Objective To report the surgical experience of “butterfly” corpus callosum glioblastoma (bGBM) resected by multimodal techniques assisted microsurgery.Methods The clinical data of 20 patients with bGBM who underwent multimodal techniques assisted microsurgery in our neurosurgery department from September 2016 to September 2022 were analyzed retrospectively.The best approach was selected according to the characteristics of preoperative imaging,and the surgical trajectory was confirmed by neuronavigation,and the ultrasound localization,nerve monitoring or magnetic resonance scanning during operation were performed.Surgical/clinical outcomes and complications were recorded.Results 12 cases achieved gross total resection and the median extent of resection was 96.7%(87.71%~100.0%).Among them,4 patients (20%) underwent intraoperative ultrasound resection,and 16 patients (80%) underwent iMRI guided resection.In which,3 patients identified residual tumors on the T1C sequence of iMRI,and continued to resect residual tumors with the assistance of neuronavigation and IONM,finally achieving total resection.New nerve dysfunction mainly includes motor disorder (1 case),memory disorder (2 cases) and language disorder (1 case),which are common in the pressure of corpus callosum,cadres and knees.At the last follow-up,the median MoCA score of survivors was 25 and the median KPS score was 80.The median disease-free survival time was 9.3 months,and the median total survival time was 11.6 months.Conclusion Multimodal techniques assisted microsurgery can achieve clinically significant resection of bGBM and obtain good clinical outcomes.

Objective To verify the secondary sentinel lymph node (SSLN) and for further exploration of refined sentinel lymph node biopsy (SLNB) for breast carcinoma via the assistance of preoperative contrast-enhanced ultrasound (CEUS) and novel crochet.Methods From December 2019 to November 2021,47 patients undergoing operation in the Breast and Thyroid Surgery Department of Peking University Shenzhen Hospital were prospectively collected.Preoperative contrast-enhanced ultrasound was performed for trace sentinel lymph node (SLN),SSLN and lymphatic channels.The SLNs were located by novel crochet.Meanwhile skin-marking was performed to label SLNs,SSLNs and lymphatic vessels.Intraoperatively,methylene blue and radioisotopes were adopted in SLNB.Both lymph nodes labeled preoperatively and intraoperatively were sent to the pathological department for definitive diagnosis,and the number of them was compared.Postoperative pathological features were analyzed.Results The CEUS identified a total of 62 SLNs in 47 patients,which are significantly fewer than methylene blue and radioisotopes(Z=-5.946,P＜0.05).The identification rate of positive SLNs was 11.29%,which is higher than methylene blue and radioisotopes(χ2=5.238，P＜0.05).A total of 83 SSLNs were identified by CEUS.The identification rate of SSLN and positive SSLN was 93.62% and 1.20% respectively.Conclusion The SSLN were successfully validated by preoperative contrast-enhanced ultrasound combined with crochet.

Objective To observe the expression and and clinical significance of long non-coding RNA (lncRNA) ANRIL and miR-191 in the plasma of patients with non-small cell lung cancer (NSCLC).Methods 153 patients with NSCLC first diagnosed in our hospital from May 2015 to August 2017 and 75 healthy physical examiners were selected.Plasma ANRIL and miR-191 levels were detected by quantitative real-time fluorescence PCR (qRT-PCR).The relationship between ANRIL and miR-191 expression levels and clinicopathological characteristics was analyzed.Kaplan-Meier was used to analyze the relationship between ANRIL and miR-191 expression levels and prognosis.COX regression was used to analyze the risk factors for poor prognosis of NSCLC patients.Results Plasma ANRIL (3.09±0.53) and miR-191 (2.82±0.47) levels were higher in NSCLC patients than in the normal population (0.64±0.04) and (0.42±0.07) (P<0.05).Plasma ANRIL and miR191 levels were higher in patients with low to moderate differentiation,stage Ⅲ+Ⅳ,and lymph node metastasis than in patients with high differentiation,stage Ⅰ+Ⅱ,and no lymph node metastasis (all P<0.05).5-year overall survival (OS) was lower in patients in the high ANRIL expression group (37/83,44.58%),the miR-191 high expression group (40/79,50.63%)than in the low ANRIL expression group (48/65,73.85%),the miR-191 low expression group (49/69,71.01%) (both P<0.05).Stage Ⅲ+Ⅳ,presence of lymph node metastasis,high plasma ANRIL expression and high plasma miR-191 expression were independent risk factors for poor prognosis in NSCLC patients (all P<0.05).Conclusion High plasma ANRIL and miR-191 expression in NSCLC patients were associated with stage,lymph node metastasis,differentiation degree and prognosis.

Objective To investigate the influences and mechanism of circHERC4 on the proliferation,migration and invasion of colorectal cancer (CRC) cells.Methods The CRC tissues and corresponding paracancerous tissues of 68 CRC patients who underwent surgical treatment in The First Affiliated Hospital of Shaoyang University from June 2020 to December 2021 were collected.Real-time quantitative PCR (qRT-PCR) was used to detect the expression levels of circHERC4,miR-105-5p and cellular S-phase kinase-associated protein 2 (Skp2) mRNA in tissues and cells;Western blot was applied to detect the expression of Skp2 protein in cells;CCK-8,plate cell cloning assay,scratch healing assay,and Transwell assay were applied to detect cell proliferation,migration,and invasion,respectively.Results The expressions of circHERC4 and Skp2 mRNA were up-regulated in CRC tissues,while the expression of miR-105-5p was down-regulated (P<0.05),the expression levels of circHERC4,miR-105-5p and Skp2 mRNA in CRC tissues were correlated with each other (P<0.05).Knockdown of circHERC4 or overexpression of miR-105-5p could inhibit the proliferation,migration and invasion of HCT116 cells and the expression of Skp2 in cells (P<0.05),while overexpression of Skp2 could partially reverse the inhibitory effects of miR-105-5p overexpression on the proliferation,migration and invasion of HCT116 cells (P<0.05),and inhibiting the expression of miR-105-5p could partially reverse the inhibitory effects of knockdown of circHERC4 on the proliferation,migration and invasion of HCT116 cells (P<0.05).Conclusion Knockdown of circHERC4 can inhibit the proliferation,migration and invasion of HCT116 cells by regulating the miR-105-5p/Skp2 axis.

Objective  To investigate whether artemisinin regulates the proliferation,apoptosis and secretion of inflammatory factors in gastric cancer cells through the Toll-like receptor 4 (TLR4)/nuclear factor-κB (NF-κB) signaling pathway.Methods Gastric cancer AGS cells were divided into control (NC) group,50μmol/L artemisinin group,100μmol/L artemisinin group,200μmol/L artemisinin group,pcDNA+200μmol/L artemisinin group and pcDNA-TLR4+200μmol/L artemisinin group.After the treatment,CCK-8 method was performed to detect cell proliferation activity,flow cytometry was used to measure cell apoptosis,cyclin D1 (CyclinD1),activated cysteine-containing aspartate proteolytic enzyme-3 (Cleaved-caspase-3),TLR4,p-p65,and p65 levels were detected by Western blot.The expression of tumor necrosis factor-α (TNF-α),interleukin (IL)-6 and IL-1β inflammatory factors were tested by enzyme-linked immunosorbent assay (ELISA),and the expression of TLR4 mRNA was detected by RT-qPCR.Results Compared with the NC group,the AGS cell proliferation activity,the expression levels of CyclinD1 protein,TNF-α,IL-6,IL-1β,TLR4 mRNA,TLR4 protein and p-p65/p65 ratio decreased in 50-μmol/L artemisinin group,100μmol/L artemisinin group and 200μmol/L artemisinin group.The apoptosis rate and Cleaved-caspase-3 level increased,and there was a statistically significant difference between the artemisinin group and the NC group at different concentrations (P<0.05).The ratio of p-p65/p65 in AGS cells in the 200 μmol/L artemisinin group was lower than that in the NC group,and the difference was statistically significant (P<0.05).Compared with the pcDNA+200 μmol/L artemisinin group,the expression level of TLR4 mRNA,proliferation activity,the expression level of CyclinD1 protein,TNF-α,IL-6,IL-1β and p-p65/p65 ratio in AGS cells in the pcDNA-TLR4+200 μmol/L artemisinin group increased,the apoptosis rate and the level of Cleaved-caspase-3 decreased,and the difference between the two groups was statistically significant (P<0.05).Conclusion Artemisinin inhibits the proliferation activity and inflammatory factor secretion of gastric cancer cells by down-regulating the TLR4/NF-κB signaling pathway,and promotes apoptosis.

Objective  To explore the feasibility and safety of hyperthermic intraperitoneal chemotherapy in patients with colorectal cancer undergoing radical resection followed by enterostomy.Method This study retrospectively analyzed the clinical data of 184 patients with colorectal cancer admitted to Affiliated Union Hospital,Tongji Medical College,Huazhong University of Science & Technology from April 2021 to December 2021,and divided them into three groups: radical resection + hyperthermic intraperitoneal chemotherapy (n=117),radical resection + enterostomy (n=36),and radical resection + enterostomy + hyperthermic intraperitoneal chemotherapy (n=31).Tube patency was evaluated by hyperthermic intraperitoneal chemotherapy curve analysis,and adverse events occurring during treatment observation were graded according to the common terminology criteria for adverse events (CTCAE 5.0) published by the US Department of Public Health.Binary logistic regression was used to analyze the independent risk factors affecting the patency of hyperthermic intraperitoneal chemotherapy tube,and χ2 test and Fisher’s exact test were used to analyze the effect of hyperthermic intraperitoneal chemotherapy on the occurrence of perioperative adverse events in colorectal cancer patients who underwent enterostomy after radical resection.Results A total of 255 times of hyperthermic intraperitoneal chemotherapy were completed in 148 patients who underwent hyperthermic intraperitoneal chemotherapy after radical resection,of which 125 times (49.0%) had smooth perfusion process,84 times (32.9%) had smooth perfusion process after adjustment,and 46 times (18.0%) had unsmooth perfusion process.The results of binary logistic regression analysis indicated that enterostomy was an independent risk factor for incomplete patency events and complete occlusion events in colorectal cancer patients who underwent hyperthermic intraperitoneal chemotherapy after radical resection (P＜0.05 for all).Of the 67 patients with colorectal cancer who underwent radical resection followed by enterostomy,a total of 35 (52.2%) had perioperative adverse events of varying degrees,including 29 patients with grade 2 adverse events,6 patients with grade 3 adverse events,no patients with perioperative grade 4 adverse events,and no perioperative deaths.There was no significant difference in the incidence rate of perioperative adverse events between colorectal cancer patients who underwent enterostomy after radical resection without hyperthermic intraperitoneal chemotherapy and those who underwent enterostomy after radical resection and hyperthermic intraperitoneal chemotherapy (P>0.05).Conclusion Occlusion events are common in patients with colorectal cancer who undergo hyperthermic intraperitoneal chemotherapy after radical resection.For colorectal cancer patients undergoing intraperitoneal hyperthermic perfusion chemotherapy after radical resection,enterostomy significantly increases the risk of incomplete patency events and complete occlusion events,increasing the difficulty of operation,but it is still safe and feasible.

Objective To explore a convenient and feasible perioperative enhanced recovery interventions of laparoscopic sleeve gastrectomy (LSG).Methods Retrospective study was performed on the clinical data of 64 patients undergoing LSG in the Third People’s Hospital of Xinjiang Uygur Autonomous Region from January 2019 to June 2022,including 11 males and 53 females.Age ranged from 24 to 51 years,They were divided into 2 groups:the control group (n=31) received routine perioperative enhanced recovery and weight loss surgical interventions and the experimental group (n=33) received the adjusted perioperative enhanced recovery and weight loss surgical interventions.The operation-related indexes,laboratory indexes at 48 hours after operation and the occurrence of surgical complications (Grade Ⅰ-Ⅱ:fever,incisional infection,postoperative nausea and vomiting,epigastric pain,pulmonary infection.Grade Ⅲ-Ⅳ:pleural effusion,gastrointestinal leakage,abdominal bleeding,deep vein thrombosis.Grade V:death) were compared and analyzed between the two groups.Result There were no statistically significant differences between the 2 groups in terms of operative time,operative bleeding,number of nail bins used,unplanned increase in the number of trocar holes,time to first anal discharge,time to feed,length of hospital stay,postoperative hospital stay,and 48h postoperative white blood cell count,calcitoninogen,lactate,oxygen saturation,serum sodium,serum potassium,albumin,triglyceride and urea levels (P>0.05).The hospitalization cost,incidence of postoperative nausea and vomiting and total incidence of surgical complications were higher in the control group than in the experimental group,and the differences were statistically significant (P<0.05).Conclusion  In the perioperative enhanced recovery interventions of LSG,It is maybe safe and feasible that abdominal drainage tube and central venous catheter were not routinely placed in normal patients,and management of venous embolism were not routinely placed on the basis of early ambulation (24h after surgery) and water and food intake (24-48h after surgery) in patients without anemia,coagulopathy or not undergoing anticoagulant therapy.Gastric tube indwelling for 12-24 hours can reduce the occurrence of postoperative nausea and vomiting and upper abdominal pain.

