Perihilar cholangiocarcinoma(PHC)is a common malignancy of biliary tract,for which surgery is the most effective treatment.However,its prognosis is not satisfactory even after surgical resection.In recent years,there have been some new advances in the surgical treatment of PHC.In this paper,we reviewed the existing literatures,demonstrated the current situation of preoperative biliary drainage,liver hyperplasia,hepatic resection,liver transplantation and minimally invasive surgery in the treatment of PHC,and prospected the future research direction.

Post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)is one of the most common complications after endoscopic retrograde cholangiopancreatography(ERCP).Numerous PEP prediction models have been established based on different statistical methods at home and abroad.The PEP prediction model,as a tool for evaluating and screening high-risk populations,can provide a basis for medical staff to find high-risk PEP patients early and take effective preventive measures.In recent years,new PEP prediction models have appeared one after another,but there is still a lack of recognized reliable prediction models in clinic.This article reviews the research status of PEP risk prediction models,aim to provide a direction for establishing a more reliable,accurate,and practical PEP risk prediction model in the later period.

Objective:To explore the different categories of family resilience in cervical cancer patients and their influencing factors.Methods:From October 2022 to September 2023, 275 cervical cancer patients admitted to the First Hospital of Shanxi Medical University were selected as the study subject by convenience sampling. Cervical cancer patients were surveyed using the self-made General Information Questionnaire, Benefit Finding Scale (BFS), Connor-Davidson Resilience Scale (CD-RISC), and shortened Chinese Version of the Family Resilience Assessment Scale (FRAS-C). Latent profile analysis was used to investigate the family resilience of patients, and Logistic regression was used to analyze the influencing factors of family resilience in different categories.Results:A total of 275 questionnaires were distributed, and 253 valid questionnaires were collected, with a valid response rate of 92.0% (253/275). Family resilience of cervical cancer patients was divided into three categories of low resilience-negative coping group (18.6%, 47/253), moderate resilience-communication disorder group (59.3%, 150/253), and high resilience-inclusive understanding group (22.1%, 56/253). The per capita family monthly income, place of residence, primary caregivers, whether to undergo radiotherapy or chemotherapy, psychological resilience, and disease benefit finding were the influencing factors of family resilience in different categories of cervical cancer patients ( P<0.05) . Conclusions:The family resilience of cervical cancer patients can be divided into three latent categories. Medical and nursing staff should identify the characteristics of different categories of patients and provide targeted intervention measures to improve their family resilience.

AIM To investigate the effects of Zuogui Jiangtang Tongmai Recipe on necroptosis pathway in a rat model of type 2 diabetes mellitus(T2DM)complicated with cerebral infarction(CI).METHODS The SD rats were randomly divided into the sham operation group,the model group,the metformin group(0.045 g/kg),and the low,medium and high dose Zuogui Jiangtang Tongmai Recipe groups(6.5,13,26 g/kg),with 9 rats in each group.In contrast to rats of the sham operation group,rats of the other groups were given 4 weeks feeding of high-sugar and high-fat diet combined with intraperitoneal injection of streptozotocin to establish a T2DM rat model with one week stable blood glucose,followed by gavage of corresponding drugs 3 days before the establishment of the middle cerebral artery occlusion(MCAO)model.After 7 days of administration,the rats had their CI injury assessed by mNSS method and TTC staining;their level of blood glucose detected by blood glucose meter;their levels of glycated serum protein,serum TNF-α and IL-1β detected by ELISA;their cerebral mRNA expressions of FADD,RIPK1,RIPK3 and MLKL detected by RT-qPCR;and their cerebral protein expressions of FADD,p-RIPK1,p-RIPK3 and p-MLKL detected by Western blot.RESULTS Compared with the sham operation group,the model group displayed increased levels of blood glucose value,glycosylated serum protein,neurological function score,cerebral infarction volume,cerebral FADD,RIPK1,RIPK3 and MLKL mRNA expressions,cerebral FADD,p-RIPK1,p-RIPK3 and p-MLKL protein expressions,serum TNF-α and IL-1β levels(P＜0.01);and more disordered and morphologically diverse neurons with smaller nucleus.Compared with the model group,the groups intervened with medium or high dose Zuogui Jiangtang Tongmai Recipe,or metformin shared improvement in terms of the aforementioned indices(P＜0.05,P＜0.01);and more neurons with regular morphology neat arrangement,and reduced cell gap.CONCLUSION Zuogui Jiangtang Tongmai Recipe can improve the neurological dysfunction of the rat model of T2DM complicated with CI,which may associate with the inhibited activation of necroptosis signaling pathway.

