Gastric cancer(GC)is one of the most common and high mortality tumors in the world,and the clinical staging during diagnosis is closely related to the prognosis of patients.Therefore,finding sensitive diagnostic biomarkers to improve the early diagnosis rate has become an urgent issue.Exosomes are nanoscale extracellular vesicles secreted by various cells,which play an important role in cellular communication by transporting bioactive substances in tumor microenvironment(TME).CircRNA is a type of non-coding RNA with a specific structure.Because it is difficulty in degradation,it can be enriched in extracellular vesicles and participate in various pathophysiological processes mediated by it.Exo-circRNA can affect the proliferation,invasion,drug resistance and tissue metastasis of tumor cells,and has more significant diagnostic specificity than conventional diagnostic biomarkers in clinical practice.It may become a supplement to biomarker for the diagnosis and prognosis of GC.This article briefly introduces the characteristics,formation mechanism and role of extracellular vesicles and circRNA in GC.It discusses in detail the role of exo-circRNA in the occurrence and development of GC,and discusses their potential clinical application value and challenges in GC.

Objective:To establish a risk assessment system focusing on surgical and anesthesian-related indicators for the incidence of complications and mortality of hip fracture surgery in senile patients, and to evaluate its prediction accuracy, sensitivity and specificity.Methods:From January 2020 to February 2021, a total of 1 086 elderly patients (493 males and 593 females) aged 76±5 years (ranging from 60 to 94 years) underwent hip fracture surgery in Tianjin Hospital were collected. A total of 543 patients were randomly selected for the establishment of the hip fracture scoring system in senile patients, including 253 males and 290 females, aged 75±6 years (ranging from 60 to 92 years). With the preoperative physiological factor score and surgical risk factor score as independent variables and the occurrence of complications and death as dependent variables, binary logistic regression analysis was performed to establish a surgical risk scoring system for hip fracture in senile patients. The remaining 543 patients, including 240 males and 303 females, aged 74±7 years (range 60-94 years), their data were used to compare AUC, sensitivity, specificity, and compliance of the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), Daping orthopedics operative risk scoring system for senile patient (DORSSSP), and our surgical risk scoring system for hip fracture in senile patients through receiver operating characteristic (ROC) curves, and to compare the predictive value of these systems for complication incidence and mortality.Results:The predictive model equation of the elderly hip fracture scoring system is: ln R1/ (1- R1) =-7.13+0.112× PS+0.148× OS; ln R2/ (1- R2) =-6.14+0.124× PS+0.136× OS; [ R1 is the incidence of complications, R2 is the mortality, PS (physiology score) is the score of preoperative physiological factors, and OS (operation score) is the score of surgical risk factors]. Among the 543 patients whose data were used to compared with the hip fracture scoring system, POSSUM and DORSSSP, 72 actually developed complications and 36 died. The complication rate predicted by surgical risk scoring system for hip fracture in senile patients was 12.05%±6.34% (range 6.18%-61.29%), and 64 cases were predicted to have complications. The predicted mortality was 6.05%±3.26% (range 2.45%-58.36%), and 29 cases were predicted to die. The complication rate predicted by POSSUM was 25.36%±13.95% (range 9.16%-76.34%), and 126 cases were predicted to have complications. The predicted mortality rate was 10.46%±5.31% (range 6.23%-59.34%), and 54 deaths were predicted. The predicted complication rate of DORSSSP was 19.34%±9.67% (range 8.36%-70.85%), and 99 cases were predicted to have complications. The predicted mortality was 10.12%±5.16% (range 7.35%-57.54%), and 52 deaths were predicted. In predicting the incidence of complications, the AUC of surgical risk scoring system for hip fracture in senile patients, POSSUM and DORSSSP were 0.95, 0.82 and 0.75, the sensitivity was 0.89, 0.83 and 0.85, the specificity was 0.80, 0.86 and 0.92, and the compliance rate was 0.94, 0.93 and 0.94, respectively. In the prediction of mortality, the AUC of surgical risk scoring system for hip fracture in senile patients, POSSUM and DORSSSP were 0.87, 0.67 and 0.71, the sensitivity was 0.85, 0.69 and 0.75, the specificity was 0.73, 0.94, 0.95, and the compliance rate was 0.94, 0.93 and 0.94, respectively. Conclusion:Compared with POSSUM and DORSSSP, hip fracture scoring system in elderly patients has improved its ability to predict surgical risk, and can accurately predict the incidence of complications and mortality in elderly patients undergoing hip surgery.

