ObjectiveTo compare two treatment methods for acute iliofemoral vein thrombosis:c atheter-directed pharmacomechanical thrombolysis (CDPT,47 cases) and intervention combined surgicaltherapy( IST,14 cases).MethodsThis study includes 61 patients of acute iliofemoral vein thrombosis treated by CDPT or IST.All discharged cases were followed up by telephone for a period of 14 -37 months.ResultsAmong the 61 patients (64 extremities),47 (forty-seven extremities) treated by CDPT,and 14 cases (seventeen extremities) treated by IST.The IST group included three patients of bilateral iliofemoral vein thrombosis,five patients on postoperative status within one month,and three patients in which the iliofemoral vein was not accessible.When discharged from hospital,the effective rate of edema relief is 93.6％ in CDPT group while that is 94.1％ in IST group; Melena occurred in one patient of CDPT group and incision hematoma occurred in one patient of IST group.According to the results of 14 -37 months follow-up,the effective rate of edema relief is 85.0％ in CDPT group while that is 85.7％ in IST group ( x2 =0.004 and the P =0.948).Calf pigmentation occurred in only one patient of CDPT group.The patency rate of vein by BUS examination is 52.6％ in CDPT group while that is 84.6％ in IST group x2 =4.157,P =0.041 ).ConclusionsComparing with CDPT group,IST group has the similar effective rate of edema relief,but has higher patency rate of iliofemoral vein.In case of bilateral acute iliofemoral vein thrombosis,in patients in whom thrombolysis is contraindicated,or when the iliofemoral vein is not accessible,IST is the treatment of choice for acute iliofemoral vein thrombosis.

Objective:To study the clinical effects of percutaneous transluminal angioplasty (PTA ) versus stent implantation (ST)after PTA for the treatment of femoral and popliteal artery lesion resulted from arteriosclerosis obliterans.Methods:One hundred and three patients (1 1 9 limbs)treated for femo-ral and popliteal artery lesion resulted from arteriosclerosis obliterans for ten years were reviewed,of whom 60 limbs were treated by PTA and the other 47 by PTA combined with stent implantation.Results:Among the 60 limbs of the PTA group,there were 22 limbs involved only in femoral and popliteal artery;1 3 limbs combined with iliac artery lesion;1 7 limbs combined with infrapopliteal artery lesion;8 limbs combined with iliac and infrapopliteal artery lesion.Among the 47 limbs of the ST group,there were 1 8 limbs involved only in femoral and popliteal artery;8 limbs combined with iliac artery lesion;1 5 limbs combined with infrapopliteal artery lesion;6 limbs combined with iliac and infrapopliteal artery lesion. There was no significant difference between the two groups on age,sex,concomitant disease,ankle bra-chial index(ABI)before treatment and Rutherford classification (P>0.05).The patients’Trans-atlantic inter-society consensus (TASC)C/D was lower in the PTA group than that in the ST group (58.3%vs. 76.6%,P=0.047).The follow-up periods were 48.0 (5.0,1 08.0)and 40.0 (3.0,96.0)months respectively (P=0.064).Compared with the PTA group,the ST group had a better short-term total effective rate (93.6% vs.80.0%,P=0.044)and a higher cost [(33 882.7 ±8 695.6)yuan vs. (1 7 754.8 ±3 654.2)yuan,P<0.001 ].The short-term marked effective rate of the ST group was higher than that of the PTA group,but the difference was not significant (31 .9% vs.21 .7%,P =0.231 ).There was no significant difference between the two groups on short-term efficiency,and compli-cation rates (58.3%vs.58.3%,P=0.724;1 .7%vs.2.1%,P=1 .000).There was no death during perioperative period and no short-term deterioration in both the groups.The long-term marked effective rate was lower and the deterioration rate was higher in the ST group than that in the PTA group,but the difference was not significant (8.5% vs.1 5.0%,P=0.381;1 4.9% vs.5.0%,P=0.081 ).There was no significant difference between the two group on long term total effective rate,accumulative limb salvage rate and reoperation rate (66.0% vs.66.7%,P=0.939;94.7% vs.94.1%,P=0.884;31 .9% vs.31 .7%,P=1 .000),and the 1 to 1 0 years primary and secondary patency rates were similar (P=0.837,P=0.622).When compared based on TASC classification,TASC A/B patients in the ST group had a higher short-term marked effective rate,a higher short-term total effective rate and a higher long-term deterioration rate than those in the PTA group,but the difference was not significant (36.4%vs.24.0%,P=0.353;1 00.0%vs.88.0%,P=0.322;1 8.2%vs.4.0%,P=0.21 6).TASC C/D patients had a similar result (30.6%vs.20.0%,P=0.307;91 .7%vs.74.3%,P=0.050;1 3.9%vs.5.7%,P=0.226).Both TASC A/B and TASC C/D patients in the ST group had a similar accumu-lative limb salvage rate with that in the PTA group (90.9% vs.90.6%,P =0.920;97.1% vs. 94.1%,P=0.796).Conclusion:Stent implantation can increase the cost and short term effective rate at the same time and is not superior to PTA on the long term effective rate and limb salvage rate for femo-ral and popliteal artery lesion resulted from arteriosclerosis obliterans.

Objective:To study the clinical effects of endovascular reconstruction versus bypass surgery for TASC Ⅱ( trans-atlantic inter-society consensus Ⅱ) C/D femoropopliteal artery lesion resulted from arteriosclerosis obliterans. Methods:One hundred and three patients(119 limbs) accepted bypass surgery or endovascular therapy for TASCⅡC/D femoropopliteal artery lesion between January 2002 and Decem-ber 2012 at our institution were retrospectively assessed. All the patients were diagnosed with arterioscle-rosis obliterins, and all their Rutherford classifications were from 2 to 5 degrees. Among them there were 71 limbs treated by endovascular reconstruction and the other 48 limbs were treated with bypass surgery. We evaluated the short term clinical effect according to the condition when patients left the hospital, and evaluated the long term clinical effect according to the results of the patients' latest follow-up in 2014. Their clinical data before treatment, complication rates, death rates, hospital stays, short term and long term effects, reoperation rates, 1 to 10 years primary and secondary accumulative patency rates and limb salvage rates were compared. Results:There was no significant difference between the bypass group and the endovascular group on the mean age and ankle brachial index before treatment [(67. 1 ± 7. 1) years (51 to 80 years) vs. (68. 0 ± 9. 4) years (49 to 91 years),P=0. 561;(0. 41 ± 0. 23) vs. (0. 40 ± 0 . 26 ) , P=0 . 928 ] . There were more TASCⅡD patients in the bypass group than those in the endovas-cular group ( P<0 . 001 ) , and the rutherford classification was higher in the endovascular group than that in the bypass group. The difference in the mean follow-up between the bypass group and the endovascular group was not significant[(41. 7 ± 23. 6) months vs. (59. 5 ± 41. 6) months,P =0. 065]. Five peri-operative complication cases occurred in the bypass group, including 2 cases of acute thrombosis,1 case of infection and 2 cases of heart failure, and only 1 complication case occurred in the endovascular group that was heart failure. The complication rate was higher in the bypass group than that in the endovascular group [10. 4% vs. 1. 4%, P=0. 039]. And there was no death in both the groups. Compared with the endovascular group, the bypass group had a longer hospital stays [(13. 2 ± 4. 7) d vs. (6. 5 ± 3. 1) d, P<0. 001],a higher reoperation rate (58. 3% vs. 31. 0%,P =0. 003), a better short term, obvious, and effective rate (25. 0% vs. 9. 9%, P =0. 027),a worse long term deterioration rate (37. 5% vs. 18. 3%,P=0. 019) and higher 1 to 10 years primary and secondary accumulative patency rates( P =0 . 001 , P=0 . 001 ) . There was no significant difference between the two groups on the increase of ankle brachial index[(0. 34 ± 0. 28) vs. (0. 31 ± 0. 23), P=0. 371], and short term and long term total ef-fective rates (89. 6% vs. 84. 5%, P=0. 426;45. 8% vs. 56. 3%, P=0. 260), and limb salvage rate (83. 3% vs. 94. 4%,P =0. 051). Conclusion:Endovascular therapy is a safe, effective and minimally invasive therapy for TASCⅡ C/D femoropopliteal artery lesion resulted from arteriosclerosis obliterans.

Objective To study the clinical characteristics and treatment strategy for isolated dissection of the superior mesenteric artery (SMA).Methods Clinical data of 19 consecutive patients with IDSMA were retrospectively analyzed.There were 15 men and 4 women.The mean age was 56 ± 12 (41-84) years old.Fifteen patients presented with abdominal pain and 4 patients had no symptom.The dissections were diagnosed by contrast-enhanced computed tomography in 18 patients and ultrasonography in 1 patient.Results The dissections were located at the anterior wall of the curvature part of the SMA in all 19 patients.Asymptomatic patients underwent conservative management.One asymptomatic patient with aneurysmal dilation was managed by stent and the 15 symptomatic patients underwent endovascular management.During the mean 7-46 (21 ± 10) months follow-up period,all patients were asymptomatic with patency of SMA.Conclusions The dissection was located at the anterior wall of the curvature part of the SMA.Conservative management can be applied to the asymptomatic patients.For symptomatic patients without intestinal necrosis or artery rupture,stent implantation is recommended,and the curvature of SMA should be covered completely.Endovascular spasmolysis is helpful in relieving pain.

