0.05), and the all had significant differences in 2 to 4 months post-infection compared with the normal controls (P

Objective: To explore the effect of single-nostril transsphenoidal approach on pituitary adenoma. Methods: We retrospectively analyzed 46 cases of pituitary tumors treated with single-nostril transsphenoidal approach and the effects and complications of surgery.Dunng the surgery,a nasal speculum was inserted through right nostril slowly towards the anterior wall of sphenoid sinus.A nasal mucosa incision of about 1.5cm was made in the right nasal cavity at the level of the middle nasal turbinate.With a fracture of the bony septum,a space was developed between the bilateral nasal mucosa and bony septum to the sphenoid sinus.Then,the face of the sphenoid sinus was exposed.The remainder of the bony septum,the anterior sphenoid sinus wall,and the sphenoid mucosa were removed.The antenor sphenoidotomy should be less than 1.5cm wide.After confirming the tumor by dural puncture,a cross incision of dura was made and the tumor was removed.The saddle was usually Collapsed and visible after total tumor removal.When the tumor was resected,sevaral gelatin sponges were stuffed into the Surgical cavity to stop bleeding. Results: Thirty-four cases had total resection and 12 cases had subtotal resection.No deaths or disability occurred.Hormone levels in almost all patients were improved.Seventeen cases had a sign of diabetes insipidus.Electrolyte disturbance occuwed in 5 cases.NO postoperative cerebrospinal fluid rhinorrhea was observed. Conclusion: Single-nostril transsphenoidal approach has many advantages in treating pituitary adenomas such as simplified approach,brief technology and high security.

Objective To evaluate the effect of dexmedetomidine as a supplementary to combined lumbar plexus-sciatic nerve block for arthroscopic knee surgery.Methods Fifty patients who were scheduled for arthroscopic knee surgery and ASA class Ⅰ or Ⅱ grade,were divided into control group and dexmedetomidine group by random digits table method with 25 cases each.The patients of dexmedetomidine group were given loading dose dexmedetomidine 0.8 μ g/kg(injection time 10 min) by intravenous infusion,then were given maintenance dose 0.4 μμ g/(kg· h) to the end of operation.The patients of control group were given 0.9％ sodium chloride,methods with the dexmedetomidine group.After 10 min,combined lumbar plexus-sciatic nerve block was performed by a nerve stimulator in both groups.Fentanyl 50 μμ g was infused intravenously to the patient whose effect of block was inadequately.The mean arterial pressure (MAP),heart rate (HR),pulse oxygen saturation (SpO2),respiratory frequency at preanesthesia (T0),beginning of dexmedetomidine infusion (T1),beginning of surgery (T2),10 minutes of surgery (T3) and the end of surgery (T4) were recorded,and intraoperative untoward reaction,using of fentanyl and doctor's satisfaction rate were recorded.Results There were no statistical differences in MAP and HR at T0 between the 2 groups (P＞ 0.05).MAP and HR at T2-4 were significantly higher than those at T0 in control group,furthermore MAP and HR at T2-4 in control group were significantly higher than those in dexmedetomidine group [MAP:(137 ± 18) mm Hg(1 mm Hg =0.133 kPa) vs.(107 ± 14) mm Hg,(132 ± 11) mm Hgvs.(107 ± 11) mm Hg,(131±13) mm Hg vs.(95 ± 12) mm Hg;HR:(99 ± 17) times/rmin vs.(88 ± 14) times/min,(99 ± 14) times/min vs.(81 ± 15) times/min,(97 ± 14) times/rmin vs.(76 ± 11) times/min],there were statistical differences (P ＜ 0.05).There were no statistical differences in respiratory frequency and SpO2 between the 2 groups (P ＞0.05),but 2 cases in dexmedetomidine group,5 cases in control group appeared SpO2 ＜0.90,they quickly returned to normal (＞ 0.97) by holding up the submaxilla.The using rate of fentanyl and doctor's satisfaction rate in dexmedetomidine group were significantly better than those in control group [28％(7/25)vs.68％(17/25),100％(25/25) vs.80％(20/25)],there were statistical differences (P＜ 0.05).There were no statistical differences in the using rate of atropine and efedrina,the rate of respiratory depression between the 2 groups (P ＞ 0.05).Conclusion Dexmedetomidine as a supplementary to combined lumbar plexus-sciatic nerve block for arthroscopic knee surgery has effect confirmed,low untoward reaction,high doctor' s satisfaction rate.

