Abstract:Chronic kidney disease has become a global public health issue with high prevalence, low awareness, poor prognosis and high cost of medical care. In 2015, the Shanghai Municipal Health and Family Planning Commission approved the "Systemic Redesign and Demonstration for Early Detection, Evaluation and Management of Chronic Kidney Disease in Shanghai" as the fourth round of Shanghai 3-Year Action Plan for Public Health System Construction, and the initial results have been achieved in three years. In this program, we established a new system of three-level prevention and treatment for chronic kidney disease by combining medicine with prevention, hoping to achieve early detection, effective prevention and standardize treatment of chronic kidney disease in Shanghai, and to reduce the incidence, morbidity and mortality, so as to make a model for the prevention and treatment of chronic kidney disease in China.

Abstract:Objective To establish a management mode for patients with chronic kidney disease (CKD) of stage 3 to 4 by continuous quality improvement (CQI), and to observe the effect of CQI on renal function in CKD patients. Methods A total of 86 patients with CKD (50 in stage 3 and 36 in stage 4) were enrolled in this study, and they were regularly followed-up in the CKD outpatient of the Department of Nephrology of Jing'an District Zhabei Centre Hospital of Shanghai. The patients were randomly divided into observation group and control group, with 43 cases in each group. In the observation group, we used the management mode combining medical intervention and health education by plan-do-check-act (PDCA) four-step method; in the control group, we used the traditional management mode of medical intervention. All the patients were followed up once a month for one year. The end points included doubling serum creatinine (Scr) or entering end-stage renal disease, and occurence of cardiovascular and cerebrovascular events. The follow-up on time rate (%), Scr level, and estimated glomerular filtration rate (eGFR) were compared between the two groups. Results In the observation group, the average follow-up times were 10.7±2.8 and the follow-up on time rate was (89.9±12.8)%; while those were 4.1±2.2 and (34.2±4.9)% in the control group, and there were significant differences between the two groups (all P<0.01). During the 1-year follow-up period, two cases had end-stage renal disease and one case had acute angina in the control group, while no end point was found in the observation group. Before the implementation of CQI, there were no significant differences in eGFR or Scr level between the two groups (all P>0.05). The eGFR of the observation group after implementation of CQI was (39.35±12.23) mL/(min·1.73 m²), which was significantly higher than those of the observation group before implementation ([37.22±11.02] mL/[min·1.73 m²], P<0.05) and the control group after implementation ([35.04±12.31] mL/[min·1.73 m²], P<0.05). The Scr level of the observation group after implementation of CQI was (139.25±14.15) μmol/L, which was significantly lower than those of the observation group before implementation ([145.16±15.41] μmol/L, P<0.05) and the control group after the implementation ([148.06±15.63] μmol/L, P<0.05). Conclusion CQI management method with the combination of medical intervention and health education can improve the renal function of patients with CKD stages 3-4, and reduce the incidence of end-stage renal disease and cardiovascular and cerevascular events.

Abstract:Objective To analyze the demographic information and related costs of inpatients with chronic kidney disease (CKD) in a tertiary referral hospital in Shanghai from 2011 to 2016, so as to provide reference for further understanding and improving the current situation of medical treatment of patients with CKD in Shanghai. Methods We retrospectively reviewed the clinical data (age, gender, hospital stay, disease diagnosis, hospitalization expenses and so on) of inpatients with CKD in a tertiary referral hospital in Shanghai from 2011 to 2016. The general characteristics and disease diagnosis of the inpatients with CKD were statistically analyzed by calculating the proportion of each index using a simple statistical description method. The treatment, hospitalization expenses of the inpatients with CKD were compared between different groups by variance analysis and non-parametric test. Results The percent of inpatients from Jiangsu, Zhejiang, Anhui and Jiangxi provinces around Shanghai was 49.97% (10 033/20 079), surpassing that of inpatients from Shanghai (38.78%, 7 787/20 079). The proportion of inpatients with chronic renal failure was the highest (51.98%, 10 438/20 079), and more young people tended to suffer from the disease. The per capita hospitalization expense was increased annually, and the median hospitalization expense was 8 252.51 yuan in 2016. There were significant differences in per capita hospitalization expenses between the different year groups (P<0.001). Conclusion Active and effective measures should be taken to deal with the problem of large numbers of nonlocal patients seeking medical services in Shanghai. It is necessary to popularize the knowledge about CKD in young people, and reduce the social and personal losses due to the illness. The economic burden caused by CKD needs to be further studied.

