Objective:To investigate the clinical efficacy of intraoperative regional lymph-adenectomy and extended lymphadenectomy in resectable hilar cholangiocarcinoma.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 187 patients of hilar cholangiocarcinoma who were admitted to Henan University People′s Hospital from January 2014 to January 2018 were collected. There were 105 males and 82 females, aged (57±9)years. Of the 187 patients, 62 patients undergoing hilar cholangiocarcinoma resection with extended lymphadenectomy were divided into the extended group, and 125 patients under-going hilar cholangiocarcinoma resection with regional lymphadenectomy were divided into the regional group. Observation indicators:(1) propensity score matching status and comparison of clinical data of patients between the two groups after matching; (2) intraoperative and postoperative conditions; (3) follow-up. Comparison of measurement data with normal distribu-tion between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the rank sum test. The Kaplan-Meier method was used to plot calculate survival rate and survival curve. The Log-rank test was used for survival analysis. Propen-sity score matching was performed using the 1∶1 nearest neighbor matching method, with the caliper value of 0.1. Results:(1) Propen-sity score matching status and comparison of clinical data of patients between the two groups after matching. Of the 187 patients, 104 patients were success-fully matched, with 52 cases in each of the extended group and the regional group. After propensity score matching, the elimination of tumor diameter, neural invasion, Bismuth classification, and TNM staging confounding bias ensured comparability. (2) Intraoperative and postoperative conditions. After pro-pensity score matching, the operation time of the extended group was (341±83)minutes, the number of lymph node dissected was 12.3±4.5, the number of positive lymph node dissected was 2.2±0.7, cases of postoperative new lymphadenectasis was 17. The above indicators of the regional group were (311±73)minutes, 9.2±3.4, 1.5±0.5, 44, respectively. There were significant differences in the above indica-tors between patients of the two groups ( t=-1.99, -3.92, -5.57, χ2=31.18, P<0.05). (3) Follow-up. After propensity score matching, all 104 patients were followed up after surgery, with the follow-up time of 29(range, 3-49)months. The postoperative 3-year overall survival rate was 44.2% of the extended group, versus 30.8% of the regional group, showing a significant difference between the two groups ( χ2=4.41, P<0.05). Conclusions:The perioperative safety of regional lymphadenec-tomy and extended lymphadenectomy in the radical resection of hilar cholangiocarcinoma are com-parable. Extended lymphadenectomy can increase the number of positive lymph node detected and improve the postoperative survival rate of patients.

Objective:To investigate the clinical efficacy of intraoperative regional lymph-adenectomy and extended lymphadenectomy in resectable hilar cholangiocarcinoma.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 187 patients of hilar cholangiocarcinoma who were admitted to Henan University People′s Hospital from January 2014 to January 2018 were collected. There were 105 males and 82 females, aged (57±9)years. Of the 187 patients, 62 patients undergoing hilar cholangiocarcinoma resection with extended lymphadenectomy were divided into the extended group, and 125 patients under-going hilar cholangiocarcinoma resection with regional lymphadenectomy were divided into the regional group. Observation indicators:(1) propensity score matching status and comparison of clinical data of patients between the two groups after matching; (2) intraoperative and postoperative conditions; (3) follow-up. Comparison of measurement data with normal distribu-tion between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the rank sum test. The Kaplan-Meier method was used to plot calculate survival rate and survival curve. The Log-rank test was used for survival analysis. Propen-sity score matching was performed using the 1∶1 nearest neighbor matching method, with the caliper value of 0.1. Results:(1) Propen-sity score matching status and comparison of clinical data of patients between the two groups after matching. Of the 187 patients, 104 patients were success-fully matched, with 52 cases in each of the extended group and the regional group. After propensity score matching, the elimination of tumor diameter, neural invasion, Bismuth classification, and TNM staging confounding bias ensured comparability. (2) Intraoperative and postoperative conditions. After pro-pensity score matching, the operation time of the extended group was (341±83)minutes, the number of lymph node dissected was 12.3±4.5, the number of positive lymph node dissected was 2.2±0.7, cases of postoperative new lymphadenectasis was 17. The above indicators of the regional group were (311±73)minutes, 9.2±3.4, 1.5±0.5, 44, respectively. There were significant differences in the above indica-tors between patients of the two groups ( t=-1.99, -3.92, -5.57, χ2=31.18, P<0.05). (3) Follow-up. After propensity score matching, all 104 patients were followed up after surgery, with the follow-up time of 29(range, 3-49)months. The postoperative 3-year overall survival rate was 44.2% of the extended group, versus 30.8% of the regional group, showing a significant difference between the two groups ( χ2=4.41, P<0.05). Conclusions:The perioperative safety of regional lymphadenec-tomy and extended lymphadenectomy in the radical resection of hilar cholangiocarcinoma are com-parable. Extended lymphadenectomy can increase the number of positive lymph node detected and improve the postoperative survival rate of patients.

