An effective and safe gastric endoscopic submucosal dissection in the right lateral position using an inverted overtube

Previously, we reported the efficacy of a newly developed inverted overtube in shortening the hemostatic time and obtaining a clear endoscopic view in emergency endoscopic hemostasis. This device also helped us to perform gastric endoscopic submucosal dissection(ESD) more safely by changing the direction of gravity in the right lateral position. To perform a safe ESD, it is important to make an appropriate angle and distance between the electric knife and the gastric mucosa. In this position, the distance to gastric mucosa is reduced, and the angle of the electric knife changes from vertical to somewhat oblique, facilitating safer cutting.

413 CASES OF ABNORMAL FETAL POSITION CORRECTED BY AURICULAR PLASTER THERAPY

The authors corrected the abnormal fetal posi-tion in 413 cases of pregnant women by the auri-cular plaster therapy(APT)with a success rate of83.3%—remarkably higher than treatment by knee-chest positioning.Further analysis showed that APTwas also supperior to the knee-chest positioning forprimiparae,breech fetal position,and pregancies over33 weeks.The authors also noted the clinical signsof successful cases and failures.

A Comparative Study of the Short-Term Efficacy of Laparoscopic Radical Resection of Right-Sided Colon Cancer with Two Different Surgeon Positions and Trocar Placements

Objective: To investigate the short-term efficacy of laparoscopic radical resection of right-sided colon cancer with two different surgeon positions and trocar placements. Methods: The data of 78 patients who underwent laparoscopic radical resection of right-sided colon cancer between January 2018 and August 2019 were retrospectively analysed. The surgical method was selected by the patients. The patients were divided into two groups according to the surgeons’ positioning habits and trocar placements. The group with the lead surgeon standing between the patient’s legs had 35 patients, and the group with the lead surgeon standing at the left side of the patient had 43 patients. The operation time, intraoperative blood loss, postoperative anal gas evacuation time, postoperative urinary catheter indwelling time, postoperative hospital stay, C-reactive protein (CRP) level on the first day after surgery, and postoperative pathological data and complications were compared between the two groups. Results: All patients underwent the laparoscopic radical resection of right-sided colon cancer, none converting to laparotomy. No significant difference (P > 0.05) in intraoperative blood loss (57.6 ± 21.3 ml vs 60.2 ± 35.3 ml), postoperative anal gas evacuation time (3.5 ± 1.1 d vs 3.8 ± 1.3 d), postoperative urinary catheter indwelling time (2.6 ± 1.3 d vs 2.4 ± 1.2 d), postoperative hospital stay (7.1 ± 1.8 d vs 7.5 ± 2.1 d), or CRP level on the first day after surgery (54.7 ± 9.6 mg/L vs 53.9 ± 8.2 mg/L) was detected between the two groups. The operation time was shorter in the group with the lead surgeon standing between the patient’s legs (185.2 ± 25.6 min vs 196.2 ±19.7 min) (P < 0.05). The two groups did not differ significantly in the tumour length (4.2 ± 1.3 cm vs 3.9 ± 1.5 cm), number of dissected lymph nodes (27.5 ± 11.6 vs 25.1 ± 15.4), pathological type, or postoperative pathological tumour-node-metastasis stage (P > 0.05). No patients died or had anastomotic fistula during their postoperative hospital stay, and the incidence of postoperative complications did not differ between the two groups (22.9% (8/35) vs 23.3% (10/42);P > 0.05). Conclusion: Under the principle of radical resection, the surgeon should adopt the most suitable standing position and trocar placement according to the specific situation. If the surgeon stands between the patient’s legs, this might shorten the operation time and promote a smoother surgery.

Right recumbent position on gastric emptying of water evidenced by ^(13)C breath testing

AIM:To compare the impact of the right recumbent position with the sitting position on gastric emptying of water. METHODS:In eight healthy male volunteers,the 13C acetate breath test was performed twice to assess gastric emptying of 100 mL tap water.Subjects were seated in one test and lying on their right side in the other.In both positions,pulmonary 13CO2 exhalation curves were obtained by plotting breath data against time.Percent gastric retention curves were created by analyzing data using the Wagner-Nelson protocol. RESULTS:No significant posture effect was found in pulmonary 13CO2 output curves(P=0.2150),whereas a significant effect was seen in gastric retention curves (P=0.0315).The percent retention values at 10 min and 15 min were significantly smaller when subjects were in the right recumbent position compared with the seated position(P<0.05).Our results verified the accelerating effect of the right recumbent position on gastric emptying of non-nutritive solutions.Concerning clinical implications,this study suggests that placing patients with acute pain on their right side after oral administration of analgesic drugs in solution is justified as an effective practice for rapid pain relief.For patients with gastrointestinal reflux symptoms,sleeping in the right recumbent position may reduce nocturnal symptoms,as delayed gastric emptying can cause reflux symptoms. CONCLUSION:Gastric emptying of water occurs more quickly when a subject lies on the right side compared with sitting.

