Pancreatic cancer is characterized by nerve invasion and a high mortality rate， and its pathological process depends on the complex interaction network between tumor and the nervous system. Based on the concept of “pancreatic cancer neuroecology”， this article analyzes the mechanism of action of peripheral motor nerve， sensory nerve， and central nerve in tumorigenesis， pain regulation， and cachexia formation and emphasizes the synergistic regulatory role of immune cells， Schwann cells， and extracellular matrix in the microenvironment of perineural invasion. At the same time， this article further elaborates on the metabolic interaction and chemotaxis between neuraxis and tumor， the effect on promoting chemotherapy resistance， and the dynamic relationship between neuroplasticity and tumor adaptability. In clinical practice， this article summarizes the key value of perineural invasion in prognostic evaluation， preoperative evaluation， and the selection of surgical strategy. In addition， this article reviews the basic research advances in the biomarkers and potential targets associated with perineural invasion in pancreatic cancer and points out the limitations of current model and transformation research. In the future， systematically analyzing the nerve-tumor-immune network and targeting its key nodes may provide multi-dimensional strategies and new breakthroughs for the precise intervention of pancreatic cancer， the reversal of drug resistance， and the relief of symptoms.

Objective To detect the expression of vacuolar protein sorting-associated protein 33A(VPS33A)in the peripheral blood of elderly patients with pulmonary tuberculosis,and explore its correlation with clinical prognosis.Methods A total of 95 elderly pulmonary tuberculosis patients admitted to Macheng City People's Hospital from February 2019 to February 2021 were collected as the research group,and 90 healthy subjects in the same period were selected as control group.The expression of VPS33A and Toll like receptor 2(TLR2)in peripheral blood was detected by real-time fluorescent quantitative PCR(qRT-PCR),and the level of interleukin-6(IL-6)in peripheral blood was detected by enzyme-linked immunosorbent assay.Patients with pulmonary tuberculosis were given standardized anti-tuberculosis regimen therapy(2HRZE/4HR)treatment,and they were followed up for 12 months.According to their prognosis,they were divided into good prognosis group(n=58)and bad prognosis group(n=37).The predictive value of VPS33A for poor prognosis was analyzed by ROC curve.The correlation between serum VPS33A,IL-6 and TLR2 in poor prognosis group was analyzed by Pearson method.Logistic regression analysis was used to explore the factors influencing poor prognosis in elderly patients with pulmonary tuberculosis.Results Compared with the control group,VPS33A level(0.87±0.22 vs 1.02±0.23)in peripheral blood was lower,but IL-6(22.13±5.36 pg/ml vs 18.53±4.68 pg/ml)and TLR2 levels(1.26±0.25 vs 0.99±0.21)were higher in the pre-treatment study group,with significant differences(t=6.170,6.682,11.241,all P＜0.05).Compared with the pre-treatment study group,VPS33A level(0.95±0.25)in peripheral blood was higher,but IL-6(19.66±5.44 pg/ml)and TLR2 levels(1.11±0.2)were lower in the post-treatment study group,with significant differences(t=3.336,4.648,6.331,all P＜0.05).The level of VPS33A(0.71±0.16)in peripheral blood of poor prognosis group was lower than that of good prognosis group(0.97±0.22),while the levels of IL-6(26.41±7.16 pg/ml)and TLR2(1.35±0.26)were higher than those of good prognosis group(19.40±4.21pg/ml,1.20±0.24),with significant differences(t=5.555,6.012,2.875,all P＜0.05).Pearson correlation analysis showed that VPS33A in the pre-treatment study group was negatively correlated with IL-6 and TLR2 levels(r=-0.649,-0.634,all P＜0.05).ROC curve analysis results showed that the AUCs of VPS33A,IL-6 and TLR2 for predicting the prognosis of tuberculosis in the elderly were 0.805,0.842 and 0.882,respectively.The combined AUC of the three was 0.971,which was higher than that predicted by the three alone(Z=4.010,3.136,2.285,P=0.001,0.002,0.022).Logistic regression analysis showed that VPS33A,IL-6 and TLR2 were the influencing factors for poor prognosis of elderly pulmonary tuberculosis patients(all P＜0.05).Conclusion The expression of VPS33A is down-regulated in the peripheral blood of elderly patients with pulmonary tuberculosis,which may be a good predictive value for the prognosis of elderly patients with pulmonary tuberculosis,and be a factor affecting bad prognosis.

Objective To verify the consistency of the reference intervals of thyroid hormone estimated in this investigation with the reference interval in the manual of the currently used reagent and industrial standard(WS/T 404.10-2022),and select the reference interval of thyroid hormone suitable for the healthy subjects at this hospital.Methods The indirect sampling technique was used to ret-rospectively analyze the results of thyroid hormone tests of healthy subjects in the Clinical Testing Center of Suzhou Dushu Lake Hospi-tal from December 2022 to August 2023.Nonparametric method was used to estimate thyroid hormone P2.5-P97.5 reference intervals and 95％confidence intervals of the testing subjects with different genders and ages,and to explore the significant differences in the data distribution among different gender and age groups.The differences were compared with the reference intervals recommended by the in-dustrial standard(WS/T 404.10-2022)and Roche reagent specification.Results There were significant differences in TSH,FT3,FT4 and TT3 between sexes(P＜0.001,Z＞Z*),but there was no significant difference in TT4 between sexes(P=0.998,Z＜Z*).In terms of TSH levels,the women were divided into 20 to 60-year-old group(reference interval:0.62-6.40 mIU/L)and≥61-year-old group(reference interval:0.85-7.47 mIU/L).There was significant difference between the 2 groups(P＜0.001),but there was no sig-nificant difference of TSH levels among the male groups with different age(reference interval:0.79-5.64 mIU/L).In terms of FT3 lev-els,the males were divided into 20 to 40-year-old group(reference interval:4.37-6.36 pmol/L)and ≥41-year-old group(reference interval:4.02-6.34 pmol/L).There was significant difference between the 2 groups(P＜0.001),but there was no significant difference in the female among various age groups(reference interval:3.44-5.63 pmol/L).In terms of FT4 level,the males were divided into 20 to 50-year-old group(reference interval:13.7-21.4 pmol/L)and ≥51-year-old group(reference interval:12.0-20.4 pmol/L),and the females were divided into 20 to 50-year-old group(reference interval:12.5-20.25 pmol/L)and≥51-year-old group(reference interval:11.34-19.18 pmol/L).There was all significant difference between various age groups in both male and female(P＜0.001).In terms of TT3 level,no difference was found between male and female regardless of age(male[reference interval:1.18-2.18 nmol/L]and female[reference interval:1.10-2.23 nmol/L]).In terms of TT4 level,there was no significant difference between sex and age(reference interval:64.1-127 nmol/L).There was no significant difference between the reference interval recommended by Roche reagent manual and the laboratory estimated FT4 reference interval,but there were significant differences in reference interval of TSH,FT3,TT3 and TT4.There was no significant difference between the industrial standard recommended reference interval and the laboratory estimated reference interval.Conclusion There were differences of TSH,FT3 and FT4 levels for gender and age,but no differences of TT4 levels for sex and age.There was gender difference of TT3 levels but no differences for age.The estimated reference interval verified by the laboratory was consistent with the industrial standard recommendation of WS/T 404.10-2022,but it was differ-ent from the recommendation of current Roche reagent manual.

Objective:To explore the risk factors for death within 1 year after hip fracture surgery in the elderly.Methods:A case control study was made on the clinical data of 551 elderly patients with hip fracture treated in Second Affiliated Hospital of Soochow University from January 2019 to December 2020, including 182 males and 369 females; aged 65-100 years [80(73,86)years]. Joint replacement, cannulated screw fixation or proximal femoral nail fixation were performed. The patients were divided into survival group ( n=494) and death group ( n=57) based on the death within 1 year after surgery recorded at postoperative telephone follow-up. The gender, age, hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, neurological diseases, chronic renal failure, anemia on admission, fracture types, American anesthesiologist Association (ASA) classification, operative methods, preoperative waiting time, duration of operation and perioperative blood transfusion were recorded in two groups. Univariate Cox regression was used to analyze the correlation between the above indexes and death within 1 year after surgery. All indexes with P<0.2 in the univariate analysis were included in multivariate Cox regression analysis to clarify the independent risk factors for death within 1 year after surgery. Results:Univariate Cox regression analysis showed that death within 1 year after surgery correlated with gender, age chronic respiratory diseases, chronic renal failure and anemia on admission (all P<0.01), but not with hypertension, diabetes, cardiovascular diseases, neurological diseases, fracture types, ASA classification, operative methods, preoperative waiting time, duration of operation or perioperative blood transfusion (all P>0.05). Multivariate Cox regression analysis showed that male ( HR=2.08, 95% CI 1.20, 3.61, P<0.01), age ≥ 80 years ( HR=2.22, 95% CI 1.15, 4.28, P<0.05), chronic respiratory diseases ( HR=2.54, 95% CI 1.19, 5.40, P<0.05), chronic renal failure ( HR=4.57, 95% CI 1.27, 16.44, P<0.05), anemia on admission ( HR=2.82, 95% CI 1.38, 5.76, P<0.01) were significantly associated with death within 1 year after surgery. Conclusion:Male age≥ 80 years, chronic respiratory disease, chronic renal failure and anemia on admission are independent risk factors for death within 1 year after hip fracture surgery in the elderly.

OBJECTIVE: To explore prevalence, risk factors and treatment of ankle sprain of young college student , in order to obtain accurate epidemiological data. METHODS: From March 2019 to May 2019, 552 college students(1 104 sides of anke joints) from Xi'an Physical Education university were enrolled in study according to inclusion and excludion standard, including 309 males and 243 females aged from 16 to 24 years old with an average of (20.9±3.7) years old. Age, gender, and body mass indes(BMI) etc were recorded. Morbidity of acute and chronic ankle sprains of physical students, treatment after the first sprain (cold compress, cast or plaster bracing and medicine), visual analogue scale (VAS) during walking were assessed through ankle sprain questionnaire;Cumberland ankle instability tool (CAIT), Maryland foot score were applied to assess ankle function. Lateral ankle ligament injury was objectively assessed by musculoskeletal ultrasonography. RESULTS: The prevalence of acute ankle sprain(AAS) was 96.20% (531/552), and the incidence of AAS was 59.96% (622/1 104). The prevalence of chronic ankle joint instability(CAI) was 16.85% (93/552), and the incidence of CAI was 8.97% (99/1 104). In the four categories of sports, college student suffered from multiple sprains in performance majors group was 22.20% (14/63), including of aerobicsand dance performance. The incidence of AAS of ball sports was 8.60%(14/163). After the first sprain, most college students(94.4%) were received cold compression, about 60% of them went to hospital;however, only 44.7% students were received standard treatmens(cast or plaster), only 35.3% of them were received hard ankle orthosis. In 552 college students, 44 students were suffered from more than 4 times of ankle sprain, and the total incidence was 7.97% (44/552). Cumberland score was 26.6±2.4, Cumberland score of students sprained ankle joint more than 4 times was (29.2±1.1), suggested it was a risk factor for ankle joint instability. VAS of students sprained ankle joint more than 4 times was higher than that of less than 4 times(P<0.05), Maryland foot score was significantly lower than that of that of <4 times(P<0.05). Musculoskeletal ultrasonography measured the thickness of anterior tibiofibular ligament(ATFL) was (2.41±0.41) mm, and the thickness of calcaneofibular ligament(CFL) was (1.92±0.21) mm, and had no statistical difference(P>0.05). CONCLUSION Ninty-four percent college students had at least once ankle sprain, ankle sprains were more common in erobics and ball sports. After the first sprain, the proportion of cast or plaster treatment was less than 50%. Sprained ankle joint more than 4 times is a risk factor, and musculoskeletal ultrasonography showed thickening of both ATFL and CFL, while no statstical difference.
Female ; Male ; Humans ; Adolescent ; Young Adult ; Adult ; Cross-Sectional Studies ; Joint Instability/epidemiology* ; Physical Education and Training ; Universities ; Ankle Injuries/therapy*

OBJECTIVE: To review the research progress of the feasibility of a new treatment method for atrophic rhinitis (ATR) based on tissue engineering technology (seed cells, scaffold materials, and growth factors), and provide new ideas for the treatment of ATR. METHODS: The literature related to ATR was extensively reviewed. Focusing on the three aspects of seed cells, scaffold materials, and growth factors, the recent research progress of ATR treatment was reviewed, and the future directions of tissue engineering technology to treat ATR were proposed. RESULTS: The pathogenesis and etiology of ATR are still unclear, and the effectiveness of the current treatments are still unsatisfactory. The construction of a cell-scaffold complex with sustained and controlled release of exogenous cytokines is expected to reverse the pathological changes of ATR, promoting the regeneration of normal nasal mucosa and reconstructing the atrophic turbinate. In recent years, the research progress of exosomes, three-dimensional printing, and organoids will promote the development of tissue engineering technology for ATR. CONCLUSION Tissue engineering technology can provide a new treatment method for ATR.
Humans ; Tissue Engineering/methods* ; Tissue Scaffolds ; Rhinitis, Atrophic ; Printing, Three-Dimensional ; Cytokines

Hydrogels/therapeutic use* ; Tissue Engineering ; Gelatin ; Intervertebral Disc/surgery* ; Methacrylates ; Tissue Scaffolds

OBJECTIVE: To compare clinical efficacy of scarf osteotomy and double metatarsal osteotomy(DMO) in treating moderate to severe hallux valgus. METHODS: Fifty patients (81 feet) with moderate to severe hallux valgus deformity were treated from January 2017 to December 2019, and were divided into Scarf osteotomy (SO) group or DMO group according to different osteotomy methods. There were 26 patients (44 feet) in SO group, including 1 male and 25 females, aged from 48 to 65 years old with an average of (55.5±4.67) years old;18 patients (30 feet) with moderate and 8 patients (14 feet) with severe. There were 24 patients(37 feet) in DMO group, including 1 male and 23 females, aged from 45 to 62 years old with an average of (52.1±6.8) years old;there were 14 patients (24 feet) with moderate and 10 patients (13 feet) with severe. Hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA) and relative length of the first metatarsal(RLFM) on weight-bearing anteroposterior radiographs before and after operation were compared. American Orthopaedic Foot and Ankle Society (AOFAS) hallux, metatarsal, and interphalangeal joint scores was used for evaluate clinical effects. Weight bearing time and complications were observed. RESULTS: Fivty patients were followed up. The follow-up time in SO group ranged from 12 to 36 months with an average of(20.50±6.22) months and from 16 to 28 months with an avaerge of(19.80±2.44) months in DMO group while there was no significant difference between two groups(P>0.05). All incision healed at stage I, and osteotomy healed at (20.31±3.17) months after operation. One patient occurred hallux adduction deformity, without transferred metatarsalgia;2 patients occurred metastatic metatarsalgia in DMO group. There were no significant difference in HVA, IMA, DMAA, and AOFAS scores between two groups(P>0.05) before and after operation. There was no significant difference in RLFM between two groups(P>0.05), while had significant difference in RLFM between two groups at final follow-up (P<0.05). Partial weight-bearing time and full weight-bearing time in SO group were significantly earlier than those in DMO group (P<0.05). CONCLUSION Both of Scarf osteotomy and the first metatarsal biplane osteotomy could effectively treat moderate to severe hallux valgus deformity, with similar imaging and clinical evaluation. However, the relative length of the first metatarsal bone in SO group was longer than that in DMO group after operation, and the time of weight bearing in Scarf osteotomy is earlier than that of double metatarsal osteotomy of the first metatarsal.
Female ; Humans ; Male ; Middle Aged ; Aged ; Hallux Valgus/surgery* ; Hallux ; Metatarsal Bones/surgery* ; Case-Control Studies ; Bunion ; Treatment Outcome ; Osteotomy/methods* ; Metatarsalgia

OBJECTIVE: To explore clinical effect of rotational Scarf osteotomy in treating hallux valgus (HV) with rotation of the first metatarsal bone. METHODS: From January 2018 to October 2019, 35 patients (40 feet) with HV and rotation deformity of the first metatarsal were treated with rotational Scarf osteotomy, including 5 males and 30 females;aged from 25 to 76 years old with an average of (40.32±5.43) years old. Hallux valgus angle(HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), the first metatarsal length (FML) were observed and compared, American Orthopedic Foot and Ankle Society(AOFAS) of hallux metatarsophalangeal interphalangeal joint score and visual analogue scale (VAS) were used to evaluate functional evaluation. RESULTS: Thirty-five patients(40 feet) were followed up from 12 to 36 months with an average of (14.35±3.62) months. HVA, IMA and DMAA were corrected from (36.32±4.51) °, (14.21±3.22) ° and (28.35±4.32) ° before operation to (14.32±5.71) °, (5.83±3.97) ° and (7.32±2.14) ° after operation respectively (P<0.05). There was no satistical difference in FML before and after operation (P>0.05). AOFAS score and VAS improved from (57.00±4.31) and (6.00±1.21) before operation to (90.31±3.28) and (1.42±0.83) after operation, respectively, and had significant difference(P<0.05);according to AOFAS score, 23 feet got excellent results, 15 feet good and 2 feet fair. CONCLUSION Rotational Scarf osteotomy with strong correction and high dimension could effectively correct HV combined with rotation deformity of the first metatarsal bone, improve function of the forefoot, and obtain good clinical results.
Male ; Female ; Humans ; Adult ; Middle Aged ; Aged ; Hallux Valgus/diagnostic imaging* ; Metatarsal Bones/surgery* ; Fluorometholone ; Rotation ; Treatment Outcome ; Radiography ; Bunion ; Osteotomy/methods*

Background: Diminutive (≤5 mm) and small (6-9 mm) polyps are the most common colorectal polyps seen clinically, and a tiny percentage of them contain advanced histology. Aims: To clarify the endoscopic characteristics of diminutive and small colorectal polyps with advanced histology. Methods: A retrospective analysis was conducted in patients undergoing colonoscopic polypectomy in Ningbo First Hospital from June 2016 to September 2021, and the clinical, endoscopic and pathological data were collected. Propensity score matching (1: 1) was performed to select the non - advanced histology controls comparable with diminutive and small polyps with advanced histology. The endoscopic characteristics related to advanced histology was identified by univariate and multivariate analyses. Results: A total of 3 631 diminutive and small adenomatous polyps were detected in 2 950 patients, among them, 14 (1.2%) diminutive polyps and 114 (4.6%) small polyps were diagnosed as advanced histology pathologically, with 14 high - grade intraepithelial neoplasia (HGIN) in diminutive polyps, and 109 HGIN and 5 submucosal invasive carcinoma in small polyps. For serrated lesions, 755 polyps less than 10 mm in diameter were detected in 504 patients, but no advanced histology was diagnosed. Multivariate Logistic regression analysis showed that chicken skin mucosa (OR=3.790, 95% CI: 1.767-8.128), congestion (OR=2.802, 95% CI: 1.450 - 5.415), hemorrhage (OR=5.074, 95% CI: 1.511 - 17.035), lobular changes (OR=2.522, 95% CI: 1.247 - 5.098) and relative depression (OR=5.317, 95% CI: 1.376-20.550) were independent risk factors for advanced histology in diminutive and small polyps, while no correlations were found between JNET classification type 2B and type 3, Paris endoscopic classification type 0 - I and advanced histology. Conclusions: When endoscopic characteristics including chicken skin mucosa, congestion, hemorrhage, lobular changes and relative depression are found in diminutive and small colorectal polyps, advanced histology should be suspected.