Objective:To investigate the safety and short-term efficacy of laparoscopic Nissen fundoplication in the treatment of refractory gastroesophageal reflux disease (rGERD).Methods:The clinical data of 61 patients underwent laparoscopic Nissen fundoplication from March 2018 to March 2022 in Jiangyin People′s Hospital were retrospectively analyzed. Among them, 14 patients had significant symptom relief after using proton pump inhibitor (PPI) before operation (group A), 30 patients had partial symptom relief after using PPI (group B), and 17 patients had persistent symptoms despite regular treatment with double-dose PPI for more than 8 weeks (group C). The surgical outcomes and recovery were compared among the three groups.Results:For the 61 patients, the surgical time was (117.46 ± 28.50) min, the intraoperative blood loss was 23.00 (8.00, 34.00) ml, and the postoperative hospital stay was 3.00 (2.00, 5.00) d. There were no statistically significant differences in surgical time, intraoperative blood loss, postoperative hospital stay, concurrent hiatal hernia repair and mesh placement among the three groups ( P>0.05). No short-term severe complications such as abdominal bleeding, abdominal infection and gastrointestinal perforation occurred in any group. There were no statistical differences in satisfaction score, subjective relief of overall postoperative symptoms, reflux symptoms, PPI usage, dysphagia, abdominal distention, diarrhea or constipation among the three groups ( P<0.05). No upper abdominal pain, recurrence and reoperation occurred in the three groups. Conclusions:Laparoscopic Nissen fundoplication has a definite therapeutic effect on rGERD, with significant anti reflux effects. There are no serious complications after surgery, and there are no recurrence or reoperation.

Objective:To introduce the experience of reconstructing the pelvic floor with a pedicled large omental flap combined with a basement membrane biological mesh in combined pelvic organ resection for locally advanced or locally recurrent rectal cancer combined with sacrococcygeal resection, and to discuss the feasibility, safety, and near-term therapeutic efficacy of this technique.Methods:For patients with sacrococcygeal resection of combined pelvic organs, a basement membrane mesh was used to rebuild the pelvic floor with a pedicled greater omentum flap to isolate the abdominopelvic cavity. The main operation was to pull the greater omentum, which preserved the double vascular arches, to the pelvic floor to cover the pelvic floor, and then the mesh was used to cover the posterior peritoneal defect and pelvic inlet with absorbable sutures of 2-0 or thicker.Results:In this study, a retrospective cohort study was used to collect clinical data through the China Rectal Cancer Combined Pelvic Organs Resections Case Database. Twenty patients with locally advanced or locally recurrent rectal cancer without extra-pelvic metastasis or only oligometastases underwent combined pelvic organ and sacrococcygeal resection in the Department of Anal and Intestinal Surgery of the Second Affiliated Hospital of the Naval Military Medical University during the period of July 1, 2022, to June 30, 2023, and 10 patients underwent simple basement membrane resection with a simple basement membrane. Among them, the pelvic floor were reconstructed by basement membrane mesh alone in 10 cases (mesh only group), and 10 cases were reconstructed the pelvic floor by pedicled large omental flap combined with basement membrane mesh (omental flap-combined mesh group). The recent outcomes of the two groups of patients were studied comparatively. Comparison of baseline data and intraoperative conditions between the two groups showed no statistically significant differences (all P>0.05); the drain removal time in the omental flap-combined mesh group was 26.7 (19-42) days, which was shorter than that in the mesh only group, which was 40.4 (24-56) days ( U=4.125, P=0.001); The empty pelvis healing time in the omental flap-combined mesh group was 29.4 (23~43) days, which was shorter than that of 42.2 (27~58) days in the mesh-only group ( U=4.043, P=0.001); the differences were all statistically significant. The postoperative complication rate of grade ≥III in the omental flap-combined mesh group was 1/10, which was lower than that of 6/10 in the mesh-only group; the difference was not statistically significant when comparing the two groups ( P = 0.057). Follow-up ended on 09/30/2023, with a median follow-up of 9.5 (3-15) months in 20 patients, and all 20 cases survived during the follow-up period, with no tumor recurrence at the surgical site. Conclusion:In locally advanced or locally recurrent rectal cancer undergoing combined pelvic organ resection with sacrococcygeal, compared with reconstruction of the pelvic floor by basement membrane mesh alone, reconstruction of the pelvic floor and isolation of the abdominopelvic cavity by a pedicled greater omentum flap combined with a basement membrane mesh is safe and feasible.

