Objective To evaluate the safety and efficacy of simultaneous resection for initially resectable rectal cancer with synchronous liver metastases. Methods A retrospective analysis was conducted on 305 patients with initially resectable rectal cancer with synchronous liver metastases. These patients were diagnosed at Zhongshan Hospital, Fudan University from January 2016 to June 2020. Among them, 191 underwent simultaneous rectum and liver resection and 114 underwent staged resection. Propensity score matching (PSM) was performed at a 1∶1 ratio. Clinical data were compared and Kaplan-Meier survival curves were plotted. Results After PSM, 85 patients were included in each group. General data showed no significant differences. Except for liver metastasis resection method, no statistical differences were found in primary tumor surgery approach, intraoperative blood loss, intraoperative complications, time to first flatus and defecation, 30-day mortality, and postoperative hospital stay between the simultaneous resection group and the staged resection group. The overall complication rate was higher in the simultaneous resection group (48.2% vs 29.4%, P＝0.04). Specifically, the grade Ⅱ complications were significantly higher (29.4% vs 14.1%, P＝0.016), but there’s no differences in severe complications (grade Ⅲ-Ⅴ). No statistically differences were observed in median progression-free survival (HR＝0.70, 95%CI 0.50-0.97, P＝0.103) and 5-year overall survival (HR＝0.95, 95%CI 0.63-1.44, P＝0.259). Conclusions Simultaneous resection demonstrates comparable safety and efficacy to staged resection for initially resectable rectal cancer with synchronous liver metastases.

Objective:To investigate the relationship between different states of cardiac function and their changes during the course of diabetic foot ulcers(DFU), and to evaluate their impact on patient prognosis.Methods:A retrospective analysis was conducted on 194 DFU patients who were rehospitalized at approximately 3-month intervals. Basic clinical data and cardiac function-related indicators were collected at baseline and follow-up. Patients were followed until death or until November 10, 2024. Outcomes including ulcer healing, recurrence, minor amputation, and death were recorded. Logistic regression models were used to analyze the effects of cardiac function status and its changes on these four outcomes. Results:After treatment, the proportion of patients with NYHA class Ⅱ-Ⅲ decreased significantly from 33.5% at baseline to 21.6%( P=0.009). Serum N-terminal pro-B-type natriuretic peptide(NT-proBNP) level also decreased after treatment compared with baseline [635.85(59.83, 453.28) pg/mL vs 728.67(81.48, 696.15) pg/mL, P=0.055]. Serum NT-proBNP level was significantly higher in the death group compared to the survival group( P=0.002). The proportion of DFU patients with baseline NYHA class Ⅱ-Ⅲ was significantly higher than that in those with class Ⅰ( P=0.012). Regression analysis showed that an improvement in NT-proBNP levels was associated with a lower risk of DFU recurrence( OR=0.378, 95% CI 0.183-0.779, P=0.008), and improvement in NYHA class was associated with a lower mortality risk( OR=0.074, 95% CI 0.020-0.275, P<0.001). Conclusion:Cardiac function status and its changes during the treatment of DFU patients have strong prognostic implications, particularly in predicting the risk of recurrence and death outcomes.

