Objective To observe the changes in intradiscal internal internal pressure before and after percutaneous nucleoplasty (PN) in the patients with discogenic low back pain (DLBP),and to explore the mechanism of PN for alleviating DLBP.Methods Thirty patients definitely diagnosed as DLBP undergoing PN in the orthopedic department of this hospital from June 2023 to October 2023 were selected.The internal pressure of the lumbar disc was measured before and after the surgery.The visual analog scale (VAS),Japa-nese orthopedic association score (JOA) and Oswestry disability index (ODI) were used to assess the pain level of the patients before operation and at postoperative 1 d,1 month,3 months.The surgical efficacy was e-valuated by using the modified MacNab criteria.The linear correlation analysis was used to observe the relation-ship between the internal pressure of lumbar disc and changes in each pain score,and the factors possibly affecting postoperative effect was analyzed by using the multivariate logistic regression analysis.Results Compared with be-fore the surgery,the immediate postoperative internal pressure of lumbar disc in the patients was significantly decreased.The JOA scores at postoperative 1 d,1 month and 3 months were significantly increased,while the VAS and ODI scores were significantly decreased,and the differences were statistically significant (P<0.05). The excellent rates of surgical efficacy at postoperative 1 d,1 month and 3 months were 66.7％,73.3％ and 63.3％,respectively.The internal pressure of lumbar disc difference value between before operation and on postoperative 1 d and internal pressure of lumbar disc decrease rate had no significant correlation with the change value of each pain score (P>0.05).The multivariate logistic regression analysis showed that the dis-ease duration and the decrease rate of internal pressure of lumbar disc were the influencing factors of clinical efficacy in PN (P<0.05).Conclusion The occurrence of DLBP may be related with the increase of internal pressure of lumbar disc.PN could effectively reduce internal pressure of lumbar disc and achieve the goal of pain relief.

Objective:To investigate the anesthetic and analgesic effects of ultrasound-guided high-position fascia iliaca compartment block (FICB) in older adult patients undergoing hip fracture surgery.Methods:A total of 120 older adult patients who underwent hip fracture surgery at the Department of Orthopedics, Dongyang People's Hospital, between January 2022 and October 2023, were enrolled in this study. This is a prospective controlled study. The patients were randomly assigned to either a conventional group or a high-position group, with 60 patients in each group, using a random number table method. The patients in the conventional group received ultrasound-guided routine FICB 30 minutes before entering the operating room, whereas the patients in the high-position group underwent ultrasound-guided high-position FICB 30 minutes prior to entering the operating room. The onset time of nerve block in both groups was observed, specifically targeting the femoral nerve, lateral femoral cutaneous nerve, and obturator nerve. Changes in hemodynamic indicators, including heart rate and mean arterial pressure, were monitored at various time points: before nerve block (T0), upon entering the operating room (T1), during anesthesia positioning (T2), and after anesthesia completion (T3). The pain level was assessed using the Visual Analogue Scale score at the same time points. Changes in pain neurotransmitters prostaglandin E 2 and 5-hydroxytryptamine were analyzed at T0 and T3. Results:The onset time of the femoral nerve, lateral femoral cutaneous nerve, and obturator nerve in the high-position group [(4.02 ± 1.16) minutes, (4.55 ± 1.29) minutes, (7.71 ± 2.02) minutes] were significantly shorter than those in the conventional group [(5.15 ± 1.42) minutes, (6.62 ± 1.78) minutes, (12.24 ± 3.68) minutes, t = 4.77, 7.29, 8.35, all P < 0.001]. At T1 and T2, the heart rates in the high-position group [(77.55 ± 9.19) beats/minute, (75.54 ± 9.37) beats/minute] and mean arterial pressures [(95.62 ± 10.51) mmHg (1 mmHg = 0.133 kPa), (92.72 ± 11.44) mmHg] were significantly higher than those in the conventional group [(74.62 ± 9.68) beats/minute, (72.41 ± 9.36) beats/minute, (92.36 ± 10.04) mmHg, (88.24 ± 11.35) mmHg, t = 1.70, 1.82, 1.73, 2.15, P = 0.046, 0.035, 0.042, 0.017]. At T1 and T2, the VAS scores of the high-position group [(3.05 ± 0.61) points, (3.44 ± 0.89) points] were significantly lower than those in the conventional group [(3.72 ± 0.67) points, (4.29 ± 1.06) points, t = 5.73, 4.76, both P < 0.001]. At T3, the levels of prostaglandin E2 and 5-hydroxytryptamine in the high-position group [(35.38 ± 6.12) mg/L, (0.59 ± 0.09) μmol/L] were significantly lower than those in the conventional group [(44.91 ± 6.72) mg/L, (0.63 ± 0.13) μmol/L, t = 8.12, 1.96, P < 0.001, P = 0.026]. Conclusion:Ultrasound-guided high-position FICB exhibits a favorable application effect in anesthetizing older adult patients undergoing hip fracture surgery. It effectively shortens the onset time of nerve block, stabilizes hemodynamic indicators, and alleviates pain.

