Objective To investigate the risk factors of decompression bleeding of CSDH patients after minimally invasive drainage and to construct prediction model to provide more reference for developing more targeted prevention and treatment strategies and improving prognosis.Methods 165 CSDH patients after minimally invasive drainage were retrospectively chosen in the period from January 2019 to January 2023 in our hospital and grouped according to whether decompression bleeding occurred after surgery or not into bleeding group (33 cases) and non-bleeding group (132 cases).The univariate and multivariate method were used to analyze the risk factors of decompression bleeding of CSDH patients after minimally invasive drainage.Construction of risk prediction model for decompression bleeding after CSDH minimally invasive drainage.Results The results of single factor analysis showed that both intracavitary pressure and midline recovery rate of hematoma may be related to decompression bleeding after CSDH minimally invasive drainage (P<0.05).The results of multifactor analysis (bleeding group =1,non-bleeding group =0) showed that intracavitary pressure and midline recovery speed were independent factors influencing the risk of decompression bleeding after CSDH minimally invasive drainage (P<0.05).Intracranial pressure,postoperative midline recovery speed and Logistic regression model P value were used to predict decompression bleeding after CSDH minimally invasive drainage.The area under ROC curve was 0.784,0.778 and 0.840,respectively,and the approximate den index was 50.76%,44.70% and 56.82%.Conclusion The incidence of decompression bleeding after CSDH minimally invasive drainage was related to the intracavitary pressure of hematoma and the recovery rate of postoperative midline and the prediction model based on the above factors can guide the identification of high risk groups of early decompression bleeding.

Objective To analyze the expression levels of serum miR-21-5p and miR-100-5p in patients with esophageal squamous cell carcinoma (ESCC) and healthy controls,and to explore their impact on the differential diagnosis,clinical characteristics correlation,and patient prognosis of ESCC.Methods A total of 158 patients with advanced ESCC who underwent radiotherapy in our hospital's radiotherapy department from January 2018 to January 2022 were collected as the experimental group.Additionally,150 healthy individuals who underwent physical examinations were selected as the control group.Peripheral blood (5 ml) was collected from each subject,and serum was prepared.The expression levels of miR-21-5p and miR-100-5p were detected using real-time quantitative PCR (RT-qPCR).The expression differences of miR-21-5p and miR-100-5p between the experimental and control groups were compared using the t-test,and the clinical prognosis survival analysis was performed using the Kaplan-Meier method with Log-Rank test.Results Compared with the healthy control group,the expression levels of serum miR-21-5p and miR-100-5p in ESCC patients were significantly increased (both P<0.001).The elevated expression levels of serum miR-21-5p and miR-100-5p can accurately distinguish ESCC from healthy controls,with an area under the curve (AUC) of 0.918 for combined diagnosis,a sensitivity of 93.2%,and a specificity of 87.1%.The increased expression of serum miR-21-5p and miR-100-5p in ESCC patients was correlated with later TNM stages and poorer disease-free survival and overall survival (both P<0.05).Multivariate Cox analysis showed that TNM stage Ⅲ,high expression of serum miR-21-5p,and low expression of miR-100-5p are independent risk factors for the disease -free survival and overall survival of ESCC patients (all P<0.05).Conclusion The expression levels of serum miR-21-5p and miR-100-5p are significantly increased in ESCC patients and indicate a poorer prognosis.Serum miR-21-5p and miR-100-5p hold promise as biomarkers for the diagnosis and prognostic prediction of ESCC.

