ObjectiveTo investigate the influence of platelet-albumin-bilirubin （PALBI） score on the textbook outcome （TO） of patients with hepatocellular carcinoma （HCC） after hepatectomy， as well as the association of different PALBI scores before surgery with the achievement of TO after hepatectomy in HCC patients. MethodsA retrospective analysis was performed for the data of HCC patients who underwent hepatectomy in West China Hospital of Sichuan University and Ziyang Central Hospital from January 2013 to January 2022. TO was defined as no serious complication within 30 days after surgery， no death within 90 days， no rehospitalization within 30 days after discharge， no blood transfusion in the perioperative period， RO resection， and no prolongation of hospital stay. The chi-square test was used for comparison of categorical data between two groups. The univariate and multivariate Logistic regression analyses were used to investigate the influencing factors for the achievement of TO after hepatectomy in HCC patients. The Kaplan-Meier method was used to plot the survival curves of HCC patients， and the Log-rank test was used for comparison. ResultsA total of 3 599 patients were included in this study， among whom 2 369 （65.8%） achieved TO. The multivariate Logistic regression analysis showed that PALBI grade （PALBI grade 2： odds ratio ［OR］=1.562， 95% confidence interval ［CI］： 1.308‍ ‍—‍ ‍1.864， P<0.001； PALBI grade 3： OR=2.216， 95%CI： 1.463‍ ‍—‍ ‍3.359， P<0.001） was an independent risk factor for achievement of TO after surgery in HCC patients. The proportion of patients achieving TO decreased with the increase in PALBI grade. Among the patients with PALBI grade 1， 2 or 3， the patients achieving TO accounted for 70.2%， 54.2%， and 38.4%， respectively （χ²=106.295， P<0.001）. The incidence rate of serious complications within 30 days， the mortality rate of patients within 90 days after hepatectomy， readmission rate within 30 days after discharge， perioperative blood transfusion rate， and the rate of prolonged hospital stay all increased with the increase in PALBI grade （all P<0.05）. For the patients achieving TO， the 1-， 3-， and 5-year relapse-free survival rates were 79.5%， 60.6%， and 51.5%， respectively， and the overall survival rates were 92.1%， 80.0%， and 71.1%， respectively； for those who did not achieve TO， the 1-， 3-， and 5-year relapse-free survival rates were 68.5%， 52.7%， and 46.2%， respectively， and the overall survival rates were 83.3%， 66.0%， and 57.1%， respectively. The patients who achieved TO had significantly better relapse-free survival rate and overall survival rate than those who did not achieve TO （χ²=18.936 and 79.371， both P<0.001）. ConclusionPreoperative PALBI grade can affect the achievement of TO after hepatectomy in HCC patients， and it is more difficult for patients with a higher PALBI grade to achieve TO. Preoperative PALBI score can be used to early identify the patients with a high risk of postoperative complications， provide early intervention， and enhance perioperative management， thereby improving the perioperative safety and long-term prognosis of HCC patients after hepatectomy.

