Objective : To develop and to validate a combined model integrating18F-FDG PET/CT radiomics with clinical features to distinguish between lymphoma and lymphoid inflammatory hyperplasia. Methods : A retrospective study was conducted on a cohort of 232 patients diagnosed with lymphoma or lymphoid inflammatory hyperplasia. Comparative analyses of clinical and traditional imaging indicators were performed to identify inter-group differences. The clinical features were delineated and extracted using medical software including 3D-Slicer and Lifex. Selection of the features was performed to construct a PET/CT-based radiomics Logistic model, with a combined model integrating PET/CT with clinical features then used to evaluate the discriminative efficacy of these models. Results: Analysis of inter-group differences indicated that age, CTmean, and metabolic tumor volume(MTV)were effective for differentiating between lymphoma and lymphoid inflammatory hyperplasia(P<0.05). The PET/CT-based radiomics Logistic model differentiated between lymphoma and lymphoid inflammatory hyperplasia, with an area under curve(AUC) of 0.924(95%CI: 0.884-0.960) and 0.863(95%CI: 0.774-0.939) in the training and testing cohorts, respectively. The integrated Logistic model that combined PET/CT-based radiomics with clinical features to distinguish between lymphoma and lymphoid inflammatory hyperplasia achieved an AUC of 0.933(95%CI: 0.889-0.969) in the training cohort and 0.884(95%CI: 0.792-0.964) in the testing cohort. Decision curve analysis(DCA) demonstrated that the integrated model provided the greatest clinical net benefit. Conclusion The hybrid model integrating18F-FDG PET/CT radiomics with clinical features shows robust diagnostic efficacy to distinguish between lymphoma and lymphoid inflammatory hyperplasia.

Objective:To investigate the safety and efficacy of the TRIANGLE operation after neoadjuvant chemotherapy in locally advanced pancreatic cancer(LAPC).Methods:This study is a retrospective case series analysis. Between January 2020 and December 2022, a total of 103 patients were diagnosed as LAPC who underwent neoadjuvant chemotherapy at the Pancreas Center, the First Affiliated Hospital of Nanjing Medical University. Among them, 26 patients (25.2%) underwent the TRIANGLE operation. There were 15 males and 11 females,with a age of (59±7) years (range: 49 to 74 years). The pre-treatment serum CA19-9( M(IQR)) was 248.8(391.6)U/ml (range: 0 to 1 428 U/ml),and the serum carcinoembryonic antigen was 4.1(3.8)μg/L(range: 1.4 to 13.4 μg/L). The neoadjuvant chemotherapy regimens included: mFOLFIRINOX regimen in 6 cases(23.1%), GnP regimen in 14 cases(53.8%), and mFOLFIRINOX+GnP regimen in 6 cases(23.1%). The follow-up duration extended until June 2023 or until the occurrence of the patient′s death or loss to follow-up. The Kaplan-Meier method was employed to estimate the 1-year and 3-year overall survival rates. Results:After neoadjuvant chemotherapy,CA19-9 levels decreased by 92.3(40.1)%(range:2.1% to 97.7%). Evaluation of the response to treatment revealed 13 cases(50.0%) of stable disease,11 cases(42.3%) of partial response,and 2 cases(7.7%) of complete response. The surgical operation consisted of 12 cases(46.2%) of pancreaticoduodenectomy,12 cases(46.2%) of distal pancreatectomy,and 2 cases(7.7%) of total pancreatectomy. Margin determination was based on the “standardised pathology protocol” and the “1 mm” principle. No R2 and R1(direct) resections were observed,while the R0 resection rate was 61.5%(16/26), and the R1(1 mm) resection rate was 38.5%(10/26).The R1(1 mm) resection rates for the anterior