Objective:To evaluate the effect of the degree of neuromuscular blockade on the intraoperative surgical conditions and postoperative recovery quality in patients undergoing lumbar interbody fusion.Methods:In this randomized controlled trial, 100 patients of either sex, aged 18-79 yr, with a body mass index of 18.5-35.0 kg/m 2, of American Society of Anesthesiologists Physical Status classification < Ⅳ, scheduled for elective lumbar interbody fusion at the Affiliated Hospital of Xuzhou Medical University from August to October 2024, were allocated into 2 groups ( n=50 each) using stratified randomization based on the number of lumbar segments: deep neuromuscular blockade group (group D) and moderate neuromuscular blockade group (group M). The intraoperative post-tetanic count was maintained at 1 or 2 in group D, and the intraoperative train-of-four was maintained at 1 or 2 in group M. The scores for surgical conditions, duration of operation, blood loss, length of incision, occurrence of severe hypoxemia after extubation, requirement for rescue analgesia in post-anesthesia care unit, 15-item Quality of Recovery scale score and length of stay were recorded. Results:Compared with group M, the scores for surgical conditions were significantly increased, the rate of rescue analgesia in post-anesthesia care unit was decreased, 15-item Quality of Recovery scale scores were increased at 3 days after surgery ( P<0.05), and no significant changes were found in the duration of operation, blood loss, length of incision, incidence of severe hypoxemia after extubation and length of hospital stay in group D ( P>0.05). Conclusions:Compared with moderate neuromuscular blockade, deep neuromuscular blockade can provide better surgical conditions and improve the quality of early postoperative recovery for patients undergoing lumbar interbody fusion.

Objective:To summarize the technical difficulties, key points and cosmetic effects of Ti-loop patch application in breast shaping of immediate reconstruction with omental flap transplantation after mastectomy.Methods:The clinical data of 90 cases with breast cancer who underwent immediate breast reconstruction by using laparoscopically harvested omental flap alone or combined with prosthesis after nipple and areola complex sparing mastectomy from May. 2020 to Jan. 2023 in Hunan Cancer Hospital was retrospectively analyzed. All patients were female between 16 and 55 years old with the average age of 42. Their courses of the disease range from 5 to 26 months with the mean of 15.5 months. These patients received mastectomy with conservation of nipple and areola, and then the greater omentum with right pedicle were harvested laparoscopically. Ti-loop patch was used to hang and fix the greater omentum as a support. 27 patients accepted immediate breast reconstruction with pedicled greater omentum alone, while 63 subjects with greater omentum and gel prosthesis. Among them, contralateral breast contraction and lift was operated on 9 cases.Results:All the pedicled greater omentum successfully survived, and wound surfaces of donor and recipient sites healed at stage I. Axillary lymph node dissection and postoperative radiotherapy were performed on 14 patients with positive pathological examination of sentinel lymph nodes. Breasts of two patients were found to be smaller after postoperative radiotherapy. All 90 subjects were followed up for 5 to 32 months, and the average follow-up period was 16.4 months. The reconstructed breasts were good in shape and tactile sensation. Only punctate scars were observed in donor sites of abdomen. All patients recovered with no upper limb lymphedema, no short and long term complications in abdomen, and only one patient had papillary recurrence without distant metastasis.Conclusions:The omental flap is hard to be sutured and shaped in the reconstructed breast, while easily to be avulsed and form hematoma. The application of Ti-loop patch, which could semi-surround and wrap the greater omentum, and suspend and fix it on the chest wall in upper pole of the breast as a support, can significantly improve the reconstruction effect.

Objective:To summarize the technical difficulties, key points and cosmetic effects of Ti-loop patch application in breast shaping of immediate reconstruction with omental flap transplantation after mastectomy.Methods:The clinical data of 90 cases with breast cancer who underwent immediate breast reconstruction by using laparoscopically harvested omental flap alone or combined with prosthesis after nipple and areola complex sparing mastectomy from May. 2020 to Jan. 2023 in Hunan Cancer Hospital was retrospectively analyzed. All patients were female between 16 and 55 years old with the average age of 42. Their courses of the disease range from 5 to 26 months with the mean of 15.5 months. These patients received mastectomy with conservation of nipple and areola, and then the greater omentum with right pedicle were harvested laparoscopically. Ti-loop patch was used to hang and fix the greater omentum as a support. 27 patients accepted immediate breast reconstruction with pedicled greater omentum alone, while 63 subjects with greater omentum and gel prosthesis. Among them, contralateral breast contraction and lift was operated on 9 cases.Results:All the pedicled greater omentum successfully survived, and wound surfaces of donor and recipient sites healed at stage I. Axillary lymph node dissection and postoperative radiotherapy were performed on 14 patients with positive pathological examination of sentinel lymph nodes. Breasts of two patients were found to be smaller after postoperative radiotherapy. All 90 subjects were followed up for 5 to 32 months, and the average follow-up period was 16.4 months. The reconstructed breasts were good in shape and tactile sensation. Only punctate scars were observed in donor sites of abdomen. All patients recovered with no upper limb lymphedema, no short and long term complications in abdomen, and only one patient had papillary recurrence without distant metastasis.Conclusions:The omental flap is hard to be sutured and shaped in the reconstructed breast, while easily to be avulsed and form hematoma. The application of Ti-loop patch, which could semi-surround and wrap the greater omentum, and suspend and fix it on the chest wall in upper pole of the breast as a support, can significantly improve the reconstruction effect.

