Objective:To explore the feasibility and application value of an automated method for generation of surgical records for resection of benign soft tissue tumor based on dense video descriptions.Methods:The Transformer deep learning model was used to establish an automated surgical record generation system to analyze the surgical videos of 30 patients with benign soft tissue tumor who had been admitted to Department of Orthopedics, Xijing Hospital, Air Force Military Medical University from September 2021 to August 2023. The patient data were randomly divided into training sets, validation sets, and test sets in a ratio of 8∶1∶1. In the test sets, 7 evaluation indexes, BLEU-1, BLEU-2, BLEU-3, BLEU-4, Meteor, Rouge, and CIDEr, were used to evaluate the text quality of surgical records generated by the model. The text of surgical records was compared with the classical algorithm, dense video captioning with paralled decoding (PDVC) in the field of video-intensive description.Results:The automated surgical record generation system running in the test sets showed the following: BLEU-1, BLEU-2, BLEU-3, BLEU-4, Rouge, Meteor, and CIDEr were 16.80, 15.23, 13.01, 11.68, 16.01, 12.67 and 62.30, respectively. The operation of the classical algorithm PDVC showed the following: BLEU-1, BLEU-2, BLEU-3, BLEU-4, Rouge, Meteor, and CIDEr were 15.63, 14.17, 11.90, 10.45, 12.97, 11.99 and 53.64, respectively. The automated surgical record generation system resulted in significant improvements compared with PDVC in all evaluation indexes. The BLEU-4, Rouge, Meteor, and CIDEr were improved by 1.23, 3.04, 0.68 and 8.66, respectively, demonstrating that the system proposed can better capture the key data in the video to help generate more effective text records.Conclusion:As the automated surgical record generation system shows good performance in generating surgical records for resection of benign soft tissue tumor based on intensive video descriptions, it can be applied in clinical practice.

Objective To analyse the safety and feasibility of laparoscopic techniques in the treatment of elderly patients with acute intestinal obstruction.Methods A prospective two-center single-arm clinical study was conducted.A total of 441 patients with acute intestinal obstruction treated at the department of general surgery of Longyou County People's Hospital and Hospital Affiliated to Qinghai University from October 2017 to October 2021 and met the inclusion criteria were selected as study subjects.Among them,10 patients had chronic obstructive pulmonary disease(COPD)and were given mechanical ventilation,noninvasive ventilation,continuous low-flow oxygen inhalation,nebulization inhalation,and bronchodilator treatment after surgery.Twelve patients had chronic kidney disease(CKD)and were given hemodialysis treatment after surgery.All 441 patients underwent laparoscopic exploration,small intestine decompression,and definitive surgery.After surgery,they received intravenous nutrition,antibiotics,and subcutaneous injection of low-molecular-weight heparin(10 U/kg).The blood gas analysis(for patients with COPD),renal function(for patients with CKD),weight,body mass index(BMI),complications,and prognosis were observed before surgery,after surgery,and at discharge.Results There were 441 elderly patients with intestinal obstruction in the study,including 240 males and 201 females.The mean duration of the disease was(74.2±6.4)hours,and the BMI was(25.4±6.7)kg/m2.A total of 280 patients with adhesions underwent adhesion lysis surgery,while 87 patients with small bowel necrosis and 19 patients with small bowel lipoangiomatosis underwent small bowel resection and anastomosis.Additionally,21 patients with obturator hernia underwent hernia repair surgery,and 34 patients with small bowel persimmon stones underwent small bowel incision and stone removal surgery.For the 10 patients with COPD,there was a significant increase in arterial partial pressure of oxygen[PaO2 mmHg(1 mmHg≈0.133 kPa):80.3±3.3 vs.72.6±2.7,P<0.01],and a significant decrease in arterial partial pressure of carbon dioxide(PaCO2)compared to preoperative levels(mmHg:35.7±3.6 vs.47.6±1.3,P<0.01).Four patients died of type Ⅱ respiratory failure,and 6 patients had a significant decrease in PaO2[(77.4±6.7)mmHg]and a significant increase in PaCO2[(42.1±5.2)mmHg]at discharge compared to postoperative levels(both P<0.01).Among the 12 patients with CKD,both blood urea nitrogen(BUN)and serum creatinine(SCr)increased significantly after surgery compared to preoperative levels[BUN(μmol/L):79.5±8.5 vs.18.8±4.7,SCr(μmol/L):312.7±12.1 vs.138.4±9.7,both P<0.01].Two patients died of renal failure,and 8 patients had a significant decrease in BUN[(9.2±0.7)μmol/L]and SCr[(112.5±3.8)μmol/L]at discharge compared to postoperative levels(both P<0.01).There were no significant differences in BMI and weight between preoperative,postoperative,and discharge times[BMI(kg/m2):25.4±6.7,24.9±3.9 vs.23.9±3.5;weight(kg):74.2±6.8,73.7±3.3 vs.72.8±4.6;all P>0.05].A total of 435 patients recovered from acute intestinal obstruction with no complications such as lower extremity venous thrombosis,intestinal fistula,wound dehiscence,or wound infection.Conclusion The strategy of treating elderly patients with acute intestinal obstruction by laparoscopic exploration,intestinal decompression,definitive surgery,treatment of underlying diseases,and subcutaneous injection of low-molecular-weight heparin is safe and feasible.

