When the elderly patients with hip fracture receive surgical treatment,they often face a high risk of unfavorable prognosis due to the influence of multiple complications,which reduces their quality of life and also brings certain economic burden to the society.Therefore,minimally invasive treatment techniques for elderly hip fracture have been developing to improve the prognosis of elderly hip fracture patients.Based on the epidemiology of elderly hip fracture and the results of domestic and foreign literature review and expert investigation,this consensus summarizes the classification,surgical path and rehabilitation measures of elderly hip fracture,to provide a reasonable and standard treatment plan for minimally invasive surgical treatment of elderly hip fracture.

Pancreatic cancer is a highly malignant disease in the digestive system.So far,surgical resection is still the primary treatment for pancreatic cancer,but only about 20% of pancreatic cancer patients can be treated with surgery.Even with comprehensive treatment measures such as surgery,radiotherapy and chemotherapy,biological therapy,and targeted therapy,the overall survival rate of pancreatic cancer patients has not been significantly improved in the past ten years.In recent years,immunotherapy has made breakthroughs in tumor treatment.Cancer immunotherapy has now been recognized as the fourth pillar of cancer treatment alongside surgery,radiotherapy,and chemotherapy.There are also many studies in the treatment of pancreatic cancer,but the results are not satisfactory.This article reviews the current status and possible prospects of immunotherapy for pancreatic cancer.

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。

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 study the effects of nalbuphine on the proliferation,apoptosis and epithelial mesenchymal transformation (EMT) of colon cancer (CC) cells by regulating Hippo/YAP signaling pathway.Methods Human colon cancer cell line HCT-116 was cultured in vitro in this study,the activity of HCT-116 cells was first detected by CCK-8 method when the concentration of Nalbuphine was increased,according to the results,the appropriate concentration of Nalbuphine was selected.then,HCT-116 cells were grouped into ctrl group(No other processing is performed),low concentration nalbuphine group (0.10 mmol/L),high concentration nalbuphine group (0.15 mmol/L),and high concentration nalbuphine (0.15 mmol/L)+XMU-MP-1 group (3 μmol/mL Hippo/YAP signal pathway inhibitor).Then,the CCK-8 method was applied to detect the cell proliferation ability of each group;flow cytometry was applied to detect cell apoptosis in each group;Transwell test was applied to detect the ability of cell migration;Western blot was applied to detect the expression of phosphorylated-YAP (p-YAP),YAP,PCNA,BAX,and EMT-related protein E-cadherin,N-cadherin,Vimentin,Snail of cells in each group.Results The results show that compared with the ctrl group,the survival rate of HCT-116 cells,the number of cell migration,the expression of YAP and PCNA,N-cadherin,Vimentin,Snail proteins in the low concentration nalbuphine group and the high concentration nalbuphine group decreased,the cell apoptosis rate,the contents of p-YAP,BAX,and E-cadherin increased (P<0.05);compared with the high concentration nalbuphine group,the survival rate of HCT-116 cells,the number of cell migration,the expression of YAP and PCNA,N-cadherin,Vimentin,Snail proteins in the high concentration nalbuphine+XMU-MP-1 group increased,the cell apoptosis rate,the contents of p-YAP,BAX,and E-cadherin decreased (P<0.05).Conclusion It is concluded that Nalbuphine may inhibit the proliferation of CC cells,promote cell apoptosis,and affect the epithelial mesenchymal transformation by activating Hippo/YAP signaling pathway.

Objective To explore the clinical practice of best evidence-based practice program for nasogastric tube insertion and evaluate its application.
Methods By referencing to Australia JBI model for evidence-based healthcare, we retrieved and summarized the best evidence for preoperative insertion of nasogastric tube, judged the position of nasogastric tube and alleviated the discomfort caused by the nasogastric tube insertion.Then we formed inspection indicators, maded baseline inspections before application of the best evidence on 29 medical staffs and 50 patients who met the inclusion criteria in department of hepatobiliary surgery, took transformative measures to boost application of the best evidence, and made post-application inspections to evlaute the effect.
Results After the application of the best evidence, the routine operation process of gastric tube insertion was improved; the awareness rate of audit indicators in medical staffs, audit indicators implementation rate, and the correct rate of gastric tube implantation were significantly improved (P<0.05 for all).
Conclusion The summarization and application of the best evidence for preoperative nasogastric tube insertion can improve medical staffs' operation level of nasogastric tube insertion,standardize the operation behaviors,reduce the patients' discomfort caused by the nasogastric tube insertion and improve their satisfaction.

