Objective To systematically evaluate the risk prediction model of anastomotic fistula after radical resection of esophageal cancer, and to provide objective basis for selecting a suitable model. Methods A comprehensive search was conducted on Chinese and English databases including CNKI, Wanfang, VIP, CBM, PubMed, EMbase, Web of Science, The Cochrane Library for relevant studies on the risk prediction model of anastomotic fistula after radical resection of esophageal cancer from inception to April 30, 2023. Two researchers independently screened literatures and extracted data information. PROBAST tool was used to assess the risk of bias and applicability of included literatures. Meta-analysis was performed on the predictive value of common predictors in the model with RevMan 5.3 software. Results A total of 18 studies were included, including 11 Chinese literatures and 7 English literatures. The area under the curve (AUC) of the prediction models ranged from 0.68 to 0.954, and the AUC of 10 models was >0.8, indicating that the prediction performance was good, but the risk of bias in the included studies was high, mainly in the field of research design and data analysis. The results of the meta-analysis on common predictors showed that age, history of hypertension, history of diabetes, C-reactive protein, history of preoperative chemotherapy, hypoproteinemia, peripheral vascular disease, pulmonary infection, and calcification of gastric omental vascular branches are effective predictors for the occurrence of anastomotic leakage after radical surgery for esophageal cancer (P<0.05). Conclusion The study on the risk prediction model of anastomotic fistula after radical resection of esophageal cancer is still in the development stage. Future studies can refer to the common predictors summarized by this study, and select appropriate methods to develop and verify the anastomotic fistula prediction model in combination with clinical practice, so as to provide targeted preventive measures for patients with high-risk anastomotic fistula as soon as possible.

Objective: To understand the relationship between serum 25 hydroxyvitamin D [25(OH)D] levels and social emotional functions in children with autism spectrum disorder (ASD), in order to provide the reference for comprehensive interventions in ASD children. Methods: From January to June 2024, 124 ASD children aged 1-3 who received rehabilitation training at designated rehabilitation institutions in Nantong City, China were selected as the case group, while 124 healthy gender and age matched children who underwent health examinations at the same time were selected as the control group. The study used liquid chromatography-mass spectrometry to measure serum 25(OH)D levels in both groups of children. The Chinese Infant-Toddler Social and Emotional Assessment (CITSEA) was used to evaluate the emotional and socialization functioning of children with ASD, and to explore the relationship between serum 25(OH)D levels and their emotional and social functioning. Results: The serum 25(OH)D levels were lower in the case group [(59.22±19.96)nmol/L] compared to the control group [(85.50±21.59)nmol/L], and the rate of 25(OH)D deficiency or insufficiency (21.77%) was higher than that of the control group (7.26%), with statistically significant differences ( t/χ 2=-7.75, 8.91, P <0.01). The CITSEA evaluation results showed that the scores of the explicit behavior domain, implicit behavior domain, dysregulation domain, and ability domain in children with ASD were (63.37±10.44, 56.29± 9.36 , 57.04±10.65, 38.92±17.91) points, and the abnormal detection rates were 50.81%, 35.48%, 41.13%, and 45.16%, respectively. Among them, the abnormal detection rates of the explicit behavior domain and ability domain were higher in boys ( 57.14 %, 51.02%) compared to girls (34.62%, 23.08%), and the differences were statistically significant ( χ 2=4.18, 6.48, P < 0.05 ). The abnormal detection rates of explicit behavioral domains and dysregulated domains in ASD children with insufficient or deficient serum 25(OH)D (77.78%, 59.26%) were higher than those in the normal serum 25(OH)D group (37.11%, 18.56%), and the differences were statistically significant ( χ 2=14.06, 17.58, P <0.01). Conclusion The serum 25(OH)D levels in children with ASD are significantly lower compared to levels in healthy children, and developmental abnormalities in social emotional functioning are common concurrent problems.

