Objective:To investigate the feasibility and therapeutic efficacy of robot-assisted radical resection for hilar cholangiocarcinoma.Methods:This is a retrospective case series study. The clinical data of 29 patients who underwent robot-assisted radical resection for hilar cholangiocarcinoma at the Department of Minimally Invasive Hepatic Surgery,the First Affiliated Hospital of Harbin Medical University from July 2021 to February 2025 were retrospectively collected. There were 16 males and 13 females, aged ( M(IQR)) 68.0 (10.0) years (range:36 to 78 years), and body mass index (24.0±2.9) kg/m 2 (range:17.5 to 29.1 kg/m 2). Bismuth-Corlette classification: 12 cases type Ⅰ, 4 cases type Ⅱ, 6 cases type Ⅲb, and 7 cases type Ⅳ. Preoperative CA19-9 was 161.7(320.9) U/ml (range:7.1 to 1 000.0 U/ml), and carcinoembryonic antigen was 2.8(2.1)μg/L (range:0.3 to 203.1 μg/L). Preoperative total bilirubin was 134.2 (348.9) μmol/L (range:10.4 to 557.9 μmol/L), direct bilirubin was 90.8 (264.1) μmol/L (range:2.5 to 418.7 μmol/L), ALT was 136.4 (134.8) U/L (range:13.0 to 569.9 U/L), AST was 122.2 (119.9) U/L (range:16.0 to 384.0 U/L), and albumin was (34.5±6.3) g/L (range:21.7 to 41.3 g/L). Comparison of quantitative data at different time points using paired t-test or Mann-Whitney U test. Cox univariate analysis was performed for the relevant variables, and Cox multivariate regression analysis was used to screen the independent prognostic factors of patients after robot-assisted radical resection for hilar cholangiocarcinoma. Results:All the 29 patients successfully underwent robot-assisted radical resection of hilar cholangiocarcinoma, and the R0 resection rate was 93.1% (27/29) without conversion to laparotomy. The operation time was 295.0 (87.5) minutes (range:195 to 590 minutes), the intraoperative blood loss was 100.0 (150.0) ml (range:20 to 1 000 ml), the intraoperative blood transfusion rate was 20.1% (6/29), the number of lymph nodes dissected was 10.0 (7.0) pieces (range: 6 to 18 pieces), the first postoperative deflatus time was 3.0 (1.0) days (range:2 to 4 days), The oral feeding time was 5.0 (1.0) days (range: 4 to 7 days), the drainage tube removal time was 8.0 (2.0) days (range: 6 to 26 days), and the postoperative hospital stay time was 10.0 (6.0) days (range:7 to 27 days). The incidence of complications above grade Ⅱ of the Clavien-Dindo complication grading system was 24.1% (7/29), including 3 cases of gastrointestinal bleeding with recurrent high fever, 1 case of delayed gastric emptying, 1 case of bile leakage, and 5 cases of hypoalbuminemia. The total bilirubin was 42.8 (66.8) μmol/L (range:6.8 to 195.9 μmol/L), direct bilirubin was 28.1 (38.5) μmol/L (range:4.3 to 88.6 μmol/L), ALT was 55.8 (56.0) U/L (range:9.9 to 207.1 U/L), AST was 33.9 (17.9) U/L (range:10.6 to 122.7 U/L), and albumin was (32.1±3.8) g/L (range:22.8 to 37.7 g/L), the levels of transaminase and bilirubin in the postoperative liver function indexes were significantly improved compared with those before operation, and the differences were statistically significant (all P<0.05). The mortality rate of patients without perioperative death was 3.4% (1/29) at 90 days after surgery. The results of Cox multivariate regression analysis showed that R0 resection was an independent prognostic factor for survival at 1 year after surgery ( P<0.05). The follow-up time was 15.0 (12.0) months (range:6 to 30 months), 1 of the 29 patients died of intra-abdominal infection 1 week after discharge, and the remaining 28 patients were completely followed up, of which 20 patients had no recurrence and metastasis during the follow-up period, and the tumor-free survival was 15.0 (12.0) months (range:6 to 30 months), the tumor-free survival rate was 65.5% (19/29), the overall survival rate was 68.9% (20/29), and 8 patients with postoperative recurrence and metastasis. One patient with liver metastasis survived after reoperation, and one patient underwent postoperative chemoradiotherapy and died due to recurrence. There were 8 deaths during the follow-up, of which 7 died due to tumor recurrence and metastasis, and 1 died due to previous underlying diseases. Conclusion:Robot-assisted radical resection for hilar cholangiocarcinoma is feasible and effective.

