Objective To evaluate the clinical efficacy of a sphincter-preserving technique combining cutting seton and loose seton drainage for the treatment of ischiorectal abscess.Methods A prospective ran-domized controlled trial was conducted involving 184 patients with ischiorectal abscess,who were randomly di-vided into an experimental group(n=92)and a control group(n=92).The experimental group underwent sphincter-preserving surgery combining cutting seton and loose seton drainage,while the control group re-ceived single-stage incision and seton drainage.Clinical outcomes,anal function,operative time,postoperative pain intensity,wound healing time,and pruritus ani were compared between the two groups.Results The sur-gical time of the experimental group was longer than that of the control group[31.50(25.00,40.00)min vs.20.00(20.00,30.00)min],and the difference was statistically significant(P<0.05).On postoperative days 1,3,and 7,the NRS scores for pain were lower than those in the control group,and the wound healing time was shorter than that in the control group[24.00(20.00,25.75)days vs.29.00(26.00,32.00)days],with statistically significant differences(P<0.05).The recent cure rate of the experimental group was lower than that of the control group(88.04%vs.94.57%),and the difference was not statistically significant(P>0.05).After follow-up,the long-term cure rate of the experimental group was lower than that of the control group(84.78%vs.93.48%),and the Wexner score for anal incontinence was lower than that of the control group[1.00(0.00,1.00)vs.1.00(0.00,2.00)],with statistically significant differences(P<0.05).Conclu-sion The sphincter-preserving technique combining cutting seton and loose seton drainage for ischiorectal ab-scess reduces postoperative pain,shortens wound healing time,and effectively protects anal function with reli-able short-term efficacy.However,further improvements are needed to enhance long-term clinical outcomes.

Objective:To establish a prediction model for symptomatic radiation pneumonitis (SRP) after radiotherapy for thoracic cancer based on a longitudinal cohort and dose interval variations.Methods:Clinical data of 587 patients who received thoracic radiotherapy in Department of Radiotherapy of Yunnan Cancer Hospital from July 2022 to June 2023 were retrospectively analyzed. The National Cancer Institute common terminology criteria for adverse events (CTCAE) version 5.0 was used to grade radiation pneumonitis, and clinical factors, traditional independent dosimetric characteristics and dose interval variation characteristics were collected. Features used to predict the occurrence of SRP were screened using genetic algorithms and analyzed the correlation between the selected features and SRP occurrence. Predictive models for SRP occurrence were established using the selected features and evaluated, and the optimal predictive model was visualized using a column chart.Results:The incidence of SRP was 35.94%. Five clinical factors, seven independent dosimetric features and six dose interval variation features were screened out by genetic algorithms to effectively predict the occurrence of SRP. The area under ROC curve (AUC) of clinical factors combined with traditional independent dosimetric factors and dose interval variation factors was 76%. The AUC of clinical factors combined with traditional independent dosimetric factors and that of clinical factors combined with dose interval variation factors was 69% and 67%, respectively. The addition of the characteristics of dose interval variation factors significantly improved the effectiveness of the prediction model.Conclusions:The supplement of the characteristics of dose interval variation factors can significantly improve the performance of the SRP prediction model for thoracic tumors after radiotherapy. The SRP prediction model based on dose interval variations can effectively predict the occurrence of SRP.

