Objective To observe the effect of limbal incision before and after phacoemulsification corneal astigmatism degree.Methods 46 patients with cataract (76 eyes) were randomly divided into two groups.23 cases (40 eyes) in group A received a temporal clear corneal incision phacoemulsification.23 cases (36 eyes) in group B received the upper clear corneal incision cataract ultrasound breast surgery.Results In group A,preoperative corrected visual acuity was (0.13 ±0.10)D,after 3 months of corrected visual acuity was (0.79 ± 0.13)D.In group B,preoperative corrected visual acuity was (0.14 ± 0.11)D,after 3 months of corrected visual acuity was (0.76 ± 0.15)D,the patients after 3 months corrected visual acuity was significantly improved than before treatment (t =4.127,P ＜0.01),the postoperative visual acuity was not statistically significant(t =0.605,P ＞ 0.05).Two groups postoperative corneal anterior surface,surface astigmatism values were gradually reduced,3 months after operation in group A after corneal anterior surface,surface astigmatism value were (0.45 ± 0.24) D,(0.09 ± 0.06) D ; those in B group were (0.52 ± 0.25) D,(0.09 ± 0.07) D,which were significantly lower than 1 week after operation and postoperation(t =2.232,2.128,all P ＜ 0.05).The remaining time two groups of corneal astigmatism value had no significant difference (P ＞ 0.05).Conclusion Temporal clear corneal incision phacoemulsification recovery of visual acuity is better,and less than the above changes of corneal astigmatism corneal incision operation.

Objective:To explore the correlation between middle cerebral artery (MCA) pulsatility index (PI) and total magnetic resonance imaging (MRI) burden in elderly patients with cerebral small vessel diseases (CSVD).Methods:A total of 203 CSVD inpatients aged 60 years and above who were hospitalized in the Department of Neurology of Hebei General Hospital from March 2017 to December 2020 were enrolled. The clinical data, transcranial Doppler ultrasound parameters and brain MRI data were collected. According to the total burden score, the patients were divided into low burden group (0-1 point) and high burden group (2-4 points). Univariate and multivariate Logistic regression analysis was used to analyze the correlation between MCA PI and total MRI burden in the elderly patients with CSVD. Subsequently, the receiver operating characteristic curve was used to evaluate the value of MCA PI for predicting the high MRI burden of CSVD in the elderly.Results:Hypertension ( OR=2.569, 95% CI 1.068-6.182, P=0.035), systolic blood pressure ( OR=1.033, 95% CI 1.006-1.061, P=0.016), creatinine ( OR=1.044, 95% CI 1.009-1.079, P=0.013) and MCA PI ( OR=1.125, 95% CI 1.087-1.166, P<0.001) were independently correlated with the increasing total MRI burden in the elderly patients with CSVD. Spearman rank correlation analysis revealed that there was strong and positive correlation between MCA PI and high MRI burden in the elderly patients with CSVD ( r=0.65, P<0.001). The analysis showed that when the cut-off for MCA PI was 1.11, it could identify high MRI burden of CSVD in the elderly. The area under the curve was 0.908 (95% CI 0.864-0.953, P<0.001). The sensitivity and specificity were 0.852 and 0.880, respectively. The positive predictive value was 92.38%, and the negative predictive value was 77.70%. Conclusion:The MCA PI is positively correlated with total MRI burden in the elderly patients with CSVD, and has a higher value in predicting the total MRI burden in the elderly CSVD patients, which probably bring brighter prospects for its clinical application.

Objective To evaluate the effects of different target plasma concentrations of propofol on ventricular repolarization in elderly patients.Methods Forty-five patients,aged 65-80 yr,weighing 43-85 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective surgery under general anesthesia,were divided into 3 groups (n=15 each) using a random number table:propofol at target plasma concentration of 2 μg/ml group (group P1),propofol at target plasma concentration of 3 μg/ml group (group P2) and propofol at target plasma concentration of 4 μg/ml group (group P3).Before induction of anesthesia (T1) and at 5 min after propofol reached the target plasma concentration (T2),12-lead electrocardiogram was recorded,the QT and Tp-e intervals were measured,and the corrected QT (QTc) interval and Tp-e/QT ratio were calculated.Results There were no significant differences in QTc interval,Tp-e interval or Tp-e/QT ratio at T1,2 between the three groups (P＞0.05).Compared with those at T1,the QTc and Tp-e intervals were significantly shortened and the Tp-e/QT ratio was decreased at T2 in P1 and P2 groups,and the Tp-e interval was shorten and the Tp-e/QT ratio was decreased at T2 (P＜ 0.05),and no significant change was found in the QTc interval at T2 in group P3 (P＞0.05).Conclusion Propofol at clinically relevant concentrations can shorten the ventricular repolarization in elderly patients.

