Objective To evaluate the clinical efficacy of anterior versus posterior surgical approaches in the treatment of thoracic spinal tuberculous kyphosis.Methods From January 2018 to January 2023,a total of 67 patients with thoracic spinal tuberculous kyphosis were treated.According to the surgical approach,patients were divided into an anterior group(30 cases)and a posterior group(37 cases).The operation time,blood loss,Cobb Angle before the operation,6 months after the operation,and at the last follow-up(12 months after the operation),visual analog scale(VAS)score,and oswestry disability index(ODI)were compared between the two groups.Results The anterior group had significantly longer operative time and greater intraoperative blood loss compared to the posterior group(P＜0.05).At 6 months post operatively,the Cobb angle in the anterior group was significantly lower than that in the posterior group(P＜0.05).Subgroup analysis showed no significant differences between the anterior and posterior groups in preoperative,6 months,and 12 months Cobb angles,correction degree,correction loss for single-segment cases(P＞0.05).However,in multi-segment cases,the anterior group had significantly higher Cobb angles at both preoperative and 6-month postoperative time points compared to the posterior group(P＜0.05),while no significant differences were observed at 12 months,including in correction degree and loss(P＞0.05).The VAS score and ODI of the anterior approach group and the posterior approach group at 6 months after surgery were lower than those before surgery,and the VAS score and ODI at 12 months after surgery were lower than those at 6 months after surgery.The differences were statistically significant(P＜0.05).During the follow-up period,no recurrence of tuberculosis,failure of internal fixation or significant loss of correction was observed.Conclusion Both anterior and posterior surgical approaches can effectively treat single-segment tuberculous thoracic kyphosis,with comparable efficacy.The anterior approach is more suitable for patients with localized lesions requiring anterior decompression,whereas the posterior approach offers advantages in deformity correction and spinal stability reconstruction,especially in cases involving multi-segmental lesions.

Colorectal cancer(CRC),a highly prevalent malignant tumor worldwide,has shown a continuously increasing incidence,particularly with the rise of early-onset CRC in young populations.Neoadjuvant therapy,as an important strategy for locally advanced CRC,shows significant potential to downstage tumors,improve radical surgical cure rates,and enhance prognosis.In this paper,a 39-year-old male patient with sigmoid colon adenocarcinoma at clinical stage cT4aN2aM0(stage ⅢC)is reported.Genetic testing revealed a mutation in the oncogene KRAS(G13D)and microsatellite stability(MSS).The patient also had significantly elevated carcinoembryonic antigen(CEA),lymph node metastasis,and suspected pelvic implant nodules,with a high risk of invasiveness and potential peritoneal metastasis.Because he had a refractory subtype of CRC with poor response to traditional immunotherapy,the patient was treated with neoadjuvant therapy,comprising CapeOx regimen(capecitabine+oxaliplatin),followed sequentially by sluzumab;after 6 treatment cycles,the tumor shrank significantly,and laparoscopic radical sigmoid colon resection was successfully performed,with no residual(ypT0N0)confirmed by postoperative pathology.This case suggests that for patients with KRAS-mutated MSS CRC resistant to traditional immunotherapy,a combination of CapeOx chemotherapy followed by programmed death-1(PD-1)inhibitors may induce a deep pathological response and provide translational treatment opportunities for locally advanced patients.However,the universality and long-term benefits of this treatment regimen still require further longitudinal studies and clinical follow-up.

