Diabetes is a common chronic non-infectious disease. Diabetic patients not only suffer from metabolic disorders, but are also prone to immune deficiencies and are at a higher risk of being infected with human papillomavirus (HPV). Many studies at home and abroad have shown that the HPV infection rate of patients with diabetes is higher than that of non-diabetic patients. Patients with diabetes can benefit from HPV vaccination, and the tolerance is good. HPV vaccination is recommended for diabetic patients. This article reviews the research on diabetes, HPV infection, and HPV vaccine, which will provide references for HPV vaccination in diabetic patients.

Objective:To explore the effect of behavioral habits on the recovery of spinal cord function in patients with cervical spondylotic myelopathy after expansive open-door laminoplasty(ELAP).Methods:Retrospective analysis of clinical data of 183 patients with cervical spondylotic myelopathy who underwent ELAP at the Spinal Surgery Department of Jining Medical University Affiliated Hospital, from February 2019 to October 2022, with complete follow-up information. General clinical data of patients were collected. The patients were followed up at 3 months, 6 months and 12 months after surgery with the modified standard MacNab.The JOA score was used to evaluate the recovery of motor and sensory functions in patients before and 12 months after surgery. The recovery rate of spinal cord function was calculated based on the JOA score, and patients were divided into two groups: the group with good therapeutic effect ( n=143, recovery rate ≥ 50%) and the group with poor therapeutic effect ( n=40, recovery rate<50%). Data statistics were conducted using SPSS 20.0 software for chi-square test, rank sum test, t-test, and Logistic regression analysis. Results:There were significant differences in age ( t=-3.252, P<0.01), smoking ( χ2=21.503, P<0.01), body mass index(BMI) ( t=-5.885, P<0.01), hypertension ( χ2=20.263, P<0.01), coronary heart disease ( χ2=13.272, P<0.01), hospitalization time ( t=-2.278, P=0.02), desk and screen time ( t=-6.589, P<0.01), and frequency of rehabilitation exercise ( χ2=10.927, P<0.01) between the group with good therapeutic effect and the group with poor therapeutic effect. Further multivariate Logistic regression analysis showed that smoking ( B=2.402, OR=11.046, 95% CI=2.334-52.285, P<0.05), high BMI ( B=0.341, OR=1.406, 95% CI=1.076-1.837, P<0.05), hypertension ( B=2.238, OR=9.370, 95% CI=2.153-40.790, P<0.05), long desk and screen time ( B=0.961, OR=2.613, 95% CI=1.540-4.435, P<0.05) and low frequency of rehabilitation exercise ( B=-1.039, OR=0.354, 95% CI=0.201-0.623, P<0.05) were risk factors for spinal cord function recovery in patients with cervical spondylotic myelopathy after ELAP( P<0.05). Conclusion:Smoking, high BMI, hypertension, long desk and screen time, and low frequency of rehabilitation exercise are not adverse to the recovery of neurological function in patients with cervical spondylotic myelopathy after ELAP.

Background With the change of the national energy development layout, Qingyang has seen a situation where oil exploitation and agriculture go hand in hand, which may lead to local soil pollution if not taken seriously. Objective To evaluate the distribution characteristics, possible sources, and ecological risks of heavy metals in farmland soils around the main production areas of Changqing Oilfield. Methods A total of 60 farmland soil samples were collected from Zhengning County, Zhenyuan County, and Qingcheng County of Qingyang City, and the contents of heavy metals such lead (Pb), mercury (Hg), chromium (Cr), cadmium (Cd), and arsenic (As) in farmland soil were detected according to GB 15618-2018 Soil environmental quality—Risk control standard for soil contamination of agricultural land (on trial). The soil background value of Gansu Province was used as the denominator in the calculation of pollution index, and the pollution characteristics and ecological characteristics of selected five heavy metals in farmland soil were evaluated by single-factor pollution index (P_i), Nemerow comprehensive pollution index (P_N), and potential ecological risk index. Results The levels of Pb, As, and Hg in farmland soils around Changqing Oilfield, the levels of Cr and Cd in Qingcheng County, and the level of Cd in Zhengning County were higher than the corresponding soil background values of Gansu Province, but lower than the national soil environmental quality standard. The single-factor pollution indexes (P_i) were: Hg, 2.14; Pb, 1.24; As, 1.13; Cr, 0.78; Cd, 0.67, which indicated that Hg were graded as moderate pollution, Pb and As were slight pollution, and Cd and Cr were not polluted. The Nemerow comprehensive pollution indexes (P_N) were: Cr, 0.92; Cd, 1.08; As, 1.20; Pb, 1.68; Hg, 3.85, which indicated that Cr was graded as no pollution, Cd, Pb and As were mild pollution, and Hg was severe pollution. The variation coefficients of Hg and Cd in Zhenyuan County and that of Hg in Qingcheng County were 60.00%, 50.00%, and 50.00%, respectively, which were all greater than 50%, indicating that the pollution of above heavy metals in the location was subject to human activities. The potential ecological risk indexes (E_r) of Pb, Cr, Cd, As, and Hg were 6.20, 1.55, 20.05, 11.28, and 81.64, respectively, indicating that Hg was graded as strong ecological risk, and the other four heavy metals were mild ecological risk. The comprehensive potential ecological risk index (R_RI) was 124.48. Combined with the potential ecological risk index of Hg, the comprehensive potential ecological risk of the five heavy metals in local farmland soils was considered to be at a strong ecological risk level. Conclusion Although the average values of selected five heavy metals in farmland soils surrounding the main production areas of Changqing Oilfield are qualified with the national soil environmental quality standards, they exceed corresponding soil background values of Gansu Province, and there are signs of human influence and potential ecological risks of different degrees.

