Objective   To explore the expression of LIM kinase 1(LIMK1) in human hepatocellular carcinoma cell line Huh7 and its effects on the proliferation,migration and ability to promote angiogenesis of Huh7 cells.  Methods   The expression of LIMK1 mRNA and protein in human normal hepatocyte line MIHA and human hepatoma cell line Huh7 was detected.After targeted siRNA transfection of Huh7 cells,the effects on the proliferation,migration and angiogenesis ability of hepatocellular carcinoma cells were investigated by CCK-8 assay,clone formation assay,wound healing assay,Transwell assay and endothelial cell tube formation assay.  Results   LIMK1 was highly expressed in Huh7 cells.The proliferation and migration ability of Huh7 cells were significantly decreased after knocking down the expression level of LIMK1.Human umbilical vein endothelial cells(HUVECs) have reduced in vitro angiogenic capacity.  Conclusion   LIMK1 was highly expressed in Huh7 cells,and knockdown of LIMK1 inhibited the proliferation,migration and ability to promote angiogenesis of Huh7 cells.

Objective   To evaluate the application value of SpyGlass system in laparoscopic cholecystectomy for difficult gallbladder.  Methods   Seventy-six patients underwent laparoscopic cholecystectomy for difficult gallbladder in our hospital from April 2019 to April 2022 were enrolled,and patients were classified into two groups by random number table methods,each with 38 cases.Control group received routine laparoscopic cholecystectomy,while experimental group received laparoscopic cholecystectomy under SpyGlass system guidance.Then the operation indexes (operation time,intraoperative blood loss,rate of conversion to open surgery),and clinical indicators (postoperative fasting time,first postoperative exhaust time,out-of-bed activity time) were compared between two groups,meantime,the postoperative recovery and complication rate were also recorded in both groups.   Results  Experimental group had shorter operation time and less intraoperative blood loss than those of control group,with statistical difference (P<0.05).The rate of conversion to open surgery was 2.63% (1/38) in experimental group,which was lower than 15.78% (6/38) in control group,with statistical difference (P<0.05).Experimental group had decreased time to postoperative fasting,first postoperative exhaust and out-of-bed activity than control group,with statistical difference (P<0.05).The C-reactive protein (CRP) and white blood cell count (WBC) levels at postoperative 1 day yielded no statistical difference between two groups (P>0.05).The complication rate was 5.26% in experimental group,which was lower than15.78% in control group,with statistical difference (P<0.05).  Conclusion   Application of SpyGlass system in laparoscopic cholecystectomy for difficult gallbladder is effective and safe,which can effectively shorten the operation time,reduce the intraoperative blood loss,and decrease the rate of conversion to open surgery with good postoperative recovery in patients.

Objective   To investigate the clinical efficacy of percutaneous catheterization combined with irrigation and drainage in the treatment of infected pancreatic necrosis.  Methods   Data of 10 patients with infectious peripancreatic necrosis admitted to our department from January 2018 to June 2022 who received puncture and catheter irrigation and drainage treatment were collated and analyzed,and the drainage time,recovery and complications of patients were recorded.  Results   All the 9 patients recovered after puncture irrigation and drainage treatment,and 1 patient failed puncture catheter irrigation and drainage treatment and was cured after open debridement.The average hospitalization time of irrigation and drainage was 32 days,and no complications occurred.  Conclusion   Percutaneous progressive replacement irrigation and drainage is minimally invasive and effective.It can be used in the treatment of infectious peripancreatic necrosis in some patients alone.It is worth promoting.

