Abstract Purpose: Postoperative pancreatic fistula (POPF) is a potentially fatal complication of distal pancreatectomy (DP) but the optimal prevention method is unknown. The standard methodology for DP is to dissect the pancreas using a stapler alone. This pilot study evaluated post-DP remnant closure by stapling plus a PGA felt patch and examined the predictors of POPF. Methods: We prospectively enrolled and analyzed 26 patients scheduled for DP in which the remnants were closed with staples and a PGA felt patch. Results: Primary disease included 17 pancreatic adenocarcinomas, 3 pancreatic neuroendocrine neoplasms, 2 mucinous cystic neoplasms, 2 solid pseudopapillary neoplasms, and 2 other disorders. The mean main pancreatic duct diameter at the excision site was 2.3 mm. The mean pancreatic parenchyma thickness was 12.3 mm. The mean pancreatic dissected line was 0.5 mm to the left from the left edge of the portal vein. We observed nine biochemical leaks and the formation of nine grade B POPFs. We found significant differences in the BMI, pancreatic parenchymal thickness, and pancreatic dissection line between patients with and without POPF. Conclusion: Although stapling and applying PGA felt did not show efficacy in preventing POPF, the pancreatic dissecting line was suggested as a risk factor.

Objective This study aimed to evaluate the effects of recombinant bovine basic fibroblast growth factor (rb-bFGF) intermittent flushing combined with vacuum sealing drainage (VSD) on acute infectious pressure ulcers. Summary of Background Data Pressure ulcers are common in elderly, bedridden, or critically ill patients and are prone to infection, complicating healing. Effective treatments are needed to promote healing and reduce infection rates. Methods Two hundred patients with acute infectious pressure ulcers were randomly divided into two groups: the control group (VSD only) and the research group (VSD combined with rb-bFGF flushing). We assessed wound healing time, dressing change frequency, drainage tube replacement frequency, length of hospital stay, granulation maturation rate, adverse reaction incidence, and serum levels of C-reactive protein (CRP), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF). Results The research group showed significantly better outcomes: higher total response rate (96.00% vs. 82.00%), shorter wound healing time, lower dressing change and drainage tube replacement frequencies, and reduced length of stay (all P<0.05). Granulation maturation rate was higher in the research group (82.00% vs. 56.00%, P<0.05). After treatment, CRP levels decreased, and VEGF and EGF levels increased significantly in the research group (P<0.05). Adverse reaction incidence was similar between the groups (P=0.674). Conclusion rb-bFGF flushing combined with VSD significantly enhances healing of acute infectious pressure ulcers, reducing inflammation and promoting granulation tissue formation with high safety.

Abstract AIM The aim of this study was to investigate the effect of miR-135a/BACH1/GATA3 signaling on the proliferation, apoptosis, invasion, and migration of gastric cancer cells. METHODS Sixty specimens of cancer tissues and sixty specimens of corresponding adjacent tissues in gastric cancer patients were collected. qPCR and immunohistochemistry were used to detect the expression levels of miR-135a, BACH1 and GATA3 in cancer tissues and adjacent tissues. miR-135a inhibitor, miR-141 mimic, BACH1 inhibitor and GATA3 inhibitor carriers were established. Cell proliferation was detected by CCK8, the invasion ability of cells in vitro was evaluated by MTT, and the cell apoptosis of each group was detected by flow cytometry. RESULTS The results of RT-PCR showed that the expression levels of miR-135a in gastric cancer tissues were significantly higher than those in adjacent tissues, while the expression levels of BACH1 and GATA3 in gastric tissues were significantly lower than those in adjacent tissues (P<0.05). Interfering with miR-135a increased both BACH1 and GATA3 expression levels; overexpression of miR-135a significantly reduced BACH1 and GATA3 expression levels. Interference with BACH1 and GATA3 significantly enhanced the proliferative capacity of gastric cancer cells. Overexpression of miR-135a significantly increased apoptosis, whereas interference with BACH1 and GATA3 increased apoptosis. CONCLUSION miR-135a participates in the development of gastric cancer by regulating gastric cancer cell proliferation and apoptosis by targeting BACH1 and GATA3.

Background Whereas a potential connection between epilepsy and frailty has been proposed in past research, the causal nature of this relationship requires additional study. Objective This research was designed to evaluate the bidirectional causality between epilepsy and frailty index (FI) through 2-sample Mendelian randomization (MR). Methods In this study, we applied genome-wide association studies to perform forward and reverse MR within a 2-sample context to explore the potential bidirectional causality between FI and epilepsy. The main analysis approach was the inverse variance weighted (IVW) used to assess the potential influence of causal relationships and to carry out sensitivity checks. Results MR analysis revealed a positive correlation between FI and the heightened risk of epilepsy [ORIVW = 1.2126, 95% confidence interval (CI): 1.0143–1.4497, P = 0.0343]. This correlation persists in MR analysis that excluded aberrant single nucleotide polymorphisms (ORIVW = 1.1862, 95% CI: 1.0236–1.3746, P = 0.0232). Reverse MR analysis corroborated a significant positive relationship between epilepsy and FI (ORIVW = 1.0896, 95% CI: 1.0242–1.1592, P = 0.0066), which was confirmed in subsequent replication analysis (ORIVW = 1.0975, 95% CI: 1.0532–1.1436, P = 9.69e-06). Sensitivity analysis further supported the hypothesis of a causal link between FI and epilepsy. Conclusion There is an evident bidirectional causal relationship between FI and epilepsy.

Objective The effect of perioperative antibiotics on postoperative infection (PI) in laparoscopic cholecystectomy (LC) remains unclear. This study aimed to assess the effectiveness of prophylactic antibiotics in preventing postoperative infection and to identify related risk factors. Methods This retrospective study included 464 patients who underwent LC. Patients were divided into the antibiotic group (260 patients, received cephalosporin after anesthesia induction) and no-antibiotic group (204 patients). Demographic data and infection rates were compared using chi-squared and t-tests, and binary logistic regression was applied to identify risk factors, with results presented as odds ratios (OR) and confidence intervals (CI). Results The overall PI rate was 2.4% (11 of 464 patients), with no statistically significant difference between the antibiotic group (2.0%, 5 of 260 patients) and no-antibiotic group (3.0%, 6 of 204 patients; P value = 0.474). Risk factors significantly associated with PI included advanced age (P = 0.001), low albumin levels (P = 0.010), long hospital stay (P < 0.001), and prolonged operation time (P = 0.002). Logistic regression analysis revealed that advanced age (OR = 1.08, 95% CI: 1.00–1.16) and extended hospital stay (OR = 1.33, 95% CI: 1.14–1.56) significantly increased the risk of postoperative infection. Conclusion Routine prophylactic antibiotics may not be necessary for all patients undergoing LC; however, older patients and those with extended hospitalizations should be carefully evaluated, as they may be at higher infection risk. Further prospective studies are warranted to confirm these findings and optimize antibiotic use in this context.

ABSTRACT Objective: This study is to explore the application value of fractional administration of compound polyethylene glycol electrolyte powder combined with simethicone for bowel preparation before colonoscopy in elderly patients. Methods: The objects are 60 elderly patients who underwent colonoscopy in our hospital in 2021.The patients were randomly divided into the control group and the observation group, 30 cases in each group. The control group took polyethylene glycol electrolyte powder for bowel preparation by several times. On this basis, the observation group was given simethicone for bowel preparation. The adverse reactions, intestinal cleanliness, air bubbles in the intestines, lens clarity, time of entering the lens, the amount of saline flushing, and lesion detection were compared between the two groups. Results There was no significant difference in adverse reactions, bowel cleanliness score, detection rate of ≥0.5 cm polyps and adenomas between the two groups（P>0.05）, but the air bubbles and lens clarity , the time of entering the lens, the amount of saline flushing, the detection rate of<0.5 cm polyps of the observation group was significantly better than that of the control group（P<0.05）. Conclusion: It is safe and effective for elderly patients to take compound polyethylene glycol electrolyte powder combined with simethicone for intestinal preparation.

Objective This study aimed to investigate the surgical approaches, clinical efficacy, and indications of a novel acetabular anatomical locking plate for acetabular fractures involving the quadrilateral plate. Methods Patients with acetabular fracture treated with the novel acetabular quadrilateral anatomical locking plates in our department from December 2017 to June 2020 were collected. According to the fracture types, a 1:1 matched-pair analysis was carried out and patients treated with reconstruction plates were selected. These 2 groups of patients were included in the observation group and control group, respectively, and ultimately each group included 11 patients. The time between injury and definitive surgery, surgical approaches, operation time, intraoperative blood loss volume, intraoperative blood transfusion volume, postoperative blood transfusion volume, fracture union time, reduction loss, and postoperative complications were recorded. The fracture reduction quality and hip function were respectively evaluated by Matta’s grading system and the modified Merle D’Aubigne-Postel grading system. A comparison was made to observe whether the 2 groups had differences in the preceding clinical parameters. Results As for the observation group, the mean operation time was 327.82 ± 137.46 min (range: 120～580 min; median: 323 min), the mean intraoperative blood loss volume was 1745.46 ± 2103.98 mL (range: 300～7000 mL; median: 1000 mL), and the mean intraoperative blood transfusion volume was 1526.18 ± 1617.46 mL (range: 0～5130 mL; median: 900 mL), and the mean postoperative blood transfusion volume was 254.55 ± 439.01 mL (range：0～1400 mL; median：0 mL). During the follow-up period ranging from 9 to 28 months, 1 incision lipoliquefaction, 1 heterotopic ossification, and 1 traumatic arthritis were recorded. According to Matta’s grading system, 4 anatomic reductions, 6 imperfect reductions, and 1 poor reduction were recorded, and the rate of satisfactory reduction quality was 90.91%. According to the modified Merle D’Aubigne-Postel grading system, 5 excellent, 4 good, 1 fair, and 1 poor were recorded, and the rate of satisfactory hip function was 81.82%. As for the control group, the mean operation time was 273.18 ± 99.15 min (range: 120～450 min; median: 270 min), the mean intraoperative blood loss volume was 1122.73 ± 469.77 mL (range: 300～1500 mL; median: 1500 mL), and the mean intraoperative blood transfusion volume was 608.55 ± 363.71 mL (range: 0～1086 mL; median: 758 mL), the mean postoperative blood transfusion volume was 281.82 ± 430.86 mL (range：0～1000 mL; median：0 mL). During the follow-up period ranging from 9 to 42 months, 2 instances of traumatic arthritis and 1 femoral head necrosis were recorded. According to Matta’s grading system, 2 anatomic reductions, 6 imperfect reductions, and 3 poor reductions were recorded, and the rate of satisfactory reduction quality was 72.73%. According to the modified Merle D’Aubigne-Postel grading system, 1 excellent, 7 good, 0 fair, and 3 poor were recorded, and the rate of satisfactory hip function was 72.73%. All the patients obtained fracture union, and no reduction loss was recorded. According to statistical analysis, there were no significant differences between the 2 groups in the time between the injury and definitive surgery, surgical approaches, intraoperative blood loss volume, intraoperative blood transfusion volume, postoperative blood transfusion volume, rate of satisfactory reduction quality, hip function score, and rate of satisfactory hip function. Conclusions Through 3 kinds of anterior approaches, the novel anatomical locking plate can be used to fix acetabular fractures involving the quadrilateral plate including anterior wall fractures, anterior column fractures, transverse fractures, and double-column fractures, which can obtain satisfactory fracture reduction quality, limit the medial displacement of the quadrilateral plate effectively, restore the postoperative hip function well, and obtain a comparable clinical efficacy as the reconstruction plate.

