Table of Content

20 December 2020, Volume 20 Issue 06

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Original Articles and Clinical Research

Targeted intraoperative radio therapy boost in breast conserving surgery for early breast cancer

HU Xiao-wu, ZHANG Le-hong, HE Yong, CHEN Xin-xin, XIA Ting, CAO Teng-fei, JIA Hai-xia

2020, 20(06):  689-693.  DOI: 10.3969/j.issn.1009-976X.2020.06.01

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Objective To investigate the safety and feasibility and Cosmetic outcomes of targeted intraoperative radio Therapy Boost with INTRABEAM in breast conserving surgery for early breast cancer. Methods We treated 69 unselected patients for early-stage breast cancer. Thirteen patients （13/69, 18.8%） were younger than 45 years of age. More than half of the tumors （36/69, 52.2%） were > 2 cm. Twenty-eight （28/69, 41.0%） had a Grade 3 tumor and, in twenty （20/69, 29.0%） had axillary lymph nodes contained metastasis. After breast-conserving therapy, 20 Gy was delivered intraoperatively to the surface of the tumor bed, followed by external-beam radiotherapy （EBRT）, 50 Gy,25 times in total,but excluding the usual boost. The early overall survival,recurrence-free survival, and non-metastatic survival and cosmetic outcomes were short-term follow-up. Results Acute complications were observed in 27.5% （19/69） of patients and included 2.9% （2/69） hematomas that required drainage, 8.7%（6/69） seromas requiring drainage more than 3 times, 7.2% （5/69）infections treated with antibiotics or surgery, 8.7%（6/69）delayed wound healing and their average wound healing time was 3.8 （1.0-11.0） months. There During a median follow-up of 24.8 months （12-51）, 2.9 （2/69） of them developed local recurrence and there was no recurrence of distant metastasis or mortality. Cosmetic evaluation of breast in BCT with IORT group was carried out postoperative at points of one year and two years with 89.9% and 89.7% as excellent or fine cosmetic state respectively. Conclusion Targeted Intraoperative Radio Therapy Boost with INTRABEAM in breast conserving surgery for early-stage breast cancer is both safe and reliable, the long-term efficacy still needs to be further verified because of the small number of patients and short follow-up time.

Clinical practice of combination of shear-wave elastography and color doppler in the diagnosis of breast fibroepithelial tumor

FENG Rui-qing, FU Zhong-dai, CAO Lei, OU Yan-yan, HUANG Jian-dong

2020, 20(06):  694-698.  DOI: 10.3969/j.issn.1009-976X.2020.06.02

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Objective To investigate the value of shear wave elastography （SWE） combined with color doppler in the diagnosis of breast fibroepithelial tumors. Methods From August 2017 to May 2019, patients with breast mass who underwent ultrasound diagnosis and histological biopsy and surgical resection in our hospital were selected. According to the inclusion criteria, 59 patients were divided into fibroadenoma group （FA） and phyllodes tumor （PT） group, 43 patients in FA group and 16 patients in PT group.B-ultrasound, SWE and color doppler US were performed for each lesion. Mean elasticity （Emean）, maximum elasticity （Emax）, and vascularity were determined by SWE and Doppler US. Results The lesion size of PT group was significantly larger than that of FA group （P< 0.05）. The heterogeneous echo pattern was more frequently observed with significance in PT group than FA group （P< 0.05）. BI-RADS categories were higher in PT group than FA group （P< 0.05）. Both Emean and Emax were significantly higher in PT group than FA group （Emean, P< 0.05; Emax, P< 0.05）. Low vascularity was more frequent in FA group than in PT group （P< 0.05）. On the other hand, the specificity and accuracy of Emean and SWE were higher than that of B-ultrasound （P< 0.05）, and the specificity of maximum elastic value was higher than that of B-ultrasound （P< 0.05）, and the sensitivity was slightly lower than that of B-ultrasound. The sensitivity and negative predictive value （NPV） of SWE combined with color Doppler ultrasound were increased to 100% with the standard of average elasticity value > 43.9 kPa or high blood flow signal or maximum elasticity value > 46.1 kPa or high blood flow signal. Conclusion Compared with phyllodes tumor, fibroadenoma tends to have lower stiffness and fewer blood vessels. In the combined application of SWE and doppler ultrasound, Emean and Emax showed higher diagnostic value in the identification of suspicious cases.

