Objective To explore the clinical features,treatment and prognosis of traumatic subdural effusion (TSE) in infants.Methods Data of 51 cases of traumatic subdural effusion in infants admitted to the single center of Dalian Women and Children Medical Center (Group) from February 2013 to February 2020 were retrospectively analyzed,and their clinical manifestations,imaging features,treatment methods and prognosis were summarized and analyzed.Results Fifty-one cases (26 males and 25 females),ranging in age from 1 month to 3 years old of traumatic subdural effusion in infants were reviewed in our hospital,all cases were confirmed by Computed Tomography (CT) examination.31 cases were treated conservatively,29 cases were cured,and 2 cases were treated surgically due to poor conservative treatment.Surgical treatment was performed in 22 cases (including 2 cases who received surgical treatment due to poor conservative treatment).One patient underwent puncture and continuous drainage at the lateral Angle of the anterior fontanelle and was cured.Twenty-one cases underwent cranial drilling,subdural space catheterization for external drainage,and 17 cases (80.95%,17/21) were cured at one time.There were 4 cases (19.05%,4/21) of recurrence after external drainage with catheterization.Two cases were cured by external drainage with Ommaya capsule insertion and intermittent aspiration and fluid drainage.It was changed to subdural peritoneal shunt surgery,and 2 cases were cured after the operation.There was no surgical infection or death in all the children in the group.The median follow-up time ranged from 3 months to 60 months,and the conditions were all stable.Conclusion Traumatic subdural effusion is a common complication after craniocerebral injury in infants and young children.Due to its lack of self-expression,the hidden condition is often ignored.Moreover,the brain tissue of infants and young children is in the growth and development stage,which will affect the development of brain tissue after its onset.

Methods A retrospective analysis was conducted on the clinical data of 46 pediatric patients with GD treated at our hospital from January 2008 to January 2025.The evaluated parameters included age,gender,symptoms,comorbidities,imaging data,surgical process,postoperative treatment and follow-up situation.Analyze the clinical characteristics of GD.
Results Forty-four cases were cystic structures,and 2 cases were sinus tracts or tubular structures respectively.The most common site was the cardia/fundus area (20 cases).Seventeen cases were asymptomatic(7 detected during prenatal screening and 10 identified incidentally).The most common associated anomalies were inguinal hernia(4 cases),pulmonary airway malformation(3 cases),pulmonary sequestration(3 cases),and hiatal hernia(3 cases).All 46 patients underwent ultrasound examination,with an accuracy of 97.8%.Upper gastrointestinal contrast studies were performed in 16 cases and computed tomography(CT) was conducted in 34 patients.Perforation occurred in 7 cases.Surgical approaches included laparoscopy(35 cases,with 5 conversions to open surgery),open surgery(9 cases),robotic surgery(1 case),transthoracic surgery(1 case).Operative time ranged from 50 to 250 minutes(median:105 minutes).Postoperative pathology identified pancreatic heterotopia in 6 cases.Time to resume oral intake ranged from 1 to 17 days(median:4 days),and postoperative hospital stay lasted 3~21 days(median:7 days).During follow-up,one patient was readmitted for adhesive intestinal obstruction and managed conservatively,with no other significant complications reported.Conclusion Pediatric GD is a rare congenital anomaly,typically presenting as non-communicating cystic lesions with nonspecific clinical manifestations.Ultrasonography is the primary diagnostic tool,with upper GI series,CT/MRI,and endoscopy as adjuncts.While prompt surgical intervention is indicated for symptomatic cases,those complicated by perforation/infection should undergo delayed elective resection ≥3 months following complete inflammatory resolution.Laparoscopic approach is the treatment of choice,while endoscopic intraoperative localization or endoscopic therapy may be considered for small intraluminal lesions.

Objective This study analyzes the risk factors for postoperative gastrointestinal dysfunction (POGD) in infants after intestinal surgery.Methods The perioperative clinical data of 220 infants who underwent intestinal surgery in Children’s Hospital of Nanjing Medical University from March 2019 to March 2024 were retrospectively analyzed.Based on the criteria of postoperative “fasting time more than 5d,vomiting bile fluid or bile fluid drainage from nasogastric tube,abdominal distension”,the infants were divided into POGD group(78 cases) and non-POGD group (142 cases),and the clinical data of the two groups were analyzed by one-way analysis,and the independent factors with a P<0.05 were included in the binary Logistic regression analysis to analyze the independent influencing factors affecting the recovery of gastrointestinal function after surgery.Results The time of the first defecation after surgery in the POGD group and the non-POGD group was (1.79±1.78) days and (1.44±0.71) days,respectively,and the time of parenteral nutrition was (9.73±4.64) days and (5.19±2.18) days,respectively,and the hospital stay was (13.31±5.70) days and (8.46±2.90) days,respectively.There was statistically significant difference between the two groups(P < 0.05).Multivariate regression analysis showed that a low preoperative weight for age Z(WAZ) score (P < 0.05,OR= 0.705) and a long operation time (P < 0.05,OR=2.642) were risk factors for POGD.Conclusion Preoperative nutritional status and duration of surgery are risk factors for the development of postoperative gastrointestinal dysfunction in infants.

