The diagnostic rate of intraductal papillary mucinous neoplasms (IPMNs) has been increased as the improvement of imaging and endoscopic techniques.All main duct type and mixed variant IPMNs should be resected as long as the patient is a good surgical candidate with reasonable life expectancy.Evaluation of resection margin ( especially circumferential margins) is very important to prevent the recurrence of IPMNs,and intraoperative pancreatoscopy plays an important role in determining the appropriate size for pancreatic resection.In this article,the experience in the treatment of 1 patient with IPMNs by precise pancreatectomy guided by endoscopy-assisted intraoperative pancreatic duct inspection was introducted.

BACKGROUNDTo evaluate the clinical significance of predicting post-operative respiratory failure in patients with lung cancer using cardiopulmonary exercise test (CPET).

METHODSBefore operation, 260 patients with lung cancer underwent CPET with incremental protocol. W%, VO₂%P, VO₂/kg, AT, MET, O₂ pulse, VTe, BF and VE were measured in the end of load exercise.

RESULTS(1) In patients after pneumonectomy, the values of the above indexes of CPET in the respiratory failure group were significantly lower than those in the non-respiratory failure group ( P < 0.05 or P < 0.01) except VTe. In patients after lobectomy, the values of 9 indexes of CPET in the respiratory failure group were similar to those in the non-respiratory failure group ( P > 0.05). However, when the patients after lobectomy were further divided into groups of upper and lower lobectomy, W% in the respiratory failure group was remarkably lower than that in the non-respiratory failure group after lower lobectomy ( P < 0.05). (2) Chi-Square test showed that abnormality of CPET indexes in different degrees was related to the morbidity of respiratory failure after pneumonectomy. Logistic regression showed that O₂ pulse < 80% and BF < 30/min correlated with the morbidity of post-operative respiratory failure. (3) For predicting post-operative respiratory failure, the sensitivity and specificity of VO₂%P < 60%, BF < 30/min, VE < 35 L/min were all more than 60% and their negative predictive values were all more than 90%.

CONCLUSIONSCPET is suitable to predict post-pneumonectomy respiratory failure. As a comprehensive index indicating cardiopulmonary function during exercise, VO₂%P < 60% should be selected to predict respiratory failure and evaluate indication of lung resection for patients with lung cancer.

BACKGROUNDTo explore the characteristics of exercise cardio-pulmonary function and its possible influencing factors in patients with lung cancer.

METHODSThe pulmonary function, ECG and exercise cardio-pulmonary function were measured in 198 patients with lung cancer and 20 healthy controls.

RESULTS1. Compared with healthy group, VO₂%P, VO₂/kg, AT, VO₂/HR%, VE and VT/VC significantly decreased in lung cancer patients with normal resting pulmonary ventilation, however, BR remarkably increased (P < 0.05 or P < 0.01). 2. In patients with normal resting pulmonary ventilation, there was no significant difference of exercise cardio-pulmonary function between the central and peripheral lung cancer groups. 3. The exercise cardio-pulmonary function was closely related to the TNM stages (P < 0.05 or P < 0.01). 4. W%, VO₂%P , AT and VO₂/HR% in patients with great vessel invasion were remarkably lower than those without great vessel invasion (P < 0.05 or P < 0.01).

CONCLUSIONSThe results suggest that exercise ventilation is impaired in lung cancer patients with normal resting ventilation. And the decrease of exercise cardio-pulmonary function may be related to TNM stage and to great vessel involvement.

Among digestive malignancies, compared with gastrointestinal tumors, biliary and pancreatic tumors are difficult to diagnose in the early stage and have fewer opportunities for radical surgical resection, with a shorter survival time and poorer quality of life, and the clinical diagnosis and treatment of such tumors remain a difficult issue that needs to be solved urgently in clinical practice. Based on the different locations and features of biliary and pancreatic tumors, the SELECT concept selects the optimal combination of minimally invasive endoscopies (laparoscopy, choledochoscopy, duodenoscopy, Spyglass, and endoscopic ultrasound) and applies traditional Chinese medicine treatment in the perioperative period, so as to achieve early diagnosis and treatment, prolong the survival time with tumor, improve quality of life, and strive to realize the goal of cure.

Hepatolithiasis is difficult to treat in clinical practice and has high recurrence rate and incidence rate of complications, improper diagnosis and treatment can easily lead to hepatic insufficiency, and thus it has become one of the difficult problems to be solved in clinical practice. With the improvement of medical equipment and the wide application of various minimally invasive endoscopic techniques, most patients with hepatolithiasis can receive effective treatment. Traditional Chinese medicine therapy can prevent the recurrence of calculi and promote patients’ recovery during the perioperative period. Based on the SELECT (Spyglass, ERCP, Laparoscopy, EUS, Choledochoscopy, Traditional Chinese Medicine) concept, minimally invasive treatment with a combination of various endoscopies should be selected according to the type and clinical features of hepatolithiasis and integrated traditional Chinese and Western medicine therapy should be given in the perioperative period to realize the minimally invasive, diversified, and individualized integrated traditional Chinese and Western medicine therapy for hepatolithiasis.

Hepatobiliary and pancreatic diseases are common and frequently occurring diseases in the digestive system, and several hepatobiliary and pancreatic diseases are difficult to diagnose and treat, with a high incidence rate of complications. With the development of minimally invasive devices and instruments and the application of various laparoscopic/endoscopic techniques, most hepatobiliary and pancreatic diseases can be diagnosed and treated by minimally invasive techniques. Traditional Chinese medicine plays an important synergistic role during the perioperative period for hepatobiliary and pancreatic diseases and can accelerate the recovery of patients. The team of Liaoning Provincial Center for Integrated Traditional Chinese and Western Medicine Therapy for Biliary and Pancreatic Diseases led by the authors has mastered various laparoscopic and endoscopic techniques and proposed the concept of SELECT (Spyglass, ERCP, Laparoscopy, EUS, Choledochoscopy, and traditional Chinese medicine) by summarizing the successful experience in the treatment of hepatobiliary and pancreatic diseases in recent years. The optimal combination of minimally invasive multi-endoscopic techniques is selected based on the features of different hepatobiliary and pancreatic diseases, and traditional Chinese medicine treatment is also applied in the perioperative period, so as to achieve minimally invasive, individualized, and precise integrated traditional Chinese and Western medicine therapy for hepatobiliary and pancreatic diseases.

Acute pancreatitis (AP) is one of the common digestive diseases. With the advances in technology, the treatment concept of AP has changed, more and more minimally invasive techniques have been applied in the treatment of AP, especially severe acute pancreatitis (SAP). Although there are various different minimally invasive treatment methods for AP, no reliable clinical studies have reported that one technique is significantly better than others. The therapeutic effect of integrated traditional Chinese and Western medicine therapy in acute pancreatitis (AP) has been widely recognized. In recent years, our team has accumulated rich experience in integrated traditional Chinese and Western medicine therapy for AP and has proposed the innovative SELECT concept (Spyglass, ERCP, Laparoscopy, EUS, Choledochoscopy, and Traditional Chinese Medicine) for diagnosis and treatment. The optimal combination of various endoscopies is SELECTed based on the severity and etiology of AP, and traditional Chinese medicine treatment can be used as well to realize the advantages of minimally invasive integrated traditional Chinese and Western medicine therapy in the treatment of AP. This article elaborates on the minimally invasive treatment methods for each clinical stage of SAP based on the SELECT concept.

CCAAT enhancer binding protein β (C/EBPβ), as a nuclear transcription factor necessary for the development of liver, airway epithelium, and adipose tissue, plays a vital role in physiological processes related to cell proliferation, apoptosis, and differentiation. However, the up-regulation of C/EBPβ activates signal pathways related to inflammatory response, epithelial-mesenchymal transition, cell proliferation and invasion, immune response, and angiogenesis by regulating a series of downstream genes transcription promotes the development of lung diseases. Therefore, targeting C/EBPβ may be a potential treatment strategy for lung diseases. This paper summarizes the regulatory effects of C/EBPβ and related signaling pathways in lung infection, asthma, chronic obstructive pulmonary disease, lung injury, pulmonary fibrosis, and lung cancer to provide a theoretical basis for the precision medicine of lung diseases.

Objective:To compare the early therapeutic effects of internal fixation with percutaneous minimally invasive hollow nail assisted by electromagnetic navigation robot and guided by C-arm in the treatment of Tile type C pelvic fracture.Methods:A retrospective cohort study was conducted to analyze the clinical data of 32 patients with Tile type C pelvic fracture admitted to Weihai Central Hospital from January 2020 to March 2022, including 18 males and 14 females; aged 36-60 years [(44.1±3.9)years]. Among them, 17 patients were treated with internal fixation with percutaneous minimally invasive hollow nail assisted by electromagnetic navigation robot (electromagnetic navigation group), and 15 with internal fixation with percutaneous minimally invasive hollow nail guided by C-arm (C-arm guidance group). Operative time, intraoperative blood loss, sacroiliac screw placement time, pubic branch screw placement time, ambulation time and fracture healing time were compared between the two groups. Visual analog scale (VAS), Majeed function score and complication rate at 1 day, 6 months, 12 months after surgery and at the last follow-up were compared between the two groups.Results:All the patients were followed up for 12-24 months [(15.4±0.5)months]. The operative time and intraoperative blood loss in the electromagnetic navigation group were (42.0±2.5)minutes and (10.9±2.6)ml, shorter or less than (50.0±3.5)minutes and (14.9±3.1)ml in the C-arm guidance group (all P<0.01). The placement time of sacroiliac screw and pubic branch screw in the electromagnetic navigation group was (12.4±0.2)minutes and (10.1±0.3)minutes, shorter than (15.3±0.3)minutes and (13.2±0.3)minutes in the C-arm guidance group (all P<0.01). The ambulation time was (3.2±0.4)weeks in the electromagnetic navigation group, earlier than (3.5±0.4)weeks in the C-arm guidance group ( P<0.05). There was no significant difference in fracture healing time between the two groups ( P>0.05). VAS scores of the electromagnetic navigation group were (4.4±0.3)points and (1.1±0.1)points at 1 day and 6 months after surgery respectively, lower than those of the C-arm guidance group [(4.8±0.4)points and (1.2±0.3)points] ( P<0.05 or 0.01). Majeed function scores of the electromagnetic navigation group were (37.3±1.1)points and (88.5±1.4)points at 1 day and 6 months after surgery respectively, higher than those of the C-arm guidance group [(30.7±4.2)points and (82.6±1.8)points] (all P<0.01). There were no significant differences in VAS and Majeed scores at 12 months after surgery and at the last follow-up between the two groups (all P>0.05). There was no significant difference in the incidence of postoperative complications between the two groups ( P>0.05). Conclusion:Compared with C-arm guidance, electromagnetic navigation robot-assisted internal fixation with percutaneous minimally invasive hollow nail for Tile type C pelvic fracture can reduce operative time and intraoperative blood loss, shorten screw placement time and ambulation time, relieve pain and improve functional recovery at early stage.

Motor imagery (MI) is an important paradigm of driving brain computer interface (BCI). However, MI is not easy to control or acquire, and the performance of MI-BCI depends heavily on the performance of the subjects' MI. Therefore, the correct execution of MI mental activities, ability evaluation and improvement methods play important and even critical roles in the improvement and application of MI-BCI system's performance. However, in the research and development of MI-BCI, the existing researches mainly focus on the decoding algorithm of MI, but do not pay enough attention to the above three aspects of MI mental activities. In this paper, these problems of MI-BCI are discussed in detail, and it is pointed out that the subjects tend to use visual motor imagery as kinesthetic motor imagery. In the future, we need to develop some objective, quantitatively visualized MI ability evaluation methods, and develop some effective and less time-consumption training methods to improve MI ability. It is also necessary to solve the differences and commonness of MI problems between and within individuals and MI-BCI illiteracy to a certain extent.
Algorithms ; Brain-Computer Interfaces ; Electroencephalography ; Humans ; Imagery, Psychotherapy ; Imagination