The adhesion in the gallbladder triangle is the most important factor influencing the conversion to laparotomy in laparoscopic cholecystectomy (LC).The degree of adhesion in the cholecystic triangle is closely related to the difficulty of LC operation.With the reduction of cholecystic triangle adhesion,the treatment of gallbladder during LC will be easy and the rate of conversion to laparotomy will decrease accordingly.In order to investigate the causes of cholecystic triangle adhesion and its influence on LC,this paper reviews the current research progress.

Objective To explore the mechanism of apoptosis after cryotherapy on tumors.Methods (1) GL261 glioma cells (1×107 cell/10 μL) were injected into the subcutaneous one ofC57 mice to establish tumor-bearing mouse models;when the diameter of tumor reached to 15-20 mm,the mice were randomly divided into cryogenic treatment group and sham-operated group (n=1 0);mice in the cryogenic treatment group were given surgical cryotherapy,while those in the sham-operated group only performed surgery without cryotherapy.TUNEL was used to detect the cell apoptosis in glioma tissues 12 and 24 h after operation;and Western blotting was employed to detect the protein expressions of pro-caspase-8,pro-caspase-9 and poly-ADP-ribose polymerase (PARP).(2) GL261 glioma cells were divided into control group and one time cryogenic release group,and DMEM and one time of cryogenic release were given to the two groups,respectively;12 h after the treatment,TUNEL was used to observe the cell apoptosis in glioma tissues,and Western blotting was employed to detect the protein expressions.Results (1) TUNEL indicated that the cells in the S1 region of the glioma tissues from mice in the cryogenic treatment group were uniformly died;significant apoptosis was noted in cells of the S2 region at 12 h after treatment;while,24 h after treatment,S1 region still showed uniform necrosis,S2 region showed apoptotic regression,and S3 region showed new apoptosis at the target side.Western blotting indicated that pro-caspase-9 and PARP protein expressions at the S2 region were signficantly decreased as compared with those at the S1,S3 and S4 regions (P＜0.05),and pro-caspase-8 protein expression at the S3 region were signficantly reduced as compared with those at the S1,S2 and S4 regions in the cryogenic treatment group (P＜0.05).(2) TUNEL showed that significantly increased GL261 glioma cell apoptosis rate was noted in the one time cryogenic release group as compared with that in the control group (P＜0.05);Western blotting indicated that as compared with the control group,the cryogenic release group had significantly decreased pro-caspase-8 and pro-caspase-9 expressions (P＜0.05).Conclusion Cryogenic release or substances released from tumor tissues after cryoablation shows an effect on promoting apoptosis.

Objective To measure the parameters of the specific electrode trajectory angles under the condition that the trajectory length in the nuclei could be as long as possible by using 3D reconstruction of subthalamic nucleus (STN).Methods A 3D atlas of deep brain nuclei was built on the 3D reconstruction station,and the parameters of STN were measured.MR imaging of 30 Parkinson's disease (PD) patients was matched to the 3D atlas to acquire the average nucleus information.Results The STN spatial location parameters showed no significant statistical difference with imaging of these 30 patients (95％ confidence interval of difference value＜l),indicating that this 3D atlas enjoyed good representative value.After simulation,the optimal trajectory angles were achieved:the combination angles ofring/slide:55°-57°/17°-19°,which extended the trajectory within the nucleus to about (5.7±0.3)mm.Conclusion The 3D atlas shows high representative of locating deep brain nucleus and could be registrated well to particular patient's images.After simulation on the atlas,the optimal trajectory angles parameters can be obtained,which shows the specific operation of achieving longer length of electrode in nucleus.

Objective To investigate the displacement characteristics of intraoperative and postoperative positions of electrodes on CT imaging for bilateral subthalamic nucleus-deep brain stimulation (STN-DBS) in Parkinson's disease (PD).Methods A retrospective analysis on preoperative MR imaging,intraoperative and postoperative CT images of 35 patients with PD treated with STN-DBS in our hospital from January 2014 to June 2018 was performed.A three-dimensional coordinate system was established based on preoperative MR imaging.MR imaging/CT fusion technique was used to fuse intraoperative and postoperative CT images with preoperative MR imaging to locate intraoperative and postoperative electrode positions.The displacement characteristics of intraoperative and postoperative electrodes were analyzed.Results The spatial distance between intraoperative and postoperative positions of bilateral electrodes was about 1 mm,and the depth displacement was minimal.The postoperative position of the first side electrode on lateral axis was shifted outwardly from intraopemtive position,and the second side electrode was shifted internally with a small degree;on anterior-posterior axis,the first side electrode obviously shifted backward,and the second side electrode slightly shifted backward.For bilateral electrodes,corresponding coordinate deviation of three axis between intraoperative electrode-preoperative target and postoperative electrode-preoperative target,showed a significant positive linear correlation,therefore,leading out the coordinate deviation regression function model.Conclusions The displacement of electrodes between intraoperative and postoperative positions has obvious rules after STN-DBS in PD,which can guide the adjustment of intraoperative electrode position and predict the postoperative position of electrode.

Objective The inadvertent lateral ventricle puncture is still a problem in subthalamic nucleus deep brain stimulation (STN-DBS) surgery,to which a solution is found in this study with a better choice of electrode angle in STN-DBS by reconstruction of the lateral ventricle and STN.Methods Forty patients with Parkinson's disease,admitted to our hospital from January 2009 to December 2015,were chosen in our study.According to the MRI data of the patients,the lateral ventricle and STN were reconstructed with mimics software;Evans indexes were measured,and the volume of lateral ventricle was reconstructed.Different lateral ventricle and STN planes were captured by using different Ring angles (50-60°,n=11),and the Slide angles of these planes were measured.The patients were divided into two groups according to their age:Group A (60-79-year-old) and Group B (40-59-year-old);their volume of lateral ventricle was measured and compared between the two groups;the correlation between age and volume of lateral ventricle was analyzed;the difference of electrode angle was compared between the two groups and the right and left side of the same group;according to the Evans indexes,these patients were then divided into three groups,the Slide angle and Ring angles were measured and the different angles between left and right brain and among the Evans groups were analyzed so as to give a recommended angle in the STN-DBS.Results Age was positively related to the volume of lateral ventricle,and left one and right volume of lateral ventricle (Pearson correlation index:0.364,0.384 and 0.362),which had statistical significance (P＜0.05).No significant difference on electrode angle was noted between group A and B of different Ring angles (P＞0.05),while significant difference was noted on right and left electrode angle between the two groups (P＜0.05).Positive correlations were noted between volume of lateral ventricle and both Evans indexes and electrode angle,and difference was noted on electrode angle in different Evans indexes groups (P＜0.05).The recommended angle was listed according to the difference of side and Evans' index.Conclusions Age is positively related to volume of lateral ventricle,however,the correlation between age and angle is not clear.Considering the difference of sides and Evans' index,we make a list of Ring and Slide angles as recommendation for deep brain stimulation.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.