Objective To explore the impact of clinical treatment decisions on the long-term survival of different molecular subtypes of locally advanced breast cancer(LABC),and to promote the development of more effective and individualized treatment regimens for LABC.Methods The cases of LABC diagnosed by pathology from 2010 to 2015 were searched in the database.Breast cancer-specific survival (BCSS) and overall survival (OS) were estimated by plotting Kaplan-Meier curves.The log rank test (Mantel-Cox) was used to analyze the difference between the groups,and the benefit population of LABC was determined after for age,TNM stage,grade,treatment methods.Results The 5-year OS and BCSS were 77.43% and 84.34% in breast-conserving,and 68.03% and 76.90% in mastectomy,respectively.The 5-year OS and BCSS of Luminal A LABC were 79.91% and 87.23% in breast-conserving,and 71.78% and 81.16% in mastectomy,respectively.The 5-year OS and BCSS of Luminal B LABC were 79.30% and 83.14% in breast-conserving,and were 70.37% and 76.92% in mastectomy,respectively.The 5-year OS and BCSS of triple-negative LABC were 60.77% and 68.13% in breast-conserving,and those of mastectomy were 47.13% and 55.94%,respectively.The 5-year OS and BCSS of HER2 positive were 75.42%,82.05% in breast-conserving,and were 67.05% and 75.01% in mastectomy,respectively;The 5-year OS and BCSS of triple-positive LABC were 86.12% and 91.63% in breast-conserving,and 74.54% and 82.56% in mastectomy,respectively.The 5-year OS and BCSS of well differentiated and N0 triple-positive LABC patients with chemotherapy were 88.24% and 76.91%,and those of patients without chmotherapy were 88.24% and 90.91%,respectively (BCSS:P=0.812;OS:P=0.311).Conclusion In the selective population,OS and BCSS of patients with LABC undergoing breast conserving surgery were significantly better than those of mastectomy.When OS and BCSS were compared for different molecular types and stages of LABC, breast-conserving surgery was still superior to total mastectomy.LABC could be considered for highly differentiated,N0 stage Triple positive without chemotherapy.

Articular cartilage is a major tissue distributed at the joint surface;it plays a role in loadbearing and lubricating.The articular cartilage of the joints in the extremities mainly consists of hyaline cartilage composed of collagen II.Fibrocartilage formation is easily observed when the cartilage is injured or degenerated,which has abundant type I collagen.In this study,a new viewpoint and concept,focusing on the modification of fibrocartilage in situ approach and regeneration of hyaline cartilage,namely “fibrocartilage hyalinization”,was proposed as a practical clinical strategy.We conducted preliminary discussions and prospects on the feasibility and potential mechanisms of fibrocartilage hyalinization.It is hoped that the strategy will be helpful to the development and clinical transformation of cartilage regeneration research.

Unlike the majority of other tissues,cartilage is low in cellularity and basically avascular in nature,therefore,chondral lesions due to injury commonly result in the development of osteoarthritis,eventually leading to progressive total joint destruction.Current clinical treatment strategies for cartilage defects include microfracture,osteochondral autografts and allografts.Although they are often used clinically,significant drawbacks and limitations still exist.To solve these problems,cartilage tissue engineering has been recommended to promote more effective treatments.In this review,we discuss current clinical approaches for repairing cartilage,as well as cartilage tissue engineering approaches which are currently developing.We also describe potential future directions in cartilage regeneration.

Objective To investigate the compliance status of ankle pump movement (APM) in high-risk patients with deep venous thrombosis (DVT) of the lower limbs and analysis the related influencing factors.Methods From January 2019 to March 2023,a total of 302 patients with high-risk lower limb DVT who admitted to our hospital were selected as the research objects.The APM compliance scale,clinical data sheet,visual analog scale (VAS),family support scale,self-efficacy scale,self-rating anxiety scale,and self-rating depression scale were used to evaluate the research subjects,and the evaluation results were analyzed.Results Among the 302 patients with high-risk DVT,171 patients had APM compliance,with a compliance rate of 56.62%.The results of univariate analysis showed that there were statistically significant differences in APM compliance among patients of different age groups,gender,education level,marital status,family economic income,work status,family support,medical insurance type,place of residence,reason for hospitalization,comorbidities,pain level,APM prescription time,self-efficacy,and psychological status (all P<0.05).The results of multivariate Logistic analysis showed that comorbidities (≥2 types),pain (moderate and above),and prescription time (≥ 7 d) were risk factors for APM compliance in DVT high-risk patients (all P<0.05),while education level (college or above),family support (moderate and above),and self-efficacy (moderate and above) were protective factors for APM compliance (all P<0.05).Conclusion The comorbidities,degree of pain,APM prescription time,educational level,family support,and patient self-efficacy can affect ankle pump compliance in high-risk patients with lower limb deep vein thrombosis,and should be given attention and targeted intervention.

Objective To explore the effect of fluorescence laparoscopy on the recognition of gallbladder triangle during cholecystectomy and its clinical application.
Methods A retrospective analysis of 130 cases of laparoscopic cholecystectomy(LC) was performed.The patients were divided into two groups:Group A(87 cases) and Group B(43 cases),the intraoperative and postoperative complications of the two groups were statistically analyzed.
Results All 130 patients underwent laparoscopic cholecystectomy without conversion to open surgery.In Group A,the operation time(69.75±25.64) Min,intraoperative blood loss(4.40±4.02)ml,hospital stay(4.49±1.01)D,extubation time(3.15±0.83)D,there were 5 patients with postoperative complications.The operation time(72.33±29.14) Min,intraoperative bleeding(4.19±2.83)ML,hospital stay(4.42±0.88) D and extubation time(3.09±0.72) D in Group B,no postoperative complications were found.There was no significant difference between the two groups(P>0.05)，there were no drug allergy and other drug-related complications during indocyanine green angiography.
Conclusion The application of Indocyanine Green(ICG) in laparoscopic cholecystectomy is helpful to judge the anatomy of biliary tract and has no effect on the operation time and postoperative complications,which increased the safety of surgery.

Objective：To summarize the clinical experience of laparoscopic transabdominal preperitoneal hernia repair(TAPP).
Methods：Retrospective analysis was made on the clinical data of 102 inpatients with inguinal hernia who underwent laparoscopic transabdominal preperitoneal hernia repair(TAPP) in the first ward of general Surgery department,the First Affiliated Hospital of Baotou Medical College from November 2016 to November 2019.
Results：All the 102 cases of TAPP were successfully completed without transferring to open surgery.The operative time was(46.87±4.94)min,the intraoperative blood loss was(5.4±1.64)ml,and the postoperative hospital stay was(4.18±1.09)d.Postoperative analgesics were used in 18 patients(17.65%),with pain score(0.93±1.53) and abdominal incision satisfaction score(4.58±0.62).Postoperative followup(6～42 months) showed good recovery and no recurrence.8 cases of postoperative inguinal seroma,accounting for 7.8%,were relieved after treatment.There were no longterm chronic pain,mesh infection,incision infection,intestinal obstruction and other serious complications.TAPP puncture site has small scar,high incision satisfaction,low postoperative pain,and short postoperative hospital stay.Conclusion：Laparoscopic transabdominal preperitoneal hernia repair(TAPP) in the treatment of inguinal hernia is minimally invasive,safe and effective,without obvious scar and other characteristics,is one of the reliable clinical treatment options for inguinal hernia.