Clinical analysis of 46 case of recurrent intrahepatic cholelithiasis treated by choledochoscopy and balloon dilatation

CHEN Zhuang-hao, LI Jian-ming, SONG Wei-wei, LI Wei, GUO Feng-man, CHANG Jian-xing

2020, 20(06):  699-702.  DOI: 10.3969/j.issn.1009-976X.2020.06.003

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Objective To explore the clinical value of percutaneous choledochostomy, choledochoscopy and balloon dilatation in the treatment of 46 cases of recurrent intrahepatic cholelithiasis. Methods From January 2015 to December 2019, the clinical data of 46 patients with intrahepatic cholelithiasis treated by percutaneous choledochostomy and balloon dilatation were reviewed. Results Among 46 patients with recurrent intrahepatic cholelithiasis, 43 （93.5%） had stones completely removed, 6 （13%） had postoperative biliary bleeding, 1（2.2%） had biliary fistula, 4（8.7%） had cholangitis, 8 had fever, and 5 had vomiting. There was no death. Follow-up for two years showed that 9 cases （12.2%） had stone recurrence. Conclusion Percutaneous choledochostomy, chodedochoscopy and balloon dilatation for the treatment of recurrent intrahepatic bile duct stones have achieve good results,stone extraction is safe and effective, and minimally invasive, which can be used as an effective supplement to the treatment of bile duct stones.



A network pharmacology approach for identifying the potential antitumor mechanism of the Gancao （Licorice） for the treatment of hepatocellular carcinoma

MA Xiao-fei, WANG Xi-cheng, CHEN Jie, LI Wen-xin, CHEN Tao

2020, 20(06):  703-710.  DOI: 10.3969/j.issn.1009-976X.2020.06.004

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Objective Gancao（Licorice），a traditional Chinese herbal drug，has been extensively applied to treat diseases in clinical. However，the pharmacological mechanisms of Gancao in treatment of Hepatocellular carcinoma（HCC）still remain equivocal. In this study，a network pharmacology?based methodology was used to elucidate its underlying mode of action. Methods We gathered candidate compounds and potential targets of Gancao based on TCMSP and potential targets of HCC relied on Gene? Cards and OMIM databases，and a Disease?Compound?Target network was built. Furthermore，A total of 93 effective compounds and 89 putative targets of Gancao were selected and GO and KEGG enrichment analysis were applied to investigate the molecular mechanism. Results The results indicated that potential targets of Gancao treating HCC are mostly involved in diversified pathways associated with Cancer ?related pathway，HBV pathway，HCV pathway，Apoptosis pathway，TNF pathway and MAPK pathway.Importantly，PPARG，AR，ESR2 and GSK3B exhibited higher interactive with other proteins and RAF1 participated in 8 signaling pathways related with liver diseases. EGFR and CCND1 took part in 6 cancer?related pathways while MYC and RB1 were active in 3 liver?related pathways. Conclusion In all，Gancao could attenuate HCC via regulating multiple molecules and pathways associated with proliferation，apop?tosis and inflammatory response.

Clinical application of “standard for evaluation of gastrointestinal motility in perioperative period”

CHEN Zhi-qiang, CAO Li-xing, QIN You, JIANG Zhi, CHEN Qi-cheng, GAN Hua-chan

2020, 20(06):  711-714.  DOI: 10.3969/j.issn.1009-976X.2020.06.005

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Objective To apply and popularize the“standard for evaluation of gastrointestinal motility in perioperative period”. Methods The clinical data related to gastrointestinal motility after abdominal operation were collected in the form of a questionnaire, and the feasibility and scientificity of the evaluation standard were statistically analyzed and evaluated. Results The perioperative postoperative gastrointestinal motility evaluation criteria were used to evaluate the postoperative gastrointestinal function of patients, which is consistent with the results of postoperative first flatus and defecation evaluation in the commonly used evaluation indicators. Subjective and Objective indicators of gastrointestinal function recovery, therefore, can more fully reflect the recovery of gastrointestinal function in patients after surgery. Conclusion The “standard for evaluation of gastrointestinal motility in perioperative period” provides a scientific evaluation tool for clinical and research related to postoperative gastrointestinal function.

Analysis of the related factors and prevention and treatment of the complications of laparoscopic inguinal hernia repair

ZHAN Shang-xin, LIU Xing-bin, GU Xu-ying, JIANG Shui-hua, CHEN Ding-guang, ZHANG Lin

2020, 20(06):  715-718.  DOI: 10.3969/j.issn.1009-976X.2020.06.006

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Objective To explore the risk factors and prevention and treatment strategies of Seroma after Laparoscopic inguinal hernia repair. Methods Retrospective analysis was made on the clinical data of 1676 patients with inguinal hernia treated by laparoscopic inguinal hernia repair in our hospital and huizhou central people′s hospital from January 2015 to January 2020. The patients were divided into Serum Tumor Group （n=56） and non?serum Tumor Group （n=1620） according to the presence or absence of serum tumor after inguinal hernia repair. Results Logistic Regression analysis showed that， preoperative complications （OR=1.499， 95%CI： 1.152~5.897，P=0.012）. The type of hernia （OR=6.599， 95%CI：1.876~14.183，P<0.001）， the diameter of hernia SAC（OR=1.461， 95%CI：1.088~5.811，P=0.002）， the operative method （OR=2.152， 95%CI： 1.166~7.801，P=0.006） and the rupture of hernia SAC （OR=3.886， 95%CI： 1.361~11.129，P<0.001） were the independent risk factors for the complication of laparoscopic inguinal hernia repair （P<0.05）. Conclusion Hernia type， hernia sac diameter， operation method and hernia sac disconnection are independent risk factors of seroma after inguinal hernia repair， the seroma can be prevented and treated by individualized treatment and precise anatomy.

