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 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 research the MRI examination and diagnostic value of intervertebral space infection after nucleus pulposus extraction in patients with lumbar disc herniation.Methods:86 cases of intervertebral space infection after lumbar disc herniation in our hospital were selected as the research objects.All patients were given MRI examination，and gave positive treatment after diagnosis.Analyzed the MRI diagnostic results，and observed the changes of WBC count，ESR and C reactive protein levels before and after treatment.Result:The location of infection in 86 cases of intervertebral disc infection was mostly located in L4～L5 or L5～S1 intervertebral space.The intervertebral disc showed varying degrees of intervertebral disc fragmentation，smaller，disappeared，and uneven edge.MRI examination showed that the intervertebral disc space of lesion lost normal shape and signal，a 77 cases with long and low T1 signal，9 cases with equal T1 signal，82 cases with long and high T2 signal，4 cases with short and short T2 signal.The lesions in 86 cases of intervertebral disc infection showed different degrees of damage to the vertebral endplate and the adjacent vertebral spongy bone around the intervertebral disc.The surrounding part of adjacent vertebral bodies had abnormal signal appears（75 cases），the whole vertebral body signal was abnormal（11 cases）.Most of them were characterized by long T1 signal and long T2 signal，while a few of the lesions showed mixed signals dominated T2 signal.The soft tissue adjacent to the vertebral body showed swelling and thickening，and T1 showed equal signal，slightly higher signal or mixed signal，and T2 showed high signal.MRI enhanced scan was performed in 21 cases，the pathological changes of intervertebral disc，adjacent vertebral body and paravertebral soft tissue were obviously enhanced.After 6 months of followup，A total of 63 patients with complete disappearance of clinical symptoms，accounting for 73.26%.All the patients had significantly lower WBC counts，ESR and C reactive protein levels than before treatment（P<0.05）.Conclusion:In the diagnosis of lumbar disc herniation discectomy intervertebral space infection after MRI，check to fully display the lesion site of infection，it is important for early diagnosis and treatment of intervertebral space infection.

 

Objective To compare the therapeutic effect of silver ion antibacterial dressing and povidone iodine gauze on the incision and drainage of the abscess.
Methods From March 2019 to November 2019,62 patients were included in this study,and divided randomly into the observation group and the control group with 31 cases in each group.The patients in the observation group were treated with silver ion antibacterial dressing,while the patients in the control group were treated with povidone iodine gauze.The patients in the two groups were recorded in detail.The infection control time of abscess incision was compared before treatment,the third day and the second week after the first treatment,the number of dressing changes and wound healing time of the two groups,and the clinical effect of the patients was evaluated.
Results .The time of wound control in the observation group was (13.9±1.81)d,shorter than that in the control group (23.4±2.32)d(P<0.05);the BWATBWAT(Bates-Jensen Wound  assessment tool，BWAT) score of the observation group in the second week after the first treatment was (14.98±1.51),lower than that in the control group (19.78±2.46)(P<0.05);the times of drug change and wound healing in the Observation group were significantly shorter than that in the control group(P<0.05).
Conclusion Compared with the traditional povidone iodine gauze,the silver ion antibacterial dressing can control the wound infection and improve the wound healing more quickly,and the dressing change times are less,the wound healing time is obviously shortened.

As the incidence of thyroid disease continues to rise，the need for surgical treatment is increasing.Total thyroidectomy and central lymph node dissection are important methods for clinical treatment of thyroid cancer.However，the incidence of postoperative complications of hypoparathyroidism and hypocalcemia is still relatively high.The main reason for the complications is the inaccurate identification of the parathyroid glands during the surgical procedure.In recent years，many scholars at home and abroad have reported a variety of new parathyroid gland recognition techniques during surgery，and this article reviews and analyzes these technological advances.

