Objective:To construct a prediction model for difficult tracheal intubation in the patients with obstructive sleep apnea-hypopnea syndrome (OSAHS).Methods:A total of 324 patients with OSAHS undergoing surgery with general anesthesia, admitted to our hospital from June 2019 to June 2021, were included in model group, and 175 patients with OSAHS undergoing surgery with general anesthesia, admitted from July 2021 to July 2022, were selected and served as validation group. The patients in model group were divided into occurrence group and non-occurrence group according to whether difficult tracheal intubation occurred. Logistic regression was used to construct the prediction model, and R4.2.1 software was used to draw the risk nomogram and calibration curve. The predictive accuracy of the model was evaluated by the area under the receiver operating characteristic curve.Results:Body mass index (BMI), sagittal minimum cross-sectional area, horizontal minimum cross-sectional area and mandibular distance were risk factors for difficult tracheal intubation in OSAHS patients ( P<0.05). A prediction model was developed using the above factors: Logit P=33.726+ 1.411×BMI score-0.014×sagittal airway minimum cross-sectional area-0.013×airway horizontal minimum cross-sectional area-0.312× mandibular distance. The area under the receiver operating characteristic curve was 0.846, Youden index 0.585, sensitivity 0.831, specificity 0.755, and the accuracy 0.889 (Hosmer-Lemeshow test χ2=9.24, P=0.322) in model group. The area under the external validation curve was 0.802, Youden index 0.545, sensitivity 0.636, specificity 0.908, and the accuracy 0.893 (Hosmer-Lemeshow test χ2=10.24, P=0.287) in validation group. Conclusions:The prediction model based on BMI, sagittal minimum cross-sectional area of airway, horizontal minimum cross-sectional area of airway and mandibular distance has a high value in predicting the risk of difficult tracheal intubation in patients with OSAHS.

Objective:To explore the differences of risk stratification of very high-risk or extreme high-risk atherosclerotic cardiovascular diseases (ASCVD) and the attainment rates of low-density lipoprotein cholesterol (LDL-C) management targets evaluated by three different criteria, and the causal attributions of these differences.Methods:Patients with ASCVD were consecutively enrolled from January 1 to December 31 in 2019, and were evaluated for very high-risk or extreme high-risk and LDL-C goal attainment rates with 2018 American guideline on the management of blood cholesterol (2018AG), 2019 China Cholesterol Education Program (CCEP) Expert Advice for the management of dyslipidemias (2019EA) and 2020 Chinese expert consensus on lipid management of very high-risk ASCVD patients(2020EC), respectively. The causal attributions of the differences in attainment rates were analyzed as well.Results:A total of 1 864 ASCVD patients were included in this study. According to 2018AG, 2019EA and 2020EC, the proportions of the patients with very high-risk or extreme high-risk were 59.4%, 90.7%, and 65.6%, respectively. The absolute LDL-C target attainment rates were 37.2%, 15.7%, and 13.7%, respectively, the differences between each two rates were statistically significant (all P<0.001). As to the differences in attainment rates between 2020EC and 2018AG, 61.5% were due to the different LDL-C goal attainment values and 38.5% were caused by the different risk stratifications, while for the differences between 2020EC and 2019EA attainment rates, different LDL-C goal attainment values were responsible for 13.2%, and different risk stratifications were responsible for 86.8% of the differences. Conclusions:There are significant differences in the proportions and LDL-C attainment rates among the three different criteria for very high-risk or extreme high-risk ASCVD. 2020EC showed a moderate proportion of patients with extreme high-risk, and had the lowest LDL-C attainment rate. The differences between 2020EC and 2018AG are mainly due to the LDL-C target values, and the differences between 2020EC and 2019EA are mainly caused by the risk stratifications.