Objective   Aim To analyze the levels of soluble leukocyte differentiation antigen CD14 subtype(Presepsin) and Toll-like receptor 4(TLR4) in patients with acute pancreatitis(AP) and their value in assessing the risk of renal injury.  Methods   A total of 132 patients with AP in our hospital from June 2020 to December 2021 were selected,and 66 healthy subjects were selected during the same period.The serum Presepsin and TLR4 levels were detected in both AP patients and healthy subjects.Spearman correlation coefficient was used to analyze the correlation between serum Presepsin and TLR4 levels and disease severity in AP patients.The influencing factors of renal injury in AP patients and the interaction of Presepsin and TLR4 levels on the risk of renal injury were analyzed.Receiver operating characteristic(ROC) curve was used to analyze the value of serum Presepsin and TLR4 in predicting renal injury in AP patients,and the decision curve and clinical impact curve were used to verify.  Results   The serum Presepsin and TLR4 levels in AP patients were higher than those in healthy people(P＜0.05).The serum Presepsin and TLR4 levels in AP patients were positively correlated with the severity of the disease(r₁=0.794，P₁＜0.001；r₂=0.835，P₂＜0.001).Serum Presepsin and TLR4 levels were the influencing factors of renal injury in AP patients(P＜0.05).Serum Presepsin and TLR4 had a synergistic effect on renal injury in AP patients,and the synergistic effect was 1.095 times the sum of the effects of the two alone(SI=1.095).When serum Presepsin>1 021.88 ng/L and TLR4>31.85 ng/ml,AP patients had a higher risk of renal injury,and the AUC value of combined detection was 0.851.Within the threshold range of 0.12 to 0.78,the combined assessment of Presepsin and TLR4 for the net benefit rate of renal injury in patients with AP was superior to the independent detection.At each threshold probability,the number of people classified as high risk by the joint detection scheme and the number of true positive cases were basically consistent when the threshold probability was 0.51.  Conclusion   After the occurrence of AP,the levels of serum Presepsin and TLR4 increase abnormally with the severity of the disease.The high levels of serum Presepsin and TLR4 are independent risk factors for renal injury in AP patients,and the two have a synergistic effect on the occurrence of renal injury.Horizontal assessment of the risk of renal injury has high value and it can provide early warning in clinical practice.

Objective   Exploring the feasibility of the cascade balloon pushing technique for the treatment of residual extrahepatic bile duct stones in the early period (3~4 weeks) after choledocholithotomy T-tube drainage.   Methods   A 72-year-old male patient was admitted to the hospital with the complaint “21 days after T-tube drainage for biliary tract exploration and severe epigastric pain for 10 hours”.After MDT discussion,a digital subtraction angiography-guided T-tube fistula with paralleling balloon pushing was performed under local anesthesia as an emergency treatment.All residual extrahepatic biliary stones were pushed into the duodenum and the T-tube was reintroduced via a guidewire for drainage.  Result   The patient was discharged on the 3rd day after surgery and the T-tube was removed on the 7th day.The sinus tract healed spontaneously and was followed up for 1 month without discomfort.  Conclusion   The cascade balloon pushing technique is feasible for the treatment of residual extrahepatic bile duct stones in the early stages after choledocholithotomy T-tube drainage and can be used as an alternative to return to surgical stone  extraction,trans-T-tube sinusoidal choledochoscopy or trans-endoscopic retrograde cholangiopancreatography for stone extraction.

Objective   To investigate the risk factors of persistent cough (cough after pulmonary resection,CAP) in patients with stage I lung cancer after thoracoscopic surgery.  Methods   The clinical data of 207 patients with stage I lung cancer who were admitted to the Department of Thoracic Surgery of Zhongnan Hospital of Wuhan University from January 2022 to January 2023 were retrospectively analyzed,including gender,age,length of hospital stay,smoking history,stage,left and right side of operation,and whether to dissect Lymph nodes around the trachea,pathological type,surgical method (lobe or segment),preoperative breathing training,etc.Univariate and multivariate Logistic regression were used to analyze the influencing factors of CAP.  Results   A total of 58 patients developed CAP after operation,the incidence rate was 28.01% (58/207).Univariate analysis showed that smoking duration,lymph node dissection around the bronchial tree,surgical method,and preoperative breathing training were associated with postoperative CAP (P<0.05).Multivariate analysis showed that smoking duration,lymph node dissection around the bronchial tree,and lobectomy were high risk factors for CAP(P<0.05).Preoperative breathing training was its protective factor(P<0.05).  Conclusion   The occurrence of CAP is related to the duration of smoking,the removal of lymph nodes around the bronchial tree,and the surgical method.Preoperative breathing training can effectively reduce the incidence of CAP.

