Objective To compare the effect of anesthesia management between enhanced recovery after surgery (ERAS) protocol and traditional protocol on stress level of thyroid surgery.Methods Sixty-two patients receiving thyroid surgery from May 2016 to August 2016, 13 males and 49 females, aged 18-65 years, of ASA physical status Ⅰ or Ⅱ, were randomly divided into group ERAS (n=29) and traditional group (group C, n=33).Each group had its own anesthesia management protocol.Operation method, operation duration, the level of pain during emergence and on the first postoperative day, the occurrence rate of complications and the satisfaction evaluation of pain and nausea and vomiting after the operation day were recorded.C-reactive protein (CRP), serum cortisol, interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor (TNF-α) before and after the operation day were evaluated.Results The visual analogue scale (VAS) pain score in group ERAS was lower than that in group C during emergence [(0.42±0.83) points vs (0.95±1.16) points]and on the first postoperative day [(1.90±1.21) points vs (2.73±1.40) points] (P<0.05).Group ERAS was more satisfied with pain relief at first day after the surgery than that of group C (P<0.05).The level of CRP in group ERAS was lower than that in group C on the operative day and the first postoperative day (P<0.05).In group C, the level of CRP on the operative day and the first postoperative day were much higher than those before the surgery (P<0.05).The occurrence rate of complications between the two groups had no statistical difference.Conclusion The perioperative ERAS anesthesia management of thyroid surgery is safe and effective in pain management, patient satisfaction and accelerated recovery.

OBJECTIVE: To explore the degree, mechanism and clinical significance of three-dimensional tumor microvascular architecture phenotype heterogeneity (3D-TMAPH) in non-small cell carcinoma (NSCLC). METHODS: Twenty-one samples of solitary pulmonary nodules were collected integrally. To establish two-dimensional tumor microvascular architecture phenotype (2D-TMAP) and three-dimensional tumor microvascular architecture phenotype (3D-TMAP), five layers of each nodule were selected and embedded in paraffin. Test indices included the expressions of vascular endothelial growth factor (VEGF), proliferating cell nuclear antigen (PCNA), EphB4, ephfinB2 and microvascular density marked by anti-CD34 (CD34-MVD). The degrees of 3D-TMAPH were evaluated by the coefficient of variation and extend of heterogeneity. Spearman rank correlation analysis was used to investigate the relationships between 2D-TMAP, 3D-TMAP and clinicopathological features. RESULTS: 3D-TMAPH showed that 2D-TMAP heterogeneity was expressed in the tissues of NSCLC. The heterogeneities in the malignant nodules were significantly higher than those in the active inflammatory nodules and tubercular nodules. In addition, different degrees of heterogeneity of CD34-MVD and PCNA were found in NSCLC tissues. The coefficients of variation of CD34- MVD and PCNA were positively related to the degree of differentiation (all P<0.05), but not related to the P-TNM stages, histological type or lymphatic metastasis (all P>0.05). The level of heterogeneity of various expression indexes (ephrinB2, EphB4, VEGF) in NSCLC tissues were inconsistent, but there were no significant differences in heterogeneity in NSCLC tissues with different histological types (P>0.05). CONCLUSION 3D-TMAPH exists widely in the microenvironment during the genesis and development of NSCLC and has a significant impact on its biological complexity.
Adult ; Aged ; Capillaries ; ultrastructure ; Carcinoma, Non-Small-Cell Lung ; blood supply ; Ephrin-B2 ; metabolism ; Female ; Humans ; Lung Neoplasms ; blood supply ; Male ; Middle Aged ; Neovascularization, Pathologic ; pathology ; Phenotype ; Proliferating Cell Nuclear Antigen ; metabolism ; Vascular Endothelial Growth Factor A ; metabolism

Objective:To analyze the correlation between Cutibacterium acnes (C. acne) ribotypes (RTs) on the skin surface and epidermal barrier function in patients with acne vulgaris.Methods:Sixty patients with acne vulgaris were enrolled in this prospective study from the Department of Dermatology, the Affiliated Hospital of Southwest Medical University from November 2018 to May 2019, including 23 males and 37 females, aged (21.6±2.6) years. According to the General Acne Grading System (GAGS) score, the patients were divided into three groups: 28 mild cases, 14 moderate cases, and 18 severe or above cases. Twenty healthy controls aged 18 to 30 years were recruited in the same period from the community, including 5 males and 15 females, aged (24.2±2.3) years. The VISIA skin testing device was used to detect the percentage of red areas and porphyrins on the facial skin of all subjects. The hydration of the stratum corneum (SCH), transepidermal water loss (TEWL), PH value and the skin surface sebum level on the facial skin were detected by CK system. The RTs of C. acne were further analyzed based on the 16s rDNA sequences. The correlation between the abundance of each RT and epidermal barrier function was analyzed using Pearson correlation analysis.Results:Compared with the healthy controls, the percentage of porphyrins [(41.69±23.10) % vs (61.33±24.27) %, t=2.98, P<0.01] and the percentage of red area [(26.71±17.13) % vs (67.97±15.22) %, t=10.78, P<0.01] decreased in the acne vulgaris patients. Meanwhile, the patients of different severity levels had decreased SCH ( P<0.01), but increased TEWL, pH value, and the skin surface sebum level ( P<0.05) compared to healthy controls. Six different RTs (RT1, RT2, RT7, RT12, RT13 and RT14) were found in both healthy controls and acne vulgaris patients with varying degrees of severity, while there was no statistically significant difference of C. acne abundance between the mild patients and the controls ( P>0.05). As the severity of disease increased, the abundance of the above RTs showed a changing trend, with the gradually decreasing abundance of RT1 and the gradually increasing abundance of RT2, RT7, RT12, RT13, and RT14 (all P<0.05). The abundance of RT1 was negatively correlated with pH value ( r=-0.33, P=0.04) and GAGS score ( r=-0.39, P=0.01). The abundance of RT2 ( r=0.39, P=0.02) and RT7 ( r=0.39, P=0.01) were positively correlated with GAGS score. The abundance of RT13 was negatively correlated with SCH ( r=-0.34, P=0.02) and positively correlated with TEWL ( r=0.30, P=0.05). Conclusions:As the severity of disease increases, the abundance of various RTs of C. acne on the skin surface of acne vulgaris patients shows a trend of gradually increasing or decreasing, and the abundance of differential RTs of C. acne is closely related to the function of the epidermal barrier.

Objective:To investigate the effect of traditional Chinese medicine enema retention time on patients with chronic renal failure under the intervention of guan yuan point in patients with TDP lamp irradiation.Methods:By convenience sampling, 65 patients with chronic renal failure who were admitted to the Chinese medicine department of a Class Ⅲ Grade A hospital in Hubei Province from 1st January 2019 to 1st November 2019 and needed Chinese medicine retention enema treatment were selected as the research subjects. 65 patients with chronic renal failure were randomly divided into observation group (32 cases) and control group (33 cases) by random table. The control group received routine enema operation, and the experimental group received TDP light irradiation at the guan yuan point on this basis. After two consecutive courses of treatment, the effective rate of enema, blood urea nitrogen and the decreased level of creatinine, and nursing satisfaction rate in the two groups were compared.Results:The total effective rate of Chinese medicine enema in the observation group was 81.82% (27/33) , and the total effective rate in the control group was 6.25% (2/32) , the difference between the two groups was statistically significant ( P<0.05) . After the intervention, the blood creatinine and blood urea nitrogen levels in the observation group were lower than those in the control group, and the differences between the two groups were no statistically significant ( P>0.05) . The total satisfaction rate of patients in the observation group was 93.94% (31/33) , which was higher than 71.88% (23/32) in the control group, the difference between the two groups was statistically significant ( P<0.05) . Conclusions:After TDP light irradiation on guan yuan point, the retention time of traditional Chinese medicine enema patients was prolonged, which promoted the absorption of traditional Chinese medicine, improved the therapeutic effect of traditional Chinese medicine enema, and delayed the course of disease.

Strengthening the performance appraisal of tertiary public hospitals is key to advancing the healthcare system reform in China. Based on the practical experience of performance appraisal of tertiary public hospitals in one city, the authors named the bottlenecks and causes impeding effective implementation of performance appraisal from the aspects of data quality, index orientation, index determination and index calculation. On such basis, they put forward corresponding countermeasures and suggestions, such as effective control of the data quality, dialectical view of the index orientation, scientific allocation of performance indicator weight, and formulation fair and reasonable index scoring methods, aiming to provide references for performance appraisal in the future.

