Objective To analyze the clinical outcomes of extended thymectomy for myasthenia gravis (MG) patients under different surgical approaches, and to determine the factors affecting the prognosis of MG. Methods The MG patients who underwent extended thymectomy from January 2014 to March 2021 in our hospital were retrospectively collected. According to the surgical approach, they were divided into a subxiphoid group and an intercostal group, and the perioperative results and prognosis were compared between the two groups. A “good outcome” was defined as complete stable remission (CSR), pharmacological remission (PR) or minimal manifestations state (MMS); a “poor outcome” was defined as outcomes worse than MMS. Univariate and multivariate logistic regression analyses were performed to assess the factors associated with the good outcomes. Results A total of 187 MG patients were included in the study, including 82 males and 105 females, with a median age of 50 (36, 60) years. There were 134 patients in the intercostal group and 53 patients in the subxiphoid group. Compared with the intercostal group, although the operation time of the subxiphoid group was longer [200.0 (172.0, 232.0) min vs. 141.0 (118.0, 169.0) min, P<0.001], the intraoperative blood loss was less [10.0 (10.0, 20.0) mL vs. 20.0 (10.0, 50.0) mL, P<0.001], the postoperative hospital stay was shorter [3.0 (2.5, 4.0) d vs. 5.0 (3.0, 7.0) d, P<0.001], and the incidence of complications was lower [1 (1.9%) vs. 26 (19.4%), P=0.001]. A total of 159 (85.0%) patients were followed up for a median period of 46 (13, 99) months, with a good outcome rate of 90.6% and CSR rate of 33.3%. There were no statistical differences in PR, MMS or overall good outcome rates between the two groups (P>0.05). Multivariate logistic analysis showed that age≤50 years was an independent predictor for "good outcome" of MG patients. Conclusion Extended thymectomy via subxiphoid for MG is a safe, feasible and effective surgical approach.

Interventional medicine plays an important role in the diagnosis and treatment of cardiovascular and cerebrovascular diseases, hepatobiliary tumors and other diseases, which has become the third largest type of treatment technology besides internal and surgical treatment. In recent years, with technological breakthroughs in imaging technology, robotic surgical system, artificial intelligence, Internet of Things and other fields, unprecedented opportunities have been provided for interventional/minimally invasive+robotics. Interventional robotic surgical systems have mushroomed around this field. The authors discuss the current status and future of interventional robotic surgical system with high recognition worldwide, especially the three categories of specialized robotic surgical system for vascular intervention, percutaneous puncture intervention and natural non-vascular luminal intervention.

Interventional therapy has become an important palliative therapy for advanced liver cancer, and meanwhile, interventional therapy is playing an important role in the downstaging of liver cancer. Local interventional therapy can help patients meet the criteria for transplantation or resection by reducing tumor volume and number in patients with advanced liver cancer. Interventional downstaging techniques include transarterial chemotherapy, drug-eluting beads, transarterial radioembolization, and various ablation techniques (radiofrequency ablation, microwave ablation, cryoablation, and ethanol ablation). No consensus has been reached on the optimal interventional downstaging strategy, while high-level evidence-based clinical studies are needed to screen out the optimal candidates for different methods and evaluate the complexity, safety, and long-term efficacy of subsequent liver transplantation after interventional downstaging therapy, so as to improve the effect of interventional therapy in the downstaging of advanced liver cancer.

