Objective:To explore the risk factors of colostomy site incisional hernia associated with colorectal can-cer and to construct and validate a nomogram model.Methods:A retrospective case-control study was conducted to collect and analyze the clinical data of patients who underwent stoma reversal after colorectal cancer surgery in the Gen-eral Surgery Department of Linyi People's Hospital from January 2019 to January 2023.A total of 371 patients were en-rolled and divided into SSIH group and non-SSIH group according to whether SSIH occurred.SPSS 25.0 software was used to perform univariate analysis on 22 related factors of patients,and multivariate analysis was performed on statisti-cally significant risk factors to screen out the independent influencing factors of SSIH related to CRC surgery.According to the results of multivariate analysis,the R language version 4.3.1 was used to establish and verify the nomogram risk prediction model.Results:SSIH occurred in 52 of 371 patients(14.02％).The results of univariate analysis showed that BMI,coronary heart disease,incision infection,stoma location,parastomal hernia,and closure time were statistically sig-nificant(P＜0.05).Multivariate analysis showed that coronary heart disease,closure time and parastomal hernia were in-dependent risk factors for SSIH after CRC(P＜0.05).Based on the above results,the nomogram prediction model was successfully drawn and verified.Conclusions:Coronary heart disease,closure time and parastomal hernia are inde-pendent risk factors for SSIH after CRC surgery.The nomogram constructed based on these factors has a high predictive value for SSIH,which can provide a basis for clinicians to prevent and treat SSIH,and help reduce the incidence of SSIH.

Objective:To analyze the influencing factors of postoperative intestinal adhesion in patients undergoing laparoscopic cholecystectomy(LC),and to construct a nomogram prediction model based on this.Methods:A total of 265 patients who underwent LC in our hospital from November 2021 to March 2025 were retrospectively selected and randomly divided into a training set(185 cases)and a validation set(80 cases)according to the ratio of 7∶3.According to the presence or absence of postoperative intestinal adhesion,185 patients in the training set were divided into occur-rence group(28 cases)and non-occurrence group(157 cases).In the validation set,13 cases occurred and 67 cases did not occur.The clinical data of patients were collected to analyze the influencing factors of postoperative intestinal adhe-sion,and a nomogram model was constructed based on this.The receiver operating characteristic(ROC)curve was used to analyze the predictive efficacy of the prediction model on the risk of postoperative intestinal adhesion.Decision curve analysis(DCA)was used to analyze the clinical benefit of the prediction model.Result:The proportion of patients aged≥65 years,complicated with diabetes,indwelling drainage tube,residual abdominal infection,and WBC level in the occurrence group were higher than those in the non-occurrence group(P<0.05).Logistic regression analysis showed that age(OR=3.025,95%CI:1.453-6.296),diabetes(OR=3.836,95%CI:1.557-9.450),indwelling drainage tube(OR=5.312,95%CI:1.898-14.864)and residual abdominal infection(OR=6.174,95%CI:2.914-13.079)were independent influencing factors for postoperative intestinal adhesion(P<0.05).The corresponding risk rate of the nomogram model based on Logistic results ranged from 0.10 to 0.80,and the C-index was 0.842(95%CI:0.765-0.919).The calibration curve of predicting postoperative intestinal adhesion was close to the ideal curve(P>0.05).The ROC of the training set showed that the sensitivity and specificity of the model in predicting postoperative intestinal adhesion were 85.70%and 88.50%,respectively,and the area under the curve(AUC)was 0.882(P<0.05).In the validation set,the sensitivity,speci-ficity and AUC of ROC curve were 81.30%,84.10%and 0.860(P<0.05),respectively.DCA curve showed that the pre-diction model could obtain the maximum clinical benefit at the threshold probability of 0-0.23.Conclusion:The pre-diction model based on age,diabetes,indwelling drainage tube and residual abdominal infection has a good predictive value for the risk of intestinal adhesion after LC.

