Carcinoma oral de células escamosas en reborde alveolar / Squamous cell carcinoma in the alveolar ridge

El carcinoma oral de células escamosas o epidermoide o espinocelular, es la neoplasia maligna más común en cavidad oral y orofaringe, representa de 3-5% de todas las neoplasias y da metástasis a los ganglios linfáticos regionales. Los factores de riesgos son múltiples, el consumo excesivo de alcohol y tabaco son los más reconocidos, los movimientos parafuncionales, la higiene y nutrición y por supuesto la genética, todos son factores importantes en el desarrollo de este carcinoma. Tiene una prevalencia mayor en el sexo masculino, aunque en los últimos años se ha visto un aumento en el sexo femenino posiblemente por el aumento en el consumo de alcohol y tabaco. La edad comprende entre la cuarta a sexta década de la vida, por el aumento en el consumo de alcohol y tabaco en este rango de edad. Las localizaciones más comunes son el borde lateral de la lengua y el piso de la boca. La presentación clínica es variable, puede encontrarse en un principio como una placa blanca o roja asintomática, exofítico, ulcerada, granular y bordes indurados. El tratamiento debe ser quirúrgico radical con radio o quimioterapia y el pronóstico depende del tiempo del diagnóstico (AU)

Squamous cell carcinoma, also known as epidermoid or squamous cell carcinoma, is the most common malignant neoplasm in the oral cavity and oropharynx. It represents 3 to 5% of all neoplasms and metastasizes to regional lymph nodes. There are multiple risk factors, with excessive alcohol and tobacco consumption being the most recognized. Parafunctional movements, hygiene and nutrition, and of course genetics, are all important factors in the development of this carcinoma. It has a higher prevalence in males, although in recent years there has been an increase in females, possibly due to increased alcohol and tobacco consumption. The age range typically affected is the 4th to 6th decade of life, due to the increased alcohol and tobacco consumption within this age range. The most common locations are the lateral border of the tongue and the floor of the mouth. The clinical presentation varies and can initially appear as an asymptomatic white or red plaque, exophytic, ulcerated, granular, or with indurated borders. The treatment should involve radical surgery with radiotherapy or chemotherapy, and the prognosis depends on the timing of diagnosis (AU)

Experience in the treatment of liver echinococcosis in Grodno Region, Belarus

Background: A parasitic hydatid disease called liver echinococcosis is brought on by the tapeworm echinococcus and is a reason for concern for global health. In addition to the liver, the lungs can harbor parasites. In the life cycle of parasites, humans occupy a middle position. Depending on the size and intensity of the cyst, the clinical signs can vary and be non-specific. The complications include bleeding, perforation, suppuration, cyst rupture, mechanical jaundice, and portal hypertension. Here is an analysis of own results of surgical treatment of patients with liver echinococcosis in Grodno region, Belarus between June 2012 to October 2022. Methods: The research design was cross-sectional. Diagnostic methods that are instrumental and laboratory-based include a general blood test, a biochemical blood test, an enzyme immunoassay (IFA), abdominal and retroperitoneal MRIs and ultrasounds, abdominal and chest CT scans and brain scans. There were 10 men and 17 women among the 27 patients. The age range of the majority of the patients was 18 to 83. Results: All patients underwent resections, including laparoscopic procedures. One of the patients in our series of cases received a two-stage therapy regimen due to a secondary focus of echinococcosis in the left lung. In our series of cases, no postoperative complications or mortality occurred. Conclusions: Patients with hepatic echinococcosis should be treated at specialized hospitals. Abdominal, chest, and brain CT scans are required in order to search for additional foci. When it comes to treating echinococcosis, minimal invasive surgical procedures should be preferred.

Fractura de seno frontal: reporte de caso clínico / Fratura do seio frontal: relato de caso clínico / Frontal sinus fracture: clinical case report

Introducción: Las fracturas del seno frontal, representando del 5% al 15% de las lesiones faciales traumáticas. La tomografía computarizada sin contraste es esencial para el diagnóstico. Clasificadas en cinco tipos según su trayectoria, la elección del tratamiento quirúrgico se basa en factores como ubicación, desplazamiento, integridad del tracto de salida del seno frontal y lesiones asociadas. Los objetivos de la intervención quirúrgica incluyen tratar fugas de líquido cefalorraquídeo, proteger estructuras intracraneales y prevenir complicaciones tardías como meningitis y osteomielitis frontal. Descripción del caso clínico: Paciente masculino de 26 años de edad, remitido al Hospital Vicente Corral Moscoso para valoración y manejo de trauma facial. A los 7 días de su ingreso bajo anestesia general balanceada se realizó el procedimiento quirúrgico que consistió en reducción más fijación con malla frontal más cinco tornillos de la fractura de la pared anterior del seno frontal derecho. Conclusiones: Se sugiere un enfoque multidisciplinario con neurocirujano y cirujano maxilofacial para tratar fracturas faciales superiores. El tratamiento actual considera la afectación de la tabla posterior, la permeabilidad del tracto de salida del seno frontal y el desplazamiento de la tabla anterior. Se prioriza el manejo temprano para proteger estructuras intracraneales, restaurar la función del seno frontal y prevenir complicaciones... (AU)

