Abstract:Low back pain caused by lumbar disc herniation is one of the main factors leading to physical disability. In the treatment of lumbar disc herniation, the collaboration of traditional Chinese medicine and Western medicine have their respective advantages, helping to reduce the burden of society and family. Based on the international surgical indications for lumbar disc herniation, we divided lumbar disc herniation into 3 stages, including conservative treatment stage, surgical intervention stage and postoperative rehabilitation stage. From the perspective of collaboration of traditional Chinese medicine and Western medicine, we discussed the signifcance, status and future prospects of stepwise therapy for lumbar disc herniation.

Abstract:Idiopathic scoliosis is a spinal deformity without clear etiology, and biomechanical factors play an important role in its pathogenesis and treatment. The spatial load inequality of the spine and its accessories, the unbalanced development of the vertebral body, and the pedestal instability caused by pelvic inclination and rotation have important influences on the development of idiopathic scoliosis. Both brace therapy and pedicle screw-rod system therapy are based on biomechanical characteristics and are continuously progressing. This review sums up the research advances on biomechanical characteristics of idiopathic scoliosis and its therapy strategy in recent years.

Abstract:Objective To explore the relationship between leg length discrepancy (LLD) and scoliosis in adolescent idiopathic scoliosis (AIS) patients, and to analyze the improvement of LLD after orthopaedic surgery and the risk factors. Methods The clinical data were collected from 85 AIS patients admitted to Department of Spine Surgery of Changhai Hospital, Naval Medical University (Second Military Medical University) from Jan. 2010 to Jan. 2013. The height difference of bilateral femoral head (HD-bFH) on standing X-ray images and the changes of HD-bFH after orthopaedic surgery were measured using the imaging data before operation and 2 years after operation. According to preoperative HD-bFH, the patients were divided into non-LLD group (HD-bFH<5 mm) and LLD group (HD-bFH ≥ 5 mm). The general characteristics and imaging parameters were compared between the two groups, and the correlation between HD-bFH changes and other parameters was analyzed. Results The HD-bFH of the 85 AIS patients was (0.80±5.57) mm before operation and (-0.49±4.93) mm 2 years after operation, and the difference was significant (P=0.022). There was no significant difference in HD-bFH between the patients with main thoracic curves (Lenke typeⅠ, Ⅱand Ⅲ; n=50) and thoracolumbar/lumbar curves (Lenke type Ⅴ and Ⅵ, n=33;[0.52±5.86] mm vs[1.53±5.12] mm, P=0.427). Among the 85 patients, 31 (36.5%) had LLD. There were no significant differences in general features and imaging parameters between the non-LLD group (n=54) and the LLD group (n=31, P>0.05). Postoperative change of HD-bFH was correlated with Risser sign (r_s=-0.512, P=0.020) and the orthopedic degree of lumbar curvature (r=-0.605, P=0.018). Conclusion The prevalence of LLD is 36.5% in AIS patients. Changes of leg length in AIS patients are closely related to orthopedic surgery, and the orthopedic degree of lumbar curvature and Risser sign are the risk factors.

Abstract:Objective To measure the spinal sagittal parameters and pelvic parameters of adult scoliosis patients, and to explore the influencing factors of proximal junctional kyphosis (PJK) after surgery. Methods The clinical data of 45 adult scoliosis patients, who underwent surgical treatment in our hospital from Jan. 2014 to Sep. 2016, were retrospectively analyzed. The participants were divided into PJK group and non-PJK group according to whether proximal junctional angle (PJA) was >20°. Before operation, at 1 week after operation and at the last follow-up, the thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS) were measured and analyzed on the anteroposterior and lateral X-ray films of the spine. The main influencing factors of PJK in adult scoliosis patients after surgery were analyzed using logistic multivariate regression analysis. Results Nineteen patients were enrolled in the PJK group and 26 in the non-PJK group. There were no significant differences in the gender, age, follow-up time, upper instrumented vertebra or lower instrumented vertebra between the two groups (all P>0.05). Compared with the non-PJK group, the LL, SVA and PT at the last follow-up, and PT before operation were significantly larger in the PJK group, and the SS before operation and at the last follow-up were significantly lower (all P<0.05). However, there were no significant differences in the other parameters between the two groups (all P>0.05). Logistic multivariate regression analysis showed that TK and SS before operation, and TK, LL and PT at the last follow-up were the main influencing factors of PJK. Conclusion TK and SS before operation, and TK, LL and PT at the last follow-up are the main influencing factors of PJK.