Objective:To explore the impacts of remimazolam(REM)on the proliferation,migration,and invasion of hepatocellular carcinoma cells by regulating sphingosine kinase 1/sphingosine 1-phosphate/sphingosine 1-phosphate receptor 3(SPHK1/S1P/S1PR3)signaling pathway.Methods:Human hepatocellular carcinoma cell line HepG2 was treated with REM at concentrations of 0,20,40,80,160,and 320 μmol/L respectively.Cell survival rate was measured,and drug concentrations were screened.Based on the results of cell survival rate,the logarithmic phase cells were di-vided into five groups:Control group,low,medium,and high concentrations of remifentanil groups(REM-L,REM-M,REM-H groups;20,40 and 80 μmol/L),and high concentrations of remifentanil+SPHK1 activator group(REM-H+K6PC-5 group).MTT assay was used to detect the survival rate of HepG2 cells.Plate cloning experiment was performed to de-tect cell proliferation ability.Scratch experiment was performed to detect cell migration ability.Transwell chamber method was performed to detect cell invasion ability.Flow cytometry was used to detect cell apoptosis.Western blot was used to detect the SPHK1,S1P,S1PR3,Bax,and Bcl-2 proteins in cells.Results:For the Control group,the REM-L,REM-M,and REM-H groups showed that the number of HepG2 cell clones,scratch healing rate,invasion rate,Bcl-2,SPHK1,S1P,S1PR3,and N-cadherin proteins gradually decreased with increasing REM concentration,while the apoptosis rate and Bax,E-cadherin proteins showed an opposite trend(P<0.05).For the REM-H group,the REM-H+K6PC-5 group showed a clear increase in the number of HepG2 cell clones,scratch healing rate,invasion rate,Bcl-2,SPHK1,S1P,S1PR3,and N-cadherin proteins,and a clear decrease in the apoptosis rate and Bax,E-cadherin proteins(P<0.05).Conclusion:REM may inhibit the proliferation,migration,and invasion of hepatocellular carcinoma cells and promote cell apoptosis by suppressing SPHK1/S1P/S1PR3 signaling pathway.

Objective:To explore the influence of different time intervals after stent implantation on the efficacy and prognosis of elective surgery in patients with malignant obstructive colorectal cancer(MOCRC).Methods:A total of 182 MOCRC patients were enrolled,including 92 who underwent emergency surgery(ES group)and 90 who received elective surgery after stent placement(SEMS group).The SEMS group was further divided into three subgroups based on the interval between stent placement and surgery:<11 d(n=27),11-17 d(n=39),and>17 d(n=24).Kaplan-Meier analysis was used to compare overall survival(OS)and disease-free survival(DFS),and Cox proportional hazards re-gression was employed to identify prognostic factors.Prognostic models based on surgical timing were constructed,and receiver operating characteristic(ROC)curves were drawn with area under the curve(AUC)calculated to assess model discrimination.A total of 182 patients with MOCRC were included.Among them,92 underwent emergency sur-gery(ES group),and 90 underwent elective surgery after stent implantation(SEMS group).The SEMS group was di-vided into the<11 d group(n=27),the 11-17 d group(n=39),and the>17 d group(n=24)according to the operation interval.Overall survival(OS)and disease-free survival(DFS)were compared using the Kaplan-Meier method,and prognostic factors were analyzed by Cox regression.Result:Compared with the ES group,the SEMS group had a higher rate of laparoscopic surgery and significantly less intraoperative blood loss(P<0.05),with no significant differ-ences in postoperative complication rate,stoma formation rate(P>0.05).Among SEMS patients,the 11～17 d group had the shortest hospital stay and the lowest complication rate(7.69%).Multivariate Cox analysis showed that surgery performed 11-17 d group significantly reduced the risk of death compared to emergency surgery(HR=0.650,P=0.034),while surgery 11 d group significantly increased the risk(HR=2.051,P=0.042).Independent predictors of OS in-cluded age(HR=1.060,P<0.001),preoperative CEA level(HR=1.323,P=0.002),tumor size(HR=1.421,P=0.028),tumor differentiation(HR=1.123,P=0.005),and venous invasion(HR=2.792,P<0.001).For DFS,age,tumor size,venous inva-sion,and perineural invasion were identified as independent risk factors(P<0.05),while surgical timing showed no sig-nificant association(P>0.05).Kaplan-Meier analysis revealed no significant difference in OS among different groups in stage Ⅰ-Ⅱ patients,whereas in stage Ⅲ patients,the 11-17 d group had better OS,and the>17 d group had signifi-cantly worse DFS than other groups(P=0.017).ROC curve analysis showed that the AUCs for OS prediction were 0.636(<11 d),0.601(11-17 d),and 0.750(>17 d);and for DFS prediction were 0.655,0.567,and 0.874,respectively,indicating that surgical timing has moderate discriminative value for survival outcomes.Conclusion:Elective surgery performed 11 to 17 d after stent placement can reduce mortality and improve postoperative recovery,although it has no significant impact on recurrence risk.Venous and peripheral nerve invasion are major factors affecting disease-free survival(DFS);therefore,clinical management should focus on identifying high-risk patients and optimizing individual-ized treatment strategies.

