Objective To investigate the values of systemic inflammatory response index(SIRI),systemic immunoinflammatory index(SII),neutrophil count/lymphocyte count(NLR),platelet count/lymphocyte count(PLR)and lymphocyte count/monocyte count(LMR)in prediction of the severity of acute pancreatitis(AP)at early stage.Methods The clinical data on 666 AP patients admitted to the department of hepatobiliary surgery,the First Affiliated Hospital of Anhui University of Science and Technology,from January 2020 to November 2023 were retrospectively analyzed.The patients were divided into a mild group(MAP group,mild acute pancreatitis)and a non-mild group(non-MAP group,including moderate to severe acute pancreatitis).Blood routine and biochemical indicators were collected at admission and 24 hours after admission.The differences in SIRI,SII,NLR,PLR and LMR between the two groups were compared,so were the values of these five indexes in prediction of non-MAP.Results Of the 666 AP patients,507 were in the MAP group and 159 in the non-MAP group.In the non-MAP group,C-reactive protein(CRP),SIRI,SII,and NLR were higher than those in the MAP group 24 hours after admission,while LMR was lower than that in the MAP group,and the differences were statistically significant(P<0.05).CRP(HR=1.008,95%CI:1.004～1.012,P<0.05)and SIRI(HR=1.216,95%CI:1.029～1.436,P<0.05)were identified as the risk factors for the severity of AP.The ROC curve showed that the AUC and sensitivity of SIRI for predicting non-MAP 24 hours after admission were 0.718 and 75.00%,respectively,higher than those of SII,CRP,NLR,and LMR.Both SIRI and CRP had AUC values greater than 0.7,and the combined AUC was 0.788(0.738～0.837),the sensitivity was 86.00%and the specificity was 81.44%.Conclusions SIRI can be used as a predictor of disease severity in early AP patients,and combined with CRP can improve the predictive value.

Objective:To investigate the correlation between preoperative thyroid function and central lymph node metastasis in cN0 unilateral papillary thyroid microcarcinoma (PTMC).Methods:The clinical data of 208 patients with cN0 unilateral PTMC admitted to the First Affiliated Hospital of Anhui University of Science and Technology from July 2020 to December 2021 were retrospectively analyzed. The patients were divided into a metastasis group( n=64) and a non-metastasis group( n=144) according to whether there was central lymph node metastasis in postoperative pathology. The preoperative serum free three iodine thyroid gland (FT3), free thyroid hormone (FT4), thyroid stimulating hormone (TSH), anti thyroid peroxidase antibody (TPOAb) , anti thyroid globulin antibody (TGAb), paraffin pathological results and general data were compared between the two groups of patients. Statistical analysis was performed using SPSS 19.0 software. The measurement data of normal distribution were expressed by Mean±SD , and comparison between groups was performed by t test. Non-normal distribution measurement data were expressed as [ M( Q1, Q3)], and comparison between groups was performed by Mann-Whitney U test. Enumeration data were represented by n(%), and comparison between groups was performed by chi-square. Multivariate analysis was conducted by binary logistic multivariate regression analysis. Results:In 208 PTMC patients with cN0, the rate of central lymph node metastasis was 30.77% (64/208). The misexcision rate of parathyroid gland was 28.13% (18/64) in the metastatic group, 25.69% (37/144) in the non-metastatic group, and the overall misexcision rate was 26.44%. There were no significant differences in age, tumor subtypes, combined hashimoto′s thyroiditis, multiple lesions, FT3, FT4, TGAb and TPOAb between the metastatic group and the non-metastatic group ( P>0.05). The proportion of male patients in the metastatic group was higher than that in the non-metastatic group (32.81% vs 19.44%, χ2=4.38, P=0.036), the tumor diameter in the metastatic group was larger than that in the non-metastatic group [(0.63±0.23)cm vs (0.49±0.22)cm, χ2=3.99, P<0.001], and the preoperative TSH in the metastatic group was higher than that in the non-metastatic group[2.87(1.92, 4.95) vs 2.04(1.56, 2.84), Z=2.48, P=0.024], and differences between the two groups was statistically significant ( P<0.05). Multivariate logistic regression analysis showed that male, tumor diameter and preoperative TSH were independent risk factors for lymph node metastasis in central region ( P<0.05). Conclusions:The central lymph node metastasis rate of cN0 unilateral PTMC is high. Male, patients with large tumor diameter and high preoperative TSH should be alert to occult lymph node metastasis, and the protection of parathyroid glands should be strengthened during central lymph node dissection.