OBJECTIVE: To observe the effect of electroacupuncture (EA) at "Tianshu" (ST 25) and "Shangjuxu" (ST 37) on mental state, visceral sensitivity and protein expression of nerve growth factor (NGF), tyrosine kinase receptor A (TrkA) and transient receptor potential vanilloid 1 (TRPV1) of colonic tissue in diarrhea-predominant irritable bowel syndrome (IBS-D) rats, and to explore its possible mechanism on treating IBS-D. METHODS: A total of 36 male SD rats of SPF grade were randomized into a blank group, a model group, an EA group and a western medication group, 9 rats in each group. In the model group, the EA group and the western medication group, IBS-D model was established by enema of dinitrobenzene sulfonic acid (DNBS) combined with chronic restraint stress method. In the EA group, EA was applied at "Tianshu" (ST 25) and "Shangjuxu" (ST 37), with disperse-dense wave, in frequency of 2 Hz/100 Hz, 20 min each time, once a day for 7 days. In the western medication group, pinaverium bromide suspension was given by gavage (15 mg•kg^-1•d^-1) for 7 days. Before and after model establishment, and after intervention, the body mass, 24 h food intake and fecal water content were observed, the visceral sensitivity was detected by abdominal withdrawal reflex (AWR); after intervention, the mental state was evaluated by elevated plus maze (EPM) test, the protein expression of NGF, TrkA and TRPV1 was detected by immunohistochemistry and Western blot in the 4 groups. RESULTS: After model establishment, compared with the blank group, the body mass and 24 h food intake were decreased (P<0.05), first systolic latency of AWR was shortened and number of contraction wave of AWR was increased (P<0.05), and fecal water content was increased (P<0.05) in the model group, the EA group and the western medication group. After intervention, compared with the blank group, open arm residence time ratio (OT%) of EPM was decreased (P<0.05) and protein expression of NGF, TrkA, TRPV1 in colonic tissue was increased in the model group (P<0.05); compared with the model group, the body mass and 24 h food intake were increased (P<0.05), first systolic latency of AWR was lengthened and number of contraction wave of AWR was decreased (P<0.05), the fecal water content was decreased (P<0.05), OT% of EPM was increased (P<0.05), and protein expression of NGF, TrkA, TRPV1 in colonic tissue was decreased (P<0.05) in the EA group and the western medication group. CONCLUSION Electroacupuncture at "Tianshu" (ST 25) and "Shangjuxu" (ST 37) can relieve the anxiety and depression-like behaviors in IBS-D rats, down-regulate the protein expression of NGF, TrkA, TRPV1 in colonic tissue, so as to reduce the visceral sensitivity and relieve symptoms.
Male ; Rats ; Animals ; Receptor Protein-Tyrosine Kinases ; Rats, Sprague-Dawley ; Irritable Bowel Syndrome/therapy* ; Sulfonic Acids ; Nerve Growth Factors ; TRPV Cation Channels/genetics*

Objective:To investigate the application value of computed tomography (CT) examination of lymph node short diameter in evaluating left recurrent laryngeal nerve lymph node metastasis in thoracic esophageal squamous cell carcinoma.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 628 patients with thoracic esophageal squamous cell carcinoma who were admitted to 2 medical centers (236 cases in the Sun Yat-sen University Cancer Center and 392 cases in the Affiliated Cancer Hospital of Zhengzhou University) from October 2009 to December 2016 were collected. There were 462 males and 166 females, aged from 38 to 85 years, with a median age of 62 years. Observation indicators: (1) operation status, dissection and metastasis of left recurrent laryngeal nerve lymph node; (2) efficacy of CT examination of the left recurrent laryngeal nerve lymph node short diameter in evaluating postoperative lymph node metastasis; (3) determination of the optimal cut-off value; (4) examination results using different diagnostic criteria. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers or percentages. The area under curve (AUC) of receiver operating characteristic curve (ROC) was used to estimate the efficiency of detection methods. The maximum value of Youden index corresponded to the optimal cut-off point. Results:(1) Operation status, dissection and metastasis of left recurrent laryngeal nerve lymph node: among the 628 patients, there were 572 cases undergoing two-field lymph node dissection while 56 cases undergoing three-field lymph node dissection, there were 408 cases undergoing minimally invasive surgery while 220 cases undergoing open surgery. Sixty of 628 patients had left recurrent laryngeal nerve lymph node metastasis. A total of 1 666 left recurrent laryngeal nerve lymph nodes were dissected from the 628 patients, among which 75 were metastatic lymph nodes, with a metastasis rate of 4.502%(75/1 666). (2) Efficacy of CT examination of the left recurrent laryngeal nerve lymph node short diameter in evaluating postoperative lymph node metastasis: the AUC of CT examination of the left recurrent laryngeal nerve lymph node short diameter in predicting postoperative lymph node metastasis was 0.854 (95% confidence interval as 0.792 to 0.916, P<0.05). (3) Determination of the optimal cut-off value: the Youden indices were 0.556, 0.384, 0.258, 0.063 and 0.003 respectively when using 5 mm, 6 mm, 7 mm, 8 mm, 9 mm or 10 mm as the optimal cut-off value for CT examination of the left recurrent laryngeal nerve lymph node short diameter. The short diameter as 5 mm was the optimal cut-off value for CT examination of the left recurrent laryngeal nerve lymph node short diameter. (4) Examination results using different diagnostic criteria: the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, cases being missed diagnosis were respectively 66.3%, 92.3%, 89.5%, 46.3%, 96.0%, 20 and 5.0%, 99.8%, 90.7%, 75.0%, 90.9%, 57 when using short diameter ≥5 mm or ≥10 mm in CT examination of the left recurrent laryngeal nerve lymph node as the diagnostic criteria for left recurrent laryngeal nerve lymph node metastasis of thoracic esophageal squamous cell carcinoma. Conclusions:CT examination of lymph node short diameter can be used to evaluate left recurrent laryngeal nerve lymph node metastasis in thoracic esophageal squamous cell carcinoma. The sensitivity, specificity and accuracy is preferable when using short diameter ≥5 mm in CT examina-tion of the left recurrent laryngeal nerve lymph node as the diagnostic criteria for left recurrent laryngeal nerve lymph node metastasis of thoracic esophageal squamous cell carcinoma.