Thymic malignancies are relatively incident solid tumors.And Lymph node metastasis in thymic malignancies used to be considered a rare phenomenon.Recently，increasing studies have shown that the lymph node metastasis in thymic malignancies is much more common than previously recognized.Yet，impact of lymph node metastasis in thymic tumor on prognosis and the strategy for surgical dissection of lymph nodes in thymic tumors need to be further explored.This paper focus on pattern of nodal involvement，its prognosis impact，and lymph node dissection in thymic malignancies.

Pancreatic cancer has always been called the “king of cancer” due to its extremely high mortality.In recent years,the global incidence rate of pancreatic cancer has risen rapidly.Furthermore,pancreatic cancer is lack of effective therapeutic strategies and has seriously harmed human health.With the rapid development of precision therapy,targeted therapy for pancreatic cancer has also progressed rapidly.Although targeted therapy for pancreatic cancer has improved the prognosis of only a few patients,it has brought light to pancreatic cancer.This article reviews the research progress of therapeutic targets and related drugs for pancreatic cancer.

Objective:To study the feasibility and safety analysis of intercostal brachial nerve preservation in modified radical mastectomy for breast cancer.Methods:The data of sixty patients with modified radical mastectomy were retrospectively analyzed.Thirtyfour patients who underwent intraoperative intercostobrachial nerve preservation were set as the study group.Twentysix patients who did not had intercostal brachial nerve preservation during the operation were set as the control group.The situation of operation and hospitalization，the quantitative score of sensory dysfunctions，the location of postoperative sensory changes，quality of life score（QOL），complications and recurrence rate of one year followup for cancer patients were compared between the two groups.Results:The operation time of the experimental group（110.45±27.53）min，intraoperative blood loss（115.76±23.13）ml，lymph node dissection（12.65±2.77）and control group was（102.37±26.15）min，（108.55±21.49）ml and （11.78±2.52），respectively（P>0.05）.The length of hospital stays in the experimental group[（7.49±1.32）d] was significantly lower than that in the control group[（8.42±1.45）d]（P<0.05）.The quantitative scores of sensory dysfunctions in the experimental group at 1 month，3 months，and 6 months were（2.04±0.71），（2.87±0.84），and（3.25±1.06），respectively，which were significantly higher than those in the control group[（1.63±0.54），（2.12±0.72） and （2.56±0.93），respectively]（P<0.05）.The sensory change rates of the axilla，anterior，posterior，medial and lateral sides of the experimental group were 14.71%，5.88%，11.76%，8.82%，and 2.94%，respectively，which were significantly lower than those of the control group[34.62%，26.92%，23.08%，30.77%，15.38%]（P<0.05）.The total score of QOL in the experimental group（41.35±6.84）was significantly higher than that in the control group（32.45±5.67）（P<0.05）.The incidence of complications in the experimental group was 14.71%，which was not significantly different from the complication rate in the control group（11.54%）（P>0.05）.The recurrence rate of the experimental group was 8.82% with one year，and the recurrence rate of the control group was 7.69%.The difference was not statistically significant（P>0.05）.Conclusion:Retaining the intercostal brachial nerve during modified radical mastectomy for breast cancer can effectively improve postoperative sensory function，and has no significant effect on the surgical outcome and complications.It has high feasibility and safety，and can be based on the degree of tumor progression to flexible use.

Congenital breast anomalies mainly include polythelia，nipples inversion，accessory breasts，gynecomastia，hypertrophic abnormalities of the breast，tubular breasts，Poland syndrome and other breast deficiencies，dysplasia and displacement.Breast dysplasia may exist alone，but sometimes it coexists with other congenital syndromes，especially tending to affect the urinary system and limb girdles.Breast，as the second sex characteristic of women，is an important manifestation of female beauty.However，congenital breast deformity not only brings  psychological burden to patients，but causes a series of complications，which seriously threaten the physical and mental health of patients.

