Objective To retrieve and evaluate relevant literatures on pain management for patients after hemorrhoidectomy and summarize the best evidence. Methods Based on the 6S evidence model, computer-based searches were conducted in relevant domestic and foreign databases for literatures related to pain after hemorrhoidectomy, including guidelines, expert consensus, systematic reviews, meta-analysis, and randomized controlled trial (RCT), from the establishment of the databases to March 12, 2023. The quality of evidence meeting the evaluation criteria was evaluated according to the corresponding literature evaluation criteria, and was summarized in combination with expert opinions. Results A total of 16 literatures were included (1 guideline, 6 expert consensus, 8 systematic reviews, and 1 RCT); the evidence included pain identification and assessment, drug management measures, traditional Chinese medicine therapy, and perioperative health education, eventually 21 pieces of evidence were extracted. Conclusion After hemorrhoidectomy, the most effective pain management plan should be developed based on the patient's condition and clinical status to relieve postoperative pain.

RNA N6-methyladenosine (m6A) modification is an important gene expression regulation mechanism of eukaryotes. The m6A modification mainly mediates the methylation of adenosine N6. It is a reversible epigenetic modification that not only occurs in messenger RNA (mRNA), but also occurs in non-coding RNA (ncRNA). In addition, RNA m6A modification participates in many physiological and pathological processes, and also plays an important role in the occurrence and development of tumors. This article reviews the role of RNA m6A modification in malignant tumors of the digestive system.

The traditional view is that breast reconstruction is not an option for day surgery center. As a result, few hospitals in the world conduct this operation in day surgery center. Endoscopic breast reconstruction with liposuction and robot-assisted breast reconstruction are minimally invasive surgeries for breast cancer patients, but they cannot be carried out in the day surgery center due to long operation time. The novel endoscopic-assisted immediate implant-based breast reconstruction after nipple sparing mastectomy through a single axillary incision for breast cancer patients has been successfully conducted in the day surgery center in our hospital due to short operation time and small trauma. Standardized management of the complete process from the patient selection to follow-up after discharge brings rapid recovery and few complications. At the same time, the development of endoscopic surgery makes the breast almost scarless and improves aesthetic results. Therefore, the mode of endoscopic-assisted reconstruction in the day surgery center of our hospital is expected to be popularized in the whole country.

The trends of age-associated change regarding lower facial fat compartments were different. The lower facial rejuvenation should be comprehensively evaluated according to the specific changes of the fat compartments, and master the anatomy of the lower blood vessels and nerves to improve the safety of clinical application. In recent years, the application of imaging methods in the study of facial fat compartments has helped to better understand the changes related to the aging of the lower part and provide new ideas for the effectiveness and safety of the volume recovery of the lower part. This article reviews the aging changes and applied anatomy of the fat compartments in the process of aging of the lower part, which helps surgeons to understand the related changes of aging of the lower part more deeply, and provides new theoretical basis and clinical enlightenment for the rejuvenationof the lower part based on the theory of fat rebalance.

The trends of age-associated change regarding lower facial fat compartments were different. The lower facial rejuvenation should be comprehensively evaluated according to the specific changes of the fat compartments, and master the anatomy of the lower blood vessels and nerves to improve the safety of clinical application. In recent years, the application of imaging methods in the study of facial fat compartments has helped to better understand the changes related to the aging of the lower part and provide new ideas for the effectiveness and safety of the volume recovery of the lower part. This article reviews the aging changes and applied anatomy of the fat compartments in the process of aging of the lower part, which helps surgeons to understand the related changes of aging of the lower part more deeply, and provides new theoretical basis and clinical enlightenment for the rejuvenationof the lower part based on the theory of fat rebalance.

Objective    To explore the surgical technique and preliminary results of endoscopic nipple-sparing mastectomy (E-NSM) and immediate pre-pectoral implant-based breast reconstruction (BR) with titanium-coated polypropylene mesh (TiLoop Bra) via single axillary incision for breast cancer patients. Methods    The clinical data of 9 consecutive female patients who underwent E-NSM and immediate pre-pectoral implant-based BR with TiLoop Bra from  March to May 2021 were retrospectively analyzed. The mean age of patients was 40.6 (22-60) years. The operation time, early complications were collected, and the patients' social and mental health, breast satisfaction and chest function before and after the operation were assessed with the BREAST-Q questionnaire. Results    All the patients had unicentric tumor with a mean diameter of 2.4 (0.6-4.7) cm. The mean distance from the tumor to the nipple was 2.5 (2-4) cm. There were 2 patients with tumor stage 0 and 7 patients with stageⅠ. The mean operation time was 161.1 (125-201) min, the mean blood loss was 41.1 mL and the hospital stay time was 1.5 d. There were 5 patients in the day-care unit. All the patients were successfully followed up with a median follow-up time of 1 (1-2) month. One (11.1%) patient with depigmentation of the nipple-areola complex caused by mild ischemia. None of the patients had incision complications, subcutaneous emphysema, hematoma, infection, nipple-areola or skin flaps necrosis, implant loss. During the follow-up period, no local/regional recurrence or distant metastasis was found. Chest well-being was decreased in the first month after the surgery compared with preoperative status, and the difference was statistically significant (P=0.001). There was no statistical difference in the breast satisfaction or psychosocial function scores between pre- and post-operation (P>0.05). Conclusion    E-NSM and immediate pre-pectoral implant-based BR with TiLoop Bra via single axillary incision has minimal trauma, rapid postoperative recovery, short operation time, few early complications and good early cosmetic effect, and the short-term result is satisfactory.