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a rare autosomal recessive hereditary mitochondrial disease, which is mainly characterized by gastrointestinal and neurological system involvement. This article reports a rare case of MNGIE which presented as chronic diarrhea. The purpose is to improve the understanding of MNGIE.

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a rare autosomal recessive hereditary mitochondrial disease, which is mainly characterized by gastrointestinal and neurological system involvement. This article reports a rare case of MNGIE which presented as chronic diarrhea. The purpose is to improve the understanding of MNGIE.

Objective:To explore the application effect and value of enhanced recovery after surgery(ERAS) in acute appendicitis.Methods:The clinical data of 70 cases of adult acute appendicitis in the Department of General Surgery, First Affiliated Hospital of Anhui University of Science and Technology from July 2017 to June 2018 were analyzed retrospectively, including 35 males and 35 females, aged (41.4 ± 14.6) years and ranging from 18 to 70 years. According to the different perioperative management methods, the study group was divided into study group ( n=35) and control group ( n=35). The study group adopted systematic and orderly intervention measures guided by ERAS during the perioperative period, and the control group adopted the traditional perioperative management scheme. The differences in the preoperative white blood cells, operation time, intraoperative bleeding, the first time of get out the bed, the time of anus ventilation, the 24 hour postoperative pain score, the hospital days, postoperative complications, leukocyte examination 72 days after operation and total cost were compared between the two groups. Measurement data were expressed by mean±standard deviation ( Mean± SD). T test was used for comparison between groups. Counting data were expressed by percentages, and chi-square test and Fisher test were used in comparison between groups. Results:In the study group, the leukocytes before operation, operation time, intraoperative blood loss, hospital stay and leukocyte examination 72 days after operation were respectively (13.3±4.7)×10 9/L, (66.5±18.7) min, (11.7±6.6) mL, (5.8±1.6) d, (7.5±2.6)×10 9/L; while the control group were respectively (13.3±3.5)×10 9/L, (71.9±21.7) min, (12.5±7.1) mL, (7.3±2.7) d, (7.9±2.4)×10 9/L. There was no significant difference between the two groups ( P> 0.05). In the study group, the first time to get out of bed, the time of anal ventilation, the 24 hour postoperative pain score, the total cost of hospitalization and postoperative complications were (8.3±1.4) h, (21.6±3.6) h, (2.3±0.5) scores, (7 058.0±1 329.9) yuan, 2 csaes; while the control group were respectively (11.1±2.8) h, (35.0±5.3) h, (3.4±0.8) scores, (8 621.3±2 625.6) yuan, 9 cases; The difference between the two groups was statistically significant ( P<0.05). Conclusions:The application of ERAS in the perioperative management of acute appendicitis is safe and effective. It can accelerate the anal ventilation, reduce postoperative pain, reduce postoperative complications, reduce the total hospitalization costs, and have significant social and economic benefits.

