Table of Content

20 August 2019, Volume 19 Issue 04

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Analysis of iodine nutrition and clinical characteristics of thyroid nodule disease in adult population of Guangzhou

WEN Xiaofang， ZENG Nan， OU Tingting， LI Wan′gen， DU Tao*

2019, 19(04):  383-386.  DOI: 10.3969/j.issn.1009?976X.2019.04.001

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［Abstract］ Objective To analyze the relationship between iodine nutritional status and clinical features of thyroid nodule disease in Guangzhou residents. Methods The adult population was collected from the Second Affiliated Hospital of Guangzhou Medical University from January 1， 2018 to February 1， 2019. Thyroid ultrasound， urinary iodine and thyroid function were detected in subjects. Urinary iodine <100 μg/L was for iodine insufficient group； urinary iodine 100-199 μg/L for iodine adequate group； urine iodine 200-299 μg/L for above requirement group； urine iodine > 300 μg/L for the iodine excess group. The relationship between urinary iodine and thyroid disease and thyroid function was explored. Results A total of 1107 patients were enrolled in the study， including 309 patients with thyroid nodules. The median urinary iodine was 93.40 μg/L. Compared with the iodine adequategroup，there was no significant difference in the rate of thyroid nodule disease in other groups. Besides， iodine nutrient had no significant effect on the prevalence of thyroid nodules complicated with hyperthyroidism or autoimmune thyroiditis. Compared with the iodine adequate group， iodine insufficient and iodine excess group showed significant higher FT3 and FT4 levels， and corresponding significantly lower TSH level. Conclusion The iodine nutrition of adults in Guangzhou is insufficient， and both iodine deficiency and iodine excess could lead to abnormal thyroid function.

Regulation of TLN1-PI3K/AKT pathway on the osteogenic differentiation of mesenchymal stem cells

LI Zhaofeng， WANG Peng， XIE Zhongyu， CEN Shuizhong， LI Jinteng， SHEN Huiyong

2019, 19(04):  387-391.  DOI: 10.3969/j.issn.1009?976X.2019.04.002

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［Abstract］ Objective To investigate the role and regulatory mechanism of Talin 1 in osteogenic differentiation of bone marrow mesenchymal stem cells. Methods The expression level of TLN1 in osteogenic differentiation of mesenchymal stem cells was detected by qRT-PCR and western blot. The proliferation of MSC was measured by CCK-8 assay after TLN1-siRNA intervention. The osteogenic differentiation capacity was determined through alizarin red S and alkaline phosphatase assays. Western blotting was used to study the molecular mechanism of TLN1 in the osteogenic differentiation of MSC. Results qRT-PCR and Western blot results suggested that TLN1 expression increased during osteogenic differentiation. The osteogenic differentiation capacity was decrease compared with the negative group after siRNA transfection. After transfection with siRNA， the expression of p-AKT was decreased by Western blot. Furthermore， the rescue experiment showed that active PI3K/AKT pathway can reserve osteogenic differentiation capacity. Conclusion Talin1 expression was gradually up-regulated after induced osteogenic differentiation of MSC. TLN1 knockdown inhibited osteogenic differentiation of MSC through PI3K/AKT pathway.

The analysis of correlation between modified frailty index and postoperative complications of aged patient with Laparoscopic rectal cancer surgery with neoadjuvant therapy

WANG Qiang， ZHONG Bingzheng， WEI Jianchang

2019, 19(04):  392-395.  DOI: 10.3969/j.issn.1009?976X.2019.04.003

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［Abstract］ Objective To evaluate the application of modified frailty index （mFI） in predicting short-term outcomes of elderly patients undergoing laparoscopic rectal cancer surgery after neoadjuvant therapy. Methods We collected 147 elderly patients who underwent laparoscopic rectal cancer surgery after neoadjuvant therapy in Guangzhou First People′s Hospital from January 2012 to June 2018. According to the preoperative mFI score， they were divided into non-weakening group （mFI < 0.29， 106 cases） and weakening group （mFI> 0.29， 41 cases）. The demographic data， operation-related data， short-term clinical efficacy and postoperative complications of the two groups were analyzed. Statistical analysis was carried out on the indicators. Results 27.9% of patients were assessed as weak. There were significant differences in hospitalization days， post-operative complications between the weakened group and the non-weakened group（13.7±8.6 vs 10.5±3.8 d，P=0.025；20/106 vs 16/14，P=0.011）. Conclusion Excessive mFI is an important index to predict the occurrence of complications after neoadjuvant therapy for rectal cancer patients. Preoperative mFI score for elderly patients with colorectal cancer is helpful to provide a reasonable basis for clinical diagnosis and treatment and reduce the incidence of complications after surgery.

Impact of using carbon nanoparticle for postoperative short?term efficacy of papillary thyroid carcinoma

MIN Lei， HE Jingsong

2019, 19(04):  396-399.  DOI: 10.3969/j.issn.1009?976X.2019.04.004

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［Abstract］ Objective To explore the application of carbon nanoparticle （CNP） during total thyroidectomy for papillary carcinoma， especially for central neck dissection and postoperative serum thyroglobulin （Tg）. Methods 112 patients were recruited retrospectively among those who performed total thyroidectomy and central neck dissection from November 2017 to September 2018. 57 of them receiving injection of CNP intraoperatively were defined as CNP group while others were control group. Number of lymph nodes （LNs） resected， rate of metastasis and postoperative Tg were compared between two groups. Results Amount of central LNs detected from CNP group and control group were 568 and 504 respectively. No significance could be discovered between them （P=0.508）. Neither did significance between LNs involved of two groups， which was 240 and 222 respectively （P=0.965）. However， metastatic rate of black?dyed LNs was significantly lower than that of undyed （21.2% vs 59.1%， P=0.000）. In terms of postoperative Tg level， there was no significance between two groups （0.43 ng/mL vs 0.19 ng/mL， P=0.401）. Conclusion The present study did not show that the use of carbon nanoparticles significantly increased the number of lymph nodes resection in the central region. The metastatic rate of black?dyed LNs is lower than that of undyed. CNP would not be benefit for improvement of postoperative short?term oncologic outcomes among patients with papillary thyroid carcinoma.

