Objective With a network meta-analysis,to compare the effects and safety of seven clinically common-used induction methods.Methods Publications of randomized controlled trials between January 1,1980 and November 20,2011 were searched on Medline,Embase and Cochrane Central Register of Controlled Trials with the following terms including dinoprostone,misoprostol,Foley catheter,oxytocin and labor induction.A network meta analysis with both direct and indirect comparison was applied for 48 randomized controlled trials (19 819 participants) recruited,and the following seven induction methods applied in the publications were compared:oxytocin (intravenous,Ⅳ),vaginal dinoprostone,intracervical dinoprostone,oral misoprostol,vaginal misoprostol,sublingual misoprostol and foley catheter.The main outcomes were the proportion of vaginal delivery within 24 hours,cesarean section rate,uterine hyperstimulation rate and Apgar score＜7 at 5 min after birth.Medline,Embase and Cochrane Central Register of Controlled Trials were searched between January 1,1980 and November 20,2011.Results Foley catheter methods had the lowest cesarean section rate and the lowest uterine hyperstimulation rate.Vaginal misoprostol method had the highest number of vaginal delivery within 24 hours,but the highest uterine hyperstimulation rate.The lowest rate of neonatal Apgar score＜7 at 5 min was found in women using sublingual misoprostol,while the highest in those using vaginal Dinoprostone.Oxytocin (Ⅳ) method had the lowest number of vaginal delivery within 24 hours and the highest cesarean section rate.Conclusion Foley catheter method is the best available option for labor induction in terms of efficacy and safety,while the induction effect of oxytocin (Ⅳ) was not good enough.Vaginal misoprostol and vaginal dinoprostone methods had relative good induction effect but with obvious adverse effects.

Objective To evaluate the relationship between positive thyroid autoantibody and risk of preterm birth.Methods Literature search was done in PubMed,Embase,China Academic Journal Network Publishing Database,Wanfang Medical Database and China Biology Medicine disc databases from January 1st,1989 to January 26th,2012.Criteria for inclusion included:(1) Prospective cohort study; (2) The exposure was positive thyroid autoantibody and outcome was preterm birth; (3) The enrolled subjects were pregnant women without cardiovascular or rheumatic disease; (4) Relative risk (RR) and its 95％ confidence interval (95％CI) of preterm birth were provided in the study.Meta-analysis was performed by Stata 12.0.The relationship between positive thyroid autoantibody and risk of preterm birth was evaluated by RR and 95％ CI.Results Ten cohort studies were enrolled.One thousand six hundred and fifty seven cases of preterm birth occurred among 25 081 pregnant women.Heterogeneity among the 10 studies was found in meta-analysis (I2 =79.2％,P＜0.01).The risk of preterm birth in pregnant women with positive thyroid autoantibody was higher than those in control group by random effects analysis (RR=1.61,95％CI:1.18-2.20,P＜0.05).Subgroup analysis was further performed.In five studies,the cases of control group were pregnant women with normal thyroid function; heterogeneity was not found in these five studies (I2=39.1％,P=0.160); and RR of the risk of preterm birth was 2.55 in pregnant women with positive thyroid autoantibody (95 ％ CI:2.04 3.19,P＜0.01).In the other five studies,the cases of controlgroup were pregnant women who had not been ruled out the possibility of thyroid dysfunction;heterogeneity was not found in these five studies either (I2 =0.0％,P =0.970); and RR was 1.18(95 ％ CI:1.01-1.37,P＜0.05).After excluding two low-quality studies,RR of the risk of preterm birth was 1.72 in pregnant women with positive thyroid autoantibody (95％CI:1.18 2.53,P＜0.05).The funnel plots presented symmetrical graphics,indicating that there was no publication bias.Conclusions Positive thyroid autoantibody in pregnant women is a risk factor of preterm birth.

Objective:To investigate the relationship between Creactive protein(CRP)/albumin ratio (CAR) and lymph node metastasis of gastric cancer. Methods:A total of 96 cases of gastric cancer were included in the study. The clinical pathological stage and lymph node detection in patients with gastric cancer were analyzed, with the preoperative CAR as the dependent variable. Results:1) The pa-tients with preoperative CAR>0.04 has higher transfer rate and metastasis than the patients with preoperative CAR≤0.04, and the dif-ference was significant (P<0.05). The lymph node stage of patients with preoperative CAR>0.04 was significantly higher than that of the patients with preoperative CAR≤0.04, and the difference was significant (P<0.05). 2) The mean CAR of patients with Borrmann typesⅠ,Ⅱ,Ⅲ, andⅣgradually increased;with the progression of the pathological stage of gastric cancer, the mean value of CAR in-creased. 3) During the operation, the total number of lymph node dissections was high and the mean value of CAR before the opera-tion was high. Conclusion:The correlation between preoperative CAR and lymph node metastasis in patients with gastric cancer may reflect the degree of lymph node metastasis to a certain extent.

