Objective:To establish and internally validate a nomogram model for predicting complicated acute appendicitis (CA).Methods:The clinical data from 663 acute appendicitis patients from the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from October 2015 to October 2022 were retrospectively analyzed. There were 411 males and 252 females, aged ( M (IQR)) 41 (22) years (range: 18 to 84 years). There were 516 cases of CA and 147 cases of uncomplicated acute appendicitis. The minimum absolute contraction and selection operator regression model was used to screen the potential relative factors of CA, and the screened factors were included in the Logistic regression model for multivariate analysis. Software R was used to establish a preoperative CA nomogram prediction model, the receiver operating characteristic curve of the model was drawn, and the value of area under the curve (AUC) was compared to evaluate its identification ability, and the Bootstrap method was used for internal verification. Results:The elderly (age≥60 years) ( OR=2.428, 95% CI: 1.295 to 4.549), abdominal pain time (every rise of 1 hour) ( OR=1.089, 95% CI: 1.072 to 1.107), high fever (body temperature≥39 ℃) ( OR=1.122, 95% CI: 1.078 to 1.168), total bilirubin (every rise of 1 μmol/L) ( OR=2.629, 95% CI: 1.227 to 5.635) were independent relative factors of CA (all P<0.05). The AUC of this model was 0.935 (95% CI: 0.915 to 0.956). After internal verification using the Bootstrap method, the model still had a high discrimination ability (AUC=0.933), and the predicted CA curve was still in good agreement with the actual clinical CA curve. Conclusion:The clinical prediction model based on the elderly (age≥60 years), prolonged abdominal pain time, high fever (body temperature≥39 ℃), and increased total bilirubin can help clinicians effectively identify CA.

Objective:To establish and internally validate a nomogram model for predicting complicated acute appendicitis (CA).Methods:The clinical data from 663 acute appendicitis patients from the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from October 2015 to October 2022 were retrospectively analyzed. There were 411 males and 252 females, aged ( M (IQR)) 41 (22) years (range: 18 to 84 years). There were 516 cases of CA and 147 cases of uncomplicated acute appendicitis. The minimum absolute contraction and selection operator regression model was used to screen the potential relative factors of CA, and the screened factors were included in the Logistic regression model for multivariate analysis. Software R was used to establish a preoperative CA nomogram prediction model, the receiver operating characteristic curve of the model was drawn, and the value of area under the curve (AUC) was compared to evaluate its identification ability, and the Bootstrap method was used for internal verification. Results:The elderly (age≥60 years) ( OR=2.428, 95% CI: 1.295 to 4.549), abdominal pain time (every rise of 1 hour) ( OR=1.089, 95% CI: 1.072 to 1.107), high fever (body temperature≥39 ℃) ( OR=1.122, 95% CI: 1.078 to 1.168), total bilirubin (every rise of 1 μmol/L) ( OR=2.629, 95% CI: 1.227 to 5.635) were independent relative factors of CA (all P<0.05). The AUC of this model was 0.935 (95% CI: 0.915 to 0.956). After internal verification using the Bootstrap method, the model still had a high discrimination ability (AUC=0.933), and the predicted CA curve was still in good agreement with the actual clinical CA curve. Conclusion:The clinical prediction model based on the elderly (age≥60 years), prolonged abdominal pain time, high fever (body temperature≥39 ℃), and increased total bilirubin can help clinicians effectively identify CA.

Objective:To study the changes in hemorheology in cirrhotic patients with portal hypertension before and after splenectomy.Methods:The data on cirrhotic patients with portal hypertension and hypersplenism who underwent splenectomy from January 2018 to May 2019 in the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine was analyzed. The hemorheology indexes were monitored during the perioperative period, and portal vein thrombosis was monitored by Color Doppler ultrasound.Results:A total of 30 patients were included, including 18 males and 12 females; aged 12.0-62.0 (31.7±14.0) years. One week after splenectomy, portal vein thrombosis was found in all the patients and it disappeared after heparin treatment. The leukocyte and bilirubin levels significantly improved after splenectomy ( P<0.05). The viscosity of high, medium and low cut blood, platelet and D-dimer significantly increased ( P<0.05). Conclusions:After splenectomy, blood viscosity and platelets of cirrhotic patients with portal hypertension and hypersplenism increased, and portal vein thrombosis formed easily.

