Objective To explore the clinical value of simplified Fournier’s gangrene severity index(SFGSI) in accessing the prognosis of patients with perianal necrotizing fasciitis. Methods 52 patients with perianal necrotizing fasciitis who were diagnosed and underwent surgical treatment from January 1, 2010 to January 1, 2022.The patients were divided into survival group and death group according to the clinical outcome.We retrospectively analyzed the risk factors of death and the discrimination and calibration of SFGSI in accessing the prognosis of patients with perianal necrotizing fasciitis. Results A total of 52 patients were collected in this study,and they were grouped as survival group(group A,43 cases) and non-survival group(group B,9 cases).The total mortality was 17.31%.There were significant differences in age,potassium and SFGSI scores between survival group and death group(P<0.05):For every 5 year increase in age,the risk of death increased 2.033 times.The risk of death from abnormal potassium group was 3.656 times higher than normal group.When SFGSI > 2 ,the risk of death was 6.429 times higher than that of patients with SFGSI≤2.SFGSI has high accuracy in predicting the prognosis of patients，AUC =0.829(0.709-0.949). Conclusion SFGSI can be used to help predict the prognosis and death risk of perianal necrotizing fasciitis.

Objective To analyze the effect and safety of “cross” suture in the reconstruction of perineal incision and closure of enterostomy for rectal cancer. Methods A total of 107 patients with perineal incision reconstruction during combined abdominal perineal resection and abdominal incision reconstruction during enterostomy closure treated in our hospital from January 2019 to January 2022 were selected.They were divided into traditional stoma group (12 cases),stoma “cross” group (14 cases),traditional reconstruction group (37 cases) and reconstruction “cross” group (44 cases).Follow up for 30 days after operation to compare the effects of each group. Results The operation time,incision healing time,postoperative extubation time,and postoperative hospital stay in the ostomy “cross” group and the reconstruction “cross” group were shorter than those in the traditional ostomy group and the reconstruction traditional group,and the intraoperative blood loss was less than that in the traditional ostomy group and the reconstruction traditional group (P<0.05).The NRS score of the “cross group” and the  reconstruction“cross group” 1,2 and 3 days after surgery was lower than that of the traditional group and the traditional reconstruction group (P<0.05).The color,thickness,blood vessels,softness and total score of postoperative incision in the “cross group” and the reconstruction“cross group” were lower than those in the traditional group and the traditional reconstruction group (P<0.05).The incidence of postoperative complications in the reconstruction “cross” group was 6.82%,significantly lower than that in the traditional reconstruction group (24.32%) (P<0.05).There was no difference in the total incidence of complications between the traditional stoma group and the stoma “cross” group (P>0.05). Conclusion “Cross” suture can be used for incision reconstruction during combined abdominal perineal resection and enterostomy closure.It has the characteristics of “unobstructed drainage” and “reduced tension suture”,and can reduce the incidence of postoperative complications.

Objective To explore the application effect of improved total mesorectal excision (TME) with complete preservation of Deng’s fascia in rectal cancer. Methods Ninety-five patients with rectal cancer who were treated in our hospital from June 2019 to May 2021 were selected as the study subjects,and they were divided into iTME group(50 cases) and TME group(45 cases) according to different surgical methods.Among them,patients in iTME group received TME surgery with complete preservation of Deng’s fascia,and patients in TME group received general TME surgery.The patients were followed up for 12 months,and their data were collected to compare the recent surgical efficacy,urinary function and erectile function of the two groups. Results There was no significant difference between the two groups in sex ratio,age,BMI,preoperative radio and chemotherapy ratio,distance between tumor and anal margin,whether diabetes mellitus was combined,intraoperative bleeding volume and postoperative recovery time (P>0.05),while the operation time in iTME group was longer than that in TME group (P<0.05).Comparing the postoperative urinary function of patients in the two groups,it was found that there were no severe symptoms in the iTME group,2 patients with moderate symptoms (4.00%).2 patients with severe symptoms (4.44%) and 9 patients with moderate symptoms (20.00%) in the TME group.There was a significant difference between the two groups in urinary function (P<0.05).After comparing the erectile function of male patients in the two groups,it was found that in the iTME group,1 patient with severe erectile dysfunction (3.45%),1 patient with moderate erectile dysfunction (3.45%),12 patients with mild erectile dysfunction (41.38%).2 patients with severe erectile dysfunction (8.00%),3 patients with moderate erectile dysfunction (12.00%),and 11 patients with mild erectile dysfunction (44.00%) were found in the TME group,but there was no significant difference between the two groups in erectile function (P>0.05). Conclusion The improved innovative TME with complete preservation of Deng’s fascia can bring better curative effect to patients on the basis of ensuring safety,and at the same time,reduce the damage to patients’ urinary function and male erectile function