margin,posterior margin,transected margin,portal vein groove margin,and uncinate margin were 23.1%(6/26),19.2%(5/26),12.5%(3/24),2/14, and 1/12, respectively. The overall postoperative complication rate was 57.8%(15/26),with major complications including grade B/C pancreatic fistula 25.0%(6/24,excluding 2 cases of total pancreatectomy),delayed gastric emptying in 23.1%(6/26),wound complications 11.5%(3/26),postoperative hemorrhage 7.7%(2/26), chylous fistula 7.7%(2/26) and bile fistula 3.8%(1/26). No reoperation was performed during the perioperative period(<90 days). One patient died on the 32 nd day postoperatively due to a ruptured pseudoaneurysm. A total of 25 patients were followed up,with a follow-up time of 21(24)months(range: 8 to 42 months). During the follow-up period,8 cases(32.0%) died due to tumor recurrence and metastasis,while 17 patients(68.0%) remained alive,including 11 cases of disease-free survival,5 cases of distant metastasis,and 1 case of local recurrence. The overall survival rates at 1- and 3-year after the initiation of neoadjuvant chemotherapy were 95.8% and 58.9%, respectively. The overall survival rates at 1- and 3-year after surgery were 77.7% and 57.8%, respectively. Conclusion:Performing pancreatoduodenectomy according to the Heidelberg triangle protocol in LAPC patients after neoadjuvant chemotherapy might increase the R0 resection rate without increasing perioperative mortality or the incidence of major postoperative complications.

Objective:To assess the safety and feasibility of selectively preserving the first branch of the right gastro-omental artery using bidirectional dissection in laparoscopic pylorus-preserving gastrectomy (LPPG).Methods:In this retrospective analysis, we studied preoperative, intraoperative, postoperative, and follow-up data of 30 patients with early gastric cancer treated in the Department of Gastric Cancer in Zhejiang Cancer Hospital (28 patients), Department of Gastrointestinal Surgery in Jiaxing Second Hospital (one patient) and Department of Gastrointestinal Surgery in Hangzhou Red Cross Hospital (one patient) who had undergone selective preservation of the first branch of the right gastro-omental artery during LPPG. The main variables studied were as follows: (1) intraoperative preservation of the first branch of the right gastro-omental artery; (2) the overall surgical situation; and (3) postoperative small bowel follow-through and endoscopy findings.Results:LPPG with selective preservation of the right gastro-omental artery vascular branch was achieved in all 30 of the study patients. The mean operation time was (244.3±29.3) minutes and the median intraoperative blood loss 50 (20–200) mL. The median tumor diameter was 1.2 (0.5–3.6) cm and an average of 32.3±11.6 lymph nodes were dissected. The overall median number of positive lymph nodes was 0 (0–6), and of No. 6 lymph nodes 5.1±1.5. Postoperative feeding resumed at an average of 5.2±0.5 days and the postoperative hospital stay averaged 8.4±3.4 days. Pathological stages were as follows: T1a (14 cases), T1b (10 cases), and T2 (6 cases). Small bowel follow-through imaging showed good results in 28 patients 5 days post-surgery, the remaining two exhibiting good results 9 days post-surgery. There were no instances of delayed gastric emptying, and only one patient (3.3%) developed intra-abdominal infection (resolved with conservative treatment).Conclusion:Selective preservation of the right gastro-omental artery during laparoscopic early gastric cancer surgery is a safe and feasible procedure for treating early mid-gastric body cancer with pyloric preservation.