Abstract:Blood Purification Training Center of Shanghai University of Medicine & Health Sciences is the first blood purification training center with PPP (Public Private Partnership) model in China. In this paper, we systematically analyzed the background and different aspects of basic design and teaching management practice of the blood purification training center, and provided the specific improvement opinions for its ownership structure, operation mode and credibility while considering the existing problems of the blood purification training center.

Abstract:The three-level prevention and treatment system for chronic kidney disease has been introduced in Jing'an District and Minhang District in Shanghai as a pilot project. In this paper, we systematically introduced the background and implementation program of this prevention and treatment system, and analyzed the prospect of the system by combining the characteristics and current treatment of patients with chronic kidney disease in China, so as to provide reference for Shanghai as well as the whole country.

Abstract:Objective To study the tendency of per diem expense and drug cost ratio of inpatients with chronic kidney disease (CKD) and the top three diseases (chronic renal failure, nephrotic syndrome, and primary glomerulonephritis) in a tertiary referral hospital in Shanghai from 2011 to 2016, so as to predict the per diem expense and drug cost ratio of inpatients in 2017. Methods We analyzed the per diem expense, drug cost ratio and other general situation of inpatients with CKD, and conducted the modeling research by the expert modeler in SPSS 23.0 software time series analysis module. Firstly, the per diem expense and drug cost ratio of inpatients with CKD from Jan. 2011 to Dec. 2015 were used to build model, and then the per diem expense and drug cost ratio of the inpatients in 2016 predicted by the model were compared with the real data of the inpatients in 2016 and the values of the model were evaluated. Secondly, the per diem expense and drug cost ratio of inpatients with CKD in 2017 were predicted. Finally, according to the same principle, the per diem expense and drug cost ratio of inpatients with chronic renal failure, nephrotic syndrome and primary glomerulonephritis in 2017 were predicted. Results The per diem expense, per capita hospitalization expense and per capita drug expense of inpatients with CKD increased annually from 2011 to 2016, and the expenses were (1 506.89±1 003.34) yuan, 8 252.51 yuan and 2 009.88 yuan in 2016, respectively, with the growth rates being 62.38%, 41.62% and 14.44%, respectively. The drug cost ratio of the inpatients decreased annually, and the ratio reached 32.33% in 2016. The time series models established by the per diem expense and drug cost ratio of inpatients with CKD were Winters additive model and simple seasonal model, respectively. According to the time series model, the predicted per diem expense and drug cost ratio in 2016 were consistent with the real values in 2016. The per diem expense and drug cost ratio of inpatients with CKD in 2017 predicted by the time series model were about 1 600 yuan and 30%, respectively. The predicted per diem expenses of inpatients with chronic renal failure, nephrotic syndrome and primary glomerulonephritis in 2017 were about 1 700 yuan, 1 800 yuan and 1 600 yuan, respectively, and the predicted drug cost ratios were about 30%, 35% and 10%, respectively. Conclusion The hospital income structure is constantly optimized, and a real-time disease cost monitoring information platform should be established. The research based on the trend of single disease expense needs to be further studied.

Abstract:Objective To investigate the attention of community population in Shanghai to chronic kidney disease (CKD) and related influencing factors. Methods Community populations in 27 community health service centers in Jing'an District and Minhang District of Shanghai were surveyed by stratified random sampling method. The investigation included the understanding the early symptoms, examination methods, dietary requirements and intervention measures of CKD and the attention to kidney health and the related influencing factors. Results The overall attention of community population in Shanghai to CKD was 31.4% (240/764). The community population paid the most attention to the treatment of CKD (57.5%, 439/764), followed by life expectancy (63.5%, 485/764), while the concerns about physical symptoms and urination change were the lowest (19.5%[149/764] and 21.7%[166/764], respectively). Residents aged 60 years or older, with junior college or above, and having participated in the CKD health lectures paid the most attention to CKD. Conclusion The attention of community population in Shanghai to CKD is low, suggesting that the health education should be strengthened to improve the cognitive level of CKD in community population.