Objective:To investigate the application value of ultrasound-guided multimodal examinations in the diagnosis of lymph node mycobacterial infection.Methods:The clinical data of 42 patients with suspected lymph node mycobacterial infection who were initially diagnosed at the Affiliated Hospital of Shaoxing University from January 2019 to December 2020 were retrospectively analyzed. All patients underwent an ultrasound-guided lymph node-negative pressure puncture. Acid-fast staining, bacterial culture, pathological examination or their combination were used to screen lymph nodes for mycobacterial infection. The results were compared with those of acid-fast staining and bacterial culture of sputum and bronchoalveolar lavage fluid smears.Results:The combined application of acid fast staining, bacterial culture, and pathological examination for the puncture fluid smear showed a positive rate of 71.4% (30/42), which was significantly higher than the positive rate [26.2% (11/42)] for acid fast staining of the puncture fluid smear, the positive rate [42.9% (18/42)] for bacterial culture of the puncture fluid, and the positive rate [50.0% (21/42)] of pathological examination ( χ2 = 17.20, 7.00, 4.04, P < 0.001, P < 0.01, P = 0.040). The positive rate for sputum smear and bacterial culture was 21.4% (9/33). The positive rate for acid fast staining and bacterial culture of the bronchoalveolar lavage fluid was 28.6% (12/30). The differences were statistically significant ( χ2 = 21.11, 15.43, both P < 0.001). Conclusion:Ultrasound-guided negative pressure aspiration and puncture biopsy of lymph nodes combined with acid fast staining, bacterial culture, and pathological examinations can markedly increase the detection rate and diagnostic rate of mycobacterial infection.

Objective To understand the awareness of the emergency physicians for thrombolytic thera-py recommended by ST-segment elevation myocardial infarction(STEMI)guidelines and implementation sit-uation,and to analyze the related influencing factors.Methods Relying on Chengdu Emergency Quality Con-trol Center,the questionnaires were distributed to the hospitals of expert group members and the hospitals of the medical union from April to July 2023 to investigate the awareness,implementation status and training status of the emergency doctors in Chengdu area on the STEMI thrombolytic therapy.The causes affecting thrombolysis decision-making were analyzed.Results A total of 137 hospitals participated in the survey.Whether the treatment system and type of chest pain,chest pain center,percutaneous coronary intervention(PCI)qualified hospitals or departments carrying out the training and hospital grade were correlated to whether STEMI patients were thrombolyzed within 12 h before transport(P＜0.05).Whether the PCI quali-fied hospital,chest pain center,chest pain treatment system and type,carrying training,hospital grade,geo-graphical location,transport duration,and thrombolytic indication understanding situation were not related to whether thrombolytic therapy was recommended for the duration from the first medical contact(FMC)to PCI(FMC-PCI)≥120 min(P＞0.05).The multivariate logistic regression analysis showed that whether the de-partment carrying out the training was an influential factor for whether thrombolytic therapy was carried out within 12 h before transport in STEMI onset(P＜0.05).The hospital grade was a influencing factor for whether thrombolysis in non-chest pain treatment system was carried before transport within 12 h of the onset of STEMI.The main reason for STEMI patients being directly transfered treatment without thrombolysis within 12 h of onset was because they knew that thrombolysis was needed but did not know how to do it(50.00％).The awareness rate of thrombolytic indication in non-main urban area was higher than that in main urban area(P＜0.05).The carrying out department training rate of PCI qualified hospitals was higher than that of non-PCI qualified hospitals(P＜0.05).The receiving superior hospital training rate also had difference among different hospital grades and geographical locations.Conclusion Conducting the thrombolysis training and enhancing the learning of treatment processes directly affect the emergency physicians'choice of reperfu-sion strategies for the patients with STEMI.Continuous promotion of the construction of chest pain center or chest pain treatment unit could further increase the early reperfusion rate of STEMI.

