ObjectiveTo investigate the incidence and influencing factors of posttraumatic stress disorder （PTSD） three months after a traffic accident， and to explore the role of social support and coping strategies. MethodsA total of 117 individuals exposed to trauma following road traffic accidents were recruited. General demographic and clinical information was collected within one week， and the hamilton anxiety rating scale （HAMA）， the hamilton depression rating scale-24 （HAMD-24）， the social support rating scale （SSRS）， and the simplified coping style questionnaire （SCSQ） were administered. A 3-month follow-up was subsequently conducted， during which PTSD symptoms were assessed using the post-traumatic stress disorder checklist for DSM-5 （PCL-5）. Participants were divided into a PTSD group and a non-PTSD group according to whether PTSD occurred. Between-group comparisons were performed using the Mann-Whitney U non-parametric test or the χ² test， as appropriate. Spearman correlation analysis was used to examine the associations between general characteristics and PCL-5 scores. Binary Logistic regression was applied to identify factors influencing PTSD， and receiver operating characteristic （ROC） curve analysis was conducted to evaluate the diagnostic value of the SCSQ and SSRS. ResultsDuring the 3-month follow-up of the 117 trauma-exposed individuals， 17 cases developed PTSD， with a higher proportion of females （70.59%）. Between-group comparisons showed that， compared with the PTSD group， the non-PTSD group had higher scores for positive coping， objective support， and subjective support （P<0.05）， and lower scores for negative coping， HAMA， HAMD， and PCL-5 （P<0.05）. Correlation analysis indicated that female gender， negative coping， and higher HAMA and HAMD scores were associated with greater PTSD severity. Logistic regression analysis demonstrated that educational level （OR=1.715， 95% CI： 1.020-2.883， P=0.042） and negative coping （OR=1.590， 95% CI： 1.003-2.522， P=0.048） were risk factors for PTSD， whereas objective support （OR=0.646， 95% CI： 0.451-0.925， P=0.017） was a protective factor. The ROC analysis showed that the total SCSQ score and its negative and positive coping dimensions， the total SSRS score and its subjective and objective support dimensions， as well as their combined use， all demonstrated good discriminative ability in distinguishing between the PTSD and non-PTSD groups. ConclusionThe results suggest that individuals who are female， with higher HAMA and HAMD scores after a motor vehicle accident， and those with lower social support and negative coping strategies， should be given particular attention. Early interventions for these individuals may reduce the incidence of PTSD.

Liver cancer is one of the most common malignant tumors in the digestive system and ranks sixth among newly diagnosed malignant tumors worldwide. Transforming growth factor-β （TGF-β） regulates cell differentiation， proliferation， apoptosis， and other physiological and pathological mechanisms and exerts cancer-suppressive and pro-cancerous dual effects in the process of tumor development. In recent years， with the continuous exploration of the mechanism of liver cancer， it has been found that the conversion of the cancer-suppressive effect into a pro-cancerous effect of this pathway plays a key role in the development of liver cancer. Traditional Chinese medicine （TCM） provides a unique perspective for the classification， diagnosis， and treatment of liver cancer with its comprehensive regulatory effects of multi-components， multi-targets， and multi-pathways. This paper summarized that the cancer-suppressive mechanisms of the TGF-β signaling pathway included promoting cancer cell cycle arrest， apoptosis， autophagy， et al， while the pro-cancerous mechanisms included promoting cancer cell proliferation， invasion and metastasis， immunosuppression， angiogenesis， et al. The TCM compounds intervening this pathway were sorted out， including Jianpi Huayu compound， Fuyang Baoyuan compound， Yipi Yanggan compound， Fuzheng Jiedu compound， compound Astragalus and Salvia， Biejia Jianwan， Dahuang Zhechong pill， and Qingxiang powder. The single TCMs mainly included Schizocapsa plantaginea， Dendrobii Caulis， Gleditsia sinensis， and Dracaena cochinchinensis. The active ingredients of TCM are mainly concentrated on flavonoids， alkaloids， glycosides， phenolics， terpenoids， polysaccharides， and other kinds of compounds. At the same time， it summarized that the liver cancer inhibition mechanism of TCM by regulating this pathway mainly included promoting apoptosis of liver cancer cells， blocking the cell cycle， and inhibiting liver cancer cell proliferation， migration， invasion， angiogenesis， immune escape， etc. The mechanism aims to give full play to the advantages of TCM and precisely regulate the TGF-β signal， thereby exerting positive anti-tumor effects， opening up a new direction for the precise targeted treatment of liver cancer， and providing a scientific basis and a new strategy for the application of TCM in the treatment of liver cancer.

