Objective To study the effects and techniques of microsurgical resection of giant hypervascular meningiomas. Methods A retrospective analysis was performed on clinical data of 32 cases of giant hypervascular meningiomas in this hospital from June 1999 to June 2002. Results The Simpson Grade 1 resection was achieved in 15 cases, Grade 2 in 9 cases, Grade 3 in 6 cases, and Grade 4, 2 cases. There were 2 fatal cases. Complications included 4 cases of intracranial hematoma, 6 cases of cerebral edema and infarction (re-operation of decompression was required in 4 cases), 1 case of mutism, 3 cases of cerebrospinal fluid leakage, and 1 case of intracranial infection. The mental dysfunctions or symptoms became worse than before the operation in 7 cases. Follow-up checkups in 30 patients found no recurrence in Simpson Grade 1 resection, 4 cases of recurrence in Simpson Grade 2 resection, and 5 cases of recurrence in Grade 3 and 4. A re-operation was performed to remove the tumor in 6 cases. The size of tumor was unchanged during follow-up period in 7 cases undergoing radiotherapy. Postoperatively, assessments with activity of daily living (ADL) associated with mental dysfunctions revealed grade Ⅰ in 25 cases, grade Ⅱ in 5 cases, and grade Ⅲ in 2. No significant differences were seen in ADL assessments before and after operation (P=0.696). Conclusions Every effort should be made to complete the total resection of intracranial meningiomas. Sufficient preoperative preparation, adequate surgical exposure, efficient management of operative bleeding, and fractionated resection of tumor using microsurgical techniques are important factors to improve clinical outcomes.

Objective To explore clinical significance of constriction of fetal ductus arteriosus diagnosed by echocardiography.Methods Seventy-one cases with constriction of fetal ductus arteriosus (DA) and one fetus with premature closure of DA were detected by fetal echocardiography among 2380 singleton fetuses.The echocardiographic characteristics and clinical outcomes were reviewed and analyzed.Results Of 71 cases with constriction of fetal DA,58 cases were found with right heart enlargement,12 cases with tricuspid regurgitation,8 cases with arrhythmia and 1 case with pericardial effusion.The echocardiographic characteristics showed narrowed diameter of DA,dilatation of pulmonary artery and descending aorta was also noted,DA was markedly curved.The peak systolic velocity(PSV) and enddiastolic velocity(EDV) in the ductus arteriosus measured by pulsed Doppler echocardiography increased (PSV≥ 180 cm/s,EDV≥35 cm/s).All cases were confirmed normal by neonate echocardiography.Conclusions Prenatal echocardiography plays important role in diagnosis of constriction of fetal DA.Early diagnosis and intimate follow-up can direct clinician to offer suitable consultation for parents and management for fetuses.

Objective To prepare a new thrombus model by fluid model method , which is suitable for evaluation of mechanical thrombectomy devices for acute stroke.Methods The fluid model adopted the Chandler loop theory , while the static model adopted conventional method.Mechanical properties of thrombi prepared by fluid model and static model were measured by manual elongation test ( 15 samples in each group) and catheter injection test (15 samples in each group ).Histological structure was compared among the above thrombus models ( 5 samples in each group ) and specimens of five patients with stroke by hematoxylin-eosin staining method.Then, thrombi in fluid model were utilized to establish embolization of vessels in swine model ( two pigs ) for evaluation of radiopacity.Independent-Sample test was performed to compare the maximum tensile length of two methods , and Fisher′s exact test was used to compare the rate of thrombus fragmentation after catheter injection test.Results The maximum tensile length of two models were (4.28 ±0.23) and (3.16 ±0.13) cm, respectively, and the difference was statistically significant (t=16.38, P<0.01);After catheter injection, the fracture rates of thrombus were 13% (2/15) and 60%(9/15), which were also statistically significant (P<0.05).As to histological structure, thrombi prepared by fluid model showed mixed thrombus structure , which similar to thrombi of stroke patients , But thrombi prepared by static model were replete with erythrocytes under the microscope .A total of eight vessels ( lingual arteries and superficial cervical arteries ) in two swines were successfully occlusive ( TIMI 0 or 1 ) , and sufficient radiopacity of each injected thrombus was observed.Conclusions The thrombi prepared by fluid model not only have good mechanical stability and sufficient radiopacity , but their histological structure is similar to thromboemboli retrieved from cerebral arteries of patients with acute stroke.