Valvuloplasty of fetal pulmonary atresia with intact ventricular septum and hypoplastic right heart: Mid-term follow-up results

Objective:This study aimed to analyze and evaluate the results of mid-term follow-up after fetal pulmonary valvuloplasty(FPV)in fetuses with pulmonary atresia with intact ventricular septum(PA/IVS).Methods:From August 31,2018,to May 31,2019,seven fetuses with PA/IVS and hypoplastic right heart were included in this study.All underwent echocardiography by the same specialist and were operated on by the same team.Intervention and echocardiography data were collected,and changes in the associated indices noted during follow-up were analyzed.Results:All seven fetuses successfully underwent FPV.The median gestational age at FPV was 27.54 weeks.The average FPV procedural time was 6 min.Persistent bradycardia requiring treatment occurred in 4/7 procedures.Finally,five pregnancies were successfully delivered,and the other two were aborted.Compared to data before fetal cardiac interventions(FCI),tricuspid valve annulus diameter/mitral valve annulus diameter(TV/MV)and right ventricle diameter/left ventricle diameter(RV/LV)of all fetuses had progressively improved.The maximum tricuspid regurgitation velocity decreased from 4.60 m/s to 3.64 m/s.The average follow-up time was 30.40±2.05 months.During the follow-up period,the diameter of the tricuspid valve ring in five children continued to improve,and the development rate of the tricuspid valve was relatively obvious from 6 months to 1 year after birth.However,the development of the right ventricle after birth was relatively slow.It was discovered that there were individual variations in the development of the right ventricle during follow-up.Conclusion:The findings support the potential for the development of the right ventricle and tricuspid valve in fetuses with PA/IVS who underwent FCI.Development of the right ventricle and tricuspid valve does not occur synchronously during pregnancy.The right ventricle develops rapidly in utero,but the development of tricuspid valve is more apparent after birth than in utero.

Severe Trauma of Uterus and the Right Limb during a Road Accident at the Department of Obstetrics and Gynecology of the Teaching Hospital Souro Sanou of Bobo-Dioulasso: A Case Report and Review of Literature

The authors reported a case of trauma with uterus rupture at 35 weeks gestation with fetal death in uterus with a trauma of the right limb injuries during a serious road accident. Aim: the aim is to show the increasing of road accident with the motorized tricycle and their many risks for pregnant woman. Case Presentation: our patient was thrown from the back cargo of a motorized tricycle (three-wheeled vehicle) after a collision with a truck in a rural area from 150 km to Bobo-Dioulasso. She sustained a closed abdominal injury and a severe right lower limb open injury. At admission in our department in the Teaching Hospital, she was conscious, shocked with hemodynamic instability, including low blood pressure (75/52 mmHg), rapid heart rate (140 pulses per minute), rapid breath rate (40 per minute), and cold extremities. Abdominal examination was painful with uterine hypertonia, 28 cm height uterus, and no fetal heart heartbeat. A laparotomy in urgency revealed a rupture of the uterus fundus with a dead fetus. A conservative surgical treatment was performed. An open trauma to the right limb was managed by the orthopedists with a good outcome. Conclusion: Accident trauma during pregnancy is becoming more and more frequent with the increase in means of transport in urban and inter urban areas. The transport ways of the pregnant woman must take into account her safety and that of the fetus.

Implementing a More Positive Employment Policy and Promoting the Development of the Chinese Human Rights Cause

Human rights refer to the basic rights to which every person is entitled based on his or her nature and dignlty under certain social and historical circumstances. Simply put, the term means that everyone has the right to live and develop in a free and equal manner.

