Objective:To investigate the correlation between lymphocyte-monocyte ratio (LMR) and long-term prognosis after distal cholangiocarcinoma.Methods:A retrospective case-control study was conducted to analyze the clinical data of 186 patients with distal cholangiocarcinoma who underwent radical pancreaticoduodenectomy at Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2013 to December 2023. Among them, there were 109 males and 77 females, with an age of (65.4±9.4) years, ranging from 29 to 85 years. The data of preoperative peripheral blood routine examination of the patients were collected, and the patients were divided into a high LMR group(LMR>2.98, n=100) and a low LMR group(LMR≤2.98, n=86). The preoperative, intraoperative and postoperative clinical characteristics of the two groups were compared. Measurement data with normal distribution were expressed as mean±standard deviation ( ± s), and t-test was used for inter-group comparison. Measurement data with non-normal distribution were expressed as M( Q1, Q3), and Mann-Whitney U test was used for inter-group comparison. Chi-square test was used for inter-group comparison of count data. The Cox proportional hazards regression model was used for univariate and multivariate prognostic analysis, and the Kaplan-Meier estimation method was used to create survival curves to analyze and evaluate the influencing factors of long-term prognosis after distal cholangiocarcinoma surgery. Results:Univariate analysis results showed that gender, age, BMI, history of diabetes, carcinoembryonic antigen; operation duration, intraoperative blood loss; resection margin status, degree of tumor cell differentiation, and presence of postoperative complications had no statistically significant differences in their impact on the prognosis of patients after distal cholangiocarcinoma surgery( P>0.05). In contrast, LMR, neutrophilto-lymphocyte ratio, platelet-lymphocyte ratio, albumin, total bilirubin, carbohydrate antigen 199, intraoperative blood transfusion, tumor diameter, and lymph node metastasis showed statistically significant differences in their influence on the postoperative prognosis of distal cholangiocarcinoma patients( P<0.05). Multivariate analysis results indicated that LMR≤2.98( HR=1.776, 95% CI: 1.153-2.736), CA19-9>37 U/mL( HR=1.521, 95% CI: 1.025-2.259), and lymph node metastasis( HR=1.601, 95% CI: 1.106-2.318) were independent risk factors affecting patient prognosis( P<0.05). The 1-, 3-, and 5-year cumulative survival rates in the high LMR group were 91%, 40%, and 20% respectively, while those in the low LMR group were 58.1%, 15.1%, and 8.1% respectively, with a statistically significant difference( P<0.05). Conclusion:Preoperative LMR for distal cholangiocarcinoma can suggest a long-term prognosis, and a low LMR value suggests a poor prognosis.

Objectives:To propose a classification method of intervertebral disc annulus fibrosus injury and explore its guiding values for annulus fibrosus repair and reconstruction in lumbar spine.Methods:Based on the degree and location of annulus fibrosus injury observed during endoscopic surgery,injuries were classified into types Ⅰ-Ⅳ.Type Ⅰ,no full-thickness tear in the annulus fibrosus,requiring artificial transverse inci-sion during nucleus pulposus removal surgery;Type Ⅱ,longitudinal tear in the annulus fibrosus without de-fect,and which was further subdivided into ⅡA(≤1cm),Ⅱ B(1-1.5cm),and Ⅱ C(≥ 1.5cm)based on the tear length;Type Ⅲ,central tear in the annulus fibrosus with defect,and which was subdivided into ⅢA(≤1cm)and ⅢB(＞1cm)based on the longest diameter of the defect;Type Ⅳ,tear in the annulus fibrosus near the endplate with defect,which was subdivided into ⅣA(≤1cm)and ⅣB(＞1cm)based on the longest diameter of the defect.A retrospective analysis was conducted on 136 patients with single-segment lumbar intervertebral disc protrusion in our hospital.There were 75 male cases and 61 female cases,with an age of 36.5±10.3 years.According to the classification method,out of the 136 patients,11 cases were classified as type Ⅰ,underwent conventional single-line linear suturing;Type Ⅱ cases were treated with near-endplate bone tunnel method for suturing,with type ⅡA 26 cases using linear suturing,type ⅡB 13 cases using triangular sutur-ing,and type ⅡC 3 cases were abandoned suturing;For type ⅢA,3 cases used triangular suturing and 3 used cross suturing,while 2 type ⅢB cases were abandoned suturing;Type Ⅳ cases also used the near-endplate bone tunnel method for suturing,with 52 type ⅣA cases using triangular suturing,15 using parallel line suturing,4 cases were failed in suturing,and 4 type Ⅳ B cases were abandoned suturing.The visual analogue scale(VAS)was used to assess the pain of the patients,and the Oswestry disability index(ODI)was used to assess the lumbar function of the patients before operation,at postoperative 3 months and final fol-low-up.At final follow-up,MRI was reexamined to observe the healing of the annulus fibrosus and compare the changes from the preoperative intervertebral;The MacNab criteria were used to assess the therapeutic ef-fect.Results:All the patients successfully underwent nucleus pulposus removal and nerve root decompression surgery.There were no intraoperative complications such as nerve root injury,dural sac tear,or pseudospinal hypertension syndrome.The operation time ranged from 36min to 50min,with an average of 44.50(36.25,50.00)min.Overall,according to the classification of annulus fibrosus injury,suturing was performed in 127 cases,with a suturing rate of 93.38％,and among which 123 cases successfully completed suturing,with a success rate of 96.85％.All 136 patients were followed up for 9-24 months,averaged 13.2 months.At final follow-up,there were 6 recurrences,including 1 type ⅡC(not sutured),1 type Ⅲ A(sutured),and 4 type ⅣA(3 sutured,1 suturing failure),with a recurrence rate of 4.412％.The intervertebral space height measured at final follow-up showed no significant change compared to the preoperative height(P＞0.05),while the VAS scores for low back pain and leg pain,and ODI at 3 months postoperatively and at final follow-up were sig-nificantly improved compared to the preoperative levels(P＜0.05).According to the MacNab criteria,there were 108 excellent,14 good,8 fair,and 6 poor in outcomes,with an excellent and good rate of 89.71％.Conclu-sions:The classification of lumbar disc annulus fibrosus injury is simple and clear;Adopting corresponding annulus fibrosus suturing repair surgery that is suitable for such classification can yield a high success rate of suturing and avoid unnecessary suturing,which has certain values in guiding clinical practice.

