Objective To observe the effect applicated of endoscopic sinus joint laryngoscope in laryngeal microsurgery.Methods 68 patients with laryngeal lesions were randomly divided into the multi-mirror combination group (34 cases) and the single laryngoscope group (34 cases).The multi-mirror combination group was taken with laryngeal microsurgery under endoscopic Joint laryngoscope.The single laryngoscope group was only taken with laryngeal microsurgery under laryngoscope.The efficacy and surgical situation of the two groups were compared.Results The total effective rate of the multi-mirror combination group was 97.06％,which was significantly higher than that of the single-laryngoscope group (85.30％) (x2 =4.031,P ＜ 0.05).Compared with the case of surgery and complications and recurrence rate,the multi-mirror combination group was superior to the single laryngoscope group (all P ＜ 0.05).Conclusion The endoscopic joint laryngoscope has the function of expanding the scope of the operative field and increasing the focus and clarity,and also has the advantages of small traumatic for patients,fewer complications,low recurrence rate,easy operation and high accuracy.

Objective To evaluate the correlation between MRI and X-Ray discography findings and pain response at provocative discography in patients with discogenic back pain. Methods Two hundred and fifty-six lumbar intervertebral discs in 93 patients who underwent MRI and X-Ray discography were included in this study. MR images were retrospectively evaluated regarding disc degeneration, endplate abnormalities and high intensity zone. Disc degeneration was graded according to the modified criteria of Pearce, et el. Evaluation of disc morphology was performed with X-Ray discography by using the classification of Adams, et al. Endplates and adjacent bone marrow abnormalities were classified according to Modic,et al. During discography concordant pain was regarded as positive, whereas discordant pain and no pain were regarded as negative. The data were analyzed using the Chi-squnre test. Results There were 116 discs with concordant pain and 140 discs with discordant pain or no pain. Of 256 discs on discography, 17 discs were type Ⅰ17(6.6%),type Ⅱ were 25(9.8%),type Ⅲ were 91(35.5%), type Ⅳ were 77(30.1%) and type Ⅴ were 46(18.0% ). On MR images, discs of grade Ⅰ were 23 (9.0%) ,grade Ⅱ were 34(13.3%), grade Ⅲ were 84(32.8%), grade Ⅳ were 85 (33.2%) and grade Ⅴ were 30(11.7%). There was positive correlation between Pearce graded of MRI and classification of Adams of discography (r=0.62, X2 =160.87,P <0.01).In 123 discs of type Ⅳ to type Ⅴ on discography, 104 discs were with concordant pain. There was positive correlation between type Ⅳ-Ⅴ and concordant pain( r=0.60, X2 = 144.08, P < 0.01). In 115 discs of Ⅳ-Ⅴ grade degeneration, 99 discs presented with concordant pain. There was positive correlation between Ⅳ-Ⅴ grade disc degeneration and concordant作者单位:510120 广州,中山大学附属第二医院放射科 pain(r = 0.59, X2 = 137.11, P <0.01 ). In 60 discs with high intensity zone(HIZ), 52 discs presented with concordant pain. There was positive correlation between HIZ and concordant pain ( r=0.41, X2= 51.93, P <0.01 ). In 58 discs with endplate degeneration, 51 presented with concordant pain. There was positive correlation between Modic degeneration and concordant pain ( r = 0.41, X2= 52.76, P < 0.01 ). Conclusion In patients with chronic low back pain, MR imaging may present moderate to severe disc degeneration, high intensity zone, endplates and adjacent bone marrow abnormalities. MR findings with concordant pain can raise the diagnostic possibility of discogenic lumbar pain. Typical discography findings, fissured or ruptured disc, with concordant pain are important diagnostic evidence for discogenic lumbar pain.