Objective: To investigate the effect of nursing intervention on information-motivation-behavioral skill (IMB) model in patients with adjuvant chemotherapy after radical resection of upper thoracic esophageal squamous cell carcinoma. Methods: A total of 128 patients with adjuvant chemotherapy after radical resection of esophageal squamous cell carcinoma from December 2016 to June 2018 were enrolled. The random number table method was used to divide them into control group (64 cases) and study group (64 cases). The control group received routine nursing, and the study group took the IMB model of nursing intervention on the basis of the control group. The intervention time was 2 months. Postoperative rehabilitation (feeding time, time to get out of bed, and length of hospital stay), pre-intervention self-efficacy score (Strategies Used by People to Promote Health, SUPPH), European Organization for Research and Treatment of Cancer-Quality of Life-Core 30 Questionnaire (EORTC-QLQ-C30), complications (reflux esophagitis, chest cavity), the incidence of effusion, infection, anastomotic leakage, and satisfaction of nursing work were compared. Results: The feeding time of the study group was (3.39±0.72) d, the time of getting out of bed (2.26±1.02) d, the length of hospital stay (9.19±1.68) d, which was shorter than that of the control group (4.48±0.81), (4.07±1.55), (12.26±2.35) d, the difference was statistically significant (t=8.046, 7.804, 8.502, P<0.05). After intervention, the self-decision, self-decompression, and positive attitude scores of the two groups were higher than those before the intervention, and the study group was (11.19±1.28), (28.37±2.79), (39.98±5.01), respectively, higher than the control group. The differences were statistically significant (t= 7.239, 5.036, 5.057, P < 0.05). After intervention, the social function, emotional function, role function and physical function score of the two groups were higher than those before the intervention, and the study group were (69.02±6.87), (70.61±7.65), (69.68±6.80), (72.55±6.51). The scores were higher than those of the control group (61.13±7.03), (63.64±7.44), (60.22±7.05), and (65.86±6.08), and the difference was statistically significant (t=5.225-6.422, P<0.05). The complication rate was 7.81% (5/64) in the study group and 20.31% (13/64) in the control group. The difference was statistically significant (χ²=4.137, P <0.05). The nursing job satisfaction of the study group was 92.19% (59/64), which was higher than that of the control group 79.69% (51/64). The difference was statistically significant (χ²=4.137, P<0.05). Conclusions The intervention of IMB model in the treatment of patients with adjuvant chemotherapy after radical resection of upper esophageal squamous cell carcinoma can effectively improve their self-efficacy, reduce postoperative complications, shorten the postoperative rehabilitation time, and improve the quality of life of patients and improve the satisfaction of their nursing work.

