Tracheoesophageal fistula （TEF） is an abnormal pathological connection between the esophagus and trachea and/or bronchus caused by various benign and malignant factors. Benign TEF in adults is mainly caused by iatrogenic injury，infectious diseases，trauma，esophageal foreign bodies，etc.The main treatment options for benign TEF in adults are surgical and non-surgical treatments，aiming to close the fistula. This article deals with the management of benign TEF in adults from the perspective of gastroendoscopist.
To analyze the clinical characteristics and course differences between smokers and non-smokers in patients with idiopathic chronic pancreatitis，in order to clarify the impact of smoking on the clinical characteristics of patients with idiopathic chronic pancreatitis.
Methods
Prospective clinical data were collected from 966 patients with idiopathic chronic pancreatitis admitted to the Department of Gastroenterology at the First Affiliated Hospital of Naval Medical University from January 2010 to December 2013. Patients were divided into a smoking group and a non-smoking group based on their smoking history，and their clinical characteristics were compared between the two groups.Kaplan-Meier method was used to calculate the cumulative incidence of steatorrhea，diabetes，pancreatic pseudocysts，pancreatic stones and biliary stricture after the onset of idiopathic chronic pancreatitis.
Results
Among 966 patients with idiopathic chronic pancreatitis，274 were smokers and 692 were non-smokers. The clinical characteristics of smokers are significantly different from non-smokers，with significant differences in the age of onset，age of diagnosis，adolescent onset，main pancreatic duct morphology，pain type，successful drainage of the pancreatic duct，treatment methods，pancreatic duct stones，and pancreatic pseudocysts （all P＜0.05）. The incidence of pancreatic duct stones （P=0.002） and pancreatic pseudocysts （P＜0.001） in the smoking group was significantly higher than that in the non-smoking group.
Conclusion
There is a significant difference in the clinical characteristics of patients with idiopathic chronic pancreatitis between the smoking group and the non-smoking group. The smoking group has a higher incidence of complications related to chronic pancreatitis and accelerates the occurrence of pancreatic pseudocysts. Therefore，smoking may have a significant impact on the clinical characteristics of patients with idiopathic chronic pancreatitis.
To investigate the correlation between early blood routine，coagulation function indicators，and spiral CT perfusion parameters in patients with acute pancreatitis （AP），as well as their predictive ability for the prognosis of AP patients.
Methods
A retrospective analysis was conducted on 100 AP patients admitted between June 2023 and June 2024. The patients were divided into two groups based on their mortality status： the non-death group and the death group. Differences in early blood routine，coagulation indicators，and spiral CT perfusion parameters between the two groups were compared. The correlation between blood routine，coagulation indicators，and spiral CT perfusion parameters was analyzed using Pearson correlation. The predictive ability of blood routine and coagulation indicators for the prognosis of AP patients was evaluated using ROC curves and multivariate logistic regression analysis.
Results
In the death group，neutrophil count，neutrophil-to-lymphocyte ratio （NLR），platelet count，activated partial thromboplastin time （APTT），fibrinogen （FIB），D-dimer （DD），and computed tomography severity index （Balthazar CTSI） score were significantly higher than those in the non-death group. The lymphocyte count，MPV level，blood flow （BF） and blood volume （BV） from the spiral CT perfusion parameters were significantly lower in the death group compared to the non-death group （P＜0.05）. Logistic regression analysis showed that NLR （OR=1.224，95% CI： 1.116-2.368），DD （OR=1.962，95% CI：1.438-2.529），BF （OR=0.569，95% CI： 0.258-0.815），BV （OR=0.462，95% CI： 0.316-0.927），and Balthazar CTSI （OR=1.485，95% CI： 1.345-3.973） were independent risk factors affecting the prognosis of AP patients. Pearson correlation analysis showed that NLR and DD were negatively correlated with spiral CT perfusion parameters BF and BV，and positively correlated with Balthazar CTSI score （P＜0.05）. ROC curve analysis showed that the area under the curve （AUC） for NLR was 0.752 （95% CI： 0.641-0.863），for DD was 0.779 （95% CI： 0.675-0.883），and for the combined NLR+DD was 0.923 （95% CI： 0.861-0.984）.
