Learning curve of robotic distal and total gastrectomy.

BACKGROUND: This study aims to assess the learning curve of robotic distal gastrectomy (RDG) and robotic total gastrectomy (RTG) for gastric cancer. METHODS: Data on consecutive patients who underwent robotic gastrectomy for gastric cancer by five surgeons between March 2010 and August 2019 at two high-volume institutions were collected. The learning curve was determined based on the analyses of operation time and postoperative complications within 30 days. Cumulative sum analysis (CUSUM) and risk-adjusted-CUSUM (RA-CUSUM) were applied to identify the turning points (TPs). RESULTS: A total of 899 consecutive patients were included. The mean number of patients needed to overcome the learning curve for operation time of RDG and RTG were 22 and 20, respectively. The number of patients needed to overcome the learning curve for postoperative complications after RDG and RTG were 23 and 18, respectively. The surgical outcomes in the post-TP group were better than in the pre-TP group and improved as surgeons' experience increased. Also, increased case numbers in RDG promoted the RTG learning process. CONCLUSION: The present study demonstrated a substantial influence of surgical cumulative volume on improved surgical outcomes in robotic gastrectomy. Increased experience in RDG may help surgeons to achieve proficiency faster in RTG.

Short-term outcomes of pelvic floor peritoneum closure in endoscopic low anterior resection of rectal cancer: A propensity score matching analysis.

BACKGROUND: The efficacy of pelvic floor peritoneum closure (PC) during endoscopic low anterior resection (E-LAR) of rectal cancer remains unclear. This study aimed to clarify whether pelvic floor PC affected short-term outcomes. METHODS: The study group comprised patients with the pathologically confirmed diagnosis of rectal cancer who underwent E-LAR with pelvic floor PC or with no PC (NPC) between January 2013 and December 2018 in Southwest Hospital. After propensity score matching (PSM), 584 patients (292 who underwent PC and 292 who underwent NPC) were evaluated. Postoperative indicators, including the rates of complications, anastomotic leakage (AL), reoperation, and inflammation, were observed in the two groups. RESULTS: No significant difference was observed in the rates of postoperative complications between the PC and NPC groups. The rates of AL were similar (11.3% vs. 9.2%, p = .414). However, the reoperation rate of patients in the PC group was significantly lower than that of patients in the NPC group after AL (36.4% vs. 11.1%, p = .025). The hospital costs were higher in the NPC leakage subgroup (p = .001). Additionally, the serum C-reactive protein levels were lower in the PC group on postoperative days (PODs) 1, 3, and 5, whereas procalcitonin levels on POD 1 and 3 were lower in the PC group but did not differ significantly on POD 5. CONCLUSION: Pelvic peritonization did not affect the rate of complications, especially AL; however, it effectively reduced the reoperation and inflammation rates and reduced hospitalization costs. Other short-term outcomes were similar, which warrant the increased use of pelvic peritonization in endoscopic surgery.

Identification of a giant mediastinal teratoma by echocardiography: A case report.

The diagnosis of mediastinal space-occupying lesions largely relies on X-ray and computed tomography. However, thanks to technological progress, transthoracic echocardiography can clearly display the mediastinal structures surrounding the heart and great vessels, thereby improving the detection rate of mediastinal space-occupying lesions. Primary mediastinal teratoma is relatively rare, and removal of giant mediastinal teratoma by thoracoscopic surgery has rarely been reported. Here, we report a case of giant mediastinal teratoma diagnosed by transthoracic echocardiography, which was treated by complete thoracoscopic resection and confirmed by histology.

Surgery strategy of 13 cases to control bleeding from the liver on laparoscopic repeat liver resection for recurrent hepatocellular carcinoma.

INTRODUCTION: Laparoscopic repeat liver resection (LRLR) is a safe and effective treatment in recurrent hepatocellular carcinoma (rHCC) in particular patients. However, there are less reports about surgery strategy of LRLR for rHCC. The aim of this study was to perform a systematic strategy for bleeding of liver to increase the safety and feasibility of LRLR for rHCC. METHODS: In this study, a total of 13 cases of LRLR for rHCC, including 8 males and 5 females; aged 28-72 years, mean age 54 years, who were received at least one laparotomy due to HCC. We employ to block the local blood flow, ligation of the left or right hepatic artery and/or approach of Pringle according to the assessment of the degree of adhesions in the abdominal and the first hepatic portal, the location of the tumour (edge/central). RESULTS: Three cases were less adhesions, nine cases were dense adhesions but 1 case was serious adhesions. Two cases were employed to block the local blood flow, 3 cases were employed to ligation of the left or right hepatic artery and 7 cases were employed to approach of Pringle. Twelve cases were successfully completed by LRLR whereas 1 case was completed by transfer to the open resection, including massive resection in 3 cases (the diameter of resection ≥3 cm), small hepatectomy in 10 cases (the diameter of resection <3 cm), no severe perioperative complication. The average operative time was (142 ± 34) min, the average intraoperative blood loss was (251 ± 92) ml and the average post-operative hospital time was (9 ± 3) d. The mean follow-up time was 25 months. Until the last follow-up, 11 cases survived while 2 cases died because of tumour recurrence. CONCLUSIONS: It can improve the safety and feasibility of LRLR for rHCC, according to the degree of adhesion of the peritoneal adhesions and the first hepatic portal, then selecting the appropriate technique to control the bleeding of the hepatectomy.

Polymer-free patterning of graphene at sub-10-nm scale by low-energy repetitive electron beam.

A polymer-free technique for generating nanopatterns on both synthesized and exfoliated graphene sheets is proposed and demonstrated. A low-energy (5-30 keV) scanning electron beam with variable repetition rates is used to etch suspended and unsuspended graphene sheets on designed locations. The patterning mechanisms involve a defect-induced knockout process in the initial etching stage and a heat-induced curling process in a later stage. Rough pattern edges appear due to inevitable stochastic knockout of carbon atoms or graphene structure imperfection and can be smoothed by thermal annealing. By using this technique, the minimum feature sizes achieved are about 5 nm for suspended and 7 nm for unsuspended graphene. This study demonstrates a polymer-free direct nanopatterning approach for graphene.

Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: comparison of surgical performance and short-term outcomes.

PURPOSE: This study was designed to compare robot-assisted gastrectomy with laparoscopy-assisted gastrectomy in surgical performance and short-term clinical outcomes for gastric cancer and evaluate the safety and feasibility of robotic surgery. METHODS: A retrospective database of patients who underwent robotic or laparoscopic gastrectomy for gastric cancer between March 2010 and May 2013 was examined. After screening, 514 patients who underwent gastrectomy for gastric cancer were enrolled in this study: 120 robotic and 394 laparoscopic surgery. Patient demographics, surgical performance, and short-term clinical outcomes were examined. RESULTS: All operations were performed successfully. The clinicopathologic characteristics were similar between the two groups. Compared with the laparoscopic group, the robotic group had less intraoperative blood loss (118.3 ± 55.8 vs. 137.6 ± 61.6 ml, P < 0.001), more lymph nodes dissection (34.6 ± 10.9 vs. 32.7 ± 11.2, P = 0.013), and longer operation time (234.8 ± 42.4 vs. 221.3 ± 44.8 min, P = 0.003). The survival rates were 90.2% at 1 year, 78.1% at 2 years, and 67.8% at 3 years in the RAG group compared with 87.3% at 1 year, 77.1% at 2 years, and 69.9% at 3 years in the LAG group. The difference in overall survival rate between the two groups was not statistically significant (P = 0.812). In view of lymph node involvement, the 3-year survival rates for patients with negative nodal metastasis were 84.4% in the RAG group versus 82.6% in the LAG group (P = 0.972) and 57.5% in the RAG group versus 60.3% in the LADG group (P = 0.653) for those with positive nodal metastasis. CONCLUSIONS: Comparing well with laparoscopic gastrectomy, robot-assisted gastrectomy is a feasible and safe surgical procedure with clear operation field, precise dissection, minimal trauma, and fast recovery. Longer follow-up time and randomized, clinical trials are needed to evaluate the clinical benefits and long-term oncological outcomes of this new technology.

Risk Factors for Anorectal Dysfunction After Interspincteric Resection in Patients With Low Rectal Cancer.

Purpose: The objective of this study was to explore the risk factors for anorectal dysfunction after intersphincteric resection in patients with low rectal cancer. Methods: A total of 251 patients who underwent intersphincteric resection from July 2014 to June 2020 were included in this study, for which the Kirwan's grade, Wexner score, and anorectal manometric index were used to evaluate the anorectal function and other parameters including demographics, surgical features, and clinical and pathological characteristics. These parameters were analysed to explore the potential risk factors for anorectal function after intersphincteric resection. Results: In the 251 included patients, 98 patients underwent partial intersphincteric resection, 87 patients underwent subtotal intersphincteric resection, and 66 patients underwent total intersphincteric resection. There were 53 (21.1%) patients who had postoperative complications, while no significant difference was observed between the three groups. Furthermore, 30 patients (45.5%) in the total intersphincteric resection group were classified as having anorectal dysfunction (Kirwan's grade 3-5), which was significantly higher than that in the partial intersphincteric resection group (27.6%) and subtotal intersphincteric resection group (29.9%). The mean Wexner score of patients that underwent total intersphincteric resection was 7.9, which was higher than that of patients that had partial intersphincteric resection (5.9, p = 0.002) and subtotal intersphincteric resection (6.4, p = 0.027). The initial perceived volume was lower in the total intersphincteric resection group than in the partial and subtotal intersphincteric resection groups at 1, 3, and 6 months after intersphincteric resection. In addition, the resting pressure, maximum squeeze pressure, and maximum tolerated volume in the total intersphincteric resection group were worse than those in the partial and subtotal groups at 3 and 6 months after intersphincteric resection. Univariate and multivariate analyses suggested that an age ≥65, total intersphincteric resection, and preoperative chemoradiotherapy were independent risk factors for anorectal dysfunction (P = 0.023, P = 0.003, and P = 0.008, respectively). Among the 66 patients who underwent total intersphincteric resection, 17 patients received preoperative chemoradiotherapy, of which 12 patients (70.6%) were classified as having anorectal dysfunction. Conclusion: The current study concluded that age ≥65, total intersphincteric resection, and preoperative chemoradiotherapy were risk factors for anorectal dysfunction after intersphincteric resection. The morbidity of anorectal dysfunction after total intersphincteric resection for patients who received preoperative chemoradiotherapy was relatively high, and the indication should be carefully evaluated.

Postoperative Functional Management Contributes to Anal Functional Recovery in Patients With Low Rectal Cancer After Robotic Total Intersphincteric Resection.

Purpose: To evaluate the effectiveness of the comprehensive post-operative management including low-frequency endo-anal electrical stimulation and daily suppository usage on post-operative anal functional recovery for low rectal cancer patients who underwent robotic total intersphincteric resection (ISR). Methods: A retrospective analysis was performed on 42 low rectal cancer patients who underwent robotic total ISR, of which 23 patients received comprehensive post-operative management, including biofeedback low-frequency endo-anal electrical stimulation and daily suppository usage (management group). Wexner score and anorectal manometric values, including resting pressure (RP), maximum squeeze pressure (MSP), initial perceived volume (IPV), and maximum tolerated volume (MTV), were assessed and compared. Results: A total of 42 low rectal cancer patients were included in our study. The RP at 6 months after ISR (40.95 ± 6.95 mmHg vs. 33.29 ± 5.40 mmHg, p = 0.002) and MSP at 3 and 6 months after ISR (72.05 ± 10.16 mmHg vs. 69.05 ± 8.67 mmHg, p = 0.031; 91.57 ± 15.47 mmHg vs. 84.05 ± 12.94 mmHg, p = 0.039, respectively) were significantly higher in the management group. The median IPV at 1 and 3 months after ISR (17.81 ± 3.61 ml vs. 15.43 ± 5.08 ml, p = 0.038; 20.19 ± 4.35 ml vs. 17.67 ± 5.16 ml, p = 0.044, respectively) and MTV at 3 months after ISR (83.71 ± 5.44 ml vs. 76.10 ± 8.42 ml, p = 0.012) were significantly higher in the management group. Wexner scores at 1 and 3 months after closure of stoma (COS) in the management group were significantly lower (11.3 ± 2.9 vs. 13.4 ± 3.0, p = 0.041; 8.9 ± 2.0 vs. 10.6 ± 2.4, p = 0.036, respectively). Conclusions: Comprehensive post-operative management could accelerate the recovery of sphincteric function and anal sensitivity after robotic total ISR and could also contribute to treatment of fecal incontinence followed by COS.

Robotic versus laparoscopic rectal resection surgery: Short-term outcomes and complications: A retrospective comparative study.

BACKGROUND: The safety of robotic-assisted surgery (RAS) remains a concern. This study aimed to compare the complications after RAS versus laparoscopic-assisted surgery (LAS) for rectal cancer using the Clavien-Dindo classification and to identify risk factors related to the complications. METHOD: Between March 2010 and June 2016, 556 rectal cancer patients who underwent successful RAS and 1029 patients who received LAS were enrolled in this study. The complications were graded according to the Clavien-Dindo classification, and the possible risk factors related to the complications were analyzed. RESULTS: The overall postoperative complication rate was 14.9%, with a 5% rate of severe complications that were classified as grade III or above in RAS group compared with 17.1% and 4.4% in LAS group. However, no significant difference was found (P = 0.608). A high ASA score was identified as an independent risk factor for overall and severe complications in both groups. The use of more than 3 staples in each operation and the anastomotic site of the anal verge at less than 5 cm were independent risk factors for complications. CONCLUSIONS: RAS for rectal cancer is technically safe and it does not significantly improve the complication rate. The incidence of overall complications is still related to tumor location, the general condition of the patients, and the surgical approach.

Research on the Existing Problems and Countermeasures of Home-based Elderly Care Services in China / 中国医学伦理学

At present, China’s response to the aging population situation is unprecedentedly urgent, and the construction and planning of the pension system face great challenges. Home-based elderly care services stand out in institutional-based elderly care and family-based elderly care due to their unique advantages in meeting the individual needs of the elderly. By sorting out the main types, policy lines, and supply and demand status of home-based elderly care service, this paper indicated that there are five aspects of problems in home-based elderly care service, including weak professional talent team construction, relatively insufficient capital investment, weak supply-demand matching, imperfect operating mechanism, and imperfect supporting facilities. It was proposed that in the future home-based elderly care services should strive to strengthen the construction of professional talent teams, widen financing channels, fully play the leading role of the government, perfect the operational mechanism and the construction of supporting facilities of home-based elderly care services, so as to provide reference for the optimization of the home-based elderly care service system in China.

New research advances in the prospective cohort study of gestational diabetes mellitus / 中华预防医学杂志

Gestational diabetes mellitus (GDM) is associated with an increased risk of suffering diverse adverse pregnancy outcomes, threating maternal and child health seriously, with an increasing incidence rate year by year. However, the exact cause of GDM is still unknown. Prospective cohort studies obtain data through follow-up, which is helpful to clarify the causal relationship, so as to draw more accurate and reliable conclusions. In recent years, numerous prospective cohort studies on the GDM have emerged. This article elaborates along the occurrence and development process of GDM, in order to provide useful reference for the establishment of relevant high-quality prospective cohort studies in China.

Analysis of individual dose monitoring results for radiation workers in Shandong province from 2016 to 2020 / 中华放射医学与防护杂志

Objective:To summarize the levels of individual dose to radiation workers in Shandong province from 2016 to 2020, and to analyze the trends in their change in order to provide scientific basis for radiation workers′ health management.Methods:The experimental detection and quality control were carried out in compliance with the national standards Specifications for individual monitoring of occupational external exposure (GBZ 128-2019) and the Testing criteria of personnel dosimetry performance for external exposure (GBZ 207-2016). The result of the personal dose monitoring of occupational external exposure of all radiation workers monitored by the Centers for Disease Control and Prevention in 16 cities of Shandong province were retrospectively analyzed by using SPSS 23.0 software.Results:The total number of monitored workers were 25 523 with an average annual individual effective dose of 0.28 mSv. There were statistically significant differences among radiation workers in different years ( H= 2 815.91, P<0. 001). The average annual individual effective dose showed an upward trend followed by a downward trend. The average annual effective dose of 0.55 mSv for nuclear medicine radiation workers in medical applications was the highest, with statistically significant differences among different occupational radiation workers ( H=310.37, P<0.001). The average annual effective dose of 0.37 mSv for radioactivity logging workers in industrial applications was the highest, with statistically significant differences among different occupational radiation workers ( H=448.07, P<0. 001). The average annual effective dose to radiation workers in medical applications was higher than in industrial applications ( Z = -14.93, P<0.001). Conclusions:The average annual effective dose to nuclear medicine radiation workers in medical applications and logging radiation workers in industrial applications are relatively high. There would be a push to furthe improve workplace protection measures and strengthen the management and supervision of radiological workers.

