Objective:To explore the application value of three-dimensional high-resolution anorectal manometry(3D-HRAM)model in the diagnosis and localization of anal sphincter injury after surgery for complex anal fistula.Methods:A prospective study was con-ducted on 92 patients who had undergone surgery for complex anal fistula in the Department of Coloproctology of The People's Hospi-tal Affiliated to Fujian University of Traditional Chinese Medicine from January 2023 to January 2024.The study was conducted in two stages.In the first stage,92 patients underwent 3D-HRAM and endoanal ultrasonography(EAUS)to examine the sphincter,and the data were compared with intraoperative records to evaluate the diagnostic efficiency and localization accuracy of 3D-HRAM and EAUS.In the second stage,92 patients who had been examined were grouped according to the presence or absence of symptoms of anal dysfunction to further verify the diagnostic and localization values of 3D-HRAM and EAUS for postoperative compensated/decompen-sated sphincter injury.Results:Among 92 patients,41 and 57 patients were diagnosed with sphincter injury through 3D-HRAM and EAUS,with a sensitivity of 61.19%and 85.07%,a specificity of 88%and 76%,an area under the curve of 0.739 and 0.813 calcu-lated by plotting the receiver operating characteristic curve,and a localization accuracy of 44.77%and 71.64%,respectively,showing significant differences between 3D-HRAM and EAUS(P=0.002),indicating that 3D-HRAM had lower diagnostic efficiency and local-ization accuracy than EAUS for anal sphincter injury after surgery for complex anal fistula.After grouping by symptoms,the diagnostic efficiency and localization accuracy of 3D-HRAM for symptomatic sphincter injury(decompensated)were significantly better than those for asymptomatic sphincter injury,and were similar to those of EAUS(P=0.763).Conclusion:The application advantage of 3D-HRAM lies in the diagnosis and localization of decompensated anal sphincter injury after surgery for complex anal fistula,which provides effective technical support for the study of anal defecation control mechanisms and injury compensation mechanisms.

Objective To analyze the cosmetic effects and postoperative complications of patients with early breast cancer who underwent oncoplastic breast-conserving reconstruction and traditional breast-conserving surgery.Methods From January 201 2 to October 201 5,we collected a total of 67 patients with early-stage breast cancer who underwent breast-conserving surgery in Affiliated Mindong Hospital of Fujian Medical Univer-sity.Thirty patients who underwent oncoplastic breast-conserving reconstruction were in observation group,and 37 patients who underwent traditional breast-conserving surgery were in the control group.The postoperative complications,cosmetic effects and survival situations in the two groups were compared.Results In the aes-thetic effects evaluation,22 patients (73.33%)and 1 6 patients (43.24%)had good or excellent cosmetic effects,6 patients (20.00%)and 1 4 patients (37.84%)had general cosmetic effects,2 patients (6.67%) and 7 patients (1 8.92%)had poor cosmetic effects in the observation group and control group,with a signifi-cant difference (Z =-2.51 3,P =0.01 2).Four patients (1 3.33%)in the observation group had postopera-tive complications,including that 1 patients had incisional dehiscence followed by incisional wound infection and skin necrosis,and 3 patients had subcutaneous exudates.However,2 patients (5.41 %)in the control group had postoperative complications,including 1 patients with incisional dehiscence,and 1 patients with inci-sional wound infection.There were no significant difference in the occurrence rates of postoperative complica-tions in the two groups (χ2 =0.490,P =0.484).The mean follow-up period was 28 months.We found 1 patients of local recurrence,and 2 patients of metastases in the control group.However,all patients were free of recurrence and metastases in the observation group,with no significant difference (P =0.1 40).Conclusion Oncoplastic surgical technique in the breast-conserving surgery for patients with early-stage breast cancer is a safe and effective procedure,with highly satisfactory cosmetic effects for the majority of patients,which is worth to recommend.

Objective This article aims to study the impact of cyclopamine,a Hedgehog signaling pathway inhibitor,on the proliferation and apoptosis of QBC939 cholangiocarcinoma cells.Methods The proliferation of QBC939 cells was detected with the MTT assay,and the apoptotic rate was analyzed with the flow cytometry assay.RT-PCR and Western blow were used to detect the expressions of tumor-related genes and proteins in QBC939 cells before and after cyclopamine treatment.Results Our results show that cyclopamine inhibited the growth of QBC939 cells in time and dose dependent manners.After a 5,10,or 20 μmol/L cyclopamine treatment for 48 hours,QBC939 cells showed increased apoptotic rates significantly higher than those in the control group (P＜0.01).Furthermore,cyclopamine down regulated the mRNA and protein levels of PTCH1,GLI1,and EGFR in QBC939 cells.Conclusion Therefore,blockage of the Hedgehog signaling pathway with cyclopamine could suppress the proliferation and promote the apoptosis of QBC939 cholangiocarcinoma cells.