Objective To explore the therapeutic effect of dual microcatheter technology on patients with intracranial wide necked aneurysms and its impact on their neurological function.Method This article adopts a prospective randomized controlled study,collect clinical data of 55 patients with intracranial wide neck aneurysms from the First People's Hospital of Suzhou City from March 2017 to March 2022.According to different treatment methods,divided treatment group 28 cases and control group 27 cases.The control group patients received stent assisted therapy,while the treatment group patients received dual microcatheter intervention therapy.Compare efficacy and complications two groups;changes in NIHSS score and ADL score before and 6 months after surgery;Postoperative prognosis at 6 months.Result The total effective rate of the treatment group was 100.00%,while the total effective rate of the control group was 96.30%;two groups of patients with intracranial wide necked aneurysms treatment efficacy no significant difference (P>0.05).The treatment group complications in patients with intracranial wide necked aneurysms (7.14%) less control group (33.33%) (P<0.05).The two groups NIHSS score of patients with intracranial wide necked aneurysms lower before surgery at 6 months after surgery,while the ADL score higher before surgery (P<0.05);the treatment group NIHSS score of patients with intracranial wide necked aneurysms (8.76±0.87) score lower control group (9.82±0.96) score after 6 months of treatment,while the ADL score (57.82±5.43) score higher control group (64.52±5.16) score (P<0.05).There was no significant difference in mRS Scores between the two groups(P>0.05).Conclusion The dual microcatheter technology has a good therapeutic effect on IWNA patients,can reduce the occurrence of complications,improve patient neurological function.

Objective To analyze the application effect and economic benefit of total parathyroidectomy(TPTX)+subcutaneous implantation of forearm(AT)+ thymectomy in patients with secondary hyperparathyroidism (SHPT).Methods The clinical data of 110 patients with SHPT who were treated in our hospital from March 2018 to January 2021 were retrospectively analyzed.They were divided into medication group (50 cases,receiving cinacalcet combined with low-dose calcitriol) and operation group (60 cases,receiving TPTX+AT+ thymectomy) according to different treatment regimens.The biochemical indexes,cardiac structure and function,clinical symptoms and quality of life of the two groups were compared before and after treatment for 24 months,and the complications,cost-effectiveness and recurrence rate of the two groups after operation were counted.Results After treatment,the levels of serum iPTH[(206.45±152.59) pg/ml],calcium [(2.05±0.26) mmol/L],phosphorus [(1.48±0.21) mmol/L],calcium-phosphorus product (3.02±0.69) and ALP [(102.03±30.25) U/L] in operation group were all lower Drug group [(721.32±325.36) pg/ml,(2.22±0.18) mmol/L,(1.91±0.22) mmol/L,(4.22±0.74),(140.62±27.15) U/L] (P<0.05);LVEF[(60.85±4.02) %] in operation group was higher than that in drug group [(55.58±3.84) %].LVED[(48.03±2.58) mm] and LVST[(9.85±0.76) mm] were lower than those in drug group [(51.02±3.65) mm,(11.12±0.86) mm](P<0.05).The scores of bone pain,skin pruritus and restless legs syndrome in the operation group were lower than those of the medication group,and the KDTA score was higher than that of the medication group (P<0.05).The total cost of treatment in the operation group [(4.06±1.42) million yuan] was not significantly different from that in the drug group [(3.46±1.85) million yuan] (P>0.05).The effective rate of iPTH reduction in operation group was 90.00%(54/60),which was higher than that in drug group (48.00%,24/50) (P<0.05).The cost-effectiveness analysis showed that the CER of the drug group and the operation group were 7.21 and 4.51 respectively,and the operation treatment had more cost-effectiveness advantages.The incremental cost-effectiveness analysis shows that compared with the drug group,the operation group needs to increase the cost by 14,800 yuan for each additional patient effectively treated for SHPT(P>0.05).There was no significant difference in the incidence of complications (13.33% VS 12.00%) and the recurrence rate (8.33% VS 4.00%) at 24 months after treatment between the operation group and the drug group (P>0.05).Conclusion TPTX+AT+ thymectomy can relieve the bone pain,reduce the iPTH level,correct the disorder of calcium and phosphorus metabolism,improve the heart function and structure,and improve the quality of life,and the cost-effectiveness is higher than SHPT of drug treatment,without increasing short-term recurrence rate.

