Liaocheng People's Hospital Research Articles

Application value of adrenal venous sampling in the surgical treatment of primary aldosteronism.

The diagnosis of primary aldosteronism (PA) is critical for determining treatment strategies. The aim of the present study was to investigate the clinical value of preoperative adrenal venous sampling (AVS) for determining the benefit of PA surgery. Patients diagnosed with PA at Liaocheng People's Hospital (Liaocheng, China) between January 2015 and December 2020 were selected and divided into two groups: Group A underwent adrenal computed tomography (CT) only, whereas Group B underwent adrenal CT and successful AVS. Subsequently, the improvement rate of adrenal CT and adrenal CT + AVS in the treatment of PA was compared. A total of 164 patients were included, with an average age of 46.69±13.64 years. There were 62 patients in Group A and 102 in Group B. Among the patients diagnosed with unilateral lesions on adrenal CT scan, 82.61% of patients in group A and 87.72% in group B showed improvement; however, the difference was not significant (χ2=0.534, P=0.465). Among the patients diagnosed with bilateral lesions on adrenal CT images, 62.50% of patients in Group A and 91.11% of patients in Group B showed improvement (P=0.019). In conclusion, unilateral adrenal lesions detected by CT did not benefit significantly from surgical decision-making after AVS. AVS should be advised for all patients with bilateral adrenal PA who are willing to undergo adrenal surgery, which is conducive to correct lateral segmentation and improve treatment choices.

Optimal surgical population for cervical lymph node dissection in PTC.

There is still controversy about whether cervical lymph node dissection should be performed in surgical treatment of PTC. Based on the data of thyroid cancer patients from Liaocheng People's Hospital from 2015 to 2018, this study focused on appropriate indications for cervical lymph node dissection surgery. The clinical and pathological data of patients with initial treatment of PTC in thyroid surgery department from 2015 to 2018 were collected. In all cases, 1001 patients underwent total thyroidectomy + central lymph node dissection, and 1107 patients underwent total thyroidectomy + central + cervical lymph node dissection. The average metastasis rate of all cases was 57.23%, and even the metastasis rate of PTMC was as high as 48.97%. The total metastasis rate of central and lateral cervical lymph nodes was 74.44%, and the cervical lymph nodes were present in 49.32% of the metastatic cases. In 55.56% of the cases, the tumor diameter was more than 1 cm, and the metastasis rate of cervical lateral area was 56%. With the increase of tumor diameter, the cervical metastasis rate increased from 22.54% to 73.33%. The metastasis rate of PTC is more than 50%, and nearly half of them have cervical metastasis, especially in patients with high risk factors. We observed that PTC 1 cm or greater has significant rates of metastasis.

Feasibility of tension-free repair of inguinal hernia in senile patients under ultrasound-guided local nerve block

The clinical characteristics of open hernia repair under local nerve block guided by ultrasound and epidural anesthesia under daytime surgery mode were compared and analyzed, and the safety, rationality and effectiveness of tension-free repair of inguinal hernia in elderly patients under local nerve block guided by ultrasound were discussed. The clinical data of 200 patients who underwent inguinal hernia day surgery in Liaocheng People's Hospital Affiliated to Shandong First Medical University from January 2022 to October 2022 were retrospectively analyzed, including 150 patients who underwent local anesthesia block surgery and 50 patients who underwent epidural surgery. The visual analog score of the ultrasound local anesthesia group was lower than that of the epidural surgery group at 4 h after operation. The time of getting out of bed and postoperative exhaust were shorter than those of epidural operation group. The recovery rate of unrestricted activity 2 weeks after surgery was higher than that in epidural surgery group (P < 0.05). The incidence of postoperative acute urinary retention between the two groups was lower in local ultrasound anesthesia group, and the difference was statistically significant (P < 0.05). The median follow-up time was 4(1–6) months, and the follow-up rate was 100%. Postoperative complications were seroma, wound infection, chronic pain and recurrence, and there was no statistical significance between the two groups (P > 0.05). No serious complications occurred in both groups. Compared with open epidural surgery, ultrasound-guided local nerve block tension-free day surgery in the elderly has the advantages of less pain, faster recovery, and is safe and feasible.

Value of neutrophil-to-lymphocyte ratio in neuronal intranuclear inclusion disease

Background and objectivesThe neutrophil-to-lymphocyte ratio (NLR) is a widely recognized marker of inflammation in peripheral blood. However, its specific role in neuronal intranuclear inclusion disease (NIID) has not been reported. This study aims to investigate the relationship between NIID and NLR. MethodsA multicenter database was collected, including 157 NIID patients from seven hospitals (The Affiliated Hospital of Xuzhou Medical University, Yantai Yuhuangding Hospital, Tengzhou Central People's Hospital,The Affiliated Brain Hospital of Nanjing Medical University, Liaocheng People's Hospital,The Second Hospital of Shandong University, Inner Mongolia People's Hospital, Xuanwu Hospital Capital Medical University,The First Affiliated Hospital of USTC), along with 157 age- and gender-matched healthy control subjects. White blood cell counts (including neutrophils, lymphocytes, monocytes, eosinophils, and basophils) were obtained, and the NLR was calculated. Additionally, cognitive impairment was assessed using clinical evaluation scores. ResultsNIID patients exhibited significantly higher NLR values compared to the healthy control group (p < 0.001). The plasma NLR levels in NIID patients showed a weak positive correlation with disease duration (r = 0.219, p = 0.016). However, no significant correlations were found between NLR and age of onset or cognitive impairment (p > 0.05). ConclusionThere is a significant association between NLR and NIID, suggesting a potential role of peripheral blood inflammation in the pathogenesis of NIID.

Delayed discharge from post-anesthesia care unit: A 20-case retrospective series.

To summarize the characteristics of patients with delayed discharge from the post-anesthesia care unit and to analyze the factors and outcomes of delayed discharge. Twenty cases of delayed discharge from the PACU (PACU stay >2 hours after surgery) of the main operating room in Liaocheng People's Hospital, a class A tertiary comprehensive hospital, between January 1, 2021, and December 31, 2022, among 28,084 patients who were transferred to the PACU from the operating rooms after surgery, were retrospectively analyzed. The collected data included patient characteristics, American society of anesthesiologists grade, information related to surgery and anesthesia, and outcomes. The factors for delay were assigned to 1 of 6 groups: delayed recovery from anesthesia, surgical complications, cardiovascular instability, hypoxia, inadequate analgesia, and waiting for the operating room. The incidence of delayed discharge from PACU was 0.7‰. Among 20 patients, more than half of the patients were over 65 years of age, American society of anesthesiologists grade II~III, body mass index <30 kg/m2, and urological surgery (7, 35%), liver surgery (4, 20%), thoracic surgery (4, 20%) accounted for a relatively high proportion. Nineteen (95%) patients received general anesthesia with or without peripheral nerve block. The main factors included delayed recovery from anesthesia (6, 30%), surgical complications (5, 25%), cardiovascular complications (4, 20%), hypoxia (3,15%). After discharge from the PACU, 1 (5%) died in the intensive care unit, and the other 19 (95%) patients were safely discharged from the hospital. The incidence of delayed discharge from the PACU was low, and it was more likely to occur in the elderly, during major operations, and under general anesthesia. Delayed recovery from anesthesia was the most common factor. Most patients were safely discharged from the hospital.

Genetic analysis of fundic gland‑type gastric adenocarcinoma.

This study aimed to analyze the molecular characteristics of gastric adenocarcinoma of the fundic-gland type (GAFG) and explore the possible mechanism of tumor development. Samples from 10 Chinese patients with GAFG were collected at the Peking University International Hospital and Liaocheng People's Hospital between January 2015 and March 2022. The nucleic acid sequence of Epstein Barr virus-encoded RNA (EBV-EBER) was detected by in situ hybridization. Genetic mutation information for GNAS, KRAS, NRAS, BRAF, PIK3CA, TP53, APC, CTNNB1, HER2, MLH1, MSH2, MSH6, and PMS2 was obtained by Next-Generation Sequencing, and the relevant literature was reviewed. A total of eight instances of missense mutations were detected, consisting of seven cases with GNAS mutations, two cases with KRAS mutations, and one case with a TP53 mutation. Additionally, two patients had simultaneous missense mutations in GNAS and KRAS. Nonsynonymous mutations in APC, CTNNB1, NRAS, BRAF, PIK3CA, HER2, MLH1, MSH2, MSH6, or PMS2 were not observed in any cases. In addition, all tumors were EBER-negative. GAFG exhibits diversity at the molecular level, and GNAS mutations are more common than KRAS mutations, TP53 mutations, and microsatellite instability. To date, no association between EBV/HER2 and GAFG has been found.

Feature pyramid network-based computer-aided detection and monitoring treatment response of brain metastases on contrast-enhanced MRI

To investigate the value of feature pyramid network (FPN)-based computer-aided detection (CAD) of brain metastases (BMs) before and after non-surgical treatment, and to evaluate its performance in monitoring treatment response of BM on contrast-enhanced (CE) magnetic resonance imaging (MRI). Eighty-five cancer patients newly diagnosed with BM who had undergone initial and follow-up three-dimensional (3D) CE MRI at Liaocheng People's Hospital were included retrospectively in this study. Manual detection (MD) was performed by reviewer 1. Computer-aided detection (CAD) was performed by reviewer 2 using uAI Discover-BMs software. The treatment response was assessed by the two reviewers for each patient separately. A paired chi-square test was used to compare the differences in the detection of BM between MD and CAD. Agreement between MD and CAD in monitoring treatment response was assessed by kappa test. The sensitivities of MD and CAD on initial 3D CE MRI were 78.65% and 99.13%, respectively. The sensitivities of MD and CAD on follow-up 3D CE MRI were 76.32% and 98.24%, respectively. There was a very good agreement between Reviewer 1 and Reviewer 2 in evaluating the treatment response of BM. FPN-based CAD has a higher sensitivity of close to 100% and lower false negatives (FNs) for BM detection, compared to MD. Although CAD had a few shortcomings in reflecting changes of BMs after treatment, it had high performance in monitoring treatment response of BM on CE MRI.

Relationship between plasma levels of thrombin activatable fibrinolysis inhibitor, plasminogen activator inhibitor-1 and tissue-type plasminogen activator and deep venous thrombosis in patients with systemic lupus erythematosus

Objective: To investigate the plasma levels of thrombin activatable fibrinolysis inhibitor (TAFI), plasminogen activator inhibitor-1 (PAI-1) and tissue-type plasminogen activator (t-PA) in patients with systemic lupus erythematosus (SLE), and their relationship with deep venous thrombosis of the lower limbs. Methods: A case-control study was conducted to retrospectively select 32 SLE patients with deep venous thrombosis of the lower extremities (thrombus group) admitted to Liaocheng People's Hospital in Shandong Province from June 2018 to June 2021, including 4 males and 28 females, with a mean age of (49.7±5.5) years. Meanwhile, 64 SLE patients without deep venous thrombosis of the lower extremities (control group) were also selected, including 11 males and 53 females, with a mean age of (50.8±5.5) years. The plasma levels of TAFI, PAI-1 and t-PA of the two groups were compared. A logistic regression model was used to analyze the correlation of TAFI, PAI-1 and t-PA with SLE in patients. Results: The plasma levels of TAFI, PAI-1 and t-PA were (32.77±5.17) mg/L, (29.43±5.51) μg/L and (6.58±1.40) μg/L in the thrombotic group, while the plasma levels of TAFI, PAI-1 and t-PA in the control group were (23.56±4.40) mg/L, (19.00±4.40) μg/L and (9.40±2.23) μg/L. The levels of TAFI and PAI-1 in the thrombotic group were higher than those in the control group, while the level of t-PA was lower than that in the control group (all P<0.05). The results of logistic regression model showed that higher TAFI levels (OR=1.75, 95%CI: 1.05-2.90, P=0.043), higher PAI-1 levels (OR=1.85, 95%CI: 1.04-3.29, P=0.046), and lower t-PA levels (OR=0.72, 95%CI: 0.52-0.99, P=0.048) were related factors for the occurrence of deep venous thrombosis of the lower limbs in SLE patients. Conclusion: The plasma levels of TAFI and PAI-1 in SLE patients with deep venous thrombosis of the lower extremities increase, while the t-PA level decreases, which are related factors for the occurrence of deep venous thrombosis of the lower extremities in SLE patients.

High-risk HPV prevalence and genotype distribution among women in Liaocheng, Shandong Province, China from 2016 to 2022.

Human papilloma virus (HPV) infection and its associated disease are major problems affecting millions of individuals around the world. The distribution of HPV genotypes is specific to different areas and different populations. Therefore, understanding the prevalence and genotype distribution of HPV in different populations in different geographical regions is essential to optimize HPV vaccination strategies and to maximize vaccine effects. In this study, 34,076 women from January 2016 to July 2022 were retrospectively analyzed at Liaocheng People's Hospital. Of these, 7540 women were high-risk HPV positive and the infection rate was 22.13%. The top ten genotypes were as follows in descending order: HPV16, HPV52, HPV58, HPV53, HPV39, HPV59, HPV66, HPV51, HPV18, and HPV56 and the least frequent genotypes were, in order, HPV 26, HPV45, and HPV82. The HPV16 positive infection rate was 25.37% and was reduced with the increase in the number of individuals who had undergone HPV screening. The HPV52 infection rate increased with increasing numbers of individuals undergoing HPV screening, and then remained unchanged. The proportion of 20-29-year-olds among all positive women began to decrease since the vaccine was available in 2018. The 30-39-year-old group accounted for the highest percentage of positive women, and the 50-59-year-old group of HPV-positive women with cervical cancer accounted for most infections. This study confirmed that HPV16, HPV52, HPV 58, and HPV53 is widely distributed in this population and the total HR-HPV infection rate remains high in this region. Our findings indicate that prevention of HPV infection in this region still faces important challenges.

Serine/Threonine Protein Kinase-3 Promotes Oral Squamous Cell Carcinoma by Activating Ras-MAPK Mediated Cell Cycle Progression.

Serine/threonine protein kinase-3 (STK3) is a key molecule in the Hippo pathway, but its biological function in the development of oral squamous cell carcinoma (OSCC) remains unclear, we explored the roles of STK3 in OSCC. In this study, GEPIA was used to analyse STK3 expression in different types of tumor patients. OSCC patients were then collected from Liaocheng People's Hospital (Shandong, China), to further detect STK3 expression by qRT-PCR and Western blotting. To explore the function of STK3, overexpression and knockdown experiment were designed. Cell proliferation, migration and invasion were analyzed. First, STK3 is significantly up-regulated in OSCC patients, and high STK3 expression is associated with poor prognosis. Then, in vitro cell proliferation, migration, and invasion tests were used to determine the role of STK3. STK3 overexpression significantly promoted the proliferation, migration and invasion of OSCC cells. The downregulation of STK3 inhibited the proliferation, migration and invasion of OSCC cells. Finally, STK3 was demonstrated to promote oral squamous cell carcinoma by activating Ras-MAPK mediated cell cycle progression. The results showed that STK3 was a potential cancer promoter for OSCC. It plays an important role in promoting the progression of oral squamous cell carcinoma. Inhibition of STK3 may prove beneficial as a therapeutic strategy for OSCC treatment.

Impact of completion rates of 3-hour and 6-hour bundle on the prognosis of septic shock patients

To explore the impact of completion rates of 3-hour and 6-hour sepsis bundle therapy on prognosis of patients with septic shock in Prefecture-level grade A hospitals, and analyze the risk factors for prognosis. A retrospective analysis was conducted to patients with septic shock in the intensive care unit (ICU) of Liaocheng People's Hospital, Shandong Province from January 1, 2020 to December 31, 2021. The data of gender, age, acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), sites of infection, pathogenic microorganisms, completion rates of 3-hour and 6-hour sepsis bundle therapy, 28-day prognosis were collected. Logistic regression analysis was used to identify risk factors for patients' mortality at 28-day. (1) Among 159 patients with septic shock, 93 survived and 66 died with 28-day. There were no significant differences in gender and age between the survival group and death group. Compared with the survival group, APACHE II score and SOFA score were significantly higher in the death group [APACHE II score: 26.85±5.04 vs. 20.67±4.29, SOFA score: 12.86±3.02 vs. 9.37±2.51, both P < 0.05]. (2) Sites of infection in the 159 patients: 47 cases were abdominal infection (29.6%), 36 case were bloodstream infection (22.6%), 31 cases were pulmonary infection (19.5%), 16 cases were soft tissue infection (10.1%), 13 cases were urinary tract infection (8.2%), 12 cases were biliary tract infection (7.5%), and 4 cases were other sites infection (2.5%). Pathogens were found in 128 cases and the positive rate was 80.5%, including 90 cases of Gram-negative (G-) bacilli (56.6%), 27 cases of Gram-positive (G+) cocci (17.0%) and 11 cases of fungi (6.9%). The top three pathogenic bacteria were Escherichia coli (49 cases, 30.8%), Klebsiella pneumoniae (21 cases, 13.2%) and Staphylococcus aureus (15 cases, 9.4%). The differences were not statistically significant. (3) Among the 159 patients, 101 cases completed 3-hour sepsis bundle therapy (63.5%), including 67 cases (72.0%) in survival group and 34 cases (51.5%) in death group; 106 cases completed 6-hour sepsis bundle therapy (66.7%), including 70 cases (75.3%) in survival group and 36 cases (54.5%) in death group. The differences between the two groups were statistically significant (all P < 0.05). (4) The factors (APACHE II score, SOFA score and completion rate of 3-hour and 6-hour sepsis bundle therapy) affecting the prognosis in the univariate analysis were included in the binary Logistic regression analysis, and the results showed that the APACHE II score, SOFA score, completion rate of 3-hour sepsis bundle therapy were independent risk factors affecting mortality within 28-day [odds ratio (OR) was 1.216, 1.303, 0.402, all P < 0.05]. The higher APACHE II score and SOFA score in septic shock, the worse the prognosis. Improving the completion rates of 3-hour and 6-hour bundle therapy especially the completion rate of 3-hour bundle therapy can reduce the mortality of patients and improve the prognosis.

Value of ultrasonography in diagnosis and classification of Masson's tumor

A retrospective analysis was performed on 11 cases of Masson's tumor admitted to Liaocheng People's Hospital from January 2010 to July 2021. Among them, there were 4 males and 7 females, aged from 14 to 62 years, with a medical history of 1 to 24 months. All of the patients complained of touching the mass under the skin. In this group, 9 cases were pure form, 1 case was mixed form and 1 case was extravascular form. Ultrasound imaging can reflect the characteristics of Masson's tumor to a certain extent, which has a certain value in the diagnosis, classification and differential diagnosis.

Analysis of disease composition and outcome of patients in intensive care department of 3A hospitals: analysis of 3 249 cases in the department of Liaocheng People's Hospital from 2019 to 2021

To provide the basis and direction for the establishment of the database of severe patients by analyizing of the disease composition and outcome of patients in the department of critical care medicine of the 3A hospital. The clinical data of 3 249 patients admitted to the department of critical care medicine of Liaocheng People's Hospital from January 1, 2019 to December 31, 2021 were retrospectively analyzed, including gender, age, admission time, admission route, diagnosis, acute physiology and chronic health evaluation II (APACHE II) score 24 hours after admission, outcome and other information. The mean age of 3 249 patients was (61.99±18.29) years old, and the proportion of young and old patients aged 60-74 years accounted the largest (34.01%). There were more males (1 800 cases) than females (1 449 cases). The most patients were admitted in January (119 cases) and the least in March (75 cases). The top eight diseases in the department of critical care medicine were respiratory system diseases (21.88%), multiple injuries (12.65%), cardiovascular system diseases (11.48%), gastrointestinal surgery diseases (9.42%), pathological obstetrics (7.76%), digestive system diseases (7.63%), urinary system diseases (5.69%) and nervous system diseases (5.23%). Among 3 249 critically ill patients, 54.36% (1 766 cases) were transferred to the general ward for treatment after improvement, with APACHE II score was 17.99±5.51. 15.91% (517 cases) returned to local hospital for further treatment after improvement, APACHE II score was 22.48±6.57. 1.51% (49 cases) were transferred to superior hospitals, APACHE II score was 21.71±5.18. 24.22% (787 cases) were discharged automatically, APACHE II score was 25.64±5.45. 4.00% (130 cases) died in intensive care unit (ICU), APACHE II score was 29.08±8.10. The APACHE II score of patients who died in ICU was higher than that of patients who were transferred to another department, another hospital or discharged automatically after their condition improved, and the differences were statistically significant (all P < 0.001). Among 3 249 patients, a total of 1 265 patients were admitted to ICU for sepsis caused by aggravated infection, and 44.43% (562 cases) of the 1 265 patients improved to the general ward after treatment, with APACHE II score was 18.99±5.46. 19.21% (243 cases) returned to local hospital after treatment with APACHE II score was 22.79±6.74. 1.50% (19 cases) were transferred to superior hospitals for further treatment with APACHE II score was 21.21±4.81. 31.54% (399 cases) were discharged automatically with APACHE II score was 25.55±4.84; 3.32% (42 cases) died in ICU with APACHE II score was 27.69±7.92. The APACHE II score of patients who died in ICU was higher than that of patients who were transferred to another department, another hospital or discharged automatically after their condition improved, and the difference was statistically significant (all P < 0.001). Among the patient admitted to ICU 2019-2021 in Liaocheng People's Hospital, respiratory system diseases accounted for the first, multiple injuries accounted for the second place, followed by cardiovascular system diseases, gastrointestinal surgery diseases, pathological obstetrics, etc. Males and elderly patients aged 60-74 years have a higher proportion of severe cases. APACHE II scores were associated with patients' prognosis.

NLRP3 Inflammasome May Be a Biomarker for Risk Stratification in Patients with Acute Coronary Syndrome.

Acute coronary syndrome (ACS) has a high incidence and mortality rate worldwide, which has a considerable negative impact on the global economy. This study aimed to identify a group of ACS patients at a high risk of recurrent adverse cardiac events using the plasma NLRP3 inflammasome. ACS patients admitted to Liaocheng People's Hospital between June 2021 and March 2022 were enrolled in this study. Patients were divided into low (levels < 3.84 ng/mL) and high (levels ≥ 3.84 ng/mL) groups based on the median NLRP3 inflammasome levels. The patients were divided into three groups according to the Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention (TRS-2P): low (scores ≤ 2 points), intermediate (scores = 3 points), and high (score ≥ 4 points) risk. We investigated the relationship between NLRP3 inflammasome and laboratory indicators. Additionally, we examined whether the NLRP3 inflammasome was an independent predictor of high TRS-2P and explored the applicability of the plasma NLRP3 inflammasome for predicting high TRS-2P. Logistic regression analysis revealed that NLRP3 inflammasome was an independent predictor of high TRS-2P (odds ratio [OR]:2.013; 95% confidence interval [CI]: 1.174-3.452). The area under the receiver operating characteristic curve value of the NLRP3 inflammasome was 0.674 (95% CI: 0.611-0.737; P < 0.001). NLRP3 inflammasome levels are an independent predictive factor for high TRS-2P levels, which indicates that the NLRP3 inflammasome may help predict the prognosis of ACS patients.

Epidemiological profile of 338 traumatic spinal cord injury cases in Shandong province, China.

Hospital-based retrospective review. To describe the epidemiological characteristics of traumatic spinal cord injury (TSCI) in Liaocheng, China. Liaocheng People's Hospital. Medical records of 338 persons with TSCI admitted to Liaocheng People's Hospital from 2013 to 2017 were reviewed. The detailed information included gender, age, marital status, occupation, time, etiology, level of injury, ASIA grade, spinal stenosis, concomitant injury, treatment, length of stay. Over this period, the mean age (SD) of persons with TSCI was 50.1 (14.1) years, and the male/female ratio was 3.1:1. 96.4% of all were married. The leading cause was fall, followed by motor vehicle accident (MVA). The most common level of injury was the cervical cord. ASIA grade D and A injuries were the most common, accounting for 48.5 and 29.3% respectively. Among the concomitant injuries, spinal fractures were the most common. Within 24 h, 91.1% of individuals with TSCI arrived hospital, 63.3% of all accepted surgery. The results showed that fall and MVA were the two main causes, so we should focused on preventing fall and reducing MVA. Cervical spinal stenosis can increase the risk of TSCI, so education should be provided to this population to raise their risk awareness. In addition, timely treatment was critical for TSCI, but the data showed that rescue process was not standard, so it was necessary for medical staff to popularize professional knowledge.

Retrospective study of perioperative cardiac arrest from a Chinese tertiary hospital.

Studies on perioperative cardiac arrest in Chinese hospitals have rarely been retrieved from international journals. This survey evaluated the incidence, causes, and outcomes of perioperative cardiac arrests in a Chinese tertiary general hospital between July 2013 and December 2020. The incidence of cardiac arrest within 24 hours of anesthesia administration was retrospectively identified using an anesthesia database in Liaocheng People's Hospital. During the study period, there were 118,152 anesthetics. Data collected included patient characteristics, surgical procedures (elective or emergency), American Society of Anesthesiologists (ASA) physical status score, type of surgery, anesthesia technique, and outcome. Cardiac arrests were grouped into one of 3 groups: totally anesthesia-related, partially anesthesia-related, or anesthesia-unrelated. In total, 41 cardiac arrests (3.5:10,000) and 26 deaths (2.2:10,000) were found. Major risk factors for cardiac arrest were children under 1 year, adults between 19 and 65 years, and the elderly (>80 years) (P < .001), male patients (P = .02), emergency surgery (P < .001), and ASA grade V patients without anesthesia (P = .009). There were 19 anesthesia-related cardiac arrests (1.6:10,000) – 2 were totally related, and 17 were partially related to anesthesia. There were 9 anesthesia-related deaths (0.8:10,000), all of which were partially related to anesthesia. Perioperative cardiac arrests were correlated with age, gender, ASA grade and surgical procedures. The 2 most important patient factors leading to cardiac arrest were hemorrhagic shock from trauma and septic shock, respectively.

Efficacy analysis of different pulmonary surfactants in premature infants with respiratory distress syndrome

To explore high-risk factors of respiratory distress syndrome (RDS) and to compare the clinical efficacy of calf pulmonary surfactant (PS) combined with budesonide suspension and poractant alfa injection in the treatment of RDS in premature infants. A retrospective analysis was conducted. Preterm infants who were born in the obstetrics department of Liaocheng People's Hospital and admitted to the neonatal intensive care unit (NICU) within 24 hours from July 2016 to July 2020 were enrolled. The clinical data of these patients including perinatal conditions, clinical features, therapeutic regimens of PS and outcomes were collected and analyzed. According to the diagnostic criteria of neonatal respiratory distress syndrome (NRDS), premature infants were divided into NRDS group and non-NRDS group. First, the clinical data of the two groups were compared to analyze the related factors of NRDS. Then the related factors of NRDS were confirmed by Logistic regression analysis. In addition, according to the trapeutic regimens of PS, the children were divided into calf PS combined with budesonide suspension group and poractant alfa injection group, and the efficacy of the two PS was compared. (1) A total of 1 690 preterm infants were included, including 297 preterm infants were diagnosed with NRDS which accounted for 17.6% of live preterm infants. There were significant differences in gender, gestational age (GA), birth parity, birth weight (BW), asphyxia of newborn, caesarean section, premature rupture of membrane, placental abruption, gestational diabetes and father's smoking addiction (maternal exposure to smoke during pregnancy) between NRDS group and non-NRDS group (male: 71.0% vs. 59.0%; GA: < 28 weeks was 4.1% vs. 0.1%, 28 weeks ≤ GA < 34 weeks was 70.0% vs. 29.9%, 34 weeks ≤ GA < 37 weeks was 25.9% vs.70.0%; birth parity: 2 (1, 3) vs. 2 (1, 3); BW: < 1 000 g was 4.1% vs. 0.4%, 1 000 g ≤ BW < 1 500 g was 31.3% vs. 6.5%, 1 500 g ≤ BW < 2 500 g was 51.5% vs. 58.9%, 2 500 g ≤ BW < 4 000 g was 12.8% vs. 33.1%, BW ≥ 4 000 g was 0.3% vs. 1.1%; asphyxia of newborn: 50.8% vs. 14.6%; caesarean section: 71.7% vs. 65.0%; premature rupture of membrane: 66.7% vs. 42.2%; premature rupture of fetal membranes: 11.4% vs. 5.2%; gestational diabetes: 12.1% vs. 7.0%; father's smoking addiction: 80.8% vs. 71.5%, all P < 0.05), but there was no significant difference in prenatal use of dexamethasone (DEX) between NRDS group and non-NRDS group (80.1% vs. 84.1%, P > 0.05). Binary multivariate Logistic regression analysis showed that GA, gender, cesarean section, premature rupture of membranes, gestational diabetes, father's smoking addiction and neonatal asphyxia were the risk factors of RDS [odds ratio (OR) and 95% confidence interval (95%CI) were 0.621 (0.557-0.693), 2.043 (1.478-2.825), 1.365 (1.036-1.797), 0.697 (0.506-0.961), 3.223 (1.906-5.449), 1.836 (1.261-2.673), 3.596 (2.622-4.933), all P < 0.05]. (2) A total of 160 patients diagnosed with grade III/IV NRDS were included to analyze the efficacy of PS. Among them, 42 cases were treated with calf PS combined with budesonide suspension, and 118 cases were treated with poractant alfa injection. Compared with the poractant alfa injection group, the total oxygen consumption time of the calf PS group was shorter [days: 9.0 (5.0, 19.0) vs. 13.0 (6.0, 26.0)], the hospitalization expenses were lower [ten thousand Yuan: 3.46 (2.88, 5.18) vs. 4.58 (3.08, 6.06)], and the incidence of bronchopulmonary dysplasia (BPD) was lower (11.9% vs. 28.8%), with statistically significant differences (all P < 0.05). In addition to GA, gender, cesarean section, premature rupture of membranes, gestational diabetes, and neonatal asphyxia, the father's smoking addiction (maternal smoke exposure during pregnancy) is an important risk factor of RDS in premature infants. The efficacy of prenatal use of DEX for prevention of RDS in preterm infants is affected by many factors, such as prenatal smoke exposure, timing of use, multiple fetuses, etc. Calf PS combined with budesonide suspension is better than poractant alfa injection in reducing the incidence of BPD.

Which is preferred for initial treatment of papillary thyroid cancer, total thyroidectomy or lobotomy?

PurposesThe incidence of thyroid cancer has increased annually, and has a heavy psychological and economic burden on society and individuals. Based thyroid cancer data from patients treated in Liaocheng People's Hospital from 2015 to 2018, with Chinese national and regional characteristics, in this study, we addressed the controversy of which initial thyroid surgical mode, lobectomy or total thyroidectomy, is most effective.MethodsClinical and pathological data from 2108 patients with thyroid cancer, who were initially diagnosed and treated surgically, were collected from the Department of Thyroid Surgery. Among them, there were 1001 cases who underwent open operation with total thyroidectomy + central lymph node dissection; meanwhile, 1107 cases were treated with neck lateral lymph node dissection at the same time.ResultsThe overall metastasis rate of all patients was 57.23%. Even the lymph node metastasis of papillary thyroid microcarcinoma (PTMC) was as high as 48.97%. When the mass rose above 2 cm, the proportion of metastasis increased to 77.22%. When the tumor was complicated with bilateral and multiple high‐risk factors, the proportion of metastasis was 65.27% and 72.21%, respectively. When the tumor breaks through the capsule, the metastasis rate was 67.08%. With the increase of tumor diameter, the metastasis of cervical lymph nodes ranged from 22.54% to 73.33%, which showed positive correlation. 49.32% of patients had lymph node metastasis in the lateral cervical region. When the diameter of the tumor reached T1c level, the metastasis of the cervical lymph nodes was 56.91%, and the number of metastatic cases above T1c level accounted for 69.96% of the total metastatic cases.ConclusionThe degree of malignancy of thyroid cancer depends on tumor genome evolution. Rates of neck lymph node metastasis are high, particularly among patients with risk factors for poor prognosis. It is recommended that initial treatment should comprise at least total thyroidectomy + central lymph node dissection in China, to avoid the risks associated with secondary surgery and effects on patient quality of life. When the tumor diameter exceeds 1 cm, the risk of cervical lymph node metastasis is high, and we recommended lateral lymph node dissection.

Increased Levels of Serum Neuregulin 1 Associated with Cognitive Impairment in Vascular Dementia.

Objective Neuregulin 1 (NRG 1) is a member of the epidermal growth factor (EGF) family and is believed to play an important role in neuroplasticity. However, the relationship between NRG 1 and vascular dementia (VaD) is poorly understood. The purpose of this study is to explore the correlation between neuregulin 1 and VaD. Patients and Methods. From October 2018 to September 2020, 93 VaD patients and 79 control populations who attended Liaocheng People's Hospital were included in the study. Baseline characteristics including age, gender, years of education, HDL, LDL, FBG, SBP, and DBP are collected. At the same time, peripheral blood was collected, and the concentration of serum NRG 1 was detected by enzyme-linked immunosorbent assay (ELISA). All research subjects received professional cognitive function assessment. Results A total of 93 VaD patients and 79 controls were enrolled. There was no significant difference in age, gender, years of education, HDL, LDL, FBG, SBP, and DBP between the two groups (p > 0.05). However, compared with the control group, VaD patients have lower MoCA and higher serum NRG 1 levels, and the difference is statistically significant (p < 0.001). The correlation analysis of MoCA and baseline characteristics showed that the MoCA score in VaD was significantly negatively correlated with serum NRG 1 (r = −0.374, p = 0.036). The results of multivariate regression showed that the MoCA score of VaD patients was only associated with NRG 1 (β = 0.258, p = 0.012). Conclusions The concentration of serum NRG 1 in VaD patients is significantly increased, which may be an independent risk factor for cognitive impairment in VaD patients.

Total thyroidectomy is superior for initial treatment of thyroid cancer.

PurposeThe incidence of thyroid cancer has increased annually, and has a heavy psychological and economic burden on the society and individuals. Based on thyroid cancer data from patients treated in Liaocheng People's Hospital in 2017, with Chinese national and regional characteristics, in this study we addressed the controversy of which initial thyroid surgical mode, lobectomy, or total thyroidectomy is the most effective.Patients and methodsClinical and pathological data from 552 patients with thyroid cancer, who were initially diagnosed and treated surgically, were collected from the Department of Thyroid Surgery. Among them, 40 patients underwent endoscopic surgery, with resection, including lobectomy + central lymph node dissection of the affected lobe, while 512 cases underwent total thyroidectomy + central lymph node dissection.ResultsThe metastasis rate for all patients was 59.42%, with lymph node metastasis of papillary thyroid microcarcinoma of 46.92%; however, for patients with tumors >2 cm, the proportion developing metastasis was increased to 77.53%.ConclusionIn thyroid cancer, rates of neck lymph node metastasis are high, particularly among patients with risk factors for poor prognosis. Our data suggest that initial treatment should comprise at least total thyroidectomy + central lymph node dissection in China, at least in tumors larger than 1 cm, to avoid the risks associated with secondary surgery and effects on patient quality of life.