Objective To investigate the survival rate and filling effect of autologous fat granules treated at 4 ℃.
Methods From January 2018 to April 2019,100 patients who were selected for frontotemporal autologous fat filling surgery were randomly divided into two groups:Group Ⅰ(normal temperature group,n=50):The extracted autologous fat was washed,purified with normal temperature saline and stored at normal temperature.Group Ⅱ(cryogenic group,n=50):The extracted autologous fat was washed,purified and cryopreserved with 4 ℃ cryogenic saline,and then the purified autologous fat was filled in frontotemporal region.Patients were interviewed and the filling effect was evaluated at 1,3 and 6 months after surgery.
Results After autologous fat filling,the total satisfaction rate of the surgeon to the two group patients at different times gradually decreased(100%,94%,86%;100%,98%,94%),but there was no significant difference between the two groups(P＜0.05).The number of dissatisfied patients in group Ⅰ at six months after surgery(32%) was significantly more than that at one month after surgery(6%),and it was also significantly more than that in group Ⅱ at six months after surgery(10%)(P＜0.05);The time of redness and swelling in group Ⅰ[(68.4±10.2)h] was significantly longer than that in group Ⅱ[(52.6±8.9)h].The number of patients in group Ⅰ(28%) who required secondary filling after autologous fat filling was also significantly higher than that in group Ⅱ(6%)(P＜0.05).However,there was no significant difference in the number of patients with postoperative complications between the two groups(P>0.05).
Conclusion Autologous fat which was washed,purified and stored at 4 ℃ low temperature is more tolerant to anoxia injury and improve filling effect.

Objective To compare the therapeutic effect of silver ion antibacterial dressing and povidone iodine gauze on the incision and drainage of the abscess.
Methods From March 2019 to November 2019,62 patients were included in this study,and divided randomly into the observation group and the control group with 31 cases in each group.The patients in the observation group were treated with silver ion antibacterial dressing,while the patients in the control group were treated with povidone iodine gauze.The patients in the two groups were recorded in detail.The infection control time of abscess incision was compared before treatment,the third day and the second week after the first treatment,the number of dressing changes and wound healing time of the two groups,and the clinical effect of the patients was evaluated.
Results .The time of wound control in the observation group was (13.9±1.81)d,shorter than that in the control group (23.4±2.32)d(P<0.05);the BWATBWAT(Bates-Jensen Wound  assessment tool，BWAT) score of the observation group in the second week after the first treatment was (14.98±1.51),lower than that in the control group (19.78±2.46)(P<0.05);the times of drug change and wound healing in the Observation group were significantly shorter than that in the control group(P<0.05).
Conclusion Compared with the traditional povidone iodine gauze,the silver ion antibacterial dressing can control the wound infection and improve the wound healing more quickly,and the dressing change times are less,the wound healing time is obviously shortened.

Objective To investigate the correlation between carotid endarterectomy(CEA) and blood pressure changes in patients with severe carotid stenosis.
Method 60 patients with severe carotid stenosis and hypertension who underwent CEA were selected as the experimental group;20 patients with severe carotid stenosis and hypertension who did not receive the CEA and receive conservative treatment were the control group.The DSA(digital subtraction angiography) confirmed the existence of unilateral carotid artery single severe stenosis and no other causes of hypertension.Based on the degree of carotid ar-tery stenosis,the experimental group was divided into the first group(70%～79% of unilateral carotid artery stenosis,n=20);the second group(80%～89% of unilateral carotid artery stenosis,n=20);the third group(90%～99% of unilateral carotid artery stenosis,n=20);the control group was the fourth group(70%～99% of unilateral carotid artery stenosis,n=20).Blood pressure was measured in 1 week before surgery，1 week after surgery，1 month after surgery，the 6 month after surgery in all four groups.Blood pressure changes were compared between the four groups.
Results  After the CEA,the blood pressure of the patients decreased significantly,the range of blood pressure decreased:the third group > the second group > the first group(P1∶2<0.05;P2∶3<0.01;P1∶3<0.001).
Conclusion CEA can significantly reduce the blood pressure in hypertensive patients with unilateral carotid artery single severe stenosis,the decrease of blood pressure is positively correlated with the degree of carotid artery stenosis,The more severe the degree of carotid stenosis,the greater the decrease of blood pressure.