Objective: To examine the effectiveness and safety of application of the ureteral access sheath in the treatment of middle or lower ureteral calculi in patients with large-volume benign prostatic hyperplasia above grade Ⅲ, which is expected to avoid the simultaneous or staged treatment of benign prostatic hyperplasia via eliminate the difficult angle and resistance of ureteroscopy caused by severe prostatic hyperplasia. Methods: From April 2018 to December 2020, the clinical data of 27 patients with massive benign prostatic hyperplasia above grade Ⅲ and middle and lower ureteral calculi treated with indwelling ureteral access sheath plus ureteroscopy holmium laser lithotripsy at Department of Urology, Zhejiang Quhua Hospital were retrospectively analyzed and followed up. All the patients were male, aged (69.7±12.8) years (range: 55 to 87 years). Prostate volume measured by transrectal ultrasound was (94.8±16.2) cm³ (range: 85 to 186 cm³). The ureteral access sheath was indwelled in advance, and then the semirigid ureteroscopy was introduced through the working channel of the sheath. Holmium laser lithotripsy was performed, and intraoperative and postoperative complications were recorded. Urinary abdominal plain X-ray or CT urography were performed at 1-and 2-month postopaerative to evaluate the residual stones and clinical efficacy. Results: The ureteral access sheath was placed and holmium laser lithotripsy under a semirigid ureteroscopy was performed successfully in all the 27 patients. In 2 patients, a second session of auxiliary procedure was required due to the large load of preoperative stones and residual stones after surgery, among whom 1 patient received extracorporeal shock wave lithotripsy and 1 patient underwent extracorporeal shock wave lithotripsy plus ureteroscopic lithotripsy. The stone free rate at 1-and 2-month postoperative were 92.6% (25/27) and 100% (27/27), respectively. There were no severe complications such as ureteral avulsion and perforation, perirenal hematoma, septic shock, severe hematuria, urinary retention, iatrogenic ureteral stricture occurred during and after the surgery. The ureteral calculus was wrapped by polyps heavily in 1 patient, he was diagnosed as ureteral stenosis 1 month postoperative, receiving laparoscopic resection of ureteral stricture plus anastomosis 3 months postoperative. Conclusions: In the operations of middle and lower ureteral calculi in patients with large-volume prostatic hyperplasia above grade Ⅲ, the ureteral access sheath can be placed first to effectively eliminate the difficult angle and resistance of ureteroscopy caused by severe prostatic hyperplasia, and then semirigid ureteroscopic lithotripsy can be safely performed. It could avoid the treatment of benign prostatic hyperplasia at the same time or by stages.
Aged ; Aged, 80 and over ; Humans ; Lithotripsy ; Lithotripsy, Laser ; Male ; Middle Aged ; Prostatic Hyperplasia/complications* ; Retrospective Studies ; Treatment Outcome ; Ureteral Calculi/surgery* ; Ureteroscopy

Objective:To explore the application value of preoperative multimodal image fusion 3D reconstruction technology in brain tumor surgery.Methods:The preoperative cranial CT and MR imaging data of 46 patients with brain tumors admitted to our hospital from October 2019 to September 2020 were collected. The image registration and fusion of above imaging data were performed by AW workstation software (GE company), and 3D reconstruction was performed to construct 3D digital anatomic image of brain tumor and its surrounding anatomic structure. Based on this, the surgical approach and surgical plan were designed, and its application value was evaluated by consistency grading.Results:The reconstructed 3D digital anatomical image could clearly show the size, location, shape of the tumors and the anatomical relationships between the tumors and surrounding structures, which was consistent with the original image before and during the surgery. Among the 46 patients, 43 were completely resected and 3 were partially resected. There were no approach-related complications after surgery. The application value of preoperative 3D image fusion was evaluated as 36 with outstanding value, 8 with value, and 2 without value.Conclusion:Preoperative multimodal image fusion 3D reconstruction technology can provide a large amount of visual information during brain tumor surgery, guide the choice of surgical approach and precise resection of tumors.

