OBJECTIVE: To evaluate precise assessment methods for predicting the optimal acetabular cup size in total hip arthroplasty (THA). METHODS: A clinical data of 73 patients (80 hips) who underwent primary THA between December 2022 and July 2024 and met the inclusion criteria was analyzed. There were 39 males and 34 females with an average age of 66.3 years (range, 56-78 years). Among them, 66 cases were unilateral THA and 7 were bilateral THAs. There were 29 patients (34 hips) of osteoarthritis, 35 patients (35 hips) of femoral neck fractures, and 9 patients (11 hips) of osteonecrosis of the femoral head. Based on anteroposterior pelvic X-ray films, three methods were employed to predict acetabular cup size, including preoperative template planning, radiographic femoral head diameter (FHD) measurement, and intraoperative FHD measurement. The predicted acetabular cup sizes from these methods were compared with the actual implanted sizes. RESULTS: The predicted acetabular cup sizes using the preoperative template planning, radiographic FHD measurement, and intraoperative FHD measurement were (51.25±2.81), (49.72±3.11), and (49.90±2.74) mm, respectively, compared to the actual implanted cup size of (50.57±2.74) mm, with no significant difference ( P>0.05). Regarding agreement with the actual implanted cup size, the preoperative template planning achieved exact matches in 35 hips (43.75%), one-size deviation in 41 hips (51.25%), and two-size deviations in 4 hips (5%); the radiographic FHD measurement achieved exact matches in 12 hips (15%), one-size deviation in 57 hips (71.25%), and two-size deviations in 11 hips (13.75%); and the intraoperative FHD measurement achieved exact matches in 26 hips (32.5%), one-size deviation in 52 hips (65%), and two-size deviations in 2 hips (2.5%). There were significant differences in agreement distributions between the three methods and the actual implanted cup sizes ( H=18.579, P<0.001). CONCLUSION The intraoperative FHD measurement, as a simple, cost-effective, and accurate method, effectively guides acetabular cup selection, reduces the risk of prosthesis wear, enhances postoperative joint stability.
Humans ; Arthroplasty, Replacement, Hip/instrumentation* ; Male ; Female ; Middle Aged ; Acetabulum/diagnostic imaging* ; Aged ; Hip Prosthesis ; Prosthesis Design ; Femur Head/surgery* ; Osteoarthritis, Hip/surgery* ; Radiography ; Femoral Neck Fractures/surgery* ; Femur Head Necrosis/surgery*

With the rapid development of artificial intelligence (AI) technology, its applica-tion in diagnosis and treatment of colorectal cancer (CRC) has deepened, covering preoperative diagnosis, surgical assistance, and prognostic evaluation. AI can accurately detect precancerous lesions and tumor characteristics during screening of CRC, improving diagnostic precision.During surgery, AI provides real-time feedback and navigation support, helping surgeons improve precision and reduce complications. After surgery, AI integrates multidimensional data to optimize treatment decisions and resource allocation. However, current AI models still face challenges in accuracy, generalization, and integration with existing medical systems, and societal issues such as privacy and ethics need to be addressed. With ongoing technological advancements, AI is expected to play a greater role in minimally invasive surgeries for CRC, particularly in robotic surgery, offering more precise and personalized treatment options in the future. The authors summarize application and prospect of artificial intelligence in minimally invasive treatment of colorectal cancer, aiming to provide references for clinical practice.

With the rapid development of artificial intelligence (AI) technology, its applica-tion in diagnosis and treatment of colorectal cancer (CRC) has deepened, covering preoperative diagnosis, surgical assistance, and prognostic evaluation. AI can accurately detect precancerous lesions and tumor characteristics during screening of CRC, improving diagnostic precision.During surgery, AI provides real-time feedback and navigation support, helping surgeons improve precision and reduce complications. After surgery, AI integrates multidimensional data to optimize treatment decisions and resource allocation. However, current AI models still face challenges in accuracy, generalization, and integration with existing medical systems, and societal issues such as privacy and ethics need to be addressed. With ongoing technological advancements, AI is expected to play a greater role in minimally invasive surgeries for CRC, particularly in robotic surgery, offering more precise and personalized treatment options in the future. The authors summarize application and prospect of artificial intelligence in minimally invasive treatment of colorectal cancer, aiming to provide references for clinical practice.

