The effects of intestinal factor on pulmonary lesion during shock were investigated. Anesthetized rabbits were dividcd at random into SMAO shock group(n=11) and sham shock group (n=8). Occlusion of SMA for 60 min followed by reperfusion produced a significant elevation of pulmonary capillary permeability index (PCPI), an increase of MDA in lung tissue, ultrastructural damage of type Ⅱ pneumocytes, and hyperemia, edema and haemorrhage in alveoli or bronchioli. There was a positive correlation between intestinal mucosal lesion and pulmonary lesion. However, PaO_2 showed no significant declination in this shock model. In vitro, the plasma collected from SMV blood of cats, which had been subjected to SMAO for 90 min, exerted a deleterious effect on isolated perfused rat lungs, characterized by elevation of pulmonary arterial perfusion presure and PCPI, increase in LDH and MDA in the perfusate. These results suggest that the humoral factors released from ischemic intestine into circulation may be, at least partially, accounted for the pulmonary damage during shock.

Objective To investigate the clinical value of wire-guided tubal recanalization under hysteroscope combined with laparoscope for the treatment of occluded oviduct infertility.Methods A total of 63 cases of infertility were diagnosed by hysterosalpingography(HSG) as having bilateral oviduct obstruction,of which at least one side of oviduct was proximally occluded.After laparoscopic exploration and hysteroscopic hydrotubation were performed for clarifying the diagnosis and managing related pelvic lesions,wire-guided tubal recanalization was conducted under hysteroscope combined with laparoscope for the treatment of proximal oviduct obstruction.Results Out of the 63 cases,a total of 118 oviducts were involved(eight oviducts had been previously resected).Of the 118 oviducts,59 were proximally occluded,45 were distally occluded or blinded,and 14 were proximally and distally occluded.After the surgery 99 oviducts were unobstructed.Intrauterine pregnancy was obtained within 1 year in 23 cases(36.6%).There were 25 cases of unpregnancy within 1 year,which were re-examined with HSG,presenting a re-obstruction in 7 cases.Conclusions Wire-guided tubal recanalization under hysteroscope combined with laparoscope is an ideal option for the treatment of occluded oviduct infertility.

Pedicle screw fixation is widely applied to spinal surgery owing to its advantages of maitaining the stability of spine,promoting the bone graft fusing and so on. Remarkably implantation accu-racy is not only closely related to ultimate fixation,but also can affect the incidence and the severity of complications. Consequently,to improve screw implantation accuracy is one of the goals that spinal sur-geons always pursue. In recent years,newly-developed techniques have been preliminarily used in clinic. An overview on the progresses of these techniques in China and overseas is presented here.

The general practice team of the Affiliated Hospital of Hangzhou Normal University and its medical consortium conducted health education for 73 diabetic patients from January to December 2019. The education was dealing with the knowledge and techniques of standardizing insulin administration, including the manipulations, rotation of injection sites and replacement of injection needles, etc. The questionnaire surveys on the knowledge of diabetic management and insulin administration were conducted before and after education. After education the number of patients who knew the injection site and skin disinfection increased from 68 and 69 to 73 and 73, respectively ( P>0.05); the number of patients who knew the injection depth and length of the needle used increased from 33 and 24 to 73 and 73, respectively ( P<0.05); the number of patients who knew pinching the skin, the angle of needle insertion increased from 30 and 44 to 73 and 73 ( P<0.05). After education the number of patients with pinch time>10 sec increased from 0 to 68 cases ( P<0.05); with needle stay>10 sec increased from 0 to 71 ( P<0.05); with rotation in the same area increased from 58 to 73 ( P<0.05); with repeated needle use decreased from 73 to 70 ( P>0.05). After education the blood glucose control of diabetic patients was improved: the glycosylated hemoglobin [(8.3±1.3)% vs. (6.8±0.5)%, t=9.00, P<0.05], fasting blood glucose [(7.7±0.8)mmol/L vs. (6.9±0.5)mmol/L, t=7.90, P<0.05] and 2-hour postprandial blood glucose[(11.4±2.1)mmol/L vs. (9.6±0.8)mmol/L, t=7.00, P<0.05] were significantly decreased. It is suggested that health education provided by the general practice team can standardize the insulin administration in diabetic patients and improve blood sugar control.

