Abstract:Objective To explore the twin maternal and infant outcomes of in vitro fertilization embryo transfer and natural conception.Method A total of 496 twin pregnant women admitted to the Northern Theater Command General Hospital from January 2017 to December 2022 were selected and divided into IVF-ET group(n=166)and natural conception group(n=330)according to their different pregnancy methods.Compare the clinical outcomes of two groups of pregnant women and newborns.Results The incidence of miscarriage,premature rupture of membranes,and cervical insufficiency(CI)in the IVE-ET group was higher than that in the natural conception group at 16 to 25+6 weeks of pregnancy,the difference was statistically significant(P＜0.05);Pregnancy ≥26 weeks,the incidence of gestational diabetes,gestational hypertension,gestational anemia,postpartum hemorrhage in IVF-ET group were higher than those in natural pregnancy group,the difference was statistically significant(P＜0.05).The incidence of hypocalcemia and hypoglycemia in newborns in the IVF-ET group was higher than that in the natural conception group,the difference was statistically significant(P＜0.05).Conclusion The IVF-ET group at 16 to 25+6 weeks of pregnancy has a higher miscarriage rate than natural conception group,in the IVF-ET group at 26 to 31+6 weeks,The delivery rate of IVF-ET group was higher than that of natural conception group.Twin pregnancies with IVF-ET at ≥26 weeks can increase the incidence of complications in pregnant women and newborns.

Abstract:Objective To compare the efficacy of ultrasound-guided paravertebral nerve block(PVB)and modified serratus anterior plane block(SAPB)in thoracoscopic lobectomy in elderly patients with non-small cell lung cancer.Methods A total of 86 elderly patients with non-small cell lung cancer who underwent elective thoracoscopic lobectomy in Cangzhou People's Hospital from July 2022 to September 2024 were selected,including 56 males and 30 females,aged(66.42±4.45)years old,the age ranging from 61 to 76 years old.Patients were divided into PVB group(n=43)and modified SAPB group(n=43)by random number table method.The PVB group was treated with general anesthesia combined with ultrasound-guided PVB,and the modified SAPB group was treated with general anesthesia combined with ultrasound-guided modified SAPB.The operation time,intraoperative blood loss,anesthesia time,pain visual analogue scale(VAS)scores in active and resting states at each time point after extubation[10 min(T0),2 h(T1),6 h(T2),12 h(T3),24 h(T4),48 h(T5)after extubation],perioperative hemodynamic parameters[mean arterial pressure(MAP)and heart rate before anesthesia induction,5 min after intubation,5 min after skin incision,30 min after skin incision,and end of operation],postoperative analgesia[number of patient controlled intravenous analgesia(PCIA)pressing,24 h analgesic rescue rate,24 h postoperative sufentanil consumption,48 h postoperative sufentanil consumption]and adverse reactions were recorded and compared between the two groups.Results There was no significant difference in operation time,intraoperative blood loss,anesthesia time,and MAP,heart rate at each time point between the two groups(P＞0.05).The pain VAS scores in active states of modified SAPB group at T1and T4 were lower than those of PVB group with statistically significant(P＜0.05).There was no significant difference in pain VAS scores in active states at T0,T2,T3 and T5 and in resting states at each time point between the two groups(P＞0.05).There was no significant difference in the number of PCIA pressing,24 h analgesic rescue rate,24 h postoperative sufentanil consumption between the two groups(P＞0.05).The 48 h postoperative sufentanil consumption in the modified SAPB group was lower than that in the PVB group at 48 h with statistically significant(P＜0.05).The incidence of adverse reactions was 11.6％(5/43)in PVB Group and 9.3％(4/43)in modified SAPB group,there was no significant difference between the two groups(P＞0.05).Conclusion The analgesic effect of ultrasound-guided PVB and modified SAPB in thoracoscopic lobectomy in elderly patients with non-small cell lung cancer is similar,with less influence on intraoperative hemodynamics,while modified SAPB can effectively reduce the dosage of sufentanil after the operation and provide better analgesic effect.