Objective:To investigate the clinical effect of free flap transfer with anastomosis of anterior interosseous artery and accompanying veins as the recipient vessels in reconstruction of forearm defects.Methods:A retrospective study was conducted on 5 patients who received free flaps transfers with anastomoses of anterior interosseous artery and accompanying veins in reconstruction of forearm defects with exposed bone and tendon in the Department of Orthopaedics of the First Affiliated Hospital of Anhui Medical University between July 2022 and November 2023. All patients were males, aged 31 to 54 years old with an average age of 41.8 years old. Two patients had defects of dorsal ulnar forearm, 2 of distal forearm and 1 of radial palmar forearm. The defected areas after debridement sized 11.0 cm×4.5 cm-20.0 cm×6.0 cm. Free anterolateral thigh perforator flaps (ALTPF), sized 13.0 cm×6.0 cm-22.0 cm×7.0 cm, were used in 4 patients to reconstruct the forearm defects. A free superficial circumflex iliac artery perforator flap was used in 1 patient with the flap sized at 12.0 cm×5.5 cm. All donor sites were directly sutured. Scheduled postoperative follow up was carried out to evaluate the blood supply to the flaps, texture, appearance, fracture healing and the function of the affected limb, as well as the flap sensation according to the criteria for sensory function of British Medical Research Council (BMRC).Results:All 5 patients had received 4 to 16 (mean 8.8) months of follow-up. All flaps survived completely without necrosis or infection. All flaps were good in colour and texture. The blood supply to hands was good, without a symptoms of coldness and fear of cold of hand. At the final follow-up review, sensation of flaps was assessed according to the criteria for sensory function of BMRC and the sensation of the flaps had recovered to S 2~S 3+. The appearance of flaps was good. Conclusion:Free flap with the anterior interosseous artery and accompanying veins as the recipient vessels in the treatment of forearm defects can achieve satisfactory clinical effect, however, further clinical studies are required.

Objective:To investigate the influencing factors for splenomegaly secondary to acute pancreatitis (AP) and construction of a nomogram prediction model.Methods:The retrospective case-control study was conducted. The clinicopathological data of 180 patients with AP who were admitted to Xuanwu Hospital of Capital Medical University from December 2017 to December 2021 were collected. There were 124 males and 56 females, aged (49±15) years. Among them, 60 AP patients who developed secondary splenomegaly were taken as the case group, including 48 males and 12 females, aged (47±13)years, and the rest of 120 cases of AP without secondary splenomegaly were taken as the control group, including 76 males and 44 females, aged (50±16)years. Observation indicators: (1) occurrence and clinical characteristics of splenomegaly secondary to AP; (2) influencing factors for splenomegaly secondary to AP; (3) construction and evaluation of a nomogram prediction model for splenomegaly secondary to AP. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was analyzed using the rank sum test. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. The univariate analysis was performed using statistical methods appropriate to the data type. The optimal cut-off value was determined by the receiver operating characteristic curves. Multivariate analysis was conducted using the Logistic regression model with forward method. Based on the results of the multivariate analysis, a nomogram prediction model was constructed. The receiver operating characteristic curve was drawn, and the discrimination was evaluated using the area under curve. The consistency of the nomogram prediction model was evaluated using calibration curve, and its clinical benefit was evaluated using decision curve. Results:(1) Occurrence and clinical characteristics of splenomegaly secondary to AP. The first detection time of 60 patients with splenomegaly secondary to AP was 60(30,120)days after the onset of AP. Cases with persistent respiratory dysfunction, multiple organ failure, severity of illness as mild or moderately severe/severe, pancreatic and/or peripancreatic infection, surgery were 19, 17, 4, 56, 37, 32 for 60 patients with splenomegaly secondary to AP, versus 16, 19, 43, 77, 39, 29 for 120 patients without splenomegaly secondary to AP, respectively, showing significant differences in the above indicators between the two groups ( χ2=8.58, 3.91, 17.64, 13.95, 15.19, P<0.05). (2) Influencing factors for splenomegaly secondary to AP. Resuts of multivariate analysis showed that white blood cell count <5.775×10?/L within 24 hours of AP onset, revised computed tomography (CT) severity index >7 in 3-7 days after onset and the presence of local complications were independent risk factors influencing the splenomegaly secondary to AP ( odds ratio=3.85, 2.86, 6.40, 95% confidence interval as 1.68-8.85, 1.18-6.95, 1.56-26.35, P<0.05). (4) Construction and evaluation of a nomogram prediction model for splenomegaly secondary to AP. The nomogram prediction model was constructed based on white blood cell count within 24 hours of AP onset, revised CT severity index in 3-7 days after onset and local complications. The area under the receiver operating characteristic curve of the nomogram prediction model was 0.76 (95% confidence interval as 0.69-0.83, P<0.05), with a sensitivity of 0.87 and a specificity of 0.55. The calibration curve demonstrated consistency between the predicted rate from the nomogram prediction model and the actually observed rate. The decision curve analysis indicated that the nomogram prediction model had favorable clinical practicability. Conclusions:Patients with AP who develop secondary splenomegaly tend to have a higher severity of illness than those develop no secondary splenomegaly. White blood cell count <5.775×10?/L within 24 hours of AP onset, revised CT severity index >7 in 3-7 days after onset and presence of local complications are independent risk factors influencing splenomegaly secondary to AP, and its nomogram prediction model can predict incidence rate of splenomegaly secondary to AP.

Objective The aim of this study was to compare the effect of injection of indocyanine green(ICG)through peripheral vein and gallbladder in laparoscopic cholecystectomy(LC)of difficult gallbladder.Methods Patients with difficult gallbladder who underwent LC by the same surgical team from May to October 2023 in the Department of Hepatobiliary Surgery,the First Affiliated Hospital of Anhui University of Science and Technology were divided into three groups according to A random number table.Group A was injected ICG through peripheral vein before operation,group B was injected ICG through gallbladder during operation,and group C was the control group.The differences of operation time,intraoperative blood loss,hospitalization time,hospitalization cost and postoperative complications among the three groups were compared,and the effects of fluorescence mode cholangio-gram in group A and group B were compared.One-way analysis of variance was used to compare the normal distri-bution of the measurement data among groups,and LSD-t test was used to compare the two groups.The counting data was compared by chi-square test.The Boferroni test was appied to compare the two groups.Results There were no differences in length of stay,hospitalization cost and postoperative complications among the three groups(P＞0.05).The operative time and intraoperative blood loss of group A and group B were lower than those of group C(P＜0.05),but there was no difference between group A and group B(P＞0.05).The total imaging rate of the first three tubes of free gallbladder triangle(early stage)in group A was 41.67%,which was significantly lower than that in group B(63.89%)(P＜0.05).Conclusion ICG is beneficial for the identification of extrahepatic bile duct structures during LC of difficult gallbladder,and ICG injection through the gallbladder is helpful for the early identification of extrahepatic bile duct.

Objective To explore the efficacy and safety of recombinant human anti-severe acute respiratory syn-drome coronavirus 2(anti-SARS-CoV-2)monoclonal antibody injection(F61 injection)in the treatment of patients with coronavirus disease 2019(COVID-19)combined with renal damage.Methods Patients with COVID-19 and renal damage who visited the PLA General Hospital from January to February 2023 were selected.Subjects were randomly divided into two groups.Control group was treated with conventional anti-COVID-19 therapy,while trial group was treated with conventional anti-COVID-19 therapy combined with F61 injection.A 15-day follow-up was conducted after drug administration.Clinical symptoms,laboratory tests,electrocardiogram,and chest CT of pa-tients were performed to analyze the efficacy and safety of F61 injection.Results Twelve subjects(7 in trial group and 5 in control group)were included in study.Neither group had any clinical progression or death cases.The ave-rage time for negative conversion of nucleic acid of SARS-CoV-2 in control group and trial group were 3.2 days and 1.57 days(P=0.046),respectively.The scores of COVID-19 related target symptom in the trial group on the 3rd and 5th day after medication were both lower than those of the control group(both P＜0.05).According to the clinical staging and World Health Organization 10-point graded disease progression scale,both groups of subjects improved but didn't show statistical differences(P＞0.05).For safety,trial group didn't present any infusion-re-lated adverse event.Subjects in both groups demonstrated varying degrees of elevated blood glucose,elevated urine glucose,elevated urobilinogen,positive urine casts,and cardiac arrhythmia,but the differences were not statistica-lly significant(all P＞0.05).Conclusion F61 injection has initially demonstrated safety and clinical benefit in trea-ting patients with COVID-19 combined with renal damage.As the domestically produced drug,it has good clinical accessibility and may provide more options for clinical practice.

Objective To explore the clinical efficacy and mechanism of Qinggan Sanjie Xiaoying Decoction in the treatment of Hashimoto's thyroiditis with syndrome of stagnation heat of liver meridian and stagnation of spleen deficiency and phlegm.Methods Totally 70 patients were divided into control group and medicine group according to their wishes,with 35 patients in each group.Both groups were restricted to an iodine diet.The medicine group was given Qinggan Sanjie Xiaoying Granules,1 sachet at a time,twice a day,orally.The treatment for both groups lasted for 4 weeks.20 healthy people were chosen as the healthy group.The clinical efficacy of both groups was observed.TCM symptom score,thyroid antibody titer levels(TPOAb,TGAb),changes in thyroid volume and isthmus of both groups before and after treatment were compared.Levels of serum IKKα,IKBα and TNF-α of the three groups were compared.Adverse reactions of patients daring the treatment period were monitored.Results The total effective rate of the medicine group was 85.71%(30/35),while the control group was 20.00%(7/35).The medicine group was superior to the control group(P<0.05).Compared with before treatment,the medication group showed significant improvement in TCM symptom scores,TPOAb and TGAb titer levels,thyroid volume,and thyroid isthmus thickness after treatment(P<0.05).After treatment,TCM symptom score,thyroid volume in the medicine group were lower than those in the control group(P<0.05),and the decrease rate of TPOAb titer was higher than that in the group(P<0.05).The levels of IKKα and TNF-α before treatment of medicine group and control group were higher than that in the healthy control group,and the level of IKBα was lower than that of the healthy control group(P<0.05);compared with before treatment,the levels of IKKα and TNF-α in the medicine group decreased,and the level of IKBα increased(P<0.05);after treatment,the levels of IKKα and TNF-α in the medicine group were lower than that in the control group,and IKBα was higher than the control group(P<0.05).No adverse events were observed during the treatment period in both groups of patients.Conclusion Qinggan Sanjie Xiaoying Decoction can reduce the antibody titer level,thyroid enlargement,isthmus thickness,and TCM syndrome score in the treatment of Hashimoto's thyroiditis.It is safe and effective in clinical practice.Qinggan Sanjie Xiaoying Decoction may play a therapeutic role by interfering with NF-κB signaling pathway.

Objective:To investigate the impact of the interval period between biopsy and MR examination on tumor detection and extraprostatic extension (EPE) assessment for prostate cancer (PCa) using multi-parametric MRI (mpMRI).Methods:The study was cross-sectional and retrospectively included 130 patients with PCa who underwent RP and preoperative systematic biopsies followed by mpMRI between January 2021 and December 2022 in the First Medical Center of Chinese PLA General Hospital. Patients were divided into 3 groups according to interval following biopsy (group A,<3 weeks, 31 cases; group B, 3-6 weeks, 67 cases; group C,>6 weeks, 32 cases). The percentages of hemorrhage volume in the total prostate were drawn on T 1WI and calculated. The junior, senior and expert radiologists independently localized the index lesions and calculated the accuracy for tumor detection, in addition to assessing the probabilities of EPE according to EPE grade. The correlation between the hemorrhage extent and interval was analyzed using the Spearman correlation coefficient. The accuracy for tumor detection was compared using χ2 test among groups. The diagnostic performance of the radiologists for EPE prediction was assessed using the receiver operating characteristic curve, and the differences between the corresponding area under the curve (AUC) were compared using the DeLong test. Results:The percentage of hemorrhage was correlated with the interval between biopsy and MR examination ( r=-0.325, P<0.001). The detection accuracy of junior radiologist was 83.9% (26/31), 76.1% (51/67), and 78.1% (25/32) in group A, B and C, respectively; no differences were observed in the detection accuracy among three groups ( χ2=0.76, P=0.685). The detection accuracy of senior radiologist was 83.9% (26/31), 80.6% (54/67), and 71.9% (23/32) in 3 groups with no differences ( χ2=1.53, P=0.464). The detection accuracy of expert radiologist was 80.6% (25/31), 77.6% (52/67), and 93.8% (30/32) with no differences ( χ2=3.95, P=0.139). The AUC (95% CI) for predicting EPE were 0.830 (0.652-0.940), 0.704 (0.580-0.809), 0.800 (0.621-0.920) in the group A, B and C for junior radiologist; 0.876 (0.708-0.966), 0.768 (0.659-0.863), 0.896 (0.736-0.975) for senior radiologist; and 0.866 (0.695-0.961), 0.813 (0.699-0.895), 0.852 (0.682-0.952) for expert radiologist, respectively. No differences were observed among the subgroups in each radiologist ( P>0.05). Conclusion:The interval period does not significantly affect the detection accuracy and EPE assessment of PCa using mpMRI. There is probably no necessity for prolonged intervals following systematic biopsy to preserve the clarity of MRI interpretation for PCa.