Neuropathic pain is a kind of chronic pain caused by nervous system injury. Because of its complex mechanism, the treatment of neuropathic pain is still a major challenge to health problems all over the world. Recent studies have shown that autophagy dysfunction is the pathophysiological basis for the occurrence and development of neuropathic pain, and neuropathic pain can be alleviated by regulating autophagy. Based on the mechanism of autophagy and neuropathic pain, this paper reviews the drugs that regulate autophagy in the treatment of neuro-pathic pain, in order to provide reference for the drug treatment of this disease.

Objective:To analyze the clinical features, diagnosis and treatment plan, clinical outcomes of pregnancy with cervical cancer.Methods:The clinical data of 10 pregnant women with cervical cancer from January 2008 to October 2018 in Dalian Obstetrics and Gynecology Hospital Affiliated to Dalian Medical University, the First Hospital of Dalian Medical University, Dalian Central Hospital, Dalian Women and Children′s Medical Center and Wafangdian Central Hospital of Liaoning Province were retrospectively analyzed.Results:The incidence of pregnancy with cervical cancer was 0.004% (10/238 128). Among the 10 cases of pregnancy with cervical cancer, the gestational weeks ≤ 20 weeks at the time of diagnosis was in 6 cases, and they all chose to terminate the pregnancy; the gestational weeks 20 +1 to 30 weeks at the time of diagnosis was in 1 case, and the patient chose to terminate the pregnancy; the gestational weeks >30 weeks at the time of diagnosis was in 2 cases, and they all chose to continue the pregnancy; 1 case was diagnosed after delivery. There were 3 newborns, including 1 premature infants, and they all survived. Conclusions:It is helpful to the diagnose of the disease to strengthen cervical cancer screening before pregnancy and improve the examination of patients with abnormal symptoms during pregnancy. The treatment plan should be individualized according to the pregnancy status, stage of the disease, and wishes of the patient and family.

Objective:To study the effects of immunity index and blood inflammatory markers pre- and post-radiotherapy on prognosis of esophageal cancer patients with clinical stage Ⅲ.Methods:A total of 84 esophageal cancer patients with clinical stage Ⅲ (T 4N 1M 0) in Fourth Hospital of Hebei Medical University were analyzed, from May 2010 to April 2012. Intensity-modulated radiotherapy was delivered with a dose of 56-66 Gy/1.8-2.0 Gy per fraction. Flow cytometry was used to analyze the distribution of T-lymphocyte subsets (CD3, CD4, CD8, CD4/CD8) and natural killer cells (CD56) in the peripheral blood pre- and post- radiotherapy. Neutrophil-lymphocyte ratio (NLR) pre- and post- radiotherapy were also tested. The correlation of immunity index and blood inflammatory markers with prognosis was analyzed by univariate and multivariate analysis. Results:For all patients, the 1-, 3- and 5-year overall survival (OS) rates were 78.57%, 34.52% and 19.59%, respectively. The median OS time was 22.60 months. The 1-, 3- and 5-year progression free survival (PFS) rates were 69.05%, 27.38% and 12.09%, respectively. The median PFS time was 21.20 months. The objective response rate was 61.90%, with 11 patients of complete remission (CR) and 41 patients of partial remission (PR). Univariate analysis revealed that NLR before radiotherapy, T-lymphocyte subsets (CD3, CD4 and CD4/CD8) after radiotherapy were significantly associated with OS and PFS (OS: χ 2=7.851, 4.443, 8.381, 5.972, P<0.05, PFS: χ 2= 7.475, 6.290, 9.659, 8.738, P<0.05). Multivariate COX regression analysis showed that NLR before radiotherapy, T-lymphocyte subsets (CD4, CD4/CD8) after radiotherapy were independent prognostic factors for OS (χ 2=10.464, 4.292, 5.507, P<0.05). The NLR before radiotherapy and CD4/CD8 after radiotherapy were independent prognostic factors for PFS (χ 2=10.835, 8.545, P<0.05). Conclusions:Radiotherapy may influence the immune function. NLR before radiotherapy and CD4/CD8 after radiotherapy are of great value in predicting the prognosis of esophageal cancer patients.

