Objective To investigate the correlation between the incidence of pancreatic fistula (POPF) after pancreaticoduodenectomy and the CT ratio of pancreatic to visceral fat and blood glucose.Methods 94 patients who underwent PD from January 2018 to December 2022 were selected.Postoperative blood glucose,pancreato-visceral fat CT ratio,blood biochemistry and other relevant indicators were collected to analyze the risk factors for POPF.Results Among the 94 patients,POPF grade B/C in 20 cases (21.3%); Logistic regression analysis showed that CT ratio of pancreas-visceral fat,preoperative lymphocyte/monocyte,and blood glucose on the first day after surgery were risk factors for postoperative pancreatic fistula in PD patients.Laparotomy is an independent risk factor for postoperative pancreatic fistula in PD patients.The sensitivity and specificity of pancreatic-visceral fat CT ratio to predict POPF were 0.80 and 0.58.The sensitivity and specificity of blood glucose prediction of POPF on the first day after surgery were 0.55 and 0.84，respectively.The sensitivity and specificity of POPF prediction were 0.60 and 0.78，respectively.Conclusion CT ratio of pancreatic to visceral fat combined with blood glucose on the first day after surgery may be a risk factor for predicting POPF in PD patients.

Objective To investigate the efficacy and complications of one-step and two-step ultrasound-guided percutaneous transhepatic hepatic duct drainage (PTHD) in the treatment of advanced low-level biliary obstruction.Methods A total of 112 patients with advanced low-level biliary obstruction who underwent palliative surgery for reducing jaundice in the hospital from January 2019 to July 2023 were selected,and divided into the one-step group and the two-step group according to the principle of complete randomization (grouped by random number table method).The one-step group (n=56) underwent one-step PTHD,while the two-step group (n=56) underwent two-step PTHD.Surgery related indicators,serum total bilirubin (TBIL),alkaline phosphatase (ALP),alanine transaminase (ALT),the incidence of postoperative complications,and satisfaction were compared between the two groups.Results There was no difference in intraoperative blood loss[(2.96±0.50)ml vs. (3.02±0.53)ml],drainage volume in 48 hours after surgery[(555.84±90.51)ml vs. (560.52±104.23)ml]between the two groups(P>0.05).Operation time and postoperative VAS score of the one-step group were significantly shorter/lower than those of the two-step group[(32.50±4.26) min vs. (36.43±3.58) min,(3.72±1.57) points vs.(4.53±1.34) points],and the success rate of puncture was significantly higher than that in the two-step group(96.43% vs.76.69%),with statistically significant differences (P＜0.05).After treatment,the levels of TBIL,ALP and ALT in the two groups were significantly reduced (P＜0.05),but there was no statistically significant difference between the groups (P>0.05).There was no statistically significant difference in the incidence of complications between the two groups (3.57% vs.7.14%,Fisher’s exact probability=0.679).The satisfaction rate in the one-step group was significantly higher than that in the two-step group (94.64% vs.75.00%),with a statistically significant difference (P＜0.05).ConclusionThe operation time of one-step PTHD is shorter and the success rate of puncture is higher.In addition,patients undergoing one-step PTHD have milder pain,and are more satisfied.

Objective To explore the molecular mechanism of programmed cell death 10 (PDCD10) mediating glioma migration.Methods A PDCD10-silenced glioma cell line (U251) was constructed by siRNA,and the cells were treated with Okadaic Acid (OA),a protein phosphatase 2A (PP2A) phosphatase inhibitor,to investigate the effect of down-regulation of PDCD10 on the behavior of U251 cells; Western Blot (WB) was applied to detect the expression of PDCD10,PP2A,PP2Ac-307,p38 and pP38 in the control group and PDCD10 down-regulation group of U251 cells,to study the mechanism of PDCD10 regulation of PP2A/p38 signaling.Results Down-regulation of PDCD10 in U251 cells promoted the cells migration (P<0.05),which could be inhibited by PP2A phosphatase inhibitor OA (P<0.01).Further studies showed that down-regulation of PDCD10 promoted glioma cell migration via modulating the phosphorylation of PP2A,which in turn altered the activity of p38 (P<0.01).Conclusion PDCD10 may mediate glioma cell migration by regulating PP2A/p38 signaling.