Objectives:To propose a classification method of intervertebral disc annulus fibrosus injury and explore its guiding values for annulus fibrosus repair and reconstruction in lumbar spine.Methods:Based on the degree and location of annulus fibrosus injury observed during endoscopic surgery,injuries were classified into types Ⅰ-Ⅳ.Type Ⅰ,no full-thickness tear in the annulus fibrosus,requiring artificial transverse inci-sion during nucleus pulposus removal surgery;Type Ⅱ,longitudinal tear in the annulus fibrosus without de-fect,and which was further subdivided into ⅡA(≤1cm),Ⅱ B(1-1.5cm),and Ⅱ C(≥ 1.5cm)based on the tear length;Type Ⅲ,central tear in the annulus fibrosus with defect,and which was subdivided into ⅢA(≤1cm)and ⅢB(＞1cm)based on the longest diameter of the defect;Type Ⅳ,tear in the annulus fibrosus near the endplate with defect,which was subdivided into ⅣA(≤1cm)and ⅣB(＞1cm)based on the longest diameter of the defect.A retrospective analysis was conducted on 136 patients with single-segment lumbar intervertebral disc protrusion in our hospital.There were 75 male cases and 61 female cases,with an age of 36.5±10.3 years.According to the classification method,out of the 136 patients,11 cases were classified as type Ⅰ,underwent conventional single-line linear suturing;Type Ⅱ cases were treated with near-endplate bone tunnel method for suturing,with type ⅡA 26 cases using linear suturing,type ⅡB 13 cases using triangular sutur-ing,and type ⅡC 3 cases were abandoned suturing;For type ⅢA,3 cases used triangular suturing and 3 used cross suturing,while 2 type ⅢB cases were abandoned suturing;Type Ⅳ cases also used the near-endplate bone tunnel method for suturing,with 52 type ⅣA cases using triangular suturing,15 using parallel line suturing,4 cases were failed in suturing,and 4 type Ⅳ B cases were abandoned suturing.The visual analogue scale(VAS)was used to assess the pain of the patients,and the Oswestry disability index(ODI)was used to assess the lumbar function of the patients before operation,at postoperative 3 months and final fol-low-up.At final follow-up,MRI was reexamined to observe the healing of the annulus fibrosus and compare the changes from the preoperative intervertebral;The MacNab criteria were used to assess the therapeutic ef-fect.Results:All the patients successfully underwent nucleus pulposus removal and nerve root decompression surgery.There were no intraoperative complications such as nerve root injury,dural sac tear,or pseudospinal hypertension syndrome.The operation time ranged from 36min to 50min,with an average of 44.50(36.25,50.00)min.Overall,according to the classification of annulus fibrosus injury,suturing was performed in 127 cases,with a suturing rate of 93.38％,and among which 123 cases successfully completed suturing,with a success rate of 96.85％.All 136 patients were followed up for 9-24 months,averaged 13.2 months.At final follow-up,there were 6 recurrences,including 1 type ⅡC(not sutured),1 type Ⅲ A(sutured),and 4 type ⅣA(3 sutured,1 suturing failure),with a recurrence rate of 4.412％.The intervertebral space height measured at final follow-up showed no significant change compared to the preoperative height(P＞0.05),while the VAS scores for low back pain and leg pain,and ODI at 3 months postoperatively and at final follow-up were sig-nificantly improved compared to the preoperative levels(P＜0.05).According to the MacNab criteria,there were 108 excellent,14 good,8 fair,and 6 poor in outcomes,with an excellent and good rate of 89.71％.Conclu-sions:The classification of lumbar disc annulus fibrosus injury is simple and clear;Adopting corresponding annulus fibrosus suturing repair surgery that is suitable for such classification can yield a high success rate of suturing and avoid unnecessary suturing,which has certain values in guiding clinical practice.

The prevalence of diabetes mellitus in China has recently been increasing year by year,and spontaneous skin ulcers in diabetic patients,as one of the most serious complications,often develop on the patient's extremities represented by foot ulcers.Due to the complexity and variety of its pathogenesis,it leads to poor clinical outcomes and difficulty in healing.Thus,pa-tients often face the risk of amputation and death.Therefore,the exploration of mechanisms of the vascular pathogenesis of diabetic delayed-healing wounds and targeted screening of therapeutic agents has become a current research hotspot.Herein,in this paper,we briefly review the role of impaired angiogenesis and vascular dysfunction in diabetic skin ulcers,and the research progress of classical hypoglycemic and natural compounds against vascular lesions is preliminarily summarized to provide a theoretical basis for effective clinical treatment.