Objective:To evaluate the efficacy of glottic closure in preventing postoperative aspiration in elderly patients undergoing supraglottic horizontal partial laryngectomy.Methods:A retrospective case series analysis was conducted on the clinical data of 12 elderly patients who underwent supraglottic horizontal partial laryngectomy with concurrent glottic closure at the Sixth Medical Center of Chinese PLA General Hospital from January 1, 2002, to December 31, 2024. Among them, there were 8 males and 4 females, aged from 68 to 80 years, with an average age of 74 years. There were 11 cases of supraglottic laryngeal cancer and 1 case of tongue base cancer. The TNM staging was T2N0M0 in 8 cases, T3N0M0 in 2 cases, T3N1M0 in 1 case, and T3N2M0 in 1 case. All patients existed comorbid cardiovascular dysfunction of varying severity. Pulmonary function tests were impaired in 8 cases. Comorbidities included hypertension ( n=5), prior coronary stent placement ( n=3), and thrombocytopenia ( n=1). Swallowing function was assessed using the EAT-10 (Eating Assessment Tool-10) one month postoperatively. All patients were followed up regularly. Results:The mean EAT-10 score at one month postoperatively was 2.42±1.71. Eleven patients successfully resumed oral feeding without obvious aspiration. Voice quality was intelligible when the tracheostomy tube was blocked. In the early stage, in 1 case, due to the suture technique problem of the glottis closure, the suture site of the glottis completely split open after the operation. The patient′s breathing was normal when the tube was blocked, and the tracheostomy tube was removed. As arytenoid edema resolved, the patient developed varying degrees of dysphagia with recurrent aspiration. This patient was hospitalized twice due to aspiration pneumonia, at 5 months and 19 months, postoperatively. The remaining 11 patients exhibited no signs of significant aspiration during follow-up. The 3-year and 5-year postoperative survival rates were 7/8 and 5/7, respectively.Conclusion:For elderly patients with supraglottic laryngeal cancer or tongue base cancer, and those who are at high risk for persistent postoperative aspiration after fully evaluated systematically, glottis closure during supraglottic horizontal partial laryngectomy is an effective strategy to prevent aspiration and to facilitate safe oral intake.

Objective To observe the value of immediate CT-guided small negative pressure thoracic drainage for pneumothorax after percutaneous lung biopsy(PTLB).Methods Totally 172 patients of unilateral pneumothorax after PTLB were retrospectively enrolled,including 83 patients underwent immediate CT-guided small negative pressure(about 30 mmHg)thoracic drainage after PTLB(group A)and 89 patients underwent bedside closed thoracic drainage after PTLB(group B).Clinical data before treamtent,degree of pneumothorax,the duration of catheterization,pain degree during catheterization(visual analogue scale[VAS]),blood oxygen saturation after treatment,the ratio of immediate relief of clinical symptoms,duration of drainage retention,duration of hospitalization after treatment and the occurrence of pleural reaction were compared between groups.Results Drainage went smoothly in both groups.No significant difference of clinical data before treatment nor pneumothorax degree was found between groups(all P＞0.05).Compared with those in group B,the duration of catheterization was shorter,and pain degree was lower during drainage in group A(both P＜0.001).After drainage,blood oxygen saturation and the proportion of immediate relief of clinical symptoms in group A were both higher than those in group B,while the duration of drainage retention and hospitalization were both shorter in group A than those in group B(all P＜0.001).Pleural reaction occurred in 2 patients in group A and 1 patient in group B,and no significant difference of pleural reaction was detected between groups(P=0.520).Conclusion Immediate CT-guided small negative pressure thoracic drainage was effective and safe for pneumothorax after PTLB.