Colorectal cancer(CRC),a highly prevalent malignant tumor worldwide,has shown a continuously increasing incidence,particularly with the rise of early-onset CRC in young populations.Neoadjuvant therapy,as an important strategy for locally advanced CRC,shows significant potential to downstage tumors,improve radical surgical cure rates,and enhance prognosis.In this paper,a 39-year-old male patient with sigmoid colon adenocarcinoma at clinical stage cT4aN2aM0(stage ⅢC)is reported.Genetic testing revealed a mutation in the oncogene KRAS(G13D)and microsatellite stability(MSS).The patient also had significantly elevated carcinoembryonic antigen(CEA),lymph node metastasis,and suspected pelvic implant nodules,with a high risk of invasiveness and potential peritoneal metastasis.Because he had a refractory subtype of CRC with poor response to traditional immunotherapy,the patient was treated with neoadjuvant therapy,comprising CapeOx regimen(capecitabine+oxaliplatin),followed sequentially by sluzumab;after 6 treatment cycles,the tumor shrank significantly,and laparoscopic radical sigmoid colon resection was successfully performed,with no residual(ypT0N0)confirmed by postoperative pathology.This case suggests that for patients with KRAS-mutated MSS CRC resistant to traditional immunotherapy,a combination of CapeOx chemotherapy followed by programmed death-1(PD-1)inhibitors may induce a deep pathological response and provide translational treatment opportunities for locally advanced patients.However,the universality and long-term benefits of this treatment regimen still require further longitudinal studies and clinical follow-up.

Objective:To explore the clinical characteristics and prognosis of malignant melanoma (MM) in the Xinjiang Uygur Autonomous Region.Methods:We collected the clinical and follow-up data of 503 MM patients admitted to the Affiliated Tumor Hospital of Xinjiang Medical University between 2010 and 2022. The Kaplan-Meier method was employed for survival analysis, with Log rank test used for comparing the survival rates between groups. Cox regression analysis was conducted to identify the influencing factors of patient prognosis.Results:From 2010 to 2022, the number of MM patients admitted to the Affiliated Tumor Hospital of Xinjiang Medical University demonstrated an upward trend. Among the 503 MM patients, the primary tumor sites were located in the extremities in 264 cases, the skin in 155 cases, the mucosal in 49 cases, and the ocular uvea in 22 cases, and in 13 cases the primary lesion was unknown. The median follow-up duration was 44 months, with a median overall survival time of 44.0 months. The overall survival rates at 1, 3, and 5 years were 85.2%, 54.3%, and 42.1%, respectively. Univariate analysis revealed that age, Breslow thickness, Clark grading, presence of ulcers, lactate dehydrogenase (LDH) levels, clinical stage at initial treatment, tumor recurrence, distant metastasis (lung, liver, bone, or brain), and postoperative adjuvant therapy were all associated with overall survival in MM patients (all P<0.05). Multivariate Cox regression analysis revealed that age ( HR=1.022, 95% CI: 1.013-1.032), LDH level ( HR=1.696, 95% CI: 1.223-2.353), clinical stage at initial treatment (TxN0M0 vs stage Ⅱ: HR=0.255, 95% CI: 0.096-0.679; TxN0M0 vs stage Ⅲ: HR=0.293, 95% CI: 0.190-0.452; TxN0M0 vs stage Ⅳ: HR=0.414, 95% CI: 0.284-0.603), bone metastasis ( HR=2.032, 95% CI: 1.252-3.298), and postoperative adjuvant therapy ( HR=0.551, 95% CI: 0.426-0.713) are independent factors influencing the overall survival of MM patients. Stratified analysis by different subtype indicated that age, clinical stage at initial treatment, gene mutations, and postoperative adjuvant therapy usage are independent factors affecting the overall survival of patients with limb MM, while age and clinical stage at initial treatment are independent factors influencing the overall survival of patients with skin and mucosal MM. Conclusions:The number of MM patients in Xinjiang Uygur Autonomous Region may be on the rise. Age, LDH level, clinical stage at initial treatment, presence of bone metastasis, and postoperative adjuvant therapy are independent risk factors for the prognosis of MM patients. Among these, age and clinical stage at initial treatment are common independent risk factors that affect the prognosis of different subtypes of MM patients.

