Objective This study aims to compare the efficacy of video stylets and video laryngoscopes in facilitating nasotracheal intubation during oral surgery.Methods A total of 80 patients,aged between 18 and 70 years old,with ASA grade Ⅰ or Ⅱ,scheduled for elective oral surgery under general anesthesia,were randomly assigned to either the video stylet group(Group N)or the video laryngoscope group(Group C),with 40 patients in each group.In Group N,a video stylet was used to shape the tracheal tube at a 90-degree angle,with the shaping position being the vertical distance from the Adam's apple to the nostril.The tube was inserted from the nasal cavity into the throat under direct visualization,and positioned behind the glottis.In Group C,the tube was initially blindly inserted into the nasal cavity without a core.Upon reaching the throat,a video laryngoscope was employed to lift the epiglottis and expose the glottis from the mouth.The tube was then inserted with the aid of intubation forceps or cuff inflation.The primary outcome measure was the intubation time.Additional measures included the time taken for nasal passage,glottis exposure,and the number of intubation attempts and assistant interventions required.Vital signs,including MAP and HR,were recorded at five minutes of quiet rest upon entering the room(T0),during glottis exposure(T1),upon passage of the tube through the glottis(T2),and one minute after the tube entered the trachea(T3).Complications such as epistaxis,oral mucosal bleeding,loose incisors,and postop-erative sore throat were also documented.Results The intubation time and nasal passage time in Group N were significantly shorter than those in Group C(P<0.05).The number of cuff inflations and intubation forceps assisted cases in Group N was significantly lower than in Group C(P<0.05).There were no significant differences between the two groups in terms of glottis exposure time,first successful intubation times,C-L glottis classification,and mandibular lift-assisted intubation(P>0.05).The increase in MAP and HR in Group N at T1 and T2 was signifi-cantly less than in Group C(P<0.05).The number of cases with mild epistaxis in Group N was significantly lower than in Group C(P<0.05).Similarly,the number of cases with loose incisors and oral mucosal bleeding in Group N was significantly less than in Group C(P<0.05).Conclusion Compared to the video laryngoscope,the video stylet-guided nasotracheal intubation results in a shorter intubation time,less damage to the oronasopharynx,eliminates the need for intubation forceps,and reduces the patient's stress and vascular stress response during intubation.

Objective This study aims to compare the efficacy of video stylets and video laryngoscopes in facilitating nasotracheal intubation during oral surgery.Methods A total of 80 patients,aged between 18 and 70 years old,with ASA grade Ⅰ or Ⅱ,scheduled for elective oral surgery under general anesthesia,were randomly assigned to either the video stylet group(Group N)or the video laryngoscope group(Group C),with 40 patients in each group.In Group N,a video stylet was used to shape the tracheal tube at a 90-degree angle,with the shaping position being the vertical distance from the Adam's apple to the nostril.The tube was inserted from the nasal cavity into the throat under direct visualization,and positioned behind the glottis.In Group C,the tube was initially blindly inserted into the nasal cavity without a core.Upon reaching the throat,a video laryngoscope was employed to lift the epiglottis and expose the glottis from the mouth.The tube was then inserted with the aid of intubation forceps or cuff inflation.The primary outcome measure was the intubation time.Additional measures included the time taken for nasal passage,glottis exposure,and the number of intubation attempts and assistant interventions required.Vital signs,including MAP and HR,were recorded at five minutes of quiet rest upon entering the room(T0),during glottis exposure(T1),upon passage of the tube through the glottis(T2),and one minute after the tube entered the trachea(T3).Complications such as epistaxis,oral mucosal bleeding,loose incisors,and postop-erative sore throat were also documented.Results The intubation time and nasal passage time in Group N were significantly shorter than those in Group C(P<0.05).The number of cuff inflations and intubation forceps assisted cases in Group N was significantly lower than in Group C(P<0.05).There were no significant differences between the two groups in terms of glottis exposure time,first successful intubation times,C-L glottis classification,and mandibular lift-assisted intubation(P>0.05).The increase in MAP and HR in Group N at T1 and T2 was signifi-cantly less than in Group C(P<0.05).The number of cases with mild epistaxis in Group N was significantly lower than in Group C(P<0.05).Similarly,the number of cases with loose incisors and oral mucosal bleeding in Group N was significantly less than in Group C(P<0.05).Conclusion Compared to the video laryngoscope,the video stylet-guided nasotracheal intubation results in a shorter intubation time,less damage to the oronasopharynx,eliminates the need for intubation forceps,and reduces the patient's stress and vascular stress response during intubation.

