Feasibility of undergoing day surgery at 3rd week after infection with SARS-CoV-2 in children / 中华麻醉学杂志

Objective:To retrospectively analyze the feasibility of undergoing day surgery at 3rd week after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children.Methods:The clinical data from children who underwent day surgery from November 1, 2022 to February 28, 2023, with operation time ≤1 h, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, regardless of gender, aged≤14 yr, with body mass index of 10-30 kg/m 2, were divided into SARS-CoV-2 group and control group according to whether the children had been infected with the SARS-CoV-2. The main outcome measure was the incidence of respiratory system-related complications within 30 days after surgery. Secondary outcome measures included the rate of unplanned ventilation, delayed discharge and secondary admission within 30 days after surgery. Preoperative creatine kinase isoenzyme (CK-MB), aspartate aminotransferase (AST), alanine aminotransferase (ALT), hemoglobin (Hb), white blood cell count, C-reactive protein (CRP) level, grade of oropharyngeal mucosa inflammation, operation time, emergence time, intraoperative respiratory depression, laryngeal spasm, hypoxemia, hypotension, incidence of sinus bradycardia and rate of additional rescue drugs were recorded. Results:There were 337 cases in SARS-CoV-2 group and 1 396 cases in control group. Compared with control group, CK-MB concentrations were significantly increased, and the Hb concentration was decreased before surgery in SARS-CoV-2 group ( P<0.05). There were no statistically significant differences in the incidence of respiratory system-related complications, unplanned ventilation, delayed discharge and rate of postoperative secondary admission, preoperative AST and ALT concentrations, white blood cell count, CRP concentrations, grade of oropharyngeal mucosa inflammation, operation time, intraoperative respiratory depression, laryngeal spasm, hypoxemia, hypotension, incidence of sinus bradycardia, rate of additional rescue drugs and emergence time between the two groups ( P>0.05). Conclusions:Feasibility of undergoing day surgery is good at the third week after being infected with the SARS-CoV-2 in children.

Berberine inhibits autophagy and promotes apoptosis of fibroblast-like synovial cells from rheumatoid arthritis patients through the ROS/mTOR signaling pathway / 南方医科大学学报

OBJECTIVE@#To evaluate the regulatory effect of berberine on autophagy and apoptosis balance of fibroblast-like synoviocytes (FLSs) from patients with in rheumatoid arthritis (RA) and explore the mechanism.@*METHODS@#The inhibitory effect of 10, 20, 30, 40, 50, 60, 70, and 80 μmol/L berberine on RA-FLS proliferation was assessed using CCK-8 method. Annexin V/PI and JC-1 immunofluorescence staining was used to analyze the effect of berberine (30 μmol/L) on apoptosis of 25 ng/mL TNF-α- induced RA-FLSs, and Western blotting was performed to detect the changes in the expression levels of autophagy- and apoptosis-related proteins. The cells were further treated with the autophagy inducer RAPA and the autophagy inhibitor chloroquine to observe the changes in autophagic flow by laser confocal detection of mCherry-EGFP-LC3B. RA-FLSs were treated with the reactive oxygen species (ROS) mimic H2O2 or the ROS inhibitor NAC, and the effects of berberine on ROS, mTOR and p-mTOR levels were observed.@*RESULTS@#The results of CCK-8 assay showed that berberine significantly inhibited the proliferation of RA-FLSs in a time- and concentration-dependent manner. Flow cytometry and JC-1 staining showed that berberine (30 μmol/L) significantly increased apoptosis rate (P < 0.01) and reduced the mitochondrial membrane potential of RA-FLSs (P < 0.05). Berberine treatment obviously decreased the ratios of Bcl-2/Bax (P < 0.05) and LC3B-II/I (P < 0.01) and increased the expression of p62 protein in the cells (P < 0.05). Detection of mCherry-EGFP-LC3B autophagy flow revealed obvious autophagy flow block in berberine-treated RA-FLSs. Berberine significantly reduced the level of ROS in TNF-α-induced RA-FLSs and upregulated the expression level of autophagy-related protein p-mTOR (P < 0.01); this effect was regulated by ROS level, and the combined use of RAPA significantly reduced the pro-apoptotic effect of berberine in RA-FLSs (P < 0.01).@*CONCLUSION@#Berberine can inhibit autophagy and promote apoptosis of RA-FLSs by regulating the ROS-mTOR pathway.

