Objective: To evaluate the effect of thoracic paravertebral nerve block (TPVB) at different time points on postoperative long-term quality of life in the patients undergoing thoracoscopic radical resection of lung cancer. Methods: One hundred and fifty patients of both sexes, aged 25-64 yr, with body mass index of 18-24 kg/m², of American Society of Anesthesiologists physical status Ⅰor Ⅱ, scheduled for elective radical resection of lung cancer, were divided into 3 groups (n=50 each) by a random number table method: preoperative TPVB group (P₁ group), TPVB at the end of operation group (P₂ group) and preoperative TPVB combined with TPVB at the end of operation group (P₃ group). In group P₁, TPVB was performed at T_{4, 6} points on the affected side under ultrasound guidance before anesthesia induction, and 0.5% ropivacaine 10 ml was injected in total.In group P₂, TPVB was performed at T_{4, 6} points on the affected side under ultrasound guidance at the end of operation, and 0.5% ropivacaine 10 ml was injected in total.In group P₃, TPVB was performed at T_{4, 6} points on the affected side under ultrasound guidance before anesthesia induction and at the end of operation, and 0.5% ropivacaine 10 ml was injected each time.The analgesia pump was connected at the end of operation in three groups.The patients were followed up after operation, and 5 ml solution extracted from the analgesic pump was intravenously injected when VAS score was greater than or equal to 4.The occurrence of postoperative chronic pain in the 3 groups was recorded though telephone follow-up at 6 and 12 months after surgery, and the effect of pain on daily life and treatment measures were scored.A concise health-related quality of life scale was used to evaluate patients′ quality of life, and the physical and mental health scores were calculated. Results: There was no significant difference in the incidence of chronic pain at 6 and 12 months after surgery among the three groups (P>0.05). The physical and mental health scores were significantly decreased at 12 months after surgery than at 6 months after surgery in the three groups (P<0.05). Compared with P₁ and P₂ groups, the scores of effect of pain on daily life and treatment measures were significantly decreased, and the physical and mental health scores were increased at 12 months after surgery in group P₃ (P<0.05). Conclusion The combination of preoperative TPVB and TPVB at the end of operation can effectively improve postoperative long-term quality of life in the patients undergoing thoracoscopic radical resection of lung cancer.

DESIGN: Surgical Innovation SETTING: Academic Tertiary Hospital OBJECTIVE: The objective of the study was to describe an alternative technique using a condylar autograft in conjunction with a fibular free flap in mandibular reconstruction and to prospectively assess the functional outcome in terms of inter-incisal distance, lateral excursion, maximum protrusion, occlusion, type of diet, speech and mandibular contour. METHODOLOGY: All patients who underwent segmental mandibulectomy with fibular free flap reconstruction done by one microvascular team from 1997 to 2004 were reviewed. From a total of 38 patients who underwent fibular free flap reconstruction, 7 patients who had condylar disarticulation, rigid fixation using miniplates to the fibula then replacement into the glenoid fossa were identified but 2 patients were excluded due to poor follow-up. Functional outcomes in terms of inter-incisal distance, lateral excursion, maximum protrusion, occlusion, type of diet, speech and mandibular contour were assessed post-operatively. Presence of tumor recurrence was also noted. RESULTS: Five patients were included in the study. The inter-incisal distance was noted to be 31 mm (+/- 12.5) with maximum protrusion of 1.4 mm (+/- 0.9). For those with right hemimandibulectomy (n=2), the right lateral excursion was 2.34mm (+/- 3.3) and left lateral excursion was 1.66mm (+/- 2.35). For those with left hemimandibulectomy (n=3), the right lateral excursion was 8.17m (+/- 2.25) and left lateral excursion was 3 mm (+/- 2.65). Four out of 5 patients had normal diet with excellent intelligible speech. The same 4 patients had good mandibular contour with a Class I occlusion as assessed by a dentist. The only patient with fair outcome had a mucoepidermoid carcinoma of the floor of the mouth with extensive soft tissue reconstruction aside from the bony reconstruction. No patient had tumor recurrence. CONCLUSION: The use of condylar autograft in conjunction with fibular free flaps holds promise as a way to restore temporomandibular function in mandibular reconstruction. (Author)
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AIM: To observe the application effect of tobramycin eye drops combined with irrigation and probing of lacrimal passage in the treatment of infant dacryocystitis.

