Objective  To explore the effect and prognostic factors of intravenous thrombolysis combined with Trevo stent mechanical thrombectomy in the treatment of ischemic stroke.Methods  A total of 120 patients with ischemic stroke diagnosed and treated in our hospital from January 2020 to December 2022 were selected as research objects and divided into two groups according to random number table method,with 60 cases in each group.Both groups were given basic treatment,the control group was given intravenous thrombolytic therapy,and the observation group was given intravenous thrombolytic therapy combined with mechanical thrombectomy with Trevo stent.The clinical efficacy of the two groups was observed, and the patients were divided into a good prognosis group (46 cases) and a poor prognosis group (74 cases) according to the prognosis. Clinical data such as gender, age, BMI, combined hypertension, combined diabetes, smoking, treatment methods, complete vascular recirculation rate, preoperative NIHSS score and postoperative NIHSS score of the two groups were collected. The independent prognostic factors were analyzed by univariate and multivariate binary Logistic regression.Results  The total effective rate of the study group was significantly higher 88.33%(53/60)than that of the control group 73.33%(44/60),and the difference was statistically significant (P<0.05).Univariate analysis showed that there were no statistically significant differences in gender, BMI, diabetes mellitus, and preoperative NIHSS score between the two groups (P>0.05), while there were statistically significant differences in age, hypertension, smoking, treatment style, complete vascular revasculosity, and postoperative NIHSS score between the two groups (P<0.05). Logistic regression analysis showed that age, treatment style and complete vascular revasculopathy rate were independent factors affecting the prognosis of ischemic stroke patients (P< 0.05).Conclusion  Intravenous thrombolysis combined with mechanical thrombectomy with Trevo stent can improve the clinical efficacy and prognostic quality of ischemic stroke patients in the time window of intravenous thrombolysis.In addition,the prognosis of patients with ischemic stroke is also closely related to the age of patients and the rate of complete vascular recirculation after surgery.

Objective  To investigate the expression of microRNA-542-3p (miR-542-3p) and long non-coding RNA taurine up-regulated gene 1 (lncRNA TUG1) in the serum of patients with severe traumatic brain injury (STBI) and their relationship with the prognosis of patients.Methods From January 2020 to July 2022, 128 STBI patients were collected as the severe group and 130 patients with mild or moderate TBI were collected as the control group,retrospectively.The expression levels of miR-542-3p and lncRNA TUG1 in serum were detected and the correlation between them was analyzed.Logistic regression was used to analyze the influencing of serum miR-542-3p and lncRNA TUG1 expression on the poor prognosis of STBI patients,and the predictive efficacy of them on the prognosis of STBI patients was analyzed by receiver operating characteristic (ROC) curve.Results  The serum miR-542-3p and lncRNA TUG1expression level in the severe group were lower and higher than that in the control group,respectively(P＜0.05).The serum miR-542-3p was negatively correlated with lncRNA TUG1 in STBI patients (r=-0.595,P＜0.001).The serum lncRNA TUG1 and miR-542-3p level in poor prognosis group were higher and lower than than that in good prognosis group,respectively(P＜0.05).High lncRNA TUG1 level was risk factor for poor prognosis in STBI patients (P＜0.05),while high miR-542-3p level was a protective factor (P＜0.05).The area under the curve (AUC) (0.939) of serum miR-542-3p and lncRNA TUG1 for predicting the prognosis of STBI patients in combination was higher than that of single prediction (Z=2.410,P=0.016;Z=3.339,P＜0.001).Conclusion  The expression of miR-542-3p in serum of STBI patients is down-regulated,while the expression of lncRNA TUG1 is up-regulated.Both of them can be used for predicting the prognosis of STBI patients,and the combination of the two has higher predictive value.

Objective To compare and analyze the operation time,detection rate and detection number of sentinel lymph node(SLN) who was using contrast-enhanced ultrasound(CEUS) body surface localization combined with nano carbon tracking and single dye method for sentinel lymph node biopsy(SLNB) in patients with cN0 invasive breast cancer(IBC).To explore the feasibility of CEUS body surface localization combined with nano carbon tracking for SLNB.Methods The clinicopathological data of 199 patients with cN0 IBC who were diagnosed and treated in Beijing Shunyi District Hospital from January 1st,2018 to April 30th,2023 were collected.We divided all patients into dye method group(100 cases) and combined method group(99 cases) according to SLN missing method.In dye method group,SLNB was performed with nano carbon tracer;In combined method group,SLN was marked and located by CEUS before surgery and SLNB was performed with nano carbon tracer during surgery.Results  The detection rate of SLN in this study was 96.48%(192/199).In the dye method group,the detection rate of SLN was 95.00% and the average detection number of SLN was(2.79±1.228).while in the combination method group,the detection rate was 97.98% and the average detection number of SLN was(3.32±1.469).There was no statistically significant difference in the detection rate of SLN between the two groups(P>0.05).The average detection number in combination method group was more than that in dye method group(P<0.05).However,there was no statistically significant difference in the distribution of SLN detection number between the two groups(P>0.05).The duration of SLNB surgery in the combination method group was significantly shorter than that in the dye method group[(13.83±4.58)minutes vs(19.85±3.20)minutes),P<0.05].Conclusion  Combined method for SLNB can reduce surgical time and increase the detection rate and number of SLN.

