Objective To investigate the effect of visual soft lens assisted nasotracheal intubation in the treatment of dental caries in children under general anesthesia.Methods Eighty children aged 3-5 years undergoing dental caries treatment under general anesthesia in Stomatological Hospital Affiliated to Nanchang University from April 2020 to April 2023 were selected.According to the random number table method,they were divided into visual laryngoscope group and visual soft lens group,with 40 cases in each group.Children in visual laryngoscope group were used visual laryngoscope endotracheal intubation,children in visual soft lens group were used visual soft lens endotracheal intubation.The incidence of intubation complications such as cuff rupture,oral soft tissue injury and hoarseness were compared between two groups.The glottis exposure time,endotracheal intubation,endotracheal intubation success rate for the first time,heart rate(HR)and mean arterial pressure(MAP)were measured 30min before induction,immediately after induction,immediately after tracheal intubation and 3min after tracheal intubation.Results HR,MAP,tracheal intubation time,the incidence of cuff rupture and oral soft tissue injury immediately after tracheal intubation in visual soft lens group were lower than those in visual laryngoscope group(P＜0.05).Conclusion The use of visual soft lens for nasotracheal intubation in children with dental caries under general anesthesia has stable hemodynamics,short intubation time,and low incidence of intubation complications,which can be effectively applied in clinical practice.

Objective:To investigate the efficacy of liver wedge resection and liver Ⅳb and Ⅴ segmentectomy for T2 gallbladder carcinoma (GBC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 168 patients who underwent radical resection of T2 GBC in The First Affiliated Hospital of Xi′an Jiaotong University from January 2011 to December 2021 were collected. There were 59 males and 109 females, aged (65±10)years. Of 168 patients, there were 112 cases in T2a stage and 56 cases in T2b stage. Of 112 patients in T2a stage, 73 cases underwent liver wedge resection and 39 cases underwent liver Ⅳb and Ⅴ segmentectomy. Of 56 patients in T2b stage, 27 cases underwent liver wedge resection and 29 cases underwent liver Ⅳb and Ⅴ segmen-tectomy. Measurement data with normal distribution were represented as Mean± SD, and measure-ment data with skewed distribution were represented as M(range). Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the Mann-Whitney U test. The Kaplan-Meier method was used to calculate survival rate and draw survival curve, and the Log-rank test was used for survival analysis. The COX proportional risk model was used for univariate and multivariate analyses. Results:(1) Clinical data analysis of patients undergoing different extent of hepatic resection for T2 GBC. There was no significant difference in gender, age, cholecystoli-thiasis, preoperative total bilirubin, carcinoembryonic antigen, CA19-9, CA125, incidental GBC, perineural invasion, microvascular invasion, pathological differentiation, histopathological subtypes, N staging, TNM staging between patients with T2a and T2b GBC who underwent different extent of hepatic resection ( P>0.05). (2) Prognostic analysis of T2 GBC patients undergoing different extent of hepatic resection. The 1-, 3- and 5-year cumulative disease-free survival rates of T2 GBC patients undergoing liver wedge resection were 78.0%, 60.1% and 51.4%, respectively, versus 86.8%, 80.0% and 68.0% of T2 GBC patients undergoing liver Ⅳb and Ⅴ segmentectomy, showing a significant difference between them ( χ2 =5.205, P<0.05). The 1-, 3-, and 5-year cumulative overall survival rates of T2 GBC patients undergoing liver wedge resection were 85.0%, 62.5%, and 55.1%, respectively, versus 92.6%, 81.6%, and 68.8% for T2 GBC patients undergoing liver Ⅳb and Ⅴ segmentectomy, showing a significant difference in cumulative overall survival rate between them ( χ2=4.351, P<0.05). The 1-, 3-, and 5-year cumulative disease-free survival rates of T2b GBC patients undergoing liver wedge resection were 70.4%, 45.9% and 39.2%, respectively, versus 89.7%, 71.3% and 54.0% of T2b GBC patients undergoing liver Ⅳb and Ⅴ segmentectomy, showing a significant difference between them ( χ2=5.047, P<0.05). The 1-, 3-, and 5-year cumulative overall survival rates of T2b GBC patients undergoing liver wedge resection were 81.5%, 53.2%, and 41.0%, respectively, versus 89.7%, 77.0%, and 60.7% of T2b GBC patients undergoing liver Ⅳb and Ⅴ segmentectomy, showing no significant difference in cumulative overall survival rate between them ( χ2=4.014, P<0.05). (3) Analysis of factors influencing prognosis of patients undergoing radical resection for T2 GBC. Results of multivariate analysis showed that CA19-9>39.0 U/mL, perineural invasion, N1 and N2 stage were independent risk factors influencing disease-free survival time of patients undergoing radical resection for T2 GBC ( hazard ratio=2.736, 3.496, 2.638, 17.440, 95% confidence interval as 1.195-6.266, 1.213-10.073, 1.429-4.869, 8.362-36.374, P<0.05). Liver Ⅳb and Ⅴ segmentectomy was an independent protective factor influencing disease-free survival time of patients undergoing radical resection for T2 GBC ( hazard ratio=0.418, 95% confidence interval as 0.230-0.759, P<0.05). CA19-9 >39.0 U/mL, perineural invasion, ⅡB stage, ⅢB stage and ⅣB stage of TNM staging were independent risk factors influencing overall survival time of patients undergoing radical resection for T2 GBC ( hazard ratio=2.740, 3.210, 2.037, 3.439, 24.466, 95% confidence interval as 1.127-6.664, 1.049-9.819, 1.004-4.125, 1.730-6.846, 10.733-55.842, P<0.05). Liver Ⅳb and Ⅴ segmentectomy was an independent protective factor influencing overall survival time of patients undergoing radical resec-tion for T2 GBC ( hazard ratio=0.476, 95% confidence interval as 0.261-0.867, P<0.05). (4) Analysis of postoperative complications in patients undergoing different extent of hepatic resection for T2 GBC. There was no significant difference in postoperative complications of patients with T2a and T2b GBC undergoing liver wedge resection or liver Ⅳb and Ⅴ segmentectomy ( P>0.05). Conclusions:Compared to liver wedge resection, liver Ⅳb and Ⅴ segmentectomy can effectively prolong the disease-free survival overall survival time of T2b GBC patients. There is no significant difference in the major complications. Liver Ⅳb and Ⅴ segmentectomy is an independent protective factor for prognosis of patients undergoing radical resection for T2 GBC.