Liver cancer is one of the most common malignant tumors in the digestive system and ranks sixth among newly diagnosed malignant tumors worldwide. Transforming growth factor-β （TGF-β） regulates cell differentiation， proliferation， apoptosis， and other physiological and pathological mechanisms and exerts cancer-suppressive and pro-cancerous dual effects in the process of tumor development. In recent years， with the continuous exploration of the mechanism of liver cancer， it has been found that the conversion of the cancer-suppressive effect into a pro-cancerous effect of this pathway plays a key role in the development of liver cancer. Traditional Chinese medicine （TCM） provides a unique perspective for the classification， diagnosis， and treatment of liver cancer with its comprehensive regulatory effects of multi-components， multi-targets， and multi-pathways. This paper summarized that the cancer-suppressive mechanisms of the TGF-β signaling pathway included promoting cancer cell cycle arrest， apoptosis， autophagy， et al， while the pro-cancerous mechanisms included promoting cancer cell proliferation， invasion and metastasis， immunosuppression， angiogenesis， et al. The TCM compounds intervening this pathway were sorted out， including Jianpi Huayu compound， Fuyang Baoyuan compound， Yipi Yanggan compound， Fuzheng Jiedu compound， compound Astragalus and Salvia， Biejia Jianwan， Dahuang Zhechong pill， and Qingxiang powder. The single TCMs mainly included Schizocapsa plantaginea， Dendrobii Caulis， Gleditsia sinensis， and Dracaena cochinchinensis. The active ingredients of TCM are mainly concentrated on flavonoids， alkaloids， glycosides， phenolics， terpenoids， polysaccharides， and other kinds of compounds. At the same time， it summarized that the liver cancer inhibition mechanism of TCM by regulating this pathway mainly included promoting apoptosis of liver cancer cells， blocking the cell cycle， and inhibiting liver cancer cell proliferation， migration， invasion， angiogenesis， immune escape， etc. The mechanism aims to give full play to the advantages of TCM and precisely regulate the TGF-β signal， thereby exerting positive anti-tumor effects， opening up a new direction for the precise targeted treatment of liver cancer， and providing a scientific basis and a new strategy for the application of TCM in the treatment of liver cancer.

Metanephric adenoma is a rare renal epithelial tumor with a low incidence and lack of specific clinical manifestations，resulting in a lack of uniformity in clinical understanding and treatment. Its etiology and pathogenesis are still unclear，and it may be related to the abnormal number and structure of chromosomes 2，7，and 17，as well as mutations in genes such as BRAF V600E，NF1，and NOTCH1，etc. There may be a transformed relationship between this tumor and Wilms’ tumor and papillary renal cell carcinoma. For diagnosis，it has diverse but non-specific clinical manifestations，and it is difficult to accurately differentiate it from other tumors in the imaging examination，and the confirmation of diagnosis relies on pathological and immunohistochemical staining. Treatment is mainly based on surgery to preserve the renal unit，such as partial nephrectomy，etc.，but the difficulty of preoperative diagnosis often leads to over-treatment，and there is a lack of standardized treatment protocols for metastatic posterior renal adenoma. The aim of this article is to provide a reference for the in-depth understanding of posterior renal adenomas and to optimize the clinical diagnosis and treatment strategies.

