Objective To investigate the clinical efficacy and safety of CT-guided percutaneous microwave ablation (MWA)in elderly patients with early-stage lung cancer who were unable to underwent surgery,and to evaluate the risk factors for prognosis.Methods A total of 51 patients with early stage(stages Ⅰ and ⅡA)non-small cell lung cancer (NSCLC)who underwent MWA in Beijing hospital from January 2016 to December 2018 were collected as the MWA group.And 50 patients with similar age and gender receiving lobectomy surgery were collected as the control group.In a retrospective follow-up study,the clinical efficacy and safety of treatment were compared between the study(n=51)and control(n=50)groups.Kaplan-Meier survival analysis was used to assess the overall survival and local recurrence-free survival.COX analysis was used to evaluate the risk factors.Results Of the 101 patients,62 were male(61.4％),aged 60-85 years(average,72.3± 11.6 years).There was no significant difference in baseline characteristics,including age,gender,smoking,medical history,lung function,tumor size,pathological type and histological grading,tumor position and clinical stage between the two groups(P＞0.05).There were no serious complications in the MWA group during perioperative period,and 14 cases (27.5％)had a small amount of pneumothorax after operation,which were absorbed after special treatment.Five cases (9.8％)had a small amount of hemoptysis,7 cases(13.7％)had a small amount of pleural effusion,9 cases(17.6％)had low fever (＜ 38.5 ℃),and 9 cases (17.6 ％) had postoperative mild pain.There were no serious complications in the control group.The follow-up period was up to December 31,2018,and the median follow-up time was 11.7 months(4.5 20.3 months).During the follow-up,local recurrence occurred in 10 patients(9.9％),including 7 patients(13.7％)in the MWA group and 3 patients(6.0％)in the control group.There was no significant difference between the MWA group and the control group in the 1-year overall survival rate(92.2％ or 47 cases vs.96.0％ or 48 cases,P =0.313),tumor-specific survivalrate(100.0％ vs.100.0％,P=1.00),local recurrence free survival rate(86.3％ or 44 cases vs.94.0％ or 47 cases,P =0.156).Multivariate COX regression analysis showed age (HR =1.22,95 ％CI:1.06-1.38,P =0.004),tumor size (HR =1.75,95 ％ CI:1.14-2.36,P =0.005) and clinical stage of tumor(HR =1.53,95 ％ CI:1.17-1.89,P =0.001) were risk factors for the local recurrencefree survival.Conclusions MWA is an effective and safe treatment for elderly patients with early-stage lung cancer who are not suitable for surgery.Age,tumor diameter and clinical stage are risk factors for local recurrence-free survival.

Objective:To explore the value of severe ultrasound measurement of internal jugular vein dilation index (ΔIJV) combined with passive leg raising (PLR) in predicting the volume responsiveness of septic shock.Methods:Patients diagnosed with septic shock under complete mechanical ventilation in the ICU of Jinshan Hospital Affiliated to Fudan University from January 2020 to March 2021 were prospectively selected as the research objects. After 500 mL crystals were injected within 30 min, the patients having the "gold standard" left stroke volume (SV) increased by 15% were allocated to the volume response positive group, and patient having an SV increased by less than 15% to the volume response negative group. First, the maximum anterior posterior diameter (IJV max) and the minimum anterior posterior diameter (IJV min) in the respiratory cycle of internal jugular vein were measured by ultrasound, then SV before and after PLR was measured, and finally SV, IJV max and IJV min were measured again after rapid infusion of 500 mL crystals, and ΔIJV=(IJV max-IJV min)/(IJV mean)×100%. The Wilcoxon rank-sum test was used to compare the hemodynamic indexes before and after capacity expansion and PLR. Spearman rank method was used to analyze the change rate of SV (ΔSV) after PLR and the correlation between ΔIJV and ΔSV of the "gold standard". The sensitivity, specificity and relevant cut-off values were obtained by drawing the subject function curve to evaluate the value of ΔIJV and PLR in predicting the volume responsiveness of patients with sepsis. Results:A total of 56 patients were enrolled in the study, and they were divided into two groups: 32 patients in the volume response positive group and 24 patients in the volume response negative group. There was a positive correlation between ΔIJV and ΔSV after capacity expansion ( r=0.778, P<0.01). Taking ΔIJV>17.3% as the threshold, the area under the curve (AUC) was 0.846 (95% CI: 0.716~0.977), the sensitivity was 84.4% and the specificity was 83.3%. PLR was also positively correlated with ΔSV ( r=0.698, P<0.01). Taking ΔSV>15.5% after PLR as the threshold, the AUC was 0.895 (95% CI: 0.796~0.993), the sensitivity was 96.9%, and the specificity was 79.2%. When ΔIJV combined with PLR predicted volume reactivity, the AUC was 0.944 (95% CI: 0.862~1.000), the sensitivity was 99.8% and the specificity was 87.5%. Conclusions:The measurement of internal jugular vein respiratory dilation index by bedside ultrasound is a reliable index to predict volume responsiveness in patients with sepsis. When combined with PLR, the sensitivity and specificity of prediction can be improved.

ObjectiveThis study aims to examine the effect of Rhei Radix et Rhizoma-Coptidis Rhizoma on reducing insulin resistance in db/db mice by regulating the adenylate activated protein kinase （AMPK）/UNC-51-like kinase 1 （ULK1）/key molecule of autophagy， benzyl chloride 1 （Beclin1） pathway and elucidate the underlying mechanism. MethodSixty 6-week-old male db/db mice were studied. They were randomly divided into the model group， metformin group （0.26 g·kg^-1）， and low-， middle-， and high-dose groups （2.25， 4.5， 9 g·kg^-1） of Rhei Radix et Rhizoma-Coptidis Rhizoma. A blank group of db/m mice of the same age was set， with 12 mice in each group. After eight weeks of continuous intragastric administration， the blank group and model group received distilled water intragastrically once a day. The survival status of the mice was observed， and fasting blood glucose （FBG） was measured using a Roche blood glucose device. Fasting serum insulin （FINS） was measured using an enzyme-linked immunosorbent assay， and the insulin resistance index （HOMA-IR） was calculated. Hematoxylin-eosin （HE） staining was performed to observe the pathological changes in the liver of the mice. The protein expression levels of AMPK， Beclin1， autophagy associated protein 5 （Atg5）， and p62 in liver tissue were determined by using Western blot. The protein expression levels of autophagy associated protein 1 light chain 3B （LC3B） and ULK1 in liver tissue were determined using immunofluorescence. Real-time fluorescence quantitative PCR （Real-time PCR） was used to measure mRNA expression levels of AMPK， Beclin1， Atg5， ULK1， and p62. ResultCompared with the blank group， the model group exhibited a significant increase in body mass （P<0.01）. Additionally， the levels of FBG， FINS， and HOMA-IR significantly changed （P<0.01）. The structure of liver cells was disordered. The protein expression levels of AMPK， Beclin1， and Atg5 in liver tissue were significantly decreased （P<0.01）， while the expression level of p62 protein was significantly increased （P<0.01）. The expression levels of mRNA and proteins were consistent. Compared with the model group， the body mass of the metformin group and high and medium-dose groups of Rhei Radix et Rhizoma-Coptidis Rhizoma was significantly decreased （P<0.05）. FBG， FINS， and HOMA-IR were significantly decreased （P<0.05，P<0.01）. After treatment， the liver structure damage in each group was alleviated to varying degrees. The protein expressions of AMPK， Beclin1， Atg5， LC3B， and ULK1 were increased （P<0.05，P<0.01）， while the protein expression of p62 was decreased （P<0.01）. The expression levels of mRNA and proteins were generally consistent. ConclusionThe combination of Rhei Radix et Rhizoma-Coptidis Rhizoma can effectively improve liver insulin resistance， regulate the AMPK autophagy signaling pathway， alleviate insulin resistance in db/db mice， and effectively prevent the occurrence and development of type 2 diabetes.