Objective: To explore the relationship between anthropometric indices and the incident risk of hypertension, compare novel anthropometric indices with traditional indices in hypertension prediction and establish hypertension prediction models among elderly Chinese. Methods: A total of 27 009 retirees from the Dongfeng Motor Corporation were recruited at baseline in 2008 and the first follow-up was conducted in 2013. After the exclusion of participants less than 60 years old, participants with hypertension, coronary heart disease, stroke, cancer, and those with missing data, a total of 6 784 elderly participants were enrolled in this study. A multivariate logistic regression model was used to analyze the relationship between traditional anthropometric indices, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), novel anthropometric indices, visceral adiposity index (VAI), body shape index (ABSI), body roundness index (BRI), and the incident risk of hypertension. Meanwhile, a multivariate logistic regression model was used to establish hypertension prediction models. Receiver operating characteristic (ROC) curve was applied to compare the prediction ability of different models. Results: A total of 1 787 incident cases of hypertension were identified, with the incidence of hypertension about 27.59%. Significant positive associations were detected between BMI, WC, WHtR, VAI, BRI and the incident risk of hypertension after adjusting for potential confounders (all P values<0.05). In men, the OR (95%CI) (upper tertile vs lower tertile) was 1.45 (1.22-1.73) for VAI, and 1.86 (1.55-2.23) for BRI. In women, the OR (95% CI) (upper tertile vs lower tertile) was 1.55 (1.22-1.96) for VAI, and 1.60 (1.27-2.01) for BRI. For ABSI, no significant association was observed in either men (OR (95%CI): 1.07 (0.90-1.28)) or women (OR (95%CI): 1.03 (0.82-1.29), both P values >0.05). The basic hypertension prediction model included age, drinking (only in men), education status (only in men), systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting blood glucose levels. Based on the basic prediction model, BMI (in men: AUC=0.697) and BRI (only in men: AUC=0.696) improved area under ROC curve (AUC) significantly (P<0.05). BMI was the strongest predictor in both men (AUC=0.697) and women (AUC=0.685) in the extended model. Conclusion Significant positive associations were detected between BMI, WC, WHtR, VAI, BRI and the incident risk of hypertension among elderly Chinese. BMI was the strongest predictor in hypertension prediction model compared with other anthropometric indices.

BACKGROUND: Thymoma is frequently associated with myasthenia gravis (MG). However, whether MG is a factor for the outcome of patients with thymoma following complete thymectomy remains unknown. The aim of this study is to investigate the effect of thymoma with MG prognostic factors. METHODS: A retrospective analysis of The Chinese Alliance for Research in Thymomas (ChART) database within 1992-2012 complete cases 875 cases, 20 years follow-up data analysis thymic tumor tissue type credits and MG, Masaoka staging and prognosis, postoperative adjuvant therapy and relationship with the prognosis of surgical removal of the way. RESULTS: Thymic tumor tissue type credit has correlation with MG, difference was statistically significant (χ²=24.908, P<0.001). MG: incidence of B2 type (58/178, 32.58%) > B3 type (65/239, 27.20%) > B1 (27/132, 20.45%) > AB (43/267, 16.10%) > type A, 10.17% (6/59), Masaoka stage has no correlation with MG (χ²=0.365, P=1.365). Survival analysis showed that the WHO classification, Masaoka stage associated with prognosis (P<0.05), and whether the merger MG (χ²=0.113, P=0.736), postoperative adjuvant radiotherapy (χ²=0.380, P=0.538) has nothing to do with the prognosis, postoperative adjuvant chemotherapy is associated with poor prognosis (χ²=14.417, P<0.001). Whether has nothing to do with the prognosis of the thymus resection (χ²=1.548, P=1.548), whether the whole correlated with the curative effect of thymus excision with MG (χ²=24.695, P<0.001). CONCLUSIONS Thymoma patients with MG and extended thymectomy have no correlation with prognosis. Extended thymectomy can improve the effect of MG patients.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Myasthenia Gravis ; complications ; diagnosis ; surgery ; Prognosis ; Retrospective Studies ; Survival Analysis ; Thymoma ; complications ; Young Adult

