Objective:To investigate the effect of laparoscopic splenectomy and azygoportal disconnection (LSD) on liver synthesis and development of liver cirrhosis.Methods:This is a prospective case series study.The clinical data of liver cirrhotic patients with portal hypertension who received LSD at the Department of Hepatobiliary Surgery of Northern Jiangsu People′s Hospital Affiliated to Yangzhou University from September 2014 to January 2016 were included. This study analyzed the diameter of the portal vein, the velocity of portal blood flow, the routine blood parameters, the liver function, the synthetic proteins of liver (antithrombin Ⅲ (AT-Ⅲ), protein S, protein C), and the serum content of liver fibrotic markers(collagen type Ⅳ, procollagen type Ⅲ, laminin, hyaluronidase). Repeated measures ANOVA was used for comparison between multiple groups, and least significance difference was used for post-hoc multiple comparison.Results:A total of 106 patients were included in the study, including 70 males and 36 females, aged (51.8±9.8) years(range: 28 to 75 years).Compared with the preoperative results, the diameter of portal vein and the velocity of portal vein decreased after surgery ( F=14.03, 12.15, respectively, both P<0.01). Compared with the preoperative results, the total bilirubin, albumin, prothrombin time, international normalized ratio, Child-Pugh score and classification were improved ( F=17.96, 56.01, 66.63, 35.83, 33.49, and 27.50, respectively, all P<0.01), and the AT-Ⅲ, protein S, protein C,collagen type Ⅳ, procollagen type Ⅲ, laminin and hyaluronidase levels were also improved ( F=47.87, 36.26, 18.02, 2.79, 14.58, 44.35, and 14.38, respectively, all P<0.01). Compared with the preoperative period, the diameter of portal vein was reduced from the first week to the 24 th month after surgery ( t=5.45 to 9.39, all P<0.01). Compared with the preoperative period, the velocity of portal vein blood from the first week after surgery to the 24 th month after surgery was decreased ( t=4.02 to 8.43, all P<0.01). Compared with the preoperative period, routine blood parameters (white blood count, hemoglobin, platelet count), liver function (total bilirubin, albumin, prothrombin time, international normalized ratio, Child-Pugh score), liver synthetic protein (AT-Ⅲ, protein S, protein C) and liver fibrotic markers (collagen type Ⅳ, procollagen type Ⅲ, laminin, hyaluronidase) were improved to varying degrees at the 24th month after surgery ( t=-20.46 to 11.93, all P<0.01). Conclusion:Preliminary findings show that LSD can reduce portal vein pressure, restore blood cell number, and improve liver synthesis function and the degree of liver fibrosis in patients with portal hypertension in liver cirrhosis.

Objective:To investigate the effect of laparoscopic splenectomy and azygoportal disconnection (LSD) on liver synthesis and development of liver cirrhosis.Methods:This is a prospective case series study.The clinical data of liver cirrhotic patients with portal hypertension who received LSD at the Department of Hepatobiliary Surgery of Northern Jiangsu People′s Hospital Affiliated to Yangzhou University from September 2014 to January 2016 were included. This study analyzed the diameter of the portal vein, the velocity of portal blood flow, the routine blood parameters, the liver function, the synthetic proteins of liver (antithrombin Ⅲ (AT-Ⅲ), protein S, protein C), and the serum content of liver fibrotic markers(collagen type Ⅳ, procollagen type Ⅲ, laminin, hyaluronidase). Repeated measures ANOVA was used for comparison between multiple groups, and least significance difference was used for post-hoc multiple comparison.Results:A total of 106 patients were included in the study, including 70 males and 36 females, aged (51.8±9.8) years(range: 28 to 75 years).Compared with the preoperative results, the diameter of portal vein and the velocity of portal vein decreased after surgery ( F=14.03, 12.15, respectively, both P<0.01). Compared with the preoperative results, the total bilirubin, albumin, prothrombin time, international normalized ratio, Child-Pugh score and classification were improved ( F=17.96, 56.01, 66.63, 35.83, 33.49, and 27.50, respectively, all P<0.01), and the AT-Ⅲ, protein S, protein C,collagen type Ⅳ, procollagen type Ⅲ, laminin and hyaluronidase levels were also improved ( F=47.87, 36.26, 18.02, 2.79, 14.58, 44.35, and 14.38, respectively, all P<0.01). Compared with the preoperative period, the diameter of portal vein was reduced from the first week to the 24 th month after surgery ( t=5.45 to 9.39, all P<0.01). Compared with the preoperative period, the velocity of portal vein blood from the first week after surgery to the 24 th month after surgery was decreased ( t=4.02 to 8.43, all P<0.01). Compared with the preoperative period, routine blood parameters (white blood count, hemoglobin, platelet count), liver function (total bilirubin, albumin, prothrombin time, international normalized ratio, Child-Pugh score), liver synthetic protein (AT-Ⅲ, protein S, protein C) and liver fibrotic markers (collagen type Ⅳ, procollagen type Ⅲ, laminin, hyaluronidase) were improved to varying degrees at the 24th month after surgery ( t=-20.46 to 11.93, all P<0.01). Conclusion:Preliminary findings show that LSD can reduce portal vein pressure, restore blood cell number, and improve liver synthesis function and the degree of liver fibrosis in patients with portal hypertension in liver cirrhosis.

