Type and approach of hysterectomy and oncological survival of women with stage II cancer of endometrium: a large retrospective cohort study.

Objective: To explore the association between the Type and approach of hysterectomy and oncological survival of women with stage II cancer of the endometrium. Patients and methods: 684 women with stage II endometrial cancer were included. Eligible cases were grouped by type of hysterectomy (simple hysterectomy or radical hysterectomy)and approach of hysterectomy (laparoscopy or laparotomy). The baseline characteristics were compared among groups. The survival outcomes (disease-free survival and overall survival) were calculated and compared among groups, and the underlying confounding factors were adjusted by the Cox proportional hazard regression analysis. Results: The radical hysterectomy group and the simple hysterectomy group had 217 cases and 467 cases, respectively. Between the groups, the difference in 5-year disease-free survival (87.3% versus 87.9%, HR=0.97, P=0.87) and 5-year overall survival (83.8% versus 83.8%, HR=0.95, P=0.95) was not statistically significant. The laparotomy group and the laparoscopy group had 277 cases and 407 cases, respectively. Between the groups, the difference in 5-year disease-free survival (88.7% versus 87.1%, HR=1.22, P=0.34) and 5-year overall survival (85.5% versus 82.7%, HR=1.00, P=0.99) was not statistically significant. Conclusion: For long-term oncological survival, radical hysterectomy is not superior to total hysterectomy in stage II endometrial cancer. Also, for stage II cancer of the endometrium, laparoscopic hysterectomy is as oncologically safe as open hysterectomy.

Development and validation of a disulfidptosis-related scoring system to predict clinical outcome and immunotherapy response in acute myeloid leukemia by integrated analysis of single-cell and bulk RNA-sequencing.

Background: Disulfidptosis is a metabolically relevant mode of cell death, and its relationship with acute myeloid leukemia (AML) has not been clarified. In this study, disulfidptosis scores were computed to examine the potential biological mechanisms. Methods: Consensus clustering was applied to detect disulfidptosis-related molecular subtypes. The least absolute shrinkage and selection operator (LASSO) regression analysis was used to construct a DRG prognostic model. Results: DRGs are upregulated in AML and associated with poor prognosis. The higher the disulfidptosis activity score, the worse the clinical outcome for patients, accompanied by increased immune checkpoint expression and tumor marker pathway activity. The two molecular subtypes exhibited distinct prognoses and tumor microenvironment (TME) profiles. A prognostic risk score model was established using six DRGs, and the AML cohort was divided into high- and low-risk score groups. Patients in the high-risk group experienced significantly worse prognosis, which was validated in seven AML cohorts. Receiver Operating Characteristic (ROC) curve analysis indicated that the area under the curve values for risk score prediction of 1-, 3-, and 5-year survival were 0.779, 0.714, and 0.778, respectively. The nomogram, in conjunction with clinicopathological factors, further improved the accuracy of prognosis prediction. The high-risk score group exhibited a higher somatic mutation frequency, increased immune-related signaling pathway activity, and greater immune checkpoint expression, suggesting a certain degree of immunosuppression. Patients with advanced age and higher cytogenetic risk also had elevated risk scores. According to drug prediction and AML anti-PD-1 therapy cohort analysis, the low-risk score group displayed greater sensitivity to chemotherapy drugs like cytarabine and midostaurin, while the high-risk score group was more responsive to anti-PD-1 therapy. Finally, clinical samples were collected for sequencing analysis, confirming that the progression of myeloid leukemia was associated with a higher risk score and a negative disulfidptosis score, suggesting that the poor prognosis of AML may be associated with disulfidptosis resistance. Conclusion: In conclusion, a systematic analysis of DRGs can help to identify potential disulfidptosis-related mechanisms and provide effective new biomarkers for prognosis prediction, TME assessment, and the establishment of personalized treatment plans in AML.

Efficacy and Safety of Robot-assisted AUS Implantation Surgery in Treating Severe Stress Urinary Incontinence: A Systematic Review and Meta-Analysis.

