To evaluate the features of carotid web (CW) by ultrasonography.

A total of 66 patients with CW were retrospectively enrolled from January 2018 to June 2019 at Xuanwu Hospital, Capital Medical University. All patients were examined by both ultrasonography and CTA, and were divided into either a<50% stenosis group (54 cases) or a ≥50% stenosis group (12 cases). The ultrasonographic characteristics of CW, including the length, thickness, direction (forward or backward to the flow), acute angle between the web and carotid wall, and thrombus between the web and carotid wall were compared between the two groups. The stenosis degrees of carotid artery were compared between patients with and without ischemic stroke.

Forty-two (42/66, 63.6%) patients were diagnosed with CW by initial CDFI examination, of whom 21 (21/66, 31.8%) were diagnosed with ulcerative plaque and 3 (3/66, 4.5%) were diagnosed with carotid dissection at first but confirmed by second examination. There were no differences in the web length, thickness, direction, or thrombus detected between the two groups (P>0.05). The angle between the web and carotid wall in the<50% stenosis group was significantly smaller than that of the ≥50% stenosis group (median angel 39o vs 73o, P=0.002), and the percentage of patients with an angle≤ 60o in the<50% stenosis group was significantly higher than that of the ≥50% stenosis group (74.1% vs 41.7%, P=0.042). The diameter of the residual carotid artery at CW location in the<50% stenosis group was significantly larger and peak systolic velocity was significantly higher in the<50% stenosis group than in the≥50% stenosis group (P<0.001). The stenosis degrees of carotid artery were not statistically different between patients with and without ischemic stroke (P=0.321).

Ultrasonography can be used to evaluate the characteristics of carotid web in 2D and color mode. When the angle between the CW and carotid wall is large, the carotid artery stenosis ≥ 50% is more likely to happen, but carotid artery stenosis is not the main cause of ischemic stroke.

The aim of the present study was to evaluate the efficiency of sling exercise, therapeuticultrasound, therapeuticultrasound and sling exercise in patients to alleviate pain and improve lumbar function with lumbar disc herniation.

Individuals were selected from a list of patients being followed at the department of Rehabilitation in the third hospital of Hebei Medical University. 30 patients who were diagnosed with lumbar disc herniation were collected, the diagnoses were established upon medical history, physical examination, and results of imaging studies. The patients were randomly divided into three groups: therapeuticultrasound group received 14 sessions of ultrasonic therapy to the lumbar region, Sling exercise group received 14 sessions of sling exercise, and therapeuticultrasound and sling exercise group received therapeuticultrasound and sling exercise therapy 14 sessions of therapeuticultrasound to the lumbar region,7 sessions per week, 2 weeks. The VAS and ODI were compared with the assessment of the patients before and at the end of the therapy.

At the end of treatment, three groups VAS scores (F=3.069, P=0.043) and ODI scores (t=12.676, P<0.001) was lower than that at the beginning of treatment (P<0.05), at the end of treatment the VAS scores (F=59.400, P<0.001) and of the ODI scores (t=12.737, P<0.001) of ultrasonic and sling exercise therapy group was lower than the other group, the difference is significantly.

All three groups could reduce pain and improve lumbar function, and the ultrasonic and sling exercise therapy was most effective for lumbar disc herniation treatment in the three groups.

To analyze the treatment of different types of traumatic cerebral infarction in children, and explore its pathogenesis in combination with literature so as to improve the cure rate and reduce disability rate.

The clinical data of 42 cases of traumatic cerebral infarction in children were retrospectively analyzed in The Hospital of 81^st Group Army PLA from January 2015 to December 2019. The diagnosis of traumatic cerebral infarction in children was made by CT scan and MRI scan. According to different conditions, children with traumatic cerebral infarction were classified, and different treatment strategies were selected. Children with lacunar infarction were treated with calcium antagonists and neurotrophic drugs, supplemented by hyperbaric oxygen and exercise rehabilitation. The children of focal cerebral infarction and complex cerebral infarction treated by junior dehydrant and hormone also included the calcium antagonist and nutritional nerve drugs. The therapeutic regimen perhaps adjusted by the evolution of the disease. The children of extensive cerebral infarction underwent emergency cranial decompression, and was treated by reducing intracranial pressure and preventing complications after operation. The treatment results and recovery were observed.