Objective:To investigate the feasibility and therapeutic efficacy of robot-assisted radical resection for hilar cholangiocarcinoma.Methods:This is a retrospective case series study. The clinical data of 29 patients who underwent robot-assisted radical resection for hilar cholangiocarcinoma at the Department of Minimally Invasive Hepatic Surgery,the First Affiliated Hospital of Harbin Medical University from July 2021 to February 2025 were retrospectively collected. There were 16 males and 13 females, aged ( M(IQR)) 68.0 (10.0) years (range:36 to 78 years), and body mass index (24.0±2.9) kg/m 2 (range:17.5 to 29.1 kg/m 2). Bismuth-Corlette classification: 12 cases type Ⅰ, 4 cases type Ⅱ, 6 cases type Ⅲb, and 7 cases type Ⅳ. Preoperative CA19-9 was 161.7(320.9) U/ml (range:7.1 to 1 000.0 U/ml), and carcinoembryonic antigen was 2.8(2.1)μg/L (range:0.3 to 203.1 μg/L). Preoperative total bilirubin was 134.2 (348.9) μmol/L (range:10.4 to 557.9 μmol/L), direct bilirubin was 90.8 (264.1) μmol/L (range:2.5 to 418.7 μmol/L), ALT was 136.4 (134.8) U/L (range:13.0 to 569.9 U/L), AST was 122.2 (119.9) U/L (range:16.0 to 384.0 U/L), and albumin was (34.5±6.3) g/L (range:21.7 to 41.3 g/L). Comparison of quantitative data at different time points using paired t-test or Mann-Whitney U test. Cox univariate analysis was performed for the relevant variables, and Cox multivariate regression analysis was used to screen the independent prognostic factors of patients after robot-assisted radical resection for hilar cholangiocarcinoma. Results:All the 29 patients successfully underwent robot-assisted radical resection of hilar cholangiocarcinoma, and the R0 resection rate was 93.1% (27/29) without conversion to laparotomy. The operation time was 295.0 (87.5) minutes (range:195 to 590 minutes), the intraoperative blood loss was 100.0 (150.0) ml (range:20 to 1 000 ml), the intraoperative blood transfusion rate was 20.1% (6/29), the number of lymph nodes dissected was 10.0 (7.0) pieces (range: 6 to 18 pieces), the first postoperative deflatus time was 3.0 (1.0) days (range:2 to 4 days), The oral feeding time was 5.0 (1.0) days (range: 4 to 7 days), the drainage tube removal time was 8.0 (2.0) days (range: 6 to 26 days), and the postoperative hospital stay time was 10.0 (6.0) days (range:7 to 27 days). The incidence of complications above grade Ⅱ of the Clavien-Dindo complication grading system was 24.1% (7/29), including 3 cases of gastrointestinal bleeding with recurrent high fever, 1 case of delayed gastric emptying, 1 case of bile leakage, and 5 cases of hypoalbuminemia. The total bilirubin was 42.8 (66.8) μmol/L (range:6.8 to 195.9 μmol/L), direct bilirubin was 28.1 (38.5) μmol/L (range:4.3 to 88.6 μmol/L), ALT was 55.8 (56.0) U/L (range:9.9 to 207.1 U/L), AST was 33.9 (17.9) U/L (range:10.6 to 122.7 U/L), and albumin was (32.1±3.8) g/L (range:22.8 to 37.7 g/L), the levels of transaminase and bilirubin in the postoperative liver function indexes were significantly improved compared with those before operation, and the differences were statistically significant (all P<0.05). The mortality rate of patients without perioperative death was 3.4% (1/29) at 90 days after surgery. The results of Cox multivariate regression analysis showed that R0 resection was an independent prognostic factor for survival at 1 year after surgery ( P<0.05). The follow-up time was 15.0 (12.0) months (range:6 to 30 months), 1 of the 29 patients died of intra-abdominal infection 1 week after discharge, and the remaining 28 patients were completely followed up, of which 20 patients had no recurrence and metastasis during the follow-up period, and the tumor-free survival was 15.0 (12.0) months (range:6 to 30 months), the tumor-free survival rate was 65.5% (19/29), the overall survival rate was 68.9% (20/29), and 8 patients with postoperative recurrence and metastasis. One patient with liver metastasis survived after reoperation, and one patient underwent postoperative chemoradiotherapy and died due to recurrence. There were 8 deaths during the follow-up, of which 7 died due to tumor recurrence and metastasis, and 1 died due to previous underlying diseases. Conclusion:Robot-assisted radical resection for hilar cholangiocarcinoma is feasible and effective.