Objective To investigate the expression of miR-30a-5p and miR-129-5p in the serum of patients with non-small cell lung cancer after EGFR targeted therapy and their relationship with the therapeutic effect.Methods A total of 186 patients with non-small cell lung cancer who received EGFR targeted therapy in our hospital from January 2020 to June 2022 were regarded as research objects.According to the efficacy of patients,they were separated into effective group (n=141) and ineffective group (n=45).The serum levels of miR-30a-5p and miR-129-5p were compared between the two groups;multivariate logistic regression was applied to analyze the factors influencing the efficacy of non-small cell lung cancer;receiver operating characteristic was applied to analyze the predictive value of serum miR-30a-5p,miR-129-5p levels for efficacy of non-small cell lung cancer.Results There were obvious differences in smoking history and TNM stage between the ineffective group and the effective group (P<0.05).The expression levels of miR-30a-5p and miR-129-5p in the ineffective group were obviously lower than those in the effective group (P<0.05).Multivariate logistic regression analysis showed that serum miR-30a-5p,miR-129-5p,smoking history,and TNM stage were all factors influencing the efficacy of non-small cell lung cancer (P<0.05).Receiver operating characteristic showed that the AUC of the combination of serum miR-30a-5p and miR-129-5p to predict the efficacy of non-small cell lung cancer was 0.926,the sensitivity was 91.11%,and the specificity was 83.69%,which was better than their respective predictions (Zcombination-miR-30a-5P=3.260,Zcombination-miR-129-5P=3.726,P=0.001,0.000).Conclusion The serum levels of miR-30a-5p and miR-129-5p in patients with non-small cell lung cancer who failed to respond to EGFR targeted therapy are obviously lower than those in the effective group;The combination of the two has a good predictive value for the efficacy of non-small cell lung cancer after EGFR targeted therapy.

Objective To explore the effects of pulsed radiofrequency(PRF) intercostal nerve block on postoperative analgesia and recovery quality in patients undergoing thoracoscopic lung surgery.Method Ninety patients scheduled for unilateral thoracoscopic lung resection between July 2021 and July 2022 were enrolled and randomly divided into two groups,with 45 patients in each group:the intercostal nerve block with local anesthetics group(INB group) and the intercostal nerve block with PRF group(PRF group).Intercostal nerve blocks were performed under ultrasound guidance before general anesthesia in both groups, followed by patient-controlled intravenous analgesia(PCIA) postoperatively.Intraoperative mean arterial pressure(MAP), heart rate(HR), propofol and remifentanil consumption, incidence of hypertension and tachycardia during recovery, visual analog scale(VAS) scores at various time points after awakening, number of presses on the postoperative analgesia pump, cases requiring rescue analgesia, postoperative sufentanil and pethidine consumption, occurrence of postoperative adverse reactions, preoperative and postoperative QoR-40 scores, pain control, and nerve injury after discharge were observed and recorded.Results The incidence of hypertension and tachycardia during recovery in the PRF group were significantly lower than those in the INB group(P＜0.05).The resting VAS scores in the PRF group at awakening(T₄),2 hours post-awakening(T₅),6 hours post-awakening(T₆),24 hours post-awakening(T₇),and 48 hours post-awakening(T₈) were significantly lower than those in the INB group(P＜0.05).Both the number of presses on the analgesia pump and the number of cases requiring rescue analgesia in the PRF group were significantly lower than those in the INB group(P＜0.05).The postoperative consumption of sufentanil at 24 hours and 48 hours,and pethidine in the PRF group was significantly lower than that in the INB group(P＜0.05).The total QoR-40 scores on postoperative days 1,3,and 7 in the PRF group were significantly higher than those in the INB group(P＜0.05).The incidence of postoperative nausea and vomiting in the PRF group was 4.44%,which was significantly lower than that in the INB group(20%)(P＜0.05).The proportion of patients with mild pain in the PRF group was significantly lower than that in the INB group at 2 weeks,1 month,2 months,and 3 months postoperatively(P＜0.05).The proportion of patients with severe pain in the PRF group was significantly lower than that in the INB group at 2 months and 3 months postoperatively(P＜0.05).Conclusion PRF intercostal nerve block can effectively alleviate postoperative pain in thoracoscopic lung surgery,significantly improve postoperative recovery quality,and has a lower incidence of postoperative adverse reactions and complications.It is a safe and effective method for pain relief.

