Adrenocortical carcinoma (ACC) with inferior vena cava thrombosis is rare and has a poor prognosis, and the current literature overwhelmingly supports aggressive surgical intervention. This article summarizes the management of a patient with ACC with inferior vena cava thrombosis, and discusses the feasibility of detailed preoperative imaging data and intraoperative ultrasound to assess the superior and inferior boundaries of ACC with inferior vena cava thrombosis, while describing the intraoperative ultrasound-guided surgical planning and procedure for ACC with retrohepatic inferior vena cava tumor thrombus. Furthermore, it also demonstrates that it is feasible to accurately assess the superior and inferior boundaries of ACC with inferior vena cava thrombosis by preoperative multimodal imaging and intraoperative ultrasound, determine the mode of flow blockage during the operation, and obtain radical resection of the tumor.

Objective:To analyze the prevention and treatment of Kaschin-Beck disease in Fu County, Shaanxi Province, so as to provide basis for consolidating the results of Kaschin-Beck disease prevention and control and the treatment of patients with Kaschin-Beck disease.Methods:The epidemiological investigation of data and clinical data Kaschin-Beck disease from 1954 to 2022 were collected from the Fu County Institute for Endemic Disease Prevention and Control and People's Hospital of Fu County in Shaanxi Province, respectively. The retrospective study was used to investigate the prevention and control of Kaschin-Beck disease in Fu County through the adoption of comprehensive measures such as relocation, grain exchange, water improvement, conversion of farmland to forest and so on.Results:In 1954, there were 6 endemic townships and 127 endemic villages of Kaschin-Beck disease in Fu County, with a total population of 78 781. A total of 16 327 patients with Kaschin-Beck disease were detected by X-ray examination, with a detection rate of 20.72%, including 5 434 patients without clinical symptoms. There were 5 850 patients with clinical grade Ⅰ, 3 725 patients with clinical grade Ⅱ and 1 318 patients with clinical grade Ⅲ. In 1975, the first general survey of Kaschin-Beck disease was conducted in the whole county, with a total population of 101 341. A total of 9 575 patients with Kaschin-Beck disease were detected by X-ray examination, with a detection rate of 9.45%, including 3 247 cases without clinical symptoms. Among the patients with symptoms, there were 3 704 cases of clinical grade Ⅰ, 2 006 cases of clinical grade Ⅱ and 618 cases of clinical grade Ⅲ. The patients with Kaschin-Beck disease were mainly local residents, accounting for 93.92% (8 993/9 575). In 1997, 27 320 students aged 7 to 16 years in 342 schools of 15 townships were examined and found that there were 169 cases without clinical symptoms with X-ray changes, only 2 cases with clinical grade Ⅰ, and the detection rate decreased to 0.63%. In 1997, Fu County began to encourage relocation and grain exchange to prevent Kaschin-Beck disease. The relocation targets were mainly the seriously ill villages with new cases among children and poor living conditions. By 1999, a total of 100 households and 469 people were relocated, and by 2020, 1 569 households and 5 334 people were relocated. In 1997 and 1998, measures were taken to improve water quality in 43 natural villages in 6 townships, with 1 591 households and 7 375 people benefiting. In 2010, a general survey of Kaschin-Beck disease was conducted in 15 townships of Fu County, with a total population of 135 858, and 3 424 patients with Kaschin-Beck disease were detected by X-ray examination, with a detection rate of 2.52%. There were 2 885 cases with clinical symptoms, including 1 584 cases with clinical grade Ⅰ, 1 024 cases with clinical grade Ⅱ and 277 cases with clinical grade Ⅲ. Among them, 32 561 minors under 16 years old were examined, and 49 patients with Kaschin-Beck disease were detected by X-ray examination, with a detection rate of 0.15%, and all of them were clinical gradeⅠ patients. In 2014, a total of 73 600 people were surveyed in 170 endemic villages of Fu county, and 2 885 patients with Kaschin-Beck disease were detected by X-ray examination, with a detection rate of 3.92%. Compared with 2010, the number of patients with Kaschin-Beck disease increased zero, and there were no underage patients under the age of 16 for 4 consecutive years. By the end of 2016, 666.67 hm 2 of farmland had been converted to forest in Fu County, involving 9 townships (including communities), 33 administrative villages and 1 993 households. In 2018, another general survey of Kaschin-Beck disease was conducted in Fu County, with a total population of 157 362. A total of 2 308 patients were detected by X-ray examination, with a detection rate of 1.47%. Among them, there were 1 270 cases of clinical grade Ⅰ, 870 cases of clinical grade Ⅱ and 168 cases of clinical grade Ⅲ, and there were no patients with Kaschin-Beck disease under 16 years old in the county for 8 consecutive years (2011-2018). In the same year, 22 cases of Kaschin-Beck disease joint replacement were completed in Fu County, and by January 2022, about 60 cases had completed joint replacement. Conclusion:The prevention and control of Kaschin-Beck disease in Fu County has achieved remarkable results through comprehensive measures such as relocation, grain exchange, water improvement and conversion of farmland to forest.

