Objective To discuss the application of the"rotating guidewire and correcting the filter recovery hook direction technique"("rotation-correction loop technique"for short),a technique invented by the authors in clinical practice,in the retrieval of complex inferior vena cava filter(IVCF),and to discuss its technical skills and advantages.Methods The clinical data of 417 patients carrying an IVCF,who were admitted to the Department of Vascular Surgery of Second Hospital of Shanxi Medical University of China to retrieve IVCF between January 2022 and December 2022,were retrospectively analyzed.Taking the time spent on the retrieval of IVCF and the intraoperative radiation dose as the evaluation indicators,the advantages and disadvantages of the standard filter retrieval technique,the"rotation-correction loop technique"and the other loop-assisted techniques were compared.Results Both the intraoperative radiation dose and the time spent on the retrieval of IVCF using"rotation-correction loop technique"were remarkably lower than those of other loop-assisted techniques(P＜0.000 1).Conclusion For the retrieval of complex IVCF,especially for the IVCF which is heavily tilted and/or its recovered hook is attached to the vascular wall,the use of"rotation-correction loop technique"can shorten the time spent on the the retrieval of IVCF and reduce the intraoperative radiation dose.This technique carries high safety and practicability,the device is simple and it can be manipulated by single physician,which is conducive to clinical application and promotion.(J Intervent Radiol,2024,33:289-294)

Objective:To investigate the feasibility and safety of a robotic surgical system (or laparoscopy) in combination with colonoscopy (combined) for the treatment of stage T1N0M0 colorectal cancer.Methods:This was a descriptive case series. Indications for combined dual-scope surgery in this study were as follows: (1) preoperative colonoscopic examination of lesions in the middle and upper rectum and colon with pathologically confirmed high-grade intraepithelial neoplasia, intramucosal adenocarcinoma, or adenocarcinoma; (2) no distant or local lymph node metastases; and (3) endoscopic ultrasound and magnetic resonance imaging evidence of tumor invasion of the mucosal or submucosal, but not the muscular, layer (i.e., T1). The clinical data of 13 patients with stage T1 colorectal cancer who had undergone dual-scope combined resection using a robotic surgery system or laparoscope-assisted combined colonoscopy surgery at the First Affiliated Hospital of Zhengzhou University from April to October 2022 were retrospectively collected, including 6 males and 7 females, with a median age of 59 (48~88) years old. The tumors were located in the upper and middle rectum in six patients, in the sigmoid colon in three, and in the ascending colon in four. The median maximum diameter of the tumors was 3.0 (1.8–5.0) cm. The surgery was performed by a robotic surgery system (or laparoscopy) with peritumoral D1 lymph node dissection at the first station in the tumor area. The tumors were resected under direct vision and the defects in the intestinal wall were using a robotic surgery system (or laparoscopy). A robotic surgery system was combined with colonoscopy in eight cases and laparoscopy combined with colonoscopy in the remaining five. Studied variables includes surgical and pathological features, postoperative factors, and outcomes.Results:Surgery was successful in all 13 patients with no need for conversion to open surgery or intraoperative blood transfusion. The median operating time was 85 (60–120) minutes, median intraoperative bleeding 3 (2–5) mL, median number of lymph nodes harvested 3 (1–5), and the median circumferential resection margin 0.8 (0.5–1.0) cm. Postoperative pathological examination showed lymph node metastasis in one patient, who therefore underwent additional radical surgery. The median postoperative time to ambulation was 1 (1–2) days. The urinary catheters of all patients were removed 1 day after surgery and the median length of stay was 4 (3–5) days. No abdominal infection, anastomotic leakage or bleeding occurred in any of the study patients. The median follow-up time was 10 (6–12) months, during which no tumor recurrence or metastasis was found, and the quality of life was satisfactory.Conclusions:The combination of two minimally invasive platforms, a robotic surgery system (or laparoscopy) and colonoscopy, is safe and feasible for resection of stage T1 colorectal cancer and has a good short-term prognosis.

