Objective To investigate the indication, feasibility and technique of minimally invasive nuss procedure with thoracoscope by using double braces in the treatment of wide-scope pectus excavatum repairing in adolescence. Methods 31 patients including 24 boys and 7 girls, suffered from pectus excavtum were corrected by nuss procedure under thoracoscope.The average age was (15.32 ± 3.89)years (ranged, 14 years and 18 years). All cases were moderate to severe degree according to Hallar index with depression scope of 4 ribs or more. A couple of braces of two-point or multipoint fixation for thoracoscopic-assisted nuss procedure were used. Results The procedure was successfully completed under thoracoscopy in all patients. Double braces were utilized in 27 cases, double are bars were required in 4 cases, and multipoint fixations were in 6 patients. The postoperative hospital stay was 5-11 days [average, ( 7.48 ± 1.95 ) days]. The duration of following up was one month to three years. The perioperative complications included intraoperative hemorrhage in 2 patients, bar invertion with displacement in 1, and interrupted pain for two months in 1. All patients recovered after expectant treatment. Conclusion Nuss procedure with double braces for the correction of a large area of asymmetric pectus excavatum under thoracoscopy is safe and effective technique for adolescence.

Objective To assess the value of spectral CT in reducing artifacts caused by metallic implants. Methods Porcine lumbar spines were chosen as anthropomorphic phantom. The model was examined before and after implanting the titanic nail into the second and fourth lumbar vertebral body using gemstone spectral CT protocol and standard 120 kVp spectra. Specific pest-processing technique was applied to generate 11 kinds of images of monochromatic energy and Metal Artifacts Reducing system (MARs) with the interval of 10 keV ranging from 40-140 keV. The image quality was compared subjectively between 120 kVp group and GSI group after implantation. Three regions of interest based on distances along the most pronounced artifact were chosen and marked as ROInear, ROImid, ROIfar successively. Artifacts parameters including CT value and SD value were measured. The CT value of different ROIs were compared with LSD and Bonferroni test. Contrast-to-noise ratio and artifacts index were calculated. An optimal range of keV was determined according to artifacts index. Results Image quality of Gemstone spectra images was rated superior to the standard images. An optimized spectrum of keV based on artifacts index was from 80 keV to 100 keV. For ROInear,CT value was ( 80. 25 ± 16. 00) HU and ( 30. 10 ± 10. 45 ) HU respectively in group Mono before implantation and group Mono + MARs after implantation. The differences were significant( Z =2. 978, P ＜ 0. 05 ). For ROImid and ROIfax, CT value was ( 63.21 ± 6. 61 ) HU and ( 54. 84 ± 10. 60 ) HU,(76. 54 ±9.07)HU and (73.20 ±5.39)HU respectively. There was no significant differences (t =0. 530,P ＞ 0. 05; t = 0. 822, P ＞ 0. 05 ). Conclusions Metal artifacts could be reduced effectively at the site 3 cm away from implants using gemstone spectral CT. An accurate CT value of surrounding tissue can be obtained.

Objective To analyze the distribution of image noise in low-dose chest CT scan and optimize the relative scanning parameters.Methods The CT images of the Chinese anthropomorphic chest phantom( CDP-1 C) were simulated into six groups of low-dose images with different noise indexs by using an image noise addition tool.The difference between the preset noise index and analog noise value was compared.The CT images of 20 volunteers were also simulated into nine groups of low dose scans with the tube currents of 10,30,50,80,100,120,150,180 and 240 mA.The noise values of images were recorded and analyzed.Results There was no statistical difference between the analog noise value and the noise index.The image noise of low-dose chest scan was increased with the decrease of tube current.The noise was increased quickly when the current was decreased from 50 to 30 mA ( F =24.09 - 40.79,P ＜ 0.05),but the noise increased slowly when the current decreased from 240 to 80 mA.There was no statistical difference between the noise of 80 mA group and that of 120 mA(P ＞ 0.05).Conclusions The noise addition tool can be used to evaluate the image noise of low-dose chest CT scan.Adoption of 80 mA in chest CT scan would result in low radiation dose without adding image noise.

