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Table of Content

    25 August 2024, Volume 45 Issue 8
    The effect of ultrasound-guided continuous pericapsular nerve group block on immune inflammatory response in elderly patients receiving THA
    ZHANG Wei1, WANG Fei1, LI Xian-peng2, GAO Cheng-jie1
    2024, 45(8):  873-878.  doi:10.3969/j.issn.1007-3205.2024.08.002
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    Objective To investigate the clinical effect of ultrasound-guided continuous pericapsular nerve group block (PENGB) in elderly patients undergoing total hip arthroplasty (THA). 
    Methods In this study, 50 patients receiving THA via unilateral posterolateral approach under elective general anesthesia in the 960th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army were selected and divided into research group (n=25) and control group (n=25) by random number table method. The research group was treated with ultrasound-guided PENGB, while the control group was treated with continuous ultrasound- guided fascia iliaca compartment block (FICB). The operating duration of nerve blocks, hemodynamic parameters, peripheral blood T lymphocytes, serum cortisol (Cor), adrenaline (AD), norepinephrine (NE), interferon- γ (IFN- γ), interleukin-10 (IL-10), and tumor necrosis factor-α (TNF-α) were compared between the two groups. The mean arterial pressure (MAP) and heart rate (HR) of both groups before anesthesia, at the time of laryngeal mask insertion, at 30 min after surgery, at the end of surgery, and at the time of tube removal were monitored. 
    Results The time for ultrasound localization, blockade operation, and injection in the research group was shorter than that in the control group, and the difference was statistically significant (P<0.05); there were significant differences in interaction between time points with respect to the MAP and HR in the two groups (P<0.05); there was no significant difference in the interaction between groups and time points between groups (P>0.05). At 24 h after surgery, the CD3+, CD4+, and CD4+/CD8+ levels of both groups were significantly lower than those of the same group before surgery (P<0.05), and the CD8+ level was significantly higher than that of the same group before surgery (P<0.05). The AD, NE, IL-10, and TNF-α levels in the research group were lower than those in the control group at 24 h after surgery, and the difference was statistically significant (P<0.05). The incidence of adverse reactions was 24.00% in the research group and 36.00% in the control group, but there was no significant difference between the two groups (P>0.05). 
    Conclusion The application of ultrasound-guided continuous PENGB is more effective than ultrasound-guided continuous FICB in reducing the duration of operation and inflammatory stress response levels in elderly patients undergoing THA under general anesthesia. 

    Impact of subcostal TAPB combined with unilateral rectus sheath block on stress and recovery quality in patients undergoing laparoscopic cholecystectomy
    ZHANG Min, ZHANG Fu-jie, TAN Hui-ling, CUI Tong-yang, WU Zhen-dong, LYU Yin-xiao
    2024, 45(8):  879-884.  doi:10.3969/j.issn.1007-3205.2024.08.003
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    Objective To explore the application of transversus abdominis plane block (TAPB) combined with unilateral rectus sheath block (RSB) in laparoscopic cholecystectomy (LC) and to observe the effects on inflammatory stress and quality and comfort during the recovery period. 
    Methods In total, 85 patients who underwent LC in our hospital were selected and grouped. The control group (n=42) was given TAPB, and the observation group (n=43) was given subcostal TAPB combined with unilateral RSB; both groups were given general anesthesia. The postoperative inflammatory stress level was observed in the two groups, the quality of the patients during the recovery period was recorded, and the postoperative comfort was evaluated. 
    Results There was no significant difference in preoperative C-reactive protein (CRP), interleukin-6 (IL-6), and blood glucose levels between the two groups (P>0.05). Compared with those before surgery, the values of the postoperative patients increased significantly, but the levels of inflammatory stress factors in the observation group were lower than that of the control group, showing significant differences (P<0.05). Comparion of the visual analogue scale (VAS) scores at 24 h after surgery showed that the VAS scores of the patients in the observation group were lower than that of the control group at different periods after surgery, and there were significant differences between the two groups (P<0.05). The duration of operation, intraoperative blood loss and length of hospital stay of the two groups were not significantly different (P>0.05), while the first time of postoperative anal exhaust, awakening time and the time of first off-bed activity in the observation group were shorter than those of the control group, and the difference was statistically significant (P<0.05). After surgery, Braden Comfort Scale (BCS) scores were higher the observation group than in the control group, and the difference was significant (P<0.05). The frequency of patients in the observation group was lower than that of the control group, and the total adverse effect rate was 18.60%, which was lower than that of the control group (40.48%), suggesting significant differences (P<0.05). 
    Conclusion The application of TAPB combined with unilateral RSB in LC can improve the postoperative comfort and quality during the recovery period, reduce the inflammatory stress response and have clinical value. 