Objective Dilated cardiomyopathy (DCM) is generally considered to be accompanied by both left and right ventricular dysfunction,but most studies only analyze the left ventricular function. In this study, we evaluated the effect of arotinolol on right ventricular function in patients with DCM. Methods Right ventricular ejection fraction (RVEF) and right ventricular diameter (RVD) were measured by two-dimensional echocardiography (2-DE) in 33 DCM patients; RVEF measured by first-pass radionuclide angiography (FPRA) was compared with that by 2-DE. Results The treatment with arotinolol for one year resulted in a reduction in the right ventricular diameter (baseline, 23.0 ± 8.3 mm vs after one-year treatment, 20.7 ± 5.4 mm; P=0.004 ) and an associated increase in ejection fraction (baseline, 36.9 ± 10.3% vs after one-year treatment, 45.8 ± 9.6%; P ＜ 0.001 ); there is a high correlation between the 2-DE method and radionuclide ventriculographic method. The correlation coefficient is 0.933 (P＜0.001). Conclusion Arotinolol therapy could not only improve left ventricular function, but also improve right ventricular function in DCM patients.

Objective: To analyze the role of thyroid imaging reporting and data system(TI-RADS), contrast-enhanced ultrasound(CEUS), fine needle aspiration cytology (FNAC) and tumor proliferation related genes in the early diagnosis of thyroid micro-papillary carcinoma(PTMC) and risk assessment of early metastasis. Methods: From May 2018 to May 2019, a total of 140 patients with Thyroid micronodules for surgical resection and pathological diagnosis of benign or malignant into the Seventh People′s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine for the retrospective study.There were 90 cases in benign group and 50 cases in malignant group.The levels of TI-RADS, CEUS enhancement mode, peak intensity (PI) and cyclin D1 (CCND1), cell nuclear Proliferating Antigen (PCNA) and vascular endothelial growth factor (VEGF) were compared between malignant and benign groups, VEGF) mRNA expression level.The positive rate of FNAC, TNM stage, capsule invasion and lymph node metastasis were evaluated. Results: The percentage of class four and more by TI-RADS grade in malignant group was significantly more than benign group((92.0% (46/50) vs.5.6% (5/90), χ²=103.718, P<0.001), more early low enhancement by CEUS(86.0%(43/50) VS.6.7%(6/90), χ²=91.328, P<0.001) and PI value higher than benign group, too((6.79±1.88) VS.(5.32±1.46), t=4.968, P=0.008). The positive rate of FNAC in malignant group was 92.0% (46/50). FNAC was positive in 42 cases of TNM stage, 9 cases of capsule invasion and 6 cases of lymph node metastasis.The pathological positive rate after resection was 50 cases of TNM stage, 10 cases of capsule invasion and 6 cases of lymph node metastasis.The expression of CCND1, PCNA and VEGF mRNA in malignant group was significantly higher than that in benign group((0.5624±0.134) VS.(0.213±0.097), t=15.639, P<0.001; (0.453±0.126) VS.(0.186±0.056), t=20.253, P<0.001; (0.633±0.159) VS.(0.252±0.097), t=31.265, P<0.001). Conclusion Ultrasound-guided FNAC is used to determine TNM staging, capsule invasion and lymph node metastasis, CCND1, PCNA and VEGF expression level, contrast-enhanced mode and peak intensity value measured by quantitative evaluation software have good accuracy for early diagnosis of PTMC, and are consistent with the pathological results of hand surgery.

