Objective:To compare the effects of thoracoscopic anatomical segmentectomy and thoracoscopic lobectomy on patients' respiratory function.Methods:Retrospective analysis of 326 patients who underwent thoracoscopic surgery from July 2016 to July 2019(209 patients underwent anatomical segmentectomy, 117 patients underwent lobectomy). According to variables including gender, age, tumor location, smoking history and BMI, two propensity score-matched cohorts including 89 patients respectively were constructed. The patients’ baseline data and respiratory function date of the patients pre-operation and post-operation were analyzed. The measurement data that obey the normal distribution were described by mean±standard deviation, and the t-test was used for comparison between groups; the measurement data of non-normal distribution was described by the median value( P25, P75), and the Wilcoxon rank sum test was used for the comparison between groups; The data was described by frequency, and the chi-square test or Fisher's exact probability method was used for comparison between groups. Results:At the first-month follow-up after surgery, there was no significant difference in the variation of FVC[(0.48±0.40)L vs.(0.34±0.37)L, P=0.215)and FEV1[(0.52±0.46)L vs.(0.43±0.77)L, P=0.364), and in the change rate of FVC(%)[15.23(8.74, 21.25) vs. 14.58(7.75, 19.40), P=0.122], FEV1(%)[17.25(9.56, 22.78) vs. 16.42(9.15, 20.28), P=0.154]and DLCO(%)[18.54(10.88, 25.68)vs. 17.45(9.58, 23.75) P=0.245]. Between the segmentectomy group and lobectomy group, there was a significant difference in the alteration of FVC[(0.50±0.47)L vs. (0.29±0.31)L, P=0.031] and FEV1[(0.44±0.34)L vs.(0.24±0.23)L, P<0.001], the change rate of FVC(%)[14.27(7.87, 22.32) vs. 9.95(5.56, 17.24), P=0.008]、FEV1(%)[15.23(8.36, 22.17)vs. 10.05(5.15, 18.54), P<0.001]and DLCO(%)[13.74(6.24, 19.78) vs. 4.45(-2.32, 13.75), P=0.023]in the 6th month after surgery. The lobectomy group had a higher variation of FEV1[(0.34±0.49)L vs.(0.18±0.26)L, P=0.006] and change rate of FVC(%)[9.28(2.15, 18.94) vs. 5.24(0.52, 11.45), P=0.0032] and FEV1(%)[10.45(3.15, 21.32) vs. 6.50(1.55, 14.24), P<0.001] in the first year after surgery. However, the variation of FVC[(0.29±0.36)L vs.(0.21±0.24)L, P=0.176) and the change rate of DLCO(%)[8.35(2.15, 16.45) vs. 6.23(2.12, 14.54), P=0.143] didn't show a significant difference between the two groups. Conclusion:Whether in the short or the middle postoperative period, segmentectomy can preserve postoperative respiratory function than lobectomy.

Inflammatory bowel disease (IBD) is a chronic, recurrent, non-specific inflammatory disease with unknown etiology. The vagus nerve and its cholinergic receptors, including nicotinic acetylcholine receptor and muscarinic acetylcholine receptor, are involved in inhibiting intestinal inflammation, regulating intestinal epithelial barrier permeability, regulating intestinal stem cell proliferation and differentiation, and play an important role in the pathogenesis of IBD. Whether there is a correlation between intestinal microbiota dysbiosis and vagus nerve structure remodeling，signal transduction changing remains to be explored. The therapeutic strategies targeting the vagus nerve and its cholinergic receptors including vagus nerve stimulation and nicotine are still being studied. This article reviewed the progress of research on vagus nerve and its cholinergic receptors in IBD.

