Hepatocellular carcinoma （HCC） with biliary duct tumor thrombus （BDTT） is currently not common in clinical practice and is easily misdiagnosed， and previously， it was often considered an advanced stage of the disease with a poor prognosis， making its treatment challenging. However， in-depth studies in recent years have gradually deepened our understanding of this disease， leading to significant changes in diagnostic and treatment concepts. Currently， comprehensive treatment， mainly surgery， is used for treatment， but there is still controversy over the selection of clinical treatment strategies. This article provides a detailed discussion on surgical methods and prognosis， in order to provide a reference for clinical treatment options.

Concurrent chemoradiotherapy (CCRT) refers to the simultaneous treatment of chemotherapy and radiotherapy, and the effect of radiotherapy is enhanced with low-dose chemotherapy, which can reduce tumor recurrence and metastasis and improve clinical prognosis of patients. At present, the main factors for the increase of radiosensitivity of concurrent chemotherapy is that concurrent chemotherapy prevents the repair of tumor cells, and chemotherapy and radiotherapy act on different cell cycles and have synergistic effects. However, even for patients with locally advanced cervical cancer (LACC) who have undergone CCRT, the 5-year survival rate is only 60%, which is still not ideal. In order to improve the efficacy, researchers have conducted a series of exploratory studies, which consist of the combination of targeted drugs and immunodrugs, and neoadjuvant regimens before CCRT, etc. Although targeted or immunologic drugs are effective treatment of LACC, in view of the lack of large-scale evidence-based medical evidence, multi-center prospective and randomized phase III clinical trials and high-level articles are needed to improve the level of evidence-based medicine. This consensus summarizes several key evidence-based medical studies published recently, especially the clinical research progress in targeted and immunological therapies, providing reference for domestic peers.

Objective:To evaluate the effects of different intervention measures on duration of mechanical ventilation and the length of intensive care unit (ICU) stay in critically ill patients using network Meta-analysis.Methods:Randomized controlled trial (RCT) on the effects of different intervention measures on duration of mechanical ventilation and the length of ICU stay in critically ill patients were systematically searched in PubMed, Embase, China Biomedical Literature Database, CNKI, and other databases. The search time limit was from the establishment of the database to November 2023. Literature screening, quality assessment, and data extraction were independently conducted by two researchers. Network Meta-analysis was employed to assess the effects of each intervention on duration of mechanical ventilation and the length of ICU stay, and funnel plots were generated.Results:A total of 37 RCTs were included, involving 3?977 severe patients, 2?041 in the intervention group and 1?936 in the control group. Thirteen types of interventions were analyzed, including usual care (UC), early activity (EA), early comprehensive rehabilitation (ECR), early pulmonary rehabilitation (EPR), cluster intervention strategy (CS), sedation, analgesia and cluster nursing (SACN), music therapy (MT), neuromuscular electrical stimulation (NMES), modified education and visitation (MV), virtual reality (VR), auricular point sticking (APS), acupoint acupuncture (AA), and concerted intervention (COR). Network Meta-analysis showed that MV significantly better than COR [standardized mean difference ( SMD) = -2.35, 95% confidence interval (95% CI) was -4.30 to -0.39], EPR ( SMD = -2.59, 95% CI was -4.81 to -0.37), and UC ( SMD = -4.10, 95% CI was -5.71 to -2.49) in improving duration of mechanical ventilation in critically ill patients. COR was significantly better than UC in shortened length of ICU stay ( SMD = -5.72, 95% CI was -10.07 to -1.37). The efficacy ranking results showed that for duration of mechanical ventilation, the surface under the cumulative ranking curve (SUCRA) was highest for MV (85.4%) and EA (85.4%), followed by AA (74.9%), NMES (63.1%), ECR (51.7%), CS (48.8%), SACN (34.3%), COR (29.4%), EPR (26.1%), and UC (0.7%). For the length of ICU stay, COR had the highest SUCRA (82.3%), followed by APS (79.7%), MV (77.7%), EPR (68.0%), NMES (57.6%), CS (54.4%), ECR (51.1%), SACN (41.9%), MT (39.8%), EA (39.3%), AA (33.0%), VR (15.4%), and UC (9.8%). The funnel plot results of ICU stay showed that the publication bias between studies were relatively small. Conclusions:MV and COR appear to be effective interventions for reducing mechanical ventilation time and ICU stay in critically ill patients. However, due to the number and quality of included studies, these findings require confirmation through additional high-quality research.