Abstract:Objective To analyze the prevalence and related risk factors of chronic kidney disease (CKD) in the high-risk residents in Minhang District of Shanghai, so as to provide recommendation for the prevention of CKD. Methods A total of 22 811 subjects with high risk of CKD in Minhang District of Shanghai were screened by cluster random sampling method. The clinical data from the population were collected by questionnaire, physical examination and laboratory examination, and were analyzed by Mann-Whitney U test, Kruskal-Wallis test and logistic regression analysis. Results Among the 22 811 subjects, 9 605 (42.1%) were males and 13 206 (57.9%) were females. The number of suspected CKD patients was 5 989 (26.3%, 5 989/22 811) and the number of CKD patients was 1 633 (7.2%, 1 633/22 811). The detection rates of positive urinary protein and abnormal urinary red blood cell count in the males were significantly lower than those in the females (P<0.01); there were no significant differences in the detection rates of abnormal estimated glomerular filtration rate (eGFR) or abnormal urinary albumin-to-creatinine ratio (UACR) between different genders (P>0.05). The detection rates of the above indexes in the non-aged group (<65 years old) were lower than those in the elderly group (≥ 65 years old). There were no significant differences in the detection rates of positive urinary protein or abnormal UACR between different age groups (P>0.05), while the detection rates of abnormal urine red blood cell count and abnormal eGFR were significantly different between different age groups (P<0.01). Gender, age, body weight, height, blood pressure, history of hypertension, history of diabetes, hyperuricemia and history of renal transplantation were risk factors of CKD (P<0.05), while body mass index, history of genetic kidney disease, family history of chronic nephritis, history of renal tubules lesions, renal ultrasound structural abnormalities and history of renal biopsy were not related to the occurrence of CKD (P>0.05). Conclusion Early screening, early intervention and standardized health management are necessary measures to reduce the incidence of CKD in high-risk population of CKD. Specific measures include real-time control of high-risk factors (blood pressure, blood glucose and so on), developing targeted regular health examination program, and strengthening the screening of CKD in elderly people, which can delay and control the CKD.

Abstract:Objective To analyzed the risk factors and clinical features of ischemic complication (IC) in the endovascular treatment (EVT) of unruptured intracranial aneurysm (UIA), so as to reduce the incidence of IC. Methods We retrospectively analyzed the clinical and imaging features of 1 232 patients with UIA, who received EVT in Changhai Hospital, Second Military Medical University from Jan. 2010 to Feb. 2017. Univariate and multivariate analyses were performed to analyze the risk factors of IC. Results IC occurred in 34 (2.8%) of 1 232 patients with UIA in this study, including 16 cases of acute stent thrombus formation, 3 cases of transient ischemic attack, and 15 cases of post-operative cerebral infarction. Univariate analysis showed that hypertension (P=0.002), smoking (P=0.050), and aneurysm maximum diameter>10 mm (P=0.005) were associated with IC. Multivariate analysis showed that hypertension (OR=3.192, P=0.003), smoking (OR=2.956, P=0.022) and aneurysm maximum diameter>10 mm (OR=2.915, P=0.004) were independent risk factors of IC. The permanent disability rate and mortality rate of IC were 8.8% (3/34) and 2.9% (1/34), respectively. Conclusion Hypertension, smoking and aneurysm maximum diameter>10 mm are independent risk factors of IC in the EVT of UIA.

