To investigate the application value of disposable subscope-assisted intestinal metal stent placement in the treatment for acute malignant colorectal obstruction, a retrospective analysis was conducted on the patients who underwent intestinal metal stent placement assisted by disposable subscope for acute malignant colorectal obstruction at the Digestive Endoscopy Center, Affiliated Hospital of Yangzhou University from June 2023 to July 2024. The technical success rate, clinical success rate, operation time, postoperative complications and first-stage surgical resection anastomosis rate of intestinal metal stent placement assisted by subscope were analyzed. Among the 16 included patients, there were 10 males and 6 females, with the age of 72.19±9.40 years. Obstruction occurred at the descending colon in 8 cases (50.00%), at the sigmoid colon in 6 cases (37.50%), at the rectosigmoid junction in 1 case (6.25%), and at the splenic flexure of the transverse colon in 1 case (6.25%). All 16 patients successfully underwent stent placement, with a technical success rate of 100.00% (16/16). Obstruction symptoms did not relieve in one patient (6.25%) after stent placement, resulting in a clinical success rate of 93.75% (15/16). The endoscopic operation time for the 16 patients was 37.8±13.9 minutes. No bleeding, perforation, stent displacement, or detachment occurred after the operation. Fourteen patients underwent subsequent surgical treatment, the first-stage surgical resection anastomosis rate was 71.43% (10/14). This preliminary study suggests that the disposable subscope-assisted intestinal metal stent placement for the treatment of acute malignant colorectal obstruction is safe and effective, with no radiation exposure.

To investigate the application value of disposable subscope-assisted intestinal metal stent placement in the treatment for acute malignant colorectal obstruction, a retrospective analysis was conducted on the patients who underwent intestinal metal stent placement assisted by disposable subscope for acute malignant colorectal obstruction at the Digestive Endoscopy Center, Affiliated Hospital of Yangzhou University from June 2023 to July 2024. The technical success rate, clinical success rate, operation time, postoperative complications and first-stage surgical resection anastomosis rate of intestinal metal stent placement assisted by subscope were analyzed. Among the 16 included patients, there were 10 males and 6 females, with the age of 72.19±9.40 years. Obstruction occurred at the descending colon in 8 cases (50.00%), at the sigmoid colon in 6 cases (37.50%), at the rectosigmoid junction in 1 case (6.25%), and at the splenic flexure of the transverse colon in 1 case (6.25%). All 16 patients successfully underwent stent placement, with a technical success rate of 100.00% (16/16). Obstruction symptoms did not relieve in one patient (6.25%) after stent placement, resulting in a clinical success rate of 93.75% (15/16). The endoscopic operation time for the 16 patients was 37.8±13.9 minutes. No bleeding, perforation, stent displacement, or detachment occurred after the operation. Fourteen patients underwent subsequent surgical treatment, the first-stage surgical resection anastomosis rate was 71.43% (10/14). This preliminary study suggests that the disposable subscope-assisted intestinal metal stent placement for the treatment of acute malignant colorectal obstruction is safe and effective, with no radiation exposure.

OBJECTIVE To compare the efficacy of Eustachian tube pressure nebulization and insuffiation system and conventional drugs on acute otitis media of effusion in adults. METHODS Sixty ears of acute otitis media of effusion in our hospital were selected as the research objects. All patients were divided into two groups according to the treatment,which received drug therapy alone and received drug therapy and nebulizer therapy. The course lasted for 7 days. ETS,ETDQ-7,related hearing tests(acoustic immitance and pure tone threshold),and the therapeutic effect were compared among the three groups. RESULTS In drug therapy alone group,6 ears were cured,10 ears were improved,and the total effective rate was 53.3％. In drug therapy and nebulizer therapy group,17 ears were cured,9 ears were improved,and the total effective rate was 86.7％. There were no complications or adverse reactions in all patients. CONCLUSION The effective rate of the patients treated with Eustachian tube pressure nebulization and insuffiation system combined drug therapy was significantly higher than that of drug therapy alone. On the basis of conventional drug therapy combined with eustachian tube pressure nebulization and insuffiation system might can be a new effective choice for acute otitis media of effusion in adults.