The role of systemic inflammatory response and local anatomy in reducing the probability of conversion in the management laparoscopic cholecystectomy

PEN Yonghui， LI Daqiang， XIE Zhihua， CUI Wenbo， GONG Duhui， MO Yuxuan， LI Binggen， NIE Xiangyang

2019, 19(04):  400-404.  DOI: 10.3969/j.issn.1009?976X.2019.04.005

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［Abstract］ Objective To investigate the role of the systemic inflammatory response and local anatomy in reducing the conversion rate during the approach of laparoscopic cholecystectomy. Methods A total of 892 patients admitted to our hospital between February 2005 and February 2015 were analyzed retrospectively. All their cholecystitis onset were smaller than 72 hours and all of them underwent surgery. The patients were divided into two group according to the time when the approach of laparoscopic cholecystectomy， and the role of the systemic inflammatory response and local anatomical factors affecting the conversion of laparoscopic cholecystectomy were discussed. Results All 892 patients underwent surgery without any intraoperative or postoperative deaths. There were no significant differences in age， gender and body mass index between groups A and B（P>0.05）. The difference of probability of conversion was significantly in the aspect of factors including fever（≥38.5℃）， peritonitis， white blood cell（WBC≥18.0×109/L）， C-reactive protein （CRP≥30.0 mg/L） and gallbladder wall thickness（≥0.8 cm） （P<0.05）. Conclusion The assessment of fever， peritonitis， WBC， CRP and the local anatomical of gallbladder can effectively reduce the rate of conversion.

Analgesic effect of OPRM1 A118G gene polymorphism on sufentanil in patients with hilar cholangiocarcinoma

LIU Yuming， LAI Jinglan， YAO Zhixiong

2019, 19(04):  405-411.  DOI: 10.3969/j.issn.1009?976X.2019.04.006

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［Abstract］ Objective To investigate the analgesic effect of OPRM1 A118G gene polymorphism on sufentanil in patients with hilar cholangiocarcinoma. Method Fifty patients scheduled for elective hilar cholangiocarcinoma operation underwent combined intravenous and inhalationanesthesia. Patient-controlled analgesia（PCA） with sufentanil injection （2.00 μg·kg-1·h-1） was used for post-operative analgesia. The total dosage of sufentanil and adverse events were recorded at 24h and 48h after operation administration. The OPRM1 A118G gene type were detected. Results Among 55 patients， the proportion of AA，AG and GG genotype was 44%， 40% and 16%，respectively. Distribution frequency of A and G allele were 64% and 36%. The 24 h dosage of sufentanil in AG and GG genotype patients were both higher than AA genotype patients 60.02±21.45 μg vs 47.12±11.39 μg， P=0.040，77.93±31.87 μg vs 47.12±11.39 μg， P=0.031. At 48 h， the dosage of sufentanil in AG and GG genotype patients were also significantly higher than AA genotype patients103.92±27.66 μg vs 88.76±19.27 μg， P=0.009； 121.90±29.88 μg vs 88.76±19.27 μg， P=0.002）. There was no significant difference in adverse events between three groups （P>0.05）. Conclusion The analgesic efficacy of sufentanil was affected with OPRM1 A118G gene polymorphism in patients with hilar cholangiocarcinoma.

Expression of miR?320a in melanoma and clinical prognosis

LIYing， LEI Ruilin*， HAN Menghu

2019, 19(04):  408-411.  DOI: 10.3969/j.issn.1009?976X.2019.04.007

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［Abstract］ Objective To analyze the expression of miR?320a in melanoma and its relationship with clinical indicators. Methods TCGA database was used to screen the miRNAs related to the prognosis of melanoma patients. Then QPCR was performed to screen differentially expressed miRNAs. The relationship between miRNA and melanoma clinical indicators and prognosis was analyzed by chi?square analysis and ROC curve. Results miR?320a was specifically expressed in melanoma tissues， and the highly expressed miR?320a patients had lower TNM stage and better prognosis. The ROC curve indicated that miR?320a had certaindiagnostic efficacy in judging the prognosis of melanoma patients. Conclusion miR?320a is lowly expressed in melanoma tissues， and the clinical indications and prognosis of patients with low expression of miR?320a are better.

Complete laparoscopic splenectomy by two steps of spleen subpedicle transection for massive splenomegaly

CHEN Sicong， MIAO Dingding， LIU Yubin

2019, 19(04):  412-415.  DOI: 10.3969/j.issn.1009?976X.2019.04.008

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［Abstract］ Objective To discuss the key points and safety of two steps of splenic pedicle transection in complete laparoscopic in situ splenectomy for massive splenomegaly. Methods A retrospective analysis was conducted on the clinical data of 48 patients with massive splenomegaly receiving splenectomy from January 2013 and June 2017. According to the operation method the patients were divided into observation group（two steps of splenic pedicle transection in complete laparoscopic in situ splenectomy） and the open group（traditional open splenectomy）. Results Forty?eight patients were successfully completed surgery， and 25 patients in study group were successfully completed two steps of splenic pedicle transection in complete laparoscopic in situ splenectomy， no transfer to open surgery. The average operation in observation group was longer than that in open group（130.40±63.60 min vs 99.13±33.97 min），while the intraoperative blood loss（75.20±50.67 mL vs 206.09±116.77 mL） were less and postoperative hospital stay （8.24±2.20 d vs 11.00±3.49 d）were shorter（P<0.05）. The number of cases of abdominal cavity drainage tube was less inobservation group（P<0.05）， but the time of wipe out the abdominal cavity drainage in the both groups was almost the same. There were no significant differences in splenic fossa effusion， incision infection and fever between the two groups （P>0.05）. In observation group， the postoperative pleural effusion was better than that in the open group， and the difference was statistically significant （P<0.05）. No complications such as abdominal bleeding， abdominal infection， portal venous thrombosis， pancreatic fistula， gastric fistula， liver failure were found in both groups. The patients were followed up for 6 months after the operation. There were no complications of portal venous thrombosis and liver failure， and pleural effusion was absorbed. Conclusion Two steps of splenic pedicle transection in complete laparoscopic in situ splenectomy for massive splenomegaly is safe and reliable， and compared with traditional laparotomy method， less intraoperative bleeding， faster recovery.

Experience and effects of laparoscopic common bile duct exploration in patients with a history of upper abdominal surgery

YU Feng， ZHANG Yongjun， BU Xuefeng， ZHOU Xiaodong

2019, 19(04):  416-419.  DOI: 10.3969/j.issn.1009?976X.2019.04.009

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［Abstract］ Objective To Summarize the clinical experience and effects of laparoscopic common bile duct exploration in patients with a history of upper abdominal surgery. Methods The clinical data of 17 patients undergoing this procedure was collected， the preoperative diagnosis depended mainly on B?ultrasound， CT， ERCP and/or MRCP. Results The procedures were completed successfully in all of 17 patients. Bile leakage occurred in 1 case， which recovered one week after abdominal cavity unobstructed drainage. The operation time ranged from 110 to 215 minutes（mean 160 minutes），and the intraoperative blood loss ranged from 5 to 50 mL （mean 23 mL）， abdominal cavity drainage tube was drawn after one week. Hospital days ranged from 8 to 10 days. Nasal bile duct was drawn from 8 to 10 days after operation. T?tube was drawn from 4 to 8 weeks after operation， and without complications. Conclusion History of upper abdominal surgery is not a contradiction of laparoscopy. The exploration of the common bile duct by laparoscopy can be safe and effective for patients who had undergone operations on the upper abdomen.

MRI findings and characteristics rhabdomyosarcoma of the maxillofacial region in children

LI Jixin， LAI Zhaoqi， YANG Qihua

2019, 19(04):  420-425.  DOI: 10.3969/j.issn.1009?976X.2019.04.010

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［Abstract］ Objective To investigate the MRI findings and characteristics of rhabdomyosarcoma of the maxillofacial region in children. Methods MRI findings and characteristics of 10 children with maxillofacial rhabdomyosarcoma confirmed by surgery and pathology in our hospital were retrospectively analyzed， and the literature was reviewed. Results Among the 10 cases of pediatric maxillofacial rhabdomyosarcoma， seven cases occurred in the temporal region， one in maxilla， one in mandible and one in pharynx. The neoplasm is irregular in shape， poorly defined， MRI showed isointensityor hyperintensity on T1WI， slightly hyperintensity on T2WI， and restricted diffusion on DWI. Uneven enhancement was seenpost contrast. The tumors tend to infiltrate surrounding tissues. The parotid gland was involved in 4 cases， ear canal in six cases， pharynx in three cases， adjacent muscles in five cases， bone destruction in six cases， internal carotid artery was pushed and compressed in three cases， and two cases reached up to the skull base. Conclusion Rhabdomyosarcoma of the maxillofacial region in children tends to occur in the temporal region and infiltrate surrounding tissues， invades adjacent muscles and lead to bone destruction. MRI can clearly show the tumor and its boundary， surrounding soft tissue infiltration range and bone destruction， providing comprehensive imaging diagnostic information。

PaCO2-EtCO2 gradient： an indicator of carbon dioxide gas embolism during laparoscopic surgery

DU Sujuan， CHEN Ruixia， LIAO Zhaoxia， Ye Xijiu

2019, 19(04):  426-428.  DOI: 10.3969/j.issn.1009?976X.2019.04.011

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［Abstract］ Objective To investigate whether the PaCO2-EtCO2 gradient can be used as a diagnosis and evaluation indicator for carbon dioxide gas embolism in laparoscopic surgery. Methods 2 cases of carbon dioxide gas embolization during laparoscopic hepatectomy were retrospectively reviewed and related literature was reviewed. Results Two patients with gas embolism showed a slight decrease in SpO2 and a transient increase in end-tidal carbon dioxide （EtCO2）. One patient had a “mill-wheel” in the precordial region. The arterial blood gas analysis of two patients showed that the oxygenation index decreased while the partial pressure of carbon dioxide increased， and the PaCO2-EtCO2 gradient increased. After treatment， the oxygenation of the two patients improved， and the PaCO2-EtCO2 gradient decreased to the basal level. Conclusion Anesthesiologists should be alert to the occurrence of carbon dioxide gas embolism during the perioperative period. Arterial blood gas analysis can be used not only to assess the patient′s internal environment， but also to derive the PaCO2-EtCO2 gradient， which can be used for the diagnosis and efficacy evaluation of carbon dioxide gas embolism.

Clinical study about the prevention of the skin scar adhesions and pain by using sodium hyaluronate at wound in endoscopic thyroidectomy via breast approach

LAI Yongqiang， LIANG Weixin， SU Xiumei， HUANG Shangshu， ZHU Mingzhang， LI Zhihong

2019, 19(04):  429-436.  DOI: 10.3969/j.issn.1009?976X.2019.04.012

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［Abstract］ Objective To investigate the preventive effect of Sodium Hyaluronate （HA） on postoperative pain and skin scar adhesion in patients underwent endoscopic thyroidectomy via breast approach. Methods According to patients′ choice， 102 patients with thyroid diseases who needed surgical treatment in our hospital were divided into 4 groups： endoscopic thyroidectomy and using HA group （endoscopic+HA group）， endoscopic group， conventional open surgery and using HA group （open + HA group） and open group. The operation time， the drainage volume in 48 h， VAS pain scores of wounds at 6 h and 24 h postoperatively， and the numbers of analgesics using patients in each group were recorded. Follow up 3 months after surgery， estimated if patients got skin paraesthesia， and skin scar adhesion （degree of light， moderate and severe）. Results Operations of groups were successfully completed. There were no serious complications except each one case of incomplete recurrent laryngeal nerve injury in the Endoscopic + HA group and Open + HA group. According to the comparative analysis， the Endoscopic group took longer time than the Open group. However， the drainage volume in 48 h， VAS pain scores of wounds at 6 h and 24 h postoperatively， and the numbers of analgesics using patients among the groups had no significantly differences. Follow?up 3 months， the numbers of patients with skin paraesthesia among 4 groups had no significant differences. Totally there was no significant difference in the severity of scar adhesions between Endoscopic group and Open group. However， after using HA in both endoscopy group and open group， the cases of moderate and severe skin scar adhesions were decreased obviously， and the differences were statistically significant. Conclusion By using HA， the wound pain won′t be lightened in patients after endoscopic thyroidectomy via breast approach， but it could effectively reduce the occurrence and degree of postoperative skin scar adhesions by following up 3 months.

The value of quantitative DCE-MRI in differential diagnosis of head and neck squamous cell carcinoma and undifferentiated carcinoma

YI Zhilong， CHEN Xuezhen， BAI Zhiqiang， LI Yong

2019, 19(04):  433-436.  DOI: 10.3969/j.issn.1009?976X.2019.04.013

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［Abstract］ Objective To evaluate the feasibility of quantitative DCE-MRI parameters in the differential diagnosis of head and neck squamous cell carcinoma and undifferentiated carcinoma. Methods Forty-two patients with head and neck squamous cell carcinoma （HNSCC） and 53 patients with undifferentiated carcinoma （UC） were enrolled. The mean age was 63±17 years， 45±23 years， and a total of 95 patients were examined with MRI before treatment， and QDCE-MRI quantitative parameters were evaluated to analyze pathological types and MRI parameters （including volume transport constant （Ktrans）， reverse reflux rate constant （Kep）， extravascular extracellular space （Ve）， plasma The relationship between volume fraction （Vp）， peak time （TTP）， maximum concentration （MAXCon）， area under the curve （AUC）， and maximum slope （MAXSlope）. Results The values of Ktrans， Kep， TTP， MAXSlope of HNSCC were 0.09620±0.3894 min-1， 0.6527±0.2608 min-1， 2.9640±0.8409 min，1.8499±0.7698， The value of Ktrans， Kep， TTP， MAXSlope of HNSCC is 0.1432±0.0527 min-1， 0.8520±0.2166 min-1， 2.1055±0.9605 min， 2.1543±0.8767（mean±SD）. The differences of Ktrans， Kep， TTP and MAXSlope between HNSCC group and UC group were statistically significant （P<0.05）. Conclusion DCE-MRI quantitative parameters including Ktrans， Kep， TTP， MAXSlope can be used to identify head and neck squamous cell carcinoma and undifferentiated cancer.

A clinical study of 89Sr， zoledronic acid and 99Tc?MDP on the eldly patients with bone metastases of prostate cancer

HU Lijuan， DAI Qishan， HU Jianbo

2019, 19(04):  437-446.  DOI: 10.3969/j.issn.1009?976X.2019.04.014

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［Abstract］ Objective To evaluate the clinical efficacy and safety of 89Sr， zoledronic acid and 99Tc?MDP for treating the elderly patients with prostate cancer and bone metastases. Methods A total of 53 elderly patients with prostate cancer and bone metastases from January 2017 to January 2018 were included in the study for a retrospective analysis. The patients were divided into three groups： 89Sr group （A group）， zoledronic acid group （B group） and 99Tc?MDPgroup （C group）. The clinical value about three?way therapy were evaluated on bone pain relief rate， number of bone metastases and adverse events. Results In early stage of treatment， patients with bone pain relief got more benefit form group A. However， the differences between the three groups decreased after 6 months of treatment， and there was no significant difference among the three groups after 12 months （P>0.05）. The relief of severe pain in A and B group looked better than that of moderate pain on extreme pain， which was not statistically significant （P>0.05）. Group C was more efficient for moderate pain. Elimination of bone lesions： Group A was higher than group B， and Group B was higher than group C， but there were no significant difference （P>0.05）. The three groups were more efficient in the patients of bone?lesion number ≥10， which had no statistical difference （P>0.05）. Adverse events： Myelosuppression of 89Sr and fever of zoledronic acid in elderly patients had difference （P<0.05） from other groups. Anther adverse reactions did not significantly. Conclusion 89Sr， zoledronic acid and 99Tc?MDP were effectively improve pain palliation and could obviously repair the bone destruction caused by metastases. To be extra careful about myelosuppression of 89Sr in elderly patients. The elderly patients had more suffering by use of long?time intravenous for 99Tc?MDP. Although treatment by zoledronic acid would cause fever， it could self?relief. zoledronic acid was clinical recommendation.

Effects of propacetamol on analgesia and hemodynamics and postoperative adverse effects in intubation and extubation of general anesthesia

