Objective:To explore a simple emergency management method for elderly patients with sigmoid volvulus.Methods:The clinical data of 22 elderly patients (>70 years) with sigmoid volvulus from January 2020 to March 2024 in the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. All patients were treated with a self-made simple closed-loop enema decompression kit. The abdominal circumference, white blood cell count and C-reactive protein (CRP) before treatment and 12 h after tube placement were measured. The patients were followed for 3 months, and the recurrence was recorded. The key indexes on recurrence, including age, American Society of Anesthesiologists (ASA) classification and procedure time, were compared. Pearson correlation analysis was used to examine the relationship between age, procedure time, pain level and gas/stool output within 30 min after tube placement.Results:All 22 patients successfully underwent transanal tube decompression. The procedure time ranged from 1 to 15 min. The gas and stool output within 30 min after tube placement was 600 to 2 100 ml, The rectal tube was retained for 2 to 6 d. Compared with before treatment, the abdominal circumference, white blood cell count and CRP 12 h after tube placement were significantly lower: (85.9 ± 9.6) cm vs. (94.5 ± 10.2) cm, (9.2 ± 2.1) ×10 9/L vs. (11.4 ± 2.5) ×10 9/L and (27.8 ± 22.6) mg/L vs. (46.2 ± 38.9) mg/L, and there were statistical differences ( P<0.01). Four patients underwent elective surgery, while 18 were discharged smoothly after tube removal. No death occurred within 1 month after treatment. Five patients experienced recurrence 3 months after treatment, all were successfully retreated using the same method and discharged. There were no statistical differences in recurrence rates between aged ≥80 years and aged < 80 years patients, ASA class ≥ Ⅳ and ASA class Ⅲ patients, or procedure times ≤5 min and procedure times >5 min patients ( P>0.05). The gas/stool output within 30 min after tube placement was positively correlated with pain level (moderate/severe vs. mild) before tube placement ( r = 215.50, P = 0.015), but showed no significant correlation with age or procedure time ( P>0.05). Conclusions:The self-made simple closed-loop enema decompression kit provides a straightforward, economical and minimally invasive emergency treatment method for elderly patients with sigmoid volvulus. For patients at very high surgical risk, this kit can achieve decompression and volvulus reposition, even in cases of recurrence.

Objective:To investigate the clinical value of right-sided overlap and single-flap valvuloplasty (ROSF) in Da Vinci robotic proximal gastrectomy.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 12 patients who underwent ROSF in Da Vinci robotic proximal gastrectomy at The Affiliated Hospital of Xuzhou Medical University from September 2023 to May 2024 were collected. There were 7 males and 5 females, aged 62(range, 35?75)years. Observation indicators: (1) surgical conditions; (2) postoperative pathological results; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and mea-surement data with skewed distribution were represented as M(range). Count data were expressed as absolute numbers. Results:(1) Surgical conditions. All patients successfully completed the surgery, without conversion to laparotomy. The operation time of 12 patients was (236±24)minutes. The time of single-layer fabrication and anastomosis was (105±28)minutes. The volume of intra-operative blood loss was (36±19)mL. Time to postoperative first fluid food intake was (3.5±1.1)days. The amylase levels in the abdominal drainage fluid on postoperative days 1, 2, and 3 were (321±121)U/L, (225±97)U/L, and (85±22)U/L, respectively. Time to postoperative drainage tube removal was (5.3±1.5)days. Duration of postoperative hospital stay was (7.6±1.1)days. All 12 patients had no anasto-motic related complications such as anastomotic leakage, anastomotic bleeding, anastomotic stenosis, and had no functional complications such as gastric emptying disorders or gastroesophageal reflux after surgery. (2) Postoperative pathological results. The distance of the proximal tumor margin of the 12 patients was (1.8±1.1)cm. The distance of distal margin was (5.7±2.1)cm. Number of lymph node dissected was 31.0(range, 22.0?45.0). Number of positive lymph node dissected was 3.4±2.4. Number of lymph node dissected from the pancreatic superior margin was 14.7±4.3. Results of postoperative pathological examination in the 12 patients showed 8 cases of Ⅰ stage, 3 cases of Ⅱ stage, 1 case of Ⅲ stage of the TNM staging. (3) Follow-up. All 12 patients were followed up for 6 (range, 3?24)months. During the follow-up period, all 12 patients had no local tumor recurrence or distant metastasis. All 12 patients had no complications such as anastomotic leakage, anastomotic bleeding, or anastomotic stenosis, and did not experience symptoms of gastroesophageal reflux such as heartburn or vomiting.Conclusion:The ROSF in Da Vinic robotic proximal gastrectomy is safe and feasible.

