Associations between indoor volatile organic compounds and nocturnal heart rate variability of young female adults: A panel study / 北京大学学报(医学版)

OBJECTIVE@#To investigate the association between short-term exposure to indoor total volatile organic compounds (TVOC) and nocturnal heart rate variability (HRV) among young female adults.@*METHODS@#This panel study recruited 50 young females from one university in Beijing, China from December 2021 to April 2022. All the participants underwent two sequential visits. During each visit, real time indoor TVOC concentration was monitored using an indoor air quality detector. The real time levels of indoor temperature, relative humidity, noise, carbon dioxide and fine particulate matter were monitored using a temperature and humidity meter, a noise meter, a carbon dioxide meter and a particulate counter, respectively. HRV parameters were measured using a 12-lead Holter. Mixed-effects models were used to evaluate the association between the TVOC and HRV parameters and establish the exposure-response relationships, and two-pollutant models were applied to examine the robustness of the results.@*RESULTS@#The mean age of the 50 female subjects was (22.5±2.3) years, and the mean body mass index was (20.4±1.9) kg/m2. During this study, the median (interquartile range) of indoor TVOC concentrations was 0.069 (0.046) mg/m3, the median (interquartile range) of indoor temperature, relative humidity, carbon dioxide concentration, noise level and fine particulate matter concentration were 24.3 (2.7) ℃, 38.5% (15.0%), 0.1% (0.1%), 52.7 (5.8) dB(A) and 10.3 (21.5) μg/m3, respectively. Short-term exposure to indoor TVOC was associated with significant changes in time-domain and frequency-domain HRV parameters, and the exposure metric for most HRV parameters with the most significant changes was 1 h-moving average. Along with a 0.01 mg/m3 increment in 1 h-moving average concentration of indoor TVOC, this study observed decreases of 1.89% (95%CI: -2.28%, -1.50%) in standard deviation of all normal to normal intervals (SDNN), 1.92% (95%CI: -2.32%, -1.51%) in standard deviation of average normal to normal intervals (SDANN), 0.64% (95%CI: -1.13%, -0.14%) in percentage of adjacent NN intervals differing by more than 50 ms (pNN50), 3.52% (95%CI: -4.30%, -2.74%) in total power (TP), 5.01% (95%CI: -6.21%, -3.79%) in very low frequency (VLF) power, and 4.36% (95%CI: -5.16%, -3.55%) in low frequency (LF) power. The exposure-response curves showed that indoor TVOC was negatively correlated with SDNN, SDANN, TP, and VLF when the concentration exceeded 0.1 mg/m3. The two-pollutant models indicated that the results were generally robust after controlling indoor noise and fine particulate matter.@*CONCLUSION@#Short-term exposure to indoor TVOC was associated with significant negative changes in nocturnal HRV of young women. This study provides an important scientific basis for relevant prevention and control measures.

Long-term outcomes of lateral vocal fold autologous fat injection for unilateral vocal fold paralysis / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the long-term outcomes of patients with unilateral vocal fold paralysis resulting in dysphonia treated with lateral vocal fold autologous fat injection. To analyze the factors that may affect the long-term efficacy of the procedure. Methods: From July 2003 to June 2020, 163 patients (86 males and 77 females), aged 9-73 years (mean (34.50±12.94) years) with unilateral vocal fold paralysis resulting in dysphonia underwent transoral laryngoscopic injection of autologous fat into the lateral vocal folds. Subjective auditory perception assessment (GRBAS scale), objective acoustic assessment, voice handicap index (VHI) evaluation and stroboscopic laryngoscopy were compared before and after the surgery. Patients were followed up for 1 to 18 years, with median follow-up time of 6 years. SPSS 22.0 software was used for statistical analysis. Results: Of 163 patients, 17 patients (10.4%) had mild hoarseness (G1) and 146 patients (89.6%) had moderate to severe hoarseness (G2-3). Stroboscopic laryngoscopy revealed an arch-shaped vocal fold on the affected side, fixed in the paramedian position or abduction position, with obvious glottic closure fissure. Postoperatively, voice recovered to normal (G0) in 139 patients (85.3%), mild hoarseness (G1) in 18 patients (11.0%) and moderate hoarseness (G2) in 6 patients (3.7%). Of these, 131 patients (80.4%) showed significant improvement in hoarseness, 29 patients (17.8%) showed mild improvement and 3 patients (1.8%) showed no significant improvement in hoarseness. Objective acoustic parameters of Jitter, Shimmer, NHR and MPT improved significantly, as did VHI scores. Stroboscopic laryngoscopy showed medialization of the affected vocal folds, improved vocal fold closure and normal or nearly normal vocal fold mucosal waves. With a fat injection volume of 3.0-4.5 ml, the patient's subjective auditory perception scores of G, R, B and A improved more significantly within 3 months after surgery, and both VHI and MPT were significantly better since 1 year after surgery. With bilateral vocal fold injection, the B and A scores improved significantly from 1 month postoperatively compared to unilateral injections(unilateral vs. bilateral injection 1 month post-operation, tB scores=1.42,tA scores=1.51,P<0.05). Conclusions: The long-term efficacy of autologous fat injection in the paraglottic space for the treatment of unilateral vocal fold paralysis was stable. The efficacy of the surgery was related to the amount of fat injected, unilateral or bilateral of the injection.