Objective:This study evaluated the efficacy of the PST technique: Preservation of the left colic artery (P), suture reinforcement (S), and transanal tube (T) combined with selective fecal diversion via end ileostomy, in preventing anastomotic leakage following laparoscopic anterior resection (LAR) for mid-to-low rectal cancer.Methods:We retrospectively collected data for this descriptive case series from patients who underwent laparoscopic LAR with complete or partial application of the PST technique, some of whom received prophylactic ileostomy, at the Department of Colorectal Surgery, Zhongshan Hospital Affiliated to Fudan University, and its Xiamen Branch between July, 2022 and December, 2024. "Partial PST" was defined as the implementation of PS (Preservation of the left colic artery + suture reinforcement), PT (Preservation of the left colic artery + transanal tube), ST (suture reinforcement + transanal tube), or a single T procedure (Transanal tube). The primary outcome measures were the proportion of patients who received the PST technique and terminal ileostomy, as well as the incidence of anastomotic leaks.Results:Among 198 patients, 145 received complete PST. Fifty-three patients underwent partial PST (PT) because anastomotic reinforcement was not feasible due to an excessively low anastomosis or obesity. All patients achieved R0 resection. Postoperative pathology showed that 108 patients (54.5%) were at T3-T4 stage, and 81 patients (40.9%) had poorly differentiated adenocarcinoma or mucinous adenocarcinoma. A total of 19.7% (39/198) of patients developed grade II or higher postoperative complications, including 11 cases (5.6%) of surgical site infection and 7 cases (3.5%) of urinary retention. Five patients were rehospitalized within 30 days after surgery, among whom 2 had intestinal obstruction, and 3 developed grade C anastomotic leaks that required reoperation for salvage enterostomy. The overall incidence of anastomotic leakage was 3.0% (6/198). Fifty-three patients (26.8%) received protective ileostomy, with an anastomotic leak incidence of 1.9% (1/53). Methylene blue leakage occurred in 20 patients (10.1%), all of whom received prophylactic ileostomy and had no anastomotic leakage postoperatively. Among 61 patients who received neoadjuvant chemoradiotherapy before surgery, 28 underwent prophylactic ileostomy, and none developed anastomotic leaks after surgery.Conclusions:Routine application of the PST technique during laparoscopic low anterior resection, along with prophylactic enterostomy for ultra-high-risk populations, can effectively control the incidence of anastomotic leakage.

Objective:This study evaluated the efficacy of the PST technique: Preservation of the left colic artery (P), suture reinforcement (S), and transanal tube (T) combined with selective fecal diversion via end ileostomy, in preventing anastomotic leakage following laparoscopic anterior resection (LAR) for mid-to-low rectal cancer.Methods:We retrospectively collected data for this descriptive case series from patients who underwent laparoscopic LAR with complete or partial application of the PST technique, some of whom received prophylactic ileostomy, at the Department of Colorectal Surgery, Zhongshan Hospital Affiliated to Fudan University, and its Xiamen Branch between July, 2022 and December, 2024. "Partial PST" was defined as the implementation of PS (Preservation of the left colic artery + suture reinforcement), PT (Preservation of the left colic artery + transanal tube), ST (suture reinforcement + transanal tube), or a single T procedure (Transanal tube). The primary outcome measures were the proportion of patients who received the PST technique and terminal ileostomy, as well as the incidence of anastomotic leaks.Results:Among 198 patients, 145 received complete PST. Fifty-three patients underwent partial PST (PT) because anastomotic reinforcement was not feasible due to an excessively low anastomosis or obesity. All patients achieved R0 resection. Postoperative pathology showed that 108 patients (54.5%) were at T3-T4 stage, and 81 patients (40.9%) had poorly differentiated adenocarcinoma or mucinous adenocarcinoma. A total of 19.7% (39/198) of patients developed grade II or higher postoperative complications, including 11 cases (5.6%) of surgical site infection and 7 cases (3.5%) of urinary retention. Five patients were rehospitalized within 30 days after surgery, among whom 2 had intestinal obstruction, and 3 developed grade C anastomotic leaks that required reoperation for salvage enterostomy. The overall incidence of anastomotic leakage was 3.0% (6/198). Fifty-three patients (26.8%) received protective ileostomy, with an anastomotic leak incidence of 1.9% (1/53). Methylene blue leakage occurred in 20 patients (10.1%), all of whom received prophylactic ileostomy and had no anastomotic leakage postoperatively. Among 61 patients who received neoadjuvant chemoradiotherapy before surgery, 28 underwent prophylactic ileostomy, and none developed anastomotic leaks after surgery.Conclusions:Routine application of the PST technique during laparoscopic low anterior resection, along with prophylactic enterostomy for ultra-high-risk populations, can effectively control the incidence of anastomotic leakage.