Objective To evaluate the Nociception Index(NOX)combined with Bispectral Index(BIS)monitoring of anesthesia management during laparoscopic radical resection of colorectal cancer.Methods A total of 80 patients,regardless of gender,aged 50 to 80 years old,and ASA grade Ⅰ or Ⅱ,chose to undergo elective laparoscopic colorectal surgery under total intravenous anesthesia.They were randomly divided into two groups:NOX combined with BIS group(Group N)and BIS alone group(Group C),with 40 cases in each group.Group N maintains an appropriate analgesia depth(NOX value is 30～50)and sedation depth(BIS value is 40～60),and group C maintains an appropriate sedation depth(BIS 40～60)and is covered with opaque cards Hide NOX and adjust the appropriate analgesia depth based on the experience of the anesthesiologist.The main observational indi-cator is the intraoperative remifentanil dosage,and the secondary observational indicators include the intraoperative propofol and cisatracurium dosage,vasoactive drug use,anesthesia recovery and extubation time,postoperative NRS pain score and sufen.The dosage of Titanyl,adverse reactions such as agitation in the postoperative recovery period,postoperative nausea and vomiting,dizziness,and intraoperative awareness.Results The amount of remi-fentanil used during the operation in group N was significantly less than that in group C(P＜0.05).The time of postoperative recovery and extubation in group N was significantly earlier than that in group C(P＜0.05).The number of cases of intraoperative use of vasoactive drugs,the incidence of postoperative agitation during recovery,postoperative nausea and vomiting,and dizziness in group N were significantly lower than those in group C(P＜0.05).There were no significant differences in the amount of propofol and cis-atracurium used during surgery and the incidence of awareness between the two groups(P＞0.05).The NRS scores of patients in group N were signifi-cantly lower than those in group C at 2,4,6,and 24 hours after surgery(P＜0.05),while there was no signifi-cant difference in the NRS scores between the two groups at 48 hours after surgery(P＞0.05).The consumption of sufentanil in group N was significantly lower than that in group C during the first 12 hours and 12 to 24 hours after surgery(P＜0.05).There was no significant difference in the consumption of sufentanil between the two groups during the second 24 to 48 hours after surgery(P＞0.05).Conclusion Compared with BIS monitoring alone,the use of NOX combined with BIS monitoring can maintain relatively stable intraoperative hemodynamics,reduce the amount of general anesthesia drugs,accelerate postoperative anesthesia recovery,improve the quality of anesthesia recovery,and reduce acute postoperative pain,which is beneficial to patients postoperative recovery.

Objective To evaluate the Nociception Index(NOX)combined with Bispectral Index(BIS)monitoring of anesthesia management during laparoscopic radical resection of colorectal cancer.Methods A total of 80 patients,regardless of gender,aged 50 to 80 years old,and ASA grade Ⅰ or Ⅱ,chose to undergo elective laparoscopic colorectal surgery under total intravenous anesthesia.They were randomly divided into two groups:NOX combined with BIS group(Group N)and BIS alone group(Group C),with 40 cases in each group.Group N maintains an appropriate analgesia depth(NOX value is 30～50)and sedation depth(BIS value is 40～60),and group C maintains an appropriate sedation depth(BIS 40～60)and is covered with opaque cards Hide NOX and adjust the appropriate analgesia depth based on the experience of the anesthesiologist.The main observational indi-cator is the intraoperative remifentanil dosage,and the secondary observational indicators include the intraoperative propofol and cisatracurium dosage,vasoactive drug use,anesthesia recovery and extubation time,postoperative NRS pain score and sufen.The dosage of Titanyl,adverse reactions such as agitation in the postoperative recovery period,postoperative nausea and vomiting,dizziness,and intraoperative awareness.Results The amount of remi-fentanil used during the operation in group N was significantly less than that in group C(P＜0.05).The time of postoperative recovery and extubation in group N was significantly earlier than that in group C(P＜0.05).The number of cases of intraoperative use of vasoactive drugs,the incidence of postoperative agitation during recovery,postoperative nausea and vomiting,and dizziness in group N were significantly lower than those in group C(P＜0.05).There were no significant differences in the amount of propofol and cis-atracurium used during surgery and the incidence of awareness between the two groups(P＞0.05).The NRS scores of patients in group N were signifi-cantly lower than those in group C at 2,4,6,and 24 hours after surgery(P＜0.05),while there was no signifi-cant difference in the NRS scores between the two groups at 48 hours after surgery(P＞0.05).The consumption of sufentanil in group N was significantly lower than that in group C during the first 12 hours and 12 to 24 hours after surgery(P＜0.05).There was no significant difference in the consumption of sufentanil between the two groups during the second 24 to 48 hours after surgery(P＞0.05).Conclusion Compared with BIS monitoring alone,the use of NOX combined with BIS monitoring can maintain relatively stable intraoperative hemodynamics,reduce the amount of general anesthesia drugs,accelerate postoperative anesthesia recovery,improve the quality of anesthesia recovery,and reduce acute postoperative pain,which is beneficial to patients postoperative recovery.

