Endometrial Neoplasms ; pathology ; Female ; Humans ; Pregnancy ; Trophoblastic Neoplasms ; pathology ; Trophoblasts ; pathology

Objective To explore the function of ERCC2/XPD polymorphisms in the repair of DNA damage induced by UVC. Methods Plas?mids stably expressing ERCC2/XPD rs13181 AA(Lys751)and ERCC2/XPD rs13181 CC(Gln751)were transfected into Chinese hamster ovary cells,and the stable ERCC2 transfected cell lines were obtained. MTT assay was used to compare the inhibitory rates of the transfected cells treated with UVC at different irradiation intensity. The DNA damage repair ability of the transfected cells treated with UVC for 1,3,6 and 24 h was detected by modified comet assay. Results Compared with UV5ERCC2(CC),UV5ERCC2(CC) was more sensitive to UVC with decreased cell viability. DNA damage level of UV5ERCC2(CC) cells was more serious than UV5ERCC2(CC). Conclusion DNA repair capacity of ERCC2/XPD rs13181A allelic is lower than its wild?type,suggesting that ERCC2/XPDpolymorphisms play a critical role in UVC?induced DNA damage repair.

Objective To evaluate the clinical application value of reflectance confocal microscopy(RCM) in the diagnosis of several common diseases manifesting as papules in children, including lichen nitidus, verruca planae, lichen striatus, milium, molluscum contagiosum and lichen pilaris. Methods A total of 579 children clinically characterized by papules were recruited into this study. RCM was used to observe lesions and perilesional normal skin. The RCM features of 6 diseases manifesting as papules were analyzed and compared. Results Based on RCM images, 236 patients were diagnosed with lichen nitidus, 70 with verruca planae, 123 with lichen striatus, 40 with milium, 53 with molluscum contagiosum and 57 with lichen pilaris. All the 6 diseases had typical RCM features. Concretely speaking, RCM images of lichen nitidus lesions showed infiltration of dense inflammatory cells and melanophages in enlarged dermal papillae. In RCM images of verruca planae lesions, cells in the granular and spinous layers were arranged in concentric circles, giving a rose cluster?like appearance. RCM images of lichen striatus lesions revealed focal swelling of stratum spinosum, absent or local liquifaction degeneration of basal cells, and clustering of a moderate number of inflammatory cells in the superficial dermis. In RCM images of milium lesions, well?circumscribed round or oval structures containing highly but nonuniformly refractive materials could be seen in the dermis. RCM images of molluscum contagiosum lesions showed intact cystoid structures containing highly refractive molluscum bodies. Lowly to moderately refractive cutin ? like materials were observed along with the dilation of hair follicle infundibula in RCM images of lichen pilaris lesions. In RCM images, the 6 diseases were distinguished mainly based on structural features(patterns and refractivity)of skin lesions shown by continuous vertical scanning. Conclusion RCM is of great value to the diagnosis of diseases manifesting as papules in children.

Objective: To explore the clinical application indications, filter selection and filter removal techniques of inferior vena cava filter. Methods: Retrospective analysis of the clinical data of 108 cases of inferior vena cava filter implantation in the Department of Vascular Surgery, People's Hospital of Xinjiang Uygur Autonomous Region from January 2018 to February 2019 was performed. One hundred and eight patients with inferior vena cava filter were eligible for filter placement, including 50 males and 58 females; the average age was 59 years, and the age ranged from 23 to 90 years. Different types of inferior vena cava filters were selected according to the patient's condition, the location of the thrombus, the type of surgery and the prognosis of the disease. In this study, lower extremity vascular ultrasound was performed by the outpatient in 2 weeks after the filter placement, 1 month after the operation, 2 months after the operation, and 3 months after the operation. The inferior vena cava filter was recovered by a catcher. Loop technology, Loop and biopsy forceps were used for patients with difficult filter recovery. After removal of the filter, the angiography confirmed the integrity of the inferior vena cava wall. Observe whether the filter was completed, deformed, broken and whether there was thrombus in the filter. Results: The removal of inferior vena cava filter was performed in patients with no free floating thrombus or fresh thrombus in popliteal, femoral, iliac and inferior vena cava confirmed by ultrasound. In this group, 108 patients with inferior vena cava filter implantation included 11 patients anticoagulant contraindications, 11 patients with pulmonary embolism, 5 patients with floating thrombosis in iliac vein, femoral vein or inferior vena cava, 35 patients with acute deep venous thrombosis of lower extremity received catheter-directed thrombolysis or percutaneous mechanical thrombectomy, 46 patients with abdominal, pelvic or lower extremity surgery for acute deep venous thrombosis of lower extremity and high risk factors of pulmonary embolism. One hundred and three patients received retrievable inferior vena cava filters and 5 patients received temporary inferior vena cava filters. Ninety-two patients were followed up successfully in this group. In 74 patients, the filter trap was recovered using a catcher, and the inferior vena cava filter of 12 patients were successfully removed by Loop technology and Loop with biopsy forceps.The success rate of the filter removal was 93.5%. After removal of the filter, angiography of inferior vena cava showed smooth wall, blood flow patency and no extravasation of contrast agent. The removal filters have normal shape, no fracture and no deformation. Conclusions Operators should strictly observe the indication of inferior vena cava filter placement, master a variety of filter removal methods to improve the success rate of filter removal and maximize the benefit of patients with inferior vena cava filter implantation.

Objective:To evaluate the effect of anesthesia factor on postoperative outcome in patients undergoing thoracoscopy through a comparison between different analgesic methods.Methods:One hundred patients of both sexes, aged 18-64 yr, with body mass index of 18.5-24.0 kg/m 2, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, scheduled for elective single-hole thoracoscopic surgery, were divided into 4 groups ( n=25 each) using a random number table method: control group (group C), erector spinae plane block (ESPB) group (group E), thoracic paravertebral nerve block (TPVB) group (group T), and ESPB combined with TPVB group (ET group). Before induction of anesthesia, ultrasound-guided nerve block was performed, and ESPB, TPVB, and ESPB combined with TPVB were performed on the affected side in E, T and ET groups, respectively.The mixture of 0.5% ropivacaine 20 ml and dexamethasone 5 mg was injected in T and E groups, and 0.5% ropivacaine 5 ml was injected into the paravertebral space, the needle tip was retracted to touch the transverse bone, and then another 15 ml was injected in group ET.The block plane was detected by acupuncture at 15 min after completion of the nerve block, and successful nerve block was defined as the block plane reaching T 4-6 in the areas innervated by the spinal nerve.Both groups received patient-controlled intravenous analgesia(PCIA) and were admitted to postanesthesia care unit after surgery.Flurbiprofen axetil 50 mg was intravenously injected as rescue analgesic when the visual analog scale(VAS)score was more than 3.Venous blood samples were collected immediately before nerve block operation (T 0), 30 min after operation (T 1), 30 min after tracheal extubation (T 2), and 24 h after operation (T 3) for determination of the concentrations of plasma cortisol and adrenocorticotropic hormone (ACTH) by enzyme-linked immunosorbent assay.The VAS score for cough was recorded at 15 min after tracheal extubation (T 4) and 6, 12, 24 and 48 h after surgery (T 5-8). The patients were followed up at 48 h after surgery.The pressing times of PCIA, consumption of flurbiprofen, and development of nausea and vomiting were recorded. Results:Compared with group C, VAS scores for cough were significantly decreased at T 4-6, the pressing times of PCIA was reduced, and the consumption of flurbiprofen, and incidence of nausea and vomiting and plasma Cor and ACTH concentrations at T 1-2 were decreased in the other three groups ( P<0.05). Compared with group E, VAS scores for cough at T 4, pressing times of PCIA and consumption of flurbiprofen were significantly decreased in T and ET groups ( P<0.05). There was no significant difference in each index between ET group and T group ( P>0.05). Conclusion:TPVB performs better than ESPB and TPVB combined with ESPB in improving the postoperative outcome of patients undergoing thoracoscopy.

Objective:To evaluate the therapeutic effect of excimer laser ablation (ELA) in the treatment of lower extremity arterial ischemic diseases.Methods:The clinical data of 44 patients with lower extremity ischemic diseases treated with ELA in the People′s Hospital of Xinjiang Uygur Autonomous Region from December 2020 to April 2021 were analyzed retrospectively. Among the 44 patients, there were 29 patients in lower extremity arteriosclerosis obliterans (ASO), including 3 patients with femoral artery stent occlusion. 8 patients of diabetes foot (DF) and 7 patients of thromboangiitis obliterans (TAO). Observation indicators include target vascular patency rate, amputation rate, vascular reintervention rate and mortality rate. The measurement data were expressed as mean ± standard deviation ( ± s), one-way analysis of variance was used for inter-group comparison, and paired sample t-test was used for intra-group comparison. The Chi-square test was used for comparison between count data. Results:The success rate of operation was 100% in 44 patients. The rate of major amputation in ASO group was 10.3%, while the other two groups had a major amputation rate of 0. The minor amputation rates of the three groups were 6.9%, 25.0% and 28.6%, respectively. The vascular reintervention rate was 10.3% in ASO group, 12.5% in DF group and 0 in TAO group. The 1-year mortality rate in the ASO group was 10.3%, while the other two groups had a mortality rate of 0. The 2-year mortality rate of the three group were 31.0%, 12.5% and 0, respectively.Conclusion:For the treatment of lower extremity arterial ischemic diseases, ELA is safe and effective, but the curative effect need to further clarify by large sample and long-term clinical follow-up observation.

Objective:To analyze the influencing factors of the medical insurance balance of hospitalization expenses for gastric cancer surgery patients under DRG payment, for reference for promoting the reform of DRG payment in public hospitals and controlling hospitalization expenses reasonably.Methods:The gastric cancer patients enrolled in the gastroenterology department of a tertiary comprehensive hospital from January to July 2022 were selected as the research subjects. The indicators such as patient age, medical insurance balance, hospitalization expenses and their composition were extracted from the hospital information management system and the medical insurance settlement system a certain city. Descriptive analysis was conducted for all data, and stepwise multiple linear regression was used to analyze the influencing factors of patients′ medical insurance balance. Monte Carlo simulation method was used to simulate different combination scenarios of various influencing factors to analyze the probability of medical insurance balance.Results:A total of 205 patients were contained, including 117 in the medical insurance balance group and 88 in the loss group. The difference in hospitalization expenses and medical insurance balance between the two groups of patients were statistically significant ( P<0.05). The intervention of medical insurance specialists, correct DRG enrollment, parenteral nutrition preparation costs, anti infective drug costs, examination costs, and consumables costs were the influencing factors of patient medical insurance balance ( P<0.05). Through Monte Carlo simulation verification, patients with different cost parenteral nutrition preparations, or different anti infective drug schemes had the higher probability of medical insurance balance in the scenario where the medical insurance commissioner intervenes and the DRG enrollment was correct. Conclusions:The hospital adopted interventions from medical insurance specialists to ensure the correct DRG enrollment of patients, accurate use of parenteral nutrition and anti infective drugs, and reasonable control the cost of examinations and consumables, which could increase the probability of medical insurance balance for gastric cancer surgery patients. In the future, hospitals should further promote the procurement of drug consumables in bulk, reduce unnecessary examinations, develop standardized perioperative nutritional interventions and anti infection treatment pathways, ensure the accuracy of DRG enrollment, optimize clinical diagnosis and treatment pathways to improve the efficiency of medical insurance fund utilization and provide high-quality medical services for patients.