On the Criminal Protection of the Right to Education of Chinese Citizens——With a Review on Article 32 of the Amendment to the Criminal Law(Ⅺ)

The Amendment(Ⅺ)to the Criminal Law of the People’s Republic of China responds to the institutional needs of civic education,and supplements the clause of the Criminal Law on protection of citizens’right to education nuy means of Article 32.Imposing legal responsibility in the form of internal punishments,administrative punishments,and economic compensation have failed to prevent infringements on citizens’right to education.Its role as a"secondary protection law"is the conceptual obstacle that hinders the Criminal Law from effectively intervening in the field of citizens’right to education.The equivalence between the legal interests of people to the right to education and the rights protected by the existing charges in the Criminal Law is the legitimate basis for it to intervene in disputes over the right to education.Based on Article 32 of the Amendment(Ⅺ)to the Criminal Law of the People’s Republic of China,it is suggested to further clarify the prepositional law,improve the liability provisions for the right to education,change the modest and restrained view of the Criminal Law regarding protection of the right to education,and expand the behavior types of Article 32 provided in the Amendment(Ⅺ)in due time.

Caudal approach to pure laparoscopic posterior sectionectomy under the laparoscopy-specific view

AIM:To study our novel caudal approach laparoscopic posterior-sectionectomy with parenchymal transection prior to mobilization under laparoscopy-specific view.METHODS:Points of the procedure are:(1) Patients are put in left lateral position and posterior sector is not mobilized;(2) Glissonian pedicle of the sector is encircled and clamped extra-hepatically and divided afterward during the transection;(3) Dissection of inferior vena cava(IVC) anterior wall behind the liver is started from caudal.Simultaneously,liver transection is performed to search right hepatic vein(RHV) from caudal;(4) Liver transection proceeds to the bifurcation of the vessels from caudal to cranial,exposing the surfaces of IVC and RHV.Since the remnant liver sinks down,the cutting surface is well-opend;and(5) After the completion of transection,dissection of the resected liver from retroperitoneum is easily performed using the gravity.This approach was performed for a 63 years old woman with liver metastasis close to RHV.RESULTS:RHV exposure is required for R0 resection of the lesion.Although the cutting plane is horizontal in supine position and the gravity obstructs the exposure in the small subphrenic space,the use of specific characteristics of laparoscopic hepatectomy,such as the good vision for the dorsal part of the liver and IVC and facilitated dissection using the gravity with the patient positioning,made the complete RHV exposure during the liver transection easy to perform.The operation time was 341 min and operative blood loss was 1356 mL.Her postoperative hospital stay was uneventfull and she is well without any signs of recurrences 14 mo after surgery.CONCLUSION:The new procedure is feasible and useful for the patients with tumors close to RHV and the need of the exposure of RHV.

Accurate hemostasis with a new endoscopic overtube for emergency endoscopy

Endoscopic hemostasis performed in the emergency room is difficult due to the presence of blood clots and food residue that makes obtaining a clear view of the bleeding vessel difficult. We experienced the efficacy of a newly developed inverted overtube to shorten the hemostatic time and obtain a clear endoscopic view with upper gastrointestinal bleeding patient who were transferred by ambulance car and required emergency endoscopy. The technique improved the endoscopic views and enabled us to perform the hemostatic procedures from the conventional standing position while freely and easily changing the patient's position. The presence of blood clots and food residue in the gastric fornix or upper gastric body makes identifying a bleeding exposed vessel impossible. This set-up significantly shortened the procedure time. The inverted overtube helped us obtain a clear view in patients who were laid in the right lateral position. Rapid identification of ex-posed vessels resulted in success of hemostasis.

Compound Heterozygous PLD1 Variants in Right-Sided Heart Malformations

We report a three-year-old male child who presented with congenital valvular defects,right ventricular malformation,and initial developmental delay.Genome sequencing showed rare deleterious biallelic missense variants in PLD1.In his parents’second pregnancy,echocardiogram at 13 weeks gestation revealed right-sided cardiac malformations resembling the clinical presentation of the family’s first child.Targeted DNA analysis showed that the fetus carried the same biallelic PLD1 variants as their older sibling.This case helps to further delineate the clinical spectrum of PLD1-related defects and highlights the value of both genome sequencing in congenital heart disease and early fetal echocardiography to establish phenotype.