Objective To investigate the current situation and existing problems regarding the diagnosis and treatment integrating traditional Chinese and western medicine in the emergency departments of various general hospitals in China to provide a reference for the development of integrated traditional Chinese and western medicine emergency medicine. Methods From November 18,2022 to February 28,2023,an online questionnaire survey was conducted among 291 hospitals in 21 provinces/municipalities directly under the Central Government across the country,which was based on the members of the Emergency Medicine Professional Committee of the Chinese Association of the Integration of Traditional Chinese and Western Medicine. The questionnaire covered 5 aspects:basic information of hospitals and emergency departments,personnel allocation,medical quality management,equipment allocation,and traditional Chinese medicine techniques and skills (including the application of traditional Chinese medicine and non-drug treatment of traditional Chinese medicine). A comparative study was carried out between the "hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine" and "western medicine hospitals" on the current situation of integrated traditional Chinese and western medicine diagnosis and treatment in the emergency department. Results A total of 291 valid questionnaires were collected,covering 291 hospitals in 21 provinces and municipalities directly under the Central Government across the country. Among them,142 were hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine,and 149 were western medicine hospitals. The number of doctors in the emergency departments of hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine were significantly less than that of western medicine hospitals[individuals:11.00 (7.00,18.75) vs. 20.00 (13.00,31.00),P<0.01]. Specifically,the numbers of traditional Chinese medicine doctors,integrated traditional Chinese and western medicine doctors,and "western medicine doctors learning traditional Chinese medicine" in these hospitals were significantly higher than those in western medicine hospitals[individuals:4.00 (2.00,9.00) vs. 0.00 (0.00,0.00),1.00 (0.00,4.00) vs. 0.00 (0.00,0.00),2.00 (0.00,5.00) vs. 0.00 (0.00,0.00),all P<0.01],while the number of western medicine doctors was significantly less than that in western medicine hospitals[individuals:4.00 (1.00,7.50) vs. 25.50 (16.00,37.00),P<0.01]. The number of nurses in the emergency departments of hospitals of traditional Chinese medicine and integrated traditional Chinese was significantly less than that of western medicine hospitals[individuals:23.00 (16.00,38.75) vs. 42.00 (30.00,80.00),P<0.01]. The numbers of traditional Chinese medicine nurses,"western medicine nurses learning traditional Chinese medicine" in these hospitals were also significantly higher than those in western medicine hospitals[individuals:1.50 (0.00,5.75) vs. 0.00 (0.00,0.00),1.00 (0.00,7.75) vs. 0.00 (0.00,0.00),all P<0.01],while the number of western medicine nurses was significantly less than that in western medicine hospitals[individuals:15.00 (9.00,25.00) vs. 42.00 (27.00,79.00),P<0.01]. In the situation of medical quality management,the setting rates of emergency clinics,resuscitation rooms and observation rooms in western medicine hospitals were close to those in hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine,but the setting rates of emergency department wards and emergency intensive care units (EICU) and the number of beds were significantly higher than those in hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine[setting rate of emergency department wards:70.47％ vs. 53.52％,setting rate of EICU:67.11％ vs. 47.89％,number of beds (individuals):18.00 (0.00,30.00) vs. 2.00 (0.00,12.00) and 8.00 (0.00,12.00) vs. 0.50 (0.00,7.00),all P<0.01]. In terms of the number of visits in 2022,the annual total number of emergency visits (10000 person-times) in western medicine hospitals:6.60 (3.38,12.00) vs. 4.00 (1.25,7.00),the number of visits to the resuscitation room (10000 person-times):0.40 (0.12,1.00) vs. 0.17 (0.05,0.50) and the annual discharge volume of EICU (number of case):216.00 (0.00,550.00) vs. 0.00 (0.00,187.50) were all higher than those in hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine (all P<0.01). In addition,the success rate of rescue in hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine was similar to that in western medicine hospitals,and the participation rate of traditional Chinese medicine in the treatment of the resuscitation room was significantly higher than that in western medicine hospitals (P<0.01). In the situation of equipment allocation,hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine had fewer numbers of equipment than western medicine hospitals (all P<0.01). The proportion of hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine equipped with non-drug treatment equipment of traditional Chinese medicine was significantly higher than that of western medicine hospitals (all P<0.01). In the application of traditional Chinese medicine techniques and skills,the proportions of hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine in using Chinese patent medicines,agreed prescriptions,syndrome differentiation and treatment prescriptions,etc. were all higher than those of western medicine hospitals (application rate of Chinese patent medicines:81.69％ vs. 61.74％,application rate of agreed prescriptions:61.97％ vs. 16.78％,application rate of syndrome differentiation and treatment prescriptions:61.27％ vs. 19.46％,all P<0.01). The application rates of decoction pieces,non-decoction agreed with prescriptions,injections,hospital preparations and