AIM: To examine how three distinct central positioning techniques for anterior capsulotomy-pupil center, limbus center, and lens apex-affect intraocular lens(IOL)placement and visual quality following femtosecond laser-assisted cataract surgery(FLACS).METHODS: A total of 36 patients(72 eyes)with age-related cataracts who underwent FLACS and ZCB00 aspherical IOL implantation at Aier Eye Hospital Medical Center, Anhui Medical University between January and December 2023 were included in this prospective study. Patients were divided into three groups based on the central positioning mode for anterior capsulotomy: pupil center, limbus center, and lens apex center groups. IOL alignment and displacement were evaluated using the Casia2 device, and the postoperative visual quality was assessed.RESULTS: At 1 d postoperatively, the IOL tilt for the pupil, limbus, and apex groups were 3.96°±1.51°, 4.63°±1.87°, and 3.90°±2.24°, respectively(F=1.07, P=0.35); IOL decentration values were 0.21±0.10 mm, 0.23±0.16 mm, and 0.21±0.12 mm, respectively(F=0.14, P=0.87); total higher-order aberrations were 0.32±0.40 μm, 0.56±0.61 μm, and 0.53±0.60 μm, respectively(F=1.38, P=0.26); and coma aberrations values were 0.13±0.10 μm, 0.16±0.15 μm, and 0.14±0.15 μm, respectively(F=0.3, P=0.74). All results obtained postoperative day 1 did not differ significantly. At 3 mo postoperatively, IOL tilt values were 5.42°±2.00°, 3.96°±1.44°, and 3.20°±1.19°, respectively(F=12.40, P<0.001); IOL decentration values were 0.33±0.07 mm, 0.23±0.11 mm, and 0.21±0.11 mm, respectively(F=4.99, P=0.008); total higher-order aberrations were 0.67±0.29 μm, 0.44±0.37 μm, and 0.42±0.19 μm, respectively(F=5.50, P=0.006); and coma aberrations values were 0.21±0.12 μm, 0.19±0.12 μm, and 0.12±0.11 μm, respectively(F=3.87, P=0.03). All results obtained 3 mo postoperatively were statistically significant.CONCLUSION: Using the lens apex as the central positioning mode for anterior capsulotomy in FLACS improves postoperative IOL stability and reduces postoperative IOL tilt and decentration. If the lens apex cannot be determined intraoperatively, the limbus center-positioning mode is recommended.

Objective To investigate the expression and prognostic significance of serum protease C1 inhib-itor(SERPING1)and plasminogen activator inhibitor type 1(SERPINE1)in patients with sepsis.Methods A total of 132 patients with sepsis treated in the hospital from March 2018 to March 2020 were se-lected as the sepsis group.According to whether they died within 28 days of admission,they were divided into a death group(n=34)and a survival group(n=98).Enzyme linked immunosorbent assay was used to detect the expression of serum SERPING1 and SERPINE1.Multivariate Logistic regression model and receiver oper-ating characteristic curve were used to study the value of serum SERPING1 and serpine1 in evaluating the prognosis of patients'death.Results[Compared with the control group,serum SERPING1(331.12±51.80 ng/L vs.639.04±91.12 ng/L)was lower and serum serpine1(412.67±64.84 ng/L vs.42.33±10.32 ng/L)was higher in the sepsis group,and the differences were statistically significant(P＜0.05).[Compared to the survival group,the levels of serum SERPINE1,procalcitonin,C-reactive protein,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score and Sequential Organ Failure Assessment(SOFA)score in the death group were higher,while serum SERPING1 was lower,and the differences were statistically significant(all P＜0.05).Serum SERPING1 showed negative correlation with APACHE Ⅱ and SOFA scores(r=-0.779,-0.653,P＜0.05),while serum SERPINE1 showed positive correlation with APACHE Ⅱ and SO-FA scores(r=0.740,0.685,P＜0.05).APACHE Ⅱ score,SOFA score,and serum SERPINE1 were risk fac-tors affecting the prognosis of sepsis patients,while serum SERPING1 was a protective factor.The area under the curve of serum SERPING1 and SERPINE1 combined for the evaluation of the death in sepsis patients was 0.938(95％CI:0.893-0.968),which was significantly higher than 0.860(95％CI:0.812-0.899)and 0.838(95％CI:0.781-0.868)of the single detection,and the differences were statistically significant(Z=3.861,4.015,P＜0.001).Conclusion The elevated levels of serum SERPING1 and SERPINE1 in patients with sepsis are related to the severity of the patient's condition.The combination of the two has high prognos-tic value for sepsis patients.