Objective:To investigate the correlation between three-dimensional (3D) true acetabular cup coverage and two-dimensional (2D) X-ray acetabular cup coverage in total hip arthroplasty (THA) and identify effective parameters for evaluating acetabular cup coverage.Methods:Sixteen pelvic models were 3D-printed from CT reconstruction data of healthy adult pelvises. Postoperative acetabular models were prepared using standard THA procedures. The postoperative models were centered on the acetabulum and positioned under a C-arm fluoroscope. Fluoroscopy was conducted by rotating the C-arm at different angles (15°, 30°, and 45°) to obtain anteroposterior (AP) and iliac oblique X-ray images of the hip joint. The 2D acetabular coverage at different fluoroscopic angles (AP, 15° iliac oblique, 30° iliac oblique, and 45° iliac oblique) was recorded and compared with the 3D acetabular coverage measured from the pelvic models. Two independent observers assessed related parameters (coverage, abduction angle, anteversion angle) from the 2D X-ray images, and inter-observer reliability was statistically analyzed. Differences between 2D and 3D acetabular coverage were compared, and multiple linear regression analysis was used to assess correlations between acetabular anteversion angle, abduction angle, and both 2D and 3D acetabular coverage.Results:The acetabular coverage for the 2D X-ray groups (AP, 15° iliac oblique, 30° iliac oblique, and 45° iliac oblique) was 87.37%±2.59%, 87.01%±2.53%, 85.39%±2.57%, and 83.20%±2.51%, respectively, with statistically significant differences ( F=6.700, P=0.001). The 45° iliac oblique group had significantly lower coverage than both the 30° iliac oblique group and the AP group, while the 30° iliac oblique group showed significantly lower coverage than the 15° iliac oblique group (all differences, P<0.05). The mean abduction and anteversion angles were 45.33°±2.22° and 14.61°±2.53°, respectively. The 3D acetabular coverage was 85.66%±2.51%. The 45° iliac oblique group had significantly lower coverage than the 3D coverage group ( P<0.05), whereas no significant difference was observed between the AP group and the 3D coverage group ( t=1.893, P=0.062). Multiple linear regression analysis revealed significant negative correlations between the acetabular abduction angle, anteversion angle, and both 2D and 3D acetabular coverage, with the following regression equations: 2D coverage=124.627-0.700× (abduction angle) -0.379× (anteversion angle) ( R2=0.814, P=0.001); 3D coverage=120.291-0.603× (abduction angle) -0.499× (anteversion angle) ( R2=0.917, P<0.001). Conclusion:Acetabular cup coverage rates vary with different X-ray projection angles, with the anteroposterior X-ray view potentially overestimating coverage. Changes in the abduction angle appear to significantly impact the differences between 2D and 3D coverage, thereby increasing errors in assessing true acetabular cup coverage. These discrepancies between 2D and 3D coverage should be carefully considered when evaluating minimal acetabular cup coverage.

Objective:To investigate the correlation between three-dimensional (3D) true acetabular cup coverage and two-dimensional (2D) X-ray acetabular cup coverage in total hip arthroplasty (THA) and identify effective parameters for evaluating acetabular cup coverage.Methods:Sixteen pelvic models were 3D-printed from CT reconstruction data of healthy adult pelvises. Postoperative acetabular models were prepared using standard THA procedures. The postoperative models were centered on the acetabulum and positioned under a C-arm fluoroscope. Fluoroscopy was conducted by rotating the C-arm at different angles (15°, 30°, and 45°) to obtain anteroposterior (AP) and iliac oblique X-ray images of the hip joint. The 2D acetabular coverage at different fluoroscopic angles (AP, 15° iliac oblique, 30° iliac oblique, and 45° iliac oblique) was recorded and compared with the 3D acetabular coverage measured from the pelvic models. Two independent observers assessed related parameters (coverage, abduction angle, anteversion angle) from the 2D X-ray images, and inter-observer reliability was statistically analyzed. Differences between 2D and 3D acetabular coverage were compared, and multiple linear regression analysis was used to assess correlations between acetabular anteversion angle, abduction angle, and both 2D and 3D acetabular coverage.Results:The acetabular coverage for the 2D X-ray groups (AP, 15° iliac oblique, 30° iliac oblique, and 45° iliac oblique) was 87.37%±2.59%, 87.01%±2.53%, 85.39%±2.57%, and 83.20%±2.51%, respectively, with statistically significant differences ( F=6.700, P=0.001). The 45° iliac oblique group had significantly lower coverage than both the 30° iliac oblique group and the AP group, while the 30° iliac oblique group showed significantly lower coverage than the 15° iliac oblique group (all differences, P<0.05). The mean abduction and anteversion angles were 45.33°±2.22° and 14.61°±2.53°, respectively. The 3D acetabular coverage was 85.66%±2.51%. The 45° iliac oblique group had significantly lower coverage than the 3D coverage group ( P<0.05), whereas no significant difference was observed between the AP group and the 3D coverage group ( t=1.893, P=0.062). Multiple linear regression analysis revealed significant negative correlations between the acetabular abduction angle, anteversion angle, and both 2D and 3D acetabular coverage, with the following regression equations: 2D coverage=124.627-0.700× (abduction angle) -0.379× (anteversion angle) ( R2=0.814, P=0.001); 3D coverage=120.291-0.603× (abduction angle) -0.499× (anteversion angle) ( R2=0.917, P<0.001). Conclusion:Acetabular cup coverage rates vary with different X-ray projection angles, with the anteroposterior X-ray view potentially overestimating coverage. Changes in the abduction angle appear to significantly impact the differences between 2D and 3D coverage, thereby increasing errors in assessing true acetabular cup coverage. These discrepancies between 2D and 3D coverage should be carefully considered when evaluating minimal acetabular cup coverage.

Objective: To explore the epidemic characteristics of injury related deaths in children and adolescents aged 1-24 years old in China from 2010 to 2020, so as to provide a basis for the formulation of policies and measures related to the control of injuries and deaths among children and adolescents. Methods: The data were sourced from the China Death Cause Monitoring Dataset from 2010 to 2020. Annual percentage change (APC) and average annual percentage change (AAPC) of injury deaths in China in this age group during the period 2010 to 2020 were analyzed by Join point regression. Results: From 2010 to 2020, the standardized death rate of injury showed a decreasing trend (AAPC=-6.90%, t =4.58, P <0.01). The standardized death rates of male and rural injuries showed an overall downward trend, with AAPC rates of -8.37% and -7.79%( t =11.87, 10.34, P <0.01). An increasing trend was observed in the 20-24 year-old age group during 2010-2018 (APC=18.11%, t =6.50, P <0.01). The death rate from injuries was higher in males than females, and higher in rural areas compared with urban areas ( χ 2=16 483.64, 3 268.65 , P <0.01). A downward trend was observed in accidental falls and suicide, the overall standardized mortality rate of traffic accidents, accidental poisoning, fire, drowning, homicide and other injuries (AAPC=-10.22%, -6.21%, -7.50%, -7.94%, -9.01% , -10.97%, t =16.23, 7.29, 2.53, 9.32, 7.88, 4.58, P <0.05). Conclusion From 2010 to 2020, the overall injury standardized mortality rate in the 1-24 year-old age group shows a decreasing trend, but it remains at a relatively high level. Prevention efforts should be continuously strengthened, especially for urban areas, and should focus on women and those aged 20-24 years old, as well as accidental falls and suicide prevention.