Objective:To explore the effect of artificial dermis combined with autogenous thin skin graft on the survival rate of compound skin graft and the scar state of joints in burn patients.Methods:94 burned patients treated in Baoding Fifth Hospital from August 2017 to August 2019 were prospectively selected as the research objects. They were randomly divided into two groups with 47 cases in each group. The control group was treated with simple medium thick skin transplantation, and the observation group was treated with artificial dermis combined with autologous thin skin grafting. The recovery of the two groups (healing time of skin donor area, healing time of skin graft area, healing time under scab of burn area and hospitalization time) were compared. The survival rate of composite skin transplantation, wound healing, Vancouver Scar Scale (VSS) score, joint range of motion (shoulder abduction, knee flexion, knee extension), Burn Specific Health Scale-Brief (BSHS-B), Profile of Mood States-Short Form (POMS-SF) score and complications were compared.Results:The healing time of donor area, skin graft area, subeschar healing time and hospital stay in the observation group were shorter than those in the control group ( P<0.05). The wound healing in the observation group was better than that in the control group, and the survival rate of composite skin transplantation was higher than that in the control group ( P<0.05). After treatment, the scar state of the joint in the two groups was improved compared with that before treatment ( P<0.05); The scar thickness, vascular distribution score and total score of VSS in the observation group were lower than those in the control group ( P<0.05). After treatment, the joint range of motion in the two groups was improved compared with that before treatment ( P<0.05); The shoulder abduction, knee flexion and knee extension in the observation group were higher than those in the control group ( P<0.05). After treatment, the quality of life and psychological status of the two groups were improved compared with those before treatment ( P<0.05); The BSHS-B score of the observation group was higher than that of the control group, and the POMS-SF score was lower than that of the control group ( P<0.05); The incidence of complications in the observation group (4.26%) was lower than that in the control group (21.28%) ( P<0.05). Conclusions:Artificial dermis combined with autologous thin skin graft can significantly improve the survival rate of compound skin graft in burned patients, and can further reduce the scar condition of the joints of patients, reduce the incidence of complications, and effectively improve the prognosis of patients.

Objective: To gain a better understanding of the status quo of the physical condition of students in Lahu Nationality Middle School, so as to provide a basis for intervention measures to improve students’ physical health. Methods: A comparative analysis on the data of the physique investigation of the students in Lahu nationality middle school in 2019 and 2014 was carried out. Results: Compared with 2014, in 2019, the BMI of the males except aged 13 increased by 0.45 kg/m2, there was no statistically significant difference in the BMI of other age groups aged(P>0.05). In 2019, there was no statistically significant difference in the BMI of females aged 13 to 18 compared with 2014(P>0.05). The vital capacity/BMI respectively increased by 3.74 and 3.99 mL/kg in males aged 13 and 15, and the differences were statistically significant(t=2.36, 2.05, P<0.05). In 2019, the vital capacity/BMI of females aged 14-15 increased by 3.18, 3.64 mL/kg, respectively; the vital capacity/BMI of females aged 16 decreased by 2.50 mL/kg, the difference was statistically significant(P<0.05). For males aged 13-18 of the Lahu nationality and compared with 2014, in the 50m race, except that those aged 15, there was no statistically significant difference in the race time in other age groups(P>0.05); there was no statistically significant difference in the sit and reach of males aged 13 to 18(P>0.05); the males aged 14 was 20.52 s faster in the 1 000 m race, while those aged 17-18 were respectively 21.04 and 19.10 s slower in the-1 000 m-race, pull-ups in those aged 13 increased by 1.32, and decreased by 0.96 and 1.32 in those aged 17-18, the standing long jump of those aged 13 to 16 and 18 increased by 18.90, 16.36, 36.27, 13.32, 8.55 cm, respectively; and the differences were statistically significant(P<0.01). For females aged 13-18 of the Lahu nationality and compared with 2014, in the 50 m race, there was no statistically significant difference in the race time in those aged 13-18(P>0.05); the sit and reach of those aged 14-15 increased by 2.38 and 2.96 cm, respectively; the females aged 13-15 was 15.15, 14.48, 15.65 s faster in the 800 m race, respectively; while those aged 16-17 were respectively 18.16 and 10.74 s slower in the 800 m race; pull-ups in those aged 13-15 and 17-18 increased by 5.58, 6.97, 5.34, 2.04, 2.64, respectively; the standing long jump of those aged 13-18 increased by 14.75, 17.10, 14.76, 8.22, 10.47, 8.36 cm, respectively; and the differences were statistically significant(P<0.01). Conclusion The physical condition of middle school students in Lahu Nationality generally shows a slow-increasing trend, the physical shape of the male students presents an upward trend, and the physical fitness students shows a positive trend, albeit featured in imbalanced development. According to the problems existing in the physical development of the students in Lahu nationality, effective intervention measures should be taken to elevate the physical health condition of middle school students in Lahu nationality.

Objective:To explore clustered epidemic of COVID-19 in Liaocheng city and analyze infection status and chain of transmission of the cases.Methods:A joint investigation team of emergency response for COVID-19 epidemic by CDC professional workers of Liaocheng city and district at two levels on January 30, 2020. According to a indicator case from ZH supermarkets, close contacts and related subjects were tracked and screened on February 1, including ZH supermarket employees, family members having contact history with related cases during January 13-26, supermarket clients during January 16-30 and family members of related cases. an epidemiological investigation was carried on and their swab of nose/throat were collected and were sent to Liaocheng CDC laboratory, real-time fluorescence quantitative RT-PCR was used to detect nucleic acids of SARS-CoV-2.Results:a total of 8 437 people were screened during January 30 to February 9, 2020 (120 employees of supermarket, 93 family members, and 8224 clients of supermarket). The epidemic was caused by ZH cases and brought clustered cases in four families. A total 25 cases of SARS-CoV-2 infection, the total infection rate of subjects was 0.30% (25/8 437) with 22 confirmed cases (0.26%, 22/8 437) and 3 asymptomatic patients (0.04%, 3/8 437), asymptomatic patients accounted for 12.00% (3/25) of all infection cases. The infection rates of supermarket employees, family members of confirmed cases and supermarket clients were 9.17% (11/120), 12.90% (12/93) and 0.02% (2/8 224).Conclusions:This was a cluster epidemic caused by one imported case of COVID-19 in a supermarket of Liaocheng city. Prevention and control of cluster epidemic should be focused on chain of community transmission and family cluster cases. It must also be an attention for transmission risk of asymptomatic patients.

Objective To investigate the expression and significance of serum NSE,HCY and 8-hydroxy-2'-deoxyguanosine (8-OHdG) in the patients with acute cerebral infarction(ACI).Methods One hundred cases of ACI treated in the neurology department of this hospital from March 2013 to December 2015 were selected as the cerebral infarction group,and contemporaneous 100 persons undergoing healthy physical examination were selected as the control group.The cerebral infarction group were re-divided into three groups according to the infarction volume,the infarction area ＞ 10 cm3 as the large volume infarction group (L),5-10 cm3 as the middle volume infarction group (M) and ＜5 cm3 as the small volume infarction group (S).The levels of serum NSE,HCY and 8-OHdG were compared between the cerebral infarction group and the control group,and among the group L,M and S.The Pearson correlation test was adopted to conduct the correlation analysis between HCY,8-OHdG and NSE with the cerebral infarction volume,neural function deficit,and prognosis.Results The levels of Hcy,8-OHdG and NSE in the observation group were higher than those in the control group,the difference was statistically significant(P＜0.05);the levels of Hcy,8-OHdG and NSE in the group L were higher than those in the group M and S,the difference was statistically significant(P＜0.05);the Hcy,8-OHdG and NSE levels were positively correlated with the cerebral infarction volume and neurological deficit,and negatively correlated with the prognosis.Conclusion Serum NSE,HCY and 8-OH-dG levels are increased in the patients with ACI,moreover with the infarct volume increase,which are gradually elevated.Therefore serum NSE,HCY and 8-OHdG can be used to assess the severity and prognosis in ACI patients.

Objective To analyze the correlation between serum leptin and osteoprotegerin with IL-6 and TNF-α in the pa-tients with gout arthritis osteoporosis .Methods Forty-eight cases of gout arthritis were selected as the research subjects (GA group) ,including 19 cases of complicating osteoporosis(OP group) and 29 cases of non-complicating osteoporosis(non-OP group) . Other 45 individuals undergoing healthy physical examination were selected as the control group .The bone mineral density (BMD) was measured by dual energy X-ray BMD absorptionmetry instrument and the levels of serum LEP ,OPG ,IL-6 and TNF-αwere de-tected by ELISA .Results The incidence rate of osteoporosis in the GA group was significantly higher than that in the control group (39 .6% vs .13 .3% ,P=0 .004) ,and BMD in various sites was significantly lower than that of the control group (P<0 .05) . The serum LEP level in the OP group was significantly increased compared with that in the non-OP group and control group(P<0 .05) ,and the OPG level was significantly decreased ,the difference was statistically significant (P<0 .05) .The serum LEP level in the non-OP group was significantly higher than that in the control group (P<0 .05) ,but the OPG level had no statistical difference between non-OP group and control group(P>0 .05) .The serum IL-6 and TNF-αlevels in the OP group were significantly higher than those in the non-OP group and control group(P<0 .05) ,and the non-OP group was significantly higher than the control group (P<0 .05) .The serum LEP level in the OP group was positively correlated with IL-6 and TNF-α(P<0 .05) ,and the serum OPG level was negatively correlated with IL-6 and TNF-α(P<0 .05) .Conclusion The serum LEP and OPG levels have abnormal change in the patients with gout arthritis osteoporosis ,which has a certain correlation with IL-6 and TNF-α.

