Objective To investigate the anatomic relationship between the upper thoracic vertebrae and adjacent structures in anterior approach of upper thoracic spine, an anatomy study was conducted and its clinical significance was evaluated. Methods Twenty upper thoracic spine specimens of adult human cadaver were exposed, measured and studied for their anatomic landmarks. The origin, course of the recurrent laryngeal nerve, thoracic duct and blood vessels and their relationship were measured and analyzed. The advantages and disadvantages of different surgical approaches exposing the upper thoracic vertebrae were also evaluated and compared. Results The right recurrent laryngeal nerve reaches the tracheo-esophageal groove at the level of C6-7 disc in 55% of the specimens and derives from vagus nerve at the level of T1,2. The thoracic duct empties into the systemic venous system from T1 to T1-2 disc space in 75% of the specimens and among them, more than 50% up to T1 level. The left brachiocephalic vein is at T3 in 55% of the specimens; and the aortic arch is at T3-4 disc in 80% of the specimens. The anterior aspect of T3 can be easily exposed through a modified anterior approach to the upper thoracic vertebrae in only 45% of the specimens(9), compared with outside space of the brachiocephalic trunk(between the right brachiocephalic vein and the brachiocephalic trunk and left brachiocephalic vein) in 95% of the specimens (19). Conclusion Surgical approach through outside space of the brachiocephalic trunk is simple and adequate to expose the T3,4 vertebra body and can get more exposed space of 0.5-1 of the vertebra body than through inner space of the brachiocephalic trunk and can be utilized selectively during anterior upper thoracic spine surgery. Attention should be paid to avoid injury of vagus nerve in the middle, right recurrent laryngeal nerve on the right and thoracic duct on the left, respectively.

Objective To investigate the procedure of anterior thoracic corpectomy and the surgical outcomes of upper thoracic spine tumors by the right space of the ascending aorta and the right space of the brachiocephalic artery. Methods 12 patients underwent surgery between June 2000 and January 2006. There were 8 cases of primary tumors and 4 metastatic carcinomas, 4 cases of tumor in T3 and 6 cases in T4 and 3 cases in T3,4. The anterior modified transmanubrium approach was made. After the exposure of the tumor through the right space of the ascending aorta and the right space of the brachiocephalic artery, the involved vertebral body and contiguous discs were resected, the spinal cord was decompressed. Curettage was performed in 3 cases for other tumors, en bloc vertebrectomies were performed. As a body replacement, in case of benign disease autogenous bone graft harvested from the dorsal iliac crest was used, and for malignant bone tumors using bone cement. To secure the strut, anterior cervical titanium alloy plates were used until T5. Neurological status was graded according to Frankel grading system. Results 6 cases of bradycardia and hypotension or increasing airway resistance occurred intraoperatively. The mean follow-up period was 28.6 months (range 4-66 months). 3 patients with autogenous bone graft had bone union 6 months postoperatively. According to Frankel grading system, 1 patient improved from grade A preoperation to B postoperation, while another patient from B to C; of the 5 cases with grade C preoperation, 4 patients improved to D postoperation and 1 patient to E; 4 patients improved from D to E; 1 patient with grade E left unchanged. 3 patients died from general metastasis and failure 10-20 months postoperatively. One patient with giant cell tumor recurred 10 months postoperatively. Conclusion Clear exposure and satisfactory outcome can be obtained by the use of the right space of the ascending aorta and the right space of the brachiocephalic artery; it is especially indicated to the upper thoracic spine T3 and T4 tumors, where the spinal compression is located anteriorly.

Objective To investigate the clonal relatedness of A.baumannii isolates from senile patients by conducting cross-sectional and longitudinal studies on antimicrobial susceptibility profiling and genomic diversity.Methods Cross-sectional study was done among the 170 non-repetitive A.baumannii isolates which were collected from senile patients during two years.Longitudinal study was conducted among 77 A.baumannii collected from 8 senile patients within longtime hospitalization.Results 75.3 ％ of the 170 isolates were non-susceptible to carbapenems,and the phenotype were XDR or MDR which spread evenly all over the senile wards.The isolates belonged to 36 pulsotypes determined by PFGE.Groups Ⅰ (contain119 isolates) were major epidemic strains,which were CRAB with XDR phenotype.In longitudinal study,comparison of pulsotypes was performed for each patient and all isolates were clustered into group Ⅰ except one isolate.All the 77 isolates were XDR.Conclusion Extensive drug-resistance of A.baumannii was a serious problem in the gerontal wards.Clone dissemina tion was the most important style of XDR strains spread.Horizontal infection control measures to interrupt person-to-person transmission should be reinforced to reduce the further spread of XDR A.baumannii.

We investigated the common diseases in patients from village clinics and compared them to those of the general population in rural areas of Jiangsu Province.We found that the treatment rates of chronic diseases such as hypertension and diabetes mellitus were quite low.Village clinics should play a more active role in health record management,healthcare education,and management of chronic diseases for the farmers.

Objective: The present study investigated the prevalence of Internet addiction in Shenzhen adolescents and its predicative factors, so as to provide a reference for precisely identifying the adolescents of internet addiction and conducting intervention. Methods: Cluster random sampling method was applied to select the middle school students of grade 1 in 5 middles schools in Shenzhen. Three waves of data were collected over 3 years from students in 5 secondary schools in Shenzhen. Young s 10 item Internet Addiction Test, Chinese Positive Youth Development Scale, Chinese Family Assessment Instrument, Academic Maladaptation Scale and Demographic Variables Questionnaire were used, and finally the data of 1 301 students was proved to be valid. Results: The adolescents met the criterion of Internet addiction were 14.4%, 15.5% and 14.7% over past three years. The incidence of Internet addiction was stable among teenagers during the three years( F =2.53, P =0.08); The multivariate linear regression analysis showed that positive youth development, good family functioning indicators and academic maladaptation could predict the higher probability of having Internet addiction( P <0.05). Conclusion The phenomenon of Internet addiction among teenagers in Shenzhen junior middle school is common and relatively stable. The teenagers from the family of positive function, with positive development and with less academic maladaptation are less likely to suffer from internet addiction.

Objective To carry out a meta-analysis,in order to evaluate the effectiveness and safety of the duodenum-preserving pancreatic head resection (DPPHR) and pancreaticoduodenectomy (PD) or pylorus-preserving pancreaticoduodenectomy(PPPD) for surgical treatment of chronic pancreatitis.Methods Medline,EMBASE,Cochrane library and other medical databases were searched for the clinical trials (randomized controlled trials) of comparing DPPHR Versus PD/PPPD.A total of 5 clinical trials (8 references) met the inclusion criteria.The data were analyzed using the RevMan 5.3 software.Results The two methods don't have statistical differ ence in terms of operation time (P=0.007),postoperative morbidity (P=0.35) and mortality (P=0.18),pain relief(P=0.36),new onset of diabetes(P=0.11),exocrine insufficiency(P=0.18),short-term(P=0.14) and long-term(P=0.16) quality of life score,the length of hospital stay (P=0.69),and pancreatic fistula (P=0.78).Weight gain (P＜0.000 01) and occupational rehabilitation (P=0.03)were significantly improved in the DPPHR group.However,PD/PPPD group was associated with fewer readmission due to pancreatic diseases.Conclusions DPPHR offers more advantages with regard to the quality of life.However,it needs more high-quality clinical trials to verify the results.

Objective:To investigate the application value of hand-sewn esophagojejunal anastomosis (EJA) in totally laparoscopic total gastrectomy (TLTG).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 35 patients with early or advanced upper gastric cancer who were admitted to Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine between July 2018 and December 2019 were collected. There were 24 males and 11 females, aged (60±10)years, with a range of 35-75 years. All the 35 patients underwent TLTG combined with hand-sewn EJA. Observation indicators: (1) intraoperative situations; (2) postoperative situations; (3) postoperative pathological examination; (4) follow-up and survival. Follow-up was conducted using telephone interview, outpatient examination, short message service and WeChat to detect tumor recurrence, metastasis and survival of patients up to January 2020.Measurement data with normal distribution were repressented as Mean± SD. Measurement data with skewed distribution were represented as M (range). Count data were expressed as absoulte numbers or persentages. Results:(1) Intraoperative situations: all the 35 patients underwent TLTG combined with hand-sewn EJA successfully. The operation time, volume of intraoperative blood loss, time of hand-sewn EJA, costs of consumables used in the intraoperative resection and reconstruction, and costs of consumables used in EJA of the 35 patients were 305 minutes(range, 232-406 minutes), 94 mL(range, 50-300 mL), 37 minutes(range, 20-65 minutes), 13 674 yuan(range, 11 929-15 255 yuan) and 491 yuan(range, 223-1 044 yuan), respectively. Of the 35 patients, 4 received intraoperative blood transfusion. (2) Postoperative situations: time to first out-of-bed activity, postoperative indwelling time of gastric tube, time to initial liquid diet intake, the time to abdominal drainage tube removal and duration of postoperative hospital stay of the 35 patients were 2 days(range, 1-3 days), 4 days(range, 2-11 days), 5 days(range, 4-12 days), 8 days(range, 5-15 days) and 9 days(range, 7-16 days), respectively. Of the 35 patients, 3 had perioperative complications. One patient had inflammation and infection in the pancreatic tail and was discharged at postoperative 16 days after conservative treatment of fasting, somatostatin to reduce the pancreatic secretion, adequate drainage, anti-infection and nutritional support. One had postoperative intestinal incomplete obstruction and was discharged at postoperative 12 days after treatment with gastrointestinal decompression and enema for relief of obstruction. One had pulmonary infection who was discharged at postoperative 9 days after symptomatic and supportive treatment. None of the 35 patients had perioperative anastomotic leakage or bleeding. Of the 35 patients, 1 was diagnosed with esophagojejunostomy stenosis at postoperative 2 months and was improved after endoscopic dilatation. The incidence of long-term anastomosis-related complications of the 35 patients was 2.9%(1/35). (3) Postoperative pathological examination: the pathological examination of the upper margin of intraoperative frozen section and postoperative paraffin section showed negative in the 35 patients. Of the 35 patients, 16 had tumor located at cardia including 4 cases with tumor involving in lower esophagus, 19 had tumor located at stomach; 21 had tumor pathological type as highly or moderately differentiated adenocarcinoma, 11 had poorly differentiated adenocarcinoma, 3 had signed-ring cell carcinoma; 14 had early gastric cancer, 21 had advanced gastric cancer; 7 had tumor invaded at mucosa lamina propria and muscularis, 7 had tumor invaded at submucosa, 1 had tumor invaded at muscularis, 1 had tumor invaded at subserosal, 17 had tumor invaded at serosal, 2 had tumor invaded at extra-serosal adipose tissue. The TNM staging of the 35 patients: 14 were in stage ⅠA , 2 in stage ⅠB, 4 in stage ⅡB, 3 in stage ⅢA, 4 in stage ⅢB and 8 in stage ⅢC. Of the 35 patients, 15 had vascular invasion and 16 had nerve invasion. The tumor diameter, the number of lymph nodes dissected and the number of positive lymph nodes of the 35 patients were 3.9 cm(range, 0.6-12.0 cm), 24(range, 10-40) and 2(range, 0-11). (4) Follow-up and survival: all the 35 patients were followed up for 1-18 months, with a median time of 5 months. Of the 35 patients, tumor recurrence or metastasis was not found in 34 patients, and the other 1 patient was diagnosed with liver metastases of tumor at postoperative 6 months and survived with tumor.Conclusion:Hand-sewn EJA in TLTG is safe and feasible.

Objective:To evaluate the measurement agreement of Roche 25(OH)D immunoassay(evaluation method) with LC-MS/MS (reference method).Methods:A total of 909 residual serum samples from routine health check participants were collected from May to June in 2019. 25(OH)D concentrations were measured by evaluation method and LC-MS/MS, respectively. Passing-bablok regression, intraclass correlation coefficient (ICC), Bland Altman plots and Kappa test were used to analyze the consistency and bias on the results derived from the two measurement methods.Results:The 25(OH)D concentration derived from evaluation method was significantly different from those from LC-MS/MS method ( P<0.001). Slope of regression for evaluation method and LC-MS/MS was 0.962(95% CI 0.919-1.007), while intercept was -0.185 (95% CI -1.191-0.745). The ICC was 0.765 (95% CI 0.735-0.792). Altman plot showed that the average deviation between evaluation method and LC-MS/MS was -0.902 ng/ml (0.300%). The coincidence rate of evaluation method′s judgment of vitamin D sufficiency, insufficiency and deficiency with LC-MS/MS was 83.39%, and the weighted Kappa values was 0.790. Conclusion:Roche automatic 25(OH)D immunoassay shows acceptable correlation and agreement with LC-MS/MS, however, it is to note that the deviation between immunoassay and LC-MS/MS may lead to wrong judgment of vitamin D nutritional status. It is recommended that each laboratory should establish own corresponding reference values for 25(OH)D concentrations derived from these two methods.

AIM: To observe the outcome of intravitreal balanced salt solution(BSS)injection to increase intraocular pressure(IOP)after extrascleral subretinal fluid drainage, then scleral buckling(SB)to treat superior bullous retinal detachment(SBRD), and compare it with the effect of conventional surgery(without any intravitreal filling)and postoperative air filling.METHODS: Retrospective case-control study. A total of 72 patients(73 eyes)who underwent SB for SBRD from January 2018 to December 2022 in ophthalmology department of Xijing Hospital were included. The extrascleral subretinal fluid drainage was performed in all eyes. According to whether intravitreal injection was performed and different injections, patients were divided into three groups: with 24 cases(24 eyes)in the conventional group(no intravitreal injection), 23 cases(23 eyes)in the air group(sterile air was injected after surgery), and 25 cases(26 eyes)in the BSS group(BSS was injected during extrascleral subretinal fluid drainage). All patients were followed up until subretinal fluid was absorbed completely. The average surgery time, postoperative IOP, retinal reattachment rate, subretinal fluid absorption, visual acuity(LogMAR)and major complications were compared.RESULTS: All surgeries were completed successfully. The average surgery time of the conventional group, air group and BSS group were 63.17±13.22, 61.65±15.55 and 57.30±11.70 min, respectively. There had no significant difference among these groups(F=0.825, P=0.443). On the first post-operative day, the average IOP of the conventional group, air group and BSS group were 13.69±2.69, 16.40±2.86 and 18.35±2.88 mmHg, respectively. The average IOP of the air group and the BSS group were significant higher than that of the conventional group(F=17.18, P<0.001). Primary reattachment rates were 88%, 96%, and 100%, respectively. The postoperative BCVA was 0.71±0.42, 0.59±0.44, and 0.91±0.50, respectively, which were significantly higher than those before operation(all P<0.05), but there was no significant difference among groups(F=3.046, P>0.05). The main complications included subretinal hemorrhage in 1 eye from the conventional group and 1 eye from the air group, and a new retinal tear in 1 eye from the air group, resulting in localized retinal detachment.CONCLUSIONS: For SBRD patients with hypotony during SB surgery, intravitreal injection of BSS to properly increase the IOP and then complete the surgery can improve the reattachment rate and reduce postoperative complications. This method is safe and effective for selected SBRD patients.