Objective:To study the neuro-protective effects of Shenfu injection on Nrf 2 signaling pathway affected by cerebral ischemia reperfusion.Methods: A total of 68 adult male Sprague-Dawley rats were randomly divided into sham group , cerebral ischemia-reperfusion group,and(8 mg/kg)Shenfu injection treatment group.Shenfu injection was injected intraperitoneally in the rats after MCAO.Neurologic deficit was evaluated after 24 hours of reperfusion.All the rats were sacrificed after 24 h of ischemia-reoerfusion for biochemical analysis or Nissl staining.Results:Shenfu injection treatment significantly increased the expression of Nrf 2,HO-1 and NQO-1(P<0.05).Furthermore,Shenfu injection treatment significantly reduced the expression of cleaved -caspase-3 and attenuated neurological deficits after cerebral ischemia reperfusion ( P<0.05 ).Lastly, Shenfu injection could evidently alleviate the severity of neuronal degeneration ( P<0.05 ).Conclusion:Shenfu injection could confer neuroprotection after cerebral ischemia reperfusion through modulating the Nrf2 signaling pathway.

ObjectiveTo analyze the perioperative curative effect of pancreaticoduodenectomy (PD) in a single center over two decades.MethodsClinical data of 523 patients who had complete medical record and underwent PD in Sun Yat-sen Memorial Hospital, Sun Yat-sen University between January 1994 and December 2013 were retrospectively analyzed. The patients were divided into the latter decade group and the former decade group according to the year when surgery was performed. Among the 396 patients in the latter decade group, 246 were males and 150 were females with the age ranging from 19 to 97 years old and the median of 58 years old. Among the 127 patients in the former decade group, 69 were males and 58 were females with the age ranging from 6 to 79 years old and the median of 56 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. The perioperative conditions of two groups were compared and analyzed using rank sum test and the comparison of rate was conducted using Chi-squaretest.ResultsThe median length of surgery in the latter decade group was 340(187-920) min, significantly longer than 310(180-730) min in the former decade group (Z=3.12, P<0.05). The intraoperative blood loss in the latter decade group was 300(50-4 500) ml, significantly less than 600(200-18 000) ml in the former decade group (Z=-7.62,P<0.05). The postoperative length of stay in the latter decade group was 23(5-148) d, signiifcantly shorter than 25(11-309) d in the former decade group (Z=-2.82,P<0.05). The perioperative mortality in the latter decade group was 6% (24/396), significantly lower than 12%(15/127) in the former decade group (χ2=4.61,P<0.05). The incidence of postoperative complications and the reoperation rate of the patients with postoperative complications in the latter decade group were respectively 39% (156/396) and 29%(45/156), while those in the former decade group were respectively 46% (58/127) and 16% (9/58). The reoperation rate in the latter decade group was signiifcantly higher than that in the former decade group (χ2=3.98,P<0.05). The most common reason for reoperation was intra-abdominal hemorrhage.ConclusionsPD has become a safe and effective operation as the intraoperative blood loss, the postoperative length of stay and the perioperative mortality decrease. Timely reoperation may has an important signiifcance in reducing the perioperative mortality when severe postoperative complications happen.

Objective To explore the risk factors of hepatic failure after major hepatectomy. Methods Clinical data of 293 patients receiving major hepatectomy in Sun Yat-sen Memorial Hospital of Sun Yat-sen University between January 2008 and February 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. According to whether there was postoperative hepatic failure, the patients were divided into the hepatic failure group and non-hepatic failure group. There were 23 cases in the hepatic failure group, including 22 males and 1 female with the mean age of (53±12) years. There were 270 cases in non-hepatic failure group, including 224 males and 46 females with the age of (49±12) years. Single factor analysis and Logistic regression analysis were used to analyze the risk factors of postoperative hepatic failure. Results The incidence of hepatic failure after major hepatectomy was 7.8% (23/293). Multi-factor Logistic regression analysis showed that preoperative Plt, Child-Pugh classification of liver function, tumor diameter and vascular tumor thrombus were the independent influence factors of postoperative hepatic failure (OR=0.983, 0.020, 0.726, 0.225;P<0.05). Conclusion Preoperative Plt, Child-Pugh classification of liver function, tumor diameter and vascular tumor thrombus are the independent influence factors of hepatic failure after major hepatectomy.

