Abstract:Objective To observe the effects of ubiquitin C-terminal hydrolase L1 (UCHL1) mutant protein and wild-type protein overdose on mouse oocyte maturation, and analyze its role and interaction mode in mouse oocyte maturation in vitro. Methods The fusion proteins of UCHL1 mutations (C90S and I93M) and wild-type UCHL1 proteins with glutathione S-transferase (GST) were prepared by recombinant protein expression technology. The fusion proteins, GST and phosphate buffered solution (PBS) were injected into immature oocytes by microinjection technology, or wild-type proteins were added to in vitro culture medium to analyze the effects of wild-type UCHL1 overdose, UCHL1 (I93M) mutant protein addition or addition of UCHL1 (C90S) mutant protein with loss of ubiquitin hydrolase activity on oocyte germinal vesicle breakdown (GVBD). The germinal vesicle oocytes of UCHL1 (I93M) mutant mice and wild-type mice were isolated and cultured in vitro for 3 h, and then the GVBD rates were compared. Results There was no significant difference in the GVBD rates of oocytes between microinjection groups with UCHL1- or its mutants-GST fusion protein, GST injection group or PBS injection group (all P<0.05). There was also no significant difference in the GVBD rates of oocytes in the group added with UCHL1-GST fusion protein in the culture medium compared with the control group without injection or addition (P>0.05). A small number of germinal vesicle oocytes in the UCHL1 (C90S)-GST fusion protein injected group progressed to MⅡ stage oocytes in vitro, and the polar body was larger than that of the control group. There was no significant difference in GVBD rates of germinal vesicle oocytes in vitro between UCHL1 (I93M) mutant mice and wild-type mice (P>0.05). Conclusion The addition of exogenous UCHL1, UCHL1 (I93M) mutant with toxic effects, or UCHL1 (C90S) mutant with loss of hydrolase activity in mouse oocytes do not affect the GVBD process of oocyte maturation. The GVBD rate of mouse oocytes with UCHL1 (I93M) mutation is normal. However, the mutation of UCHL1 (C90S) may affect the formation of polar bodies.

Abstract:Objective To investigate the role of miRNA-455-3p in the process of glomerulosclerosis in rats with diabetic kidney disease (DKD) and the intervention effect of irbesartan. Methods Intervention experiment of miRNA-455-3p agonist:there were 18 male SD rats, 6 of which were randomly selected as normal control group, and the other 12 rats were fed with high-fat and high-sugar diet and intraperitoneally injected with streptozotocin (STZ) to prepare DKD models. After successful modeling, they were randomly divided into model group (STZ group) and overexpression miRNA-455-3p group (STZ+miRNA-455-3p group), with 6 rats in each group. In the STZ+miRNA-455-3p group, miRNA-455-3p agonist was injected intraperitoneally at a dose of 20 mg/kg at the second and fifth weeks after STZ injection. Irbesartan intervention experiment:18 male SD rats were divided into normal control group, model group (STZ group) and irbesartan intervention group (STZ+irbesartan group), with 6 rats in each group. The STZ+irbesartan group was gavaged with 50 mg/kg irbesartan suspension. The 24-h urine volume and 24-h urine protein levels were recorded after 12 weeks. The expression levels of miRNA-455-3p in sera and kidney tissues were detected by qRT-PCR. The pathological changes of rat kidney tissues were observed by periodic acid Schiff staining, and the expression levels of collagenⅠand proliferating cell nuclear antigen (PCNA) were detected by Western blotting. Results The 24-h urine volume and 24-h urine protein levels of rats in the STZ+miRNA-455-3p and STZ+irbesartan groups were significantly lower than those in the STZ groups (all P<0.05); the expression levels of miRNA-455-3p in sera and kidney tissues of rats in the STZ+miRNA-455-3p and STZ+irbesartan groups were significantly higher than those of the STZ groups (all P<0.05); and the expression levels of collagenⅠand PCNA in the kidney tissues of rats in the STZ+miRNA-455-3p and STZ+irbesartan groups were significantly lower than those in the STZ groups. Conclusion miRNA-455-3p participates in the process of DKD and may be a new target for DKD treatment, and irbesartan can delay the process of DKD glomerulosclerosis by regulating miRNA-455-3p.

