Objective To evaluate the clinical efficacy and safety of preoperative endovascular embolization of Solid Hemangioblastomas. Methods The data bases including Wan Fang,CNKI(China National Knowledge Infrastructure),VIP Database,PubMed、Medline、Springer were searched for the related studies.Two independent surgeons assessed trails for eligibility and quality,and all data marching the standards were abstracted for Meta-analysis by RevMan 5.3. Results 8 randomized controlled trails (RCT) were included.Selected analysis of embolized and non-embolized groups of Solid Hemangioblastomas were observed for variables of clinical efficacy in surgery time,number of blood loss and transfusions,complete resection,there were statistical difference.(P<0.000 01，WMD=-1.18, 95%CI[-1.16,-0.71];P<0.000 01，WMD=-464.17,95%CI[-492.17,-437.24];P<0.000 01， WMD=-238.81,95%CI[-282.84,-194.77];P<0.006，RR=1.17,95%CI[1.05，1.31]). Conclusion The preoperative endovascular embolization is beneficial for Hemangioblastomas because it can shorten the time of surgery,diminish the necessity of intra-operative blood loss and transfusion,it also raises the ratio of complete resection of Solid Hemangioblastomas.

Objective The combined detection of serum angiopoietin-like protein 8 (ANGPTL8) and Vascular cell adhesion molecule-1 (VCAM-1) levels was analyzed for the predictive value of cerebral vasospasm (CVS) after intracranial aneurysm embolization. Methods A total of 196 patients who underwent intracranial aneurysm embolization in our hospital from March 2019 March 2022 were selected as the study subjects,99 patients with CVS were in the CVS group,and 97 patients without CVS were in the non CVS group.Serum ANGPTL8 and VCAM-1 levels were detected by ELISA;the correlation between serum ANGPTL8 and VCAM-1 levels was analyzed by Pearson method,Logistic regression was used to analyze the influencing factors of CVS in patients undergoing intracranial aneurysm embolization;ROC curve was used to analyze the serum levels of ANGPTL8 and VCAM-1 to predict the cutoff value of CVS in patients undergoing intracranial aneurysm embolization;four grid table method was used to analyze the predictive value of ANGPTL8,VCAM-1 and their combination on the occurrence of CVS in patients undergoing intracranial aneurysm embolization. Results The differences between CVS and non-CVS groups were statistically significant in hypertension, Hunt-Hess grade, and Glasgow coma (GCS) scores (P<0.05). The serum ANGPTL8 and VCAM-1 levels in the CVS group were significantly higher than those in the non-CVS group (P<0.05).There was a positive correlation between serum ANGPTL8 and VCAM-1 (r=0.468,P<0.05).Multivariate analysis showed that high level of ANGPTL8 (OR=3.652,95% CI:1.434-9.302),high level of VCAM-1 (OR=2.619,95% CI:1.212-5.658),Hunt Hess grade Ⅲ-Ⅳ (OR=1.927,95% CI:1.104-3.362),GCS score of 3-8(OR=2.813,95% CI:1.257-6.295) were independent risk factors for CVS in patients undergoing intracranial aneurysm embolization.The AUC of serum ANGPTL8 level in predicting CVS in patients undergoing intracranial aneurysm embolization was 0.844,and the cut-off value was 189.233U/L;the AUC of serum VCAM-1 level in predicting CVS in patients undergoing intracranial aneurysm embolization was 0.795,and the cutoff value was 17.984mg/L.The accuracy,sensitivity and specificity of the combined prediction for CVS were 89.81%,93.94% and 85.57%,respectively,which were obviously higher than those of the single prediction.Conclusion The serum levels of ANGPTL8 and VCAM-1 in CVS group are obviously higher than those in non CVS group.The combination of the two has a high predictive value for CVS after intracranial aneurysm embolization.

Objective To summarize the clinical experience in the treatment of postoperative upper gastrointestinal cancer of esophageal cancer. Methods The clinical data of 16 patients with postoperative upper gastrointestinal malignancies treated in our hospital from January 2018 to June 2022 were retrospectively analyzed. Results All the 16 patients successfully completed the operation,and no perioperative death occurred.The cumulative length of hospitalization was 18-38 days.After operation,2 cases of pulmonary infection,1 case of respiratory failure,and 1 case of cervical anastomotic fistula were cured after conservative treatment.All patients could eat normally during postoperative follow-up,and no tumor recurrence and metastasis was found. Conclusion For patients with recurrent upper gastrointestinal cancer after esophageal cancer surgery,if the lesion is relatively limited,surgical treatment is reliable and an optional treatment plan.

Objective To investigate the difference in the expression of long non-coding RNA NORAD(LncRNA NORAD) and microRNA-199a-3p(miR-199a-3p) in the serum of patients with esophageal squamous cell carcinoma and healthy people,and analyze their diagnostic value for esophageal squamous cell carcinoma. Methods A total of 286 patients with esophageal squamous cell carcinoma admitted to our hospital from January 2018 to December 22 were included in the esophageal squamous cell carcinoma group,the clinicopathological characteristics were recorded,in the same period,204 healthy people excluding esophageal squamous cell carcinoma and other systemic diseases were included as the healthy control group.The expression levels of serum LncRNA NORAD and miR-199a-3p were detected by real-time fluorescence quantitative PCR(qRT-PCR);Pearson correlation was applied to analyze the correlation between serum LncRNA NORAD and miR-199a-3p expression levels;the diagnostic value of serum LncRNA NORAD and miR-199a-3p expression levels in esophageal squamous cell carcinoma was analyzed by the ROC curve. Results The expression level of serum LncRNA NORAD in esophageal squamous cell carcinoma group was higher than that in healthy control group,the expression level of miR-199a-3p was obviously lower than that in the healthy control group(P<0.05).There was a negative correlation between serum LncRNA NORAD and miR-199a-3p expression in patients with esophageal squamous cell carcinoma(r=-0.649,P<0.05).The proportions of high expression of LncRNA NORAD and low expression of miR-199a-3p in patients with lymph node metastasis,TNM stage T3+T4 and poorly differentiated esophageal squamous cell carcinoma were higher than those in patients with no lymph node metastasis,TNM stage T1+T2 and moderately/highly differentiated esophageal squamous cell carcinoma,with statistically obvious difference(P<0.05).The AUC of LncRNA NORAD and miR-199a-3p in the diagnosis of esophageal squamous cell carcinoma was 0.817,0.796 and 0.854,respectively. Conclusion The serum level of LncRNA NORAD is high and miR-199a-3p is low in patients with esophageal squamous cell carcinoma.LncRNA NORAD and miR-199a-3p can both be used as an auxiliary diagnostic index for esophageal squamous cell carcinoma.

Objective To investigate the potential benefits of thoracic duct vein anastomosis in the management of recurrent and severe chylothorax. Methods According to the drainage volume and presence of thoracic duct injury，63 chylothorax patients admitted to our hospital from January 2014 to December 2021 were divided into two groups: A and B. Among them, a total of 37 patients in Group A had a daily thoracic drainage volume of <1000ml and no thoracic duct injury; a total of 26 patients in Group B had a daily drainage volume of >1000ml and had thoracic duct injury confirmed by lymphangiography. Different methods of intervention such as conservative treatment, thoracic duct ligation or thoracic duct and vein anastomosis are used to intervene, and the patient’s symptoms, the characteristics and amount of thoracic closed drainage fluid, postoperative recovery time and prognosis are observed. Results According to multifactor analysis, patients over the age of 60 (p<0.01), with a long history of smoking (p=0.04), prolonged alcohol consumption (p=0.03), and a history of malignancy (p=0.02) exhibited a higher incidence of Group B chylothorax. Most chylothorax cases in Group A were successfully treated using conservative methods. Among the 21 patients in Group B treated through thoracic duct ligation surgery, 3 cases showed recurrence of chylothorax. These 3 patients were cured by performing thoracic duct with venous anastomosis. Conclusion Chylothorax cases with a daily drainage volume exceeding 1000ml and accompanying thoracic duct injury should be treated promptly and aggressively with surgical intervention.Thoracic duct ligation has shown favorable treatment outcomes for typical chylothorax cases.However,in the event of persistent and recurrent severe chylothorax,a thoracic duct surgery with innominate or odd vein anastomosis may prove to be more effective.

Objective To analyze the risk factors for recurrence of primary spontaneous pneumothorax and to establish a prediction model. Methods The clinical data of 803 patients clearly diagnosed with primary spontaneous pneumothorax in the First Affiliated Hospital of Xinjiang Medical University from January 2010 to January 2021 were retrospectively analyzed,and 70% of the patients were randomly included in the modeling group (562 patients) and 30% in the validation group (241 patients).Risk factors for recurrence were analyzed by univariate and multivariate Cox regression using R 4.2.1 software,and a Nomogram prediction model was developed.Receiver operating characteristic curves were plotted,and the area under the curve (AUC) was calculated to assess model discrimination,and calibration curves were plotted to assess model calibration. Results The overall recurrence rate was 22.67% (182/803).Multivariate Cox regression analysis showed that age,smoking index,dystrophic severity score and treatment regimens were independent risk factors for recurrence of primary spontaneous pneumothorax,and the AUC of the Nomogram prediction model was 71.7% (95% CI 64.1-79.2),with high predictive efficiency. Conclusion This recurrence prediction model of primary spontaneous pneumothorax can assist clinicians to accurately assess the risk of recurrence in individual patients.