Objective   To explore the expression of miR-205 and chromosome 10 phosphatase and tensin homologous deletion gene(PTEN) in esophageal carcinoma and their relationship with the prognosis after radical surgery.  Methods   78 patients with esophageal cancer undergoing radical resection admitted to the hospital from September 2018 to September 2019 were selected.Their paracancerous tissue and cancerous tissue samples were collected.Fluorescent quantitative PCR  was used to detect the expression of miR-205 and PTEN in adjacent and cancerous tissues.The relationship between the expression level of miR-205,PTEN and the pathological characteristics of esophageal cancer tissues was analyzed.All patients were followed up until September 30,2022.Kaplan Meier was used to analyze the relationship between the expression of miR-205,PTEN and the prognosis after radical resection of esophageal cancer.  Results   The expression level of miR-205 in cancer tissues was higher than that in adjacent tissues(P<0.05),and the expression level of PTEN was lower than that in adjacent tissues(P<0.05).The expression level of miR-205 was negatively correlated with that of PTEN(r=0.397,P<0.001).The expression level of miR-205 in cancer tissue of patients with lymph node metastasis,low differentiation,and stage Ⅲ to Ⅳ esophageal cancer was higher than that of patients without lymph node metastasis,high school differentiation,and stage Ⅰ to Ⅱ(P<0.05),and the expression level of PTEN was lower than that of patients without lymph node metastasis,high school differentiation,and stage Ⅰ to Ⅱ(P<0.05).All patients were followed for 3 years,a total of 32 patients died and 44 patients survived.The expression level of miR-205 in cancer tissues of the deceased patients was higher than that of the surviving patients(P<0.05),and the expression level of PTEN was lower than that of the surviving patients(P<0.05).Kaplan-Meier analysis showed that the difference of survival curve between patients with high and low expression of miR-205 and PTEN in cancer tissues was statistically significant,and patients with low expression of miR-205 and high expression of PTEN in cancer tissues had higher survival rates(P<0.05).  Conclusion   The expression levels of miR-205 and PTEN in cancer tissues of patients with esophageal cancer are closely related to the prognosis after radical surgery.The expression levels of miR-205 and PTEN in cancer tissues of patients with esophageal cancer were detected,which can be used as an important reference index to predict the prognosis after radical resection.

Objective   To analyze the expression of bromodomaincontaining protein 4 (BRD4) in colorectal cancer (CRC) tissue,and to explore its relationship with clinicopathological characteristics and prognosis of patients.  Methods   CRC patients admitted to our hospital from November 2014 to May 2017 were collected,and CRC tissue and paracancerous tissue were excised from the patients during radical resection.Real-time fluorescence quantitative PCR (qRT-PCR) and immunohistochemistry were used to measure the expression of BRD4 mRNA and BRD4 protein in CRC tissue and paracancerous tissue,respectively;Kaplan-Meier survival curve was used to analyze the relationship between BRD4 expression and patient prognosis;COX regression was applied to analyze the risk factors affecting the prognosis of CRC patients.  Results   Compared with the adjacent tissues,the expression level of BRD4 mRNA and the positive expression rate of BRD4 protein in CRC tissues were obviously increased (P<0.05).The expression level of BRD4 mRNA was correlated with regional lymph node metastasis (N) and distant metastasis (M) in CRC patients (P<0.05),the expression of BRD4 protein was correlated with the degree of tissue differentiation,N and M in CRC patients (P<0.05).Kaplan-Meier analysis showed that the 5-year progression-free survival rates of patients with high BRD4 mRNA expression and BRD4 protein positive expression were obviously lower than those of patients with low BRD4 mRNA expression (P＜0.05) and BRD4 protein negative expression (P＜0.05).The 5-year cumulative survival rates of patients with high expression of BRD4 mRNA and positive expression of BRD4 protein were significantly lower than those with low expression of BRD4 mRNA (P＜0.05) and negative expression of BRD4 protein (24/32) (P＜0.05) patients.Multivariate COX regression analysis showed that N₁-N₂,M₁,the high expression of BRD4 mRNA and the positive expression of BRD4 were risk factors affecting the prognosis of CRC patients (P<0.05).  Conclusion   BRD4 is highly expressed in CRC tissue,there is a certain correlation with N,M and prognosis of patients,and it can be used as one of the indicators for the prognosis of CRC patients.

Objective   To investigate the value of peripheral blood penetrating cytokine 3 (PTX-3) combined with miR-486-3p in predicting postoperative recurrence and metastasis before laparoscopic radical resection of colorectal cancer.  Methods   A total of 157 patients with laparoscopic radical resection of colorectal cancer were selected from March 2018 to May 2021.The levels of PTX-3 and miR-486-3p in peripheral blood of all patients were detected before surgery,and patients were followed up for 1 year after surgery.Patients were divided into relapse-metastasis group and non-relapse-metastasis group according to the recurrence and metastasis after surgery.The clinical data of the two groups were compared,and the factors related to recurrence and metastasis after laparoscopic radical resection of colorectal cancer were analyzed by multivariate Logistic regression.The receiver operating characteristic curve (ROC) was plotted,and the area under the curve (AUC) was used to evaluate the predictive value.  Results   After 1 year’s follow-up,5 of 157 patients were lost to follow-up,with a follow-up rate of 96.82%.Among them,recurrence and metastasis was 28 patients,recurrence and metastasis rate was 18.42%,and the remaining 124 patients had no recurrence and metastasis.Age ≥60 years old,lymph node metastasis,stage Ⅲ,low differentiation,tumor diameter ≥5cm,preoperative platelet count,CEA,glycoantigen 19-9 (CA19-9),peripheral blood PTX-3,miR-486-3p levels in the relapsed and metastatic group were higher than those in the non-relapsed and metastatic group (P<0.05).Logistic regression analysis showed that lymph node metastasis,stage Ⅲ,low differentiation,preoperative peripheral blood PTX-3 level and preoperative peripheral blood miR-486-3p level were the factors affecting recurrence and metastasis after laparoscopic radical resection of colorectal cancer (P<0.05).ROC curve results show that,The AUC values (95%CI) of peripheral blood PTX-3,miR-486-3p and their combination in predicting recurrence and metastasis after laparoscopic radical resection of colorectal cancer were 0.746 (0.643-0.833),0.805 (0.707-0.881) and 0.868 (0.779-0.930),respectively (P<0.0 5),and the combined AUC values were higher than those detected alone (P<0.05).Preoperative peripheral blood PTX-3 combined with peripheral blood miR-486-3p predicted the AUC value of recurrence and metastasis after laparoscopic radical resection of colorectal cancer was higher than that of lymph node metastasis and stage Ⅲ combined with low differentiation (P<0.05).  Conclusion   Preoperative detection of peripheral blood PTX-3 and miR-486-3p levels can be used to predict recurrence and metastasis after laparoscopic radical resection of colorectal cancer,and the combination of the two has higher predictive value.

Objective   To study the clinical effects of automatic hemorrhoidal banding (RPH) combined with sclerosing agent injection in the treatment of second- and third-degree internal hemorrhoids.  Methods   A total of 156 cases of second-degree and third-degree internal hemorrhoids were randomly divided into three groups,namely hemorrhoidal ligation group,RPH group,and (RPH + sclerotherapy injection) group,with 52 cases in each group,and the three groups underwent hemorrhoidal ligation,RPH surgery,and (RPH + sclerotherapy injection) respectively.The surgical effect was evaluated by the three groups such as operation time,hospital stay,hemorrhoidal lump shedding time,postoperative bleeding,postoperative swelling,postoperative margin edema,and postoperative stenosis.  Results   After treatment,the effective rate of all three groups reached 100%.In terms of operation time,hospital stay and hemorrhoidal lump shedding time,the hemorrhoidal ligation group was (34.13±5.80)min,(8.65±0.96)d,(5.94±0.46)d,the RPH group was (22.81±1.95)min,(6.58±0.75)d,(8.02±0.43)d,the (RPH + sclerotherapy injection) group was (23.73±2.02)min,(6.46±0.75)d,(8.00±0.56)d,RPH and (RPH + sclerotherapy injection) group compared with hemorrhoidal ligation group,hemorrhoidal mass shedding time,surgery time and hospital stay shortened,and all were statistically significant (P＜0.05),and the (RPH + sclerotherapy injection) group had less hospital stay than RPH group (P<0.05）. In terms of postoperative bleeding,the hemorrhoidal ligation group was (177.40±30.45)ml,the RPH group was (105.44±15.92)ml,the (RPH + sclerotherapy injection) group was (59.46±14.99)ml,the amount of blood loss in the RPH group and the (RPH + sclerotherapy injection) group was less than that in the hemorrhoidal ligation group (P<0.05),and the blood loss in the (RPH + sclerotherapy injection) group was significantly less than that in the RPH group (P<0.05）. In terms of postoperative swelling,the hemorrhoidal ligation group was 15 cases,the RPH group was 10 cases,the (RPH + sclerotherapy injection) group was 7 cases,the swelling in the RPH group and the (RPH + sclerotherapy injection) group was significantly less than that in the hemorrhoidal ligation group (P<0.05)。 In terms of postoperative edema and stenosis,the hemorrhoidal ligation group was 3 cases and 0 case,RPH group was 2 cases and 0 case,and (RPH + sclerotherapy injection) group was 3 cases and 0 case,and there was no significant difference between the three surgical methods (P>0.05).  Conclusion   RPH combined with sclerosing injection can significantly reduce the postoperative bleeding,hospital stay,and postoperative swelling,and the postoperative effect is satisfactory,which provides a reliable basis for the clinical treatment of Ⅱ and Ⅲ.degree internal hemorrhoids.

Objective   By optimizing and improving the traditional RAPT score,the screening accuracy of thrombosis tendency is improved,and the relevant basis for thrombosis prevention in patients with early traumatic fracture is provided,so as to select an efficient individualized anticoagulation therapy.  Methods   The clinical data of 300 patients with traumatic fracture admitted to Shiyan Taihe Hospital from January 2021 to December 2021 were retrospectively analyzed.According to whether venous thromboembolism (VTE) occurred during hospitalization,they were divided into thrombosis group(150 cases) and non-thrombosis group(150 cases).In addition to the four categories included in the traditional RAPT score,the history of smoking and drinking,diseases of vascular endothelial injury,time from injury to admission,preoperative prophylactic anticoagulation measures,upper limb fractures or simple lower limb fractures,type of anesthesia,emergency treatment,blood biochemical index,and dynamic data of D-dimer were also collected.The clinical data of the two groups were compared,and the independent risk factors were screened by univariate and multivariate logistic regression analysis to formulate the optimized RAPT score.The traditional and optimized RAPT scores during hospitalization were dynamically evaluated.The ROC curve was used to evaluate the efficacy of traditional and optimized RAPT scores in the evaluation of traumatic fracture thrombosis.  Results    Single factor analysis showed that there were statistically significant differences between the two groups in smoking history, time from injury to admission, anesthesia method, VTE history, vascular endothelial injury diseases (diabetes, coronary heart disease, hyperlipidemia, cerebrovascular diseases, varicose veins of lower limbs or arteriosclerosis oblast), no use of preventive antithrombotic measures before surgery, and central venous catheterization (P<0.05). Logistic regression analysis after adding age and gender factors showed that with the increase of age, people with smoking history, diabetes and cerebrovascular disease increased the incidence of thrombosis. Men with a history of smoking, diabetes, hyperlipidemia, and women with pre-operative anticoagulation and simple upper or lower limb fractures are increased risk of thrombosis.The AUC of traditional RAPT score at admission,before operation and after operation were 0.636 1,0.639 5 and 0.649 2,respectively.The optimized RAPT scores were 0.806 4,0.806 7 and 0.803 1.  Conclusion   In this study,the predictive value of the optimized RAPT score for thrombosis at admission,before operation and after operation was 15%-17% higher than that of the traditional RAPT score.The optimized RAPT score has a higher predictive value and is more conducive to early detection of thrombosis risk and early treatment than the traditional score.

