Objective To investigate the feasibility and safety of laparoscopic surgery of giant hysteromyoma.Methods A total of 56 cases of giant hysteromyoma(at least 1 lesion ≥ 9 cm in diameter) underwent laparoscopic operations from January 2003 to August 2006 in this hospital.There were 30 cases of laparoscopic myomectomy(LM),10 cases of laparoscopic-assisted vaginal hysterectomy(LAVH),1 case of total laparoscopic hysterectomy(TLH),and 15 cases of laparoscopic supracervical hysterectomy(LSH).Results All of the operations were successfully performed under laparoscope.No conversion to open surgery was needed.The operation time was 40～100 min(mean,52 min),and the hemorrhage volume was 10～100 ml(mean,45 ml).Postoperatively,ureterovaginal fistula was observed in 1 case,which was cured by a re-operation of laparoscopic ureteroneocystostomy.Conclusions Laparoscopic operation for giant hysteromyoma is safe and feasible.

Objective To evaluate efficacy and safety of laparoscopic surgery for ectopic pregnancy with hemorrhagic shock.Methods One hundred and thirty women with hemorrhagic shock due to ectopic pregnancy underwent laparoscopic surgery from January 2003 to August 2006,including salpingectomy in 80 cases,partial ovariotomy in 8 cases,uterus wedge resection in 15 cases,salpingotomy in 19 cases,and tubal lesion clearance in 8 cases.Results Laparoscopic surgery was successfully performed in all the cases.Intra-abdominal blood loss was 1000 to 3500 ml,with an average of 1500 ml.The operation time was 30-60 minutes(mean:40 minutes).No postoperative complication occurred.Follow-up was conducted in 106 cases,once in a week in the first month after discharge.Serial ?-hCG levels decreased gradually and reached the normal level 1-2 weeks after operation.Persistent ectopic pregnancy was not found in the studied cases.Conclusions Laparoscopic surgery is a safe and effective treatment for hemorrhagic shock due to ectopic pregnancy,given the skill of an experienced laparoscopist with the aid of optimal anesthesia and advanced cardiovascular monitoring.

Objective To investigate the diagnostic value and therapeutic effect of laparoscopy combined with hysteroscopy in patients with tubal infertility.Methods A total of 133 patients with tubal infertility were treated by laparoscopy combined with hysteroscopy in our hospital from September 2004 to December 2007.All the cases were diagnosed by hysterosalpingography(HSG) and hysteroscopy.Results Totally 225 fallopian tubes were examined in the 133 patients,among which 180 tubes were completely occluded,57 were partially occluded,and 18 were patent.After the surgeries,211 tubes wee patent,24 were partially blocked,while 20 were still occluded.The success rate of the operations was 81.4%(193/237).Follow-up was achieved in 92 patients for 4 to 18 months,in the cases,30 were pregnant during the period(pregnancy rate: 32.6%).Of the 30 cases,2 women had tubal pregnancy;22 women were pregnant in 6 months after the treatments,and the other 8 were pregnant in 6-12 months after the operations.In this group of patients,the pregnancy rate in the women with both patent fallopian tubes was 26.1%(24/92),and in those with single patent fallopian tube was 6.5%(6/92).The pregnancy rate in patients with simple tubal infertility was 22.8%(21/92),while that of those who were complicated with tubal diseases was 9.8%(9/92).Conclusion Laparoscopy combined with hysteroscopy can accurately diagnose tubal infertility,and improve the therapeutic effect.

Objective: To investigate the clinicopathologic and prognostic features of Claudin-low breast cancers (CLBC). Methods: Tissue microarray sections were scored semiquantitatively for the immunohistochemical expression of claudin-1, -3, -4, -7 and -8 in 233 cases of invasive breast cancers collected from Qingdao Central Hospital from January 2010 to December 2011. Results: The expression rate of Claudin-3 (72/212, 33.9%) and -4 (56/212, 45.2%) was most similar, and Claudin-4 showed the highest expression. Twenty one cases (21/212, 9.0%) were diagnosed as CLBC, with triple-negative breast cancer (TNBC) accounted for the highest proportion (11/21, 52.4%). Among the CLBC cases, the invasive carcinoma no special type (66.7%, 14/21) and metaplastic carcinoma (14.3%, 3/21) were mostly seen, while metaplastic squamous carcinoma did not show Claudin-low pattern. Compared to the non CLBC in this cohort, CLBC had higher proportion of histologic grade 3 and tumors larger than 2 cm, and the proportions were slightly lower than TNBC. Patients with CLBC had lower 5 year disease-free(P>0.05) and overall survival rates(P=0.018). Conclusion CLBC shows distinct clinicopathologic and prognostic features comparing to other subtypes, and is associated with poor prognosis.

Objective:To explore the status of post-traumatic growth and meaning in life among family caregivers of the disabled elderly in the community, and to analyze the correlation between the two.Methods:From August 2019 to August 2020, convenience sampling was used to select 560 family caregivers of the disabled elderly in the community of Guangzhou as the research object. The General Information Questionnaire, Posttraumatic Growth Inventory (PTGI) and the Chinese Meaning in Life Questionnaire (C-MLQ) were used for the investigation. Pearson correlation and hierarchical regression were used to analyze the correlation between post-traumatic growth and meaning in life in family caregivers of the disabled elderly. A total of 560 questionnaires were distributed, and 526 valid questionnaires were recovered after excluding incomplete questionnaires and answering questionnaires according to a certain rule.Results:The total scores of PTGI and C-MLQ of 526 family caregivers of the disabled elderly were (49.43±20.43) and (42.96±7.61) , respectively. The total score of PTGI and the scores of each dimension were positively correlated with the total score of C-MLQ and the two dimensions of meaning experience and meaning pursuit ( P<0.01) . The hierarchical regression showed that, after controlling for general data, both meaning experience and meaning pursuit could positively predict post-traumatic growth. Conclusions:Post-traumatic growth of family caregivers of disabled elderly is at low level. Family caregivers' meaning in life has a positive effect on post-traumatic growth. Community workers should strengthen the meaning in life education, help caregivers to effectively cope with traumatic events, improve the level of post-traumatic growth, and promote mental health.

Radiomics and radiogenomics are used to provide comprehensive tumor biological characte-ristics and further clinical information by extracting,screening and analyzing the most valuable quantitative ra-diomics features. In recent years,numerous studies have shown that radiomics plays a role in the diagnosis, treatment and predicting efficacy and prognosis of lung cancer. Radiogenomics shows a great value in the pre-diction of lung cancer gene phenotype and individualized precision treatment by combining radiomics features with genomics,proteomics and so on. Radiomics and radiogenomics are non-invasive,quantitative,and repro-ducible,and they can provide multidirectional tumor biological characteristics,which are expected to be widely used in the precise medical treatment of lung cancer in the future.

Objective:To explore the efficacy and safety of low- and medium-dose of glucocorticoids in adult patients with acute respiratory distress syndrome (ARDS) through Meta-analysis and trials sequential analysis (TSA).Methods:Databases associated with adult ARDS treatment with low- and medium-dose glucocorticoids both in English and in Chinese were searched from PubMed, Medline, China Biology Medicine (CBM), Cochrane Library, CNKI, Wanfang Data and VIP, of which the search duration was from the establishment of the database to December 2020. Low-dose glucocorticoids were defined as methylprednisolone ≤ 1 mg·kg -1·d -1, and medium dose glucocorticoids were defined as methylprednisolone ≤ 2 mg·kg -1·d -1. According to the Cochrane Collaboration bias risk assessment tool, the quality of the included literature was evaluated, and the data were extracted. Meta-analysis and TSA were used to evaluate the effects of low- and medium-dose glucocorticoids on the hospital mortality, intensive care unit (ICU) mortality, and mechanical ventilation free time in ICU for 28 days, PaO 2/FiO 2, and the occurrence of nosocomial infections and hyperglycemia. Results:A total of 996 patients in 7 literatures were finally included, including 515 patients in the low- and medium-dose glucocorticoid group (hormone group) and 481 patients in the conventional treatment group (control group). The research quality of 7 literatures was relatively high. The results of Meta-analysis and TSA showed that, compared with the control group, the hospital mortality in the hormone group was significantly decreased [relative risk ( RR) = 0.77, 95% confidence interval (95% CI) was 0.66-0.89, P = 0.000 6], and mechanical ventilation free time in ICU for 28 days was significantly prolonged [standardized mean difference ( SMD) = 0.50, 95% CI was 0.36-0.65, P < 0.000 1]. Although Meta-analysis showed that the ICU mortality of the hormone group was significantly lower than that of the control group ( RR = 0.61, 95% CI was 0.38-0.99, P = 0.04), the TSA results showed that the cumulative Z value crossed the traditional threshold, but did not cross the TSA cut-off value, and the sample size did not reach required information size (RIS, n = 3 252), needed more research to confirm. Although Meta-analysis showed that PaO 2/FiO 2 in the hormone group was significantly higher than that in the control group ( SMD = 0.78, 95% CI was 0.13-1.43, P = 0.02), TSA showed that the cumulative Z value did not pass the traditional and TSA cut-off values. More research was needed for verification. Meta-analysis also showed that there was no significant difference in the incidence of new infection ( RR = 0.93, 95% CI was 0.74-1.17, P = 0.54) and the incidence of hyperglycemia ( RR = 1.11, 95% CI was 1.00-1.23, P = 0.05) between the hormone group and the control group. Conclusion:low- and medium-dose of glucocorticoids therapy can reduce the hospital mortality of adult ARDS patients and shorten the mechanical ventilation duration in ICU for 28 days, and low- and medium-dose of glucocorticoids therapy does not increase the risk of infection and hyperglycemia.

