Objective To summarize the influencing factors of central lymph node metastasis in thyroid papillary carcinoma. Method Relevant literature about papillary thyroid carcinoma were reviewed and predictive factors of central lymph node metastasis were summarized. Results Studies had shown that, male, younger age, larger tumor size, multifocal, and BRAF mutations were risk factors for central lymph node metastasis in thyroid papillary carcinoma, while tumors located in the upper pole and combined with Hashimoto disease (HT) were the protective factors for central lymph node metastasis. Conclusions The central lymph node metastasis detection rate is low, so it is unable to meet with the preoperative diagnosis in papillary thyroid carcinoma. A large number of studies have confirmed that clinical pathological features have predictive value for preoperative lymph node diagnosis, and can provide a reference for the selection of surgical methods in thyroid papillary carcinoma.
ObjectiveTo recognize the intraoperative recognition of parathyroid gland optical technology and explore its application value in thyroid surgery to protect the parathyroid gland.MethodsLiterature review was conducted on the principle and application status of intraoperative recognition of parathyroid gland optical technology by using " thyroidectomy” " parathyroid gland” " Near-Infrared imaging” " laser speckle contrast imaging”, and " optical coherence tomography” as retrieval terms to retrieve literatures.ResultsIntraoperative optical technique alone or in combination with contrast agent could improve the recognition rate of parathyroid gland, reduce the damage of feeding vessels, and thus reduce the incidence of postoperative hypocalcemia.ConclusionsTraditional intraoperative parathyroid gland recognition methods needs to be improved in real-time protection effectiveness and accuracy, and the combination of new optical technology and contrast agent can largely make up for these shortcomings, but there are still obstacles in the promotion.
In order to solve imperfection of heart rate extraction by method of traditional ballistocardiogram (BCG), this paper proposes an improved method for detecting heart rate by BCG. First, weak cardiac activity signals are acquired in real time by embedded sensors. Local BCG beats are obtained by signal filtering and signal conversion. Second, the heart rate is estimated directly from the BCG beat without the use of a heartbeat template. Compared with other methods, the proposed method has strong advantages in heart rate data accuracy and anti-interference, and it also realizes non-contact online detection. Finally, by analyzing the data of more than 20,000 heart rates of 13 subjects, the average beat error was 0.86% and the coverage was 96.71%. It provides a new way to estimate heart rate for hospital clinical and home care.
Objective To prepare carboxymethyl-chitosan/hyaluronic acid/poly(vinyl alcohol) (CHP) blend membrane, evaluate its physicochemical properties and intraocular biocompatibil ity and to investigate its feasibil ity to be appl ied to glaucoma filtering surgery. Methods CHP blend membrane was prepared using solution casting method after blending carboxymethyl-chitosan, HA and poly(vinyl alcohol) in a proportion of 5 ∶ 4 ∶ 1 (M/M). Its water absorption rate, swell ing rate, permeabil ity, and mechanical properties were detected. Subconjunctival fibroblasts separated from subconjuncitival tissue of New Zealand white rabbits were cultured, and the cells at passage 4 were cultured on cell culture plate with or without the CHP blend membrane, serving as the experimental group and the control group, respectively. Effectof the CHP blend membrane on the subconjunctival fibroblasts was tested by MTT method 24, 48, and 72 hours after culture. Six New Zealand white rabbits were randomly divided into two groups (n=3 rabbits per group), and the CHP blend membrane and SK gel were implanted into the rabbits’ subconjunctival space and anterior chamber in the experimental group and the control group, respectively. Sl it lamp observation and binocular reaction record were conducted 1, 3, 5, 9, 11, 20, 30, 45, and 60 days after operation. Corneal tissue harvested from the experimental group was observed using scanning electron microscope 15 days after operation to study ophthalmic biocompatibil ity and biodegradabil ity. Results The water absorption rate and the swell ing rate of the CHP blend membrane was 83.8% ± 1.3% and 3.59 ± 0.50, respectively. The tensile strength of the dry and the wet CHP blend membrane was (20.59 ± 1.73) and (0.51 ± 0.13) MPa, respectively. The breaking elongation rate of the dry and the wet CHP blend membcane was 10.69% ± 1.16% and 53.15% ± 2.46%, respectively. The CHP blend membrane had good permeabil ity to NaCl and L-tyrosine. Absorbance (A) value of the experimental group 24, 48, and 72 hours after breeding was 0.207 ± 0.083, 0.174 ± 0.080, and 0.181 ± 0.048, respectively, while the A value of the control group was 0.284 ± 0.011, 0.272 ± 0.083, and 0.307 ± 0.056, respectively. Significant difference was evident between two groups (P lt; 0.05). In the experimental group, a small amount of floccus was exuded around the implanted membrane 1 day after operation; the floccus was absorbed on the third day, and there was no obvious inflammatory reaction occurring on the eleventh day. Most of the membrane degraded on the sixtieth day. Scanning electron microscope observation showed that the hexagonal morphology of the corneal endothel ial cells was intact, and no degradation particles adhered to the surface. In the control group, the implantation of SK gel into anterior chamber was unsuccessful because the SK gel was quite soft and easily broken. In the experimental group, mild hyperemia emerged around the implanted membrane 1 day after the subconjunctival implantation of the membrane, and it became normal on the ninth day. No corneal edema and inflammatory reaction of anterior chamber occurred till the sixtieth day. The results in the control group and the experiment group were similar. Conclusion Due to its good physicochemical properties and biocompatibil ity, the CHP blend membrane has potential appl ications in glaucomafiltering surgery.
Objective Through a retrospective study on esophageal function changes and symptom relief after video-assisted thoracoscopic surgery treatment for achalasia of cardia (AC) to assess the clinical value of this operation. Methods We reviewed the data of 34 AC patients who received modified Heller operation by video-assisted thoracoscopic surgery in the Affiliated Hospital of Guizhou Medical University from March 2012 to September 2014. There were 11 males and 23 females with a median age of 35 (11–67) years. These patients were divided into four groups according to the time of treatment and follow-up: preoperative group, postoperative one-month group, postoperative three-month group and postoperative six-month group. Changes of symptoms, radiography and esophageal dynamics before and after therapy were collected. These different groups were analyzed based on statistical methods. Results There was no statistical difference in ages and genders among groups (P>0.05). The surgery was successful and no complication or death occurred. Symptoms of patients showed different degrees of relief and the postoperative grade of clinical symptoms decreased (P<0.05). After surgery, lower esophageal sphincter pressure (LESP), lower esophageal sphincter resting pressure (LESRP) and esophageal body pressure (EBP) decreased significantly, while lower esophageal sphincter relax rate (LESRR) increased (P<0.05). While there was no significant difference in length of lower esophageal sphincter (LESL,P>0.05). Angiography of upper digestive tract revealed that compared to the preoperative group, the maximum width in postoperative three-month group decreased significantly (P<0.05). During the follow-up, 3 patients suffered gastroesophageal reflux, 2 patients esophageal perforation and 1 patient empyema due to esophago-pleural fistula. No massive hemorrhage of upper digestive tract and hiatal hernia occured. Conclusion Sugery can significantly ameliorate the clinical symptoms of the patients with AC, and improve esophageal dynamics. And it is simple and easy to perform with less complications and better long-term outcomes. Improved Heller operation by video-assisted thoracoscopy is a less invasive procedure when compared with the traditional thoracotomy. Moreover, esophageal manometry can objectively assist in the diagnosis and degree of the disease and effect of therapy.
ObjectiveTo evaluate the bone repair efficacy of the new nano-hydroxyapatite (n-HA)/polyurethane (PU) composite scaffold in the treatment of chronic osteomyelitis in tibia.MethodsA novel levofloxacin@mesoporous silica microspheres (Lev@MSNs)/n-HA/PU was successfully synthesized. Its surface structure was observed by scanning electron microscopy (SEM). Fifty adult female New Zealand rabbits were randomly selected, and osteomyelitis was induced in the right tibia of the rabbit by injecting bacterial suspension (Staphylococcus aureus; 3×107 CFU/mL), which of the method was described by Norden. A total of 45 animals with the evidence of osteomyelitis were randomly divided into 4 groups, and the right medullary cavity of each animal was exposed. Animals in the blank control group (group A, n=9) were treated with exhaustive debridement only. The remaining animals were first treated by exhaustive debridement, and received implantations of 5 mg Lev@PMMA (group B, n=12), 1 mg Lev@MSNs/n-HA/PU (group C, n=12), and 5 mg Lev@MSNs/n-HA/PU (group D, n=12), respectively. At 12 weeks postoperatively, the right tibia of rabbits were observed by X-ray film, and then gross observation, methylene blue/acid fuchsin staining, and SEM observation of implant-bone interface, as well as biomechanical test (measuring the maximal compression force) were performed.ResultsX-ray films showed that the infection were severer than those of preoperation in group A, while the control of inflammation and bone healing of rabbits in group D were obviously better than those at preoperation. The gross observation showed extensive bone destruction in group A, a significant gap between bone tissue and the material in groups B and C, and close combination between bone tissue and the material in group D. The histology of the resected specimens showed that there was no obvious new bone formation around the materials in groups B and C, and there was abundant new bone formation around the periphery and along the voids of the materials and active bone remodeling in group D. The SEM observation of the bone-implant interface demonstrated that no new bone formation was observed at the bone-implant interface in groups B and C. However, bony connections and blurred boundaries were observed between the material and host bone tissue in group D. The biomechanical test showed the maximal compression force of groups B and D were significantly higher than that of groups A and C (P<0.05), but there was no significant difference between groups B and D (P>0.05).ConclusionThe novel synthetic composite Lev@MSNs/n-HA/PU exhibit good antibacterial activities, osteoconductivity, and biomechanical properties, and show great potential in the treatment of chronic osteomyelitis of rabbits.
ObjectiveTo introduce patients with long-term hypocalcemia and normal parathyroid hormone (PTH) values after total thyroidectomy, and to analyze the possible causes of this phenomenon. MethodsThe medical records of 1 010 consecutive patients with total thyroidectomy treated in the Center for Diagnosis and Treatment of Thyroid Disease, the First Affiliated Hospital of Kunming Medical University from January 2019 to December 2020 were collected. Seven patients with normal PTH and blood calcium before operation and at least 2 times of PTH with hypocalcemia detected more than 6 months after operation were followed-up to understand the symptoms of hypocalcemia, vitamin D level and calcium consumption. ResultsSeven patients with thyroid papillary carcinoma underwent total thyroidectomy without parathyroid autotransplantation, and there were 6 cases with mild deficiency or insufficient of vitamin D before operation. The follow-up time was 12–28 months, and the median follow-up time was 19 months. Seven patients developed hypocalcemia after continuous administration of calcium and calcitriol, and vitamin D levels remained mild deficiency or insufficient, PTH decreased by more than 50% in 6 patients one year after operation compared with that before operation. ConclusionsPatients with long-term normal PTH values and hypocalcemia after total thyroidectomy have obviously lower PTH levels than those before operation. The possible factors are parathyroid damage during operation and vitamin D deficiency. Such these patients should be more properly referred to as “parathyroid insufficiency”.
ObjectiveTo investigate the differences in middle ear function between adenoid hypertrophy (AH) children with type A tympanogram and normal children, and to evaluate the value of wideband acoustic immittance (WAI) in diagnosing middle ear dysfunction in AH children with type A tympanogram. MethodsThis retrospective cohort study included 96 children (192 ears) with AH and 40 healthy children (80 ears) as the control group. All children underwent pure tone audiometry, 226 Hz tympanometry, WAI, otoscopy, and electronic nasopharyngoscopy. Type A AH children were selected as the study group (AH group) to compare the 226 Hz tympanometry index and WAI between the two groups. A binary logistic regression model was constructed after dimensionality reduction by principal component analysis of the frequencies with statistical significance, and the diagnostic value of the model was evaluated by receiver operating characteristic (ROC) curve. ResultsThere was no significant difference in 226 Hz tympanometry between the two groups (P>0.05). This study found that there were significant differences in WAI between children with AH and healthy children. Under tympanic peak pressure, the wideband absorbance (WBA) of the AH group was significantly higher than that of the control group at 226～630 Hz and 3 150～6 000 Hz; Under ambient pressure, the WBA of the AH group was significantly lower than that of the control group at 1 250～1 600 Hz and significantly higher than that of the control group at 4 000～6 000 Hz. The dimensionality of 15 statistically significant frequencies was reduced to 3 principal components (89.79% of the original information) by principal component analysis. The binary logistic regression model constructed after dimensionality reduction by principal component analysis had a high diagnostic value, with an AUC of 0.813, a sensitivity of 62.18%, and a specificity of 87.50%. ConclusionWAI can be used as an effective method for evaluating the middle ear function of AH children with type A tympanogram.
目的 探讨静脉留置针封管用肝素诱导的血小板减少症（HIT）的临床特点。 方法 分析2010年1月－2011年12月，在1 215例静脉留置针肝素封管患者中发生的14例HIT患者的临床表现，血小板（PLT）、HIT抗体的变化，氯吡格雷、阿加曲班、地塞米松等治疗的结果。 结果 1 215例患者中：发生HIT 14例，发生率1.15%；HIT并血栓形成综合征4例，发生率0.33%。14例HIT患者中：经典型12例，占85.7%。出血7例，发生率50.0%，其中1级、2级出血发生率分别为42.9%（6/14）、7.1%（1/14），分别占出血的85.7%（6/7）、14.3%（1/7）。血栓形成4例，发生率28.6%，其中静脉血栓3例，占血栓形成的75.0%。14例均发生于肝素封管后第1～14天，其中第6～7天8例，占57.1%。PLT降低到最低值的时间为肝素封管后2～10 d内，其中2～5 d内13例，占92.9%。PLT降低的最低值为（1.81～101）×109/L，其中PLT（20～70）×109/L12例，占85.7%；PLT降至最低时下降的比值为51.1%～90.1%，其中50%～80%10例、占71.4%。1例至28 d死亡时血小板没有恢复至肝素封管前水平，其余13例患者PLT减少持续时间5～13 d，其中5～10 d 10例，占76.9%。14例（100%）HIT患者HIT抗体阳性，其中13例（92.9%）在PLT开始减少时即阳性，1例在PLT减少2周后呈阳性。14例HIT患者中12例（85.8%）痊愈，1例（7.1%）脑血栓后遗症，1例（7.1%）死于急性肺栓塞。 结论 静脉留置针封管用肝素可导致HIT，PLT减少及血栓、HIT抗体是诊断的可靠依据。及时停用肝素，必要时抗凝、抗PLT、类固醇激素治疗效果好，部分患者进展快，死亡率高。
ObjectiveTo determine the effectiveness of continuous intercostal nerve block for pain relief after thoracotomy.MethodsFrom November 2017 to October 2018, 120 patients who received thoracotomy procedure in our hospital were collected, including 60 males and 60 females aged 40-77 (58.10±7.00) years. The patients were randomly allocated into three groups by digital table including a continuous intercostal nerve block group (group A, n=40), a single intercostal nerve block group (group B, n=40), and an epidural analgesia group (group C, n=40). All the groups received the same basic analgesia. The pain scores and rescue analgesic doses were compared.ResultsOn postoperative day (POD) 0, all groups achieved effective pain control, and the visual analogue score was 2.02±0.39 points in the group A, 2.13±0.75 points in the group B and 2.03±0.69 points in the group C (P>0.05). On POD 0-2 and POD 3-4 (without basement analgesia), there was no significant difference between the group A and group C in the pain scores (2.08±0.28 points vs. 1.93±0.53 points, 3.20±0.53 points vs. 3.46±0.47 points, P>0.05), however, the difference between POD 0-2 and POD 3-4 in each group was stastically different (group A, 2.08±0.28 points vs. 3.20±0.53 points; group B, 2.42±0.73 points vs. 5.45±0.99 points; group C 1.93±0.53 points vs. 3.46±0.47 points, P<0.05). In terms of the rescue analgesic doses, there was no significant difference between the group A and group C (220.00±64.08 mg vs. 225.38±78.85 mg, P>0.05); it was larger in the group B than that in the group A and group C (343.33±119.56 mg vs. 220.00±64.08 mg; 343.33±119.56 mg vs. 225.38±78.85 mg, P<0.05).ConclusionMultimodal analgesia is an optimal choice in the initial stage after thoracotomy surgery. Continuous intercostal nerve block is an effective way to pain management in patients with thoracotomy.