Abstract:Objective To discuss the value of pulmonary ventilation score in evaluating the extravascular lung water (EVLW) of patients with acute respiratory distress syndrome (ARDS). Methods We retrospectively collected the clinical data of 32 patients with ARDS, who were treated in the Department of Critical Care Medicine of Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine from Jun. 2015 to Feb. 2017 and improved within 7 days. The total pulmonary ventilation score, extravascular lung water index (EVLWI), oxygenation index (PaO₂/FiO₂), and central venous pressure (CVP) of patients at admission and after treatment for 7 d were recorded. The correlations between total pulmonary ventilation score and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, EVLWI, oxygenation index and CVP were analyzed. Results The APACHE Ⅱ score, total pulmonary ventilation score and EVLWI of the ARDS patients after treatment for 7 d were significantly decreased compared with those at admission, and the oxygenation index was significantly increased (all P<0.01). The pulmonary ventilation score was positively correlated with the APACHE Ⅱ score, EVLWI and CVP (r=0.95, 0.95, 0.64; all P<0.01), and was negatively correlated with the oxygenation index (r=-0.94, P<0.01). Conclusion Pulmonary ventilation score can effectively evaluate the EVLW of patients with ARDS, and can be used as an effective supplement for EVLW monitoring in patients with ARDS in addition to pulse indicator continous cadiac output.

Abstract:Objective To study whether plasma amino acid metabolites in patients with gastric cancer can be used as biomarkers for the diagnosis of gastric cancer. Methods The levels of 24 kinds of plasma amino acids were detected by ultra-high-performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS), and were compared between patients with gastric cancer and normal controls, between patients with different stages of gastric cancer, and between gastric cancer patients before and after operation. Results The levels of 18 kinds of plasma amino acids including alanine (Ala), glycine (Gly) and glutamic acid (Glu) in gastric cancer patients were significantly lower than those in the normal controls, while the levels of valine (Val), arginine (Arg) and serine (Ser) were significantly higher than those in the normal controls (all P<0.05); there were no significant differences in symmetric dimethylarginine (SDMA), kynurenine (Kyn) or hippuric acid (HA) levels between the two groups (P>0.05). The plasma level of Arg in patients with Ⅲ-Ⅳ stage of gastric cancer was significantly higher than that in the Ⅰ-Ⅱ stage, while the plasma glutamine (Gln), Glu, methionine (Met) and phenylalanine (Phe) levels were significantly lower than those in the Ⅰ-Ⅱ stage (all P<0.05). The levels of plasma leucine (Leu), Arg and citrulline (Cit) in patients after operation were significantly lower than those before operation, while the plasma Gln, lysine (Lys), Glu and Phe levels were significantly higher than those before operation (all P<0.05). Conclusion Amino acids metabolites in plasma of patients with gastric cancer such as Gln and Arg play important roles in the early prediction of gastric cancer.

Abstract:Objective To evaluate the performance of magnetic nanoparticle chemiluminescence immunoassay (NM-CLIA) in detection of allergen-specific immunoglobulin E (sIgE) antibodies to Dermatophagoides pteronyssinus (International Allergen Code D1) and Dermatophagoides farinae (International Allergen Code D2). Methods A total of 489 serum samples from the patients with suspected allergic disease (244 cases caused by D1, and 245 caused by D2), who were treated at Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, were detected by NM-CLIA and immunofluorescence assay, respectively. χ² test and Kappa test were used to evaluate the correlation between the two methods in detection of D1 and D2 sIgE antibodies. The limit of detection (LoD), linear range and precision of NM-CLIA in detection of D1 and D2 sIgE antibodies were verified by the standard method of American Clinical Laboratory Standardization Association. Results The LoDs of NM-CLIA in detecting D1 and D2 sIgE antibodies were both less than 0.01 U/mL, the linearity ranged from 0.1 to 100 U/mL, the within-run precision was less than 5%, and the between-run precision was less than 8%. Methodological comparison results showed that NM-CLIA and immunofluorescence assay had good consistency in detecting D1 and D2 sIgE antibodies. For D1, the positive coincidence rate and negative coincidence rate were 95% and 92%, respectively (χ²=174.45, P<0.001, Kappa=0.843), and the ±1 class agreement was 95.6%; for D2, the positive coincidence rate and negative coincidence rate were 91% and 97%, respectively (χ²=154.263,P<0.001,Kappa=0.787), and the ±1 class agreement was 94.2%. Conclusion NM-CLIA has good correlation with immunofluorescence assay in detecting D1 and D2 sIgE antibodies, and has good LoD, linear range and precision, suggesting that it can be recommended for clinical testing of D1 and D2 sIgE antibodies.

