Objective To evaluate the clinical analgesic effect of different doses of dexmedetomidine(DEX) mixed with ropivacaine in hip surgery in children.Method 60 children aged 2-8 years(inclusive) were selected with developmental dysplasia of the hip(DDH) diagnosed,who needed open reduction of hip joint and osteotomy of pelvis and femur.Ultrasonicguided lumbar plexus block combined with general anesthesia was used.According to the composition of local anesthetics,children were randomly divided into three groups:simple 0.2% ropivacaine group(R group),0.2% ropivacaine+0.5μg/kg DEX group(0.5DEX group) and 0.2% ropivacaine+1μg/kg DEX group(1DEX group).The dosage of sufentanil used during operation,the dosage of sufentanil used in Post anesthesia care unit(PACU),postoperative Children's Hospital of Eastern Ontario Pain Scale(CHEOPS),intraoperative hypotension,bradycardia,postoperative excessive sedation,nausea and vomiting were observed. Result There was no significant difference in general information,operation time,intraoperative bleeding volume and blood transfusion rate among the three groups（P>0.05）.The dosage of sufentanil used during operation and the scores of CHEOPS 12 and 24 hours after operation in 0.5DEX group and 1DEX group were significantly lower than those in R group(P<0.05),but there was no significant difference between the two DEX groups（P>0.05）.There was no significant difference in the dosage of sufentanil used in PACU,intraoperative hypotension,bradycardia,postoperative excessive sedation,nausea and vomiting among the three groups（P>0.05）.Conclusion A certain dose of DEX combined with ropivacaine for lumbar plexus block provides better postoperative analgesia than ropivacaine alone in children undergoing hip surgery,and there is no obvious dose dependent effect and no obvious side effects.

Objective Retrospectively analyze the effect of general anesthesia combined with caudal block on the prognosis ofcongenital Hirschsprung's radical excision in children.Methods 229 Children withcongenital Hirschsprung'sradical excisionsurgery were retrospectivelycollected in Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 1,2016 to December 31,2018.They were divided into simple general anesthesia group(G group，139 cases) and general anesthesia combined caudal block group(GC group,90 cases) according to anesthesia method.The vital signs during anesthesia,postoperative complications,reoperation rate and length of hospital stay were compared.Results Compared with G group,the operation time and anesthesia time of the GC group were slightly short(P>0.05);the change of temperature was less in GC group(P<0.05),the postoperative complications and reoperation rate of the GC group were less than those of the G group(P<0.05).There were no differences in the length of hospitalization between the two groups of children(P>0.05).Conclusion General anesthesia combined with sacral block may reduce the postoperative complications andreoperation rate and improve the prognosis of children undergoing laparoscopic radical operation of Hirschsprung's disease.The reason may be related to sacral block inhibiting stress response and reducing intraoperative hypermetabolic response.

Objective To observe the safety and efficacy of high-voltage long-term pulsed radiofrequency therapy on cervical 2 dorsal root ganglia in the treatment of cervicogenic headache patients. Methods  Forty patients with cervicogenic headache who were admitted from July 2020 to December 2021 were enrolled.Ultrasound combined with CT positioning was performed on the dorsal puncture of the ipsilateral atlantoaxial joint to give high-voltage long-term radiofrequency treatment,and the visual simulation scores,clinical efficacy and complications preoperation,1,4,and 12 weeks after surgery were recorded.Results The visual analog scores of the patients at 1, 4 and 12 weeks after surgery were 2.7±1.0, 2.7±1.0 and 2.2±0.8, respectively, which were significantly lower than those before surgery and the difference was statistically significant(P<0.05).The effective rate was still up to 92.5% at 12 weeks postoperation,and there were no serious complications during the treatment.Conclusion The short term efficacy of high-voltage long-term pulsed radiofrequency in the cervical dorsal root ganglion in patients with cervicogenic headache is good,without serious complications.

