Objective To evaluate the technique of finger palpation in thoracoscopic localization in patients with pulmonary nodules,and to summarize its technical details,especially with exploit of chest computed tomography (CT) facilitating it.Methods 95 patients with total amount of 109 pulmonary nodes 20 mm or smaller in size shown with lung window of CT,were reviewed.They were located subpleurally,with a median depth of 8.2 mm and a median size of 10.0 mm.The value of their depth over their size (D/d value) could be used as the extent of localizing difficulty.Each node had its own radiographic fealures for being localized,which was built preoperatively.Under thoracoscopic vision,nodules were finger-palpated by index finger via the 4th or 5th intercostal space on anterior axillary line,followed by wedgectomy or lobectomy for instant histopathological diagnosis to further decide the final surgical type.The distance between the nodule and the origin of segmental bronchus (L value) were also calculated out,as it might be relevant to the way the nodule could be biopsied.Results All nodules were successfully localized and resected for biopsy goal,105 by wedgectomy,4 by lobectomy.After intraoperative diagnosis was made by the pathologist,VATS lobectomy and lymph node dissection were further performed in 55 patients.L value of 4 cases being biopsied by lobectomy ranged from 18.3 to 30.3 mm,averaging 26.1 mm.Conclusion Finger palpation is viable in any cases of pulmonary nodules.Detailed reference of CT digital information,and enough detachment of mediastinal pleura,can greatly facilitate thoracoscopic localization by finger palpation.Lobectomy or segementectomy is preferable when L value is less than 30 mm.

Background and aims:Promoting gastrointestinal function recovery is one of the key aspects of enhanced recovery after surgery(ERAS)for colorectal cancer(CRC).Many ancient Chinese medical texts suggest that acupuncture at four acupoints—Zusanli,Shangjuxu,Sanyinjiao,and Neiguan—helps promote gastrointestinal peristalsis.However,there is currently no systematic study on multi-point acupuncture to promote postoperative gastrointestinal function recovery in CRC patients.Therefore,this study was conducted to evaluate the clinical efficacy of multi-point acupuncture in promoting gastrointestinal function recovery in CRC patients through a prospective study to provide new options for implementing ERAS in CRC patients in clinical practice. Methods:Using a prospective,randomized,controlled design,a total of 100 eligible patients who underwent laparoscopic CRC radical surgery at the Department of Gastrointestinal Surgery,Third Xiangya Hospital of Central South University,between January 2021 and February 2022,were randomly divided into an observation group and a control group,with 50 patients in each group.Both groups underwent the same ERAS protocols and radical surgery during the perioperative period.The observation group received acupuncture treatment from the day of surgery to the third postoperative day,once per day,while the control group did not receive acupuncture.Primary outcomes included the time to bowel sound recovery,time to first flatus,and time to first defecation.Secondary outcomes included abdominal pain scores,incidence of bloating,nausea,vomiting,white blood cell count,neutrophil percentage,C-reactive protein,hemoglobin,serum albumin,blood potassium levels,postoperative hospital stay,and incidence of postoperative complications. Results:A total of 96 patients completed the study,with 48 in each group.There were no statistically significant differences in baseline characteristics such as age,gender,or surgery time between the two groups(all P＞0.05).Compared with the control group,the observation group had a significantly shorter time for bowel sound recovery,first flatus,first defecation,and postoperative hospital stay(all P＜0.05).Additionally,the observation group showed reduced abdominal pain scores on postoperative day(POD)2 and 3,a lower incidence of bloating on POD 1 and 2,and a reduced incidence of nausea and vomiting on POD 3(all P＜0.05).There were no statistically significant differences in the remaining comparisons between the two groups(all P＞0.05). Conclusion:Multi-point acupuncture treatment can promote the recovery of gastrointestinal function in patients undergoing minimally invasive CRC surgery without increasing postoperative complications,and it is recommended for integration into routine ERAS protocols.

Objective:To investigate the functional connectivity of default mode network (DMN) and limbic system, the expression level of inflammatory cytokine and their correlation in bipolar disorder type Ⅱ(BDⅡ) patients with depressive episodes.Methods:Thirty-three BD Ⅱ patients with depressive episodes and forty-six healthy controls were recruited to complete the resting-state functional magnetic resonance imaging (rs-fMRI). After image preprocessing, the DMN and limbic system were extracted from the image data by independent component analysis (ICA), so as to compare the differences of functional connectivity of resting brain network between the patients and the controls.Serum levels of inflammatory cytokines interleukin-6 (IL-6), interleukin-8(IL-8), interleukin-10(IL-10), tumor necrosis factor-α (TNF-α), and C-C motif chemokine ligand 4 (CCL4) in patients and healthy controls were detected.The correlation between functional connectivity of different brain regions and inflammatory cytokines was analyzed.SPSS 17.0 software was used for data statistical analysis.The two samples were compared using t-test or Mann-Whitney U-test, and Spearman was used for correlation testing. Results:In BDⅡ patients, the functional connectivity of the right medial prefrontal cortex(cluster-size=7 voxel, cluster-level PGRF<0.05, MNI: x=6, y=54, z=9, t=-3.765) and the left superior frontal gyrus(cluster-size=10 voxel, cluster-level PGRF<0.05, MNI: x=-21, y=54, z=15, t=-4.139) in DMN decreased, while the left cerebellum Ⅳ and Ⅴ lobules of limbic system (cluster-size=21 voxel, cluster-level PGRF<0.05, MNI: x=-15, y=-24, z=-30, t=4.468) and cerebellar tonsil of left cerebellum posterior lobe(cluster-size=8 voxel, cluster-level PGRF<0.05, MNI: x=-15, y=-51, z=-45, t=4.138) in the limbic system increased.Compared with the healthy controls, the serum levels of IL-10(7.39 (6.33, 9.32) pg/mL vs 6.54 (5.84, 7.39) pg/mL, Z=-2.937, P=0.003)and CCL4 (39.31 (25.77, 68.70) pg/mL vs 31.30 (20.32, 40.89) pg/mL, Z=-2.209, P=0.027) were higher in BDⅡ patients.The functional connectivity of the left cerebellum Ⅳ and Ⅴ lobules was positively correlated with the serum levels of IL-10 ( r=0.432, P=0.031) and that of the cerebellar tonsil of left cerebellum posterior lobe was positively correlated with the serum levels of IL-10 ( r=0.429, P=0.032) and CCL4 ( r=0.402, P=0.046). Conclusion:The functional connectivity of DMN and limbic system in BDⅡ patients with depressive episode is abnormal in resting-state fMRI.The expression level of inflammatory cytokines in patients' serum increases, and has correlation with the functional connection of limbic system.

Objective To discuss the relationship between topographic location and neurological deterioration (ND) in patients with acute isolated pontine infarction.Methods Two hundred and fifty-nine patients with acute isolated pontine infarction,collected in our hospital from January 2010 to August 2013 and identified by diffusion weighted imaging (DWI),were included for retrospective review.Patients were divided into two groups according to their clinical symptoms:patients with ND and patients without ND.According to neuroimaging of DWI,the topographic location of pontine infarction was divided into three types:the upper,middle and lower ones;and the correlations of ND with risk factors,laboratory examination results,clinical manifestations and different topographic locations were explored by statistical tests.Results Of 259 patients,27.4％ (71) were diagnosed with ND;72.6％ (188) were diagnosed without ND.Univariate analysis showed that there were no differences in laboratory test results,NIHSS scores and medications between the two groups (P＞0.05);there were differences in female ratio (41 [57.7％] vs.82[43.6％]),smoking ratio (10[14.2％] vs.49[26.2％]),mean length of hospital stay ([22.72±7.01] d vs.[19.42±7.76] d),ratio of worse short-term clinical outcomes (56[78.87％] vs.64[34.04％]) and ratio of lower pontine infarction (31 [43.7％] vs.57[30.3％]) between the two groups (P＜0.05).Logistic regression analysis showed that lower pontine infarction was the independent risk factor of ND (odds ratio=1.952,95％ confidence interval=l.081-3.524,P=0.027).Conclusion Topographic location of lower pons lesions may be reliable predictor of ND in acute isolated pontine infarction.

Objective:To analyze the molecular epidemiological characteristics of the Corona virus disease 2019 (COVID-19) cases in Shijiazhuang, which can reveal the origin of the outbreak and provide a scientific basis for COVID-19 prevention and control.Methods:From January 2 to January 8, 2021, a total of 404 samples from 170 COVID-19 cases were collected from the Shijiazhuang Fifth Hospital. The consensus sequence of 2019 novel Coronavirus(2019-nCoV) was obtained through multiplex polymerase chain reaction-based sequencing. The sequences of 170 COVID-19 cases were analyzed by the PANGOLIN, and the data were statistically analyzed by T-test.Results:Among the 404 COVID-19 samples, a total of 356 samples obtained high quality genome sequences (>95%,100×sequencing depth). The whole genome sequences of 170 COVID-19 cases were obtained by eliminating repeated samples. All 170 sequences were recognized as lineage B1.1 using PANGOLIN. The number of single nucleotide polymorphism arrange from 18-22 and most of the single nucleotide polymorphism were synonymous variants. All of 170 genomes could be classified into 48 sub-groups and most of the genomes were classified into 2 sub-groups (66 and 31, respectively).Conclusions:All cases in this study are likely originated from one imported case. The viruses have spread in the community for a long time and have mutated during the community transmission.

OBJECTIVETo evaluate the sleep architecture and hypoxia and clinical features of habitual snoring children with an obstructive sleep apnea-hypopnea index (OAHI) 1 to 5.

METHODThe polysomnographic data of 267 children aged from 2 to 16 years with habitual snoring were analyzed retrospectively, and the clinical features were analyzed in 108 of the children. The recruited children were divided into primary snoring group (PS group, OAHI≤1), obstructive sleep apnea hypopnea syndrome (OSAHS) group (15 or dostructive apnea index>1, LSpO2<0.92).

RESULTThe oxygen desaturation index of the intermediate OSAHS group (3.8±0.4) was significantly higher than that of PS group (1.6±0.1) (χ2=34.5, P<0.01). The LSpO2 of intermediate OSAHS group was significantly lower than that of PS group (89(87,91) vs. 93(91,94), χ2=40.2, P<0.01). Comparing to the PS group, the non-rapid eye movement 1 ratio (N1%) was significantly higher (19.0±1.2 vs. 14.2±0.1, χ2=14.1, P<0.01), and the non-rapid eye movement 3 ratio (N3%) was significantly lower (24.4±1.0 vs. 29.0±1.1, P<0.01) in the intermediate OSAHS group. The pediatric questionnaire score intermediate OSAHS group was higher than PS (0.41±0.19 vs. 0.28±0.14, χ2=8.52, P=0.01). The adenoids-nasopharynx ratio was higher than that of PS group (0.70±0.07 vs. 0.62±0.10, χ2=8.96, P=0.01). The hypertrophy of tonsil was higher than PS group (2(1,2) vs. 1(1,2), χ2=7.95, P<0.05).

CONCLUSIONHypoxia and abnormal sleep structure are present in HS children with an OAHI of 1 to 5, and they also have the clinical features of OSAHS.

Adenoids ; pathology ; Adolescent ; Child ; Child, Preschool ; Humans ; Hypertrophy ; Hypoxia ; Oxygen ; blood ; Palatine Tonsil ; pathology ; Polysomnography ; Retrospective Studies ; Sleep ; Sleep Apnea, Obstructive ; diagnosis ; Snoring ; Surveys and Questionnaires