Objective To explore the clinical effects of integrative nursing for rectal cancer patients with colostomy.Methods A total of 80 cases of rectal cancer patients after colostomy were selected from our hospital from December 4,2009 to May 15,2013.They were assigned to the control group and the observation group according to the admission sequence with 40 patients in each group.The control group had been treated with conventional care,the observation group had been treated with integrative care intervened by ostomy technician.Postoperative anxiety,quality of life and complication rates were analyzed between the two groups.Results Anxiety score from the Self-Rating Anxiety Scale was lower in the treatment group respectively on the day of the operation,one month after operation and one year after operation (58.22 ± 8.23 vs.64.46 ± 9.82,50.55 ± 7.53 vs.59.76 ± 9.83,42.26 ± 2.88 vs.58.46 ± 9.82),P ＜ 0.05.the incidences of complications were significantly rarer than the control group such as the postoperative infection [7.50％ (3/40) vs.25.00％ (10/40)],colostomy hemorrhage [5.00％ (2/40) vs.25.00％ (10/40)],colostomy necrosis [2.50％ (1/40) vs.30.00％ (12/40)],other complications [5.00％ (2/40) vs.15.00％ (6/40)],P ＜0.01 or ＜0.05.Moreover,the defecation function,psychological function,social function and material life (92.55 ± 20.56 vs.84.03 ± 24.60,83.05 ± 23.66 vs.61.86 ± 18.20,79.95 ± 36.02 vs.71.09 ± 27.56,59.08 ± 28.56 vs.50.55 ± 25.96) were improved obviously in the observation group,while the incidences of nausea and vomiting and pain (10.15 ± 3.67 vs.18.99± 7.29,12.05 ± 7.90 vs.22.10 ± 9.56) were lower than the control group,based on QLQ-C30 core questionnaire for the European Quality of Life Evaluation,P ＜ 0.05.Conclusions Integrative nursing may effectively improve rectal cancer patients' quality of life after colostomy,reduce the postoperative complications and relieve anxiety,which may be useful in the clinical application.

Objective To explore the effect of comprehensive intervention on postoperative pain of patients with rectal disease. Methods A total of 200 patients with postoperative pain after the treatment of anorectal perianal disease from May 2015 to May 2016 were randomly divided into two groups with 100 cases each. The control group was treated with drugs and usual nursing, the observation group were adopted drugs and comprehensive nursing intervention. The improvement of pain, psychological states and the quality of sleep were compared between two groups. Results The VAS pain scores at 4, 6, 12, 24, 48 h after treatment was (2.1 ± 0.6), (3.3 ± 0.4), (3.5 ± 0.3), (2.3 ± 0.5), (1.9 ± 0.5) points in the observation group, and (3.0 ± 0.5), (5.1 ± 0.6), (6.2 ± 0.6), (5.7 ± 0.8), (5.8 ± 0.5) points in the control group, and the difference was statistically significant (t=8.539-38.806, P < 0.05). The Self-rating Anxiety Scale was (20.32 ± 6.16) points in the observation group, and (35.58 ± 7.43) points in the control group, and the difference was statistically significant (t=41.188, P<0.05). The sleep quality, the amount of sleep , sleep time, sleep efficiency of Pittsburgh Sleep Quality Index Questionnaire scores was (0.91±0.28), (0.86±0.2), (0.83±0.27), (0.59±0.31), (0.62±0.27), (0.58±0.41), (4.39±1.79) points in the observation group, and (1.61± 0.88), (1.32 ± 0.75), (1.59 ± 0.89), (1.34 ± 0.58), (1.36 ± 0.45), (1.29 ± 0.86), (8.51 ± 3.55) points in the control group, and the difference was statistically significant (t=4.557-17.740, all P<0.05). Conclusions The comprehensive intervention on postoperative pain relief in patients with anal disease is significant, it is beneficial to relieve the pain response, improve sleep quality, and achieve physical and psychological comfort, and has a positive effect to clinical.