Abstract:Objective To analyze the relationship between the JAK2V617F mutation and the expressions of phosphorylated Janus kinase 2 (p-JAK2), suppressor of cytokine signaling 1 (SOCS1), and SH2-containing protein tyrosine phosphatase 1 (SHP1) in JAK2V617F mutation positive myeloproliferative neoplasm (MPN) tissues, and to investigate the effects of JAK2 inhibitor ruxolitinib on regulating the proliferation of JAK2V617F mutation positive human erythroleukemia cell lines HEL and the expressions of SOCS1 and SHP1 in HEL cells. Methods A total of 48 patients with JAK2V617F mutation positive MPN (MPN group) and 24 patients with anemia (control group) in Hebei General Hospital and The First People's Hospital of Baoding from Jul. 2012 to Aug. 2016 were enrolled in this study. The protein expressions of p-JAK2, SOCS1 and SHP1 in bone marrow biopsies (BMBs) were detected by immunohistochemistry. The correlations between JAK2V617F mutation level and the protein expressions of SOCS1 and SHP1 were analyzed by Spearman rank correlation analysis. HEL cells were treated with ruxolitinib at different concentrations (50, 100, 250, 500 and 1 000 nmol/L), and the viability of cells was determined by CCK-8 assay. The JAK2V617F mutation levels in MPN tissues and HEL cells and the mRNA expressions of JAK2, SOCS1 and SHP1 in HEL cells were detected by qPCR. The protein expressions of JAK2, SOCS1 and SHP1 in HEL cells were detected by Western blotting analysis. Results The ratio of JAK2V617F/JAK2 was (57.33±20.82)% in the MPN group and was zero in the control group. The protein expressions of p-JAK2, SOCS1 and SHP1 in BMBs of MPN patients were significantly different from those in the control group (all P<0.01). The protein expressions of SOCS1 and SHP1 were negatively correlated with the mutation level of JAK2V617F (r=-0.648, -0.692; P<0.05). The expressions of SOCS1 and SHP1 in MPN patients with JAK2V617F/JAK2<50% were significantly higher than those in MPN patients with JAK2V617F/JAK2 ≥ 50% (P<0.01), while the expression of p-JAK2 was significantly lower than that in MPN patients with JAK2V617F/JAK2 ≥ 50% (P<0.01). After treatment with 250 nmol/L ruxolitinib for 24 h, 48 h, and 72 h, the viabilities of HEL cells were (60.06±3.87)%, (52.05±2.88)%, and (36.43±2.01)%, respectively. With the increase of ruxolitinib concentrations, the mRNA and protein expressions of JAK2 and the protein expression of p-JAK2 were gradually decreased (P<0.01, P<0.05), while the mRNA and protein expressions of SOCS1 and SHP1 were gradually increased (all P<0.01). Conclusion Ruxolitinib can inhibit the expressions of JAK and the phosphorylation of JAK in HEL cells, enhance the expressions of SOCS1 and SHP1, and reduce the viability of HEL cells.

Abstract:Bladder cancer is one of the malignant tumors that seriously endanger human health, but its diagnosis and treatment progress are relatively slow. With the rapid development of molecular biology and the continuous emergence of biological detection technology, the molecular typing of bladder cancer through gene analysis is expected to become an important means to improve the diagnosis and treatment of bladder cancer. In this paper, we summarized the recent advances in the molecular typing of bladder cancer and its clinical significance in predicting drug responsiveness and judging prognosis.

Abstract:Cerebral vasospasm is common in aneurysmal subarachnoid hemorrhage (aSAH). It often occurs several days after aSAH, and then peaks at 1 week, causing local cerebral ischemia, cerebral infarction and neurological deficit dysfunction. Cerebral vasospasm is an important reason for death or disability after aneurysm rupture. Cerebral angiography is the gold standard for the diagnosis of cerebral vasospasm, but now transcranial Doppler ultrasound, CT cerebral perfusion imaging, near infrared spectroscopy and other non-invasive inspection methods are increasingly popular and easy to carry out extensively. Treatments of cerebral vasospasm include hemodynamics and drug therapy, with early removal of hematoma, diastolic blood vessels, and enhanced brain perfusion as the main research direction. Joint treatments are the future trends of cerebral vasospasm therapy. In this review, we summarized the diagnosis and treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage.