Objective To investigate the effect of cervical manual stratified anastomosis and anastomosis with tube stapler on the recent complications in thoracic laparoscopy combined with radical resection of esophageal cancer．Methods From February 2019 to April 2022,a total of 196 patients who underwent endoscopic surgery for esophageal cancer who met the study criteria were divided into the manual group (87 cases) and the tubulostomy group (109 cases) according to the different ways of gastro-esophageal cervical anastomosis.The incidence of cervical surgery time,total operation time,postoperative anastomotic fistula,anastomotic stenosis and other complications of the two groups were evaluated,and the differences in treatment effects between the two groups were compared．Results The preoperative basic conditions of patients in the manual group and the tube kiss group were comparable,and the cervical anastomosis time in the tube kiss group[(23±3.57)min] was shorter than that in the manual group[(31±4.5)min] (P<0.05),but there was no statistical significance in the overall operation time between the two groups (P>0.05).The comparison of postoperative anastomotic fistula and anastomotic stenosis between the two groups showed that the manual group was significantly lower than the tube kiss group,and the difference was statistically significant (P<0.05)．Conclusion In thoracic laparoscopic combined with esophageal cancer surgery,cervical manual stratified anastomosis can reduce the incidence of postoperative anastomotic complications． 

Objective To investigate the expression and clinical significance of microRNA (miR)-539-5p, Caspase activity and apoptosis inhibitory factor 1 (CAAP1) in gastric cancer tissue. Methods The gastric cancer tissue specimens and corresponding adjacent tissues of gastric cancer patients (102 cases) who underwent surgery in Xi ’an Ninth Hospita from January 2018 to December 2019 were collected, and the expression levels of miR-539-5p and CAAP1 in the tissues were detected and compared. The relationship between the expression of miR-539-5p and CAAP1 and clinicopathological parameters and prognosis was explored. The correlation between miR-539-5p and CAAP1 expression was analyzed by Pearson method. Kaplan-Meier method was used to analyze the survival time of gastric cancer patients. Cox regression model was used to analyze the prognostic factors of patients with gastric cancer. Results The expression level of miR-539-5p in gastric cancer tissue lower than that in adjacent tissue, and the expression level of CAAP1 higher than that in adjacent tissue (P<0.05). There was a negative correlation between the expression levels of miR-539-5p and CAAP1 in gastric cancer tissue (P=0.000). Further analysis showed that the expression of miR-539-5p and CAAP1 in gastric cancer tissue was greatly correlated with TNM stage, depth of invasion, lymph node metastasis and tumor size (P<0.05). The 3year survival rate of miR-539-5p high expression group was higher than that of low expression group (P=0.045). The 3year survival rate of CAAP1 high expression group which was lower than low expression group (P=0.015). Cox regression showed that TNM stage, depth of invasion, lymph node metastasis and miR-539-5p and CAAP1 expression were prognostic factors in patients with gastric cancer (P<0.05). Conclusion The decreased expression level of miR-539-5p and increased expression level of CAAP1 in gastric cancer tissues were related to TNM staging, depth of invasion, lymph node metastasis and tumor size, and they are closely related to the prognosis of patients.

Objectivem To explore the protective effect of laparoscopic radical resection of rectal cancer on urinary function based on membrane anatomy. Methods Ninety-two patients with rectal carcinoma underwent surgical treatment in our hospital from August 2019 to August 2021 were enrolled,and divided into two groups according to random number table methods,each with 46 cases.The reference group received laparoscopic radical resection of rectal cancer,and the study group received laparoscopic radical resection of rectal cancer under membrane anatomy.The operation related indexes,urination function indexes,incidence of urination dysfunction,postoperative complications and 1year prognosis were compared between two groups. Results Compared with reference group,study group had significantly less intraoperative bleeding,shorter postoperative anal exhaust time and significantly longer operative time,with statistical difference (P<0.05).Compared with reference group,the catheter removal time and residual urine volume of study group were significantly reduced (P<0.05),the maximum urine flow rate was significantly increased (P<0.05),and no statistical significance was found in urine volume between two groups (P>0.05).The incidence rate of urination dysfunction was 10.87% in study group,which was notably lower than 30.43% in reference group,with statistical difference (P<0.05).The incidence rate of postoperative complications demonstrated no statistical difference between two groups (P>0.05).One year after surgery,the distant metastasis rate (2.17% vs 4.35%),recurrence rate (4.35% vs 6.52%) and mortality rate (2.17% vs 2.17%) yielded no statistical difference between two groups (P>0.05). Conclusion Application of laparoscopic radical resection of rectal carcinoma based on membrane anatomy has a certain protective effect on the urinary function of patients and can effectively reduce the incidence of postoperative urinary dysfunction.

