OBJECTIVE: To investigate the clinical effect of transposition of gracilis muscle flap in repairing urethral perineal fistula after Miles operation. METHODS: The clinical data of 3 patients with urethral perineal fistula treated in the Second Affiliated Hospital of Zhejiang University from September 2023 to November 2024 were analyzed retrospectively. All patients were male, aged from 59 to 68 years (mean 63 years). All patients underwent Miles operation because of low rectal cancer. Urethral perineal fistula occurred after 2 months to 13 years of the operation. The underlying comorbidities included diabetes (2/3), preoperative chemoradiotherapy (1/3), and chemotherapy alone (1/3). The endourethral fistula was located in the apical and membranous part of the prostate, with a diameter of 1.5-2.0 cm and a mean of 1.7 cm. Suprapubic cystostomy was performed one month before operation. In all 3 cases, perineal inverted "Y" incision was taken under general anesthesia to expose urethral fistula, cut off necrotic tissue and suture urethral fistula. The gracilis muscle of the right thigh was taken and turned through the perineal subcutaneous tunnel. and 6 stitches were suture at the urethral fistula. RESULTS: The operations of all 3 patients were completed successfully. The follow-up period ranged from 2 months to 12 months, with an average of 8 months. There was no case of urinary incontinence after removal of catheter 3 weeks after operation. In two patients, urethrography was reviewed 1 month after surgery to show no fistula residue and urethral stenosis, and the fistula was removed. In one patient with a history of radiotherapy, urethrography was reviewed 1 month after surgery to show a small amount of contrast overflow around the urethra, and urethrography was reviewed again 3 months after surgery to show no contrast overflow around the urethra. All the 3 patients had no disturbance of movement of the right lower limb, and the pain of different degrees of thigh incision was acceptable and basically relieved half a month after operation. CONCLUSION Gracilis muscle flap is one of the effective methods for repairing urethral perineal fistula after Miles operation，which has a precise surgical result and few complications.
Humans ; Male ; Middle Aged ; Aged ; Gracilis Muscle/transplantation* ; Urinary Fistula/surgery* ; Retrospective Studies ; Surgical Flaps ; Perineum/surgery* ; Rectal Neoplasms/surgery* ; Postoperative Complications/surgery* ; Urethral Diseases/surgery* ; Urethra/surgery*

Objective: To investigate the prevalence of depressive symptoms among college freshmen and analyze their influencing factors, so as to provide insights into the prevention and intervention of depressive symptoms among college students. Methods: The freshmen enrolled in a college of Hunan Province from 2020 to 2022 were recruited, and demographic data, diet and sleep status were collected using questionnaire surveys. Depressive symptoms were evaluated using Patient Health Questionnaire-9. Factors affecting depressive symptoms were analyzed using a multivariable logistic regression model. Results: Totally 17 862 questionnaires were allocated, and 16 480 valid questionnaires were recovered, with an effective rate of 92.26%. There were 3 374 students of 2020 cohort, 7 038 students of 2021 cohort and 6 068 students of 2022 cohort, 6 029 boys (36.58%) and 10 451 girls (63.42%). The prevalence of depressive symptoms among freshmen was 41.37%. Multivariable logistic regression analysis showed that female (OR=1.482, 95%CI: 1.377-1.594), enrolling through the college entrance examination (OR=1.561, 95%CI: 1.384-1.809), depression history (OR=1.990, 95%CI: 1.513-2.618), abnormal marital status of parents (divorced, OR=1.197, 95%CI: 1.064-1.348; other problem, OR=1.401, 95%CI: 1.174-1.672), abnormal diet (mild, OR=2.883, 95%CI: 2.585-3.105; moderate, OR=6.755, 95%CI: 4.653-9.808; severe, OR=38.897, 95%CI: 12.200-124.012) and abnormal sleep (mild, OR=2.785, 95%CI: 2.593-2.992; moderate, OR=9.009, 95%CI: 7.011-11.578; severe, OR=29.281, 95%CI: 14.163-60.536) were associated with increased risk of depressive symptoms among college freshmen. Conclusion The prevalence of depressive symptoms among college freshmen is relatively high, and is influenced by gender, mode of admission, history of depression, parental marital status, diet and sleep.

Non-T2 asthma, also known as non-eosinophilic asthma or low T2 asthma, does not have markers of type 2 inflammation and is often associated with hormone insensitivity and severe asthma. This article reviews the progress in drug therapy for non-T2 asthma.
Humans ; Asthma/therapy* ; Anti-Asthmatic Agents/therapeutic use*

Percutaneous coronary intervention(PCI)is one of the most important therapeutic measures for coronary heart disease.It can quickly and effectively relieve coronary artery obstruction.Patients with coronary heart disease often suffer from the complication of emotional disorders like anxiety and depression.The incidence of anxiety and depression in patients having undergone PCI is significantly higher in those having not.But anxiety and depression can remarkably increase the major adverse cardiac events(MACE)in patients after PCI.This article reviews the associations,mechanisms and treatments of anxiety and depression after PCI.