Objective:To explore the effects of pressure controlled ventilation-volume guaranteed (PCV-VG) mode on intraoperative pulmonary ventilation and postoperative pulmonary complications (PPC) in elderly patients undergoing thoracoscopic lobectomy.Methods:Sixty patients of American Society of Anesthesiologists (ASA) classification Ⅱor Ⅲ, aged 65-80 years old, with body mass index (BMI) 18-30 kg/m 2, received thoracoscopic lobectomy under general anesthesia from November 2021 to June 2022 in the Second Hospital of Shanxi Medical University were recruited. The patients were divided into PCV-VG and volume-controlled ventilation (VCV) groups using the randomized number table method, with 30 patients in each group. The ventilatory parameters of two-lung ventilation were set to respiratory rate (RR) at 10-12 breaths/min, with a tidal volume (VT) of 8 ml/kg (ideal body weight). The ventilatory parameters of one-lung ventilation (OLV) were set at 12-16 breaths/min, with a VT of 6 ml/kg (IBW). The peak airway pressure (Ppeak), plateau airway pressure (Pplat), driving pressure (ΔP), dynamic lung compliance (Cdyn), end-tidal carbon dioxide (ETCO 2), heart rate (HR), mean arterial pressure (MAP), partial pressure of oxygen (PaO 2) and partial pressure of carbon dioxide (PaCO 2) were obtained at 1 min before OLV (T 0), 30 min after OLV (T 1) and 60 min after OLV (T 2). The incidence and severity of PPC, chest tube duration time and postoperative hospital stay time were recorded. Results:The Ppeak, Pplat and ΔP were higher and Cdyn was lower in both groups at T 1-T 2 than at T 0 (all P<0.001). The Ppeak, Pplat and ΔP were higher and Cdyn was lower in PCV-VG group than in VCV group (all P<0.05). There were no statistical differences in HR, MAP, ETCO 2, PaO 2 and PaCO 2 between the two groups (all P > 0.05). There were no statistical differences in the incidence of PPC [43.3% (13/30) vs. 30.0% (9/30)] and chest tube duration time [(4.4±0.9) d vs. (4.2±1.2) d] between VCV group and PCV-VG group (all P>0.05). Compared with VCV group, the proportion of patients with ≥grade 2 PPC was lower in PCV-VG group [10.0% (3/30) vs. 36.7% (11/30), χ2=5.96, P<0.05]. The postoperative hospital stay time in PCV-VG group was shorter than that in VCV group [(6.4±1.3) d vs. (8.0±1.9) d, t = 4.85, P<0.05]. Conclusions:PCV-VG mode can effectively reduce the severity of PPC, shorten the postoperative hospital stay time and improve the prognosis in elderly patients undergoing thoracoscopic lobectomy.

Objective:To compare the clinical results and costs of treatment between internal fixation and total hip replacement in patients aged 60 to 75 years with femoral neck fractures, in order to provide a reference basis for choosing the appropriate surgical procedure for patients in this age group.Methods:According to the inclusion and exclusion criteria, we selected 69 patients treated with internal fixation and 88 patients treated with total hip replacement for femoral neck fractures, and collected relevant data to analyze the differences in clinical characteristics and prognosis between the two groups.Results:The total hip replacement group was older than the internal fixation group[68(64, 72) vs.63(61, 68), Z=-4.536, P<0.001]. There were 20 men(29.0%)and 49 women(71.0%)in the internal fixation group, and 13 men(14.8%)and 75 women(85.2%)in the total hip replacement group.Both groups had more women than men( χ2=4.706, P=0.030). The ratio of the displaced type to the non-displaced type was higher in the total hip replacement group than in the internal fixation group(90.9% vs.46.4%, χ2=37.510, P<0.001). Postoperative serum albumin levels were lower than preoperative levels in both groups, with greater decreases in the total hip replacement group than in the internal fixation group[(9.06±3.45)g/L vs.(7.07±3.37)g/L, t=-3.393, P=0.001]. The total hip replacement group had a higher intraoperative bleeding volume and blood transfusion volume than the internal fixation group( P<0.05), and the days of hospitalization[12(9, 14)d]and hospitalization costs[￥89222.1(84826.8, 93040.0)]were higher than those in the internal fixation group[9(8, 10)d; ￥51158.9(47816.5, 54098.4), Z=-5.138, -10.737, P<0.001 for both]. Weight-bearing after total hip replacement occurred earlier than the internal fixation group[32.0(28.0, 36.5)d vs.92.0(89.3, 95.5)d, Z=-10.228, P<0.001]. There were no significant differences between the two types of surgery for non-displaced femoral neck fractures at 1 year after surgery in the Harris hip score and the quality of life score EQ-5D.For patients with displacement, the rates of excellent and good outcomes based on the Harris score for the total hip replacement group were significantly higher than those for the internal fixation group at 1 year after surgery(97.5% vs.81.3%, χ2=6.697, P=0.010); the postoperative quality of life score EQ-5D was also better than that of the internal fixation group[0.9(0.7, 1.0) vs.1.0(1.0, 1.0), Z=-4.785, P<0.001], and the incidence of postoperative pain and anxiety was lower than that in the internal fixation group(6.3% vs.28.1%, 1.3%, vs.50.0%, χ2=7.928, 38.032, all P<0.01). Conclusions:The mortality and short-term postoperative complications between internal fixation and total hip replacement have no significant differences.There is no significant difference in postoperative function between the two surgical methods for patients with non-displaced femoral neck fractures.For patients with displacement, total hip arthroplasty is superior to internal fixation.The cost of initial hospitalization for internal fixation is significantly lower than for total hip replacement.

