Objective To explore the construction of a risk prediction model for vertebral compression fractures in patients with multiple myeloma(MM). Method Prospectively selected 114 patients with MM admitted to Tangshan People's Hospital from April 2017 to January 2021 as the research objects.According to whether the patients had vertebral compression fractures,they were divided into the fracture group and the non-fracture group.Multi-factor analysis was used to explore the influencing factors of the risk of vertebral compression fractures in MM patients,and the nomogram prediction model was constructed,and the prediction performance of the model was tested through the C-index index and the calibration curve. Result As of May 1,2021,44 cases had vertebral compression fractures,70 cases had no vertebral compression fractures,and the incidence of vertebral compression fractures was 38.60%.There were statistically significant differences in body mass index,HU value,bone marrow plasma cell ratio,and spinal tumor spinal instability score(SINS) between the fracture group and the unfractured group(P<0.05).Multivariate logistic analysis showed that body mass index(OR=0.464,95%CI 0.293~0.735) and HU value(OR=0.966,95%CI 0.949~0.984) were protective factors for fractures,SINS(OR=1.285,95%CI 1.111~1.487),bone marrow plasma cell ratio(OR=1.078,95%CI 1.025~1.133) are risk factors for fracture(all P<0.05).The fracture risk prediction model based on the above factors predicts the consistency index(C-index) is 0.913(95%CI 0.863~0.963),and the calibration curve shows that the observation is in good agreement with the actual prediction.Conclusion The risk model of vertebral compression fracture in MM patients constructed by body mass index,HU value,bone marrow plasma cell ratio and SINS factors has high predictive value.

Objective To explore the clinical efficacy of percutaneous endoscopy and oblique lateral lumbar interbody fusion(olif) in the treatment of traumatic grade Ⅰ and Ⅱ lumbar spondylolisthesis(meyerding). Methods 155 patients with traumatic grade Ⅰ and Ⅱ lumbar spondylolisthesis treated in our hospital from March 2018 to January 2020 were selected.According to different surgical methods,they were divided into two groups.Group A(76 cases) underwent percutaneous endoscopic assisted lumbar interbody fusion,and group B(79 cases) underwent oblique lateral lumbar interbody fusion.The operation conditions of the two groups,preoperative,3 months and 12 months after operationintervertebral disc height,intervertebral foramen and width,lumbar lordosis,visual analog pain scale(VAS),Oswestry disability index(ODI),36 concise health survey scale(SF-36) and complications were observed. Results The operation time and blood loss in group A were (155.32±10.21)min and (35.10±8.65)ml,respectively;The operation time and blood loss in group B were (160.43±19.87)min and (80.10± 13.91 )ml,respectively(P<0.05).Compared with group B,group A had smaller intervertebral foramen and larger intervertebral foramen width 3 months and 12 months after operation(P<0.05).There was no statistical significance in the comparison of lumbar lordosis angle between the two groups(P>0.05).Compared with group B,the scores of 36 items of concise health survey scale in group a increased(P<0.05).There was no statistical significance between the two groups in VAS,ODI at three months after surgery and SF-36 scores at 12 months after operation(P>0.05).There was no statistically significant difference in complications between the two groups at 3 months and 12 months after surgery(P>0.05).Conclusion Compared with oblique lateral lumbar interbody fusion,percutaneous endoscopic assisted lumbar interbody fusion is safer and more effective in the treatment of traumatic grade Ⅰ and Ⅱ lumbar spondylolisthesis.