Objective:To introduce the experience of reconstructing the pelvic floor with a pedicled large omental flap combined with a basement membrane biological mesh in combined pelvic organ resection for locally advanced or locally recurrent rectal cancer combined with sacrococcygeal resection, and to discuss the feasibility, safety, and near-term therapeutic efficacy of this technique.Methods:For patients with sacrococcygeal resection of combined pelvic organs, a basement membrane mesh was used to rebuild the pelvic floor with a pedicled greater omentum flap to isolate the abdominopelvic cavity. The main operation was to pull the greater omentum, which preserved the double vascular arches, to the pelvic floor to cover the pelvic floor, and then the mesh was used to cover the posterior peritoneal defect and pelvic inlet with absorbable sutures of 2-0 or thicker.Results:In this study, a retrospective cohort study was used to collect clinical data through the China Rectal Cancer Combined Pelvic Organs Resections Case Database. Twenty patients with locally advanced or locally recurrent rectal cancer without extra-pelvic metastasis or only oligometastases underwent combined pelvic organ and sacrococcygeal resection in the Department of Anal and Intestinal Surgery of the Second Affiliated Hospital of the Naval Military Medical University during the period of July 1, 2022, to June 30, 2023, and 10 patients underwent simple basement membrane resection with a simple basement membrane. Among them, the pelvic floor were reconstructed by basement membrane mesh alone in 10 cases (mesh only group), and 10 cases were reconstructed the pelvic floor by pedicled large omental flap combined with basement membrane mesh (omental flap-combined mesh group). The recent outcomes of the two groups of patients were studied comparatively. Comparison of baseline data and intraoperative conditions between the two groups showed no statistically significant differences (all P>0.05); the drain removal time in the omental flap-combined mesh group was 26.7 (19-42) days, which was shorter than that in the mesh only group, which was 40.4 (24-56) days ( U=4.125, P=0.001); The empty pelvis healing time in the omental flap-combined mesh group was 29.4 (23~43) days, which was shorter than that of 42.2 (27~58) days in the mesh-only group ( U=4.043, P=0.001); the differences were all statistically significant. The postoperative complication rate of grade ≥III in the omental flap-combined mesh group was 1/10, which was lower than that of 6/10 in the mesh-only group; the difference was not statistically significant when comparing the two groups ( P = 0.057). Follow-up ended on 09/30/2023, with a median follow-up of 9.5 (3-15) months in 20 patients, and all 20 cases survived during the follow-up period, with no tumor recurrence at the surgical site. Conclusion:In locally advanced or locally recurrent rectal cancer undergoing combined pelvic organ resection with sacrococcygeal, compared with reconstruction of the pelvic floor by basement membrane mesh alone, reconstruction of the pelvic floor and isolation of the abdominopelvic cavity by a pedicled greater omentum flap combined with a basement membrane mesh is safe and feasible.

Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.

Objective To compare the repair effects of different eyelid defect repair methods after eyelid tumor resection. Methods The clinical data of 90 patients with eyelid malignancies were retrospectively analyzed. All patients underwent eyelid tumor resection and eyelid defect was repaired after surgery. According to the repair method, they were divided into observation group (n=34) and traditional group (n=56). The observation group was repaired using allogeneic scleral transplantation, while the traditional group was repaired using autologous lip mucosa and adjacent skin flap transfer. The repair effects, eyelid morphology, and cosmetic effects before and after repair were compared between the two groups. The occurrence of complications was compared between the two groups at one month after surgery. Results After repair, the total effective rate of the observation group was 94.12%, which was higher than 73.21% of the traditional group, and the difference was statistically significant (P < 0.05). After repair, the difference in eyelid fissure height and length of the two groups was lower than before surgery, and the observation group was lower than the traditional group (P < 0.05). After repair, the cosmetic effect score of the observation group was (1.65±0.27), which was higher than (1.36±0.20) of the traditional group, and the difference was statistically significant (P < 0.05). After repair, the total complication rate of the observation group was 11.76%, which was lower than 30.36% of the traditional group, and the difference was statistically significant (P < 0.05). Conclusion The clinical effect of allogeneic scleral transplantation in repairing eyelid defects is better, which can effectively improve eyelid morphology and cosmetic effects, and reduce the incidence of complications.

Traumatic cerebrospinal fluid leakage commonly presents in traumatic brain injury patients, and it may lead to complications such as meningitis, ventriculitis, brain abscess, subdural hematoma or tension pneumocephalus. When misdiagnosed or inappropriately treated, traumatic cerebrospinal fluid leakage may result in severe complications and may be life-threatening. Some traumatic cerebrospinal fluid leakage has concealed manifestations and is prone to misdiagnosis. Due to different sites and mechanisms of trauma and degree of cerebrospinal fluid leak, treatments for traumatic cerebrospinal fluid leakage varies greatly. Hence, the Craniocerebral Trauma Professional Group of Neurosurgery Branch of Chinese Medical Association and the Neurological Injury Professional Group of Trauma Branch of Chinese Medical Association organized relevant experts to formulate the " Chinese expert consensus on the diagnosis and treatment of traumatic cerebrospinal fluid leakage in adults ( version 2023)" based on existing clinical evidence and experience. The consensus consisted of 16 recommendations, covering the leakage diagnosis, localization, treatments, and intracranial infection prevention, so as to standardize the diagnosis and treatment of traumatic cerebrospinal fluid leakage and improve the overall prognosis of the patients.

