Objective To observe the value of gastric filling ultrasound(GFUS)for diagnosing dysphagia after surgical operation of hiatal hernia(HH).Methods Totally 71 HH patients who underwent laparoscopic HH repair and fundoplication surgery were retrospectively enrolled and divided into dysphagia group(n=23)and non dysphagia group(n=48)according to postoperative Saeed scores.GFUS parameters,including inner diameter of esophageal hiatus lumen(IDE),wall thickness of abdominal esophageal(WTE)and inner diameter of the esophageal lumen at the fold(FIDE)were compared between groups,and their value of diagnosing postoperative dysphagia were analyzed.Results In dysphagia group,IDE and FIDE were lower,while WTE was higher than those in non dysphagia group(all P＜0.05).Low IDE and high WTE were both independent risk factors of postoperative dysphagia in HH patients.The sensitivity,specificity and area under the curve(AUC)of IDE for diagnosing dysphagia after surgical operation of HH was 82.64％,66.69％and 0.773,of WTE was 82.59％,68.73％and 0.793,of their combination was 88.89％,77.59％and 0.843,respectively.The AUC of the combination of IDE and WTE was higher than that of IDE and WTE alone(Z=1.328,1.364,P=0.044,0.043).Conclusion Combination of GFUS parameters IDE and WTE was valuable for diagnosing dysphagia after surgical operation of HH.

Objective:To investigate the effect of growth hormone (GH) supplementation during luteal phase one cycle before ovulation induction in patients undergoing in vitro fertilization-embryo transfer (IVF-ET).Methods:IVF-ET pregnancy-assisted patients who underwent long-term Gonadotropin Releasing Hormone-agonist (GnRH-a) protocol from January 1, 2019 to June 30, 2020 were collected from the Reproductive Center of Hunan Provincial Maternal and Child Health Hospital. Among them, 106 patients (GH group) were added with GH during luteal phase one cycle before ovulation induction, and 212 patients (control group) were not added with GH. Ovulation induction and pregnancy outcome were compared between the two groups.Results:(1) There was no statistically significant difference in primary infertility/secondary infertility rate, infertility years, age, and transplant cancellation cycle rate between the two groups (all P>0.05). (2) There were no significant differences in the number of oocytes obtained, MII oocytes, two pronucleus (2PN) oocytes, high-quality embryos and average number of transplanted embryos between GH group and control group (all P>0.05). The total amount of Gn in control group and GH group was (2 109.75±555.75)IU and (1 863±610.52)IU, respectively, with statistically significant difference ( P<0.05). (3) The embryo implantation rate of the control group and GH group was 43.73%(129/295) and 60.42%(87/144), respectively, with statistically significant difference ( P<0.05). The clinical pregnancy rates of the control group and GH group were 58.79%(107/182) and 71.91%(64/89), the difference was statistically significant ( P<0.05). The spontaneous abortion rate of early pregnancy in control group (4.67%, 5/107) was slightly higher than that in GH group (3.12%, 2/64), but there was no significant statistical difference ( P>0.05). Conclusions:For patients with normal ovarian response, adding small dose of growth hormone during luteal stage one cycle before controlled hyperovulation can improve the embryo implantation rate and clinical pregnancy rate, and reduce the amount of Gn, which is beneficial to patients.

