Objective To analyze the value of peripheral blood helper T cell 17(Th17)/regulatory T cell(Treg),programmed death receptor-1(PD-1)+CD3+,miR-146a,miR-122 and serum C-reactive protein(CRP)in the diagnosis of postoperative infection of endometrial cancer,and to explore the influencing factors of postoperative infection for endometrial cancer.Methods A total of 289 patients with endometrial cancer who underwent surgery from January 2021 to August 2024 were selected and divided into the infection group(n=53)and the non-infection group(n=236)according to the postoperative infection of the patients.Clinical data of two groups were collected and compared.The levels of Th17,Treg and PD-1+CD3+in peripheral blood of the two groups were detected by flow cytometry,and the ratio of Th17/Treg was calculated.The levels of miR-146a and miR-122 in peripheral blood of the two groups were detected by real-time fluorescence quantitative polymerase chain reaction(RT-qPCR).The serum CRP levels of the two groups were detected by enzyme-linked immunosorbent assay(ELISA),and the influencing factors of postoperative infection in endometrial cancer were analyzed by multivariate Logistic regression.The receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of peripheral blood Th17/Treg,PD-1+CD3+,miR-146a,miR-122 and serum CRP for postoperative infection of endometrial cancer.Results Compared with the non-infection group,the infection group had higher proportions of diabetes,anemia,adjuvant chemoradiotherapy,open abdominal surgery,drainage and catheterization time≥7 d,as well as higher levels of Th17,Th17/Treg,PD-1+CD3+,miR-122,and serum CRP(P<0.01),while the levels of Treg and miR-146a in peripheral blood were lower(P<0.01).Multivariate Logistic regression analysis showed that combined diabetes,anemia,adjuvant chemoradiotherapy,open abdominal surgery,drainage and catheterization time≥7 d,peripheral blood Th17/Treg,PD-1+CD3+,miR-122 and serum CRP levels were all risk factors for postoperative infection of endometrial cancer(P<0.05,P<0.01),while miR-146a in peripheral blood was its protective factor(P<0.05).ROC curve analysis showed that the area under the curve of the combined detection of Th17/Treg,PD-1+CD3+,miR-146a,miR-122 in peripheral blood and serum CRP was higher than that of the individual detection of Th17/Treg,PD-1+CD3+,miR-146a,miR-122 and serum CRP in peripheral blood(P<0.01).Conclusion Postoperative infection of endometrial cancer is closely related to the patients'combined diabetes,anemia,adjuvant chemoradiotherapy,open surgery,and drainage and catheterization time≥7 d.Moreover,Th17/Treg,PD-1+CD3+,miR-122 in peripheral blood and serum CRP are highly expressed in patients with postoperative infection of endometrial cancer,while miR-146a in peripheral blood is expressed at a low level.The combined detection of the five has more advantages in evaluating postoperative infection of endometrial cancer.