Current use of oral anticoagulation therapy and influencing factors among coronary artery disease patients with nonvalvular atrial fibrillation in China / 中华心血管病杂志

Objective: To investigate current use of oral anticoagulant (OAC) therapy and influencing factors among coronary artery disease (CAD) patients with nonvalvular atrial fibrillation (NVAF) in China. Methods: Results of this study derived from "China Atrial Fibrillation Registry Study", the study prospectively enrolled atrial fibrillation (AF) patients from 31 hospitals, and patients with valvular AF or treated with catheter ablation were excluded. Baseline data such as age, sex and type of atrial fibrillation were collected, and drug history, history of concomitant diseases, laboratory results and echocardiography results were recorded. CHA2DS2-VASc score and HAS-BLED score were calculated. The patients were followed up at the 3rd and 6th months after enrollment and every 6 months thereafter. Patients were divided according to whether they had coronary artery disease and whether they took OAC. Results: 11 067 NVAF patients fulfilling guideline criteria for OAC treatment were included in this study, including 1 837 patients with CAD. 95.4% of NVAF patients with CAD had CHA2DS2-VASc score≥2, and 59.7% of patients had HAS-BLED≥3, which was significantly higher than NVAF patients without CAD (P<0.001). Only 34.6% of NVAF patients with CAD were treated with OAC at enrollment. The proportion of HAS-BLED≥3 in the OAC group was significantly lower than in the no-OAC group (36.7% vs. 71.8%, P<0.001). After adjustment with multivariable logistic regression analysis, thromboembolism(OR=2.48,95%CI 1.50-4.10,P<0.001), left atrial diameter≥40 mm(OR=1.89,95%CI 1.23-2.91,P=0.004), stain use (OR=1.83,95%CI 1.01-3.03, P=0.020) and β blocker use (OR=1.74,95%CI 1.13-2.68,P=0.012)were influence factors of OAC treatment. However, the influence factors of no-OAC use were female(OR=0.54,95%CI 0.34-0.86,P=0.001), HAS-BLED≥3 (OR=0.33,95%CI 0.19-0.57,P<0.001), and antiplatelet drug(OR=0.04,95%CI 0.03-0.07,P<0.001). Conclusion: The rate of OAC treatment in NVAF patients with CAD is still low and needs to be further improved. The training and assessment of medical personnel should be strengthened to improve the utilization rate of OAC in these patients.

Chinese Guideline on the Management of Polypoidal Choroidal Vasculopathy (2022) / 中国医学科学杂志(英文版)

Background In mainland China, patients with neovascular age-related macular degeneration (nAMD) have approximately an 40% prevalence of polypoidal choroidal vasculopathy (PCV). This disease leads to recurrent retinal pigment epithelium detachment (PED), extensive subretinal or vitreous hemorrhages, and severe vision loss. China has introduced various treatment modalities in the past years and gained comprehensive experience in treating PCV.Methods A total of 14 retinal specialists nationwide with expertise in PCV were empaneled to prioritize six questions and address their corresponding outcomes, regarding opinions on inactive PCV, choices of anti-vascular endothelial growth factor (anti-VEGF) monotherapy, photodynamic therapy (PDT) monotherapy or combined therapy, patients with persistent subretinal fluid (SRF) or intraretinal fluid (IRF) after loading dose anti-VEGF, and patients with massive subretinal hemorrhage. An evidence synthesis team conducted systematic reviews, which informed the recommendations that address these questions. This guideline used the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach to assess the certainty of evidence and grade the strengths of recommendations. Results The panel proposed the following six conditional recommendations regarding treatment choices. (1) For patients with inactive PCV, we suggest observation over treatment. (2) For treatment-na?ve PCV patients, we suggest either anti-VEGF monotherapy or combined anti-VEGF and PDT rather than PDT monotherapy. (3) For patients with PCV who plan to initiate combined anti-VEGF and PDT treatment, we suggest later/rescue PDT over initiate PDT. (4) For PCV patients who plan to initiate anti-VEGF monotherapy, we suggest the treat and extend (T&E) regimen rather than the pro re nata (PRN) regimen following three monthly loading doses. (5) For patients with persistent SRF or IRF on optical coherence tomography (OCT) after three monthly anti-VEGF treatments, we suggest proceeding with anti-VEGF treatment rather than observation. (6) For PCV patients with massive subretinal hemorrhage (equal to or more than four optic disc areas) involving the central macula, we suggest surgery (vitrectomy in combination with tissue-plasminogen activator (tPA) intraocular injection and gas tamponade) rather than anti-VEGF monotherapy. Conclusions Six evidence-based recommendations support optimal care for PCV patients' management.