METHODS: Totally 158 infants(174 eyes)with dacryocystitis treated in the hospital between January 2018 and December 2019 were enrolled. They were randomly divided into observation group(79 cases, 85 eyes)and control group(79 cases, 89 eyes)according to the order of treatment. The observation group was treated with tobramycin eye drops combined with irrigation and probing of lacrimal passage, while the control group was treated with irrigation and probing of lacrimal passage alone. The therapeutic effects of two groups were evaluated. The number of successful probing, incidences of complications, changes in inflammatory factors \〖interleukin 6(IL-6), tumor necrosis factor-α(TNF-α), high-sensitivity C-reactive protein(hs-CRP)\〗 before and after treatment and satisfaction of family members were compared between two groups.

RESULTS: The total response rate and the success rate of one-time probing in the observation group were significantly higher than those in the control group(91.8% vs 76.4%, 94.1% vs 80.9%, P<0.05). After treatment, the observation group had significantly lower levels of IL-6, TNF-α and hs-CRP than the control group(P<0.05). The incidence rate of complications in the observation group was significantly lower than that in the control group(4.7% vs 14.6%, P<0.05). Family members of the observation group had significantly higher satisfaction than those of the control group(96.2% vs 82.3%, P<0.05).

CONCLUSION: Tobramycin eye drops combined with irrigation and probing of lacrimal passage can effectively strengthen the curative effect on infant dacryocystitis, improve the success rate of one-time treatment, control local infectious inflammation, and reduce the incidence of postoperative complications. Besides, family members are highly satisfied.

Idiopathic hypereosinophilic syndrome (IHES) is a very rare disorder in children, characterized by increased eosinophils in bone marrow, peripheral blood and tissue, resulting in multiple organ damage. We report a case of an 8-yearold girl with IHES, whose initial complaints were diarrhea and abdominal distension. Image examinations indicated that the digestive tract, lung and urinary bladder were all affected. Routine blood test showed that the eosinophilia was 20.64×109/L. Bone marrow smear showed that the mature eosinophilic granulocytes increased to 32%. The FIL1P1/PDGFRA, FGFR1 and IGH gene detection, parasites and antibody tests were all negative. The diagnosis of IHES was considered. The eosinophil decreased significantly and symptoms relieved after steroid treatment, though with recurrences, steroids were still sensitive. Then we reviewed the relevant literature and cases of children with IHES in China.

BACKGROUND: The study aims to illustrate the clinical characteristics and development of septic shock in intensive care unit (ICU) patients confirmed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and to perform a comprehensive analysis of the association between septic shock and clinical outcomes in critically ill patients with coronavirus disease (COVID-19). METHODS: Patients confirmed with SARS-CoV-2 infection, who were admitted to the ICU of the Third People’s Hospital of Shenzhen from January 1 to February 7, 2020, were enrolled. Clinical characteristics and outcomes were compared between patients with and without septic shock. RESULTS: In this study, 35 critically ill patients with COVID-19 were included. Among them, the median age was 64 years (interquartile range [IQR] 59-67 years), and 10 (28.4%) patients were female. The median ICU length of stay was 16 days (IQR 8-23 days). Three (8.6%) patients died during hospitalization. Nine (25.7%) patients developed septic shock in the ICU, and these patients had a significantly higher incidence of organ dysfunction and a worse prognosis than patients without septic shock. CONCLUSIONS: Septic shock is associated with a poor outcome in critically ill COVID-19 patients and is one of the hallmarks of the severity of patients receiving ICU care. A dysregulated immune response, uncontrolled inflammation, and coagulation disorders are strongly associated with the development and progression of COVID-19-related septic shock.

AIM:To analyze the effects of corneal surface morphology and tear-film with different incisions guided by corneal topography after phacoemulsification.

METHODS: Retrospective study. Totally 56 patients(60 eyes)were selected and divided into clear corneal incision group and angle scleral margin incision group who were treated by phacoemulsification in our hospital from June 2019 to December 2020. Best corrected visual acuity(BCVA), ocular surface disease index(OSDI)questionnaire, tear film break-up time(TBUT), corneal surface regularity index(SRI), corneal surface asymmetry index(SAI)and corneal surface astigmatism(CYL)were measured preoperatively and postoperatively, the results were statistically analyzed.

RESULTS: BCVA in both groups increased after operation(P<0.01). The OSDI score of the two groups increased significantly after surgery(P<0.01). TBUT was shortened to varying degrees after surgery(P<0.05). SAI and SRI increased to varying degrees in both groups after surgery, and SAI value of angle scleral margin incision group in 1wk and 1mo postoperatively was significantly lower than that in clear corneal incision group(P<0.05). The corneal astigmatism at 1wk postoperatively was significant increased in both groups(P<0.05). The astigmatism increase of clear corneal incision group at 3mo postoperatively was still higher than that before surgery.