Objective:To explore a simple emergency management method for elderly patients with sigmoid volvulus.Methods:The clinical data of 22 elderly patients (>70 years) with sigmoid volvulus from January 2020 to March 2024 in the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. All patients were treated with a self-made simple closed-loop enema decompression kit. The abdominal circumference, white blood cell count and C-reactive protein (CRP) before treatment and 12 h after tube placement were measured. The patients were followed for 3 months, and the recurrence was recorded. The key indexes on recurrence, including age, American Society of Anesthesiologists (ASA) classification and procedure time, were compared. Pearson correlation analysis was used to examine the relationship between age, procedure time, pain level and gas/stool output within 30 min after tube placement.Results:All 22 patients successfully underwent transanal tube decompression. The procedure time ranged from 1 to 15 min. The gas and stool output within 30 min after tube placement was 600 to 2 100 ml, The rectal tube was retained for 2 to 6 d. Compared with before treatment, the abdominal circumference, white blood cell count and CRP 12 h after tube placement were significantly lower: (85.9 ± 9.6) cm vs. (94.5 ± 10.2) cm, (9.2 ± 2.1) ×10 9/L vs. (11.4 ± 2.5) ×10 9/L and (27.8 ± 22.6) mg/L vs. (46.2 ± 38.9) mg/L, and there were statistical differences ( P<0.01). Four patients underwent elective surgery, while 18 were discharged smoothly after tube removal. No death occurred within 1 month after treatment. Five patients experienced recurrence 3 months after treatment, all were successfully retreated using the same method and discharged. There were no statistical differences in recurrence rates between aged ≥80 years and aged < 80 years patients, ASA class ≥ Ⅳ and ASA class Ⅲ patients, or procedure times ≤5 min and procedure times >5 min patients ( P>0.05). The gas/stool output within 30 min after tube placement was positively correlated with pain level (moderate/severe vs. mild) before tube placement ( r = 215.50, P = 0.015), but showed no significant correlation with age or procedure time ( P>0.05). Conclusions:The self-made simple closed-loop enema decompression kit provides a straightforward, economical and minimally invasive emergency treatment method for elderly patients with sigmoid volvulus. For patients at very high surgical risk, this kit can achieve decompression and volvulus reposition, even in cases of recurrence.

Objective:To investigate the clinical value of right-sided overlap and single-flap valvuloplasty (ROSF) in Da Vinci robotic proximal gastrectomy.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 12 patients who underwent ROSF in Da Vinci robotic proximal gastrectomy at The Affiliated Hospital of Xuzhou Medical University from September 2023 to May 2024 were collected. There were 7 males and 5 females, aged 62(range, 35?75)years. Observation indicators: (1) surgical conditions; (2) postoperative pathological results; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and mea-surement data with skewed distribution were represented as M(range). Count data were expressed as absolute numbers. Results:(1) Surgical conditions. All patients successfully completed the surgery, without conversion to laparotomy. The operation time of 12 patients was (236±24)minutes. The time of single-layer fabrication and anastomosis was (105±28)minutes. The volume of intra-operative blood loss was (36±19)mL. Time to postoperative first fluid food intake was (3.5±1.1)days. The amylase levels in the abdominal drainage fluid on postoperative days 1, 2, and 3 were (321±121)U/L, (225±97)U/L, and (85±22)U/L, respectively. Time to postoperative drainage tube removal was (5.3±1.5)days. Duration of postoperative hospital stay was (7.6±1.1)days. All 12 patients had no anasto-motic related complications such as anastomotic leakage, anastomotic bleeding, anastomotic stenosis, and had no functional complications such as gastric emptying disorders or gastroesophageal reflux after surgery. (2) Postoperative pathological results. The distance of the proximal tumor margin of the 12 patients was (1.8±1.1)cm. The distance of distal margin was (5.7±2.1)cm. Number of lymph node dissected was 31.0(range, 22.0?45.0). Number of positive lymph node dissected was 3.4±2.4. Number of lymph node dissected from the pancreatic superior margin was 14.7±4.3. Results of postoperative pathological examination in the 12 patients showed 8 cases of Ⅰ stage, 3 cases of Ⅱ stage, 1 case of Ⅲ stage of the TNM staging. (3) Follow-up. All 12 patients were followed up for 6 (range, 3?24)months. During the follow-up period, all 12 patients had no local tumor recurrence or distant metastasis. All 12 patients had no complications such as anastomotic leakage, anastomotic bleeding, or anastomotic stenosis, and did not experience symptoms of gastroesophageal reflux such as heartburn or vomiting.Conclusion:The ROSF in Da Vinic robotic proximal gastrectomy is safe and feasible.

