Thoracolumbar spine fracture often leads to severe pain, functional impairments, and neurological deficits, for which open reduction and internal fixation can effectively restore the spinal structural stability. Open decompression and reduction with internal fixation can help relieve spinal cord compression and improve spinal function in cases of concomitant cord injury. Although spinal stability can be restored through surgery, patients often face chronic pain and functional impairments postoperatively. A postoperative rehabilitation program is critical in optimizing therapeutic outcomes, reducing complications, and minimizing the risk of secondary injuries. However, current rehabilitation methods, such as physical therapy, functional training, and pain management, are confronted with problems in clinical practice, including significant variation in efficacy, poor patient adherence, and prolonged rehabilitation period. There is an urgent need for a unified rehabilitation strategy to address these problems. To this end, the Spinal Trauma Group of the Orthopedic Physicians Branch of the Chinese Medical Association and the Spine Health Professional Committee of the Chinese Human Health Technology Promotion Association organized experts from relevant fields to formulate Evidence-based guidelines for rehabilitation treatment after internal fixation of thoracolumbar spine fracture in adults ( version 2025) by integrating evidences from clinical researches and advanced rehabilitation concepts at home and abroad. A total number of 14 recommendations concerning the rehabilitation treatment with multimodal analgesia, psychological intervention, deep vein thrombosis prevention, core muscle and extremity exercise, appropriate use of braces, early weight-bearing, device-aided rehabilitation exercise, neuroregulatory therapy, rehabilitation team were put forward, aiming to standardize the post-operative rehabilitation process following internal fixation, promote the functional recovery, and enhance patients′ quality of life.

Objective:To establish and explore a novel model and its clinical application value based on abnormal des-gamma-carboxy prothrombin (DCP) for the early-stage diagnosis of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC).Methods:A total of 420 cases with chronic HBV infection with nodular liver lesions examined by imaging at the Third Hospital of Hebei Medical University from January 2021 to June 2024 were retrospectively selected. They were divided into the HBV-HCC group (182 cases) and the control group (238 cases) according to the current HCC diagnostic criteria. The basic information of patients, liver-related biochemical indicators, serum DCP, alpha-fetoprotein (AFP) levels, and the efficacy of combined detection in diagnosing early-stage HCC were collected and analyzed. A DSGAA model based on DCP (D) combined with gender (S), γ-glutamyl transferase (GGT, G), AFP (A) and age (A) as independent variables was constructed. The diagnostic performance of the novel model was compared with that of the traditional model through nomogram visualization output and calibration curve.Results:The age, sex, hemoglobin, albumin, alanine aminotransferase, alkaline phosphatase, and GGT levels were significantly higher in patients with HCC than those of the control group ( P<0.05). The positivity detection rate in patients with HBV-HCC was significantly higher in DCP than that of AFP (85.71% vs. 59.89%, P<0.05). The abnormal detection rate of DCP in patients with AFP-negative was 76.7%. The sensitivity for diagnosing HCC was significantly higher in DCP than AFP (73.63% vs. 64.29%, P<0.05), with specificity of 83.6% in all. The specificity for diagnosing early-stage HCC was 89.09%, surpassing that of AFP at 68.06% ( P<0.05). The area under the receiver operating characteristic curve (AUC) for the constructed DSGAA diagnostic model was 0.8841, with an optimal cutoff value of 0.377, a sensitivity of 80.22%, and a specificity of 86.13%. The AUC for diagnosing early-stage HCC was 0.8122, with a sensitivity of 66.18%, and a specificity of 86.13%, and the diagnostic efficacy was higher than other models ( P<0.05). Conclusion:DCP has superior diagnostic efficacy for HBV-related HCC, and the DSGAA model is expected to be used as a new method for screening and diagnosing early-stage HBV-related HCC.

Thoracolumbar spine fracture often leads to severe pain, functional impairments, and neurological deficits, for which open reduction and internal fixation can effectively restore the spinal structural stability. Open decompression and reduction with internal fixation can help relieve spinal cord compression and improve spinal function in cases of concomitant cord injury. Although spinal stability can be restored through surgery, patients often face chronic pain and functional impairments postoperatively. A postoperative rehabilitation program is critical in optimizing therapeutic outcomes, reducing complications, and minimizing the risk of secondary injuries. However, current rehabilitation methods, such as physical therapy, functional training, and pain management, are confronted with problems in clinical practice, including significant variation in efficacy, poor patient adherence, and prolonged rehabilitation period. There is an urgent need for a unified rehabilitation strategy to address these problems. To this end, the Spinal Trauma Group of the Orthopedic Physicians Branch of the Chinese Medical Association and the Spine Health Professional Committee of the Chinese Human Health Technology Promotion Association organized experts from relevant fields to formulate Evidence-based guidelines for rehabilitation treatment after internal fixation of thoracolumbar spine fracture in adults ( version 2025) by integrating evidences from clinical researches and advanced rehabilitation concepts at home and abroad. A total number of 14 recommendations concerning the rehabilitation treatment with multimodal analgesia, psychological intervention, deep vein thrombosis prevention, core muscle and extremity exercise, appropriate use of braces, early weight-bearing, device-aided rehabilitation exercise, neuroregulatory therapy, rehabilitation team were put forward, aiming to standardize the post-operative rehabilitation process following internal fixation, promote the functional recovery, and enhance patients′ quality of life.

