Objective To explore the surgical treatment experience of primary giant gastrointestinal stromal tumors（GIST）(with isolated lesions with a maximum diameter ＞ 10cm).Methods A retrospective analysis was conducted on the clinical and pathological data of 67 patients with primary giant GIST admitted from January 2018 to December 2024.Among them, 35 cases underwent surgical operations after preoperative neoadjuvant therapy (25 effective cases and 10 ineffective cases) (neoadjuvant therapy group).Due to the initial diagnosis assessment expecting radical (R0) resection (13 cases), or preoperative complications (12 cases), or difficulty in obtaining a pathological diagnosis through puncture biopsy (7 cases), 32 cases underwent direct surgery without neoadjuvant therapy (direct surgery group).Compare the general information,tumor condition,surgical condition,postoperative recovery,postoperative pathology,postoperative adjuvant therapy,and recurrence between two groups.Results Comparative analysis revealed that there was no statistically significant difference(P>0.05) between the neoadjuvant therapy group and the direct surgery group in terms of gender,age,primary tumor location,initial maximum diameter,growth type,localized or locally advanced stage,and postoperative follow-up time.The maximum diameters of the tumors before surgery in the neoadjuvant therapy group and the direct surgery group were (12.4±7.1)cm and (18.2±5.0) cm respectively, and the operation times were (125.4±30.6) minutes and (153.0±31.7) minutes respectively. The intraoperative blood loss was (228.3±76.4)ml and (300.3±67.2)ml, respectively. The postoperative hospital stay was (9.1±2.6) days and (11.1±3.2) days, respectively. There was a statistically significant difference between the two groups (P < 0.05).The proportion of laparoscopic surgery in the neoadjuvant therapy group was 17.1%, which was higher than that in the direct surgery group (0), and the difference was statistically significant (P < 0.05). There was no statistically significant difference between the two groups in terms of the proportion of tumor rupture, combined organ resection, postoperative complications and postoperative recurrence (P>0.05).Conclusion Primary giant gastrointestinal stromal tumors can mostly be reduced in size and progression through neoadjuvant therapy,improving the chances of minimally invasive surgery.However,there is also a risk of tumor progression during neoadjuvant therapy leading to increased surgical difficulty or even loss of curative surgical opportunities.

Objective To investigate the effect of through frontal keyhole approach neuroendoscopic surgery of basal ganglia hemorrhage on nerve conduction tract and prognosis.Methods 56 patients with hypertensive basal ganglia hemorrhage treated in our department from October 2017 to October 2023 were selected and divided into observation group and control group.Among them,28 patients in the control group underwent microscopic surgery through temporal cortex approach,while 28 patients in the observation group underwent endoscopic surgery through frontal keyhole approach.Fractional anisotropy and activities of daily living were compared between the two groups after operation.Results The proportion of FA Ⅰ grade in observation group was 88.9% and 70.0% in GCSⅠ grade and GCSⅡ grade patients,respectively,while in control group it was 75.0% and 41.7%.The proportion of ADL Ⅰ and Ⅱ grade in observation group was 94.4% and 70.0% in GCSⅠ grade and GCSⅡ grade patients,respectively,whereas in control group it was 81.3% and 41.7%.The integrity of the corticospinal tract and activities of daily living in observation group were better than those in control group,with statistical significance(P<0.05).Conclusion The surgery of hypertensive basal ganglia hemorrhage with neuroendoscopy through frontal keyhole approach has little influence on nerve conduction tract and the prognosis was better than traditional microscopic surgery through temporal cortex approach.

Objective To explore the correlation between serum iron levels and granulomatous lobular mastitis (GLM).Methods A total of 102 patients with GLM were admitted from May 2022 to May 2023. According to the disease course stage at the time of the patients’ visit, they were divided into the mass stage group (29 cases), the abscess stage group (48 cases), and the remission stage group (25 cases).Compare the serum iron levels of patients with GLM at different stages.Spearman correlation analysis was used to analyze the correlation between serum iron levels and inflammatory indicators, and the changes in serum iron levels of patients before and after treatment remission were compared through follow-up.Results All the 102 GLM patients were female.The serum iron levels of patients in the abscess stage group, the mass stage group and the remission stage group were 12.8 (10.20,17.50) μmol/L, 12.8 (10.20,17.50) μmol/L and 15.4 (13.65,18.50) μmol/L, respectively. The abscess stage group was lower than the mass stage group and the remission stage group, and the difference was statistically significant (P<0.001).The results of bivariate Spearman correlation analysis showed that the serum iron levels were moderately negatively correlated with white blood cell count, neutrophil count and the percentage of neutrophils（r=-0.336,P=0.001；r=-0.361,P=0.001；r=-0.334,P<0.01）,low intensity negative correlation with monocyte count（r=-0.214,P=0.031）,moderately positively correlated with the percentage of lymphocytes, the levels of interleukin (IL)-2,IL-4,IL-10（r=0.328,P<0.01;r=0.494,P=0.023;r=0.514,P=0.017;r=0.478,P=0.028）.Serum iron levels in 45 GLM follow-up patients after treatment remission were higher than those before remission [(15.09±4.78) μmol/L vs. (10.64± 4.47) μmol/L,P<0.001].Conclusion Serum iron level is associated with disease severity,inflammatory markers such as immune cells and cytokines,and disease outcome of GLM.

