Objective To study the safety,feasibility and efficacy of trans-diaphragm thoracoscopic hepatectomy for liver carcinoma.Methods Thoracoscopic hepatectomy was performed in 5 cases with single liver neoplasm from Jan 2016 to Aug 2018,including hepatocellular carcinoma (HCC) in 4 cases and metastatic liver cancer in 1 case.During the operation,the diaphragm just above the tumor was opened.Then we completely removed the tumor.After meticulous hemostasis of cut surface,the diaphragm was closed.A thoracic drain was placed.Results Thoracoscopic hepatectomy was performed successfully in all 5 cases,the median total operating time was 140 min (120-230 min),and the median blood loss was 300 ml (200-500 ml),Patients recovered quickly.One patient had pleural effusion and recovered after chest drainage.There were not other major post-operative complications.During 6 to 31 months' follow-up,one patient was lost to follow-up,two patients were survival with tumor recurrence,two patients were recurrence free.Conclusions Thoracoscopic hepatectomy is a safe and feasible operation in selected liver cancer patients and has advantages in post-operative recovery.

Objective:To observe the regulatory effect of microRNA-10b(miR-10b)on the immune effect of glioma cells and explore its mechanism.Methods:Human glioma cell U251 was cultured to obtain cells in logarithmic growth stage.The cell suspen-sion was prepared according to the concentration of 1.0×105 cells/ml,and the control group,overexpression group,low expression group and blank group were set up,with 6 wells in each group.The negative control,miR-10b mimics and miR-10b inhibitor were transfected by liposome transfection in control group,overexpression group and low expression group,respectively.The blank group was given the same amount of sterile normal saline.Natural killer(NK)cells from peripheral blood of a healthy volunteer was isolated and cultured.The killing activity of NK cells was detected by MTT method.The expression of NK cell activated receptor(NKG2D)on the surface of NK cells in each group were detected by flow cytometry,and the expression of major histocompatibility complex class Ⅰ chain-related gene A(MICA),UL16 binding protein 2(ULBP2)and UL16 binding protein 3(ULBP3)on the surface of U251 hu-man glioma cells in each group were detected.Results:The transfection efficiency of control group,overexpression group and low ex-pression group were(93.55±2.05)％,(95.67±3.14)％,(94.18±3.26)％,respectively.Compared with control group and blank group,the expression of miR-10b increased in overexpression group and decreased in low expression group,and the difference were statisti-cally significant(P<0.05).There was no significant difference in the expression of miR-10b between control group and blank group(P>0.05).Compared with control group and blank group,the killing activity of NK cells with different effect target ratios in overex-pression group decreased,the expression of NKG2D decreased,the killing activity of NK cells with different effect target ratios in low expression group increased,and the expression of NKG2D increased,and the difference were statistically significant(P<0.05).The killing activity of NK cells in each group increased with the increase of effect target ratio,and the difference were statistically signifi-cant(P<0.05),and there was no significant difference in NK cell killing activity and NKG2D expression between control group and blank group(P>0.05).Compared with control group and blank group,the expression of MICA,ULBP2 and ULBP3 on the surface of human glioma cell U251 in overexpression group decreased,and the expression of MICA,ULBP2 and ULBP3 on the surface of human glioma cell U251 in low expression group increased,the difference were statistically significant(P<0.05),and there was no signifi-cant difference in the expression of MICA,ULBP2 and ULBP3 on the surface of U251 glioma cells between control group and blank group(P>0.05).Conclusion:Inhibiting the expression of miR-10b can increase the expression of NKG2D on the surface of NK cells and MICA,ULBP2 and ULBP3 on the surface of human glioma cell U251,and enhance the killing activity of NK cells against human glioma cell U251.

