The present study reported the case of a patient with degenerative lumbar scoliosis who suffered from postoperative hemorrhage due to lumbar artery injury in corrective osteotomy. The patient presented with decline of blood pressure, extremely low hemoglobin, even after blood transfusion and fluid infusion. Digital subtraction angiography showed lumbar artery injury. Successful control of bleeding and gradually stable vital signs were observed after vascular embolisation. Severe and complex spinal deformity, severe osteophytes in the anterior edge of vertebral body, hypertension, and angiosclerosis were the risk factors of large vascular injuries in spinal osteotomy. Lumbar artery injury should be highly suspected when unknown and progressively aggravating abdominal or back pain, abdominal distention, neurological symptoms of lower limbs, decline of blood pressure, increase of heart rate, decrease of hemoglobin level, continuously bloody drainage or incision bleeding occurred. Vascular embolisation was effective and safe in the management of iatrogenic lumbar artery injury.

Objective To report the application of C7T1extensive osteotomy and C7pedicle subtraction osteotomy(PSO) in the correction of cervicothoracic deformity secondary to ankylosing spondylitis(AS)and to investigate the efficacy and safety of the techniques.Methods Between April 2006 and August 2017,eight male patients with cervicothoracic deformity undergoing C7T1extensive osteotomy(3 cases)or C7PSO(5 cases)were retrospectively reviewed.The mean age was 31.3±14.9 years(range, 14-60 years).C2-T1kyphosis,C2-T1scoliosis and C2-T1sagittal vertical axis(SVA)were measured on the lateral cervical radio-graphs and chin-brow vertical angle(CBVA)was measured on clinical photographs preoperatively and at the final follow-up.The operative time, blood loss and complications were recorded. Results The average follow-up duration was (11.3 ± 7.9) months (range,3-48 months).In C7T1extensive osteotomy group,the mean operative time was 305 min(300-310 min)and the average blood loss was 1 250 ml(1 000-1 500 ml).Preoperative and postoperative C2-T1kyphosis were 17.0°±16.3°and-13.3°±20.2°,re-spectively.The preoperative CBVA was 20.0°±4.5°,which improved to 4.7°±5.9°at the final follow-up with a mean correction rate of 76.5%.C2-T1SVA was improved from(6.9±4.0)cm preoperatively to(3.5±1.8)cm at the final follow-up with an average correc-tion rate of 49.3%.In C7PSO group,the mean operative time was 536 min(375-730 min)and the average blood loss was 2 450 ml (700-4 200 ml).There were four patients with concomitant scoliosis and kyphosis.Preoperative and postoperative C2-T1kyphosis were 22.8°±10.5°and-13.5°±10.0°,respectively.The preoperative C2-T1scoliosis was 24.8°±12.7°,which improved to 5.0°±3.5° at the final follow-up with a mean correction rate of 79.8%.CBVA was improved from 60.5°±10.2°preoperatively to 14.3°±8.6°at the final follow-up with an average correction rate of 76.4%.C2-T1SVA was corrected to(6.4±2.5)cm at the final follow-up from(10.4 ± 4.3) cm preoperatively. One patient was presented with severe cervicothoracic scoliosis and the C2-T1scoliosis was im-proved to 10°from 33°with a 69.7% correction rate.No neurological complications,infection,or implant-related complications were observed both intraoperatively and during the follow-up period.One patient who underwent C7PSO experienced intraopera-tive subluxation of the osteomized vertebra.Fortunately,there was no neurological deficit.Solid bony fusion was observed after six-month Halo-vest immobilization.Conclusion Both C7T1extensive osteotomy and C7PSO are effective in the correction of cervico-thoracic deformity secondary to AS with acceptable complication rate.C7PSO is particularly suitable for the correction of severe and complicated biplanar cervicothoracic deformity.