ObjectiveTo investigate the postoperative 3D MRI appearances and their evolvement patterns of ACL grafts and bone tunnels at follow-up.Methods There were 26 double bundles ACL reconstructions and 16 single bundle ACL reconstructions,and a total of 56 follow-up 3D MR Imaging.MR images were reconstructed with MPR technique to evaluate grafts,bone tunnels,fixers and associated.complications.Proportions of grafts with hypointensity or hyperintensity and occurrence rates of marrow edema around bone tunnels were calculated respectively among groups of different periods after operation.ResultsThere were 24 grafts of hypointensity and 32 grafts of hyperintensity.Grafts of 2 cases were suspended with cross pins within femoral tunnels,graft of 1 case was suspended with an endobutton within the femoral tunnel,and grafts of other sites were fixed with interference screws.In the three periods as 3 months,6 to 9 months and over 12 months after cruciate ligament reconstruction,proportions of hypointensive grafts were 20/25,0/14 and 4/10 respectively,while proportions of hyperintensive grafts were 5/25,14/14 and 6/10 respectively,occurrence proportions of marrow edema around bone tunnels were 54/54,10/32 and 4/26 respectively.There was 1 tear graft,4 tibial tunnels placed anteriorly with ACL graft impingement on the intercondylar roof,3 femoral tunnels placed anteriorly,and 2 bone tunnels with mismatching interference screws.Conclusion3D MRI can accurately demonstrate the state of ACL grafts,bone tunnels,fixers and associated complications.Intensity of grafts presented a rise and reduce pattern after operation.

Objective To evaluate the apparent diffusion coefficient (ADC) of parenehyma and necrosis in distinguishing among metastatic lymph nodes, lymphoma and tuberculous lymph nodes. Methods Thirty-six patients with cervical lymph nodes metastasis from the head and neck squamous cell carcinomas,19 patients with lymphoma and 23 patients with lymph nodes tuberculosis underwent diffusion-weighted imaging. The ADC values were measured and compared in parenchyma and necrosis of 177 lymph nodes confirmed by histopathology (n = 114) and clinical follow-up (n = 63). The means between two groups were compared by t-test, and one-way analysis of variance (one-way ANOVA) was used to analyze the data among three or more groups. Results The mean ADC values of parenchyma in metastatic nodes, lymphoma and tuberculous nodes were (0.93±0.16) × 10-3mm2/s, (0.64±0.13) × 10-3mm2/s and (1.01±0.11) ×10 -3 mm2/s respectively (F = 82.928, P < 0.01) ; the ADC values of necrosis in metastatic and tuberculous nodes were (2.02 ± 0. 36) × 10-3 mm2/s and (1.25 ± 0.15) × 10-3 mm2/s respectively (t = 12.045, P <0.01). An ADC value of parenchyma lower than or equal to 0.77 × 10 -3mm2/s was used as the threshold for lymphoma, with a sensitivity 83% and specificity of 89%. An ADC value of necrotic area greater than or equal to 1.60 × 103mm2/s was used as the threshold for metastatic nodes, with a sensitivity of 88% and specificity of 100%. Conclusion The ADC value of lymph nodes, especially for their internal necrotic areas, can help judge the nature of the cervical lymph nodes.

ObjectiveTo evaluate the nutritional status of elderly Chinese operative patients with lung cancer as well as its correlation with postoperative complications through the application of modified mini-nutritional assessment (MNA) and short-form MNA (MNA-SF).MethodsOne hundred and fifty elderly Chinese patients with lung cancer underwent operation were enrolled in this study from June 2010 to June 2011.Collected information including preoperative nutritional evaluation in modified MNA and MNA-SF,general information of patients,disease status,anthropometric measurements,biochemical markers,and postoperative complications.ResultsAccording to the modified cutoff point of the full MNA in the 150patients (98 males,52 females),10.7％(16/150) patients were malnourished,32.0％(48/150) patients were at risk of malnutrition and 57.3％(86/150) patients were well nourished.MNA was (23.7 ± 3.8) scores.Positive correlations were found between MNA and body mass index (BMI),mid-arm circumference(MAC)and calf circumference (CC) (P ＜ 0.01 ).MNA-SF was ( 11.5 ± 2.4) scores.Positive correlations were found between MNA-SF and BMI,triceps skinfold (TSF),MAC,CC,MNA (P＜0.01 or ＜0.05).The incidence of postoperative complications was as following sequentially: respiratory complication was 37.4％ (55/147),cardiovascular complication was 31.3％(46/147),thoracic cavity complication was 0.7％( 1/147 ).There was no significant difference among groups in different numbers of complications (P=0.590) and among groups in different types of complications (P =0.601 ).ConclusionsModified MNA is suited to elderly Chinese operative patients with lung cancer.Evaluation shows that there is high prevalence of malnutrition among this population,and the correlations between MNA results and postoperative complications should be confirmed in further study.Positive correlations were found between MNA and body mass index (BMI),mid-arm circumference(MAC)and calf circumference (CC) (P ＜ 0.01 ).MNA-SF was ( 11.5 ± 2.4) scores.Positive correlations were found between MNA-SF and BMI,triceps skinfold (TSF),MAC,CC,MNA (P＜0.01 or ＜0.05).The incidence of postoperative complications was as following sequentially: respiratory complication was 37.4％ (55/147),cardiovascular complication was 31.3％(46/147),thoracic cavity complication was 0.7％( 1/147 ).There was no significant difference among groups in different numbers of complications (P=0.590) and among groups in different types of complications (P =0.601 ).ConclusionsModified MNA is suited to elderly Chinese operative patients with lung cancer.Evaluation shows that there is high prevalence of malnutrition among this population,and the correlations between MNA results and postoperative complications should be confirmed in further study.