Objective:To investigate the risk factors of thrombocytopenia in elderly patients with sepsis-associated acute kidney injury(SA-AKI), and to further evaluate whether the degree of thrombocytopenia is related to the increased risk of death on day 28.Methods:Elderly patients with SA-AKI admitted to ICU of our hospital from June 2017 to June 2020 were selected.The patients were divided into normal platelet group(56 cases)and thrombocytopenia group(72 cases)according to the platelet(PLT)count, and according to the degree of thrombocytopenia, they were further divided into three groups: PLT<20×10 9/L(group A, 22 cases), 20×10 9/L≤ PLT<50×10 9/L(group B, 27 cases), 50×10 9/L≤ PLT<100×10 9/L(group C, 23 cases).The general data, clinical baseline indicators and prognostic indicators of each group were compared to evaluate the risk factors of thrombocytopenia.At the same time, the impact of platelet count on the prognosis of elderly patients with SA-AKI was evaluated according to the length of stay in ICU, total length of stay and whether the patient died, and the correlation between the degree of thrombocytopenia and survival was analyzed. Results:A total of 128 elderly patients with SA-AKI were enrolled, including 73 males and 55 females.59.4 % of the patients were hospitalized in the department of internal medicine.The APACHEⅡ score was(15.5 ± 3.3)points, invasive mechanical ventilation accounted for 78.9%, positive inotropic therapy accounted for 12.8%, and 56 patients had normal platelet count.Thrombocytopenia occurred in 72 patients, including 22 patients with PLT<20×10 9/L, 27 patients with platelet count in 20-50×10 9/L, and 23 patients with platelet count in 50-100×10 9/L.There were significant differences in bloodstream infection, Gram-negative bacteria, APACHEⅡ score and procalcitonin(PCT)among the four groups( P<0.05).Further multivariate logistic regression showed that PCT was an independent risk factor for thrombocytopenia in elderly patients with SA-AKI( OR=1.05, 95% CI: 1.00-1.10, P=0.042).Compared with the normal platelet group, the 28-day mortality rate of the thrombocytopenia group was significantly higher than that of the normal platelet group, while the length of stay in ICU and the total length of stay were prolonged( P<0.05).Kaplan-Meier survival curve showed that the 28-day cumulative survival rate of thrombocytopenia group was lower than that of normal platelet group, and the risk of death increased with the degree of thrombocytopenia( χ2=31.479, P<0.001).Univariate Cox regression analysis showed that thrombocytopenia, bloodstream infection, APACHEⅡ score and PCT were risk factors for 28-day death in elderly patients with SA-AKI.Multivariate Cox analysis showed that bloodstream infection and APACHEⅡ score were independent risk factors for 28-day death.After adjusting these confounding factors, thrombocytopenia was an independent risk factor for death, and the degree of thrombocytopenia was related to the increased risk of death. Conclusions:Thrombocytopenia is common in elderly patients with SA-AKI, and elevated PCT levels increase the risk of thrombocytopenia.The degree of thrombocytopenia is an independent risk factor for 28-day mortality in such patients.

OBJECTIVES: To construct a quantitative index system with the integrated medical and nursing care assessment for the elderly service needs, this system can assess the cost of medical and care services accurately and objectively, so as to provide scientific basis for the allocation of old-age service resources in China. METHODS: Based on the survival needs of the Existence, Relation and Growth theory, an index system is constructed through literature analysis, group discussion, and expert correspondence. Analytic hierarchy process was used to determine the weights of indicators at all levels. The 3-grades service items corresponding to each index were quantified through the measurement of working hours, and the medical and nursing care needs of 624 disabled/demented elderly people over 60 years old in Changsha were investigated to evaluate their reliability and validity. RESULTS: The authoritative coefficients of the 2 rounds of expert correspondence were 88.5% and 88.6%, respectively, and the opinion coordination coefficients were 0.159 and 0.167, respectively. The final quantitative evaluation index system included 4 first-level indicators, 17 second-level indicators, and 105 third-level indicators. The service time of doctor ranged from 6.01 to 22.64 min, the service time of nurses ranged from 0.77 to 24.79 min, and the service time of caregiver ranged from 0.12 to 51.88 min. The Cronbach's αcoefficient was 0.73, the split-half reliability was 0.74, the content validity was 0.93, and the calibration validity was 0.781. CONCLUSIONS The quantitative evaluation index system of medical and nursing service need for the elderly can be used to accurately evaluate the medical and nursing service need.
Humans ; Aged ; Middle Aged ; Reproducibility of Results ; Surveys and Questionnaires ; Delphi Technique ; Nursing Care ; China