Objective  To compare the effects of two different surgical methods in the treatment of female unilateral cT1N0-1a thyroid cancer and the satisfaction of incision cosmetics.Methods A retrospective analysis of the data of female patients with unilateral cT1N0-1a stage thyroid cancer in our hospital from October 2020 to September 2022 was conducted.They were divided into open group(65 cases) and oral group(55 cases) according to different surgical methods.Patients in open group were underwent traditional open thyroid surgery,and patients in oral group were underwent transoral vestibular approach laparoscopic thyroid surgery.Intraoperative conditions,postoperative complications and  satisfaction degree of postoperative incision beauty between the two groups were comparded.Results The operation time was (124.40±11.59)minutes and the dissection time of the central lymph node was (26.44±5.33)minutes in the transoral group,which were longer than those in the open group [(65.91±11.44)minutes and (17.38±4.32)minutes,(P<0.05)].Vancouver scar evaluation [(3.29±0.96)points],patient scar evaluation [(8.62±1.57)points],observer scar evaluation [(6.67±1.17)points] and scar self awareness score [(1.65±0.70)points] in the oral group were significantly lower than those in the open group [(5.29±1.20)points,(15.02±2.85)points,(19.57±2.94)points and (3.12±0.98)points,(P<0.05)].There were no significant difference in the amount of blood loss,the amount of drainage,the number of days in hospital and the number of central lymph nodes dissection between the two groups(P>0.05).There was no significant difference in  total incidence of postoperative complications(hoarseness,cough after drinking water,postoperative bleeding,subcutaneous effusion) between oral group and open group(7.2% vs 7.6%,P>0.05).Conclusion  The two surgical methods have their own advantages,the incidence of postoperative complications is low,safe and reliable,and the patients in the oral group are more satisfied with the cosmetology of the postoperative incision.In actual clinical work,the appropriate operation can be chosen according to the specific conditions of the patients.

Objective To investigate the risk factors of nausea and vomiting during postoperative chemotherapy in patients with gastric cancer and to construct a corresponding risk prediction model.Methods This study collected gastric cancer patients from the first affiliated hospital of Hunan university of traditional Chinese medicine from February 2020 to February 2021 as a modeling set to explore the risk factors of nausea and vomiting during chemotherapy in gastric cancer patients after surgery,and constructed a corresponding risk prediction models.The data were collected from March 2021 to February 2022(Year 1),March 2022 to February 2023(Year 2),and March 2023 to February 2024(Year 3) as a validation set,which was used to validate the risk prediction model constructed by the modeling set.The incidence of vomiting during chemotherapy was detected in the modeling set.The univariate and multivariate Logistic regression to analyze the risk factors of nausea and vomiting during chemotherapy in gastric cancer patients after surgery,and constructing a corresponding risk prediction model.The accuracy of the corresponding risk prediction model was validated using receiver operating characteristic curve(ROC) with a validation set from March 2021 to February 2024.Results  A total of 112 patients were included in the modeling set,of which 75 patients(66.96%) did not have nausea and vomiting during postoperative chemotherapy and were included in the control group,while 37 patients(33.04%) developed nausea and vomiting during postoperative chemotherapy and were included in the observation group.The univariate analysis showed that age,gender,history of alcohol consumption,history of motion sickness,frequency of chemotherapy,history of chemotherapy-related nausea and vomiting,history of vomiting during pregnancy,Pittsburgh sleep quality index(PSQI) and psychological expectation of post chemotherapy nausea and vomiting were related to the occurrence of nausea and vomiting during postoperative chemotherapy(P＜0.05).Logistic regression analysis showed that age,gender,history of motion sickness,chemotherapy frequency,history of vomiting during pregnancy,PSQI,and psychological expectation of postoperative nausea and vomiting in gastric cancer patients were risk factors for nausea and vomiting during postoperative chemotherapy(P＜0.05).A risk prediction model based on Logistic regression to identify statistically significant factors.Internal validation of the model was conducted by the Bootstrap method,with an area under curve(AUC) of 0.71(95% CI:0.71-1.00) for the first year validation set,0.69(95% CI:0.58-0.96) for the second year validation set,and 0.66(95% CI:0.54-0.95) for the third year validation set.Conclusion The Age,gender,history of motion sickness,frequency of chemotherapy,history of vomiting during pregnancy,PSQI and psychological expectation of postoperative nausea and vomiting during chemotherapy are risk factors for nausea and vomiting during postoperative chemotherapy.The risk prediction model for nausea and vomiting during chemotherapy in gastric cancer patients constructed based on the above factors has good predictive performance and can provide reference for clinical treatment of gastric cancer patients.