Objective:To systematically review the non-surgical and minimally invasive treatment techniques for diabetic foot ulcers, in order to provide evidence-based medical reference for orthopedic surgeons in the treatment of diabetic foot ulcers.Methods:Chinese and English databases such as PubMed, Embase, the Cochrane Library, CNKI, Wanfang and VIP were used to search the literature related to non-surgical and minimally invasive treatment of diabetic foot ulcers. The retrieval time was set to September 2023. The key words were Diabetic Foot Ulcer, Minimally Invasive Surgical Treatment, Non-surgical Treatment. According to the research type of the included literature, the quality of the included literature was evaluated by selecting corresponding tools. The outcome measures mainly included treatment response rate, amputation rate, mortality rate and other measures related to treatment effect. The Medical Literature King software was used to screen literatures and extract relevant data for systematic review.Results:In this study, 20 articles were included. There were 15 studies from China, 2 studies from Egypt, 2 study from the United States, and 1 study from Sweden. There were 16 high quality literatures and 4 low quality literatures. Among them, there were five non-surgical treatment techniques of diabetic foot ulcers, including customized diabetic foot insoles, autologous platelet-rich plasma (PRP) , Chinese medicine treatment, external dressing therapy, and vacuum sealing drainage (VSD) technology. There were two minimally invasive treatment techniques for diabetic foot ulcer, including vascular intervention technology and periosteal distraction technology. The plastic surgeon should choose the appropriate treatment technique according to the specific situation of the patient with DFUs. Diabetes custom insoles were mainly used in the treatment of patients with recurrent DFUs or Wagner grade 0. For DFUs patients with Wagner grade 1 and above, the effect of PRP, VSD and vascular intervention techniques were more significant. Traditional Chinese medicine also showed significant result in the treatment of DFUs patients with Wagner grade 1 and above. Topical dressing treatment was often used for daily dressing change of DFUs to promote wound healing. Periosteal distraction technique was less invasive and had significant therapeutic effect on severe DFUs.Conclusions:Non-surgical and minimally invasive techniques are effective in the treatment of DFUs. Plastic surgeons should master and reasonably choose these non-surgical and minimally invasive treatment techniques for the treatment of patients with DFUs according to the patients＇conditions and medical conditions.

Objective:To systematically review the non-surgical and minimally invasive treatment techniques for diabetic foot ulcers(DFUs), in order to provide evidence-based medical reference for orthopedic surgeons in the treatment of diabetic foot ulcers.Methods:Chinese and English databases such as PubMed, Embase, The Cochrane Library, CNKI, Wanfang and VIP were utilized to search the literature related to non-surgical and minimally invasive treatment of diabetic foot ulcers. The retrieval time was set to September 2023. The key words were Diabetic Foot Ulcer, Minimally Invasive Surgical Treatment, Non-surgical Treatment. According to the research type of the included literature, the quality of the included literature was evaluated by selecting corresponding tools. The outcome measures mainly included treatment response rate, amputation rate, mortality rate and other measures related to treatment effect. The Medical Literature King software was used to screen literatures and extract relevant data for systematic review.Results:In this study, 20 articles were included. There were 15 studies from China, 2 studies from Egypt, 2 studies from the United States, and 1 study from Sweden. There were 16 high quality literatures and 4 low quality literatures. Among them, there were five non-surgical treatment techniques of diabetic foot ulcers, including customized diabetic foot insoles, autologous platelet-rich plasma (PRP), Chinese medicine treatment, external dressing therapy, and vacuum sealing drainage (VSD) technology. There were two minimally invasive treatment techniques for diabetic foot ulcer, including vascular intervention technology and periosteal distraction technology. The plastic surgeon should choose the appropriate treatment technique according to the specific situation of the patient with DFUs. Diabetes custom insoles were mainly used in the treatment of patients with recurrent DFUs or Wagner grade 0. For DFUs patients with Wagner grade 1 and above, the effect of PRP, VSD and vascular intervention techniques were more significant. Traditional Chinese medicine also showed significant result in the treatment of DFUs patients with Wagner grade 1 and above. Topical dressing treatment was often used for daily dressing change of DFUs to promote wound healing. Periosteal distraction technique was less invasive and had significant therapeutic effect on severe DFUs.Conclusion:Non-surgical and minimally invasive techniques are effective in the treatment of DFUs. Plastic surgeons should master and reasonably choose these non-surgical and minimally invasive treatment techniques for the treatment of patients with DFUs based on the patients’ conditions and medical conditions.

