ObjectiveTo investigate the safety and feasibility of intra-biliary drainage tube placement after laparoscopic common bile duct exploration in elderly patients with choledocholithiasis， and to provide more options for surgical procedures in the clinical management of elderly patients with choledocholithiasis. MethodsA retrospective analysis was performed for the clinical data of 52 elderly patients with choledocholithiasis who were admitted to Department of Hepatobiliary Surgery， Affiliated Dalian Friendship Hospital of Dalian Medical University， from November 2021 to October 2024. According to the biliary drainage method after surgery， the patients were divided into internal drainage group with 24 patients and T-tube drainage group with 28 patients， and there were 19 patients in each group after propensity score matching. The two groups were compared in terms of perioperative parameters and postoperative complications. The Wilcoxon rank-sum test was used for comparison of continuous data between two groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. ResultsCompared with the T-tube drainage group， the internal drainage group had a significantly shorter length of postoperative hospital stay and a significantly lower volume of postoperative bile loss （Z=-2.845 and -5.633， both P<0.05）， while there were no significant differences between the two groups in time of operation， intraoperative blood loss， and drainage tube indwelling time （all P>0.05）. There were no significant differences between the two groups in postoperative bile leak， stone recurrence， biliary stricture， and drainage tube-related complications， and the internal drainage group had a significantly lower total complication rate than the T-tube drainage group ［1 （5.3%） vs 7 （36.8%）， P<0.05］. ConclusionFor elderly patients with choledocholithiasis， intra-biliary drainage tube placement after laparoscopic common bile duct exploration can shorten the length of postoperative hospital stay， reduce bile loss， and lower the incidence rate of postoperative complications， thereby helping to accelerate postoperative recovery.

Beta-thalassemia major(β-TM)is an inherited disease caused by a defect in the synthesis of globin. The disease requires long-term blood transfusion and iron chelator treatment, which can cause various secondary changes in the body and eye tissues. Compared with normal peers, β-TM patients will show changes in the eye such as steeper corneal curvature, shallower anterior chamber, increased lens thickness, shorter axial length, and reduced tear secretion. At the same time, nutritional deficiencies and the use of iron chelator drugs will increase the risk of complicated cataract and retinal degeneration, thus affecting the quality of life of β-TM patients.This article combines relevant domestic and foreign literatures to explore and review the changes in the eye of β-TM patients, with a view to providing valuable insights for clinical practice.

Objective To explore the difference in efficacy of metoprolol versus ivabradine in the treatment of postural orthostatic tachycardia syndrome(POTS)in the elderly after COVID-19 infection.Methods A total of 110 patients diagnosed with POTS at our department from Decem-ber 1,2022 to January 31,2023 were included.According to their drug regimen,they were divided into metoprolol group(62 patients)and ivabradine group(48 patients).On the 28th day of out-patient follow-up,the resting heart rate,heart rate of 10 min of standing,symptom disappearance rate,hospitalization rate,and mortality rate were compared between the two groups.Results On the 28th day of treatment,the resting heart rate and postural heart rate for 10 min were decreased in both groups when compared with the levels at initial diagnosis(P＜0.01).And there were no significant differences in the two types of heart rate between the two groups on the 28th day(71.0±7.0 vs 72.1±7.0,P=0.401;76.5±7.2 vs 77.4±7.6,P=0.573).No obvious differences were observed between the two groups in symptom disappearance rate,hospitalization rate,or mortality rate(88.7％vs 89.6％,3.2％vs2.1％,0％vs 0％,P＞0.05).Conclusion Metoprolol and ivabradine can effectively treat POTS in the elderly patients after COVID-19 infection.

Objective To investigate the impact of type 2 inflammation markers blood eosinophils(EOS)and fractional exhaled nitric oxide(FeNO)on bronchodilator responsiveness(BDR)in patients with chronic obstructive pulmonary disease(COPD).Methods This study was conducted among 389 patients with an established diagnosis of COPD in our hospital from October,2019 to October,2023,who all underwent bronchial dilation test(BDT)of the large and small airways.Based on smoking history,blood EOS,and FeNO,these patients were divided group A(blood EOS<300/μL+FeNO<35 ppb+smoking history<20 pack-years),group B(blood EOS<300/μL+FeNO<35 ppb+smoking history≥20 pack-years),group C(blood EOS≥300/μL or FeNO≥35 ppb+smoking history≥20 pack-years),and group D(blood EOS≥300/μL or FeNO≥35 ppb+smoking history<20 pack-years)for analyzing the relationship between clinical indexes and BDR.Results BDR evaluation based on forced expiratory volume in 1 second(FEV1),forced vital capacity(FVC),and maximum mid-expiratory flow(MMEF)yielded consistent results,all showing a younger mean age,higher FeNO levels,and higher blood EOS counts and percentages in patients positive for BDT(P<0.05).The improvement value and improvement rate of FEV1 were significantly lower in group A than in group D.The improvement value and improvement rate of FEV1 as well as the improvement rate of MMEF were significantly lower in group B than in group D.In the overall patients,age and FeNO were significantly correlated with the improvement value and improvement rate of FEV1 and the improvement rate of MMEF(P<0.05).Conclusion Type 2 inflammation markers have different effects on BDR in the large and small airways of COPD patients,and their clinical significance needs further investigation.

