Objective   To study the relationship between detachment and puncture site and chest wall thickness after preoperative positioning of peripheral lung nodules by CT-guided Hookwire puncture. Methods   From July 2017 to December 2021, 190 patients in our hospital underwent thoracoscopic surgery for peripheral lung nodules.All patients underwent preoperative CT-guided HOOKWIRE puncture mapping, recording the puncture site, whether the needle had fallen off, chest wall thickness, and the interval between the end of the puncture and the start of the surgery, logistic regression analysis, and receiver operating characteristic (ROC) curve analysis to explore the risk factors affecting needle fall off.  Results   Clinical data were collected for 190 patients, including 119 males and 71 females, age 22 to 78 (58.1 ± 10.2) years.There were 31 cases of shedding, with a shedding rate of 16.3%.Among them, 31 cases were detached in the medial aspect of the subscapular horn line, 15 cases were detached, with detachment rate being 48.4%; 67 cases were detached in the medial axillary line, 10 cases were detached, with detachment rate being 14.9%; 65 cases were detached in the medial axillary line of the midclavicular line, 5 cases were detached, with detachment rate being 7.6%; 27 cases were detached in the medial axillary line, 1 case was detached, with detachment rate being 3.7%; the detachment rate was highest in the subscapular horn line, with statistical significance (P<0.05) compared with other locations; the tissue thickness of the thoracic wall was (49.38 ± 6.28) mm, but the tissue thickness of the thoracic wall was (36.36 ± 7.77) mm, with statistical significance (P<0.05).The interval between puncture and operation was 73 to 98 min, with an average one of (81.99 ± 4.48) min. Conclusions   The detachment of the positioning needle is related to the thickness of the chest wall, and the proportion of detachment is significantly higher in the chest back, especially in the subscapular angle, before surgical treatment of peripheral lung nodules.In cases of peripheral pulmonary nodules with surface projections medial to the inferior scapular horn line, other methods of localization should be preferably considered.

Objective   To explore the effect of Endoanal advancement flap (ERAF) and transanal opening of interphincteric space (TROPIS) in the treatment of complex anal fistula and their impact on anorectal pressure,so as to provide a reference for clinical selection of surgical methods.Methods   Eighty-four patients with complex anal fistula admitted from October 2018 to October 2022 were divided into group E received ERAF treatment (n=48) and group T received TROPIS treatment (n=36).The clinical efficacy,operation,wound surface and anorectal pressure of the two groups were compared.Results   The effective rate of treatment in Group T was 97.22%,which was higher than that in Group E(87.50%),with no statistically significant difference (P＞0.05).The surgical time [(31.53±7.29) minutes],intraoperative bleeding volume [(29.56±7.37) ml],and wound area [(10.03±0.96) cm²,(8.76±0.87) cm²,(6.20±0.77) cm²] on the day of surgery,7 and 14 days after surgery in Group T were all smaller than those in Group E[（35.36±8.54）min,（36.86±8.04)ml,（12.09±1.23）cm²,（10.52±1.09）cm² and（7.36±0.85）cm²] (P<0.05).After surgery,the VAS score and Wexner incontinence score of Group T were (1.38±0.27) and (0.21±0.08),respectively.Group E was (1.56±0.29) and (0.33±0.09),respectively.In group T, the anorectal systolic pressure at 20mm and 30mm and the anorectal resting pressure at 20mm and 30mm were(138.18±29.58) mmHg,(136.22±35.41) mmHg,(35.47±6.58) mmHg,and (32.97±8.01) mmHg,respectively.In Group E, the data was (152.78±31.53) mmHg,(156.29±32.74) mmHg,(38.29±7.62) mmHg and (36.41±7.63) mmHg,respectively.Both groups showed a decrease in score and anorectal pressure,and group T was lower than group E (P<0.05).The incidence of adverse reactions in Group E was 20.83% ,which was higher than that in Group T(11.11%),but the difference was not statistically significant (P＞0.05).Conclusion   TROPIS has a better effect in the treatment of complex anal fistula,which can shorten the operation time,reduce intraoperative bleeding,reduce postoperative pain,and protect anal function.