Objective   To evaluate the value of establishing a standard operating procedure(SOP) based on the venous anatomy system to improve the learning curve of robotic-assisted laparoscopic partial nephrectomy(VAB-RAPN).  Methods   The clinicopathological data of 40 consecutive patients who underwent RAPN were collected.Patients were divided into Group A,B,C,and D,with 10 cases in each group.All procedures were completed by a single surgeon.Our procedure is to perform the operation by identifying the landmark of the gonadal vein,inferior vena cava,renal vein,and lumbar vein.The differences in operation time(OT),renal warm ischemia time(WIT),estimated blood loss(EBL),time of drainage removed,positive surgical margins(PSM) and operative complications were compared.And the significance of the groups was statistically analyzed.  Results   All the patients successfully underwent the operation.The average OT of the 40 patients was 114.25 ± 30.65 min.The average renal WIT was 22.5 ± 7.42 min.And the average EBL was 290 ± 314.44 ml.With the accumulation of surgical cases,the OT of groups A,B,C,and D gradually shortened,which were 142 min,122 min,107 min,and 87 min.The WIT gradually shortened,which were 30 min,23 min,22 min,and 18 min.The time of drainage removed was 5.9 d,6.1 d,5.6 d,and 5.1 d.The EBLs in group D were 335 ml,330 ml,335 ml,and 160 ml.No significant difference had been found in drainage removal and post-operative complications.  Conclusion   By conducting the standard operating procedures,the junior surgeon can manipulate the RAPN in 10 cases.After 20 cases,the surgeon has mastered the core skills of RAPN.After 30 cases,the surgeon can manage the procedure skillfully.The learning curve shows a significant decline after 30 cases.And it can help to save the OT and WIT,and reduce intraoperative EBL.The VAB-RAPN standard procedure in our center is worth being recommended.

Objective   To investigate the predictive effect of Ribophorin1 (RPN1) on postoperative recurrence of non-muscular invasive bladder cancer (NMIBC).  Methods   GEPIA2 database was used to analyze the difference of RPN1 mRNA expression in bladder cancer and its relationship with prognosis.76 paraffin specimens of patients who underwent transurethral resection for tumor in our hospital from May 2018 to May 2021 were collected,the normal tissues of 32 cases by cystoscopy were normal group.Immunohistochemistry was used to detect the expression of RPN1 protein in 76 patients with NMIBC,and the relationship between its expression and clinicopathological parameters of NMIBC as well as postoperative recurrence was studied.  Results   It was determined through a comprehensive analysis of the database that the expression levels of RPN1 mRNA in bladder cancer tissue were significantly augmented when compared to those found in normal bladder tissue.Immunohistochemical techniques showed for the identification of RPN1 protein predominantly localized to the cytoplasm of cells,and the positive expression rate of RPN1 protein in NMIBC patients was 64.47% (49/76).The positive expression rate of RPN1 protein in 32 normal tissues was 9.37% (3/32).The expression level of RPN1 protein in cancer tissues was significantly higher than that in normal bladder tissues (P<0.05),and the expression of RPN1 was closely correlated with tumor size,histological grade,pathological stage and recurrence (P<0.05). Survival analysis was conducted and revealed that patients with high RPN1 expression exhibited a notably diminished rate of recurrence-free survival in comparison to those with low RPN1 expression(P<0.05).Cox regression analysis determined that high RPN1 expression is a significant independent risk factor for post-surgical recurrence in instances of NMIBC.  Conclusion  RPN1 is highly expressed in NMIBC,and its expression level is correlated with recurrence and prognosis,which is expected to be a predictor of postoperative recurrence of NMIBC.