Objective:To investigate the clinicopathological features and pathological diagnosis methods of calcifying fibrous tumor (CFT) of the stomach.Methods:The clinicopathological data of 9 patients with gastric CFT in the Second Hospital of Hebei Medical University from August 2015 to May 2020 were retrospectively analyzed, immunohistochemistry was used to detect the immunophenotypic characteristics of gastric CFT, and the relevant literature was reviewed.Results:Among 9 patients with gastric CFT, 1 case was male and 8 cases were female, with a median age of 53 years old (18-63 years old). There were 7 cases occurred in the body of the stomach, while 2 cases in the fundus. All cases were single solid nodule with the cut surface gray-white or gray-red in colour and hard and tough in texture. Maximum diameter of tumor ranged from 0.6 cm to 1.5 cm. Observation under the microscope showed the spindle-shaped tumor cells were sparsely distributed in a large amount of collagenized stroma with scattered lymphocytes and plasma cells infiltration. Calcification or gravel formation was detected in all cases. The tumor cells in 9 cases expressed Vimentin, 3 cases expressed CD34, none of them expressed PDGFRA, SMA, SMMS-1, Desmin, ALK, DOG-1, CD117, S-100, β-catenin, CKpan and calponin; Ki-67 positive index was 1%-3%.Conclusions:Gastric CFT is more common in middle-aged and elderly people, which is characterized by gastric body with smaller volume. The diagnosis of gastric CFT mainly depends on pathological morphology and immunohistochemical examination. It needs to be differentiated from a variety of spindle cell tumors more commonly found in the stomach.

Objective To explore the effect of using smart products (including smart phones, computers and other electronic products),as well as having hobbies on their cognitive function in pension agency elderly people,and analyze if there is certain protective effect on cognitive function by using smart products and having hobbies.So as to reduce the risk of mild cognitive impairment in the future. Methods By convenience sampling, 160 residents living in the nursing home of suzhou city (mean age 60 or higher) were selected, and demographic data were collected by using a homemade questionnaire, their cognitive function was investigated by using the Montreal Cognitive Assessment Scale. Results Single factor analysis showed that the score of the elderly who often use smart products in every cognitive field and overall cognitive function were superior to those who could not use smart products,the difference was statistically significant(t=-4.47--2.15,all P<0.05).The scores of the elderly with hobbies were higher in the overall cognitive function and the other six areas except the orientation, than those who had no hobby,and the differences were statistically significant(t=-6.80--1.81,all P<0.05).After adjusting for age,gender,body mass index(BMI),cultural level,often using smart products in total cognitive function in the elderly(t=4.842,P<0.01)and executive function(t=4.008,P<0.01),attention(t=3.045,P=0.003), abstract(t=2.135,P=0.034),delayed recall(t=3.759,P<0.01),the directional(t=2.866,P=0.005)of the five areas showed significant correlation. The total cognitive function of the elderly with hobbies (t=3.496, P = 0.001) and the visual spatial execution function (t=3.316, P = 0.001), naming (t=3.241, P =0.001), abstract (t=2.643, P = 0.009), and delayed recall (t=2.073, P= 0.04) were all significantly correlated.Conclusions Often using smart products and having certain hobbies are protective factors of cognitive function,build corresponding intervention plans for the future,by cultivating the elderly hobby, guiding the elderly using intelligent products and other measures to achieve successful aging, slow the cognitive decline,thus reducing the risk of mild cognitive impairment.

OBJECTIVETo investigate the better method of digestive tract reconstruction in proximal gastrectomy for early gastroesophageal junction adenocarcinoma.

METHODSA total of 153 cases of early gastroesophageal junction adenocarcinoma who were planned to receive radical proximal gastrectomy from January 2003 to December 2011 were prospectively enrolled and randomly divided into two groups by table of random number according to methods of digestive tract reconstruction, including 3S anastomosis group (80 cases, 3S jejunal interposition) and traditional anastomosis group (73 cases, esophageal remnant gastric posterior wall anastomosis). Postoperative complications, operative time, mortality, nutritional parameters and postoperative quality of life were compared between these two groups.