Objective:To explore the possibility of using a inferior gluteal artery perforator flap (IGAPF) for breast reconstruction in the patient who did not have suitable donor site in back and abdomen.Methods:In November 2024, a 25-year-old unmarried and childless woman with right breast cancer received immediate right breast reconstruction by a right free IGAPF after modified right mastectomy in the Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Hainan Medical University. The locations of perforators were confirmed by both Multi-detector computed tomography angiography (MDCTA) and portable Doppler blood flow detector before surgery. The IGAPF was designed to take the inferior gluteal wrinkle as the lower edge, the axis of the flap was parallel to the inferior gluteal wrinkle, and the width of the flap was estimated where the incision could be directly closed. The size of right IGAPF was 6.0 cm×19.0 cm. Sharp dissection was performed between the sarcolemma and muscle fibres of gluteus, then the perforators were dissected along the direction of muscle fibres of gluteus. The vascular pedicle was kept at about 8.0 cm in length. The diameter of artery was about 2.0 mm and that for the veins was about 1.5 mm. End-to-end anastomoses with the right thoracodorsal artery and vein were successfully carried out. The donor site was directly closed, and it was hidden in the inferior gluteal wrinkle. Postoperative outpatient clinical review was made.Results:Pathological examination reported: an invasive carcinoma of right breast, axillary lymph node metastasis (2/10). The patient recovered well and the flap survived without any complication, i.e. ischemic necrosis, infection and haematoma. The patient was off-bed at 3 days and discharged at 13 days after surgery. At the 40 days of postoperative follow-up, the patient achieved a good recovery and the lower limb activity was not affected by the surgery. The patient was satisfied with the reconstructed breast and donor site recovery. The patient followed with scheduled chemotherapy and subsequent radiotherapy. The volume of reconstructed breast was smaller than the other breast, of which the patient was fully informed before the surgery.Conclusion:A free IGAPF provides an alternative donor sites for achieving a breast reconstruction due to the reliable pedicle vessels and invisible donor scars.

Objective:To investigate the clinical results of gasless endoscopic thyroidectomy via posterior chest-collarbone approach (GETPCA) compared with open neck surgery for papillary thyroid carcinoma (PTC) .Mthods:Retrospective analysis of PTC patients admitted to the Department of Thyroid and Breast Surgery of the Third Affiliated Hospital of Anhui Medical University from Jan. 2022 to Dec. 2023,and randomly divided into the open group and the lumbo-scopic group according to whether or not they had a requirement for an unmarked neck, in which the open group was n=100,and the lumbo-scopic group was n=67,with 39 male cases and 128 female cases. Clinicopathological characteristics, surgery-related indexes, postoperative complications, postoperative pain scores and postoperative cosmetic satisfaction were compared between the two groups.The t-test,Wilcoxon rank-sum test, χ2 test, consecutively corrected χ2 test, or Fisher’s exact probability method were used to compare the groups. Results:No recurrence was seen during the follow-up period,and none of the cases in the luminal group was open in the middle. The differences in age, body mass index BMI, gender, relative tumor location,preoperative TSH, T stage and N stage between the two groups were not statistically significant ( P>0.05) . The total operation time [ (121.07±39.80) min vs. (93.87±26.97) min]in the luminal group was greater than that in the open group,intraoperative bleeding was less than that in the open group, and the postoperative drainage flow[ (130.69±31.01) mL vs. (105.52±32.71) mL] was greater than that in the open group in the postoperative period of 72 h, and the difference was statistically significant ( P<0.001) .There was no statistical difference between the two groups in terms of 24-h postoperative drainage volume, number of central zone lymph node dissection, number of positive central zone lymph nodes,postoperative hospitalization days or total hospitalization cost ( P>0.05) .The number of cases of neck discomfort (3 cases vs.23 cases, P<0.001) and swallowing dysfunction (2 cases vs.20 cases, P=0.003) in the luminal group was smaller than that in the open group,and the difference was statistically significant.The difference in the incidence of bleeding,incision infection,seroma,temporary recurrent laryngeal nerve injury and temporary parathyroid gland injury between the two groups was also not statistically significant ( P>0.05) .The postoperative NRS on day 1 and postoperative NRS on day 3 of the luminal group were lower than those of the open group,and the difference was statistically significant ( P>0.05) ,while there was no statistically significant difference between the postoperative NRS on day 7,the postoperative NRS on month 1 and the postoperative NRS on month 3 ( P>0.05) .Cosmetic satisfaction at 6 months postoperatively was higher in the luminal group than in the open group,and the difference was statistically significant ( P<0.001) . Conclusion:GETPCA for the treatment of the PTC is safe and feasible,with satisfactory cosmetic results and reduction of neck discomfort and swallowing dysfunction,which is worthy of clinical popularization.

