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 explore the safety and feasibility of preferential manual bronchoplasty in single-port video-assisted thoracoscopic surgery (VATS) upper lobectomy. Methods    The clinical data of 457 patients with non-small cell lung cancer who underwent single-port VATS lobectomy in the Department of Thoracic Surgery of Peking University First Hospital from March 2020 to March 2022 were retrospectively analyzed. The patients were divided into a preferential manual bronchoplasty group and a traditional single-port VATS lobectomy group with a 1 : 1 propensity score matching for further research. Results     A total of 204 patients were matched, and there were 102 patients in each group. There were 50 males and 52 females aged 62.2±10.1 years in the preferential bronchoplasty group, and 49 males and 53 females aged 61.2±10.7 years in the traditional single-port VATS group. The preferential bronchoplasty group had shorter surgical time (154.4±37.0 min vs. 221.2±68.9 min, P<0.01), less bleeding (66.5±116.9 mL vs. 288.6±754.5 mL, P=0.02), more lymph node dissection (19.8±7.5 vs. 15.2±4.7, P<0.01), and a lower conversion rate to multi-port or open surgery (2.3% vs. 13.8%, P=0.04) in left upper lobe resection. In the right upper lobe resection surgery, there was no statistical difference in postoperative results between two groups. There was no perioperative death or occurrence of bronchopleural fistula in both groups. Conclusion    Compared with traditional single-port VATS upper lobectomy, preferential bronchoplasty has similar safety and feasibility. In addition, priority bronchoplasty in left upper lobectomy has the advantages of shorter surgical time, less bleeding, more lymph node dissection, and lower conversion rate to multi-port or open surgery.

The inconsistency of diagnostic criteria for malnutrition has confused clinicians since the 1980s. After the implementation of disease diagnosis related group payment (DRG) in China's public hospitals, the diagnosis of malnutrition and the correct documentation of nutrition-related diagnosis on the front sheet of medical records are related to the correct classification of the disease group and the medical insurance payment. Therefore, the reliable diagnostic criteria for malnutrition, especially disease-related malnutrition, is urgently needed in clinical practice. In September 2018, The global leadership Iinitiative on malnutrition (GLIM) diagnostic criteria consensus was launched. GLIM aimed to provide the explicit and unified diagnostic criteria for malnutrition in adult hospitalized patients. However, GLIM criteria was based on the voting by nutritional experts and was merely a consensus in nature. The clinical validity of GLIM criteria needs prospective verification, i.e., to demonstrate that patients with malnutrition as per GLIM criteria could have improved clinical outcomes with reasonable nutritional interventions. In November 2020, the article titled Nutritional support therapy after GLIM criteria may neglect the benefit of reducing infection complications compared with NRS 2002 was published on the journal Nutrition. It was the first study comparing nutritional risk screening 2002 (NRS 2002) and GLIM malnutrition diagnostic criteria among Chinese patients for the indication of nutritional support therapy. The clinical effectiveness of the two tools was retrospectively verified as well. Here we discussed the key points of this retrospective study, including the critical research methods, to inform the currently ongoing prospective validation of the GLIM malnutrition diagnostic criteria (the item of reduced muscle mass not included).

BACKGROUND/OBJECTIVES: This study aimed to investigate cancer-specific survival (CSS) and associated risk factors in elderly gastric cancer (EGC) patients. SUBJECTS/METHODS: EGC patients (≥ 70 yrs) who underwent curative gastrectomy between January 2013 and December 2017 at our hospital were included. Clinicopathologic characteristics and survival data were collected. Receiver operating characteristic (ROC) analysis was used to extract the best cutoff point for body mass index (BMI). A Cox proportional hazards model was used to determine the risk factors for CSS. RESULTS: In total, 290 EGC patients were included, with a median age of 74.7 yrs. The median follow-up time was 31 (1–77) mon. The postoperative 1-yr, 3-yr and 5-yr CSS rates were 93.7%, 75.9% and 65.1%, respectively. Univariate analysis revealed risk factors for CSS, including age (hazard ratio [HR] = 1.08; 95% confidence interval [CI], 1.01–1.15), intensive care unit (ICU) admission (HR = 1.73; 95% CI, 1.08–2.79), nutritional risk screening (NRS 2002) score ≥ 5 (HR = 2.33; 95% CI, 1.49–3.75), and preoperative prognostic nutrition index score < 45 (HR = 2.06; 95% CI, 1.27–3.33). The ROC curve showed that the best BMI cutoff value was 20.6 kg/m 2 . Multivariate analysis indicated that a BMI ≤ 20.6 kg/m 2 (HR = 2.30; 95% CI, 1.36–3.87), ICU admission (HR = 1.97; 95% CI, 1.17–3.30) and TNM stage (stage II: HR = 5.56; 95% CI, 1.59–19.43; stage III: HR = 16.20; 95% CI, 4.99–52.59) were significantly associated with CSS. CONCLUSIONS Low BMI (≤ 20.6 kg/m2 ), ICU admission and advanced pathological TNM stages (II and III) are independent risk factors for CSS in EGC patients after curative gastrectomy. Nutrition support, better perioperative management and early diagnosis would be helpful for better survival.