Objective:This study aimed was to analyze the disease progression of postoperative recurrence/me-tastasis of pancreatic ductal adenocarcinoma(PDAC)and provide clinical evidence for evaluating the difference in prog-nosis between site and pattern of recurrence/metastasis.Methods:The clinical data of 167 patients with PDAC who underwent pancreatectomy in Panjin Liao-Oil Gem Flower Hospital from January 2011 to June 2019 were retrospec-tively analyzed.Kaplan-Meier curves and Cox-regression analyses were applied to assess survival outcomes.Results:In this study,96 patients(57.5%)recurred within 12 months after surgery,and the median recurrence time was 10.9 months.Compared to patients without recurrence,patients with recurrence/metastasis had higher baseline CA19-9>100 IU/mL and were treated more often with neoadjuvant chemotherapy(P<0.05).In the no recurrence group,patients had histopathological analyses yielded lower less poorly differentiated tumors,less positive margin,less pT3+4 stages and pN1+2 stages(P<0.05).In a multivariate Cox regression analysis,receipt of neoadjuvant chemotherapy,poor tumor differ-entiation and positive margin were independent predictors for recurrence/metastasis within 12 months after surgery(P<0.05).Neoadjuvant treated patients had less pT1+2 stages(P=0.015),a lower lymph node ratio,less perineural invasion,less positive margin,and were less likely to be treated with adjuvant chemotherapy compared to upfront surgery treated patients(P<0.05).Recurrence/metastasis rates were higher in the neoadjuvant treated cohort versus the upfront surgery cohort(P=0.014).There was no statistical difference in the recurrence/metastasis rate distribution between neoadjuvant therapy and upfront surgery,and neoadjuvant therapy exhibited no significant impact on recurrence/metastasis patterns in PDAC(P>0.05).The overall survival period of patients without recurrence/metastasis within 12 months was signifi-cantly longer than that of patients with recurrence/metastasis after PDAC resection(P<0.001).Conclusion:The varying site recurrence/metastasis rates and time to recurrence/metastasis,underline the inherent heterogeneity of PDAC and the specific interactions in the tumor microenvironments at the recurrence/metastasis sites.Further research is essential to establish optimal personalized treatment strategies for patients with recurrent PDAC.

Objective:To investigate the expression of Neurexophilin 4(NXPH4)in hepatocellular carcinoma(HCC)and its clinical significance and function.Methods:Retrieved LIHC project data(mRNA expression profiles and clinical records)from TCGA,analyzed differential NXPH4 expression in HCC versus adjacent non-tumor tissues,and investi-gated correlations between NXPH4 expression and clinicopathological characteristics/prognostic outcomes in HCC.Using GOEA and GSEA to investigate potential biological functions of NXPH4 in hepatocellular carcinoma.Results:NXPH4 exhibited significant upregulation in 23 cancer types(P<0.05),with significant associations to advanced HCC progression markers including TNM stage(P<0.05),histologic grade(P<0.05),and vascular invasion(P<0.05).Clinically,elevated NXPH4 expression correlated with reduced OS(HR=1.64,95%CI:1.15-2.33,P=0.006)and DSS(HR=1.88,95%CI:1.19-2.96,P=0.007).The immune infiltration results showed that NXPH4 expression was significantly correlated with Th2 cells and Th17 cells(all P values<0.05).Furthermore,NXPH4 expression was positively correlated with the levels of several immune checkpoint markers:TIGIT(r=0.265),PD-1(r=0.297),CTLA-4(r=0.302),and LAG-3(r=0.179,all P<0.001).Gene enrichment analysis revealed NXPH4 was significantly enriched in:pattern specification process(P<0.001);receptor ligand activity(P<0.001);collagen formation(P=0.009);activation of matrix metalloproteinases(P<0.001);neuro-active ligand receptor interactions(P<0.001);and ALK2 signaling(P=0.039).Conclusion:NXPH4 is associated with clinical pathological staging and poor prognosis in HCC patients;NXPH4 is associated with oncogenic pathways and im-mune infiltration,and has high value in predicting patient prognosis and immunotherapy.