Objective:To explore the disease-related impairment of functional and structural connectivity network and their relationship with psychometric hepatic encephalopathy score (PHES) in patients with chronic hepatitis B virus-related cirrhosis (HBV-RC) by combining resting-state functional MRI (rs-fMRI) and diffusion tensor imaging (DTI).Methods:Data of 30 HBV-RC patients [including 13 HBV-RC patients with minimal hepatic encephalopathy (MHE) and 17 HBV-RC patients without MHE (NMHE)] from April 2011 to October 2011 in Guangdong No.2 People′s Hospital were analyzed prospectively, and 38 healthy individuals matched for age, sex, and education with HBV-RC patients (HC group) were included during the same period. Rs-fMR and DTI data as well as PHES data of all participants were collected. Gretna and PANDA software package were used to preprocess the imaging data and construct the functional and structural network respectively. The network-based statistic (NBS) approach was used to compare the differences of the functional and structural connections among three groups. Spearman′s correlation analysis was used to identify the relationship between functional or structural connectivity and PHES. The structural equation modeling (SEM) was used to explore the relationships among functional connectivity, structural connectivity, and PHES.Results:Compared to HC group, both functional and structural connectivity in the whole brain progressively destroyed from NMHE to MHE, mainly involving cognitive control network, default mode network, and limbic network (NBS corrected, all P<0.01). There were significantly negative relationships between functional or structural connectivity and PHES in HBV-RC patients (false discovery rate corrected, all P<0.05). The SEM results showed the influence of structural connectivity on neurocognitive impairment was mediated by functional connectivity ( P<0.05). Conclusion:Both functional and structural networks progressively destroy in HBV-RC patients as the disease advanced and these alterations significantly correlate with PHES. Besides, the influence of structural connectivity on neurocognitive impairment is mediated by functional connectivity.

Objective:To explore the optimal labeling conditions of 177Lu-1, 4, 7-triazacyclononane-1, 4, 7-triacetic acid (NOTA)- D-Phe1-Tyr3-Thr8-octreotide (TATE), and evaluate its biodistribution and imaging characteristics in mice. Methods:The reaction temperature, pH, reaction time and other labeling conditions were changed to realize the rapid labeling of NOTATATE by 177Lu. The optimal labeling conditions, radiochemical purity, in vitro stability, plasma protein binding rate, and lipid-water partition coefficient were determined. Twenty-four normal KM mice were divided into 6 groups by random number table method. After injected with 3.7 MBq 177Lu-NOTATATE through tail vein, they were sacrificed at 0.5, 1, 4, 24 h and 4, 6 d respectively to research the biological distribution (injection dose rate per gram of tissue percentage, %ID/g). Six normal mice were randomly divided into 2 groups and injected with 11.1 MBq 177Lu-NOTATATE and 177Lu-1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetraacetic acid (DOTA)TATE, respectively. SPECT planar imaging was performed at 1, 2, 3 h after injection. Another 8 mice were divided into 4 groups, injected with 3.7, 7.4, 18.5 MBq 177Lu-NOTATATE and saline respectively for an acute toxicity test. Results:At pH 5 and reaction temperature between 95 ℃ and 100 ℃ for 15 min, the labeling rate could reach more than 98%. After being placed in human serum for 24 h, the radiochemical purity was still higher than 95%. The plasma protein binding rate of 177Lu-NOTATATE was (58.6±1.9)% and the lipid-water partition coefficient was 0.048±0.014. In normal mice, the concentration of radioactivity is mainly in the liver, kidney and spleen, especially in the kidney (up to (29.120±1.204) %ID/g after 0.5 h of injection), which is less distributed in the blood and excreted rapidly. Compared with 177Lu-DOTATATE, 177Lu-NOTATATE was excreted faster by the kidney. The toxicity study results revealed that no damage was observed in mice of each group, and no obvious damage or inflammatory changes were observed in organ tissue sections. Conclusions:The optimal labeling condition of 177Lu-NOTATATE were determined in this study. The physical, chemical, and biological properties of 177Lu-NOTATATE were proved to be good and safe, and it was excreted faster by the kidney than 177Lu-DOTATATE. The results of this study lay a foundation for further clinical transformation research.

Objective:To establish a supportive and effective management mode of scientific research project application, promote the capacity building of scientific research in the hospital.Methods:Retrospective analysis was conducted on the national and provincial scientific research projects of Xinhua Hospital Affiliated to Shanghai Jiaotong University Medical School from 2010 to 2019, and the practical effect of " point to point" management mode of scientific research project application was evaluated.Results:The funding rate of Xinhua Hospital, especially national scientific research projects and provincial talents projects, was greatly improved by adoption of the multi-dimensional " point to point" management mode of scientific research project application. The number of national scientific research projects increased from 34 (26.02 million) in 2010 to 72 (51.0851 million) in 2019.The number of provincial talents projects increased from 5 (1.05 million) in 2010 to 26 (6.5 million) in 2019.Conclusions:The " point to point" management mode of scientific research project application plays an important role in promoting the overall funding rate. Enhancement of comprehensive capacity of hospital scientific research can be achieved by further improvement of this management mode, early initiation and arrangement of funding application depending on the " close partner" entity, emphasizing scientific research talents cultivation.