Abstract:Objective To mine stemness-related biomarkers of renal cancer based on the renal cancer stem cell microarray data from Gene Expression Omnibus (GEO) database, and to construct a new model for the prognosis of renal cancer with the clinical and transcriptome data of renal cancer in the Cancer Genome Atlas (TCGA) database. Methods The microarray data were downloaded from the GSE48550 dataset of GEO database to screen the differentially expressed genes between renal cancer stem cells and normal renal tubular epithelium cells. Gene function and pathway were identified by Gene Ontology (GO) and Gene Set Enrichment Analysis (GSEA). The hub genes of renal cancer stem cells were identified by protein-protein interaction (PPI) network construction. Age, clinical stage, prognosis and expression levels of related genes of patients with renal cancer were downloaded from the TCGA database. The independent risk factors of prognosis of renal cancer were screened by univariate and multivariate Cox regression analyses, and a nomogram model for predicting the overall survival of patients with renal cancer was constructed. Results By analyzing the microarray data of renal cancer stem cells and normal renal tubular epithelial cells, we found that the differentially expressed genes were enriched in the biological processes such as cell chemotaxis, extracellular matrix formation and receptor ligand activity; and inflammatory response, P53 and tumor necrosis factor α (TNF-α)/nuclear factor κB (NF-κB) pathways were significantly activated in renal cancer stem cells. Univariate and multivariate Cox regression analyses showed that age and clinical stage were independent risk factors for the prognosis of renal cancer, and C-X3-C motif chemokine ligand 1 (CX3CL1) in chemokine family was an independent protective factor for the prognosis of renal cancer. The risk model based on age, clinical stage, and CX3CL1 expression level could accurately predict the overall survival rate of patients with renal cancer, with a C-index of 0.803. Conclusion Stemness-related genes of renal cancer is screened through the joint analysis of GEO and TCGA. A new model combining patient age, clinical stage and CX3CL1 expression level is constructed to evaluate the prognosis of renal cancer patients.

Abstract:Objective To investigate the difference of serum amino acid levels between breast cancer patients and normal volunteers, and explore its significance in breast cancer screening. Methods Totally 59 breast cancer patients (breast cancer group) diagnosed by the Department of Pathology, Chongqing University Cancer Hospital from Apr. to Jun. 2019 were recruited, and 53 normal healthy women were selected as control group. The levels of 20 amino acids in the sera of recruited people were detected by high performance liquid chromatography-mass spectrometry (HPLC-MS). The differences of amino acid levels were analyzed between breast cancer group and control group, between different molecular subtype groups of breast cancer, and between early and advanced breast cancer groups. Receiver operating characteristic (ROC) curve was used to evaluate the effectiveness of different serum amino acids in breast cancer screening. Results The levels of alanine (Ala), asparagine (Asn), citrulline (Cit), glutamic acid (Glu), histidine (His), isoleucine (Ile), leucine (Leu), lysine (Lys), ornithine (Orn), phenylalanine (Phe), proline (Pro), threonine (Thr), tyrosine (Tyr) and valine (Val) were higher in the breast cancer group than in the control group (all P<0.05). The level of arginine (Arg) was lower in the breast cancer group than in the control group (P=0.003). ROC curve analysis showed that of the 14 amino acids which were elevated in the sera of breast cancer patients, Ala or Pro alone had better performance in screening breast cancer, and the area under curves (AUCs) were both 0.75; Ile alone had the highest sensitivity, with the AUC of 0.79; Lys alone had the highest specificity, with the AUC of 0.94; and the combined detection of the 14 amino acids improved the performance of breast cancer screening, with the AUC of 0.88, sensitivity of 0.69, and specificity of 0.94. The level of serum Val was higher in early breast cancer patients (TNM stageⅠand Ⅱ) than in advanced patients (TNM stageⅢandⅣ) (P=0.044), and there was no significant difference in the levels of other 19 amino acids (all P>0.05). No significant difference was found in the 20 amino acids between Luminal A type, Luminal B type, triple-negative, and human epidermal growth factor receptor 2 (HER2) positive breast cancer groups (all P>0.05). Conclusion The levels of 15 serum amino acids in breast cancer patients are different from those in normal persons, which is helpful for breast cancer screening. The combination detection of 14 elevated serum amino acids in breast cancer patients can improve the screening performance and may serve as potential biomarkers.