The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.

Objective:To understand the psychology of patients undergoing breast augmentation, and to provide reference for preoperative communication between clinicians and patients.Methods:From September 2016 to September 2017, the Guangdong Second Provincial General Hospital formulated a 37-question questionnaire based on BREAST-Q and Chinese national conditions, and investigated patients who planned to undergo breast augmentation in 34 hospitals.Results:A total of 2066 valid questionnaires were collected. Fifty-four percent of women were dissatisfied with their nude appearance, which was more dissatisfied compared with their appearance when dressed. Surgical safety (20.1%), surgical effect (16.8%), surgical method and incision selection (16.5%), breast implant material (14.5%) and doctor′s skill (11.6%) were the five most important factors for considering breast augmentation. Only 26.6% of the respondents were supported by their family members or partners when they made the decision to have breast augmentation. Most women had limited knowledge of breast augmentation, with only 24.9 percent of respondents having a thorough understanding of the procedure.Conclusions:Women undergoing breast augmentation have an urgent need to improve their appearance, and their decision-making process is affected by many factors, among which surgical safety is the most worrying factor for patients. This group of people have limited knowledge about surgery, and the popularization of breast augmentation by plastic surgeons remains to be strengthened.

Objective:To analyze the epidemic situation of plague among animals in the foci of Meriones unguiculatus in Inner Mongolia Plateau, and to find out key influencing factors affecting the epidemic of the plague, and to provide theoretical basis for the prediction, early warning and risk assessment of the plague. Methods:The monitoring data including gerbils density, gerbils body flea index, plague epidemic intensity, etc., as well as environmental data including temperature, precipitation and El Ni?o activity (Southern Oscillation Index, SOI) from 19 banners (counties, cities and districts) in Ulanqab Plateau area, the foci of Meriones unguiculatus in Inner Mongolia Plateau were selected. The methods of correlation analysis, structural equation model and rank correlation were used to analyze the epidemic and key influencing factors of plague among animals in the foci. Results:The plague epidemic cycle in the foci of Meriones unguiculatus in Inner Mongolia Plateau was 5 to 10 years. The correlation analysis results showed that all the factors had influence on each other. Structural equation model screened out that the main influencing factors of plague epidemic were SOI, gerbils density and temperature. SOI had a negative effect on plague epidemic intensity (-0.022) and temperature (-0.029), while gerbils density had a positive effect on plague epidemic intensity (0.014), and temperature had a negative effect on plague epidemic intensity (-0.065). In rank correlation, when the gerbils density was at a high value, the probability of high plague epidemic intensity in that year was 4/9; when SOI was at a low value, the probability was 5/9; when the temperature was at a low value, the probability was 5/9. When the plague epidemic intensity was at a high value in that year, the probability of the plague epidemic intensity being high in the following year was 5/8; when the gerbils density was at a high value in that year, the probability was 4/9; when SOI was at a low value in that year, the probability was 4/9. Conclusion:Climate and biological factors can affect prevalence of plague, and countermeasures should be taken in advance to prevent plague outbreaks when El Ni?o phenomenon, low temperature, high density of gerbils, and high previous-year prevalence of plague appear.

Objective:To clarify patterns of skin diseases among outpatients at first and return visits to Hospital of Dermatology of Chinese Academy of Medical Sciences in 2019.Methods:Data were collected from the outpatient electronic medical record information system in Hospital of Dermatology of Chinese Academy of Medical Sciences from January 1st to December 31st, 2019, and patterns of skin diseases among outpatients at first and return visits were analyzed retrospectively.Results:The total number of outpatient consultations was 1 440 580 in 2019, including 941 755 (65.37%) first visits and 498 825 (34.63%) return visits, and the daily average number of outpatient consultations was 4 332. The top 10 most prevalent skin diseases were eczema, acne, urticaria, psoriasis, seborrheic dermatitis, vitiligo, neurodermatitis, pigmented nevus, tinea pedis and onychomycosis among outpatients at the first visits, with the number of outpatient visits being 739 175 and accounting for 78.49% of the total first visits; the top 10 most prevalent skin diseases among outpatients at the return visits were eczema, acne, psoriasis, urticaria, vitiligo, seborrheic dermatitis, neurodermatitis, pigmented nevus, keloid and rosacea, with the number of outpatient visits being 399 594 and accounting for 80.11% of the total return visits.Conclusion:In 2019, skin diseases predominated by common diseases, such as eczema and acne, among outpatients at Hospital of Dermatology of Chinese Academy of Medical Sciences.