Objective To investigate the expression of miR-93 in plasma exosomes of patients with malignant pleural effusion and its diagnostic value for malignant pleural effusion.Methods A total of 118 patients with pleural effusion admitted to our hospital from July 2018 to August 2020 were selected as the research objects.Among them,63 patients with malignant pleural effusion were in the malignant group,and 55 patients with benign pleural effusion were in the benign group.The clinical data of all research subjects were collected,the levels of serum and pleural fluid routine indicators(pleural fluid protein,carcinoembryonic antigen,chloride ion,white blood cell count,aspartate aminotransferase,alanine aminotransferase,phosphocreatine kinase) of patients were detected;the expression level of miR-93 in plasma exosomes was detected by qRT-PCR;the correlation between miR-93 and routine indexes of patients' serum and pleural fluid was detected by Pearson method;the predictive value of plasma exosomal miR-93 level for malignant pleural effusion was evaluated by receiver operating characteristic curve(ROC).Results The level of plasma exosomes miR-93 in the malignant group was lower than that in the benign group(P＜0.05);the levels of pleural fluid protein,carcinoembryonic antigen,white blood cell count,aspartate aminotransferase,alanine aminotransferase and chloride ion in the malignant group were higher than those in the benign group(P＜0.05),and the level of phosphocreatine kinase was lower than that in the benign group(P＜0.05);miR-93 was negatively correlated with pleural fluid protein,carcinoembryonic antigen,chloride ion,white blood cell count,aspartate aminotransferase,alanine aminotransferase levels(r=-0.386、-0.363、-0.404、-0.423、-0.404、-0.453,P＜0.05),and positively correlated with phosphocreatine kinase level(r=0.462，P＜0.05);ROC results showed that the area under the curve(AUC) of plasma exosomes miR-93 predicting malignant pleural effusion was 0.972(95%CI:0.925-0.993),the corresponding sensitivity was 87.30%,and the specificity was 96.55%.Conclusion The expression level of miR-93 in plasma exosomes in patients with malignant pleural effusion is lower than that in patients with benign pleural effusion.The clinical detection of miR-93 expression has important value in the diagnosis of malignant pleural effusion.

Objective To explore the predictive value of serum uric acid levels for the occurrence of sarcopenia after hepatectomy in patients with primary liver cancer (PLC).Method A convenience sampling method was used to prospectively include 161 PLC patients who underwent liver resection surgery at Baoding NO.2 Central Hospital of Hebei Province from January 2019 to December 2021.They were divided into occurrence group and non occurrence group based on whether they had muscle deficiency.The clinical data,serum uric acid and other blood biochemical examination results were compared between the two groups,and the predictive value and influence of serum uric acid level on sarcopenia after hepatectomy in PLC patients were analyzed.Results Among the 158 PLC patients who underwent hepatectomy in the final inclusion of this study,34 patients developed postoperative sarcopenia,with an incidence rate of approximately 21.52%.The serum uric acid level (311.79±35.32) μmol/L in the occurrence group was higher than that in the non-occurrence group (280.52±31.15) μmol/L,the ALB level (31.59±5.73) g/L was lower than that in the non-occurrence group (35.63±5.13) g/L,and the proportion of postoperative adjuvant hepatic arterial infusion chemotherapy (HAIC) (38.24%) was higher than that in the non-occurrence group (20.16%),with statistical significant differences (P＜0.05).Multiple Logistic regression analysis showed that serum uric acid 、 ALB 、postoperative adjuvant HAIC were associated with sarcopenia after hepatectomy in PLC patients(OR=0.853,1.035,11.189,95%CI:0.770-0.945，1.018-1.052，3.533-35.433,P＜0.05).The receiver operating characteristic curve (ROC) showed that the area under the curve (AUC) of serum uric acid in predicting sarcopenia after hepatectomy in PLC patients was 0.754(95%CI:0.657-0.850),which had certain predictive value.The nomogram showed that the C-index of the prediction model constructed by serum uric acid assisted other major clinical indicators to predict the occurrence of sarcopenia after hepatectomy in PLC patients was 0.847(95%CI:0.782-0.913),suggesting that the model had certain predictive value.The results of the decision curve showed that when the threshold was in the range of 0.00-1.00,the actual clinical net benefit rate of the model was always greater than 0,and the maximum net benefit rate was 0.215,suggesting that the model had good clinical application value.Conclusion The increase of serum uric acid level in PLC patients is a risk factor for postoperative sarcopenia.The detection of serum uric acid level is helpful to assist in the early prediction of the risk of sarcopenia.

