Objective To investigate the effect of nasal mask on preventing respiratory depression and hypoxia during anesthesia under painless gastroscopy.Methods 246 patients underwent elective painless gastroscopy from September 2022 to March 2023 were selected and divided into nasal catheter oxygen group(group C)and nasal mask oxygen group(group M)according to random number table method.The group C was inhaled oxygen by conventional nasal cannula,and in group M,oxygen was inhaled by a nasal mask.Patients in both groups were given 5 L/min preoxygenation for 3 min.After induction of anesthesia,gastroscopy was performed when modified observer's assessment of alertness/sedation(MOAA/S)score≤1.During anesthesia,hypoxia interventions were performed in group C based on percutaneous arterial oxygen saturation(SpO2)and in group M based on partial pressure of end-tidal carbon dioxide(PetCO2)and SpO2.The incidence of subclinical respiratory depression,hypoxia and severe hypoxia during anesthesia was recorded.The minimum SpO2 value during anesthesia was recorded;Implementation of intervention measures of jaw lifting,mask pressure oxygen and tracheal intubation.Record the number of gastroscope withdrawal cases.Mean arterial pressure(MAP),heart rate(HR),and respiratory rate(RR)were recorded at the time of entry(T0),immediately after induction of anesthesia(T1),at the end of gastroscopy(T2),and 5 minutes after awakening(T3).The occurrence of perioperative adverse events and the satisfaction of anesthesiologists and endoscopists were recorded.Results Compared with group C,the incidence of subclinical respiratory depression,hypoxia and severe hypoxia in group M was significantly decreased(P<0.05).The minimum value of SpO2 during anesthesia in group M was higher than that in group C(P<0.05).The incidence of jaw-lifting and mask ventilation were lower in group M than that in group C(P<0.05).The incidence of gastroscope withdrawal due to airway intervention in group M was lower than that in group C(P<0.05).Compared with T0,MAP,HR and RR of the two groups were significant reduction at T1 and T2(P<0.05).There was no significant difference in the incidence of adverse events between the two groups(P>0.05).The satisfaction of endoscopists in group M was higher than that in group C(P<0.05).Conclusion Compared with nasal catheter oxygen inhalation,anesthesia nasal mask can timely detect hypopnea and respiratory depression during gastroscopy,reduce the occurrence of hypoxia,and improve the airway safety of painless gastroscopy patients.

Objective To investigate the efficacy and safety of preemptive one lung ventilation(OLV)combined with disconnection technique for lung collapse during OLV with bronchial blocker(BB)in thoracoscopic surgery.Methods 75 patients who were scheduled for elective left lung segment or lobectomy under thoracoscopy were randomly divided into preemptive OLV group(group A),disconnection technique group(group B)and preemptive OLV combined with disconnection technique(group C),25 cases in each group.The time of complete lung collapse,surgeon satisfaction,pre-thoracic preparation time,OLV time,operation time,and occurrence of hypoxemia[percutaneous arterial oxygen saturation(SpO2)<90%]within 20 minutes after the onset of OLV were recorded;The lung collapse score(LCS)at the moment of pleural cavity opening(T0),1 min(T1),5 min(T2),10 min(T3)and 20 min(T4)after pleural cavity opening were recorded.Results Compared with group A and B,the complete lung collapse time in Group C was significantly shortened,and the surgeon satisfaction was significantly improved,the differences were statistically significant(P<0.05).There was no statistical significance in the complete lung collapse time and surgeon satisfaction between group A and B,the differences were not statistically significant(P>0.05).Compared with group A,the LCS at T0 in group B was lower than that in group A,but significantly higher at T1,the differences were statistically significant(P<0.05).The LCS at T1,T2,T3 and T4 in group C were significantly higher than those in group A and group B,the differences were statistically significant(P<0.05).The value of SpO2 at T2 in group C was obviously lower than that in group A and group B,the difference was statistically significant(P<0.05).Conclusion Preemptive OLV combined with disconnection technique can improve the lung collapse of the non-ventilated lung during OLV with BB in thoracoscopic surgery,shorten complete lung collapse time,with higher surgeon satisfaction,and higher LCS score during OLV.However,SpO2 during OLV still needs to be monitored.