In recent years, with the increase of traffic accidents and the further development of aging, the incidence of pelvic fracture is gradually increasing. Based on the in-depth study about biomechanics of pelvic fracture fixation, the surgical treatment has been widely carried out. The purpose of surgical treatment is to effectively reduce and fix the fracture, correct deformity, restore integrity and stability of the pelvis, and minimize the complications caused by internal and external fixation. How to improve stability of the pelvis while ensuring therapeutic effect is a problem that every doctor will face in clinic. This paper summarizes the biomechanical research progress of pelvic fracture in recent years from the aspects of anatomy, normal biomechanics, classification and biomechanics of pelvic fracture fixation, so as to provide some references for reasonable treatment of pelvic fracture.

Objective:To explore the intention of exclusive breastfeeding and its influencing factors within six months after delivery of pregnant women in the third trimester of pregnancy in Xi'an.Methods:From January to February 2019, convenience sampling was used to select 2 671 pregnant women in the third trimester of pregnancy who underwent regular obstetric examinations in Obstetrics Clinic of five hospitals in Xi'an for a cross-sectional survey. Pregnant women were surveyed by means of a field survey using a self-designed Exclusive Breastfeeding Intention of Pregnant Women in the Third Trimester Questionnaire. Multivariate Logistic regression was used to analyze the influencing factors of the intention of exclusive breastfeeding among pregnant women in the third trimester. A total of 2 671 questionnaires were distributed, 2 479 valid questionnaires were recovered, and the valid recovery rate was 92.8% (2 479/2 671) .Results:A total of 60.8% (1 507/2 479) of pregnant women planned to exclusively breastfeed within 6 months of delivery. Pregnant women in the third trimester of pregnancy whose husbands ( OR=2.950, 95% CI: 2.097-4.066) and family members ( OR=2.171, 95% CI: 1.571-3.000) supported exclusive breastfeeding had high intention to exclusively breastfeed, and those who participated in breastfeeding courses had a high intention to exclusively breastfeed ( OR=1.436, 95% CI: 1.199-1.719) . Conclusions:More than half of third-trimester women plan to exclusively breastfeed within six months postpartum. Husband and family support and enrolment in breastfeeding classes increase the intention of pregnant women to exclusively breastfeed. Prenatal breastfeeding courses should be carried out to raise the awareness of pregnant women and family members about exclusive breastfeeding, and focus on the support of husbands and family members for exclusive breastfeeding, so as to increase the exclusive breastfeeding rate within six months after delivery.

Objective:To evaluate the day-surgery unit-based training of laparoscopic cholecystectomy (LC).Methods:Perioperative data of 438 patients (187 males and 251 females) with a median age of 54 (aged 17 to 91) years undergoing LC during January 2019 to April 2021 in the day-surgery unit of Chinese PLA General Hospital were retrospectively collected and subdivided according to the training methods of surgeons [Group A( n=260): conventional training vs. Group B ( n=178): protocoled stepwise training]. The protocoled stepwise training consists of the rotation in open biliary surgery unit, the stimulator-based laparoscopic training, and the stepwise procedural tutoring. The conventional training features the traditional surgical practice following senior surgeons. The technical data involving operation time, blood loss, the percentages of intraoperative decision-making by senior surgeons and the handing-over of procedure to senior surgeons, etc. were statistically analyzed. Results:The operation time was shortened in Group B [(55±30) min vs. (61±33) min], with significantly decreased percentages of intraoperative decision-making by senior surgeons [7.9% (14/178)vs. 16.9%(44/260), P<0.05] and the handing-over of procedure to senior surgeons [3.4%(6/178) vs. 11.2%(29/260), P<0.05]. Conclusion:Based on the protocoled stepwise training and the consecutive, high-volumed and standardized procedures, the laparoscopic technical proficiency and competency of the trainee surgeons have been improved.

Objective:To explore a new training mode for nursing professionals suitable for the 1+X certificate system, and realize the training goal of "one specialty and multi-ability" compound technical nursing talents.Methods:To take the "1+ X" certificate standard as the basis for the construction of nursing specialty, to reconstruct the talent training program of integration of graduation certificate and certificate. To take the content of "1+X" certificate as the basis for the construction of professional courses, construct the core curriculum system of integration of curriculum and certificate. To build a "new double-qualified" teaching staff and constructing of new double-qualified teachers and accelerate the development of quality resources.Results:The talent training mode of integration of graduation certificate and certificate under the 1+X certificate system was constructed. The curriculum structure has been optimized. The teachers′ability of teaching, training and examination was improved.Conclusions:The new mode of training nursing professionals under the 1+X certificate system meets 1 degree education and X vocational training of nursing students and achieve a "1" and "X" seamless convergence. It provides innovative ideas for the promotion and implementation of 1+X certificate system pilot work in the field of nursing education nationwide.

