Objective To observe the impact of different surgical procedures on ovarian reserve and analge-sic effects of drug use in patients with uterine fibroids.Methods 100 patients with uterine fibroids were randomly divided into two groups.50 patients in control group were implemented traditional open surgery.50 cases in the obser-vation group received laparoscopic myomectomy.The ovarian reserve changes were compared before and after surgery, pain medication use and changes in the degree of pain conditions.Results The levels of follicle stimulating hormone and luteinizing in the control group one,three months after operation were significantly higher than before surgery and the observation group,the level of estrogen was significantly lower than before surgery and observation group,the differences were statistically significant(t=10.23,14.58,9.78,11.76,9.83,9.92,10.07,11.23,all P<0.05).The postoperative first pain time of the observation group was significantly longer than the control group,the difference was statistically significant[(513.74 ±284.52)min vs.(61.38 ±37.21)min,t=92.34,P<0.05].The postoperative analgesic usage of the observation group was significantly lower than the control group,the difference was statistically significant(14.0% vs.58.0%,χ2 =7.83,P<0.05).The pain scores 3d,4d,5d,6d and 7d after operation of the observation group were significantly lower than the control group(t=2.11,2.30,2.58,7.03,6.46,all P<0.05). Conclusion The patients with uterine fibroids laparoscopic myomectomy for treatment will not cause great impact on the patients'ovarian reserve,and can effectively reduce the use of analgesics,and it is worthy of further promotion.

Objective To explore diagnosis and treatment of thoracolumbar spine and spinal cord trauma complicated by thoracoabdominal viscera injury. Methods A retrospective study was performed on 84 cases with thoracolumbar spine and spinal cord trauma complicated by thoracoabdominal viscera injuries treated in our unit from January 1986 to December 2002, of which there were 52 cases with thoracic vertebra fracture (T_6-T_(12)), 32 with lumbar fracture (L_1-L_4), 70 with complicated chest injury, 14 with abdominal injury and 34 with injuries of cranium, extremities and pelvis. Spinal fixation or decompression of spinal cord was performed in 62 cases, drainage in 22, laparotomy in 10 and exploration of skull in nine. Results Eighty-two cases survived, with follow up period for 6-36 months. According to Frankel standard nerve function recovery showed that among 36 cases at grade A, 10 had partial or sensation recovery and the other got nerve function improvement for gradeⅠ-Ⅲ. Delayed diagnosis and missed injuries totaled seven cases (12%). Two cases were died of postoperative MODS. Conclusions As for patients with thoracolumbar spine and spinal cord trauma complicated by thoracoabdominal viscera injury, a comprehensive clinical examination including X-ray or CT is necessary. The treatment should first focus on thoracoabdominal viscera trauma and try to avoid aggravation of spine and spinal cord injury.

Objective To observe the histomorphological changes of sciatic nerves following pasteurizing warm temperature treatment. Methods The 12 mm left sciatic nerve from healthy adult male Wistar rats was pasteurized at 60℃ for 30 minutes and observed at the first week (1-week group) and the sixth week (6-week group), 15 rats per group. Number, diameter and area ratio of the myelinated axons in the control (proximal to the treated part), treatment and peripheral nerves (distal to the treated part) were calculated. The histomorphological changes were examined with electrophysiological and electron microscopies. Results (1) In the peripheral part, the number of the myelinated axons was significantly decreased in the 1-week group compared with the control group (P

Objective To study the effects of Fasudil on expression of Nogo-A and NF200 in neonatal hypoxic-ischemic brain damage(HIBD) rats.Methods One hundred and twenty 7-day-old Wistar rats were divided into 3 groups with random number table:Sham operation group (n =40),HIBD group (n =40) and Fasudil group (n =40).Sham group only separated from the common carotid artery,without ligation,direct suture the incision does not do hypoxia; HIBD group were injected with saline; Fasudil group was injected with fasudil(10 mg/kg).The rats were killed at 6 h,12 h,24 h,72 h,7 d,after administration.The pathological changes were observed by means of HE.The expression of Nogo-A and NF200 was studied with immunohistochemical staining.Results 1.Naked eye observation:Sham group bilateral symmetrical cerebral hemispheres; HIBD group of brain edema aggravated,the visible hemisphere focal necrosis; fasudil treatment group of edema than HIBD group ease.2.HE stain:the structure and shape of brain in Sham operation group were normal.In HIBD group,the cells became edema,karyopyknosis,lyse,and the inflammatory cells became more.The number of edema cells and karyopyknosis decreased in Fasudil group.3.Immunohistochemical stain:there were less expressions of Nogo-A in Sham operation group.It increased slightly after 12 h in HIBD group but decreased later.The expression of Nogo-A in Fasudil group was less than the other two groups at any time except 6 h (P ＜0.01).There was more expression in HIBD and Fasudil group compared with Sham operation group(P ＜0.01).NF200 was less expression in Sham operation group.NF200 appeared after 6 h and became less after 12 h.The expression of NF200 was at 24 h and later became more.The expression of NF200 in Fasudil group was more with HIBD group at each different time (P ＜ 0.01).The expressions of NF200 in Fasudil and HIBD group were more compared with Sham operation group.Conclusions Fasudil can rehabilitate the damaged axon and promote nerve regeneration through controlling the Rho/Rock and make the expression of NF200 increase.