Objective:To construct a random forest prediction model for non-invasive identification of perineural invasion in gallbladder carcinoma (GBC) based on preoperative enhanced CT imaging features.Methods:The clinical data of 180 patients who underwent curative-intent resection for gallbladder carcinoma at the First Affiliated Hospital of Xi′an Jiaotong University from January 2022 to December 2023 were retrospectively analyzed, including 61 males and 119 females with the age of (65.3±10.2) years old. The 180 patients were divided into a training set ( n=126) and a testing set ( n=54), and based on perineural invasion, the 126 patients in the training set were divided into the perineural invasion group ( n=33) and the non-perineural invasion group ( n=93), and the other 54 patients in the testing set, there were 15 patients with perineural invasion and 39 patients without perineural invasion. Clinical data such as gender, age, perineural invasion, carbohydrate antigen 19-9 (CA19-9) level and tumor stage were collected from patients. Multivariate logistic regression model was used to analyze the risk factors of perineural invasion in gallbladder carcinoma patients. The correlation between clinical variables and perineural invasion was ranked in order of importance using the "feature_importance" package in Python software. Then, we developed a random forest prediction model for perineural invasion in gallbladder carcinoma patients, and the area under the receiver operating characteristic (ROC) curve and confusion matrix were used to assess the predictive ability of the model. Results:Multivariate logistic regression model analysis showed that patients with CA19-9 >39.0 U/ml ( OR=5.165, 95% CI: 1.650-16.174), T3 stage ( OR=6.037, 95% CI: 1.571-23.197), T4 stage ( OR=9.996, 95% CI: 2.177-45.898), and lymph node metastasis ( OR=7.829, 95% CI: 2.705-22.627) were with a high risk of perineural invasion occurrence (all P<0.05). The top three variables in the order of the importance ranking were CA19-9, lymph node metastasis, and T stage. Combining the results of multivariate analysis and importance ranking, CA19-9, lymph node metastasis, and T stage were used to develop a random forest prediction model for perineural invasion in gallbladder carcinoma patients. The results of ROC curve analysis showed that the areas under curves of the random forest model in the training and testing sets were 0.8250 and 0.7667, respectively. The confusion matrix results showed that the sensitivity were 75.76% and 73.33%, the specificity were 80.65% and 76.92%, and the accuracy were 79.36% and 75.93% in the training and testing sets, respectively. Conclusion:Random forest prediction model based on preoperative enhanced CT image features can be used as a noninvasive means of identifying perineural invasion in patients with gallbladder carcinoma.

