OBJECTIVE To investigate the improvement mechanism of Huatan tongmai decoction on rats with polycystic ovary syndrome （PCOS） by regulating autophagy through phosphatidylinositol-3-kinase（PI3K）/protein kinase B（AKT）/mammalian target of rapamycin （mTOR） pathway. METHODS A total of 40 rats were randomly divided into blank group （purified water）， model group （purified water）， traditional Chinese medicine group [Huatan tongmai decoction， 24 g/（kg·d）] and chemical drug group [metformin， 0.16 g/（kg·d）]， with 10 rats in each group. Except for blank group， other groups were given a combination of high-fat diet and intragastric administration of 1 mg/kg letrozole suspension to establish PCOS rat model. After modeling， they were given relevant medicine or water intragastrically， once a day， for 42 consecutive days. After the last administration， the pathological and ultrastructural changes of ovarian tissue were observed. The levels of follicle stimulating hormone （FSH）， testosterone （T）， estradiol （E2） ，luteinizing hormone （LH） in serum were detected，and the LH/FSH ratio was calculated. mRNA expressions of Beclin-1， p62 and microtubule-associated protein 1 light chain 3 （LC3） in ovarian tissue were detected. The expressions of related proteins of PI3K/AKT/mTOR pathway and autophagy in rat ovarian tissues were also detected. RESULTS Compared with blank group， the pathological damage and ultrastructural changes of the ovarian tissue in the model group rats were obvious， and a large number of autophagosomes could be seen in cells. The levels of T and LH and the LH/FSH ratio in serum， as well as mRNA and protein expressions of Beclin-1 and LC3， were increased significantly （P＜0.05）， while the levels of E2 and FSH in serum， as well as mRNA and protein expressions of p62 and the phosphorylation levels of PI3K， AKT and mTOR proteins in ovarian tissue， were significantly decreased （P＜0.05）. Compared with model group， the pathological damage of ovarian tissue in the administration groups was significantly reduced， the number of autophagosomes was smaller， and the expression levels of the above indicators were significantly reversed （P＜0.05）. CONCLUSIONS Huatan tongmai decoction can inhibit autophagy in ovarian granular cells by activating the PI3K/AKT/mTOR pathway， regulate the secretion of sex hormones， alleviate pathological damage in ovarian tissues， and promote normal follicular development， thereby exerting an ameliorative effect on PCOS rats.

Objective:To examine the impact of pressure support ventilation(PSV)in combination with low inspired oxygen concentration on atelectasis during the emergence from general anesthesia in elderly patients undergoing robotic-assisted radical prostatectomy.Methods:In this prospective randomized controlled study, a total of 144 elderly patients, aged 65-80 years(average age: 71.4±4.4 years), who were undergoing elective robotic-assisted radical prostatectomy under general anesthesia, were divided into 4 groups(n=36 each)using the random number table method.The groups were as follows: PSV+ 40% fraction of inspiration oxygen(FiO 2)(P40 group), PSV+ 80%FiO 2(P80 group), spontaneous breathing+ 40%FiO 2(S40 group), and spontaneous breathing+ 80%FiO 2(S80 group). These methods were used during the general anesthetic emergence, which refers to the period from the end of the operation to extubation.Atelectasis aeration loss score was measured using ultrasound, and the oxygenation index(OI)was calculated through arterial blood gas analysis.These measurements were recorded at different time points: at the end of surgery(T 1), after extubation(T 2), 30 minutes after entering the post anesthesia care unit(PACU)(T 3), and 48 hours after surgery(T 4). The number of hypoxemia cases(defined as saturation of pulse oxygen <92%)during emergence and within 30 minutes of entering the PACU, as well as the incidence of postoperative pulmonary complications(PPCs)at T 4, were also recorded. Results:A total of 137 patients completed the study.Compared with the P40 group, the patients in the P80 group had higher atelectasis aeration loss scores at T 2[6.0(3.0)scores vs.4.0(2.0)scores; Z=-3.733, P<0.001], the S40 group[8.0(3.0)scores vs.4.0(2.0)scores; Z=-4.868, P<0.001], and the S80 group[9.0(3.0)scores vs.4.0(2.0)scores; Z=-6.835, P<0.001]. At T 3, the S40 group[7.0(2.0)scores vs.5.0(2.0)scores; Z=-4.631, P<0.001]and the S80 group[9.0(2.5)scores vs.5.0(2.0)scores; Z=-6.590, P<0.001]also had higher atelectasis aeration loss scores.There was no significant difference in the incidence of hypoxemia between the four groups during the recovery period( χ2=0.405, P=0.939)and in PACU( χ2=4.048, P=0.256). The incidence of PPCs in the four groups at 48 hours after operation was 5.9%(2/34), 11.4%(4/35), 8.6%(3/35), and 6.1%(2/33)respectively( χ2=0.947, P=0.814). Conclusions:The combination of positive end-expiratory pressure support ventilation(PSV)and low inspired oxygen concentration can effectively decrease the occurrence of atelectasis in elderly patients undergoing robotic-assisted radical prostatectomy during the emergence phase.This approach also helps in reducing the incidence of hypoxemia in the post-anesthesia care unit(PACU)and improves the postoperative oxygenation index.

