Objective To investigate the clinical efficacy of thiophene tiotropium powder inhaler for postop-erative lung function recovery in lung cancer patients.Methods 80 patients of thoracic surgery lobectomy who had lung cancer were selected as research subjects.The patients were randomly divided into two groups.The observation group received tiotropium bromide powder for inhalation therapy,the control group was inhaled salmeterol /fluticasone propionate powder for inhalation therapy.Before treatment,after treatment,2d,6d of CRP,absolute neutrophil ANC, tumor necrosis factor α(TNF -α) were observed.Before treatment,after treatment 4 weeks,8 weeks of forced vital capacity (FVC),within one second force expiratory volume in FEV1 ,FEV1 percent predicted (FEV1%),FEV1 /FVC, PaO2 ,PaCO3 were detected.Results Before treatment,CRP,AND,TNF -αhad no significant differences between the two groups (all P >0.05).Postoperative 2d,CRP,ANC,TNF -αof the two groups were all increased.Postopera-tive 6d,the above indicators of the two groups were declined,and the decline of the observation group was significantly lower than the control group (t =3.163 4,3.651 8,4.025 3,all P <0.05).Before treatment,FVC,FEV1 ,FEV1%, FEV1 /FVC,PaO2 ,PaCO3 between the two groups had no significant differences (all P >0.05).4 weeks,8 weeks af-ter treatment,FVC,FEV1%,FEV1 /FVC,PaO2 of the observation group were significantly higher than the control group (t =2.041 8,4.116 7;2.043 1,3.722 8;3.056 2,4.138 6;3.227 6,5.161 9;all P <0.05),FEV1 ,PaCO3 were significantly lower than the control group (t =1.523 7,3.427 6;3.439 2,4.521 7;all P <0.05).Conclusion Tiotropium bromide inhalation powder agents has certain effect on lung function recovery for lung cancer patients after surgery,it is worthy of clinical application.

To analysis the reason of the arguments of “Sexual hallucinations” or “Sexual harassment”between clinicians and patients,and find out how to prevent its happening.Methods:Base on clinical case about patients complaints that clinicians sexually assault,review and analysis the prtinent literatures.Results:Sexual hallucinations is a complication following anesthesia with psychotropic drugs,it 's easy to be misunderstand as Sexual harassment and result in allegations of sexual misconduct between patient and clinician.Conclusion:Clinicians need to be aware that sexual hallucinations to occur during sedation or after anesthesia,to protect themselves against the accusations of sexual harassment,the practitioner should never be unchaperoned with a patient of the opposite sex during sedation or anesthesia.

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Hoarseness ; diagnosis ; etiology ; Humans ; Vocal Cord Paralysis ; complications ; diagnosis

Objective To investigate the effect of vitamin D (VD) on gastric cancer and its underlying mechanisms by detecting serum VD levels in gastric cancer patients and the expression of vitamin D receptor (VDR) in gastric tumor.Methods Serum VD levels was detected by enzyme linked immunosorbent assay,VRD expression of tumor tissue and normal mucosa were detected by immunohistochemistry.At the same time,relationships of VDR expression and the prognosis of the patients were analyzed.Results The serum levels of VD of gastric cancer patients were lower than that of healthy people (P＜0.05),and they were negatively related to the degree of cell differentiation significantly (P＜0.001).VDR expression in gastric tumor tissue significantly decreased compared to that of the normal mucosa (P＜0.05).A significant correlation was found between the VDR expression and the differentiation grade of the carcinoma,with well differentiated carcinoma having the highest level of VDR expression (P＜0.05).For patients with gastric cancer,those with positive VDR expression had significant longer progression-free survival (PFS) and overall survival (OS) than the patients with negative VDR expression (P＜0.05).Conclusions VD may be a protecting factor of gastric cancer.VDR can be regarded as a marker of differentiation of gastric cancer and served as an effective prognostic factor in patients with postoperative gastric cancer.

