Objective: To compare the efficacy between conventional laryngeal microsurgery and different power CO₂ laser on benign vocal cord lesions for clinical reference. Methods: From June 2016 to December 2018, 580 patients with benign vocal cord lesions admitted to Jiaxing Hospital of Traditional Chinese Medicine were divided into A, B, C, D, E group according to the random number table rule, with 116 cases in each group.A group was treated with conventional laryngeal microsurgery.B, C, D and E groups were treated with CO₂ laser with the output power 2W, 3W, 4W, and 5W.All the patients were tested for phonological parameters (Jitter, Shimmer, F0, MPT, DSI) and Rosent simplified Voice Hand Index (VHI-10). The main vocal parameters and VHI-10 changes were compared among the five groups before surgery and 4 weeks after surgery. Results: Four weeks after operation, Jitter, Shimmer, F0 and DSI of A, B, C, D and E groups decreased with the range B group>C group>D group>E group>A group[(2.42±0.21)% vs.(2.70±0.25)% vs.(2.91±0.31)% vs.(3.24±0.38)% vs.(3.58±0.42)%, F=27.603, P=0.000; (3.86±0.43)% vs.(4.18±0.48)% vs.(4.55±0.56)% vs.(4.87±0.58)% vs.(5.22±0.62)%, F=22.352, P=0.000; (168.50±20.13)Hz vs.(175.24±22.71)Hz vs.(180.65±24.68)Hz vs.(187.28±26.44)Hz vs.(195.55±28.35)Hz, F=18.193, P=0.000; (2.88±0.34) vs.(3.46±0.38) vs.(3.82±0.41) vs.(4.50±0.44) vs.(5.40±0.51), F=31.604, P=0.000]. The MPT of A, B, C, D and E groups were prolonged with the prolongation B group>C group>D group>E group>A group[(16.26±1.69)s vs.(15.65±1.67)s vs.(14.58±1.64)s vs.(13.85±1.60)s vs.(12.61±1.59)s, F=20.415, P=0.000]. Four weeks after operation, VHI-10 in A, B, C, D and E groups decreased with the extents B group>C group>D group>E group>A group[(7.23±0.74)points vs.(9.58±0.95)points vs.(11.48±1.17)points vs.(13.68±1.45)points vs.(15.46±1.74)points, F=27.467, P=0.000]. Conclusion Low-power (2W) CO₂ laser is the best treatment for benign vocal cord lesions, which is worthy of clinical promotion.

Short-term intermittent fasting (IF) is beneficial to weight control in patients with nonalcoholic fatty liver disease, but the impact of long-term IF is not clear. In this study, healthy C57BL/6N mice with 4-month alternate day fasting (ADF) were used to study the effects of long-term IF on systemic and liver lipid metabolism. The results showed that, compared with the Ad Libitum group, the weight and food conversion rate of mice in the ADF group were markedly decreased and increased respectively, and the liver index and the liver content of triglyceride were significantly increased by pathological examination. qRT-PCR analysis revealed that the mRNA expression of the lipogenesis gene Pparγ and lipolysis gene Atgl was up-regulated in the ADF group (P < 0.05). Western blot analysis showed that the ratio of microtubule associated protein LC3-II/LC3-I was increased, while the abundance of autophagy adaptor protein p62 was decreased in the ADF group. In addition, autophagy signal positive regulation key factor AMPK phosphorylation was increased (P < 0.05), and negative regulation factor mTOR phosphorylation was decreased (P < 0.05) in the ADF group, indicating that hepatocyte autophagy activity was elevated. Taken together, ADF for 4 months results in an excessive liver triglyceride accumulation, accompanied by a marked decrease in liver mTOR phosphorylation and a significant increase in hepatic autophagy.
Mice ; Animals ; Intermittent Fasting ; Mice, Inbred C57BL ; Liver/pathology* ; TOR Serine-Threonine Kinases ; Lipid Metabolism ; Autophagy ; Triglycerides

Adult ; Atlanto-Axial Joint ; surgery ; Bone Screws ; Female ; Fractures, Bone ; diagnostic imaging ; pathology ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Odontoid Process ; injuries ; Tomography, X-Ray Computed

"Living the old age life with multimorbidity" has become the normal life of the elderly. How to realize the management of multimorbidity in the context of the combination of medical and health care is a hot topic of geriatrics, and also one of the important measures to cope with the national health strategy of "all-round and full-cycle protection of people's health" put forward in "Healthy China 2030". On the basis of literature search, this paper summarizes the research status and progress of the multimorbidity in elderly patients, so that it is expected to play a certain promoting role in the comorbidity management of chronic disease for the elderly in China.

OBJECTIVEThe study aims to analyze patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ).

METHODSTwelve patients treated in the Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Me-dical School, Zhejiang University from May 2013 to September 2015 were included. Patients' basic situation, medication, clinical symptoms, therapies, and effects were obtained and analyzed.

RESULTSThe treatment of nine patients focused on the mandible, whereas that of three patients was on the maxilla. The clinical symptoms appeared from 10 to 80 months, with an average of about (28.00±21.42) months. Nine patients had tooth extraction history. After operation (nine patients), eight were treated, one had stable in bone exposure and three patients received conservative treatment.

CONCLUSIONSIntravenous infusion of bisphosphonates can induce BRONJ. The mandible is commonly involved and tooth extraction is a big inducement. Treatments nowadays seek to relieve clinical symptoms, but prevention is more important.