Objective:To evaluate the frailty status, and to explore its related factors among the community-dwelling elderly people in Beijing, so as to provide scientific basis for taking corresponding measures to delay the frail process of the elderly.Methods:From November 2015 to January 2016, a cross-sectional study was performed among elderly adults of Longtan Community in Dongcheng District, Beijing.Persons aged 60 years and over were selected using a stratified cluster sampling method, and the geriatric frailty-related information was collected through face-to-face household interview.The frailty index(FI)was used to evaluate the frailty status.Multivariate linear regression analysis was used to explore influencing factors on FI value among the elderly.Results:Of the 1 557 interviewees, the median(quartile)value of FI was 0.09(0.08); and women had a higher FI median value than men[0.10(0.08) vs.0.08(0.07)]( Z=5.376, P=0.000). The FI value increased with age( H=329.698, P=0.000). In addition, multivariate linear regression analysis showed that female, older age, disability, being hospitalized in the previous year, being hospitalized during the past 3 years, being unsatisfied to living conditions had relatively higher FI value than the control group( β=0.082, 0.236, 0.336, 0.065, 0.089, 0.193, all P<0.05); and people with high education level, family harmony, a large number of friends who gave support and help, more frequency of participating in organization activities, regular physical examination, and routine exercise had lower FI value than the control group( β=-0.049, -0.052, -0.089, -0.047, -0.045, -0.219, all P<0.05). For FI value, physiological disability was the greatest influencing factor, followed by ageing and not often physical exercise. Conclusions:Similar to foreign studies, the FI method is an effective method to evaluate the frailty status and characteristics among older adults, and is also applicable for the elderly in China.Frailty in elderly people is related not also to intrinsic factors, such as physiology and disease, but also to interventionable factor, such as society, psychology and behavior.Therefore, comprehensive measures should be adopted to delay the process of frailty among the elderly.

Objective:To evaluate the clinical effect of laparoscopic surgery after transformation therapy for patients with stage Ⅳ gastric cancer.Methods:Clinical data of 55 patients with stage Ⅳ gastric cancer underwent transformation therapy at Zhejiang Provincial People′s Hospital from January 2018 to January 2021 were reviewed retrospectively. All patients had distant metastasis and underwent multi-disciplinary treatment (MDT) directed transformation therapy. 21 patients was appraised to have indications of laparoscopic exploration. Of which 18 patients underwent D2 radical laparoscopic gastrectomy, 1 patient underwent gastrojejunostomy and 2 patient underwent laparoscopic biopsy. The remission of patients after conversion therapy and the related intraoperative and postoperative indicators were analyzed.Results:After the transformation therapy, there were 2 cases of complete response (CR), 22 cases of partial response (PR), 14 cases of stable disease (SD) and 17 cases of progressive disease (PD). The objective response rate was 69.09%(38/55). 18 cases finally completed laparoscopic gastric cancer surgery (1 case converted to laparotomy), including total gastrectomy in 10 cases, distal gastrectomy in 8 cases, and R0 resection in 12 cases (R0 resection rate 12/18). In all 18 cases, the surgical time was (223±28)min, the intraoperative blood loss was (100±48)ml, and the number of lymph nodes resected was (28±8). The median postoperative hospital stay was 12(10.25, 19.25)d. After surgery, there were 2 cases of grade Ⅲ complications, 5 cases of grade Ⅱ complications and 1 case of grade Ⅰ complications. There was no perioperative death. The 1-year survival rate was 12/18. The median progression-free survival time was 11 months and the median overall survival time was 19 months.Conclusions:Laparoscopic surgery for stage Ⅳ gastric cancer after transformation therapy is safe and clinical effect is fine.

