Objective:To explore the clinical manifestations of IgG4-related diseases（IgG4-RD） complicated with moderately differentiated adenosquamous carcinoma of the parotid gland, the diagnostic criteria for IgG4-related diseases and parotid malignant tumors, treatment regimens, and the application of fine-needle aspiration in disease diagnosis, so as to reduce clinical misdiagnosis and missed diagnosis. Methods:A retrospective analysis was conducted on the case data of a patient with IgG4-related diseases（IgG4-RD） complicated with moderately differentiated adenosquamous carcinoma of the parotid gland admitted to our department in March 2024. The clinical characteristics, imaging findings, preoperative puncture results, and postoperative pathological features were analyzed, and relevant literatures on both diseases were reviewed and summarized. Results:The elderly male patient was admitted due to "a mass in the parotid area in front of the right ear for more than 3 months". Through clinical examination, imaging examination, laboratory examination, and preoperative needle biopsy, the diagnosis of "right parotid moderately differentiated adenosquamous carcinoma complicated with IgG4-related disease" was considered. It was also considered that IgG4-related disease did not involve other organs before surgery, so no systemic hormone therapy was given before or after surgery. After surgery combined with postoperative radiotherapy, follow-up showed that neither the parotid tumor nor IgG4-related disease recurred. Conclusion:"IgG4-related disease complicated with moderately differentiated adenosquamous carcinoma"is a rare clinical disease. Both lack typical clinical manifestations and specific imaging features, and the diagnosis is mostly unclear before surgery. Pathological examination is of great significance in the diagnosis of the disease, while fine-needle aspiration has limited value in the diagnosis, which should attract the attention of clinicians. In addition, for patients with both diseases, individualized treatment plans should be formulated.
Humans ; Parotid Neoplasms/pathology* ; Male ; Carcinoma, Adenosquamous/pathology* ; Immunoglobulin G4-Related Disease/complications* ; Parotid Gland/pathology* ; Retrospective Studies ; Aged ; Biopsy, Fine-Needle ; Immunoglobulin G

Objective:To investigate the analgesic effect of nalbuphine combined with sufentanil on elderly patients with colorectal cancer after laparoscopic surgery.Methods:From January 2017 to December 2019, 106 elderly patients with colorectal cancer underwent laparoscopic surgery in Jiangshan People's Hospital were divided into observation group (53 cases) and control group (53 cases) according to the random digital table method.The control group was given sufentanil analgesia, and the observation group was given nalbuphine analgesia on the basis of the control group.The recovery time and catheter extubation time, pain visual analogue score (VAS) scores at 3, 12 and 24 hours after operation, changes of stress response before and 24h after operation, and adverse reactions were compared between the two groups.Results:The recovery time [(9.87±1.42)min] and catheter extubation time [(13.24±3.51)min] in the observation group were shorter than those in the control group [(17.34±2.98)min and (21.83±5.62)min] ( t=16.474, 9.438, all P<0.05). The postoperative 12h VAS score[(1.63±0.19)points] and 24h VAS score[(1.06±0.13)points] in the observation group were lower than those in the control group [(2.37±0.27)points and (1.83±0.32)points] ( t=16.318, 16.230, all P<0.05). The serum levels of Cor [(234.18±19.98)μg/L] and NE [(1.59±0.21)mmol/L] in the observation group were lower than those in the control group [(287.24±14.26)μg/L and (1.97±0.16)mmol/L] ( t=15.737, 10.479, all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups ( P>0.05). Conclusion:Nalbuphine combined with sufentanil has good analgesic effect on elderly patients with colorectal cancer after laparoscopic surgery, and can reduce the postoperative stress response.