Objective:To investigate the application value of laparoscopic intra-gastric surgery (LIGS) in the treatment of gastrointestinal stromal tumors (GIST) around the cardia.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 5 patients who underwent LIGS for GIST around the cardia in the Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2019 to December 2021 were collected. There were 3 males and 2 females, aged 52(range, 35?69)years. All patients underwent LIGS. Observation indicators: (1) intraoperative and postoperative conditions; (2) follow-up. Follow-up was conducted using tele-phone interview or outpatient examination. Patients were followed up once every 3 months to detect long-term complications and tumor recurrence up to April 1st, 2022. Measurement data with skewed distribution were represented as M(range) and count data were described as absolute numbers. Results:(1) Intraoperative and postoperative conditions. All 5 patients underwent LIGS successfully, without conversion to laparotomy or changes in surgical methods. Intraoperative tumor exploration showed that the tumor was located on the lesser curvature of the cardia in 3 patients and on the posterior wall of the gastric fundus in 2 patients. The distance between the tumor and the dentate line of the cardia was 1.5(range, 1.0?3.0)cm. Of the 5 patients, 3 cases with tumor patholo-gically evaluable margins as 0.3, 0.8, and 1.5 cm and 2 cases without tumor pathologically evaluable margins but the tumor had an intact capsule. The operation time, volume of intraoperative blood loss, time to postoperative first anal exsufflation, time to postoperative initial fluid diet intake, time to extubation and duration of postoperative hospital stay were 75(range, 65?112)minutes, 25(range, 15?70)mL, 2(range, 1?3)days, 3(range, 2?4)days, 4(range, 3?5)days and 6(range, 5?8)days in the 5 patients. There was no short-term postoperative complication such as bleeding, anastomotic leakage, and gastroparesis in the 5 patients and results of postoperative histopathological examina-tion showed GIST in all 5 patients, with tumor diameter as 3.0(range, 1.8?5.5)cm. There were 2 patients with tumor diameter ≤2.0 cm and 3 patients with tumor diameter ≥3.0 cm. The 5 patients were classified as very low risk in 2 cases, low risk in 2 cases, and intermediate risk in 1 case. (2) Follow-up. All 5 patients were followed up after operation, with the follow-up time of 9(range, 3?15)months. During the follow-up, there was no long-term complication such as dysphagia and gastroesophageal reflux, and no recurrence or metastasis of tumor occurred in patients by computed tomography examinations.Conclusion:LIGS can be used for the treatment of GIST around the cardia.

BACKGROUND:The medial patellofemoral ligament reconstruction is the most commonly used method for the treatment of lateral dislocation of patella at present.The ultimate goal is to adjust the patella to the normal anatomical position and restore the patella track.Currently,the main core problem of medial patellofemoral ligament reconstruction is the selection of its femoral end fixation point. OBJECTIVE:Finite element method was used to analyze the limiting effect of the reconstructed medial patellofemoral ligament on the patella at different flexion angles of the knee joint,and to simulate the limiting effect of medial patellofemoral ligament reconstruction at different fixation points of the femoral end on the patellofemoral end,so as to provide help for the selection of fixation points of the femoral end during the reconstruction of the medial patellofemoral ligament. METHODS:A finite element model of knee including bone and soft tissue was established according to the extracted CT and MRI data of knee joint.When the knee flexion angle of 30° and 60° was simulated,the medial patellofemoral ligament was constructed by selecting different fixation points of femur end.The contact stress and contact area between patellofemoral joints at different points were compared,as well as the transverse binding force on patella.The equilength of the medial patellofemoral ligament constructed from the same fixation point of the femoral end at different flexion angles was verified to study the effect of various reconstruction positions of the medial patellofemoral ligament. RESULTS AND CONCLUSION:(1)A three-dimensional finite element model of the knee joint at 30° and 60° flexion angles was established to construct the medial patellofemoral ligament at different fixation points of the femur end.The medial patellofemoral ligament constructed at the same position of the femur end had usable isometric length at different flexion angles.(2)After the lateral displacement of the patella,in the transverse direction,the medial patellofemoral ligament constructed at different fixed points of the femur end produced different transverse binding force on the patella,and the transverse binding force was maximum at the anterior 10 mm and minimum at the proximal 5 mm.In the longitudinal direction,the location and size of stress concentration points on the patella cartilage were roughly the same,and the contact pressure did not change much.However,the contact area between the patella cartilage and the femoral cartilage was significantly different,with the maximum contact area at 10 mm at the front end and the minimum contact area at 5 mm at the proximal end.(3)The medial patellofemoral ligament constructed at the center of the saddle region has a good lateral restriction on the patella,but does not cause excessive restriction on the patella in the longitudinal restriction,and can achieve a good restriction on the patella.

BACKGROUND:The injury of the anterior talofibular ligament is most common in joint ligament injuries.The use of the finite element method to simulate ankle joint motion has the advantages of short experimental time,complex boundary conditions that can be simulated,and mechanical properties. OBJECTIVE:To analyze the effect of the anterior talofibular ligament on the stress distribution of the talus trochlea and the stability of the ankle joint. METHODS:A finite element model of the ankle was established based on CT and MRI images of patients with anterior talofibular ligament injury who were followed up for two months after Brostr?m surgery to simulate ankle joint stress in patients with anterior talofibular ligament injury before and after surgery during normal gait cycles(ground phase,neutral phase,and off-ground phase).The stress distribution and maximum stress value of the talus bone cartilage were measured before and after surgery,and their differences were analyzed. RESULTS AND CONCLUSION:Under normal gait,the anterior talofibular ligament has a certain protective effect on the talus trochlea in any position,reducing the wear of the ankle joint on the talus trochlea during movement.In all three phases,stress concentration was observed on the surface of the talus trochlea near the inner side of the ankle joint.The influence of the anterior talofibular ligament on the stability of the talus trochlear is much greater in the off-ground phase than in the ground phase and neutral phase.Under certain circumstances,the greater the torque on the ankle joint,the more significant the effect of the anterior talofibular ligament on the stability of the talus trochlea.

Objective:To compare the efficacy of single-agent versus multi-agent adjuvant chemotherapy after radical gastrectomy for elderly patients with stage Ⅲ gastric cancer.Methods:The propensity score matching and retrospective cohort study were conducted. The clinicopatholo-gical data of 456 elderly patients with stage Ⅲ gastric cancer who underwent D 2 radical resection in the Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine from January 2016 to December 2020 were collected. There were 343 males and 113 females, aged 71(range, 65?89)years. Of the 456 patients, 274 cases undergoing single-agent adjuvant chemotherapy after surgery were divided into single-agent chemotherapy group, 182 cases undergoing double-agent or triple-agent adjuvant chemotherapy after surgery were divided into multi-agent chemotherapy group. Observa-tion indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) adverse events during chemotherapy; (3) follow-up. Propensity score matching was done by the 1∶1 ratio, with the caliper value of 0.05. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data between groups was conducted using the non-parameter rank sum test. The Kaplan-Meier method was used to draw survival curves and calculate survival rates, and the Log-Rank test was used for survival analysis. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of 456 patients, 306 cases were successfully matched, including 153 cases in the single-agent chemotherapy group and 153 cases in the multi-agent chemotherapy group. The elimination of age, age-adjusted Charlson comorbidity index, pathological TNM staging confounding bias ensured comparability between the two groups after propensity score matching. (2) Adverse events during chemotherapy. In terms of hematological adverse events, 6 cases in the single-agent chemotherapy group and 16 cases in the multi-agent chemotherapy group had neutropenia, showing a significant difference in the neutropenia ( χ2=4.90, P<0.05). In terms of non-hematological adverse events, cases with anorexia and nausea were 77 and 50 for the single-agent chemotherapy group, versus 96 and 69 for the multi-agent chemotherapy group, showing significant differences between the two groups ( χ2=4.80, 4.96, P<0.05). (3)Follow-up. All the 306 patients were followed up for 48(range, 8?61)months. The 5-year overall survival rates of the single-agent chemotherapy group and the multi-agent chemotherapy group were 36.08% and 38.31%, respectively, showing no significant difference between the two groups ( hazard ratio=0.93, 95% confidence interval as 0.70?1.20, P>0.05). Results of further analysis showed that the 5-year overall survival rates were 32.41% and 39.40% for 97 patients of the single-agent chemotherapy group and 97 patients with double-agent regimen of the multi-agent chemotherapy group, respectively, showing no significant difference between them ( hazard ratio=1.20, 95% confidence interval as 0.82?1.70, P>0.05). The 5-year overall survival rates were 43.15% and 37.11% for 56 patients of the single-agent chemotherapy group and 56 patients with triple-agent regimen of the multi-agent chemotherapy group, respectively, showing no significant difference between them ( hazard ratio=0.81, 95% confidence interval as 0.65?1.00, P>0.05). Conclusions:For adjuvant chemotherapy in elderly patients with stage Ⅲ gastric cancer, there is no significant survival advantage of double-agent or triple-agent chemotherapy over single-agent oral chemotherapy. However, there is a higher incidence of neutropenia, anorexia, ausea.