Objective To evaluate the effects of community-based rehabilitation therapy on activitv of daily living performance of the Chinese stroke patients. Methods In a single blinded,randomized,controlled multicenter trial,737 consecutive stroke patients were stratified by two groups of cerebral infarction and hemorrhage. All the patients were randomly divided into a rehabilitation group and a control group.The patients in the rehabilitation group received atandardized community-based rehabilitation therapy,while those in the control group did not.All the patients were followed up for 5 months for evaluation of their performance with activity of daily living by using Modified Barthel Index before intervention,after follow-up 2 and 5 months,respectively. Results Patients in the rehabilitation group performed better in ADL as reflected by the Modified Barthel Index score than those in the control group after 5 months of intervention(P＜0.05).Although both the rehabilitation group and control group improved over time,the rehabilitation group showed a greater improvement with the Modified Barthel Index scores when compared with the control group(P＜0.01).After 5 months follow-up,the total gain of Modified Barthel Index scores was 26.28 and 32.89 for those with cerebral infarction and hemorrhage,respectively,in the rehabilitation group. In comparison,the gain of Modified Barthel Index scores was 7.65 and 2 1.70 for those with cerebral infarction and those with hemorrhage,respectively in the control group.This implies a difference in improvement of 1 8.63 in cerebral infarction group and 1 1.19 in hemorrhage group,in favor of the rehabilitation group. Conclusion Standardized community-based rehabilitation therapy may help stroke patients to improve their performance in activity of daily living significantly.

OBJECTIVETo assess the feasibility and safety of excising or patching the inferior vena cava (IVC) without replacement in patients with primary retroperitoneal tumors (PRPT) involving the IVC.

METHODSA retrospective analysis was conducted in 116 consecutive patients with PRPT presented to our Hospital between December 2007 and December 2008. IVC involvement was found in 11.2% of the cases, and in 93 cases receiving surgical tumor removal, the complete resection rate was 93.55%. According to the location of IVC involvement by the PRPT, the cases were classified into 3 groups with IVC involvement in the segment from the second hepatic portal vein to the renal vein (segment A), the segment on the bilateral renal vein plane (segment B), and the segment from the caval bifurcation to the renal vein (segment C).

RESULTSThe most common vascular involvement occurred in segment C (61.54%, 8/13), and 2 cases presented with segment A involvement and 2 had segment B involvement. All the 3 segments of IVC were involved in 1 case. Five cases with IVC involvement received IVC patching only, and 4 had resection or ligation of the segment C of the IVC, and resection of the segment A and B of the IVC was performed in 2 and 1 case, respectively. One patient received complete resection of whole IVC involved. All patients recovered smoothly and were discharged.

CONCLUSIONThe infrarenal IVC can be ligated or resected safely without reconstruction. Combined resection of the bilateral renal vein and segment B of the IVC may result in renal insufficiency. IVC involvement and occlusion between the second hepatic portal and renal veins can be ligated safely without affecting the renal function.

Adult ; Feasibility Studies ; Female ; Humans ; Ligation ; Male ; Middle Aged ; Neoplasm Invasiveness ; Retroperitoneal Neoplasms ; pathology ; surgery ; Retrospective Studies ; Vascular Surgical Procedures ; methods ; Vena Cava, Inferior ; pathology ; surgery ; Young Adult