OBJECTIVE: To establish a two-segment vertebrectomy model using the finite element method, and to measure and compare the biomechanical properties of the lower cervical anterior transpedicular root screw (ATPRS) plate system, lower cervical anterior pedicle screw (ATPS) plate system, and lower cervical anterior cervical locked-plate (ACLP) system on this model. METHODS: CT data of the cervical spine (C₀-T₁) from a 34-year-old healthy adult male volunteer were collected. A nonlinear complete model of the lower cervical spine (C₃-C₇) was established using Mimics 10.01 software, based on which the ATPRS fixation model, ATPS fixation model, and ACLP fixation model were constructed respectively. An axial pressure of 75 N and a pure couple moment of 1.5 N·m were applied to C3 to make the model perform flexion-extension, left-right lateral bending, and left-right rotation movements. The range of motion (ROM) and stress distribution of each model under different working conditions were compared. RESULTS: The ROM of the C₄-C₇ segments in the ACLP group, ATPS group, and ATPRS group was reduced to 0.65° (-95.2%), 0.58° (-95.7%), and 0.62° (-95.4%) respectively compared with the intact model during flexion-extension movement;during lateral bending movement, it was reduced to 0.58° (-95.2%), 0.51°(-95.8%), and 0.60° (-95.1%) respectively;during rotation movement, it was reduced to 1.17° (-89.6%), 1.26° (-88.8%), and 1.27°(-88.7%) respectively. In terms of the stress on the titanium mesh graft, the ATPS group and ATPRS group had the maximum load during extension and the minimum load during flexion. Compared with the ACLP group, the stress on the titanium mesh graft in ATPS and ATPRS decreased by (-33.7%) and (-15.8%) in flexion, (-29.4%) and (-13.2%) in extension, (-26.2%) and (-23.4%) in lateral bending, and (-18.8%) and (-5.4%) in rotation, respectively. In terms of bone-screw interface stress, the peak bone stress near the C₇ screw in the ACLP group, ATPS group, and ATPRS group increased by 49.2%, 45.0%, and 47.6% respectively compared with the peak bone stress near the C₄ screw during extension. However, during flexion and lateral bending, there was no significant difference in the peak bone stress near the C₄ and C₇ screws. During rotation, the difference between the peak bone stress near the C₄ screw and that near the C₇ screw showed that in the ACLP group, left rotation (37.6%) was similar to right rotation (36.7%), while in the ATPS group and ATPRS group, left rotation was lower than right rotation. CONCLUSION Compared with the ACLP group, the ATPS group and ATPRS group have greater fixation stiffness and more stable fixation. However, in rotational movement, due to the uneven distribution of fixation stiffness, the stress distribution during torsion is uneven, but it is still better than the ACLP group. This indicates that ATPRS, like ATPS, has good primary stability, providing favorable conditions for bone graft fusion.
Humans ; Finite Element Analysis ; Male ; Cervical Vertebrae/physiopathology* ; Adult ; Biomechanical Phenomena ; Bone Plates ; Bone Screws ; Range of Motion, Articular ; Fracture Fixation, Internal

Driven by multiple factors such as policy incentives,enhanced economic capacity of residents,aging popula-tion,and medical system reform,China's rehabilitation industry has been in a rapid development stage where opportunities and challenges coexist.Various rehabilitation hospitals urgently need new development thinking on how to seize the new opportunities for the development of rehabilitation medicine,give full play to the benefits of high-quality rehabilitation medical resources,and deal with the development of rehabilitation institutions under the new situation.Taking the tertiary rehabilitation hospital where the authors work as an example,this paper deeply analyzes the practical difficulties and challenges faced by the development of reha-bilitation hospital under the new circumstance,further explores the construction of a new working mode based on people-oriented and medical-rehabilitation integration.It also briefly summarizes the beneficial experiences and practices in the reform of rehabili-tation service models,and elaborates on the periodic achievement,so as to provide a meaningful reference for the majority of re-habilitation hospitals to plan and practice high-quality development and reform.

With the number of cases of coronavirus disease-2019 (COVID-19) increasing rapidly, the World Health Organization (WHO) has recommended that patients with mild or moderate symptoms could be released from quarantine without nucleic acid retesting, and self-isolate in the community. This may pose a potential virus transmission risk. We aimed to develop a nomogram to predict the duration of viral shedding for individual COVID-19 patients. This retrospective multicentric study enrolled 135 patients as a training cohort and 102 patients as a validation cohort. Significant factors associated with the duration of viral shedding were identified by multivariate Cox modeling in the training cohort and combined to develop a nomogram to predict the probability of viral shedding at 9, 13, 17, and 21 d after admission. The nomogram was validated in the validation cohort and evaluated by concordance index (C-index), area under the curve (AUC), and calibration curve. A higher absolute lymphocyte count (
Aged ; Aged, 80 and over ; Antibodies, Viral/blood* ; Area Under Curve ; COVID-19/virology* ; Female ; Humans ; Lymphocyte Count ; Male ; Middle Aged ; Nomograms ; Proportional Hazards Models ; Retrospective Studies ; Viral Load ; Virus Shedding

