Objective To compare the different therapeutic efficacies between radiofrequency and cryoballoon ablation in atrial fibrillation(AF)patients with enlarged left atrium.Methods A total of 106 AF patients with enlarged left atrium(LAVI)>34ml/m2 who visited our center between December 2016 and May 2022 for catheter ablation were enrolled.They were divided into radiofrequency group(R-group)and cryoballoon group(C-group)according to the procedure.The recurrence of AF was compared between the two groups.Results The median follow-up time was 12 months and no death occurred.The rate of loss of follow-up was 3.8%.The overall recurrence rate of AF after ablation was 36.8%.There was no significant difference in clinical baseline between the two groups(P>0.05).The radiofrequency group had longer operation time(P<0.001),shorter X-ray time and less exposure(P<0.05);There was no significant difference in clinical baseline and postoperative complications between the two groups(P>0.05).The results of survival analysis showed that there was no significant difference in the survival rate of patients without atrial fibrillation/atrial flutter/atrial tachycardia between the two groups(P>0.05).Conclusion For AF patients with enlarged left atrium,the clinical effects of the two methods were similar.Cryoballoon takes a shorter time,while radiofrequency has a lower X-ray time and exposure dose for physicians and patients.Therefore,appropriate ablation methods should be selected according to the actual situation.

BACKGROUND:Traditional scoliosis orthosis has some disadvantages,such as complex manufacturing process,long processing cycle,poor fit and so on.Three-dimensional printed scoliosis orthosis has the advantages of high manufacturing precision and personalization. OBJECTIVE:To evaluate the efficacy of three-dimensional printed scoliosis orthosis for scoliosis based on multi-criteria decision model. METHODS:Clinical data of 72 patients with scoliosis admitted to Chen Xinghai Hospital of Integrated Traditional Chinese and Western Medicine from January 2019 to October 2022 were retrospectively collected and divided into two groups according to the treatment of orthosis.Study group(n=23)received three-dimensional printed scoliosis orthosis.Traditional group(n=49)received the traditional polypropylene spine brace treatment.The clinical efficacy and complications were compared between the two groups.A multi-criteria decision model for the treatment of scoliosis with three-dimensional printed scoliosis orthosis was established,and the stability of the benefit value,risk value and decision model of the two groups were evaluated. RESULTS AND CONCLUSION:(1)Compared with the traditional group,there were significant differences in the top vertebral offset distance,Cobb angle,top vertebral rotation,Functional Movement Screen score,visual analog scale score and total effective rate in the study group at 6 months after surgery(P<0.05).(2)Among the benefit indexes,Cobb angle had the greatest impact on the condition of patients,while the risk indexes had the greatest impact on dyspnea.(3)The benefit values of the study group and the traditional group for scoliosis were 79 and 64,and the risk values were 74 and 57,respectively.The combined benefit and risk values found that the benefit-risk value of the study group was 16 higher than that of the traditional group.(4)In the range of 0-100%relative risk weight,the benefit-risk value of the study group was always higher than that of the traditional group,which proved that the multi-criteria decision-making model had good stability.(5)It is indicated that three-dimensional printed scoliosis orthosis can better restore the physiological curvature of scoliosis and improve the efficiency of treatment.

OBJECTIVE To explore the application value of indocyanine green combined with near-infrared autofluorescence imaging technique in identifying pathological parathyroid glands during surgery for primary hyperparathyroidism (PHPT). METHODS Data from 40 patients with PHPT treated in Beijing Tongren Hospital,Capital Medical University were collected,including 10 patients in the indocyanine green treated group and 30 patients in the non-treated group. All patients underwent surgical treatment to remove the affected parathyroid glands. Near-infrared autofluorescence imaging was used for image acquisition,and ImageJ software was used for fluorescence intensity analysis. RESULTS The fluorescence intensity of the pathological parathyroid glands in the indocyanine green-treated group was significantly higher than that in the non-treated group(142.7±23.7 vs. 94.5±31.4,t=-4.434,P=0.000);the fluorescence ratio of pathological parathyroid glands/thyroid glands was significantly higher than that in the non-treated group(1.6±0.3 vs. 1.2±0.4,t=-3.162,P=0.004). There was no correlation between the fluorescence intensity of parathyroid glands in the non-treated group and preoperative blood calcium(r=0.029,P=0.088) and preoperative PTH level(r=-0.142,P=0.455),and there was also no correlation between the fluorescence intensity of parathyroid glands in the treated group and preoperative blood calcium(r=0.206,P=0.568) and preoperative PTH level(r=0.160,P=0.658). The detection rate of near-infrared light in the non-treated group was 53.3％(16/30),while that in the treated group was 100％(10/10). The average detection time for the non-treated group was (71.0±16.9)minutes,while that for the treated group was (52.7±11.1)minutes,with a significant difference between the two groups(t=3.187,P=0.003). CONCLUSION The combination of indocyanine green and near-infrared autofluorescence imaging technique is helpful for identifying the diseased parathyroid glands during the surgical treatment of PHPT.