Objective To observe the effect of obstructive sleep apnea hypopnea syndrome (OSAHS) on the renal function in patients with type 2 diabetes mellitus (T2DM).Methods Sleep apnea hypopnea index (AHI), oxygen desaturation index (ODI), and nighttime lowest oxygen saturation (LSaO2) were evaluated in 298 patients with T2DM using a portable sleep apnea monitor.Patients were divided into T2DM without OSAHS group (n=120) and with OSAHS group (n=178) according to AHI<5.Patients were divided into 3 groups according to estimated glomerular filtration rate (eGFR): eGFR>90 ml·min-1·(1.73 m2)-1 (n=190), 90>eGFR>60 ml·min-1·(1.73 m2)-1 (n=84), eGFR<60 ml·min-1·(1.73 m2)-1 (n=24).The influencing factors of eGFR and AHI were analyzed by logistic regression analysis.Results There were significant differences in eGFR, uric acid (UA), high density lipoprotein-cholesterol (HDL-C), waist circumference, hip circumference, body mass index (BMI), and urinary albumin between T2DM without OSAHS and with OSAHS groups(all P<0.05).eGFR showed a significant correlation with AHI(r=-0.154, P=0.008), ODI(r=-0.236,P<0.01),and LSaO2(r=0.145, P=0.024).Logistic regression revealed that eGFR(OR=0.991, 95%CI 0.983~0.998, P=0.014), BMI(OR=1.107, 95%CI 1.028~1.193, P=0.008)were independent risk factors for AHI.There were significant differences in age, urinary albumin, AHI, ODI, LSaO2 among groups with various eGFR levels (P<0.05).Stepwise regression showed that age(β=-0.456, 95%CI-0.571~-0.346,P<0.01)and AHI(β=-0.119, 95%CI-0.226~-0.007,P=0.037) were independent risk factors for eGFR.Conclusions OSAHS is a risk factor for renal impairment in patients with T2DM.

This study started with the comprehensive experimental research and practice of pre-ventive medicine. Taking the school of public health of China Medical University as an example, this paper introduced the ideas, principles, and experience of reform and implementation of comprehensive experimen-tal teaching. The methods of comprehensive experiments construction and implementation were introduced, such as subjects, application, basic training, implementation, writing, replying and score. In addition, the comprehensive experimental topics (such as classic experiment, new technology experiment, interesting ex-periment and fund project experiment et al), and basic training (such as literature searching, epidemiology and statistical analysis, laboratory safety and quality of experimental data, network sharing et al) were pre-sented in detail. It gave the evaluation that the comprehensive experimental teaching played an important role in the process of improving the quality of teaching and formed a unique preventive medicine experi-mental teaching system and talent training mode.

Objective:To explore the effect of acute kidney injury(AKI)on near-term survival after lung transplantation(LT)in patients with idiopathic pulmonary fibrosis(IPF).Methods:Through consulting electronic medical records, anesthetic modes and Chinese Lung Transplant Registration System, clinical data are retrospectively reviewed for 275 IPF patients undergoing LT at Affiliated Wuxi People's Hospital of Nanjing Medical University from January 2017 to April 2021.According to the diagnostic criteria of Kidney Disease: Improving Global Outcomes(KDIGO), they are divided into two groups of AKI(169 cases)and non-AKI(106 cases).Perioperative findings of two groups are recorded.Then univariate and multivariate Cox regression models are employed for determining whether or not inter-group differences existed in survival rates post-LT.Also AKI is staged according to the KDIGO.And the effect of stage 1/2/3 AKI on near-term postoperative prognosis is examined.Results:The differences are significantly different in recipient gender, creatinine, 6-minute walking test, forced vital capacity(FVC), lung allocation score, oxygenation index, N-terminal pro-brain natriuretic peptide(NT-Pro BNP), preoperative hormone use and volume of crystal infusion( P<0.05).After multivariate Cox regression correcting for covariates, no statistical significance exists in effect of AKI stage 1 on near-term postoperative survival rate( P<0.05).AKI stage 2/3 still has statistical significance in risk of mortality at Day 30/90/180/365 post-operation( P>0.05). Conclusions:As a common complication post-LT, AKI significantly affects near-term postoperative prognosis of transplant IPF patients.Stage 2/3 AKI impacts near-term postoperative survival while stage 1 AKI is not associated with higher mortality.

Objective:To compare the efficacy and side effects between simultaneous and sequential integrated boost intensity-modulated radiotherapy after operation for high-grade glioma.Methods:We retrospectively analyzed 142 patients with high-grade glioma who underwent postoperative radiotherapy from January 2010 to December 2017. All patients were divided into the simultaneous and sequential integrated boost intensity-modulated radiotherapy groups. Concurrent temozolomide chemotherapy was delivered during radiotherapy in two groups. The follow-up outcomes were statistically compared between two groups.Results:For the whole group, the median overall survival (OS) was 24 months, the median progression-free survival (PFS) was 17 months, and the median disease-free survival (DFS) was 25 months. In the simultaneous and sequential integrated boost intensity-modulated radiotherapy groups, the median OS were 27.2 and 21.0 months ( P=0.950), the median PFS were 21.2 and 15.0 months ( P=0.21), and the median DFS were 28.0 and 18.0 months ( P=0.171), and the disease control rates were 92.86% and 85.17%( P=0.541), respectively. There was no statistical difference in OS, PFS, DFS, short-term efficacy and side effects between two groups. However, the conformity index in the simultaneous integrated boost intensity-modulated radiotherapy group was better than that in the sequential integrated boost intensity-modulated radiotherapy group ( P=0.032). Conclusions:Postoperative simultaneous and sequential integrated boost intensity-modulated radiotherapy yield no statistical differences in the survival, short-term efficacy and side effects in the treatment of high-grade glioma. However, the conformity index in the simultaneous integrated boost intensity-modulated radiotherapy group is significantly better, which can be recommended for postoperative radiotherapy of high-grade glioma.

Background and purpose:Despite the significant advancements that have been made in the treatment of gastric cancer,there are still problems such as poor prognosis and low five-year survival rate in advanced gastric cancer.Therefore,exploring effective treatment options remains a key focus of clinical research.As a new type of immune checkpoint inhibitor,the clinical efficacy and safety of pembrolizumab still need to be confirmed by extensive research.Therefore,this study conducted regression analysis of the effect of pembrolizumab combined with XELOX regimen in the treatment of advanced gastric cancer,providing a reference for clinical treatment.Methods:Clinical data of patients with advanced gastric cancer who were admitted to Shanxi Province Cancer Hospital from March 2020 to August 2022 were retrospectively collected.Inclusion criteria:patients with HER2-negative,untreated advanced gastric cancer or adenocarcinoma of the esophagogastric junction,confirmed by clinical histopathological examination and meeting relevant diagnostic criteria;TNM stage Ⅳ;age≥20 years;expected survival≥6 months;no severe organ damage before treatment;Karnofsky score＞60;patients with complete clinical data.Exclusion criteria:patients with concurrent major organ dysfunction;hypothyroidism or hyperthyroidism;blood or coagulation disorders;autoimmune diseases;lactating or pregnant women;individuals with mental illnesses or a history of mental illness;those with concurrent other malignancies;those with severe liver or kidney dysfunction;patients with incomplete clinical data.Based on the inclusion and exclusion criteria,91 patients with advanced gastric cancer were selected.Among them,45 received XELOX regimen treatment(control group),and 46 received pembrolizumab combined with XELOX regimen treatment(observation group).After establishing the database,one patient in the observation group was found to have logical errors in their treatment information and was therefore excluded.Ultimately,90 patients were included in the study,with 45 in each of the control and observation groups.The efficacy,median overall survival(OS),median progression-free survival(PFS),toxic side effects,improvement in quality of life,and levels of carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA19-9),Escherichia coli,Bifidobacterium and Lactobacillus before and after treatment were compared between the two groups.This study was approved by the ethics committee of Shanxi Province Cancer Hospital(ethics number:KY2023081).Results:After treatment,the proportion of progressive disease(PD)in the observation group was 20.0%(9/45),which was lower than that in the control group(40.0%,18/45).However,there was no significant difference between the two groups in proportion of stable disease(SD),complete response(CR)and partial response(PR)(P＞0.05).The improvement rate of quality of life in the observation group after treatment was 60.0%(27/45),which was higher than that in the control group,with a rate of 37.8%(17/45)(P＜0.05).The median OS and PFS in the observation group were longer compared with the control group(P＜0.05).After treatment,the levels of CEA and CA19-9 in peripheral blood of the observation group were lower compared with the control group(P＜0.05).After treatment,the number of Escherichia coli was lower in the observation group than in the control group,while the numbers of Bifidobacterium and Lactobacillus were higher(P＜0.05).There was no significant difference in the incidence of nausea and vomiting,diarrhea,leukopenia,rash,liver function damage between the two groups(P＞0.05).Conclusion:The combination of pembrolizumab and XELOX regimen can regulate the expression levels of tumor markers in patients with advanced gastric cancer,prevent disease progression,improve patient quality of life,and help maintain intestinal microecology balance.