Conclusion
NLR and DD are correlated with spiral CT perfusion parameters BF and BV and Balthazar CTSI score，and they can be used as indicators for predicting the prognosis of AP patients.
To construct and verify the prediction model for recurrence of young and middle-aged patients with liver cancer in different periods after radical surgery，and then provide more effective postoperative monitoring and intervention strategies for clinic.
Methods
From January 2017 to December 2021，341 cases of primary hepatocellular carcinoma （PHC） were selected as the research object，and the cases were screened according to certain inclusion and exclusion criteria，and detailed clinical data were collected. Five machine learning algorithms，including logistic regression （LR），decision tree （DT），support vector machine （SVM），random forest （RF） and extreme gradient lifting algorithm （XGBoost），were used to construct the prediction model. All patients were divided into training set and validation set，and the data of training set were trained and optimized by 50% cross validation. Receiver operating characteristic curve （ROC） was used to evaluate the prediction performance of each model，and the area under the curve （AUC），sensitivity，specificity and Jordan index of each model for predicting recent recurrence and long-term recurrence were counted.
Results
Of the 341 PHC patients，173 （50.73%） had postoperative recurrence，of which 78 （22.87%） had recent recurrence and 95 （27.86%） had long-term recurrence. The levels of neutrophil to lymphocyte ratio （NLR），platelet to lymphocyte ratio （PLR），alanine aminotransferase，aspartate transaminase，total bilirubin and alpha fetoprotein in recent and long-term relapses were significantly higher than those in patients without recent and long-term relapses. At the same time，there were significant differences between those with recent recurrence and those without recent recurrence，and between those with long-term recurrence and those without long-term recurrence in portal vein tumor thrombus，tumor envelope integrity，BCLC staging and tumor differentiation （P＜0.05）. The model prediction results showed that XGBoost algorithm had the best performance in predicting recent recurrence （AUC=0.989） and long-term recurrence （AUC=0.983），followed by RF （AUC=0.926，0.939）and SVM algorithm （AUC=0.914，0.904）.
Conclusion
LR，DT，SVM，RF and XGBoost can all predict the recurrence possibility of young and middle-aged patients with liver cancer in different periods after radical surgery. Among them，the prediction performance of RF，SVM and XGBoost model is relatively good，especially XGBoost model shows high prediction accuracy. In addition，NLR，PLR，related liver function indexes，portal vein tumor thrombus，tumor capsule integrity，BCLC stage and tumor differentiation degree may be predictive factors for recurrence.
To evaluate the efficacy of lenvatinib combined with transcatheter arterial chemoembolization （TACE） in the treatment of unresectable advanced liver cancer，and to analyze the risk factors affecting the survival rate of patients.
Methods
The clinical data of 160 patients with unresectable advanced liver cancer admitted to the Department of Oncology and Department of Intervention of our hospital from January 2023 to July 2023 were retrospectively analyzed. All patients received lenvatinib combined with TACE. The clinical efficacy of all patients after 8 weeks of treatment and the changes of alanine aminotransferase （ALT），aspartate aminotransferase （AST），total bilirubin （TBIL），alpha-fetoprotein（AFP），carcinoembryonic antigen （CEA），carbohydrate antigen 199 （CA199） were recorded，and the 12-month survival rate and progression-free survival （PFS） were recorded，the multivariate Logistic regression analysis was used to analyze the risk factors affecting the survival rate of patients.
Results
Among the 160 patients，the objective response rate （ORR） was 36.25% and the disease control rate （DCR） was 73.13%. ALT，AST，TBIL，AFP，CEA and CA199 after treatment were all lower than before treatment，with statistically significant differences （P＜0.05）. The follow-up analysis showed that 54 patients died and 106 survived，the 12-month survival rate was 63.75%，and PFS was 7.55 months. Multivariate Logistic regression analysis showed that Barcelona （BCLC） stage （OR： 5.801，95% CI： 2.345-14.347），portal vein cancer embolus （OR：6.328，95% CI： 2.509-15.961），peripheral blood neutrophil/lymphocyte ratio （NLR） （OR： 4.978，95% CI：2.350-10.545） and systemic immunoinflammatory Index （SII） （OR： 4.773，95% CI： 2.275-10.013） were the risk factors affecting the prognosis of patients （P＜0.05）.
