Objective To summarize the experiences in the diagnosis and treatment of the hepatic hereditary hemorrhagic telangiectasia (HHHT).Methods The clinical data of 15 HHHT patients who were admitted to the Qilu Hospital,People's Hospital of Mengyin,People's Hospital of Liaocheng,Henan Provincial People's Hospital,the Second Hospital of Hebei Medical University,First Affiliated Hospital of Zhejiang University were retrospectively analyzed.The clinical manifestation,features of imaging and laboratory examination were summarized,and the diagnosis,treatment and prognosis of the disease were investigated.Results HHHT patients had nonspecific symptoms in the early stage,and some patients presented with right upper quadrant discomfort,shortness of breath,anemia and liver bruit.The condition of HHHT patients could be worsened by liver cirrhosis or portal hypertension rapidly.The results of color doppler ultrasound and computed tomography showed intrahepatic telangiectasia,arteriovenous fistula and hepatic artery aneurysm in the 15 patients.Digital subtraction angiography was not clear enough for 2 HHHT patients with more than 1 enlarged hepatic arteries,but computed tomographic angiography was feasible.According to the degree and stages of the HHHT,all the 15 patients were divided into asymptomatic HHHT,simple HHHT and complex HHHT.Among the 6 patients who underwent surgical treatment,5 received ligation or banding of the enlarged hepatic arteries with subsequent disappearance of symptoms.Three patients received interventional treatment,and the treatment for 1 patient with complex HHHT was failed,and the patient died 30 months after medical treatment.Six patients were treated by conservative treatment,2 patients of them had no symptoms at the beginning,then they suffered from hepatic dysfunction and ascites at 21 and 35 months,respectively,and 1 of them died 6 months later.Four patients received medical treatment,and the results of color doppler ultrasound and computed tomography showed the pathological changes were aggravated gradually.Conclusions Telangiectasia,intrahepatic arteriovenous fistula and hepatic artery aneurysm are the main imaging characteristics of HHHT,and imaging diagnosis has significant value in the diagnosis of HHHT.HHHT is a progressive disease,early,active and individualized treatment is beneficial to the patients.The outcome of ligation or banding of the hepatic arteries is satisfactory.

Objective To analyzed the left ventricular (LV) regional and global strains in coronary artery stenosis by using three-dimensional speckle tracking imaging (3D-STI) and two-dimensional speckle tracking imaging (2D-STI) for the assessment of left ventricular systolic function,and to compare the clinical values between 3D-STI and 2D-STI in the detection of coronary stenosis.Methods 39 patients with coronary artery stenosis and 32 sex-age matched controls were enrolled in this study.Coronary artery stenosis group was divided into ischemic group and non-ischemic group.Real-time three dimensional full volume and two-dimensional dynamic image of the LV were obtained and then analyzed by off-line analysis software.The parameters of 3D-STI were three-dimensional longitudinal strain (3D-LS),circumferential strain (3D-CS),radial strain (3D-RS),area strain (3D-AS),global longitudinal strain (3D-GLS),global circumferential train (3D-GCS),global radial strain (3D-GRS) and global area strain (3D-GAS).The parameters of 2D-STI were two-dimensional longitudinal strain (2D-LS),circumferential strain (2D-CS),radial strain (2D-RS),global longitudinal strain (2D-GLS),global circumferential train (2D-GCS) and global radial strain (2D-GRS).The global/regional strains derived from 3D-STI and 2D-STI in patient group and controls were analyzed for comparing their efficacy in detecting coronary artery stenosis.Results Compared with non-ischemic group,2D-LS,2D-CS,3D-LS,3D-CS and 3D-AS were lower in ischemic group (P ＜0.05).ROC curves showed the sensitivity of 2D-LS,3D-LS and 3D-AS for the diagnosis of myocardial ischemia was 60.1％,64.2 ％ and 74.0 ％,while the specificity of them was 60.0％,61.0％ and 63.1％,respectively.There was no significant difference in 2D-GCS and 2D-GRS between coronary artery stenosis group and control group (P ＞ 0.05).Compared with control group,2D-GLS,3D-GLS,3D-GCS,3D-GRS and 3D-GAS were significantly lower in coronary artery stenosis group (P ＜0.05).ROC curves showed the sensitivity of 2D-GLS,3D-GLS and 3D-GAS in the diagnosis of coronary artery stenosis was 61.3％,73.3％ and 79.3 ％,while the specificity was 65.4％,66.0 ％ and 70.8 ％,respectively.The sensitivity and specificity of 3D-GAS were the highest in these parameters.It is revealed that 2D-GLS,2D-GCS and 2D-GRS were correlated with LVEF (r1 =-0.668,P1 ＜0.001 ;r2 =-0.551,P2 ＜0.001 ;r3 =0.310,P3 ＜0.05),and 3D-GLS,3D-GCS,3D-GRS,3D-GAS were correlated with LVEF (r1 =-0.634,P1 ＜0.001 ;r2 =-0.672,P2＜0.001 ;r3 =0.698,P3＜0.001 ;r4 =-0.707,P4＜0.001).The correlate of 3D-GAS and LVEF was higher than other parameters.Conclusions 3D-STI is superior to 2D-STI in assessing regional and global left ventricular systolic function in patients with coronary artery stenosis,and 3D-GAS derived from 3D-STI is a ideal parameter of detecting significant coronary artery stenosis based on its highest sensitivity and specificity.

