Objective:To evaluate the efficacy of angiogenesis inhibitors and poly ADP-ribose polymerase (PARP) inhibitors in the treatment of recurrent ovarian cancer using a mesh meta-system.Methods:Subject terms were used to search Pubmed, Embase, the Cochrane Library and web of science databases to collect randomized controlled trials related to angiogenesis inhibitors and PARP inhibitors in the treatment of recurrent ovarian cancer. The search time was established until January 1, 2024. Outcome measures included progression-free survival (PFS) and overall survival (OS). Bias risk assessment was performed using Revman 5.4 software and mesh meta-analysis was performed using gemtc package in R 4.3.1 software.Results:34 randomized controlled trials were included in the PFS and 26 in the OS. Olaparib ( HR=0.63, 95% CI: 0.40-0.99), rucaparib ( HR=0.48, 95% CI: 0.24-0.99), niraparib ( HR=0.49, 95% CI: 0.26-0.93), niraparib+ bevacizumab ( HR=0.17, 95% CI: 0.05-0.61), chemotherapy+ bevacizumab+ maintenance bevacizumab ( HR=0.54, 95% CI: 0.3-0.97) and chemotherapy+ bevacizumab ( HR=0.50, 95% CI: 0.31-0.81) had longer PFS than conventional platinum-based chemotherapy/chemotherapy+ placebo. Niraparib+ bevacizumab had the longest PFS of all pharmacological interventions. Chemotherapy plus bevacizumab ( HR=0.72, 95% CI: 0.57 -0.88) had a longer OS than conventional platinum-based chemotherapy/chemotherapy plus placebo. Conclusions:There is limited evidence that angiogenesis inhibitors alone (bevacizumab) or PARP inhibitors alone (niraparib, olaparib, and rucaparib) can improve PFS or OS in recurrent ovarian cancer, and that the combination of angiogenesis inhibitors and PARP inhibitors may be more beneficial in prolonging PFS or OS in recurrent ovarian cancer.

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.

Objective:To investigate the relationship between propofol anesthesia maintenance and cerebral tissue edema after craniotomy and its protective effect on the brain.Methods:A total of 98 patients who received craniotomy in the Second Affiliated Hospital of Air Force Medical University from June 2022 to June 2023 were selected and divided into control group and observation group according to random number table method, with 49 cases in each group. Sevoflurane was inhaled to maintain anesthesia in the control group after tracheal intubation, and propofol was injected intravenously into the observation group after tracheal intubation. The indexes were compared between the two groups in terms of dynamic changes of cerebral tissue edema, intracranial pressure, brain injury factors [S100 calcified protein β (S100-β), neuron-specific enolase (NSE), glial fibrillary acidic protein (GFAP)], cerebral oxygen metabolism indexes [arterial blood oxygen content (AVDO 2), arterial blood lactic acid (AVDL), cerebral oxygen metabolism rate (CMRO 2)], oxidative stress indicators [malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px)]. Results:There were no significant differences in the degree of cerebral tissue edema, intracranial pressure, brain injury factors, cerebral oxygen metabolism indexes and oxidative stress indexes between the two groups (all P>0.05). There were significant differences in the degree of cerebral tissue edema, intracranial pressure, brain injury factors, cerebral oxygen metabolism indexes and oxidative stress indexes between the two groups after surgery (all P<0.05). The degree of cerebral edema in the observation group at 24 h and 72 h after operation was less than that in the control group, and the difference was statistically significant (all P<0.05). The intracranial pressure after craniotomy, before skull reduction and after operation in the observation group was lower than that in the control group, with statistical significance (all P<0.05). The serum levels of S100-β, NSE, GFAP in observation group were lower than those in the control group after craniotomy, before skull reduction and after operation, and the difference was statistically significant ( P<0.05). AVDO 2, AVDL, CMRO 2 of the observation group after craniotomy, before skull reduction and after surgery were better than those of the control group, with statistical significance (all P<0.05). In terms of oxidative stress indexes after craniotomy, before skull reduction and after surgery, MDA levels in observation group were lower than those in control group, while SOD and GSH-Px levels were higher than those in control group, the differences were statistically significant (all P<0.05). Conclusions:Propofol anesthesia maintenance can alleviate cerebral tissue edema after craniotomy, reduce intracranial pressure, reduce the release of brain injury factors, improve cerebral oxygen metabolism, enhance antioxidant capacity, and significantly protect the brain of patients.

