operating characteristic (ROC) curve, calibration curve, and decision curve were used to evaluate model performance and clinical applicability.SHAP model was used to explore the contribution of each independent influencing factor to the prediction model.A risk stratification system was established based on the risk score of the nomogram model.Results A total of 60 cases of hypoxemia occurred during postoperative anesthesia recovery period.Six non-zero coefficient variables were obtained through LASSO regression variable screening, namely body mass index (BMI), the ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC), one-lung ventilation time, intraoperative dexmedetomidine use, intraoperative hypothermia, and airway aspiration frequency.The results of the multivariate Logistic regression analysis showed that BMI (OR=1.189, 95%CI: 1.040-1.360), intraoperative hypothermia (OR=2.227, 95%CI: 1.079-4.598), postoperative airway suction frequency (OR=5.326, 95%CI: 2.927-9.690), intraoperative use of dexmedetomidine (OR=2.502, 95%CI: 1.101-5.686), and single-lung ventilation time (OR=1.035, 95%CI: 1.009-1.063) were risk factors for postoperative anesthesia recovery period-related hypoxemia in patients, while preoperative FEV1/FVC (OR=0.860, 95%CI: 0.803-0.921) was a protective factor (P<0.05).A nomogram model was constructed based on the above factors.ROC curve showed that the area under the curve (AUC) of this model was 0.897 (95%CI: 0.854-0.940).The C-index after internal validation of the model obtained by Bootstrap method was 0.904.Calibration curve showed high consistency between the ideal probability curve and the actual probability curve.Clinical decision curve showed that when the threshold probability was between 0.06 and 0.88, the nomogram prediction model could produce better clinical benefit.The SHAP results showed that the order of importance of each independent related factor on the ogram model was airway aspiration frequency, preoperative FEV1/FVC, one-lung ventilation time, BMI, intraoperative hypothermia, and the use of dexmedetomidine during the operation.The risk stratification of the risk prediction model established based on the above related influencing factors was low risk ≤134 points and high risk >134 points, with risk probabilities of 60.24% and 6.94%, respectively.Conclusion The related factors of hypoxemia during anesthesia recovery period after thoracoscopic radical resection for lung cancer under general anesthesia include BMI, intraoperative hypothermia, frequency of postoperative airway suctioning, intraoperative use of dexmedetomidine, one-lung ventilation time, and preoperative FEV1/FVC.The nomogram model constructed accordingly demonstrates good predictive utility.

Objective To investigate the effects of different generations of epidermal growth factor receptor tyrosine kinase inhibitors (epidermal growth factor receptor-tyrosine kinase inhibitors, EGFR-TKIs) on peripheral blood RNA 5-methylcytosine (5-methylcytosine, m5C) modification patterns in patients with EGFR-mutant non-small cell lung cancer (non-small cell lung cancer, NSCLC), and to analyze their associations with clinical efficacy and progression-free survival (progression-free survival, PFS).Methods This single-center prospective cohort study consecutively enrolled 86 patients with EGFR-mutant lung adenocarcinoma who underwent surgical resection and were pathologically confirmed at Baoding First Central Hospital between January 2021 and December 2023.According to the postoperative adjuvant EGFR-TKI regimen, patients were divided into an icotinib group (n=42) and a befotertinib group (n=44).Peripheral blood samples were collected on postoperative day 1, after two treatment cycles, and at 6 months of treatment.Global RNA m5C levels and the expression of RNA m5C-related regulatory genes were measured.Dynamic changes in RNA m5C modification during treatment with different generations of EGFR-TKIs were compared, and Cox proportional hazards models were used to evaluate their associations with PFS.Results No significant differences were observed between the two groups in baseline clinical characteristics or baseline peripheral blood RNA m5C levels (P>0.05).During treatment, peripheral blood RNA m5C levels decreased significantly over time in the icotinib group, reaching 0.78±0.17 at 6 months, which was significantly lower than that in the befotertinib group (0.94±0.20, P<0.001).The magnitude of RNA m5C reduction was also greater in the icotinib group (-0.22±0.11 vs.-0.09±0.08, P<0.05).Within the icotinib group, patients who developed disease progression exhibited a significantly larger decline in RNA m5C levels than those without progression (-0.31±0.12 vs.-0.14±0.09, P<0.05).The median follow-up time for the entire cohort was 24.6 months (interquartile range: 18.2-32.4 months).Multivariate Cox regression analysis demonstrated that treatment regimen (hazard ratio=1.72, 95% confidence interval: 1.11-2.67, P=0.015) and a marked decrease in peripheral blood RNA m5C levels (hazard ratio=2.08, 95% confidence interval: 1.34-3.22, P=0.001) were independent predictors of unfavorable PFS.Conclusion Different generations of EGFR-TKIs induce distinct dynamic patterns of peripheral blood RNA m5C modification in patients with EGFR-mutant NSCLC, and a significant decrease in RNA m5C was associated with poor PFS.Dynamic changes in peripheral blood RNA m5C may represent a potential marker of systemic molecular status during treatment, and their clinical utility and tumor specificity require further validation.