Objective  To explore the clinical effect of using the Brisson technique combined with a precise measurement scheme in the treatment of hidden penis.Methods The clinical data of 120 children with hidden penis treated in our hospital from January 2021 to June 2024 were retrospectively analyzed.The enrolled children were randomly divided into the study group (n=60) and the control group (n=60).The study group was treated with the Brisson technique combined with a precise measurement scheme,and the cutting of the penile skin was designed according to the data.The control group was treated with the traditional Devine technique.The surgical effects,penile lengths before and after surgery,and the incidence of postoperative complications of the children in the two groups were compared and analyzed.Results The effective rate of the study group reached 100%,which was significantly higher than that of the control group (93%,P<0.05).Six months after surgery,the penile length of the children in the study group was longer than that in the control group,and the difference was statistically significant (P<0.05).The incidence of surgical complications in the study group was 5%,which was significantly lower than that in the control group (17%,P<0.05).Conclusion Using the Brisson technique combined with a precise measurement scheme to treat hidden penis has a good effect,a high effective rate,and a low incidence of complications.

Objective To investigate the impact of early surgical intervention on mid-term prognosis in patients with Hirschsprung’s disease (HSCR) and to evaluate the risk of Hirschsprung-associated enterocolitis (HAEC).Methods From February 2016 to February 2022,230 children with HSCR who underwent one-stage radical Soave surgery in our hospital were divided into two groups according to the surgical age:the ≤4 months old group (126 cases) and the > 4 months old group (104 cases).The basic conditions of the two groups were compared.The mid-term defecation function of the children was evaluated using the Kelly scoring system.The clinical outcomes were analyzed to assess the risk of HAEC.Results There was no statistically significant difference in postoperative defecation function between the two groups of children (P > 0.05).The incidence of postoperative HAEC was 10.32% in the ≤4 months age group and 21.15% in the > 4 months age group.There was a statistically significant difference between the two groups (P<0.05).The length of intestinal resection,operation time and postoperative hospital stay in the ≤4 months age group were 19.00 cm,83.10 minutes and 6.30 days,respectively;those in the > 4 months age group were 22.83 cm,129.37 minutes and 8.40 days,respectively.There were statistically significant differences between the two groups (P<0.05).Conclusion Early surgical intervention for HSCR has no significant impact on mid-term postoperative bowel function.However,early surgery can reduce the extent of bowel resection,expedite the surgical process,shorten postoperative hospital stay and overall disease course,and effectively decrease the incidence of HAEC.

Objective To evaluate the prognosis of infants with common Hirschsprung’s disease who undergo laparoscopic-assisted Soave procedure below 6 months of age,and to explore its feasibility.Methods A retrospective analysis was conducted on the clinical data of 82 cases of common Hirschsprung’s disease admitted to our department from January 2018 to August 2022.The patients were divided into two groups based on their age at the time of surgery:Young surgical age group (<6 months,50 cases) and Old surgical age group (≥6 months,32 cases).All patients underwent the treatment of laparoscopic-assisted Soave procedure.The surgical time,length of hospital stay,postoperative complications,and anal function were compared between the two groups.Results There were no significant differences between young surgical age group and old surgical age group in terms of surgical time [(145.04±11.21) min vs.(149.25±12.18) min,P=0.20],length of hospital stay [(13.56±0.93) d vs.(13.91±0.99) d,P=0.55],postoperative complications [22.00%（11/50）vs.28.13%（9/32）,P=0.53],and Rintala score for anal function [(18.58±1.44) vs.(17.22±1.64),P=0.06].The main postoperative complications,including enterocolitis [10.00%（5/50 ） vs.12.50%（4/32）,P=0.72],fecal/anal incontinence [6.00%（3/50） vs.6.25%（2/32）,P=0.96],and constipation [4.00%（2/50）and 6.25%（2/32）,P=0.65],showed no significant differences between the two groups(all P＞0.05).However,there was a statistically significant difference in terms of bleeding volume [ (7.86±2.02) ml vs.(9.13±2.17) ml,P＜0.05].No deaths occurred in this study.Conclusion Laparoscopic-assisted Soave procedure is safe and effective for infants below 6 months of age with common congenital Hirschsprung’s disease.It can achieve satisfactory anal function and reduce the incidence of adverse events during the waiting period for surgery.

Objective  To investigate the impact of different lymph node dissection (RLNLN) around the recurrent laryngeal nerve (RLN) on the clinical efficacy of esophagectomy (EC) with thoracoscopic radical surgery.Methods Ninety-eight EC patients were selected from 2022-01 to 2022-10 in our hospital and divided into the control group and the study group,each with 49 cases,using simple randomization method.Both groups underwent EC thoracoscopic radical surgery,with conventional RLNLN clearance in the control group and modified RLNLN clearance in the study group.The operation and postoperative recovery of the two groups were compared,as well as myeloid triggered receptor-1 (TREM-1),tumor necrosis factor receptor-associated protein-1 (TRAP1),and complications before and after the operation,and the recurrence rate and survival rate of the two groups were counted at 1 year after the operation.Results The RLNLN dissection time in the study group was (11.93±3.57) minutes,which was shorter than that in the control group (17.15±4.28) minutes.The number of RLNLN dissections on both sides was (7.19±1.24),which was higher than that in the control group (5.56±1.10),and the differences were statistically significant (P<0.05).Three and seven days after surgery,the CD3+,CD4+/CD8+ of the study group were higher than those of the control group,while CRP,PCT,TREM-1,and TRAP1 were lower than those of the control group,and the differences were statistically significant (P<0.05).The postoperative complication and recurrence rates in the study group were 4.08% (2/49) and 10.87% (5/46),respectively,which were lower than the control group[18.37%(9/44),29.55% (13/44)].Conclusion Thoracoscopic radical resection of esophageal cancer with modified RLNLN dissection can can enhance the effect of lymph node clearance,down-regulate the expression of TREM-1 and TRAP1,reduce the inflammatory response of the body,regulate the immune function,reduce the risk of complications and recurrence,and improve the quality of life.