Objective To investigate the effect of narrow-band imaging combined with endoscopic submucosal dissection in the treatment of lateral developmental tumors (LST) of the large intestine and the analysis of postoperative recurrence.Method 78 LST patients admitted to Changzhou Traditional Chinese Medicine Hospital between April 2019 and April 2022 were retrospectively selected,and the surgical methods were selected according to the patients' wishes.According to the surgical methods,they were divided into observation group (narrowband imaging combined with endoscopic submucosal dissection,n=39) and control group (endoscopic submucosal dissection,n=39).The perioperative period and postoperative recovery,tumor resection,postoperative complications and quality of life were compared.Result The operation time of the observation group was (68.16±10.13) minutes, the recovery time of defecation was (51.34±6.36) hours, the exhaust time was (47.28±10.78) hours, and the recovery time of bowel sound was (32.67±6.02) hours.In the control group, they were (76.03±10.11) minutes, (54.55±6.27) hours, (52.56±11.55) hours and (35.84±5.97) hours, respectively, and there was statistical significance between the two groups (P<0.05).The overall resection rate of observation group (39 cases /39 cases) was higher than that of control group (32 cases /39 cases), and the difference was statistically significant (P<0.05). The total rate of intestinal infection, dyspepsia and adverse reactions in observation group (5 cases /39 cases) was lower than that in control group (18 cases /39 cases), with statistical significance (P<0.05).The mental health scores of the observation group were (76.16±12.13), emotional function scores were (77.32±11.13), social function scores were (80.37±11.13),vitality score was (81.23±9.07), body pain score was (83.15±8.15),the physiological function score was (82.09±10.28) and the physiological function score was (85.27±8.28).the scores of control group were (62.34±11.09),(65.50±12.13),(72.18±10.07),(75.10±9.11),(76.11±7.07),(76.11±7.07) and (75.14±8.32), respectively.There was statistical significance between the two groups (P<0.05).Conclusion The combination of narrowband imaging technology and endoscopic submucosal dissection has a good therapeutic effect on laterally spreading tumor,with fewer postoperative complications.

Objective To establish a nomogram model for efficiently predicting overall survival (OS) and cancer-specific survival (CSS) in patients with CRCHBM.Method 2239 patients from 2010 to 2019 were retrospectively analyzed from the Surveillance,Epidemiology,and End Results Program (SEER) databases and Wuhan Union Hospital Cancer Center.SEER is randomly assigned to the training and internal validation cohorts,and the Wuhan database serves as the external validation.Cox regression analyses were used to determine the independent clinicopathological prognosis factors affecting OS and CSS,and a nomogram was constructed to predict OS and CSS.The clinical utility of columnar plots was assessed using calibration curves,area under the curve (AUC),and decision curve analysis (DCA).Result OS column line graphs were constructed based on nine independent predictors:age,tumor location,degree of differentiation,tumor size,TNM stage,chemotherapy,primary focus surgery,number of lymph nodes sampled,and serum carcinoembryonic antigen (CEA) level.The C-index of the nomogram to predict the 1 -,3 -,and 5-year OS were 0.764,0.790,and 0.805 in the training group,0.754,0.760,and 0.801 in the internal validation group,and 0.822,0.874,and 0.906 in the external validation group.CSS column line graphs were constructed based on 3 independent predictors of TNM staging,radiotherapy and chemotherapy.The 1 -,3 -,and 5-year CSS AUROC values of the training group were 0.791,0.757,and 0.782,respectively.0.682,0.709,0.625 in the internal validation group and 0.759,0.702,0.755 in the external validation group,respectively.The results of receiver operating characteristic curve(ROC),ROC and DCA showed that the use of our model was more effective in predicting OS and CSS than other single clinicopathological features.Conclusion In summary,the nomogram based on significant clinicopathological features can be conveniently used to predict OS and CSS individually in patients with CRCHBM.

