简介：AbstractAdvances in imaging for preoperative localization have propelled the widespread adoption of minimally invasive/focused parathyroidectomy in primary hyperparathyroidism. Though it is performed through a relatively small incision, studies have shown that the presence of a neck scar increases attentional bias towards the neck resulting in compromised quality of life. Transoral endoscopic parathyroidectomy vestibular approach (TOEPVA) eliminates a neck scar. While indications for TOEPVA are the same as that of minimally invasive open parathyroidectomy, confident preoperative localization of the parathyroid with a surgeon performed ultrasound along with concordant localization with SPECT CT is an essential prerequisite before offering patients this approach for parathyroidectomy. Early data has demonstrated the feasibility and safety of this approach.

简介：根据灵龟八法取穴，并辨证配穴，治疗肥胖症惠者30例，结果显效6例，有效21例，无效3例，总有效率为90．0％。

简介：Objective:Survivalandtreatmentofpatientswithmicroinvasivebreastcancer(MIBC)remaincontroversial.Inthispaper,weevaluatedwhetheradjuvantchemotherapyisnecessaryforpatientswithMIBCtoidentifyriskfactorsinfluencingitsprognosisanddecidetheindicationforadjuvantchemotherapy.Methods:Inthisretrospectivestudy,108patientswithMIBCwererecruitedaccordingtoseventheditionofthestagingmanualoftheAmericanJointCommitteeonCancer(AJCC).Thesubjectsweredividedintochemotherapyandnon-chemotherapygroups.Wecomparedthe5-yeardisease-freesurvival(DFS)andoverallsurvival(OS)ratesbetweengroups.Furthermore,weanalyzedthefactorsrelatedtoprognosisforpatientswithMIBCusingunivariateandmultivariateanalyses.Wealsoevaluatedtheimpactofadjuvantchemotherapyontheprognosticfactorsbysubgroupanalysisaftermedianfollow-uptimeof33months(13-104months).Results:The5-yearDFSandOSratesforthechemotherapygroupwere93.7%and97.5%,whereasthoseforthenonchemotherapygroupwere89.7%and100%.Resultsindicatethat5-yearDFSwassuperior,butOSwasinferior,intheformergroupcomparedwiththelattergroup.However,nostatisticalsignificancewasobservedinthe5-yearDFS(P=0.223)orOS(P=0.530)rateofthetwogroups.Mostrelevantpoor-prognosticfactorswereKi-67overexpressionandnegativehormonalreceptors.Cumulativesurvivalwas98.2%vs.86.5%betweenlowKi-67(≤20%)andhighKi-67(>20%).ThehazardratioofpatientswithhighKi-67was16.585[95%confidenceinterval(CI),1.969-139.724;P=0.010].Meanwhile,ER(-)/PR(-)patientswithMIBChadcumulativesurvivalof79.3%comparedwith97.5%forER(+)orPR(+)patientswithMIBC.ThehazardratioforER(-)/PR(-)patientswithMIBCwas19.149(95%CI,3.702-99.057;P<0.001).SubgroupanalysisshowedthatchemotherapycouldimprovetheoutcomesofER(-)/PR(-)patients(P=0.014),butnotthosewhooverexpressKi-67(P=0.105).Conclusions:PatientswithMIBCwhooverexpressKi-67and

简介：

简介：

简介：ObjectiveToreportuseoftheVibrantSoundbridge(VSB)inpatientswithcongenitaldeformationofthemiddleandouterearsandinvestigateitsutilityinthispatientpopulation.MethodFourpatientswithcongenitaldeformationofmiddleandouterearsunderwentVSBimplantation.Allweremale(aged3-18years,average13.5years)andoperatedontheleftside.Malformationwasbilateralin3patientsandunilateralin1patient.Surgicaltechniquesweremodifiedtoaccommodateeachpatient’suniqueconditionsandneeds.Theimplantsitewasapproachedviathefacialrecessin3patientsandthrougharetro-facialnerveroutein1patient.TheVSBimplantwasconnectedtoeitherthestapes(2cases)ortheroundwindow(2cases).PuretoneandspeechaudiometryresultsanddailycommunicationcapabilitiesbeforeandafterVSBactivationwerecompared.ResultsTheoperationsweresuccessfulinallpatients,withnocomplications.ThepatientcommunicationlevelimprovedsignificantlyafterVSBactivation.Averageairconductionpuretonethresholdorconditionedreflexaudiometrythresholdimprovedby35dBinthe0.25-4kHzrange,from69dBHLbeforeVSBactivationto34dBHLafter.Thesentencerecognitionrateinquietat65dBSPLwentupto86%from0%withoutVSBforpatientswithbilateraldeformationandremainedat100%forthepatientwithunilateraldeformity.However,forthelatterpatient,therateimprovedto20%from0%withoutVSBinnoise(-8dBSNR).ConclusionVSBisanexcellentsolutionforimprovinghearinginpatientswithcongenitaldeformationofmiddleandouterears.Operationcanbecompletedandgoodresultscanbeachievedeveninpatientswithuniqueconditionsandneeds.

简介：无

简介：Objective:Toobservetheeffectofacupunctureonsimpleobesityandcellularhemorheology.Methods:Thirty-twocasesofsimpleobesitypatientswereenrolledintothisstudy.AcupointsoftheStomachMeridianandSpleenMeridianasZhongwan(中脘CV12),Liangmen(梁门ST21),Tianshu(天枢ST25),Guanyuan(关元CV4),etc.werepunctured,oncedailyinthefirst5days,andonceeveryotherdayafterwards,with10sessionsbeingatherapeuticcourse.Beforetreatmentandafter3coursesoftreatment,thebodyweight,waistline,weightindex,serumcholesterol(CH),triglycerideandaggregationindexofredbloodcell(RBC)weredetected.Results:Afteracupuncturetreatment,alltheindexesofbodyweight,waistline,weightindex,serumCH,triglycerideandaggregationindexofRBCdecreasedsignificantlyincomparisonwiththoseofpre-treatment(P<0.05).Conclusion:Acupuncturecanapparentlyimprovecellularhemorheology,reducebodyweight,serumcholesterolandTGlevelsinsimpleobesitypatients.

简介：Objective:Toinvestigatetheprevalenceoflong-termfatigue,anxiety,depressionandsocialsupport,andtherelationshipsamongthesesymptomsinpostoperativepatientswithbreastcancer.Methods:Atotalof180postoperativepatientswithbreastcancermeetingcriterionwererecruitedinthiscross-sectionalstudy.TheBriefFatigueInventory(BFI),HospitalAnxietyandDepressionScale(HADS)andTheSocialSupportSurvey-Chineseversionwereusedtoassessingthefatigue,anxietyanddepression,Socialsupportofparticipants.ThemagnitudeoftherelationshipamongthesymptomsoffatigueandothervariableswasmeasuredbySpearmanRhocorrelation.Results:Theprevalenceoflong-termfatiguewas52.7%,and18.3%occurredmoderate/severefatigue.Two-thirdsofpatientshadabasalsocialsupport,only12.8%ofpatientshadbetter-perceivedsocialsupport.ResultsofHADSshowedthat16.7%and21.1%oftheparticipantshaveanxietyordepressiondisorder.Moderate/severefatiguewasnegativelycorrelatedwithsocialsupport(r=–0.158,P=0.038)andpositivelycorrelatedwithage(r=0.132,P=0.042),chemotherapy(r=0.297,P=0.027),anxiety(r=0.324,P=0.018)anddepression(r=0.211,P=0.034).Conclusions:Long-termfatiguewashighlyprevalentamongoverhalfofpostoperativepatientswithbreastcancer,andmoderate/severefatiguewasassociatedwithsocialandpsychologicalfactorssuchassocialsupport,anxietyanddepression.Ourresultssuggestthatoverallnursingcaremaybeamoreeffectivemannerinimprovingfatigueandqualityoflife.

简介：BackgroundArrhythmogenicrightventricularcardiomyopathy(ARVC)isamajorcauseforsuddencardiacdeathduetoventriculartachycardia.Litterisknownaboutitslong-termoutcomesinChineseARVCpatients.Thepurposeofthisstudywastoevaluatethelong-termclinicaloutcomesinpatientswithARVCandtoclarifytheriskfactorsofcardiacevents.MethodsFortysubjectsfulfillingmodifiedTaskForcecriteriawereincludedinthisstudy.Informationonclinicalpresentation,electrocardiographicandcardiacimagingfindings,andlong-termoutcomeofcaseswereinvestigated.ResultsAveragefollow-upperiodfromonsetwas57.5±42.6months.Themeanageatonsetofsymptoms(32.2±12.7years)andmalepredominance(85.0%)weresimilartothatreportedinotherstudies.Palpitationswerethemostfrequentsymptom(82.5%).T-waveinversionwasthemostcommonpresentingabnormalityonresting12-leadECG(75%).Ventriculartachycardiawithleftbundlebranchblockmorphologywassubsequentlydocumentedinatotalof28(70%)subjectsduringastudyperiod.Thecumulativemortalityratewas7.5%.ConclusionClinicalpresentationinChineseARVCpatientswassimilartothatreportedinotherstudies.ARVCisassociatedwithearlymortalitythatisdifferenttoothercountrypopulation.

简介：

简介：Toinvestigatetherelationshipbetweenthechronotropicincompetenceandangiographicseverityofcoronaryarterydisease,andtheclinicalvalueofinappropriatechronotropicresponsesinexercise.MethodsCoronaryangiographywasperformedin130patientssuspectedordiagnosedascoronaryheartdisease(CHD),andangiographicseverityofcoronaryarterydiseasewasquantitatedbyDukescoreandGensiniscore.Thepatientsweredividedinto4groups:non-CHDgroup(39cases),CHDgroupwithonlyonecoronaryarteryinvolved(CHD1,30cases),CHDgroupwithtwocoronaryarteriesinvolved(CHD2,31cases)andCHDgroupwiththreecoronaryarteriesinvolved(CHD3group,30cases).Amonthbeforecoronaryangiography,symptom-limitedbicycleergometorexercisehadbeenaccomplished,thechronotropicresponsehadbeenmeasuredandexpressedasratioofheartratereserve(HRR)andthemaximalage-predictedheartrateachieved(rHR).ResultsAnalysisofvarianceshowedthatrHRandHRRweremuchsignificantlylower(allP<0.01)inCHD2group(rHR0.793±0.078,HRR0.626±0.110)andCHD3group(rHR0.775±0.065,HRR0.586±0.125)thanthatinnon-CHDgroup(rHR0.888±0.062,HRR0.798±0.105)andCHD1group(rHR0.857±0.084,HRR0.735±0.146).rHRwassimilarbothbetweennon-CHDgroupandCHD1group(P>0.05)andbetweenCHD2groupandCHD3group(P>0.05).HRRhasnodifferencebetweenCHD2groupandCHD3group(P>0.05),butwassignificantlydifferentbetweennon-CHDgroupandCHD1group(P<0.05).TherewasasignificantlynegativecorrelationbetweenrHR,HRRandDukescore(r=-0.554,-0.578,respectively,allP<0.01),Gensiniscore(r=-0.453,-0.467,respectively,allP<0.01).CHDproportionreached75%inpatientswhohadpositiverHR(orHRR)andnon-STdepression.Diagnosticvalue[sensitivity0.868(P<0.01),0.846(P<0.01),specificity0.462,0.462,accuracy0.746(P<0.05),0.731,positivepredictivevalue0.790,0.786,negativepredictivevalue0.600,0.563,respectively]ofrHR<85%orHRR<72%whichwereusedasan

简介：ObjectiveToanalyzethecharacteristicsofauditorybrainstemresponse(ABR)inpresbycusispatientsel-derthan90years.MethodsFourteenpresbycusispatientselderthan90years(presbycusisgroup,91.1.4±1.3years,26ears)and9normal-hearingyoungadults(controlgroup,22.7±1.2years,18ears)participatedinthestudy.Alternativeclick-evokedABRswererecordedinbothgroups.Thepeaklatency(PL)ofpeakI,Ⅲ,andV,andtheinter-peaklatency(IPI)ofI-Ⅲ,Ⅲ-V,andI-Vwerecomparedbetweengroups.ResultsInelderpresbycusispatients,theoccurrencerateofpeakIandⅢwereboth76.9%,andthatofpeakVwas84.6%.Inpresbycusisgroup,thepeaklatenciesofI,Ⅲ,Vweresignificantlylongerthanthatofcontrolgroup(P<0.001).TherewasnosignificantdifferencebetweengroupsintheIPIofpeakI-IⅢ(P=0.298,peakⅢ-V(P=0.254)andpeakI-V(P=0.364).ConclusionsAuditorybrainstemresponsesinpresbycusispa-tientselderthan90yearsshowedworsewavedifferentiation.

简介：AbstractAs a highly infectious respiratory tract disease, coronavirus disease 2019 (COVID-19) can cause respiratory, physical, and psychological dysfunction in patients. Therefore, pulmonary rehabilitation is crucial for both admitted and discharged patients of COVID-19. In this study, based on the newly released pulmonary rehabilitation guidelines for patients with COVID-19, as well as evidence from the pulmonary rehabilitation of patients with severe acute respiratory syndrome, we investigated pulmonary rehabilitation for patients with COVID-19 having complications, such as chronic pulmonary disease, and established an intelligent respiratory rehabilitation model for these patients.

简介：客观：与严重煽动性的反应症候群(先生)在创伤的病人调查甲状腺荷尔蒙的引申。方法：有严重先生的五十个创伤的病人被注册并且根据他们是否介绍了multiorgandysfunction症候群(MODS)把组划分了成二。甲状腺荷尔蒙大小被拿，包括totaltriiodothyronine(TT3)，全部的甲状腺素(TT4)，免费triiodothyronine(FT3)，免费甲状腺素(FT4)和甲状腺刺激荷尔蒙(TSH)。尖锐生理学和长期的健康评估Ⅱ(APACHEⅡ)20根据临床的数据被计算。恢复或恶化的结果被记录，以及从到时间甲状腺荷尔蒙的先生的发作的时间的长度被测量。结果：Euthyroid病了的症候群(S字)在45cases.TT3水平被介绍否定地与APACHEH分数被相关(r=-0.330,P<0。05)，并且TT3/TT4value否定地与先生的持续时间被相关(r=-0.316,P<0.05)。没有MODS，在MODS病人的TT3，TT4和FT3levels是比那些显著地低的(P<0.05)。没有MODS，给低TT4或FT4的MODS病人比那些经常铺平更多(P<0.05)。与在正常TSH组的病人相比，有有的减少的TSH的病人降低T3，T4，恢复率和更高的APACHEⅡ分数，MODS发生，但是二个组之间没有差别(P>0.05).Conclusions：有严重先生的损伤病人有高可能性得到S字，它更经常并且严重地发生在MODS病人。它在甲状腺轴上显示出先生的影响。Withthe坚持和先生的恶化，有甲状腺荷尔蒙的进步减小。

简介：Maintainingstandingposturalbalanceisimportantforwalkingandhandlingabilitiesinpatientswithcerebralpalsy.Thisstudyincluded23patientswithcerebralpalsy(sevenwithspasticdiplegiaand16withspastichemiplegia),agedfrom7to16yearsofage.StandingposturebalancemeasurementswereperformedusinganAMTImodelOR6-7forceplatformwiththeeyesopenandclosed.Patientswithdiplegiccerebralpalsyexhibitedgreatercenterofpressuredisplacementareaswiththeeyesopenandgreatercenterofpressureswayinthemedial-lateraldirectionwiththeeyesopenandclosedcomparedwithhemiplegicpatients.Thus,diplegicpatientsexhibitedweakerposturalbalancecontrolabilityandlessstandingstabilitycomparedwithhemiplegiccerebralpalsypatients.

简介：无

简介：目的：研究手法对于颈本体觉紊乱的眩晕患者的头颅空间回复能力的影响。方法：利用头颅三维空间运动测量仪，临床观察72例颈本体觉紊乱的眩晕患者手法治疗前后其头颅空间回复能力的变化。另外选取51颈椎动脉供血不足的眩晕患者及138例正常人作对照组。结果：手法治疗后本体觉组在三个运动轴线上的头颅空间偏移度均有明显减小，结论手法有即刻改善颈本体觉功能的作用，在临床椎动脉供血不足型眩晕的发病也存在着本体觉紊乱的因素。

简介：Objective:Secretorybreastcarcinoma(SBC)isararetypeofbreastmalignancy,accountingforlessthan0.02%ofallinfiltratingbreastmalignancies.ThepureSBC,atypeofSBCwithoutanothertypeofbreastmalignantneoplasm,isparticularlyrare.ThisstudyaimedtoinvestigatetheclinicopathologicandmolecularfeaturesofpureSBC.Methods:Themainpathologicalparameterssuchasestrogenreceptor(ER),progesteronereceptor(PR),andhumanepithelialgrowthfactorreceptor2(C-erbB-2)weredetectedbyimmunohistochemistry(IHC),andtheclinicopathologicandprognosticdifferencewerecomparedwithinvasiveductalcarcinoma(IDC).Fluorescentinsituhybridization(FISH)andreversetranscriptionpolymerasechainreaction(RT-PCR)wasperformedtoidentifytheETV6-NTRK3rearrangementofSBC.Results:WefoundthatthepositivityratesofER,PR,C-erbB-2,p53,andS-100were47.7%(21/44),52.3%(23/44),36.4%(16/44),27.3%(12/44),and95.5%(42/44),respectively,whichwerehigherthanthosereportedinpreviousstudies.Specialperiodicacid-Schiffanalysiswasperformedin36patients,andthevalueoftheKi-67indexrangedfrom1%to50%(meanvalue:10%).Interestingly,mostpatientswithpureSBCharboredanETV6-NTRK3rearrangementwithan88.6%(39/44)expressionrate.ComparedwithIDC,thetumorsizeofmostpatientswithSBCwaslargerthan2cm(P=0.024).Ultrasoundshowedbenignlesions,andthetotalmisdiagnosisratewashigher(P=0.020).Althoughthepathologicalclassificationwasmostlytriple-negativebreastcancers(P=0.036),therewaslessmetastasis(P=0.029),andtheoverallprognosiswasbetterthanthatoftheIDCgroup.Conclusions:Althoughaxillarylymphnodemetastasis,localrecurrence,ordistantmetastasismayoccur,SBCisalsoconsideredanindolentneoplasmwithagoodprognosis.Oncediagnosed,surgicaltreatmentshouldbeperformedassoonaspossible,followedbyappropriateadjuvantchemotherapy,irradiation,andendocrinetherapies.

简介：AbstractPurpose:Hemodynamically unstable patients with pelvic fractures still represent a challenge to trauma surgeons and have a very high mortality. This study was designed to explore the effect of the interventions of direct preperitoneal pelvic packing for the hemodynamically unstable pelvic fractures.Methods:This retrospective study enrolled 67 cases of severe pelvic fractures with unstable hemodynamics from October 2011 to December 2019. All patients presented in our emergency center and received preperitoneal pelvic packing were included in this study. The indication was persistent systolic blood pressure ≤90 mmHg during initial resuscitation and after transfusion of two units of red blood cells. Patients with hemodynamic stability who need no preperitoneal pelvic packing to control bleeding were excluded. Their demographic characteristics, clinical features, laboratory results, therapeutic interventions, adverse events, and prognostic outcomes were collected from digital information system of electronic medical records. Statistics were described as mean ± standard deviation or medium and analyzed using pair sample t-test or Mann-Whitney U-test.Results:The patients’ average age was 41.6 years, ranging from 10 to 88 years. Among them, 45 cases were male (67.2%) and 22 cases were female (32.8%). Significant difference was found regarding the systolic blood pressure (mmHg) in the emergency department (78.4 ± 13.9) and after preperitoneal pelvic packing in the surgery intensive care unit (100.1 ± 17.6) (p < 0.05). Simultaneously, the arterial base deficit (mmol/L) were significantly lower in the surgery intensive care unit (median -6, interquartile range -8 to -2) than in the emergency department (median -10, interquartile range -14 to -8) (p < 0.05). After preperitoneal pelvic packing, 15 patients (22.4%) underwent pelvic angiography for persistent hypotension or suspected ongoing haemorrhage. The overall mortality rate was 29.5% (20 of 67).Conclusions:Preperitoneal pelvic packing, as a useful surgical technique, is less invasive and can be very efficient in early intra-pelvic bleed control.