OBJECTIVE: To study the expression of BIRC6 in renal cancer tissues and investigate the effect of BIRC6 silencing on apoptosis and autophagy of 786-O cells. METHODS: Twenty surgical specimens of renal cancer tissues and adjacent renal tissues were collected from Meizhou People's Hospital between February, 2016 and December, 2018 for detection of BIRC6 protein expression using immunohistochemistry. Renal cancer 786-O cells were transfected with a control small interfering RNA (siRNA) or BIRC6 siRNA RESULTS: The expression of BIRC6 protein was significantly higher in renal cancer tissues than in the adjacent renal tissues. Western blotting showed that siRNA-mediated silencing of BIRC6 significantly lowered the expression of BIRC6 in 786-O cells. In the cells with BIRC6 silencing, treatment with 12.5, 25, 50, 100 and 200 μg/mL 5-FU resulted in significantly higher proliferation inhibition rates than in the cells transfected with the control siRNA ( CONCLUSIONS Interference of BIRC6 mediated by siRNA can inhibit autophagy and promote 5-FU-induced apoptosis to enhance the sensitivity of 786-O cells to 5-FU.
Apoptosis ; Autophagy ; Cell Line, Tumor ; Cell Proliferation ; Humans ; Inhibitor of Apoptosis Proteins/genetics* ; Kidney Neoplasms/genetics* ; RNA, Small Interfering/genetics*

OBJECTIVETo study a case with weak D59 phenotype identified among ethnic Han Chinese population.

METHODSRoutine serological tests were used to analyze the reaction patterns, and the RhD epitopes were verified with 12 monoclonal antibodies. Sequence-specific primer PCR was applied for typing the weak RhD and RhD zygosity in the proband and his family members.

RESULTSA c.1148T>C variant was identified in the proband, for which serological test indicated a weak D phenotype. RHD zygosity testing confirmed that the proband had a RHD+ /RHD- genotype.

CONCLUSIONA weak D59 phenotype was firstly identified in a Chinese individual.

Asian Continental Ancestry Group ; genetics ; China ; ethnology ; Humans ; Male ; Middle Aged ; Phenotype ; Rh-Hr Blood-Group System ; genetics

With the development of specialization and specialist differentiation of modem medicine,the developing mode of "reducing and specializing" has promoted the explosive growth of medical knowledge.Meanwhile,the medical practice based on medical knowledge is being fragmented,and medical activities are gradually moving away from the'people-oriented'core value.Therefore,current medical modality needs to be transformed into a "holistic medicine" stage,which also requires reforms of medical personnel cultivation,including the emphasizes of holistic view as well as multidisciplinary integration.Medical schools are exploring paths to achieve holistic medicine-oriented education and training of students.Currently,the concept of holistic medicine have begun to permeate in medical curriculum design and teaching method innovationand yet needs to befurther deepened in understanding and practicing the essence of the holistic medical modality in the future.

Objective To explore the correlations between self-management and quality of life in elderly patients with chronic heart failure (CHF) in Xinjiang Uygur Autonomous Region, so as to provide effective measures to improve quality of life of them. Methods A total of 750 elderly patients with CHF were selected as the research subjects by convenience sampling method from 5 regions of Xinjiang Uygur Autonomous Region from February to August 2015. General Data Questionnaire, Heart Failure Self-Management Scale and Minnesota Living with Heart Failure Questionnaire (MLHFQ) were applied in the investigation to analyze the correlation between self-management and quality of life. Results A total of 750 questionnaires were distributed and 704 valid questionnaires were collected, with an effective recovery rate of 94.1%. The total score of self-management and MLHFQ in the 704 CHF patients was (47.6±11.1) and (57.1±18.5) respectively. Pearson correlation analysis showed that patients' self-management was positively correlated with quality of life (r=0.114, P＜ 0.05). Conclusions The overall level of self-management and quality of life in elderly patients with chronic heart failure in Xinjiang Region is mid-to-low. Nursing intervention can give full play to the initiative of self-management behavior in accordance with patients' cultural background, so as to improve their quality of life.

Objective To compare the differences of the development of mathematical cognitive characteristics between ADHD children and normal children aged from 7 to 12 years old with event?related potentials ( ERP ) in the mathematical tasks, and to explore the neural mechanisms and characteristics. Methods ERP and behavioral data of 72 ADHD children and 88 normal children in three groups( 7?8 years old,9?10 years old,11?12 years old) were recorded,and analyzed N1,P2 and N2 components'amplitude and latency of Fz by judging the answers to simple calculation within 20. Results ( 1) Vertical comparative a?nalysis( the three age groups were compared):the differences of N1,P2 and N2 amplitudes in normal groups were considered to be statistically significant (right answer:N1(-3.8±2.1)μV,(-4.3±3.4)μV,(-2.2± 2.4)μV;P2(10.6±4.3)μV,(12.6±5.1)μV,(8.5±2.4)μV;N2(-6.5±3.1)μV,(-10.2±4.2)μV,(-6.8± 3.4)μV;error answer:N1(-2.8±2.7)μV,(-4.5±3.0)μV,(-2.9±2.5)μV;P2(9.3±5.9)μV,(12.1±5.0)μV,(8.2±3.6)μV;N2(-7.4±3.7)μV,(-11.4±5.5)μV,(-7.7±3.7)μV;all P<0.05),while was not sig?nificant in ADHD group(all P>0.05). (2)Horizontal comparative analysis(ADHD group and normal group were compared):N1 amplitude of ADHD group aged from 7 to 8 years old was higher than normal group’ s while judging the right answer((-5.3±2.4)μV,(-3.8±2.1)μV, P<0.05).P2 and N2 components’ ampli?tude of ADHD group aged from 9 to 10 years old were lower than of that normal group.(right answer:P2(9.6 ±4.4)μV,(12.6±5.1)μV;N2(-8.0±4.3)μV,(-10.2±4.2)μV;error answer:P2(9.6±4.4)μV,(12.1± 5.0)μV;N2(-7.9±4.6)μV,(-11.4±5.5)μV;all P<0.05).(3)Comparison of different tasks(the judge?ment of right and wrong answer):There was no statistically significant difference between ADHD and normal group in amplitude( P>0.05) . The latent period of the wrong answers was longer than that of the right ones among normal groups aged from 11?12 while the difference of ADHD group had no statistical significance ((312.9±42.3)ms,(292.2±21.2)ms, P<0.05). Conclusion The development trend of mathematical ERP component in ADHD children is different from normal ones,and it is closely related to the maldevelopment of frontal lobe.The characteristics of cognitive deficit differ from ages.ADHD children in low and intermediate level were damaged primarily with inhibition function,while the senior were damaged mainly in collision de?tection function.

Objective To compare the differences of event-related potentials (ERP) of left and right cerebral hemispheres and behavioral characteristics in the mental arithmetic practice between ADHD and normal children,and to explore the neural mechanisms of mental arithmetic by ADHD children.Methods ERP and behavioral data of 32 ADHD and 32 normal children in mental arithmetic,to illustrate,simple addition,subtraction and multiplication within 20 were recorded.Results ERP:① The differences of N2 amplitudes in ADHD children 's left and right cerebral hemispheres while doing mental arithmetic,such as,addition,subtraction and multiplication were not statistically significant (addition:(-6.2±7.3) μV,(-6.6± 8.1) pV ; subtraction:(-5.5±6.4) μV,(-5.8± 6.5) μV ; multiplication:(-5.9± 8.2) μV,(-6.0± 8.6) μV ; all P＞0.05).However,normal group's N2 amplitude of left hemisphere(F3) were obviously higher than those of the right hemisphere (F4),considered to be statistically significant difference (addition:(-6.8±4.0) μV,(-5.9±4.3) μV ; subtraction:(-7.5±4.8) μV,(-6.3±4.4) μV ;multiplication:(-6.9±3.7)μV,(-5.7±4.4)pV ; all P＜0.05).② ADHD group's N2 amplitude of subtraction practice was significantly lower than that of addition and multiplication,while normal control group was the opposite.③There were not statistically difference between N2 incubation of left and right hemisphere while addition,subtraction,and multiplication were done (P＞0.05).Behaviorism:① ADHD group's reaction time towards answer making were much longer than those of the normal control group (addition:(983± 183) ms,(833± 164) ms ; subtraction:(1005±160)ms,(859±170)ms;multiphcation:(975±180)ms,(836±175)ms; P＜0.05).② Accurate rate:ADHD group were all lower than those of normal group.Conclusion There were functional limitations of no obviously advantage hemisphere and two hemisphere coordination while ADHD children were performing mental arithmetic,also hmitations in conflicting information processing,decision making,and more obviously in subtraction practice.