Objective:To evaluate the effect of the degree of neuromuscular blockade on the intraoperative surgical conditions and postoperative recovery quality in patients undergoing lumbar interbody fusion.Methods:In this randomized controlled trial, 100 patients of either sex, aged 18-79 yr, with a body mass index of 18.5-35.0 kg/m 2, of American Society of Anesthesiologists Physical Status classification < Ⅳ, scheduled for elective lumbar interbody fusion at the Affiliated Hospital of Xuzhou Medical University from August to October 2024, were allocated into 2 groups ( n=50 each) using stratified randomization based on the number of lumbar segments: deep neuromuscular blockade group (group D) and moderate neuromuscular blockade group (group M). The intraoperative post-tetanic count was maintained at 1 or 2 in group D, and the intraoperative train-of-four was maintained at 1 or 2 in group M. The scores for surgical conditions, duration of operation, blood loss, length of incision, occurrence of severe hypoxemia after extubation, requirement for rescue analgesia in post-anesthesia care unit, 15-item Quality of Recovery scale score and length of stay were recorded. Results:Compared with group M, the scores for surgical conditions were significantly increased, the rate of rescue analgesia in post-anesthesia care unit was decreased, 15-item Quality of Recovery scale scores were increased at 3 days after surgery ( P<0.05), and no significant changes were found in the duration of operation, blood loss, length of incision, incidence of severe hypoxemia after extubation and length of hospital stay in group D ( P>0.05). Conclusions:Compared with moderate neuromuscular blockade, deep neuromuscular blockade can provide better surgical conditions and improve the quality of early postoperative recovery for patients undergoing lumbar interbody fusion.

This article reports a case of acute kidney injury (AKI) following near drowning with reduced urine output as the main manifestation. The patient was a 37-year-old middle-aged man. His renal function deteriorated sharply after accidentally falling into the water, and renal pathology showed acute tubular injury. After hemodialysis treatment, urine output increased significantly, and renal function and proteinuria improved significantly. AKI following near drowning lacks typical clinical manifestations and is prone to delayed diagnosis and treatment. The patients with a history of near drowning should be followed up to determine whether they are complicated by AKI.

Objective To investigate the correlation of human epididymis protein 4(HE4)with proteinuria in patients with type 2 diabetes mellitus(T2DM).Methods A total of 147 T2DM patients from January 2020 to July 2023 in Jiujiang NO.l People's Hospital were enrolled in observation group.According to the severity of proteinuria,observation group was divided into three groups:Normal albuminuria group(101 cases),microalbuminuria group(25 cases),and massive albuminuria group(21 cases).50 healthy examinees with gender and age matching during the same period were selected as control group.HE4 levels and clinical indicators in each group were compared and analyzed.Correlation between HE4 and proteinuria was analyzed by using univariate and multivariate linear regression.Results The correlation network diagram reveals that HE4 functions was a pivotal node linking serum albumin,urinary microalbumin,urinary microalbumin-to-creatinine ratio(UACR),and renal function biomarkers.Compared to control group,HE4 levels significantly elevated in observation group(P＜0.01).Both univariate and multivariate linear regression analysis demonstrate a positive correlation between HE4 and UACR.Logistic regression analysis shew that after adjusting for confounding factors including age,gender,estimated glomerular filtration rate(eGFR),albumin(ALB),blood urea nitrogen(BUN),serum creatinine(SCr),uric acid(UA),lactate dehydrogenase(LDH)etc.elevated HE4 levels was a risk factor for proteinuria(OR=1.110,95％CI:1.005-1.226).Conclusion Elevated HE4 levels in patients with T2DM is positivly correlated with UACR.Increase its level increases the risk of proteinuria in T2DM patients.