Conclusion
Lenvatinib combined with TACE improves liver function in patients with unresectable advanced liver cancer，BCLC stage，portal vein cancer embolus，NLR and SII are risk factors affecting the survival rate of patients，and should be paid attention to clinically.
To establish a risk model of severe thrombocytopenia in patients with esophageal squamous cell carcinoma after concurrent radiotherapy and chemotherapy，and to explore its application value.
Methods
A total of 150 patients with esophageal squamous cell carcinoma admitted to Chang'an Hospital from January 2016 to January 2024 were selected，and divided into training set （n=105）and verification set （n=45） according to the ratio of 7∶3. According to the occurrence of severe thrombocytopenia during postoperative concurrent radiotherapy and chemotherapy，the patients in the training group were divided into the occurrence group and the non-occurrence group，and the clinical data of the two groups were compared. Logistic multivariate regression analysis was used to summarize the risk factors，and Nomogram was used to establish a prediction model，and receiver operating characteristic（ROC） curve was drawn to evaluate the effectiveness of the model. Validation set was used for model validation.
Results
Among the 105 patients in the training set，24 patients suffered from severe thrombocytopenia，with an incidence rate of 22.86%. Logistic regression analysis showed that age ≥65 years，diabetes mellitus and three cycles of induction chemotherapy were independent risk factors for severe thrombocytopenia in patients with esophageal squamous cell carcinoma during concurrent radiotherapy and chemotherapy （P＜0.05）. Taking the total score ≥83 as the cut-off value，the AUC predicted by Nomogram prediction model for patients with severe thrombocytopenia in the training set was 0.886，with sensitivity and specificity of 91.67% and 87.65%，positive predictive value and negative predictive value of 68.75% and 97.26% respectively. Among the 45 patients in the training set，10 patients suffered from severe thrombocytopenia，with an incidence rate of 22.22%. The AUC of patients with severe thrombocytopenia in the model prediction validation set was 0.822，and its sensitivity and specificity were 86.36% and 78.26%，respectively. The positive predictive value and negative predictive value were 79.17%and 85.17%，respectively.
Conclusion
The risk of severe thrombocytopenia in patients with esophageal squamous cell carcinoma after concurrent radiotherapy and chemotherapy is high，which is related to the patient's age，complications and induction chemotherapy cycle. The prediction model based on the above risk factors can provide reliable reference for the risk assessment of severe thrombocytopenia in patients.
To analyze the correlation between the ultrasound features of esophageal carcinoma and the levels of neutrophil to lymphocyte ratio （NLR），lymphocyte to monocyte ratio （LMR），neutrophil to monocyte ratio （NMR），and to evaluate the risk of IV lymph node metastasis.
Methods
120 patients with esophageal cancer admitted to Xi'an People's Hospital （Xi'an Fourth Hospital） from January 2021 to January 2024 were selected for endoscopic ultrasonography and ultrasonic characteristics such as lesion diameter，depth of invasion and location were recorded. According to the postoperative pathological examination results of the patients' lymph nodes，Patients with cervical region IV lymph node metastasis and those without cervical region IV lymph node metastasis were included in metastatic group and non-metastatic group，respectively. Differences in NLR，LMR and NMR among patients with different ultrasonic characteristics were compared，and differences in ultrasonic characteristics and laboratory indexes between patients with metastatic and non-metastatic region were compared. Receiver operating characteristic curve （ROC） was used to analyze ultrasonic features of esophageal cancer with NLR，LMR，and NMR，and to evaluate the area under the curve （AUC） and efficacy of cervical region IV lymph node metastasis.
Results
The NLR of patients with lesion diameter ＜2 cm was higher than that of patients with lesion diameter ≥2 cm （P＜0.05）. The NLR of patients with infiltration ＜0.5 cm was lower than that of patients with infiltration ≥ 0.5cm，and the LMR and NMR were higher than those of the latter （P＜0.05）.There was no significant difference in NLR，LMR and NMR among patients with different lesion sites（P＞0.05）. The NLR of non-invasive patients was lower than that of invasive patients，and the LMR and NMR were higher than those of the latter （P＜0.05）. The NLR of patients without microcalcification was lower than that of patients with microcalcification，and the LMR and NMR of patients with microcalcification were higher than those of the latter （P＜0.05）. Of the 120 patients，27 were found to have cervical IV lymph node metastasis，with a metastasis rate of 22.50%. There were significant differences in lesion diameter，invasion depth，envelope invasion and microcalcification between metastatic group and non-metastatic group compared with NLR，LMR and NMR （P＜0.05）. ROC curve showed that the AUC of ultrasonic characteristics combined with laboratory parameters to predict lymph node metastasis in cervical IV region of esophageal cancer was 0.833，and the sensitivity and specificity were 92.59% and 80.65%，respectively （P＜0.05）.
Conclusion
The appearance of cervical IV lymph node metastasis of esophageal cancer is accompanied by changes in the diameter，depth of invasion，capsule invasion，and calcification of esophageal cancer，and is correlated with changes in NLR，LMR，and NMR. The combined ultrasonic characteristics and laboratory parameters can provide a reliable reference for the evaluation of cervical IV lymph node metastasis.
To compare the characteristic changes in the structure and function of the intestinal microbiota in patients with liver cirrhotic gastrointestinal bleeding before and after transjugular intrahepatic portosystemic shunt （TIPS）.
Methods
A total of 20 patients with cirrhotic gastrointestinal bleeding admitted to the Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2020 to January 2024 were selected. Fecal samples before and after TIPS were collected，and fecal samples from 20 healthy volunteers were selected a as controls for metagenomic analysis.Subsequently，species and function annotations were conducted on the sequencing results，the differential flora，metabolic pathways and their correlation were analyzed.
Results
Compared with the healthy control group，patients with cirrhotic gastrointestinal bleeding showed a lower trend in the abundance and functional diversity of gut microbiota. There was no statistically significant difference in α-diversity between the pre-TIPS surgery group and the post-TIPS surgery group （P＞0.05）. However，a statistically significant difference in β-diversity was observed when comparing the three groups （P＜0.05）. The preliminary study revealed that after TIPS，the abundance of Enterobacteriaceae decreased，and the B/E ratio correspondingly increased. This reversed the downward trend of the B/E ratio caused by liver cirrhosis and thus enhanced the colonization resistance of gut bacteria. In terms of carbohydrate metabolism，the gut microbiota tended to shift from the genus Bacteroides，which was more effective in decomposing carbohydrates，to the genus Prevotella，which utilized plant-based carbohydrates. In terms of lipid metabolism，the abundance of butyrate-producing Ruminococcus in the intestine decreased.
Conclusion
There are significant differences in the structural and functional annotations of the intestinal microbiota in patients after TIPS，which may provide a potential novel microecological strategy for the prevention and treatment of postoperative complications of TIPS.
To establish a nomogram model of the risk of hepatic encephalopathy induced by hepatitis B virus （HBV）-related chronic and acute liver failure （HBV-ACLF） and verify its clinical application efficiency.
Methods
A total of 464 patients with HBV-ACLF admitted to Qingdao Eighth People's Hospital from January 2020 to January 2024 were enrolled in the training set （n=325） and the verification set （n=139） according to the ratio of 7∶3. According to the occurrence of hepatic encephalopathy in the training set，the patients were divided into the occurrence group and the non-occurrence group，and the clinical data of the two groups were compared. Logistic multivariate model was used to summarize the risk factors affecting the occurrence of hepatic encephalopathy in HBV-ACLF patients，and nomogram prediction model was established based on the risk factors. The prediction model was applied to the verification set，and the receiver operating characteristic curve （ROC） was plotted to analyze the area under curve （AUC） and prediction efficiency of the prediction model.