other dosage forms in hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine were all significantly higher than those in western medicine hospitals (application rate of decoction pieces:29.58％ vs. 4.70％,the application rate of non-decoction agreed prescriptions:40.85％ vs. 7.38％,application rate of injections:80.28％ vs. 53.02％,application rate of hospital preparations:33.80％ vs. 12.75％,all P<0.01). The application proportions of oral administration,nasal feeding,enema,gastric lavage,external use,intravenous injection,etc. in hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine were all higher than those in western medicine hospitals (oral application rate:71.13％ vs. 42.28％,nasal feeding application rate:47.18％ vs. 26.17％,enema application rate:48.59％ vs. 19.46％,gastric lavage application rate:21.13％ vs. 6.04％,external use application rate:53.52％ vs. 16.78％,intravenous injection application rate:71.83％ vs. 54.36％,all P<0.01). The application proportions of some drugs such as Shenmai/Shengmai injection,Tianma injection in hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine were higher than those in western medicine hospitals (application rate of Shenmai/Shengmai injection:59.15％ vs. 35.57％,application rate of Tianma injection:40.85％ vs. 10.07％,application rate of Danshen Honghua injection:30.99％ vs. 14.77％,application rate of Angong Niuhuang pill:26.76％ vs. 12.08％,P<0.01). The proportions of hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine in carrying out traditional Chinese medicine non-drug treatment operations such as acupuncture,acupoint application,cupping,scraping,bone-setting,moxibustion,press needles,collateral pricking method,etc. were higher than those in western medicine hospitals (application rate of acupuncture:65.49％ vs. 11.41％,application rate of acupoint application:60.56％ vs. 10.07％,application rate of cupping:32.39％ vs. 4.70％,application rate of scraping:28.17％ vs. 2.01％,application rate of bone-setting:26.76％ vs. 10.74％,application rate of moxibustion:24.65％ vs. 5.37％,application rate of press needles:17.61％ vs. 1.34％,application rate of collateral pricking method:16.90％ vs. 0.67％,all P<0.01). Conclusion The proportion of integrated traditional Chinese and western medicine personnel in the emergency departments of hospitals in China is relatively low,and the utilization rate and equipment rate of non-drug treatment of traditional Chinese medicine and traditional Chinese medicine emergency drugs are not high. It is necessary to strengthen the cultivation of integrated traditional Chinese and western medicine skills of emergency department doctors and the application of non-drug treatment of traditional Chinese medicine and traditional Chinese medicine emergency drugs to improve the ability of integrated traditional Chinese and western medicine emergency treatment.

Objective To investigate the current situation and existing problems regarding the diagnosis and treatment integrating traditional Chinese and western medicine in the emergency departments of various general hospitals in China to provide a reference for the development of integrated traditional Chinese and western medicine emergency medicine. Methods From November 18,2022 to February 28,2023,an online questionnaire survey was conducted among 291 hospitals in 21 provinces/municipalities directly under the Central Government across the country,which was based on the members of the Emergency Medicine Professional Committee of the Chinese Association of the Integration of Traditional Chinese and Western Medicine. The questionnaire covered 5 aspects:basic information of hospitals and emergency departments,personnel allocation,medical quality management,equipment allocation,and traditional Chinese medicine techniques and skills (including the application of traditional Chinese medicine and non-drug treatment of traditional Chinese medicine). A comparative study was carried out between the "hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine" and "western medicine hospitals" on the current situation of integrated traditional Chinese and western medicine diagnosis and treatment in the emergency department. Results A total of 291 valid questionnaires were collected,covering 291 hospitals in 21 provinces and municipalities directly under the Central Government across the country. Among them,142 were hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine,and 149 were western medicine hospitals. The number of doctors in the emergency departments of hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine were significantly less than that of western medicine hospitals[individuals:11.00 (7.00,18.75) vs. 20.00 (13.00,31.00),P<0.01]. Specifically,the numbers of traditional Chinese medicine doctors,integrated traditional Chinese and western medicine doctors,and "western medicine doctors learning traditional Chinese medicine" in these hospitals were significantly higher than those in western medicine hospitals[individuals:4.00 (2.00,9.00) vs. 0.00 (0.00,0.00),1.00 (0.00,4.00) vs. 0.00 (0.00,0.00),2.00 (0.00,5.00) vs. 0.00 (0.00,0.00),all P<0.01],while the number of western medicine doctors was significantly less than that in western medicine hospitals[individuals:4.00 (1.00,7.50) vs. 25.50 (16.00,37.00),P<0.01]. The number of nurses in the emergency departments of hospitals of traditional Chinese medicine and integrated traditional Chinese was significantly less than that of western medicine hospitals[individuals:23.00 (16.00,38.75) vs. 42.00 (30.00,80.00),P<0.01]. The numbers of traditional Chinese medicine nurses,"western medicine nurses learning traditional Chinese medicine" in these hospitals were also significantly higher than those in western