Biliary tract cancer is one of the digestive system malignances with very poor prognosis.Majority of patients belongs to the advanced stage when diagnosed.Currently,systemic chemotherapy is the standard first-line treatment option for advanced biliary tract cancer.However,the clinical efficacy is not satisfactory.A new era has been coming while the immunotherapy is introduced in the treatment of hepatobiliary cancers.Many clinical studies have been conducted in the treatment of biliary tract cancer with immune checkpoint inhibitor drugs,and the clinical efficacy and safety are acknowledged by the clinicians.Meanwhile,further studies should focus on how to treat biliary tract cancer with immunotherapy drugs more precisely.

晚期胃癌治疗选择有限，易发生化疗耐药。目前，包括免疫检查点抑制剂、过继细胞疗法、肿瘤疫苗、非特异免疫增强剂及细胞因子疗法在内的免疫疗法对胃癌显示出了良好的疗效。载体药物及3D打印技术也在临床前实验中取得了疗效。临床试验采用免疫肿瘤学单一疗法或联合免疫化学疗法来提高胃癌病人的总体生存时间和客观反应率。根据初步证据，我们相信免疫治疗可以积极影响自然病史，改善胃癌病人的预后。

Osteoporotic vertebral compression fractures is a common type of osteoporotic fractures,often occurring with minimal external force or even without obvious trauma.They manifest as pain,deformity,and functional impairment,significantly impacting patients’ quality of life.Following reduction of vertebral compression fractures,bone defects often occur and typically require bone grafting for repair.Surgical treatments primarily include percutaneous vertebral augmentation and open surgery.Cement augmentation,appropriate bone implantation,and anti-pullout internal fixation are crucial components of bone repair therapy.Different types of cement materials and novel vertebral augmentation techniques offer more options for vertebral fracture repair.This consensus incorporates epidemiological characteristics of osteoporotic vertebral compression fractures,referencing literature search results and expert survey opinions,to address common controversies regarding commonly used vertebral bone repair materials,strategies,and postoperative considerations in clinical practice.It is hoped that this consensus will improve treatment outcomes,enhance patient prognosis,and promote standardized clinical management of osteoporotic vertebral compression fracture repair.

Objective To explore the feasibility of improving the indwelling technique of drainage tube orifice after single-port thoracoscopic lung cancer surgery and analysis of drainage effect.Methods The clinical data of 80 patients who underwent single-port thoracoscopic radical resection of lung cancer who were admitted to Ningbo Huamei Hospital,University of Chinese Academy of Sciences from January to December 2021 were retrospectively analyzed,and they were divided into observation group and control group according to the different drainage tube indwelling techniques.Postoperative drainage tube indwelling time,postoperative hospital stay,postoperative total drainage volume,intraoperative blood loss,operative time,incision infection,postoperative pain score,and drainage port healing.Results The postoperative incision exudation,poor incision healing,incision infection,drainage tube indwelling time,and postoperative hospital stay in the observation group were better than those in the control group,and the differences were statistically significant(P<0.05).There were no significant differences in the total drainage volume,intraoperative blood loss,operation time,and secondary suture rate of the incision(P>0.05).Conclusion The single-port thoracoscopic surgery is beneficial to reduce the incidence of postoperative incision infection and incision exudation,shorten the indwelling time of the drainage tube,improve the safety of extubation,and shorten the hospitalization of patients.time.

Objective To investigate the regulatory effect of leucine-rich-alpha2-glycoprotein 1(LRG1) on the proliferation,migration and invasion of non-small cell lung cancer(NSCLC) cellsvia the Runt-related transcription factor 1(RUNX1)/osteopontin(OPN) axis. Methods To determin the expression of LRG1,RUNX1 and OPN in cultured human type II alveolar epithelial cells and human NSCLC cell lines A549,NCI-H838 and NCI-H1650.The human NSCLC cell line A549 cultured in vitro was randomly divided into control group,LRG1 knockdown group,negative control group,RUNX1 overexpression group,LRG1 knockdown + RUNX1 overexpression group by random number table method,after cells were grouped and transfected with plasmids,to detect the proliferation,apoptosis,migration,invasion,the expression of apoptosis proteins(Bcl-2,caspase-3,Bax) and epithelial-mesenchymal transition marker proteins(N-cadherin,E-cadherin),the expressions of LRG1,RUNX1 and OPN in A549 cells in each group.〖WTHZ〗Results Compared with human type II alveolar epithelial cells,the mRNA and protein expressions of LRG1,RUNX1 and OPN in human NSCLC cell lines A549,NCI-H838 and NCI-H1650 higher(P<0.05).Compared with the control group,the positive rate of EdU,the migration rate,the number of invasion,the mRNA and protein expressions of LRG1,RUNX1 and OPN,and the protein expression of Bcl-2 and N-cadherin in the LRG1 knockdown group were decreased(P<0.05),and the apoptosis rate and the protein expression of caspase-3,Bax,and E-cadherin were increased(P<0.05);The changes of various indicators in RUNX1 overexpression group were contrary to those in LRG1 knockdown group,and the overexpression of RUNX1 could reverse the effects of LRG1 knockdown on various indicators of cells.Conclusion Knockdown of LRG1 can inhibit the proliferation,migration and invasion of NSCLC cells and promote their apoptosis by down-regulating the expressions of RUNX1 and OPN.

Objective To evaluate the clinical efficacy and safety of a new spiral thermo-expandable prostate stent(Memokath 028,Pnn Medical) in the treatment of patients with benign prostatic hyperplasia with moderate to severe lower urinary tract symptoms.Methods Retrospective analysis was peformed on 50 patients with benign prostatic hyperplasia who underwent implantation of prostatic stent from October 2020 to June 2021 in the Shanghai Fourth People’s Hospital of Tongji University.The urodynamic parameters of patients before operation and 1,3,6 and 12 months after operation were collected,including International Prostate Symptom Score(IPSS),Quality of Life(QOL),and maximum urinary flow rate(Qmax),residual urine parameter values,and records such as perioperative and postoperative complications.Results The average operation time was 19.8 minutes,and the average VAS score at 10 minutes after surgery was 1.8±0.6 points.Spontaneous urination was restored after the operation,and all patients were discharged on the first day after the operation.In terms of postoperative complications,there were 7(14%) cases of postoperative hematuria,6(12%) cases of urination urgency,and 4(8%) cases of painful urination.Acute urinary tract infection(UTI) occurred in 5 patients(10%).The first follow-up was conducted at 1 months after the operation.The average IPSS,QOL score and PVR were 13.9±3.2 points,2.4±0.5 points,and （52.7±22.5）ml，respectively,which were significantly lower than those before the operation(P＜0.05).Qmax was （11.9±1.6）ml/s,which was significantly higher than that before surgery(P＜0.05).As time went on,the above indicators remain stable.Conclusion The new spiral thermo-expandable prostate stent is easy to operate.It is safe and feasible for the treatment of urinary tract obstruction in the prostate.The short-term clinical efficacy is definite,and the early complications are few.

Objective To observe the influencing factors of cerebrospinal fluid leakage after endoscopic transsphenoidal pituitary adenoma resection,and promote the early identification of high-risk patients with this complication. Methods Retrospective analysis was made on the clinical data of 176 patients with pituitary adenoma who underwent endoscopic transsphenoidal pituitary adenoma resection in Department of Neurosurgery,Second Affiliated Hospital of Nanjing Medical University from May 2019 to October 2022,and the cerebrospinal fluid leakage after operation was counted.Single factor analysis was used to screen the possible influencing factors of postoperative cerebrospinal fluid leakage,and logistic regression analysis was used to determine the independent risk factors. Results 12 of 176 patients with pituitary adenoma had cerebrospinal fluid leakage after operation,the incidence was 6.82% (12/176).Univariate analysis showed that tumor diameter,reoperation,intraoperative cerebrospinal fluid leakage,and intraoperative cerebrospinal fluid leakage classification were related to postoperative cerebrospinal fluid leakage (P＜0.05).Logistic regression analysis showed that tumor diameter (OR=3.843,95%CI=1.652～8.940),reoperation (OR=2.407,95%CI=1.094～5.298),intraoperative cerebrospinal fluid leakage (OR=4.552,95%CI=1.483～13.972),and intraoperative cerebrospinal fluid leakage classification (OR=3.516,95%CI=1.204～10.269) were independent risk factors for postoperative cerebrospinal fluid leakage (P＜0.05). Conclusion Tumor diameter,reoperation,intraoperative cerebrospinal fluid leakage,and intraoperative cerebrospinal fluid leakage classification are closely related to cerebrospinal fluid leakage after endoscopic transsphenoidal pituitary adenoma resection,we should pay close attention to the strategies of sellar floor reconstruction in the above patients,and strengthen the observation of the signs of cerebrospinal fluid leakage after surgery.

The erector spinae plane block(ESPB) technique proposed by Forero et al.has drawn increasing attention due to its reliable effects and fewer complications in simple and safe procedures.It has been successfully applied in anesthesia management during the perioperative period.This article mainly introduces the anatomical basis,possible mechanism of action,common operating methods,and clinical applications during the perioperative period of ESPB.Starting from the advantages,disadvantages,and complications of ESPB,it compares ESPB with other common thoracolumbar analgesic methods,providing better evidence support for the perioperative application and future development of ESPB.

Objective To review the experience approaching middle mediastinal mass by surgery.Method  Clinical data of 9 patients with middle mediastinal mass who were treated in between 2018 to 2022 in Tongji hospital were retrospectively analyzed.8 cases underwent radical resection and 1 case underwent mediastinal tumor biopsy.5 mediastinal tumors were operated by video-assisted thoracoscopic surgery(VATS),and 4 cases required conversion thoracotomy. Result Histologic diagnosis was mediastinal cysts in 2 cases,Castleman disease in 1 case,metastatic lymphadenopathy in 1 case,neurogenic tumors in 3 cases(Schwannoma in 1 case,Neurofibroma in 1 case,and Paraganglioma in 1 case),angiolipoma in 1 case and undifferentiated malignant tumors in 1 case.All recovered and were discharged from hospital.Conclusion Surgical resection is an important treatment for mediastinal tumors. Surgical treatment should not only pursue the thoroughness of excision, but also pay attention to organ protection.

Objective To retrospectively analyze the incidence and influencing factors of proximal femoral shortening after intertrochanteric fracture surgery. Methods The clinical data of 97 patients with intertrochanteric fracture treated from January 2017 to February 2020 were retrospectively analyzed.There were 31 cases with the dynamic hip screw(DHS),41 cases with the proximal femoral nail antirotation(PFNA),25 cases with Intertan.They were divided into normal group(59 cases) and PFS group(38 cases) according to the shortening of proximal femur after operation.The differences of age,gender,body mass index(BMI),bone mineral density,fracture type,internal fixation method,reduction quality,TAD value and complete weight-bearing time between the two groups were observed.Results In this group,the proportion of proximal femoral shortening was 38/97(39.18%).In PFS group,the shortening of femoral neck main screw was (5.43±1.72)mm,including 2 cases(2.06%) with internal fixation penetrating the femoral head and 5 cases(5.14%) with nonunion； The proportion of type Ⅲ and type Ⅳ fractures in the normal group was 40.68%,and that in the PFS group was 76.32%,the difference was statistically significant(P<0.05).The proportion of PFNA /Intertan was 76.27% in the normal group and 65.79% in the PFS group(P<0.05).There were 26 cases of positive reduction,18 cases of neutral support and 15 cases of negative support in the normal group,while there were 8 cases,13 cases and 17 cases in the PFS group,the difference was statistically significant(P<0.05).The complete weight-bearing time of normal group was (8.54±2.37)weeks,which was significantly later than that of PFS group(4.15±1.83)weeks(P<0.001).Conclusions  Internal fixation,reduction quality and complete weight-bearing time were important factors affecting the proximal femoral shortening after intertrochanteric fracture.