Results
Among the 325 patients in the training set，72 patients developed hepatic encephalopathy，the incidence rate was 22.15%. Among the 139 patients in the verification set，29 cases developed hepatic encephalopathy，with an incidence rate of 20.86%. Logistic multivariate regression analysis showed that model of end-stage liver disease （MELD） score≥25，peritonitis，international normalized ratio≥2.54，activated partial thromboplastin time≥48.10 s，and illness in the middle to late stage were all independent risk factors for HBV-ACLF patients to induce hepatic encephalopathy （P＜0.05）. DCA curve showed that the nomogram model showed good clinical net benefit in both training set and verification set. Taking the total score≥117 as the cut-off value，the AUC of the nomogram model in predicting the occurrence of hepatic encephalopathy in the training set and the verification set was 0.957 and 0.899，respectively，with sensitivity of 95.83% and 89.66%，specificity of 95.65% and 90.00%，respectively. Delong test showed that the predictive value of nomogram model was higher than ACLF score （Z=2.594） and MELD score （Z=3.113） （P＜0.05）.
Conclusion
The risk of hepatic encephalopathy in HBV-ACLF patients is high，and it is closely related to the condition，symptoms，coagulation function and other factors. The nomogram model based on the above factors can provide reliable reference for the risk assessment of hepatic encephalopathy in patients.
To investigate the changes of blood cell parameters，serum prealbumin（PA），blood urea nitrogen/creatinine （BUN/Cr） ratio，prognostic nutrition index （PNI），modified critical illness nutritional risk （mNUTRIC） score and their correlation with prognosis in cirrhotic patients with portal hypertension and acute upper gastrointestinal hemorrhage.
Methods
A total of 120 patients with cirrhotic portal hypertension accompanied with upper gastrointestinal acute hemorrhage admitted to Honghui Hospital Affiliated to Xi'an Jiaotong University and Hanzhong Central Hospital from January 2020 to December 2023 were selected as study group，and 100 patients with cirrhotic portal hypertension were selected as control group. Blood cell parameters ［erythrocyte distribution width （RDW），platelet（PLT），platelet volume （PCT），hematocrit （HCT），mean platelet volume （MPV），serum PA，BUN/Cr ratio，PNI and mNUTRIC score were compared between the two groups，and the changes of the above indexes in patients with different prognosis were compared. The correlations between blood cell parameters，serum PA，BUN/Cr ratio，PNI，mNUTRIC score and prognosis in cirrhotic patients with portal hypertension and acute upper gastrointestinal hemorrhage were analyzed by Pearson correlation analysis.
Results
RDW，MPV，BUN/Cr ratio and mNUTRIC score in study group were higher than those in control group，while RDW，PLT，PCT，HCT，MPV，serum PA and PNI levels were lower than those in control group，with statistically significant differences （P＜0.05）； RDW，MPV，BUN/Cr ratio and mNUTRIC score in death group were higher than those in survival group，while RDW，PLT，PCT，HCT，MPV，serum PA and PNI levels were lower than those in survival group，with statistically significant differences （P＜0.05）； the results of Pearson correlation analysis showed that RDW，MPV，BUN/Cr ratio and mNUTRIC score were positively correlated with prognosis，while RDW，PLT，PCT，HCT，MPV，serum PA and PNI were negatively correlated with prognosis （P＜0.05）.
Conclusion
The changes of blood cell parameters，serum PA，BUN/Cr ratio，PNI and mNUTRIC score in cirrhotic patients with portal hypertension accompanied with acute upper gastrointestinal bleeding are closely related to the prognosis，and monitoring these indicators can help advance intervention and improve prognosis.
To analyze the clinical data of MSCT examination and Child-Pugh score of liver function in patients with clinically proven cirrhosis，to establish the evaluation model of liver function compensatory status based on MSCT liver volume measurement，and to verify its accuracy and reliability.
