Clinical application of modified radical neck dissection by gasless unilateral axillary approach in papillary thyroid cancer / 中华内分泌外科杂志

Objective:To investigate the effectiveness, safety, and advantages of modified radical neck dissection by gasless unilateral axillary approach (GUA-MRND) in the surgical management of selected patients with papillary thyroid cancer.Methods:We retrospectively analyzed patients with papillary thyroid cancer who underwent GUA-MRND (endoscopic group, n=16) versus unilateral open modified radical neck dissection (MRND) (open group, n=32) during the period from Jan. 2019 to Jun. 2021, including the differences in surgical efficiency, complication rate, and incisional satisfaction.Results:Compared MRND with GUA-MRND, the patients were younger ( P<0.05) , operative time and postoperative drainage anterior ( P<0.01) were slightly inferior in the latter, but it had obvious advantages in cervical swallowing discomfort and incision satisfaction evaluation ( P<0.05) . There was no significant difference in the incidence of temporary recurrent laryngeal nerve injury, intraoperative and postoperative bleeding, hematoma, infection, lymphatic or chylous leakage and supraclavicular numbness after surgery ( P>0.05) . The number of dissected lymph nodes in area II in the GUA-MRND was lower ( P<0.05) , but it was significantly higher ( P<0.01) in area III. And the average regional cleaning efficiency in the GUA-MRND was level Ⅲ (35.5%) , level Ⅵ (28.59%) , level Ⅳ (23.21%) , level Ⅱ (7.18%) and level Ⅴ (7.12%) , suggested that GUA-MRND had higher efficacy for level III, level Ⅵ and Level IV. Conclusion:GUA-MRND is safe, effective, and has high cosmetic satisfaction in the treatment of selected patients with lateral cervical lymph node metastases from papillary thyroid cancer.

Effects of cystectomy for ovary benign cyst on ovarian reserve and pregnancy outcome of in vitro fertilization-embryo transfer cycle / 中华妇产科杂志

Objective To investigate the impact of previous cystectomy for ovary benign cyst on ovarian reserve and pregnancy outcome in in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) cycles. Methods Totally 622 infertility patients were retrospectively investigated who underwent first IVF/ICSI-ET cycle in Reproductive Hospital Affiliated to Shandong University from January 2013 to June 2014. There were 153 cases who had been removed ovarian cyst by cystectomy surgeries recruited as study group, in which 44 cases of ovarian endometriosis cyst, 35 cases of benign ovarian teratomas, 67 cases of simple ovarian cyst and 7 cases of ovarian mucinous cystadenoma. In contrast, 469 infertility patients with tubal-factor infertility or male factor were included as control group. The age-matched women in the control group had no ovarian surgery previously. The indicators of ovarian reserve and pregnancy outcome were analyzed between two groups. The influence of different types of ovarian cysts on ovarian reserve and pregnancy outcome in IVF/ICSI-ET cycles were also studied, ovarian endometriosis cyst was studied as Group A, and Group B consisted of benign ovarian teratomas, simple ovarian cyst and mucinous cystadenoma. Results (1) The significantly lower serum antimullerian hormone (AMH) level (median: 1.92 versus 2.90 mg/L), antral follicle count (AFC; median: 12.0 versus 13.0), retrieved oocytes (12 ± 5 versus 13 ± 6) and the number of embryo cryopreserved (median:1.0 versus 3.0) were found in study group compared with control group (all P0.05). A better clinical pregnancy rate was achieved in control group (61.6%, 241/391) than that in study group (61.4%, 81/132), but no significant difference was existed (P=0.96). (2) Compared to Group B, Group A had fewer AFC, lower serum AMH level, retrieved oocytes and the number of embryo cryopreserved (11±4 versus 13±5;1.65 versus 2.15 mg/L;9±4 versus 13±5;0 versus 2.0;all P0.05). Conclusions Ovarian reserve declines after the cystectomy for ovarian benign cysts and the cystectomy has a negative impact on IVF/ICSI-ET cycle, resulting in a decrease of the number of retrieved oocytes and the number of embryo cryopreserved, but do not influence clinical pregnancy outcome. Ovarian reserve is impaired more seriously by cystectomy for ovarian endometriosis cyst than other ovarian benign cyst.