Abstract:Objective To observe the effects of individualized home enteral nutrition support on body mass index (BMI), incidence of malnutrition, postoperative body weight loss and nutritional indexes in patients on tube feeding after radical esophagectomy. Methods Patients on home enteral nutrition tube feeding after radical esophagectomy treated in Shanghai Chest Hospital, Shanghai Jiao Tong University from 2018 to 2019 were selected, including 136 patients who received routine home enteral nutrition education from Jan. to Dec. 2018 (control group) and 146 patients who received routine home enteral nutrition education+individualized nutrition diet intervention from Jan. to Dec. 2019 (intervention group). The changes in body weight, BMI, incidence of malnutrition, weight loss and nutritional indexes were compared between the 2 groups before and after nutrition intervention. Results There were no significant differences in weight, BMI or incidence of malnutrition between the 2 groups at discharge (all P>0.05). However, the nutritional indexes (total protein, albumin and lymphocyte count) of the intervention group were significantly lower than those of the control group (all P<0.05). After 3 weeks of nutrition intervention, there was no significant difference in body weight or BMI between the 2 groups (both P>0.05); the incidence of malnutrition of the intervention group was significantly lower than that of the control group (17.8%[26/146]vs 27.9%[38/136], P<0.05); the changes of body weight loss and BMI of the intervention group were significantly lower than those of the control group (both P<0.001); and the total protein and prealbumin levels were significantly higher than those of the control group (both P<0.05). Conclusion Home enteral nutrition support combined with individualized whole-course nutrition guidance can significantly prevent postoperative body weight loss, reduce the risk of postoperative malnutrition and improve postoperative nutritional status in patients on tube feeding after esophageal cancer surgery.

Abstract:Objective To evaluate the value of enhanced magnetic resonance imaging (MRI) in the preoperative diagnosis of Siewert type Ⅱ/Ⅲ adenocarcinoma of esophagogastric junction (AEG). Methods The imaging data of 76 patients with Siewert type Ⅱ/Ⅲ AEG confirmed by postoperative pathology from Jan. 2018 to May 2020 in our hospital were retrospectively analyzed. Two attending physicians measured and diagnosed the lesions on enhanced computed tomography (CT) and enhanced MRI images by blind method. The consistency between the 2 examination results and pathological results was analyzed by Kappa test. Results All 76 patients underwent imaging examination within 1 week before surgery:27 cases underwent enhanced CT only, 9 cases underwent enhanced MRI only, and 40 cases underwent both (with an interval of 1 d). A total of 67 preoperative enhanced CT images and 49 preoperative enhanced MRI images were obtained. Among the 67 patients with AEG who underwent enhanced CT, there were 35 cases of Siewert type Ⅱ and 32 cases of Siewert type Ⅲ, and the diagnosis was correct in 56 patients, showing moderate agreement with the pathological results (Kappa=0.672). Among the 49 patients with AEG who underwent enhanced MRI, there were 27 cases of Siewert type Ⅱ and 22 cases of Siewert type Ⅲ, and the diagnosis was correct in 44 patients, showing good agreement with the pathological results (Kappa=0.791). The positive metastatic lymph nodes suggested by preoperative enhanced MRI were not consistent with the postoperative pathological results (Kappa=0.115), and the positive metastatic lymph nodes suggested by enhanced CT were also not consistent with the postoperative pathological results (Kappa=-0.129). With the pathological results as the gold standard, the accuracy of enhanced MRI in grouping positive metastatic lymph nodes was 59.2% (29/49), which was higher than that of enhanced CT (41.8%[28/67]). Conclusion The accuracy of preoperative enhanced MRI for Siewert classification and grouping areas of positive metastatic lymph nodes in AEG patients is higher than that of enhanced CT, which may provide favorable evidence for the clinical treatment, choice of surgical route and extent of lymph node dissection.

