Objective:To identify independent risk factors for early recurrence following curative resection of resectable pancreatic cancer and establish a nomogram prediction model.Methods:Clinical data from 405 patients with resectable pancreatic cancer treated at Renji Hospital, Shanghai Jiao Tong University School of Medicine from February 2010 to December 2020 were retrospectively reviewed. Patients were stratified into a training cohort (265 patients form February 2010 to December 2018) and a validation cohort (140 patients from January 2019 to December 2020) based on surgery dates. Optimal cutoff values for clinical variables were determined using X-tile software. Independent risk factors were identified through univariate and multivariate Cox proportional hazards regression analyses. Kaplan-Meier curves for recurrence-free survival (RFS) were generated across subgroups, and a nomogram was developed to predict early recurrence (within 1 year post-surgery). Time-dependent receiver operating characteristic (tROC) curves was drawn and area under the curve (AUC) metrics were utilized to evaluate predictive accuracy, while model reliability was assessed by calibration curves. Individualized risk scores derived from the nomogram were stratified into high- and low-risk groups using X-tile-derived cutoff values. Survival differences between groups were analyzed via log-rank tests. The clinical application value was judged by decision curve analysis (DCA) compared to TNM staging. Results:In the training cohort, 139 patients (52.45%) experienced early recurrence, with a median RFS of 11.1 months [interquartile range ( IQR): 6.0-26.0]. The validation cohort reported 70 early recurrences (50.00%) and a median RFS of 11.8 months ( IQR: 4.9-21.4). Univariate analysis revealed significant associations between early recurrence and tumor diameter, carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 125 (CA125), systemic immune-inflammation index (SⅡ), and prognostic nutritional index (PNI). Multivariate analysis identified tumor diameter ≥3.75 cm ( HR=1.718, 95% CI 1.223-2.412, P=0.002), CA19-9≥218 U/ml ( HR=1.567, 95% CI 1.107-2.220, P=0.011), CA125≥20.98 U/ml ( HR=2.501, 95% CI 1.768-3.539, P<0.001), SⅡ≥388.28 ( HR=1.708, 95% CI 1.096-2.662, P=0.018), and PNI<53.18 ( HR=0.596, 95% CI 0.404-0.879, P=0.009) as independent risk factors for early recurrence. The nomogram achieved AUC values of 0.771 and 0.708 in the training and validation cohorts, respectively. Calibration curves demonstrated strong agreement between predicted and observed survival probabilities. Kaplan-Meier analysis revealed significantly lower 1-year RFS rates in high-risk versus low-risk groups for both cohorts (training: HR=3.65, 95% CI 2.45-5.44, P<0.001; validation: HR=2.37, 95% CI 1.39-4.06, P=0.001). DCA indicated superior net benefit of the nomogram over TNM staging across threshold probabilities of 0.2-0.9. Conclusions:The proposed nomogram effectively integrates clinical and serological biomarkers to preoperatively assess early recurrence risk in resectable pancreatic cancer patients, offering enhanced precision for clinical decision-making.

[Objective]To investigate the mechanism action of Yiqi Bushen Formula on the proliferation and migration of gastric cancer stem cells(GCSCs).[Methods]SGC-7901 GCSCs with double positive markers of CD44 and epithelial cell adhesion molecule(EpCAM)were sorted by immunomagnetic beads.The selected CD44+EpCAM+SGC-7901 GCSCs were subcultured and stably transfected with circ_0051246 control,pcDNA circ_0051246 and si-circ_0051246 respectively.The above four groups of cells(including untransfected)were divided into three subgroups:blank control group,negative control group and Yiqi Bushen Formula group.The blank control group was normally subcultured,the negative control group was intervened with blank serum,and the Yiqi Bushen Formula group was intervened with Yiqi Bushen Formula-containing serum.The microstructure of SGC-7901 GCSCs was observed by laser confocal and transmission electron microscopy.Cell counting kit-8(CCK-8)and cell cloning experiments were used to detect the proliferation ability of SGC-7901 GCSCs.Flow cytometry was used to detect the positive rate of CD44 and EpCAM and the apoptosis rate.Cell scratch test and transwell were used to detect the migration and invasion ability of SGC-7901 GCSCs.The expression of circ_0051246 in each experimental group was detected by quantitative reverse transcription-polymerase chain reaction(qRT-PCR).[Results]Compared with respective negative control group,the number of mitochondrial cristae in each group of Yiqi Bushen Formula was significantly reduced,the endoplasmic reticulum was significantly swollen.Compared with respective blank control group,the expression of actin in the cytoskeleton structure of each group of Yiqi Bushen Formula was significantly decreased.Compared with respective negative control group,the cell proliferation ability of Yiqi Bushen Formula groups was weakened(P＜0.05,P＜0.01),the rate of double positive cells of CD44 and EpCAM antibodies was significantly decreased(P＜0.01),the cloning ability was significantly decreased(P＜0.01),the apoptosis rate was significantly increased(P＜0.01),the migration rate was significantly decreased at 24 and 48 h(P＜0.05,P＜0.01),the number of cell migration and invasion was significantly reduced(P＜0.01).The expression level of circ_0051246 in Yiqi Bushen Formula group was significantly decreased(P＜0.01).[Conclusion]Yiqi Bushen Formula may play a role in anti-proliferation and migration of GCSCs by inhibiting the expression of circ_0051246 and reducing the expression of SGC-7901 CSCs surface markers CD44 and EpCAM,which provides a new idea for the treatment of gastric cancer.

Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

Objective To explore the clinical efficacy,safety and changes in sexual function of 450 nm blue laser vaporization resection of the prostate in the treatment of benign prostatic hyperplasia(BPH).Methods The clinical data of 132 BPH patients treated in Yingsheng Branch of Taian Central Hospital during Jan.and Oct.2023 were retrospectively analyzed.The perioperative related indicators,incidence of complications were recorded.The international prostate symptoms(IPSS)score,maximum urine flow rate(Qmax),post voiding residual(PVR),quality of life score(QoL),prostate-specific antigen(PSA)level,the Chinese index of premature ejaculation score(CIPE)and international erectile function index-5(IIEF-5)score before operation,and 1,3,6,and 12 months after operation were analyze.Results The operation time was(18.37±5.38)min,intraoperative blood loss(6.73±2.57)mL,postoperative hospital stay(4.31±1.54)d,catheter indwelling time(2.45±1.27)d,and bladder irrigation time(19.61±2.45)h.There were significant differences in Qmax,PVR,PSA level,QoL and IPSS before and after operation(P＜0.05).There was no statistically significant difference in IIEF-5 and CIPE before operation and 3,6 and 12 months after operation(P＞0.05).The retrograde ejaculation rate remained 6.25％3,6 and 12 months after operation.Conclusion The 450 nm blue laser vaporization resection of the prostate can relieve lower urinary tract symptoms,preserve the sexual function,and improve patients'quality of life.

Objective To explore the clinical efficacy,safety and changes in sexual function of 450 nm blue laser vaporization resection of the prostate in the treatment of benign prostatic hyperplasia(BPH).Methods The clinical data of 132 BPH patients treated in Yingsheng Branch of Taian Central Hospital during Jan.and Oct.2023 were retrospectively analyzed.The perioperative related indicators,incidence of complications were recorded.The international prostate symptoms(IPSS)score,maximum urine flow rate(Qmax),post voiding residual(PVR),quality of life score(QoL),prostate-specific antigen(PSA)level,the Chinese index of premature ejaculation score(CIPE)and international erectile function index-5(IIEF-5)score before operation,and 1,3,6,and 12 months after operation were analyze.Results The operation time was(18.37±5.38)min,intraoperative blood loss(6.73±2.57)mL,postoperative hospital stay(4.31±1.54)d,catheter indwelling time(2.45±1.27)d,and bladder irrigation time(19.61±2.45)h.There were significant differences in Qmax,PVR,PSA level,QoL and IPSS before and after operation(P＜0.05).There was no statistically significant difference in IIEF-5 and CIPE before operation and 3,6 and 12 months after operation(P＞0.05).The retrograde ejaculation rate remained 6.25％3,6 and 12 months after operation.Conclusion The 450 nm blue laser vaporization resection of the prostate can relieve lower urinary tract symptoms,preserve the sexual function,and improve patients'quality of life.

