Objective To explore the effects of preoperative transcatheter arterial chemoembolization(TACE)on early postoperative recurrence in the China liver cancer(CNLC)staging Ⅰb-Ⅱa patients with primary hepatocellular carcinoma.Methods The data of patients with CNLC Ⅰb-Ⅱa stage hepatocellular carcinoma who underwent curative liver resection in Xiangyang Central Hospital from May 2017 to May 2022 were retrospectively analyzed.A total of 76 patients were included,patients were divided into preoperative TACE group(n=32)and surgery group(n=44)according to whether they underwent preoperative TACE.Observe the postoperative recovery of patients.Combined with the postoperative pathological results,adjuvant TACE treatment is performed.Regular reexamination and follow-up are conducted after discharge.The Kaplan-Meier method was used to estimate survival time,calculate 95％CI,and plot the Disease-free(DFS)survival curve.The Cox proportional risk model was used for univariate and multivariate analysis.Results The 1-year disease-free survival rate in the preoperative TACE group was higher than that in the direct surgery group(96.9％vs.84.1％,P＞0.05).The 2-year disease-free survival rate in the preoperative TACE group was higher than that in the direct surgery group(90.6％vs.70.5％,P＜0.05).The disease-free survival of the preoperative TACE group was higher than the direct surgery group(23.03 months vs.20.14 months,P＜0.05).The incidence of treatment-related adverse events after surgery in the preoperative TACE group was higher than that in the direct surgery group(34.4％vs.20.5％,P＞0.05).Multivariate Cox regression analysis showed that different treatment methods,tumor number ≥ 2,and tumor microvascular invasion were prognostic factors affecting tumor recurrence.No severe adverse reactions occurred in either group,and no deaths caused by adverse reactions were observed.Conclusion Compared with direct surgery,preoperative TACE can help improve early postoperative recurrence,prolong patients'disease-free survival,and do not lead to serious adverse events.

Objective To explore the clinical application effects of Chen's pancreatojejunostomy in laparoscopic pancreaticoduodenectomy.Methods Clinical data of 176 patients who underwent laparoscopic pancreaticoduodenectomy in Xiangyang Central Hospital from January 2019 to December 2024 were retrospectively analyzed.According to the methods of intraoperative pancreatojejunostomy,the patients were divided into two groups,the research group(102 cases)using Chen's pancreatojejunostomy,and the control group(74 cases)using duct-to-mucosa pancreatojejunostomy.The two groups were compared on clinical indicators,including operation time,pancreatojejunostomy time,intraoperative blood loss,incidence of postoperative complications,length of hospital stay,and 30-day postoperative mortality rate.Results All 176 patients successfully underwent laparoscopic pancreaticoduodenectomy.There were no statistically significant differences between the two groups in intraoperative blood loss,biochemical leakage,abdominal bleeding,upper gastrointestinal bleeding,delayed gastric emptying,bile leakage,abdominal infection,and 30-day postoperative mortality rate(P＞0.05).The pancreatojejunostomy time[(22.33±5.95)min]and operation time[(334.60±66.42)min]in the study group were significantly shorter than those in the control group[(30.70±5.50)min]and[(414.46±60.96)min],with statistically significant differences(P＜0.05).Two groups of patients did not develop grade C pancreatic fistula.The incidence of grade B pancreatic fistula in the study group(5.88％)was significantly lower compared to the control group(16.22％),and this difference was statistically significant(P＜0.05).Additionally,The postoperative hospital stay of the study group patients[(17.10±6.89)days]was significantly shorter than in the control group[(20.88±8.40)days],with a statistically significant difference(P＜0.05).Conclusion Chen's pancreatojejunostomy is a feasible,safe,and effective procedure in laparoscopic pancreaticoduodenectomy,which can shorten the pancreatojejunostomy time,reduce the incidence of postoperative pancreatic fistula,and decrease the length of hospital stay.