Objective:To systematically review the non-surgical and minimally invasive treatment techniques for diabetic foot ulcers, in order to provide evidence-based medical reference for orthopedic surgeons in the treatment of diabetic foot ulcers.Methods:Chinese and English databases such as PubMed, Embase, the Cochrane Library, CNKI, Wanfang and VIP were used to search the literature related to non-surgical and minimally invasive treatment of diabetic foot ulcers. The retrieval time was set to September 2023. The key words were Diabetic Foot Ulcer, Minimally Invasive Surgical Treatment, Non-surgical Treatment. According to the research type of the included literature, the quality of the included literature was evaluated by selecting corresponding tools. The outcome measures mainly included treatment response rate, amputation rate, mortality rate and other measures related to treatment effect. The Medical Literature King software was used to screen literatures and extract relevant data for systematic review.Results:In this study, 20 articles were included. There were 15 studies from China, 2 studies from Egypt, 2 study from the United States, and 1 study from Sweden. There were 16 high quality literatures and 4 low quality literatures. Among them, there were five non-surgical treatment techniques of diabetic foot ulcers, including customized diabetic foot insoles, autologous platelet-rich plasma (PRP) , Chinese medicine treatment, external dressing therapy, and vacuum sealing drainage (VSD) technology. There were two minimally invasive treatment techniques for diabetic foot ulcer, including vascular intervention technology and periosteal distraction technology. The plastic surgeon should choose the appropriate treatment technique according to the specific situation of the patient with DFUs. Diabetes custom insoles were mainly used in the treatment of patients with recurrent DFUs or Wagner grade 0. For DFUs patients with Wagner grade 1 and above, the effect of PRP, VSD and vascular intervention techniques were more significant. Traditional Chinese medicine also showed significant result in the treatment of DFUs patients with Wagner grade 1 and above. Topical dressing treatment was often used for daily dressing change of DFUs to promote wound healing. Periosteal distraction technique was less invasive and had significant therapeutic effect on severe DFUs.Conclusions:Non-surgical and minimally invasive techniques are effective in the treatment of DFUs. Plastic surgeons should master and reasonably choose these non-surgical and minimally invasive treatment techniques for the treatment of patients with DFUs according to the patients＇conditions and medical conditions.

Objective:To systematically review the non-surgical and minimally invasive treatment techniques for diabetic foot ulcers(DFUs), in order to provide evidence-based medical reference for orthopedic surgeons in the treatment of diabetic foot ulcers.Methods:Chinese and English databases such as PubMed, Embase, The Cochrane Library, CNKI, Wanfang and VIP were utilized to search the literature related to non-surgical and minimally invasive treatment of diabetic foot ulcers. The retrieval time was set to September 2023. The key words were Diabetic Foot Ulcer, Minimally Invasive Surgical Treatment, Non-surgical Treatment. According to the research type of the included literature, the quality of the included literature was evaluated by selecting corresponding tools. The outcome measures mainly included treatment response rate, amputation rate, mortality rate and other measures related to treatment effect. The Medical Literature King software was used to screen literatures and extract relevant data for systematic review.Results:In this study, 20 articles were included. There were 15 studies from China, 2 studies from Egypt, 2 studies from the United States, and 1 study from Sweden. There were 16 high quality literatures and 4 low quality literatures. Among them, there were five non-surgical treatment techniques of diabetic foot ulcers, including customized diabetic foot insoles, autologous platelet-rich plasma (PRP), Chinese medicine treatment, external dressing therapy, and vacuum sealing drainage (VSD) technology. There were two minimally invasive treatment techniques for diabetic foot ulcer, including vascular intervention technology and periosteal distraction technology. The plastic surgeon should choose the appropriate treatment technique according to the specific situation of the patient with DFUs. Diabetes custom insoles were mainly used in the treatment of patients with recurrent DFUs or Wagner grade 0. For DFUs patients with Wagner grade 1 and above, the effect of PRP, VSD and vascular intervention techniques were more significant. Traditional Chinese medicine also showed significant result in the treatment of DFUs patients with Wagner grade 1 and above. Topical dressing treatment was often used for daily dressing change of DFUs to promote wound healing. Periosteal distraction technique was less invasive and had significant therapeutic effect on severe DFUs.Conclusion:Non-surgical and minimally invasive techniques are effective in the treatment of DFUs. Plastic surgeons should master and reasonably choose these non-surgical and minimally invasive treatment techniques for the treatment of patients with DFUs based on the patients’ conditions and medical conditions.