OBJECTIVE: To investigate the effectiveness and safety of robot-assisted artificial urinary sphincter (AUS) implantation surgery for female patients with severe stress urinary incontinences (SUI) by performing a systematic literature review. METHODS: A comprehensive search was carried out across multiple databases, including PubMed, EMBASE, Web of Science Clarivate, Cochrane library, Medicine and clinicaltrials.gov between inception to March 2022. Studies were included if they met the inclusion criteria and were evaluated by different quality evaluation methods according to study types. P value and 95% confidence intervals (CI) of outcome measures mainly including continence rates, intraoperative and postoperative complication rates were pooled to present the efficacy and safety. RESULTS: A total of 9 studies with 157 participants were finally included. Eight retrospective and 1 prospective study met the inclusion criteria with moderate and high evidence levels. The pooled results showed that patients with robot-assisted AUS implantation treatment, presented great continence rate (P = .83, 95%CI:0.76-0.89) but high complication rate (Intraoperation: 0.21 95%CI:0.11-0.34; Postoperation: 0.20 95%CI: 0.12-0.29). In addition, subgroup analysis of 2 approaches showed that compared with the posterior approach, the traditional surgical approach had better efficacy and safety. CONCLUSION: The results of this study indicated that robot-assisted AUS implantation surgery improved SUI patients' urinary continence, but the complication rates were high, which mainly included intraoperative vaginal and bladder injury and postoperative acute urinary retention. More evidence from prospective studies is needed to provide guidance for clinical practice.

Using machine learning to predict gamma passing rate in volumetric-modulated arc therapy treatment plans.

PURPOSE: This study aims to develop an algorithm to predict gamma passing rate (GPR) in the volumetric-modulated arc therapy (VMAT) technique. MATERIALS AND METHODS: A total of 118 clinical VMAT plans, including 28 mediastina, 25 head and neck, 40 brains intensity-modulated radiosurgery, and 25 prostate cases, were created in RayStation treatment planning system for Edge and TrueBeam linacs. In-house scripts were developed to compute Modulation indices such as plan-averaged beam area (PA), plan-averaged beam irregularity (PI), total monitor unit (MU), leaf travel/arc length, mean dose rate variation, and mean gantry speed variation. Pretreatment verifications were performed on ArcCHECK phantom with SNC software. GPR was calculated with 3%/2 mm and 10% threshold. The dataset was randomly split into a training (70%) and a test (30%) dataset. A random forest regression (RFR) model and support vector regression (SVR) with linear kernel were trained to predict GPR using the complexity metrics as input. The prediction performance was evaluated by calculating the mean absolute error (MAE), R2 , and root mean square error (RMSE). RESULTS: RMSEs at γ 3%/2 mm for RFR and SVR were 1.407 ± 0.103 and 1.447 ± 0.121, respectively. MAE was 1.14 ± 0.084 for RFR and 1.101 ± 0.09 for SVR. R2 was equal to 0.703 ± 0.027 and 0.689 ± 0.053 for RFR and SVR, respectively. GPR of 3%/2 mm with a 10% threshold can be predicted with an error smaller than 3% for 94% of plans using RFR and SVR models. The most important metrics that had the greatest impact on how accurately GPR can be predicted were determined to be the PA, PI, and total MU. CONCLUSION: In terms of its prediction values and errors, SVR (linear) appeared to be comparable with RFR for this dataset. Based on our results, the PA, PI, and total MU calculations may be useful in guiding VMAT plan evaluation and ultimately reducing uncertainties in planning and radiation delivery.

Changes in early postoperative outcomes and complications observed in a single center during the 2022 COVID-19 pandemic wave in China: A single-center ambispective cohort study / 中华医学杂志(英文版)