Pancreatobiliary maljunction(PBM)represents a congenital anatomical abnormality of the pancreaticobiliary ductal system,frequently predisposing individuals to recurrent cholangitis and pancreatitis.Accumulating evidence indicates that PBM is a precancerous lesion,and PBM plays an important role in the development and progression of gallbladder cancer(GBC).GBC arising from PBM is designated as PBM-associated GBC.Consequently,early diagnosis and treatment of PBM is paramount in mitigating the risk of GBC.This review outlined the epidemiology and advancements in the diagnosis and management of PBM,along with the clinical features,underlying mechanisms,and therapeutic progressions pertaining to PBM-associated GBC,in order to underscore the clinical significance of early intervention in PBM,so as to reduce the incidence of PBM-associated GBC.

Objective:To explore the value of a new modified T3 sub-staging for the prognosis evaluation in gallbladder cancer patients.Methods:This is a retrospective case-series study. The clinical data of patients with pathologically confirmed stage T3 gallbladder cancer who were admitted to the Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi′an Jiaotong University from January 2011 to December 2021 were retrospectively analyzed. A total of 190 patients were enrolled in this study, 67 males and 123 females, with an age ( M(IQR)) of 63(14) years (range:17 to 88 years). The stage T3 was divided into four sub-stages according to the site of tumor invasion: (1) T3a:tumor perforates the serosa,but not invading the liver and one other adjacent structure; (2) T3b:tumor perforates the serosa and invades one other adjacent structure,but not the liver; (3) T3c:tumor perforates the serosa and invades the liver,but not one other adjacent structure; (4) T3d:tumor perforates the serosa,invades the liver and one other adjacent structure. To evaluate the application value of this modified sub-staging,the Kaplan-Meier method was used to draw the survival curve,univariate analysis and multivariate analysis were done using the Log-rank test and Cox proportional hazard model respectively. Results:According to the modified T3 sub-staging method,34 patients (17.9%) were in stage T3a,24 cases(12.6%) were in stage T3b, 97 cases (51.1%) were in stage T3c, and 35 cases (18.4%) were in stage T3d. The median survival time of patients in stages T3a,T3b,T3c and T3d after radical resection was 72.0 months, 32.0 months, 12.0 months and 10.0 months, respectively. The 1-, 3-, and 5-year survival rates of patients in stage T3a, T3b, T3c and T3d were 79.4%, 53.3%, and 53.3%; 79.2%, 44.6%, and 26.0%;49.5%,27.5%,and 18.1%;42.9%,15.9%, and 15.9% ( χ2=18.349, P<0.01),respectively. Univariate analysis showed that gallbladder stones,pathological differentiation,perineural invasion, N stage,postoperative adjuvant therapy and modified T3 substage were factors affecting patient prognosis(all P<0.05). Cox multivariate analysis showed that modified sub-stages with T3c ( HR=2.043, 95% CI:1.176 to 3.549) and T3d( HR=2.419, 95% CI:1.284 to 4.555), accompanied by gallbladder stones ( HR=1.661,95% CI:1.150 to 2.398),pathological differentiation with poorly differentiated( HR=1.709,95% CI:1.198 to 2.438), and the N stage with N1 and N2( HR=1.602, 95% CI:1.090 to 2.355, 2.714, 95% CI: 1.621 to 4.544) were independent prognostic risk factors for patients in stage T3,while postoperative adjuvant chemotherapy( HR=0.351) was a protective factor for prognosis. There was no statistically significant difference in survival between patients with stage T3a and T3b who underwent hepatic wedge resection and liver segment or major resection ( P=0.402). For patients with stage T3c and T3d with liver invasion,the survival difference after hepatic wedge resection and segmental or major resection was statistically significant ( P=0.008). Conclusion:The modified T3 sub-staging system based on the depth and direction of tumor invasion maybe helpful to further stratify the prognosis of patients with gallbladder cancer.