Effect of nutritional enema combined with biofeedback on modified colitis

ZHONG Cui-na, OUYANG Man-zhao, CHEN Ling, XU Jin-huan, DENG Xiu-fen, CEN Yong-ying, HU Hui-ling, LI Zhen

2020, 20(06):  719-722.  DOI: 10.3969/j.issn.1009-976X.2020.06.007

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Objective To explore the effect of nutritional enema combined with biofeedback in the treatment of modified colitis. Methods Ninety-six patients were randomized into three groups according to digital method. Nutrition enema combined biofeedback training was experimental group 1, biofeedback training was experimental group 2, and routine treatment patients were used as control group. Results Enteroscopy in the three groups were compared, the defecation times, abdominal pain and mucus defecation before and after treatment were compared, and the pelvic floor muscle strength was evaluated before and after treatment. Results the clinical efficacy of test group 1 was higher than that of test group 2 and routine treatment group （P< 0.05）, and that of test group 2 was higher than that of routine treatment group （P< 0.05）. The frequency of abdominal pain, mucus defecation and defecation in test group 1 was significantly lower than that in test group 2 and control group （P< 0.05）. The evaluation value of pelvic floor muscle strength in group 1 and group 2 was significantly better than that in control group （P< 0.05）. There was no significant difference between group 1 and group 2 （P> 0.05）. The results of enteroscopy showed no erythema swelling, erosive ulcer and inflammatory polyp in group 1, which was significantly better than that in group 2 and control group （P< 0.05）. Conclusion Nutritional enema combined with biofeedback can improve the therapeutic effect of modified enteritis, improve postoperative abdominal pain, defecation, increase the frequency of defecation, increase pelvic floor muscle strength, reduce the incidence of erythema swelling, erosive ulcer and inflammatory polyp, and reduce the incidence of distal intestinal diversion colitis.

Diagnosis and treatment of acute fibrinous and organizing pneumonia due to allergic reaction and literature review

GAO Min-nan, ZHNAG Lu, YANG Yan-qi, JIANG Hui-qi, ZENG Kuan, WANG Meng

2020, 20(06):  723-728.  DOI: 10.3969/j.issn.1009-976X.2020.06.008

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As a rare type of interstitial lung disease, the etiology and pathogenesis of fibrinous and organizing pneumonia are still unclear. There are few studies and reports on this disease all over the world, and there are no clear criteria for its diagnosis and treatment. At present, most of the reports are related to infection or adverse drug reactions, but such diseases caused by allergic reaction are rare. This paper summarizes the process of one such patient successfully diagnosed and treated, and reviews the relevant literature, in order to improve the understanding of this disease, avoid misdiagnosis, and provide a treatment plan for clinical reference.

Application of ECMO in the treatment of tricuspid valve prolapse with atrial septal perforation caused by trauma： a case report

ZHENG Qian-wei, CHENJie, GAN Yu, CAO Wei-dong, GUO Su-xia, CAI Li-hua, SHEN Li-han

2020, 20(06):  729-731.  DOI: 10.3969/j.issn.1009-976X.2020.06.009

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Extracorporeal membrane oxygenation （ECMO） has shown unique advantages in the treatment of patients with severe cardiopulmonary failure, and it has been used more and more widely, but in emergency trauma patients, its application is limited because of the high risk of bleeding. Recently, our hospital successfully used ECMO to treat a critically ill patient with tricuspid valve prolapse complicated with atrial septal perforation caused by a car accident, and the prognosis is good. Now review the cases and summarize the experience and plan of diagnosis and treatment combined with the literature.

Effect of Sanqidan granule on restenosis after balloon expansion of femoral artery in diabetic rabbit

MO Wei, XU Xiu-ting, XIAO Zhi-xiong, ZHANG Wen-zhi, LIN Yi-xia, ZHOU Hui, WANG He

2020, 20(06):  732-735.  DOI: 10.3969/j.issn.1009-976X.2020.06.010

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Objective To investigate the effect of Sanqidan Granule on blood vessels after balloon dilatation of femoral artery in diabetic rabbits. Methods New Zealand white rabbits were randomly divided into blank group, control group and traditional Chinese medicine group; the blank group did not do any treatment and was fed with common feed; the control group and traditional Chinese medicine group were treated with alloxan intravenous injection to establish a diabetic rabbit model. after successful diabetes modeling, they were fed with high fat, and both groups received balloon dilatation femoral artery. The control group was fed with clear water and the traditional Chinese medicine group was fed with Sanqi Dan granule solution. fasting blood glucose （FBG）, total cholesterol （TC）, triglyceride （TG）, high-density lipoprotein （HDL-C）, low-density lipoprotein （LD） were then tested The contents of high sensitive C reactive protein （hs-CRP）, interleukin-6（IL-6）, tumor necrosis factor-a （TNF-a） and endothelin （ET） were determined by ELISA method. Results Sanqidan granule can improve the content of FBG, TC, TG, HDL-C, LDL-C, inhibit the content of hs-CRP, IL-6, TNF-α, ET and other inflammatory factors, pathological results suggest that the balloon dilatation caused by intimal proliferation and lumen stenosis. Conclusion Sanqidan granule can improve the vascular disease after balloon dilatation of femoral artery in diabetic rabbits.

Effect of stent implantation on recanalization and nerve biochemical in patients with carotid artery stenosis

LIN Mao-hui, ZHAN Meng-xiong, ZHENG Lin-fei, LIU Sheng-ze

2020, 20(06):  736-740.  DOI: 10.3969/j.issn.1009-976X.2020.06.011

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Objective To study the effect of stent implantation on recanalization and nerve cell biochemical in patients with carotid artery stenosis. Methods A total of 61 patients with carotid artery stenosis admitted to our hospital from January 2016 to January 2020 were selected and numbered by visiting sequence. SPSS22.0 software was applied to generate a random number table, and patients were into surgical intervention group and control group, consisting of experimental group （n=30） and control group （n=31） by random number table. The control group received internal medicine surgery of routine carotid artery stenosis; the experimental group received stent implantation. The two groups of patients were compared before treatment and four weeks after treatment in terms of nerve cell biochemicals [central nervous system specific protein （S100β）, human brain myelin basic protein （MBP）, neuron specific enolase （NSE）], oxidative stress factor [superoxide dismutase （SOD）, malondialdehyde （MDA）], and cognitive function assessment. The adverse reactions of the two groups of patients during treatment and the vascular patency of the two groups of patients after 3 and 6 months of treatment were compared. Results After treatment, compared with the control group, S100β, MBP, NSE were significantly lower in the experimental group （P< 0.05）. After treatment, compared with the control group, the experimental group had significantly higher SOD and significantly lower MDA （P> 0.05）. After treatment, the MOCA score of the experimental group was significantly higher than that of the control group （P< 0.05）. Conclusion Stent implantation can significantly improve the neuronal biochemicals, oxidative stress factors and cognitive function in patients, increase the rate of postoperative vascular recanalization with high safety.

Treatment of isolated superior mesenteric artery dissection： single-center experience

LI Yong-hui, PENG Xin-zhi, CHEN Zhi-bo, SHEN Run-nan, HUANG Kai

2020, 20(06):  741-745.  DOI: 10.3969/j.issn.1009-976X.2020.06.012

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Objective Isolated superior mesenteric artery dissection （sISMAD） is rare and its optimal treatment remains uncertain. The present study was performed to present our single-center clinical outcomes and experiences. Methods Patients who were diagnosed during the period from April 2014 to June 2020 were included. Clinical and follow-up data were retrospectively collected and analyzed. Results A total of 29 patients were involved. Twenty-eight male and 1 female were included, with a median age of 56.9± 10.2 years. According to Yun Classification, 12 cases, 8, 8 and 1 were classified as Type I,ⅡA, ⅡB and Ⅲ, respectively. Fourteen patients, 5 and 11 patients accepted observation treatment, conservative treatment and endovascular treatment, respectively. Among these, one case manifested with peritonitis, and he accepted further intestinal resection and anastomosis. All Type I patient underwent observation treatment, while Type Ⅱ underwent conservative treatment or endovascular treatment. The patient underwent endovascular treatment and sequent intestinal resection was classified as Type Ⅲ. During a median follow-up period of 12 months, four patients were lost to follow-up. The patient experienced intestinal resection developed repeated gastrointestinal bleeding, and antiplatelet treatment was discontinued. A computed tomography angiography（CTA） performed 4 years after endovascular treatment revealed that the stent was patent. Other stents was patent as well, confirmed by CTA. For those patients without stent implantation, no progression was observed. Conclusions Observation could be given for asymptomatic ISMAD patients, while conservative treatment and endovascular treatment are suitable for symptomatic ISMAD patients. As to patients with intestinal necrosis, open surgery should be considered. Yun Classification could be used for treatment option.

Impact of peri-operative variation of pulmonary artery pressure on short-term mortality after cardiac surgery

