Objective: To evaluate the efficacy of the left spermatic vein transposition to the great saphenous vein in treating left varicocele (VC) secondary to nutcracker syndrome (NCS). Methods: Clinical data of 8 patients treated during Feb.2020 and Feb.2023 in our hospital were retrospectively analyzed.A meticulous preoperative evaluation of the vascular status of the spermatic vein and the great saphenous vein was performed using color Doppler ultrasound.A spermatic vein-great saphenous vein shunt surgery was performed in patients who were strictly selected.The clinical symptoms and hemodynamics of renal vein were compared before and after operation. Results: The median age of patients was 23.5(18-33) years.There was a notable reduction in post-exercise scrotal and lower back pain in all patients，and the score of scrotal pain decreased to 0 in 7 patients. The median quantification of urinary protein was 352.8(54.4-687.3) mg prior to surgical intervention，which significantly diminished to 125.5(25.9-255.1) mg 6 months after operation.Notably，3 cases of preoperative positive urine occult blood tests were undetectable in the subsequent postoperative assessments.The median peak blood flow velocity at the site of stenosis in the left renal vein measured at 74.4(48.7-117.6) cm/s preoperatively，subsequently reduced to 45.1(25.5-61.2) cm/s postoperatively.During the 6-month follow-up，no recurrence of varicocele，vascular anastomotic stenosis or thrombosis were observed. Conclusion: Our research indicates that spermatic vein to great saphenous vein bypass is safe and feasible in the treatment of left varicocele secondary to nutcracker syndrome for strictly selected patients，which can effectively alleviate renal vein congestion without significant complications.

Objective:To compare the efficacy and safety between WangShiBaoChiWan and mosapride in the treatment of functional dyspepsia (FD).Methods:From September 2019 to September 2020, patients with postprandial fullness and early satiation who met the Rome Ⅳ criteria for FD diagnosis were enrolled from 15 hospitals, including the First Affiliated Hospital of Naval Medical University (Shanghai Changhai Hospital), Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical College. The subjects were randomly divided into WangShiBaoChiWan (experimental) group and mosapride (control) group in the ratio of 1∶1. The treatment regimens were WangShiBaoChiWan+ mosapride simulator, WangShiBaoChiWan simulator+ mosapride, respectively with a treatment period of 2 weeks. The primary efficacy outcome was the improvement rates of main symptoms before and after treatment, the secondary efficacy primary efficacy outcome was the total clinical effective rate and the change of the single symptom score. And the safety indicator included adverse events. Independent sample t-test, paired t-test and chi-square test were used for statistical analysis. Results:A total of 251 FD patients were enrolled in the full analysis set, including 124 in the experimental group and 127 in the control group; 241 FD patients were in the per-protocol analysis set, including 117 in the experimental group and 124 in the control group. The analysis of per-protocol analysis set showed that the improvement rates of the main symptoms of the experimental group and the control group were (66±29)% and (60±30)%, respectively, and the difference was not statistically significant ( P>0.05). The improvement rate of the main symptoms of the experimental group reached 117% of that of the control group, which exceeded the expected non-inferiority standard of 80%. The total clinical effective rates of the experimental group and the control group were 76.07% (89/117) and 75.81% (94/124), respectively, and the difference was not statistically significant ( P>0.05). The results of full analysis set showed that the incidence of adverse events of the experimental group and the control group was 1.62% (2/124) and 1.57% (2/127), respectively, and the difference was not statistically significant ( P>0.05). There were no serious adverse events in the two groups. Conclusion:The improvement rate of the main symptoms of WangShiBaoChiWan is not inferior to that of mosapride in the treatment of FD, and it has good safety.