Objective  To investigate the effect of serum soluble tumor necrosis factor receptor P55(sTNFR-P55) and metallothionein 1E(MT1E) on the clinical outcome of estrogen receptor(ER) positive breast cancer patients undergoing radical mastectomy.Methods The clinical data of 146 patients with ER positive breast cancer who were treated in our hospital from February 2017 to March 2018 were retrospectively analyzed.According to the clinical outcome of patients after surgery,they were divided into recurrent metastatic group and non-recurrent metastatic group.The clinical data,serum sTNFR-P55 and MT1E levels were compared between patients with recurrent metastatic group and non-recurrent metastatic group.Multivariate Logistic regression analysis was used to analyze the related factors influencing the clinical outcome of ER positive breast cancer patients undergoing radical mastectomy.The receiver operating characteristic curve(ROC) was made,and the area under the curve(AUC) was used to analyze the predictive value of serum sTNFR-P55,MT1E and their combination on the clinical outcome of ER positive breast cancer patients undergoing radical surgery.Results By the end of follow-up,32 of 146 patients with ER positive breast cancer had recurrence and metastasis.Tumor size and levels of tumor necrosis factor- α,carbohydrate antigen 125(CA125),cytokeratin 19 fragment antigen 21-1(CYFRA21-1),carcinoembryonic antigen(CEA),tumor stage Ⅲ,serum sTNFR-P55 and MT1E in the recurrent metastatic group were higher than those in the non-recurrent metastatic group(P<0.05).Multivariate Logistic  analysis showed that CYFRA21-1(OR=2.768,95%CI 1.107-6.920),CEA(OR=2.751,95%CI 1.101-6.879),tumor stage Ⅲ(OR=3.611,95%CI 1.444-9.029),sTNFR-P55(OR=3.343,95%CI 1.337-8.361) and MT1E(OR=3.267,95%CI 1.307-8.169) were all related factors affecting the clinical outcome of ER positive breast cancer patients undergoing radical surgery(P<0.05).ROC curve analysis results showed that the sensitivity of serum sTNFR-P55,MT1E and their combination in predicting the clinical outcome of ER positive breast cancer patients undergoing radical surgery was 78.12%(95%CI 59.56-90.06),75.00%(95%CI 56.25-87.87) and 71.88%(95%CI 53.02-85.60),respectively.The specificity was 63.16%(95%CI 53.56-71.85),75.44%(95%CI 66.32-82.80) and 96.49%(95%CI 90.73-98.87),respectively.AUC- was 0.723(95%CI 0.642-0.793),0.760(95%CI 0.682-0.827) and 0.880(95%CI 0.816-0.928) respectively.Conclusion Serum sTNFR-P55 and MT1E are related to the clinical outcome of ER positive breast cancer patients undergoing radical mastectomy,and the combination of serum sTNFR-P55 and MT1E is more effective in predicting the clinical outcome of ER positive breast cancer patients undergoing radical mastectomy.

Objective To determine the appropriate time to perform laparoscopic cholecystectomy (LC) for acute calculous cholecystitis.Methods The clinical data of 125 patients with acute calculous cholecystitis who underwent LC between Jan.2018 and Dec.2021 were retrospectively analyzed.According to the interval time from symptom onset to operation,all patients were divided into 2 groups:immediate group (43 cases) who underwent LC within 24 hours and delayed group (82 cases) who underwent LC in 25-72h.The operation time,intraoperative blood loss,conversion to laparotomy,postoperative complications,postoperative hospitalization days and hospitalization expenses between the two groups were compared Results  The operation time,intraoperative blood loss of immediate group were lower than those of delayed group [50(45,65)min vs 65(55,95)min,10(10,20)ml vs 20(10,30)ml,P<0.05].There were no significant differences between the two groups with respect to incision infection,bile leak and biliary duct injury (4.7% vs 13.4%,2.3% vs 2.4%,2.3% vs 1.2%,P>0.05),but the total rate of postoperative complications in immediate group reduced significantly (9.3% vs 29.3%,P<0.05).No mortality occurred in either group.Both of postoperative hospitalization days and direct medical costs reduced in immediate group[5(5,7)d vs 7(6,7)d,6503(6231,7749)yuan vs 7056(6448,9105)yuan,P<0.05].Conclusion LC for the operable patient with acute calculous cholecystitis,during 24 h from onset of symptom,significantly reduced the operation time,intraoperative blood loss and postoperative hospital stay without increasing the rate of bile leak and biliary duct injury.