OBJECTIVETo analyze the characteristics of lymph node metastasis and prognosis in patients with T1 breast cancer.

METHODSThe clinicopathological data of 354 patients with T1 breast cancer after standard treatment from March 2007 to September 2011 were collected to analyze the relationship between the clinical characteristics of T1 breast cancer, lymph node metastasis and prognostic features.

RESULTSIn the 354 patients with T1 breast cancer, 105 patients (29.7%) had lymph node metastasis, among them 73 cases (69.5%) had 1-3 lymph node metastasis, and 32 cases (30.5%) had more than 4 lymph node metastasis. The lymph node metastasis rate was 8.3% in T1a patients, 39.7% in T1b patients, and 30.4% in T1c cases (P = 0.005). Pairwise comparison showed that the difference of lymph node metastasis rate between T1a, T1b and T1c patients was statistically significant (P = 0.001 and P = 0.006, respectively). The difference of lymph node metastasis rates in T1b and T1c patients was statistically insignificant (P = 0.171). In the 354 patients of T1 breast cancer, 92 patients had vascular tumor thrombi and their lymph node metastasis rate was 71.7%, while the lymph node metastasis rate in 262 patients without vascular tumor thrombus was 14.9% (P < 0.001). The median follow-up was 49 months (range 27-81 months). 12 patients developed recurrence, and 3 patients died, one of them died of cerebrovascular accident. The 4-year disease-free survival for all patients was 96.6%, and the 4-year overall survival rate was 99.2%.

CONCLUSIONSThere is a correlation between vascular tumor thrombus, tumor size and lymph node metastasis rate. The lymph node metastasis rate is lower in T1a patients and relatively higher in T1b/c patients. Compared with patients without vascular tumor thrombus, the T1 breast cancer patients with vascular tumor thrombi have a higher lymph node metastasis rate. Generally speaking, there is a still good prognosis in patients with T1 breast cancer.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Breast Neoplasms ; drug therapy ; pathology ; surgery ; Carcinoma, Ductal, Breast ; drug therapy ; pathology ; surgery ; Carcinoma, Lobular ; drug therapy ; pathology ; surgery ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Lymphatic Metastasis ; Mastectomy, Radical ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Neoplastic Cells, Circulating ; Prognosis ; Survival Rate ; Young Adult

Objective:To investigate the value of growth differentiation factor-15 (GDF-15) and extravascular lung water index (EVLWI) in severity grading and prognosis prediction of patients with acute respiratory distress syndrome (ARDS).Methods:Patients with ARDS aged 18-75 years admitted to the department of respiratory intensive care unit (RICU) of Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2019 to February 2020 were enrolled. All patients were treated with conventional therapies such as mechanical ventilation, anti-infection, stabilization of water, electrolytes and acid-base environment, blood purification and nutritional support according to their conditions. Besides, the pulse-indicated continuous cardiac output (PiCCO) was performed after admission to the department, and EVLWI before treatment and at 24, 48 and 72 hours of treatment were recorded. Serum GDF-15 level was measured by enzyme linked immunosorbent assay (ELISA) during the same period. Patients were classified as mild, moderate, and severe degree according to the 2012 Berlin Definition of ARDS, and EVLWI and GDF-15 levels in patients with different disease levels before and after treatment were compared. In addition, the length of intensive care unit (ICU) stay, ICU mortality, and 28-day mortality of patients with different GDF-15 or EVLWI levels were analyzed comparatively, with the GDF-15 3 458 ng/L and EVLWI 15 mL/kg as the cut point.Results:A total of 82 patients with ARDS were enrolled, including 22 patients with mild ARDS, 28 patients with moderate ARDS, and 32 patients with severe ARDS. The GDF-15 and EVLWI levels in patients with moderate and severe ARDS at each time point before and after treatment were higher than those in patients with mild ARDS. Both GDF-15 and EVLWI levels in patients with severe ARDS were higher than those in the patients with moderate ARDS. The differences were statistically significant at all the time points except for the difference of GDF-15 levels at 24 hours after treatment (ng/L: 3 900.41±546.43 vs. 3 695.66±604.73, P > 0.05). [GDF-15 (ng/L): 3 786.11±441.45 vs. 3 106.83±605.09 before treatment, 3 895.48±558.96 vs. 3 333.29±559.66 at 48 hours, 3 397.33±539.56 vs. 3 047.53±499.57 at 72 hours; EVLWI (mL/kg): 19.06±1.91 vs. 14.31±1.50 before treatment, 18.56±2.23 vs. 13.26±1.69 at 24 hours, 17.23±1.76 vs. 12.45±1.36 at 48 hours, 15.47±1.81 vs. 11.13±2.19 at 72 hours, all P < 0.05]. According to the cut-off value, there were 23 patients with GDF-15 ≥ 3 458 ng/L and GDF-15 < 3 458 ng/L respectively and there were 23 patients with EVLWI ≥ 15 mL/kg and EVLWI < 15 mL/kg respectively. The length of ICU stay and 28-day mortality in patients with high GDF-15 were significantly higher than those in patients with low GDF-15 [length of ICU stay (days): 21.22±2.69 vs. 15.37±3.14, 28-day mortality: 56.5% vs. 21.7%, both P < 0.05]. The length of ICU stay and 28-day mortality in patients with high EVLWI were also significantly higher than those in patients with low EVLWI [length of ICU stay (days): 18.45±2.61 vs. 14.98±2.75, 28-day mortality: 47.8% vs. 17.4%, both P < 0.05]. Conclusion:To some extent, GDF-15 and EVLWI levels reflect the severity of patients with ARDS, and high GDF-15 and EVLWI levels are significantly associated with poor prognosis in patients with ARDS.

Objective:To evaluate the efficacy of remimazolam combined with alfentanil for gastroscopy in frail elderly patients.Methods:Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ elderly patients, aged 65-85 yr, with body mass index of 18-30 kg/m 2, of Clinical Frailty Scale score≥5, scheduled for elective painless gastroscopy, were divided into 2 groups ( n=30 each) using a random number table method: remimazolam combined with alfentanil group (group R) and propofol combined with remifentanil group (group P). A combination of alfentanil 10 μg/kg and remimazolam 0.2 mg/kg was intravenously injected until loss of consciousness in group R. Remifentanil 0.5 μg/kg combined with propofol 1.0-2.0 mg/kg was intravenously injected until loss of consciousness in group P. According to the intraoperative conditions, 1/4 of the initial dose of remimazolam was intravenously injected in group R, and 1/4 of the initial dose of propofol was intravenously injected in group P. The time for gastroscopy, requirement for additional remimazolam or propofol, onset time of anesthesia, emergence time and time of post-anesthesia care unit stay were recorded.Physician′s satisfaction scores, patient′s satisfaction scores and Verbal Pain Scale scores were recorded.The occurrence of injection pain, respiratory depression, bradycardia, hypotension and nausea and vomit was recorded. Results:There was no significant difference in the requirement for additional remimazolam or propofol, onset time of anesthesia, time for gastroscopy, physician′s satisfaction scores, and patient′s satisfaction scores, Verbal Pain Scale scores and incidence of nausea and vomit between two groups ( P>0.05). Compared with P group, the emergence time and time of post-anesthesia care unit stay were significantly shortened, and the incidence of injection pain (0 vs.33%), respiratory depression (0 vs.20%), hypotension (3% vs.23%) and bradycardia (3% vs.23%) was decreased in R group ( P<0.05). Conclusions:Remimazolam combined with alfentanil is safe and effective, with rapid recovery from anesthesia, and provides better efficacy than the combination of propofol and remifentanil when used for gastroscopy in frail elderly patients.

Objective:To investigate the features of chest computed tomography (CT) imaging and dynamic changes of severe corona virus disease 2019 (COVID-19).Methods:The clinical and CT data of 17 patients diagnosed with severe COVID-19 admitted to Chongqing Public Health Medical Center from January 24 to February 6, 2020 were collected. The first chest CT manifestations and the dynamic changes of imaging during treatment were retrospectively analyzed.Results:The first chest CT manifestations of the 17 patients showed that 16 cases presented with peripheral and subpleural distributions, and two cases presented with three lobes involved, one case with four lobes involved and 14 cases with five lobes involved, and 17 cases presented with ground-glass opacities, ten cases with consolidation, seven cases with subpleural line, nine cases with air bronchogram, three cases with thickened lobular septum, two cases with bronchiectasis, two cases with pleural effusion, three cases with lymphadenopathy with the short diameter of 1.0-1.2 cm.Among 16 patients who underwent repeated CT examination, the lesions of eight patients showed continuous improvement, and those of the other eight patients showed fluctuating changes.Conclusions:The CT findings of severe COVID-19 patients are mainly ground-glass opacities and consolidation, with the peripheral distribution. The range of lesions is wide, with five-lobe involvement mostly. Lymphadenopathy or pleural effusion is rare. Pynamic monitoring chest CT is useful for the evaluation for the therapeutic effects.