Objective To investigate the application value of intravoxel incoherent motion (IVIM) MRI for evaluating the sensitivity of chemoradiotherapy on nasopharyngeal carcinoma (NPC). Methods Sixty eight consecutive patients newly diagnosed with NPC in the stage of T3 (30 patients) or T4 (38 patients) were retrospectively enrolled. They were divided into effective group (45 patients) and poor?effective group (23 patients) clinically after a standard chemoradiotherapy according to the RECIST criteria. IVIM with 13 b?values (range,0 to 800 s/mm2) and general MRI were performed at 3.0 T MR scanner before and after chemoradiotherapy. Two radiologists major in MRI diagnose analyzed all images independently and placed regions of interest (ROIs). Intraclass correlation coefficient (ICC) was used to evaluate intra?observer and inter?observer agreement. And Mann?Whitney test was used to assess the differences between the two groups. Results The reproducibility between intra?observer and inter?observer was relatively good. Statistically,D [(0.69±0.06)×10?3 mm2/s vs. (0.52±0.10)×10?3 mm2/s; U=51.5,P<0.01)] and D* [(161.33 ± 11.50)×10-3 mm2/s vs. (126.96 ± 10.27)×10-3 mm2/s; U=18.0, P<0.01] were significantly higher in effective group than those in poor?effective group, whereas the difference of f (16.68 ± 1.94% vs. 16.40±1.11%, U=434.5, P=0.282) and ADC (1.23±0.11)×10?3 mm2/s vs. (1.25±0.10)×10?3 mm2/s,U=427.0,P=0.240) could not reach statistical significance between the 2 groups (P>0.05). Conclusions IVIM may be potentially useful in assessing the chemoradiotherapy on NPC. The higher D value combined with higher D*value might indicate the chemoradiotherapy on NPC is more sensitive,and the higher D*value might reflect increased blood vessel generation and parenchymal perfusion in NPC.

Objective To evaluate the feasibility, safety and efficacy of the treatment of chronic symptomatic internal carotid artery long?segmental occlusion. Methods Fifty?one cases of chronic symptomatic internal carotid artery long?segmental occlusion (arterial occlusion more than 2 anatomical segments) who were treated with hybrid surgery (plaque located at the carotid sinus) or endovascular revascularization (plaque located at the distal end of the internal carotid artery occlusion) from May 2015 to May 2018 were reviewed. Recanalization, perioperative complications, stroke events, and reocclusion events during the follow?up period were recorded. Results The occlusion was recanalized successfully in 45 of 51 patients (88.2%, 45/51), 6 patients failed because the guidewire could not cross the distal arterial occlusion. And the technical success rate was 96.0% (24/25) in hybrid surgery and 80.8% (21/26) in endovascular revascularization. Perioperative complications occurred in 2 patients who underwent combined endovascular treatment. One patient had a small branch embolism due to intraoperative thrombus shift, and 1 patient had large area cerebral infarction. The complications occurred in 2 patients who underwent thybrid surgery, including 1 case of internal carotid cavernous fistula and 1 case of acute reocclusion of internal carotid artery. Forty?four patients with successful operation received clinical follow?up, with the median follow?up time of 24 months (7-43 months). No recurrent stroke and death occurred during the follow?up period. Clinical symptoms were improved in 34 cases. Totally 44 patients received imaging follow?up, and during the median imaging follow?up time of 8 month (4-28 months), 6 cases had reocclusion, and 2 cases had restenosis. Conclusion The treatment of chronic symptomatic internal carotid artery long?segmental occlusion is technically feasible and safety with good short?term efficacy. However, its exact efficacy remains to be confirmed by long?term follow?up studies with large samples.

Objective:To compare the biomechanical properties of different circular external fixators for the fracture site of oblique long bone fractures.Methods:15 polyethylene (PE) plastic rods with the same batch were selected to make the model of oblique fractures in the middle of long bones. According to the connection between PE rods and external fixators, the PE rods were randomly divided into: the group that was simply used kirschner wires (group kirschner wires), the group that was simply used olive wires (group olive wires), the group that was simply inserted half pins (group half pins), the group that was inserted single cortical fixed half pins at either side of the fracture site after being fixed by the tensioned olive wires (group olive wires+ half pin), the group that was inserted tensioned trans-fracture olive wires after being fixed by the tensioned olive wires (group olive wires+ olive wires). The axial compression tests were carried out, and the interfragmentary displacements under axial loads of 200 N, 400 N, 600 N and 800 N were measured and the axial stiffness was calculated. Then, the torsional tests were carried out, and the interfragmentary torsional angles were measured under torsional loads of 4 N·m, 7 N·m and 10 N·m, and the torsional stiffness was calculated.Results:With the increase of axial load from 200 N to 800 N, the axial interfragmentary displacement in each group gradually increased. The interfragmentary axial displacement of each group in ascending order was: group olive wires+ olive wires, group olive wires+ half pins, group half pins, group olive wires, group kirschner wires. The axial stiffness of each configuration under 800 N axial load in descending order was: group olive wires+ olive wires [863.93 (824.32, 875.87) N/mm], group olive wires+ half pins [119.92 (113.16, 123.58) N/mm], group half pins [81.92(79.42, 82.40) N/mm], group olive wires [76.83 (72.45,79.47) N/mm], group kirschner wires [70.80 (67.49, 71.59) N/mm]. The pairwise comparisons of the axial stiffness data of each configuration had statistical significance (all P <0.05). With the increase of the torque load from 4 N·m to 10 N·m, the interfragmentary rotational angle in each configuration gradually increased. The interfragmentary torsion angle of each group in ascending order was: group half pins, group olive wires+ olive wires, group olive wires+ half pins, group olive wires, group kirschner wires. The torsional rigidity of each configuration under 10 N·m torsional load in descending order was: group half pins [1.80 (1.63, 1.85) N·m/°], group olive wires+ olive wires [1.05 (1.02, 1.07) N·m/°], group olive wires+ half pins [0.99 (0.98, 1.03) N·m/°], group olive wires [0.81 (0.78, 0.82) N·m/°], group kirschner wires [0.75 (0.74, 0.76) N·m/°]. The pairwise comparisons of the torsional rigidity data of each configuration had statistical significance (all P < 0.05). Conclusion:The axial stiffness and torsional stiffness of circular external fixators can be increased by using tensioned olive wires or half pins at the fracture site. Due to the insufficient support between oblique fracture site, when the load is applied, the axial displacement and torsion angle of the fracture site will still be fairly large after being fixed the fracture site with half pins. Treating with tensioned trans-fracture olive wires after being fixed by the tensioned olive wires at either side of the fracture site can effectively control the interfragmentary shear and displacement, thus providing an ideal mechanical environment for fracture healing.

Objective To explore the feasibility,safety and effect of endovascular revascularization for chronic long segment internal carotid artery occlusion. Methods The cases of chronic long segment internal carotid artery occlusion who were treated by endovascular revascularization in our center from May 2015 to April 2017 were reviewed. Eleven cases met the inclusion criteria:the duration of the occlusion was more than three weeks and the segment of the occlusion was beyond the petrosal segment of internal carotid arteries from the initial segment. All of the cases had the related symptoms and had declining cerebral perfusion. The analysis index included:baseline information,radiological information,perioperative results, clinical follow-up and imaging follow-up. The imaging follow-up index were the re-stenosis or re-occlusion of the revascularized artery. Results The occlusion was recanalized successfully in 9 of 11 patients,the two procedures were abandoned after repeated attempts and the guide wire could not reach the true lumen when navigating in the cavernous segment. Six cases of the nine successfully recanalized cases accepted perfusion-weighted imaging scan. Cerebral perfusion of all the cases were improved. Thrombus shifting was observed in one case and occluded a subbranch,mechanical thrombectomy was performed successfully,the case was recovered well without sequela. No symptomatic stroke or death was happened in the perioperative period. All of the nine cases who successfully recanalized acquired clinical follow-up,median follow-up time was ten months(4—28 months). No ischemic stroke and death happened after the procedures. Seven of nine cases improved in the clinical symptoms. Five cases accepted the imaging follow-up. The meantime was six months. No re-occlusion was happened. Conclusions Endovascular revascularization for chronic long segment internal carotid artery occlusion is feasible,safe,and short-term effective. More clinical research is needed to verify the long-term effect.