Objective:We aimed to develop a novel visualized model based on nomogram to predict postoperative overall survival.Methods:This was a multicenter, retrospective, observational cohort study, including participants with histologically confirmed gastric and colorectal cancer who underwent radical surgery from 11 medical centers in China from August 1, 2015 to June 30, 2018. Baseline characteristics, histopathological data and nutritional status, as assessed using Nutrition Risk Screening 2002 (NRS 2002) score and the scored Patient-Generated Subjective Global Assessment, were collected. The least absolute shrinkage and selection operator regression and Cox regression were used to identify variables to be included in the predictive model. Internal and external validations were performed.Results:There were 681 and 127 patients in the training and validation cohorts, respectively. A total of 188 deaths were observed over a median follow-up period of 59 (range: 58 to 60) months. Two independent predictors of NRS 2002 and Tumor-Node-Metastasis (TNM) stage were identified and incorporated into the prediction nomogram model together with the factor of age. The model's concordance index for 1-, 3- and 5-year overall survival was 0.696, 0.724, and 0.738 in the training cohort and 0.801, 0.812, and 0.793 in the validation cohort, respectively.Conclusions:In this study, a new nomogram prediction model based on NRS 2002 score was developed and validated for predicting the overall postoperative survival of patients with gastric colorectal cancer. This model has good differentiation, calibration and clinical practicability in predicting the long-term survival rate of patients with gastrointestinal cancer after radical surgery.

Objective:To carry out evidence-based nursing for postoperative exercise rehabilitation of patients with vertebral fractures, develop review indicators, analyze obstacles and facilitators in evidence-based nursing practice, and formulate reform strategies.Methods:Guided by the evidence-based nursing practice model of the Joanna Briggs Institute, this study incorporated evidence of postoperative exercise rehabilitation in patients with vertebral fractures and developed review items. Based on baseline review, the obstacles and facilitators in evidence-based nursing practice were analyzed, and reform strategies were formulated.Results:A total of 29 evidence items were included, and 16 review indicators were formulated. Only seven indicators had a compliance rate of 100%, two indicators had a compliance rate of 0, and the compliance rate of the remaining indicators was between 11% and 95%. The obstacles in evidence-based nursing practice came from three levels: system, practitioner, and patient. The facilitators included strong leadership and organizational abilities, close cooperation between medical and nursing teams, and so on. Corresponding change strategies were developed based on obstacles and facilitators.Conclusions:There is a certain gap between the evidence of exercise rehabilitation and evidence-based nursing practice in postoperative patients with vertebral fractures. We should make full use of facilitators to overcome obstacles and implement reform strategies.

Objective:After initially establishing a health performance evaluation index system for county health alliance,this study aimed to calculate the weight coefficients of various indicators and dimensions through the entropy weight method,which provided an evaluation orientation for county health alliance to achieve health-centered sustainable development.Methods:Based on existing research,the entropy weight method was used to standardize and calculate the weights of 27 indicators from five sample regions.Results:The weight coefficients for the three dimensions of construction structure,organizational process,and health outcomes are 0.261,0.301,and 0.439,respectively.In the construction structure dimension,the weight coefficients for inside-county medical utilization rate(0.105)and the proportion of outpatient and emergency visits in primary healthcare institutions inside-county(0.048)are relatively high.In the organizational process dimension,the weight coefficients for standardized management service rates for hypertension at the primary health care(0.062)and diabetes control rates(0.050)are relatively high.In the health outcome dimension,the weight coefficients for the low birth weight rate(0.072)and life expectancy(0.051)are relatively high.Conclusions:The weight coefficients of the health performance evaluation indicators for county health alliance calculated based on the entropy weight method highlighted the important role of health outcomes,as well as objectively reflect the contribution of each evaluation index to the health performance of the county health alliance.

