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Objective:Through retrospective analysis of perioperative management data of ambulatory thyroid surgery under the concept of enhanced recovery after surgery (ERAS), we provide foundation for the safe implementation of ambulatory thyroid surgery.Methods:From January 2019 to December 2019, patients undergoing thyroid surgery were enrolled in the study under the concept of ERAS at the ambulatory surgery center of Xiangya Hospital, Central South University. Data of patients during perioperative period were collected, including adverse events, anesthesia recovery, postoperative and post-discharge recovery were recorded.Results:This study was included 703 cases of patients, thyroid nodules in 374 cases, thyroid malignant tumor in 329 cases. There were no significance difference in the operation time, anesthesia time, wake up of time, and postanesthesia care unit (PACU) time between the two groups (all P>0.05). No hypertension, hypotension, tachycardia, bradycardia or other arrhythmias occurred during perioperative period. No adverse events such as intraoperative awareness and delay of wake up occurred. No severe pain, nausea, vomiting, dizziness and other discomfort occurred after surgery. All 703 patients were discharged from hospital within 24 hours. Conclusions:Anesthesiologists participate in patient management according to the perioperative medicine requirements, and ambulatory thyroid surgery may be performed safely under the concept of ERAS.
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At present, the surgical treatment of peripheral facial paralysis includes non-dynamic and dynamic treatment. The former suspends the facial soft tissue with various materials to reconstruct the static symmetry of the face. The latter, through nerve repair and the transplantation of vascularized neuromuscular flap, restores the facial nerve and expressive muscle contractile function of the affected side, to achieve the ideal therapeutic effect. This article summarises the relevant literatures, reviews the application of various nerve repair methods in peripheral facial paralysis, to discusses the scope of application, advantages and disadvantages, and provides reference and help for clinicians in selection of surgical methods for peripheral facial paralysis.
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The development of portable ultrasound equipment and point-of-care ultrasonography has promoted the application of ultrasound technology in the field of anesthesia and pain medicine.ultrasound is primarily used to evaluate blood volume and volume responsiveness,airway,lung and stomach volume,as imaging guidance tools for regional anesthesia and chronic pain management in perioperative and pain clinics.Transesophageal echocardiography is mainly used to obtain the information of cardiac anatomy,pathology and cardiac function.It is especially advantageous for the unsatisfactory image obtained by transthoracic ultrasound,left auricular thrombosis,infective endocarditis,aortic dissection,intraoperative monitoring,etc.The application of ultrasound technology improves the accuracy and safety of perioperative and pain medical diagnosis and treatment,and improves the quality of perioperative and pain medical treatment.
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Objective To investigate the effect of tripterygium glycosides combined with recombinant human tumor necrosis factor receptor Ⅱ antibody fusion protein for injection on serum vascular endothelial growth factor (VEGF),rheumatoid factor (RF),receptor activator of nuclear factor κ B ligand (RANKL) levels in patients with rheumatoid arthritis.To provide reference for rational clinical application.Methods From December 2014 to January 2016,132 patients with rheumatoid arthritis were divided into observation group and control group by random number table method,,with 66 cases in each group,The control group was treated with tripterygium glycosides alone (10 mg each time,3 times daily,orally) for 3 months.The observation group was treated with a combination of tripterygium glycosides and recombinant human tumor necrosis factor receptor Ⅱ (0.4 mg/kg,once weekly,hypodermic injection) for 3 months.The clinical efficacy,and serum VEGF,RF and RANKL levels were compared between 2 groups.Results The effective rate of the observation group was 92.4％ (61/66),which was significantly higher than that in the control group (80.3％,53/66).There was a significant difference between the two groups (x2=4.117,P＜0.05).There was no significant difference in the levels of serum VEGF,RF and RANKL between the two groups (t =0.174,0.103,0.359,all P＞0.05).After treatment,the levels of serum VEGF,RF and RANKL in the observation group and the control group were (20.8± 11.5) ng/L and (27.3 ±13.1) ng/L,(258.4±54.5) U/L and (298.1 ±49.5) U/L,(0.083±0.021) pmol/L and (0.197 ± ±0.064),respectively.There were significant differences between the two groups (t =3.029,4.381,13.750,all P＜0.05).The incidence rate of adverse reactions in the control group was 10.5％ (7/66),which was significantly higher than that in the observation group (1.5％,1/66).There was a significant difference between the two groups(x2 =4.790,P＜0.05).The one-year recurrence rate was 25.0％ (13/52) in the control group and that was 6.7％ (4/60) in the observation group,respectively,and there was a significant difference between the two groups (x2 =7.272,P＜ 0.05).Conclusion Tripterygium glycosidescombined with recombinant human tumor necrosis factor receptor Ⅱ antibody fusion protein for injection is effective in the treatment of rheumatoid arthritis,which reduces the levels of serum VEGF,RF and RANKL,and has a low incidence of adverse reactions and recurrence.