Objective:To analyze the change trend of survival rate after hip fragility fracture in Tianjin Hospital from 2015 to 2021, and the influence of gender, marital status, age and number of complications on survival rate.Methods:From January 1, 2015 to December 31, 2021, a total of 12,570 patients with fragility fracture of hip were retrieved, including 3,934 males and 8,636 females. The age at admission was 74.11±9.50 years and 74.62±8.99 years respectively. By comparing the ID number with the Tianjin population information database, 2,054 cases died, including 804 males and 1,250 females, aged 81.34±7.88 years and 81.92±7.42 years respectively at the time of death. Acquire the patient's survival status, calculate the cumulative survival rate at 3 month intervals, study the change rule of the cumulative survival rate over time, and use Kaplan-Meier method to calculate the cumulative survival rate of the whole population and the impact of gender, marital status, age, and number of complications on the survival rate.Results:The median survival time of all the dead people after fracture was 13(3, 31) months, including 11(2, 27) months for males and 15(4, 32) months for females. Joinpoint regression showed that 9 months after the hip fragility fracture was the break point of the survival rate. The mortality rate changed significantly within 9 months after fracture (the annual change rate was 47%), and slowed down 9 months later (the annual change rate was 1%). There was a statistically significant difference in trend detection before and after the break point ( P<0.05). The age at admission was 80.11±7.71 years for the dead and 73.36±9.01 years for the non dead, with a statistically significant difference ( t=31.80, P<0.001). After normalization, the number of complications was 0.20±0.93 among the dead and 0.00±0.87 among the non dead, with a statistically significant difference ( t=88.81, P<0.001). The survival rate of men after hip fracture is lower than that of women, the number of people without spouse is lower than that of people with spouse, the number of people with more than 70 years old is lower than that of people with less than 70 years old, and the number of complications ≥2 people is lower than that of people with less than 1 complication, all of which are statistically significant ( P<0.05). Conclusion:The survival rate within 9 months after the occurrence of hip fragility fracture decreased significantly, and it needs to be tracked and managed for at least 9 months to effectively reduce the risk of death; Male, no spouse, age>70 years old, number of complications ≥2 will increase the risk of death after hip fragility fracture, leading to reduced survival rate of patients.

Objective    To investigate the feasibility and safety of non-intubation anesthesia in thoracic surgery. Methods    From September 2017 to December 2019, 296 patients were operated at department of thoracic surgery in our hospital. There were 167 males and 129 females with an average age of 50.69±12.95 years, ranging from 16 to 76 years. The patients were divided into two groups according to whether they were intubated: 150 patients were in a non-intubation group, including 83 males and 67 females with an average age of 49.91±13.59 years, ranging from 16 to 76 years, and 146 patients were in an intubation group including 84 males and 62 females with an average age of 51.49±12.26 years, ranging from 16 to 74 years. Intraoperative data, postoperative recovery, inflammatory response of the two groups were compared. Results    There was no statistical difference between the two groups in operation time, blood loss, the lowest oxygen saturation or other indicators (P>0.05). But the highest partial pressure of carbon dioxide of the non-intubation group was higher than that of the intubation group (P=0.012). The non-intubation group was superior to the intubation group in postoperative recovery and inflammatory response (P<0.05). Conclusion    The non-intubation anesthesia is safe and maneuverable in thoracic surgery, and it has some advantages in accelerating postoperative rehabilitation.

