Objective To evaluate the therapeutic efficacy of stenting combined with medication versus medication alone in treating severe extracranial carotid artery stenosis.Methods This prospective,multicenter cohort study enrolled 337 patients with carotid artery stenosis ranging from 70%to 99%.Based on patient preference,they were divided into two groups:a stent combined with medication group(antiplatelet drugs+statins,n=169)and a medication-only group(n=168).The study assessed perioperative safety and the incidence of recurrent cerebrovascular events related to the target vessel within one year.Results The success rate of the stent combined with medication group was 100%.There was one case of hyperperfusion-related intracranial hemorrhage during the perioperative period(1/169)The patient recovered well after medical treatment.There was no statistically significant difference in perioperative complications between the two groups(P=0.318).During the 1-year follow-up,the stent combined with medication group(3/169)had a significantly lower incidence of recurrent ischemic stroke compared to the medication-only group(15/168),with a statistically significant difference(P=0.003).Univariate analysis showed that gender(χ2=4.372,P=0.037),stenosis rate≥85%(χ2=10.738,P=0.001),and non-stent treatment(χ2=7.171,P=0.007)were risk factors for recurrent stroke.However,the number of recurrent ischemic strokes in females was relatively small and after adjusting the chi-square test,the difference was not statistically significant(P=0.075).Logistic regression analysis revealed that stenosis rate≥85%(OR=115.925,95%CI:2.077-122.102,P=0.008)and non-stent treatment(OR=0.158,95%CI:0.044-0.564,P=0.004)were independent risk factors for recurrent cerebrovascular events within one year.Conclusions In patients with≥85%extracranial carotid artery stenosis,stenting combined with medication reduces recurrent ischemic cerebrovascular events within 1 year.

Objective To evaluate the therapeutic efficacy of stenting combined with medication versus medication alone in treating severe extracranial carotid artery stenosis.Methods This prospective,multicenter cohort study enrolled 337 patients with carotid artery stenosis ranging from 70%to 99%.Based on patient preference,they were divided into two groups:a stent combined with medication group(antiplatelet drugs+statins,n=169)and a medication-only group(n=168).The study assessed perioperative safety and the incidence of recurrent cerebrovascular events related to the target vessel within one year.Results The success rate of the stent combined with medication group was 100%.There was one case of hyperperfusion-related intracranial hemorrhage during the perioperative period(1/169)The patient recovered well after medical treatment.There was no statistically significant difference in perioperative complications between the two groups(P=0.318).During the 1-year follow-up,the stent combined with medication group(3/169)had a significantly lower incidence of recurrent ischemic stroke compared to the medication-only group(15/168),with a statistically significant difference(P=0.003).Univariate analysis showed that gender(χ2=4.372,P=0.037),stenosis rate≥85%(χ2=10.738,P=0.001),and non-stent treatment(χ2=7.171,P=0.007)were risk factors for recurrent stroke.However,the number of recurrent ischemic strokes in females was relatively small and after adjusting the chi-square test,the difference was not statistically significant(P=0.075).Logistic regression analysis revealed that stenosis rate≥85%(OR=115.925,95%CI:2.077-122.102,P=0.008)and non-stent treatment(OR=0.158,95%CI:0.044-0.564,P=0.004)were independent risk factors for recurrent cerebrovascular events within one year.Conclusions In patients with≥85%extracranial carotid artery stenosis,stenting combined with medication reduces recurrent ischemic cerebrovascular events within 1 year.

Objective     To compare the short-term efficacy and long-term survival of patients with non-small cell lung cancer (NSCLC) treated by uniportal or three portal thoracoscopic radical resection. Methods     A total of 388 patients who underwent uniportal or three portal thoracoscopic radical resection of lung cancer in the Department of Thoracic Surgery of Anhui Chest Hospital from 2015 to 2016 were analyzed retrospectively. The patients were divided into two groups including an uniportal group and a three portal group according to the procedure. The clinicopathological features, perioperative data and long-term survival of the two groups were compared. Results     Finally, we included 205 patients with 105 males and 100 females at an average age of 58.73±10.93 years. There were 102 patients in the uniportal group and 103 patients in the three portal group. There was no statistical difference in clinicopathological features between the two groups (P>0.05). But compared with the three portal group, the uniportal group had less postoperative drainage, shorter postoperative catheterization time and postoperative hospital stay (P<0.05). There was no statistical difference in the number of lymph node dissection stations between the two groups (P=0.058). The pain score at 24 hours after operation in the uniportal group was significantly lower than that in the three portal group (P<0.001). There was no  statistical difference in the total incidence of complications and the incidence of pulmonary complications between the two groups (P=0.161 and P=0.275). The median survival period and the 1st, 3rd, and 5th year survival rate in the uniportal group was 63.0 months and 95.0%, 75.2%, 51.5%, respectively. The median survival period and the 1st, 3rd, and 5th year survival rate in the three portal group was 61.0 months and 89.3%, 70.9%, 50.5%, respectively. There was no satistical difference in the survival results between the two groups (P=0.440). Conclusion     Uniportal thoracoscopic radical resection of lung cancer is more minimally invasive and safe and effective in the treatment of NSCLC. It can make patients recover faster after operation.