[Objective]To investigate the mechanism action of Yiqi Bushen Formula on the proliferation and migration of gastric cancer stem cells(GCSCs).[Methods]SGC-7901 GCSCs with double positive markers of CD44 and epithelial cell adhesion molecule(EpCAM)were sorted by immunomagnetic beads.The selected CD44+EpCAM+SGC-7901 GCSCs were subcultured and stably transfected with circ_0051246 control,pcDNA circ_0051246 and si-circ_0051246 respectively.The above four groups of cells(including untransfected)were divided into three subgroups:blank control group,negative control group and Yiqi Bushen Formula group.The blank control group was normally subcultured,the negative control group was intervened with blank serum,and the Yiqi Bushen Formula group was intervened with Yiqi Bushen Formula-containing serum.The microstructure of SGC-7901 GCSCs was observed by laser confocal and transmission electron microscopy.Cell counting kit-8(CCK-8)and cell cloning experiments were used to detect the proliferation ability of SGC-7901 GCSCs.Flow cytometry was used to detect the positive rate of CD44 and EpCAM and the apoptosis rate.Cell scratch test and transwell were used to detect the migration and invasion ability of SGC-7901 GCSCs.The expression of circ_0051246 in each experimental group was detected by quantitative reverse transcription-polymerase chain reaction(qRT-PCR).[Results]Compared with respective negative control group,the number of mitochondrial cristae in each group of Yiqi Bushen Formula was significantly reduced,the endoplasmic reticulum was significantly swollen.Compared with respective blank control group,the expression of actin in the cytoskeleton structure of each group of Yiqi Bushen Formula was significantly decreased.Compared with respective negative control group,the cell proliferation ability of Yiqi Bushen Formula groups was weakened(P＜0.05,P＜0.01),the rate of double positive cells of CD44 and EpCAM antibodies was significantly decreased(P＜0.01),the cloning ability was significantly decreased(P＜0.01),the apoptosis rate was significantly increased(P＜0.01),the migration rate was significantly decreased at 24 and 48 h(P＜0.05,P＜0.01),the number of cell migration and invasion was significantly reduced(P＜0.01).The expression level of circ_0051246 in Yiqi Bushen Formula group was significantly decreased(P＜0.01).[Conclusion]Yiqi Bushen Formula may play a role in anti-proliferation and migration of GCSCs by inhibiting the expression of circ_0051246 and reducing the expression of SGC-7901 CSCs surface markers CD44 and EpCAM,which provides a new idea for the treatment of gastric cancer.

Objective:To identify independent risk factors for early recurrence following curative resection of resectable pancreatic cancer and establish a nomogram prediction model.Methods:Clinical data from 405 patients with resectable pancreatic cancer treated at Renji Hospital, Shanghai Jiao Tong University School of Medicine from February 2010 to December 2020 were retrospectively reviewed. Patients were stratified into a training cohort (265 patients form February 2010 to December 2018) and a validation cohort (140 patients from January 2019 to December 2020) based on surgery dates. Optimal cutoff values for clinical variables were determined using X-tile software. Independent risk factors were identified through univariate and multivariate Cox proportional hazards regression analyses. Kaplan-Meier curves for recurrence-free survival (RFS) were generated across subgroups, and a nomogram was developed to predict early recurrence (within 1 year post-surgery). Time-dependent receiver operating characteristic (tROC) curves was drawn and area under the curve (AUC) metrics were utilized to evaluate predictive accuracy, while model reliability was assessed by calibration curves. Individualized risk scores derived from the nomogram were stratified into high- and low-risk groups using X-tile-derived cutoff values. Survival differences between groups were analyzed via log-rank tests. The clinical application value was judged by decision curve analysis (DCA) compared to TNM staging. Results:In the training cohort, 139 patients (52.45%) experienced early recurrence, with a median RFS of 11.1 months [interquartile range ( IQR): 6.0-26.0]. The validation cohort reported 70 early recurrences (50.00%) and a median RFS of 11.8 months ( IQR: 4.9-21.4). Univariate analysis revealed significant associations between early recurrence and tumor diameter, carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 125 (CA125), systemic immune-inflammation index (SⅡ), and prognostic nutritional index (PNI). Multivariate analysis identified tumor diameter ≥3.75 cm ( HR=1.718, 95% CI 1.223-2.412, P=0.002), CA19-9≥218 U/ml ( HR=1.567, 95% CI 1.107-2.220, P=0.011), CA125≥20.98 U/ml ( HR=2.501, 95% CI 1.768-3.539, P<0.001), SⅡ≥388.28 ( HR=1.708, 95% CI 1.096-2.662, P=0.018), and PNI<53.18 ( HR=0.596, 95% CI 0.404-0.879, P=0.009) as independent risk factors for early recurrence. The nomogram achieved AUC values of 0.771 and 0.708 in the training and validation cohorts, respectively. Calibration curves demonstrated strong agreement between predicted and observed survival probabilities. Kaplan-Meier analysis revealed significantly lower 1-year RFS rates in high-risk versus low-risk groups for both cohorts (training: HR=3.65, 95% CI 2.45-5.44, P<0.001; validation: HR=2.37, 95% CI 1.39-4.06, P=0.001). DCA indicated superior net benefit of the nomogram over TNM staging across threshold probabilities of 0.2-0.9. Conclusions:The proposed nomogram effectively integrates clinical and serological biomarkers to preoperatively assess early recurrence risk in resectable pancreatic cancer patients, offering enhanced precision for clinical decision-making.

Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

Objective:To further improve the understanding of paroxysmal nocturnal hemoglobinuria (PNH), we retrospectively analyzed and summarized the clinical characteristics, treatment status, and survival status of patients with PNH in Zhejiang Province.Methods:This study included 289 patients with PNH who visited 20 hospitals in Zhejiang Province. Their clinical characteristics, comorbidity, laboratory test results, and medications were analyzed and summarized.Results:Among the 289 patients with PNH, 148 males and 141 females, with a median onset age of 45 (16-87) years and a peak onset age of 20-49 years (57.8% ). The median lactic dehydrogenase (LDH) level was 1 142 (604-1 925) U/L. Classified by type, 70.9% (166/234) were classical, 24.4% (57/234) were PNH/bone marrow failure (BMF), and 4.7% (11/234) were subclinical. The main clinical manifestations included fatigue or weakness (80.8%, 235/289), dizziness (73.4%, 212/289), darkened urine color (66.2%, 179/272), and jaundice (46.2%, 126/270). Common comorbidities were hemoglobinuria (58.7% ), renal dysfunction (17.6% ), and thrombosis (15.0% ). Moreover, 82.3% of the patients received glucocorticoid therapy, 70.9% required blood transfusion, 30.7% used immunosuppressive agents, 13.8% received anticoagulant therapy, and 6.3% received allogeneic hematopoietic stem cell transplantation. The 10-year overall survival (OS) rate was 84.4% (95% CI 78.0% -91.3% ) . Conclusion:Patients with PNH are more common in young and middle-aged people, with a similar incidence rate between men and women. Common clinical manifestations include fatigue, hemoglobinuria, jaundice, renal dysfunction, and recurrent thrombosis. The 10-year OS of this group is similar to reports from other centers in China.

Objective To explore the effect of the astigmatism precise positioning marker used in small incision lent-icule extraction(SMILE)to correct myopic astigmatism.Methods A total of 120 patients(120 right eyes)with myopic astigmatism between-5.00 D and-1.25 D,who underwent SMILE in our hospital from January to December 2022,were selected in this study.According to the random number table,the patients were divided into the marking group(60 eyes)and the non-marking group(60 eyes).The patients in the marking group were marked by surgeons using the astigmatism precise positioning marker developed by our department.All patients were examined before operation and at 1 day,1 week and 3 months after operation,and the data such as uncorrected visual acuity(UCVA),best corrected visual acuity(BC-VA),and computer optometry results were collected before and 3 months after operation.The vector analysis tools were used to calculate the relevant astigmatism evaluation indicators:absolute value of the difference vector(|DV|),correction index(CI),and absolute value of the angle of error(|AofE|).Higher-order aberrations,including spherical aberration,coma aberration and clover aberration,were measured by Nidek refractive analyzer.Relevant data of patients in the two groups were statistically analyzed using the SPSS 26.0 software.Results There was no significant difference in the BC-VA,spherical and cylindrical power between the two groups before operation(all P＞0.05).At 3 months after operation,the UCVA(logMAR)in the marking group was better than that in the non-marking group(P＜0.05),while the spherical and cylindrical power showed no significant difference between the two groups(both P＞0.05).There was no significant difference in|DV|and CI between the two groups at 3 months after operation(both P＞0.05).The|AofE|in the marking group was significantly lower than that in the non-marking group at 3 months after operation(P＜0.05).There was no sig-nificant difference in coma,trefoil and spherical aberrations between the two groups before operation(all P＞0.05).The coma,trefoil and spherical aberrations in the two groups significantly increased at 3 months after operation(all P＜0.05).The coma aberration in the marking group was smaller than that in the non-marking group at 3 months after operation(P＜0.05).Conclusion SMILE with the marking by the astigmatism precise positioning marker can better correct astigma-tism,optimize the coma aberration caused by SMILE,and improve the visual quality of patients.