Lung cancer is one of the malignant tumors with the highest incidence rate and mortality in the world today. Although significant progress has been made in the treatment of lung cancer, its 5-year survival rate is still very low. Ferroptosis is a cell death mode characterized by an increase in intracellular free iron, lipid peroxidation, and accumulation of reactive oxygen species. More and more evidence suggests that ferroptosis plays a crucial role in the occurrence and development of lung cancer, and exploring the mechanism of ferroptosis in lung cancer is of great significance for finding new diagnostic and treatment methods for lung cancer. This article reviews the regulatory mechanism of cell ferroptosis and its role in the occurrence and development of lung cancer, with the aim of providing new directions and ideas for the diagnosis and treatment of lung cancer.
Pain caused by surgery is an important clinical issue that seriously affects postoperative rehabilitation and health-related quality of life. Failure to effectively manage postoperative pain not only leads to a decrease in patient quality of life, increases medical expenses, but also has a negative impact on patient recovery. Therefore, it is of great clinical significance to address the challenges of acute postoperative pain management, find effective management strategies, and improve the quality of pain management. This article summarizes the current status of acute postoperative pain management in recent years, including the mechanism of pain occurrence, pain assessment methods, drug and non drug management strategies, and predictive factors for chronic postoperative pain. It also looks forward to future research directions and application prospects.
Objective:To analyze the characteristics and clinical significance of ascites, peripheral blood lymph nodes, and cell subpopulations in patients with decompensated liver cirrhosis caused by alcoholic liver disease.Methods:Sixty decompensated liver cirrhosis patients with alcoholic liver disease admitted to the Affiliated Hospital of Jining Medical Unversity from July 2020 to July 2022 were selected as the observation group, and 40 healthy volunteers who underwent physical examinations in our hospital were randomly selected as the control group. The observation group was divided into A, B, and C grades based on the severity of the condition, according to the Child-Pugh grading of liver function. The differences in clinical data, peripheral blood lymphocyte subpopulation indicators, and ascites lymphocyte subpopulation indicators (CD3 + , CD4 + , CD8 + , CD20 + ) under different disease grades were analyzed, and the differences in peripheral blood lymphocyte subpopulation indicators between the two groups of people were compared. Resultsl:The levels of CD3 + , CD4 + , CD8 + , CD4 + /CD8 + , and CD20 + in the observation group were significantly lower than those in the control group (all P<0.05). Compared with Child-Pugh A grade patients, the expression of CD3 + , CD4 + , CD8 + , CD4 + /CD8 + , and CD20 + in peripheral blood of Child-Pugh B and C grade patients decreased significantly (all P<0.05); Compared with Child-Pugh B grade patients, the expression of CD3 + , CD4 + , CD8 + , CD4 + /CD8 + , and CD20 + in peripheral blood of Child-Pugh C grade patients decreased significantly (all P<0.05). Compared with Child-Pugh A grade patients, the expression of CD3 + , CD4 + , CD8 + , CD4 + /CD8 + , and CD20 + in ascites of Child-Pugh B and C grade patients decreased significantly (all P<0.05); Compared with Child-Pugh B grade patients, the expression of CD3 + , CD4 + , CD8 + , CD4 + /CD8 + , and CD20 + in ascites of Child-Pugh C grade patients decreased significantly (all P<0.05). The peripheral blood and ascites lymphocyte subsets were negatively correlated with the Child-Pugh grading of decompensated liver cirrhosis in alcoholic liver disease (all P<0.05). Conclusions:Patients with decompensated liver cirrhosis caused by alcoholic liver disease are accompanied by varying degrees of immune dysfunction. Detection of lymphocyte subsets in the patient′s peripheral blood and ascites has significant clinical significance for the diagnosis and prognosis of this disease.
Glioma is the most common primary intracranial tumor. Imaging examination has important clinical significance for the diagnosis of glioma, such as magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET). Imageomics is a new technology combining artificial intelligence and medical imaging big data. It efficiently mines and integrates a large number of advanced imaging features from massive data, and establishes predictive models. For the clinical application of imageomics, this article expounds the application of imageomics in glioma diagnosis from four aspects: glioma grading, prediction of gene expression, differential diagnosis, and prognostic evaluation.
