Objective To investigate the cause of gynecological misdiagnosis in small intestinal stromal tumor and operation principle,treatment protocol.Methods Gynecological misdiagnosis in 4 female patients with small intestinal stromal tumor admitted were retrospectively analyzed.Results Four patients had abdominal ultrasound examination,1 patient was misdiagnosed as hysteromyoma,3 patients were misdiagnosed as ovarian tumor.All patients without further abdominal CT or MRI examination,operated by gynecology first and then treated by general surgery.All of 4 patients were confirmed with small intestinal stromal tumor by pathology.Conclusions For patients who are considered with hysteromyoma or ovarian tumor have melena must be identified with small intestinal stromal tumor.Further CT examination is valuable and can reduce misdiagnosis.Operation principle and oral imatinib mesylate after operation must be insisted.

Purpose To investigate the clinicopathological and molecular of embryonal tumor with multilayered rosettes(ETMR).Methods The clinical data and follow-up data of 9 cases of ETMR were collected,and the expression of Syn,LIN28A,vimentin,GFAP,Olig2,S-100,INI1,H3K27me3,and Ki67 was detected by immunohistochemistry EnVision two-step method.The amplification genes of C19MC were detected by fluorescence in situ hybridization(FISH).And relevant lit-eratures were reviewed.Results There were 6 males and 3 fe-males with 2∶1 of M:F;seven cases were located supratentorial-ly and two cases located subratentorially,one of the case located to the brainstem was resemble of diffuse intrinsic pontine glioma in imaging.Histopathologically,there 9 cases were diagnosed as embryonal tumor with abundant neuropil and true rosettes(four cases),ependymoblastoma(three cases),or medulloepithelio-ma(two cases).Immunohistochemistry showed that LIN28A,Syn and vimentin were positive,GFAP was variable,BRG1,INI1 and H3K27me3 were retained.The Ki67 proliferation index rangeed from 40％to 70％.C19MC amplification were detected in 8 samples by FISH.In all 9 cases,four cases had undergone gross total tumor resection,two cases only subtotal tumor re-moved,one patient was underwent biopsy,two patients were un-known.Seven patients were adjuvant therapy.Four patients had CSF seeded,but without extraneural metastases.The follow-up time ranged from 0 to 36 months.The overall survival(OS)was 36 months and the median survival was 10 months.Eight pa-tients died within 3 years after their initial diagnosis.Conclu-sion ETMR almost occurs in the cerebral hemisphere,and a few cases can occur in the brainstem and show the imaging char-acteristics of DIPG.ETMR have highly aggressive and poor prognosis.The combination of histological,LIN28A immunohis-tochemistry,and C19MC tests is helpful for diagnosis and differ-ential diagnosis.

Objectives:To verify the reliability and validity of the frailty assessment scale for elderly patients with inguinal hernia and to evaluate the value of its clinical application.Methods:A convenience sampling method was used to collect 129 geriatric patients who underwent inguinal hernia surgery from January 2018 to January 2023 in nine hospitals in Liaoning Province. There were 120 males and 9 females, of whom 89 patients were 60 to <75 years old, 33 patients were 75 to <85 years old and 7 patients were ≥85 years old. The 129 patients included 11 elderly patients with inguinal hernia who had recovered from preoperative infection with COVID-19. Statistical methods such as Cronbach′s coefficient, Kaiser-Meyer-Olkin test, Bartlett′s test, Pearson′s correlation analysis, etc. were calculated to verify the reliability indexes such as feasibility, content validity, structural validity, criterion-related validity, internal consistency reliability, and re-test reliability. Taking the 5-item modified frailty index (5-mFI) as the gold standard, the area under the curve was used to analyze the ability of the two scales to predict the occurrence of postoperative acute urinary retention, postoperative delirium, poor incision healing, operative hematoma seroma, and postoperative complications.Results:The frailty assessment scale for elderly patients with inguinal hernia showed good reliability and validity (valid completion rate of 99.2%; item content validity index of 1.000, and the scale content validity index of 1.000; exploratory factor analysis extracted a total of 1 principal component, and factor loadings of each item of 0.565 to 0.873; the AUC for frailty diagnosis using 5-mFI as the gold standard of 0.795 ( P<0.01) Cronbach′s coefficient of 0.916, retest reliability coefficient of 0.926), it could effectively predict postoperative acute urinary retention, delirium, hematoma seroma in the operative area and total complications (AUC of 0.746, 0.870, 0.806, and 0.738, respectively; all P<0.05), and prediction efficiency was higher than that of 5-mFI (AUC of 0.694, 0.838, 0.626 and 0.641, P<0.05 for delirium only), but both scales were inaccurate in predicting poor incision healing (AUC of 0.519, P=0.913 for the frailty assessment scale and 0.455, P=0.791 for the 5-mFI). Conclusions:The frailty assessment scale for elderly patients with inguinal hernia is reliable and significantly predicts the occurrence of postoperative adverse events in elderly inguinal hernia patients. The scale can also be used for preoperative frailty assessment in elderly patients with inguinal hernia after rehabilitation from COVID-19 infection.

Objectives:To verify the reliability and validity of the frailty assessment scale for elderly patients with inguinal hernia and to evaluate the value of its clinical application.Methods:A convenience sampling method was used to collect 129 geriatric patients who underwent inguinal hernia surgery from January 2018 to January 2023 in nine hospitals in Liaoning Province. There were 120 males and 9 females, of whom 89 patients were 60 to <75 years old, 33 patients were 75 to <85 years old and 7 patients were ≥85 years old. The 129 patients included 11 elderly patients with inguinal hernia who had recovered from preoperative infection with COVID-19. Statistical methods such as Cronbach′s coefficient, Kaiser-Meyer-Olkin test, Bartlett′s test, Pearson′s correlation analysis, etc. were calculated to verify the reliability indexes such as feasibility, content validity, structural validity, criterion-related validity, internal consistency reliability, and re-test reliability. Taking the 5-item modified frailty index (5-mFI) as the gold standard, the area under the curve was used to analyze the ability of the two scales to predict the occurrence of postoperative acute urinary retention, postoperative delirium, poor incision healing, operative hematoma seroma, and postoperative complications.Results:The frailty assessment scale for elderly patients with inguinal hernia showed good reliability and validity (valid completion rate of 99.2%; item content validity index of 1.000, and the scale content validity index of 1.000; exploratory factor analysis extracted a total of 1 principal component, and factor loadings of each item of 0.565 to 0.873; the AUC for frailty diagnosis using 5-mFI as the gold standard of 0.795 ( P<0.01) Cronbach′s coefficient of 0.916, retest reliability coefficient of 0.926), it could effectively predict postoperative acute urinary retention, delirium, hematoma seroma in the operative area and total complications (AUC of 0.746, 0.870, 0.806, and 0.738, respectively; all P<0.05), and prediction efficiency was higher than that of 5-mFI (AUC of 0.694, 0.838, 0.626 and 0.641, P<0.05 for delirium only), but both scales were inaccurate in predicting poor incision healing (AUC of 0.519, P=0.913 for the frailty assessment scale and 0.455, P=0.791 for the 5-mFI). Conclusions:The frailty assessment scale for elderly patients with inguinal hernia is reliable and significantly predicts the occurrence of postoperative adverse events in elderly inguinal hernia patients. The scale can also be used for preoperative frailty assessment in elderly patients with inguinal hernia after rehabilitation from COVID-19 infection.