Abstract:Degenerative scoliosis is common in the elderly, and is usually accompanied with underlying diseases such as hypertension, coronary heart disease, diabetes, and osteoporosis, resulting in high risk of surgery and many complications. Enhanced recovery after surgery (ERAS) requires the surgical team to draw up individualized surgical plans and perioperative interventions considering comprehensive aspects, including age, symptoms, physical signs, physical condition, and bone quality, so as to improve the prognosis and rehabilitation of patients after surgery. This consensus on the perioperative management procedure of ERAS for degenerative scoliosis has been made by experts of Spinal Surgery Department based on evidence-based medicine, and it can be used for clinical reference and application.

Abstract:With the development of artificial intelligence (AI), medical health has become one of the most important and potential application fields of AI. The diagnosis and treatment of spinal deformity is a research focus of spinal surgery departments. AI plays an indispensable role in the screening, diagnosis, surgical planning and implementation, prognosis and rehabilitation of spinal deformity. However, AI use in spinal deformity field is still at the initial stage, and many problems still need to be solved. This review sums up the research progress of AI in the screening, diagnosis, surgical planning and implementation, prognosis and rehabilitation of spinal deformity, and explores the future research direction.

Abstract:Objective To assess whole and regional spinal sagittal radiographic parameters before and after a long walk in adult scoliosis patients. Methods A total of 98 adult scoliosis patients, who were admitted to Changzheng Hospital of Naval Medical University (Second Military Medical University) from Jan. 2016 to Jun. 2018, were retrospectively included. According to sagittal radiographic parameters before a long walk, the patients were assigned to two groups:compensated group (sagittal balance before walking, with sagittal vertical axis[SVA]<40 mm and pelvic tilt[PT]>20°) and decompensated group (sagittal imbalance before walking, with SVA ≥ 40 mm and PT>20°). The anteroposterior and lateral radiographs of whole spine were taken before and after a 15-min walk, and the sagittal radiographic parameters were measured, including SVA, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), PT and sacral slope (SS). The sagittal radiographic parameters were compared between the two groups before and after a 15-min walk. The correlations between the differences of SVA and other sagittal parameters before and after a 15-min walk were analyzed in two groups. Results There were 19 patients in the compensated group, including 16 females and 3 males, with an average age of (64.1±5.9) years and a body mass index (BMI) of (24.2±4.6) kg/m². There were 79 patients in the decompensated group, including 67 females and 12 males, with an average age of (66.7±7.2) years and a BMI of (24.9±5.1) kg/m². There were no significant differences in age, gender or BMI between the two groups (all P>0.05). Before walking, the LL was significantly larger in the compensated group than that in the decompensated group (Z=2.784, P=0.003), and the PI-LL and SVA were significantly smaller in the compensated group than those in the decompensated group (Z=1.953, P=0.028; Z=3.815, P<0.01). There were no significant differences in PT, SS or TK between the two groups (all P>0.05). After a 15-min walk, there were no significant differences in PT, SS, LL, TK, PI-LL or SVA between the two groups (all P>0.05). Compared with before walking, the SS, PI-LL and SVA were significantly increased after a 15-min walk in the compensated and decompensated groups (compensated group Z=1.718, P=0.043; Z=2.198, P=0.015; Z=3.875, P<0.01; and decompensated group Z=1.842, P=0.031; Z=1.943, P=0.021; Z=2.917, P=0.002); however, the PT and LL were both significantly decreased after walking (compensated group Z=1.639, P=0.047; Z=3.624, P<0.01; and decompensated group Z=1.812, P=0.039; Z=3.893, P<0.01). In the decompensated group, the TK was also significantly increased after walking versus before walking (Z=2.287, P=0.012). The difference of SVA before and after 15-min walk was negatively correlated with the difference of PT in the compensated and decompensated groups (r_s=-0.519, -0.625; P=0.024, 0.001), and was positively correlated with differences of SS, LL and PI-LL (compensated group r_s0.519, 0.645, and 0.645, all P<0.05; and decompensated group r_s0.625, 0.407, and 0.407, all P<0.01). Conclusion The compensatory mechanisms of sagittal balance in adult scoliosis patients are gradually weakened or disappeared after a long walk, and the fatigue of pelvic and spinal extensor muscles may be the reasons. For the adult scoliosis patients with SVA<40 mm and PT>20°, it is suggested that the anteroposterior and lateral radiographs of whole spine should be taken again after a 15-min walk to re-evaluate the potential sagittal imbalance.