[Objective] To explore the clinical efficacy and feasibility of blue laser transurethral incision of prostate (BLTUIP) in the treatment of small volume (≤30 mL) benign prostatic hyperplasia (BPH). [Methods] The clinical data of 34 BPH patients treated with BLTUIP in the First Affiliated Hospital of Xinjiang Medical University during Mar.and Oct.2023 were retrospectively analyzed.The operation time, 450 nm blue laser light emission time, 980 nm red laser light emission time, postoperative bladder irrigation time, international prostate symptom score (IPSS), quality of life score (QoL), maximum flow rate (Qmax), post-void residual (PVR), international index of erectile function-5 (IIEF-5), ejaculation and incidence of postoperative complications were analyzed. [Results] All operations were successful, without conversion to open or transurethral resection of the prostate (TURP). The operation time was 12.7 (10.8, 14.3) min, the 450 nm blue laser light emission time was 11.7 (9.6, 13.3) min, the 980 nm red laser light emission time was 1.0 (1.0, 2.0) min, the postoperative bladder irrigation time was 5.0 (2.8, 8.0) h, the total hospital stay was 6.0 (4.0, 7.0) d, the postoperative hospital stay was 2.0 (2.0, 3.0) d, and the postoperative catheter retention time was 2.0 (0, 2.0) d. After 3 or 6 months of follow-up, the IPSS, QoL and PVR were significantly lower than those before operation, while the Qmax was significantly higher, with significant differences (P<0.001); but there was no significant difference in the IIEF-5 score (P>0.05). During the 3-month follow-up, 4 patients (11.8%) had fever; during the 3-6 month follow-up, 1 patient (2.9%) had external urethral stricture; of the 8 patients with sexual life before operation, 1 (12.5%) had retrograde ejaculation after operation.No hematuria occurred. [Conclusion] BLTUIP is a new, safe and efficient surgical treatment for BPH with a volume ≤30 mL, which can shorten the operation time, reduce postoperative complications, and improve the quality of life.

Objective:To investigate the prognosis and the factors that influence it in patients with non-gastric gastrointestinal stromal tumors (GISTs) who are at low risk of recurrence.Methods:This was a retrospective cohort study. Clinicopathologic and prognostic data from patients with non-gastric GISTs and at low risk of recurrence (i.e., very low-risk or low-risk according to the 2008 version of the Modified NIH Risk Classification), who attended 18 medical centers in China between January 2000 and June 2023, were collected. We excluded patients with a history of prior malignancy, concurrent primary malignancy, multiple GISTs, and those who had received preoperative imatinib. The study cohort comprised 1,571 patients with GISTs, 370 (23.6%) of whom were at very low-risk and 1,201 (76.4%) at low-risk of recurrence. The cohort included 799 (50.9%) men and 772 (49.1%) women of median age 57 (16–93) years. Patients were followed up to July 2024. The prognosis and its influencing factors were analyzed. Receiver operating characteristic curves for tumor diameter and Ki67 were established, and the sensitivity, specificity, area under the curve (AUC) and optimal cut-off value with 95% confidence intervals were calculated. Propensity score matching was implemented using the 1:1 nearest neighbor matching method with a matching tolerance of 0.02.Results:With a median follow-up of 63 (12–267) months, the 5- and 10-year overall survival (OS) rates of the 1,571 patients were 99.5% and 98.0%, respectively, and the 5- and 10-year disease-free survival (DFS) rates were 96.3% and 94.4%, respectively. During postoperative follow-up, 3.8% (60/1,571) patients had disease recurrence or metastasis, comprising 0.8% (3/370) in the very low-risk group and 4.7% (57/1,201) in the low-risk group. In the low-risk group, recurrence or metastasis occurred in 5.5% (25/457) of patients with duodenal GISTs, 3.9% (25/645) of those with small intestinal GISTs, 9.2% (6/65) of those with rectal GISTs, and 10.0% (1/10) of those with colonic GISTs. Among the 60 patients with metastases, 56.7% (34/60) of the metastases were located in the abdominal cavity, 53.3% (32/60) in the liver, and 3.3% (2/60) in bone. During the follow-up period, 13 patients (0.8%) died of disease. Receiver operating characteristic curves were plotted for