Objective To analysis the effect of axial loading to ADC value, FA of lumbar intervetebral discs. Methods Forty five patients with low back pain (age range, 25 to 54 years) were evaluated with MR T2WI, MR T1WI and diffusion tensor imaging (DTI) of the lumbar spine. Following axial loading with 40% to 50% body weight for 10 minutes, a repeat DTI was performed. DTI were obtained by using an echo-planar imaging ( EPI ) sequence, TE 89 ms, TR 2500 ms, b value of 400 s/mm2,6 noncollinear diffusion directions. Scan time was approximately 4 min 10 s. An isotropic ADC map, FA map and bo map were calculated from DTI sequence. The mean ADC value, FA prior to and following axialloading were analyzed with t test and Rank Sum test. Results Forty five patients with 225 discs were evaluated and 223 discs were included in the study except for 2 calcified discs. The Pfirrmann grading results were as following: 100 Grade Ⅱ , 48 Grade Ⅲ, 59 Grade Ⅳ, and 16 Grade Ⅴ. No significant difference existed in the mean ADC value before [ ( 1666 ± 252 ) × 10-3 mm2/s ] and after [ ( 1662 ± 253 ) ×10 -3 mm2/s ] axial loading ( Z = - 1.363, P ＞ 0.05 ), but the mean FA [ ( 301 ± 104 ) × 10 -3, ( 316 ±112) × 10-3 ] value increased ( Z = - 2.794, P ＜ 0.05 ). The paired-samples t test show that the mean ADC value [ ( 1685 ± 190) × 10-3 mm2/s, ( 1624 ± 180) × 10-3mm2/s] of Grade Ⅲ discs decreased after axial loading, t=3.513, P＜0. 05, Grade Ⅲ, Ⅳdiscs mean FA value [(300±87) ×10-3, (326±87) ×10-3 for Grade Ⅲ and (348 ±67) × 10-3, (351 ± 71 ) × 10-3 for Grade Ⅳ ] increased, t = - 2. 210,- 2.006, P ＜ 0.05. No significant difference existed in Grade Ⅱ , Ⅳ and Ⅴ discs ADC value, all the P ＞0.05. No significant difference existed in Grade Ⅱ and Ⅴ discs FA value, both the P ＞ 0.05. Conclusions Short time axial loading mainly affect the mildly degenerated discs, the ADC value decreases and the disc diffusion ability decreases. No obvious change in ADC value or disc diffusion ability existed in the normal and severely degenerated discs.