Objective   To explore the effects of small incision in situ release on surgical indications,nerve conduction velocity and upper limb function in patients with carpal tunnel syndrome(CTS). Methods   A total of 100 CTS patients admitted to our hospital from January 2018 to January 2022 were selected,they were randomly divided into the control group(50 cases,treated with traditional carpal tunnel release) and the observation group(50 cases,treated with small incision in situ release),the clinical data of CTS patients were collected and surgical indications,nerve conduction velocity,upper limb function and the incidence of complications were compared between the two groups. Results   The total effective rate was 98.00% in the observation group and 84.00% in the control group(P<0.05).In the observation group,the length of incision was(1.65±0.29) cm,the time of opening and closing incision was(4.85±1.02) min,the hospitalization time was(3.24±0.62) d,the intraoperative blood loss was(17.88±3.53) mL,and the VAS score was(3.03±0.56) points one day after operation.The control group were(4.02±0.81) cm,(10.06±2.28) min,(7.11±1.34) d,(24.37±5.27) ml,(4.04±0.89) points,the differences were statistically significant(P<0.05).After treatment,The thumle-wrist sensory conduction velocity of CTS patients in the study group was(46.05±8.39) m/s,the middle finger-wrist sensory conduction velocity was(45.05±8.95) m/s,the thenar muscles-wrist motor conduction velocity was(53.94±11.47) m/s,the FIM ADL score was(34.38±7.22) points,and FMA The upper limb score was(34.23±7.25) points,and the control group was(41.86±8.22) m/s,(40.88±8.28) m/s,(49.05±10.01) m/s,(27.81±6.01) points,(41.05±9.19) points.The difference between the two groups was statistically significant(P<0.05).The total incidence of complications was 4.00% in the observation group and 20.00% in the control group(P<0.05). Conclusion   Small incision in situ release is effective in the treatment of CTS patients,which can improve the surgical indications and nerve conduction velocity,help patients recover upper limb function,and reduce the incidence of postoperative complications.

Objective   To investigate the effect of locking plate combined with cortical screw internal fixation on ankle function and quality of life in patients with ankle fracture with tibiofibular separation. Methods   A total of 120 patients with ankle fracture and distal tibiofibular separation treated in our hospital from May 2020 to December 2021 were selected and divided into control group and observation group according to random number table method,with 60 patients/group.The control group was treated with cortical screw fixation alone,and the observation group was treated with locking plate combined with cortical screw internal fixation.Before surgery and 6 months after surgery,the recovery function of the two groups was compared.X-ray,operation duration,healing time,intraoperative blood loss,postoperative complications were compared,and the living ability of the two groups of patients was evaluated.  Results   Before treatment,there was no difference in joint function between the two groups (P>0.05).After treatment,the longest walking of the control group (15.89±0.85),foot alignment (15.06±0.71),pain response (29.03±4.48) and ground walking (15.65±0.59).The longest walking distance (16.19±0.87),foot alignment (15.29±0.76),pain response (31.24±4.55) and ground walking (15.96±0.68) in the observation group,which were higher than those in control group (P<0.05).Compared with the control group,the intraoperative blood loss and healing time in the observation group were lower (P<0.05).BI index of the two groups before treatment had no difference (P> 0.05);After treatment,BI index of observation group was higher than that of control group (P<0.05).There was no difference in the total complication rate between the two groups (P>0.05). Conclusion   Locking plate combined with cortical screw internal fixation has a good therapeutic effect on improving ankle function,reducing intraoperative blood loss,promoting healing and improving behavioral ability in the treatment of ankle fracture combined with hypotibiofibular syndesmosis injury.