Objective To detect the expression levels of microRNA-193a-3p(miR-193a-3p) and inhibitor of growth gene 1(ING1) in esophageal cancer tissue,and to explore the relationship between them and clinicopathological parameters and prognosis.
Methods The esophageal cancer and adjacent paracancerous tissues were collected from 90 patients with esophageal cancer who were treated in our hospital from January 2013 to June 2014.Quantitative real-time PCR(qRT-PCR) was used to detect miR-193a-3p expression in esophageal cancer and adjacent paracancerous tissues.Immunohistochemistry(IHC) was used to detect ING1 expression in esophageal cancer and adjacent paracancerous tissues.Target Scan7.1 was used to predict and analyze targeting relationship of miR-193a-3p and ING1.Spearman rank correlation analysis was used to detecte the correlation between miR-193a-3p and ING1 expression in esophageal cancer tissues.The relationship between the expression of miR-193a-3p,ING1 and the clinicopathological parameters and prognosis of esophageal cancer were analyzed.
Results The expression of miR-193a-3p in esophageal cancer tissues was significantly higher than that in adjacent paracancerous tissues(P<0.05),and the positive expression rate of ING1 in esophageal cancer tissues was lower than that in adjacent paracancerous tissues(P<0.05).Target scan 7.1 predicted that there was a binding site of miR-193a-3p in 3'UTR region of ING1.There was a negative correlation between the expression of miR-193a-3p and ING1 in esophageal cancer tissues(P<0.05).The expression of miR-193a-3p and ING1 in esophageal cancer was related to lymph node metastasis and TNM stage(P<0.05).Kaplan Meier survival curve showed that the survival rate of esophageal cancer patients with high expression of miR-193a-3p was lower than that of esophageal cancer patients with low expression of miR-193a-3p(P<0.05),and the survival rate of esophageal cancer patients with negative expression of ING1 was lower than that of esophageal cancer patients with positive expression of ING1(P<0.05).
Conclusion The expressions of miR-193a-3p and ING1 are abnormal in esophageal cancer,and the expressions of miR-193a-3p and ING1 are related to the poor pathological parameters and prognosis of esophageal cancer.Mir-193a-3p may promote the development of esophageal cancer by regulating ING1.

Objective To observe the treatment of Modified Robicsek and bilateral pectoralis major muscle flap for sternal dehiscence  after open heart surgery.
Methods February 2012  November 2019 17 cases of patients with sternal dehiscence after cardiac surgery were treated  by modified Robicsek  to reseat the sternum, bilateral pectoralis major muscle flap repaired the defect.
Results All the patients were with fixed sternum, muscle flaps survived well without necrosis was 100%. Sternal dehiscence without recurrence, muscle flap repaired the sternum effectively and surrounded tissue defect after surgical debridement, repaired the wound zone satisfactory.
Conclusion The treatment of Modified Robicsek  and bilateral pectoralis major muscle flap for   sternal dehiscence after open heart surgery is safe and effective.

Objective To evaluate whether patient elder than 70 can benefit from aortic valve replacement(AVR) with upper sternal mini-incision.
Methods From January 2017 to January 2020,85 patients elder than 70 underwent AVR in our department.All of the patients received AVR either with upper sternal mini-incision(minimally invasive group,n=46)or traditional median sternal incision(control group,n=39).Clinical observational index included durations of cardiopulmonary bypass,aortic cross clamp,postoperative assisted mechanical ventilator,intensive care unit(ICU)stay,postoperative drainage volume within 24 hours,postoperative hospital stay and probability of MACE.
Results There was no significant difference in the durations of cardiopulmonary bypass,aortic cross clamp, postoperative drainage volume within 24 hours and probability of MACE(P＞0.05).Compared to the control group,the durations of postoperative assisted mechanical ventilator,ICU stay and postoperative hospital stay were shorter（P＜0.05）.
Conclusion AVR with upper sternal mini-incision is a safe,effective and minimally invasive surgical technique among elder patients.

Objective To explore the predictive value of postoperative C-reactive protein(CRP) levels in patients with esophageal cancer for postoperative anastomotic fistula,in order to provide clues for early detection of esophageal anastomotic fistula after surgery.
Methods The clinical data of 127 patients who underwent esophageal cancer surgery in our hospital from January 2017 to May 2019 were divided into two groups,according to the occurrence of anastomotic fistula after operation.The group with anastomotic fistula(n=37) was the observation group,and the group without anastomotic fistula(n=90) was the control group.We compared the changes of CRP levels before and 7 days after operation,and the predictive value of the anastomotic fistula was further analyzed.
Results The CRP levels in the observation group and the control group during 7 days after operation were higher than those before operation,and the difference was statistically significant(P<0.05).There was no significant difference in CRP levels between the two groups on the first 1-4 days after surgery(P>0.05).The CRP level of the observation group on the 5th-7th day after operation was higher than that of the control group,the difference was statistically significant(P＜0.05).The ROC curve analysis showed that 57.05 mg/L was taken as the intercept point,and the sensitivity of the CRP level to predict the occurrence of anastomotic leakage was 81.8% at the 7th day after surgery,the specificity was 90.9%,and the area under the curve was 0.93.
Conclusion The postoperative CRP level of esophageal cancer can predict the occurrence of anastomotic fistula earlier,and it can be used as a useful index for predicting and diagnosing anastomotic fistula.

Objective To summarize and analyze the application value of vacuum sealing drainage combined with wound drainage and washing in refractory chest wall tuberculosis.
Methods From January 2015 to January 2020,75 patients with refractory chest wall tuberculosis were selected and analyzed retrospectively.According to the condition of skin defect,the surgical patients were divided into three groups:group A with stage Ⅰ suture drainage,group B with vacuum sealing drainage and wound washing,and group C with conventional tension reduction suture.The non-surgical patients were divided into vacuum sealing drainage(Group D) and wound washing(Group E) at the same time of anti tuberculosis and anti infection treatment.
Result Use time of anti infective Drugs:Group A was (18.611±1.787)days,Group B was (20.158±1.893)days,Group C was (27.571±3.006)days,the difference between the two groups was statistically significant(P<0.05);Group D was (21.455±3.045)days,Group E was (27.923±2.178)days,the difference between the two groups was statistically significant(P<0.05).Wound healing time:Group A was (17.167±6.662)days,Group B was (26.579±3.991)days,Group C was (36.786±5.102)days,the difference between the two groups was statistically significant(P<0.05).Group D was (29.273±7.072)days,Group E was (48.923±8.893)days,The difference between the two groups was statistically significant(P<0.05).VAS pain score 3 days before treatment:the score of group A was (2.361±0.637)，the score of group B was (2.648±0.853)，there was no significant difference(P>0.05)；the score of group B was (2.648±0.853)，the score of group C was (5.429±1.124)，the difference between the two groups was statistically significant(P<0.05).The score of group D was (3.455±1.293),the score of group E was (5.192±0.855),the difference between the two groups was statistically significant(P<0.05).
Conclusion In the treatment of refractory chest wall tuberculosis wounds,the application of negative pressure wound drainage combined with wound washing can speed up the healing process, reduce the use time of antibiotics and relieve the pain of patients.

Objective To investigate the relationship between the expression of miR-21,vascular endothelial growth factor (VEGF) and matrix metalloproteinase (MMP)-9 and prognosis in patients with colorectal cancer.
Methods From December 2013 to June 2016,144 cases of patients with colorectal cancer were enrolled in this hospital.All patients were underwent endoscopic radical surgery,and the clinicopathological features were investigated.The prognosis were followed up and given correlation analysis.
Results The positive rates of miR-21,VEGF and MMP-9 in the lesion group were 72.9%,69.4% and 84.0%,which were significantly higher than those in the control group (15.3%,23.6% and 38.9%) (P<0.05).In the 144 patients,the positive expression of miR-21,VEGF and MMP-9 in the lesions were closely related to tumor differentiation,lymph node metastasis,clinical stage and tumor diameter (P<0.05).Follow-up to October 2019,there were 34 patients were deaths that the mortality rates were 23.6%,COX regression model showed that miR-21,VEGF,MMP-9 are the factors that affected the prognosis of colorectal cancer patients (P<0.05).
Conclusion The high expression of miR-21,VEGF and MMP-9 in patients with colorectal cancer are significantly correlated with the pathological features of patients,and miR-21,VEGF and MMP-9 may affect the prognosis of patients.

Objective To study and compare the clinical effects of laparoscopic appendectomy(LA)and open appendectomy(OA)in the treatment of acute gangrenous appendicitis with root perforation.
Methods Review and analysis the data of 67 patients of gangrenous appendicitis with root perforation received in my hospital from July 2013 to June 2019 were divided into two groups,including 36 cases in LA group and 31 cases in OA group,2 cases changed from LA to OA.The treatment effect was analyzed and compared such as the mean intraoperative time,bleeding volume and postoperative intestinal ventilation time,extubation time,incidence of complications,average hospitalization days and hospitalization costs.
Results Patients in LA group and OA group were cured and discharged from hospital.The mean intraoperative time of LA was(83.17±31.54)min,bleeding volume was(6.59±5.91)ml and postoperative intestinal ventilation time was(2.56±0.92)d ,which was less than OA group[(104.97±47.40)min,(30.09±22.76)ml and(3.38±2.40)d].Extubation time,hospitalization day and hospitalization cost in LA was(2.67±0.64)d、(7.02±1.58)d、(15 561±3 191)RMB,but in OA was(4.13±2.46)d,(12.55±7.57)d and(18 924±12 252)RMB(P＜0.05).The incidence of complications average in LA was 14.70% ,which is less than 35.48% in OA,the difference is statistically significant(All P<0.05).
Conclusion LA and OA both have good effects;however,LA is much better than OA in operation time,less intraoperative bleeding,lower operative complications,faster postoperative recovery.And minimally invasive surgery is the trend of surgical development at present.If the medical equipment and technology is prepared well,LA can be used as a perfect treatment for acute gangrenous appendicitis with root perforation.

Objective To investigate the relationship between preoperative platelet/lymphocyte ratio(PLR) and prognosis in patients with gastric cancer,and analyze factors affecting the prognosis of patients.
Methods The clinical and prognostic data of 267 patients with gastric cancer who were admitted to the Secend Hospital of Anhui Medical University form January 2013 to December 2015 were retrospective analyzed.The survival curve was drawn by Kaplan-Meier method.The survival analysis and univariate analysis were done using the Log-rank test,and multivariate analysis was done using the COX proportional hazards model.
Resrults The mean preoperative PLR in the 267 patients was 177.2±109.9.According to the preoperative PLR,the patients were divided into the low PLR group(PLR<177.2,n=167) and the high PLR group(PLR≥177.2,n=100).The median survival time and 5-year cumulative survival rate of the high PLR group and the low PLR group were 17 months and 22.9%,33 months and 41.20%,respectively,with a significant difference in the survival of patients in low and high PLR groups(P<0.05).The results of univariate analysis showed that age,tumour size,Borrmann type,T stage,N stage,TNM stage,carcinoembryonic antigen value and PLR were factors affecting the prognosis of patients with gastric cancer(P<0.05).The results of multivariate analysis showed that age more than 65 years,tumour size more than 5cm,stage Ⅲ and high PLR were independent risk factors affecting the prognosis of patients with gastric cancer(P<0.05).
Conclusion High preoperative PLR corresponded to poor prognosis of patients with gastric cancer.

Objective To compare the clinical efficacy of laparoscopic total extraperitoneal hernia repair based on different anatomical sites.
Methods The Clinical data of 82 patients with inguinal hernia who underwent totally extraperitoneal hernia repair(TEP) in our hospital from February 2019 to April 2020 were collected for retrospective analysis.According to the TEP operation under different anatomy,all the patients were divided into two groups with 41 patients in each group.Group A was given membrane dissection under laparoscopic total extraperitoneal hernia repair,group B line based on the anatomy of the peritoneal clearance before laparoscopic total extraperitoneal hernia repair.The operative time,intraoperative blood loss,recovery time of restricted activities,length of stay,rate of conversion to open surgery,rate of postoperative recurrence,and incidence of complications related to urinary retention,intestinal obstruction,seroma,and scrotal edema were analyzed and compared between the two groups.
Results The time of operation,the amount of bleeding during operation,the time of recovery of restrictive activity and the time of hospitalization in group A were significantly shorter than those in group B,the difference was statistically significant(P＜0.05).There was no significant difference in VAS score within 12 hours after operation between the two groups,and the VAS score in group A was significantly lower than that in group B at 24 hours,48 hours,7 days and 15 days after operation,the difference was statistically significant(P<0.05).After 30 days,the pain of the two groups basically disappeared;the rate of conversion to open surgery and postoperative complications in group A were significantly lower than those in group B,the difference was statistically significant(P＜0.05).
Conclusion Mastering the anatomy of inguinal region membrane is helpful to improve the safety of laparoscopic total extraperitoneal hernia repair,shorten the operation time,reduce the recurrence rate and postoperative complications.

Objective To investigate the application effect of the camera holder act in fixed scene in laparoscopic inguinal hernia TAPP repair.
Methods From January 2019 to January 2020,a total of 122 patients underwent TAPP in Shaanxi Provincial People's Hospital were retrospectively researched,63 of them underwent surgery while the camera holder act in fixed scene,the other 59 patients underwent common practice.The clinic data of operative time,hospital stay,Visual Analogue Scale(VAS),postoperative complication were analyzed.
Results All 122 patients underwent surgery successfully.The operative time of unilateral hernia was(66.4±16.2)min and the bilateral hernias was(121.4±33.2)min when the camera holder act in fixed scene,while in common practice,the operative time of unilateral hernia was(78.7±18.0)min and the bilateral hernias was(147±34.6)min.So compared with common practice,the camera holder act in fixed scene shorten operation time both in unilateral hernia and bilateral hernias(P<0.05).There was no significant difference in postoperative hospital stay,VAS score on the first day after surgery,incidence of seroma and hematomas between two groups(P>0.05).There was no hernia recurrence and mesh infection in all patients.
Conclusion The camera holder act in fixed scene make it standardized and routinized to support the laparoscope.It shorten the operation time effectively,and do not increase the complication incidence.

Objective To investigate the effect of vertebral body size on axial syndrome(AS) after posterior cervical open-door laminoplasty.
Methods A total of 40 patients underwent posterior cervical single-door decompression surgery completed by the same professional group.Patients were divided into groups A and B according to the size of the vertebral body,The group A,11 patients,was the small vertebral body group.The group B,29 patients,was the non-small vertebral body group.They were recorded operation time and the incidence and duration of axial symptoms to assess the effect of vertebral body size on the incidence of axial symptoms after single-door surgery.
Results There wasn’t statistically significant difference in the operative time and intraoperative blood loss between the two groups(P>0.05).Among the two groups,the prevalence of axial symptoms in group A was 63.6%.The prevalence of axial symptoms in group B was 27.6%.The difference between the two groups was statistically significant(P<0.05).In the reexamination 3 months after surgery,there were 6 patients in group A and 3 patients in group B which still had axial symptoms,the persistent prevalence rate of A was 54.5% and B was 10.3%.The data of the two groups were statistically significant(P<0.05).In the reexamination 1 year after surgery,there were 3 patients in group A and 1 patients in group B which still had axial symptoms,〖JP2〗the persistent prevalence rate of A was 27.3％ and B was 3.4％.The data of the two groups were statistically significant(P<0.05).
Conclusion Patients in the small vertebral body group are more likely to have axial symptoms after surgery,and early and late axial symptomatic persistence have a higher rate.

Objective To investigate the effect of vacuum sealing drainage (VSD) on skin necrosis after orthopaedic trauma in plateau area above 4000 meters.
Methods From August 2018 to May 2019, 10 patients with open injuries of limbs caused by trauma and necrosis of skin after primary debridement and suture were selected from Dingri County People's Hospital of Tibet Autonomous Region (the average altitude of Dingri County is 5000 meters). All patients underwent VSD coverage for 7～10 days after secondary debridement of soft tissue wounds, and finally underwent thick skin grafting.
Results After VSD treatment, none of the wounds were infected and the skin graft survived at one time. The therapeutic effect was satisfactory.
Conclusion The application of VSD in the treatment of orthopedic post-traumatic skin necrosis in high altitude areas can promote wound healing.

Objective To reduce the incidence of SIRS and sepsis in patients with upper urinary tract calculi and pyonephrosis in non-acute infection stage by perfusion of povidone iodine and negative pressure aspiration sheath into the renal collecting system on the surgical side.
Methods The clinical data of PCNL patients with pyonephrosis and upper urinary calculi from April 2019 to August 2019 were retrospectively analyzed.5 cases were actually included.Those who met any of the following conditions before operation were included in the analysis,including positive nitrite in urine,positive urine culture,abdominal CT plain scan considering pyonephritis or repeated turbidity of urine with significant increase of urinary white blood cells.Ultrasound-guided percutaneous nephrolithotomy confirmed the drainage of purulent urine in 5 cases,including 4 cases with positive urine culture 48 hours before operation.Negative pressure of these 5 cases was evaluated in terms of lithotripsy rate,liver and kidney function,inflammation and infection index,length of operation and lithotripsy and complications.
Results 80%(4/5) of the patients with ureterolithiasis and pyonephrosis treated by the above method in the first stage achieved the effect of primary lithotripsy.One patient underwent stage Ⅱ flexible ureteroscopic surgery because of the stone burden;all patients had no perioperative liver and kidney function damage（P<0.05）.Preoperative procalcitonin level and preoperative blood C-reactive protein(CRP) level compared with postoperative had not significantly different（P<0.05）.No sepsis occurred in one case,SIRS occurred in one case and improved after anti-infection treatment for 3 hours.The average length of lithotripsy and operation were 39 minutes and 60 minutes,respectively.No complications such as puncture injury,severe bleeding,ureteral injury and allergic reaction occurred.
Conclusion PCNL combined with negative pressure aspiration sheath for primary treatment of renal and ureteral calculi complicated with pyonephrosis by povidone iodine perfusion can reduce hospitalization time and avoid long-term indwelling nephrostomy,while ensuring the safety and effectiveness of lithotripsy.

Objective To investigate curative effect of modified plasma kinetic resection of prostate(PKRP) for senile high-risk benign prostatic hyperplasia(BPH) and the risk factors of postoperative bladder neck contracture.
Methods The clinical date of 105 senile high-risk BPH patients in our hospital from January 2017 to January 2019 were retrospectively analyzed,and patients divided into two groups according to different surgical methods,modified group(n=73) and the traditional group(n=32).The outcomes of two groups were compared,and the incidence of postoperative bladder neck contracture in modified group was statistically analyzed.Then the risk factors affecting postoperative bladder neck contracture were analyzed by multivariate Logistic regression model.
Results The operative time,postoperative flushing time,postoperative extubation time and postoperative hospital stay of modified group were significantly shorter than those of traditional group(P<0.05),and the intraoperative blood loss was significantly less than that of traditional group(P<0.05).There was no significant difference in the amount of intraoperative tissue resection between two groups(P>0.05).After surgery,the maximum flow rate(MFR) was significantly increased in both groups,and postvoid residual(PVR) and international prostate symptom score(IPSS) were decreased significantly in both groups,with significant differences within groups(P<0.05).After treatment,MFR of modified group was significantly higher than that of traditional group,and PVR was significantly lower than that of traditional group(P<0.05).There was no significant difference in postoperative complications between groups(P>0.05).Logistic multivariate regression analysis suggested that smoking history and postoperative obstruction of urethral catheters would increase the risk of bladder neck contracture after surgery.
Conclusion Compared with traditional PKRP operation,the modified PKRP has the advantages of shorter operation time,less intraoperative blood loss,and faster postoperative recovery.The effective way to prevent bladder neck contracture includes quitting smoking and keeping catheter smooth.

Objective To evaluate the anesthesia effect of ultrasound-guided single shot spinal anesthesia at L5-S1 and L4-5 intervertebral space in transurethral ureteroscopic lithotripsy.
Methods Forty patients who were scheduled for transurethral ureteroscopic lithotripsy were enrolled in this study.The patients allocated randomly into two parallel groups(20 patients for each),namely L5-S1(Group A) and L4-5(Group B).Forty patients underwent real-time ultrasound-guided spinal anesthesia,When the puncture is successful,10 to 17 mg of 0.5% bupivacaine was injected.The hemodynamic parameters,total duration of surgery,anesthesia effect,anesthesia satisfaction,total bupivacaine used,total blocked segments,sedative analgesics and vasoactive drugs used were recorded.
Results The vital signs were stable during the operation.There was no significant difference in heart rate(P>0.05),systolic blood pressure and diastolic blood pressure between the two groups at each time measured.The satisfaction rate of anesthesia in both group A and group B was 100%.None of the patients transferred to general anesthesia due to pain or insufficient block.One patient in group B needed vasoactive drugs to maintain hemodynamic stability.There was no statistical significance in the dose of bupivacaine used in group A and group B(P>0.05),but the total blocked segments in group A was less than that in group B with the equal bupivacaine dosage[Group A was (14±2),Group B was (15±2),P<0.05].
Conclusion Real-time ultrasound-guided spinal anesthesia at L5-S1 and L4-5 intervertebral space are feasible and can be safely used for patients underwent transurethral ureteroscopic lithotripsy.With the same dose of bupivacaine,spinal anesthesia by L5-S1 approach produced less blocked segments than L4-5 approach.

Objective To assess the assess the utility of the Nottingham Hip Fracture Score(NHFS) as a predictor of postoperative complications in elderly patients undergoing hip surgery.
Methods NHFS was retrospectively calculated for 820 patients who had undergone hip fracture surgery between January 1st 2016 and November 30th 2019.Patients’ gender,age,height,weight,Body Mass Index,ASA class,fracture type,type of surgery and anesthesia,postoperative visual analogue score,intraoperative blood loss and urine output,history of blood transfusion,history of dementia,preoperative hospital stay,postoperative hospital stay,length of hospital stay,admission to ICU,preoperative coexistent diseases,and postoperative complications were compared.According to the NHFS,patients were divided into two groups:NHFS≤5 scores group and NHFS>5 scores group.
Results Compared with patients in NHFS≤5 scores group,the patients with NHFS>5 scores group showed significantly higher age and ASA class,lower BMI,and larger proportion of subcephalic fracture and combined spinal-epidural anesthesia(P＜0.05).There were significant differences in postoperative anemia,deep vein thrombosis(DVT),delirium,arrhythmia,pulmonary infection,cerebral infarction,electrolyte disturbance,hypoxemia,renal dysfunction,heart failure,and admission to ICU between the two groups(P＜0.05).
Conclusion Postoperative complications are more likely to occur in patients with higher NHFS,which might delay the hospital length of stay with poor total outcome.The NHFS is a reliable tool for predicting prognosis.It may be useful for discharge planning,and for the design of future research trials.

Objective To explore the mechanism and preventive measures of spinal cord ischemia after endovascular aortic repair.
Methods A analysis of 7 patients with spinal cord ischemia (SCI) after endovascular aortic repair in our department from November 2017 to November 2019 was carried out. By summarizing the surgical characteristics and follow-up results, a comparative analysis of the possible risk factors for spinal cord ischemia,as well as targeted prevention and treatment measures.
Results Seven patients with SCI after endovascular aortic repair did not undergo preventive cerebrospinal fluid drainage, including 6 early SCI and 1 delayed SCI;4 patients with renal insufficiency, 6 patients with dyslipidemia and 3 patients with chronic obstructive pulmonary before operation; the average operation time was 2.5±1.35 hours; the average length of aortic isolation was 8 vertebral segments;4 cases were reconstructed branch arteries during operation; 4 cases were treated with therapeutic cerebrospinal fluid drainage after operation.After treatment,the symptoms improved in 2 cases and the prognosis was poor in 5 cases, including 4 deaths.
Conclusion SCI is the result of a combination of factors,and the therapeutic cerebrospinal fluid drainage has limited effect.

Understanding of the importance of posterior ligamentous complex (PLC) has gradually deepened.Complications of traditional posterior approach and internal fixation have become increasingly apparent.Decompression and stabilization with less trauma has becomea popular research area in spinal surgery.Oblique lateral interbody fusion (OLIF) performed well on lumbar spondylolisthesis ofⅠ/Ⅱ degree,mild spinal stenosis and degenerative scoliosis.However,an obvious disadvantage of OLIF is that it cannot achieve satisfactory decompression of the spinal canal.Although hypertrophy of the ligamentum flavum and articular processes are important factors of spinal stenosis,these structural changes are responsive to spinal degenerations and can increase spinal stability.Only two or more anatomical factors at the same time can cause LSS,and nerve decompression can be achieved after removing compressive factors in any direction.Based on the above theory,we reviewed three cases diagnosed with LSS and decompressed with usage of spinal endoscopes and angled drills,and discs and posterior osteophytes were removed through the oblique lateral approach.This article discusses the theory and techniques of this surgery.

Urethral injury or stricture has become a serious problem affecting health and quality of life in men.Common treatment methods,such as urethral dilatation,urethrotomy or urethroplasty,are not effective and satisfactory for patients with complex and extensive urethral injury.Therefore,researchers have tried to use tissue engineering technology to treat urethral stricture or injury and developed a large number of tissue engineering strategies related to urethral regeneration in the past few decades;they have carried out extensive research in cell source,material and method selection,and also obtained rich scientific achievements.In the future,researchers will continue to use cell sheet technology,3D bioprinting and other new methods to help the research and development of tissue-engineered urethra,expecting to be widely used in clinical practice as soon as possible and benefiting associated patients.