AIM: To compare the efficacy, safety, and complications of 27G and 25G vitrectomy in the treatment of rhegmatogenous retinal detachment(RRD)involving the macular area.METHODS:This retrospective study analyzed 60 patients(60 eyes)initially diagnosed with RRD involving the macular area and undergoing 25G or 27G vitrectomy combined with retinal reattachment at our hospital from January 2021 to December 2023. Patients were divided into 25G group(30 eyes)and 27G group(30 eyes). Best corrected visual acuity(BCVA), intraocular pressure(IOP), surgical duration, retinal reattachment rate and complications of both groups of patients were compared before and after surgery.RESULTS: The mean surgical time in the 27G group was slightly longer than in the 25G group(40.20±7.52 vs 36.97±7.47 min). Incision leakage occurred in 7 eyes(23%)in the 25G group versus 1 eye(3%)in the 27G group, though the difference was not statistically significant between two groups(P>0.05). At 6 mo postoperatively, BCVA(LogMAR)improved significantly in both groups(27G: 0.37±0.19 vs preoperative 0.98±0.32; 25G: 0.40±0.17 vs preoperative 0.84±0.33; all P<0.05), with no statistical difference in BCVA(P>0.05). At 1 d postoperatively, the 25G group had lower mean IOP(12.29±2.86 mmHg)compared to the 27G group(15.87±3.70 mmHg; P<0.001), but no differences were observed at 1 wk or 1 mo postoperatively(all P>0.05). Retinal reattachment rates and complications(intra- or postoperative)showed no significant intergroup differences(all P>0.05).CONCLUSION: Both 25G and 27G vitrectomy are safe and effective in treating rhegmatogenous retinal detachment. However, the 27G vitrectomy offers advantages such as small incisions, better self-sealing properties, and more stable IOP.

Objective:To evaluate the clinical efficacy of endoclip papillaplasty (ECPP) for preventing recurrent choledocholithiasis after endoscopic retrograde cholangiopancreatography (ERCP).Methods:A retrospective analysis was conducted on 1 941 patients who underwent ERCP for choledocholithiasis in Henan Provincial People's Hospital from January 2019 to December 2023. A total of 250 patients who received ECPP were assigned to the ECPP group, while 251 matched controls were selected via 1∶1 year-stratified sampling into the control group. After follow-up, 209 ECPP cases and 190 controls were ultimately included in the analysis. Stone removal success rate, incidence of perioperative complications, and postoperative choledocholithiasis recurrence were compared between the two groups. Univariate and multivariate logistic regression were used to determine the risk factors for choledocholithiasis recurrence after ERCP.Results:Both groups achieved 100.0% stone removal success rate. There was no significant difference in the incidence of intraoperative perforation [0.5% (1/209) VS 1.1% (2/190), χ2=0.01, P=0.934], postoperative hyperamylasemia [21.5% (45/209) VS 17.4% (33/190), χ2=1.10, P=0.295] or post-ERCP pancreatitis [3.8% (8/209) VS 8.1% (9/190), χ2=0.20, P=0.653] between the ECPP group and the control group. The ECPP group showed significantly lower bleeding rate [5.1% (11/209) VS 12.3% (23/190), χ2=5.98, P=0.014] and choledocholithiasis recurrence rate [10.5% (22/209) VS 18.9% (36/190), χ2=5.68, P=0.017] compared with the control group. The multivariate logistic regression identified dilated common bile duct diameter ( OR=1.881, 95% CI: 1.101-3.213, P=0.021) as an independent risk factor for choledocholithiasis recurrence, while being female ( OR=0.482, 95% CI: 0.266-0.875, P=0.016) and ECPP ( OR=0.497, 95% CI:0.278-0.887, P=0.018) were protective factors. Conclusion:ECPP effectively reduces choledocholithiasis recurrence rate and bleeding risk after ERCP. ECPP and being female serve as protective factors for choledocholithiasis recurrence, while dilated bile duct diameter is an independent risk factor.

