With the growing popularity of video assisted thoracic surgery(VATS), the concept of enhanced recovery after surgery(ERAS) has become widely recognized. Alongside the emphasis on minimally invasive techniques during surgery, there is also a heightened focus on the management of postoperative thoracic drainage. The placement of a chest tube after thoracoscopic surgery often leads to wound pain, which can hinder patient recover. Numerous studies have demonstrated that for sublobar resections, lobectomies, and mediastinal procedures, it is safe and feasible to forgo chest tube placement, thereby accelerating patient recovery. This article reviews the structural anatomy of the thoracic cavity and the mechanisms underlying pleural effusion, drawing on pertinent research findings from both domestic and international studies. It examines the current practices regarding the postoperative placement of chest drainage tubes, evaluates the safety and feasibility of omitting such tubes, and outlines tube-free strategies for various surgical procedures. Additionally, the article addresses associated complications and their prevention.

With the growing popularity of video assisted thoracic surgery(VATS), the concept of enhanced recovery after surgery(ERAS) has become widely recognized. Alongside the emphasis on minimally invasive techniques during surgery, there is also a heightened focus on the management of postoperative thoracic drainage. The placement of a chest tube after thoracoscopic surgery often leads to wound pain, which can hinder patient recover. Numerous studies have demonstrated that for sublobar resections, lobectomies, and mediastinal procedures, it is safe and feasible to forgo chest tube placement, thereby accelerating patient recovery. This article reviews the structural anatomy of the thoracic cavity and the mechanisms underlying pleural effusion, drawing on pertinent research findings from both domestic and international studies. It examines the current practices regarding the postoperative placement of chest drainage tubes, evaluates the safety and feasibility of omitting such tubes, and outlines tube-free strategies for various surgical procedures. Additionally, the article addresses associated complications and their prevention.

Objective:To compare the aneuploidy rate of embryos between poor ovarian response (POR) patients and women with normal ovarian reserve stratified by age, and to eliminate the influence of ovarian reserve on embryo quality.Methods:This was a retrospective case-control study of patients who underwent preimplantation genetic testing for aneuploidies (PGT-A) at the Department of Reproduction and Genetics in Hospital for Reproductive Medicine, Shandong University from January 2017 to December 2020. According to the POSEIDON criteria, POR patients were divided into group 1 [age<35 years, anti-Müllerian hormone (AMH)≥1.2 μg/L, number of oocytes retrieved≤9, 258 cycles], group 2 (age≥35 years, AMH≥1.2 μg/L, number of oocytes retrieved≤9, 397 cycles), group 3 (age<35 years, AMH<1.2 μg/L, number of oocytes retrieved≤9, 99 cycles) and group 4 (age≥35 years, AMH<1.2 μg/L, number of oocytes retrieved≤9, 377 cycles). The aneuploidy rate of the blastocysts in each group was compared with age-matched control women with normal ovarian reserve and normal ovarian response (non-POR 1 group, non-POR 2 group, non-POR 3 group and non-POR 4 group, AMH≥1.2 μg/L, number of oocytes retrieved>9). Based on the difference in sample size of POR groups and control groups, a 1∶2 propensity score matching (PSM) analysis was performed between the <35 years old POR groups and age-matched control groups (POR 1 group vs. non-POR 1 group, POR 3 group vs. non-POR 3 group) and a 1∶1 PSM analysis was performed between the ≥35 years old POR groups and age-matched control groups (POR 2 group vs. non-POR 2 group, POR 4 group vs. non-POR 4 group). The main outcomes were the rates of euploid and aneuploid embryo, the secondary outcomes were the numbers of oocytes retrieved, metaphaseⅡ oocytes, two pronuclei, embryos biopsied, euploid embryos, aneuploid embryos and mosaic embryos per cycle. Results:The number of oocytes retrieved and embryos biopsied embryos in POR 1-4 groups was significantly decreased compared with non-POR 1-4 groups [No. of oocytes retrieved: 7.0 (6.0, 9.0) vs. 16.0 (13.0, 20.0), 7.0 (5.0, 8.0) vs. 14.0 (11.0, 17.0), 6.0 (4.0, 9.0) vs. 16.0 (13.0, 20.0), 5.0 (3.0, 7.0) vs. 13.0 (11.0, 17.0), all P<0.001; No. of embryos biopsied: 3.0 (2.0, 4.0) vs. 4.0 (3.0, 6.0), 2.0 (1.0,3.0) vs. 3.0 (2.0, 5), 3.0 (2.0, 4.0) vs. 4.0 (3.0, 6.0), 2.0 (1.0, 3.0) vs. 3.0 (2.0, 5.0), all P<0.001]. After adjusting for repeated egg retrieval, PGT-A indications, ovarian stimulation protocol and total dosage of gonadotrophin, the embryo aneuploidy rate in group 4 POR patients was significantly higher than controls ( OR=1.252, 95% CI:1.053-1.488, P=0.011). However, no differences were identified in embryo aneuploidy rate between POR patients in groups 1, 2, 3 and corresponding controls, respectively (all P>0.05). Conclusion:The ovarian reserve adversely affects the quantity and quality of oocytes in advanced age POR women (≥35 years old). Decreased ovarian reserve in young women (<35 years old) mainly affects the number of oocytes retrieved.