Objective To compare the clinical efficacy of neuroendoscopic intracranial hematoma evacuation and stereotactic minimally invasive puncture in the treatment of hypertensive intracerebral hemorrhage.Methods A total of 111 patients with hypertensive intracerebral hemorrhage admitted from January 2019 to November 2023 were divided into the puncture group(58 cases) and the endoscopy group(53 cases) according to the surgical method. The puncture group was treated with stereotactic minimally invasive puncture, and the endoscopy group was treated with neuroendoscopic surgery. The perioperative indicators, activity of daily living(ADL), prognosis quality, and complications were compared between the two groups.Results The operation time of the endoscopy group and the puncture group was (90.19±20.18) minutes and (55.43±16.39) minutes, the intraoperative blood loss was (102.55±29.58)ml and (14.76±8.27)ml, and the hematoma evacuation rate was (95.98±5.50)% and (72.16±6.97)%, respectively. The differences were statistically significant(P＜0.05). There was no significant difference in ADL score between the two groups before surgery(P＞0.05). After surgery, the ADL scores of both groups increased, and the endoscopy group was higher than the puncture group [(81.59±9.34) points vs.(72.63±8.47) points], with a statistically significant difference(P＜0.05). The overall prognosis quality of the endoscopy group was higher than that of the puncture group, and the difference was statistically significant(P＜0.05). The total complication rate of the endoscopy group(5.66%) was lower than that of the puncture group(12.07%), but there was no significant difference between the two groups(P＞0.05).Conclusion Compared with stereotactic minimally invasive puncture, neuroendoscopic intracranial hematoma evacuation has better efficacy in the treatment of hypertensive intracerebral hemorrhage, with higher hematoma evacuation rate and better prognosis.

Objective To investigate the effects of sufentanil on proliferation,invasion,migration,and apoptosis of thyroid cancer cells,and analyze whether its mechanism is related to the AMP-activated protein kinase(AMPK) -silent information regulator 1(SIRT1) -peroxisome proliferator activator receptor gamma coactivator 1α(PGC-1α) signaling pathway.Methods The human thyroid cancer cell line(TPC-1) was separated into a control group,L,M,H-sufentanil groups,and H-sufentanil+AICAR group.TPC-1 cell activity,apoptosis,invasion,migration,and expression of proteins were detected using CCK-8 assay,flow cytometry,Transwell assay,scratch assay,and Western blot,respectively.〖WTHZ〗ResultsCompared with the control group,the absorbance value,invasion number,scratch healing rate,cleaved-Caspase-3,programmed cell death 1 ligand 1,B lymphoblastoma-2,p-AMPK/AMPK,SIRT1,and PGC-1α protein levels in L,M,and H-sufentanil groups were reduced;the apoptosis rate and Bax protein level were increased(P＜0.05).AICAR treatment reversed the effect of H-sufentanil on the above indicators(P＜0.05).Conclusion Sufentanil may inhibit the AMPK-SIRT1-PGC-1α signaling pathway,thereby inhibiting the proliferation and invasion migration of thyroid cancer cells,and promoting cell apoptosis.