Objective To construct a predictive model for the 3-year recurrence-free survival (RFS) after total endoscopic resection of early and mid-stage esophageal cancer,and to test it,in order to provide decision support for standardized management after total endoscopic resection of early and mid-stage esophageal cancer.Methods A retrospective study was conducted to include 306 patients with early-to-mid stage esophageal cancer who underwent total endoscopic resection in our hospital from January 2018 to December 2020.The patients were divided into a modeling set (n=204) and a validation set (n=102) according to a 2∶1 ratio.Univariate analysis and random forest algorithm were used to screen variables,and Cox regression analysis was used to analyze the factors affecting the 3year RFS after total endoscopic resection for early-to-mid stage esophageal cancer.The R language was used to construct a nomogram prediction model for model validation,and the receiver operating characteristic curve (ROC curve) was drawn to calculate the area under the curve (AUC).The discrimination of the prediction model was evaluated,and the calibration curve and decision curve (DCA curve) were used to evaluate the predictive performance and clinical applicability of the prediction model.〖WTHZ〗Results〓〖WTBZ〗Among the 306 patients with early and midstage esophageal cancer who underwent total endoscopic resection,18 died 3 years after the operation,55 relapsed,233 achieved RFS,and the 3year RFS rate was 76.14%.Through univariate and random forest algorithm screening,seven factors were identified as being associated with the RFS of patients three years after surgery.These factors were entered into a Cox regression analysis,and the results showed that positive abdominal lymph nodes,vascular cancer thrombus,clinical stageⅢ,gross type of erosion,age ≥65 years,and tumor diameter >3cm were risk factors for RFS three years after surgery (P<0.05).Based on this,a nomogram prediction model for RFS three years after full endoscopic resection for earlytomid stage esophageal cancer was constructed.Internal and external validation showed that the consistency index of the prediction model in the modeling set was 0.881,and the consistency index in the validation set was 0.867.The ROC curve validation showed that the AUC of the prediction model in the modeling set and validation set were 0.855 (95%CI:0.7780.932) and 0.826 (95%CI:0.7630.890),respectively.The DCA curve validation showed that the risk threshold of the modeling set and validation set were 00.95 and 00.77,respectively,when the model could achieve high net benefits.〖WTHZ〗Conclusion〓〖WTBZ〗The 3year RFS after total endoscopic resection for early and middle stage esophageal cancer is related to multiple factors.The nomogram model based on clinical stage Ⅲ,positive abdominal lymph nodes,vascular tumor thrombus,and gross type of erosion has good clinical utility for predicting the 3year RFS of patients after surgery,and is of guiding significance for medical staff in making decisions about the management of early and middle stage esophageal cancer after surgery.

Objective  To investigate the impacts of midazolam (MDZ) on the proliferation,migration,and invasion of esophageal cancer (EC) cells by regulating the monocyte chemotactic protein-1 (CCL2) -CC chemokine receptor 2 (CCR2) signaling pathway.Methods QRT-PCR method was applied to determine the expression of CCL2 and CCR2 mRNA in EC tissue,adjacent cancer tissue,human normal esophageal epithelial cell HEEC,and EC cell Eca-109.MTT assay and colony formation were applied to measure cell proliferation.Scratch test,Transwell test,and TUNEL method were applied to determine cell migration,invasion,and apoptosis,respectively.The expression of CCL2-CCR2 signaling pathway proteins was determined using Western blot method.Results Compared with adjacent cancer tissues and normal human esophageal epithelial cells (HEEC),the mRNA and protein expression levels of CCL2 and CCR2 in cancer tissues and Eca-109 cells were increased (P＜0.05).Compared with the control group,the OD 450 value,colony formation number,scratch healing rate,and invasive cell count of Eca-109 cells in the MDZ-L group,MDZ-M group,and MDZ-H group decreased,while the proportion of TUNEL positive cells increased (P＜0.05).Compared with the MDZ-H group,the OD-450 value,colony formation number,scratch healing rate,and number of invasive cells in the MDZ-H+GW0742 group all increased,while the proportion of TUNEL positive cells decreased (P＜0.05).Compared with the control group,protein and mRNA expressions of CCL2 and CCR2 proteins in Eca-109 cells in the MDZ-L group,MDZ-M group,and MDZ-H group decreased (P＜0.05).Compared with the MDZ-H group,the MDZ-H+GW0742 group showed an increase in the expression of CCL2 and CCR2 proteins in Eca 109 cells (P＜0.05).Conclusion MDZ can inhibit the proliferation,migration,and invasion of EC cells by inhibiting the activation of the CCL2-CCR2 signaling pathway.