Objective To investigate the effect of laparoscopic radical resection of rectal cancer by reserving the left colon artery and root lymph node accurately according to different types of inferior mesenteric artery. Methods In this study,80 cases of rectal cancer patients diagnosed and treated from January 2019 to January 2022 were selected as the research objects.According to the envelope random grouping method,the above patients were randomly divided into observation group and control group,with 40 cases in each group.According to the intestinal mesenteric classification of patients,the observation group carried out precise low ligation operation,while the control group adopted traditional high ligation operation.The perioperative indexes,complications,gastrointestinal function,gastrin and motilin were compared between the two groups. Result There was no significant difference in operation time,intraoperative blood loss,exhaust time and lymph node positive rate between the two groups (P>0.05),and the number of lymph node dissection in the observation group (24.27±5.92) was significantly higher than that in the control group (16.12±5.99)，there was significant difference (P＜0.05).There was no significant difference in dysuria,anastomotic bleeding and anastomotic leakage between the two groups (P>0.05). There was no significant difference between the recovery time of bowel sounds and the time of eating (P>0.05).After operation,the gastrin and motilin water in the two groups decreased significantly,but the gastrin[(133.33±16.14)pg/ml] and motilin(318.33±24.11) pg/ml] in the observation group were significantly higher than that of the control group[(114.78±15.97) pg/ml,(287.44±23.09)pg/ml]，the difference was statistically significant(P＜0.05). Conclusion Laparoscopic radical resection of rectal cancer according to the different types of inferior mesenteric artery accurately retain the left colon artery and root lymph node dissection,postoperative gastrointestinal function and lymph node dissection significantly improved,for the prognosis of patients with positive significance.

Objective To investigate the efficacy and safety of transumbilical single-port laparoscopic appendicectomy in acute complicated appendicitis. Methods Retrospective analysis was conducted for the data of 1104 patients with complicated appendicitis who underwent emergency laparoscopic appendectomy at the Department of General Surgery of Aerospace Center Hospital from April 2014 to August 2022;among them,788 patients underwent transumbilical single-port laparoscopic appendectomy (SILA) and 316 cases underwent traditional three-port laparoscopic appendectomy (LA)；the operation time,intraoperative blood loss,leukocyte value on the first day after surgery,postoperative exhaust time,hospital stay,postoperative pathology and postoperative complications were statistically analyzed. Results The surgical duration of the single hole laparoscopic appendectomy (SILA) group was (68.26±22.29) minutes,intraoperative blood loss was (15.93±13.10) ml,postoperative exhaust time was (2.29±0.52) days,and white blood cells were (11.12±1.67)×10⁹/L on the first day after surgery,and the surgical duration of the hree hole laparoscopic appendectomy (LA) groupwas (66.47±20.40) minutes,intraoperative blood loss was (16.65±12.98) ml,postoperative exhaust time was (2.23±0.58) days,and white blood cells were (11.35±1.54)×10⁹/L on the first day after surgery,there was no statistically significant difference in the data between each group（P>0.05）.After 1 month of follow-up,no incisional hernia and other complications occurred in the two groups,the cosmetic effect of abdominal incision in SILA group was satisfactory,the hospitalization time of SILA group was (4.60±1.18) days,which was shorter than that in the traditional LA group (4.93±1.71) days,and the difference was statistically significant（P<0.05）.Conclusion Based on proficiency in traditional LA operations,SILA is safe and viable;in addition to the hidden aesthetic function of scars,it does not prolong the operation time and increase the risk of postoperative complications.

Objective To explore the application value of medial caudal approach combined with middle page-turning lymphadenectomy in laparoscopic radical right hemicolectomy. Methods Eighty-six patients with right hemicolon cancer admitted to our hospital from May 2019 to May 2020 were selected as the research objects,and they were divided into an observation group of 43 cases and a control group of 43 cases by random drawing.The control group adopts the intermediate approach,and the observation group adopts the medial caudal approach combined with middle page-turning lymphadenectomy.The surgical recovery index,complication rate,serum tumor markers and survival index were compared between the two groups to evaluate the clinical efficacy and safety. Results There were no significant differences between the two groups in the number of lymph nodes removed,the length of the intestinal tube removed,extubation,fluid feeding and hospitalization time,the incidence of postoperative complications (P>0.05),but the operation time and intraoperative bleeding in the observation group were significantly lower,and the postoperative exhaust time was shorter (P<0.05).The serum CA19-9 and CEA levels of the two groups after one year decreased， and the serum CA19-9 and CEA levels of the observation group were lower than those of the control group (P<0.05).The disease-free progression period was prolonged in the observation group (P<0.05),but there was no difference in survival time. Conclusion The medial caudal approach combined with the middle page-turning lymphadenectomy has higher clinical application value in the laparoscopic radical right hemicolectomy,which is conducive to shortening the operation time and postoperative exhaust time,reducing the amount of intraoperative bleeding and postoperative serum CA19-9 and CEA levels,and improving the disease-free progression period with high safety.

Objective To investigate the significance of BRAF^V600E in the detection of benign,malignant and borderline thyroid lesions. Methods A total of 273 formalin fixed and paraffinembedded specimens of papillary thyroid carcinoma (PTC) were selected for study from January 2010 to December 2018 .There were 254 cases of classical variant of papillary carcinoma (CVPTC) and 19 cases of follicular variant of papillary carcinoma (FVPTC).30 benign lesions were made into tissue microarray (TMA),and 17 uncertain borderline lesions diagnosed by HE.Polymerase chain reaction (PCR) was used to detect 17 cases of CVPTC 12 cases of FVPTC 17 cases of borderline lesions and 13 cases of benign lesions. BRAF^V600E gene mutation and protein expression were observed. Results The positive expression rates of BRAF^V600E protein in CVPTC,FVPTC,borderline lesion and benign lesion were 86.6%,15.9%,23.5% and 26.7%,respectively.Mutation rates of BRAF^V600E gene in CVPTC,FVPTC,borderline lesions and benign lesions were 82.4%,41.7%,23.5% and 0,respectively.There were significant differences in expression of BRAF^V600E protein in CVPTC,FVPTC,borderline lesions and benign lesions(P＜0.05).There was statistically significant difference between BRAF^V600E gene mutation in CVPTC and FVPTC and borderline diseases(P＜0.05).The coincidence coefficient between BRAF^V600E gene mutation and protein expression in CVPTC was K=0.821,P＜0.05.It was statistically significant.The positive expression of BRAF^V600E protein in PTC was not correlated with gender,age,tumor size and lymph node metastasis (P＞0.05),but was correlated with tissue type and capsule invasion (P＜0.05). Conclusion BRAF^V600E has reference value in the diagnosis and differential diagnosis of benign and malignant thyroid and borderline thyroid lesions.

Objective To investigate the expression, function and prognostic value of Ras-related C3 botulinum toxin substrate 2(RAC2) in breast cancer. Methods The expression profile of RAC2 mRNA was investigated in the TCGA-BRCA cohort,the prognostic value was analyzed using the Kaplan-Meier algorithm,the potential molecular function was investigated by gene set enrichment analysis,the relationship between RAC2 and immune infiltration was analyzed by Estimate and Cibersort algorithms,and the association between Rac2 and mutation spectrum was evaluated by maftools software package.The RNA-seq software package “pRRophetic” was used to predict the effect of chemotherapy drugs.In the validation cohort,Immunohistochemistry (IHC) staining was performed on tumor pathological sections of patients.Kaplan-Meier survival analysis and cox regression analysis were used to analyze the relationship between RAC2 and the prognosis of breast cancer. Results Bioinformatics analysis showed that the expression of RAC2 was up-regulated in estrogen receptor (ER) positive BC. In the Pam50 molecular subtype of BC, its expression decreased in the order of normal-like group, triple negative group, HER2 overexpression group, Luminal A group and Luminal B group. BC patients with high RAC2 expression had better overall survival (OS) and recurrence-free survival (RFS). The results of the validation cohort confirmed that RAC2 can be used as an independent predictor of BC prognosis. RAC2 was involved in the process of immune infiltration of tumor cells, and its high expression was mainly related to the mutations of CCDC168, VPS13C and AHNAK genes. Its up-regulation increased the drug sensitivity of doxorubicin, cisplatin, paclitaxel and gemcitabine. In terms of metabolism, it was negatively correlated with glycolysis and pentose phosphate pathway(PPP), and positively correlated with fatty acid oxidation (FAO) and glutamine metabolism. Conclusion High expression of RAC2 is associated with a good prognosis of BC and plays a role in the metabolism and immune infiltration. Further study on the molecular mechanism of RAC2 may provide new strategies for the prognosis and treatment of BC.

