The authors give an account of the historical development of neurological intensive care and its current status in China and put forward the view that establishment of neurological intensive care units can improve the level of neurological departments in delivering emergency treatments and give impetus to the improvement of expertise in diagnosing and treating acute neurological diseases. It will also play a key role in clinically conducting encephalic resuscitation and hibernation therapy, finely monitoring changes of intracranial physiologic indexes by electro physiological methods, further clarifying organ failure resulting from cerebral and neural failure, and promoting the study of nerve grafting and regeneration. Neurological intensive care units can serve as both the teaching base for training professional staff and the research base for advancing neurological emergency medicine.

Objective:To determine the effect of hypoxic stress on glioma cell XBP1 expression, the relationship between XBP1 expres-sion and sugar metabolism, the influence of XBP1 repression on the survival rate of glioma cells under normoxia and hypoxia, and the influence of XBP1 on glioma cell glycolysis. Methods:We tested XBP1 activation in human glioma cell lines cultured under normoxia and hypoxia. XBP1 expression was repressed with siRNA technology. Cells were treated with oxidative phosphorylation inhibitor. We then detected the variation in cell apoptosis, sugar metabolism mode, and cell apoptosis and glycolysis products under normoxia and hypoxia. Results:XBP1 activation increased under hypoxia. Silencing XBP1 expression reduced glioma cell survival level, ATP and lactic acid production, and glucose consumption under hypoxia. After inhibiting cell oxidative phosphorylation, XBP1 repression significantly reduced the survival level of glioma cells. Conclusion:Hypoxia can activate XBP1 in glioma cells. Under hypoxia, XBP1 silencing de-presses cell activity and glycolysis. Glycolysis of glioma cells under hypoxia depends on XBP1 activation.

OBJECTIVESTo increase the diagnosis and treatment of ectopic ACTH syndrome.

METHODSThe data of 12 ectopic ACTH syndrome patients treated from 1985 to 1999 were retrospectively analyzed.

RESULTSTwelve patients were diagnosed as having ACTH syndrome by endocrinary test and primary tumors were ascertained by imaging examination. Follow-up from 7 months to 8 years showed 3 out of 5 patients with radical resection of primary tumor died. One patient with bilateral adrenorectomy was still alive. All patients received only chemotherapy except one died.

CONCLUSIONSPatients with Cushing's syndrome should be evaluated by endocrine test and followed up by imaging screen examination. The key points to increase treatment effect include early detection, localization and resection of primary tumors.

Background and objective In recent years, Da Vinci robot system applied in the treatment of intratho-racic surgery mediastinal diseases become more mature. hTe aim of this study is to summarize the clinical data about mediasti-nal lesions of General Hospital of Shenyang Military Region in the past 4 years, then to analyze the treatment effect and prom-ising applications of da Vinci robot system in the surgical treatment of mediastinal lesions. Methods 203 cases of mediastinal lesions were collected from General Hospital of Shenyang Military Region between 2010 and 2013. hTese patients were di-vided into two groups da Vinci and video-assisted thoracoscopic surgery (VATS) according to the selection of the treatments. hTe time in surgery, intraoperative blood loss, postoperative drainage amount within three days atfer surgery, the period of bearing drainage tubes, hospital stays and hospitalization expense were then compared. Results All patients were successfully operated, the postoperative recovery is good and there is no perioperative death. hTe different of the time in surgery between two groups is Robots group 82 (20-320) min and thoracoscopic group 89 (35-360) min (P>0.05). hTe intraoperative blood loss between two groups is robot group 10 (1-100) mL and thoracoscopic group 50 (3-1,500) mL. hTe postoperative drainage amount within three days atfer surgery between two groups is robot group 215 (0-2,220) mL and thoracoscopic group 350 (50-1,810) mL. hTe period of bearing drainage tubes atfer surgery between two groups is robot group 3 (0-10) d and thora-coscopic group:5 (1-18) d. hTe difference of hospital stays between two groups is robot group 7 (2-15) d and thoracoscopic group 9 (2-50) d. hTe hospitalization expense between two groups is robot group (18,983.6±4,461.2) RMB and thoracoscopic group (9,351.9±2,076.3) RMB (All P<0.001). Conclusion hTe da Vinci robot system is safe and effcient in the treatment of mediastinal lesions compared with video-assisted thoracoscopic approach, even though its expense is higher.

Objective:To investigate the characteristics, causes and preventive strategies of intraoperative and postoperative complications of Da Vince robotic radical resection for lung cancer.Methods:From January 2018 to June 2020, 306 patients with lung cancer who underwent robotic radical resection of lung cancer in our department were reviewed, the perioperative data were statistically analyzed. There were 154 males and 152 females, aged(58.5±10.3) years old, 238 lobectomy cases and 68 segmental lobectomy cases.Results:There were no perioperative death, no conversion to thoracotomy, and no intraoperative vascular injury. Intraoperative blood loss was(41.5±37.4)ml, 302 cases(98.7%) underwent R0 resection, 54 cases(17.6%) of intraoperative bleeding from troca mouth of robot operating arm. 32 cases(10.5%) of postoperative complications, including 3 cases(1.0%) of chylothorax, 1 case(0.3%) of pleural effusion, 28 cases( 9.2%) of alveolar fistula over 7 days with 5 cases of large area subcutaneous emphysema.Conclusion:The most common intraoperative complication in robotic lung cancer radical operation is troca bleeding, and the most common postoperative complication is alveolar fistula. Robot surgery is safe, and targeted preventive measures can reduce the incidence of complications.

Background and objective A solitary pulmonary nodule (SPN) is deifned as a round intraparenchimal lung lesion less than 3 cm in size, not associated with atelectasis or adenopathy. hTe aim of this study is to learn clinical experi-ence of the treatment of SPN with Da Vinci Surgical System. Methods A total of 9 patients with solitary pulmonary nodules (SPN) less than 3 cm in diameter was treated with Da Vinci Surgical System (Intuitive Surgical, California) in thoracic surgery department from General Hospital of Shenyang Militrary Region from November 2011 to March 2014. hTis group of patients included 3 males and 6 females, and the mean age was 51±9.9 yr (range:41-74 yr). Most of the patients were no obvious clini-cal symptoms (7 cases were found by physical examination, others were with cough and expectoration). hTeir median medical history was 12 mo (range:4 d-3 yr). All the lesions of patients were peripheral pulmonary nodules and the mean diameter of those was (1.4±0.6) cm(range:0.8-2.8 cm). Wedge-shaped resection or lobectomy was performed depending on the result of rapid pathology and systemic lymph node dissection was done for malignant leision. We used general anesthesis with double lumens trachea cannula. We set the patients in lateral decubitus position with jackknife. hTe patient cart enter from top of the patient. hTe position of trocars would be set according to the position of lesion. A 12 mm incision was positioned at the 8th intercostal space in the posterior axillary line as vision port, and two 8 mm incisions were positioned at the 5th intercostal space between the anterior axillary line and midclavicular line, and the 8th infrascapular line as robotic instrument ports about 10 cm apart from the vision port. One additional auxiliary small incision for instrument without retracting ribs was set at the 7th in-tercostal space in the middle axillary line. Results hTere were 4 benign leisions and 5 malignancies identiifed. Wedge-shaped resection was performed for 4 patients, lobectomy with systemic lymph node dissection for 3 patients (including 2 right middle lobectomies and 1 letf upper lobectomy) and wedge-shaped resection with systemic lymph node dissection for 2 patients of poor lung function. All of the 9 cases were completed with total robotic procedure without conversion. hTe pathological results included 3 inlfammatory pseudotumors, 1 hamartoma, 5 adenocarcinomas. All of the 29 patients were hospital discharged smoothly. hTe patients were followed up for 0.1-18.5 mo (median 11 mo) without recurrence or metastasis. Conclusion hTe SPN patients should be given active surgical treatments to improve the diagnose rate as well as the cure rate of early non-small cell lung cancer. Since da Vinci Surgical System is a safe and minimally invasive treatment for SPN, it has higher value to the diagnosis and treatment of SPN.

Objective:To explore the application effect of 3D printing technology in comprehensive reconstruction of thumb and finger.Methods:From January, 2018 to January, 2020, 67 patients with 84 thumbs and fingers defects were selected, which were 37 thumbs and 47 fingers, and 45 of I-III degree and 39 of IV-VI degree. The method of operation was comprehensive reconstruction of thumbs and fingers assisted by 3D printing technology. The patient's hands and feet were scanned with CT and 3D modeling, and the 1∶1 model was derived. The skin model and bone model of thumb and finger defect were printed. Put the skin model on the great toes, and design the shape of the nail flap to be cut. Then the flap was spread in the groin area to design the perforating branch flap of the superficial circumflex iliac artery. The interphalangeal joint or metatarsophalangeal joint of the second toe was cut off according to the skeleton model (when the length of the bone joint was not enough, the iliac bone strip was taken to be connected in series). The effect of operation was observed in outpatient.Results:All of the 84 thumbs and fingers survived and were followed-up for 3 to 24 months. The appearance of the reconstructed thumbs and fingers was similar to that of the normal ones, with good texture and elasticity. The nail was smooth and glossy. The sensory recovery was S 3+, and the TPD was 4-6 mm. According to the Evaluation Standard of Finger Replantation and Reconstruction of Hand Surgery Society of Chinese Medical Association, 70 thumbs and fingers were excellent and 14 thumbs and fingers were good. In 64 thumbs and fingers, all toes were preserved in the donor area, and the color and texture of the flap were satisfactory, which did not affect walking, running and jumping, and had no walking pain. Conclusion:With the help of 3D printing technology, the tissues can be cut more accurately during the thumb and finger comprehensive reconstruction, which not only improves the beauty of reconstructed thumbs and fingers, but also avoids unnecessary trauma and improves the satisfaction of patients.

Objective:To compare the short-term outcomes of segmentectomy for stage ⅠA non-small cell lung cancer by two surgical methods.Methods:A retrospective analysis was performed on 101 patients with stage ⅠA non-small cell lung cancer and undergoing segmentectomy admitted to the Department of Thoracic Surgery of The General Hospital of the Northern Theater Command from July 2016 to July 2020, including 50 patients who underwent Da Vinci robotic segmentectomy and 51 patients who underwent video-assisted thoracoscopic segmentectomy during the same period. By collecting the clinical data of the patients, the operation time, intraoperative blood loss, lymph node dissection stations, lymph node dissection number, drainage volume on the first day after the operation, total drainage volume on the third day after the operation, postoperative chest catheter insertion time, postoperative hospitalization days, and postoperative complication rate were compared and analyzed.Results:Patients in both groups successfully completed pulmonary segmental resection, and there were no cases of conversion to thoracotomy and perioperative death.Compared and analyzed the postoperative clinical results of the two groups, the intraoperative blood loss [(34.40±12.96) ml vs.(85.10±26.41)ml, P=0.000], the number of lymph node dissection stations(4.72±1.20 vs. 3.60±1.40, P=0.000) and the number of lymph node dissection(15.14±5.91 vs. 10.76±5.26, P=0.000) showed statistically significant differences, and RATS group was superior to VATS group.There were no statistically significant differences in operation time[(153.90±21.88) min vs.(155.39±25.04) min, P=0.751], drainage volume on the first day after surgery[(217.80±76.94) ml vs.(210.98±86.98) ml, P=0.678], total drainage volume three days after surgery[(612.60±169.93) ml vs.(595.10±203.90) ml, P=0.641], duration of chest drainage tube after operation[(5.36±2.33) days vs.(5.18±2.54) days, P=0.706], postoperative hospitalization days[(7.50±2.35) days vs.(7.47±2.93) days, P=0.956]and postoperative complication incidence. Conclusion:Da Vinci robot segmentectomy is a safe and effective surgical method, with less bleeding and more lymph node dissection stations and number than video-assisted thoracoscopic segmentectomy for stage ⅠA non-small cell lung cancer.

Thymectomy is an important treatment for thymoma and myasthenia gravis. The application of minimally invasive surgery to complete thymectomy and rapid recovery of patients after surgery is a developmental goal in thoracic surgery technology. Surgical robots have many technical advantages and are applied for many years in mediastinal tumor resections, a process that has led to its recognition. We published this consensus with the aim of examining how to ensure surgical safety based on the premise that better use of surgical robots achieving rapid recovery after surgery. We invited multiple experts in thoracic surgery to discuss the safety and technical issues of thymectomy under nonintubated anesthesia, and the consensus was made after several explorations and modifications.

Objective    To compare the the effectiveness of robot-assisted thoracic surgery (RATS) with video-assisted thoracic surgery (VATS), in stageⅠ lung adenocarcinoma. Methods    From January 2012 to December 2018, 291  patients were included. The patients were allocated into two groups including a RATS group with 125 patients and a VATS group with 166 patients. Two cohorts (RATS, VATS ) of clinical stageⅠ lung adenocarcinoma patients were matched by propensity score. Then there were 114 patients in each group (228 patients in total). There were 45 males and 69 females at age of 62±9 years in the RATS group; 44 males, 70 females at age of 62±8 years in the VATS group. Overall survival (OS) and disease-free survival (DFS) were assessed. Univariate and multivariate analyses were performed to identify factors associated with the outcomes. Results     Compared with the VATS group, the RATS group got less blood loss (P<0.05) and postoperative drainage (P<0.05) with a statistical difference. There was no statistical difference in drainage time (P>0.05) or postoperative hospital stay (P>0.05) between the two groups. The RATS group harvested more stations and number of the lymph nodes with a statistical difference (P<0.05). There was no statistical difference in 1-year, 3-year and 5-year OS and mean survival time (P>0.05). While there was a statistical difference in DFS between the two groups (1-year DFS: 94.1% vs. 95.6%; 3-year DFS: 92.6% vs. 75.2%; 5-year DFS: 92.6% vs. 68.4%, P<0.05; mean DFS time: 78 months vs. 63 months, P<0.05) between the two groups. The univariate analysis found that the number of the lymph nodes dissection was the prognostic factor for OS, and tumor diameter, surgical approach, stations and number of the lymph nodes dissection were the prognostic factors for DFS. However, multivariate analysis found that there was no independent risk factor for OS, but the tumor diameter and surgical approach were independently associated with DFS. Conclusion    There is no statistical difference in OS between the two groups, but the RATS group gets better DFS.