To analyze the imaging features of thyroid papillary carcinoma diagnosed by CEUS and the diagnostic efficacy of CEUS in cervical lymph node metastasis / 中华内分泌外科杂志

Objective:To analyze the diagnostic performance of contrast-enhanced ultrasound (CEUS) in the diagnosis of papillary thyroid carcinoma (PTC) and related parameters in the diagnosis of cervical lymph node metastasis.Methods:The clinical data of 130 patients who underwent ultrasonography in Ningbo Hospital of Traditional Chinese Medicine from Jan. 2019 to Jan. 2022 were retrospectively analyzed. All patients received contrast-enhanced ultrasonography and postoperative pathological examination. According to the pathological diagnosis of benign and malignant tumors, they were divided into PTC group and benign nodule group. In the PTC group, there were 46 males and 40 females, aging 51.79±5.01 years old, ranging from 32 to 63 years old; In the nodule group, there were 25 males and 19 females, aging 52.05±4.89 years old, ranging from 33 to 64 years old. According to the presence or absence of cervical LNM, they were divided into a metastasis group of 31 cases, 17 males and 14 females; age (51.69±6.14 years), ranging from 36 to 63 years; 55 cases in the non-transfer group, 29 males and 26 females, aging (51.75±6.18) years, ranging from 36 to 62 years. Comparative analysis of different nodule properties, presence or absence of LNM, different lesion diameters in imaging manifestations and time-intensity curve (time-intensity curve, TIC) parameters differences, measurement data between groups were conducted by independent sample t test, count data between groups were compared by χ2. The receiver operating characteristic curve (receiver operating characteristic, ROC) was drawn to evaluate the diagnostic performance of TIC parameters for cervical LNM. Results:The proportion of PTC nodules with low enhancement, irregular enhancement, heterogeneous enhancement, unclear lesion boundary, and perfusion defect (72.09%, 87.21%, 88.64%, 69.77%, 70.93%) was significantly higher than that of benign nodules (38.64%, 11.36%) %, 27.27%, 77.27%, 27.27%) ( χ2=13.67, 70.75, 49.69, 25.92, 18.24, P<0.05) ; PTC nodule peak intensity (peak intensity, PI), TIC area under the curve (area under curve, AUC) was significantly lower than that of benign nodules (14.86±2.11dB vs 23.94±3.51dB, 985.14±105.31dB·s vs 1621.14±182.61dB·s) ; time to peak (TTP) was significantly higher than that of benign nodules ( 44.82±5.01s vs 36.95±4.18s) ( t=18.39, 21.36, 8.94, P<0.05) ; there was no significant difference in mean transit time (MTT) ( P>0.05) ; AUC was significantly higher than that of the non-metastatic group (16.86±2.09) dB vs (13.73±1.42) dB, (1163.54±131.41) dB·s vs (884.59±93.25) dB·s ( t=8.25, 11.46, P<0.05) ; The PI and AUC of PTC patients with lesion diameter ≤1.5 cm were significantly lower than those of patients with lesion diameter > 1.5 cm (11.56±1.94) dB vs (15.93±2.46) dB, (876.97±100.21) dB·s vs (1020.09±125.41) dB·s ( t=8.39, 5.34, P< 0.05), there was no significant difference in terms of TTP or MTT ( P>0.05) ; the AUC of PI in the diagnosis of cervical lymph node metastasis in PTC patients was 0.888 (95% CI: 0.807-0.969), the sensitivity was 90.91%, and the specificity was 77.42%; The AUC for the diagnosis of cervical lymph node metastasis in PTC patients was 0.972 (95% CI: 0.943-1.000), with a sensitivity of 87.10% and a specificity of 96.36%. Conclusion:The CEUS manifestations of PTC nodules are mostly irregular and heterogeneous low-enhancement, and the TIC-related parameters of PTC nodules and benign nodules are significantly different, and TIC-related parameters have good diagnostic efficiency for patients with cervical lymph node metastasis.

Effects of different blood purification methods on nutritional status and inflammatory response in elderly patients with chronic renal failure / 中国医师进修杂志

Objective:To investigate the effects of different blood purification methods on their nutritional status and inflammatory response in elderly patients with chronic renal failure.Methods:A total of 120 elderly patients with chronic renal failure who were treated in Lishui People′s Hospital from January 2020 to January 2022 were selected as the research objects, and they were divided into the control group and the observation group according to the random number table method, with 60 cases in each group. The patients in the control group were given hemodialysis alone, and the patients in the observation group were given hemofiltration dialysis treatment on the basis of the patients in the control group. The nutritional status-related indicators, inflammation-related indicators and renal function-related indicators before and after treatment were compared between the two groups.Results:After treatment, the levels of serum total protein (TP), albumin (ALB), hemoglobin (HGB) and creatinine clearance (Ccr) in the observation group were significantly higher than those in the control group: (65.61 ± 4.82) g/L vs. (61.26 ± 3.51) g/L, (36.54 ± 4.52) g/L vs. (31.53 ± 3.32) g/L, (97.58 ± 5.84) g/L vs. (93.06 ± 5.17) g/L, (41.88 ± 4.87) ml/min vs. (34.51 ± 4.36) ml/min, while the levels of interleukin-6 (IL-6), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), creatinine (Cr) and blood urea nitrogen (BUN) were significantly lower than those in control group: (120.09 ± 9.36) ng/L vs. (157.17 ± 14.27) ng/L, (7.15 ± 1.16) mg/L vs. (14.17 ± 2.74) mg/L, (22.14 ± 6.67) ng/L vs. (33.87 ± 7.28) ng/L, (327.16 ± 44.35) μmol/L vs. (378.59 ± 48.27), (10.15 ± 2.03) mmol/L vs. (15.83 ± 3.31) mmol/L, there were statistical differences ( P<0.05). Conclusions:For elderly patients with chronic renal failure, the use of hybrid blood purification can significantly reduce toxins in the body and improve the nutritional status and inflammation of patients, which is worthy of clinical promotion.

Risk factors for perioperative atelectasis in pediatric patients undergoing day surgery / 中华麻醉学杂志

Objective:To identify the risk factors for perioperative atelectasis in pediatric patients undergoing day surgery.Methods:The data of pediatric patients (aged 28 days-7 yr) undergoing elective surgery in our hospital from January 2021 to April 2021 were retrospectively collected.The pediatric patients were divided into atelectasis group and non-atelectasis group according to the results of postoperative ultrasound examination of the lung.The basic conditions and perioperative indicators of the children were recorded, and logistic regression analysis was used to identify the independent risk factors.Results:A total of 122 pediatric patients were enrolled, there were 68 pediatric patients in atelectasis group, and the incidence of atelectasis was 55.7%.Compared with non-atelectasis group, significant changes were found in the amount of sufentanil, rate of laryngeal mask insertion, and rate of intraoperative inhalation of high-concentration oxygen in atelectasis group ( P<0.05). After adjusting variables such as age, upper respiratory tract infection, and overweight, intraoperative inhalation of high-concentration oxygen (FiO 2>60%) ( OR=2.863, 95% confidence interval 1.148-7.137, P=0.024) and consumption of sufentanil >0.2 μg/kg ( OR=1.214, 95% confidence interval 1.069-1.379, P=0.003) were independent risk factors for perioperative atelectasis in pediatric patients undergoing day surgery. Conclusion:Inhalation of high-concentration oxygen (FiO 2>60%) and consumption of sufentanil >0.2 μg/kg during operation are independent risk factors for perioperative atelectasis in pediatric patients undergoing day surgery.

Valve surgery in combination with cryoablation in the treatment of atrial fibrillation

Objective: To investigate the effectiveness and safety of valve surgery in combination with cryoablation in the treatment of atrial fibrillation

Methods: Fifty patients who needed to undergo valve surgery because of heart valve disease and sixtyfive patients who needed to undergo valve surgery in combination with cryoablation were selected as the research subjects. The perioperative technical characteristics, postoperative curative effect and complications were compared between the two different treatment modalities in our hospital between October 2013 and November 2015

Results: No significant differences were observed between the two groups in valve surgery mode, valve type and postoperative length of hospital stay [P>0.05], but the duration of extracorporeal bypass and aorta occlusion of the observation group was longer than that of the control group [P<0.05]. The 3-month, 6-month and one-year atrial fibrillation cardioversion rates of patients in the observation group were superior to those of the control group, and the differences were notable [P<0.05]. The improvement of left atrial diameter of the observation group was also superior to that of the control group [P<0.05]. The incidence of postoperative complications of the two groups had no significant difference [P>0.05]

Conclusion: Valve surgery in combination with cryoablation has favorable short-term clinical effect in the treatment of heart valve disease in combination with atrial fibrillation, which is worth promotion

Application of Computed Tomography Angiography in Evaluation of Coronary Heart Disease Before Aortic Valve Replacement / 中国微创外科杂志

Objective To discuss the accuracy of computed tomography angiography(CTA)in the diagnosis of coronary heart disease before aortic valve replacement(AVR). Methods A total of 150 elderly aortic valve disease patients from January 2011 to December 2015 were investigated.The ECG showed ST-T changes.All the patients underwent coronary angiography(CAG) and CTA pre-operation.With the results of CAG as a golden standard, the sensitivity, specificity, positive predictive value and negative predictive value of CTA were analyzed. Results In patients with more than 50% stenosis, the sensitivity, specificity, positive predictive value,and negative predictive value were 97.4%(115/118),87.5%(28/32),96.6%(115/119), and 90.3%(28/31),respectively.According to the number of involved coronary artery,the sensitivity,specificity,positive predictive value,and negative predictive value were 97.4%(115/118),87.5%(28/32),96.6%(115/119), and 90.3%(28/31), respectively.In patients with more than 75% stenosis, the sensitivity, specificity, positive predictive value, and negative predictive value were 100.0%(52/52),67.3%(66/98),61.9%(52/84),and 100.0%(66/66),respectively.According to the number of involved coronary artery,the sensitivity,specificity,positive predictive value,and negative predictive value were 98.2%(166/169),64.3%(277/431),51.9%(166/320), and 98.9%(277/280), respectively. Conclusion Coronary CTA can be reliably used for screening before AVR.For patients with negative findings by CTA,CAG is not necessary.

Epidemiological characteristics of human infection with avian influenza A(H7N9) virus in Xiaoshan, China, 2013-2016 / 中国人兽共患病学报

To analyze the epidemiological characteristics of human infection with avian influenza A(H7N9) virus from 2013 to 2016 in Xiaoshan,China,we collected the epidemiological data of human A(H7N9) cases as well as the results of environmental monitoring and analyzed it by case study,descriptive epidemiological method,and statistical analysis.Results showed that a total of 22 cases were confirmed,including 12 deaths.All the cases occurred in winter and spring,and most of them had been exposed to live poultry,and with the underlying condition of chronic diseases.Chi-square test showed that the ratio of cases with chronic diseases in death group was higher (P=0.01).The environmental monitoring result showed there were distinctive seasonal differences of positive rate with peaks in winter and spring and nadirs in autumn and summer.Positive rates for the samples from external environmental monitoring were consistent with the distribution of the case onset.Due to rise of environmental monitoring positive rate,we should be alert to the occurrence of new cases,especially in rural areas where live poultry fairs still exist and among people with occupational exposure.We should further improve ability to prevent and control this disease.

Resting State Functional Magnetic Resonance Imaging of Tinnitus:Regional Homogeneity and Functional Connectivity / 实用医学杂志

Objective To explore the probable mechanism of tinnitus and the accompanied symptoms us-ing RS-FMRI. Methods We recruited 10 adults with chronic tinnitus and 10 health adults for fMRI in the resting state. Then we compared the differences of regional homogeneity(REHO)maps and functional connectivity to the whole-brain maps with the auditory cortex as a region of interest between the two groups. Results The REHO maps of tinnitus group showed significant differences in the automated anatomical labeling brain map including the middle frontal_gyrus (right),superior frontal_gyrus (left),entorhinal cortex_(right),middle occipital_gyrus (right),middle occipital gyrus(bilateral),lingual gyrus(left)and cuneate lobe(left). The functional connectivity maps of tinnitus group showed significant differences in lingal_gyrus(left)of AAL brain regions. The p threshold value was<0.001 in all results. Conclusion Tinnitus may cause abnormal neural activity in several non-auditory brain regions,which may be the neurophysiological mechanism of tinnitus accompanied symptoms.

Application of transthoracic echocardiography and CT in diagnosis of complex congenital heart disease / 中华超声影像学杂志

Objective To investigate the application of transthoracic echocardiography (TTE) and 320-row CT in diagnosis of complex congenital heart disease(CCHD).Methods A retrospective analysis was performed in 68 patients with CCHD,which contained the echocardiographic apprarance,320-row CT and surgical outcoming.All of malformations were divided into three groups:intracardiac group,heart-large vascular connecting group and extracardiac group.Results One hundred and eighty-four malformations were comfirmed by surgery in the 68 cases.The misdiagnosis and missed diagnosis rate of CT and TTE:for the intracardiac anomalies were 12％ (11/93),1％ (1/93) respectively (P ＜ 0.05),for the heart-large vascular connecting malformation were 4％ (2/49),6％ (3/49) respectively (P ＞ 0.05),and for the extracardiac anomalies were 2％(1/42),19％(8/42) respectively (P ＜0.05),for the total anomalies were 8％(14/184),7％ (12/184) respectively (P ＞0.05).While it was 1％ (2/184) in diagnosis of total anomalies by both CT and TTE.Conclusions Both 320-row CT and TTE have their own advantages and shortcomings in the diagnosis of CCHD.Joint application of two methods could reduce the rate of misdiagnosis and missed diagnosis of CCHD.

Analysis of the misdiagnosis and missed diagnosis of prenatal ultrasonography in screening fetal heart disease / 中华超声影像学杂志

Objective To investigate the application of prenatal ultrasonograpy in diagnosis of fetal heart disease during the medium-term and terminal pregnancy,and to avoid misdiagnosis.Methods The prenatal ultrasonographic screening was conducted in 7020 pregnant women with medium-term and terminal pregnancy.All confirmed and suspicious cases of fetal heart disease were observed by echocardiography once 4 weeks until postnatal sixth month to 1 year while normal cases was traced at the intervals of 8 weeks.All the cases were confirmed by autopsy or surgery while part of them were confirmed by postnatal angiocardiography before surgery.The reasons of misdiagnosis were analyzed.Results In fifty-three cases of fetal cardiovascular abnormality,43 cases were found,2 cases were misdiagnosis while 8 cases were missed diagnosis.2 cases of misdiagnosis included 1 case of pulmonary valve stenosis and 1 case of tetralogy of Fallot.8 cases of miss diagnosis included 2 cases of inferior vena cava in ectopic drainage and 6 cases of ventricular septal defect (defect diameter ＜ 5 mm).The accuracy rate of diagnosis of fetal heart disease was 81.1 ％ by echocardiography.Conclusions Using high frequency probe,image zoom,enhancing the detection of vein-atrium connection and the structure of right ventricular outflow with pulmonary artery are important factors to avoid missed diagnosis and incomplete diagnosis.

Evaluation of depression status following basal ganglia infarction by diffusion tensor magnetic resonance imaging / 中华神经科杂志

ObjectiveTo study the anatomical abnormalities of basal ganglia and research their influence on depression status in patients with post stroke depression (PSD)by diffusion tensor imaging (DTI) of MRI.MethodsPatients with basal ganglia infarction were recruited,and divided into groups of PSD and non depression control group by Hamilton Depression Rating Scale (HAMD) assessment. All the patients were evaluated with National Institute of Health Stroke Scale ( NIHSS). And the patients were checked by DTI sequence.Fractional anisotropy (FA),average diffusion coefficient (ADC) values and the number of nerve fiber were measured in bilateral caudatum,pallidum,putamen and thalamus.ResultsThe score of NIHSS (6.29 ± 3.45 ) was significantly higher in PSD group than that in non-depression group (3.95 ± 1.90 ;t =2.219,P =0.036). No significant difference was found between the two groups for the DTI data of the basal ganglia nuclei ( t =0.056-1.618,all P ＞ 0.05 ). Compared with contralateral construction (0.40 ± 0.02 ),the FA value decreased in the left putamen ( 0.37 ± 0.03 ) in the PSD group ( t =2.243,P =0.045 ).By Spearman correlations analysis,the HAMD score was positively correlated with NIHSS score ( r =0.464,P =0.017 ),and negatively correlated with the FA values of left pallidum (r=-0.563,P=0.005),right pallidum (r=-0.416,P=0.035) and left putamen (r =-0.428,P =0.029).Conclusions The occurrence of PSD was associated with neurological functional deficit following basal ganglia infarction.The depression level was correlated with the increasing of NIHSS score,the reductions in bilateral pallidum and left putamen FA values.This research contributes to evaluation of the PSD status in patients with basal ganglia infarction.

The nodular fasciitis in the head and neck region with one case report / 临床耳鼻咽喉头颈外科杂志

The case of the nodular fasciitis was with a short history and rapid growth speed. The lesion was nodular, not encapsulated. Histologically, the fibroblasts proliferated actively, with some mitoses. The reality of the nodular fasciitis is the proliferation of fibroblasts and myofibroblasts. This disease is a benign lesion. It is very important to make a different diagnosis between this lesion and sarcomas. Ultrasonography and MRI are important assistants in diagnosis of nodular fasciitis. This disease could be effectively treated by local excision with a low recurrence rate and a satisfactory prognosis.