Objective:To establish and explore a novel model and its clinical application value based on abnormal des-gamma-carboxy prothrombin (DCP) for the early-stage diagnosis of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC).Methods:A total of 420 cases with chronic HBV infection with nodular liver lesions examined by imaging at the Third Hospital of Hebei Medical University from January 2021 to June 2024 were retrospectively selected. They were divided into the HBV-HCC group (182 cases) and the control group (238 cases) according to the current HCC diagnostic criteria. The basic information of patients, liver-related biochemical indicators, serum DCP, alpha-fetoprotein (AFP) levels, and the efficacy of combined detection in diagnosing early-stage HCC were collected and analyzed. A DSGAA model based on DCP (D) combined with gender (S), γ-glutamyl transferase (GGT, G), AFP (A) and age (A) as independent variables was constructed. The diagnostic performance of the novel model was compared with that of the traditional model through nomogram visualization output and calibration curve.Results:The age, sex, hemoglobin, albumin, alanine aminotransferase, alkaline phosphatase, and GGT levels were significantly higher in patients with HCC than those of the control group ( P<0.05). The positivity detection rate in patients with HBV-HCC was significantly higher in DCP than that of AFP (85.71% vs. 59.89%, P<0.05). The abnormal detection rate of DCP in patients with AFP-negative was 76.7%. The sensitivity for diagnosing HCC was significantly higher in DCP than AFP (73.63% vs. 64.29%, P<0.05), with specificity of 83.6% in all. The specificity for diagnosing early-stage HCC was 89.09%, surpassing that of AFP at 68.06% ( P<0.05). The area under the receiver operating characteristic curve (AUC) for the constructed DSGAA diagnostic model was 0.8841, with an optimal cutoff value of 0.377, a sensitivity of 80.22%, and a specificity of 86.13%. The AUC for diagnosing early-stage HCC was 0.8122, with a sensitivity of 66.18%, and a specificity of 86.13%, and the diagnostic efficacy was higher than other models ( P<0.05). Conclusion:DCP has superior diagnostic efficacy for HBV-related HCC, and the DSGAA model is expected to be used as a new method for screening and diagnosing early-stage HBV-related HCC.

Objective:To investigate the feasibility of oblique overlap anastomosis plus single flap valvuloplasty (OSF) for reconstruction after laparoscopic proximal gastrectomy.Methods:The C-shaped seromuscular flap (2.5 × 3.5 cm), which was 2 cm from the top of the remnant stomach, was extracorporeally created on the anterior wall of the remnant stomach. The stomach was opened approximately 1.0 cm above the lower edge of the mucosal flap. Four supporting stitches were sutured around the hole and the right wall of the esophageal stump was incised with a support suture to prevent the linear stapler from entering the submucosa. Liner stapler was inclined to the left side of the esophagus at an angle of about 30 degrees to the longitudinal axis of the esophagus for oblique anastomosis between the dorsal side of the esophagus and the anterior stomach and then esophagogastrostomy was performed with the length of anastomosis was 4 cm. Entry hole was suture with 3 stitches and then the linear stapler was used for closing the entry hole. Finally, the seromuscular flap was closed using barbed sutures.Results:Clinical data of 11 patients with Siewert type II esophagogastric junction adenocarcinoma who underwent radical gastrectomy and reconstruction by OSF between January 2022 and May 2023 were retrospectively collected. There were 7 males and 4 females. The average age was (69.9±7.8) years, the BMI was (21.7±7.2) kg/m 2 and the tumor size was (2.1±0.6) cm. OSF reconstruction was successfully completed in all 11 patients. The median operative time was 275 (270-428) minutes, the time for OSF reconstruction was 112 (80-140) minutes, and the blood loss was 50 (20-400) ml. The pathological stage was 0-I in 7 cases and II-III in 4 cases. The patients were fed on the 4th day (4-7 days) and discharged from hospital on the 7th day (6-9 days) after surgery. No patient had gastroesophageal reflux symptoms of grade B and above, and no patient took anti-reflux medicine. Conclusions:OSF is a safe and feasible treatment for Siewert type II esophagogastric junction adenocarcinoma.

