OBJECTIVE: To compare the trauma of neck dissection on the human body between two-striae incision and traditional "L" shaped incision by serum trauma cytokines. METHODS: Patients with differentiated thyroid carcinoma hospitized from December 2008 to July 2011 were divided into 2 groups according to their own will. The first group 26 patients) had two-striae incision and the second group 32 patients) had traditional "L" shaped incision. The serum level of interleukin(IL)-2, IL-6 and C-reactive protein (CRP) in all patients were examined 1 day before and 1, 3 and 5 days after the surgery. RESULTS: No statistical significance was found between the 2 groups, although level of IL-2 decreased 1 day after the surgery, but recovered to normal 3 days later. The level of IL-6 in both groups increased 1 day after the surgery, began to decrease 3 days after the surgery, and recovered to normal 5 days after the surgery. The level of CRP suggested statistical significance (P<0.05), which increased obviously 1, 3 and 5 days after the surgery. No statistical difference was found before or after the surgery between the 2 groups (P>0.05). After follow-up for 8-40 months, no local recurrence or lymph node metastasis was found. CONCLUSION Compared with the traditional "L" shaped incision, two-striae incision in neck dissection does not increase the serum level of trauma cytokines and trauma to human body after the surgery. Two-striae incision is an ideal surgical approach to differentiated thyroid carcinoma.
Adult ; C-Reactive Protein ; metabolism ; Carcinoma, Papillary ; blood ; surgery ; Cytokines ; blood ; Female ; Humans ; Interleukin-2 ; blood ; Interleukin-6 ; blood ; Male ; Middle Aged ; Neck Dissection ; methods ; Thyroid Neoplasms ; blood ; surgery

ObjectiveToinvestigatethecorrelationbetweenbloodpressurevariabilityandcognitive impairment in ischemic stroke. Methods The inpatients with acute ischemic stroke were enroled. The demographic and clinical data were colected. The coefficient of variation of blood pressure within 7 days after onset w as calculated. Montreal Cognitive Assessment w as used to evaluate the cognitive function at three month after onset. Multivariate logistic regression analysis w as used to identify the relationship betw een the coefficient of variation of blood pressure w ithin 7 days and the cognitive impairment at 3 months after onset. Results A total of 708 patients w ith acute ischemic stroke w ere enrol ed in the study. At 3-month folow-up, 510 patients (72.0%) had cognitive impairment and 198 (28.0%) had normal cognitive function. The coefficient of variation for systolic blood pressure ( 8.3 ±1.2 vs.8.7 ±1.4; t= -3.299, P=0.001) and coefficient of variation for diastolic blood pressure ( 7.8 ±1.3 vs.8.0 ±1.5; t= -2.529, P=0.012) in the cognitive impairment group w ere significantly higher than those in the normal cognitive function group. With the first quintile as a reference, after adjusting other confounding factors, multivariate logistic regression analysis show ed that cognitive impairment at 3 months after onset w as significantly associated w ith coefficient of variation for systolic blood pressure. The odds ratios and 95 % confidence intervals for the 2-5 quantile groups w ere 2.33 (1.18-4.6), 2.31 (1.15-4.66), 2.70 (1.29-5.65), and 4.82 (1.92-12.1), respectively ( al P<0.05 ). Conclusion Systolic blood pressure variability in the acute phase of ischemic stroke is associated w ith cognitive impairment.