Objective:To explore the effect of well-being therapy on fatigue and self-management efficacy of leukemia patients undergoing chemotherapy.Methods:From January 2018 to December 2019, totally 76 leukemia patients who undergoing chemotherapy were divided into experimental group and control group according to the enrolled time, with 38 cases in each group. Patients in the control group recieved routine nursing, the experimental group carried out well-being therapy. Before and after intervention, the effects were assessed by Cancer fatigue scale-Chinses version (CFS-C) and Strategies used by people to promote health-Chinses version (SUPPH-C), respectively.Results:After intervention, the physical fatigue, affective fatigue, cognitive fatigue, and total fatigue scores in CFS-C were 7.64±3.63, 7.28±1.60, 5.19±1.24 and 20.11±3.96 in the experimental group, significantly lower than those in the control group (9.57±3.52, 8.76±2.60, 6.08±1.62 and 24.41±3.86); the positive coping, stress reduction, making decisions, and total scores in SUPPH-C were 57.56±9.72, 40.11±5.99, 12.17±1.95 and 109.83±11.69 in the experimental group, significantly higher than in the control group (50.54±10.80, 36.70±7.62, 10.86±2.10 and 98.11±14.13), the difference was statistically significant ( t value was 2.119-3.856, P<0.05). Conclusion:Well-being therapy can effectively allivate cancer fatigue and promote self-management efficacy of leukemia patients undergoing chemotherapy.

Objective To study the effects and mechanism of serum containing modified Shengmai liquid ( MSL) on migration and adhesion of non small cell lung cancer ( NSCLC) cells.Methods Rabbit ser-um containing MSL was prepared by intragastric administration ( i.g.) with MSL at the dose of 18 g/kg and control serum was prepared by i.g.normal saline.NSCLC cells were cultured, and those in logarith-mic growth phase collected were divided into four groups:10%control serum(CS) group, 2.5%, 5%, 10%MSL serum group.Migration cells were detected by using Transwell invasion assay, and adhension rate was measured by using matrigel adhensive assay.The expressions of N-cad and vimentin were de-termined by RT-PCR.Results The number of migration cells decreased as the concentration of serum containg MSL increased:migration rate of 5%MSL group was 25.64%and that of 10%MSL group was 13.31%(P<0.01).As the concentration of serum containing MSL increased and the duration of treat-ment prolonged, heterogeneous adhesion rate decreased and was negatively correlated with serum concen-tration and duration;while the gene expressions of N-cad and vimentin decreased in dose-and time-de-pendent manner.Conclusion The mechanism of inhabitation migration and reduction heterogeneity ad-hension of MSL on NSCLC cells would be related to the epithelial-mesenchymal transition.

Objective:To retrieve, evaluate, and integrate the best evidence for the management of neurogenic bowel dysfunction (NBD) in spinal cord injury patients both domestically and internationally, providing a basis for relevant evidence-based practices.Methods:The guidelines, expert consensus, clinical decision-making, and systematic review of NBD management for spinal cord injury patients were electronically searched in various databases and professional association websites at home and abroad. The search period was from database establishment to March 31, 2023.Results:A total of 13 articles were included, including five guidelines, five evidence summaries, two expert consensus, and one clinical decision-making. A total of 33 recommendations for NBD management in spinal cord injury patients were summarized from five aspects of medical history assessment, medication management, physical therapy, diet and exercise, and health education.Conclusions:The best evidence for NBD management in spinal cord injury patients summarized is scientific and practical. Medical and nursing staff should selectively apply the best evidence based on clinical practice.

Objective:To systematically review and integrate the real feelings and needs of caregivers of children with liver transplantation.Methods:The computer search was conducted on China National Knowledge Infrastructure, China Biology Medicine disc, VIP, Wanfang Data, PubMed, Scopus, Web of Science, SDS, PsycINFO, CINAHL and Embase to collect qualitative studies on the real experiences of caregivers of children with liver transplantation. The search period was from establishment of the databases to July 31, 2023. The quality of the included literature was evaluated using the qualitative research appraisal tool of Australia Joanna Briggs Institute Evidence-based Health Care Center, and the results were analyzed using the Meta-integration method.Results:A total of eight articles were included, and 35 research results were extracted, which were summarized into 10 new categories and integrated into four results, namely, the dilemma of multiple challenges, complex emotional experience, multi-dimensional care needs and positive coping strategies.Conclusions:The caregivers of children with liver transplantation are faced with great pressure and difficulties in the process of care, and they are eager for multifaceted support. Medical staff should pay attention to the inner experience and needs of caregivers and construct supportive intervention programs to reduce their physical and mental burden and improve the quality of care for children with liver transplantation.