Abstract:Objective To explore the clinical value of Hoffmann sign in patients with degenerative cervical disorder. Methods The clinical data of 104 patients with degenerative cervical disorder who underwent anterior cervical decompression and fusion in our department from Jun. 2017 to Jan. 2019 were retrospectively analyzed, including 49 Hoffmann sign-positive patients and 55 Hoffmann sign-negative patients. The patients were followed up for at least 12 months. The general clinical manifestations, clinical signs, magnetic resonance imaging (MRI), preoperative clinical scores, perioperative complications and postoperative neurological function recovery were evaluated. The correlations between Hoffmann sign and preoperative clinical scores were evaluated by the receiver operating characteristic (ROC) curve. Results Compared with the Hoffmann sign-negative group, the patients in the Hoffmann sign-positive group had more hyperintense spinal cord and worse preoperative Japanese Orthopaedic Association (JOA) and Nurick scores (all P<0.05). ROC curve analysis showed that the sensitivity, specificity and area under curve (AUC) of Hoffmann sign were 85.29%, 42.22% and 0.666 (95% confidence interval[CI] 0.547-0.785, P=0.012) in predicting preoperative JOA score and were 67.65%, 75.56% and 0.731 (95% CI 0.618-0.845, P<0.01) in predicting Nurick score, respectively. JOA score in isolation analysis showed that the upper limb motor function and lower limb sensory function of the patients were worse in the Hoffmann sign-positive group than in the Hoffmann sign-negative group (both P<0.01). ROC curve analysis showed that the sensitivity, specificity and AUC of Hoffmann sign were 47.06%, 80.00% and 0.679 (95% CI 0.561-0.798, P=0.007) in predicting upper limb motor function and were 44.12%, 84.45% and 0.660 (95% CI 0.536-0.783, P=0.016) in predicting lower limb sensory function, respectively. There was no significant difference in the incidence of perioperative complications between the 2 groups. At the final follow-up, the postoperative functional recovery rate was lower, and the upper limb motor function and lower limb sensory function of the patients were worse in the Hoffmann sign-positive group than in the Hoffmann sign-negative group (all P<0.05). Conclusion Hoffmann sign can be used as a reliable clinical index to reflect the preoperative clinical presentation and postoperative functional recovery of patients with degenerative cervical disorder, especially to predict the recovery of upper limb motor function and lower limb sensory function.

Abstract:Objective To explore the surgical treatment strategies of tumors involving the upper renal segment of inferior vena cava from different histological origins. Methods The clinical data of 32 renal cell carcinoma patients with inferior vena cava tumor thrombus, 11 patients with primary leiomyosarcoma of inferior vena cava and 8 patients with inferior vena cava leiomyomatosis were collected from Changhai Hospital of Naval Medical University (Second Military Medical University) from Jan. 2008 to Apr. 2018. There were 20 males and 31 females, with an average age of (50.1±12.8) (ranged 26-76) years. All patients were confirmed by pathology and underwent open or laparoscopic surgery. Results Fifty patients received surgical resection and 1 surgery was terminated. Of the 32 patients with inferior vena cava tumor thrombus, 30 received thrombectomy and 2 received resection of the inferior vena cava (1 case of right renal cell carcinoma with tumor thrombus did not receive reconstruction of the inferior vena cava, and 1 case of the left renal cell carcinoma with tumor thrombus underwent reconstruction of the inferior vena cava). Of the 11 patients with primary leiomyosarcoma of inferior vena cava, 6 received complete resection of the inferior vena cava and the inferior vena cava was replaced by artificial blood vessel, 4 received partial resection of the invaded inferior vena cava and the inferior vena cava was sutured for reconstruction, and 1 surgery was terminated after intraoperative exploration. Eight patients with inferior vena cava leiomyomatosis did not undergo resection or reconstruction of the inferior vena cava. At a median follow-up of 17 months (ranged 1-36 months), the survival rates of the 3 groups were 84.4% (27/32), 63.6% (7/11) and 100.0% (8/8), respectively. Four cases died during the perioperative period, including 2 cases of renal cell carcinoma with thrombus shedding during operation, 1 case of renal cell carcinoma with inferior vena cava tumor thrombus and 1 case of inferior vena cava leiomyosarcoma resulted in hepatic congestion and postoperative disseminated intravascular coagulation. Five cases died of tumor metastasis during follow up. Conclusion There were significant differences in demography, vascular invasion, shedding risk of cancer/tumor thrombus and prognosis among patients with renal cell carcinoma with inferior vena cava tumor thrombus, primary leiomyosarcoma of inferior vena cava and inferior vena cava leiomyomatosis. Preoperative comprehensive evaluation of the patient's condition can be helpful, but there is no effective method to assess the difficulties of surgery preoperatively or to avoid the shedding of cancer/tumor thrombus and severe postoperative complications.