ZHANG Guoqiang， WU Shouhe， WENG Canhui， HU Xiaojun， LI Jieling

2019, 19(04):  442-446.  DOI: 10.3969/j.issn.1009?976X.2019.04.015

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［Abstract］ Objective To investigate the effect of propranolol on analgesia and hemodynamics and postoperative adverse reactions in general cannula and extubation. Methods A total of 80 patients undergoing general anesthesia for tracheal intubation in our hospital aged 30-65 years with a body weight of 48-75 kg were enrolled in this study. ASA was classified as grade Ⅰ and grade Ⅱ. Randomly divided into： saline control group （control group） and propatinam group （experimental group）. The two groups were given intravenous drip of saline 100 mL or propatinol 2 g/100 mL 15 minutes before anesthesia respectively. Before tracheal intubation （T1）， 5 min after intubation （T2）， 5 min before extubation （T3）， immediately after extubation （T4）， extubation MAP （mean arterial pressure）， heart rate （HR） and central venous pressure （CVP） at 5 min （T5） were measured and analyzed by using CA-7000 automatic coagulation analyzer and ancillary reagents The two groups of patients were respectively treated with propantamil， platelet aggregation rate， prothrombin time （PT）， thrombin time （APTT）， partial prothrombin time （APTT） Fibrinogen concentration （FIB）. In addition， RS restlessness score， Ramsay sedation score and VAS score were used to assess perioperative and postoperative agitation， sedation and pain. Results There was no significant difference in HR， MAP and CVP between T1 and T3 in both groups （P>0.05）. Compared with T3 at T2， T4 and T5， MAP and HR in both groups increased， However， MAP and HR at each time point in the experimental group were significantly lower than those in the control group （P<0.05）. In addition， CVP in both groups only increased significantly in T4； PT， TT， APTT and FIB at each time point in both groups were not significantly different between groups and between groups. In addition， the RS and Ramsay scores of the test group after extubation were significantly lower than those of the control group， and the VAS scores at 1 h and 6 h were also lower than those of the control group. Conclusion The prophylaxis of propranolol in patients with general anesthesia can maintain the hemodynamics of intubation and extubation in patients with general anesthesia， which can reduce and reduce postoperative pain and do not affect patients Perioperative coagulation function， can be safely used for general anesthesia of the analgesic.

Application of noninvasive positive pressure ventilation after extubation in elderly patients undergoing thoracic surgery

YANG Jiaheng， LI Weiwen

2019, 19(04):  447-450.  DOI: 10.3969/j.issn.1009?976X.2019.04.016

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［Abstract］ Objective To summarize the clinical experience of noninvasive positive pressure ventilation in elderly patients after thoracic surgery. Methods The clinical data of 30 elderly patients undergoing thoracic surgery from January 2015 to February 2017 were selected. Among them， 15 patients received conventional respiratory therapy （group B） and 15 patients received noninvasive positive pressure ventilation （group A） after surgery. The therapeutic effects of the two groups were compared. Results The incidence rate of complications in group a （13.3%） was significantly lower than that in group b （26.7%）， and the difference was statistically significant （P<0.05）. There was no significant difference in PaCO2， PaO2， HR， respiration and MBP between the two groups at 1 d after operation （P>0.05）. The difference between the two groups at 3 d after operation was statistically significant （P<0.05）. The hospitalization time and expenses of patients in group a were significantly less than those in group b （P< 0.05）. There was significant difference in anxiety and depression scores between the two groups after treatment （P<0.05）. The quality of life scores of patients in group a， including physiological function， emotional function， social function， general health and general health， were significantly better than those in group b （P<0.05）. Conclusion Non-invasive positive pressure ventilation is needed after thoracic surgery in the elderly， which is beneficial to the recovery of patients and reduces the incidence of complications.

Comparison of patient controlled epidural analgesia effect between morphine and hydromorphone： meta?analysis

CHEN Weiqiang1， ZHENG Chunqin2， CAO Minghui3

2019, 19(04):  451-454.  DOI: 10.3969/j.issn.1009?976X.2019.04.017

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［Abstract］ Objective To systematically evaluate thepatient controlled epidural analgesia（PCEA） effect between morphine and hydromorphone， so as to provide evidence for clinical application. Methods Databases including the PubMed， Cochrane Library， WanFang Data， and CNKI （by February 2019） were searched for randomized controlled trials （RCTs） involving the PCEA effect between morphine and hydromorphone in adult patients， with no language limit. According to the modified Jadad quality scale， literature was screened， data were extracted， and quality of the included studies was critically evaluated. then meta?analysis was performed using Stata 12.0 software. Results A total of 5 RCTs involving 455 patients were included. The results of meta?analyses showed that： compared with patients in the morphine group， the incidence ofpruritus was lower for patients in the hydromorphone group； neither scores of visual analog scale（VAS） for pain at rest nor VAS scores for pain with movement differed statistically between the two groups. There was no significant difference in the incidence of nausea and vomiting and other side effects between the two groups. Conclusion Compared with morphine， PCEA with hydromorphone has less side effects and is worthy to recommend its clinical use.

Analysis of the distribution of age and fracture type in elderly proximal humeral fractures with rotator cuff tear

WANG Xiong， XIE Ruimin， LI Xiang， LI Bohua， WANG Yongping

2019, 19(04):  455-458.  DOI: 10.3969/j.issn.1009?976X.2019.04.018

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［Abstract］ Objective Severe rotator cuff injury is a common cause of limited and unstable shoulder joint activity after the reduction of proximal humerus fracture in older people. In this study， we evaluate the prevalence of full thickness rotator cuff tear in patients with proximal humeral fractures. Methods Clinical data from 336 patients with proximal humeral fracture were retrospectively collected. We compared the incidence of rotator cuff tear in different types of fracture according to age and Neer classification. Results The proportion of elderly patients with proximal humeral fractures and rotator cuff tears increased with age. Statistically significant difference was found between patients with rotator cuff tear group and patients without rotator cuff tear group for the age of the patient （72.9±8.5 vs 65.7±9.1； t=6.912， P=0.042）. Rotator cuff tear was most common in Neer 3 greater tuberosity fracture （54.8%， 92/168）. Conclusion Patient age was found as a risk factor for full thickness rotator cuff tear in humeral proximal fractures. Full thickness rotator cuff tear was most common in Neer 3 greater tuberosity fracture.

Analysis of kyphosis after thoracolumbar fracture surgery： a report of 39 cases

ZHANG Tianqi， WANG Dawei， FANG Qingmin， XING Jianqiang， SHAO Bin， ZHANG Daijie

2019, 19(04):  459-462.  DOI: 10.3969/j.issn.1009?976X.2019.04.019

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［Abstract］ Objective To analyze the causes of kyphosis deformity after short?segment posterior pedicle screw fixation for thoracolumbar fracture. Methods A retrospective clinical study was donein 39 patients with thoracolumbar fractures who had kyphosis deformity after short?segment posterior pedicle screw fixation in our hospital from 2014 to 2018. Results In our data， many reasons led to kyphosis deformity after thoracolumbar fracture surgery. The kyphosis deformity in the early stage was mainly due to inappropriate surgical methods，and within one year mostly due to short fixed segment or screw， which could not support fixation effectively；no external fixation brace or external fixation was unreliable； the patient had osteoporosis and severe injury of intervertebral disc. Kyphosis after removal of internal fixation was mainly due to poor stability of fracture decompression and fixation without adequate bone graft fusion. Conclusion In the present study， the surgical treatment of thoracolumbar fractures depended on the correct diagnosis， appropriate surgical methods and effective bone graft fusion.

Therapeutic effect of Henry′s access for the treatment of unstable distal radius fractures with volar locking plate

PAN Minghui， SHI Tonghe， HAO Shiqiang， WEN Jingtao

2019, 19(04):  463-466.  DOI: 10.3969/j.issn.1009?976X.2019.04.020

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［Abstract］ Objective To summarize the clinical experience of volar locking plate fixation of distal radius fractures through Henry′s approach. Methods A retrospective analysis was performed in 28 cases of unstable distal radius fractures undergone volar locking plate fixation by Henry′s approach from January 2015 to June 2017. Results All cases were followed up for 9 to 15 months， with an average of 12.1 months. No cases with nerve， blood vessel or tendon injury were found during operation. There were no wound infection or necrosis， no rejection， no carpal tunnel syndrome， no reduction failure and other complications. Radiographs showed optimal reduction and healing. According to the Gartland & Werley score， 14 patients showed excellent results， 10 showed good results， and 2 showed fair results. Two cases of wrist stiffness due to lack of functional exercise. Conclusion Henry′s approach for the treatment of unstable distal radius fractures is satisfactory.

Clinical Study of Hematoma Removal of Basal Ganglia Hemorrhage under Neuro?endoscope

HE Jingsi， LIANG Shuangdi， LAO Huiling， TAN Xiaosui

2019, 19(04):  467-471.  DOI: 10.3969/j.issn.1009?976X.2019.04.021

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［Abstract］ Objective To study the treatment of basal ganglia by neuro?endoscopic hematoma removal and traditional craniotomy hematoma removalin the clinical effect difference of cerebral hemorrhage. Methods The patients with basal ganglia hemorrhage admitted to our department on January 1， 2017 and August 31， 2018 were selected as the research objects. The patients were divided into the craniotomy group and the endoscopic group based on the tension?matching principle， with 49 cases and 53 cases respectively， to ensure the comparability of the two groups of patients′ conditions. Traditional craniotomy hematoma clearance was performed in the craniotomy group， and complete endoscopic hematoma clearance was performed in the endoscopic group. Then， intraoperative and postoperative information， postoperative complications， and clinical prognosis of the two groups of patients were compared to evaluate the advantages and disadvantages of the two surgical methods. Results There were no statistically significant differences in operative time， hematoma clearance rate and rebleeding incidence between the endoscopic group and the craniotomy group （P>0.05）， but the intraoperative blood loss was lesser， and the GCS score of the endoscopic group was higher than that of the craniotomy group at 2 week and 3 month after surgery， with statistically significant differences （P<0.05）. There were no statistically significant differences between the two groups in postoperative pulmonary infection， urinary tract infection， venous thrombosis， gastrointestinal bleeding， intraoperative oral infection and postoperative epilepsy （P>0.05）， but the incidence of postoperative cerebral edema was lower in the endoscopic group than in the craniotomy group （P<0.05）. The GOS score and ADL score of the endoscopic group were both higher than those of the craniotomy group at 3 months postoperatively， and the difference was statistically significant （P<0.05）. Conclusion Endoscopic hematoma removal is superior to traditional hematoma removal in the surgical treatment of basal ganglia hemorrhage.

Effect of swallowing training on swallowing function and quality of life in patients with dysphagia after tongue cancer operation

CHENG Zhen， TAO Jiangfeng， JIANG Qianglin， WANG Qiujiao

2019, 19(04):  472-475.  DOI: 10.3969/j.issn.1009?976X.2019.04.022

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［Abstract］ Objective To investigate the effects of early swallowing training on swallowing function and quality of life in postoperative patients with tongue cancer. Methods A total of 148 patients with postoperative tongue cancer were enrolled in our hospital. The mean age was 62.8±10.4 years. They were randomly divided into the treatment group and the control group （74 cases each）. The treatment group began 2 weeks of swallowing training on the first day after operation while the control group did not receive swallowing intervention. The degree of dysphagia and quality of life were evaluated using the 10?Item Eating Assessment Tool （EAT?10）， and changes in swallowing function and quality of life before and after swallowing training （14 days） were recorded. The two sets of continuous variables were compared using the SPSS 24.0 software package using the t test， which was used to compare the categorical variables. Results Compared with the control group， there was no significant difference in gender， age， lymph node dissection， tumor stage and EAT?10 score between the treatment group （P<0.05）. The two groups had good comparability. The total score of EAT?10 standard scores in the treatment group was lower than that before treatment （P<0.05）. There was no significant difference between the EAT?10 total score and the first day after surgery in the control group. Conclusion Early swallowing training can improve the swallowing function and quality of life of postoperative patients with tongue cancer.

Analysis of the difference of blood gas detection results by bed after cardiac surgery

YE Huanxia， WU Lan， ZHANG Chongjian， ZHONG Xing

2019, 19(04):  476-479.  DOI: 10.3969/j.issn.1009?976X.2019.04.023

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［Abstract］ Objective To analyze the difference of bedside blood gas test results after cardiac surgery， so as to improve the compliance of bedside blood gas test management standards for improving the accuracy of the results. Methods 363 patients in the cardiac intensive care unit from January to February 2018 were selected as the research objects. At the same time， each patient was tested by electrolyte of bedside blood gas analysis and sent to the laboratory for blood biochemistry and routine blood test. The differences of sodium， potassium， blood sugar and hematocrit results obtained by bedside blood gas analyzer and routine biochemical blood test in laboratory were compared， and the influence of different operators on the difference of test results was analyzed. By the Point?of?care testing （POCT） model， the quality management evaluation scores of bedside blood gas testing were collected from January to June 2018. Results The outcomes showed that there were significant differences between the two methods only in the results of blood sodium and hematocrit. Among the objective factors of operators， only basic education has statistical significance. The quality management evaluation score of bedside blood gas test increased from 55 to 93. Conclusion By analyzing the difference between the results of two methods of bedside blood gas detection and laboratory， strict management rules of bedside blood gas analysis are formulated to improve the compliance of implementation。

Efficacy and safety of laparoscopic pyeloplasty in the treatment of ureteropelvic junction stenosis

HUANG Yingchu， XIE Juntao， LI Guanxuan， ZENG Gelin

2019, 19(04):  480-482.  DOI: 10.3969/j.issn.1009?976X.2019.04.024

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［Abstract］ Objective To investigate the effect of laparoscopic ureteroplasty in children with ureteropelvic junction stenosis. Methods 62 children with ureteropelvic junction stenosis were selected from Jiangmen People′s Hospital and the First Affiliated Hospital of Sun Yat?sen University from January 2018 to March 2019. According to the surgical plan， 31 cases were included. The control group underwent open surgery， and the observation group underwent laparoscopic pyeloplasty. The surgical indexes， complications， recurrence rate of hydronephrosis， and interleukin?6 （IL?6）， C?reactive protein （CRP） were compared between the two groups. Results The intraoperative blood loss was lower in the observation group than in the control group. The operation time， intestinal recovery and hospitalization time were shorter than the control group （P<0.05）. The incidence of complications in the observation group was 3.23% lower than that in the control group （P<0.05）. The levels of serum IL?6 and CRP in the observation group were lower than those in the control group 1 day after operation and 2 days after operation （P<0.05）. There was no significant difference in the recurrence rate of hydronephrosis between the two groups （P>0.05）. Conclusion Laparoscopic pyeloplasty for the treatment of ureteropelvic junction stenosis in children has the advantages of less trauma and quicker postoperative recovery， and it is safer.

The effect of transurethral prostatectomy on patients′ negative emotion

GAO Xianglin， WU Zhensheng， HE Yuhui

2019, 19(04):  483-485.  DOI: 10.3969/j.issn.1009?976X.2019.04.025

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［Abstract］ Objective To observe the effect of transurethral prostatic plasma exenteration on negative emotion of patients. Methods From January 2013 to December 2016， 156 cases of patients with hyperplasia of prostate were selected， and divided into control group and observation group. Transurethral plasmakentic vaporization of prostate， the control group， 78 cases of cutting operation， the observation group 78 examples， through transurethral plasma kinetic resection of prostate. It compare that scores of SAS， SDS and mental health before and aft treatment. Results There was no statistically significant difference in SAS and SDS scores between the two groups before treatment （P>0.05）， but the score of the observation group was better than that of the control group after treatment （P<0.05）. The mental health score of the observation group was higher than that of the control group， and the difference was significant （P<0.05）. Conclusion The effect of transurethral prostatic plasma extirpation in the treatment of prostatic hyperplasia is positive， which can significantly improve patients′ negative emotions and regulate their mental health.

Application of fast?track surgery combined with comprehensive therapy in complicated acute appendicitis during perioperative period

CHEN Jiyi， HUANG Haijun， LIU Shiyong， TIAN Qiaolin

2019, 19(04):  486-492.  DOI: 10.3969/j.issn.1009?976X.2019.04.026

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［Abstract］ Objective To explore the effect of accelerated rehabilitation surgery in the perioperative period of complex acute appendicitis （CAA）. Methods Ninety?two patients with CAA admitted in our department from October 2016 to October 2018 were divided into two groups（ERAS，control）， in which 46 patientswere assigned to the control group and underwent traditional surgery， while 46 patients received the management based on a standard protocolbased on enhanced recovery after surgery （ERAS） during perioperative period. All patients were treated with laparoscopic appendectomy （LA）. The clinical components such as anesthesia，treatment effects， complications were recorded and compared between two groups. Results The accelerated rehabilitation surgery protocolwas well implemented in CAA perioperative period. The ERAS group had lower pain score， faster recovery of intestinal function， less postoperative complications， shorter hospitalization time and lower hospitalization costs. Conclusion It is safe and effective to selectively adopt ERAS in CAA perioperative period according to individual conditions.

A tentative analysis of status and development tendency of MBBS education

DU Tao， WANG Guoqiang， YE Ziguan， XU Miqing， LI Wan′gen

2019, 19(04):  490-492.  DOI: 10.3969/j.issn.1009?976X.2019.04.027

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［Abstract］ China has been the third largest country with highest number of international students. Education of international students of bachelor of medicine & bachelor of surgery （MBBS） in China is an important component of the higher medical education. Improving education quality of MBBS， meanwhile， is universal object for medical college. The authors summarized the characters of MBBS education according to their own teaching experiences. It should be benefit to increase the communication and development of MBBS education，to promote the standardization of MBBS education， and cultivate medical international students to become higher level professionals.

Progress in the treatment of intertrochanteric fracture of femur in elderly patients

CHEN Huirun， YU Shenghua， HU Hansheng， LI Yuanhui， LIU Song

2019, 19(04):  493-498.  DOI: 10.3969/j.issn.1009?976X.2019.04.028

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［Abstract］ With the increase of population aging， the incidence of intertrochanter fracture of femur is also gradually increasing. In the United States， more than 200 000 people have this fracture every year， and the mortality rate has risen from 15% to 30%. It is pedicted that by 2025 year， the average annual incidence of intertrochanter fracture will reach 2.6 million to 4.6 million， and the number of unstable fractures will increase. Treatment of intertrochanter fracture includes conservative treatment and surgical treatment. Conservative treatment cycle is relatively long， prone to complications， such as hip rotation， hip varus， muscle atrophy， limb shortening， deformity and other adverse phenomena. The elderly patients due to stay in bed for a long time during the treatment， prone to urinary system infection， bedsore， falling pneumonia， lower extremity venous thrombosis and joint stiffness contracture and other complications. Because of so many shortcomings of conservative treatment， surgical treatment is becoming the first choice for the treatment of intertrochanter fracture of femur. In this paper， the treatment of intertrochanteric fracture of femur in elderly patients in China in recent years is reviewed.

Application of quality control circle on reducing exposure keratopathy incidence among ICU patients

HUANG Yuehua， ZHUANG Shuibing， CAI Min， XIE Shaohua， MO Hongping

2019, 19(04):  499-506.  DOI: 10.3969/j.issn.1009?976X.2019.04.029

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［Abstract］ Objective To explore the effects of quality control circle on the reducing of exposure keratopathy incidence among ICU patients. Methods Set up ICU quality control circle， establish the theme of the campaign： to reduce the incidence of exposure keratopathy in critically ill patients， update and strengthen the knowledge of exposure keratopathy among nursing staff， and standardize eyerelated operations. Before the implementation of the QCC （from January to February 2018）， 58 ICU patients were selected as the control group. After the implementation of the QCC （March to April 2018）， 81 patients with ICU were included in the intervention group， and the incidence of exposure keratopathy was compared between the two groups. Results Compared with the control group， the incidence of exposure keratopathy was lower in the intervention group （P<0.05）. Conclusion The correct use of medical care tubes can reduce the incidence of exposure keratopathy in critically ill patients and improve the comprehensive nursing ability of the circlers.

The observation of therapeutic effect of semiconductor laser therapy combined with psychological care on breast pain

HAN Ni， FAN Yunfei， YU Haijing， YANG Jianmin， LI Qinghua

2019, 19(04):  503-506.  DOI: 10.3969/j.issn.1009?976X.2019.04.030

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［Abstract］ Objective To explore the efficacy of semiconductor laser therapy combined with psychological care in the treatment of breast pain and summarize care experience. Methods One hundred and twenty patients with breast pain were selected， with an average age of 35±2.4 years. The criterion for admission was pain score above 4. Ultrasound or/and Mammography were all grade Ⅲ or below. The patients were divided into laser group （60 cases） and control group （60 cases） according to their wishes. The laser group was treated with SUNDOM?300IB?130 semiconductor laser combined with psychological care. The laser treatment course was 7 days， once a day， 20 minutes each time. Evaluation of therapeutic effect after 3 courses of treatment. The control group received psychological care. According to the change of pain score before and after treatment， the curative effect was evaluated. Reducing the score by more than 3 points was considered effective. All patients were followed up for 3 months by specially?assigned person. Results After treatment， the effective rate was 87.5%（49/56）in the laser group and 67.31%（35/52）in the control group. There was significant difference between the two groups （χ2=6.361，P=0.012）. After 3 months of follow?up， the effective rate of the laser group was 60.71%（34/56） and that of the control group was 40.38%（21/52）. There was significant difference between the two groups （χ2=4.459， P=0.035）. Conclusion Semiconductor laser therapy combined with psychological care can effectively alleviate breast pain， and can be used as one of the preferred adjuvant treatment measures for breast pain.

Effects of painless concept on postoperative pain and satisfaction in patients undergoing urologicalambulatory surgery

DING Fenghua， LIANG Donghong， WU Liying

2019, 19(04):  507-509.  DOI: 10.3969/j.issn.1009?976X.2019.04.031

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［Abstract］ Objective To explore the effects of painless concept on postoperative pain and satisfaction in patients undergoing urological ambulatory surgery. Methods 100 patients with urological outpatient surgery in the outpatient department of the Affiliated Hospital of Guangdong Medical University from January 2017 to January 2019 were selected for the study and were divided into control group and observation group according to the odd and even visiting order （each n=50）. Control group was given routine nursing， and observation group was given painless concept nursing on the basis of control group. The postoperative pain， comfort at 2 h after surgery， postoperative hospital stay and satisfaction were compared between the two groups. Results The numerical rating scale （NRS） score at 30 min after surgery was not significantly different from that in control group （P>0.05）， and the NRS scores were lower than those in control group at 1 h， 1.5 h and 2 h after surgery （P<0.05）. The physiological comfort score， psychological comfort score and total comfort score in observation group were significantly higher than those in control group （P<0.05）. The postoperative satisfaction in observation group was higher than that in control group （P<0.05）. The postoperative hospital stay in observation group was shorter than that in control group （P<0.05）. Conclusion Painless concept can reduce postoperative pain and improve comfort and patient satisfaction in patients undergoing urological outpatient surgery.

Prevention and nursing measures of perioperative infection and complications of breast reconstruction with deep inferior epigastric perforator flap

CHEN Huiyi， DING Yu， ZENG Minhua， GE Shiyao

2019, 19(04):  510.  DOI: 10.3969/j.issn.1009?976X.2019.04.032

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［Abstract］ Objective To investigate the perioperative nursing care interventions of immediate breast reconstruction with deep inferior epigastric perforator （DIEP） flap after breast cancer resection. Methods A total of 96 patients who got breast reconstruction with deep inferior epigastric perforator （DIEP） flap treatment， from June 2016 to June 2018 were enrolled in this study. Perioperative infection and complications were observed. Effective nursing care interventions were taken timely. Results The operation time was 7.0±1.5 h， the postoperative hospital stay was 11.4±3.7d， 17 cases in all 96 patients occurred with perioperative complications， an incidence of 17.7%， in which an infection rate of 4.1% was observed. Conclusion Great treatment risk and nursing difficulty are found in immediate breast reconstruction with DIEP flap after breast cancer resection. Synthetic perioperative nursing interventions should be carried out， including making patients fully prepared for a successful operation， a strict sterile procedure and the prophylactic use of antibiotics. Moreover， the observation and treatment of vascular crisis after free flap transplantation and infection monitoring play a vital role， which improve the effectiveness of clinical treatment and the quality of recovery.