Glioma remains the most common malignant tumor in the brain and is also the most difficult to treat. Immunotherapy achieving long-lasting tumor remission in multiple cancer types has received considerable attention due to its potential to improve the treatment outcomes of patients with glioma. However, clinical trials have not yet demonstrated major improvements in prognoses, which might be attributable to the extrinsic components and intrinsic mechanisms involved in the tumor microenvironment and immune system. It is particularly noteworthy that there is emerging evidence that current routine treatment modalities and the physical and psychological characteristics of patients have different impacts on the efficacy of glioma immunotherapy. This article addresses how these factors interact with the host immune system and tumor microenvironment, and highlights their potential roles in glioma immunotherapy, with the ultimate goal of developing better immunotherapybased personalized medicine strategies.

Objective To explore the accuracy and clinical efficacy of advanced 3D printing navigation templates in assisting placement of atlantoaxial pedicle screw.Methods A retrospective analysis was carried out on 49 cases of patients with atlanto-axial vertebral fractures and dislocations between June 2013 and June 2016,and all of them were given posterior incision,reduction and internal fixation of atlantoaxial pedicle screw.The patients were divided into advanced 3D printing navigation template group (14 cases),early 3D printing navigation template group (16 cases),and routine pedicle screw placement group (19 cases).Atlantoaxial CT data of patients in advanced 3D printing navigation template group and early 3D printing navigation template group were input into Mimics 17.0,then advanced 3D printing navigation template group and early 3D printing navigation which were used in clinic surgery were designed and printed.The relationship between positions of pedicle screw with the pedicle and bone cortex in plain CT image was observed after operation.The quality of the screw position was assessed and the accuracy of three kinds of screwing methods was compared.The accuracy of the screwing angle was assessed by comparing with the differences between the preoperative designed channel inclination angle and postoperative actual screwing angle.Three groups were compared for differences between operation time,intraoperative blood loss,and scores of cervical nerve scale and visual analogue scale (VAS) of neck and shoulder pain by Japanese Orthopaedic Association (JOA).Results All 49 cases of patients successfully completed the surgery.Patients of the routine pedicle screw placement group,early 3D group and advanced 3D group correspond operation time for 141.2±20.7 min,112.5±12.1 min and 103.1±10.4 min,intraoperative blood loss for 314.0±81.4 ml,243.6±71.2 ml and 181.0+59.1 ml;total accuracy of screwing for 75.0％ (54/72),93.75 ％ (60/64) and 96.43 ％ (54/56).There were statistically significant differences among the routine group,3D group and advanced 3D group in the mentioned programs.There were no statistical differences between advanced 3D group and 3D group in the inclination angle and head tilt angle with the pre-designed values,while there was statistically significant difference between the routine group and the pre-designed value.The accuracy of the inclination angle and bead tilt angle screwing angle were obviously superior in the advanced 3D group and early 3D group to that of the routine group.There were statistically significant differences between preoperative with postoperative VAS scores and JOA scores in the same group,while there were no statistically significant differences among groups in JOA.But there was statistically significant difference between the routine group and the advanced 3D in VAS,and there was no statistically significant difference between the routine pedicle screw placement group and the early 3D in VAS.All three groups of patients had bony fusion of atlantoaxial vertebral body,without loosening,dislocation and fracture of the internal fixators.Conelusion Advanced 3D printing templates in assisting the surgical treatment for atlantoaxial fracture and dislocation can improve the accuracy of pedicle screwing and safety of the surgery,reduce the surgery risk,and obtain satisfied clinical curative effects.

Objective To explore clinical effect of double-tube continuous negative pressure drainage in the treatment of Morel-Lavallée leision.Methods We retrospectively analyzed the clinical data of 13 patients with Morel-Lavallée leision,which were diagnosed and treated in our hospital from May 2009 to July 2010.They were 11 women and 2 men,aged from 19 to 57 years (average,32.5 years).All patients underwent operations within 3 days after injury,except for 2 patients whose diagnosis was postponed.The operation was performed with small incision and double-tubes were placed for continuous negative pressure drainage.Double-tubes were not removed until effusion was less than 30 ml/24 hours.The heal was defined as no skin necrosis and subcutaneous hydrops at lesion site,no skin floating and sliding at palpation.Results Double-tubes were removed 4 to 12 days postoperatively (average,6.3 day).All of 13 patients were followed up for an average of 13.7 months (range,10 to 18 months).Skin necrosis occurred in 1 patient.Lesions were healed 4 to 10 weeks postoperatively(average,7.2 weeks).No deep infection or delayed hematogenous infection was found.There were no general systematic complications.Superficial infection at wound site occurred in one patient and healed after wound management.Conclusion Application of double-tube continuous negative pressure drainage is a safe,less invasive,low-cost and effective treatment for Morel-Lavallée leision.