Abstract:Objective To establish an artificial intelligence (AI) algorithm model for the diagnosis of hilar cholangiocarcinoma (HC) and to evaluate its ability to recognize tumor cells and perineural invasion (PNI). Methods AI algorithm was used for deep learning on 825 HC and 175 non-cancerous tissue images (600 for training set, 300 for test set, and 100 for comparison set). The neural network combined with GoogLeNet and DenseNet with different parameters was used for feature extraction and deep learning of HC cells and PNI. The AI algorithm model was compared among 3 pathologists (1 associate chief physician, 1 attending physician and 1 resident) in judging the presence or absence of tumor and the proportion of tumor cells. Results The AI algorithm based on deep learning could accurately identify tumor cells and PNI in HC tissue sample images. The AI algorithm was as good as experienced associate chief physicians in the department of pathology in diagnosing tumors, and was better in estimating the proportion of tumor cells. Conclusion AI algorithm model is helpful in identifying HC cells and PNI.

Abstract:Objective To observe the expression stages and characteristics of Plasmodium berghei quiescin sulfhydryl oxidase (PbQSOX). Methods SignalP-5.0 Server and TMHMM Server 2.0 were used to predict and analyze the signal peptide and transmembrane regions of PbQSOX protein. With homologous recombination, PbQSOX-HA tag plasmids were linearized by restriction enzyme NotⅠ, and the linearized plasmids were electroporated into Plasmodium berghei strain and infected mice. The PbQSOX-HA tag Plasmodium berghei was obtained from the peripheral blood of pyrimethamine resistant mice and was identified by polymerase chain reaction (PCR). Schizonts, gametocytes and ookinetes of PbQSOX-HA tag Plasmodium berghei were purified. Western blotting and indirect immunofluorescence assay (IFA) were used to detect the expression stages and characteristics of PbQSOX protein in Plasmodium berghei. Results Bioinformatics analysis showed that PbQSOX protein had a signal peptide, but had no transmembrane region. All the proteins were expressed outside the cell membrane. PbQSOX-HA tag Plasmodium berghei was successfully obtained by homologous recombination of PbQSOX-HA tag targeting plasmid and Plasmodium berghei and confirmed by PCR. The purified schizonts, gametocytes and ookinetes of PbQSOX-HA tag Plasmodium berghei were obtained. Western blotting revealed that PbQSOX protein was mainly expressed in the gametocyte and ookinete stages, and IFA showed that PbQSOX was expressed on the surface of gametocytes, male-gametes, zygotes, retorts and ookinetes. Conclusion PbQSOX is a protein expressed at sexual reproduction stage of Plasmodium berghei, and it is mainly expressed on the surface of gametocytes, male-gametes, zygotes, retorts and ookinetes.

Abstract:Objective To explore the mechanism of electroacupuncture at "Zusanli" (ST36) and "Sanyinjiao" (SP06) to activate A2A adenosine receptor (A2AR) for reducing joint inflammation and bone erosion in rats with collagen-induced arthritis (CIA) based on p38 mitogen-activated protein kinase (MAPK) signaling pathway. Methods A total of 32 male SD rats were evenly randomized into control, CIA model, methotrexate (MTX)-treated and electroacupuncture-treated groups. The rats in model, MTX-treated and electroacupuncture-treated groups were immunized to replicate the CIA model by twice injection of fetal bovine typeⅡ collagen and Freund's adjuvant mixture. After the model was successfully established, the rats in the MTX-treated group were injected with MTX 2 mg/kg every 7 days for 14 days, and those in the electroacupuncture-treated group were treated with electroacupuncture (2/100 Hz density wave and output current of 2 mA) bilaterally at ST36 and SP06 for 20 min every day for 14 days. The pathological changes of hind foot bone were observed by computed tomography (CT) imaging; the histopathological changes of synovium, cartilage and osteoclasts of the knee joint were observed by hematoxylin-eosin (H-E), safranin O-fast green and tartrate-resistant acid phosphatase (TRAP) staining; the expression of A2AR, p38, phosphorylated p38 (P-p38), nuclear factor κB (NF-κB) and nuclear factor-activated T cell 1 (NFATc1) proteins in the knee synovial tissue was determined by Western blotting; and the peripheral serum interleukin 1β (IL-1β) content was measured by enzyme-linked immunosorbent assay (ELISA). Results Compared with the control group, the bone density of hind foot in the model group was decreased and the spatial structure was disordered; the cartilage of knee joint was obviously damaged and the synovial tissue was hyperplastic; the number of TRAP positive osteoclasts was increased significantly (P<0.01), while the expression of A2AR, p38, P-p38, NF-κB and NFATc1 in the knee synovial tissue was significantly up-regulated (P<0.01); and the peripheral serum IL-1β content was significantly increased (P<0.01). Compared with the model group, the overall structure of hind foot, synovium and cartilage damage of knee joint in the electroacupuncture-treated group and MTX-treated group were significantly improved; the number of TRAP positive osteoclasts was decreased (P<0.01); the expression of A2AR was significantly up-regulated (P<0.01) and expression of p38, P-p38, NF-κB and NFATc1 was significantly down-regulated (all P<0.01); and the serum IL-1β content was greatly reduced (P<0.01). Compared with the MTX-treated group, the number of TRAP positive osteoclasts was increased in the electroacupuncture-treated group (P<0.05); the expression of A2AR protein was down-regulated (P<0.01), the expression of NF-κB and NFATc1 proteins was up-regulated (P<0.05); and there was no significant difference in the expression of total p38 (P>0.05), but the expression of P-p38 was up-regulated (P<0.05). Conclusion Electroacupuncture at ST36 and SP06 can alleviate the joint bone erosion in CIA rats by inhibiting p38 MAPK pathway to reduce the production of osteoclasts after activating A2AR.

Abstract:Objective To investigate the analgesic effect of repetitive transcranial magnetic stimulation (rTMS) on rats with neuropathic pain (NPP) caused by chronic compression of dorsal root ganglion (CCD) and to explore the mechanism. Methods A total of 36 male rats aged 10 weeks were evenly randomized into 3 groups:sham operation+sham stimulation group, NPP+sham stimulation group, and NPP+rTMS group. The rats in the sham operation+sham stimulation group and NPP+sham stimulation group received sham stimulation in the morning and afternoon, while the rats in the NPP+rTMS group received sham stimulation in the morning and high frequency rTMS (M1 area of cerebral cortex, 20 Hz) in the afternoon. On the 8^th day after CCD-caused NPP modeling, rats were intervened by rTMS or sham stimulation for 11 consecutive days. Von Frey filaments and conditioned place preference test were used to evaluate the mechanical withdrawal threshold and spontaneous pain before and after rTMS intervention. The left L₄-L₅ dorsal root ganglion (DRG), spinal cord dorsal horn and sera were collected on the 20^th day after NPP modeling, the expression levels of glial fibrillary acidic protein (GFAP), an activation marker of satellite glial cells and astrocytes, in DRG and spinal cord dorsal horn and the postsynaptic density-95 (PSD-95) in spinal cord dorsal horn were measured by Western blotting. The interleukin 18 (IL-18) and tumor necrosis factor α (TNF-α) in sera were detected by enzyme-linked immunosorbent assay (ELISA). Results Compared with the sham operation+sham stimulation group, the mechanical withdrawal threshold was significantly decreased, the expression of GFAP in DRG was significantly increased, the expression levels of GFAP and PSD-95 in spinal cord dorsal horn were significantly higher, and the serum levels of IL-18 and TNF-α were significantly increased in the NPP+sham stimulation group (all P<0.05); and the rats in the 2 groups had no preference for cage A or cage B. However, these changes were all reversed in the NPP+rTMS group after receiving high-frequency rTMS, and the rats had a preference for cage B compared with the NPP+sham stimulation group (all P<0.05). Conclusion High-frequency rTMS may relieve CCD-caused NPP by inhibiting the activation of satellite glial cells in DRG, by inhibiting astrocyte activation and synaptic connection formation in spinal cord dorsal horn, and by improving inflammatory microenvironment.