Objective:To evaluate the clinical effect of striated free wrist transverse flap pedicled with superficial palmar branch of radial artery carrying sensory nerve in repairing pulp defect of middle-and-distal segments of fingers.Methods:From February 2019 to March 2021, the data of 20 patients with defects of middle-and-distal finger segment were collected. The defects were repaired with striated free wrist transverse flaps pedicled with superficial palmar branch of radial artery. The defects sized were 2.0 cm×1.5 cm-4.0 cm×1.5 cm, and the flaps sized were 2.5 cm×2.0 cm-4.5 cm×2.0 cm. The flap carried metacarpal cutaneous branch of median nerve for the reconstruction of the sensation of finger pulps. The donor sites were directly sutured. After operation, the patients were evaluated according to the shape, sensation and functional recovery of the repaired fingers through outpatient visits and reviews via WeChat.Results:All 20 flaps survived and the wounds healed well. All patients entered regular follow-up for 6-12(average, 8) months. The colour of the flaps was close to the finger skin, without bloating flaps. The flaps were soft in good shapes and function. TPD were 6-11 mm, at 8 mm in average. The scars at the donor sites were hidden and the wrist function was not affected. According to the Trial Evaluation Standard of Upper Limb Function of Hand Surgery Society of Chinese Medical Association, 16 patients were classified as excellent and 4 as good.Conclusion:The striated transverse wrist flap with radial artery palmar superficial branch and sensory nerve offers many advantages, such as a good texture, hidden donor site, convenient flap harvesting, good recovery of sensation, etc. More clinical studies and the promotion of the technique are expected.

Objective:To explore the protective factors of psychological resilience in patients with inflammatory bowel disease (IBD) , so as to provide a basis for improving the psychological resilience of patients.Methods:From December 2020 to March 2021, 16 IBD patients in the Department of Gastroenterology of Peking Union Medical College Hospital were selected as the research object by purpose sampling, and the semi-structured in-depth interview was conducted with them. The interview data was organized and analyzed using the directed content analysis method.Results:A total of 3 themes and 10 sub-themes were extracted, including internal characteristics of individuals, social support network, environmental perception and active transformation. Among them, the internal characteristics of individuals included calm acceptance of the disease, positive disease cognition, appropriate emotion regulation, and clear goal motivation. Social support network consisted of solid family support, professional medical care, stable relationships, normal work status. Environmental perception and active transformation comprised selective perception of the environment and active behavioral coping.Conclusions:Medical and nursing staff should cooperate with the patient's family, friends and other parties to implement cognitive intervention, perfect the support system, and promote positive behaviors, thereby improving the patients' psychological resilience.

Objective:We investigated the incidence of surgical site infection (SSI) following emergency abdominal surgery (EAS) in China and further explored its risk factors, providing a reference for preventing and controlling SSI after EAS.Methods:This was an observational study. Data of patients who had undergone EAS and been enrolled in the Chinese SSI Surveillance Program during 2018–2021were retrospectively analyzed. All included patients had been followed up for 30 days after surgery. The analyzed data consisted of relevant patient characteristics and perioperative clinical data, including preoperative hemoglobin, albumin, and blood glucose concentrations, American Society of Anesthesiologists (ASA) score, grade of surgical incision, intestinal preparation, skin preparation, location of surgical site, approach, and duration. The primary outcome was the incidence of SSI occurring within 30 days following EAS. SSI was defined as both superficial and deep incisional infections and organ/space infections, diagnoses being supported by results of microbiological culture of secretions and pus. Secondary outcomes included 30-day postoperative mortality rates, length of stay in the intensive care unit (ICU), duration of postoperative hospitalization, and associated costs. The patients were classified into two groups, SSI and non-SSI, based on whether an infection had been diagnosed. Univariate and multivariate logistic regression analyses were performed to identify risk factors associated with SSI following EAS.Results:The study cohort comprised 5491 patients who had undergone EAS, comprising 3169 male and 2322 female patients. SSIs were diagnosed in 168 (3.1%) patients after EAS (SSI group); thus, the non-SSI group consisted of 5323 patients. The SSIs comprised superficial incision infections in 69 (41.1%), deep incision infections in 51 (30.4%), and organ or space infections in 48 (28.6%). Cultures of secretions and pus were positive in 115 (68.5%) cases. The most frequently detected organism was Escherichia coli (47/115; 40.9%). There were no significant differences in sex or body mass index between the SSI and non-SSI groups (both P>0.05). However, the proportion of individuals aged 60 years or older was significantly greater in the SSI than in the non-SSI group (49.4% [83/168] vs. 27.5% [1464/5323), χ 2=38.604, P<0.001). Compared with the non-SSI group, the SSI group had greater proportions of patients with diabetes (11.9% [20/168] vs. 4.8% [258/5323], χ 2=16.878, P<0.001), hypertension (25.6% [43/168] vs. 12.2% [649/5323], χ 2=26.562, P<0.001); hemoglobin <110 g/L (27.4% [46/168] vs. 13.1% [697/5323], χ 2=28.411, P<0.001), and albuminemia <30 g/L (24.4% [41/168] vs. 5.9% [316/5323], χ 2=91.352, P<0.001), and a reduced rate of preoperative skin preparation (66.7% [112/168] vs. 75.9% [4039/5323], χ 2=7.491, P=0.006). Furthermore, fewer patients in the SSI group had preoperative ASA scores of between one and two (56.0% [94/168] vs. 88.7% [4724/5323], χ 2=162.869, P<0.001) in the non-SSI group. The incidences of contaminated and infected incisions were greater in the SSI group (63.1% [106/168] vs. 38.6% [2056/5323], χ 2=40.854, P<0.001). There was a significant difference in surgical site distribution between the SSI and non-SSI groups (small intestine 29.8% [50/168] vs. 10.6% [565/5323], colorectal 26.2% [44/168] vs. 5.6% [298/5 323], and appendix 24.4% [41/168] vs. 65.1% [3465/5323]) χ 2=167.897, P<0.001), respectively. There was a significantly lower proportion of laparoscope or robotic surgery in the non-SSI group (24.4 % [41/168] vs. 74.2% [3949/5323], χ 2=203.199, P<0.001); the percentage of operations of duration less than 2 hours was significantly lower in the SSI than non-SSI group (35.7% [60/168] vs. 77.4% [4119/5323], χ 2=155.487, P<0.001). As to clinical outcomes, there was a higher 30-day postoperative mortality rate (3.0%[5/168] vs. 0.2%[10/5323], χ 2=36.807, P<0.001) and higher postoperative ICU occupancy rate (41.7% [70/168] vs. 19.7% [1046/5323], χ 2=48.748, P<0.001) in the SSI group. The median length of stay in the ICU (0[2] vs. 0[0] days, U=328597.000, P<0.001), median total length of stay after surgery (16[13] vs. 6[5] days, U=128146.000, P<0.001), and median hospitalization cost (ten thousand yuan, 4.7[4.4] vs. 1.7[1.8], U=175965.000, P<0.001) were all significantly greater in the SSI group. Multivariate logistic regression analysis revealed that the absence of skin preparation before surgery (OR=2.435,95%CI: 1.690–3.508, P<0.001), preoperative albuminemia <30 g/L (OR=1.680, 95%CI: 1.081–2.610, P=0.021), contaminated or infected incisions (OR=3.031, 95%CI: 2.151–4.271, P<0.001), and laparotomy (OR=3.436, 95% CI: 2.123–5.564, P<0.001) were independent risk factors of SSI. Operative duration less than 2 hours (OR=0.465, 95%CI: 0.312–0.695, P<0.001) and ASA score of 1–2 (OR=0.416, 95% CI: 0.289–0.601, P<0.001) were identified as independent protective factors for SSI. Conclusions:It is important to consider the nutritional status in the perioperative period of patients undergoing EAS. Preoperative skin preparation should be conducted and, whenever possible, laparoscope or robot-assisted surgery. Duration of surgery should be as short as possible while maintaining surgery quality and improving patient care.