Objective To explore the application value of three dimensional reconstruction technique in laparoscopic hepatectomy for hepatic carcinoma.Methods  From September 2019 to March 2022,the clinical data of 62 patients with primary hepatic carcinoma were gathered.The enhanced CT scanning was performed before surgery.Patients with three dimensiona reconstruction technology were set as observation group (n=31).Patients who did not use three dimensiona reconstruction technology were set as the control group (n=31),and intraoperative conditions (time of operation,bleeding volume during operation) and postoperative conditions (occurrence rate of postoperative complications,postoperative length of stay) of the two groups were compared.Results 62 patients successfully completed laparoscopic hepatectomy without liver failure or death.For patients with tumors located in liver segment Ⅱ and Ⅲ,there were no significant difference of operation time,intraoperative blood loss,postoperative hospital stay and postoperative complication total rate between control group and observation group（P＞0.05）.For patients with tumors located in liver segment Ⅳ-Ⅵ,operation time[（211.36±11.22）minutes vs （231.69±19.73 ）minutes],intraoperative blood loss[（274.29±23.84）ml vs （306.54±21.05）ml],postoperative hospital stay[（7.93±1.33）days vs （9.62±1.80）days] in observation group were lower than those in control group（P＜0.05）,and there was no significant difference of postoperative complication total rate between two groups（P＞0.05）.For patients with tumors located in liver segment Ⅰ,Ⅶ and Ⅷ,operation time[（165.88±10.60）minutes vs (187.30±17.29）minutes],intraoperative blood loss[（271.25±12.17）ml vs （308.00±28.21）ml],postoperative hospital stay[（7.63±0.74）days vs （9.30±1.06）days] in observation group were lower than those in control group（P＜0.05）,and there was no significant difference of postoperative complication total rate between two groups（P＞0.05）.Conclusion The three dimensiona reconstruction technique may have  prominent guiding significance for complex laparoscopic hepatectomy for hepatic carcinoma.

Objective To investigate the significance and prognostic value of integrin α5,β1 and β2 in colorectal cancer (CRC).Methods The clinical data of 187 patients with CRC who were diagnosed in the hospital from January 2017 to January 2018 were analyzed retrospectively.The expression of integrin α5,β1 and β2 in cancer tissues and adjacent tissues,and its relationship with pathological characteristics of CRC were analyzed.All patients were followed up for 5 years after operation.Postoperative recurrence and survival time were recorded.Results The positive expression rates of integrin α5,β1 and β2 in cancer tissues were higher than adjacent tissues (P<0.05).There was no statistically significant difference in the expression levels of integrin α5,β1 and β2 in patients of different gender,patients of different age and patients with different tumor diameters (P>0.05).The expression levels of integrin α5,β1 and β2 in patients with different differentiation degrees,patients in different TNM stages,and patients with and without lymph node metastasis were significantly different (P<0.05).All of the 187 patients were followed up for 5 years,without any case lost to follow-up,and a total of 84 patients had recurrence.The positive expression rates of integrin α5,β1 and β2 in patients with recurrence were higher than those in patients without (P<0.05).The average survival time and survival rate of patients with positive expression of integrin α5,β1 and β2 were shorter/lower than those of patients with negative expression (P<0.05).Conclusion The positive expression rates of integrin α5,β1 and β2 in CRC patients are increased.They are closely related to differentiation degree,TNM stage and lymph node metastasis,and influence postoperative recurrence and survival time of the patients.Therefore,the above indicators can be used for prognosis.

Objective  To investigate the impacts of serum microRNA-448 (miR-448) and microRNA-153 (miR-153) expression on intestinal microbiota and immune function in colon cancer patients.Methods A total of 127 patients with colon cancer admitted to our hospital from February 2020 to February 2023 were collected as the study group,89 patients with benign colon lesions were collected as the benign colon lesion group,and 127 healthy individuals who underwent physical examination in our hospital during the same period were collected as the control group.The study group were grouped into miR-448 high expression group (63 cases) and miR-448 low expression group (64 cases),and the miR-153 high expression group (64 cases) and miR-153 low expression group (63 cases) based on the median expression levels of serum miR-448 (1.12) and miR-153 (0.98) as the critical values.Pearson method was applied to analyze the correlation between the expression levels of serum miR-448 and miR-153 and intestinal microbiota and immune function indicators in colon cancer patients;receiver operating characteristic (ROC) curve was plotted to analyze the diagnostic value of serum miR-448 and miR-153 for colon cancer.Results There were significant differences among the study group,the benign colon disease group and the control group in terms of Escherichia coli,bifidobacteria,bifidobacteria/Escherichia coli ratio,and immunoglobulin (Ig) G,IgM,IgA (P<0.05);The expression level of serum miR-448 in the study group (1.25±0.22) was higher than that in the control group (1.09±0.03) and colon benign lesion group (1.18±0.15),while the expression level of serum miR-153 (0.89±0.12) was lower than that in the control group (1.03±0.17) and colon benign lesion group (0.96±0.16) (P<0.05);there were significant differences in the Escherichia coli,bifidobacteria,bifidobacteria/Escherichia coli ratio,the expression levels of IgG,IgM,and IgA between the high and low expression groups of serum miR-448 and miR-153(P<0.05).There was significant correlation between serum miR-448,miR-153 and Escherichia coli,bifidobacteria,bifidobacteria/Escherichia coli ratio(r=0.657，-0.742，-0.753；r=-0.711，0.813，0.771，P<0.05);IgG,IgM,IgA were positively correlated with serum miR-448(r=0.686,0.709,0.744),and negatively correlated with miR-153 (r=-0.690，-0.841,-0.769，P<0.05);the combined detection of serum miR-448 and miR-153 for the diagnosis of colon cancer had an AUC of ^0.845,which was better than the individual detection (Zcombination-miR-448=4.561,Z combination-miR-153=2.426,P=0.000、0.015).Conclusion The expression levels of serum miR-448 and miR-153 in patients with colon cancer are correlated with intestinal microbiota and immune function,and the combination of the two has high diagnostic value for colon cancer.