Objective:To explore the value of a new modified T3 sub-staging for the prognosis evaluation in gallbladder cancer patients.Methods:This is a retrospective case-series study. The clinical data of patients with pathologically confirmed stage T3 gallbladder cancer who were admitted to the Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi′an Jiaotong University from January 2011 to December 2021 were retrospectively analyzed. A total of 190 patients were enrolled in this study, 67 males and 123 females, with an age ( M(IQR)) of 63(14) years (range:17 to 88 years). The stage T3 was divided into four sub-stages according to the site of tumor invasion: (1) T3a:tumor perforates the serosa,but not invading the liver and one other adjacent structure; (2) T3b:tumor perforates the serosa and invades one other adjacent structure,but not the liver; (3) T3c:tumor perforates the serosa and invades the liver,but not one other adjacent structure; (4) T3d:tumor perforates the serosa,invades the liver and one other adjacent structure. To evaluate the application value of this modified sub-staging,the Kaplan-Meier method was used to draw the survival curve,univariate analysis and multivariate analysis were done using the Log-rank test and Cox proportional hazard model respectively. Results:According to the modified T3 sub-staging method,34 patients (17.9%) were in stage T3a,24 cases(12.6%) were in stage T3b, 97 cases (51.1%) were in stage T3c, and 35 cases (18.4%) were in stage T3d. The median survival time of patients in stages T3a,T3b,T3c and T3d after radical resection was 72.0 months, 32.0 months, 12.0 months and 10.0 months, respectively. The 1-, 3-, and 5-year survival rates of patients in stage T3a, T3b, T3c and T3d were 79.4%, 53.3%, and 53.3%; 79.2%, 44.6%, and 26.0%;49.5%,27.5%,and 18.1%;42.9%,15.9%, and 15.9% ( χ2=18.349, P<0.01),respectively. Univariate analysis showed that gallbladder stones,pathological differentiation,perineural invasion, N stage,postoperative adjuvant therapy and modified T3 substage were factors affecting patient prognosis(all P<0.05). Cox multivariate analysis showed that modified sub-stages with T3c ( HR=2.043, 95% CI:1.176 to 3.549) and T3d( HR=2.419, 95% CI:1.284 to 4.555), accompanied by gallbladder stones ( HR=1.661,95% CI:1.150 to 2.398),pathological differentiation with poorly differentiated( HR=1.709,95% CI:1.198 to 2.438), and the N stage with N1 and N2( HR=1.602, 95% CI:1.090 to 2.355, 2.714, 95% CI: 1.621 to 4.544) were independent prognostic risk factors for patients in stage T3,while postoperative adjuvant chemotherapy( HR=0.351) was a protective factor for prognosis. There was no statistically significant difference in survival between patients with stage T3a and T3b who underwent hepatic wedge resection and liver segment or major resection ( P=0.402). For patients with stage T3c and T3d with liver invasion,the survival difference after hepatic wedge resection and segmental or major resection was statistically significant ( P=0.008). Conclusion:The modified T3 sub-staging system based on the depth and direction of tumor invasion maybe helpful to further stratify the prognosis of patients with gallbladder cancer.

During the Jin dynasty,the two major academic schools of Hejian and Yishui emerged in northern China.At this time,the Song dynasty migrated southward,accompanied by the southward movement of the Han ethnic culture and economic center.The dissemination of medicine also showed a trend of spreading from the north to the south.The late Yuan dynasty was an important period for the academic dissemination of the Yishui school to the south.On the one hand,ZHU Danxi,GE Yinglei,HUA Shou,and other clinicians studied the academic works of LI Dongyuan,comprehended his academic ideas,and further disseminated them through their disciples and Confucian scholars.On the other hand,academic works such as Jisheng Bacui and Weisheng Baojian carrying the study of Yishui were published in the south,playing an essential role in disseminating Yishui's study in the south.The dissemination of Yishui's learning to the south adopted a combination of book learning and mentorship,effectively breaking down the academic barriers between the Hejian and Yishui schools.The network formed by the interaction between medical scholars and Confucian scholars was an essential medium for academic dissemination.The study of Yishui was transmitted to the south and integrated with the original spleen and stomach theory in the south,promoting the further development of traditional Chinese medicine spleen and stomach theory.