Abstract:Objective To investigate the relationship between anxiety sensitivity (AS), resilience and mental health of soldiers. Methods A total of 260 soldiers were selected from an army troop, and were surveyed by anxiety sensitivity index Ⅲ (ASI-3), Conner-Davidson resilience scale (CD-RISC) and self-reporting inventory (SCL-90). The relationships of these variables were analyzed by structure equation modeling analysis. Results Totally 240 (92.3%) valid questionnaires were collected. There were no significant differences in AS or mental health between soldiers with different demographic factors including service length, single-child or not, job division, educational level, or residence before entering army (P>0.05). The total score of SCL-90 and each factor scores of soldiers with high-AS were significantly higher than those with low-AS (P<0.01). The correlation analysis results showed that the total score of SCL-90 was positively correlated with the total score and each factor score of ASI-3 (r_ASI=0.487, r_somatic=0.435, r_social=0.455, r_cognitive=0.445; P<0.001), and was negatively correlated with each factor score of CD-RISC (r_tenacity=0.315, r_strength=0.321, r_optimism=0.227; P<0.001). Structural equation modeling analysis and Sobel test showed that AS indirectly affected the mental health of soldiers through the mediating effect of resilience (χ²/df=20.222/12=1.685 2, P=0.063, goodness of fit index[GFI]=0.977, adjusted goodness of fit index[AGFI]=0.946, normed fit index[NFI]=0.977, relative fit index[RFI]=0.960, incremental fit index[IFI]=0.991, Tucker-Lewis index[TLI]=0.983, comparative fit index[CFI]=0.990, and root mean square error approximation[RMSEA]=0.054). Conclusion RS has partial mediating effect on the relationship between AS and mental health of soldiers. More attention should be paid on the mental health of soldiers with high AS, so as to improve their RS and mental health.

Abstract:Objective To investigate the application of video head impulse test in detecting the impairment of semicircular canal of patients with acute vestibular neuritis and the recovery features of the damaged semicircular canal. Methods The clinical data of 28 patients with acute vestibular neuritis, who were diagnosed in the Department of Neurology, Changzheng Hospital, Second Military Medical University from Mar. 2015 to Mar. 2016, were analyzed and regularly followed up. The damage and recovery of each semicircular canal function were evaluated by video head impulse test. Results During the onset period, the horizontal semicircular canal function was abnormal in 28 patients (100.00%), the anterior semicircular canal function was abnormal in 24 cases (85.71%), and the posterior semicircular canal function was abnormal in 4 cases (14.29%). After 2 months of follow-up, the gain of the patients with severe damage of horizontal semicircular canal (gain<0.5) at onset did not return to normal, while that of 80.00% (12/15) of the patients with less damage of horizontal semicircular canal (gain ranged from 0.5 to 0.8) recovered; 82.35% (14/17) of the patients with severe damage of anterior semicircular canal (gain<0.5) at onset did not recover, while that of the patients with less damage of anterior semicircular canal (gain ranged from 0.5 to 0.7) returned to normal. Conclusion In patients with vestibular neuritis, the damage of semicircular canal dominated by superior vestibular nerve is more severe than that dominated by inferior vestibular nerve. Video head impulse test is suitable for the detection and follow-up of the function of impaired semicircular canal. The recovery of impaired semicircular canal is related to its severity at onset.