In 42 cases of traumatic cerebral infarction in children, 35 cases (83.3%) were good recovery, 4 cases (9.5%) were moderate disability, 2 cases (4.8%) were severe disability, 1 case (2.4%) died, and no vegetative state. The good recovery rate of lacunar infarction was 100%, that of focal cerebral infarction was 62.5%, that of mixed cerebral infarction was 60%, and that of extensive cerebral infarction was 50%.

It is of great significance to improve the therapeutic effect and prognosis of children with traumatic cerebral infarction to adopt different treatment schemes for different types of cerebral infarction.

To characterize the patients with supratentorial hypertensive intracerebral hemorrhage (ICH) in the Tibetan Plateau over an altitude of 4000 meters.

A total of 68 cases with supratentorial hypertensive ICH were retrospectively included in Ali Regional People’s Hospital from January 2017 to September 2018. The clinical and laboratory data were collected. A simple linear correlation analysis was applied to analyze the correlation between the amount of bleeding and sex, age, nationality, time from onset , systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin (Hb), serum triglyceride (TG), and cholesterol. According to computed tomography (CT) findings, 68 cases were divided into the basal ganglia ICH group (33 cases) and the lobar ICH group (35 cases). The characteristics between two groups were analyzed using t-test or χ² test.

The data of sex, age, nationality, time from onset, SBP, DBP, Hb, TG, and cholesterol of 68 cases on admission did not show any definitive correlation with the hematoma volumes (P＞0.05). The SBP and DBP of patients in the basal ganglia ICH group were significantly higher than that in the lobar ICH group, respectively [(184.9±28.5) mmHg vs (164.6±24.4) mmHg; (113.0±18.1) mmHg vs (103.0±18.4) mmHg] (t=0.499, 0.486; P=0.002, 0.033).

The relevant factors of hematoma volumes in patients with ICH in plateau area were not yet clear. Diastolic and systolic blood pressure of patients in the basal ganglia ICH group was higher than that in those in lobar ICH group.

To compare the efficacy evaluation of electrospun composite biomaterials and a porcine small intestine submucosa mesh for hernia repair.

A randomized, single-blind, controlled multicenter trial was performed in 3 hospitals in Shanghai. Eligible adult patients with primary unilateral reducible groin hernias were randomly assigned (1∶1) to electrospun composite biomaterials (experimental group) or porcine small intestine submucosa (control group) mesh groups. Patients were treated with the tARB technique and assessed at 1,3 and 6 months after the surgery. The primary endpoint was hernia recurrence. The secondary endpoints were postoperative complications including groin pain and operative site infections.

172 patients were assigned to experimental (n=86) and control (n=86) groups. At 6 months follow-up, postoperative complications occurred in 5 patients (5/86, 5.95%) and 2 (2/86, 2.35%) patients in the control and experimental groups, respectively (P>0.05). There was no significant difference in VAS or SVS score between the two groups.

We demonstrate that electrospun composite biomaterial mesh can be used as a ideal choice for inguinal hernia repair. Electrospun composite biomaterial has the characteristics of low recurrence rate, absorbability and long-term comfort.It can be further applied in clinical practice in the future.

Pancreaticoduodenectomy(PD)remains one of the most complicated hepatobiliary operations. The development of minimally invasive surgery for PD has always been an hot spot. Laparoscopic pancreaticoduodenectomy(LPD) has not been widespread carried out due to its difficulty and long learning curve. LPD accounts for 9% of all PD, according to the National Cancer Data base. Compared with laparoscopic surgery, robotic surgery system has significant advantages in the field of minimally invasive PD, including stereotactic amplified vision, filtering hand tremor and simulating the wrist. The article would review the surgical techniques and notes, which could provide clinical reference for other surgeons.

To investigate the preventive effect of laparoscopic sleeve gastrectomy (LSG) combined with intraoperative sharp His angle reconstruction (LSG-His) on postoperative gastroesophageal reflux disease (GERD) in obese patients.

A retrospective analysis was conducted on clinical data of 58 obese patients who underwent surgery at Bazhou People’s Hospital from January 2021 to December 2023. Patients were divided into LSG group (n=33) and LSG-His group (n=25) according to the surgical procedure. Univariate analysis (independent sample t-test, χ² test) was used to compare perioperative indicators (operation time, intraoperative blood loss, postoperative hospital stay), postoperative complications, weight loss outcomes at 12 months postoperatively, and incidence of GERD between the two groups. Multivariate logistic regression was performed to identify independent influencing factors for GERD.

The incidence of postoperative GERD in the LSG-His group was 24.0% (6/25), which was significantly lower than that in the LSG group (44.0%, 14/33; χ²=4.211, P=0.048). The LSG-His group had a shorter postoperative hospital stay than the LSG group [(4.1±0.5) days vs (4.6±0.7) days, t=2.350, P=0.032]. There were no statistically significant differences between the two groups in terms of percentage of excess weight loss at 12 months postoperatively [(47.2%±6.3%) vs (46.8%±6.1%)] or overall complication rate (16.00% vs 27.27%; P>0.05). Multivariate regression analysis showed that surgical procedure was an independent predictor of GERD (OR=0.414, 95%CI: 0.175–0.982, P=0.046).

The LSG-His procedure effectively reduces the risk of postoperative GERD in obese patients without compromising weight loss outcomes or increasing surgical risks.

To analyze the clinical and endoscopic features of patients with reflux esophagitis complicated with peptic ulcer.

The date of 3311 patients’ gender, age, the location and stage of peptic ulcer, combined upper gastrointestinal obstruction, esophageal hiatal hernia and the infection of Helicobacter pylori with reflux esophagitis complicated with peptic ulcer were retrospectively analyzed in the Gastroenterology Department of the People’s Hospital of Xinjiang Uygur Autonomous Region from March 2015 to February 2021. Patients were stratified into a mild RE combined with PU group (2977 cases, LA grades A and B) and a severe RE combined with PU group (334 cases, LA grades C and D) according to the Los Angeles (LA) classification system. The chi-square test was used to compare between-group differences in gender, concomitant upper gastrointestinal obstruction, concurrent hiatal hernia and Helicobacter pylori infection status, while the independent-samples t-test was applied for intergroup comparison of age.

3311 case of reflux esophagitis complicated with peptic ulcer, the male to female ratio was 3.74:1 (2612 vs 699), the mild to severe reflux esophagitis ratio was 8.91:1 (2977 vs 334); There was no statistically significant difference in the male-to-female ratio between the two groups (P>0.05). The difference in age between males and females was statistically significant (50.82±13.27 vs 57.76±15.11; t=-7.72, P<0.001). There were 2471 patients with duodenal bulbar ulcer, accounting for 74.63%; Of the 3540 ulcers, 2808 (79.32%) were in the active or healing stage. 157 and 108 cases were developed upper gastrointestinal obstruction, There was a statistical difference between them (P<0.001). 262 and 67 cases of combined hiatal hernia of the esophagus, which were statistically different from each other (P<0.001), 73.06% and 80.54% were the infection rate of Helicobacter pylori, which were statistically different from each other (χ²=8.690, P=0.003).

In patients with reflux esophagitis complicated by peptic ulcer, males are significantly more affected than females. Duodenal bulb ulcers are the most common type, mostly in the active or healing stage. The infection rate of Helicobacter pylori is high. Severe reflux esophagitis complicated by peptic ulcer is more often associated with upper gastrointestinal obstruction and hiatal hernia.

Anatomical abnormalities and dysfunction of anti reflux barrier are important causes of gastroesophageal reflux disease. This paper proposes to use the "door system" as a metaphor for the composition of the anti reflux barrier, emphasizing that the anti reflux barrier is not a single anatomical unit, but an organic whole with multiple structures, such as the lower esophageal sphincter (door plate), diaphragm foot (door frame), phrenic esophageal ligament (hinge), his angle, gastroesophageal valve flap (door handle), which are precisely combined and coordinated with each other. The phrenic esophageal ligament connects the lower esophageal sphincter (LES) with the diaphragm foot to form a spatial structure that overlaps anatomically and functionally, namely the "coincide" structure. The his angle and gastroesophageal valve flap are the same antireflux valve complex described from different perspectives inside and outside the gastric wall. The "coincide" structure and the anti regurgitant valve complex are cross-linked to each other to play an anti regurgitant role, and they constitute the main structure of the anti regurgitant barrier. Hiatal hernia is an important anatomic etiology leading to the occurrence and development of gastroesophageal reflux disease. Esophageal hiatal hernia through the diaphragm foot expansion, diaphragmatic esophageal fascia relaxation, gastroesophageal junction upward, resulting in lower esophageal sphincter pressure drop, gastroesophageal valve flap loose, his angle blunt, resulting in the systematic destruction of the anatomical structure of the anti reflux barrier, resulting in the overall obstacle of anti reflux function. Based on this holistic perspective, the article demonstrates that the essence of anti reflux repair surgery is the precise repair of the organic complex of anti reflux barrier: repair the "coincide" structure consisting of the lower esophageal sphincter and the diaphragm foot together with the phrenic esophageal ligament, restore the length of the abdominal esophagus, and rebuild the anti reflux valve complex consisting of his angle and gastroesophageal valve flap, namely the door handle system, to achieve the restoration of anti reflux structure function integration through "four in one" reconstruction. The destroyed anti reflux barrier was reconstructed into an anti reflux organic complex with precise combination of anatomic components and functional cooperation of multiple structures.

The surgical treatment of hiatal hernia has undergone a minimally invasive revolution, progressing from open thoracotomy and laparotomy to thoracoscopy, laparoscopy, and robotics. In recent years, laparoscopic surgery has become the gold standard in abdominal surgery. The introduction of robotic surgical systems signifies a new wave of technological evolution. This article primarily reviews the technical development of hiatal hernia repair from laparoscopy to robotics, focusing on comparing the evidence regarding surgical precision, learning curve, perioperative outcomes, and cost-effectiveness between these two minimally invasive techniques. It also delves into current core controversies, such as the application of mesh and the choice of fundoplication techniques, and looks ahead to future technological directions including artificial intelligence and technical advancements. This article posits that the robotic surgical platform offers significant technical advantages for hiatal hernia repair, but its widespread application still requires higher-level evidence-based medical support.

To compare the short-term efficacy and safety of endoscopic antireflux mucosal ablation (ARMA) versus an optimized, guideline-based step-up proton pump inhibitor (PPI) regimen in patients with refractory or PPI-dependent gastroesophageal reflux disease (GERD) classified as gastroesophageal flap valve (GEFV) grade Ⅰ-Ⅲ.

A prospective, randomized, open-label, active-controlled trial was designed. Fifty patients were planned to be recruited and randomly assigned (1:1) to either the ARMA group or the optimized PPI group. The primary endpoint was the change from baseline in GERD health-related quality of life (GERD-HRQL) score at 6 months post-treatment. Secondary endpoints included symptom scores (GERD-Q), acid exposure time (AET) percentage, DeMeester score, PPI usage status, and adverse events. A prespecified subgroup analysis based on GEFV grade (Ⅰ/Ⅱ vsⅢ) was conducted.

Forty-eight patients completed the 6-month follow-up and were included in the analysis. The improvement in GERD-HRQL score was significantly greater in the ARMA group than in the optimized PPI group (median improvement: 23.5 vs 8.0, P<0.001). Analysis of secondary endpoints showed that the ARMA group was significantly superior to the optimized PPI group in improving objective reflux parameters such as AET (decreased from 20.1% to 4.6%) and DeMeester score, as well as in promoting PPI discontinuation or dose reduction (all P <0.001). Preliminary subgroup analysis showed that the efficacy of ARMA in improving GERD-HRQL was superior to optimized PPI in both GEFV I/II and Ⅲ grade patients (all P<0.05). Treatment-related adverse events occurred in 12.5% (3/24) of patients in the ARMA group, all of which were mild and transient dysphagia.

For patients with refractory GERD and GEFV grade Ⅰ-Ⅲ, ARMA is significantly superior to systematic optimized PPI therapy in improving symptoms, quality of life, and objective reflux parameters within 6 months, with a good safety profile. ARMA provides an effective minimally invasive therapeutic option for patients who remain symptomatic despite adequately optimized medical therapy or who wish to avoid long-term medication dependence.

To screen and identify key genes associated with oxidative stress in ulcerative colitis.

The GSE179285 gene expression profiles were acquired from the gene expression omnibus database. And GEO2R was used to identify differentially expressed genes. We intersected the differentially expressed genes with the oxidative stress-related genes screened in the GeneCard database to find the oxidative stress-related genes in ulcerative colitis. R software was used to conduct gene ontology and Kyoto Encyclopedia of Genes and Genomes analyses of differentially expressed genes. Module of PPI network and analysis of key genes using Cytoscape software. colon mucosal Tissue samples from 30 patients with active ulcerative colitis and healthy control subjects were collected, the expression of Hub genes was verified using quantitative real-time polymerase chain reaction (qPCR).

We identified 95 differentially expressed genes in response to oxidative stress. Five key genes—CD44,CXCL8,hypoxia inducible factor 1 subunit alpha (HIF1α),interleukin-1 beta (IL1β) and angiotensinogen (AGT)—were selected as a result.qPCR analysis revealed that compared with the control group, the mRNA expression of CD44, CXCL8, HIF1α, and IL1β was elevated in the ulcerative colitis group (P<0.0001). There was no significant difference in AGT expression between the two groups (P>0.05).

CD44, CXCL8, HIF1α, and IL1β play critical roles in ulcerative colitis and could serve as potential diagnostic and therapeutic targets for the disease.

To investigate the clinical efficacy of laparoscopic hiatal hernia repair combined with fundoplication in the treatment of patients with hiatal hernia (HH) complicated by gastroesophageal reflux disease (GERD) in primary hospital.

A retrospective analysis was conducted on 46 cases of patients treated with laparoscopic hiatal hernia repair combined with fundoplication for HH complicated by GERD at Linxiang District People’s Hospital from April 2019 to June 2025. The surgical methods and techniques were summarized, and perioperative data were analyzed. Postoperative outcomes were evaluated using the short form health survey (SF-36), GERD questionnaire (GERD-Q), and numerical rating scale (NRS).

All 46 patients underwent successful surgery, with an average operative time of (103.17± 26.97) min, average blood loss of (12.71± 8.94) ml, and average time to resume liquid diet of (1.37±0.49) days. Postoperative pain scores on the NRS were (1.97±0.79) points, with 2 cases of pneumothorax and 3 cases of dysphagia. The average postoperative hospitalization duration was (5.40± 1.31) days. Patient satisfaction was high at 6 months postoperatively, with an SF-36 score of (83.88±5.5) points. Postoperative reflux symptoms were significantly alleviated, and the GERD-Q score [(2.11±0.90) points] was markedly lower than the preoperative score [(11.29±2.02) points], with a statistically significant difference (P<0.01).

Laparoscopic hiatal hernia repair combined with fundoplication is safe, feasible, and effective in treating HH complicated by GERD.

To clarify the current awareness status of laryngopharyngeal reflux disease (LPRD) among County-level Hospitals of Southern Xinjiang, and provide a scientific basis for formulating the disease’s prevention and treatment strategies.

A total of 10 county-level medical institutions were enrolled using the cluster sampling method. A cross-sectional survey was conducted among physicians in the departments of otorhinolaryngology, gastroenterology, and gastrointestinal surgery to investigate their awareness of laryngopharyngeal reflux disease (LPRD). Chi-square test and multivariate Logistic regression analysis were performed to identify the factors influencing LPRD awareness. Receiver operating characteristic (ROC) curves were plotted and the area under the curve (AUC) was calculated to evaluate the predictive efficacy of the multivariate Logistic regression model.