Objective: To investigate the value of the folate receptor (FR)-positive circulating tumor cell (CTC) detection in the diagnosis of benign and malignant subcentimeter pulmonary nodules(the maximum diameter ≤10 mm). Methods: Thirty-seven patients with subcentimeter pulmonary nodules (the chest CT showed the maximum diameter was ≤10 mm) in the Xuanwu Hospital of Capital Medical University from July to December 2018 were collected. Among them, 22 cases were diagnosed with early stage lung adenocarcinoma by postoperative pathological diagnosis and another 15 cases were benign lung lesion. Venous blood samples from these patients were collected before surgery and then utilized to detect FR⁺ CTC level (defined unit as FU/3 ml) by novel ligand-targeted polymerase chain reaction (LT-PCR), and the enzyme-linked immunosorbent assay was used to detect the levels of tumor markers, including carcinoembryonic antigen (CEA), neuron-specific enolase(NSE), cytokeratin 19 fragment CYFRA21-1, carbohydrate antigen 125 (CA125), CA199, pro-gastrin releasing peptide (pro-GRP), etc. The t-test was used to compare the measurement values between the groups. The CTC value 8.70 FU/3 ml described in the detection kit instruction was used as the threshold. The binary logistic regression was used to analyze the risk factors of malignant pulmonary nodules. The kappa consistency test was used to identify the consistency of the diagnosis results obtained by the FR⁺ CTC level and the pathological results of surgically resected specimens. The receiver operating characteristic curve (ROC) was drawn to evaluate the efficiency of each index for the diagnosis of benign and malignant subcentimeter pulmonary nodules. Results: The level of FR⁺ CTC in patients with early stage lung cancer was higher than that in patients with benign lung lesion, and the difference was statistically significant [(11.0±3.0) FU/3 ml vs. (7.0±3.7) FU/3 ml, t=-3.327, P = 0.001]. The level of FR⁺ CTC was not related to the age, gender and smoking history of patients (all P>0.05). Logistic regression analysis indicated that high-level FR⁺ CTC was one of the risk factors for malignant pulmonary nodules (OR = 37.333, 95% CI 3.994-349.010, P = 0.002). The kappa consistency test indicated that the level of FR⁺ CTC used for the diagnosis of lung subcentimeter nodules presented a certain accuracy (κ = 0.627, P < 0.01). ROC illustrated that the FR⁺ CTC was better than CEA, NSE and CYFRA21-1 when it was used as an indicator for the diagnosis of malignant pulmonary nodules. The area under the curve(AUC) of FR⁺ CTC was 0.830 (95% CI 0.639-0.968), and the diagnostic sensitivity and specificity were 72.7% (95% CI 49.6%-88.4%) and 93.3% (95% CI 66.0%-99.7%), respectively. When FR⁺ CTC, CEA, NSE and CYFRA21-1 were combined for lung cancer diagnosis, the AUC, sensitivity and specificity were 0.776 (95% CI 0.614-0.938), 86.4% and 73.3%, respectively. Conclusion The detection of FR⁺ CTC has a high value in the diagnosis of benign and malignant subcentimeter pulmonary nodules.

Objective To investigate the feasibility and preventive effect of benign esophageal restenosis by binding 125I seeds to upper esophageal stent through animal experiments.Methods Eight 125I seeds were evenly bound to upper normal esophageal stents for the animal experiments.A total of 32 beagle dogs were randomly assigned to 2 groups:experimental group,implanted with esophageal stents with eight 125I seeds (33.3 MBq),and the control (stents without 125I seeds).Four dogs of each group were killed at the 1 st,2nd,4th,and 8th week after imaging studies.The tissue of 2 cm upper stent underwent pathology analysis.Results All the novel stents were successfully implanted.No radioactive leak was detected by ECT.The lumen diameter of the top stent showed the tract gradually narrowed and at the 4th and 8th weeks,the experiment group narrowed more seriously compared with the control group and the difference was statistically significant (P ＜ 0.05).PCNA,ot-SMA mean optical density were significantly different in the 4th week.Both hydroxyproline and total amino acid increased progressively,with significant difference at the 4th and 8th weeks.The macroscopic and optical findings of the trachea and major vessels were basically the same in both groups.Conclusion The novel stent is feasible and safe for preventing benign esophageal restenosis and preventing benign esophageal stent restenosis.

Objective To explore the impact of the variable number of tandem repeats of monoamine oxidase A gene (MAOA-uVNTR) on the concentration of gray matter in patients with major depressive disorders.Methods 56 cases of depression, as well as 37 healthy controls who were matched in gender, age and years of education were divided into low-activity genotype (3R or 3R/4R), and high-activity genotype (4R) with the methods of polymerase chain reaction (PCR) amplification and 1.5％ agarose gel electrophoresis separation. 93 cases all were performaned structural magnetic resonance imaging scanning. Results ① The difference of genotype and allele frequency between the depression group and the healthy group was not statistically significant(P＞0.05 ). ②Compared with the healthy,the concentration of gray matter( GMC ) of bilateral caudate nucleus (K = 11/68, Z =3.76/4.76 ), bilateral thalamus ( K = 21/181, Z = 3.26/3.63 ) and right hypothalamus ( K = 38/12, Z = 4.20/3.60) reduced significantly in depressed patients. ③ In patients with depression, cases with the high-activity genotype showed reduced GMC bilateral caudate nucleus (K = 17/33, Z = 3.23/4.36 ), left putamen ( K = 16, Z =3.42 ) and right hypothalamus( K = 12, Z = 3.62 ) in comparision with patients with low-activity genotype. In highactivity genotype group,compared with the healthy,patients with depression had reduced GMC in left caudate nucleus ( K = 11, Z = 4.13 ), bilateral thalamus ( K = 13/14, Z = 3.53/3.23 ) and left parahippocampal gyrus ( K = 13,Z = 4.04). Conclusion High-activity genotype may be an important factor contributing to the structural abnormalitily of the limbic-striatum-globus pallidus-thalamus loop.