数据产权刑法保护模式的构建

数据产权是一种具有财产权属性的新型权利,该权利与虚拟财产权和知识产权具有明显差异。数据产权属于刑法保护的公法益范畴,其应归属于市场经济秩序法益之中。现行刑法有关财产犯罪、知识产权犯罪和数据犯罪的规定均无法实现对数据产权的全面保护。刑法对数据产权的保护应以促进数据流通为主要目标,且应当覆盖数据处理的各流程阶段。对侵犯数据产权行为进行刑法规制时,应对“未经同意”获取数据行为审慎入罪。应增设妨害数据流通管理秩序罪,对“情节严重的”妨害数据流通管理秩序行为予以刑法规制。

国有企业负责人经营业绩考核:制度特征分析与指标维度优化

业绩考核制度是落实企业责任、激发企业活力,并由此推动经济社会运行的重要机制。在对比股东主导和市场主导两种业绩考核逻辑,分析、认知国有企业负责人经营业绩考核制度的基础上,探究了业绩考核制度的本质特征,即国有企业负责人经营业绩考核制度是一项以考核为抓手的产权管理体系,是以目标设定与过程管理为核心的“自驱式”机制设计。强调应唯经营(而非考核)出业绩,并且正向激励与风险容错是业绩考核赋能企业发展的重要属性。现行业绩考核指标体系还难以引导国有企业高质量发展,建议围绕“产业布局、经营生态、创新驱动、风险管理、财务收益”五个维度进一步优化国有企业负责人经营业绩考核指标,且以年度考核为核心,形成导向明确、相对稳定、可预期的考核指标体系,并赋予企业负责人一定的自由裁量权,以提高考核制度效果,助力中国经济高质量发展。

以中国话语在生态环境法典中确认环境权

编纂生态环境法典作为重大政治任务和立法任务,已列入全国人大常委会2024年年度工作计划。通过法典编纂,将党的十八大以来生态文明建设理论、制度、实践成果以法典的形式确认下来,适应新时代我国社会主要矛盾新变化,回应人民群众对美好生态环境的新期盼,是生态环境法典编纂的目标和方向。在生态环境法典编纂研究中,我们要以习近平新时代中国特色社会主义思想特别是习近平生态文明思想和习近平法治思想为指引,坚持人民立场,认真对待生态环境新期盼带来的利益关系新变化;坚持改革开放,准确把握我国环境权益保护现状与政策取向;坚持道路自信,以中国话语在生态环境法典中确认环境权并作出一般规定、建立相应的保障制度和救济制度,提升中国生态环境治理体系与治理能力现代化水平,提供加强全球生态环境治理的中国方案。

CMA、CNV-seq诊断引产胎儿DNA异常及病因效果

目的:探讨染色体微阵列芯片技术(CMA)、低深度全基因组测序技术(CNV-seq)对引产胎儿DNA异常的诊断价值及病因检出情况。方法:将2021年1月-2023年12月于本院进行引产的150例孕妇作为研究对象,以产前无创基因筛查(NIPT)技术检测结果作为引产胎儿DNA结果的金标准,对引产胎儿行CMA、CNV-seq检测。比较CMA、CNV-seq检测结果与金标准的符合情况;受试者特征曲线(ROC)分析CMA、CNV-seq检测对引产胎儿DNA异常的诊断价值;对比CMA、CNV-seq检测对引产胎儿DNA异常病因检测结果。结果:引产胎儿DNA异常的阳性检出率CNV-seq检测(85.9%)高于CMA检测(73.7%);CNV-seq检测诊断引产胎儿DNA异常的曲线下面积(0.870)高于CMA检测(0.761),CNV-seq检测对引产胎儿DNA异常病因的检出情况(85.9%)高于CMA检测(73.7%)(均P<0.05)。结论:CMA、CNV-seq对引产胎儿DNA异常及其病因均有较高检出率,且CNV-seq检测诊断效能更高,可为产前诊断胎儿DNA异常提供参考。

《庄子·齐物论》“成心”意蕴探析

“成心”是《庄子·齐物论》中的重要概念,但关于“成心”的解释自古以来便有争议,且古人与今人学者诠释“成心”的褒贬倾向也有着明显不同。若从逻辑认知的角度来看,“成心”以贬义解就更为合理,若从超越是非逻辑的“道通为一”来看,“成心”如同从有限中通往无限的途径,既可以通向齐物之境,又可以导向世俗的是非。只有从超越逻辑的角度,才能发现欲求对“成心”作出正确的理解,本身就是将其置于是非的定义之中,这就导致即便可以从逻辑上确定“成心”的贬义立场,也只是在不自觉间成为庄子批判的对象。