Objective To investigate the value of serum double M protein analysis and laboratory index detection in predicting the efficacy of bone marrow transplantation in patients with IgA multiple myeloma(IgA-MM).Methods Sixty IgA-MM patients with double M bands admitted to the General Hospital of the Central Theater Command of the Chinese People's Liberation Army from January 2019 to January 2022 were selected as the study objects.The chromatographic data of serum protein electrophoresis and immunofixation electrophoresis(IFE)were compared.Serum with double M protein bands of IgA-MM was treated with 2-dimercaptoethanol(2-DE),and the double M protein bands were identified by IFE.Immunological test indexes of patients with two double M protein types were compared,including immunoglobulin A(IgA),immunoglobulin G(IgG),immunoglobulin M(IgM),serum free light chain(sFLC)and Bene Jone protein(BJP).The conventional experimental indexes of patients with two types of double M protein were compared.The staging and efficacy of multiple myeloma in the international staging system(ISS)were compared between two IgA types of double-M proteinemic myeloma.Kaplan-Meier method and LOG-rank test were used to analyze the survival rate of patients with two types of double M protein.Results IFE showed that monoclonal light chain type and IgA polymeric type were two types of double M protein bands in IGA-MM serum.Monoclonal light chain patients had higher levels of sFLC(2970.14±876.82 mg/L vs 118.68±74.10 mg/L)and BJP(6.22±3.01 g/L vs 0.55±0.12 g/L)than the polymeric type patients(t=21.684,12.659,all P＜0.05).Compared with polymeric type patients,serum β2-MG(β2-microglobulin)(7.88±2.14 mg/L vs 4.65±1.56 mg/L),serum Ca(calcium)(2.64±0.24 mmol/L vs 2.32±0.20 mmol/L)and serum Creatinine(Scr)(182.85±64.23 μmol/L vs 90.52±42.20 μmol/L)of monoclonal light chain patients were increased(t=21.684,12.659,6.400,5.193,6.473),while the levels of Hb(Hemoglobin)(74.32±19.44 g/L vs 90.75±15.52 g/L)and Alb(albumin)(28.42±3.64 g/L vs 31.72±4.96 g/L)of monoclonal light chain patients were decreased(t=3.386,2.428),with significant differences(all P＜0.05).Compared with IgA polymerized type patients,monoclonal light chain type patients had higher ISS stage and lower curative effect(t=11.827,4.519,all P＜0.05).Survival analysis showed that the survival rate of IgA polymerized type was higher than that of monoclonal light chain type(x2=4.482,P＜0.05).Conclusion The two types of IgA-type double-M protein differed in efficacy and prognosis,so identifying the type of IgA-MM double M protein band may be particularly important.

Objective To investigate the impact of type 2 inflammation markers blood eosinophils(EOS)and fractional exhaled nitric oxide(FeNO)on bronchodilator responsiveness(BDR)in patients with chronic obstructive pulmonary disease(COPD).Methods This study was conducted among 389 patients with an established diagnosis of COPD in our hospital from October,2019 to October,2023,who all underwent bronchial dilation test(BDT)of the large and small airways.Based on smoking history,blood EOS,and FeNO,these patients were divided group A(blood EOS<300/μL+FeNO<35 ppb+smoking history<20 pack-years),group B(blood EOS<300/μL+FeNO<35 ppb+smoking history≥20 pack-years),group C(blood EOS≥300/μL or FeNO≥35 ppb+smoking history≥20 pack-years),and group D(blood EOS≥300/μL or FeNO≥35 ppb+smoking history<20 pack-years)for analyzing the relationship between clinical indexes and BDR.Results BDR evaluation based on forced expiratory volume in 1 second(FEV1),forced vital capacity(FVC),and maximum mid-expiratory flow(MMEF)yielded consistent results,all showing a younger mean age,higher FeNO levels,and higher blood EOS counts and percentages in patients positive for BDT(P<0.05).The improvement value and improvement rate of FEV1 were significantly lower in group A than in group D.The improvement value and improvement rate of FEV1 as well as the improvement rate of MMEF were significantly lower in group B than in group D.In the overall patients,age and FeNO were significantly correlated with the improvement value and improvement rate of FEV1 and the improvement rate of MMEF(P<0.05).Conclusion Type 2 inflammation markers have different effects on BDR in the large and small airways of COPD patients,and their clinical significance needs further investigation.