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.

The complex anatomy of the distal radioulnar joint is the basis for its forearm rotation function and power transmission.It is important to research the anatomical structure and biomechanical mechanism of the distal radioulnar joint to understand the mechanism of the instability of the distal radioulnar joint.The instability of the distal radioulnar joint can be divided into primary instability，post-traumatic or postoperative instability.The combination of medical history，physical examination and imaging findings on the classification of instability of the distal radioulnar joint is helpful for the diagnosis and treatment of the disease.The treatments for the instability of the distal radioulnar joint are conservative treatment and surgical treatment.

Objective  To evaluate the outcome of the one-stage and two-stage implant-based breast reconstruction(IBBR) in terms of postoperative complications and patient satisfaction.
Methods  Clinical datawere retrospectively collected for patients who underwent one-stage and two-stage IBBR from 2013 to 2017.Postoperative complications,reoperations and patients' satisfaction were compared between the two groups.
Results  Biological patch resulted an increased risk of poor healing wound(OR:4.40,95%CI:1.27-15.29,P=0.02) and seroma(OR:9.30,95%CI:1.60-53.93,P=0.01).Radiotherapy resulted an increased risk of capsular contracture(OR:0.12,95%CI:0.03-0.49,P=0.003).The above complications appeared to be independent of operation mode.Two-stage IBBR only had more satisfactory aesthetic outcomes compared to one-stage IBBR(P<0.001),with no difference in complications and reoperations.
Conclusion  Both one-stage and two-stage IBBR could satisfy tumor safety and cosmetic effect.We recommend that the choice of techniquesshould be considered on a case-by-case basis.

Objective：The pathogenic bacteria and drug resistance of postoperative intracranial infection patients in the department of neurosurgery of our hospital were statistically analyzed,in order to understand the distribution of intracranial infection strains and drug tolerance.Method：A total of 156 patients with postoperative intracranial infection were selected from the Department of neurosurgery in our hospital from 2013.1.1 to 2018.12.31,and the samples of cerebrospinal fluid were collected from the patients.The distribution and drug resistance of the patients in the cerebrospinal fluid culture examination and culture were statistically analyzed.Result：A total of 147 pathogens were cultured in 156 postoperative intracranial infection;62 strains of grampositive bacteria(42.2%),the main strains include staphylococcus aureus,staphylococcus epidermidis,coagulasenegative staphylococcus;84 strains of gramnegative bacteria(57.1%),the main strains include acinetobacter baumannii,pseudomonas aeruginosa,klebsiella pneumonia,enterobacter cloacae;1 strain of fungi(0.68%).The lower resistance rates among grampositive bacteria were piperacillin/tazobactam,linezolid,The drug resistance rate of vancomycin and tigecycline was 0.The rate of drug resistance is generally high in gramnegative,acinetobacter baumannii is resistant to most antibiotics,the resistance rate to polymyxin was 0.〖WTHZ〗Conclusion：Gramnegative bacteria of postoperative intracranial infection accounted for a larger proportion of grampositive bacteria,and the drug resistance rate in gramnegative bacteria is generally higher.Currently,piperacillin/tazobactam,linezolid or vancomycin is still effective against grampositive bacteria.Gramnegative bacteria are resistant to most antibiotics.polymyxin are still highly sensitive to it.

Congenital chylous ascites is a rare disease in infants and young children,which is characterized with milky white ascites,but as a result of the relevant reports and study is less,and the lack of standardized diagnosis and treatment standards,clinical practitioners don't understand it deeply,and children can't get timely and effective treatment,which not only cause the prolonged course of the disease,but also bring great worries and troubles to parents and children.In severe cases,the children can die.In this paper,combined with the existing literature,the pathogenesis,clinical manifestations,diagnostic examination and treatment of congenital chylous ascites are systematically summarized,so as to provide clinicians with a perfect basis for the treatment of congenital chylous ascites,and provide suggestions for refractory chylous ascites,amd promote the early recovery of children.