Objective:To compare the efficacy of stereotactic body radiotherapy(SBRT) and surgery in treating intrapulmonary recurrence of non-small cell lung cancer (NSCLC) after radical surgery.Methods:A retrospective analysis was conducted on NSCLC patients, who underwent radical surgery at the Cancer Hospital Affiliated to University of Chinese Academy of Sciences from November 2012 to December 2018 and then received SBRT or secondary surgery because of postoperative intrapulmonary recurrence. The survival rates of these patients were calculated using the Kaplan-Meier method. The comparison between the two groups was made using the Log-rank method, and the univariate and multivariate analysis was made using the Cox regression method.Results:Among 62 eligible patients, 33 received SBRT and 29 received secondary surgery, and they were divided into the SBRT group and the surgery group accordingly. For the SBRT and surgery groups, the median follow-up time was 45.8 months and 37.4 months, the 3-year locoregional control rate (LRCR) 79.8% and 90.2%, respectively ( P > 0.05), the progression-free-survival (PFS) 58.5% and 42.3%, respectively ( P >0.05), and the overall survival (OS) 78.0% and 85.5%, respectively ( P >0.05). The multivariate analysis suggested that treatment method, Charlson comorbidity index (CCI), and adjuvant drug therapy were independent prognostic factors for PFS ( P = 0.027, 0.013, 0.001). Conclusions:The efficacy of SBRT and surgery is comparable for patients with intrapulmonary recurrence of NSCLC after radical surgery.

Objective To compare the perioperative efficacy and safety of da Vinci robot-assisted thoracoscopic surgery (RATS) for treatment of anterior mediastinal tumors through subxiphoid versus lateral thoracic approaches under the laryngeal mask anesthesia. Methods We retrospectively analyzed the clinical data of 102 patients with anterior-mediastinal tumors treated by RATS under laryngeal mask anesthesia completed by the same operator. Forty-five patients underwent the subxiphoid approach (subxiphoid group), and 57 patients were treated with the lateral thoracic approach (lateral thoracic group). The operating time, intraoperative bleeding, and total postoperative drainage volume in the two groups were compared and analyzed. Results All patients successfully completed resection of the anterior mediastinal tumor without the occurrence of perioperative death. In terms of total postoperative drainage volume, postoperative drainage time, postoperative hospital stay, and VAS pain on postoperative days 2 and 3, the subxiphoid group was more advantages (P < 0.05). No statistically significant difference was found between the two groups in terms of operative time, docking time, total operative time, intraoperative bleeding volume, postoperative day 1 VAS pain score, or postoperative complications (P > 0.05). Conclusion The subxiphoid approach of RATS is safe and feasible for resection of anterior mediastinal tumors. Compared with the lateral thoracic approach, the subxiphoid approach has advantages in terms of rapid postoperative recovery and postoperative pain.

Objective:To investigate the effects of fasudil hydrochloride(FH) on Rho-associated kinase 2(ROCK2) protein and ferroptosis in hippocampal area during early brain injury in rats with subarachnoid hemorrhage(SAH).Methods:Total 36 SPF grade Sprague-Dawley rats were divided into 3 groups by random number table method: Sham group, SAH group and SAH+ FH (a ROCK2 protein inhibitor) group (FH goup) with 12 rats in each group.SAH animal model was established by internal carotid artery perforation.The rats in FH group were injected intraperitoneally with FH(15 mg/kg) 30 minutes after successful modeling, and rats in Sham group and SAH group were injected intraperitoneally with the same volume of 0.9% sodium chloride solution.Twenty-four hours after the intervention, shuttle box test was used to observe the learning and memory ability of rats.The Fe 2+ content in rat hippocampus tissue was detected by colorimetry, and the protein levels of ROCK2 and ferroptosis-related long-chain acyl-CoA synthetase 4(ACSL4) and glutathione peroxidase 4(GPX4) in hippocampus were detected by immunohistochemistry and Western blot.Statistical analysis was performed by SPSS 20.0 software.One-way ANOVA was used for multigroup comparison, and LSD test was used for further pairwise comparison. Results:(1)In the shuttle box test, there were statistically significant differences in the number of avoidance reactions and avoidance reaction time of rats among the three groups( F=20.348, 22.316, both P<0.05). The number of avoidance reaction in SAH group was less than that in Sham group ((17.92±2.94) times, (27.13±3.48) times, P<0.05), the time of avoidance reaction in SAH group was longer than that in Sham group ((9.15±2.87) s, (3.68±1.09) s, P<0.05), while the number of avoidance reaction in FH group ((21.63±4.11) times) was more than that in SAH group, and the time of avoidance reaction ((6.08±1.76) s) was shorter than that in SAH group (both P<0.05). (2) The colorimetry results showed that there was a statistically significant difference in the content of Fe 2+ in hippocampus of rats among the three groups( F=7.965, P<0.05). The Fe 2+ content in SAH group was significantly higher than that of Sham group((0.091±0.032) nmol/mg, (0.038±0.024) nmol/mg, P<0.05), and the Fe 2+ content in the FH group ((0.065±0.021) nmol/mg) was lower than that of SAH group ( P<0.05). (3) There were significant differences in the number of ROCK2, ACSL4 and GPX4 positive cells in hippocampus of rats among the three groups in immunohistochemistry ( F=7.602, 14.171, 36.077, all P<0.05). The positive cells of ROCK2 and ACSL4 in SAH group ((21.63±4.72), (55.13±19.41)) were significantly higher than those of Sham group ((11.63±3.62), (23.38±3.74)) (both P<0.05), and the positive cells of ROCK2 and ACSL4 in FH group ((15.88±6.64), (44.75±8.29)) were both lower than those of SAH group(both P<0.05), while the number of GPX4 positive cells in SAH group (25.38±6.30) was significantly lower than that of Sham group (60.25±10.36) ( P<0.05), and the number of GPX4 positive cells in FH group (45.13±7.51) was higher than that of SAH group( P<0.05). (4)The results of Western blot showed that there were significant differences in the expression levels of ROCK2, ACSL4 and GPX4 proteins in the hippocampus of rats among the three groups( F=4.812, 12.573, 10.849, all P<0.05). The protein expression levels of ROCK2 and ACSL4 in SAH group were significantly higher than those in Sham group(both P<0.05), and the protein expression levels of ROCK2 and ACSL4 in FH group were lower than those in SAH group (both P<0.05), while the expression level of GPX4 protein in SAH group (0.27±0.09) was significantly lower than that in Sham group( P<0.05), and the expression level of GPX4 protein in FH group was higher than that of SAH group ( P<0.05). Conclusion:FH can inhibit ferroptosis in the hippocampus and improve the learning and memory ability of rats, and the mechanism may be related with down-regulation of ROCK2 protein.