Objective  To investigate the characteristics of the three-dimensional gait changes of the knee joint after the single bundle anatomical reconstruction of autologous hamstring tendons after the rupture of the anterior cruciate ligament (ACL) of the knee. Methods  From August 2018 to June 2020，twenty five patients with ACL rupture of the lateral knee joint were selected as the injury group.During the operation,ACL rupture was confirmed by arthroscopy and the autologous hamstring tendon anatomical reconstruction was performed.Then 25 healthy people were selected as the control group.The three-dimensional gait data of normal knee joints were recorded with the three-dimensional motion capture system and compared with the injury group.In addition,the injury group was followed up before and after surgery and Lysholm knee joint function score was performed. Results  In the control group,the flexion and extension angle was - 2 °~66 °,the internal and external rotation angle was - 5 °~9 °,and the internal and external rotation angle was - 4 °~8 °.After ACL injury,the flexion and extension angle is - 5 °~52 °,the internal and external rotation angle is - 3 °~24 °,and the internal and external rotation angle is - 13 °~14 °.Three months after ACL autologous hamstring tendon reconstruction,the flexion and extension angle was - 2 °~47 °,the internal and external rotation angle was - 5 °~9 °,and the internal and external rotation angle was - 6 °~10 °.Six months after ACL reconstruction,the flexion and extension angle was - 2 °~59 °,the internal and external rotation angle was - 4 °~8 °,and the internal and external rotation angle was - 5 °~8 °.Nine months after ACL reconstruction,the flexion and extension angle was - 2 °~64 °,the internal and external rotation angle was - 2 °~9 °,and the internal and external rotation angle was - 2 °~8 °.12 months after ACL reconstruction,the flexion and extension angle was - 2 °~65 °,the internal and external rotation angle was - 1 °~9 °,and the internal and external rotation angle was - 1 °~8 °.After ACL rupture,the variation range of knee joint from flexion to extension,internal and external rotation,and internal and external turnover angle became larger than that of the control group,and there was significant difference in statistics(P<0.05).The angle range of each motion direction of knee joint after reconstruction was significantly improved compared with that before surgery（P＜0.05）,the difference at each time point after reconstruction was statistically significant compared with that before reconstruction(P<0.05).The gait at 9 and 12 months after reconstruction was significantly improved compared with that at 3 months after reconstruction (P<0.05).The Lysholm score increased from (62.35±3.45) before operation to (93.62±3.51) at 12 months after operation,and the difference was significant (P<0.05).  Conclusion  ACL reconstruction surgery has played a role in stabilizing the knee joint and improved the Lysholm knee joint function score,and with the passage of time after the operation,the Lysholm knee joint function score gradually improved,and basically returned to normal 9 months after the operation.

Objective  To analyze the current status,hot spots and future trends of nutrition related research in elderly fracture patients.Methods  Relevant literatures on nutrition in elderly patients with fracture in the core collection of web of science and CNKI were searched by computer from January 1,2013 to August 31,2023.and the search results were analyzed by using the software of CiteSpace,vision 6.2.R4.Results A total of 1 174 articles were included,including 366 Chinese articles and 808 English articles.In recent years,the number of literatures on nutrition related research of elderly fracture patients at home and abroad has shown an upward trend.The research hotspots abroad are hip fracture,bone mineral,vitamin D deficiency,bone mineral density,vitamin D,sarcopenia,proximal femur,population;Domestic research focuses on influencing factors,perioperative period,bone mineral density,nursing,osteoporosis,the elderly,tissue engineering,incision healing.Conclusion  Our country has certain advantages in the field of nutrition for elderly fracture patients,which can help researchers to understand the development trend,research hotspots and shortcomings of nutrition related to elderly fracture patients,and provide reference and guidance for future research.

In the terminal stage of the human wound repair process,it is often accompanied by scar formation.Hypertrophic scar and keloid may occur when the orderly repair process of the body is broken and the wound heals abnormally.The emergence of them not only brings physical and mental burden to patients,but also consumes a lot of medical resources.Clinically,scar is mainly treated by surgery,local radiation and drug injection,but there is still a little gap between its curative effect and expectation.Therefore,it is of great significance to explore new treatment methods.Existing studies have shown that exosomes  have a certain therapeutic effect on scar.This review will summarize the mechanism and recent research progress of exosome in the treatment of hypertrophic scar and keloid.