BACKGROUND@#Currently, the effect of the 2022 nationwide coronavirus disease 2019 (COVID-19) wave on the perioperative prognosis of surgical patients in China is unclear. Thus, we aimed to explore its influence on postoperative morbidity and mortality in surgical patients.@*METHODS@#An ambispective cohort study was conducted at Xijing Hospital, China. We collected 10-day time-series data from December 29 until January 7 for the 2018-2022 period. The primary outcome was major postoperative complications (Clavien-Dindo class III-V). The association between COVID-19 exposure and postoperative prognosis was explored by comparing consecutive 5-year data at the population level and by comparing patients with and without COVID-19 exposure at the patient level.@*RESULTS@#The entire cohort consisted of 3350 patients (age: 48.5 ± 19.2 years), including 1759 females (52.5%). Overall, 961 (28.7%) underwent emergency surgery, and 553 (16.5%) had COVID-19 exposure (from the 2022 cohort). At the population level, major postoperative complications occurred in 5.9% (42/707), 5.7% (53/935), 5.1% (46/901), 9.4% (11/117), and 22.0% (152/690) patients in the 2018-2022 cohorts, respectively. After adjusting for potential confounding factors, the 2022 cohort (80% patients with COVID-19 history) had a significantly higher postoperative major complication risk than did the 2018 cohort (adjusted risk difference [aRD], 14.9% (95% confidence interval [CI], 11.5-18.4%); adjusted odds ratio [aOR], 8.19 (95% CI, 5.24-12.81)). At the patient level, the incidence of major postoperative complications was significantly greater in patients with (24.6%, 136/553) than that in patients without COVID-19 history (6.0% [168/2797]; aRD, 17.8% [95% CI, 13.6-22.1%]; aOR, 7.89 [95% CI, 5.76-10.83]). Secondary outcomes of postoperative pulmonary complications were consistent with primary findings. These findings were verified through sensitivity analyses using time-series data projections and propensity score matching.@*CONCLUSION@#Based on a single-center observation, patients with recent COVID-19 exposure were likely to have a high incidence of major postoperative complications.@*REGISTRATION@#NCT05677815 at https://clinicaltrials.gov/ .

Clinical features and prognostic factors of blastemal Wilms tumor / 中华泌尿外科杂志

Objective:To describe the clinical features and analyze the prognostic factors of blastemaltype Wilms tumor. To explore the clinical risk factors affecting the prognosis of blastoma.Methods:Clinical data of 75 patients admitted to the surgery department of Beijing Children's Hospital from January 2008 to June 2020 who were confirmed to be blastemal-type Wilms tumor by postoperative pathology without preoperative chemotherapy. The patients' general information, clinical characteristics, inspection data, surgical methods and follow-up results were collected. The related factors which influences its prognosis were analyzed. Among the 75 patients, 45 cases (60.0%) were male and 30 cases (40.0%) were female. The diagnosis age was 6-144 m, mean age was 39.1 m. Left side: 38 cases (50.7%), right side: 37 cases (49.3%). The clinical manifestations were abdominal mass in 35 cases (46.7%), hematuria in 24 cases (32.0%), abdominal pain in 7 cases (9.3%) and physical examination in 9 cases (12.0%). There were Stage Ⅰ 30 cases, Stage Ⅱ 28 cases, Stage Ⅲ 15 cases, Stage Ⅳ 2 cases. There were preoperative tumor rupture in 5 cases, intraoperative tumor rupture in 2 cases. Clinical stage Ⅰ and Ⅱ were classified as early, while stage Ⅲ, Ⅳ were classified as late. According to COG protocol, stage Ⅰ and Ⅱ patients received EE4A, stage Ⅲ and Ⅳ patients received DD4A protocol and radiotherapy. The number of lymph nodes sampled during operation was more than 7 in 10 patients.Results:7 cases were tested for 1p16q. One case(stage Ⅱ) was absent at 1p/16q LOH, and chemotherapy was upgraded from EE4A to DD4A. After the recurrence of 1 case in clinical stage Ⅰ, the 1p/16q heterozygotic deletion test was performed, which was changed to M regimen chemotherapy. Only 1p lost in one case, and 1p/16q was negative in 4 cases, so the original chemotherapy regimen was maintained. A total of 67 patients were recruited to the study. The median follow-up time was 57 months. The 5-year relapse-free survival(RFS) rate was74.7%, and the 5-year overall survival(OS) rate was 88.0%. Cox multivariate regression analysis showed that: advanced clinical stage ( HR=4.9, 95% CI 1.2-19.6, P=0.025), tumor volume ( HR=1.7, 95% CI 0.4-6.9, P=0.048), and tumor rupture ( HR=20.1, 95% CI 4.7-85.5, P<0.001) were independent risk factors for prognosis of blastoma. Gender, age, side profile, clinical manifestations, tumor embolism, and number of lymph nodes sampled had no significant influence on the survival rate of blastoma ( P>0.05). Conclusion:Advanced stage (Ⅲ-Ⅳ), tumor volume≥1 000 ml, tumor weight and tumor rupture were independent risk factors for relapse. Insufficient lymph node sampling and incomplete 1p16q, may be the reasons for the increased risk of local recurrence in low-stage patients due to the underestimated risk classification and insufficient treatment intensity.