During the Jin dynasty,the two major academic schools of Hejian and Yishui emerged in northern China.At this time,the Song dynasty migrated southward,accompanied by the southward movement of the Han ethnic culture and economic center.The dissemination of medicine also showed a trend of spreading from the north to the south.The late Yuan dynasty was an important period for the academic dissemination of the Yishui school to the south.On the one hand,ZHU Danxi,GE Yinglei,HUA Shou,and other clinicians studied the academic works of LI Dongyuan,comprehended his academic ideas,and further disseminated them through their disciples and Confucian scholars.On the other hand,academic works such as Jisheng Bacui and Weisheng Baojian carrying the study of Yishui were published in the south,playing an essential role in disseminating Yishui's study in the south.The dissemination of Yishui's learning to the south adopted a combination of book learning and mentorship,effectively breaking down the academic barriers between the Hejian and Yishui schools.The network formed by the interaction between medical scholars and Confucian scholars was an essential medium for academic dissemination.The study of Yishui was transmitted to the south and integrated with the original spleen and stomach theory in the south,promoting the further development of traditional Chinese medicine spleen and stomach theory.

During the Jin dynasty,the two major academic schools of Hejian and Yishui emerged in northern China.At this time,the Song dynasty migrated southward,accompanied by the southward movement of the Han ethnic culture and economic center.The dissemination of medicine also showed a trend of spreading from the north to the south.The late Yuan dynasty was an important period for the academic dissemination of the Yishui school to the south.On the one hand,ZHU Danxi,GE Yinglei,HUA Shou,and other clinicians studied the academic works of LI Dongyuan,comprehended his academic ideas,and further disseminated them through their disciples and Confucian scholars.On the other hand,academic works such as Jisheng Bacui and Weisheng Baojian carrying the study of Yishui were published in the south,playing an essential role in disseminating Yishui's study in the south.The dissemination of Yishui's learning to the south adopted a combination of book learning and mentorship,effectively breaking down the academic barriers between the Hejian and Yishui schools.The network formed by the interaction between medical scholars and Confucian scholars was an essential medium for academic dissemination.The study of Yishui was transmitted to the south and integrated with the original spleen and stomach theory in the south,promoting the further development of traditional Chinese medicine spleen and stomach theory.

AIM: To analyze the modeling characteristics and validation indexes of diabetic retinopathy model, analyze the shortcomings of the present animal experimental modeling, and provide a reference basis for the establishment of the standardization of the diabetic retinopathy model.METHODS: Literatures related to animal experiments on diabetic retinopathy were searched through the databases of CNKI, Wanfang, VIP and PubMed, and the experimental animal species, grade, gender, age, modeling method, modeling period, validation indexes, and other indexes were summarized and analyzed.RESULTS: The 275 papers that met the criteria were included. The animal models of diabetic retinopathy were mainly SD rats and Wistar rats, the sex of the experimental animals was mainly male, and the animal breeds were mostly of the SPF class. The age of most of the animals used was in the range of 6-8 weeks old; the modeling was based on those who established the type 1 diabetes model, mainly using STZ as the induction model. While the type 2 diabetes model was based on the high-fat, high-sugar diet combined with STZ. The modeling criteria were verified by detecting retinal morphology and structure, retinal vascularization, retinal function, and retinal cell apoptosis. In addition, the model was evaluated by detecting abnormal vascular proliferation, oxidative stress indicators, and inflammatory factor levels in retinal tissues, as well as abnormal vascular proliferation and inflammatory factor levels in aqueous humour, vitreous humor, and blood serum.CONCLUSION: Although the animal model of diabetic retinopathy has become a hotspot, the existing review is not comprehensive. Therefore, we summarized and analyzed the elements of the animal model through literature collation, including its characteristics and limitations, and providing methodological references for the establishment of the model, with a view to laying a solid foundation for the subsequent clinical and basic research of traditional Chinese medicine.