Objective To explore the factors influencing the occurrence of cardiac complications after endoscopic surgery in patients with non-small cell lung cancer (NSCLC) and construct the prediction model.Methods A total of 312 patients with non-small cell lung cancer who were diagnosed and underwent thoracoscopic treatment in our hospital from January 2020 to January 2023 were selected as the objects of this study,and were divided into cardiac complication group and non-cardiac complication group according to whether cardiac complications occurred after surgery.The clinical data of patients in each group were analyzed,and the factors affecting the occurrence of cardiac complications in patients with non-small cell lung cancer after endoscopic surgery were discussed by multivariate Logistic regression analysis.A full-variable risk prediction model for the occurrence of cardiac complications was constructed,and the predictive model was verified by receiver operating characteristic curve (ROC) analysis.Results The incidence of postoperative cardiac complications in 312 patients with non-small cell lung cancer was 24.04%.Univariate analysis showed that Age,smoking history,smoking history,comorbidities,intraoperative blood loss,operative time,systolic blood pressure,FEV1,FEV1%,FPG,HbA1c and urinary microalbumin were correlated with the incidence of cardiac complications in patients with non-small cell lung cancer after endoscopic surgery (P<0.05).Multivariate Logistic stepwise regression analysis showed:age,comorbidities,operation time and HbA1c were independent risk factors for postoperative cardiac complications in patients with non-small cell lung cancer (P<0.05).A risk prediction model for cardiac complications was established based on multiple factors,that is,P = 1/ (1+ e-y),y=-3.114+ 0.881× age +0.754× complications +1.285× operation time + 1.185×HbA1c,and the ROC curve diagnosis showed that the risk prediction model predicted the occurrence of cardiac complications with an AUC of 0.847,95%CI of 0.769-0.925,sensitivity of 82.5%,specificity of 83.2%.Conclusion Age,complications,operation time,and HbA1c are all independent risk factors affecting the occurrence of cardiac complications in patients with non-small cell lung cancer after endoscopic surgery,and the risk prediction model constructed by the above factors has a good predictive value for the occurrence of cardiac complications.

Objective To explore the impact of clinical treatment decisions on the long-term survival of different molecular subtypes of locally advanced breast cancer(LABC),and to promote the development of more effective and individualized treatment regimens for LABC.Methods The cases of LABC diagnosed by pathology from 2010 to 2015 were searched in the database.Breast cancer-specific survival (BCSS) and overall survival (OS) were estimated by plotting Kaplan-Meier curves.The log rank test (Mantel-Cox) was used to analyze the difference between the groups,and the benefit population of LABC was determined after for age,TNM stage,grade,treatment methods.Results The 5-year OS and BCSS were 77.43% and 84.34% in breast-conserving,and 68.03% and 76.90% in mastectomy,respectively.The 5-year OS and BCSS of Luminal A LABC were 79.91% and 87.23% in breast-conserving,and 71.78% and 81.16% in mastectomy,respectively.The 5-year OS and BCSS of Luminal B LABC were 79.30% and 83.14% in breast-conserving,and were 70.37% and 76.92% in mastectomy,respectively.The 5-year OS and BCSS of triple-negative LABC were 60.77% and 68.13% in breast-conserving,and those of mastectomy were 47.13% and 55.94%,respectively.The 5-year OS and BCSS of HER2 positive were 75.42%,82.05% in breast-conserving,and were 67.05% and 75.01% in mastectomy,respectively;The 5-year OS and BCSS of triple-positive LABC were 86.12% and 91.63% in breast-conserving,and 74.54% and 82.56% in mastectomy,respectively.The 5-year OS and BCSS of well differentiated and N0 triple-positive LABC patients with chemotherapy were 88.24% and 76.91%,and those of patients without chmotherapy were 88.24% and 90.91%,respectively (BCSS:P=0.812;OS:P=0.311).Conclusion In the selective population,OS and BCSS of patients with LABC undergoing breast conserving surgery were significantly better than those of mastectomy.When OS and BCSS were compared for different molecular types and stages of LABC, breast-conserving surgery was still superior to total mastectomy.LABC could be considered for highly differentiated,N0 stage Triple positive without chemotherapy.