171 physicians were surveyed. While 84.21% had heard of LPRD, overall awareness was only 13.5%, with textbooks (72.9%) the most common source. 15.2% knew the reflux symptom index; 33.92% could correctly apply the laryngeal reflux sign scale; 20.5% recognized 24-hour MII-pH monitoring as the diagnostic "gold standard" ; 14.6% knew proton pump inhibitors as first-line therapy. Educational background, specialty, and title influenced LPRD knowledge: Bachelor’s or above degree holders had higher awareness than lower-educated counterparts (OR=12.689); gastrointestinal surgeons had lower awareness than otolaryngologists (OR=0.191); intermediate (OR=15.719) and senior (OR=95.415) title holders outperformed juniors.

Though most relevant specialty physicians in county hospitals are aware of LPRD, overall understanding is suboptimal, needing enhanced screening and treatment capabilities.

To systematically analyze the research status and development trends in the field of laparoscopic fundoplication and anti-reflux surgery in the treatment of gastroesophageal reflux disease (GERD).

The PubMed database was searched for relevant literature from January 2014 to September 2024, and 809 research papers and reviews were included. The R language bibliometrix software package was used for bibliometric analysis, covering publication trends, journal distribution, author contributions, national cooperation, keyword co-occurrence, and topic evolution. The time stratified analysis method is used to calculate the citations per paper (CPP) and the normalized citation impact index (NCLI) according to the year of publication to correct the impact of publication time on citation accumulation.

This field publishes an average of about 73 articles per year, and its activity has increased significantly in the past five years. The main journals publishing articles focus on the field of surgery and minimally invasive surgery, with the "Journal of Laparoendoscopic & Advanced Surgical Techniques" having the highest number of articles (40 articles). Author productivity is in line with Lotka’s law. Highly productive authors are concentrated in a small number of researchers, represented by Omura Nobuo and Yano Fumiaki. Country analysis shows that the United States leads in terms of total number of articles published (356), total number of citations (401 times), and international cooperation; China ranks third in number of articles published (158) and second in total number of citations (229 times). After correction by time-stratified analysis, China’s average citation frequency (1.45 times/article) is still significantly higher than the global average (1.28 times/article). The standardized citation impact index (NCLI=1.13) shows that its academic quality is internationally recognized, but there is still a gap compared with the United States (CPP=3.12, NCLI=1.89). Keyword analysis shows that "fundoplication" , "Nissen fundoplication" and "GERD" are core topics, while "bariatric surgery" and "obesity" are emerging niche directions. The co-citation network shows that the documents of Stefanidis (2010) and Galmiche (2011) play an important role in laying foundation for knowledge.

Research on laparoscopic anti-reflux surgery for the treatment of GERD has continued to develop in the past decade and has formed a centralized academic landscape. The United States occupies a dominant position, and Chinese research shows robust academic influence under standardized indicators. In the future, further attention should be paid to personalized treatment, robot-assisted surgery, GERD and metabolic disease comorbidity management, and international cooperation should be strengthened to increase citation influence and promote innovation in the field.

This article systematically compares the multiple mechanisms by which laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB) affect postoperative metabolism in obese patients with obstructive sleep apnea (OSAS). As a key comorbidity of OSAS, gastroesophageal reflux disease (GERD) has a bidirectional pathological exacerbation relationship with OSAS, and the different effects of these two procedures on GERD are directly related to the postoperative remission of OSAS. In addition to reducing upper airway fat deposition and alleviating intermittent hypoxia and systemic inflammation through weight-dependent mechanisms, both procedures directly regulate glucose and lipid metabolism via non-weight-dependent mechanisms such as gastrointestinal hormone remodeling, bile acid signal activation, and gut microbiota regulation. Among them, RYGB shows superior advantages in the regulation of enteric hormones and bile acids, and has a definite anti-reflux effect; while LSG exerts metabolic benefits by strongly inhibiting ghrelin and enhancing GLP-1/PYY responses, and can also inhibit oxidative stress-induced adipose inflammation through regulating the GLP-1/DPP-4 pathway, but carries the risk of inducing or exacerbating GERD. This review aims to provide a comprehensive mechanistic basis for the individualized selection of surgical procedures for obese patients with OSAS, especially those with concomitant GERD.