Objective To investigate the clinical effect of hemorrhoidal artery ligation combined with ultrasonic knife resection,suture,ligature and suspension in the treatment of mixed hemorrhoids with annular prolapse.Methods A retrospective analysis was conducted to select 80 patients with annular prolapse mixed hemorrhoids admitted to the anorectal Department of our hospital from January 2022 to April 2023.According to different treatment plans,they were divided into control group(n=40 cases) who received external stripping and internal ligation combined with tape ligation,and study group(n=40 cases) who received hemorrhoidal artery ligation combined with ultrasonic knife resection,suture,ligation and suspension.The operative effect,operative status,postoperative anal pain,anal edema,stool blood score and quality of life were evaluated.Results The effective rate of the study group was 97.50%,which was higher than that of the control group(77.50%)(P＜0.05).The operation time, intraoperative blood loss, hospital stay and wound healing time of the research group were (25.03±10.00) minutes, (10.00±5.32)ml, (7.25±1.54) days and (12.21±2.00) days respectively. [is better than that of control group (29.85±14.00) minutes, ml (17.85±10.25), (11.87±2.35), (18.89±4.85) days], two groups of comparison, the difference was statistically significant (P< 0.05 ).The VAS scores of anal pain in the study group on 1 day, 3 days and 7 days after the operation were (4.25±0.85) points, (2.89±0.54) points and (2.00±0.30) points,respectively.The scores of perianal edema were (1.87±0.36) points, (1.41±0.30) points, and (1.00±0.20) points,respectively.The hematochezia scores were (1.85±0.21) points, (1.34±0.18) points, and (0.85±0.13) points,respectively.Which were better than that of control group [(7.56±1.10), (6.54±1.03), (4.87±1.00)] [(2.40±0.58), (2.03±0.49), (1.87±0.45)] [(2.45±0.55), (2.03±0.47),(1.88±0.25)], and the differences were statistically significant (P < 0.05).The recurrence rate was 2.50% in the study group and 17.50% in the control group(P＜0.05).The scores of SF,MH,PF and GH of the Modified Health Survey Summary Form(SF-36) in the study group were(88.54±10.22,87.87±10.58,88.97±10.00,89.95±10.05) higher than those of the control group(67.52±10.00,70.10±11.25,71.10±9.85,70.00±10.00)(P＜0.05).Conclusion Hemorrhoidal artery ligation combined with ultrasonic knife resection,suture,ligature and suspension in the treatment of patients with annular prolapse mixed hemorrhoids has ideal surgical effect and little trauma,which is beneficial to promoting postoperative rehabilitation,alleviating anal pain,improving anal edema and hematostoecium,and improving quality of life.

Objective To explore the risk factors and possible preventive measures of delayed postoperative intestinal paralysis (PPOI) in elderly (aged ≥75 years) patients with colorectal cancer.Methods This retrospective study included 333 patients with CRC who underwent laporascopic resection in General Department of Beijing Chaoyang Hospital from June 2016 to August 2023.There were 126 patients were enrolled in PPOI group and 207 patients were enrolled in non-PPOI group.The perioperative clinical characteristics of the patients were compared between PPOI group and non-PPOI group,and the risk factors of PPOI and potential preventive measures for them were investigated using-Logistic-regression.Results The incidence of PPOI after laparoscopic surgery in elderly patients with colorectal cancer was 37.84%. The ages of the PPOI group and the non-PPOI group were (82.60±3.587) years and (80.38±3.847) years respectively. The rates of primary enterostomy during the operation were 20.63% and 9.66%,respectively, and the preoperative combined nutritional risks were 53.97% and 20.77%,respectively.The preoperative serum albumin levels were lower, which were (35.32±3.77) g/L and (38.36±3.91) g/L,respectively, and the preoperative hemoglobin levels were (104.47±20.31) g/L and (110.33 ±20.27) g/L,respectively. The intraoperative blood loss was (140.48±130.65) ml and (98.26±56.45) ml,respectively. The patients who received enhanced recovery after surgery (ERAS) measures during the perioperative period were 14.29% and 75.85%,respectively. There was a statistically significant difference between the two groups (P<0.05).The Logistic analysis showed that the risk factors for elderly patients with PPOI including increased age ,preoperative nutritional risk ,low preoperative albumin ,increased intraoperative blood loss.Moreover,the implementation of ERAS protocols  including preoperative nutritional support ,multimodal low-opioid anesthesia,gastric tube removal  and ground activity  early after surgery may be the protective factors of PPOI.Conclusion The risk factors of PPOI for colorectal patients older than 75 years including increased age,preoperative nutritional risk,low preoperative albumin,increased intraoperative blood loss.The ERAS protocols including preoperative nutritional support,multimodal low-opioid anesthesia,gastric tube removal and ground activity early after surgery may be useful to prevent the occurrence of PPOI for elderly patients with colorectal cancer.