Objective:To discuss the protective effect of ginsenoside Rh1(G-Rh1)on kidney injury in the diabetic mellitus(DM)mice,and to clarify its mechanism.Methods:The diabetic kidney disease(DKD)model was prepared by using the high-fat,high-sugar diet combined with intraperitoneal injection of streptozotocin(STZ).A total of 48 C57/BL6 model mice were randomly divided into model group,nuclear factor erythroid 2-related factor 2(Nrf2)inhibitor ML385 group(ML385 group)(30 mg·kg-1),G-Rh1 group(30 mg·kg-1),and G-Rh1+ML385 group(30 mg·kg-1 G-Rh1+30 mg·kg-1 ML385),and there were 12 mice in each group.Additionally,12 C57/BL6 mice were selected as control group.After treated for 8 weeks,automatic analyzer was used to detect the levels of fasting blood glucose(FBG),blood urea nitrogen(BUN),and serum creatinine(Scr)in serum of the mice in various groups,as well as 24 h urinary protein(24 h UP)levels in urine,and the kidney index was calculated;kits were used to detect the activities of superoxide dismutase(SOD)and lactate dehydrogenase(LDH),and the levels of malondialdehyde(MDA)in kidney tissue of the mice in various groups;Western blotting method was used to detect the expression levels of Nrf2 and heme oxygenase-1(HO-1)proteins in kidney tissue of the mice in various groups.Results:Compared with control group,the levels of FBG and kidney indexes in serum of the mice in model group,ML385 group,and G-Rh1+ML385 group were significantly increased(P<0.01),and the level of FBG in serum of the mice in G-Rh1 group was significantly increased(P<0.01);compared with model group,the kidney index of the mice in ML385 group was significantly increased(P<0.05),while the levels of FBG and kidney index of the mice in G-Rh1 group were significantly decreased(P<0.05 or P<0.01);compared with G-Rh1 group,the level of FBG and kidney index of the mice in G-Rh1+ML385 group were significantly increased(P<0.01).Compared with control group,the levels of BUN and Scr in serum,and 24 h UP in urine of the mice in model group,ML385 group,G-Rh1 group,and G-Rh1+ML385 group were significantly increased(P<0.01);compared with model group,the level of BUN in serum and 24 h UP in urine of the mice in ML385 group were significantly increased(P<0.05),while the levels of BUN and Scr in serum,and 24 h UP in urine of the mice in G-Rh1 group were significantly decreased(P<0.01);compared with G-Rh1 group,the levels of BUN and Scr in serum,and 24 h UP in urine of the mice in G-Rh1+ML385 group were significantly increased(P<0.01).Compared with control group,the activities of SOD in kidney tissue of the mice in model group,ML385 group,G-Rh1 group,and G-Rh1+ML385 group were significantly decreased(P<0.01),while the levels of MDA and LDH activities were significantly increased(P<0.01);compared with model group,the activity of SOD in kidney tissue of the mice in ML385 group was significantly decreased(P<0.05),and the level of MDA was significantly increased(P<0.05);the activity of SOD in kidney tissue of the mice in of G-Rh1 group was significantly increased(P<0.01),and the level of MDA and activity of LDH were significantly decreased(P<0.01);compared with G-Rh1 group,the activity of SOD in kidney tissue of the mice in G-Rh1+ML385 group was significantly decreased(P<0.01),and the level of MDA and activity of LDH were significantly increased(P<0.01).Compared with control group,the expression levels of Nrf2 and HO-1 proteins in kidney tissue of the mice in model group,ML385 group,G-Rh1 group,and G-Rh1+ML385 group were significantly decreased(P<0.05 or P<0.01);compared with model group,the expression levels of Nrf2 and HO-1 proteins in kidney tissue of the mice in ML385 group and G-Rh1+ML385 group were significantly decreased(P<0.05),while the expression levels of Nrf2 and HO-1 proteins in kidney tissue of the mice in G-Rh1 group were significantly increased(P<0.01);compared with G-Rh1 group,the expression levels of Nrf2 and HO-1 proteins in kidney tissue of the mice in G-Rh1+ML385 group were significantly decreased(P<0.01).Conclusion:Ginsenoside Rh1 reduces the oxidative stress and improves the kidney function,providing protective effects on kidney injury in the DM mice,and its mechanism may be related to the activation of the Nrf2/HO-1 signaling pathway.

Objective: To explore the special situation in subxiphoid uniportal VATS surgery and summarize the treatment strategies. Methods: In September 2014, the subxiphoid uniportal VATS surgery was carried out. Up to now, our research team has completed more than 300 subxiphoid uniportal VATS operations, especially including 242 cases of subxiphoid uniportal VATS segmentectomy and 22 cases of subxiphoid uniportal VATS mediastinal tumor resection. Some special situations were encountered during the operation, including cardiac arrest, pericardial tamponade, innominate venous injury, severe arrhythmia, difficulty in positioning the lung segment, and difficulty in positioning the small nodule et al. Results: Some patients changed the surgical procedure during surgery due to intraoperative emergencies such as severe arrhythmia, heart problems, intraoperative bleeding. Postoperative complications mainly included thoracotomy and hemostasis, continuous air leak after operation, pulmonary hematoma, arrhythmia, and no perioperative death. Conclusion Under the subxiphoid uniportal VATS surgery is an important manifestation of the minimally invasive technique of the chest. It is safe and feasible to select suitable cases, master the thoracoscopic technique and special surgical techniques. Special situations during subxiphoid uniportal VATS surgery should be known.

The biological clock(also known as the circadian rhythm)is the fundamental reliance for all organisms on Earth to adapt and survive in the Earth's rotation environment.Circadian rhythm is the most basic regulatory mechanism of life activities,and plays a key role in maintaining normal physiological and biochemical homeostasis,disease occurrence and treatment.Recent studies have shown that the biologi-cal clock plays an important role in the development of oral tissues and in the occurrence and treatment of oral diseases.Since there is cur-rently no guiding literature on the research methods of biological clock in stomatology,researchers mainly conduct research based on pub-lished references,which has led to controversy about the research methods of biological clock in stomatology,and there are many confusions about how to rationally apply the research methods of circadia rhythms.In view of this,this expert consensus summarizes the characteristics of the biological clock and analyzes the shortcomings of the current biological clock research in stomatology,and organizes relevant experts to summarize and recommend 10 principles as a reference for the rational implementation of the biological clock in stomatology research.

Cryoablation therapy with explicit anti-tumor mechanisms and histopathological manifestations has a long history.A large number of clinical practice has shown that cryoablation therapy is safe and effective,making it an ideal tumor treatment method in theory.Previously,its efficacy and clinical application were constrained by the limitations of refrigerants and refrigeration equipment.With the development of the new generation of cryoablation equipment represented by argon helium knives,significant progress has been made in refrigeration efficien-cy,ablation range,and precise temperature measurement,greatly promoting the progression of tumor cryoablation technology.This consensus systematically summarizes the mechanism of cryoablation technology,indications for oral mucosal melanoma(OMM)cryotherapy,clinical treatment process,adverse reactions and management,cryotherapy combination therapy,etc.,aiming to provide reference for carrying out the standardized cryoablation therapy of OMM.

Objective To investigate the advantage of the concept of wide exposure in uniportal video-assisted thoracoscopic surgery (uniportal-VATS) for radical resection of lung cancer and assess its safety and feasibility. Methods Clinical data of 255 patients (110 males and 145 females, a mean age of 54.3±7.9 years) with non-small cell lung cancer (NSCLC) who received wide exposure in uniportal-VATS or three portal VATS (3P-VATS) during August 2017 to March 2018 were retrospectively analyzed. There were 153 patients (67 males and 86 females, a mean age of 56.1±8.5 years) in the uniportal-VATS group and 102 patients (43 males and 59 femals, a mean age of 54.4±7.4 years) in the 3P-VATS group. The clinical effects were compared between the two groups. Results There was no statistical difference in the operation time between the uniportal-VATS and 3P-VATS (135.0±45.6 min vs. 142.0±39.5 min, P>0.05). The overall number of dissected stations (6.9±1.0) and LNs (14.5±3.0) in the uniportal-VATS group were similar with those in the 3P-VATS group (7.1±1.0, 15.1±1.7). The dissected stations of N2 LNs (uniportal-VATS: 4.1±1.7, 3P-VATS: 3.9±0.8) and number of dissected N2 LNs (uniportal-VATS: 8.0±0.9, 3P-VATS: 7.8±1.1) were both similar between the two groups. The duration of postoperative tube drainage and postoperative hospital stay of uniportal-VATS group (3.5±1.8 d and 7.2±0.9 d) were much shorter than those of 3P-VATS group (4.0±1.3 d and 8.8±2.0 d). No significant difference was found in incidence of postoperative complication between the two groups except that the incidence of subcutaneous emphysema in the uniportal-VATS group was much lower. There was no perioperative death in the two groups. Conclusion The concept of wide exposure in uniportal-VATS can meet the requirment of radical resection and it is a safe and valid method which can be used for radical resection of lung cancer.

Curettage is the main treatment method for oral maxillofacial cystic lesions,but simple curettage may easily damage surrounding structures such as adjacent teeth and nerves,leading to incomplete removal of the cyst and large jaw defects.The curettage assisted by endoscopy can provide a good surgical field for the surgeons,can clearly identify the important anatomical structure during the operation and can remove the cyst wall tissue as much as possible,thereby reducing the damage and reducing the recurrence rate of the lesion.This article combines the characteristics of maxillofacial surgery with clinical treatment experience,summarizes relevant literature from both domestic and international sources,and engages in discussions with experts in order to provide reference for the clinical treatment of jaw cystic lesions with endo-scope assisted curettage.

Surgery is currently the most appropriate treatment for early-stage non-small cell lung cancer (NSCLC). Increasing unilateral or bilateral multiple primary lung cancer being found, segmentectomy has attracted wide attention for its unique advantages in the treatment for such tumors. Ground glass opacity dominant early-stage NSCLC is associated with a good prognosis and can be cured by segmentectomy, however, the treatment of solid-dominant NSCLC remains controversial owing to the invasive nature. With the in-depth study on the lymph node metastasis pathway, radiological characteristics and molecular biology of NSCLC, a large part of solid nodules with certain characteristics can also be cured by segmentectomy. This paper reviews the research status and progress about the indication of segmentectomy.
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