Objective To investigate the expression and clinical value of long non-coding RNA GAS5 (lncRNA GAS5) and matrix metalloproteinase 9 (MMP9) in the serum of patients with non-small cell lung cancer (NSCLC).Methods A total of 115 NSCLC patients who were treated in our hospital from December 2018 to December 2019 were collected as the NSCLC group.Based on prognosis,they were grouped into a survival group of 94 cases and a death group of 21 cases;another 115 volunteers who were physically healthy in our hospital during the same period were selected as the control group.Real-time fluorescence quantitative PCR (qRT-PCR) was applied to measure serum lncRNA GAS5 level;Enzyme linked immunosorbent assay (ELISA) was applied to measure serum MMP9 level;Pearson was applied to analyze the correlation between serum lncRNA GAS5 level and MMP9 level in NSCLC patients;receiver operating characteristic curve (ROC) was applied to evaluate the value of serum lncRNA GAS5 and MMP9 levels in the diagnosis of NSCLC;multivariate Cox regression was applied to analyze the influencing factors of prognosis in NSCLC patients.Results Compared with the control group,the serum lncRNA GAS5 level in the NSCLC group obviously decreased,while the MMP9 level obviously increased (P<0.05);a negative correlation between serum lncRNA GAS5 level and MMP9 level in NSCLC patients (r=-0.523,P<0.05);the levels of serum lncRNA GAS5 and MMP9 were correlated with tumor diameter,TNM staging,and lymph node metastasis (P<0.05);the area under the curve (AUC) of serum lncRNA GAS5 and MMP9 levels for diagnosing NSCLC was 0.842 and 0.916,respectively,the AUC of the combined diagnosis of the two was 0.952,which was superior to their individual diagnoses (Z=3.904 and 1.982,P<0.05);the serum lncRNA GAS5 level in the death group was obviously lower than that in the survival group,while the serum MMP9 level in the death group was obviously higher than that in the survival group (P<0.05);Multivariate Cox regression analysis showed that high levels of lncRNAGAS5 were independent protective factors for poor prognosis in NSCLC while high levels of MMP9 and lymph node metastasis Migration is an independent risk factor for poor prognosis in NSCLC (P<0.05).Conclusion The serum lncRNA GAS5 level is significantly reduced and MMP9 level is significantly increased in NSCLC patients,both of which have certain potential value in the clinical diagnosis of NSCLC and are factors affecting the poor prognosis of NSCLC.

Objective To investigate the influencing  factors for early acute gastrointestinal injury in critically ill patients in the intensive care unit.Methods Among the patients admitted from January 2021 to July 2023,there were 80 critically ill patients with an APACHE Ⅱ score of ≥15 points.Based on whether gastrointestinal injury occurred within one week of admission,they were divided into an acute gastrointestinal injury group (observation group,40 cases) and a control group of 40 cases randomly selected from cases without gastrointestinal injury.Univariate analysis was conducted on various clinical data of the two groups of patients,and the meaningful indicators of univariate analysis were included as independent variables in logistic regression analysis to further screen for risk factors causing gastrointestinal injury in early severe patients.Receiver operating characteristic(ROC) curve was drawn to further evaluate the predictive value of risk factors.Results The results of univariate analysis showed that the observation group had neutrophil/lymphocyte ratio (NLR),lactate,albumin,and application time of vasoactive drugs (h) of 14.05±4.52,(6.94±1.66)mmol/L,(24.49±2.73)g/L,and 63 (0,93.5)h,respectively,while the control group had neutrophil/lymphocyte ratio (NLR),lactate,albumin,and vasoactive drug application time (h) of 8.78±3.74,(4.06±1.30)mmol/L,(26.89±2.90)g/L,and 0 (0,43)h,respectively.The differences between the two groups were statistically significant (P<0.05).The results of logistic regression analysis showed that NLR (OR=1.36,95%CI1.18-1.57,P<0.001),lactate (OR=18.54,95%CI 3.28-104.73,P=0.001),and application time of vasoactive drugs (h) (OR=1.03,95%CI 1.01-1.04,P<0.001) all had statistical significance and were risk factors for early acute gastrointestinal injury in critically ill patients;The variable albumin is a protective factor for early acute gastrointestinal injury in critically ill patients,but it has statistical significance (OR=0.74,95%CI 0.63-0.88,P=0.001).ROC curve analysis showed that NLR,lactate,and application time of vasoactive drugs(h) AUC (95%CI) were 0.800 (0.707-0.894),0.969 (0.940-0.999),and 0.716 (0.600-0.831),respectively;The sensitivities were 65%,85%,and 55%,respectively;and the specificities were 80%,95%,and 88%,respectively;the differences were statistically significant (P<0.05).Conclusion NLR,lactate,and application time of vasoactive drugs(h) are the risk factors for early acute gastrointestinal injury in critically ill patients in the intensive care unit,and have high predictive value.

Objective To explore the risk factors of asymptomatic gallbladder stones secondary to common bile duct stones.Methods  A retrospective analysis was conducted on the data of asymptomatic gallstone patients diagnosed by the physical examination center of our hospital from January 2019 to October 2021,as well as asymptomatic gallstone patients with secondary common bile duct stones admitted to the hospital.According to whether secondary common bile duct stones occurred,the patients were divided into two groups.Among them,134 patients with asymptomatic gallbladder stones were the control group.There were 150 cases of common bile duct stones secondary to asymptomatic gallbladder stones,which were the observation group.The differences in baseline data between the two studies were balanced by propensity match scoring.The relevant data were compared and analyzed.Statistical analysis of the data was performed using SPSS 26.0 software and R software.Results  There was no statistical significance in the distribution of age,gender,BMI index,smoking,drinking,exercise,hypertension and diabetes between the two groups (P>0.05).The comparison of clinical indicators between groups showed that the number of gallbladder stones (multiple),the maximum diameter of stones (≥ 10mm),and the diameter of the common bile duct may be related to asymptomatic gallbladder stones secondary to common bile duct stones,with pvalues all less than 0.05 and statistically significant differences.There were statistically significant differences in the number of gallbladder stones (multiple),the maximum diameter of the stones (≥10mm),and the diameter of the common bile duct (P<0.05).Youdaoplaceholder0 Logistic Multivariate regression analysis showed that OR of the maximum diameter of the stone was 0.362(0.181-0.725),which was a protective factor for common bile duct stones secondary to asymptomatic gallbladder stones,and OR of the common bile duct diameter was 2.076(1.571-2.743),which was a risk factor for common bile duct stones secondary to asymptomatic gallbladder stones.Conclusion  Asymptomatic gallbladder stones secondary to common bile duct stones are the result of multiple factors working together.