Objective:To investigate the mechanism of Mycobacterium tuberculosis ( Mtb) WhiB2 in the pathogenesis of tuberculosis. Methods:A recombinant vector of pET28a-WhiB2 for heterogeneous expression of WhiB2 was constructed. The target protein WhiB2 and the inclusion bodies were purified. The differences between denatured and non-denatured WhiB2 were analyzed by circular dichroism and nuclear magnetic resonance. Ferrous ion (Fe 2+ ) was used to restore the iron-sulfur cluster of WhiB2. The interaction between WhiB2 and the upstream promoter sequence of the WhiBMtb gene was analyzed by nuclear magnetic resonance. The tertiary structure of WhiB2 and interacting proteins were analyzed and protein structure alignment was performed based on bioinformatics. Results:The structure of the renatured WhiB2 was basically the same as that of the non-denatuous WhiB2. In addition, Fe 2+ could restore the iron-sulfur cluster of WhiB2. It was found that WhiB2 could bind to the upstream promoter sequence of the WhiBMtb/WhiB2Ms gene. Conclusions:Mtb WhiB2 played a key role in the pathogenesis of tuberculosis, which would contribute to future exploration of novel targets against Mtb.

With the development of Internet technology and big data, artificial intelligence has been widely used in the field of clinical anesthesia. In the field of clinical teaching, artificial intelligence has also led to a series of innovations and changes in teaching model, contents, and evaluation. With reference to the current status of the application of artificial intelligence in the field of anesthesia, this article analyzes the possible impact of artificial intelligence on teaching model, teaching effect evaluation, teaching management, and ethical issues in clinical anesthesia teaching, so as to provide a theoretical basis for integrating artificial intelligence into clinical anesthesia teaching practice in the future.

【Objective】 To explore the causes and management of nephrostomy catheter following percutaneous nephrostolithotomy (PCNL) entering the inferior vena cava. 【Methods】 A retrospective analysis was performed on the management of two cases of nephrostomy catheter entering the inferior vena cava. The causes, changes of minimally invasive treatment and prevention plans were discussed. 【Results】 Two patients underwent digital subtraction angiography (DSA) to restore the nephrostomy tube to the renal pelvis collecting system. No renal vein rupture or bleeding occurred during the operation, and the patients’ vital signs were stable. Nephrostomy tube was removed successfully after operation. The wound healing was good, and there was no secondary hemorrhage such as perirenal hematoma. The prognosis was good. 【Conclusion】 Although intravenous nephrostomy tube misplacement is an uncommon PCNL complication, the consequences are serous. One-step retraction displacement of nephrostomy tube to the renal collecting system can effectively manage nephrostomy catheter entering the inferior vena cava.

Indoleamine 2, 3-dioxygenase (IDO) is an important immunoregulatory enzyme, which can degrade the level of the mammalian essential amino acid tryptophan (TRP), catalyze the initiation and rate-limiting steps through the kynurenine pathway, and produce a variety of metabolites to participate in the immune response. On the one hand, IDO plays an immunosuppressive role in microenvironment and thus leads to infection and immune escape of tumor cells; on the other hand, IDO also exerts an inhibitory effect on the pathogens such as bacteria and parasites and thus protects the body from the harm of pathogens to a certain extent. Therefore, IDO is considered an important medium with the role of a double-edged sword in the development and progression of various liver diseases. This article reviews the latest research advances in IDO in viral hepatitis, liver fibrosis, liver cirrhosis, liver cancer, and hepatic echinococcosis.