Background and objective The aim of this study is to determine the effcacy and feasibility of a novel folate receptor (FR)-based circulating tumor cell (CTC) detection method in the diagnosis of lung cancer. CTCs were col-lected from 3 mL of blood based on negative enrichment by immunomagnetic beads and then labeled by a conjugate of a tumor-speciifc ligand folate and an oligonucleotide.Methods Atfer washing off redundant conjugates, the bound conjugates were removed and analyzed by quantitative polymerase chain reaction.Results The CTC levels of 97 patients with lung cancer were signiifcantly higher than that of the controls (18 patients with benign lung diseases;P<0.001). With a threshold of 8.7 Folate units, the method showed a sensitivity of 82.5% and a speciifcity of 72.2% in the diagnosis of lung cancer, especially a sensitivity of 86.8% in stage I disease. Compared with the existing clinical biomarkers such as neuron-speciifc enolase (NSE), carcinoembryonic antigen (CEA), and CYFAR21-1, the method showed the highest diagnostic effciency in lung cancer (area under the curve, 0.859; 95%CI: 0.779-0.939) and stage I lung cancer (area under the curve, 0.912; 95%CI: 0.829-0.994). For future work, the CTC levels of 5 lung cancer patients higher than 8.7 Folate units/3 mL in their postoperation.Conclusion FR-positive CTCs were feasible diagnostic biomarkers in patients with lung cancer, as well as in early-stage tumors.

OBJECTIVETo explore the effects of early intervention of acupuncture on urinary function reconstruction of neurogenic bladder after spinal cord injury, so as to find the optimal treatment timing of acupuncture.

METHODSFifty-three patients of neurogenic bladder after spinal cord injury were randomly divided into a prior-to-catheter group (25 cases) and a posterior-to-catheter group (28 cases). For the prior-to-catheter group, one week before the removal of catheter, acupoints on the abdomen and back such as Guanyuan (CV 4), Zhongji (CV 3), Baliao (Shangliao (BL 31), Ciliao (BL 32), Zhongliao (BL 33), Xialiao (BL 34), Jiaji (EX-B 2) and acupoints at distal end such as Zusanli (ST 36) and Sanyinjiao (SP 6) were selected; after the catheter removal, simple method. of water column was used to measure bladder capacity pressure to classify the type of bladder, and then different acupuncture manipulations were given; intermittent catheterization was performed if condition was allowed. The posterior-to-catheter group applied identical treatment after removal of catheter as the prior-to-catheter group. The treatment was given 5 times per week; after one-month treatment, five aspects including the time of first effective urination, time of establishing reflex urination, average residual volume of urine, time of residual urine less than 100 mL and quality of life (QOL) were evaluated.

RESULTSAfter treatment, the time of first effective urination, time of establishing reflex urination, average residual volume of urine and time of residual urineless than 100 mL in the prior-to-catheter group were all superior to those in the posterior-to-catheter group (all P<0. 05) ; the score of QOL was improved in two groups after treatment (both P<0. 01), but the difference between two groups was not statistically significant (P>0. 05); each index of urination function was not significant among patients with different injured segments of spinal cord (all P>0. 05).

CONCLUSIONThe early intervention of acupuncture (prior to catheter) has obvious improving function on establishing balanced bladder in patients with neurogenic bladder after spinal cord injury, which is superior to acupuncture intervention after removal of catheter, however, the effects of different injured segments on establishing balanced bladder are not different.

Acupuncture Points ; Acupuncture Therapy ; Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Spinal Cord Injuries ; complications ; Treatment Outcome ; Urinary Bladder ; physiopathology ; Urinary Bladder, Neurogenic ; etiology ; physiopathology ; therapy ; Urination ; Young Adult

Objectives To investigate the clinical effect of hemoperfusion in severe juvenile dermatomyositis. Meth-ods Two patients with severe juvenile dermatomyositis, who accepted hemoperfusion treatment, were retrospectively analyzed. Results In these 2 patients, the hemoperfusion process were smooth. The muscle pain was reduced and the muscle enzymes were decreased. After hemoperfusion, one patient refused to continue treatment and the disease recurrent. The other patient con-tinued to accept the immunosuppressive therapy and eventually improved. Conclusions For juvenile dermatomyositis, hemo-perfusion was a safe and effective auxiliary treatment. It could be applied when the general treatment was invalid.