Development of adolescent health literacy evaluation scale under public health emergencies and its reliability and validity analysis in junior middle school students / 中华行为医学与脑科学杂志

Objective:To develop and examine the reliability and validity of the adolescent health literacy evaluation scale under public health emergencies (AHLES-PHE) in junior middle school students.Methods:The initial version of AHLES-PHE was formed by combining the characteristics of public health emergencies and adolescent health literacy.The expert version of AHLES-PHE was formed by two rounds of Delphi expert consultation.Totally 1 729 adolescent students from three junior middle schools in Changzhou City were tested.The formal version of AHLES-PHE was formed through item analysis and factor analysis (structural validity). The content validity of the formal version of AHLES-PHE was evaluated by specialist analysis and sensibility analysis, and its correlation validity with the everyday health information literacy (EHIL) was tested.The internal consistency reliability, parity split-half coefficient and test-retest reliability were calculated.Results:(1)Item analysis: the correlation coefficient between the scores of each item and the total score of AHLES-PHE expert version was 0.420 to 0.722 ( P<0.01), and the CR of decision value was 10.140 to 66.980 ( P<0.01). (2)Validity analysis: the formal version of AHLES-PHE with 45 items and 8 factors was obtained by exploratory factor analysis.The 8 factors could explain 61.30% of the total variation.The fitting indexes of the confirmatory factor analysis model were χ2/ df=3.325, RMSEA=0.052, GFI=0.853, CFI=0.912, TLI=0.904, NFI=0.880.Sensibility analysis of the formal version of AHLES-PHE showed the Cronbach's α ranged from 0.957 to 0.958.The correlation coefficient between the total score of AHLES-PHE formal version and the total score of EHIL was 0.340 ( P<0.01). (3)Reliability analysis: the Cronbach's α coefficient and parity split-half coefficient of the formal version of AHLES-PHE were 0.958 and 0.975, respectively.The test-retest reliability of the formal version of AHLES-PHE was 0.753 ( P<0.01). Conclusion:The formal version of AHLES-PHE developed in this study has good reliability, structural validity and content validity, and the correlation validity with EHIL is common.This scale has a certain degree of applicability to the assessment of health literacy for junior middle school students under public health emergencies.

Development and Validation of Prognostic Nomogram Based on Negative Lymph Node Count for Patients with Gastric Signet Ring Cell Carcinoma / 肿瘤防治研究