Objective This study aimed to explore the risk factors for neurological complications in patients with liver cancer after transarterial chemoembolization (TACE), and to construct and validate a predictive model.Methods A total of 300 patients with liver cancer who underwent TACE treatment for the first time from January 2022 to September 2025 were selected.They were divided into the complication group (51 cases) and the non-complication group (249 cases) based on whether neurological complications occurred within 30 days after the operation.Logistic regression was used to screen independent influencing factors, a nomogram model was constructed, and the model's efficacy was evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve (DCA).Results The incidence of neurological complications after TACE was 17.00%.Multivariate Logistic regression analysis showed that the Eastern Cooperative Oncology Group (ECOG) score, operation time, alpha-fetoprotein (AFP), abnormal prothrombin (DCP), and C-reactive protein (CRP) were independent risk factors, while platelet count was a protective factor (P<0.05).The area under the curve (AUC) of the nomogram model based on these 6 indicators was 0.906 (95%CI: 0.865-0.947), the calibration curve fitted well (Hosmer-Lemeshow test P=0.691), and the decision curve showed that the model had good clinical net benefit within the probability range of 0.05-0.90.Conclusion ECOG score, operation time, AFP, DCP, CRP, and platelet count are the key influencing factors for neurological complications in patients with liver cancer after TACE.The constructed nomogram model has good predictive efficacy and clinical practicability, and can be used for the screening of high-risk patients.

Objective To understand the changes in the gut microbiota during small bowel obstruction, thereby providing a theoretical basis for guiding anti-infective therapy in affected patients.Methods From August 2022 to August 2024, 21 patients with small intestinal obstruction who were hospitalized and underwent nasal cannula insertion for intestinal obstruction.Intestinal fluid specimens of the small intestine were extracted through nasal intestinal obstruction catheters for 16S rRNA high-throughput sequencing to analyze the composition characteristics of intestinal flora in patients with small intestinal obstruction.Results (1)Streptococcus was the most prevalent genus (90.5%, 19/21), but Candida exhibited the highest mean relative abundance (75.9%).(2)A "fungal-bacterial" symbiotic pattern (Candida + Enterococcus/Klebsiella) was detected in 5 patients.(3)The elderly group (age ≥60 years) showed significantly higher abundances of Candida and Enterococcus versus the non-elderly group (P<0.05).(4)Genus co-occurrence analysis revealed: Strong positive correlation between Candida and Enterococcus (r=0.82, P<0.001), Negative correlation between Streptococcus and Bacteroides (r=-0.71, P=0.002).Conclusion SBO patients exhibit significant age-related dysbiosis, with elderly patients characterized by a Candida-Enterococcus symbiotic pattern.Early fungal surveillance and prophylactic anti-infective therapy are recommended for patients aged ≥60 years.