Objective  To analyze the clinical risk factors for gastrointestinal dysfunction in patients with traumatic brain injury.Methods A retrospective analysis was conducted on clinical data of 313 cases of traumatic brain injury in our hospital from January 2022 to October 2023.According to whether gastrointestinal dysfunction occurred at admission,the patients were divided into the occurrence group (Group A,90 cases) and the nonoccurrence group (Group B,223 cases).Multivariate Logistic regression was used to analyze the risk factors of gastrointestinal dysfunction.The receiver operating characteristic (ROC) curve was used to evaluate the efficacy of each factor in predicting gastrointestinal dysfunction in patients with craniocerebral injury.Results Among 313 patients,90 cases (28.75%) experienced gastrointestinal dysfunction.Logistic analysis showed that the admission GCS score was ≤8 points(OR=3.117,95%CI:1.358-7.157,P=0.007),pulmonary infection (OR=7.129,95%CI:1.889-27.377,P=0.004),intracranial infection (OR=3.152,95%CI:1.162-8.548,P=0.024),frontal lobe injury (OR=5.430,95%CI:1.481-19.915,P=0.011),abnormal serum Na levels (OR=8.482,95%CI:1.958-36.247,P=0.004),and decreased Alb (OR=3.001,95%CI:1.137-7.918,P=0.026) and elevated hs CRP (OR=3.142,95%CI:1.159-8.522,P=0.024) were independent risk factors for gastrointestinal dysfunction in patients with traumatic brain injury.The receiver operating characteristic (ROC) curve was used to evaluate the efficacy of each factor in predicting gastrointestinal dysfunction in patients with craniocerebral injury.Conclusion Admission GCS score ≤ 8,pulmonary infection,intracranial infection,frontal lobe injury,abnormal serum Na levels,decreased Alb,and elevated hs CRP are independent risk factors for gastrointestinal dysfunction in patients with traumatic brain injury.

Objective To analyze the risk factors of delayed bleeding after colonic polyp resection.Methods 700 patients with colonic polyps admitted to General medical treatment Hanzhong 3201 hospital from January 2022 to May 2023 were included as the research object,and all patients were treated with colonoscopy polypectomy.According to whether Post-procedural bleeding (PPB) occurred after operation,they were divided into two groups:the group with PPB occurrence (n=85 cases) and the group without PPB occurrence (n=615 cases).The general data,clinical data and operation related data of the two groups were analyzed by univariate analysis.Multivariate Logistic regression was used to analyze the risk factors of postoperative PPB,and receiver operating characteristic curve was drawn to analyze the predictive value of risk factors.Results 700 patients in this study were all treated by colon polypectomy,and 85 patients (12.14%) developed PPB within 30 days after operation,that is,the incidence of PPB in this study was 12.14%.There was significant difference in sex,age,hypertension and treatment history of thrombosis between the two groups (P<0.05).There was significant difference in the morphology,diameter and surgical methods between the two groups (P<0.05).Multivariate Logistic regression analysis showed that polyp morphology (stalk),polyp diameter (>1cm),Endoscopic mucosal resection(EMR) and Endoscopic submucosal dissection(ESD) were the risk factors for postoperative PPB (P<0.05).The ROC curve showed that the area under curve of polypoid-shaped is 0.653,95%CI is 0.616-0.688,the AUC of polyp-diameter is 0.741,95%CI is 0.707-0.773;and in the way of operation,the AUC of argon plasma coagulation/ESD is 0.730,95%CI is 0.713-0.802,the AUC of EMR/ESD is 0.541,95%CI is 0.498-0.584,the AUC of APC/EMR is 0.604 and 95%CI is 0.565-0.641.Conclusion Polyp pedicled,diameter > 1cm,EMR and ESD are the risk factors for postoperative PPB.

Objective To investigate the safety and efficacy of zero-ischemia and sutureless laparoscopic partial nephrectomy using thulium laser for the treatment of localized renal cell carcinoma.Methods A retrospective analysis was performed on the clinical data of 28 patients with localized renal cell carcinoma admitted to our hospital from January 2020 to March 2023.Laparoscopic zero-ischemia suturing thulium laser partial nephrectomy was adopted.The surgical data,postoperative changes in renal function,perioperative complications,and prognosis were analyzed.Results Three patients underwent traditional partial nephrectomy immediately by blocking the renal arteries during the operation due to poor hemostasis.The remaining 25 patients successfully completed zero ischemia and sutureless laparoscopic partial nephrectomy using thulium laser,without intraoperative blood transfusion or open surgery.The surgical time ranged from 85 to 135 min,with an average of (108.4±14.7) min，the estimated blood loss was 50-250 ml,with an average of (117.7±51.7)ml.The drainage tube was removed 4-7 days postoperative,with an average of(5.6±0.9)days.The postoperative hospital day was 6～10 days,with an average of (7.7±0.9)days.There were no severe complications such as urinary fistula or secondary bleeding occurred.Preoperative serum creatinine was 60.4-116.0 μmol/L,with an average of (74.0±20.5)μmol/L.One week after the operation,the creatinine was 58.6-120.8 μmol/L,with an average of  (73.5±21.8)μmol/L,which was not significant compared with that before surgery (P>0.05).Postoperative pathology revealed 23 cases of clear cell renal cell carcinoma,4 cases of papillary renal cell carcinoma,and 1 case of chromophobe cell carcinoma.All cases was shown negative margins and there was no recurrence or metastasis during a follow-up period of 12 to 24 months.
Conclusion Zero-ischemia and sutureless laparoscopic partial nephrectomy using thulium laser can better preserve kidney function without ischemia reperfusion injury.It is a safe and feasible surgical option for patients with localized renal cell carcinoma.

Objective To study the efficacy and safety of flexible ureteroscopy holmium laser lithotripsy (FURS) in the treatment of urinary tract stones of different sizes and positions.Methods A retrospective analysis was conducted on the clinical data of 121 patients with upper urinary tract stones from January 2021 to December 2023.According to the size of the stones,they were divided into the diameter ≤20 mm group (n=98) and the 20mm＜diameter≤40 mm group (n=23).According to the location of the stones,19 cases were divided into the renal pelvis stone group and 102 cases were non renal pelvis stones.The surgical related indicators and incidence of complications were compared between the groups.Result The operation time of the group with diameter ≤20 mm and the group with diameter 20 mm < diameter ≤40 mm was (44.13±12.6) minutes and (57.52±20.98) minutes,respectively.The hospitalization periods were (4.55±1.54) days and (5.74±2.00) days,respectively.There were statistically significant differences between the two groups (P<0.05).The stone clearance rates in the group with diameter ≤20 mm and the group with 20 mm < diameter ≤40 mm were 84.69% and 78.26%,respectively.There was no statistically significant difference between the two groups (P>0.05).The operation time of the subcalyx kidney stone group and the non-subcalyx kidney stone group was (44.05±11.08) minutes and (47.17±16.19) minutes respectively,the hospital stay was (4.74±1.52) days and (4.78±1.73) days respectively,and the ESWL selection rates after the operation were 5.26% and 10.78% respectively.The stone recurrence rates were 15.79% and 4.90% respectively,and there was no statistically significant difference between the two groups (P>0.05).The stone clearance rates in the subcalyx kidney stone group and the nonsubcalyx kidney stone group were 63.16% and 87.25%,respectively.There was a statistically significant difference between the two groups (P<0.05).There was no statistically significant difference in the incidences of urosepsis,fever,low back pain,hematuria and total complications between the 20 mm < diameter ≤40 mm group and the diameter ≤20 mm group (P>0.05).There was no statistically significant difference in the incidences of urosepsis,fever,low back pain,hematuria and total complications between the noninferior calyx stone group and the inferior calyx stone group (P>0.05).Conclusion FURS treatment for upper urinary tract stones with a diameter of ≤20 mm has shorter surgical and hospitalization times compared to patients with a diameter of ≤40 mm.ESWL and lower stone recurrence rates are also preferred after surgery.FURS treatment for non lower renal calyx stones has a higher stone clearance rate compared to lower renal calyx stones.The safety of FURS treatment for upper urinary tract stones of different sizes and positions is equivalent.

Obejective  To explore whether it is possible to detect the ¹²³I prostate-specific membrane antigen(PSMA) radiation value of the puncture tissue during prostate biopsy to achieve real-time,rapid,and accurate identification of benign and malignant prostate tissues,so as to improve the current clinical biopsy strategy and achieve  accurate diagnosis of prostate cancer during operation with fewer puncture needles.Method In this prospective,diagnostic trial,we included 29 patients with suspected prostate cancer.All patients underwent transperineal biopsy guided by ultrasound within 24 hours after injection of ¹²³I PSMA，a total of 435 punctures were performed.The radiation value of punctured tissue was measured in real-time with a gamma counter.〖JP2〗Pearson test is used to correlate radiation value with histopathology.Result The median radiation value of prostate cancer tissue (1906.50cpm) was significantly higher than that of benign prostate tissue (415.00cpm).The optimal cut-off value for distinguishing benign and malignant prostate tissues was 828.50cpm.The median radiation value of clinically significant prostate cancer tissue (2652.50cpm) was significantly higher than that of clinically insignificant prostate cancer (1386.00cpm).The optimal cut-off value for distinguishing clinically significant and clinically insignificant prostate cancer tissues was 1767.00cpm.In additional,there was a significant positive correlation between the radiation value of puncture tissue and ISUP pathological grade (r=0.834).Conclusion It is preliminarily confirmed that detection of ¹²³I PSMA radiation value of prostate puncture tissue can realize real-time,rapid and accurate identification of benign and malignant prostate tissues during operation.

Objectives To retrospectively analyze the clinical outcomes of lateral malleolus osteotomy combined with cannulated screws and inverted proximal humerus locking plate fixation in the treatment of end-stage ankle osteoarthritis.Methods A clinical study was conducted on 21 patients with end-stage ankle osteoarthritis who were treated at our hospital from June 2018 to May 2022.Preoperative evaluations included weight-bearing Xrays to assess lower limb alignment and joint space,CT to evaluate the degree of bone sclerosis,and MRI to examine the extent of articular cartilage damage.The surgery involved a lateral malleolus osteotomy approach,using the resected lateral malleolus cartilage for grafting at the fusion site,and fixation of the tibiotalar joint with cannulated screws and an inverted proximal humerus locking plate.After the operation,the joint fusion was evaluated by Xray films followed up in the outpatient department.The clinical efficacy was evaluated by using the Visual Analogue Scale (VAS) for pain and the Ankle and hindfoot Function Score of the American Orthopaedic Foot and Ankle Society (AOFAS).ResultsTwenty patients were followed up (95.2% followup rate) over a period of 14 to 40 months,with an average follow-up duration of 27.8 months.All 21 patients experienced primary wound healing.One patient developed lateral foot numbness,and 19 patients achieved primary osseous fusion.One patient with diabetes required secondary bone grafting with PRP injection to achieve fusion.Postoperative AOFAS scores significantly improved from a preoperative average of 45.7±3.3 to 84.7±3.3,while VAS scores for pain decreased from 7.54±1.83 preoperatively to 1.94±0.33 postoperatively (P＜0.05)Conclusion Lateral malleolus osteotomy combined with cannulated screws and inverted proximal humerus locking plate fixation for the treatment of end-stage ankle osteoarthritis demonstrated a high rate of fusion and low complication rates， The short-term outcomes are favorable,and the procedure eliminates the need for iliac bone grafting,indicating its potential for broader clinical application.

Objective To evaluate the efficacy and safety of transforaminal lumbar interbody fusion (TLIF) and oblique lateral interbody fusion (OLIF) combined with posterior pedicle screw fixation in treating degenerative lumbar spondylolisthesis.MethodsThis retrospective analysis included 65 patients with degenerative lumbar spondylolisthesis treated at the Second Affiliated Hospital of Xi’an Medical University’s Department of Spine Surgery from January 2021 to February 2023.Patients were divided into two groups based on the surgical method:30 patients underwent OLIF combined with posterior pedicle screw fixation,and 35 patients underwent TLIF combined with posterior pedicle screw fixation.Perioperative outcomes (surgical time,intraoperative blood loss,etc.) were assessed,along with pre and post-operative evaluations using the Visual Analog Scale (VAS) for back pain,the Oswestry Disability Index (ODI),the Japanese Orthopaedic Association (JOA) score,the modified Macnab criteria,and radiological parameters (intervertebral disc height,foraminal height,lumbar lordosis angle,fusion segment lordosis angle,and vertebral slip rate).Results Both groups of patients completed a 6month follow-up.The intraoperative blood loss in the OLIF group was (57.79±11.54) ml,and the postoperative hospital stay was (5.85±0.94) days,while in the TLIF group,the values were (150.57±29.68) ml and (6.76±1.13) days,respectively.The differences between the two groups were statistically significant (P<0.05).The VAS score,ODI index,and JOA score on the 3rd postoperative day in the OLIF group were (1.50±0.61) points,(17.06±2.92)%,and (12.06±2.90) points,respectively,while in the TLIF group,they were (2.05±0.72) points,(26.41±3.38)%,and (10.24±2.68) points.The differences between the two groups were statistically significant (P<0.05).The intervertebral space height and foramen height on the 3rd postoperative day in the OLIF group were (14.43±1.50) mm and (23.87±1.41) mm,respectively,while in the TLIF group,they were (13.66±1.12) mm and (23.14±1.39) mm.The differences between the two groups were statistically significant (P<0.05).At 3 months postoperatively,the intervertebral space height and foramen height in the OLIF group were (13.42±1.41) mm and (23.34±1.33) mm,while in the TLIF group,they were (12.63±1.33) mm and (22.42±1.40) mm.The differences between the two groups were statistically significant (P<0.05).However,there were no statistically significant differences between the two groups in VAS score,ODI index,JOA score,modified Macnab criteria score,intervertebral space height,or foramen height at 6 months postoperatively (all P>0.05).From the 3rd postoperative day to 6 months,there were no statistically significant differences between the two groups in lumbar lordosis angle,segmental lordosis angle,or vertebral slippage rate (all P>0.05).Conclusion OLIF combined with posterior pedicle screw fixation may provide better short-term perioperative outcomes,particularly in terms of intraoperative blood loss and postoperative pain control,compared to TLIF.However,there were no significant differences in short-term outcomes between the two methods.

Objective To investigate the effect of modified dorsal palmar artery flap in repairing skin defect of hand. Methods A prospective study was conducted on 78 patients with hand skin defects in our hospital from May 2018 to May 2023,who were randomly divided into a control group (n=39) and a study group (n=39) using a random number table method.The control group was given conventional flap repair,while the study group was given modified dorsal metacarpal artery flap repair.The surgical conditions,flap blood supply,motor function of the affected finger,sensory function,postoperative complications and appearance satisfaction of the two groups were compared.Results The operation time,hospital stay and wound healing time of the research group were (110.28±17.65)minutes,(8.94±1.76) d and (14.39±3.82)d,respectively.Which were shorter than the control group [(121.43±15.94)min,(10.13±1.88)d,and (16.51±4.07)d,respectively].The intraoperative blood loss in the research group was (38.12±7.81)ml,which was lower than that of the control group [(42.59±7.43)ml].The elasticity scores of the study group at 1 month,3 months,and 6 months after surgery were (1.31±0.28),(2.34±0.31),and (2.81±0.08),respectively,which were higher than those of the control group [(1.12±0.25),(2.05±0.28),and (2.59±0.17),respectively].The capillary filling time scores were (1.24±0.26),(2.42±0.27),and (2.75±0.12),respectively,which were higher than those of the control group (1.06±0.23),(2.13±0.25),and (2.43±0.27),respectively;the excellent and good rate of motor function of the affected fingers in the study group was 97.44%,which was higher than that of the control group (79.49%),the incidence of complications was 5.13%,which was lower than that of the control group (23.08%),the appearance satisfaction rate was 89.74%,which was higher than that of the control group (71.79%) (P<0.05).Conclusion The modified dorsal palmar artery flap for the treatment of hand skin defects can optimize the operation process,improve the local blood flow of the flap,promote the recovery of finger motor function and sensory function,enhance the appearance effect and reduce the risk of complications.