Objective To analyze the value of peripheral blood helper T cell 17(Th17)/regulatory T cell(Treg),programmed death receptor-1(PD-1)+CD3+,miR-146a,miR-122 and serum C-reactive protein(CRP)in the diagnosis of postoperative infection of endometrial cancer,and to explore the influencing factors of postoperative infection for endometrial cancer.Methods A total of 289 patients with endometrial cancer who underwent surgery from January 2021 to August 2024 were selected and divided into the infection group(n=53)and the non-infection group(n=236)according to the postoperative infection of the patients.Clinical data of two groups were collected and compared.The levels of Th17,Treg and PD-1+CD3+in peripheral blood of the two groups were detected by flow cytometry,and the ratio of Th17/Treg was calculated.The levels of miR-146a and miR-122 in peripheral blood of the two groups were detected by real-time fluorescence quantitative polymerase chain reaction(RT-qPCR).The serum CRP levels of the two groups were detected by enzyme-linked immunosorbent assay(ELISA),and the influencing factors of postoperative infection in endometrial cancer were analyzed by multivariate Logistic regression.The receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of peripheral blood Th17/Treg,PD-1+CD3+,miR-146a,miR-122 and serum CRP for postoperative infection of endometrial cancer.Results Compared with the non-infection group,the infection group had higher proportions of diabetes,anemia,adjuvant chemoradiotherapy,open abdominal surgery,drainage and catheterization time≥7 d,as well as higher levels of Th17,Th17/Treg,PD-1+CD3+,miR-122,and serum CRP(P<0.01),while the levels of Treg and miR-146a in peripheral blood were lower(P<0.01).Multivariate Logistic regression analysis showed that combined diabetes,anemia,adjuvant chemoradiotherapy,open abdominal surgery,drainage and catheterization time≥7 d,peripheral blood Th17/Treg,PD-1+CD3+,miR-122 and serum CRP levels were all risk factors for postoperative infection of endometrial cancer(P<0.05,P<0.01),while miR-146a in peripheral blood was its protective factor(P<0.05).ROC curve analysis showed that the area under the curve of the combined detection of Th17/Treg,PD-1+CD3+,miR-146a,miR-122 in peripheral blood and serum CRP was higher than that of the individual detection of Th17/Treg,PD-1+CD3+,miR-146a,miR-122 and serum CRP in peripheral blood(P<0.01).Conclusion Postoperative infection of endometrial cancer is closely related to the patients'combined diabetes,anemia,adjuvant chemoradiotherapy,open surgery,and drainage and catheterization time≥7 d.Moreover,Th17/Treg,PD-1+CD3+,miR-122 in peripheral blood and serum CRP are highly expressed in patients with postoperative infection of endometrial cancer,while miR-146a in peripheral blood is expressed at a low level.The combined detection of the five has more advantages in evaluating postoperative infection of endometrial cancer.

Craniovertebral junction malformation is a congenital malformation located in the foramen magnum and upper cervical spine, including bone and nerve malformation, resulting in motor and sensory disorders, cerebellar and lower cranial nerves, etc. The evaluation methods of clinical symptoms and efficacy of craniovertebral junction malformation are important for the surgical indications and effects, mainly including the evaluation of clinical symptoms and the quality of life. At present, the commonly used methods in clinical work and literature are the Japanese orthopaedic association scores, visual analogue scales, 36-item short-form health survey, etc. Most of these clinical evaluations are not aimed at craniovertebral junction diseases but focus on the description of a certain type of clinical symptoms. Chicago Chiari outcome scale and syringomyelia outcome scale of Xuanwu hospital are dedicated to Craniovertebral junction malformation, but more clinical studies are needed to prove their effectiveness. Based on the literature reports, this article reviewed the previous clinical evaluation methods of craniovertebral junction malformation and discusses their applications and limitations.

Craniovertebral junction malformation is a congenital malformation located in the foramen magnum and upper cervical spine, including bone and nerve malformation, resulting in motor and sensory disorders, cerebellar and lower cranial nerves, etc. The evaluation methods of clinical symptoms and efficacy of craniovertebral junction malformation are important for the surgical indications and effects, mainly including the evaluation of clinical symptoms and the quality of life. At present, the commonly used methods in clinical work and literature are the Japanese orthopaedic association scores, visual analogue scales, 36-item short-form health survey, etc. Most of these clinical evaluations are not aimed at craniovertebral junction diseases but focus on the description of a certain type of clinical symptoms. Chicago Chiari outcome scale and syringomyelia outcome scale of Xuanwu hospital are dedicated to Craniovertebral junction malformation, but more clinical studies are needed to prove their effectiveness. Based on the literature reports, this article reviewed the previous clinical evaluation methods of craniovertebral junction malformation and discusses their applications and limitations.