Effects of dexmedetomidine on recovery period of anesthesia and postoperative cognitive function after robot-assisted laparoscopicradical prostatectomy in the elderly people / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the neuroprotective effect of dexmedetomidine on recovery period of anesthesia and postoperative cognitive function after robot assisted laparoscopicradical prostatectomy in the elderly people.@*METHODS@#A total of 100 elderly patients who underwent robotic laparoscopic radical prostatectomy were divided into 2 groups: A dexmedetomidine group (n=50) and a control group (n=50). Patients in the dexmedetomidine group were given a loading dosage of dexmedetomidine [0.8 μg/(kg.h)] intravenously 10 min before the induction of general anesthesia followed by continuous infusion [0.3 μg/(kg.h)]. Patients in the control group were given 0.9% saline solution instead of dexmedetomidine. After pneumoperitoneum establishment, all patients adopted 40°trendelenberg position. MAP, HR, and BIS from each patient at the end of surgery immediately (T0), wake up (T1), extubation (T2), 10 min after extubation (T3) were monitored. Ramsay score, surgery comfort score, postoperative delirium score, and VAS scores were measured. At the time of preoperative 1 d, postoperative 1 d or 5 d, cognitive function was assessed and the concentration of neuron-specific enolase (NSE), tumor necrosis factor-α (TNF-α), superoxide dismutase (SOD) and interleukin-6 (IL-6) were detected.@*RESULTS@#In the dexmedetomidine group, delirium rating scale was significantly smaller than that of the control group (P<0.05) while Ramsay sedation score was significantly greater than that of the control group (P<0.05). The levels of TNF-α, NSE, and IL-6 in the dexmedetomidine group were significantly reduced compared with those in the control group (P<0.05). The level of SOD in the dexmedetomidine group significantly elevated compared with that in the control group (P<0.05). Seventeen patients in the control group and 11 in the dexmedetomidine group displayed postoperative cognitive dysfunction (POCD) at the 1st day after surgery. Meanwhile, 12 patients in the control group and 9 in the dexmedetomidine group showed POCD at the 5th day after surgery (P<0.05).@*CONCLUSION@#Dexmedetomidine could exert a neuroprotective effect on elderly patients in robotic-assisted laparoscopic radical prostatectomy in recovery period of anesthesia and postoperative recovery period, which might be related to the reduction of inflammatory reaction by dexmedetomidine.

Effects of carbon dioxide pneumoperitoneum and steep Trendelenburg positioning on cerebral blood backflow during robotic radical prostatectomy / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe the effect of carbon dioxide pneumoperitoneum and Trendelenburg position on cerebral blood backflow during robot-assisted radical prostatectomy in elderly patients.</p><p><b>METHODS</b>Fifty elderly patients (65-80 years) and 50 middle-aged patients (45-64 years) undergoing elective robot-assisted prostatectomy were enrolled in this study. For all the patients, jugular bulb and arterial blood gas was monitored and recorded before pneumoperitoneum (0), 10 min after pneumoperitoneum was achieved (T₁), 10 min (T₂) and 60 min (3) after Trendelenberg position, and 10 min in supine position after termination of pneumoperitoneum (4).</p><p><b>RESULTS</b>Compared with those at 0, the mean arterial pressure, heart rate, and BIS value at 1, 2, 3 and 4 all showed no significant variations (P>0.05), but rSO2, SjvO2, and JBP increased significantly in both groups (P<0.01). Compared with those in the middle-aged group, rSO₂, SjvO₂, and JBP increased significantly and Da-jO₂decreased at 2, 3 in the elderly group (P<0.01), but jugular vein blood glucose or lactic acid content showed no significant difference between the two groups (P>0.05).</p><p><b>CONCLUSION</b>Pneumoperitoneum and Trendelenburg position cause more obvious cerebral blood backflow in elderly patients than in middle-aged patients but do not affect cerebral metabolism of oxygen.</p>

Factors affecting the quality of life of elderly diabetic patients: survey in north and south Wanjiang river regions / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the quality of life of elderly diabetic patients and its influencing factors.</p><p><b>METHODS</b>By randomized cluster sampling, we conducted a survey in 1450 elderly residents (over 60 years old) living in urban, suburban and rural areas in south and north Anhui province. We evaluated the quality of life of the elderly diabetic patients using a demographic information questionnaire and full items on Short Form (36) Health Survey (SF-36).</p><p><b>RESULTS</b>The elderly diabetic patients had lower scores in all dimensions of quality of life than the elderly without diabetes. Multiple linear regression analysis showed a linear regression in the quality of life among the elderly diabetic patients in terms of geographic regions, education, personality, sleep quality, and age.</p><p><b>CONCLUSION</b>Elderly diabetic patients have generally poor quality of life, which was subjected to the influences by geographic regions, education, personality, sleep quality, and age, suggesting the necessity of corresponding interventions to improve the quality of life of these patients.</p>

Effects of different target effect-site concentrations of remifentanil on the sedative effect of propofol / 中华麻醉学杂志

Objective To investigate the effects of different target effect-site concentrations (Ces) of remifentanil on the sedative effect of propofol. Methods Fifty ASA Ⅰ or Ⅱ patients aged 20-55 yr weighing 48-86 kg with body mass index ＜ 30 kg/m2 were randomly divided into 5 groups ( n = 10 each) . Anesthesia was induced with TCI of remifentanil (Ce = 0, 2, 4, 6 and 8 ng/ml in groups R0-R4 respectively) and propofol. The initial Ce of propofol was 2.0 μg/ml in the 5 groups, and then the Ce of propofol increased by 0.5 μg/ml every 1 min until BIS value decreased to 50. BIS value and Ce of propofol were recorded as the patient lost consciousness. The effect-site concentration and consumption of propofol and the time required were recorded when BIS value decreased to 50.Results BIS value was significantly increased, while the effect-site concentration of propofol was significantly decreased as the patient lost consciousness, and the effect-site concentration and consumption of propofol were significantly decreased and the time required was shortened when BIS value decreased to 50 in R2-R4 groups compared with group R0 (P ＜ 0.05 or 0.01) . Conclusion The sedative effect of propofol can be enhanced when the Ce of remifentanil reaches 4 ng/ml, and the effects are comparable when the Ce of remifentanil reaches 4, 6 and 8 ng/ml.