Objective:To investigate the feasibility and safety of a robotic surgical system (or laparoscopy) in combination with colonoscopy (combined) for the treatment of stage T1N0M0 colorectal cancer.Methods:This was a descriptive case series. Indications for combined dual-scope surgery in this study were as follows: (1) preoperative colonoscopic examination of lesions in the middle and upper rectum and colon with pathologically confirmed high-grade intraepithelial neoplasia, intramucosal adenocarcinoma, or adenocarcinoma; (2) no distant or local lymph node metastases; and (3) endoscopic ultrasound and magnetic resonance imaging evidence of tumor invasion of the mucosal or submucosal, but not the muscular, layer (i.e., T1). The clinical data of 13 patients with stage T1 colorectal cancer who had undergone dual-scope combined resection using a robotic surgery system or laparoscope-assisted combined colonoscopy surgery at the First Affiliated Hospital of Zhengzhou University from April to October 2022 were retrospectively collected, including 6 males and 7 females, with a median age of 59 (48~88) years old. The tumors were located in the upper and middle rectum in six patients, in the sigmoid colon in three, and in the ascending colon in four. The median maximum diameter of the tumors was 3.0 (1.8–5.0) cm. The surgery was performed by a robotic surgery system (or laparoscopy) with peritumoral D1 lymph node dissection at the first station in the tumor area. The tumors were resected under direct vision and the defects in the intestinal wall were using a robotic surgery system (or laparoscopy). A robotic surgery system was combined with colonoscopy in eight cases and laparoscopy combined with colonoscopy in the remaining five. Studied variables includes surgical and pathological features, postoperative factors, and outcomes.Results:Surgery was successful in all 13 patients with no need for conversion to open surgery or intraoperative blood transfusion. The median operating time was 85 (60–120) minutes, median intraoperative bleeding 3 (2–5) mL, median number of lymph nodes harvested 3 (1–5), and the median circumferential resection margin 0.8 (0.5–1.0) cm. Postoperative pathological examination showed lymph node metastasis in one patient, who therefore underwent additional radical surgery. The median postoperative time to ambulation was 1 (1–2) days. The urinary catheters of all patients were removed 1 day after surgery and the median length of stay was 4 (3–5) days. No abdominal infection, anastomotic leakage or bleeding occurred in any of the study patients. The median follow-up time was 10 (6–12) months, during which no tumor recurrence or metastasis was found, and the quality of life was satisfactory.Conclusions:The combination of two minimally invasive platforms, a robotic surgery system (or laparoscopy) and colonoscopy, is safe and feasible for resection of stage T1 colorectal cancer and has a good short-term prognosis.

There is no unified thoracic surgery training system in China, neither in the trainee selection or evaluation, nor in the training curriculum or the graduation requirements. A literature review was performed for available publications regarding international thoracic surgical training. A brief comparison was made regarding the thoracic surgery residency programs in China, Japan, United States and United Kingdom, including training pathway, recruitments, training content, performance assessment and academic experience. In conclusion, there are four key aspects worth noting. Firstly, an effective residency programme is invaluable to specialty training, and effort should be made to create a unified training programme that allows trainee to progress from residency to specialty training smoothly. Secondly, flexibility and personalization should be allowed in higher specialty training, so that trainee can develop their subspecialty interests. Thirdly, a unified clinical curriculum, selection and standardized income should be promoted to minimalize the variation of training outcome between provinces. Fourthly, additional training and time should be allowed for trainee who wants to pursue an academic career, and academic outcomes should be evaluated alongside with the standard clinical training.

Objective: To establish a method for isolation and culture of primary endothelial cells from non-human primate coronary arteries, and to provide a cell model for the study of human coronary endothelial cells. Methods: The coronary arteries of macaca mulattas were separated aseptically. The primary endothelial cells were separatedviatissue adhesion after collagenase digestion. CD31 positive cells were detected and sorted by flow cytometry to determine the purity of endothelial cells. After stimulation with prostaglandin E2(PGE2), the cellular viability and proliferation ability of primary coronary endothelial cells from macaca mulattas were evaluated by high-content cell imaging and CCK-8 assay, and the migration ability and tube function of primary coronary endothelial cells from macaca mulattas were measured by Transwell method and Matrigel glue method, respectively. Results: The confluence percentage of primary coronary artery cells of macaca mulattas was about 80% after 10-14 daysin vitroculture, and the cellular morphology was irregular polygons and paver shape. The purity of endothelial cells was about 31.7% by flow cytometry. After sorting, the purity of endothelial cells was confirmed by flow cytometry, which was more than 95%. PGE2could significantly up-regulate the proliferation, migration and tube formation abilities of primary coronary endothelial cells of macaca mulattas. Conclusion This study successfully established the isolation and culture method of primary coronary endothelial cells from macaca mulattas, and proved that it could be used as anin vitrocell model to simulate human coronary endothelial cells through functional studies.

Objective: To compare the efficiency of different methods for extracting rhesus monkey lung fibroblasts and their effects on functions, so as to provide a method for obtaining primary lung fibroblasts that are closer to human fibroblasts. Methods: Two extraction methods for rhesus monkey lung fibroblasts were used, direct tissue block adhesion method and collagenase combined digestion with tissue block adhesion method. The cell morphology was observed with the inverted microscope, the purity of isolated rhesus monkey lung fibroblasts was identified by immunofluorescence, cell viability was detected by CCK-8, the expression of α-SMA was detected by flow cytometry and the effect of long-term in vitro culture on cell apoptosis was detected by apoptosis kit. Western blot was used to detect the expression of α-SMA protein. Results: The combined digestion with collagenase and tissue block adhesion method could see small and bright cells crawling out in 24 hours, and cells could be seen crawling out in a large area after 48 hours. The cells were in a long spindle shape, after 4 days to 5 days, a single layer of cells could be formed. Identified by immunofluorescence, all cells expressed α-SMA. Tissue adhesion method showed small and bright cells crawling out after 72 hours. After 4 days to 5 days, the cells crawled out in a small area and showed a long spindle shape. After a week, the cells crawled out in a large area and formed a single layer of cells and the cells are all expressed α-SMA by immunofluorescence. The experimental results showed that the cell viability of the cells crawled out by the collagenase digestion method was significantly higher than that of the tissue adhesion method. After TGF-β1 stimulates the cells, the cells extracted by collagenase digestion method proliferated faster and expressed α-SMA more obviously. Conclusion Both methods can isolate rhesus monkey lung fibroblasts in vitro, but the collagenase digestion method extracts cells in a shorter time and in better condition. The expression of related proteins is more stable after stimulation by stimulants, which is an effective method to obtain rhesus monkey lung fibroblasts, and it is also an effective method to obtain primary lung fibroblasts that are closer to human.