Objective To evaluate the clinical efficacy of anterior versus posterior surgical approaches in the treatment of thoracic spinal tuberculous kyphosis.Methods From January 2018 to January 2023,a total of 67 patients with thoracic spinal tuberculous kyphosis were treated.According to the surgical approach,patients were divided into an anterior group(30 cases)and a posterior group(37 cases).The operation time,blood loss,Cobb Angle before the operation,6 months after the operation,and at the last follow-up(12 months after the operation),visual analog scale(VAS)score,and oswestry disability index(ODI)were compared between the two groups.Results The anterior group had significantly longer operative time and greater intraoperative blood loss compared to the posterior group(P＜0.05).At 6 months post operatively,the Cobb angle in the anterior group was significantly lower than that in the posterior group(P＜0.05).Subgroup analysis showed no significant differences between the anterior and posterior groups in preoperative,6 months,and 12 months Cobb angles,correction degree,correction loss for single-segment cases(P＞0.05).However,in multi-segment cases,the anterior group had significantly higher Cobb angles at both preoperative and 6-month postoperative time points compared to the posterior group(P＜0.05),while no significant differences were observed at 12 months,including in correction degree and loss(P＞0.05).The VAS score and ODI of the anterior approach group and the posterior approach group at 6 months after surgery were lower than those before surgery,and the VAS score and ODI at 12 months after surgery were lower than those at 6 months after surgery.The differences were statistically significant(P＜0.05).During the follow-up period,no recurrence of tuberculosis,failure of internal fixation or significant loss of correction was observed.Conclusion Both anterior and posterior surgical approaches can effectively treat single-segment tuberculous thoracic kyphosis,with comparable efficacy.The anterior approach is more suitable for patients with localized lesions requiring anterior decompression,whereas the posterior approach offers advantages in deformity correction and spinal stability reconstruction,especially in cases involving multi-segmental lesions.

Objective:To explore the clinical characteristics and prognosis of malignant melanoma (MM) in the Xinjiang Uygur Autonomous Region.Methods:We collected the clinical and follow-up data of 503 MM patients admitted to the Affiliated Tumor Hospital of Xinjiang Medical University between 2010 and 2022. The Kaplan-Meier method was employed for survival analysis, with Log rank test used for comparing the survival rates between groups. Cox regression analysis was conducted to identify the influencing factors of patient prognosis.Results:From 2010 to 2022, the number of MM patients admitted to the Affiliated Tumor Hospital of Xinjiang Medical University demonstrated an upward trend. Among the 503 MM patients, the primary tumor sites were located in the extremities in 264 cases, the skin in 155 cases, the mucosal in 49 cases, and the ocular uvea in 22 cases, and in 13 cases the primary lesion was unknown. The median follow-up duration was 44 months, with a median overall survival time of 44.0 months. The overall survival rates at 1, 3, and 5 years were 85.2%, 54.3%, and 42.1%, respectively. Univariate analysis revealed that age, Breslow thickness, Clark grading, presence of ulcers, lactate dehydrogenase (LDH) levels, clinical stage at initial treatment, tumor recurrence, distant metastasis (lung, liver, bone, or brain), and postoperative adjuvant therapy were all associated with overall survival in MM patients (all P<0.05). Multivariate Cox regression analysis revealed that age ( HR=1.022, 95% CI: 1.013-1.032), LDH level ( HR=1.696, 95% CI: 1.223-2.353), clinical stage at initial treatment (TxN0M0 vs stage Ⅱ: HR=0.255, 95% CI: 0.096-0.679; TxN0M0 vs stage Ⅲ: HR=0.293, 95% CI: 0.190-0.452; TxN0M0 vs stage Ⅳ: HR=0.414, 95% CI: 0.284-0.603), bone metastasis ( HR=2.032, 95% CI: 1.252-3.298), and postoperative adjuvant therapy ( HR=0.551, 95% CI: 0.426-0.713) are independent factors influencing the overall survival of MM patients. Stratified analysis by different subtype indicated that age, clinical stage at initial treatment, gene mutations, and postoperative adjuvant therapy usage are independent factors affecting the overall survival of patients with limb MM, while age and clinical stage at initial treatment are independent factors influencing the overall survival of patients with skin and mucosal MM. Conclusions:The number of MM patients in Xinjiang Uygur Autonomous Region may be on the rise. Age, LDH level, clinical stage at initial treatment, presence of bone metastasis, and postoperative adjuvant therapy are independent risk factors for the prognosis of MM patients. Among these, age and clinical stage at initial treatment are common independent risk factors that affect the prognosis of different subtypes of MM patients.