Objective To investigate the clinical efficacy of endoscopic assisted minimally invasive trans foraminal lumbar interbody fusion (MIS-TLIF) and traditional open TLIF in the treatment of senile degenerative spondylolisthesis. Methods From January 2020 to March 2021, 100 elderly patients with degenerative spondylolisthesis were selected and divided into MIS-TLIF group and TLIF group according to the surgical method,with 50 cases in each group.The preoperative and postoperative VAS,Japanese 0rthopedic Association score (JOA) and Oswestry disability index (ODI),and the rate of interbody fusion and the incidence of complications were compared and analyzed between the two groups. Results In MIS-TLIF group, the operative time, intraoperative blood loss, incision length, postoperative drainage volume and hospital stay were (167.5±54.2) minutes, (173.8±47.1) ml, (3.5±0.7) cm, (69.6±16.3) ml, and (8.3±2.7) days, respectively.In the TLIF group, it was (136.3±38.9) minutes, (281.0±50.3) ml, (10.0±2.1) cm, (148.4±28.2) ml, and (11.2±3.1) days, respectively.The difference between the two groups was statistically significant(P<0.05).The VAS, JOA and ODI scores of MIS-TLIF group were (2.17±0.62)points, (21.72±3.14)points and (13.22±2.43)points, respectively.The results in TLIF group were (3.24±1.06) points, (17.06±2.85) points and (16.83±2.87) points, respectively, and there was statistical significance between the two groups (P<0.05).There was no significant difference in the rate of interbody fusion between the two groups at 12 months after operation (P>0.05).The incidence of postoperative complications in MIS-TLIF group(8.00%) was significantly lower than that in TLIF group(24.00%,P<0.05). Conclusion MIS-TLIF assisted by endoscope has the advantages of less trauma,faster recovery and less postoperative complications,and the short-term curative effect is more satisfactory than TLIF.

Objective  To explore and compare the efficacy of open reduction Kirschner-wire internal fixation and closed reduction Herbert screw internal fixation in the treatment of fresh unstable scaphoid lumbar fracture. Methods 72 patients with fresh unstable scaphoid lumbar fracture admitted to our hospital from January 2020 to January 2022 were selected and randomly divided into the experimental group(36 cases,open reduction Kirschberg wire internal fixation) and the control group(36 cases,closed reduction Herbert screw internal fixation).The operation time,fracture healing time,healing rate at 12 weeks,complication rate,scaphoid osteonecrosis rate,wrist functional recovery 6 months and 1 year after surgery were observed and compared within 2 groups,including wrist range of motion,improved Mayo wrist function score,pain index using visual analog scale(VAS).Results There were no significant differences in operation time,fracture healing time,healing rate and complication rate in 2 groups(P>0.05).6 months after surgery,the wrist motion of ulnar deviation,radial deviation,dorsalis extension and palmaris flexion in 2 groups were significantly improved compared with before surgery(P＜0.05).There was no significant difference in wrist motion in 2 groups after surgery(P＞0.05).Compared with 6 months after surgery,Mayo score of experimental group was significantly improved at 12 months after surgery(95.36±3.34) vs.(78.52±5.62)(P＜0.05),and VAS was significantly decreased(1.04±2.24) vs.(3.25±1.62)(P＜0.05),but there was no significant difference in Mayo score and VAS between 2 groups(P＞0.05).Conclusions Compared with closed reduction and Herbert screw internal fixation,open reduction and Kirschner wire internal fixation can also achieve satisfactory results.However,the operation cost and difficulty of Kirschner wire internal fixation are relatively low.

Objective To investigate the mid-and long-term effect of arthroscopic percutaneous internal fixation for the treatment of tibial plateau fractures. Methods 31 patients with tibial plateau fractures treated by arthroscopic percutaneous internal fixation from May 2005 to May 2015 were followed up for a minimum of 3 years.The Lysholm score,Tegner motor level score,Rasmussen functional score,Rasmussen radiological score and Ahlback osteoarthritis classification of the knee joints were recorded at 6 months and the last follow-up. Results  Bone union was achieved in all patients,and no nonunion or malunion occurred.There were 3 cases of stiffness of knee joint after operation,2 cases of them were improved after physiotherapy combined with rehabilitation exercise,1 case underwent arthroscopic soft tissue release after 6 months of operation to confirm fracture healing,and the range of motion of knee joint was satisfactory after operation.All  patients were followed up,with a minimum follow-up of 3 years and an average followup time of (56.90±17.03) months.There was no significant difference in Lysholm score,Tegner score and Rasmussen score between the last followup and 6 months after operation in all patients(P＞0.05).At the last follow-up,the knee flexion and extension were (132.06±4.89)° and 1.55±2.84)°,respectively.There was significant difference in Rasmussen radiological score of knee joint and Ahlback osteoarthritis classification between the last follow-up and 6 months after operation(P＜0.05).Compared the affected side with the healthy side on the full-length weight-bearing X-ray film of lower extremity,it was found that the average rotation angle of the axial force line of lower extremity was significantly different between the last follow-up and 6 months after operation(P＜0.05).At the last follow-up,among the 31 patients,6 had valgus deflection and 2 had varus deflection.Age and intra-articular soft tissue injury were factors for osteoarthritis(P＜0.05). Conclusion For patients who received arthroscopic percutaneous reduction and internal fixation for lateral tibial plateau fractures,the Lysholm score,Tegner score and Rasmussen score in the mid-and long-term follow-up after the operation showed that the overall function of the knee joint was satisfactory.The incidence of arthritis was lower than that reported in the literature for those receiving open reduction and internal fixation,and the curative effect was not good enough for patients who were older(＞50 years) and those with fractures combined with intra-articular soft tissue injuries.

Objective To explore the risk factors of early traumatic coagulation (TIC) in elderly patients with chest trauma. Methods The data of 113 elderly patients with chest trauma admitted in a hospital from January 2016 to January 2022 were retrospectively analyzed.Patients were divided into TIC group and non-TIC group according to whether they had early TIC.The risk factors of early TIC in elderly patients with thoracic trauma were analyzed by single factor and multi factor methods.Analysis of the predictive value of early TIC in elderly patients with thoracic trauma using multifactor model. Result Of all the patients included in the study,27 were determined as TIC,and the rest 86 were non-TIC.The results of univariate analysis showed that there were statistically significant differences in the data of shock index,platelet count at admission and plasma fibrinogen at admission between patients in TIC group and non-TIC group (P＜0.05).Multivariate analysis showed that the shock index at admission,platelet count at admission,and plasma fibrin at admission were all independent influencing factors of early TIC in elderly patients with chest trauma (all P＜0.05).The P value of multivariate model and independent variables predict the early TIC of elderly patients with chest trauma.The Yoden index is 36.95%,42.89%,75.58% and 78.85% respectively.Conclusion The shock index,platelet count and plasma fibrin at the time of admission can affect the early occurrence of TIC in elderly patients with chest trauma.

Objective To compare the clinical efficacy of a new low notch plate system (Carmen synchronous adaptive cervical fusion system) and Zero-p in the treatment of single level cervical spondylotic radiculopathy (CSR). Methods Retrospective analysis was made on 48 patients with single level cervical spondylosis of nerve root type admitted from January 2015 to January 2020,including 26 patients with new low notch steel plate system (observation group) and 22 patients with Zero-P (control group).The operation duration,intraoperative blood loss,incidence of postoperative dysphagia,preoperative and postoperative JOA scores,cervical dysfunction index (NDI) Visual analog score of pain (VAS) and Cobb angle and intervertebral space height of postoperative imaging.Results There was no significant difference between the two groups in terms of operation time,intraoperative blood loss and the incidence of postoperative dysphagia (P>0.05).All patients were followed up for 12-15 months,with an average of (12.6±0.7) months.There was no significant difference in JOA score,NDI index and VAS score of pain between the two groups before and 3 and 12 months after operation (P>0.05). Conclusion The clinical efficacy of the new low notch plate system in the treatment of single segment cervical spondylotic radiculopathy is equivalent to Zero-P,and it is a reliable new type of anterior cervical internal fixation system.

Objective To evaluate the effect of thoracoscope assisted intercostal nerve block combined with nalbuphine for postoperative multimodal analgesia after lung segment resection surgery.  Methods From April 2022 to September 2022,60 patients scheduled for thoracoscopic lung segment resection surgery were selected and divided into two groups according to the random number table,with 30 patients in each group.The patients in the observation group received intercostal nerve block under thoracoscope before closing the chest,and the postoperative analgesia pump was Naborphine combined with sufentanil for patient-controlled intravenous analgesia;In the control group,the thoracic cavity was closed directly,and sufentanil was used for patient-controlled intravenous analgesia.The visual analog pain score(VAS),the number of PCIA effective pressing,the situation of rescue analgesia and the occurrence of related adverse reactions were recorded 2h,4h,8h,24h and 48h after surgery.Results The VAS scores at rest of the observation group at 2h,4h,8h,24h and 48h after operation 1.8±0.8,1.9±0.8,2.1±0.9,2.3±0.9,2.1±0.8,compared with control group 3.3±1.1,3.5±1.0,2.8±0.9,2.7±0.7,2.6±0.8 were all significantly lower(P<0.05).The VAS scores during activity of the observation group at 2h,4h,and 8h after operation 2.2±0.6,2.3±0.6,2.5±0.9,compared with control group 3.9±1.9、3.9±1.7、3.3±1.7 were significantly lower(P<0.05).The effective press times of PCIA in the observation group within 24 hours and 48 hours after operation were 2.7±1.5 and 5.4±2.3 times,while those in the control group were 5.2±3.4 and 10.2±6.0 times.The difference between the two groups was statistically significant(P<0.05).The number of patients in the observation group receiving postoperative analgesia was less than that in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).The satisfaction rate of patients in the observation group was higher than that in the control group,with a statistically significant difference(P<0.05).Conclusion Thoracoscope assisted intercostal nerve block combined with nalbuphine can be a good choice for postoperative multimodal analgesia in lung segment resection surgery.

