Objective To study the special traits of primiparae’s compliance with labor analgesia, so as to offer individualized analgesia solutions during spontaneous labor. Methods The uniparous primiparae with cephalic presentation between gestational weeks 38 and 40 were divided into two groups based on their educational background (college education or above, and high school education or below), each group with 20 cases. The demographical statistics of the two groups including their State-Trait Anxiety Inventory (STAI) grading, PCA results, and delivery situation were recorded and analyzed. Results Differences in age, height, and weight were not statisticallysignificant (Pgt;0.05); differences in T-AI were not statistically significant (Pgt;0.05); differences in S-AI were statistically significant (Plt;0.05); differences in anxiety and numbers of adding anesthetics were not statistically significant (Pgt;0.05); differences in failure to tolerate labor pains and requiring caesarean section were statistically significant (Plt;0.05). Conclusion Primiparae with higher educational degree tend to have higher S-AI grading and perform poorly in compliance with labor analgesia.
Objective To evaluate the outcomes of sleeve resection following neoadjuvant chemoimmunotherapy for lung cancer. Methods The clinical data of patients diagnosed with lung cancer and undergo sleeve lobectomy surgery at Tianjin Chest Hospital were retrospectively analyzed. Patients were divided into two groups: a neoadjuvant treatment group and a surgery alone group. The clinical data of two groups were compared. Results Finally 22 patients were collected, including 19 males and 3 females with a median age of 63 years. There were 7 patients in the neoadjuvant treatment group, and 15 patients in the surgery alone group. There was no statistical difference in surgical time, intraoperative bleeding, lymph node dissection, postoperative catheterization time, or postoperative drainage volume between the two groups (P>0.05). In the neoadjuvant treatment group, 1 patient had a second thoracotomy exploration for hemostasis due to bronchial artery bleeding, 2 patients had wound infection, 1 patient had immune-associated pneumonia before surgery, and 1 patient had immune-associated pneumonia before postoperative adjuvant therapy. Postoperative pathological results of patients in the neoadjuvant treatment group showed that 1 (1/7, 14.3%) patient had pathological complete response, and 3 (3/7, 42.9%) patients achieved major pathological response. Conclusion Neoadjuvant chemoimmunotherapy can lead to complications, including operation-related complications and immunotherapy-related complications. However, the degree of postoperative pathological remission is also significantly improved. Overall, sleeve resection following neoadjuvant chemoimmunotherapy can be considered as a treatment option for patients with lung cancer.
Objective To investigate the influence of including HIV/AIDS patients on the consolidated fund under the New Cooperative Medical System （NCMS）. Methods Designed questionnaires were used to investigate 24 HIV/AIDS patients and 1155 randomized sample of the population to compare their income, requirement for public health service, expenditure of medical care and to analyze the influence of including HIV/AIDS patients. Results We found the income of HIV/AIDS patients was lower than healthy population in 2003 （722 vs. 2 162 RMB） ; but the requirement （outpatient：2 ：1, inpatient：5 ：1 ）and expenditure of medical care was higher in HIV/AIDS patients. Including HIV/ AIDS patients into NCMS would cause an adverse-effect on consolidated fund. When more than 293 HIV/AIDS patients were included, it would be beyond what the consolidated fund can afford. Conclusions Including HIV/AIDS patients into NCMS can decrease the HIV/AIDS expenditure to some degree. But the government still needs to get involved to share risks and to establish an HIV/AIDS fund to cover that part which NCMS could not afford.
ObjectiveTo investigate effects of sleeve gastrectomy (SG)-transit bipartition (SG-TB) and simple SG on bariatric and anti-diabetic and protective effect on esophagus reflux. MethodsA total of 36 male Sprague-Dawley rats were used to successfully induce the obesity with type 2 diabetes mellitus (T2DM) model by dietary feeding and receiving intraperitoneal injection of streptozotocin (35 mg/kg), then were randomly averagely divided into SG, SG-TB, and sham operation (SO) groups according to the surgical methods, and 8 rats from each procedure were randomly selected and included to use for experimental observation. The observation period was 12 weeks. The changes of terminal esophageal mucosa were observed at the 12th week after operation. The body weight and food intake were measured every 2 weeks after operation. The fasting blood glucose (FBG), oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) blood glucose levels were measured before operation and at the 4th and 12th week after operation. And the changes of glucagon like peptide-1 (GLP-1) and insulin levels were measured before operation and at the 12th week after operation. ResultsThere were no significant differences in all indexes among the 3 groups before operation (P>0.05). ① No esophageal papillomatosis was observed in the SG-TB group at the 12th week after operation, but more severe esophageal papillomatosis was observed in the SG group, and the mucosal height in the SG-TB group was lower than that in the SG group (P<0.05). ② From the 4th week after operation, the body weight and food intake of the SG-TB group and SG group were lower than the SO group (P<0.05), and their changes of these two groups over time were generally stable. While no significant difference was found in the reduction of body weight between the SG-TB group and the SG group (P>0.05), however the food intakes of the SG-TB group were higher than the SG group at the 10th and 12th week after operation (P<0.05). ③ The levels of FBG, OGTT and ITT blood glucoses in the SG-TB group and SG group were lower than in the SO group at the 4th and 12th week after operation (P<0.05) and remained stable after operation. However, no significant difference was found in the FBG and ITT blood glucose level between the SG-TB group and the SG group (P>0.05), while the level of OGTT blood glucose in the SG-TB group was lower than that in the SG group at the 12th week after operation (P<0.05). ④ The levels of GLP-1 in the SG-TB group and SG group were higher than in the SO group and still higher than before operation (P<0.05), while the insulin levels were lower than in the SO group and lower than before operation (P<0.05). ConclusionsFrom preliminary results of this study, change of terminal esophageal mucosa after SG-TB is weaker than that of SG operation, and it is found that SG-TB surgery shows a better trend in blood glucose control as compared with SG operation. However, due to the limitations of sample size, further research and anti-reflux effect of SG-TB operation still need to be verified.
As an important intracellular genetic and regulatory center, the nucleus is not only a terminal effector of intracellular biochemical signals, but also has a significant impact on cell function and phenotype through direct or indirect regulation of nuclear mechanistic cues after the cell senses and responds to mechanical stimuli. The nucleus relies on chromatin-nuclear membrane-cytoskeleton infrastructure to couple signal transduction, and responds to these mechanical stimuli in the intracellular and extracellular physical microenvironments. Changes in the morphological structure of the nucleus are the most intuitive manifestation of this mechanical response cascades and are the basis for the direct response of the nucleus to mechanical stimuli. Based on such relationships of the nucleus with cell behavior and phenotype, abnormal nuclear morphological changes are widely used in clinical practice as disease diagnostic tools. This review article highlights the latest advances in how nuclear morphology responds and adapts to mechanical stimuli. Additionally, this article will shed light on the factors that mechanically regulate nuclear morphology as well as the tumor physio-pathological processes involved in nuclear morphology and the underlying mechanobiological mechanisms. It provides new insights into the mechanisms that nuclear mechanics regulates disease development and its use as a potential target for diagnosis and treatment.
ObjectiveTo investigate the safety and feasibility of domestic MP1000 robotic surgical system assisted thyroidectomy via submaxillary approach in porcine animal model. MethodThe thyroidectomy process assisted by the MP1000 robotic surgical system via submaxillary approach for a Bama pig in the 960th Hospital of the Joint Logistics Support Force was retrospectively analyzed. ResultsThe operation was performed as planned programme using the MP1000 robotic surgical system without opening, adding or lengthening the surgical incision. There was no mechanical problems during the MP1000 robotic surgical operation. The operative time was 53 min and the estimated intraoperative blood loss was 10 mL. There was no shaking of instruments and robotic arm during the operation, and the 3 surgical instruments cooperated skillfully, the establishment of surgical operation space successfully was completed, the thyroid blood vessels accurately and finely was dissected, and the separation, coagulation and cutting of blood vessels were smoothly completed. The recurrent laryngeal nerve and parathyroid gland were delicately dissected and protected. The carotid sheath, trachea, esophagus, and other important organs around the thyroid did not be damaged. The master-slave mapping frequency was high, and there was no delay sense during the operation. The lens resolution of MP1000 was 1 920×1 080, the surgical field of vision was clear, no visual field was defected and the visual field was stable and not shaking, light source front and intelligent adaptive temperature control system reduced the fogging of the lens, and the lens was scoured for 4 times during the operation. ConclusionAccording to the preliminary results of the experimental animal in this study, MP1000 robotic surgical system can successfully complete thyroidectomy via submaxillary approach in porcine animal model.
ObjectiveTo develop an experimental model of gastroesophageal reflux-induced esophageal stricture in rats and explore the mechanism of esophageal stricture. MethodsA total of 30 male Sprague-Dawley (SD) rats by random number table method were randomly divided into three groups as follows: an operation+acid perfusion group, first the models of lower esophageal sphincter relaxation and hiatal hernia were made, and then the rats’ esophagus were perfused with hydrochloric acid-pepsin; acid perfusion group, the rats’ esophagus were directly perfused with hydrochloric acid-pepsin; and control group, rats’ esophagus were perfused with normal saline. After 4 weeks of continuous perfusion, the esophageal mucosal injury of SD rats in each group were observed, and the concentrations of inflammatory cytokines [tumor necrosis factor-α (TNF-α), interleukin (IL)-1β and IL-18] in esophageal tissues were detected by enzyme-linked immunosorbent assay. ResultsIn the operation+acid perfusion group, esophageal stricture was formed in 2 SD rats, but no esophageal stenosis was found in the acid perfusion group and the control group. The body weight of rats in the operation+acid perfusion group and the acid perfusion group were lower than that in the control group (P<0.05). The esophageal mucosal injury scores of rats in the operation+acid perfusion group and the acid perfusion group were higher than that in the control group (P<0.001), and the operation+acid perfusion group was higher than that in the acid perfusion group (P=0.014). The concentrations of TNF-α, IL-1β and IL-18 in esophageal tissues were higher in the operation+acid perfusion group and the acid perfusion group than that in the control group (P<0.001), and the operation+acid perfusion group was higher than that in the acid perfusion group (P<0.001). ConclusionsThe anti-reflux barrier is an important part of preventing gastroesophageal reflux disease. The destruction of anti-reflux barrier, hydrochloric acid-pepsin perfusion and inflammatory cytokines jointly induced esophageal inflammation and injury, and even caused esophageal stricture.
ObjectiveAicardi and Goutières syndrome was first reported as a rare hereditary encephalopathy with white matter involvement in 1984. Typical clinical manifestations include severe mental motor development retardation or regression, pyramidal and extrapyramidal symptoms and signs, epilepsy, microcephaly and frostbite.MethodsTo collect a case of patient who presented with convulsions 14 days after birth without obvious inducement. The child was diagnosed as epilepsy in the local hospital and the symptoms improved after treatment with antiepileptic drugs. At 4 months, the child presented nods and clenched fists, and was diagnosed as infantile spasm. After Adrenocorticotrophic hormone and drug treatment, the symptoms gradually improved. Due to upper respiratory track infection, the child was aggravated at the age of 1 year and 2 months, and then diagnosed as Aicardi-Goutières syndrome by video EEG, skull MRI, fundus and gene screening.ResultsSurgery and treatment with antiepileptic drugs significantly improved the symptoms of the child, and the pathological biopsy of the brain tissue supported the previous diagnosis.ConclusionsThe report of this case will help to improve the clinician's diagnosis and treatment of Aicardi-Goutières syndrome.
ObjectiveTo explore the clinical manifestation, diagnosis, treatment and prognosis of infantile spasm complicated with craniostenosis.MethodsA case of infantile spasm complicated with craniostenosis in the Department of Neurology of Qilu Children's Hospital in December 2017 was reviewed with the literature. The clinical manifestations, diagnosis, treatment and prognosis of infantile spasm with craniostenosis were analyzed.ResultsThe proband infantile spasms and craniostenosis was diagnosed by clinical, imaging examination and VEEG. Epileptic attack was prevented and craniostenosis was corrected by hormone shock therapy (corticotrophin was administered for 14 days, followed by topiramate)and surgical treatment (cranial cap reconstruction was performed), and good clinical prognosis was obtained.ConclusionThis case was the first reported case of craniostenosis with infantile spasm in China, and compared with the foreign treatment method, better treatment method and the operation opportunity were obtained. Which has a significant effect on the clinical treatment of infantile spasm complicated with transcranial disease.
Objective To exploring the effectiveness of perioperative application of new surgical clinical classification and staging for myasthenia gravis (MG) in reducing the incidence of postoperative myasthenic crisis (MC). Methods The clinical data of patients with generalized MG admitted to the Comprehensive Treatment Center for Myasthenia Gravis of Henan Provincial People’s Hospital from January 2018 to June 2022 were retrospectively analyzed, who were scored with myasthenia gravis-activities of daily living (MG-ADL) score and quantification of the myasthenia gravis (QMG) score at the first visit, 1 day before surgery, and 3 days after surgery. The patients were divided into a group A (typeⅡ) and a group B (typeⅢ+Ⅳ+Ⅴ) by the new surgical clinical classification and staging of MG according to the disease progression process, and all patients underwent expanded thoracoscopic thymus (tumor) resection after medication and other interventions to control symptoms in remission or stability. The incidence of MC and the efficiency rate after surgery were analyzed. The normal distribution method and percentile method were used to calculate the unilateral 95% reference range of the QMG score and MG-ADL score. Results Finally 126 patients were enrolled, including 62 males and 64 females, aged 13-71 years, with an average age of 46.00±13.00 years. There were 95 patients in the group A and 31 patients in the group B, and the differences of the preoperative baseline data between the two groups were not statistically significant (P>0.05). The incidence of postoperative MC was 1.05% (1/95) in the group A and 3.23% (1/31) in the group B (P>0.05). The effective one-sided 95% reference range of the QMG score and MG-ADL score 1 day before surgery was 0-7.75 and 0-5.00, and there was no postoperative death in both groups. Conclusion The new surgical clinical classification and staging of MG can guide the timing of surgery, which can benefit patients undergoing surgery for MG and greatly reduce the incidence of postoperative MC.