Objective To analyze the risk factors associated with morbidity and mortality of aortic dissection through the retrospective analysis.Methods Two hundred and thirty-two patients with aortic dissection(AD) who were treated in the Central Hospital of Taian were select as cases group,and were divided into A group of dissection involved ascending aorta with 91 cases and B group of dissection not involved ascending aorta with 141 cases according to type of Stanford.And 232 cases patients with chest pain in the same period of hospitalization and exclusion of aortic dissection were randomly selected as the control group.Through the history data collection,the relationship between age,sex,smoking and drinking history,history of previous illness,family history of cardiovascular disease,predisposing factors and the incidence of AD,and the difference of risk factors between A type and B type were analized.Single factor and multi factor Logistic regression analysis were performed on part of the related factors in the case group.Results Smoking history,hypertension history,coronary atherosclerotic heart disease history,Marfan syndrome and hyperuricemia of cases group were higher than of control group (x2 =6.165,11.700,9.260,14.070,35.170;P＜ 0.05).Marfan syndrome,coronary atherosclerotic heart disease history and hyperlipidemia history of A group were higher than of B group,hypertension history of B group was higher than A group,and the differences were significant (x2 =3.998,4.534,7.308,7.827;P＜0.05).In the correction of other factors,the risk of death in patients with type A was 3.27times that of the B type(P＜0.001),the risk of death in patients with a history of hypertension were 1.48 times more than that without history of hypertension(P=0.014),the risk of death in patients with hypotension shock were 2.27 times more than that without hypotension shock (P ＜ 0.001).Conclusion History of smoking,history of hypertension,history of coronary heart disease and hyperuricemia are the risk factors of aortic dissection.A aortic dissection type,a history of hypertension,and hypotension or cardiogenic shock are the independent risk factors causing the death of patients with aortic dissection.

Objective: To investigate occupational and procreation health of roadsweeping female sanitation workers in a city district. Methods: Using cross-sectional survey methods, all 303 the road sweeping female sanitation workers of one company were selected and interviewed face to face with questionnaires in june 2017. Data were analysed by SPSS22.0 statistical software. Results: The total prevalence of reproduction tract infection was 21.47%. The prevalence of uterine fibroids was 6.38%, and menstruation abnormal rate was 25.17%. The sanitation worker of menstruation abnormal rate was 31.03%, which were exposed low temperature, automobile exhaust and air contaminant at the same time, or else was 19.61%. There were statistical significance between them. (χ²=5.161, P<0.05) The sanitation worker of menstruation abnormal rate was 28.81%, which were not satisfied with women/s rights protection, or else was 11.67%. There were statistical significance between them. (χ²=7.435, P<0.01) . Conclusion Female sanitation workers in the city district were exposed to many occupational hazards. The status of procreation health among road sweeping female sanitation workers in the city district is not optimistic. Occupational health protection and laborers's rights protection should be emphasized to improve health status of female sanitation workers.

Objective:To analyze the expression of mismatch repair genes MLH1 and PMS2 in elderly colorectal cancer patients and its association with the clinicopathological features.Methods:This study was a single-center retrospective cohort study.According to the loss of MLH1 and PMS2 gene expression, elderly patients with colorectal cancer admitted to Beijing Hospital from January 2014 to December 2018 were consecutively enrolled and divided into the MLH1 group(n=65)and the PMS2 group(n=80). Pathological features were compared between the MLH1 group, the PMS2 group and patients with normal MLH1 and PMS2 gene expression.Results:Among patients with the loss of MHL1 protein expression, pathological features were similar in males and females.A minority of patients(16.9%)had a family history of tumors.Most lesions were either moderately differentiated(63.1%)or poorly differentiated(24.6%). Regarding staging, 44.6% were in stage T4, 27.7% were in stage T3, 61.5% were in N0, 89.2% were in M0, and most patients were in TNM stage Ⅲ.Lesions were mostly located in the ascending colon(61.5%). Compared with patients with normal expression of MHL1, patients with the loss of MHL1 protein expression were younger[(74.6±8.8) years old vs.(77.3±6.2) years old, t=-2.072, P=0.040]and had greater maximal tumor length[(5.7±2.3) cm vs.(4.4±1.3) cm, t=3.753, P<0.001], and there were significant differences in lesion differentiation, T staging and tumor location between the two groups( P<0.05). Conclusions:Loss of MLH1 or PMS2 gene expression in elderly colorectal cancer patients is associated with an early age of onset, rapid tumor progression, poor differentiation, and pathological staging.

Objective: To investigate the risk factors of anastomotic leakage (AL) after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy and construct a nomogram prediction model. Methods: This study was a retrospective case-control study that collected and reviewed the clinicopathological data of 359 patients who underwent laparoscopic surgery from January 2012 to January 2018, including 202 patients from the Department of General Surgery, Nanfang Hospital of Southern Medical University and 157 patients from the Department of Gastrointestinal Surgery of Fujian Provincial Cancer Hospital. Inclusion criteria: (1) age ≥ 18 years old; (2) diagnosis as rectal cancer by biopsy before treatment; (3) distance from tumor to anus within 12 cm; (4) locally advanced stage (T3-T4 or N+) diagnosed by imaging (CT, MRI, PET or ultrasound); (5) standardized neoadjuvant therapy followed by laparoscopic radical operation. Exclusion criteria: (1) previous history of colorectal cancer surgery; (2) short-term or incomplete standardized neoadjuvant therapy; (3) Miles, Hartmann, emergency surgery, palliative resection; (4) conversion to open surgery. Clinicopathological data, including age, gender, body mass index (BMI), preoperative albumin, distance from tumor to anus, operation hospital, American Society of Anesthesiologists score (ASA score), operation time, T stage, N stage, M stage, TNM stage, pathological complete response (pCR) were analyzed with univariate analysis to identify predictors for AL after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy. Then, incorporated predictors of AL, which were screened by multivariate logistic regression, were plotted by the "rms" package in R software to establish a nomogram model. According to the scale of the nomogram of each risk factor, the total score could be obtained by adding each single score, then the corresponding probability of postoperative AL could be acquired. The area under ROC curve (AUC) was used to evaluate the predictive ability of each risk factor and nomogram on model. AUC > 0.75 indicated that the model had good predictive ability. The Bootstrap method (1000 bootstrapping resamples) was applied as internal verification to show the robustness of the model. The discrimination of the nomogram was determined by calculating the average consistency index (C-index) whose rage was 0.5 to 1.0. Higher C-index indicated better consistency with actual risk. The calibration curve was used to assess the calibration of prediction model. The Hosmer-Lemeshow test yielding a non-significant statistic (P>0.05) suggested no departure from the perfect fit. Results: Of 359 cases, 224 were male, 135 were female, 189 were ≥ 55 years old, 98 had a BMI > 24 kg/m², 176 had preoperative albumin ≤ 40 g/L, 128 had distance from tumor to anus ≤ 5 cm, 257 were TNM 0-II stage, 102 were TNM III-IV stage, and 84 achieved pCR after neoadjuvant therapy. The incidence of postoperative AL was 9.5% (34/359). Univariate analysis showed that gender, preoperative albumin and distance from tumor to the anus were associated with postoperative AL (All P<0.05). Multivariate logistic regression analysis revealed that male (OR=2.480, 95% CI: 1.012-6.077, P=0.047), preoperative albumin ≤40 g/L (OR=5.319, 95% CI: 2.106-13.433, P<0.001) and distance from tumor to anus ≤ 5 cm (OR=4.339, 95% CI: 1.990-9.458, P<0.001) were significant independent risk factors for postoperative AL. According to these results, a nomogram prediction model was constructed. The male was for 55 points, the preoperative albumin ≤ 40 g/L was for 100 points, and the distance from tumor to the anus ≤ 5 cm was for 88 points. Adding all the points of each risk factor, the corresponding probability of total score would indicated the morbidity of postoperative AL predicted by this nomogram modal. The AUC of the nomogram was 0.792 (95% CI: 0.729-0.856), and the C-index was 0.792 after internal verification. The calibration curve showed that the predictive results were well correlated with the actual results (P=0.562). Conclusions Male, preoperative albumin ≤ 40 g/L and distance from tumor to the anus ≤ 5 cm are independent risk factors for AL after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy. The nomogram prediction model is helpful to predict the probability of AL after surgery.

【Objective】 To explore the effects of sexual function-preserving 450 nm blue laser vaporization of the prostate on the postoperative sexual function of patients with benign prostatic hyperplasia (BPH), and to evaluate the clinical efficacy, safety and feasibility of this procedure. 【Methods】 The clinical data of 20 BPH patients treated in our department during Jan. and Mar.2023 were analyzed. The International Prostate Symptom Score (IPSS), Quality of Life Scale (QoL) score, maximum urinary flow rate (Qmax), residual urine volume (PVR) and International Index of Erectile Function (IIEF-5) data were compared before and after the operation. The operation time, postoperative catheter indwelling time, and hospital stay were recorded. The ejaculation status 2 months after operation was followed up. 【Results】 All 20 patients completed the operation successfully. The operation time was (13.41±4.30) min, catheter indwelling time (1.2±0.4) d, and hospital stay (3.0±0.6) d. The IPSS, QoL, PVR and Qmax data 1 month after operation were significantly improved compared with those before operation (P<0.01). Two months after operation, all patients had sex and ejaculated, and no retrograde ejaculation occurred. The erection function remained unchanged (P>0.05). 【Conclusion】 The modified 450 nm blue laser vaporization of the prostate can improve the urination symptoms of BPH patients while retaining sexual function. It is a safe and feasible technique for BPH patients who have sexual needs, and provides an alternative surgical approach for those looking to preserve sexual function.

【Objective】 To investigate the efficacy and safety of 450 nm blue laser with 6 o’clock positioning in the treatment of middle lobe hyperplasia of prostate, in order to promote the clinical application of this surgery. 【Methods】 Clinical data of 20 patients with middle lobe hyperplasia of prostate treated with 450 nm blue laser with 6 o’clock positioning during Mar.and Aug.2023 were retrospectively analyzed.The operation time, postoperative bladder irrigation time, catheter indwelling time, hospital stay, and complications were recorded.The maximum urinary flow rate (Qmax), post-void residual volume (PVR), quality of life scale (QoL), international prostate symptom score (IPSS) before surgery and 1 month after surgery were compared. 【Results】 The operation time was (26.80±7.22) min, and bladder irrigation time was (20.50±1.79) h.The catheter was removed on the next day after surgery and all patients were discharged 2 days after operation.Compared to preoperative, one month after surgery, the Qmax [(7.40±1.05) mL/s vs.(19.60±1.76) mL/s] was significantly higher, PVR [(73.50±12.26) mL vs.(9.25±4.94) mL], QoL [(4.55±1.19) vs.(1.95±0.95)], and IPSS [(26.55±1.88) vs.(10.05±1.36)] were significantly lower, the differences being statistically significant (P<0.05).No complications occurred during operation and 1-month follow-up. 【Conclusion】 The 450 nm blue laser with 6 o’clock positioning is a new, safe and effective surgical treatment of middle lobe hyperplasia of prostate, which is worthy of clinical promotion and application.