    Study on the mechanism of phospholipase C epsilon-1 in mechanical ventilation-induced increased permeability of pulmonary microvascular endothelial cells
    YANG Guo-mei1, WANG Wen-fa2, WANG Li1, TIAN Ling-fang2, LIU Rui1, LUO Jing3
    2024, 45(8):  885-891.  doi:10.3969/j.issn.1007-3205.2024.08.004
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    Objective To compare and observe the effects of different levels of phospholipase C epsilon- 1 (PLCE l) expression on the expression of cytoplasmic phospholipase A2 (C-PL2) and its metabolic products in lung tissue of rats undergoing mechanical ventilation (MV), and to elucidate the role of phospholipase C epsilon-1(PLCE l) in MV- induced increased permeability of pulmonary microvascular endothelial cells (PMEC). 
    Methods Twenty-four 8-10 week-old SPF rats (weighing 180-200 g) with an equal number of males and females were randomized equally into wild-type rats+"lung protective" or "injurious" MV group (WPM group or WIM group)and PLCE1 knock-down(PLCE1-KD))rats+ "lung protective" or " injurious" MV group (PPM group or PIM group). Rats were subjected to 2 h "lung protective" tidal volume(TV)=7 mL/kg, positive end expiratory pressure (PEEP)=5 cmH2O) or "injurious" (TV=20 mL/kg, PEEP=0 cmH2O) MV. The expressions of PLCEl and cytoplasmic phospholipase A2(C-PLA2) were examined by Western blotting and real-time quantitative PCR(QPCR). Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of arachidonic acid (AA) metabolites such as prostacyclin (PGI2), thromboxane A2 (TXA2) and leukotriene B4 (LTB4) in the lung tissue. The pulmonary permeability index and the lung wet/dry weight (W/D) ratio were determined to evaluate the permeability of PMEC (PMVECs). The severities of lung injury were evaluated by pathological morphology scores of lung tissues. 
    Results In WIM and PIM groups, PLCE1 and C-PLA2 expressions at both the protein and mRNA levels were significantly upregulated, the levels of PGI2,TXA2 and LTB4 in lungs were increased, and pulmonary permeability index,lung W/D ratio,and pathological morphology scores of lung tissues were significantly increased as compared with those in WPM and PPM groups (P<0.05). Under the same MV mode, the expression levels of PLCE1 and C-PL2 at both the protein and mRNA levels in rat lung tissue, the levels of PGI2, TXA2, and LTB4 in the lungs, and various indicators for evaluating lung injury were significantly lower in PIM and PPM groups than in WIM and WPM groups (P<0.05). 
    Conclusion Downregulation of PLCE1 can alleviate MV-induced increased PMVEC permeability by inhibiting C-PL2 activity, exerting a protective effect on the lungs, suggesting that PLCE1 may be a potential intervention target for anti-VILI therapy.

    The application value of dexmedetomidine in patients undergoing laparoscopic cholecystectomy and its effect on the glycocalyx
    SONG Cheng-feng, QI Li-jun, GUO Ji-yan
    2024, 45(8):  892-898.  doi:10.3969/j.issn.1007-3205.2024.08.005
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    Objective To investigate the effects of dexmedetomidine before induction of general anesthesia on intraoperative hemodynamics, postoperative analgesia, inflammatory factors and glycocalyx in patients undergoing laparoscopic cholecystectomy. 
    Methods A total of 200 patients with cholecystolithiasis complicated with acute cholecystitis undergoing laparoscopic cholecystectomy under general anesthesia in our hospital were randomly divided into an observation group (n=100) and a control group (n=100). In the control group, 10 mL of 0.9% sodium chloride solution was injected intravenously before induction of general anesthesia, while dexmedetomidine (0.8 μg/kg) was injected in the observation group. The hemodynamics, duration of operation, duration of anesthesia, time to extubation, duration of minimum alveolar concentration equal to 1, degree of postoperative pain, incidence of adverse effects, leukocyte values, interleukin (IL)-1, IL-6, IL-8, tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), procalcitonin and glycocalyx injury markers (syndecan-1, heparan sulfate, hyaluronic acid) were observed in the two groups. 
    Results This study showed that there was no difference between the two groups in terms of general characteristics such as duration of operation, duration of anesthesia, and time to extubation.However, the observation group was able to maintain intraoperative hemodynamic parameters better (P<0.05), and the visual analogue scale (VAS) scores of the observation group were significantly lower than those of the control group at 3 h, 6 h, 9 h, and 12 h postoperatively; the difference of interaction between groups, time points and time points between groups were statistically significant (P<0.05). Although the postoperative leukocyte values were comparable, the postoperative levels of inflammatory factors and glycocalyx injury markers were different between the two groups. The levels of IL-1, IL-6, IL-8, TNF-α, CRP, procalcitonin, and glycocalyx injury markers in the observation group were significantly lower than those in the control group (P<0.05). In addition, the incidence of postoperative adverse reactions in the observation group was significantly lower than that in the control group (P<0.05). 
    Conclusion In patients undergoing laparoscopic cholecystectomy for cholecystolithiasis with acute cholecystitis, the administration of dexmedetomidine before induction of general anesthesia can better maintain intraoperative hemodynamic parameters, effectively improve postoperative pain, and reduce the occurrence of postoperative inflammation and adverse reactions. In addition, it can inhibit the shedding of vascular endothelial glycocalyx and improve the immune function of the body, and thus promote the recovery of patients after surgery.