Abstract:Objective To explore the difference of sagittal spino-pelvic parameters at different age stages and the changes with age in Eastern China. Methods The medical records of 311 asymptomatic healthy volunteers from Jan. 2014 to Aug. 2015 in Physical Examination Center of our hospital were retrospectively analyzed. The demographic data and radiological parameters were collected by two individual surgeons, including age, gender, maximum thoracic kyphosis (maxTK), maximum lumbar lordosis (maxLL), maxLL minus maxTK (maxLL-maxTK), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), PT/SS, PI minus lumbar lordosis (PI-LL), sagittal vertical axis (SVA), T₁ sagittal angle, T₁ pelvic angle (TPA) and T₁ spinopelvic inclination (T₁SPI). Pearson correlation analysis was performed to evaluate the relationship between age and sagittal spino-pelvic parameters. A multiple linear regression equation was established to analyze the relationship between age and maxTK. The volunteers were divided into seven groups (<20 years, ≥ 20 and <30 years, ≥ 30 and <40 years, ≥ 40 and <50 years, ≥ 50 and <60 years, ≥ 60 and <70 years, and ≥ 70 years), and the sagittal spino-pelvic parameters were compared using Kruskal-Wallis H test. Results In 311 healthy volunteers, the maxTK (r=0.280, P<0.01), maxLL-maxTK (r=-0.320, P<0.01), SS (r=-0.216, P<0.01), PT (r=0.237, P<0.01), PT/SS (r=0.282, P<0.01), SVA (r=0.279, P<0.01), T 1 sagittal angle (r=0.247, P<0.01) and TPA (r=0.259, P<0.01) were all related to age, while the maxLL, PI, PI-LL, and T₁SPI were not related to age (all P>0.05). According to the established multiple linear regression equation:maxTK=0.175×age+28.233, the maxTK increased by 1.75° every 10 years of age. There were 8, 56, 51, 59, 56, 56 and 25 volunteers in the groups of <20 years, ≥ 20 and <30 years, ≥ 30 and <40 years, ≥ 40 and <50 years, ≥ 50 and <60 years, ≥ 60 and <70 years, and ≥ 70 years, respectively. The maxTK, PT, PT/SS, SVA, T₁ sagittal angle and TPA were significantly increased with age (all P<0.01), and the maxLL-maxTK and SS were significantly decreased with age (P<0.01, P<0.05). Conclusion In asymptomatic population of Eastern China, maxTK is increased with age (1.75° per 10 years old).

Abstract:Objective To establish a thoracolumbar model by three-dimensional finite element analysis, and to compare the stress conduction and distribution of screw-rod system and anterior edge of vertebral body in flexion, extension, rotation and lateral bending between modified partial pedicle subtraction osteotomy and SRS-Schwab four-stage osteotomy. Methods A T₁₁-L₃ model of normal male spine was established using computed tomography (CT) data. L₁ was used as the operative vertebral body, and the three-dimensional finite element models were established for SRS-Schwab four-stage osteotomy (A operation), modified partial pedicle subtraction osteotomy with preservation of 1/3 inferior wall of pedicle (B1 operation) and modified partial pedicle subtraction osteotomy with preservation of 1/2 inferior wall of pedicle (B2 operation). Titanium mesh cage was used to support the anterior edge of vertebral body. The total stresses, the range of motion of each intervertebral space and the stress of each implant in flexion, extension, rotation and lateral bending were compared between the three-dimensional finite element models of A, B1 and B2 operations. The stresses of titanium cage implantation part, residual vertebral body, and residual accessory structure of vertebral body and screw-rod system were compared. Results During flexion, extension, rotation and lateral bending, the total stress of B2 operation was the lowest (205.6 MPa), followed by B1 operation (207.0 MPa), and that of A operation was the highest (217.0 MPa). The range of motion of each intervertebral space was similar among the three surgical methods. During flexion, extension, rotation and lateral bending, the stresses of the anterior titanium cage implantation part and remaining accessory structure and screw-rod system of posterior vertebral body of B2 operation were the lowest (22.2, 187.7, 105.8 and 141.6, and 75.4, 168.4, 75.9 and 214.8 MPa, respectively), and the stresses of A operation were the highest (27.3, 241.8, 133.4 and 188.0, and 97.5, 216.4, 98.5 and 243.0 MPa, respectively). And they were lower than yield stress and tensile limit of titanium alloy (760 and 860 MPa, respectively). Conclusion The modified partial pedicle subtraction osteotomy with preservation of 1/2 inferior wall of pedicle (B2 operation) has advantage in reducing the stress of surgical segment, especially in reducing the stress of implant, so as to decrease the risk of breaking nail and rod. However, it is similar to SRS-Schwab four-stage osteotomy in preserving the range of motion of intervertebral space.