Objective:To investigate the feasibility of oblique overlap anastomosis plus single flap valvuloplasty (OSF) for reconstruction after laparoscopic proximal gastrectomy.Methods:The C-shaped seromuscular flap (2.5 × 3.5 cm), which was 2 cm from the top of the remnant stomach, was extracorporeally created on the anterior wall of the remnant stomach. The stomach was opened approximately 1.0 cm above the lower edge of the mucosal flap. Four supporting stitches were sutured around the hole and the right wall of the esophageal stump was incised with a support suture to prevent the linear stapler from entering the submucosa. Liner stapler was inclined to the left side of the esophagus at an angle of about 30 degrees to the longitudinal axis of the esophagus for oblique anastomosis between the dorsal side of the esophagus and the anterior stomach and then esophagogastrostomy was performed with the length of anastomosis was 4 cm. Entry hole was suture with 3 stitches and then the linear stapler was used for closing the entry hole. Finally, the seromuscular flap was closed using barbed sutures.Results:Clinical data of 11 patients with Siewert type II esophagogastric junction adenocarcinoma who underwent radical gastrectomy and reconstruction by OSF between January 2022 and May 2023 were retrospectively collected. There were 7 males and 4 females. The average age was (69.9±7.8) years, the BMI was (21.7±7.2) kg/m 2 and the tumor size was (2.1±0.6) cm. OSF reconstruction was successfully completed in all 11 patients. The median operative time was 275 (270-428) minutes, the time for OSF reconstruction was 112 (80-140) minutes, and the blood loss was 50 (20-400) ml. The pathological stage was 0-I in 7 cases and II-III in 4 cases. The patients were fed on the 4th day (4-7 days) and discharged from hospital on the 7th day (6-9 days) after surgery. No patient had gastroesophageal reflux symptoms of grade B and above, and no patient took anti-reflux medicine. Conclusions:OSF is a safe and feasible treatment for Siewert type II esophagogastric junction adenocarcinoma.

Objective:To investigate the relationship between micropapillary patten, cribriform pattern and retraction clefting of HPV associated endocervical adenocarcinoma and Silva classification and prognosis; and to validate the application and clinical significance of Silva system in endocervical adenocarcinoma.Methods:Cases of endocervical adenocarcinoma from January 2009 to November 2017 were selected from the Second Hospital of Jilin University and followed up. The morphologic characteristics of Silva classification, micropapillary patten, cribriform pattern and retraction clefting were observed and recorded. Inferential analysis was performed to compare clinicopathological variables data between pattern subgroups.Results:The study included 120 patients (ranging from 26 to 73 years) with an average age of (48.0±9.1)years. Silva A, B and C accounted for 9.2% (11/120), 18.3% (22/120) and 72.5% (87/120), respectively. Cases with micropapillary pattern accounted for 25.8%(31/120), of which six cases were Silva B and 25 cases were Silva C. Cases with cribriform pattern accounted for 53.3%(64/120), including three cases of Silva A, 17 cases of Silva B and 44 cases of Silva C. Retraction clefting occurred in 28.3%(34/120) cases, all were Silva C. The three morphologic features were associated with lymph node metastasis ( P<0.05). Univariate analysis showed that micropapillary pattern was related to prognosis of endocervical carcinoma ( P<0.05), while cribriform pattern, retraction clefting and Silva classification showed no correlation with overall survival and disease-free survival. Conclusions:The suggestion is revising the Silva C criteria by adding papillary patten and retraction clefting as factors and expanding the Silva pattern system to include more histologic variants. The Silva system is helpful to select appropriate operation before surgery, but its prognostic value requires further evaluation.

Traumatic scar can not only exert influence on appearance and function of patients, but also affect psychological health status and life quality of patients to varying degrees. At present, scholars have confirmed from basic research that mechanical tension promotes the proliferation of inflammatory cells, fibroblasts, and other cells, as well as angiogenesis and epithelialization through a variety of mechanical conduction pathways and plays an important role in the formation of hypertrophic scar. Clinical studies have confirmed that surgical methods and adjuvant treatment to reduce the mechanical tension on wound can promote wound healing and inhibit hyperplasia of scar. This article summarizes the mechanism of hypertrophic scar formation, and surgical methods and adjunct means of reducing mechanical tension in traumatic wounds, aiming to provide a reference for reducing formation of hypertrophic scar in clinics.

Objective:To investigate the clinical effect of minimally invasive scar release combined with autologous microfat graft in the treatment of facial depressed scar.Methods:From September 2015 to May 2019, a total of 11 patients who had facial depressed scar were treated with minimally invasive scar release combined with autologous microfat graft in Huaihe Hospital of Henan University. Needle scar separator or 10 ml syringe needle was inserted under skin to release scar adhesion thoroughly. Microfat was harvested from the abdomen, which was separated and purified, and then evenly transplanted into the stripped space (0.5 cm wider than the edge of scar) under the scar with a 1 ml syringe. The severity of scar was evaluated pre-operation, 3-month post-operation and 6-month post-operation, using Vancouver Scar Scale score and Stony Brook Scar Evaluation Scale score to evaluate the efficacy. Using Visual Analogue Scale score to evaluate patient satisfaction. Analyses were performed using SPSS Statistics 25.0, and measurement data were expressed as Mean±SD if they conformed to normality and homogeneity of variance. One-way ANOVA was used for multi-time point data, and the Bonferroni test was performed for pairwise comparison. P<0.05 was considered a statistically significant difference. Results:The depression of scars disappeared immediately after treatment. 6 months after treatment, the surface of the scars was flat, the color and elasticity were close to adjacent normal skin, and the texture of the scars was soft. All patients were followed up for 6 months without recurrence, and 11 patients were satisfied. In Vancouver Scar Scale score, the pre-operation score was 7.27±1.10, the 3-month post-operation score was 2.64±0.81 and the 6-month post-operation score was 0.91±0.54, showing a significant difference ( F=467.98, P<0.001). Pairwise comparison result show that comparing the pre-operation score with 3 or 6 months post-operation score, showing a significant difference ( P<0.001). The comparison between 3 and 6 months post-operation score also showing a significant difference ( P<0.001). In Stony Brook Scar Evaluation Scale score, the pre-operation score was (2.00±0.89), the 3-month post-operation score was 4.45±0.69 and the 6-month post-operation score was 4.45±0.69, showing a significant difference ( F=67.00, P<0.001). Pairwise comparison result show that comparing pre-operation score with 3 or 6 months post-operation score, showing a significant difference ( P<0.001). The comparison between 3 and 6 months post-operation score also showing a significant difference ( P=0.006). The 6-month post-operation Visual Analogue Scale score was 95.0±6.74. Conclusions:Minimally invasive scar release combined with autologous microfat graft in the treatment of facial depressed scar can avoid the post-surgery scar formation and adhesion, and improve the color and texture of the facial hypertrophic scar. This method can be carried out under local anesthesia, with simple procedure and exact effect.

Objective:To investigate the clinical effect of minimally invasive scar release combined with autologous microfat graft in the treatment of facial depressed scar.Methods:From September 2015 to May 2019, a total of 11 patients who had facial depressed scar were treated with minimally invasive scar release combined with autologous microfat graft in Huaihe Hospital of Henan University. Needle scar separator or 10 ml syringe needle was inserted under skin to release scar adhesion thoroughly. Microfat was harvested from the abdomen, which was separated and purified, and then evenly transplanted into the stripped space (0.5 cm wider than the edge of scar) under the scar with a 1 ml syringe. The severity of scar was evaluated pre-operation, 3-month post-operation and 6-month post-operation, using Vancouver Scar Scale score and Stony Brook Scar Evaluation Scale score to evaluate the efficacy. Using Visual Analogue Scale score to evaluate patient satisfaction. Analyses were performed using SPSS Statistics 25.0, and measurement data were expressed as Mean±SD if they conformed to normality and homogeneity of variance. One-way ANOVA was used for multi-time point data, and the Bonferroni test was performed for pairwise comparison. P<0.05 was considered a statistically significant difference. Results:The depression of scars disappeared immediately after treatment. 6 months after treatment, the surface of the scars was flat, the color and elasticity were close to adjacent normal skin, and the texture of the scars was soft. All patients were followed up for 6 months without recurrence, and 11 patients were satisfied. In Vancouver Scar Scale score, the pre-operation score was 7.27±1.10, the 3-month post-operation score was 2.64±0.81 and the 6-month post-operation score was 0.91±0.54, showing a significant difference ( F=467.98, P<0.001). Pairwise comparison result show that comparing the pre-operation score with 3 or 6 months post-operation score, showing a significant difference ( P<0.001). The comparison between 3 and 6 months post-operation score also showing a significant difference ( P<0.001). In Stony Brook Scar Evaluation Scale score, the pre-operation score was (2.00±0.89), the 3-month post-operation score was 4.45±0.69 and the 6-month post-operation score was 4.45±0.69, showing a significant difference ( F=67.00, P<0.001). Pairwise comparison result show that comparing pre-operation score with 3 or 6 months post-operation score, showing a significant difference ( P<0.001). The comparison between 3 and 6 months post-operation score also showing a significant difference ( P=0.006). The 6-month post-operation Visual Analogue Scale score was 95.0±6.74. Conclusions:Minimally invasive scar release combined with autologous microfat graft in the treatment of facial depressed scar can avoid the post-surgery scar formation and adhesion, and improve the color and texture of the facial hypertrophic scar. This method can be carried out under local anesthesia, with simple procedure and exact effect.