Laparoscopic ultrasound (LUS) has the advantage of high resolution,multi-angle exploration,and is widely used in minimally invasive surgery of biliary tract.LUS has a series of auxiliary function in difficult laparoscopic cholecystectomy (LC),common bile duct exploration,surgery of intrahepatic biliary calculi,and intraoperative staging of pancreato-biliary tumor.This paper summarizes the application of LUS in laparoscopic biliary surgeries and the related technical essentials.

Objective To objectively and standardly compare the bare-handed CPR and Thumper cardiopulmonary resuscitation CPR recovery effect based on cardiopulmonary resuscitation (CPR) Utstein model.Methods A retrospective study was conducted. CPR adult patients admitted to the Emergency Room of First Hospital of Qinhuangdao in Hebei Province from January 2015 to January 2017 were enrolled. Seventy patients who underwent CPR using the Thumper cardiopulmonary resuscitator were included in the Thumper CPR group; 80 patients who underwent manual hand-held CPR were included in the bare-handed CPR group. Return of spontaneous circulation (ROSC) and return of spontaneous breathing, and blood gas analysis indexes of recovery for 5 minutes and 15 minutes [arterial oxygen partial pressure (PaO2), arterial blood carbon dioxide partial pressure (PaCO2), arterial blood oxygen saturation (SaO2), blood lactic acid (Lac)] were collected.Results There was no significant difference in gender, age and cardiac arrest (CA) causes between the two groups. Compared with the bare-handed CPR group, the ROSC rate in the Thumper CPR group was significantly increased [68.57％ (48/70) vs. 51.25％ (41/80),χ2 = 4.642,P = 0.031], but there was no significant difference in return of spontaneous breathing rate [48.57％ (34/70) vs. 47.50％ (38/80),χ2 = 0.017,P = 0.896]. There was no significant difference in blood gas index between the two groups after 5 minutes of recovery. The PaO2 and SaO2 in the Thumper CPR group were significantly higher than those in the bare-handed CPR group [PaO2 (mmHg, 1 mmHg = 0.133 kPa): 88.13±5.06 vs. 84.26±5.53, SaO2: 0.828±0.068 vs. 0.766±0.031, bothP < 0.05), PaCO2 and Lac were significantly lower than those in the bare-handed CPR group [PaCO2 (mmHg):34.04±4.62 vs. 40.43±5.29, Lac (mmol/L): 6.90±2.07 vs. 8.50±2.12, bothP < 0.05].Conclusions In the process of emergency rescue, Thumper cardiopulmonary resuscitator is more successful than bare-handed CPR. The recovery rate of Thumper cardiopulmonary resuscitator is more conducive to save manpower and obtain better metabolic effect, which is worthy of clinical promotion and application.

Objective:To investigate the changes of gene or protein expression and activity of matrix metalloprotein9 (MMP9) and tissue inhibitor ofmetalloproteinasel (TIMP1) in the carotid artery (CA) of 4 wk hindlimb unweighted rat.Methods:A 4 weeks(wk) hindlimb unweighted (HU) rat model was used to simulate the effect of weightlessness on the cardiovascular system.Transmission electron microscopy was used to detect the content of ECM.Reverse transcriptase polymerase chain reaction(RT-PCR) was conducted to measure the mRNA content MMP and TIMP1.Immunohistochemistry and Western blot technique were used to measure the protein abundance.Gelatin zymography was carried out to detect the activity of MMP9.Results:Compared to the control group (CON),the area of ECM was enhanced (P＜0.05) and the content of collage fiber was increased (P＜0.05) in the CA of HU rats;moreover,HU did not affect the mRNA expression of MMP9,but significantly reduced the protein content (P＜0.05) or enzymatic activity (P＜0.05).Accordingly,the mRNA or protein expression of TIMP1 in the CA was significantly increased by HU (P＜0.05).Conclusion:Simulated weightlessness caused imbalance between MMP and TIMP1 expression,which might contribute to the ECM aggregation and stiffness of CA.

MicroRNAs (miRNAs) are small non-coding RNAs that contain 22 to 25 nucleotides and play important roles in post-transcriptional regulation of target genes. MiRNAs are involved in cell proliferation, differentiation, apoptosis, inflammation, and cancer development. Alveolar bone resorption is the main clinical manifestation of periodontitis. Osteoclasts are unique cells regulated by osteoblasts and inflammatory cytokines and are responsible for bone resorption in periodontitis. Recently, miRNAs have emerged as an important regulator of osteoclast differentiation and function. In this study, we review the recent research progress on the effects of miRNAs on osteoclast differentiation and function, particularly the mechanisms of miRNAs-mediated osteoclast formation and bone loss in periodontitis.
Bone Resorption ; Bone and Bones ; Cell Differentiation ; Cell Proliferation ; Humans ; MicroRNAs ; Osteoblasts ; Osteoclasts