BACKGROUND:Allicin,the main active ingredient in garlic,has anti-inflammatory and antioxidant effects,but the role and mechanism of allicin in ameliorating rheumatoid arthritis remain unclear.OBJECTIVE:To analyze differentially expressed genes in rheumatoid arthritis using gene expression data and explore the regulatory role of alliin in rheumatoid arthritis.METHODS:Gene expression data for rheumatoid arthritis were collected from the GSE45291 and GSE93777 datasets,and differential expression analysis was then performed.Co-expression network analysis was conducted on the common differentially expressed genes identified in both datasets to identify the module genes most closely related to rheumatoid arthritis,followed by functional enrichment analysis.The SwissTargetPrediction database was used to predict the target genes of allicin in the differentially expressed genes.The area under the receiver operator characteristic curve(AUC)of the differentially expressed target genes was calculated.Human immortalized rheumatoid arthritis fibroblast-like synoviocytes were seeded onto pore plates and cultured for 24 hours,and the cells were then divided into five groups.The control group was not treated;methotrexate was added to the positive drug group;and 20,80,and 160 μg/mL allicin was added to the low-,medium-,and high-dose allicin groups,respectively.After 48 hours of treatment,cell activity was assessed using cell counting kit-8 assay and cell apoptosis was detected using TUNEL assay.Levels of oxidative stress and inflammatory factors were measured by ELISA.Changes in mitochondrial membrane potential were detected by JC-1 staining.The expression levels of target genes and related signaling pathways were detected by RT-qPCR and western blot.RESULTS AND CONCLUSION:A total of 6 487 common differentially expressed genes were identified in the GSE45291 and GSE93777 datasets,and 12 co-expression modules were obtained.The magenta module had the highest correlation with rheumatoid arthritis,with module genes primarily enriched in the phosphatidylinositol 3-kinase/protein kinase B signaling pathway.Database predictions revealed that seven differentially expressed genes were targeted by allicin,with epidermal growth factor receptor having the highest AUC value in the GSE45291 dataset and kynureninase having the highest AUC value in the GSE93777 dataset.Treatment of human immortalized rheumatoid arthritis fibroblast-like synoviocytes with allicin significantly inhibited cell activity,promoted cell apoptosis,decreased the levels of reactive oxygen species,malondialdehyde,interleukin-6,interleukin-1β,increased the expression of mitochondrial membrane potential,decreased the mRNA and protein expression of epidermal growth factor receptor,kynureninase,mitochondrial dynamin-related protein 1,elevated the mRNA and protein expression of mitochondrial fusion protein 2,and increased the protein expression of p-AKT and p-PI3K.To conclude,allicin plays the potential therapeutic effects on rheumatoid arthritis through the regulation of target genes such as epidermal growth factor receptor and kynureninase.

BACKGROUND:Allicin,the main active ingredient in garlic,has anti-inflammatory and antioxidant effects,but the role and mechanism of allicin in ameliorating rheumatoid arthritis remain unclear.OBJECTIVE:To analyze differentially expressed genes in rheumatoid arthritis using gene expression data and explore the regulatory role of alliin in rheumatoid arthritis.METHODS:Gene expression data for rheumatoid arthritis were collected from the GSE45291 and GSE93777 datasets,and differential expression analysis was then performed.Co-expression network analysis was conducted on the common differentially expressed genes identified in both datasets to identify the module genes most closely related to rheumatoid arthritis,followed by functional enrichment analysis.The SwissTargetPrediction database was used to predict the target genes of allicin in the differentially expressed genes.The area under the receiver operator characteristic curve(AUC)of the differentially expressed target genes was calculated.Human immortalized rheumatoid arthritis fibroblast-like synoviocytes were seeded onto pore plates and cultured for 24 hours,and the cells were then divided into five groups.The control group was not treated;methotrexate was added to the positive drug group;and 20,80,and 160 μg/mL allicin was added to the low-,medium-,and high-dose allicin groups,respectively.After 48 hours of treatment,cell activity was assessed using cell counting kit-8 assay and cell apoptosis was detected using TUNEL assay.Levels of oxidative stress and inflammatory factors were measured by ELISA.Changes in mitochondrial membrane potential were detected by JC-1 staining.The expression levels of target genes and related signaling pathways were detected by RT-qPCR and western blot.RESULTS AND CONCLUSION:A total of 6 487 common differentially expressed genes were identified in the GSE45291 and GSE93777 datasets,and 12 co-expression modules were obtained.The magenta module had the highest correlation with rheumatoid arthritis,with module genes primarily enriched in the phosphatidylinositol 3-kinase/protein kinase B signaling pathway.Database predictions revealed that seven differentially expressed genes were targeted by allicin,with epidermal growth factor receptor having the highest AUC value in the GSE45291 dataset and kynureninase having the highest AUC value in the GSE93777 dataset.Treatment of human immortalized rheumatoid arthritis fibroblast-like synoviocytes with allicin significantly inhibited cell activity,promoted cell apoptosis,decreased the levels of reactive oxygen species,malondialdehyde,interleukin-6,interleukin-1β,increased the expression of mitochondrial membrane potential,decreased the mRNA and protein expression of epidermal growth factor receptor,kynureninase,mitochondrial dynamin-related protein 1,elevated the mRNA and protein expression of mitochondrial fusion protein 2,and increased the protein expression of p-AKT and p-PI3K.To conclude,allicin plays the potential therapeutic effects on rheumatoid arthritis through the regulation of target genes such as epidermal growth factor receptor and kynureninase.

Objective:To evaluate the clinical efficacy of endoclip papillaplasty (ECPP) for preventing recurrent choledocholithiasis after endoscopic retrograde cholangiopancreatography (ERCP).Methods:A retrospective analysis was conducted on 1 941 patients who underwent ERCP for choledocholithiasis in Henan Provincial People's Hospital from January 2019 to December 2023. A total of 250 patients who received ECPP were assigned to the ECPP group, while 251 matched controls were selected via 1∶1 year-stratified sampling into the control group. After follow-up, 209 ECPP cases and 190 controls were ultimately included in the analysis. Stone removal success rate, incidence of perioperative complications, and postoperative choledocholithiasis recurrence were compared between the two groups. Univariate and multivariate logistic regression were used to determine the risk factors for choledocholithiasis recurrence after ERCP.Results:Both groups achieved 100.0% stone removal success rate. There was no significant difference in the incidence of intraoperative perforation [0.5% (1/209) VS 1.1% (2/190), χ2=0.01, P=0.934], postoperative hyperamylasemia [21.5% (45/209) VS 17.4% (33/190), χ2=1.10, P=0.295] or post-ERCP pancreatitis [3.8% (8/209) VS 8.1% (9/190), χ2=0.20, P=0.653] between the ECPP group and the control group. The ECPP group showed significantly lower bleeding rate [5.1% (11/209) VS 12.3% (23/190), χ2=5.98, P=0.014] and choledocholithiasis recurrence rate [10.5% (22/209) VS 18.9% (36/190), χ2=5.68, P=0.017] compared with the control group. The multivariate logistic regression identified dilated common bile duct diameter ( OR=1.881, 95% CI: 1.101-3.213, P=0.021) as an independent risk factor for choledocholithiasis recurrence, while being female ( OR=0.482, 95% CI: 0.266-0.875, P=0.016) and ECPP ( OR=0.497, 95% CI:0.278-0.887, P=0.018) were protective factors. Conclusion:ECPP effectively reduces choledocholithiasis recurrence rate and bleeding risk after ERCP. ECPP and being female serve as protective factors for choledocholithiasis recurrence, while dilated bile duct diameter is an independent risk factor.

BACKGROUND:In recent years,tranexamic acid has been extensively used to mitigate the substantial blood loss associated with total knee arthroplasty.However,the optimal method of topical application has not yet been established. OBJECTIVE:To evaluate the effectiveness and safety of intraoperative topical application of tranexamic acid combined with physical compression dressing in reducing perioperative blood loss in total knee arthroplasty. METHODS:A retrospective analysis was conducted on 90 patients who underwent total knee arthroplasty at the Honghui Hospital in Xi'an from January 2021 to December 2022.Based on the different topical use methods of tranexamic acid during surgery,patients were divided into three groups,with 30 cases in each group.In the compression dressing group,2 g of tranexamic acid was placed in the articular cavity,and after packing the wound with gauze and cotton pads,a bandage was used to compress the wound.In the periarticular injection group,2 g of tranexamic acid was injected into the surrounding tissue of the articular cavity.In the intra-articular injection group,2 g of tranexamic acid was injected into the articular cavity.The blood loss,operation time,coagulation indicators,inflammatory indicators,and postoperative complications of the three groups were statistically analyzed. RESULTS AND CONCLUSION:(1)In terms of total blood loss,hidden blood loss,and maximum hemoglobin drop,the periarticular injection group had the least amount,and there was no statistically significant difference between the compression dressing group and periarticular injection group(P>0.05).In terms of intraoperative blood loss,the compression dressing group had the least amount,and there were statistically significant differences compared with the periarticular injection group and intra-articular injection group(P<0.05).There was no statistically significant difference in operation time among the three groups(P>0.05).(2)There were no statistically significant differences in coagulation indicators(D-dimer and fibrinogen degradation products)and inflammation indicators(C-reactive protein and erythrocyte sedimentation rate)among the three groups preoperatively and on the first and third days after operation(P>0.05).(3)There was no statistically significant difference observed among the three groups in terms of slow blood flow in the affected limb,intramuscular venous thrombosis,soft tissue swelling,and incidence of wound complications(P>0.05).Additionally,no cases of deep vein thrombosis or pulmonary embolism were detected in any of the groups.(4)The topical application of tranexamic acid combined with compression dressing achieves the same effect as a periarticular injection in terms of simplicity of operation and reduced perioperative blood loss.This method also avoids the trauma caused by repeated punctures and does not increase the incidence of postoperative complications,making it a worthwhile option for clinical promotion.

Objective:To evaluate the value of endoclip-assisted and submucosal injection-assisted cannulation techniques for difficult cannulation during endoscopic retrograde cholangiopancreatography (ERCP).Methods:Data of 12 458 patients treated with ERCP for the first time in the First Affilated Hospital of Naval Medical University from June 2015 to September 2020 were retrospectively analyzed. Twenty eight (0.22%) were identified as difficult cannulation where metal clip- or submucosal injection-assisted cannulation was used. The selective cannulation success rate, intubation time and complication incidence of the two techniques in difficult cannulation patients were analyzed.Results:Difficult cannulation was performed in 18 males (64.3%) and 10 females (35.7%) with an age of 69.6±14.1 years assisted by metal clips or submucosal injection. Five cases (17.9%) were type Ⅱ, 5 cases (17.9%) type Ⅲ, and 18 cases (64.3%) type Ⅴ according to papilla classification. Sixteen patients (57.1%) received metal clip-assisted cannulation, and 12 cases (42.9%) submucosal injection-assisted cannulation. Twenty-five (89.3%) patients successfully underwent selective cannulation with the cannulation time of 9.9±4.3 min. One case (3.6%) of mild post-ERCP pancreatitis and 3 cases (10.7%) of post-ERCP hyperamylasemia occurred. No postoperative bleeding or perforation occurred. All patients were cured and discharged after conservative treatment.Conclusion:When selective cannulation is difficult due to poor papilla exposure or deflection, endoclip- or submucosal injection-assisted cannulation can effectively improve the successful selective cannulation rate during ERCP with low complication incidence, which is worth of clinical promotion.

Objective:To explore the clinical effect of a two-staged repair and reconstruction of composite soft tissue defect of dorsal wrist with transfer of free flap (in stage-one) repair and followed by transplantation of allogeneic tendon (in stage-two) reconstruction.Methods:From December 2018 to January 2021, 6 cases with dorsal wrist composite tissue injury and extensor tendon defect were treated in the Department of Hand and Microsurgery of the Fourth People's Hospital of Guiyang City. Four cases were treated with free anterolateral thigh flap (ALTF) combined with allogeneic tendon in the first stage to reconstruct finger dorsiflexion function, and 2 cases were treated with free ilioinguinal flap combined with allogeneic tendon in the second stage to reconstruct finger dorsiflexion function. The age of the patients ranged from 22 to 62 years old. The areas of defect were 5.0 cm×12.0 cm-8.0 cm×20.0 cm. Two cases had 2 extensor tendons defect, 1 had 3 extensor tendons defect, 2 had 4 extensor tendons defect, and 1 had 5 extensor tendons defect. The length of extensor tendon defects was 7.0-22.0 cm. In 5 cases, the wounds were covered by VSD for 5 to 7 days after complete emergenly debridement. Then, after the wounds had been cleared and clean, the wounds of 3 cases were covered with free ALTF, 2 with free ilioinguinal flap, and 1 with free ALTF after skin graft scar resection. At 3-4 months later, the extension function of digit was reconstructed with the transplantation of allogeneic tendons. Postoperative appearance of the flaps and functions of digits were observed at the outpatient clinics during the follow-up.Results:The postoperative follow-up lasted for 10 to 26 (15 in average) months. All 6 flaps surrived completely, and 1 case was further treated with flap thinning at 4 months after the second surgery. During the follow-up, all flaps healed well and were good in appearance and texture. Meanwhile, the donor areas were all healed well with no dysfunction nor sensory disorder. All the transplanted tendons were in good glide without adhesion. The active motion of metacarpophalangeal joints ranged from (10±10) ° to (80±10) °. According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, at the final follow-up, 4 cases were excellent and 2 cases were good.Conclusion:It is safe and effective that using the two-staged procedure in repair of composite tissue defect of dorsal wrist with stage-one ALTF or ilioinguinal flap transfer combined with stage-two reconstruction with transplantation of allogeneic tendon. It can minimize the adhesion after tendon transplantation and donor site damage

With the development of laparoscopic technology, surgeon's requirements for precise anatomy are gradually increasing. Laparoscopic system has great advantages in the selection of anatomical level, the protection of nerve and blood vessel in surgery. 4K laparoscopic system can provide high-definition vision of operative field, which is conducive to precise anatomical operation. The authors share the practical team cooperation experience of laparoscope left hemi-colectomy for colon cancer in order to provide references for surgical colleagues.