Purpose:To discuss the treatments for lung cancer which involved carina of the bronchus and its complications. Methods:The surgical skill, airway management, postoperative complications of the pneumonectomy of right lung and reconstruction of carina and bronchus for lung cancer in 12 patients were discussed. Results:The 1.2.3 year survival rates are 100%(12/12),67%(8/12)and17%(2/12) respectively.There was no cases operative mortality and no severe past-operative complications. Conclusions:There is some value in this method but the indication must be strictly controlled.

Objective To construct DNA vaccine expressing Mycobacterium tuberculosis(Mtb) immunodominant antigen Ag85A and analyze its anti-tuberculosis T cell responses in BCG primed-mice after DNA vaccination boosting.Methods The coding gene of Ag85A mature fragment was amplified by PCR with H37Rv genomic DNA as template,and then cloned into the eukaryotic expression vector pVAX1 to construct Ag85A DNA vaccine.After purification,Ag85A DNA vaccine was injected intramuscularly twice in BCG primed-mice with BCG vaccination and DNA vaccination alone as control.Eight weeks post-vaccination,spleen lymphocytes were separated and were then used to analyze Mtb antigen specific effector T cell response and polyfuntional IFN-γ/TNF-α/IL-2 secreting CD4+ T cell frequencies and intensities,and CD8+T cell responses by IFN-γ ELISPOT assay and intracellular staining,respectively.Results Compared to BCG vaccinated-and DNA vaccinated-mice,Ag85A DNA boosting not only enhanced significantly BCG primed-mice IFN-γ+TNF-α+IL-2+,IFN-γ+ IL-2+,TNF-α+IL-2+ and IL-2+ CD4+ T cell frequencies and IL-2 secretion,but also improved significantly IFN-γ-secreting and IL-2-secreting CD8+ T cell frequencies.Condusion Ag85A DNA vaccine was constructed successfully and was demonstrated to enhance significantly BCG primed-mice Mtb antigen specific CD4+ and CD8+ T cell responses when boosting,which is beneficial to improve BCG immunogenicity and its waning immune protection against Mtb.

Objective To evaluate combined buccal mucosa and lingual mucosa grafts for urethroplasty in a dog model. Methods Seven female mongrel dogs were selected.After a segment of proximal urethra mucosa (4 cm×1 cm) was excised and onlayed,urethroplasty was performed by using the combined free buccal mucosa (2 cm×1 cm)graft which had been harvested from the inferior cheek and free lingual mucosa graft(2 cm×1 cm)harvested from the inferior lateral surface of the tongue.A 12 F urethral catheter was kept for 7 d.Retrograde urethrography was done and urethra diameter was calibrated with a 10 F catheter before animals were sacrificed at week 12.Then the grafted areas excised and evaluated grossly and histopathologically. Results All dogs survived during the procedure and there was no tongue or bueeal complications.One dog developed a severe urethral stricture at the proximal anastomosis site.The remaining 6 dogs voided spontaneously with no difficulty.Retrograde urethrography showed that no stricture or fistula formed.The combined buccal mucosa graft and lingual mucosa graft shortened from a mean (SD) of 4.00(0.15)to 3.75(0.23)cm (statistically.significant,P＜0.05).No stricture was found in the connection of the buccaI mucosa and lingual mucosa grafts.Histological examination showed that the combined buccal mucosa and lingual mucosa grafts were well-incorporated into the urethral walls and covered by a keratinized squamous epithelium.Neovascularization was evident beneath the grafts. Conclusion Combined buccal mucosa graft and lingual mucosa graft could be an option for urethral substitution.