Objective To investigate the distribution of pathogens and changes in serum human β-defendin-3(HBD3) and FMS like tyrosine kinase 3 ligand(Flt3L) levels in patients with pulmonary infection after esophageal cancer radical surgery.Methods Prospectively, patients who underwent radical resection of esophageal cancer and developed pulmonary infection from January 2022 to January 2024 were selected as the infection group (75 cases), and patients who underwent radical resection of esophageal cancer and did not develop pulmonary infection were selected as the non-infection group (93 cases).Patients in the infection group were divided into the mild group (25 cases), the moderate group (39 cases), and the severe group (11 cases) based on the CURB-65 score. The distribution of pathogenic bacteria in patients of the infection group was analyzed by the fully automatic microbial identification instrument. The expression levels of HBD3 and Flt3L in serum were detected by enzyme-linked immunosorbent assay (ELISA).Multivariate Logistic regression was applied to analyze the risk factors for postoperative pulmonary infection in esophageal cancer patients.ROC curve was applied to analyze the diagnostic value of HBD3 and Flt3L levels for postoperative pulmonary infection in esophageal cancer patients.Results Among 75 infected patients,90 strains of pathogens were detected,including 49 strains(54.44%) of Gram negative bacteria,29 strains(32.22%) of Gram positive bacteria,and 12 strains(13.33%) of fungi.The serum HBD3 and Flt3L levels in the infection group were greatly higher than those in the non infection group(P＜0.05).The serum HBD3 and Flt3L levels in the severe group were higher than those in the moderate group and mild group(P＜0.05),while the serum HBD3 and Flt3L levels in the moderate group were higher than those in the mild group(P＜0.05).Multivariate Logistic regression analysis showed that HBD3,Flt3L,tumor location in the upper/middle segment,intraoperative bleeding ≥ 500 ml,diabetes,and smoking history were all factors influencing the pulmonary infection after radical resection of esophageal cancer(P＜0.05).According to the ROC curve,the AUC value for diagnosing postoperative pulmonary infection in esophageal cancer patients with serum HBD3 level alone was 0.789.The AUC value for diagnosing postoperative pulmonary infection in esophageal cancer patients with serum Flt3L level alone was 0.863,the AUC value of the combined diagnosis of the two was 0.934,which was greatly higher than that of the individual diagnosis(Z_{combination vs HBD3}=3.723,Z_{combination vs Flt3L}=2.098,P＜0.05).Conclusion The serum HBD3 and Flt3L levels in patients with pulmonary infection after esophageal cancer radical surgery are highly expressed,and the serum HBD3 and Flt3L levels are correlated with the severity of pulmonary infection.The two are risk factors for postoperative pulmonary infection in esophageal cancer patients after radical surgery,and their combination can effectively diagnose postoperative pulmonary infection in esophageal cancer patients.

Objective To evaluate the effects of thoracoscopic intercostal nerve block and incision infiltration block on postoperative recovery quality and analgesia in patients with partial pulmonary resection.Methods From July 2023 to December 2023, 60 patients scheduled for elective thoracoscopic partial lung resection were divided into two groups by random number table method, with 30 cases in each group.The observation group underwent thoracoscopic vision intercostal nerve block,and the control group underwent incision local infiltration block.Intravenous patient-controlled analgesia was adopted in all cases after the operation.The 15-item Recovery Quality Scale (QOR-15) score was recorded 1 day before surgery,24 hours and 48 hours after surgery.The visual analogue pain scores (VAS) at rest and cough at 2,4,8,24,and 48 hours after surgery,consumption of sufentanil within 24 hours and 48 hours after surgery,remedial analgesia and related adverse reactions were recorded.Results The QOR-15 scores of the observation group at 24 hours and 48 hours after operation were (103.4±14.2) and (111.2±6.9),which were higher than those of the control group (91.3±21.4) and (101.8±14.8),and the differences were statistically significant (P<0.05).At rest,the VAS scores of the observation group at 2,4,8 and 24 hours after surgery were (2.0±0.9),(2.1±0.9),(2.5±1.2) and (2.4±1.2).Compared with the control group (3.1±1.2),(3.4±1.7),(3.5±1.7) and (3.2±1.3),the differences were statistically significant (P<0.05).When coughing,the VAS scores of the observation group at 2,4 and 8 hours after operation were (2.4±0.6),(2.5±0.6) and (3.0±1.2),which were lower than (3.2±1.2),(3.7±1.7) and (4.0±2.1) of the control group.The difference was statistically significant (P<0.05).The consumption of sufentanil within 24 hours and 48 hours after surgery in the observation group was (58.1 ± 7.5)μg and (116.5 ± 14.9)μg,respectively,which were lower than those in the control group (63.2 ± 8.5)μg and (125.0 ± 16.7)μg,and the difference was statistically significant (P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).Conclusion Compared with incision infiltration block,thoracoscopic intercostal nerve block has better postoperative analgesic effect and higher postoperative recovery quality.

Objective To investigate the risk factors and significance of catheter dislocationat the venipuncture site after the implantation of a totally implantable venous access port (TIVAP) in patients with breast cancer.Methods From January 2019 to September 2021,1003 patients who underwent vein approach transfusion port implantation were divided into the catheter dislocation group(7 cases) and the non-catheter dislocation group(996 cases).Risk factors for post operative recurrence of catheter dislocationwere analyzed through univariate analysis and logistic regression analysis.Results The results of the univariate analysis indicated that the incidence of catheter dislocation in the group with age≥60 years, axillary vein approach, and left-side puncture was higher than that in the control group, and the difference was statistically significant (P< 0.05). The BMI of the dislocation group [(27.06 ± 2.16)kg/m²] was higher than that of the non-dislocation group [(25.09 ± 3.33)kg/m²],there was a statistically significant difference between the two groups (P=0.05).The multivariate Logistic regression analysis showed that the catheterization approach and puncture side had no significant effect on catheter dislocation (P>0.05); high BMI and age≥ 60 years were independent risk factors for catheter dislocation complications (P<0.05).Conclusion Axillary vein approach transfusion port implantation is relatively safe and reliable.Age≥ 60years old and high BMI are independent risk factors affecting the complication of catheter dislodgement.