Objective To explore the influence of negative lymph node count (NLNC) on the prognosis of patients with gastric signet ring cell carcinoma (GSRC) and develop a prognostic nomogram based on NLNC. Methods On the basis of the SEER database, 2 101 patients diagnosed with GSRC were collected and randomly divided into the modeling group and validation group to test the relationship between clinicopathological characteristics and the prognosis of GSRC. The multivariate Cox proportional hazard regression model was used to analyze the independent risk factors affecting overall survival and establish a prognostic prediction model. The consistency index (C-index), calibration curve, net reclassification index (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA) were used to evaluate the accuracy and clinical applicability of the nomogram. Results All patients were divided according to the ratio of 7:3, with 1 473 in the modeling group and 628 in the validation group. NLNC > 10 (HR=0.578, 95%CI: 0.504-0.662, P < 0.001) was a protective factor for the prognosis of patients with GSRC, and the nomogram model was established based on multivariate Cox proportional hazards model. The C-index values of the nomogram were 0.737 (95%CI: 0.720-0.753) and 0.724 (95%CI: 0.699-0.749) in the modeling and validation groups, respectively, showing good discrimination. The calibration curves showed high consistency of the model. NRI=17.77%, continuous NRI=36.34%, and IDI=4.2% indicated that the model had positive returns compared with the traditional model. The DCA was far from the baseline, indicating that the model had good clinical applicability. Conclusion The increase in NLNC is a favorable factor for the prognosis of patients with GSRC, and a relatively accurate nomogram was established to predict the prognosis of patients with GSRC and help clinicians conduct individualized prognostic evaluations.

Prognostic Value of Negative Lymph Nodes Count in Solid Tumors / 肿瘤防治研究

The postoperative pathological staging system (pTNM) has become an important reference for the selection of various tumor treatment strategies and prognosis evaluation at a global scale, and is a powerful predictor of the prognosis of a variety of solid tumors, but the prognosis is still different in patients with the same pTNM staging. In recent years, studies have confirmed that the negative lymph nodes count (NLNC) is related to the prognosis of a variety of solid tumors. Higher NLNC can improve the prognosis of cancer patients, and NLNC can reduce staging migration, which is expected to be a supplement to the pTNM staging system. This article reviews the value of NLNC in the prognosis of solid tumors.

Association of ambient fine particulate air pollution with hospitalization costs and stays for depression in China: a multicity analysis / 中华预防医学杂志

Objective: To explore the effect of fine particulate matter (PM2.5) pollution on depression hospitalization cost and length of stay in 57 cities of China. Methods: A total of 84 207 patients with depression in 57 cities of China from January 2013 to December 2017 were selected as the subjects. The demographic characteristics and hospitalization status of the patients were obtained from the database of basic medical insurance for urban workers and urban residents in China. The environmental exposure data of the same period were obtained from the national air quality real-time release platform of China Environmental Monitoring Station. A generalized additive model based on quasi-Poisson distribution was used to analyze PM2.5 exposure effect in each city, and the nonlinear mixing of moving average temperature, relative humidity and date was controlled by natural smooth spline function. Results: Among the included cities, southern cities accounted for 50.88% (29), and the number of female inpatients, hospitalization costs and hospitalization days accounted for 62.65%, 63.50% and 60.85% (42 735 cases, 567.78 million yuan and 1.14 million days, respectively). The proportion of hospitalized cases, hospitalization cost and length of stay in the age group of 40 to 64 years old were 59.15% (40 346 cases), 53.92% (482.15 million yuan) and 52.07% (0.98 million days), respectively. PM2.5 level was positively correlated with the number of hospitalized cases with depression, hospitalization cost and length of stay. When the 3-day moving average of PM2.5 exposure level increased by 10 μg/m3, the number of hospitalization cases increased by 0.64%. The attributed percentage (95%CI) of hospitalized cases, hospitalization costs and length of stay were 3.35% (0.57%-6.04%), 3.04% (0.52%-5.48%) and 3.07% (0.49%-5.56%), respectively. Subgroup analysis showed that the attributed percentage of hospitalization cases, hospitalization cost and length of stay to PM2.5 exposure ranged from 3.97% to 4.68%, 4.04% to 4.33% and 4.13% to 4.30% in northern China, male and cold season, respectively. Conclusion: PM2.5 exposure is associated with the increase of hospitalization cost and length of stay among Chinese urban population with depression.