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Objective@#To investigate the effect of axillary lymph node status in evaluating the prognosis of patients with local recurrence after breast-conserving surgery.@*Methods@#The clinical data of 72 patients with local-regional recurrence who had undergone breast-conserving therapy in Tianjin Cancer Hospital from February 2001 to December 2009 were collected and retrospectively analyzed. These patients were divided into axillary lymph node positive group (23 cases) and negative group (49 cases), according to their axillary lymph node status.@*Results@#Among 72 patients, 21 cases were local recurrence, 35 cases were regional recurrence, and 16 cases were local-regional recurrence. In the axillary lymph node positive group, 7 cases were local recurrence, 10 cases were regional recurrence, 6 cases were local-regional recurrence. In the axillary lymph node negative group, 14 cases were local recurrence, 25 cases were regional recurrence, 10 cases were local-regional recurrence. There was no significant difference between these two groups (P=0.807). Moreover, no significant differences of the age, recurrent site, estrogen receptor (ER) and/or progesterone receptor (PR) status, human epidermal growth factor receptor 2 (HER-2) status, disease-free period, local and systemic therapeutic effect, non-distant metastasis survival between these two groups were observed (P>0.05). However, the overall survival of axillary lymph node positive group after recurrence was significantly lower than that of negative group (P=0.014). Cox multivariate analysis showed that recurrent site is an independent prognostic factor of disease-free survival of patients with regional recurrence after breast-conserving surgery (OR=2.050, P=0.002). The axillary lymph node status and recurrent site were independent prognostic factors of overall survival of these patients (OR=3.469, P=0.003; OR=3.676, P<0.001).@*Conclusions@#Axillary lymph node status is an independent factor of overall survival of patients with regional recurrence after breast-conserving surgery, but it is marginally related with their non-distant metastasis survival.
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Objective@#To explore the oncological safety of immediate breast reconstruction after nipple-areola complex(NAC) sparing mastectomy(NSM+ IBR) in patients with early stage breast cancer, and to analyze the prognostic factors of NSM+ IBR.@*Methods@#From January 2004 to December 2015, the clinical data of 118 cases of stage Ⅰ-ⅡA breast cancer who had undergone NSM+ IBR in Tianjin Tumor Hospital were collected, comparing with 75 cases of Ⅰ-ⅡA breast cancer patients who had undergone immediate breast reconstruction after modified radical mastectomy (MRM+ IBR) at the same period. In addition to the prognosis of these two groups, the prognostic factors were also retrospectively analyzed.@*Results@#The median follow-up were 53 months in the NSM+ IBR group and 51 months in the MRM+ IBR group, respectively. In the NSM+ IBR group, local recurrence, distant metastasis, death and NAC necrosis occurred in 4, 6, 9 and 4 cases during 3 years after operation, respectively. The local recurrence rate (LRR) was 3.4%, 3-year disease-free survival (DFS) rate was 91.5%, and the overall survival (OS) rate was 92.4%. In the MRM+ IBR group, local recurrence, distant metastasis, and death occurred in 1, 4, and 3 cases during 3 years after operation, respectively. The LRR was 1.3%, 3-year DFS was 93.3%, whereas the OS rate was 96.0%. No statistical difference was noted between the two groups (all P>0.05). That HER-2 positive and molecular type correlated with the 3-year DFS (P<0.05) independently and molecular type correlated with OS (P<0.05) independently in the NSM+ IBR group.@*Conclusions@#NSM does not impair patients′ prognosis and could ensure oncological safety of patients with early stage breast cancer. IBR could improve female patients′ figure and ensure the quality of life. HER-2 status and molecular type are the independent prognostic factors of the 3-year DFS. Molecular type is the independent prognosis factor of OS.
