The directed functional connectivity in cerebral cortical is the key to understanding the pattern of the behavioral tissue. This process was studied to explore the directed functional network of rifle shooters at cerebral cortical rhythms from electroencephalogram (EEG) data, aiming to provide neurosciences basis for the future development of accelerating rifle skill learning method. The generalized orthogonalized partial directed coherence (gOPDC) algorithm was used to calculate the effective directed functional connectivity of the experts and novices in the pre-shot period. The results showed that the frontal, frontal-central, central, parietal and occipital regions were activated. Moreover, the more directed functional connections numbers in right hemispheres were observed compared to the left hemispheres. Furthermore, as compared to experts, novices had more activated regions, the stronger strength of connections and the lower value of the global efficiency during the pre-shot period. Those indirectly supported the conclusion that the novices needed to recruit more brain resources to accomplish tasks, which was consistent with " neural efficiency” hypothesis of the functional cerebral cortical in experts.
ObjectiveTo compare short-term efficacy of non-intubated video-assisted thoracic surgery (NIVATS) in patients with lobectomy and intubated video-assisted thoracic surgery (IVATS) for rapid postoperative recovery. Methods The CNKI, Wanfang Database, VIP, China Biology Medicine disc, Web of Science, Clinicaltrials.gov, The Cochrane Library and EMbase, PubMed were searched by computer for RCT literature and observational literature on topics related to routine thoracoscopic lobectomy under non-tracheal intubation were collected. The search period was from inception to April 1, 2023. After literature collection and quality evaluation with strict inclusion criteria, the effectiveness and feasibility of the two anesthesia methods were systematically analyzed. Results A total of 14 articles were included in this study, consisting of 4 randomized controlled studies and 10 retrospective studies, including 1 840 patients. The results showed that NIVATS in the treatment of lung cancer compared with IVATS, there were significant differences in operative time [MD=–13.39, 95%CI (–20.16, –6.62), P<0.05)], postoperative anesthesia waking time [MD=–20.34, 95%CI (–26.83, –13.84), P< 0.05], incidence of postoperative airway complications [MD=0.49, 95%CI (0.34, 0.71), P<0.001], length of hospital stay [MD=–0.86, 95%CI (–1.46, –0.26), P<0.05], chest tube indwelling time [MD=–0.73, 95%CI (–1.36, –0.10), P<0.05], total drainage of chest tube [MD=–231.82, 95%CI (–328.64, –135.01), P < 0.05] and postoperative feeding time [MD=–5.68, 95%CI (–7.63, –3.73), P < 0.05] were safer and more effective, and can significantly accelerate the rapid recovery of patients after surgery. Conclusion Under the current ERAS concept at home and abroad, NIVATS is a safe and technically feasible anesthesia method for patients undergoing thoracoscopic lobectomy, which can replace IVATS to a certain extent and can be widely used in clinical practice, providing a basis for clinical decision-making.
ObjectiveTo investigate the prognostic value of preoperative serum albumin-to-globulin ratio (AGR) and neutrophil-lymphocyte ratio (NLR) in the overall survival (OS) of patients with esophageal squamous cell carcinoma (ESCC), and to establish an individualized nomogram model and evaluate its efficacy, in order to provide a possible evaluation basis for the clinical treatment and postoperative follow-up of ESCC patients. MethodsAGR, NLR, clinicopathological and follow-up data of ESCC patients diagnosed via pathology in the Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical University from 2010 to 2017 were collected. The correlation between NLR/AGR and clinicopathological data were analyzed. Kaplan-Meier analysis and log-rank test were used for survival analysis. The optimal cut-off values of AGR and NLR were determined by X-tile software, and the patients were accordingly divided into a high-level group and a low-level group. At the same time, univariate and multivariate Cox regression analyses were used to identify independent risk factors affecting OS in the ESCC patients, and a nomogram prediction model was constructed and internally verified. The diagnostic efficacy of the model was evaluated by receiver operating characteristic (ROC) curve and calibration curve, and the clinical application value was evaluated by decision curve analysis. ResultsA total of 150 patients were included in this study, including 105 males and 45 females with a mean age of 62.3±9.3 years, and the follow-up time was 1-5 years. The 5-year OS rate of patients in the high-level AGR group was significantly higher than that in the low-level group (χ2=6.339, P=0.012), and the median OS of the two groups was 25 months and 12.5 months, respectively. The 5-year OS rate of patients in the high-level NLR group was significantly lower than that in the low-level NLR group (χ2=5.603, P=0.018), and the median OS of the two groups was 18 months and 39 months, respectively. Multivariate Cox analysis showed that AGR, NLR, T stage, lymph node metastasis, N stage, and differentiation were independent risk factors for the OS of ESCC patients. The C-index of the nomogram model was 0.689 [95%CI (0.640, 0.740)] after internal validation. The area under the ROC curve of predicting 1-, 3-, and 5-year OS rate was 0.773, 0.724 and 0.725, respectively. At the same time, the calibration curve and the decision curve suggest that the model had certain efficacy in predicting survival and prognosis. ConclusionPreoperative AGR and NLR are independent risk factors for ESCC patients. High level of AGR and low level of NLR may be associated with longer OS in the patients; the nomogram model based on AGR, NLR and clinicopathological features may be used as a method to predict the survival and prognosis of ESCC patients, which is expected to provide a reference for the development of personalized treatment for patients.
Objective To evaluate the risk factors of the patients with myasthenia gravis (MG) after resection of thymoma. Methods We retrospectively analyzed the clinical data of 126 thymoma patients without preoperative MG who underwent a thymectomy in our hospital from June 2002 through May 2015. There were 51 males and 75 females at age of 51.71±14.06 years. The risk factors for MG after resection of thymoma were evaluated. Results MG occurred in nine patients after resection of thymoma (7.1%). Incomplete resection (P=0.024), A and AB type of WHO classification (P=0.048), concomitant autoimmune diseases (P=0.024), postoperative pulmonary infection (P=0.036) were the risk factors for the MG after resection of thymoma. Postoperative radiotherapy and chemotherapy (P=0.011) reduced the risk for the patients with incomplete resection or invasive thymoma. Conclusion Incomplete resection, A and AB type of WHO classification, concomitant autoimmune diseases, postoperative pulmonary infection are considered as the risk factors for MG after resection of thymoma, and postoperative radiotherapy and chemotherapy should be performed for the patients with incomplete resection or invasive thymoma.
Objective To compare the pain relief and rehabilitation effect of intercostal nerve block and conventional postoperative analgesia in patients undergoing thoracoscopic surgery. Methods China National Repository, Wanfang Database, VIP, China Biomedical Literature Database, Web of Science, Clinicaltrials.gov, Cochrane Library, EMbase and PubMed were searched from establishment of each database to 10 Febraray, 2022. Relevant randomized controlled trials (RCTs) of intercostal nerve block in thoracoscopic surgery were collected, and meta-analysis was conducted after data extraction and quality evaluation of the studies meeting the inclusion criteria. Results A total of 21 RCTs and one semi-randomized study were identified, including 1 542 patients. Performance bias was the main bias risk. Intercostal nerve block had a significant effect on postoperative analgesia in patients undergoing thoracoscopic surgery. The visual analogue scale (VAS) score at 12 h after surgery (MD=–1.45, 95%CI –1.88 to –1.02, P<0.000 01), VAS score at 24 h after surgery (MD=–1.28, 95%CI –1.67 to –0.89, P<0.000 01), and VAS score at 48 h after surgery significantly decreased (MD=–0.90, 95%CI –1.22 to –0.58, P<0.000 01). In exercise or cough state, VAS score at 24 h after surgery (MD=–2.40, 95%CI –2.66 to –2.14, P<0.000 01) and at 48 h after surgery decreased significantly (MD=–1.89, 95%CI –2.09 to –1.69, P<0.000 01). In the intercostal nerve block group, the number of compression of the intravenous analgesic automatic pump on the second day after surgery significantly reduced (SMD=–0.78, 95%CI –1.29 to –0.27, P=0.003). In addition to the analgesic pump, the amount of additional opioids significantly reduced (SMD=–2.05, 95%CI –3.65 to –0.45, P=0.01). Postoperative patient-controlled intravenous analgesia was reduced (SMD=–3.23, 95%CI –6.44 to –0.01, P=0.05). Patient satisfaction was significantly improved (RR=1.31, 95%CI 1.17 to 1.46, P<0.01). Chest tube indwelling time was significantly shortened (SMD=–0.64, 95%CI –0.84 to –0.45, P<0.001). The incidence of analgesia-related adverse reactions was significantly reduced (RR=0.43, 95%CI 0.33 to 0.56, P<0.000 01). Postoperative complications were significantly reduced (RR=0.28, 95%CI 0.18 to 0.44, P<0.000 01). Two studies showed that the length of hospital stay was significantly shortened in the intercostal nerve block group, which was statistically different (P≤0.05), and there was no statistical difference in one report. Conclusion The relief of acute postoperative pain and pain in the movement state is more prominent after intercostal nerve block. Intercostal nerve block is relatively safe and conforms to the concept of enhanced recovery after surgery, which can be extensively utilized in clinical practice.
ObjectiveTo compare postoperative efficacy of thoracoscopic partial pneumonectomy with or without thoracic drainage tube postoperatively.MethodsThe PubMed, Wanfang database, CNKI and Web of Science from January 2000 to August 2020 were searched by computer to collect randomized controlled studies (RCT), cohort studies and case-control studies on the efficacy of chest drainage tube placement versus no placement after thoracoscopic partial pneumonectomy. Two reviewers independently screened articles and extracted data to evaluate the risk of literature bias. Meta-analysis was performed with RevMan software.ResultsA total of 15 articles were included, including 1 RCT and 14 cohort studies. A total of 1 524 patients were enrolled, including 819 patients in the test group (no postoperative chest drainage tube group) and 705 patients in the control group (postoperative chest drainage tube group). Compared with the control group, the length of hospital stay in the test group was shorter (MD=–1.3, 95%CI –1.23 to –0.17, P<0.000 01) and the incidence of postoperative pneumothorax was higher (RD=0.06, 95%CI 0.01 to 0.10, P=0.01). There was no significant difference between the two groups in operation time (MD=–2.37, 95%CI –7.04 to 2.30, P=0.32), the incidence of postoperative complications (RR=2.43, 95%CI 0.79 to 1.80, P=0.39), the reintervention rate of postoperative complications (RD=0.02, 95%CI=–0.00 to 0.04, P=0.05), postoperative subcutaneous emphysema (RD=0.02, 95%CI –0.01 to 0.06, P=0.20) and the incidence of postoperative pleural effusion (RD=0.04, 95%CI –0.00 to 0.09, P=0.10) .ConclusionCompared with the patients with chest drainage tube placement after thoracoscopic partial pneumonectomy (the control group), the test group can shorten the hospital stay. Although the incidence of postoperative pneumothorax is higher than that of the control group, the operation time, incidence of postoperative subcutaneous emphysema and in-hospital complications, and reintervention rate of in-hospital complications are not statistically significant between the two groups. Therefore no chest drainage tube may be placed after partial pneumonectomy.
ObjectiveTo study the influence of infection in incision of abdominal wall on peritoneal adhesion. MethodsOne hundred and twenty white rats were divided into low, medium, high concentration (LC, MC, HC) groups and control group, 30 rats each, and were made animal models of abdominal incision infection, then were respectively given hypodermic injections in incisional wound of 0.2 ml quantitative mixture of Escherichia coli, staphylococcus aureus and pseudomonas aeruginosa in the concentration of 1×102, 1×105 and 1×108 cfu/ml. While the control group,normal saline was given. All the subjects were killed 8 days after operation and compared the peritoneal adhesion among the four groups.ResultsInfection rate of the incisional wounds was 81.48%, 86.67%, 90.00% and 50.00% respectively in LC, MC, HC and the control, peritoneal adhesion rate was 53.33%, 60.00%, 70.00% and 26.67% respectively. There was significant difference between LC and the control (P＜0.05), between MC or HC and the control (P＜0.01). While no difference was among LC, MC and HC (P＞0.05).Conclusion Infection of incision may increase peritoneal adhesion which might not be closely related to the number of the bacteria. This suggests that the prevention of infection plays an important role in preventing peritoneal adhesion.