    Effects of pulmonary alveolar recruitment strategy combined with intrabronchial administration of dexmedetomidine on perioperative inflammatory factors and pulmonary oxygenation in elderly patients undergoing thoracoscopic radical resection for esophageal cancer
    XIE Jing1, ZHAO Xiao-ling2, FENG Shi-qiang1, QU Zhen-hua1
    2024, 45(8):  899-905.  doi:10.3969/j.issn.1007-3205.2024.08.006
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    〓Objective To investigate the effects of alveolar recruitment strategy (ARS) combined with intrabronchial administration of dexmedetomidine on pulmonary oxygenation and inflammatory factors in elderly patients undergoing thoracoscopic radical resection for esophageal cancer. 
    Methods A total of 60 patients, aged 55-75 years and classified as American Society of Anesthesiologists (ASA) grade Ⅰ-Ⅱ, were selected for elective thoracoscopic radical surgery for esophageal cancer under general anesthesia in Xingtai People′s Hospital. They were randomly divided into three groups: intrabronchial administration group (group A), intravenous administration group (group B), and ARS+ intrabronchial dexmedetomidine group (group C). In group C, ARS was performed before, during and after surgery, that is, 10 consecutive manual breaths, with the duration of >15 s each time, enabling the inspiratory platform pressure to reach 40 cmH2O, followed by implementation of the volume-controlled ventilation mode, 1〖DK〗∶E=1〖DK〗∶2, VT 6 mL/kg, fraction of inspiration O2 (FiO2) 80%, RR 14 times/min. The first ARS was performed before single lung ventilation after surgery, the second ARS was performed at 90 min after the initiation of operation, and the third ARS was performed after operation. The ARS was performed for three times simultaneously with intravenous administration of dexmedetomidine at a concentration of 10 μg/mL and a dose of 1.0 μg/kg. Group B received a dose of 1.0 μg/kg dexmedetomidine within 10 min before initiation of anesthesia, and then the dose was adjusted to 0.5 μg·kg-1·h-1 until the end of the operation. Group A and group C were given the same concentration and dose of dexmedetomidine in the bronchus at the same period of time (that is, before single lung ventilation, at 90 min after surgery, and after surgery). Routine single lung ventilation (the same as group C) was performed in both groups after operation, and no ARS was performed before, during and after operation. Before anesthesia induction (T0), immediately after single lung ventilation (T1), at 60 min after single lung ventilation (T2), at 90 min after single lung ventilation (T3), and at 24 h after operation (T4), interleukin 6 (IL-6) concentration, partial pressure of oxygen (PaO2), and end-expiratory CO2 were recorded, intrapulmonary shunt rate Qs/Qt was calculated, and perioperative adverse reaction rate [hypotension, i.e., intraoperative mean artery pressure (MAP) decrease of more than 30%], incidence of bradycardia, i.e. HR less than 50 times/min and duration greater than 10 min, pulmonary infection, i.e., increased respiratory secretions, pulmonary bronchial rales or increased sputum aspiration, progressive and persistent pulmonary infiltration by chest radiography, hypoxemia, i.e. PaO2<80 mmHg (1 mmHg=0.133 kPa), atelectasis, namely, increased lung density on chest X-ray examination was recorded. 

    Results IL-6 and IL-8 indexes showed an increasing trend at T3 and a decreasing trend at T4 in all groups, and there were significant differences in interaction betwen groups, time points, and time points between groups (P<0.05). PaO2 index showed an increasing trend at T1 in all groups, groups A and B showed a decreasing trend at T2, and all groups showed a decreasing trend at T3 and T4. There were significant differences in interaction betwen groups, time points, and time points between groups (P<0.05). CO2 index showed a downward trend at T1 in both groups A and C, but an upward trend in group B. At T2, group B showed a downward trend while group C showed an upward trend. At T3, both groups A and C showed a decreasing trend, while group B showed an increasing trend. At T4 point, A group showed an increasing trend, while B group and C showed a decreasing trend, and there were significant differences in interaction between groups, time points, and time points between groups (P<0.05). For the intrapulmonary shunt rate Qs/Qt, groups A, B and C showed a downward trend at T1, while groups A, B and C showed an upward trend at T2; groups A, B and C showed an upward trend at T3, and groups A, B and C showed a downward trend at T4, with significant differences in interaction between groups, time points and time points between groups (P<0.05). For the comparison among the three groups, the incidence of hypotension and bradycardia in group B was higher than that in group A and group C, and the difference was statistically significant (P<0.05). The postoperative pulmonary complications in groups A and B were higher than those in group C, and the difference was statistically significant (P<0.05). There was no significant difference in the incidence of hypotension and bradycardia between group A and group C (P>0.05). 
    Conclusion ARS combined with intrabronchial administration of dexmedetomidine can improve perioperative pulmonary oxygenation function, reduce intrapulmonary shunt, alleviate inflammatory response, and reduce complications in patients undergoing thoracoscopic radical resection of esophageal cancer. 