Abstract:Objective To study the damage of underwater explosion to the brain and lung of beagles in the swimming battle position. Methods Twenty healthy beagles were evenly randomized into 4 experimental groups (5 m, 8 m, 11 m or 15 m away from the explosion source) and a control group (n=4). Beagles in water were subjected to the explosion of 1 kg 2,4,6-trinitrotoluene (TNT) equivalent bare explosive 2 m underwater. Underwater and intracranial pressure sensors and high-speed camera were used to record the process of explosion injury. Computed tomography (CT) scans of the head and chest, as well as magnetic resonance imaging (MRI) scans of head were performed 3 h after the explosion. Brain and lung specimens were taken 24 h after the explosion, and injuries of them were observed. Hematoxylin-eosin (H-E) staining and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) staining were performed afterwards to observe the histopathological changes and apoptosis of brain and lung tissues. Results The records of pressure sensors and high-speed camera showed the injury process of underwater explosion included 2 stages:blast wave and bubble pulsation. There were 4, 3, 1 and 0 beagles died in 5 m, 8 m, 11 m and 15 m groups, respectively. The head CT and MRI showed that there was no obvious brain injury in the experimental groups, while the chest CT showed that there were intrapulmonary hemorrhage, pneumothorax, hemothorax or pleural effusion. H-E staining showed that there were no obvious changes in the brain tissue of beagles in the experimental groups, but the alveoli were ruptured, and there were a large number of red blood cells in the alveolar cavity, and many inflammatory cells infiltrated in the lung interstitial. TUNEL staining showed only a few positive cells in the hippocampus, while the alveolar epithelial cells and interstitial cells in the lung showed a trend of extensive apoptosis and necrosis. Conclusion The main injury caused by underwater explosion to beagles in swimming battle position is lung blast injury, while the brain tissue injury is relatively slight.

Abstract:Objective To explore the effect of open chromatin state on functional pathways related to colon cancer using the data of assay for transposase-accessible chromatin using sequencing (ATAC-seq) and RNA sequencing (RNA-seq) from The Cancer Genome Atlas (TCGA) database. Methods ATAC-seq and RNA-seq data of colon cancer were downloaded from TCGA, and the quality of ATAC-seq data was controlled using R 3.5.3 software. The ATAC-seq peaks of all samples were annotated, and the Gene Ontology (GO) function and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were carried out. The key genes of colon cancer, including APC regulator of Wnt signaling pathway (APC), Kirsten rat sarcoma viral oncogene (KRAS) and v-raf murine sarcoma viral oncogene homolog B1 (BRAF), were selected to analyze the correlation between ATAC-seq peaks of the 3 genes and the fragments per kilobase of exon model per million mapped fragments (FPKMs) of RNA-seq. The tissue samples of TNM stage Ⅲ+Ⅳ and Ⅰ+Ⅱ were selected to analyze the differential ATAC-seq peaks, and KEGG pathway enrichment analysis was performed for up-regulated and down-regulated peaks annotated genes. Results The ATAC-seq peaks of colon cancer were evenly distributed in the chromosome, and most of them were located in promoter region (30.17%, 5.42% and 3.88% in the distance from transcription initiation site ≤ 1 kb, >1-2 kb and >2-3 kb, respectively) and distal intergenic region (26.17%), which were consistent with 2 main types of chromatin open region. GO function and KEGG pathway enrichment analyses showed that the peaks annotated genes in ATAC-seq data of colon cancer were significantly enriched in cancer-related functions and pathways, such as intercellular signaling conduction of Wnt signaling pathway and epidermal growth factor receptor (ErbB) signaling pathway. The RNA-seq FPKMs of APC, KRAS and BRAF were positively correlated with ATAC-seq peaks in promoter region. The up-regulated peaks annotated genes were significantly enriched in ErbB signal pathway, Wnt signal pathway, PI3K-Akt signal pathway, p53 signal pathway and other signal pathways related to proliferation, invasion and metastasis, while down-regulated peaks annotated genes were significantly enriched in T cell receptor signaling pathway, B cell receptor signaling pathway, cell adhesion molecule signaling pathway and other immune recognition related signaling pathways in patients at TNM stage Ⅲ+Ⅳthan at stage Ⅰ+Ⅱ. Conclusion Open chromatin plays an important role in the functional pathways related to colon cancer.