Objective:The risk factors for hepatocellular carcinoma (HCC) in hepatitis B virus (HBV)-positive cirrhosis patients were screened based on commonly used laboratory indexes for the purpose of establishing a predictive model and the prediction efficacy of established model was validated in a validation patient cohort.Methods:The clinical data of 661 male patients with HBV-positive cirrhosis (cirrhosis group) and 694 male patients with HBV-positive HCC admitted to the First Hospital of China Medical University from 2010 to 2020 were retrospectively analyzed, age and complete blood count,liver function index (aspartate transaminase/alanine transaminase,glutamine transpeptidase,total protein, prealbumin, total bile acid, total bilirubin,direct bilirubin,cholinesterase), HBV markers, alpha-fetoprotein (AFP), fibrinogen,calcium were compared between the two groups. Multivariate Logistic regression was used to analyze the independent risk factors of HCC. The prediction model of high risk HCC ( P<0.05) was constructed and validated by receiver operating characteristic (ROC) curve and calibration curve. Results:There was significant difference in complete blood count, liver function index, HBV core antibody, HBV core antibody IgM, alpha-fetoprotein, fibrinogen, calcium between the two groups ( P<0.05). Multivariate analysis showed that calcium ( OR=35.770,95% CI 13.39-99.304),HBV core antibody ( OR=0.878,95% CI 0.816-0.944), AFP ( OR=1.002, 95% CI 1.001-1.003), fibrinogen ( OR=1.369, 95% CI 1.202-1.564) were the independent risk factors for HCC ( P<0.05), and were used for the nomogram. The AUC of the nomogram was 0.750 (95% CI 0.720-0.781) and the AUC of the validation group was 0.752 (95% CI 0.705-0.798). Conclusions:Based on calcium, hepatitis B virus core antibody, AFP, fibrinogen, a nomogram of the HCC is established and verified by ROC curve, which could be used to predict the risk of HBV-positive HCC.

Objective:The aim of our study was to compare the short-term and long-term outcomes between minimally invaisive Ivor-Lewis esophagectomy(MIILE)and minimally invasive McKeown esophagectomy(MIME) for squamous cell carcinoma of middle and lower esophagus.Methods:The data of 268 patients diagnosed with middle and lower esophageal spuamous cell carcinoma who had received MIILE or MIME between August 2010 and March 2014 at department of thoracic surgery, The First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital), was analyzed retrospectively. We divided the subjects into two groups according to the mode of the operation, each group was identified 81 patients after propensity score matching. We were using t test, χ2 test, Kaplan- Meier curve and Log- rank test to compare preoperative data and overall survival of the two groups. Results:Compared with MIME, MIILE had lower complication in pulmonary infection and anastomotic fistula, also had less operating time, whereas MIME had an advantage in the number of lymph nodes dissection adjacent to recurrent laryngeal nerve( P<0.05). The 1-year、3-year、5-year survival rate of MIILE were 87.7%、59.2%、45.9%, and the 1-year、3-year、5-year survival rate of MIME were 86.4%、58.7%、42.8%.There were no significant difference between two groups in 5-year survival rate. Conclusion:For squamous cell carcinoma of middle and lower esophagus, minimally invasive Ivor-Lewis esophagectomy and minimally invasive McKeown have no significant difference in long-term survival, but minimally invasive Ivor-Lewis esophagectomy has advantages in reduce the operating time, decrease pulmonary infection and anastomotic fistula during perioperative period.Nevertheless minimally invasive McKeown has an advantage in dissection of the lymph nodes adjacent to recurrent laryngeal nerve.