Objective:To analyze the blood differential metabolites of patients with intrahepatic cholestasis (IHC) by liquid chromatography-mass spectrometry metabolomics technology so as to find potential metabolic target.Method:Serum samples were collected from thirty patients with intrahepatic cholestasis and thirty healthy individuals after metabolomics analysis. The differential metabolites were initially screened based on the multiple differences and significance. KEGG enrichment analysis was performed on the differential metabolites to determine the candidate targets. The potential clinical application value of these characteristic metabolites was analyzed using the receiver operating characteristic curve.Result:A total of thirty patients with intrahepatic cholestasis and thirty healthy adults were included. The age difference between the two groups was not statistically significant ( P>0.05). The clinical condition was consistent with the statistically significant differences in liver biochemical indicators, blood routine, coagulation, and inflammatory indicators between the two groups ( P<0.05). Furthermore, a blood metabolomics screening analysis revealed 99 differentially expressed metabolites associated with intrahepatic cholestasis. Of these, 15 showed statistically significant differences. Glucose, lipid, and energy metabolisms were the various primary types of differential metabolites involved. The receiver operating characteristic curve>0.9 included the following twelve kinds of metabolites: 1H-indole-3-carboxaldehyde, 6-hydroxy-1H-indole-3-acetamide, phenylalanyl tryptophan, 1-methylguanosine, 2-ethoxy-5-methylpyrazine, p-hydroxybenzaldehyde, 5-(2-chlorophenyl)-3,4-dihydro-2H-pyrrole, methylthioadenosine, alanylisoleucine, anabsinthin, N-acetyl-DL-histidine monohydrate, N-methylnicotinamide, and others. The fifteen metabolites that were previously identified and calculated according to the differential quantitative value of the metabolite corresponding ratio exhibited fold-changes in the upregulated and downregulated potential biomarkers (phenylalanine tryptophan, phenylalanine, 5'-methylthioadenosine, anabsinthin, and N-methylnicotinamide) in combination with the area under the receiver operating characteristic curve>0.9. Conclusion:Phenylalanyl tryptophan, phenylalanylalanine, 5'-methylthioadenosine, anabsinthin, and N-methylnicotinamide may serve as potential metabolic markers to distinguish patients with cholestasis from healthy controls. N-methylnicotinamide, among them, is of great importance as a potential marker.

Objective:Clinical characteristics and diagnosis and treatment process was reported and analyzed of a patient with brucellosis complicated with thyroid abscess, providing reference for the clinical diagnosis of brucellosis complicated with thyroid abscess.Methods:Clinical medical records of a patient with brucellosis complicated with thyroid abscess who was treated at the General Surgery Department of Yanchi County People's Hospital in Wuzhong City, Ningxia Hui Autonomous Region in November 2021 were collected. The clinical manifestations, blood routine, brucella antibodies, thyroid function, bacterial culture, thyroid ultrasound and other examination results, as well as the diagnosis and treatment process, were comprehensively analyzed. Results:The patient was a male, 61 years old, who presented with a neck mass without typical clinical manifestations of brucellosis. Thyroid ultrasound revealed a space occupying lesion, and the preliminary diagnosis was thyroid cystadenoma. Thyroid right lobe and isthmus resection surgery was performed. During the operation, it was found that some of the thyroid glands were tightly adhered to the cervical blood vessels, so the resection surgery was changed to abscess drainage, and the drainage fluid was purulent and bloody. The bacterial culture result of thyroid purulent fluid (intraoperative puncture fluid and postoperative drainage fluid) was brucella lamblia, and the serum brucella test tube agglutination test titer was 1 ∶ 400 (+++). The patient improved and was discharged after local drainage and anti brucella treatment. Follow up for 4 months showed no abnormalities. Conclusions:Brucellosis which begins with a local infection of the thyroid gland is extremely rare, with no characteristic clinical manifestations, and is prone to misdiagnosis. Timely correction of the surgical plan during the treatment process avoids the removal of the patient's thyroid, which has a certain clinical reference value.