Objective:To evaluate the day-surgery unit-based training of laparoscopic cholecystectomy (LC).Methods:Perioperative data of 438 patients (187 males and 251 females) with a median age of 54 (aged 17 to 91) years undergoing LC during January 2019 to April 2021 in the day-surgery unit of Chinese PLA General Hospital were retrospectively collected and subdivided according to the training methods of surgeons [Group A( n=260): conventional training vs. Group B ( n=178): protocoled stepwise training]. The protocoled stepwise training consists of the rotation in open biliary surgery unit, the stimulator-based laparoscopic training, and the stepwise procedural tutoring. The conventional training features the traditional surgical practice following senior surgeons. The technical data involving operation time, blood loss, the percentages of intraoperative decision-making by senior surgeons and the handing-over of procedure to senior surgeons, etc. were statistically analyzed. Results:The operation time was shortened in Group B [(55±30) min vs. (61±33) min], with significantly decreased percentages of intraoperative decision-making by senior surgeons [7.9% (14/178)vs. 16.9%(44/260), P<0.05] and the handing-over of procedure to senior surgeons [3.4%(6/178) vs. 11.2%(29/260), P<0.05]. Conclusion:Based on the protocoled stepwise training and the consecutive, high-volumed and standardized procedures, the laparoscopic technical proficiency and competency of the trainee surgeons have been improved.

Objective:To investigate the clinical features and effect of prognostic factors in patients with different pathological types of non-Hodgkin lymphoma-associated hemophagocytic lymphohistiocytosis.Methods:We collected and analyzed the clinical data of 89 patients with non-Hodgkin lymphoma-associated hemophagocytic lymphohistiocytosis who were treated at Huadong Hospital from March 2013 to May 2020. The data were analyzed via log-rank and Cox multivariate analyses.Results:The median overall survival time of the 89 cases was 10.2 months. Patients with B-cell lymphoma-associated hemophagocytic lymphohistiocytosis did not reach the median overall survival time. The median overall survival times of T-cell lymphoma-associated hemophagocytic lymphohistiocytosis and NK-cell lymphoma-associated hemophagocytic lymphohistiocytosis were 10.2 and 3.0 months, respectively. The pathological type of non-Hodgkin lymphoma (OS: P=0041, PFS: P=0.015) , ECOG score ≥ 3 (OS: P=0.031, PFS: P=0.030) , hematopoietic stem cell transplantation (OS: P=0.005, PFS: P=0.040) , lymphadenopathy (OS: P=0.007, PFS: P=0.012) , and splenomegaly (OS: P=0.276, PFS: P=0.324) were related to the overall survival and progression-free survival of patients with non-Hodgkin lymphoma-associated hemophagocytic lymphohistiocytosis. Splenectomy could improve the prognosis of patients with lymphoma-associated hemophagocytic lymphohistiocytosis, especially T-cell lymphoma-associated hemophagocytic lymphohistiocytosis. Conclusion:The clinical characteristics of patients with different pathological types of non-Hodgkin lymphoma-associated hemophagocytic lymphohistiocytosis were similar but were different in the overall survival rate and the effect of prognostic factors. We suggested that patients with non-Hodgkin lymphoma-associated hemophagocytic lymphohistiocytosis should receive more than combined chemotherapy. To improve the prognosis and survival rate of patients, those with B-cell lymphoma-associated hemophagocytic lymphohistiocytosis and NK-cell lymphoma-associated hemophagocytic lymphohistiocytosis promptly require hematopoietic stem cell transplantation. Moreover, patients with T-cell lymphoma-associated hemophagocytic lymphohistiocytosis should consider splenectomy.