Abstract:Objective To evaluate the effect of combined acupuncture anesthesia on the risk of postoperative urinary retention (POUR) in patients after anal surgery based on real-world data, so as to provide evidence-based basis for optimal anesthesia method for anal surgery. Methods The data of patients undergoing anal surgery from Jan. 1, 2012 to Dec. 31, 2018 were retrospectively collected from the electronic medical records (EMR) system of Shuguang Hospital, Shanghai University of Traditional Chinese Medicine. The information of gender, age, length of hospital stay, anesthesia method and International Classification of Diseases, Ninth Revision, Clinical Modification Volume 3 (ICD-9-CM3) codes were extracted. Ascertainment of POUR was based on the medical order of indwelled catheterization and the charge of catheter. For cases with intraoperative anesthesia change, final anesthesia method was recorded. Results A total of 11 440 patients undergoing anorectal surgery were enrolled with an age of 39 (32, 51) years and a male to female ratio of 1.94:1. Among them, 6 083 cases (53.2%) were treated with combined acupuncture anesthesia, 3 392 cases (29.7%) with posterior perineal nerve block anesthesia, 1 420 (12.4%) cases with intravenous anesthesia, 408 (3.6%) cases with local anesthesia, 65 (0.6%) cases with spinal anesthesia, 46 (0.4%) cases with general anesthesia, and 26 (0.2%) cases with other anesthesia methods. The incidence of POUR was 3.5% (395 cases). Univariate logistic regression analysis showed that age ≥ 60 years (odds ratio[OR]=1.76, 95% confidence interval[CI]1.36-2.27, P<0.001) and female (OR=1.36, 95% CI 1.11-1.67, P=0.003) were risk factors for POUR in patients undergoing anal surgery. Multivariate logistic regression analysis showed that compared with combined acupuncture anesthesia, posterior perineal nerve block anesthesia, intravenous anesthesia and spinal anesthesia were significantly associated with increased risk of POUR (posterior perineal nerve block anesthesia:OR=1.42, 95% CI 1.13-1.78, P=0.002; intravenous anesthesia:OR=1.48, 95% CI 1.10-1.99, P=0.009; spinal anesthesia:OR=2.75, 95% CI 1.09-6.93, P=0.032). Multivariate logistic regression analysis was performed after adjusting for gender, age and disease diagnosis, and showed the similar results (posterior perineal nerve block anesthesia:adjusted OR=1.33, 95% CI 1.06-1.67, P=0.014; intravenous anesthesia:adjusted OR=1.43, 95% CI 1.06-1.92, P=0.019; and spinal anesthesia:adjusted OR=4.93, 95% CI 1.92-12.67, P=0.001). Subgroup analysis showed that compared with posterior perineal nerve block anesthesia, combined acupuncture anesthesia could reduce the risk of POUR by 41% in female patients (OR=0.59, 95% CI 0.42-0.84, P=0.003) and 30% in patients <60 years (OR=0.70, 95% CI 0.54-0.90, P=0.006). Conclusion Age ≥ 60 years and female sex are risk factors of POUR in patients undergoing anal surgery. Combined acupuncture anesthesia is helpful to reduce the risk of POUR after anal surgery.

Abstract:Objective To explore the mental health status of military personnel with closed-off management 1 year after the outbreak of coronavirus disease 2019 (COVID-19). Methods A total of 294 officers and soldiers with closed-off management were investigated with self-made questionnaire of demographic data, generalized anxiety disorder (GAD-7), impact of event scale-revised (IES-R), patient health questionnaire 9 (PHQ-9) and insomnia severity index (ISI) scale to explore the mental health status 1 year after the outbreak of COVID-19. The influencing factors were analyzed by multiple linear regression model. Results A total of 257 valid questionnaires were collected, with an effective rate of 87.4%. Overall, the prevalence of depressive, anxious, post-traumatic stress disorder (PTSD) and insomnia was 47.5% (122/257), 29.6% (76/257), 39.7% (102/257) and 30.4% (78/257), respectively. Multiple linear regression analysis showed that gender and self-esteem were the influencing factors of depression (β=0.145 and -0.544, both P<0.01) and anxiety (β=0.192 and -0.515, both P<0.01). Age, education level and self-esteem were the influencing factors of PTSD (β=0.233, 0.126 and -0.484, all P<0.05). Gender, education level and self-esteem were the influencing factors of insomnia (β=0.118, 0.135, and -0.456, all P<0.05). Conclusion Depression, anxiety, PTSD and insomnia appear in some officers and soldiers with closed-off management 1 year after the outbreak of COVID-19, suggesting attention is needed to the mental health of military personnel 1 year after the outbreak of COVID-19. Tailored psychological counseling and interventions should be given to improve the mental health level of soldiers during the epidemic.