Objective The aim of this study was to investigate the effect of microinjection ibudilast on the appendix pain threshold in nucleus accumbens(NAC)of morphine-addicted rats. Methods Normal rats and morphine-addicted rats were injec-ted with ibudilast(5 μg/2 μL)or saline(2 μL)into NAC through glass microelectrode. The tail-flick period(TFL)was used as an in-dicator to observe the thermal pain threshold before and after ibuilast injection. Results After injected ibudilast 5 μg into the NAC of normal rats and morphine-added rats,the TFL was prolonged compared with that before injection,and the TFL prolongation of mor-phine-addicted rats was more significant than that of normal rats. There was no significant change in TFL after 2 μL of saline was in-jected into the NAC of normal rats and morphine-addicted rats. Conclusion Microinjection of ibudilast into NAC of normal rats and morphine-added rats can cause analgesic effect,and the analgesic effect of morphine-addicted rats is more significant.

Objective: To analyze the learning curve of uniportal video-assisted thoracoscopic surgery (VATS) lobectomy for the treatment of resectable lung cancer. Methods: The clinical data of 160 patients with resectable lung cancer who underwent uniportal VATS lobectomy by a single surgical team between May 2016 and April 2017 at Department of Thoracic Surgery, the First Affiliated Hospital of the University of Science and Technology of China were analyzed retrospectively. The study group consisted of 90 male and 70 female patients with age of 28 to 84 years (median: 62 years). The patients were divided into four groups from group A to D according to chronological order. The operation time, incision length, intraoperative blood loss, number of dissected lymph nodes and nodal stations, the proportion of changes in operation mode, postoperative complications, chest drainage duration and hospitalization time were individually compared among the four groups by variance analysis and χ² test. Results: The 4 groups were similar in terms of incision length, chest drainage duration, number of dissected lymph nodes and nodal stations and postoperative hospitalization time (P>0.05). The difference of the operation time ((185.9±17.9) minutes vs. (139.9±10.7) minutes vs.(128.7±7.8) minutes vs.(124.0±9.3) minutes, F=219.605, P=0.000), intraoperative blood loss ((233.9±135.8) ml vs. (126.8±18.1) ml vs. (116.4±22.6) ml vs.(112.8±25.3) ml, F=26.942, P=0.000), the proportion of changes in operation mode (17.5% vs.7.5% vs. 5.0% vs. 5.0%, χ²=8.300, P=0.040), and the incidence of postoperative complications (27.5% vs. 10.0% vs. 10.0% vs. 7.5%, χ²=8.643, P=0.034) among the 4 groups was statistically significant. Conclusions Uniportal VATS lobectomy can be safely and feasibly performed for resectable lung cancer, learning curve for uniportal VATS lobectomy is approximately 40 cases. Operation time, intraoperative blood loss, postoperative complications and the proportion of changes in operation mode can be used as the main measures during surgery.

Objective: To evaluate the effect of the postoperative short-term quality of life between uniportal and three portal video-assisted thoracic surgery for radical lung cancer resection. Methods: The perioperative data and short-term quality of life of 120 patients received uniportal and three portal video-assisted thoracic surgery for radical lung cancer resection were analyzed from September to November 2017 at Department of Thoracic Surgery, the First Affiliated Hospital of University of Science and Technology of China. There were 64 male and 56 female patients aging of (62±10) years (ranging from 28 to 82 years). There were 60 cases received uniportal (uniportal group) and 60 cases received three portal video-assisted thoracic surgery (three-portal group). Quality of life by measurement of functional and symptom scales was assessed before surgery at baseline, and 1, 2, 4, and 8 weeks after the operation. The t test, χ² test, Fisher exact test and Wilcoxon rank-sum test were used to compare the date between the 2 groups. Repeated measurement variance was used for comparison of the quality of life at different time points. Results: There were no statistically significant differences in the clinicopathological features of the two groups (P>0.05). Intraoperative bleeding volume ((92±85) ml vs. (131±91) ml, t=2.387, P=0.019), postoperative catheter time ((4.4±3.1) days vs. (6.0±3.9) days, t=2.401, P=0.018), and postoperative hospitalization time ((6.2±4.0) days vs. (8.3±4.6) days, t=2.626, P=0.010) in the patients with uniportal group were less than that in three-portal group. Preoperative functional areas, symptom areas and overall health scores were similar in the two group. The functional areas such as physical function, role function, emotional function and social function and overall health status of uniportal group were significantly higher than those of three-portal group in postoperative time, while the fatigue and pain of uniportal group were significantly lower than that of three-portal group. Conclusions Uniportal video-assisted thoracic surgery can achieve the same safety and radical of three-portal video-assisted thoracic surgery. It has advantages in intraoperative bleeding volume, postoperative time after operation, hospitalization time and postoperative life quality.

Objective To observe the impact of minimally invasive Sweet esophagectomy on short term quality of life for patients with Siewert typeⅡesophagogastric junction adenocarcinoma.Methods From January 2015 to September 2017, 60 patients underwent minimally invasive Sweet esophagectomy(MISE group) and 60 patients underwent open sweet esophagecto-my(OSE group).The questionnaires(EORTC QLQ-C30 and QLQ-OES18) were applied to assess the quality of life of the pa-tients before and 1,2,4,8 weeks after operation.The clinicopathologic factors, operational factors and postoperative complica-tions of the two groups were compared by t test and χ2test.The Mann-Whitney test was used to test for statistical significance because the responses were not normally distributed.Results The two groups were similar in terms of clinical characteristics and preoperative QOL scores(P ＞0.05).The MISE group was associated with a significant decrease in surgical blood loss [(88.1 ±32.2)ml vs.(119.5 ±34.1)ml, t＝5.052, P＝0.001], chest tube duration[(8.1 ±4.4)d vs.(10.5 ±4.0)d, t＝3.110, P＝0.002] and postoperative stay[(9.1 ±4.6)d vs.(11.6 ±3.8)d, t＝3.167, P＝0.002] relative to the OSE group.The postoperative in-hospital mortality and total morbidity did not differ between the two groups (P＞0.05).The MISE group was associated with significantly fewer respiratory complications than the OSE group (8.5%vs.22.7%, t＝4.063, P＝ 0.044).The MISE group was associated with a significant increase in hospitalization costs [(54 106 ±4 352) yuan vs. (51 143 ±5 315)yuan, P＝0.001] relative to the OSE group.MISE group gained higher scores in physical function, role func-tion, emotional function, Global QOL and lower scores in pain, fatigue, acid reflux than OSE group after surgery.Conclusion Our minimally invasive technique for Siewert typeⅡesophagogastric junction adenocarcinoma can be safely and effectively performed with favorable early outcomes.Compared to conventional open Sweet approach, MISE impoved the short term quality of life after surgery.

Objective To discribe the technique for uniportal video-assisted thoracoscopic pneumonectomy and lymphadenectomy,and to evaluate the feasibility,safety and the short-term clinical outcomes of this approach.Methods The clinical data of 283 patients with resectable non-small cell lung cancer who received uniportal or three-port video-assisted thoracoscopic pneumonectomy between January 2015 and December 2016 was analyzed retrospectively.Of those 283 patients,151 underwent uniportal video-assisted thoracoscopic pneumonectomy and 132 underwent three-port video-assisted thoracoscopic pneumonectomy.The clinicopathologic factors,operatinal factors,postoperative complications,the number of total lymph nodes dissected or the stations of the total lymph nodes dissected,and conversive rate of the two groups were compared by t test and x2 test.Results The two groups were similar in terms of clinicopathologic data,postoperative complications,length of opertion and conversive rate(P ＞ 0.05).The approach of uniportal video-assisted thoracoscopic pneumonectomy was associated with a significant decrease in surgical blood loss [(126.12 ± 212.13) ml vs.(178.61 ± 173.17) ml,P =0.02],volume of 3 days of post operative chest drainage [(505.25 ± 109.60) ml vs.(566.67 ± 233.35) ml,P =0.004],chest tube duration [(4.31 ±3.12)dvs.(6.93 ±3.10)d,P＜0.001] and postoperative stay [(5.49 ± 4.77) d vs.(7.23±4.24)d,P=0.001].There was no significant difference between the two groups in the number of total lymph nodes dissected or the stations of the total lymph nodes dissected (P ＞ 0.05).The stations of 4L and 5-13 in left lymphadenectomy and the stations of 2 R,3,4R and 7-13 in the right lymphadenectomy did not differ between the two groups(P ＞ 0.05).Conclusion Our uniportal video-assisted thoracoscopic pneumonectomy can be safety and effectively performed for resectabte non-small cell lung cance with favorable early outcomes.