Objective:To explore effects of controlled ovarian stimulation (COS) protocols on pregnancy outcomes for patients with polycystic ovarian syndrome (PCOS) undergoing in vitro fertilization-embryo transfer (IVF-ET). Methods:A total of 1 032 patients with PCOS who underwent IVF-ET from September 1, 2016 to July 31, 2020 in the Reproductive Center of Hunan Provincial Maternal and Child Health Care Hospital were retrospectively analyzed. The patients were divided into modified long regimen group (group A, 126 cases), luteal phase long regimen group (group B, 185 cases), antagonist regimen group (group C, 344 cases), and progestin primed ovarian stimulation (PPOS) group(group D, 377 cases) according to different ovulation stimulation regimens. The ovulation promotion status [days of gonadotropin (Gn), total amount of Gn, estradiol (E 2) level on the day of human chorionic gonadotropin (HCG) injection, number of retrieved eggs, number of mature eggs (MII eggs), number of normal fertilized embryos (2PN), number of high-quality embryos] and the first frozen embryo transfer pregnancy status (clinical pregnancy rate, implantation rate, early abortion rate) were compared among the patients in each group. Results:(1) There was no significant difference in general clinical data between the four groups (all P>0.05). (2) The number of Gn days in group D was significantly less than that in groups A, B and C, and the total number of Gn was significantly less than that in groups A, B and C (all P<0.05); The E 2 level of patients in group C and group D on the day of hCG injection was significantly lower than that of group A and group B (all P<0.05); The number of eggs obtained and MII eggs in group C and group D were significantly lower than those in group A and group B (all P<0.05); The number of high-quality embryos and 2PN in group D were significantly different from those in group A, group B and group C (all P<0.05). (3) The clinical pregnancy rates of the first frozen embryo transfer after whole embryo cryopreservation in group A, group B, group C and group D were 54.72%(29/53), 56.79%(46/81), 52.56%(82/156) and 54.32%(195/359), respectively, with no significant difference among the four groups (all P>0.05). There was no significant difference in embryo implantation rate and early abortion rate among the four groups (all P>0.05). Conclusions:The modified long regimen, luteal phase long regimen, antagonist regimen and PPOS regimen can achieve better pregnancy outcomes in patients with PCOS. Among them, PPOS regimen can reduce the amount and time of Gn, and frozen embryo transfer does not affect the pregnancy outcome of patients. It can be used as one of the priority recommended strategies for PCOS patients who plan to undergo frozen embryo transfer.

Objective:To investigate the early clinical effects of orthopedic surgery robot-assisted double Endobutton titanium plate internal fixation in the treatment of fresh acromioclavicular joint dislocation.Methods:Thirty-nine patients with fresh acromioclavicular joint dislocation were included from January 2020 to January 2022. A total of 19 patients were treated with double Endobutton suspension internal fixation assisted by the domestic third-generation orthopaedic surgical robot (TiRobot ? 2.0) Dimensity system. There were Rockwood type III in 11 cases, type IV in 8 cases. Twenty cases were treated with conventional incision double Endobutton internal fixation, with Rockwood type III in 13 cases, type V in 7 cases. The operation duration, blood loss volume, incision length and hospitalization time were compared between the two groups. The following CT parameters of acromioclavicular joint at 2 days and 1 year after operation, distance between distal inferior cortex of clavicle and subacromial cortex, distance between upper and lower endobuttons, horizontal distance between anterior edge of distal clavicle and anterior edge of acromion and diameter of coracoid process and diameter of clavicular tunnel were measured. The visual analogue score (VAS), Constant-Murley shoulder function score and shoulder abduction activity were also evaluated before and at 12 months after operation. Results:The follow-up duration was 10.8±2.4 months in the robot group and 11.5±3.1 months in the routine group. The VAS score of the robot group decreased from 5.3±2.1 to 0.3±0.2 at 12 months after operation ( t=10.46, P=0.014). The Constant-Murley score increased from 55.6±6.4 to 92.0±4.2. The range of shoulder abduction increased from 42.2°±5.4° to 172.6°±6.1° ( t=17.24, P<0.001). The operation duation of the robot group was 74.4±6.6 min, which was longer than that of the conventional group 61.7±7.2 min ( t=5.43, P=0.037). There was no significant difference in VAS score, Constant-Murley score, shoulder abduction activity or CT measurement between the two groups ( P>0.05). During the follow-up, two cases in the robot group had cortical osteolysis on the supraclavicular surface, one case in the conventional group had loss of reduction, one case in the supraclavicular cortical osteolysis, and 4 cases in the cortical defect on the side of the coracoid process tunnel. Conclusion:Orthopedic robot-assisted and conventional incision with double Endobutton titanium plate internal fixation in treating fresh acromioclavicular joint dislocation can achieve satisfied early clinical effects. Accurate establishment of clavicle and coracoid bone tunnel assisted by robot can overcome the defects of bone tunnel deviation in conventional incision operation and can prevent reduction and bone loss. However, robot-assisted and conventional incision Endobutton internal fixation could enlarge bone tunnel.

Objective:To investigate the effect of complete decongestive therapy in the treatment of severe grade Ⅲ lower limb lymphedema.Methods:From January 2018 to December 2018, The patients were admitted to the lymphedema clinic of the cancer prevention and treatment center of Sun Yat-sen University, seven patients with severe gradeⅢ lower limb lymphedema were intervened with complete decongestive therapy, including problem skin care, special techniques of unarmed lymphatic drainage, foam block bandage combined with air wave pressure therapy, filled elastic bandage pressure bandage, functional exercise combined with home bare-handed lymphatic drainage and weight loss management. The intervention had two courses, and 20 times was a course of treatment. Perimeter measurement and weight measurement were used to evaluate the therapeutic effect at the 0, 5, 10, 15, 20, 30, 40 times of treatment.Results:After two courses of treatment, the circumference value of each measurement point on the affected side was lower than that before treatment, and the difference was statistically significant ( F values were 7.449-23.073, P < 0.05). The circumference value of the affected side decreased by 7.10 - 24.53 cm, and the weight after treatment was 9.0 - 20.5 kg less than that before treatment. During the follow-up period, it was found that the lower extremity diameter value at 3 months of follow-up at 5 sites increased and tended to be stable compared with that at 1 year of follow-up. Conclusion:Step 6 comprehensive swelling treatment can obviously improve the symptoms of patients with lower limb lymphedema of this research, and in the subsequent follow-up found that self-therapy at home, no recurrence or aggravate the limb swelling degree, and can reduce or stability treatment effect, enhance confidence in the treatment of patients, so as to improve the quality of life of patients and treatment compliance.

Objective:To explore the effect of dynamic multi-dimensional management model based on informatization on improving the home self-care of lymphedema patients.Methods:A total of 80 patients who received lymphedema combined detumescence treatment from January 2018 to June 2018 were selected as the control group.From July 2018 to December 2018, 80 patients were treated as the intervention group, and the whole process was managed on the basis of the control group using the dynamic multidimensional management mode based on informatization. Patients' compliance and quality of life were compared between the two groups.Results:The intervention group patients' compliance was better than control group, correctly measure the circumference of limbs, the law of life that occupy the home was good, correct manual lymph drainage direction, bandages, functional exercise, 18 standards compliance, respectively, 95.0%(76/80), 87.5%(70/80), 97.5%(78/80), 95.0%(76/80), 100.0%(80/80), 87.5%(70/80), better than that of control group were 77.5%(62/80), 75.0%(60/80), 80.0%(64/80), 70.0%(56/80), 75.0%(60/80), 50.0%(40/80), difference was statistically significant ( χ2 values were 4.103-26.182, P<0.05 or 0.01). After a course of treatment and 3 months of home-based self-care, the scores of role function, physical function, emotional function and social function of the quality of life in the intervention group were (75.44 ± 2.78), (80.11 ± 3.01), (78.25 ± 2.78), (79.93 ± 5.43), which were better than those of the control group (66.25 ± 2.58), (75.88 ± 3.57), (65.16 ± 2.47), (62.78 ± 4.01), with statistically significant differences ( t values were 8.09, 31.50, P<0.01). Conclusions:The dynamic multi-dimensional management model based on informationization and doctor-patient participation can improve the compliance and quality of life of patients participating in home-based self-care and better meet the needs of home-based nursing.

Objective:To investigate the effect of scar uterus on assisted reproduction treatment strategy.Methods:From January 1, 2017 to December 31, 2017, 109 cases of scar uterus group and 63 cases of vaginal delivery history group who underwent in vitro fertilization-embryo transfer (IVF-ET) assisted pregnancy fresh embryo transfer in our hospital were retrospectively analyzed. Results:⑴ There was no significant difference in the total amount of gonadotropin (Gn) and the total days of GN in patients <35 between scar uterus group and the vaginal delivery history group ( P>0.05), but there were significant differences in the number of oocytes, mature oocytes, two pronucleus (2PN) and excellent embryos between the scar uterus group and the vaginal delivery history group ( P<0.05). When the age was ≥35 years old, there was no significant difference in the total number of GN, the total days of GN, the number of oocytes obtained, the number of mature oocytes, the number of 2PN and the number of excellent embryos between the two groups ( P>0.05). ⑵ There were no statistically significant differences in clinical pregnancy rate and embryo implantation rate between the two groups of patients < 35 years old, no matter single embryo transplantation or double embryos transplantation. When transplant two embryos, the clinical pregnancy rate and embryo implantation rate in the scar uterus group were slightly lower than those in the vaginal delivery history group (57.57% vs 71.05% and 39.39% vs 47.37%, respectively), but with no significant difference ( P>0.05). There were no statistically significant differences in the clinical pregnancy rate and embryo implantation rate between single embryo transplantation and double embryo transplantation in patients≥35 years old ( P>0.05). ⑶ There were no statistically differences in biochemical pregnancy rate, early abortion rate, preterm birth rate and average newborn weight between the scar uterus group and the vaginal delivery history group ( P>0.05). Conclusions:Cesarean section may affect the ovarian function. For patients with previous cesarean section, early evaluation of ovarian function is recommended. Single embryo transfer does not reduce the outcome in IVF-ET. It is recommended to perform single embryo transfer for patients with scar uterus to reduce the risk during pregnancy of twin pregnancy.

Hypertension with high serum Homocysteine (Hcy) significantly increases the incidence of cardiovascular and cerebrovascular events, which is defined as H-Type Hypertension by Chinese scholars. Plenty of researches have confirmed that high prevalence of H-Type Hypertension in Chinese population is now the big public problem in China. Traditional Chinese Medicine(TCM)treatment shows the advantages in integral regulation, less side effect, and anti-Hcy effect in hypertension. This paper discussed the prevalence, TCM syndrome and TCM treatment progress in H-Type Hypertension to provide some ideas and references for the intervention of H-Type Hypertension by TCM.

Objective To assess the effects of artificial cycle after long-acting gonadotropin-releasing hormone (GnRH) agonist down regulation scheme and artificial cycle only scheme in preparation of endometrium before frozen embryo transfer in polycystic ovary syndrome (PCOS) patients on pregnancy outcome.Methods A retrospective analysis was made on the frozen embryo transfer of 132 PCOS patients in the reproductive center of Hunan Maternal and Child Health Hospital from November 2016 to October 2017.The patients were divided into GnRH-a down regulation + artificial cycle group (n =66) and simple artificial cycle group (n =66) according to the different endometrial preparation schemes before frozen embryo transplantation.The transplantation cycle and pregnancy outcome of the two groups were compared.Results (1) There was no statistically significant difference in age,primary infertility rate,infertility years and body mass index (BMI) between the two groups (P ＞ 0.05).(2) In the artificial cycle group,4 cases in which the transplantation was cancelled,including 2 cases who were cancelled due to breakthrough bleeding and 2 cases due to endometrial thickness that were less than 7 mm.There was a statistically significant difference in the cancellation rate between the two groups (x2 =4.13,P =0.04).There were no statistically significant difference in embryo frozen storage time,retrieved oocytes in fresh embryo cycle,frozen thawed embryos in the survival rate,graftage embryonic number,high-quality embryonic rate,endometrium thickness in conversion day (P ＞ 0.05).Estrogen level,luteinizing hormone (LH) levels on endometrium conversion day in GnRH-a down regulation plus artificial cycle group and artificial cycle group were respectively as [(1 439.38 ± 357.43) nmoL/ml vs (1 580.54 ± 479.69) nmol/ml and (2.32 ± 0.94) mIU/ml vs (9.46 ±1.52) mIU/ml],with statistically significant difference (x2 =53.64,P ＜ 0.001;x2 =14.32,P ＜ 0.001).(3) The biochemical pregnancy rates of the patients in the GnRH-a down regulation plus artificial cycle group and artificial cycle group were 72.73％ and 53.23％ respectively,with statistically significant difference (x2 =5.23,P =0.036).The clinical pregnancy rate (65.15％) in GnRH-a down regulation plus artificial cycle group was higher than that of the artificial cycle group (46.77％),with statistically significant difference (x2 =4.39,P =0.022).There was no statistically significant difference in early abortion rate and ectopic pregnancy rate between the two groups.Conclusions In frozen embryo transplantation cycle,long-term GnRH-a down regulation after artificial cycle scheme is superior to simple artificial cycle scheme with significantly reduced cycle cancellation rate,low estrogen and LH levels in endometrium transformation day and higher biochemical pregnancy rate and clinical pregnancy rate.

Objective To explore the effects of seven-step complex decongestion therapy (CDT) on post-operative upper limb lymphede-ma of breast cancer. Methods From August, 2015 to September, 2016, 71 patients with upper limb lymphedema after breast cancer surgery accepted CDT for 20 days, including skin care, opening of lymphatic pathway, relief of scar tissue, manual lymphatic drainage, bandage compression, air pressure wave therapy and functional exercise. The circumference of eight sites of both limbs was measured and the differ-ences were calculated before treatment, and one, five, ten, fifteen and twenty days of the treatment. Results The differences of circumfer-ence increased one to 15 days of the treatment (Z>2.03, P<0.05), and decreased 20 days of the treatment (Z=3.01, P<0.01). Conclusion CDT is effective on lymphedema after breast cancer surgery for 20 days of a course, but may worsen in the first 15 days, which may be relat-ed to acute stress response or redistribution of lymph.