Objective To explored the operation opportunity，operation skill and therapeutic effect of emergency pancreaticoduodenectomy for severe pancreaticoduodenal trauma.Methods Seven patients with severe pancreaticoduodenal trauma underwent emergency pancreatoduodenectomy，one with liver rupture repair and right hemicolectomy，and one with left  kidney and splenectomy resection.Results All the operations were successfully completed.Two patients had bile leakage after operation，recovered after the conservative treatment.No evere intraabdominal infection，pancreaticointestinal anastomotic leakage，postoperative bleeding and other complications occurred.There were no reoperations and postoperative death occurred.All patients returned to normal diet and discharged from hospital.Conclusions Emergency pancreatoduodenectomy can be considered as an effective treatment for patients with severe pancreaticoduodenal trauma which can not be cured by other methods.

At present,the most direct method for preoperative diagnosis of thyroid cancer is ultrasound-guided fine needle biopsy,but it cannot achieve high accuracy.There are many molecular markers in the thyroid,such as BRAF gene,RAS gene,thyroglobulin,thyroid antibody,etc.This article reviewed some studies and found that some common gene mutations or changes in the level of circulating markers are related to the judgment of benign and malignant thyroid nodules,the aggressiveness of thyroid cancer,and even the prognosis,recurrence,or metastasis of thyroid cancer after surgery.We will analyze some common molecular markers in differentiated thyroid cancer,including genetic markers and circulating markers,analyze their value and significance in the diagnosis of disease,and discuss whether these molecular markers can provide different diagnostic methods for patients with thyroid nodule.

Objective To investigate the efficacy and safety of negative pressure suction sheath lithotriptic for incarcerated ureteral calculi. Methods Ninety-eight patients with ureteral embedded stones admitted to our hospital were selected for the study.They were divided into 2 groups according to the differences in surgical methods.Forty-five patients in the study group were treated with negative pressure suction sheath ureteral lithotripsy,while 53 patients in the control group were treated with conventional ureteroscopic lithotripsy,comparing the clinical efficacy and other differences between the two groups.Results The operation time and renal pelvis pressure in the study group were lower than those in the control group,and the stone clearance rate was higher than that in the control group(P<0.05).There was no difference in the relevant test indexes between the two groups before surgery(P>0.05),while the relevant test indexes in the study group improved significantly after surgery than those in the control group(P<0.05).Postoperative day 1,the complication rate of patients in the study group was significantly lower than that of the control group(P<0.05).After surgery,the prognosis of patients in the study group was significantly better than that of patients in the control group(P<0.05).Conclusion The efficacy of negative pressure suction sheath ureterolithotripsy in patients with incarcerated decrease the occurrence of postsurgical complications,which not only significantly improves the stone removal rate,but also reduces the inflammatory response of patients to surgery and ultimately improves their prognosis.

Objective To investigate the differential effects of the optimization of anesthesia protocols on intestinal barrier function,oxidative stress,and inflammatory response in patients with intestinal obstruction.Methods Ninety-three patients receiving intestinal obstruction surgery in our hospital from January 2019 to January 2022 were enrolled,and classified into two groups according to different anesthesia methods.Control group(n=53) received routine general anesthesia,while experimental group(n=40) received  general anesthesia combined with transverse abdominal plane(TAP) + rectus sheath block block.Then comparison was conducted on intestinal barrier function [diamine oxidase(DAO) activity and endotoxin(ETX)],oxidative stress [catalase(CAT) and epinephrine],inflammatory response [tumor necrosis factor-α(TNF-α) and interleukin6(IL-6)],along with the postoperative time of first anal exhaust,defecation and out-of-bed activity.Results Compared with control group,experimental group had lower intraoperative sufentanil consumption,and shorter postoperative time of first anal exhaust and defecation(all P<0.05).Compared with baseline data,an increase in DAO activity,ETX,TNF-α,IL-6 and epinephrine levels along with a decrease in CAT were observed in both groups at postoperative 1 d and 3 d(all P<0.05).Compared with control group,experimental group had higher DAO activity,ETX,TNF-α,IL-6 and epinephrine levels,and lower CAT levels at postoperative 1 d and 3 d,with statistical difference(all P<0.05).Conclusion Compared with other anesthesia protocol,general anaesthesia combined with TAP + rectus sheath block is more effective for patients receiving intestinal obstruction surgery,which cause less impact on intestinal barrier function and oxidative stress,and can attenuate the inflammatory response.

Objective To investigate the clinical value of watershed analysis to anatomical sublobectomy in the treatment of early peripheral Non-Small-Cell Lung Carcinoma(NSCLC) characterized by Ground Glass Nodules(GGN) through fluorescence thoracoscopy. Method A total of 81 cases of early peripheral GGN-like non-small-cell lung carcinoma treated by thoracic surgery in our hospital from September 2021 to September 2022 were retrospectively studied.According to the different methods of fluorescence thoracoscopic surgery,the patients were divided into two groups.The group of anatomical sublobectomy with the watershed analysis(hereinafter,referred to as the watershed group) including 42 cases,and the anatomical pulmonary segmental resection group(hereinafter,referred to as the pulmonary segmental resection group) including 39 cases.The general surgical data,perioperative indexes and postoperative complications were compared between the two groups. Results The operations of the patients were successfully completed for both groups,without any perioperative death.For the watershed group,there were no cases that switched to thoracotomy or changed the operation style,and no cases of incision or missed incision were observed.For the pulmonary segmental resection group,there were 2 cases that changed the operation style.The surgical margin distance of the watershed group[(26.24±3.87)mm] was slightly smaller than that of the pulmonary segmental resection group[(26.62±3.32)mm].But the difference was not statistically significant(P>0.05).The amount of blood loss[32.14(20.00,50.00)ml vs 85.38(30,100)ml],operative time[(146.76±41.51)min vs (184.944±50.42)min] and postoperative drainage time[2.43(2.00,3.00)d vs 4.05(3.00,5.00)d] of the watershed group were lower than those of the pulmonary segmental resection group.And the differences were statistically significant(P<0.05).The complication rate of the watershed group(11.91%) was lower than that of the pulmonary segmental resection group(30.77%).And the difference was statistically significant(P<0.05).Totally,25 patients(64.12%) in the pulmonary segmental resection group underwent the preoperative puncture localization,but none in the watershed group.For both groups,there was no tumor recurrence during the follow-up.Conclusion The application of watershed analysis to anatomical sublobectomy in the treatment of early peripheral NSCLC by fluorescent thoracoscopy can simplify the surgical procedure,accurately remove the lesion,and ensure the curative effect of oncology.The clinical practices have proved that the approach is scientifically reasonable,safe and feasible.

Objective To construct a prediction model of postoperative poor anastomotic healing in colorectal patients based on LASSO variable selection,and analyze the prediction efficiency of this model for anastomotic prognosis.Methods 215 patients with colorectal cancer who were treated in our hospital from March 2018 to January 2023 were prospectively included as the research object.All patients underwent laparoscopic radical resection of colorectal cancer,and all patients were followed up for 30 days after operation.They were divided into the poor healing group(24 cases) and the good healing group(191 cases) according to whether there was anastomotic malunion.The general data and clinical data of all patients were collected,and the characteristic factors with non-zero coefficient were screened by using LASSO regression model.Lasso-Logistics regression model was constructed to analyze the related factors leading to poor anastomosis healing,and the receiver operating characteristic curve (ROC) was drawn to calculate the area under receiver operating characteristic curve curve (AUC),sensitivity and specificity.Bootdtrap method was used to carry out 500 repeated sampling for verification.Results The number of male cases in poor healing group was significantly higher than that in good healing group.The levels of white blood cell WBC and C-reactive protein CRP in poor healing group were higher than those in good healing group (P<0.05).The operation time in the group with poor healing was longer than that in the group with good healing,the tumor diameter was more than 4cm,the distance between the lower edge of the tumor and the perianal region was less than ≤7cm,there were neoadjuvant chemotherapy before operation,and the number of patients with Ⅲ - Ⅳ was significantly higher than that in the group with good healing (P<0.05).Logistics regression screen showed that the operation time,preoperative neoadjuvant chemotherapy,the distance between the lower margin of tumor and perianal region and the growth of peripheral tumor were the predictive factors of poor anastomosis healing.According to Logistics regression,the ROC curve was drawn,and the AUC was 0.892 (95% CI:0.813 ~ 0.945),the sensitivity was 75.81%,and the specificity was 89.47%.Youden index is 0.6528;Using Bootdtrap technology to draw the calibration curve of the model shows that the model has good prediction efficiency.Conclusion Long operation time,preoperative neoadjuvant chemotherapy,the distance between the lower edge of tumor and perianal region < 7cm,and the growth of peripheral tumor are the risk factors for postoperative patients with colorectal cancer with poor anastomotic healing.The prediction model can be used to screen people with poor anastomotic healing and has good prediction efficiency.

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.

Objective To evaluate the significance and reasonability of select in various types of circumcision in children of different ages.
Methods A retrospective analysis was performed for 1 440 children of different ages(3-15 years) between Jan 2019 and Sep 2019 in urological ward and ambulatory surgery area of our hospital.280 were preschool children,620 were school-age children,240 were adolescent children.In different ages,divide them into 4 groups by different types of circumcision：traditional circumcision group,circumcision group with ligation device,circumcision group with anastomoses device,circumcision group with stitching instrument.The indications such as blood loss、operating time、  pain duration、 shedding time、 short-term complication and long-term complication were compared.
Result Among the 4 surgical procedures,preschoolers had the shortest pain duration,shedding time and fewer short-term complication.School-age children had the lowest operative time and blood loss by circumcision with ligation device.Adolescent children had lower operative time,blood loss and the fewer long-term complication by circumcision with stitching instrument.
Conclusion With the development of circumcision apparatus,different surgical methods should be adopted for children's  circumcision in combination with different age.Traditional circumcision should be recommended for preschoolers,circumcision with ligation device for school-age children,circumcision with stitching instrument for adolescent children.

Objective   To compare the efficacy of three different surgical methods in the treatment of common bile duct stones after cholecystectomy:open common bile duct exploration (OCBDE),endoscopic retrograde cholangiopancreatography and papillary sphincterotomy (ERCP/EST),and laparoscopic common bile duct exploration (LCBDE). Methods   The clinical data of 109 cases of recurrent choledocholithiasis after cholecystectomy treated in our hospital from July 2016 to July 2020 were analyzed retrospectively.Among them,33 cases were ERCP,40 cases were OCBDE group,and 36 cases were LCBDE.The influence of confounding factors among the groups was balanced by the tendentious score matching method (PSM),and the clinical efficacy and complications of the three groups after matching were compared.  Results   28 patients were included in each group by PSM method,and the baseline data of the three groups were not statistically significant(P>0.05).No statistical difference was found in the success rate of operation and stone clearance rate among three groups (P>0.05).The specific amount of bleeding,specific duration of operation,specific duration of anal exhaust and specific duration of hospitalization after operation in ERCP group were lower/shorter than those in OCBSE group and LCBDE group,with obvious difference (P<0.05),while the specific amount of bleeding,specific duration of operation,specific duration of anal exhaust and specific duration of hospitalization after operation in LCBDE group were lower/shorter than those in OCBSE group,with obvious difference (P<0.05).The incidence rate of perioperative complications of ERCP group showed no obvious difference with that of other 2 groups (P>0.05),while the incidence rate of postoperative complications in LCBDE group was lower than that in OCBDE group,with statistical difference (P<0.05).Postoperative follow-up showed that the recurrence rate of common bile duct stones in ERCP group was higher than OCBDE and LCBDE groups,with statistical difference (P<0.05),while the recurrence rate yielded no statistical difference between OCBDE group and LCBDE group (P>0.05). Conclusion   ERCP,OCBDE and LCBDE can effectively remove common bile duct stones after gallbladder surgery.ERCP surgery is less traumatic,but it is prone to severe complications such as acute pancreatitis and hyperamylasemia after surgery,and the residual rate of stones after surgery is high.LCBDE has the advantage of micro-invasive surgery than OCBDE,but it is not suitable for patients with severe abdominal adhesion.It is recommended that the operator select an appropriate surgical method according to the specific situation of the patient.

Objective To compare the curative effect of postoperative sphincter fistula ligation and incision and suture for postoperative pain，anal function and wound healing time of sphincter anal fistula.Methods The date of 124 patients with sphincter anal fistula were retrospectively analyzed.Among them，60 patients who underwent sphincter fistula ligation were set as the study group，and 64 patients who underwent incision and suture were set as the control group.Anal incontinence score，anal function，postoperative pain，wound healing time and clinical efficacy were compared between two groups.Results The total score of anal incontinence in the control group（8.68±1.65）was significantly higher than that（7.03±1.46）in the study group，and the difference was statistically significant（P<0.05）.The total anal function score of the control group（6.71±0.93）was significantly lower than the total anal function score of the experimental group（8.04±1.11），and the difference was statistically significant（P<0.05）.The postoperative pain score of the control group（6.22±1.24）was significantly higher than that of the experimental group（3.52±1.06），the difference was statistically significant（P<0.05）.The wound healing time of the control groupand the test There was no significant difference in the wound healing time（5.78±1.43）between control group [（5.31±1.32）d]  and study group[（5.78±1.43）d](P>0.05）.The total effective rate of the control group was 95.31%，which was not significantly different from the total clinical effective rate of the experimental group（88.33%）（P>0.05）.Conclusion Ligation of sphincter fistula can significantly alleviate postoperative pain in patients with sphincter anal fistula and promote the improvement of anal function.There is no significant difference between clinical efficacy and incision and suture.It can flexible used as an ideal procedure for anal fistula in clinical practice.

Objective Reported and analyzed a case of “Spinal cord hypertension syndrome” in percutaneous intervertebral endoscopic surgery,with a view to early diagnosis and early treatment of this complication in future surgery.
Methods Retrospectively analyze the clinical data of a patient with lumbar disc herniation during the operation in the first hospital of Wuhan City in December 2019.
Results The main clinical manifestations of “Spinal cord hypertension syndrome” are sudden and severe pain in the head and neck,chest tightness,and tinnitus.Signs of sexual numbness,abdominal distension,increased intracranial pressure,or a sudden rise in blood pressure and increased heart rate.The patient in this case improved after active treatment such as lowering perfusion pressure and oxygen sedation.
Conclusion “Spinal cord hypertension syndrome” focuses on prevention,advocates early identification and discovery,and should be promptly and appropriately dealt with after the occurrence.

Objective  Through retrospective analysis of the case data of infusion port implantation by various approaches,tried to find out the best approach for infusion port implantation. Methods  104 patients who underwent infusion port implantation from January 2019 to December 2021 in our department were retrospectively analyzed.Including internal jugular vein approach in 55 cases (group A),subclavian vein approach in 49 cases (group B),compared the differences in operative time,puncture time,catheter length,intraoperative and postoperative complications.Results  Compared with group B,the puncture time of the group A was shorter[(8.84±3.10)min vs. (11.22±3.86)min],,less bleeding[(12.64±5.63)ml vs (15.71±7.07)ml],the incidence of catheters heterotopia was low(0 vs 8.16%,all P＜0.05).There was no significant difference in intraoperative complications such as pneumothorax and postoperative complications between the two groups（P>0.05). Conclusion  The puncture time of the internal jugular vein is shorter,the success rate is higher,and the incidence of complications such as catheter heterotopia is lower,therefore,the first choice should be the right internal jugular vein.