Objective:To investigate the efficacy and safety of bladder neck resection combined with multipoint injection of triamcinolone acetonide in the treatment of bladder neck contractures (BNC) after transurethral resection prostate (TURP).Methods:The data of 25 patients with BNC after TUPR who underwent transurethral surgery in West China Hospital of Sichuan University from July 2019 to November 2021 were retrospectively analyzed, and the patients were divided into 2 groups according to the treatment method. There were 15 cases in the steroid injection group, with an average age of (67.5±8.8) years, 1 case of diabetes, and 2 cases of hypertension. And the average postoperative time after TURP was (21.9±29.1) months, the preoperative International Prostate Symptom Score (IPSS) was (30.0±3.5) points, quality of life (QOL) score was (5.7±0.5) points. There were 10 cases in the non-steroid injection group, with an average age of (65.2±10.5) years, 1 case of diabetes, and 2 cases of hypertension. And the average postoperative time of TURP was (29.3±33.5) months, and the preoperative IPSS was (30.4±2.6) points, QOL score was (5.8±0.4) points. There was no significant difference between the two groups ( P>0.05). In the steroid injection group, bladder neck resection combined with multipoint injection of triamcinolone acetonide was performed. The patients were in the lithotomy position, and a scope was placed through the urethra into the distal end of the narrow urethra under direct vision for observation, and a supersmooth guide wire was placed. The narrow section is then incised at 6 o'clock. After replacing the resectoscope, the urethral stricture scar was excised until the normal tissue of the bladder neck was exposed. Hemostasis by electrocoagulation resulted in no active bleeding from the urethra after resection. After the bladder injection needle was inserted, 80 mg (12 ml) of triamcinolone acetonide injection was injected in 6 equally spaced needles at the direction of the bladder neck from 3 to 9 o'clock. A supersmooth guide wire was placed, and a three-channel silicone urinary catheter was indwelled along the guide wire. The non-steroid injection group underwent simple bladder neck resection. Re-examination of urethroscopy at 3 and 6 months after operation showed that the patient had obvious dysuria and the microscopic examination showed that the recurrence of bladder neck stenosis was defined as the recurrence of stenosis. The efficacy, complications, and recurrence-free survival rates of the two groups were compared. Predictors of postoperative BNC recurrence were analyzed. Results:The operations in both groups were successfully completed. The operation time of the steroid injection group and the non-steroid injection group were (36.0±17.8) min and (48.5±57.9) min respectively ( P=0.438), and the intraoperative blood loss was (1.9±3.0) ml and (12.0±31.1) ml ( P=0.221)respectively. The length of hospital stay was (5.8±1.2) d and (4.4±2.5) d, respectively ( P=0.070). There was 1 case of transient hematuria and 1 case of epididymitis in the steroid injection group, and 1 case of transient hematuria and 1 case of transient dysuria in the non-steroid injection group ( P>0.05), all of which were relieved after symptomatic treatment. The IPSS of steroid injection group and non-steroid injection group were (11.0±5.6) points and (12.4±3.9) points at 3 months after operation, and (10.1±4.9) points and (14.7±7.7) points at 6 months after operation, respectively. QOL at 3 months after operation was (1.7±1.2) points and (2.1±1.5) points, respectively, and at 6 months after operation, it was (1.5±1.3) points and (3.0±2.0) points, respectively. There was statistical significance ( P<0.05). There were 1 case and 2 cases of recurrence in the steroid injection group and non-steroid injection group at 3 months after operation ( P=0.543), and 1 case and 5 cases at 6 months after operation ( P=0.023). The difference in survival curve between the two groups was statistically significant ( P=0.013). Combined steroid therapy ( OR=14.000, 95% CI1.299-150.889, P=0.030), time after scar resection ( OR=1.138, 95% CI1.017-1.273, P=0.025), postoperative IPSS( OR=1.302, 95% CI1.018-1.666, P=0.036), postoperative QOL score ( OR=4.280, 95% CI1.523-12.030, P=0.006) were the predictors of stenosis recurrence 6 months after surgery. Conclusion:Bladder neck scar resection combined with steroid injection could be safe and effective in the treatment of BNC after TURP, and local steroid injection may help reduce the recurrence rate of postoperative stenosis.

T cell infiltration and proliferation in tumor tissues are the main factors that significantly affect the therapeutic outcomes of cancer immunotherapy. Emerging evidence has shown that interferon-gamma (IFNγ) could enhance CXCL9 secretion from macrophages to recruit T cells, but Siglec15 expressed on TAMs can attenuate T cell proliferation. Therefore, targeted regulation of macrophage function could be a promising strategy to enhance cancer immunotherapy via concurrently promoting the infiltration and proliferation of T cells in tumor tissues. We herein developed reduction-responsive nanoparticles (NPs) made with poly (disulfide amide) (PDSA) and lipid-poly (ethylene glycol) (lipid-PEG) for systemic delivery of Siglec15 siRNA (siSiglec15) and IFNγ for enhanced cancer immunotherapy. After intravenous administration, these cargo-loaded could highly accumulate in the tumor tissues and be efficiently internalized by tumor-associated macrophages (TAMs). With the highly concentrated glutathione (GSH) in the cytoplasm to destroy the nanostructure, the loaded IFNγ and siSiglec15 could be rapidly released, which could respectively repolarize macrophage phenotype to enhance CXCL9 secretion for T cell infiltration and silence Siglec15 expression to promote T cell proliferation, leading to significant inhibition of hepatocellular carcinoma (HCC) growth when combining with the immune checkpoint inhibitor. The strategy developed herein could be used as an effective tool to enhance cancer immunotherapy.