Objective To observe the effects of remimazolam combined with alfentanil in elderly obese patients undergoing painless gastrointestinal endoscopy.Methods A total of 110 elderly obese patients who underwent painless gastrointestinal endoscopy in the hospital from January 2021 to December 2023 were divided into group A and group B according to the random number table method,with 55 cases in each group.Group A and group B were anesthetized with propofol combined with alfentanil and remifentanil combined with alfentanil,respectively.The sedation effect,gastrointestinal motility (serum gastrin and motilin concentrations),postoperative fatigue syndrome (POFS),induction time,examination time,recovery time,room exit time,and intraoperative adverse reactions were compared between the two groups.Results The excellent and good sedation rate in group B was 94.55%,higher than 81.82% in group A (P<0.05).Group B had shorter recovery time and room exit time [(8.26±1.73) min,(28.51±4.26) min] compared  to group A [(12.49±1.27) min,(37.63±5.45) min] (P<0.05).At the time of leaving the post-anesthesia care unit (T2),serum gastrin and motilin levels in group B [(97.53±18.81) pg/ml,(535.43±82.61) pg/ml] were higher than those in group A [(88.59±17.54) pg/ml,(504.62±83.19) pg/ml] (P<0.05).The duration of POFS in group B [(4.36±1.18) h] was longer than that in group A [(3.49±1.37) h] (P<0.05).There was no significant difference in the incidence of intraoperative adverse reactions between group B (7.27%) and group A (18.18%) (P>0.05).Conclusion The use of remimazolam combined with alfentanil in elderly obese patients undergoing painless gastrointestinal endoscopy provides better sedation,shorter recovery and room exit times,and less inhibition of excitatory gastrointestinal hormone secretion,which is beneficial for the recovery of gastrointestinal motility.However,the duration of POFS is longer.

Objective To explore the differences between various monitoring methods of anesthetic depth during total knee arthroplasty under general anesthesia combined with ultrasound-guided femoral nerve block.Methods From January 2021 to March 2021,60 patients undergoing total knee arthroplasty under ultrasound-guided femoral nerve block combined with general anesthesia were randomly divided into IoC group and BIS group,30 cases in each group.IoC group awareness index (Index of Consciousness,IoC) monitoring;bIS group was monitored by bispectral index (BIS) to guide the use of sedative and analgesic drugs during operation.The primary outcome measure was the time of first eye opening,and the secondary outcome measures included the average target concentration of sedative and analgesic drugs during operation,the number of perioperative adverse events and the quality of recovery.ResultsThe average difference in the first eye opening time between the two groups was 1.57 min (95% confidence interval:-0.61~2.63).The upper limit of the 95 % confidence interval was 2.63 min,which was less than the non-inferiority boundary value (δ=2.8 min),suggesting that the non-inferiority hypothesis of the main efficacy indicators was established.There was no significant difference in the dosage of propofol and sufentanil and the quality of recovery between the two groups (P>0.05).The target-controlled concentration of remifentanil in IoC group (8.55±1.45)ng/ml was significantly higher than that in BIS group (4.62±0.96) ng/ml,and the difference was statistically significant (P<0.05).At the same time,compared with BIS group,the number of stress hypertension (10 vs 32) in IoC group was significantly reduced and the number of bradycardia (17 vs 6) was significantly increased,the difference was statistically significant (P<0.05).At the same time,no intraoperative awareness and body movement were found in both groups.Conclusion During total knee arthroplasty surgery under general anesthesia combined with ultrasound-guided femoral nerve block:1.IoC monitoring is not inferior to BIS monitoring in terms of awakening speed and quality.2.The increased use of remifentanil in the IoC group and the reduced incidence of hypertension may indicate that IoC monitoring is more sensitive to intraoperative nociceptive stimuli.

Hepatocellular carcinoma is one of the most common malignant tumors in China.Hepatectomy continues to be one of the principal therapeutic modalities for early-stage hepatocellular carcinoma.The first elective hepatectomy was performed by Langenbuch in 1888 that marked the start of hepatic surgery.With the advances in studies on liver anatomy,in 1957，Goldsmith and colleagues proposed the concept of anatomical hepatectomy.In 1985,Makuuchi introduced the concept of anatomical subsegmentectomy.Over the past century,hepatic resection has evolved through multiple stages,including partial hepatectomy,hemi-hepatectomy,anatomical hepatectomy， anatomical subsegmentectomy and non-anatomical hepatectomy.Unfortunately,the long-term survival rates after hepatectomy of hepatocellular are still less than satisfactory.With recent development of studies on underlying liver diseases,mechanisms of hepatocarcinogenesis,and the tumor biological features of hepatocellular carcinoma,along with the breakthroughs in targeted therapy and immunotherapy for Hepatocellular carcinoma,the traditional concept of technically focused,anatomy-based hepatectomy is no longer sufficient to meet the demands of modern surgical treatment for hepatocellular carcinoma.Guided by the concept of scientific hepatectomy that combines local and systemic therapies,hepatectomy for HCC has been entered into a new era of hepatectomy with science.