Purpose Patients undergoing surgery for esophageal cancer (EC) frequently experience postoperative pneumonia (POP). POP promotes poor prognosis as well as increased medical costs and longer hospital stays. Therefore, it is desirable to prevent and strictly control high-risk cases to reduce the incidence of pneumonia. The present study aimed to determine the risk factors for POP in EC. Patients and Methods The subjects of this retrospective study were 151 patients with EC who underwent subtotal esophagectomy in our department between January 2012 and December 2021. Univariate and multivariate logistic regression analyses were used to evaluate the association between the incidence of POP and clinical factors. Results Among 151 patients, 33 cases (21.8%) developed POP. Multivariate analysis identified preoperative C-reactive protein-to-albumin ratio (CAR) ≥0.03 [odds ratio (OR), 2.69; P = 0.0352], chronic obstructive lung disease (COPD) (OR, 7.32; P = 0.0001), and diabetes mellitus (DM) (OR, 3.35; P = 0.0252) as independent risk factors for POP. In accordance with the number of risk factors, the incidence rate of POP drastically increased, and its rate in patients with 3 risk factors was 80%. Conclusion High CAR, COPD, and DM are independent risk factors for the development of POP in patients undergoing subtotal esophagectomy for EC. Clinicians should be aware of the risk factors for POP and consider more intensive preventive measures and postoperative management in patients with EC.

Abstract Introduction. Cystic duct anatomical variations are encountered frequently during surgical procedures. In this report, a female patient underwent laparoscopic cholecystectomy for acute cholecystitis and developed symptoms of obstructive jaundice subsequently, which was diagnosed as low insertion of the cystic duct and an impacted stone that was causing common hepatic duct obstruction. Case report. A 42-year-old female presented to the emergency room complaining of persistent right upper quadrant pain that was radiating to the back. White blood count (WBC) was slightly elevated with normal liver function tests (LFTs). An abdominal ultrasound was performed and confirmed cholelithiasis with no signs of acute cholecystitis or biliary dilatation. The patient underwent laparoscopic cholecystectomy as an emergency procedure for persistent biliary colic. Eight days later, the patient returned to the emergency room with obstructive jaundice and continued right upper quadrant pain with elevated WBC and LFTs. Further tests were conducted, and the patient was found to have a long cystic duct with a low insertion variant to the common hepatic duct. An impacted stone was identified in the cystic duct, referred to as Mirizzi syndrome Type I. The patient underwent endoscopic retrograde cholangiopancreatography (ERCP) several times, but the common bile duct could not be cannulated. In the last ERCP session, SpyGlass and electrohydraulic lithotripsy were performed with a balloon sweep. Conclusion. This case demonstrates the importance of understanding Mirizzi syndrome and cystic duct variation to achieve optimal treatment, and careful assessment and investigation are essential for proper diagnosis. In experienced hands, Mirizzi syndrome secondary to an impacted cystic duct stone can be managed successfully with ERCP, electrohydraulic lithotripsy, and SpyGlass.

Objective To explore the effect of 60 knee flexion combined with multiple tranexamic acid application on postoperative recovery of knee replacement patients. Methods Knee replacement patients admitted to our hospital from February 2022 to February 2024 were selected as the study subjects, and randomly divided into 2 groups. Postoperative D-dimer, prothrombin time, and partial thrombin time were recorded in the 2 groups, and the differences between the 2 groups were compared. Erythrocyte, hemoglobin, and erythrocyte volume were recorded before, 1 day, and 3 days after surgery, and the affected limb circumference were also assessed. Results On the first and third day after surgery, red blood cells, hemoglobin, and hematocrit levels in the experimental group were higher than those in the control group, and the differences were statistically significant (P < 0.05). The difference in visual analogue score (VAS) and circumference between the two groups on the first day and third day after surgery was compared, and the difference was statistically significant. The difference in VAS score and circumference was lower in the control group (P < 0.05). After surgical treatment, knee joint function recovered, knee joint mobility, and Healthcare Security and Safety (HSS) score improved, and the difference between the experimental groups was statistically significant (P < 0.05). Conclusion Perioperative 60° flexion combined with multiple tranexamic acids can significantly reduce blood loss in patients undergoing knee replacement surgery, increase red blood cells, hemoglobin levels, and red blood cell volume on postoperative days 1 and 3, and reduce postoperative swelling of the affected limb.