Objective:To explore the safety and efficacy of chimeric antigen receptor T-cell (CAR-T) therapy for relapsed/refractory acute B-cell lymphoblastic leukemia (B-ALL) with T315I mutation.Methods:The clinical data of a patient with relapsed/refractory B-ALL with T315I mutation who underwent CAR-T therapy in the Second Affiliated Hospital of Anhui Medical University was analyzed, and the related literature was reviewed.Results:The patient was a 34-year-old man. He was diagnosed with chronic myelogenous leukemia (CML) in January 2017 and started to take imatinib orally. However, the primary affection transformed to B-ALL 4 months later. Because of the E355G gene mutation, the treatment drug was adjusted to dasatinib, and induction chemotherapy was given at the same time. The sequential consolidation chemotherapy was given for 3 times after complete remission (CR). After half a year of remission, T315I mutation was detected and re-induced chemotherapy was given, but ineffective. The patient was treated with CAR-T 3 days after FC regimen (fludarabine 30 mg/m 2 per day, day 1 to day 3; cyclophosphamide 200 mg/m 2, day 1 to day 3). The number of CD19 CAR-T was 1.0×10 9, 98% activity degree. Grade 1 cytokine-releasing syndrome appeared after infusion, and was resolved after symptomatic treatment. No serious adverse reactions were observed. CR was achieved half-month after CAR-T treatment, and umbilical cord blood transplantation was successfully performed 1 month later. At the last follow-up, the relapse-free survival time of the patient was 396 days. Conclusion:CAR-T therapy may be a new, safe and effective therapy for patients with relapsed/refractory B-ALL with T315I mutation.

Objective To assess the influence of metabolic syndrome(MS)on the success rate of catheter ablation for the treatment of atrial fibrillation (AF)in the elderly. Methods A retrospective study included a total of 221 aged patients with AF who underwent AF ablation for the first time. The patients were divided into two groups :an MS group(n＝72)and a control group(without MS)(n＝149) . The MS group had a mean age of (67.1 ± 5.2) years ;the control group had a mean age of (68.3 ± 5.7) years. Forty-six patients in the MS group and 105 patients in the control group experienced paroxysmal atrial fibrillation. Prognoses in two groups were compared at the end of the follow-up. Results At the end of the follow-up ,the success rates of the procedure in the MS group and the control group were 37.5%(n ＝ 27)and 51.7%(n ＝ 77) ,respectively (χ2＝ 3.917 ,P ＝ 0.049) .Recurrence happened in 19 patients of the MS group and 28 patients of the control group ,and they underwent a repeat ablation. The overall success rates after the last ablation in the two groups were 51.4%(n＝37)and 65.8%(n＝98) ,respectively (χ2＝4.224 ,P＝0.034).In the multivariable model adjusted for risk factors ,MS(HR＝1.42 ,95% CI :1.11-1.64 ,P＝0.033)and left atrial diameter(HR＝ 1.83 ,95% CI :1.27-3.19 , P ＝ 0.017 ) were independent predictors for recurrence. Conclusions MS can affect the success rate of catheter ablation for AF in elderly patients and the effect remains even after the procedures are repeated

Objective: To evaluate the efficacy and safety of three-dimensional electroanatomical mapping system for catheter ablation of paroxysmal supraventricular tachycardiain (PSVT) children. Methods: Clinical data from 187 children with paroxysmal supraventricular tachycardia undergoing radiofrequency catheter ablation in our department between January 2012 and April 2016 were analyzed. Among the patients, 91 cases were treated with traditional two-dimensional X-ray radiofrequency ablation, 96 cases were treated with radiofrequency ablation guided by three-dimensional electroanatomical mapping system. Postoperative electrocardiogram and echocardiography follow-up was performed at 1, 3, 6, 12, and 24 months. The success rate, recurrence rate, complication rate, operation time and amount of X-ray exposure were compared between the two groups. Kaplan-Meier survival curve was used to analyze the PSVT-free survival rate of the patients between the 2 groups. Results: The mean follow-up time was (739±92) days. The success rate (95.8%(92/96) vs. 94.5%(86/91), P=0.912), recurrence rate (5.4%(5/92) vs. 4.7%(4/86), P=0.807), complication rate (4.2%(4/96) vs. 5.5%(5/91), P=0.379), operation time ((73±31)min vs. (79±36)min, P=0.124) were similar between the two groups. However, X-ray exposure time ((8.1±2.9)min vs. (21.3±8.4)min, P=0.026), amount of X-ray ((23±11)mGy vs. (58±23)mGy, P=0.013) were significantly lower in the three-dimensional electroanatomical mapping system group than in the traditional two-dimensional X-ray radio frequency ablation group. PSVT-free survival rate was similar between the two groups (χ²=0.060, P=0.807) . Conclusion Three-dimensional electroanatomical mapping system is safe and effective for radiofrequency ablation of paroxysmal supraventricular tachycardia in children, and can significantly reduce the amount of radiation as compared to the traditional two-dimensional X-ray radiofrequency ablation.