Objective  To evaluate the effect of intraoperative multimodal analgesia on the early postoperative quality of recovery in end-stage head and neck cancer patients undergoing open gastrostomy surgery.  Methods  This was a prospective, parallel, randomized controlled study. The research subjects were end-stage head and neck cancer patients who underwent elective open gastrostomy at Beijing Tongren Hospital affiliated to Capital Medical University from November 2022 to May 2023. The patients were randomly divided into local anesthesia group and multimodal analgesia group at a 1∶1 ratio. For local anesthesia group, 0.25% ropivacaine 20-30 mL was administered for local infiltration anesthesia. For multimodal analgesia group, the anesthesia method was nerve block + intravenous analgesia: ultrasound-guided left transverse abdominis plane block (0.25% ropivacaine 0.3 mL/kg)+bilateral rectus abdominis sheath block (0.25% ropivacaine 0.3 mL/kg per side)+intravenous injection of oxycodone 0.1 mg/kg, flurbiprofen 1 mg/kg, and dexamethasone 0.2 mg/kg. The primary outcome measure was the quality of requirements-15 (QoR-15) score at postoperative 24 h, while the secondary outcome measures were the QoR-15 score at postoperative 48 h, the numerical rating scale (NRS) and Bruggemann comfort scale (BCS) scores at different time points after the surgery, the first time of rescue analgesia, the first time of off-bed activity and intestinal exhaust, as well as the incidences of adverse reactions within postoperative 48 h.  Results  A total of 46 patients with end-stage head and neck cancer who underwent open gastrostomy and met the inclusion and exclusion criteria were ultimately enrolled, with 23 patients in multimodal analgesia group and 23 patients in local anesthesia group. There was no statistically significant difference in preoperative QoR-15 scores between the two groups (P > 0.05). Multimodal analgesia group had higher QoR-15 scores at 24 h postoperatively[(81.77±8.91) vs. (71.46±7.61), P < 0.05] and 48 h postoperatively[(86.26±7.92) vs. (80.13±6.98), P < 0.05], and the difference in QoR-15 scores at 24 h postoperatively was clinically significant. Compared with local anesthesia group, at 6 h and 24 h after surgery, the multimodal analgesia group showed a decrease in NRS scores at rest and during exercise, while the comfort BCS score increased (all P < 0.05). Multimodal analgesia group also had a delayed time for the first rescue analgesia, a reduced incidence of rescue analgesia within 48 h after surgery, an earlier time for first postoperative off-bed activity and intestinal exhaust (all P < 0.05). The incidence of adverse reactions in multimodal analgesia group and local anesthesia group was 8.70% and 13.04%, respectively, but the difference was not statistically significant (P > 0.05).  Conclusion  Intraoperative multimodal analgesia can effectively alleviate postoperative pain, increase the comfortable degree, shorten the first time of postoperative off-bed activity and intestinal exhaust, and accordingly improve the quality of early postoperative recovery in patients undergoing open gastrostomy.

This case report described an 80-year-old male patient with Parkinson disease(PD)complicated with myasthenia gravis(MG).Six years ago,the patient was diagnosed with PD based on the motor symptoms including bradykinesia and static tremor and treated with levodopa-benserazide and piribedil sustained-release tablets.He was admitted to the hospital due to left eyelid ptosis one month ago.The result of Neostigmine test was positive and anti-acetylcholine receptor(AChR)antibodies of serum was positive,which met the diagnostic criteria for myasthenia gravis(MG).The symptom of MG improved significantly after treatment with glucocorticoid and pyridostigmine but the PD symptoms worsened.The symptoms of PD were improved after withdrawal of pyridostigmine and use of the levodopa-benserazide and his condition maintained stable at 3 years of follow-up.The PD complicated with MG was fairly rare.We also reviewed the literature on the possible comorbidity mechanism and treatment strategies to improve the comprehensive understanding and ability of diagnosis and treatment of clinicians.

Objective To investigate the efficacy of high-resolution computed tomography (HRCT)imaging radiomics for the classification and diagnosis of rheumatoid arthritis associated interstitial lung disease(RA-ILD).Methods A total of 261 patients diagnosed with RA-ILD admitted in our hospital from January 2019 to July 2023 were recruited in this study.There were 143 cases of usual interstitial pneumonia (UIP )and 118 cases of nonspecific interstitial pneumonia (NSIP).All the patients underwent HRCT.A U-net deep learning lung segmentation model was applied to obtain HRCT images for automatic lung segmentation,and 1688 imaging histologic features were extracted from each lung segmentation. Variance thresholding,univariate feature selection,and least absolute shrinkage and selection operator (LASSO ) were used for feature dimensionality reduction step by step,and various machine learning algorithms were conducted to construct the RA-ILD diagnostic histology model.The diagnostic value of each model was compared using receiver operating characteristic (ROC)curve and area under curve (AUC),and the accuracy,sensitivity and specificity of the models were evaluated.Results Feature screening finally identified 18 best features from the HRCT images of RA-ILD patients.Statistical difference was found in the distribution of Radiomics score (Radscore)between the UIP and NSIP patients in both the training and test sets (P<0.01 ).Among the 5 imaging histology models,the support vector machine (SVM)algorithm had an AUC value of 0.943 (95％CI:0.916～0.966),a sensitivity of 0.787 and a specificity of 0.912,respectively for the training set,and an AUC value of 0.909 (95％CI:0.849～0.969),a sensitivity of 0.625 and a specificity of 0.897,respectively for the testing set.Conclusion Our constructed RA-ILD classification and diagnosis model performs well,and the model based on SVM algorithm shows the best potential in classifying and diagnosing RA-ILD.