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The incidence rate of thyroid cancer and thyroid nodule in China are rising and surgical operation is the main treatment for thyroid nodule and thyroid carcinoma.It has been controversial whether thyroid surgery is suitable for day surgery.Perfect preoperative examination and anesthesia assessment,selection of an appropriate of patients and minimally invasive surgery,good postoperative analgesia and the prevention and treatment of postoperative nausea and vomiting,recognition and treatment of postoperative complications timely,postoperative follow-up,can ensure safety of patient with thyroid ambulatory surgery,and made the same medical quality as the surgery in hospital.Under certain criteria,thyroid ambulatory surgery is safety,high efficient,economy and time-efficient.It is a reasonable surgical management mode which can reduce days of hospitalization and hospitalization cost.But it still need further study on the inclusion and exclusion criteria of patients,anesthesia techniques and perioperative management.
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Objective To evaluate the quality of Isatidis Radix from different ecotypes by using projection pursuit model. Methods Totally 11 batches of Isatidis Radix from different ecotypes in Gansu Province were used as evaluation samples. With the contents of epigoitrin, uridine, guanosine, adenosine, benzoic acid, salicylic acid, indigo, indirubin, and alcohol extract as evaluating indexes, combined with projection pursuit model established by DPS V 9.50 statistics software, the quality of Isatidis Radix was evaluated. Results Based on the evalution of nine main indexes, quality order of the 11 batches of Isatidis Radix was acquired: S2>S1>S9>S7>S8>S3>S5>S10>S11>S4>S6. Conclusion The projection pursuit model was available for the quality evaluation of different ecotype Isatidis Radix. The quality of Isatidis Radix from different ecotypes is different significantly, and the quality of tetraploid Isatidis Radix of Shijiazhuang is the best.
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BACKGROUND:Traumatic auricle defectsin upper 1/2 or lower 1/2,seriously involve theauricular cartilage and skin blood vessels. The autogenic rib cartilage graft and acelular dermal matrix have good histocompatibility, and expanded flapis a kind of thin and achromatic tissue for skin defect repair. OBJECTIVE:To explore theapplication ofacelular dermal matrix and expanded flap in half auricular reconstruction,and to find out the fine carving and anastomosis of autogenic rib cartilage graftas wel as its similarities with the ear and clinical significance. METHODS:Eight cases of half auricular defects were treated with expanded flap, autogenic rib cartilage graft, fine anastomosisofautogenic rib cartilage graft and residual earfor half auricular reconstruction,during which theacelular dermal matrixwas usedto promote residual ear docking and skul auricle angle formation. The reconstructionwasperformed in three stages:first,anexpander(volume, 80mL)wassubcutaneously implanted attheretro-auricular area;second, the auricular defects were reconstructed with fine rib cartilage graft, acelular dermal matrix and auriculoplasty;finaly, acelular dermal matrixwas usedto promote residual ear docking. Thenthehalf auricular reconstructionwas evaluatedby objective measurement and subjective rating. RESULTS AND CONCLUSION:Half auricular reconstruction was successful in al the eight caseswithout obvious complications, and the cartilage grafts were in good condition.During thefolow-up,thereconstructed auriclewasshapedwel andformed a good involution withtheresidualauricle. In addition, the flange was smooth withoutobviouscolor difference and edema, and its position, size and shape were consistent with those of thecontralateralone. Afterthefolow-up of 6 months, objective indicators showed that the affected side had no significant differencefromthe contralateralone(P> 0.05). In conclusion,theacelular dermal matrixcanobviously decrease the complications of the cartilage grafts andcontributeto agood shaped auricle;and half auricular reconstructionby expanded flap, autogenic rib cartilage graft,andfine anastomosis of autogenic rib cartilage graftcanachieve significant clinical effects.