Objective:To explore the effect of diclofenac sodium suppository combined with tramadol sustained-release tablets on postoperative pain relief and recovery in patients with mixed hemorrhoids.Methods:Sixty patients with mixed hemorrhoids who underwent external dissection and internal ligation at the Shenzhen Traditional Chinese Medicine Proctology Hospital from September to October 2023 were selected and randomly divided into A group and AS group using a random number table method, with 30 patients in each group. The group A patients received oral tramadol sustained-release tablets 4 hours after surgery, while the group AS received diclofenac sodium suppositories for anal canal therapy in addition to the group A. Two groups were compared for postoperative pain [Visual Analog Scale (VAS)] and patient comfort [Numerical Rating Scale (NRS)], cumulative tramadol consumption, supplementary rescue pethidine needs, and adverse reactions at 4, 8, 24, and 48 hours.Resultsl:The VAS of the AS group were lower than those of the A group at 4, 8, 24, and 48 hours after surgery. The NRS scores of the group A patients at 4, 8, and 24 hours were significantly better than those of the group AS. The cumulative consumption of tramadol in the AS group at 4, 8, 24, and 48 hours after surgery was significantly lower than that in the A group; The demand rate for postoperative rescue of pethidine in the group A was significantly higher than that in the group AS. The incidence of nausea in the group A was significantly higher than that in the group AS.Conclusions:The combination of postoperative diclofenac sodium suppositories and oral tramadol sustained-release tablets for mixed hemorrhoid surgery has a significant improvement effect on pain. It can reduce the dosage of tramadol, reduce the need for rescue and supplementary analgesia, and have fewer adverse reactions.
Objective:To analyze the relationship between the expression of dynamin 1 (DNM1) gene and clinical pathological parameters and prognosis of colorectal cancer (CRC) patients, and explore the association between DNM1 and autophagy mechanisms.Methods:The tumor genome atlas (TCGA) database was used to analyze the mRNA levels of DNM1 in normal intestinal mucosa and cancer tissues of CRC patients, as well as in early [tumor node metastasis (TNM) stage Ⅰ and Ⅱ] and late (TNM stage Ⅲ and Ⅳ) cancer tissues. The Kaplan-Meier method was used to estimate survival time and analyze prognosis; Immunohistochemical staining was used to detect the expression of DNM1 protein in cancer tissues of 118 CRC patients, and the relationship between its expression characteristics, clinical pathological parameters, and prognosis was analyzed; The signal pathways related to DNM1 and autophagy in cancer tissues of (GSEA) CRC patients were analyzed using gene set enrichment; Confocal microscopy was used to detect and analyze the Pearson correlation coefficient (PCC) of DNM1 [along with five other autophagy related proteins Autophagy-related protein 9B (ATG9B), Unc-51 like autophagy activating kinase 1 (ULK1), Beclin1, sequestosome-1 (P62/SQSTM1), Autophagy related 16 like protein1 (ATG16L1)] and the immunofluorescence double staining of microtubule associated protein 1 light chain 3 (LC3).Resultsl:The expression of DNM1 was increased in CRC tumor tissue, and significantly increased in the late stage of the tumor ( P<005); Kaplan-Meier survival analysis showed that the expression level of DNM1 was negatively correlated with tumor prognosis [ HR=1.71, 95% CI (1.21, 2.40), P<0.01]. The positive intensity of DNM1 was related to the depth of tumor infiltration, lymph node metastasis, cancer nodules, distant metastasis, nerve and vascular invasion, degree of differentiation, histological classification, and special histological classification (all P<0.01). The ordered logistic regression model verified that tumor differentiation and the degree of DNM1 positivity were risk factors for poor prognosis in CRC patients, and a strong positive DNM1 was positively correlated with adenocarcinoma recurrence ( P<0.05). The high expression of DNM1 involved negative regulation of key signaling pathways in negative autophagy, such as rapamycin target protein complex 1 (mTORC1), phosphatidylinositol 3 kinase/protein kinase B/rapamycin target protein (PI3K/AKT/mTOR) ( P<0.05, FDR<0.001). Among the six sets of immunofluorescence double staining, the correlation between the expression patterns of DNM1 and LC3B genes was the highest. Conclusions:High expression of DNM1 is a poor prognostic factor for CRC patients, which may be related to tumor progression through positive regulation of autophagy.