Objective: Understand the clinical characteristics of confirmed pneumonia patients infected with new corona virus in secondary epidemic areas and guide the diagnosis and treatment of novel pneumonia in secondary epidemic areas and provide a reference for clinical prevention and control of the epidemic situation. Methods: The clinical data of 33 patients admitted with pneumonia caused by a novel coronavirus in the Second Affiliated Hospital of Wenzhou Medical University from January 15 to February 1, 2020, were retrospectively reviewed. At the onset of the disease, we analyzed the primary symptoms such as fever, cough, fatigue, chest tightness, chest pain and also a significant blood test results of the patients. According to the patient's contact history, it was divided into the direct infection group of the main epidemic area and the indirect contact infection group of the main epidemic areas. The difference between clinical manifestations among the two groups was analyzed. Results: The main clinical symptoms of patients with novel coronavirus pneumonia in the secondary epidemic area were respiratory tract and systemic symptoms. After grouping according to the presence and absence of direct contact in the main epidemic area, there was no significant difference in baseline data between the two groups, and there was no significant difference in symptoms and signs between the two groups (P < 0.05). Some patients had serum amyloid protein (SAP) increased abnormall. Conclusions The respiratory tract and systemic symptoms are the primary symptoms of the patients with the new type of coronavirus pneumonia in the secondary epidemic area, which are not typical. The abnormal increase of serum amyloid protein (SAA) may be used as an auxiliary index for diagnosis and treatment.

Objective: To investigate the CT features of primary mediastinal neuroendocrine carcinoma and improve the diagnostic accuracy. Methods: CT findings of 12 patients with primary mediastinal neuroendocrine carcinoma diagnosed by clinic and pathology were retrospectively analyzed. The location, size, growth pattern, density, degree of enhancement, invasion of surrounding tissues and metastasis of the tumor were observed, a control analysis was performed. Results: Among the 12 cases, 4 cases were located in the anterior superior mediastinum, 4 cases in the middle superior mediastinum and 4 cases in the middle mediastinum. There were 5 cases on the left side, 4 cases on the right side and 3 cases in the middle. The maximum diameter of the tumor ranged from 1.5 cm to 12.0 cm, with an average of (6.74±3.65) cm. The tumors were round or quasi-round in 6 cases, irregular in 6 cases, clear boundary in 9 cases and unclear in 3 cases. Uniform density was found in 6 cases. The density was heterogeneous in 6 cases, including necrosis and cystic degeneration in 4 cases, and fine-grained calcification in 1 case. The average CT value of plain scan was (38±4.8) HU. There was 1 case of perivascular growth, 2 cases of adjacent vascular compression, 3 cases of adjacent pleural invasion, and 6 cases of infiltrating the surrounding fat space. After contrast enhancement, all cases showed mild and moderate enhancement, including 4 cases with homogeneous enhancement and 8 cases with heterogeneous enhancement. After contrast enhancement, the mean CT value was (55±7.7) HU. There were 9 cases with mild enhancement and 3 cases with moderate enhancement. There were 3 cases with small linear abnormally enhanced vascular shadow in the tumor, and 4 cases with no enhancement both in the central necrosis and the cystic areas. There were 7 cases of typical carcinoid, 2 cases of atypical carcinoid, 2 cases of small cell carcinoma and 1 case of large cell neuroendocrine carcinoma. Conclusion Primary mediastinal neuroendocrine carcinoma is mainly located in the anterior-mediastinum. When the tumor is large, necrosis, cystic degeneration and invasive growth are easy to occur. The enhanced scan shows mild and moderate enhancement. Combined with clinical history, it can improve the accuracy of diagnosis.