medicine hospitals[individuals:1.50 (0.00,5.75) vs. 0.00 (0.00,0.00),1.00 (0.00,7.75) vs. 0.00 (0.00,0.00),all P<0.01],while the number of western medicine nurses was significantly less than that in western medicine hospitals[individuals:15.00 (9.00,25.00) vs. 42.00 (27.00,79.00),P<0.01]. In the situation of medical quality management,the setting rates of emergency clinics,resuscitation rooms and observation rooms in western medicine hospitals were close to those in hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine,but the setting rates of emergency department wards and emergency intensive care units (EICU) and the number of beds were significantly higher than those in hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine[setting rate of emergency department wards:70.47％ vs. 53.52％,setting rate of EICU:67.11％ vs. 47.89％,number of beds (individuals):18.00 (0.00,30.00) vs. 2.00 (0.00,12.00) and 8.00 (0.00,12.00) vs. 0.50 (0.00,7.00),all P<0.01]. In terms of the number of visits in 2022,the annual total number of emergency visits (10000 person-times) in western medicine hospitals:6.60 (3.38,12.00) vs. 4.00 (1.25,7.00),the number of visits to the resuscitation room (10000 person-times):0.40 (0.12,1.00) vs. 0.17 (0.05,0.50) and the annual discharge volume of EICU (number of case):216.00 (0.00,550.00) vs. 0.00 (0.00,187.50) were all higher than those in hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine (all P<0.01). In addition,the success rate of rescue in hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine was similar to that in western medicine hospitals,and the participation rate of traditional Chinese medicine in the treatment of the resuscitation room was significantly higher than that in western medicine hospitals (P<0.01). In the situation of equipment allocation,hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine had fewer numbers of equipment than western medicine hospitals (all P<0.01). The proportion of hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine equipped with non-drug treatment equipment of traditional Chinese medicine was significantly higher than that of western medicine hospitals (all P<0.01). In the application of traditional Chinese medicine techniques and skills,the proportions of hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine in using Chinese patent medicines,agreed prescriptions,syndrome differentiation and treatment prescriptions,etc. were all higher than those of western medicine hospitals (application rate of Chinese patent medicines:81.69％ vs. 61.74％,application rate of agreed prescriptions:61.97％ vs. 16.78％,application rate of syndrome differentiation and treatment prescriptions:61.27％ vs. 19.46％,all P<0.01). The application rates of decoction pieces,non-decoction agreed with prescriptions,injections,hospital preparations and other dosage forms in hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine were all significantly higher than those in western medicine hospitals (application rate of decoction pieces:29.58％ vs. 4.70％,the application rate of non-decoction agreed prescriptions:40.85％ vs. 7.38％,application rate of injections:80.28％ vs. 53.02％,application rate of hospital preparations:33.80％ vs. 12.75％,all P<0.01). The application proportions of oral administration,nasal feeding,enema,gastric lavage,external use,intravenous injection,etc. in hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine were all higher than those in western medicine hospitals (oral application rate:71.13％ vs. 42.28％,nasal feeding application rate:47.18％ vs. 26.17％,enema application rate:48.59％ vs. 19.46％,gastric lavage application rate:21.13％ vs. 6.04％,external use application rate:53.52％ vs. 16.78％,intravenous injection application rate:71.83％ vs. 54.36％,all P<0.01). The application proportions of some drugs such as Shenmai/Shengmai injection,Tianma injection in hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine were higher than those in western medicine hospitals (application rate of Shenmai/Shengmai injection:59.15％ vs. 35.57％,application rate of Tianma injection:40.85％ vs. 10.07％,application rate of Danshen Honghua injection:30.99％ vs. 14.77％,application rate of Angong Niuhuang pill:26.76％ vs. 12.08％,P<0.01). The proportions of hospitals of traditional Chinese medicine and integrated traditional Chinese and western medicine in carrying out traditional Chinese medicine non-drug treatment operations such as acupuncture,acupoint application,cupping,scraping,bone-setting,moxibustion,press needles,collateral pricking method,etc. were higher than those in western medicine hospitals (application rate of acupuncture:65.49％ vs. 11.41％,application rate of acupoint application:60.56％ vs. 10.07％,application rate of cupping:32.39％ vs. 4.70％,application rate of scraping:28.17％ vs. 2.01％,application rate of bone-setting:26.76％ vs. 10.74％,application rate of moxibustion:24.65％ vs. 5.37％,application rate of press needles:17.61％ vs. 1.34％,application rate of collateral pricking method:16.90％ vs. 0.67％,all P<0.01). Conclusion The proportion of integrated traditional Chinese and western medicine personnel in the emergency departments of hospitals in China is relatively low,and the utilization rate and equipment rate of non-drug treatment of traditional Chinese medicine and traditional Chinese medicine emergency drugs are not high. It is necessary to strengthen the cultivation of integrated traditional Chinese and western medicine skills of emergency department doctors and the application of non-drug treatment of traditional Chinese medicine and traditional Chinese medicine emergency drugs to improve the ability of integrated traditional Chinese and western medicine emergency treatment.

