Objective:To investigate the inflammatory state and immune function of patients experiencing acute exacerbation of chronic obstructive pulmonary disease complicated by hypercapnia before and after noninvasive mechanical ventilation.Methods:The clinical data of 120 patients experiencing acute exacerbation of chronic obstructive pulmonary disease complicated by hypercapnia who received treatment in Taizhou Central Hospital from August 2018 to August 2019 were retrospectively analyzed. According to different treatment methods, they were divided into a noninvasive ventilation group ( n = 57) and a conventional treatment group ( n = 63). The therapeutic effect was observed in each group. Before and after treatment, serum levels of inflammatory factors (tumor necrosis factor-α, interleukin-6, C-reactive protein), immune indexes (CD 4+, CD 8+, CD 4+/CD 8+), blood gas analysis indexes (PaCO 2, PaO 2, pH) and pulmonary function indexes (forced expiratory volume in 1 second, forced vital capacity, peak expiratory flow) were measured in each group. Adverse reactions such as sputum obstruction and gastric distension during treatment were statistically analyzed. Results:Total effective rate in the noninvasive ventilation group was significantly higher than that in the conventional treatment group ( P < 0.05). After treatment, serum levels of tumor necrosis factor-α, interleukin-6, C-reactive protein were (61.98 ± 5.16) ng/L, (19.77 ± 3.41) ng/L, (15.39 ± 3.22) mg/L respectively in the noninvasive ventilation group, which were significantly lower than those in the conventional treatment group [(68.24 ± 5.12) ng/L, (21.04 ± 3.52) ng/L, (19.28 ± 3.50) mg/L, t = 6.664, 2.003, 6.314, all P < 0.05]. After treatment, CD 4+ and CD 4+/CD 8+ were (29.28 ± 2.81) and (1.18 ± 0.17) respectively in the non-invasive ventilation group, which were significantly higher than (27.34 ± 2.96) and (1.09 ± 0.15) in the conventional treatment group ( t = 3.672, 3.081, both P < 0.05). After treatment, PaCO 2 [(48.34 ± 6.92) mmHg] in the noninvasive ventilation group was lower than that in the conventional treatment group [(53.09 ± 7.07) mmHg, t = 3.712, P < 0.05]. PaO 2, pH, forced expiratory volume in 1 second, forced vital capacity and peak expiratory flow were (70.61 ± 9.82) mmHg, (7.35 ± 0.15), (2.39 ± 0.48) L, (2.50 ± 0.46) L, (4.65 ± 0.75) L/s, respectively in the non-invasive ventilation group, which were significantly higher than those in the conventional treatment group [(65.19 ± 8.23) mmHg, (7.29 ± 0.14), (2.16 ± 0.47) L, (2.21 ± 0.45) L, (4.06 ± 0.69) L/s, t = 3.287, 2.266, 2.650, 3.488, 4.488, all P < 0.05]. There was no significant difference in the incidence of adverse reactions between the two groups ( P > 0.05). Conclusion:Noninvasive mechanical ventilation for patients experiencing acute exacerbation of chronic obstructive pulmonary disease complicated by hypercapnia can improve the inflammatory state and immune function, enhance lung function and reduce the degree of hypoxia.

Objective To evaluate the impact of aderent perirenal fat (APF) on retroperitoneal laparoscopic partial nephrectomy (RLPN). Methods Clinical data of 52 patients who underwent RLPN for a small renal tumor from October 2013 to December 2015 was analyzed retrospectively. All the patients were divided into two groups according to the presence of APF by preoperative computed tomography imaging. Clinical data was collected including patients' age, gender, BMI, history of hypertension, history of diabetes, American Society of Anesthesiologists score (ASA), intra-abdominal fat (IAF), tumor size, RENAL Nephrometry score (RNS), operative time, warm ischaemia time (WIT), estimated blood loss (EBL), and length of hospital stay. Results Between the two groups, the BMI, tumor size, WIT, length of hospital stay were similar [(26.70 ± 3.33) kg/m2 vs (25.65 ± 4.01) kg/m2, (3.53 ± 1.21) cm vs (3.64 ± 1.05) cm, (27.17 ± 7.55) min vs (25.21 ± 5.64) min, (12.54 ± 4.06) d vs (10.61 ± 3.70) d, P > 0.05)], as well as the ASA and RNS. APF patients were older [(59.25 ± 11.03) y vs (49.71 ± 11.86) y, P = 0.004]. There were a high proportion of men (75.0% vs 46.4%, P = 0.036), patients with hypertension (62.5% vs 28.6%, P = 0.014), and patients with diabetes (41.7% vs 14.3%, P = 0.026). In the APF group, IAF was more [(2.02 ± 0.47) cm vs (1.35 ± 0.66) cm, P = 0.000], operative time was longer [(146.08 ± 45.45) min vs (119.32 ± 28.83) min, P = 0.017], and EBL was higher [(82.92 ± 45.73) ml vs (51.79 ± 25.10) ml, P = 0.005]. Conclusion The adherent preirenal fat sticking renal results in a longer operative time and a higher EBL, but has no influences on the WIT and length of hospital stay. APF makes it difficult to expose the tumor, not to remove it.

Objective To investigate the method of the resectoscope combined with ureteroscope in seeking for the difficult ureteral orifice in glandular cystitis, which improved the success rate of double J stent insertion under endoscopy.Methods The clinical data of 8 patients with dififcult ureteral oriifce in glandular cystitis from March 2015 to May 2016 were retrospectively analyzed. All male patients, their age ranged from 38 to 64 years old, the average age was 44.3 years. The depth of the submucosa and muscle layer of the bladder lesion was treated by transurethral resection. The necrotic tissue of ureteral oriifce was excised, which revealed the changing of muscular layer of texture. Then, resected the muscle tissue, urine was seen through the thin layer of muscle tissue. Under the guidance of the guide wire was inserted, the ureteroscope observation was confirmed ureteral lumen and the double J stent was placed.Results All patients were successfully placed double J stent. The mean operation time was 83.2 min (range, 35.0~205.0 min). Intraoperative blood loss was range 20~50 ml. The catheter was removed in 3~5 d. The abdominal plain iflm was reviewed in 1 - 2 days and the position of the double J stent was good, there was no ectopic, distortion and so on. There was no complications occurred during the perioperative period.Conclusions Resectoscope combine with ureteroscope in seeking for the dififcult ureteral oriifce in glandular cystitis is an effective way of increasing the successful rate of ifnding dififcult ureteral oriifce. This method is safe,minimally invasive and avoiding open surgery.

Objective : To investigate the status of occupational stress and analyze its influencing factors among frontline employees working in a chemical fiber manufacturing enterprise, so as to provide insights into the development of occupational stress interventions. Methods : The frontline employees working in a chemical fiber manufacturing enterprise were selected as the study subjects using a cluster sampling method in October 2018. The status of occupational stress was investigated using the Chinese version of the effort-reward imbalance ( ERI ) questionnaire. The influencing factors for occupational stress were identified using a multivariable logistic regression model. Results : A total of 1 780 questionnaires were sent out, and 1 115 valid ones ( 62.64% ) were recovered. Among the 1 115 respondents, there were 427 men ( 38.30% ) and 688 women ( 61.70% ), and 71.22% were at ages of 21 to 39 years. There were 561 respondents with < 1 year of service ( 50.31% ), and the longest length of service was 11 years. In addition, there were 1 069 respondents ( 95.87% ) exposed to high noise, and 346 respondents ( 31.03% ) were diagnosed at a high occupational-stress state and 769 ( 68.97% ) at a low state. Multivariable logistic regression analysis identified 5 years or longer of service ( OR=1.540, 95%CI: 1.057-2.245 ) and exposure to high noise ( OR=1.917, 95%CI: 1.004-3.659 ) as risk factors for occupational stress among frontline employees in the chemical fiber manufacturing enterprise. Conclusions There are 31.03% of frontline employees at a high occupational-stress state in the chemical fiber manufacturing enterprise, and a high occupational-stress state is associated with exposure to high noise and 5 years or longer of service.

Objective The diagnostic efficacy of the two gene methylation indexes was verified by lung biopsy or postoperative disease examination results.Methods A prospective study was conducted to collect 99 patients diagnosed with pulmonary nodules and masses in the Third People's Hospital of Yunnan Province from March 2019 to March 2020.After bronchoscopy and BALF samples were collected,regular follow-up,lung puncture biopsy and post-operative disease examination were performed.Results Ninety-nine patients with pulmonary nodules and masses were divided into lung cancer group(n = 50)and benign lung disease group(n = 49)after pathological diagnosis.The age of patients in the lung cancer group was(62.64±9.71)years,and that of the benign lung disease group was(60.48±13.69)years,and there was a statistical difference between the two groups(P = 0.032).In the diagnosis of lung cancer,the sensitivity and specificity of SHOX2 and RASSF1A genes alone were found to be 72%and 58%,respectively,and 92.3%and 95.9%,respectively.The combined test of the two genes showed a higher sensitivity in the diagnosis of lung cancer,0.84,compared to 0.102 in the benign disease group(P<0.001).ROC curve analysis showed that the sensitivity of the two genes could be increased to 84%when methylation was combined.Conclusion The methylation test of SHOX2 and RASS1A gene in alveolar lavage fluid has a good value in the diagnosis of lung cancer patients with pulmonary nodules and masses and SHOX2 combined with RASSF1A can be an important supplementary tool for early diagnosis of lung cancer when imaging and histological diagnosis are unclear.

Objective To observe the clinical effect of repairing the defect after extended resec-tion of lower lip cancer by modified lip and cheek fan-shaped flap .Methods Six cases of lower lip cancer were treated .The defect of the lower lip was about 1/3-1/2 after 1 cm of enlarged resection outside the margin of the mass .The defect was repaired with modified lip and cheek fan-shaped flaps . The morphology and function were observed 3-36 months after operation .Results All patients healed in one stage ,and the shape and function of lower lip recovered well without complications .Conclusions Lower lip defect about 1/3-1/2 of patients with modified lip and cheek fan-shaped flap is an ideal method of restoration and reconstruction ,with satisfactory results after surgery .

Objective:To explore the early surgical outcomes of Thoracoscopic Transmitral Myectomy(TTM) on patients with hypertrophic obstructive cardiomyopathy(HOCM).Methods:Preoperative echocardiography and cardiac magnetic resonance were used to evaluate the patient's hypertrophy extent, mitral valve morphology and function. Myocardial resection was performed via the trans-mitral approach under total thoracoscopy, and the surgical methods and early results were analyzed.Results:From April 2019 to October 2019, a total of 15 cases of TTM were performed by a single surgeon in our ward. Preoperative imaging evaluation revealed that 6 patients(40.0%) had predominantly hypertrophic basal septum while another 9 patients(60.0%) had concomitant midventricular septal hypertrophy. Two(13.3%) patients were interrogated ruptured posterior mitral chord by preoperative echocardiogram. After myocardial resection, the mitral valve was treated as follows: 11 patients(73.3%) underwent anterior leaflet enlargement, and 3(20.0%) were directly reattached to mitral valve annulus, and 1(6.7%) underwent bioprosthetic mitral replacement. There was no case of perioperative death, ventricular septal perforation, residual left ventricular outflow tract obstruction and complete atrioventricular block. Median aortic crossclamp time, cardiopulmonary bypass time, postoperative ventilator use time, ICU stay time, and postoperative hospital stay were 129.0min(116.0, 147.0), 184.0 min(158.0, 227.0), 22.0 h(9.0, 26.0), 3 days(2, 7) and 9 days(7, 14) respectively. No patient lost to follow up, the median follow-up time was 4 months(2, 5). One patient(6.7%) underwent mitral angioplasty three months after surgery due to a tear in the A3 area; the ventricular septal thickness and left ventricular outflow tract pressure decreased significantly(preoperative vs follow-up), and were(19.3±3.3)mm vs. (8.9±4.4) mm( P=0.001), (90.8±23.2)mmHg vs. (8.9±4.4) mmHg(1 mmHg = 0.133kPa)( P<0.001) respectively; no residual SAM was observed during follow-up. Patients with moderate-to severe mitral regurgitation were decreased from 12(80.0%) before surgery to 1(6.7%) during follow up( P<0.001). Conclusion:TTM is a safe and effective procedure for HOCM patients with appropriate surgical indications, providing better exposure to septum from basal to apical area, eliminating left ventricular outflow tract obstruction and SAM-related mitral regurgitation. The anterior mitral valve leaflet should be carefully treated during surgery to reduce the occurrence of residual mitral regurgitation resulted in inappropriate selection of patch size and suturing technique.

【Objective】 To compare the clinical efficacy of peritoneolaparoscopic single position nephreteral total length resection (PSPNTLR) and posterior laparoscopic subabdominal incision technique (PLSIT) in the treatment of upper urothelial carcinoma (UTUC). 【Methods】 A total of 82 UTUC patients treated in our hospital during Jan.2018 and Feb.2021 were divided into the observation group (n=41, treated with PSPNTLR) and control group (n=41, treated with PLSIT) according to the random number table method.Perioperative indicators, pain degree, inflammatory factors, bladder recurrence and distant metastasis were compared between the two groups. 【Results】 The operation time \[(122.15±15.14) min vs.(160.88±17.26) min\], hospitalization time \[(10.07±2.14) d vs.(12.22±3.13) d\] and postoperative exhaust time \[(1.46±0.57) d vs.(3.10±0.88) d\] were significantly shorter, the intraoperative blood loss \[(42.85±4.88) mL vs. (78.22±8.17) mL\] and drainage volume \[(53.61±9.74) mL vs.(81.56±11.06) mL\] were significantly less in the observation group than in the control group (P<0.05).The visual analogue score (VAS) of the observation group at 6, 12 and 24 h after operation was significantly lower than that of the control group (P<0.05).The levels of interleukin-6 (IL-6) and C-reactive protein (CRP) were increased in both groups one day after surgery, but the indexes were increased more significantly in the control group (P<0.05).During the 2-year follow-up after surgery, there were no statistical difference in bladder recurrence (12.20% vs.14.63%) and distant metastasis (9.76% vs.4.88%) between the two groups (P>0.05). 【Conclusion】 Both PSPNTLR and PLSIT have good therapeutic safety, but PSPNTLR is more effective in improving perioperative indicators, reducing postoperative pain, and inhibiting inflammatory factors.

Objective    To investigate the effectiveness and safety of totally endoscopic transmitral myectomy (TETM) for hypertrophic obstructive cardiomyopathy (HOCM), comparing with traditional sternotomy modified Morrow procedure (SMMP). Methods    Thirty-eight patients with HOCM who needed surgical intervention were selected from our hospital in 2019, including 14 males and 24 females, with an average age of 56 (44-68) years. According to the operation method, they were divided into a TETM group (n=18) and a SMMP group (n=20). Appropriate patients  were screened by propensity matching scores. Finally, the clinical data of two matched groups were compared and