Catheter ablation versus medical therapy for atrial fibrillation with prior stroke history: a prospective propensity score-matched cohort study / 老年心脏病学杂志（英文版）

BACKGROUND@#Patients with atrial fibrillation (AF) and prior stroke history have a high risk of cardiovascular events despite anticoagulation therapy. It is unclear whether catheter ablation (CA) has further benefits in these patients.@*METHODS@#AF patients with a previous history of stroke or systemic embolism (SE) from the prospective Chinese Atrial Fibrillation Registry study between August 2011 and December 2020 were included in the analysis. Patients were matched in a 1:1 ratio to CA or medical treatment (MT) based on propensity score. The primary outcome was a composite of all-cause death or ischemic stroke (IS)/SE.@*RESULTS@#During a total of 4.1 ± 2.3 years of follow-up, the primary outcome occurred in 111 patients in the CA group (3.3 per 100 person-years) and in 229 patients in the MT group (5.7 per 100 person-years). The CA group had a lower risk of the primary outcome compared to the MT group [hazard ratio (HR) = 0.59, 95% CI: 0.47-0.74, P < 0.001]. There was a significant decreasing risk of all-cause mortality (HR = 0.43, 95% CI: 0.31-0.61, P < 0.001), IS/SE (HR = 0.73, 95% CI: 0.54-0.97, P = 0.033), cardiovascular mortality (HR = 0.32, 95% CI: 0.19-0.54, P < 0.001) and AF recurrence (HR = 0.33, 95% CI: 0.30-0.37, P < 0.001) in the CA group compared to that in the MT group. Sensitivity analysis generated consistent results when adjusting for time-dependent usage of anticoagulants.@*CONCLUSIONS@#In AF patients with a prior stroke history, CA was associated with a lower combined risk of all-cause death or IS/SE. Further clinical trials are warranted to confirm the benefits of CA in these patients.

Expert consensus on late stage of critical care management / 中华内科杂志

We wished to establish an expert consensus on late stage of critical care (CC) management. The panel comprised 13 experts in CC medicine. Each statement was assessed based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) principle. Then, the Delphi method was adopted by 17 experts to reassess the following 28 statements. (1) ESCAPE has evolved from a strategy of delirium management to a strategy of late stage of CC management. (2) The new version of ESCAPE is a strategy for optimizing treatment and comprehensive care of critically ill patients (CIPs) after the rescue period, including early mobilization, early rehabilitation, nutritional support, sleep management, mental assessment, cognitive-function training, emotional support, and optimizing sedation and analgesia. (3) Disease assessment to determine the starting point of early mobilization, early rehabilitation, and early enteral nutrition. (4) Early mobilization has synergistic effects upon the recovery of organ function. (5) Early functional exercise and rehabilitation are important means to promote CIP recovery, and gives them a sense of future prospects. (6) Timely start of enteral nutrition is conducive to early mobilization and early rehabilitation. (7) The spontaneous breathing test should be started as soon as possible, and a weaning plan should be selected step-by-step. (8) The waking process of CIPs should be realized in a planned and purposeful way. (9) Establishment of a sleep-wake rhythm is the key to sleep management in post-CC management. (10) The spontaneous awakening trial, spontaneous breathing trial, and sleep management should be carried out together. (11) The depth of sedation should be adjusted dynamically in the late stage of CC period. (12) Standardized sedation assessment is the premise of rational sedation. (13) Appropriate sedative drugs should be selected according to the objectives of sedation and drug characteristics. (14) A goal-directed minimization strategy for sedation should be implemented. (15) The principle of analgesia must be mastered first. (16) Subjective assessment is preferred for analgesia assessment. (17) Opioid-based analgesic strategies should be selected step-by-step according to the characteristics of different drugs. (18) There must be rational use of non-opioid analgesics and non-drug-based analgesic measures. (19) Pay attention to evaluation of the psychological status of CIPs. (20) Cognitive function in CIPs cannot be ignored. (21) Delirium management should be based on non-drug-based measures and rational use of drugs. (22) Reset treatment can be considered for severe delirium. (23) Psychological assessment should be conducted as early as possible to screen-out high-risk groups with post-traumatic stress disorder. (24) Emotional support, flexible visiting, and environment management are important components of humanistic management in the intensive care unit (ICU). (25) Emotional support from medical teams and families should be promoted through"ICU diaries"and other forms. (26) Environmental management should be carried out by enriching environmental content, limiting environmental interference, and optimizing the environmental atmosphere. (27) Reasonable promotion of flexible visitation should be done on the basis of prevention of nosocomial infection. (28) ESCAPE is an excellent project for late stage of CC management.

The protective effect of scalp acupuncture on cerebral neurons in rats with ischemic stroke and its influence on PI3K/AKt pathway / 西安交通大学学报(医学版)

【Objective】 To investigate scalp acupuncture’s protective effect on brain neurons and its effect on motor function in ischemic stroke rats and the possible mechanisms. 【Methods】 The rat model of ischemic stroke was prepared by the modified Longa suture method； the rats were randomly divided into model group， scalp acupuncture treatment group， inhibitor group， scalp acupuncture treatment + inhibitor group， and sham operation group. After a series of interventions， we evaluated the neurological， behavioral and motor functions of rats in each group after the treatment was over. TTC staining was used to detect cerebral infarction area. Neuron morphology was observed by Nissl staining. qPCR and Western blotting were used to detect the mRNA and protein expression levels of genes related to phosphatidyl inositol-3-kinase （PI3K）/serine-threonine protein kinase （AKt） pathway in the ischemic brain tissue of the rats. 【Results】 In the inhibitor group， the model group， the scalp acupuncture treatment group， and the scalp acupuncture treatment+inhibitor group， the neurological impairment and motor function score gradually decreased， the escape latency gradually shortened， the target quadrant residence time prolonged， the proportion of cerebral infarction area decreased， the number of Nissl bodies increased， the relative expressions of PI3K and AKt mRNA and protein increased （P<0.05）， and the neuronal morphology improved. 【Conclusion】 Scalp acupuncture can protect cerebral neurons of rats with ischemic stroke and enhance their motor function. The mechanism may be related to the regulation of PI3K/AKt signaling pathway.

Prognostic value of pretreatment 18F-FDG PET/CT metabolic parameters in elderly classical Hodgkin′s lymphoma / 中华核医学与分子影像杂志

Objective:To investigate the prognostic value of pretreatment 18F-FDG PET/CT metabolic parameters in patients with elderly classical Hodgkin′s lymphoma (cHL). Methods:From April 2011 to April 2020, the pretreatment clinical and 18F-FDG PET/CT metabolic parameters of 42 elderly cHL patients (29 males and 13 females, median age 69 years) pathologically confirmed in the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were obtained with 41%SUV max as the threshold. ROC curve analysis was applied to obtain the best prognostic cut-off value of SUV max, MTV and TLG. Kaplan-Meier method and log-rank test were used for univariate survival analysis, and Cox proportional hazard regression model was used for multivariate survival analysis. Results:SUV max, MTV and TLG of 42 elderly cHL patients were 16.49(12.24, 23.59), 79.29(26.29, 184.51) ml and 729.02(206.03, 2 073.98) g, respectively. ROC curve showed that the AUCs of SUV max, MTV and TLG were 0.425, 0.882 and 0.832, respectively, and the best prognostic cut-off values were 16.49, 82.38 ml and 556.26 g, respectively. Univariate analysis showed that age, B symptoms, lactate dehydrogenase (LDH) level, Hb content, Ann Arbor stage, German Hodgkin Study Group (GHSG) score, MTV and TLG were relative factors affecting progression-free survival (PFS) rate ( χ2 values: 4.50-12.60, all P<0.05), and age, B symptoms, LDH level, Ann Arbor stage, GHSG score, MTV and TLG were relative factors affecting overall survival (OS) rate ( χ2 values: 5.20-11.17, all P<0.05). Multivariate analysis showed that MTV (relative risk ( RR)=5.370, 95% CI: 1.697-16.277) and TLG ( RR=4.854, 95% CI: 1.228-23.352) were independent prognostic predictors of PFS rate (both P<0.05), and GHSG score ( RR=3.761, 95% CI: 1.092-12.955; RR=3.668, 95% CI: 1.068-12.571), MTV ( RR=6.173, 95% CI: 1.431-16.322) and TLG ( RR=5.162, 95% CI: 1.200-22.199) were independent prognostic predictors of OS rate (all P<0.05). Conclusion:MTV and TLG in pretreatment 18F-FDG PET/CT are independent prognostic factors for predicting PFS and OS in patients with elderly cHL patients, which have certainly reference value for prognosis.

Relationship between nucleoprotein TAR DNA/RNA binding protein 43 and mouse amyotrophic lateral sclerosis / 解剖学报

Objective Transgenic mice expressing human TAR DNA/RNA binding protein 43 (hTDP-43) mutant protein in spinal cord motor neurons were constructed using HB9 promoter to establish a disease model of amyotrophic lateral sclerosis ( ALS) and explore the mechanism of ALS induced by hTDP-43 mutation. Methods HB9 promoter junction mutant hTDP-43 vector was constructed in vitro, and the positive transgenic mouse strains were prepared by prokaryotic injection and screened (There were 8-10 mutations at Q331K and M337V). Gait analysis, rotary rod fatigue test, and suspension test were used to detect locomotion ability of mice. Immunohistochemistry, immunofluorescence staining and Western blotting were used to detect hTDP-43, phosphorylated HTDP-43 ( p-hTDP-43) , Caspase-3, cleaved Caspase-3, respectively. Expression of ubiquitin, (3-tubulinIH(Tujl) , Ki67 and cyclin-dependent kinase 5 (CDK5) proteins were also detected. Results In transgenic mice expressing mutant hTDP-43 protein in spinal motor neurons, both hind limbs were atrophied to the trunk side, and motor function showed progressive decline with increasing age. hTDP-43, p-hTDP-43, Caspase-3, and cleaved Caspase-3 were observed in spinal motor neurons Caspase-3 positive staining and ubiquitin protein positive inclusion body, and in vitro isolation and culture of spinal motor neurons, it was found that hTDP-43 and ubiquitin protein co-located in choline acetyl translocation enzyme ( ChAT) positive motor neurons, accompanied by ectopic expression of CDK5. Conclusion The mutant HDP 43 protein expressed in mouse spinal cord motor neurons can promote the re-entry of differentiated mature neurons into the cell cycle, leading to the occurrence of ALS.

RGO and Three-Dimensional Graphene Networks Co-modified TIMs with High Performances.

With the development of microelectronic devices, the insufficient heat dissipation ability becomes one of the major bottlenecks for further miniaturization. Although graphene-assisted epoxy resin (ER) display promising potential to enhance the thermal performances, some limitations of the reduced graphene oxide (RGO) nanosheets and three-dimensional graphene networks (3DGNs) hinder the further improvement of the resulting thermal interface materials (TIMs). In this study, both the RGO nanosheets and 3DGNs are adopted as co-modifiers to improve the thermal conductivity of the ER. The 3DGNs provide a fast transport network for phonon, while the presence of RGO nanosheets enhances the heat transport at the interface between the graphene basal plane and the ER. The synergy of these two modifiers is achieved by selecting a proper proportion and an optimized reduction degree of the RGO nanosheets. Moreover, both the high stability of the thermal conductivity and well mechanical properties of the resulting TIM indicate the potential application prospect in the practical field.