Objective To evaluate the surgical treatments of refractory sclerosing peritonitis related peritoneal dialysis.Methods Clinical data of 15 patients with refractory sclerosing peritonitis related to peritoneal dialysis treated in the General Surgery Department of the 900th Hospital of the Joint Logistics Support Force of the People's Liberation Army from June 30,2014 to May 30,2018.Among them,5 cases underwent"open abdomen peritoneal catheter removal+intestinal adhesiolysis+abdominal infection flushing and drainage with catheter",4 cases underwent"laparoscopic peritoneal catheter removal+intestinal adhesiolysis+abdominal infection flushing and drainage with catheter",3 cases underwent"laparoscopic peritoneal dialysis catheter removal+abdominal infection flushing and drainage with catheter",2 cases underwent"open abdomen peritoneal dialysis catheter removal+abdominal infection flushing and drainage with catheter",and 1 case underwent"laparoscopic examination combined with laparotomy exploration and removal of lower abdominal catheter+intestinal adhesiolysis+abdominal infection flushing and drainage with catheter".Age,gender,clinical symptoms,abdominal CT examination,peripheral blood routine,blood biochemistry,blood C-reactive protein(CRP),white blood cells,biochemistry,and aetiology of peritoneal dialysis fluid were collected and followed up,and the therapeutic effect was evaluated.Results 15 patients were transferred to the Department of Surgery after ineffective treatment in the Department of Internal Medicine.Preoperatively(after 5 days of antibiotic treatment)compared to before antibiotic treatment,there were no significant changes in blood WBC,blood NEUT％,CRP,and peritoneal fluid WBC(P＞0.05).Laparoscopic exploration or laparotomy exploration was performed,during which the peritoneal dialysis catheter was removed and the abdominal infection focus was cleared.A pelvic cavity washout drainage tube was left in place postoperatively.Fourteen patients had a good recovery after surgery,with effective control of peritonitis symptoms and no complications such as intestinal obstruction or enterocutaneous fistula.After the removal of the peritoneal dialysis catheter,all patients switched to hemodialysis.A comparison of inflammatory markers before and after surgery showed a significant decrease after surgery.Three days postoperatively compared to before surgery(after 5 days of antibiotic treatment),there were no significant changes in blood WBC,blood NEUT％,CRP,and peritoneal fluid WBC(P＞0.05).Seven days postoperatively compared to before surgery(after 5 days of antibiotic treatment),there was a significant decrease in blood WBC[(7.43±2.65)× 109/L VS(10.17±5.24)× 109/L],blood NEUT％[(88.23±9.02)％VS(85.07±11.57)％],and CRP[(152.88±113.01)mg/L VS(114.49±92.97)mg/L](P＜0.05);the peritoneal fluid WBC at 7 days postoperatively showed no significant change compared to before surgery(after 5 days of antibiotic treatment)(P＞0.05).The cases were followed up for at least 22 months,and 13 patients did not experience peritonitis or intestinal obstruction again.One patient died 39 days after surgery due to multiple organ failure,and one patient died from other causes after a 2-year follow-up.Conclusion For refractory sclerosing peritonitis related peritoneal dialysis that is ineffective in medical conservative treatment,On the basis of reasonable and effective antibiotics to control infection,surgical intervention should be actively carried out and surgical methods such as surgery should be used to control the progress of peritonitis,reduce mortality and improve the cure rate.