Introdução: Fraturas do seio frontal, representando 5% a 15% das lesões faciais traumáticas. A TC sem contraste é essencial para o diagnóstico. Classificada em cinco tipos de acordo com sua trajetória, a escolha do tratamento cirúrgico baseia-se em fatores como localização, deslocamento, integridade da via de saída do seio frontal e lesões associadas. Os objetivos da intervenção cirúrgica incluem o tratamento de fístulas liquóricas, proteção de estruturas intracranianas e prevenção de complicações tardias, como meningite e osteomielite frontal. Relato de caso clínico: Paciente do sexo masculino, 26 anos, encaminhado ao Hospital Vicente Corral Moscoso para avaliação e manejo de trauma facial. Sete dias após a internação, sob anestesia geral balanceada, foi realizado o procedimento cirúrgico que consistiu na redução mais fixação com tela frontal mais cinco parafusos da fratura da parede anterior do seio frontal direito. Conclusões: Sugere-se uma abordagem multidisciplinar com neurocirurgião e cirurgião maxilofacial para tratar fraturas faciais superiores. O tratamento atual considera o envolvimento da mesa posterior, a patência da via de saída do seio frontal e o deslocamento anterior da mesa. O manejo precoce é priorizado para proteger as estruturas intracranianas, restaurar a função do seio frontal e prevenir complicações... (AU)

Introduction: Fractures of the frontal sinus, representing 5% to 15% of traumatic facial injuries. Non-contrast CT is essential for diagnosis. Classified into five types according to their trajectory, the choice of surgical treatment is based on factors such as location, displacement, integrity of the frontal sinus outflow tract and associated injuries. The goals of surgical intervention include treating cerebrospinal fluid leaks, protecting intracranial structures, and preventing late complications such as meningitis and frontal osteomyelitis. Clinical case report: 26-year-old male patient, referred to the Vicente Corral Moscoso Hospital for evaluation and management of facial trauma. Seven days after admission, under balanced general anesthesia, the surgical procedure was performed, which consisted of reduction plus fixation with frontal mesh plus five screws of the fracture of the anterior wall of the right frontal sinus. Conclusions: A multidisciplinary approach with neurosurgeon and maxillofacial surgeon is suggested to treat upper facial fractures. Current treatment considers posterior table involvement, frontal sinus outflow tract patency, and anterior table displacement. Early management is prioritized to protect intracranial structures, restore frontal sinus function, and prevent complications... (AU)

Divertículo de Meckel complicado. Experiencia de 15 años en un hospital interzonal / Complicated Meckel's diverticulum. Fifteen years of experiencein an interzonal hospital in the Province of Buenos Aires

Introducción: el divertículo de Meckel es la anomalía congénita más frecuente del tracto gastrointestinal. Puede presentarse con hemorragia, obstrucción intestinal o diverticulitis, complicaciones que disminuyen con la edad, por lo que en el adulto el diagnóstico suele ser incidental. El tratamiento de las complicaciones es quirúrgico, mediante diverticulectomía o resección segmentaria del intestino delgado, dependiendo de sus características morfológicas. Objetivo: analizar nuestra experiencia en el manejo del divertículo de Meckel complicado en un período de 15 años. Diseño: estudio descriptivo, observacional, transversal, retrospectivo. Material y métodos: se revisaron las historias clínicas de los pacientes operados por divertículo de Meckel complicado en el Servicio de Cirugía General del Hospital San Roque durante el periodo 2007-2022. Se registraron datos demográficos, presentación clínica, diagnóstico preoperatorio, tratamiento quirúrgico, complicaciones postoperatorias y hallazgos histopatológicos. Resultados: se incluyeron 25 pacientes, 21 (84%) hombres, 3 menores de 18 años. La presentación clínica fue un síndrome de fosa iliaca derecha en el 80% de los casos, obstrucción intestinal en el 16% y hemorragia en el 4%. En solo 2 casos se realizó el diagnóstico preoperatorio, confirmado mediante tomografía computada. Se realizó diverticulectomía en el 68% de los pacientes y resección segmentaria el 32%. El abordaje fue laparotómico en el 64%, principalmente en el periodo inicial y laparoscópico en el 36%. Hubo una complicación IIIb de Clavien-Dindo en un paciente pediátrico tratado con drenaje percutáneo. En un solo paciente (4%), que se presentó con hemorragia digestiva masiva, se encontró epitelio de tipo gástrico y páncreas ectópico en el divertículo. Conclusiones: En nuestra experiencia el divertículo de Meckel complicado se presentó predominantemente en hombres. La complicación más frecuente en el adulto fue la diverticulitis. El diagnóstico preoperatorio fue infrecuente y realizado por tomografía computada. La diverticulectomía es suficiente en la mayoría de los casos. Actualmente, la laparoscopia es una herramienta segura, rentable y eficiente que permite el diagnóstico y tratamiento oportunos de esta entidad. (AU)

Introduction: Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract. It can present with bleeding, intesti-nal obstruction or diverticulitis, complications that decrease with age, so in adults the diagnosis is usually incidental. Treatment of complications is surgical, through diverticulectomy or segmental resection of the small intestine, depending on its morphological characteristics. Objective: to analyze our experience in the management of complicated Meckel's diverticulum over a period of 15 years. Design: descriptive, observational, cross-sectional, retrospective study. Materials and methods: the medical records of patients operated on for complicated Meckel's diverticulum in the General Surgery Service of the San Roque Hospital during the period 2007-2022 were reviewed. Demo-graphic data, clinical presentation, preoperative diagnosis, surgical treatment, postoperative complications, and histopathological findings were recorded. Results: twenty-five patients were included, 21 (84%) men, 3 under 18 years of age. The clinical presentation was a right iliac fossa syndrome in 80% of cases, intestinal obstruction in 16% and hemorrhage in 4%. In only 2 cases was the preoperative diagnosis made, confirmed by computed tomography. Diverticulectomy was performed in 68% of patients and segmental resection in 32%. The approach was by laparotomy in 64%, mainly in the initial period, and by laparoscopy in 36%. There was a Clavien-Dindo IIIb complication in a pediatric patient treated with percutaneous drain-age. In only one patient (4%), who presented with massive gastrointestinal bleeding, gastric-type epithelium and ectopic pancreas were found in the diverticulum. Conclusions: In our experience, complicated Meckel's diverticulum occurred predominantly in men. The most frequent complication in adults was diverticulitis. Preoperative diagnosis was infrequent and was made by computed tomography. Diverticulectomy is sufficient in most cases. Currently, laparoscopy is a safe, profitable and efficient tool that allows for the timely diagnosis and treatment of this entity. (AU)

Comparison of complications associated with conservative and surgical treatment for stable cases of coronary artery disease: meta-analysis and systematic review

Coronary artery disease (CAD) is a severe public health issue. Genetic, environmental, and lifestyle factors affect the development of coronary artery disease. There are several medicinal and interventional treatments offered to treat CAD. This study aimed to compare the complications associated with conservative and surgical treatments of CAD. Data was taken from PubMed, where 679 clinic trials and randomised control trials were chosen after adding filters and 25 studies were added by hand search. Articles were then analysed, and only ten studies were taken for meta-analysis. A total of 41025 patients were added to these studies, out of which 12077 were treated surgically and 28948 were treated by conservative management either by monotherapy or combined medicinal therapy. Further, the meta-analysis done with the help of Revman concluded that 6% (CI 0.00–16.8%) complication cases were reported in conservative treatment and 2% (CI 0.00–23%) in surgical treatment, where the I2 was 100%. Considering the treatments separately, 901 patients given monotherapy and 354 given combined medicinal therapy were reported to have complications. As per the surgical treatments, 509 cases were reported when treated by SAG, and MAG, 216 with PCI, and CABG, 40 when treated by EVH and OVH, and 10 patients faced complications when treated with angioplasty, reported to suffer complications after treatment. So, the surgical treatments, as per this review, have been proven to have less complications than conservative treatment.

Advances in research on treatment of tympanosclerosis / 临床耳鼻咽喉头颈外科杂志

Tympanosclerosis is the hyaline degeneration and calcium deposition of the lamina propria of tympanic membrane and the submucosa of middle ear under long-term chronic inflammatory stimulation. At present, treatment primarily involves the surgical removal of sclerotic foci and reconstruction of auditory ossicular chain. However, excision of sclerotic lesions near critical structures like the facial nerve canal and vestibular window may result in complications like facial paralysis, vertigo, and sensorineural hearing loss. Developing safer and more effective treatments for tympanosclerosis has become an international research focus. Recent years have seen novel explorations in the treatment of tympanosclerosis. Therefore, this article reviews the latest advancements in research on the treatment of tympanosclerosis.

Application of double-layer soft tissue suture closure technique in the surgical treat-ment of patients with mandible medication-related osteonecrosis of the jaw of early and medium stages / 北京大学学报(医学版)

Objective:To investigate the clinical application effect of double-layer soft tissue(DLST)suture closure technique in patients with mandible medication-related osteonecrosis of the jaw(MRONJ)of early and medium stages resulted in application of anti-bone-resorptive drugs.Methods:Early to me-dium stage mandible MRONJ patients who underwent surgical treatment in the fourth ward of Peking Uni-versity School and Hospital of Stomatology from October 2021 to September 2022 were included.Clinical information of the patients were collected,including primary disease,concomitant disease,medication regimen(drug type,duration of medication),MRONJ stage,clinical symptoms,imaging manifestations,etc.During surgery,after using marginal mandibulae resection to remove the necrotic bone,the wound was closed using DLST closure technique.Regular post-operative follow-up was performed to evaluate the therapeutic effect and complications of the DLST technique,the pain score and functional status of the patiens were evaluated.Results:This study totally included 13 patients,12 women and 1 man,aged(66.69±13.14)years.Seven patients had osteoporosis,2 had lung cancer,3 had breast cancer and 1 had prostate cancer among their primary diseases;7 had no concomitant diseases,2 had diabetes melli-tus,2 had cardiovascular disease and 1 had dry syndrome.Intravenous zoledronic acid were used in 9 patients,the average duration was(37.7±20.0)months,and other drugs,such as letrozole tablets were taken in 7 patients at the same time;Denosumab injection was used in 3 patients for an average of(10.3±11.9)months;Alendronate sodium tablets were taken in 5 patients for an average of(55.20± 27.20)months,and prednisone acetate tablets or acarbose tablets were taken to varying degrees in 2 pa-tients.The average post-operative follow-up was 11.9 months(9 to 17 months),and all the 13 patients were cured without complications,such as pus overflow and so forth.The pre-operative score of Karnof-sky performance status(KPS)in the patients was 68.46±14.05,and the post-operative score was 82.31±15.36,and the difference was statistically significant(P＜0.05).The pre-operative score of visual analogue scale(VAS)in the patients was 5.77±0.73 and the post-operative score was 0.38±0.51,and the difference had statistical significance(P＜0.001).Conclusion:The double-layer soft tissue suture closure technique can achieve good clinical results in patients with MRONJ of the man-dible using anti-bone-resorptive drugs alone,and can provide clinical treatment ideas for MRONJ patients with more complicated drug use.

Clinical status and controversy of parathyroid autotransplantation in the surgical management of Secondary Hyperparathyroidism / 临床外科杂志

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.

Achievements of thyroid surgery in China in recent ten years / 西安交通大学学报(医学版)

In the past decade,thyroid surgery in China has developed rapidly.With the improvement of thyroid diagnosis technology,the standardization of thyroid surgery,the clinical application of systematic therapy,and the progress in fundamental research,thyroid surgery has achieved all-round development.Patients with thyroid disease have benefited significantly from safer,more standardized,more effective,and more diverse treatments,which results in the remarkable increase in the 5-year survival rate.Moreover,Chinese experts have published a number of guidelines and expert consensus related to thyroid surgery,which promotes the standardization of the diagnosis and treatment of thyroid disease.Additionally,the specialized multidisciplinary teams in cancer centers allow patients to receive more standardized diagnosis and treatment of complex thyroid diseases.In the present article,we summarize the important developments of China's thyroid surgery in the past decade,including preoperative diagnosis technology,surgical methods,operation safety,application of minimally invasive techniques,diagnosis and treatment of special thyroid cancers,multidisciplinary diagnosis and treatment models,and standardized postoperative managements.We expect to popularize the concept of standardized diagnosis and treatment of thyroid diseases,and improve the level of standardized diagnosis and treatment in thyroid surgery.

Network meta-analysis of different anatomical repair strategies to improve chronic lateral ankle instability / 中国组织工程研究

OBJECTIVE:At present,there are various surgical repair strategies for the lateral stability of chronic ankle instability after the injury of the lateral collateral ligament of the ankle,but the specific repair strategy to maximize the recovery of lateral stability of the ankle still lacks of evidence-based medical evidence.Based on this,for the first time,this paper systematically evaluated the effects of four popular repair strategies to restore the lateral stability of chronic ankle instability using the network meta-analysis method. METHODS:Computer retrieval was conducted on CNKI,WanFang,VIP,PubMed,Embase,Web of Science and Cochrane Library.The retrieval time was from the establishment of each database to December 2022.The randomized controlled trials or clinical controlled trials on different repair strategies to recover chronic ankle instability after injury of the lateral ligament of the ankle were included.The literature was screened and extracted.The literature quality was evaluated and data were analyzed using RevMan 5.4,R4.2 and Stata 14.2 software. RESULTS:Twelve studies(including 10 randomized controlled trials and 2 cohort studies)were included.A total of 673 patients with chronic ankle instability were involved in 4 repair strategies.The observation indicators were:anterior talar translation distance and talar tilt angle of ankle joint stress X-ray film(hereinafter referred to as anterior talar translation distance and talar tilt angle).The results of network meta-analysis showed that:(1)In terms of anterior talar translation distance,the sequence of reticular meta-analysis results from inferior to superior was anatomical repair>anatomical repair + enhancement of inferior extensor retinaculum>internal brake anatomical reconstruction>autologous/allogeneic tendon anatomical reconstruction.(2)In terms of talar tilt angle,the sorting results of reticular meta-analysis from inferior to superior were as follows:anatomical repair>anatomical repair + inferior extensor retinaculum enhancement>internal brace anatomical reconstruction>autologous/allogeneic tendon anatomical reconstruction. CONCLUSION:Anatomical reconstruction strategy of autologous/allogeneic tendon is the first in improving anterior talar translation distance and talar tilt angle,suggesting that this strategy may have the best effect in restoring the stability of chronic joint instability after injury of the lateral ligament of ankle,but more large sample,multicenter,double-blind randomized controlled trials are still needed in the future to further confirm.

Modified calcaneal plate combined with suture anchors in treatment of comminuted fracture of split-type greater tuberosity of humerus(Liu-Gang type IV) / 中国组织工程研究

BACKGROUND:Numerous scholars have previously researched certain greater tuberosity fractures and the procedures used to treat them.Few researchers,however,have studied the comminuted split fracture of the greater tuberosity of the humerus(Liu-Gang type IV)with rotator cuff tear in great detail. OBJECTIVE:To compare the clinical therapeutic effect of open repair position modified calcaneal plate combined with suture anchors and proximal humeral internal locking system(PHILOS)plate in the treatment of comminuted fracture of split-type greater tuberosity of humerus combined with rotator cuff tears(Liu-Gang type IV). METHODS:Case data of 30 patients with comminuted fracture of split-type greater tuberosity of humerus combined with rotator cuff tears(Liu-Gang type IV)from May 2012 to May 2022 were retrospectively analyzed.They were divided into the modified calcaneal plate combined with suture anchor group(group A)and the PHILOS with#2 Johnson group(group B),with 15 cases in each group.Intraoperative blood loss,surgical time,and incision length of all patients were recorded.Pain visual analog scale score,Constant-Murley score,as well as shoulder joint abduction,forward flexion,external rotation,and dorsal expansion activities during the last follow-up(>1 year)were evaluated. RESULTS AND CONCLUSION:(1)The surgical incision length and operation time were shorter,and blood loss was less in group A than those in group B(P<0.05).(2)No significant difference in visual analog scale score and Constant-Murley score was detected between the two groups(P>0.05).(3)During the last follow-up,forward flexion in group A was better than that in group B(P<0.05).No significant difference in abduction,external rotation,and dorsal expansion was determined between group A and group B(P>0.05).(4)In terms of complications,there was 1 case of shoulder joint pain and discomfort in group A(7%),2 cases of subacromial impingement syndrome,2 cases of upward movement of nodules,and 2 cases of shoulder joint pain(40%)in group B.There were significant differences in complication rates between the two groups(P=0.031).(5)In summary,the modified calcaneal plate combined with suture anchors in the treatment of comminuted fracture of split-type greater tuberosity of humerus combined with rotator cuff tears(Liu-Gang type IV)could better restore the forward flexion function of the shoulder joint and has a small incision,less blood loss,shorter operation time and fewer complications.

Prognosis and influencing factors analysis of patients with initially resectable gastric cancer liver metastasis who were treated by different modalities: a nationwide, multicenter clinical study / 中华消化外科杂志

Objective:To investigate the prognosis of patients with initially resectable gastric cancer liver metastasis (GCLM) who were treated by different modalities, and analyze the influencing factors for prognosis of patients.Methods:The retrospective cohort study was conducted. The clinicopathological data of 327 patients with initially resectable GCLM who were included in the database of a nationwide multicenter retrospective cohort study on GCLM based on real-world data from January 2010 to December 2019 were collected. There were 267 males and 60 females, aged 61(54,68)years. According to the specific situations of patients, treatment modalities included radical surgery combined with systemic treatment, palliative surgery combined with systemic treatment, and systemic treatment alone. Observation indicators: (1) clinical characteristics of patients who were treated by different modalities; (2) prognostic outcomes of patients who were treated by different modalities; (3) analysis of influencing factors for prognosis of patients with initially resectable GCLM; (4) screening of potential beneficiaries in patients who were treated by radical surgery plus systemic treatment and patients who were treated by palliative surgery plus systemic treatment. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. The Kaplan-Meier method was used to calculate survival rate and draw survival curve, and Log-Rank test was used for survival analysis. Univariate and multivariate analyses were conducted using the COX proportional hazard regression model. The propensity score matching was employed by the 1:1 nearest neighbor matching method with a caliper value of 0.1. The forest plots were utilized to evaluate potential benefits of diverse surgical combined with systemic treatments within the population. Results:(1) Clinical characteristics of patients who were treated by different modalities. Of 327 patients, there were 118 cases undergoing radical surgery plus systemic treatment, 164 cases undergoing palliative surgery plus systemic treatment, and 45 cases undergoing systemic treatment alone. There were significant differences in smoking, drinking, site of primary gastric tumor, diameter of primary gastric tumor, site of liver metastasis, and metastatic interval among the three groups of patients ( P<0.05). (2) Prognostic outcomes of patients who were treated by different modalities. The median overall survival time of the 327 pati-ents was 19.9 months (95% confidence interval as 14.9-24.9 months), with 1-, 3-year overall survival rate of 61.3%, 32.7%, respectively. The 1-year overall survival rates of patients undergoing radical surgery plus systemic treatment, palliative surgery plus systemic treatment and systemic treatment alone were 68.3%, 63.1%, 30.6%, and the 3-year overall survival rates were 41.1%, 29.9%, 11.9%, showing a significant difference in overall survival rate among the three groups of patients ( χ2=19.46, P<0.05). Results of further analysis showed that there was a significant difference in overall survival rate between patients undergoing radical surgery plus systemic treatment and patients undergoing systemic treatment alone ( hazard ratio=0.40, 95% confidence interval as 0.26-0.61, P<0.05), between patients undergoing palliative surgery plus systemic treatment and patients under-going systemic treatment alone ( hazard ratio=0.47, 95% confidence interval as 0.32-0.71, P<0.05). (3) Analysis of influencing factors for prognosis of patients with initially resectable GCLM. Results of multivariate analysis showed that the larger primary gastric tumor, poorly differentiated tumor, larger liver metastasis, multiple hepatic metastases were independent risk factors for prognosis of patients with initially resectable GCLM ( hazard ratio=1.20, 1.70, 1.20, 2.06, 95% confidence interval as 1.14-1.27, 1.25-2.31, 1.04-1.42, 1.45-2.92, P<0.05) and immunotherapy or targeted therapy, the treatment modality of radical or palliative surgery plus systemic therapy were independent protective factors for prognosis of patients with initially resectable GCLM ( hazard ratio=0.60, 0.39, 0.46, 95% confidence interval as 0.42-0.87, 0.25-0.60, 0.30-0.70, P<0.05). (4) Screening of potentinal beneficiaries in patients who were treated by radical surgery plus systemic treatment and patients who were treated by palliative surgery plus systemic treatment. Results of forest plots analysis showed that for patients with high-moderate differentiated GCLM and patients with liver metastasis located in the left liver, the overall survival rate of patients undergoing radical surgery plus systemic treatment was better than patients undergoing palliative surgery plus systemic treatment ( hazard ratio=0.21, 0.42, 95% confidence interval as 0.09-0.48, 0.23-0.78, P<0.05). Conclusions:Compared to systemic therapy alone, both radical and palliative surgery plus systemic therapy can improve the pro-gnosis of patients with initially resectable GCLM. The larger primary gastric tumor, poorly differen-tiated tumor, larger liver metastasis, multiple hepatic metastases are independent risk factors for prognosis of patients with initial resectable GCLM and immunotherapy or targeted therapy, the treatment modality of radical or palliative surgery plus systemic therapy are independent protective factors for prognosis of patients with initially resectable GCLM.

Analysis of risk factors for 1-year survival rate in patients with spinal metastasis secondary to lung cancer / 中华骨科杂志

Objective:To investigate the risk factors for 1-year survival rate in patients with spinal metastasis secondary to lung cancer.Methods:The data of 343 patients with spinal metastases secondary to lung cancer from January 2011 to December 2018 were retrospectively studied. There were 188 males (54.8%) and 155 females (45.2%) with an average age of 59.47±10.21 years old (range 23-91 years). The patients were divided into operation group (150 cases, 43.7%) and non operation group (193 cases, 56.3%). The demographics, types of primary tumor, non spinal metastasis, visceral metastasis, spinal metastasis and segments, pathological fractures of vertebra, Frankel classification, physical function status (Karnofsky performance scale, KPS), visual analogue score (VAS), the spinal instability neoplastic score (SINS) were recorded and analyzed. The impact of different treatments on the survival prognosis of patients with spinal metastasis was evaluated. The independent factors affecting survival in those patients were analyzed by Cox proportional hazards regression model.Results:The peak incidence of spinal metastases was found in the age group of 46-60 years (43.7%, 150/343). 38.5% (132/343) of the patients had pathological fractures of the involved vertebral body. 58.3% (200/343) of the patients had extraspinal bone metastasis. 36.2% (124/343) of the patients had visceral metastasis. Among the primary tumors, adenocarcinoma was the most common tpye (61.5%, 211/343), followed by large cell lung cancer (12.5%, 43/343), small cell lung cancer (6.4%, 22/343), squamous cell cancer (6.1%, 21/343) and mixed cell lung cancer (5.3%, 18/343). The type of lung cancer cells in about 8.2 (28/343) patients was unknown. Among the surgical patients, 21 patients underwent minimally invasive surgery (14.0%), 28 patients underwent simple decompression surgery (18.7%), 76 patients underwent separation surgery (50.7%), and 25 patients underwent radical surgery (16.6%). 59.3% (89/150) of the patients had a better neurological function than before surgery. The average survival time of all patients was 9.88 months with the median survival time of 8 (5,14) months. The survival rates were 62.1% (213/343), 30.0% (103/343), and 3.8% (13/343) at 6, 12, and 24 months, respectively. The average survival time of patients in the operation group was 10.24 months with the median survival time of 9 (5, 15) months, and the average survival time of patients in the non operation group was 9.41 months with the median survival time of 7 (5, 13) months with no significant difference between the groups (χ 2=0.300, P=0.584). Multivariate Cox proportional hazard regression model analysis showed that radiotherapy [ HR=1.913, 95% CI(1.471, 2.488), P<0.001], chemotherapy [ HR=1.313, 95% CI(1.040, 1.658), P=0.022], targeted drug therapy [ HR=1.683, 95% CI(1.221, 2.319), P=0.001], KPS [ HR=1.593, 95% CI(1.140, 2.225), P=0.006] and pathological type (non-small cell lung cancer) were independent factors affecting the 1-year survival rate of patients with spinal metastasis secondary to lung cancer [ HR=0.322, 95% CI(0.225, 0.460), P<0.001] with significant difference. Conclusion:Surgical treatment can improve both the neurological function and general status of patients with spinal metastasis. Treatments of radiotherapy, chemotherapy, and targeted drug therapy can significantly improve 1-year survival rate, while a KPS less than 50 points and a primary lung cancer other than adenocarcinoma were independent risk factors reducing 1-year survival rate.

Renal malakoplakia invading descending colon complicated with bladder malakoplakia: a case report / 中华泌尿外科杂志

Malacoplakia is a rare granuloma disease mainly occurred in the urinary system, it is even rarer for renal malacoplakia invading the descending colon complicated with bladder malacoplakia. In this study, one such case was reported. Imaging examination suggested that the left kidney was a large patchy mixed density shadow, and enhancement scan lesion was uneven enhancement. CT guided renal puncture biopsy was performed, and postoperative pathology suggested renal malacoplakia. Transurethral cystoscopy was performed, and postoperative pathology confirmed that it was malacoplakia of the bladder. The effect of conservative antibiotic treatment was not good. The patient underwent radical nephrectomy + left hemicolectomy under general anesthesia, and postoperative pathology confirmed the diagnosis of renal malacoplakia, which involved the mucosa of the intestinal tube and the entire muscular layer. The patient was followed up for 6 months after surgery, and no recurrence was seen on CT.

Progress of pancreatic surgical treatment in 2023 / 中华普通外科杂志

Pancreatic surgery is one of the most challenging specialties in general surgery. Due to the variety of pancreatic diseases, the difficulty of surgery, and the differences in diagnosis and treatment among different diseases, treatment strategies for these diseases remain controversial. From the aspects of surgical treatment such as pancreatitis, pancreatic cystic neoplasms, pancreatic neuroendocrine neoplasms, and pancreatic cancer, as well as neoadjuvant therapy, adjuvant therapy, immunotherapy, and targeted therapy. We review and summarize the frontier progress of clinical and translational research in pancreatic surgery in 2023, in order to further standardize the diagnosis and treatment of pancreatic surgery.

Safety and mid- to long-term efficacy analysis of surgical correction of isolated partial anomalous pulmonary venous connection / 中国胸心血管外科临床杂志

@#Objective To evaluate the safety and mid- to long-term efficacy of surgical correction of isolated partial anomalous pulmonary venous connection (IPAPVC). Methods We retrospectively collected consecutive patients who were diagnosed with IPAPVC and underwent surgical correction at Fuwai Hospital of Chinese Academy of Medical Sciences and Fuwai Yunnan Cardiovascular Hospital from June 2009 to May 2019, summarized the basic preoperative and intraoperative data of patients, analyzed the postoperative and mid- to long-term follow-up results. Results A total of 54 patients were enrolled, including 29 males and 25 females, with an average age of 16.20±2.40 years, ranging from 1 month to 62 years. There were 28 (51.9%) patients with varying degrees of arrhythmia, 22 (40.7%) patients with cardiac insufficiency, and 39 (72.2%) patients with pulmonary hypertension. According to Bordy's typing, 14 (25.9%) patients were classified as type A, 23 (42.6%) type B, 4 (7.4%) type C, 5 (9.3%) type D and 8 (14.8%) mixed type. Transthoracic echocardiography was performed in the whole group of patients and the accuracy of staging diagnosis was 66.7% (36/54), and cardiac CT angiography (CTA) was performed in 37 patients and the accuracy of staging diagnosis was 94.6% (35/37). All surgical procedures were assisted with cardiopulmonary bypass, aortic cross-clamping time was 0-219 (67.02±5.23) min, cardiopulmonary bypass time was 40-261 (105.09±5.23) min, and there was no serious intraoperative complication. Postoperative tracheal intubation time was 0-230 (13.33±4.20) h, intensive care unit stay was 0-13 (1.89±0.28) days, postoperative hospital stay was 5-18 (7.20±0.38) days, and follow-up time was 16-140 (62.58±5.12) months. There were 2 (3.7%) all-cause postoperative deaths, including 1 in-hospital death and 1 death during the follow-up, and there was no intraoperative death. Among the survivors, there were 3 patients with surgery-related complications: 1 patient had atrial septal defect with the second surgical treatment, 1 early obstruction of the superior vena cava and 1 arrhythmia. Two patients had complications of IPAPVC (atrial fibrillation, collateral circulation) prior to surgery and underwent the second surgery with a poor prognosis, and 1 patient had preoperative cardiac insufficiency and atrial fibrillation, whose symptoms persisted for a long time during the follow-up. Conclusion IPAPVC accounts for a lower percentage of partial anomalous pulmonary venous connection, transthoracic echocardiography combined with CTA improves diagnostic accuracy, and IPAPVC should be treated with elective surgery after diagnosis. The surgical approach should be individualized with imaging features such as disease staging, number of drains and drainage location. Surgical treatment of IPAPVC is safe and effective, and regular follow-up is warranted.

The application and progress of enhanced recovery after surgery in the surgical treatment of esophageal cancer / 中国胸心血管外科临床杂志

@#Esophageal cancer threatens the lives and health of humans for a long time owing to its high morbidity and mortality. Surgical treatment is still the first choice for early-stage esophageal cancer now, but its high mortality and complication rate during perioperative period cause a huge physiological and psychological burden on patients. The concept of enhanced recovery after surgery (ERAS) was first proposed for colorectal surgery, and later promoted to other surgical fields. Its application in esophagectomy successfully reduces the high mortality and complication rate in the perioperative stage and promotes the rapid recovery of patients. However, the application of ERAS in the field of esophageal cancer is relatively late, and its promotion and application are relatively limited compared to other surgical procedures. In this paper, we review the relevant literature at home and abroad in combination with the current progress of ERAS application of esophageal cancer in China. We also summarize the relevant problems related to the implementation of ERAS, in order to help the promotion and application of ERAS in the surgical treatment of esophageal cancer.

Surgical treatment decision and clinical value of molecularly defined renal carcinoma with highly aggressive behavior / 现代泌尿外科杂志

Molecularly defined renal carcinoma is a pathologic subtype of renal cell cancer (RCC) with a definite driver gene, which was first proposed in the 2022 WHO classification of tumors of the urinary system and male reproductive organs. The fumarate hydratase-deficient renal cell carcinoma and SMARCB1-deficient renal medullary carcinoma are highly aggressive and lethal subtypes. Due to the low incidence and lack of research on the mechanism, there is almost no effective treatment for these aggressive RCC subtypes. Cytoreductive nephrectomy or metastasectomy are important methods to improve the survival and quality of life of metastatic RCC patients under effective systemic therapy. However, for the highly aggressive RCC, the clinical value of the above surgical strategies is still unclear. In this review, we will discuss these problems in order to provide reference for the improvement of prognosis for patients with highly aggressive RCC subtypes.

Progress in surgical treatment of congenital entropion / 国际眼科杂志(Guoji Yanke Zazhi)

Congenital entropion, an abnormal condition in which the eyelids roll inward, with the eyelashes losing their normal angulation and tilting toward the eye, especially in the lower eyelids and inner canthus, often occurs in infants and young children. Congenital entropion may lead to corneal epithelial abrasion, inflammation and ulcer, which may affect the function of the eye if not treated in time. Early surgical intervention is helpful to the health of children's eyes. The purpose of surgery is to change the structure of eyelid and weaken the force of entropion, thus improving the symptoms and corneal astigmatism. At present, there are many surgical treatments for congenital entropion. In this paper, the advantages, disadvantages and indications of these treatments are analyzed and summarized, providing a reference for clinical practice.

Short-term efficacy of surgical treatment for multiple pulmonary nodules: A retrospective study in a single center / 中国胸心血管外科临床杂志

@#Objective To summarize and analyze the clinical diagnosis, surgical treatment and prognosis of multiple pulmonary nodules (MPNs). Methods The clinical data of lung cancer patients who received surgical treatment in our hospital from 2018 to 2020 were collected. The short-term efficacy of surgical treatment for MPNs was analyzed. Results A total of 97 patients were enrolled, including 30 males and 67 females with an average age of 56.1±10.0 years at onset ill. There were 62 patients with double lesions, 22 patients with three lesions, 4 patients with four lesions, and 9 patients with more than four lesions. A total of 213 lesions were surgically treated, including 88 pure ground-glass nodules, 81 partially solid nodules, and 7 solid nodules. There were 87 simultaneous surgeries and 10 staged surgeries, with an average operation interval of 5.2 months. The pathological combination type included adenocarcinoma-adenocarcinoma in 96 (99.0%) patients, squamous cell carcinoma-squamous cell carcinoma in 1 (1.0%) patient, and no lymph node metastasis was found. The 2-year disease-free survival (DFS) rate was 92.1%, and the overall survival (OS) rate was 100.0%. Univariate analysis showed that high-risk lesion size>2 cm (P=0.316), residual lesions (P=0.782) and pathological combination type (P=0.913) had statistical effect on the 2-year DFS rate. Conclusion MPNs are mainly diagnosed with multiple primary lung cancers, and the pathological combination is mostly adenocarcinoma-adenocarcinoma combination. Imaging examination is of great help to the surgical approach selection, diagnosis and differential diagnosis of MPNs. During the operation, maximal preservation of lung function and complete resection of high-risk nodules should be taken as the principle, and the prognosis is satisfactory.