[Purpose]To analyze the trends of incidence and age at onset of bone malignant tumors in cancer registration areas of Jiangsu Province from 2009 to 2019.[Methods]Incidence data of bone malignant tumors from 2009 to 2019 were collected from 16 consecutive and quality-con-trolled cancer registries in Jiangsu Province.The incidence rates,average age at onset,and inci-dence composition of bone malignant tumors were calculated.A birth cohort model was constructed to analyze the changes in the incidence of bone malignant tumors in the population born from 1929 to 2019.Joinpoint regression models were used to analyze the average annual percentage change(AAPC)in the incidence rates and the incidence composition of bone malignant tumors for each year in those aged 60 years old and above.A general linear regression model was used to ana-lyze the trend of the average age of onset.[Results]The crude incidence rate of bone malignant tumors in women in Jiangsu cancer registration areas decreased from 2009 to 2019,with an AAPC of-2.62％(P=0.025).After adjusting the population composition,except for urban areas,the incidence of bone malignant tumors in the whole province,men,women and rural areas all decreased significantly,with AAPC of-3.15％,-2.49％,-4.31％and-2.23％,respectively.The average age at onset of bone malignant tumors in the whole province,men and urban areas de-creased significantly yearly,with an average annual decrease of 0.365,0.504 and 0.469 years old,respectively.In the same period,the incidence of malignant bone tumors in the whole province,men,women and urban areas of age groups of 50～59,60～69 and 70～79 years old showed a decreasing trend,the AAPC ranged from-9.06％to-4.14％(all P＜0.05),and the inci-dence decreased gradually with the year of birth.The incidence of malignant bone tumors in men＜30 years old increased yearly with an AAPC of 4.30％(P＜0.05).Compared with 2009,the com-position of incidence in men aged 15～39 years old and in urban population increased in 2019,while the incidence of bone malignant tumors in the age group of 60～79 years old in the province generally decreased.After age structure adjustment,the incidence of bone malignant tumors in people over 60 years old in urban areas decreased with an AAPC of-1.42％(P＜0.05).[Conclu-sion]The incidence of bone malignant tumors in Jiangsu Province is decreasing and the age at on-set is moving forward,indicating that the prevention and control measures of bone malignant tu-mors should be adjusted accordingly.

Objective To assess the effectiveness of the Regulations on Medical Dispute Prevention and Resolution(hereafter referred to as the Regulations)and to provide evidence-based recommendations for enhancing the legal governance sys-tem of medical dispute management.Methods A cross-sectional study was conducted involving physicians,nurses,techni-cians,clinical department directors,and head nurses.The investigation was conducted through literature review,questionnaire surveys,and expert interviews.Factor analysis and chi-square tests were employed for statistical analysis.Results Significant differences(P＜0.01)were observed among healthcare practitioners in Guangxi concerning their understanding of the Regula-tions,preferences for dispute resolution methods,implementation of informed consent,and risk intervention practices.However,no significant differences emerged in medical quality and safety evaluations or recommendations for surgical accident insurance.Conclusion This study suggests it is a need to refine the legal framework for medical dispute prevention and resolution.It is rec-ommended to strengthen medical personnel's compliance with informed consent obligations and deepen their understanding of rel-evant laws and regulations.Efforts should be intensified to promote third-party mediation mechanisms such as the Medical Dispute Mediation Committee(MedMC)and medical accident insurance coverage.Additionally,pre-dispute risk assessments should be enhanced,and a risk early intervention model integrating artificial intelligence,healthcare practices,and legal regulations should be established.