Objective:To assess the safety and feasibility of selectively preserving the first branch of the right gastro-omental artery using bidirectional dissection in laparoscopic pylorus-preserving gastrectomy (LPPG).Methods:In this retrospective analysis, we studied preoperative, intraoperative, postoperative, and follow-up data of 30 patients with early gastric cancer treated in the Department of Gastric Cancer in Zhejiang Cancer Hospital (28 patients), Department of Gastrointestinal Surgery in Jiaxing Second Hospital (one patient) and Department of Gastrointestinal Surgery in Hangzhou Red Cross Hospital (one patient) who had undergone selective preservation of the first branch of the right gastro-omental artery during LPPG. The main variables studied were as follows: (1) intraoperative preservation of the first branch of the right gastro-omental artery; (2) the overall surgical situation; and (3) postoperative small bowel follow-through and endoscopy findings.Results:LPPG with selective preservation of the right gastro-omental artery vascular branch was achieved in all 30 of the study patients. The mean operation time was (244.3±29.3) minutes and the median intraoperative blood loss 50 (20–200) mL. The median tumor diameter was 1.2 (0.5–3.6) cm and an average of 32.3±11.6 lymph nodes were dissected. The overall median number of positive lymph nodes was 0 (0–6), and of No. 6 lymph nodes 5.1±1.5. Postoperative feeding resumed at an average of 5.2±0.5 days and the postoperative hospital stay averaged 8.4±3.4 days. Pathological stages were as follows: T1a (14 cases), T1b (10 cases), and T2 (6 cases). Small bowel follow-through imaging showed good results in 28 patients 5 days post-surgery, the remaining two exhibiting good results 9 days post-surgery. There were no instances of delayed gastric emptying, and only one patient (3.3%) developed intra-abdominal infection (resolved with conservative treatment).Conclusion:Selective preservation of the right gastro-omental artery during laparoscopic early gastric cancer surgery is a safe and feasible procedure for treating early mid-gastric body cancer with pyloric preservation.

Objective:To investigate the safety and efficacy of the TRIANGLE operation after neoadjuvant chemotherapy in locally advanced pancreatic cancer(LAPC).Methods:This study is a retrospective case series analysis. Between January 2020 and December 2022, a total of 103 patients were diagnosed as LAPC who underwent neoadjuvant chemotherapy at the Pancreas Center, the First Affiliated Hospital of Nanjing Medical University. Among them, 26 patients (25.2%) underwent the TRIANGLE operation. There were 15 males and 11 females,with a age of (59±7) years (range: 49 to 74 years). The pre-treatment serum CA19-9( M(IQR)) was 248.8(391.6)U/ml (range: 0 to 1 428 U/ml),and the serum carcinoembryonic antigen was 4.1(3.8)μg/L(range: 1.4 to 13.4 μg/L). The neoadjuvant chemotherapy regimens included: mFOLFIRINOX regimen in 6 cases(23.1%), GnP regimen in 14 cases(53.8%), and mFOLFIRINOX+GnP regimen in 6 cases(23.1%). The follow-up duration extended until June 2023 or until the occurrence of the patient′s death or loss to follow-up. The Kaplan-Meier method was employed to estimate the 1-year and 3-year overall survival rates. Results:After neoadjuvant chemotherapy,CA19-9 levels decreased by 92.3(40.1)%(range:2.1% to 97.7%). Evaluation of the response to treatment revealed 13 cases(50.0%) of stable disease,11 cases(42.3%) of partial response,and 2 cases(7.7%) of complete response. The surgical operation consisted of 12 cases(46.2%) of pancreaticoduodenectomy,12 cases(46.2%) of distal pancreatectomy,and 2 cases(7.7%) of total