Objective To investigate the clinical efficacy of wrapping the hepatic artery with the hepatogastric ligament for preventing bleeding of the hepatic artery and its branches following pancreaticoduodenectomy(PD).Methods 194 patients who underwent PD in Xiangyang Central Hospital from January 2017 to November 2024 were enrolled and categorized into two groups based on whether the hepatic artery was enwrapped with the hepatogastric ligament during the operation.The wrapped group consisted of 95 cases where the hepatic artery was wrapped,while the non-wrapped group had 99 cases without such wrapping.Intraoperative parameters(intraoperative blood loss and operative time)and postoperative complications(pancreatic fistula,abdominal cavity infection,biliary fistula,delayed gastric emptying,postoperative bleeding,and bleeding of the hepatic artery and its branches)were compared between the two cohorts.Univariate and multivariate Logistic regression analyses were conducted to identify the independent risk factors for postoperative bleeding.Results PD was accomplished successfully in both groups.There was no remarkable difference in intraoperative indices like blood loss and operative time between the two groups(P＞0.05).Similarly,no significant disparities were noted in postoperative complications such as pancreatic fistula,abdominal infection,biliary fistula,and delayed gastric emptying(P＞0.05).Nevertheless,the incidence of postoperative bleeding in the wrapped group was lower than that in the non-wrapped group(3.16％vs.12.12％,P=0.019),and the incidence of bleeding of the hepatic artery and its branches after surgery was also significantly decreased in the wrapped group(0 vs.10.10％,P=0.004).Logistic regression analysis revealed that the operation time(OR=1.013,P=0.011),pancreatic fistula(OR=9.006,P=0.006)and celiac infection(OR=7.930,P=0.014)are independent risk factors of postoperative bleeding,Hepatogastric ligament encapsulation of hepatic artery was an independent protective factor for postoperative hemorrhage of PD(OR=0.084,P=0.006).Conclusion Wrapping the hepatic artery with the hepatogastric ligament reduces PD postoperative bleeding,especially that of the hepatic artery and its branches,without adding other complications.

Objective To explore the effects of preoperative transcatheter arterial chemoembolization(TACE)on early postoperative recurrence in the China liver cancer(CNLC)staging Ⅰb-Ⅱa patients with primary hepatocellular carcinoma.Methods The data of patients with CNLC Ⅰb-Ⅱa stage hepatocellular carcinoma who underwent curative liver resection in Xiangyang Central Hospital from May 2017 to May 2022 were retrospectively analyzed.A total of 76 patients were included,patients were divided into preoperative TACE group(n=32)and surgery group(n=44)according to whether they underwent preoperative TACE.Observe the postoperative recovery of patients.Combined with the postoperative pathological results,adjuvant TACE treatment is performed.Regular reexamination and follow-up are conducted after discharge.The Kaplan-Meier method was used to estimate survival time,calculate 95％CI,and plot the Disease-free(DFS)survival curve.The Cox proportional risk model was used for univariate and multivariate analysis.Results The 1-year disease-free survival rate in the preoperative TACE group was higher than that in the direct surgery group(96.9％vs.84.1％,P＞0.05).The 2-year disease-free survival rate in the preoperative TACE group was higher than that in the direct surgery group(90.6％vs.70.5％,P＜0.05).The disease-free survival of the preoperative TACE group was higher than the direct surgery group(23.03 months vs.20.14 months,P＜0.05).The incidence of treatment-related adverse events after surgery in the preoperative TACE group was higher than that in the direct surgery group(34.4％vs.20.5％,P＞0.05).Multivariate Cox regression analysis showed that different treatment methods,tumor number ≥ 2,and tumor microvascular invasion were prognostic factors affecting tumor recurrence.No severe adverse reactions occurred in either group,and no deaths caused by adverse reactions were observed.Conclusion Compared with direct surgery,preoperative TACE can help improve early postoperative recurrence,prolong patients'disease-free survival,and do not lead to serious adverse events.