Objective   This study explored the clinical effect of using transforaminal technique to treat patients with lumbar disc herniation and lateral recess stenosis. Methods   132 patients with lumbar disc herniation and lateral recess stenosis who were treated by orthopedic surgery in our hospital from July 2018 to December 2022 were selected for retrospective analysis.They were divided into the endoscopic group and the traditional group according to the surgical method.70 patients in the endoscopic group were treated by the inter-laminar approach under the technique of intervertebral foramen,and 62 patients in the traditional group were treated by the traditional open surgery.The operation process indexes of the two methods were compared The clinical symptoms of patients after operation were different. Results   The average operation time[（76.1±7.5）min],surgical blood loss[（30.5±8.4）ml],incision length[（0.88±0.12）cm],post-operative drainage[（24.5±4.4）ml],bed time[（26.8±4.4）h],and length of stay[（5.6±1.8）d] in the endoscopic group were significantly lower than those in the traditional group[（88.0±9.3）min,（103.4±18.6）ml,（6.10±1.04）cm,（208.3±34.0）ml,（32.7±6.6）h and （9.4±2.0）d,respectively].The difference was statistically significant (P＜0.05).VAS scores of 3 months and 6 months after surgery were lower than those before surgery, and JOA scores were higher, the difference was statistically significant(P＜0.05).The lumbar function of the endoscopic group was excellent in 43 cases (61.43%) and good in 15 cases (21.43) %),29 cases of lumbar spine function were excellent (46.77%) and 17 cases (21.43%) were good in the traditional group.Overall,there was no statistically significant difference in the recovery of lumbar spine function between the endoscopic group and the traditional group (P >0.05).2 patients(2.86%) in the endoscopy group had postoperative complications,and 7 patients(11.29%) in the traditional group had postoperative complications,but there was no significant statistical difference in the incidence of surgical complications between the two groups (P＞0.05). Conclusion   For the treatment of lumbar disc herniation with lateral recess stenosis under intervertebral foraminal technique,the treatment of lumbar intervertebral disc herniation with lateral recess stenosis can achieve better functional recovery and effectively relieve the clinical symptoms of the patient,but its advantage lies in the operation time.Shorter,less traumatic impact on patients.

Objective   To investigate the difference of surgical effect of exclusion,simple continuous suture and circular suture suspension in TAPP for the treatment of false hernia sac in patients with direct inguinal hernia. Method   From May 2020 to May 2022,120 patients diagnosed with direct inguinal hernia and treated with TAPP in our hospital were retrospectively.The  false hernia sacs were divided into three groups according to different methods of treatment patients treated with false hernia sac exclusion were included in group A,those treated with simple continuous suture were included in group B,and those treated with circular suture suspension were included in group C.There were 40 patients in each group.The perioperative indicators (operation time,intraoperative blood loss,postoperative hospital stay,hospitalization cost) and postoperative effects (chronic pain,seroma,incision or mesh infection,foreign body traction feeling) were compared among the three groups. Results   All 120 patients successfully completed TAPP surgery.There was no significant difference in general condition,intraoperative blood loss,postoperative hospital stay,wound or mesh infection and chronic pain among the three groups (P>0.05).The operation time of group B and C was longer than that of group A,and the incidence of seroma was significantly lower than that of group A,the difference was statistically significant (P<0.05).The incidence of foreign body traction in group A and group C was lower than that in group B,and the difference was statistically significant (P<0.05).The hospitalization cost of group B and group C was lower than that of group A,with statistically significant difference (P<0.05). Conclusion   In clinical practice,direct hernia and false hernia sac often need to be treated.In direct hernia TAPP operation,simple continuous suture method and circular suture suspension method have the effect of improving the condition of the false hernia sac,but in terms of economy and postoperative effect,the circular suture suspension method can benefit patients more.

Objective   To explore the related risk factors of postoperative venous thromboembolism (VTE) in patients with gastric cancer,establish a prediction model and verify the predictive value of the model. Methods   160 gastric cancer patients who underwent radical surgery at the First Affiliated Hospital of Hainan Medical College from January 2019 to June 2021 were included as the modeling group,167 cases as validation group.Their clinicopathological data were collected.All modeling group patients were divided into VTE group and N-VTE group according to the occurrence of VTE within 6 months after operation.The clinicopathological factors of the two groups were analyzed by univariate analysis.Then,the statistically significant indexes in the univariate analysis were substituted into the multivariate logistic regression model for multivariate analysis to obtain the independent risk factors affecting the postoperative VTE of patients with gastric cancer.The independent risk factors obtained based on the results of multivariate analysis were combined β Value,assign scores to independent risk factors according to the principle of nomogram,construct the nomogram model,draw the nomogram with R software,internal and external validation of nomogram model with Bootstrap method and calibration curve,calculate the discrimination evaluation Index C index,and evaluate the calibration ability of the prediction model through goodness of fit (H-L). Results   160 modeling group patients with gastric cancer underwent radical gastrectomy.According to the occurrence of VTE within 6 months after operation,they were divided into VTE group (23 cases) (14.38%) and N-VTE group (137 cases) (85.62%).Multivariate analysis showed that the age of 60 years old,the diameter of the lesion was more than 5cm,the stage of diabetes,the TNM/T stage was 3-4,and the lymph node metastasis was the independent risk factors affecting the postoperative VTE of patients with gastric cancer (P<0.05).Construct nomogram:P=1/(1+e-X),X=1.885×Age (≥ 60 years=1,< 60 years=0)+2.051×Diabetes mellitus (=1,no =0) +2.646×Lesion diameter (≥ 5 cm=1,<5 cm=0) + 2.952 × TNM/T stage (stage 1-2 = 0,stage 3-4 = 1) + 0.694 × Lymph node metastasis (yes = 1,no = 0)-0.436.The C index of nomogram model was 847 (95%CI:0.784-0.932) and 0.832(95%CI:0.772-0.910).H-L test showed that the predicted value of postoperative VTE in patients with gastric cancer was in good agreement with the actual value (P>0.05). Conclusion   A nomogram model for predicting the risk of postoperative VTE in patients with gastric cancer was established.It was verified that the model can accurately predict the risk of postoperative VTE in patients with gastric cancer.