ZHANG Lu, GAO Min-nan, JIANG Hui-qi, ZENG Kuan, YANG Yan-qi

2020, 20(06):  746-752.  DOI: 10.3969/j.issn.1009-976X.2020.06.013

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Objective Preoperative pulmonary hypertension complicates postoperative outcome of non-cardiac surgery. It is little known whether peri-operative pulmonary artery pressure impacts short-term mortality after cardiac surgery. Methods Totally 526 adult patients without preoperative pulmonary hypertension who underwent different types of cardiac surgery were included in the present study. Pulmonary artery pressure （PAP） was continuously monitored and recorded through a trans-thoracic pulmonary artery catheter （TPAC） being put intra-operatively. The area under PAP pressure-time curve was calculated. The total variation of PAP under the period of monitoring was presented by the area exceeded normal range of PAP. Average variation of systolic and diastolic PAP （AVPAPs and AVPAPd） in each hour under the period of monitoring was calculated. Relationship between AVPAP and 30-day mortality was analyzed by using logistic regression. Results Patients with larger peri-operative AVPAPs had significantly higher 30-day mortality （P< 0.05）. The odds ratio was 1.050 （95% confidence interval, 1.002~1.100） for AVPAPs. AVPAPs showed a significant correlation to postoperative pulmonary infection （P< 0.001） and atrial fibrillation （P< 0.001）. Conclusion Peri-operative variation of systolic PAP showed an adverse impact on short-term mortality and was correlated with postoperative pulmonary infection and atrial fibrillation in patients underwent cardiac surgery.

Application of point-of-care testing for procalcitonin in emergency clinical work

FENG Bi-juan, SHI Yi-ni, ZHONG Yu-lan, WU Hao, YU Tao, CHEN Fei-xia

2020, 20(06):  753-756.  DOI: 10.3969/j.issn.1009-976X.2020.06.014

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Objective The feasibility of point-of-care testing（POCT） for procalcitonin （PCT）in emergency clinical work was assessed. Methods PCT determination of whole blood samples from patients with suspected infection was implemented by POCT. The results from POCT were compared with that from a central laboratory. Results The clinical Turn-around Time （TAT） of PCT determination were significantly shortened by POCT. Consistency analysis of the results obtained by the two methods was carried out by kappa test. With 0.5 ng/mL and 2 ng/mL: as the critical points, the kappa coefficients are 0.786 and 0.923, and the results obtained by the two detection methods are highly consistent. Conclusion Determination of PCT by POCT is fast and reliable and it is suitable for emergency clinical work.

Comparison of preoperative immobilization effect between splint and skin traction in intertrochanteric fracture patients

HUANG Xiao-ying, ZHANG Yan, LU Ying-xia

2020, 20(06):  757-761.  DOI: 10.3969/j.issn.1009-976X.2020.06.015

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Objective To compare preoperative immobilization effect between splint and skin traction in intertrochanteric fracture patients. Methods 66 intertrochanteric fracture patients were retrospectively analyzed. 66 patients were assigned to the splint group and the traction group according to the preoperative immobilization method （n=33）. Patients in the splint group received splint immobilization preoperatively, and patients in the traction group received skin traction. Patients′ comfort, pain and satisfaction were recorded by visual analogue scale （VAS）. Immobilization Comfort Questionnaire （ICQ） was used to evaluate patients′ comfort during preoperative immobilization period. Results Comfort VAS scores were significantly higher in the splint group than those in the traction group 15 min, 1 h and 2 h after immobilization （P< 0.05）. ICQ scores were significantly higher in the splint group than those in the traction group from 1 d to 7d after immobilization （P< 0.05）. Pain VAS scores were significantly lower in the splint group than those in the traction group 15 min, 1 h, 2 h, 1 d, 2 d, 3 d, 4 d, 5 d, 6 d and 7 d after immobilization （P< 0.05）. Satisfaction VAS scores were significantly higher in the splint group than those in the traction group from 1 d to 7 d after immobilization （P< 0.05）. Incidence rate of preoperative complication was significantly lower in the splint group than those in the traction group （P< 0.05）. Conclusion Preoperative splint immobilization could decrease pain level and incidence rate of complication and increase comfort and satisfaction in intertrochanteric fracture patients, which is worth popularizing clinically.

Comparative study of non thoracoscopic subaxiphoid small incision and thoracoscopic assisted Nuss surgery in the treatment of pectus excavatum

SHEN Tao, LU Zhu-ming, DUAN Chu-xiao, ZHANG Dong-xi, YE Min, LIN Zhi-chao

2020, 20(06):  762-765.  DOI: 10.3969/j.issn.1009-976X.2020.06.016

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Objective To investigate the differences and advantages of Nuss surgery in the treatment of pectus excavatum by non thoracoscopic subaxiphoid incision （xiphoid group） and thoracoscopic assisted （thoracoscopic group）. Methods From 2016 to 2019, 59 patients with pectus excavatum were treated in our department, with an average age of 16 ± 3.82 years old. 33 patients underwent non thoracoscopic small incision Nuss operation, and 26 patients underwent thoracoscopic assisted Nuss surgery. The age, Haller index, operation time, blood loss and postoperative discharge time were compared. Results Satisfactory results were obtained in both groups. There were no significant differences in age, Haller index, operation time and blood loss between xiphoid process group and thoracoscopic group, but the discharge time of xiphoid process group was shorter than VATS group. The pain was significantly increased from 6 h to 24 h, after operation, while the pain was alleviated 48 h after operation, while the pain in the 24 xiphoid group was lighter than that in thoracoscopy, which was statistically significant. The incidence of postoperative pleural effusion in xiphoid group （33.3%） was higher than VATS group （15.4%）, while the incidence of pneumothorax in xiphoid group （27.3%） was lower than VATS group （42.3%）. In VATS group, pericardial effusion occurred 2 weeks after operation, and a large number of bilateral pleural effusion occurred. After treatment, the rest of the patients recovered smoothly. Conclusion For patients with symmetrical pectus excavatum, there is no significant difference between non thoracoscopic subaxiphoid incision and thoracoscopic assisted Nuss surgery in terms of operation time and blood loss, which can obtain satisfactory results. However, for asymmetric or complex pectus excavatum, the safety of small incision under xiphoid process is more guaranteed.