Objective To investigate the occurrence of postoperative delirium in elderly patients undergoing radical resection of colorectal cancer and analyze its related risk factors.Methods A retrospective study was conducted involving 267 elderly patients who underwent elective radical resection for colorectal cancer at our hospital from June 2024 to October 2025.According to whether delirium occurred within 3 days after surgery, the patients were divided into a delirium group and a non-delirium group.Multivariate Logistic regression analysis was used to determine independent related factors.A regression prediction model was constructed.Receiver operating characteristic (ROC) curve of this model was drawn, and its discriminative ability was evaluated by area under the curve.Internal validation was performed using Bootstrap method.Concordance index was used to evaluate model discrimination, calibration plot was used to evaluate calibration, and clinical decision curve was used to evaluate the clinical practicability of the model.Results The incidence of delirium within 3 days after surgery in elderly patients undergoing radical resection of colorectal cancer was 16.10% (43/267).Multivariate Logistic regression analysis showed that preoperative modified Frailty Index-5 (mFI-5), preoperative C-reactive protein/albumin ratio, intraoperative hypothermia, and anesthesia time were independent risk factors for postoperative delirium in elderly patients undergoing radical resection of colorectal cancer (P<0.05).A Logistic regression prediction model was established based on the above factors: Logit(P) =-16.152+0.991×preoperative mFI-5 score(≥2 points=1, <2 points=0)+0.257×preoperative C-reactive protein/albumin ratio (%) + 1.225 × intraoperative hypothermia (no=0, yes=1)+0.022×anesthesia duration (min).The ROC curve demonstrates that the model achieves an area under the curve (AUC) of 0.908 for predicting the incidence of postoperative delirium in elderly patients undergoing radical resection for colorectal cancer.The C-index after internal validation of the model obtained by Bootstrap method was 0.917.Calibration curve showed high consistency between the ideal probability curve and the actual probability curve, with a mean absolute error of 0.039.Decision curve showed that when the threshold probability was 0.1-0.9, clinical benefit was high.Conclusion The incidence of postoperative delirium is high in elderly patients undergoing radical resection of colorectal cancer.The occurrence of postoperative delirium is related to preoperative frailty, C-reactive protein/albumin ratio, intraoperative hypothermia, and anesthesia time.The regression prediction model constructed accordingly has good predictive value.

Objective To investigate the clinical outcomes of complex perianal fistulas treated with mucosal advancement flap (MF) combined with fistulectomy (FT).Methods A total of 408 patients with complex anal fistula who underwent surgery from January 2012 to January 2022 were selected.According to the surgical methods, they were divided into the observation group (214 cases treated with MF combined with FT) and the control group (194 cases treated with FT combined with seton therapy).Gender, age, location type of fistula, recurrence rate of anal fistula and postoperative anal sphincter function of the two groups were compared through case review and outpatient follow-up.Results At 12, 24, and 48 months after surgery, fistula recurrence rate were 8.2%, 18.2%, and 21.0% in observation group, respectively, compared to 25.5%, 41.9%, and 48.0% in control group (P＜0.05).The curative rate was 80.9% in the observation group and 49.0% in the control group at 24 months postoperatively (P＜0.05).Additionally, 8.2% of patients in the observation group experienced defecation dysfunction compared to 36.7% in the control group postoperatively (P＜0.05).There was no statistically significant difference in wound healing time between the two groups (P>0.05).There was no statistically significant difference in the fecal incontinence severity index(FISI) between the two groups before the operation (P>0.05).One month after surgery, FISI score of treatment group was significantly lower than that of control group (P<0.05).In particular, two months after surgery, FISI of the treatment group was significantly lower than that of the control group (P<0.05).Conclusion The combination of mucosal advancement flap with fistulectomy possesses higher curative rate and lower recurrence and defecation dysfunction rate compared to fistulectomy alone in treating complex anal fistulas.

Objective To explore the expression levels of microRNA(miR)-514b-3p and miR-599 in the serum of patients with Colorectal Cancer (CRC), and to analyze their correlations with the clinicopathological characteristics and prognosis of the patients.Methods A total of 213 CRC patients diagnosed by pathology in our hospital from January 2019 to March 2022 were prospectively selected as the CRC group.Another 109 healthy individuals who underwent physical examinations during the same period were selected as the control group.According to the follow-up results, the patients were divided into the survival group (n=134) and the death group (n=79).Compare the expression levels of serum miR-514b-3p and miR-599 in each group of subjects; Compare the expression differences of miRNAs in CRC patients with different pathological features.The Kaplan-Meier curve and log-rank test were used to deeply explore the association between serum miRNAs expression and prognosis.the ROC Curve and the Area Under the Curve (AUC) were used to evaluate the predictive efficacy of miRNAs for CRC and its prognosis.Cox proportional Cox regression analysis was used to analyze the influencing factors related to the prognosis of CRC patients.Results The serum miR-514b-3p in the CRC group and the control group were 1.56 ±0.51 and 3.45±1.95 respectively, and miR-599 were 1.91±0.51 and 3.97±1.57 respectively.There was a statistically significant difference between the two groups (P<0.05).The expression levels of serum miR-514b-3p and miR-599 in CRC patients were closely related to tumor size, invasion depth, TNM stage, lymph node metastasis, distant metastasis, degree of differentiation and CEA (P<0.05).Compared with the survival group, the levels of serum miR-514b-3p and miR-599 in the death group were significantly decreased (P<0.05).The ROC results showed that the AUC of the combined prediction of CRC by miR-514b-3p and miR-599 was 0.986, which was significantly higher than that of miR-514b-3p (Z=3.921, P < 0.001) and miR-599 (Z=4.571, P<0.001) when used alone.The AUC of the combined prediction of the above indicators for the prognosis of CRC patients was 0.936, which was significantly higher than that of miR-514b-3p (Z=3.697, P<0.001) and miR-599 (Z=5.217, P<0.001) when used alone.The Kaplan-Meier survival curve results showed that there were statistically significant differences between the high-expression and low-expression groups of each index (log-rank χ2=57.386, 46.790, P<0.05).Multivariate Cox regression analysis indicated that lower levels of miR-514b-3p and miR-599 were both independent risk factors for poor prognosis in CRC patients (P<0.05).Conclusion The expression levels of miR-514b-3p and miR-599 in the serum of CRC patients were significantly decreased.Both can be used as independent molecular markers for evaluating the pathological progression of patients and predicting poor prognosis, and the combined detection has higher clinical diagnostic and prognostic predictive value.

Objective To investigate the risk factors of positive urinary nitrite before urological stone lithotripsy and construct a nomogram prediction model.Methods Retrospective data collection was conducted on 400 patients undergoing lithotripsy for urinary tract stones admitted to our hospital between October 2023 and October 2025.Preoperative urinary nitrite positivity was analyzed using univariate and multivariate Logistic regression to identify risk factors.A cut-off point prediction model was constructed using R software, with predictive value assessed via receiver operating characteristic (ROC) curve analysis.Results The preoperative urinary nitrite positivity rate in this study was 13.25%.Bivariate Logistic regression analysis revealed that the female gender, diabetes mellitus, ureteral stone location, bilateral stones, stone size, severe hydronephrosis, and preoperative blood WBC count were all independent risk factors (P<0.05).ROC results showed that the AUC for predicting preoperative urinary nitrite positivity in urolithiasis using the Logistic regression model was 0.824 (95%CI: 0.767-0.880).Calibration curves closely approximated the standard curve.Decision curves indicated high net benefit for the model's predictions within a threshold probability range of 0.1-0.9.Paired differences in ROC curves revealed that the predictive model's AUC exceeded that of the single predictor (P<0.05).Conclusion Female gender, diabetes, ureteral stones, bilateral stones, stone size, severe hydronephrosis, and preoperative blood WBC were all independent risk factors for positive urinary nitrite prior to urolithotomy.The nomogram prediction model constructed based on these factors demonstrated excellent discrimination, calibration, and clinical utility.

Objective To investigate the risk factors for vascular crisis after replantation surgery for finger amputation injuries.Methods A total of 181 patients who underwent replantation surgery for finger amputation injuries in our hospital from January 2024 to September 2025 were enrolled.According to postoperative outcomes, patients who developed vascular crisis were assigned to the observation group(46 cases), while the remaining patients were assigned to the control group(135 cases).Clinical data were compared between the two groups, and Logistic regression analysis was performed to identify risk factors for postoperative vascular crisis.Based on the results of the Logistic regression analysis, a nomogram prediction model was established, and calibration curves were used to evaluate the performance of the model.Results Among the 181 patients with finger amputation injuries who underwent replantation surgery included in this study, 46 cases (25.41%, 46/181) developed postoperative vascular crisis.The proportion of patients with a smoking history in the observation group (with vascular crisis) was 60.87% (28/46), significantly higher than 36.30% (49/135) in the control group; similarly, the proportion of patients with rotational avulsion injuries in the observation group was 34.78% (16/46), also significantly higher than 15.56% (21/135) in the control group(P＜0.05).The average finger ischemia time [(10.03±2.14)hours], operative time [(171.19±20.65)minutes] and postoperative SAS score [(58.13±6.78)points] in the observation group were all significantly higher than those in the control group [(7.19±1.68)hours, (143.08±16.32)minutes and (51.13±6.02)points, respectively].There was a statistically significant difference between the two groups (P<0.05).Regarding vascular repair, the proportion of patients who underwent only one arterial repair in the observation group was 65.22% (30/46), significantly higher than 38.52% (52/135) in the control group; the proportion of patients with no venous repair (0 veins) was as high as 45.65% (21/46) in the observation group, also significantly higher than 17.78% (24/135) in the control group.There was a statistically significant difference between the two groups (P<0.05).Multivariate Logistic regression analysis further confirmed that smoking history, finger ischemia time, operative time, number of arterial and venous repairs, rotational avulsion injury, and postoperative anxiety are independent risk factors for postoperative vascular crisis(P＜0.05).The nomogram prediction model established based on these factors shows a calibration curve that closely approximates the ideal curve, indicating high predictive value.Conclusion Smoking history, finger ischemia time, operative time, number of venous repairs, rotational avulsion injury, and postoperative anxiety are independent risk factors for vascular crisis after finger replantation.The nomogram prediction model constructed based on these factors shows high predictive value.

Objective To compare the effects of external fixator fixation, anterior plate fixation, and posterior pedicle screw-rod system fixation on postoperative gait biomechanics, quality of life, and functional recovery in patients with Tile C pelvic fractures.Methods Clinical data of 136 patients with Tile C pelvic fractures admitted to the Department of Orthopedics, Nanjing Jiangbei Hospital from August 2022 to December 2024 were retrospectively analyzed.Patients were divided into external fixator group (45 cases), anterior plate group (42 cases), and posterior pedicle screw-rod system group (49 cases) according to the fixation method.Gait biomechanical indicators (spatiotemporal, kinematic, and kinetic parameters) at 3, 6, and 12 months after surgery, quality of life (SF-36 score), functional recovery (excellent and good rate of Majeed score), and complication rate were compared among the three groups.The correlation between gait indicators and quality of life/functional recovery was analyzed.Results At 3, 6, and 12 months postoperatively, gait parameters including walking speed, step length, maximum hip flexion angle, and peak ground reaction force were significantly better in the posterior pedicle screw-rod fixation group than in the external fixator group and anterior plate fixation group (P<0.05).Specifically, at 12 months postoperatively, the posterior pedicle screw-rod group showed walking speed of (0.97±0.09) m/s, maximum hip flexion angle of (92.3±5.1)°, and peak ground reaction force of (925.7±62.9) N, all significantly higher than those in the external fixator group [(0.73±0.10) m/s, (78.5±5.9)°, (815.3±68.9) N] and the anterior plate group [(0.82±0.08) m/s, (84.2±5.5)°, (868.2±65.8) N] (P<0.05).Moreover, the improvement in walking speed from 3 to 12 months postoperatively was significantly greater in the posterior pedicle screw-rod group [(0.32±0.08) m/s] than in the external fixator group [(0.21±0.07) m/s] (P<0.001).At 12 months postoperatively, the SF-36 scores for physical functioning (82.3±7.5), bodily pain (78.6±8.2), and social functioning (80.5±7.8) in the posterior pedicle screw-rod group were significantly higher than those in the external fixator group [(68.5±8.1), (65.2±7.9) and (67.8±8.3)] and the anterior plate group [(75.6±7.3), (72.3±7.6) and (74.2±7.5)] (P<0.01).The excellent-to-good rate of Majeed score was 87.76% (43/49) in the posterior pedicle screw-rod group, which was significantly higher than that of the external fixator group [64.44% (29/45)] and the anterior plate group [76.19% (32/42)] (P<0.05).The complication rates were 15.56% (7/45) in the external fixator group, 11.90% (5/42) in the anterior plate group, and 8.16% (4/49) in the posterior pedicle screw-rod group, with no statistically significant difference among the three groups (P=0.340).Correlation analysis revealed that walking speed was positively correlated with SF-36 physical functioning score (r=0.723, P<0.001) and Majeed score (r=0.685, P<0.001).Maximum hip flexion angle was negatively correlated with SF-36 bodily pain score (r=-0.592, P<0.001), and peak ground reaction force was positively correlated with the walking subdomain score of Majeed scale (r=0.547, P<0.001).Conclusion Posterior pedicle screw-rod fixation for complex unstable Tile C pelvic fractures demonstrates superior outcomes in gait biomechanical recovery, quality of life improvement, and functional prognosis compared with external fixation and anterior plate fixation, with a favorable safety profile.

Objective To explore the clinical curative effect of modified transverse tibial bone transport in Wagner grade 3-4 diabetic foot ulcer (DFU).Methods A total of 146 patients with Wagner grade 3-4 DFU admitted to the Beijing Longfu Hospital were enrolled From March 2016 to December 2025.According to random number table method, they were divided into observation group and control group, 73 cases in each group.On basis of systemic basic treatment, control group was treated with traditional transverse tibial bone transport, while observation group was treated with modified transverse tibial bone transport.The pain degree [visual analogue scale (VAS)], ankle-brachial index (ABI), foot skin temperature and transcutaneous oxygen pressure (TcPO2) were compared between the two groups before treatment, at 1 month and 3 months after treatment.The ulcer healing time and ulcer area were recorded to evaluate safety.All were followed up for 1 year to observe incidence of major amputation.Results The ulcer area and ulcer healing time in observation group were (2.25±0.58) cm2 and (64.95±3.52) d, smaller (shorter) than those in control group [(3.17±0.82) cm2, (71.24±4.89) d, P<0.05].At 1 month and 3 months after treatment, VAS scores in observation group were (3.07±1.86) points and (1.18±0.31) points, VAS scores in control group were (4.04±1.12) points and (2.29±0.51) points; ABI in observation group were (0.70±0.19) and (0.95±0.23), ABI in control group were (0.56±0.13) and (0.81±0.20); foot skin temperature in observation group were (31.54±1.16)℃ and (33.17±1.62)℃, foot skin temperature in control group were (29.32±1.08)℃ and (30.51±1.24)℃, TcPO2 in observation group were (30.55±2.71) mm Hg and (34.92±3.05) mm Hg, TcPO2 in control group were(29.13±2.52) mm Hg and (31.80±2.73) mm Hg, the differences between two groups were all statistically significant (P<0.05).The incidence of complications in observation group was lower than that in control group (6.85% vs 17.81%, P<0.05).There was no difference in amputation rate between two groups (P=0.497).Conclusion The modified transverse tibial bone transport can promote fast healing of ulcer wound, relieve pain, improve foot temperature and blood supply of affected limbs, and reduce incidence of complications in patients with Wagner grade 3-4 DFU.

Objective To observe the clinical efficacy of personalized 3D printed osteotomy guide plate assisted total ankle arthroplasty in the treatment of ankle osteoarthritis.Methods From January 2021 to January 2024, 42 patients with ankle osteoarthritis who underwent total ankle arthroplasty (TAA) were analyzed retrospectively.Divided into two groups according to the surgical method: the guide plate group (24 cases) used personalized 3D printed osteotomy guide plates made before surgery, simulated osteotomy before surgery, and assisted osteotomy during surgery.The traditional group (18 cases) used standard osteotomy guides provided by the manufacturer to locate and perform osteotomy with the assistance of X-ray fluoroscopy.The operation time, intraoperative blood loss, incision length, X-ray fluoroscopy times, pain degree 48 hours after operation, addition of analgesics, hospitalization time and incidence of complications were compared between the two groups, and compare the postoperative ankle joint function recovery between two groups of patients.Results In the guide plate group, the operation time was (78.50±9.96)min, the intraoperative blood loss was (168.08±36.86)ml, the incision length was (10.92±1.28)cm, the times of X-ray fluoroscopy were (6.58±1.59), the VAS score of postoperative pain was (3.33±0.76), the number of analgesic supplements was (2.08±0.97), and the hospitalization time was (8.67±1.63) days, all of which were less than those in the traditional group[(119.78±18.01)min, (230.78±34.77)ml, (12.78±1.44)cm, (14.33±2.28)times, (4.89±0.90), (3.78±0.81) and (11.67±1.81)d], with statistical significance (P<0.05).There were 4 cases of B-class healing in the guide plate group and 6 cases in the traditional group, there was no significant difference between the two groups (P>0.05), and no complications such as incision infection occurred in the two groups.Three months, six months and one year after operation, the ankle joint function of the two groups was significantly improved (P<0.05).Three months after operation, the average ankle function score of both groups reached a good level.From 6 months to 1 year after operation, the ankle joint function scores (Kofoed score) of the two groups all reached excellent level, and there was no significant difference in ankle joint function scores between the two groups (P<0.05).Conclusion In this study, based on 3D printing technology, personalized 3D printing osteotomy guide was made and pre-operation planning was carried out for patients, and TAA was assisted to complete, which achieved excellent clinical efficacy, making TAA more accurate, safe and feasible in the treatment of ankle arthritis.

Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) have become severe complications in patients with obesity and overweight.Liver fibrosis is a major characteristic of MASLD and may progress to cirrhosis or hepatocellular carcinoma.Bariatric surgeries, such as Roux-en-Y gastric bypass and sleeve gastrectomy, have gradually become optional treatments for improving obesity and MASLD.However, the mechanisms by which bariatric surgery improves liver fibrosis still need further exploration.This article explores the mechanisms by which gut microbiota after bariatric surgery exert direct or indirect therapeutic effects on liver fibrosis through maintaining gut barrier function, regulating metabolic function, and influencing the immune system.

This article reports the management of a 59-year-old male patient with adenocarcinoma of the proximal jejunum.The patient was admitted to the hospital with epigastric distension and pain in February, and was referred to our hospital after small enteroscopy from an outside hospital revealed an irregular peripheral neoplasm in the proximal jejunum, which was diagnosed as adenocarcinoma pathologically.After admission, CT examination of small intestine was completed, and jejunectomy was performed on April 10, 2025 under general anesthesia.Postoperative pathology showed moderately differentiated adenocarcinoma, with the cancer cells penetrating into the lamina propria and reaching the surrounding adipose tissue, but without metastasis.Adenocarcinoma of the small intestine is rare and the early symptoms are hidden, which may lead to delayed diagnosis and affect the prognosis.

Iatrogenic vertebral artery injury (IVAI) is uncommon in clinical practice; however, when it occurs, it may result in massive hemorrhage within a short period, readily attracting clinical attention.In contrast, occult IVAI is characterized by minimal and easily controlled bleeding and may therefore be overlooked intraoperatively.Eventually, delayed rupture of the vertebral artery can occur days or weeks later, leading to life-threatening hemorrhage.

Metastasis of breast cancer to the thyroid is even rarer; clinical and imaging findings lack specificity, and definitive diagnosis relies primarily on pathology and immunohistochemistry.This report describes a 59-year-old woman who developed cervical lymph node metastasis following surgery for invasive ductal carcinoma of the left breast, and in whom bilateral thyroid nodules enlarged markedly within a short period during treatment with exemestane combined with dacarbazine.Total thyroidectomy and bilateral central lymph node dissection were performed.Postoperative pathology, combined with ER, PR, and GATA-3 positivity and PAX-2 negativity, confirmed thyroid metastasis from breast cancer.Therefore, in patients with a history of breast cancer-particularly those with hormone receptor-positive disease and a long disease course-metastasis should be suspected if rapidly growing thyroid nodules are detected during follow-up.

This paper reviewed the clinical data of a patient with unicentric Castleman disease presenting with a right axillary mass in our hospital, The patient underwent complete surgical resection, recovered smoothly after the operation.There had shown no recurrence since then.

The clinical data of one patient with acute massive lower gastrointestinal bleeding caused by colonic Dieulafoy's disease was retrospectively analyzed, and the key points of clinical diagnosis and treatment were summarized in combination with the relevant diagnostic and therapeutic characteristics of the disease.Dieulafoy's disease is of unknown etiology and is essentially a submucosal arterial malformation, with a higher incidence in patients with underlying diseases or those taking anticoagulant, antipyretic and analgesic drugs for a long time.It most commonly occurs in the stomach and can involve any other part of the gastrointestinal tract.Acute massive lower gastrointestinal bleeding caused by colonic involvement is clinically rare.Endoscopy is the main method for locating the bleeding source of the disease, but the overall diagnostic difficulty is high, especially for colorectal lesions, and misdiagnosis or delayed treatment can lead to death.

Giant colonic duplication (GCD) is a rare congenital malformation associated with significant morbidity, particularly in adult patients, where it can lead to chronic refractory constipation and various complications, imposing a considerable burden on patients and their families.Colonic duplication may lead to various clinical manifestations, and the treatment approaches may differ.This study presents a detailed case report of a 47-year-old female patient with GCD and a 20-year history of refractory constipation, which worsened over the previous month, accompanied by notable abdominal distension and reduced bowel frequency.Clinical evaluation and imaging revealed a markedly dilated colonic segment, contributing to bowel obstruction.The surgical intervention successfully resolved the obstruction, with intraoperative findings indicating a 70 cm segment of the colon terminating at the blind end, highlighting the complexity of this condition.This article primarily focuses on the surgical treatment methods for colonic duplication associated with refractory constipation through a literature review.The study underscores the importance of thorough clinical assessment and imaging in diagnosing GCD, suggesting that early identification may facilitate timely surgical management, thereby improving patient outcomes and quality of life.