Objective:To observe the effectiveness of photon therapeutic instrument combined with magnesium sulfate on puerperants with hemorrhoids.Methods: Sixty eight puerperants cases with hemorrhoids were chosen and randomly divided into an observation group and a control group, each with 34 cases. In the control group, Mayinglong hemorrhoids suppository was used on the hemorrhoids. While in the observation group patients were given photon therapeutic instrument combined with magnesium sulfate on the hemorrhoids. The curative effectiveness, the scores of pain, breastfeeding rates were compared between the two groups.Results: After one course of treatment, the treatment effect of observation group was 91.18%, which was higer than control group that was 82.35%, the difference was statistically significant(x2=4.086,P<0.05). After one course of treatment, the scores of pain in observation group was lower than that in control group, the difference was statistically significant(t=2.773,P<0.05). During the four months of postpartum, the breastfeeding rates in observation group was higher than that in control group, the difference was statistically significant(x2=4.403,P<0.05).Conclusion: Treating by photon therapeutic instrument combined with magnesium sulfate on puerperants with hemorrhoids, can increase treatment effect, reduce the severity of pain, and enhance breastfeeding rates, is worthy of clinic application.

Objective To analyze the impact of lymphocyte subsets on chemotherapy efficacy and long-term survival of patients with advanced non-small cell lung cancer(NSCLC).Methods Totally 125 NSCLC patients who had received first-line chemotherapy including paclitaxel and pemetrexed with/without platinum were enrolled in this study.Lymphocytes from peripheral blood were collected before and after two cycles of first-line chemotherapy.Flow cytometry was performed to determine the expressions of 21 fluorescence-labeled lymphocyte subsets.Based on the imaging findings,chemotherapy efficacy was evaluated,and impact of the lymphocyte subsets on progression-free survival(PFS)and overall survival(OS)were analyzed.Results The baseline peripheral lymphocyte subsets showed no significant difference among groups receiving different treatment protocols(all P>0.05).After 2 cycles of chemotherapy,the percentage of CD4CD29lymphocytes was(16.87±5.28)% in progressive disease group,which was significantly lower than those in complete remission+partial remission group [(22.42±7.88)%,P=0.013] and stable disease group [(21.88±6.81)%,P=0.009].The median PFS was 7.07 months and median OS was 23.00 months.Cox multivariable regression analysis showed that the percentages of HLA-DR(HR:1.03,95%CI:1.01-1.05,P<0.001) and CDHLA-DRlymphocytes (HR:1.05,95%CI:1.01-1.08,P<0.001)were positively correlated with OS.Conclusions The rise of CD4CD29T lymphocytes in patients after chemotherapy indicates good chemotherapy efficacy.Higher percentage of HLA-DRand CD3HLA-DRlymphocytes in peripheral blood before chemotherapy predicts favorable prognosis.

Objective To investigate the alexithymia, mental health condition and their relationship in female rheumatoid arthritis patients. Methods Fifty-four female patients with rheumatoid arthritis and 50 healthy women were enrolled and assessed with Chinese version of the 20-item Toronto Alexithymia Scale (TAS-20) and the symptom checklist-90(SCL-90). Disease duration and DAS28 of the patients were also recorded and calculated. The data were statistical analyzed by t test between the two groups and other block groups. The association between TAS-20, SCL-90, duration and DAS28 was assessed using Spearman corre-lations. Results ① The TAS-20 total score and Tf1, Tf2, Tf3 factors score of female rheumatoid arthritis patients were significantly higher than those of the control group (57±9, 51±7, t=4.15, P<0.01); it was also the same with the total score and factors score of SCL-90 (beside the paranoid factor) between patients and control groups (165±50, 138±41, t=3.06, P<0.05). ② Correlation analysis showed significantly positive correlation between Tf1 factor and all factors of SCL-90, also between Tf3 factor and obsession-compulsion, interpersonal sensitivity, phobias and paranoid factors(P<0.05). ③ Only hostility factor was different between the higher TAS-20 total score group and the lower one. However, the obsession-compulsion, anxiety and phobias factors scores of the higher Tf1 score group were significantly higher than those of the lower one (P<0.05); The higher Tf3 score group was significantly different from the lower one in obsession-compulsion, interpersonal sensitivity, depression, hostility, paranoid and psychoticism factors (P<0.05). The Tf1 factor score of higher SCL-90 total score group was significant higher than that of the lower one (P<0.05). ④ There were significantly positive correlation between duration and depression and paranoid factors, also between
DAS28 and anxiety and paranoid factors (P <0.05). Conclusion There is obvious alexithymia and psychological problems in female rheumatoid arthritis patients; the Tf1 and Tf3 factors of TAS-20, duration and DAS28 are all major factors related to the psychological state.

Objective To investigate the influence factors on length of ICU stay in cardiac rupture patients after surgical repair.Methods A retrospective study was conducted and enrolled survived cardiac rupture patients admitted to ICU of Wuxi People's Hospital from January 2009 to January 2017.Clinical data of patients were recorded including age,causes,complications,blood transfusion,duration of mechanical ventilation,duration of vasoactive agent employment,and length of ICU stay.At the same time,the laboratory findings were documented including hemoglobin(Hb),hematocrit (Hot),serum creatinine,blood lactic acid and creatine kinase muscle b(CK-MB).Patients were divided into two groups according to length of ICU stay(A group ＞3 d,B group ≤ 3 d).Data were analyzed using SPSS20.0 and MedCalc software.Pearson correlation test and ROC curve were taken to analyze the predicting factors for the prognosis.Results Twenty-two patients were referred to ICU after operation and survived.The length of ICU stay varied from 2 to 12 d.The statistical analysis showed the levels of Hb and Hct in group A were lower than those in group B (P＜0.05);the levels of CK-MB and lactic acid in group A were higher than those in group B (P＜0.05);and larger volume of blood transfusion (P=0.002),higher complications (P=0.024),longer duration of mechanical ventilation (P=0.001) and longer duration of vasopressor application (P=0.003) were found in group A.Pearson correlation test showed Hb and Hct had negative correlation with duration of mechanical ventilation,duration of vasoactive agent application and length of ICU stay (P＜0.05),whereas the CK-MB and lactic acid had positive correlation with duration of mechanical ventilation,duration of vasoactive agent employment and length of ICU stay (P＜0.05).ROC curve showed lactic acid,Hct,and CK-MB all had significance in prediction of prolonged ICU stay,and there were no statistically significant differences in areas under the curve(AUC) among these three biomarkers (P＞0.05).With the employment of ROC curve,the optimal cut-off points of three biomarkers for clinical diagnosis were lactic acid ≥ 3.4 mmol/L,Hct ≤ 39％,CK-MB ≥ 58 U/L.Conclusion Hb,Hct,lactic acid,CK-MB,blood transfusion,complications,duration of mechanical ventilation,duration of vasoactive agent employment were factors influencing on length of ICU stay in cardiac rupture patients after operations.The levels of lactic acid,Hct,and CK-MB had significance in prediction of prolonged ICU stay.

Objective:To summarize the strategy of using extracorporeal membrane oxygenation (ECMO) support during lung transplantation from 2 coronavirus disease 2019 (COVID-19) with end-stage respiratory failure.Methods:Two COVID-19 with end-stage respiratory failure patients were admitted to Nanjing Medical University Affiliated Wuxi People's Hospital in March 2020. As the homoeostasis and vital signs could not be maintained in balance by conventional treatments, lung transplantations were performed. Here, detail information about combined application of peripheral veno-venous ECMO (VV-ECMO) and central veno-arterial ECMO (CVA-ECMO) during the operation will be discussed.Results:Case 1: 59 years old, 172 cm height, 72 kg weight, who received mechanical ventilation for 22 days, tracheotomy tube for 17 days, and VV-ECMO support for 7 days. Case 2: 72 years old, 178 cm height, 71 kg weight, who received mechanical ventilation for 19 days, tracheotomy tube for 17 days, and VV-ECMO support for 18 days. As both of them have severe COVID-19-associated respiratory failure, and the recovery was determined to be unlikely, lung transplantations were performed. Severe pulmonary arterial hypertension (PAH) and cardiac insufficiency were found during the operation. Based on preoperative VV-ECMO, CVA-ECMO was added. The concomitant use of peripheral VV-ECMO and CVA-ECMO offered satisfied intraoperative oxygenation and cardiopulmonary status, the operations run smoothly, and the CVA-ECMO was successfully removed, no ECMO-related complications occurred.Conclusion:The combined use of VV-ECMO and CVA-ECMO is an optimal strategy in the end-stage ARDS patients with severe PAH and cardiac insufficiency, which can offer benefits on respiratory and cardiac functions simultaneously, and ensure surgery safety.

Objective    To explore the surgical design and efficacy of novel modified Nuss procedure for pectus excavatum (PE). Methods    We retrospectively analyzed the clinical data of 903 patients with PE who were treated by the new kind of steel bar and the novel modified Nuss procedure. There were 716 males and 187 females at mean age of 2-45 (12.1±6.8) years. Preoperative chest CT scans Haller index (HI) was 3.1-15.2 (4.6±1.3), with 38 patients of mild PE (HI<3.2), 302 patients of moderate PE (HI 3.2-3.5), 521 patients of severe PE (HI 3.6-6.0), and 42 patients of extremely severe PE (HI>6.0). The operative time, operative blood loss, hospital stay time as well as postoperative complications were reviewed and analyzed. Results    All of the 903 patients successfully completed the surgery. The mean operative time was 20-45 (25.2±2.6) min for primary PE and that for special type of PE (including recurring PE, PE patients after heart disease operation and those corrected by 2 bars) was 48-150 (63.5±28.1) min. Blood loss was less than 10 mL for primary PE and 15-50 (23.5±5.5) mL for special type of PE. Postoperative hospital stay was 3-15 (4.5±1.6) d. A total of 845 patients (93.6%) required 1 steel bar insertion, 58 patients (6.4%) required 2 steel bars. Postoperative evaluation of the surgery outcomes revealed the following: excellent in 805 patients, good in 84 patients, fair in 14 patients and poor in 0. The good quality rate was 98.4%. Conclusion    Novel modified Nuss procedure can simplify and optimize the surgical design with good short and mid-term effects.