Objective:To investigate the therapeutic effect of open suture and selective suture in patients with high complexity anal fistula and its effect on anal function and complications.Methods:Prospectively selected 174 patients with high complex anal fistula who were hospitalized in the Anorectal Surgery Department of the Second People′s Hospital of Yibin City from December 2018 to December 2021 as the study subjects, including 138 males and 36 females, aged from 26 to 45 years, with an average of (35.20 ± 8.86) years. According to the admission order of patients, grouped them into single and double numbers, with single numbers being the control group ( n=87) and double numbers being the observation group ( n=87). The control group was treated with traditional incision and thread hanging therapy, while the observation group was treated with selective suture through incision and thread hanging therapy. Compared the surgical time, blood loss, surgical cost, wound healing time, and anal function at 6 months after surgery between the two groups of patients. Compared the treatment effects of two groups of patients at 6 months after surgery. Compared the postoperative complications within 6 months and recurrence within 1 year between the two groups. The measurement data subject to normal distribution were expressed by mean ± standard deviation( ± s). The two groups were compared by independent sample t test, and the count data were compared by Chi-square test. Rank sum test was used for comparison of hierarchical data. Results:The surgical time in the observation group was higher than that in the control group [(44.30 ± 8.11) min vs (42.18 ± 7.25) min, ( t=-2.44, P<0.05], and the surgical cost was higher than that in the control group [(1184.81 ± 372.68) yuan vs (835.28 ± 320.03) yuan, t=-8.75, P<0.001]. There was no statistically significant difference in blood loss data between the two groups [(19.57 ± 6.07) mL vs (18.35 ± 5.25) mL, t=-1.88, P>0.05]. The length of wound healing time in the observation group was lower than that in the control group [(24.18 ± 4.35) d vs (29.35 ± 5.08) d, t=11.09, P<0.001]. The anal function score of the observation group at 6 months after surgery was lower than that of the control group [(4.80 ± 1.21) score vs (6.71 ± 1.35) score, t=14.72, P<0.001]. All patients did not experience any loss of follow-up. In the comparison of treatment effects 6 months after surgery, the observation group had a better efficacy rating than control group ( Z=3.86, P<0.001). At 6 months after surgery, the incidence of complications in the observation group was lower than that in the control group [2.30% (2/87) vs 10.34% (9/87), χ2=4.76, P<0.05]. One year after surgery, the recurrence rate in the observation group was lower than that in the control group [2.30% (2/87) vs 10.34% (9/87), χ2=4.76, P<0.05]. Conclusion:The application of incision and thread-drawing selective suture in the treatment of patients with high complex anal fistula is beneficial to the treatment effect of patients, reduces postoperative complications, and protects the anal function of patients, with good use value.

Objective:To investigate the theoretical knowledge level of clinical nurses engaged in enterostomy nursing in secondary and tertiary general hospitals in Henan Province, so as to provide the basis for departments to carry out specialized training and improve the quality of enterostomy special nursing.Methods:On the basis of literature review and expert letter consultation, enterostomy knowledge test for clinical nurses was formed, including the dimensions of enterostomy special nursing and patient health education. Using the convenient sampling method, clinical nurses who engaged in enterostomy-related nursing work in 39 secondary and tertiary general hospitals in Henan Province were selected as the research objects from February to May 2019. The enterostomy knowledge test for clinical nurses was used to investigate enterostomy specialized knowledge of nurses, and their scores were analyzed by single factor analysis. In this study, a total of 420 tests were issued and 382 valid tests were effectively recovered, with an effective recovery rate of 90.95%.Results:The total score of the enterostomy knowledge test of 382 nurses was (65.80±13.84) , the total score of enterostomy special nursing dimension was (32.17±7.12) , and the total score of patient health education dimension was (33.64±7.66) . 62.83% (240/382) of nurses basically mastered the knowledge of enterostomy. In the enterostomy knowledge test for clinical nurses, the error rates of prevention and identification of complications, management of complications and clinical selection and application of stoma bag were relatively high. There were statistically significant differences in the scores of the enterostomy knowledge test among nurses of different hospital levels, highest educational background, technical title, working time limit and the time limit of engaging in enterostomy nursing work ( P<0.05) . Conclusions:Professional nurses engaged in enterostomy nursing do not have a comprehensive grasp of enterostomy related knowledge, so the departments should pay more attention to special nursing training of enterostomy and improve overall level of enterostomy nursing in the department.