Abstract:Objective To study the safety profile of dupilumab using the U. S. Food and Drug Administration Adverse Event Reporting System (FAERS) database and to mine the potential adverse event signals, so as to provide reference for rational clinical drug use. Methods The dupilumab-related adverse event records were selected by searching the FAERS database from the second quarter of 2017 to the second quarter of 2020 and standardizing dupilumab's drug name, with the primary suspected drug as a restriction. Potential adverse event signals were mined using the disproportionality analysis, including reporting odds ratio (ROR) and information component (IC), and MedDRA 23.0 was used to systematically classify the results. Results A total of 97 205 dupilumab-related adverse event records out of 16 684 618 data records were obtained. According to the results of 2 adverse event signal mining methods, 365 adverse event signals were obtained under the restricted conditions of the lower limit of the ROR value 95% confidence interval (CI) >1 or the lower limit of the IC value 95% CI >0. Finally, 82 adverse event signals with greater clinical significance were obtained through the removal of non-adverse events and the merger of the same name, and the adverse events of dupilumab were mainly eye, skin and subcutaneous diseases, infections and infestations. The adverse event signals leading to serious adverse event outcomes mainly included eye diseases, infections and inflammations that may be caused by the drug, accelerated deterioration of cutaneous T-cell lymphoma, hypersensitivity of immune system, bronchitis of respiratory system, arthralgia and systemic diseases of skeletal system, and deterioration of various reactions at the site of administration. The top 5 drugs were prednisone, cyclosporine, treprostinil, prednisolone and methotrexate among the total adverse events and serious adverse events of drug combination. Conclusion In addition to the mild and moderate shallow corneal damage and conjunctivitis, clinicians should pay attention to the more serious eye detection signals such as corneal degeneration and ulcerative keratitis. It is also recommended to conduct a medical assessment with the ophthalmologist to instruct patients on medication. Doctors need to be more vigilant in medicine for patients with original eye problems. The adverse reaction signals detected by other systems still require long-term monitoring of adverse drug reactions of real-world medications. The outcome of serious adverse events of dupilumab and the corresponding detection signals, as well as the medications in combination with the most adverse events are worthy of attention.

Abstract:Objective To translate the English version of fear of coronavirus disease 2019 (COVID-19) scale (FCV-19S) into Chinese and assess its reliability and validity. Methods FCV-19S was translated and culture-adapted to form a Chinese version of fear of COVID-19 scale (FCV-19S-C). A total of 334 questionnaires were sent out online, including FCV-19S-C, Chinese version of depression, anxiety and stress scale (DASS-C21), impact of event scale-revised (IES-R) and public stigma scale. The reliability and validity of FCV-19S-C and the influencing factors of COVID-19 fear were analyzed with the survey data. Results FCV-19S-C contained 7 items. One common factor was extracted by exploratory factor analysis, reflecting that all items in the scale belonged to the common factor, which could explain 69.5% of total variation. The load of item factors ranged from 0.780 to 0.873, showing good construct validity. The total score of FCV-19S-C was positively correlated with the total scores of DASS-C21 and IES-R (r=0.403 and 0.471, both P<0.01), indicating that the scale had good concurrent validity. The Cronbach's α coefficient of FCV-19S-C was 0.924, showing good reliability. Linear regression analysis showed that the influences of COVID-19 on the psychological level and family income could predict the total score of FCV-19S-C (β=0.62 and 0.20, both P<0.01). The total score of FCV-19S-C could predict the total score of the public stigma scale (β=0.37, P<0.01). Conclusion FCV-19S-C has good reliability and validity, and can be used as a tool to understand the public fear of COVID-19 in China. The fear of COVID-19 is related to the loss of family income and the public stigma of COVID-19 patients.

Abstract:Yellow fever virus (YFV) is a member of the Flavivirus genus within the Flaviviridae family. It is an enveloped single-stranded positive-sense RNA virus. Although the vaccine can effectively prevent YFV infection, the low coverage of vaccination and lack of effective antiviral drugs result in frequent outbreaks of YFV. YFV genome encoded proteins play important roles in basically all steps of viral infection. Therefore, the development of therapeutic drugs targeting YFV proteins is an effective measure to improve the therapeutic effect and reduce the mortality of this infectious disease. In this review, we briefly introduce the structure and function of the YFV genome encoded proteins, and summarize the research progresses and prospects of anti-YFV drugs targeting these proteins, so as to provide references for prevention and treatment of YFV infection.

Abstract:Chronic pancreatitis is a complex inflammatory disease characterized by tissue atrophy and irreversible fibrosis. In the late course of the disease, a progressive loss of endocrine and exocrine function occurs. Since the discovery of the first pathogenic mutation of chronic pancreatitis, great progress has been made in the genetic study of pancreatitis. Most of the chronic pancreatitis-related risk genes encode trypsin, trypsin inhibitors or other proteins highly expressed in the pancreas. Herein we reviewed the genetic research progress of chronic pancreatitis in recent years and summed up its genetic pathogenesis.

Abstract:Although the era of precise minimally invasive robotic surgery has arrived, currently used imaging techniques still cannot meet the needs of optimal surgical planning and intraoperative navigation for urinary malignancy. Three dimensional (3D) virtual reconstruction based on 2D cross-sectional imaging can help surgeons understand the anatomy of different individuals. Many urologists have applied this method to the treatment of prostate cancer, and have superimposed 3D models on human body structure to realize augmented reality. This paper reviews the application of augmented reality in robot-assisted radical prostatectomy, and prospects the application of cross-fusion of augmented reality and surgery.

Abstract:In doctor-patient interaction, the patient-centered communication focuses on patient care and patient participation in treatment decision-making. There is a huge information asymmetry between doctors and patients with different backgrounds of knowledge and experience. The quantity and quality of disease information and treatment information are related to the communication satisfaction. Different doctor-patient communication patterns should be chosen according to different diseases. In addition, the symmetry of risk information also affects the patients' treatment satisfaction. Future researches are needed from the perspectives of doctor-patient information matching, patient information cognitive psychological mechanism and communication promotion technology.

Abstract:Objective To explore the diagnostic value of ultrasonography for musculoskeletal injuries of soldiers in long-distance sailing. Methods A total of 182 soldiers in Chinese navy escort fleets in Aden Gulf were selected, and the pain, swelling and discomfort parts of joint and/or soft tissue were examined by ultrasound. Results Forty-one soldiers were examined, and 29 cases were positively diagnosed. There were 17 cases of knee joint cavity effusion (11 cases on one side and 6 cases on both sides), of which 4 cases were accompanied by ligament bursitis (2 cases of inferior patellar ligament bursitis, 1 case of lateral collateral ligament bursitis, and 1 case of subcutaneous deltoid ligament bursitis of ankle joint); 7 cases of soft tissue injuries, including 4 cases of subcutaneous superficial soft tissue injuries, 2 cases of tendon injuries, and 1 case of muscle injury; 2 cases of soft tissue infection; 1 case of tendon sheath cyst; 1 case of tibial tubercle osteochondrosis; and 1 case of hyperplasia of the extensor tendon sheath trauma after injury. Conclusion Ultrasound is suitable for early diagnosis, differential diagnosis and efficacy evaluation of common musculoskeletal injuries in long-distance sailing.

Abstract:Key training personnel cultivation became increasingly more important for combat readiness training of mobile medical service force affiliated to military hospitals in the new era. Military training practice over the past decades has shown that outstanding training personnel and their leading role can improve the level and effectiveness of military training. For the mobile medical service force affiliated to military hospitals, lack of commanders and professional and technical personnel should be solved as soon as possible. We should innovate in the talent selection, application and administration to establish and improve the training constructure and mechanism of new combat readiness training talents. In the new era, direct recruiting, joint training and other new forms of civil-military integration will be adopted to broaden the training channels for key personnel in organizing training and promoting the construction of the training system, so as to train competent personnel that can skillfully handle the mobile medical service force.

Abstract:Objective To summarize the imaging features and clinical treatment experience of intravascular leiomyomatosis. Methods The clinical manifestations, imaging data, surgical treatment, postoperative pathology and immunohistochemical staining of 5 patients with intravascular leiomyomatosis diagnosed in our hospital from Jan. 2014 to Dec. 2019 were retrospectively analyzed, and the imaging features and clinical treatment experience were summarized. Results The 5 patients were all females, with an average age of 51.8 years (ranged 46-60 years), and all had a history of hysteromyoma, and 2 of them had a history of hysterectomy and bilateral adnexectomy. Two cases presented with leiomyoma invading the right atrium, showing symptoms of impaired cardiac function; the remaining 3 cases presented with right lower limb swelling, abdominal masses, and lower abdominal distension. Four cases underwent ultrasound and computed tomography (CT) angiography of the inferior vena cava, 2 cases underwent magnetic resonance imaging (MRI) plain scan + enhanced examination, and 1 case underwent angiography. All patients underwent angiomyoma resection+angioplasty. Of the 2 cases presented with leiomyoma invading the right atrium, 1 case underwent primary surgery, 1 case underwent secondary surgery, and both patients recovered well after surgery. One case was re-operated due to recurrence 4 years after surgery. One case underwent a major resection of the tumor + ligation of the common iliac vein due to excessive bleeding during the operation, and the tumor in right common iliac vein was not resected. In the 5 cases, the common features of immunohistochemical staining were smooth muscle actin (SMA) (+), calponin (CALP) (+), P53 (-), CD31 (-), Ki-67 (-); only 1 case was positive for estrogen receptor (ER) and progesterone receptor (PR), 1 case was partially positive for both ER and PR, 1 case was partially positive for ER and slightly positive for PR, and 2 cases had no ER or PR staining data. All the 5 patients were followed up regularly and no recurrence was found until Feb. 2021. Conclusion The clinical manifestations of intravascular leiomyomatosis are not specific, but the imaging features are clear. The diagnosis accuracy can be improved by combining clinical manifestations and gynecological history.