Objective:To analyze the plasma levels of soluble immune checkpoint molecules in patients with primary liver cancer and their prognostic significance.Methods:The levels of sCD28, sCD80, sCD137, sCD27, sGITR, sTIM3, sCTLA4, sHVEM, IDO, sLAG3, sBTLA, sPD1, sPDL1 and sPDL2 in plasma samples of 58 patients with primary liver cancer and 30 healthy controls were detected by liquid chip technology and compared between different groups. The relationship between the plasma levels of soluble immune checkpoint molecules and tumor recurrence was analyzed.Results:The levels of sCD28 and sCD80 were higher in patients in Barcelona Clinic Liver Cancer (BCLC) stage 0/A and B than in healthy controls and patients in BCLC-C stage ( P<0.05). However, the levels of sCD27 and sHVEM in BCLC-C patients were significantly lower than those in BCLC-0/A and BCLC-B patients, and even lower than healthy control group. The levels of sCD137, IDO and sPD1 in BCLC-0/A and BCLC-B patients were higher than those in healthy controls. The levels of sPDL1 and sPDL2 in different BCLC stages were all higher than those in healthy controls, and maintained at high level in the three stages, but there was no significant difference between different stages. After 24 months of interventional treatment, the preoperative sCD28 level was lower in patients with recurrent tumor recurrence than in patients without recurrence ( t=2.843, P=0.007). The optimal cut-off value of sCD28 based on the receiver operating characteristic (ROC) curve for predicting tumor recurrence was 101.42 pg/ml and the area under the ROC curve was 0.771 (95%CI: 0.611-0.931) with a sensitivity of 0.889 and a specificity of 0.666. The cumulative recurrence rate in patients with high sCD28 level (≥101.41 pg/ml) was 57.9% at 24 months after surgery, which was lower than the rate (95.5%) in patients with low sCD28 level (<101.41 pg/ml). The difference in the cumulative recurrence rate between the two groups was statistically significant (χ 2=15.777, P=0.000). Conclusions:The expression patterns of soluble immune checkpoint molecules varied in patients at different stages of primary liver cancer, suggesting that there were differences in their immune status and sCD28 could be used as a prognostic marker for postoperative recurrence of liver cancer.

In China, the prevalence of overweight and obesity among adults is 34.3% and 16.4% respectively. Bariatric/metabolic surgery can effectively relieve morbid obesity by limiting nutrient absorption or regulating metabolism, consequently reducing obesity-related complications such as type 2 diabetes and hypertension and improving the quality of life for patients. Currently, the mainstream surgical methods are sleeve gastrectomy, Roux-en-Y gastric bypass, etc. Other new exploratory surgical methods, including combined laparoscopic sleeve gastrectomy, intragastric balloon, etc., are also undergoing continuous development. Here we reviewed the evolution of mainstream and emerging exploratory methods for bariatric/metabolic surgeries and discussed the merits and limitations of individual surgical methods, in aim to provide clinicians with more options for individualized treatment strategy for patients.