Objective To explore the influencing factors of urinary dysfunction in patients with rectal cancer after laparoscopic surgery,and to construct and validate a column chart prediction model.Methods A retrospective analysis was conducted on the clinical data of 415 rectal cancer patients in our hospital from January 2021 to April 2024.According to the computer-generated allocation order,they were stochastically grouped into a modeling group of 311 cases and a validation group of 104 cases in a 3∶1 ratio.The modeling group was further separated into a urinary dysfunction group of 55 cases and a non urinary dysfunction group of 256 cases.The patient's sex, diabetes history, tumor diameter and other relevant data were collected; Multivariate-Logistic-regression analysis was used to screen for risk factors; R software was used to construct a column chart prediction model for predicting urinary dysfunction in patients with colorectal cancer after laparoscopic surgery; The Hosmer-Lemeshow test, ROC curve, calibration curve, and DCA curve were used to validate the predictive performance of the column chart model.Results Male [OR (95% CI)=3.512 (1.637~7.533), P=0.001], diabetes [OR (95% CI)=3.684 (1.639~8.280), P=0.002], tumor diameter ≥ 5 cm [OR (95% CI)=4.459 (1.993~9.979), P=0.000], large intraoperative bleeding [OR (95% CI)=1.018 (1.011~1.026), P=0.000], anterior resection of rectum combined with abdominal perineum resection [OR (95% CI)=3.885 (1.901~7.940), P=0.000] were Independent risk factors for postoperative urination dysfunction in rectal cancer patients after laparoscopic surgery.In internal and external validations,the Hosmer-Lemeshau test for the column chart model showed χ2=0.159,P=0.254>0.05,and χ2=5.991,P=0.648>0.05.The areas under the receiver operating characteristic curve were 0.846 and 0.828,respectively.The calibration curve indicated that the simulated curve had a similar trend to the actual curve,indicating good discrimination and calibration of the column chart prediction model.Clinical decision curve analysis results showed that when the high-risk threshold probability was between 0.05 and 0.98,the column chart prediction model could produce better clinical benefits.Conclusion The column chart model constructed by integrating independent risk factors for urinary dysfunction in rectal cancer patients after laparoscopic surgery has high predictive value.

Objective  To investigate the relationship between preoperative serum high mobility group protein 1(HMGB1),macrophage inflammatory protein-1α (MIP-1α),osteopontin (OPN) and the prognosis of patients with basal ganglia intracerebral hemorrhage after neuroendoscopic surgery.Methods From March 2022 to March 2024,98 patients with cerebral hemorrhage in basal ganglia treated by neuroendoscopic removal were selected.Serum HMGB1,MIP-1 a and OPN were detected before operation,and they were followed up for 1 month after operation.Cox-regression analysis was used to analyze the risk factors affecting the prognosis of patients with cerebral hemorrhage in basal ganglia.Kapla-Meier survival curve and Log-rank test were used to analyze the survival rate of patients with cerebral hemorrhage in basal ganglia.Results Among the 98 patients with cerebral hemorrhage in basal ganglia,21 patients died within 1 month after neuroendoscopic removal,and the mortality rate was 21.43%.The proportion of patients with midline shift ≥ 10mm（76.19%） and hematoma volume[（51.18±7.62）ml] in the death group were higher than those in the survival group[14.29% and (31.93±5.66）ml],and the hematoma clearance rate[（78.13±5.86）%] was lower than that in the survival group[（90.58±6.29）%] (P<0.05).The preoperative levels of HMGB1, MIP-1 α and OPN in the death group were (12.44±2.26)ng/ml, (417.25 ±134.12)pg/ml and (12.32±3.19)ng/ml, respectively.The survival groups were (7.52±2.37)ng/ml, (200.35±31.36)pg/ml and (6.29±2.37)ng/ml,respectively. There was a statistically significant difference between the two groups (P<0.05).Cox regression analysis showed that preoperative high HMGB1 (HR=1.629,95%CI:1.274-2.083),high MIP-1α (HR=2.875,95%CI:1.384-5.972),high- OPN (HR=1.429,95%CI:1.073-1.093) were risk factors for death within 1 month after neuroendoscopic removal of basal ganglia intracerebral hemorrhage (P<0.05).Survival curve analysis showed that the survival rate of high HMGB1,high MIP-1α and high OPN at 1 month after operation was significantly lower than that of low HMGB1,low MIP-1α and low OPN (Long-rank- χ2 = 7.539,6.028,8.220,P<0.05).Conclusion The prognosis of patients with basal ganglia intracerebral hemorrhage with high HMGB1,high MIP-1α and high OPN before neuroendoscopic surgery was poor.Preoperative HMGB1,MIP-1α and OPN may be used as indicators for postoperative evaluation of neuroendoscopic removal in patients with basal ganglia intracerebral hemorrhage.

Objective To observe the efficacy and safety of 3D video-assisted thoracoscopic segmentectomy in patients with stage Ⅰ lung cancer treated with indocyanine green (ICG) fluorescence reverse-staining.Methods A total of 132 patients with stage Ⅰ lung cancer who were admitted from May 2022 to September 2024 all underwent three-dimensional video-assisted thoracoscopic segmental resection of the lung. They were divided into the observation group (63 cases) and the control group (69 cases) according to the method of intersegmental plane exposure. The control group was treated with the modified expansion and collapse method, while the observation group was treated with the ICG fluorescence backstaining method. The surgical conditions, pulmonary function, postoperative pain degree, quality of life and complications of the two groups were compared. Results The postoperative chest tube retention time, surgical time, postoperative hospitalization time, total postoperative thoracic drainage volume,and inter-segmental plane exposure time in the observation group were as follows(2.13±0.37) d，(145.12±25.26) min，(5.21±0.95) d，(261.41±28.57) ml and (9.15±1.73) s,respectively.The data of the control groups were (3.29±0.48) d,(178.31±30.45) min,(6.34±1.36) d,(352.03±36.74) ml and (1 651.28±179.84) s,respectively.There was a statistically significant difference between the two groups (P<0.05). There was no statistically significant difference in the number of intraoperative blood loss and intraoperative lymph node dissections between the two groups (P>0.05).There was no statistically significant difference in the levels of maximal expiratory flow (PEF),forced expiratory volume in one second (FEV-1), and FEV-1/ forced vital capacity (FVC) between the two groups before the operation and one month after the operation (P>0.05).The Visual Analogue Scale (VAS) scores of the observation group at 12 hours, 48 hours and 72 hours after the operation were (3.25±0.46) points, (2.13±0.35) points and (1.02±0.24) points respectively. The control groups were (4.11±0.59) points, (2.98±0.42) points, and (1.73±0.30) points,respectively. There was a statistically significant difference between the two groups (P<0.05). There was no statistically significant difference in the scores of negative and positive items between the two groups before the operation and one month after the operation (P>0.05). There was no statistically significant difference in the total incidence of complications between the two groups (P>0.05).Conclusion The modified dilatation collapse method and ICG fluorescence reverse staining method have no significant effects on lung function and complications in patients with stage Ⅰ lung cancer,and both can improve the quality of life.Compared with the modified dilatation collapse method,ICG fluorescence reverse staining method can shorten the plane exposure time between segments and the operation time,promote postoperative rehabilitation and alleviate postoperative pain.

Objective To investigate the expression of N-acetyltransferase 10 (NAT10),serine hydroxymethyltransferase 2 (SHMT2) and YTH domain family protein 1 (YTHDF1) in lung cancer tissues and their correlation with clinicopathological characteristics and prognosis. Methods A total of 98 lung cancer patients admitted to our hospital from April 2020 to April 2021 were regarded as the observation subjects.The cancerous tissues and adjacent tissues of the patient during surgery were collected.Immunohistochemistry was used to detect the expression levels of NAT10,SHMT2 and YTHDF1.The patients were followed up for 3 years and divided into the survival group and the death group according to their prognosis.The data of general clinicopathological characteristics were collected and analyzed.The relationship between NAT10,SHMT2 and YTHDF1 with the prognosis of patients were analyzed.Multivariate Cox- regression was used to analyze the influencing factors of lung cancer patients.Results The high expression ratios of NAT10,SHMT2 and YTHDF1 in cancer tissues were obviously higher than those in adjacent tissues (P<0.05).The expression of NAT10 and YTHDF1 was related to clinical stage,degree of differentiation and lymph node metastasis (P<0.05),and the expression of SHMT2 was correlated with clinical stage,degree of differentiation,tumor diameter,and lymph node metastasis (P<0.05).There were statistically significant differences in tumor diameter, clinical stage, degree of differentiation, lymph node metastasis, and expressions of NAT10, SHMT2, and YTHDF1 between the survival group and the death group (P<0.05). NAT10, SHMT2, YTHDF1 patient survival rates significantly below the low of high expression patients (χ2=6.354, P=0.012, χ 2 =8.512, P=0.004, χ2=4.791, P=0.029).Lymph node metastasis, high expression of NAT10, SHMT2 and YTHDF1 are all risk factors affecting the prognosis of patients (P < 0.05 ).Conclusion NAT10,SHMT2,and YTHDF1 are all highly expressed in the tissues of lung cancer,and have a certain correlation with clinical pathological characteristics and prognosis.They may serve as relevant evaluation indicators for the prognosis of lung cancer patients.

Objective  To analyze the risk factors associated with intraoperative parathyroid injury during thyroid cancer surgery and develop a predictive model to evaluate its predictive efficacy.Methods A retrospective study was conducted involving 76 patients who experienced intraoperative parathyroid injury during thyroid cancer surgery between May 2021 and February 2024.These patients were included in the parathyroid injury group.For the control group,76 patients who underwent thyroid cancer surgery without intraoperative parathyroid injury during the same period were selected.Clinical data,complete blood count parameters,and other relevant variables were collected.Univariate analysis was performed to screen for potential risk factors,and Logistic regression analysis was used to identify independent risk factors.A regression predictive model was established,and the model's goodness-of-fit and predictive power were evaluated.Results Among the 76 patients, 75 had temporary parathyroid function impairment and 1 had permanent parathyroid function impairment. Univariate and multivariate Logistic regression analyses showed that bilateral lymph node dissection, bilateral total lobectomy, capsule invasion, and combined hashimoto's thyroiditis were independent risk factors (P< 0.05).A predictive regression model was developed based on these factors.The Hosmer-Lemeshow test showed a χ2 = 2.064,P=0.356,indicating good model fit.The receiver operating characteristic (ROC) curve revealed that the model had an area under the curve (AUC) of 0.713,with a 95% confidence interval (CI) of 0.639 to 0.787,suggesting good predictive efficacy.Conclusion Hashimoto's thyroiditis,capsular invasion,bilateral lymph node dissection,and bilateral total lobectomy are significant risk factors for intraoperative parathyroid injury during thyroid cancer surgery.The predictive model constructed based on these factors has good predictive efficacy.

Objective  To investigate the value of serum micro ribonucleic acid-335-5p (miR-335-5p) and endothelial cell-specific molecule-1 (ESM1) in the early diagnosis and prognosis of patients with esophageal cancer.Methods A total of 81 patients diagnosed with esophageal cancer by pathological examination were selected from April 2019 to April 2023 as the esophageal cancer group,and 81 healthy volunteers who underwent physical examination in our hospital were selected as the control group.Real-time quantitative polymerase chain reaction (qRT-PCR) was used to detect the levels of miR-335-5p and ESM1.According to the follow-up results,46 cases were grouped into the good prognosis group and 35 cases in the poor prognosis group.Pearson correlation analysis was used to analyze the relationship between serum miR-335-5p and ESM1 in patients with esophageal cancer.Receiver operating characteristic (ROC) curve was plotted to analyze the value of serum miR-335-5p and ESM1 levels in diagnosing esophageal cancer and the value in evaluating the prognosis of esophageal cancer patients.Results Compared with the control group,the serum level of miR-335-5p in the esophageal cancer group was greatly reduced,the level of ESM1 was greatly increased (P<0.05).MiR-335-5p had binding sites with ESM1.Pearson correlation analysis showed that serum miR-335-5p was negatively correlated with ESM1 level in patients with esophageal cancer (r=-0.538,P<0.001).Compared with the individual diagnosis,the AUC of the combination of serum levels of miR-335-5p and ESM1 in the diagnosis of esophageal cancer was greatly higher (ZmiR-335-5p~miR-335-5p+ESM1=2.625,P=0.009;ZESM1~miR-335-5p+ESM1=4.156,P<0.001).The levels of miR-335-5p and ESM1 were correlated with TNM stage,lymph node metastasis and differentiation (P<0.05).Compared with the good prognosis group,the serum level of miR-335-5p in the poor prognosis group was greatly reduced,and the ESM1 level was greatly increased (P<0.05).Compared with the individual diagnosis,the AUC of combination of serum miR-335-5p and ESM1 levels in the prognostic assessment of esophageal cancer patients was greatly higher (ZmiR-335-5p~miR-335-5p+ESM1=2.128,P=0.033;ZESM1~miR-335-5p+ESM1=2.440,P=0.015).Conclusion MiR-335-5p is low expressed and ESM1 is highly expressed in the serum of esophageal cancer patients,they have certain clinical value for early diagnosis and prognostic evaluation of esophageal cancer patients.

Objective To explore the correlation between preoperative airway preparation and postoperative day 1 drainage volume in patients undergoing radical esophagectomy and the occurrence of postoperative pulmonary complications.Methods Analyzing the clinical data of esophageal cancer 147 patients who underwent thoracoscopic and laparoscopic radical surgery from January 2022 to June 2024,they were divided into PPCs group and non-PPCs group based on whether PPCs occurred postoperatively.Clinical data of the two groups were compared.Multivariate logistic regression analysis was applied to analyze the influencing factors for the occurrence of PPCs after radical resection of esophageal cancer,and a decision tree prediction model for postoperative PPCs was constructed.Receiver operating characteristic(ROC) curve was used to analyze the value of related factors in predicting the occurrence of PPCs after radical resection of esophageal cancer.Results Univariate analysis showed that age,albumin/fibrinogen ratio,neutrophil/lymphocyte ratio,preoperative respiratory preparation,and drainage volume on the first day after surgery were associated with the occurrence of PPCs after radical resection of esophageal cancer(P<0.05).Multivariate logistic regression analysis indicated that age,albumin/fibrinogen ratio and drainage volume on the first day after surgery were independent influencing factors for the occurrence of PPCs after radical resection of esophageal cancer(P<0.05).The decision tree model identified drainage volume on the first day after surgery,albumin/fibrinogen ratio,age and neutrophil/lymphocyte ratio as predictive factors.The incidence rate of PPCs in the group without preoperative respiratory preparation was significantly higher than that in the group with preoperative respiratory preparation (62.5% vs. 37.5%,P<0.05).A drainage volume of 246.59ml on the first day after surgery was the optimal cutoff value for predicting the occurrence of PPCs after radical resection of esophageal cancer,and specificity was 93.04%,sensitivity was 87.5%,area under ROC curve(AUC) was 0.958,95%CI was 0.911-0.984.Moreover,the incidence rate of PPCs in patients with a drainage volume≤246.59ml on the first day after surgery was significantly higher than that in patients with a drainage volume >246.59ml (77.78% vs.3.60%,P<0.01).Conclusion Preoperative airway preparation and postoperative drainage volume are closely related to the occurrence of postoperative pulmonary complications (PPCs) after thoracoscopic radical surgery for esophageal cancer.Therefore,targeted measures should be taken for airway preparation before surgery,and changes in the patient's condition should be closely monitored after surgery to accurately determine the timing of drainage tube removal,which plays an important role in effectively preventing and treating PPCs.

Objective  To explore the factors associated with complete resolution of sentinel lymph node metastasis (pCR) after neoadjuvant chemotherapy in breast cancer and to establish a predictive model.Methods The medical records of 136 female patients with breast cancer who received neoadjuvant chemotherapy in the First Hospital of Lanzhou University from January 2022 to February 2024 were retrospectively analyzed.According to the 80/20 rule,the patients were randomly divided into a training set (108 cases) and a validation set (28 cases).Based on the pathological examination results of axillary lymph node dissection (ALND) after neoadjuvant chemotherapy in breast cancer patients,they were classified into the sentinel lymph node pCR group and non-pCR group.Multivariate logistic regression analysis was used to screen the independent risk factors of sentinel lymph nodes failing to reach pCR.Build a nomogram prediction model based on the screened risk factors.By drawing the receiver operating characteristic(ROC) curve calculation curve, the area under ROC curve, sensitivity and specificity are used to evaluate the discrimination of the model.Results Among the 108 breast cancer patients,46 cases achieved pCR in the sentinel lymph nodes,accounting for 42.59% (46 cases/108 cases).In addition,33 cases (30.56%) achieved pCR in the primary tumor lesion.The non-pCR group showed a higher proportion of stage Ⅲ clinical staging,lymph node short-axis reduction of less than 50% before and after treatment,tumor maximum diameter reduction of less than 50% before and after treatment,lymph node type Ⅲ classification,and blood flow grade Ⅲ compared to the pCR group (P<0.05).Multivariate logistic regression analysis showed that Clinical staging (OR=3.593,95%CI:1.276~10.121),lymph node short-axis reduction of less than 50% before and after treatment (OR=4.272,95%CI:1.517~12.032),tumor maximum diameter reduction of less than 50% before and after treatment (OR=3.710,95%CI:1.317~10.449),lymph node type (OR=3.827,95%CI:1.359~10.779),and blood flow grade (OR=4.764,95%CI:1.691~13.418) were identified as risk factors for not achieving pCR in the sentinel lymph nodes after neoadjuvant chemotherapy in breast cancer patients (P<0.05).The sensitivity of the risk model for predicting non-achievement of pCR in the sentinel lymph nodes after neoadjuvant chemotherapy in the training set of breast cancer patients was 0.826 (95%CI:0.705~0.943),with a specificity of 0.826 (95%CI:0.712~0.919) and an area under the ROC curve of 0.847 (95%CI:0.738~0.952).In the validation set,the sensitivity for predicting non~achievement of pCR in the sentinel lymph nodes after neoadjuvant chemotherapy in breast cancer patients was 0.731 (95%CI:0.608~0.904),with a specificity of 0.827 (95%CI:0.713~0.941) and an area under the ROC curve of 0.834 (95%CI:0.729~0.951).Conclusion Clinical staging,changes in lymph node short-axis before and after treatment,changes in tumor maximum diameter before and after treatment,lymph node type,and blood flow grade are associated with pCR in the sentinel lymph nodes after neoadjuvant chemotherapy in breast cancer patients.Constructing a predictive model can help evaluate the pCR status of sentinel lymph nodes after neoadjuvant chemotherapy.

Objective To explore the efficacy of vacuumassisted minimally invasive gyrotomy for benign lesions in the lower quadrant of the breast.Methods From August 2022 to August 2023, 90 patients with benign lesions in the lower quadrant of the breast were treated. According to the different surgical methods, they were divided into two groups: the traditional group included 45 cases, which underwent surgery through the trans-areolar incision; the minimally invasive group included 45 cases, which underwent surgery through the trans-mammary fold incision with vacuum-assisted minimally invasive technique. The surgical-related indicators, inflammatory response indicators, patient satisfaction, and safety were compared between the two groups.Results The operation time [(20.45±6.18) min],intraoperative bleeding [(7.78±2.23) ml],hospital stay [(4.37±1.05) d],scar length [(2.32±0.42) cm] and healing time [(3.46±1.08) d] in the minimally invasive group were significantly better than those in the traditional group [(34.52±9.46)min,(23.16±6.44)ml,(8.72±2.73)d,(19.14±4.18)cm and (7.37±2.16)d] (P<0.05).The levels of IL-6 [(12.14±2.86)ng/L],IL-10 [(14.33±3.74)pg/ml],CRP [(13.85±3.11)mg/L],Cor [(131.27±6.43)nmol/L] and NE [(82.55±8.44) in the minimally invasive group at 3 days after surgery ng/ml were increased and VEGF was decreased [(59.72±7.44)mg/L] than the traditional group [(17.23±3.38)ng/L,(19.62±4.88)pg/ml,(28.36±4.67）mg/L,（196.52±8.84）nmol/L,（117.62±7.14）ng/ml and (88.46±7.89)mg/L](P<0.05).The satisfaction of patients in minimally invasive group (97.78%,44/45) was significantly higher than that in traditional group (82.22%,37/45) (P<0.05).The incidence of adverse events in minimally invasive group (4.44%,2/45) was significantly lower than that in traditional group (22.22%,10/45) (P<0.05).Conclusion Vacuum-assisted minimally invasive rotatory excision can optimize surgical indicators,improve serological indicators,enhance patient satisfaction and treatment safety compared to traditional areola incision surgery.

Objective To investigate the influencing factors of ERCP stent implantation for patients with malignant obstructive jaundice.Methods 130 patients with malignant obstructive jaundice who received ERCP stent implantation in our hospital from January 2017 to January 2024 were retrospectively included,and grouped according to the jaundice control effect 4 weeks after surgery.Univariate and multivariate analysis of the efficacy of ERCP stent placement in malignant obstructive jaundice after 4 weeks.Construction of a predictive model for the efficacy of ERCP stent placement in malignant obstructive jaundice after 4 weeks and clinical efficacy analysis.Results There were 64 cases for jaundice resolved in 4 weeks after surgery among all 130 patients with the regression rate for 49.23%.The results of univariate analysis showed that the type of biliary obstruction,stent type,and preoperative Child Pugh grading may all be related to the efficacy of ERCP stent placement in malignant obstructive jaundice after 4 weeks (P<0.05).The results of Logistic multivariate analysis showed that the type of biliary obstruction,stent type,and preoperative Child Pugh grade were all independent influencing factors on the efficacy of ERCP stent placement for malignant obstructive jaundice at 4 weeks (P<0.05).Using the independent influencing factors and pvalue prediction probability of Logistic regression model to predict the prognosis of patients,the ROC curve was used,with areas under the curve of 0.713,0.823,0.907,and 0.971,respectively.Conclusion The clinical effects of ERCP stent implantation in malignant obstructive jaundice was closely related to the type of biliary obstruction,stent type and preoperative Child-Pugh grade.The data model constructed using the above three factors has shown good performance in predicting the prognosis of patients.

Objective To investigate the predictive value of Caprini model score combined with neutrophil/lymphocyte ratio (NLR) for deep vein thrombosis in elderly patients with intertrochanteric fracture.Methods A total of 70 elderly patients with intertrochanteric femoral fractures who received surgical treatment in the hospital from November 2022 to May 2024 were prospectively selected as the study subjects.The enrolled patients were divided into occurrence group and non-occurrence group according to whether DVT was complicated during postoperative hospitalization.,general data,surgery-related indexes were compared between the two groups,multivariate Logistic regression analysis was used to identify the risk factors affecting postoperative DVT.The efficacy of Caprini model score combined with NLR in predicting postoperative DVT was evaluated by receiver operating characteristic curve (ROC).Results Compared with the non-occurrence group,the Caprini model score,NLR,combined diabetes rate,Ddimer (D -D) and hypersensitive Creactive protein (hs-CRP) levels in the occurrence group were higher (P<0.05),the injury-hospital admission time was longer (P<0.05),the intraoperative blood loss was greater (P<0.05),and the platelet-derived growth factor (PDGF) was lower (P<0.05).Logistic multivariate regression analysis results show that Caprini model has high score (OR=2.044,95%CI:1.825~2.764),high NLR (OR=2.008,95%CI:1.840~2.696),combined with diabetes (OR=1.834,95%CI:1.726~2.463),long duration of injury-hospital admission (OR=1.828,95%CI:1.625~2.531),large intraoperative blood loss (OR=1.851,95%CI:1.682~2.421),high D-D level (OR=1.910,95%CI:1.771~2.605) and low PDGF level (OR=1.934,95%CI:1.706~2.568) were risk factors for deep vein thrombosis in elderly patients with intertrochanteric fracture.ROC curve results show that the sensitivity and AUC of Caprini model score combined with NLR in predicting postoperative deep vein thrombosis in elderly patients with intertrochanteric fracture are 90.50% and 0.902,respectively,these indexes are higher than Caprini model score (87.20%,0.869) and NLR (84.60%,0.848).Conclusion Both Caprini model score and NLR are higher in elderly patients with DVT after operation,and Caprini model score combined with NLR is more effective in predicting DVT after operation.

Objective  The aim of this study was to explore the effects of lumbar lordosis on spinal sagittal balance after Roussouly type Ⅱ spinal lumbar fusion.Methods In the experiment,96 patients undergoing Roussouly type Ⅱ spinal lumbar fusion in Laohekou First Hospital were enrolled as the research objects between January 2022 and December 2023.According to random number table method,they were divided into control group (intraoperative maintaining of the original lumbar lordosis,n=48) and study group (intraoperative increasing of lumbar lordosis by 5°,n=48).The clinical symptoms [numerical rating scale (NRS),Oswestry disability index (ODI)],spinal and pelvic sagittal parameters [pelvic incidence (PI),sacral slope (SS),pelvic tilt (PT),lumbar lordosis (LL),thoracic kyphosis (TK)],rehabilitation status [Japanese Orthopaedic Association (JOA),Berg balance scale (BBS)] and postoperative complications were compared between the two groups.Results The experiment results showed that at 6 months after surgery,scores of NRS and ODI were decreased in both groups,which were lower in study group than control group (P<0.05).At 6 months after surgery,PI,SS,PT and LL in study group were (48.48±1.62) °,(35.42±5.39) °,(16.75±1.84) ° and (39.36±3.72) °,higher than those in control group [(47.51±2.32) °,(28.83±4.46) °,(13.95±1.77) °,(30.78±3.64),P<0.05],while TK was lower than that in control group [(11.72±1.08) °vs. (14.26±1.23) °,P<0.05].At 6 months after surgery,scores of JOA and BBS were increased in both groups,which were higher in study group than control group (P<0.05).There was no significant difference in incidence of postoperative complications between study group and control group (12.50% vs.14.58%,P>0.05).Conclusion It can be concluded that appropriate increase of lumbar lordosis can significantly improve spinal sagittal balance,promote the remission of clinical symptoms and rehabilitation process in patients after Roussouly type Ⅱ spinal lumbar fusion.

Objective To establish and test a 3-year prognosis model for elderly intertrochanteric fractures after intramedullary nail fixation.Methods A total of 205 elderly patients with intertrochoteric fracture of femur who underwent intramedullary nail fixation in our hospital from April 2019 to April 2021 were selected for observation study,followed up for 3 years after surgery,according to the Harris score, they were divided into the good group and the poor group.Univariate analysis was conducted to investigate the influencing factors of disease prognosis in the two groups 3 years after surgery.After the variables were screened by LASSO regression and cross-validation method,the independent influencing factors of the 3-year postoperative prognosis were analyzed by multi-factor Logistic-regression,and the prediction model of the nomogram was built,and the model was evaluated and validated.Results Among 205 elderly patients with intertrochanteric fractures of the femur who underwent intramedullary nailing fixation,201 were followed up for 3 years.Among them,148 patients had a Harris score of ≥70 points,while 53 patients had a score of <70 points.Univariate analysis results showed that the poor group had a higher proportion of patients with age,stroke,osteoporosis,Evans-Jensen type Ⅲ and Ⅳ fractures,poor intraoperative reduction,and a tip-apex distance of ≥30 mm compared to the good group,and had a lower lateral wall thickness than the good group,the difference was statistically significant (P < 0.05).LASSO regression analysis and cross-validation were used to screen variables.Multivariate Logistic regression analysis showed that stroke (OR=2.127,95%CI:1.478-3.061) and fracture Evans-Jensen classification Ⅲ (OR=1.149,95%CI:1.105-1.195) and type Ⅳ (OR=1.187,95%CI:1.143-1.233),intraoperative reduction was not good (OR=3.290,95%CI:2.319-4.668),apex distance ≥30mm (OR=1.413,95%CI:1.066-1.874) was an independent associated risk factor for disease outcome 3 years after surgery,the external wall thickness (OR=0.600,95%CI:0.4280.841) was an independent correlated risk factor for 3-year prognosis (P < 0.05).Based on the results of multiple factors,a nomogram prediction model was drawn,and the results showed that the model had certain predictive value for the disease outcome three years after surgery.The evaluation and verification results showed that when the threshold probability was 0-96%,the model had good clinical applicability and positive clinical net benefit.Conclusion Stroke,fracture Evans-Jensen classification Ⅲ and Ⅳ,poor intraoperative reduction,apical distance ≥30 mm,and lateral wall thickness are independent and relevant factors for 3-year prognosis of senile intertrochanteric fractures after intramedullary nail fixation.The establishment of a nematographic model has good predictive value for postoperative long-term prognosis and positive clinical net benefit.It can be used as an effective model to predict the long-term prognosis of postoperative disease.

Objective To explore the clinical efficacy of percutaneous ureteral flexible ureteral holmium laser lithotripsy (PNHLL) and single ureteral flexible percutaneous nephrolithotomy (ECIRS) in the treatment of complex kidney stones.Methods The clinical data of 103 patients with complex renal calculi admitted to our hospital from January 2015 to March 2023 were retrospectively analyzed.According to the surgical methods,they were divided into PNHLL group (53 cases) and ECIRS group (50 cases).The perioperative related indicators,stone clearance rate,renal function,stress response and postoperative complications were compared between the two groups.Results The operation time of ECIRS group was longer than that of PNHLL group[(97.62±19.52) min vs.  (72.43±14.48) min] ,and the success rate of stone removal was higher than that of PNHLL group[92.00% (46/50) vs .75.47% (40/53)]  (P<0.05).After operation,the levels of blood urea nitrogen (BUN) [(15.44±3.08)mmol/L vs. (17.21±3.44)mmol/L],cystatin C (CysC) [(611.85±34.22)μg/L vs(637.42±35.41)μg/L],creatinine (Scr) [(77.52±8.64)μmol/L vs. (81.63±9.07)μmol/L],superoxide dismutase (SOD) [(108.64±7.24)U/ml vs. (115.27±7.68)U/ml],prostaglandin E2 (PGE2) [(162.41±18.05)μmol/L vs.(175.48±19.47)μmol/L],nitric oxide (NO) [(74.61±8.29)μmol/L vs.(78.58±8.73)μmol/L] and cortisol (Cor)  [(188.64±29.02)nmol/L vs.(212.42±32.68)nmol/L]in ECIRS group were lower than those in PNHLL group (P<0.05).Conclusion Compared with PNHLL,ECIRS has a higher success rate of stone clearance in the treatment of complex renal calculi,and has less renal function and postoperative traumatic stress response,which is beneficial to postoperative recovery.