Phosphoinositide 3-kindase,an important signal transduction molecule in cells,plays a key role in the process of cell survival,proliferation and differentiation.Significant progress has been made in the treatment of cancer with PI3K inhibitors,yet the drug resistance of PI3K inhibitors affects their long-term efficacy in clinical treatment.In order to overcome the drug resistance,a variety of rational combined therapies have been developed.In this paper,the research progress of phosphoinositide-3 kinase inhibitors in combination with other drugs to overcome the drug resistance were reviewed.

Objective To explore the clinical experience and surgical method of the repairment of frontal plantar tissue defects by using "tennis racket"-like flap with the medial plantar retrograde,and to study the reliability in the clinical application of the medial plantar retrograde flap.Methods From June 2011 to June 2016,"tennis racket"-like flap with the medial plantar retrograde was used to repair the frontal plantar tissue defects in 10 cases.The cutting range of flap was from 3.5 cm × 2.0 cm to 8.0 cm x 4.0 cm in size;in all patients the donor area was covered by skin grafts.Results All flaps survived and wounds healed by first intention.In 10 patients the donor sites healed primarily with a straight scar,and the appearance and texture of the flaps were satisfactory.All patients were followed up from 6 to 24 months (mean 12 months).According to the Chinese foot function evaluation standard trial evaluation,the outcomes were excellent in 9 cases,good in 7 cases,and medium in 2 cases.Conclusions "Tennis racket"-like flap with the medial plantar retrograde is less anatomic variation with reliable blood supply,and sensory recovery is quick;the donor site is a small crater and cicatrial contractures are light;the cost is low.All patients are treated on one session and therefore it is an ideal method for the repairment of frontal plantar tissue defects.

Objective To explore the shielding effect that Tween has made on the erythrocyte’ s surface antigen( ABO and D antigen mainly) and the stability of the RBC. Methods Various types red blood cells’ surface antigens were incubated with different concentrations of Tween,then the titers of RBC’ s surface antigen before and after incubation were compared. The erythrocyte’ s function alterations and sta-bility through the morphological obersavation,the osmotic fragility,RBC’ s own hemolysis rate,oxygen saturation( SO2 ) ,routine test of blood as well as the supernatant of free hemoglobin determination were confirmed. Results The masking effect of the Tween-20 on D antigen with the weaken titer keeping above“ +” was better and more stable than that on A,B antigen. The impact on B antigen was a little worse,and A was the worst. The advantaged concentration is about 0. 004%. Besides,the influence of Tween-80’s on B and D antigen was not apparent e-nough. Among all of the concentration,0. 74% and 0. 80% did a relatively better job,which also could keep the weaken titer above “ +”. Conclulsion The shielding effect that Tween has made on the erythrocyte’ s surface antigen( ABO and D antigen mainly) is stable,which keeps above “ +”. The morphology and function of the RBC does not change.

Objective To investigate the expression of phosphorylated mammalian target of rapamycin (p-mTOR) and phosphorylated eukaryotic translation initiation factor 4E binding protein 1 (p-4EBP1) in pathologic scar,and comprehend its role and significance in the pathologic scar formation.Methods SP immunohistochemical method was used to detect the expression of p-mTOR and p-4EBP1 in 20 cases of keloid,20 cases of hypertrophic scar,20 cases of non-pathologic scar and 20 cases of normal skin tissue.The positive rates of expression in different tissues were analyzed,and the relationship in pathological scar was explored.Results The positive rates of p-mTOR and p-4EBP1 in keloidand hypertrophic scar were 75.0％ (15/20),60.0％ (12/20) and 60.0％ (12/20),50.0％ (10/20),nom-pathologic scars were 20％ (4/20),10％ (2/20);normal skin tissue were 10％ (2/20),5％ (1/20),which were higher respectively compared with the two control groups (P＜ 0.05);there was a highly positive correlation between p-mTOR and p-4EBP1 expression in pathologic scar (r=0.323,P＜0.05).Conclusions p-mTOR and p-4EBP1 might be involved and cooperated in promoting the progress of pathologic scars.