Objective:The influence factors of recurrence of triple negative breast cancer(TNBC)after breast con-serving surgery were analyzed based on case-control trials,and the prediction scheme was constructed accordingly.Method:The clinical data of 186 TNBC patients treated with breast conserving surgery from January 2022 to August 2023 were retrospectively analyzed,and the postoperative recurrence of TNBC patients was counted.The recurrent pa-tients were selected as the case group,while age,parity,pregnancy,and family history were used as matching variables,and non-recurrent patients were matched in a 1∶1 ratio as the control group.The clinical data of the two groups was compared.The influence factors of recurrence of TNBC after breast conserving surgery was analyzed by Cox model,and the nomogram model of recurrence after TNBC breast conserving surgery was drawn.The nomogram was internally verified by Bootstrap method.The calibration curve and ROC curve were used to evaluate the calibration and predictive efficacy of the model.Results:All of the 186 TNBC patients,60 cases had recurrence after breast conserving surgery,with an incidence of 32.26%.The proportions of invasive ductal carcinoma,TNM stage III,tumor size>3cm,lymph node metastasis ratio,and the levels of neutrophil/lymphocyte ratio(NLR)and proliferating cell antigen(Ki-67)in the case group were higher than those in the control group(P<0.05).The results of Cox model analysis showed that invasive duc-tal carcinoma,TNM stage Ⅲ,tumor size>3 cm,lymph node metastasis,and increased levels of NLR and Ki-67 were all risk factors for recurrence of TNBC after breast conserving surgery(P<0.05).The consistency index of the nomogram model constructed according to the above influence factors verified by Bootstrap method was 0.886.The calibration curve fitted well with the ideal curve.The ROC curve showed that the area under the curve,sensitivity and specificity of the nomogram model for predicting the recurrence of TNBC after breast conserving surgery were 0.837,71.67%and 85.00%,respectively.Conclusion:Invasive ductal carcinoma,TNM stage Ⅲ,tumor size>3 cm,lymph node metasta-sis,and increased levels of NLR and Ki-67 are all risk factors for recurrence of TNBC after breast conserving surgery,and the nomogram model constructed based on this has good predictive efficacy.

Objective:A model for predicting sentinel lymph node metastasis was established based on positron emission tomography(PET)-related metabolic parameters and clinicopathological characteristics.Methods:A retro-spective analysis was conducted on 211 patients diagnosed with breast cancer through surgical pathology from January 2016 to March 2023 in Meizhou People's Hospital,who underwent whole-body PET/CT examinations prior to surgery.Clinical,pathological,and PET-related metabolic parameters were collected.The study analyzed the association be-tween clinicopathological characteristics of the primary breast cancer lesion,PET metabolic parameters,and sentinel lymph node metastasis.A logistic regression predictive model was constructed using Broussonetia papyrifera.Results:Breast cancer primary lesion PET-suspicious axillary lymph nodes,vascular tumor thrombus,estrogen receptor(ER),and progesterone receptor(PR)showed statistically significant differences between the two groups(all P<0.05),while maxi-mum tumor diameter,SUVmax tumor location,maximum standardized uptake value(SUVmax),metabolic tumor volume(MTV),total lesion glycolysis(TLG),tumor location,number of lesions,pathological type,histological grade,neural inva-sion,Homo sapiens epidermal growth factor receptor 2(HER-2),and nuclear-associated antigen Ki-67(Ki-67)showed no statistically significant differences between the two groups(all P>0.05).Parameters with P<0.05 in the univariate analysis were subjected to multivariate logistic regression analysis,and the logistic regression model was established as Logit(P)=-0.437×vascular tumor thrombus+4.685×suspicious axillary lymph node metastasis.The predictive model AUC was 0.738(P<0.001,95%CI:0.664～0.812),with sensitivity and specificity of 63.4%and 74.4%,respectively.Con-clusion:PET findings of the primary breast cancer lesion regarding suspicious axillary lymph node metastasis,vascular tumor thrombus,ER and PR are associated with sentinel lymph node metastasis.The predictive model established based on PET-detected suspicious axillary lymph node metastasis and vascular tumor thrombus in primary breast cancer lesions has certain value in predicting sentinel lymph node metastasis,potentially providing a non-invasive examination modality for clinical practice.