Objective To explore the role and mechanism of the exosomes derived from bronchoalveolar lavage fluid(BALF)of patients with chronic obstructive pulmonary disease(COPD-Exo)in regulating osteoblast differentiation.Methods A total of 6 COPD patients and 6 non-COPD patients admitted in our hospital in June 2023 were recruited,and their BALF samples were collected during the process.COPD-Exo and exosomes from the non-COPD patients(Ctrl-Exo)were extracted and identified by electron microscopy and Western blotting.Alizarin red staining and qRT-PCR were used to detect the differences in osteoblast differentiation after COPD-Exo and Ctrl-Exo intervention.Bioinformatics analysis was performed on the microRNA(miRNA)expression profiles of COPD-Exo and Ctrl-Exo in the GEO database(GSE218571)to obtain differentially expressed miRNAs.Antagomir was used to block mircoRNA function,and the miRNAs with osteogenic differentiation regulatory function were identified.Targetscan software was used to predict the downstream target genes of the miRNAs,and then these miRNAs were verified.Results Exo could be extracted from BALF of both COPD and non-COPD patients.Alizarin red staining and qRT-PCR results showed that COPD-Exo inhibited the osteogenic differentiation of human hFOB 1.19 osteoblasts(P＜0.05).Bioinformatics analysis indicated that the expression level of miR-223-3p was significantly up-regulated in COPD-Exo.Blocking miR-223-3p with Antagomir could alleviate the osteogenic differentiation of human hFOB 1.19 osteoblasts inhibited by COPD-Exo(P＜0.05).Targetscan prediction revealed that miR-223-3p may target and inhibit the expression of osteogenic differentiation-related factor FOXO3(P＜0.05).Conclusion COPD-Exo can inhibit the osteogenic differentiation of human hFOB 1.19 osteoblasts through miR-223-3p,which may be related to the inhibition of FOXO3 expression by miR-223-3p.

Objective: To explore the current status related to behavioral problems among children and adolescents aged 12-16 years old in Guizhou Province, China, and to provide a reference for timely prevention and intervention measures. Methods: To capture different economic development levels, a multistage stratified cluster sampling method was used. A total of 3 217 children and adolescents aged 12-16 years old from six middle schools and six primary schools in Guiyang, Duyun, Kaili City from Guizhou Province participated in this study. The Achenbach Child Behavior Checklist (CBCL) and a self designed questionnaire were administered between August and December 2021. Results: The overall detection rate of behavioral problems among the students was 16.60% , and the rate was 14.41% and 18.62% among male and female students, respectively. The results of the Logistic regression analysis showed that good peer relationships ( OR=0.25, 0.16, P <0.05) were associated with a lower risk of behavioral problems in children and adolescents. However, the following factors were associated with an elevated risk of behavioral problems: nonparents as the main caregivers( OR = 1.44 ); children s daily screen time was 1-2 h ( OR =1.47) or more than 2 h( OR =2.75); children who had no sports hobbies( OR = 1.36); father parenting for doting or neglect( OR =1.85, 2.01); maternal parenting for doting( OR = 2.12 ); father had bad life habits( OR =1.69); father and mother were occasionally sick( OR =1.30, 1.38)( P <0.05). Conclusion Behavioral problems among children and adolescents in Guizhou Province is related to children s unhealthy living habits and various factors in the family environment. It is suggested that families, schools and relevant functional departments give full play to their own advantages and take comprehensive measures to prevent the occurrence of behavioral problems among children and adolescents.

Humans ; Heparin/therapeutic use* ; Extracorporeal Membrane Oxygenation ; Respiratory System ; Respiratory Insufficiency

Objective:To evaluate the clinical efficacy and safety of compound acid combined with Chinese medicinal liniment pourmask in the treatment of pigmentation after acne.Methods:From October 2020 to October 2021, the Department of Dermatology, the First Affiliated Hospital of Anhui College of Traditional Chinese Medicine divided 96 patients with pigmentation after acne inflammation, 34 males, 62 females, aged 18-53 (27.4±7.3) years, into a joint group (compound acid combined with Chinese medicinal liniment pourmask, n=32), compound acid group ( n=32) and Chinese medicinal liniment pourmask group ( n=32). Compound acid was used once every 2 weeks, Chinese medicinal liniment pourmask twice a week, a total of 8 weeks. The clinical efficacy of 2 weeks and 4 weeks after treatment was different from that before treatment ( P<0.05). The pigmentation degree score and the total efficacy of each group were assessed at 2 weeks and 4 weeks after the end of treatment. The occurrence of adverse reactions in each group during the treatment cycle was also recorded. Results:After 2 weeks and 4 weeks of follow-up after the course of treatment, the pigmentation score of the three groups of patients decreased, and the difference was statistically significant ( P<0.05). The total effective rates of the combined group were 68.75% (22/32) and 96.88% (31/32) at 2 and 4 weeks after treatment respectively, both were higher than that of the compound acid group and Chinese medicinal liniment pourmask group ( P<0.05). There was no significant difference in total effective rate between compound acid group and Chinese medicinal liniment pourmask group ( P>0.05). Conclusions:The efficacy of compound acid combined with Chinese medicinal liniment pourmask group in the treatment of pigmentation after acne is remarkable and the safety is good, and therefore it is worth promoting.

Diabetes mellitus is a metabolic disease characterized by hyperglycemia. It is found that the incidence and mortality of abdominal aortic aneurysm (AAA) in diabetes mellitus patients are lower than that in non-diabetes mellitus patients. This review will present the protective role of diabetes mellitus and its treatment on the aortic disease process, aiming to provide more support for the clinical treatment of AAA.

The incidence and mortality of lung cancer rank first among all malignant tumors in China. With the popularization of high resolution computed tomography (CT) in clinic, chest CT has become an important means of clinical screening for early lung cancer and reducing the mortality of lung cancer. Imaging findings of early lung adenocarcinoma often show partial solid nodules with ground glass components. With the development of imaging, the relationship between the imaging features of some solid nodules and their prognosis has attracted more and more attention. At the same time, with the development of 3D-reconstruction technology, clinicians can improve the accuracy of diagnosis and treatment of such nodules.This article focuses on the traditional imaging analysis of partial solid nodules and the imaging analysis based on 3D reconstruction, and systematically expounds the advantages and disadvantages of both.
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Adenocarcinoma of Lung/pathology* ; Humans ; Image Processing, Computer-Assisted ; Lung Neoplasms/pathology* ; Solitary Pulmonary Nodule/pathology* ; Tomography, X-Ray Computed

BACKGROUND: At present, the research progress of targeted therapy for epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) gene mutations in lung adenocarcinoma is very rapid, which brings new hope for the treatment of advanced lung adenocarcinoma patients. However, the specific imaging and pathological features of EGFR and ALK gene mutations in adenocarcinoma are still controversial. This study will further explore the correlation between EGFR, ALK gene mutations and imaging and pathological features in invasive lung adenocarcinoma. METHODS: A total of 525 patients with lung adenocarcinoma who underwent surgery in our center from January 2018 to December 2019 were included. According to the results of postoperative gene detection, the patients were divided into EGFR gene mutation group, ALK gene mutation group and wild group, and the EGFR gene mutation group was divided into exon 19 and exon 21 subtypes. The pathological features of the mutation group and wild group, such as histological subtype, lymph node metastasis, visceral pleural invasion (VPI) and imaging features such as tumor diameter, consolidation tumor ratio (CTR), lobulation sign, spiculation sign, pleural retraction sign, air bronchus sign and vacuole sign were analyzed by univariate analysis and multivariate Logistic regression analysis to explore whether the gene mutation group had specific manifestations. RESULTS: EGFR gene mutation group was common in women (OR=2.041, P=0.001), with more pleural traction sign (OR=1.506, P=0.042), and had little correlation with lymph node metastasis and VPI (P>0.05). Among them, exon 21 subtype was more common in older (OR=1.022, P=0.036), women (OR=2.010, P=0.007), and was associated with larger tumor diameter (OR=1.360, P=0.039) and pleural traction sign (OR=1.754, P=0.029). Exon 19 subtype was common in women (OR=2.230, P=0.009), with a high proportion of solid components (OR=1.589, P=0.047) and more lobulation sign (OR=2.762, P=0.026). ALK gene mutations were likely to occur in younger patients (OR=2.950, P=0.045), with somking history (OR=1.070, P=0.002), and there were more micropapillary components (OR=4.184, P=0.019) and VPI (OR=2.986, P=0.034) in pathology. CONCLUSIONS The EGFR and ALK genes mutated adenocarcinomas have specific imaging and clinicopathological features, and the mutations in exon 19 or exon 21 subtype have different imaging features, which is of great significance in guiding the clinical diagnosis and treatment of pulmonary nodules.
Adenocarcinoma of Lung/genetics* ; Aged ; Anaplastic Lymphoma Kinase/genetics* ; ErbB Receptors/genetics* ; Female ; Genes, erbB-1 ; Humans ; Lung Neoplasms/pathology* ; Mutation ; Tomography, X-Ray Computed/methods*