Objective To evaluate the effect of nalbuphine used as an adjuvant to ropivacaine during FICB on the duration of preoperative analgesia in patients with hip fracture.Methods eventy elderly patients with hip fracture (femoral neck fracture and intertrochanteric fracture) were selected from Our hospital from March 1, 2020 to December 1, 2020.Random number table method was used to divide them into two groups:ropivacaine group(group L) and nalbuphine combined with ropivacaine group(group N)(n=35 in each).All of the patients received fascia iliaca block inferior to the inguinal ligament soon after admission.Patients in group L received a local anesthetic of 30ml of 0.1% ropivacaine and 2ml of saline while those in group N used local 30ml of 0.1% ropivacaine and 20mg of nalbuphine.The primary outcome measure was the duration of analgesia.Secondary outcomes included sensory block area at 30min,2h,6h,and 8h after block,the number of sleep disturbances by pain,side effects,and the length of stay.Results Compared with group L,the duration of analgesia was significantly prolonged[(9.250±0.465)h vs (6.143±0.851)h，P<0.05],the times of sleep disturbances by pain was lower in group N[0(0,0) vs 0(0,2),P<0.05].There was no difference in the incidence of side effects(0 vs 5.88% for nausea,0 vs 2.94% for vomiting,0 vs 0 for neurological complications,all P>0.05) and llength of stay before surgery[3(2,4) days vs 3(2,4) days for preoperative hospital stay,7(7,9) days vs 8(7,9)days for postoperative hospital stay,both P>0.05].Conclusion Nalbuphine can prolong the duration of analgesia when it was used as an adjuvant to ropivacaine during FICB in patients with hip fractures.

Objective To explore the effect comparison of dexamethasone combined with ropivacaine in intermuscular groove brachial plexus block.Methods  A total of 100 patients who underwent elective upper limb surgery in orthopedics department of our Hospital from March 2020 to July 2021 were enrolled.They were divided into control group according to the random number table method and groups A,B,C,and D,20 cases in each.The control group was given 0.5% ropivacaine 20ml + saline 1ml;group A was given 0.5% ropivacaine 20ml + dexamethasone 1mg,group B was given 0.5% ropivacaine 20ml + dexamethasone 2mg,and group C was given 0.5% ropivaca 20ml + dexamethasone 3mg ,group D was given 0.5% ropivacaine 20ml+ dexamethasone 4mg.Compare the effects of anesthesia,stress related indicators and adverse reactions of patients in each group.Results There were no obvious differences in the mean arterial pressure(MAP)mmHg and heart rate(HR)between the five groups of patients before anesthesia,5 min utes after anesthesia,and 6 hours after anesthesia(P>0.05).The maintenance time of sensory and motor nerve blocks in patients in groups A,B,C,and D was obvious longer than control group,and with the increase of dexamethasone dosage,the maintenance time of sensory and motor nerve blocks was gradually extended(P<0.05).The levels of norepinephrine(NE),epinephrine(E),and cortisol(Cor)in each group increased to varying degrees at 24 hours after operation,but the levels of NE,E,and Cor in the two groups were lower than those in the control group,A,B three groups,the difference is statistically significant(P<0.05).There was no significant difference in adverse reactions between the five groups during and after surgery(P>0.05).Conclusion Dexamethasone combined with ropivacaine and brachial plexusblock anesthesia can significantly prolong the nerve block time and reduce the body's stress response in patients,and it is within the safe dose range of dexamethasone  more obvious.

Objective To evaluate the effects of different loading doses of Sketamine on postoperative cognitive dysfunction in elderly patients with hip replacement.Methods This was a prospective case control study.120 patients who underwent hip replacement surgery from September 2020 to September 2021 were randomly divided into three groups(n=40) by random number table method:low load dose Sketamine(group L,0.3mg/kg),highload dose of Sketamine(group H,0.5mg/kg) and control group(group C),After the level of anesthesia was stabilized,each group was given intravenous injection of corresponding doses of drugs.At the beginning of operation,both group L and group H were given 0.1mg/(kgoh) Sketamine by pump,and group C was given 0.1ml/(kgoh) normal saline pump until the end of the operation.To evaluate the patients' preoperative and postoperative Mini mental Status Examination(MMSE) scores,postoperative 3minute Delirium Diagnostic Scale(3D CAM) scores,sleep scores,intraoperative sedation assessment scale(RASS) scores and ICU non verbal communication patient pain assessment scale(COPT) score,assess patients for the occurrence of POCD.Results Compared with group C,the incidence of POCD and the analgesia score at 24 hours after operation were decreased in groups L and H(P<0.05).The incidence of POCD:13 cases in group C,5 cases in group L,and 4 cases in group H,analgesia scores:group C(3.15±0.81),group L(2.1±0.96),group H(1.9±0.96)(P<0.05);the incidence of adverse reactions in group H(13 cases) was higher than group C(5 cases) and group L(3 cases)(P<0.05).Conclusion The application of low dose Sketamine in elderly hip replacement patients can improve there postoperative cognitive cognition,reduce the occurrence of postoperative complications.