Objective:To confirm the reuse of mismatched regenerated motor axons of brachial plexus and explore the effect of target organs on their regeneration in a rat model.Methods:This study was carried out between January 2021 and December 2021 at the research laboratory of the Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, the First Affiliated Hospital of Sun Yat-sen University. Animals were randomly assigned into 2 groups, as a regeneration group (RGen) with 5 subgroups and a reuse group (RUs) with 3 subgroups. There were 6 rats per subgroup with 42 rats in total. It was observed that in the groups of RGen1-4, after the transection and suture of the musculocutaneous nerve, the motor axons of the proximal end could accurately grow into the distal corresponding endoneural tube. It was also observed that in the mismatched regenerated group, motor axons were the axons that grew into the endoneurial tube of the lateral forearm cutaneous nerve (LFCN), and other non-target organ contacts were made to the regenerated nerves after mismatch. It was specifically further divided into RGen1, the group without an organ for nerve to make contact with; RGen2, the group with skin as the target organ with nerves contact by neurorrhaphy; RGen3, the group with skin as the target organ with originally reserved natural nerve contact; RGen4, the group with muscle as the target organ with nerves contact by neurorrhaphy and RGen5, a control group. After 8 weeks, the positive area (PA), mean density (MD) and integral optical density (IOD) were measured, with AChE and ChAT fluorescence staining of the medial branch of LFCN, to evaluate the regenerated nerves after mismatch. Of the RUs group, firstly, the innervating branches of the flexor carpi radialis (FCR) were dissected and exposed, then further assigned according to initially innervated FCR (RUs1), contacted with regenerated nerves after mismatch (RUs2) and denervated (RUs3), respectively. After 8 weeks, compound muscle action potential (CMAP) and wet weight ratio of FCR were taken. Masson staining of FCR was also performed to evaluate muscle reinnervation by the regenerated nerves after mismatch. Data analysis with One-Way ANOVA and Bonferroni 0.05 indicated a statistically significant difference.Results:In the RGen groups, after AChE staining, the PA, MD and IOD of RGen3 and RGen4 were higher than that of RGen1 and RGen5, and PA of RGen4 were higher than that of RGen2, with a statistically significant difference ( P<0.05). After ChAT staining, the values of PA and IOD of RGen3 and RGen4 were higher than that of RGen1 and RGen5, and PA of RGen4 were higher than that of RGen2, with a statistically significant difference ( P<0.05). In the RUs, electrophysiological assessment showed that no CMAP was observed in RUs3, there was no significant difference in Latency of RUs1 and RUs2. The difference was statistically significant ( P<0.05). Wet weight rate of muscle of RUs1 (98.91%±3.86%) was higher than that of RUs3 (86.67%±4.68%) with a statistically significant difference ( P<0.01), but no significant difference when compared with RU2 (92.74%±3.88%). Masson staining showed that the CVF value of RUs2 (8.61%±1.16%) was significantly higher than that of RUs1 (3.17%±0.76%), and statistic significantly lower than that of RUs3 (16.44%±2.26%)( P<0.01). Conclusion:Target organ contact can promote the regenerated nerves after mismatched regeneration, and the muscle target organs exhibit greater facilitation than the cutaneous target organs. Besides, regenerated nerves after mismatch can establish effective innervation with muscle target organs, comfirming their effective reuse.

Objective:To investigate the preoperative risk factors affecting early extremity blood supply after repair of major arterial injury so as to provide clues for prevention of limb ischemia.Methods:The clinical data were retrospectively analyzed of the 139 patients (140 extremities) with major extremity arterial injury who had been admitted to Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, The First Hospital Affiliated to Sun Yat-sen University from January 2003 to December 2019. There were 112 males and 27 females, with a mean age of 30 (20, 44) years. The primary outcome was the early status of blood supply to the injured extremity (48 hours after surgery). Univariate analysis was conducted of such factors as gender, age, ischemia time, injury mechanism, injury site, fracture, soft tissue lesion, and duration of surgery. The significant factors ( P<0.1) were then analyzed by logistic regression, and P<0.05 was considered statistically significant. Results:Ischemia happened in 44 (31.4%, 44/140) extremities within 48 hours after surgery. There were significant differences in injury mechanism, ischemia time, fracture, and soft tissue lesion between patients with and without postoperative extremity ischemia ( P<0.05). Logistic regression analysis indicated that blunt injury ( OR=5.639, 95% CI: 1.068 to 29.761, P=0.042) and soft tissue lesion ( OR=12.568, 95% CI: 3.402 to 46.431, P<0.001) were significant preoperative risk factors affecting the early blood supply after repair of major extremity arterial injury. Conclusion:As blunt injury and soft tissue defect are preoperative risk factors for early extremity ischemia after repair of major extremity arterial injury, surgeons should pay more attention to them when assessing patients and making repair protocols.

Objective:For Bayne and Klug type Ⅲ radial longitudinal deficiency, the aim of the surgical methods is to create a centralized stable wrist and restore the length of the radius. The purpose of the current study was to validate the use of the staged procedures with vascularized proximal fibular epiphyseal transfer, based on a single vascular pedicle of the inferior lateral genicular artery to treat radius defects.Methods:Between June 2007 and June 2012, five children with an averaged age of 4.3 years (range, 3.3 to 5.8 years) who had a type Ⅲ radial longitudinal deficiency were identified. The staged procedures we performed for this patient consisted of: (1) soft tissue distraction of the wrist with an external distraction device to centralize the wrist and create a space for placement of the proximal fibular graft, ulnar osteotomy, and internal fixation to correct the bowing deformity of the ulna if necessary; (2) vascularized proximal fibular epiphysis transferred to repair the radius defect and to reconstruct the wrist; and (3) pollicization or thumb reconstruction to treat thumb deficiency. In all patients, the range of motion of the digits, wrist, forearm, and elbow; the length of the forearm; and the deviation of the wrist were evaluated.Results:The averaged duration of follow-up was 52.6 months (range, 42 to 72 months). All transplants survived and united with the host bone within 3 months postoperatively. An averaged correction of 28 degrees in the hand-forearm angle was obtained. At the final follow-up, the average ulna and radius lengths were 14.4 cm and 12.1 cm, respectively; the percentage length compared with the normal side was 64.0 and 56.3 percent, respectively. The overall range of wrist motion was approximately 56 percent of that of the contralateral extremity. The averaged pronation and supination were 75 and 45 percent of the normal side, respectively. The overall range of elbow motion was similar to the normal side.Conclusions:The results of the present study indicated that vascularized proximal fibular epiphyseal transfer, based on the inferior lateral genicular artery, is a technically feasible method for treatment of Bayne and Klug type Ⅲ deficiency, which restores the length of the radius and stabilized the wrist.

Objective:For Bayne and Klug type Ⅲ radial longitudinal deficiency, the aim of the surgical methods is to create a centralized stable wrist and restore the length of the radius. The purpose of the current study was to validate the use of the staged procedures with vascularized proximal fibular epiphyseal transfer, based on a single vascular pedicle of the inferior lateral genicular artery to treat radius defects.Methods:Between June 2007 and June 2012, five children with an averaged age of 4.3 years (range, 3.3 to 5.8 years) who had a type Ⅲ radial longitudinal deficiency were identified. The staged procedures we performed for this patient consisted of: (1) soft tissue distraction of the wrist with an external distraction device to centralize the wrist and create a space for placement of the proximal fibular graft, ulnar osteotomy, and internal fixation to correct the bowing deformity of the ulna if necessary; (2) vascularized proximal fibular epiphysis transferred to repair the radius defect and to reconstruct the wrist; and (3) pollicization or thumb reconstruction to treat thumb deficiency. In all patients, the range of motion of the digits, wrist, forearm, and elbow; the length of the forearm; and the deviation of the wrist were evaluated.Results:The averaged duration of follow-up was 52.6 months (range, 42 to 72 months). All transplants survived and united with the host bone within 3 months postoperatively. An averaged correction of 28 degrees in the hand-forearm angle was obtained. At the final follow-up, the average ulna and radius lengths were 14.4 cm and 12.1 cm, respectively; the percentage length compared with the normal side was 64.0 and 56.3 percent, respectively. The overall range of wrist motion was approximately 56 percent of that of the contralateral extremity. The averaged pronation and supination were 75 and 45 percent of the normal side, respectively. The overall range of elbow motion was similar to the normal side.Conclusions:The results of the present study indicated that vascularized proximal fibular epiphyseal transfer, based on the inferior lateral genicular artery, is a technically feasible method for treatment of Bayne and Klug type Ⅲ deficiency, which restores the length of the radius and stabilized the wrist.

Objective To explore the expression of cullin 4A (CUL4A) in cholangiocarcinoma tissues and its clinical significance.Methods Primary fresh cholangiocarcinoma tissues (n =35) and normal bile duct tissues (n =15) from patients who underwent curative surgery in Binzhou People's Hospital of Shandong Province from February 2011 to December 2013 were collected.The expressions of CUL4A mRNA were detected by quantitative real-time PCR (qRT-PCR).Then,cholangiocarcinoma tissues (n =72) and normal bile duct tissues (n =36) from patients who underwent curative surgery in Binzhou People's Hospital of Shandong Province from January 2008 to January 2014 were collected.The expressions of CUL4A protein were tested by immunohistochemistry.The relationships between the expression of CUL4A and the patients' clinicopathologic features and prognosis were analyzed.Results The expression of CUL4A mRNA in cholangiocarcinoma tissues was obviously higher than that in normal bile duct tissues (3.876 ±0.975 vs.1.216 ±0.265),and the difference was statistically significant (t =12.23,P ＜ 0.001).The positive rates of CUL4A protein in cholangiocarcinoma and normal bile duct tissues were 70.8％ (51/72) and 2.8％ (1/36) respectively,and the difference was statistically significant (x2 =44.524,P ＜ 0.001).The expression of CUL4A protein in cholangiocarcinoma was related to the differentiated degree (x2 =4.341,P =0.037),neural invasion (x2 =8.326,P =0.004),TNM stage (x2 =7.745,P =0.005),lymph node metastasis (x2 =3.869,P =0.049) and vascular invasion (x2 =5.555,P =0.018).Survival analysis results showed that the median survival time of CUL4A positive patients was significantly shorter than that of CUL4A negative patients (32.40 months vs.51.30 months),and the difference was statistically significant (x2 =6.561,P =0.011).Conclusion The expression of CUL4A in cholangiocarcinoma tissues is higher than that in normal bile tissues.CUL4A plays an important role in the process of tumor invasion and metastasis and indicates poor prognosis,which may become a potential target for the diagnosis and therapy of the cholangiocarcinoma.