Objective:Based on value orientation,it aimed to scientifically define the concept and connotation of accessibility to novel anticancer drugs,in order to deeply understand the nature and current status of the accessibility issues of novel anticancer drugs,and to provide a reference for the formulation and optimization of policies related to novel anticancer drugs.Methods:Data was collected through literature review and expert interviews,and the concept of drug accessibility was defined using the atomic diagram method.Results:The core images include"affordability","availability","high quality"and"patients".The concept of accessibility to novel anticancer drugs is defined as"the process of ensuring the sustainable supply,equitable access,affordability,and rational use of high-quality anticancer drugs to safeguard the realization of patient benefit goals."The connotation of the value orientation in policies on the accessibility of novel anticancer drugs is profoundly reflected in the multi-dimensional value-driven approach to ensure the ultimate benefit of patients,which includes quality,sustainability,equity,affordability,and rational use.Conclusion:The proposal of the concept and connotation of accessibility provides a theoretical basis for a deep understanding of the accessibility of novel anticancer drugs and offers valuable references for subsequent policy-making and practical operations.

Objective To analyze the policy texts related to pediatric medications in China over the past decade,to explore the deficiencies in existing policy formulation from the perspective of stakeholders,and to propose reasonable optimization suggestions based on the current situation.Methods Collecting national-level policies related to pediatric drugs in China from 2013 to 2023,a two-dimensional policy analysis framework of"Policy tools-Stakeholder"were established.And the content analysis method was used to code,categorize,and statistically analyze the policy texts.Results A total of 54 pediatric drug policies were included in the analysis.In terms of policy tools,a total of 197 policy codes were formed,with environmental tools being the most prevalent with 92 codes(46.70％),primarily consisting of regulatory management tools(28 codes,30.43％).This was followed by supply-oriented tools with 53 codes(26.90％),mainly focused on the issuance of technical guidelines(21 codes,39.62％).Demand-oriented tools accounted for the least with 52 codes(26.40％),with inter-departmental collaboration tools having the highest proportion(17 codes,32.69％).In the dimension of stakeholders,a total of 223 policy codes were formed,with the government having the highest number of codes at 133(59.64％),followed by medical institutions with 56 codes(25.11％).The proportions for medical personnel,pharmaceutical companies,and patients were similar,with 14 codes(6.28％),11 codes(4.93％),and 9 codes(4.04％),respectively.Conclusions Pediatric drugs face challenges with policy tools where supply-oriented tools,particularly those providing financial support,suffer from insufficient policy depth and customization.The demand-oriented tools have a low proportion,leading to structural imbalance and underutilized effectiveness;the environment-oriented tools focus more on regulation than incentives,restricting the accessibility of pediatric drugs;the potential of multiple stakeholders is not fully activated,and there is a lack of policies centered around pediatric patients.To address these issues,supply-oriented policy tools need to establish a diversified financial support model and clearly define the scope of coverage.Demand-oriented policy tools require further adjustments to the catalog,procurement upgrades,and international collaborative research to reshape the pediatric drug security system.Environmental policy tools should enhance economic support,strengthen intellectual property rights,and implement targeted education to build a development ecosystem for pediatric drugs.Regarding stakeholders,it is essential to strengthen multi-stakeholder collaboration and optimize pediatric drug policy tools with a patient-centered approach.