Objective:To explore the application value of virtual reality technology in thoracoscopic anatomical segmentectomy.Methods:Eighty-four patients with early stage non-small cell lung cancer admitted to the First Hospital of Jiaxing from December 2017 to December 2018 were enrolled in the study.They were divided into observation group and control group according to the random digital table method, with 42 cases in each group.The observation group used virtual reality technology to construct a three-dimensional digital model, and performed preoperative evaluation and simulated surgical drills and intraoperative navigation on the three-dimensional digital model, based on the preoperative evaluation and simulated surgical drill results, combined with the specific actual situation during the operation, developed and implemented individualized thoracoscopic anatomical segmentectomy.Thoracoscopy anatomical segmentectomy was routinely performed in the control group.The operation time, intraoperative blood loss, intraoperative lymph node dissection number, intraoperative lymph node dissection, postoperative hospital stay, postoperative thoracic closed drainage tube, total postoperative drainage, total hospitalization, cost and incidence of postoperative complications were compared between the two groups.Results:The operation of both two groups was successfully completed, and no intraoperative thoracic surgery was performed during the operation.There was no perioperative death.The operation time, intraoperative blood loss, intraoperative lymph node dissection number, intraoperative lymph node dissection, postoperative hospital stay, postoperative thoracic closed drainage tube, total postoperative drainage, total hospitalization cost and the incidence of postoperative complications in the observation group were (100.98±26.51)min, (67.98±32.96)mL, (7.79±1.32), (11.98±4.69), (4.60±1.43)d, (2.86±0.81)d, (437.14±193.86)mL, (3.76±0.31)million, 9.52%(4/42), respectively, which in the control group were (114.88±24.26)min, (104.52±52.37)mL, (6.45±0.3), (8.31±1.94), (6.50±2.55)d, (4.00±2.25)d, (667.26±415.01)mL, (4.20±0.65)million, 26.19%(11/42), respectively, the differences between the two groups were statistically significant ( t=-2.208, -3.328, 5.916, 4.678, -4.221, -3.993, -3.265, -3.968, χ 2=3.977, all P<0.05). No local recurrence or distant metastasis was found during the follow-up period. Conclusion:Virtual reality technology can provide preoperative evaluation and simulated surgical exercises and intraoperative navigation for thoracoscopic anatomical segmentectomy, which can reduce the difficulty of surgery and improve the accuracy and safety of the operation.

In recent years, with the development of neurointerventional techniques, transradial approach (TRA) has been able to meet most needs of neurointerventional procedures. Compared with tranfemoral approach (TFA), TRA can obviously reduce access-site complications, shorten hospital stays and improve patient satisfaction. However, due to the long learning curve, lack of radial-specific catheters, small artery diameter and specific vascular access-site complications, TRA development is relatively slow, and relevant domestic and foreign studies are still at initial stage. Therefore, this article mainly focuses on the anatomy, advantages and limitations, approaches of radial artery, and discuss the safety and feasibility of TRA in neurointerventional diagnosis and treatment, in order to provide more references for neurointerventionalists.

To unravel the genetic mechanisms of disease and physiological traits, it requires comprehensive sequencing analysis of large sample size in Chinese populations. Here, we report the primary results of the Chinese Academy of Sciences Precision Medicine Initiative (CASPMI) project launched by the Chinese Academy of Sciences, including the de novo assembly of a northern Han reference genome (NH1.0) and whole genome analyses of 597 healthy people coming from most areas in China. Given the two existing reference genomes for Han Chinese (YH and HX1) were both from the south, we constructed NH1.0, a new reference genome from a northern individual, by combining the sequencing strategies of PacBio, 10× Genomics, and Bionano mapping. Using this integrated approach, we obtained an N50 scaffold size of 46.63 Mb for the NH1.0 genome and performed a comparative genome analysis of NH1.0 with YH and HX1. In order to generate a genomic variation map of Chinese populations, we performed the whole-genome sequencing of 597 participants and identified 24.85 million (M) single nucleotide variants (SNVs), 3.85 M small indels, and 106,382 structural variations. In the association analysis with collected phenotypes, we found that the T allele of rs1549293 in KAT8 significantly correlated with the waist circumference in northern Han males. Moreover, significant genetic diversity in MTHFR, TCN2, FADS1, and FADS2, which associate with circulating folate, vitamin B12, or lipid metabolism, was observed between northerners and southerners. Especially, for the homocysteine-increasing allele of rs1801133 (MTHFR 677T), we hypothesize that there exists a "comfort" zone for a high frequency of 677T between latitudes of 35-45 degree North. Taken together, our results provide a high-quality northern Han reference genome and novel population-specific data sets of genetic variants for use in the personalized and precision medicine.