Coronavirus disease 2019 (COVID-19) is a multi-system disease that can lead to various severe complications. Acute limb ischemia (ALI) has been increasingly recognized as a COVID-19-associated complication that often predicts a poor prognosis. However, the pathophysiology and molecular mechanisms underlying COVID-19-associated ALI remain poorly understood. Hypercoagulability and thrombosis are considered important mechanisms, but we also emphasize the roles of vasospasm, hypoxia, and acidosis in the pathogenesis of the disease. The angiotensin-converting enzyme 2 (ACE2) pathway, inflammation, and platelet activation may be important molecular mechanisms underlying these pathological changes induced by COVID-19. Furthermore, we discuss the hypotheses of risk factors for COVID-19-associated ALI from genetic, age, and gender perspectives based on our analysis of molecular mechanisms. Additionally, we summarize therapeutic approaches such as use of the interleukin-6 (IL-6) blocker tocilizumab, calcium channel blockers, and angiotensin-converting enzyme inhibitors, providing insights for the future treatment of coronavirus-associated limb ischemic diseases.
Humans ; COVID-19/physiopathology* ; Ischemia/etiology* ; SARS-CoV-2 ; Extremities/blood supply* ; Risk Factors ; Interleukin-6/antagonists & inhibitors* ; Acute Disease ; Angiotensin-Converting Enzyme 2

Acral melanoma(AM)is the most common histologic subtype of melanoma in dark-skinned patients and is associated with a worse prognosis and a high mortality rate,largely due to the inconspicuous nature of early-stage lesions,which can lead to late diagnosis.Because of the overlapping clinical and histopathological features of AM with other forms of cutaneous melanomas,early detection of AM requires a multidisciplinary approach that integrates various diagnostic modalities,including clinical examination,dermoscopy,histopathology,molecular testing,radiological imaging,and blood tests.While surgery is the preferred method of treatment for AM,other therapeutic options may be employed based on the stage and underlying etiology of the disease.Immune checkpoint inhibitors,molecular targeted therapy,radiotherapy,chemotherapy,and oncolytic virotherapy represent promising advanced treatment options for AM.In this review,we provide an overview of the latest advancements in diagnostic and therapeutic methods for AM,highlighting the importance of early detection and the prompt,individualized management of this challenging disease.

Coronavirus disease 2019 (COVID-19) is an acute respiratory infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. It is highly contagious and can cause death in severe cases. As reported by the World Health Organization (WHO), as of 6:36 pm Central European Summer Time (CEST), 12 August 2022, there had been 585 950 285 confirmed cases of COVID-19, including 6 425 422 deaths (WHO, 2022).
Humans ; COVID-19 ; SARS-CoV-2 ; Mental Health ; Cohort Studies ; Quality of Life ; China/epidemiology* ; Health Personnel ; Hospitals ; Lung

Objective:To explore the effect of combining motor imagery therapy (MIT) with kinesio taping in rehabilitating the upper limb motor function of stroke survivors.Methods:Ninety-two stroke survivors were randomized into a control group ( n=31), an MIT group ( n=31), and a combination group ( n=30). All were given 40 minutes of basic rehabilitation therapy daily, while the MIT group received additional MIT therapy, and the combination group received kinesio taping with the MIT therapy. The taping was applied according to a patient′s condition and changed every other day. The MIT was conducted twice a day. The experiment lasted 8 weeks, six days a week. Before and after the 8 weeks, the upper limb functioning, ability in the activities of daily living and muscle tension of each subject were assessed using the Fugl-Meyer assessment for the upper extremities (FMA-UE), the Hong Kong version of the functional test for a hemiplegic upper extremity (FTHUE-HK), the modified Barthel index (MBI) and the modified Ashworth scale (MAS). Results:The average post-treatment FMA-UE and MBI scores of the combination group were significantly higher than those of the MIT group, and both were significantly higher than the control group′s averages. The average FTHUE-HK grading of the combination group and MIT group after the treatment was significantly higher than in the control group, with that of the combination group significantly superior to the MIT group′s average. After the intervention the average MAS rating of the combination group was significantly lower than that of the control group.Conclusion:MIT combined with Kinesio taping can significantly improve the upper limb motor functioning of stroke survivors, and significantly reduce their abnormal muscle tone compared to traditional treatments.

Surgery is still the first choice for the curation of early gallbladder cancer, and the surgical strategy is selected based on anatomic position of primary tumor, accurate preoperative stage, and strict indication assessment in order to achieve the optimal curative effect. However, most patients are in advanced stage or with distant metastasis at the first diagnosis, and the recurrence rate and 5-year survival rate are not satisfied even if they receive curative resection. Subsequently, it is urgent for the employment of more treatment strategies in the process management of gallbladder cancer patients, such as neoadjuvant therapy, postoperative therapy and first-line or second-line treatment of local advanced and metastatic patients. In recent years, application of molecular targeted agents and immunotherapy have brought greater hope and laid a vaster prospect for the treatment of gallbladder cancer. However, there is still lack of evidence-based medicine data on the prognostic results, and further researches are needed. By integrating the domestic and abroad new research achievements, the authors systematically summarize the current status and future trend on the management of gallbladder cancer, and hope to provide a macroscopic and systemic treatment chart, including necessary details.

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors, and its features of insidious onset, rapid development, and high recurrence bring great challenges to the long-term survival of HCC patients. Molecular-targeted drugs and immune checkpoint inhibitors have become the research hotspots in the treatment of HCC, and a large number of clinical trials have found that combined therapy has achieved a good clinical effect. This article mainly introduces the application of combined therapy with molecular-targeted drugs and immune checkpoint inhibitors and other combined therapies in HCC and points out that combined therapy related to systemic therapy or local therapy has become the latest research hotspot in HCC treatment.

Objective:To investigate the feasibility and safety of laparoscopic liver tumor resection in children.Methods:The clinical data of 6 children undergoing laparoscopic liver tumor resection from June 2018 to March 2020 in the Affiliated Tumor Hospital, Zhengzhou University were retrospectively analyzed.Results:There were 4 males and 2 females among the 6 cases, with the average age of (7±2)years.All the children were admitted to the hospital with a liver occupying examination due to physical discomfort.Preoperative diagnosis: 3 cases of hepatoblastoma, 1 case of primary liver cancer, 1 case of hepatic adenoma and 1 case of hepatic nodular hyperplasia.All the children successfully completed laparoscopic liver tumor resection without conversion to open surgery.Among them, 3 children obtained left hemihepatectomy, 1 child underwent hepatic left lobectomy, 1 child was given VI hepatectomy, and 1 child accepted hepatic caudate lobectomy.The operation time was(90±9)min, and the average intraoperative blood loss was (83±26) mL.All children had no blood transfusion during or after operation.There were no bleeding, bile leakage, infection and liver failure after operation.All children had no gastric tube before surgery and the fluid diet was given on the first day after operation, and the postoperative median hospital stay was 4(3-5) days.The pathology were consis-tent with the preoperative diagnosis, and the resections were all radical operation resections.The follow-up period was from 2 to 23 months, and all the children recovered well and no recurrence was observed.Conclusions:Laparoscopic liver tumor resection in children is safe and feasible, which can minimize trauma, reduce intraoperative bleeding and shorten the hospital stay without increasing the incidence of postoperative complications.Laparoscopic liver tumor resection in children has certain advantages.

Objective:To compare the clinical outcomes between the new cold-circulation bipolar radiofrequency assisted versus Habib-4X bipolar radiofrequency assisted open hemihepatectomy.Methods:A retrospective study was conducted on 45 patients who underwent bipolar radiofrequency assisted open hemihepatectomy at the Affiliated Tumor Hospital of Zhengzhou University from October 2016 to January 2020. There were 28 males and 17 females, with an average age of 52.2 years. These patients were divided into the experimental group ( n=20) who underwent the new cold-circulation bipolar radiofrequency assisted open liver resection, and the control group ( n=25) who underwent the Habib 4X bipolar radiofrequency assisted open liver resection. The postoperative alanine aminotransferase (ALT), postoperative aspartate aminotransferase (AST), liver coagulative necrosis plane width, speed of liver parenchymal transection, electrode needle carbonization rate, and postoperative complications were compared between groups. Results:In the experimental group, the speed of liver parenchymal transection was (5.0±2.0) cm 2/min, the width of the coagulative necrosis plane was (1.36±0.21) cm, the AST on the first postoperative day was (177.0±79.3) U/L, the ALT on the first postoperative day was (200.2±78.5) U/L, and the electrode needle tip carbonization rate was 20.0% (4/20). These figures were significantly better than the control group with (3.6±1.7) cm 2/min, (1.93±0.16) cm, (233.2±66.6) U/L, (249.2±62.9) U/L, and 56.0% (14/25), respectively (all P<0.05). The postoperative complication rate was 15.0% (3/20) in the experimental group and 24.0% (6/25) in the control group ( P>0.05). Conclusion:Cold-circulation bipolar radiofrequency assisted hemihepatectomy was safe and feasible. It had the advantages of rapid transection of liver parenchyma, a low electrode tip carbonization rate, and a more accurate coagulation range.

Objective:To investigate the safety and efficacy of ultrasound-guided percutaneous radiofrequency ablation (RFA) for caudate lobe hepatocellular carcinoma (HCC) and the failure factors of incomplete tumor ablation.Methods:Twenty-four cases with caudate lobe hepatocellular carcinoma who underwent ultrasound-guided percutaneous RFA in the Affiliated Tumor Hospital of Zhengzhou University from January 2017 to October 2019 were enrolled. The ablation effect and complications conditions were recorded, and the primary technical effectiveness and local tumor progression (LTP) were evaluated.Results:Among 24 cases, 20 cases had complete ablation at one session, 4 cases had incomplete ablation, and after supplementary radiofrequency ablation all cases had achieved complete ablation. There was no evidence of local tumor progression in 24 cases after one-month postoperative evaluation. The primary technical effectiveness rate was 100%. The postoperative follow-up was 2 to 29 months (median follow-up time was 18 months). Of the 24 cases after ablation, LTP were detected in 11 cases, of which only 3 cases had distant intrahepatic recurrence, 1 case had distant intrahepatic recurrence and distant metastasis, and 5 cases had only distant metastasis, 2 cases died, and 4 cases had SIR grade B complications related to ablation.Conclusion:Ultrasound-guided percutaneous radiofrequency ablation was safe and effective for caudate lobe hepatocellular carcinoma. In addition, the distance between the tumor and the inferior vena cava < 0.5cm is a suspected risk factor for incomplete ablation of caudate lobe hepatocellular carcinoma ( P < 0.05).

Objective:To investigate the application value of a new internal cold circula-tion bipolar radio frequency device in open hepatectomy.Methods:The retrospective cohort study was conducted. The clinical data of 85 patients with hepatocellular carcinoma who underwent open hepatectomy at the Affiliated Tumor Hospital of Zhengzhou University from February 2017 to January 2020 were collected. There were 48 males and 37 females, aged from 32 to 74 years, with a median age of 52 years. Of 85 patients, 45 cases undergoing hepatectomy assisted by the new internal cold circulation bipolar radio frequency device were allocated into new internal cold circulation bipolar radio frequency device group, and 40 cases undergoing hepatectomy assisted by Habib-4X bipolar radio frequency device were allocated into Habib-4X group, respectively. Observation indicators: (1) intraoperative situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted by outpatient, inpatient reexamination and telephone interview to detect the postoperative complications and death of patient within postoperative 30 days up to May 2020. Measurement data with normal distribution were represented as Mean± SD, and independent sample t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M(range), and nonparametric Mann-Whitney U test was used for comparison between groups. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Repeated measurement data were anlyzed by the repeated ANOVA. Results:(1) Intraoperative situations: the time of crosscutting process for liver parenchyma, average area transection speed, coagulation tissue width, cases with needle bleeding rate and electrode needle charring were (55±16)minutes, (4.8±1.2)cm 2/minute, (1.4±0.2)cm, 6, 10 for the new internal cold circulation bipolar radio frequency device group, versus (64±15)minutes, (3.6±1.0)cm 2/minute, (1.8±0.2)cm, 14, 25 for the Habib-4X group, respectively, showing significant differences in the above indicators between the two groups ( t=2.665, 4.973, 9.204, χ2=5.525, 14.184, P<0.05). (2) Postoperative situations: for the new internal cold circulation bipolar radio frequency device group, the total bilirubin (TBil) was (20±12)μmol/L, (25±12)μmol/L, (20±14)μmol/L at postoperative 1, 3, 7 days, the prothrombin time (PT) was (15.4±2.2)seconds, (14.2±2.1)seconds, (12.7±0.8)seconds, the alanine aminotransferase (ALT) was (288±248)IU/L, (132±61)IU/L, (67±32)IU/L, the aspartate aminotransferase (AST) was (279±114)IU/L, (50±22)IU/L, (30±13)IU/L. For the Habib-4X group, the TBil was 1(22±15)μmol/L, (23±10)μmol/L, (19±8)μmol/L at postoperative 1, 3, 7 days, PT was (15.8±2.8)seconds, (14.3±2.0)seconds, (13.6±1.3)seconds, the ALT was (369±269)IU/L, (133±99)IU/L, (54±30)IU/L, the AST was (345±125)IU/L, (60±36)IU/L, (32±11)IU/L. There were significant differences in the time effect of PT, ALT, AST between the two groups ( F=18.364, 23.020, 93.786, P<0.05). There was no significant difference in the time effect, between-group effect, interaction effect of TBil or between-group effect, interaction effect of PT, ALT, AST between the two groups ( F=2.421, 1.424, 0.522, 1.593, 0.312, 0.121, 0.267, 1.027, 0.600, P>0.05). (3) Follow-up: 85 patients were followed up for 4 to 39 months, with a median follow-up time of 16 months. There were 5 patients in the new internal cooling circulation bipolar radiofrequency device group and 8 patients in the Habib-4X group with complications, respectively, showing no significant difference in overall complications between the two groups ( χ2=1.292, P>0.05). The number of deaths in the new internal cooling circulation bipolar radio frequency device group and Habib-4X group was 0 and 1, respectively, showing no significant difference between the two groups ( P>0.05). Conclusion:The new internal cold-circulating bipolar radio frequency device for open hepatectomy is safe and effective, which cuts the liver parenchyma faster, has lower carbonization rate at the tip of electrode needle, and has more accurate coagulation range.