Objective:To analyze the causes of hyperdynamic left ventricular ejection fraction (LVEF) in sepsis patients in the intensive care unit (ICU) and its impact on prognosis.Methods:A retrospective cohort study was conducted. The clinical data of 273 sepsis patients admitted to the department of critical care medicine of the Affiliated People's Hospital of Jiangsu University from January 2018 to October 2021 were collected including gender, age, severity score, comorbidities, source of infection, vital signs, transthoracic echocardiographic (TTE) parameters, fluid intake and output, vasoactive drug dose, therapeutic measures and prognostic indicators. The patients were divided into normal LVEF group (LVEF 0.55-0.70), low LVEF group (LVEF < 0.55) and hyperdynamic LVEF group (LVEF > 0.70) according to the TTE examination results within 7 days of ICU admission. The clinical indicators among the three groups were compared and analyzed, and multivariate Logistic regression analysis was used to screen risk factors for the development of hyperdynamic LVEF in patients with sepsis. Spearman correlation analysis was used to determine the correlation between the mortality of different types of LVEF and clinical variables.Results:Among 273 patients, 20 patients with severe valvular or cardiomyopathy at admission and those who did not completed cardiac ultrasound within 7 days of ICU admission were excluded. A total of 253 patients were finally enrolled, including 169 patients in the normal LVEF group, 40 patients in the low LVEF group, and 44 patients in the hyperdynamic LVEF group. There were statistically significant differences in age, sequential organ failure assessment (SOFA) score, central venous pressure (CVP), heart rate (HR), oxygenation index (PaO 2/FiO 2), blood lactate (Lac), urine output, vasoactive drug dose, ratio of hypertension, ischemic heart disease, chronic liver disease, cancer, invasive mechanical ventilation and renal replacement therapy (RRT), and incidence of septic shock among the different types of LVEF groups. TTE results analysis showed that the hyperdynamic LVEF group had higher stroke volume (SV) and cardiac index (CI) than those in the normal LVEF and low LVEF groups, lower systemic vascular resistance (SVR) than that in the normal LVEF and low LVEF groups, and an increased E/A ratio. The 90-day mortality in the hyperdynamic LVEF group was significantly higher than that in the normal LVEF and low LVEF groups [59.1% (26/44) vs. 24.9% (42/169), 32.5% (13/40), both P < 0.05]. Multivariate Logistic regression analysis showed that chronic liver disease [odds ratio ( OR) = 1.712, 95% confidence interval (95% CI) was 0.912-3.234, P < 0.001], cancer ( OR = 2.784, 95% CI was 1.296-6.151, P < 0.001), HR ( OR = 1.026, 95% CI was 1.014-1.038, P < 0.001), vasoactive drug dose ( OR = 1.133, 95% CI was 1.009-1.291, P < 0.001), and invasive mechanical ventilation ( OR = 2.141, 95% CI was 1.285-3.651, P < 0.001) were independent factors for hyperdynamic LVEF in ICU sepsis patients. Correlation analysis showed that the mortality of hyperdynamic LVEF, normal LVEF and low LVEF patients was positively correlated with vasoactive drug dose ( r value was 0.251, 0.361, 0.289, respectively, all P < 0.001). The mortality of the hyperdynamic LVEF patients was negatively correlated with SVR ( r = -0.545, P < 0.001). Conclusions:Chronic liver disease, cancer, HR, vasoactive drugs dose, and invasive mechanical ventilation are independent risk factors for hyperdynamic LVEF in patients with sepsis. Hyperdynamic LVEF is positively associated with mortality in sepsis patients, which may be due to the the decrease of SVR caused by septic vascular paralysis.

Objective:To investigate the effect of the replantation in situ of donor skin graft with perforation and expansion in small and medium-sized skin transplantation. Methods:Patients were selected as group A with skin and soft tissue defects caused by various reasons treated in the Plastic and Aesthetic Surgery Department of Henan Provincial People’s Hospital from January 2002 to December 2019. A medium thick skin piece was harvested from the donor area with a drum dermatome, covering an area of 200-220 cm 2. The skin piece at the root of the drum dermatome was not broken, but the free skin piece of the drum dermatome was removed to the required area, transplanted to the wound surface, stitched intermittently and dressed with packing heap. The remaining skin graft in the donor area was punctured evenly with No. 15 surgical blade, then covered all the wounds in the donor area, sutured intermittently, and bandaged under pressure. The same kind of patients treated in other medical groups in our department in the same time were selected as group B. The skin donor area was not covered with skin graft in situ, but wrapped with traditional gauze. The patients were followed up in the outpatient department after operation, when the healing of the donor skin area and the degree of local scar was evaluated for data statistical analysis. The scars were scored according to Vancouver Scar Scale. The quantitative data were expressed in M( Q1, Q2), and were analyzed by Mann-Whitney U test. The qualitative data were analyzed by Chi-square test. P< 0.05 was statistically significant. Results:Group A had 63 cases, except for 1 case of graft avulsion, 2 cases of hematoma under the skin with partial survival of skin graft, 1 case of poor survival of infected skin graft after operation, the other skin grafts in the recipient area survived well. Group B included 59 patients, 38 males and 21 females, aged from 4 to 78 years old, with a skin defect area of 40 to 80 cm 2. The patients in both groups were followed up for 7-12 months. The healing time in group A was 11.1(10.2, 12.2) days. There were no skin pigmentation, severe hypertrophic scar and delayed healing of donor area. Four cases had mild scar hyperplasia and no keloid. The score of Vancouver Scar Scale was 3(2, 4). The healing time of group B was 15.8(13.9, 17.5) days with 23 cases of hypertrophic scar and 2 cases of keloid after healing. The score of Vancouver Scar Scale was 17(17, 17). There was significant difference in healing time between group A and group B ( P<0.01); there was significant difference in Vancouver Scar Scale scores between the two groups( P<0.01); what’s more, there was significant difference in the number of cases of hypertrophic scar between the two groups ( P<0.01). Conclusions:Compared with the traditional skin transplantation, the improved technology of the replantation in situ of donor skin graft with perforation and expansion has the advantages of intact skin, uniform thickness, timely blood circulation establishment after transplantation, no wound exposure in the donor area, natural skin color after primary healing, less scar and more in line with the skin function and aesthetic requirements of human body.

Objective:To investigate the effect of the replantation in situ of donor skin graft with perforation and expansion in small and medium-sized skin transplantation. Methods:Patients were selected as group A with skin and soft tissue defects caused by various reasons treated in the Plastic and Aesthetic Surgery Department of Henan Provincial People’s Hospital from January 2002 to December 2019. A medium thick skin piece was harvested from the donor area with a drum dermatome, covering an area of 200-220 cm 2. The skin piece at the root of the drum dermatome was not broken, but the free skin piece of the drum dermatome was removed to the required area, transplanted to the wound surface, stitched intermittently and dressed with packing heap. The remaining skin graft in the donor area was punctured evenly with No. 15 surgical blade, then covered all the wounds in the donor area, sutured intermittently, and bandaged under pressure. The same kind of patients treated in other medical groups in our department in the same time were selected as group B. The skin donor area was not covered with skin graft in situ, but wrapped with traditional gauze. The patients were followed up in the outpatient department after operation, when the healing of the donor skin area and the degree of local scar was evaluated for data statistical analysis. The scars were scored according to Vancouver Scar Scale. The quantitative data were expressed in M( Q1, Q2), and were analyzed by Mann-Whitney U test. The qualitative data were analyzed by Chi-square test. P< 0.05 was statistically significant. Results:Group A had 63 cases, except for 1 case of graft avulsion, 2 cases of hematoma under the skin with partial survival of skin graft, 1 case of poor survival of infected skin graft after operation, the other skin grafts in the recipient area survived well. Group B included 59 patients, 38 males and 21 females, aged from 4 to 78 years old, with a skin defect area of 40 to 80 cm 2. The patients in both groups were followed up for 7-12 months. The healing time in group A was 11.1(10.2, 12.2) days. There were no skin pigmentation, severe hypertrophic scar and delayed healing of donor area. Four cases had mild scar hyperplasia and no keloid. The score of Vancouver Scar Scale was 3(2, 4). The healing time of group B was 15.8(13.9, 17.5) days with 23 cases of hypertrophic scar and 2 cases of keloid after healing. The score of Vancouver Scar Scale was 17(17, 17). There was significant difference in healing time between group A and group B ( P<0.01); there was significant difference in Vancouver Scar Scale scores between the two groups( P<0.01); what’s more, there was significant difference in the number of cases of hypertrophic scar between the two groups ( P<0.01). Conclusions:Compared with the traditional skin transplantation, the improved technology of the replantation in situ of donor skin graft with perforation and expansion has the advantages of intact skin, uniform thickness, timely blood circulation establishment after transplantation, no wound exposure in the donor area, natural skin color after primary healing, less scar and more in line with the skin function and aesthetic requirements of human body.

