Vessels encapsulating tumor clusters (VETC) is a unique histological vascular pattern associated with a novel mechanism of metastasis. In recent years, the incidence of VETC in hepatocellular carcinoma (HCC) and its prognostic significance have garnered significant attention. Current studies indicate that VETC serves as an independent predictor of recurrence and overall survival following liver resection and transplantation, and has gradually become a research hotspot in HCC. Furthermore, VETC may also function as a biomarker for predicting the efficacy of targeted therapy, interventional therapy, and their combined regimens. However, internationally standardized criteria for reporting and the clinical application of VETC in HCC are yet to be established. To promote the standardized and practical application of VETC in the prognostic evaluation and therapeutic decision-making for HCC, this consensus is developed by organizing domestic experts from fields including radiology, hepatobiliary surgery, interventional medicine, oncology, and pathology. Based on current evidence-based medical data and combined with clinical practice, and through multiple rounds of discussion and revisions, the "Expert consensus on the clinical application of vessels encapsulating tumor clusters in the diagnosis and treatment of hepatocellular carcinoma (2026 edition)" is formulated. This consensus is intended as a reference for domestic colleagues and will be continuously updated and refined with the accumulation of new evidence.

To explore the value of preoperative combined monitoring of platelet aggregation function and coagulation indexes in predicting postoperative complications in elderly patients with gastrointestinal tumors.

A retrospective selection was made of 252 elderly patients with gastrointestinal tumors who were scheduled to undergo radical surgery for gastrointestinal tumors in Jieshou People's Hospital and Bozhou People's Hospital from January 2021 to May 2024. The platelet aggregation function [maximum platelet aggregation rate induced by adenosine diphosphate (ADP-MAR), maximum platelet aggregation rate induced by arachidonic acid (AA-MAR)] and coagulation indicators [prothrombin time (PT), D-dimer (D-D), fibrinogen (FIB), activated partial thromboplastin time (APTT)] of all patients 1 day before the operation were collected. The occurrence of complications within 30 days after the operation was recorded, and the patients were divided into the complication group (74 cases) and the non-complication group (178 cases). The clinical data of the two groups and the factors influencing the occurrence of complications were analyzed, and the predictive efficacy of the influencing factors was evaluated.

The overall incidence of postoperative complications was 29.36% (74/252). There were significant differences between the complication group and the non-complication group in terms of age, ASA classification, TNM stage, surgical method, ADP-MAR, AA-MAR, PT, APTT, FIB, and D-D (P<0.05). Spearman correlation analysis showed that preoperative platelet aggregation function indicators and coagulation indicators were significantly positively correlated with the occurrence of complications (P<0.05). Multivariate Logistic regression model analysis showed that age, ADP-MAR, AA-MAR, FIB, D-D levels, and ASA classification were risk factors affecting the occurrence of postoperative complications in elderly patients with gastrointestinal tumors (P<0.05). ROC curve analysis showed that the AUC of the nomogram model for predicting overall complications was 0.906 (95% CI: 0.860-0.953). The AUC for predicting thrombosis-related complications was 0.923 (95% CI: 0.881-0.965), and the AUC for predicting non-thrombosis-related complications was 0.878 (95% CI: 0.821-0.935).

Preoperative combined monitoring of platelet aggregation function and coagulation indexes, combined with clinical characteristics such as age and ASA classification, can effectively identify patients at high risk of postoperative complications in elderly patients with gastrointestinal tumors. This combined monitoring mode can provide evidence-based basis for clinical development of individualized perioperative management plan, thereby reducing the incidence of postoperative complications and improving the prognosis of patients.

To explore the clinical effect of local radiotherapy in patients with recurrent and metastatic colorectal cancer.