The patient, a 28-year-old male, had experienced splenomegaly for four years with lymphadenopathy for more than two months and presented to the First Affiliated Hospital of the Naval Medical University on October 16th, 2024. On July 31, 2024, he noticed right upper quadrant pain, and an enhanced abdominal CT performed in an external facility revealed splenomegaly with a rounded nodular lesion at the splenic hilum, suggestive of an accessory spleen; in addition to retroperitoneal lymphadenopathy, while tumor marker levels were unremarkable. A complete blood count on August 22nd, 2024, demonstrated leukopenia (2.22×10 9/L), hemoglobin level of 144 g/L, and thrombocytopenia (60×10 9/L). To further elucidate the diagnosis, the patient visit our hematology clinic on August 26th, 2024. His physical examination was normal in general condition, except for a firm palpable spleen 10 cm below the left costal margin, and ultrasonography revealed right thyroid nodule and hepatosplenomegaly. Because of hepatosplenomegaly and retroperitoneal lymphadenopathy, a PET-CT scan was performed. The scan confirmed marked hepatosplenomegaly, multiple enlarged lymph nodes in the retroperitoneal and mesenteric regions with increased metabolic activity, and evidence of elevated bone metabolic activity in the proximal limbs and axial skeleton. Given the possibility of a hematologic lymphoproliferative disorder, a bone marrow biopsy was recommended. On September 12th, 2024, the patient underwent a bone marrow biopsy for evaluations of cell morphology, initial lymphoma immunophenotyping, cytogenetic analysis, and lymphoma-related FISH testing. Flow cytometry, cytogenetic analysis, and FISH results on September 14th, 2024, were unremarkable, manual microscopy of bone marrow morphological evaluation revealed a small population of poorly differentiated lymphocytes; additionally, AI-assisted automated cell scan identified a subset of abnormal cells suspected to be ′Gaucher cells′. Bone marrow pathology indicated a histiocytic neoplasm accompanied by stage 2 myelofibrosis (MF), with tumor cells comprising approximately 70% of the nucleated cells in the marrow, suggesting immunohistochemistry for confirmation. On October 16th, immunohistochemical analysis confirmed the presence of a histiocytic proliferative disorder suspecting Gaucher disease. After admission, the patient initiated enzyme replacement therapy, receiving an initial intravenous dose of 60 U/kg in a weekly basis. On October 31st, 2024, based on enzyme activity assays, genetic testing, and other results, adult Gaucher disease was finally diagnosed. The patient was scheduled for follow-up with stable vital signs, and reduced size of the spleen compared with previous assessments.

Aim To detect the changes of serum cardiotrophin-1(CT-1)and angiopoietin-like protein 3(ANGPTL3)levels in patients with coronary heart disease(CHD)complicated with heart failure(HF)after percutaneous coronary intervention(PCI),and analyze their relationship with prognosis.Methods 199 patients with CHD compli-cated with HF who underwent PCI in the Second Affiliated Hospital of Zhengzhou University from March 2022 to March 2023 were selected.The serum CT-1 and ANGPTL3 levels of patients with different New York Heart Association(NYHA)cardiac function grades were compared before surgery.The prognosis was followed up after PCI,and the pa-tients who had major adverse cardiovascular event(MACE)were included in the poor prognosis group,and the rest were included in the good prognosis group.The general data and serum CT-1 and ANGPTL3 levels were compared between the poor prognosis group and the good prognosis group.Logistic regression model was used to analyze the influencing factors of poor prognosis after surgery in patients with CHD and HF.The predictive value of serum CT-1 and ANGPTL3 alone and in combination were analyzed.Results Compared with the patients with cardiac function grade Ⅰ,the serum CT-1 and ANGPTL3 levels of the patients with cardiac function grade Ⅱ,Ⅲ and Ⅳ were increased(P＜0.05).Compared with the patients with cardiac function grade Ⅱ,the serum CT-1 and ANGPTL3 levels of the patients with cardiac function grade Ⅲ and Ⅳ were increased(P＜0.05).Compared with the patients with cardiac function grade Ⅲ,the serum CT-1 and ANGPTL3 levels of the patients with acrdiac function grade Ⅳ were increased(P＜0.05).Spearman correlation a-nalysis showed that the serum CT-1 and ANGPTL3 levels were positively correlated with NYHA cardiac function grade(r=0.518,95％CI:0.408～0.613,P＜0.001,r=0.737,95％CI:0.666～0.794,P＜0.001).The poor prognosis rate of patients was 17.93％.Compared with the good prognosis group,the serum CT-1 and ANGPTL3 levels of the poor progno-sis group were increased(P＜0.05).Logistic regression model analysis showed that smoking,diabetes,lesion vessel number ≥3,irregular medication outside the hospital,serum CT-1 and ANGPTL3 levels were the influencing factors of poor prognosis in patients with CHD complicated with HF(P＜0.05).ROC curve analysis showed that the sensitivity and area under the curve(AUC)of combined serum CT-1 and ANGPTL3 levels for predicting poor prognosis of patients with CHD complicated with HF were higher than those of either marker alone,while the specificity was basically similar to that of sin-gle-marker prediction.Conclusion Serum CT-1 and ANGPTL3 levels are abnormally elevated in patients with CHD complicated with HF after PCI,and are closely related to the cardiac function and prognosis.