Objective:To evaluate the feasibility and preventive efficacy of a fascia- locking circular continuous suture ostomy technique in reducing parastomal hernia incidence.Methods:This technique was applied to patients undergoing permanent colostomy following radical rectal cancer resection. Surgical steps included: (1) A circular incision was made 1-2 cm medial to the intersection of the lateral margin of the rectus abdominis muscle and the line connecting the umbilicus to the left anterior superior iliac spine. Subcutaneous tissues were dissected vertically to expose the anterior rectus sheath, followed by blunt separation of the rectus abdominis after longitudinal incision of the sheath. The posterior rectus sheath and peritoneum were similarly incised. (2) Eight equidistant interrupted sutures (anchoring knots) were placed through the anterior rectus sheath, partial rectus abdominis, posterior rectus sheath, and peritoneum. (3) The terminal colon was exteriorized, and continuous sutures were applied to secure the anchoring knots and seromuscular layers of the bowel between knots, forming a circular locking mechanism by tying the terminal suture to the initial knot's tail. (3) The skin and seromuscular layers of the bowel margin were intermittently sutured (8-12 stitches) to achieve mucosal eversion.Results:From February to October 2023, 13 patients (11 males, 2 females; age: 67 ± 10 years; BMI: 23.8 ± 4.0 kg/m2) underwent this technique at the Second Affiliated Hospital of Army Medical University. Mean stoma creation time was 15.7 ± 3.0 minutes. During a follow-up of 14.6 ± 3.1 months, physical examinations and abdominal CT scans identified parastomal hernias in 2 male patients at 10 and 7 months postoperatively. Only one patient experienced a Clavien-Dindo grade ≥Ⅲ complication, which resolved with treatment. No stoma-related complications (e.g., infection, stenosis, or prolapse) occurred in any patient.Conclusion:The fascia-locking circular continuous suture ostomy technique is safe and feasible, demonstrating potential efficacy in preventing parastomal hernia following colostomy.

Objective To explore the CT and MRI manifestation of salivary gland mucosa-associated lymphoid tissue(MALT)lymphoma.Methods The preoperative CT and MRI images of 89 patients with salivary gland MALT lymphoma who were confirmed by surgical pathology were analyzed retrospectively.Results Salivary gland MALT lymphoma were mainly located in the parotid gland(64 cases,71.9％).The ratio of male to female was 1 ≤ 5.Sixty-nine cases(77.5％)showed concomitant Sjogren's syndrome(SS).Typical imaging findings were round or lobulated well-marginated solid masses with moderate to severe enhancement.Atypical imaging findings were all from parotid gland MALT lymphoma,including cyst-solid mixed masses(34 cases,38.2％),poorly marginated boundaries(9 cases,10.1％),and punctuate calcification(5 cases,5.6％).The average apparent diffusion coefficient(ADC)value of lesions was(0.59±0.09)× 10-3 mm2/s and the time-signal intensity curve(TIC)type was mainly type Ⅱ(66.7％).Conclusion Salivary gland MALT lymphoma exhibits certain clinical and imaging characteristics.But when occur in parotid gland,some lesions may present atypically,which require diagnosis with the aid of functional MRI.

Objective·To explore the value of synthetic magnetic resonance imaging(SyMRI)technology in the diagnosis of cervical lymph node metastasis in patients with oral cancer.Methods·A retrospective analysis was conducted on patients admitted to Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,from November 2023 to April 2024,who were pathologically diagnosed with oral cancer and had a clear lymph node metastasis status.Pre-operative maxillofacial magnetic resonance images of these patients were collected.Histogram features were extracted and screened from the quantitative maps generated by SyMRI,including synthetic T1,T2,and proton density(PD)maps,apparent diffusion coefficient(ADC)maps,and volumes of interest(VOIs)from contrast-enhanced images.The optimal range was determined by comparing the histogram parameters of different peritumoral regions.On this basis,habitat analysis was further carried out by combining the quantitative maps and ADC maps,and the habitat features of the tumor invasive sub-regions were extracted to construct a prediction model.The performance of the model was comprehensively evaluated using receiver operator characteristic curves(ROC curves),net reclassification improvement(NRI),integrated discrimination improvement(IDI),and decision curve analysis(DCA).Results·A total of 61 patients with oral cancer were included in the study.The area under the curve(AUC)value for predicting cervical lymph node metastasis based on the intratumoral histogram features extracted from SyMRI was 0.798(95%CI 0.673?0.924).Adding the ADC map could increase the AUC value to 0.818(95%CI 0.635?0.861).By combining the histogram features from the 12-mm peritumoral region with habitat features,the AUC value for predicting lymph node metastasis could be further increased to 0.907(95%CI 0.812?0.993).The analysis results of NRI,IDI,and DCA all showed that the predictive performance of the model was better than that of clinical diagnosis.Conclusion·Based on SyMRI,combining the histogram features from the intratumoral and peritumoral regions with habitat features shows high performance in the prediction of lymph node metastasis in oral cancer,providing a feasible,contrast agent-free approach for rapid imaging and prediction of metastatic lymph nodes.

Objective:To explore the safety and efficacy of camrelizumab combined with tegafur gimeracil oteracil potassium (S-1) and albumin-bound paclitaxel in the treatment of initially unresectable cholangiocarcinoma.Methods:From October 2022 to August 2024, 17 patients with unresectable intrahepatic cholangiocarcinoma and 4 patients with hilar cholangiocarcinoma were admitted to Xiangyang Central Hospital. They received treatment with camrelizumab combined with S-1 and nab-paclitaxel. Their short-term efficacy and adverse reactions were evaluated, and their long-term survival was followed up.Results:Of the 21 patients, 2 were in complete remission, 6 were in partial remission, 12 had stable disease, and 1 had progressive disease. The objective remission rate was 38.10% (8/21), and the disease control rate was 95.23% (20/21). Five patients were converted to resectable cholangiocarcinoma, with a conversion success rate of 23.81%,2 patients had complete postoperative pathological remission, and 3 patients had major pathological remission. The median progression-free survival time was 11 months (95% CI: 8.37-13.62), and the 1-year progression-free and overall survival rates were 28.57% and 95.23%, respectively. The overall adverse event rate was 90.48% (19/21), and the grade 3 adverse event rate was 28.57% (6/21). Conclusion:The combination of camrelizumab with S-1 and nab-paclitaxel for initially unresectable cholangiocarcinoma has favorable short-term efficacy, tolerable adverse reactions, and improved long-term survival for patients.