Abstract:Objective Evaluation of the effectiveness and material degradability of polylactic acid/gelatin/absorbable hemostatic particles(PLA/GEL/AHP)combined with in situ electrospun n-butyl cyanoacrylate/cyanoacrylate-polyethylene glycol-cyanoacrylate/polymethyl methacrylate(504/CPC/PMMA)for cardiac penetration injury hemostatic and material degradability.Methods A total of 9 healthy male small Bama pigs were selected,with body mass(41.44±2.22)kg,ranging from 39 to 46 kg,aged(6.94±0.30)months,ranging from 6.5 to 7.0 months.Based on the new"two-step"rapid hemostasis technology established by the team for cardiac penetration injuries in the early stage,the newly developed 504/CPC/PMMA medical glue was used instead of the 508 medical glue in the previous experiment.Bama small pig was used as the experimental subject,and the right ventricular penetration injury bleeding model was standardized under the condition of mid-open chest and carried out the"two-step"hemostasis experiment,evaluating the effectiveness of hemostasis with immediate hemostasis success rate and long-term material stability,and evaluating biosafety and material degradability using hematological indicators and HE staining of organ specimens.Results One experimental animal died unexpectedly due to anesthesia,and the remaining 8 were of body mass(41.63±2.38)kg,all of which stopped bleeding successfully and survived.The dosage of medical glue(0.44±0.04)ml,the electrospinning time is 40 to 50 s,and the wound surface is completely closed from 50 to 60 s after the electrospinning is completed.The time for chest modeling to complete hemostasis(564±23)s was achieved,and all experimental animals were stable during the operation.One month after the operation,the medical glue has been completely degraded,the PLA/GEL/AHP hemostasis plug has been completely wrapped by the collagen fibers regenerated by the myocardium,and the part in contact with the myocardium has been initially degraded.Three months after the operation,the surface of the material protruding into the myocardium was smooth,the hemostasis plug degrades by more than 50％,there was no obvious inflammatory reaction around the material,and there was no obvious inflammatory cell infiltration in each organ at all stages after the operation.Hematological indicators showed that there was no statistically significant difference in comparison of hemoglobin,red blood cell count and white blood cell count of Bama pigs(P＞0.05).Three months after the operation,there was no significant difference between the levels of alanine aminotransferase,aspartate aminotransferase,creatine kinase isozyme MB and creatinine in Bama pigs(P＞0.05).Conclusion The"two-step"hemostasis technology constructed by PLA/GEL/AHP hemostasis plug combined with in situ electrospinning 504/CPC/PMMA can achieve effective hemostasis of right ventricular penetration injuries at large animals,and both biological materials have corresponding biosafety and degradability.

Abstract:Objective To explore the clinical efficacy of the fast-track surgery concept around perioperative total knee ar-throplasty .Methods A retrospective study was performed on 60 cases of patients that received first artificial total knee ar-throplasty in the General Hospital of Shenyang Military Command from July 1 to December 31 ,2015 .Patients were randomly divided into the fast-track surgery group and the traditional rehabilitation group ,with 30 cases in each group .The length of stay,hospital costs and perioperative complications were recorded .Using visual analogue scale ( VAS) to assess the level of pain between the two groups and range of motion ( ROM) to assess the clinical efficacy .Results The hospitalized time in fast-track surgery group was significantly shorter than that in the traditional rehabilitation group ( P<0.05 );the surgical curative effect in the fast-track surgery group was significantly superior to that in the traditional rehabilitation group ( P<0.05 );the hospitalization costs between the two groups had no statistical significance ( P>0.05 ) .Conclusion The appli-cation of fast-track surgery around perioperative total knee arthroplasty can be beneficial to patients with fast early rehabili -tation,reduce hospitalization time and improve the clinical curative effect .