Objective:To investigate the changes of cognitive function in non-fatal drowning rats after blast-induced traumatic brain injury (bTBI).Methods:Eighty SD rats were divided into normal group, bTBI group, drowning group and bTBI plus drowning group according to the random number table, with 20 rats per group. Rats in normal group were not injured. In bTBI group, bTBI was established in a BST-I biological shock tube with a pressure of 4.0 MPa in the driving section. In drowning group, rats were subjected to non-fatal drowning by falling into the water with temperature of 18 ℃ and depth of 30 cm from the height of 1 m and were taken out quickly after swimming to exhaustion. After being injured in a biological shock tube, rats in bTBI plus drowning group were immediately forced to drowning using the same method. On day 3 post-injury, the neurocognitive function was evaluated by elevated plus maze and Morris water maze tests. Morphological changes of neurons in CA1 and CA3 regions of hippocampus were observed by Nissl staining, and the number of surviving neurons were counted. The concentrations of hippocampal neurotransmitters glutamate, γ-aminobutyric acid (GABA), glycine and endoplasmic reticulum stress (ERS) related glucose-regulated protein 78 (GRP78) and caspase-12 were examined by ELISA analysis. Levels of B-cell lymphoma-2 (Bcl-2), Bcl-2 associated protein (Bax) and caspase-3 were detected by Western blotting. The ratio of Bcl-2 to Bax was calculated as well.Results:In elevated plus maze test, the percentage of open arm entry and number of head-dipping behaviour were decreased in bTBI plus drowning group compared with normal and bTBI groups at 3 days after injury ( P<0.05 or 0.01), with no statistical difference from those in drowning group ( P>0.05). The number of head-dipping behaviour in drowning group was lower than that in bTBI group ( P<0.05). In Morris water maze test, bTBI plus drowning group showed increased target latency on the third and fourth days of spatial acquisition training and decreased number of crossing the target area and percentage of swimming time in the target quadrant during probe trials as compared with normal group ( P<0.05 or 0.01), but there was no statistical difference among bTBI, drowning and normal groups (all P>0.05). Nissl staining showed that the neurons in the CA1 and CA3 regions of hippocampus in normal group were arranged neatly with clear Nissl bodies at 3 days after injury, while the other groups showed different degrees of injury. In contrast with normal group, the neurons in the CA1 and CA3 regions of hippocampus in all other groups were decreased with the lowest number in bTBI plus drowning groups ( P<0.05 or 0.01). In ELISA analysis, the level of hippocampal glutamate in bTBI plus drowning group was higher than that in all other groups at 3 days after injury and the level in bTBI injury and drowning groups was higher than that in normal group ( P<0.05 or 0.01); the level of hippocampal glycine in bTBI plus drowning group was lower than that in normal group ( P<0.05), but there was no statistical difference among bTBI, drowning or normal groups (all P>0.05); the concentration of hippocampal GABA had no statistical difference among all groups (all P>0.05). In addition, the concentration of GRP78 in bTBI injury, drowning and bTBI injury plus drowning groups were increased compared with normal group ( P<0.05 or 0.01), but did not statistically differ from each other (all P>0.05). The concentration of caspase-12 in drowning and bTBI plus drowning groups were increased compared with normal group ( P<0.05 or 0.01), but was not statistically different from each other ( P>0.05), and its concentration in bTBI plus drowning group was increased compared with bTBI group ( P<0.05). In Western blotting, the level of Bcl-2 in bTBI plus drowning group was decreased compared with all other groups at 3 days after injury, and the level in bTBI and drowning groups were decreased compared with normal group, but a much lower level was observed in drowning group than that in bTBI group ( P<0.05 or 0.01); the level of Bax in bTBI plus drowning group was increased compared with all other groups at 3 days after injury, and the level in drowning group was increased compared with normal group ( P<0.05 or 0.01), with no statistical difference between bTBI and drowning groups ( P>0.05). The ratio of Bcl-2 to Bax in bTBI plus drowning group was decreased compared with all other groups, while the ratio in bTBI and drowning groups were decreased compared with normal group, showing a much lower level in drowning group than that in bTBI group ( P<0.05 or 0.01). Also, the level of caspase-3 in drowning and bTBI plus drowning groups were increased compared with normal and bTBI groups ( P<0.05 or 0.01), but there was no statistical difference between drowning and bTBI plus drowning groups ( P>0.05). Conclusions:Non-fatal drowning can aggravate hippocampal neuron damage in bTBI rats and cause memory, emotion and other cognitive dysfunction. The mechanism may involve the imbalance of hippocampal neurotransmitters glutamate and glycine, which activates the downstream pro-apoptotic pathway through ERS in the early stage of injury to induce hippocampal neuron apoptosis.

Objective:To evaluate the post-marketing safety and immunogenicity of a 23-valent pneumococcal polysaccharide vaccine (PPV23).Methods:From September 2020 to June 2021, a clinical trial of single-dose PPV23 was conducted in people ≥3 years old in Centers for Disease Control and Prevention of Guizhou, Hunan and Fujian provinces. Blood samples were collects from the subjects before and 30 d after vaccination. ELISA was used to quantitatively detect IgG antibodies against capsular polysaccharides of 23 Streptococcus pneumoniae serotypes in serum samples. The adverse events (AEs) were monitored within 7 d after vaccination. Results:A total of 409 subjects were enrolled and included in safety analysis. Except for one with antibody level inversion, the other 408 participants were included in immunogenicity analysis. The levels of antibodies against the 23 Streptococcus pneumoniae serotypes were all increased after vaccination by an average of 4.24 folds. The two-fold growth rates of the antibodies ranged from 51.72% to 96.81% with a total two-fold growth rate of 78.59%. The overall rate of AEs was 27.14% (111/409). Local AEs were mainly pain, induration, redness and swollen. No serious adverse events related to vaccination occurred. Conclusions:This study preliminarily demonstrated the good immunogenicity and safety of PPV23 vaccine.

Objective: To understand neglect and its associated factors among migrant middle school students in Tianjin, and to help them develop physically and mentally. Methods: A survey of 3 666 middle school students in 10 middle schools located in migrant gathering regions was conducted. Neglect and associated factors were collected and compared between migrant and non-migrant students. Results: The neglect rate of migrant middle school students in Tianjin was 45.79% and that of non-migrant students was 31.37%, the difference was statistically significant (χ2=56.25, P<0.01). The total neglect of middle school students who moved with them was (52.46±8.12) points; the neglect of boys, junior high schools, non-only children, fathers and mothers with high school education and below were significantly higher than those of girls, high schools, single children, and parents with high school education (t=3.73, 10.40, -11.36, 13.81, 15.57, P<0.01). The longer the follow-up period and the lower the family income, the higher the degree of neglect among the middle school students, and the difference was statistically significant (F=89.27, 53.48, P<0.01). Regression analysis showed that the following time (OR=3.55), whether the only child (OR=4.19) showed a positive correlation with the neglect of middle school students; family income (OR=0.71), parental education (OR=0.48, 0.25) were negatively correleted with neglect (P<0.05). Conclusion The neglect of middle school students in Tianjin is serious. The time of family migration, family income and parental education are important factors affecting neglect.

Objective:To explore the causes of misdiagnosis and missed diagnosis of fetal liver, hemangioma by prenatal ultrasound, aimed at improving the diagnostic rate of fetal liver hemangioma by prenatal ultrasound.Methods:Six cases of misdiagnosed fetal liver hemangioma in Hunan Province Maternal and Child Health Hospital between January 2016 and October 2018 were selected. In these cases, live births were tracked until they were 6-24 months old, while autopsy was carried out on induced fetuses. These failed cases were analyzed retrospectively, in terms of their scanning methods, ultrasonographic features and pregnancy outcomes.Results:Three cases were misdiagnosed by perinatal ultrasound: the time for the first discovery of masses in these cases was 37 + 3 weeks, 39 + 5 weeks and 37 + 4 weeks respectively. All of these tissues appeared as mixed echogenic masses and were misdiagnosed as hepatoblastoma. The other three cases were categorized as prenatal ultrasound missed diagnosis: in one case, prenatal ultrasound examination failed to detect the disease in question during the whole pregnancy, while ultrasound examination revealed lesions 2 days after birth; the other case didn′t see the detection of hepatic hemangioma was not detected until the 40th week of pregnancy by ultrasound in another case, as prenatal ultrasound at 31 + 6 weeks and 37 + 4 weeks showed nothing abnormal; yet prenatal ultrasound examination of the third case showed no findings in which at 26 + 6 weeks pregnant, but ultrasound performed at 33 weeks into gestation suspected slightly hypoechoic area in the liver, which was indicated hepatic hemangioma by MRI. Among the 6 cases, 2 of the induced fetuses were confirmed as hepatic capillary tumor by autopsy and pathological examination by with the consents of their family; four live births were confirmed to be hepatic hemangioma by contrast-enhanced CT scan and clinical follow-up observation. Conclusions:Multi-angle and multi-section scanning technique should be adopted in prenatal ultrasound examination of fetal liver. Mean while observations must also be made of any changes in the hepatic vein and any displacement of the peripheral organs of the liver, while ultrasonic images and color Doppler flow imaging features of the lesions are further analyzed. These actions lead to an improvement in the diagnostic accuracy of fetal liver hemangioma, which serves as a useful clinical guide to active and effective intervention measures.