Objective   To investigate the effect of femoral nerve combined with femoral artery block on intraoperative tourniquet response in patients with knee microscopic ligament reconstruction.  Methods   150 patients with knee microscopic ligament reconstruction were selected.They were divided into three control groups (group A),femoral nerve block (Group B) and femoral nerve combined femoral artery nerve block (Group C),with 50 patients in each group.No nerve block was performed in group A,group B received 20 ml of 0.2% ropivacaine femoral nerve block and Group C received 0.2% ropivacaine 10 ml femoral nerve block + 10 ml femoral artery block.Perioperative vital signs,lactate values at different time points,amount of esmolol,incidence of tourniquet reaction,postoperative sensory block time,and VAS scores at different postoperative time points were compared in the 3 groups.   Results  The systolic blood pressure of patients in group A, Group B and group C at 60 minutes after applying tourniquet was (140.14±5.46)mmHg, (136.02±4.55)mmHg and (131.02±9.26)mmHg, respectively,MAP values were (90.26±4.45)mmHg, (84.62±4.28)mmHg and (79.18±3.53)mmHg, respectively,the heart rate was (86.9±3.80) times/min, (76.18±3.19) times/min and (72.90±3.33) times/min, respectively. The systolic blood pressure at 1 minute before the tourniquet was (150.06±5.69)mmHg, (145.20±4.83)mmHg and (136.66±9.04)mmHg, respectively. MAP was (103.30±4.74)mmHg, (95.24±3.89)mmHg and (83.98±3.97)mmHg, respectively; Heart rate was (92.44±5.79) times/min, (81.66±4.44) times/min and (74.26±4.93) times/min, respectively;the difference was statistically significant (P< 0.05).The 5minute lactic acid values of pine tourniquet were (1.38±0.10)mmol/L, (1.35±0.09)mmol/L and (1.26±0.09)mmol/L, respectively. The lactate values at 30min were (1.48±0.08)mmol/L, (1.46±0.08)mmol/L and (1.29±0.07)mmol/L, respectively, and there was statistical significance among all groups (P<0.05). The intraoperative dosage of esmolol in 3 groups were (31.20±16.12)mg, (25.4±21.11)mg and (8.80±8.49)mg, respectively. The incidence of tourniquet reaction was 72%, 64% and 32%, respectively, with statistical significance (P<0.05).The VAS scores of the 3 groups were (2.72±0.73) , (0.32±0.47) and (0.30±0.46) at 1 hour after operation, and (5.40±0.61), (1.62±0.67) and (1.66±0.63) at 6 hours, respectively. At 12 hours (4.28±0.78), (3.24±0.77) and (3.36±0.60), 24hour VAS scores were (3.16±0.68) and (2.50±0.74), respectively. There was statistical significance at all time points (P<0.05).  Conclusion   The femoral nerve combined with femoral artery block can reduce the incidence of intraoperative tourniquet reaction in patients with knee endoscopic ligament reconstruction,make the intraoperative circulation more stable,reduce the rapid growth of lactic acid value,and reduce the postoperative pain.