Objective: To investigate the effect of the frenulum identification positioning method with a disposable suture device in circumcision for the prevention of postoperative penile frenulum malposition. METHODS: Totally 212 patients with phimosis or redundant prepuce underwent circumcision from March 2015 to September 2016, including 109 cases of conventional circumcision (the control group) and 103 cases treated by frenulum identification positioning with a disposable suture device (the observation group). We observed the postoperative position of the penile frenulum and median raphe and compared the deviation angles of the frenulum between the two groups of patients. RESULTS: The median of penile frenulum deviation angle (interquartile range) was 0 (3.56) in the observation group, significantly smaller than 12.41 (19.59) in the control (P <0.001, P = 0.000). And the rate of frenulum deviation was remarkably lower in the former (8.74% ［9/103］) than in the latter group (66.06% ［72/109］) (P <0.01). CONCLUSIONS Circumcision using the frenulum identification positioning method with a disposable suture device can effectively avoid postoperative penile frenulum malposition. With the advantages of safety and easy operation, it deserves clinical application and popularization.
Circumcision, Male ; instrumentation ; methods ; Disposable Equipment ; Foreskin ; surgery ; Humans ; Male ; Penis ; surgery ; Phimosis ; surgery ; Postoperative Complications ; prevention & control ; Suture Techniques ; instrumentation ; Sutures

Objective To investigate the incidence of insomnia in patients with nasopharyngeal carcinoma during radiotherapy and analyze the influencing factors.Method A sleep quality questionnaire for patients with nasopharyngeal carcinoma during radiotherapy was designed and used for the investigation of the incidence of insomnia as well as the influencing factors related to insomnia.Results The incidence of insomnia was 42.2%.Univariate analysis revealed that radioactive xerostomia,nausea,hospital environmental noise,radioactive oral mucositis,worry about job,worry about prognosis,burp,vomiting,worry about family influence were related to insomnia in nasopharyngeal carcinoma patients during radiotherapy;multivariate analysis showed that radioactive oral mucositis,environmental noise and job stress were the independent factors leading to insomnia(All P<0.05).Conclusions There is a high incidence of insomnia in patients with nasopharyngeal carcinoma during radiotherapy.Radioactive oral mucositis,environmental noise and job stress might be the independent factors relative with insomnia during radiotherapy.

Objective To explore the effects of H 2 S on neuronal injuries induced by oxygen glucose deprivation /reoxygenation ( OGD/R) in cortical neurons .Methods For OGD, the primary cultured cortical neurons were incubated with glucose-free EBSS media for 4h in N2/CO2/O2 (93%/5%/2%) atmosphere.Thereafter, the media were replaced by Neurobasal/B27 culture media and the neurons were incubated for 12 h in a 5%CO2 incubator at 37℃.NaHS was used as a H2S donor and cell survival rate was determined by cell counting kit 8(CCk-8).[Ca2+]i was determined using fura-2/AM and fluorescence microscopic imaging systems .The release rate of lactate dehydrogenase ( LDH) was determined by lactate dehydrogenase assay kit , and cell damage was analyzed by staining of propidium iodide ( PI ) .Results After pretreated with 200, 300 and 600μmol/L sodium hydrosulfide ( NaHS) for 30min before OGD/R, the cell survival rate of neurons significantly increased (n=4).[Ca2+]I(n=5), LDH release rate (n=4) and cell damage percentage (n=6) in the neuron pretreated with 300 μM NaHS were significantly lower than those in ODG/R cells.Treatment with 10μmol/L calcium chelator BAPTA also reduced the LDH release rate and cell damage percentage induced by ODG /R in neurons . Conclusion The results indicate that H 2 S may inhibit the OGD/R induced damage in cortical neurons via reducing calcium overload of neurons .