Meta-analysis of the rationality of arthroplasty in the treatment of undisplaced femoral neck fracture

LI Hong-bin, LIU Nan

2020, 20(06):  766-770.  DOI: 10.3969/j.issn.1009-976X.2020.06.017

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Objective To compare the effect of internal fixation and arthroplasty for senile femoral neck fracture without displacement. Methods The MEDLINE, Ovid and China KnowledgeNet database were searched,entry criteria were over 70 years of age; garden I or II femoral neck fracture and study comparing screw internal fixation with arthroplasty. The main result is the reoperation rate. Secondary outcomes included mortality, postoperative complications, and hip Harris score. Data was independently extracted from included studies by two researchers. Stata MP16 software was used for Statistical analysis. Results Of the 901 selected articles, 5 literatures met the selection criteria, with a total of 28,591 patients （14,296 receiving arthroplasty and 14,295 receiving internal fixation）. The reoperation rate in the internal fixation group was higher than that in the joint replacement group （OR：0.02,95% CI：0.43~0.84）, and the difference was statistically significant （Z=3.46, P=0.00）. There was no significant difference in one-year mortality risk, complications and Harris scores between the two treatment groups. Conclusion For the senile femoral neck fracture without displacement, arthroplasty can reduce the reoperation rate, which is better than internal fixation. It is reasonable to perform the first stage arthroplasty for the elderly with undisplaced femoral neck fracture.

Correlation between lumbar disc high-intensity zone on MRI and low back pain and its correlated clinical significance

HE Yong-zhong, LIU Shuang, ZHANG Wen-jun

2020, 20(06):  771-773.  DOI: 10.3969/j.issn.1009-976X.2020.06.018

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Objective To analyze the imaging manifestations and clinical comparison of the localized high-signal area of lumbar disc MRI, so as to improve the clinical significance of this sign. Methods Retrospective analysis of 35 patients with low back pain associated with lumbar disc MRI localization high signal area imaging characteristics were analyzed, diagnosis, clinical data and surgical pathology control. Results MR sagittal T2WI images in the localized high signal area of lumbar disc MRI were round （71.4%）, arc-shaped （20.0%） or radial （8.6%）. The axial image was striate or fusiform, consistent with the annulus rupture of intervertebral disc. The location of the high signal is consistent with clinical symptoms. Conclusion The localized high signal area of LUMBAR disc MRI has a certain specificity for the diagnosis of lumbar intervertebral disc low back pain. The presence of this sign may indicate disc annulus tear and provide reference for the diagnosis and treatment of patients with low back pain.

Expression and transcriptional regulatory function prediction of zinc finger protein 521 in nephroblastoma

HU Shi-hua, WEI Kang-lai

2020, 20(06):  774-783.  DOI: 10.3969/j.issn.1009-976X.2020.06.019

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Objective To investigate the expression and diagnostic value of zinc finger protein 521 （ZNF521） in nephroblastoma. The related genes and target genes of ZNF521 are predicted, and the related functions and regulatory mechanisms are analyzed. Methods Based on the RNA-seq data in the TARGET, GTEx, and GEO databases, the differential genes of nephroblastoma were screened, the expression of ZNF521 in nephroblastoma was calculated and the diagnostic Meta-analysis was used to evaluate the diagnostic efficacy. Pearson correlation analysis was used to screen out the related genes of ZNF521 and perform enrichment analysis. Based on the ChIP-Seq data of ZNF521 downloaded from the Cistrome DB website, the potential target genes of ZNF521 are predicted, and the intersection of nephroblastoma differential genes, ZNF521-related genes, and potential target genes is taken as the best potential target genes, function annotation analysis is performed by constructing protein-protein interaction （PPI） network. Results A total of 185 cases of nephroblastoma tissues and 69 cases of non-tumor kidney tissues were included in RNA-seq data. ZNF521 was highly expressed in tumor tissues （SMD=3.385, 95%CI： 1.024~5.747,P=0.005）, the under area of SROC curve is 0.990 （95%CI： 0.970~0.990）. Enrichment analysis showed that the significantly enriched functions and diseases of ZNF521 related genes include DNA replication, cell cycle, kidney development, and urinary system cancer. Finally, the 101 best potential target genes were obtained. Among them, FGFR1 is involved in multiple biological processes such as cell metabolism, cell division, embryonic development, and has a potential interaction relationship with IGF2 and EZH2 that have similar functions in PPI. Conclusion ZNF521 is highly expressed in nephroblastoma samples. ZNF521-related genes and the best-predicted target genes are closely related to nephroblastoma and may serve as potential targets for clinical diagnosis and treatment of nephroblastoma.

Review

Research status of indications, surgical methods and complications of primary closure after laparoscopic common bile duct exploration

LI Wen-tao, LI Han-qing, HUANG Zhan-ren, CHEN Nian-ping

2020, 20(06):  784-788.  DOI: 10.3969/j.issn.1009-976X.2020.06.020

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With the development of laparoscopy and choledochoscopy and the renewal of the concept of enhanced recovery after surgery, the primary closure of common bile duct exploration, which has been idled for a century, has once again become a research hotspot. Primary closure can be divided into three methods： simple primary closure,primary closure combined with internal biliary drainage, and primary closure combined with external biliary drainage. Although there have been a number of Meta-analysis confirming the effectiveness and safety of primary closure, many scholars worry that primary closure may increase the risks of postoperative bile leakage, biliary residual stones, and biliary stricture. There is still no consensus for T-tube drainage or primary closure after laparoscopic common bile duct exploration at present.

Research progress of multimodal image feature extraction and classification diagnosis for breast tumor

CHEN Ji-xin, KONG Heng

2020, 20(06):  789-795.  DOI: 10.3969/j.issn.1009-976X.2020.06.021

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Breast cancer isoneof the most common malignant tumoraffecting women in recent years. Imaging examination is an important method for diagnosing breast tumors. It mainly includes ultrasound, mammography, CT, magnetic resonance imaging （MRI） and so on. The use of a single technique has limitations, and the combined use of multiple imaging techniques can improve the efficiency of graded diagnosis. At this stage, an artificial intelligence breast cancer diagnosis system is expected to help clinicians improve the overall diagnosis efficiency and reduce the rate of missed diagnosis. The most important step in developing an accurate and efficient breast tumor diagnosis system is image feature extraction. This article discusses the practical value of the combined use of ultrasound （US）,mammography and magnetic resonance imaging （MRI） for the classification diagnosis of breast cancer. This paper reviews the research advances in feature extraction and hierarchical diagnosis of multimodal breast tumor images.



Research of DNA methylation in breast cancer

GUO Yu-juan, FENG Ying-ye, WANG Yong-nan, YAN Shan-shan

2020, 20(06):  796-800.  DOI: 10.3969/j.issn.1009-976X.2020.06.022

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The molecular mechanism of breast cancer remains unclear. Studies have shown that abnormal gene expression caused by Epigenetics changes is also an important reason for the occurrence and development of breast cancer. Epigenetic changes are heritable changes in gene expression without changes in nucleotide sequence, which including DNA methylation, histone acetylation, chromatin remodeling, genomic imprinting, non-coding RNA, and so on. DNA methylation of breast is a common molecular event with unique DNA methylation characteristics. Previous studies have found that DNA methylation can be used as a molecular marker for early diagnosis, classification, monitoring of drug treatment effect and prognosis of breast cancer. This article will review the research progress of DNA methylation in breast cancer.

Treatment progress of tibial eminence fracture

HE Yi-xiang, WANG Wen-ji

2020, 20(06):  801-804.  DOI: 10.3969/j.issn.1009-976X.2020.06.023

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Tibial Eminence fracture is a special intra-articular fracture, which is an avulsion fracture caused by the traction of the cruciate ligament. Because of injury, it is easy to lead to dysfunction of knee joint, so it is necessary to take appropriate treatment early to avoid joint adhesion, knee arthritis and other complications. This article reviews the diagnosis, classification, examination and treatment of Tibial eminence fractures.

Surgical Nursing

Preliminary discussion on nursing care missed and errors in patients at risk of or having pressure injury

HUANG Li-xia, PAN Hong, LAI Chun-Lan

2020, 20(06):  810-813.  DOI: 10.3969/j.issn.1009-976X.2020.06.026

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Objective To investigate the occurrence and causes of nursing omission in patients with pressure injury and high-risk patients. Methods Inpatients and nursing staff in our hospital from January 2011 to January 2012 were selected as the research objects. The nursing problems of patients with pressure injury and with high-risk pressure injury were recorded by random survey, including nurses′ understanding and completion of nursing elements for prevention and treatment of pressure injury, and nursing omission and errors. Results A total of 161 nurses and 359 patients participated in this study. The nursing staff who participated in the study varied between 26 and 30 years, with an average wage of 8.6 years （3~17 years）. The night shift was predominant （39.75%）, followed by the afternoon shift （33.49%） and morning shift （26.76%）. The largest proportion of the staff works at the Internal Medicine service （22.4%）, followed by Surgery （19.9%）, neurology department （16.1%） and Intensive Care Unit （11.2%）. The average length of stay was 7.25 ± 6.3 （2 ~ 47） days. The problems found in nursing records mainly included discharge education （25.77%）, suggestions for patients and their families to prevent stress injury （4.11%）, perfect pressure injury nursing （3.0%）, recording the risk factors of stress injury （2.9%）, how to do skin care/wound care in response and operation errors （16.32%）, and patients′ request for help in toilet （5.5%）. In clinical practice, the most common problems were the use of pneumatic mattress （36.92%）, clean and dry diapers （12.42%）, maintenance of patients′ daily hygiene （11.32）, proper fixation of drainage tube （11.15）, urinary incontinence and perineum dampness （10.13）. The main cause of nursing omission or error is the lack of human resources. Conclusion in patients with pressure injury risk or suffering from stress injury, nurses′ cognition and specific practice are different. The occurrence and reasons of nursing omission are caused by many factors. Conclusion In patients with pressure injury risk or suffering from pressure injury, nurses′ cognition and specific practice are different. The occurrence and causes of nursing omission are caused by many factors.