Objective To investigate the effects of different approaches of periacetabular osteotomy (PAO) on traumatic stress,lower limb strength and prognosis of acetabular dysplasia (DDH).Methods Ninety-seven patients with DDH in our hospital from January 2021 to January 2022 were randomly divided into two groups.Among them,48 patients in the control group received conventional ilioinguinal approach PAO treatment,while 49 patients in the study group received modified ilioinguinal approach PAO treatment.The surgical and postoperative rehabilitation indexes,Mckay clinical efficacy,lower limb line of force,complications,traumatic stress factors before and after surgery [adrenalin (NE),cortisol (COR),angiotensin Ⅱ (AngⅡ)],hip imaging indexes [anterior CE Angle (ACEA),lateral CE Angle (LCEA),acetabular index (AI)] and changes were compared between the two groups Good Harris hip function Score (mHHS),hip outcome score Daily Living Ability Scale (HOS-ADL).Results The operation time of the study group and the control group were (128.64±18.73) min and (141.80±21.59) min respectively,the intraoperative blood loss were (472.95±35.18) ml and (495.68±40.26) ml respectively,the postoperative drainage were (242.39±32.74) ml and (305.81±39.56) ml respectively,and the hospital stay were (11.57±2.29) D and (12.86±2.41) d respectively,with significant differences between the two groups (P<0.05);The excellent and good rate of McKay's clinical efficacy in the study group (95.92%) was higher than that in the control group (81.25%),and the differences were statistically significant (P<0.05);Serum NE in the study group and control group at 1 d,3 d,and 7 d postoperatively were (73.16±8.07) ng/L and (81.33±8.52) ng/L,(65.81±7.29) ng/L and (72.24±7.65)ng/L,(45.98±6.31) ng/L and (50.37±7.02) ng/L,respectively,and COR were (164.84±19.35) ng/L and (178.62±21.46) ng/L,(142.69±17.81) ng/L and (157.36±19.22)ng/L,(88.79±16.13)ng/L and (97.62±17.50)ng/L,respectively,and AngII was (138.74± 20.51)mmol/L and (150.19±21.36)mmol/L,(128.35±17.69)mmol/L and (137.18±19.24)mmol/L,and (119.82±17.41)mmol/L and (128.73±18.50)mmol/L,respectively,and the differences between the two groups were all statistically significance (P<0.05);ACEA at 3,6,and 12 months postoperatively in the study and control groups were (29.71±4.81)° and (27.68±4.53)°,(29.80±4.75)° and (27.72±4.60)°,(29.64±4.79)° and (27.63±4.51)°,respectively,and LCEA was (33.79±6.12)° and (31.04±5.83)°,(33.82±6.10)° and (31.10±5.90)°,(33.75±6.08)° and (31.05±5.77)°,and AI was (6.15±1.86)° and (7.03±1.94)°,(6.08±1.82)° and (7.01±1.89)°,(6.12±1.84)° and (7.06±1.90)°,respectively.mHHS scores was (72.15±7.65) and (68.23±7.71),(76.51±7.52) and (72.19±7.94),(90.13±5.16) and (86.76±5.72),and HOS-ADL scores were (79.92±7.50) and (76.26±7.62) points,(80.85±7.42) and (77.13±7.66) points,(89.73±6.37) and (86.25±7.15) points,and the differences between the two groups were statistically significant (P<0.05);the comparison of lower limb force lines and complications between the two groups showed no statistically significant differences (P>0.05).Conclusion Modified ilioinguinal approach PAO in the treatment of DDH can optimize the operation,reduce traumatic stress factors,further improve the curative effect,improve the status of femoral head coverage and hip function,and improve the quality of life,with high safety.

Objective To explore the application value of 3D print technology-assisted plate internal fixation in the treatment of Schatzker type Ⅰ-Ⅵ tibial plateau fractures.Methods Patients with Schatzker type Ⅰ-Ⅵ tibial plateau fractures admitted to department of emergency trauma surgery of Jining First People' s Hospital were retrospectively analyzed from January 2020 to October 2022,and they were classified into the observation group and the control group by different treatment methods.The patients who received 3D print technology-assisted plate internal fixation were assigned as the observation group,and the patients who underwent traditional plate internal fixation were enrolled as the control group.The confounding factors of baseline data such as gender and age were excluded by propensity matching score (caliper=0.02),and 43 cases were finally obtained in each group.The surgical time,intraoperative blood loss,intraoperative fluoroscopy frequency,excellent and good rate of fracture reduction,bone healing time of fracture and knee function score were compared.Results The surgical time,fluoroscopy frequency and blood loss in the observation group were shorter or lower than those in the control group (P<0.05).The fracture healing time in the observation group was (12.56±1.49) weeks,which was shorter than (16.53±1.83) weeks in the control group (P<0.05).At 6 months after surgery,the Rasmussen radiology score in the observation group with (16.86±1.04) points，which was higher than (15.07±1.55) points in the control group,and the reduction effect grading was better than that in the control group (P<0.05).The knee Rasmussen clinical score in the observation group was (26.63±1.56) points,which was higher than (25.67±2.21) points in the control group (P<0.05).Conclusion 3D print technology-assisted plate internal fixation has significant value in treating Schatzker type Ⅰ-Ⅵ tibial plateau fractures,and can shorten the surgical time,reduce the surgical trauma,lower the intraoperative fluoroscopy frequency,enhance the fracture reduction effect and significantly restore the knee function.