Abstract:Objective To explore the application of CHA₂DS₂-VASc score in perioperative stratified anticoagulation for elderly hip fracture patients with non-valvular atrial fibrillation (NVAF). Methods A total of 78 elderly hip fracture patients with NVAF were enrolled. Age, gender, diabetes mellitus, hypertension, heart failure, stroke and vascular disease history were scored according to the preoperative CHA₂DS₂-VASc score, and the patients were divided into 3 groups:low-risk group (CHA₂DS₂-VASc score ≤ 1, 18 cases), medium-risk group (CHA₂DS₂-VASc score >1-2, 36 cases), and high-risk group (CHA₂DS₂-VASc score>2, 24 cases). Three groups were all switched to low molecular heparin for bridging anticoagulation 5 days before operation, and treated with aspirin, rivaroxaban and low molecular heparin for stratified anticoagulation 24-48 h after operation. The general clinical data, intraoperative blood loss, postoperative drainage and hemoglobin, perioperative international normalized ratio (INR), incidence of complications in 1 year after operation and the elderly hip fracture functional recovery scale (FRS) score were compared among the 3 groups. Results The CHA₂DS₂-VASc scores of patients in the low-, medium- and high-risk groups were 0.56±0.48, 1.73±0.23 and 5.62±0.76, respectively, showing significant differences (P<0.01). There was no significant difference in gender among the 3 groups (P=0.506). There was significant difference in age among the 3 groups (P<0.01), with patients in the low-risk group being the youngest and those in the high-risk group being the oldest. Compared with the low-risk group, the proportions of patients with previous diabetes mellitus, hypertension, congestive heart failure, ischemic stroke or transient ischemic attack (TIA), and vascular disease were significantly higher in the medium- and high-risk groups (all P<0.05); the proportion of patients with previous ischemic stroke or TIA was significantly higher in the high-risk group than in the medium-risk group (P=0.031); there were no significant differences in the proportions of patients with previous heart failure, hypertension, diabetes mellitus or cardiovascular disease between the medium- and high-risk groups (all P>0.05). There were no significant differences in operation time, intraoperative blood loss, postoperative drainage, hemoglobin levels or INR before, 1 d after, and 3 d after operation among the 3 groups, and the same was true for the incidences of ischemic/hemorrhagic stroke, acute coronary syndrome, deep vein thrombosis, and FRS scores 1 year after operation (all P>0.05). There were no deaths among the 3 groups. Conclusion The CHA₂DS₂-VASc score can guide the use of perioperative stratified anticoagulants in elderly hip fracture patients with NVAF according to the risk factors of thrombosis.

Abstract:Objective To explore the clinical application of superb micro-vascular imaging (SMI) in evaluating the role of Banxia Baizhu Tianma decoction in improving the stability of carotid atherosclerotic plaque of hypertension with phlegm dampness obstruction. Methods A total of 120 patients with carotid atherosclerotic plaque of hypertension with phlegm dampness obstruction were enrolled, they visited the First Affiliated Hospital of Heilongjiang University of Chinese Medicine from Sep. 2018 to Sep. 2020. The patients were randomly divided into control group and treatment group (60 cases in each group). The control group was treated with atorvastatin calcium tablets, 20 mg once a day, orally after breakfast; the treatment group was also treated with Banxia Baizhu Tianma decoction, 50 watered pills each time, twice a day, orally after meals. Both groups were treated for 6 months. The serum levels of low-density lipoprotein-cholesterol (LDL-C), total cholesterol (TC) and triglyceride (TG) were recorded before and after treatment. Routine ultrasound and SMI were performed. Carotid intima-media thickness (IMT), carotid plaque Crouse score and carotid plaque SMI grade were observed before and after treatment. Results There were no significant differences in serum levels of LDL-C, TC or TG between the 2 groups before treatment (all P>0.05); the serum levels of LDL-C, TC and TG in the 2 groups were significantly lower after treatment than those before treatment (all P<0.05); and the serum levels of LDL-C, TC and TG in the treatment group were significantly lower than those in the control group after treatment (all P<0.05). There were no significant differences in carotid IMT or plaque Crouse score between the 2 groups before treatment (both P>0.05); the carotid IMT and plaque Crouse scores of the 2 groups were decreased after treatment, with no significant difference (both P>0.05); there were no significant differences in carotid IMT or plaque Crouse score between the 2 groups after treatment (both P>0.05). There was no significant difference in carotid plaque SMI grade between the 2 groups before treatment (P>0.05); after treatment, the proportions of patients with carotid plaque SMI grade 2 were decreased and those with SMI grade 0 were increased in both groups compared with those before treatment (both P<0.01), and the proportion of patients with carotid plaque SMI grade 2 in the treatment group was significantly lower than that in the control group (P<0.05). Conclusion SMI can be used to evaluate the role of Banxia Baizhu Tianma decoction in improving the stability of carotid atherosclerotic plaque of hypertension with phlegm dampness obstruction, which can help to evaluate the clinical effect of medication.

Abstract: