Objective  To explore the clinical value of micro ribonucleic acid (miR)27a and miR-1299 in predicting the long-term prognosis of patients with esophageal cancer. Methods  A total of 89 patients with esophageal cancer in the hospital were enrolled between June 2020 and June 2022,and all underwent Minimally invasive thoracic and laparoscopic resection of esophageal cancer.The expression levels of miR-27a and miR-1299 were detected by real-time fluorescence quantitative polymerase chain reaction (PCR) before surgery,and level of serum ferritin (SF) was detected by enzyme linked immunosorbent assay.The relationship between miR-27a,miR-1299,SF and clinicopathology in patients with esophageal cancer was analyzed.All were followed up till February 2023 after surgery,and survival of patients was record.The relationship between miR-27a,miR-1299,SF and prognosis was analyzed.The risk factors of long-term prognosis in patients with esophageal cancer were analyzed by multivariate Cox regression model.The relationship between miR-27a,miR-1299 and serum SF was analyzed by Pearson.Results  There were significant differences in miR-27a,miR-1299 and serum SF among patients with different tumor staging,lymph node metastasis and differentiation degree (P<0.05).The results of survival analysis showed that overall survival rates in high-expression miR-27a and SF groups were lower than those in low-expression miR-27a and SF groups (P<0.05),while which was higher in high-expression miR-1299 group than low-expression miR-1299 group (P<0.05).Cox regression analysis showed that miR-27a ≥2.54,miR-1299 <4.18 and serum SF ≥223.78 μg/L (P<0.05) were independent risk factors of postoperative long-term prognosis of patients with esophageal cancer.Pearson correlation analysis showed that level of serum SF was positively correlated with relative expression level of miR-27a(P＜0.05，r=0.612),while negatively correlated with relative expression level of miR-1299(P＜0.05,r=-0.517).Conclusion The miR-27a,miR-1299 and serum SF are related to tumor staging,lymph node metastasis and differentiation degree in patients with esophageal cancer,which can be applied to evaluate postoperative long-term prognosis.

Objective  To explore the effect of improved total cavity endoscopy on lung function,postoperative feeding and complications in patients with chronic lung disease of esophageal cancer. Methods  120 esophageal cancer patients with chronic lung disease admitted to our hospital from September 2022 to June 2023 were randomly divided into two groups.The observation group consisted of 60 patients who underwent improved total cavity endoscopy assisted esophageal cancer resection,while the control group consisted of 60 patients who underwent traditional open surgery.The perioperative related indexes,lung function indexes [forced expiratory volume in the first second (FEV-1),forced vital capacity (FVC),maximum ventilation volume (MVV)],inflammatory level [interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor (TNF-α)] were compared between the two groups.Results  The blood loss,operation time,number of lymph node dissection and drainage time in the observation group were (329.51±78.84)ml,(175.47±10.41)min,(29.67±17.86) pieces per case and (3.14±0.98) d respectively.In the control group,the intraoperative blood loss,operation time,number of lymph node dissection and drainage time were (372.31±99.23)ml,(148.54±10.68)min,(28.36±18.15) pieces and (6.37±1.23) d,respectively, there was statistical significance between the two groups (P<0.05).The FEV-1,FVC and MVV of the observation group were (1.88±0.53) L,(2.33±0.46) L and (32.59±11.84)L,respectively.Two weeks after operation,the control group was (1.37±0.31) L,(1.75±0.38) L and (23.68±9.41) L respectively, there was statistical significance between the two groups (P<0.05).The inflammatory factors IL-6,IL-8 and TNF-α in the observation group were (2.17±1.62)ng/ml,(2.09±1.52)ng/ml and (1.32±0.57) ng/ml,respectively.The control group were (3.06±1.52)ng/ml,(2.75±1.29)ng/ml and (1.73±0.75) ng/ml respectively, there was statistical significance between the two groups (P<0.05).The incidence of postoperative complications in the observation group and the control group were 6.67% and 20.00% respectively,and patients in the observation group ate earlier than those in the control group (P<0.05).Conclusion Compared with the traditional open surgery,the improved total laparoscopic surgery has the advantages of less trauma,simpler operation,less damage to lung function,significantly lower incidence of postoperative complications,and shorter postoperative eating time.

Objective  To investigate the clinical outcomes of cranioplasty with polyether ether ketone(PEEK) or titanium after large craniectomy in patients. Methods  Clinical data of 150 patients undergoing skull repair due to large frontotemporal skull defect in our hospital from April 2018 to June 2022 were retrospectively analyzed,and they were divided into titanium mesh group and PEEK group according to different repair materials.The conditions of surgical site infection,bleeding,subcutaneous effusion,seizure,implant rupture or exposure in the two groups were compared.Results In the PEEK group,96.3% of patients needed to implant the repair material under the temporal muscle,which was significantly higher than that in the titanium mesh group(78.1%) (P＜0.05).There were no significant differences in postoperative complications including infection,bleeding,seizure,implant rupture or leakage between the two groups (P>0.05).However,the incidence of postoperative subcutaneous effusion in PEEK group was higher than that in titanium mesh group (14.8% VS 4.2%,P＜0.05),and the difference was statistically significant.Conclusion  Both titanium and PEEK can be used in cranioplasty for patients with large frontotemporal cranial defects.Subcutaneous effusion is common in patients underwent cranioplasty with PEEK postoperatively,which needs to be paid more attention.