Objective To investigate the efficacy of biological extended stem hemiarthroplasty for elderly patients with unstable intertrochanteric fractures of the femur.Methods A retrospective analysis was conducted on 80 elderly patients with unstable intertrochanteric fractures of the femur treated with biological extended stem hemiarthroplasty from February 2018 to February 2023.The Harris score was used to evaluate the efficacy of hip joint function.Results All 80 cases were followed up for an average follow-up time of 10.3 (6~22) months.After 6 months of surgery,the hip joint function recovered according to Harris score with an average score of 85.6 (72~94).Among them,42 cases were excellent,28 cases were good,and 10 cases were still good,with a good rate of 87.5%．Conclusions The selection of biological extended stem hemiarthroplasty for the treatment of unstable intertrochanteric fractures of the femur in elderly patients has the advantage of fast postoperative recovery,early weight bearing,reduced various complications of long-term bed rest,and achieved good joint function．

Objective  To investigate the effect of ulnar styloid fracture and its type on distal radius fracture surgery.Methods A total of 92 patients with distal radius fracture were randomly selected in our hospital from January 2020 to December 2021.According to whether the patients were combined with ulnar styloid fracture and the Hauck classification criteria of fracture,they were divided into non-combined group(n=48),type Ⅰ group (n=21) and type Ⅱ group(n=23).The palmar angle,ulnar declination,height recovery of radial styloid,Gartland-Werly score,grip strength and DASH score preoperative,6 months and 1 year after surgery in 3 groups were collected and compared.The complication in 3 groups were compared.Results Before operation,there was no statistically significant difference in the palm angle,ulnar deviation angle,radius styloid process height and joint surface flatness in 3 groups (P>0.05).6 months and 1 year after operation,the palm angle,ulnar deviation angle,radius styloid process height and joint surface flatness in 3 groups were improved (P<0.05).Except for the palm angle and ulnar deviation angle in 3 groups at 6 months after operation,there was no statistically significant difference in the other imaging parameters at 6 months and 1 year after operation(P>0.05).There was no significant difference in the Gartland-Welly score in 3 groups at 6 months and 1 year after operation(P>0.05).Before operation,there was no significant difference in grip strength and DASH score among in 3 groups (P>0.05).6 months and 1 year after operation,the grip strength and DASH score of in 3 groups were improved (P>0.05).No obvious complications occurred in 3 groups.Conclusion Type Ⅱ styloid fracture can affect the postoperative effect of distal radius fracture,while type Ⅰ styloid fracture has little effect on wrist function.

Objective To study the expression of RNA PolymeraseⅢ Subunit G (POLR3G) expression in muscle-invasive bladder cancer (MIBC) and its relationship with response to adjuvant chemotherapy (ACT) or prognosis.Methods 42 consecutive MIBC patients were recruited from March 2016 to January 2022 and treated by radical cystectomy in our hospital.Quantitative real-time polymerase chain reaction (qRT-PCR) was used to analyze the expression of POLR3G in MIBC clinical samples,to construct the relationship between tissue POLR3G expression and clinical characteristics of patients,and to further analyze clinical outcomes.Results In clinical cohort analysis,higher expression of POLR3G mRNA in MIBC tissues was associated with higher tumor grade and pT stage (P＜0.05).Kaplan-Meier survival analysis showed that OS (median:9.5 months vs.25.0 months) and PFS (median:15.0 months vs.25.0 months) in patients with high POLR3G expression were significantly shorter than those in the low POLR3G expression subgroup (P＜0.05).In addition,the overexpression of POLR3G in tissues was an independent prognostic indicator of poor PFS (P=0.003) and OS (P=0.048) in MIBC patients.Compared with pT3/4 or N+ MIBC patients with high POLR3G expression receiving ACT,patients with pT3/4 or N+ MIBC with low POLR3G expression receiving ACT had significantly longer OS (P＜0.001).Conclusion POLR3G mRNA expression is upregulated in MIBC tissues,which may be a potential prognostic indicator of MIBC,and may be a candidate marker for predicting adjuvant chemotherapy in patients with local progression.

Objective To investigate the therapeutic effect and postoperative complications of negative pressure suction stone clearing sheath assisted percutaneous nephrolithotomy(PCNL) applied to kidney stones,and to analyze the influence of postoperative complicated infection.Methods The clinical data of 260 renal stone patients who underwent PCNL in our hospital from January 2020 to October 2022 were reviewed,divided into negative pressure suction group(118 cases) versus control group(142 cases) according to whether negative pressure stone clearing sheath was applied intraoperatively,and the baseline data,perioperative conditions as well as postoperative complications were statistically compared between the two groups.We further divided the infected group into infected group vs.uninfected group according to whether postoperative intercurrent infection was observed,and the data of the two groups were recalibrated,and multivariate logistic regression model was used to analyze the factors related to postoperative intercurrent infection after PCNL in patients with renal stones.Results There were no significant differences in baseline data such as gender,age,BMI,stone location,and stone length diameter between the two groups(P>0.05),and there were no significant differences in perioperative conditions such as operation time,intraoperative blood loss,and stone clearance rate(P>0.05).However,the postoperative hospital stay in the negative pressure suction group was shorter than that in the control group(P<0.05).The incidence of abnormal blood routine [6.78%(8/118) vs.17.61%(25/142)] and SIRS [5.08%(6/118) vs.14.08%(20/142)] in the negative pressure suction group were lower than those in the control group(P<0.05).Multivariate Logistic regression analysis showed that:BMI≥25kg/m2(OR=4.329),diabetes mellitus(OR=3.096),stone diameter ≥3.0cm(OR=2.905) were independent risk factors for postoperative infection in patients with renal calculi after PCNL(P<0.05).Negative pressure suction of stone sheath(OR=0.305) was a protective factor for postoperative infection in patients with renal calculi after PCNL(P<0.05).Conclusion PCNL assisted by negative pressure suction Qingshi sheath can significantly reduce the incidence of postoperative infection in patients with kidney stones,and is conducive to rapid postoperative recovery.BMI≥25kg/m2,diabetes mellitus and stone diameter ≥3.0cm are risk factors for postoperative infection.

Objective To investigate the status of neurotropic invasion (PNI) in patients with colorectal cancer resection and its correlation with prognosis.Methods A total of 200 patients who underwent colorectal cancer resection in our hospital from September 2018 to August 2019 were prospectively selected as research objects,and divided into PNI group and no PNI group according to whether PNI occurred.The general data such as clinical characteristics and condition of the two groups were compared,and the postoperative overall survival time (OS) of all patients was recorded to evaluate the prognosis.The Kaplan-Meier method was used to analyze the prognosis of patients with different characteristics;Cox regression was used to analyze the prognostic factors of colorectal cancer patients after resection.Results Among the 200 patients,39 (19.50%) had PNI and were classified as PNI group,and the remaining 161 patients were classified as non-PNI group;Compared with non-PNI group,the tumor diameter in PNI group was larger,the proportion of T stage T3 to T4,the proportion of metastatic lymph nodes and the proportion of postoperative adjuvant therapy were higher (P<0.05);Kaplan-Meier curve showed that the 3-year overall survival time of patients with pathological stages T3 to T4 was significantly lower than that of patients with pathological stages T1 to T2 (Log-rankχ2=3.936,P=0.047).The 3-year overall survival of PNI positive patients was significantly lower than that of PNI negative patients (Log-rankχ2=10.629,P<0.001).The 3-year overall survival time after adjuvant treatment was significantly higher than that without adjuvant treatment (Log-rankχ2=8.362,P=0.003).The 3-year overall survival of PNI positive patients was significantly higher than that of PNI negative patients (Logrankχ2=28.824,P<0.001).Without adjuvant treatment,the 3year overall survival time of PNI-negative patients was significantly higher than that of PNI-positive patients (Logrankχ2=6.509,P=0.011).Cox multivariate regression analysis showed that:T3~T4 (HR=3.228,95%CI 1.813~5.747),proportion of metastatic lymph nodes (HR=3.304,95%CI 1.996~5.469),large tumor diameter (HR=2.571,95%CI 1.161~5.694),positive PNI (HR=2.792,95%CI 1.669~4.669) was a risk factor for prognosis after colorectal cancer resection (all P<0.05).Conclusion PNI phenomenon exists in patients undergoing colorectal cancer resection,and PNI is related to prognosis.

Objective To analyze the changes of gait parameters in patients with Crowe type Ⅳ developmental hip dysplasia (DDH) before and after total hip replacement (THA) with anatomic location and subtrochanteric osteotomy.Methods 46 patients with Crowe type Ⅳ DDH from January 2018 to June 2022 were selected as the observation group.THA was performed in all patients with anabular cup and subtrochanteric osteotomy.Gait tests were performed before surgery and 6 months after surgery.The spatio-temporal parameters,kinematic parameters and dynamic parameters (peak joint torque,peak surface reaction force) before and after treatment were analyzed.Meanwhile,according to age,sex and height,46 healthy subjects were matched as control group.They performed the same gait test.Results Six months after operation,multiple spatio-temporal parameters,kinematic parameters and dynamic parameters in the observation group improved compared with those before operation,and bilateral spatio-temporal parameters,joint torque peak and ground reaction force parameters except the medial peak all tended to be consistent.The bilateral step length,stride frequency,swing period,hip flexion moment,hip extension moment,knee flexion moment,ankle plantar flexion moment,longitudinal peak 1,longitudinal peak 2,forward peak,backward peak,hip maximum flexion,hip maximum extension,hip maximum sagittal range of motion,knee maximum flexion,knee maximum dorsalis extension,ankle maximum malleolus and ankle sagittal range of motion of the observation group were lower than that of the control group before and 6 months after surgery.The bilateral Step time,brace period,maximum knee extension  and intraoperative medial peak of operative side before and 6 months after surgery were higher than that of the control group (P<0.05).Conclusion The gait of patients with Crowe type Ⅳ DDH improve significantly after THA anatomic location and subtrochanteric osteotomy with good symmetry,but there are still some differences from normal patients,suggesting that patients still need to strengthen rehabilitation training to further improve their gait.

Objective To measure the shape of renal pelvis and calyces by three-dimensional digital measurement,analyze its correlation with the occurrence of kidney stones,and explore the correlation between anatomical morphological factors and disease,so as to provide important reference for the prevention and treatment of kidney stones in central Inner Mongolia.
Methods Patients with kidney stones who visited the department of Urology, Affiliated Hospital of Inner Mongolia Medical University from January 2018 to May 2021 were randomly collected,The patients who lived in the central Inner Mongolia(Hohhot, Ordos, Baotou, and Jining for >10 years before the illness) for a long time were chosen as the experimental group [68 cases,(52.12±16.32)years old].68 cases were chosen as the control group[including 43 cases on the normal side of patients and 25 cases in the normal people,(49.52±18.14)years old],excluding patients with abnormal metabolism and organic kidney disease.CT data were imported into Mimics16.01 software for 3D digital reconstruction after iodoparol urography,and measured six indicators of anteroposterior diameter of renal pelvis(APD),infundibular width(IW),infundibular length(IL),infundibular pelvis angle(IPA),calyx and pelvis height(CPH),renal pelvis and hilum width(RHW) were analyzed.The above indexes were compared between groups and Logistics regression analysis was carried out with the formation of kidney stones.Results There was no significant difference between the APD and the RHW in the experimental group and the control group (P>0.05),and there were statistically significant differences in IL,IW,IPA and CPH between the two groups (P<0.05).There was no significant correlation between the APD,IW and the formation of renal stones (P>0.05),IW and IPA were negatively correlated with the formation of kidney stones,while IL and CPH were positively correlated with the formation of kidney stones.Conclusion Three-dimensional digital reconstruction can clearly display the renal pelvis, calyces and calculi lesions. There was no significant correlation between the anterior and posterior pelvis diameter and the width of the pyelonephric gate and the occurrence of kidney stones,while the IW,IL,IPA and CPH have certain correlation with the occurrence of renal calculi.

Objective To investigate the value of dexmedetomidine combined with ropivacaine type Ⅱ pectoral nerve block (PECS Ⅱ) in breast segmental resection.Methods A total of 168 patients who underwent elective breast segmental resection in our hospital from March 2020 to March 2022 were selected and divided into the combined group (dexmedetomidine combined with ropivacaine PECS Ⅱ,n=84) and the conventional group (ropivacaine PECS Ⅱ,n=84) according to the simple random method with a coin toss.The hemodynamics,quality of anesthesia recovery,perioperative pain stress factors,immune function,postoperative recovery and adverse reactions were compared at T0, 10 minutes after PECSⅡ (T1), immediately after intubation (T2), 5 minutes after intubation (T3), at extubation (T4), 5 minutes after extubation (T5).Results At T0, there was no significant difference in heart rate and mean arterial pressure between the two groups(P<0.05).At T1~T5,the heart rate and mean arterial pressure in the two groups were lower than those at T0 (P<0.05),and the heart rate and mean arterial pressure in the combind group were lower than those in the conventional group at the above time points,with statistically significant differences (P<0.05);The onset time of sensory block,extubation time and recovery time of spontaneous respiration in the combined group were (7.75±2.43) min,(14.59±1.53) min and (8.96±1.57) min,respectively,which was shorter than those in the conventional group[(10.23±3.02)min,(16.23±1.79)min,(11.63±2.79)min],and the maintenance time was (752.52±60.25) min,which was longer than that in the conventional group (489.36±90.14) min (P<0.05).The dosage of remifentanil and sufentanil in the combined group was (0.81±0.12) mg and (98.42±2.63) μg,respectively,which was less than that in the conventional group (0.93±0.22) mg and (103.52±1.44) μg,and the times of self-controlled analgesia pump were (2.01±0.35) times,which was less than those in the conventional group (3.35±0.55) times,with statistically significant differences (P<0.05).The levels of cortisol,norepinephrine and epinephrine in the combined group at 2 hours after operation were (311.71±50.53) mmol/L,(306.51±75.25) ng/ml and (80.02±21.02) ng/ml,respectively,which was lower than those in the conventional group [(398.61±98.14) mmol/L,(378.52±83.14) ng/ml,(101.75±25.01) ng/ml],and CD3+ and CD4+ were (50.02±5.79) % and (32.25±5.76) %,respectively,which was higher than those in the conventional group (47.52±6.71) % and (29.87±6.33) %,with statistically significant differences (P<0.05).1 day after surgery,the scores and total scores of all dimensions of the postoperative recovery quality scale in the combined group were higher than those in the conventional group,with statistically significant differences (P<0.05).There was no statistically significant difference in adverse reactions between the two groups (P>0.05).Conclusion Dexmedetomidine combined with ropivacaine PECSII can maintain the stability of intraoperative hemodynamics in patients with breast segmental resection,reduce surgical stress and influence on immune function,prolong analgesia time,improve the quality of anesthesia and postoperative recovery of patients,with high safety.

Bariatric surgery is an effective measure for treating severe obesity and metabolic-related diseases;however,it carries the risk of postoperative loss of lean mass and skeletal muscle.Exercise,as an important non-pharmacological intervention,is widely recognized for its positive role in weight loss.In the implementation of exercise interventions following bariatric surgery,aerobic exercise,resistance training,and their combination have been found to optimize weight loss outcomes,further improve metabolic status,develop muscle strength,and enhance cardiorespiratory function.To optimize the effects of bariatric surgery and improve the overall health of postoperative patients, future research should consider the surgical procedure,  exercise modalities, and individual characteristics of the patients. Moreover, comprehensive interventions and personalized approaches targeting postoperative health behaviors should also be implemented.