Objective To study the association of gestational weight gain (GWG) with perinatal outcomes in twin pregnant women categorized by different prepregnant body mass index (BMI) and to explore the optimal GWG.Methods A retrospective cohort study was conducted on 1 297 twin pregnancies delivered at Beijing Obstetrics and Gynecology Hospital,Capital Medical University from January 2013 to December 2016.Based on the prepregnant BMI categories defined by World Health Organization (WHO),these subjects were divided into four groups:under weight (n=154,BMI＜18.5 kg/m2),normal weight (n=890,BMI ≥ 18.5-＜ 25 kg/m2),overweight (n=209,BMI ≥ 25-＜30 kg/m2) and obese (n=44,BMI ≥ 30 kg/m2) groups.Women with BMI＜18.5 kg/m2 were excluded from the study and the rest 1 143 subjects were categorized into three groups according to the Institute of Medicine (IOM) guidelines:inadequate GWG (n=334),appropriate GWG (n=634) and excessive GWG groups (n=175).The association of maternal prepregnant BMI and GWG with maternal complications and neonatal weight were studied.Only 585 women who delivered twins weighted ≥ 2 500 g on average at ≥ 37 gestational weeks were included when exploring the optimal GWG.The P25-P75 of pregnant women with different prepregnant BMI was calculated to be the suitable range for weight gain during pregnancy.Chi-square test and multivariate logistic regression analysis were used for statistical analysis.Results (1) Compared with the normal weight group,the under weight group had an increased risk of low birth weight twins (OR=1.64,95％CI:1.16-2.31),but decreased risks of gestational diabetes mellitus (GDM) and cesarean section (OR=0.58,95％CI:0.35-0.96;OR=0.41,95％CI:0.22-0.77).The risks of preeclampsia (OR=1.64,95％CI:1.09-2.49;OR=2.63,95％CI:1.29-5.37) and GDM (OR=2.07,95％CI:1.49-2.89;OR=4.12,95％CI:2.23-7.60) increased in overweight and obese women.(2) Compared with the women with appropriate GWG,the risks of preterm delivery (OR=1.46,95％CI:1.12-1.91) and low birth weight twins (OR=2.03,95％CI:1.55～2.65) increased,while those of preeclampsia (OR=0.49,95％CI:0.31-0.79) and cesarean section (OR=0.38,95％CI:0.21-0.70) decreased in inadequate GWG women.Subgroup analysis according to prepregnant BMI showed that inadequate GWG increased the risks of preterm birth (OR=1.46,95％CI:1.08-1.97) and low birth weight twins (OR=2.22,95％CI:1.64-3.02) in the normal weight women,but decreased the risks of preeclampsia in both normal weight and overweight and obese women (OR=0.55,95％CI:0.31-0.97;OR=0.39,95％CI:0.16-0.94).Moreover,the risks of cesarean section for women with inadequate GWG were reduced in both normal weight and overweight and obese groups (OR=0.43 and 0.23,95％CI:0.22-0.85 and 0.06-0.96).Compared with the women with appropriate GWG,the risk of small for gestational age (SGA) (OR=0.63,95％CI:0.42-0.95)decreased,but the risk of preeclampsia increased (OR=1.71,95％CI:1.11-2.62) in excessive GWG women.Subgroup analysis by prepregnant BMI showed that excessive GWG decreased the risks of SGA (OR=0.10,95％CI:0.02-0.45) and low birth weight twins (OR=0.28,95％CI:0.11-0.71) in the overweight and obese group,but increased the risk of preeclampsia in the normal weight group (OR=2.08,95％CI:1.26-3.43).(3) Multivariate logistic regression analysis revealed that inadequate GWG was a risk factor for preterm birth (OR=1.44,95％CI:1.31-1.59) and low birth weight twins (OR=2.08,95％CI:1.70-2.53),but a protective factor for preeclampsia (OR=0.51,95％CI:0.32-0.82) and cesarean section (OR=0.38,95％CI:0.20-0.69).Excessive GWG reduced the risk of SGA (OR=0.61,95％CI:0.50-0.75),but increased the risk of preeclampsia (OR=1.65,95％CI:1.07-2.55).(4) The total GWG reference values (P25-P75) for twin pregnancies at term were 17-25 kg for under weight women,17-24 kg for normal weight women,14-22 kg for overweight women and 9.5-17 kg for obese women.Conclusions Adverse perinatal outcomes might be increased in either inadequate or excessive GWG in normal prepregnant weight women with twins,so IOM guidelines is recommended in GWG management in this population.The optimal total GWG reference values (P25-P75) for non-obese twin pregnancies are consistent with the IOM recommendations,but those for obese women are yet to be explored.

