Objective To compare clinical outcome of microvascular decompression (MVD) and percutaneous balloon compression (PBC) by using a prospective cohort study in order to provide a reliable evidence for the clinical decision-making. Methods Patients with trigeminal neuralgia hospitalized at Hangzhou First People′s Hospital in 2010 were chosen as database for cohort study. The patients were divided into MVD group (30 cases) and PBC group (30 cases). The clinical efficacy was followed by independent observers for 36 months after surgery. Chi-square test for hierarchical data, t test for quantitative data, and Kaplan-Meier plot for clinical outcomes were applied in the research. The endpoint was follow-up accomplishment or severe occurrence. Results Sixty patients were included in the research till the endpoint. The general records before surgery were almost the same with the literature records. By comparing painless period, mild and severe relapse, MVD group was superior to PBC group (P < 0.05). As for the painless survival period, MVD group was 96.7% of pain free after 1 year, 93.3% after 3 years, while PBC group was 90.0% after 1 year and 83.3% after 3 years. Regarding 3 years of follow-up, the relapse seemed occurred after 1 year in both groups. Conclusions As a curative and nondestructive procedure , MVD is more effective and has longer lasting pain free period , which should be considered as the first choice of treatment for trigeminal neuralgia in healthy people.

Objective To investigate and summarize the MRI characteristics of splenic sclerosing angiomatoid nodular transformation (SANT).Methods A retrospective analysis of 5 SANT cases were analyzed,in terms of their MRI characteristics and pathological findings.Results MRI findings of SANT included:T1WI presents iso-signal or slightly low signal,all displayed lesions were detected as low signal compared with spleen,but higher than muscle signal on T2 WI,and with speck dots or starlike low signal in the central area,without necrosis and cystic change.The signal was significantly differentiated compared with the spleen on DWI.On chemical shift imaging,2 cases were showed slightly higher signal on out phase,the others without signal change.On enhanced scan,4 cases had edge obvious enhancement on arterial phase,inward filling enhancement,and the signal was higher than the spleen,1 case without arterial phase enhancement,but with mild concentric delayed enhancement.All of the speck dots and starlike areas decreased with time delay,with certain degree enhancement on delayed phase.Conclusions There were some MRI features of SANT,preoperative MRI can prompt diagnosis,but final diagnosis depends on pathology.

BACKGROUND: Exosomes derived from breast cancer have been reported to play a role in promoting cell proliferation, migration, and angiogenesis, which has the potential to accelerate the healing process of diabetic wounds. The aim of this investigation was to examine the function of exosomes originating from 4T1 mouse breast carcinoma cells (TEXs) in the process of diabetic wound healing. METHODS: The assessment of primary mouse skin fibroblasts cell proliferation and migration was conducted through the utilization of CCK-8 and wound healing assays, while the tube formation of HUVECs was evaluated by tube formation assay. High-throughput sequencing, RT-qPCR and cell experiments were used to detect the roles of miR-126a-3p in HUVECs functions in vitro. The in vivo study employed a model of full-thickness excisional wounds in diabetic subjects to explore the potential therapeutic benefits of TEXs. Immunohistochemical and immunofluorescent techniques were utilized to evaluate histological changes in skin tissues. RESULTS: The findings suggested that TEXs facilitate diabetic wound healing through the activation of cell migration, proliferation, and angiogenesis. An upregulation of miR-126a-3p has been observed in TEXs, and it has demonstrated efficient transferability from 4T1 cells to HUVEC cells. The activation of the PI3K/Akt pathway has been attributed to miR-126a-3p derived from TEXs. CONCLUSIONS The promotion of chronic wound healing can be facilitated by TEXs through the activation of cellular migration, proliferation, and angiogenesis. The activation of the PI3K/Akt pathway by miR-126a-3p originating from TEXs has been discovered, indicating a potential avenue for enhancing the regenerative capabilities of wounds treated with TEXs.

Objective To evaluate the clinical effects of percutaneous micro-balloon compression (PBC) trigeminal ganglion for the treatment refractory trigeminal neuralgia. Methods Surgical results of 452 patients with trigeminal neuralgia treated by PBC from October 2009 to May 2013 were analyzed retrospectively. 125 cases aged over 80 years old and 70 cases′ pain belongs to the first branch neuralgia. Such procedures as Meckle′s cave cannulated with No.4 Forgarty catheter and the balloon inflated and compressed the gasserian ganglion monitored by X-ray were observed by PBC. Follow-up interview and curative effects were recorded. Results The average hospitalization was 6.1 days. Among them, 432(95.6%) cases had immediate relief from pain. The overall pain relief rate was 97.8% in our group without serious surgical complications. Postoperative complications include hemifacial numbness in 385 patients (85.2%), mild masseter muscle weakness in 248 patients (54.9%), diplopia in 2 patients. All symptoms relived or disappeared within 1 ~ 6 months. The average follow-up intervier period is 23.5 months. The recurrence rate is 10.2% (46 cases). Conclusion PBC is a safe and effective method with high pain relief rate in the treatment of refractory trigeminal neuralgia , especially for the treatment of the high risk patients , patients with recurrent symptoms or the patients suffered from the first branch neuralgia.

Objective: To investigate fusidic acid resistance in Staphylococcus aureus (S.aureus) strains and to analyze their molecular characteristics. Methods: A total of 1 333 strains of S. aureus isolated in the First Affiliated Hospital of Wenzhou Medical University from October 2013 to March 2016 were collected. Fusidic acid resistance in these strains was detected by K-B method. Minimum inhibitory concentrations (MIC) of fusidic acid were measured by agar dilution method. Resistance genes of fusB, fusC and fusD and S. aureus A protein-coding gene (spa) were detected by PCR. Strains that did not carry fusB, fusC or fusD were detected for mutations in fusA by sequencing. Housekeeping genes were detected by PCR and analyzed by multilocus sequence typing (MLST). Results: Among the 1 333 strains of S. aureus, 52 were resistant to fusidic acid, accounting for 3.90%. From 2013 to 2016, fusidic acid-resistant strains accounted for 5.3% (7/132), 3.5% (20/571), 4.1% (21/510) and 3.3% (4/120), respectively. The MIC values of fusidic acid against S. aureus were 2, 4, 8, 64 and >64 μg/ml, which inhibited the growth of 26.9% (14/52), 34.6% (18/52), 13.5% (7/52), 1.9% (1/52) and 23.1% (12/52) of strains, respectively. MLST revealed that there were 13 sequence types (STs), among which ST630 was the predominant type accounting for 50% (26/52), followed by ST5 accounting for 17.3% (9/52). There were 19 spa types, among which t4549 (11/52), t2460 (8/52), t377 (8/52) were the predominant types. Nine strains carried drug resistance genes accounting for 17.3% (9/52), including seven fusB-positive and two fusD-positive strains. No fusc-positive strains were detected. Mutations in fusA gene were detected in 11 strains (21.2%, 11/52) and the MIC values against them were all >64 μg/ml. The predominant type of the strains with fusA gene mutations was ST5-t2460. Conclusion Fusidic acid shows a good and relatively stable in vitro antibacterial activity against S. aureus. The mechanism of high resistance to fusidic acid is closely related to fusA gene mutation.

Objective:To investigate and summarize the early management experience of 22 patients with end-stage heart failure(ESHF) who underwent left ventricular assist device(LVAD) implantation in an intensive care unit(ICU) in a single center.Methods:Data of 22 patients with ESHF treated with LVAD in the ICU of TEDA International Cardiovascular Hospital from September 2020 to August 2022 were retrospectively analyzed. There were 16 males and 6 females, aged from 20 to 67 years old, with a mean age of(51.0±13.3)years old. There were 21 cases with dilated cardiomyopathy, 1 case with ischemic cardiomyopathy, 6 cases with tricuspid regurgitation, 1 case with intra-aortic balloon pump for cardiogenic shock, and 5 cases with cardiac resynchronization therapy for arrhythmia. After the operation, all patients received restricted fluid therapy, a " stepwise" anticoagulation strategy, and strict blood pressure management. The postoperative complications and treatment process were reviewed, the treatment and management experience were summarized, and the prognosis of the patients was statistically analyzed.Results:All 22 patients survived within 90 days after surgery, and 21 patients(95.5%) recovered well, the pump works fine and there was no hemolysis and thrombosis of LVAD. Major complications included: 1 case of severe pneumonia(4.5%), 2 cases of pericardial tamponade(9.1%), 1 case of intracerebral hemorrhage(4.5%), 1 case of mediastinal infection(4.5%), 5 cases of positive occult blood in gastric juice(22.7%), no cases of right ventricular failure、aortic insufficiency and cerebral infarction. The duration of postoperative mechanical ventilation was 17(8.5, 51.5) h, and the ICU stay was 14(10, 27) days.Conclusion:LVAD is another effective treatment for patients with ESHF in addition to heart transplantation. Good postoperative blood pressure control, " stepwise" anticoagulation strategy and " restrictive" fluid management can reduce postoperative complications in the early phase of post-operation, which is crucial for the prognosis of patients with LVAD.

Objective:To investigate the application value of 3D printed model in hemostasis training for laparoscopic sleeve gastrectomy.Methods:The retrospective and descriptive study was conducted. Data were collected from six surgeons who participated in hemostasis training for laparoscopic sleeve gastrectomy using 3D printed model at Zhejiang Provincial People′s Hospital in July 2023. All participants were male, aged (33.5±9.9)years. A 3D printed model simulating bleeding during laparoscopic sleeve gastrectomy was created using hydrogel. Videos were recorded to document the surgeons′ hemostasis techniques and outcomes during laparoscopic sleeve gastrectomy. Two external expert reviewers blindly assessed the training videos using the objective structured assess-ment of technical skills (OSATS) scoring system to evaluate mesentery mobilization, vessel exposure, vessel clipping and bleeding after vessel clipping. Observation indicators: (1) face validity and content validity of the 3D printed model; (2) validity verification of the 3D printed model. Measurement data with normal distribution were represented as Mean± SD. Comparison between groups was conducted using the t test. Results:(1) Face validity and content validity of the 3D printed model. The surgeons′ scores for overall impression, fidelity, texture, appearance, workspace and tactile similarity of the 3D printed model were 4.5±0.6, 4.0±0.6, 3.7±0.5, 4.2±0.8, 3.8±0.8 and 4.2±0.4, respectively. The surgeons′ scores for similarity to real scenarios, operation convenience, learning curve shortening and operation skills improving, patient risk reduction, trainee′s interest enhancing, confidence increasing and recommendation for promotion were 4.0±0.6, 4.2±0.8, 4.3±0.8, 4.3±0.5, 4.3±0.5, 4.0±0.6 and 4.8±0.4, respectively. (2) Validity verification of the 3D printed model. The OSATS scores and operation time to treat bleeding during laparoscopic sleeve gastrectomy for expert surgeons were 18.7±0.6 and (125±12)seconds, respectively, versus 13.7±1.5 and (212±51)seconds for junior doctors, showing significant differences between the two groups ( t=5.30, -2.89, P<0.05). Conclusion:The 3D printed model effectively simulates bleeding scenarios during laparoscopic sleeve gastrectomy and distinguishes between different technical levels of expertise.

OBJECTIVE: To study the mechanism of tumor necrosis factor( TNF)-α and its receptor( TNFR) signal transduction pathways in regulating cell apoptosis of alveolar macrophage( AM) in coal workers' pneumoconiosis( CWP).METHODS: Twenty-four coal workers with pneumoconiosis at stage Ⅰ were selected as CWP group and four observation subjects exposed to coal were chosen as observation group by using simple random sampling method. The bronchoalveolar lavage fluids of whole-lung lavage of two groups were collected. AMs were separated and purified. Then they were divided into 6 groups: a control group,a superoxide dismutase( SOD) group,a TNF/TNFR group,an anti-TNF-α antibody group,a Caspase-8 suppression group and a nuclear factor-κB( NF-κB) suppression group. The AMs of 6 groups with corresponding treatment were cultivated. After 24 hours,the cells were harvested and proteins extracted. The relative expression of TNF-α,TNFR1,TNFR2,Caspase-8,Caspase-3,NF-κB P50 and NF-κB P65 protein was detected by Western blotting. RESULTS: The protein relative expression of TNF-α,TNFR2,Caspase-8,Caspase-3,NF-κB P50 and NF-κB P65 in CWP group was significantly higher than those in the observation group( P < 0. 05). The protein relative expression of TNF-α,TNFR1,Caspase-8,Caspase-3 and NF-κB P50 in the TNF/TNFR group and the anti-TNF-αantibody group was lower than that of the control group( P < 0. 05). The above indexes in the anti-TNF-α antibody group were lower than that of the NF-κB suppression group( P < 0. 05). The protein relative expression of TNFR1,Caspase-8and Caspase-3 in the TNF/TNFR group was higher than that of the SOD group and the Caspase-8 suppression group( P <0. 05). The protein relative expression of TNFR1,Caspase-8 and NF-κB P50 in the TNF/TNFR group was lower than that of the NF-κB suppression group( P < 0. 05). Among the CWP patients,the relative expression of TNFR2 and NF-κB P65 in the TNF/TNFR group was lower than that of the control group( P < 0. 05),and higher than that of the SOD group( P <0. 05). CONCLUSION: AM apoptosis mediated by TNF-α/TNFR/NF-κB signal transduction pathway plays an important role in the occurrence and development of CWP. The TNF-α/TNFR/NF-κB signal transduction pathways inhibited or blocked at different stages can affect the expression of proteins related to AM apoptosis.

OBJECTIVE To provide re ference for accurate measurem ent of population health status ，pharmacoeconomic evaluation and guidance of health resource allocation. METHODS Using quota and convenient sampling ，five administrative villages were selected from the rural areas under the jurisdiction of Liuzhi special zone ，Qianxi city and Jianhe county of Guizhou province from July to September 2020. Based on the gender and age ratio quota of rural population in the results of the national census，330 respondents were selected for questionnaire survey. The contents of the questionnaire included the self-made scale containing sociodemographic characteristics and general health information ，five-level EuroQoL five-dimension questionnaire （EQ-5D-5L，hereinafter referred to as the “new dimension scale ”）with cognitive dimensions （including attention ，memory， computing ability and learning ability ）and mini-mental state examination （MMSE）. The effects of reliability ，validity and new dimensions of new dimension scale on respond ents’quality of life were investigate ，and its measurement characteristics were verified；the application value of it in pharmacoeconomic hy_cheer@126.com evaluation and guiding the allocation of health resources were explored. RESULTS A total of 330 questionnaires weredistributed，320 were recovered and 320 were effective. The recovery rate and effective rate were 96.97％ and 100％ respectively. The ceiling effect of new dimension scale was 13.44％，the split-half reliability was 0.821，and the overall Cronbach ’s α was 0.852. Exploratory factor analysis showed that the new dimension scale was loaded with physiological ，cognitive and psychological factors ，and the cumulative contribution rate was 69.35％. The correlation coefficient between the new dimension and the dimension of MMSE scale were 0.19-0.61，showing a moderate or medium to strong correlation （P＜0.01）. Compared with EQ- 5D-5L，after adding each dimension ，the interpretation ability of the regression model was improved by 5.00％-17.50％. CONCLUSIONS The new dimension scale has high feasibility ，good reliability and validity ，significantly reduces the ceiling effect of EQ- 5D-5L，has higher sensitivity to the evaluation of people ’s quality of life，and can better evaluate the quality of life of rural population. It is suggested that it can be applied for quality of life evaluation，intervention effect analysis and related economic evaluation.