ObjectiveThis paper aims to analyze the clinical characteristics and medication rationality of liver injury related to Epimedii Folium preparation （EP） and explore the possible risk factors of liver injury， so as to provide a reference for the safe clinical application of Epimedii Folium （EF）. MethodA retrospective analysis was conducted on liver injury cases related to EP from 2012 to 2016. ResultThe number of reported liver injury cases and the proportion of severe cases related to the use of EP show an increasing trend， indicating the objective existence of liver injury caused by EP. There are more cases of liver injury related to EP in women than in men， with an onset age range of 15-91 years old and a median onset age of 60 years old （median onset ages for men and women are 59 and 60 years old， respectively）. The time span from taking EP alone to the occurrence of liver injury is 1-386 days， with a median of 38 days. The time span from taking both EP and Western medicine to the occurrence of liver injury is 1-794 days， with a median of 34 days. EF-related liver injury preparations are mostly composed of traditional Chinese medicines that promote immunity and tonify the liver and kidney， indicating that immune stress in the body may be the mechanism of liver injury caused by the use of EP alone or in combination. There is no increasing trend of toxicity with time or dose in the liver injury caused by EP. By further exploring its risk factors， it is found that patients have unreasonable medication methods such as excessive dosage， repeated use， and multi-drug combination， which may also be one of the important risk factors for EF-related liver injury. ConclusionEP has a certain risk of liver injury and should be emphasized in clinical diagnosis and treatment. Immune stress may be the mechanism of liver injury caused by EP， and in clinical use， it is necessary to be vigilant about the risk of liver injury caused by unreasonable use and combined use with Western medicine.

Objective : To analyze the epidemiological characteristics and pathogen spectrum of hand，foot mouth disease (HFMD) in Anhui province from 2015 to 2022，and to provide scientific evidence for prevention and control measures of HFMD． Methods : The surveillance data of hand，foot and mouth disease in Anhui province from 2015 to 2022 were analyzed by descriptive epidemiology. Real-time PCR was used to detect and classify HFMD samples. Results : A total of 650 590 HFMD cases were reported in Anhui province from 2015 to 2022，including 1 406 se- vere cases and 17 deaths．The annual reported incidence was 131. 45 /100 000．The epidemic features of“low incidence in odd years and high incidence in even years”were presented from 2015 to 2019．The incidence showed a continuous decline from 2020 to 2022．The monthly distribution showed the characteristics of bimodal epidemic，and the main peak was not obvious in 2020．Hefei，Fuyang，Bozhou，Chuzhou and Suzhou ranked the top five cities in terms of cumulative incidence．The age of onset was mainly distributed in children aged 5 years and below，accounting for 89. 26% of the total cases．The male to female ratio was 1. 48 ∶ 1．A total of 28 657 laboratory-confirmed cases had been reported from 2015 to 2022．EV71 cases accounted for 10. 57% ，Cox A16 cases accounted for 24. 90% ，and other enterovirus cases accounted for 64. 53%．The dominant pathogens showed dynamic changes in different years．Since 2018，the proportion of EV71 decreased significantly，and the proportion of other enteroviruses gradually increased to become the dominant pathogens．Among other enteroviruses，Cox A6 strain was dominant (80. 48% ) ． Conclusion This study suggests that the prevention and control of HFMD in Anhui province should be paid more attention from April to July and from October to December．The focus areas are the cities in northern Anhui and Hefei where the floating population is large．The focus of prevention and control is on children aged 5 years and below．Other enteroviruses have become the dominant pathogens of hand-foot-mouth disease in Anhui province，Cox A6 strain is dominant.

Despite growing prevalence and incidence, the management of gout remains suboptimal. The intermittent nature of the gout makes the long-term urate-lowering therapy (ULT) particularly important for gout management. However, patients are reluctant to take medication day after day to manage incurable occasional gout flares, and suffer from possible long-term toxicity. Therefore, a safe and easy-to-operate drug delivery system with simple preparation for the long-term management of gout is very necessary. Here, a chitosan-containing sustained-release microneedle system co-loaded with colchicine and uricase liposomes were fabricated to achieve this goal. This microneedle system was confirmed to successfully deliver the drug to the skin and maintain a one-week drug retention. Furthermore, its powerful therapeutic potency to manage gout was investigated in both acute gouty and chronic gouty models. Besides, the drug co-delivery system could help avoid long-term daily oral colchicine, a drug with a narrow therapeutic index. This system also avoids mass injection of uricase by improving its stability, enhancing the clinical application value of uricase. In general, this two-drug system reduces the dosage of uricase and colchicine and improves the patient's compliance, which has a strong clinical translation.