Traditional vascular intervention relies on C-arm rotation and use of contrast to obtain imaging,which results in the loss of 3D-image information and increased burden on kidney.Moreover,interventional operators bear higher occupational hazard risk under longtime X-ray exposure and the heavy burden of lead protection apron.Robot-assisted vascular intervention system carries certain advantages,it can significantly reduce the X-ray exposure to operators,obtain precise localization of lesions as well as accurate and stable manipulation.While reducing the contact of the instruments with the vascular wall and the operation tremor,it can improve operator's comfortable sensation.This paper aims to make a detailed summary about the development of robot-assisted vascular intervention system and its clinical application.The future development directions of robot-assisted vascular intervention system is also discussed.

At present, thoracic endovascular aortic repair (TEVAR) is the routine treatment for Stanford type B aortic dissection. Usually, during the interventional treatment only the primary entry tear, i.e. so-called proximal entry tear, is to be isolated with a stent-graft, while less intervention is adopted for the distal entry tear. With the deepening of research concerning aortic remodeling after TEVAR, the researchers have found that 25％-50％ of patients will develop aneurysmal dilation at the distal end of dissected aorta, which needs to be treated again. Among them, the treatment of entry tear at visceral branch area of the abdominal aorta has a certain degree of difficulty and technical particularity as the interventional management may affect the blood supply of vital organs. Referring to the research progress at home and abroad, this article aims to make a review about the common therapeutic methods for the entry tear at visceral branch area of the abdominal aorta.

Objective To evaluate the efficacy of ultrasound-guided transversus abdominal plane (TAP) and posterior rectus sheath (PRS) block for postoperative analgesia in the patients undergoing radical resection for gastric cancer.Methods One hundred twenty patients of both sexes,aged 18-64 yr,with body mass index of 19-25 kg/m2,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective radical resection for gastric cancer,were divided into 2 groups (n =60 each) using a random number table:control group (group C) and ultrasound-guided TAP and PRS block group (group T+R).Bilateral TAP (0.375％ ropivacaine 0.5 ml/kg was injected) and PRS block (0.375％ ropivacaine 0.3 ml/kg was injected) were performed before induction of general anesthesia in group T+R.Patient-controlled intravenous analgesia was provided to all the patients after surgery in the two groups,and the visual analog scale score at rest and during activity was maintained less than 4 within 48 h after surgery.The requirement for rescue analgesia within 48 h after surgery and occurrence of adverse reactions during the analgesia period were recorded.Results Compared with group C,the requirement for rescue analgesia within 48 h after surgery and incidence of nausea and vomiting were significantly decreased in group T+R (P＜0.05).Conclusion Ultrasound-guided TAP and PRS block provides better efficacy for postoperative analgesia with less adverse reactions in the patients undergoing radical resection for gastric cancer.

Objective To evaluate the diagnosis and treatment of transcatheter small bowel radiography in intestinal obstruction.Methods From January 2016 to December 2016,150 cases of adhesive small intestine obstruction were divided into small bowel radiography group and control group.The long-term results were collected after 6-month follow-up.Results First aerofluxus time [(72 ± 5) h vs.(109 ±7) h],defecation [(89 ±8)h vs.(139 ± 17)h],extubation [(81 ± 18)h vs.(105 ± 17)h] and first oral intake [(84 ±6)h vs.(109 ±9)h] in catheter group were shorter compared with control group (all P ＜ 0.05).The accuracy of determining obstruction site were superior in catheter group than control group (92％ vs.63％,P ＜ 0.05).Conclusion Endoscopic transnasal ileus tube significantly relieves symptoms in the adhesive intestinal obstruction,the transcatheter small intestinal radiography helps determine the obstruction site.

Objective To study the hemodynamic changes before and after splenectomy plus periesophagogastric devascularization in patients with splenic artery steal syndrome (SASS) so as to provide a theoretical basis for the treatment of portal hypertension concomitant with hypersplenism.Methods The database of 30 patients who underwent splenectomy plus devascularization from January 2015 to January 2017 was studied retrospectively.Color Doppler ultrasound was performed to detect hemodynamic changes in the hepatic artery,splenic artery,splenic vein and portal vein in patients with portal hypertension and in healthy controls.The outcomes between preoperative and postoperative biochemical indicators were compared.Results The hemodynamic indexes of splenic artery,splenic vein and portal vein in the study group were significantly higher than those in the control group (P ＜ 0.05).The peak systolic velocity [(35.3 ± 5.1) cm/s vs.(53.1 ±7.0) cm/s] and blood flow [(175.9 ±30.5) ml/min vs.(297.0 ±48.3) ml/min)] of the hepatic artery were significantly lower than those of the control group (P ＜ 0.05).The peak systolic velocity [(60.7 ± 11.9) cm/s vs.(35.3 ±5.1) cm/s] and blood flow [(388.8 ±79.6) ml/min vs.(175.86 ±30.46) ml/min] of the hepatic artery increased significantly after operation (P ＜ 0.05).After splenectomy,the levels of the leucocyte [(7.9 ± 3.8) × 109/L vs.(2.8 ± 1.4) × 109/L)],thrombocyte [(491.3±194.9) × 109/L vs.(47.4 ± 16.0) × 109/L)],bilirubin [(15.0 ± 10.6) μmol/L vs.(24.4±13.8) μmol/L)] and transaminase [(32.94±8.57) U/L vs.(43.37 ±16.59) U/L)] recovered when compared with the preoperative data (P ＜ 0.05).Conclusions SASS was detected in cirrhotic patients who had portal hypertension concomitant with hypersplenism.Splenectomy plus periesophagogastric devascularization were effective and safe for cirrhotic patients with hypersplenism and concomitant esophageal and gastric variceal bleeding.

BACKGROUND: Tissue engineering provides a new way for the repair of urinary tissue and organ defects.Urinary tissue engineering has shown a bright prospect.OBJECTIVE: To review the latest research on urinary tissue engineering at national and international level.METHODS: With the keywords of tissue engineering, urology, scaffold, vascularization in Chinese and in English,respectively, a computer-based search for articles published from January 2000 to January 2016 was performed in CNKI and PubMed databases. The articles addressing urology tissue engineering, scaffolds and vascularization were collected,summarized and analyzed.RESULTS AND CONCLUSION: The selection and cultivation of seed cells, scaffold material performance, tissue construction in vitro, and degree of vascularization all make an important influence on the repair of urinary injuries. As different seed cells hold different biological characteristics, we should make full consideration prior to choosing an appropriate seed cell, so as to pave a good foundation for urinary tissue engineering. Scaffolds with good three-dimensional structure can promote the cell growth and proliferation, tissue in-growth and vascularization.Tissue-engineered materials are superior to traditional repair materials, but still on initial stage, and further large scale trials will be necessary. Moreover, some problems needed to be solved, such as the regenerated tissue with incomplete function different from natural tissues, and regeneration failure caused by biological stent rejection.

Objective To evaluate the efficacy and safety of bilateral transversus abdominis plane block (TAPB)combined with bilateral rectus sheath block (RSB)in abdominal surgery. Methods Ninety ASA Ⅰ or Ⅱ patients,35 males,55 females,aged 19-79 years,with body mass index 18-30 kg/m2 ,scheduled for elective laparoscopic cholecystectomy were randomly divided into three groups(n=30):ultrasound-guided bilateral TAPB combined with bilateral RSB group (group TR),ultrasound-guided bilateral TAPB group (group T),patient-controlled intravenous analgesia (PCIA)group (group P).In group TR,ultrasound-guided bilateral TAPB were performed with 20 ml of 0.22% ropivacaine mesylate injection in each side and ultrasound-guided bilateral RSB were per-formed with 10 ml of 0.22% ropivacaine mesylate injection in each side before surgery.In group T, ultrasound-guided bilateral TAPB were performed with 20 ml of 0.22% ropivacaine mesylate injection in each side and ultrasound-guided bilateral RSB were performed with 10 ml of NS in each side before surgery.In group P,ultrasound-guided bilateral TAPB were performed with 20 ml of NS in each side and ultrasound-guided bilateral RSB were performed with 10 ml of NS in each side before surgery, and PCIA was applied in group P.BP,HR,SpO2 were observed when patients were sent into the op-erating room, 2 minutes before trocar puncture, and 2 minutes after trocar puncture, the consumption of propofol and remifentanil used during the surgery were recorded.The score of visual analogue scale (VAS)during rest and movement were recorded at 2,6,12,24 h after surgery.The patient analgesia satisfaction and the adverse reactions were recorded.Results Compared with group T and group P,group TR had less change of BP before and after trocar puncture(P <0.05).The VAS score was significantly lower in group TR after operation(P <0.05).There were no statistical significant differences of VAS score at 24 h after operation among the three groups.The patient anal-gesia satisfaction was significantly better in group TR than other two groups (P < 0.05 ). Conclusion Ultrasound-guided bilateral transversus abdominis plane block combined with bilateral rectus sheath block is of safety and much efficacy of postoperative analgesia in patients undergoing laparoscopic cholecystectomy.