Objective To investigate the effect of orthopedic distractor assisted reduction and percutaneous plate implantation in the treatment of distal tibial fractures.Methods 120 patients with distal tibial fractures treated in Wendeng orthopedic hospital of Shandong Province from January 2019 to January 2021 were randomly divided into two groups:the control group (60 cases,percutaneous plate implantation and internal fixation under traditional manual reduction) and the observation group (60 cases,orthopedic distractor assisted manual reduction and percutaneous plate implantation and internal fixation).The treatment effect,intraoperative indexes and postoperative fracture recovery of the two groups were compared,and the complications of the two groups were recorded and compared.Results After treatment,there was no significant difference in the excellent and good rate of fracture healing in the observation group (P>0.05);The operation time[（72.56±27.54）min] and fracture healing time[（16.45±4.59）w] of the observation group were shorter than those of the control group[（89.94±28.20）min and（21.15±4.54）w],and the amount of intraoperative bleeding in the observation group[（82.27±20.14）ml] was less than that of the control group[（90.12±21.48）ml],the differences were statistically significant (P<0.05);12 months after operation,the knee joint score of American Special Surgery Hospital (HSS) and ankle hindfoot score of American ankle Orthopedic Association (AOFAS) in the observation group[（85.24±7.52） and （84.58±7.29）] were lower than those in the control group [（74.45±7.64） and （74.56±6.38）](P<0.05).There was no significant difference in the total incidence of complications between the two groups (P>0.05).Conclusion Orthopedic distractor assisted reduction and percutaneous steel plate implantation and internal fixation have good curative effect,which can effectively reduce the amount of intraoperative bleeding,shorten the operation time,and have a good recovery of foot and ankle function after operation.

Objective To construct a predictive model of thrombus clearance rate to guide the selection of therapeutic strategies for acute lower extremity venous thromboembolism patients by studying the clinic data of patients who underwent AngioJet mechanical thromboaspiration surgery.Methods By calculating the thrombus clearance rate in 83 VTE patients treated with AngioJet surgery,correlation analysis of clinical data,combined with the characteristic factors in the LASSO regression model,multiple logistic regression analysis was applied to build a prediction model of thrombus clearance rate column line graph,and the accuracy of the prediction model was evaluated using C index,calibration curve and decision curve.Results VTE type was significantly correlated with thrombus clearance rate,and the predictors in the column line plot contained:age,sex,thrombus type,surgical history,tumor history,and smoking history.The model showed great predictive power and high accuracy with a C-index of 0.795 (95%CI:0.682 3-0.905 7).Decision curve analysis showed that prediction of thrombus clearance by column line plot for AngioJet procedure was effective when the threshold probability was in the range of 0.02-0.63.Conclusion In the correlation analysis,VTE type was significantly correlated with thrombus clearance.The results of this study showed that the AngioJet thrombus aspiration procedure was able to achieve a high rate of thrombus clearance in men older than 65 years with a history of tumors,a central thrombus type,no history of surgery,and no history of smoking.

Objective To investigate the effect of drug-coated balloon(DCB) percutaneous transluminal angioplasty(PTA) on clinical indicators and prognosis of patients with long-segment occlusion of lower extremity arteries.Methods A total of 91 patients with long-segment occlusion of lower extremity arteries admitted to the hospital from October 2020 to October 2022 were selected and divided into DCB group(n=46) and ordinary balloon(POB) group(n=45) according to different treatment methods.POB group underwent POB-PTA,DCB group underwent DCB-PTA.The vascular endothelial function indexes [ nitric oxide(NO),endothelin-1(ET-1),P-selectin ] were compared between the two groups before operation,6 h and 2 weeks after operation.The patients were followed up for 1 year.The primary patency rate,restenosis rate,target lesion revascularization rate,incidence of postoperative complications and the degree of target vessel stenosis,minimum lumen diameter(MLD),ankle brachial index(ABI),Rutherford vascular surgery(Rutherford) classification were measured before operation,6 months,12 months after operation were compared between the two groups.Results The serum NO levels at 6 h and 2 weeks after operation in the DCB group were(30.83±3.95) pg/ml and(33.62±4.20) pg/ml,which were higher than(26.70±3.58) pg/ml and(29.96±3.82) pg/ml in the POB group.The levels of ET-1 and P-selectin were(70.25±7.24) pg/ml,(67.29±7.05) pg/ml,(30.12±3.68) μg/L and(25.61±3.32) μg/L,which were lower than(75.98±7.63) pg/ml,(70.73±7.31) pg/ml,(37.03±3.90) μg/L and(27.29±3.50)(P< 0.05).The primary patency rate of the DCB group(82.61 %) was higher than that of the POB group(55.56 %),and the restenosis rate(10.87 %) was lower than that of the POB group(31.11 %)(P<0.05).There was no difference in the rate of target lesion revascularization between the two groups(P> 0.05).The degree of target vessel stenosis and Rutherford grade in DCB group were(18.07±5.25) %,(25.68±4.35) %,(2.05±0.64) grade and(2.24±0.81) grade at 6 months and 12 months after operation,which were lower than those in POB group (41.20±5.86) %,(57.36±5.18) %,(2.60±0.72) grade and(2.75±0.94) grade.MLD and ABI were(3.37±0.68) mm,(3.02±0.59) mm,(0.85±0.19) grade,(0.82±0.15) grade,which were higher than those in POB group(1.59±0.41) mm,(1.46±0.38) mm,(0.65±0.15) grade,(0.62±0.11) grade(P< 0.05).There was no difference in postoperative complications between the two groups(P> 0.05).Conclusion The application of DCB-PTA can significantly reduce vascular endothelial injury,improve primary patency rate,increase vascular diameter,relieve lower limb ischemia symptoms,reduce restenosis rate,and has good safety.