Objective:To analyze the influencing factors of achieving textbook outcome (TO) after pancreaticoduodenectomy (PD) in patients with pancreatic ductal adenocarcinoma, and to construct a nomograph model to explore its predictive value in TO.Methods:The clinical data of 205 patients with pancreatic ductal adenocarcinoma treated by PD in Henan University People's Hospital from January 2019 to December 2022 were analyzed retrospectively, including 88 males and 117 females with the age of (61.3±9.8) years old. Patients were divided into two groups based on whether they achieved TO after surgery: TO group ( n=113) and non-TO group ( n=92). Clinical data such as age, gender, intraoperative blood loss, operation time, blood transfusion volume, pancreatic CT value, and tumor differentiation degree were collected. Logistic regression analysis screened the influencing factors of PD postoperative TO and built a nomogram model. The performance of the nomogram model was evaluated using receiver operating characteristic (ROC) curve, calibration diagram, and decision curve analysis. Results:Multivariate logistic regression analysis showed that the higher the degree of tumor differentiation was in patients with pancreatic ductal adenocarcinoma (high differentiation to medium differentiation: OR=7.20, 95% CI: 1.20-43.28; high differentiation to low differentiation: OR=16.55, 95% CI: 2.01-136.11), CT value>38.45 Hu ( OR=0.29, 95% CI: 0.13-0.65), blood transfusion volume ≤350 ml ( OR=8.05, 95% CI: 2.94-22.01) and operative time ≤407.5 min ( OR=10.88, 95% CI: 3.90-30.41), the easier it was to achieve TO after PD (all P<0.05). Based on the above influencing factors, a nomogram model of the postoperative effect of PD on TO was established, and the consistency index of this column graph model was 0.863 (95% CI: 0.816-0.911). The sensitivity and specificity of ROC curve were 0.804 and 0.752, respectively. The calibration diagram showed that the calibration curve fits well with the ideal curve, and the decision curve showed that the model had obvious positive net benefit. Conclusion:The degree of tumor differentiation, CT value, blood transfusion volume, and operation time are independent influencing factors for the achievement of TO after PD in patients with pancreatic ductal adenocarcinoma, and the nomogram model constructed based on which has good predictive performance for TO.

Objective:To analyze the influencing factors of not achieving textbook outcome (TO) after laparoscopic radical surgery in patients with malignant pancreatic body and tail tumor, and to establish and evaluate a nomogram for predicting the failure to achieve TO.Methods:The clinical data of 111 patients with malignant pancreatic body and tail tumors undergoing laparoscopic radical surgery in the Department of Hepatobiliary and Pancreatic Surgery in Henan Provincial People's Hospital from January 2020 to December 2022 were retrospectively analyzed, including 44 males and 67 females, aged (53.8±14.7) years. All patients were staged TNM I to II, including pancreatic ductal adenocarcinoma ( n=102, 91.9%), pancreatic neuroendocrine tumor ( n=5, 4.5%), and pancreatic intraductal papillary mucinous tumors ( n=4, 3.6%). The patients were randomly divided into a training set ( n=78) and a test set ( n=33) at a ratio of 7∶3. The 78 patients in the training set were further divided into TO group ( n=28) and control group ( n=50, not achieving TO). Based on the univariate and multivariate logistic regression analysis of training set, the influencing factors of failure to achieve TO after laparoscopic radical surgery in patients with pancreatic body and tail tumor were analyzed. A nomogram based on the multi-factors were established to predict the failure to achieve TO. Receiver operating characteristic (ROC) curve, calibration curve, decision curve analysis (DCA) were utilized to evaluate the nomogram. Results:There were significant differences in tumor diameter, positive lymph nodes, operation time and CT value of pancreas between the TO and control groups (all P<0.05). Multivariate logistic regression analysis showed that tumor diameter >4 cm ( OR=9.673, 95% CI: 2.198-42.579), positive lymph node ( OR=5.385, 95% CI: 1.514-19.154), pancreatic CT value ( OR=0.594, 95% CI: 0.392-0.902) were the influencing factors for patients who did not achieve TO (all P<0.05). Based on the results of multiple factors, a nomogram was established to predict the failure to achieve TO after laparoscopic radical surgery. The area under the ROC curve of the nomogram was 0.849 (95% CI: 0.757-0.940) and 0.873 (95% CI: 0.730-1.000) in the training and test sets, respectively. The calibration curve was close to the ideal curve and the predicted results of the nomogram matched well with the actual results. The DCA showed that the nomogram has obvious positive net benefit. Conclusion:The nomogram constructed with tumor diameter > 4 cm, positive lymph nodes and CT value of pancreas for prediction of the patients with pancreatic body and tail malignant tumor after laparoscopic radical surgery did not achieve TO has good performance.