Objective:To investigate the clinical results of gasless endoscopic thyroidectomy via posterior chest-collarbone approach (GETPCA) compared with open neck surgery for papillary thyroid carcinoma (PTC) .Mthods:Retrospective analysis of PTC patients admitted to the Department of Thyroid and Breast Surgery of the Third Affiliated Hospital of Anhui Medical University from Jan. 2022 to Dec. 2023,and randomly divided into the open group and the lumbo-scopic group according to whether or not they had a requirement for an unmarked neck, in which the open group was n=100,and the lumbo-scopic group was n=67,with 39 male cases and 128 female cases. Clinicopathological characteristics, surgery-related indexes, postoperative complications, postoperative pain scores and postoperative cosmetic satisfaction were compared between the two groups.The t-test,Wilcoxon rank-sum test, χ2 test, consecutively corrected χ2 test, or Fisher’s exact probability method were used to compare the groups. Results:No recurrence was seen during the follow-up period,and none of the cases in the luminal group was open in the middle. The differences in age, body mass index BMI, gender, relative tumor location,preoperative TSH, T stage and N stage between the two groups were not statistically significant ( P>0.05) . The total operation time [ (121.07±39.80) min vs. (93.87±26.97) min]in the luminal group was greater than that in the open group,intraoperative bleeding was less than that in the open group, and the postoperative drainage flow[ (130.69±31.01) mL vs. (105.52±32.71) mL] was greater than that in the open group in the postoperative period of 72 h, and the difference was statistically significant ( P<0.001) .There was no statistical difference between the two groups in terms of 24-h postoperative drainage volume, number of central zone lymph node dissection, number of positive central zone lymph nodes,postoperative hospitalization days or total hospitalization cost ( P>0.05) .The number of cases of neck discomfort (3 cases vs.23 cases, P<0.001) and swallowing dysfunction (2 cases vs.20 cases, P=0.003) in the luminal group was smaller than that in the open group,and the difference was statistically significant.The difference in the incidence of bleeding,incision infection,seroma,temporary recurrent laryngeal nerve injury and temporary parathyroid gland injury between the two groups was also not statistically significant ( P>0.05) .The postoperative NRS on day 1 and postoperative NRS on day 3 of the luminal group were lower than those of the open group,and the difference was statistically significant ( P>0.05) ,while there was no statistically significant difference between the postoperative NRS on day 7,the postoperative NRS on month 1 and the postoperative NRS on month 3 ( P>0.05) .Cosmetic satisfaction at 6 months postoperatively was higher in the luminal group than in the open group,and the difference was statistically significant ( P<0.001) . Conclusion:GETPCA for the treatment of the PTC is safe and feasible,with satisfactory cosmetic results and reduction of neck discomfort and swallowing dysfunction,which is worthy of clinical popularization.

Pancreaticoduodenectomy (PD) stands as one of the most challenging landmark procedures in general surgery. Postoperative pancreatic fistula (POPF), a common complication following PD, predisposes patients to secondary pathologies and remains difficult to avoid. Reducing its incidence and mitigating its impact have become focal points in pancreatic surgical research. This article comprehensively reviews domestic and international literature to systematically analyze key factors influencing POPF across three phases: preoperative, intraoperative, and postoperative management. By gaining deeper insights into the pathogenesis of POPF, this review aims to enhance clinical understanding among healthcare professionals, facilitate the implementation of preventive strategies, and offer novel perspectives for minimizing postoperative fistula risks.