Abstract:Objective To carry out text data mining from discharge summary of patients with stroke (a disease with high incidence and poor prognosis) using natural language processing technology, and to convert unstructured text data into structured database for subsequent statistical analysis through Python. Methods Based on the discharge summary of patients with ischemic stroke, the named entity recognition model of enhanced representation from knowledge integration (ERNIE)+neural network+conditional random field was constructed to identify 5 kinds of medical named entities, including disease, drug, surgery, imaging examination and symptoms. The entities were extracted and the semi-structured database was constructed. In order to further extract structured data from semi-structured databases, a similarity matching model of twin texts based on ERNIE was constructed. The evaluation index was accuracy, and the optimal model was used to construct the covariable extractor. Results The overall F1 value of the named entity recognition model reached 90.27%, including 88.41% for disease F1, 91.03% for drug F1, 87.71% for imaging examination F1, 87.07% for surgery F1, and 96.59% for symptom F1. The overall accuracy of the text similarity matching model reached 99.11%. Conclusion The construction process from complete unstructured data, to semi-structured data, and then to structured data, is realized through natural language processing technology. Compared with reading and extracting medical records manually, the natural language processing technology greatly improved the efficiency of database construction.

Abstract:In recent years, the research on metagenomics and metabonomics of intestinal flora has progressed rapidly, but the interaction with intestinal immune cells remains unclear. Group 3 innate lymphoid cells (ILC3) are a population of innate immune cells enriched in the intestinal mucosa, which is an important defense against intestinal microbial infection. On the one side, intestinal flora and its metabolites can directly or indirectly affect the development, proliferation and function of ILC3, and ILC3 may transform into different phenotypes and play a double-edged-sword role according to different microbial signals; on the other side, ILC3 can maintain the balance of resident microbiota and regulate responses of other immune cells to intestinal commensal bacteria. This article reviews the interaction between ILC3 and intestinal flora.

Abstract:Organ transplantation is the ultimate treatment for various end-stage diseases, and cellular rejection has been effectively controlled due to the application of new immunosuppressants. However, humoral rejection, that is, the rejection mediated by donor-specific antibodies, is still an important factor leading to graft failure or even death of recipients. Antibody-mediated rejection plays a significant role in the development and progression of hyperacute rejection and chronic rejection, but the understanding is still limited in the medical community. This article reviews the mechanism, detection and treatment of antibody-mediated rejection.

Abstract:Premenstrual dysphoric disorder (PMDD) is diagnosed as a type of mood disorder in the Diagnostic and Statistical Manual of Mental Disorders 5^th edition (DSM-5). In addition to depressive symptoms, PMDD can be accompanied by somatic symptoms and is characterized by cyclicity (premenstrual). The etiology and pathogenesis of PMDD are not clear, probably involving the fluctuation of estrogen, the weakened role of neurosteroids hormones, immune activation and inflammatory response, the abnormal functional activities of some brain areas (such as amygdala, prefrontal cortex), psychosocial factors, etc. There is no radical treatment for PMDD due to the unknown pathogenesis. Treatments including drugs (such as antidepressants, oral contraceptives), psychotherapy, and complementary medicines (such as traditional Chinese medicine, acupuncture) are used to relieve patients' symptoms.