Abstract:Objective To investigate the patterns and risk factors of central lymph node metastasis (CLNM) in the clinically node-negative neck (cN0) papillary thyroid microcarcinoma (PTMC) patients with tumor maximum diameter ≤ 5 mm. Methods A total of 186 patients with cN0 PTMC (tumor maximum diameter ≤ 5 mm) were enrolled from Department of General Surgery (Ⅲ), Changzheng Hospital, Second Military Medical University from Jan. 2011 to Dec. 2015. The clinicopathological characteristics of the patients were retrospectively analyzed, including gender, age, tumor location, bilateral carcinoma, multiplicity, extrathyroidal invasion, Hashimoto thyroiditis, and immunohistochemical results. χ² test and logistic regression were used to evaluate the patterns and risk factors of CLNM in cN0 PTMC patients. Results In this study, 58 (31.2%) of 186 patients with cN0 PTMC (tumor maximum diameter ≤ 5 mm) developed CLNM. The average number of lymph nodes in prophylactic lymph node dissection was 4.92±6.82 (ranged from 0 to 14), with the average number of metastatic lymph nodes being 0.78±1.41 (ranged from 0 to 5). The average ratio of metastatic lymph nodes number/dissected lymphatic nodes number was (50±28)% (ranged from 0% to 100%). Univariate analysis showed that gender and multifocal tumor were risk factors of CLNM (P<0.05). Multivariate analysis showed that male and multifocal tumor were independent risk factors of CLMM in PTMC (tumor maximum diameter ≤ 5 mm) patients (P<0.05). Conclusion Prophylactic central lymph node dissection may be more valuable for male cN0 PTMC (tumor maximum diameter ≤ 5 mm) patients with multifocal tumors.

Abstract:Objective To analyze the recent clinical results and experience of extracorporeal membrane oxygenation (ECMO) in treating critical patients, so as to summarize the methods, timing and indications of ECMO treatment. Methods We retrospectively analyzed the clinical data (primary disease, supportive mode, adjuvant time and so on) of 18 critical patients treated with ECMO from Jan. 2014 to Nov. 2016 in our hospital, compared the offline rate and success rate of different kinds of critical patients, and analyzed the survival factors and causes of death of the patients. Results Among the 18 critical patients, 12 cases were treated with vein-artery ECMO, four with vein-vein ECMO and two with vein-artery-artery ECMO. Totally seven (38.9%) cases were successfully offline and five (27.8%) cases survived. The offline rate and success rate of the patients with circulatory failure were 62.5% (5/8) and 37.5% (3/8), respectively, while those of the patients with respiratory failure were both 20% (2/10). None of the six patients with adult respiratory distress syndrome (ARDS) secondary to severe burn, trauma or operation survived. The survival rates of patients with ARDS secondary to pulmonary disease (HR=12.3, 95%CI:2.2-69.9; P<0.01) and patients with circulatory failure (HR=4.6, 95% CI:1.1-19.5; P<0.05) were significantly higher than that of patients with ARDS secondary to non-pulmonary causes, while there was no significant difference in survival rate between the patients with circulatory failure and ARDS secondary to pulmonary disease. Conclusion Prompt selection of ECMO treatment time, improvement of the treatment procedure, active treatment of primary disease, and prevention of complications are the keys of ECMO treatment. The establishment of hospital emergency channel and the formation of ECMO treatment team with multidisciplinary and multisectoral cooperation should be carried out to insure the success of ECMO treatment.

Abstract:Objective To investigate the preliminary experience of laparoscopic partial nephrectomy in patients with adherent perinephric fat. Methods We retrospectively analyzed the clinical data of 16 patients with adherent perinephric fat undergoing laparoscopic partial nephrectomy by the single surgeon in the Department of Urology of Changhai Hospital, Second Military Medical University between Jan. 2016 and Dec. 2016. For the patients with serious adherent perinephric fat, the tumor could be located by the intra-operative B-mode ultrasound after exposing the general boundaries of tumor and normal renal tissues, and the boundaries were marked with electric knife. The adherent adipose tissue and tumor were both resected with scissors along the marking line after blocking the blood flow. Results The operations were successfully completed in all the 16 patients, and the intra-operative B-mode ultrasound positioning was used in 5 cases. The maximal diameter of tumor was 2.1-3.5 (2.8±0.4) cm, the Mayo adhesive probability (MAP) score was 3-5 (3.8±0.7), the renal artery occlusion time was 20-31 (25.6±3.1) min, and the operation time was 90-133 (112.0±10.5) min. During a follow-up of 6-20 months, no patients had recurrence or metastasis. Conclusion It is important to locate the tumor boundaries during laparoscopic partial nephrectomy in patients with adherent perinephric fat, and the intra-operative B-mode ultrasound can be used if necessary. The tumor and adherent adipose tissue must be both resected to avoid forced separation of perirenal fat from renal capsule.

Abstract: