Objective To analyze the effect of LncRNA FOXD2-AS1 on the sternal incision problem after heart valve replacement and the other factors,and to build a visual prediction model,evaluate its clinical effectiveness. Methods Retrospective analysis of the data about heart valve replacement in Sanya people’s Hospital and Xinjiang Military Region General Hospital from January 2016 to January 2022,analysis of the factors affecting the incision problem using R software to build a visualized prediction model of nomogram,and using rms and pROC package to evaluate the model. Results Among the 546 cases,39 had incision problem,BMI,LncRNA FOXD2-AS1,age and pulmonary hypertension were independent predictors.The prediction model based on all independent prediction factors have better prediction ability.From the evaluation results of calibration curve,Hosmer-lemeshow test and clinical decision curve,the prediction model also shown more significant advantages. Conclusion The prediction model based on BMI,LncRNA FOXD2-AS1,age and pulmonary hypertension has better discrimination ability,accuracy and clinical applicability,which can provide reference for clinicians in the diagnosis and treatment of incision problem after valve replacement.

Objective To investigate the effect of single-hole thoracoscopy in the operation resection of early lung cancer with ground-glass nodules. Methods A total of 168 patients with early lung cancer mainly represented by ground-glass nodules who received surgical resection in our hospital from January 2015 to March 2021 were selected and divided into 2 groups according to different surgical methods.The observation group included 84 invalids were received single-hole thoracoscopic radical resection of early lung cancer,while the control group included 84 invalids were received traditional three-hole thoracoscopic radical resection.The pain,perioperative conditions,changes of inflammatory reaction indexes before and after operation,quality of life before and after surgery and the incidence of complications were compared between 2 groups. Results The visual analogue scale scores of(6.12±0.93) points,(5.12±0.73) points and(3.67±0.82) points in the observation group were lower than those of(6.53±0.91) points,(6.15±0.58) points and(4.36±0.91) points in the control group at 1 day,3 days and 5 days after operation(P＜ 0.05).The average incision length of(3.91±0.46) cm and drainage tube indwelling time of(2.85±0.71) d in the observation group were shorter than those of(6.63±0.86) cm and(3.69±0.87) d in the control group(P＜ 0.05).C-reactive protein(12.39±2.15) ng/L,procalcitonin(3.34±0.39) ng/ml and interleukin-6(148.57±18.52) pg/ml in the observation group were lower than those in the control group(24.09±3.41) ng/L,(4.78±0.51) ng/ml and(163.21±19.69) pg/ml at 5 days after operation(P＜0.05).The quality of life scale of lung cancer patients in the observation group(108.41±4.26) was higher than that in the control group(103.26±3.54) at 6 months after operation(P＜ 0.05).The incidence rate of complications in the observation group(17.86%) was not statistically significant compared with 22.62% in the control group(P>0.05). Conclusion The implementation of single hole thoracoscopic radical surgery for early lung cancer patients with ground glass nodules has significant clinical effect,which can reduce the trauma to patients,reduce the postoperative inflammatory reaction and promote the postoperative rehabilitation of patients.

Objective To study the regression factors of recurrent laryngeal nerve deep lymph node metastasis in papillary thyroid carcinoma patients.Methods 98 papillary thyroid carcinoma patients treated from August 2020 to August 2021 in our hospital were chosen as research subjects.According to the occurrences of recurrent laryngeal nerve deep lymph node metastasis,patients were divided into metastasis group and non-metastasis group.General data was acquired.Logistic regression equation was used to analyze the regression factors of recurrent laryngeal nerve deep lymph node metastasis.Results Among 98 papillary thyroid carcinoma patients,there were 36 metastasis cases (36.73%) and 62 non-metastasis cases (63.27%).The lesion number,tumor diameter,envelope invasions and surgical modes between metastasis group and non-metastasis group were found to be statistically significant (P<0.05);there were no significant differences about the gender,age,lesion positions and complications of hashimoto thyroiditis between metastasis group and non-metastasis group (P>0.05).Logistic regression equation indicated that the influence factors of recurrent laryngeal nerve deep lymph node metastasis were the lesion number,tumor diameter,envelope invasions and surgical modes.Conclusion There are multiple influence factors about recurrent laryngeal nerve deep lymph node metastasis,including lesion number,tumor diameter,envelope invasions and surgical modes.Therefore,the proper interventions shall be taken to decrease the occurrences of recurrent laryngeal nerve deep lymph node metastasis.

Objective To verify the safety and feasibility of modified transcricothyroid electromyography for intraoperative nerve monitoring in total areolar endoscopic thyroid surgery.Methods 50 patients who were going to undergo total areola endoscopic thyroidectomy were recruited.At the same time of using the surface electrode of endotracheal intubation,a paired needle electrode was inserted between the cricothyroid muscle and thyroid cartilage under the guidance of the endoscopy.The standard four-step method(V1-R1-R2-V2) was used to locate,expose and evaluate the function of the recurrent laryngeal nerve during the operation,and the electronic fiber laryngoscope was used to evaluate the vocal cord movement before and after the operation. Results A total of 50 recurrent laryngeal nerves were monitored during the operation,and effective electromyography(EMG) signals were successfully recorded through cricothyroid needle electrode and endotracheal intubation surface electrode.The EMG signal amplitude of the cricothyroid needle electrode is larger than that of the endotracheal intubation surface electrode[V1/R1=(2 179.3±1 252.3/2 304.8±1 644.0)μV vs (937.2±612.8/1 088.9±613.5)μV].There was no loss of EMG signal during the operation,and there was no obvious change of EMG signal before and after tumor resection.The electronic fiber laryngoscope indicated normal vocal cord movement before and after the operation.Conclusion Improved transcricothyroid EMG signal recording method is safe and feasible for neuromonitoring in total areola endoscopic thyroidectomy.It has the advantages of convenient installation,strong EMG signal,no influence of tracheal intubation position and little influence on endoscopic operation.

Objective To investigate the predictive significance of serum intact parathyroid hormone (iPTH) and calcium for permanent hypoparathyroidism (PHPP) after total thyroidectomy,and to observe the correlation with postoperative renal functional.Methods 16 PHPP patients 6 months after total thyroidectomy in Nanjing drum tower hospital from July 2019 to July 2021 were selected as the PHPP group.48 patients who did not develop PHPP within 6 months after surgery were randomly selected as the control group.The serum iPTH and calcium were compared between 2 groups before operation,1 d and 3 d after operation.The relationship between serum iPTH and calcium on the 1st and 3rd day after surgery and renal function in PHPP group after surgery were analyzed.The related influencing factors of PHPP after total thyroidectomy were analyzed.Results Compared with the control group,the serum iPTH and calcium on the 1st and 3rd day after operation were lower,the serum BUN and SCr at 6 months after operation were higher in the PHPP group(P＜0.05).The serum iPTH and calcium 1 d and 3 d after operation were negatively correlated with the serum blood urea nitrogen(BUN) and serum creatinine,(SCr) in the PHPP grou(P＜0.05).Logistic multivariate regression analysis showed that Hashimoto’s Thyroiditis,tumor size,parathyroid incision,serum iPTH and calcium on the 1st and 3rd day after surgery were influencing factors for PHPP after total thyroidectomy (P＜0.05).The receiver operating characteristic curve(ROC) showed that the area under the curve (AUC) of the serum iPTH combined with calcium on the 1st after operation was the largest.Conclusion Serum iPTH and calcium are low expressed on the 1st after total thyroidectomy.The serum iPTH combined with calcium on the 1st after surgery has a high value in predicting PHPP,and are related to the renal function in patients.