Objective  To observe the effects of minimally invasive puncture and drainage combined with urokinase on the severity of cerebral edema,serum malondialdehyde(MDA),matrix metalloproteinase-9(MMP-9) and intercellular adhesion molecule-1(ICAM-1) after cerebral hemorrhage.Methods A total of 82 patients with hypertensive intracerebral hemorrhage(HICH) admitted to our hospital were retrospectively enrolled between January 2020 and September 2022.According to different treatment methods,they were divided into two groups: observation group (44 cases, control group combined with UK) and control group (38 cases,control treatment).The cerebral edema volume,nerve function [National Institutes of Health Stroke Scale(NIHSS)] and serological indexes(MDA,MMP-9,ICAM-1) in both groups were observed.The occurrence of postoperative complications was recorded.The prognosis [scores of Glasgow Outcome Scale(GOS) and activity of daily living scale(ADL),death] in the two groups was compared at 3 months after surgery.Results  At 14d after surgery,peripheral cerebral edema volume in the observation group was smaller than that in the control group[(14.76±2.39) ml vs(16.87±2.24) ml,P<0.05],NIHSS score was lower than that in the control group[(11.12±1.96) points vs(11.96±1.65) points,P<0.05].The levels of serum MDA,MMP-9 and ICAM-1  in the observation group were (8.65±1.16)nmol/ml,(96.17±19.34)ng/ml and (624.31±32.76)μg/ml,respectively,which were lower than those in the control group[(16.14±2.16) nmol/ml,(120.47±21.32) ng/ml,(661.24±35.21)μg/ml,P<0.05].There was no significant difference in incidence of postoperative complications between the observation group and the control group(9.09% vs 18.42%,P>0.05).There was no death in either group within 3 months after surgery.At 3 months after surgery,GOS and ADL scores in the observation group were (4.03±0.92) points and (71.21±12.65) points,which were higher than those in the control  group[(3.52±1.12) points,(62.98±15.58) points,P<0.05].Conclusion  The control combined with UK can effectively control cerebral edema,down-regulate MDA,MMP-9 and ICAM-1 levels,protect nerve function and improve prognosis in HICH patients.

Objective  To explore the correlation of serum matrix metalloproteinase-9 (MMP-9) and heat shock protein-47 (HSP-47) levels with prognosis in patients with acute cerebral hemorrhage.Methods  One hundred and forty-five patients with acute cerebral hemorrhage attending our hospital from March 2018 to May 2022 were selected,and assigned into good prognosis group (n=80) and poor prognosis group (n=65) according to their postoperative prognosis.General information of patients was recorded.The early morning of the day after admission fasting peripheral venous blood samples were collected for the detection of serum MMP-9 and HSP47 levels.Multivariate Logistic- regression analysis was conducted to screen the risk factors affecting poor prognosis in patients with acute cerebral hemorrhage,and the predictive value of serum MMP-9 and HSP47 levels on prognosis of patients with acute cerebral hemorrhage was evaluated by plotting ROC curve.Results Statistical difference was found in shape and volume of hematoma between two groups (P<0.05).Serum MMP-9 and HSP47 levels in poor prognosis group were higher than that in good prognosis group (P<0.05).Multivariate Logistic- regression analysis denoted that duration of surgery,hematoma shape,hematoma volume,serum MMP-9 and HSP47 levels were all risk factors for poor prognosis in patients with acute cerebral hemorrhage (P<0.05).Patients with the time of onset to surgery > 24 hours irregular shaped hematoma,large hematoma volume,and elevated serum levels of MMP-9 and HSP47 suffered a high risk of poor prognosis.ROC curve analysis demonstrated that AUC of serum MMP-9 and HSP47 levels for predicting the postoperative prognosis of patients with acute cerebral haemorrhage were 0.718 and 0.827,with a sensitivity of 81.5% and 80.0%,and a specificity of 50.0% and 81.2%,respectively.The AUC,sensitivity and specificity of combined detection of serum MMP-9 and HSP47 for prognosis prediction were 0.891,86.2% and 85.0%.Conclusion  Serum MMP9 and HSP47 levels are elevated in patients with poor prognosis after acute cerebral haemorrhage,and irregular shaped hematoma,hematoma volume,and serum MMP-9 and HSP47 levels are risk factors for poor prognosis after acute cerebral haemorrhage.Furthermore,serum MMP-9 and HSP47 are of great predictive value for the prognosis of patients with acute cerebral haemorrhage,and the predictive efficacy of combined detection of the two is better than that of separate test.