Abstract:Objective To explore the application for integration of doctor-nurse in the patients with severe multiple injury combined fracture .Methods A retrospective study was performed on 57 cases of patients with severe multiple injury com-bined fracture.Among them,37 cases that received from January 2012 to December 2013 were given the traditional first aid and nursing model as the control group ,and 20 cases that received from January 2014 to December 2015 were in the obser-vation group of the integration of doctor-nurse.The rescue successful rate of two groups was analyzed .Results In the ob-servation group,there were 14 cases cured,6 cases died,the successful rate was 70%;in the control group,there were 20 cases cured,17 cases died,the successful rate was 54%,the success rate of two groups were compared ,there was no statisti-cally significant difference ( P>0.05 ) .The success rate of rescue was on an upward trend .For the satisfaction survey ,in the control group ,there were 37 copies of questionnaire were issued ,32 copies were handed in ,recovery rate was 86%and sat-isfaction rate was 78 .7%;in the observation group ,there were 20 copies of questionnaire were issued ,18 copies were hand-ed in,recovery rate was 90%and satisfaction rate was 97.3%.In the observation group ,the satisfaction rate was significant-ly better than the control group .Conclusion The integration of doctor-nurse can make the health care cooperate closely , highlight individualized treatment and improve the successful rate of severe multiple injury combined fracture .

Abstract:Frostbite is the cold effect on human body under certain conditions,which cause the local and systemic injury. The auricle,hand and foot appears as purple,red and swelling,accompanied with shock,infection,multiple organs dysfunc-tion syndrome,limb necrosis and even death.Whether in peacetime or wartime,frostbite can occur in cold regions.Especial-ly in wartime,it happens because of hunger,fatigue,longer field operations,lack of cold equipment and footwear discomfort. Recently,both basic research and clinical studies in the treatment of frostbite have made great achievements.With deep re-search of frostbite,the treatment has been greatly improved.The article is to summarize the research progress on pathophysi-ology,clinical manifestation and treatment of frostbite.

Abstract:Objective To investigate the clinical effect of Cisplatin combined with recombinant human vascular endostatin intrapleural perfusion in the treatment of non-small cell lung cancer (NSCLC) complicated by malignant pleural effusion.Methods A retrospective study was performed on 96 cases of patients with NSCLC complicated with malignant pleural effusion who were admitted from March 2016 to November 2017.Patients were randomly divided into the Group A and Group B, with 48 cases in each group.Patients in the Group A were performed Cisplatinintrapleural perfusion, the others in the Group B were given recombinant human vascular endostatin.The levels of squamous cell carcinoma antigen, carbohydrate antigen 125 (CA125), carcinoembryonic antigen (CEA), vascular endothelial growth factor (VEGF), and hypoxia-inducile factor 1α (HIF-1α) were observed and compared between the two groups before and after treatment.Results In Group A, there were 12 cases of complete remission, 17 cases of partial remission, 10 cases of stability and 9 cases of progress, with an effective rate of 60.4％ (29/48). In Group B, there were 23 cases of complete remission, 20 cases of partial remission, 4 cases of stability and 1 case of progress, with an effective rate of 89.6％ (43/48). The difference between the two groups was statistically significant (P＜0.05). The levels of VEGF and HIF-1αin the two groups after treatment were lower than those before treatment, and those in Group B were lower than those in Group A (P＜0.05). There was no significant difference between the two groups in the level of CEA, squamous cell carcinoma antigen and CA125 before and after treatment (P＞0.05). In Group A, there were 63 adverse reactions, including gastrointestinalreaction, fever, fatigue, leukopenia, thrombocytopenia, liver function damageand electrocardiogram changes, with an incidence of 131.3％ (63/48). There were 62 cases in Group B, and the incidence of adverse reactions was 129.2％ (62/48). There was no significant difference between the two groups (P＞0.05). ConclusionThe clinical effect of intrapleural infusion of Cisplatin combined with recombinant human vascular endostatin in the treatment of non-small cell lung cancer complicated with malignant pleural effusion is better than that of single Cisplatin, which can reduce the level of vascular endothelial growth factor and hypoxia-inducible factor 1α, and does not increase the risk of adverse reactions.