ObjectiveTo investigate the mechanism of modified Si Junzitang and Shashen Maidong Tang ［Yiqi Yangyin Jiedu prescription （YQYYJD）］ in enhancing the sensitivity of cisplatin in epidermal growth factor receptor tyrosine kinase inhibitor （EGFR-TKI）-resistant lung adenocarcinoma cells based on aerobic glycolysis. MethodsThe effects of different concentrations of YQYYJD （0， 2， 3， 4， 5， 6， 7， 8 g·L^-1） and cisplatin （0， 3， 6， 9， 12， 15， 18， 21， 24， 27 mg·L^-1） on the proliferation and activity of PC9/GR cells were detected by the cell counting kit-8 （CCK-8） assay after 24 hours of intervention. The half-maximal inhibitory concentration （IC₅₀） for PC9/GR cells was calculated to determine the concentrations used in subsequent experiments. PC9/GR cells were divided into blank group （complete medium）， YQYYJD group （5 g·L^-1）， cisplatin group （12 mg·L^-1）， and combined group （YQYYJD 5 g·L^-1 + cisplatin 12 mg·L^-1）. After 24 hours of intervention， cell viability was measured using CCK-8 assay. Cell proliferation was assessed by colony formation assay， and cell migration was evaluated by scratch and Transwell assays. Glucose consumption， lactate production， and adenosine triphosphate （ATP） levels were measured by colorimetric assays. The expression levels of glycolysis-related proteins， including hexokinase 2 （HK2）， phosphofructokinase P （PFKP）， pyruvate kinase M2 （PKM2）， lactate dehydrogenase A （LDHA）， glucose transporter 1 （GLUT1）， and monocarboxylate transporter 4 （MCT4）， were determined by Western blot. ResultsBoth YQYYJD and cisplatin inhibited the viability of PC9/GR cells in a concentration-dependent manner. The IC₅₀ of PC9/GR cells for YQYYJD and cisplatin were 5.15 g·L^-1 and 12.91 mg·L^-1， respectively. In terms of cell proliferation， compared with the blank group， the cell survival rate and the number of colonies formed in the YQYYJD group， cisplatin group， and combined group were significantly decreased （P<0.01）. Compared with the YQYYJD and cisplatin groups， the combined group showed a further significant reduction in cell survival rate and colony formation （P<0.01）. In terms of cell migration， compared with the blank group， the cell migration rate and the number of cells passing through the Transwell membrane in the YQYYJD group， cisplatin group， and combined group were significantly decreased （P<0.01）. Compared with the YQYYJD and cisplatin groups， the combined group exhibited a further significant reduction in cell migration rate and the number of cells passing through the Transwell membrane （P<0.01）. In terms of glycolysis， compared with the blank group， glucose consumption， lactate production， and ATP levels in the YQYYJD group， cisplatin group， and combined group were significantly decreased （P<0.01）. Compared with the YQYYJD and cisplatin groups， the combined group showed a further significant reduction in glucose consumption， lactate production， and ATP levels （P<0.05）. Compared with the blank group， the protein expression levels of HK2， PFKP， PKM2， and LDHA in the YQYYJD， cisplatin， and combined groups were significantly decreased （P<0.01）. The combined group showed a further significant reduction in the expression levels of these proteins compared with the YQYYJD and cisplatin groups （P<0.01）. No significant differences were observed in the protein expression levels of GLUT1 and MCT4 among the groups. ConclusionYQYYJD can synergistically inhibit the proliferation and migration of PC9/GR cells and enhance their sensitivity to cisplatin. The mechanism may be related to the downregulation of the expression of glycolysis-related rate-limiting enzymes， including HK2， PFKP， PKM2， and LDHA， thereby inhibiting glycolysis.

Objective To explore the safety of Yttrium-90 resin microsphere selective internal radiation therapy (⁹⁰Y-SIRT) on malignant liver tumors. Methods A retrospective analysis was conducted on 64 patients with malignant liver tumors who underwent ⁹⁰Y-SIRT from February 2023 to November 2024 at Weifang People’s Hospital. The clinical characteristics of the patients and the occurrence of adverse reactions after treatment were analyzed to assess the safety of ⁹⁰Y-SIRT. Results Among the 64 patients, there were 52 males (81.25%) and 12 females (18.75%); the average age was (56.29±11.08) years. Seven patients (10.94%) had tumors with maximum diameter of less than 5 cm, 38 patients (59.38%) had tumors with maximum diameter of 5-10 cm, and 19 patients (29.68%) had tumors with maximum diameter of greater than 10 cm. There were 47 cases (73.44%) of solitary lesions and 17 cases (26.56%) of multiple lesions; 53 cases (82.81%) were primary liver cancers and 11 cases (17.19%) were metastatic liver cancers. Of the 64 patients, 63 successfully completed the Technetium-99m macroaggregated albumin (^99mTc-MAA) perfusion test and received the ⁹⁰Y-SIRT; one patient received ⁹⁰Y-SIRT after the second ^99mTc-MAA perfusion test due to a work error. The most common adverse reactions included grade 1 alanine aminotransferase (ALT) elevation in 26 cases (40.62%) and grade 2 in 2 cases (9.37%), grade 1 aspartate aminotransferase (AST) elevation in 27 cases (42.18%) and grade 2 in 7 cases (10.93%); grade 1 nausea in 17 cases (26.56%) and grade 2 in 6 cases (9.37%); grade 1 abdominal pain in 12 cases (18.75%), grade 2 in 5 cases (7.81%), and grade 3 in 1 case (1.56%); grade 1 vomiting in 11 cases (17.18%), grade 2 in 5 cases (7.81%), and grade 3 in 1 case (1.56%). Conclusion The adverse reactions of ⁹⁰Y-SIRT for treating malignant liver tumors are mild, indicating good safety.