Objective To observe the analgesic effect and safety of ropivacaine and levobupivacaine in high ligation of hernia sac under ultrasonography guided transversus abdominis plane block.Methods A retrospective study was conducted on 133 children with inguinal hernia admitted to our hospital from March 2018 to March 2020.Nerve block drugs were divided into two groups:ropivacaine group(RP group) and levobupivacaine group(LB group),with 62 cases in RP group and 71 cases in LB group.Clinical indexes,analgesic effect(FLACC) and safety were compared.Results There were no significant differences in extubation time,recovery time and hospitalization time between the two groups(P>0.05),and the dosage of remifentanil in LB group was significantly lower than that in RP group(P<0.05).The FLACC score at T1 was significantly higher than that at T0,T2 and T3(P<0.05).The FLACC scores of LB group at T1 and T2 were significantly lower than those of RP group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion The ultrasonic guided ropivacaine or levobupivacaine transversus abdominis plane block had good analgesic effect in the high ligation of children's hernia sac.The analgesic effect of levobupivacaine was stronger than that of ropivacaine,both are equally safe.

Objective To explore risk factors of high activity delirium after laparoscopic radical nephrectomy combined with inferior vena cava tumor removal under general anesthesia in elderly patients with renal cell carcinoma.Methods 115 elderly patients with renal cell carcinoma who were underwent laparoscopic radical nephrectomy combined with inferior vena cava tumor thrombectomy were divided into N group (86 cases) and PHTD group(29 cases) from January 2019 to January 2021.They.Statistic and analyze the clinical data,operation and anesthesia conditions and postoperative conditions of patients in each group.Results The multiple factors Logistic regression analysis showed that age,ASA grade,anesthesia time,anesthetic dosage,extubation time,PACU residence time,sleep interference,intraoperative hypotension,postoperative pethidine dosage and postoperative body temperature were independent risk factors for the occurrence of highly-active delirium in elderly patients with cell carcinoma (P<0.05).The Nomogram analysis prediction model shows that the higher total risk of each factor,the high risk of delirium in elderly patients with cell carcinoma after kidney cancer surgery.The receiver operating characteristic（ROC）curve analysis showed performed,and the results showed that the area under the curve (AUC) of the prediction performance of the nomogram prediction model was 0.911（95%CI：0.847-0.975）（P<0.01）.Conclusion Age,ASA grade,anesthesia time,anesthetic dosage,extubation time,PACU residence time,sleep interference,intraoperative hypotension,postoperative pethidine dosage and postoperative body temperature are all independent risk factors for the occurrence of high-activity delirium during the recovery period after renal cancer surgery.

Objective To investigate the effects of naborphine combined with dexmedetomidine on the serum β-Endorphins(β-EP),prostaglandin-E2(PGE2),tumor necrosis factor- α(TNF-α) and interleukin-6(IL-6)in patients with undergoing laparoscopic radical gastrectomy.Methods 126 patients with laparoscopic radical gastrectomy in our hospital were randomly divided into two groups,63 cases in each group.In group C,dexmedetomidine hydrochloride was injected intravenously 10 minutes before anesthesia induction(1μg/kg).the N group was injected  Naborphine(0.2 mg/kg).The anesthetic effect between two groups were compared.Results Compared with that before anesthesia induction,the levels of MAP and HR were increased in C group and N group at the time of extubation(P<0.05).the levels of serumβ-EP,PGE2,TNF-αand IL-6  were significantly higher in N group than that in the C group(all P<0.05).the RS score of the N group were lower than that in the C group(P<0.05).Conclusion Naborphine combined with dexmedetomidine can maintain hemodynamic stability and reduce surgical stress response in laparoscopic radical gastrectomy for gastrointestinal tumors.

Objective To investigate the effect of remazolam on postoperative delirium,stress response in patients with thyroid-related ophthalmopathy undergoing orbital decompression surgery.Methods A total of 100 patients with thyroid-related ophthalmopathy who were diagnosed in our hospital from January 2021 to December 2021 and underwent orbital wall decompression were selected as the research subjects,and were divided into the intervention group(n=51) and the control group(n=49) according to the random number method.The intervention group received remazolam and propofol anesthesia induction and maintenance during the operation,while the control group received normal saline and propofol anesthesia induction and maintenance during the operation.The incidence of delirium,stress response(epinephrine,norepinephrine,cortisol,blood glucose levels),hemorheology(MAP,HR),adverse reactions and satisfaction were observed and recorded in the two groups of patients at different time points after operation.Results The incidence of delirium in the intervention group within 5 days after surgery(3.92%) was lower than that in the control group(15.67%)(P<0.05),but the incidence of delirium in the intervention group within 7 days after surgery(1.96%) was not statistically different with that in the control group(5.88%)(P>0.05).The epinephrine [(100.52±18.41)ng/ml,(112.20±19.22)ng/ml],norepinephrine [(401.14±30.14)ng/ml,(436.63±32.11)ng/ml],cortisol [(231.29±26.63) ng/ml,(246.25±26.79)ng/ml],blood glucose [(6.33±1.22)mmol/L,(7.15±1.36)mmol/L] levels in the intervention group at 6h and 1d after operation were significantly lower than those in the control group [(120.25±20.22)ng/ml,(135.52±21.63) ng/ml,(452.11±33.20)ng/ml,(560.14±35.16)ng/ml,(286.63±28.52)ng/ml,(310.14±30.10)ng/ml,(7.85±1.52)mmol/L,(8.85±1.89)mmol/L](P<0.05),but the epinephrine,norepinephrine,cortisol  and blood glucose in the two groups at 2d after operation had no significant difference(P>0.05).The rate of postoperative adverse reactions in the intervention group(11.76%) was lower than that in the control group(31.37%)(P<0.05),but there was no statistically significant difference in doctor satisfaction between the two groups(P>0.05).Conclusion  The use of remazolam in orbital wall decompression patients with thyroid-related eye disease does not increase the incidence of postoperative delirium,while reducing stress response and postoperative adverse reactions,and increasing patient and physician satisfaction.

Objective This study aims to assess the feasibility,safety and analgesic efficacy of paravertebral blockade(PVB) for percutaneous nephrolithotomy(PCNL).Methods The clinical data of 45 patients with upper urinary calculi treated by Shanghai Fourth People's Hospital affiliated to Tongji University from March 2019 to December 2020 were retrospectively analyzed.Intraoperative hemodynamic changes were observed.Through visual analog pain scale(VAS) questionnaire survey were corded the  degree of pain for establishing gravel channel,after 6 hours,and after 24 hours postoperatively,postoperative analgesic usage,hospitalization duration,postoperative complications and stone clearance rate，perioperative important parameters，adverse reactions during the operation.
Results Of all the 45 patients,the mean diameter of the stones was 2.2cm.The mean operative time was 47.6min.The mean laser lithotripsy time was 18.6min.The average VAS scores of intraoperatively and at 6 and 24 hours postoperatively were 2.7,3.5,and 2.2,respectively.No additional opioid drugs were needed 6 and 24 hours after the operation.The average hospital -in time was 6.4 d.Postoperative low fever occurred in 2 patients and amild bleeding wound appeared in 1 patient,and one had mild nausea.All of whom were cured by conservative treatment.One month after the operation,the stone clearing rate was 95.6%.Two patient had residual stone in the renal calyces after the operation,and the second stage flexible ureteroscope lithotripsy was performed to achieve stone-free.
Conclusion For patients with increased risk of complications after general anesthesia or epidural anesthesia,ultrasound guided paravertebral block anesthesia in PCNL has an ideal analgesic effect with high safety and few adverse reactions.This method reduces the need for opioids in patients undergoing PCNL,improves pain experience.

Objective To analyze the value of monitoring intraoperative regional cerebral oxygen saturation(rSO-2) and serum heme oxygenase-1(HO-1) and superoxide dismutase(SOD) levels for predicting postoperative cognitive dysfunction(POCD) of patients with rectal cancer.Methods A sample of 113 patients receiving laparoscopic radical resection for rectal cancer in our hospital from January 2019 to September 2021 were retrospectively analyzed.Patients were classified into POCD group and non-POCD group according to mini-mental state examination(MMSE) score.Results A total of 46 patients had POCD and 67 had no POCD after surgery.The rSO-2 values at T3~T5 were significantly higher in POCD group than in non-POCD group(P<0.05).The change rate of rSO-2 was also significantly higher in POCD group than in non-POCD group,the level of POCD group was higher than that of no POCD group (P<0.05).Postoperative MMSE score had no significant changes in non-POCD group(P>0.05),while the MMSE score after operation was significantly lower in POCD group than in non-POCD group(P<0.05).The change rate of rSO-2,serum HO-1 and SOD levels were negatively correlated with postoperative MMSE scores(P<0.05).ROC curve analysis showed that the AUC,sensitivity and specificity were 0.702,73.9% and 70.1% under rSO-2 change rate curve,those were 0.779,84.8% and 73.1% under HO-1 curve,and were 0.839,87.0% and 82.1% under SOD curve.Conclusion The abnormally increased rSO-2 change rate,and elevated serum HO-1 and SOD levels in patients undergoing laparoscopic radical resection for rectal cancer are closely related to the development of POCD. 

Objective To investigate the effects of pre-administration of mannitol on optic nerve sheath diameter and postoperative recovery quality in patients undergoing robot-assisted laparoscopic radical resection of rectal cancer.Methods Seventy patients undergoing laparoscopic radical resection of rectal cancer under general anesthesia in our hospital were enrolled and randomly divided into two groups:mannitol group(group G) and control group(group C)，35 cases in each.The patients in group G were infused with 20% mannitol 0.5g/kg within 30 minutes after pneumoperitoneum(PP),and the patients in group C were infused with the same amount of normal saline at the same time point.The optic nerve sheath diameter was compared between the two groups at 1 min after intubation (T0), 5mins after pneumoperitoneum (T1), 30mins after pneumoperitoneum (T2), 60mins after pneumoperitoneum (T3), 90mins after pneumoperitoneum (T4), 10mins after surgery (T5) and differences in optic nerve sheath diameter and quality of resuscitation.Results The ONSDs of group G at T2-T4 were(4.27±0.19)mm,(4.48±0.19)mm and (4.54±0.19)mm,respectively,which were bigger than ONSD at T0 [(4.04±0.17)mm,P＜0.05].The ONSDs of group C at T2-T4 were (4.38±0.26)mm,(4.66±0.28)mm and(4.90±0.26)mm,respectively,which were bigger than ONSD at T0 [(4.00±0.23)mm,P＜0.05].There were significant differences in ONSDs between group G and group C at T3 and T4 [(4.48±0.19)mm vs (4.66±0.28)mm,P＜0.05;(4.54±0.19)mm vs (4.90±0.26)mm,P＜0.05].The recovery time,extubation time and PACU time in group G were (20.34±6.38)min,(26.69±6.54)min,(48.74±11.40)min,which were respectively shorter than those in group C [(47.71±10.57)min,(48.77±12.28)min and (76.74±12.57)min,P＜0.05].OAAS score at 30min after extubation in group G was significantly higher than that in group C [(4.43±0.66) vs (2.80±0.99),P＜0.05].Agitation score at 30min after extubation in group G was significantly lower than that in group C [(0.80±0.58) vs (1.63±0.84),P＜0.05].The incidences of headache and eye pain in group G was both lower than those in group C(2.9% vs 17.1%,P＜0.05;5.7% vs 25.7%,P＜0.05).Cnclusiono Pre-administration of mannitol can prevent the increase of ONSD,improve the recovery quality and reduce the incidence of adverse reactions.

Objective To detect the expression of serum miR-448-3p and Krüpple-like factor 5 (KLF5) in patients with unruptured intracranial aneurysms and to explore their clinical significance.Methods A total of 143 patients with unruptured intracranial aneurysm (observation group) admitted to our hospital from September 2017 to May 2020 were selected as the research objects,and 150 healthy patients (control group) during the same period of physical examination were selected as controls.The expression levels of serum mir-448-3p and KLF5 mRNA,serum IL-6 and TNF were detected-α level;The t-test compared the serum miR-448-3p,KLF5 mRNA levels between the two groups;Pearson method was used to analyze the correlation between serum miR-448-3p,KLF5 mRNA levels and serum IL-6,TNF-α levels in patients with unruptured intracranial aneurysm,and the correlation between serum miR-448-3p and serum KLF5 mRNA levels.ROC curve analysis of the diagnostic value of serum miR-448-3p,KLF5 mRNA expression levels for unruptured intracranial aneurysm.Results Compared with the control group,the level of serum miR-448-3p in patients with unruptured intracranial aneurysms in the observation group were significantly reduced,and the levels of KLF5 mRNA,IL-6,and TNF-α were significantly increased (P＜0.05);compared with the number of tumors =1,the level of serum miR-448-3p in patients with unruptured intracranial aneurysms with the number of tumors ≥2 was significantly reduced (P＜0.05),and the level of KLF5 mRNA was increased (P＜0.05);compared with tumor diameter <7 mm,the level of serum miR-448-3p in patients with unruptured intracranial aneurysms with tumor diameter ≥ 7 mm were significantly reduced (P<0.05),and the level of KLF5 mRNA was significantly increased (P<0.05);the serum miR-448-3p level in patients with unruptured intracranial aneurysms was negatively correlated with serum KLF5 mRNA,IL-6,and TNF-α levels (r=-0.429,-0.442,-0.471,P＜0.05),and the serum KLF5 mRNA level was positively correlated with serum IL-6 and TNF α levels (r=0.454,0.523,P＜0.05).The area under the ROC curve of the serum miR-448-3p,KLF5 mRNA expression level for the diagnosis of unruptured intracranial aneurysm was 0.978 and 0.995,sensitivity was 93.7% and 95.8%,and the specificity was 90.7% and 98.7%,respectively.Conclusion The serum miR-448-3p level of patients with unruptured intracranial aneurysm is decreased,and the KLF5 level is increased.Both levels are closely related to the number of tumors,tumor diameter,and inflammation levels in patients,and may jointly participate in the progression of the aneurysm.