Application of montmorillonite powder combined vitamin B complex tablets on oral ulcer after high-dose methotrexate chemotherapy

HUANG Wan-yun, QIU Yi-hong, YAN Jie, DONG Ying

2020, 20(06):  814-817.  DOI: 10.3969/j.issn.1009-976X.2020.06.027

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Objective To investigate the clinical effect of montmorillonite powder combined with vitamin B complex tablets（Vit.Bco） for oral ulcer after high dose methotrexate chemotherapy in patients with acute lymphoblastic leukemia. Methods 102 patients with acute lymphoblastic leukemia who were hospitalized in hematology department from January 2018 to December 2019 with high dose methotrexate chemotherapy were divided into control group and observation group. The control group was gargle with conventional mouthwash,the montmorillonite powder combined with Vit.Bco was applied to montmorillonite powder combined with Vit.Bco ulcer on the basis of the control group. Comparative analysis of the oral ulcer cure rate and pain scores between the two groups were performed. Results The cure rate of oral ulcer was 94.33%,77.55% in the observation group and the control group,respectively. The pain scores in the observation group and the control group were 2.29± 1.09,2.97± 1.12, respectively. The difference was statistically significant（P< 0.05）. Conclusion In our study, montmorillonite powder combined with Vit.Bco can effectively cure oral ulcers caused by high dose methotrexate chemotherapy. However, the exact effect needs to be verified by multicenter randomized controlled trial.

Practice of PDCA cycle in the management of pressure injury during the operative phase

QIU Yi-hong, TAN Shu-fang, FENG Li-jun, LIANG Min, LIANG Yan-fang

2020, 20(06):  818-820.  DOI: 10.3969/j.issn.1009-976X.2020.06.028

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Objective Toexplore theeffect of PDCA cycle management in reducing the incidence of pressure injury in operating room. Methods From January to December 2018, PDCA cycle management was applied to the management of pressure injury in operating room. Seventy-seven cases of pressure injury occurred during the operative phase in our hospital from January to December 2017 were investigated and analyzed, corresponding rectification measures were formulated and implemented, and the incidence of intraoperative pressure injury before and after PDCA activity was compared. Results After the implementation of PDCA cycle, the incidence of intraoperative stress injury decreased from 0.284% before the activity to 0.113% after the activity, and the improvement rate reached 151%. Conclusion The application of PDCA cycle management method can significantly reduce the incidence of intraoperative stress injury, and further ensure the safety of patients.

The effect of individualized nutrition nursing on head and neck cancer patients who received chemoradiotherapy

LIANG Qun-ying, WU Yue-xin, QIU Hai-mei

2020, 20(06):  821-824.  DOI: 10.3969/j.issn.1009-976X.2020.06.029

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Objective To investigate the effect of individualized nutritional nursing on patients with head and neck tumors undergoing chemotherapy. Methods A total of 104 patients who underwent chemoradiotherapy for head and neck cancer in oncology department from May 2018 to December 2018,were divided into control group and observation group according to admission time, with 52 cases in each group. The control group made use of the European Nutrition Risk Screening 2002 （NRS-2002） ^[1] in order to evaluate the nutritional status of patients for routine guidance. The observation group based on the NRS-2002 assessment results based on the results of NRS-2002 combined with telephone and WeChat follow-up to implement individual nutrition nursing. Seven days after the end of radiotherapy and chemotherapy, we observed and compared the differences in nutritional status indicators, the incidence of complications, the length of hospital stay, and the total cost of hospitalization. Results Seven days after the end of radiotherapy and chemotherapy, the nutritional status indicators of the observation group were significantly better than the control group. All indicators were statistically significant （P< 0.05）. The incidence of complications in the observation group was lower than that in the control group, and the differences were statistically significant （P< 0.05）. The hospital stays and total hospitalization costs of the observation group were lower than those in the control group. Conclusion Individualized nutritional nursing on head and neck cancer patients who receive chemoradiotherapy can effectively improve the nutritional status of patients, reduce the incidence of complications, shorten the length of hospital stay and lower the total hospitalization cost, which is worthy of clinical promotion.