Objective:To investigate the changes of serum helper T cell 1 (Th1)/helper T cell 2 (Th2) cytokines in patients with idiopathic oligonasthenospermia (IO).Methods:A total of 136 patients with IO admitted to the Xianyang Central Hospital from January 2020 to June 2022 were prospectively selected and divided into mild to moderate group (86 cases) and severe group (50 cases) according to the severity of IO. Another 60 healthy males were selected as normal control group. Baseline data, serum Th1 and Th2 cytokines [interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α) and interleukin (IL)-2, IL-4, IL-6, IL-10, IL-21] of the three groups were compared. Spearman correlation analysis was used to evaluate the correlation between IFN-γ, TNF-α, IL-2, IL-4, IL-6, IL-10, IL-21 and the severity of IO disease.Results:The sperm concentration, total sperm and percentage of forward motile sperm in severe group were lower than those in mild to moderate group and normal control group (all P<0.05), and the sperm concentration, total sperm and percentage of forward motile sperm in mild to the moderate group were lower than those in the normal control group (all P<0.05). The serum levels of Th1 cytokines IFN-γ, TNF-α, IL-2 and IL-21 in severe group were higher than those in the mild-moderate group and the normal control group (all P<0.05), and the serum levels of Th1 cytokines IFN-γ, TNF-α, IL-2 and IL-21 in mild-moderate group were higher than those in the normal control group (all P<0.05). The serum levels of Th2 cytokines IL-4, IL-6 and IL-10 in severe group were higher than those in the mild-moderate group and the normal control group (all P<0.05), and the serum levels of Th2 cytokines IL-4, IL-6 and IL-10 in mild-moderate group were higher than those in the normal control group (all P<0.05). Spearman correlation analysis showed that the severity of IO disease was positively correlated with the levels of serum Th1 cytokines (IFN-γ, TNF-α, IL-2, IL-21) and serum Th2 cytokines (IL-4, IL-6, IL-10) (all P<0.001). Conclusions:The Th1/Th2 immune imbalance in patients with IO is aggravated with the increase of disease severity. Early diagnosis and treatment of IO should be strengthened to prevent disease progression.

Objective:To investigate the effects of remifentanil and fentanyl combined with propofol intravenous anesthesia on hemodynamics and quality of anesthesia recovery in children undergoing laparoscopic surgery for oblique inguinal hernia.Methods:A total of 98 children with oblique inguinal hernia admitted to the Urumqi First People′s Hospital from January 2022 to January 2023 were selected as the study objects, and randomly divided into control group and observation group with 49 cases in each group according to the 1∶1 ratio number list method. The control group received fentanyl+ propofol anesthesia, and the observation group received remifentanil+ propofol anesthesia. The hemodynamics, quality of anesthesia recovery, stress response indexes and adverse reactions were compared at different time points between the two groups.Results:The recovery time and extubation time of the observation group were shorter than those of the control group ( P<0.05). There was no significant difference in Steward and 15-item Recovery Quality Scale (QoR-15) scores between the two groups (all P>0.05). The scores of Steward, QoR-15 and revised Wang Baker Facial Expression Pain Assessment Scale (FPSR) in both groups were higher than those in the recovery room and 24 h after surgery, and the scores of Steward and QoR-15 in the observation group were higher than those in the control group at the recovery room and 24 h after surgery ( P<0.05). The FPSR scores of the observation group were lower than those of the control group at the time of recovery, exit from the recovery room and 24 h after operation (all P<0.05). There was no significant difference in mean arterial pressure and heart rate between the two groups at T 1 ( P>0.05). Compared with T 1, the mean arterial pressure and heart rate of T 2, T 3 and T 4 in both groups showed significant fluctuations (all P<0.05). Compared with the control group, the mean arterial pressure and heart rate of T 2, T 3 and T 4 in the observation group were significantly smaller (all P<0.05). There was no significant difference in T 1 stress response between the two groups (all P>0.05). The levels of epinephrine (E), C-reactive protein (CRP) and cortisol (Cor) in serum at T 2, T 3 and T 4 were higher than those at T 1 (all P<0.05). The levels of E, CRP and Cor in serum at T 2, T 3 and T 4 in the observation group were significantly lower than those in the control group (all P<0.05). The incidence of adverse reactions in the observation group was lower than that in the control group, and the difference was statistically significant (χ 2=4.159, P<0.05). Conclusions:Intravenous anesthesia with remifentanil combined with propofol can reduce the effect on hemodynamics, improve the quality of anesthesia recovery and alleviate the stress response of the body in children with laparoscopic oblique inguinal hernia.