Objective:To investigate anxiety symptoms and associated factors in relocated elderly residents of new townships,and to provide evidence for prevention interventions.Methods:A cross-sectional study was conduc-ted in relocated elderly residents in new townships of three urban areas in Shandong Province from 2021 to 2023.The study instruments included Ascertain Dementia-8,Generalized Anxiety Disorder-7,self-administered de-mographic characteristics information questionnaire.Multivariate analysis of factors associated with anxiety symp-toms in elderly residents was performed using multivariate logistic regression.Results:The prevalence rate of mild anxiety symptoms was 5.8％,and the rate of moderate-to-severe anxiety symptoms was 1.3％in 3 313 resi-dents.Multivariate analysis found that self-assessed general psychological condition(OR=0.52),good family envi-ronment(OR=0.34),no self-perceived cognitive impairment(OR=0.31),no chronic diseases(OR=0.42),and only one chronic disease(OR=0.61)were protective factors for mild anxiety symptoms,and very good dietary structure(OR=2.15)and fair dietary structure(OR=2.39)were risk factors for those.Very good family environ-ment(OR=0.11)and average family environment(OR=0.16),and no self-perceived cognitive impairment(OR=0.14)were protective factors for moderate-to-severe anxiety symptoms,and 0-3 years(OR=3.24)and 4-6 years(OR=3.28)of relocation were risk factors for those.Conclusion:Family environment,dietary structure,and duration since relocation are key factors associated with anxiety symptoms among relocated elderly residents in new townships.Targeted interventions should be implemented to address their mental health needs.

Objective To observe the value of immediate CT-guided small negative pressure thoracic drainage for pneumothorax after percutaneous lung biopsy(PTLB).Methods Totally 172 patients of unilateral pneumothorax after PTLB were retrospectively enrolled,including 83 patients underwent immediate CT-guided small negative pressure(about 30 mmHg)thoracic drainage after PTLB(group A)and 89 patients underwent bedside closed thoracic drainage after PTLB(group B).Clinical data before treamtent,degree of pneumothorax,the duration of catheterization,pain degree during catheterization(visual analogue scale[VAS]),blood oxygen saturation after treatment,the ratio of immediate relief of clinical symptoms,duration of drainage retention,duration of hospitalization after treatment and the occurrence of pleural reaction were compared between groups.Results Drainage went smoothly in both groups.No significant difference of clinical data before treatment nor pneumothorax degree was found between groups(all P＞0.05).Compared with those in group B,the duration of catheterization was shorter,and pain degree was lower during drainage in group A(both P＜0.001).After drainage,blood oxygen saturation and the proportion of immediate relief of clinical symptoms in group A were both higher than those in group B,while the duration of drainage retention and hospitalization were both shorter in group A than those in group B(all P＜0.001).Pleural reaction occurred in 2 patients in group A and 1 patient in group B,and no significant difference of pleural reaction was detected between groups(P=0.520).Conclusion Immediate CT-guided small negative pressure thoracic drainage was effective and safe for pneumothorax after PTLB.

Objective To investigate the diagnostic and therapeutic value of single-use mother-baby choledochoscope-assisted endoscopic retrograde appendicitis therapy in the treatment of acute uncomplicated appendicitis.Methods A retrospective analysis was conducted on the clinical data of 39 patients with acute uncomplicated appendicitis who underwent single-use mother-baby choledochoscope-assisted endoscopic retrograde appendicitis treatment at the Endoscopy center of the hospital from September 2022 to September 2024.Observe the endoscopic manifestations,the rate of maternal and child basket stone removal,the rate of appendiceal stent implantation,the technical success rate,the clinical success rate,the operation time,the hospital stay,the incidence of complications,the visual analogue scale(VAS)score 6 hours after the operation,and the inflammatory indicators 24 hours after the operation.Results In 28 cases(71.8%),congestion and edema could be seen at the opening of the appendix under colonoscopy.In 10 cases(25.6%),pus could be seen flowing out of the opening of the appendix under colonoscopy.In 32 cases(82.1%),a large amount of pus could be seen in the lumen of the appendix under subscopy.In 20 cases(51.3%),appendiceal fecalith could be seen in the lumen of the appendix under subscopy.The technical success rate of single-use mother-baby choledochoscope-assisted endoscopic retrograde appendicitis treatment was 100.0%(39/39).The operation time was(21.08±7.49)min;Hospital stay:(3.97±2.08)days;Eight cases(20.5%)of patients underwent endoscopic maternal basket stone removal.Appendiceal stent implantation was performed in 14 cases(35.9%)of patients.The clinical success rate is 97.4%(38/39).One patient's clinical symptoms and inflammatory indicators did not improve after the operation,and was transferred to the surgery department for appendectomy.The VAS score of 38 patients was less than 3 points 6 hours after the operation,and the abdominal pain symptoms were significantly relieved.The white blood cell count and the percentage of neutrophils 24 hours after the operation decreased significantly compared with those before the operation,and the differences were statistically significant(P<0.05).None of the 39 patients had complications.The postoperative follow-up was(5.94±4.03)months,and recurrence occurred in 3 cases(7.7%).Conclusion single-use mother-baby choledocoscope-assisted endoscopic retrograde appendicitis therapy is safe and effective in the diagnosis and treatment of acute uncomplicated appendicitis,which is worthy of further promotion and popularization in clinical practice.

Objective:To investigate anxiety symptoms and associated factors in relocated elderly residents of new townships,and to provide evidence for prevention interventions.Methods:A cross-sectional study was conduc-ted in relocated elderly residents in new townships of three urban areas in Shandong Province from 2021 to 2023.The study instruments included Ascertain Dementia-8,Generalized Anxiety Disorder-7,self-administered de-mographic characteristics information questionnaire.Multivariate analysis of factors associated with anxiety symp-toms in elderly residents was performed using multivariate logistic regression.Results:The prevalence rate of mild anxiety symptoms was 5.8％,and the rate of moderate-to-severe anxiety symptoms was 1.3％in 3 313 resi-dents.Multivariate analysis found that self-assessed general psychological condition(OR=0.52),good family envi-ronment(OR=0.34),no self-perceived cognitive impairment(OR=0.31),no chronic diseases(OR=0.42),and only one chronic disease(OR=0.61)were protective factors for mild anxiety symptoms,and very good dietary structure(OR=2.15)and fair dietary structure(OR=2.39)were risk factors for those.Very good family environ-ment(OR=0.11)and average family environment(OR=0.16),and no self-perceived cognitive impairment(OR=0.14)were protective factors for moderate-to-severe anxiety symptoms,and 0-3 years(OR=3.24)and 4-6 years(OR=3.28)of relocation were risk factors for those.Conclusion:Family environment,dietary structure,and duration since relocation are key factors associated with anxiety symptoms among relocated elderly residents in new townships.Targeted interventions should be implemented to address their mental health needs.

Objective To investigate the diagnostic and therapeutic value of single-use mother-baby choledochoscope-assisted endoscopic retrograde appendicitis therapy in the treatment of acute uncomplicated appendicitis.Methods A retrospective analysis was conducted on the clinical data of 39 patients with acute uncomplicated appendicitis who underwent single-use mother-baby choledochoscope-assisted endoscopic retrograde appendicitis treatment at the Endoscopy center of the hospital from September 2022 to September 2024.Observe the endoscopic manifestations,the rate of maternal and child basket stone removal,the rate of appendiceal stent implantation,the technical success rate,the clinical success rate,the operation time,the hospital stay,the incidence of complications,the visual analogue scale(VAS)score 6 hours after the operation,and the inflammatory indicators 24 hours after the operation.Results In 28 cases(71.8%),congestion and edema could be seen at the opening of the appendix under colonoscopy.In 10 cases(25.6%),pus could be seen flowing out of the opening of the appendix under colonoscopy.In 32 cases(82.1%),a large amount of pus could be seen in the lumen of the appendix under subscopy.In 20 cases(51.3%),appendiceal fecalith could be seen in the lumen of the appendix under subscopy.The technical success rate of single-use mother-baby choledochoscope-assisted endoscopic retrograde appendicitis treatment was 100.0%(39/39).The operation time was(21.08±7.49)min;Hospital stay:(3.97±2.08)days;Eight cases(20.5%)of patients underwent endoscopic maternal basket stone removal.Appendiceal stent implantation was performed in 14 cases(35.9%)of patients.The clinical success rate is 97.4%(38/39).One patient's clinical symptoms and inflammatory indicators did not improve after the operation,and was transferred to the surgery department for appendectomy.The VAS score of 38 patients was less than 3 points 6 hours after the operation,and the abdominal pain symptoms were significantly relieved.The white blood cell count and the percentage of neutrophils 24 hours after the operation decreased significantly compared with those before the operation,and the differences were statistically significant(P<0.05).None of the 39 patients had complications.The postoperative follow-up was(5.94±4.03)months,and recurrence occurred in 3 cases(7.7%).Conclusion single-use mother-baby choledocoscope-assisted endoscopic retrograde appendicitis therapy is safe and effective in the diagnosis and treatment of acute uncomplicated appendicitis,which is worthy of further promotion and popularization in clinical practice.