Objective:To explore the lung protective effect of nebulized inhalation of lidocaine (NL) on elderly patients undergoing hip fracture surgery.Methods:A prospective study was conducted on 80 elderly patients who underwent hip fracture surgery at the Huizhou Sixth People′s Hospital from September 2020 to December 2021. They were randomly divided into an NL group and a control group with 40 patients in each group. Within 30 minutes before the start of anesthesia, the NL group was given 2% lidocaine 10 ml oxygen driven nebulization inhalation, while the control group was given equal volume sterile injection water nebulization inhalation. All patients underwent general anesthesia with laryngeal mask intubation and iliac fascia space block. A randomized, double-blind, and controlled clinical study was conducted. The average values of intraoperative peak airway pressure (P peak), plateau airway pressure (P plat), and lung dynamic compliance (C dyn) were compared between two groups of patients; We compared the changes in arterial partial pressure of CO 2 (PaCO 2), alveolar arterial oxygen differential pressure (A-aDO 2), respiratory index (RI), and oxygen index (OI) between the two groups of patients and before and after surgery; The clinical pulmonary infection score (CPIS) and lung ultrasound score (LUS) were also compared between two groups of patients on the first day before surgery, the second day after surgery, and the seventh day after surgery. Resultsl:There was no statistically significant difference in the average values of P peak, P plat, and C dyn between the two groups during surgery (all P>0.05). After surgery, A-aDO 2 and RI in both groups increased compared to before surgery, while OI decreased compared to before surgery (all P<0.05); After surgery, A-aDO 2 and RI in the NL group decreased compared to the control group, while OI increased compared to the control group (all P<0.05); There was no statistically significant difference in PaCO 2 between the two groups before and after skin incision (all P>0.05). Compared with the 1st day before surgery, the CPIS and LUS in both groups were significantly increased on the 2nd and 7th day after surgery (all P<0.05); Compared with the second day after surgery, the CPIS and LUS of both groups of patients were significantly reduced on the seventh day after surgery (all P<0.05); On the second day after surgery, the CPIS and LUS in the NL group were significantly lower than those in the control group (all P<0.05); On the 7th day after surgery, the LUS of the NL group was significantly lower than that of the control group ( P<0.05); There was no statistically significant difference in CPIS scores between the two groups ( P>0.05). Conclusions:Nebulized inhalation of lidocaine can reduce lung function damage in elderly patients undergoing hip fracture surgery, and has a certain lung protective effect.
目的:分析颅内压监护对无中线移位的重型颅脑外伤(sTBI)合并脑肿胀患者的影响。方法:回顾性选取2017年5月至2020年5月瑞安市人民医院收治的80例无中线移位的sTBI合并脑肿胀患者，按治疗方法不同分为两组，行保守治疗的40例患者为A组，在保守治疗基础上行颅内压监护和去骨瓣减压术的40例患者为B组。比较两组治疗后的大脑动脉血流速度、脑灌注情况[脑血流容量(CBV)、脑血流流量(CBF)、对比剂平均通过时间(MTT)]、神经功能[改良RANKIN量表(mRS)、美国国立卫生院卒中量表(NIHSS)]、并发症及预后。结果:治疗后7 d，B组收缩期峰流速、平均血流速度、CBV和CBF均明显高于A组(均 P<0.05)，MTT明显低于A组( P<0.05)。治疗后3个月，B组mRS评分和NIHSS评分均明显低于A组(均 P<0.05)。B组并发症总发生率明显低于A组( P<0.05)，预后较好率明显高于A组( P<0.05)。 结论:相较于保守治疗，颅内压监护和去骨瓣减压术可明显改善无中线移位的sTBI合并脑肿胀患者大脑动脉血流速度与脑灌注情况，调节神经功能，降低并发症，提高预后较好率。
Hypertrophic obstructive cardiomyopathy (HOCM) is the most common type of hypertrophic cardiomyopathy, which is prone to left ventricular outflow obstruction and causes various adverse effects. It is also the main cause of sudden death in adolescents and athletes. Timely intervention is crucial for the prognosis of patients. Radiofrequency ablation has been widely used in the treatment of various arrhythmias, but it is still a new treatment method in HOCM. This article mainly reviews the clinical application progress of radiofrequency ablation in the treatment of HOCM patients.