Objective:To analyze the effect of sarcopenia on the prognosis of patients with hepatocellular carcinoma (HCC) after laparoscopic radical resection.Methods:Clinical data of 165 patients with HCC undergoing laparoscopic radical resection in Henan University People's Hospital from January 2018 to December 2021 were retrospectively analyzed, including 122 males and 43 females, aged (55.5±11.4) years. Patients were divided into sarcopenia group ( n=79) and control group (non-sarcopenia, n=86) according to the skeletal muscle index. The survivals were analyzed using the Kaplan-Meier method, and were compared by the log-rank test. Univariate and multivariate Cox regression were utilized to analyze the effect of sarcopenia on the prognosis of HCC after laparoscopic radical surgery. Results:The 1- and 3-year cumulative survival rates of control group were 96.4% and 81.2%, which were higher than those of the sarcopenia group (83.2% and 48.9%, respectively, χ2=19.67, P<0.001). The 1- and 3-year recurrence-free survival (RFS) rates of control group were 88.4% and 66.1%, which were higher than those of sarcopenia group (70.9% and 37.7%, respectively, χ2=18.80, P<0.001). Multivariate Cox regression analysis showed that the risk of recurrence ( HR=1.35, 95% CI: 1.20-1.59, P<0.001) and the risk of death ( HR=2.21, 95% CI: 1.23-3.41, P=0.001) after laparoscopic radical resection for HCC in patients with sarcopenia rises compared to non-sarcopenic patients. Conclusion:Sarcopenia is a risk factor for the survival and recurrence of HCC after laparoscopic radical surgery.

Objective:To establish a machine learning model to predict the risk of post hepatectomy liver dysfunction (PHLD) in patients with hilar cholangiocarcinoma (HCCA).Methods:Clinical data of 203 patients with HCCA undergoing open radical hemihepatectomy in Henan University People's Hospital from January 2017 to December 2023 were retrospectively analyzed, including 112 males and 91 females, aged 63 (55, 69) years. According to the diagnostic criteria for PHLD, patients were divided into two groups: PHLD group ( n=45) and non-PHLD group ( n=158). Clinical data such as age, sex, neutrophil count (NEU), systemic immunoinflammatory index (SII), nutritional prognosis index (PNI), neutrophil to lymphocyte ratio (NLR), operative time and complications were compared between the two groups. The variables with statistically significant difference between the two groups were included in seven machine learning models, namely logistic regression, random forest, extreme gradient boosting, light gradient boosting, decision tree, gaussian naive bayes and support vector machine. The area under receiver operating characteristic curve optimization model was adopted, and Shapliga sum-interpretation method (SHAP) was used to analyze and interpret the final optimal model. Results:There were statistically significant differences in age, preoperative data including management of jaundice, albumin, total bilirubin, aspartate aminotransferase, NEU, SII, PNI, and NLR, operative time, postoperative complication of Dindo-Clavien≥Grade Ⅲ, and the ratio of FLR/TLV between in the two groups (all P<0.05). Finally, it was determined that the prediction performance of the extreme gradient boosting model was the best, with an area under curve of 0.888 (95% CI: 0.776-0.985), an accuracy of 0.854, a sensitivity of 0.506, a specificity of 0.965, an F1 value of 0.625, and a Kappa value of 0.519. SHAP analysis of the extreme gradient boosting model showed that total bilirubin on admission, operation time, postoperative complication of Dindo-Clavien≥grade Ⅲ, SII and NEU were five important factors of this model, which were positively correlated with the occurrence of PHLD in HCCA patients. Conclusion:The extreme gradient boosting model established in this study has a good predictive performance and stability for PHLD in HCCA patients.

Objective:To establish a machine learning model to predict the risk of post hepatectomy liver dysfunction (PHLD) in patients with hilar cholangiocarcinoma (HCCA).Methods:Clinical data of 203 patients with HCCA undergoing open radical hemihepatectomy in Henan University People's Hospital from January 2017 to December 2023 were retrospectively analyzed, including 112 males and 91 females, aged 63 (55, 69) years. According to the diagnostic criteria for PHLD, patients were divided into two groups: PHLD group ( n=45) and non-PHLD group ( n=158). Clinical data such as age, sex, neutrophil count (NEU), systemic immunoinflammatory index (SII), nutritional prognosis index (PNI), neutrophil to lymphocyte ratio (NLR), operative time and complications were compared between the two groups. The variables with statistically significant difference between the two groups were included in seven machine learning models, namely logistic regression, random forest, extreme gradient boosting, light gradient boosting, decision tree, gaussian naive bayes and support vector machine. The area under receiver operating characteristic curve optimization model was adopted, and Shapliga sum-interpretation method (SHAP) was used to analyze and interpret the final optimal model. Results:There were statistically significant differences in age, preoperative data including management of jaundice, albumin, total bilirubin, aspartate aminotransferase, NEU, SII, PNI, and NLR, operative time, postoperative complication of Dindo-Clavien≥Grade Ⅲ, and the ratio of FLR/TLV between in the two groups (all P<0.05). Finally, it was determined that the prediction performance of the extreme gradient boosting model was the best, with an area under curve of 0.888 (95% CI: 0.776-0.985), an accuracy of 0.854, a sensitivity of 0.506, a specificity of 0.965, an F1 value of 0.625, and a Kappa value of 0.519. SHAP analysis of the extreme gradient boosting model showed that total bilirubin on admission, operation time, postoperative complication of Dindo-Clavien≥grade Ⅲ, SII and NEU were five important factors of this model, which were positively correlated with the occurrence of PHLD in HCCA patients. Conclusion:The extreme gradient boosting model established in this study has a good predictive performance and stability for PHLD in HCCA patients.

