Objective:To investigate the clinical value of three-dimensional (3D) visualization technology in the precise drainage through endoscopic retrograde biliary drainage (ERBD) for hilar cholangiocarcinoma.Methods:Clinical data of 42 patients with highly suspected hilar cholangiocarcinoma who underwent ERBD in Qinghai University Affiliated Hospital from September 2019 to August 2022 were retrospectively collected. Twenty patients underwent 3D biliary tract reconstruction before surgery (the reconstruction group) and 22 others did not undergo 3D biliary tract reconstruction before surgery (the non-reconstruction group). The surgery time, X-ray exposure time, the technical success rate, the clinical success rate, incidence of postoperative complications, recent and short-term endoscopic retrograde cholangiopancreatography (ERCP) reintervention rate of the two groups were compared.Results:There was no significant difference in preoperative baseline data between the two groups ( P>0.05). ERBD was conducted successfully in all 42 patients. The operation time in the reconstruction group [35.00 (25.00, 57.50) min] was significantly shorter than that in the non-reconstruction group [60.00 (33.75, 60.00) min] with significant difference ( Z=-2.251, P=0.024). There was no significant difference in the X-ray exposure time between the two groups [10.00 (5.00, 12.00) min VS 10.55 (9.50, 17.50) min, Z=-1.552, P=0.121]. The technical success rates of both groups were 100.0%, and the clinical success rate of the reconstruction group was higher than that of the non-reconstruction group [70.0% (14/20) VS 31.8% (7/22)] with significant difference ( χ 2=6.109, P=0.013). There was no significant difference in the incidence of postoperative complications between the two groups [20.0% (4/20) VS 22.7% (5/22), χ 2=0.141, P=0.708]. All patients were followed up for 6 months after the procedure. The median survival time was 3.91 months in the reconstruction group and 2.78 months in the non-reconstruction group. There was no ERCP intervention in the reconstruction group within 2 weeks after the procedure, while 4 cases (18.2%) in the non-reconstruction group received 6 ERCP interventions due to cholangitis and postoperative pancreatitis. Within 2 weeks to 3 months, 2 patients (10.0%) in the reconstruction group received 4 ERCP interventions for cholangitis, and 2 patients (9.1%) in the non-reconstruction group received 3 ERCP interventions for cholangitis. There was no significant difference in recent ( χ 2=2.183, P=0.140) or short-term ( χ 2=0.000, P=1.000) ERCP reintervention rate between the reconstruction group and the non-reconstruction group. Conclusion:3D visualization biliary duct reconstruction technology can measure the volume of liver drainage for hilar cholangiocarcinoma, shorten the operation time and improve the clinical success rate through precise preoperative planning, which is worth of promotion.

Objective:To investigate the influencing factors of operation time for laparos-copic sleeve gastrectomy (LSG) and analyze the learning curve of LSG in sarcopenic obesity (SO) and non-sarcopenic obesity (NSO).Methods:The retrospective cohort study was conducted. The clinical data of 240 obesity patients who underwent LSG in the Fujian Medical University Union Hospital from January 2018 to June 2022 were collected. There were 52 males and 188 females, aged (30±8)years. Patients underwent L3 vertebral body horizontal axial computer tomography (CT) scanning before and after receiving LSG to accurately segment muscles and fats. Observation indicators: (1) treatment and follow-up; (2) influencing factors of operation time for LSG; (3) cumulative sum (CUSUM) of learning curve; (4) comparison of clinical data between patients in the initial and profi-cient stages. Measurement data with normal distribution were represent as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(IQR), and comparison between groups was conducted using the non-parameter test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Univariate and multivariate analyses were conducted using the Logistic regression model. The CUSUM of learning curve was calculated and the fitting process was conducted on scatter plot of learning curves. Results:(1) Treatment and follow-up. Of the 240 patients, there were 97 cases of SO and 143 cases of NSO. All 240 patients underwent LSG successfully, without conversion to open surgery. The operation time of 240 patients was (108±23)minutes. None of patient died during the perioperative period and all patients underwent follow-up during the postoperative 6 months. (2) Influencing factors of operation time for LSG. Results of multivariate analysis showed that SO was an independent factor influencing operation time for LSG ( odds ratio=2.207, 95% confidence interval as 1.207-4.038, P<0.05). (3) CUSUM of learning curve. Results of CUSUM of operation time in patients of SO and NSO showed that the best fit equation of patients of SO was y=-4E-08x 6+1E-05x 5-0.001 1x 4+0.063 1x 3-1.89x 2+28.126x-48.671 (x means the number of surgical cases), with goodness-of-fit R 2 as 0.833, and the best fit equation of patients of NSO was y=3E-09x 6-1E-06x 5+0.000 2x 4-0.010 9x 3+0.063 8x 2+12.053x-65.025 (x means the number of surgical cases), with goodness-of-fit R 2 as 0.716. Based on the trend of CUSUM of learning curve of operation time, the peak value of number of surgical cases in patients of SO and NSO was 81 and 36, respec-tively, which was used to divide the learning curve as two stages of the initial stage and the proficient stage. (4) Comparison of clinical data between patients in the initial and proficient stages. ① Of the 97 patients of SO, there were 81 cases and 16 cases in the initial stage and the proficient stage of LSG, with the operation time, postoperative duration of hospital stay as (119±23)minutes, (5.9±2.3)days and (106±21)minutes, (4.7±0.5)days, showing significant differences between them ( t=2.074, 2.147, P<0.05). ②Of the 143 patients of NSO, there were 36 cases and 107 cases in the initial stage and the proficient stage of LSG, with gender (female), height, preoperative body mass, defatted body mass, operation time, postoperative duration of hospital stay, body mass at postoperative 6 month, body mass index (BMI) at postoperative 6 month, percentage of excess weight loss (EWL%) at postoperative 6 month, cases with EWL% >100% at postoperative 6 month, excess BMI at post-operative 6 month as 20, (170±10)cm, (110±25)kg, (57±12)kg, (108±22)minutes, (6.1±1.6)days, (80±16)kg, (27.63±4.22)kg/m2, 83%±35%, 9, 1.99(6.03)kg/m2 and 87, (164±8)cm, (99±20)kg, (52±12)kg, (100±19)minutes, (4.7±1.1)days, (71±16)kg, (25.89±4.48)kg/m2, 103%±42%, 48, 0.31(5.82)kg/m2, showing significant differences between them ( χ2=9.484, t=3.266, 2.424, 2.141, 2.137, 5.821, 2.740, 1.993, -2.524, χ2=4.432, Z=-2.300, P<0.05). Conclusions:SO is an independent factor influencing operation time for LSG. It is suggested that the surgeons need to finish 81 cases and 36 cases master LSG in patients of SO and NSO.

The precise resection and suture of bronchia, vascular and pulmonary tissue are the key techniques in thoracic surgery. Mechanical suture technique has gradually become a routine operation in thoracic surgery. However, at present, there is still a lack of consensus and guidelines on the application of this technique in thoracic surgery, neither strong evidence-based medical support. In this study, we discuss the application standard of mechanical suture technique in thoracoscopic surgery, irregular treatment techniques, intraoperative complications, and management principles to promote the standardized application of mechanical suture technique. We also explain the shortcomings of the technique in order to promote the further improvement and perfection.

The quality control of lung transplantation involves many aspects, such as team building, selection of recipients, preoperative diagnosis and evaluation of recipients, maintenance of brain-dead donors, evaluation and acquisition of donors, surgical operation, postoperative management and postoperative follow-up. Precision management is the core concept of operation quality control. Only by normalizing the operation quality control of lung transplantation to provide basic guarantee for multi-team cooperation and development of lung transplantation management in the future, building a complete lung transplantation database to excavate data resources and improve the quality of transplanta-tion, and comprehensively building a Chinese lung transplantation quality control system with multi-team participation and cooperation, can we improve the overall level of surgical diagnosis and treatment of lung transplantation in China.

Objective To investigate the safety and efficacy of total thoracoscopic pneumonectomy for malignant lesion from a single-center pneumonectomy database.Methods A retrospectively analysis of 43 cases of malignant lesions in patients underwent total thoracoscopic pneumonectomy from surgical database of Shanghai Pulmonary Hospital from December 2013 to August 2017 was conducted,and then the mortality,complications,and disease recurrence were summarized.Results All lesions in 43 patients were pathologically comfirmed malignant,including 39 non-small cell lung cancers and 3 small cell lung cancers and 1 pulmonary metastasis.Complete thoracoscopic pneumonectomy was pedormed in 43 patients.The average operation time was (181.1 ± 68.0) min,blood loss was (146.5 t 113.6) ml,mean tube length was (8.4 ± 3.4) days.Perioperative mortality was 2.3％ (1/43).The complication rate of grade 3 or above was 16.3％.Median follow-up was 18 months,with 9 cases occuning local recurrence or distant metastasis;6 cases suffered from cancer-related death while non-cancer related death happened in 1 patient.Conclusion For selected locally advanced pulmonary malignant lesion,total thoracoscopic pneumonectomy is an alternative to open thoracic surgery with a better perioperative safety and satisfied mid-term oncologic survival.

AIM:Increasing evidence indicates that inflammation contributes to the initiation and perpetuation of atrial fibrillation ( AF) .Al-though tumor necrosis factor ( TNF)-αlevels are increased in patients with AF , the role of TNF-αin the pathogenesis of AF remains unclear.Recent research has revealed that T-type Ca2+currents ( ICa,T ) play an important role in the pathogenesis of AF .METH-ODS:In this study , we used the whole-cell voltage-clamp technique and biochemical assays to explore the role of TNF-αin the regula-tion of ICa,T in atrial myocytes.RESULTS:We found that compared with sinus rhythm (SR) controls, T-type calcium channel (TCC) subunit mRNA levels were decreased , while TNF-αexpression levels were increased , in human atrial tissue from patients with AF .In murine atrial myocyte HL-1 cells, after cultured for 24 h, 12.5, 25 and 50 μg/L TNF-αsignificantly reduced the protein expression levels of the TCC α1G subunit in a concentration-dependent manner .The peak current was reduced by the application of 12.5 or 25μg/L TNF-αin a concentration-dependent manner [from ( -15.08 ±1.11) pA/pF in controls to ( -11.89 ±0.83) pA/pF and (-8.54 ±1.55) pA/pF in 12.5 and 25 μg/L TNF-αgroups, respectively].TNF-αapplication also inhibited voltage-dependent inactivation of ICa,T shifted the inactivation curve to the left .CONCLUSION:These results suggest that TNF-αis involved in the path-ogenesis of AF, probably via decreasing ICa,T function in atrium-derived myocytes through impaired channel function and down -regula-tion of channel protein expression .This pathway thus represents a potential pathogenic mechanism in AF .

Objective To detect the difference of cerebral gray matter change in children with different karyotype Turner Syndrome (TS) by using voxel-based morphometry (VBM).Methods Nineteen children with 45XO karyotype TS,21 children with heterozygous TS and 20 age-matched control girls were recruited in this study.Wechsler intelligence scale for children was used to obtain their intelligence quotients (IQ).High-resolution magnetic MR imaging was performed in TS children and control girls to collect the whole brain structural data.The data was analyzed by VBM based on SPM8 to compare the volume of gray matter among the monosomy TS children,heterozygous TS children and normal controls by using covariance analysis.Alphasim method in the software of analysis of functional neuroimages(AFNI) was used for clusterlevel multiple comparison.Results The IQ was 89 ± 16 for the monosomy TS children,and it was 91 ± 13 for heterozygous TS children and 109 ± 15 for the controls.Statistical analysis revealed significant difference of IQ among them (F =10.75,P ＜ 0.05).Compared with normal controls,both monosomy TS children and heterozygous TS children showed significantly decreased volume (voxel numbers in clusters were 4117,1392,1085,t =5.75,5.33 and 5.02 for monosomy TS; voxel numbers in clusters were 4501,2437,591,t =5.40,5.11 and 4.95 for heterozygous TS respectively,P ＜ 0.01,FWE-corrected) in the gray matter of bilateral precuneus lobule,postcentral gyrus,and cingulum cortex.However,the volume of the orbitofrontal lobe,parahippocampal gyrus,cerebellum,temporal pole,corpus striatum and posterior midbrain were increased in the monosomy and heterozygous TS children compared to the controls (voxel numbers in clusters were 1444,1188,791,725,695,431,386,t =5.01,5.96,5.67,5.23,4.85,4.43,4.94 for monosomy TS; voxel numbers in clusters were 6988,2709,2510,2380,1987,1709,1185,t =6.50,7.06,7.26,5.27,5.71,6.02,4.56 for heterozygous TS,P ＜ 0.01,FWE-corrected).Compared with monosomy TS,heterozygous TS showed increased gray matter volume in the left parahippocampal gyrus and corpus striatum (voxel numbers were 1014 and 496,t =4.75,4.53,P ＜0.01,FWE-eorreeted),while they had decreased gray matter volume in the right supramarginal gyrus (voxel number was 350,t =4.28,P ＜ 0.01,FWE-corrected).Conclusions Both monosomy and heterozygous TS show brain atrophy in the parietooccipital lobe,indicating similar abnormality of gray matter development.However,heterozygous TS shows more increased gray matter volume in the prefrontal lobes and the cerebellum than monosomy TS,which may be the compensatory mechanism in this condition.

Objective To explore the association between interleukin (IL)-28B variation and spontaneous clearance of hepatitis C virus (HCV) infection.MethodsA total of 280 HCV infected patients including 200 chronic hepatitis C (CHC) patients and 80 spontaneous clearance patients of HCV infection were enrolled in the study.The rs8099917 single nucleotide polymorphyism (SNP) of IL-28B gene was detected and the association between IL-28B variation and spontaneous clearance of HCV infection was analyzed.The data were compared using chi square test.ResultsThe genotype frequencies of TT and non TT (TG and GG) of IL-28B rs8099917 between CHC patients and spontaneous clearance patients were not significantly different ( x2 =15.874,P ＜ 0.01 ). The prevalence of TT genotype in the spontaneous clearance group was 86.2％,which was higher than that in CHC group (62.0％).T and G allele frequencies in CHC group were 78.0％ and 22.0％,respectively,and those in spontaneous clearance group were 92.5％ and 7.5％,respectively,which indicated that T allele was dominant in spontaneous clearance patients. The allele frequency of rs8099917 was statistically different between the two groups (P＜0.01).The spontaneous HCV clear rate in rs8099917 TT patients was 2.84 folds of non-TT patients,while the risk of chronicity of non-TT (TG+GG) patients was 1.36 folds of TT patients.Conclusion The IL-28B (rs8099917) TT genotype is associated with spontaneous clearance of HCV infection,which can be an important factor to predict the spontaneous clearance of HCV.

Objective To investigate the relationship between serum levels of alanine aminotransferase (ALT)or aspartate aminotransferase (AST)apportioned by the same hepatic parenchyma cell volume and liver histological necroinflammation grades in HBeAg-negative chronic hepatitis B (CHB)patients.Methods A total of 145 CHB patients were divided into four groups:Gl,G2,G3 and G4 based on the liver histological necroinflammation grade.The serum ALT and AST levels were determined by automatic biochemical instrument in these four groups.Furthermore,serum ALT and AST levels were then apportioned by the same hepatic parenchyma cell volume.The data were analyzed by ANOVA.Results Mean serum ALT levels in G1,G2,G3 and G4 groups were (35.3±29.1),(91.6±120.4),(111.6± 116.1)and (118.0±122.1)U/L,respectively,and the serum ALT levels apportioned by same hepatic parenchyma cell volume were ( 54.0 ± 45.1 ),( 144.2 ± 184.9 ),(191.3± 204.8)and (215.1 ± 226.5)U/L,respectively.The pairwise comparison between G1 and other three groups all showed statistically significant difference (P＜0.05).Meanwhile,AST levels in G1 to G4 groups were (35.5± 29.0),(64.9±71.7),(96.0±81.9)and (102.8±77.0)U/L,respectively and the serum AST levels apportioned by the same hepatic parenchyma cell volume were (54.3±44.6),(102.3± 107.9),(165.2±148.7)and (189.4±145.4)U/L,respectively.The pairwise comparison between G1 and G3,G1 and G4,G2 and G3,G2 and G4 all showed statistically significant difference (P＜0.05).Conclusion Both AST and ALT levels are sensitive indicators for liver inflammation grading in HBeAg-negative CHB patients during the natural history of the disease.