Objective:To investigate the clinical significance of preserving supraclavicular nerve in the reduction and fixation of clavicular fracture.Methods:A retrospective study was conducted of the 68 pa-tients with clavicular fracture who had been treated surgically from October 2016 to April 2018 at Department of Orthopedics and Traumatology, Heyuan Hospital of Traditional Chinese Medicine.They were 35 males and 33 females, aged from 25 to 45 years (average, 34.8 years).The supraclavicular nerve was preserved in the re-duction and fixation of clavicular fracture in 32 patients (reservation group) but not in the other 36 ones (control group).The 2 groups were compared in terms of operation time, intraoperative blood loss, fracture healing time; postoperative pain tolerance, feeling (by the British Medical Research Council assessment), shoulder function (by the Constant-Murley scoring) and impact of numbness on life.Results:The 2 groups were compatible due to insignificant differences in the general clinical data between them ( P>0.05).All the 68 patients were followed up for 12 to 26 months (average, 15 months).There was no significant difference between the 2 groups either in intraoperative blood loss or fracture healing time ( P>0.05).The preservation group had significant longer operation time (72.6 min±7.2 min) than the control group (47.3 min±7.4 min), but a significantly lower rate of analgesic usage on the postoperative day [6.3%(2/32)] than the control group [91.7%(33/36)] (both P<0.05).By the British Medical Research Council assessment, the postoperative feeling was rated as S3 or S4 in 93.8%(30/32) of the patients in the preservation group, significantly higher than the 72.2% (26/36) of the control group ( P<0.05).The preservation group was also significantly better than the control group in Constant-Murley scores of the injured shoulder [100.0 (93.5, 100.0) versus 87.0 (81.0, 89.0)] and impact of numbness on life [0 versus 50.0%(18/36)] (both P<0.05). Conclusion:In surgical treatment of clavicular fracture, preservation of the supraclavicular nerve can have a positive effect on reducing postoperative pain in the operative area and impact of numbness on life.

BACKGROUND: Pneumonectomy and sleeve resection are routine operations for the treatment of central non-small cell lung cancer (NSCLC), but some patients suffered of central NSCLC, whose pulmonary function is too poor to tolerate pneumonectomy, or the tumor involves the bronchus and pulmonary artery extensively,it is hard to perform bronchovascular sleeve lobectomy. The aim of this study is to assess the feasibility of lung autotransplantation in the treatment of central NSCLC. METHODS: The clinical data of 3 cases with central NSCLC treated by lung autotransplantation was reviewed from December 2016 to December 2018. One patient underwent double sleeve resection of left upper lobe with end-to-end anastomosis of the bronchus. Because the resection of the pulmonary artery was too long to perfrom a tension-free anastomosis, the inferior pulmonary vein was cut off, then the left lower lobe was moved up for an anastomosis of the inferior pulmonary vein and the stump of the superior pulmonary vein. In the other 2 cases, left pneumonectomy was performed directly, and the upper left lobe was excised in vitro. The lower left lobe was reset to the chest after trimming and flushing and then the bronchus, pulmonary artery and pulmonary vein were anastomosed in turn. RESULTS: The average operation time was 333 min, the average time of vascular occlusion was 86 min, the average blood loss was 450 mL, and the average hospital stay was 18.7 d; Perioperative complications included a case of bronchial obstruction, which improved after sputum aspiration through bronchofibroscope. The average follow-up period was 20 mon; One case died of cancer, one case had recurrence of anastomotic stoma and brain metastasis, one case had 4R lymph node metastasis (stable condition after chemotherapy), and one case survived without recurrence. CONCLUSIONS For patients with central NSCLC with extensive tumor invasion, thus inability to tolerate sleeve resection or pneumonectomy, autologous lung transplantation can preserve lung function to the greatest extent with a complete tumor resection and improve postoperative quality of life.

Objective To investigate the characteristics of 18F-FDG PET/CT imaging in pulmonary sclerosis pneumocytoma (PSP).Methods The clinical and PET/CT data of 16 patients with pathologically proved PSP were retrospectively analyzed.The location,shape,size,internal and external edge of the lesion,as well as the metabolism of the lesions were observed.The mean retention index (RI) was calculated in 6 patients with 18F-FDG PET/CT dual phase imaging.The difference of SUVmax between early and delayed phase were compared.And the correlation between the diameter of lesions and SUVmax were analyzed.Results There were 16 lesions in all 16 patients,including 7 cases located at right lung and 9 located at left lung.The lesions were round with the diameter of (1.97-4-0.61)cm.The uniform density were observed with the CT value of (29.87±4.71)HU.And there was no cystic degeneration and necrosis.Calcification was found in 5 lesions.The edge of 14 lesions was smooth,and the edge of another 2 lesions showed short spicular sign.Two lesions showed visible edges of ground glass opacity.There were 12 lesions with vascular welt sign and 3 lesions with air crescent sign.The SUVmax value of PSP was 2.71 ± 2.13.There was no significant difference between the early SUVmax (2.44±1.57) and delayed SUVmax (2.74±1.83) in patients with dual phase imaging (t=2.09,P＞0.05).RI was (7.23±10.29)％.There was no correlation between PSH diameter and SUVmax(r=0.188,P＞0.05).Conclusion Most of PSP showed solitary pulmonary nodules in PET/CT imaging.The radioactive distribution was mild and moderate increase.The vascular welt sign,air crescent sign and the surrounding ground glass opacity are the references findings of PSP.

Objective To investigate the expression and significance of myeloid cell leukemia-1 (Mcl-1 )gene and protein in Hepatocellular Carcinoma(HCC).Methods The expression of Mcl-1 was detected respectively by Reverse Transcription-Polymerase Chain Reaction (RT-PCR),Western blot and ENVISION immunohistochemistry in 20 HCC specimens,19 liver cirrhosis(LC)specimens,and 12 control ones.Their relationship with clinical and pathological characteristics of HCC was investigated.Results The expression of Mcl-1 mRNA in the control group,LC group and HCC group was 0.52±0.17, 3.46±1.7,3.65±2.93,respectively.The level in HCC and LC group was statistically different compared with the control group,respectively (t=7.925,5.334,P<0.05).The relative expression of Mcl-1 protein in LC group (0.51±0.35)and HCC group (0.75±0.36)were significantly higher than that in the control group (0.21±0.19)(t=5.526,6.355,P<0.05).The positive expression rate of Mcl-1 in HCC group was 55.00% (11/20),significantly higher than that in the con-trol group 33.33% (4/12)(t=7.835,P<0.05).The positive expression of Mcl-1 was related to tumor necrosis and TNM staging (χ2=4.201,P<0.05).Conclusion Mcl-1 gene and protein are differentially expressed in HCC,LC and the control, which may be involved in the occurrence,development and malignant transformation of HCC.

Background:Secondary lymphoid tissue chemokine( SLC)is involved in lymphoid homing and anti-tumor immune response,and has a chemotactic effect on intestinal lymphocytes. Several animal studies have shown that SLC is involved in the occurrence and development of ulcerative colitis( UC). Aims:To investigate the expression and significance of SLC in UC. Methods:Forty active UC patients from Dec. 2010 to Dec. 2012 at Affiliated Hospital of Nantong University were enrolled,and 20 healthy volunteers were served as controls. Expression of SLC in the colon mucosa was detected by immunohistochemistry,and its relationship with severity of UC was analyzed. Results:SLC was positively expressed in all UC patients,while was negatively or weakly positively expressed in controls. Expression of SLC in UC patients was significantly higher than that in controls(4. 16 ± 0. 78 vs. 0. 52 ± 0. 11,P<0. 05). Expression of SLC was correlated with the severity of involvement of UC. Conclusions:Expression of SLC participates in development and progress of UC. SLC may play an important role in the induction of local damage and pathological changes of UC.

Objective To investigate the antimicrobial‐resistant profile and genes carried by 80 staphylococcus aureus and analy‐size its antimicrobial‐resistant mechanism .Methods The bacteria identification and the antimicrobial susceptibility test were con‐ducted by VITEK‐2 compact automatic system .Methicillin resistant taphylococcus aureus (MRSA) were screened by disk diffusion method with cefoxitin .The polymerase chain reaction(PCR)was used to detect the antimicrobial‐resistant genes .Results The re‐sistance rates of 80 staphylococcus aureus to penicillin ,erythromycin and gentamicin were 91 .25% ,85 .0% and 71 .25% ,respective‐ly .All of the isolates were susceptible to linezolid ,vancomycin ,teicoplanin and tigecycline .Among the 80 isolates ,there were 22 MRSA ,accounting for 27 .5% ,and 13 were inducible antimicrobial‐resistant .57 (71 .25% ) carried antimicrobial‐resistant genes ,in‐cluding 6 genes .Of which ,21(26 .25% )carried ermB and aac(6′)/aph(2) simultaneously ,9(11 .25% )carried ermA ,mecA ,qacA simultaneously ,and all of the 9 were MRSA ,13(16 .25% ) only carried ermC .Conclusion The resistance rates of staphylococcus aureus were high to penicillin ,erythromycin and gentamicin .The various antimicrobial‐resistant genes were positive in staphylococ‐cus aureus .We should pay attention to the detection of the antimicrobial‐resistant gene and choose antibacterial drug rationally .

Objective To preliminarily explore the role of serum procalcitonin (PCT) quantization in differntiating coagulase-negative staphylococci (CNS) blood stream infection and contamination derived from blood culture in children. Methods Clinical data of 83 cases of CNS derived from blood culture in People’s Hospital of Changning city, Hunan province between January, 2013 and December, 2013 were retrospectively reviewed. The cases were divided into blood stream infection group and contamination group. The basic demographic characteristics, origins of patients, C reactive protein, time to positivity of blood culture (TP), procalcitonin were compared between the two groups, and the diagnostic performance of PCT according to the ROC curve were analyzed. Results Age, gender, C reactive pretein and TP showed no difference between blood stream infection group (n=38) and contamination group (n=45)(P>0.05), while the proportion of contamination of patients from medical wards was higher than that from surgery wards (P<0.05). PCT was signiifcantly higher in blood stream infection group than that of contamination group (P<0.001). The diagnostic sensitivity, spectivity, accuracy of PCT in differentiating the two groups were 86.8%, 82.2%and 84.3%, respectively, at the best cutoff of 0.195 ng/ml. Conclusions PCT may be a good marker for differentiating CNS blood stream infection and contamination derived from blood culture in children, and may help clinicians make early and reasonable selection of antibiotics.

Objective To study the microstructural characteristics of white matter fiber tracts of visual pathways using diffusion tensor imaging (DTI)in the patients with primary glaucoma.Methods Twenty patients with primary bilateral glaucoma and 30 nor-mal adults were recruited and scanned with visual pathways magnetic resonance imaging (MRI)and DTI,obtaining T1 FLAIR ima-ges and directionally encoded color (DEC)images.On DEC images,ROIs were put in the anterior,middle and posterior part of bi-lateral optic nerve,optic tract and optic radiation,to calculate the average FA and MD value of each region.Results T1 FLAIR and DEC images could clearly show the optic nerve,optic tract and optic radiation.In patients with glaucoma,the FA values of optic nerve,optic tract and optic radiation were:0.372±0.040,0.340±0.036,0.31 5±0.026,while the MD values were:1.760±0.1 1, 1.831±0.09,1.927±0.10.The FA values of optic nerve,optic tract and optic radiation of normal adults were:0.538 ±0.073, 0.460±0.082,0.455±0.083,whilst the MD values were:0.995 ±0.27,1.312 ±0.40,1.347 ±0.37.Compared with the normal controls,FA values of all parts are deceased whereas the MD values of all parts are increased in patients.Conclusion Glaucoma is a central nervous system disease involving the whole visual pathways.Use DTI can evaluate the microstructural characteristics of white matter fiber tracts of visual pathways in the patients with glaucoma.