Abstract:Objective To explore the therapeutic effect of homogeneous spinal-shortening axial decompression (HSAD) in patients with tethered cord syndrome (TCS) and scoliosis. Methods Six patients with TCS and scoliosis, who underwent HSAD in Orthopaedics Department of Changzheng Hospital of Naval Medical University (Second Military Medical University) from Apr. 2015 to Jan. 2018, were retrospectively included. The operation time, intraoperative blood loss and complications were recorded. Urodynamic examination was performed to evaluate the bladder function before and after surgery, including detrusor reflex, sphincter function, functional bladder capacity and maximal urination speed. Results There were three males and three females, aged 7-23 (mean 15.7±6.9) years old, with an average follow-up of (28±9) months. Five patients had incontinence, three had foot-drop, four had decreased lower limb muscle strength, one had low back pain, and one had congenital dislocation of the hip. The operation time was 180-320 min (mean[261±63]min), and the intraoperative blood loss was 650-1 100 mL (mean[925±167]mL). After surgery, the low back pain was completely relieved in one patient, and the muscle strengths of the lower extremities were improved in four patients. Five patients received urodynamic examination before and after surgery. Before surgery, four cases were evaluated as external sphincter overactivity and one case as uncoordinated sphincter activity; after surgery, two cases were evaluated as normal external sphincter activity, one case as coordinated external sphincter activity, and two cases as external sphincter overactivity. The functional bladder capacity of the five patients was 195.0 (127.5, 233.5) mL and 213.0 (188.5, 251.5) mL before and after surgery, respectively, and the difference was not significant (Z=-0.4, P=0.70). The maximal urination speed and residual urine before surgery were 7.3 (1.4, 10.3) mL/s and 130 (106, 200) mL, respectively, and were significantly different from those after surgery (10.3[5.6, 16.2]mL/s and 30[6, 174]mL, respectively; both Z=-2.0, both P=0.04). In the five patients, the bladder detrusor muscle strength was improved to different extents, the maximal urination speed was increased, and the residual urine was reduced. Conclusion HSAD is an effective one-stage technique to relieve the TCS combined with scoliosis, and it can effectively relieve the axial tension of the spinal cord, correct the deformity of the spine and improve the coordination between spine and spinal cord. The lower limb symptoms and bladder function are improved after surgery, and complications such as cerebrospinal fluid leakage, bleeding, and deterioration of neurological function are avoided.

Abstract:Objective To propose a novel classification of L₅ spondylolysis and spondylolisthesis in children based on surgical treatment and to explore its availability. Methods A total of 47 children with L₅ spondylolysis or spondylolisthesis, who underwent surgical treatment in Changzheng Hospital of Naval Medical University (Second Military Medical University) between Jan. 2012 and Sep. 2017, were retrospectively included. According to the severity of spondylolisthesis (Meyerding grade), the degree of L₅/S₁ disc degeneration (Pfirrmann grade) and dysplastic features (classification described by Mac-Thiong and Labelle), a novel classification of L₅ spondylolysis and spondylolisthesis based on surgical treatment was proposed. This classification contains four types. Type Ⅰ:using pedicle screw-U rod system to repair the isthmic defect without segment fusion. Type Ⅱ (single-segment L₅/S₁ fusion type):requiring posterior L₅/S₁ fusion and internal fixation. Type Ⅲ (doublesegment L₄-S₁ fusion type):using pedicle screw system to perform L₄-S₁ reduction, decompression, fusion and internal fixation. Type Ⅳ(multi-segment L₅-S₂ fusion type):using pedicle screw system to perform L₅-S₂ reduction, decompression, fusion and internal fixation. Lumbar Japanese Orthopaedics Association (JOA) score and Oswestry disability index (ODI) were evaluated before and after surgery. Results There were 13 cases of type Ⅰ (8 males and 5 females), 14 cases of type Ⅱ (6 males and 8 females), 11 cases of type Ⅲ (4 males and 7 females), and 9 cases of type Ⅳ (3 males and 6 females). The average ages of type Ⅰ, Ⅱ, Ⅲ and Ⅳ patients were (14.6±2.1), (15.7±2.4), (13.2±2.3) and (14.6±3.2) years old, respectively. The lumbar JOA score and ODI were improved two years after surgery compared with those before surgery in type Ⅰ, Ⅱ, Ⅲ and Ⅳ patients (JOA score 19.2±2.1 vs 14.7±2.5, 20.2±1.9 vs 14.3±2.4, 21.1±2.2 vs 13.3±2.4, and 20.7±1.9 vs 11.8±2.4; ODI[16.1±1.8]% vs[56.2±1.7]%,[14.7±1.7]% vs[54.8±1.8]%,[13.7±2.2]% vs[55.7±2.4]%, and[12.9±1.7]% vs[52.5±2.3]%), and the differences were significant (all P<0.01). Conclusion A novel classification of L 5 spondylolysis and spondylolisthesis in children is proposed, and it can better guide the surgical treatment. Pedicle screw-U rod system is more effective in the treatment of simple L₅ spondylolysis, and fusion from L₅ to S₂ is more suitable for L 5 spondylolysis and spondylolisthesis patients with high-degree dysplasia.

Abstract:Objective To explore the incidence and precautionary methods of typical drainage-related pain (TDRP) after lumbar surgery. Methods The clinical data of 336 patients with degenerative lumbar disease, who underwent singlelevel posterior lumbar interbody fusion (PLIF) surgery from Jan. 2015 to Jan. 2017 in Orthopaedics Department of Changhai Hospital of Naval Medical University (Second Military Medical University), were retrospectively analyzed. The incidence and relief methods of TDRP were compared between the patients with exit point of muscle of drainage tube at L₃, L₄, L₅ and S 1 levels. A total of 100 patients with degenerative lumbar disease, who underwent single-level transforaminal lumbar interbody fusion (TLIF) surgery from Jun. 2017 to Jun. 2018 in Orthopaedics Department of Changhai Hospital of Naval Medical University (Second Military Medical University), were prospectively enrolled. One side of the patients was randomly selected as L 4 group and the other side as L₅ group. The exit points of muscle of drainage tubes in L₄ group were in line with the superior endplate of the L₄, and those in L₅ group were in line with the inferior endplate of the L₅. The incidence and relief methods of TDRP, drainage volume, drainage duration, dressing saturation grades and wound complications were compared between the two groups after surgery. Results There were no significant differences in gender, age, body mass index (BMI), operation time, intraoperative blood loss, postoperative drainage volume, drainage duration, duration of fever, or hemoglobin or hematocrit one day before surgery, three days after surgery and at discharge between the patients with TDRP (n=65) and without TDRP (n=271) after PLIF (all P>0.05). There were 63, 94, 110 and 69 patients with exit points of muscle of drainage tube at L₃, L₄, L₅ and S₁ levels, respectively; and the incidence rates of TDRP were 0, 5.32% (5 cases), 29.09% (32 cases) and 40.58% (28 cases), respectively. Among the 65 patients with TDRP, four patients (6.15%) were relieved after removal of drainage tube, five patients (7.69%) had sudden relief by changing body position after drainage tube removal, 39 patients (60.00%) were relieved obviously by thermotherapy (generally within two months) after drainage tube removal, 12 patients (18.46%) were relieved by non-steroidal anti-inflammatory drugs after removal of drainage tube, and five patients (7.69%) were relieved by local blockage after the drainage tube removal. In the prospective study, there were no significant differences in postoperative drainage volume, drainage duration, wound dressing two days after surgery or the incidence of wound complications between the L₄ group and L₅ group (all P>0.05). The incidence rate of TDRP was significantly higher in the L 5 group than that in the L₄ group (39.00%[39/100]vs 4.00%[4/100], χ²=36.291, P<0.01). Pain symptoms of 71.79% (28/39) and 75.00% (3/4) patients could be relieved by thermotherapy after removal of drainage tube in the L₅ group and the L 4 group, respectively. Conclusion The incidence of TDRP is high in patients with lumbar degenerative disease whose exit points of muscle of drainage tubes are at or below the level of the L₅ vertebral body after surgery. It is suggested that the exit points of muscle of drainage tubes should be above the level of L₅ vertebral body after lumbar surgery.