OBJECTIVE: To measure the concentration of bone morphogenetic protein 2 (BMP-2) in demineralized bone matrix (DBM) prepared from different long bones and to evaluate the osteoinductivity of different DBM on MC3T3-E1 cells. METHODS: Different bones from the same cadaver donor were used as the initial materials for making DBM, which were divided into ulna group (uDBM), humerus group (hDBM), tibia group (tDBM), and femur group (fDBM) according to the origins, and boiled DBM (cDBM) was taken as the control group. The proteins of DBM were extracted by guanidine hydrochloride, and the concentrations of BMP-2 were determined by ELISA assay. Then the DBM were co-cultured with MC3T3-E1 cells, the proliferation of MC3T3-E1 cells was observed by cell counting kit 8 (CCK-8) assay. The osteogenic differentiation ability of MC3T3-E1 cells was qualitatively observed by alizarin red, alkaline phosphatase (ALP), and Van Gieson staining, and the osteogenic differentiation ability of MC3T3-E1 cells was quantitatively analyzed by ALP content. Linear regression was used to analyze the effect of BMP-2 concentration in DBM on ALP synthesis. RESULTS: There were significant differences in the concentration of BMP-2 among the DBM groups (P<0.05). The concentrations of BMP-2 in the lower limb long bone were higher than those in the upper limb long bone, and the concentration of BMP-2 in the fDBM group was about 35.5 times that in the uDBM group. CCK-8 assay showed that the cells in each group continued to proliferate within 5 days of co-culture, and the absorbance (A) values at different time points were in the order of cDBM groupP<0.05). Linear regression analysis showed that y^=0.361+0.017x, the effect of BMP-2 concentration in DBM on cellular ALP content was significant (t=3.552, P=0.005); for every 1 ng/g increase in BMP-2 concentration, ALP content would increase by 0.017 [95%CI (0.006, 0.027)] U/100 mL. CONCLUSION The concentration of natural BMP-2 in different long bones varies greatly, and the lower limb long bone is higher than the upper limb long bone. The harvested location of bone material was an important factor affecting the osteoinductivity of DBM.
Alkaline Phosphatase ; Bone Matrix ; Bone Morphogenetic Protein 2 ; Cell Count ; Coloring Agents ; Osteogenesis ; Animals ; Mice

OBJECTIVE: To study the effectiveness of TightRope elastic fixation combined with functional total repair of the inferior tibiofibular ligament in the treatment of distal tibiofibular syndesmosis injury. METHODS: The clinical data of 34 patients with distal tibiofibular syndesmosis injury who met the selection criteria between January 2020 and January 2022 were retrospectively analyzed, and they were divided into improved group (TightRope elastic fixation combined with functional total repair of inferior tibiofibular ligament) and control group (distal tibiofibular screw fixation) according to the surgical methods, with 17 cases in each group. There was no significant difference in age, gender, body mass index, fracture type, and other baseline data between the two groups (P>0.05). The operation time, intraoperative blood loss, and complications were recorded in the two groups. The American Orthopaedic Foot and Ankle Society (AOFAS) score, ankle metatarsal flexion and dorsal extension range of motion were used to evaluate the ankle function. The patient satisfaction survey was conducted at last follow-up. RESULTS: All 34 patients were followed up 8-20 months, with a median of 13 months. The operation time and intraoperative blood loss in the improved group were significantly longer than that in the control group (P<0.05). In the improved group, no infection or poor reduction occurred, and only 1 patient had TightRope knot reaction at 6 months after operation. In the control group, there were 2 cases of poor reduction, 1 case of lower tibiofibular screw rupture, and 1 case of subcutaneous infection (cured after anti-infection treatment). There was no significant difference in the incidence of complications between the two groups (P>0.05). At last follow-up, the AOFAS score and ankle metatarsal flexion and dorsal extension range of motion of the improved group were significantly better than those of the control group (P<0.05). The satisfaction rates of patients in the improved group and the control group were 94.1% and 82.4%, respectively, showing significant difference (P<0.05). CONCLUSION TightRope elastic fixation combined with functional total repair of inferior tibiofibular ligament in the treatment of distal tibiofibular syndesmosis injury has sufficient fixation strength, and can achieve better effectiveness and joint function compared with traditional screw fixation.