Objective:To explore the clinical characteristics and influencing factors of hematologic disease patients with chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and their effects on the prognosis of patients.Methods:The clinical data of 225 hematologic disease patients who underwent allo-HSCT from January 2014 to February 2021 in the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed. The efficacy of allo-HSCT, post-transplantation infection, as well as the incidence of cGVHD and its related factors, and its effect on the overall survival (OS) rate, disease-free survival (DFS) rate, cumulative incidence of relapse (CIR) and non-relapse mortality (NRM) rate of patients according to Seattle diagnostic criteria and National Institutes of Health (NIH) diagnostic criteria were analyzed.Results:All 225 hematologic disease patients had hematopoietic reconstruction after allo-HSCT. Among the 225 patients, 156 patients (69.33%) had early infection (207 times), and 92 patients (40.89%) had late infection (107 times). According to the Seattle diagnostic criteria, 58 patients developed cGVHD (111 times), with a cumulative incidence of 39.5%. The involved organs included skin (33 times), liver (32 times), eyes (19 times), lung (11 times), oral cavity (10 times), intestine (4 times) and hematological system (twice). Multivariate Cox regression analysis showed that acute graft-versus-host disease (aGVHD) was an independent influencing factor for cGVHD ( HR= 3.706, 95% CI 2.025-6.783, P<0.001). Compared to patients without cGVHD, patients with cGVHD had lower 5-year CIR (4.0% vs. 21.8%, P= 0.010) and higher 5-year NRM rate (25.5% vs. 11.8%, P= 0.029), while 5-year OS rate (72.5% vs. 73.6%, P= 0.908) and DFS rate (64.6% vs. 65.9%, P= 0.670) between the two groups had no statistical difference. Compared to patients with limited cGVHD, patients with extensive cGVHD had lower 5-year OS rate (56.0% vs. 83.9%, P= 0.035), lower 5-year DFS rate (52.0% vs. 73.4%, P = 0.038) and higher 5-year NRM rate (43.0% vs. 13.0%, P = 0.018). More erythrocyte suspension infusion during the transplantation was an independent influencing factor for early infection ( P = 0.011). Blood type incompatibility between donor and recipient ( P = 0.017), limited cGVHD ( P = 0.039) and extensive cGVHD ( P = 0.003) were independent influencing factors for late infection. According to the NIH diagnostic criteria, 5 patients (8.62%) who developed cGVHD after 100 days of transplantation were reclassified as aGVHD, and 12 patients (20.69%) were reclassified as overlap syndrome. The cumulative incidence of cGVHD was 36.4%, and aGVHD was the only independent influencing factor for cGVHD ( P<0.001). Compared to patients without cGVHD, patients with cGVHD had lower 5-year CIR (6.7% vs.21.7%, P = 0.006) and higher 5-year NRM rate (26.1% vs. 12.0%, P = 0.035), while 5-year OS rate (73.7% vs. 73.2%, P = 0.845) and DFS rate (64.9% vs. 65.7%, P = 0.522) between the two groups had no statistical difference. Conclusions:The incidence of cGVHD after allo-HSCT in hematologic disease patients is high, and there are many organs involved. cGVHD can reduce the relapse rate of patients, but severe cGVHD increases the mortality of patients. aGVHD is the only independent influencing factor for cGVHD.

With the popularization of ureteroscopy, ureteral avulsion has become a common complication of urological surgery in recent years. In the study, we reviewed the clinical management of 2 patients who underwent emergency ureterostomy and selective operation of ileoureteral substitution, emergency repair and selective operation of Boari-flap ureteroneocystostomy respectively. After 22 and 17 months of follow-up, no ureter stricture were found, and hydronephrosis were relieved compared with preoperative in both.