Objective:To evaluate the analgesic effect of intercostal muscle plane block of external oblique muscle in patients undergoing endoscopic pancreaticoduodenectomy.Methods:A total of 48 patients undergoing endoscopic pancreaticoduodenectomy under elective general anesthesia in Nanjing First Hospital from February to July 2023 were prospectively selected and divided into two groups ( n=24) according to random number table method: abdominal external oblique intercostal muscle plane block combined with general anesthesia group (EG group) and general anesthesia group (G group). The EG group was blocked in the intercostal muscle plane of the external oblique muscle before general anesthesia induction, and 0.375% ropivacaine 20 ml was injected on both sides, respectively. Patient-controlled intravenous analgesia (PCIA) was performed in both groups after operation, and the pain Visual Analogue Scale (VAS) score was less than 4 points. When the VAS score was ≥4, 1 mg oxycodone was injected intravenously for relief and analgesia. VAS scores at 30 min (T 0), 6 h (T 1), 12 h(T 2), 24 h(T 3), 48 h(T 4) after extubation, intraoperative drug and fluid dosage, postoperative sleep quality, analgesic satisfaction score, remedial analgesia and the occurrence of adverse reactions were recorded. Results:The scores of rest and exercise VAS at T 0, T 1, T 2, T 3 and T 4 in the EG group were significantly lower than those in the G group (all P<0.05). The dosage of norepinephrine, propofol, remifentanil and total fluid infusion in the EG group were significantly lower than those in the G group (all P<0.05). The sleep quality and analgesic satisfaction of the EG group were better than those of the G group (all P<0.05), the first time of PCIA compression after surgery was longer than that of the G group ( P<0.05), the number of effective compressions, the amount of oxycodone relief and analgesia, the proportion of nausea and vomiting, and the stay time of anesthesia intensive care unit (AICU) were lower than those of the G group (all P<0.05). There was no significant difference in total hospital stay between the two groups ( P>0.05). Conclusions:Compared with general anesthesia alone, abdominal external oblique intercostal muscle plane block combined with general anesthesia in patients with endoscopic pancreaticoduodenectomy has significant postoperative analgesia effect, which can not only reduce postoperative VAS score and opioid consumption, but also improve sleep quality and increase postoperative analgesia satisfaction. Ultrasound-guided intercostal muscle plane block of external oblique muscle can be used as a better analgesic method in endoscopic pancreaticoduodenectomy.

Preoperative planning, a prerequisite for proper implementation of laparoscopic anatomical hepatectomy, mainly includes individual vascular territorial analysis, determination of surgical approach, confirmation of anatomical landmarks, and selection of techniques and insturments required. Understanding of the surgery-related anatomy of the liver is crucial for surgical planning. This review enumerates the limitations of the existing Couinaud’s segmentation and proposes a novel liver segmentation method according to subsegmental characteristics of inflow and outflow pathways of the liver based on 3D image reconstruction. We also aim to evaluate the surgical approaches and key anatomical landmarks of each subsegment in its surgical planning for anatomial resection.

Background::Atopic dermatitis (AD) is a chronic inflammatory skin disorder impacting populations worldwide, although its clinical characteristics and patient demographics remain uncharacterized in China. The aim of this study was to investigate the demographics, comorbidities, aggravating factors, and treatments in AD patients across different age groups in China.Methods::This cross-sectional study included Chinese AD patients from 205 hospitals spanning 30 provinces. Patients completed dermatologist-led surveys of general medical history, comorbidities, AD-related aggravating factors, and medications. Two-level mixed-ordered logistic regression was used to evaluate aggravating factors.Results::Overall, 16,838 respondents were included in the final analysis (aged 30.9 ± 24.1 years). The proportion of severe AD was the highest in patients with AD onset at ≥60 years (26.73%). Allergic rhinitis and hypertension were the most common atopic and metabolism-related non-atopic comorbidities, respectively. AD severity was significantly associated with chronic urticaria, food allergies, and diabetes. Aggravating factors including foods, seasonal changes, and psychological factors were also linked to AD severity. The cross-sectional survey implied that severe AD may be related to the undertreatment of effective systemic or topical interventions.Conclusion::To enhance the management of AD, it is crucial to consider both aggravating factors and the increased utilization of systemic immunotherapy.Registration::ClinicalTrials.gov, NCT05316805