The clinical data of 31 patients with recurrent and metastatic colorectal cancer admitted to the Affiliated Hospital of Inner Mongolia Medical University from January 2020 to August 2025 were analyzed retrospectively. These patients received salvage local radiotherapy after multiple lines of treatment failure, with the main goals being palliative symptom relief and local control. Radiotherapy was performed with CT simulation machine enhance scanning for positioning. The target area was delineated using the Pinnacle planning system. The prescription dose of the target area was formulated according to different lesion sites, with the prescription dose of 24-62.5 Gy/10-30 fraction. Different radiotherapy schemes calculated the biologically effective dose (BED, α/β=10) according to the segmentation method, so as to improve the comparability between doses. Chemotherapy and/or targeted immunotherapy were combined during radiotherapy. The clinical efficacy of local lesions was evaluated one month after radiotherapy, and the overall survival time after comprehensive treatment was followed up. At the same time, the adverse reactions of patients were observed during radiotherapy, and the adverse reactions were graded according to the common adverse event evaluation standard (CTCAE 5.0). Kaplan-Meier method was used for survival analysis, and the survival differences between different groups were compared by Log-rank test.

Among the 31 patients in the entire group, the average age was 61 years old, and the median follow-up time was 7.4 months. Up to the end of follow-up, 23 patients died and 8 patients survived. One month after the end of radiotherapy, the clinical effects were: partial remission in 14 cases (45.16%), stable disease in 16 cases (51.61%), progressive disease in 1 case (3.13%), with an objective response rate of 45.2% and a disease control rate of 96.8%. After comprehensive treatment, the median overall survival was 7.2 months, and the one-year overall survival rate was 23%. At the end of radiotherapy, 9 patients had grade 1-2 adverse reactions.

Local radiotherapy has high local control rate and tolerable safety for patients with recurrent and metastatic colorectal cancer after failure of ≥2-line system treatment, and can be used as a salvage treatment option.

To explore the preoperative precise predictive value of multi-parameter combined detection of transrectal ultrasound (TRUS) for lymph node metastasis of middle and low rectal cancer.

The medical records of 200 patients with middle and low rectal cancer who were treated in Hanzhong People's Hospital from March 2022 to March 2024 were retrospectively collected, according to the postoperative pathological results, they were divided into the metastasis group (89 cases) and the non-metastasis group (111 cases). All patients underwent TRUS examination before the operation, and TRUS-related parameters were collected, the predictive efficacy of each parameter and combined detection was analyzed using the receiver operating characteristic (ROC) curve.

The long diameter of lymph nodes, short diameter of lymph nodes, and the ratio of long to short diameter in the metastasis group were significantly larger than those in the non-metastasis group, and the number of cases where rectal masses accounted for more than 1/2 of the intestinal lumen circumference and the number of cases with ultrasound T₃ or above stages were significantly higher than those in the non-metastasis group (P<0.05). ROC curve analysis showed that the AUC, sensitivity and specificity of combined detection of long diameter of lymph nodes, short diameter of lymph nodes, ratio of long to short diameter, rectal mass accounting for more than 1/2 of the intestinal lumen circumference, and ultrasound T₃ and above stages were significantly higher than those of individual detection of each index (P<0.05).

The joint prediction model constructed based on TRUS multi-parameters can effectively improve the preoperative prediction accuracy of lymph node metastasis in middle and low rectal cancer, combined with the nomogram, it can provide reliable references for clinical condition assessment and individualized treatment plan formulation.

To explore the diagnostic value of liver blood flow ultrasound parameters jointed with serum endothelin-1 (ET-1) and nuclear factor-κB (NF-κB) for esophageal gastric variceal bleeding (EVB) in patients with liver cirrhosis.

From February 2022 to May 2024, 98 patients with liver cirrhosis admitted to the First Hospital of Yulin were served as the research subjects (all patients underwent ultrasound examination). Complying with whether the patients developed EVB, they were assigned into EVB group and cirrhosis group, and complying with the severity of EVB patients, they were assigned into mild, moderate, and severe groups. ELISA method was used to detect levels of serum ET-1 and NF-κB. Logistic method was used to analyze the influencing factors of EVB in patients with liver cirrhosis. In addition, ROC curve was used to analyze the diagnostic value of liver blood flow ultrasound parameters jointed with serum ET-1 and NF-κB for EVB in patients with liver cirrhosis.

