Abstract:Clinically traditional Chinese medicine (TCM) has been proven to possess obvious anti-tumor effects. It is critical to further explore the effective components and the corresponding mechanism of the TCM against target cells, which also has great significance for developing novel nano-TCM formulations for clinical treatment of tumor. This paper systematically reviews the anti-tumor effects of Chinese herbal compound and the anti-tumor mechanism of single herb. We also summarized the progress in the current traditional nano-TCM preparations. Taking the shikonin in Herba Arnebiae as an example, using the nano-material self-assembly technology, we discussed the design of novel nano-macromolecule TCM formulations while considering the mechanism of single herb and the clinical obstacles.

Abstract:Objective To explore the feasibility and safety of uniportal video-assisted thoracoscopic anatomic pulmonary segmentectomy in the treatment of benign and malignant small lung lesions. Methods A retrospective analysis was conducted on the clinical data of 395 patients with small pulmonary lesions undergoing uniportal video-assisted thoracoscopic anatomic pulmonary segmentectomy by a single surgery group between Aug. 2013 and May 2017 in Shanghai Pulmonary Hospital of Tongji University. Among them, there were 139 males and 256 females, with a mean age of (56.25±10.53) years, and 193 left lung lesions and 202 right lung lesions. The double-lumen trachea cannula was performed under general anesthesia. Thoracoscopy and surgical instruments were inserted through a 4 cm single-hole incision in the 4^th or 5^th intercostal of anterior line axillary, and anatomical segmentectomy was performed. The perioperative data, postoperative pathology, intraoperative open thoracotomy transit, postoperative complications and long-term follow-up results were statistically analyzed. Results Of the 395 patients, 7 patients were converted to lobectomy, 3 to thoracotomy, 1 to basal pulmonary segmentectomy from posterior basal pulmonary segment, and all the other patients were successfully completed. There were no significant differences in the operation time, intraoperative blood loss, lesion diameter, number of lymph node samples, thoracic drainage at 24 h after operation, postoperative thoracic drainage tube insertion time or postoperative hospital stay between left and right lung lesions (all P>0.05). Postoperative pathology showed malignant lesions in 310 cases and benign lesions in 85 cases. Postoperative complications occurred in 11 cases (6 cases of left lung and 5 cases of right lung), including 2 cases of hemothorax, 6 cases of delayed leakage, and 3 cases of arrhythmia. There were no operative death. The average follow-up time was (40.06±2.86) months, ranging from 9 to 54 months. There were no long-term complications, no abnormal cardiopulmonary function and no recurrence or metastasis in patients with malignant tumors. Conclusion The uniportal video-assisted thoracoscopic anatomic pulmonary segmentectomy is safe and feasible, and can resect lesions accurately and minimally invasively. And thus it is worthy of clinical application.

Abstract:Objective To observe the therapeutic effect of subxiphoid uniportal video-assisted thoracoscopic anatomic pulmonary segmentectomy in the treatment of the early malignant lung tumors and localized benign lung lesions. Methods A retrospective analysis was conducted on the clinical data of 220 patients with early malignant lung tumors or localized benign lung lesions undergoing subxiphoid uniportal video-assisted thoracoscopic anatomic pulmonary segmentectomy in the Shanghai Pulmonary Hospital of Tongji University between Sep. 2014 to Apr. 2017. Follow-up after operation was performed regularly to evaluate incision pain and surgical outcome. Results The average age of 220 patients was (56.34±10.66) years, and 68 cases (30.91%) were males and 152 cases (69.09%) were females. The average operation time was (2.07±0.72) h, the average perioperative blood loss was (91.64±94.20) mL, and the average postoperative hospital stay was (4.64±9.97) d. A total of 14 patients underwent surgical conversion during the operation. Among them, 7 cases (3.18%, 7/220) had additional intercostal auxiliary hole during operation, 3 (1.36%, 3/220) were converted to subxiphoid uniportal video-assisted thoracoscopic lobectomy due to iatrogenic vascular or bronchial injury, and 4 cases (1.82%, 4/220) were converted to thoracotomy. The incidence of major complication (bleeding) was 0.45% (1/220). No patients suffered from bronchopleural fistula or developed incisional hernia. There were no perioperative deaths, with a postoperative 30 d survival rate of 100.00%. A total of 227 lesions were resected in 220 patients, 183 (80.62%) were malignant and the rest were benign or precancerous lesions. The median follow-up time was 30 months. No postoperative intractable incision pain occurred. Only 2 patients had itching of incision and surrounding skin, and 1 patient had hyposensation of incision and surrounding skin. No recurrence or metastasis occurred in patients with malignant tumors. Conclusion Subxiphoid uniportal video-assisted thoracoscopic anatomic pulmonary segmentectomy is an effective method for early malignant tumors and localized benign lesions. It can alleviate postoperative incision pain and has satisfactory therapeutic effects.