Abstract:Objective To explore the feasibility and repeatability of Surgimap software in measurement of Cobb angle of adolescent idiopathic scoliosis (AIS). Methods Four surgeons (1 associate chief physician and 3 residents) measured the coronal main curve Cobb angle and sagittal parameters (thoracic kyphosis[TK], thoracolumbar kyphosis[TLK] and lumbar lordosis[LL]) of 67 AIS patients using Surgimap software and traditional measurement method on standard standing position X-ray images before operation. The measurement time of the two methods was recorded and compared. The reliability analysis was performed for the measurement results of 4 surgeons, and the repeatability analysis was performed for 2 measurement results of 3 residents. Results The coronal main curve Cobb angles measured by Surgimap software and traditional measurement method were 49.4°±8.2° and 41.4°±15.6°, respectively, and the absolute average difference between the two methods was 8.29°±4.36°. The measurement time of Surgimap software and traditional measurement method was (5.2±0.7) min and (8.8±1.5) min, respectively, with the absolute average difference being (3.6±0.9) min, and the difference was significant (t=2.57, P<0.01). The reliability analysis showed that the coronal main curve Cobb angle, TK, TLK and LL measured by 4 surgeons using Surgimap software had excellent or good consistency (intraclass correlation coefficient[ICC]=0.972, 0.924, 0.875, 0.962). Repeatability analysis showed that the coronal main curve Cobb angle, TK, TLK and LL measured by 3 residents had excellent or good consistency using Surgimap software (ICC ranged from 0.875 to 0.984). Conclusion Surgimap software is superior to the traditional method in measuring Cobb angle, and has the advantages of high efficiency, short learning curve and unified data derivation.

Abstract:Objective To analyze the correlation between adjacent segment disease (ASDis) after lumbar fusion and spinopelvic sagittal parameters, and to explore the risk factors. Methods From Jan. 2013 to Oct. 2017, the patients undergoing revision surgery for ASDis after lumbar fusion in Changhai Hospital of Naval Medical University (Second Military Medical University) were enrolled as ASDis group, and the patients who did not have ASDis after lumbar fusion during the same follow-up period were taken as controls. The clinical data of the patients in the two groups were retrospectively analyzed. The differences of the general data (age, gender, body mass index[BMI], follow-up time and the etiology of the first operation) and the spinopelvic sagittal parameters (thoracic kyphosis[TK], sagittal vertical axis[SVA], lumbar lordosis[LL], segmental lumbar lordosis[sLL], pelvic incidence[PI], pelvic tilt[PT] and sacral slope[SS]) were compared between the two groups. Results There were 25 patients in the ASDis group and 50 patients in the control group. There were no significant differences in the age, gender, BMI, follow-up time or the etiology of the first operation between the two groups (all P>0.05). Compared with the control group, the LL, sLL and SS were significantly lower in the ASDis group (36.00°±5.44°vs 43.88°±10.62°, 17.80°±5.79°vs 27.62°±6.74°, 27.50°±5.30°vs 31.06°±7.48°; all P<0.05), while the PT was significantly greater (26.12°±8.24°vs 18.80°±7.67°, P<0.01). There were no significant differences in the TK or PI between the two groups (both P>0.05). Meantime, the proportion of patients with SVA>50 mm, the difference of PT and LL (PT-LL) ≥ 10°, and the ratio of sLL to LL (RL)<60% were significantly higher in the ASDis group than those in the control group (18/25 vs 21/50, 16/25 vs 11/50, 21/25 vs 17/50; all P<0.05). Conclusion The sagittal imbalance after lumbar fusion is closely associated with ASDis, and compensatory kyphosis of adjacent lumbar segments due to surgical segmental lordosis may be one of the causes of ASDis after lumbar fusion.

