Objective To evaluate the effect of nitrous oxide-inhale combined with lidocaine-injection by Ciliao and Uterine points and single therapy in labor analgesia,and the impact on maternal and child.Methods 400 cases were randomly divided into four groups.Observation group:100 cases take the therapy of Nitrous oxide-inhale combined with lidocaine-injection in Ciliao and Uterine points in the time of active period.Control group 1:100 cases take the therapy of gas mixture-inhale( 50％ Nitrous oxide and 50％ Oxygen) in the time of active period.Control group 2:100 cases take the therapy of lidocaine-injection in Ciliao and Uterine points in the time of active period.Control group 3:100 cases do not take any analgesia.Analgesic effects,labor time,mode of delivery,neonatal conditions,the amount of bleeding in every group were observed.Results There was statistically significant differences between the observation group with the control group 1,2,3 on analgesic effects ( x2 =48.513,P ＜ 0.05 ) labor time( F =782.88,1120.81,1104.57,all P ＜ 0.05 ),mode of delivery ( x2 =85.715,P ＜ 0.05 ),neonatal conditions,the amount of bleeding( F =422.66,P ＜ 0.05 ).Conclusion Combination therapy was more effective than the single treatment.

Epidermal growth factor receptor (EGFR) gene is one of the most common driving genes in non-small cell lung cancer patients, and immune checkpoint inhibitors (ICIs) have been controversial in the clinical application of non-small cell lung cancer with EGFR mutant. The expression abundance of programmed death ligand 1 (PD-L1) is an important predictor to guide the application of ICIs, and EGFR mutations may affect PD-L1 expression in tumor cells. Recent clinical studies have pointed out that the single drug of ICIs is not effective in patients with EGFR mutation, however, the combination of ICIs combined with chemotherapy and the four drugs proposed in the IMpower150 trial show good clinical benefits. In addition, the safety of ICIs and epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) combination model needs to be further clarified.

With the progress of comprehensive treatment of breast cancer, the surgical treatment of axillary lymph nodes presents a degraded treatment mode under the guidance of evidence-based medicine. The indications and contraindications of sentinel lymph node biopsy for early breast cancer have been very clear, but there are still many specific problems in clinical practice that surgeons are concerned about. This article discusses the recently published research on sentinel lymph node biopsy in order to draw the attention of surgical colleagues to the new hot issues of sentinel lymph node biopsy in early breast cancer, and promote standardized surgery and the promotion of new treatment concepts.

Objective:To explore the risk factors associated with tibia fractures in children with congenital anterolateral bowing of the tibia (ALBT).Methods:A retrospective analysis was conducted on data from 87 children diagnosed with ALBT at the Children's Hospital of Hunan Province from January 2012 to January 2020. The collected data included age at initial diagnosis, affected limb side, whether there was a concomitant type I neurofibromatosis, whether there was a concomitant fibular pseudoarthrosis, whether there was concomitant ankle joint deformity, whether there was bone cystic change in the region of tibial bowing deformity, location of the apex of the bowing deformity, diameter of the tibial bowing deformity on the affected side, diameter on the healthy side in the same plane as the tibial bowing deformity, angle of lateral bending deformity of the tibia, angle of anterior bending deformity of the tibia, occurrence of tibia fracture, history of trauma before fracture, location of fracture, and age at the time of fracture. The follow-up endpoint was January 2023. Receiver operating characteristic (ROC) curves were used to determine the optimal cutoff values for the angles of lateral and anterior bending deformity of the tibia and the ratio of cross-sectional areas. The correlation between the above factors and tibial fractures in children was analyzed by single factor survival analysis, and the indicators with statistical significance were included in multivariate Cox proportional risk regression analysis to determine the risk factors for tibial fractures in children with ALBT.Results:Of the 87 children diagnosed with ALBT, the median age at initial diagnosis was 14.0 months (range, 1-93 months), with 42 males and 45 females, 44 left-sided and 43 right-sided cases. The median follow-up time for non-fracture cases was 42.0 months (range, 1-124 months). At the last follow-up, 43 children had experienced fractures, while 44 had not. The average time to fracture-free survival was 70.3 months, the median fracture-free survival time was 55.0 months, and the median survival time without fractures was 42.0 months. The ROC curve results indicated a cutoff value of 25.55° for the lateral bending angle of the tibia and 32.63° for the anterior bending angle of the tibia, with no statistically significant significance for the cross-sectional area ratio [AUC=0.54, 95% CI (0.42, 0.66), P=0.530]. Single-factor analysis of fracture-free survival suggested that there were statistically significant differences in the intergroup fracture-free survival rates of four factors: lateral bending angle of the tibia (χ 2=7.06, P=0.008), anterior bending angle of the tibia (χ 2=8.96, P=0.003), history of trauma (χ 2=18.26, P<0.001), and tibial bone cystic change (χ 2=4.30, P=0.038). The results of the multivariate Cox proportional hazards regression analysis showed that a lateral bending angle of the tibia≥25.55° ( HR=2.73, P=0.007), tibial bone cystic change ( HR=2.35, P=0.018), and history of trauma ( HR=2.65, P=0.004) were all positively correlated with fractures. Conclusion:The main risk factors for tibia fractures in children with ALBT include trauma, tibial bowing deformity with concomitant bone cystic change, and lateral bending angle of the tibia≥25.55°.

The finite element method(FEM)is a widely employed mathematical technique in mechanical research that divides an object into discrete and interacting finite elements. Medically, finite element analysis(FEA)enables the simulation of biomechanical experiments that are challenging to conduct. Orbital surgery poses significant challenges to ophthalmologists due to its inherent difficulty and steep learning curve. FEM enables the simulation and analysis of the mechanical properties of orbital tissue, offering a novel approach for diagnosing and treating orbital-related diseases. With technological advancements, FEM has significantly matured in the diagnosis and treatment of orbital diseases, becoming a popular area of research in orbital biomechanics. This paper reviewed the latest advancements in orbital FEM, encompassing the development of orbital FEA models, simulation of orbital structure, and its application in orbital-related diseases. Additionally, the limitations of FEM and future research directions are also discussed. As a digital tool for auxiliary diagnosis and treatment, orbital FEA will progressively unlock its potential for diagnosing and treating orbital diseases alongside technological advancements.