Objective:To explore the influencing factors and the impact of artificial liver treatment on the prognosis and survival of patients with acute-on-chronic liver failure (ACLF).Methods:Clinical data from 201 cases with ACLF from January 2016 to December 2019 was retrospectively analyzed. The survival rate was calculated by the Kaplan-Meier method, the log-rank test of univariate analysis, and the multivariate analysis of the stepwise Cox regression forward method.Results:The median survival time of patients was 6 months, and the survival rates at 6, 9, and 12 months were 51.2%, 38.3%, and 29.9%, respectively. In univariate analysis, age, presence or absence of hypertension and upper gastrointestinal bleeding, treatment method, model for end-stage liver disease (MELD) score, and cholinesterase were associated with prognosis ( P < 0.05). Multivariate regression analysis results showed that MELD score was the main factor affecting the 1-year prognosis of ACLF patients ( P = 0.002). Artificial liver treatment was beneficial for the 1-year prognosis of ACLF patients aged < 50 years or with a MELD score of ≥20 ( P < 0.05 ). The relative risk ratio (RR) of mortality was 2.55 times higher in patients with advanced age (≥50 years old) than that of younger patients ( P < 0.001). Regression analysis was performed using age as a stratification factor, and upper gastrointestinal bleeding was related to the prognosis of younger patients, while choline esterase was related to the prognosis of advanced age. Regression analysis after stratified MELD score showed that age and hypertension were related to the prognosis of patients with MELD score < 20, and treatment method and age were related to the prognosis of patients with MELD score≥20. Conclusion:Artificial liver treatment is beneficial for the 1-year prognosis of ACLF patients. Age, MELD score, hypertension, and upper gastrointestinal bleeding are independent risk factors affecting the prognosis of ACLF patients.

Objective:To study the remote multi-disciplinary team (MDT) model in diagnosis and treatment of plague, in order to provide scientific basis for clinical treatment of plague.Methods:A retrospective analysis was made on the diagnosis and treatment process of a case of bubonic plague, a sudden imported Class A infectious disease, which was secondary to septicemic plague, involving a remote MDT team consisting of the Infectious Diseases Department, Intensive Care Unit, Respiratory and Critical Care Department, Cardiology Department, Pharmacy Department, and Nosocomial Infection Department of the General Hospital of Ningxia Medical University.Results:The patient was a middle-aged female who was engaged in herding work on the grassland. The first symptom was a sudden pain in the left lower abdomen for three days, accompanied by chest tightness and shortness of breath. After hospitalization, blood culture indicated Yersinia, abdominal CT indicated left lower abdominal lymph node enlargement, and lymph node puncture fluid was positive for Yersinia pestis nucleic acid. Combined with clinical symptoms and signs, the patient was diagnosed as bubonic plague secondary to septicemic plague, and was isolated for treatment. After remote MDT consultation, comprehensive treatment was given, including anti-infection treatment of streptomycin and ciprofloxacin, short-term application of hormones, nutritional support, and local application of chloramphenicol ointment, etc. Secondary acute pancreatitis occurred during the course of the disease, which improved after symptomatic treatment. Finally, after 20 days of treatment, MDT expert group assessed that it met the discharge criteria. No abnormalities were found in follow-up visits outside the hospital. Conclusion:The remote MDT is effective in the treatment of bubonic plague secondary to septicemic plague, which is worth popularizing.