pancreatectomy. Margin determination was based on the “standardised pathology protocol” and the “1 mm” principle. No R2 and R1(direct) resections were observed,while the R0 resection rate was 61.5%(16/26), and the R1(1 mm) resection rate was 38.5%(10/26).The R1(1 mm) resection rates for the anterior margin,posterior margin,transected margin,portal vein groove margin,and uncinate margin were 23.1%(6/26),19.2%(5/26),12.5%(3/24),2/14, and 1/12, respectively. The overall postoperative complication rate was 57.8%(15/26),with major complications including grade B/C pancreatic fistula 25.0%(6/24,excluding 2 cases of total pancreatectomy),delayed gastric emptying in 23.1%(6/26),wound complications 11.5%(3/26),postoperative hemorrhage 7.7%(2/26), chylous fistula 7.7%(2/26) and bile fistula 3.8%(1/26). No reoperation was performed during the perioperative period(<90 days). One patient died on the 32 nd day postoperatively due to a ruptured pseudoaneurysm. A total of 25 patients were followed up,with a follow-up time of 21(24)months(range: 8 to 42 months). During the follow-up period,8 cases(32.0%) died due to tumor recurrence and metastasis,while 17 patients(68.0%) remained alive,including 11 cases of disease-free survival,5 cases of distant metastasis,and 1 case of local recurrence. The overall survival rates at 1- and 3-year after the initiation of neoadjuvant chemotherapy were 95.8% and 58.9%, respectively. The overall survival rates at 1- and 3-year after surgery were 77.7% and 57.8%, respectively. Conclusion:Performing pancreatoduodenectomy according to the Heidelberg triangle protocol in LAPC patients after neoadjuvant chemotherapy might increase the R0 resection rate without increasing perioperative mortality or the incidence of major postoperative complications.

Objective:To assess the efficacy of neoadjuvant treatment with PD-1 (programmed cell death protein 1) inhibitors combined with paclitaxel (albumin-conjugated) and cisplatin (TP regimen) for locally advanced hypopharyngeal squamous cell carcinoma and laryngeal organ function preservation.Methods:Data of 53 patients, including 51 males and 2 females, aged 38-70 years old, who were diagnosed with locally advanced hypopharyngeal squamous carcinoma confirmed by histology and enhanced CT at the Cancer Prevention and Control Center of Sun Yat-sen University during the initial treatment from January 1, 2019 to January 15, 2023, were retrospectively analyzed. All patients received neoadjuvant therapy with PD-1 inhibitors combined with albumin-bound paclitaxel (260 mg/m 2) and cisplatin (60 mg/m 2) for 3 to 4 cycles. The main outcome measures were larynx dysfunction-free survival (LDFS), overall survival (OS), and progression-free survival (PFS). Survival curves were plotted using the Kaplan-Meier method, and Cox multifactorial analysis was further performed if Cox univariate analysis was statistically significant. Results:The overall efficiency was 90.6% (48/53). The 1-year and 2-year LDFS rates were 83.8% (95% CI: 74.0% to 94.8%) and 50.3% (95% CI: 22.1% to 91.6%), the 1-year and 2-year OS rates were 95.2% (95% CI: 88.9% to 100.0%) and 58.2% (95% CI: 25.6% to 81.8%), and the 1-year and 2-year PFS rates were 83.9% (95% CI: 74.2% to 94.9%) and 53.5% (95% CI: 32.1% to 89.1%). Adverse events associated with the neoadjuvant therapy were mainly myelosuppression (45.3%), gastrointestinal reactions (37.7%) and hypothyroidism (20.8%). Conclusion:The neoadjuvant treatment of locally advanced hypopharyngeal squamous cell carcinoma using PD-1 inhibitors combined with paclitaxel and cisplatin can provide with a higher survival rate with a improved laryngeal organ function preservation rate.