    Study on the impact of cerebral oxygen saturation on postoperative cognitive dysfunction and inflammatory response in elderly patients undergoing hip surgery during perioperative anesthesia
    NIU Lin-jie1, ZHANG Dong-ying2, TONG Meng1, YUAN Ruo-lin1, LI Zhao1
    2024, 45(8):  906-911.  doi:10.3969/j.issn.1007-3205.2024.08.007
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    Objective To explore the effect of cerebral oxygen saturation on postoperative cognitive dysfunction and inflammation in elderly patients undergoing hip surgery during perioperative anesthesia. 
    Methods A total of 120 elderly patients undergoing hip arthroplasty were collected, and the decrease in regional saturation of cerebral oxygen (rScO2) during perioperative anesthesia was set to be greater than 20% before surgery as cerebral hypoxia. According to the intraoperative rScO2, the patients were divided into hypoxia group (n=57) and non-hypoxia group (n=63). The preoperative and postoperative cognitive levels of patients were assessed using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA)Scale score. Statistical analysis of the correlation of rScO2with MMSE and MoCA was performed. ELISA was used to detect neuron specific enolase (NSE), S100-β protein, tumor necrosis factor α (TNF-α), and interleukin-6 (IL-6) levels in the plasma of patients before and after surgery. The number of white blood cells (WBCs) and neutrophils in peripheral blood of the patients was measured. 
    Results The rScO2 in the non-hypoxia group and the hypoxia group firstly decreased and then increased with the increase of time, and there were significant differences in interaction between groups, time points, and time points between groups (P<0.05). There were no significant differences in MMSE, MoCA scores, plasma NSE, S100-β, TNF-α, IL-6 levels, peripheral blood WBC and neutrophil counts between the two groups before surgery (P>0.05). The scores of MMSE and MoCA in the hypoxia group were significantly lower than those in the non-hypoxia group (P<0.05). Spearman correlation analysis showed that rScO2 level during anesthesia was positively correlated with MMSE and MoCA scores. The levels of plasma NSE, S100-β, TNF-α, IL-6 as well as peripheral blood WBC and neutrophil counts in the hypoxia group were significantly higher than those in the non-hypoxia group (P<0.05). 
    Conclusion Insufficient cerebral oxygen saturation during perioperative anesthesia can promote postoperative cognitive dysfunction and immune dysfunction in elderly patients undergoing hip surgery. This study provides a reference for the control of cerebral oxygen saturation during perioperative anesthesia in elderly patients undergoing hip surgery. 

    Application of artificial chordae tendineae in posterior valvoplasty for mitral regurgitation and short-and medium-term therapeutic effect
    LIANG Yi-wu, TANG Zhi-xiang, LI Qian, YIN Chen, WANG Run-zhe, LIU Yu
    2024, 45(8):  917-921.  doi:10.3969/j.issn.1007-3205.2024.08.009
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    Objective To evaluate the feasibility and short- and medium-term clinical efficacy of artificial chordae tendineae in the treatment of posterior leaflet prolapse of the mitral valve.  
    Methods A total of 99 patients diagnosed with mitral valve prolapse and regurgitation who underwent mitral valvoplasty at the Second Hospital of Hebei Medical University were selected, including 41 patients with simple anterior leaflet prolapse, 44 patients with simple posterior leaflet prolapse, 4 patients with both anterior and posterior leaflet prolapse, and 10 patients with junctional prolapse.We used artificial chordae tendineae to correct mitral regurgitation in 48 patients with posterior leaflet prolapse. 
    Results In total, 48 patients who were given artificial chordae tendineae to correct posterior leaflet regurgitation were followed up for 13-81 months, with an average of (40.60±15.57) months. There was 0 patient who underwent re-operation due to mitral valve disease at 1 year after surgery, 2 patients who underwent re-operation at 2 years after operation, and 2 patients who underwent re-operation at 5 years after surgery, accounting for 4.2% of all patients receiving posterior valvoplasty. Postoperatively, patients showed significant improvements in left ventricular ejection fraction, left ventricular end diastolic diameter, mitral regurgitation area, and cardiac function, as compared with preoperative levels, with statistical differences. Follow-up data showed that these indicators improved more significantly from 6 months to 1 year after surgery. The area of mitral regurgitation gradually increased with time, but currently there was no significant difference. The postoperative mitral valve orifice blood flow velocity, blood flow velocity of left ventricular outflow tract, and mitral valve orifice area were all within the normal range, and no stenosis of mitral valve was found. 
    Conclusion Artificial chordae tendineae is effective in the treatment of posterior leaflet prolapse of the mitral valve, which can achieve favorable therapeutic results. 

    Application of Kirschner wire in laparoscopic sleeve gastrectomy
    GAO Tian, GU Jing-feng, PANG Li-yun, GAO Hao-wen, ZHANG Xin-xin, WANG Gui-qi
    2024, 45(8):  922-926.  doi:10.3969/j.issn.1007-3205.2024.08.010
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    Objective To explore the feasibility and safety of using Kirschner wire and suture to block the liver in laparoscopic sleeve gastrectomy, and to improve the use of Kirschner wire. 
    Methods A total of 88 patients with metabolic syndrome undergoing laparoscopic sleeve gastrectomy were randomly divided into suture group (n=44) and Kirschner wire group (n=44). In the suture group, the conventional suture to the abdominal wall and diaphragm foot was "V" type to block the liver. With the use of Kirschner wire, different sites could be selected to block the liver or block the exposure field of fat in the abdominal cavity. The liver function, length of hospitalization, duration of operation, hospitalization expenses, intraoperative condition (presence or absence of liver bleeding) and complications of Kirschner wire (infection, bleed, etc.) were compared between the two groups. 
    Results The length of hospitalization of patients in the suture group was (4.80±0.70) d, hospitalization expenses were (52 423.22±3 956.57) yuan, the duration of operation was (100.14±5.51) min, and there were 2 patients with liver bleeding. The length of hospitalization of patients in the Kirschner wire group was (4.77±0.80) d, hospitalization expenses were (50 986.61±4 114.21) yuan, the duration of operation was 88.00 (5.75) min, and there was no patient with liver bleeding. There was no significant difference between the two groups in terms of the length of hospitalization and the hospitalization expenses (P>0.05), but there was significant difference between the two groups in terms of the duration of operation and liver bleeding (P<0.05). There was no significant difference in ALT and AST before operation and at 1 d after operation (P>0.05). 
    Conclusion Compared with the suture method, the application of Kirschner wire can significantly expand the exposure range of the operation field, effectively shorten the duration of operation, does not increase the use of trocar, and has no related complications. It has great advantages in safety, beauty, manpower, and economy, and the application effect is favorable. 

    Effect and preliminary follow-up of percutaneous foraminal endoscopic discectomy assisted by a novel three-axis adjustable positioner for multi-segment lumbar disc herniation
    ZHEN Rui-xin, MA Gui-yun, SHI Fan-qi, CHANG Cheng-bing, AN Yong-sheng
    2024, 45(8):  927-933.  doi:10.3969/j.issn.1007-3205.2024.08.011
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    Objective To investigate the effect and follow-up results of percutaneous foraminal endoscopic discectomy (PTED) assisted by a novel three-axis adjustable positioner in the treatment of multi-segment lumbar disc herniation (LDH). 
    Methods A total of 100 patients with multi-segment LDH in our hospital were selected and divided into two groups by simple randomization method, with 50 patients in each group. The control group received traditional PTED, and the observation group received PTED assisted by a novel three-axis adjustable positioner. Perioperative indexes, complications, excellent and good rate of surgery, inflammatory stress indexes [interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-17 (IL-17)], surface electromyography [root mean square (RMS) value, median frequency (MF)value, integrated electromyography (IEMG) of multifidus muscle on the affected side],Oswestry Disability Index (ODI) score, visual analog scale (VAS) score, and excellence and good rate of surgery of the two groups before and after surgery were observed and compared. 
    Results The number of fluoroscopy, puncture times and intraoperative blood loss in the observation group were less than those in the control group, the puncture time and duration of operation were shorter than those in the control group, and the success rate of one-time puncture was higher than that in the control group (P<0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). The serum levels of IL-17, IL-6 and IL-2 in the observation group were lower than those in the control group at 1 d after surgery (P<0.05). RMS, MF and IEMG of multifidus muscle on the affected side were higher than those before surgery, and at 1 month, 3 months, 6 months and 12 months after surgery, while ODI scores were lower than those before surgery (P<0.05). The VAS scores of the lower back and lower limbs in the observation group were lower than those in the control group at 1 and 5 d after surgery (P<0.05). At 12 months after surgery, there was no significant difference in excellent and good rate of surgery between the two groups (P>0.05). 
    Conclusion The novel three-axis adjustable positioner assisted PTED and traditional PTED can achieve satisfactory results in the treatment of multi-segment LDH, which can improve the surface electromyography of the multifidus muscle on the affected side, restore the function of the lumbar spine, relieve the pain of patients, and has good safety. However, the former can optimize the operation, shorten the duration of operation, reduce postoperative inflammation, and contribute to early pain relief. 

    Effect of vaseline gauze-double-layer compression dressings on postoperative efficacy of concealed penis
    YANG Hao-xuan1, CHEN Hong-yu1, ZHANG Wan-ze2, XUE Wen-yong1, MA Zi-yue1, QI Jin-chun1
    2024, 45(8):  934-939.  doi:10.3969/j.issn.1007-3205.2024.08.012
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    Objective To analyze the impact of different inner wound dressings on local wound recovery after surgery for concealed penis, and to explore more appropriate wound dressings and bandaging methods after surgery for concealed penis. 
    Methods A total of 158 children with concealed penis treated in our hospital  were retrospectively analyzed including the clinical data, postoperative recovery, the first time of changing dressings, and patients′ satisfaction with changing dressings. The patients were divided into three groups according to the application of the inner wound dressings (A. Sterile gauze group; B. Iodophor gauze group; C. Vaseline gauze group). The bleeding, infection, and adhesion in each group were calculated. The effects of different dressings on postoperative complications were analyzed. 
    Results The numbers of bleeding and adhesion in group C were lower than those in groups A and B (P<0.05). There was no difference in the number of infected individuals among the three groups. The mean time of dressing changes was shorter in group C than in groups A and B (P<0.05). In the three groups, more serious adhesion led to longer time of dressing changes; conversely, less serious adhesion led to short time of dressing change. The patients′ satisfaction with changing dressings was higher in group C (90.2%) than in groups A and B (P<0.05). 
    Conclusion The vaseline gauze-gauze and double-layer compression dressing has the advantages of low cost and significant effect. It effectively reduces children′s pain during dressing changes and is worthy of clinical promotion.
    Effect of different skin graft harvest methods combined with VSD on the outcome of emergency trauma with large-area skin avulsion
    NIU Lu-jie1, CHEN Wei-xin2
    2024, 45(8):  940-945.  doi:10.3969/j.issn.1007-3205.2024.08.013
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    Objective To investigate the effect of different thin-medium-thick skin grafts combined with vacuum sealing drainage (VSD) on the outcome of emergency trauma with large-area skin avulsion. 
    Methods Seventy patients with emergency trauma with large-area skin avulsion were selected and divided into skin graft harvesting group (n=35) and reverse skin graft harvesting group (n=35) according to different methods of skin graft harvesting. The two groups were compared in terms of healing, number of dressing changes, length of hospital stay, treatment expenses, visual analogue scale (VAS) score at 12 h, 24 h, 48 h and 72 h after treatment, Vancouver Scar Scale (VSS) score, skin sensation at the affected area and complications. 
    Results The rate of primary healing in the reverse skin graft harvesting group was higher than that of the skin graft harvesting group, the number of dressing changes was less than that of the skin graft harvesting group, and the length of hospital stay was shorter than that of the skin graft harvesting group (P<0.05). The VAS score at 12-72 h after surgery showed a decreasing trend in both groups, and there were significant differences in interaction between groups, time points and time points between groups (P<0.05). The color, thickness, and softness of the VSS score in the reverse skin graft harvesting group were lower than those in the skin graft harvesting group, and the skin sensory grading of the affected area was better than that in the skin graft harvesting group (P<0.05). There was no significant difference in the treatment expenses and complication rate between the reverse skin graft harvesting group and the skin graft harvesting group (P>0.05). 
    Conclusion Compared with thin-medium-thick skin graft harvesting, reverse thin-medium-thick skin graft harvesting combined with VSD in the treatment of emergency trauma patients with large-area skin avulsion have a higher primary healing rate, lower pain, better aesthetic effects, better skin sensation, fewer dressing changes, and shorter hospital stay, and will not increase the risk of complications and treatment expenses. 

    Predictive value of mean platelet volume/lymphocyte ratio combined with soluble thromboxodulin in postoperative deep vein thrombosis of lower extremity in patients with lower extremity fracture
    WANG Yan-yan1, WANG Xu1, LI Jia2
    2024, 45(8):  946-951.  doi:10.3969/j.issn.1007-3205.2024.08.014
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    Objective To investigate the predictive value of mean platelet volume/lymphocyte ratio (MPVLR) and soluble thrombolodulin (sTM) in postoperative deep vein thrombosis (DVT) of lower extremity in patients with lower extremity fracture. 
    Methods A total of 89 patients with lower extremity fracture admitted to the hospital were selected. All patients received surgical treatment and were divided into the occurrence group and non-occurrence group according to whether the patients developed DVT of lower extremity after surgery. The incidence of DVT of lower extremity in patients with lower extremity fracture after surgery was analyzed, the levels of peripheral blood MPVLR and sTM in the occurrence and non-occurrence groups were compared, and the clinical data of the occurrence and non-occurrence groups were compared. The influencing factors of DVT of lower extremity in patients with lower extremity fracture after surgery were analyzed by multivariate Logistic regression, and receiver operating characteristic (ROC) curve was drawn. Area under the ROC curve (AUC) was used to analyze the predictive value of preoperative peripheral blood MPVLR and sTM levels alone and in combination for postoperative DVT of lower extremity in patients with lower extremity fracture. 
    Results Postoperative DVT occurred in 21 of 89 patients with lower extremity fracture, with an incidence of 23.60% (21/89), and no DVT occurred in the remaining 68 patients. The levels of MPVLR and sTM in peripheral blood of the occurrence group were higher than those of the non-occurrence group, suggesting significant differences (P<0.05). There were significant differences between the two groups in age ≥60 years, duration of operation ≥2 h, postoperative use of anticoagulant drugs, body mass index (BMI) and duration of postoperative bed rest (P<0.05). Logistic regression analysis showed that age ≥60 years, duration of operation ≥2 h, increased BMI, MPVLR level and sTM level in peripheral blood were influencing factors for postoperative DVT of lower extremity in patients with lower extremity fracture (P<0.05). ROC curve results showed that the AUC values of preoperative peripheral blood MPVLR and sTM levels alone and in combination for prediction of postoperative DVT in patients with lower extremity fracture were 0.716, 0.705 and 0.861, respectively (P<0.05), and the AUC value of the combined prediction of the two indexes was higher than that predicted by the single index (P<0.05). 
    Conclusion Preoperative detection of peripheral blood MPVLR and sTM can be used to predict the occurrence of DVT of lower extremity in patients with lower extremity fracture, and the combination of the two has higher predictive value. 

