ObjectiveTo observe nailfold capillary changes in a cohort of conncctive tissue disease ( CTD ) with Raynaud's phenomenon (RP) and to explore the diagnostic value of nailfold videocapillaroscopy (NVC) in systemic sclerosis(SSc).MethodsSixty CTD patients with RP divided into SSc group (n =36) and non-SSc group ( n =24) were referred to an experienced operator for NVC.ResultsThe patients had decreased capillary loops in SSc group with the capillary diameter more enlarged in SSc group than nonSSc group.The number of patients in SSc group with giant capillaries was 14,while 3 in non-SSc group.There were 23 patients with haemorrhagcs in SSc group and 9 in non-SSc group.The number of patients with severe effusion was 15 in SSc group,while 2 in non-SSc group.By using the ROC curves,indexes with AUC at least 0.7 of the input capillary diameter,the output capillary diameter,the middle capillary diameter,blood color and effusion for the diagnostic cutoff points were 18.5 μm,24.5 μm,19.5μm,deep red and severe effusion.With at least 2 out of the top 3 indexes,the diagnostic sensitivity and specificity of SSc were higher.ConclusionsCTD Patients with RP of SSc have less capillary loops,more enlarged capillaries,more giant capillaries, moresevereeffusionandmorehaemorrhagesthannon-SScpatients. The characteristics of nailfold capillary changes in SSc patients with RP can be helpful tor the diagnosis and the differential diagnosis of SSc.

Objective To determine the risk factors for perioperative cardiovascular events (PCEs) in patients with diabetes mellitus undergoing noncardiac surgery.Methods From June 2011 to October 2012 in our hospital,500 diabetic patients scheduled for elective non-cardiac surgery were divided into 2 groups according to the development of PCEs:PCE group and non-PCE group.The general data of patients,anesthetic methods,anesthesia time,blood glucose level during surgery and fluctuation of hemodynamics were recorded.The risk factors of which P values were less than 0.05 would enter the binary logistic regression analysis to stratify PCE-related risk factors.Results Seventy-nine patients developed PCEs (15.8 ％) during perioperative period.There was significant difference between the two groups in age,levels of triglyceride and hs-CRP,fluctuation of hemodynamics,and abnormality in ECG (P ＜ 0.05).Logistic regression analysis showed that the risk factors for PCEs included triglyceride level ≥ 1.7 mmol/L,age ≥ 65yr,hs-CRP level ≥ 8 mg/L and fluctuation of hemodynamics during surgery ≥ 30％ of the baseline value.Conclusion High triglyceride levels,advanced age,high hs-CRP levels and fluctuation of hemodynamics during surgery (≥ 30％ of the baseline value) are the risk factors for PCE in diabetic patients undergoing noncardiac surgery.

Objective To investigate the expression changes of interferon gene stimulating factor(STING)and E-box zinc finger binding protein 1(ZEB1)in elderly cervical cancer(CCA)patients and their correlation with human papillomavirus(HPV)infection.Methods Sixty-two patients with CCA who underwent patho-logical examination in this hospital from January 2021 to September 2022 were selected as the CCA group,65 patients with cervical intraepithelial neoplasia(CIN)as the CIN group,and 63 patients with normal cervix as the control group.The positive expression rates of cervical STING and ZEB1 and high-risk HPV infection in each group were observed and recoraded.The correlation of STING and ZEB1 levels with clinicopathological features of CCA and high-risk HPV infection was analyzed.Results The positive expression rates of STING and ZEB1 in CCA group were higher than those in CIN group and control group,and the level of ZEB1 in CIN group was higher than that in control group,with statistical significance(P＜0.05).The detection rates of HPV16 and 18 in CCA group were higher than those in CIN group and control group,and the detection rates of HPV16 and 18 in CIN group were higher than those in control group,the differences were statistically sig-nificant(P＜0.05).The infiltration depth and FIGO stage of CCA patients were correlated with the positive expression rates of STING and ZEB1,the degree of tumor differentiation and lymph node metastasis were cor-related with the positive expression rates of STING(P＜0.05),and the positive expression rates of STING and ZEB1 in CCA patients were positively correlated with the infection rates of HPV16 and 18(P＜0.05).Conclusion The positive expression levels of STING and ZEB1 proteins in the CCA group are higher than those in the control group and CIN group,and their expression levels were related to FIGO staging and depth of cervical cancer infiltration.STING and ZEB1 proteins are positively correlated with HPV16 and 18 infec-tion,and STING and ZEB1 proteins may jointly act with HPV16 and 18 on the occurrence and development of CCA.

Objective:To investigate the influencing factors and regularity of inferior mediastinal lymph node metastasis in Siewert type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction (AEG).Methods:The retrospective case-control study was conducted. The clinicopatho-logical data of 185 Siewert type Ⅱ and Ⅲ AEG patients in two medical centers (113 cases in Changzhi People's Hospital Affiliated to Changzhi Medical College and 72 cases in Heji Hospital Affiliated to Changzhi Medical College) from January 2017 to January 2022 were collected. There were 143 males and 42 females, aged (64±8)years. Patients underwent radical resection of AEG combined with inferior mediastinal lymph node dissection. Observation indicators: (1) clinicopathological charac-teristics of Siewert type Ⅱ and Ⅲ AEG patients; (2) analysis of influencing factors for inferior mediastinal lymph node metastasis in Siewert type Ⅱ and Ⅲ AEG; (3) regularity of inferior mediastinal lymph node metastasis in Siewert type Ⅱ and Ⅲ AEG. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were represented as absolute numbers or percentages, and comparsion between groups was analyzed using the chi-square test or Fisher exact probability. Comparison of ordinal data was analyzed using the rank sum test. Univariate and multivariate analyses were conducted using the Logistic regression model. Results:(1) Clinicopathological characteristics of Siewert type Ⅱ and Ⅲ AEG patients. Pathologic staging as stage Ⅰ, Ⅱ, Ⅲ and Ⅳ, degree of tumor invasion as stage T1, T2, T3 and T4, length of esophageal invasion ≤1 cm, >1 cm and ≤2 cm, >2 cm and ≤3 cm, >3 cm and ≤4 cm were found in 30, 61, 75, 7, 3, 41, 79, 50, 101, 46, 18, 8 cases of the Siewert type Ⅱ and Ⅲ AEG patients without inferior mediastinal lymph node metastasis, respectively, versus 0, 2, 10, 0, 0, 0, 5, 7, 4, 3, 2, 3 cases of the Siewert type Ⅱ and Ⅲ AEG patients with inferior mediastinal lymph node metastasis, showing a significant differences between them ( Z=?2.21, ?2.49, ?2.22, P<0.05). (2) Analysis of influencing factors for inferior mediastinal lymph node metastasis in Siewert type Ⅱ and Ⅲ AEG. Results of univariate analysis showed that pathological staging, depth of tumor invasion and length of esophageal invasion were related factors affecting inferior mediastinal lymph node metastasis in Siewert type Ⅱ and Ⅲ AEG ( odds ratio=2.48, 3.26, 2.03, 95% confidence intervals as 1.02?6.01, 1.21?8.80, 1.18?3.51, P<0.05). Results of multivariate analysis showed that depth of tumor invasion and length of esophageal invasion were independent influening factors affecting inferior mediastinal lymph node metastasis in Siewert type Ⅱ and Ⅲ AEG ( odds ratio=4.01, 2.26, 95% confidence interval as 1.35?11.96, 1.26?4.06, P<0.05). The inferior mediastinal lymph node metastasis probability of AEG patients with the length of esophageal invasion >3 cm and ≤4 cm was 9.47 times that of AEG patients with the length of esophageal invasion ≤1 cm. (3) Regularity of inferior mediastinal lymph node metastasis in Siewert type Ⅱ and Ⅲ AEG. The number of inferior mediastinal lymph nodes including No.110, No.111 and No.112 dissected in 185 patients of Siewert type Ⅱ and Ⅲ AEG were 127, 50 and 27. The number of lymph nodes dissected and the number of metastatic lymph nodes in No.110 and No.111 of patients with length of esophageal invasion ≤1 cm, >1 cm and ≤2 cm, >2 cm and ≤3 cm, >3 cm and ≤4 cm were 69, 4, 42, 4, 4, 1, 12, 4 and 23, 0, 17, 0, 7, 2, 3, 0, respectively. There were significant differences in metastatic lymph nodes in No.110 and No.111 of patients with length of esophageal invasion ≤1 cm, >1 cm and ≤2 cm, >2 cm and ≤3 cm, >3 cm and ≤4 cm ( χ2=8.45, 7.30, P<0.05). Of the 185 patients of Siewert type Ⅱ and Ⅲ AEG, the ratio of cases with inferior mediastinal lymph nodes metastasis was 6.49%(12/185). The ratio of inferior mediastinal lymph nodes metastasis in cases with length of esophageal invasion ≤1 cm, >1 cm and ≤2 cm, >2 cm and ≤3 cm, >3 cm and ≤4 cm were 3.81%(4/105), 6.12%(3/49), 10.00%(2/20), 27.27%(3/11), respectively. The ratio of No.110 lymph nodes metastasis in cases with length of esophageal invasion ≤1 cm, >1 cm and ≤2 cm, >2 cm and ≤3 cm, >3 cm and ≤4 cm were 2.86%(3/105), 6.12%(3/49), 5.00%(1/20), 27.27%(3/11), respectively, showing a significant difference among them ( χ2=8.26, P<0.05). Conclusions:Depth of tumor invasion and length of esophageal invasion are independent influening factors affecting inferior mediastinal lymph node metastasis in Siewert type Ⅱ and Ⅲ AEG. The rate of inferior mediastinal lymph node metastasis increases with the increase of the length of esophageal invasion.

Objective:To investigate the short-term clinical efficacy of Kamikawa anasto-mosis and jejunal interposed double channel anastomosis in laparoscopic proximal gastrectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 68 patients with esophagogastric junctional tumors and upper gastric tumors who underwent laparoscopic proximal gastrectomy in two medical centers, including 63 cases in the Changzhi People's Hospital Affiliated to Changzhi Medical College and 5 cases in the Heji Hospital Affiliated to Changzhi Medical College, from March 2018 to December 2020 were collected. There were 57 males and 11 females, aged 62(range, 39?78)years. Of 68 patients, 35 patients undergoing Kamikawa anastomosis in laparoscopic proximal gastrectomy were allocated into Kamikawa group, and 33 patients under-going jejunal interposed double channel anastomosis in laparoscopic proximal gastrectomy were allocated into double channel group. Observation indicators: (1) intraoperative situations; (2) post-operative situations; (3) follow-up. The patients were followed up by outpatient examinations and telephone interview to detect the postoperative score of chew-wun wu special symptoms, post-operative reflux anastomotic esophagitis and anastomotic stenosis up to December 2021. Measure-ment data with normal distri-bution were represented as Mean±SD, and comparison between groups was performed by the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted by Mann-Whitney U test. Comparison of ordinal data was performed by nonparametric rank sum test. Count data were expressed as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability method. Results:(1) Intraoperative situations. All the 68 patients successfully under-went laparoscopic proximal gastrectomy combined with D 1+ lymph node dissection. The operation time and volume of intraoperative blood loss of the Kamikawa group were (5.15±0.31)hours and (89±11)mL, versus (4.21±0.11)hours and (142±20)mL of the double channel group, respectively, showing significant differences between the two groups ( t=2.81, ?2.34, P<0.05). The digestive tract reconstruction time and the number of lymph node dissection were (1.95±0.13)hours and 30.4±2.4 of the Kamikawa group, versus (1.69±0.76)hours and 28.0±2.4 of the double channel group, respectively, showing no significant difference between the two groups ( t=1.79, 0.73, P>0.05). (2) Postoperative situations. The time to postoperative first flatus, duration of drainage tube placement, duration of postoperative hospital stay were (3.03±0.12)days, (5.46±0.22)days, (13.00±0.50)days of the Kamikawa group, versus (4.42±0.21)days, (9.97±0.76)days, (16.46±0.92)days of the double channel group, showing significant differences in the above indicators between the two groups ( t=?5.80,?5.58, 3.40, P<0.05). Cases with or without drainage tube placement were 32 and 3 of the Kamikawa group, versus 33 and 0 of the double channel group, respectively, showing no significant difference between the two groups ( P>0.05). Cases with grade 1, grade 2, grade 3, grade 4 complica-tions of Clavien-Dindo classification were 31, 0, 4, 0 of the Kamikawa group, versus 27, 3, 1, 2 of the double channel group, respectively, showing a significant difference between the two groups ( Z=?6.28, P<0.05). Postoperative anastomotic stenous, reflux symptoms, anastomotic fistula, pancreatic fistula, pulmonary infection were found in 4, 2, 0, 0, 0 case of the Kamikawa group and 0, 1, 3, 1, 2 cases of the double channel group, respectively. There was no significant difference in the above indicators between the two groups ( P>0.05). There was no complication of incisional infection, abdominal hemorrhage, lymphatic fistula or gastroparesis in either group. Of the 4 patients with perioperative anastomotic stenosis in the Kamikawa group, 2 cases were improved after once gastroscopic balloon dilatation, 2 cases were improved after 4 times of gastro-scopic balloon dilatation. (3) Follow-up. All the 68 patients were followed up at postoperative 3, 6, 12 months. The scores of chew-wun wu special symptoms scale at postopertaive 12 months of the Kamikawa group and double channel group were 16.8±0.7 and 14.6±0.7, respectively, showing a significant difference between the two groups ( t=2.20, P<0.05). There were 2 cases of grade B reflux esophagitis and 1 case of grade B reflux esophagitis, respectively, showing no significant difference between the two groups ( P>0.05). There was no anastomotic stenosis occurred in either group. Conclusions:Laparos-copic proximal gastrectomy with Kamikawa anastomosis or jejunal interposed double channel anastomosis is safe and feasible for esophagogastric junction tumors and upper gastric tumors. The Kamikawa anastomosis has less volume of intraoperative blood loss, shorter time to postoperative first flatus, duration of drainage tube placement and postoperative hospital stay, higher quality of postoperative lfe.

Objective To analyze the efficacy of drug-coated balloon in the treatment of hetero-geneous in-stent restenosis.Methods A total of 118 patients who received treatment and diagnosed with heterogeneous in-stent restenosis were selected as study objects,and were divided into two groups using a random table method.The experimental group(n=59)received drug-coated balloon thera-py,and the control group(n=59)received drug-eluting stent therapy.The therapeutic effects of the two different treatment methods on heterogeneous in-stent restenosis were compared.Results There was no significant difference in the incidence of in-stent restenosis in the right coronary artery,cir-cumflex artery,and anterior descending artery between the two groups(P＞0.05).There was no sig-nificant difference between the two groups in the preoperative reference vessel diameter,lesion length,lumen stenosis degree,and localized restenosis(P＞0.05).The postoperative residual ste-nosis rate in the experimental group was significantly higher than that in the control group(P＜0.05).There was no significant difference between the two groups in the preoperative lumen area,neointimal load,stent inner area,neointimal area,incidence of neoatherosclerosis and thrombus(P＞0.05).Operative lumen area of the experimental group was smaller than that of the control group(P＜0.05).No target vessel reconstruction,stent thrombosis,nonfatal myocardial infarction,or cardiac death occurred in two groups during 12 months of follow-up.Conclusion Drug-coated balloons are effective and safe in the treatment of heterogeneous in-stent restenosis,and can obtain similar effects to drug-eluting stents.

Objective To analyze the efficacy of drug-coated balloon in the treatment of hetero-geneous in-stent restenosis.Methods A total of 118 patients who received treatment and diagnosed with heterogeneous in-stent restenosis were selected as study objects,and were divided into two groups using a random table method.The experimental group(n=59)received drug-coated balloon thera-py,and the control group(n=59)received drug-eluting stent therapy.The therapeutic effects of the two different treatment methods on heterogeneous in-stent restenosis were compared.Results There was no significant difference in the incidence of in-stent restenosis in the right coronary artery,cir-cumflex artery,and anterior descending artery between the two groups(P＞0.05).There was no sig-nificant difference between the two groups in the preoperative reference vessel diameter,lesion length,lumen stenosis degree,and localized restenosis(P＞0.05).The postoperative residual ste-nosis rate in the experimental group was significantly higher than that in the control group(P＜0.05).There was no significant difference between the two groups in the preoperative lumen area,neointimal load,stent inner area,neointimal area,incidence of neoatherosclerosis and thrombus(P＞0.05).Operative lumen area of the experimental group was smaller than that of the control group(P＜0.05).No target vessel reconstruction,stent thrombosis,nonfatal myocardial infarction,or cardiac death occurred in two groups during 12 months of follow-up.Conclusion Drug-coated balloons are effective and safe in the treatment of heterogeneous in-stent restenosis,and can obtain similar effects to drug-eluting stents.