Objective To observe the comfort effect of gene-transfected pig skin in patients with arc burn wound.Methods A total of 56 patients with electric arc burn treated in our hospital from June 2020 to December 2022 were enrolled and then randomly divided into treatment group and control group,with 28 cases in each group.Both groups were treated with debridement,including removing pollutants and necrotic skin,and cleaning the wounds with normal saline.After debridement,the shallow second-degree burn wounds in the control group were covered with silver ion functional antibacterial dressing and wrapped with sterile cotton pad,while those in the treatment group were covered with thawed and softened gene-transfected pig skins.For the deep second-degree burn wounds,after simple debridement,the wounds were treated with scab grinding in 48 h after burn when the condition of the patients was stable.After this,the wounds in the control group and the treatment group were treated as the shallow wounds,respectively.Visual Analogue Scale(VAS),State Anxiety Inventory(SAI)score,treatment process satisfaction,patient comfort and time for wound healing were observed and compared between the 2 groups.Results There was no significant difference in the VAS score and SAI score between the 2 groups at the first dressing change(P＞0.05),but the VAS score and SAI score were obviously lower in the treatment group than the control group at the second and third dressing changes(P＜0.05).The treatment group obtained notably better comfort level and shorter time for wound healing than the control group(P＜0.05).Conclusion Gene-transfected pig skin shows good efficacy in the wound surface of arc burn,which can shorten the wound healing time,reduce the pain of dressing change and improve the satisfaction and comfort of patients.

β thalassemia is a hereditary hemolytic disease caused by the defect of β globin gene. Transfusion-dependent β thalassemia patients need long-term blood transfusion to survive, and a series of systemic and ocular complications will occur in the disease itself and long-term blood transfusion. Retinal blood vessel density decreases, retinal thickness thinned and elastic pseudoxanthoxanoma syndrome are found in fundus due to long-term anemia and side effects of iron chelating agent. At present, there are few reports about eye changes in thalassemia patients, and the cognition is relatively scarce. Therefore, it is necessary to be vigilant for physicians, deeply explore the cause and symptomatic treatment, combined with individual disease characteristics, to provide a more scientific and accurate plan for clinical treatment.

Objective To analyze the influencing factors of ovulation induction therapy in patients with polycystic ovary syndrome (PCOS), and to construct a predictive model for the efficacy of ovulation induction therapy in PCOS patients. Methods A total of 200 infertile PCOS patients suitable for ovulation induction therapy were selected as the study subjects.All patients underwent ovulation induction with letrozole or letrozole combined with urinary gonadotropins. They were divided into effective group (n=160) and ineffective group (n=40) based on the efficacy of ovulation induction. The clinical data of the two groups were retrospectively collected and analyzed. Logistic regression analysis was used to analyze the influencing factors of ovulation induction therapy in PCOS patients, and a nomogram prediction model for the efficacy of ovulation induction was constructed. The predictive performance of the nomogram model for ovulation induction therapy in PCOS patients was evaluated. Results The number of ovulations and mature follicles, proportion of ovulation patients and endometrial thickness in the effective group were significantly higher, and the androgen level in the effective group was significantly lower than that in the ineffective group (P<0.05). Logistic regression analysis showed that androgen level, ovulation count, the number of mature follicles and endometrial thickness were influencing factors for the efficacy of ovulation induction in PCOS patients (OR<1, P<0.05). Receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) values for ovulation count, the number of mature follicles, endometrial thickness and androgen level in assessing the efficacy of ovulation induction therapy in PCOS patients were greater than 0.60. The verification results of the nomogram prediction model showed that the consistency index value of the calibration curve was 0.984. Conclusions Androgen level, ovulation count, the number of mature follicles and endometrial thickness areinfluencing factors for the efficacy of ovulation induction therapy in PCOS patients. The evaluation performance of the nomogram prediction model based on the above factors is good.