tumor diameter and Ki67 and assessed using the Jordon index. This showed that the difference in DFS between the two groups was statistically significant when the cutoff value for tumor diameter was 3.5 cm (AUC 0.731, 95% CI: 0.670–0.793, sensitivity 77.7%, specificity 64.1%). Furthermore, the difference in DFS between the two groups was statistically significant when the cutoff value for Ki67 was 5% (AUC 0.693, 95% CI: 0.624–0.762, sensitivity 60.7%, specificity 65.3%). Multifactorial analysis revealed that tumor diameter ≥3.5 cm, Ki67 ≥5%, and R1 resection were independent risk factors for DFS in patients with non-gastric GISTs at low risk of recurrence (all P<0.05). Furthermore, age >57 years, Ki67 ≥5%, and R1 resection were also independent risk factors for OS in patients with non-gastric GISTs at low risk of recurrence (all P<0.05). We also grouped the patients according to whether they had received postoperative adjuvant treatment with imatinib for 1 or 3 years. This yielded 137 patients in the less than 1-year group, 139 in the 1-year plus group; and 44 in both the less than 3 years and 3-years plus group. After propensity score matching for age, tumor diameter, Ki67, and resection status, the differences in survival between the two groups were not statistically significant (all P>0.05). The 10-year DFS and OS were 87.5% and 95.5%, respectively, in the group treated with imatinib for less than 1 year and 88.5% and 97.8%, respectively, in the group treated for more than 1 year. The 10-year DFS and OS were 89.6% and 92.6%, respectively, in the group treated with imatinib for less than 3 years and 88.0% and 100.0%, respectively, in the group treated with imatinib for more than 3 years. Conclusion:The overall prognosis of primary, non-gastric, low recurrence risk GISTs is relatively favorable; however, recurrences and metastases do occur. Age, tumor diameter, Ki67, and R1 resection may affect the prognosis. For some patients with low risk GISTs, administration of adjuvant therapy with imatinib for an appropriate duration may help prevent recurrence and improve survival.

Objective:To investigate the prognosis and the factors that influence it in patients with non-gastric gastrointestinal stromal tumors (GISTs) who are at low risk of recurrence.Methods:This was a retrospective cohort study. Clinicopathologic and prognostic data from patients with non-gastric GISTs and at low risk of recurrence (i.e., very low-risk or low-risk according to the 2008 version of the Modified NIH Risk Classification), who attended 18 medical centers in China between January 2000 and June 2023, were collected. We excluded patients with a history of prior malignancy, concurrent primary malignancy, multiple GISTs, and those who had received preoperative imatinib. The study cohort comprised 1,571 patients with GISTs, 370 (23.6%) of whom were at very low-risk and 1,201 (76.4%) at low-risk of recurrence. The cohort included 799 (50.9%) men and 772 (49.1%) women of median age 57 (16–93) years. Patients were followed up to July 2024. The prognosis and its influencing factors were analyzed. Receiver operating characteristic curves for tumor diameter and Ki67 were established, and the sensitivity, specificity, area under the curve (AUC) and optimal cut-off value with 95% confidence intervals were calculated. Propensity score matching was implemented using the 1:1 nearest neighbor matching method with a matching tolerance of 0.02.Results:With a median follow-up of 63 (12–267) months, the 5- and 10-year overall survival (OS) rates of the 1,571 patients were 99.5% and 98.0%, respectively, and the 5- and 10-year disease-free survival (DFS) rates were 96.3% and 94.4%, respectively. During postoperative follow-up, 3.8% (60/1,571) patients had disease recurrence or metastasis, comprising 0.8% (3/370) in the very low-risk group and 4.7% (57/1,201) in the low-risk group. In the low-risk group, recurrence or metastasis occurred in 5.5% (25/457) of patients with duodenal GISTs, 3.9% (25/645) of those with small intestinal GISTs, 9.2% (6/65) of those with rectal GISTs, and 10.0% (1/10) of those with colonic GISTs. Among the 60 patients with metastases, 56.7% (34/60) of the metastases were located in the abdominal cavity, 53.3% (32/60) in the liver, and 3.3% (2/60) in bone. During the follow-up period, 13 patients (0.8%) died