Objective  To Identify alternative indicators related to the risk of osteoporosis fractures in postmenopausal women through metabolomics and attempting to determine the predictive value of candidate metabolites.Methods From December 2018 to August 2021,158 postmenopausal women with non-traumatic hip fracture (fracture group) were enrolled in our hospital,and 197 postmenopausal women without fracture (non-fracture group) were enrolled.Quantitative analysis of serum metabolites was performed using AbsoluteIDQTM p180 kit and targeted metabolomics approach.Univariate and Multivariate Logistic regression were used to analyze the influencing factors of osteoporotic fracture in postmenopausal women,and Spearman and Pearson analysis were used to analyze their correlation.Results Compared with the non-fracture group, Only serum arginine [(105.2±22.4) μmol/L vs. (96.3±23.5)μmol/L], leucine[(180.9±50.0) μmol/L vs. (156.7±39.5) μmol/L) and spermine [(1.03±0.67)μmol/L vs. (0.51±0.12)μmol/L] were significantly increased in the fracture group (P<0.05).Logistic regression analysis showed that only serum spermidine concentration was significantly associated with hip fracture risk after adjustment for age,BMI,complications,and smoking status (HR=1.35,95%CI=1.03 to 1.65，P=0.020).According the receiver operating characteristic,serum spermidine level predicted hip fracture in postmenopausal women with an area under the curve of 0.882(95%CI:0.847 to 0.916).Spearman analysis showed that T value of hip was negatively correlated with serum spermidine level (r=-0.192,P＜0.001).The levels of serum spermine and putrescine in patients of low spermine level group were increased than those in high spermine level group.Pearson correlation analysis showed that serum spermidine level was negatively correlated with spermidine (r=-0.237,P<0.001) and putrescine (r=-0.189,P=0.004) in fracture group.Univariate and multivariate Logistic regression analysis showed that serum spermidine≥0.58 μmol/L was an independent risk factor for an increased risk of fragility hip fracture in postmenopausal women (P<0.001).Conclusion Elevated baseline serum spermidine level are associated with increased risk of hip fracture in postmenopausal women and may be useful in predicting fragility fracture in postmenopausal women.

Objective  To explore the risk factors of anal fistula after incision and drainage surgery for perianal abscess,and establish an individualized predictive nomogram model.Methods A retrospective analysis was conducted on the clinical data of 224 patients with perianal abscess who underwent incision and drainage surgery in Affiliated Hospital of Shanxi University of Chinese Medicine from May 2020 to January 2023,according to whether anal fistula occurred within 3 months after surgery,there were 169 cases in the non anal fistula group and 55 cases in the anal fistula group.Single factor method and multivariate Logistic regression analysis were applied to analyze the influencing factors of anal fistula after incision and drainage of perianal abscess,a nomogram risk model was constructed using independent risk factors to predict the occurrence of anal fistula after incision and drainage of perianal abscess,and the consistency and differentiation of the model were verified.Results The proportions of male,diabetes,deep abscesses,intestinal origin of pathogenic bacteria,and abscesses in anal fistula group were higher than those in non anal fistula group (P＜0.05).Male,diabetes,deep abscess,intestinal origin of pathogenic bacteria,and history of abscess were independent risk factors for anal fistula after incision and drainage of perianal abscess (P＜0.05).The ideal curve of the nomogram model fitted well with the correction curve,indicated that the measured values were basically consistent with the predicted values.The area under the receiver operating characteristic (ROC) curve was 0.946 (95%CI=0.914-0.979),indicated that the column plot model has good predictive discrimination.Conclusion The independent risk factors for anal fistula after incision and drainage surgery of perianal abscess include male,diabetes,deep abscess,intestinal origin of pathogenic bacteria,and history of abscess.The construction of related nomogram model can guide clinical screening of high-risk groups to a certain extent.