Objective:To evaluate the application of amide proton transfer weighted (APTw) magnetic resonance imaging(MRI) for grading of brainstem glioma (BSG) in children.Methods:Twenty-five children (16 males and 9 females) aged 0.7-12.4(5.6±3.3)years were diagnosed as BSG by surgery or biopsy in Beijing Children′s Hospital from December 2019 to March 2022, including 13 cases of low-grade BSG and 12 cases of high-grade BSG. APTw imaging and conventional MRI were performed on a 3.0 T MRI scanner. The differences in gender distribution, age, conventional MRI appearance, APTw signal intensity and apparent diffusion coefficient (ADC) between children with high and low grade BSG were analyzed. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of APTw signal intensity in the differential diagnosis of high and low grade BSG, and Youden index was calculated to obtain the optimal diagnostic threshold. Pearson′s correlation coefficient analysis was used to evaluate the correlation between APTw signal intensity and Ki-67 expression.Results:There was no significant difference in age and gender distribution between high-grade and low-grade BSG patients. The maximum diameter of high-grade BSG was significantly larger than that of low-grade BSG [(4.7±0.9) vs. (3.1±1.7)cm; t=-2.94, P=0.007]; the maximum signal intensity of APTw (APTw max) in high-grade BSG was significantly higher than that in low-grade BSG [(4.9±0.6)% vs. (3.0±1.2)%; t=-5.14, P<0.001]; the average signal intensity of APTw (APTw mean) in high-grade BSG was significantly higher than that in low-grade BSG[(3.6±0.4%) vs. (2.7±1.1)%; t=-2.66, P=0.014].The area under the curve(AUC)of APTw max in distinguishing high-and low-grade BSG was 0.897; with 4.07% as the optimal diagnostic threshold of APTw max, the sensitivity for the diagnosis of high-grade BSG was 0.917 and specificity was 0.846. The AUC of APTw mean in distinguishing high-and low-grade BSG was 0.769; with 2.85% as the optimal diagnostic threshold of APTw mean, the sensitivity for the diagnosis of high-grade BSG was 0.917 and specificity was 0.692. There was a positive correlation between the value of APTw max and Ki-67 expression( r=0.453, P=0.023). Conclusion:APTw imaging is helpful to distinguish high-grade and low-grade BSG in children. APTw max value can be used to effectively evaluate the proliferative activity of BSG in children.

Objective To validate bioelectrical impedance analysis(BIA) for measuring the area of visceral fat of school-age populations using MRI as a reference method.Methods Sixty healthy children (30 boys and 30 girls) aged 7 to 18 years were enrolled in the study.Both MRI and BIA were completed in seven days.We obtained the indexes of the body composition from BIA and MRI in the morning before the participants had their breakfast.For reference,the navel plane image obtained with MRI was used to analyze the area of adipose tissue.With BIA,the area of visceral adipose tissue could be derived directly.Results Sixty healthy school-age children were enrolled in the study.The average age of the school children was (11.9±4.6) years,and their BMI was (22.8±7.3) kg/m2.The average area of visceral fat obtained with BIA was (85.4±64.2) cm2,which was higher than that obtained with MRI [(49.4±32.4) cm2](t=-6.524,P =0.000).The Pearson correlation coefficient was r=0.806 (P=0.000) and the simple linear regression equation for the areabetween the two was:y=0.41x + 14.78;β (95％CI) was 0.41(0.04-0.81).The Bland-Altman plot was (x-) ±1.96 s:(35.9± 83.7) cm2.Conclusion BIA is comparable to MRI for assessing the area of visceral fat and is a reliable and simple tool to evaluate the visceral fat area in school-age children.

Objective To explore the clinical value of 3D fast spin echo with an extended echo train acquistion (CUBE) T1WI enhancement sequence for purulent meningitis by comparing to contrast?enhanced T2WI?FLAIR sequence in the detection of lesions. Methods From August 2016 to July 2017, children with clinically suspected purulent meningitis underwent cranial magnetic resonance examination in our hospital. There were 35 children, 19 males and 16 females, aged 2 months to 3 years (median age 8 months) in total.A GE Discovery MR 750 3.0 T scanner was used to perform routine plain and enhanced scan in all children. After enhancement, the sequences of CUBE T1WI and FLAIR T2WI were applied randomly. Using the FLAIR T2WI enhancement sequence as the reference, we evaluated the detection rate of CUBE T1WI enhancement sequence for dura mater and leptomeningeal thickening. The number of enhanced lesions detected was tested by χ2 test. Results The enhanced FLAIR T2WI sequence showed 21 cases with dural enhancement, showing a rate of 60.0%. The enhanced CUBE T1WI sequence showed 31cases with dural enhancement, showing a rate of 88.6%. There were significant differences between the dural lesions detected(χ2＝6.058, P<0.01). The enhanced FLAIR T2WI sequence showed 16 cases of leptomeningeal enhancement,showing a rate of 45.7%. The enhanced CUBE T1WI sequence showed 19 cases of leptomeningeal enhancement,showing a rate of 54.3%.The enhanced CUBE T1WI sequence was not significantly higher than that of enhanced T2WI?FLAIR sequence in displaying leptomeningeal enhancement (χ2=0.229, P>0.05). Conclusion Enhancement of the CUBE T1WI sequence enables better visualization of meningeal thickening than FLAIR T2WI. It has great clinical value in the diagnosis of purulent meningitis in children.