Objective To explore the relationship between long non-coding RNA (lncRNA) non-coding repressor of nuclear factor of activated T cells (NRON),long non-coding RNA small NF90-associated RNA (snaR) and the prognosis of triple negative breast cancer (TNBC).Methods From February 2018 to February 2020,100 TNBC patients accepted by our hospital were collected,and their tumor and adjacent tissues were taken during surgery.Based on the 3-year follow-up prognosis,they were separated into a good prognosis group（72 cases） and a poor prognosis group(28 cases).Real-time quantitative fluorescent PCR (RT-qPCR) method was applied to detect the expression levels of lncRNA NRON and lncRNA snaR in tumor tissue and adjacent tissues.Pearson method was applied to analyze the correlation between lncRNA NRON and lncRNA snaR in tumor tissue of TNBC patients.Multivariate Cox regression was applied to analyze the prognostic factors of TNBC patients.Receiver operating characteristic (ROC) curve was applied to analyze the prognostic value of lncRNA NRON and lncRNA snaR expression levels in tumor tissue of TNBC patients.Results Compared with adjacent tissues,the level of lncRNA NRON in tumor tissues of TNBC patients obviously decreased (1.01±0.10 vs 0.65±0.08，P<0.001),while the level of lncRNA snaR obviously increased (1.03±0.13 vs 2.42±0.30，P<0.001).The expression levels of lncRNA NRON and lncRNA snaR were related to TNM staging and tumor differentiation (P<0.05).Compared with the good prognosis group,the level of lncRNA NRON in tumor tissue of TNBC patients in poor prognosis group obviously decreased (0.69±0.09 vs 0.55±0.05，P<0.001),while the level of lncRNA snaR obviously increased (2.28±0.26比2.78±0.40，P＜0.001).Pearson method analysis showed that there was a negative correlation between lncRNA NRON and lncRNA snaR expression levels in tumor tissue of TNBC patients (r=-0.617,P<0.001).Multivariate Cox regression analysis showed that lncRNA NRON was a protective factor for the prognosis of TNBC patients (P<0.05),LncRNA snaR was a risk factor for the prognosis of TNBC patients (P<0.05).The combination of lncRNA NRON and lncRNA snaR expression levels in predicting better prognosis in TNBC patients than lncRNA snaR alone (Z_combination-lncRNA snaR=3.200,P=0.001).Conclusion The level of lncRNA NRON is down-regulated and lncRNA snaR level is obviously up-regulated in tumor tissues of TNBC patients,they are related to the prognosis of TNBC patients and may be biomarkers for evaluating TNBC prognosis.

Objective To explore the correlation between hyponatremia at admission and all-cause mortality within one year after discharge in elderly patients with intestinal obstruction.Methods The 331 cases of elderly patients with intestinal obstruction (aged≥60 years) who visited the General Surgery Department of Nanjing Meishan Hospital from January 2017 to December 2020 were selected as the research objects for retrospective cohort study analysis.According to the patient's blood sodium level at admission,they are divided into two groups:the hyponatremia group (Na<135 mmol/L) and the non hyponatremia group (Na≥135 mmol/L).Divided into death group and survival group based on whether death occurred within one year after discharge.SPSS 25.0 software was used for statistical analysis.Independent sample t test,χ² test,Kaplan Meier method,and multivariate Cox regression analysis were used to observe the correlation between admission hyponatremia and all-cause mortality within one year after discharge in elderly patients with intestinal obstruction.Results A total of 331 patients were enrolled.The incidence of hyponatremia was 32.3%,and 56 deaths occurred within one year,accounting for 16.92%.The one-year mortality rate in the hyponatremia group was 23.4% (25/107),which was higher than 13.8% (31/224) in the non hyponatremia group.The difference was statistically significant (P < 0.05).The survival analysis (Kaplan Meier) results showed that the survival rate of the hyponatremia group was lower than that of the non hyponatremia group (Log Rank P<0.05).After adjusting for other confounding factors in multivariate Cox regression analysis,hyponatremia (HR=1.88,95%CI:1.07-3.29) was an independent risk factor for one-year all-cause mortality in elderly patients with intestinal obstruction (P<0.05).Conclusion Hyponatremia at admission is an independent risk factor for all cause mortality in elderly patients with intestinal obstruction within one year after discharge.