Objective: To analyze the epidemiological characteristics of acute paraquat(PQ)poisoning in children in southwest Shandong, and the risk factors for pulmonary interstitial fibrosis. Methods: This retrospective study was performed on the clinical data of children with acute PQ poisoning admitted from January 2013 to December 2017 in 12 hospitals in southwest Shandong.All participants were divided into pulmonary interstitial fibrosis group and no pulmonary interstitial fibrosis group on the basis of the chest CT 14 days after poisoning.The epidemiological characteristics and risk factors of pulmonary interstitial fibrosis were analyzed. Results: During the study period, a total of 307 children with acute PQ poisoning were admitted to 12 hospitals, of which 61 (19.87%) were suffering from acute PQ poisoning.Forty-nine cases with complete clinical data were analyzed, including 26 male and 23 female patients poisoned by oral.The age distribution ranged from 8 months to 14 years.Poisoning mainly occured from July to September of each year.The mortality of acute PQ poisoning was 8.2%(4/49), and the incidence of pulmonary interstitial fibrosis in survival patients was 44.4%(20/45). Statistical differences (P<0.05) were found between the pulmonary interstitial fibrosis and no pulmonary interstitial fibrosis, with regard to the times of blood purification, the time from poison exposure to blood purification, the application rate of glucocorticoids, the concentration of PQ in urine, the pediatric critical illness score, the time from poison exposure to gastric lavage, the white blood count at admission, serum creatinine, arterial blood lactate, PaO₂, PaCO₂, and PaO₂/FiO₂; however, there was no significant difference in the proportion of blood purification treatment, the mode of blood purification treatment, alanine aminotransferase, aspartate aminotransferase, urea nitrogen, creatine kinase and troponin.Stepwise logistic regression analysis showed that the time from exposure to poison to gastric lavage(OR=0.683, 95%CI 0.210-2.222)and to blood purification(OR=0.0133, 95%CI 0.004-0.042), the times of blood purification(OR=2.862, 95%CI 1.450-5.648), concentration of PQ in urine(OR=1.435, 95%CI 1.085-1.898), and the use of glucocorticoids(OR=0.190, 95%CI 0.048-0.757) were the risk factors for pulmonary interstitial fibrosis(P<0.05). Conclusion Early gastric lavage and blood purification, increasing the frequence of adminitrating purification appropriately, using low-dose glucocorticoids can reduce the incidence of pulmonary interstitial fibrosis of children with acute PQ poisoning.

Objective:To understand the status of sedation and analgesia treatment and management in pediatric intensive care unit(PICU) in Shandong Province, and to provide the basis for the improvement of sedation and analgesia treatment plan.Methods:This study was a multi-center retrospective study.The PICUs of 6 tertiary hospitals in Shandong Province participated in this study.The data of 1 340 children admitted to these 6 PICUs from January 2016 to December 2018 were collected.The age, gender, the pediatric risk of mortality score Ⅲ at 24 hours after admission, whether they received mechanical ventilation, whether they received sedation and(or) analgesia, whether they were monitored sedation and(or) analgesia, and in-hospital mortality were analyzed.The children were divided into the simple sedation group( n=798), the sedation + analgesia group( n=120) and the non-sedation analgesia group( n=422) according to whether they received sedation and(or) analgesia.The diseases, proportion of mechanical ventilation, incidence of hypotension, average length of stay in PICU and in-hospital mortality were compared among the three groups. Results:The median age of the 1 340 children was (13.3±6.4) months, including 786 males(58.7%). Sedation therapy had been carried out in 6 PICUs, of which 5 PICUs had routine sedation assessment; 4 PICUs had carried out analgesic therapy, of which only 2 had routine pain assessment.A total of 918 children(68.5%)received sedation and(or) analgesia, midazolam was the most commonly used sedative drug, followed by dexmedetomidine, and 526 children(57.3%)were monitored for sedation assessment, the most commonly used assessment method was the Richmond agitation sedation score.One hundred and twenty(9.0%)cases received sedation combined with analgesia, fentanyl was the most commonly used analgesic, and 38 children(31.7%) underwent routine pain assessment.There was no significant difference in age and sex among the three groups.The proportion of surgical diseases and patients received mechanical ventilation(100.0%, 120/120) were the highest in the sedation + analgesia group.The proportion of mechanically ventilated patients was the lowest in the non-sedation analgesia group(11.4%, 48/422). The mean duration of mechanical ventilation in the sedation + analgesia group was slightly shorter than that in the simple sedation group( P>0.05). The incidence of hypotension was highest in the sedation + analgesia group, and lowest in the non-sedation analgesia group[21.7%(26/120) vs.2.1%(9/422), P<0.01]. There was no significant difference in in-hospital mortality and mean PICU stay among three groups. Conclusion:Benzodiazepines are still the main sedative drugs used in PICUs in Shandong Province.In recent years, the usage of dexmedetomidine has gradually increased, but the proportion of analgesic use is very low.At present, analgesic and sedative therapy is mainly used for children after surgery and receiving mechanical ventilation.Although analgesic and sedative therapy does not increase the in-hospital mortality and average length of stay in PICU, it increases the incidence of hypotension.The sedative and analgesic treatment and assessment in the PICU of Shandong Province are still not standardized, mainly reflected in infrequently analgesic treatment and the assessment of sedation and pain, which need to be further improved.

Objective: To investigate clinical characteristics of urodynamics in elderly male patients with indwelling urinary catheterization. Methods: Clinical urodynamics of 497 male patients with indwelling urinary catheterization aged 60 years and over from December 2010 to April 2019 in our center were retrospectively analyzed and divided into 3 groups: 60-69-year-old group(n=114), 70-79-year-old group(n=220), and 80-111-year-old group(n=163). According to the catheter indwelling time, the patients were divided into 3 groups: 1-2 weeks group(n=262), 2-4 weeks group(n=47)and over 4 weeks group(n=188). The cause of indwelling urinary catheterization, bladder outlet obstruction, acontractile detrusor and other indicators were observed. Results: The main cause of indwelling urinary catheterization in elderly men was acute urinary retention(55.1%, 274 cases), in that the most common diagnosis was benign prostatic hyperplasia(90.3%, 449 cases). No statistically significant difference in the different catheter indwelling time-related urodynamics between the different age groups was found(χ²=1.606, 0.199 and 2.477, all P>0.05). There were statistically significant differences both in the incidences of bladder outlet obstruction between the 1-2 weeks vs.2-4 weeks vs.over 4 weeks groups[56.9%(149/262)vs.55.3%(26/47) vs.42.6%(80/188), χ²=9.315, P<0.05)], and in the incidences of acontractile detrusor between the 1-2 weeks vs.2-4 weeks vs.over 4 weeks groups[15.6%(41/262)vs.12.8%(6/47)vs.29.8%(56/188), χ²=15.319, all P<0.05)]. There was no statistically significant difference in catheter indwelling time-related urodynamics between two groups with normal detrusor muscle function and weak detrusor muscle function(P>0.05). Clinical urodynamics had no statistically significant in different age groups(P>0.05). Conclusions Bladder outlet obstruction is the main cause of indwelling urinary catheterization in elderly men.Urodynamic examination can be performed 1-2 weeks after indwelling urinary catheterization.Age has no significant effect on the catheter indwelling time-related urodynamics.The duration of indwelling urinary catheterization has little effect on the urodynamic diagnosis in patients with normal or weak detrusor muscle contractile strength.The elderly patients may have acontractile detrusor if the duration of indwelling urinary catheterization is more than 4 weeks.