Abstract: To observe the histomorphological features of the hypothalamic-pituitary-adrenal axis in macaques to provide a reference for simulating the physiological functions and pathological responses of the human hypothalamic-pituitary-adrenal axis. Methods: After euthanasia of macaques, hypothalamus, pituitary and adrenal tissues were removed intact, fixed by PFA, and paraffin sections and frozen sections were prepared; the basic structure and cellular distribution were observed by HE staining; the secreted hormones and receptors were detected by immunohistochemistry; the effects of staining in frozen and paraffin sections were compared, and the cellular composition of some hypothalamus tissues was identified. Results: The hypothalamic region was hollow and funnel-shaped, the pituitary gland resembles a pea, and the right and left adrenal glands were located between the liver and kidneys; HE staining showed that the hypothalamic region was mainly composed of neurons and microglia, the pituitary gland was divided into neuro-pituitary and adeno-pituitary, and the adrenal gland was composed of cortex and medulla; immunohistochemical results showed that the hypothalamus secretes CRH and expresses GR, the pituitary gland secretes ACTH and expresses CRHR1 and GR, and the adrenal gland expresses ACTHR; immunofluorescence of frozen sections better showed that the hypothalamus contains neurons and microglia. Conclusion In this study, sections of hypothalamus, pituitary and adrenal gland tissues from macaques were successfully produced, and the relevant anatomical and morphological features were observed and examined, which provided a reference method for simulating the physiological and pathological responses of the human hypothalamic-pituitary-adrenal axis.

HER2 gene is expressed in 20%-30% of breast cancer patients, and HER2 expression provides a new direction for treatment. However, breast cancer with positive HER2 still has a poor prognosis and is prone to recurrence and metastasis. Trastuzumab is a classic basic drug for anti-HER2 therapy. However, the problem of primary and acquired drug resistance of trastuzumab has attracted people's attention. Studies have found that the occurrence of insensitive and drug resistance mechanism is related to PD-L1 up-regulation on tumor cell surface. Therefore, a large number of studies on PD-1/PD-L1 inhibitor combined with trastuzumab were carried out to improve its sensitivity and drug resistance. This article reviews the preclinical and clinical studies on PD-1/PD-L1 inhibitors in breast cancer with positive HER2.

There is no unified thoracic surgery training system in China, neither in the trainee selection or evaluation, nor in the training curriculum or the graduation requirements. A literature review was performed for available publications regarding international thoracic surgical training. A brief comparison was made regarding the thoracic surgery residency programs in China, Japan, United States and United Kingdom, including training pathway, recruitments, training content, performance assessment and academic experience. In conclusion, there are four key aspects worth noting. Firstly, an effective residency programme is invaluable to specialty training, and effort should be made to create a unified training programme that allows trainee to progress from residency to specialty training smoothly. Secondly, flexibility and personalization should be allowed in higher specialty training, so that trainee can develop their subspecialty interests. Thirdly, a unified clinical curriculum, selection and standardized income should be promoted to minimalize the variation of training outcome between provinces. Fourthly, additional training and time should be allowed for trainee who wants to pursue an academic career, and academic outcomes should be evaluated alongside with the standard clinical training.

Objective    To compare the clinical effects of segmentectomy and lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections. Methods    The patients with adenocarcinoma who received segmentectomy or lobectomy in multicenter from June 2020 to March 2021 were included. They were divided into two groups according to a random number table, including a segmentectomy group (n=119, 44 males and 75 females with an average age of 56.6±8.9 years) and a lobectomy group (n=115, 43 males and 72 females with an average of 56.2±9.5 years). The clinical data of the patients were analyzed. Results    There was no significant difference in the baseline data between the two groups (P>0.05). No perioperative death was found. There was no statistical difference in the operation time (111.2±30.0 min vs. 107.3±34.3 min), blood loss (54.2±83.5 mL vs. 40.0±16.4 mL), drainage duration (2.8±0.6 d vs. 2.6±0.6 d), hospital stay time (3.9±2.3 d vs. 3.7±1.1 d) or pathology staging (P>0.05) between the two groups. The postoperative pulmonary function analysis revealed that the mean decreased values of forced vital capacity and forced expiratory volume in one second percent predicted in the segmentectomy group were significantly better than those in the lobectomy group (0.2±0.3 L vs. 0.4±0.3 L, P=0.005; 0.3%±8.1% vs. 2.9%±7.4%, P=0.041). Conclusion    Segmentectomy is effective in protecting lungs function, which is expected to improve life quality of patients.