Objective To explore the impacts of dietary diary combined with path based eating management on gastrointestinal function and dietary health behavior in postoperative patients with laparoscopic distal gastric cancer.Methods From January 2021 to January 2023, 150 patients who underwent laparoscopic distal gastric cancer surgery were randomly divided into two groups.The control group received routine dietary management intervention,while the observation group received dietary diary combined with path based eating management intervention.The gastrointestinal function and dietary health behavior of the two groups were compared.Results The excellent and good rate of gastrointestinal function recovery was 57.33% in the observation group,which was higher than 47.33% in the control group 3d after operation (P<0.05);One month after surgery and three months after discharge,the scores of dietary health behaviors in the observation group were higher than those in the control group (P<0.05);One month after discharge and three months after discharge,the serum albumin level in observation group was (37.68±5.30) g/L,(38.25±4.82) g/L,and the hemoglobin level was (120.08±20.02) g/L,(124.62±24.23) g/L,which was higher than that in control group [1 month after discharge:(30.32±4.17) g/L,(32.99±4.41) g/L;3 months after discharge:(110.75±16.12) g/L,(115.34±18.44) g/L] (P<0.05);The complication rate of the observation group was lower than that of the control group (P<0.05).Conclusion Dietary diary combined with path based eating management can promote the recovery of gastrointestinal function and improve dietary health behavior in postoperative patients with laparoscopic distal gastric cancer.

Objective To explore the influencing factors of postoperative pancreatitis in elderly patients with common bile duct stones undergoing endoscopic retrograde cholangiopancreatography (ERCP).Methods 304 elderly patients with common bile duct stones treated with ERCP in our hospital from February 2021 to June 2023 were selected as the study subjects.They were divided into a group with concurrent pancreatitis (n=22) and a group without concurrent pancreatitis (n=282) based on whether postoperative pancreatitis occurred.And the levels of serum lipase,whole blood PLR,and serum CRP were measured before surgery and 3,6,and 24 hours after surgery,respectively.At the same time,the differences in other relevant clinical data between the two groups of patients were compared.Binary Logistic regression was used to analyze the risk factors of pancreatitis after ERCP.Results The serum lipase levels in the concurrent pancreatitis group at 3, 6, and 24 hours after the operation were (1060.48±131.23) U/L, (1137.45±126.34) U/L, and (1152.87±135.05) U/L, respectively. The levels of PLR in whole blood were 192.24±29.26, 216.45±30.24, and 243.62±38.22 respectively, all of which were higher than those in the group without concurrent pancreatitis during the same period. There was a statistically significant difference between the two groups (P<0.05).The serum CRP level in the group with pancreatitis was significantly higher than that in the group without pancreatitis at 6 and 24 h after operation (P<0.05).Body mass index,Oddi sphincter dysfunction,difficulty in intubation,pancreatic development,ERCP operation time >60 min,multiple entry of the catheter into the pancreatic duct were associated with postoperative pancreatitis after ERCP in elderly patients (P<0.05).Multivariate Logistic regression analysis showed that after adjusting for confounding factors such as gender,age,BMI,course of disease,and number of stones,Serum lipase at 3 h after surgery,whole blood PLR at 3 h after surgery,serum CRP level at 6 h after surgery,difficulty in intubation and pancreatic development were independent risk factors for pancreatitis after ERCP in elderly patients (P<0.05).Conclusion Serum lipase,whole blood PLR levels 3 hours after surgery,and serum CRP levels 6 hours after surgery are independent risk factors for pancreatitis after ERCP in the elderly with common bile duct stones.

Objective To explore the correlation between serum G protein signaling modulator 2 (GPSM2),adapter related protein complex 3 subunit mu2 (AP3M2) with clinical pathological features and postoperative prognosis of early colorectal cancer (CRC) patients.Methods From January 2020 to December 2021,142 early CRC patients (CRC group) and 96 colorectal polyp patients (benign lesion group) treated in our hospital were included,and 80 healthy volunteers (control group) were also included.RT-qPCR was used to detect serum GPSM2 and AP3M2.Kaplan-Meier survival curve was performed to analyze the relationship between serum GPSM2 and AP3M2 with the prognosis of CRC.Cox regression was performed to analyze the risk factors affecting the prognosis of CRC.ROC curve was used to explore the forecast value of serum GPSM2 and AP3M2 for the prognosis of CRC.Results The benign lesion group and CRC group had manifestly higher serum GPSM2 and AP3M2 than the control group,and with the CRC group being higher than the benign lesion group (P<0.05).Serum GPSM2 and AP3M2 in CRC patients were related to their differentiation degree (P<0.05).The 3-year survival rate of patients with low GPSM2 and AP3M2 was higher than that of patients with high GPSM2 and AP3M2 (85.29%、87.14% vs 67.57%、65.28%) (Log Rank χ²=7.205,10.800,P<0.05).Low differentiation degree and elevated serum GPSM2 and AP3M2 were risk factors affecting the prognosis of CRC (P<0.05).The AUC of serum GPSM2 and AP3M2 combined to predict the prognosis of CRC patients was 0.903 (Z_joint-GPSM2=2.882,Z_joint-AP3M2=3.322,P<0.05),the sensitivity is 88.24%,and the specificity is 82.41%.Conclusion The serum GPSM2 and AP3M2 in CRC patients are elevated and closely related to differentiation degree and prognosis.The joint of the two has high clinical value in forecasting the prognosis of CRC.

Objective To investigate and analyze the expression of microribonucleic acid-30c-5p(miR-30c-5p) and chitinase-3-like protein 1(CHI3L1) in colorectal cancer tissue,and their relationship with clinical pathological features and lymph node metastasis.Methods 106 colon cancer patients admitted to First Affiliated Hospital of Bengbu Medical College from January 2022 to July 2024 were gathered.The patients were divided into two groups based on whether lymph node metastasis occurred. There were 50 cases in the metastasis group and 56 cases in the non-metastasis group. The cancer tissues and adjacent tissues were collectedQRT-PCR and immunohistochemistry were applied to detect the expression of miR-30c-5p and CHI3L1 in cancer and adjacent tissues.Multivariate Logistic regression was applied to analyze the influencing factors of lymph node metastasis in patients.Results Compared with adjacent tissues,the expression level of miR-30c-5p（0.74±0.08 vs 1.00±0.11） in cancer tissues was obviously reduced(P＜0.05),and the positive expression rate of CHI3L1（67.92% vs 39.62%） was obviously increased(P＜0.05).There were statistically significant differences in the expression of miR-30c-5p and CHI3L1 in cancer tissues of patients with different tumor diameters（68.42% vs 44.90%，65.28% vs 41.18%）,TNM staging（40.35% vs 63.27%，67.65% vs 43.06%）,tissue differentiation degree（36.84% vs 59.18%，38.89% vs 64.71%）,and lymph node metastasis（49.12% vs 24.49%，29.41% vs 55.56%）(P＜0.05).There were statistically significant differences in tumor diameter,tissue differentiation,TNM staging,vascular invasion,neurological invasion and expression of miR-30c-5p(0.85±0.09 vs 0.62±0.07）,CHI3L1（57.14% vs 80.00%) and carcinoembryonic antigen(CEA)（3.25±0.38 vs 4.21±0.45） between the metastasis group and non metastasis group(P＜0.05).The Logistic regression analysis showed, the Elevated expression of miR-30c-5p[OR（95%CI）=0.682（0.500-0.930）] was a protective factor affecting lymph node metastasis in patients(P＜0.05),while positive expression of CHI3L1,low tissue differentiation,TNM staging T3+T4 and the level of CEA[OR(95%CI)=1.593(1.037-2.447), 1.852(1.155-2.970), 1.603(0.926-2.775), 1.742(1.006-3.016)] were risk factors affecting lymph node metastasis in patients(P＜0.05).Conclusion The expression level of miR-30c-5p is obviously reduced in cancer tissues of colon cancer patients,while CHI3L1 is positively expressed and they are associated with clinicopathological features,both of which are influential factors in the development of lymph node metastasis in patients.

Objective To investigate the effects of traditional laparoscopic surgery,natural orifice specimen extraction surgery(NOSES),and intersphincteric resection(ISR) on treatment outcomes and quality of life in patients with low rectal cancer.Methods A total of 152 patients with low rectal cancer who were admitted from January 2020 to June 2022,and they were divided into the traditional laparoscopic group(49 cases),the NOSES group(51 cases),and the ISR group(52 cases) according to the surgical method.The operation status,postoperative recovery status,pain,anal function recovery status,quality of life and complications were compared in the 3 groups.Results The operation time of the traditional laparoscopic group [(193.98±12.31) min] was lower than that of the NOSES group [(203.54±15.02) min] and the ISR group [(199.85±11.98) min](P<0.05),operation time of NOSES group and ISR group was no difference(P>0.05).The first exhaust time [(60.21±10.05) h],the first time of getting out of bed [(37.52±6.21) h],and the length of postoperative hospital stay [(12.51±1.47) d] in the traditional laparoscopic group were all higher than those in the NOSES group [(51.06±8.67) h,(30.13±4.92) h,and(11.27±) 1.23) d] and ISR group [(53.19±9.24) h,(28.97±4.71) h,(11.73±1.35) d](P<0.05),and there were no statistically significant differences in the first exhaust time,the first time to get out of bed,and the length of postoperative hospital stay between the NOSES and ISR groups(P>0.05). There was no statistically significant difference in the Visual Analogue Scale (VAS) scores for pain at 4 hours, 24 hours, and 48 hours after surgery among the three groups (P>0.05).The VAS scores of the three groups at 24 hours after surgery were higher than those at 4 hours and 48 hours after surgery, and the difference was statistically significant (P < 0.05).The VAS scores of the three groups at 48 hours after surgery were higher than those at 4 hours after surgery, and the difference was statistically significant (P< 0.05).The NOSES group’s Wexner score [(4.93±0.76) points] at 3 months after surgery and Wexner score [(3.21±0.42) points] at 6 months after surgery were lower than those of the ISR group [(6.32±0.93) points,(4.48±0.54) points] and the traditional laparoscopic group [(5.93±0.81) points,(4.01±0.53)points](P<0.05),and the Wexner score of the 3 groups at 3 months after surgery was lower than that at 1 month after surgery(P<0.05).The EORTC QLQ-C30 score of the NOSES group at 3 months after surgery was (74.82±4.01) points, and that at 6 months was (85.49±4.93) points, which were higher than those of the ISR group [(67.05±5.03) points and (71.64±4.21) points] and the traditional laparoscopic group [(70.42±3.92) points,(76.28±4.48) points](P<0.05),and the EORTC QLQ-C30 scores of the traditional laparoscopic group at 3 and 6 months after surgery were higher than those of the ISR group, and the difference was statistically significant (P < 0.05). The EORTC QLQ-C30 score of the 3 groups at 6 months after surgery was higher than that before surgery and 3 months after surgery(P<0.05),and the EORTC QLQ-C30 score of the 3 groups at 3 months after surgery was higher than that before surgery(P<0.05).There was no significant difference in the incidence of total complications among the three groups(P>0.05).Conclusion Compared with traditional laparoscopic surgery for low rectal cancer,the NOSES and ISR methods accelerate postoperative bowel function recovery,and the NOSES methods have advantages in anal function recovery and better and satisfactory quality of life.

Objective To explore the effects of drug-coated balloons (DCB) on the patency rate of target lesion vessels, coagulation function and vascular endothelial function in patients with in-stent restenosis (ISR) after percutaneous endovascular angioplasty (PTA) for lower extremity arteriosclerosis obliterans (ASO).Methods A total of 62 patients with ISR and ASO admitted to the hospital were retrospectively enrolled between March 2020 and March 2022.According to different treatment methods,they were divided into DCB group (n=38) and common balloon (SAB) group (n=24).All were followed up for 12 months after surgery.The changes in primary patency rate of target lesion vessel,clinically driven-target lesion revascularization (CD-TLR) rate,late loss of values in the lumen (LLL),ankle-brachial index (ABI),coagulation function indexes [prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (FIB),D-dimer (D-D)] and vascular endothelial function indexes [serum endothelin-1 (ET-1),nitric oxide (NO),flow-mediated dilatation (FMD)] were observed,and the occurrence of postoperative complications in the two groups was recorded.Results At 12 months after surgery,primary patency rate of target lesion vessels in DCB group was higher than that in SAB group (86.84% vs 50.00%),CD-TLR rate,LLL and ABI were lower than those in SAB group[13.16%,(1.39±0.52)mm,(0.76±0.12) vs 50.00%,(1.79±0.64) mm,(0.62±0.11);P<0.05].At 24h and 2 weeks after surgery,there was no significant difference in PT,APTT,FIB or D-D between the two groups (P>0.05).At 24h and 2 weeks after surgery,levels of serum ET-1 in DCB group were lower than those in SAB group [(66.65±7.12)pg/ml,(65.58±6.98)pg/ml vs (71.74±6.92)pg/ml,(68.84±6.51)pg/ml)],while NO levels were higher than those in SAB group [(32.21±4.17)pg/ml,(34.62±3.32)pg/ml vs (28.53±5.23)pg/ml,(31.21±4.19)pg/ml;P<0.05].At 2 weeks after surgery,FMD in DCB group was higher than that in SAB group [(12.49±5.33)% vs (9.14±4.42)%,P<0.05].There was no significant difference in the total incidence of complications between the two groups (21.50% vs 12.50%,P>0.05).Conclusion Compared with SAB,DCB can effectively protect vascular endothelial function and improve the primary patency rate of ISR after PTA in patients with lower extremity ASO.