Analysis on conformance with the standardized construction requirements in vaccination outpatient services in Huangpu District of Shanghai in 2019 / 上海预防医学

Objective To fully understand the actual situation and existing problems in vaccination outpatient services, which will provide information to support and improve the standardized construction of vaccination outpatient service and the whole-process vaccination management. Methods Cross-sectional study was conducted among all the vaccination outpatient services in Huangpu District of Shanghai.Data were collected by self-examination and health supervision.Analysis was focused on the conformance with the six aspects of management requirements, which included institution and personnel management, layout of facilities, vaccine and cold-chain management, vaccination management, disinfection and isolation management and medical waste management. Results Twenty-one vaccination clinics were included in the study.There were significant differences for conformance between self-examination and health supervision, public and private medical institutions (P < 0.05).There was no significant difference in the overall compliance rate among six aspects of management requirement (P > 0.05), indicating that they were relatively balanced.On analysis within the 6 aspects, there were significant differences in the indicator compliance rate for 4 aspects of management requirement, including institution and personnel management, layout of facilities, vaccine and cold-chain management, disinfection and isolation management (P < 0.05). Conclusion The standardized construction of vaccination outpatient service should be strengthened with the emphasis on the following: implementation and consolidation of management requirements, enhancement of responsibility consciousness in vaccination outpatient service, construction of special-need vaccination outpatient service in private medical institutions, and improvement of publicity and guidance education.

Minimally invasive direct lateral approach debridement, interbody bone grafting, and interbody fusion combined with posterior percutaneous pedicle screw fixation for lumbar spinal tuberculosis / 中国骨伤

OBJECTIVE@#To investigate the clinical efficacy and superiority of direct lateral interbody fusion combined with posterior percutaneous screw fixation in the treatment of lumbar tuberculosis.@*METHODS@#From June 2013 to August 2016, the clinical data of 83 patients with lumbar tuberculosis were retrospectively analyzed, including 55 males and 28 females, aged from 27 to 72 (49.5±13.5) years. These 83 patients were divided into two groups according to different operation methods, 35 cases in group A were treated with direct lateral interbody fusion combined with posterior percutaneous screw fixation;48 cases in group B were treated with anterior traditional extraperitoneal debridement combined with posterior internal fixation. After operation, regular quadruple antituberculosis drugs were continued for 18 months. The operation time, intraoperative blood loss, hospital stay, bone graft fusion time and complications were compared between the two groups. Visual analogue score (VAS) of lumbar pain, Oswestry Disability Index (ODI), sagittal Cobb angle, erythrocyte sedimentation rate (ESR) and C-reactive protein(CRP) values before and after operation were analyzed.@*RESULTS@#The operation was successfully completed in both groups, and the operation mode was not changed during operation. The operation time, intraoperative blood loss and hospital stay were (149.4±13.3) min, (354.3±69.0) ml, (9.4±1.6) d in group A and(116.8±10.0) min, (721.9±172.3) ml, (11.8±1.7) d in group B, respectively, with significant difference between the two groups (@*CONCLUSION@#The two kinds of operation can obtain satisfactory clinical effect. Direct lateral interbody fusion combined with posterior percutaneous screw fixation can reduce intraoperative blood loss and hospital stay, which is conducive to early rehabilitation of patients.

Advance of Netrin-1 for Protection and Repairment of Injuries after Cerebral Infarction (review) / 中国康复理论与实践

Netrin-1 may protect and repair the damage caused by cerebral infarction, in terms of inhibiting apoptosis and inflammatory, and promoting angiogenesis and axon regeneration, etc. Netrin-1 may associate with the pathogenesis and outcome of cerebral infarction. The application of Netrin-1 in clinic needs more researches.

Design, synthesis and activity evaluation of protein arginine methyltransferase 5 inhibitor / 药学学报

Protein arginine methyltransferase 5 (PRMT5) is an important type II human methyltransferase. It catalyzes the symmetrical double-methylation of many histones and non-histones, and it is highly expressed in many kinds of tumors. PRMT5 has been proven to be a potential new target for cancer treatment. Based on the reported crystal complex of EPZ015666 with PRMT5, a series of new compounds was designed using GSK3326595 (EPZ015938) as the lead compound and using the conformational restriction approach. We found that compounds B8 and the C series of derivatives displayed enzyme inhibitory activity comparable to that of GSK3326595. Compounds C3 and C4 showed poor permeability in Caco-2 cells, and that might be one of the reasons for their poor anti-proliferative activity against Z-138 cells. These data provide insights for further structural optimization.