Objective:To compare the clinical efficacy and safety of conventional transcatheter arterial chemoembolization (TACE) with drug-eluting bead transcatheter arterial chemoembolization (DEB-TACE) in treatment of patients with unresectable hepatocellular carcinoma.Methods:The data of patients with unresectable hepatocellular carcinoma who underwent hepatic artery chemoembolization at General Hospital of Ningxia Medical University from July 2019 to April 2020 were retrospectively analyzed. Of 282 patients who were enrolled, there were 233 males and 49 females, aged (55.9±10.0) years. The groups were divided into the conventional TACE group ( n=179) and the DEB-TACE group ( n=103) based on the treatments. The efficacy of the two groups was compared according to the modified response evaluation criteria in solid tumors. Postoperative adverse effects and liver function between the two groups were compared. Results:The differences in comparing the preoperative and postoperative liver function indexes between the two groups were not statistically significant. Patients who died and were lost to follow-up at 6 months after surgery were excluded and 240 patients were excluded in the efficacy analysis, with 148 patients in the conventional TACE group and 92 patients in the DEB-TACE group. At 6 months after treatment in the conventional TACE group, there were 64 patients (43.2%) with complete remission, 18 patients (12.2%) with partial remission, 27 patients (18.2%) with stable disease, and 39 patients (26.4%) with disease progression. In the DEB-TACE group, the corresponding figures were 38 patients (41.3%), 17 patients (18.5%), 26 patients (28.3%), and 11 patients (12.0%), respectively. The efficacy of DEB-TACE was better than conventional TACE with statistically significant differences between the 2 groups (χ 2=8.96, P=0.030). The incidence of postoperative embolic syndrome was 53.1% (95/179) in the conventional TACE group, which was significantly higher than the 34.0% (35/103) in the DEB-TACE group (χ 2=7.34, P=0.007). Conclusion:The efficacy and safety of DEB-TACE for unresectable hepatocellular carcinoma were superior to those of the conventional TACE group.

Objective:To analyze the clinical phenotype of adult patients with epidemic encephalitis B (encephalitis B) in Ningxia Hui Autonomous Region, and to explore the influence of related factors of the development of encephalitis B.Methods:The medical records of confirmed patients with encephalitis B admitted to the General Hospital of Ningxia Medical University from August to November 2018 were collected, and the general data of patients and the results of laboratory indexes such as blood routine examination and cerebrospinal fluid routine examination were analyzed. Logistic regression analysis and survival curve were used to evaluate the risk factors of the development of encephalitis B.Results:Totally 97 patients with encephalitis B were included, 32 of them died, with a case fatality rate of 32.99%. There were 63 males and 34 females, and the age of onset was (59.13 ± 14.70) years old. There were statistically significant differences in case distribution rate between different sexes and ages (χ 2 = 97.00, 291.00, P < 0.001). The most common clinical type was extremely severe (43 cases), followed by mild (27 cases), severe (15 cases) and ordinary (12 cases). The results of laboratory tests showed that the number of neutrophils, lymphocytes and monocytes in the blood of patients increased; and the white blood cells number in cerebrospinal fluid increased significantly, while neutrophils ratio increased slightly. There were significant differences in cerebrospinal fluid glucose level and neutrophil ratio among patients with different clinical types of encephalitis B ( H = 4.21, 2.74, P < 0.05). There were statistically significant differences in death, hypertension, cerebrovascular diseases, and pulmonary infection among patients with different clinical types of encephalitis B (χ 2 = 34.22, 16.97, 9.91, 15.59, P < 0.05). Logistic regression analysis showed that hypertension [ OR (95% CI) = 5.544 (1.450-21.191)] and pulmonary infection [ OR (95% CI) = 6.490 (1.887-22.325)] were risk factors for the development of encephalitis B patients ( P = 0.012, 0.003). Pulmonary infection was the influencing factor for the death of encephalitis B patients (χ 2 = 18.88, P < 0.001). The survival curve showed that the survival status of encephalitis B patients with cerebrovascular disease and pulmonary infection was significantly worse than that of patients without comorbidity or complications (χ 2 = 6.45, 20.33 , P < 0.05). Conclusions:The majority of encephalitis B patients in this outbreak are the elderly people, and the patient's nervous system has inflammatory reaction. Complicated pulmonary infection is an important factor for the aggravation and death of encephalitis B patients.