RESULTSThere were no significant differences between two groups in postoperative complications, operative time and mortality (all P>0.05). 3S anastomosis group was better in nutritional parameters than traditional group six months after operation (P<0.05). As compared to traditional group, incidence of reflux esophagitis decreased [20.0%(16/80) vs. 46.6%(34/73), P<0.01] and gastric emptying time prolonged obviously [(160.8±8.1) min vs. (61.1±10.8) min, P<0.01] in 3S anastomosis group 18 months after operation. Postoperative QLQ-C30 rating scale revealed quality of life was significantly higher in 3S anastomosis group as compared to traditional group.

CONCLUSIONJejunal interposition is a better method of digestive tract reconstruction in proximal gastrectomy for early gastroesophageal junction carcinoma.

Adenocarcinoma ; surgery ; Anastomosis, Surgical ; methods ; Digestive System Surgical Procedures ; Esophageal Neoplasms ; surgery ; Esophagogastric Junction ; pathology ; Gastrectomy ; methods ; Humans ; Jejunum ; pathology ; Operative Time ; Postoperative Complications ; Postoperative Period ; Quality of Life ; Reconstructive Surgical Procedures ; methods ; Stomach Neoplasms ; pathology

OBJECTIVETo study the safety and feasibility of fast track surgery (FTS) in the promotion of postoperative recovery for gastric cancer patients undergoing gastrectomy.

METHODSFrom January to December in 2013, 71 gastric cancer patients were prospectively enrolled and randomized into the FTS group and the control group. Patient in the FTS group received FTS management and those in the control group received routine management. The postoperative recovery and stress were compared between the two groups.

RESULTSFTS was associated with shorter time to bowel function return [(67.8±19.7) h vs. (90.0±20.6) h, P<0.01], shorter hospital stay [(13.5±3.0) d vs. (17.8±7.3) d, P=0.01], lower hospital cost [(23.8±3.7) thousand Yuan vs. (27.8±6.1) thousand Yuan, P<0.05], and less stress response (lower pain score, WBC count, C-reactive protein, all P<0.01). The postoperative complications including ileus, infection, anastomotic leakage were similar (all P>0.05).

CONCLUSIONFast track surgery decreases postoperative stress response and promotes recovery.

Aged ; Female ; Gastrectomy ; Humans ; Male ; Middle Aged ; Perioperative Care ; Postoperative Complications ; prevention & control ; Prospective Studies ; Stomach Neoplasms ; surgery ; Treatment Outcome

Objective:To investigate the diagnostic value of thyroid imaging report and data system (TIRADS) combined with BRAF V600E mutation detection in differentiating uncertain thyroid nodules by using fine needle aspiration cytology (FNAC), and to analyze the role of TIRADS classification in screening the nodules needed to be routinely detected for BRAF V600E mutation.Methods:The clinicopathological data of 337 thyroid nodules patients diagnosed with TIRADS classification, FNAC Bethesda classification, BRAF V600E mutation detection and postoperative histopathology from the Second Hospital of Hebei Medical University between January 2018 and August 2021 were retrospectively analyzed. The role of TIRADS classification, FNAC Bethesda classification and BRAF V600E mutation detection alone and the combined detection in the differentiation of benign and malignant thyroid nodules was also analyzed.Results:The postoperative histopathological result was regarded as the gold standard. The sensitivity of TIRADS classification, FNAC Bethesda classification and BRAF V600E mutation for thyroid cancer diagnosis was 76.0%, 88.1% and 80.4% respectively, and the corresponding specificity was 84.0%, 96.0% and 100.0%, respectively. Histologically, 37 (62.7%) of 59 nodules with FNAC uncertainty were malignant nodules after the surgery. The sensitivity and accuracy of BRAF V600E mutation detection in the diagnosis of FNAC uncertain nodules were 51.4% and 69.5%, respectively, while the sensitivity and accuracy of BRAF V600E mutation detection combined with TIRADS classification were 86.5% and 84.7%, respectively. The sensitivity and accuracy of BRAF V600E mutation detection combined with TIRADS classification were both improved ( P values were 0.002 and 0.049, respectively). The positive rate of BRAF V600E mutation in thyroid nodules increased step by step with the rise of risk degree in TIRADS classification, and the type 3 cases were lower than those in type 4a cases [14.3% (1/7) vs. 68.6% (24/35), P = 0.012], and there were no statistically significant differences among the adjacent groups above 4a (all P > 0.05). Conclusions:TIRADS combined with BRAF V600E mutation detection can improve the sensitivity and accuracy in the diagnosis of FNAC uncertain thyroid nodules. The BRAF V600E mutation rate of TIRADS 4a and above nodules is high, so routine detection is recommended.