Objective:To investigate the effect of body mass index (BMI) on the first in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment for young women of childbearing age (20-35 years old) with tubal factor infertility.Methods:A retrospective analysis was conducted on the clinical data of 747 patients who underwent assisted reproductive technology (IVF/ICSI) treatment for the first time at the Reproductive Medicine Center of the First People′s Hospital of Changde City from January 1, 2019 to September 30, 2021. The patients were aged 20-35 years old and all received controlled ovarian hyperstimulation treatment using a long-term follicular protocol. Patients were divided into four groups based on their BMI values during physical examinations before assisted pregnancy treatment: the weight loss group [body mass index (BMI)<18.5 kg/m 2 in 72 cases], the normal weight group (18.5 kg/m 2≤BMI<24 kg/m 2 in 455 cases), the super recombination group (24 kg/m 2≤BMI<28 kg/m 2 in 161 cases), and the obesity group (BMI≥28 kg/m 2 in 59 cases). The differences in relevant indicators during controlled ovarian hyperstimulation treatment and pregnancy outcomes after fresh embryo transfer were analyzed among each group. Resultsl:There were no statistically significant differences in age, infertility years, primary/secondary infertility ratio, basal follicle stimulating hormone levels, and sinus follicle count among the lean, normal weight, overweight, and obese groups (all P>0.05). There were no statistically significant differences in the duration of gonadotropin (Gn) administration, the number of follicles with a diameter of ≥14 mm on the trigger day, the level of estrogen on the trigger day, the number of retrieved eggs, the number of double pronuclei, the rate of cyst formation, the rate of transplantation, and the rate of whole embryo cryopreservation among the four groups (all P>0.05). The total amount of Gn was found to be (2 374.5±892.5)U in the lean group, (2 643.8±1 213.5)U in the normal weight group, (2 950.5±1 156.5)U in the super recombinant group, and (2 949.8±1 030.5)U in the obese group, with a statistically significant difference ( P=0.001). The number of excellent embryos was (3.06±2.50) in the lean group, (2.96±2.16) in the normal weight group, (2.45±1.96) in the super recombinant group, and (2.39±2.03) in the obese group, with a statistically significant difference ( P=0.015). The embryo free rate among the four groups significantly increased with increasing BMI, and the difference was statistically significant ( P=0.039). There was no statistically significant difference in the number of embryos transferred, biochemical pregnancy rate, clinical pregnancy rate, embryo implantation rate, multiple pregnancy rate, early abortion rate, mid-term abortion rate, and live birth rate among the four groups (all P>0.05). Conclusions:In patients with simple tubal factor infertility who receive long-term follicular phase assisted fertilization treatment, an increase in BMI can significantly increase the dosage of Gn, reduce the number of excellent embryos, and increase the rate of no embryos. Although there is currently no statistical difference in various indicators of pregnancy outcomes after fresh embryo transfer among different BMI groups, there is a risk of an increase in early or mid-term miscarriage rates as BMI increases.
Objective:To investigate the value of multi-slice spiral CT (MSCT) combined with three myocardial markers in the diagnosis of acute chest pain etiology.Methods:A retrospective study was conducted on 120 patients with acute chest pain admitted to the Affiliated Hospital of Jining Medical University from January 2020 to December 2020. All patients underwent MSCT imaging examination upon admission, and serum creatine kinase isoenzyme MB (CK-MB), troponin I (cTnI), and myoglobin (MYO) levels were also tested. The final clinical diagnosis was used as the judgment standard to draw a 2×2 four-square table, and calculate the value of MSCT, CK-MB, cTnI, and MYO in the diagnosis of acute chest pain etiology.Resultsl:Among the 120 acute chest pain patients included, 75 were diagnosed with acute coronary syndrome (62.50%), 16 with aortic dissection (13.33%), and 29 with pulmonary embolism (24.17%). The coincidence rate of MSCT diagnosis of coronary heart disease was 86.67%(65/75), the diagnosis of aortic dissection coincidence rate was 12/16, and the diagnosis of pulmonary embolism coincidence rate was 75.86%(22/29). The serum CK-MB, cTnI, and MYO levels in the coronary heart disease group were significantly higher than those in the aortic dissection group and pulmonary embolism group, and the differences were statistically significant (all P<0.05). There was no significant difference in serum CK-MB, cTnI, and MYO levels between the aortic dissection group and pulmonary embolism group (all P>0.05). The sensitivity of CK-MB, cTnI, and MYO in the differential diagnosis of acute chest pain patients with coronary heart disease and non-coronary heart disease were 93.33%, 85.33%, and 89.33%, respectively, and the specificity were 73.33%, 80.00%, and 77.78%, respectively. The areas under the receiver operating characteristic (ROC) curve were 0.833, 0.826, and 0.836, respectively. Conclusions:MSCT can better identify coronary heart disease, aortic dissection, and pulmonary embolism in patients with acute chest pain, while the three myocardial markers can better distinguish patients with coronary heart disease and non-coronary heart disease. Therefore, MSCT combined with myocardial markers should be used for the diagnosis of acute chest pain patients in clinical practice to facilitate early clinical diagnosis.