Objective To evaluate the surgical treatments of refractory sclerosing peritonitis related peritoneal dialysis.Methods Clinical data of 15 patients with refractory sclerosing peritonitis related to peritoneal dialysis treated in the General Surgery Department of the 900th Hospital of the Joint Logistics Support Force of the People's Liberation Army from June 30,2014 to May 30,2018.Among them,5 cases underwent"open abdomen peritoneal catheter removal+intestinal adhesiolysis+abdominal infection flushing and drainage with catheter",4 cases underwent"laparoscopic peritoneal catheter removal+intestinal adhesiolysis+abdominal infection flushing and drainage with catheter",3 cases underwent"laparoscopic peritoneal dialysis catheter removal+abdominal infection flushing and drainage with catheter",2 cases underwent"open abdomen peritoneal dialysis catheter removal+abdominal infection flushing and drainage with catheter",and 1 case underwent"laparoscopic examination combined with laparotomy exploration and removal of lower abdominal catheter+intestinal adhesiolysis+abdominal infection flushing and drainage with catheter".Age,gender,clinical symptoms,abdominal CT examination,peripheral blood routine,blood biochemistry,blood C-reactive protein(CRP),white blood cells,biochemistry,and aetiology of peritoneal dialysis fluid were collected and followed up,and the therapeutic effect was evaluated.Results 15 patients were transferred to the Department of Surgery after ineffective treatment in the Department of Internal Medicine.Preoperatively(after 5 days of antibiotic treatment)compared to before antibiotic treatment,there were no significant changes in blood WBC,blood NEUT％,CRP,and peritoneal fluid WBC(P＞0.05).Laparoscopic exploration or laparotomy exploration was performed,during which the peritoneal dialysis catheter was removed and the abdominal infection focus was cleared.A pelvic cavity washout drainage tube was left in place postoperatively.Fourteen patients had a good recovery after surgery,with effective control of peritonitis symptoms and no complications such as intestinal obstruction or enterocutaneous fistula.After the removal of the peritoneal dialysis catheter,all patients switched to hemodialysis.A comparison of inflammatory markers before and after surgery showed a significant decrease after surgery.Three days postoperatively compared to before surgery(after 5 days of antibiotic treatment),there were no significant changes in blood WBC,blood NEUT％,CRP,and peritoneal fluid WBC(P＞0.05).Seven days postoperatively compared to before surgery(after 5 days of antibiotic treatment),there was a significant decrease in blood WBC[(7.43±2.65)× 109/L VS(10.17±5.24)× 109/L],blood NEUT％[(88.23±9.02)％VS(85.07±11.57)％],and CRP[(152.88±113.01)mg/L VS(114.49±92.97)mg/L](P＜0.05);the peritoneal fluid WBC at 7 days postoperatively showed no significant change compared to before surgery(after 5 days of antibiotic treatment)(P＞0.05).The cases were followed up for at least 22 months,and 13 patients did not experience peritonitis or intestinal obstruction again.One patient died 39 days after surgery due to multiple organ failure,and one patient died from other causes after a 2-year follow-up.Conclusion For refractory sclerosing peritonitis related peritoneal dialysis that is ineffective in medical conservative treatment,On the basis of reasonable and effective antibiotics to control infection,surgical intervention should be actively carried out and surgical methods such as surgery should be used to control the progress of peritonitis,reduce mortality and improve the cure rate.