Objective To evaluate the surgical treatments of refractory sclerosing peritonitis related peritoneal dialysis.Methods Clinical data of 15 patients with refractory sclerosing peritonitis related to peritoneal dialysis treated in the General Surgery Department of the 900th Hospital of the Joint Logistics Support Force of the People's Liberation Army from June 30,2014 to May 30,2018.Among them,5 cases underwent “open abdomen peritoneal catheter removal + intestinal adhesiolysis + abdominal infection flushing and drainage with catheter”,4 cases underwent “laparoscopic peritoneal catheter removal + intestinal adhesiolysis + abdominal infection flushing and drainage with catheter”,3 cases underwent “laparoscopic peritoneal dialysis catheter removal + abdominal infection flushing and drainage with catheter”,2 cases underwent “open abdomen peritoneal dialysis catheter removal + abdominal infection flushing and drainage with catheter”,and 1 case underwent “laparoscopic examination combined with laparotomy exploration and removal of lower abdominal catheter + intestinal adhesiolysis + abdominal infection flushing and drainage with catheter”.Age, gender, clinical symptoms, abdominal CT examination, peripheral blood routine, blood biochemistry, blood C- reactive protein (CRP), white blood cells, biochemistry, and aetiology of peritoneal dialysis fluid were collected and followed up, and the therapeutic effect was evaluated.Results 15 patients were transferred to the Department of Surgery after ineffective treatment in the Department of Internal Medicine.Preoperatively(after 5 days of antibiotic treatment) compared to before antibiotic treatment,there were no significant changes in blood WBC,blood NEUT%,CRP,and peritoneal fluid WBC(P>0.05).Laparoscopic exploration or laparotomy exploration was performed,during which the peritoneal dialysis catheter was removed and the abdominal infection focus was cleared.A pelvic cavity washout drainage tube was left in place postoperatively.Fourteen patients had a good recovery after surgery,with effective control of peritonitis symptoms and no complications such as intestinal obstruction or enterocutaneous fistula.After the removal of the peritoneal dialysis catheter,all patients switched to hemodialysis.A comparison of inflammatory markers before and after surgery showed a significant decrease after surgery.Three days postoperatively compared to before surgery(after 5 days of antibiotic treatment),there were no significant changes in blood WBC,blood NEUT%,CRP,and peritoneal fluid WBC(P>0.05).Seven days postoperatively compared to before surgery(after 5 days of antibiotic treatment),there was a significant decrease in blood WBC[（7.43±2.65）×10⁹/L VS（10.17±5.24)×10⁹/L],blood NEUT%[(88.23±9.02）% VS（85.07±11.57)%],and CRP[(152.88±113.01）mg/L VS（114.49±92.97)mg/L](P<0.05);the peritoneal fluid WBC at 7 days postoperatively showed no significant change compared to before surgery(after 5 days of antibiotic treatment)(P>0.05).The cases were followed up for at least 22 months,and 13 patients did not experience peritonitis or intestinal obstruction again.One patient died 39 days after surgery due to multiple organ failure,and one patient died from other causes after a 2-year follow-up.Conclusion For refractory sclerosing peritonitis related peritoneal dialysis that is ineffective in medical conservative treatment,On the basis of reasonable and effective antibiotics to control infection,surgical intervention should be actively carried out and surgical methods such as surgery should be used to control the progress of peritonitis,reduce mortality and improve the cure rate.

Objective To investigate the risk factors of hip instability in elderly patients with femoral neck fracture after hemiarthroplasty (HA).Methods The medical records of 133 patients with femoral neck fracture who received HA treatment in the Department of Orthopedics of our hospital from January 2015 to October 2022 were retrospectively collected.According to whether the patients suffered hip dislocation after surgery,the patients were divided into dislocation group (n=35) and non-dislocation group (n=98).Demographic variables such as age,sex and body mass index (BMI) were recorded in the two groups.Complications such as diabetes,hypertension,heart disease and chronic obstructive pulmonary disease (COPD) were recorded.Prosthetic type,surgical approach,soft tissue repair type,blood loss and other surgical phase variables were recorded.Central marginal Angle (CEA),extraneous Angle (ABA),eccentricity,lower limb length difference (LLD),acetabular width,acetabular depth,and femoral head coverage (FCR) were measured on radiographs.Wald method was used to establish Logistic regression model to elucidate the risk factors of dislocation after HA.Results The proportion of COPD in the dislocation group was significantly higher than that in the control group (P<0.05),and there was no significant difference in baseline characteristics between the two groups (P>0.05).There was no significant difference between the two groups (P>0.05).There were no significant differences in CEA,ABA,LLD,acetabular width,eccentricity and FCR between 2 groups (P>0.05),but the acetabular depth and depto-width ratio in luxation group were significantly lower than those in control group (P<0.05).Gender,COPD,CEA,acetabular width-to-depth ratio and LLD were independent risk factors for hip instability after HA (P<0.05).Conclusion In this study,COPD,male,LLD,and small CEA and acetabular broad-to-depth ratio are independent risk factors for hip instability after HA,and therefore HA is not recommended for the treatment of femoral neck fractures in elderly patients with these conditions.