Objective To systematically evaluate the effect of preoperative transarterial chemoembolization (TACE) on perioperative safety of patients with resectable hepatocellular carcinoma (HCC).Methods Literatures were researched using Chinese Journal Full-text Database,Wanfang database,VIP database,PubMed,Medline from December 1,1994 to May 30,2016 with the key words including “肝细胞癌,肝切除,术前化疗栓塞,经动脉化疗栓塞,liver cancer,hepatocellular carcinoma,liver resection,hepatectomy,transcatheter arterial chemoembolization,transarterial chemoembolization,preoperative” Manual retrieval was also conducted simultaneously.The randomized controlled trials (RCTs) about TACE on perioperative safety of patients with resectable HCC were received and enrolled.Patients undergoing surgery after preoperative TACE were allocated into the case group and patients undergoing first-stage resection were allocated into the control group.Two reviewers independently screened literatures,extracted data and assessed the risk of bias.Count data were described as relative risk (RR) and 95％ confidence interval (CI).Measurement data were represented as standardized mean difference (SMD) and 95％CI.The heterogeneity of the studies was analyzed using the I2 test.Results Five RCTs were enrolled in the Meta analysis,and the total sample size was 430 cases including 212 in the case group and 218 in the control group.Results of Meta analysis showed that there was no statistically significant difference in the hemihepatic resection rate between the 2 groups (RR=0.99,95％CI:0.81～ 1.20,P＞0.05).The combined resection rate of perihepatic organs in the case group was significantly higher than that in the control group (RR=3.42,95％CI:1.91-6.12,P＜0.05).Results of subgroup analysis showed that operation time and incidence of postoperative complications of patients with an average tumor diameter ＞5 cm in the case group were respectively longer and higher than these in the control group (SMD=0.31,RR=1.65,95％CI:0.06-0.57,1.01-2.69,P＜0.05).Conclusion There is no obvious effect of preoperative TACE on resectable HCC,and it can evaluated combined resection rate of perihepatic organs,operation time and incidence of postoperative complications of patients with resectable HCC and an average tumor diameter ＞ 5 cm,and also reduce the perioperative safety.

Objective To observe the expression of Caspase-12 and GRP78 of endoplasmic reticulum stress (ERS) in cardiac arrest and beating heart mitral valve replacement Methods Thirty patients with rheumatic heart disease mitral stenosis were randomly divided into beating heart group (BH,n=15) and cardiac arrest group(CA, n = 15). Both groups accepted MVR by beating heart surgery and cardiac arrest surgery under cardiopulmonary bypass (CPB) respectively. Right atrial myocardial tissues were collected at prior the start of CPB (T0), after aortic cross-clamping 30 minutes (BH group 30 minutes after CPB, T1) and stitched right atrium (T2) respectively. The method of reverse transcriptase polymerase chain reaction (RT-PCR) was applied to detect the expression level of Caspase-12 and GRP78 in two groups and positive staining of Caspase-12 and GRP78 of myocardial tissue slices in both groups was observed by immunohistochemical method. Results The expression of Caspase-12 in CA group heightened at T1and significantly increased at T2 (P < 0.05) but the expression of Caspase-12 in BH group had increased in T2 only (P < 0.05). Caspase-12 in CA group expressed higher than that in BH group at T1 and T2. The expression of GRP78 had increased at T1 in two groups but it in CA group expressed higher than that inBH group at T2. The number of positive staining of Caspase-12 and GRP78 in CA group was higher than that in BH group at T2. Conclusion MVR of beating heart can reduce the reaction of ERS to enhance the myocardial protection under CPB.

Injury monitoring is an important approach for injury control and is an important part of comprehensive disease monitoring. With the development of medical digitalization, an intelligent injury monitoring system has been created in Yinzhou District, Ningbo City, Zhejiang Province using artificial intelligence techniques based on Ningbo Municipal Health Information Platform and has been applied across the district since 2019. The manual card-reporting mode has been transformed to intelligent card-reporting mode in this system, which achieves functions of epidemiological analyses of the monitoring data, early warning of high-incidence injuries, classified management of injury and quality control of report cards. Nearly 300 thousand cards have been automatically reported since the system was online available since November 2022, and the epidemiological characteristics of injury were preliminarily understood, which provide data supports to early earning and interventions of injury. The intelligent injury monitoring system greatly improves the injury monitoring efficiency and card-reporting quality, and saves a large number of manpower and material resources, which provides a powerful technical support to widespread injury monitoring.

OBJECTIVE:To systematically investigate the management mode of non-medical prescribing in Britain and its enlightenment to the establishment and implementation of non-medical prescribing in China. METHODS:By retrieving domestic and foreign literatures,non-medical prescribing in Britain was introduced systematically in terms of development history,types, core elements,implementation status and effect;the suggestions were put forward for the development of non-medical prescribing in China. RESULTS & CONCLUSIONS:Britain implemented non-medical prescribing since 1994. After years of practice and a series of legislation and revision,independent prescribers (including nurses and pharmacists) have owned the statutory right to prescribe any medicine for patients by 2012. In Britain,non-medical prescribing is divided into independent prescribing which mainly exists in community pharmacies and is limited to specific diseases,supplementary prescribing which exists in hospitals or clinic and needs to be signed with doctors. The management institutions are mainly composed of one state administrative department (British Department of Health) and three professional associations (British Nursing and Midwifery Council,The Royal Pharmaceutical Society of Great Britain,The Pharmaceutical Society of Northern Ireland). There are detailed and strict stipulations on the qualification and corresponding responsibilities of the prescribing authority. The British government has provided legal protection for the development of the non-medical prescribing model,and the number of non-medical prescribers is increasing. The implementation of this model has increased the patients'access to medical services. Drawing lessons from the development of non-medical prescribing management in Britain,our country needs to improve legislation,provide legislative protection for the implementation of non-medical prescribing,expand the scope of practice of nurses and pharmacists,establish and improve the training program of non-medical prescribing professionals to promote the development of non-medical prescribing model in China.

Objective:To investigate the risk factors for chronic subdural hematoma(CSDH)recurrence and reoperation strategies in elderly patients.Methods:From October 2012 to December 2018, 56 patients aged 85 years and over with CSDHs undergoing surgery in our hospital were enrolled.After surgery, 12 patients had hematoma recurrence, of whom 11 received reoperation.The strategies of reoperation and the risk factors of recurrence were analyzed.Results:The average age was similar between patients with and without recurrence( t=0.308, P=0.759). However, the rates of recurrence between patients with mixed and with homogeneous density were significantly different(53.3% vs 12.8%, χ2=6.54, P=0.011), and there was also a significant difference in recurrent rate between patients with a small maximum thickness(1.0 cm to 2.5 cm)and those with a large maximum thickness(≥2.5 cm)before operation(12.5% vs 50.0%, χ2=4.753, P=0.029). Patients with a maximum thickness≥1.0 cm after surgery was associated with a comparable risk of hematoma recurrence compared with those with a thickness<1.0 cm(31.0% vs 12.0%, χ2=1.823, P=0.177). Most patients(10/11)achieved a good prognosis after reoperation. Conclusion:Reoperation can improve the quality of life in elderly patients with CSDH recurrence and without obvious contraindications.

Lung cancer is one of the malignant tumors with the highest incidence and mortality rate worldwide and has a poor prognosis. With the popularization of thin layer CT, more and more early lung cancers are being detected. In recent years, thoracoscopic technology and robotic surgery technology have been innovated, and multiple adjuvant therapies such as chemotherapy, targeted therapy and immunotherapy have progressed rapidly, providing lung cancer patients with multiple treatment options. However, the prognosis of lung cancer patients has not been significantly improved, which is related to the overall poor prognosis of lung cancer patients on the one hand, and the urgent need to find effective predictive markers for patients' prognosis, to accurately screen patients, and to carry out targeted treatment in order to improve patients' prognosis on the other hand. In this paper, we review the progress of tertiary lymphoid structures (TLSs) in lung cancer and discuss the prognostic predictive value of TLSs in lung cancer and their feasibility as biomarkers for adjuvant therapy.

OBJECTIVETo analyze the value of fractional flow reserve (FFR) measurement on endovascular therapy for patients with renal artery stenosis.

METHODSClinical data of 9 patients underwent endovascular therapy due to moderate renal artery stenosis (50%-69%) in Anzhen hospital from May to September 2013 were retrospectively analyzed. Fractional flow reserve (FFR) were measured in patients with moderate stenosis in renal artery and abnormal glomerular filtration rate (GFR) or different between renal artery angiography and ultrasound before the procedure. Endovascular therapy was not applied for patients with FFR > 0.90, and the patients were subsequently followed up clinically. Endovascular therapy was applied in patients with FFR less than 0.90 or the pressure difference between the two ends of stenosis was more than 20 mmHg (1 mmHg = 0.133 kPa). Blood pressure, ultrasound and contrast-enhanced ultrasonography data were obtained at 1 and 3 months later, respectively.

RESULTSThere were 6 patients diagnosed as severe renal artery stenosis (≥ 70%) and the other 3 patients diagnosed as moderate renal artery stenosis by renal artery ultrasound before operation. Two patients with FFR > 0.90 were not undertaken the endovascular therapy. Seven patients with FFR < 0.90 underwent endovascular therapy. After renal artery stenting, renal stenosis was relieved immediately and the transstent blood flow was fluency in these 7 patients. There was significant difference in the FFR before and after operation (0.81 ± 0.09 vs.0.94 ± 0.03, P = 0.008). Among the patients underwent endovascular therapy, blood pressure was normal without medication in 2 patients and well controlled with 1 or 2 combined antihypertensive drugs in the rest 5 patients.

CONCLUSIONIn patients with moderate renal artery stenosis, fractional flow reserve measurement could be used as a useful index to guide intervention procedure and to evaluate the efficacy of endovascular therapy.

Angiography ; Constriction, Pathologic ; therapy ; Fractional Flow Reserve, Myocardial ; Hemodynamics ; Humans ; Renal Artery ; diagnostic imaging ; Renal Artery Obstruction ; therapy ; Retrospective Studies ; Stents ; Ultrasonography