Objective   To investigate the effect of Qijin mixture on residual stone rate and stone recurrence after ureteroscopic holmium laser lithotripsy. Methods   A total of 108 patients with upper ureteral calculi treated in our hospital from October 2015 to October 2020 were randomly divided into control group(n=54) and study group(n=54).Patients in both groups were treated with Ureteroscopic holmium laser lithotripsy,the control group was treated with traditional natural stone removal,and the study group was treated with Qijin mixture on the basis of the control group.All patients were reexamined 3 days,1 month and 6 months after the end of treatment.The postoperative residual stone rate and postoperative complications were compared between the two groups. Results   After treatment,hematuria,abdominal pain,frequency and urgency of urination,burning sensation of urination,and the total score of TCM symptoms in the two groups were significantly lower than those before treatment (P<0.05).The symptoms of the study group were slighter than those of the control group,and the total score of TCM symptoms was lower than that of the control group (P<0.05).The total effective rate of the study group was 96.30%,which was higher than 85.19% of the control group (P<0.05).The stone clearance rate of the study group was higher than that of the control group (P<0.05).The total incidence of complications such as low back pain,fever,infection and urinary tract irritation was lower than that of the control group (P<0.05).There was no significant difference in the residual stone rate between the two groups at 3 days after operation (P>0.05).Abdominal X-ray examination 1 month after operation showed no residual stones in the study group,while 8 patients in the control group still had residual stones (P<0.05).CT examination of urinary system 6 months after operation showed no recurrence of calculi in the study group.In the control group, 5 of the 8 patients with residual stones had increased stone diameter and stone recurrence was visible, and 2 of the 46 patients without residual stones found new stones.The recurrence rate of stone in the study group was lower than that in the control group, the difference was statistically significant(P<0.05). Conclusion   Qijin mixture has a significant effect on stone removal after Ureteroscopic holmium laser lithotripsy,which can accelerate the discharge of residual stone,and reduce the incidence of complications.

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 This study was designed to evaluate the effect and mechanism of adipose derived stem cells（ADSCs） in the process of promoting fibroblasts proliferation and migration.

Methods ADSCs were obtained from back subcutaneous adipose tissue of porcine with collagenase digestion and cultured in vitro.Flow cytometric analysis and cyto immumofluorescence staining technique were carried to detect the immunophenotypes of ADSCs.Porcine skin fibroblasts were cultured by tissue pieces and cyto immumofluorescence staining technique were used to detect the immunophenotypes of cells.The experiment was divided into ADSCs group and fibroblast group，cell to cell co culture experiment and transwell co culture experiment were used to evaluate the proliferation effect of ADSCs supernatant to fibroblasts.MTT assay was used to detect the proliferation effect of conditioned medium of ADSCs to fibroblasts.Also whether the conditioned medium of ADSCs has the stimulatory effect on migration of fibroblasts were determined by in vitro wound healing models.The concentrations of vascular endothelial growth factor（VEGF）、platelet derived growth factor（PDGF-AA）and transforming growth factor（TGF-β1）in conditioned medium of ADSCs were detected by using enzyme linked immunosorbent assay（ELISA）.

Results The stem cells isolated from subcutaneous adipose tissue were positive for CD44（90.2%） and CD105（99.2%），lacking in CD34（0.3%） and CD45（1.2%）.Porcine skin fibroblasts were positive for Hsp47.ADSCs promoted fibroblasts proliferation，not only by cell-to-cell direct contact，which was confirmed by co-culture experiment，but also by paracrine activation through secretory factors，resolved by transwell co-culture and culturing with conditioned medium of ADSCs（P<0.05）.Additionally，the fibroblasts showed vigorous proliferate and migratory responses to the conditioned medium of ADSCs.ADSCs produced a variety of growth factors：VEGF（765.63±56.23pg/ml），TGF-β1（133.42±24.35pg/ml）and PDGF（78.43±16.56pg/ml）.

Conclusion ADSCs can promote the proliferation and migration of fibroblasts.This study can provide some theoretical and experimental basis for the treatment of wound healing.