Objective To explore the effects of massive open online courses (MOOC) teaching in new entry nurses standardized training of respiratory medicine. Methods A total of 33 new entry nurses of respiratory medicine at a hospital were selected as control group from 2013 to 2014 with the routine training method. A total of 34 new entry nurses were chosen as intervention group from 2015 to 2017. Nurses of intervention group accepted standardized training with the MOOC teaching method by formulating systematic online and offline training course. The training effects of two groups were evaluated. Results The specialized theoretical achievements and skill achievements of nurses were (72.68±9.44) and (75.78±10.32) in intervention group, and (67.33±8.89) and (62.64±5.8) in control group with significant differences (P< 0.05). After intervention, the degree of satisfaction of patients in intervention group was higher than that in control group with a significant difference (χ2=10.823, P< 0.05). Conclusions MOOC teaching can effectively improve the level of specialized skill in new entry nurses, contribute to linking theory with practice, fast role switching and improve the occupational satisfaction.

Objective:To integrate qualitative research on the experience of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) , to understand the experience of patients with pulmonary rehabilitation and its influencing factors, so as to provide evidence support for pulmonary rehabilitation.Methods:Qualitative research on pulmonary rehabilitation experience of COPD patients was retrieved by computer in 8 databases including the Cochrane Library, Web of Science, Embase, PubMed, CINAHL, China National Knowledge Infrastructure, WanFang and VIP. The retrieval time limit was from the establishment of the database to August 20, 2021. The quality of the articles those met the requirements were evaluated by the quality evaluation criteria for qualitative research of the Australian Joanna Briggs Institute Evidence-Based Health Care Center, and the results of each study were further integrated and analyzed.Results:A total of 12 articles were included, and 47 clear topics were extracted, and similar topics were summarized into 7 new categories. A total of 3 integrated results were synthesized, namely rehabilitation efficacy, pulmonary rehabilitation motivation, and pulmonary rehabilitation obstacles.Conclusions:COPD patients who can persist in training perceive the benefits of pulmonary rehabilitation, and both the pulmonary rehabilitation environment and interpersonal support are factors that promote their pulmonary rehabilitation. The patients' own condition and transportation and economic difficulties are the main obstacles. Therefore, the patients' physical and economic status should be comprehensively evaluated during pulmonary rehabilitation, and the most suitable pulmonary rehabilitation program should be selected.

Alveolar ridge preservation (ARP) has developed rapidly as a method for preserving the alveolar socket's bone volume after tooth extraction. ARP can create conditions for implant restoration, and reduce operation difficulties by decreasing alveolar ridge absorption. There are certain difficulties of ARP applicationin patients with tooth extracted due to periodontitis. This paper mainly introduces the characteristics of ARP, compares the similarities and differences among ARP, guided tissue regeneration, guided bone regeneration and immediate implant, and then summarizes their advantages and disadvantages. The paper focuses on the specificity of ARP and the progress of ARP application in patients with tooth extracted due to periodontitis, in order to offer direction for clinical application and future research on ARP.

Fear memory contextualization is critical for selecting adaptive behavior to survive. Contextual fear conditioning (CFC) is a classical model for elucidating related underlying neuronal circuits. The primary visual cortex (V1) is the primary cortical region for contextual visual inputs, but its role in CFC is poorly understood. Here, our experiments demonstrated that bilateral inactivation of V1 in mice impaired CFC retrieval, and both CFC learning and extinction increased the turnover rate of axonal boutons in V1. The frequency of neuronal Ca²⁺ activity decreased after CFC learning, while CFC extinction reversed the decrease and raised it to the naïve level. Contrary to control mice, the frequency of neuronal Ca²⁺ activity increased after CFC learning in microglia-depleted mice and was maintained after CFC extinction, indicating that microglial depletion alters CFC learning and the frequency response pattern of extinction-induced Ca²⁺ activity. These findings reveal a critical role of microglia in neocortical information processing in V1, and suggest potential approaches for cellular-based manipulation of acquired fear memory.
Mice ; Animals ; Primary Visual Cortex ; Extinction, Psychological/physiology* ; Learning/physiology* ; Fear/physiology* ; Hippocampus/physiology*

OBJECTIVE: To investigate the effect of treatment time on the outcome of patients with ischemic stroke undergoing reperfusion therapy. METHODS: The clinical data of 3229 ischemic stroke patients who received intravenous thrombolysis with or without arterial thrombolysis from 71 hospitals in Zhejiang province from June 2017 to September 2018 were retrospectively reviewed. The good outcome was defined as modified Rankin Scale (mRS) ≤ 2. Binary logistic regression analysis was used to investigate the association of door to needle time (DNT), or door to reperfusion time (DRT) with the outcomes in patients treated by intravenous thrombolysis or bridging arterial thrombolysis, respectively. RESULTS: Binary logistic regression showed that DNT (=0.994, 95%:0.991-0.997, <0.01) or DRT (=0.989, 95%:0.983-0.995, <0.01) were independently associated with good outcomes, respectively. Every hour decreases in DNT resulted in a 4.7%increased probability of functional independence (mRS 0-2) in patients treated by intravenous thrombolysis; Every hour decreases in DRT was associated with a 11.4%increased probability of functional independence in patients treated by intravenous thrombolysis with arterial thrombolysis. CONCLUSIONS Good outcomes are associated with lower DNT in ischemic stroke patients treated by intravenous thrombolysis or lower DRT in patients treated by intravenous thrombolysis bridging arterial thrombolysis.
Brain Ischemia ; drug therapy ; Fibrinolytic Agents ; therapeutic use ; Humans ; Reperfusion ; Retrospective Studies ; Stroke ; drug therapy ; Thrombolytic Therapy ; Time Factors ; Treatment Outcome