Objective:To compare the aneuploidy rate of embryos between poor ovarian response (POR) patients and women with normal ovarian reserve stratified by age, and to eliminate the influence of ovarian reserve on embryo quality.Methods:This was a retrospective case-control study of patients who underwent preimplantation genetic testing for aneuploidies (PGT-A) at the Department of Reproduction and Genetics in Hospital for Reproductive Medicine, Shandong University from January 2017 to December 2020. According to the POSEIDON criteria, POR patients were divided into group 1 [age<35 years, anti-Müllerian hormone (AMH)≥1.2 μg/L, number of oocytes retrieved≤9, 258 cycles], group 2 (age≥35 years, AMH≥1.2 μg/L, number of oocytes retrieved≤9, 397 cycles), group 3 (age<35 years, AMH<1.2 μg/L, number of oocytes retrieved≤9, 99 cycles) and group 4 (age≥35 years, AMH<1.2 μg/L, number of oocytes retrieved≤9, 377 cycles). The aneuploidy rate of the blastocysts in each group was compared with age-matched control women with normal ovarian reserve and normal ovarian response (non-POR 1 group, non-POR 2 group, non-POR 3 group and non-POR 4 group, AMH≥1.2 μg/L, number of oocytes retrieved>9). Based on the difference in sample size of POR groups and control groups, a 1∶2 propensity score matching (PSM) analysis was performed between the <35 years old POR groups and age-matched control groups (POR 1 group vs. non-POR 1 group, POR 3 group vs. non-POR 3 group) and a 1∶1 PSM analysis was performed between the ≥35 years old POR groups and age-matched control groups (POR 2 group vs. non-POR 2 group, POR 4 group vs. non-POR 4 group). The main outcomes were the rates of euploid and aneuploid embryo, the secondary outcomes were the numbers of oocytes retrieved, metaphaseⅡ oocytes, two pronuclei, embryos biopsied, euploid embryos, aneuploid embryos and mosaic embryos per cycle. Results:The number of oocytes retrieved and embryos biopsied embryos in POR 1-4 groups was significantly decreased compared with non-POR 1-4 groups [No. of oocytes retrieved: 7.0 (6.0, 9.0) vs. 16.0 (13.0, 20.0), 7.0 (5.0, 8.0) vs. 14.0 (11.0, 17.0), 6.0 (4.0, 9.0) vs. 16.0 (13.0, 20.0), 5.0 (3.0, 7.0) vs. 13.0 (11.0, 17.0), all P<0.001; No. of embryos biopsied: 3.0 (2.0, 4.0) vs. 4.0 (3.0, 6.0), 2.0 (1.0,3.0) vs. 3.0 (2.0, 5), 3.0 (2.0, 4.0) vs. 4.0 (3.0, 6.0), 2.0 (1.0, 3.0) vs. 3.0 (2.0, 5.0), all P<0.001]. After adjusting for repeated egg retrieval, PGT-A indications, ovarian stimulation protocol and total dosage of gonadotrophin, the embryo aneuploidy rate in group 4 POR patients was significantly higher than controls ( OR=1.252, 95% CI:1.053-1.488, P=0.011). However, no differences were identified in embryo aneuploidy rate between POR patients in groups 1, 2, 3 and corresponding controls, respectively (all P>0.05). Conclusion:The ovarian reserve adversely affects the quantity and quality of oocytes in advanced age POR women (≥35 years old). Decreased ovarian reserve in young women (<35 years old) mainly affects the number of oocytes retrieved.

BACKGROUND: Preoperative diagnosis and differential diagnosis of small solid pulmonary nodules are very difficult. Computed tomography (CT), as a common method for lung cancer screening, is widely used in clinical practice. The aim of this study was to analyze the clinical data of patients with malignant pulmonary nodules and intrapulmonary lymph nodes in the clinical diagnosis and treatment of <1 cm solid pulmonary nodules, so as to provide reference for the differentiation of the two. METHODS: Patients with solid pulmonary nodules who underwent surgery from June 2017 to June 2020 were analyzed retrospectively. The clinical data of 145 nodules (lung adenocarcinoma 60, lung carcinoid 2, malignant mesothelioma 1, sarcomatoid carcinoma 1, lymph node 81) were collected and finally divided into two groups: lung adenocarcinoma and intrapulmonary lymph nodes, and their clinical data were statistically analyzed. According to the results of univariate analysis (χ² test, t test), the variables with statistical differences were selected and included in Logistic regression multivariate analysis. The predictive variables were determined and the receiver operating characteristic (ROC) curve was drawn to get the area under the curve (AUC) value of the area under the curve. RESULTS: Logistic regression analysis showed that the longest diameter, Max CT value, lobulation sign and spiculation sign were important indicators for distinguishing lung adenocarcinoma from intrapulmonary lymph nodes, and the risk ratios were 106.645 (95%CI: 3.828-2,971.220, P<0.01), 0.980 (95%CI: 0.969-0.991, P<0.01), 3.550 (95%CI: 1.299-9.701, P=0.01), 3.618 (95%CI: 1.288-10.163, P=0.02). According to the results of Logistic regression analysis, the prediction model is determined, the ROC curve is drawn, and the AUC value under the curve is calculated to be 0.877 (95%CI: 0.821-0.933, P<0.01). CONCLUSIONS For <1 cm solid pulmonary nodules, among many factors, the longest diameter, Max CT value, lobulation sign and spiculation sign are more important in distinguishing malignant pulmonary nodules from intrapulmonary lymph nodes.

Patients with chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are frequently complicated by autoimmune disorders, which is commonly seen in patients with hepatitis C. This article introduces the mechanism of immune disorders in patients with chronic hepatitis C, the proportion of patients with non-organ specific autoantibody, and the clinical manifestations, diagnosis, and treatment of related immune diseases, such as mixed cryoglobulinemia, glomerulonephritis, Sjogren's syndrome, thyroid disease, and type 2 diabetes, as well as the mechanism of immune disorders, related immune manifestations, and effect of antiviral therapy in patients with chronic hepatitis B. Antiviral therapy for chronic hepatitis B and C can alleviate related immune diseases, but interferon therapy is not appropriate. Therefore, the patients with hepatitis B should be treated with nucleos(t)ide analogues, while those with hepatitis C should be treated with direct-acting antiviral agents.

Objective To investigate clinical predictors in early pregnancy for adverse pregnancy outcomes in women complicated with chronic nephropathy. Methods One hundred and eighty-four pregnancies complicated with chronic nephropathy who delivered between January, 2005 and January, 2014 in Peking University First Hospital were retrospectively analyzed. Two hundred pregnant women without chronic nephropathy were selected as the control group. Pregnancy outcomes were compared between the two groups. Relationships between clinical predictors in early pregnancy [age, history of kidney disease, drugs used before pregnancy (in three months), results of renal biopsy, blood pressure, serum creatinine, urea nitrogen, 24 h urinary protein, estimated glomerular filtration rate, stage of chronic nephropathy] and adverse pregnancy outcomes [maternal mortality;pregnancy complicated by severe preeclampsia;renal function decline, early preterm birth, very low birth weight infants, fetal loss after 20 weeks of pregnancy] were assessed by logistic regression analysis. T-test, Chi-square test and multivariate regressions were used for statistical analysis. Results There were 174 and 197 livebirths in the study and the control groups, respectively. The most popular type of chronic nephropathy in pregnant women was IgA nephropathy (38.6%, 71/184). Compared with the control group, the risk of premature labor [9.8%(17/174) vs 3.0%(6/197), χ2=7.184], low birth weight infants[18.4%(32/174) vs 7.1%(14/197),χ2=9.813], very low birth weight infants [5.7%(10/174) vs 1.5%(3/197),χ2=4.536], fetal loss after 20 weeks of pregnancy [5.7%(10/184) vs 1.5%(3/200), χ2=4.536] and severe preeclampsia [17.9%(33/184) vs 1.5%(3/200), χ2=33.544] increased significantly in the study group (all P < 0.05). Twenty-four-hour urinary protein content (OR=1.84, 95%CI: 1.36-2.50, P=0.001) and mean arterial pressure (OR=1.04, 95%CI: 1.00-1.07, P=0.027) in early pregnancy were risk factors for adverse pregnancy outcomes. The risk of renal function decline increased significantly in patients with higher stages of chronic nephropathy in early pregnancy (OR=6.50, 95%CI: 3.34-8.21, P<0.01). Mother complicated by preeclampsia during pregnancy was an independent risk factor (OR=11.10, 95%CI: 4.48-27.20, P<0.01). Compared with women whose 24 h urinary protein content less than 1g in early pregnancy (122 livebirths within 126 cases), the risk of premature labor [17.3%(9/52) vs 6.6%(8/122), χ2=4.780], increased significantly in women whose 24 h urinary protein content were more than or equal to 1 g in early pregnancy (52 livebirths within 58 cases) (P<0.05). Conclusions Elevated urinary protein level and mean arterial pressure in early pregnancy were risk factors of adverse pregnancy outcomes. The risk of renal function decline increased in patients with higher stages of chronic nephropathy in early pregnancy. Mother complicated by preeclampsia during pregnancy was an independent risk factor for poor prognosis of the fetus.

This study was aimed to explore the mechanism of electroacupuncture (EA) on improvement of Parkinson’s disease (PD). A total of 40 SD male rats were randomly divided into 4 groups, which were the normal group, sham-operation group, model group, and EA group (n=10). The 6-hydroxydopamine (6-OHDA) was used to prepare PD rat rotational model. The 0.2% Vitamin C of physiological saline was injected in the sham-operation group. EA on GV16-Fengfuand LR3-Taichongwas given for 30 min in the EA group after the model was successfully established, once a day, 7 days a treatment course. The treatment was given for 2 courses. Behavioral test was used to detect PD rat rotational behavior changes. Glu concentration in the striatum was detected by HPLC assay. The expression levels of GS and PAG were detected with western blot. The results showed that there were significant differences in the rotational behavior before and after treatment in the EA group (P < 0.01). Compared with the normal group and sham-operation group, Glu concentration significantly increased, GS expression obviously decreased, and PAG expression significantly increased in the model group (P < 0.01). Compared with the model group, Glu concentration obviously decreased (P < 0.05), GS expression significantly increased, and PAG significantly decreased in the EA group (P < 0.01). It was concluded that the protective effect of EA in PD may be associated with EA improving the expression of GS, reducing the expression of PAG, and relieving the cytotoxicity induced by Glu in the brain.

BACKGROUNDPercutaneous pedicle screw use has a high rate of cranial facet joint violations (FVs) because of the facet joint being indirectly visualized. Computer-assisted navigation shows the anatomic structures clearly, and may help to lower the rate of FVs during pedicle screw insertion. This study used computed tomography (CT) to evaluate and compare the incidence of FVs between percutaneous and open surgeries employing computer-assisted navigation for the implantation of pedicle screw instrumentation during lumbar fusions.

METHODSA prospective study, including 142 patients having lumbar and lumbosacral fusion, was conducted between January 2013 and April 2014. All patients had bilateral posterior pedicle screw-rod instrumentation (top-loading screws) implanted by the same group of surgeons; intraoperative 3-dimensional computer navigation was used during the procedures. All patients underwent CT examinations within 6 months postoperation. The CT scans were independently reviewed by three reviewers blinded to the technique used.

RESULTSThe cohort comprised 68 percutaneous and 74 open cases (136 and 148 superior-level pedicle screw placements, respectively). Overall, superior-level FVs occurred in 20 patients (20/142, 14.1%), involving 27 top screws (27/284, 9.5%). The percutaneous technique (7.4% of patients, 3.7% of top screws) had a significantly lower violation rate than the open procedure (20.3% of patients, 14.9% of top screws). The open group also had significantly more serious violations than did the percutaneous group. Both groups had a higher violation rate when the cranial fixation involved the L5. A 1-level open procedure had a higher violation rate than did the 2- and 3-level surgeries.

CONCLUSIONSWith computer-assisted navigation, the placement of top-loading percutaneous screws carries a lower risk of adjacent-FVs than does the open technique; when FVs occur, they tend to be less serious. Performing a single-level open lumbar fusion, or the fusion of the L5-S1 segment, requires caution to avoid cranial adjacent FVs.

Aged ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Pedicle Screws ; Prospective Studies ; Zygapophyseal Joint ; surgery

Objective To investigate the significance of metastasis associated lung adenocarcinoma transcript 1 ( MALAT1 ),cyclooxygerase-2 ( COX-2 ),beta catenin ( β-catenin )、matrix metalloproteinase (MMP)-3 and MMP-9 in the occurrence and development of colorectal carcinoma.Methods Real-time PCR was used to detect MALAT1,COX-2,β-catenin,MMP-3 and MMP-9 rnRNA expression in samples from 30 fresh colorectal carcinomas and 30 corresponding adjacent tissues.And the correlation analysis of the gender and age of patients,CEA,immune cellular factors ( CD4 and CD8 ),clinical stages,and the degree of differentiation was undertaken.Results The expression levels of MALAT1,COX-2,β-catenin and MMP-9 were significantly different between colorectal carcinoma tissues and adjacent colorectal tissues (P ＜ 0.05 ).MMP-3 showed no significant difference (P ＞ 0.05).MALAT1,COX-2,β-catenin and MMP-9 expression levels showed an average 2.22-fold,1.86-fold,2.16-fold,0.58-fold ( P ＜ 0.01 ) increase in colorectal carcinoma tissues when compared with adjacent colorectal tissues respectively.There were negative correlation between MALAT1 and β-cateuin ( colorectal carcinoma tissues vs adjacent colorectal tissues) ( r =- 0.346,P =0.030).While there were positive correlation between MMP-9 and β-catenin ( colorectal carcinoma tissues vs adjacent colorectal tissues) ( r =0.312,P =0.047 ).There were significant difference between male patients and female patients in terms of COX-2 and MMP-9 (colorectal carcinoma tissues vs adjacent colorectal tissues) (P =0.047; P =0.018).There were significant difference between patients with tumor marker CEA increase and patients without CEA increase in terms of COX-2 ( colorectal carcinoma tissues vs adjacent colorectal tissues) ( P =0.021 ).Conclusion MALAT1,COX-2,MMP-9 and β-catenin have significance in the occurrence and development of colorectal carcinoma,while MMP-3 has no significant reference value. The negative correlation between MAL(A)T-1 and β-catenin and the positive correlation between MMP-9 and β-catenin might show some interaction relationship in the development of colorectal carcinoma.The expression differences of COX-2 and MMP-9 (colorectal carcinoma tissues vs adjacent colorectal tissues) in male and female patients suggest that above two genes may affect the occurrence ratio of colorectal carcinoma.Detecting of COX-2 maybe helpful to the tumor marker CEA during the diagnosis of colorectal carcinoma.