    Comparison of short-term and long-term efficacy of HIFU and UEA in the treatment of diffuse and localized adenomyosis
    ZHAO Ming-yang, SONG Xue-wei, JIA Fan, LU Jie-hong, SHI Li-kun, YANG Xiu-mei
    2024, 45(8):  952-957.  doi:10.3969/j.issn.1007-3205.2024.08.015
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    Objective To compare the short-term and long-term efficacy of high intensity focused ultrasound (HIFU) and uterine artery embolization (UAE) in the treatment of diffuse and localized adenomyosis. 
    Methods A total of 120 patients with adenomyosis who received treatment in the Department of Gynecology, Cangzhou People′s Hospital were selected. The patients were classified into diffuse group (group D, n=60) and limited group (group L, n=60). According to different treatment methods, Groups D and L were divided into subgroups D1, D2 and subgroups L1, L2, respectively. Groups D1 and L1 were treated with HIFU, and groups D2 and L2 were treated with UAE. Symptom severity score (SSS), visual analogue scale (VAS) pain score, Pictorial Blood Loss Assessment Chart (PBAC) score of menstrual volume and health-related quality of life (HRQL) score of each group were recorded and compared before treatment, and at 6 and 12 months after treatment. The uterine volume and lesion volume were evaluated at 12 months after treatment, and the follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), anti-mullerian hormone (AMH) levels and antral follicle (AFC) of the two groups were measured before and at 12 months after treatment. The clinical efficacy of the two groups was calculated for 12 months, they were followed up for 24 months, and the recurrence was recorded. 
    Results SSS, VAS pain score and PBAC score of menstrual volume were decreased significantly at 6 and 12 months after treatment in the four groups (P<0.05), and HRQL score was increased significantly (P<0.05). However, there was no significant difference among the four groups (P>0.05). Compared with those before treatment, the uterine volume and lesion volume of the four groups were significantly reduced at 12 months after treatment, showing significant differences (P<0.05), which were smaller in group D1 than in group D2, as well as in group L1 group than in group L2, suggesting significant differences(P<0.05). The levels of FSH, LH and E2 in the four groups were significantly lower after treatment, as compared with those before treatment, and significantly lower in group D1 than in group D2 (P<0.05), while the level of AMH in group D1 was significantly higher than that in group D2 (P<0.05). The levels of FSH and LH in group L1 were significantly lower than those in group L2, while AMH level was significantly higher than that in group L2 (P<0.05); however,AFC was not significantly different among the four groups (P>0.05).There was no significant difference in the total effective rate and recurrence rate among the four groups (P>0.05). 
    Conclusion HIFU is comparable to UAE in short-term and long-term efficacy in the treatment of diffuse and localized adenomyosis. Therefore, the appropriate treatment plan can be selected according to the specific situation. 

    Effect of laparoscopic excision ofgiant ovarian cysts on ovarian function, inflammatory factors and T lymphocyte subsets in patients
    ZAN Pei-xia, ZHANG Rong-rong, HUANG Ru-liang
    2024, 45(8):  958-963.  doi:10.3969/j.issn.1007-3205.2024.08.016
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    Objective To explore the effect of laparoscopic excision of giant ovarian cystson ovarian function, inflammatory factors and T lymphocyte subsets in patients. 
    Methods A total of 76 patients with giant ovarian cysts treated in our hospital were prospectively randomly selected. They were divided into control group and observation group according to random number table method, with 38 patients in each group. The control group received traditional open surgery for the removal of giant ovarian cysts, and the observation group underwent laparoscopic removal of ovarian giant cysts. The perioperative related indicators, stress indicators, ovarian function, inflammatory factors, T lymphocyte subsets and postoperative complications were compared between the two groups. 
    Results The duration of operation and the length of hospitalization in the observation group were shorter than those in the control group, and the blood loss of the observation group was less than that of the control group (P<0.05). After operation, cortisol (Cor), adrenaline (A) levels and visual analogue scale (VAS) scores were increased in the two groups, which, however, were lower in the observation group than in the control group (P<0.05). After operation, the levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH) in the two groups were increased, but the levels were lower in the observation group than in the control group (P<0.05). After operation, the levels of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in the two groups were increased, but the levels in the observation group was lower than those in the control group (P<0.05). After operation, the levels of CD3+, CD4+/CD8+ in the two groups were decreased, but the levels in the observation group were higher than those in the control group (P<0.05). The postoperative complications in the observation group were fewer than those in the control group (P<0.05). 
    Conclusion Compared with traditional open surgery, laparoscopic excision of giant ovarian cysts can significantly reduce the stress response of patients, with lower postoperative inflammation, less damage to ovarian function and immune function, fewer postoperative complications, and higher clinical application value. 

    The study of application of body composition analysis in nutritional diagnosis of hospitalized mental patients
    SONG Shi-ming, HU Huan-yu, DU Hong-zhen, LI Zeng-ning
    2024, 45(8):  968-973.  doi:10.3969/j.issn.1007-3205.2024.08.018
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    Objective To investigate the role of body composition analysis in the nutritional diagnosis of hospitalized mental patients. 
    Methods A total of 100 hospitalized mental patients were enrolled as the case group, and 100 age- and gender-matched healthy individuals were recruited as the control group. Bioelectrical impedance analysis was used to detect body composition, and the test results of each group were compared. 
    Results The body mass index (BMI) (21.05 vs. 24.30; 18.40 vs. 23.30), protein (9.40 vs. 10.70; 6.85 vs. 7.95), minerals (3.02 vs. 3.74; 2.48 vs. 2.94), bone mineral content (2.46 vs. 3.10; 2.05 vs. 2.47), arm circumference (28.85 vs. 31.10; 25.05 vs. 28.60), phase angle (4.95 vs. 6.00; 4.70 vs. 5.19), body cell mass (24.65 vs. 35.45; 24.50 vs. 26.45), intracellular water (ICW) ratio (0.61 vs. 0.62; 0.61 vs. 0.62), fat-free mass (FFM) (38.25 vs. 53.95; 38.05 vs. 40.75), skeletal muscle mass (20.45 vs. 30.30; 20.30 vs. 22.10), FFM index (14.39 vs. 18.80; 14.57 vs. 15.70), skeletal muscle mass index (7.58 vs. 10.50; 7.78 vs. 8.55) and body fat mass (11.45 vs. 15.60; 12.60 vs. 17.95) in the case group were lower than those in the control group (P<0.05), while the extracellular water ratio (0.39 vs. 0.38; 0.39 vs. 0.38) was higher than that in the control group (P<0.05). In case and control groups, the phase angles of men and women were positively correlated with ICW, ICW ratio, protein, skeletal muscle mass and body cell mass (P<0.05). 
    Conclusion The body composition analysis results of men and women in the case group are worse than those in the control group; therefore, it can be used for the nutritional diagnosis of hospitalized mental patients. 