孕妇药物依赖的胎儿权益与母体自主冲突之思考

聚焦医学伦理学视角下孕妇药物依赖及其对胎儿健康的潜在影响,探索胎儿权利与母体自主权之间的伦理平衡及在医疗与社会法律层面的复杂挑战。探讨了胎儿权益与母体自主间的伦理张力,分析了药物依赖的成因,包括治疗性药物使用和药物滥用,进而审视全球孕妇药物依赖现状及其影响。同时,评估了医学伦理四大原则在两种情境中的应用挑战,以及法律在定义和处理该伦理问题时的作用与临床实践中的差异。强调了公共卫生策略在解决孕妇药物依赖问题中的重要性,并提出了具体实施策略,以期为医疗从业者和政策制定者提供理论与实践指导。

分娩镇痛初产妇采用自由体位纠正胎方位异常的研究

目的探讨自由体位在分娩镇痛初产妇纠正胎方位异常中的应用效果。方法选取分娩镇痛足月初产妇为研究对象,按入院时间分为对照组及干预组。对照组104例行常规仰卧位或半坐卧位分娩,干预组129例采用自由体位分娩。比较两组产妇胎方位异常纠正率、缩宫素使用、分娩方式、第二产程及总产程时间、产后2 h阴道流血量、会阴损伤情况及新生儿Apgar评分。结果干预组胎方位自然纠正率显著高于对照组,两组分娩方式比较,差异有统计学意义(均P<0.05);两组缩宫素使用、会阴损伤、产程时长、产后2 h阴道流血量及新生儿Apgar评分比较,差异无统计学意义(均P>0.05)。结论自由体位分娩能够有效纠正胎方位异常,促进正常分娩,改善不良妊娠结局。

婴幼儿髋关节发育不良的危险因素研究

目的探究分析婴幼儿发育性髋关节发育不良(DDH)的危险因素。方法回顾性分析本院在2022年1月至2024年3月收治的166例可疑DDH婴幼儿的病历资料,按不同月龄选择不同的影像学检查:即0~6月婴幼儿采取Graf法超声检查;≥7月婴幼儿采用X线检查。根据影像学诊断结果,将研究对象分为髋关节发育不良阳性组与阴性组,其中阳性组73例,阴性组93例,收集2组资料,并采用多因素广义线性回归分析法(Logistic)分析婴幼儿DDH的危险因素。结果阳性组患儿的性别、家族遗传史、臀位、羊水量<300 mL、头胎、多胎、传统襁褓、首检月龄、髋关节弹响、肌性斜颈例数均多于阴性组,差异有统计学意义(P<0.05);多因素Logistic分析,女性、有家族遗传史、臀位、羊水量<300 m L、头胎、多胎、有传统襁褓史、首检月龄≥3个月、有髋关节弹响、有肌性斜颈情况是婴幼儿DDH的危险因素(P<0.05)。结论婴幼儿是女性、有家族遗传史、臀位、羊水量<300 mL、头胎、多胎、有传统襁褓史、首检月龄≥3个月以及检查合并有髋关节弹响、肌性斜颈情况可能会出现DDH,针对各影响因素为降低婴幼儿DDH发生提供参考。

体位改变结合胎头手转对胎位异常产妇分娩方式的影响分析

目的探讨体位改变联合胎头手转在胎位异常产妇分娩方式中的意义。方法单纯随机选取2021年10月—2023年10月滕州市中心人民医院接收的120例产妇为研究对象,根据随机数字法分成对照组(60例)与观察组(60例)。对照组产妇接受体位改变,观察组产妇接受体位改变+胎头手转。比较两组产妇胎位矫正成功率、剖宫产率、新生儿Apgar评分及分娩时间。结果观察组的胎位矫正成功率为65.00%,高于对照组的43.33%;剖宫产率为35.00%,低于对照组的56.67%,差异有统计学意义(χ^(2)=5.673、5.673,P均<0.05)。观察组新生儿Apgar评分优于对照组,差异有统计学意义(P<0.05);观察组分娩时间短于对照组,差异有统计学意义(P<0.05)。结论联合应用体位改变与胎头手转,可以提高胎位异常产妇的胎位矫正成功率,进而降低剖宫产率,缩短产妇分娩时间。