Objective To investigate the effect of multiaxial locking plate internal fixation combined with tranexamic acid on postoperative blood loss and serum inflammatory factors of Schatzker type V and VI tibial plateau fractures. Methods From September 2019 to December 2020,100 patients with complex tibial plateau fractures were randomly divided into group A Group B was treated with internal fixation with multi axis locking plate.Group A was given 15 mg/kg normal saline before skin incision,and group B was given 15 mg/kg intravenous tranexamic acid.The perioperative blood loss and blood transfusion of the two groups were compared,The perioperative blood loss and blood transfusion of the two groups were compared,the levels of Hemoglobin(HB),D-Dimer(D-dimer) and fibrin degradation product(FDP) were compared 24 and 72 hours after operation.the levels of Serum interleukin-1(IL-1),tumor necrosis factor-α(TNF-α) and matrix metalloproteinase-2(MMP-3) were compared before and after operation. Results The blood transfusion rate of group B was 21.28%,which was lower than that of group A 41.51%( P ＜0.05).The level of Hb in group B was higher than that in group A[(114.83±11.94)g/L VS (104.57±10.28)g/L],the levels of D-dimer in group B were lower than those in group A[(4.12±0.75)mg/L,(5.17± 1.30)mg/L](all P＜0.05).7 days after operation,the levels of serum IL-1,TNF-α and MMP-3 in group B[24.22±6.16)ng/L,(42.30±6.62)ng/L,(11.57±2.13)g/L] were lower than that in the group A[(30.95±5.50)ng/L,(56.09±6.50)ng/L,(15.63±2.41)g/L](all  P ＜0.05). Conclusion The application of multi axis locking plate internal fixation combined with tranexamic acid in Schatzker type Ⅴ and Ⅵ tibial plateau fractures can effectively reduce the postoperative blood loss,reduce the postoperative HB loss,and promote the rapid recovery of postoperative joint function.

Objective To analyze the influencing factors of chest wall malignant tumor recurrence. Methods The clinical data of 32 patients with chest wall malignant tumor treated from January 1,2010 to December 30,2020 in the First Affiliated Hospital of Xi’an Jiaotong University were retrospectively analyzed,and the diagnosis and treatment process,operation scheme and recurrence were statistically analyzed.Chest wall tumors were successfully resected in all 32 patients,including 9 cases of restrictive radical resection,15 cases of extended radical resection,and 8 cases of palliative resection.Ten patients were relapsed,including 4 cases of 2 operations,5 cases of 3 operations,and 1 case of 4 operations. Results All patients were followed up for 3 to 60 months.There were no tumor recurrence and metastasis. Conclusion The recurrence of chest wall malignant tumor is mainly due to the difficulty in clarifying the nature and scope of tumor before operation,which leads to unclear surgical methods and insufficient resection scope;also because of the difficulty of reconstruction during operation,out of fear that the extended radical resection was not implemented;patients with palliative resection after operation did not receive further treatment.Therefore,it is necessary to obtain complete examination data and formulate rigorous surgical plan before chest wall tumor operation;R0 resection should be achieved during operation.For patients with palliative resection,further treatment after surgery must be performed.A series of schemes should be adopted to reduce the recurrence rate.

Objective To explore the clinical application and effect of an improved method of drainage tube fixation and incision suture after thoracoscopic surgery. Methods Between February 2020 and October 2020,202 patients who underwent video-assisted thoracic surgery in Department of Lung Cancer,Tianjin Medical University Cancer Institute and Hospital were enrolled in this study.All patients used an improved drainage tube fixation and incision suture method. Results All 202 patients have no obvious leakage.To a certain extent,this improved method can well improve the problem of easy leakage of thoracoscopic drainage nozzle after surgery,promote rapid wound healing,significantly reduce postoperative scar hyperplasia,and thus improve the incision aesthetics. Conclusion The improved method of drainage tube fixation and incision suture after thoracoscopic surgery has achieved satisfactory results in clinical practice.