Background:Recurrence after stone removal is common in patients with choledocholithiasis.Recent studies have indicated that dysbiosis in gut microbiota plays an important role in the formation of cholesterol gallstones.Aims:To explore the effect of probiotics supplementation on serum lipopolysaccharide(LPS)and the indicators of bile acid metabolism in patients with a high risk of cholesterol gallstone formation.Methods:Sixty choledocholithiasis patients undergoing ERCP lithotomy were recruited at the First Affiliated Hospital of Shihezi University from June 2021 to June 2023.Bile and stool samples were collected for bacterial culture.Then the patients were randomly allocated into two groups:patients in control group received conventional supportive therapy after calculus removal,while those in probiotics intervention group were given oral bifid triple viable enteric capsule 420 mg,twice a day for 6 months based on conventional therapy.Changes in serum levels of LPS,the cell wall component of Gram-negative bacteria,fibroblast growth factor 19(FGF19),the key molecule in bile acid metabolism,and cholesterol 7α-hydroxylase(CYP7A1),the rate-limiting enzyme of bile acid synthesis,were determined and compared between the two groups.Results:Escherichia coli and Klebsiella pneumoniae were the main pathogens in bile and stool of patients with choledocholithiasis.Six months after ERCP lithotomy,the serum levels of LPS and FGF19 were decreased,and the serum level of CYP7A1 was increased in both groups(all P<0.05),especially in probiotics intervention group(all P<0.05).Conclusions:Oral probiotics supplementation can reduce the serum LPS level and modulate the canonical pathway of enterohepatic circulation of bile acids--farnesoid X receptor(FXR)-FGF19 pathway in high-risk patients of cholesterol gallstone formation.These alterations reduce the cholesterol supersaturation in bile and inhibit the probability of cholesterol gallstone formation.

Objective:To evaluate the clinical application value of iohexol plasma clearance assay in assessing glomerular filtration rate (GFR) in patients with chronic kidney disease (CKD), and identify alternative methods of 99mTc-diethylene triamine pentaacetic acid renal kinetic imaging (Gates) method for measuring GFR ( 99mTc-mGFR). Methods:It was a cross-sectional study. The CKD patients hospitalized in the Department of Nephrology at the Second Affiliated Hospital of Nanjing Medical University between October 2022 and September 2023 were enrolled. Iohexol plasma clearance was determined by collecting blood samples at 2 and 4 hours after intravenous administration of 5 ml iohexol, and high performance liquid chromatography was used to measure the plasma concentration of iohexol. Br?chner-Mortensen and Jacobsson formulas were used to calculate the double and single plasma iohexol clearance, respectively. CKD-epidemiology collaboration equation based on serum creatinine concentration was used to calculate the estimated GFR (eGFR). Pearson's coefficient was performed to analyze the correlation of iohexol dual plasma clearance assay-measured GFR (iohexol-DS-mGFR), iohexol single plasma 4 hours clearance assay-measured GFR (iohexol-SS 4h-mGFR), iohexol single plasma 2 hours clearance assay-measured GFR (iohexol-SS 2h-mGFR) and eGFR with 99mTc-mGFR as the gold standard. Bland-Altman analysis, 95% limits of agreement, and intra-correlation coefficient were used to compare the diagnostic concordance of Iohexol-DS-mGFR, Iohexol-SS 4h-mGFR, Iohexol-SS 2h-mGFR and eGFR with 99mTc-mGFR. Results:The study enrolled 64 CKD patients, aged (58.91±13.08) years old, comprising of 38 males and 26 females. The distribution of patients across CKD stages based on 99Tc-mGFR was as follows: 12 patients (18.8%) in stage 1, 14 patients (21.9%) in stage 2, 26 patients (40.6%) in stage 3, 10 patients (15.6%) in stage 4, and 2 patients (3.1%) in stage 5. The Pearson correlation analysis revealed that the correlation coefficients of iohexol-DS-mGFR, iohexol-SS 4h-mGFR, iohexol-SS 2h-mGFR and eGFR with 99mTc-mGFR were 0.925, 0.867, 0.820 and 0.894 (all P<0.001), respectively. The median deviation of absolute value of iohexol-DS-mGFR, iohexol-SS 4h-mGFR, iohexol-SS 2h-mGFR and eGFR in the total study population were 6.66, 9.63, 11.47 and 9.59 ml·min -1·(1.73 m 2) -1, respectively. The proportions of iohexol-DS-mGFR, iohexol-SS 4h-mGFR, iohexol-SS 2h-mGFR and eGFR located in the gold-standard GFR ± 10% interval (P10) were 35.9%, 29.7%, 26.6% and 29.7%, respectively, and the proportions located in the gold-standard GFR ± 30% interval ( P30 ) were 87.5%, 68.8%, 60.9% and 73.4%, respectively. Conclusions:Iohexol dual plasma clearance is well correlated and consistent with 99mTc-mGFR. It is a safe and easy alternative to isotope 99mTc-mGFR for clinical use in determining GFR.

Objective:To explore the causal relationship between social activity and depressive symptoms in the elderly, and to provide a reference for preventing and interventing depressive symptoms in the elderly.Methods:Data were sourced from the China Health and Retirement Longitudinal Study (CHARLS) program, involving 3 164 elderly individuals aged≥60 years with data collected in two measurements, in 2015 (T1) and 2018 (T2). The sample included 1 240 males and 1 924 females aged (71±7) years. Social activities were assessed by constructing a social activity index from the 11 social activities included in the CHARLS questionnaire and the frequency of their activities. The depressive symptoms were assessed using the short version of the Center for Epidemiological Studies Depression Scale (the 10-item Center for Epidemiological Studies Depression Scale, CESD-10). A mixed-design ANOVA was used to explore the trends in social activity and depressive symptoms over time and across genders in the elderly adults. Pearson correlation analysis was used to investigate whether social activity and depressive symptoms in the elderly met the criteria for simultaneous and sequential correlations, followed by a cross-lagged model to analyze the causal temporal or mutual prediction between social activeness and depressive symptoms over a 3-year intervals.Results:The social activity of elderly men at T2 was significantly lower than at T1 ( F=21.00, P<0.001), while no significant difference observed in elderly women ( F=0.31, P<0.001). At both T1 and T2, elderly men scored higher in social activity than elderly women [T1: 2.93±2.98 vs 2.55±2.65,T2: 2.28±2.49 vs 2.24±2.43); F=43.60, 11.24, both P<0.01]. Depressive symptoms at T2 were higher than at T1 for both elderly men and elderly women ((male: 1.90±6.10 vs 21.52±6.08, female: 23.84±6.54 vs 23.07±6.44); F=5.20, 32.77, both P<0.05). Elderly men scored lower than elderly women on depression symptoms at both T1 and T2 (T1: F=45.74, P<0.001; T2: F=69.96, P<0.001). Pearson correlation analysis showed a negative correlation between social activity and depressive symptoms at both measurement points (T1: r=-0.329, P<0.01; T2: r=-0.343, P<0.01), and a positive correlation across T1 and T2 ( r=0.391, 0.573; both P<0.01), meeting the criteria for simultaneous and sequential correlations, and supporting the basic assumptions of cross-lagged design. Cross-lagged analysis revealed that T1 social activity negatively predicted T2 depressive symptoms (β=-0.128, P<0.001), and T1 depressive symptoms negatively predicted T2 social activity (β=-0.202, P<0.001). Conclusion:There is a bidirectional predictive relationship between social activity and depression symptoms in the elderly. Depression symptoms lead to a decrease in social activity, and a decrease in social activity predicts an exacerbation of depression in the elderly.