Humans ; Ankle Joint/surgery* ; Blood Loss, Surgical ; Ligaments/surgery* ; Plastic Surgery Procedures ; Retrospective Studies ; Ankle Injuries/surgery*

OBJECTIVE: To compare the effectiveness of subtalar arthroereisis (STA) combined with modified Kidner procedure versus STA alone in the treatment of flexible flatfoot combined with painful accessory navicular bone in children. METHODS: The clinical data of 33 children with flexible flatfoot combined with painful accessory navicular bone who were admitted between August 2018 and August 2021 and met the selection criteria were retrospectively analyzed. They were divided into a combination group (17 cases, treated by STA combined with modified Kidner procedure) and a control group (16 cases, treated by STA alone) according to the surgical methods. There was no significant difference in baseline data between the two groups ( P>0.05), such as gender, age, affected side of the foot, disease duration, and preoperative visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, talus-first metatarsal angle (T1MT), talus-second metatarsal angle (T2MT), talonavicular coverage angle (TCA), talus first plantar angle (Meary angle), calcaneal inclination angle (Pitch angle), and heel valgus angle (HV). The operation time, incision length, intraoperative blood loss, number of intraoperative fluoroscopies, and perioperative complications were recorded in both groups. The anteroposterior, lateral, and calcaneal axial X-ray films for the affected feet were taken regularly, and T1MT, T2MT, TCA, Meary angle, Pitch angle, and HV were measured. The VAS score, AOFAS ankle-hindfoot score were used to evaluate pain and functional recovery before and after operation. RESULTS: Surgeries in both groups were successfully performed without surgical complication such as vascular, nerve, or tendon injuries. Less operation time, shorter incision length, less intraoperative blood loss, and fewer intraoperative fluoroscopies were found in the control group than in the combination group ( P<0.05). One case in the combination group had partial necrosis of the skin at the edge of the incision, which healed after the dressing change and infrared light therapy, and the rest of the incisions healed by first intention. All children were followed up 12-36 months, with a mean of 19.6 months. At last follow-up, VAS score and AOFAS ankle-hindfoot score significantly improved in both groups when compared with preoperative ones ( P<0.05), and the differences of these scores between before and after operation improved more significantly in the combination group than in the control group ( P<0.05). Imaging results showed that the T1MT, T2MT, TCA, Meary angle, and HV significantly improved in both groups at last follow-up when compared with preoperative ones ( P<0.05), and the Pitch angle had no significant difference when compared with preoperative one ( P>0.05). But there was no significant difference in the difference of these indicators between before and after operation between the two groups ( P>0.05). CONCLUSION Both procedures are effective in the treatment of flexible flatfoot children with painful accessory navicular bone. STA has the advantage of minimally invasive, while STA combined with modified Kidner procedure has better effectiveness.
Humans ; Child ; Flatfoot/surgery* ; Blood Loss, Surgical ; Retrospective Studies ; Treatment Outcome ; Osteotomy/methods* ; Talus ; Pain

Objective:To investigate the safety of minimally invasive liver resection for resectable hepatocellular carcinoma (HCC) complicated with portal hypertension.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 807 patients with resectable HCC who underwent minimally invasive liver resection in 8 medical centers, including Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine et al, from June 2011 to November 2022 were collected. There were 670 males and 137 females, aged 58(50,66)years. Of the 807 patients, 173 cases with portal hypertension were divided into the portal hypertension group, and 634 cases without portal hypertension were divided into the non-portal hypertension group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) intraoperative and post-operative situations; (3) subgroup analysis. Propensity score matching was done by the 1:1 nearest neighbor matching method, with the caliper setting as 0.001. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the rank sum test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was constructed using the non-parameter rank sun test. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of the 807 patients, 268 cases were successfully matched, including 134 cases in the portal hypertension group and 134 cases in the non-portal hypertension group. The elimination of the tumor diameter and robot-assisted surgery confounding bias ensured comparability between the two groups after propensity score matching. (2) Intraoperative and postoperative situations. The occlusion time of porta hepatis, cases with intraoperative blood transfusion, cases with postoperative complication, cases with complication >Ⅱ grade of Clavien-Dindo classification, cases of Clavien-Dindo classification as Ⅰ grade, Ⅱ grade, Ⅲ grade, Ⅳ grade, cases with liver related complication were 27.0(15.0,43.0)minutes, 33, 55, 15, 13, 29, 14, 1, 37 in the portal hypertension group, versus 35.0(22.0,60.0)minutes, 17, 25, 5, 14, 9, 4, 1, 13 in the non-portal