Abstract:Objective To explore the risk factors of perioperative complications of radical gastrectomy for gastric cancer. Methods A retrospective study was conducted on 1 580 patients with gastric cancer who underwent radical gastrectomy in our hospital from Jan. 2016 to Dec. 2018. The demographic information, preoperative clinical data, operative information, postoperative pathological data and complications of the patients were recorded, and the complications were graded by Clavien-Dindo grading. Pearson χ² test was used to evaluate the relationship between the perioperative complications and clinicopathological characteristics. Multivariate logistic regression was used to analyze the independent risk factors of perioperative complications. Results Of the 1 580 patients, 134 (8.48%) had perioperative complications. Anastomotic complications are the most common complications (44 cases, 2.78%), including 34 cases (2.15%) of anastomotic leakage, 7 cases (0.44%) of anastomotic bleeding, and 3 cases (0.19%) of anastomotic stenosis, followed by pancreatic leakage (27 cases, 1.71%) and chylous leakage (19 cases, 1.20%). Seventeen patients (1.08%) had complications with ClavienDindo grade ≥ Ⅲa. Univariate analysis showed that age ≥ 70 years (P=0.012), underlying diseases (P<0.01), preoperative prognostic nutritional index<38 (P=0.033), extent of resection (P=0.036), reconstruction mode (P<0.01), intraoperative blood loss ≥ 300 mL (P<0.01) and number of removed lymph nodes<25 (P=0.026) were associated with perioperative complications in gastric cancer patients. Multivariate logistic regression analysis showed that underlying diseases (odds ratio[OR]=1.964, 95% confidence interval[CI] 1.231-3.133, P=0.005) and intraoperative blood loss (OR=1.002, 95% CI 1.001-1.003, P<0.01) were the independent risk factors of perioperative complications in gastric cancer patients. Conclusion In gastric cancer patients with underlying diseases and large intraoperative blood loss, it is necessary to pay attention to perioperative symptoms and signs to avoid the development of complications.

Abstract:Objective To explore the correlation between neutrophil-lymphocyte ratio (NLR) and diagnosis and disease activity of dermatomyositis (DM). Methods The clinical and laboratory data of 50 DM patients, who were admitted for the first time in Changzheng Hospital or Changhai Hospital of Naval Medical University (Second Military Medical University) from Jan. 2016 to Dec. 2019, were retrospectively analyzed. During the same period, 31 healthy controls, 26 rheumatoid arthritis (RA) patients and 27 ankylosing spondylitis (AS) patients were included in control groups. Mann-Whitney U test was used to compare the NLR values between DM, healthy control, RA and AS groups. Spearman rank correlation analysis was performed to explore the relationship of NLR with creatine kinase (CK), lactic dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic efficiency of NLR for DM, and the area under ROC curve was compared using Z test. Pairwise Wilcoxon signed rank test was carried out to compare the NLR, CK, AST, ALT and LDH of DM patients before and after treatment. Results The NLR values were significantly higher in the DM, RA and AS groups than that in the healthy control group (U=29.0, 156.0, and 194.0, all P<0.01). The NLR value was significantly higher in the DM group than those in the RA and AS groups (U=333.0 and 213.0, both P<0.01). Spearman rank correlation analysis showed that NLR was positively correlated with CK, LDH, AST, ALT, CRP and ESR in DM patients (r_s0.540, 0.288, 0.440, 0.498, 0.304, and 0.311, all P<0.05). The areas under the ROC curve of NLR, LDH, CK, ALT and AST in the diagnosis of DM were 0.981, 0.954, 0.931, 0.913 and 0.867, respectively, and the best cut-off values were 2.824, 241.0 U/L, 101.0 U/L, 25.50 U/L and 30.00 U/L, respectively. The area under the ROC curve of NLR was significantly higher than those of ALT and AST (Z=2.05 and 2.67, P=0.040 and 0.008). There was no significant difference in the area under the ROC curve among the other laboratory indicators (P>0.05). The NLR, CK, AST, ALT and LDH of DM patients were significantly decreased after treatment versus before treatment (Z=3.28, 4.68, 4.62, 2.12, and 4.44, all P<0.05). Conclusion NLR can be used to evaluate the disease activity and severity of DM, and it is helpful for the clinical diagnosis and prediction of treatment response in DM.

Abstract:Objective To evaluate the application value of ultrasound-guided superficial cervical plexus block positioned by great auricular nerve in clavicle surgery. Methods A total of 100 patients who were scheduled to undergo clavicular surgery were enrolled in this study after the great auricular nerve was confirmed by ultrasound and transcutaneous electrical stimulation. The patients were randomly assigned to two groups:routine ultrasound-guided group and great auricular nerve-positioned group, with 50 cases in each group. A mixture of 1% lidocaine and 0.375% ropivacaine was used for local anesthesia. In the routine ultrasound-guided group, nerve block was performed by skin puncture at the midpoint of the sternocleidomastoid muscle posterior margin (from the attachment point of the clavicular head to the most prominent point of the mastoid process). In the great auricular nerve-positioned group, relevant morphological data were measured before puncture, and then nerve block was performed by skin puncture at the great auricular nerve puncture point under ultrasound guidance. Pinprick test was used to evaluate the blocking effect and the adverse events were recorded. Results There were no significant differences in age, gender, body mass index (BMI) or operation time between the two groups (all P>0.05). In the great auricular nerve-positioned group, the average current intensity to elicit positive reaction of great auricular nerve was (1.1±0.3) mA, and mean time from start of scan to completion of marking of the great auricular nerve puncture point was (30.5±8.2) s. In the great auricular nerve-positioned group, the puncture sites of 94% (47/50) patients were coincident or caudal to the routine ones, only 3 patients' puncture sites were cranial to the routine ones, with average distance between the two points being (1.27±0.84) cm. The success rate of nerve blocking was significantly higher in the great auricular nervepositioned group than that in the routine ultrasound-guided group (98.0%[49/50]vs 78.0%[39/50], P<0.05), and the great auricular nerve-positioned group had a faster onset. At 24 h of post-operative observation, one patient in each group had hoarseness after block, and no other adverse events or complications occurred. Conclusion Ultrasound-guided superficial cervical plexus block positioned by great auricular nerve has the advantages of rapid onset, high success rate, and few complications.

Abstract:Coronavirus disease 2019 (COVID-19) was first reported in late December 2019, and then erupted in China. COVID-19 is characterized by strong infectivity and a high mortality rate. The public and medical staff are under great psychological pressure. Scholars at home and abroad have carried out researches on mental health during the outbreak of COVID-19. This article summarizes the current researches on mental health related to COVID-19 from three aspects:mental health policy, mental intervention measures and mental health of key population.

Abstract:Coronavirus disease 2019 (COVID-19) is highly infectious, and the risk of cross infection is high among front-line medical staff. In our department, we have made full use of bed call intercom system and monitoring system in the isolation wards for COVID-19, and also tried to use mobile phones, walkie talkie and other means of communication. These means greatly reduced occupational exposure, close contact between medical staff and patients, nosocomial infection risk and the use of medical protective equipment, which improves the efficiency of diagnosis and treatment.

Abstract:Endovascular treatment with platinum coils has become a vital therapeutic option for ruptured intracranial aneurysms. However, the high aneurysm recurrence rates and early rebleeding cause some limitations. Hydrogel coil, which is consisted of a bare platinum coil and an inner core of hydrogel, is initially designed to improve the packing density of intracranial aneurysm. Several randomized controlled trials have demonstrated that hydrogel coils could significantly reduce the incidence of aneurysm recurrence compared with bare platinum coils. However, the inspiring conclusion was derived from those studies that included all states of intracranial aneurysms (ruptured and unruptured aneurysms). Whether hydrogel coils can reduce the recurrence and early rebleeding of ruptured intracranial aneurysms is still unclear. Therefore, this paper reviews the current status of research on hydrogel coils in the treatment of acute ruptured intracranial aneurysms.

Abstract:Coronary microvascular dysfunction (CMD) seriously affects human health. Non-obstructive coronary artery disease (NOCAD) is common in patients undergoing coronary angiography for angina. CMD may be closely related to the incidence of angina in NOCAD patients; however, the relationship between microvascular angina and CMD is still unclear. This review focuses on the main risk factors (diabetes mellitus, inflammation, aging, gender, etc.), pathogenesis (endothelial cell dysfunction, smooth muscle cell dysfunction, etc.) and treatment of CMD.