Objective:To systematically evaluate the molecular characteristics and prognostic value of ammonia death-related genes in hepatocellular carcinoma(HCC).Methods:Consensus unsupervised clustering was used to identify ammonia death-related molecular subtypes in HCC samples.Weighted gene co-expression network analysis(WGCNA)was applied to identify gene modules associated with ammonia death.Support vector machine(SVM)and LASSO algorithms were used to screen four hub genes,and a risk score system was constructed based on a LASSO-Cox regression model.The association between the risk model and patient survival,tumor microenvironment,and re-sponse to immunotherapy was further analyzed.Results:Consensus clustering identified two distinct ammonia death-related molecular subtypes(P<0.05).The constructed risk score model showed good predictive performance for overall survival in HCC patients and was closely associated with immune infiltration characteristics of the tumor microenviron-ment and immunotherapy responsiveness(P<0.05).Conclusion:The ammonia death-related risk score model may serve as a novel prognostic biomarker for HCC and provide potential guidance for immunotherapy strategies.

Objective:To explore the potential prognostic value of the HAMP(hepcidin)gene in gastric adenocarci-noma and its correlation with immune infiltration in gastric cancer.Methods:This study systematically analyzed the ex-pression characteristics of the HAMP gene using bioinformatics approaches based on mRNA data from 448 gastric ad-enocarcinoma tissues and non-tumor tissues in the TCGA database.Firstly,the cBioPortal platform was employed to analyze the genetic variation features of the HAMP gene,and the LinkedOmics database was used to evaluate the corre-lation between its methylation status and expression levels.Kaplan-Meier survival analysis with log-rank test was per-formed to assess the relationship between HAMP expression levels and patient prognosis.Furthermore,by integrating TIMER2.0 and TISIDB databases,we systematically evaluated the correlation between HAMP expression and immune-related genes as well as immune cell infiltration.Gene Set Enrichment Analysis(GSEA)was conducted to investigate HAMP-associated signaling pathway characteristics.Finally,STRING and Gepia databases were utilized to construct a protein-protein interaction network of HAMP and identify core interacting genes,comprehensively evaluating the role of HAMP in immune infiltration in gastric adenocarcinoma.Results:The expression level of HAMP was significantly higher in gastric adenocarcinoma tissues compared to normal tissues(P<0.01),and its elevated expression was strongly associ-ated with poor patient prognosis,manifested by significantly shorter overall survival(OS),progression-free survival(PFS),and post-progression survival(PPS)(all P<0.05).Genomic analysis revealed that HAMP mutations in gastric cancer were predominantly amplification-type,and its methylation level showed a positive correlation with mRNA expression(r=0.14,P<0.001).Immunological analysis demonstrated that high HAMP expression was significantly correlated with multiple key immune checkpoint molecules(PD-1:rho=0.274;PD-L1:rho=0.211;CTLA-4:rho=0.199,all P<0.001)and immune cell infiltration(dendritic cells:r=0.548;macrophages:r=0.414;neutrophils:r=0.374,all P<0.001).Pathway enrichment analy-sis indicated that the high HAMP expression group was significantly enriched in immune-related pathways including anti-gen presentation and NK cell-mediated cytotoxicity.Furthermore,protein-protein interaction network analysis identified core interacting genes such as TREM2 and TYROBP,suggesting that HAMP may participate in tumor immune regulation through specific molecular networks.Conclusion:HAMP is highly expressed in gastric cancer,and its high expression significantly reduces the survival time of gastric adenocarcinoma patients,demonstrating prognostic value.HAMP ex-pression is positively correlated with most immune-related genes in STAD and significantly associated with the abun-dance of multiple immune cell infiltration levels,serving as an independent prognostic factor related to immune infiltration.