Objective:To explore the outcomes of urethra around corpora cavernosus anastomotic urethroplasty for the treatment of complex posterior urethral strictures.Methods:Between June 2008 and June 2020, 35 patients with complex posterior urethral strictures were treated using urethra rerouted under one corpora cavernosus anastomotic urethroplasty. The patients’ age was 3-54 years(mean 23.2 years), the urethral stricture or loss length was 4-7 cm(mean 5.2 cm), and 6 patients associated with urethrorectal fistula. The technique involved: ①The anterior urethra is dissected long more than 5 cm, separation of the proximal corporeal bodies, inferior pubectomy and the dissected proximal urethra.②A channel around the left crus of the penis through the inferior pubectomy is separated and urethra rerouted under left corpora cavernosus to allow a tension-free anastomosis to the proximal urethra.Results:Two patients lost follow-up; the remainder 33 patients were followed-up for 3 to 144 months(mean 37 months). Thirty-two patients could void normally(97%), The examination of maximal urinary flow rates(Q max) were taken in 21 patients, of whom Q max was 13.6-35.5 ml/s (mean 17.5 ml/s) in 7 children and 16.3-77.6 ml/s(mean 27.9 ml/s) in 14 adult patients. All 6 patients associated with urethrorectal fistula successful repaired, of these patients 1 had died of hemorrhage of brain 6 years postop. One patient developed urethral stenosis postoperatively. Continence was achieved in 29 patients, the remaining 3 patients had incontinence from mild to moderate. Conclusions:Urethra rerouted under left corpora cavernosus anastomotic urethroplasty is not only an effective surgical salvage option, with low recurrent rate for patients with complex posterior urethral strictures, but also do not cause curve and affect growth of corpora cavernosus.

Objective: To investigate the clinical characteristics and outcomes of Maisonneuve fractures. Methods: Data of 21 cases of Maisonneuve fractures from February 2015 to December 2017 were retrospectively analyzed. There were 16 males and 5 females with an average age of 38.8 years (range, 21 to 61 years). The fractures occurred on the left side in 11 patients and on the right side in 10 patients. The causes of injuries were traffic accident in 4 patients, sprain injury in 9 patients and falling injury from height in 8 patients. There were 16 cases of medial malleolar fractures and 5 cases of ruptures of deltoid ligament (4 entirely and 1 partial). There were 17 cases of fractures of the posterior malleolus, among which there were 5 of typeⅠ, 8 of typeⅡ and 4 of type Ⅲ according to the Bartonícek classification of posterior malleolus. There were 4 cases without fracture of posterior malleolus including 1 complete disruption of posterior inferior tibiofibular ligament. Four cases were overlooked of Maisonneuve fracture at the first time. The interval between injury and operation was 2-12 days (mean, 4.9 days). Results: Stabilization of proximal fibular fractures were achieved with plate in 3 cases. There were 16 cases of medial malleolar fractures, and the fixation were achieved with cannulated screws in 13 cases and with anti-glide plates in 3 cases. The entirely rupture of deltoid ligament was repaired in 4 cases with suture anchors, the partial rupture of deltoid ligament was not repaired. There were 17 cases of posterior malleolar fractures, 12 cases treated with open reduction and internal fixation including cannulated screws in 9 cases and anti-glide plates in 3 cases. Stabilization of syndesmosis was achieved with syndesmotic plate in 1 case; the medial and posterior malleolar fractures were stabilized and anterior inferior tibiofibular ligament was repaired with suture anchor in 1 case; the other 19 cases were stabilized with syndesmotic screws, 2 screws in 11 cases and 1 screw in 8. Twenty-one patients were followed up for 13-48 months with an average of 25.6 months. The time of bony union was from 3 to 6 months with an average time of 4.9 months after operation. All patients received anatomical reduction without postoperative complications such as incision infection, reduction lose, breakage of screw and posttraumatic arthritis. In 13 cases, the syndesmotic screw was removed at the mean time of 15.38 weeks postoperative (range, 13-25 weeks). At the latest follow up, AOFAS score was from 84 to 100, with excellent in 13 cases, good in 8 cases, and the excellent and good rate was 100% (21/21). Baird-Jackson score was from 83 to 100, with excellent in 11 cases, good in 8 and fair in 2, and the excellent and good rate was 90.48%(19/21). Conclusion The diagnosis of proximal fibular fracture of Maisonneuve fracture is easily missed. The complete rupture of deep deltoid ligament and displaced obviously of posterior malleolar fracture should be reduction and stabilization. The accuracy of reduction of the syndesmosis is of great concern. The outcome of operation is satisfied.