Abstract:By analyzing the characteristics of warships under multiple attacks and quantifying the ability of surface warships to withstand attacks, we established a rational mathematical model of attack probability. The Markov chain in random process was used to evaluate the operational casualty. The operational casualty under multiple attacks was calculated through examples, which achieved satisfactory results and could provide an effective method for evaluating operational casualty.

Abstract:Objective To explore the value of radiomics with principal component analysis (PCA) based on magnetic resonance imaging (MRI) high-resolution T2-weighted images for predicting treatment response after neoadjuvant chemoradiotherapy (nCRT) of rectal cancer. Methods Clinical data of 80 patients with locally advanced rectal cancer, who received nCRT before radical resection from Jan. 1, 2018 to Dec. 31, 2018 in our hospital, were retrospectively analyzed. There were 60 males and 20 females with a mean age of (56.2±9.9) years (range, 28-74 years). All the patients underwent 3.0 T MRI examination before nCRT. The radiomics features were extracted from the high-resolution T2-weighted images. PCA was applied to reduce the dimension. The logistic regression classifier model was built using the dimension-reduced feature and pathologic complete response label. The samples were randomly divided into training set and testing set for machine learning. ROC curves were drawn and AUC, sensitivity, specificity and accuracy were calculated. Results A total of 1 409 radiomics features were extracted from MRI high-resolution T2-weighted images. Five optimal features, which could best represent the overall radiomics feature matrix, were recombined and selected by PCA method. They represented the information on 9.926 016 67×10^-1, 4.854 545 00×10^-3, 2.509 013 91×10^-3, 2.489 032 30×10^-5 and 7.372 984 50×10^-6, respectively. The mean AUC of the logistic regression classifier model was 0.761 (95% CI 0.694-0.828), sensitivity was 90.3%, specificity was 40.0%, and accuracy was 79.0%. Conclusion Radiomics with PCA based on MRI high-resolution T2-weighted images has good predictive value of treatment response after nCRT of rectal cancer.

Abstract:Objective To explore the application value of bi-pedicle flap in the repair of complex soft-tissuedefect wounds. Methods From Jan. 2014 to Dec. 2018, 92 patients with soft-tissue-defect caused by tumors or traumatic factors were treated with bi-pedicle flap transplantation in Burn and Trauma Surgery Department of Changhai Hospital, Naval Medical University (Second Military Medical University). The clinical and surgical data were observed and recorded, including the pathogenesis, location, ratio of length to width and covering area of the flap, management of flap donor area, preservation of perforator vessels, surviving rate of the flap, and secondary transplantation rate. Results Of the 92 patients receiving bi-pedicle flap transplantation, 49 cases were caused by tumor resection, 36 cases were caused by trauma (17 cases of bone exposure, 12 cases of internal fixation exposure and 7 cases of tendon exposure), and 7 cases were caused by other reasons (5 cases of pressure sore and 2 cases of electric burn). The locations of tissue defects were crus (28 cases), ankle (16 cases), thigh (14 cases), trunk (12 cases), upper limb (11 cases), hip (6 cases), and foot (5 cases). The ratio of length to width of the flap was 1.2-2.8, and the average covering area was (16.55±4.83) cm×(9.88±4.20) cm. There were 43 cases of direct suture of flap donor area, 26 cases of delayed suture and 23 cases of skin-graft. In nine patients, the perforating branches of the musculocutaneous vessels were preserved during the separation due to the large transfer span, area and length-width ratio of the flap. Twenty-one days after surgery, the bi-pedicle flap in 89 patients survived completely, and that in 3 cases had a little necrosis on the edge. After removing the necrotic tissues, the bi-pedicle flap was closed and sutured. In nine patients, there were residual wounds in the flap donor area, and the secondary skin grafting was performed. Conclusion The bi-pedicle flap has the advantages of simple operation, reliable survival, less trauma and direct or delayed suture of partial flap donor areas, and it has great potentials in the repair of complex soft-tissue-defect wounds caused by tumors or trauma.