Objective: To investigate the clinical value of laparoscopic peritoneal dialysis catheter implantation in peritoneal chemotherapy for gastric cancer with peritoneal metastasis. Methods: From January 2019 to June 2019, the clinical data of 6 patients diagnosed as gastric cancer with peritoneal metastasis were retrospectively analyzed in the Gastrointestinal Surgery Department of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine. Five were male and 1 was female. The median age was 69.5 (28-77) years. The median body mass index (BMI) was 22.8 (19.6-23.5). All procedures were performed under general anesthesia with endotracheal intubation. The patient′s body position and facility layout in the operating room were consistent with those of laparoscopic gastrectomy. The operator′s position: the main surgeon was located on the right side of the patient, the first assistant stood on the left side of the patient, and the scopist stood between the patient′s legs. Surgical procedure: (1) trocar location: three abdominal trocars was adopted, with one 12 mm umbilical port for the 30° laparoscope (point A). Location of the other two trocars was dependent on the procedure of exploration or biopsy as well as the two polyester cuff position of the peritoneal dialysis catheter: Usually one 5 mm port in the anterior midline 5 cm inferior to the umbilicus point was selected as point B to ensure that the distal end of the catheter could reach the Douglas pouch. The other 5 mm port was located in the right lower quadrant lateral to the umbilicus to establish the subcutaneous tunnel tract, and the proximal cuff was situated 2 cm away from the desired exit site (point C).(2) exploration of the abdominal cavity: a 30° laparoscope was inserted from 12 mm trocar below the umbilicus to explore the entire peritoneal cavity. The uterus and adnexa should be explored additionally for women. Once peritoneal metastasis was investigated and identified, primary laparoscopic peritoneal dialysis catheter implantation was performed so as to facilitate subsequent peritoneal chemotherapy. Ascites were collected for cytology in patients with ascites. (3) peritoneal dialysis catheter placement: the peritoneal dialysis catheter was introduced into the abdominal cavity from point A. Under the direct vision of laparoscopy, 2-0 absorbable ligature was reserved at the expected fixation point of the proximal cuff (point B) for the final knot closure. Non-traumatic graspers were used to pull the distal cuff of peritoneal dialysis catheter out of the abdominal cavity through point B. The 5-mm trocar was removed simultaneously, and the distal cuff was fixed between bilateral rectus sheaths at the anterior midline port site preperitoneally. To prevent subsequent ascites and chemotherapy fluid extravasation, the reserved crocheted wire was knotted. From point C the subcutaneous tunnel tract was created before the peritoneal steath towards the port site lateral to the umbilicus. Satisfactory catheter irrigation and outflow were then confirmed. Chemotherapy regimen after peritoneal dialysis catheterization: all patients began intraperitoneal chemotherapy on the second day after surgery. On the 1st and 8th day of each 3-weeks cycle, paclitaxel (20 mg/m²) was administered through peritoneal dialysis catheter, and paclitaxel (50 mg/m²) was injected intravenously. Meanwhile, S-1 was orally administered twice daily at a dose of 80 mg·m^-2·d^-1 for 14 consecutive days followed by 7-days rest. To observe the patients′ intraoperative and postoperative conditions. Results: All the procedures were performed successfully without intraoperative complications or conversion to laparotomy. No 30 day postoperative complications were observed. The median operative time was 33.5 (23-38) min. The median time to first flatus was 1(1-2) days, and the median postoperative hospital stay was 3 (3-4) days, without short-term complications within 30 days postoperatively. The last follow-up was up to July 10, 2019, and the patients were followed for 4(1-6) months. No ascites extravasation was observed and no death occurred in the 6 patients. There was no catheter obstruction or peritoneal fluid extravasation during and after chemotherapy. Conclusion Laparoscopic peritoneal dialysis catheter implantation was safe and feasible for patients with peritoneal metastasis of gastric cancer. The abdominal exploration, tumor staging and the abdominal chemotherapy device implantation can be completed simultaneously, which could simplify the surgical approach, improve the quality of life for patients and further propose a new direction for the development of abdominal chemotherapy.

