Objective:To assess the diagnostic performance of serum anti-toxocara immunoglobulin G (anti-T-IgG) in ocular toxocariasis (OT) patients.Methods:A diagnostic tests. A total of 109 patients (109 eyes) with clinically-suspected OT who treated in Department of Ophthalmology of Xuzhou First People’s Hospital from June 2015 to December 2022 were included. Patients were divided into two groups, 76 with OT and 33 with non-OT, according to the clinical manifestations and Goldmann-Witmer coefficient. Paired serum and intraocular fluid samples from each patient were collected and analyzed for specific anti-T-IgG using enzyme linked immunosorbent assay. Mann-Whitney test was performed for comparison between groups. The area under the receiver operating characteristic curve (ROC) was used to assess the diagnostic performance of serum anti-T-IgG. Kappa analysis was performed to examine the consistency of serum or intraocular fluid anti-T-IgG positive rate with OT diagnostic result. Spearman’s rank correlation test was performed to assess the association.Results:Compared with the non-OT group, the proportions of children and history of exposure to cats and dogs ( χ2=9.785, 12.026) were significantly higher in OT group, and the differences were statistically significant ( P<0.01). The positive rate ( χ2=24.551) and U value ( Z=-4.379) of serum anti-T-IgG in OT group were higher than those in non-OT group, and the differences were statistically significant ( P<0.000 1). The recommended serum anti-T-IgG cut-off value of 11 U had 0.72 sensitivity, 0.79 specificity, 0.89 positive predictive value, 0.55 negative predictive value, and 0.77 area under the ROC with 95% confidence interval ( CI) 0.669-0.860. Correlation analysis showed that serum anti-T-IgG was positively correlated with intraocular fluid anti-T-IgG ( r s=0.520, 95% CI 0.363-0.648, P<0.000 1). The Kappa values of serum and intraocular fluid anti-T-IgG positive rate with OT diagnosis were 0.457 (95% CI 0.292-0.622) and 0.711 (95% CI 0.582-0.840), respectively. The Kappa value of serum anti-T-IgG positive rate with OT diagnosis was lower than that of intraocular fluid. Conclusion:The sensitivity and specificity of serum anti-T-IgG and the consistency between serum anti-T-IgG positive rate and OT diagnosis are low, suggesting that serum anti-T-IgG level cannot be used as a basis for OT diagnosis.

OBJECTIVE: To evaluate the current status of classification and repair methods for dural injury caused by spinal surgery or trauma, providing new strategies and ideas for the clinical repair of dural injury and the development of related materials. METHODS: The literature related to dural injury both at home and abroad in recent years was thoroughly reviewed and analyzed in order to draw meaningful conclusions. RESULTS: There have been numerous retrospective studies on dural injury, but there is a scarcity of prospective and multi-center studies, resulting in a low level of evidence-based research. The incidence and risk factors of dural injury have primarily been studied in relation to common degenerative spinal diseases of the cervical and lumbar spine, with insufficient research on thoracic spine-related diseases. Currently, a universally recognized method for grading and classifying dural injury has not been established, which hampers the development of clinical guidelines for their repair. Furthermore, although there are repair materials and surgical strategies available to address clinical issues such as suture leakage and surgical repair of dural injury in complex locations, there is a lack of comprehensive clinical research and evidence-based data to validate their scientificity and reliability. CONCLUSION Regardless of the classification of dural injury, suture remains the most important repair method. It is important to further develop new patches or sealants that can meet clinical needs and reduce the difficulty of repair.
Prospective Studies ; Reproducibility of Results ; Retrospective Studies ; Lumbar Vertebrae ; Lumbosacral Region

Objective To systematically evaluate the qualitative studies on the care experience of caregivers for primary malignant bone tumors patients,in order to provide references for the construction of bone tumor support care system.Methods The Cochrane Library,PubMed,Embase,CNKI,Wanfang Database,VIP database,and China Biomedical Literature Database were searched by computer to collect qualitative studies on the care experience of caregivers of malignant bone tumors patients from the establishment of the databases to November 2022.The quality of the literature was evaluated using the Joanna Briggs Institute(JBI)Quality Evaluation Criteria for Quality Research in Evidence-Based Health Care Centers(2016),and the results were integrated by a pooled integration approach.Results A total of 12 studies were included;48 themes were extracted and summarized into 9 categories,which were combined into 3 integrated results.Integration result 1 is obvious physical and mental disturbance.Integration result 2 is multiple role maladaptation.Integration result 3 is positive growth after adjustment.Conclusion Caregivers of patients with malignant bone tumors have serious physical and mental burden and are eager for multiple support.It is suggested that medical staff pay attention to the multi-dimensional needs of patients,formulate personalized support strategies,help caregivers adapt and transform their roles,and promote the post-traumatic growth of caregivers.

Objective:To explore the predictability cytokines in aqueous humor affecting optical coherence tomography angiography (OCTA) parameters after anti-vascular endothelial growth factor (VEGF) treatment in patients with polypoidal choroidal vasculopathy (PCV).Methods:A cross-sectional study was carried out.Twenty eyes of 20 patients with PCV were included in Xuzhou First People's Hospital from July 2017 to July 2020.All PCV eyes were treated by intravitreal injection of conbercept (IVC) following 3+ PRN regimen.One hundred μl of aqueous humor was collected before treatment and before the third injection, respectively.Thirteen kinds of cytokines in the aqueous humor were detected with Luminex bead-based multiplex array.The aqueous humor of 16 eyes of 16 cataract patients with age and gender matched were collected in the same way during phacoemulsification surgery as control.The values of center macular thickness (CMT), subretinal fluid height (SRFH), pigment epithelial detachment height (PEDH) and pigment epithelial detachment diameter (PEDD) of the eyes in the PCV group were examined with OCTA system.The target cytokines in aqueous humor affecting OCTA parameter change values (the difference between before and after treatment) was analyzed.This study protocol was approved by an Medical Ethic Committee of Xuzhou First People's Hospital (No.xyyll[2020]27) and complied with Declaration of Helsinki.Written informed consent was obtained from each patient prior to any medical invention.Results:The concentration of interleukin-8 (IL-8), Leptin, hepatocyte growth factor (HGF), fibroblast growth factor-2 (FGF-2), angiopoietin-2 (Ang-2), endothelin-1 and vascular endothelial growth factor-A (VEGF-A) were significantly higher in aqueous humor of the PCV group before treatment than those in the cataract group (all at P<0.05). After treatment, the concentration of VEGF-A in aqueous humor of the PCV group was significantly lower than that before treatment ( P<0.001). The values of CMT, SRFH, PEDH and PEDD were significantly reduced in comparison with before treatment, showing statistical significances (all at P<0.05). The concentration of VEGF-A in aqueous humor was positively correlated and endothelin-1 in aqueous humor was negatively correlated with the change value of CMT ( r=0.592, -0.485, both at P<0.05). The concentration of IL-8 and HGF were positively correlated with SRFH change value ( r=0.492, 0.466, both at P<0.05). VEGF-A and IL-8 concentraions of aqueous humor before treatment were the risk factor of the change value of CMT and SRFH.Every 1pg/ml increase of baseline VEGF-A, the CMT change value reduced 0.836 μm ( P=0.006), and every 1pg/ml increase of baseline IL-8, the SRFH change value reduced 12.522 μm ( P=0.028). Conclusions:The concentrations of VEGF-A and IL-8 in aqueous humor might predict the CMT and SRFH improvement in PCV eyes after anti-VEGF therapy.

Objective:To evaluate the safety and efficacy of combination of transjugular intrahepatic portosystemic shunt (TIPS) combined with interventional therapy for primary hepatic carcinoma complicated with portal hypertension.Methods:From October 2013 to December 2017, medical records of 141 patients with primary hepatic carcinoma complicated with portal hypertension hospitalized and treated in Anhui Provincial Cancer Hospital were collected. According to the inclusion and exclusion criteria, 32 cases were in the TIPS combined with interventional treatment group and 29 cases were included in the intervention-only group after age, gender, mean tumor diameter and Child-Pugh classification matched with TIPS combined with intervention treatment group. The efficacy of TIPS was obsented, and the related complications and prognosis of the two groups at six, 12 and 24 months after treatment were compared. Independent sample t test, Mann-Whitney U test and Chi-square test were used for statistical analysis, and Kaplan-Merier method was used for survival analysis. Results:There were no statistically significant differences between TIPS combined with intervention group and intervention-only group in age, gender, mean tumor diameter, Child-Pugh classification, Child-Turcotte-Pugh (CTP) score, Barcelona staging, interventional treatment, causes of liver cirrhosis, portal hypertension related symptoms , portal vein tumor thrombus, alanine aminotransferase (ALT), and total bilirubin (TBil) (all P>0.05). The success rate of TIPS of patients in TIPS combined with intervention group was 100% (32/32). All the portal hypertension related symptoms after TIPS were relieved, and the remission rate was 100% (32/32). Compared with that before TIPS, after TIPS, the portal vein pressure decreased ((36.5±6.9) cmH 2O vs. (25.5±5.6) cmH 2O (1 cmH 2O=0.098 kPa)), the diameter of portal vein decreased ((15.9±3.5) mm vs. (13.7±2.7) mm), and ascites volume decreased (abdominal circumference ((105.6±13.9) cm vs. (88.0±9.8) cm), red blood cell count ((2.6±0.8)×10 12/L vs. (3.3±1.3)×10 12 /L) and hemoglobin level ((78.9±15.5) g/L vs. (108.4±14.6) g/L) both increased, and the differences were statistically significant ( t=2.866, 3.105, 10.769, -3.548 and -3.869, all P<0.01). The stent patency rate six months after TIPS was 100% (32/32), the 12-month patency rate was 94% (30/32), and the 24-month patency rate was 84% (27/32). Six months, 12 months and 24 months after treatment, the incidence of ascites of patients in the TIPS combined with interventional treatment group was 0, 3.1% (1/32) and 9.4% (3/32), respectively, and the incidence of bleeding was 3.1% (1/32), 9.4% (3/32) and 15. 6% (5/32), respectively, which were all lower than those of the intervention-only group (13.8%, 4/29; 27.6%, 8/29; 65.5%, 19/29; 20.7%, 6/29; 34.5%, 10/29 and 62.1%, 18/29), and the differences were statistically significant ( χ2=4.72, 7.24, 20.80; and 4.62, 5.72, 13.97; all P<0.05). There were no statistically significant differences in the incidence rates of hepatic encephalopathy 6 and 12 months after treatment between the two groups (both P>0.05). The incidence of hepatic encephalopathy of intervention-only group (48.3%, 14/29) 24 months after treatment was higher than that of TIPS combined with intervention group (21.9%, 7/32), and the difference was statistically significant ( χ2=4.70, P=0.030). The results of Kaplan-Merier analysis indicated that 12 and 24 months after treatment the cumulative survival rates of TIPS combined with intervention group (84.4%, 27/32 and 53.1%, 17/32) were both higher than those of the intervention-only group (41.4%, 12/29 and 13.8%, 4/29), and the differences were statistically significant ( χ2=12.20 and 5.06, both P<0.05). The median survival time of TIPS combined with intervention group was 25 months, which was longer than that of the intervention-only group (12 months), and the difference was statistically significant ( Z=3.341, P=0.001). Conclusions:TIPS combined with interventional therapy is safe and effective in the treatment of primary hepatic carcinoma complicated with portal hypertension, which can improve the quality of life and increase the survival rate.

Objective To evaluate the efficacy of transjugular intrahepatic portosystemic shunt (TIPS)in the treatment of patients with hepatic sinusoidal obstruction syndrome (HSOS).Methods From April 2015 to August 2018,at The First Affiliated Hospital of University of Science and Technology of China,21 patients with gynura segetum caused HSOS were selected.All the patients received TIPS treatment because of unresponsiveness to anticoagulant therapy for at least two weeks.After operation patients were followed up with liver and portal vein Doppler ultrasonography examination,liver and kidney function tests,and survival observation.T test,logistic univariate regression analysis and Cox regression analysis were performed for statistical analysis.Results Among the 21 patients with gynura segetum-related HSOS,18 patients were in the subacute phase and three patients in the chronic phase.All of them were moderate or severe patients and all successfully underwent TIPS.The postoperative portal vein pressure was (16.71 ± 4.68) cmH2O (1 cmH2O =0.098 kPa),which was lower than that before operation ((41.52 ±6.27) cmH2O),and the difference was statistically significant (t =16.936,P ＜ 0.01).The postoperation portal vein blood flow velocity was (41.52 ±7.70) cm/s,which was higher than before operation ((11.19 ± 3.29) cm/s),and the difference was statistically significant (t =-15.191,P ＜0.01).At one month after operation,15 of 21 patients were clinically cured;among the remaining six patients,four patients were improved and two patients were ineffective (including one patient died).At four months after operation,two patients died,and the remaining 19 patients were clinically cured.At one month after operation,the levels of alanine aminotransferase (ALT),aspartate aminotransferase (AST),total bilirubin (TBil) and serum creatinine were (23.7 ± 16.8) U/L,(33.9 ±7.4) U/L,(52.7 ± 38.2) μmol/L and (62.7 ± 12.6) μmol/L,respectively,which were lower than those before operation ((60.5 ± 42.4) U/L,(78.4 ± 42.4) U/L,(74.9 ± 38.2) μmol/L and (82.4 ± 19.6) μmol/L,respectively),and the differences were statistically significant (t =3.193,3.493,2.378 and 4.519;all P ＜ 0.05).The level of albumin was (39.0 ±3.1) g/L,which was higher than that before operation ((30.9 ± 3.8) g/L),and the difference was statistically significant (t =-10.283,P ＜ 0.01).Portal vein thrombosis and preoperative TBil level had predictive value for therapeutic efficacy (both P ＜0.05).The one-year cumulative survival rate of patients was 90.5％.Preoperative TBil level and hepatic encephalopathy had effects on the prognosis of patients (both P ＜ 0.05).Conclusion TIPS is a safe,reliable and effective treatment for patients with subacute and chronic gynura segetum-related HSOS who are not responding to ineffective anticoagulant therapy,which can improve the prognosis and survival rate of the patients.

Objective To explore the mid-term results of the staged total aortic replacement in Stanford type A aortic dissection.Methods During March 2009 to September 2016,a total of 49 patients with Stanford type A aortic dissection in Beijing Anzhen Hospital cardiovascular center underwent total aortic replacement with a median age of 36 (27,41 years),male 36 (73.5％) cases.30 (61.2％) cases of them combined with Marfan syndrome.Results The interval between two stage operation was 23 (10,57) months.In the first stage operation,45 (91.8％) cases underwent Sun's procedure,2 (4.1％) underwent total aortic arch replacement,2 (4.1％) cases underwent classic elephant trunk and total aortic arch replacement.All patients underwent thoracoabdominal aortic repair(TAAAR).Deep hypothermic circulatory arrest surgery was 12(24.5％)cases in the second stage.7 (14.3％)cases dead postoperative.Spinal cord related complications happened in 3 (6.1％) cases with stroke in 2(4.1％) cases,acute renal insufficiency in 7(14.3 ％) cases,respiratory insufficiency in 7 cases (14.3％),re-operation for hemostasis in 3 (6.1％) cases and gastrointestinal bleeding in 3 cases(6.1％).Univariate analysis showed that the interval between two stage operation,operation time,deep hypothermic circulatory arrest surgery are risk factors for in-hospital mortality;multivariate analysis showed that deep hypothermic circulatory arrest surgery and the interval between two stage operation were independent risk factors for in-hospital mortality.3 years,5 years survival rate were 94.4％ and 78.7％.Conclusion For Stanford type A dissection especially the thoracoabdominal aortic expands,staged total aortic replacement shows good mid-term results.Block stentgraft can reduce the use of deep hypothermic circulatory arrests to decrease the mortality.

Objective To summarize the clinical outcomes and surgical indications for chronic type A aortic dissection (CTAD) by using Sun's procedure with preservation of autologous brachiocephalic vessels.Methods From September 2010 to December 2013, 23 patients with CTAD underwent Sun's procedure with preservation of autologous brachiocephalic vessels under moderate hypothermic circulatory arrest combined with selective cerebral perfusion in our center .The data was collected and analysed retrospectively.There were 20 males and 3 females patients with a mean age of(49.91 ±10.05) years.Preopera-tive comorbidities included Marfan syndrome in 1 patient, isolated left vertebral artery in 1, hypertension in 19, coronary artery disease in 2, heart dysfunction in 1, renal insufficiency in 1, mitral regurgitation in 1, and pulmonary infection in 1.Previous operation history included thoracic endovascular aortic repair in 3, percutaneous coronary intervention in 1, aortic valve re-placement in 1, Bentall procedure in 1, and coronary artery bypass grafting in 1.Results The average operation time, car-diopulmonary bypass time, aortic cross clamping time and selective cerebral perfusion time was(6.43 ±1.03) h,(167.07 ± 49.62) min,(80.74 ±29.00) min, and(27.35 ±6.03) min, respectively.Concomitant procedures included Bentall proce-dure in 6 patients, ascending aorta replacement in 17, ascending aorta-femoral artery bypass in 1, mitral valvuloplasty in 1, and CABG in 1.There were 2(8.70%) in hospital deaths.Three patients suffered temporary renal dysfunction, and 1 with re-nal failure recieved continuous renal replacement therapy .Postoperative hypoxemia were found in 2 patients, and 1 of them re-ceived reintubation.These patients recovered before discharge.The mean follow-up time was(52.52 ±9.89) months with a follow-up rate of 95.23%(20/21).One patient suffered cerebral embolism but recovered soon after treatment.The others were free from any complications.Conclusion Sun's procedure with preservation of autologous brachiocephalic vessels simplified the aortic arch surgery and obtained satisfactory outcomes for suitable patients with CTAD , but surgical indications should be strictly considered.

Objective    To evaluate the short- and middle-term outcomes of surgical treatment for distal aortic arch lesions using stented elephant trunk implantation combined with transposition of left subclavian artery to left common carotid artery. Methods    The clinical data of 14 patients with distal aortic arch lesions undergoing stented elephant trunk procedure with left subclavain artery transposition under hypothermic cardiopulmonary bypass (CPB) with antegrade selective cerebral perfusion from May 2009 to November 2015 in our hospital were retrospectively reviewed. All of them were males with a mean age of 52±14 years ranging from 20 to 69 years. Hypertension was observed in nine patients, coronary artery disease in five and prior cerebral infarction in one. History of percutaneous coronary intervention was noted in one patient, history of Bentall operation in one, ligation of patent ductus arteriosus in one and endovascular aneurysm repair in one. Results    There was no hospital death. Concomitant procedures included coronary artery bypass grafting in two patients and plasty of the ascending aorta replacement in one. Mean duration of mechanical ventilation and ICU stay was 21±7 h and 43±19 h, respectively. All patients survived and were discharged. One patient was lost to follow-up and no patient died during the follow-up. Postoperative computed tomography revealed good patency of  the anastomotic site between the left subclavian artery and the left common carotid artery. Conclusion    Stented elephant trunk procedure with left subclavain artery transposition obtains satisfactory surgical results in patients with distal aortic arch lesions.