Endoplasmic reticulum stress and destruction of pancreatic β cells in type 1 diabetes / 中华医学杂志(英文版)

Type 1 diabetes (T1D) results from dysfunction of pancreatic islets β cells. Recent studies supported that endoplasmic reticulum (ER) stress takes an important role in pancreatic β cell excessive loss, resulting in T1D. Here, we aimed to review the relationship between ER stress and T1D. Additionally, we also reviewed the potential mechanisms underlying ER stress mediated T1D. Studies have shown that severe ER stress is directly involved in the pancreatic β cells destruction and pathogenesis of T1D. ER stress plays a key part in pancreatic β cells and T1D, which will help in developing new effective therapeutics for T1D.

Effect of Comprehensive Reminder System on Health Knowledge, Belief and Behaviors, and Clinical Outcomes for Stroke Patients Six Months after Discharge / 中国康复理论与实践

Objective:To investigate the effect of Comprehensive Reminder System Based on Health Belief Model (CRS-HBM) on health knowledge, belief, behaviors, utilization of health services and clinical outcomes in stroke patients after discharge. Methods:From February, 2015 to March, 2016, 174 stroke patients with hypertension were divided into control group (n = 87) and intervention group (n = 87). The control group received routine stroke health education, and the intervention group received the CRS-HBM program in addition. They were investigated with Stroke Knowledge Questionnaire (SKQ), Short Form Health Belief Model Scale for Stroke Patients (SF-HBMS-SP), Health Behavior Scale for Stroke Patients (HBS-SP), and the utilization of health services and clinical outcomes (emergency, re-hospitalization, recrudescence and death) were recorded six months after discharge. Results:A total of 75 cases in the control group and 76 in the intervention group finished the research. The total scores of SKQ (U = 903.000), SF-HBMS-SP (t = -9.099) and HBS-SP (t = -7.786) were more in the intervention group than in the control group (P < 0.001). The outpatient re-visit rate was more in the intervention group (97.37%) than in the control group (76.00%) (P < 0.001). The incidence of emergency, re-hospitalization, recrudescence and death were not significantly different between the two groups (P > 0.05). Conclusion:The application of CRS-HBM can improve the health knowledge, belief, behaviors for stroke patients after discharge, but there are not enough effects on clinical outcomes.

Reliability and validity of the Columbia suicide screen in junior middle school students / 中华行为医学与脑科学杂志

Objective@#To examine the reliability and validity of the Columbia suicide screen (CSS) in detecting suicide risk for junior middle school students.@*Methods@#Using convenient sampling, 902 students of a junior middle school were tested with CSS and Beck depression inventory (BDI) .Cronbach's alpha coefficient, parity split-half coefficient and test-retest reliability were examined after two weeks.Content validity was evaluated using specialist analysis and sensibility analysis.The BDI was used to explore the correlative validity.The convergent validity of CSS and another suicide risk screening method was examined.@*Results@#The proportion of students with suicide problem (suicide ideation or suicide attempts), suicide ideation within the previous year and suicide attempts in the past were 14.97%(135/902), 14.19%(128/902)and 3.66%(33/902) respectively.The Cronbach's alpha coefficient and Parity split-half coefficient of CSS were 0.844 and 0.908, respectively.The test-retest reliability of CSS were screening of suicide ideation (ICC=0.897), screening of suicide attempts (ICC=0.798), screening of substance use (ICC=0.882), screening of suicide problem (ICC=0.881), and screening of suicide problem combine depression (ICC=0.829) (P<0.01). Sensibility analysis of CSS showed the cronbach α ranged from 0.834 to 0.845.Correlative validity between CSS and BDI were screening of suicide ideation(ρ=0.238, 0.337, 0.334, 0.599), screening of suicide attempts(ρ=0.122, 0.231, 0.310, 0.221), screening of depression(ρ=0.335, 0.309, 0.196, 0.215), screening of suicide problem(ρ=0.240, 0.328, 0.321, 0.590)and screening of suicide problem combine depression(ρ=0.212, 0.324, 0.320, 0.474)(P<0.01). Convergent validity between CSS and another suicide risk screening method were screening of suicide ideation(ρ=0.468), screening of suicide attempts(ρ=0.349), screening of suicide problem(ρ=0.453), and screening of suicide problem combine depression(ρ=0.469)(P<0.01).@*Conclusion@#CSS has good internal consistency reliability, split-half reliability and content validity.Screening of suicide ideation, suicide attempts, suicide problem and suicide problem combine depression have good test-retest reliability, but the correlative validity and convergent validity are not satisfying.These four screening methods can only be used for preliminary screening suicide risk in junior middle school students.