Aim To investigate the effect of theaflavin on oxidized low density lipoprotein(ox-LDL)-induced foam cell formation and oxidative stress in THP-1 macrophages and its mechanism.Methods THP-1 derived macro-phages were pretreated with 50 μmol/L theaflavin and(or)10 μmol/L nuclear factor erythroid 2-related factor 2(NRF2)inhibitor ML385,then 100 mg/L ox-LDL was added to the cells for 24 h to establish the foam cell model.The effect of theaflavin on THP-1 macrophages viability was evaluated by CCK-8 assay and LDH release.The expression of inflamma-tory cytokines interleukin-6(IL-6),interleukin-1 β(IL-1β),tumor necrosis factor-α(TNF-α)were analyzed by real-time quantitative polymerase chain reaction(RT-qPCR)and Western blot.The release of inflammatory cytokines were detected by enzyme linked immunosorbent assay(ELISA).Intracellular lipid accumulation was detected by Oil red O staining,and lipid absorption was observed by DiL-labeled oxidized low density lipoprotein(DiL-ox-LDL)staining.Re-active oxygen species(ROS)level was detected by DCFH-DA probe.The expression of lipid uptake,cholesterol efflux and oxidative stress-related proteins were detected by Western blot and RT-qPCR.Results Treatment with 100 mg/L ox-LDL significantly decreased cell viability and cholesterol efflux-related protein expressions,increased lipid uptake,ac-cumulation and lipid uptake-related protein expressions,and significantly promoted inflammation and ROS level,as well as the expressions of myeloperoxidase(MPO),NADPH oxidase 2(NOX2)in THP-1 macrophages(all P＜0.05).After pretreatment with theaflavin,cell viability was increased,intracellular lipid uptake,accumulation and lipid uptake-related protein expressions were significantly reduced,cholesterol efflux-related protein expressions were significantly increased,the expression and release of IL-6,IL-1β and TNF-α were significantly decreased,ROS level was significantly decreased,and the expression of MPO and NOX2 were decreased(all P＜0.05).Pretreatment with theaflavin effectively alleviated intracellular oxidative stress by altering the expression of NRF2,heme oxygenase-1(HO-1)and Kelch-like ECH-associated protein 1(KEAP1)in NRF2 signaling pathway,and enhanced the translocation of NRF2 into the nucleus.After pretreat-ment with ML385,the expression levels of NRF2,HO-1,KEAP1 and CD36 were significantly decreased.Conclusion Theaflavin can significantly inhibit ox-LDL-induced foam cell formation,inflammation,and oxidative stress through NRF2/HO-1 signaling pathway in THP-1 macrophages.

Objective:To assess the impact of preoperative Naples prognostic score on the prognosis of patients with hepatocellular carcinoma (HCC) after hepatic resection.Methods:Retrospective analysis was conducted on the data of 323 patients with HCC who underwent radical hepatectomy in Zhejiang Provincial People's Hospital from January 2012 to December 2017, including 281 males and 42 females, aged (56.6±11.3) years. All patients were divided into three groups according to their preoperative Naples prognostic scores: group A (0) ( n=37), group B (1-2) ( n=193), group C (3-4) ( n=93). Survival was analysed by the Kaplan-Meier method, and differences in survival were compared by the log-rank test. Univariate and multivariate Cox regression were used to analyse the effect of Naples prognostic score on prognosis. Results:The 1-, 3- and 5-year cumulative survival rates of HCC patients after hepatectomy were 91.9%, 78.4% and 68.3% in the A group, 89.1%, 76.1% and 64.4% in the B group, and 84.9%, 63.3% and 43.5% in the C group, respectively, and the cumulative survival rates showed a decreasing trend among the three groups, and the differences were statistically significant (all P<0.05). The recurrence-free survival rates at 1, 3 and 5 years after hepatectomy were 93.4%, 63.3% and 44.3% in the A group, 77.7%, 46.5% and 35.6% in the B group, and 64.1%, 41.1% and 28.2% in the C group, respectively, and the recurrence-free survival rates showed a decreasing trend among the three groups, and the differences were statistically significant (all P<0.05). On Cox multivariate analysis, patients with HCC of 3-4 had a higher risk of death after hepatic resection than those patients of 0 ( HR=2.011, 95% CI: 1.048-3.859, P=0.036), and the risk of postoperative recurrence was also higher than those patients of 0 ( HR=1.820, 95% CI: 1.081-3.066, P=0.024). Conclusion:Preoperative Naples prognostic score performs as a prognostic influence factor on survival and recurrence-free survival after hepatectomy in patients with HCC.