Abstract:Objective To establish a convenient, reliable and sensitive liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for determination of warfarin in plasma of patients undergoing cardiac valve replacement surgery. Methods An Agilent G6410A triple quadrupole mass spectrometer with positive ion mode was applied to carry out all experiments. Nitrendipine was used as internal standard. The chromatographic separation was achieved on an Agilent Poroshell 120 Phenyl Hexyl column (2.1 mm×50 mm, 2.7 μm) with isocratic elution. The mobile phase contains 0.2% formic acid and 1% acetonitrile in water (A) and 0.2% formic acid in acetonitrile (B), with volume ratio being 60:40; flow rate was 0.3 mL/min; injection volume was 10 μL; column temperature was 25℃; and analytical time for each sample was 4 min. The precursor ion and the product ion used for quantitative analysis were:warfarin mass-to-charge ratio (m/z) 309→163, nitrendipine m/z 361.2→315.1. Results The linear concentration ranges of free warfarin and total warfarin were 5-500 ng/mL and 50-5 000 ng/mL, respectively, with the correlation coefficient (r) both over 0.990. The relative standard deviation (RSD) values of the lowest limit of quantification were less than 15%. The RSD values of the inter- and intra-day precision were less than 15%. The recoveries of free warfarin and total warfarin by protein precipitation were 78.34%-91.59% and 87.33%-89.99%, respectively, and the matrix effect was 87.50%-104.87%. All the items required in pharmacopeia for methodology validation were acceptable. Conclusion This established LC-MS/MS method can be used to determine the concentrations of free and total warfarin, providing a reference for individualized clinical treatment.

Abstract:Objective To translate the English version of Perceived Barriers to Seeking Mental Health Services into Chinese, and to test the reliability and validity of the Chinese version in evaluating psychological help-seeking disorders of navy soldiers. Methods The Chinese version of Perceived Barriers to Seeking Mental Health Services was introduced through translating, back-translating and culture adjusting. Reliability and validity of the Chinese version were tested in 659 Chinese Navy soldiers. Results Totally 654 valid questionnaires were collected, with a valid recovery rate of 99.24%. Two items were combined during culture adjusting. Three factors, namely, negative attitudes, stigma, and organizational barriers, were extracted by means of exploratory factor analysis. Two items, "It would be too embarrassing" and "I would be seen as weak", were eliminated. Fit indices by means of confirmatory factor analysis were acceptable (χ²=233.058 8, goodness of fit index[GFI]=0.809 4, root mean square error of approximation[RMSEA]=0.167 5, root mean square residual[RMR]=0.101 3, standard root mean square residual[SRMR]=0.084 3, normed fit index[NFI]=0.738 6, and comparative fit index[CFI]=0.773 1). The total Cronbach α was 0.865. The Cronbach α values for the three subscales were 0.706, 0.818 and 0.869, respectively. Conclusion The Chinese version of Perceived Barriers to Seeking Mental Health Services has high internal consistency and acceptable validity. Further sample enlargement and revision are required.

Abstract:Pseudohypoparathyroidism (PHP) is a group of dominant/recessive genetic diseases characterized by low calcium, high phosphorus and parathyroid hormone (PTH) resistance. The main clinical manifestations are repeated low-calcification convulsions, often accompanied by language and physical developmental delay and Albright hereditary osteodystrophy. Symptoms can be relieved after calcium supplementation. The disease is rare in clinical practice, and it is often caused by hand and foot convulsions, which often leads to misdiagnosis and missed diagnosis. This article mainly discusses the classification and mechanism of PHP, differential diagnosis, treatment and other aspects, aiming to improve the understanding of the majority of clinicians through this typical case report.

Abstract:Portal vein aneurysms (PVA) are a rare vascular anomaly of the portal system, Pseudoportal vein aneurysms complicated to laparoscopic cholecystectomy(LC) are much less encountered. If a pseudoportal vein aneurysm was misdiagnosed as a focal abscess at gallbladder fossa on base of the clinical manifestations and imaging findings after LC, it is readily for the surgeon to make a therapeutic decision to take ultrasound-guided catheterization and drainage against the gallbladder fossa abscess, however, which can cause a life-threatening bleeding. In this paper, we reported the experience of successful rescue of one patient who faced life-threatening bleeding from a pseudoportal vein aneurysm, which was complicated to a laparoscopic cholecystectomy procedure and was managed by ultrasound-guided puncture and drainage treatment. We described the possible mechanism of the formation of pseudoportal vein aneurysm after laparoscopic cholecystectomy and the causes of misdiagnosis of pseudoportal vein aneurysm by ultrasonography and MRI. We also intend to share our experience how to appropriately manage the emergency in face of bleeding while the aneurysm has been punctured.