Objective To explore anatomical features and variation of non-recurrent laryngeal nerve and to summarize identification method, operation skill, and damage treatment experience of it. Method The clinical data of 15 patients with non-recurrent laryngeal nerve in 4 054 patients who underwent thyroidectomy from our division by the same medical group from January 2006 to January 2016 were retrospectively analyzed. Results A total of 6 626 recurrent laryngeal nerve (left side 3 248, right side 3 378) were exposed in 4 054 cases. Fifteen patients with non-recurrent laryngeal nerve were detected with an incidence of 0.23% (15/6 626), all located on the right side. There were 3 males and 12 females. There were 3 cases of type Ⅰ, 10 cases of type Ⅱa, 2 cases of type Ⅱb. And 2 patients with non-recurrent laryngeal nerve were injured. Conclusions Incidence of non-recurrent laryngeal nerve is lower, most of which occur on right side of neck, there is a high injury rate for its special anatomical location. It’s key to prevent nerve injury for careful interpreting preoperative auxiliary examination results and improving awareness of non-recurrent laryngeal nerve, fining dissection, conventional exposuring recurrent laryngeal nerve, and accurate using nerve monitor during operation.
Objective To investigate the expression of c-met in tall cell variant of papillary thyroid carcinoma, and to compare it with other types of thyroid carcinoma and benign thyroid tissue. Methods The expressions of c-met in 60 cases of thyroid specimens were tested by immunohistochemical staining. Results The levels of expressed c-met in tall cell variant specimens were significantly higher than those in other types of papillary thyroid carcinoma and benign thyroid tissue. c-met expressions were significantly different in the following pairs of types: tall cell variant vs common papillary carcinoma of thyroid (P=0.000 1), tall cell variant vs follicular variant papillary thyroid carcinoma (P=0.000 1), and tall cell variant vs benign thyroid tissue (P=0.000 1). In addition, for all types of papillary carcinomas evaluated, c-met expression was significantly higher in specimens with extracapsular spread (P=0.010 0) and skeletal muscle invasion (P=0.020 0). Conclusion The high expression of c-met is a significant marker for tall cell variant papillary carcinoma of thyroid and its invasive behavior. This finding may explain the unusually aggressive behavior of this tumor and suggest a role for c-met in the early identification of patients with tall cell variant thyroid carcinoma.
The peak period of cardiovascular disease (CVD) is around the time of awakening in the morning, which may be related to the surge of sympathetic activity at the end of nocturnal sleep. This paper chose 140 participants as study object, 70 of which had occurred CVD events while the rest hadn’t during a two-year follow-up period. A two-layer model was proposed to investigate whether hypnopompic heart rate variability (HRV) was informative to distinguish these two types of participants. In the proposed model, the extreme gradient boosting algorithm (XGBoost) was used to construct a classifier in the first layer. By evaluating the feature importance of the classifier, those features with larger importance were fed into the second layer to construct the final classifier. Three machine learning algorithms, i.e., XGBoost, random forest and support vector machine were employed and compared in the second layer to find out which one can achieve the highest performance. The results showed that, with the analysis of hypnopompic HRV, the XGBoost+XGBoost model achieved the best performance with an accuracy of 84.3%. Compared with conventional time-domain and frequency-domain features, those features derived from nonlinear dynamic analysis were more important to the model. Especially, modified permutation entropy at scale 1 and sample entropy at scale 3 were relatively important. This study might have significance for the prevention and diagnosis of CVD, as well as for the design of CVD-risk assessment system.
Thumb and finger reconstruction by the method of pedal digit transplantation had been successfully performed in 541 casee from 1977 to 1996, which contained 404 cases of thumbs and 78 cases of fingers. The thumb reconstruction was mainly the simple transplantation of distal phalanx (42 cases) and the compound transplantation of hallucal nail-cutaneous flap with iliac bone segment (16 cases) for the defect of thumbs in degree 1 and 2. The combined transplantation of hallucal nail-cutaneous flap with the joint and tendons of the second toe (34 cases) and the transplantation of the distal part of the second toe (182 cases) for the defect of degree 3 and 4. The combined transplantation of the second pedal digit with its metatarsalphalangeal joint (189 caese) for the defect in degree 5 and 6. The finger reconstruction was performed by anastomosis of the arteries of the digit with those of the fingers for 29 cases with the defect in degree 2 and 3, 60 cases with the defect in degree 4 and 5, and 17 cases with the defect in degree 6. One-hundred and four cases of versels vasiation were found in this group (19 cases with the pedal dorsal artery, 13 cases with the greater saphenous vein and 72 cases with the first dorsal metatarsal artery). The main point of the operation and the treatment of the vessel variations were discussed.
Objective To systematically review the effect of percutaneous acupoint electrical stimulation (TEAS) on heart rate variability (HRV). Methods The PubMed, Embase, Ovid MEDLINE, Cochrane Library, CNKI, WanFang Data, VIP, and CBM databases were electronically searched to collect randomized controlled trials (RCTs) on the effects of percutaneous acupoint electrical stimulation on heart rate variability from inception to February 28, 2023. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results A total of 14 RCTs involving 719 patients were included. The results of meta-analysis showed that SDNN (MD=12.95, 95%CI 9.18 to 16.72, P<0.01), RMSSD (MD=1.81, 95%CI 0.10 to 3.53, P=0.04), pNN50 (MD=1.75, 95%CI 1.02 to 2.48, P<0.01), HF (SMD=0.27, 95%CI 0.01 to 0.52, P=0.04), LF/HF (MD=−0.07, 95%CI −0.12 to −0.03, P<0.01), ln-LF (MD=0.63, 95%CI 0.25 to 1.01, P<0.01), ln-HF (MD=1.05, 95%CI 0.60 to 1.49, P<0.01), mean RR (MD=−11.86, 95%CI −21.77 to −1.96, P=0.02), and HR (SMD=−0.43, 95%CI −0.66 to −0.20, P<0.01) all showed improvement compared with the control group. However, there were no significant differences between the two groups in LF (SMD=0.15, 95%CI −0.10 to 0.40, P=0.23), LF norm (SMD=0.24, 95%CI −0.10 to 0.58, P=0.16) or HF norm (SMD=0.25, 95%CI −0.47 to 0.97, P=0.5). TEAS on PC6: SDNN, pNN50, HF, LF/HF, LF norm, HF norm, ln-LF, ln-HF, and HR all showed improvement compared with the control group. However, there were no significant differences between the two groups in RMSSD, LF, or RR interval. Conclusion This study supports the improvement of heart rate variability by transcutaneous acupoint electrical stimulation and PC6 acupoint selection. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
目的:研究老年患者依托咪酯靶控输注时不同BIS值(脑电双频指数)的HRV(心率变异性)的变化情况,探讨不同镇静深度与HRV之间的关系。方法:选择65岁以上行门诊胃镜检查患者30例,随机分为3组,A组BIS45~55,B组55~65,C组65~75,各组均在麻醉前、麻醉诱导后,术中、术毕监测BIS、HRV及血液动力学指标。结果:A组各监测HRV明显降低(Plt;0.05),B组仅有轻度下降(Pgt;0.05),C组明显升高(Plt;0.05)。结论:患者镇静深度BIS55~65时,即可明显抑制内镜操作刺激所致的HRV变化,是临床较为合适的镇静深度,可显著降低老年患者交感神经活性、交感/迷走神经均衡性和自主神经总张力,利于机体血液动力学稳定。
High performance liquid chromatography (HPLC) is currently the mainstream technology for detecting hemoglobin. Glycated hemoglobin (HbA1c) is a gold indicator for diagnosing diabetes, however, the accuracy of HbA1c test is affected by thalassemia factor hemoglobin F (HbF)/hemoglobin A2 (HbA2) and variant hemoglobin during HPLC analysis. In this study, a new anti-interference hemoglobin analysis system of HPLC is proposed. In this system, the high-pressure three-gradient elution method was improved, and the particle size and sieve plate aperture in the high-pressure chromatography column and the structure of the double-plunger reciprocating series high-pressure pump were optimized. The system could diagnose both HbA1c and thalassemia factor HbF/HbA2 and variant hemoglobin, and the performance of the system was anti-interference and stable. It is expected to achieve industrialization. In this study, the HbA1c and thalassemia factor HbF/HbA2 detection performance was compared between this system and the world’s first-line brand products such as Tosoh G8, Bio-Rad Ⅶ and D10 glycosylated hemoglobin analysis system. The results showed that the linear correlation between this system and the world-class system was good. The system is the first domestic hemoglobin analysis system by HPLC for screening of HbA1c and thalassemia factor HbF/HbA2 rapidly and accurately.
ObjectiveTo understand the significance of common gene variations in the diagnosis, treatment, and prognosis of papillary thyroid cancer (PTC). MethodThe literature relevant research on PTC gene variations both domestically and internationally was reviewed. ResultsThe most common genetic variations in the PTC in clinical studies included mutations or rearrangements in BRAF, TERT promoter, RAS, RET, and other genes, which had certain diagnostic value for PTC, but the drugs available for their treatment was relatively limited; Moreover, it had been found that multiple genes co-mutations were also common in the PTC, and the prognosis was often worse. ConclusionsBy sorting out the genetic variations in PTC, new ideas and methods are provided for the diagnosis, treatment, and prognosis of PTC. By detecting the types of genetic variations, the occurrence, development, and prognosis of PTC can be predicted, and personalized treatment plans can be developed for patients with PTC.
ObjectiveTo evaluate the value of stroke volume variation (SVV) and intrathoracic blood volume index (ITBVI) to predict fluid responsiveness in mechanically ventilated septic shock patients with spontaneous breathing. MethodsA prospective observational study was conducted in the Department of Critical Care Medicine of the First Affiliated Hospital of Guangzhou Medical University. Fluid resuscitation data was collected in septic shock patients who received PiCCO monitoring from June 2013 to June 2014. Transpulmonary thermodilution data were collected before and after fluid resuscitation, including cardiac index (CI), SVV, ITBVI, and central venous pressure (CVP). Seventeen patients were defined as responders by an observed increase of≥15% in the cardiac index (CI) after fluid resuscitation, 12 patients were defined as non-responders. Pearson correlation between changes of CI (ΔCI) and SVV, ITBVI, CVP was established. Area under the receiver operating characteristic (ROC) curve of SVV, ITBVI and CVP was calculated for predicting fluid responsiveness. ResultsBaseline CI and ITBVI were significantly lower in the responders (P < 0.05).There was no significant difference in baseline SVV between the responders and the non-responders (P > 0.05). A significant correlation was found between baseline ITBVI andΔCI (r=-0.593, P < 0.001), but no significant correlation between SVV andΔCI (r=0.037, P=0.847) or CVP andΔCI (r=0.198, P=0.302). The area under ROC curve of SVV, ITBVI and SVV for predicting fluid responsiveness was 0.640 (P=0.207), 0.865 (P=0.001), and 0.463 (P=0.565), respectively. The cut-off value of ITBVI for predicting fluid responsiveness was 784 mL/m2 with a sensitivity of 100.0% and a specificity of 70.6%. ConclusionIn mechanically ventilated septic shock patients with spontaneous breathing, ITBVI may be a valuable indicator in predicting fluid responsiveness compared with SVV.