Objective:To investigate the risk factors for early complications after laparoscopy-assisted gastrectomy in patients with gastric cancer.Methods:The retrospective case-control study was conducted. The clinicopathological data of 196 patients who underwent laparos-copy-assisted radical gastrectomy at Peking Union Medical College Hospital from March 2016 to March 2019 were collected. There were 144 males and 52 females, aged (61±10)years. Observation indicators: (1) early complications after laparoscopy-assisted radical gastrectomy and treatment; (2) analysis of risk factors for early complications after laparoscopy-assisted radical gastrectomy.Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( P25,P75). Count data were represented as absolute numbers. Univariate analysis was conducted using the t test, Mann-Whitney U test or chi-square test. Multivariate analysis was conducted using the Logistic regressional model. Results:(1) Early complications after laparoscopy-assisted radical gastrectomy and treatment: 51 of 196 patients had early postoperative complications, including 7 cases of grade Ⅰ according to Clavien-Dindo classi-fication system, 32 cases of grade Ⅱ, 9 cases of grade Ⅲa, 3 cases of grade Ⅲb. There was no grade Ⅳ or Ⅴ complication. There were 25 cases with abdominal complications, 7 cases with thoracic complications, 3 cases with internal/catheter related complications and 16 cases with other unclassified complications. All patients with complications were improved after symptomatic and supportive treatments. (2) Analysis of risk factors for early complications after laparoscopy-assisted radical gastrectomy: results of univariate analysis showed that the lymphocyte count, neutrophil-to-lymphocyte ratio, radiotherapy, operation time, volume of intraoperative blood loss, T stage, lymph node metastasis were related factors for early complications after laparoscopy-assisted radical gastrectomy in patients with gastric cancer ( Z=?2.048, χ2=6.385, 4.168, 8.068, 6.336, 12.497, 7.522, P<0.05). Results of multivariate analysis showed that the neutrophil/lymphocyte ratio ≥1.96, operation time ≥222 minutes, and lymph node metastasis were independent risk factors for early complica-tions after laparoscopy-assisted radical gastrectomy in patients with gastric cancer ( odds ratio=2.279, 2.245, 2.226, 95% confidence interval as 1.149-4.519, 1.116-4.517, 1.125-4.402, P<0.05). Conclusions:The abdominal complications are the most common early complications after laparoscopy-assisted radical gastrectomy. The neutrophil-to-lymphocyte ratio ≥1.96, operation time ≥222 minutes, and lymph node metastasis are independent risk factors for early complications after laparoscopy-assisted radical gastrectomy in patients with gastric cancer.

In the 42 nd and 44 th workshops of CSPEN-nutritional risk-undernutrition-support-outcome-cost effectiveness ratio (NUSOC) multi-center database collaboration group, Jens Kondrup and Henrik Rasmussen described again the application of NRS 2002, the evidence-based basis of NRS 2002 development and the methodology for prospective validation of clinical effectiveness. There is no gold standard for validation. They both considered that malnutrition could be identified as a score of 3 or more for impaired nutritional status in NRS 2002. Although NRS 2002 is simple and easy to be applied, it is not comprehensive enough for malnutrition diagnosis. ASPEN and ESPEN on-line published the Global Leadership (nutritional) Initiative on Malnutrition(GLIM)diagnosis criteria in September 2018. With the gradual implementation of medicare payment based on diagnosis related groups(DRG)in China, the nutritional risk and the malnutrition diagnosis with Chinese version of ICD-10 (2016) code should be recorded in the first page of the medical records. In this terminology interpretations, the terms of nutritional risk screening(NRS 2002.01.016)and malnutrition diagnosis (GLIM-phenotypic criteria 01.028, etiologic criteria 01.029) published in Parenteral and Enteral Nutrition Terminology 2019 are discussed based on the reports given by Kondrup and Rasmussen in Beijing and Zhengzhou.

Alanyl-glutamine dipeptide is an important component in parenteral nutrition, which can be decomposed into alanine and L-glutamine in vivo. It plays multiple functions including maintaining intestinal barrier, improving immunity, promoting protein synthesis, and regulating the production and release of inflammatory mediators. Substantial clinical evidences have demonstrated its favorable effectiveness and safety. Rational application of alanyl-glutamine dipeptide can reduce postoperative complications, shorten hospital stay and save medical costs. There are still controversies at home and abroad on the applicable population and dosage of alanyl-glutamine dipeptide. Chinese Society of Parenteral and Enteral Nutrition organized China's experts of related disciplines to compile international standards in accordance with the latest guidelines and consensus, so as to achieve the goal of standardized application and patient benefits.

To compare changes in platelet related parameters in obese patients before and after sleeve gastrectomy (SG), we retrospectively analyzed the clinical data of 31 obese patients who underwent SG in Peking Union Medical College Hospital from December 2012 to September 2020. Results showed that compared with those before surgery, platelet count (PLT) decreased significantly at 2-12 weeks of follow-up ( P=0.009), while platelet distribution width (PDW), mean platelet volume (MPV), and large platelet ratio (P-LCR) increased significantly at the same periods of follow-up after operation ( P<0.001). However, the levels of PDW, MPV, and P-LCR began to decrease at 16-55 weeks when compared with those at 2-12 weeks of follow-up ( P<0.01). PLT was positively correlated with white blood cells and neutrophils at 2-12 weeks of follow-up and positively correlated with high sensitivity C-reactive protein at 16-55 weeks of follow-up after operation ( P<0.05).