Reliability and validity of the Columbia suicide screen in junior middle school students / 中华行为医学与脑科学杂志

Objective To examine the reliability and validity of the Columbia suicide screen (CSS) in detecting suicide risk for junior middle school students.Methods Using convenient sampling,902 students of a junior middle school were tested with CSS and Beck depression inventory (BDI).Cronbach's alpha coefficient,parity split-half coefficient and test-retest reliability were examined after two weeks.Content validity was evaluated using specialist analysis and sensibility analysis.The BDI was used to explore the correlative validity.The convergent validity of CSS and another suicide risk screening method was examined.Results The proportion of students with suicide problem (suicide ideation or suicide attempts),suicide ideation within the previous year and suicide attempts in the past were 14.97％ (135/902),14.19％ (128/902)and 3.66％ (33/902) respectively.The Cronbach's alpha coefficient and Parity split-half coefficient of CSS were 0.844 and 0.908,respectively.The test-retest reliability of CSS were screening of suicide ideation (ICC =0.897),screening of suicide attempts (ICC =0.798),screening of substance use (ICC =0.882),screening of suicide problem (ICC =0.881),and screening of suicide problem combine depression (ICC =0.829)(P＜0.01).Sensibility analysis of CSS showed the cronbach α ranged from 0.834 to 0.845.Correlative validity between CSS and BDI were screening of suicide ideation (ρ =0.238,0.337,0.334,0.599),screening of suicide attempts (ρ =0.122,0.231,0.310,0.221),screening of depression (ρ =0.335,0.309,0.196,0.215),screening of suicide problem(ρ =0.240,0.328,0.321,0.590)and screening of suicide problem combine depression(ρ=0.212,0.324,0.320,0.474) (P＜0.01).Convergent validity between CSS and another suicide risk screening method were screening of suicide ideation (ρ =0.468),screening of suicide attempts (ρ =0.349),screening of suicide problem (ρ =0.453),and screening of suicide problem combine depression(ρ=0.469)(P＜0.01).Conclusion CSS has good internal consistency reliability,split-half reliability and content validity.Screening of suicide ideation,suicide attempts,suicide problem and suicide problem combine depression have good test-retest reliability,but the correlative validity and convergent validity are not satisfying.These four screening methods can only be used for preliminary screening suicide risk in junior middle school students.

Optimal relationship between physical activity and body fat indexes during puberty / 中国学校卫生

Objective@#To explore the optimal correlation between physical activity and body fat indexes during pubertal transition,and to provide a reference for reducing obesity of adolescents and making the interventional measures.@*Methods@#A total of 366 junior high school students were recruited. ActiGraPh-GT3X accelerometer was used to collect daily physical activity data for 7 days. InBody 520 was used to assess body composition. Pearson partial correlation was used to analyze the correlation between physical activity level and body composition. Curve fitting was used to construct the optimal model of physical activity and body fat index.@*Results@#There was no gender difference in waist height ratio and fat mass between boys and girls(P>0.05), and the percentage of body fat in boys was significantly lower than that in girls(t=-4.73,P<0.01). There was no gender difference in light physical activity (LPA) time between boys and girls (P>0.05).The time of moderate physical activity (MPA), moderate-to-vigorous physical activity (MVPA) and vigorous physical activity (VPA) in boys was significantly higher than that in girls (P<0.01).The sedentary time in boys was significantly lower than that in girls (t=2.64，3.23，4.24，-2.85，P<0.01). For overweight and obese group, less time was spent in LPA, MPA, MVPA and VPA compared with normal group, while more time spent in sedentary time. Waist height ratio, fat mass and body fat percentage among male and female adolescents were positively correlated with sedentary time (F=14.63，15.54,P<0.01), while negatively correlated with LPA, MPA and MVPA time (P<0.05).@*Conclusion@#The body fat percentage was higher in boys than in girls,and the level of physical acitivity was even higher in boys than in girls.The adolescents of normal weight has got a higher level of physical activity than over weight or obese adolescents. Long-term adherence to certain physical activities and appropriate reduction of sedentary time are of vital importance for teenagers to effectively control their weight and prevent chronic diseases.