Abstract:Objective To explore the surgical technique and effectiveness of uniportal video-assisted thoracoscopic double-sleeve lobectomy and its clinical popularization value. Methods The clinical data of 19 consecutive patients (18 left-sided operations and 1 right-sided operation), who underwent uniportal video-assisted thoracoscopic double-sleeve lobectomy in Shanghai Pulmonary Hospital of Tongji University between Dec. 2016 and Jul. 2018, were included. Pre-, intra-and post-operative indicators were statistically analyzed, and the surgical patients were followed up. Results Among 19 patients, there were 17 males and 2 females, with an average age of (62.3±6.6) years. The average operative time was (258.0±66.6) min, average operative blood loss was (210.0±157.8) mL, average bronchus anastomosis time was (26.0±5.8) min, average artery anastomosis time was (47.7±7.2) min, and average postoperative hospital stay was (7.6±4.5) d. Postoperative pathologic examination indicated that 15 cases had squamous cell carcinoma, 2 had adenocarcinoma, 1 had small cell carcinoma, and 1 had large cell carcinoma. TNM staging:11 cases was Ⅲa and 8 was Ⅲb. Four patients suffered postoperative complications, including 1 case of thrombosis at the vascular anastomosis, 1 arrhythmia and 2 prolonged airleak. There were no bronchial anastomotic fistula and anastomotic stenosis, vascular anastomosis stenosis or operative death. The average follow-up time was (16.4±6.4) months and no tumor recurrence or metastasis was found during follow-up after operation. Conclusion Uniportal video-assisted thoracoscopic double-sleeve lobectomy is a technique-demanding operation, which can be carried out in the thoracic centers with endoscopy proficiency. It is feasible for completely removing tumor, preserving lung function to the greatest extent, and reducing surgical trauma to achieve rapid recovery of patients.

Abstract:Objective To explore the feasibility and clinical effect of subxiphoid uniportal video-assisted thoracoscopic surgery in the treatment of the anterior mediastinal tumors. Methods The clinical data of 38 patients, who underwent subxiphoid uniportal video-assisted thoracoscopic surgery for anterior mediastinal tumor in Shanghai Pulmonary Hospital of Tongji University from Oct. 2014 to Aug. 2018, were retrospectively analyzed. Among them, 20 were males and 18 were females, the average age was (57.8±14.8) years, and the average diameter of anterior mediastinal tumors was (2.8±1.7) cm. The surgery was performed under video-assisted thoracoscope through an about 4 cm subxiphoid longitudinal incision. Results All the 38 cases of subxiphoid uniportal video-assisted thoracoscopic surgery were performed successfully without conversion to thoracotomy or perioperative death. Except for one patient who received mechanical ventilatory support for 1 week because of worsened myasthenia gravis symptoms, there were no other complications. The operative time, volume of bleeding, volume of drainage on the operation day and hospital stay after surgery were 1-4 (1.9±0.8) h, 10-400 (87.5±68.7) mL, 50-650 (237.4±176.4) mL and 1-19 (4.1±2.9) d, respectively. Postoperative pathology showed 1 case of type A thymoma, 1 case of type B2 thymoma, 1 case of type B3 thymoma, 5 cases of type AB thymoma, 1 case of thymic squamous carcinoma, 6 cases of thymic hyperplasia, 16 cases of thymic cyst, 6 cases of simple thymus and fat and 1 case of bronchial cyst. The visual analogue scale scores on 1, 3 and 6 months after surgery were 3.8±2.2, 1.5±1.4 and 0.8±0.6, respectively. Conclusion Subxiphoid uniportal video-assisted thoracoscopic surgery is a safe, efficient, satisfactory procedure for early stage thymoma, benign anterior mediastinal tumors and some early stage anterior mediastinal malignant tumors, and it can effectively avert the intractable incision pain caused by intercostal nerve injury.

Abstract:Pulmonary small nodules are common diseases of the lung, and are the initial stage of lung cancer progression. This review describes the definition of pulmonary small nodules, the identification methods of benign and malignant pulmonary small nodules, and the common diagnostic methods for pulmonary small nodules. In addition, we compared the follow-up strategies of pulmonary small nodules in common guidelines at home and abroad. We also explained the principles of minimally invasive surgery, precise treatment and accelerated rehabilitation of pulmonary small nodules, providing directions for the clinical diagnosis and treatment of pulmonary small nodules.