Objective To investigate the inhibitory effect and mechanism of arsenic trioxide on hepatocellular carcinoma (HCC) cells migration induced by low dose of sorafenib. Methods Human HCC cells MHCC97H in logarithmic phase were treated with 2μmol/L arsenic trioxide (arsenic trioxide group), 3μmol/L sorafenib (sorafenib group), 2μmol/L arsenic trioxide+3μmol/L sorafenib (combination group), 50 μmol/L LY294002(LY group) and 3 μmol/L sorafenib + 50 μmol/L LY294002 (LY+ sorafenib group) respectively. Dimethyl sulfoxide (DMSO) was used in the control group. Wound healing assay and Transwell migration assay were used to detect the ability of horizontal and vertical cell migration. The expression of p-Akt, E-cadherin, Vimentin and Snail proteins was measured by Western blot. The experiment data were compared using one-way ANOVA and Bonferroni test. Results Wound healing assay revealed that the horizontal migration speed in the sorafenib, arsenic trioxide and combination groups was (1.59±0.14), (0.39±0.08) and (0.58±0.12) times of that in the control group (t=7.20,-12.58,-6.62;P<0.05). Transwell migration assay revealed that the number of cells in the sorafenib, arsenic trioxide, combination and control groups was 285±26, 169±18, 194±19 and 228±9 respectively. Compared with the control group, the number of cells was signiifcantly increased in the sorafenib group (t=3.48, P<0.05), whereas signiifcantly decreased in the arsenic trioxide group (t=-3.80, P<0.05). The number of cells in the combination group was signiifcantly decreased than that in the sorafenib group (t=-5.67, P<0.05). Western blot revealed that the expression of p-Akt, Snail and Vimentin proteins was up-regulated, whereas the expression of E-cadherin protein was down-regulated in the sorafenib group compared with those in the control group. Compared with the control group, the expression of p-Akt, Snail and Vimentin proteins was down-regulated whereas the expression of E-cadherin protein was up-regulated in the arsenic trioxide, combination, LY and LY+sorafenib groups. Conclusion Arsenic trioxide can inhibit the epithelial-mesenchymal transition and reverse the promoting effect of low-dose sorafenib upon MHCC97H cell migration through suppressing the activation of PI3K/Akt/Snail signaling pathway.

Objective     To systematically evaluate the accuracy of endoscopy-based artificial intelligence (AI)-assisted diagnostic systems in the diagnosis of early-stage esophageal cancer and provide a scientific basis for its diagnostic value. Methods    PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang database, VIP database and CNKI database were searched by computer to search for the relevant literature about endoscopy-based AI-assisted diagnostic systems for the diagnosis of early esophageal cancer from inception to March 2022. The QUADAS-2 was used for quality evaluation of included studies. Meta-analysis of the literature was carried out using Stata 16, Meta-Disc 1.4 and RevMan 5.4 softwares. A bivariate mixed effects regression model was utilized to calculate the combined diagnostic efficacy of the AI-assisted system and meta-regression analysis was conducted to explore the sources of heterogeneity. Results    A total of 17 articles were included, which consisted of 13 retrospective cohort studies and 4 prospective cohort studies. The results of the quality evaluation using QUADAS-2 showed that all included literature was of high quality. The obtained meta-analysis results revealed that the AI-assisted system in the diagnosis of esophageal cancer presented a combined sensitivity of 0.94 (95%CI 0.91 to 0.96), a specificity of 0.85 (95%CI 0.74 to 0.92), a positive likelihood ratio of 6.28 (95%CI 3.48 to 11.33), a negative likelihood ratio of 0.07 (95%CI 0.05 to 0.11), a diagnostic odds ratio of 89 (95%CI 38 to 208) and an area under the curve of 0.96 (95%CI 0.94 to 0.98). Conclusion    The AI-assisted diagnostic system has a high diagnostic value for early stage esophageal cancer. However, most of the included studies were retrospective. Therefore, further high-quality prospective studies are needed for validation.

Objective    To evaluate the efficacy and safety of robot-assisted thymectomy (RATS) versus video-assisted thoracoscopic thymectomy (VATS). Methods    Web of Science, PubMed, EMbase, The Cochrane Library, Wanfang, VIP and CNKI databases were searched by computer from inception to February 2022. Relevant literatures that compared the efficacy and safety of RATS with those of VATS were screened. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of included cohort studies, and Review Manager 5.4 software was utilized to perform a meta-analysis. Results    A total of 16 retrospective cohort studies were included, covering a total of 1 793 patients (874 patients in the RATS group and 919 patients in the VATS group). The NOS scores of the included studies were≥7 points. Meta-analysis results revealed that RATS had less intraoperative bleeding (MD=−22.45, 95%CI −34.16 to −10.73, P<0.001), less postoperative chest drainage (MD=−80.29, 95%CI −144.86 to −15.72, P=0.010), shorter postoperative drainage time (MD=−0.69, 95%CI −1.08 to −0.30, P<0.001), shorter postoperative hospital stay (MD=−1.14, 95%CI −1.55 to −0.72, P<0.001) and fewer conversion to thoractomy (OR=0.40, 95%CI 0.23 to 0.69, P=0.001) than VATS; whereas, the operative time (MD=8.37, 95%CI −1.21 to 17.96, P=0.090), incidence of postoperative myasthenia gravis (OR=0.85, 95%CI 0.52 to 1.40, P=0.530), overall postoperative complications rate (OR=0.80, 95%CI 0.42 to 1.50, P=0.480) and tumour size (MD=−0.18, 95%CI −0.38 to 0.03, P=0.090) were not statistically different between the two groups. Conclusion    In the aspects of intraoperative bleeding, postoperative chest drainage, postoperative drainage time, postoperative hospital stay and conversion to thoracotomy, RATS has unique advantages over the VATS.

Objective To evaluate the short-term outcome of robot-assisted thoracoscopic surgery (RATS) for the treatment of posterior mediastinal neurogenic tumour. Methods The clinical data of consecutive patients with mediastinal neurogenic tumors who received RATS treatment completed by the same operator in the Department of Thoracic Surgery, Gansu Provincial People's Hospital from June 2016 to June 2022 were retrospectively analyzed. The tumors were preoperatively localized and evaluated using magnetic resonance imaging or enhanced CT. Results A total of 35 patients were enrolled, including 19 males and 16 females with a mean age of 34.9±7.1 years. All patients successfully completed the resection of posterior mediastinal neurogenic tumors under RATS, and no conversion to thoracotomy occurred during the operation. The average operative time was 62.3±18.0 min, docking time was 10.3±2.6 min, intraoperative bleeding was 33.9±21.6 mL, postoperative 24-hour chest drainage was 69.0±28.9 mL, postoperative chest drainage time was 2.0 (1.0, 3.0) d and the postoperative hospital stay was 3.0 (2.0, 4.0) d. Postoperative complications occurred in 3 patients, including 2 patients with transient Honor syndrome and 1 patient with transient anhidrosis of the affected upper limb. Conclusion RATS for posterior mediastinal neurogenic tumours is safe, effective and feasible, and allows the full benefit of the robotic surgical system to be exploited.