Objective:To analyze the effect on the expressions of nuclear factor-erythroid 2-related factor 2(Nrf2) and NAD(P)H quinone oxidoreductase 1 enzyme (NQO1) in A549 cells exposed to hyperoxia and interfered by small interfering RNA, and to investigate the role of Nrf2 and NQO1 in hyperoxia-induced lung injury as well as their relationship with apoptosis.Methods:A549 cells were gained by serial sub cultivation in vitro and then randomly divided into 4 groups: the air group without interference ( group Ⅰ), the hyperoxia group without interference (group Ⅱ), the air group transfected with Nrf2 siRNA (group Ⅲ), and the hyperoxia group transfected with Nrf2 siRNA (group Ⅳ). The hyperoxia groups (Ⅱ, Ⅳ group) were continuously exposed to an atmosphere containing a high concentration of oxygen (950 mL/L O 2, 50 mL/L CO 2), while the air groups (group Ⅰ, Ⅲ) were still placed in the incubator with 50 mL/L CO 2. In the pre-experiment, cells were transduced with a mixture of siRNA-1, siRNA-2, and siRNA-3. Then the siRNA with the highest efficiency for repressing Nrf2 expression was used for subsequent experiments. The mRNA and protein expression levels of Nrf2 and NQO1 in the 4 groups were detected by quantitative real-time polymerase chain reaction (qPCR) and Western blot.The distribution of Nrf2, Kelch-like ECH-associated protein 1(Keap1) and antioxidant response element(ARE) proteins in A549 cells after interference with Nrf2 was analyzed by immunofluorescence and confocal laser scanning microscope, and the cell apoptosis of the 4 groups were observed. Results:(1) Nrf2 siRNA significantly down-regulated the mRNA expression of Nrf2 in the groups siRNA-1, siRNA-2 and siRNA-3, and the inhibition efficiency of group siRNA-1 was the highest (80.57%). (2) The re-lative mRNA expression levels of Nrf2 and NQO1 in the group Ⅱ were 4.553±0.498 and 5.866±0.582, respectively.The mRNA and protein expression of Nrf2 and NQO1 and the cell apoptosis rate [(21.67±0.75)%]in the hype-roxia group were significantly higher than those in the group Ⅰ (all P<0.01). (3) The relative mRNA expression levels of Nrf2 and NQO1 in the group Ⅳ were 0.937±0.057 and 0.789±0.058, respectively.Compared with the group Ⅱ, the mRNA and protein expression of Nrf2 and NQO1 in the group Ⅳ were significantly decreased, while the cell apoptosis rate [(35.83±0.42)%]was significantly increased (all P<0.01). Conclusions:The abnormal expression of Nrf2 and NQO1 in A549 cells induced by hyperoxia and siRNA interference suggests that Nrf2 and NQO1 are involved in the pathogenesis of hyperoxia induced lung injury.Nrf2 and NQO1 are possibly protective factors in the hyperoxia induced lung injury and apoptosis.

Bronchopulmonary dysplasia(BPD), a common respiratory disease in premature infants, leads to poor long-term prognosis.The crosstalk between the gut and lung which can be mediated by microbiota is known as the gut-lung axis.Recently, an increasing amount of evidence has indicated that the gut microbiota is closely related to the pathogenesis of many respiratory diseases.The gut-lung axis affects the occurrence and development of BPD through microbiota translocation and regulation of immune pathways.At present, the relationship between the gut-lung axis and BPD is still in the research stage and exploring the potential association may help to search early markers and new therapies for BPD.In order to provide insights into preventing and treating BPD, this review describes the relationship between the gut-lung axis and BPD.