Objective To investigate the value of tranexamic acid combined with aspirin,low molecular weight heparin calcium in regulating inflammatory mediators and TEG in blood management of Total knee arthroplast (TKA).Methods 120 elderly patients with TKA in our hospital from January 2020 to October 2022 were randomly divided into group A (n=60) and group B (n=60).They were given tranexamic acid + aspirin and tranexamic acid + low molecular weight heparin calcium,respectively,for 2 weeks.Perioperative indexes,complications [lower limb deep vein thrombosis (DVT),intermuscular vein thrombosis (MCVT),incision infection],blood transfusion rate,adverse reactions (gastrointestinal discomfort,subcutaneous ecchymosis),TEG parameters[coagulation reaction time (R),blood coagulation time (K),maximum amplitude (MA),coagulation angle (α)],inflammatory mediators[soluble CD40 ligand (sCD40L),Toll-like receptor 4 (TLR4),tumor necrosis factor (TNF-α)],vascular endothelial injury factors[soluble thromboregulatory protein (sTM),vascular endothelial cell growth factor (VEGF),Eselectin] were compared between the two groups.Results  There was no significant difference in the 24 h postoperative drainage volume,latent blood loss,total blood loss,intraoperative blood loss,Hb and HCT levels 72 h after surgery between the two groups (P>0.05).There was no statistically significant difference in TEG parameters between the two groups,at different time points,and between groups at different time points (P>0.05);The serum levels of TLR4,sCD40L and TNF-α in group A were lower than those in group B 2 weeks after surgery (P<0.05).The levels of plasma sTM and serum VEGF and Eselectin in group A were lower than those in group B 2 weeks after surgery (P<0.05).There was no significant difference in the incidence of deep vein thrombosis (DVT),intermuscular vein thrombosis (MCVT),incision infection and blood transfusion rate between group A and group B(P>0.05).There was no significant difference in the total incidence of adverse reactions between group A and group B (P>0.05).Conclusion Compared with the combination of low molecular weight heparin calcium,the combination of tranexamic acid and aspirin can protect vascular endothelium and inhibit inflammatory response.However,both can maintain the patient’s coagulation function and avoid massive blood loss or thrombosis.There is no significant difference in safety and effectiveness.

Objective Investigating the relationship between smoking,overweight,and bibulosity with plasma PAI-1 and osteonecrosis of the femoral head after internal fixation by retrospective study,and providing reference for clinical treatment.Methods A total of 95 patients with femoral neck fracture treated with internal fixation from January 2021 to January 2022 were retrospectively studied.The data of smoking,overweight,alcohol abuse,preoperative and postoperative plasma PAI-1 levels were collected.The patients were divided into necrosis group and non-necrosis group according to the occurrence of femoral head necrosis at the last follow-up.Univariate analysis was performed on smoking,overweight,alcohol abuse,plasma PAI-1 level before and 2 days after operation,and the presence of smoking,overweight and bibulosity factors was analyzed.The association of smoking,overweight and bibulosity with plasma PAI-1 level was analyzed.Figure out the relationship between smoking,overweight,bibulosity and plasma PAI-1 and femoral head necrosis after internal fixation.Results Femoral head necrosis occurred in 22 of 95 patients.Age,gender,smoking,overweight and bibulosity were not independent risk factors for postoperative femoral head necrosis (P>0.05).The plasma PAI-1 level at 2 days after operation in necrosis group was (46.95±2.35) ng/ml,which was significantly higher than that in non-necrosis group [(41.94±4.73) ng/ml,P<0.05].The level of plasma PAI-1 at 2 days after operation was (48.29±1.78)ng/ml in patients with smoking,overweight and alcohol abuse at the same time,which was significantly higher than that in other patients [(42.40±4.60 ng/ml,P<0.05].In addition,when the smoking,overweight,and bibulosity were concurrent,it was a risk factor for femoral head necrosis (P<0.05).Conclusion  When the smoking,overweight,and bibulosity were concurrent,it can increases the risk of osteonecrosis of the femoral head after internal fixation,which may be related to the significant increase of plasma PAI-1 level,especially at 2 days after surgery.