Objective To investigate the effect of pectointercostal fascial block（PIFB)PECSⅡ block-general anesthesia on hemodynamics and stress response in patients undergoing modified radical mastectomy for breast cancer.Methods A total of 95 patients with breast cancer who underwent modified radical mastectomy in the hospital from November 2021 to November 2023 were enrolled in this study.They were divided into the control group (n=46) and the observation group (n=49) according to the anesthesia mode.The control group received PECS Ⅱ block general anesthesia and the observation group received PIFB-PECS Ⅱ block-general anesthesia.The dosage of remifentanil,the dosage of cisatracurium,recovery time,tracheal extubation time,postoperative analgesia pump compression times,VAS scores,hemodynamics (HR,MAP),oxidative stress response (SOD,CAT,MDA),and hyperthermia were compared between the two groups Susceptibility to MMSE score and adverse reactions.Results The dosage of remifentanil,dosage of cisatracurium,effective pressing times of analgesia pump within 48 h,wake-up time,tracheal extubation time and time to postoperative first pressing in the observation group were lower and shorter than those in the control group (P<0.05).The observation group had lower VAS scores than the control group after surgery (P<0.05).The HR of after anesthesia induction (T1),at tracheal intubation (T2),at the beginning of surgery (T3) and at the end of surgery (T4) in the observation group was (78.45±6.12) times /min,(100.28±11.54) times /min,(103.90±14.82) times /min and (93.66±9.17) times /min,respectively,which were lower than the control group [(84.66±7.04) times /min,(112.33±13.28) times /min,(122.44±17.06) times /min and (106.26±11.03) times /min,respectively].MAP of T1,T2,T3 and T4 in the observation group were (67.73±4.09) mmHg,(75.22±9.51) mmHg,(90.76±10.77) mmHg and (82.50±8.63) mmHg,respectively,the control groups were (70.10±5.66) mmHg, (82.62±10.17) mmHg, (96.43±12.59) mmHg and (90.82±11.04) mmHg,respectively.There was a statistically significant difference between the two groups (P<0.05). The levels of SOD, CAT and MDA in both groups at 24 hours and 72 hours after the operation were all higher than those before the operation (P<0.05).The SOD levels in the observation group were (83.22±15.44) nU/ml and (77.41±10.39) nU/ml at 24h and 72h after operation.It was lower than that of the control group, which was (90.40±18.23) nU/ml and (82.80±13.18) nU/ml.The CAT scores of observation group were (16.20±5.03) kU/L and (14.12±3.27) kU/L at 24h and 72h after operation,which were lower than those of control group [(20.75±6.57) kU/L and (17.06±4.35) kU/L].The MDA levels in the observation group were (5.12±1.33) mmol/L and (3.23±0.76) mmol/L at 24h and 72h after surgery,which were lower than those in the control group [(6.03±2.24) mmol/L and (4.88±1.05) mmol/L],and the differences were statistically significant (all P<0.05).The MMSE scores of the observation group were (28.01±1.35) and (28.46±1.39),which were higher than those of the control group [(26.44±1.08) and (27.36±1.23)] (P<0.05).Conclusion Applying PIFB-PECS Ⅱ block-general anesthesia in modified radical mastectomy for breast cancer can maintain hemodynamic stability,reduce oxidative stress and alleviate the damage to cognitive function,with high safety.

Constipation is a common functional gastrointestinal disorder with a global prevalence of approximately 10% to 20%.Its causes include functional disorders,organic diseases,and drug factors,with the majority being functional constipation.In recent years,driven by advancements in biomedicine,artificial intelligence (AI),and microbiome research,significant progress has been made in the diagnosis and treatment of constipation.This review systematically explores the latest developments in constipation treatment,including the role of the gut microbiota in constipation,the metabolic regulatory effects of short-chain fatty acids (SCFAs),the impact of mental factors on intestinal motility.Additionally,it discusses future development directions such as AI-assisted diagnosis,AI-based consultation systems,personalized microbiota transplantation,and minimally invasive neuromodulation,providing new insights for precision medicine in constipation.

Hepatic arterial infusion chemotherapy(HAIC) is a therapeutic strategy that delivers chemotherapy drugs directly to the liver through the hepatic arterial system,which enriches the concentration of the drug in the liver to 400 times of the systemic intravenous administration.It has the significant advantage of maximizing the concentration of liver local chemotherapy drugs,while reducing systemic side effects.HAIC plus intravenous chemotherapy has shown promising results in conversion to resection and survival rate for metastatic liver cancer,especially for initially unresectable colorectal liver metastasis.The primary tumor and liver metastasis can be simultaneously addressed by combined transcatheter arterial infusion chemotherapy with chemoembolization,which can rapidly reduce tumor burden,ameliorate clinical symptoms of gastrointestinal hemorrhage and incomplete intestinal obstruction.To date,though,there is no consensus on the definitive indication,medication regimen and multi-method combination therapy.This article discusses the basic principle,technical methods,clinical application and current research progress of HAIC.

With changes in lifestyle,the incidence of osteoporotic vertebral burst fractures is increasing.These fractures are prone to being underdiagnosed or misdiagnosed.In severe cases,they can lead to nonunion,kyphotic deformity,and even neurological injury.The best treatment plan for such unstable fractures has always been controversial. On the one hand, the fracture degree is severe and the morphology is complex, and there is no unified classification standard. On the other hand, the general condition and bone quality of the patients are poor, which affects the surgical decision.This article reviews the progress in the diagnosis and treatment of osteoporotic lumbar body blowout fractures.

Adipocytic tumors are the most common type of soft tissue tumors, which can be divided into lipomas and liposarcomas. Studies have found that benign lipomas resected from the same site can transform into liposarcomas,especially atypical lipomatous tumors(ALT), suggesting an underlying biological association. In this case, the patient underwent resection of a right neck mass in our hospital in 2017, and the pathology showed fibrolipoma. One year later, the mass recurred at the original site but was not treated. By 2023, the mass had significantly enlarged and extended deeply. MRI showed that the lesion had an unclear boundary with the surrounding fat, suggesting liposarcoma. Puncture and molecular pathology showed MDM2 gene amplification, and the diagnosis of ALT was made, which was confirmed by pathology after complete surgical resection. It can be seen that adipocytic tumors have great differences in biological behavior, and benign lipomas can transform into liposarcomas (especially ALT). Clinically, it is necessary to combine imaging, pathology and molecular detection (such as MDM2/CDK4) for differentiation to formulate treatment plans.