Objective To investigate the impacts of sevoflurane combined with lung protective ventilation strategy on pulmonary ventilation function and lung compliance in obese patients undergoing laparoscopic weight loss surgery.Methods 60 obese patients underwent laparoscopic weight loss surgery were randomly divided into two groups.The control group was given lung protective ventilation intervention alone during anesthesia,and the study group was given sevoflurane inhalation anesthesia combined with lung protective ventilation intervention.Arterial blood was collected before tracheal intubation(T0),5 min after tracheal intubation(T1),40 min after tracheal intubation(T2)and 5 min after tracheal extubation(T3)for blood gas analysis.The pulmonary ventilation function and lung compliance of patients in the two groups were compared.Results Peak airway pressure(Ppeak)and plateau airway pressure(Pplat)at T2 were lower in the study group than those in the control group,and the differences were statistically significant(P<0.05);At T2 and T3 time points,the dynamic lung compliance(Cldyn)of the study group was higher than that of the control group,and the differences were statistically significant(P<0.05);7 days after surgery,the forced vital capacity(FVC)and forced expiratory volume in one second(FEV1)in the study group were higher than those in the control group,and the differences were statistically significant(P<0.05);At time points T1,T2 and T3,the levels of serum transforming growth factor-β1(TGF-β1),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)in the study group were lower than those in the control group(P<0.05);After surgery,the awakening time,spontaneous breathing recovery time,and extubation time in the study group were shorter than those in the control group,the number of adverse events during the recovery period was less than that in the control group,after awakening,the Ramsay score was lower than that in the control group(P<0.05).Conclusion The combination of sevoflurane and lung protective ventilation strategy can reduce inflammatory response,improve pulmonary ventilation function,and improve lung compliance in obese patients undergoing laparoscopic weight loss surgery,with good safety and fast postoperative recovery.

Objective Rinse the common bile duct with 100 mL of 0.9%sodium chloride injection after choledocholithotomy to observe if it can improve the clearance rate of residual stones.Methods A study enrolled patients receiving endoscopic retrograde cholangiopancreatography(ERCP)and mechanical lithotripsy for calculus of common bile duct(≥12 mm)were conducted.After occlusion cholangiography confirmed common bile duct stone clearance,intraductal ultrasonography(IDUS)was performed to determine clearance scores based on the number of residual stones.The amounts of residual stones spotted via IDUS were graded,a large amount of stone fragments scored 1,a small amount of stone fragments scored 2,completely cleared common bile duct without any biliary sludge scored 3.After clearing calculus of common bile duct in ERCP and rinsing with 50 mL and 100 mL 0.9%sodium chloride injection,IDUS examination was performed and scored.Results No patient had common bile duct clearance scores of reached 3 without saline irrigation,45(40.18%)patients reached 3 with 50 mL 0.9%sodium chloride injection irrigation,and 99(88.39%)patients reached 3 with 100 mL irrigation.Multivariate Logistic regression analysis showed that common bile duct diameter>15 mm[odds ratio(O＾R)=4.90,95%confidence interval(CI):1.19～22.57,P=0.013],angulation of the distal common bile duct(the angle between the axis of the common bile duct and the ampulla axis of the common bile duct in cholangiography)≤140°(O＾R=6.92,95%CI:1.83～38.98,P=0.047)and duodenal diverticulum(O＾R=4.10,95%CI:1.14～16.90,P=0.041)were independent risk factors for failure to rinse with 100 mL 0.9%sodium chloride injection.Conclusion Irrigation with 100 mL 0.9%sodium chloride injection can effectively remove the residual calculus of common bile duct after lithotripsy.

Objective To explore the clinical effect of endoscopic sclerosing agent injection combined with ligation in the treatment of third degree internal hemorrhoids.Methods 100 patients with internal hemorrhoids from January 2019 to August 2022 were prospectively selected and divided into control group(50 patients,treated with ligation)and study group(50 patients,treated with endoscopic sclerosing agent injection combined with ligation).Clinical data of patients were collected,and the clinical efficacy,postoperative recovery related indicators,resting anal pressure,anal canal maximum systolic pressure(AMSP),degree of hemorrhoid prolapse and the incidence of postoperative complications were compared between the two groups.Results The total effective rate of the study group was higher than that of the control group,and the difference was statistically significant(P<0.05);After surgery,the pain score,wound bleeding score,degree of hemorrhoid prolapse score,and anal edema score in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).After operation,the resting anal pressure and AMSP in both groups were obviously reduced,and the study group was lower than the control group(P<0.05).Conclusion The combination of endoscopic sclerosing agent injection combined with ligation for the treatment of internal hemorrhoids has a significant effect,which can improve the recovery of surgical and postoperative related indicators,improve the anal and intestinal dynamics,reduce the score of hemorrhoid prolapse,and have good safety.

Objective Given the extensive application of machine learning(ML)in medical models and its remarkable learning and generalization capabilities,this study employed automated ML(AutoML)combined with patient demographics and clinical conditions to early assess the risk of failure in bowel preparation prior to colonoscopy.Methods A retrospective analysis was conducted on patients who underwent colonoscopy examinations in Hospital 1 and Hospital 2 from January 2022 to January 2023,and their general and clinical information was collected.According to the Boston bowel preparation scale(BBPS),a BBPS of≤5 was defined as a failure in bowel preparation,>5 was deemed satisfactory.From the data of the two hospitals,we randomly divided the dataset into a training set(n=303)and a validation set(n=76)at an 8∶2 ratio.Least absolute shrinkage and selection operator(LASSO)logistic regression(LR)model was used for feature selection,a nomogram scoring system was constructed,and models were established using AutoML based on five algorithms.Model performance was evaluated through receiver operator characteristic curve(ROC curve),calibration curves,LR-based decision curve analysis(DCA),SHAP plots,and force plots.Results Among the 379 patients,105 cases(27.7%)experienced bowel preparation failure(BBPS≤5).21 study variables were narrowed down to 10 through LASSO with 5-fold cross-validation,resulting in the development of a Nomogram chart with demonstrated reliability via calibration curves.Using the H2O platform and five algorithms[gradient boosting machine(GBM),deep learning(DL),generalized linear model(GLM),Stacked Ensemble and distributed random forest(DRF)],67 models were developed.Stacked Ensemble outperformed the others with an area under the curve(AUC)of 0.871,LogLoss of 0.403,and RMSE of 0.354,surpassing traditional LR model and other models.Variable importance contribution plots indicated significant predictive influences from factors such as the interval between laxative ingestion and examination,history of constipation,completion of laxative regimen,age,and presence of a companion during the procedure.Finally,SHAP plots and force plots revealed variable distribution patterns in binary classification predictions and the impact of variables on predictive outcomes.Conclusion The AutoML model based on the Stacked Ensemble algorithm exhibits clear clinical utility in early prediction of bowel preparation failure risk.Moreover,a clinically applicable column chart scoring tool is constructed.

Objective To investigate the short and long term effects of preincision of pancreatic duct sphincter in different types of patients with difficult intubation by endoscopic retrograde cholangiopancreatography(ERCP).Method A retrospective study was conducted on 100 patients with difficulty in ERCP intubation from January 2019 to June 2020.Patients were divided into a control group(50 cases)and a study group(50 cases)according to different treatment methods.The control group underwent routine ERCP intubation without pancreaticotomy,while the study group underwent preincision of pancreatic duct sphincter on the basis of routine ERCP intubation.Calculate the successful intubation time,successful intubation rate,and length of hospital stay for two groups;Enzyme linked immunosorbent assay was used to detect postoperative C-reactive protein(CRP),interleukin-6(IL-6),and blood amylase levels in two groups of patients;Calculate the incidence of complications related to pre incision surgery in two groups of patients;Follow up the incidence of reflux cholangitis and recurrent pancreatitis in two groups of patients at 3,6,and 12 months after surgery,and evaluate the long-term efficacy of the two groups of patients.Result Compared with the control group,the study group showed a shorter in successful intubation time,and an increase in successful intubation rate(P<0.05).There was no difference in hospital stay between the two groups(P>0.05);Compared with the control group,the study group showed a decrease in CRP,IL-6 and blood amylase levels on the first day after surgery(P<0.05);The postoperative complication rate of patients in the control group was 14.0%,including 4 patients with acute pancreatitis,2 patients with bleeding,and 1 patient with perforation.The postoperative complication rate of patients in the study group was 2.0%,with 1 patient with bleeding.Compared with the control group,the postoperative complication rate of patients in the study group decreased(P<0.05);Compared with the control group,the incidence of reflux cholangitis in the study group decreased at 12 months after surgery,and the incidence of recurrent pancreatitis decreased at 3,6,and 12 months after surgery(P<0.05).Conclusion Preincision of the pancreatic duct sphincter has a mild impact on systemic inflammation in patients with difficult ERCP intubation,with normal blood amylase indicators and no increase in the incidence of postoperative pancreatitis.It can improve the success rate of intubation and has significant long-term efficacy.It is a safe and effective technique which is worth recommending.

Objective To investigate the impacts of transumbilical single-port laparoscopic cholecystectomy(TUSPLC)on gastrointestinal function and serum sterol regulatory element-binding protein-2(SREBP-2)level in patients with cholecystolithiasis.Methods 100 patients with cholecystolithiasis from September 2021 to August 2022 were selected as the study objects,and divided them into control group and study group by random number table method,with 50 cases in each group.The control group underwent laparoscopic cholecystectomy,study group underwent TUSPLC,the efficacy of the two groups was compared.Results The intraoperative blood loss of patients treated with different treatment methods showed no difference(P>0.05).Patients treated with TUSPLC had longer operation time,and shorter hospital stay,the anal exhaust time,feeding time,bowel sound recovery time and defecation time compared with control group(P<0.05).Before operation,there were no differences in McGill Brisbane symptom score(MBSS),serum SREBP-2,interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)between the two groups(P>0.05).Three months after surgery,the MBSS,serum SREBP-2,IL-6 and TNF-α were decreased compared with before the surgery in two groups,and the change in the study group was greater compared with control group,the differences were statistically significant(P<0.05).There was no difference in the incidence of complications(P>0.05).Conclusion TUSPLC has a definite effect in the treatment of cholecystolithiasis,can reduce the levels of serum SREBP-2 and inflammatory factors in patients,and can improve the gastrointestinal function of patients with high safety.

Objective To compare the diagnostic value of white light endoscopy and intelligent scan(i-Scan)endoscopy for nasopharyngeal masses.Methods We collected 127 patients with nasopharyngeal masses from January 2019 to December 2021 and obtained biopsy pathological results.From January 2019 to December 2020,59 cases were treated with white light endoscopy,and from January 2021 to December 2021,68 cases were treated with i-Scan endoscopy.Compare the accuracy of diagnosis between the two groups based on pathological results as the gold standard;Evaluate the microvascular morphology and lesion boundaries of nasopharyngeal masses under i-Scan endoscopy,and conduct correlation analysis with pathological results.Results The specificity and accuracy of i-Scan endoscopy in the diagnosis of nasopharyngeal masses were higher than those of white light endoscopy(91.80%and 86.00%,91.17%and 86.44%),and the sensitivity was lower than that of white light endoscopy(85.71%and 88.89%),but there was no significant difference(P>0.05).The diagnostic consistency of i-Scan group was slightly higher than that of white light group(Kappa=0.619 and 0.588);The lesion site boundary score,microvascular score,and their total score in i-Scan group were positively correlated with the pathological score(r=0.429,r=0.421,r=0.460),the differences were statistically significant(P<0.05);Typical disordered and twisted submucosal vessels(SV)and branching vessels(BV)were observed in nasopharyngeal carcinoma,most benign lesions could observe dilated and regularly distributed SV and BV,regardless of pathological malignancy,no obvious intraepithelial papillary capillary loop(IPCL)was observed in the nasopharynx.Conclusion The diagnostic efficacy of i-Scan endoscopy for nasopharyngeal masses is higher than that of white light endoscopy.

Objective To investigate the clinical efficacy of artificial dura mater and epidermal growth factor in the repair of tympanic membrane perforation after endoscopic tympanic membrane repair.Methods 58 patients with tympanic membrane perforation were randomly divided into two groups,29 cases in each.Group A was repaired with gelatin sponge,group B was repaired with artificial dura mater and epidermal growth factor.The tympanic membrane healing was reviewed every month,and the pure tone audiometry was reviewed after 3 months.Results The success rate of repair in group A was 34.48%(10/29),and that in group B was 75.86%(22/29).The difference was statistically significant(P<0.05).The air-bone gap in group A was improved by(7.32±2.68)dB HL,and that in group B was improved by(21.77±4.65)dB HL.The difference was statistically significant(P<0.05).Conclusion Artificial dura mater is a suitable tympanic membrane regeneration scaffold.Epidermal growth factor can promote the healing of tympanic membrane perforation.The combination of the two is a feasible treatment for tympanic membrane repair.