Abstract:Objective To understand the influence of Arctic environment on sleep quality of expeditioners. Methods Pittsburgh sleep quality index (PSQI) scale was used to investigate the sleep statuses of the 131 expeditioners for the China's 9^th Arctic research expedition before, during and after the expedition, and the sleep time point, morning rise time, sleep latency and actual sleep time were recorded. Results A total of 131 questionnaires were sent out, and 88 valid questionnaires were collected from 77 males and 11 females, aged 22-50 (48.1±17.9) years, including 18 crew members and 70 scientific research team members. During the expedition, the median morning rise time was 180 min earlier than that before the expedition, the sleep latency was longer than that before and 3 months after the expedition ([45.23±25.84] min vs[18.45±14.34] min and[19.50±12.57] min, both P<0.01), and the sleep time at night was shorter than that before and 3 months after the expedition ([6.83±2.24] h vs[8.36±1.45] h and[8.14±1.45] h, both P<0.01). According to the score of PSQI scale, the sleep quality was decreased, the sleep latency was prolonged, the sleep time was shortened, the sleep efficiency was decreased and the use of hypnotic drugs was increased during the expedition, with significant differences as compared with those before the expedition (all P<0.01). Conclusion Polar day and low temperature environment significantly affect the sleep rhythm of expeditioners, prolonging the sleep latency, shortening the sleep time and increasing the use of hypnotic drugs, which may affect the working state of expeditioners.

Abstract:Medical corpsmen are medical service staff in grassroots units. They play an important role in battlefield rescue, health and epidemic prevention, disease prevention and treatment, rehabilitation guiding and psychological counseling. American medical corpsmen have clear positioning, clear classification and complete training system, which are worthy of reference. This paper systematically reviews the classification and training mode of American medical corpsmen, compares and analyzes the current situation of our training mode, and puts forward opinions and suggestions on our military medical corpsman training in combination with the medical service reform under the new situation.

Abstract:Objective To analyze the risk factors of pessimistic ideation of military officers and soldiers. Methods With cluster sampling, 432 military officers and soldiers were selected. Self-designed general information questionnaire was compiled to collect the age, gender, residence, parental relationship, family economic condition and marital status. Patient health questionnaire (PHQ-9), generalized anxiety disorder scale (GAD-7), insomnia severity index (ISI), satisfaction with life scale (SWLS) and mental health continuum-short form (MHC-SF) were used to investigate the depression, anxiety, subjective sleep quality, life satisfaction and well-being. Pessimistic ideation was measured by the 9th item of PHQ-9, and the relationship between pessimistic ideation and the above factors was analyzed. Results Depression (r_s=0.285, P<0.01), anxiety (r_s=0.245, P<0.01), subjective sleep quality (r_s=0.117, P=0.016), life satisfaction (r_s=-0.181, P<0.01) and well-being (r_s=-0.241, P<0.01) were correlated with pessimistic ideation. The logistic regression model included 2 effective factors:depression (P=0.017) and well-being (P=0.029). Well-being had a complete mediating effect between subjective sleep quality and pessimistic ideation, accounting for 66.37% of the total effect. Conclusion The higher the degree of depression and the lower the sense of well-being, the higher the possibility of pessimistic ideation. Poor subjective sleep quality may reduce well-being and increase the risk of pessimistic ideation among military officers and soldiers.

Abstract:Objective To investigate the relationship between locus of control, mental resilience and fatigue among military personnel. Methods Internality, powerful others, and chance (IPC) scale, Conner-Davidson resilience scale (CD-RISC) and fatigue scale 14 (FS-14) were used to investigate locus of control, mental resilience and fatigue among 553 soldiers, respectively. Structural equation model was built to analyze the relationship between variables. Results There were 532 valid questionnaires and the effective response rate was 96.2%. There were no significant differences in locus of control between soldiers with different demographic factors including only-child or not, residence before entering army or complete structure of natal family (all P>0.05), but significant differences were found in gender and education level (senior high school or below vs university or above) (both P<0.05). For fatigue, there was significant difference in gender (P<0.01), but no significant difference in other demographic variables (all P>0.05); soldiers with low internal control (high external control) scored higher in fatigue than those with high internal control (low external control). The 3 dimensions of locus of control, 3 dimensions of mental resilience and 2 dimensions of fatigue were all correlated with each other significantly (all P<0.01), except correlation between internality and physical fatigue. Locus of control and mental resilience were able to explain 22.8% of the total variation of fatigue. The results of mediation model and Bootstrap test presented that mental resilience mediated the relationship between locus of control and fatigue among military personnel (χ²/df=4.888, goodness of fit index=0.983, adjusted goodness of fit index=0.940, normed fit index=0.983, relative fit index=0.957, incremental fit index=0.986, Tucker-Lewis index=0.966, comparative fit index=0.986, root mean square error of approximation=0.086). The total mediation effect of mental resilience was 22.58%. Conclusion Mental resilience partially mediates the association between locus of control and fatigue. We should pay more attention to fatigue of soldiers who tend to be externally controlled, help them improve mental resilience, reduce their fatigue, and enhance their work efficiency.