Objective:To explore the application value of the "Dual-Wing" traction technique in the medial & head lateral laparoscopic left hemicolectomy with radical resection.Methods:The "Dual-Wing " traction technique is based on the theory of mesenteric anatomy. The assistant lifts the proper mesentery of the digestive tract to be resected or the adjacent mesenteric tissue connected to it,thereby elevating the target organ and its mesentery as a whole away from the mesenteric bed. By utilizing the tension transmission between the proper mesenteries of adjacent organs to create counter-tension,the surgeon's operative actions are always maintained along the line of maximum counter-tension.After incising the mesenteric fusion line,this technique assists the surgeon in entering the fusion plane. A descriptive case series study method was adopted to retrospectively analyze the clinical and pathological data of 37 colorectal cancer patients who underwent laparoscopic left hemicolectomy with the "Dual-Wing" traction technique via a medial and cephalad approach, performed by the Department of Gastrointestinal Surgery at Dongjie Campus of the First Hospital of Quanzhou, Fujian Medical University, from May 2023 to November 2023.Results:All patients successfully underwent laparoscopic left hemicolectomy via the medial & head lateral approach using the "Dual-Wing" traction technique.The surgery adhered to the principles of total mesocolic excision and safely mobilized the left colon and its mesentery from the correct anatomical plane. In the entire group of patients,there were 14 males and 23 females; the mean operative time was 94.1±18.3 minutes; the mean intraoperative blood loss was 9.8±5.4 ml; the mean number of lymph nodes dissected was 18.1±3.9; the mean number of positive lymph nodes was 1.4±1.6; the pathological specimen resection margin grading was Grade A in 29 cases, Grade B in 8 cases, and no Grade C cases; the tumor TNM staging was Stage I in 3 cases, Stage IIA in 7 cases, Stage IIB in 6 cases, Stage IIIA in 2 cases, Stage IIIB in 15 cases, and Stage IIIC in 4 cases; the mean time to first flatus postoperatively was 35.7±7.5 hours; the mean length of hospital stay was 9.1±1.7 days. There were no intraoperative injuries to the pancreas or spleen. Postoperative complications occurred in 3 cases. No anastomotic leakage was observed in the entire group, and there were no deaths following the surgery.Conclusion:The application of the "Dual-Wing" traction technique to establish a stable surgical scenario can significantly reduce the demands on the assistant. It is conducive to maintaining mesenteric tension and fully exposing the surgical field. It also allows for the rapid identification and maintenance of the correct anatomical plane. For colorectal cancer patients, the surgery is safe and feasible, with satisfactory short-term therapeutic effects.

Objective:To compare bowel function 12 months after surgery between side-to-end anastomosis (SEA) and end-to-end anastomosis (EEA) groups of patients who had undergone rectal cancer resection.Methods:This single-center, prospective, open-label, phase III randomized controlled trial was approved by the Ethics Committee of Peking University People's Hospital (2018PHB040-01) and registered at ClinicalTrials. org (NCT03669237). Inclusion criteria were as follows: (1) histologically confirmed rectal adenocarcinoma; (2) tumor located 0 to 12 cm from the anal verge; (3) age≥18 years; and (4) planned R0 resection with primary reconstruction. Exclusion criteria included: (1) emergency surgery; (2) cognitive impairment; (3) non-primary anastomosis; (4) history of left-sided colonic or anorectal surgery; and (5) preexisting chronic defecation dysfunction. Eligible rectal cancer patients scheduled for elective sphincter-preserving surgery at Peking University People's Hospital were prospectively enrolled between October 2018 and March 2021 and randomly assigned to either the EEA group or the SEA group via computer-generated numbers prior to entering the operating room. All patients underwent standard radical tumor resection. Bowel function was evaluated by the low anterior resection syndrome (LARS) questionnaire. It consists of five single-choice questions and yields a total score ranging from 0 to 42. Defecation function is categorized into three levels: no LARS (0-20 points), minor LARS (21-29 points), and major LARS (30-42 points). The primary endpoint was the LARS score 12 months after surgery. Secondary endpoints included LARS scores from 1 to 11 months and during long-term follow-up(>12 months). The final follow-up was completed in July 2022. All randomized patients were included in the intention-to-treat set (ITTS). The full analysis set (FAS) was defined as ITTS patients with valid outcome data. All primary statistical analyses were performed in the FAS, and results were further compared in the per-protocol set (PPS) based on the actual treatment received.Results:A total of 323 patients underwent eligibility assessment, of whom 71 did not meet the inclusion criteria and 52 declined to participate. Ultimately, 200 patients were randomized. Median age was 64 years and 85 were women. The SEA and EEA groups comprised 102 and 98 patients, respectively. A total of 181 patients (90.5%) were included in the FAS, and 170 (85.0%) were included in the PPS. Among these, the 12-month LARS score was evaluated in 178 patients (98.3%) in the FAS and in 167 (98.2%) in the PPS. Median LARS score at 1–12 months were significantly lower in the SEA group in both the FAS dataset [12 months:8 (interquartile range [IQR], 0–22) vs. 14 (IQR, 8–29); Z=2.687, P=0.007] and the PPS dataset [12 months: 8 (IQR, 0–22) vs. 14 (IQR, 6–29); Z=2.543, P=0.011]. During long-term follow-up, the median LARS score was also significantly lower in the SEA group in the FAS dataset [2 (IQR, 0–4) vs. 11 (IQR, 2–23); Z=2.968, P=0.003] and the PPS dataset [2 (IQR, 0–14) vs. 11 (2, 27); Z=2.687, P=0.007]. Conclusion:Compared with the EEA group, bowel function was superior in the SEA group 1 year after surgery and during long-term follow-up.

[Purpose]To analyze the trends of incidence and age at onset of bone malignant tumors in cancer registration areas of Jiangsu Province from 2009 to 2019.[Methods]Incidence data of bone malignant tumors from 2009 to 2019 were collected from 16 consecutive and quality-con-trolled cancer registries in Jiangsu Province.The incidence rates,average age at onset,and inci-dence composition of bone malignant tumors were calculated.A birth cohort model was constructed to analyze the changes in the incidence of bone malignant tumors in the population born from 1929 to 2019.Joinpoint regression models were used to analyze the average annual percentage change(AAPC)in the incidence rates and the incidence composition of bone malignant tumors for each year in those aged 60 years old and above.A general linear regression model was used to ana-lyze the trend of the average age of onset.[Results]The crude incidence rate of bone malignant tumors in women in Jiangsu cancer registration areas decreased from 2009 to 2019,with an AAPC of-2.62％(P=0.025).After adjusting the population composition,except for urban areas,the incidence of bone malignant tumors in the whole province,men,women and rural areas all decreased significantly,with AAPC of-3.15％,-2.49％,-4.31％and-2.23％,respectively.The average age at onset of bone malignant tumors in the whole province,men and urban areas de-creased significantly yearly,with an average annual decrease of 0.365,0.504 and 0.469 years old,respectively.In the same period,the incidence of malignant bone tumors in the whole province,men,women and urban areas of age groups of 50～59,60～69 and 70～79 years old showed a decreasing trend,the AAPC ranged from-9.06％to-4.14％(all P＜0.05),and the inci-dence decreased gradually with the year of birth.The incidence of malignant bone tumors in men＜30 years old increased yearly with an AAPC of 4.30％(P＜0.05).Compared with 2009,the com-position of incidence in men aged 15～39 years old and in urban population increased in 2019,while the incidence of bone malignant tumors in the age group of 60～79 years old in the province generally decreased.After age structure adjustment,the incidence of bone malignant tumors in people over 60 years old in urban areas decreased with an AAPC of-1.42％(P＜0.05).[Conclu-sion]The incidence of bone malignant tumors in Jiangsu Province is decreasing and the age at on-set is moving forward,indicating that the prevention and control measures of bone malignant tu-mors should be adjusted accordingly.

Objective:To explore the application value of the "Dual-Wing" traction technique in the medial & head lateral laparoscopic left hemicolectomy with radical resection.Methods:The "Dual-Wing " traction technique is based on the theory of mesenteric anatomy. The assistant lifts the proper mesentery of the digestive tract to be resected or the adjacent mesenteric tissue connected to it,thereby elevating the target organ and its mesentery as a whole away from the mesenteric bed. By utilizing the tension transmission between the proper mesenteries of adjacent organs to create counter-tension,the surgeon's operative actions are always maintained along the line of maximum counter-tension.After incising the mesenteric fusion line,this technique assists the surgeon in entering the fusion plane. A descriptive case series study method was adopted to retrospectively analyze the clinical and pathological data of 37 colorectal cancer patients who underwent laparoscopic left hemicolectomy with the "Dual-Wing" traction technique via a medial and cephalad approach, performed by the Department of Gastrointestinal Surgery at Dongjie Campus of the First Hospital of Quanzhou, Fujian Medical University, from May 2023 to November 2023.Results:All patients successfully underwent laparoscopic left hemicolectomy via the medial & head lateral approach using the "Dual-Wing" traction technique.The surgery adhered to the principles of total mesocolic excision and safely mobilized the left colon and its mesentery from the correct anatomical plane. In the entire group of patients,there were 14 males and 23 females; the mean operative time was 94.1±18.3 minutes; the mean intraoperative blood loss was 9.8±5.4 ml; the mean number of lymph nodes dissected was 18.1±3.9; the mean number of positive lymph nodes was 1.4±1.6; the pathological specimen resection margin grading was Grade A in 29 cases, Grade B in 8 cases, and no Grade C cases; the tumor TNM staging was Stage I in 3 cases, Stage IIA in 7 cases, Stage IIB in 6 cases, Stage IIIA in 2 cases, Stage IIIB in 15 cases, and Stage IIIC in 4 cases; the mean time to first flatus postoperatively was 35.7±7.5 hours; the mean length of hospital stay was 9.1±1.7 days. There were no intraoperative injuries to the pancreas or spleen. Postoperative complications occurred in 3 cases. No anastomotic leakage was observed in the entire group, and there were no deaths following the surgery.Conclusion:The application of the "Dual-Wing" traction technique to establish a stable surgical scenario can significantly reduce the demands on the assistant. It is conducive to maintaining mesenteric tension and fully exposing the surgical field. It also allows for the rapid identification and maintenance of the correct anatomical plane. For colorectal cancer patients, the surgery is safe and feasible, with satisfactory short-term therapeutic effects.

Objective:To compare bowel function 12 months after surgery between side-to-end anastomosis (SEA) and end-to-end anastomosis (EEA) groups of patients who had undergone rectal cancer resection.Methods:This single-center, prospective, open-label, phase III randomized controlled trial was approved by the Ethics Committee of Peking University People's Hospital (2018PHB040-01) and registered at ClinicalTrials. org (NCT03669237). Inclusion criteria were as follows: (1) histologically confirmed rectal adenocarcinoma; (2) tumor located 0 to 12 cm from the anal verge; (3) age≥18 years; and (4) planned R0 resection with primary reconstruction. Exclusion criteria included: (1) emergency surgery; (2) cognitive impairment; (3) non-primary anastomosis; (4) history of left-sided colonic or anorectal surgery; and (5) preexisting chronic defecation dysfunction. Eligible rectal cancer patients scheduled for elective sphincter-preserving surgery at Peking University People's Hospital were prospectively enrolled between October 2018 and March 2021 and randomly assigned to either the EEA group or the SEA group via computer-generated numbers prior to entering the operating room. All patients underwent standard radical tumor resection. Bowel function was evaluated by the low anterior resection syndrome (LARS) questionnaire. It consists of five single-choice questions and yields a total score ranging from 0 to 42. Defecation function is categorized into three levels: no LARS (0-20 points), minor LARS (21-29 points), and major LARS (30-42 points). The primary endpoint was the LARS score 12 months after surgery. Secondary endpoints included LARS scores from 1 to 11 months and during long-term follow-up(>12 months). The final follow-up was completed in July 2022. All randomized patients were included in the intention-to-treat set (ITTS). The full analysis set (FAS) was defined as ITTS patients with valid outcome data. All primary statistical analyses were performed in the FAS, and results were further compared in the per-protocol set (PPS) based on the actual treatment received.Results:A total of 323 patients underwent eligibility assessment, of whom 71 did not meet the inclusion criteria and 52 declined to participate. Ultimately, 200 patients were randomized. Median age was 64 years and 85 were women. The SEA and EEA groups comprised 102 and 98 patients, respectively. A total of 181 patients (90.5%) were included in the FAS, and 170 (85.0%) were included in the PPS. Among these, the 12-month LARS score was evaluated in 178 patients (98.3%) in the FAS and in 167 (98.2%) in the PPS. Median LARS score at 1–12 months were significantly lower in the SEA group in both the FAS dataset [12 months:8 (interquartile range [IQR], 0–22) vs. 14 (IQR, 8–29); Z=2.687, P=0.007] and the PPS dataset [12 months: 8 (IQR, 0–22) vs. 14 (IQR, 6–29); Z=2.543, P=0.011]. During long-term follow-up, the median LARS score was also significantly lower in the SEA group in the FAS dataset [2 (IQR, 0–4) vs. 11 (IQR, 2–23); Z=2.968, P=0.003] and the PPS dataset [2 (IQR, 0–14) vs. 11 (2, 27); Z=2.687, P=0.007]. Conclusion:Compared with the EEA group, bowel function was superior in the SEA group 1 year after surgery and during long-term follow-up.