Objective To evaluate the in vitro synergistic effect of tetrandrine on ketoconazole against Candida parapsilosis complex.Methods According to the Clinical and Laboratory Standards Institute (CLSI) M27-A3 guidelines,the microdilution checkerboard method was used to evaluate in vitro antifungal activities of ketoconazole alone and in combination with tetrandrine against 21 clinical isolates of Candida parapsilosis complex based on the fractional inhibitory concentration index (FICI).Antifungal effects of the above drugs at different time points were evaluated by the XTT assay,and then time-killing curves were drawn and assessed to investigate the in vitro dynamic antifungal activity.Results The minimum inhibitory concentrations (MICs) of tetrandrine and ketoconazole alone against 21 clinical isolates of Candida parapsilosis complex were 32-64 mg/L and 0.031 25-2 mg/L,respectively.When ketoconazole was combined with tetrandrine,MICs of tetrandrine and ketoconazole were reduced to 2-8 mg/L and 0.008-0.25 mg/L respectively,and the FICI ranged from 0.09 to 0.5.The time-killing curves revealed that the fungal growth was delayed obviously in the combination group compared with the ketoconazole alone group and tetrandrine alone group.Conclusion Tetrandrine has obvious synergistic effects on ketoconazole against Candida parapsilosis complex in vitro.

OBJECTIVETo compare the clinical effect of the double eyelid blepharoplasty with central minimal incision and with three minimal incisions. Methods: From Jul. 2010 to May 2012, 268 cases (Group A) received double eyelid blepharoplasty with central minimal incision, while 102 cases (Group B) underwent double eyelid blepharoplasty with three minimal incisions. Photos were taken immediately, and 1,2, 4, 8,12 weeks after operation. Operation time, recovery time and postoperative complications were evaluated and recorded. The operation time and recovery time were analyzed by Wilcoxon rank sum test. The postoperative complications were analyzed by chi square test. The satisfactory degree was analyzed by t test.

RESULTSThe operation time in Group A was (25.63 ± 3.74) min, compared with that (29.90 ± 4.13) min in Group B (Z = -8.011, P <0.01). Meanwhile, the recovery time in Group A was shorter than that in Group B (Z = -15.887, P <0.01). The occurrence rate of postoperative complications,including hematoma,recurrence and scar hyperplasia in Group A was also lower than that in Group B. At the same time, the satisfactory degree in Group A was(97.302 ± 1.764), which was higher than that(88.628 10.880) in Group B (t = 12.650, P <0.05).

CONCLUSIONSThe double eyelid blepharoplasty with central minimal incision, which is suitable for all cases except those who has serious blepharochalsais, has more advantages than double eyelid blepharoplasty with three minimal incisions.

Blepharoplasty ; adverse effects ; methods ; Cicatrix ; pathology ; Eyelids ; surgery ; Hematoma ; Humans ; Hyperplasia ; Photography ; Postoperative Complications ; Prospective Studies ; Recurrence

In this study,adults of Armillifer agkistrodontis (A.agkistrodontis) were collected from Agkistrodon acutus,and then the eggs were separated to feed mice.In the next step,when the infection model was established,blood serum of infected mice were collected after 1,2 and 3 weeks,respectively.Furthermore,ELISA and dot- ELISA were used to detect the dynamic change of specific antibodies and circulating antigens respectively.The specific antibodies increased from 8th week,reached the top at 12th week,decreased from 16th week,and then maintain at the same level constantly.Meanwhile,the specific antibodies were typed.It is evident that IgM antibody appeared first.However,it was substitute by IgG1 after 16 weeks.Moreover,the circulating antigens have been detected in the 1st week by dot-ELISA.Then,the dilution between 1:8 to 1:128were founded in 3rd week.The highest dilution with 1:256 appeared at 8th week,maintained before 11th week and then decreased gradually,which might provide a significant clinical implication for early diagnosis of circulating antigens.