Objective    To summarize the experience of treating adult recurrent pectus excavatum without plate turnover. Methods    Twenty-seven patients with recurrent pectus excavatum treated by thoracoscopy-assisted placement without plate turnover from 2010 to 2019 in our hospital were enrolled. There were 23 males and 4 females with the age of 3-29 (12.81±7.79) years at the first operation, and 18-29 (21.74±3.56) years at this operation. Incision of 2-3 cm at bilateral axillary midline of the deepest point of pectus excavatum was made, and an auxiliary incision under xiphoid process was adopted according to the intraoperative situation. Results    All patients underwent thoracoscopy-assisted correction of pectus excavatum without bar turnover, and subxiphoid incision was performed in 11 patients. Twenty-five patients had one bar placed, and two patients required two bars. The operation time was 28-45 (33.00±6.44) min. Postoperative Haller index (2.95±0.40) was improved compared with preoperation (4.63±1.03). The postoperative hospital stay was 4-6 (4.00±0.32) day. All patients were followed up for 1-8 years. Complications included poor wound healing in 1 patient, and steel wire fracture and displacement in 1 patient. There was no plate rotation or bar displacement. Fourteen patients removed the bar 29-84 (40.36±13.93) months after the placement. Haller index was improved to 2.43-3.61 (2.86±0.35) during removal of steel plate. Untill June 2020, there was no recurrence of pectus excavatum. Conclusion    The treatment of adult recurrent pectus excavatum without plate turnover is satisfactory, and the protection of intercostal muscle and firm fixation is the key to ensure the success of operation and long-term effects.

BACKGROUND: To date, there is no effective treatment for thromboangiitis obliterans (TAO). Anlotinib, as a third-line therapy, is recommended for patients with refractory advanced non-small cell lung cancer (NSCLC). We presented a case report of a patient suffering from right lung squamous cell carcinoma combined with thromboangiitis obliterans, and analyzed the treatment dilemma, which provided a new idea for the treatment of these two diseases. METHODS: A patient of right lung squamous cell carcinoma complicated with TAO was admitted to the department of respiratory and critical care medicine of the Shanghai General Hospital in August 2018. The diagnosis and treatment was retrospectively analyzed, and the literature was reviewed. RESULTS: The 73-year-old male patient complained of cough and sputum for 5 months and was diagnosed with NSCLC (T4N2M0, stage IIIb, performance status score 2) in right upper lung by tracheoscopy biopsy. Pigmentation in both lower extremities accompanied by weakened pulse of dorsal foot artery was confirmed. He had a history of smoking, and suspected vascular intermittent claudication and wandering phlebitis for more than one year. Ultrasound indicated multiple arterial occlusion in both upper and lower extremities and deep venous thrombosis in lower extremities. TAO was diagnosed. Peripherally inserted central catheter (PICC) implantation and intravenous infusion post implantation failed and he could not receive chemotherapy. Vascular endothelial growth factor (VEGF) signal pathway dysfunction is also involved in TAO. Anlotinib (12 mg qd po) was selected for treatment NSCLC and TAO, accordingly. He had partial response (PR) and the cancer kept stable for 14 months. At the same time, TAO improved. CONCLUSIONS Anlotinib effectively controlled the growth of NSCLC and improved TAO related symptoms. Anlotinib maybe normalize disordered growth of blood vessels through the VEGF signaling pathway, rather than simply inhibiting angiogenesis.

Breast cancer is a malignant tumor that seriously threatens women’s health at present. Although surgical treatment is the most direct and effective， it is limited by many factors and needs to be assisted by other treatments. In addition to conventional radiotherapy， these adjuvant therapies also include chemotherapy， gene therapy， phototherapy and so on. However， the therapeutic agents used in these treatment methods have some limitations， such as poor water-solubility， instability and targeting. With the development of nano-technology， more and more researchers construct and study nano delivery system for breast tumor treatment， such as response system designed based on tumor microenvironment， temperature sensitive response system， nano delivery system based on specific proteins of tumor cell membrane， etc. The author summarizes the nano delivery system， and finds that these nano delivery systems can not only improve the water-solubility and stability of the therapeutic agents， but also accurately deliver them to the breast tumor site by targeted means， improve the efficacy and reduce toxic side effects， which provides new ideas for the treatment of breast cancer in the future.

Lianhuaqingwen (LHQW) capsule, a herb medicine product, has been clinically proved to be effective in coronavirus disease 2019 (COVID-19) pneumonia treatment. However, human exposure to LHQW components and their pharmacological effects remain largely unknown. Hence, this study aimed to determine human exposure to LHQW components and their anti-COVID-19 pharmacological activities. Analysis of LHQW component profiles in human plasma and urine after repeated therapeutic dosing was conducted using a combination of HRMS and an untargeted data-mining approach, leading to detection of 132 LHQW prototype and metabolite components, which were absorbed