Objective To assess the effectiveness of the Regulations on Medical Dispute Prevention and Resolution(hereafter referred to as the Regulations)and to provide evidence-based recommendations for enhancing the legal governance sys-tem of medical dispute management.Methods A cross-sectional study was conducted involving physicians,nurses,techni-cians,clinical department directors,and head nurses.The investigation was conducted through literature review,questionnaire surveys,and expert interviews.Factor analysis and chi-square tests were employed for statistical analysis.Results Significant differences(P＜0.01)were observed among healthcare practitioners in Guangxi concerning their understanding of the Regula-tions,preferences for dispute resolution methods,implementation of informed consent,and risk intervention practices.However,no significant differences emerged in medical quality and safety evaluations or recommendations for surgical accident insurance.Conclusion This study suggests it is a need to refine the legal framework for medical dispute prevention and resolution.It is rec-ommended to strengthen medical personnel's compliance with informed consent obligations and deepen their understanding of rel-evant laws and regulations.Efforts should be intensified to promote third-party mediation mechanisms such as the Medical Dispute Mediation Committee(MedMC)and medical accident insurance coverage.Additionally,pre-dispute risk assessments should be enhanced,and a risk early intervention model integrating artificial intelligence,healthcare practices,and legal regulations should be established.

OBJECTIVE To construct a clinical model of motion sickness(MS),provide a relatively objective diagnostic model for MS research,and provide a basis for further clinical intervention of the disease.METHODS A total of 60 subjects were included and divided into experimental group and control group according to the presence or absence of MS.The MS clinical model was established using SRM-IV rotating chair.Peripheral blood was collected before and after acceleration exposure,and the contents of adrenocorticotropic hormone(ACTH),growth hormone(GH),prolactin(PRL),follicle stimulating hormone(FSH),luteinizing hormone(LH),thyroid stimulating hormone(TRH)and gastrin-17(G-17),acetylcholine(ACH)and 5-hydroxytryptamine(5-HT)were detected,Graybiel scale was used to evaluate the severity of MS.The correlation between MS symptoms and signs and peripheral blood indexes was analyzed by multiple linear regression,and the diagnostic model was established.construct a clinical model of MS and a diagnostic model based on blood parameters,so as to provide a reliable clinical model and an objective diagnostic model for MS research,and to provide a basis for further clinical intervention of the disease.RESULTS After acceleration exposure,the Graybiel scores,ACH,5-HT,ACTH,GH and PRL levels in peripheral blood of the experimental group were higher than those before exposure,and were significantly different from those of the control group(P<0.001).There was no significant difference in FSH,LH,TRH and G-17 between the two groups before and after acceleration exposure(P>0.05).Multi-index combined diagnostic model:Graybiel scores=-9.32+0.131×ACTH+0.055×ACH+0.041×5-HT.CONCLUSION The levels of ACH,5-HT,ACTH,GH and PRL increased during the onset of MS.The multi-index combined diagnosis model can provide a certain basis for the objective diagnosis of MS in clinical practice.

OBJECTIVE To identify key factors involved in the regulation of hypoxia-induced inflammation-related signaling pathways using a combination of bioinformatics methods and experiments. METHODS A cellular model of hypoxia-induced hippocampal neuronal damage was prepared by treating mouse hippocampal neuronal HT22 cells with CoCl2. The cells were then collected for transcriptome sequencing. Based on the sequencing results,key molecules were identified using differential analysis,gene ontology(GO) function and Kyoto Encyclopedia of Genomes(KEGG) pathway analysis,and protein-protein interaction network(PPI) analysis. The effects of key molecules on cells were investigated. RESULTS Differential analysis revealed a total of 8975 differential genes,which were subjected to GO and KEGG analysis. KEGG analysis revealed that these genes were involved in signaling pathways such as pancreatic cancer,EGFR tyrosine kinase inhibitor resistance,animal mitosis,base excision repair,and chronic myeloid leukemia. PPI networks were constructed for genes enriched in these pathways,and the MCC algorithm screened the top 5 key genes,which were shown to be HRAS,KRAS,PTEN,VEGFA,and SRC. HRAS and VEGFA were selected for subsequent experiments,and the results showed that after CoCl2 treatment,the viability of HT22 cells was significantly decreased(P<0.05),HRAS was significantly down-regulated and VEGFA was significantly up-regulated in CoCl2-treated cells(P<0.05),the levels of TNF-α,IL-1β,and IL-6 were significantly increased(P<0.001). However,treatment with overexpression of HRAS or low expression of VEGFA led to an increase in the activity of cell growth(P<0.05) as well as a significant decrease in TNF-α,IL-1β,and IL-6 levels(P<0.001). CONCLUSION In sleep apnea,HRAS or VEGFA may lead to cognitive impairment by affecting inflammatory factors.