Abstract:Objective To determine the effective volume of 0.5% ropivacaine in patients receiving thoracoscopic analgesia with erector spinae plane block (ESPB) by Dixon's up-and-down sequential method. Methods A total of 31 patients who underwent thoracoscopic lobectomy in Yueyang Hospital of Integrated Traditional Chinese and Western MediCIne, Shanghai University of Traditional Chinese MediCIne from Jan. to Sep. 2020 were selected. Ultrasound-guided 0.5% ropivacaine ESPB of corresponding spinal ganglion segment was performed according to the operation site. The initial volume of 0.5% ropivacaine was 35 mL. If the first patient reached the best effective analgesic standard, the drug volume of the second patient decreased by 2 mL; on the contrary, the drug volume increased by 2 mL. The trial was terminated when 7 inflection points of invalid volume appeared. The following 3 criteria were met, and the best effective analgesic standard was achieved:(1) there was no significant fluctuation in vital signs at the beginning of skin inCIsion (the rise of mean arterial pressure and heart rate did not exceed 20% before skin inCIsion); (2) there was no pain-related agitation after extubation; and (3) when no remedial analgesics were used 2 h after operation, the visual analogue scale score of pain was ≤ 3. Probit probability regression analysis was used to calculate 50% effective volume (EV₅₀), 95% effective volume (EV₉₅) and their 95% confidence interval (CI). Results A total of 30 patients were enrolled, including 21 males and 9 females, aged (60.0±6.8) years, with body mass index of (22.7±3.1) kg/m² and American SoCIety of Anesthesiologists gradeⅡ(9 cases) orⅢ(21 cases). Eighteen (60.0%) patients achieved the best effective analgesia. The EV₅₀ of 0.5% ropivacaine was 23.6 mL (95% CI 21.8-25.0 mL), and the EV₉₅ was 26.9 mL (95% CI 25.3-35.2 mL). No complications such as bleeding, hematoma, local anesthetic poisoning, infection or nerve injury occurred in the patients. Conclusion EV₅₀ and EV₉₅ of 0.5% ropivacaine in patients receiving thoracoscopic analgesia with ultrasound-guided ESPB are 23.6 and 26.9 mL, respectively.

Abstract:Objective To investigate the clinicopathological features, diagnosis, differential diagnosis and prognosis of intracranial solitary fibrous tumor/hemangiopericytoma (SFT/HPC). Methods The clinicopathological data of 7 patients with intracranial SFT/HPC diagnosed in JiuJiang No.1 People's Hospital and Jiangxi Cancer Hospital from Jun. 2015 to Dec. 2020 were collected, and the histological morphology and immunohistochemistry results were analyzed retrospectively. Results Of the 7 cases of intracranial SFT/HPC, 5 were males and 2 were females, aged from 23 to 60 years, with a mean age of 46.1 years. The main clinical manifestations were dizziness, headache, vomiting and other symptoms of nerve compression and increased intracranial pressure. Imaging showed intracranial space occupying lesions with arterial phase enhancement. Microscopically, the tumors in 5 cases of World Health Organization (WHO) gradeⅡ SFT/HPC were composed of short spindle cells with interstitial "antler like" vascular and fibrous hyperplasia; the tumor cells in 2 cases of WHOⅢ SFT/HPC were significantly abundant and heterotypic. Immunohistochemical staining showed that vimentin, CD34, and signal transducer and activator of transcription 6 (STAT6) were diffusely expressed in tumor cells of 7 patients, and Bcl-2 (3/7), P53 (3/7) and CD99 (2/5) were expressed in varying degrees. Except for 1 patient transferred to other hospital and lost, the other 6 patients were followed up for 5 to 67 months. One patient recurred 33 months after the operation, and there was no recurrence or metastasis after the secondary operation. Conclusion Intracranial SFT/HPC is rare. With atypical clinical and imaging manifestations, it is easy to be confused with other intracranial tumors. The diagnosis depends on its characteristics of histological morphology and immunohistochemical markers. Early detection, complete surgical resection and radiotherapy can reduce recurrence of SFT/HPC.