Objective:To compare the clinical features, X-ray, CT, MRI imaging findings of C 3, 4 single segment cervical spondylotic myelopathy among the elderly group, the middle-aged group and the young group. Methods:The medical records and imaging data of 51 cases of single segment C 3, 4 cervical spondylotic myelopathy treated from January 2017 to December 2021 were retrospectively reviewed. There were 10 cases in the young group, including 8 males and 2 females, 23-44 years, with an average age of 35.8±7.62 years; 14 cases in the middle-aged group, including 9 males and 5 females, 48-60 years, with an average age of 53.21±4.14 years; 27 cases in the elderly group, including 24 males and 3 females, 61-84 years, with an average age of 68.04±5.97 years. Based on the medical record data, the differences in clinical manifestations among the three groups (initial symptoms, symptom distribution, pathological sign distribution and JOA score) were analyzed. Based on the imaging data, the static factors (cervical osteophyte, alignment and thickness of cervical ligamentum flavum) and dynamic factors [overall cervical range of motion (ROM), individual segment cervical ROM, cervical instability and cervical nuchal ligament calcification] were analyzed. Anatomical factors (C 2-C 7 Cobb angle, C 4-C 7 Cobb angle, C 3 vertebral canal diameter, C 4 vertebral diameter, C 3 Pavlov ratio, C 4 Pavlov ratio) and spinal cord compression (spinal cord signal, compression position and compression nature) were also analyzed. Results:There were no statistically significant difference in gender distribution and height in three groups of patients ( P>0.05). In terms of clinical manifestations, there were statistically significant differences among the three groups in initial symptoms and chief symptoms ( P<0.05). The elderly group had upper limb weakness as the first symptom, lower limb weakness and abnormal gait as the chief complaint; the middle-aged group had upper limb numbness as the first symptom, upper limb numbness and weakness as the chief complaint; the young group had upper limb pain as the first symptom, upper limb numbness as the chief complaint. There were statistically significant differences in Hoffmann sign and Babinski sign among the three groups ( P<0.05). Hoffmann sign and Babinski sign were more common in the elderly group than in the young group ( P<0.05). There were significant differences among the three groups in total JOA score, JOA score of motor and lower limb motor JOA ( P<0.05). The total JOA score in the elderly group was lower than that in the young group ( P<0.05), especially for motor JOA score ( P<0.05), and lower limb motor JOA score ( P<0.05). There were no significant differences in first symptoms distribution, symptoms distribution, biceps reflex, triceps reflex, radial reflex or knee tendon reflex among the three groups ( P>0.05). In terms of static factors, there was significant difference in alignment and thickness of cervical ligamentum flavum among the three groups (P<0.05). The elderly group was more prone to slip than the young and middle aged groups ( P<0.05). The thickness of ligamentum flavum in the elderly group (2.18±0.68 mm) was thicker than that in the young group (1.60±0.30 mm) and the middle-elderly group (1.60±0.62 mm) ( P<0.05). There was no significant difference in cervical osteophyte among the three groups ( P>0.05). In terms of dynamic factors, there were statistically significant difference in C 3-C 7 ROM, C 4-C 7 ROM, C 3, 4 ROM and ossification of nuchal ligament among the three groups ( P<0.05). In the elderly group, C 3-C 7 ROM (22.18°) was larger than that in the young group (21.27°) ( P<0.05), while in the elderly group C 4-C 7 ROM (9.60°) was smaller than that in the young group (14.19°) ( P<0.05). In the elderly group, C 3, 4 ROM (15.30°) was larger than that in the young group (9.97°) ( P<0.05), and the elderly group was more prone to nuchal ligament calcification than the young and the middle-elderly group ( P<0.05). There were no significant difference among the three groups in C 4, 5 ROM, C 5, 6 ROM, C 6, 7 ROM or cervical instability ( P>0.05). For spinal cord compression, there were statistically significant differences among the three groups in the compression nature, compression location and MRI T2WI spinal cord signal ( P<0.05). The elderly group was more prone to anterior and posterior bony compression. The elderly group was more likely to show high signal intensity on spinal cord MRI T2WI than the young group ( P<0.05). For anatomical factors, there were statistically significant differences in C 2-C 7 Cobb, C 3 vertebral diameter and C 3 Pavolv among the three groups ( P<0.05) . The C 2-C 7 Cobb of the elderly group (21.06°) was larger than that of the young group (16.45°) ( P<0.05), and the C 3 diameter of the elderly group (9.61±0.33 mm) was smaller than that of the young group (10.38±1.19 mm) ( P<0.05). The C 3 Pavolv of the elderly group (0.52±0.03) was lower than that of the young group (0.59±0.11) ( P<0.05). In the presence of lordosis, C 4-C 7 Cobb in the elderly group (4.96°±4.05°) was smaller than that in the young group (12.42°±4.83°) and the middle-aged group (10.07°±6.14°) ( P<0.05). In the presence of kyphosis, C 4-C 7 Cobb in the elderly group (4.02°±1.19°) was larger than that in the young group (0.06°±0.01°) and the middle-aged group (1.83°±0.93°) ( P<0.05). There were no significant differences in C 3-C 7 Cobb, C 4 vertebral diameter or C 4 Pavolv among the three groups ( P>0.05). Conclusion:Young patients mostly have anteriorly soft compression of disc herniation, and most of them complain of neck and upper limb pain, while spinal cord compression and clinical manifestations are relatively mild. For the elderly patients, most of them have C 3 retrolisthesis, with the pinching type bony compression of spinal cord from both anteriorly and posteriorly, and their complaints are usually upper limb numbness, mostly accompanied by radiographically severe spinal cord compression and clinically gait abnormalities. In the middle-aged patients, the rigid compression of anterior calcified disc herniation is the main reason, and the numbness of upper limb is the chief complain.

Humans ; Immune Checkpoint Inhibitors/therapeutic use* ; Prospective Studies ; HIV Infections/drug therapy* ; Anti-HIV Agents/therapeutic use* ; Comorbidity

Objective:To explore the application value of the new gastric cancer screening scoring system for risk populations in the island of Fujian province.Methods:From April to June 2019, gastric cancer screening was performed on the population of Nanri Island, Putian City, Fujian Province, and epidemiological data of all subjects were prospectively collected. Participants underwent gastroscopy based on gastric cancer risk stratification of the new scoring system. Suspected positive cases further received magnifying endoscopy and biopsy. Additional endoscopic procedures and other surgical treatments were conducted. The detection rates of gastric cancer and precancerous lesions in each group of gastric cancer risk stratification were compared, and the Chi-square test was used for statistical analysis.Results:A total of 1 423 subjects were included, and 19 cases (1.34%) of gastric cancer were detected. The detection rates of gastric cancer were 0.88% (9/1 025) in the low-risk group, 1.76% (6/341) in the medium-risk group, and 7.02% (4/57) in the high-risk group. Paired comparison between the low-risk group and the high-risk group showed significant difference ( χ2=12.364, P=0.003). There was no significant difference between the low-risk group and medium-risk group, or between the medium-risk group and high-risk group ( P>0.05). Among all participants, 87 (6.11%) cases of gastric precancerous lesions were identified. The detection rates of precancerous lesions in the low-risk, medium-risk, and high-risk groups were 6.24% (64/1 025), 5.87% (20/341), and 5.26% (3/57) respectively, with no significant difference among the three groups ( P>0.05) .Conclusion:During gastric cancer screening, the novel gastric cancer screening scoring system helps to stratify gastric cancer risk for population in the islands of Fujian province, serving as a foundation for subsequent detailed endoscopy.

Objective:To investigate the clinical efficacy and safety of transcervical non-inflatable endoscopic thyroidectomy through the posterior inferior sternocleidomastoid approach. Methods:From December 2022 to May 2023, the clinical data of 35 patients with papillary thyroid carcinoma treated by transcervical non-inflatable endoscopic surgery via posterior inferior sternocleidomastoid approach were retrospectively analyzed. There were 14 males and 21 females, with an average age of 44.7 years. The operation time, bleeding volume, postoperative recovery, complications and follow-up were recorded. Results:All 35 patients successfully completed the surgery, with an average operation time of 4 hours and 7 minutes, an average bleeding volume of 14 ml, and an average postoperative hospital stay of 3.5 days. There were no serious complications and no obvious neck discomfort during postoperative follow-up. Conclusion:Transcervical non-inflatable endoscopic thyroidectomy via posterior inferior sternocleidomastoid approach is safe and effective, with fast postoperative recovery,high appearance satisfaction and good neck comfort.
Female ; Male ; Humans ; Adult ; Retrospective Studies ; Neck ; Neck Muscles/surgery* ; Thyroid Neoplasms/surgery*