Objective To investigate the clinical efficacy and postoperative complications of surgical treatment for middle-aged and severe elderly patients with Methods A retrospective analysis was conducted on the clinical data,efficacy,and postoperative complications of 80 elderly patients with traumatic intracranial hematoma who underwent surgical treatment at the Neurosurgery Department of Jianli People’s Hospital from January 2021 to November 2023.The Glasgow Outcome Scale was used to evaluate their clinical prognosis,and they were divided into a good prognosis group and a poor prognosis group based on their scores.Univariate analysis and multivariate logistic regression analysis were used to analyze the influencing factors related to poor prognosis,and compared with the expected prognosis calculated by the International Clinical Trial Study on Brain Injury Prognosis (IMPACT) model to evaluate the therapeutic effect of the surgery.Results Among 80 patients aged 60 and above who underwent surgery for moderate to severe traumatic intracranial hematoma,46 (57.5%) had a good prognosis after 6 months of follow-up,34 (42.5%) had a poor prognosis,and 13 (16.25%) died.The expected poor prognosis rate was calculated to be 63.8% by using the IMPACT experimental core model,and the expected mortality rate was 46.6%.The actual prognosis was better than the expected one.The difference between the actual and expected prognosis and the actual and expected mortality was statistically significant (P<0.05).Univariate analysis suggests that patient’s pupil response,preoperative GCS score,hematoma location,cisternaambiens status,midline displacement,and hematoma size are correlated with patient prognosis.Multivariate analysis suggests that the status of the cisternaambiens is an independent risk factor for poor prognosis in elderly patients with moderate to severe traumatic brain injury.Conclusion Elderly patients with traumatic intracranial hematoma who have surgical indications should be treated with surgery,and the results of aggressive treatment are good.The failure to correct intracranial hypertension in postoperative patients is the main cause of death. traumatic intracranial hematoma.

Objective To explore the risk factors for lower limb venous thrombosis in patients after craniocerebral surgery,and establish a prognostic nomogram for the occurrence of lower limb venous thrombosis. Methods A total of 427 patients who underwent craniotomy for craniocerebral trauma and met the inclusion criteria in the First People’s Hospital of Taicang from January 2018 to December 2020 were collected as training group, and the nomogram was drawn and verified internally. And 106 patients who underwent surgery from January 2021 to June 2021 were used as test group, and the model was externally verified set. The nomogram was established and internally validated with the data of the training group,and externally validated with the data of the test group. For the training group,multivariate Logistic regression analysis was performed by including all variables with P<0.05 in univariate analysis,and established the prognostic nomogram by R software. In the training group and the test group,the performance of the nomogram was verified by C-index,calibration chart and decision curve analysis respectively. Results In the training group of 427 people,107 had lower limb venous thrombosis,with an incidence rate of 25.1%. Among the 106 people in the test group,33 developed lower limb venous thrombosis,with an incidence rate of 31.1%. Multivariate logistic regression analysis showed that age,lower preoperative GCS score,postoperative lower limb muscle strength＜3,hypertension,and diabetes were independent risk factors for the occurrence of lower limb vein thrombosis after craniocerebral surgery. The C-index of this nomogram in the training group and the test group was 0.837 (95%CI:0.796-0.878) and 0.933 (95% CI:0.886-0.979),respectively. Conclusion The nomogram including the age,preoperative GCS score,postoperative lower limb muscle strength＜3,hypertension,and diabetes can predict the probability of lower limb vein thrombosis after craniocerebral surgery with convenient discrimination and clinical utility.

Objective To investigate the relationship between the expression of serum microRNA-326 (miR-326) and microRNA-623 (miR-623) in non-small cell lung cancer (NSCLC) patients and their clinical pathological characteristics and prognosis.Methods A total of 114 NSCLC patients diagnosed in our hospital from March 2019 to June 2020 were collected as study subjects as case group,123 healthy individuals who underwent physical examination were as the control group.According to the 3-year prognosis,patients were separated into a survival group of 71 cases and a death group of 43 cases.Patient related clinical data were collected,real-time fluorescence quantitative PCR method was applied to detect the expression levels of miR-326 and miR-623 in various serum samples;Kaplan-Meier method was applied to analyze the relationship between the expression levels of serum miR-326 and miR-623 in NSCLC patients and their 3-year prognosis;Cox proportional risk regression model was applied to analyze the influencing factors of 3-year prognosis in NSCLC patients.Results The expression levels of serum miR-326 in the case group and control group were 0.64±0.15 and 1.02±0.23, respectively， and the expression levels of miR-623 were 0.56±0.10 and 0.98±0.15, respectively.The difference between the two groups was statistically significant (P<0.05).The proportions of patients with low expression of miR-326 and miR-623 in low differentiation,TNM stage III+IV,and lymph node metastasis were higher than those in high differentiation,TNM stage I and II,and no lymph node metastasis (P<0.05).The 3-year survival rates of patients with low expression of miR-326 (20/55,36.36%) and miR-623 (27/61,44.26%) in the serum of NSCLC patients were lower than those of patients with high expression of miR-326 (51/59,86.44%) and miR-623 (44/53,83.02%) (Log Rank χ²=32.060，22.812，P<0.05).Serum miR-326 [(0.55±0.09) vs. (0.69±0.11)] and miR-623 levels [(0.48±0.08)vs. (0.61±0.10)] of patients in the death group were significantly lower than those in the survival group (P<0.05).The area under the curve (AUC) for poor prognosis of serum miR-326 and miR-623 alone and in combination in patients diagnosed with NSCLC were 0.828 (95%CI:0.754 to 0.901),0.763 (95%CI:0.671 to 0.855),and 0.903 (95%CI:0.849 to 0.958),respectively.The proportions of patients with TNM stage Ⅲ+Ⅳ,lymph node metastasis,low expression of miR-326 and low expression of miR-623in the death group were higher than those in the survival group (P<0.05).MiR-326 and miR-623 were protective factors affecting 3-year mortality in NSCLC patients,while TNM staging and lymph node metastasis were independent risk factors affecting 3-year mortality in NSCLC patients (P<0.05).Conclusion The low expression of miR-326 and miR-623 may be involved in the occurrence and development of lung cancer,which is closely related to the clinical pathological characteristics and poor prognosis of patients.