With the increasing proportion of human papilloma virus(HPV)infection in the pathogenic factors of oro-pharyngeal cancer,a series of changes have occurred in the surgical treatment.While the treatment mode has been im-proved,there are still many problems,including the inconsistency between diagnosis and treatment modes,the lack of popularization of reconstruction technology,the imperfect post-treatment rehabilitation system,and the lack of effective preventive measures.Especially in terms of treatment mode for early oropharyngeal cancer,there is no unified conclu-sion whether it is surgery alone or radiotherapy alone,and whether robotic minimally invasive surgery has better func-tional protection than radiotherapy.For advanced oropharyngeal cancer,there is greater controversy over the treatment mode.It is still unclear whether to adopt a non-surgical treatment mode of synchronous chemoradiotherapy or induction chemotherapy combined with synchronous chemoradiotherapy,or a treatment mode of surgery combined with postopera-tive chemoradiotherapy.In order to standardize the surgical treatment of oropharyngeal cancer in China and clarify the indications for surgical treatment of oropharyngeal cancer,this expert consensus,based on the characteristics and treat-ment status of oropharyngeal cancer in China and combined with the international latest theories and practices,forms consensus opinions in multiple aspects of preoperative evaluation,surgical indication determination,primary tumor re-section,neck lymph node dissection,postoperative defect repair,postoperative complication management prognosis and follow-up of oropharyngeal cancer patients.The key points include:① Before the treatment of oropharyngeal cancer,the expression of P16 protein should be detected to clarify HPV status;② Perform enhanced magnetic resonance imaging of the maxillofacial region before surgery to evaluate the invasion of oropharyngeal cancer and guide precise surgical resec-tion of oropharyngeal cancer.Evaluating mouth opening and airway status is crucial for surgical approach decisions and postoperative risk prediction;③ For oropharyngeal cancer patients who have to undergo major surgery and cannot eat for one to two months,it is recommended to undergo percutaneous endoscopic gastrostomy before surgery to effectively improve their nutritional intake during treatment;④ Early-stage oropharyngeal cancer patients may opt for either sur-gery alone or radiation therapy alone.For intermediate and advanced stages,HPV-related oropharyngeal cancer general-ly prioritizes radiation therapy,with concurrent chemotherapy considered based on tumor staging.Surgical treatment is recommended as the first choice for HPV unrelated oropharyngeal squamous cell carcinoma(including primary and re-current)and recurrent HPV related oropharyngeal squamous cell carcinoma after radiotherapy and chemotherapy;⑤ For primary exogenous T1-2 oropharyngeal cancer,direct surgery through the oral approach or da Vinci robotic sur-gery is preferred.For T3-4 patients with advanced oropharyngeal cancer,it is recommended to use temporary mandibu-lectomy approach and lateral pharyngotomy approach for surgery as appropriate;⑥ For cT1-2N0 oropharyngeal cancer patients with tumor invasion depth＞3 mm and cT3-4N0 HPV unrelated oropharyngeal cancer patients,selective neck dissection of levels ⅠB to Ⅳ is recommended.For cN+HPV unrelated oropharyngeal cancer patients,therapeutic neck dissection in regions Ⅰ-Ⅴ is advised;⑦ If PET-CT scan at 12 or more weeks after completion of radiation shows intense FDG uptake in any node,or imaging suggests continuous enlargement of lymph nodes,the patient should undergo neck dissection;⑧ For patients with suspected extracapsular invasion preoperatively,lymph node dissection should include removal of surrounding muscle and adipose connective tissue;⑨ The reconstruction of oropharyngeal cancer defects should follow the principle of reconstruction steps,with priority given to adjacent flaps,followed by distal pedicled flaps,and finally free flaps.The anterolateral thigh flap with abundant tissue can be used as the preferred flap for large-scale postoperative defects.