Objective:To analyze the clinic effects of arthroscopic partial trapeziectomy and suture button suspensionplasty in the treatment of first carpometacarpal joint (CMCJ) Eaton stage II/III arthrosis.Methods:A retrospective study was conducted on a total of 15 cases (16 hands) of patients including 5 males (1 bilateral) and 10 females with CMCJ stage II/III arthrosis who underwent surgical treatment at the first affiliated hospital of Shenzhen university from January 2020 to June 2022, with mean age of 56.7±6.4 years (range, 46-75 years). The duration from pain to treatment was 7.8±3.2 months (range, 4-14 months). X-ray showed narrowing of CMCJ with osteophytes and distal radial subluxation. All the patients were treated with arthroscopic partial trapeziectomy and suture button suspensionplasty. The preoperative and last postoperative follow-up radiographs, visual analogue scale (VAS), thumb's Kapandji scores, disabilies of the arm, shoulder, and hand (DASH) scores, grip and pinch strength and time to return to work were compared.Results:All cases were followed up for 19.6±6.3 months (range, 11-36 months). The postoperative X-ray showed all the CMCJs were reduced with a normal height of first metacarpal. The mean time for patients to return to their daily activities was 18.69±3.70 d and the mean time to return to work was 24.63±4.91 d. The average VAS score decreased from 6.56±1.15 preoperatively to 1.00 (0.75, 1.25). The preoperative Kapandji's score was 8.00±0.82 and the postoperative Kapandji's score was 8.00 (7.25, 9.00). The average DASH values improved from 24.06±3.19 to 4.00 (3.00, 5.00). The were significant differences except for Kapandji score ( Z=-4.905, P<0.001; Z=-0.121, P=0.905; Z=-4.846, P<0.001). The mean grip and pinch strength showed improvement from an average of 16.4 (14.13, 18.68) kg and 1.70±0.35 kg to 26.14±3.27 kg and 3.58±0.91 kg with significant difference ( Z=-4.617, P<0.001; t=-7.669, P<0.001). Conclusion:Arthroscopic partial trapeziectomy and suture button suspensionplasty is a minimally invasive surgery for the treatment of first CMCJ Eaton stage II/III arthrosis. By this technique, the patients' existing instability and pain problems can be solved.

Objective:To investigate the clinical efficacy of wrist arthroscopic transosseous footprint repair technique for treating triangular fibrocartilage complex (TFCC) injury.Methods:A retrospective case series study was conducted to analyze the clinical data of 56 patients with TFCC injury admitted to Shenzhen Second People′s Hospital from July 2017 to September 2020, including 38 males and 18 females, aged 17-45 years [(33.5±3.6)years]. All patients had unilateral injury. Physical examination showed instability of the distal radioulnar joint, and MRI and arthroscopy confirmed deep ligament injury of TFCC. All patients underwent repair of deep insertion of the TFCC by using wrist arthroscopic transosseous footprint. The operation time, intraoperative blood loss, wound healing and postoperative complications were recorded. The flexion and extension range of motion of the wrist, radial and ulnal deviation of the wrist, rotation range of motion of the forearm, patient related wrist evaluation (PRWE) score, modified Mayo wrist score, visual analogue scale (VAS), and percentage of grip strength between the affected side and unaffected side were compared preoperatively, at 3 months postoperatively and at 1 year postoperatively.Results:All patients were followed up for 12-18 months [(13.4±5.2)months]. The operation time was (61.3±8.9)minutes, with the intraoperative blood loss of (2.4±1.2)ml. All wounds were healed by first intension. There was no wound infection or ulnar nerve irritation symptom after operation. Four patients experienced clicking on the ulnar side of the wrist in a short period of time post-operation, with spontaneous disappearance of the symptom. At 3 months postoperatively, the radial and ulnar deviation of the wrist was decreased from (52.5±5.9)° preoperatively to (42.6±5.9)°, and rotation range of motion of the forearm was decreased from (94.9±8.4)°preoperatively to (84.6±5.9)° (all P<0.01). The flexion and extension range of motion of the wrist was (93.1±17.4)° preoperatively, with insignificant difference compared with (89.4±5.8)° at 3 months postoperatively ( P>0.05). At 1 year postoperatively, the flexion and extension range of motion of the wrist, radial and ulnar deviation range of motion of the wrist, and rotation range of motion of the forearm were significantly increased to (101.3±13.6)°, (52.4±6.6)°, and (116.4±16.4)° when compared with those at 3 months postoperatively (all P<0.01). At 3 months postoperatively, the PRWE score was increased to (17.1±3.8)points from (10.6±3.2)points preoperatively ( P<0.01), modified Mayo wrist score was decreased to (70.3±6.7) points from (78.1±12.7)points preoperatively ( P<0.01), VAS was decreased to (4.4±1.7)points from (6.2±1.5)points preoperatively ( P>0.05), and percentage of grip strength between the affected side and unaffected side was decreased to (55.7±8.7)% from (74.4±15.2)% preoperatively ( P<0.01). At 1 year postoperatively, the PRWE score was increased to (2.0±0.9)points, modified Mayo wrist score was increased to (94.8±3.3)points, VAS was decreased to (2.1±1.1)points, and percentage of grip strength between the affected side and unaffected side was increased to (93.2±8.7)% when compared with those at 3 months postoperatively (all P<0.01). Conclusion:Wrist arthroscopic transosseous footprint repair technique can effectively treat deep ligament injury of TFCC, with advantages of significantly improving postoperative joint range of motion and functional score, relieving the pain on the ulnar side of the wrist and enhancing grip strength.