Objective:To investigate the risk factors that were associated with the death of elderly patients who were admitted to the intensive care unit (ICU) after elective abdominal surgery, and to find reliable and sensitive predictive indicators for early interventions and reducing the mortality.Methods:A retrospective case-control study was conducted. The clinical data of elderly (age≥65 years old) patients after elective abdominal surgery admitted to the ICU of the Affiliated Hospital of Guizhou Medical University from January 1st 2016 to December 31st 2020 were collected, including the patient's gender, age, body mass index (BMI), medical history, American Society of Anesthesiologists (ASA) grades, surgical classification, intraoperative blood loss, duration of operation, interval time between end of operation and admission to the ICU, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score and the worst laboratory examination results within 24 hours of ICU admission, the first blood gas analysis in ICU, the duration of invasive mechanical ventilation, and the length of ICU stay. Postoperative abdominal infection was evaluated by the pathogenic culture of peritoneal drainage fluid and clinical symptoms and signs. The patients were divided into death group and survival group based on clinical outcomes, and clinical data were compared between the two groups. Binary multivariate Logistic regression analysis was used to screen the risk factors of death, and the receiver operator characteristic curve (ROC curve) was plotted to analyze the predictive values of these risk factors.Results:A total of 226 elderly patients with elective abdominal surgery were admitted to the ICU of our hospital during the past 5 years, of whom, two patients who did not undergo laboratory examinations within 24 hours of admission to the ICU were excluded. Finally, 224 patients met the criteria, with 158 survivors and 66 deaths. Univariate analysis showed that: compared with survival group, APACHEⅡscore, blood lactate acid (Lac) and the proportion of postoperative abdominal infection were higher in death group [APACHEⅡ score: 27.5 (25.0, 31.3) vs. 23.0 (18.0, 27.0), Lac (mmol/L): 2.9 (1.8, 6.6) vs. 1.8 (1.1, 2.8), the proportion of postoperative abdominal infection: 65.2% (43/66) vs. 35.4% (56/158), all P < 0.01], prothrombin time (PT), activated partial thromboplastin time (APTT) and interval time between end of surgery and admission to ICU were longer [PT (s): 17.20 (14.50, 18.63) vs. 14.65 (13.90, 16.23), APTT (s): 45.15 (38.68, 55.15) vs. 39.45 (36.40, 45.70), interval time between end of surgery and admission to ICU (hours): 39.2 (0.7, 128.9) vs. 0.7 (0.3, 2.0), all P <0.01], postoperative hemoglobin (Hb), platelet count (PLT), prealbumin (PA), mean arterial pressure (MAP) and oxygenation index (PaO 2/FiO 2) were lower in death group [Hb (g/L): 95.79±23.64 vs. 105.58±19.82, PLT (×10 9/L): 138.5 (101.0, 177.5) vs. 160.5 (118.5, 232.3), PA (g/L): 80.88±43.63 vs. 116.54±50.80, MAP (mmHg, 1 mmHg = 0.133 kPa): 76.8±19.1 vs. 91.6±19.8, PaO 2/FiO 2 (mmHg): 180.0 (123.5, 242.5) vs. 223.5 (174.8, 310.0), all P < 0.05]. Binary multivariate Logistic regression analysis showed that APACHEⅡscore [odds ratio ( OR) = 1.187, 95% confidence interval (95% CI) =1.008-1.294, P < 0.001], interval time between end of operation and admission to ICU ( OR = 1.005, 95% CI = 1.001-1.009, P = 0.016) and postoperative abdominal infection ( OR = 2.630, 95% CI = 1.148-6.024, P = 0.022) were independent risk factors for prognosis in these patients. MAP ( OR = 0.978, 95% CI = 0.957-0.999, P = 0.041) and PaO 2/FiO 2 ( OR = 0.994, 95% CI = 0.990-0.998, P = 0.003) were protective factors for the patients' prognosis. Lac, Hb, PLT, PA, PT and APTT had no predictive value for the prognosis of elderly patients admitted to ICU after elective abdominal surgery [ OR value and 95% CI were 1.075 (0.945-1.223), 1.011 (0.99-1.032), 1.000 (0.995-1.005), 0.998 (0.989-1.007), 1.051 (0.927-1.192) and 1.003 (0.991-1.016), respectively, all P > 0.05. ROC curve analysis showed that APACHEⅡscore, interval time between end of operation and admission to the ICU and the postoperative abdominal infection had certain predictive values for the prognosis of elderly patients, the area under ROC curve (AUC) were 0.755, 0.732 and 0.649 respectively, all P < 0.001; When the cut-off of APACHEⅡscore and interval time between end of operation and admission to the ICU were 24.5 scores and 2.15 hours, the sensitivity were 78.8% and 66.7%, respectively, and the specificity were 62.0% and 76.6%, respectively. The combined predictive value of the three variables was the highest, which AUC was 0.846, the joint prediction probability was 0.27, the sensitivity was 83.3%, and the specificity was 75.3%. Conclusion:APACHEⅡscore, interval time between end of surgery and admission to ICU, and postoperative abdominal infection may be independent risk factors for the death of elderly patients who were admitted to the ICU after elective abdominal surgery, there would be far greater predictive values when the three variables were combined.