Objective To analyze the expression,tumor immunoinvasion and clinical value of Human leukocyte antigen(HLA) class II antigen DPB1 in Lung adenocarcinoma(LUAD) tissues. Methods Oncomine,TIMER,UALCAN,GEPIA and other databases were used to analyze the expression of HLA-DPB1 in LUAD patients,tumor immunoinvasion and its clinical value. Results HLA-DPB1 was low expressed in LUAD tissues,and its expression level was correlated with the clinicopathological characteristics and tumor protein 53(Tp53) mutation in LUAD patients(P<0.05).Further analysis showed that decreased HLA-DPB1 expression was significantly associated with poorer prognosis in patients with lung adenocarcinoma( P <0.005).The expression level of HLA-DPB1 was related to the purity of LUAD immunoinfiltrate,the level of immune cells(B cells,CD8+T cells,CD4+T cells,macrophages,dendritic cells and neutrophils) and their markers. Conclusion The expression level of HLA-DPB1 in LUAD tissues is decreased,and LUAD patients with elevated HLA-DPB1 expression tend to have a better prognosis.The low expression of HLA-DPB1 is associated with immunoinfiltrating cells in LUAD patients,suggesting that HLA-DPB1 is expected to be a prognostic biomarker and a potential target for immunotherapy in LUAD patients.

Objective To identify the prognostic role of hsa-mir-337 in breast cancer.Methods The TGGA database was used to gain miRNA-seq expression as well as clinical data.R software was used for data analysis.Univariate Cox analysis as well as Multivariate Cox analysis were used to identify the prognostic significance of hsa-mir-337 in BREAST CANCER patients.GSEA was performed to analyze the functional annotation of the predicted genes. Results Hsa-mir-337 was significantly associated with overall survival(OS)of BREAST CANCER.The low expression group had worse OS compared to the high expression group.Through Multivarite analysis with Cox proportional hazards model indicated that hsa-mir-337(HR=0.981062,P<0.001) was independent progonostic factor for patients with breast cancer. Conclusion Hsa-mir-337 was identified as an independent factor in the prognosis of breast cancer.

Objective To explore the clinical significance of three-dimensional simulation imaging based pneumoperitoneum CT in the diagnosis of postoperative abdominal adhesion. Methods 826 patients with unexplained chronic abdominal pain or recurrent mechanical small bowel obstruction after abdominal operation were selected.The clinical diagnosis was obtained by the use of three-dimensional simulation imaging of pneumoperitoneum CT obtained by manual scanning and assisted by laparoscopy. Results Pneumoperitoneum CT examination based on volume rendering method(volume render，VR) could realize three-dimensional imaging of peritoneal cavity and simulate the morphological characteristics of peritoneal cavity.In the 826 cases of pneumoperitoneum CT examination,602 cases showed abnormal abdominal wall suspension structure through pneumoperitoneum space and counterweight displacement,which was diagnosed as abdominal adhesion and confirmed by laparoscopy.Among the 224 cases without adhesions,12 cases with simple visceral adhesions were found by laparoscopy.The sensitivity and specificity of pneumoperitoneum CT were 96.5% and 100%,respectively. Conclusion The three-dimensional imaging of peritoneal cavity obtained by pneumoperitoneum CT could directly show the existence of abdominal wall adhesion or not,but has poor correlation with visceral adhesion,which had a certain effect of replacing laparoscopic examination.

Objective To study the expression level of PTEN phosphorylation(p-PTEN) in gastric cancer tissues,and to explore its correlation with the clinicopathological characteristics and prognosis of gastric cancer patients. Methods Collect 85 cases of gastric cancer patients who underwent radical gastric cancer surgery in our hospital from January 2015 to January2016 and were confirmed by pathology,and collected their gastric cancer tissue specimens and adjacent tissues;Immunohistochemistry was used to analyze the expression of p-PTEN in gastric cancer tissues and adjacent tissues;at the same time,according to the expression of p-PTEN in gastric cancer tissues,gastric cancer patients were divided into p-PTEN low expression group and high expression group;Compare the differences in clinicopathological data and prognosis between the two groups of gastric cancer patients,and analyze the risk factors that affect the survival of gastric cancer patients. Results In gastric cancer tissues,51cases had low expression and 34 cases had high expression of p-PTEN;in the adjacent tissue,69 cases had low expression and 16 cases had high expression.The expression level of p-PTEN in gastric cancer tissue was significantly higher than that in adjacent tissue,and the difference between the two groups was statistically significant( P <0.05).The high expression of p-PTEN was correlated with the degree of differentiation,depth of invasion,TNM stage and metastasis rate of gastric cancer patients( P <0.05).p-PTEN low expression patients were significantly shortened(χ₂=14.296, P <0.001).Multivariate Cox proportional hazards regression model analysis showed that CEA,CA19-9,TNM stage,lymph node metastasis and p-PTEN expression were independent risk factors for OS in gastric cancer patients( P <0.05). Conclusion The level of p-PTEN in patients with gastric cancer is significantly increased.The level of p-PTEN is closely related to the clinicopathological characteristics of patients with gastric cancer,and is negatively related to overall survival.

Objective To preliminary discuss the application effect of “gunsight” skin flap technique compared with primary linear closure during the skin closure of the stoma reversal. Methods The clinical datas of 57 patients performed stoma reversal in the digestive center of Panyu central hospital during June of 2015 to May of 2018 were retrospectively analysed.Among them,41 patients were performed by “gunsight” closure technique,while 26 patients were performed by primary linear closure method.Finally,the clinical parameters,postoperative complications,healing time,the length of stay,pain score,satisfaction score were recorded and compared. Results The infection rate of the patients in the “gunsight” closure group were significantly lower than that of the primary liner closure group(4.88% vs 26.92%).The wound healing time and post operational hospital stay of the “gunsight” closure group was (9.61±2.82) and (10.29±3.87)days,which was significantly shorter than that of the primary linear closure group((12.65±5.69) and (14.58±9.35))days,The difference between the two groups was statistically significant( P ＜0.05). Conclusion Compared with the conventional suture method,“gunsight” skin flap technique appeared to be of more advantages.The “gunsight” suture method can not only reduce the wound infection rate,but also shorten hospital stays.

Objective To study the repair effect of SIS anal fistula plug on anal fistula after perianal infection. Methods 86 patients with perianal infection combined with high anal fistula in our hospital from June 2018 to June 2020 were selected as the research objects.According to different treatment methods,they were divided into observation group(43 cases) treated with SIS anal fistula plug and control group(43 cases) treated with traditional incision and thread drawing.The clinical efficacy,postoperative pain score,anal incontinence Wexner score,serum cytokine levels and adverse reactions were compared between the two groups. Results The cure rate(86.05%) and total effective rate(93.02%) of the observation group were significantly higher than those of the control group(72.09%,83.72%),and the pain scores of 1,3,7,14 days after operation were significantly lower than those of the control group（ P ＜ 0.05）.There was no significant difference in the preoperative Wexner score of anal incontinence between the observation group and the control group（ P >0.05）,but the Wexner score of anal incontinence in the observation group was significantly lower than that in the control group at one month,three months and six months after operation（ P ＜0.05）.Adverse reactions occurred in both groups,but the total incidence of adverse reactions in the observation group(11.63%) was significantly lower than that in the control group(32.56%)（ P ＜ 0.05）. Conclusion SIS anal fistula plug has a better clinical effect in the repair of high anal fistula after perianal infection,which can effectively reduce the symptoms of postoperative pain and anal incontinence,reduce the incidence of inflammatory reactions and adverse reactions.

Objective To explore the diagnostic value of folate receptor-positive circulating tumor cells(FR+CTCs) in patients with hepatocellular carcinoma(HCC). Methods From October 2020 to August 2021,91 cases of HCC in the Department of Liver Surgery of Tongji Hospital were prospectively collected,and the detection values of FR + CTCs in peripheral blood bodies were measured by immunomagnetic bead negative screening and targeted fluorescence quantitative PCR.The patients were divided into non-vascular invasion group (NVI)( n =30),microvascular invasion group (MVI)( n =26) and portal vein tumor thrombus group(PVTT)( n =35) according to preoperative imaging and postoperative pathological results.The difference of FR + CTCs among 3 groups was analyzed. Results The average values of FR + CTCs in the three groups were (10.52±2.21)FU/3 ml,(12.35±2.47)FU/3 ml,(14.79±3.68)FU/3 ml( P <0.05).There was a positive correlation between the detection value of FR + CTCs and the degree of vascular invasion in patients with HCC( r=0.499,P <0.05).FR + CTCs were used as auxiliary diagnostic indicators for vascular invasion and PVTT,and the area under the ROC curve was 0.769 (95%CI was 0.668-0.869) and 0.830(95%CI was 0.733-0.928),respectively.When the cut-off points were 12.35 FU/3 ml and 11.8 FU/3 ml,respectively,the diagnostic sensitivity was  0.672  and 0.829,and the specificity was 0.767 and 0.733,respectively. Conclusion The detection value of FR + CTCs was positively correlated with the degree of vascular invasion in HCC patients,and the detection value of FR + CTCs had higher auxiliary diagnostic value for patients with vascular invasion and PVTT,but lower diagnostic value for MVI in patients with HCC.

Objective To assess the effect of tumor location(pelvis VS ureter) on overall survival(OS) and progression-free survival(PFS) in patients with upper urinary tract urothelial carcinoma(UTUC). Methods The clinical data of 167 UTUC patients admitted to the Second Hospital of Lanzhou University from January 2014 to August 2019 were retrospectively analyzed.Kaplan-Meier analysis was used to assess the OS and PFS and test the equivalences of the curve by Log-rank test.Univariate and multivariate survival analyses was carried out using Cox proportional hazard regression model. Results Median follow-up time was 42(3-89)months.In general,the renal pelvis tumors were larger than the ureteral tumors.The survival curve showed that there was no significant difference between tumor location and Prognosis.Multivariate analysis with a Cox proportional hazards regression model was performed and showed that tumor grading,pathological T stage and FIB was significantly correlated with OS,pathological T stage and FIB were significantly correlated with PFS. Conclusions Tumor location is independent of prognosis in patients with UTUC,and there should be no difference in clinical decisions regarding therapy or postoperative prevention.

Objective To explore the open surgical treatment of ureteral stricture after renal transplantation,and to analyze the therapeutic effect and clinical practicability of the operation. Methods The clinical data of 6 patients with ureteral stricture after kidney transplantation admitted to the Department of Organ Transplantation,People’s Hospital of Wuhan University from April 2018 to November 2020 were retrospectively analyzed.All the 6 cases underwent nephrostomy status and ureterovesical replantation.Six patients were followed up after operation. Results The ureteral stenosis occurred 1-76 months postoperatively,with a mean of 16.3 months postoperatively.The serum creatinine（Cr） after kidney transplantation was 100-161 μmol/L,with an average of 119.8 μmol/L.After ureteral stenosis,the Cr of patients was 100-337 μmol/L,with an average of 238.8 μmol/L.All the 6 patients had had their ureteral stents removed within the prescribed time limit before surgery No complications such as transplant hemorrhage and infection occurred during renal graft fistula.Renal function recovered in 6 patients after renal graft fistula,and the postoperative CR was 97-283  μmol/L,with an average of 173.5 μmol/L.All the 6 patients underwent open surgery,and no ureteral mucosal injury occurred during the operation.All the 6 patients were followed up for 3 to 6 months after operation.Now the renal function of the 6 patients has returned to normal level. Conclusion Ureteral stricture is one of the most serious complications after renal transplantation.Open operation has the advantages of obvious therapeutic effect and good postoperative recovery.

Objective To explore the surgical method and effect evaluation of Progressive pedicled skin flap transfer combined with modified devine procedure in the treatment of concealed penis in children. Methods 80 patients with concealed penis admitted to Heze Municipal Hospital from July 2020 to July 2021 were retrospectively analyzed.Among them,44 cases were treated with progressive flap transfer technique combined with modified Devine operation(Experimental group);36 cases were treated with modified Devine operation(Control group).All operations were performed by the same surgeon.The operation effect was evaluated by observing and recording the operation time,blood loss in operation,penile length improvement,penile prepuce edema time,skin flap necrosis rate and postoperative satisfaction.Results Experimental group and control group of patients had successful operations,The length of penis extension,the time edema of penis foreskin and surgical satisfaction in experimental group were(2.67±0.29)cm,(55.09±5.52)days,and 95.5%,respectively,significantly better than the control group(2.12±0.36)cm,(70.22±7.73)days,and(75.0%),respectively,the difference was statistically significant( P <0.05).The time of operation,intraoperative bleeding and postoperative infection rate of patients in the experimental group were(66.61±7.45) min,(5.64±1.35)ml,2.3% ,respectively;compared with control group[(63.58±8.07)min,(5.75±1.40)ml,2.8%],the difference was not statistically significant ( P >0.05). Conclusion The surgical method of progressive pedicled skin flap transfer combined with modified Devine procedure is simple and effective,and it is worthy of clinical application in the treatment of concealed penis in children.

Objective To explore the technique and clinical application of Fustar combined with disposable biopsy forceps in the recovery of inferior vena cava filter. Methods A retrospective analysis of 117 cases of the inferior vena cava filter recovered from December 2017 to December 2020 in Wangjing Hospital of the Chinese Academy of Chinese Medical Sciences.The Fustar combined with disposable biopsy forceps were used during the operation.The filter was successfully recovered and performed after the operation.Follow-up observation. Results In this study,117 cases of vena cava filters,including 103 cases of Aegisy filter,9 cases of Optease filter,and 5 cases of Günther Tulip filter,were successfully recovered using the Fustar combined with disposable biopsy forceps,and the recovery success rate was 100%.The operation time of grasping the filter under fluoroscopy It was 45 seconds to 12 minutes and 57 seconds,with an average of 2 minutes and 38 seconds.The angiography showed that the inferior vena cava blood flowed smoothly,and there was no extravasation of contrast agent.Observation and removal of the filter was normal,without deformation or damage.The patients were followed up for 1 to 36 months,with an average of 6 months,and there were no complications such as inferior vena cava stenosis or secondary thrombosis. Conclusion The Fustar combined with disposable biopsy forceps in the recovery of the inferior vena cava filter has the characteristics of simple operation,small trauma,accurate positioning,high recovery rate,and short operation time.It can be promoted as the preferred solution for recovery of vena cava filter.

In recent years,with development of the theory of biportal endoscopy and the continuous updating and optimization of relevant surgical instruments and techniques,biportal endoscopic lumbar interbody fusion (BELIF) has become a new choice of minimally invasive lumbar interbody fusion surgery.BELIF not only has the advantages of traditional spinal endoscopy,such as less trauma,magnifying the surgical field and avoiding the operator’s bow for a long time,but also could use traditional open surgical instruments,which is more efficient and flexible and widely decompressed.However,it also has some disadvantages,such as longer operation time and steep learning curve compared with traditional open surgery.Moreover,at present,BELIF has a short development history,the followup time of most relevant studies is short,and its safety and efficacy are still lack of highlevel evidence support.It is necessary to further evaluate and verify the medium and longterm efficacy of this technology.This paper reviews the development history,technical points,indications,contraindications,advantages and disadvantages and complications of BELIF.

In early stage operable breast cancer patients,sentinel lymph node biopsy(SLNB) has long replaced the traditional axillary lymph node dissection(ALND),enabling patients with negative axillary lymph node(ALN) to reduced postoperative discomfort such as arm edema、paresthesia and shoulder dysfunction caused by axillary dissection.However,there is still some controversy regarding the treatment of the axillary of patients who underwent neoadjuvant chemotherapy(NAC).This article reviews the research progress of SLNB after NAC.

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.