CONCLUSION: Angle scleral margin incision has less effect on stability of tear film and corneal surface morphology, which is reliable on phacoemulsification.

Objective: To analyze the clinical characteristics of fatal cases with confirmed severe adenovirus pneumonia in children in order to improve the diagnosis and treatment. Methods: The fatal cases of severe adenovirus pneumonia admitted to Pediatric Intensive Care Unit of Hunan Provincial People′s Hospital from January 2019 to July 2019 were collected, whose clinical features, diagnosis, treatment, and the causes of death were analyzed retrospectively. Results: A total of eight children were enrolled, and the age ranged from 3 months to 3 years old, and five cases were between 6 months to 2 years old.Three cases had underlying diseases.Adenovirus genotype identification was performed on six patients, and the results showed that all patients were infected with adenovirus type 7.All patients presented persistent high fever, with a peak temperature between 39.8℃ to 41.0℃, which persisted 10 to 37 days.Blood routine test before admission PICU showed that four cases had the decrease in white blood count and hemoglobin concentration, accompanied byincreased serum ferritin levels.Seven cases complicated with infection.Four cases had parainfluenza virus type 3 infection.Six cases had bacterial infection, and Gram-negative bacilli were predominant.One had fungal septicemia.Conventional mechanical ventilation were performed in all patients in this group.Four cases in this group died of severe acute respiratory distress syndrome.The other four cases died of disseminated intravascular coagulation associated with massive gastrointestinal bleeding, pulmonary hemorrhage, heart failure and septic shock combined with multiple organ failure. Conclusion Fatal adenoviruspneumonia mostly apppears in children between 6 months to 2 years old or with underlying diseases.Adenovirus type 7 was the main serotype.The occurrence of reactive hemophagocytic phenomenon should be worsen progression of the disease.Co-infection may be an important cause of death.

Objective: To investigate the effect of long non-coding RNA(lncRNA) Linc01296 on cisplatin (DDP) resistance in ovarian cancer cells and the mechanism. Methods: Fifty-three cases of ovarian cancer tissues, 22 cases of borderline ovarian tumor tissues and 17 cases of benign ovarian mass tissues were collected from Department of Gynecology, Sichuan Provincial People's Hospital during October 2017 to October 2018. The differential expression of Linc01296 mRNAin above tissue samples was detected by qPCR, and its relationship with clinicopathological data was analyzed. Human ovarian cancer cell line OVCAR-3 (OVCAR-3 Control) and its DDPresistant cell line (OVCAR-3 DR) were cultured. Lentiviral vectors expressing siRNA that targeting Linc01296 or siRNA control were transfected into OVCAR-3 DR cells respectively, as siLinc01296 group and siControl group. CCK-8 assay was used to detect DDP semi-inhibitory concentration (IC50) and drug resistance index of each group; real-time fluorescence quantitative PCR (qPCR) was used to detect the mRNA expressions of Linc 01296 and tumor stem cell related genes (Oct-4 and Sox-2) in cell lines of OVCAR-3 control, DR, DR siControl and siLinc 01296; and the protein expressions of Oct-4 and Sox-2 in each group were detected by Wb. Results: DDP IC50 and drug resistance index in OVCAR-3 DR group was significantly higher than that in Control group (all P <0.01), and DDP IC50 and drug resistance index in siLinc01296 group was significantly lower than that in DR siControl group (all P <0.01), but significantly higher than that in Control group (all P <0.01). The mRNA and protein expressions of Linc01296, Oct-4 and Sox-2 in DR group were significantly higher than that in Control group (all P <0.01), while those expressions in siLinc01296 group were significantly lower than those in DR siControl group ( P <0.01), and the mRNA and protein expressions of Oct-4 and Sox-2 in siLinc01296 group were higher than that in control group ( P <0.01). The expression of Linc01296 in ovarian cancer tissues was significantly higher than that in borderline ovarian tumor tissues and benign ovarian mass tissues ( P <0.01), which was positively correlated with lymph node metastasis and clinical stage ( P <0.05). Conclusion: Linc01296 can promote the occurrence of DDP resistance via promoting the expression of cancer stem cell markers in ovarian cancer; Linc01296 is highly expressed in ovarian cancer tissues and closely related to disease progression of patients.

[摘 要] 目的：探索RAD18影响结直肠癌细胞增殖及调节NK细胞对结直肠细胞的杀伤作用及其可能的机制。方法：采用生物信息学技术分析结直肠癌组织中RAD18和miR-145-5p的表达及两者之间的调控关系、分析RAD18富集通路。采用qPCR法验证RAD18和miR-145-5p在结直肠癌细胞中的表达，双荧光素酶报告基因实验验证miR-145-5p与RAD18的调控关系。按转染物的不同将SW480、HCT-15细胞分为将si-RAD18组、si-NC组，另向SW480细胞分别转染inhibitor-NC+si-NC、miR-145-5p inhibitor+si-NC或miR-145-5p inhibitor+si-RAD18，采用CCK-8法、克隆形成实验分别检测敲降miR-145-5p和/或RAD18对细胞增殖、克隆形成的影响；将各组细胞分别与经IL-2激活的NK92细胞共培养，采用乳酸脱氢酶释放法、ELISA和免疫荧光染色法分别检测NK细胞的细胞毒性、细胞因子分泌及细胞表面穿孔素和颗粒酶B表达的影响。结果：RAD18在结直肠癌组织和细胞中呈高表达（均P<0.01）。敲降RAD18可以抑制结直肠癌细胞增殖能力（P<0.05）和促进NK细胞活力、细胞毒性、IFN-γ、TNF-α、GM-CSF分泌及穿孔素和颗粒酶B的表达（均P<0.05）。双荧光素酶报告实验验证了RAD18-3’UTR与miR-145-5p的结合关系，miR-145-5p在结直肠癌组织和细胞中低表达（P<0.05或P<0.01）。miR-145-5p可以靶向下调RAD18的表达（P<0.05），过表达RAD18可以逆转miR-145-5p过表达对NK细胞杀伤效应的促进作用（均P<0.05）。结论：miR-145-5p可靶向下调RAD18的表达，miR-145-5p/RAD18轴能够影响结直肠癌细胞的增殖和NK细胞对其的细胞毒作用。

【Objective】 To analyze the correlation between thromboelastogram(TEG) index and postoperative bleeding in patients underwent percutaneous nephrolithotomy, thus providing evidence for clinical treatment and prevention. 【Methods】 The clinical data of 90 patients suffered from percutaneous nephrolithotomy were collected for a retrospective study. According to the presence or absence of bleeding, they were divided into non-bleeding group (n=71) and bleeding group (n=19).1) The clinical data, including gender, age, operation time, glomerular filtration rate (GFR), stone length, stone width, stone CT value, white blood cell count (WBC), hemoglobin (Hb), platelet count (Plt), neutrophil ratio, prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), D2 polymer, procalcitonin (PCT), interleukin-6 (IL-6), and TEG indicators (R value, K value, MA value, and angle), of the bleeding group and the non-bleeding group were compared. 2) The risk factors of postoperative bleeding in patients underwent percutaneous nephrolithotomy were analyzed. 3) The K, MA, R value, angle and ROC curve of the combined index were analyzed. 【Results】 There was no significant difference in gender, age, operation time, stone length, stone width, WBC, Plt, neutrophil ratio, PT, INR, APTT, R value between the two groups (P>0.05). General data of the two groups, including GFR, CT value of stones, Hb, D2 polymer, PCT, IL-6, K value, MA value, and angle, were statistically different (P<0.05). Binary logistic regression analysis showed that the decrease of Hb and K value, and the increase of angle were independent factors in the prediction of postoperative bleeding in patients underwent percutaneous nephrolithotomy (P<0.05). Correlation analysis displayed that Hb was positively related to K and R value, and negatively correlated with MA value and angle (r=0.508/0.391/-0.349/-0.548, both P<0.05); ROC curve analysis indicated the AUC of K value: (0.707, P<0.05), 0.416 of Youden index, 89.50% of sensitivity, and 52.10% of specificity; the AUC of MA value: (0.618, P>0.05), 0.303 of Youden index, 89.50% of sensitivity, and 40.80% of specificity; AUC value of angle: (0.720, P<0.05), 0.430 of Youden index, 89.50% of sensitivity, and 53.50% of specificity; AUC of R value: (0.610, P>0.05), 0.377 of Youden index, 84.20% of sensitivity, and 53.50% of specificity; AUC value of the combined index: (0.696, P<0.05), 0.384 of Youden index, 94.70% of sensitivity, and 43.70% of specificity. 【Conclusion】 TEG indicators can assess the coagulation function of patients underwent percutaneous nephrolithotomy, predict the risk of postoperative bleeding, and help guide clinical postoperative treatment.