Objective:To analyze the clinical characteristics of patients with femoral neck fracture in Tianjin Hospital.Methods:Data of femoral neck fracture patients discharged from Tianjin Hospital from January 1, 2016 to December 31, 2017 were retrospectively analyzed. The gender, age, fracture type, injury mechanism and treatment method were collected.Results:Total of 2,150 eligible patients including 736 males and 1414 females were selected. There were significant differences in the gender distribution in different age groups ( χ2=91.63, P<0.001). Among young patients, males were more than females, while among middle-aged and elderly patients, females were more than males. The main type of fracture was displaced type (75.56%, 1,646/2,150), the displaced rate was the lowest in young patients (55.17%, 64/116), while it was the highest in old patients (81.91%, 1,159/1,415). The main injury mechanism of the three age groups were falls [young 61.21% (71/116), middle 80.29% (497/619), eldly 91.24% (1,291/1,415)]. There was a significant difference in the treatment methods between different age groups ( χ2=1,057.11, P<0.001). The main treatment method for young and middle-aged patients was internal fixation, no matter whether the fracture was displaced or not. The proportion of undisplaced patients with internal fixation (86.22%, 169/196) was higher than that of displaced patients with internal fixation (62.88%, 266/423) in middle-aged group ( χ2=34.93, P<0.001). In the elderly, more patients used internal fixation in undisplaced group, while more patients used hemiarthroplasty in displaced group. The age of old femoral neck fracture (median age was 74) was older than that of fresh fracture (median age was 70) ( Z=-2.777, P=0.005). And the displaced rate of patients with old femoral neck fracture (92.41%, 73/79) was higher than that of the fresh ones (75.95%, 1,573/2,071)( χ2=11.48, P=0.001). The patients with old femoral neck fracture usually adopt total hip replacement, while the proportion of three kinds of operation (internal fixation, hemiarthroplasty, total hip replacement) were similar among the fresh ones, and the internal fixation was the most. Conclusion:Femoral neck fracture is the most common in elderly women. The patients with displaced fracture are more than that with undisplaced fracture. Falling is the main injury mechanism in both young and old people. Internal fixation is commonly used in young and middle-aged patients, while arthroplasty is often used in elderly patients.

Objective:To study the effect of intravenous injection with butorphanol at different time points on stress response, recovery time after drug withdrawal, emergence agitation and postoperative pain in lung cancer patients undergoing thoracoscopic lobectomy.Methods:A total of 90 lung cancer patients who underwent elective thoracoscopic lobectomy from September 2019 to May 2020 in the Second Hospital of Shanxi Medical University were selected and randomly divided into three groups according to random number table, 30 cases in each group. Group A was set as a preemptive analgesia group, and 20 μg/kg butorphanol was injected intravenously at 15 min before anesthesia induction; group B was injected with 20 μg/kg butorphanol at 30 min before the end of operation; and the blank control group (group C) was given with the same volume of 0.9% NaCl injection at the same time points. The following data including blood glucose, cortisol, heart rate and mean arterial pressure (MAP), recovery time after skin suture and drug withdrawal, emergence agitation score and incidence rate of restlessness, postoperative pain visual analogue scale (VAS) were observed.Results:The level of blood glucose [(5.25±0.32), (5.17±0.58) mmol/L] and cortisol [(253.63±48.29), (222.17±35.73) ng/ml] in group A were lower than those in group B [(5.85±0.53), (5.52±0.48) mmol/L; (302.83±48.63), (274.87±47.93) ng/ml] and group C [(6.07±0.70), (5.68±0.52) mmol/L; (319.97±32.05), (295.57±46.83) ng/ml] immediately after skin suture and 6 h after the operation (all P < 0.05). There were no significant differences in MAP and heart rate at intubation among the three groups (all P > 0.05). The levels of MAP and heart rate in group A at intubation were higher than those before anesthesia induction (all P < 0.05); there were no statistical differences of the levels of MAP and heart rate at 30 min after one-lung ventilation and at extubation compared with those before anesthesia induction (all P > 0.05). In group B and group C, heart rate and MAP at intubation, 30 min after one-lung ventilation and extubation were higher than those before anesthesia induction (all P < 0.05). Among them, the recovery time after drug withdrawal in group B [(16.53±3.64) min] was longer than that in group A [(13.83±3.24) min] and group C [(12.47±3.35) min] (all P < 0.05), while there was no significant difference between group A and group C ( P > 0.05). In addition, in terms of emergence agitation score and agitation incidence, group A [(3.20±0.41) scores, 0 (0/30)] was lower than group B [(3.73±0.74) scores, 7% (2/30)] and group C [(4.00±0.79) scores, 10% (3/30)] (all P < 0.05). The pain VAS in group A [(3.10±0.61) scores, (3.27±0.52) scores] at 3 h and 12 h after operation were lower than those in group B [(3.53±0.86) scores, (3.70±0.53) scores] and group C [(4.00±0.83) scores, (4.10±0.71) scores] at the same time points (all P < 0.05). However, there was no significant difference in pain VAS among the three groups at 24 h and 48 h after operation (all P > 0.05). Conclusions:For lung cancer patients who underwent thoracoscopic lobectomy, preemptive analgesia with butorphanol not only can reduce the stress response and increase the stability of hemodynamics, but also can effectively reduce the incidence of postoperative pain and restlessness without prolonging the recovery time after stopping drug.