    Correlation between serum Ang-2, IL-23 and acute kidney injury in patients with sepsis
    SHI Dong-jian1, DUAN Li-juan1, ZHAO Da-ming2, ZHANG Kun1
    2024, 45(8):  974-979.  doi:10.3969/j.issn.1007-3205.2024.08.0019
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    Objective To investigate the expression of serum angiopoietin-2 (Ang-2) and interleukin-23 (IL-23) in patients with sepsis and to analyze their relationship with acute kidney injury (AKI) in patients with sepsis. 
    Methods A total of 185 patients with sepsis treated in the Affiliated Hospital of Chengde Medical College, Hebei Province, were selected as the research subjects. All patients were treated and divided into AKI group and non-AKI group according to the occurrence of AKI during hospitalization. The levels of serum Ang-2 and IL-23 were detected by enzyme-linked immunosorbent assay (ELISA) at admission, and the baseline data of patients were collected. The serum Ang-2, IL-23 and baseline data were compared between the two groups. Logistic regression analysis was used to test the influencing factors of AKI in patients with sepsis, and then the receiver operating curve (ROC) was drawn to explore the predictive value of serum Ang-2 and IL-23 for AKI in patients with sepsis. 
    Results Among 185 patients with sepsis, 87 patients with AKI were diagnosed by blood and urine examination, and the incidence rate was 47.03%. The proportion of patients with combined shock was higher in AKI group than in non-AKI group, and the levels of serum Ang-2 and IL-23 at admission were higher than those in non-AKI group, with significant differences (P<0.05). The results of binary Logistic regression analysis showed that combined shock, high expression of Ang-2 and IL-23 at admission were risk factors for AKI in patients with sepsis (OR>1, P<0.05). The ROC curve was drawn, and the results showed that, the area under the ROC curve (AUC) of the levels of serum Ang-2, IL-23 alone and in combination in predicting AKI in patients with sepsis was all >0.70, showing certain predictive value, among which the combined detection was the highest. There was a linear dose-response relationship between the levels of serum Ang-2 and IL-23 and AKI in patients with sepsis (P<0.05). The levels of serum Ang-2 and IL-23 were positively correlated with AKI in patients with sepsis, especially when serum Ang-2 was >9.23 μg/L and serum IL-23 was >101.97 pg/L. The risk of AKI in patients with sepsis was increased with the increase of serum Ang-2 and IL-23 levels. 
    Conclusion Serum Ang-2 and IL-23 are the influencing factors of AKI in patients with sepsis, and the risk of AKI is positively correlated with Ang-2 and IL-23 levels. 

    The relationship of MMP-9, E-cadherin in tissues with MELF pattern invasion and degree of tumor invasion in endometrial carcinoma
    LI Kun1, WANG Jing2, JIN Chun-ting3, BAI Rui1, LIU Xiao-juan2
    2024, 45(8):  980-986.  doi:10.3969/j.issn.1007-3205.2024.08.020
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    Objective To analyze the relationship of matrix metalloproteinase-9 (MMP-9), and E-cadherin in endometrioid carcinoma tissues with the microencystic, elongated and fragmented (MELF) pattern invasion and degree of tumor invasion, and to explore the indicators that could identify the endometrial carcinoma with MELF invasion, so as to inhibit tumor invasion. 
    Methods A retrospective analysis was conducted on the clinical data of 112 patients with endometrioid carcinoma who underwent surgical treatment at the First Affiliated Hospital of Hebei North University. All patients successfully completed modified radical hysterectomy and met tumor criteria. Based on pathological examination results, 112 patients were divided into MELF group and non-MELF (N-MELF) group. The general clinical data of 112 patients were recorded. The blood examination items included tumor markers, and immunohistochemical examination items included MMP-9 and E-cadherin in tissues. According to the results of the examination, a Logistic regression model was constructed to analyze the relationship of MMP-9, E-cadherin and related indicators in the tissue with the MELF pattern invasion and degree of tumor invasion of endometrial carcinoma. 
    Results Among the 112 patients with endometrioid carcinoma in this study, 21 patients (18.75%) were evaluated as MELF invasion. The proportion of patients with low pathological grade of MELF invasion, the International Federation of Gynecology and Obstetrics (FIGO) stage ⅣA, lymphatic vascular space invasion (LVSI), and positive MMP-9 in tissues was higher than that of N-MELF invasion patients, and the proportion of E-cadherin positive patients was lower than that of N-MELF invasion patients. The levels of human epididymis protein 4 (HE4) and human cartilage glycopmtein (YKL-40) were higher than those of N-MELF patients, and the difference was statistically significant (P<0.05). Multivariate Logistic regression analysis showed that the expression rate of E-cadherin was low, that the expression rate of MMP-9 was high in tissues, and that MELF invasion was related to FIGO staging of endometrial carcinoma (P<0.05). 
    Conclusion The MELF invasion of endometrioid carcinoma is related to MMP-9 and E-cadherin in the tissues. The high expression rate of MMP-9 and the low expression rate of E-cadherin can lead to the MELF invasion and hence enhance the tumor invasion ability.