Compared with the cirrhosis group, the EVB group had prominently higher partal vein diameter(PVD), hepatic venous damping index(HV-DI), serum ET-1, and NF-κB (P<0.05), and prominently lower portal vein flow velocity (PVV) and intrahepatic circulatory time (IHCT) (P<0.05). The PVD, HV-DI, serum ET-1, and NF-κB increased sequentially in the mild, moderate, and severe groups (P<0.05), while the PVV and IHCT decreased sequentially (P<0.05). Logistic analysis showed that prothrombin time, ET-1, and NF-κB were risk factors for EVB in patients with liver cirrhosis (P<0.05), while platelet was a protective factor (P<0.05). ROC curve results showed that the joint of PVD, PVV, HV-DI, IHCT, and serum ET-1 and NF-κB had an AUC of 0.969 for diagnosing EVB in patients with liver cirrhosis, in addition, the AUC of joint diagnosis was better than that of individual indicator detection (Z=2.696, 2.723, 2.706, 2.718, 2.705, 2.699, P<0.05).

Changes in PVD, PVV, HV-DI, IHCT, serum ET-1, and NF-κB levels are all related to EVB in patients with cirrhosis. The combination of hepatic blood flow ultrasound parameters with serum ET-1 and NF-κB has certain clinical value in diagnosing EVB in patients with cirrhosis.

To analyze the risk factors for recurrence in patients with hyperlipidemic acute pancreatitis (HLAP) and to construct a nomogram based on these factors.

A total of 500 patients with HLAP treated in Hanzhong Central Hospital from January 2020 to December 2023 were selected retrospectively and followed up until February 28, 2025. According to the recurrence status during the follow-up period, the patients were divided into non-recurrence group and recurrence group. Baseline data, laboratory indicators, chronic disease history, and HLAP onset information were compared between the two groups. Univariate and multivariate logistic regression analyses were used to identify risk factors for HLAP recurrence, and a nomogram prediction model was established.

The non-recurrence group consisted of 325 patients, while the recurrence group comprised 175 patients. Multivariate logistic regression analysis indicated that body mass index (BMI) >28.24 kg/m² (OR=3.263), C-reactive protein (CRP) >44.12 mg/L (OR=9.215), neutrophil-to-lymphocyte ratio (NLR) >8.93 (OR=8.100), severe acute pancreatitis (SAP) (OR=12.213), and serum calcium (Ca) ≤2.38 mmol/L (OR=8.574) were independent risk factors for HLAP recurrence (P<0.05). The receiver operating characteristic (ROC) curve showed that the area under the curve of this prediction model for HLAP recurrence was 0.992 in the training set and 0.961 in the validation set. The calibration curve indicated that the C-index of the prediction model for HLAP recurrence was 0.788 in the training set and 0.813 in the validation set, and the Hosmer-Lemeshow goodness-of-fit test values were 0.930 (P=0.335) and 0.930 (P=0.628), respectively. The decision curve analysis (DCA) suggested that the model was far from the extreme curves in both the training and validation sets. Sensitivity analysis confirmed that when continuous variables were included in the model in their original form, its predictive performance showed no significant difference from that of the original model (DeLong test P>0.05).

The nomogram prediction model constructed based on the five risk factors (BMI, CRP, NLR, SAP, and Ca) has been validated by ROC curve, calibration curve, and DCA curve, demonstrating significant application value. Additionally, sensitivity analysis confirms that the model is robust and reliable, offering promising clinical benefits.

To explore the risk factors for colonic diverticular disease and construct a risk early warning model.

A retrospective selection was made of 163 patients with colonic diverticular disease diagnosed and treated in Bozhou People's Hospital from January 2022 to January 2024 as the occurrence group. During the same period, 163 individuals who underwent colonoscopy and whose examination results excluded colonic diverticular disease, inflammatory bowel disease and intestinal tumors were selected as the non-occurrence group. For the two groups of clinical data, univariate and multivariate Logistic regression analyses were used to screen for independent risk factors of colonic diverticular disease, and a risk early warning model was constructed. Bootstrap internal validation was used to evaluate the model performance, and the training set and test set were divided in a 7∶3 ratio for validation.

The results of univariate analysis showed that there were significant differences between the two groups of patients in terms of gender, age, dietary habits, family history, constipation, inflammatory polyps, C-reactive protein (CRP), and fecal calprotectin (FC) levels (all P<0.05). The results of multivariate analysis showed that male gender, advanced age, inflammatory polyps and high FC levels were independent risk factors for colonic diverticular disease (all P<0.001). Based on the above factors, a nomogram model was constructed. The C-indices of the training set and the test set were 0.835 and 0.808 respectively. ROC analysis showed that the AUC of the model in the training set was 0.918 and that in the test set was 0.904. The model has good calibration, and the decision curve showed a positive net gain within a wide threshold range.

Male gender, advanced age, and inflammatory polyps are independent risk factors for the occurrence of colonic diverticular disease. FC can serve as a potential biomarker for identifying related subclinical inflammatory activities or predicting the risk of complications. The risk early warning model constructed based on this has good discrimination and calibration, and has certain potential for clinical risk stratification. However, its applicability needs to be further verified in prospective cohorts.

To explore the value of high-frequency ultrasound combined with color Doppler ultrasound in evaluating the blood flow state of intestinal wall in children with intussusception and its predictive effect on the success rate of enema reduction.

A retrospective analysis was conducted to collect clinical data of 293 children with acute intussusception admitted to Northwest Women's and Children's Hospital from January 2022 to December 2024, among them, there were 259 cases in the successful reduction group and 34 cases in the failed reduction group. All patients completed high-frequency ultrasound examination within 2 hours of admission. The concentric circle diameter, sheath diameter, and sleeve sign length were quantitatively measured, and the concentric circle sign, pseudorenal sign, and fluid accumulation were qualitatively observed. The color Doppler ultrasound was simultaneously used to evaluate the intestinal wall blood flow status according to the modified Rubin grading system. All patients received ultrasound-guided air enema reduction treatment. The differences in ultrasound indicators between two groups were compared and the predictive value of single and combined diagnosis for reset failure was analyzed through receiver operating characteristic (ROC) curve.

The concentric circle diameter, sheath diameter, and sleeve sign length in the reduction failure group were significantly greater than those in the reduction success group (P<0.001). The incidences of pseudorenal sign (85.29% vs. 16.60%) and ascites (44.12% vs. 6.18%) in the reduction failure group were significantly higher than those in the reduction success group, while the incidence of concentric circle sign was significantly lower (76.47% vs. 96.91%, P<0.001). The vast majority of children in the reduction success group (73.36%) presented with grade 0 blood flow, whereas the proportions of grade Ⅱ-Ⅳ blood flow signals in the reduction failure group were significantly higher than those in the reduction success group (P<0.001). High-frequency ultrasound combined with color Doppler ultrasound demonstrated excellent diagnostic performance in predicting reduction failure. The sensitivity (94.12%), specificity (97.68%), and Youden index (0.918) of the combined diagnosis were higher than those of high-frequency ultrasound alone or color Doppler ultrasound alone. ROC curve analysis further confirmed that the area under the curve (AUC) of the combined diagnosis (0.962) was significantly greater than that of high-frequency ultrasound alone (0.875) or color Doppler ultrasound alone (0.884) (P<0.05).

High-frequency ultrasound combined with color Doppler ultrasound has important evaluation value for the success rate of intussusception enema reduction by quantifying the morphological characteristics and blood flow state of intestinal wall, and can provide reliable imaging basis for clinical prognosis prediction.

To investigate the relationship between serum levels of CD4⁺T lymphocyte subsets, microRNA-26a (miR-26a), and tumor necrosis factor-α (TNF-α) and Helicobacter pylori (Hp) infection in patients with peptic ulcers.

A total of 162 patients with peptic ulcers admitted to Xi'an International Medical Center Hospital from May 2021 to May 2024 were selected as the research subjects, including 45 cases who were Hp negative, 61 cases who were typeⅠ Hp positive, and 56 cases who were typeⅡ Hp positive. Clinical indicators of different groups and serum levels of CD4⁺T cells, miR-26a, and TNF-α in different subtypes of Hp positive patients were compared. Spearman correlation analysis was used to investigate the relationship between the types of Hp infection and the levels of CD4⁺T cells and TNF-α.

There was no statistically significant difference in ulcer location or Frorrest grading between the Hp negative and Hp positive groups (P>0.05). The average diameter and GBS score of ulcers in the Hp positive group were greater than those in the Hp negative group (P<0.05). There was no statistically significant difference in ulcer location or Frorrest grading between typeⅠ and typeⅡ Hp positive patients (P>0.05). The average diameter and GBS score of type Ⅰ ulcers were larger than those of typeⅡ ulcers (P<0.05). The levels of TNF-α and CD4⁺T cells in Hp positive patients were higher than those in Hp negative patients (P<0.05), and there was no statistically significant difference in miR-26a expression level between the two groups (P>0.05). The levels of TNF-α and CD4⁺T cells in typeⅠ Hp positive patients were higher than those in typeⅡ Hp positive patients (P<0.05), and there was no statistically significant difference in miR-26a expression level between the two groups (P>0.05). Spearman correlation analysis showed that the type of Hp infection in peptic ulcer (typeⅠ=1, typeⅡ=0) was positively correlated with the levels of CD4⁺T cells and TNF-α (r=0.542, 0.587, P<0.05).

TypeⅠ Hp infection and peptic ulcer are associated with higher levels of CD4⁺T cells and TNF-α. Monitoring changes in these indicators is conducive to identifying severe immunoinflammatory response potentially triggered by high-virulence infection, thus enabling more targeted stratification and management of patients.

To explore the clinical value of a multi-parameter regression model based on preoperative microvascular flow imaging (MFI) combined with contrast-enhanced ultrasound (CEUS) in predicting microvascular invasion (MVI) in hepatocellular carcinoma (HCC).

A retrospective analysis was conducted on the clinical data of 186 HCC patients who had undergone postoperative pathological confirmation in Tangshan Third Hospital from January 2022 to August 2025. All patients underwent MFI and CEUS examinations before surgery. The postoperative pathological diagnosis of MVI was used as the gold standard to divide the patients into the MVI positive group (72 cases) and the MVI negative group (114 cases). Univariate analysis and LASSO regression were used to screen the predictive factors, and a combined predictive model was constructed through multivariate Logistic regression. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of the model and each independent predictive factor.

The maximum diameter of tumors in the MVI positive group was significantly larger than that in the MVI negative group, and the proportion of patients with alpha-fetoprotein (AFP) >400 μg/L was also higher (both P<0.001). The proportions of high MFI blood flow grading, peritumoral nutrient vessels, heterogeneous enhancement, early clearance ≤60 seconds, and peritumoral enhancement in the MVI positive group were significantly higher than those in the MVI negative group (all P<0.001). Spearman correlation analysis showed that the MVI status was weakly to moderately positively correlated with MFI blood flow grading, peritumoral nutrient vessels, heterogeneous enhancement, early clearance, and peritumoral enhancement (r ranged from 0.173 to 0.419, all P<0.05). Multivariate Logistic regression analysis showed that the maximum tumor diameter (OR=2.182), AFP> 400 μg/L (OR=6.664), high MFI blood flow grading (OR=7.126), heterogeneous enhancement (OR=4.418), and peritumoral enhancement (OR=5.849) were independent risk factors for MVI (all P<0.05). ROC analysis showed that the area under the curve of the combined prediction model was 0.930, which was superior to any single indicator (all P<0.001), with a sensitivity of 0.764 and a specificity of 0.939.

The combined prediction model constructed based on preoperative MFI and CEUS can effectively predict the MVI status of HCC. Its diagnostic value is significantly superior to that of either imaging or serological indicators, and it is expected to provide an important reference for the preoperative individualized treatment decisions of HCC patients.

To explore the application effect of flurbiprofen axetil (FA) combined with transverse abdominal muscle plane (TAP) block in anesthesia for laparoscopic radical resection of colorectal cancer (LRRCC) and its influences on the levels of serum cyclooxygenase-2 (COX-2) and matrix metalloproteinase-9 (MMP-9).

A total of 110 patients who underwent radical surgery for LRRCC at the No.215 Hospital of Shaanxi Nuclear Industry were selected. and randomly divided into the TAP group (TAP block anesthesia) and the FA group (FA combined with TAP block anesthesia). The anesthetic effects of two group and the changes in the levels of serum COX-2 and MMP-9 in patients were compared.

The FA group had earlier postoperative first exhaust time, defecation time, and time for getting out of bed for activities than the TAP group (P<0.05). At 6 h, 12 h and 24 h after surgery, the FA group had a lower Visual Analogue Scale (VAS) score than the TAP group (P<0.05), and a higher Ramsay sedation score than the TAP group (P<0.05). At 1 day after surgery, the FA group had lower levels of serum prostaglandin E2 (PGE2), β-endorphin (β-EP), COX-2 and MMP-9 than the TAP group (P<0.05). The FA group had fewer times of postoperative remedial analgesia than the TAP group (P<0.05), but there was no statistically significant difference in adverse reactions between the FA group and the TAP group (P>0.05).

FA combined with TAP block has a good application effect in the anesthesia of radical resection of LRRCC. It can significantly reduce the levels of serum COX-2 and MMP-9 in the early postoperative period, effectively inhibit the acute phase inflammatory stress response, and has good safety.

To investigate the analgesic effect and postoperative cognitive function of nalbuphine combined with dezocine multimodal analgesia on patients undergoing radical surgery for colon cancer.

A total of 150 patients who underwent radical surgery for colon cancer at Ankang Traditional Chinese Medicine Hospital from June 2022 to June 2025 were selected as the study subjects, they were randomly divided into group A, group B, and group C, with 50 patients in each group. Group A received self-administered intravenous analgesia with nalbuphine combined with dezocine after surgery, group B received dezocine for self-administered intravenous analgesia after surgery, and group C received nalbuphine for self-administered intravenous analgesia after surgery. At 4 hours (T1), 8 hours (T2), 12 hours (T3), 24 hours (T4), and 48 hours (T5) after surgery, the hemodynamic indicators [heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP)], neuroendocrine hormones [cortisol (Cor), norepinephrine (NE), substance P (SP)], inflammatory mediators [prostaglandin E2 (PGE2), interleukin-1β (IL-1β)], pain severity [visual analog scale (VAS)], sedative effect [using Ramsay sedation score], cognitive function [Mini-Mental State Examination (MMSE) score], the number of self-controlled presses of the analgesic pump between the two groups of patients were compared, and the incidence of adverse reactions between the two groups were compared and analyzed.

From T1 to T5 after surgery, the changes in HR, SBP, DBP, and MAP in group A were significantly lower than those in group B (P<0.05), while there was no statistically significant difference in the changes in HR, SBP, DBP, and MAP between group B and group C (P>0.05). At postoperative time T2-T5, the levels of Cor, NE, SP, PGE2, IL-1β, VAS, Ramsay score, and the number of self-controlled presses of the analgesic pump in the three groups were significantly lower than the previous time (P<0.05). At postoperative time T1-T5, the levels of Cor, NE, SP, PGE2, IL-1β, VAS, Ramsay score, and the number of self-controlled presses of the analgesic pump in group A were significantly lower than those in groups B and C (P<0.05). The levels of Cor, NE, SP, PGE2, IL-1β, VAS, Ramsay score, and the number of self-controlled presses of the analgesic pump in group B were significantly lower than those in group C (P<0.05). At T2-T5 after surgery, the MMSE scores of the three groups were significantly higher than the previous time (P<0.05). At postoperative time T1-T5, the MMSE score in group A was significantly higher than that in groups B and C (P<0.05), and the MMSE score of group B was significantly higher than that of group C (P<0.05). The incidence of adverse reactions in group A was lower than that in groups B and C (P<0.05), and the incidence of adverse reactions in group B was lower than that in group C (P<0.05).

The use of nalbuphine combined with dezocine anesthesia for postoperative analgesia in patients undergoing radical surgery for colon cancer can effectively reduce postoperative pain and stress reactions, improve analgesic and sedative effects, and has high safety.

To explore the effects of intravenous anesthesia with remifentanil combined with midazolam on the operation time of endoscopic submucosal dissection (ESD)/endoscopic mucosal resection (EMR), the accuracy of endoscopic operation and the evaluation of submucosal injection diffusion imaging.

A total of 100 patients who underwent ESD/EMR in the Second Hospital of Tianjin Medical University from January 2023 to January 2025 were selected, and the patients were divided into the control group and the observation group, each with 50 cases, by using the method of randomized numerical table. The control group was given propofol combined with remifentanil intravenous anesthesia, and the observation group was given remifentanil combined with midazolam intravenous anesthesia. The two groups were compared in terms of surgery-related indexes, endoscopic operation precision, submucosal injection diffusion image assessment, hemodynamic indexes [mean arterial pressure (MAP), heart rate (HR)] before and after anesthesia, serum stress indexes [cortisol, norepinephrine (NE), epinephrine (E)] levels and the incidence of adverse reactions.

The operation time of the observation group was shorter than that of the control group (P<0.05). The excellent rate of endoscopic operation precision and the good rate of submucosal injection diffusion in the observation group were higher than those in the control group (P<0.05). At 10 min after anesthesia and at the end of surgery, the MAP and HR of the two groups were lower than that before anesthesia, and the values of the observation group was lower than that of the control group (P<0.05). The serum cortisol, NE, and E levels in both groups were higher than those before anesthesia, and the levels in the observation group were lower than those in the control group (P<0.05). The incidence of adverse reactions in the observation group was lower than that in the control group (P<0.05).

Remifentanil combined with midazolam intravenous anesthesia for ESD/EMR can shorten the surgical operation time, improve the endoscopic operation precision, optimize the submucosal injection diffusion image assessment, stabilize the hemodynamic indexes, and reduce the body's stress response, and has a higher safety profile.

To investigate the optimizing effect of the propofol-remifentanil closed-loop feedback target-controlled infusion (TCI) system on body movement responses and surgical field clarity during painless gastrointestinal endoscopy.

A total of 120 patients scheduled for painless gastrointestinal endoscopy in XD Group Hospital between July 2023 and July 2024 were selected as the research subjects and randomly divided into an observation group and a control group, with 60 cases in each group. The control group received anesthesia using a conventional TCI system, while the observation group was anesthetized with a propofol-remifentanil closed-loop feedback TCI system. The incidence of body movement, clarity of the surgical field, anesthetic drug consumption, awakening time, and adverse reactions were compared between the two groups.