Objective To investigate the expression pattern of skeletal muscle specific miR-206,myogenesis related myoD which change with time in dcnervated muscle atrophy rats.Methods From June,2015 to January,2016,40 SPF sprague-dawley rats were equally classified into 5 groups randomly according to standard settled before,5 groups were separately defined as denervated 0d group,denervated 1d group,denervated 7d group,denervated 14d group,and denervated 28d group.Each group contained 8 rats.The rats atrophy models were established by cutting sciatic never on left side.According to the different denervated time,the gastrocnemii on both sides were obtained under anesthesia,respectively.The wet weight ratio of two compared gastrocnemii were measured,and the gastrocnemii transection was observed by HE stain,measured the expression of myoD protein by western blot,obtained the expression of miR-206,myoD mRNA by qPCR.Results According to our study on rats denervated atrophy models,the wet ratio of compared gastrocnemius would decrease rapidly,by HE stain,decease of cross sectional area in muscle fiber was observed as well as degeneration.Collagen fibers hyperplasia appeared and increased with time change.Wet ratio and transaction aera ratio of group Od,1d,7d,14d,28d were 0.99±0.04,0.92±0.07,0.68±0.11,0.39±0.06,0.27±0.07 and 0.99±0.02,0.96±0.04,0.51±0.09,0.34±0.08,0.23±０.03 respectively,difference between experimental groups and control group were statistically significant (P＜ 0.05),the differences between each experimental groups were also statistically significant (P＜ 0.05).After qPCR test of miR-206,myoD mRNA expression,it was found that their expression patterns were similar,miR-206,myoD mRNA increased at first and would reach the expression peak at the 7 th day,after that their contents decreased but still higher at the 14th day when compared with that at the 1 st day.Their expression of group 0d,1 d,7d,14d,28d were 0.24±0.06,0.34±0.04,0.68±0.04,0.49± 0.07,0.25±0.03 and 0.41 ±0.06,0.49±0.09,0.93±0.06,0.66±0.03,0.39±0.04,respectively.All experimental groups were statistically significant different when compared with 0d group except 1d group (P＜ 0.05),the differences between each experimental groups were also statistically significant(P＜ 0.05).The protein expression of myoD was also measured by western blot test,which showed nearly the same expression pattern as the mRNA expression pattern.After injury,the protein expression increased and reached the expression peak at the 7th day.The relative expression of myoD of group 0d,1d,7d,14d,28d measured by grey ratio were 1.03±0.05,1.06±0.06,1.42±0.10,0.66±0.13,0.24±0.07,respectively.The difference between experimental groups and control group were statistically significant (P ＜ 0.05),the differences between each experimental groups were statistically significant (P ＜ 0.05) as well.Conclusion The degree of muscle denervation atrophy was related to the denervated duration in rats.The expression regulation of miR-206 and myoD in gastrocnemius was similar during the muscle denervation atrophy,which suggesting having internal relationship between miR-206 and myoD.

Objective To evaluate the feasibility and safety of thoracoscopic lung cancer surgery under non-tracheal intubation anesthesia. Methods Twenty patients with peripheral lung cancer were enrolled in experimental group and control group. Then monitored and recorded Systolic pressure (SBP), diastolic pressure (DBP), mean arterial pressure (MAP), heart rate (HR), electrocardiogram (ECG), heart rate (HR), Oxygen saturation (SpO2), Final moisture CO2 partial pressure (PETCO2), central venous pressure, invasive arterial blood pressure and blood glucose and the related complications like sore throat, hoarse voice, nausea and so onin such time points: before induction (T0), induction of intubation (T1), operation (T2), and sudden removal (T3) of the two groups. Results The laryngeal mask group was given a smaller stimulus to the cardiovascular system during anesthesia.The time of feeding, the exhaust, the time of getting out of bed, the average hospitalization day, the reduction of hospitalization expenses, pharynx, respiratory and cardiovascular complications were shorter and less than intubation group. Conclusion The laryngeal mask ventilation intravenous anesthesia with thoracic vagal nerve block in the thoracoscopic lobectomy is simple, safe, no intubation-related complications and single lung ventilation lung injury, in line with surgery -anesthesia overall minimally invasive development concept, worthy of clinical promotion.