Objective  To investigate the risk factors of severe hypoxemia after cardiovascular surgery with cardiopulmonary bypass in adults.Methods  Retrospective analysis of clinical data of 395 adult patients after cardiovascular surgery with cardiopulmonary bypass from January 2021 to December 2021.The general socio-demographic data,disease-related data,preoperative test results,intraoperative data,test indexes within 6 hours after surgery and oxygenation index within 72 hours after surgery were collected using an electronic case system;patients with postoperative oxygenation index≤100 mmHg was defined as severe hypoxemia group(20 cases),oxygenation index＞100mmHg was defined as non-hypoxemia group (375 cases),compared the perioperative clinical data of two groups,and explored the risk factors for severe hypoxemia by multifactorial logistic review.Results A total of 395 patients were included,and the incidence of postoperative severe hypoxemia was 5.06% (20/395).Multifactorial logistic retrospective analysis showed that body mass index(OR=3.713,95%CI 1.946~ 7.083,P<0.001),preoperative neutrophil count(OR=1.164,95%CI 1.034~1.312,P<0.012),and aortic clamping time(OR=1.009,95%CI 1.001~ 1.018,P=0.030)were independent risk factors for postoperative severe hypoxemia.In addition,the duration of invasive ventilation,ICU stay,and total hospital days were prolonged and the incidence of reintubation was higher in the severe hypoxemia group(P<0.05).Conclusion  The results howed that body mass index,preoperative neutrophils count,and aortic clamping time were independent risk factors for postoperative severe hypoxemia after cardiovascular surgery with cardiopulmonary bypass,and patients with severe hypoxemia had a worse prognosis.

Objective  To analyze the effects of extended subxiphoid thymus resection on inflammatory factors,T lymphocyte subsets and stress response in thymoma patients.Methods  The clinical data of 118 patients with thymoma admitted to our hospital from May 2021 to May 2023 were retrospectively analyzed,of which 61 patients underwent subxiphoid enlargement thymectomy (recorded as the study group) and 57 patients underwent lateral thoracotomy enlargement thymectomy (recorded as the control group).The postoperative and perioperative pain,stress response,inflammatory response,T lymphocyte subsets and complications were compared between the two groups.Results  There was no significant difference in operation time,intraoperative blood loss and postoperative drainage volume between the two groups (P> 0.05).The visual analogue scale (VAS) of the study group (3.21±0.47,2.47±0.34 points) was lower than that of the control group (3.62±0.53,2.61±0.39 points) at 24h and 48h after surgery (P＜0.05).The levels of adrenaline (Adr) and cortisol (Cor) 48h after operation were higher than those before operation (P＜0.05).The levels of Adr and Cor [(101.94±12.83)ng/L,(276.84±31.05)nmol/L] in the study group were lower than those in the control group [(108.15±14.72)ng/L,(308.91±35.24)nmol/L] 48 hours after operation (P＜0.05).The levels of TNF-α and IL-6 48h after surgery were higher than those before surgery (P＜0.05).The levels of tumor necrosis factor α (TNF-α) and interleukin-6 (IL-6) in the study group [(40.91±6.93)pg/ml,(55.62±8.67)pg/ml] 48h after surgery were lower than those in the control group [(45.85±8.12)pg/ml,(61.98±10.51)pg/ml] (P＜0.05).The levels of Th1/Th2 and Th17/Treg in both groups 48h after surgery were lower than those before surgery (P＜0.05).The levels of Th1/Th2 and Th17/Treg in the study group (4.75±0.74,0.95±0.17) were lower than those in the control group (5.16±0.89,1.06±0.19) 48h after surgery (P＜0.05).The changes of Th1/Th2 and Th17/Treg in two groups were different (P＜0.05).Conclusion  Compared with lateral thoracotomy,transxiphoid enlargement of thymus can reduce perioperative pain,inhibit perioperative inflammatory response and stress response,improve T lymphocyte subpopulation,and is safe and reliable.

Objective  To investigate the efficacy of micrornas (miR)27B-3P combined with miR-215 in predicting the recurrence of early gastric cancer after endoscopic submucosal dissection (ESD).Methods A total of 122 patients with early gastric cancer admitted to the hospital from January 2021 to February 2022 were selected.All patients received ESD surgery and were followed up for 10~15 months, average (12.57±1.83) months.Patients with early gastric cancer were divided into recurrence group and non-recurrence group according to whether they had recurrence after ESD surgery.The relative expression levels of miR-27b-3p and miR-215 and clinical data of the two groups were compared to analyze the factors affecting the recurrence of early gastric cancer patients after ESD surgery,and analyze the relative expression levels of miR-27b-3p and miR-215 and the predictive value of their combination for the recurrence of early gastric cancer patients after ESD surgery.Results  After 10~15 months, average (12.57±1.83) months of follow-up,3 cases of 122 patients were lost to follow-up,the follow-up rate was 97.54%,of which 12 cases relapsed,and the remaining 107 cases did not relapse.The miR-27b-3p in the relapsed group was lower than that in the non-relapsed group (P<0.05),and the relative expression of miR-215 in the relapsed group was higher than that in the non-relapsed group (P<0.05).The proportion of patients with lesion size ≥3cm and infiltration depth of SM2-SM3 in recurrence group was higher than that in non-recurrence group (P<0.05),and the proportion of patients with R0 resection in recurrence group was lower than that in non-recurrence group (P<0.05).Logistic multivariate regression analysis showed that the lesion size was ≥3cm  and the depth of invasion was SM2-SM3 ,the relative expression level of miR-27b-3p ,the relative expression level of miR-215  were the influential factors for recurrence of early gastric cancer patients after ESD operation (P<0.05).The relative expression levels of miR-27b-3p and miR-215 and their combined prediction of the area under the curve (AUC) of ESD postoperative recurrence in early gastric cancer patients were 0.783,0.845 and 0.935,respectively.Conclusion  miR-27b-3p and miR-215 can be used to predict the recurrence risk of early gastric cancer patients after ESD surgery,and the combination of Mir-27B-3P and Mir-215 has higher predictive value.

Objective To analyze the efficacy and safety of double-ring sandwich procedure in the treatment of acute A-type aortic dissection root.Methods The clinical data of 103 patients with acute A-type aortic dissection treated by double-ring sandwich procedure in our center from October 2020 to May 2023 were retrospectively analyzed to investigate the surgical effect,short-term cardiac structural changes and short-term postoperative complications.Results  Needle hemostasis was applied in 11.65% of all patients.The amount of red blood cell transfusion during the perioperative period was (2.95±1.97)U,plasma was (543.68±208.48)ml,and blood platelet was (0.08±0.30)U.The residual aortic regurgitation,cardiac function and pericardial effusion were significantly improved at 2 weeks after operation (P<0.05).The proportion of residual false lumen in the aortic root was significantly reduced after operation (P<0.05).The length of hospital stay,duration of intubation,and drainage within 24 hours after surgery were less.The incidence of postoperative short-term complications such as secondary thoracotomy,cerebral infarction,cerebral hemorrhage,hemofiltration,tracheal incision and death was low.Conclusions Double-ring sandwich procedure in the treatment of acute A-type aortic dissection can effectively block the false lumen of aortic root dissection,reduce the risk of aortic intimal avulsion,and the operation is safe and effective.

Objective  To investigate the expression of 8-hydroxy deoxyguanosine (8-OHdG) and nectin-4 in the serum of primary liver cancer (PLC),and to evaluate the efficacy of transcatheter chemoembolization (TACE) for PLC.Methods  From January 2021 to June 2022,180 patients with primary liver cancer with TACE were studied.According to the efficacy of TACE patients,they were separated into a good group (n=137) and an adverse group (n=43).The general clinical data and the serum expression levels of 8-OHdG and nectin-4 were compared between the two groups;multivariate Logistic- regression was applied to analyze the influencing factors of postoperative efficacy in TACE for primary liver cancer;receiver operating characteristic was applied to analyze the value of serum 8-OHdG and nectin-4 levels in evaluating the efficacy of TACE for primary liver cancer.Results There were no significant differences in age,sex,BMI,Child-Pugh grade,tumor location,tumor number,tumor diameter,tumor contour,degree of differentiation,tumor envelope,vascular cancer thrombus,bile duct cancer thrombus and lymph node metastasis between the poor postoperative efficacy group and the good efficacy group after TACE for primary liver cancer (P>0.05).The expression levels of serum 8-OHdG and nectin-4 in the poor postoperative efficacy group after TACE for primary liver cancer were obviously higher than those in the good efficacy group (P<0.05).Multivariate -Logistic regression analysis showed that serum 8-OHdG,nectin-4,tumor diameter,TNM staging and Lymph node metastasis were all independent influencing factors for the postoperative efficacy of TACE in primary liver cancer (P<0.05).The AUC of the combined evaluation of serum 8-OHdG and nectin-4 for the postoperative efficacy of TACE in primary liver cancer was 0.930,with a sensitivity of 86.05% and a specificity of 94.16%,which was superior to their respective individual evaluations (Zcombination-8-OHdG=2.033,Z combinationnectin-4=3.221,P=0.042,0.001).Conclusion The serum levels of 8-OHdG and nectin-4 are obviously increased in the poor postoperative efficacy group after TACE for primary liver cancer.The combination of the two has a good evaluation effect on the postoperative efficacy of TACE for primary liver cancer.