Objective To investigate the clinical efficacy and aesthetic outcome of liposuction combined with mammary adenectomy through a periareolar small incision in the management of gynecomastia(GYN).Methods From January 2019 to June 2023,18 patients with GYN were admitted.All of them were treated with small incision through the areola combined with liposuction.The postoperative aesthetic effect,occurrence of complications and patient satisfaction of the patients were evaluated.Results All 18 patients in this study were follwed up for a period of 3 to 18 months.No serious complications such as wound infection or necrosis of the nipple-areola occurred.Pathological examinations were consistent with the diagnosis of GYN.Except for one patient,who exhibited slight skin folds in the surgical area at the 12-month follow-up,the other patients all achieved symmetrical and smooth chest contours with noticeable aesthetic improvement,resulting in a 100％patient satisfaction rate.Conclusion The combined approach of liposuction combined with mammary adenectomy through a periareolar small incision for the treatment of GYN is straightforward,minimally invasive,and yields satisfactory therapeutic and aesthetic outcomes.

Objective:To understand the current situation and influencing factors of functional constipation among elderly people in nursing homes, and construct a risk prediction model.Methods:Conveniently select 542 elderly people from 8 nursing homes in Tangshan urban area from July to November 2023 as the research subjects, use binary logistic regression analysis to construct a risk prediction model, and conduct internal validation of the model.Results:Among the 542 elderly people who were included in the study, there were 250 males and 292 females with an average age of 78.00 (70.00, 86.00) years. The incidence of functional constipation among elderly people in nursing homes was 54.06%(293/542). The predictive model includes six predictive factors: age, Barthel index, water intake, daily vegetable intake, insomnia, and perianal disease. The model AUC was 0.885 (95% CI 0.858-0.913), the Youden index was 0.628, the best critical value was 0.585, sensitivity was 0.819, specificity was 0.809. The Hosmer-Lemeshow test χ2=6.38, P=0.605. The internal validation results of the Bootstrap method showed that the AUC of the model was 0.876, the calibration curve was close to the standard line, and the Brier score was 0.135. The DCA results showed that the threshold was 0.1-0.9, and the model had good clinical net benefits. Conclusions:The incidence of functional constipation in elderly care institutions is relatively high. The functional constipation risk prediction model constructed in this study has good predictive efficacy and applicability, which can provide reference for nursing home staff.

Aim To detect the changes of serum cardiotrophin-1(CT-1)and angiopoietin-like protein 3(ANGPTL3)levels in patients with coronary heart disease(CHD)complicated with heart failure(HF)after percutaneous coronary intervention(PCI),and analyze their relationship with prognosis.Methods 199 patients with CHD compli-cated with HF who underwent PCI in the Second Affiliated Hospital of Zhengzhou University from March 2022 to March 2023 were selected.The serum CT-1 and ANGPTL3 levels of patients with different New York Heart Association(NYHA)cardiac function grades were compared before surgery.The prognosis was followed up after PCI,and the pa-tients who had major adverse cardiovascular event(MACE)were included in the poor prognosis group,and the rest were included in the good prognosis group.The general data and serum CT-1 and ANGPTL3 levels were compared between the poor prognosis group and the good prognosis group.Logistic regression model was used to analyze the influencing factors of poor prognosis after surgery in patients with CHD and HF.The predictive value of serum CT-1 and ANGPTL3 alone and in combination were analyzed.Results Compared with the patients with cardiac function grade Ⅰ,the serum CT-1 and ANGPTL3 levels of the patients with cardiac function grade Ⅱ,Ⅲ and Ⅳ were increased(P＜0.05).Compared with the patients with cardiac function grade Ⅱ,the serum CT-1 and ANGPTL3 levels of the patients with cardiac function grade Ⅲ and Ⅳ were increased(P＜0.05).Compared with the patients with cardiac function grade Ⅲ,the serum CT-1 and ANGPTL3 levels of the patients with acrdiac function grade Ⅳ were increased(P＜0.05).Spearman correlation a-nalysis showed that the serum CT-1 and ANGPTL3 levels were positively correlated with NYHA cardiac function grade(r=0.518,95％CI:0.408～0.613,P＜0.001,r=0.737,95％CI:0.666～0.794,P＜0.001).The poor prognosis rate of patients was 17.93％.Compared with the good prognosis group,the serum CT-1 and ANGPTL3 levels of the poor progno-sis group were increased(P＜0.05).Logistic regression model analysis showed that smoking,diabetes,lesion vessel number ≥3,irregular medication outside the hospital,serum CT-1 and ANGPTL3 levels were the influencing factors of poor prognosis in patients with CHD complicated with HF(P＜0.05).ROC curve analysis showed that the sensitivity and area under the curve(AUC)of combined serum CT-1 and ANGPTL3 levels for predicting poor prognosis of patients with CHD complicated with HF were higher than those of either marker alone,while the specificity was basically similar to that of sin-gle-marker prediction.Conclusion Serum CT-1 and ANGPTL3 levels are abnormally elevated in patients with CHD complicated with HF after PCI,and are closely related to the cardiac function and prognosis.

Objective To investigate the clinical efficacy and aesthetic outcome of liposuction combined with mammary adenectomy through a periareolar small incision in the management of gynecomastia(GYN).Methods From January 2019 to June 2023,18 patients with GYN were admitted.All of them were treated with small incision through the areola combined with liposuction.The postoperative aesthetic effect,occurrence of complications and patient satisfaction of the patients were evaluated.Results All 18 patients in this study were follwed up for a period of 3 to 18 months.No serious complications such as wound infection or necrosis of the nipple-areola occurred.Pathological examinations were consistent with the diagnosis of GYN.Except for one patient,who exhibited slight skin folds in the surgical area at the 12-month follow-up,the other patients all achieved symmetrical and smooth chest contours with noticeable aesthetic improvement,resulting in a 100％patient satisfaction rate.Conclusion The combined approach of liposuction combined with mammary adenectomy through a periareolar small incision for the treatment of GYN is straightforward,minimally invasive,and yields satisfactory therapeutic and aesthetic outcomes.

Objective:To understand the current situation and influencing factors of functional constipation among elderly people in nursing homes, and construct a risk prediction model.Methods:Conveniently select 542 elderly people from 8 nursing homes in Tangshan urban area from July to November 2023 as the research subjects, use binary logistic regression analysis to construct a risk prediction model, and conduct internal validation of the model.Results:Among the 542 elderly people who were included in the study, there were 250 males and 292 females with an average age of 78.00 (70.00, 86.00) years. The incidence of functional constipation among elderly people in nursing homes was 54.06%(293/542). The predictive model includes six predictive factors: age, Barthel index, water intake, daily vegetable intake, insomnia, and perianal disease. The model AUC was 0.885 (95% CI 0.858-0.913), the Youden index was 0.628, the best critical value was 0.585, sensitivity was 0.819, specificity was 0.809. The Hosmer-Lemeshow test χ2=6.38, P=0.605. The internal validation results of the Bootstrap method showed that the AUC of the model was 0.876, the calibration curve was close to the standard line, and the Brier score was 0.135. The DCA results showed that the threshold was 0.1-0.9, and the model had good clinical net benefits. Conclusions:The incidence of functional constipation in elderly care institutions is relatively high. The functional constipation risk prediction model constructed in this study has good predictive efficacy and applicability, which can provide reference for nursing home staff.

Objective:To investigate the relationship between different states of cardiac function and their changes during the course of diabetic foot ulcers(DFU), and to evaluate their impact on patient prognosis.Methods:A retrospective analysis was conducted on 194 DFU patients who were rehospitalized at approximately 3-month intervals. Basic clinical data and cardiac function-related indicators were collected at baseline and follow-up. Patients were followed until death or until November 10, 2024. Outcomes including ulcer healing, recurrence, minor amputation, and death were recorded. Logistic regression models were used to analyze the effects of cardiac function status and its changes on these four outcomes. Results:After treatment, the proportion of patients with NYHA class Ⅱ-Ⅲ decreased significantly from 33.5% at baseline to 21.6%( P=0.009). Serum N-terminal pro-B-type natriuretic peptide(NT-proBNP) level also decreased after treatment compared with baseline [635.85(59.83, 453.28) pg/mL vs 728.67(81.48, 696.15) pg/mL, P=0.055]. Serum NT-proBNP level was significantly higher in the death group compared to the survival group( P=0.002). The proportion of DFU patients with baseline NYHA class Ⅱ-Ⅲ was significantly higher than that in those with class Ⅰ( P=0.012). Regression analysis showed that an improvement in NT-proBNP levels was associated with a lower risk of DFU recurrence( OR=0.378, 95% CI 0.183-0.779, P=0.008), and improvement in NYHA class was associated with a lower mortality risk( OR=0.074, 95% CI 0.020-0.275, P<0.001). Conclusion:Cardiac function status and its changes during the treatment of DFU patients have strong prognostic implications, particularly in predicting the risk of recurrence and death outcomes.