The Corona Virus Disease 2019 (COVID-19) since December, 2019 has a wide range of infection due to the strong infectious characteristics. Both medical staff and patients are at increased risk of infection. It is an urgent clinical problem for specialist doctors to work with diagnosis and treatment of cancer patients during the epidemic situation. Based on the colorectal cancer diagnosis and treatment guidelines (2019 CSCO guideline), combined with their own experience, the authors propose the overall management strategies for colorectal cancer patients. This strategies cover the key diagnosis and treatment of colorectal cancer, and provide targeted clinical practice. These work will be helpful for colorectal cancer specialists to carry out the diagnosis and treatment of colorectal cancer effectively under the epidemic of COVID-19.

Objective:To investigate the risk factors associated with anastomotic leakage after robotic surgery in mid-low rectal cancer.Methods:A retrospective case-control study method was conducted. Inclusion criteria: (1) 18 to 80 years old; (2) pathologically confirmed rectal cancer; (3) distance <10 cm from tumor to anal margin; (4) robotic anterior rectal resection. Patients with previous history of colorectal cancer surgery, distant metastases or other malignant tumors, undergoing emergency surgery, with severe abdominal adhesions or those receiving combined organ resection were excluded. Based on the above criteria, 636 patients undergoing robotic radical sphincter-preserving surgery for mid-low rectal cancer in Zhongshan Hospital from January 2015 to December 2018 were included in this study, including 398 males (62.6%) and 238 females (37.4%) with a mean age of (61.9±11.3) years. Sixty-eight cases (10.7%) received neoadjuvant chemoradiotherapy. Amony the 636 included patients, 123(19.3%) underwent natural orifice specimen extraction surgery (NOSES) and 15 (2.3%) underwent preventive stoma. According to the cirteria developed by the International Rectal Cancer Research Group in 2010, the anastomotic leakage was classified as grade A (no requirement of intervention), B (requirement of intervention), and C (requirement of operation). Logistic regression was used to analyze the relationship between anastomotic leakage and clinicopathological factors. Factors in univariate analysis with P<0.05 were included in the multivariate analysis. Results:Anastomotic leakage occurred in 38 cases (6.0%). The grading of anastomotic leakage was grade A in 13 cases (2.0%), grade B in 19 cases (3.0%), and grade C in 6 cases (0.9%). The 3-year disease-free survival rate of patients with anastomotic leakage and without anastomotic leakage was 83.5% and 83.6% respectively ( P=0.862); the 3-year overall survival rate of the two group was 85.1% and 87.5% respectively ( P=0.296). The results of univariate logistic regression analysis showed that male ( P=0.011), longer operation time ( P=0.042), distance ≤5 cm from tumor to anal margin ( P=0.012), more intraoperative blood loss ( P=0.048) were associated with anastomotic leakage (all P<0.05). NOSES was not associated with anastomotic leakage ( P=0.704). Multivariate analysis confirmed that male (OR=3.03, 95%CI: 1.37 to 7.14, P=0.010), operation time ≥180 minutes (OR=2.04, 95%CI: 1.03 to 3.99, P=0.040), distance ≤5 cm from tumor to anal margin (OR=2.56, 95%CI:1.28 to 5.26, P=0.008) were independent risk factors for anastomotic leakage. Conclusion:Male, short distance from tumor to anal margin, and long operation time are independent risk factors for anastomotic leakage in patients undergoing robotic mid-low rectal cancer radical surgeries. These patients need to be cautiously treated during surgery.