Hepatohilar cholangiocarcinoma is a common malignant tumor of the biliary system,and radical surgery is one of the important treatment methods.Due to the narrow space at the hi-lum and the high rate of anatomical variation,radical surgery is challenging.By using medical imag-ing technology and 3D reconstruction,surgeons can accurately determine the stage and classifica-tion of hilar cholangiocarcinoma preoperatively.They can assess the tumor's resectability by Ac-cording to the bile duct separation limit points(U point,P point)and anticipate the impact of portal vein,bile duct,and arterial variations on the surgical plan,thereby improving the rate of radical re-section and reducing complication rates.

Objective To investigate the value of combined serum levels of neutrophil gelatinase-associated lipocalin(NGAL)and growth differentiation factor 15(GDF-15)in diagnosis of renal injury in elderly patients with H-type hypertension.Methods A total of 177 patients with H-type hypertension admitted to Department of Neurology and Department of General Medicine of the Affiliated Hospital of Chengde Medical College from April 2021 to June 2022 were enrolled,and based on their estimated glomerular filtration rate(eGFR),they were divided into the renal im-pairment group(81 cases)and normal renal function group(96 cases).General data and laboratory indicators were collected in the two groups.ROC curve analysis was used to evaluate the diagnos-tic value of combined NGAL and GDF-15 levels for renal injury in the elderly patients with H-type hypertension,and Pearson correlation analysis was performed to analyze the correlation between serum NGAL and GDF-15 levels and renal injury in the patients.Results SBP level was significantly higher in the renal impairment group than the normal renal function group[148.53±14.62 mm Hg(1 mm Hg=0.133 kPa)vs 138.75±13.36 mm Hg,P＜0.01],but no such difference was observed in DBP level between the two groups(P＞0.05).The levels of creatinine(Cr),urea nitrogen(BUN),β2-microglobulin(β2-MG),cystatin C(Cys C),urinary microalbumin(MA),NGAL and GDF-15 levels were obviously higher in the renal impairment group than the group with normal renal function(P＜0.01).ROC curve analysis showed that the combined detection of NGAL and GDF-15 levels was significantly higher than that of the two indicators alone(P＜0.01).Pearson correlation analysis indicated that serum NGAL and GDF-15 levels were positively correlated with Cr,BUN,β2-MG,Cys C and MA levels(P＜0.01).Conclusion Serum NGAL and GDF-15 levels are elevated in elderly H-type hypertension patients.Combined detection of the two indicators has higher value in the diagnosis of renal injury in elderly H-type hypertension patients.

Objective To investigate the safety and effectiveness of laparoscopic orchiopexy assisted by needle grasper hydrodissection for cryptorchidism.Methods From September 2020 to September 2022,21 children with cryptorchidism on 25 sides underwent laparoscopic orchiopexy assisted by needle grasper hydrodissection in our department.The water injection function of needle grasper was applied to inject normal saline into the retroperitoneal space to fully separate the retroperitoneum from the vas deferens and spermatic cord,establishing a liquid barrier to protect the vas deferens and spermatic cord.Then the retroperitoneum was bridge-likely cut off with the assistance of needle grasper.The vas deferens and spermatic cord were completely released in accordance with the principle of integrity and non-destructiveness,then the testes were successfully induced and fixed.Results During the operation,15 cases of inguinal cryptorchidism and 6 cases of intra-abdominal cryptorchidism were confirmed.There were 17 cases of unilateral cryptorchidism and 4 cases of bilateral cryptorchidism.All the 25 testes were successfully re-located into the dartos pouch of the scrotum under laparoscopic guidance.The operation time was 35-75 min(mean,45.1±14.3 min),and there were no surgical complications.During follow-ups for 12-24 months in 21 cases,the testicles were found located in the scrotum without retraction,atrophy,incision infection,incision hernia,or inguinal hernia.Conclusions Needle grasper hydrodissection assisted laparoscopic orchiopexy can effectively protect the vas deferens and spermatic cord.The operation is simple,safe,and effective.