Abstract:Objective To explore the efficacy of 4 minimally invasive surgery for the treatment of cholecystolithiasis with choledocholithiasis. Methods A total of 144 patients who was diagnosed as cholecystolithiasis with choledocholithiasis in our hospital from Jan. 2017 to Jun. 2018 were selected, and randomly divided into laparoscopic cholecystectomy (LC)+laparoscopic common bile duct exploration (LCBDE) with T tube drainage group (n=44), LC+LCBDE with primary suture group (n=35), LC+laparoscopic transcystic common bile duct exploration (LTCBDE) group (n=27), and LC+endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (EST) group (n=38). The surgical conditions, postoperative indexes, and early and long-term complications of the 4 groups were compared and analyzed. Results There were no significant diffierences in operation success rate, operation time, intraoperative bleeding or anal exhaust time among the 4 groups (all P>0.05). The proportion of postoperative discomfort (such as bloating and vomitting) in the LC+LCBDE with T tube drainage group was significantly higher, the score of gastrointestinal quality of life index was significantly lower, the postoperative hospital stay in the LC+LTCBDE group was significantly shorter, and the postoperative serum amylase level in the LC+ERCP/EST group was significantly higher than the other 3 groups (all P<0.05). There were no serious postoperative complications in the 4 groups. In the LC+LCBDE with T tube drainage group, 2 cases had biliary tract infection, 1 had T tube detachment, and 4 had hyperamylasemia; in the LC+LCBDE with primary suture group, 4 cases had biliary leakage and 2 had hyperamylasemia; in the LC+LTCBDE group, 2 cases had hyperamylasemia; and in the LC+ERCP/EST group, 8 cases had hyperamylasemia and 2 had pancreatitis during the early postoperative period. After follow-up for more than half a year, there were 1 case of stone residue, 1 case of stone recurrence and 1 case of biliary stenosis in the LC+LCBDE with T tube drainage group; and 4 cases of stone recurrence and 2 cases of biliary stenosis in the LC+ERCP/EST group. Conclusion The 4 minimally invasive surgery methods are all effective for the treatment of cholecystolithiasis with choledocholithiasis. The LTCBDE has the advantages of minimal trauma, rapid recovery and low complication incidence, and it is worthy of clinical promotion. The surgeon should choose the best surgery according to the individual condition and surgical indications of the patients.

Abstract:Objective To explore the characteristics and risk factors of occupational exposure to blood-borne diseases among medical staff, so as to provide effective basis for prevention and intervention. Methods The data of 746 cases of occupational exposure to blood-borne diseases reported by Changhai Hospital, Naval Medical University (Second Military Medical University) from Apr. 2006 to Jan. 2021 were analyzed retrospectively, which including gender, age, occupation, working department, time of occupational exposure, source of exposure, route of exposure and treatment measures. Results In terms of gender, more females (540 cases, 72.39%) had occupational exposure to blood-borne diseases than males (206 cases, 27.61%); in terms of occupation, nurses (305 cases, 40.88%), doctors (171 cases, 22.92%) and student nurses (111 cases, 14.88%) were the main groups with occupational exposure to blood-borne diseases; in terms of department distribution, the top 5 departments were emergency department (105 cases, 14.08%), general surgery (73 cases, 9.79%), anesthesiology department (67 cases, 8.98%), gastroenterology department (55 cases, 7.37%) and cardiothoracic surgery (54 cases, 7.24%). The main source of exposure was hepatitis B virus (508 cases, 68.10%); the main route of exposure was sharp instrument injuries (666 cases, 89.28%). Thirty-six cases (4.83%) did not receive any emergency treatment after exposure to blood-borne diseases, while all exposed staff received preventive treatment and follow-up, and no occupational exposure infection occurred in the end. Conclusion To reduce the incidence of blood-borne diseases and ensure the physical and mental health of medical staff, we should strengthen the awareness to prevent blood-borne diseases, strengthen occupational protection training, establish reasonable and effective protection system, and improve the diagnosis and treatment.

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