Objective To collect the clinical data of patients and construct a nomogram model to predict the prognosis of patients with humeral fracture treated with limited contact dynamic compression plate(LC-DCP).Methods A total of 372 patients with humeral fractures who received LC-DCP in our hospital from January 2013 to December 2020 weree randomly divided into a modeling cohort(n=260) and a validation cohort(n=112) according to 7∶3.Logistic regression model was used to analyze the data of the modeling cohort,and a Nomogram model was established according to the results of the influencing factors of poor prognosis of LC-DCP treatment for patients with humerus fractures.Nomogram was validated internally(modeling cohort) and externally(validation cohort) using calibration curve and ROC curve.Results The incidence of poor prognosis was 20.43%(76 / 372) in 372 patients with humeral fracture treated with LC-DCP.Univariate analysis showed that the age, incision length, intraoperative blood loss, time to start functional exercise and postoperative complications in the good prognosis group were significantly lower than those in the poor prognosis group (P<0.05).Multivariate Logistic regression analysis showed that age ≥60 years old, incision length ≥5 cm, intraoperative blood loss ≥110 ml, start time of functional exercise ≥7 days after surgery, and postoperative complications were independent risk factors for the efficacy of LC-DCP in the treatment of proximal humeral fracture (P<0.05).The calibration curve and ROC curve of the Nomogram model showed that the slope of the calibration curve for internal verification and external verification was close to 1, and the area under ROC for internal verification and external verification was 0.823 and 0.839 respectively.Conclusion The Nomogram model established in this study based on postoperative complications,intraoperative blood loss,age,postoperative functional exercise start time and incision length is effective and discriminative.

Objective To explore the influence of longitudinal and oblique hollow lag screw internal fixation on interphalangeal range of motion,metacarpal range of motion and complications in patients with transverse fractures of proximal phalanges.Methods Retrospective analysis was performed on 102 patients with transverse fractures of proximal phalanges admitted to department of orthopedics of our hospital from June 2021 to February 2022.According to treatment methods,the patients were divided into longitudinal group and oblique group.The longitudinal group was given longitudinal hollow lag screw internal fixation while the oblique group was treated with oblique hollow lag screw internal fixation.The baseline data of the enrolled subjects were excluded from the influence of confounding factors according to the propensity matching scoring method (caliper value=0.02),and 51 patients with comparable baseline data were obtained in each group.The surgical status (surgical time and healing time),ranges of motions of interphalangeal and metacarpal joints,excellent and good rate of hand function (total active movement,TAM) and complications at 18 months after surgery were compared between the two groups.Results All patients successfully completed the surgery,and at least 18 months of follow-up data were obtained.There was no statistical significance in the surgical time or follow-up time between the two groups (P>0.05).The healing time in oblique group(6.57±1.22)weeks,was significantly shorter than that in longitudinal group(7.82±1.54)weeks (P<0.05).At 18 months after surgery,the interphalangeal range of motion was significantly higher in oblique group(82.62±3.41)° than that in longitudinal group(77.45±7.46)° (P<0.05),but there was no statistical difference in metacarpal range of motion between the two groups (P>0.05).The excellent and good rate of hand function in oblique group (94.12%) at 18 months after surgery was significantly higher than that in longitudinal group (80.39%) (P<0.05).The incidence of complications revealed no statistical significance between oblique group (1.96%) and longitudinal group (3.92%) (P>0.05).Conclusion In the hollow lag internal screw fixation treatment of patients with transverse fractures of proximal phalanges,both longitudinal and oblique screw methods have good effects,but the oblique screw method is more beneficial to the recovery of hand function.

Objective To evaluate the effectiveness of treatment for osteoarthritis of the first carpometacarpal joint.Methods From June 2019 to June 2022,15 patients with osteoarthritis of the first carpometacarpal joint underwent a combined procedure of trapezium excision,first carpometacarpal joint arthroplasty,ligament reconstruction,and tendon interposition.Surgical efficacy was assessed using X-rays,thumb joint range of motion,grip strength,pinch strength,and pain rating(VAS).Results 9 months postoperative follow-up revealed significant pain reduction,increased thumb range of motion,enhanced grip and pinch strength,with an overall surgical excellence rate of 86.7%.Conclusion Trapeziecotomy arthroplasty with ligament reconstruction and tendon tamponade demonstrates significant efficacy in treating osteoarthritis of the first carpometacarpal joint,effectively alleviating pain,improving thumb mobility,and enhancing hand strength.The method is simple and effective.

Objective To explore the efficacy of microvascular technology combined with perforator flap repair in the treatment of soft tissue defects in hand injuries.Method 98 patients with hand injury soft tissue defects admitted to our hospital from August 2018 to February 2023 were selected as the study subjects.The patients were randomly divided into a control group and an observation group using a random number table method,with 49 cases in each group.The control group was treated with thoracoabdominal pedicle flap repair,while the observation group was treated with microvascular technology combined with perforator flap repair.Compare the efficacy,visual analogue scale (VAS) score,histopathological score,total finger mobility (TAM) score,sensory function grading,and comprehensive quality of life assessment questionnaire 74 (GQOLI-74) score between two groups before and after treatment.Result After 6 months of surgery,the therapeutic effect of the observation group was significantly higher than that of the control group (95.92% vs 79.59%)(P<0.05).On postoperative days 3 and 7,the VAS score of the observation group was significantly lower than that of the control group,while the histopathological score was significantly higher than that of the control group (P<0.05).After 6 months of surgery,the TAM score and sensory function grading in the observation group were (3.37±0.43) and (4.17±0.12) levels,respectively,higher than those in the control group (2.27±0.26) and (3.32±0.12) levels (P<0.05).After 6 months of surgery,the psychological,physical,social,and material function scores of the observation group were significantly higher than those of the control group (P<0.05).Conclusion The combination of microvascular technology and perforator flap repair has a significant therapeutic effect on patients with hand injury tissue injury,which can improve their hand sensation and motor function,alleviate pain,and improve tissue healing and quality of life.

Objective To improve the level of diagnosis and treatment through analyzing the clinical characteristics,treatment and prognosis with testicular torsion in children.Methods We conducted a retrospective analysis of 221 boys with testicular torsion,who received trearment from May 2003 to May 2023 at the Children's Hospital of Chongqing Medical University and Guizhou Provincial People's Hospital.Data analysed included:clinical characteristics,treatment progress and outcome.Results The peak onset age of testicular torsion in children was infancy and prepuberty (71%).The incidence of left side (77%) was higher than that of right side (23%).The first symptoms were mainly scrotal pain and swelling (62%),but some cases mainly manifested lower abdominal pain and inguinal pain (11%).The rate of misdiagnosis and mistreatment of patients in basic hospitals was high.Scrotal color Doppler ultrasonography is the first choice for assistant examination,and mainly showed none or dramatically decrease of blood supply in testis,and abnormal axial direction.The golden time for testicular torsion diagnosis was within 8 hours.The chief pathological manifestation were interstitial hyperemia,edema and seminiferous tubules degeneration within 8 hours,and hemorrhagic necrosis or infarction over 8 hours.Conclusions Children Testicular torsion occurs more frequently in infancy and prepuberty,torsion position in the left side is more than that in right side.The main symptoms are scrotal pain and swelling,as well as lower abdominal or inguinal pain.Testicular pathological lesion is closely associated with the diagnosis time and degree of torsion.

Objective To evaluate the clinical effect of ultra-early endovascular treatment of ruptured tiny intracranial aneurysms(RTIAs).Methods A total of 35 patients with RTIAs who were treated with endovascular embolization within 24 hours after subarachnoid hemorrhage in our department from May 2017 to November 2022 were retrospectively analyzed.The basic clinical information, endovascular treatment results, clinical and imaging follow-up results were analyzed.Results The mean aneurysms maximum diameter is was (2.5±0.4)mm.Of these 35 patients with RTIAs，23 patients(65.7%) were treated with simple coil embolization，12 patients(34.3%) with stent assisted coiling.Immediate angiographic results showed that Raymond gradeⅠin 20 patients(57.1%)，Ⅱ in 13(37.2%)，Ⅲ in 2(5.7%).Perioperative complications occurred in 4 patients(11.4%)，including Intraoperative aneurysm rupture in 2(5.7%)，intra-stent thrombosis in 2(5.7%)，massive cerebral infarction followed by decompressive craniectomy in 1，postoperative death in 1.Angiographic follow-up was performed in 24 patients(68.6%)，recurrence in 1 patient receiving retreatment.Clinical follow-up were performed in 33 patients，The mRS of 0-2 were in 31 patients(93.9%).Conclusion Ultra-early endovascular treatment of RTIAs is effective and relatively safe,with favorable angiographic results and clinical outcomes at follow up.Intraoperative aneurysm rupture and thrombosis are the major perioperative complications.

Objective To evaluate the clinical effect and satisfaction of ultrasound-assisted liposuction(UAL) in minimally invasive treatment of Nape fat pad.Methods Collect clinical data of 43 patients undergoing the surgery of UAL,At the last follow-up,the satisfaction of patients was investigated by questionnaire,The satisfaction rate of patients was counted.Results The maximum subcutaneous fat thickness was significantly smaller (17± 6mm) than preoperative (38 ± 11mm).The results of patient satisfaction rate showed that 27 cases were perfect,11 cases were satisfied,4 cases were normal,and 1 case was invalid.Overall satisfaction rate was 88.4%.Conclusion UAL is safe and effective in the treatment of the fat pad on the back of the neck, and the patient's satisfaction rate is high.

Objective To study the effects of nalbuphine on the proliferation,apoptosis and epithelial mesenchymal transformation (EMT) of colon cancer (CC) cells by regulating Hippo/YAP signaling pathway.Methods Human colon cancer cell line HCT-116 was cultured in vitro in this study,the activity of HCT-116 cells was first detected by CCK-8 method when the concentration of Nalbuphine was increased,according to the results,the appropriate concentration of Nalbuphine was selected.then,HCT-116 cells were grouped into ctrl group(No other processing is performed),low concentration nalbuphine group (0.10 mmol/L),high concentration nalbuphine group (0.15 mmol/L),and high concentration nalbuphine (0.15 mmol/L)+XMU-MP-1 group (3 μmol/mL Hippo/YAP signal pathway inhibitor).Then,the CCK-8 method was applied to detect the cell proliferation ability of each group;flow cytometry was applied to detect cell apoptosis in each group;Transwell test was applied to detect the ability of cell migration;Western blot was applied to detect the expression of phosphorylated-YAP (p-YAP),YAP,PCNA,BAX,and EMT-related protein E-cadherin,N-cadherin,Vimentin,Snail of cells in each group.Results The results show that compared with the ctrl group,the survival rate of HCT-116 cells,the number of cell migration,the expression of YAP and PCNA,N-cadherin,Vimentin,Snail proteins in the low concentration nalbuphine group and the high concentration nalbuphine group decreased,the cell apoptosis rate,the contents of p-YAP,BAX,and E-cadherin increased (P<0.05);compared with the high concentration nalbuphine group,the survival rate of HCT-116 cells,the number of cell migration,the expression of YAP and PCNA,N-cadherin,Vimentin,Snail proteins in the high concentration nalbuphine+XMU-MP-1 group increased,the cell apoptosis rate,the contents of p-YAP,BAX,and E-cadherin decreased (P<0.05).Conclusion It is concluded that Nalbuphine may inhibit the proliferation of CC cells,promote cell apoptosis,and affect the epithelial mesenchymal transformation by activating Hippo/YAP signaling pathway.

Objective To discuss the optimized pain control with standard analgesia plus duloxetine hydrochloride for patients undergoing lumbar fusion surgery,and to analyze its effect on prognostic quality of life.Methods A prospective study was conducted on 106 patients who underwent lumbar fusion surgery in our hospital from May 2019 to December 2020.Patients were randomly assigned into two groups according to analgesic methods.Control group (n=52) was given standard analgesia,while observation group (n=54) received standard analgesia plus duloxetine hydrochloride.Then the degree of postoperative pain,the use of analgesics (the time of the first additional analgesic drugs,effective pressing times within 48 hours after operation),the improvement of psychological emotions,quality of life,and the occurrence of adverse reactions were compared between two groups.Results Observation group scored (4.19±0.78),(2.84±0.61) and (1.73±0.42) on visual analogue scale (VAS) at postoperative 1 d,3 d and 7 d,which were lower than (5.24±0.80),(3.51±0.57) and (2.49±0.56) in control group (P<0.05).Compared with control group,observation group had delayed time of the first additional analgesic drugs [(12.33±2.34)h vs (7.61±0.85)h] and less effective pressing times within 48 hours after operation [(3.78±0.92) vs (10.44±3.27)] than those of control group (P<0.05).Observation group scored lower on Self-rating Anxiety Scale (SAS) at postoperative 7 d [(52.44±6.71) vs (57.39±6.43)] and 14 d [(37.85±6.49) vs (42.66±5.25)],lower on Self-rating Depression Scale (SDS) at postoperative 7 d [(51.16±5.43) vs (55.37±5.25)] and 14 d [(35.64±5.36) vs (40.18±5.22)],and higher on 36-item Short-Form Health Survey (SF-36) at postoperative 4w [(83.44±6.72) vs (78.63±5.11)] than those of control group,with statistical difference (all P<0.05).The adverse reaction rate was 7.41% in observation group,which was lower than 21.15% in control group (P<0.05).Conclusion The optimized pain control with standard analgesia plus duloxetine hydrochloride for patients undergoing lumbar fusion surgery can effectively can effectively improve the analgesic effect,reduce the use of opioids,alleviate negative emotions and improve quality of life with less adverse reactions,which is worth promoting.

Objective To investigate the effect of preoperative dexmedetomidine (DEX) combined with fascia iliac compartment block (FICB) analgesia on perioperative sleep quality and delirium in elderly patients with hip fracture.Methods A total of 90 elderly patients who received total hip replacement (THA) for hip fracture in our hospital from January 2021 to June 2023 were selectively included,and all patients were randomly divided into control group (n=30),FICB group (n=30) and combination group (n=30).Patients in control group were prepared according to routine surgical procedures before surgery.Patients in combination group and FICB group were given continuous ultrasus-guided iliofascial space block and analgesia two days before surgery after admission.Patients in combination group were given dexmedetomidine nose drops on the night before surgery,the day after surgery and the night after surgery.Visual analogue pain (VAS) scores were recorded at admission (T1),30 minutes after nasal drops (T2),immediately after entry to the operating table (T3),and at the position of intraspinal anesthesia (T4).Hamilton Anxiety (HAM-A) score and Athens Insomnia Scale (AIS) score were recorded 1 day before surgery,1 day after surgery and 1 day after surgery.Adverse reactions and postoperative delirium (POD) were recorded one week after surgery.Results There were no significant differences in age,sex,body mass index (BMI),fracture type,anesthesia duration,operation time,blood loss and adverse reactions (except daytime sleepiness) among all groups (P＞0.05).The VAS scores of T2,T3 and T4 in the combination group were significantly lower than those in the other two groups.HAM-A and AIS scores were significantly lower than those of the other two groups (P<0.05).The incidence and duration of postoperative delirium were significantly lower than those in the other two groups(P＜0.05).Conclusion Prospective randomized controlled trials show that FICB combined with DEX can relieve pain,improve perioperative sleep quality and relieve postoperative delirium in patients with THA.