Objective To analyze the possible influencing factors of hematoma expansion in patients with hypertensive cerebral hemorrhage(HICH)during pre-hospital treatment.Methods The emergency clinical data of 169 cases patients with HICH treated in Lianyungang Emergency Center from January 2019 to June 2021 were collected retrospectively.According to the comparison of the two cranial CT bleeding volumes,they were divided into hematoma expansion group(42 cases)and hematoma non expansion group(127 cases).Multivariate Logistic regression were used to analyze the possible influencing factors of hematoma expansion.Results The change of systolic blood pressure,hematoma volume difference in the hematoma expansion group were higher than those in the non expansion group.The proportion of antihypertensive drugs,dehydrating drugs during transmission were lower than those in non expansion group.The transit time was higher than that in the non expansion group(P<0.05).Multivariate Logistic regression analysis showed that non antihypertensive drugs(OR=48.526,95%CI:7.778-302.737,P=0.001),non dehydrating drugs(OR=12.330,95%CI:3.084-49.296,P=0.001),systolic blood pressure at admission(OR=1.157,95%CI:1.082-1.238,P=0.001)were the risk factors of hematoma expansion in patients with HICH during pre-hospital care.Initial hematoma volume may be a protective factor(OR=0.893,95%CI:0.849-0.938,P=0.001).Conclusion Uncontrolled hypertension and longer transit time are related risk factors for hematoma enlargement in patients with HICH during pre-hospital care.

Objective To determine the effects of ciprofol and propofol on hemodynamics and cardiac work were determined by hemodynamic monitoring,so as to provide reference for anesthesia induction in car-diac surgery.Methods A total of 90 patients scheduled for mitral valve replacement under cardiopulmonary bypass from June 2022 to June 2023 were randomly divided into two groups:the ciprofol group (group P,n=45) and the propofol group (group B,n=45).The heart rate (HR),oxygen saturation (SpO2),index of con-sciousness (ICO1),mean arterial pressure (MAP),central venous pressure (CVP),stroke volume (SV),car-diac output (CO),systemic vascular resistance (SVR),cardiac cycle efficiency (CCE),stroke volume variation (SVV),maximum pressure gradient reflecting myocardial contractility (dp/dt) were recorded before adminis-tration (T0) and five min after administration (T1).Results In group P,ICO1,MAP,SV,CO,and SVR at T1 were lower than those at T0,and CCE was higher than that at T0 (P<0.01,P<0.05).In group B,ICO1, MAP,CVP,SV,CO,SVR,CCE,SVV,dp/dt at T1 were significantly lower than those at T0 (P<0.01,P<0.05).There was no statistically significant difference in HR,SpO2,ICO1,MAP,CVP and hemodynamic indi-cators between group B and group P at T0 (P>0.05).There was no statistically significant difference in HR, SpO2,ICO1,CVP and SVV between group B and group P at T1 (P>0.05).MAP,SV,CO,SVR,CCE and dp/dt at T1 in group P were higher than those in group B (P<0.05).Conclusion Ciprofol can better maintain hemodynamic stability and reduce cardiac impairment during the induction phase of mitral valve replacement surgery under cardiopulmonary bypass.

Objective:To analyze the molecular epidemiological characteristics of the Corona virus disease 2019 (COVID-19) cases in Shijiazhuang, which can reveal the origin of the outbreak and provide a scientific basis for COVID-19 prevention and control.Methods:From January 2 to January 8, 2021, a total of 404 samples from 170 COVID-19 cases were collected from the Shijiazhuang Fifth Hospital. The consensus sequence of 2019 novel Coronavirus(2019-nCoV) was obtained through multiplex polymerase chain reaction-based sequencing. The sequences of 170 COVID-19 cases were analyzed by the PANGOLIN, and the data were statistically analyzed by T-test.Results:Among the 404 COVID-19 samples, a total of 356 samples obtained high quality genome sequences (>95%,100×sequencing depth). The whole genome sequences of 170 COVID-19 cases were obtained by eliminating repeated samples. All 170 sequences were recognized as lineage B1.1 using PANGOLIN. The number of single nucleotide polymorphism arrange from 18-22 and most of the single nucleotide polymorphism were synonymous variants. All of 170 genomes could be classified into 48 sub-groups and most of the genomes were classified into 2 sub-groups (66 and 31, respectively).Conclusions:All cases in this study are likely originated from one imported case. The viruses have spread in the community for a long time and have mutated during the community transmission.

Objective:To explore the safety and therapeutic effect of programmed death 1 (PD-1) antibody combined with chemotherapy as a neoadjuvant therapy for patients with stage Ⅱ to Ⅲ non-small cell lung cancer (NSCLC).Methods:Thirteen patients, who had been diagnosed as stage Ⅱ-Ⅲ NSCLC and received PD-1 inhibitor plus chemotherapy as a neoadjuvant treatment in National Cancer Center/Cancer Hospital were recruited. The patients received consecutive neoadjuvant chemotherapy for 21 days as a cycle and the therapeutic efficacy was evaluated after two cycles.Results:At the last time of follow-up on December 2, 2019, the objective response rate (ORR) and disease control rate (DCR) of these patients were 61.5% (95% CI 30.9%-92.1%) and 100%, respectively. The downregulation rate of disease stage was 61.5% (8/13). The resectable rate was 38.5% (5/13), among them, the major pathologic response (MPR) was 60.0% (3/5) and the complete pathologic response (CPR) was 20.0% (1/5). The neoadjuvant chemotherapy displayed a low incidence of adverse reaction. The main grade 3 to 4 toxicities were neutropenia (38.5%) and leukopenia (23.1%). There was no significant immune-related toxicity. The safety and tolerability of perioperative period of patients underwent resection were promising. Conclusions:Immunotherapy combined with chemotherapy as a neoadjuvant treatment is an effective, low-toxicity treatment manner, which has perioperative safety and high rate of MPR for patients with resectable NSCLC. It is a promising treatment option for patients with stage Ⅱ to Ⅲ NSCLC.

Objective:To explore the safety and therapeutic effect of programmed death 1 (PD-1) antibody combined with chemotherapy as a neoadjuvant therapy for patients with stage Ⅱ to Ⅲ non-small cell lung cancer (NSCLC).Methods:Thirteen patients, who had been diagnosed as stage Ⅱ-Ⅲ NSCLC and received PD-1 inhibitor plus chemotherapy as a neoadjuvant treatment in National Cancer Center/Cancer Hospital were recruited. The patients received consecutive neoadjuvant chemotherapy for 21 days as a cycle and the therapeutic efficacy was evaluated after two cycles.Results:At the last time of follow-up on December 2, 2019, the objective response rate (ORR) and disease control rate (DCR) of these patients were 61.5% (95% CI 30.9%-92.1%) and 100%, respectively. The downregulation rate of disease stage was 61.5% (8/13). The resectable rate was 38.5% (5/13), among them, the major pathologic response (MPR) was 60.0% (3/5) and the complete pathologic response (CPR) was 20.0% (1/5). The neoadjuvant chemotherapy displayed a low incidence of adverse reaction. The main grade 3 to 4 toxicities were neutropenia (38.5%) and leukopenia (23.1%). There was no significant immune-related toxicity. The safety and tolerability of perioperative period of patients underwent resection were promising. Conclusions:Immunotherapy combined with chemotherapy as a neoadjuvant treatment is an effective, low-toxicity treatment manner, which has perioperative safety and high rate of MPR for patients with resectable NSCLC. It is a promising treatment option for patients with stage Ⅱ to Ⅲ NSCLC.

Objective? To explore the clinical effects of traditional Chinese medicine at the acupoint on gastrointestinal function recovery after abdominal surgery. Methods? Totally 84 patients receiving laparoscopy were divided into the observation group (n=42) and the control group (n=42) using randomized, double-blinded and placebo controls. Patients in the observation group received traditional Chinese medicine at the acupoint, while patients in the control group received placebo. Both groups were observed continuously for 3 days. Time of postoperative borborygmus recovery, time of first exhaust, and time of first defecation were compared between the two groups postoperatively, and safety evaluation was performed. Results? The time of borborygmus recovery of the observation group was 15.5 (13-22) h, and the time of first defecation was 45.5 (29-62) h, both lower than those of the control group (Z=2.40, 2.05; P＜ 0.05). The time of first exhaust of the control group was 18 (15-27) h, and there was no statistically significant difference as compared with the observation group (Z=1.96,P=0.05). Neither group showed adverse effects on local skin after the use of traditional Chinese medicine. Conclusions? Traditional Chinese medicine at the acupoint can promote gastrointestinal function recovery after abdominal surgery, which is simple, easy, cheap and effective and is worth promoting in clinical practice.

Objective: To investigate the efficacy of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs) on patients with lung adenosquamous carcinoma, and to analyze relative factors. Methods: From August 2007 to July 2017, 40 patients who were pathologically diagnosed as lung adenosquamous carcinoma in our hospital and received EGFR TKIs treatment were retrospectively analyzed. All patients underwent EGFR mutation detection, resulted in 11 wild type, 13 19Del, 13 21L858R mutations, and 3 uncommon EGFR mutations in 20 exon and 19/21 complex mutation. A higher frequency of EGFR mutation was found in non-smokers and patients with adenocarcinoma components over 50.0%. Results: Twenty-six (65.0%) patients had disease progression after EGFR TKIs treatment, with a median progression-free survival (PFS) of 5.5 months (95% CI 0.52-10.49 months). A total of 20 (50.0%) patients died with an median overall survival (OS) of 15 months (95% CI 11.03-18.97 months). Multivariate analysis showed that gender, age, smoking, histopathological subtypes, EGFR mutations, and brain metastasis had no influence on PFS (all P>0.05). Gender, age, smoking, histopathological subtypes, and the presence of brain metastasis during TKI treatment had no influence on OS (P>0.05), while EGFR mutation is the only influencing factor of OS (P<0.05) in the current study. Conclusions EGFR TKIs had modest efficacy in lung adenosquamous carcinoma, especially in patients with EGFR mutation. Based on the pathological features, EGFR mutation and EGFR TKIs treatment should be introduced into the routine clinical practice to improve the survival of patients with lung adenosquamous carcinoma.

Objective To investigate and summarize the MRI characteristics of splenic sclerosing angiomatoid nodular transformation (SANT).Methods A retrospective analysis of 5 SANT cases were analyzed,in terms of their MRI characteristics and pathological findings.Results MRI findings of SANT included:T1WI presents iso-signal or slightly low signal,all displayed lesions were detected as low signal compared with spleen,but higher than muscle signal on T2 WI,and with speck dots or starlike low signal in the central area,without necrosis and cystic change.The signal was significantly differentiated compared with the spleen on DWI.On chemical shift imaging,2 cases were showed slightly higher signal on out phase,the others without signal change.On enhanced scan,4 cases had edge obvious enhancement on arterial phase,inward filling enhancement,and the signal was higher than the spleen,1 case without arterial phase enhancement,but with mild concentric delayed enhancement.All of the speck dots and starlike areas decreased with time delay,with certain degree enhancement on delayed phase.Conclusions There were some MRI features of SANT,preoperative MRI can prompt diagnosis,but final diagnosis depends on pathology.

Network examination and learning has become the main form of test and training for nurses, doctors and pharmacists in the field of medicine and health. The system design of Jsp+Servlet+Extjs 4.1+Tomcat server+Mysql database implements the simulation training and learning function of the medical qualification examination by system positioning , functional development and hierarchical construction . Question bank should be developed and optimized according to the examination syllabus and achievement analysis. Test sites, examples, difficulties and so on have been developed into micro courses. With the sup-port of the system, the micro courses and examination questions have been linked together to achieve the organic integration of examination and guidance. This kind of examination system based on network and on-line learning has good compatibility and strong pertinence. It can be perfected according to the application of learning end.

OBJECTIVETo retrospectively evaluate the clinical evaluation of preoperative lumbar T2 sagittal MRI image in predicting the recurrent lumbar disc herniation (RLDH).

METHODSBetween January 2009 and April 2011, 28 patients were diagnosed as recurrent L4-5 disc herniation within 2.5 years after surgery, and 25 of them were included in the study as relapse group. At the same time, selected 25 patients implemented the same surgical methods in the same level as a control group randomly, they were all with good to excellent result and the follow-up time was at least 2.5 years. There was no statistical significance between the two groups in gender, age and body mass index(BMI) (P > 0.05). The lumbar MRI image of two groups of patients before surgery were collected and analyzed, with the disc degeneration grade classified. The χ(2) test was used to analyzed the difference of degeneration between the two groups of patients before surgery. Rank correlation analysis evaluated the correlation between disc degeneration and the period of time from the first operation to the recurrence.

RESULTSIn terms of preoperative lumbar disc degeneration, there were 22 cases of low-grade disc degeneration and 3 cases of advanced disc degeneration in the relapse group and 5 cases and 20 cases respectively in the control group. there was significant difference between two groups (χ(2) = 23.27, P < 0.05), low-grade disc degeneration (gradesIand III) was significantly more frequent in the relapse group than in the control group. The patients with low-grade disc degeneration had a higher risk of recurrence, that was the risk of recurrent disc herniation increased by a factor of 4.4 from advanced disc degeneration to low-grade disc degeneration(OR = 4.4, 95%CI:1.983-9.765, P < 0.05). In cases of recurrence, the time interval between primary surgery and the recurrence of the patient with advanced disc degeneration was longer compared with low-grade disc degeneration (r = 0.733, P < 0.05).

CONCLUSIONSPreoperative lumbar MRI image may suggest the possibility of the recurrence lumbar disc herniation.Light disc degeneration is an important risk factor for recurrent disc herniation, and the time interval between primary surgery and the recurrence is positively correlated with severity of disc degeneration.

Adult ; Aged ; Diskectomy ; Female ; Humans ; Intervertebral Disc Displacement ; diagnosis ; surgery ; Lumbar Vertebrae ; surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Recurrence ; Retrospective Studies