Objective:To observe the effect of combination of esketamine and sufentanil on postoperative analgesia and postpartum depression after cesarean section.Methods:A total of 150 primiparous women who underwent lower segment cesarean section under spinal anesthesia and postoperative analgesia at Changsha Maternal and Child Health Hospital from February to October 2021 were selected and randomly divided into three groups: A, B, and C, with 50 cases in each group. All three groups underwent combined spinal epidural anesthesia and received patient-controlled intravenous analgesia (PCIA) after surgery. The group A received low-dose esketamine via intravenous pump after fetal delivery, with PCIA formula esketamine combined with sufentanil; After the delivery of fetuses in the group B and the group C, an equal dose of physiological saline was pumped into the vein. The PCIA formula of esketamine combined with sufentanil for the group B and Sufentanil for the group C. We compared the pain Visual Analogue Scale (VAS) and Edinburgh Postpartum Depression Scale (EPDS) scores of three groups of patients at different time points after surgery, as well as the postoperative pain relief rate and incidence of adverse reactions.Resultsl:There was a statistically significant difference in VAS between the group A and the group B within 48 hours after surgery compared to the group C (all P<0.05), while there was a statistically significant difference in VAS between the group A and the group B within 24 hours after surgery (all P<0.05). The postoperative pain relief rate in the group A and group B was significantly lower than that in the group C, and the incidence of postpartum depression within 7 days after surgery was significantly lower than that in the group C. Moreover, the incidence of postpartum depression in the group A was lower than that in the group B within 3 days after surgery, and the differences were statistically significant (all P<0.05). There was no statistically significant difference in the incidence of postpartum depression among the three groups 42 days after surgery (all P>0.05), and there was no statistically significant difference in the incidence of adverse reactions among the three groups ( P>0.05). Conclusions:Esketamine combined with sufentanil can synergistically enhance the analgesic effect after cesarean section and reduce the incidence of early postpartum depression after surgery.
Objective:To study the role of red blood cell distribution width (RDW) in the prognosis of diabetes patients with blood stream infection (BSI).Methods:Retrospective analysis was made on the clinical data of 121 patients with diabetes complicated with BSI admitted to Ningbo Second Hospital from January 2017 to April 2022. According to the prognosis of the patients, they were divided into a good prognosis group of 93 cases and a bad prognosis group of 28 cases. We compared the basic data, blood routine, liver and kidney function, coagulation function, C-reactive protein, procalcitonin, etiology, acute physiology, and chronic health status scoring system Ⅱ (APACHE Ⅱ) scores of the two groups of patients. Multivariate logistic regression was used to analyze the factors affecting the prognosis of diabetes patients with BSI, Spearman correlation analysis was used to study the correlation between RDW and APACHE Ⅱ score, and the receiver operating characteristic curve (ROC) of subjects was drawn to evaluate the predictive efficacy of RDW on the prognosis of diabetes patients with BSI.Resultsl:The RDW, urea nitrogen, blood creatinine, aspartate aminotransferase, and APACHE Ⅱ scores of the poor prognosis group were higher than those of the good prognosis group (all P<0.05), while the white blood cell count, lymphocyte count, monocyte count, hemoglobin, red blood cell count, hematocrit, and albumin levels were lower than those of the good prognosis group (all P<0.05); Spearman correlation analysis showed a positive correlation between RDW and APACHE Ⅱ scores ( r=0.366, P<0.01); Multivariate logistic regression analysis showed that RDW and APACHE Ⅱ scores were risk factors affecting the prognosis of diabetes patients with BSI (all P<0.05); The ROC curve results showed that the area under the curve of RDW to predict the prognosis of diabetes patients with BSI was 0.900 (95% CI: 0.817-0.983), the optimal cut-off value was 14.0%, the sensitivity was 85.7%, and the specificity was 84.9%. Conclusions:The increase of RDW can be used as an important predictor of poor prognosis in diabetes patients with BSI. Detection of RDW has important clinical value in evaluating the prognosis.