Objective:To investigate the influencing factors of major adverse cardiovascular events (MACE) in maintenance hemodialysis (MHD) patients, and to construct and verify the nomogram.Methods:The clinical data of 240 patients with MHD admitted to the First Affiliated Hospital of Hebei North University from July 2022 to October 2023 were retrospectively analyzed. According to whether the patients had MACE, they were divided into two groups, namely the occurrence group (with MACE, n=55) and the non-occurrence group (without MACE, n=185). After comparing the clinical data of the two groups, The independent risk factors of MHD patients with MACE were screened by binary logistic regression analysis, and the risk nomogram prediction model was constructed according to the risk factors, and the prediction efficiency of the model was analyzed by Bootstrap method. Results:There were significant differences in age, dialysis age, hyperlipidemia, hyperuricemia and hemodialysis flux between the two groups (all P<0.05). Binary logistic regression model analysis showed that dialysis age >12 months, combined with hyperlipidemia, combined with hyperuricemia, and low throughput hemodialysis were independent risk factors for MHD patients with MACE (all P<0.05). The neomorph risk prediction model was constructed based on independent risk factors. The area under the curve (AUC) of the prediction model was 0.842(95% CI: 0.789-0.896), the specificity was 69.1%, the sensitivity was 89.7%, the cutoff value was 13.128, and the Yoden index was 0.588, suggesting that the accuracy of the model was good. Conclusions:Dialysis age >12 months, combined with hyperlipidemia, combined with hyperuricemia and low throughput hemodialysis are independent risk factors for MACE in MHD patients. Intervention and control of risk factors can reduce the incidence of MACE.

Objective:To compare the effect and complications of immediate and delayed restoration after immediate implantation in the anterior tooth region of elderly patients with periodontal disease.Methods:A total of 86 elderly patients with periodontal disease who underwent anterior dental restoration admitted to the Second People′s Hospital of Huai′an from February 2019 to August 2021 were prospectively selected and divided into observation group ( n=43) and control group ( n=43) according to the order of admission. Both groups received immediate implantation, the observation group received immediate repair after surgery, the control group received delayed repair after surgery. Both groups were followed up for 12 months after implantation. The soft tissue around the implant, White Aesthetic Score (WES), Pink Esthetic Score (PES), bone resorption value, implant success rate and complications were compared between the two groups. Results:One month after repair, periodontal probing depth (PD) in observation group was lower than that in the control group ( P<0.05), and modified sulcus bleeding index (mSBI) was higher than that in the control group ( P<0.05). At 3 months after repair, PD in both groups was lower than that at 1 month after repair (all P<0.05), and PD in the observation group was lower than that in the control group ( P<0.05), while mSBI in the observation group was lower than that at 1 month after repair ( P<0.05), and there was no statistical significance between the two groups ( P>0.05). Six months after repair, WES scores and PES scores in the observation group were higher than those in the control group ( P<0.05). At 6 months after repair, the bone resorption value of the observation group was lower than that of the control group ( P<0.05). At 12 months after repair, the bone resorption values of both groups were higher than those of 6 months after repair (all P<0.05), and there was no statistical significance in the bone resorption values of the two groups at 2 months after repair ( P>0.05). At 12 months after implantation, there was no significant difference in the success rate between the two groups ( P>0.05). The total incidence of complications in the observation group (6.98%, 3/43) was lower than that in the control group (27.91%, 12/43) ( P<0.05). Conclusions:Immediate repair and delayed repair are effective in the restoration of the anterior tooth region in elderly patients with periodontal disease. Compared with delayed repair, immediate repair can reduce the alveolar bone absorption of patients, improve the soft tissue health around the implant, have better aesthetic effects, and reduce the risk of complications.

Objective:To investigate the predictive value of serum N-terminal B-type natriuretic peptide precursor (NT-proBNP) and cardiac ultrasound parameters in patients with hypertrophic cardiomyopathy (HCM) complicated with pulmonary hypertension (PAH).Methods:A total of 280 patients with HCM admitted to the 960th Hospital of the Joint Logistics Support Force of Chinese People′s Liberation Army from September 2020 to September 2023 were selected as the study objects. Patients with PAH were set as the observation group ( n=116), and patients without PAH were set as the control group ( n=164). General data of the two groups of patients were collected, and the serum indexes [cardiac troponin I (cTnI), cardiac troponin T (cTnT), NT-proBNP, cardiac fatty acid binding protein (H-FABP)] and cardiac ultrasound indexes [left and right atrial diameter, left ventricular posterior wall thickness, left ventricular ejection fraction (LVEF) were measured. Pulmonary artery diameter (PAD), mitral valve E/e′ value, etc.]. Multivariate logistic regression analysis was used to study the factors affecting the occurrence of PAH in HCM patients, and a model for predicting PAH was developed based on these factors. The validity of the diagnostic model was evaluated by receiver operating characteristic (ROC) curve. Results:Serum NT-proBNP, left atrial diameter, right atrial diameter, left ventricular posterior wall thickness, PAD and pulmonary artery systolic pressure (PASP) in the observation group were higher than those in the control group, while LVEF was lower than that in the control group, with statistical significance (all P<0.05). Multivariate logistic analysis showed that NT-proBNP, left atrial diameter, right atrial diameter, left ventricular posterior wall thickness, LVEF, PAD and PASP were all influencing factors of HCM with PAH (all P<0.05). The model constructed with this factor predicted that the area under ROC curve of HCM patients with PAH was 0.991. Conclusions:NT-proBNP, atrial inner diameter, left ventricular posterior wall thickness, LVEF, PAD and PASP are all influential factors of PAH in HCM patients, and have high predictive value for the diagnosis of PAH.