Objective In view of the controversy over radiotherapy target volume for patients with limited-stage small cell lung cancer ( SCLC), a prospective randomized controlled trial was conducted to compare the impact of different radiotherapy target volumes on prognosis. Methods After 2 cycles of EP chemotherapy,patients without progressive disease were randomly assigned to receive thoracic radiotherapy (TRT) to either the post-or pre-chemotherapy primary tumour extent as study arm or control. Involved field radiotherapy (IFRT) to the entire metastatic lymph node regions was applied for both arms. TRT consisted of 45 Gy/30Fx/19 d administered concurrently with cycle 3 chemotherapy. Prophylactic cranial irradiation was administered to patients achieved complete or partial remission. Kaplan-Meier method was used for survival analysis. Results Between June 2002 and December 2017,159 and 150 patients were randomly assigned to study arm and control respectively. The 1-,2-,and 5-year local/regional control rates were 79. 4%,61. 5% and 60. 1% respectively in the study arm versus 79. 8%,66. 5%,and 57. 3% in the control arm (P=0. 73). The median OS time was 22. 1 months in the study arm (95%CI,18. 2-26. 0 months) and 26. 9 months (95%CI,23. 5-30. 3 months) in the control arm,the 1-,3-,5-,and 7-year OS rates were 81. 1%,31. 6%, 23. 9% and 22. 2% respectively in the study arm versus 85. 3%,36. 6%,26. 1% and 20. 0% in the control arm (P=0. 51).Grade 2-3 acute esophagitis was developed in 32. 9% and 43. 2% of patients respectively in study arm and control arm (P=0. 01),while grade 2-3 pulmonary fibrosis was observed in 2. 0% and 10. 9% of patients ( P= 0. 01 ) respectively. Conclusions For patients with limited-stage SCLC who received induction chemotherapy,thoracic radiotherapy can be limited to post-chemotherapy tumour extent and IFRT can be routinely applied.

Objective To evaluate the application value of different MR sequences in cerebral developmental venous anomalies (DAVs),and to explore the relationship between DVAs and its associated lesions.Methods MRI findings in 38 patients of DAVs were analyzed retrospectively.Imaging performance and characteristics of DAVs and its associated lesions in different MR sequences were analyzed.Results In all of the 38 cases,3 cases were multiple DVAs without associated lesions,1 case was combined right lateral ventricle hemorhage,1 case was combined with multiple cavernous hemangioma,8 cases were single DVAs with solitary cavernous hemangioma,5 cases were combined with astrocytoma,1 case was combined with intracranial hematoma,and 19 cases were single DVAs with no comorbidity.DVAs in 16 cases showed strip or small patchy hypo-intensity lesions and 15 cases were not visible on T1WI;16 cases showed strip or small patchy hypo-intensity,5 cases showed strip or flocculent hypo-intensity and 10 cases could not seen on T2WI;19 cases showed patchy or strip hypo-intensity and 8 cases showed iso intensive signal on DWI;8 of the 10 cases who performed susceptibility weighted imaging (SWI) examination showed dendritic low signal,showing a typical caput medusae sign,2 cases showed no lesions on SWI;30 cases underwent 3D-T1WI enhanced scan showed clearly all lesions of DAVs,19 cases of them showed typical caput medusae sign and large draining veins.Conclusion Routine MR sequence can demonstrate part of the DVAs and associated peripheral lesions,DWI showed lesions of DAVs is superior to routine MR sequence,SWI and enhanced 3D-T1WI can accurately diagnose DVAs and show the venous drainage.

Objective To investigate the value of glycated hemoglobin(HbA1c)and urine trace albumin (u -ALB)content in early diagnosis of type 2 diabetic nephropathy.Methods 200 patients with type 2 diabetes were selected as diabetes group,and 30 cases of healthy people as control group.According to the content of HbA1c, the diabetes patients were re -divided into low group (HbA1c <7%),the median group(7.1%≤HbA1c≤10%) and high value group (HbA1c >10.1%).The levels of HbA1c and u -ALB were detected and the correlation between them was calculated.Results The values of HbA1c (8.85 ±1.22)% and u -ALB (88.3 ±12.4)mg/L in the diabetes group were significantly higher than those of the control group (t =10.88,54.25,all P <0.05);The level of HbA1c in the high,medium and low group[(11.02 ±1.37)%,(8.45 ±2.01)%,(6.88 ±1.23)%]were consistent with the levels of the respective levels of fasting glucose[(13.22 ±2.05)mmol/L,(9.25 ±1.28)mmol/L, (6.27 ±0.63)mmol/L].HbA1c and constituting the u -ALB levels were positively correlated in the high,medium and low group(r =0.452,0.512,0.452,all P <0.05).Conclusion The combined detection of HbA1c and u -ALB levels has important value for early diagnosis of type 2 diabetic nephropathy.