Objective  To verify the superiority and safety of natural orifice specimen extraction surgery(NOSES)compared with traditional laparoscopic surgery in patients with colorectal cancer. Methods The clinical data of 128 patients underwent colorectal cancer surgery in our department from January 2018 to October 2021 were retrospectively analyzed,including 60 NOSES and 68 traditional laparoscopic surgery,and the differences of intraoperative and postoperative indicators were compared between the two groups. Results The NOSES group was superior to the traditional laparoscopic group in incision length [(3.93±0.10)cm vs(10.77±1.23)cm],pain score [(3.52±1.13)points vs(4.12±1.11)points],first activity time [(19.13±6.81)h vs(25.03±9.38)h],exhaust time [(52.23±14.05)h vs(61.59±16.87)h],nutrition score [(3.92±0.96)points vs(4.41±1.04)points],length of hospital stay [(11.22±2.22)d vs(12.59±2.36)d](P<0.05).There was no difference in operation time [(142.41±20.28)min vs(138.63±17.92)min],blood loss [(62.58±35.68)ml vs(66.03±51.34)ml],number of lymph nodes dissected [(11.15±2.62)vs(10.59±2.54)] and complications(20.00% vs 22.06%)between the two groups(P>0.05). Conclusion NOSES was more superior in aesthetics,pain and rehabilitation when ensuring the safety of surgery.

Objective To analyze the relationship between the expression of transcription factors E2F2 and mucin-like receptor 2(EMR2) in colorectal cancer(CRC) tissues and the clinicopathological characteristics of patients,and to evaluate the diagnostic value of the two in cancer metastasis. Methods CRC tissue specimens and adjacent tissue specimens of CRC patients were collected during surgery,88 cases in each,real-time fluorescence quantitative PCR was used to detect the expression levels of E2F2 mRNA and EMR2 mRNA in all tissues.The expression of E2F2 protein and EMR2 protein in tissues was detected by Streptomycetin antibiotin protein-catalase linkage method(SP method),and the relationship between E2F2 protein and clinicopathological features was analyzed,and ROC curve was used to analyze the diagnostic value of E2F2 mRNA and EMR2 mRNA expression levels for lymph node metastasis in CRC patients.Results The positive rates of E2F2 protein and EMR2 protein in CRC tissues(76.50%,65.50%) were significantly higher than those in adjacent tissues(20.45%,26.14%)(P＜0.05).The expression of E2F2 protein and EMR2 protein in CRC tissue was correlated with TNM stage,lymph node metastasis and infiltration depth(P＜0.05).Compared with patients without lymph node metastasis,the expression levels of E2F2 mRNA and EMR2 mRNA in CRC tissue of patients with lymph node metastasis were obviously increased(P＜0.05).The ROC curve was drawn,and it was found that the AUC of E2F2mRNA and EMR2mRNA expression levels in CRC tissue alone and in the diagnosis of lymph node metastasis was 0.782,0.844,and 0.877,respectively.The AUC of E2F2mRNA combined with EMR2mRNA in diagnosis of lymph node metastasis was higher than that of E2F2mrna combined with EMR2mrna separately(P＜0.05). Conclusion E2F2 and EMR2 are related to TNM stage,lymph node metastasis and depth of invasion in CRC patients,and the combination of the two has certain diagnostic value for lymph node metastasis.

Objective To observe the influencing factors of cerebrospinal fluid leakage after endoscopic transsphenoidal pituitary adenoma resection,and promote the early identification of high-risk patients with this complication. Methods Retrospective analysis was made on the clinical data of 176 patients with pituitary adenoma who underwent endoscopic transsphenoidal pituitary adenoma resection in Department of Neurosurgery,Second Affiliated Hospital of Nanjing Medical University from May 2019 to October 2022,and the cerebrospinal fluid leakage after operation was counted.Single factor analysis was used to screen the possible influencing factors of postoperative cerebrospinal fluid leakage,and logistic regression analysis was used to determine the independent risk factors. Results 12 of 176 patients with pituitary adenoma had cerebrospinal fluid leakage after operation,the incidence was 6.82% (12/176).Univariate analysis showed that tumor diameter,reoperation,intraoperative cerebrospinal fluid leakage,and intraoperative cerebrospinal fluid leakage classification were related to postoperative cerebrospinal fluid leakage (P＜0.05).Logistic regression analysis showed that tumor diameter (OR=3.843,95%CI=1.652～8.940),reoperation (OR=2.407,95%CI=1.094～5.298),intraoperative cerebrospinal fluid leakage (OR=4.552,95%CI=1.483～13.972),and intraoperative cerebrospinal fluid leakage classification (OR=3.516,95%CI=1.204～10.269) were independent risk factors for postoperative cerebrospinal fluid leakage (P＜0.05). Conclusion Tumor diameter,reoperation,intraoperative cerebrospinal fluid leakage,and intraoperative cerebrospinal fluid leakage classification are closely related to cerebrospinal fluid leakage after endoscopic transsphenoidal pituitary adenoma resection,we should pay close attention to the strategies of sellar floor reconstruction in the above patients,and strengthen the observation of the signs of cerebrospinal fluid leakage after surgery.

Objective To investigate the treatment,clinical effect and prognosis of subdural effusion after decompressive craniectomy in patients with severe brain injury.Method A retrospective analysis was performed on the clinical data of 54 patients with severe craniocerebral injury secondary to subdural hydrops after decompression after craniectomy admitted to the First Affiliated Hospital of Xinxiang Medical College from January 2015 to December 2020.According to clinical symptoms and fluid accumulation,34 patients were treated conservatively,and 20 patients were treated surgically.3 months after treatment,head CT was re-examined to evaluate fluid absorption.After 6 months of treatment,the daily living ability of patients was assessed by the Daily Living Ability Assessment Scale(ADL).Result The effective rate was 85%(29/34) in the non-surgical group and 90%(18/20) in the surgical group.There was no significant difference in effective rate between the two groups(P>0.05).After 6 months of follow-up,the ADL score of 2 groups was higher than that of the corresponding group before treatment,and the difference was statistically significant(P<0.05). Conclusion For patients with subdural effusion after decompression after craniocerebral decompression,individualized treatment can achieve satisfactory results according to the amount of effusion and clinical symptoms.

Objective Comparative analysis of the application effects of straight bipolar coagulation forceps,Focus ultrasonic equipment and high frequency electrosurgical equipment in thyroid cancer surgery. Methods Select 165 patients accept standard radical resection of thyroid cancer from May 2020 to April 2021.Divide randomly into bipolar electrocoagulation group,ultrasonic equipment group and electrosurgical equipment group,with 55 cases in each group.The general patient’s information of the three groups are operation time,intraoperative blood loss,postoperative drainage time,total drainage,preoperative and postoperative parathyroid hormone value,serum calcium ion value,postoperative complication rate and individual costs.This study conducts a comparative analysis of these indicators. Results The three groups of operations were successfully completed;the bipolar electrocoagulation group and the ultrasonic equipment group have significant differences in the postoperative parathyroid hormone value,serum calcium ion value,and postoperative complication rate,and they were statistically significant(P< 0.05),the rest of the indicators were not statistically significant(P>0.05).Among them,the single cost of the bipolar electrocoagulation group is higher than that of the ultrasonic equipment group.The first two groups are compared with the electrosurgical equipment group and find that the operation time,intraoperative blood loss,and postoperative Drainage time,total drainage volume,postoperative parathyroid hormone value,serum calcium ion value,and complication rate are all lower than those in the electrosurgical group,the difference was statistically significant(P<0.05),and the individual cost is higher than that in the electrosurgical group. Conclusion All three groups of energy devices can successfully complete the operation and achieve the treatment goals.In the operation time,intraoperative blood loss,postoperative drainage time,total drainage,postoperative parathyroid hormone value,serum calcium ion value and complications In terms of efficiency,straight bipolar coagulation forceps and Focus ultrasonic scalpel have advantages in higher frequency electrosurgical units.In terms of economy,straight bipolar coagulation forceps are slightly higher than high frequency electrosurgicals,but they have obvious advantages over Focus ultrasonic scalpels.Straight bipolar coagulation forceps has an absolute advantage in fine anatomy.

Objective To investigate the clinical value of watershed analysis to anatomical sublobectomy in the treatment of early peripheral Non-Small-Cell Lung Carcinoma(NSCLC) characterized by Ground Glass Nodules(GGN) through fluorescence thoracoscopy. Method A total of 81 cases of early peripheral GGN-like non-small-cell lung carcinoma treated by thoracic surgery in our hospital from September 2021 to September 2022 were retrospectively studied.According to the different methods of fluorescence thoracoscopic surgery,the patients were divided into two groups.The group of anatomical sublobectomy with the watershed analysis(hereinafter,referred to as the watershed group) including 42 cases,and the anatomical pulmonary segmental resection group(hereinafter,referred to as the pulmonary segmental resection group) including 39 cases.The general surgical data,perioperative indexes and postoperative complications were compared between the two groups. Results The operations of the patients were successfully completed for both groups,without any perioperative death.For the watershed group,there were no cases that switched to thoracotomy or changed the operation style,and no cases of incision or missed incision were observed.For the pulmonary segmental resection group,there were 2 cases that changed the operation style.The surgical margin distance of the watershed group[(26.24±3.87)mm] was slightly smaller than that of the pulmonary segmental resection group[(26.62±3.32)mm].But the difference was not statistically significant(P>0.05).The amount of blood loss[32.14(20.00,50.00)ml vs 85.38(30,100)ml],operative time[(146.76±41.51)min vs (184.944±50.42)min] and postoperative drainage time[2.43(2.00,3.00)d vs 4.05(3.00,5.00)d] of the watershed group were lower than those of the pulmonary segmental resection group.And the differences were statistically significant(P<0.05).The complication rate of the watershed group(11.91%) was lower than that of the pulmonary segmental resection group(30.77%).And the difference was statistically significant(P<0.05).Totally,25 patients(64.12%) in the pulmonary segmental resection group underwent the preoperative puncture localization,but none in the watershed group.For both groups,there was no tumor recurrence during the follow-up.Conclusion The application of watershed analysis to anatomical sublobectomy in the treatment of early peripheral NSCLC by fluorescent thoracoscopy can simplify the surgical procedure,accurately remove the lesion,and ensure the curative effect of oncology.The clinical practices have proved that the approach is scientifically reasonable,safe and feasible.

Objective To investigate the regulatory effect of leucine-rich-alpha2-glycoprotein 1(LRG1) on the proliferation,migration and invasion of non-small cell lung cancer(NSCLC) cellsvia the Runt-related transcription factor 1(RUNX1)/osteopontin(OPN) axis. Methods To determin the expression of LRG1,RUNX1 and OPN in cultured human type II alveolar epithelial cells and human NSCLC cell lines A549,NCI-H838 and NCI-H1650.The human NSCLC cell line A549 cultured in vitro was randomly divided into control group,LRG1 knockdown group,negative control group,RUNX1 overexpression group,LRG1 knockdown + RUNX1 overexpression group by random number table method,after cells were grouped and transfected with plasmids,to detect the proliferation,apoptosis,migration,invasion,the expression of apoptosis proteins(Bcl-2,caspase-3,Bax) and epithelial-mesenchymal transition marker proteins(N-cadherin,E-cadherin),the expressions of LRG1,RUNX1 and OPN in A549 cells in each group.〖WTHZ〗Results Compared with human type II alveolar epithelial cells,the mRNA and protein expressions of LRG1,RUNX1 and OPN in human NSCLC cell lines A549,NCI-H838 and NCI-H1650 higher(P<0.05).Compared with the control group,the positive rate of EdU,the migration rate,the number of invasion,the mRNA and protein expressions of LRG1,RUNX1 and OPN,and the protein expression of Bcl-2 and N-cadherin in the LRG1 knockdown group were decreased(P<0.05),and the apoptosis rate and the protein expression of caspase-3,Bax,and E-cadherin were increased(P<0.05);The changes of various indicators in RUNX1 overexpression group were contrary to those in LRG1 knockdown group,and the overexpression of RUNX1 could reverse the effects of LRG1 knockdown on various indicators of cells.Conclusion Knockdown of LRG1 can inhibit the proliferation,migration and invasion of NSCLC cells and promote their apoptosis by down-regulating the expressions of RUNX1 and OPN.

Objective  To evaluate the safety of a snake-shaped flexible robotic arm in thoracic surgery. Methods From March 2022 to June 2022,208 cases of lung surgery were performed under single hole thoracoscopic in our hospital.According to whether this kind of snake-shaped flexible robotic arm was used during the surgery,we divided them into two groups,including 105 cases in the robotic arm group and 103 cases in the control group.The operation time,hospital stay,and incidence of postoperative adverse reactions were counted. Results In the control group,the average operating time was (71.29±30.33) minutes,the hospital stay was (5.86±4.66) days and the incidence of serious complications was 5.8%,while in the robotic arm group the average operating time was （74.31±29.98）minutes,the average hospital stay and the incidence of serious complications were (5.11±2.32) days and 2.9%，respectively.There was no significant difference in operation time,hospital stay and incidence of adverse reactions between the two groups(P>0.05). Conclusion The application of the snakeshaped robotic arm in thoracic surgery is safe and reliable,and will not increase the extra risk in the perioperative period.

Objective To investigate the expression levels of microRNA-3619-5p(miR-3619-5p) and long noncoding RNA(LncRNA) LINC00857 in serum of hepatocellular carcinoma(HCC) and their clinical diagnostic value.Methods 78 patients with HCC,76 patients with benign liver lesions,and 78 patients with chronic liver disease were taken as HCC group,benign lesion group,and chronic liver disease group,respectively,another 78 healthy subjects who underwent physical examination were taken as the control group.The serum levels of miR-3619-5p,LncRNA LINC00857 and alpha-fetoprotein(AFP) in each group were compared;the diagnostic value of serum miR-3619-5p,LncRNA LINC00857 and AFP for HCC was analyzed.Results Comparison of serum miR-3619-5p [(1.05±0.35),(0.74±0.25),(0.72±0.24),(0.46±0.15)] and LncRNA LINC00,857 [(1.01±0.34),(1.62±0.54),(1.66±0.55),(2.95±0.98)],AFP [(3.13±1.14)μg/L,(48.86±16.29)μg/L,(50.23±18.74)μg/L,(301.25±117.23)μg/L] levels in patients with control group,chronic liver disease group,benign disease group,and HCC group,the difference was statistically significant(P<0.05).The areas under the curve(AUC) of serum miR-3619-5p,LncRNA LINC00857,and AFP for the diagnosis of HCC were 0.870,0.868,and 0.701,respectively,the AUC of serum miR-3619-5p combined with LncRNA LINC00857 to diagnose HCC was 0.956,the sensitivity was 94.9%,and the specificity was 86.4%.Conclusion The expression level of serum miR-3619-5p in HCC patients is low,while the expression level of LncRNA LINC00857 is high.The combination of miR-3619-5p and LncRNA LINC00857 may be more helpful for clinical diagnosis of HCC.

Objective To explore the risk factors of bile leakage in patients with common bile duct stones (CBDS) after choledochoscope and duodenoscope combined with Laparoscopic choledochal exploration of stone calculi for primary suture.Methods A total of 176 patients with CBDS undergoing triple endoscopy combined with choledocholithotomy for primary suture were enrolled as the research objects between January 2019 to October 2022.The clinical data of patients and occurrence of postoperative bile leakage were statistically analyzed.The risk factors of bile leakage were analyzed by multivariate regression analysis.Results In the 176 patients with CBDS undergoing triple endoscopy combined with choledocholithotomy for primary suture,there were 29 cases (16.48%) with bile leakage.Multivariate Logistic analysis showed that serum albumin ≤ 35g/L,stone incarceration,diameter of common bile duct ≤1cm and no nasobiliary drainage were risk factors of bile leakage. Conclusion Serum albumin ≤35g/L,stone incarceration,diameter of common bile duct ≤1cm and no nasobiliary drainage are risk factors of bile leakage after triple endoscopy combined with choledocholithotomy for primary suture.Clinically,early prevention and supportive treatment can be conducted for patients with high-risk factors to reduce the incidence of postoperative bile leakage.

Objective To explore the clinical value of laparoscopic cholecystectomy with the “A-C-P” lines as anatomic markers. Methods We found out the patients who treated by laparoscopic cholecystectomy with the “A-C-P” lines as anatomical markers  in The Affiliated Hospital of Traditional Chinese Medicine Southwest Medical University from January 2018 to December 2021,and we analyzed the clinic date of the 1364 patients retrospectively to investigate the safety and efficacy of the“A-C-P” lines approach laparoscopic cholecystectomy procedure.Results The 1364 patients were successfully treated by laparoscopic cholecystectomy with the “A-C-P” lines as anatomic markers.The mean operation time was (35.20±11.30) min,the mean amount of intraoperatively bleeding was (10.62±5.51) ml,and the mean postoperative hospitalization time was (5.33±1.47) d.Seven cases had postoperative complications,including 3 cases of umbilical incision infection which were cured by clinic dressing change，and 4 cases of secondary common bile duct stones which were cured by endoscopic retrograde cholangiopancreatography or laparoscopic common bile duct exploration,without biliary tract injury and perioperative death. Conclusion We can finish a laparoscopic cholecystectomy with the “A-C-P” lines as Anatomical markers,our clinical practice preliminarily confirmed the safety of the procedure.

Objective To investigate the effect of renal tumor enucleation on renal function,renal parenchyma and teratoma-derived growth factor-1(Cripto-1) in patients with localized renal cell carcinoma. Methods The clinical data of 100 patients with localized renal cell carcinoma who were diagnosed and treated in our hospital from February 2016 to June 2021 were retrospectively analyzed,and then the patients were included in the study group(60 cases) and the control group(40 cases) according to the different treatment options in the data.The study group underwent laparoscopic nephrectomy,and the control group underwent open partial nephrectomy.The operation time,renal artery occlusion time,intraoperative blood loss,hospitalization time,renal function,renal parenchyma and serum Cripto-1 levels before and after the operation were observed and compared.Results The intraoperative blood loss [(89.65±20.22) ml] and hospital stay [(8.25±2.25) d] in the study group were lower than those in the control group [(126.69±25.63) ml,(11.40±3.52)d](P＜0.05).After operation,the levels of GFR,BUN and Scr in the study group were(85.24±2.25) ml/min,(10.47±2.14) mmol/L,and(80.65±10.28) μmol/L,and the levels of GFR,BUN and Scr in the control group were divided into(118.65±3.20) ml/min,(13.41±2.25) mmol/L,(97.45±11.25) μmol/L,and there were significant differences in the levels of GFR,BUN and Scr between the two groups(P＜0.05).After operation,the renal parenchyma volume loss value in the study group [(9.86±2.20) cm3] was lower than that in the control group [(15.96±3.25) cm3](P＜0.05).Three months after operation,the serum Cripto-1 level in the study group [(1.01±0.55)ng/ml] was lower than that in the control group [(2.55±0.85)ng/ml](P＜0.05).Conclusion Renal tumor enucleation can effectively reduce the amount of intraoperative blood loss in patients with localized renal cancer,shorten the time of discharge,and reduce serum Cripto-1 level,while retaining more normal renal parenchyma and improving renal function.

Objective To investigate the clinical safety and efficacy of one needle continuous suture with barbed thread in laparoscopic nephron sparing nephrectomy.Methods  The clinical data of 140 patients who underwent nephron sparing nephrectomy from January 2017 to January 2021 were analyzed retrospectively.Those patients were divided into two groups according to the surgical wound suture method.Among them,there were 70 cases in the barbed thread one needle continuous suture group and 70 cases in the Hem-o-lok knot free layered suture group.The operation time,warm ischemia time,intraoperative bleeding,changes of hemoglobin and creatinine before and after operation,drainage tube extraction time,length of hospital stay and postoperative complications were compared between the two groups.Results All 140 patients underwent laparoscopic nephron sparing nephrectomy,and no open operation or radical operation was performed during the operation.There was no significant difference in gender,age,height,weight,tumor size,side,R.E.N.A.L score and pathological type and stage between the two groups(P>0.05).The operation time[(107.4±25.2) min vs (110.9±21.7)min],the indwelling time of drainage tube[(4.1±1.2)d vs (4.2±1.4)d] and length of hospital stay[(9.4±2.1) d vs (8.5±3.4)d] in one needle continuous suture group and Hem-o-lok knot free layered suture group had no significant difference(P>0.05).Compared with Hem-o-lok knot free layered suture group,the one needle continuous suture group had significantly shorter warm ischemia time[(19.9±3.3) min vs (23.9±4.9)min],significantly less intraoperative bleeding[(110.8±65.9)ml vs (167.9±125.4)ml],and significantly lower decrease of hemoglobin[(8.9±5.6)g/L vs (12.7±8.3)g/L] and higher increase of creatinine[(9.6±8.6)μmol/L vs (13.9±14.4)μmol/L] before and after operation(P<0.05).Conclusion For the enucleation wound of renal tumor(especially those involving the renal pelvis),the “one needle continuous suture method” with barb line is simple and effective.It can effectively reduce the complications such as perioperative bleeding and urinary leakage,significantly shorten the wound closure time,and release the vascular clamp blocking the renal artery as soon as possible,It can definitely prevent the excessive injury of residual renal tissue and function caused by medical thermal ischemia.

Objective To study the correlation of high mobility group box protein 1/toll-like receptor 4 (HMGB1/TLR4) signaling pathway with the risk of recurrence after interventional therapy for lower extremity arteriosclerosis obliterans (ASO) in the elderly.〖WTHZ〗Methods A total of 84 patients (96 vessels) with ASO who underwent interventional treatment from January 2020 to January 2021 were enrolled.One week after operation,the levels of HMGB1 and TLR4 mRNA in peripheral blood mononuclear cells (PBMCs) were detected by Real-time Reverse Transcription-Polymerase Chain Reaction (qRT-PCR),and the levels of serum endothelin-1 (ET-1) and high-sensitivity C-reactive protein (hs-CRP) were detected by radioimmunoassay and immunoturbidimetry.The patients were followed up for 12 months,and the restenosis of target vessels was counted.Patients were classified into recurrence group and control group according to the presence or absence of restenosis.The levels of HMGB1 and TLR4 mRNA in peripheral blood PBMCs and the levels of hs-CRP and ET-1 in serum were compared between groups,and the relationship between the above indexes and vascular restenosis in ASO patients after interventional therapy was discussed.Results Postoperative examination showed recanalization in 96 diseased vessels of 84 patients after interventional therapy.All patients completed a 12 months follow-up,and 16 patients (18 vessels) had restenosis (recurrence group) as indicated by ultrasound and CTA of both lower limbs.The levels of HMGB1 and TLR4 mRNA in peripheral blood PBMCs and the levels of hs-CRP and ET-1 in serum were remarkably elevated in recurrence group compared with control group,with statistical difference (all P＜0.05).Correlation analysis denoted that HMGB1 and TLR4 mRNA expression in peripheral blood PBMCs of patients in recurrence group were positively correlated with serum ET-1 and hs-CRP levels (r=0.393,0.378,0.411,0.407,P＜0.05).Conclusion The HMGB1/TLR4 signaling pathway may be involved in post-interventional recurrence in ASO patients by activating the release of inflammatory factors and promoting vascular injury.