Abstract:Objective To explore the characteristics of spinopelvic sagittal parameters in degenerative lumbar spondylolisthesis patients and the relationship between these parameters and lumbar spondylolisthesis. Methods From Jun. 2016 to Jun. 2018, 42 patients with degenerative lumbar spondylolisthesis (DLS) were enrolled in study group, and 58 degenerative lumbar disease patients without spondylolisthesis were enrolled in control group. The general characteristics of the patients were collected. The sagittal parameters, including pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL) and sagittal vertical axis (SVA), were measured on lateral X-ray films of full-length spine. The differences of general characteristics and sagittal parameters were compared between the two groups. With the lumbar spondylolisthesis rate as dependent variable and the spinopelvic sagittal parameter as independent variable, logistic regression model was used to analyze the risk factors of lumbar spondylolisthesis. Results There were no significant differences in the age, gender, height or body mass of the patients between the two groups (all P>0.05). There were significant differences in the PT, PI, SS, LL, TLK and SVA between the DLS group and the control group (all P<0.05), but there was no significant difference in the TK (P>0.05). Logistic regression analysis showed that LL and PT were risk factors of lumbar spondylolisthesis (both P<0.05). Conclusion The sagittal parameters (PT, PI, SS, LL, TLK and SVA) in the patients with DLS are significantly changed. LL and PT are the risk factors of lumbar spondylolisthesis.

Abstract:Objective To explore whether microR-21 (miR-21) can alleviate doxorubicin (DOX)-induced cardiotoxicity and whether silent information regulator 1 (SIRT1) signaling pathway mediates the roles. Methods Neonatal rat cardiac myocytes were treated with DOX (1 μmol/L) to induce DOX myocardial toxicity model. The cardiomyocytes were randomized into 8 groups:control group, miR-21 group, miR-21 inhibitor group, DOX group, miR-21+DOX group, miR-21 inhibitor+DOX group, Sirtinol+miR-21+DOX group and Sirtinol+DOX group. The miR-21 mimics, miR-21 inhibitors and Sirtinol (SIRT1 inhibitor) were given at 24 h before DOX treatment. After treatment with DOX for 24 h, the cell viability, apoptosis rate, and the expression levels of apoptosis-related proteins and SIRT1 signaling pathway were detected. Results Compared with the control group, the cell viability, and the expression levels of Bcl-2 and SIRT1 were significantly decreased in the cardiomyocytes after treatment with DOX for 24 h, while the expression levels of Bax and cleaved Caspase-3, and apoptotic rate were significantly increased (P<0.05). Compared with the DOX group, miR-21 significantly increased cell viability and the expression levels of Bcl-2 and SIRT1, and significantly decreased the expression levels of Bax and cleaved Caspase-3 and apoptotic rate (P<0.05). Inhibiting SIRT1 signaling pathway could significantly weaken the protective effect of miR-21 on cardiomyocytes (P<0.05). Conclusion miR-21 can inhibit cardiomyocyte apoptosis, increase cell viability and alleviate DOX-induced cardiotoxicity by activating SIRT1 signaling pathway.

Abstract:Objective To analyze the clinicopathological and immunohistochemical characteristics of renal cell carcinoma (RCC) bone metastasis, and to explore the pathological characteristics and high-risk factors of bone metastasis in RCC patients. Methods A retrospective study was conducted on the clinicopathological and immunohistochemical characteristics of 1 694 RCC patients without bone metastasis and 133 RCC patients with bone metastasis, who were admitted to Changzheng Hospital of Naval Medical University (Second Military Medical University) from Jan. 2012 to Dec. 2017. The paired pathological data of primary and bone metastatic lesions were analyzed in 25 RCC patients whose primary and bone metastatic lesions were removed successively or simultaneously in Changzheng Hospital. Results Compared with the RCC patients with bone metastasis, the proportion of males was significantly lower in the RCC patients without bone metastasis (70.1%[1 188/1 694] vs 84.2%[112/133], P<0.01), and the proportion of clear cell RCC (CCRCC) patients was also significantly lower (83.4%[1 412/1 694] vs 93.6%[103/110], P=0.004). Fuhrman nuclear grade Ⅲ/Ⅳ accounted for 17.7% (247/1 398) and 51.6% (32/62) in the CCRCC patients without bone metastasis and with bone metastasis, respectively, and the difference was significant (P<0.001). The proportion of the patients having tumor invasion or breakthrough of the renal capsule was 44.0% (11/25) in the 25 patients with bone metastasis having matched data and 18.9% (320/1 694) in the RCC patients without bone metastasis, and the difference was significant (P=0.002). Matching analysis showed that the Ki-67 marker index was significantly lower in the primary lesions than that in the bone metastatic lesions (median[lower quartile, upper quartile]:5.0%[2.0%, 6.0%] vs 6.0%[3.0%, 15.0%], P<0.001). Conclusion CCRCC is more prone to bone metastasis than non-CCRCC. Male, Fuhrman grade Ⅲ/Ⅳ and invasion of renal capsule are high risk factors of bone metastasis. The Ki-67 marker index is higher in bone metastatic lesions than that in primary tumor, suggesting that the pathological characteristics of primary and bone metastatic lesions are not identical and the pathological analysis may guide treatment.

Abstract:Objective To explore the efficacy, safety and prognostic factors of drug-eluting bead-transarterial chemoembolization (DEB-TACE) in treatment of the patients with early and middle stage hepatocellular carcinoma (HCC). Methods Twenty-six early and middle stage HCC patients receiving DEB-TACE treatment were enrolled in this prospective cohort study. Modified response evaluation criteria in solid tumors (mRECIST) was used to evaluate the efficacy of DEB-TACE treatment. The deadline for follow-up was Dec. 20, 2017, and the progression free survival (PFS) and overall survival (OS) were recorded. Multivariate logistic regression model and Cox proportional regression model were used to analyze the factors affecting the efficacy and prognosis. Results A total of 32 DEB-TACE treatment were performed in 26 patients. Treatment-related adverse events were recorded in 31 DEB-TACE treatments. Perioperative pain frequency was 15 times (48.4%), including mild pain 10 times (32.3%) and moderate pain 5 times (16.1%); and fever frequency was 10 times (32.3%) and gastrointestinal reaction was 5 times (16.1%). Within 3 months of DEB-TACE treatment, the overall response rate (ORR) was 65.4% (17/26), and disease control rate (DCR) was 84.6% (22/26). Compared with the patients with maximum diameter of tumors ≥ 50 mm, the patients with maximum diameter of tumors<50 mm had a significantly higher ORR (92.3%[12/13] vs 38.5%[5/13], P=0.013). Compared with the patients with Barcelona stage B, the patients with Barcelona stage A had a significantly higher ORR (81.3%[13/16] vs 40.0%[4/10], P=0.031). The follow-up ranged from 2.9 to 20.0 months (median 7.2 months), median PFS was 11.9 months (95% CI 5.0-18.9 months), and median OS was 14.6 months (95% CI 9.9-19.2 months). Multivariate logistic regression revealed that tumor maximum diameter ≥ 50 mm was an independent predictor of poor ORR (P=0.036). Cox proportional regression model analysis showed that no clinicopathological characteristics were independent predictors of PFS or OS. Conclusion DEB-TACE treatment is an effective and safe method for early and middle stage HCC patients, and maximum diameter of tumor ≥ 50 mm can be used as an independent prognostic biomarker.

Abstract:Objective To explore the curative effect of hyperbaric oxygen (HBO) on carbon monoxide (CO) poisoning of pregnant rats and its effect on learning and memory ability of the offspring rats. Methods A total of 120 pregnant SD rats (E3) were randomly divided into four groups:control, CO poisoning, CO poisoning+HBO and CO poisoning+normobaric oxygen (NBO) groups. The rats in the control group were not treated, while those in the other 3 groups were treated with acute CO poisoning. After successful modelling, the rats in the HBO group were treated with HBO (O₂ ≥ 99%, absolute pressure 250 kPa) till delivery, and the rats in the NBO group were treated with NBO (O₂ ≥ 99%, normal pressure) till delivery. The mortality rate of pregnant rats, the number of pups, the body mass of the pups and the mortality rate of pups were recorded, and the memory and learning ability of the offspring rats was assessed with Morris water maze. Results Compared with the CO poisoning group, HBO treatment could significantly reduce the mortality rate of pregnant rats and pups (0 vs 14.8%[4/27], 1.0%[3/292] vs 8.6%[18/209]; P<0.01, P<0.05), increase the number of pups and the body mass of pups (11.2±1.6 vs 9.1±2.1,[6.55±1.13] g vs[5.27±1.02] g; both P<0.05), and enhance the learning and memory ability of pups (escape avoidance latency was significantly shortened in Morris water maze, P<0.01). The above indicators were also improved after NBO treatment, but the effect was significantly lower than HBO treatment (P<0.05). Conclusion Both HBO and NBO can treat CO poisoning of pregnant rats, and can reduce the effects of CO poisoning on learning and memory ability of offspring rats, but the therapeutic effect of HBO treatment is better than NBO.

Abstract:Objective To explore the effect of aerobic exercise on blood lipid of hyperlipidemia rats and its mechanism. Methods A total of 120 healthy male SD rats aged 8 weeks were randomized into normal control group, high-fat diet (HF) group, SBC-115076 group and aerobic exercise group, with 30 rats in each group. The rats in the normal control group were fed with standard diet, and the rats in the other 3 groups were fed with HF to establish hyperlipidemia rat model. The rats in the SBC-115076 group were injected with proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor SBC-115076 (8 mg/kg) once a week for 8 weeks, and the rats in the aerobic exercise group underwent swimming without load 6 days a week for 8 weeks. After 8 weeks, the rats were sacrificed and the blood samples were collected to determine the levels of serum triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL) and high-density lipoprotein (HDL). Pathological changes of thoracic aorta were observed using H-E staining. The mRNA and protein expression levels of PCSK9, low-density lipoprotein receptor (LDLR) and sterol regulatory element binding protein (SREBP) in the hepatic tissues were detected by quantitative real-time PCR, Western blotting and immunofluorescence. Results Compared with the normal control group, the levels of serum TG, TC and LDL of the rats were significantly higher in the HF group, and the level of HDL was significantly lower (P<0.01). Compared with the HF group, the levels of serum TG, TC and LDL of the rats were significantly lower in the SBC-115076 and aerobic exercise groups, and the level of HDL was significantly higher (P<0.01). In the HF rats, the aortic tunica intima was thickened and endothelial cells were damaged and exfoliated. Compared with the HF group, the aortic intima thickening was reduced and endothelial damage was less in the aerobic exercise group. Compared with the normal control group, the mRNA and protein expression levels of PCSK9, SREBP1 and SREBP2 were significantly higher in the HF group, and the mRNA and protein expression levels of LDLR were significantly lower (P<0.01). Compared with the HF group, the mRNA and protein expression levels of PCSK9, SREBP1 and SREBP2 were significantly lower, and the mRNA and protein expression levels of LDLR were significantly higher (P<0.01). Conclusion Aerobic exercise can down-regulate the expression of TG, TC and LDL, up-regulate the expression of HDL, and alleviate the intimal thickening of aorta. The mechanism may be related to down-regulating the expression of PCSK9 and SREBPs, thus eliminating the inhibition of LDLR.

Abstract:L₃ skeletal muscle index (L₃ SMI) is an emerging nutritional assessment tool. It has been well documented that L₃ SMI can correctly reflect body skeletal muscle mass, and can be used to evaluate the prognosis of sarcopenia, chronic liver disease and many malignant tumors. Moreover, it can also be used to predict some surgical complications. This review sums up the recent advances of L₃ SMI in evaluating prognosis of diseases.

Abstract:Elevated serum amylase is a common clinical syndrome which can be caused by a variety of causes. Hyperamylasemia is diagnosed as elevation of serum amylase level 3 or more times of upper limit of the normal value, and there are no obvious clinical symptoms such as upper abdominal pain. Hyperamylasemia can occur in a variety of diseases. Isozyme analysis can improve the specificity of diagnosis and has high diagnostic value. Clinically, the patients with hyperamylasemia shall be examined properly to make a definite diagnosis and symptomatic treatment as soon as possible.

Abstract:Microparticles are small vesicles with a diameter ranging from 0.1 to 1 μm that fall off from cell membranes through germination when cells are activated or apoptotic. Microparticle contains proteins, cytokines, mRNA, microRNA and other substances, and exerts a variety of biological functions. Microparticle plays an important role in endothelial cell dysfunction, inflammation, and smooth muscle cell proliferation and migration in the development and progression of atherosclerosis. High-level microparticles in circulation are not only biomarkers of vascular injury in atherosclerosis patients, but also potential diagnostic and therapeutic targets of atherosclerosis. This review focuses on the role of microparticle in the development and progression of atherosclerosis, and sums up the related research progresses at the cellular level.

Abstract:Ankylosing spondylitis (AS) is an immune-mediated chronic inflammatory disease characterized by involvement of sacroiliac and spinal joints. The main pathological features of AS are enthesitis and new bone formation-caused joint fusion, but its pathogenesis is still unclear. Wnt signaling pathway exerts an important effect on the normal bone homeostasis, especially on the formation of osteoblasts, and may contribute to the pathogenesis of AS. Studies have shown that chronic inflammation and genetic regulation participate in the new bone formation of AS through Wnt signaling pathway. This review sums up the effect of Wnt/β-catenin signaling pathway on bone metabolism of AS in recent years.

Abstract:Objective To explore the insomnia status and the influencing factors of navy soldiers during escort in Aden Gulf. Methods Totally 476 soldiers were collected by random cluster sampling method. The mental health status of the soldiers was assessed by Eysenck personality questionnaire-revised, short scale for Chinese (EPQ-RSC) and symptom check list-90 (SCL-90) at 1 week before the escort. At 2 months after the long voyage, the insomnia status and general situation were assessed using the insomnia severity index (ISI) scale and the general situation questionnaire, respectively. The multivariate linear regression analysis was conducted to analyze the influencing factors of insomnia. Results A total of 474 valid questionnaires were collected. During the escort, 44.1% (209/474) of the soldiers suffered from insomnia of different extents, with 28.1% (136/474) subthreshold insomnia, 13.5% (64/474) moderate insomnia and 1.9% (9/474) severe insomnia. The multivariate linear regression analysis showed that the times of escort, night duties and the frequency of oral ulcer were the influencing factors of insomnia (R²=0.68; standardized regression coefficients were -0.101, 0.111 and 0.172, respectively; all P<0.05). Meantime, emotional stability also influenced insomnia to a small extent (R²=0.03, standardized regression coefficient=0.173, P<0.05). Conclusion The sleep quality of the soldiers during long-time escort is severely influenced, with high prevalence of insomnia. The main influencing factors include the times of escort, night duties and the frequency of oral ulcer, and emotional stability may also be an influencing factor.

Abstract:Objective To investigate the status of anxiety and depression in lung cancer inpatients and to explore their influencing factors. Methods One hundred lung cancer patients, who were treated in Changhai Hospital of Naval Medical University (Second Military Medical University) from Nov. 2016 to May 2017, were enrolled in this study. The demographic, sociological and clinical characteristics of the inpatients were collected by self-designed questionnaires through cross-sectional survey. The self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were employed to evaluate the anxiety and depression symptoms of the lung cancer inpatients, respectively. Pearson correlation analysis, Fisher exact test, χ² test and multiple linear regression analysis were used to analyze the correlation of anxiety and depression and the related factors. Results The incidence rates of depression and anxiety in lung cancer inpatients was 20.0% (20/100) and 48.0% (48/100), respectively. The SAS and SDS scores of lung cancer inpatients were significantly higher than the normal values (both P<0.01). SAS score was positively correlated with SDS score (r=0.409, P<0.001). The rate of comorbidity of depresson and anxiety was high. The proportion of anxiety inpatients with comorbid depression was 85.0% (17/20). The proportion of depressive inpatients with comorbid anxiety was 35.4% (17/48). Univariate analysis showed that child number and tumor metastasis were significantly correlated with anxiety symptoms in the lung cancer inpatients. The inpatients having 0-1 child had significantly higher incidence of anxiety versus those having 2 or more children (P=0.042). The inpatients with tumor metastasis had significantly higher incidence of anxiety versus those without metastasis (P=0.044). Multiple linear regression analysis showed that child number and clinical stage of tumor were the influencing factors of anxiety in the lung cancer inpatients, with the standard regression coefficients being -0.238 and 0.202, respectively (both P<0.05). Conclusion The incidence rates of anxiety and depression are high in lung cancer inpatients, and there is a strong correlation between depression and anxiety. Number of child, clinical stage of tumor and tumor metastasis can influence the severity of anxiety. Clinicians should pay attention to the psychological status of lung cancer patients, identify depression and anxiety symptoms in time, and carry out individualized psychological therapy and drug therapy according to the characteristics of patients.

Abstract:Objective To explore the causes, diagnosis and treatment of biliary tract hemorrhage after hepatic cancer thermal ablation. Methods The clinical data of 6 patients with biliary tract hemorrhage developed after hepatic cancer thermal ablation in our hospital from May 2013 to May 2018 were retrospectively analyzed. Endoscopic or digital subtraction angiography (DSA) was used to determine the bleeding points. After a definite diagnosis of biliary tract hemorrhage, selective hepatic artery embolization was performed. Hemoglobin, hepatic function and other indicators were detected after surgery to evaluate the treatment effect. Results Preoperative imaging diagnosis showed that 3 patients had mild dilatation of the intrahepatic bile duct. Endoscopy examination showed that there was persistent bleeding in the duodenal papilla with blood clot formation in all 6 patients. DSA examination showed that there were clear bleeding points in 4 patients, and no bleeding points in 2 patients. After embolization, the patients complained of biliary colic disappearance. Within 24 h after embolization, the patients still had hematochezia but the hemoglobin levels were stable. After 24 h operation, the hematochezia gradually disappeared. After selective hepatic artery embolization treatment, 6 patients obtained good hemostatic effects with the effective rate being 100%. All patients were discharged. No biliary bleeding reoccured in the 6-month follow-up. Conclusion Local expansion of intrahepatic bile duct is one of the main risk factors of biliary tract hemorrhage after hepatic cancer ablation. Triad of biliary bleeding is a typical symptom. Endoscopic detection rate is high. DSA examination diagnosis still need to be supported by clinical symptoms. Selective hepatic artery embolization is an effective treatment method. Selective hepatic artery embolization is also satisfactory in diagnostic treatment of patients without bleeding points on DSA examination.

Abstract:Objective To explore the feasibility and effectiveness of external ureteral clipping and insertion of double J tube in laparoscopic ureterobladder reimplantation. Methods The clinical data of 21 patients with lower ureteral stricture undergoing laparoscopic ureterobladder reimplantation from Mar. 2014 to Mar. 2016 were retrospectively analyzed. Twelve patients receiving conventional laparoscopic ureterobladder reimplantation were assigned to control group, and 9 patients receiving laparoscopy-assisted external ureterobladder reimplantation were assigned to improvement group. The ureter of the patients in the improvement group was separated under laparoscopy, the narrow ureter was severed, and the proximal ureter was taken out from the 12-mm Trocar. Then, the broken end of ureter was clipped under euthyphoria, and the double J tubes were inserted and fixed on the ureteral mucosa with 4-0 absorbable sutures and then sent back to the pelvis. The bladder was mobilized under laparoscopy, and the bladder and ureter were anastomosed. Results The surgery was successfully completed in all the 21 patients without transferring to open surgery or urine leakage after operation. The operation time was significantly shorter in the improvement group versus the control group ([77±17] min vs[104±20] min, P<0.05). All patients were followed up for at least 6 months after operation. Both ultrasonography and intravenous pyelography showed no ureteral anastomotic stricture. The hydronephrosis was alleviated to some extent. Cystography showed that 2 patients had reflux, with 1 case in each group. Conclusion In laparoscopic ureteral reimplantation, external ureteral clipping and insertion of double J tube are minimally invasive, and can shorten operation time and make the surgery less complex.

Abstract:Objective To explore the application of high-speed dental handpiece and original luxator in the impacted wisdom tooth extraction. Methods Seventy patients with impacted wisdom teeth, who underwent impacted wisdom tooth extraction between Dec. 2016 and Dec. 2017, were selected. The patients were divided into control group (n=35) and minimally invasive group (n=35) according to the surgical options. The patients in the control group received conventional tooth extraction, and the patients in the minimally invasive group received tooth extraction using high-speed dental handpiece and original luxator. The surgical parameters (extraction integrity, mouth restriction, swelling and operation time), pain extent, complications and the quality of life after operation (psychological function, physiological function, physical pain, vitality) were compared between the two groups. Results The surgical parameters, including extraction integrity, mouth restriction, swelling and operation time, were significantly better in the minimally invasive group than those in the control group (all P<0.05). There was no significant difference in the visual simulation scale (VAS) score before extraction between the two groups (P>0.05). After extraction, the VAS score was significantly lower in the minimally invasive group than that in the control group (P<0.05). The incidence of complications in the minimally invasive group was 11.43% (4/35), which was significantly lower than that in the control group (34.29%[12/35], P<0.05). At 3 months after extraction, the scores of psychological function and the other quality of life scores were significantly higher in the minimally invasive group than those in the control group (all P<0.05). Conclusion Application of high-speed dental handpiece and original luxator in impacted wisdom tooth extraction can significantly improve the treatment efficacy and reduce complication incidence.

Abstract:Objective To investigate the difference of hypoxia-inducible factor 1α (HIF-1α) and vascular endothelial growth factor (VEGF) expression in endometrial cancer and para-carcinoma tissues, and to explore the clinical significance of hypoxia and the two proteins in the development and progression of endometrial cancer. Methods From Jan. 2011 to Dec. 2012, 128 patients with endometrial cancer underwent surgery in Tongji Hospital of Tongji University. The expression of HIF-1α and VEGF in cancer tissues and paired para-carcinoma tissues was detected using immunohistochemical method. The patients were followed up regularly, and the relationship between the expression of HIF-1α and VEGF and the prognosis of the patients was analyzed. The hypoxic cell model of human endometrial cancer was constructed to detect the expression of HIF-1α and VEGF proteins and observe the cell proliferation, invasion and apoptosis. Results The positive rates of HIF-1α and VEGF in cancer tissues were significantly higher than those in the para-carcinoma tissues (both P<0.05). The positive rate of HIF-1α was higher in the patients with lymph node metastasis, high histological grade, maximal tumor dimeter ≥ 4 cm or positive progesterone receptor (all P<0.05). The positive rate of VEGF was higher in the patients with lymph node metastasis, high histological grade, deep myometrial invasion, maximal tumor dimeter ≥ 4 cm, positive estrogen receptor, positive progesterone receptor or high pathological stage (all P<0.05). The 5-year overall survival rate of the patients with negative HIF-1α was significantly higher than that of the patients with positive HIF-1α (P<0.05), while there was no significant difference in the 5-year overall survival rate between the patients with negative and positive VEGF (P>0.05). In the hypoxic cell model of human endometrial cancer, the expression levels of HIF-1α and VEGF were significantly increased, cell proliferation and invasion were significantly increased, and the cell apoptosis was significantly reduced (all P<0.05). Conclusion HIF-1α and VEGF are related to the progress of endometrial cancer, and positive expression of HIF-1α indicates a poor prognosis.

Abstract: