Objective:To explore the application efficacy of Buzhong Yiqi Decoction combined with Chinese Herbal Pack Therapy in elderly female patients with internalrectal prolapse of qi deficiency type after surgery.Meth-ods:A total of 71 olderly female patients with internal rectal prolapse of qi deficiency type admitted to the Depart-ment of Anorectal Surgery of our Hospital from February 2023 to October 2024 were selected and randomly divided into a treatment group of 36 cases and a control group of 35 cases.Both groups were treated with modified Gant sur-gery.The treatment group received oral administration of Buzhong Yiqi Decoction combined with Chinese Herbal Pack Therapy after surgery,while the control group received no Traditional Chinese medicine intervention.Results:Post-operative symptoms such as defecation disorders and rectal bearing-down sensation in both groups were significantly improved compared with those before surgery(P<0.05).The treatment group showed significantly better improvement in symptoms such as defecation disorders,rectal bearing-down sensation,and at 6 months after surgery compared with the control group(P<0.05).The scores of the Constipation Severity Index(CSI)in both groups were significantly lower after surgery than before(P<0.05),and the scores of the treatment group at 1 month and 6 months after surgery were significantly lower than those of the control group(P<0.05).The rectal contraction pressure and rectal-anal pres-sure gradient in both groups were higher after surgery than before(P<0.05),and the increase was more significant in the treatment group at 1 month and 6 months after surgery(P<0.05).No serious complications occurred in either group after surgery.Conclusion:Buzhong Yiqi Decoction combined with Chinese Herbal Pack Therapy can improve postop-erative symptoms,defecation disorders,and anorectal function in elderly female patients with internal rectal prolapse of qi deficiency type,and improve the short-term and long-term efficacy of patients after surgery.

Gallstones are the primary benign disease diagnosed and treated in biliary surgery.With the development of medical technology and the increasing awareness of health among the population,the detection rate of gallstones has been increasing annually,with the majority being asymptomatic or mild cases.Currently,the clinical treatment of gallstones mainly includes observation,conservative,or surgical treatment(laparoscopic cholecystectomy).However,there remains some controversy regarding the clinical management of these patients.For asymptomatic or mild gallstones,the main point of contention in both academic and clinical settings is how to determine the indications for cholecystectomy.This article reviews relevant literature from both domestic and international sources,addressing the controversies surrounding the clinical management of gallstones and the determination of indications for cholecystectomy,and elaborates on these issues from multiple perspectives.

The difficult radical cure of intrahepatic bile duct stones is attributed to their tendency to leave residues and recur.Therefore,it is crucial to raise awareness of the importance of standardized treatment.The inability to perform true anatomical liver resection and effectively correct bile duct stenosis are the root causes of stone retention and recurrence.Precise and comprehensive preoperative assessment is the prerequisite for standardized treatment.Attention should be focused on evaluating the distribution of stones,biliary strictures,the function of the Oddi sphincter,as well as the anatomical variations of the hepatic artery,bile duct,and portal vein.Therefore,the author proposed the LHO classification and CRL classification to guide decision-making.High-quality and meticulous surgery is the core of standardized treatment.Timely and correct management of complications and standardized postoperative follow-up throughout the process are the guarantee and continuation of standardized treatment.By integrating various techniques such as perihilar surgical techniques,and strictly adhering to the"removing lesions,removing all stones,correcting strictures,and ensuring unobstructed drainage"principle,standardized treatment can improve the safety and effectiveness of the treatment of intrahepatic bile duct stones,reducing the stone retention and recurrence rates.

Polycystic ovary syndrome(PCOS)is a common endocrine disorder in women of reproductive age and is closely associated with obesity.In recent years,the role of bariatric and metabolic surgery in improving obesity complicated with PCOS has gradually attracted attention.The Chinese Society of Thyroid and Metabolism Surgery,Chinese Society of Surgery,Chinese Medical Association,Chinese Society for Metabolic&Bariatric Surgery,Chinese College of Surgeons,Chinese Medical Doctor Association,Metabolic Disease Professional Committee of the Chinese Medical Education Association,and the National Key Laboratory of Reproductive Medicine and Offspring Health jointly developed this consensus based on the latest domestic and foreign guidelines,clinical research evidence,and expert opinions.In the consensus,the diagnostic criteria,preoperative evaluation,surgical indications,selection of surgical methods,perioperative management,and postoperative PCOS follow-up are recommended to provide standardized guidance for bariatric metabolic surgery for obese patients with PCOS.

Intestinal obstruction is one of the most common and challenging acute abdominal conditions in general surgery,and its prevention and treatment have always been a key focus in clinical practice.The advent of ileus tubes has provided a new approach to the treatment,prevention,and auxiliary diagnosis of intestinal obstruction.It has significantly improved the success rate of non-surgical treatment and played an essential role in preventing recurrence and assisting in diagnosis.In recent years,with the widespread application of the ileus tubes,an increasing number of hospitals have begun using this treatment method.However,there are still considerable controversies regarding to the indications of ileus fubes,management of complications,efficacy evaluation,and the timing of surgical intervention.Given the lack of authoritative reference standards for the standardized use of ileus tubes and the absence of relevant guidelines or consensus to guide their clinical practice at home and abroad,experts in this field in our country have formed an editorial panel at the initiative of the Anorectal Physicians Branch of the Chinese Medical Doctor Association,and the Bowel Obstruction Branch of the Hunan Province Geriatric Society.Based on the latest evidence from clinical practice and relevant research findings,the expert panel developed the"Expert consensus on clinical application of ileus tubes in prevention and treatment of bowel obstruction."This consensus aims to provide guidance for physicians in general surgery,gastroenterology,interventional medicine,and related specialties,hoping to promote the standardized clinical application of ileus tubes in China.

Incidental gallbladder cancer(IGC)is a type of gallbladder cancer identified during or after cholecystectomy for benign gallbladder diseases through intraoperative or postoperative pathological examination.Since gallbladder cancer often coexists with benign conditions such as gallstones and polyps,and routine abdominal ultrasound has limited sensitivity in early diagnosis,IGC accounts for more than two-thirds of all gallbladder cancer cases.To improve early diagnosis rates,high-risk patients should undergo high-resolution ultrasound after surgery,combined with the use of radiomics and molecular biomarkers to reduce misdiagnosis and missed diagnoses.Most IGC patients are diagnosed at early stages,with a high incidence of residual disease.Delayed radical surgery can effectively improve prognosis.However,for patients with locally advanced disease,radical surgery should not be performed indiscriminately,and conversion surgery may be a better option.The optimal timing for delayed radical surgery is within 2 to 8 weeks after the initial surgery,with specific timing based on the resolution of acute inflammation and the evaluation of tumor staging and metastasis.For patients with T1b and T2 stage cancer,liver segment IVb/V resection and lymph node dissection are recommended to ensure curative outcomes.The application of laparoscopic techniques in gallbladder cancer treatment is becoming increasingly widespread,with confirmed surgical safety and tumor control effects,leading to growing support for minimally invasive treatment among hepatobiliary surgeons.Additionally,indocyanine green-guided fluorescence laparoscopic technology allows for precise lymph node dissection and liver resection,reducing the risk of postoperative complications.In light of the complex anatomy in the hepatic hilum and hepatoduodenal ligament region in IGC patients,performing delayed radical surgery using the 3D laparoscopic PH approach(based on the portal vein and hepatic artery as the anatomical axis)helps prevent organ damage and tumor dissemination.This review summarizes the current surgical treatment of IGC and discusses the application of the PH approach in laparoscopic gallbladder cancer radical surgery.

Objective:To investigate the effect of FOXQ1 expression on chemoresistance in colorectal cancer and analyze its regulatory role in SIRT1 expression and p53 deacetylation under DNA damage response(DDR)condi-tions.Methods:qRT-PCR was used to detect FOXQ1 mRNA expression levels in SW620 cells and SW620 cells stimulated with cisplatin(CDDP).Lentiviral vectors were constructed for FOXQ1 overexpression and RNA interference.The cells were divided into three groups:FOXQ1 overexpression group(oe-FOXQ1),FOXQ1 RNA interference group(sh-FOXQ1),and a control group transfected with an empty vector(NC).The half-maximal inhibitory concentration(IC50)of CDDP in each group was determined using the CCK-8 assay.Apoptosis level and cell viability were assessed using the Annexin V-APC/7-ADD apoptosis detection kit and Calcein/PI staining.Western blot analysis was performed to evaluate the effect of FOXQ1 on SIRT1 expression and acetylated p53 levels.The SIRT1 pathway inhibitor(S)-Selisi-stat was introduced to observe changes in p53 acetylation levels.Results:Compared to normal colon tissues,FOXQ1 expression was significantly upregulated in SW620 cells(P＜0.05),and low-dose CDDP stimulation further en-hanced its expression(P＜0.05).After 24 hours of CDDP treatment,the IC50 values for the oe-FOXQ1,sh-FOXQ1,and NC groups were 58.3 μmol/L,36.4 μmol/L,and 43.7 μmol/L,respectively,with statistically significant differences among the groups(P＜0.05).Compared to the NC group,the oe-FOXQ1 group showed a decrease in late apoptotic cell count(P＜0.05),while the sh-FOXQ1 group exhibited an increase(P＜0.05).Cytotoxic fluorescence staining re-vealed that the proportion of cell death was lower in the oe-FOXQ1 group and higher in the sh-FOXQ1 group com-pared to the NC group(P＜0.05).Protein expression analysis showed that FOXQ1 and SIRT1 levels were higher in the oe-FOXQ1 group and lower in the sh-FOXQ1 group compared to the NC group(P＜0.05).FOXQ1 overexpression pro-moted p53 deacetylation,while the addition of the SIRT1 pathway inhibitor(S)-Selisistat restored p53 acetylation levels(P＜0.05).Conclusion:FOXQ1 promotes p53 deacetylation by upregulating SIRT1 expression,thereby inhibiting DDR-induced apoptosis.

Objective:To investigate the immuno-inflammatory regulatory effects of the Qing Gan San Jie Xiao Ying Formula(QGSJXYF)on Hashimoto's thyroiditis(HT)by modulating thyroid cell-derived exosomes to provide experi-mental evidence for its immunomodulatory mechanisms.Methods:Nthy-ori-3-1 thyroid cells were treated with QGSJXYF-medicated serum,with untreated cells serving as controls.Exosomes from both groups were extracted and analyzed using nanoparticle tracking analysis(NTA),transmission electron microscopy(TEM),and Western blot to assess concentration,size distribution,morphology,and the expression of characteristic exosomal markers.An inflammatory model of human T lymphocytes(H9)was established and co-incubated with normal exosomes(EXO-C group)or QGSJXYF-treated exosomes(EXO-T group).The levels of inflammatory cytokines in H9 cells were measured using Western blot(WB)and ELISA.Results:Exosome characterization showed that the particle concentration of Nthy-ori-3-1 cell-derived exosomes in both the control and QGSJXYF groups ranged from 1×109 to 1×1011/mL,with particle diameters between 80～300 nm.The exosomes exhibited a typical spherical or cup-shaped morphology with positive expression of TSG101,CD63,and HSP70.Compared with the inflammation model group and the EXO-C group,the EXO-T group significantly reduced the intracellular expression of IL-17A protein in H9 cells(P<0.05)and suppressed IL-17 and IL-6 levels in the cell supernatant(P<0.01).Conclusion:QGSJXYF may exert its anti-inflammatory and thyroid-protective effects by modulating the functional state of thyroid cell-derived exosomes,regulating the inflamma-tory microenvironment,and inhibiting the expression of inflammatory cytokines associated with Hashimoto's thyroiditis.

Objective:To investigate the impact of fibroblast growth factor(FGF)on recurrence following segmen-tal mastectomy in patients with plasma cell mastitis.Methods:A total of 162 female patients diagnosed with plasma cell mastitis(PCM)were selected from our hospital from October 2021 to May 2023.All patients underwent segmental mastectomy.They were divided into recurrence group(n=28)and non-recurrence group(n=134)according to the follow-up survey on recurrence.Conduct a univariate analysis on the factors influencing recurrence in patients with PCM who undergo segmental mastectomy.After correcting for confounding factors,conduct a multiple linear regression analysis.Using a multivariate logistic regression model to explore the independent risk factors for recurrence in patients undergo-ing segmental mastectomy for PCM.Utilizing logistic regression analysis to explore the independent,multiplicative,or additive interaction between FGF and angiogenic factor in the management of recurrence in PCM patients undergoing segmental mastectomy.The Local Weighted Regression Scatter Method(LOWESS)is used to analyze the two-dimensional curve relationship of continuous variables.Evaluate the predictive efficacy of FGF for PCM recurrence fol-lowing segmental mastectomy using Receiver Operating Characteristic(ROC)curves.Results:The results of univariate analysis showed that the body mass index(BMI),estradiol,prolactin levels,nipple depression,and sinus phase propor-tion of patients in the recurrent group were significantly higher than those in the non recurrent group,and the differ-ences were statistically significant(P＜0.05).Before surgery and 1 and 3 months after surgery,the levels of FGF,vascu-lar endothelial growth factor(VEGF),endostatin(ES),and VEGF/ES in the recurrent group were higher than those in the non recurrent group,with statistically significant differences between the groups(P＜0.05).The intra group comparison results showed that compared with before surgery,all indicators in both groups of patients were significantly reduced at 1 month after surgery(P＜0.05),while in the recurrent group,all indicators were significantly increased at 3 months after surgery(P＜0.001).Logistic regression analysis showed that patients with elevated FGF had a higher risk of recurrence in PCM(P＜0.05).LOWESS analysis found that there is a certain non-linear relationship between PCM recurrence rate and FGF.FGF has good predictive performance for PCM recurrence.After further adjusting for various confounding fac-tors such as BMI,it was found that the angiogenic factor is related to FGF.The interaction results show that there is an additive or multiplicative interaction between FGF and VEGF/ES.Conclusion:FGF elevation increases the risk of re-currence after segmental mastectomy for PCM.FGF and VEGF/ES exhibit additive or multiplicative interactions.FGF has good predictive performance for PCM recurrence.

Objective:To investigatetheclinicalefficacy and satetyoflaparoscopic abdominoperineal resection with pelvicperitoneum colsure for low rectal cancer.Methods:A comprehesive search was conducted across multiple da-tabases,including the Cochrane Library、PubMed、Embase、CBM、VIP、CNKI、and WanFang Data,focusing on studies re-lated to pelvic peritoneum colsure(PPC)-oriented laparoscopic abdominoperineal resection from database inception to July,2024.Then,meta-analysis was performed using RevMan 5.3 software.Results:A total of 12 studies involving 999 patients were included.The results showed that there was no significant difference in intraoperative blood loss.The laparoscopic pelvicperitoneum colsure takes a longer time,with a statistically significant difference(WMD=12.37,95%CI=2.27～22.46,P=0.02),but the postoperative exhaust time and hospitalization time are shorter,with a statistically significant difference(WMD=0.40,95%CI=0.07～0.72,P=0.02;WMD=-2.36,95%CI=-3.33～-1.38,P＜0.00001).In terms of postoperative complications,the overall complication rate was higher in the group that did not undergo pelvic-peritoneum colsure,with a statistically significant difference(OR=0.12,95%CI=0.08～0.18,P＜0.00001).The incidence of postoperative intestinal obstruction,perineal incisional hernia,pelvic effusion infection,and radiation enteritis was higher,and the differences were statistically significant(OR=0.24,95%CI=0.13～0.45,P＜0.00001,OR=0.23,95%CI=0.11～0.49,P=0.0001,OR=0.27,95%CI=0.14～0.51,P＜0.0001,OR=0.24,95%CI:0.07～0.81,P=0.03).Conclusion:In lapa-roscopic abdominoperineal resection,closing the pelvicperitoneum has lower postoperative complications,shorter post-operative exhaust time and hospitalization time,and longer operation time,which has better clinical efficacy and safety.