Objective  To analyze the efficacy, safety, and survival of laparoscopic cholecystectomy (LC) combined with lymph node dissection in the treatment of elderly primary gallbladder cancer.Methods 59 elderly patients with primary gallbladder cancer who underwent open cholecystectomy combined with lymph node dissection from January 2018 to July 2021 were selected as the control group, and 59 elderly patients with primary gallbladder cancer who underwent LC combined with lymph node dissection were selected as the study group. The clinical efficacy, perioperative indicators, and T cell subsets were compared between the two groups CD4⁺、CD4⁺/CD8⁺]、 Quality of life (SF-36). Results  The difference in recent treatment effectiveness between the research group and the control group is relatively small,(94.0% vs. 72.5%,χ2=0.209,P=0.648).The time required for lymph node dissection was (39.27±5.63)min and surgery time was (235.16±31.37)min in the study group,which was longer than that in the control group [(35.61±4.75)min and (194.59±30.82)min（P<0.05）.In the study group,the intraoperative bleeding volume was (32.63±5.42)ml and first exhaust time was (3.18±0.72)d,gastrointestinal function recovery time was (3.98±1.04)d,and hospitalization time  was (6.24±1.25)d,which were shorter than those in the control group [(61.27±7.85)ml,(4.02±0.83)d,(4.65±1.18)d,(10.41±2.18)d,respectively,(P<0.05)].After surgery,the levels of CD3⁺(16.52%±5.24%),CD4⁺(15.79%±3.83%),and CD4⁺/CD8⁺(0.47%±0.11%) in the study group were higher than those in the control group (13.74%±4.30%,10.83%±3.14% and 0.29%±0.05%) (P<0.05).One month after surgery,the total quality of life score (SF-36) of the observation group (90.86±3.75) was higher than that of the control group (86.85±3.14) (P<0.05).The incidence of complications in the study group was lower than that in the control group (7.01% vs. 23.73%,χ2=4.627,P<0.05).The median survival time of the study group was (13.8±1.50)months,which was significantly higher than that of the control group [(12.5±1.25)months,P>0.05].Conclusion  LC combined with lymph node dissection is a safe and effective treatment for elderly primary gallbladder cancer,without affecting long-term prognosis and survival.

Objective To construct the nomographic chart model for gastrointestinal symptoms after operation of alcoholic cirrhosis complicated with cholecystolithiasis and to explore its predictive value.Methods One hundred patients with ALC complicated with gallbladder stones who received treatment in our hospital from October 2021 to October 2022 were selected for surgical treatment,collect relevant patient data and analyze the occurrence of postoperative gastrointestinal symptoms and their scores,based on the evaluation results of gastrointestinal symptoms,patients are divided into mild and moderate to severe groups,analyze the factors affecting the severity of postoperative gastrointestinal symptoms,and construct a column chart prediction model;evaluate and validate the model using ROC curves,calibration curves,and DCA curves.Results  Patients with mild to moderate to severe postoperative gastrointestinal symptoms showed statistically significant differences in age,intraoperative blood pressure abnormalities,early postoperative eating,early postoperative bed movement,advanced analgesia,anxiety selfassessment scale (SAS) scores,postoperative use of gastrointestinal motility drugs,and surgical time (P<0.05);Age,intraoperative abnormal blood pressure,early postoperative eating,early postoperative bed movement,preemptive analgesia,surgical time,SAS score,and gastrointestinal motility promoting drugs of the model group were influencing factors for the severity of postoperative gastrointestinal symptoms in patients (P<0.05);building a column chart prediction model based on the above factors,ROC,calibration curve,and DCA indicate that the prediction model has good predictive ability and clinical effectiveness,and has good accuracy and differentiation.Conclusion  The factors influencing the severity of gastrointestinal symptoms after surgery for ALC combined with gallbladder stones include age,abnormal intraoperative blood pressure,early postoperative feeding,early postoperative bed exercise,duration of surgery,over the counter analgesia,SAS score,and postoperative use of pro-gastrointestinal motility drugs,and the above factors were constructed into a columnar graph prediction model with good predictive efficacy and clinical utility.

Objective  To explore the application effect of negative pressure sealing drainage combined with active factor dressing and flap transfer in Gustilo Ⅲ type tibiofibular fractures.Methods  From March 2019 to March 2022,92 patients with Gustilo type Ⅲ tibiofibular fracture admitted to the Department of Orthopaedics of the Third People’s Hospital of Zhangjiagang City were randomly divided into the experimental group (internal and external fixation+flap transfer+negative pressure sealing drainage+active factor dressing,n=46) and the control group (internal and external fixation+flap transfer+conventional dressing change+active factor dressing,n=46),and the clinical indexes,clinical efficacy,ankle joint function,lower limb function and complications were compared.Result  The hospital stay time (25.32±8.36)d,the flap healing time (9.69±1.24)d,the fracture healing time (8.24±1.84)month and the wound healing time (14.24±3.84)d of the experimental group were shorter than those of the control group (43.44±11.84)d,(11.53±2.07)d and (9.12±2 .50) month,(50.11±5.12) d (P<0.05).The total effective rate of the experimental group (93.48%,43 cases /46 cases) was higher than that of the control group (71.74%,33 cases /46 cases,P<0.05).The ankle pain scores of both groups after treatment were lower than before treatment,and the experimental group was lower than the control group,and the scores of ankle function and stability,the scores of American Association of Foot and Ankle Surgery (AOFAS) and the knee joint score of American Hospital for Special Surgery (HSS) after treatment were higher in both groups than before treatment,and the experimental group was higher than the control group (P<0.05).The total complication rate of the experimental group (4.34%,2 cases /46 cases) was lower than that of the control group (17.39%,8 cases /46 cases,P<0.05).Conclusion  The application of negative pressure closed drainage combined with active factor dressing in Gustilo type Ⅲ tibia and fibula fracture is effective,can promote postoperative wound recovery,improve ankle and lower limb function,and the incidence of complications is low.