Abstract:Objective To explore the role of long non-coding RNA (lncRNA)-H19 in the proliferation and migration of non-small cell lung cancer (NSCLC) cells and the molecular mechanisms. Methods The expressions of lncRNA-H19 in 20 NSCLC tissues and paired non-tumor tissues, which were collected from Changhai Hospital of Naval Medical University (Second Military Medical University) from Oct. 2015 to May 2016, were detected by real-time quantitative PCR (qPCR). We also examined lncRNA-H19 expressions in NSCLC cell lines A549 and NCI-H1299 and normal lung epithelial cell line BEAS-2B by qPCR. The proliferation and migration of A549 cells overexpressing lncRNA-H19 were detected by CCK-8 assay and Transwell assay, respectively. Bioinformatics analysis and duel-luciferase reporter assay were conducted to predict and confirm the interaction between microRNA (miRNA)-760 and lncRNA-H19. Western blotting analysis and RT-qPCR were performed to observe the influence of lncRNA-H19 overexpression on the expression of miRNA-760 and target gene nanog. MiRNA-760 was overexpressed in A549 cells, and its role in lncRNA-H19 promoting proliferation and migration of NSCLC cells was observed. Results The expressions of lncRNA-H19 in NSCLC tissues and A549 and NCI-H1299 cells were significantly upregulated compared with those in normal tissues and BEAS-2B cells (all P<0.01). Overexpression of lncRNA-H19 significantly improved the proliferation ability (P<0.05) and migration ability (P<0.01) of A549 cells compared with the negative control group. The results of starBase v3.0 showed that lncRNA-H19 could specifically adsorb miRNA-760, and duel-luciferase reporter assay showed that lncRNA-H19 directly bound to miRNA-760. Compared with the negative control group, overexpression of lncRNA-H19 significantly inhibited miRNA-760 expression in A549 cells (P<0.05) and promoted the expression of the downstream gene nanog at mRNA and protein levels (all P<0.01). Overexpression of miRNA-760 significantly inhibited lncRNA-H19-induced proliferation and migration of A549 cells (all P<0.05). Conclusion LncRNA-H19 can promote the proliferation and migration of NSCLC cells through sponging miRNA-760 to regulate nanog gene expression.

Abstract:Objective To investigate the preventive effect of resveratrol against acute gouty arthritis in mice and whether M2 polarization of macrophage mediates the effect. Methods Eighteen C57BL/6 mice were randomly divided into three groups (n=6):sham group, model+solvent control group, and model+resveratrol group. The right hind limb ankle joint of mice in the sham group were treated with sterile normal saline. The right hind limb ankle joint of mice in the model+solvent control group were treated with DMSO in advance and then with monosodium urate (MSU) crystals to establish acute gouty arthritis model. Mice in the model+resveratrol group were treated with resveratrol dissolved in DMSO in advance and then with MSU crystals to establish acute gouty arthritis model. The bilateral paw thickness of mice in each group was measured and H-E staining was used to observe the inflammation of synovial tissue of feet and metacarpal joints of mice in each group. The primary macrophages from abdominal cavity of normal mice were extracted, treated with resveratrol, and then stimulated with MSU crystals. The expression of M1-polarized macrophage markers inducible nitric oxide synthase (iNOS) protein and the inflammatory indexes tumor necrosis factor α (TNF-α) mRNA and interleukin 1β (IL-1β) mRNA were detected by Western blotting or qPCR. The expression of M2-polarized macrophage markers F4/80 and CD163 were detected by flow cytometry. Results Acute gouty arthritis model of mice was successfully established. The right hind limb thickness of mice in the model+resveratrol group was significantly lower than that in the model+solvent control group ([1.98±0.02] mm vs[2.49±0.12] mm, P<0.01). The infiltration area of neutrophils in synovial tissue of feet and metacarpal joints in mice of model+resveratrol group were also significantly reduced. In vitro, resveratrol significantly inhibited the expression of iNOS protein, TNF-α mRNA and IL-1β mRNA in primary peritoneal macrophages (all P<0.01) and increased the percentage of F4/80⁺CD163⁺ in macrophages (P<0.01). Conclusion Resveratrol may effectively alleviate acute gouty arthritis in mice by promoting M2 polarization of macrophages and inhibiting the expression of inflammatory factors.