Objective To analyze the clinical characteristics and prognostic risk factors of esophageal signet ring cell carcinoma (SRCC) patients and construct a column chart prediction model.Methods The training queue consists of 226 patients diagnosed with esophageal SRCC from 2010 to 2017 in the SEER database,and the validation queue consists of 21 patients diagnosed with esophageal SRCC in our hospital from January 2010 to January 2019.Use Cox proportional risk regression model for single factor and multivariate analysis.Use the “rms” software package of R software to generate column charts.Results Univariate analysis showed that age,gender,tumor location,local invasion,lymph node metastasis,distant metastasis,surgical treatment,chemotherapy,and radiotherapy were risk factors affecting the prognosis of SRCC patients (P<0.05);In multivariate cox regression analysis,the results showed that tumor location,local invasion,lymph node metastasis,distant metastasis,surgical treatment,chemotherapy,and radiotherapy were independent risk factors affecting the prognosis of SRCC patients (P<0.05);A nomogram prediction model was successfully constructed using multivariate cox regression analysis,with a certain degree of predictive accuracy.Conclusion The nomogram prediction model was successfully constructed based on the risk factors affecting the prognosis of esophageal signet ring cell adenocarcinoma patients in the SEER database,which can provide more accurate predictions for the prognosis of esophageal SRCC patients.

Objective To investigate the risk factors for cervical anastomotic leakage after esophagectomy of esophageal cancer,and to establish a predictive nomogram model and verify its predictive ability.Methods A total of 623 patients diagnosed with esophageal cancer and treated with esophagectomy in the affiliated cancer hospital of Nantong university from January 2019 to December 2022 were selected and randomly divided into the modeling set group (n=428) and the validation set group (n=195) in a ratio of 7∶3.The patients in the modeling set group were divided into 2 groups based on the incidences of cervical anastomotic leakage.The baseline clinical data of 2 groups were collected and compared,and the risk factors of cervical anastomotic leakage were analyzed by multivariate Logistic regression.The nomogram model was constructed by R software and its accuracy was verified.The internal and external validation were conducted.Results Among the 428 patients with esophageal cancer in the modeling group,8.18% (35/428) had cervical anastomotic leakage after esophagectomy.The proportion of patients with hypertension,diabetes,neoadjuvant therapy,upper esophageal tumor,postoperative albumin ≤30 g/L and postoperative hypoxemia in the anastomotic leakage group were significantly higher than those in the non-anastomotic leakage group (P＜0.05).Multivariate Logistic regression analysis showed that neoadjuvant therapy,upper esophageal tumor,postoperative albumin ≤30 g/L and postoperative hypoxemia were independent risk factors for cervical anastomotic leakage after esophagectomy of esophageal cancer (P＜0.05).The C-index of the modeling set and validation set were 0.873 (95%CI:0.781-0.965) and 0.887 (95%CI:0.744-0.972),respectively.The calibration curves of 2 groups fitted well with the standard curve.The receiver operating characteristic curve (ROC) analysis of 2 groups showed that the area under the curve (AUC) was 0.811 (95%CI：0.738-0.865) and 0.825 (95%CI:0.720-0.913),,respectively,showing good prediction accuracy.Conclusion Establishing a nomogram model based on neoadjuvant therapy,upper esophageal tumor,postoperative albumin≤30 g/L and postoperative hypoxemia can accurately predict the risk for cervical anastomotic leakage after esophagectomy of esophageal cancer.

Objective To investigate the expression of long non-coding RNA (lncRNA) brain-derived neurotrophic factor-antisense (BDNF-AS) and semaphorin 3B-antisense 1 (SEMA3B-AS1) in patients with gastric cancer and the application value of combined ultrasound in the diagnosis of gastric cancer.Methods From January 2021 to February 2023,118 gastric cancer patients admitted to our hospital were retrospectively selected as the gastric cancer group,another 113 cases with benign gastric lesions in our hospital were as the benign lesion group.Real-time fluorescence quantitative PCR (qRT-PCR) was applied to detect the expression levels of serum BDNF-AS and SEMA3B-AS1,and patients were divided into BDNF-AS high expression group (n=55) and BDNF-AS low expression group (n=63),SEMA3B-AS1 high expression group (n=57),and SEMA3B-AS1 low expression group (n=61) based on the average value;Kappa test was applied to analyze the consistency between ultrasound diagnosis and clinical pathological diagnosis;receiver operating characteristic curve (ROC) was applied to analyze the diagnostic value of serum BDNF-AS and SEMA3B-AS1 combined with ultrasound for gastric cancer.Results Compared with the benign lesion group,the serum levels of BDNF-AS and SEMA3B-AS1 in the gastric cancer group were obviously lower (t=10.205,t=9.590,P＜0.05);the expression levels of BDNF-AS and SEMA3B-AS1 were obviously lower in gastric cancer patients with tumor diameter ≥ 3 cm,deeper infiltration depth,lower differentiation,and lymph node metastasis (P＜0.05);Kappa test results showed a high consistency between ultrasound diagnosis and clinical pathological diagnosis (Kappa value=0.723,P＜0.05);ROC results showed that the AUC of serum levels of BDNF-AS,SEMA3B-AS1,and ultrasound in diagnosis of gastric cancer was 0.848,0.835,and 0.861,respectively,the AUC (0.949) diagnosed by the combination of the three was obviously higher than that diagnosed by serum BDNF-AS alone (Z=4.713,P=0.000),serum SEMA3B-AS1 level alone (Z=4.112,P=0.001 5),and ultrasound diagnosis (Z=3.350,P=0.000 8),the sensitivity and specificity of the combined diagnosis were superior to those diagnosed by the three alone.Conclusion The combination of serum BDNF-AS and SEMA3B-AS1 ultrasound has high practical value in the diagnosis of gastric cancer.

Objective To investigate the influencing factors of pulmonary infection in elderly patients with gastric cancer (GC) after laparoscopic surgery.Methods A total of 228 elderly patients with GC who underwent laparoscopic radical resection in our hospital from September 2020 to September 2023 were selected.According to the pulmonary infection within 30 days after operation,they were divided into pulmonary infection group and control group.The clinical data of the two groups were compared,the independent risk factors of postoperative pulmonary infection were identified,the regression risk prediction model was established,and the goodness of fit and prediction efficiency of the model were judged.Results There were 31 cases (13.60 %) of postoperative pulmonary infection in 228 elderly patients with GC.Logistic regression analysis showed that operation time,intraoperative blood transfusion,postoperative wound pain,nutritional risk and frailty were independent risk factors for postoperative pulmonary infection (P<0.05).Hosmer-Lemeshow test showed that P=0.147,suggesting that the model was effective.The receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) of the model for predicting postoperative pulmonary infection was 0.775,the predictive sensitivity was 70.97 %,and the specificity was 81.22 %.Conclusion Operative time, intraoperative blood transfusion, postoperative wound pain, nutritional risk and frailty were all independent risk factors for postoperative pulmonary infection in elderly patients with GC (OR were 1.022, 2.607, 3.629, 2.938, 2.789, respectively)(P < 0.05). The risk model established based on these factors had good predictive value.

Objective To apply gastrointestinal ultrasound to evaluate the gastrointestinal function of patients with acute gastrointestinal injury (AGI) and to determine the timing of starting enteral nutrition (EN) therapy to guide clinical enteral nutrition therapy.Methods One hundred and three critically ill patients with AGI level 2 (AGI Ⅱ) were prospectively screened at the Department of Intensive Care Medicine (ICU) of the Second People’s Hospital of Anhui Province from March 2022 to May 2023,and the following data were recorded,including ultrasound gastric sinus cross-sectional area (CSA),diameter of the descending or ascending colon (CD),peristaltic frequency (CPF),time of EN initiation,prealbumin (PA),EN dose and EN complications.Recovery of gastrointestinal function after EN treatment was judged as successful,and failure was judged if there were complications of EN treatment.Changes in gastrointestinal function after EN treatment were analyzed to determine the timing of enteral nutrition.Results There were 68 cases in the successful group and 35 cases in the failed group.There were no statistically significant differences between the two groups in terms of age,intra-abdominal pressure (IAP),Acute Physiology and Chronic Health Status Score Ⅱ (APACHE-Ⅱ),PA,and disease composition (all P>0.05).The EN initiation time [(14.71±8.89)h],CSA [(9.24±1.30)cm²] and CD [(2.86±0.41)cm] in the successful group were earlier or smaller than the failed group [(19.52±13.53)h,(10.82±1.96)cm² and (3.38±0.46)cm](all P<0.05),whereas the CPF [(2.84±0.96) times/min] in the successful group was faster than thefailed group [(2.32±0.98) times/min] (P<0.05).ROC analysis showed greater value for CSA,CD and CPF to predict EN success,with thresholds of CSA ≤ 9 cm² (AUC = 0.892),CD ≤ 2.8 cm (AUC = 0.858) and CPF > 3 times/min (AUC =0.744);when the combination of CSA,CD and CPF was predicted to generate PRE_1,the AUC was the largest (0.968) and had the highest predictive value,which could determine the best time to initiate EN.Conclusion Ultrasound monitoring of the cross-sectional area of the gastric sinus,the internal diameter of the colon,and the frequency of colonic peristalsis can predict the efficacy of enteral nutrition therapy in critically ill patients with grade Ⅱ acute gastrointestinal injury and guide the optimal timing of initiating enteral nutrition therapy.

Objective To investigate the effect of laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) in the treatment of obese diabetes.Methods The clinical data of 20 obese diabetic patients who received LRYGB from 2012 to 2018 in the Minimally Invasive and Herniac Abdominal Surgery Center of Xinjiang People’s Hospital were retrospectively analyzed.Result The all 20 surgeries were successfully completed,and 1 case was converted to open surgery.The surgical time ranged from 60 to 420 minutes, with an average of (150±105.64) minutes,the intraoperative blood loss ranged from 20 to 100, with an average of (37.5 ± 20.99) ml,and the postoperative hospital stay ranged from 5 to 15, with an average of (8.25 ± 2.51) days.Complications occurred in 7 cases (35.00%) within 5 years after surgery,all of which were Clavien Dindo grade Ⅱ.The body weight,BMI,glycosylated blood glucose,fasting blood glucose,and the percentage of total weight loss (TWL%) at 1,3,and 5 postoperatively improved compared with those before surgery (P＜0.05).15 cases (75.00%) of type 2 diabetes were completely relieved by LRYGB 5 years after operation.Conclusion Laparoscopic gastric bypass surgery is an effective way to reduce weight and blood sugar in obese patients with type 2 diabetes.

Objective Exploring the effect of Percutaneous angular vertebroplasty (PCVP) on functional recovery in elderly patients with osteoporotic vertebral compression fractures (OVCF).Methods Retrospective selection of clinical data from 108 OVCF patients admitted to our hospital from August 2020 to December 2022.According to the different surgical methods,52 cases were divided into a control group (percutaneous vertebroplasty) and an observation group (percutaneous vertebroplasty) with 56 cases;Compare the recovery of vertebral body function,imaging related parameters,functional impairment and lumbar function,surgical related conditions,gait,and complications between the two groups.Results The intraoperative blood loss in the observation group was less than that in the control group[(10.65±3.52)ml vs.(13.11±3.66)ml,P＜0.05],the number of intraoperative fluoroscopy was less than that of control group[(14.21±4.27) vs.(17.04±4.25)，P＜0.05],there was no statistically significant difference in the total clinical effective rate between the observation group of 89.28% and the control group of 86.53% (P>0.05).After 2 months of surgery,the imaging related parameters,functional impairment,lumbar function,surgical and gait related conditions in the control group were better than those in the control group (P<0.05).There was no statistically significant difference in the incidence of incision infection,nerve root injury,and recurrent fractures between the two groups (P>0.05),but the leakage rate of bone cement in the observation group was lower than that in the control group (P<0.05).Conclusion Both surgeries can effectively improve the level of lumbar vertebral function in OVCF patients.PVCP has advantages in increasing the height of the anterior and posterior edges of the vertebral body,reducing the Cobb angle,and relatively fewer intraoperative fluoroscopy times and bleeding.The incidence of bone cement leakage is lower,making it more safe.

Objective To evaluate the efficacy of combining 3D printing with T-shaped steel plate elastic fixation in the treatment of complex acetabular fractures involving the posterior column.Methods A total of 84 patients with complex acetabular fractures involving the posterior column,admitted to the hospital from January 2020 to January 2023,were randomly divided into an observation group (42 cases) and a control group (42 cases) using a random number table.The control group underwent T-shaped steel plate elastic fixation,while the observation group received 3D printing in addition to the conventional treatment.The surgical outcomes,fracture healing time,and reduction quality were compared between the two groups.Additionally,serum bone morphogenetic protein-2 (BMP-2),transforming growth factor-β1 (TGF-β1),bone callus density,and postoperative complications were compared between the two groups.Results The operation time and fracture healing time of the observation group were (227.58±25.96) minutes and (42.54±3.68) days, which were lower than (285.47±35.85) minutes and (56.98±6.74) days of the conventional group, and the differences were statistically significant (P < 0.05). The intraoperative blood loss of the observation group was (458.25±48.14) ml, which was less than the conventional group[(526.35±58.52) ml] , and the difference was statistically significant (P < 0.05).On the 30th day after surgery,BMP-2 of the observation group and the conventional group was(86.98±10.36) ng/L and (82.39±9.20) ng/L,respectively,TGF-β1was (63.85±8.17) ng/ml and (55.85±7.12) ng/ml,respectively.The levels of BMP-2 and TGF-β1 in the observation group and the conventional group were higher than those before operation (P＜0.05),and the levels of BMP-2 and TGF-β1 in the observation group were higher than those in the conventional group (P＜0.05).The excellent and good rate of fracture reduction in observation group (95.24%) was higher than that in conventional group (80.95%) (P<0.05).The bone callus density [(0.44±0.07) g/cm² and (0.59±0.10) g/cm²] in the observation group were higher than those in the conventional group [(0.32±0.04) g/cm² and (0.42±0.09) g/cm²] at 30 d and 3 months after surgery (P<0.05),and there were 2 cases of traumatic arthritis in the conventional group.One case of ectopic ossification,the total complication rate was 7.14%;In the observation group,there were 2 cases of traumatic arthritis and 2 cases of ectopic ossification.The total complication rate was 9.52%.There was no significant difference in the total complication rate between the two groups (P＞0.05).Conclusion The combination of 3D printing and T-shaped steel plate elastic fixation in the treatment of complex acetabular fractures involving the posterior column can achieve satisfactory surgical reduction,promote fracture healing,improve bone callus density,and is safe and reliable.

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

Objective To analyze the typical biomarker of cancer-related fibroblasts-fibroblast activation protein-α(FAP) expression in tumor tissue and perinephric adipose tissue and its clinical value in risk stratification of clear cell renal cell carcinoma(ccRCC).Methods A retrospective cross-sectional study was conducted on ccRCC patients who underwent nephrectomy in Dongfeng General Hospital of Sinopharm Affiliated to Hubei Medical College from June 2018 to September 2022.The expression of FAP in ccRCC renal tumor tissue(n=114),non-neoplastic renal cortex tissue(n=68) and perirenal adipose tissue(n=60) was detected by immunohistochemical staining,and immunohistochemical images were quantitatively analyzed.The benign adipose tissue around the kidneys from 19 patients with benign kidney disease were collected as a control group, and also detect FAP expression. Receiver operating characteristic (ROC) curves was used to analyze the ability of FAP expression in perirenal adipose tissue to diagnose ccRCC and predict distant metastasis.Results Compared with matched non-neoplastic renal tissues,the expression of FAP in ccRCC was not up-regulated.The receiver operating characteristic(ROC) curve analysis showed that the percentage of FAP positive staining in ccRCC tissue had good tumor clinical stage,tumor size and distant metastasis potential(P＜0.001),and the area under the curve(AUC) were 0.90(95%CI:0.81-0.98),0.79(95%CI:0.66-0.92) and 0.86(95%CI:0.74-0.99),respectively.The percentage of FAP positive staining in perinephric adipose tissue of ccRCC can predict distant metastasis,and the AUC is 0.91(95%CI:0.84～0.97).The staining intensity of FAP expression in perinephric adipose tissue of ccrcc(191.77±3.14 vs.188.90±2.89,P＜0.001) was slightly higher than that of benign renal disease,and the staining intensity of FAP in perinephric adipose tissue had a certain distinguishing value for benign and malignant renal tumors,with AUC of 0.68(95%CI:0.60～0.77).Conclusion FAP in tumor and perinephric adipose tissue is expected to be one of the effective indicators of ccrcc risk stratification.

Objective To contrast the diagnostic efficacies of perineal and transrectal approaches for combined prostate biopsies guided via magnetic resonance imaging (MRI) and ultrasound fusion imaging.Method A retrospective analysis of clinical data from 271 patients subjected to combined prostate biopsies guided by MRI and ultrasound fusion imaging at the first people’s hospital of Wuxue city and Wuhan Tongji Hospital from January 2022 to November 2023 was conducted.They were divided into two groups according to the puncture path, 132 cases were transrectal and 139 cases were perineal.The differences between the detection rates of prostate cancer (PCa) and clinical significant prostate cancer (csPCa) across different prostate imaging reporting and data system (PI-RADS) scores and lesion localizations within the two puncture paths were compared.Results The detection rates of PCa in the perineal and transrectal puncture groups (68.3% vs. 59.8%,P=0.145) and csPCa (64.7% vs. 55.3%,P=0.112) did not exhibit statistically significant differences.However,the perineal puncture group experienced fewer complications.For patients with a PI-RADS score of 4,both PCa (77.2% vs.56.1%,P=0.027) and csPCa (71.9% vs.48.8%,P=0.02) detection rates were higher via the perineal combined biopsy),compared to the transrectal path.Additionally,for apical (PCa：84.3% vs.48.7%，P=0.001；csPCa：81.8% vs.48.7%，P=0.004) and anterior (PCa：77.1% vs.46.5%，P=0.006；csPCa：68.6% vs.44.2%，P=0.031) prostate lesions,the detection rates via the perineal combined biopsy were considerably higher than those of the transrectal path.Conclusion For patients carrying a PI-RADS score of 4 or with prostate lesions situated at the apical or anterior section,the perineal approach for biopsy sampling emerges as the most appropriate method.

Objective To investigate the expression of miR-143-3p and ATG2B in serum of patients with bladder cancer and their relationship with clinicopathology,prognosis and survival of patients.Methods Eighty-eight patients who underwent radical bladder cancer surgery in our hospital from January 2017 to January 2019 were regarded as the research group,and 80 volunteers who underwent physical examination in our hospital were included as the control group.Quantitative real-time PCR (qRT-PCR) method was performed to detect the levels of miR-143-3p and ATG2B;The predictive value of miR-143-3p and ATG2B for bladder cancer was evaluated by ROC curve.Draw survival curve using Kaplan Meier method;The prognostic factors of bladder cancer patients were analyzed by Cox regression.Results The expression level of miR-143-3p in the serum of bladder cancer patients was lower than that in the control group (0.68±0.12 vs. 0.87±0.26),and the expression level of ATG2B was higher (1.02±0.30 vs. 0.61±0.18) (P<0.05);the expression level of miR-143-3p in serum of postoperative patients was higher than that before operation (0.77±0.23 vs. 0.68±0.12),and the expression level of ATG2B was lower than that before operation (0.85±0.26 vs. 1.02±0.30) (P<0.05);The study group showed a negative correlation between miR-143-3p and ATG2B expression (r=-0.454,r=-0.407,P<0.01);The AUC of miR-143-3p in the diagnosis of bladder cancer was 0.846 (95%CI:0.783-0.897),the sensitivity and specificity were 79.55% and 78.75% respectively;The AUC of ATG2B in the diagnosis of bladder cancer was 0.883 (95%CI:0.824-0.927),the sensitivity and specificity were 78.41% and 81.25% respectively;The AUC for the diagnosis of bladder cancer was 0.939 (95%CI:0.891-0.970),the sensitivity and specificity were 87.50% and 88.75%,respectively.The 3-year survival rate of the miR-143-3p low expression group was 34.88% (15/43) lower than that of the high expression group 77.78% (35/45),and the 3-year survival rate of the ATG2B high expression group was 40.91% (18/44) lower than that of the low expression group 72.73% (32/44).The differences were statistically significant (Log rank χ²=18.055,8.658,P=0.000,0.003).Lymph node metastasis,distant metastasis,tumor pathological grade,TNM stage,miR-143-3p,ATG2B are all factors influencing the survival of bladder cancer patients.Conclusion The serum expression of miR-143-3p in patients with bladder cancer is low,and the expression of ATG2B is high,and the expressions of the two are closely related to the clinicopathological characteristics and prognosis of patients with bladder cancer.

Objective To explore the clinical study of the treatment of Diabetic foot with wound negative pressure treatment (NPWT) combined with periosteal distraction.Methods 129 patients with Diabetic foot admitted to our hospital from June 2022 to April 2023 were randomly divided into a combination group (n=43),a negative pressure group (n=43),and a control group (n=43).The control group was treated with conventional treatment,the negative pressure group was treated with NPWT,and the combined group was combined with periosteal distraction technique on the basis of the negative pressure group.The treatment efficiency,inflammatory index level,peripheral blood picture level,visual pain (VAS) score,and foot related index level of the three groups were compared.Results After 4 weeks of treatment,the scores of pain scale (VAS),white blood cell count (WBC),Calcitonin (PCT),Interleukin 6 (IL-6),and high-sensitivity C-reactive protein (hs CRP) in the combined group were lower than those in the other two groups (P<0.05);The effective rate,foot temperature,toe blood oxygen,Ankle-brachial pressure index,vascular diameter,blood flow velocity,and perfusion index (PI) of the combined group were higher than those of the other two groups (P<0.05).Conclusion The combination of wound negative pressure therapy and periosteal distraction surgery can effectively alleviate pain,improve foot blood supply,and alleviate inflammatory reactions.

Objective To investigate the effects of dexmedetomidine (DEX) combined with sufentanil for patient-controlled intravenous analgesia (PCIA) on postoperative immune function and respiratory function recovery in patients undergoing thoracoscopic radical resection of lung cancer.Method From October 2020 to June 2022,92 ASA Ⅰ or Ⅱ patients scheduled for thoracoscopic radical resection of lung cancer were selected in our hospital,and they were randomly divided into sufentanil group (Group S) and DEX group (Group D) with 46 cases in each group.There was one case of postoperative bleeding in group S and one case of intraoperative bleeding in group D withdrew from the experiment.the group S postoperative PCIA with sufentanil injection 1.0 μg/kg pre day and tropisetron hydrochloride 20 mg/150 ml,Group D was treated with dexmedetomidine 1.0 μg/kg pre day and sufentanil injection 1.0 μg/kg pre day and tropisetron hydrochloride 20 mg/150 ml.At the four time points in preoperative day (T₀),24 h(T₁),48h(T₂) and 72 h(T₃) after operation.Rest and cough NRS scores and SAS scores were recorded and venous blood samples were taken to detected CD3⁺,CD4⁺,CD8⁺,CRP and PCT,Arterial blood gas analysis was detected to calculate OI;clinical pulmonary infection score (CPIS),the incidence of hypoxemia and pulmonary edema and adverse reactions including nausea and vomiting,drowsiness,bradycardia,respiratory depression and shivers were recorded at T₂.Results Compared with S group,NRS score of resting or cough,SAS score,CRP and PCT of group D were significantly decreased at T₁ to T₃ (P<0.05),while CD3⁺,CD4⁺,CD4⁺/CD8⁺ and OI value was increased,CD8⁺ was only lower in T₁ (P<0.05).There were no significant differences in rest and cough NRS scores、SAS scores、CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺、CRP,PCT and OI between the two groups at T₀(P＞0.05).Compared with T₀,Rest and cough NRS scores、CRP and PCT were significantly increased,CD3⁺、CD4⁺、CD4⁺/CD8⁺、OI and SAS scores were decreased in the two groups at T₁-T₃,CD8⁺ increased only at T₁ and T₂(P<0.05).Compared with group S[8(17.8%),(3.5±1.3)],the proportion of nausea and vomiting and CPIS score in group D[1(2.2%),(1.2±1.1)] was decreased (P<0.05).There was no significant difference in the proportion of hypoxemia,pulmonary edema,drowsiness,bradycardia,respiratory depression and shivers(P＞0.05).Conclusion Dexmedetomidine combined with sufentanil patient-controlled analgesia has better analgesic and sedative effects,which can not only reduce the degree of immunosuppression caused by surgical trauma,but also reduce the adverse reactions of opioids,and is conducive to the recovery of postoperative respiratory function.It is a safer PCIA method after thoracoscopic radical resection of lung cancer.

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.

Laparoscopic distal pancreatectomy is the conventional treatment for tumors of the pancreatic body or tail.And laparoscopic spleen-preserving distal pancreatectomy has been emphasized because it can preserve the spleen’s function and lower the complications following splenectomy.However,the occult onset and complex anatomical location of pancreatic tumors pose a challenge to their diagnosis and spleen-preserving distal pancreatectomy.In recent years,our team has accumulated rich experience in the diagnosis and treatment of pancreatic tumors,and innovatively proposed the “SELECT” concept (S-Single-Operator Cholangiopancreatoscopy,E-ERCP,L-Laparoscopy,E-Endoscopic ultrasound,C-Choledochoscopy/Confocal laser endomicroscopy,T-Traditional Chinese medicine) for diagnosis and treatment.Based on the various characteristics of pancreatic tumors,various endoscopic and laparoscopic techniques are applied,and an optimal combination of various minimally invasive methods is selected.Fully applying the SELECT concept to laparoscopic spleen-preserving distal pancreatectomy is conducive to accurate preoperative diagnosis,accurate intraoperative resection,prediction and treatment of postoperative complications,and one-stop diagnosis and treatment of pancreatic tumors,maximizing patient benefits.

At present,the incidence of breast cancer has been the first in the world,and hormone receptor-positive (HR⁺) / human epidermal growth factor receptor 2-negative (HER2^-) advanced breast cancer has seriously affected the prognosis of patients.In the past,the therapeutic drugs were mainly third-generation aromatase inhibitors (AI) and fulvestrant.In recent years,the era of endocrine therapy combined with cyclin-dependent kinase4/6(CDK4/6) inhibitors has begun.Different CDK4/6 inhibitors have different related adverse events,and they need to evaluate the physical condition of patients and develop a treatment plan,but neutropenia is prevalent.Everolimus,Alpelisib,and Chidamide are second-line therapeutic drugs.