Objective To investigate the effect of ultrasound-guided transverse abdominal plane block (TAPB) on pain inhibition and stress response in patients undergoing laparoscopic sleeve gastrectomy (LSG). Methods 98 cases of laparoscopic sleeve Gastrectomy patients admitted from March 2021 to October 2022 were selected as the research object,and they were randomly divided into control group (49 cases) and observation group (49 cases) by double blind method.The control group received general anesthesia,and the observation group received TAPB+general anesthesia.The postoperative pain,analgesic dosage,stress level,hemodynamics and adverse reactions of the two groups were compared. Results The dosage of sufentanil and propofol in the observation group,as well as the effective press frequency of the intravenous analgesia pump 48 hours after surgery[(232.38±29.62)μg ,(328.40±40.68) mg and (5.60±1.25)],were lower than those in the control group[(294.07±35.88)μg,(402.25±46.74)mg and(9.75±2.40)](P<0.05).The visual analogue scale (VAS) scores for each time period of the observation group were (2.43±0.49),(2.29±0.46),(2.85±0.49),(2.41±0.39),(2.12±0.41) and(1.82±0.32),respectivly.While,the control group were (2.95±0.46),(3.22±0.51),(3.92±0.47),(3.13±0.65),(2.83±0.57) and(2.05±0.53),respectivly.The difference between the two groups was statistically significant(P<0.05).At the time of tracheal intubation (T₂),at the end of operation (T₃),and at the time of leaving the anesthesia recovery room (T₄),the fluctuation range of mean arterial pressure[86 .00(79.00,94.00)mmHg,87.00(80.00,90.00)mmHg and 89.00(84.00,95.00)mmHg vs 82.00(75.00,90.00)mmHg,85.00(77.00,93.00)mmHg and 87.00(80.00,97.00)mmHg],heart rate[78.00(67.00,83.00）times/min,80 .00(74.00,86.00）times/min and 81.00(76.00,90.00)times/min vs 78.00(67.00,83.00)times/min,80.00 (74.00,86.00)times/min and 81.00(76.00,90.00)times/min] and blood oxygen saturation[97.38(97.00,97.75)%,98.69(98.30,99.05)% and 99.16(98.80,99.35)% vs 96.54(96.15,96.80)%,98.02(97.65,98.45)% and 98.73(98.43,99.15)%] in the observation group was significantly smaller than that of the control group (P<0.05).In the observation group, cortisol levels were (192.47±40.25)ng/ml, (151.34±39.62)ng/ml and (118.69±30.57)ng/ml at 6 hours, 24 hours and 48 hours, respectively,while in the control group were (206.24±45.34)ng/ml,(178.24±37.58)ng/ml and (143 .63±32.34)ng/ml,respectively;C-reactive protein (CRP) in the observation group were (25.24±6.29)mg/L,(20.93±5.83)mg/L and (13.61±4.29)mg/L, respectively,while in the control group were (28.13±6.92)mg/L,(23.25±5.21)mg/L and (16.38±4.35)mg/L, respectively;interleukin-6 (IL-6) in the observation group were (44.87±7 .95)pg/L,(38.34±6.13)pg/L and (34.27±5.32)pg/L,respectively,while in the control group were (56.43±7.23)pg/L、(42.24±6.58)pg/L、(37.66±6.03)pg/L,respectively.The difference between the two groups was statistically significant(P<0.05).The total incidence of adverse reactions of the observation group(4.08%) was lower in than that of the control group(20.41%) (P<0.05). Conclusion Ultrasound-guided TAPB for LSG patients has a good effect on postoperative pain suppression,can reduce the stress response of the body after surgery,and is safe.