Objective:To investigate the effects of biologics on psychological status and quality of life in patients with inflammatory bowel disease (IBD).Methods:A cross-sectional survey was conducted in 42 hospitals in 22 provinces (autonomous regions and municipalities directly under the central government) from September 2021 to May 2022. General clinical information and the use of biologics were obtained from adult patients diagnosed with IBD who voluntarily participated in the study. Psychological status was evaluated using the Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Pittsburgh Sleep Quality Index (PSQI), and Inflammatory Bowel Disease Questionnaire (IBDQ) assessment tools. Counts were analyzed via the Chi-square test, and datasets that were not normally distributed were analyzed via nonparametric tests. P<0.05 was considered statistically significant. Results:A total of 2 478 valid questionnaires were collected. The GAD-7 score of the biologics group was significantly lower than that of the non-use group [6 (2, 9) vs. 7 (3, 10), Z=-3.49, P<0.001]. IBDQ scores [183 (158, 204) vs. 178 (152, 198), Z=-4.11, P<0.001], intestinal symptom scores [61 (52, 67) vs. 58 (49, 65), Z=-5.41, P<0.001], systemic symptom scores [28 (24, 32) vs. 27 (23, 31), Z=-2.37, P=0.018], emotional ability scores [69 (58, 77) vs. 67 (56, 75), Z=-3.58, P<0.001] and social ability scores [26 (22, 29) vs. 25 (22, 29), Z=-2.52, P=0.012] in the biologics group were significantly higher than in the non-use group. GAD-7 scores [5 (2, 9) vs. 6 (3, 10), Z=-3.50, P<0.001] and PSQI scores [6 (4, 9) vs. 6 (4, 9), Z=-2.55, P=0.011] were significantly lower in the group using infliximab than in the group not using it. IBDQ scores were significantly higher in patients using vedolizumab than in those not using it [186 (159, 205) vs. 181 (155, 201), Z=-2.32, P=0.021] and were also significantly higher in the group treated with adalimumab than in the group not treated with adalimumab [187 (159, 209) vs. 181 (155, 201), Z=-2.16, P=0.030]. However, ustekinumab had no significant effect on any of the scores. Conclusion:The use of biologics is strongly associated with improvements in anxiety status and quality of life in IBD patients.

Thoracic endovascular aortic repair has served as the predominant treatment approach for patients with thoracic aortic diseases. In order to ensure the successful release of the stent as well as a good proximal anchoring effect, it is necessary to preserve or reconstruct the left subclavian supply as much as possible. With the advance of various endovascular assistive technologies, different left subclavian artery revascularization techniques have gained widespread acceptance. So far, techniques include carotid-subclavian bypass or transposition, chimney grafts, fenestrations, branched aortic devices can reconstruct the left subclavian artery and other branch vessels on the arch. This article reviewed the present situation of left subclavian artery reconstruction and the selection of surgical methods of thoracic endovascular aortic repair.

Inflammatory bowel diseases (IBD) is a chronic recurrent gastrointestinal inflammatory disease. As the important nano-level regulatory factors in physiological and pathological processes, exosomes have been confirmed to participate in the development, progression and intestinal tissue repair of IBD, and have potential clinical application prospects in the diagnosis and treatment of IBD. This article summarizes the regulatory effects of exosomes in the pathogenesis of IBD, and elucidate the research advances of exosomes in the diagnosis and treatment of IBD.

Inflammatory bowel diseases (IBD) is a chronic recurrent gastrointestinal inflammatory disease. As the important nano-level regulatory factors in physiological and pathological processes, exosomes have been confirmed to participate in the development, progression and intestinal tissue repair of IBD, and have potential clinical application prospects in the diagnosis and treatment of IBD. This article summarizes the regulatory effects of exosomes in the pathogenesis of IBD, and elucidate the research advances of exosomes in the diagnosis and treatment of IBD.