Objective To investigate the expression of NDRG2 in breast cancer and its effect on macrophage polarization and breast cancer proliferation,invasion and migration.Methods Bioinformatics was used to detect the expression of NDRG2 in breast cancer tissues and its relationship with clinically relevant pathological features and prognosis.Knockdown or overexpression NDRG2 to explore the effects of altered NDRG2 expression levels on macrophage polarization and immune status in breast cancer microenvironment.The localization and expression of NDRG2 and macrophage molecular markers in breast cancer tissues were detected by immunofluorescence.A co-culture system of macrophages and breast cancer cells was constructed to observe the effects of changes in NDRG2 levels in macrophages on the proliferation,invasion and migration of breast cancer cells.Results NDRG2 expression was down-regulated in breast cancer tissues and was associated with poor prognosis,NDRG2 deficiency in macrophages promoted macrophages polarized to tumor-promoting phenotype named M2,and up-regulation of NDRG2 promoted macrophages polarized to tumor-inhibiting phenotype named M1,and down-regulation of NDRG2 expression in macrophages in co-culture system could increase breast cancer cell proliferation,invasion and migration,thereby promoting breast cancer progression.Conclusion Down-regulation of NDRG2 expression in macrophages can not only promote the transition of macrophages to tumor-promoting M2,but also enhance the proliferation,invasion and migration of breast cancer cells.

Objective To investigate the clinical value of ligation of the intersphincteric fistula tract(LIFT) combined with endorectal advancement flap(ERAF) in the treatment of high complex anal fistula.Method From August 2016 to December 2021, a total of 40 patients with high complex anal fistula in the anorectal Department were included.They were randomly divided into the experimental group and the control group according to the method of drawing lots,with 20 cases in each group.The experimental group was treated with LIFT+ERAF,and the control group was treated with LIFT.The patients were followed up for 6-12 months to compare the clinical efficacy.Results There was no significant difference in pain degree on the first day after operation,wound healing time and cure rate between the two groups(P＞0.05).There was no significant difference in Wexner anal incontinence score,anal resting pressure and anal maximum systolic pressure before operation,after wound healing and 6 months after operation in both groups(P＞0.05).The anal resting pressure and the maximum anal systolic pressure after wound healing and 6 months after operation were significantly different from those before operation in both groups(P＜0.05).Followed up for 6-12 months,there was no recurrence in the experimental group and there were 3 recurrences in the control group.There was significant difference in the recurrence rate between the two groups(P＜0.05).Conclusion LITF combined with ERAF is a new surgical method with good curative effect,less pain,short course of disease,low postoperative recurrence rate and little impact on anal control function.

Objective To analyze thetransurethral resection combined with laparoscopic ureterovesical replantation in patients with high-risk glandular cystitis and ureteral stenosis.Methods The clinical data of 6 patients with recurrent high-risk cystitis glandularis with terminal ureteral stenosis admitted to our hospital from May 2016 to March 2020 were retrospectively analyzed.All were high-risk cystitis glandularis,which recurred repeatedly after multiple resections(2 patients who had undergone 2 resections and 4 patients who had undergone 3 or more resections),were accompanied by bilateral ureteral end obstruction,bilateral kidney,ureteral hydrops.The completely transurethral resection combined with laparoscopic ureterocyst reimplantation was used for treatment.Results All 6 patients successfully completed the operation.All patients in this group recovered and were discharged from the hospital 1 week after the operation.They were followed up regularly for 2 years after the operation.One patient was found to have a small recurrence 1 year after the operation and was cured after re-resection.Bilateral renal hydroureter improved continuously in 6 patients,and no cases of ureteral restenosis were found.Conclusion Completely transurethral resection combined with ureteral bladder reimplantation is a safe and feasible treatment method for the treatment of high-risk glandular cystitis with ureteral stenosis.