of disease. Receiver operating characteristic curves were plotted for tumor diameter and Ki67 and assessed using the Jordon index. This showed that the difference in DFS between the two groups was statistically significant when the cutoff value for tumor diameter was 3.5 cm (AUC 0.731, 95% CI: 0.670–0.793, sensitivity 77.7%, specificity 64.1%). Furthermore, the difference in DFS between the two groups was statistically significant when the cutoff value for Ki67 was 5% (AUC 0.693, 95% CI: 0.624–0.762, sensitivity 60.7%, specificity 65.3%). Multifactorial analysis revealed that tumor diameter ≥3.5 cm, Ki67 ≥5%, and R1 resection were independent risk factors for DFS in patients with non-gastric GISTs at low risk of recurrence (all P<0.05). Furthermore, age >57 years, Ki67 ≥5%, and R1 resection were also independent risk factors for OS in patients with non-gastric GISTs at low risk of recurrence (all P<0.05). We also grouped the patients according to whether they had received postoperative adjuvant treatment with imatinib for 1 or 3 years. This yielded 137 patients in the less than 1-year group, 139 in the 1-year plus group; and 44 in both the less than 3 years and 3-years plus group. After propensity score matching for age, tumor diameter, Ki67, and resection status, the differences in survival between the two groups were not statistically significant (all P>0.05). The 10-year DFS and OS were 87.5% and 95.5%, respectively, in the group treated with imatinib for less than 1 year and 88.5% and 97.8%, respectively, in the group treated for more than 1 year. The 10-year DFS and OS were 89.6% and 92.6%, respectively, in the group treated with imatinib for less than 3 years and 88.0% and 100.0%, respectively, in the group treated with imatinib for more than 3 years. Conclusion:The overall prognosis of primary, non-gastric, low recurrence risk GISTs is relatively favorable; however, recurrences and metastases do occur. Age, tumor diameter, Ki67, and R1 resection may affect the prognosis. For some patients with low risk GISTs, administration of adjuvant therapy with imatinib for an appropriate duration may help prevent recurrence and improve survival.

Objective To investigate the inhibition of gigantol on corneal neovascularization(CNV)in rats after corneal alkali burn.Methods Animal models of corneal alkali burn were made with SD rats,which were divided into normal control group,model control group,low-concentration gigantol group,high-concentration gigantol group and aflibercept group,with 10 rats in each group.The rats in low-concentration gigantol group,high-concentration gigantol group and aflibercept group were treated with 2.5 mg/0.05 mL gigantol,5 mg/0.05 mL gigantol,and 2 mg/0.05 mL aflibercept by subconjunctival injection after modeling.The CNV,corneal opacity score,and thickness of the cornea were observed and compared on the 3rd,7th,and 14th days after alkali burn.The ratio of CNV area to corneal area was calculated.On the 14th day,all rats were sacrificed.Hematoxylin and eosin staining and immunohistochemistry were used to detect the expression of CD34 and VEGF.The protein expression of VEGF,IL-1β,and TNF-α was detected by ELISA.Results On the 7th and 14th days after alkali burn,the percentages of CNV to total corneal area in low-concentration gigantol group,high-concentration gigantol group and aflibercept group were significantly smaller than those in model control group(all P＜0.05).On the 14th day,the corneal opacity score was lower in high-concentration gigantol group than model control group(P＜0.05).The corneal thickness in model control group and low-concentration gigantol group were significantly greater than that in normal control group(all P＜0.001).However,the corneal thickness in high-concentration gigantol group and aflibercept group were not significantly different from that in normal control group(all P＞0.05).In addition,the protein expression of VEGF,IL-1β,and TNF-α in corneal tissues in low-concentration gigantol group,high-concentration gigantol group and aflibercept group were significantly lower than that in model control group(all P＜0.01).Conclusions Gigantol administration by subconjunctival injection can inhibit the formation of CNV in rats after alkali burn and promote absorption of the corneal edema.

The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.