hypertension group, showing significant differences in the above indicators between the two groups ( Z=-2.15, χ2=6.30, 16.39, 4.38, 20.72, 14.16, P<0.05). (3) Subgroup analysis. Results of subgroups analysis showed that in cases with major live resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 243.5(174.6,296.3)minutes, 200.0(150.0,600.0)mL, 7.5(6.0,13.0)days in the portal hypertension group, versus 270.0(180.0,314.5)minutes, 200.0 (75.0,450.0)mL, 7.0(5.5,10.0)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-0.54, -1.73, -0.92, P>0.05). In cases with non-major live resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 170.0(120.0,227.5)minutes, 100.0(50.0,200.0)mL, 8.0(5.0,10.0)days in the portal hypertension group, versus 170.0(120.0,227.5)minutes, 100.0(50.0,200.0)mL, 7.0(5.5,9.0)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-1.39, -0.10, 1.05, P>0.05). In cases with anatomical liver resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 210.0(150.0,285.0)minutes, 150.0(50.0,200.0)mL, 8.0(6.0,9.3)days in the portal hypertension group, versus 225.5(146.3,306.8)minutes, 100.0(50.0,250.0)mL, 7.0(6.0,9.0)days in the non-portal hypertension group, showing no significant difference in the above indica-tors between the two groups ( Z=-0.75, -0.26, -0.91, P>0.05). In cases with non-anatomical liver resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 173.5(120.0,231.5)minutes, 175.0(50.0,300.0)mL, 7.0(5.0,11.0)days in the portal hyper-tension group, versus 186.0(123.0,262.5)minutes, 100.0(50.0,200.0)mL, 7.0(5.0,9.5)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-0.97, -1.12, -0.98, P>0.05). Conclusion:Minimally invasive liver resection or even major liver resection is safe and feasible for screened HCC patients complicated with portal hyper-tension, but attention should be paid to the prevention and treatment of postoperative complications.

Objective:To study the early-onset epilepsy of intracerebral hemorrhage and build a prediction model to evaluate its prediction efficiency.Methods:A cross-sectional investigation was conducted to construct a specialized optimized prediction model. The prediction model was converted into a visual optimized scoring scale, so as to quantify the probability of secondary epilepsy after intracerebral hemorrhage. Based on the current prediction model of acute cerebral infraction and post-stroke seizure (AIS-PSS), the evaluation efficacy of optimized score for secondary epilepsy after hemorrhagic stroke was explored.Results:① After sample size calculation and sufficient inclusion and exclusion, 159 patients with cerebral hemorrhage were continuously selected as the model group of this cross-sectional study. A total of 29 patients with early-onset epilepsy and 130 patients without secondary epilepsy were enrolled. The time span was from January 2021 to August 2021. In addition, 77 patients with acute cerebral hemorrhage from August 2021 to February 2022 were selected as the verification group, among which 12 patients had early-onset epilepsy and 65 patients had not any secondary epilepsy. ② There were significant differences in demographic characteristics such as diabetes history, cerebral infarction history, smoking history, National Institutes of Health Stroke Scale (NIHSS) score, intracerebral hemorrhage hematoma volume, serum creatinine (SCr), neuron-specific enolase (NSE), S-100 protein and intracerebral hemorrhage site between the two model groups with different prognosis (all P < 0.05). ③ The above indexes were included in univariate and multivariate Poisson regression analysis, and the results showed that the duration of diabetes [relative risk ( RR) = 1.229, 95% confidence interval (95% CI) was 1.065-1.896, P = 0.036], smoking history ( RR = 1.419, 95% CI was 1.133-2.160, P = 0.030), history of cerebral infarction ( RR = 1.634, 95% CI was 1.128-2.548, P = 0.041), hematoma volume of cerebral hemorrhage ( RR = 1.222, 95% CI was 1.024-2.052, P = 0.041), NES content ( RR = 1.146, 95% CI was 1.041-1.704, P = 0.032), were independent influencing factors to constitute the prediction model. The prediction model was converted into a visual optimized scoring scale in the form of a line diagram to obtain the prediction probability corresponding to the corresponding score. ④ Receiver operator characteristic curve (ROC curve) was used to test the evaluation efficiency of optimized score and AIS-PSS score for early-onset cerebral hemorrhage epilepsy. Relevant data of patients in the verification group were extracted according to the information of two scores, and the final score of each patient in the verification group was obtained. The score and prognosis were put into the ROC curve to evaluate the predictive ability of different prediction models. The results showed that the cut-off value of the optimized score and the AIS-PSS score were 144 points and 7 points, respectively, and the area under the ROC curve (AUC) and the Yoden index of the optimized score were slightly lower than the AIS-PSS score. However, compared with AIS-PSS score, there was no significant difference in the evaluation efficiency of optimized score for early-onset epilepsy ( Z = 1.874, P > 0.05). Conclusion:This study constructed a specific early-onset epilepsy prediction model for patients with hemorrhagic stroke, and transformed it into an optimized score that is easy for clinical use, and its evaluation efficiency is reliable.