Design and preliminary application of outdoor flying pigeon-robot / 生物医学工程学杂志

Control at beyond-visual ranges is of great significance to animal-robots with wide range motion capability. For pigeon-robots, such control can be done by the way of onboard preprogram, but not constitute a closed-loop yet. This study designed a new control system for pigeon-robots, which integrated the function of trajectory monitoring to that of brain stimulation. It achieved the closed-loop control in turning or circling by estimating pigeons' flight state instantaneously and the corresponding logical regulation. The stimulation targets located at the formation reticularis medialis mesencephali (FRM) in the left and right brain, for the purposes of left- and right-turn control, respectively. The stimulus was characterized by the waveform mimicking the nerve cell membrane potential, and was activated intermittently. The wearable control unit weighted 11.8 g totally. The results showed a 90% success rate by the closed-loop control in pigeon-robots. It was convenient to obtain the wing shape during flight maneuver, by equipping a pigeon-robot with a vivo camera. It was also feasible to regulate the evolution of pigeon flocks by the pigeon-robots at different hierarchical level. All of these lay the groundwork for the application of pigeon-robots in scientific researches.

An Automatic HFO Detection Method Combining Visual Inspection Features with Multi-Domain Features / 神经科学通报·英文版

As an important promising biomarker, high frequency oscillations (HFOs) can be used to track epileptic activity and localize epileptogenic zones. However, visual marking of HFOs from a large amount of intracranial electroencephalogram (iEEG) data requires a great deal of time and effort from researchers, and is also very dependent on visual features and easily influenced by subjective factors. Therefore, we proposed an automatic epileptic HFO detection method based on visual features and non-intuitive multi-domain features. To eliminate the interference of continuous oscillatory activity in detected sporadic short HFO events, the iEEG signals adjacent to the detected events were set as the neighboring environmental range while the number of oscillations and the peak–valley differences were calculated as the environmental reference features. The proposed method was developed as a MatLab-based HFO detector to automatically detect HFOs in multi-channel, long-distance iEEG signals. The performance of our detector was evaluated on iEEG recordings from epileptic mice and patients with intractable epilepsy. More than 90% of the HFO events detected by this method were confirmed by experts, while the average missed-detection rate was < 10%. Compared with recent related research, the proposed method achieved a synchronous improvement of sensitivity and specificity, and a balance between low false-alarm rate and high detection rate. Detection results demonstrated that the proposed method performs well in sensitivity, specificity, and precision. As an auxiliary tool, our detector can greatly improve the efficiency of clinical experts in inspecting HFO events during the diagnosis and treatment of epilepsy.

Biomedical applications of bionic untethered micro-nano robots / 生物医学工程学杂志

Bionic untethered micro-nano robots, due to their advantages of small size, low weight, large thrust-to-weight ratio, strong wireless mobility, high flexibility and high sensitivity, have very important application values in the fields of biomedicine, such as disease diagnosis, minimally invasive surgery, targeted therapy, etc. This review article systematically introduced the manufacturing methods and motion control, and discussed the biomedical applications of bionic untethered micro-nano robots. Finally, the article discussed the possible challenges for bionic untethered micro-nano robots in the future. In summary, this review described bionic untethered micro-nano robots and their potential applications in biomedical fields.

SARS-CoV-2 infection in health care workers: a retrospective analysis and a model study

BackgroundThere had been a preliminary occurrence of human-to-human transmissions between healthcare workers (HCWs), but risk factors in the susceptibility for COVID-19, and infection patterns among HCWs have largely remained unknown. MethodsRetrospective data collection on demographics, lifestyles, contact status with infected subjects for 118 HCWs (include 12 COVID-19 HCWs) from a single-center. Sleep quality and working pressure were evaluated by Pittsburgh Sleep Quality Index (PSQI) and The Nurse Stress Index (NSI), respectively. Follow-up duration was from Dec 25, 2019, to Feb 15, 2020. Risk factors and transmission models of COVID-19 among HCWs were analyzed and constructed. FindingsA high proportion of COVID-19 HCWs had engaged in night shift-work (75.0% vs. 40.6%) and felt they were working under pressure (66.7% vs. 32.1%) than uninfected HCWs. COVID-19 HCWs had higher total scores of PSQI and NSI than uninfected HCWs. Furthermore, these scores were both positively associated with COVID-19 risk. An individual-based model (IBM) estimated the outbreak duration among HCWs in a non-typical COVID-19 ward at 62-80 days and the basic reproduction number R0 =1.27 [1.06, 1.61]. By reducing the average contact rate per HCW by a 1.35 factor and susceptibility by a 1.40 factor, we can avoid an outbreak of the basic case among HCWs. InterpretationPoor sleep quality and high working pressure were positively associated with high risks of COVID-19. A novel IBM of COVID-19 transmission is suitable for simulating different outbreak patterns in a hospital setting. FundingFundamental Research Funds for the Central Universities

Spatially Explicit Modeling of 2019-nCoV Epidemic Trend based on Mobile Phone Data in Mainland China

As of February 11, 2020, all prefecture-level cities in mainland China have reported confirmed cases of 2019 novel coronavirus (2019-nCoV), but the city-level epidemical dynamics is unknown. The aim of this study is to model the current dynamics of 2019-nCoV at city level and predict the trend in the next 30 days under three possible scenarios in mainland China. We developed a spatially explicit epidemic model to consider the unique characteristics of the virus transmission in individual cities. Our model considered that the rate of virus transmission among local residents is different from those with Wuhan travel history due to the self-isolation policy. We introduced a decay rate to quantify the effort of each city to gradually control the disease spreading. We used mobile phone data to obtain the number of individuals in each city who have travel history to Wuhan. This city-level model was trained using confirmed cases up to February 10, 2020 and validated by new confirmed cases on February 11, 2020. We used the trained model to predict the future dynamics up to March 12, 2020 under different scenarios: the current trend maintained, control efforts expanded, and person-to-person contact increased due to work resuming. We estimated that the total infections in mainland China would be 72172, 54348, and 149774 by March 12, 2020 under each scenario respectively. Under the current trend, all cities will show the peak point of daily new infections by February 21. This date can be advanced to February 14 with control efforts expanded or postponed to February 26 under pressure of work resuming. Except Wuhan that cannot eliminate the disease by March 12, our model predicts that 95.4%, 100%, and 75.7% cities will have no new infections by the end of February under three scenarios. The spatial pattern of our prediction could help the government allocate resources to cities that have a more serious epidemic in the next 30 days.

Fuzheng Yanggan Fomula alleviates liver injury through inhibiting NLRP3 inflammasome / 药学学报

In this study, the model of Propionibacterium acnes/lipopolysaccharide (P. acnes/LPS)-induced acute liver injury in mice was employed to investigate the protective effects of Fuzheng Yanggan Fomula (FYF) on acute liver injury. The effects of FYF on the contents of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and interleukin-1β (IL-1β) in the serum, and the levels of malondialdehyde (MDA), oxygen radical absorbance capacity (ORAC), and glutathione (GSH) were examined in the livers of mice treated with P. acnes/LPS; The protein expression levels of Nod-like receptor protein 3 (NLRP3), apoptosis-associated speck-like protein containing a CARD (ASC), cysteinyl aspartate specific proteinase-1 (caspase-1), and IL-1β in liver tissues were detected by Western blot; Furthermore, hematoxylinendash-eosin (HE) staining, terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining, and immunohistochemical assay were used to observe pathological changes, apoptosis index, and inflammation infiltration of the liver tissue sections. All animal welfare and experimental procedures were followed by the Animal Ethics Committee of Jinan University. We conclude that FYF could alleviate P. acnes/LPS induced pathological damage and inflammatory infiltration in the liver of mice. Meanwhile, FYF decreases the contents of ALT, AST, IL-1β, and MDA, increases the contents of ORAC and GSH, and downregulates the expression of caspase-1 and IL-1β proteins. Collectively, these findings suggested that FYF could alleviate P. acnes/LPS induced acute liver injury in mice by inhibiting the activation of NLRP3 inflammasome, which provides a theoretical basis and a new drug target for the prevention and treatment of liver injury.

Research advances in the role of exosomes in non-neoplastic liver diseases / 临床肝胆病杂志

The liver is an important metabolic and immune organ in human body. Exosomes are extracellular vesicles released by cells and carry a variety of molecules such as proteins, lipids, DNA, and RNA. Studies have found that exosomes play an important role in various liver diseases. This article elaborates on the role of exosomes in the pathogenesis of non-neoplastic liver diseases and related research advances in their role as biomarkers for disease diagnosis and therapeutic methods. It is pointed out that in-depth studies are needed to explore the biogenesis and release of exosomes and the exact mechanism of exosomes in liver diseases, in order to provide a basis for the prevention and treatment of non-neoplastic liver diseases.

Effect of heterotopic ossification on cervical motion following Prestige artificial cervical disc replacement / 解剖学报

[Abstract] Objective To analyze the effect of heterotopic ossification(HO) on the postoperative segmental range of motion(ROM)after Prestige artificial cendcal disc replacement, and to explore the related factors leading to the formation of heterotopic ossification after artificial cendcal disc replacement. Methods We recruited of 66 patients who had Prestige artificial cendcal disc replacement from January 2014 to January 2018 in Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University were retrospectively reviewed. To evaluate cendcal spine X-ray, the replacement segment ROM was measured in picture, and the occurrence of HO was defined by the McAfee' s classification. The Wilcoxon signed rank test was used to analyze the relationship between heterotopic ossification formation and replacement segment ROM,the t test was used to analyze the influence between heterotopic ossification grading and replacement segment ROM. Nine clinical factors including age, gender, bod)' mass index(BMI), number of replacement segments, preoperative ligament ossification, the preoperative disc height ratio of the target level and its adjacent level, preoperative mobility of replacement segments, postoperative mobility of replacement segments, whether to use nonsteroidal autiinflammatory drugs (NSAIDs) during perioperative period. The correlation between these nine clinical factors and the occurrence of postoperative HO was evaluated with logistic regression analysis. Results The occurrence rate of HO was 34. 8% in last follow-up. The replacement segmental ROM of the heterotopic ossification group was significantly smaller than that of the non-ectopic ossification group, and the difference was statistically significant (P<0. 05),and the McAfee grade IH-IV group was significantly less than the McAfee grade I-H group, and the difference was statistically significant (P < 0. 05). Correlation analysis showed that preoperative and postoperative ROM of the replacement segment presented statistical correlation (P < 0. 05). Furthennore analysis of ROC curve showed that heterotopic ossification was more likely to occur when the degree of ROM of the replacement segment

Lower limb ischemia cured by stimulation electrode implantation assisted with microendoscopic discectomy system: A case report / 北京大学学报(医学版)

A 58-year-old male patient diagnosed with thromboangiitis obliterans (Fontaine stage IV) was recently treated with microendoscope discectomy system-assisted spinal cord stimulation electrode implantation and cured by department of vascular surgery combined with department of spinal surgery at Peking University People's Hospital. The patient suffered from cold injury to the right foot 14 years ago, which was cold, painful, numb, and then the toe was ulcerated and gangrene. Only the right foot small toe was left. The right foot skin was swollen from the toe to the proximal segment 1 year ago, accompanied by resting pain. Both pain and autologous bone marrow stem cell transplantation were ineffective. The above symptoms were aggravated three months ago, and the pain was severe. The visual analogue score was 10 points. A high amputation of the left lower extremity was performed 30 years ago due to trauma. Physical examination: the bilateral femoral artery was weak, and the right radial artery, posterior tibial artery, and dorsal artery were not touched. Buerger sign (+). Auxiliary examination: angiography of both lower extremities showed complete occlusion of the bilateral external iliac artery and its distal end. The percutaneous oxygen partial pressure was measured to be 30 mmHg on the right side of the iliac crest. The operation was performed under the local anesthesia. After X-ray positioning, the body projection of the lumbar vertebrae 1-2 lamina gap was marked. The skin had a 1.8 cm incision on the caudal side 2 cm from the mark. Then the dilators were used, and the working sleeve was tilted to the lumbar vertebrae 1-2 lamina gap. The microendoscope discectomy system was installed, the electrode was directly placed into the epidural space from the interlamina space under the microendoscope, the vascular surgeon adjusted the position of the electrode in the spinal canal under fluoroscopy, then connected the stimulator, adjusted the current until the patient had the lower limb fever, fixed electrode position, removed the microendoscope discectomy system after hemostasis under the microendoscope, used the guide needle to lead the electrode through the lumbar subcutaneous and then sutured the incision. After the operation, the electrode was connected to the temporary stimulator to stimulate for several minutes, the patient felt numbness in his lower limbs. In less than one hour, the skin temperature of the affected limb increased, and the painkiller could be stopped while sleeping. After 1 week, the skin temperature of the affected limb increased, and the percutaneous oxygen partial pressure of the foot and ankle was 36 mmHg, and the pain improved, and the score was reduced to 2 points. One month after surgery, the patient underwent permanent stimulator implantation. The pain disappeared after 3 months and half year of follow-up, and the score was reduced to 1 point. Microendoscope discectomy system-assisted spinal cord stimulation electrode implantation can complete the operation quickly, safely and effectively, and greatly reduce the number of intraoperative fluoroscopy and reduce the occurrence of complications.

Optimized strategy of anesthesia for total knee arthroplasty: IPACK-adductor canal block combined with general anesthesia / 中华麻醉学杂志

Objective:To evaluate the optimized effect of infiltration between the popliteal artery and the capsule of the knee (IPACK)-adductor canal block (ACB) combined with general anesthesia when used for the total knee arthroplasty.Methods:Sixty patients of both sexes, aged 18-64 yr, with body mass index of 18-24 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective unilateral total knee arthroplasty, were divided into 2 groups ( n=30 each) using a random number table method: IPACK-ACB combined with general anesthesia group (group IA) and conventional anesthesia femoral nerve block-popliteal superior sciatic nerve block combined with general anesthesia group (group C). Before induction of general anaesthesia, 0.375% ropivacaine 15 ml was injected for IPACK and 0.375% ropivacaine 25 ml for ACB under the ultrasound guidance in group IA, femoral nerve block and popliteal superior sciatic nerve block was performed under the guidance of ultrasound combined with a nerve stimulator and 0.375% ropivacaine 20 ml was injected in group C. After confirming the efficacy of nerve block, total intravenous anesthesia was carried out to maintain bispectral index values at 40-60.Patient-controlled intravenous analgesia was performed with sufentanil after operation, and the visual analog scale score was maintained ≤ 3.The quadriceps muscle strength score was recorded when discharge from postanesthesia care unit and at 24, 48 and 72 h after surgery.The first postoperative off-bed time and development of foot drop in awake patients after surgery, requirement for rescue analgesia and adverse reactions were recorded.The postoperative length of hospital stay and score for patients′ satisfaction with postoperative recovery were also recorded. Results:Compared with group C, the postoperative quadriceps muscle strength scores and score for patients′ satisfaction with postoperative recovery were significantly increased, the incidence of postoperative foot drop was decreased, and the length of hospital stay and first postoperative off-bed time were shortened in group IA ( P<0.05). Conclusion:IPACK-ACB combined with general anesthesia may be an optimized strategy which is helpful for outcomes after total knee arthroplasty.

Treatment and prognosis of children with torsion of inguinal cryptorchidism / 中华泌尿外科杂志

Objective:To discuss the treatment and prognosis of children with torsion of inguinal cryptorchidism.Methods:Clinical data of 15 cases of inguinal cryptorchidism with testicular torsion admitted to Beijing Children's Hospital from October 2015 to February 2019 were retrospectively analyzed. The average age of onset was 5.1 years (4 months-17 years). The clinical manifestations included inguinal swelling and pain in 13 cases, abdominal pain in 1 case and abdominal pain with vomiting in 1 case. The average duration of symptoms (up to the time of surgery) was 45.9 (5-170) h. Physical examination showed scrotal voided on affected side, groin swelling with tenderness. Lesions were found in 12 cases on the left and 3 cases on the right. Groin color Doppler ultrasound examination showed testis enlargement, uneven echo, decrease or disappearance of blood flow signal, suspected testicular torsion. Clinical diagnosis was inguinal cryptorchidism testicular torsion. Inguinal canal testicular exploration under general anesthesia. During the operation, the testicle was dark and twisted with an average torsion of 600°(180°-1 080°). Testicular activity was observed after exposure and reduction and torsion. After reduction, testicular color was immediately restored in 5 cases. After cutting open the white membrane of the testicular, there was blood outflow. In 2 cases, the testis was found to be inactive during the operation, but the parents requested to retain the testis and performed orchiopexy. 8 cases underwent orchiectomy due to necrosis of testis. The mean symptom duration (up to the time of operation) of the orchiectomy group and the orchiectomy group was 24.3 (5-73) h and 64.8 (7-170) h, respectively. The average torsion degree was 514° and 675°, respectively.Results:The average operative time of 15 patients was 56.7 min (40-85 min). Intraoperative blood loss averaged 1.5 (1-2) ml. There were no complications during and after operation. Postoperative follow-up averaged 27 (8-47) months. Among the 7 patients in the orchiopexy group, 3 patients had atrophy of testis 7.3 months after operation, and the remaining 4 patients had normal testis. In the orchiectomy group, 8 cases had normal contralateral testis without torsion.Conclusions:Inguinal cryptorchidism testicular torsion is a relatively rare disease in children. Color Doppler ultrasonography and inguinal canal exploration can help diagnosis and treatment. According to the condition of testis, orchiopexy or orchiectomy can be performed. Early diagnosis of this disease is difficult, easy to lead to testicular loss or postoperative atrophy.

Epidural versus intravenous analgesia following radical gastrectomy for gastric cancer: A systematic review and Meta-analysis / 国际外科学杂志

Objective:To compare the application of epidural analgesia (EA) with intravenous analgesia (IA) in radical gastrectomy for gastric cancer.Methods:A systematic review and meta-analysis of randomized controlled trials of EA and IA in radical gastrectomy was conducted. Primary outcome was pain scores at 24 h after surgery, while the secondary outcomes included incidence of postoperative complications, first flatus time and (LOS).Results:A total of 6 randomized controlled studies was identified and 393 patients were enrolled in this review, 4 published in English and 2 in Chinese. Meta-analysis revealed that, the EA group had lower pain score at 24h either pain at rest ( WMD=-0.74, 95% CI: -1.35~-0.13, P=0.02) or pain on movement or coughing( WMD=-1.5, 95% CI: -1.95~-1.05, P<0.001) than that of the IA group. In terms of complications, postoperative nausea and vomiting ( RR=0.32, 95% CI: 0.18~0.58, P<0.001) and respiratory complications ( RR=0.50, 95% CI: 0.29~0.85, P=0.01) in EA group were obviously lower than those of the IA group. No difference was observed in postoperative urinary complications between the two groups ( RR=0.87, 95% CI: 0.38~1.96, P=0.73). However, the incidence of hypotension was obviously higher than that of IA group ( RR=3.27, 95% CI: 1.28~8.32, P=0.01). Time of first exhaust time after operation ( WMD=-14.01, 95% CI: -22.85~-5.17, P=0.002), postoperative length of hospital stay ( WMD=-0.69, 95% CI: -0.90~-0.49, P<0.001) were shorter than IA group. Conclusions:For patients who undergoing radical gastrectomy for gastric cancer, epidural analgesia could provide better pain control either pain at rest or on movement, although a rising incidence of hypotension was leaded, reduced pulmonary complications, nausea and vomiting were found, and promote the bowel function and shorten the duration of hospital stay.

A survey on sun protection behavior among middle-aged and elderly women in two districts in Beijing / 中华皮肤科杂志

Objective To investigate sun protection behavior among middle-aged and elderly women in Beijing.Methods The central (Xuanwumen district) and peripheral areas (Yanqing district) of Beijing city were selected for investigation from May to June in 2016.By random sampling and field investigation,interviewees completed questionnaires with the help of dermatologists.Results A total of 400 females aged 40-90 years were investigated,including 190 in the Xuanwumen district and 210 in the Yanqing district.Among all the subjects,the average duration of outdoor activities was 2 hours.Moreover,117 (29.2％) of the 400 interviewees had the active sun exposure habit,including 38 (18.1％) in the Yanqing district and 79 (41.6％) in the Xuanwumen district,and the proportion of subjects with the active sun exposure habit significantly differed between the two districts (x2 =26.582,P ＜ 0.001).In addition,67 (16.8％) interviewees had a sunburn history,and 130 (32.5％) were used to applying sunscreen.The proportion of sunscreen users was significantly higher in moderately or highly educated women (103 [45.2％]) than in lowly educated women (28/172 [16.3％],P ＜ 0.001).The proportion of sunscreen users in women with skin type Ⅲ (41.2％ [70/170]) was significantly higher than that in those with skin type Ⅳ (26.5％ [61/230],P =0.002).The scores for facial skin aging and dorsal hand skin aging were both significantly lower in sunscreen users than in non-users (Z =18.536,10.731,P =0.002,0.026,respectively).Conclusion The active sun exposure habit in the middle-aged and elderly women differs between the central and peripheral areas of Beijing,and the use of sunscreen is associated with education level.