In China，more than 80% of patients with hepatocellular carcinoma (HCC) are associated with varying degrees of HBV-related liver cirrhosis.Different from the Western countries,hepatectomy remains as the one of the mainstay choices for HCC with liver cirrhosis.The severity of cirrhosis of HCC patients varies greatly from individual to individual. Although the patients’liver function is at the compensated stage.With the development of liver cirrhosis,both hepatic functional reserve and regenerative capacity are considerably diminished,the incidence of surgical complications and post-hepatectomy liver failure will increase correspondingly.Therefore,maximally preserving the amount of liver parenchyma is crucial to maintaining essential liver function for cirrhotic HCC patients.The insufficient understanding of the relationship between post-hepatectomy liver failure and the severity of liver cirrhosis for patients has led to a lack of agreement on selecting reasonable surgical modalities and preserving sufficient future liver remnant volume.This results in a scarcity of concrete guidance for clinically preventing and treating post-hepatectomy liver failure,substantially compromising the surgical efficacy in HCC patients.Minimizing the incidence of postoperative hepatic insufficiency and mortality rates in cirrhotic HCC patients deserve to be further studied.The Chinese Chapter of the International Hepato-Pancreato-Biliary Association and Hepatic Surgery Group of Surgical Branch of Chinese Medical Association invited well-known experts in liver surgery and hepatology in China,mainly elaborate the role of the severity of liver cirrhosis in the safety evaluation of hepatectomy, and how to improve surgical safety,which may assist liver surgeons to make appropriate surgical decisions for HCC patients with liver cirrhosis.

Objective Investigate the clinical efficacy and application value of gasless trans-subclavian approach endoscopic surgery(GTAES) for the treatment of primary hyperparathyroidism(PHPT).Methods 55 PHPT patients who underwent unilateral parathyroid adenoma resection from January 2023 to October 2024 were absorbed.Based on surgical approaches,31 patients were divided into the traditional low-collar arc incision open surgery group(open group) and 24 patients were divided into gasless trans-subclavian approach endoscopic surgery group(endoscopic group).The perioperative data,anterior neck function recovery,and incision healing were compared between two groups.Results There were no significant differences in operation time, intraoperative blood loss, postoperative drainage volume and postoperative hospital stay between the two groups(P > 0.05).The preoperative blood calcium levels of the endoscopic group and the open group were (2.68±0.10) mmol/L and (2.63±0.16) mmol/L, respectively.The blood calcium levels on the first day after surgery were (2.39±0.12) mmol/L and (2.36±0.16) mmol/L, respectively.Preoperative parathyroid hormone(PTH) was 27.55(110.05,155.75)pg/ml in endoscopic group and 137.00(107.00,210.30)pg/ml in open group, respectively.PTH on the first day after surgery was 18.98(12.64,23.53)pg/ml and 13.85(7.36,23.23)pg/ml, respectively.Blood calcium and PTH in each group 1 day after surgery decreased compared with that before surgery, and the difference was statistically significant(P < 0.05).There were no postoperative complications such as hoarseness, bleeding and incision infection in both groups. Postoperative hand and foot numbness: 5 cases(20.8%) in endoscopic group and 8 patients(25.8%) in the open group, there was no significant difference between the two groups(P=0.667).There was no significant difference in the score of neck pain 3 days after surgery between the two groups(P > 0.05). The score of swallowing tension [(1.92±1.06) points compared with(2.77±1.38) points, P=0.015] and the score of anterior neck discomfort [(1.63±0.88) points compared with (2.35±1.33) points, P=0.018] in the endoscopic group one month after surgery were better than those in the open group.There was no significant difference in the score of neck scar scale between the two groups 3 months after surgery(P > 0.05). VAS score of incision satisfaction was (9.08±0.88) in endoscopic group and (8.19±1.30) in open group, and the endoscopic group was better than the open group, the difference was statistically significant (P=0.004).Conclusion For PHPT patients caused by unilateral parathyroid adenoma confirmed through preoperative localization examination,GTAES is a safe and effective surgical approach,which offers unique advantages in intraoperative lesion identification,cosmetic outcomes of the incision,and preservation of anterior neck function,providing a new surgical option for PHPT patients.

Objective To investigate the effects of miR-362-3p on the proliferation,migration and invasion of esophageal cancer EC9706 cells and its molecular mechanism.Methods The cancerous tissues and adjacent tissues of 30 patients with esophageal cancer from January 2018 to January 2020 were selected,and human normal esophageal epithelial cells HET-1A and esophageal cancer cells EC9706,TE10,KYSE-140,KYSE-150 were cultured in vitro.Real-time fluorescence quantitative PCR(RT-qPCR) was used to detect the expression levels of miR-362-3p and dual specificity phosphatase 10(DUSP10) mRNA in tissues and cells.EC9706 cells were divided into NC group(normally cultured),miR-NC group(transfected miR-362-3p mimic NC) and miR-362-3p group(transfected miR-362-3p mimic),si-NC group(transfected with DUSP10 siRNA NC),si-DUSP10 group(transfected with DUSP10 siRNA),miR-362-3p+pcDNA group(co-transfected with miR-362-3p mimic and pcDNA3.1-DUSP10 NC) and miR-362-3p+pcDNA-DUSP10 group(co-transfected with miR-362-3p mimic and pcDNA3.1-DUSP10).The expression levels of miR-362-3p and DUSP10 mRNA in each group were detected by RT-qPCR.Cell proliferation activity was detected by MTT assay.Cell migration and invasion were detected by Transwell assay.The expressions of DUSP10,CyclinD1,p21,matrix metalloproteinase(MMP)-2 and MMP-9 were detected by Western blot.Dual luciferase reporter gene assay was used to detect the targeting relationship between miR-362-3p and DUSP10.Results The expression of miR-362-3p was high and DUSP10 was low in esophageal cancer tissues and cells.Overexpression of miR-362-3p or knockdown of DUSP10 expression significantly reduced the activity,migration and invasion number and the expression of CyclinD1,MMP-2 and MMP-9,and significantly increased the expression of p21 in EC9706 cells(P<0.05).miR-362-3p targeted the expression of DUSP10(P<0.05).And up-regulation of DUSP10 expression partially reversed the effects of overexpression of miR-362-3p on the proliferation,migration and invasion of EC9706 cells(P<0.05).Conclusion miR-362-3p can inhibit the proliferation,migration and invasion of EC9706 cells by down-regulating the expression of DUSP10.

ObjectiveTo investigate the influencing factors of postoperative complications with Clavien-Dindo grade ≥Ⅲ in elderly patients with esophageal cancer and construct a line graph prediction model.Methods 376 esophageal cancer patients who underwent radical esophagectomy in our hospital from January 2021 to December 2022 were selected as the study subjects.According to the Claven Mindo surgical complication grading system,the groups were divided into two groups:Clavien Mindo grading ≥ Grade Ⅲ group (93 cases) and Clavien Mindo gradingLogistic regression were used to analyze the influencing factors of postoperative complications of esophageal cancer with Clavien-Dindo grade ≥Ⅲ,and establish a risk prediction column chart model using R 3.5.1 software; The discrimination and calibration of the area verification model under the ROC curve; Use calibration curves and Hosmer Lemeshoe goodness of fit tests to evaluate the fit of the column chart model.Results 376 patients with esophageal cancer,93 patients with Clavien-Dindo grade ≥Ⅲ had complications,accounting for 24.73%.The results of univariate analysis showed that chronic respiratory disease,intraoperative blood loss,surgical time,ASA grading,prognostic nutritional index,and Charlson comorbidities index were significantly correlated with postoperative complications in elderly esophageal cancer patients with Clavien Dundo grading ≥ grade Ⅲ (P<0.05).The results of the logistic multiple regression model showed that intraoperative bleeding volume,surgical time,ASA grading,prognostic nutritional index,and Charlson Comorbidity Index were independent risk factors for postoperative complications in elderly esophageal cancer patients with Clavien Dundo grading ≥ grade Ⅲ (all P<0.05)，Based on five variables,a nomogram prediction model for postoperative complications in elderly patients with esophageal cancer with Clavien-Dindo grade ≥Ⅲ was constructed.ROC curve analysis verified that the area under ROC curve was 0.835 (0.794~0.876),indicating a good differentiation of the model.The calibration curve is drawn.The slope of the calibration curve is close to 1,and the predicted probability is basically consistent with the actual probability.Hosmer-Lemeshow goodness of fit test,χ²=5.737,df=8,P=0.676.The analysis results of decision curve show that the threshold probability is less than 0.8 and the net benefit rate is greater than 0.Conclusion The prediction model based on 5 independent risks can reliably predict the probability of postoperative complications with Clavien-Dindo grade ≥Ⅲ,which is helpful to provide targeted preventive measures for high-risk patients and reduce the occurrence of complications with Clavien-Dindo grade ≥Ⅲ.

Objective To investigate the expression of Excision repair cross-complementation group 6-like(ERCC6L) in non-small cell lung cancer(NSCLC),and evaluate its prognostic value.Methods From September 2016 to 2019, 144 cases of NSCLC tissues and adjacent tissues (non-tumor tissues at least 5cm away from cancerous tissues) were admitted.The expression of ERCC6L protein in NSCLC tissues and their adjacent tissues were detected using immunohistochemistry(IHC) method.The clinicopathological data of patients with high and low expression of ERCC6L were compared,and the Kaplan-Meier curves and Cox proportional hazards regression model were used to evaluate the relationship between ERCC6L expression and overall survival(OS) of NSCLC patients.Results The data of IHC staining showed that high expression of ERCC6L was detected in 42.4%(61/144) of NSCLC tissues,which was higher than in their adjacent tissues(37.7,%,37/144)(χ²=8.909,P<0.05).High expression of ERCC6L was frequently detected in poorly differentiated carcinoma(χ²=38.660,P<0.001),T2/T3 stage(χ²=6.528,P=0.011) and TNM stage Ⅲ(χ²=12.522,P<0.05).In addition,patients with high expression of ERCC6L had higher rates of lymph node metastasis(χ²=5.802,P<0.05),lymphovascular invasion(χ²=29.899,P<0.05) and pleural invasion(χ²=7.942,P<0.05) than those with low expression(P<0.05).Survival analysis revealed that patients with high expression of ERCC6L had a worse prognosis than those with low expression,and the 5-year overall survival(OS) rate of two patient groups was 44.8% and 70.5%,respectively(χ²= 15.919,P<0.05).Univariate and multivariate Cox regression analysis demonstrated that high expression of ERCC6L(HR=2.106,95%CI=1.087-4.079,P<0.05) was an independent prognostic factor for NSCLC patients.Conclusion High expression of ERCC6L is closely correlated to tumor aggressive features,and it might be a valuable prognostic biomarker for NSCLC patients.

Objective To investigate the expression of PROM2,RALY and Rab15 in non-small cell lung cancer (NSCLC) and the predictive value for the development of bone metastasis in NSCLC.Methods One hundred and thirty four patients diagnosed with NSCLC in our hospital from Mar 2016 to Feb 2022 were retrospectively analyzed.Patients were divided into bone metastasis (BM) and non-bone metastasis (NBM) groups based on the occurrence of bone metastasis during follow-up.Immunohistochemistry was used to detect the expression of PROM2,RALY,and Rab15 in cancer tissues.The relationship between the expression of these markers and bone metastasis was analyzed,and Cox regression was used to identify risk factors for bone metastasis in NSCLC patients.Results During the follow-up period,43 patients with NSCLC developed bone metastases.Patients with bone metastases had higher age,BMI,percentage of adenocarcinoma,and positive expression of PROM2,RALY and Rab15 than those without bone metastases (P<0.05).Multifactorial Cox analysis showed that age,type of pathology,ECOG, and the positive PROM2 expression were significant risk factors for bone metastases in NSCLC patients(P<0.05).Among patients with bone metastases,those with positive PROM2 expression had a shorter median bone metastasis-free survival time compared to PROM2-negative patients (P<0.05).Conclusion PROM2 positive expression is an independent risk factor for bone metastasis in NSCLC patients,and is closely related to their prognosis.

Objective To explore the effects of ultrasound-guided intercostal nerve block(INB) and thoracic paravertebral nerve block(TPVB) on the dosage of anesthetics and the efficacy of analgesia in video-assisted thoracoscopic lobectomy.Methods From October 2019 to October 2023,90 patients undergoing video-assisted thoracoscopic lobectomy at the People's Hospital of Tongling City,Anhui,were selected.They were divided into the INB group(42 cases) and the TPVB group(48 cases).The INB group received ultrasound-guided intercostal nerve block,while the TPVB group was administered ultrasound-guided thoracic paravertebral nerve block.The two groups were compared before anesthesia induction (T0), 15 minutes of anesthesia (T1), 30 minutes of anesthesia (T2), 45 minutes of anesthesia (T3), and after extubation (T4), vital signs, anesthetic dosage, analgesic effect, pain stress index and adverse reactions.Results In the TPVB group,systolic blood pressure (SBP) of T1, T2, T3 and T4 were (115.88±9.29) mmHg, (113.58±9.72) mmHg, (117.33±9.17) mmHg and (121.15±10.51) mmHg, respectively;diastolic blood pressure (DBP) were (86.74±7.35) mmHg, (90.83±8.82) mmHg, (90.83±8.82) mmHg and (91.05±8.73) mmHg, respectively;Heart rate (HR) were (79.94± 7.46)times/min, (81.97±7.28)times/min, (82.36±7.41)times/min and (85.83±8.32) times/min, respectively.Which were all higher than the INB group[ (103.53±8.28) mmHg, (105.40±8.66) mmHg, (109.03±8.13) mmHg, (114.64±9.65) mmHg. (77.68±6.57) mmHg, (79.27±6.69) mmHg, (83.21±7.37) mmHg, (85.83±8.21) mmHg, (71.17±6.21) times/min, (75.18±6.47) times/min, (74.82±6.12) times/min and (79.35±7.12) times/min,respectively], there were statistical significance between the two groups (P<0.05).Postoperatively,the TPVB group had lower 24-hour sufentanil consumption[(27.68±2.64) μg] and fewer presses of the analgesia pump[(5.16±0.38) times] compared to the INB group[(36.22±3.36) μg and (6.87±0.42) times,(P<0.05)].Visual analogue scale(VAS) scores for pain at rest and during coughing at 2,24,and 48 hours in group TPVB were 2.44±0.27,3.55±0.42,2.81±0.34 and 3.36±0.23,4.13±0.33,3.80±0.25,respectively,which were also lower than the INB group(2.83±0.44,3.98±0.55,3.33±0.46 and 3.87±0.30,4.59±0.47,4.17±0.29,respectively)(P<0.05).Levels of prostaglandin E2(PGE2)(1.53±0.28 μg/L),norepinephrine(NE)(362.25±33.85 ng/L),and cortisol(Cor)(278.72±25.13 ng/L) in the TPVB group were lower than those in the INB group(2.71±0.32 μg/L,425.67±38.37 ng/L,315.68±29.21 ng/L)(P<0.05).Adverse reactions such as nausea and vomiting,and dizziness were less frequent in the TPVB group [1(2.1%),1(2.1%)] compared to the INB group [6(12.5%),5(10.4%)](P<0.05).Conclusion Ultrasound-guided thoracic paravertebral nerve block is superior to intercostal nerve block in terms of anesthetic dosage and analgesic efficacy in video-assisted thoracoscopic lobectomy.

Objective To investigate the effects of paravertebral nerve block(PVNB) under thoracoscopic direct vision on postoperative pain,stress response and T lymphocyte subsets in patients undergoing thoracoscopic lobectomy under general anesthesia.Methods A total of 104 patients who were scheduled to undergo thoracoscopic lobectomy in the hospital from January 2021 to August 2023 were enrolled in this study.They were divided into the control group(52 cases) and the observation group(52 cases) using the random number table.The control group was given general anesthesia,and the observation group was given PVNB on the basis of general anesthesia.Both groups received patient-controlled intravenous analgesia(PCIA) after surgery.Visual analogue pain (VAS) scores were recorded 1 hour (T₁), 6 hours (T₂), 12 hours (T₃), 24 hours (T₄) and 48 hours (T₅) after surgery in both groups.The drug use for PCIA,postoperative stress response,changes in T lymphocyte subsets,and incidence rates of adverse reactions in the two groups were analyzed.Results From T₁ to T₅,VAS scores of the two groups increased firstly and then decreased.From T₁ to T₄,VAS scores of the observation group were lower than those of the control group(P<0.05).The first pressing time of PCIA in the observation group [(11.18±3.29) h] was longer than that in the control group [(9.61±2.48) h].The pressing times of PCIA and dosage of sufentanil [(4.63±1.51) times and(46.29±6.24) ml] were lower than those in the control group [(7.22±1.86) times and(55.41±7.88) ml](P<0.05).At 24 h after surgery,the levels of cortisol,norepinephrine and blood glucose in the observation group [(252.27±19.75) ng/ml,(346.63±25.06) ng/ml and(5.48±0.72) mmol/L] were lower than those in the control group [(275.78±21.46) ng/ml,(381.71±23.71) ng/ml and(6.03±0.64) mmol/L](P<0.05).The levels of CD3⁺,CD4⁺,CD8⁺ T lymphocyte count and CD4⁺/CD8⁺ T lymphocyte count in the observation group [(0.57±0.05)×10⁹/L,(0.39±0.04)×10⁹/L,(0.26±0.02)×10⁹/L and (1.50±0.35)] were higher than those in the control group[（0.55±0.05）×10⁹/L,（0.36±0.03）×10⁹/L,（0.29±0.04）×10⁹/L and （1.24±0.31）](P<0.05).The incidence rates of adverse reactions in the two groups were 1.92% and 2.77%,without statistically significant difference between groups(P＞0.05).Conclusion Applying PVTB under thoracoscopic direct vision to patients undergoing thoracoscopic lobectomy under general anesthesia is beneficial for reducing postoperative pain,stress response,and the influence on immune system.

Objective To explore the new mechanism of Escin inhibiting the progression of breast cancer cells.Methods Escin treatment groups with different concentrations (0,10,20,30,40 μg/ml) were set up, and BC cells were treated with corresponding concentrations of Escin,then CCK8, clonal formation, flow cytometry, transmission electron microscopy and protein immunoblotting were used to evaluate the cell phenotype and possible mechanisms.Control group, Escin group and Escin+VX-765 group were set up,to determine the role of Caspase-1/GSDMD signaling pathway in Escin-induced pyroptosis of BC cells, cells were pretreated with Caspase-1 inhibitor VX-765.The cells in control group, Escin group and Escin+NAC group were pretreated with the reactive oxygen species (ROS) scavher N-Acetylcysteine (NAC),to determine the role of ROS in Escin induced pyroptosis of BC cells.Results Compared with the control group,different concentrations of Escin inhibited the proliferation and colony formation of BC cells in a concentration dependent manner (P<0.05).Compared with the control group,the ROS and pyroptosis rate were increased in Escin-treated group (P<0.05).The protein expression levels of FL-GSDMD and pro-Caspase-1 were significantly decreased in the Escin-treated group,while N-GSDMD,cleaved Caspase-1 and IL-18 protein expression were significantly increased (P<0.05).Compared with the Escin-treated group,the proliferation rate of Escin+VX-765 group was increased (P<0.05),and the expression of pyroptosis protein was decreased (P<0.05).Compared with the Escin-treated group,the proliferation rate of Escin+NAC group was increased (P<0.05),and the ROS,pyroptosis rate and pyroptosis protein expression were decreased (P<0.05).Conclusion The inhibitory effect of Escin on the progression of breast cancer cells may be related to its regulation of ROS/Caspase-1/GSDMD signaling pathway to promote cell pyroptosis.

Objective To explore the clinical application effects of Chen's pancreatojejunostomy in laparoscopic pancreaticoduodenectomy.Methods Clinical data of 176 patients who underwent laparoscopic pancreaticoduodenectomy in Xiangyang Central Hospital from January 2019 to December 2024 were retrospectively analyzed.According to the methods of intraoperative pancreatojejunostomy,the patients were divided into two groups,the research group(102 cases) using Chen's pancreatojejunostomy,and the control group(74 cases) using duct-to-mucosa pancreatojejunostomy.The two groups were compared on clinical indicators,including operation time,pancreatojejunostomy time,intraoperative blood loss,incidence of postoperative complications,length of hospital stay,and 30-day postoperative mortality rate.Results All 176 patients successfully underwent laparoscopic pancreaticoduodenectomy.There were no statistically significant differences between the two groups in intraoperative blood loss,biochemical leakage,abdominal bleeding,upper gastrointestinal bleeding,delayed gastric emptying,bile leakage,abdominal infection,and 30-day postoperative mortality rate(P>0.05).The pancreatojejunostomy time[(22.33±5.95)min] and operation time[(334.60±66.42)min] in the study group were significantly shorter than those in the control group[(30.70±5.50)min] and [(414.46±60.96)min],with statistically significant differences(P<0.05).Two groups of patients did not develop grade C pancreatic fistula.The incidence of grade B pancreatic fistula in the study group(5.88%) was significantly lower compared to the control group(16.22%),and this difference was statistically significant(P<0.05).Additionally,The postoperative hospital stay of the study group patients[(17.10±6.89)days] was significantly shorter than in the control group[(20.88±8.40)days],with a statistically significant difference(P<0.05).Conclusion Chen's pancreatojejunostomy is a feasible,safe,and effective procedure in laparoscopic pancreaticoduodenectomy,which can shorten the pancreatojejunostomy time,reduce the incidence of postoperative pancreatic fistula,and decrease the length of hospital stay.

Objective To investigate the clinical efficacy of wrapping the hepatic artery with the hepatogastric ligament for preventing bleeding of the hepatic artery and its branches following pancreaticoduodenectomy(PD).Methods 194 patients who underwent PD in Xiangyang Central Hospital from January 2017 to November 2024 were enrolled and categorized into two groups based on whether the hepatic artery was enwrapped with the hepatogastric ligament during the operation.The wrapped group consisted of 95 cases where the hepatic artery was wrapped,while the non-wrapped group had 99 cases without such wrapping.Intraoperative parameters(intraoperative blood loss and operative time) and postoperative complications(pancreatic fistula,abdominal cavity infection,biliary fistula,delayed gastric emptying,postoperative bleeding,and bleeding of the hepatic artery and its branches) were compared between the two cohorts.Univariate and multivariate Logistic regression analyses were conducted to identify the independent risk factors for postoperative bleeding.Results PD was accomplished successfully in both groups.There was no remarkable difference in intraoperative indices like blood loss and operative time between the two groups(P>0.05).Similarly,no significant disparities were noted in postoperative complications such as pancreatic fistula,abdominal infection,biliary fistula,and delayed gastric emptying(P>0.05).Nevertheless,the incidence of postoperative bleeding in the wrapped group was lower than that in the non-wrapped group(3.16% vs. 12.12%,P=0.019),and the incidence of bleeding of the hepatic artery and its branches after surgery was also significantly decreased in the wrapped group(0 vs. 10.10%,P=0.004).Logistic regression analysis revealed that the operation time (OR=1.013,P=0.011), pancreatic fistula (OR=9.006,P=0.006) and celiac infection (OR=7.930,P=0.014) are independent risk factors of postoperative bleeding, Hepatogastric ligament encapsulation of hepatic artery was an independent protective factor for postoperative hemorrhage of PD (OR=0.084,P=0.006).Conclusion Wrapping the hepatic artery with the hepatogastric ligament reduces PD postoperative bleeding,especially that of the hepatic artery and its branches,without adding other complications.

Objective To evaluate the safety and feasibility of primary endoscopic retrograde cholangiopancreatolithiasis (ERCP) plus laparoscopic cholecystectomy (LC) in patients with choledocholithiasis combined with cholecystolithiasis.Methods From January 2023 to August 2024,185 patients with common bile duct stones combined with gallbladder stones were treated at our hospital.Patients who underwent ERCP+LC during the same surgical period were assigned to Group A(94 patients),and those who underwent LC+ERCP in separate sessions during the same hospital stay were assigned to Group B(91 patients).The gender,age,total hospitalization costs,number and size of stones,whether a drainage tube was left in place,intraoperative blood loss,duration of anesthesia,time to postoperative bowel gas passage,length of hospital stay,incidence of postoperative cholangitis,incidence of postoperative pancreatitis(PEP),rate of residual stones in the bile ducts,and changes in preoperative and postoperative neutrophils,neutrophil percentage,total serum bilirubin,indirect serum bilirubin,alanine aminotransferase,aspartate aminotransferase,and γ-glutamyl transferase were recorded for both groups of patients.Results Compared to Group B[(9.7±2.0)d],the hospital stay duration for patients in Group A[(8.6±2.6)d] was significantly reduced(P<0.05).The duration of anesthesia for patients in Group A[(2.5±0.8)h] was also significantly shorter than that for Group B[(3.7±0.5)h],with a statistically significant difference(P<0.05).Similarly,the total hospitalization costs for patients in Group A[(23969±7421)yuan] were lower than those for Group B[(25427±5236)yuan],and this difference was statistically significant(P<0.05).Conclusion The one-stage ERCP combined with LC treatment protocol for common bile duct stones with gallbladder stones is safe and feasible,with the potential advantages of reducing hospital stay,costs,and duration of anesthesia.

Objective To explore the analgesic effect of low-dose ketamine combined with remifentanil after laparoscopic cholecystectomy(LC).Methods This study was a prospective study.A total of 114 patients who underwent LC in hospital from June 2022 to June 2023 were selected and randomly divided into two groups by computer-generated random number table method:low-dose group and conventional-dose group,with 57 cases in each group,they were treated with esketamine 0.5 and 1 mg/kg combined with remifentanil for patient controlled intravenous analgesia(PCIA),respectively.The PCIA press times,the pain after surgery,adverse reactions were compared between the two groups.Results The comparison of PCIA press times,the visual analogue scale(VAS) pain scores at 2,8,12,24,and 48 hours after surgery between the low-dose group and the conventional-dose group [(3.16±0.63)times vs(3.14±0.65)times,(2.65±0.67) vs(2.63±0.69),(3.01±0.56) vs(3.05±0.70),(3.58±0.67) vs(3.60±0.69),(2.93±0.37) vs(2.95±0.30),(2.04±0.52) vs(2.06±0.59)] showed no statistically significant difference(P>0.05).The incidence of hallucinations and increased heart rate in the low-dose group was lower than that in the conventional-dose group(0 vs 10.53%,1.75% vs 14.04%)(P＜0.05).Conclusion The analgesic effect of small dose esketamine combined with remifentanil after LC are comparable to those of conventional dose,but the former is safer.

Objective To explore the influence of different doses of remimazolam for general anesthesia induction on tracheal intubation stress response and hemodynamics in patients undergoing radical resection of colon cancer.Methods From August 2020 to August 2023, 75 patients undergoing radical resection of colon cancer were induced by general anesthesia using remazolam.According to the random number table method,they were divided into group A (25 cases,0.2 mg/kg of remimazolam),group B (25 cases,0.3 mg/kg of remimazolam) and group C (25 cases,0.4 mg/kg of remimazolam).The stress response status [cortisol (Cor),epinephrine (E),norepinephrine (NE)] and hemodynamics [heart rate (HR),mean arterial pressure (MAP)] before anesthesia (T0),at tracheal intubation (T1),at 30 min after intubation (T2) and at 10 min after extubation (T3),anesthesia recovery status and total incidence rate of adverse anesthesia reactions were compared among the three groups.Results At T0,there were no obvious differences in the levels of Cor,E,NE,HR,SVI and MAP among the three groups (P>0.05).At T1-T3,the levels of Cor,E and NE in group A [T1:(181.76±12.49) pg/ml,(67.94±2.66) ng/ml,(355.12±19.82) ng/ml;(231.90±15.82) pg/ml,(72.15±2.83) ng/ml,(379.86±20.31) ng/ml;T3:(300.65±17.43) pg/ml,(77.82±2.85) ng/ml,(405.31±24.36) ng/ml] were higher than those in group B [T1:(172.31±12.07) pg/ml,(66.22±2.73) ng/ml,(326.47±19.24) ng/ml;T2:(214.75±14.88) pg/ml,(70.34±2.79) ng/ml,(354.18±20.66) ng/ml;T3:(279.08±16.62) pg/ml,(75.03±2.81) ng/ml,(387.05±22.82) ng/ml] and group C [T1:(165.44±11.74) pg/ml,(64.01±2.75) ng/ml,(300.66±19.50) ng/ml;T2:(200.42±14.35) pg/ml,(67.59±2.80) ng/ml,(330.18±21.05) ng/ml;T3:(251.33±16.08) pg/ml,(72.44±2.70) ng/ml,(354.11±22.07) ng/ml] (P＜0.05).At T1-T2,the HR and MAP were higher in group A [T1:(79.49±4.05) beats/min,(96.09±1.77) mmHg;T2:(76.55±3.83) beats/min,(94.88±1.55) mmHg] than those in group B [T1:(76.22±3.89) beats/min,(95.01±1.63) mmHg;T2:(74.23±3.76) beats/min,(93.89±1.51) mmHg] and group C [T1:(73.65±3.81) beats/min,(94.02±1.61) mmHg;T2:(71.55±3.61) beats/min,(92.97±1.46) mmHg] (P＜0.05).There were no significant differences in HR and MAP among the three groups at T3 (P>0.05).The time of breathing recovery,open eye and extubation in group C was significantly longer compared with that in group A and group B (P＜0.05).There were no significant difference in total incidence rate of anesthesia adverse reactions between group B and group A,group C(P>0.05).Conclusion 0.3 mg/kg remimazolam in patients undergoing radical resection of colon cancer has an ideal sedative effect,and it has small impact on stress response and hemodynamics,and has fast postoperative recovery and high safety.

Objective To explore the characteristics and influencing factors of complicated intra-abdominal infection in ICU patients after abdominal surgery.Methods A retrospective study was performed on ICU patients (n=92,observation group) developing complicated intra-abdominal infection after abdominal surgery versus patients (n=104,control group) without complicated intra-abdominal infection after abdominal surgery in our hospital from January 2020 to December 2023.The characteristics of patients who developed complicated intra-abdominal infections were analyzed and the relevant influencing factors were identified using multivariate Logistic regression analysis.Results A total of 124 strains of pathogenic bacteria were isolated and identified in 92 infected patients,with 64.52% (80/124) of Gram-negative strains comprising mainly 29.03%(36/124) of Escherichia coli,25.81% (32/124) of Gram-positive strains comprising mainly 12.90% (16/124) of Enterococcus faecalis,and 9.68% (12/124) of fungi comprising mainly 6.45% (8/124) of Candida albicans.Multivariate Logistic regression results showed that preoperative underlying disease,surgical methods,duration of surgery,invasive procedures ,antibiotic use,and length of ICU stay,enteral nutrition were the influencing factors of complicated intra-abdominal infection in ICU patients after abdominal surgery (P<0.05).Conclusion Patients with complicated intra-abdominal infection are infected with a variety of pathogenic bacteria,predominantly Gram-negative.The patient's preoperative underlying disease,surgical approach,duration of surgery,invasive procedures,use of antibiotics,length of ICU stay,and early enteral nutrition all affect the risk of complicated intra-abdominal infection in ICU patients after abdominal surgery.

Objective To explore the effects of different grinding amounts of articular processes on the biomechanical stability and inflammatory response of lumbar spine during percutaneous foraminoscopic surgery (PTED).Methods A total of 195 patients with lumbar disc herniation (LDH) in our hospital were selected for prospective study from January 2018 to October 2020,and they were divided into three groups by randomized numerical table method,each with 65 cases,and all of them were implemented PTED.Patients with intraoperative upper joint process grinding < 33% were treated as a small group,patients with intraoperative grinding < 33%~50% were treated as a medium group,and patients with > 50% were treated as a large group.The surgery-related indexes of the three groups of patients were observed,as well as the inflammatory indexes [interleukin-6 (IL-6),tumor necrosis factor-alpha (TNF-α)],biomechanical stability,and joint functional recovery scores at different time points before and after surgery.Results The operation time and intraoperative bleeding were (61.32±7.86) min and (11.85±1.10) ml in the small group,(70.06±8.53) min and (14.32±2.21) ml in the medium group,and (74.47±10.00) min and (19.86±3.00) ml in the large group,and the differences among the three groups were statistically significant (P<0.05).Serum IL-6 and TNF-α were (6.10±1.12) pg/ml and (8.21±1.87) ng/L in the small group 3d postoperatively,and (3.27±0.58) pg/ml and (4.32±1.00) ng/L in the discharge group,and in the medium group 3d postoperatively,they were (6.68±1.35) pg/ml and (9.00±1.20) ng/L at discharge and (4.10±0.63) pg/ml and (6.85±1.28) ng/L at discharge,respectively,and (7.32±1.00) pg/ml and (10.57±1.28) ng/L in the massive group at 3d postoperatively and (4.57±0.49) pg/ml and (8.14±1.35) ng/L at discharge,and the difference between the three groups was statistically significant (P<0.05);the serum lumbar lordosis angle,lumbar flexion,and lumbar stability scores were (42.28±2.12)°,(1.86±0.36)cm,and (10.52±2.01)° at 1 month postoperatively,and (42.11±1.97)°,(1.87±0.52)cm,and (10.63±1.96)° at 1 year postoperatively,respectively,for the small group，and (40.86±1.89)°,(1.72±0.28)cm,(10.63±2.15) scores,(39.15±2.11)°,(1.60±0.42)cm,(12.11±1.63) scores for the medium group,respectively,1 month postoperatively in the large volume group,(39.01±2.35)°,(1.61±0.29) cm,(11.20±2.75) scores,and (38.11±2.32)°,(1.43±0.33) cm,(13.24±1.52) scores at 1 year postoperatively,respectively,and the difference between the three groups were statistically significant (P<0.05).Conclusion PTED treatment of LDH can reduce the amount of grinding of the superior articular process during surgery,reduce operative time and intraoperative bleeding,alleviate inflammatory response,and achieve good short- and medium-term lumbar function and joint stability.

Objective To assess the efficacy of the oblique lateral approach with percutaneous pedicle screw fixation for treating lumbar spinal tuberculosis and compare it with conventional posterior surgery.Methods A retrospective study analyzed 29 patients treated for lumbar spinal tuberculosis in our hospital from January 2020 to October 2022.They were divided into two groups according to different treatment methods,the observational group (18 case) underwent oblique lateral lesion clearance,bone graft fusion,and posterior percutaneous pedicle screw fixation,while the control group (11 case) received conventional posterior lesion clearance,bone graft fusion,and internal fixation surgery.The operative time and intraoperative blood loss were compared between the two groups.Operation time and intraoperative blood loss were compared between the two groups,the healing of tuberculosis foci, ASIA grade, intervertebral bone graft fusion, VAS score, ODI score, Cobb Angle and complications were recorded in the two groups,follow-up was 12 months.Results There was no statistically significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). All patients' tuberculosis foci healed, and the neurological function ASIA classification was E level, with an intervertebral bone graft fusion rate of 100%. The VAS scores of the observation group and the control group at 3 days, 3 months, and 12 months after surgery were (3.79 ± 0.57) ° vs (4.27±0.61) °, (0.95±0.43) ° vs (1.44±0.42) °, (0.53±0.20) ° vs (0.76±0.19) °, respectively, and the difference between the two groups was statistically significant (P<0.05). The ODI scores of the observation group and the control group at 3 days, 3 months, and 12 months after surgery were (29.94±2.84) ° vs (31.36±2.58) °, (8.94±1.98) ° vs (11.27±2.19) °, (9.28±2.52) ° vs (12.72±1.90) °, respectively, and the difference between the two groups was statistically significant (P<0.05). The Cobb angles of the observation group and the control group at 3 days, 3 months, and 12 months after surgery were (41.82±2.35) ° vs (41.5±2.72) °, (41.28±1.67) ° vs (41.18±1.60) °, (39.33 ±3.52) ° vs (38.46±2.75) °, respectively, and the difference between the two groups was not statistically significant(P＞0.05）.Conclusion Both surgical techniques can promote the healing of tuberculosis lesions and bone graft fusion. The oblique lateral approach combined with percutaneous pedicle screw fixation has the advantages of minimal invasiveness and better functional recovery.

Objective To explore the effect of the preservation of infrapatellar fat pad on pain,incision healing and function recovery in patients with knee osteoarthritis after joint replacement.Methods The clinical data of 127 patients with knee osteoarthritis who underwent joint replacement in the hospital from June 2019 to September 2022 were retrospectively collected.According to the preservation of infrapatellar fat pad,the subjects were divided into a control group (removing infrapatellar fat pad,67 cases) and an observation group (preserving infrapatellar fat pad,60 cases).The changes in length of patellar tendon,pain,knee function and range of motion were analyzed.The occurrence of adverse reactions was statistically analyzed.Results At 12 months after surgery,the length of patellar tendon was reduced.The length of patellar tendon in observation group [(38.8±6.24) mm] was longer than that in control group [(36.2±6.71) mm] (P＜0.05).Observation group of patellar tendon length rate is lower than the control group [(4.1±1.18)% vs (10.7±3.01)%],there was statistical significance between the two groups(P< 0.05).Pain in both groups was alleviated at 1 month,3 months,6 months and 12 months after surgery.The changes in observation group were greater than those in control group (P＜0.05).During follow-up,the incidence of adverse reactions in observation group (6.67%) was lower than that in control group (14.93%) (P>0.05).The range of motion and function of knee joint were improved at 12 months after surgery,and the improvement in observation group was greater than that in control group (P＜0.05).Conclusion Preserving infrapatellar fat pad is more beneficial to relieving postoperative pain and restoring knee function in patients with knee osteoarthritis after joint replacement.Therefore,the intact infrapatellar fat pad should be preserved as possible in clinical practice.

Objective To compare the clinical effects of improved rivet double pulley fixation method and traditional Kirschner wire tension band in the treatment of patellar lower pole fractures.Methods 78 patients with patellar inferior pole fractures who underwent surgery in our department between January 2020 and January 2024 and met the inclusion criteria were collected.Divided into two groups according to different fixing methods,the observation group(39 cases) were fixed by modified rivet double pulley,the control group(39 cases) were fixed by steel wire tension band.The operation time, hospital stay, medical expenses, knee motion of the two groups at 1.5 months, 3 months and 6 months after surgery, and knee lyshom function score at 3 months and 6 months after surgery were compared between the two groups.Results The observation group had a surgery time of (62.58±6.37) minutes compared to the control group [(60.20±11.18) minutes],and the observation group had a hospital stay of (6.45±1.35) days compared to the control group[(6.40±1.30) days].There was no significant difference in surgical time and hospitalization time between the two group (P>0.05).The total medical expenses of the observation group were significantly lower than those of the control group (P<0.05).Knee joint activity in observation group was higher than that in control group at 1.5 months, 3 months and 6 months after surgery (P<0.05), and knee lyshom function scores in observation group at 3 months and 6 months after surgery were significantly higher than those in control group (P<0.05).Conclusion Compared with Kirschner wire tension band fixation for the treatment of patellar lower pole fractures,the improved riveting double pulley surgery does not require secondary surgery to remove internal fixation,resulting in lower overall medical costs,better postoperative knee joint mobility,and better postoperative knee joint function scores.The improved riveting double pulley surgery has more advantages in treating patellar lower pole fractures compared to traditional Kirschner wire tension band fixation.

At present,breast cancer is still the first place in the global incidence and mortality of female cancer.Searching for reliable biological markers plays an extremely important role in clarifying the early diagnosis of breast cancer and improving the long-term survival rate and prognosis of breast cancer patients.In recent years,long non-coding RNA HOTAIR(LncRNA HOTAIR) is still the focus of research by many scholars,and HOTAIR is closely related to the occurrence and development of a variety of malignant tumors.The expression of HOTAIR is particularly obvious in breast cancer patients.More and more studies have shown that HOTAIR is highly expressed in both peripheral blood and breast cancer tissues of breast cancer patients,and is closely related to the proliferation,metastasis and drug resistance of breast cancer.HOTAIR may become an important biomarker for the early diagnosis of breast cancer and a target for breast cancer treatment.

Hepatocellular carcinoma (HCC) primarily relies on surgical resection for curative treatment,but the high recurrence rate after surgery is a pressing issue that needs to be addressed.Neoadjuvant immunotherapy,represented by immune checkpoint inhibitors (ICIs),has the potential to reduce postoperative recurrence,increase the rate of radical resection,and prolong survival time.The combination of ICIs with other treatments is gradually becoming a hot area in clinical research for liver cancer.