Objective To analyze the efficacy and effects of balloon dilation combined with iliac vein balloon dilatation on complications and coagulation function of acute deep venous thrombosis of lower limbs(DVT) complicated with Cockett syndrome.Methods Data of 102 patients with acute DVT combined with Cockett syndrome admitted to the hospital from March 2018 to September 2022 were retrospectively analyzed,including 53 patients treated with catheter thrombolytic balloon dilation of iliac vein (recorded as the study group) and 49 patients treated with catheter thrombolytic therapy (recorded as the control group).Both groups were followed up for 1 year.Thrombosis clearance,edema reduction of affected limb,lower limb hemodynamics,coagulation function,peripheral blood inflammatory factors,complications and thrombosis recurrence were compared between the two groups.Results The thrombus removal grade of the study group was better than that of the control group (P＜0.05).Before and 1 year after surgery,In the control group,the leg circumference diameter difference above the knee between the affected side and the healthy side was (8.02±1.41)cm and (2.89±0.32)cm, respectively.In the study group,the data were (8.19±1.38)cm and (2.57±0.29)cm, respectively.Before and 1 year after surgery,in the control group,the leg circumference diameter difference below the knee between the affected side and the healthy side was (6.84±1.18)cm and (2.13±0.38)cm, respectively.In the study group,the data were (6.63±1.09)cm and (1.76±0.32)cm, respectively.The difference was statistically significant (P < 0.05), and the study group was lower 1 year after surgery (P<0.05).The average blood flow velocity of femoral vein in control group was (24.75±4.03)cm/s and (28.82±4.29)cm/s before and 3 days after surgery, respectively.In the study group,the data were (24.02±3.86)cm/s and (30.94±4.37)cm/s, respectively.The femoral vein blood flow before and 3 days after surgery in the control group was (13.02±2.12)ml/s and (15.05±2.29)ml/s, respectively, while that in the study group was (13.36±2.09)ml/s and (16.26±2.34)ml/s, with statistical significance (P < 0.05).The study group was higher 3 days after surgery(P<0.05).The prothrombin time before and 3 days after operation were (22.93±2.04)s and (18.13±1.34)s in the control group, and (23.24±1.99)s and (17.29±1.21)s in the study group, respectively.The thrombin time before and 3 days after operation were (24.86±2.31)s and (21.04±1.75)s in the control group, and (24.13±2.16)s and (19.89±1.53)s in the observation group, respectively.The activated partial thromboplastin time before and 3 days after surgery was (59.21±3.92)s and (49.13±3.02)s in control group, and (60.17±3.85)s and (47.09±2.98)s in observation group, respectively, and the difference was statistically significant (P<0.05). It was lower 3 days after surgery in study group (P<0.05).In the study group,preoperative tumor necrosis factor (TNF) -α, platelet activating factor (PAF) and thromboxen B2(TXB2) were (31.91±4.89)ng/L, (14.59±2.36)pg/ml, and (213.12±30.98)pg/ml, respectively. Three days after surgery, the levels were (36.24±4.29) ng/L, (16.12±2.59) pg/ml, and (239.86±32.85) pg/ml, respectively, with statistical significance (P < 0.05).TNF-α, PAF and TXB2 were higher in the study group 3 days after surgery (P<0.05).There was no significant difference in the incidence of total complications between the two groups (P>0.05). The recurrence rate of thrombosis in study group was lower than that in control group(3.77% vs 16.33%,P<0.05).Conclusion Catheter thrombolytic balloon dilation of iliac vein for acute DVT complicated with Cockett syndrome can enhance the thrombolysis effect,improve the swelling of the affected limb,lower limb hemodynamics and coagulation function,and reduce the risk of thrombosis recurrence,which is safe and reliable.However,this treatment plan can mediate the occurrence of inflammation,and reasonable anti-inflammatory therapy should be actively implemented after surgery.