The total incidence of body movement in the observation group was significantly lower than that in the control group (8.33% vs. 28.33%), and the rate of excellent or good surgical field clarity was 96.67% in the observation group, significantly higher than 81.67% in the control group, with significantly significant differences (P<0.05). The dosages of propofol and remifentanil, as well as the awakening time, were significantly reduced in the observation group compared with the control group (P<0.05). The incidence of adverse reactions (hypotension, respiratory depression and nausea and vomiting) was also significantly lower in the observation group (P<0.05).

The propofol-remifentanil closed-loop feedback TCI system can effectively reduce body movement responses, enhance surgical field clarity, decrease anesthetic drug usage and the risk of adverse reactions.

To explore the predictive value of electrolyte imbalance and abnormal coagulation function for the failure of fluid replacement therapy in children with rotavirus enteritis (RE).

The clinical data of 268 children with RE who underwent fluid replacement treatment in Suzhou Wujiang District Children's Hospital from February 2021 to February 2025 were selected. According to the outcome of fluid replacement treatment, they were divided into the successful treatment group (n=207) and the failed treatment group (n=61). The levels of electrolytes and coagulation function indicators of the two groups of children at admission were compared. Spearman correlation analysis was conducted to investigate the correlation between electrolyte imbalance, coagulation function and the failure of fluid replacement therapy in children with RE. Multivariate Logistic regression analysis was used to screen for independent risk factors of fluid replacement therapy failure, and the predictive efficacy was evaluated through the receiver operating characteristic (ROC) curve.

The levels of C-reactive protein (CRP) and procalcitonin in the treatment failure group were higher than those in the treatment success group, while the levels of blood sodium, blood potassium and blood calcium were all lower than those in the treatment success group, with statistically significant differences (all P<0.05). The prothrombin time (PT) and activated partial thromboplastin time (APTT) values in the treatment failure group were both higher than those in the treatment success group, while the fibrinogen (FIB) value was lower than that in the treatment success group, with statistically significant differences (all P<0.05). Spearman correlation showed that the levels of blood sodium, blood potassium, blood calcium and FIB were negatively correlated with the failure of fluid replacement treatment in children with RE, while the levels of PT and APTT were positively correlated with the failure of fluid replacement treatment in children with RE (all P<0.05). Binary logistic showed that high CRP, low blood sodium, low blood potassium, high APTT, and low FIB levels were independent risk factors for the failure of fluid replacement treatment in children with RE (all P<0.05). ROC showed that CRP, blood sodium, blood potassium, APTT, FIB and combined detection all demonstrated certain predictive values for the failure of fluid replacement therapy, with AUCs of 0.767, 0.780, 0.751, 0.764, 0.731 and 0.941, respectively. The sensitivities were 0.590, 0.449, 0.643, 0.623, 0.483, and 0.885 respectively, and the specificities were 0.836, 0.967, 0.787, 0.787, 0.918, and 0.894. Moreover, the ROC AUC of the combined detection was higher than that of each individual independent prediction (all P<0.05).

CRP, blood sodium, blood potassium, APTT, and FIB are independent risk factors for the failure of fluid replacement therapy in children with RE, and the combined detection of the above indicators can significantly improve the predictive efficacy for treatment failure.

Constipation-predominant irritable bowel syndrome (IBS-C), as a common functional gastrointestinal disorder, has a significant negative impact on the quality of life of patients. Currently, drug treatment faces many limitations, and non-pharmaceutical rehabilitation intervention based on the brain-gut axis theory has become a research hotspot. This article systematically reviews and compares the application evidence, mechanism of action and scope of application of non-pharmaceutical intervention strategies based on the brain-gut axis (including central nervous system regulation, peripheral orientation intervention, diet and cognitive behavioral intervention, traditional medicine and complementary and alternative therapies) in IBS-C. Analysis shows that individualized and multimodal intervention targeting specific pathophysiological subtypes (such as central sensitization and pelvic floor dysregulation) is the future trend. This article aims to provide evidence-based basis for the formulation of precise rehabilitation plans in clinical practice and clarify future research directions.