The incidence rate of adult diaphragmatic hernia is low, which can be divided into congenital diaphragmatic hernia and acquired diaphragmatic hernia. In emergency situations, it may present as incarceration or strangulation. In non-emergency situations, it may be asymptomatic or present with nonspecific respiratory and digestive symptoms, making it prone to misdiagnosis and missed diagnosis. For suspected cases, multi-slice spiral CT examination should be performed, with attention paid to sagittal imaging. In emergency situations, CT contrast-enhanced scanning should be focusing on assessing the viability of the hernia contents. Once diagnosed, surgical treatment should be performed, with transabdominal approach being the preferred choice. In emergency situations, laparoscopic exploration and repair can be considered for patients with stable hemodynamics. For delayed traumatic diaphragmatic hernia and adult congenital diaphragmatic hernia with large defects, the necessity of a thoracic approach should be considered. During surgery, the complete removal of the hernia sac should not be pursued. The decision to remove or partially remove the hernia sac should be evaluated based on intraoperative conditions. Intraoperative diaphragmatic defects should be closed as much as possible with non-absorbable sutures. For diaphragmatic defects that are tensioned after suturing, or those close to the costal margin, anti-adhesion mesh should be used by intraperitoneal repair approach. When fixing the patch near the pericardium, the use of tacks should be avoided.

The incidence rate of adult diaphragmatic hernia is low, which can be divided into congenital diaphragmatic hernia and acquired diaphragmatic hernia. In emergency situations, it may present as incarceration or strangulation. In non-emergency situations, it may be asymptomatic or present with nonspecific respiratory and digestive symptoms, making it prone to misdiagnosis and missed diagnosis. For suspected cases, multi-slice spiral CT examination should be performed, with attention paid to sagittal imaging. In emergency situations, CT contrast-enhanced scanning should be focusing on assessing the viability of the hernia contents. Once diagnosed, surgical treatment should be performed, with transabdominal approach being the preferred choice. In emergency situations, laparoscopic exploration and repair can be considered for patients with stable hemodynamics. For delayed traumatic diaphragmatic hernia and adult congenital diaphragmatic hernia with large defects, the necessity of a thoracic approach should be considered. During surgery, the complete removal of the hernia sac should not be pursued. The decision to remove or partially remove the hernia sac should be evaluated based on intraoperative conditions. Intraoperative diaphragmatic defects should be closed as much as possible with non-absorbable sutures. For diaphragmatic defects that are tensioned after suturing, or those close to the costal margin, anti-adhesion mesh should be used by intraperitoneal repair approach. When fixing the patch near the pericardium, the use of tacks should be avoided.

Rectus abdominis diastasis(RAD)is a phenomenon in which the rectus abdominis muscles on both sides of the white line of the abdomen separate from each other,causing a series of physiological dysfunction.It is commonly seen in pregnant women and obese individuals.Currently,RAD has gradually attracted the attention of relevant surgeons.There is relatively little research on RAD both domestically and internationally,and there is no unified standard for diagnosis and treatment.This article will summarize the research progress on the diagnosis and treatment methods of rectus abdominis separation by combining domestic and foreign literature.

Perineal hernia can be divided into congenital and acquired types based on its etiology. Acquired perineal hernia can be further divided into primary and secondary perineal hernias. Among them congenital and primary perineal hernias are very rare. Secondary perineal hernia is most common in perineal hernia after Miles′ operation, and closure of the pelvic peritoneum during Miles′ operation can effectively reduce the occurrence of secondary perineal hernia. Surgical repair is the only treatment for postoperative perineal hernia, but there is a lack of relevant consensus and guidelines. Based on comprehensive literature review and unit′s experience, the authors recommend to use synthetic mesh repair through the abdominal approach. Laparoscopy can be used first, and if necessary, open surgery can be performed in a timely manner. For complex and difficult cases, the combined approach of abdominal and perineal area can be considered, and even synthetic mesh combined with myofascial flap repair can be used. In mesh repair, surgeons should pay attention to the fixed position and shaping of the mesh to achieve sufficient fixation and reduce recurrence.