Objective To investigate the effects of intratumoral implantation of ~(32)P-CP-PLLA seeds on the normal canine liver tissue and to exolore the metabolism of ~(32)P-CP-PLLA seeds implanted in the liver of experimental dogs.Methods Twelve beagles were enrolled in this study.The dogs were randomly and equally divided into four groups:group A(185 MBq),group B(370 MBq),group C(740 MBq)and group D(0 MBq).By using laparotomy procedure ~(32)P-CP-PLLA seeds were implanted into dog's liver.CT scan was performed before operation as well as before the dog was sacrificed.All dogs were sacrificed three months after the implantation.Before the procedure and 1,2,4,8 and 12 weeks after the procedure the blood tests and serum biochemical tests were conducted.One dog from group B and group C was selected respectively and was fed in a metabolic cage.Within one month after the procedure the cpm in feces and in urine was determined every 24 hours.One dog was picked out from each of the three groups and was punctured to get its liver tissue for pathologic exam each time at 1,2,4,8 and 12 weeks after the implantation,and SPECT imaging was also performed at the same time.Pathologic study,both macroscopic and microscopic(including optical and electronic microscopy)was made to observe the liver damage after the dog was sacrificed.The statistical analysis was processed by using SPSS 13.0 software and the measuring data were expressed with mean±standard deviation((x)±s).Results Two months after the procedure,serological examination found that the serum alkaline phosphatase(BKP)in both group Band group C was significantly higher than that in other groups,the difference was statistically significant (P ＜0.05),and the BKP levels returned to normal in three months.The postoperative 30-day inspection of the urine showed that the radioactive particles slowly released into the body and eliminated from the body with the urine and feces,mainly through the renal excretion.The 30-day cumulative percentage of eliminated radioactive dose in the urine and in the feces was 6.34% and 11.64% respectively.No sign of particle displacement was found on SPECT imaging.On autopsy three months after the implantation,the size of the radioactive seeds became smaller and fragile.With the radioactive dose used increasing,the area of liver damage at the site of seed implantation became bigger,which was demonstrated on CT scan,macroscopic exam and pathologic study.The local damaged focus of the liver caused by ~(32)P-CP-PLLA seeds was manifested as a spherical lesion which was encysted by a layer of fibrous tissue with an edematous zone peripherally.Conclusion The implantation of ~(32)P-CP-PLLA seeds in dog's liver causes only localized hepatic damage with no general adverse effects.The implanted seeds can slowly release the radioactive dose and will not immigrate to other organs in the body.Besides,the seeds possess excellent stability,targeted orientation and safety.

Objective To examine the white matter micro structural changes of hippocampus in the mid-die-aged major depression, and hypothesis that the hippocampal neurogenesis during the effective antidepressants can be found by diffusion tensor imaging(DTI) technology. Methods Middle-aged patients with major depression were enrolled, twenty patients received open but controlled with SSRIs for 10 weeks,twenty age, gender, education-matched healthy controls were involved as control group. All the subjects were scanned by DTI,using both whole-brain,voxel-based analysis(VBA) and Regions of interests (ROIs) methods to analyze the data. Results The VBA analysis found the post treatment patients made significant improvement in the fight inferior frontal lobe, left cingulate gyms of iimbic lobe and the right sub-gyral of occipital,but no significant difference in the hippocampus were found between any groups (all P<0.01, cluster>20). For the hippocampal relative FA of ROIs analysis,there were no significant difference between the patients before and after treatment, even no difference between the prior-treatment patients and healthy control,the remitted patients and the healthy controls(P<0.05). Conclusions Micro structural white matter changes in the frontal gyms, temporal and cingulated gyms are associated with mid-die-aged depression,no changes were found in the hippocampus. These findings do not support the hypothesis that the hippocampal neurogenesis can be found by DTI technology.

Objective To investigate the trans-arterial delivery of p53 gene transfection efficiency and therapy effect on hepatic carcinoma in combination with transferrin mediated by liposome. Methods Twenty-five VX2 experimental rabbits were randomly divided into five groups, and the different doses of transferrin combined with p53-LipofectAMINE complex were delivered into the hepatic arteries of the VX2 hepatic carcinoma models. The tissue protein of the carcinoma was extracted after 48 h and the transfection efficiency and expression rate of p53 gene were analyzed by western blot and immune histochemical techniques, to inspect the expression proportion of p53 with different doses transferring. Another ten VX2 were divided into two groups, recombinant plasmid p53-LipofectAMINE complex and transferrin-p53-LipofectAMINE complex were delivered into the hepatic arteries in two groups respectively. The liver function, size of the tumor and survival time of the animals was compared between the two groups, and results were analyzed statistically. Results Semiquantitative analysis by Western Blot showed that the transfection and expression efficiency of p53 gene combined with transferrin were higher than those without it. By immune histochemieal techniques, the p53 gene's positive rate of highly expression with various doses of transferrin were found to be different, and there was remarkable difference between the groups with and without transferring. They were 58. 33%, 69. 44%, 80. 00%, 83.33%, 81.67% respectively, there was remarkable difference between the groups with and without transferring ( Totality: x2 = 42. 37, P < 0. 01 ). The p53 gene's positive rate of expression increased gradually as the doses of transferrin increasing from 0 up to 200 μg, but the differences of positive rate had no statistical significance as the doses of transferrin increasing from 200 up to 400 μg ( x2 section : 3 groups as former x2 = 4. 82, P < 0. 05,3 groups as latter x2 =0. 67 ,P <0. 05). There was no statistical difference in the liver function at points of time between VX2 rabbits with and without transferring. But the tumors' sizes had significant difference at various points of time. Conclusion Liposome-mediated p53 gene on treating hepatic carcinoma by trans-arterial gene delivery combined with transferrin is safe, and it can markedly enhance transfection efficiency and improve the therapy effect of p53 gene.

Objective To investigate the tissue characteristics within vascular stent and transjugular intrahepatic portosystemic shunt(TIPS)on swine and to provide more information for the understanding and prevention of vascular stent and TIPS restenosis.Methods Animal models for TIPS were built in 6 swine and vascular stents were implanted in iliac veins simultaneouly.14-28 days after the operation.the 6 swine were killed to remove the TIPS and vascular stent and the pathological examinations were performed on the tissues within the shunt and stent.The similarities and difierences of the tissues within the shunt and stent were analvzed with Kruskal Wallis test. Results Restenosis of TIPS occurred in 4 models and complete occlusion were seen in 2,while all vascular stents were patent and coated with a thin layer of intimal tissueElectron micmscopic results showed that the tissues in restenotic TIPS were loose and with more extra matrix and fibers.and less smooth muscle,fibroblastic and myofibroblastic cells with different and irregular shape and rich secretory granules.The tissues in patent,TIPS contained more extra fibers,smooth muscle and fibmblastic cells with normal organdie.The intimal tissues in vascular stent contained more fibers and fibroblasts cells.less smooth muscle cells.On immunohistoehemical staining,the tissues in restenotlc and Datent TIPS as well as the intimal tissues in vascular stent had strong positive expression for anti-SMCactin-α.the expression were gradually weakened for PCNA,the intimal tissues in vascular stent had a strong positive expression for vimentin,while the expression of the tissues in restenotic and patent TIPS were weakened gradually.For myoglobulin,the tissues in restenotic TIPS had weakly positive expression,the expression in patent TIPS and vascular stent were almost negative. Western blot results for TGF-β showed that the absorbance ratios of the intima tissues in vascular stent,normal vascular tissues,normal liver tissues.the tissues in restenotic and patent TIPS were 0.23,0,0,0.57 and 0.30 respectively,and they were significantiy different (H=27.8,P＜0.01).Conclusions The tissues in restenotic TIPS mainly contain proliferated SMCs which have positive expression for anti-SMC-actin-α,strong proliferation and movement but unstability.The tissues in patent TIPS and intimal tissues in Vascular stent mainly contain fibroblastie cells which have positive expression for vimentin and stability.