Objective To evaluate the clinical diagnosis and treatment of gastrointestinal stromal tumors(GISTs). MethodsThe clinical data of patients with GISTs admitted into surgical department from Jan 1999 to Mar 2004 were retrospectively analyzed. ResultsThere were 40 cases enrolled, with a male to female ratio of 30∶10. Thirty -eight patients underwent complete tumor resection, two did laparotomy only. According to the Fletcher classification, six patients were of very low risk, seven of low risk, eleven of intermediate risk, and sixteen of high risk.CD119 staining was positive in 80% cases, and CD34 was in 85%.Thirty-one patients were followed up, with 5 out of 29 postoperative patients suffering from recurrence and metastasis 6 to 30 months postoperatively. Two patients with unresectable tumor survived an average of 9 months. Gleevec was administered to two patients with partial relief achieved in one. Conclusion 1.GISTs are predominantly found in the middle-aged. Stomach and small bowel are most often affected. 2.Immunohistochemical staining was necessary for the diagnosis of GISTs.3.Fletcher classification is useful guide for clinical treatment and prognosis prediction.

Objective:To evaluate the safety and effectiveness of neglecting superficial femoral artery (SFA) recanalization for chronic lower extremity arteriosclerosis obliterans (ASO).Methods:Thirty-six cases treated for severe stenosis or occlusion of superficial femoral artery resulted from ASO were randomly divided into 2 groups.Twenty of them were treated by endovascular reconstruction of superficial femoral artery and the other 16 cases were not treated with their superficial femoral artery,but were only treated with the accompanied iliac and/or profunda femoral artery lesion.Results:There was no significant difference between the two groups on mean age,gender,ABI before treatment,accompanied diseases,Rutherford classification and trans-atlantic inter-society consensus (TASC) classification (P ＞ 0.05).One week after operation,the reconstruction group had better marked effect and total effective rate [75.0％ vs.12.5％ (P ＜0.001);90.0％ vs.37.5％ (P =0.001)] and lower no effective rate [10.0％ vs.62.5％ (P =0.001)],There was no significant difference between the two groups on effective rate [15.0％ vs.25.0％ (P =0.675)].The deteriorate cases in both groups were zero,and there was no morbidity of complications and death in both groups during the perioperative period.In the 3-month follow up,the reconstruction group had a better marked effect rate [65.0％ vs.25.0％ (P =0.017)];There was no significant difference between the two groups on the effective rate,no effective rate and total effective rate [20.0％ vs.43.8％ (P=O.124);15.0％ vs.31.3％ (P =0.422);85.0％ vs.68.8％ (P =0.422)].The deteriorate cases and morbidity of complications and death in both groups during the perioperative period were still zero.In the 6-and 12-month follow ups,there were no significant differences between the two groups on marked effect and total effective rate [60.0％ vs.37.5％ (P =0.180),80.0％ vs.87.5％(P=0.672);60.0％ vs.43.8％(P=0.332),85.0％ vs.87.5％(P=1.000)].The deteriorate case was zero in both groups,and there was no morbidity of complications and death in both groups.The limb salvage rate in both groups was 100％ during the whole follow up period.The reconstruction group had a higher cost [(53 367.4 ± 24 518.3) yuan vs.(30 397.5 ± 15 354.4) yuan(P =0.011)].There were 8 cases of SFA restenosis/ reocclusion during the follow up,three of which accepted another endovascular treatment,and the reoperation rate was 15.0％.while in the nonreconstruction group,there was no case that needed another endovascular therapy,and the reoperation rate was zero.Conclusion:Only dealing with accompanied iliac and profunda artery lesion and neglecting superficial femoral artery reconstruction is a safe,effective and inexpensive therapy for chronic lower extremity arteriosclerosis obliterans,and should be the preferred alternative for some patients.

Objective To understand the current status of research on lung cancer immunotherapy to provide a reference for further investigation and future topic selection in this field. Methods CiteSpace visualization analysis software was used to analyze 400 Chinese studies in CNKI and 5 001 English studies in the Web of Science database from 2005 to 2021, with "lung cancer" and "immunotherapy" as keywords. Keyword co-occurrence analysis was performed on 17 English studies of "Lung Cancer" "Immunotherapy" and "Single cell sequencing" in the Web of Science database. Results "Non-small cell lung cancer" "immunosuppressants" "PD-L1" "dendritic cells" and "cytokine-induced killer cells" are current research hotspots in lung cancer immunotherapy. Monoclonal antibody drugs including nivolumab, pembrolizumab, atezolizumab, and durvalumab are hotspot drugs. Immunotherapy combined with chemotherapy as well as PD-L1 expression have become the focus of continuous research. The majority of studies on lung cancer immunotherapy are conducted in the United States, followed by China. Conclusion Lung cancer immunotherapy has gradually become a research hot spot in China. In the future, in-depth research is needed to provide cutting-edge directions for lung cancer immunotherapy.

Objective To investigate the efficacy and safety of Rotarex mechanical thrombectomy combined with drug-coated balloon(DCB)dilatation for the treatment of in-stent restenosis(ISR)in femoropopliteal atherosclerotic occlusive disease.Methods A total of 53 patients with in-stent restenosis after stent implantation(9 covered stents and 44 bare stents)from March 2020 to March 2022 were retrospectively analyzed.All the cases were treated with Rotarex mechanical thrombectomy combined with DCB dilatation.Antiplatelet and anticoagulant therapy were used after operation.Results All the 53 patients had successful recanalization of the lower limb arteries.Imaging after Rotarex mechanical thrombectomy combined with DCB dilatation showed 3 cases of residual thrombus in the stent treated with indwelling thrombolytic catheters for thrombolysis,with follow-up angiography showing blood flow recovery,and 5 cases of embolism of the below-knee arteries intraoperatively,including 3 cases at the opening of the tibiofibular trunk artery,which were opened with 6F peripheral thrombus aspiration catheter until unobstructed blood flow,and 2 cases of proximal occlusion of the posterior tibial artery,which were opened with balloon dilatation.Three cases of residual stenosis>30%were treated with remedial stents placement.There were no postoperative complications related to the puncture point,cardiovascular or cerebrovascular accidents,or deaths.The ankle brachial index(ABI)was0.33±0.06 preoperatively and0.84±0.07 postoperatively at the time of discharge(t =-39.443,P<0.001).All the 53 cases completed 3-month follow-ups,52 cases completed 6-month follow-ups,and 49 cases completed 12-month follow-ups.The phaseⅠpatency rates were 100%(53/53)at 3 months,92%(48/52)at 6 months,and 84%(41/49)at12 months,postoperatively.Recurrence of lower limb ischemic symptoms happened in 2 cases,which were given DCB dilatation at 9 and 10 months postoperatively,respectively.The 12-month freedom from clinically-driven target vessel reintervention was 95.9%(47/49).There were 4 deaths(1 case of gastrointestinal hemorrhage,2 cases of COVID-19,and 1 case of unknown cause)and 3 cases of amputation beyond the ankle joint.Conclusion The Rotarex mechanical thrombectomy combined with DCB is safe and effective in treating ISR of the femoropopliteal artery with satisfactory patency and reintervention rates.

Tetanus consists of neonatal tetanus and non-neonatal tetanus. Although neonatal tetanus in China has been eliminated since 2012, non-neonatal tetanus remains a serious public health problem. Non-neonatal tetanus is a potential fatal disease, and the mortality rate of severe cases is almost 100% in the absence of medical intervention. Even with vigorous treatment, the mortality rate is still 30~50% globally. In order to standardize the diagnosis and treatment of non-neonatal tetanus in China, this specification is hereby formulated. This standard includes etiology, epidemiology, pathogenesis, clinical manifestations, laboratory tests, diagnosis, differential diagnosis, classification, grading and treatment of non-neonatal tetanus.

Tetanus consists of neonatal tetanus and non-neonatal tetanus. Non-neonatal tetanus remains a serious public health problem, although neonatal tetanus has been eliminated in China since 2012. Non-neonatal tetanus is a potential fatal disease. In the absence of medical intervention, the mortality rate of severe cases is almost 100%. Even with vigorous treatment, the mortality rate remains 30%-50% globally. These specifications aim to regulate non-neonatal tetanus diagnosis and treatment in China, in order to improve medical quality and safety. These specifications introduce the etiology, epidemiology, pathogenesis, clinical manifestations and laboratory tests, diagnosis, differential diagnosis, grading and treatment of non-neonatal tetanus.