Objective:To observe the effect of pre injection of three different doses of butorphanol tartrate on postoperative pain in gynecological laparoscopic surgery.Methods:A prospective study was conducted on 172 patients who underwent gynecological laparoscopic surgery under general anesthesia at the First Affiliated Hospital of Dalian Medical University from April to December 2022. According to the random number table method, patients were divided into B1 group, B2 group, and B3 group. These three groups were given 10, 20, and 30 μ g/kg butorphanol tartrate 15 minutes before surgery, respectively. Ramsay sedation score at 10 minutes after patient administration, the pain Numerical Rating Scale (NRS) scores and Bruggrmann Comfort Scale (BCS) for resting and active states at 2, 6, 12, 24, and 48 hours after surgery, hemodynamic parameters at different time points during surgery, postoperative use of adjuvant analgesics and effective number of compressions for patient-controlled intravenous analgesia (PCIA) and the incidence of postoperative adverse reactions were recorded.Resultsl:There was no statistically significant difference in general characteristics among the three groups of patients (all P>0.05). At 10 minutes after administration, there was a statistically significant difference in Ramsay scores between groups B2 and B3 compared to group B1 (all P<0.05). At 12 and 24 hours after surgery, the resting NRS score of B3 group was lower than that of B2 group and B1 group, and B2 group was lower than B1 group (all P<0.05); At 6, 12, and 24 hours after surgery, the NRS scores of postoperative activity in the B2 and B3 groups were lower than those in the B1 group (all P<0.05); At 6 and 12 hours after surgery, the NRS score of the B3 group was lower than that of the B2 group (all P<0.05). At 6 and 24 hours after surgery, there was a statistically significant difference in BCS between groups B2 and B3 compared to group B1 (all P<0.05). There was no statistically significant difference in the hemodynamic parameters at each time point during surgery, the effective number of PCIA compressions within 48 hours after surgery, and the incidence of postoperative adverse reactions among the three groups of patients (all P>0.05). There was a statistically significant difference in the rate of postoperative addition of analgesics among the three groups ( P<0.05). Conclusions:Intravenous injection of 15 minutes before gynecological laparoscopic surgery 30 μg/kg butorphanol tartrate can achieve good analgesic effects with fewer adverse reactions, and can be used as a priority dose for preventive analgesia in gynecological laparoscopic surgery.
Low carbohydrate diet (LCD), as an adjunctive therapy of type 1 diabetes (T1DM), has attracted much attention in recent years, but its exact efficacy and safety have not yet been determined. Limited literature has reported that LCD plays an important role in controlling blood sugar and its complications in T1DM patients, regulating intestinal microbiota, and autoimmunity. This article elaborates on the research progress of T1DM medical nutritional therapy related to LCD mode in recent years, including its control of blood sugar, adverse reactions, and regulation of intestinal microbiota.
目的:探讨软性输尿管镜钬激光碎石术(FURL)与标准经皮肾镜取石术(PCNL)治疗>2 cm上尿路结石老年患者的临床疗效以及对患者围手术期应激反应、外周血辅助性T细胞(Th)1/Th2免疫平衡的影响。方法:回顾性选取华北医疗健康集团邢台总医院2019年1月至2022年1月收治的90例>2 cm上尿路结石老年患者作为研究对象，根据手术方式的不同分成两组，每组45例。其中观察组行FURL治疗，对照组行PCNL治疗，比较两组手术相关指标。分别于术前及术后6、24、48 h检测受术者血清应激指标[皮质醇(Cor)、去甲肾上腺素(NE)、促肾上腺皮质激素(ACTH)]水平，外周血Th1、Th2比例及其比值(Th1/Th2)。结果:观察组手术时间显著长于对照组( P<0.05)，血红蛋白(Hb)降低值低于对照组( P<0.05)，术后住院时间短于对照组(均 P<0.05)。观察组术后1 d、1个月结石清除率分别为80.00%(36/45)、93.33%(42/45)，对照组依次为88.89%(40/45)、95.56%(43/45)，组间差异无统计学意义(均 P>0.05)。两组术后6、24、48 h血清Cor、NE和ACTH水平均较术前显著上升(均 P<0.05)，且观察组术后6、24、48 h血清Cor、NE及ACTH水平均显著低于对照组(均 P<0.05)。观察组围手术期外周血Th1、Th2比例及Th1/Th2均无明显变化( P>0.05)。对照组术后6、24、48 h外周血Th1比例、Th1/Th2均较术前显著降低(均 P<0.05)，外周血Th2比例均较术前显著升高(均 P<0.05)。两组术后6、24、48 h外周血Th1、Th2及Th1/Th2比较差异均有统计学意义(均 P<0.05)。观察组并发症发生率为6.67%(3/45)，显著低于对照组的26.67%(12/45)，差异有统计学意义( P<0.05)。 结论:FURL与PCNL治疗>2 cm上尿路结石老年患者的疗效相当，但FURL创伤更小，围手术期应激反应更轻，对Th1/Th2免疫平衡影响小，并发症少。