Methods
This study was a retrospective analysis. A total of 170 patients with liver cirrhosis who underwent MSCT examination in Beijing Daxing District People's Hospital from July 2020 to July 2023 were selected as the research objects. The patients were divided into a modeling set and a validation set according to a 3∶1 ratio. There were 144 cases in the modeling set and 26 cases in the validation set.According to the total score of Child-Pugh classification of liver function，the modeling set was divided into two groups： Child-Pugh A and B group and Child-Pugh C group. The differences in clinical data，CT parameters，CT volume and perfusion parameters between the two groups were compared in the modeling set. Binary Logistic regression was used to construct the prediction model，and ROC curve and Z test were used. The diagnostic performance of each model was compared.
Results
In the modeling set，the proportion of hepatic encephalopathy，ascites，TBIL and INR in Child-Pugh C group were higher than those in Child-Pugh A and B group，and ALB was lower than that in Child-Pugh A and B group，with statistically significant differences （P＜0.05）. In the modeling set，the MTT in Child-Pugh C group was longer than that in Child-Pugh A and B group，and HAF，A/V and caudate lobe volume were higher than those in Child-Pugh A and B group. BF，BV，PVP，HAP，total liver volume，right liver volume and left medial lobe volume were lower than those in Child-Pugh A and B group，and CAAT was shorter than that in Child-Pugh A and B group （P＜0.05）. According to multivariate Logistic regression model analysis，BF，BV，MTT，HAF，PVP，CAAT，HAP，A/V，total liver volume，right liver volume，left medial lobe volume and caudate lobe volume were all independent risk factors affecting liver function compensatory status in patients with cirrhosis （P＜0.05）. Hosmer-Lemeshow fit test showed that there were no statistically significant differences between the prediction model of liver volume parameters without MSCT and the prediction model with MSCT （P=0.889，0.388）. Z-test showed that the difference of area under ROC curve between the two prediction models was 0.037 （P＜0.05）. The ROC AUC of liver volume parameter prediction model with MSCT was 0.865 （95% CI： 0.814-0.936），and the prediction efficiency was good.The AUC of liver volume parameter prediction model with MSCT of the independent validation set was 0.749 （95% CI： 0.622-0.840）. The Hosmer-Lemeshow test of verification set showed that the model prediction was in good agreement with the actual value （P=0.084）.
Conclusion
MSCT liver volume measurement shows a good application prospect in evaluating liver function compensatory status in patients with cirrhosis. By combining the liver volume and perfusion parameters provided by MSCT，the liver function compensatory status of patients can be evaluated more accurately and provide strong support for clinical decision-making.
To explore the application value of Th17/Treg immune imbalance in the diagnosis and disease evaluation of children with abdominal Henoch-Schonlein purpura （HSP）.
Methods
A total of 122 children with abdominal HSP admitted to Taihe County People's Hospital from January 2019 to March 2024 were retrospectively analyzed，and 95 children with acute gastroenteritis （AG） and 109 healthy children were selected for comparison. Baseline clinical data and peripheral blood samples were collected from all subjects. Flow cytometry was used to detect the levels of Th17 and Treg in peripheral blood of children with abdominal HSP，and the Th17/Treg ratio was calculated. The ROC curve was drawn to analyze the diagnostic and differential efficacy of Th17/Treg ratio for abdominal HSP. According to the symptom score，the children with abdominal HSP were further divided into mild，moderate and severe groups，and the Th17/Treg ratio in peripheral blood of children with abdominal HSP with different disease severity was compared. Pearson coefficient was used to analyze the correlation between Th17/Treg ratio and IgA level. Logistic regression model was used to analyze the risk factors of severe abdominal HSP.
Results
Compared with AG group and healthy children group，the children with abdominal HSP group had significantly higher Th17 level and Th17/Treg ratio，and a significantly lower Treg level （all P＜0.05）.In healthy children and children with abdominal HSP，the AUC of Th17/Treg in the diagnosis of abdominal HSP was 0.898 （sensitivity 93.44%，specificity 81.65%）. The AUC of Th17/Treg in differentiating AG from HSP was 0.822 （sensitivity was 81.97%，specificity was 71.58%）. With the aggravation of the severity of abdominal HSP，the level of Th17 and Th17/Treg ratio in peripheral blood gradually increased，while the level of Treg gradually decreased （all P＜0.05）. The Th17/Treg ratio in peripheral blood of children with abdominal HSP was positively correlated with IgA level （r=0.407，P＜0.05）. Increased CRP，D-dimer，serum IgA and Th17/Treg ratio were independent risk factors for severe abdominal HSP （all P＜0.05）.