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BACKGROUND:At present, the common filing materials used to correct secondary unilateral cleft lip nasal deformity include conchae cartilage, costal cartilage, Medpor implants, expanded polytetrafluoroethylene (ePTFE), alogenic acelular dermal matrix. OBJECTIVE:To analyze the therapeutic effects of comprehensive procedures with alogenic acelular dermal matrix or ePTFE for secondary unilateral cleft lip nasal deformity. METHODS: Thirty-six patients with secondary unilateral cleft lip nasal deformity were enroled, including 19 males and 17 females, aged 15-32 years. Alogenic acelular dermal matrix (n=22) or ePTFE (n=14) was used to correct nasal base colapse deformities. Anthropometry method was employed to make measurements. Fixed-point measurement was performed based on patient's pictures before and after correction. Long-term effects of these two kinds of filing materials were analyzed and assessed objectively and quantitatively. RESULTS AND CONCLUSION: After the folow-up of 6 months, al the patients were satisfied with their results, and no infection and no exposure occurred. The treatment effect of the alogenic acelular dermal matrix group was excelent in 16 cases and good in 6 cases; there were 10 cases of excelent and 4 cases of good in the ePTFE group. The objective indicators in the two groups were al improved at 6 months after correction (P 0.05). These findings indicate that alogenic acelular dermal matrix or ePTFE is useful to correct secondary unilateral cleft lip nasal deformity.
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Objective To explore whether miR-451 suppresses cell migration and invasion by targeting macrophage migration inhibitory factors (MIF),thus to reveal molecular mechanism that miR-451 functions as a tumor suppressor in gastric cancer.Methods A quantitative real-time polymerase chain reaction (qRT-PCR) was carried out to detect the expression of miR-451 in gastric cancer and normal stomach mucosa.Western blotting was performed to detect the expressions of MIF protein regulated by miR-451 in MGC 803 cells.The migration and invasion abilities of MGC-803 cell were evaluated with wound-healing and transwell invasion assays.Results miR-451 was down-regulated in gastric cancer tissues.The expressions of miR-451 were negatively correlated with the clinical stage and lymph node metastasis in gastric cancer patients.Western blot showed that a notable reduction of the protein level of MIF by restoring miR-451 in MGC-803 cells.Overexpression of miR-451 inhibited the migration and invasion of MGC-803 cells.Conclusions miR-451 suppresses cell migration and invasion by targeting MIF in gastric cancer.
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<p><b>BACKGROUND</b>Melanoma has the highest mortality among all superficial malignant tumors. The poor prognosis is due to its high metastasis rate and the lack of therapeutic targets. As a molecular switch that controls tumor metastasis, Ras homology C (RhoC) has been correlated with tumor progression, especially tumor invasion and metastasis. However, little research has been done about the effects of RNA interference (RNAi) targeting RhoC on the invasion and metastasis of melanoma. In this study, we constructed an RNAi lentivirus vector targeting the RhoC gene of melanoma cells and identified its silencing effects on the RhoC gene.</p><p><b>METHODS</b>Based on the RhoC gene encoding information, three pGPU6/GFP/Neo-short hairpin (shRNA) plasmids were constructed. After detecting their silencing effects on the RhoC gene of A375 cells, the most effective pGPU6/GFP/Neo-shRNA plasmid was packed with lentivirus to construct the recombinant pLenti6.3-EGFP-453 targeting RhoC. The lentivirus vector was used to infect A375 cells, and then the expression of RhoC mRNA and protein were determined with real-time PCR and Western blotting.</p><p><b>RESULTS</b>The plasmids pGPU6/GFP/Neo-shRNA 336, pGPU6/GFP/Neo-shRNA 453, and pGPU6/GFP/Neo-shRNA 680 were constructed. After they were transfected into A375 cells, the expressions of RhoC mRNA and protein were 1.47 ± 0.26, 1.13 ± 0.16, 1.39 ± 0.11 and 70.98 ± 9.21, 50.67 ± 6.06, 65.77 ± 4.06, respectively. pGPU6/GFP/Neo-shRNA 453 was the most effective sequence, and was used to successfully construct the pLenti6.3-EGFP-453 lentiviral vector targeting RhoC. pLenti6.3-EGFP-453 was used to infect A375 cells. The expression of RhoC mRNA and protein were 1.05 ± 0.05 and 62.04 ± 15.86 in the lentivirus group, 4.21 ± 0.24 and 220.86 ± 24.07 in the negative lentivirus control group, and 4.63 ± 0.32 and 257.39 ± 12.30 in the normal control group respectively with the difference between the lentivirus group and the control groups being statistically significant (P < 0.05).</p><p><b>CONCLUSION</b>The successfully constructed pLenti6.3-EGFP-453 vector targeting the RhoC can effectively infect human melanoma A375 cells in vitro, and significantly inhibit the RhoC mRNA and protein expression.</p>
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Humans , Cell Line, Tumor , Genetic Vectors , Genetics , Lentivirus , Genetics , Melanoma , Genetics , Therapeutics , RNA Interference , Physiology , rho GTP-Binding Proteins , Genetics , Metabolism , rhoC GTP-Binding ProteinABSTRACT
Objective To observe the inhibitation and radiosensitization effect of hematoporphyrin and radiotherapy on H22 liver cancer mice.Methods Mice models of liver cancer were established by subcutaneous injection of H22 cells,tumor-bearing mice were randomly divided into:control group, simple radiotherapy group, small dose hematoporphyrin with radiotherapy group (combined treatment group Ⅰ), middle dose hematoporphyrin with radiotherapy group(combined treatment group Ⅱ),and high dose hematoporphyrin with radiotherapy group (combined treatment group Ⅲ).Tumor volumes,inhibition rate,sensitizing factor,the survival time of mice,pathology,apoptosis and other indicators in five groups were observed after14 days. Results Hematoporphyrin and radiotherapy can inhibit tumor growth in mice,The q values in three combined treatment groups were all above 1.0 at different time points ,and combined treatment groupⅢwas the highest.The three combined treatment groups had higher apoptosis rate than control group and simple radiotherapy group,but the difference within groups were not statistically significant. The survival time in three combined treatment groups were higher than control group,the combined treatment group Ⅱ was the longest and simple radiotherapy group was the shortest.Conclusion Hematoporphyrin has tumor inhibitition and radiation sensitizing effect on H22 liver cancer mice,and the effect was positive correlation with drug dose. Hematoporphyrin combined with radiotherapy can extend the lifespan of mice in H22 liver cancer,its sensitizing mechanism may be association with induction of H22 cell apoptosis.
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Objective To study the possible causes of ST-elevated acute myocardial infarction (STEAMI) occurring one month after percutaneous coronary intervention (PCI). Methods One hundred and ninety two patients aged from 40-79 years who had a successful previous PCI and also received primary PCI due to STEAMI in this hospitalization were included in this study. The AMI-related lesions and previous angiographic findings such as the number of lesions, the degree of the stenosis, the type of stents and the acute results of last PCI, etc. were recorded in detail. If the AMI-related lesion was localized in-stents or at the edge of stents (distance from the edge ≤5 mm), it was defined aslate thrombosis, otherwise it was regarded as an AMI induced by new-lesion. Results New lesions, as the cause of STEAMI, were found in 144 cases (Group A, 75%), and late thrombosis in 48 patients (Group B, 25%). There was a significant difference in the average time from previous PCI to AMI (30.1±12.4 vs. 20.3±11.9 months) between the two groups. Diabetes mellitus (DM) and drug-eluting stents (DES) utilization were associated with markedly higher morbidity of late thrombosis in adjusted logistic regressionanalysis [hazard ratio (HR) 3.387, 95% CI 1.053-10.898 and HR 5.311, 95% CI 1.066-26.464]. Conclusions STEAMI occurred 1 month after PCI are more likely to be developed from previous insignificant lesions than from late thrombosis in stents. Moreover, DM and DES are associated with a high incidence of late thrombosis, which may indicate that intensive antiplatelet therapy should be considered in diabetic patients receiving PCI.
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Objective To investigate the expression of interleukin-17 in the salivary gland and peripheral blood of patients with primary Sjogren's syndrome (pSS).Methods Biopsy specimens of labial glands were collected from 30 patients and 5 controls.Immunohistochemistry examination was conducted to detect IL-17 expression cells (Th-17),while CD45RO and CD20 were tested by using monoclonal antibodies.IL-17 levels were assessed by ELISA in 30 pSS patients and 20 healthy controls.Results Th-17 cell numbers in the salivary glands of pSS patients with few infiltrating lymphocytes were lower than that with massive infiltrating lymphocytes (15±5 vs 21±8,P＜0.05).However,the percentage of Th-17 positive cells over the total infiltrating lymphocytes in the salivary glands of pSS patients with few infiltrating lymph-ocytes was higher than that with massive infiltrating lymphocytes (P＜0.05).There was no expression of IL-17 in the controls.The distribution pattern of Th-17 was shown that Th-17 cells were distributed evenly in the salivary glands of pSS patients with few infiltrating lymphocytes,but only appeared in the periphery zone of massive or focal infiltration in the glands of pSS patients with massive infiltrating lymphocytes.The amount of Th-17 positive cells were associated with the disease activity which was evaluated by levels of erythrocyte sedimentation rate (r=0.557,P＜0.05).There was no significant differ-ence in IL-17 levels of peripheral blood between patients with pSS and normal controls.Conclusion The results of this study have shown that Th-17 is expressed in the salivary glands of patients with pSS,which indicates that IL-17 may play an important role in the pathogenesis of salivary gland destruction.
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AIM: To study the time-dependent effects of diabetes mellitus (DM) on the development of cardiac remodeling in untreated streptozotocin (STZ)-induced rats with acute myocardial infarction (MI). METHODS: The left anterior descending coronary arteries were ligated 10 weeks after DM induction without any therapy. Transmission electron microscopy, echocardiography, heart weight to tibial length ratios, histological examination, microarray analysis, and real time-PCR were utilized to monitor the changes up to 56 d. RESULTS: After MI, the diabetic rats experienced lower survival rate compared to non-diabetic animals. The pathophysiologic changes indicated that DM accelerated the cardiac remodeling post-infarction. In primary examination, 164 genes related to cardiac remodeling were found to be candidates for hierarchical analysis, such as leucine-rich PPR-motif containing (interleukin-6 signaling pathway), procollagen type I and III, fibronectin-1, RT1, and TIMP-1, etc. The gene expression profile at 14 d in diabetic rats were comparably similar to both 14 d and 28 d in non-diabetic rats, while such changes at 28 d and 56 d in diabetic rats was also similar to the ones at 56 d in non-diabetic rats. CONCLUSION: The accelerated cardiac remodeling of post-infarction in STZ-induced untreated diabetic rats seems be associated with the different profile of gene expressions.
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Anatomy and histology embryology are the major courses in basic medical sci-ence. According to the evaluated target,practice and reforms of constructing the quality course have been taken positively by intensifying teaching group,optimizing teaching content,innovating teaching methods,constructing laboratory,and strengthening teaching administration etc. As a con-sequence,satisfying result has been achieved.
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AIM:To observe the antipyretic effect of Naoreqing(NRQ)oral solution in rabbits with endotoxin-induced fever.METHODS:The ET-induced fever model was established in rabbits.The digital thermometer was used to register rectal temperature.The endothelin content in blood plasma,and tumor necrosis factor-?(TNF?)in blood serum were determined by radioimmunoassay.The activities of tissue-type plasminogen activator(t-PA)and plasminogen activator inhibitor(PAI)in plasma were measured by the assay of chromogenic substrate.At the same time,the pathology of lung,kidney and liver were observed.RESULTS:① NRQ showed obvious antipyretic effect in the rabbits with endotoxin-induced fever(P