OBJECTIVE:To discuss the effect and safety of dezocine on hemodynamics and inflammatory cytokines in esoph-ageal cancer patients with one-lung ventilation(OLV). METHODS:80 esophageal cancer patients were randomly divided into ob-servation group and control group,40 cases in each group. All patients received 0.5 mg penehyclidine hydrochloride+0.1 mg/kg midazolam+4 μg/kg fentanyl+2 mg/kg propofol+0.15 mg/kg cisatracurium for anesthesia induction,propofol 4-10 mg/(kg·h)+remifentanil 0.1 μg/(kg·min)were pumped after double-lumen endobronchial catheter. Observation group received 1 mg dezocine by Intravenous injection in surgical skin incision,control group received the same amount of normal saline. Hemodynamic parame-ters [heart rate (HR),mean arterial pressure (MAP)] and inflammatory cytokine levels in 2 groups before anesthesia induction (T1),when skin incision(T2),5 min after dezocine/normal saline(T3),OLV 30 min(T4),recovery two-lung ventilation 10 min (T5)and end of the operation(T6)were compared,and the incidence of adverse reactions was observed. RESULTS:There was no significant difference in HR and MAP in 2 groups at T1,T5 and T6(P>0.05);HR and MAP in observation group at T2,T3 and T4 were significantly lower than control group,the difference was statistically significant(P<0.05). There were no significant differ-ences in TNF-α and IL-8 at T1,T2 and T3 and IL-6 at T1,T2,T3 and T4 between 2 groups(P>0.05);TNF-α and IL-8 at T4,T5 and T6 and IL-6 at T5 and T6 in observation group were significantly lower than control group,the differences were statistically signifi-cant(P<0.05). And there was no obvious adverse reactions during treatment. CONCLUSIONS:Dezocine shows more stable hemo-dynamics and lower expression level of inflammatory cytokines in esophageal cancer patients with OLV,with good safety.

To explore the status of two-week illness in primary and secondary students and to provide the basis for rationally distributing heath resources in primary and secondary schools.
 Methods: Stratified cluster sampling method was used to select 6 744 primary and secondary students aged from 9.0-16.9 years, and the name or symptoms of two-week illness, frequencies, medical expenses and days of sick leave were surveyed by using the self-made questionnaires.
 Results: Respiratory system disease (73.6%) and digestive system diseases (13.2%) were the major two-week illness. When they were ill, 58.9% students went to hospital, 39.9% took medicine by themselves, and 1.2% received non-treatment. The two-week morbidity, sick frequencies, average medical expenses per time and days of sick leave were 12.6%, (1.34±0.81) times, 10.0 yuan, and (0.39±0.98) days, respectively. The two-week sick frequencies, average medical expenses per time and days of sick leave among primary or secondary students were (1.37±0.87) or (1.26±0.69) times, 12.0 or 9.0 yuan, and (0.44±1.14) or (0.30±0.55) days, respectively. There was a positive correlation between two week sick frequencies and medical fees per time, or days of sick leave (r=0.301, r=0.275 for primary students, respectively, P<0.01; r=0.334, r=0.290 for secondary students, respectively, P<0.01). The positive correlation between medical fees per time and days of sick leave was also found (r=0.312, r=0.343 for primary students and secondary students, respectively, P<0.01).
 Conclusion: Characteristics of two-week illness among primary and secondary students possess common symptoms, frequent, low medical expenses per time. The frequencies, medical expenses and days of sick leave in primary students were increased compared with that in secondary students.
Adolescent ; Child ; Digestive System Diseases ; epidemiology ; therapy ; Fees, Medical ; statistics & numerical data ; Female ; Humans ; Male ; Respiratory Tract Diseases ; epidemiology ; therapy ; Schools ; Sick Leave ; statistics & numerical data ; Students ; Surveys and Questionnaires