The tibial plateau fractures is basically characterized by the collapse and split of the articular surface, increasing the difficulty of surgical reduction and fixation.The complex soft tissue structure adjacent to the tibial plateau prevents the reduction and fixation of tibial plateau fractures. The injuries associated with the fracture and surgical approach also aggravate the loss of knee joint stability. Therefore, the bony reconstruction and soft tissue protection of the knee joint have been the difficulties during the operation of tibial plateau fractures. The authors review the literatures relevant to the progress in surgical management of tibial plateau fractures from aspects of surgical approach, internal and external fixation technology, application of arthroscopic technique, balloon angioplasty, total knee arthroplasty, digital orthopedic technology and repair of soft tissue injury, hoping to provide references for clinical treatment of tibial plateau fractures.

Objective:To explore the influencing factors of delayed surgery for hip fracture in the elderly patients.Methods:A totally 779 elderly hip fracture patients who were hospitalized and operated in the first ward of the Department of Trauma and Hip Arthritis of Tianjin Hospital from January 2018 to December 2018 were collected. According to the time from admission to surgery, the patients were divided into early surgery group (received surgery within 48 hours after admission) 213 cases, delayed surgery group (received surgery more than 48 hours after admission) 566 cases. In this study, the following parameters were collected as potential factors affecting surgery, including: age, gender, fracture type, American Society of Anesthesiologists (ASA) classification, blood test indicators, chest radiograph, urine routine indicators, lower extremity venous thrombosis, and basic comorbidities, mental state, surgical methods, combined medication.Results:In the early operation group, there were 213 cases, 81 males and 132 females; age 69.9±10.2 years (range, 60-74 years); 95 cases of femoral neck, 118 of femoral intertrochanteric or subtrochanteric fractures; 128 cases of ASA I-II grade, 85 of III-V grade; 26 cases of abnormal cardiac function, 187 of normal; 23 cases of abnormal liver function, 190 of normal; 35 cases of abnormal renal function, 178 of normal; 104 cases of abnormal respiratory system, 109 of normal; 110 cases of electrolyte imbalance, 103 of normal; 96 cases were positive for urinary ketone bodies and 117 cases were negative; 86 cases had lower extremity venous thrombosis, 127 cases had no lower extremity venous thrombosis; 32 cases had mental disorders, and 181 cases had no mental disorders; internal fixation was selected in 102 cases, and artificial hip replacement was selected in 111 cases. There were 48 cases with combined medication and 165 cases without combined medication. In the delayed operation group, there were 566 cases, including 262 males and 304 females; age 71.7±15.6 years (range, 58-91 years); 224 cases of femoral neck fractures, 342 of femoral intertrochanteric or subtrochanteric fractures; 169 cases of ASA I-II, 397 of grade III-V; 169 cases of abnormal heart function and 397 of normal; 52 cases of abnormal liver function and 514 of normal; 90 cases of abnormal renal function and 476 of normal; 368 cases of abnormal respiratory system and 198 of normal; electrolyte imbalance 203 cases, 363 cases were normal; 261 cases were positive for urine ketone body, 305 cases were negative; 197 cases had lower extremity venous thrombosis, 369 cases had no lower extremity venous thrombosis; 141 cases had mental disorders, and 425 cases had no mental disorders; 226 cases had internal fixation as surgical method, 340 cases of artificial hip replacement were selected; 311 cases were combined with drugs, and 255 cases were not combined with drugs. There was no statistically significant difference between the early operation group and the delayed operation group in terms of age, gender, fracture type, abnormal liver function, abnormal renal function, urine ketone body, lower extremity venous thrombosis, and choice of surgical methods. There were statistically significant differences between the early operation group and the delayed operation group in terms of ASA classification, abnormal cardiac function, abnormal respiratory system, electrolyte disturbance, mental disorder, and combined medication. Multivariate Logistic regression analysis indicated that abnormal cardiac function, mental disorder, and combined medication were the influencing factors of delayed surgery for hip fracture in the elderly.Conclusion:The influencing factors of delayed surgery for hip fractures in the elderly are abnormal heart function, mental disorders, taking reserpine, clopidogrel and abnormal coagulation function.