Objective To explore relationship between the nature of carotid atherosclerotic plaque and the number and function of endothelial progenitor cells in peripheral blood.Methods A prospective study of 80 carotid atherosclerotic plaque patients were selected from June 2016 to March 2017 in Guangdong Second Provincial General Hospital.All patients were examined with Cranial magnetic resonance imaging or X-ray computed tomography,pathological examination,carotid artery color Doppler ultrasonography.Patients were divided into hard plaque group (n =42) and soft plaque group (n =38) according to the nature of carotid atherosclerotic plaque.Forty healthy subjects were selected as controls.Monocytes were obtained from 10 ml of elbow venous blood by density gradient centrifugation.Adherent cells were cultured and identified by confocal laser microscopy.The number,migration,proliferation and adhesion of EPCs in soft plaque group and hard plaque group were evaluated.Results The number of proliferating cells (0.847 ± 0.037),migrating cells(27.697±8.248) and adherent cells (46.184± 7.876) in the normal control group were significantly higher than those in the hard plaque group ((0.647±0.019),(18.643±3.289),(32.165±4.325)) and the soft plaque group ((0.679± 0.023),(23.576± 6.327),(40.587±6.523)) (all P＜ 0.001),while the proliferation,migration and adherent cells in the hard plaque group were lower than those in the soft plaque group (all P＜0.001).Conclusion The nature of carotid atherosclerosis plaque is closely related to the number and function of endothelial progenitor cells in peripheral blood.The number of endothelial progenitor cells in carotid atherosclerosis patients with hard plaque is small,and their proliferation,migration and adhesion ability are impaired.

Objective To study the effect and mechanism of S1PR2 inhibition on epithelial ovarian cancer SKOV3 cell proliferation in vitro and in vivo. Methods(1)A pair of S1PR2 gene small interference RNA(siRNA),namely si-S1PR2,and a pair of negative control siRNA were designed.Western blot methods were used to detect the silence efficiency of the S1PR2 in the si-S1PR2 group,blank control group and negative control group.(2)Study in vitro: the experiment included three groups, namely si-S1PR2 group, blank control group and negative control group. Cell counting kit-8(CCK-8)assay was used to detect the proliferation inhibition rates of the transfected cells. The cell cycles of the transfected cells were measured by flow cytometry. Western blot was used to detect the levels of phosph-extracellular regulated protein kinase 1/2(p-ERK1/2)of the transfected cells.(3)Study in vivo:to establish intraperitoneal transplantation models, 8 mice in each group were intraperitoneally injected with 5×106SKOV3 cells. Phosphate buffered saline(PBS)or JTE-013 were administered into mice twice per week starting on day 7 after the injection of the cancer cells. Twenty-eight days after nude mice intraperitoneal injection with JTE-013 or PBS,the mice were sacrificed and the number and the weight of visible tumors were calculated. Results(1)The results of western blot showed that the relative S1PR2 protein expression levels were 0.24±0.04 in the si-S1PR2 group,which was lower than that in the blank control group(1.10±0.14,P<0.01) and negative control group(1.07 ± 0.13, P<0.01).(2)The results of CCK-8 assay indicated that after transfected for 24, 48 and 72 hours, the proliferation inhibition rate of si-S1PR2 group were respectively (26.6±3.3)%,(35.0±3.4)%,and(34.0±2.8)%,significantly lower than those in the blank control group (all 0;all P<0.01)and negative control group[(1.7±0.9)%,(2.5±0.5)%,and(2.4±1.1)% respectively;all P<0.01].The results of flow cytometry showed that the G0/G1ratio in the si-S1PR2 group[(70.9±2.8)%]was significantly higher than those in the blank control group[(61.7±2.4)%,P<0.01]and negative control group [(62.1 ± 3.3)%, P<0.01]. Western blot showed that the relative expression level of p-ERK1/2 in si-S1PR2 group(0.11±0.03)was significantly lower than those in the blank control group[(0.62±0.09),P<0.01]and negative control group[(0.68±0.09),P<0.01].(3)Twenty-eight days after nude mice intraperitoneal injection with JTE-013 or PBS,the tumor number of the control group and JTE-013 group were respectively 15.4±4.3 and 8.2±3.7,the tumor weight were(0.45±0.12)and(0.21±0.07)g,respectively.The tumor number and weight in the JTE-013 group were significantly less than those in the control group(all P<0.01). Conclusions The growth of ovarian cancer cells could be decreased by S1PR2 inhibition in vitro and in vivo. One of the mechanisms of the growth inhibitory effect is probably that S1PR2 inhibition lower the phosphorylation level of extracellular regulated protein kinase 1/2(ERK1/2)pathway, which prevent the transformation of ovarian cancer cells from phase G1to S.

Objective To evaluate desmopressin stimulated inferior petrosal sinus sampling in diagnosing Cushing′s disease.Methods Sixteen ACTH-dependent Cushing′s disease patients underwent bilateral desmopressin stimulated inferior petrosal sinus ( IPS ) sampling because of negative or equivocal magnetic resonance imaging.Cortisol response to high-dose dexamethasone suppression test was also evaluated.ACTH sampling was taken from a peripheral vein and bilateral IPS before and both 5 and 10 min after injection of desmopressin.Diagnosis was based on the ratio of ACTH level in between IPS to peripheral vein by desmopressin test.Diagnosis was confirmed after surgery.Results High-dose dexamethasone suppression test showed suppressible in 9 of 16 patients with Cushing′s disease.An IPS gradient ＞2 was found in 14 of the 16 cases (87.5％ )with Cushing′s disease after desmopressin injection,while before injection the respective figure was 12 of 16 (75.0％).No severe adverse effects were observed during or after the procedure.Conclusion Desmopressin test during bilateral IPS sampling is a safe and effective diagnostic procedure in Cushing′s disease.