Objective Exploring the clinical efficacy of using autologous rib cartilage grafting to reconstruct finger hemiarticular defects.Methods From August 2022 to February 2024, for 6 patients with hemiarticular surface defects in the metacarpophalangeal joints and interphalangeal joints of 8 fingers, costal cartilage was used for joint remodeling and transplantation to reconstruct the hemiarticular surface defects of the fingers.All 8 joint transplants in 6 patients were two-stage surgeries. In the first stage, antibiotic bone cement was used to fill the space-occupying lesions, and in the second stage, costal cartilage joint remodeling was performed to reconstruct the finger joint defects.Postoperative follow-up and assessment of fracture healing according to Paley fracture healing scoring criteria.Outpatient and WeChat follow-up,upper limb function is evaluated according to the upper limb functional assessment standards of the Chinese Medical Association Hand Surgery Society.Record VAS pain score.Results In this group,there were a total of 6 patients with 8 cases of hemiarticular defects.Among them,2 patients had two joint surgical sites,while the remaining 4 patients had a single joint surgical site.There were 2 cases of metacarpophalangeal joint head defects,2 cases of proximal articular surface defects,3 cases of proximal articular head defects,and 1 case of thumb proximal articular head defect.After surgery,8 out of 6 patients’ hand wounds healed successfully.All patients were followed up for 6-12 months postoperatively,with an average of 9 months.The VAS pain score (affected finger) for the last follow-up was 0-2 points,with an average of 0.6 points.According to Paley’s scoring criteria,all 6 patients had excellent fracture healing.According to the evaluation criteria for upper limb functional assessment of the Chinese Medical Association Hand Surgery Society,3 cases were rated as excellent,3 cases were rated as good,and 2 cases were rated as fair.Conclusion For patients with half joint defects on one side of the finger,rib rib cartilage was used for joint reconstruction,which significantly improved the joint shape and function at the defect site,and reduced joint pain scores.

Objective To evaluate the clinical efficacy of anterior versus posterior surgical approaches in the treatment of thoracic spinal tuberculous kyphosis.Methods From January 2018 to January 2023,a total of 67 patients with thoracic spinal tuberculous kyphosis were treated.According to the surgical approach,patients were divided into an anterior group(30 cases) and a posterior group(37 cases).The operation time, blood loss, Cobb Angle before the operation, 6 months after the operation, and at the last follow-up (12 months after the operation), visual analog scale (VAS) score, and oswestry disability index (ODI) were compared between the two groups.Results The anterior group had significantly longer operative time and greater intraoperative blood loss compared to the posterior group(P<0.05).At 6 months postoperatively,the Cobb angle in the anterior group was significantly lower than that in the posterior group(P<0.05).Subgroup analysis showed no significant differences between the anterior and posterior groups in preoperative,6 months,and 12 months Cobb angles,correction degree,correction loss for single-segment cases(P>0.05).However,in multi-segment cases,the anterior group had significantly higher Cobb angles at both preoperative and 6-month postoperative time points compared to the posterior group(P<0.05),while no significant differences were observed at 12 months,including in correction degree and loss(P>0.05).The VAS score and ODI of the anterior approach group and the posterior approach group at 6 months after surgery were lower than those before surgery, and the VAS score and ODI at 12 months after surgery were lower than those at 6 months after surgery. The differences were statistically significant (P<0.05). During the follow-up period, no recurrence of tuberculosis, failure of internal fixation or significant loss of correction was observed.Conclusion Both anterior and posterior surgical approaches can effectively treat single-segment tuberculous thoracic kyphosis,with comparable efficacy.The anterior approach is more suitable for patients with localized lesions requiring anterior decompression,whereas the posterior approach offers advantages in deformity correction and spinal stability reconstruction,especially in cases involving multi-segmental lesions.