Objective:To develop a logistic regression model to predict the prognosis of patients with hepatocellular carcinoma (HCC) based the oxidative stress-related genes.Methods:The HCC dataset was download from the cancer genome atlas (TCGA) database, and the oxidative stress-related genes were extracted from geneontology unifying biology database. Through the difference analysis and univariate Cox regression analysis of normal liver tissue and HCC tissue, the oxidative stress genes associated with HCC-related death were screened out. The least absolute shrinkage and selection opetator (LASSO) regression analysis were used to select prognostic oxidative stress genes, and the genes screened by LASSO regression were incorporated into the logistic regression model to construct the prognosis prediction model. The receiver operating characteristic (ROC) curve were used to assess the performance accuracy of the predictive model. The international cancer genome consortium (ICGC) database was used for external validation of the model.Results:A total of 147 oxidative stress-related genes were differentially expressed between HCC tissues and adjacent non-cancerous tissues (all P<0.05). Forty-three prognostic genes were identified by univariate Cox regression analysis and included in LASSO regression, and subsequently 11 features with nonzero coefficient were obtained. The 11 oxidative stress-related genes were incorporated into the logistic regression model. The findings revealed that HCC patients exhibiting positive expression of SRXN1, G6PD, MAPK7, STK25, GLRX2, ANKZF1, STC2, APEX1, PRKCD, MT3 and EZH2 genes had a significantly increased risk of postoperative death (all P<0.05). The logistic regression model was constructed as follows: 0.100 575×SRXN1+ 0.002 908×ANKZF1+ 0.010 061×MAPK7+ 0.022 816×STK25+ 0.018 489×GLRX2+ 0.004 291×G6PD+ 0.004 790×STC2+ 0.000 135×APEX1+ 0.007 531×PRKCD+ 0.025 770×MT3+ 0.079 615×EZH2. The logistic regression model demonstrated good predictive efficacy for the 1-, 2-, and 3-year survival of HCC patients after surgery, the values in area under the curve of ROC is 0.798, 0.752, and 0.720, respectively. According to the TCGA cohort, a median risk score model of 4.80 was established, which facilitated the division of ICGC patients into two distinct groups: the high-risk ( n=121) and low-risk ( n=122). The Kaplan-Meier survival curves demonstrated a significantly lower cumulative survival rate in the high-risk group ( P=0.003). Conclusion:The constructed logistic regression model of oxidative stress-related genes can be utilized to predict the outcome of HCC patients, thereby facilitating personalized treatment strategies and serving as a valuable reference for clinical decision-making.

Objective:To develop a logistic regression model to predict the prognosis of patients with hepatocellular carcinoma (HCC) based the oxidative stress-related genes.Methods:The HCC dataset was download from the cancer genome atlas (TCGA) database, and the oxidative stress-related genes were extracted from geneontology unifying biology database. Through the difference analysis and univariate Cox regression analysis of normal liver tissue and HCC tissue, the oxidative stress genes associated with HCC-related death were screened out. The least absolute shrinkage and selection opetator (LASSO) regression analysis were used to select prognostic oxidative stress genes, and the genes screened by LASSO regression were incorporated into the logistic regression model to construct the prognosis prediction model. The receiver operating characteristic (ROC) curve were used to assess the performance accuracy of the predictive model. The international cancer genome consortium (ICGC) database was used for external validation of the model.Results:A total of 147 oxidative stress-related genes were differentially expressed between HCC tissues and adjacent non-cancerous tissues (all P<0.05). Forty-three prognostic genes were identified by univariate Cox regression analysis and included in LASSO regression, and subsequently 11 features with nonzero coefficient were obtained. The 11 oxidative stress-related genes were incorporated into the logistic regression model. The findings revealed that HCC patients exhibiting positive expression of SRXN1, G6PD, MAPK7, STK25, GLRX2, ANKZF1, STC2, APEX1, PRKCD, MT3 and EZH2 genes had a significantly increased risk of postoperative death (all P<0.05). The logistic regression model was constructed as follows: 0.100 575×SRXN1+ 0.002 908×ANKZF1+ 0.010 061×MAPK7+ 0.022 816×STK25+ 0.018 489×GLRX2+ 0.004 291×G6PD+ 0.004 790×STC2+ 0.000 135×APEX1+ 0.007 531×PRKCD+ 0.025 770×MT3+ 0.079 615×EZH2. The logistic regression model demonstrated good predictive efficacy for the 1-, 2-, and 3-year survival of HCC patients after surgery, the values in area under the curve of ROC is 0.798, 0.752, and 0.720, respectively. According to the TCGA cohort, a median risk score model of 4.80 was established, which facilitated the division of ICGC patients into two distinct groups: the high-risk ( n=121) and low-risk ( n=122). The Kaplan-Meier survival curves demonstrated a significantly lower cumulative survival rate in the high-risk group ( P=0.003). Conclusion:The constructed logistic regression model of oxidative stress-related genes can be utilized to predict the outcome of HCC patients, thereby facilitating personalized treatment strategies and serving as a valuable reference for clinical decision-making.

The etiology of diaphragmatic hernia in adults is mainly congenital and traumatic, its overall incidence in adults is low, and adult diaphragmatic hernia is easily misdiagnosed and missed diagnosis because of lacking specificity in clinical presentation. There is no clinical guidelines or consensus for the diagnosis and treatment of diaphragmatic hernia in adults. The authors inquire into the diagnosis and treatment of diaphragmatic hernia in adults by summarizing relevant litera-tures and combining with clinical practice, and recommend that multi-slice spiral computed tomo-graphy should be promptly refined for suspected cases, especially focusing on sagittal images. The symptomatic patients should be repaired promptly, with a preference for laparoscopic surgery, and mesh augmentation is recommended in those with larger defects.

Objective To explore the application value of the extra-glissonian pedicle transection approach guided by arantius' ligament in laparoscopic left hemihepatectomy.Methods The retrospective cohort study was conducted.The clinical data of 57 patients who underwent laparoscopic left hemihepatectomy in the First Affiliated Hospital of Fujian Medical University from January 2015 to January 2018 were collected.There were 18 males and 39 females,aged from 29 to 75 years,with an average age of 57 years.Of the 57 patients,22 undergoing the laparoscopic left hemihepatectomy with extra-glissonian pedicle transection approach guided by arantius' ligament and 35 undergoing laparoscopic left hemihepatectomy with regular intra-glissonian pedicle transection approach were allocated into the extra-glissonian transection group and intra-glissonian transection group,respectively.Observation indicators:(1) intraoperative situations and postoperative short-term outcomes;(2) postoperative complications;(3) follow-up.Patients were followed up by outpatient examination and telephone interview to investigate postoperative recurrence of diseases up to June 2018.Measurement data with normal distribution were represented as Mean±SD and comparison between groups was analyzed using the t test.Count data were described as absolute number or percentage and comparison between groups was analyzed using the chi-square test.Results (1) Intraoperative situations and postoperative short-term outcomes:the operation time,dissection time of left hepatic pedicle,volume of intraoperative blood loss were (123± 37) minutes,(14± 5) minutes,(337± 169) mL in the extra-glissonian transection group and (148± 27) minutes,(22± 3) minutes,(495±203) mL in the intra-glissonian transection group,respectively,showing statistically significant differences between the two groups (t =2.992,7.733,3.045,P＜0.05).Cases with intraoperative blood transfusion,time of gastrointestinal recovery,time for postoperative drainage-tube removal,duration of postoperative hospital stay were 1,(1.8±0.9)days,(3.2±0.9)days,(8.2± 1.7)days in the extra-glissonian transection group and 4,(2.0± 0.8)days,(3.6±0.8)days,(10.0±4.0)days in the intra-glissonian transection group,respectively,showing no statistically significant difference between the two groups (x2 =0.171,t=1.304,1.857,1.622,P＞0.05).There was no uncontrolled hemorrhage or air embolism in the two groups.(2) Postoperative complications:3 patients had complications of Clavien-Dindo classification Ⅰ in the extra-glissonian transection group including 1 of pulmonary infection,1 of abdominal infection,1 of incisional infection and 7 had complications in the intraglissonian transection group including 2 of pulmonary infection,2 of liver sectional effusion,1 of subphrenic abscess,1 of biliary leakage,1 of incisional infection,showing no statistically significant difference between the two groups (x2=0.066,P＞0.05).Patients with postoperative complications were cured and discharged after symptomatic treatment.There was no perioperative death in the two groups.(3) Follow-up:57 patients were followed up for 5-41 months,with a median time of 23 months.Two and 1 patients had tumor recurrence and hepatolithiasis recurrence in the intra-glissonian transection group,without recurrence of hepatic hemangioma or cholangiocarcinoma.Five patients had tumor recurrence in the intra-glissonian transection group,without recurrence of hepatic hemangioma,hepatolithiasis or cholangiocarcinoma.The disease recurrence rate was 13.6％ (3/22) and 14.3％(5/35) in the extra-glissonian transection group and intra-glissonian transection group,respectively,showing no statistically significant difference between the two groups (x2 =0.104,P＞0.05).Conclusions Extraglissonian pedicle transection approach guided by arantius' ligament in laparoscopic left hemihepatectomy is feasible and effective,which can control hepatic blood inflow of left liver,simplify the surgery procedure and shorten dissection time of left pedicle,in order to save operation time and reduce volume of intraoperative blood loss.

Objective: To analyze relevant preoperative risk factors for microvascular invasion (MVI) in patients with small hepatocellular carcinoma and establish a prediction model. Methods: A retrospective analysis of 157 cases of singlehepatocellular carcinoma with tumor diameter ≤5 cm undergoing hepatectomy at the First Affiliated Hospital of Fujian Medical University from Dec 2012 to Mar 2019 was conducted. There were 59 cases with MVI and 98 cases without MVI.According to different time periods, the enrolled cases were divided into modeling group (n=137) and validation group (n=20). The independent risk factors of small hepatocellular carcinoma with MVI were discussed and a prediction model was established by using preoperative specific imaging characteristics and clinical data. Results: Multivariate Logistic regression analysis showed that AFP, imaging tumor maximum diameter and tumor margin status were independent risk factors for small hepatocellular carcinoma complicated by microvascular invasion. Preoperative prediction model was established according to the above factors : P=1/1+ [e^(2.751-1.090X1-1.778X2-1.147X3)]. (X1-X3 represent the assignment of AFP, maximum tumor diameter and tumor margin state, respectively). The area under curve (AUC) and the receiver operating characteristic curve (ROC) of the model is 0.786. Conclusion Based on three preoperative clinical data, including AFP, tumor maximum diameter and tumor margin, the preoperative prediction model of small hepatocellular carcinoma complicated with MVI was successfully established with clinical value.

Objective To evaluate the feasibility and efficacy of laparoscopic liver resection (LLR) in elderly patients with hepatocellular carcinoma (HCC). Methods Twenty-nine elderly patients undergoing laparoscopic liver resection (LLR) and 58 elderly patients receiving open liver resection (OLR) for HCC were included from January 2013 to December 2015 in our department of Fujian Medical University. Two groups were 1:2 matched for gender ,tumor numbers ,and operative procedure.Besides ,general clinical data ,intraoperative data ,postoperative recovery ,and postoperative survival were compared. Results The postoperative hospital stay was shorter in the LLR group [(9.1±3.8)days]thanintheOLRgroup[(11.8±5.1)days](t= -2.66,P<0.05).Theincidence of portal triad clamping was lower in the LLR group than in the OLR group (34.5％ vs.60.3％ ,χ2 =5.18 ,P<0.05). The removal time of abdominal drainage tube was earlier in the LLR group (4.18 ± 1.94)days than in the OLR group (5.4 ± 2.1)days (t= -2.48 ,P<0.05). The overall survival (OS) showed no difference (37.08 months vs.38.72 months ,t=0.72 ,P=0.789). The disease-free survival (DFS) showed no difference (29.00 months vs.27.49 months ,t=0.53 ,P=0.467). Conclusions LLR in elderly patients with HCC can achieve the same long-term outcome as the conventional open hepatectomy ,and LLR has better short-term outcomes with obvious advantages of minimal invasion.