Objective:To compare the effect of different plane block under general anesthesia combined with ultrasound guidance in laparoscopic radical gastrectomy for gastric cancer.Methods:A total of 160 patients with gastric cancer admitted to the Quzhou Hospital Affiliated to Wenzhou Medical University from June 2022 to September 2023 were selected and divided into control group and observation group by random number table method, with 80 cases in each group. All participants underwent general anesthesia. On this basis, the control group combined with ultrasonic-guided vertical spinal plane block (ESPB). The observation group was combined with ultrasound-guided quadratus lumbar block (QLB). The hemodynamics, stress response, pain degree, postoperative recovery time, adverse events and quality of recovery from anesthesia were compared between the two groups.Results:The mean arterial pressure (MAP) level at the time of skin incision (T 1) and lesion resection (T 2) in observation group was lower than that in control group, and the heart rate (HR) at the time of T 1, T 2 and after surgery (T 3) was lower than that in control group (all P<0.05). The levels of cortisol (Cor) and interleukin-6 (IL-6) in the observation group were lower than those in control group after anesthesia induction, 10 min after skin resection, 24 h after surgery (all P<0.05). The scores of Visual Analogue Scale (VAS) at rest and exercise at 2, 6, 12, 24 and 48 h in the observation group were lower than those in the control group (all P<0.05). The time of awakening, getting out of bed and anal exhaust in the observation group was shorter than that in the control group (all P<0.05). There was no significant difference in the incidence of adverse events between the observation group and the control group [11.25%(9/80) vs 16.25%(13/80), P>0.05]. The scores and total scores of 40-item Quality of Recovery Score (QoR-40) in the observation group were higher than those in the control group (all P<0.05). Conclusions:Compared with ultrasound-guided ESPB combined with general anesthesia, the application of ultrasound-guided QLB combined with general anesthesia in laparoscopic radical gastrectomy for gastric cancer can achieve better perioperative analgesia effect, which is conducive to stabilizing the hemodynamics of patients and alleviating the stress response of the body, and the postoperative recovery time of patients is shorter, which can improve the quality of anesthesia recovery of patients.

Objective:To investigate the screening, clinical and genetic characteristics and prognosis of hereditary tyrosinemia type Ⅰ (HT-Ⅰ) in some areas of Shanghai, and to summarize the relevant characteristics of Chinese cases reported at home and abroad.Methods:From December 2010 to May 2023, the clinical data of children diagnosed with HT-Ⅰ by tandem mass spectrometry combined with genetic detection in Neonatal Screening Center of Shanghai Children′s Hospital were retrospectively analyzed, and the relevant literature was reviewed.Results:A total of 282 149 neonates were screened for genetic metabolic disease by tandem mass spectrometry, and 1 case of HT-Ⅰ was diagnosed, with an incidence of 1∶282 149. Complex heterozygous mutations of FAH genes c. 974C>T and c. 22G>T were found by genetic testing. c. 22G>T was not reported as a new mutation. Diet and drug therapy were given immediately after diagnosis. At present, the follow-up was up to 8 months, and the physical and intellectual development were normal. A total of 32 literatures meeting the inclusion criteria were obtained through database search, and 46 cases of HT-Ⅰ Chinese children were reported. Most of the clinical manifestations were abdominal distension, poor appetite, jaundice, etc., accompanied by different degrees of abnormal coagulation function, hepatosplenomegalysis, cirrhosis and even liver failure. A total of 25 alleles were reported, and the variation of c. 455G>A was the most common. Conclusions:HT-Ⅰ is rare in the population of Shanghai, China, and new mutations enrich the variation spectrum of HT-Ⅰ, which provides basis for family genetic counseling and prenatal diagnosis of children.