Objective To investigate the effects of intrathecal different doses of dexmedetomidine hydrochloride in spinal block by ropivacaine hydrochloride . Methods Forty lower limb surgery scheduled for elective under spinal anesthesia, were randomly divided into 2 groups (n = 20 each): the control and the treatment groups.The control and the treatment group were intrathecally injected with 4,12 μg dexmedetomidine hydrochloride respectively.The 0.75% ropivacaine hydrochloride 1.5 mL was injected for spinal anesthesia.SBP,DBP,HR,SpO2 and Ramsay Sedation Score were recorded before the spinal anesthesia conduct and thereafter every five minutes. And the onset and duration of block were recorded,adverse reaction like nausea, vomiting and respiratory depression were also observed. Results Compared with the control group,the onset of sensory block was shorter [(6.9±2.6) min vs (8.7±2.9) min] (P<0.05),and the duration of sensory and motor block was longer in the treatment group[(130.8±30.1) min vs (115.9±23.9) min] (P<0.05) and [(145.9±29.0) min vs (130.0±30.1) min] (P<0.05). Conclusion Intrathecal dexmedetomidine hydrochloride at 12 μg improves anesthesia via shortening the sensory block onset and prolonging sensory and motor block,which maintains hemodynamically stable,and does not generate adverse reactions as nausea,vomiting,bradycardia and respiratory depression.

Objective To investigate the effect of dexmedetomidine on sedation and cognitive function in elderly pa-tients after abdominal operation. Methods From January 2013 to January 2014 in our department,100 cases of abdominal operation were randomly divided into observation group (infusion of dexmedetomidine﹚ and control group (infusion of saline﹚,50 cases in each group, compared two groups of patients before treatment and 10 min after administration, 30 min after administration of Ramsay score changes,changes in the two groups before operation 1 days, 1 days after operation,postoperative 3 days,7 days after operation,MMSE score, the two groups before operation (T0﹚, 5 min after operation(T1﹚,before extubation 15 min T2﹚,extubation 30 min(T3﹚systolic blood pressure (SBP﹚,diastolic blood pres-sure (DBP﹚,heart rate(HR﹚ and oxygen saturation(SpO2﹚changes. Results Patients with 10 min after administration, 30 min Ramsay after administration scores were higher than those in the control group,there was significant difference (P<0.05﹚. The MMSE score of the patients in control group after operation 1 d, postoperative were lower than that of the observation group,there was significant difference (P<0.05﹚. 2 groups of patients with T2 in T3,SBP levels were significantly higher than T0,but the control group was significantly higher than those in the observation group,there was significant difference(P<0.05﹚. Patients in the control group DBP level was T0 increased significantly,and the level of DBP in patients with T2 group,T3 was significantly higher than that in the control group,and the observation of DBP level significantly changes in T0-T2 group were not significant (P>0.05﹚. Patients in control group and T1-T3 in HR were higher than that of the observation group,there was significant difference(P<0.05﹚. Conclusion Dexmedetomidine for sedation in elderly patients after abdominal operation,the cognitive function of patients recovered quickly,and can maintain the stability of hemodynamics.

Objective To investigate the effects of different anesthesia methods on immunity in patients underwent radical resection of rectal carcinoma.Methods 82 patients underwent radical resection of rectal carcinoma were divided into two groups,each group had 41 cases.A group received total intravenous anesthesia while B group received total intravenous anesthesia combined with eqidural anesthesia.CD3+,CD4+,CD4+/CD8+,CD3+HLA-DR+and NK cells were inspected before induction of anesthesia(T0),2 h after skin incision(T1),2 h(T2) and 24 h(T3) after the end of operation.The T-lymphocyte subsets,activated T cells and NK cells were measured by flow cytometry. Visual analogue scale(VAS) was observed at T2 and T3.Results The VAS score of T2,T3 in A group[(3.86 ± 0.46)points,(3.62 ±0.26)points]were higher than those in B group[(1.67 ±0.57)points,(1.94 ±0.42)points] (all P<0.05).The percentages of CD3+,CD4+,CD4+/CD8+,CD3+HLA-DR+and NK cells of T1,T2,T3 were lower than those of T0 in A group(all P<0.05);The percentages of CD3+,CD4+,CD4+/CD8+,CD3+HLA-DR+and NK cells of T1, T2 were lower than those of T0 in B group ( all P <0.05 );The percentages of CD3+, CD4+, CD4+/CD8+, CD3+HLA-DR+ and NK cells of T1, T2, T3 in A group were lower than those in B group ( all P <0.05 ). Conclusion Total intravenous anesthesia combined with eqidural anesthesia produces less immune suppression than total intravenous anesthesia.

Objective To explore the expression of glial cell line-derived neurotrophic factor (GDNF) in rats with spinal cord injury (SCI) after epidermal neural crest stem cells (EPI-NCSCs) transplantation.Method EPI-NCSCs were isolated from GFP transgenic rats for transplantation.The rat SCI model was made by NYU-II impactor (10 g 25 mm) at T10 level.Then 30 SD rats were randomly divided into blank injury group (group A),DMEM transplantation group (group B),and experimental group (group C).The EPI-NCSCs were transplanted into the injured region one week after SCI.In DMEM group,the DMEM/F12 was used to substitute for the EPI-NCSCs.No treatment was done in blank injury group.The locomotor function was appraised by BBB score every week after transplantation.At sixth week after transplantation,GDNF mRNA and protein expression was detected.Result The BBB score in experimental group was significantly higher than the other two groups from two weeks after transplantation (P＜0.05).The expression of GDNF mRNA and protein in experimental group was significantly higher than the other two groups (P＜0.05).There was no significant difference between blank injury group and DMEM transplantation group (P ＞ 0.05).Conclusion The expression of GDNF can be up-regulated by EPI-NCSCs transplantation,which may be one of the mechanisms for EPI-NCSCs repairing SCI.

ObjectiveTo analyze the influence of different anesthesia methods on the stress response and hemodynamic of elderly patients undergoing laparoscopic cholecystectomy(LC).Methods Fifty-eight elderly patients who needed LC were selected and divided by random digits table method into GAEA group received general anesthesia combined with epidural anesthesia and GA group received general anesthesia with 29 cases each.The stress response and changes of hemodynamic were observed.Results Blood pressure and heart rate (HR) were elevated during pneumoperitoneum in both groups.Blood pressure and HR returned to normal at 30 minutes after pneumoperitoneum in GAEA group,which were recovered more slowly in GA group.There was no significant difference in systolic blood pressure (SBP),diastolic blood pressure (DBP),HR between two groups before and after anesthesia (P＞0.05).SBP,DBP,HR of GAEA group were ( 123.8 ± 25.9) mm Hg ( 1 mm Hg =0.133 kPa),(85.9 ± 8.4) mm Hg,(83.2 ± 7.4) times/min during pneumoperitoneum,respectively,(118.2 ±21.1) mm Hg,(84.4 ±8.3) mm Hg,(82.8 ±7.5)times/min at 10 min after pneumoperitoneum,( 114.9 ± 20.7) mm Hg,(80.2 ± 7.6) mm Hg,(78.5 ± 10.4)times/min at 30 min after pneumoperitoneum.SBP,DBP,HR of GA group were (138.3 ±26.7) mm Hg,(91.2 ± 8.8) mm Hg,(89.3 ± 10.1 ) times/min during pneumoperitoneum,( 130.3 ± 21.3) mm Hg,(89.2 ±8.6) mm Hg,(88.2 ± 9.7) times/min at 10 min after pneumoperitoneum,( 126.2 ± 20.7) mm Hg,(85.2 ±8.4) mm Hg,(84.9 ± 9.6 ) times/min at 30 min after pneumoperitoneum,respectively.SBP,DBP,HR during pneumoperitoneum,at 10 min and 30 min after pneumoperitoneum in two groups had significant differences (P ＜0.05).The anesthesia onset time in GAEA group was(73.2 ±24.9) s,and the awake time after operation was (31.6 ± 10.2) min,while those in GA group were (78.1 ± 22.4) s and (35.9 ± 14.3) min.The anesthesia onset time and awake time after operation in GAEA group were shorter than those in GA group,but had no significant difference (P＞ 0.05 ).Postoperative visual analogue score of GAEA group [ ( 13.4 ± 8.2)scores] was obviously lower than that of GA group[(26.3 ± 10.1) scores] (P ＜0.05).The incidence of adverse reactions between GAEA group [27.59％(8/29)] and GA group [6.90％(2/29)] had statistical difference (P ＜ 0.05).ConclusionsCompared with general anesthesia,general anesthesia combined with epidural anesthesia during LC for elderly patients can reduce the occurrence of intraoperative stress responses and have more steady hemodynamic,better anesthetic effect and faster recovery.But it may cause the incidence of nausea,headache and other postoperative adverse reactions increase.