Objective:To evaluate the recurrence patterns of esophageal squamous cell carcinoma (ESCC) after radical surgery and analyze the predictors of post-recurrence survival (PRS).Methods:A total of 382 ESCC patients who developed recurrence after radical surgery were retrospectively reviewed from January 2007 to December 2011. All of them received salvage treatment after recurrence. The Univariate analysis was determined using the Kaplan-Meier method and log-rank test. Multivariate prognostic analysis was determined using the Cox proportional hazard model.Results:The 1-, 3-, 5-year overall survival (OS) rates were 80.9%, 35.6% and 20.4%, respectively. The median survival time and recurrence time were 29.2 months and 15.0 months. The 1-, 3-, 5-year PRS rates were 37.7%, 14.6% and 11.9%, respectively. The median PRS time was 10.2 months. Locoregional recurrence was noted at 462 sites among 382 patients including 20.5% (95/462) of sites in supraclavicular LN (lymph node), 10.0% (46/462) in anastomosis, 56.1% (259/462) in mediastinal regional LN and 13.4% (62/462) in upper abdominal LN. There were 156, 43, 82 and 101 patients treated with salvage radiotherapy, chemotherapy, chemoradiotherapy and palliative care after recurrence, respectively. The univariate analysis showed that T stage, N stage, TNM stage, recurrence site, number of recurrent regions and treatment regimen after recurrence were significantly correlated with PRS ( χ2=5.336, 4.292, 8.067, 7.482, 4.093, 76.426, P<0.05). Patients receiving salvage radiotherapy with the median dose of 60 Gy, were divided into <60 Gy group and ≥ 60 Gy group. The ≥60 Gy group had a better PRS than <60 Gy group ( χ2=8.320, P<0.05). Multivariate analysis showed that number of recurrent regions and treatment regimen were independent prognostic factors of PRS. Conclusions:Mediastinal and supraclavicular regions were the most common sites of recurrence in ESCC patients after radical surgery. Salvage radiotherapy and chemoradiotherapy could significantly improve PRS in recurrent ESCC patients.

The causes of stroke in young people are diverse, most of which are cardiogenic. However, cerebral embolism caused by cardiac myxoma is rare. Intravenous thrombolysis is given in the time window, and the therapeutic effect depends on the nature of embolus. This case is a young female patient, with acute onset, excluding bleeding on the basis of the symptoms, signs and craniocerebral CT. After diagnosed as acute ischemic stroke, the patient was performed an immediate intravenous thrombolysis, though the curative effect was poor. Excluding contraindications six hours after onset, bridging mechanical thrombectomy was performed, postoperative embolus biopsy indicating myxoma. Atrial myxoma was removed in cardiac surgery two months later, and the pathology indicated atrial myxoma. The patient recovered well during the out-of-hospital follow-up, and no further embolization occurred. Therefore, it is suggested that bridging mechanical thrombectomy may be safe and effective for acute ischemic stroke caused by atrial myxoma when intravenous thrombolysis is ineffective, and myxoma resection should be performed immediately after the disease is stable.

Objective: To study the relationship between the dose-volume indexes and acute toxicity of intrathoracic stomach in esophageal cancer patients receiving radiotherapy after esophagectomy. Methods: A total of 104 patients treated with postoperative radiotherapy followed by radical esophagectomy were enrolled. The dose-volume indexes of intrathoracic stomach were collected from treatment planning system. The ROC curve and logistic regression were performed to analyze the relationship between acute toxicity of intrathoracic stomach and clinical parameters, dose-volume indexes. Results: A total of 29 patients (27.88 %) suffered from grade 2 or above acute toxicity. The ROC curve analysis showed that the dose-volume indexes including D_max, D_mean, L₅-L₄₅ and V₅-V₅₀were associated with occurrence of grade 2 or above acute toxicity. The univariate analysis showed that location, D_max, D_mean, L₅-L₄₅ and V₅-V₅₀ were significantly correlated with the incidence of grade 2 or above acute toxicity (P<0.05). The multivariate analysis showed that location, L₅ and V₃₅ were independent factors for incidence of grade 2 or above acute toxicity. The ROC curve analysis showed that cut-off values of L₅ and V₃₅ were 14.00 cm and 44.00%, respectively. And the rates of Grade 2 or above acute toxicity were 20.00% for L₅>14.00 cm and 38.64% for L₅≥14.00 cm (χ²=4.473, P<0.05), 14.08% for V₃₅<44.00% and 57.58% for V₃₅≥44.00% (χ²=7.263, P<0.05), respectively. The incidence of grade 2 or above acute toxicity was significantly higher in post-mediastinum stomach group than the other two groups (χ²=12.881, P<0.05). Conclusions Dose-volume index may be indicator to predict acute toxicity of intrathoracic stomach. It is recommended that post-mediastinum stomach should be chosen carefully if esophageal cancer patients require postoperative radiotherapy.

Objective To investigate the application value of root seeking method and suspension method in lymph nodes dissection of recurrent laryngeal nerve (RLN) during minimally invasive McKeown surgery of thoracic esophageal cancer.Methods The retrospective cohort study was conducted.The clinical data of 120 patients with thoracic esophageal cancer who were admitted to the First Affiliated Hospital of Zhengzhou University from March 2015 to May 2016 were collected.Sixty patients using root seeking method and suspension method in lymph nodes dissection of RLN were allocated into the study group,and 60 using unexposed lymph nodes dissection of RLN were allocated into the control group.All the patients underwent minimally invasive McKeown surgeries.Observation indicators:(1) intraoperative situations;(2) postoperative situations;(3) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative tumor recurrence or metastasis and injury of RLN up to January 2017.Measurement data with normal distribution were represented as-x±s.Comparisons between groups were evaluated with the independent-sample t test.Count data were analyzed using the chi-square test.Results (1) Intraoperative situations:patients between groups underwent successful minimally invasive McKeown surgery,without conversion to open surgery.The operation time and volume of intraoperative blood loss were respectively (250± 19)minutes,(484±80)mL in the study group and (248±22) minutes,(493±60)mL in the control group,with no statistically significant difference between groups (t =0.532,-0.697,P＞0.05).The number of lymph nodes dissection,successful dissection rate and metastasis rate in the left RLN and metastasis rate in the right RLN were respectively 5.0±4.1,86.7％ (52/60),23.3％ (14/60),16.7％ (10/60) in the study group and 1.0±0.9,60.0％ (36/60),1.7％ (1/60),5.0％ (3/60) in the control group,with statistically significant differences between groups (t =5.170,x2=10.909,12.876,4.227,P＜0.05).The number of lymph nodes dissection,successful dissection rate and metastasis degree in the right RLN and metastasis degree in the left RLN were respectively 3.5±3.6,93.3％(56/60),8.55％(20/234),7.69％ (20/260) in the study group and 1.5± 1.0,83.3％ (50/60),4.00％ (4/100),1.72％ (1/58) in the control group,with no statistically significant difference between groups (t=1.075,x2 =2.911,2.172,1.856,P＞0.05).(2) Postoperative situations:time to initial anal exsufflation,time of initial defecation and time for initial fluid diet intake were respectively (2.0±0.6)days,(3.1 ± 0.6)days,(7.2± 0.3)days in the study group and (2.2±0.8) days,(3.2±0.5) days,(6.9±0.5) days in the control group,with no statistically significant difference between groups (t=2.618,-0.991,3.985,P＞0.05).Comparisons of injury degree of RLN:5 and 1 patients in the study and control groups had mild injury,respectively,showing no statistically significant difference between groups (x2=1.581,P＞0.05);1 and 8 patients in the study and control groups had respectively moderate injury,showing a statistically significant difference between groups (x2 =4.323,P＜0.05);there was no severe injury between groups.Duration of hospital stay in the study and control groups were respectively (14.8±2.5)days and (14.5±2.8) days,showing no statistically significant difference between groups (t =0.619,P＞ 0.05).(3)Follow-up:120 patients were followed up for 4-22 months,with a median time of 13 months.During the follow-up,3 and 2 patients in the study and control groups had cervical lymph node metastases and received postoperative assisted chemotherapy and local radiotherapy of neck,without death between groups.There was no hoarseness in 6 patients with mild injury of RLN during the follow-up;voices in 9 patients with moderate injury of RLN were improved at 1-2 months postoperatively,and no bucking symptom was detected after fluid diet intake.Conclusion The root seeking method and suspension method in lymph nodes dissection of RLN is safe and effective during minimally invasive McKeown surgery of thoracic esophageal cancer,especially conducive to lymph nodes exposure and dissection of the left RLN,and reduce the incidence of moderate injury of RLN.