Objective To analyze the clinical characteristics and factors influencing adverse treatment outcomes in elderly patients with multidrug-resistant pulmonary tuberculosis (MDR-TB) to guide the clinical diagnosis and treatment of elderly MDR-TB patients. Methods Clinical data of elderly patients with multidrug-resistant pulmonary tuberculosis initially treated at Beijing Chest Hospital from 2008 to 2023 were retrospectively collected. Complications/comorbidities, adverse drug reactions, drug resistance during initial treatment, and retreatment were statistically described. Factors influencing adverse treatment outcomes were analyzed using the chi-square test and logistic regression analysis. Results A total of 238 elderly patients with MDR-TB were collected, of which 152 (63.9%) had adverse drug reactions, 184 (77.3%) were retreated MDR-TB, 27 (11.3%) were extensively drug-resistant tuberculosis (XDR-TB), 41 were cured, 6 completed treatment, 39 failed treatment, 6 died, 107 lost to follow-up, 31 could not be evaluated, 8 did not finish treatment, and the treatment success rate was 20.4% (47/230). The adverse outcome of treatment accounted for 79.6% (183/230). Univariate analysis showed that differences in age groups, the occurrence of drug adverse reactions, and patient sources had a statistically significant impact on treatment outcomes (P<0.05). Logistic regression analysis was performed using good and adverse treatment outcomes as dependent variables for the three factors, which showed that being aged 70 and above, the occurrence of drug adverse reactions during treatment, and being a non-local patient were factors influencing adverse treatment outcomes [OR (95%CI): 2.507 (1.027-6.121), 3.253 (1.635-6.473), 2.563 (1.285-5.111), respectively]. Conclusions Elderly patients with MDR-TB exhibit a high prevalence of complications/comorbidities, a high incidence of drug adverse reactions, and unfavorable treatment outcomes. Out-of-town medical treatment, advanced age, and experiencing drug adverse reactions are risk factors for adverse treatment outcomes.

BACKGROUND: In recent years, ultrasound microbubble gene transfer system has been applied for gene transfection in many parts of the body, but it has been seldom reported to be used for gene transfection in bone parts. OBJECTIVE: To investigate the efficiency and feasibility of ultrasound-targeted microbubble destruction applied for transfection of enhanced green fluorescent protein plasmid into the femoral head of rabbits.METHODS: Japanese big-ear rabbits were randomly divided into five groups: bare transfection, pre-irradiation + bare transfection, ultrasound transfection, pre-irradiation+ultrasound transfection, and repeatable transfection. In the first two groups, ultrasound-targeted gene transfection and irradiation was not used, but in the latter three groups, ultrasound-targeted microbubble destruction was used to transfect enhanced green fluorescent protein (EGFP) plasmid into the femoral head of rabbits. At 1 week after transfection, EGFP expression in femoral head was observed under the fluorescence microscope. RESULTS AND CONCLUSION: EGFP expression appeared in the ultrasound transfection, pre-irradiation + ultrasound transfection and repeatable transfection. The transfection efficiency of EGFP plasmid was significantly higher in the repeatable transfection group than in the other groups (P < 0.01). Obvious injury loci were not observed in the soft tissue and bone tissue slices of ultrasonic irradiation parts in the ultrasound transfection, pre-irradiation + ultrasound transfection and repeatable transfection groups. These results confirm that ultrasound-targeted microbubble destruction is a safe and effective method to transfect EGFP plasmid into the femoral head of rabbits.

Objective: To construct an evaluation index system of oral health literacy for children's parents, so as to provide an index system for the evaluation of oral health literacy for children's parents in China. Methods: The evaluation index system of oral health literacy for children's parents was designed based on literature review and semi-structured interview. Experts from oral prevention and pediatric oral medicine were invited to participate in two-round Delphi consultations. The indicators were scored and screened according to the importance, and the weight determined using analytic hierarchy process. The effectiveness of the consultation was evaluated by positive coefficient, authority coefficient and coordination coefficient. Results: Twenty-four experts participated in the consultation, including 6 males and 18 females. There were 21 experts with a master degree, 3 experts with a doctor degree, and 20 experts with vice senior professional titles and above. The recovery rates of the two rounds of consultations were 96.00% and 100.00%, the authority coefficients were 0.866 and 0.917, the Kendall's coefficient of concordance were 0.120 and 0.156 (both P<0.05), and the coefficient of variation was 0.15-0.38 and 0.03-0.17, respectively. The final evaluation index system included 3 primary indicators, 11 secondary indicators and 40 tertiary indicators. The primary indicators were basic knowledge and concepts related to oral health, promoting lifestyle and behaviors related to oral health, and maintaining basic skills related to oral health. Conclusion The evaluation index system of oral health literacy for children's parents has been established in this study and needs to be further applied and evaluated.

Objective:To explore the the evaluation value of stress hyperglycemia ratio (SHR), C-reactive protein (CRP), and serum procalcitonin (PCT) for postoperative infection in patients with open tibiofibular fractures.Methods:This study was a prospective analysis. Patients with open tibiofibular fractures hospitalized in the Department of Orthopaedic Surgery of The Second Hospital of Tangshan and North China University of Science and Technology Affiliated Hospital from January 2018 to January 2023 were collected as the research objects, and a total of 839 cases were assessed for outcome, which were divided into infection group (103 cases) and non-infection group (736 cases) according to whether the selected subjects had postoperative infection. The clinical data of the two groups were analyzed by univariate analysis, and the risk factors of postoperative infection of open fracture of tibia and fibula were analyzed by multivariate Logistic regression, and the receiver operating characteristic (ROC) curve was drawn to analyze the predictive efficacy of SHR, CRP, PCT, and their combined models on adverse outcomes.Results:Univariate analysis showed that the infection group had SHR (1.82±0.31), CRP (92.28±36.07) mg/L, PCT (6.35±1.79) μg/L, the non infection group had (1.05±0.12), (56.35±10.21) mg/L and (2.17±0.41) μg/L, respectively, and there were significant differences between the two groups ( t values were 46.90, 21.60, and 54.17, respectively; all P<0.001). The proportion of albumin (<30 g/L) in the infection group was higher than that in the non-infection group (63.11%(65/103), 37.64%(277/736) (χ 2=24.28, P<0.001), and the two groups had significant differences in the rate of time from injury to operation (the infection group ≥6 h was 71.84%(74/103), <6 h was 28.16%(29/103); the non-infection group ≥6 h was 43.07%(317/736), <6 h was 56.93%(419/736); χ 2=35.37, P<0.001), the rate of Gustilo-Anderson classification (the infection group Ⅰ、Ⅱ was 44.46%(46/103), ⅢA was 33.98%(35/103), ⅢB was 12.62%(13/103), ⅢC was 8.47%(9/103);the non-infection groupⅠ、Ⅱ was 59.10%(435/736), ⅢA was 32.47%(239/736), ⅢB was 5.98%(44/736), ⅢC was 2.45%(18/736); χ 2=20.34, P<0.001) and the rate of postoperative drainage volume (the infection group was 40.60%(48/103),the non-infection group was 58.02%(427/736); χ 2=4.79, P=0.029). Multivariate Logistic regression analysis showed that SHR ( OR=1.871,95% CI 1.621-2.160, P<0.001), CRP ( OR=1.060, 95% CI 1.015-1.107, P=0.009), PCT ( OR=1.497, 95% CI 1.420-1.577, P<0.001) were independent risk factors for postoperative infection in open tibiofibular fractures. Among them, SHR had the highest OR value, which was the strongest factor affecting the outcome of the study. Other independent factors were age ( OR=1.052, 95% CI 1.038-1.066, P<0.001) and Gustilo-Anderson type-ⅢC ( OR=1.875, 95% CI 1.038-2.015, P<0.001). By drawing the ROC curve of SHR, CRP, PCT and their combined model to predict the incidence of postoperative infection in open tibiofibular fractures, the results showed that the combined model had higher diagnostic predictive value than the single application, and its sensitivity and specificity were 86.4% and 70.4%, respectively, which were higher than the sensitivity (78.6%, 77.7%, 75.7%) and specificity (69.2%, 69.3%, 69.6%) of the single assessment. Conclusion:The combined model of SHR, CRP and PCT has a higher predictive value than the single detection, which can provide a better clinical basis for the early diagnosis of postoperative infection in patients with open tibiofibular fractures.

Objective: To investigate the impact of parental conflict perception on adolescent anxiety and the therapeutic effect of family therapy on adolescent anxiety. Methods: A total of 120 adolescent anxiety patients who attend the psychological clinic of the fourth renming hospital in Hefei were selected and were divided into two groups, the treatment group and control group, impact clinical medication while the treatment group recevied both clinical medication and family therapy(for three months). Parents Conflict Consciousness Scale(CPIC), Hamilton Anxiety Scale (HAMA) was used to assess parents conflict consciousness of adolescent anxiety. Effects of family therapy on teenagers anxiety and CPIC, HAMA score were analyzed. Results: CPIC conflict intensity, threats of cognitive conflict and content for adolescent anxiety were positively correlated with HAMA scores(r=0.26, 0.20, 0.18, P<0.05), At the end of the three-month treatment, the score on HAMA and CPIC of the treatment group (HAMA: 9.23±1.98, CPIC: 9.52±2.35) was significantly lower than that of the control group(HAMA: 14.52±2.66, CPIC:11.98±2.55)(t=11.88, 5.48, P<0.01). HAMA and CPIC scores of patients in both groups significantly decreased compared to before treatment(control group t=13.88, 16.84; treatment group t=20.50, 21.89, P<0.01). Conclusion Parental conflict perception shows impact on adolescent anxiety, and family therapy can reduce parental conflict perception and relieve adolescent anxiety.

Objective:To investigate clinical characteristics and high-risk factors of prognosis of twin-to-twin transfusion syndrome(TTTS) combined with necrotizing enterocolitis(NEC).Methods:The clinical data of 102 children with TTTS admitted to the NICU at the Third Affiliated Hospital of Zhengzhou University from January 2017 to January 2020 were collected.Fifty-one pairs(102 cases)of twins without TTTS who were hospitalized at the same time and in the same gestational age were selected as the control group, and the relevant case data were collected and compared.The clinical data of 14 children with NEC in TTTS group were analyzed retrospectively.Results:(1)The average gestational age of TTTS group was(32.24±2.12)weeks, and that was (32.47±1.84) weeks in control group, with no statistical significance( P>0.05). The average birth weight of TTTS group was(1 547.63±523.80)g, which was lower than that of control group(1 658.71±454.13)g( P<0.05). There were 14 children in TTTS group with NEC, with an incidence of 13.7%(14/102), and seven children in the control group with NEC, with an incidence of 6.9%(7/102)( P<0.05). The proportion of very low birth weight infants, NEC occurrence within 2 weeks and mortality in TTTS group were higher than those in control group( P<0.05). (2)Compared with the non-NEC group, the NEC group of TTTS children had lower birth weight, the incidence of intrauterine distress and severe postnatal asphyxia, and the rate of sepsis were significantly higher than those in non-NEC group( P<0.05). (3)Among TTTS children, NEC was diagnosed in ten donors(71.4%) and four recipients(28.6%), with statistically significant difference between two groups( P<0.05). (4)The early clinical symptoms of TTTS complicated with NEC were mainly bloody stools, abdominal distension, poor response, apnea, and vomiting. Conclusion:TTTS is one of the risk factors for NEC, which the occurrence time of TTTS combined with NEC is not completely consistent with the classic NEC, which is more likely to occur within 2 weeks after birth.Children with TTTS complicated with NEC mostly occur in donor infants, and fetal distress in utero, severe asphyxia and sepsis are the high risk factors.The early clinical symptoms of TTTS combined with NEC are not significantly different from those of common NEC, mainly including bloody stools, abdominal diste, poor response, apnea, and vomiting.Vigilance should be raised when similar digestive symptoms appear in children.