Objective: To investigate the application value of magnetic resonance imaging (MRI) in the classification diagnosis of rectal mucinous adenocarcinoma. Methods: The retrospective and descriptive study was conducted. The clinical data of 74 patients with rectal mucinous adenocarcinoma who were admitted to Chongqing Traditional Chinese Medicine Hospital from July 2009 and February 2019 were collected. There were 40 males and 34 females, aged (46±8)years, with a range from 32 to 82 years. Among the 74 patients, 41 were simple mucinous adenocarcinoma, 26 were partial mucinous adenocarcinoma, and 7 were focal or small foci mucinous adenocarcinoma. All patients underwent MRI plain scan and dynamic enhanced scan. Observation indicators: (1) morphology of rectal mucinous adenocarcinoma; (2) the lesion margin of rectal mucinous adenocarcinoma; (3) the value of apparent diffusion coefficient (ADC) of rectal mucinous adenocarcinoma; (4) internal enhancement features of rectal mucinous adenocarcinoma; (5) timesignal intensity curve of rectal mucinous adenocarcinoma. Measurement data with normal distribution were represented as Mean±SD, and count data were described as absolute numbers. Results: (1) Morphology of rectal mucinous adenocarcinoma: 74 patients had different morphological changes. Among the 41 cases of simple mucinous adenocarcinoma, 22 were oval, 8 were round, and 11 were irregular. Among the 26 patients with partial mucinous adenocarcinoma, 15 were oval, 8 were round and 3 were irregular. Among the 7 patients with focal or small foci mucinous adenocarcinoma, 2 were oval, 1 was round and 4 were irregular. (2) The lesion margin of rectal mucinous adenocarcinoma: the lesion margin of 74 patients was mainly unclear and irregular. Among the 41 cases of simple mucinous adenocarcinoma, 32 had unclear and irregular margin, 7 had clear margin, and 2 had unclear margin combined with fissure. Among the 26 cases of partial mucinous adenocarcinoma, 20 had unclear margin combined with fissure, 5 had unclear margin and irregular margin, and 1 had clear margin. Among the 7 patients with focal or small foci mucinous adenocarcinoma, 5 had unclear or irregular margin, 1 had unclear or irregular margin, and 1 had clear margin. (3) The value of ADC of rectal mucinous adenocarcinoma: diffusion weighted imaging of 74 patients showed diffused limited changes. The average ADC value was (1.24±0.23)×10^-3 mm²/s of 41 patients with simple mucinous adenocarcinoma, (0.91±0.42)×10^-3 mm²/s of 26 patients with partial mucinous adenocarcinoma, and (1.07±0.24)×10^-3 mm²/s of 7 patients with focal or small mucinous adenocarcinoma. (4) Internal enhancement features of rectal mucinous adenocarcinoma: 74 patients showed delayed heterogeneous enhancement and marginal enhancement. Among 41 cases of simple mucinous adenocarcinoma, 24 showed delayed heterogeneous enhancement, 17 showed marginal enhancement, and none showed homogeneous enhancement. Among 26 patients with partial mucinous adenocarcinoma, 20 showed marginal enhancement, 6 showed homogeneous enhancement, and none showed heterogeneous enhancement. All the 7 cases of focal or small foci mucinous adenocarcinoma showed heterogeneous enhancement. (5) Timesignal intensity curve of rectal mucinous adenocarcinoma: 74 patients showed mainly outflow type in the timesignal intensity curve. Among the 41 cases of simple mucinous adenocarcinoma, 22 presented progressive curve, 12 presented platform type, and 7 presented outflow type. Among the 26 patients with partial mucinous adenocarcinoma, 17 presented outflow type, 8 presented platform type, and 1 presented progressive type. Among the 7 patients with focal and small forci mucinous adenocarcinoma, 4 presented outflow type, 2 presented platform type, and 1 presented progressive type. Conclusions MRI findings show different results for different types of rectal mucinous adenocarcinoma. A correct understanding of the MRI features of different types of rectal mucinous adenocarcinoma is helpful for the classification diagnosis of rectal mucinous adenocarcinoma.

Objective: To investigate the efficacy of Kinesio taping combined with warm needling on knee osteoarthritis (KOA) and its effect on serum levels of immune globulin(Ig)A, IgG, IgM. Methods: Sixty-two KOA patients who met the inclusion criteria were divided into 2 groups by random number table (31 cases in each group). The control group was treated with routine thrapy. Based on the control group, the observation group was treated with Kinesio taping combined with warm needling. After 6 weeks treatment, scores of visual analogue scale (VAS) was used to evaluate knee pain, Japanese orthopaedic association (JOA) scale was used to evaluate knee function, and Lequesne index was used to evaluate disease severity. The score of TCM clinical symptoms was conducted according to the KOA symptom grading quantification table, and the quality of life was evaluated according to the Chinese version of the MOS item short from health survey (SF-36). The Immunoglobulin(Ig)A, IgG and IgM levels were detected by ELISA method. Results: The total effective rate in the observation group was 93.5%, and the control group was 71.0% (28/31). The difference was statistically significant between two groups (χ²=5.415, P=0.020).The total effective rate of clinical symptoms in traditional Chinese medicine in the observation groups as 90.3% (28/31) was higher than the control group as 64.5% (20/31), and the difference was statistically significant (χ²=5.905, P=0.015). After treatment, the serum level of IgA (2.91 ± 0.35 ng/ml vs. 4.50 ± 0.50 ng/ml, t=7.621), IgG (11.17 ± 1.31 pmol/L vs. 15.83 ± 1.94 pmol/L, t=13.523), IgM (3.14 ± 0.44 pmol/L vs. 5.44 ± 0.62 pmol/L, t=8.441) were significantly lower than control group (P<0.01). After 6 weeks’ treatment, tthe scores of VAS, Lequesne index, and clinical symptom of traditional Chinese medicin of the observation group were significant lower than those of the control group (t=7.765 and 9.903 respectively, all Ps<0.01), but the scores of JOA and the SF-36 were significantly higher than those of the control group (t=18.441, P<0.01). After 6 weeks’ treatment, the scores of pain in bed at night, morning stiffness, walking pain, pain from sitting up, maximum walking distance, daily activities, walking up stairs, walking down stairs, bending knee joint score in the observation group were significantly lower than those in the control group (t=8.933, 9.112, 9.225, 8.809, 9.240, 8.910, 7.903, 8.033, 7.031, respectively, all Ps<0.01), but the scores of physical pain, physiological function, physiological function, vitality, social function, emotional function, mental health in the observation group were significantly higher than those in the control group (t=12.450, 13.446, 13.779, 9.003, 13.331, 12.440, 15.309, all Ps<0.01). Conclusions The kinesio taping combined with warm needling can improve symptoms of traditional Chinese medicine and reduce pain of KOAand increase quality of life with the regulation of IgA, IgG, IgM.

Objective To observe the clinical characteristic and prognosis of primary lung cancer patients with venous thromboembolism (VTE).Methods 589 primary lung cancer patients were selected and divided into VTE group(n =49) and non VTE group(n =540).49 cases with VTE were divided into pulmonary thromboembolism (PTE) group(n =15),including single PTE and PTE combined with deep venous thrombosis(DVT) and DVT group (n =34).Single factor and multiple logistic regression analysis were performed to determine the factors influencing primary lung cancer patients with VTE.Clinical manifestation,time of onset and prognosis of patients with VTE were analyzed.Results 49 patients with VTE included 10 patients(20.4％) with single PTE,34 patients(69.4％) with single DVT and 5 PTE patients combined with DVT(10.2％).D-dimer(OR =1.560,95％ CI =1.018 ～ 2.392,x2 =4.161,P =0.041),interleukin-1 (IL-1,OR =1.846,95％ CI =1.054-3.234,x2 =4.594,P =0.033),tumor necrosis factor (TNF OR =1.486,95％ CI =1.014-2.178,x2 =4.126,P =0.042),adenocarcinoma (OR =2.854,95％CI=1.217-6.695,x2 =5.812,P=0.016) and phase Ⅲ-Ⅳ(OR =2.198,95％CI=1.122-4.305,x2 =5.272,P =0.022) were the factors influencing primary lung cancer patients with VTE.Chest tightness,coughing,accelerated heart rate,swelling and pain in lower limb were common clinical manifestations of primary lung cancer patients with VTE.Most patients with VTE occurred within 3 months after a diagnosis of primary lung cancer.There was no significant difference in the time of onset between PTE group and DVT group(P ＞0.05).As of July 2014,31 cases (63.2％) died,12 cases (24.5 ％) survived,and 6 cases (12.2％) lost in 49 patients with VTE.The median survival time of 49 patients with VTE was 9.5 months.The median survival time of PTE group was 5.8 months,while DVT group was 15.2 months,but no significant difference between them (P ＞ 0.05).Conclusion Increased D-dimer,increased IL-1,increased TNF,adenocarcinoma and phase Ⅲ-Ⅳ could increase the risk of primary lung cancer patients with VTE.There were little typical.clinical symptoms in most patients with VTE,which occurred with in 3 months after a diagnosis of primary lung cancer.They had high mortality and needed to take early diagnosis and treatment through auxiliary examination.

Objective To investigate the effect of baicalin on inflammatory factors and oxygen free radical metabolism in patients with traumatic shock.Methods 38 patients with traumatic shock were treated with baicalin 200mg intravenous injection when admitted to hospital.Before and 1 h after treatment,TNF-α,IL-6,IL-8,MDA and SOD were measured in blood.Results Compared with before treatment,TNF-,IL-6,IL-8,and MDA levels were decreased after treatment (t =7.32,6.12,20.21,16.10,all P ＜ 0.05),while SOD activity was significantly increased (t =1.69,P ＜ 0.01).Conclusion Baicalin could inhibit the production and release of inflammatory factors TNF-α,IL-6,IL-8 in patients with traumatic shock,reduce the damage of oxygen free radicals to the cells.Early treatment with baicalin had protective effect on patients with traumatic shock.