Objective To investigate the relationship between structural changes and imaging changes of quadriceps fat pad (QFP) and prefemoral fat pad (PFP) in patients with knee osteoarthritis.Methods A retrospective analysis was conducted on the clinical data of 100 patients with knee osteoarthritis admitted to our hospital from June 2020 to June 2022,all of whom underwent magnetic resonance examination.100 patients had a total of 150 knees,and the 150 knees were divided into two groups:non-knee radiologic Osteoarthritis (ROA) group and ROA group.The basic data, QFP and PFP parameters of the two groups were compared, and the correlation between each parameter and KLG grade, Hoffa synovitis and exudative synovitis was analyzed.Results The head and tail diameter of QFP in ROA group was significantly longer than that in non-ROA group,the number of QFP high signal and PFP patellofemoral high signal cases was significantly higher than that in non-ROA group,the number of QFP mass effect cases was significantly lower than that in non-ROA group,and the maximum thickness of PFP was significantly lower than that in non-ROA group.QFP high signal and PFP patellar high signal were positively correlated with KLG grading (r=0.271, 0.399). The maximum thickness of PFP was negatively correlated with KLG grade（r=-0.418）.QFP high signal was positively correlated with Hoffa synovitis (r=0.330).QFP mass effect and PFP maximum thickness were negatively correlated with Hoffa synovitis (r=-0.291, -0.441).PFP maximum thickness was negatively correlated with exudative synovitis (r=-0.561).  PFP patellar high signal was positively correlated with cartilage defects at different sites (r=0.320, 0.418, 0.358, 0.410, 0.291). QFP mass effect and PFP maximum thickness was negatively correlated with different sites of cartilage defects (r=-0.358,-0.287, -0.287, -0.287, -0.170, -0.399, -0.438,-0.498, -0.457, -0.350).The anteroposterior diameter of the QFP was negatively correlated with the medial tibial cartilage defect (r=-0.260).Conclusion Imaging changes of QFP and PFP are closely related to KLG grade,synovitis,articular cartilage defect,and subchondral myelopathy in patients with knee osteoarthritis,and play an important role in the occurrence and development of knee osteoarthritis.

Objective To explore the predictive value of systemic immune inflammatory index (SII),systemic inflammatory response index (SIRI),neutrophil to lymphocyte ratio (NLR),lymphocyte to monocyte ratio (LMR),platelet to lymphocyte radio (PLR),albumin to globulin (AGR) and heat shock protein 90α (HSP90α) in Fuhrman grade of clear cell renal cell carcinoma (ccRCC).Methods From October 2019 to August 2022,212 patients who underwent surgical treatment for ccRCC were divided into low-grade tumor group and highgrade tumor group according to Fuhrman grade.The independent influencing factors of Fuhrman grading were determined by univariate and multivariate Logistic regression analysis,and the predictive value of each inflammatory index to Fuhrman grading was evaluated by drawing Receiver operating characteristic curve (ROC).We constructed the line chart prediction model and evaluated the effectiveness of the model.Results The preoperative levels of SII,PLR,AGR,HSP90α and the maximum diameter of tumor were significantly different between high-grade group and lowgrade group (P＜0.05).Logistic regression analysis showed that the maximum diameter of tumor,PLR,AGR  and HSP90α were independent influencing factors of Furhman grade.By drawing the ROC curve,it was found that the area under the curve (AUC) of PLR,AGR and HSP90α to predict Furhman grade were 0.641,0.675 and 0.696.In addition,the Furhman grade line chart prediction model had good prediction ability,the AUC was 0.789 (95%CI:0.717~0.862),the sensitivity was 61.80%,and the specificity was 85.40%.Conclusions  There was a significant correlation between inflammation-related indexes in peripheral blood and Furhman grade of clear cell renal cell carcinoma.The Furhman grade line chart prediction model based on the maximum diameter of tumor and peripheral blood inflammation index has good predictive ability.

Objective  To introduce the robotic-assisted left hemicolectomy and Soave procedure and its clinical outcome for Hirschsprung’s allied disease.Methods From June 2015 to November 2022,19 cases diagnosed with Hirschsprung’s allied disease underwent left colectomy and Soave pull-through by using the da Vinci surgical system,and the clinical data of 19 children were summarized and analyzed.A four trocar technique was used.The left colon was firstly mobilized by laparoscopy from splenic flexure of colon to the level of peritoneal reflection,then the rectum was mobilized by Robotic system to the level of dentate line.A circumferential incision was made in the mucosa at 0.5 cm proximal to the dentate line.The upward submucosal dissection was carried out for approximately 1-2cm.The left colon was pulled through the anal canal and resected.The coloanal anastomosis was fashioned manually 0.5cm above the dentate line.21 cases underwent conventional laparoscopic-assisted Soave surgery were used as control group.Results All patients were successfully operated.Compared with conventional laparoscopic-assisted Soave surgery,the operation time was significantly prolonged (P<0.01),the intraoperative blood loss was significantly reduced (P<0.01),and the overall postoperative complication rate was significantly reduced (11% VS.43%,P<0.05).There were no serious complications such as major bleeding and death.Conclusion Robotic-assisted left hemicolectomy and Soave procedure are safe and feasible in the treatment of Hirschsprung’s allied disease,with few postoperative complications and satisfactory clinical outcome.

Objective To investigate the effect of elastic pants on coagulation function and deep vein thrombosis by examining blood coagulation function and deep vein thrombosis in patients with liposuction in the thigh before and after operation.Methods  80 patients with liposuction were randomly divided into Ankle-length elastic pants (Ankle group,A group,n=40)and Knee-length elastic pants (Knee group,K group,n=40) from October 2021 to October 2022.After liposuction surgery,the two groups of patients used elastic bandage to initially compress and bind the thigh.According to the length of the patients’ thigh,the patients in A group wore appropriate ankle-length elastic pants and the patients in K group wore appropriate knee-length elastic pants.The index were recorded including the popliteal vein flow rate,the common femoral vein flow rate,the instep temperature,the incidence of deep vein thrombosis(DVT),the incidence of intramuscular vein thrombosis of leg and the coagulation indexes (APTT,PT,Fib,D-dimer).Results Compared with pre-operation,the blood flow rate of popliteal vein and common femoral vein in A group was significantly faster,while the blood flow rate of popliteal vein in K group was significantly slower (P<0.05).There was no significant change in APTT and PT in the two groups after operation (P>0.05),but the Fib and D-Dimer increased significantly on the first day after operation,and then decreased gradually (P<0.05).Compared with K group,the blood flow of popliteal vein and common femoral vein in A group was significantly faster at each time point after operation (P<0.05).The Fib and D-Dimer of patients in A group were significantly lower than those in K group on the 1st,3rd and 7th day after operation (P<0.05),and the blood coagulation index between the two groups returned to normal around the 14th day.There was no statistically significant difference in the instep temperature between groups and within groups (P>0.05).No deep venous thrombosis was found in A group after surgery,while there were 3 cases of deep venous thrombosis without clinical symptoms in K group on the 3rd and 7th day,with no statistical difference（P>0.05).After surgery,patients in A group and K group had intramuscular venous thrombosis of the leg on the 1st,3rd and 7th day after surgery,and there was statistically significant difference on the 3rd and 7th day between the two groups (P<0.05).Conclusion Thigh liposuction can lead to deep vein thrombosis without obvious clinical symptoms and intramuscular vein thrombosis of leg.Ankle-length elastic pants are more conducive to blood circulation of patients’ legs,improve blood hypercoagulability,and reduce the risk of deep vein thrombosis after operation.

There are several special types of tumors in the rectal and anal canal,such as neuroendocrine tumors(NETs),gastrointestinal stromal tumors(GIST),squamous cell anal carcinoma(SCAC),anorectal malignant melanoma(ARMM),and primary rectal lymphoma(PRL).They are rare and have different clinical characteristics from the rectal cancer,resulting in insufficient understanding of them by clinicians.This article reviews the diagnosis and treatment of special types of tumors in the rectal and anal region.

The terminal ileostomy is an important surgical procedure for reducing the severity of anastomotic leakage (AL) and serious postoperative complications in rectal cancer surgery.The decision of terminal ileostomy is related to the subjective judgment of surgeons and the risk of AL,however,due to the lack of objective clinical guidelines,the decision of terminal ileostomy mainly relies on the surgeons’ experience.A large number of researches have developed or proposed some tools,such as scoring models,Nomogram,expert consensus,clinical guidelines,and artificial intelligence (AI) models,are dedicated to predicting postoperative AL or making reasonable decisions for the implementation of terminal ileostomy.Although some studies have shown favorable expected results,there is still a lack of highquality data validation.At present,the rational implementation of decisionmaking for terminal ileostomy is still being explored.It is believable that the personalized implementation of terminal ileostomy can be achieved in the near future with the development of new technologies for intraoperative anastomosis detection and the advancement of highquality clinical big data research.

Bile reflux is a common physiological phenomenon in the body,which is caused by the retrograde movement of bile into the stomach and above.Long-term bile reflux causes bile reflux gastritis.It can also lead to intestinal metaplasia,Barrett’s esophagus,and even gastric cancer,esophageal cancer,pharyngeal cancer risk factors.Therefore,long-term frequent bile reflux should be regarded as pathological bile reflux.bile reflux is divided into primary bile reflux and secondary bile reflux.The common clinical symptoms of bile reflux include abdominal distension,bitter mouth,upper abdominal pain,nausea and vomiting.Primary bile reflux can occur without transgastric surgery,whereas secondary bile reflux often occurs after gastrointestinal surgery.This article reviews the pathogenesis,diagnosis and corresponding treatment progress of bile reflux,so as to provide reference for further research on bile reflux.

Encapsulated papillary carcinoma (EPC) of the breast is a rare,low grade malignant tumor which is more common in postmenopausal women.The clinical manifestations of EPC are nonspecific and easily confused with other benign breast tumors,leading to misdiagnosis and delayed diagnosis.There is currently no consensus on the diagnosis and treatment plan for EPC,and few clinical trials have been conducted on it.Therefore,this article reviews the diagnostic characteristics and therapeutic approaches of EPC.