Objective:To investigate the short-term effects of staged hybrid abdominal aortic debranching technique in the treatment of thoracoabdominal aorta.Methods:From January 2018 to December 2018, 22 patients with thoracoabdominal aortic aneurysms underwent surgical treatment in Nanjing Drum Tower Hospital. Among them, 12 underwent staged hybrid abdominal aortic debranching (AAD), and 10 underwent traditional thoracoabdominal aortic replacement (TAR). AAD consisted of two phases: the first phase of surgery was mid-opening, Y-type artificial blood vessels replaced the lower abdominal aorta and bilateral common iliac arteries, and the abdominal aortic branches were reconstructed at the same time: right branch artificial blood vessels-right renal artery-left renal artery, the left branch artificial blood vessel-superior mesenteric artery-common hepatic artery; the second phase was endovascular repair anchoring normal and long-term normal aorta or artificial blood vessel. The clinical effected of two methods for the treatment of thoracoabdominal aortic aneurysms were compared and analyzed.Results:The overall mortality rate was 13.6%, and the mortality rate in the TAR group increased significantly (0 vs. 30%). The main cause was dissection (91.7% vs. 90.0%, P=0.895). Crawford classification was predominantly type Ⅱ in both groups(58.3% vs. 50.0%, P=0.082). The proportion of patients with Marfan syndrome in the TAR group was higher (30% vs. 0, P=0.046). The TAR group was significantly more drained 24 h after surgery [(355.0±199.2)ml vs. (1244.0±716.1)ml, P= 0.003]. The TAR group had a higher proportion of lung infections (40% vs. 0, P= 0.018). The average cost was higher in the AAD group [(28.4±8.3) ten thousands yuan vs. (19.3±10.4) ten thousands yuan, P= 0.033]. Conclusion:The staged hybrid abdominal aortic debranching technique can effectively treat thoracoabdominal aortic aneurysms. Compared with traditional thoracoabdominal aortic replacement, the surgical trauma is smaller but more expensive.

Objective:To investigate the value of diffusion tensor imaging (DTI) in evaluating the cognitive function of patients with leukoaraiosis (LA).Methods:A prospective study was chosen. Sixty patients with LA admitted to our hospital from July 2019 to May 2021 were selected. All patients accepted brain MRI. According to Fazekas visual grading standards, these 60 LA patients were divided into mild LA group, moderate LA group, and severe LA group ( n=20). Mini-mental state examination (MMSE) was used to evaluate the cognitive function of these patients. Diffusion tensor imaging was used to analyze the fractional anisotropy (FA) values of 6 regions of interest, namely the frontal lobe, temporal lobe, occipital lobe, parietal lobe, anterior horn of lateral ventricle, and corpus callosum. The differences of general data, cognitive function and FA values among the 3 groups were compared. The cognitive functions were assessed based on FA values (FA scores), and compared with those evaluated by MMSE (clinical scores). Results:(1) Age and homocysteine (Hcy) level of patients in mild, moderate and severe LA groups were increased successively, with statistical differences ( P<0.05). As compared with that in the mild and moderate LA groups, the educational level of patients in the severe LA group was significantly lower ( P<0.05). (2) Memory scores of patients in mild LA group, moderate LA group and severe LA group decreased successively, with statistical differences ( P<0.05). As compared with mild LA group and moderate LA group, MMSE total scores and recall scores in severe LA group were statistically decreased ( P<0.05). (3) FA values of parietal lobe and corpus callosum were successively decreased in mild, moderate and severe LA groups, with significant differences ( P<0.05). As compared with those in the mild and moderate LA groups, the FA values of frontal lobe, temporal lobe, occipital lobe and anterior horn of lateral ventricle in severe LA group were significant decreased, ( P<0.05). (4) There were no significant differences in FA scores and clinical scores of cognitive function scores in mild LA group ( P>0.05), except for attention and counting scores. There were no significant differences in FA scores and clinical scores of cognitive function scores in moderate LA group ( P>0.05), except for language function scores and tMMSE otal scores. Except for scores of location orientation, attention and counting, FA scores and clinical scores of all cognitive function scores in the severe LA group were significantly different ( P<0.05). Conclusions:The LA severity is related to the patient's age, Hcy level, education level, and cognitive function. In patients with mild LA, the cognitive function can be assessed according to FA values in addition to attention and counting ability; in patients with moderate LA, cognitive function can be assessed according to FA values in addition to language function; the cognitive function of patients with severe LA cannot be assessed according to FA values.