Objective:To explore the influence of the timing of the drainage tube removal on the clinical pathway after radical resection of papillary thyroid carcinoma.Methods:The clinical data of 64 patients with radical resection of papillary thyroid carcinoma discharged to the department of general surgery, First Affiliated Hospital of Anhui University of Science and Technology from December 2019 to May 2020 were retrospectively analyzed. There were 14 males and 50 females, aged (45.8 ± 11.7) years and ranging from 23 to 73 years. According to the amount of postoperative drainage fluid, decide whether to extubate and divide the patient into a study group and a control group, there were 37 cases in the study group and 27 cases in the control group. The extubation indication in the study group was 24 hours of drainage fluid volume <20 mL, the control group was 24 hours of drainage fluid volume <10 mL. The differences in operation time, intraoperative blood loss, tumor diameter, number of lymph node dissection, extubation time, postoperative complications, hospitalization cost, postoperative hospitalization time, total hospitalization time, and clinical path completion rate were compared between the two groups. The measurement data of normal distribution were expressed as mean±standard deviation ( Mean± SD), and the t test was used for comparison between groups, the measurement data of non-normal distribution were measured by M ( P25, P75), and the Mann-Whitney U test were used for comparison between groups.Counting data were expressed as percentages(%), and chi-square test was used in comparison between groups. Results:There were no significant difference between the two groups in the operation time, total intraoperative blood loss, tumor diameter, number of lymph node dissections, postoperative complications and hospitalization costs( P>0.05). The extubation time, postoperative hospitalization time, hospitalization time and clinical path completion rate of the study group were 2.9(2.5, 3.5) d、3.0(3.0, 3.5) d、7.0(7.0, 8.5) d and 70.3% (26/37), vespectively. In the control group, they were 4.5(3.8, 5.5) d、5.0(4.0, 6.0) d、11.0(10.0, 13.0) d and 11.1% (3/27), respectively. The difference between the two groups were statistically significant ( P<0.05). Conclusion:After radical resection of papillary thyroid cancer, taking the 24 h drainage volume <20 mL as the timing of extubation does not increase the incidence of postoperative complications, which can significantly shorten the extubation time, postoperative hospitalization time and total hospitalization time and improve clinical path completion rate.

Objective To investigate the effect of enhanced recovery after surgery (ERAS) on the clinical pathway of laparoscopic cholecystectomy in patients with chronic cholecystitis and gallstones.Methods From June 2017 to December 2017,94 patients with chronic cholecystitis and cholecystolithiasis underwent laparoscopic cholecystectomy in the Department of General Surgery of First Hospltal of Huainan City were analyzed retrospectively.All patients were included in clinical pathway management.According to whether the perioperative period was combined with ERAS,there were 45 cases in the study group and 49 cases in the control group.The study group was combined with ERAS during perioperative period,while the control group received traditional perioperative management.The preoperative hospitalization days,operative time,intraoperative bleeding volume,total hospitalization days,postoperative complications,hospitalization costs,postoperative hospitalization days,clinical pathway completion rate and positive and negative variation rates were compared between the two groups.The measurement data were expressed by (Mean ± SD),and the comparisons between groups were performed by t test;Comparisons of count data were analyzed using chi-square test or Fisher exact probability.Results Preoperative hospitalization days,operation time,intraoperative bleeding volume,total hospitalization days and postoperative complications in the study group were (3.3 ± 1.2) d,(63.1 ± 24.3) min,(9.4 ± 3.9) ml,(7.1 ± 1.5) d and 1 case respectively,while those in the control group were (3.2 ± 1.5) d,(68.4 ± 25.4) min,(9.5 ± 2.9) ml,(8.4 ± 1.8) d and 2 cases respectively,and the differences between the two groups ware not statistically significant (P ＞ 0.05).Postoperative hospitalization days,hospitalization expenses and shortened hospitalization days in the study group were (2.9 ± 0.8) d,(9 407.2 ± 500.9) yuan and 64.4％ (29/45) respectively,while those in the control group were (4.5 ± 1.1) d,(10 594.9 ±792.3) yuan and 36.7％ (18/49) respectively.The difference between the two groups was statistically significant (P ＜ 0.05).Conclusion Laparoscopic cholecystectomy for chronic cholecystitis with cholecystolithiasis combined with ERAS during the implementation of clinical pathway can shorten postoperative hospital stay,reduce hospitalization costs,increase the positive variation rate of clinical pathway without increasing postoperative complications.