目的:观察依达拉奉右莰醇联合丁苯酞对急性缺血性脑卒中(AIS)患者重组组织型纤溶酶原激活物(rt-PA)溶栓术后同型半胱氨酸(Hcy)、神经元特异性烯醇化酶(NSE)、S-100β蛋白水平及出血性转化(HT)和微循环的影响。方法:选取河北中石油中心医院于2021年5月至2022年5月收治的AIS患者100例，根据入院顺序采用简单随机法分为观察组( n＝50)与对照组( n＝50)。两组均予以rt-PA溶栓治疗，同时对照组给予丁苯酞注射液治疗，观察组给予依达拉奉右莰醇注射用浓溶液联合丁苯酞注射液治疗。比较两组治疗前后的血清Hcy、NSE、S-100β蛋白水平，血液流变学指标，美国国立卫生研究院脑卒中量表(NIHSS)评分及疗效，HT发生率，不良反应情况。 结果:两组治疗前血清Hcy、NSE、S-100β水平比较差异无统计学意义(均 P>0.05)；治疗后两组血清Hcy、NSE、S-100β水平均低于治疗前(均 P<0.05)，且观察组血清Hcy、NSE、S-100β水平明显低于对照组(均 P<0.05)。两组治疗后全血高切黏度、全血低切黏度、血浆黏度、血小板聚集率、红细胞压积均低于治疗前(均 P<0.05)，且观察组全血高切黏度、全血低切黏度、血浆黏度、血小板聚集率、红细胞压积均低于对照组(均 P<0.05)。两组治疗后NIHSS评分均低于治疗前(均 P<0.05)，且观察组NIHSS评分低于对照组( P<0.05)。观察组总有效率高于对照组( P<0.05)，HT发生率低于对照组( P<0.05)，但两组不良反应发生率比较差异无统计学意义( P>0.05)。 结论:依达拉奉右莰醇注射用浓溶液联合丁苯酞注射液可降低急性AIS患者rt-PA溶栓术后血清Hcy、NSE、S-100β水平的表达，减轻神经功能损伤，改善微循环，降低HT的发生率，提高疗效。
Objective:To evaluate the effect of ultrasound guided modified-subcostal approach to anterior quadratus lumborum block (MSC-AQLB) on postoperative pain relief in open gynecological tumor surgery.Methods:Fifty patients with open gynecological tumor surgery admitted to the Changsha Central Hospital from June 2022 to March 2023 were selected, aged 35-70 years old, with American Society of Anesthesiologist (ASA) grades Ⅰ-Ⅱ. They were randomly divided into two groups using a random number table: an improved subcostal lumbar quadratus anterior block combined with general anesthesia group (MQ group) and a simple general anesthesia group (GA group), with 25 patients in each group. Before induction of general anesthesia, the MQ group received bilateral MSC-AQLB under ultrasound guidance, with 20 ml of 0.4% ropivacaine administered to both sides; The GA group did not receive nerve block. Both groups received intravenous inhalation combined with general anesthesia during the surgery, and both groups received patient-controlled intravenous analgesia (PCIA) with sufentanil after the surgery. The block plane of the MQ group at 5 and 15 minutes after block was recorded, as well as the resting and active (cough) Visual Analogue Scale (VAS) of patients in both groups at extubation (T 1), departure from post anesthesia care unit (PACU) (T 2), postoperative 6 hours (T 3), 12 hours (T 4), 24 hours (T 5), and 48 hours (T 6), the effective and total compressions of the analgesic pump within 48 hours after surgery, the analgesic recovery rate, and postoperative patient satisfaction, the incidence of nausea and vomiting, complications related to nerve block (local anesthetic poisoning, muscle weakness, pneumothorax, bleeding, accidental entry into the abdominal cavity, kidney damage, etc.)were also recorded. Resultsl:The highest and lowest blocking planes of bilateral MSC-AQLB under ultrasound guidance were T 6 and L 1 (at 5 minutes), T 5 and L 2 (at 15 minutes), respectively. The resting and active VAS scores of the MQ group at T 1 to T 6 were significantly lower than those of the GA group (all P<0.05), and the effective press frequency, total press frequency, and analgesic recovery rate of the analgesic pump within 48 hours were significantly lower than those of the GA group (all P<0.05). The postoperative analgesic satisfaction score was higher than that of the GA group ( P<0.05), and the incidence of nausea and vomiting within 48 hours after surgery was significantly lower than that of the GA group ( P<0.05). The MQ group of patients did not experience complications related to nerve block such as kidney injury and muscle weakness. Conclusions:In open gynecological tumor surgery, ultrasound guided MSC-AQLB can effectively reduce postoperative pain scores, reduce the dosage of postoperative analgesics, reduce the incidence of nausea and vomiting, and significantly improve patient satisfaction with pain relief.
目的:探讨低位肛瘘患者应用括约肌间瘘管结扎联合瘘管隧道式切除术对其疼痛与肛门功能评分的影响。方法:前瞻性选取廊坊市中医医院2017年9月至2020年4月院就诊的低位肛瘘患者124例，按随机数字表法分为观察组(括约肌间瘘管结扎联合瘘管隧道式切除术)与对照组(括约肌间瘘管结扎术)，每组62例。比较两组的临床指标，评估两组各时段的疼痛视觉模拟评分(VAS)、便秘严重程度量表(Wexner)评分，统计复发率与并发症发生率。结果:观察组创面愈合时间、住院时间短于对照组(均 P<0.05)；两组术后12~48 h的疼痛VAS均明显改善，且观察组改善更为显著(均 P<0.05)；观察组术后1~6个月的Wexner评分均低于对照组(均 P<0.05)；观察组复发率、并发症发生率低于对照组(均 P<0.05)。 结论:括约肌间瘘管结扎联合瘘管隧道式切除术能促进低位肛瘘患者的快速恢复，缓解术后疼痛，提升肛门功能，且能有效降低术后复发率及并发症发生率。
目的:探究宝石CT能谱的多参数对原发型肺癌患者病理类型与其转移淋巴结同源性的评估价值。方法:回顾性收集2019年1月至2021年1月就诊于陕西省人民医院的原发型肺癌患者131例，所有患者均行宝石CT检查且经病理学检查确诊，其中鳞癌43例、腺癌59例、小细胞肺癌29例，比较鳞癌、腺癌及小细胞肺癌与其转移淋巴结的碘浓度及能谱衰减曲线斜率。结果:鳞癌、腺癌及小细胞肺癌患者的动脉期水浓度(WC)及标准化水浓度(NWC)组间比较差异无统计学意义(均 P>0.05)；碘浓度(IC)、标准化碘浓度(NIC)、40 keV-140 keV能谱斜率比较差异有统计学意义(均 P<0.05)。鳞癌、腺癌及小细胞肺癌患者组间行两两比较，各组间的WC及NWC比较差异无统计学意义(均 P>0.05)；IC、NIC、40 keV-140 keV能谱斜率比较差异有统计学意义(均 P<0.05)。鳞癌与其转移性淋巴结于动脉期及静脉期的IC、NIC、40 keV-140 keV能谱斜率差异均无统计学意义(均 P>0.05)。腺癌与其转移淋巴结于动脉期的IC、NIC、40 keV-140 keV及静脉期的40 keV-140 keV能谱斜率差异均无统计学意义(均 P>0.05)；而静脉期IC、NIC比较差异具有统计学意义(均 P<0.05)。小细胞肺癌与其转移淋巴结于动脉期的IC、NIC、40 keV-140 keV能谱斜率及静脉期的40 keV-140 keV能谱斜率差异均无统计学意义(均 P>0.05)；而静脉期IC、NIC比较差异有统计学意义(均 P<0.05)。 结论:动脉期肺癌与其转移淋巴结具有同源性，宝石光谱成像(GSI)技术可用于早期鉴别诊断转移但尚未肿大的淋巴结。
