Objective To evaluate the efficacy of transfrontal neuroendoscopic surgery in the treatment of chronic subdural hematoma.Methods Analysis of clinical data of 80 cases of chronic subdural hematoma.According to the surgical method,40 cases were divided into traditional external drainage of parietaltuber,40 cases were divided into transfrontal neuroendoscopic small bone window hematoma removal.The treatment efficiency,hematoma recurrence rate,operation time and intraoperative blood loss were compared between the two groups.Results Treatment efficiency of neuroendoscopic group was 95.0%,significantly higher than drainage group 75.0%,hematoma recurrence rate one month after surgery of neuroendoscopic group was 5.0%,significantly lower than that in drainage group 25.0%,operation time of neuroendoscopic group was(54.1±7.5)min,longer than that of drainage group(40.7±9.4)min,the differences were statistically significant(P<0.05).The intraoperative blood loss of neuroendoscopic group was(30.1±4.5)mL,compared with(27.1±6.4)mL in the drainage group,the difference was not statistically significant(P>0.05).Conclusion Transfrontal neuroendoscopic surgery can significantly improve the efficacy of chronic subdural hematoma,and hematoma recurrence rate is extremely low.It is worthy of clinical application.

Objective To explore the clinical effect and safety of remimazolam combined with alfentanil in painless gastroenteroscopy in elderly patients.Methods 188 elderly patients who were scheduled to undergo painless gastroenteroscopy from October 2021 to February 2023 were selected and divided into group A,group B,group C,and group D by random number table method,with 47 cases in each group.The group A,group B and group C were used remimazolam 0.2,0.3 and 0.4 mg/kg,and alfentanil 3 μg/kg respectively,and the remimazolam 2.5 mg/time was added during the operation.The group D was used propofol 1.5 mg/kg and alfentanil 3 μg/kg,and a single dose of propofol 0.5 mg/kg was added during the operation.The hemodynamics at different time points[3 min before anesthesia administration(T0),immediately after endoscopy(T1),3 min after endoscopy(T2),at the end of examination(T3),at the time of awakening(T4)],anesthesia onset time,sedation success rate,gastrointestinal endoscopy time,awakening time,time to leave the observation room and intraoperative/postoperative complications were compared,and the test results of neurobehavioral cognitive state examination(NCSE)were compared at different times.Results The percutaneous arterial oxygen saturation(SpO2)at T1 and T2 time point were higher than group C and group D,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the heart rate(HR)and mean arterial pressure(MAP)among group A,group B,group C and group D at each time point(P>0.05).There was no statistically significant difference in SpO2 between group A and group B at each time point(P>0.05).There was no statistically significant difference in the success rate of sedation,gastrointestinal endoscopy examination time and time of leaving the observation room among the four groups(P>0.05),but the onset time of anesthesia in group A was longer than that in group B,group C and group D,and the awakening time in group A and group B was shorter than that in group C and group D,and the differences were statistically significant(P<0.05).There was no statistically significant difference in awakening time between group A and group B(P>0.05).The incidence rate of bradycardia in group A and group B was lower than in group D,and the incidence rates of hypoxemia,respiratory depression,hypotension,and dizziness in group A were lower than those in group D,and the incidence rate of injection pain in group A,group B and group C was lower than that in group D,and the differences were statistically significant(P<0.05).After 10 minutes of complete wakefulness,there was no statistically significant difference in the passing rates of calculation ability and the memory tests between group A and group B(P>0.05),but the passing rates of calculation ability and memory test in group A were higher than those in group C and group D,and the differences were statistically significant(P<0.05).Conclusion During painless gastroenteroscopy in elderly patients,the sedative effect of using 0.3 mg/kg remimazolam combined with alfentanil is good,and it has stable hemodynamics,and the occurrence rate of complications such as bradycardia and espiratory depression is low,and the early postoperative cognitive function is recovered well.

Objective To explore the feasibility and safety of MCCE in gastrointestinal examination of elderly patients with malignant tumors.Methods Clinical data of 127 patients who underwent MCCE examination from April 2019 to September 2022 were retrospectively analyzed.According to age,the patients were divided into the elderly group(age≥65 year-old,n = 88)and the middle-aged group(40≤age<65 year-old,n = 39),and the clinical data of patients with malignant tumors were screened from the two groups for analysis and comparison.Results 131 patients received MCCE examination,and 4 elderly patients were excluded from this study due to swallowing failure,so 88 elderly patients were actually included in the study.In the elderly group,45.4%had serious cardiovascular diseases(40/88),27.3%had malignant tumors(24/88),8.0%had serious respiratory diseases(7/88),6.8%had anesthesia problems(6/88),and 9.1%had neurological diseases(8/88).Among the 24 elderly patients with malignant tumors,25.0%had severe cardiovascular disease,25.0%had poor general status,20.8%had brain metastases,and 12.5%had severe respiratory dysfunction.The positive diagnosis rate of gastric P2 lesions in the elderly group(52/88,59.1%)was significantly higher than that in the middle-aged group(13/39,33.3%)(P = 0.013).There was significant difference in positive rate of ulcer diagnosis between the two groups(29.5%and 10.2%)(P = 0.032).In patients with malignant tumors,the positive rate of ulcer diagnosis between the two groups(45.8%and 11.1%)was statistically significant(P = 0.038).The cleanliness and visualization scores of proximal stomach in the middle-aged group were higher than those in the elderly group,and the differences were statistically significant(P<0.05).Conclusion MCCE is generally effective and safe in elderly patients,especially those with malignant tumors,without missing any significant gastric lesions.

Objective To analyze the factors affecting diagnosis and morbidity of upper gastrointestinal cancer.Methods Clinical data of 17 830 patients who were performed with upper gastrointestinal endoscopy between January 2020 and January 2022 was collected.Combined with questionnaire and pathological examination,the diagnosis and morbidity of upper gastrointestinal cancer was analyzed.Results There were 88,33 and 119 cases of carcinoma of esophagus,cardia and stomach respectively.Among them,57,27 and 91 cases of early carcinoma of esophagus,cardia and stomach were found.They were divided into the observation group(240 cases)and control group(17 590 cases).Univariate analysis showed significant differences between the two groups in education,drinking,pickled food,atrophic gastritis,intraepithelial neoplasia,painless gastroscopy,standard gastroscopy,and anxiety.Multivariate unconditional Logistic regression analysis and propensity score matching showed that drinking,atrophic gastritis,pickled food,intraepithelial neoplasia and anxiety were risk factors influencing the diagnosis and morbidity of upper gastrointestinal cancer.Conclusion Drinking,atrophic gastritis,pickled food,intraepithelial neoplasia and anxiety are risk factors influencing the diagnosis and morbidity of upper gastrointestinal cancer.Adjust the diet and life style,enhance the awareness of early cancer screening,can control the risk factors influencing the diagnosis and morbidity of upper gastrointestinal cancer.

Objective To analyze the detection of helicobacter pylori(Hp)in different parts of gastric antrum,and to provide clinical guidance for finding the best biopsy site for Hp.Methods Patients who underwent 13C urea breath test and electronic gastroscopy from January 2020 to December 2022 were retrospectively analyzed and divided into 13C urea breath test positive group[delta over baseline(DOB)≥4]and 13C urea breath test negative group(DOB<4)according to DOB value.Gastroscopy reports and pathological data of patients were collected.According to different biopsy sites in gastric antrum,patients were divided into conventional biopsy site group,elevated erosive site group and flat erosive site group,and the detection rate of Hp in different biopsy sites was compared.13C urea breath test positive group was divided into group A(435)according to DOB value,and the gastric antral biopsy and pathology of each group were classified and analyzed.Combined with endoscopic reports and pathological data,patients were divided into atrophic gastritis group and non-atrophic gastritis group.Results In the 13C urea breath test positive group,the detection rate of Hp in the elevated erosive site group(96.4%)was higher than that in the conventional biopsy site group(92.7%)and the flat erosive site group(93.9%),and the difference was statistically significant(P = 0.036).In DOB group A,the detection rate of Hp was the highest at the site of elevated erosive and the lowest at the site of conventional biopsy,and the detection rate of Hp at the three biopsy sites was compared,the difference was statistically significant(P = 0.016);There was no significant difference in the detection rate of Hp at three biopsy sites between group B and group C(P = 0.622;P = 0.721);the non-atrophic gastritis group,the detection rate of Hp at the elevated erosive site(96.5%)was higher than that at the conventional biopsy site(91.2%)and the flat erosive site(92.0%),and the difference was statistically significant(P = 0.043).There was no significant difference in the detection rate of Hp at three biopsy sites in the atrophic gastritis group(P = 0.614).13C urea breath test negative group:There was no significant difference in Hp detection rate among the three biopsy sites(P = 0.255).Conclusion For patients with positive 13C urea breath test but low DOB value,the positive rate of Hp in the elevated erosive site is higher.For non-atrophic gastritis patients,the detection rate of Hp was higher in the elevated erosive sites than in the conventional biopsy sites.But for patients with atrophic gastritis,there was little difference in the detection rate of Hp in different parts of antrum.For patients with negative 13C urea breath test,there was no significant difference in Hp detection rate among the three biopsy sites.In future clinical work,for similar patients,precise biopsy can be performed to improve the detection rate of Hp.

Objective To investigate the relationship between serum miR-505,miR-15 and endoscopic activity of ulcerative colitis(UC).Methods 98 patients with UC from May 2020 to May 2022 were selected as the observation group,and 80 patients with irritable bowel syndrome(IBS)were selected as the control group during the same period.The modified Mayo score was used to evaluate the endoscopic activity in patients with UC,and the relationship among the changes of serum miR-505 and miR-15 levels and the endoscopic activity in patients with UC was analyzed.Results The level of serum miR-505 in observation group was lower than that in control group,while the level of miR-15 in observation group was higher than that in control group(P<0.05).The level of serum miR-505 in patients with active UC was lower than that in patients with the healing stage,while the level of serum miR-15 in patients with active UC was higher than that in patients with healing stage(P<0.05).The serum miR-505 level of E3 type was lower than that of E2 type and E1 type,and the serum miR-15 level of E3 type was higher than that of E2 type and E1 type(P<0.05).The Mayo score of type E3 was higher than that of type E2 and E1(P<0.05).Pearson correlation analysis showed that serum miR-505 was negatively correlated with Mayo score(r =-0.51,P<0.05),while serum miR-15 was positively correlated with Mayo score(r = 0.54,P<0.05).Receiver operator characteristic curve(ROC curve)results showed that the cut-off value of miR-505 was 0.93,and the area under the curve(AUC)for evaluating the endoscopic activity of patients with UC was 0.67(95%CI:0.659～0.785),and the sensitivity and specificity were 73.24%and 68.55%,respectively.The cut-off value of miR-15 was 0.85,and the AUC for evaluating the endoscopic activity of patients with UC was 0.69(95%CI:0.672～0.814),and the sensitivity and specificity were 76.38%and 69.72%,respectively.The AUC for the joint evaluation of UC by both was 0.82(95%CI:0.809～0.912),and the sensitivity and specificity were 84.56%and 68.49%,respectively.Conclusion Serum miR-505 levels decrease and serum miR-15 levels increase in UC patients than IBS,and the level is closely related to patients'pathological conditions and endoscopic activity.Combined detection of serum miR-505 and miR-15 has a good value in evaluating endoscopic activity in UC patients.

Objective To explore the influence of different storage methods on flexible endoscope.Methods 500 compliant soft endoscopes in the endoscopy center of our hospital from January 2019 to January 2020 were selected as research objects.The endoscopes of the observation group were placed horizontally in the storage cabinet,while those of the control group were placed vertically in the storage cabinet.The effects of the two storage methods on bacterial colony number,quality qualified rate and quality of soft endoscopes were compared.Results The study found that the number of bacterial colonies in the flexible endoscope in the 2 h storage of the observation group was(10.27±2.22)cfu/piece and the control group was(13.18±1.33)cfu/piece,and the difference was not statistically significant(P>0.05);The number of bacterial colonies in the flexible endoscope in the 72 h of the observation group was(14.75±2.00)cfu/piece,and the control group was(223.28±17.07)cfu/piece,and the difference was statistically significant(P<0.05).The observed cost of consumables and labor were obliviously lower than those of the control group,there was statistical significance(P<0.05).Conclusion The flexible endoscope is placed horizontally in the designated storage cabinet,which can eliminate the daily morning pre-cleaning within 72 h,and will not increase the damage rate of endoscope.It is a clinically recommended storage method for endoscopes.

Objective To present our initial experience of suturing uterine blood vessels with barbed polydioxanone cog thread by single-port-access large laparoscopic hysterectomy.Methods A respective non-randomized study with two parallel groups was performed from June 2021 to June 2022.The medical records of a total of 41 patients with enlarged uterus were divided into two groups:The single-port access large laparoscopic hysterectomy group by suturing uterine blood vessels with barbed cog thread(experimental group,n = 20),and the four-port assess laparoscopic hysterectomy group(control group,n = 21).The age,body mass index(BMI),a history of abdominal and pelvic surgery,pre-and post-operative hemoglobin(HGB),operative duration,intraoperative bleeding volume,uterine weight,postoperative pain visual analogue scale(VAS)at 24 h,the first postoperative exhaust time and postoperative length of hospital stay were compared between the two groups.Results 41 patients completed the entire procedure successfully without serious complications.Experimental group had a longer median operative time(P<0.01).There were no significant differences in intraoperative bleeding volume,uterine weight,HGB on postoperative day 1,postoperative hospital stays,postoperative exhaust time and postoperative 24-hour pain VAS(P>0.05).Conclusion Our study shows that suturing uterine blood vessels with barbed polydioxanone cog thread in experimental group is safe and feasible for large uterus,but the surgical time is significantly longer than the control group,as the technology becomes more proficient,this situation will be improved.

Objective To analyze the clinical efficacy of functional endoscopic surgery combined with posterior nasal neurotomy in the treatment of recurrent sinusitis with polyps and its impact on important inflammatory indicators,and explore its clinical mechanism of action.Method 54 patients with recurrent sinusitis and polyps who visited our hospital from January to December 2021 were selected and randomly divided into an experimental group(27 cases)and a control group(27 cases).The control group underwent functional endoscopic sinus surgery,while the experimental group underwent functional endoscopic surgery combined with posterior nasal neurotomy.The total effective rate at preoperative,postoperative 6 and 12 months,sino-nasal outcome test-22(SNOT-22)score,Lund-Kennedy score of the nasal endoscopy,and changes in important inflammatory factors[eosinophil(EOS),immunoglobulin E(IgE),interleukin-4(IL-4),interleukin-5(IL-5)]were compared.Results There was no statistically significant difference in the observation indicators between the two groups of patients before surgery.The number of follow-up patients in the experimental group at 6 and 12 months after surgery was 25 and 23,respectively.The number of follow-up patients in the control group at 6 and 12 months after surgery was 26 and 25,respectively.All postoperative observation indicators was significantly improved compared to before surgery;The total effective rate,SNOT-22 score,and Lund-Kennedy score of the nasal endoscopy in the experimental group were better than those in the control group at 6 and 12 months after surgery,and the levels of EOS,IgE,IL-4,and IL-5 in the experimental group were significantly lower than those in the control group at 12 months after surgery,the differences were statistically significant(P<0.05).Conclusion For patients with recurrent sinusitis and polyps,functional endoscopic surgery combined with posterior nasal neurotomy can better inhibit IgE secretion and mucosal inflammatory response,and improve the postoperative treatment effect.

Objective To observe the clinical effectiveness of unilateral biportal endoscopy(UBE)decompression in the treatment of lumbar disc herniation.Methods 80 patients with lumbar disc herniation who were treated with UBE decompression from January 2021 to March 2022 were collected,and the visual analogue scale(VAS)was applied to assess patient pain,Oswestry disability index(ODI)to assess limb function,and the Japanese Orthopaedic Association(JOA)score to evaluate patient vertebral body function at the preoperative and postoperative periods of 1 day,3 months,6 months,and 12 months,respectively.Results The mean VAS of the lumbar and back of patients before surgery was(5.72±2.18),(2.74±1.52),(1.92±1.26),(1.73±1.36),and(0.87±0.72)at the 1 day,3 months,6 months,and 12 months after surgery,respectively,with statistical significance(P<0.05).The VAS of the patient's leg decreased from(4.63±2.17)to(4.22±1.91)before and 1 day after surgery,with no significant difference(P>0.05),at 3 months(3.73±1.42),6 months(2.13±1.16),and 12 months(0.76±0.63)after surgery,with statistical significances(P<0.05);The preoperative ODI of the patients was(60.23±8.13)%,and decreased to(41.91±6.53)%,(12.82±4.24)%,(8.19±3.84)%,and(6.75±2.14)%after 1 day,3 months,6 months,and 12 months of follow-up,respectively,with statistical significances(P<0.05).The preoperative JOA scores was(9.08±1.34),1 day after surgery,the score was(10.89±0.88),3 months(13.34±1.25),6 months(15.75±1.24),and 12 months(18.12±1.86)after surgery,with significant improvement in lumbar function(P<0.05).Conclusion UBE decompression can achieve good clinical efficacy in the treatment of lumbar disc herniation,providing another option for the treatment of lumbar disc herniation,which is worth promoting.