Objective   To analyze the effect of remazolam on serum malondialdehyde (MDA),superoxide dismutase (SOD) and glutathione peroxidase (GSH Px) levels in patients undergoing laparoscopic cholecystectomy.  Methods   From december 2021 to november 2022,110 patients undergoing laparoscopic cholecystectomy in our general surgery department were divided into propofol group and ramazolam group according to the random number table method.55 patients in the propofol group were anesthetized with propofol for induction and maintenance,55 patients in the ramazolam group were anesthetized with ramazolam for induction and maintenance.The vital signs(mean arterial pressure, heart rate),indexes of anesthesia awakening(eye opening time, orientation recovery time, extubation time),indexes of oxidative stress(MDA, SOD, GSH Px),cognitive function(MMSE score) and adverse reactions(respiratory depression, restlessness, dizziness, headache, hypotension, drowsiness) of the two groups were compared.  Results   The mean arterial pressure and heart rate at the time of intubation,pneumoperitoneum and extubation in the ramazolam group were higher than those in the propofol group (P＜0.05).The time of eye opening,recovery of orientation and extubation in remiazolam group [(10.37±2.15)min,(10.83±2.41)min,(11.06±2.19)min] were shorter than those in propofol group [(12.44±2.78)min,(13.16±2.84)min,(14.78±2.55)min] (P＜0.05).The level of MDA at 1 day after surgery in remiazolam group [(19.73±2.32)mmol/L] were lower than those in propofol group [(27.82±2.95)mmol/L],and the level of SOD and GSH Px in remiazolam group [(310.85±27.61)U/ml,(939.63±105.14)U] were higher than those in propofol group [(275.33±24.97)U/ml,(844.73±96.30)U](all P＜0.05).MMSE score of remiazolam group (26.89±1.00) was higher than that of propofol group (25.33±0.92) on the first day after operation (P＜0.05).The incidence of adverse reactions in remidazolam group was 7.27%,lower than 21.82% in propofol group(P＜0.05).  Conclusion   Remazolam is effective in anesthesia of laparoscopic cholecystectomy.It can stabilize the vital signs of patients,improve the quality of recovery from anesthesia,reduce oxidative stress reaction and cognitive function damage,and has few adverse reactions.

Objective   To investigate the clinical effect of retrograde femoral anterolateral composite flaps with double blood supply and fascia on reconstruction of knee extension device and repair of wounds in knee and upper middle leg.  Methods   From July 2018 to March 2022,5 patients with deep burns of knee joint and middle and upper leg were treated in our hospital.The wounds were repaired by double blood supply composite tissue flap,and the knee extensor device was repaired and reconstructed by fascia.Observe and follow up the operation effect.  Results   Five patients underwent double blood supply composite tissue flap to repair knee and leg wounds,and five patients underwent debridement and VSD treatment after admission,and then underwent double blood supply composite tissue flap to repair wounds.The flap survived by using fascia lata flap to repair and reconstruct knee extender device.During follow-up,the skin flap was soft in texture without obvious swelling,and the knee joint function recovered well.  Conclusion   The double blood supply combined tissue flap can reconstruct the knee extension device and restore the function of the knee joint.It is an ideal treatment method to repair the deep wounds of the knee and lower leg.

Hepatocellular carcinoma (HCC) is a common malignant tumor.Patients often lose the opportunity for surgery because of the middle and late stage when they are diagnosed,and the prognosis is extremely poor.In recent years,anti-PD immunotherapy has made a breakthrough in the treatment of advanced liver cancer.Immunotherapy has achieved good results in some patients,but there are still many patients with poor response to immunotherapy.Therefore,there is an urgent need to find clinical or biological indicators that can be used to predict the efficacy of immunotherapy in order to maximize clinical benefits while avoiding adverse effects.This article aims to summarize the relevant indicators and potential predictive mechanisms that can be used to predict the efficacy of liver cancer immunotherapy,so as to provide help for guiding clinical treatment.

The occurrence and development of cancer are closely related to micro RNAs.Micro RNAs are key factors in gene expression and regulation and can bind to specific messenger mRNAs or other non-coding ncRNAs to affect cellular processes such as transcription,translation,or signaling.MiR-204-5p is a member of the micro RNAs family.A large number of studies have confirmed that miR-204-5p can inhibit the malignant biological behavior of various cancers,including colorectal cancer (CRC),and down-regulated miR-204-5p can induce the growth,proliferation,migration,invasion and angiogenesis of cancer cells.In recent years,it has been reported that the downregulation of miR-204-5p expression is one of the important reasons for the poor prognosis of CRC.Therefore,miR-204-5p may become a biomarker for CRC screening and a new target for CRC treatment in the future.We will review the role of miR-204-5p in the development of colorectal cancer.