Conclusion
Th17/Treg immune imbalance has a significant value in the diagnosis and disease evaluation of abdominal HSP in children.
To investigate the characteristics of intestinal flora and the clinical significance of serum neuron-specific enolase （NSE），nitric oxide （NO），interleukin-1 （IL-1） and interleukin-6 （IL-6） in children with benign infantile convulsion associated with mild gastroenteritis（BICE）.
Methods
A total of 40 children with BICE treated in Yulin First Hospital from November 2022 to November 2023 were selected as the study group，and 40 children with mild gastroenteritis were selected as the control group. The levels of intestinal flora，serum NSE，NO，IL-1 and IL-6 in children with BICE were compared between the two groups，and the levels of intestinal flora，serum NSE，NO，IL-1 and IL-6 in children with BICE with different disease degrees and recurrence conditions were compared. Pearson correlation analysis was used to analyze the correlation between intestinal flora，serum NSE，NO，IL-1，IL-6 and disease and recurrence in children with BICE.
Results
The levels of Enterococcus，Escherichia coli，Lactobacillus and Bifidobacterium in the study group were lower than those in the control group，and serum NSE，NO，IL-1 and IL-6 were higher than those in the control group，with statistically significant differences （P＜0.05）. The levels of Enterococcus，Escherichia coli，Lactobacillus and Bifidobacterium in the intestinal flora of children with BICE in severe group were lower than those in normal group，and serum NSE，NO，IL-1 and IL-6 were higher than those in normal group，with statistically significant differences （P＜0.05）. The levels of Enterococcus，Escherichia coli，Lactobacillus and Bifidobacterium in the intestinal flora of children with BICE in the relapsed group were lower than those in the non-relapsed group，and the serum NSE，NO，IL-1 and IL-6 were higher than those in the non-relapsed group，with statistically significant differences （P＜0.05）. The results of Pearson correlation analysis showed that Enterococcus，Escherichia coli，Lactobacillus and Bifidobacterium were negatively correlated with disease and recurrence in children with BICE，while serum NSE，NO，IL-1 and IL-6 were positively correlated with disease and recurrence in children with BICE （P＜0.05）.
Conclusion
The changes of intestinal flora，serum NSE，NO，IL-1 and IL-6 in children with BICE are closely related to the severity and recurrence of the disease，and monitoring these indicators is helpful for early clinical intervention and treatment.
To investigate the value of ketorolac tromethamine combined with postoperative transdermal fentanyl for perioperative analgesia in patients undergoing daytime anorectal surgery.
Methods
A prospective study was conducted on 120 patients with mixed hemorrhoids who underwent daytime anal surgery in Xinhua Hospital Affiliated to the School of Medicine，Shanghai Jiao Tong University from January 2020 to January 2022. They were divided into a control group （n=60） and an observation group （n=60） using a random number table method. All patients underwent intravenous tracheal intubation combined with lumbar anesthesia for stapler hemorrhoid mucosal circumcision. The control group received intravenous infusion of the same volume of physiological saline after anesthesia induction，and fentanyl transdermal patch was administered postoperatively. The observation group received preemptive analgesia with ketorolac tromethamine on the basis of the control group. The surgical outcomes，analgesic and sedative effects after needle extraction，changes in plasma stress hormone levels，and incidence of adverse reactions were compared between the two groups.
Results
There was no significant difference in the onset time of anesthesia between the two groups （P＞0.05）. The observation group had shorter recovery time for spontaneous urination and lower limb muscle strength compared to the control group，and the highest pain block plane time was longer than the control group，with statistically significant differences （P＜0.05）. At 10 min，1 h，2 h，6 h，and 12 h after needle extraction，the visual analogue scale score of the observation group was lower than that of the control group，while the Ramsay score was higher than that of the control group （P＜0.05）. After 5 min of needle extraction，the levels of norepinephrine，dopamine，and adrenaline in the observation group were lower than those in the control group（P＜0.05）. The observation of adverse reactions 24 hours after surgery showed that there was no significant difference in the incidence of adverse reactions between the two groups （P＞0.05）.