Objective   Summarizing the recent efficacy and initial experience of using da Vinci robot surgery for pediatric annular pancreas in our hospital. Methods   The clinical data of 3 children with annular pancreas treated by Da Vinci robotic surgery in Wuhan Children’s Hospital from October 2020 to December 2022 were retrospectively analyzed. Results   All three cases were successfully completed with robot-assisted lateral duoduodenal anastomosis without intraoperative complications.The operation time was 240min,212min,135min,respectively.Postoperative feeding was started at 12d,7d,and 6d,respectively.The postoperative hospital stays were 33d,18d,and 13d,respectively.The first case was complicated with neonatal necrotizing enterocolitis after operation,and was cured and discharged after conservative treatment.The remaining 2 cases were cured and discharged.The follow-up time was 2 years,3 months and 5 months,respectively.No relevant complications occurred during the follow-up period,and the prognosis of the three children was good. Conclusion   Da Vinci robotic surgery is safe and feasible in the treatment of annular pancreas in children,but it still needs to be supported by large sample studies.

In recent years,there have been significant advancements in tumor immunotherapy.Immune checkpoint inhibitors have emerged as a pivotal approach for treating advanced malignant tumors.The use of immunotherapy has been widely recommended and applied in clinical treatment both domestically and internationally.However,its clinical treatment efficacy still falls short of expectations.Improving the efficacy of immunotherapy for patients with advanced malignant tumors is currently a prominent research focus.Studies indicate that the combined use of immune enhancers and immune checkpoint inhibitors in various advanced malignant tumors significantly enhances the outcomes of immunotherapy.This article primarily highlights the combined application of immune enhancers and immune checkpoint inhibitors in cancer therapy,offering insights into their potential in the field of oncology treatment.

Secondary hyperparathyroidism (SHPT) is one of the common complications in patients with advanced chronic kidney disease.Since the surgical procedure of total parathyroidectomy with autotransplantation (TPTX+AT) was proposed in 1977,there has been no consensus on some issues related to autotransplantation.This article reviews the basis and clinical value of autotransplantation,transplantation site,transplantation method,transplant survival,and function monitoring,diagnosis and management of recurrence,etc.

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 unilateral biportal endoscopic spinal surgery(UBE) technique is an emerging endoscopic technique,mainly used as treatment for lumbar degenerative disease.The procedure is characterized by two working channels,one being endoscopic,the second to be employed as an operating channel.Through the use of such dual-channel-technology,it allows the operating instruments to be unrestricted in size.Therefore,it is a highly efficient surgical technique for minimally invasive spinal surgery(MISS).However,the clinical complications of UBE technology must be taken into consideration.Possible side effects include dural injury,epidural hematoma,occult blood loss,postoperative headache,nerve root injury and insufficient decompression.This article reviews the causes,prevention and management of UBE-related complications.            

Ubiquitin-specific protease 7(USP7) is a deubiquitinating enzyme involved in a wide range of cellular processes,playing a key role in the regulation of cell proliferation and apoptosis,cell division,differentiation,DNA damage repair,epigenetic regulation and other biological processes.This article briefly summarizes the structure and extensive biological functions of USP7,and also describes the research progress of USP7 in colorectal cancer in recent years and potential directions for future research.