Objective To explore the impact of Video-Assisted Protrusion Treatment with Endoscope (VPTED) on red blood cell immunity,complications,and lumbar extensor muscle groups in patients with lumbar disc herniation (LDH).Methods A total of 103 LDH patients in our hospital from March 2021 to March 2023 were prospectively selected. Among them, 6 cases were lost to follow-up, and 97 cases were included in the study. They were divided into the observation group (49 cases) and the control group (48 cases) by random number table method, and VPTED and microscopic minimally invasive channel technique (MITM) were performed respectively.The perioperative indicators, complications, and excellent and good rates of the two groups were statistically analyzed. The tissue trauma indicators interleukin-6 (IL-6),IL-8,IL-17, red blood cell immune indicators, Oswestry disability index (ODI), and biomechanical indicators of the lumbar and dorsal extensor muscle group (peak moment, average power, and lumbar and dorsal flexion and extension ratio in the lumbar and dorsal extension state) before and after the operation were compared between the two groups.Results The surgical time,mobilization time,and hospitalization time of the observation group were (68.62±5.59) minutes,(1.44±0.31) days,and (7.24±1.08) days,respectively,which were shorter than those of the control group [(94.11±10.34) minutes,(2.38±0.46) days,and (9.26±1.23) days].The intraoperative blood loss and VAS scores at 3 and 5 days after surgery were (12.68±2.37) ml,(2.78±0.34)points and (1.45±0.33) points,respectively.Which were lower than those of the control group [(50.54±4.49) ml,(3.31±0.36)points and (2.12±0.40) points](P<0.05).The incision length of the observation group was (0.87±0.21)cm, which was shorter than that of the control group [(1.23±0.26)cm]. There was a statistically significant difference between the two groups (P < 0.05).From pre-operation to 7 days post-operation,the levels of IL-6,IL-17,IL-8,and RBC-ICR in both groups exhibited an increase-decrease trend,while RBC-C3bRR and RBC-NTFR showed a decrease-increase trend (P<0.05).From pre-operation to 12 months post-operation,the ODI index and lumbar back flexion-extension ratio in both groups decreased with time,while peak torque and average power in lumbar back extension increased with time (P<0.05).At 12 months post-operation,there were no statistically significant differences in complication rates (2.04% vs 6.25%) and surgical excellence rates (89.80% vs 87.50%) between the two groups (P>0.05).Conclusion VPTED is safe and effective in the treatment of LDH,and has unique advantages in the improvement of perioperative indexes.

Objective To investigate the risk factors of latent blood loss after internal fixation of intertrochanteric fracture of femur.Methods The clinical data of 112 patients with intertrochanteric fracture of femur treated with internal fixation in our hospital from May 2019 to July 2022 were retrospectively analyzed,and the hidden blood loss after surgery was recorded.SPSS software was used to analyze the influencing factors of hidden blood loss after internal fixation of intertrochanteric fracture of femur.Results None of the 152 patients with intertrochanteric fracture of femur had serious complications or died during perioperative period,and the wound was not infected.The fixation alignment was good.The postoperative dominant blood loss was (236.37±71.52) ml,the recessive blood loss was (709.74±132.36) ml,and the total blood loss was (946.11±205.61) ml.The recessive blood loss was significantly higher than the dominant blood loss (P<0.05).Multiple linear regression analysis showed that age,hypertension,diabetes,fracture type,preoperative anticoagulation,time from injury to operation,and operation time were all risk factors for latent blood loss after internal fixation of intertrochanteric fracture of femur (P<0.05).Conclusion Age,hypertension,diabetes,fracture type,preoperative anticoagulation,time from injury to operation and operation time are all risk factors for latent blood loss after internal fixation of intertrochanteric fracture of femur.According to these factors,medical staff can formulate corresponding prevention and treatment programs to reduce the latent blood loss after internal fixation of intertrochanteric fracture of femur.

Imatinib is the standard first-line treatment for advanced gastrointestinal stromal tumors(GISTs),but half of patients develop drug resistance within 18 to 24 months.In recent years,more and more retrospective studies have shown that surgery can be used as an adjunct therapy to tyrosine kinase inhibitors(TKIs),delay the onset of drug resistance,and improve patient prognosis.Patients with advanced GISTs who have benefited from targeted therapy or have limited progression and those who are expected to achieve R0/R1 resections may benefit from surgery.Due to the lack of high-quality research evidence,surgical decision-making,patient selection,and the sequence of targeted therapy are still under controversy.The surgical treatment of advanced GISTs should be carried out in a case-by-case manner under the framework of multidisciplinary team guidance.

Drug therapy is the main treatment for advanced gastrointestinal stromal tumors.Tyrosine kinase inhibitors targeting KIT/PDGFRA have significant efficacy.However, the problem of primary/induced drug resistance has promoted the development of new drugs to improve the treatment effect of the disease, and drugs with new targets/mechanisms of action are also being developed continuously.This article provides an overview of the recent progress in drug therapy research in this field.

Hip joint cysts are a type of cystic lesion involving the hip joint and its surrounding soft tissues,mainly caused by degenerative changes or abnormal synovium.In imaging examinations, MRI and ultrasound examinations are crucial for the diagnosis of cysts.The clinical manifestations of hip joint cysts mainly include pain, swelling and compression symptoms. The treatment strategy depends on the size of the cyst, the severity of the symptoms and the nature of the primary disease.Conservative treatment can be adopted for asymptomatic patients,while symptomatic patients may require puncture aspiration or surgical treatment.In surgical treatment,hip arthroscopy has gradually become the preferred treatment due to its minimally invasive and high-precision characteristics.