Objective To assess the CT characteristics of thoracoabdominal localized Castleman disease (LCD) in 55 cases and correlate with histopathologic features. Methods Fifty-five patients with LCD proved histopathologically in thorax ( n = 25 ) and abdomen ( n = 30 ) were collected during past 20 years. The unenhanced and contrast-enhanced CT were performed in all patients. Two radiologists reviewed CT images and the CT findings were analyzed simultaneously. Results In 54 patients with hyaline-vascular type ( n = 50 ) and mixed type ( n = 4 ) localized CD, the lesion typically presented as solitary mass (90. 7% , 49 cases), with irregular or lobular or infiltrative margin ( 83.3% , 45 cases),central calcification (38. 9%, 21 cases), marked enhancement (100% , 54 cases), focal non-necrosis low attenuation areas (72. 2%, 39 cases), lymphadenopathy (70.4%, 38 cases) and dilated feeding vessels adjacent to the mass (96.3%, 52 cases). One lesion with plasma cell type localized CD presented as a mass with irregular margin, mild enhancement and central necrosis. Four morphologic patterns wereclassified on CT, including solitary mass with well-circumscribed margin (n =4), irregular or lobular margin ( n = 30), infiltrative or halo-like margin ( n = 16 ), and multiple coalescent maasses ( n = 5 ). Conclusion CT features of thoracoabdominal localized CD are closely related to the location and pathological type. LCD with hyaline-vascular and mixed type has typical CT characteristics, while LCD with plasma cell type has no typical CT findings.

Objective To explore the detection trend of vaginal intraepithelial neoplasia(VaIN)of lower genital tract from 2013 to 2015. Methods A retrospective analysis was undertaken of colposcopy-directed biopsy of cervical, vaginal and vulvar intraepithelial neoplasia lesions include cervical intraepithelial neoplasia (CIN), VaIN and vulvar intraepithelial neoplasia (VIN) in Obstetrics and Gynecology Hospital of Fudan University from January 2013 to December 2015. Results (1) Overall data of CIN, VaIN and VIN:a total of 16732 cases were diagnosed of lower genital intraepithelial neoplasia in 3 years, accounting for 23.20% (16732/72128) of total colposcopy-directed biopsy cases. Among them, CIN, VaIN and VIN accounted for 19.48%(14053/72128), 2.67%(1923/72128), 1.05%(756/72128) of total colposcopy-directed biopsy cases of the lower genital tract, 83.99%(14053/16732), 11.49%(1923/16732), 4.52%(756/16732) of total lower genital intraepithelial neoplasia, respectively. (2) Annual data of CIN, VaIN and VIN from 2013 to 2015. The annual proportion of CIN in all intraepithelial neoplasia of lower gential tract was basically stable, consisting of 86.02%(3955/4598),83.25%(4795/5760) and 83.20%(5303/6374), respectively. The annual proportion of VaIN was gradually increasing, consisting of 8.09% (372/4598), 12.45%(717/5760) and 13.08%(834/6374), respectively. The annual proportion of VIN was gradually decreasing, consisting of 5.89% (271/4598), 4.31% (248/5760) and 3.72% (237/6374), respectively. Conclusion The increasing detection of VaIN from 2013 to 2015 might correlate with the increasing attention to inspection of the entire vaginal wall.