Conclusion
The application of ketorolac tromethamine preemptive analgesia and postoperative fentanyl transdermal patch in daytime anorectal surgery has significant analgesic and sedative effects，accelerates the time for patients to recover from spontaneous urination and lower limb muscle strength，and has inhibitory effect on stress hormones in plasma，with high safety.
To investigate the correlation of fecal bacteria，fecal calprotectin （FC），systemic immunoinflammatory index （SII），D-dimer （D-D） levels and disease severity in patients with ulcerative colitis （UC）.
Methods
A total of 115 UC patients admitted to Xijing Hospital from October 2018 to December 2019 were selected as the study objects，and they were divided into the mild group（n=46），the moderate group （n=39），and the severe group （n=30） according to the severity of the disease.The distribution of fecal bacteria，FC，SII，and D-D levels of patients in the three groups were compared，and the distribution of fecal bacteria，FC，SII and D-D levels in patients with different prognosis were compared. Pearson correlation analysis was used to analyze the correlation between fecal bacteria，FC，SII and D-D levels and disease severity and prognosis in UC patients.
Results
The levels of Enterococcus，Escherichia coli and Bacteroides in the severe UC group were higher than those in the moderate and mild UC groups； the levels of Lactobacillus and Bifidobacteria were significantly lower than those in the moderate and mild UC groups，the levels of Enterococcus，Escherichia coli and Bacteroides in the moderate UC group were higher than those in the mild UC group； the levels of Lactobacillus and Bifidobacteria in the moderate UC group were significantly lower than those in the mild UC group，with statistically significant differences （P＜0.05）； the levels of FC，SII and D-D in the severe UC group were higher than those in the moderate and mild UC groups，and the levels of FC，SII and D-D in the moderate UC group were higher than those in the mild UC group，with statistically significant differences （P＜0.05）.After 6 months of outpatient follow-up of 115 UC patients，88 cases had good prognosis and 27 cases had poor prognosis. The levels of Enterococcus，Escherichia coli，Bacteroides，FC，SII and D-D in UC patients with poor prognosis were higher than those in UC patients with good prognosis，while Lactobacillus and Bifidobacterium were significantly lower than those in UC patients with good prognosis，with statistically significant differences （P＜0.05）. The results of Pearson correlation analysis showed that the levels of Enterococcus，Escherichia coli，Bacteroides，FC，SII and D-D were positively correlated with disease severity and negatively correlated with prognosis in UC patients （P＜0.05）. The levels of Lactobacillus and Bifidobacterium were negatively correlated with disease severity and positively correlated with prognosis（P＜0.05）.
Conclusion
Significantly elevated levels of fecal bacterial dysbiosis，FC，SII，and D-D in UC patients are closely associated with disease severity，and clinical testing of these indicators can help to accurately assess the condition and treatment efficacy of UC patients.
Irritable bowel syndrome （IBS） is a common intestinal dysfunction disease，which brings a heavy burden to patients' life，spirit and economy. The pathogenesis of IBS is still unclear. The main clinical treatment is to regulate gastrointestinal motility and relieve intestinal spasm，but the effect is not good. In recent years，traditional Chinese medicine such as oral Chinese medicine，massage and acupuncture have been proved to have a good effect on the treatment of IBS. Among them，massage therapy，as a non-drug and non-invasive means，acts on the body surface through specific techniques，harmonizing qi and blood，dredging meridians，and adjusting zangfu organs，which has been confirmed by many studies to alleviate IBS symptoms and improve the quality of life of patients. This review systematically combs the research progress of massage therapy for IBS，covering the theoretical basis of massage therapy for IBS，discussion of mechanism of action，clinical operation methods and skills，efficacy evaluation system，current problems and future research directions. The aim is to provide more scientific，systematic and comprehensive reference and guidance for clinical massage treatment of IBS，and promote the in-depth application and development of massage therapy in the treatment of IBS.