 Objective To analyze the gene mutation in a pair of rare twins with mitral valve prolapse and severe regurgitation,and to explore the relationship between the new gene mutation and mitral valve prolapse.Methods Chordae tendineae and blood samples were taken for examination during operation,and analyzed by whole exon sequencing and gene copy number variations(CNV).Results The results of ultrasonography showed that the lesion location and shape of mitral valve were consistent between the two.The anterior and posterior leaflets of mitral valve were slightly lengthy,the tendons were thin,and the left atrium was detached during systole.Gene detection showed that there were mutations in bone morphogenetic protein receptor type-2(BMPR2) gene. Conclusion The mutation of BMPR2 gene exon may be related to mitral valve prolapse.If the role of this gene mutation can be confirmed,it can provide help for clinical diagnosis and treatment in the future.

Objective To explore the efficacy and strategy of hepatectomy for complicated hepatolithiasis.Methods Fifty-six patients with complicated hepatolithiasis were divided into open hepatectomy group (32 cases) and laparoscopic hepatectomy group (24 cases).The operation mode,operation time,operation bleeding volume,hospitalization time,postoperative complication rate,residual stone rate and recurrence rate were analyzed.Results The operation time was (367.81±113.46) minutes,the operation bleeding volume was 534.00(300.00,1 000.00) ml,and the hospitalization time was (25.16±7.51) days in open surgery group.The operation time was (320.46±110.89) minutes,the operation bleeding volume was 200.00(200.00,600.00) ml,and the hospitalization time was (19.71±6.55) days in laparoscopic surgery group.There were statistically significant differences between the two groups in the operation bleeding volume and hospitalization time (all P＜0.05).Bile leakage occurred in 2 cases (6.25%) and residual stones in 10 cases (31.25%),3 cases had recurrence of calculi(9.38%).Laparoscopic operation group:3 cases (12.5%) had residual stones,3 cases had recurrence of calculi(8.33%) .There were no statistically significant differences in postoperative complications,stone remnant and recurrence rates between the two groups（P>0.05）.Conclusions Biliary drainage should be completed before hepatectomy for complicated hepatolithiasis.If it is difficult to perform anatomic hepatectomy,the lesion should be removed as far as possible.Laparoscopic surgery has the advantages of less bleeding and shorter hospital stay.Combined with PTCS,ERCP and other technologies can make the treatment of complex hepatolithiasis accurate and minimally invasive.

Objective To investigate the clinical curative effect and feasibility of sleeve gastrectomy plus jejunal bypass(SG + JJB). Methods The clinical data of 97 patients with BMI ≥ 35 kg/m2 who underwent bariatric surgery from January 2015 to December 2017 were analyzed retrospectively.They were divided into three groups according to the operation method,of which 37 cases in SG + JJB group were treated with SG + JJB,29 cases in SG group were treated with SG,and 31 cases in RYGB group were treated with RYGB.The weight loss,diabetes remission and Surgical complaints were compared between 3 years after operation.Results The average percentage of total weight loss(% TWL) in SG + JJB group was higher than that in SG group[(35.3±9.0)% vs (31.7±7.2)%],the difference was statistically significant(P<0.05),which was equivalent to that in RYGB group.The remission rate of diabetes in group SG+JJB was similar to those in group SG and RYGB.The incidence of postoperative abdominal distension in SG + JJB group was higher than that in SG group(18.9% vs 0,P<0.05),and the incidence of postoperative gastroesophageal reflux disease(GERD) was higher than that in RYGB group(16.2% vs 0,P<0.05).Conclusion The weight loss effect of SG + JJB is better than that of SG,which is similar to RYGB.Compared with SG,SG + JJB has an increased risk of abdominal distension.Compared with RYGB,the incidence of gastroesophageal reflux increased.

Objective To investigate the efficacy of cystoscopic laser resection and electric resection of bladder tumor in 166 patients with non muscular invasive bladder cancer (NMIBC).Methods NMIBC patients admitted to our hospital from July 2013 to June 2015 were selected as the research objects,and were randomly divided into laser group and electro-resection group，83 cases in each group.The laser group was treated with laser resection of bladder tumor,and the electro-resection group was treated with electro-resection of bladder tumor.The levels of oxidative stress factors, surgical indicators, postoperative complications, tumor recurrence rate and tumor-free survival were compared between the two groups 1 day before surgery (T0), 1 day after surgery (T1), 3 days after surgery (T2) and 7 days after surgery (T3).Results  After treatment,compared with the electrical group[(30.87±3.92)min,(23.56±4.23)h,(7.13±1.24)(27.86±4.35)ml],the operation time[(23.63±2.78)min],hematuria duration[(21.16±5.37)h] and catheter indwelling time[(4.97±0.89)d] and the intraoperative blood loss[(20.91±3.21)ml] in the laser group were shorter(P<0.05).The incidence of postoperative bladder perforation,obturator nerve reflex and the total incidence of postoperative complications in the laser group were 0， 0， 6.02%,respectively,which were lower than the electrical group(7.23%,9.64%,21.10%)(P<0.05).Compared with the electrical group,the laser group of Glutathione peroxidase(GSH-Px) and superoxide dismutase(SOD) were higher at T1,T2 and T3[GSH-Px：(42.84±2.98)pg/ml、(55.61±3.79)pg/ml、(74.16±5.04)pg/ml；SOD：(97.78±8.24)μmol/L、(122.57±10.03)μmol/L、(154.24±11.34)μmol/L],while malondialdehyde(MDA) was lower at T1,T2 and T3[(14.33±0.93)mmol/ml、（10.22±0.85）mmol/ml、（5.25±0.57)mmol/ml](P<0.05).During the 5-year follow-up,there were 10 cases of recurrence in the laser group and 17 cases in the electro-resection group,and there was no significant difference in the 5-year postoperative total recurrence rate(12.05% vs.20.48%) and cumulative disease-free survival rate[(87.95±3.57）% vs（79.52±4.43)%] between the two groups(P>0.05).Conclusion Compared with electro-resection of bladder tumor,laser resection is safe,efficient and reliable,with shorter operation time,lower complication rate and less stress response.

Objective To observe the effect of atorvastatin on the healing of osteoporotic fractures(OPF) in rats and related mechanisms.Methods Forty rats were established OPF models.They were randomly divided into model group,experimental-A group,experimental B group,and experimentalC group,each with 10 rats.Experimental A,B,and C groups were given atorvastatin 10,20,and 40 mg·kg-1 respectively,and the model group was given an equal volume of normal saline.The fracture healing in rats were observed by X-ray film.The biomechanical properties of callus were detected by biomechanical test.The protein expression of activated T cell nuclear factor 1(NFATc1) and osteoclast-associated receptor(OSCAR),osteocalcin(OCN),collagen Type I(COL-I) in the callus tissue were detect by Western blotting.Results Compared with the model group,the X-ray scores of experimental-A group was increased,the maximum load and stiffness was increased,the protein expressions of NFATc1 and OSCAR were decreased,and the protein expressions of OCN and COL-I were increased(P＜0.05)，and ot was dose-dependent.Conclusion Atorvastatin can promote the healing of OPF in rats and enhance the biomechanical properties.It is speculated that its mechanism of action is related to the inhibition of the NFATc1 signaling pathway.