Objective: To explain the true experience of death anxiety in elderly inpatients with chronic diseases, and provide a theoretical basis for hospice care. Methods: The phenomenological study method was used to deeply interview the true feelings of death anxiety in 13 elderly inpatients with chronic diseases. Results: Through analysis, collation and refinement, the five themes of death anxiety, life regret, death attitude, death reminder and final decision power. Conclusions As clinical medical workers, we must always pay attention to the death anxiety of elderly inpatients with chronic diseases and strengthen the assessment of death anxiety. In particular, patients with cancer and patients at the end of life are provided with personalized care to remind them of the meaning of life and reduce the anxiety level of death.

Objective : To explore the effects of isogenous micro-grafting(MG) technology and the combined use of botulinum toxin type A(BTX-A) on hair regeneration in mice． Methods : Forty-five C57BL /6 mice were randomly divided into five groups : normal saline group (NS group) ，MG group (MB-0 group) ，MG + low-dose BTX-A group (MB-2 group) ，MG + medium dose BTX-A group ( MB-10 group ) ，MG + high-dose BTX-A group ( MB-50 group) ．The growth of hair on the backs of the mice was observed after the administration of the drugs，and the hair follicles were evaluated by hematoxylineosin ( HE) staining on the 7th ，14th，and 21st days of the experiment， and the expression of vascular endothelial growth factor ( VEGF) and β-catenin was evaluated by immunohisto- chemical staining on day 21 . Results : After treatment with micrograft and botulinum toxin type A，the skin darke- ning time was shortened (P＜0. 05) ，and the coverage rate of new hair increased on the 14 th day (P＜0. 05) . Compared with the NS group，the number of hair follicles increased (P＜0. 05) and the expression of VEGF and β-catenin increased in each other group． Conclusion Isogenous micro-grafting technology combined with botulinum toxin type A has a promotional effect on hair regeneration in mice，and the mechanism may be related to the promotion of vascular growth and activation of β-catenin signaling.

Objective To explore the safety of minimally invasive esophagectomy (MIE) with three-field lymphadenectomy (3-FL) for esophageal squamous cell carcinoma (ESCC) by comparing the short-term outcomes between the 3-FL and the two-field lymphadenectomy (2-FL) in MIE. Methods The clinical data of patients with ESCC who underwent minimally invasive McKeown esophagectomy in our hospital from July 2015 to March 2022 were collected retrospectively. Patients were divided into a 3-FL group and a 2-FL group according to lymph node dissection method. And the clinical outcomes and postoperative complications were compared between the two groups. Results A total of 257 patients with ESCC were included in this study. There were 211 males and 46 females with an average age of 62.2±8.1 years. There were 109 patients in the 3-FL group and 148 patients in the 2-FL group. The operation time of the 3-FL group was about 20 minutes longer than that of the 2-FL group (P<0.001). There was no statistical difference between the two groups in the intraoperatve blood loss (P=0.376). More lymph nodes (P<0.001) and also more positive lymph nodes (P=0.003) were obtained in the 3-FL group than in the 2-FL group, and there was a statistical difference in the pathological N stage between the two groups (P<0.001). But there was no statistical difference in the incidence of anastomotic leak (P=0.667), chyle leak (P=0.421), recurrent laryngeal nerve injury (P=0.081), pulmonary complications (P=0.601), pneumonia (P=0.061), cardiac complications (P=0.383), overall complications (P=0.147) or Clavien-Dindo grading (P=0.152) between the two groups. Conclusion MIE 3-FL can improve the efficiency of lymph node dissection and the accuracy of tumor lymph node staging, but it does not increase the postoperative complications, which is worthy of clinical application.