Objective  To analyze the current status,hot spots and future trends of nutrition related research in elderly fracture patients.Methods  Relevant literatures on nutrition in elderly patients with fracture in the core collection of web of science and CNKI were searched by computer from January 1,2013 to August 31,2023.and the search results were analyzed by using the software of CiteSpace,vision 6.2.R4.Results A total of 1 174 articles were included,including 366 Chinese articles and 808 English articles.In recent years,the number of literatures on nutrition related research of elderly fracture patients at home and abroad has shown an upward trend.The research hotspots abroad are hip fracture,bone mineral,vitamin D deficiency,bone mineral density,vitamin D,sarcopenia,proximal femur,population;Domestic research focuses on influencing factors,perioperative period,bone mineral density,nursing,osteoporosis,the elderly,tissue engineering,incision healing.Conclusion  Our country has certain advantages in the field of nutrition for elderly fracture patients,which can help researchers to understand the development trend,research hotspots and shortcomings of nutrition related to elderly fracture patients,and provide reference and guidance for future research.

Objective  To investigate the effect of arthroscopic surgery on anterior ankle impingement syndrome.Method  Arthroscopic surgery was performed on 42 patients with anterior ankle impingement syndrome admitted to the People’s Hospital of Wuhan University from April 2016 to October 2021.The patients were followed up for 14 to 26 months.The visual analogue scale (VAS) was used to evaluate pain, and the American Orthopaedic Foot and Ankle Society, AOFAS (Ankle and hind foot function scores) were used to evaluate the therapeutic effect and ankle joint function, and to compare the preoperative and postoperative changes.Results  The wounds of all patients were healed in stage Ⅰ without infection, nerve, blood vessel or tendon injury.The AOFAS score was (45.52±6.64) before surgery, (76.33±6.52), (92.86±3.48) and (94.95±3.68) at 1 month, 3 months and 14 months after surgery, respectively.The VAS score was (7.95±0.70) before surgery, (3.86±0.65), (1.83±0.79) and (1.24±0.96) at 1 month, 3 months and 14 months after surgery, respectively.AOFAS scores and VAS scores at 1 month, 3 months and 14 months after operation were significantly improved compared with those before operation, and the difference was statistically significant(P<0.05),there was significant improvement at 3 and 14 months after surgery compared with 1 month after surgery, and the difference was statistically significant(P<0.05),14 months after surgery was better than 3 months after surgery, but the difference was not statistically significant (P> 0.05).Conclusion  Arthroscopic surgery in the treatment of anterior ankle impingement syndrome, less trauma, quick recovery, good effect, can be effective in the treatment of ligamentous and osteochondral injury, mid-term follow-up effect is stable.

Objective  To explore the efficacy and safety comparison of intelligent small splints and polymer plaster fixation for the treatment of distal radius fractures in the elderly.Methods  Forty elderly patients with distal radius fractures who were diagnosed and treated in our hospital from January 2021 to December 2022 were selected as the research subjects.They were divided into two groups using a random number table method,with 20 cases in each group.The control group was treated with polymer gypsum fixation,while the treatment group was treated with intelligent small splints combined with polymer gypsum fixation.Observe the reduction status (palm tilt angle,ulnar deviation angle,radius height),joint function (DASH score),pain (VAS score),joint range of motion (wrist flexion,radius deviation,ulnar deviation,back extension,pronation,and supination),and complications of the two groups of patients after treatment.Result  Before treatment,there was no statistically significant difference (P＞0.05) in the values of palmar inclination,ulnar deviation angle,and radius height between the two groups.After treatment,the values of palmar inclination,ulnar deviation angle,and radius height increased compared to before treatment,and after treatment,the values of palmar inclination,ulnar deviation angle,and radius height in the treatment group were higher than those in the control group,with a statistically significant difference (P<0.05).Before treatment,there was no statistically significant difference in DASH and VAS scores between the two groups (P＞0.05).After treatment,both DASH and VAS scores decreased compared to before treatment,and the DASH and VAS scores in the treatment group were lower than those in the control group (P<0.05).After treatment,the joint mobility of palm flexion,radial deviation,ulnar deviation,back extension,pronation,and supination in the treatment group was significantly higher than that in the control group (P<0.05).After treatment,the total incidence of complications in the control group was 20.00% (4/20),slightly higher than that in the treatment group of 5.00% (1/20),but the difference was not statistically significant (P＞0.05).The patients were followed up for 6 months.At the end of follow-up,there was no significant difference in treatment satisfaction between the two groups （P＞0.05).Conclusion  The combination of intelligent small splints and polymer gypsum fixation therapy is superior to polymer gypsum fixation therapy alone in terms of reduction,joint function,pain,and joint mobility.

Objective  To investigate the clinical effect of dual incision and dual plate internal fixation for the treatment of tibial plateau fractures in the elderly and its impact on knee joint function.Methods  Using retrospective analysis method,103 elderly patients with tibial plateau fractures admitted to Rugao Hospital affiliated to Nantong University from April 2015 to May 2021 were selected for clinical research.According to the surgical method,they were divided into two groups,52 patients in the study group were treated with double incision double plates,and 51 patients in the control group were treated with locking plate internal fixation.Perioperative indicators,knee function,knee stability Knee joint complications.Results The hospitalization time of the study group was (7.8±2.0) days, and that of the control group was (10.0±2.4) days, and the difference was statistically significant between the two groups (P<0.05).The HSS scores at 3 months, 6 months and 12 months were (66.9±5.4), (78.4±6.6) and (83.8±6.1) in the study group, and (64.2±6.1), (74.0±7.3) and (82.0±6.8) in the control group, respectively. There was statistical significance in HSS scores 3 months and 6 months after operation between the two groups (P<0.05).The tibial migration distance 3 months after operation was (2.54±0.50) mm in the study group and (2.84±0.67) mm in the control group, and the difference was statistically significant (P<0.05).The knee posterior inclination angles of the study group were (4.12±1.10) °, (5.03±0.96) ° and (5.46±1.52) ° at 3 months, 6 months and 12 months after surgery, respectively, while those of the control group were (6.11±1.43) °, (6.67±1.54) ° and (7.50±1.88) °, respectively. The difference was statistically significant (P<0.05).The activity of the study group at 3 months and 6 months after surgery was (104.3±8.2) ° and (117.4±7.6) °, respectively, while that of the control group was (96.8±8.9) ° and (111.8±8.2) °, and the difference was statistically significant (P<0.05).There were 3 cases of postoperative complications in the study group and 10 cases in the control group, and the difference was statistically significant (P<0.05).Conclusion  The clinical effect of dual incision and dual plate internal fixation in the treatment of tibial plateau fractures in the elderly is affirmative,which is more beneficial for promoting early recovery of knee function and maintaining stability of knee function than locking plate internal fixation.

Objective  The aim of this study was to investigate the high risk factors of intraoperative stress injury in children with posterior spinal scoliosis and to construct a corresponding risk prediction model.Methods  A total of 237 cases of orthopaedic surgery for posterior scoliosis performed in three first-class hospitals in Changsha City from October 2021 to February 2023.The patients were divided into injury group (31 cases) and uninjured group (206 cases) according to whether stress injury occurred.The risk factors were screened by single factor analysis and multiple Logistic-regression analysis,and the corresponding risk prediction model was constructed.Results  The results of single factor analysis showed that constitutional index,preoperative skin condition,preoperative hypoproteinemia,preoperative anemia,operative time,intraoperative body temperature and intraoperative bleeding were related to the occurrence of vascular crisis.BMI,preoperative skin condition,preoperative hypoproteinemia,operative time and intraoperative bleeding are high risk factors for the occurrence of intraoperative stress injury in children with posterior scoliosis.The area under ROC curve is 0.612,the sensitivity is 89.7%,and the specificity is 91.0%,indicating that this model has good risk prediction ability.Conclusion  BMI,preoperative skin condition,preoperative hypoproteinemia,operative time and intraoperative bleeding are high risk factors for the occurrence of intraoperative stress injury in children with posterior scoliosis.

Objective  To explore the effects of three different patient-controlled analgesia protocols on sedation and analgesia in patients undergoing thoracoscopic surgery for lung cancer.Methods  Ninety-three patients undergoing thoracoscopic surgery for lung cancer in our hospital from November 2022 to April 2023 were selected,and randomly assigned into three groups according to different postoperative analgesic protocols.Group P (n=30) was given patient-controlled intravenous analgesia,group T (n=31) received patient-controlled intravenous analgesia combined with thoracic paravertebral block,while group S (n=32) received patient-controlled intravenous analgesia combined with serratus intercostal plane block.Then the Visual Analogue Scale (VAS) score,Ramsay sedation scores,the press times of analgesic pump,the use of sedative drugs and adverse effects were compared among all three groups,and the sensory block plane,performance time,onset time and duration of the block were compared between group T and S.Results  VAS scores in the resting state at postoperative 2h,24h and 48h were (3.09±0.69),(2.83±0.59) and (2.07±0.51) in group P,which were higher than group T[(1.22±0.33),(2.51±0.54) and (1.57±0.45)] and group S[(1.01±0.30),(2.23±0.51) and (1.22±0.25)],group T was higher than group S.VAS scores in the coughing state at postoperative 2h,24h and 48h were (3.63±0.55),(3.24±0.67) and (2.61±0.51) in group P,which were higher than the group T[(1.45±0.29),(2.71±0.56) and (2.33±0.53)] and group S[(1.14±0.28),(2.40±0.57) and (2.03±0.52)],group T was higher than group S.VAS scores in the resting and coughing states at postoperative 2h,24h and 48h yielded statistical difference among three groups (all P<0.05).Ramsay sedation scores at postoperative 2h,24h and 48h were (2.21±0.51),(2.34±0.56) and (2.31±0.55) in group P,(2.23±0.53),(2.35±0.55) and (2.33±0.54) in group T and (2.22±0.52),(2.36±0.57) and (2.32±0.55) in group S,with no statistical difference (all P>0.05).The press times of analgesic pump at postoperative 24h and 48h were (10.18±2.42) and (14.51±3.20) in group P,which were higher than the group T[(3.32±0.79) and (6.84±1.62)] and group S[(1.17±0.28) and (2.63±0.62)],group T was higher than group S,with statistical difference (all P<0.05).The additional dose of sufentanil and the total amount of sufentanil used in postoperative period were (8.05±1.99)μg and (71.53±6.91)μg in group P,which were more than the group T[(3.77±0.93)μg and (65.82±5.77)μg] and the group S[(2.23±0.55)μg and (47.54±4.56)μg],group T was higher than group S,with statistical difference (all P<0.05).Group S had shorter performance time[(5.32±1.77)min] and longer block duration time[(12.51±2.14)h] than those of group T[(12.41±3.42)min and (10.31±2.01)h],with statistical difference(all P<0.05).The incidence of adverse reactions was 6.25% in group S,which was lower than the group P (30.00%,P<0.05),and no statistical difference was reported among three groups in the occurrence rate of comparisons (all P>0.05).Conclusion  The sedation effects of the three different patient-controlled analgesia protocols are comparable,but patient-controlled intravenous analgesia combined with serratus intercostal plane block provides better postoperative analgesia for patients undergoing thoracoscopic surgery for lung cancer,which has less analgesic pump presses and lower dose of postoperative analgesic drugs used,and fewer adverse effects.

Objective  To analyze the influencing factors of poor anal function after laparoscopic intersphincteric resection(Lap-ISR) for extremely low rectal cancer,and to construct and verify a prediction model based on this model,in order to provide guidance for improving the anal function of patients with extremely low rectal cancer after Lap-ISR.Method  A total of 127 patients with extremely low rectal cancer who underwent Lap-ISR in Taizhou People’s Hospital from June 2020 to June 2022 were retrospectively selected.Patients were followed up for 12 months after surgery,and postoperative anal function was evaluated by the anal incontinence score(Wexner).According to Wexner score,the patients were divided into good anal function group(106 cases) and poor anal function group(21 cases).The clinical data of patients were collected and the risk factors affecting postoperative poor anal dysfunction were analyzed,and a Nomogram model was constructed to predict the risk of postoperative anal dysfunction in patients after Lap-ISR,and the receiver operating characteristic curve(ROC) was drawn.The area under the curve(AUC) was used to analyze the predictive efficacy of the prediction model for poor anal dysfunction after Lap-ISR.Result The incidence of anal dysfunction after Lap-ISR in patients with extremely low rectal cancer was 16.54%(21/127).Univariate analysis showed that there was no significant difference in gender,age,body mass index,clinical stage,combined underlying diseases,operation time,intraoperative blood loss,anastomosis method,and the distance from the lower edge of the tumor to the dentate line between the two groups(P>0.05).The proportion of tumor diameter≥5 cm,the proportion of neoadjuvant chemotherapy,the distance between anastomosis and anal verge<2 cm,and the proportion of anastomotic leakage in the anal dysfunction group were higher than those in the good anal function group(P<0.05).Cox multivariate regression analysis showed that tumor diameter≥5 cm(OR=5.124),neoadjuvant chemotherapy(OR=5.761) and anastomotic leakage(OR=6.881) were risk factors for postoperative anal function(P<0.05).Wexner score of patients with tumor diameter ≥5 cm was higher than that of patients with tumor diameter < 5 cm,Wexner score of patients with neoadjuvant chemotherapy was higher than that of patients without neoadjuvant chemotherapy,and Wexner score of patients with anastomotic leakage was higher than that of patients without anastomotic leakage(P<0.05).Internal validation of Bootstrap method showed that the C-index was 0.785(95%CI: 0.692~0.851).The results of ROC curve showed that the sensitivity and specificity of the nomogram model in predicting postoperative poor anal function of patients were 85.70% and 88.70%,respectively,and the AUC was 0.895(95%CI: 0.795~0.984).Conclusion Tumor diameter,neoadjuvant chemotherapy and anastomotic leakage are risk factors for poor anal function after Lap-ISR in patients with extremely low rectal cancer.The nomogram risk prediction model based on the above risk factors has a good risk efficiency in evaluating the risk of postoperative anal dysfunction in patients.