Objective:To compare the effects between video-assisted thoracoscopic surgery (VATS) and conventional surgery in internal fixation of multiple rib fractures.Methods:Patients with multiple rib fractures, who were admitted to Emergency Center of Shenzhen People's Hospital from June 2010 to May 2020, were included. Patients were divided into the VATS group (incision positioning with VATS) and the conventional group (incisionpositioning with CT scan). The primary outcome measures was the risk of complications, and the secondary outcome measures included postoperative pain, incision length, operation time, and mechanical ventilation rate. Continuous and categorical variables were compared using LSD- t test and Chi-square test. Repeated measures analysis of variance was performed to assess the trend of postoperative pain over time. A logistic regression analysis was used to explore the association of VATS with postoperative complications. Results:A total of 221 patients, including 128 patients in the VATS group and 93 patitents in the conventional group, were enrolled. Baseline characteristics were identical between the two groups ( P>0.05). In the VATS group, the length of incision, intraoperative blood loss, operation time, mechanical ventilation rate after operation, ventilation time, thoracic tube indwelling time, ICU and total length of stay, and medical costs were better than those in the conventional group (all P<0.05). Repeated measures analysis of variance showed that pain relief was faster and more profoundly in the VATS group than in the conventional group ( F=3 517.808, P<0.01). Logistic regression analysis indicated that VATS was an independent protective factor for reducing postoperative complications ( OR=0.225, 95% CI:0.121-0.416, P<0.01). Conclusions:During internal fixation of multiple rib fractures, VATS is an effective approach to reduce postoperative pain and complications. Moreover, video-assisted technique is associated with a rapid recovery for patients, resulting in shorter length of hospital stay and less medical costs.

To explore the organ-system oriented integrated program, this project constructed a new clinical skill training program of sensory system for"5+3" medical students. According to the current trend and requirement of medical teaching reform, taking into consideration of the present status of clinical skills teaching, this project integrated the basic and clinical teaching contents of otolaryngology, ophthalmology and dermatology to design a new training program of clinical skills for"5+3"medical students. Specifically, the project group edited a new textbook and syllabus, and set up a specialized teaching group. In this system, the training models included simulation training and practical bedside training, the assessment included operation ability and analyzing ability for clinical cases, and the training contents involved all conventional skills of each specialty. It has been demonstrated that the new training program is capable of promoting the clinical skills of students quickly and effectively.

Objective To compare the efficacy and safety of nicardipine versus urapidil in blood pressure (BP) management during the acute phase of intracerebral hemorrhage (ICH).Methods ICH patients admitted in Emergency Intensive Care Unit of Shenzhen People's Hospital from March,2013 through March,2016 were retrospectively studied.Patients were enrolled as nicardipine group or urapidil group depending on the initial antihypertensive drug given at admission.The differences in rate of patients reached the goal BP within the first 24 h,time required for getting goal BP,blood pressure variability (BPV),rebleeding or hematoma expansion during the first 24 h,cerebral state index (CSI) within 7 days and 28-day mortality were compared between the two groups.The differences in adverse events including bradycardia,tachycardia and hypotension were also compared between two groups.An independent t test and x2 test were performed to compare different variables.An analysis of variance of repeated measurement was performed to compare CSI within 7 days between two groups.Results Seventy-seven patients were included with 42 in nicardipine group and 55 in urapidil group.Rate of patients getting goal BP in nicardipine group was (94±5)％ and (86±11)％ in urapidil group (P＜0.01).Time required to get goal BP was (35 ± 28) min in nicardipine group and (52 ± 37) min in urapidil group (P =0.02).BPV was (11.23 ± 2.38) in nicardipine group and (13.16 ± 3.15) in urapidil group (P =0.003).Rebleeding or hematoma expansion rate during the first 24 h and 28-day mortality rate were comparable between the two groups (P ＞ 0.05).Through analysis of variance of repeated measurement,CSI in nicardipine group improves more rapidly than that in urapidil group (F =1 581.115,P =0.000).Hypotension,bradycardia and tachycardia were also comparable between groups (P ＞ 0.05).Conclusion Compared with urapidil,nicardipine produces effect more rapidly with more stable BP and higher rate of patients with ICH getting goal BP.Moreover,the application of nicardipine may be better to improve the CSI of ICH patients.

Objective To evaluate the efficacy and safety of lenalidomide in a real-world clinical practice in Chinese patients with multiple myeloma (MM).Methods It was a prospective,multi-center,observational study.A total of 165 consecutive patients with MM treated with lenalidomide-based regimens were enrolled in 12 hospitals from June 2013 to November 2015.Relevant information was recorded,such as baseline clinical data,cytogenetic abnormalities,treatment regimens,and duration of treatment,safety,and survival.Results (1)There were 126 relapsed and refractory MM (RRMM) patients,25 newly diagnosed patients and 19 maintenance patients.The evaluable RRMM patients accounted for 120 cases,among which 74 cases(61.7％) reached the partial response (PR) or above,and a very good partial response (VGPR) in 16 patients (13.3％),a complete response (CR) in 14 cases (11.7％),a strictly complete response (sCR) in 4 cases (3.3％).Thus,a VGPR or above in 34 patients accounted for 28.3％.(2)The median follow-up was 13 months,the median time to progression 12 months.The median survival after receiving lenalidomide was 19 months,and the median overall survival (OS) was 62 months.(3) The univariate analysis in 120 RRMM patients suggested that prognostic factors for significant improvement in PFS included normal karyotype,international staging system (ISS) Ⅰ-Ⅱ,t(4;14) negative (detected by fluorescence in situ hybridization),non-bortezomib resistance and response to previous regimens.As to OS,nonbortezomib resistance,response to previous regimens and non-primary refractoriness were positive factors.Multivariate analysis showed that the response to previous regimens (PR or better) was an independent good prognostic factor for progress-free survival (PFS),non-bortezomib resistance and non-primary refractoriness for OS.(4) Grade 3 or 4 adverse events that occurred in more than 10％ of all enrolled patients were neutropenia (12.7％),leukocytosis (11.5％) and thrombocytopenia (12.7％).Owing to intolerance of toxic side effects,7 cases withdrew lenalidomide.Conclusions No matter what combination,regimens containing lenalidomide are effective to RRMM patients with overall response rate 61.7％,a time to progression 12 months and an overall survival 62 months.The toxicity is quite tolerable and manageable.In addition,the response to previous treatment (reached PR or above) is the independent good prognostic factor for PFS,non-bortezomib resistance and non-primary refractoriness for OS.Clinical trail registration Clinicaltrials.gov,NCT01947309

Objective To observe the clinical efficacy of acupuncture in treating severe pneumonia complicated with gastrointestinal dysfunction (GIDF).Method Sixty patients with severe pneumonia complicated with GIDF were randomized into a treatment group and a control group, 30 cases in each group. The two groups were both given conventional Western medications. In addition, the treatment group was intervened by acupuncture, and the control group by oral administration of Mosapride citrate capsules and enteral nutrition via nasogastric tube. After 7-day treatment, the changes of GIDF score, intraabdominal pressure, bowel sound and gastric retention were observed in the two groups, and the clinical efficacies were compared.Result The total effective rate was 93.1% in the treatment group versus 78.6% in the control group, and the between-group difference was statistically significant (P<0.05). The scores of GIDF and the indexes (intraabdominal pressure, bowel sound, and gastric retention) were significantly changed after the treatment in both groups (P<0.05). The scores of GIDF and the indexes in the treatment group were significantly different from those in the control group after the intervention (P<0.05).Conclusion Acupuncture can promote the recovery of gastrointestinal function in severe pneumonia patients, since it can significantly improve the intraabdominal pressure, bowel sound and gastric retention.

Objective To investigate the changes of circulating miRNAs expression profiles in different subtypes of ischemic stroke according to the Trial of Org 10 172 in Acute Stroke Treatment.Methods We selected 16 patients diagnosed as acute ischemic stroke at first time in the Department of Neurology,the Affiliated Hospital of Medical College Qingdao University from November to December in 2012.They were divided into large artery atherosclerosis (LAA) stroke group (n =8) and small artery occlusive (SAO) stroke group (n =8).At the same time,8 healthy checkup subjects were selected as control.High-throughput sequencing was used to detect the expression profiles of miRNAs in the plasma,and the high-throughput sequencing results were validated by quantitative real-time polymerase chain reaction.We performed the miRNAs variance analysis and associated bioinformatics analysis.Results Thirty hundred and sixty-nine miRNAs were detected in LAA group,SAO group and the control group.We found remarkable differences (fold change ＞2,P ＜0.01) in the expression of 12 miRNAs,including let-7a-5p,miR-744-5p,etc.,between any two groups of the three groups.Thirty-four miRNAs,containing miR-126-5p,miR-23a-3p,miR-143-3p,etc.,had a lower expression (fold change ＞2,P ＜0.01)in LAA group than that in the control group.In comparison with the control group,miR-1304-3p and miR-451a were significantly down-regulated (fold change ＞ 2,P ＜ O.01),while 27 miRNAs were significantly up-regulated (fold change ＞2,P ＜0.01) in SAO group.The expression levels of miR-146b-5p,miR-23a-3p and miR-451 a were validated in accordance with the results of real-time PCR.Target gene prediction and functional analysis revealed that target genes regulated by differential expression of miRNAs were mainly associated with cell proliferation,adhesion,metabolism and other biological functions.Conclusion miRNAs are differently expressed in the plasma of LAA group,SAO group and healthy control group,which suggest that miRNAs might play different roles in the pathogenesis of LAA stroke and SAO stroke by regulating downstream target genes.

Objective To investigate the relationships of plasma alpha2-macroglobulin (α2-MG) level with occurrence of small-artery occlusion (SAO) and cognitive function in SAO patients.Methods Subjects were collected in our hospital from December 2012 to September 2013;58 patients with SAO stroke,56 with large artery atherosclerosis (LAA) classified by Trial of Org 10172 in Acute Stroke Treatment (TOAST),as well as 58 healthy controls,were enrolled.The serum α2-MG levels were measured by enzyme-linked immunosorbent assay (ELISA) and compared among the three groups.The receiver operating characteristic (ROC) curve was drawn to evaluate the value of α2-MG as a biomarker for SAO.White matter lesions (WMLs) were assessed by MRI using Fazekas classification,and mini-mental state examination (MMSE) was used to evaluate the cognitive function.The correlations of plasma α2-MG level with both Fazekas scores and MMSE scores were analyzed.Results The serum α2-MG levels in SAO patients ([6.70±3.17] μg/mL) were significantly higher than those in LAA patients ([5.04±1.93] μg/mL) and controls ([4.86±1.68] μg/mL) (P＜0.05).Binary Logistic regression analysis showed that the plasma α2-MG level was an independent risk factor for occurrence of SAO (OR=1.409,P=0.001;OR=1.443,P=0.004).The ROC curves obtained that α2-MG=4.23 μg/mL was the cutoff values for SAO,enjoying sensitivity up to 86.2％.SAO patients with different severities of WMLs had significantly different serum α2-MG levels (F=26.509,P=0.000);the serum α2-MG levels were positively correlated with Fazekas scores (r=0.733,P=0.000) and negatively correlated with MMSE scores (r=-0.679,P=0.000).Conclusions Serum α2-MG level is an independent risk factor for SAO and might be a biomarker for SAO.Furthermore,serum α2-MG level,being associated with high-grade WMLs,might contribute to evaluating the cognitive impairment in SAO patients.

Objective To investigate the difference of expression profiling of plasma miRNAs (microRNA) between the patients with small artery occlusive stroke (SAO) and the healthy subjects.Methods Eight patients with SAO classified by TOAST were selected and 8 healthy subjects were used as a control group.High-throughput sequencing technology was used to detect the expression profiling of plasma miRNAs.The differentially expressed miRNAs were screened.Real-time fluorescent quantitative polymerase chain reaction was used to validate the results,and the target gene prediction and bioinformatics analysis were performed.Results The miRNA difference analysis showed that the expression profilings of miRNA-127,miRNA-99b-5p,miRNA-320,and other 19 miRNAs in the SAO group were significantly upregulated compared with those in the control group (all P＜0.01),while miRNA-451a and other 5 miRNAs in the SAO group were significantly downregulated compared with those in the control group (all P ＜0.01).The validated results of miRNA-127,miRNA-99b-5p,miRNA-320,and miRNA-451a with real-time fluorescent quantitative polymerase chain reaction were consistent with those of the high-throughput sequencing.Bioinformatics analysis showed that the miRNA-regulated target genes expressed differentially were mainly correlated with cell proliferation,adhesion,phylogenetic development,macromolecule metabolism,and other biological functions.Conclusions There are significant differences in the expression profiling of plasma miRNAs between the patients with SAO and the healthy subjects,suggesting that miRNAs may play a regulatory role via target genes in pathogenesis of SAO.

Aim To investigate the effect and mecha-nism of valproic acid on neuroglobin expression, and the neuroprotective role of valproic acid against H2 O2-induced neurotoxicity. Methods Western blot, RT-PCR and luciferase assay were used to detect the pro-tein levels, mRNA levels and promoter activity of mouse and human neuroglobin induced by valproic acid. Luciferase assay was used to investigate the role of transcription factor CREB in the up-regulation of neuroglobin by valproic acid. MTT assay was used to evaluate the effect of valproic acid against H2 O2-in-duced neurotoxicity. Results VPA treatment marked-ly increased the protein levels, mRNA levels and pro-moter activity of Ngb in mouse N2 a cells and human SKNSH cells. CREB specific inhibitor KG501 or CREB dominant negative mutant KCREB attenuated VPA-induced Ngb promoter activity. VPA could pro-tect N2a cells from H2 O2-induced neurotoxicity. Con-clusion CREB mediates VPA-induced Ngb up-regula-tion, which may contribute to the neuroprotective effects of VPA in oxidative stress in neurons.