Objective To explore the clinical effect of ultrasonic osteotome assisted anterior cervical hybrid decompression and fusion in the treatment of multilevel cervical spondylotic myelopathy.Methods From January 2019 to January 2021,patients with multilevel cervical spondylotic myelopathy treated by ultrasonic osteotome assisted anterior cervical hybrid decompression and fusion were studied retrospectively(31 cases).The perioperative and late follow-up data and imaging data of all cases were collected.Results All 31 patients successfully completed the operation.3 patients had transient swallowing foreign body sensation after operation,and 1 patient had titanium mesh sinking after 1 month.After close observation,they finally fused stably.No serious complications such as vertebral artery injury and esophageal fistula occurred.The JOA and NDI scores were(11.23±1.41),(14.77±3.10) at 1 month after operation,and the JOA and NDI scores at the last follow-up were(12.84±1.73),(12.77±3.80),respectively.JOA and NDI scores at each follow-up time point after operation were improved compared with those before operation(P<0.05).One month after operation,the cervical lordosis angle(Cobb angle),sagittal axial distance(SVA) and T1 tilt angle(T1s) were(15.44±2.39)°,(14.26±3.23)°,(28.18±4.49)°, respectively.At the last follow-up, the Cobb angle,SVA and T1s were(16.24±1.06),(12.96±2.43),(27.50±3.05),respectively.The Cobb angle,SVA and T1S were higher than those before operation(P<0.05).Conclusion Ultrasonic osteotome assisted anterior cervical hybrid decompression and fusion in the treatment of multilevel cervical spondylotic myelopathy has good short-term effect,and can effectively improve the sagittal parameters of cervical spine,which is conducive to the recovery of spinal cord and nerve function.

Objective To investigate the clinical efficacy of Platelet-rich Plasma(PRP) combined with allogeneic bone transplantation in the treatment of pathological fractures caused by benign bone tumors or tumor-like lesions.Methods Patients with pathological fractures caused by benign bone tumors or tumor-like lesions in the orthopedic department of our hospital from March 2018 to March 2021 were retrospectively analyzed.The operation time,intraoperative blood loss,hospital stay,clinical healing time,healing rate and postoperative X-ray callus score,serum inflammatory index,and the incidence of complications of group A(Patients who received PRP + allogeneic bone transplantation,n=21) and group B(Patients who received autologous bone transplantation,n=23) were observed and compared.The bone metabolism value and FMA score between the healthy side and the affected side at 1 month and 3 months after operation were compared.Results The operation time of the group B(132.65±20.84) min was shorter than that of group A(158.62±23.57) min and group C(156.79±23.36) min,and the intraoperative blood loss(475.84±68.33)ml was less than that of group A(525.00±73.82) ml and group C(528.39±74.72) ml(all P＜0.05).The clinical healing time of pathological fractures X-ray callus score at 3 months after operation,fracture healing rate at 1 year after operation and hospital stay had no significant differences in 3 groups(P＞0.05).The levels of serum CRP and IL-6 in 3 groups were increased on the 1st and 3rd day after the operation(all P＜0.05).The levels of serum CRP and IL-6 in the group A and C were higher than those of group B.In group A and B,2 patients had postoperative immune rejection,and 1 patient had postoperative incision redness and swelling.In group C,2 patients had persistent pain in the donor site after surgery,and 2 patients had incision redness and swelling.There was no significant difference in the total incidence of complications in 3 groupsP＞0.05).Compared with the groupA and C,the FMA value of group B increased significantly at 1 st and 3 rd month after operation(all P＜0.05). 3 months after operation,the bone metabolism value of the affected side was significantly increased(P＜0.05).Conclusion PRP combined with allogeneic bone transplantation in the treatment of pathological fractures caused by benign bone tumors or tumor-like lesions can shorten the operation time,reduce the amount of intraoperative blood loss and postoperative inflammatory reaction,and the bone healing effect is similar to that of autogenous bone transplantation,with less postoperative complications.

Objective To evaluate the clinical efficacy of unilateral and bilateral percutaneous vertebroplasty(PVP) combined with high viscosity bone cement in the treatment of thoracolumbar osteoporotic vertebral compression fractures(OVCFs). Methods From January 2017 to December 2020, 83 patients with thoracolumbar OVCF underwent PVP in our hospital.According to the surgical method,they were divided into a unilateral group(43 cases) or a bilateral group(40 cases).The unilateral group underwent unilateral percutaneous vertebroplasty with high viscosity bone cement,and the bilateral group Bilateral percutaneous vertebroplasty with high viscosity bone cement was performed.Bone cement dispersion in the fractured vertebra was observed.The operation time,fluoroscopy frequency,injection volume of bone cement,compression degree of anterior vertebral body,Cobb angle of kyphosis,bone cement leakage rate,visual analogue scale(VAS) score and ODI(The Oswestry Disability Index) score were recorded.Results Among the 83 patients included,the operation time and frequency of fluoroscopy in the unilateral group were significantly lower than those in the bilateral group(P<0.05).The amount of bone cement injected in the bilateral group was significantly higher than that in the unilateral group(P<0.05).Compared with the baseline,the VAS scores and ODI scores of the two groups at 1 month and 6 months after operation were significantly decreased(P<0.05).There was no significant difference in the leakage rate of ground bone cement between the two groups(P>0.05).Conclusion Unilateral or bilateral high-viscosity bone cement PVP in the treatment of thoracolumbar OVCF can relieve pain and improve spinal function,and has a good clinical effect.Unilateral approach has the advantages of short operation time and less fluoroscopy.

Objective To explore the effect of Cox interaction model of client health behavior on kinesiophobia patients with osteoporotic vertebral compression fracture after minimally invasive procedures.Methods 96 patients with kinesiophobia after percutaneous vertebroplasty and percutaneous kyphoplasty in our hospital from October 2020 to March 2021 were selected as observation group,among whom 50 patients admitted to hospital from October 2020 to December 2020 served in an observation group,and 46 patients admitted to the hospital from January 2021 to March 2021 were selected into a control group.The observation group was implemented with Cox interaction model of client health behavior,and the control group was implemented with the conventional nursing.The differences of two groups in the scores ofTampa Scale for Kinesiophobia(TSK-11),Visual Analogue Scale(VAS),Chronic Pian Self-efficacy Scale(CPSS),and Oswestry disability index(ODI)were compared before and after the intervention.In addition,the rehospitalization rate and reoperation rate were compared between the two groups 6 months after discharge.Results After the intervention,the scores of TSK-11,VAS and ODI in the observation group were lower than those in the control group,The total score of CPSS and the scores of self-efficacy for pain management(PSE) and self-efficacy for coping with symptoms(CSE)in the observation group were higher than those in the control group.The difference was statistically significant(P＜0.05).In addition,the rehospitalization rate and reoperation rate in the observation group were lower than those in the control group.Conclusion COX healthy behavior interaction model can reduce the level of kinetophobia and pain in patients with kinetophobia after minimally invasive OVCF surgery,and promote the functional recovery of patients.

Surgical treatment is still the most important means of breast cancer treatment,but in recent years,with the continuous development of systemic treatment level of breast cancer,the surgical treatment concept of breast cancer is also changing.Including surgical treatment strategy of ductal carcinoma in situ,sentinel lymph node micrometastases or macro metastasis of axillary processing strategy,Safety of sentinel lymph node biopsy and breast conserving after neoadjuvant therapy,the timing of surgery after neoadjuvant therapy,surgical treatment of young breast cancer，Surgical treatment of stage Ⅳ breast cancer,radiation time to implant breast reconstruction,etc.,in the face of these problems, Breast surgeons are often confused.In this paper,ten hot issues in the surgical treatment of breast cancer are summarized based on the latest progress in the surgical treatment of breast cancer in recent years and guidelines at home and abroad,so as to make the surgical treatment of breast cancer more standardized and individualized.