Objective Based on the Wntβ-catenin signaling pathway,the effect of macrophages on osteolysis after artificial hip replacement was investigated.Methods 60 patients without osteolysis and 55 patients with osteolysis after secondary femoral head necrosis in the later stage of femoral neck fracture were collected as the control group and the study group respectively.The concentration of IL-6,TNF-α,β-CTX,CD206,CD68,β-catenin protein were detected.Correlation analysis of continuous variables were tested by Pearson.Results The levels of IL-6,TNF-α and β-CTX,CD206 protein expression and the CD206/CD68 ratio of the study group were significantly higher than those of the control group(P<0.05),while the CD68 and β-catenin protein expressions were significantly lower than the control group(P<0.05).β-catenin was negatively correlated with CD206,positively correlated with CD68,negatively correlated with CD206/CD68 ratio(P<0.05).IL-6,TNF-α,β-CTX were positively correlated with CD206 and CD206/CD68,negatively correlated with CD68(P<0.05).Conclusion In THA patients,inhibition of the β-catenin pathway promotes the polarization of macrophages to M1 type,causing an inflammatory response,leading to osteolysis.

Objective To investigate the effect of white noise on sleep quality in patients undergoing total knee arthroplasty.Methods A total of 197 patients undergoing total knee arthroplasty in our department were selected as the study subjects and randomly divided into control group and experimental group.The control group was treated with normal perioperative treatment and was in normal environment.In the experimental group,in addition to the conventional perioperative treatment measures,white noise intervention was used to compare the postoperative psychological state and sleep quality of the two groups.Results Patients with total knee arthroplasty had a high level of anxiety before intervention,the Hamilton Anxiety Scale score was 32.34±2.49 in the control group and 32.11±2.45 in the experimental group,the difference was not statistically significant(t=0.6534，P>0.05).After intervention,compared with the control group,the score of Hamilton Anxiety Scale in the experimental group decreased significantly32.68±2.24 in the control group and 14.26±1.97 in the experimental group,the difference was statistically significant(t=61.37,P<0.05).Pittsburgh sleep quality index score showed that there were sleep disorders in both groups,before intervention,the difference was not statistically significant,the control group score was 9.21±1.87,the experimental group was 9.16±1.45,(t=0.2103,P>0.05);After intervention,sleep quality was improved in both groups.However,the improvement effect of sleep quality in the experimental group was better than that in the control group,with a score of 8.45±1.39 in the control group and 5.22±1.63 in the experimental group(t=14.93,P<0.05).Conclusion The use of white noise can effectively improve the mental state and sleep quality of patients undergoing total knee arthroplasty.

Objective estigate the clinical effect of total hip arthroplasty(THA) through medius gluteus space approach(MGA).Methods The clinical data of 72 hospitalized THA patients in the Department of joint surgery of our hospital from February 2016 to February 2018 were analyzed retrospectively,including 30 cases of THA(medius gluteal space approach,MGA group),42 cases of THA(posterolateral approach,PLA group).Perioperative data of the two groups were compared.Results The incision length of MGA group was significantly shorter than that of PLA group,and the first walking time of MGA group was significantly earlier than that of PLA group，the operation time was longer than that of PLA group(P<0.05).There were 1 cases of deep venous thrombosis(DVT) in MGA group,5 cases with intermuscular venous thrombosis;and 4 cases DVT in PLA group,and 7 cases with intermuscular venous thrombosis.Postprosthetic dislocation occurred in 2 patients in PLA group,and abductor muscle strength in 3 patients in MGA group was weaker than that on the opposite side,and recovered at 3month follow-up.The postoperative Harris score and SF-36 score of the two groups were significantly higher than those before operation(P<0.001).1 month after operation,the Harris score and SF-36 score in MGA group were significantly better than those in PLA group(P<0.05).There was no significant difference in anteversion angle and abduction angle between the two groups(P>0.05).The limb length in MGA group was (5.17±2.37)mm,which was significantly higher than PLA group[(4.26±1.91)mm](P<0.05).Conclusion Total hip arthroplasty through the medial gluteus medius approach could achieve satisfactory clinical results,with less trauma.

Abstract Colorectal cancer (CRC) is one of the most common malignant tumors. Although the diagnosis of CRC has made great progress, most patients are in advanced stage when diagnosed, accompanied by tumor infiltration and distant metastasis, resulting in poor prognosis. Long non-coding RNA (lncRNA) is one of the main causes of CRC, but the potential mechanism of lncRNA in CRC remains to be further explored. The role of lncRNA in CRC is closely related to the following biological processes, such as apoptosis and escape, angiogenesis, cell cycle, epithelial mesenchymal transition(EMT), DNA damage repair and epigenetics. In this paper, we systematically described the diagnostic value of lncRNA in CRC, then described the role of lncRNA in CRC cell apoptosis and escape, angiogenesis, cell cycle, EMT, DNA damage repair and epigenetics, and finally described the application value and prospect of lncRNA in CRC.