Objective To investigate the safety and efficacy of different surgical sequences in the ultrasound-guided endovenous microwave ablation combined with foam sclerotherapy for the treatment of primary great saphenous varicose veins.Method A total of 80 patients with great saphenous varicose vein admitted in the affiliated hospital of Jiangsu University，from January 2022 to January 2023 were selected.Patients were divided into observation group and control group according to different operation order, with 40 cases in each group.The control group was treated with ultrasound-guided microwave ablation of the main saphenous vein was performed first,followed by superficial calf vein foam sclerotherapy injection and local small incision point extraction,and the observation group was treated with superficial calf vein foam sclerotherapy injection and local small incision point extraction first,followed by ultrasound-guided microwave ablation of the main saphenous vein was performed.Perioperative relevant indicators at the 1st week of the two groups were counted,and the incidence of hematoma,ecchymosis,induration,skin burn,thrombotic superficial phlebitis,and endovenous heat induced thrombosis at the 1st week after surgery.The venous clinical severity score and chronic venous insufficiency quality of life at the 3rd and 6th month after surgery were compared between the two groups.VCSS and CIVIQ were used to evaluate the postoperative recovery of patients with varicose veins.Six months after the operation,the recurrence rate of great saphenous vein was compared by color Doppler ultrasonography.Result The operation time of the two groups was (68.13±3.34）min and（66.83±3.19）min,respectively.The intraoperative blood loss was (15.35±2.63) ml and (14.83±2.66) ml, respectively.The underground activity time was (14.35±3.34) hours and (13.60±2.63) hours, respectively.The length of hospitalization was (2.93±0.52) days and (3.15±0.61) days, respectively.There was statistical significance between the two groups (P<0.05).The preoperative VCSS of the two groups were 4.08±1.37 and 4.23±1.33, respectively,3 months after surgery were 3.00±0.59 and 3.03±0.61, respectively,and 6 months after surgery were 2.20±1.17 and 2.35±0.96, respectively.The preoperative CIVIQ of the two groups were 79.63±5.41 and 80.03±7.44,respectively,3 months after operation was 69.90±2.98 and 70.43±3.55, respectively,the 6-month CIVIQ was 59.05±3.79 and 58.00±4.66, respectively.There was no statistical significance between the two groups (P>0.05).The incidence of adverse events [hematoma (0 vs 0),ecchymosis (12.5% vs 15.0%),sclerosis (10.0% vs 7.5%),skin burns (0 vs 0),thrombosed superficial phlebitis (12.5% vs 17.5%),and thermal ablation-induced thrombosis (10.0% vs 5.0%)] in the patients of the two groups in the 1-week period after the procedure were compared,and the difference were statistically non-significant (P>0.05).Comparison of trunk recanalisation rate (5.0% vs 2.5%) at 6 months after surgery,the difference was not statistically significant (P>0.05).Conclusion There is no significant difference in the efficacy of the two procedures in the treatment of primary saphenous varicose veins,with a high degree of safety,both of which are worthy of clinical promotion.

Rectus abdominis diastasis (RAD) is a phenomenon in which the rectus abdominis muscles on both sides of the white line of the abdomen separate from each other,causing a series of physiological dysfunction.It is commonly seen in pregnant women and obese individuals.Currently,RAD has gradually attracted the attention of relevant surgeons.There is relatively little research on RAD both domestically and internationally,and there is no unified standard for diagnosis and treatment.This article will summarize the research progress on the diagnosis and treatment methods of rectus abdominis separation by combining domestic and foreign literature.

Inguinal hernia is a common long-term complication after prostatectomy,which may be related to low BMI,patent sheath process,different surgical methods and other factors.Postoperative inguinal hernia significantly affects the long-term quality of life of patients undergoing prostate cancer surgery,and patients with severe inguinal hernia need reoperation.Some doctors use preventive measures such as tension-free repair and spermatic cord separation in prostate surgery for patients with multiple risk factors or(and) complicated with inguinal hernia,in order to reduce the incidence of postoperative inguinal hernia.Lichtenstein repair and TAPP can be used for patients with postoperative inguinal hernia.

Operation duration has consistently been regarded as a important factor influencing the outcome of total knee arthroplasty (TKA).Prolonged operation time can give rise to an array of adverse events,ultimately leading to surgical failure,escalated healthcare expenses,and even jeopardizing patient survival.Numerous studies have demonstrated that prolonged operation time is linked with an augmented risk of postoperative complications.Recent investigations have revealed that extended operation duration can heighten the likelihood of postoperative pain,wound dehiscence,anemia and blood transfusion requirements,surgical site infection,sepsis,prolonged hospitalization and readmission rates；impact prosthetic longevity and patient survival rate.

This paper presented the method and advantages of gasless endoscopic thyroid lobectomy via unilateral subclavian approach.The summarized “four-marker method” simplifies surgical procedures,enabling surgeons to quickly identify crucial anatomical structures and successfully complete the operation.This approach demonstrates broad applicability and feasibility,warranting its widespread clinical adoption.