Abstract:Objective To study the changes and significance of adrenaline, transient receptor potential vanilloid 1 (TRPV1) channel and substance P in rats with acute spinal cord injury (ASCI) complicated with lung injury. Methods Two hundred and twenty eight female Sprague-Dawley rats were randomly divided into sham operation group (sham group, n=90), ASCI group (n=108), bilateral adrenalectomy group (n=15), and ASCI after bilateral adrenalectomy group (n=15). The ASCI model was established on the T₁₀ spinal cord segment using a modified Allen's strike model (10 g, 25 mm). The sham group only exposed the T₁₀ spinal cord, and the ASCI after bilateral adrenalectomy group was established 5 days after bilateral adrenalectomy. High-performance liquid chromatography was used to detect the changes of serum adrenaline. The pulmonary tissue specimens were collected from rats. Wet-to-dry lung weight ratio was used to detect the changes of pulmonary edema, and H-E staining was used to detect the pathological changes of lung tissue. The expression of TRPV1 protein in lung tissue was detected by immunohistochemistry and Western blotting. The contents of substance P in the lung tissue were detected by enzyme-linked immunosorbent assay. Results Serum adrenaline levels in the ASCI group were significantly higher than those in the sham group at 2, 6, 12, 24, 48, and 72 h after spinal injury (all P<0.01). The pulmonary edema and lung injury gradually aggravated in the ASCI group at 24, 48 and 72 h after spinal injury, and began to recover at 1 week. The expression levels of TRPV1 protein and substance P contents in ASCI group were significantly upregulated compared with the sham group at 24, 48, and 72 h after spinal injury (all P<0.05, P<0.01). The edema of lung tissue and pathological injury in the ASCI after bilateral adrenalectomy group were alleviated compared with the ASCI group 72 h after spinal injury. Conclusion Adrenaline may involve in the pathogenesis of pulmonary edema and lung injury in rats with ASCI, which may be related to the upregulation of TRPV1 and P substance expression. The pulmonary edema and lung injury after ASCI can be alleviated by adrenalectomy.

Abstract:Objective To evaluate the appropriate indications, key points of surgical techniques, and early to mid-term outcomes of valve-sparing aortic root reimplantation in patients with Marfan syndrome. Methods The clinical data of 52 patients with Marfan syndrome who underwent valve-sparing aortic root reimplantation in our department from June 2006 to July 2017 were retrospectively analyzed. Preoperative patient characteristics, surgical techniques, and follow-up outcomes were summarized. Results The patients had a mean age of (36.6±14.5) years, with 35 males and 17 females. Severe aortic valve insufficiency (AI) was found in 37 cases (71.2%) preoperatively. Echocardiography indicated that the average diameter of aortic annulus, aortic sinus, and sinotubular junction of this cohort were 22-30 mm, 40-56 mm, and 34-51 mm, respectively. Pure valve-sparing aortic root reimplantation was performed in 40 patients presenting aortic root aneurysm, with a cross-clamp time of 61-108 min and a mean of (81.3±11.6) min, and with a cardiopulmonary bypass time of 88-129 min and a mean of (97.3±10.8) min. The other 12 patients with Stanford type A aortic dissection underwent concomitant total arch replacement and elephant trunk implantation in the descending aorta, with a cross-clamp time of 93-126 min and a mean of (107.4±11.2) min, and with a cardiopulmonary bypass time of 127-180 min and a mean of (143.5±17.1) min. Vascular prostheses with a diameter of ≤ 30 mm were adopted in all patients. Aortic root bleeding was drained to the right atriums in 9 patients. Transesophageal echocardiography was performed in 42 cases before extracorporeal circulation removal, with 16 cases presenting no AI, 18 presenting trace AI, and 8 presenting mild AI. There was one in-hospital death (1.9%) and no secondary thoracotomy for bleeding or other major complications. The mean follow-up was (3.2±2.1) years, with 43 cases completed the follow-up and no death during follow-up. Echocardiography in the latest follow-up indicated that 6 cases presented no AI, 24 presented trace AI, 12 presented mild AI, and only one case presented moderate AI, with 97.7% (42/43) patients free from moderate AI. No case underwent aortic valve replacement for severe AI. There were 39 (90.7%) patients in New York Heart Association classⅠand 4 (9.3%) patients in classⅡ. Conclusion Application of valve-sparing aortic root reimplantation using vascular prostheses with appropriate diameter is safe and effective for suitable patients with Marfan syndrome, and can obtain satisfactory outcomes.

Abstract:Objective To screen novel drugs for hepatocellular carcinoma (HCC) prevention based on drug repositioning strategy. Methods We collected the gene expression profiles of tissue samples representing the stepwise carcinogenic process covering 4 stages:cirrhosis, low-grade dysplastic nodule (LGDN), high-grade dysplastic nodule (HGDN) and early HCC, and identified the gene signatures between two consecutive stages. We also collected the gene expression data of human hepatocellular carcinoma cell lines HepG2 treated by 3 927 drugs and small molecules. The similarity between disease expressions and the drug gene expressions was calculated using gene set enrichment analysis (GSEA) algorithm, and drugs negatively correlated with the disease signatures were selected. Finally, we constructed the activated sub-network and performed pathway enrichment analysis to explore the underlying mechanisms of these drugs. Results We screened out the drugs that could prevent HCC during different stages, and found that importazole, picotamide and paclitaxel exhibited preventive potentials at all stages from cirrhosis to early HCC. The genes affected by these 3 drugs showed inverse expression pattern during HCC development, and pathways such as cancer-related pathway, p53 signaling pathway, focal adhesion and retinol metabolism pathway were enriched. Conclusion Preventive drugs for HCC have been screened through drug repositioning strategy, and our results indicated that antiplatelet therapy may play a role in the prevention of HCC, which provides information for further study.

Abstract:Lung diseases, with high-incidence, are clinically common and difficult to treat, posing a serious threat to human health. With the development of gene detection and high-throughput sequencing technology, circular RNA (circRNA) has become a research focus again. CircRNA is widely expressed in organisms and plays important regulatory roles in biological progress. Due to its high specificity, conservation and stability, circRNA has great potential in the diagnosis and treatment of diseases. This paper summarizes the roles of circRNA in lung diseases research, hoping to provide theoretical support for the diagnosis and treatment of lung diseases.

Abstract:Objective To study the psychological quality of the soldiers stationed at a reef and their influencing factors, and to analyze the relationship between psychological quality, subjective evaluation of health and social support. Methods A questionnaire survey was conducted on 100 soldiers stationed at a reef using the military psychology quality scale, self-test health rating scale and comprehension social support scale. The military psychology quality scale includes five dimensions:intelligence, loyalty, courage, self-confidence and frustration. The self-test health rating scale includes three dimensions:physical health, mental health, and social health. The comprehension social support scale includes three dimensions:family support, friend support, and other support. The scores of the military psychological quality scale of the soldiers stationed at the reef were compared with the norm of military mental quality using independent-sample t test. Pearson correlation analysis was used to analyze the correlation between scores of each dimension and total scores for the three scales. Multivariate linear regression was used to analyze the influence between social support, healthy subjective evaluation and the psychological quality of soldiers stationed at the reef. Results The scores of dimension confidence (calm+independent+sociable) of the soldiers were significantly better than the overall norm score (P=0.030), and the difference for the other 4 dimensions was not statistically significant between the soldiers and the norm (all P>0.05). Pearson correlation analysis showed that the scores of all dimensions and total scores were positively correlated between the three scales used in this study (all P<0.01), except for loyalty dimension of military psychology quality scale and social health dimension of self-test health rating scale (P=0.366). Multiple linear regression analysis showed that mental health was the influencing factor of the tolerance (P=0.006); family support and physical health were the influencing factors of mental health (P=0.022, P<0.001), and family support was the influencing factor of physical health (P=0.025). Conclusion The psychological quality of soldiers stationed at a reef is vulnerable to the environment of the reef. It is necessary to improve the psychological quality by strengthening social support and improving their own health awareness of the soldiers.

Abstract:On-shore port-based training is important to improve naval submarine rescue and escape capability. It is highly necessary to establish subordinate comprehensive training base for submarine rescue and escape, so as to solve the current problems in on-shore port training. Taking into consideration of the organizational leadership, coordination mechanism, supporting system, operational mode, main function, role design, numbers and location of setting, and supplementary measures, we put forward a general concept for the training base, hoping to provide ideas for innovating the training mechanism and improving the training effectiveness of naval submarine rescue and escape capability.

Abstract:Objective To compare the treatment of acute ST-elevated myocardial infarction (STEMI) before and after the certification of chest pain center model, so as to provide reference for the construction of chest pain center. Methods We retrospectively analyzed the clinical data of patients with acute STEMI before and after certification of the chest pain center of Shanghai General Hospital of Shanghai Jiao Tong University. Totally 119 patients were included in the pre-certification group from January 2017 to December 2017, and 160 patients were included in the post-certification group from January 2018 to April 2019. The baseline data, first medical contact to electrocardiogram (ECG) time, first ECG confirmation time, troponin reporting time, cath lab activation time, door-to-balloon dilation time, hospitalization stay, hospitalization drug cost, hospitalization inspection cost, hospitalization examination cost, total hospitalization cost, and outcomes were compared between the two groups. Results There was no significant difference in the gender, age, history of hypertension or history of diabetes between the two groups (all P>0.05). The cath lab activation time was not significantly different between the two groups (P>0.05). The first medical contact to ECG time (Z=-7.247, P<0.001), first ECG confirmation time (Z=-5.072, P<0.001), troponin reporting time (Z=-3.210, P=0.001) and door-to-balloon dilation time (Z=-7.025, P<0.001) were significantly shorter in the post-certification group than those in the pre-certification group. There were no significant differences in hospitalization stay, hospitalization drug cost, hospitalization inspection cost, hospitalization examination cost, total hospitalization cost, or mortality between the two groups (all P>0.05). Conclusion Through the certification and standardized operation of chest pain center, the time of treatment for acute STEMI can be significantly shortened.

Abstract:Objective To evaluate the effectiveness of transcatheter aortic valve replacement (TAVR) using domestic valves for treating aortic valve stenosis or regurgitation, and to explore the incidence of cardiac conduction block after surgery and its influence on the prognosis of the patients. Methods The patients with severe aortic valve stenosis or regurgitation receiving TAVR surgery in our department from Sep. 2017 to Jan. 2018 were enrolled in this study. The TAVR surgery was performed with domestic valves (J-Valve or Venus-A), and the outcomes and incidence of complications were assessed after surgery. The patients were observed for the incidence of new-onset cardiac conduction block during and after TAVR and the recovery of arrhythmia during hospitalization. According to the presence of cardiac conduction block at discharge, the patients were divided into normal rhythm group and conduction block group. The baseline and postoperative characteristics, and left ventricular structure and function were compared between the two groups. Results Sixteen patients were enrolled in this study, including 12 in the normal rhythm group and 4 in the conduction block group. Brain natriuretic peptide ([1 114.87±802.32] pg/mL vs[530.39±276.26] pg/mL, P=0.026), aortic transvalvular pressure difference ([83.06±37.76] mmHg vs[24.14±9.73] mmHg, P<0.001; 1 mmHg=0.133 kPa), maximum transvalvular velocity of aortic valve ([466.00±82.30] cm/s vs[249.30±43.98] cm/s, P<0.001) and left ventricular end-diastolic diameters ([5.41±0.83] cm vs[4.93±0.52] cm, P=0.010) were significantly decreased after TAVR. After TAVR, there was no or only mild aortic valve regurgitation. Two patients with renal insufficiency developed deterioration of renal function, and one of whom received hemodialysis treatment. There were no death, acute myocardial infarction, stroke, or severe vascular complications during the hospitalization. A total of 4 patients (25.00%) had new-onset cardiac conduction block, including 1 patient with complete atrioventricular block who recovered to complete left bundle branch block, 1 patient with intraventricular block who progressed to complete left bundle branch block, and 2 patients with complete left bundle branch block during hospitalization. At discharge, the 4 patients still had complete left bundle branch block. There were no patients requiring permanent pacemaker implantation during the hospitalization. There were no significant differences in the postoperative liver function, renal function, hemoglobin, brain natriuretic peptide, or cardiac structure and function between normal rhythm group and conduction block group (all P>0.05). Conclusion TAVR with domestic valves can effectively reduce the aortic transvalvular pressure difference with fewer complications. It may cause complete left bundle branch block, which has no significant influence on the short-term adverse cardiac events and cardiac function after operation.

Abstract:Objective To analyze the relationship between the factors causing thoracolumbar burst fracture and the corresponding clinical manifestations, so as to improve the early warning and diagnosis of thoracolumbar burst fracture, reduce the misdiagnosis and missed diagnosis, and improve the success rate of first aid. Methods The clinical data of thoracolumbar burst fractures treated in the Intensive Care Unit of Depretment of Emergency of our hospital from Jan. 2009 to Dec. 2018 were retrospectively analyzed. The clinical data, including age, sex, hospital duration, causes, complications, discharge, and prognosis, were analyzed retrospectively. Results A total of 83 patients with thoracolumbar burst fracture, including 69 males (83.13%) and 14 females (16.87%), were selected for this study. The average age was (44.64±15.26) years. The causes of the injury included:high falling injury (53 cases, 63.86%), traffic accident injury (17 cases, 20.48%), and heavy object injury (12 cases, 14.46%). There were 31 cases (37.35%) of craniocerebral injury, 53 cases (63.86%) of chest injury, 37 cases (44.58%) of abdominal injury, 44 cases (53.01%) of other fracture. Among the 53 cases of chest injury, there were 19 cases (35.85%) with hemopneumothorax, 13 cases (13.21%) with simple hemothorax, 7 cases (24.53%) with simple pneumothorax, 8 cases (15.09%) with mediastinal hemorrhage, 7 cases (13.21%) with mediastinal emphysema, 11 cases (20.75%) with flail chest, and 5 cases (9.43%) with diaphragmatic hernia. Among 37 cases of abdominal injuries, there were 8 cases (21.62%) with rupture of spleen, 3 cases (8.11%) with subcapsule hematomas, and 4 cases (10.81%) with simultaneous injury of liver and spleen. The missed diagnoses at the initial diagnosis included:5 cases (100.00%) of diaphragmatic hernia, 5 cases (62.50%) of mediastinal hemorrhage, 4 cases (57.14%) of mediastinal emphysema, 2 cases (18.18%) of flail chest, and 2 cases (15.38%) of simple hemothorax. Missed diagnosis rate of the other complications were all under 10.00%. The main complications were bronchopneumonia (37 cases, 44.58%) and traumatic hemorrhagic shock (17 cases, 20.48%). There were 8 cases (9.64%) complicated with multiple organ dysfunction syndrome (MODS), with more than 3 systems involved. There were 39 patients (46.99%) had paraplegia and 3 cases (3.61%) died at discharge. Conclusion Thoracolumbar burst fractures are more common in young and middle-aged men, with high falling being the primary cause and hemopneumothorax being the main clinical manifestation. Diaphragmatic hernia, mediastinal hemorrhage and mediastinal emphysema are easy to have missed diagnosis. Nearly 50% patients have traumatic paraplegia, which is worthy of attention and in-depth study.

Abstract:Objective To evaluate the clinical effect of conjoint fascial sheath (CFS) suspension in treatment of severe blepharoptosis. Methods A total of 43 patients (68 eyes) with severe blepharoptosis were treated with CFS suspension in Changzheng Hospital of Naval Medical University (Second Military Medical University) from Jul. 2016 to Sep. 2018. The clinical data of the 68 eyes with severe blepharoptosis were retrospectively analyzed. The correction effect of this method was evaluated by the margin reflex distance (MRD1) and its improvement, the radian of eyelid margin, the shaping of double eyelid line and complications. The patients were followed up for 3-12 months. Results Blepharoptosis was effectively corrected after CFS suspension. Three months after operation, MRD1 was improved by (3.84±0.55) mm and blepharoptosis was significantly improved versus before operation (P<0.01). According to MRD1 improvement, 66 eyes (97.06%, 66/68) were satisfactory and 2 eyes (2.94%, 6/68) were improved, with the upper eyelid margin being symmetrical and the radian being natural. The upper eyelid regained part of the movement one week after operation; and 3 months after operation, all patients could completely close the eyes. There were few postoperative complications:2 cases had exposed keratitis in the early stage, which was cured after drug treatment; and there were no other complications such as eyelid ectropion, trichiasis, eye movement disorder, or diplopia. Conclusion CFS suspension is effective for correction of severe blepharoptosis, with the advantage of good appearance, natural activity, minor trauma, easy repetition, less complications, and high satisfaction rate with curative effect, and it is worth popularizing in clinic.

Abstract:Objective To explore local surgical excision of duodenal gastrointestinal stromal tumor (GIST) and the way of digestive tract reconstruction, and to summarize our clinical experience. Methods The clinical data of 29 patients with duodenal GIST who underwent local resection from Jan. 2010 to Jan. 2018 in the Department of Anorectal Surgery of our hospital were included for study. The local resection methods and the reconstruction of digestive tract were analyzed, and the clinical efficacy and indications of different local resection methods were discussed while considering the clinicopathological parameters and follow-up data. Results We found that 24 (82.8%) cases had their lesions located in the bulb and descending part of the duodenum and 5 (17.2%) cases in the horizontal and ascending part of the duodenum. Nineteen cases underwent simple wedge resection and one-stage anastomosis (16 cases underwent open surgery and 3 cases underwent laparoscopic surgery), 7 cases underwent open segment resection+Billroth Ⅱ gastrojejunostomy+Roux-en-Y anastomosis, 2 cases underwent open wedge resection+Roux-en-Y duodenojejunostomy, and 1 case underwent open segment resection+duodenojejunostomy lateral anastomosis. Postoperative pathology showed that all patients had negative resection margin (R0). Anastomotic fistula occurred in 2 cases and intestinal obstruction in 3 cases. No local recurrence was noticed during the follow-up. Conclusion Local excision is a reasonable choice for duodenal GIST, with reliable curative effect.

Abstract:Objective To explore the influencing factors of moderate-to-severe pain in transvaginal real-time three-dimensional hysterosalpingo-contrast sonography (RT-3D-HyCoSy). Methods Totally 235 suspected infertility patients who underwent RT-3D-HyCoSy in the First Affiliated Hospital of Anhui University of Chinese Medicine between Jan. 2017 and Dec. 2018 were chosen for this study. The degree of pain was assessed by numeric rating scale (NRS). The patients were divided into non-moderate-to-severe pain group (NRS score was 0-3) and moderate-to-severe pain group (NRS score was 4-10). Patients' age, infertile time, infertile type, fallopian tube patency, balloon size (≥ 2 mL), contrast agent reflux, uterine space-occupying lesion, uterine malformation, intrauterine adhesion, uterine position, ectopic pregnancy history, gynecological inflammation, pelvic surgery history and emotion were collected for comparison between the two groups. Multivariate logistic regression model was used to analyze the risk factors of moderate-to-severe pain during RT-3D-HyCoSy examination, and receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of each factor. Results The univariate analysis showed that the balloon size (≥ 2 mL), contrast agent reflux, abnormal fallopian tube patency, intrauterine adhesion, and emotional tension were the influencing factors for moderate-to-severe pain (P<0.01, P<0.05). The multivariate logistic regression model showed that balloon size (≥ 2 mL), abnormal fallopian tube patency, and emotional tension were the risk factors for moderate-to-severe pain (odds ratio[OR]=2.223, 95% CI:1.088-4.542, P<0.05; OR=13.824, 95% CI:5.582-34.239, P<0.01:OR=2.606, 95% CI:1.255-5.414, P<0.05). ROC curve confirmed that multi-factor (balloon size ≥ 2 mL, abnormal fallopian tube patency, and emotional tension) combined had the highest prediction accuracy for moderate-to-severe pain (area under curve[AUC]=0.841, 95% CI:0.785-0.898). Conclusion Balloon size (≥ 2 mL), abnormal fallopian tubal patency and emotional tension are risk factors for moderate-to-severe pain in RT-3D-HyCoSy examination. During RT-3D-HyCoSy examination, we should pay attention to the causes of moderate-to-severe pain and avoid them, so as to improve the comfort level of patients and the success rate of the examination.

Abstract:Objective To investigate the application and safety of stereoelectroencephalography (SEEG) in invasive preoperation evaluation of drug-refractory epilepsy (DRE). Methods We retrospectively analyzed the clinical data of patients with DRE who underwent SEEG implantation in Shenzhen Second People's Hospital and Shenzhen University General Hospital between Aug. 2016. and Nov. 2018. The suspicious epileptogenic focus and propagation path was proposed based on the non-invasive preoperative evaluation, and then the implantation protocol of the SEEG electrodes was designed. Finally, according to the SEEG and electrical stimulation results, the resection or thermocoagulation of suspicious epileptogenic focus was done. Results A total of 359 electrodes were implanted in 31 DRE patients, with an average of 11.58 per patient. There were 13 electrodes (3.62%) failed to be implanted, with no additional electrode implantation. One case of intracranial hemorrhage was noted after operation, and there was no intracranial infection or cerebrospinal fluid leakage. Twenty patients received epileptogenic zone resection, 8 received epileptic network radiofrequency thermocoagulation, 1 with epileptic foci in the eloquent cortex underwent vagus nerve stimulation, and 2 received no operation. Thirty-one DRE patients were followed up for 6-30 months, with an average of (11.68±7.46) months. Of the 20 patients who underwent epileptogenic zone resection, 17 patients (85.00%, 17/20) had grade Ⅰ ILAE (International League Against Epilepsy), 2 (10.00%, 2/20) had grade Ⅱ, and 1 (5.00%, 1/20) had grade Ⅲ. For the 8 patients undergoing epileptic network radiofrequency thermocoagulation, 6 (75.00%, 6/8) had grade ⅠILAE and 2 (25.00%, 2/8) had grade Ⅲ. There was no significant difference in outcome between the two treatments (P=0.61). For 13 patients with negative magnetic resonance imaging (MRI), 10 (76.92%, 10/13) had grade Ⅰ ILAE, 2 (15.38%, 2/13) had grade Ⅱ, and 1 (7.69%, 1/13) had grade Ⅲ; for 15 MRI-positive patients, 13 (86.67%, 13/15) had grade Ⅰ ILAE and 2 (13.33%, 2/15) had grade Ⅲ. There was no significant difference in outcome between MRI-positive patients and MRI-negative patients (P=0.64). Conclusion Surgical treatment of DRE patient under the guidance of SEEG is safe and effective, and SEEG can improve the accuracy of epileptogenic foci localization, no matter in MRI positive or MRI negative patients.

Abstract:Objective To explore the pathogeneic characteristics and ideas of ultrasonic diagnosis of type 2 multiple endocrine neoplasm (MEN-2), so as to improve the clinical diagnosis rate. Methods The clinical data of 2 patients with pathologically confirmed MEN-2 in Changzheng Hospital of Naval Medical University (Second Military Medical University) were retrospectively analyzed. The pathogenic characteristics of 2 patients were summarized. The process of ultrasound diagnosis was discussed, and the ideas of ultrasound diagnosis was summarized. Results Patient 1 presented with hypertension. Abdominal ultrasonography showed multiple pheochromocytomas in the bilateral adrenal glands, which attracted attention because of bilateral involvement. Further examination of other endocrine glands revealed that the right upper and middle thyroid junction had an occupation, and there was no abnormality in the pancreas. Ultrasound finally diagnosed medullary thyroid carcinoma. Patient 2 had recurrent urinary calculi for many years. Considering its symptoms might be caused by hyperparathyroidism, we performed ultrasonography and found hyperplasia of parathyroid gland and medullary thyroid cancer. Therefore, we further examined several endocrine organs such as pancreas and adrenal gland, and finally found pheochromocytoma of adrenal gland. Based on the different clinical symptoms of the 2 patients, we made accurate diagnoses through ultrasound examination of endocrine glands associated with multiple lesions combined with pathological results. Conclusion MEN-2 has a variety of clinical manifestations and is difficult to diagnose. It is helpful for early diagnosis of MEN-2, a multi-organ involvement disease, by mastering its pathogenic characteristics, clinical characteristics and ultrasound diagnosis ideas.