Application of natural orifice transluminal endoscopic surgery in gynecological malignant tumors / 中国实用妇科与产科杂志

Minimally invasive treatment is of great significance to gynecological tumors. Laparoendoscopic single-site surgery(LESS)and natural orifice transluminal endoscopic surgery(NOTES)are recent advances in the field of minimally invasive treatment. At present,a variety of gynecological benign surgery can be managed by LESS or NOTES surgery,and achieved good clinical results. Operation for gynecologic malignancies are complicated,and LESS and NOTES surgery are still controversial for the treatment of gynecologic malignancies. At present,domestic and foreign scholars have made some useful attempts to apply NOTES surgery to malignant tumors.Preliminary data have confirmed the feasibility of these procedure,but due to the small operating space,the operation is difficult,and the operation skills still need to be developed.Based on the experience of our hospital's initial exploration,this article briefly explains the current situation,advantages,difficulties and technical experience in the application of NOTES surgery for gynecological malignancies.

Effect of Tripterygium Glycosides Tablets in treating rheumatoid arthritis:a systematic review and Meta-analysis / 中国中药杂志

To evaluate the effect of Tripterygium Glycosides Tablets extract in the treatment of rheumatoid arthritis( RA). Clinical trials of treating rheumatoid arthritis with Tripterygium Glycosides Tablets published by Meta-analysis were retrieved from EMbase,PubMed,Clinical Trials,Web of Science,Cochrane Library,CNKI,Wanfang,VIP,CBM and Chi CTR,and comprehensively analyzed. A total of 3 studies were enrolled,the modified Sharp score( m TSS),tender join joint erosions( JE) and joint space narrowing( JSN) of Tripterygium Glycosides Tablets group were significant superior to those of control group,including positive drugs methotrexate( MTX) and salazopyridine( SSZ)( P<0. 01). Tripterygium Glycosides Tablets had an effect in treating RA. Due to the small sample size,this study shall be verified with high-quality,large-sample-size double-blinded RCTs.

One stage temporary atlantoaxial segmental fixation and reduction for Grauer type IIB dens fractures in teenagers / 中国骨伤

OBJECTIVE@#To assess the clinical results of one stage temporary atlantoaxial segmental fixation and reduction for Grauer type IIB dens fractures in teenagers.@*METHODS@#From February 2009 to April 2015, 19 teenagers with Grauer type IIB dens fractures not amenable to anteiror screw fixation were enrolled and treated using one stage temporary atlantoaxial segmental fixation and reduction without fusion. There were 14 males and 5 females, aged from 14 to 32 years with an average of (24.6±5.0 ) years. The internal fixation was removed after bone healing confirmed by CT scan. At the last follow-up (at least 1 year after internal fixation removal), dynamic CT was used to assess the atlantoaxial rotation activity. Visual analogue scale (VAS) was recorded before the first operation, before the second operation (removal of internal fixation) and at the last follow-up. Neck Disability Index(NDI) was used to evaluate the efficacy before the second operation (removal of internal fixation) and the last follow-up.@*RESULTS@#After operation, 2 patients developed the symptoms of occipital nerve stimulation such as numbness and pain in the occipitocervical region, and were treated with drugs such as dehydration and neurotrophic drugs, and the symptoms were relieved after 1 to 2 months. All the internal fixations were removed and all the patients were followed up more than 1 year, with time ranging from 18 to 25 months and an average of (21.47±2.41) months. The time of bone fusion after operation was 6 to 10 months with the mean of(8.21±1.27) months. Secondary surgical removal of internal fixation were performed immediately after fracture healing without internal fixation failure. The symptoms of neck pain improved significantly after operation, VAS score decreased from 6.74±0.65 before operation to 0.42±0.51 at the last follow-up after the second operation (removal of internal fixation), with statistically significant differences(<0.01). The NDI value decreased from (10.58±2.04)% before the second operation (removal of internal fixation) to (3.79±2.23)% at the last follow-up after the second operation (removal of internal fixation), with statistically significant difference(<0.01). At the last follow-up after the second operation (removal of internal fixation), dynamic CT showed that the unilateral rotation of the atlantoaxial spine reached (15.73±5.57)° to the left, (15.55±5.78)° to the right, and the overall rotation of the atlantoaxial spine was (31.28±10.71)°.@*CONCLUSIONS@#One stage temporary atlantoaxial segmental fixation and reduction for the treatment of Grauer type IIB dens fractures not amenable to anteiror screw fixation in teenagers can avoid the loss of atlantoaxial rotation function caused by atlantoaxial fusion, and to some extent retain the rotation activity of atlanto-axial joint.

Application of transesophageal ultrasound-guided minimally invasive surgical closure for congenital heart disease / 中华全科医师杂志

The clinical data of 31 patients with congenital heart disease(CHD)receiving minimally invasive surgical closure through chest or femoral venous catheter from June 2016 to September 2017 were analyzed retrospectively.All patients were diagnosed with esophageal echocardiography before operation.During the operation,the insert of guide wire and the sheath tube,and the placement of the sealing parasol were monitored and guided by transesophageal echocardiography (TEE).Satisfactory results were obtained in 30 patients.In 1 patients,the sealing parasol was detached,and open chest surgery was performed to remove the detached parasol and to repair the defect.TEE-guided minimally invasive surgical closure through chest or femoral vein catheter is safe and effective in the treatment of congenital heart disease and has certain clinical applicative value.

Virtual touch tissue imaging quantification and contrast-enhanced ultrasonography in the differential diagnosis of benign and malignant breast non-mass-like lesions / 安徽医科大学学报

Objective To explore the value of virtual touch tissue imaging quantification(VTIQ) and contrast-enhanced ultrasonography(CEUS) in the differential diagnosis of benign and malignant breast lesions with non-mass type. Methods A retrospective analysis of 85 cases by conventional ultrasound examination for the type of breast lesions in patients of image data,with pathologic results as the gold standard,analysis of US,VTIQ,CEUS and VTIQ joint CEUS for the breast type value in the differential diagnosis of benign and malignant lesions. Results There were 46 benign cases and 39 malignant cases in 85 cases of breast non-mass lesions. The internal shear wave velocity (SWV) and SWV ratio of breast non-mass benign lesions were significantly lower than that of malignant lesions(3. 43 ± 0. 59 m/s vs 4. 76 ± 0. 95 m/s,1. 73 ± 0. 43 vs 2. 67 ± 0. 77). The sensitivity,specificity and accuracy of VTIQ in the diagnosis of breast non-mass-like lesions were 76. 9％,80. 4％ and 78. 8％ respectively. Type of breast malignant lesions CEUS was high-enhanced enhancement compared with glandular tissue around the contrast agent into early enhancement and immediately wash-out and more for the nonuniformity,around the lesions or internal contrast enhancement of blood vessels,the sensitivity of CEUS in the diagnosis of mammary gland non tumor lesions, specific degrees and accuracy were 79. 5％,80. 4％ and 80. 0％ respectively. VTIQ type combined with CEUS in the diagnosis of breast mass lesions sensitivity and accuracy of the specific degree were 89. 7％,93. 5％ and 91. 8％ respectively,the joint diagnosis efficiency was significantly higher than single use of CEUS or VTIQ (P< 0. 05),CEUS and VTIQ diagnostic value were significantly higher than the US (P < 0. 05). Conclusion CEUS,VTIQ type in breast tumors in the differential diagnosis of benign and malignant lesions has good diagnostic value,VTIQ joint CEUS complementary advantages,more comprehensive diagnostic information available pathological changes,the type of breast disease diagnosis accuracy is improved.