Compared to traditional suturing, lung stapling using automatic staplers offers advantages such as smaller trauma, faster wound healing, ease of operation, and lower complication rates, making it widely used in clinical practice. However, there are significant differences in bronchial tissue thickness at different anatomical locations, and the market is flooded with various types of staplers. Currently, there is a lack of recommended stapling schemes for bronchial staplers at different anatomical locations. This article reviews the development and application of automatic staplers and summarizes some types of staplers that are currently used in clinical practice, with the aim of promoting the formation of individualized stapler selection protocols for minimally invasive thoracic surgery based on the Chinese population.

Objective:To explore the effect of continuous nursing on the psychology and quality of life of patients with mild traumatic brain injury.Methods:A review of 120 patients with mild traumatic brain injury who were hospitalized in the Second Affiliated Hospital of Wenzhou Medical University from January 2016 to December 2019 were selected. According to the order of admission, sample numbers were drawn from the random number list and entered into groups. There were 60 cases in the control group and the intervention group. The control group received routine general nursing, and the intervention group received continuous nursing. The Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), and Quality of Life Scale (SF-36) were used to evaluate the psychology and quality of life of patients on the day of discharge and one week, one month, and three months after discharge.Results:There was no significant difference in the scores of HAMA, HAMD and SF-36 between the two groups on the day of discharge ( P>0.05). The HAMA scores at 1 week, 1 month and 3 months after the intervention of the intervention group were (18.2±8.6), (13.7±5.8) and (5.6±2.3), which were significantly lower than those of the control group (24.2±11.2), (20.4±8.2), (8.9±3.6), the differences were statistically significant ( t values were 2.32, 3.67, 4.13, P<0.05). The HAMD scores at 1 week, 1 month and 3 months after the intervention of the intervention group were (24.3±7.1), (10.9±4.2), (6.8±2.9), which were significantly lower than those of the control group (28.6±8.5), (15.3±8.3), (14.8±4.6), the differences were statistically significant ( t values were 2.11, 2.57, 7.99, P<0.05). The SF-36 scores at 1 week, 1 month and 3 months after the intervention of the intervention group were (77.2±8.9), (85.2±9.7), (87.8±12.9), which were significantly higher than those of the control group (72.3±8.2), (79.4±10.9), (81.0±11.5), the differences were statistically significant ( t values were -2.23, -2.14, -2.13, P<0.05). Conclusions:Continuing care can be extended to the patient's family, so that the health problems faced by the patient after discharge from the hospital can be effectively solved, relieve psychological pressure and improve the quality of life, and it is worthy of clinical application.

Objective To investigate the effect of piR-9994 on the biological behavior of gastric cancer cells and its possible mechanism. Methods The expression of piR-9994 in gastric cancer cell lines (MGC803 and AGS) and normal gastric epithelial cells (GES-1) were detected by qRT-PCR. MGC803 cell line with piR-9994 overexpression and knockdown were constructed. The effects of piR-9994 expression changes on cell proliferation were detected by MTT and clone formation assay. The scratch wound healing assay and Transwell invasion assay were used to detect cell migration and invasion abilities. qRT-PCR and Western blot were used to detect cell proliferation and EMT-related genes expression. Results The expression level of piR-9994 in MGC803 cells was significantly higher than that in normal gastric epithelial cell line GES-1 (P < 0.05). The overexpression of piR-9994 promoted the proliferation, invasion and metastasis of gastric cancer cells, while piR-9994 knockdown had the opposite effect. piR-9994 expression was closely related to cell cycle, especially in S phase. The overexpression of piR-9994 promoted the expression of proliferation-related genes PCNA, CCND1 and Bcl-2, inhibited the expression of apoptosis gene C-PARP, and promoted the expression of EMT-related genes N-cadherin, MMP7, Twist and Vimentin; while piR-9994 knockdown had the opposite effect. Conclusion Abnormal expression of piR-9994 affects the proliferation, invasion, metastasis and EMT process of gastric cancer cells. piR-9994 may be a new biomarker and therapeutic target for gastric cancer.

Cell-Free Nucleic Acids ; blood ; Female ; Humans ; Mosaicism ; Placenta ; Pregnancy

OBJECTIVE: To explore the cause for the failure of non-invasive prenatal testing (NIPT) and feasibility of repeated testing. METHODS: Clinical data, test results and pregnancy outcomes of 40 311 pregnant women who received NIPT test from January 2011 to December 2018 were reviewed. RESULTS: Among all the pregnant women, 1116 cases failed in the first test, 9 cases (0.81%) had fetal free DNA concentration lower than 4%, 663 cases (59.41%) were retested after the establishment of Z value gray area, and the remainder 444 cases (39.78%) needed to be retested after the blood collection due to the fetal free DNA concentration lower than 4%. After retesting, 1069 cases (95.78%) obtained effective NIPT results. The results showed that 53 cases were at high risk (6 cases for trisomy 21, 6 cases for trisomy 18, 13 cases for trisomy 13, 16 cases for sex chromosomal abnormality, 12 cases for chromosomal copy number variation). Forty-eight cases were selected for invasive prenatal diagnosis, and 2 cases of 47, XXY and 2 CNV were confirmed. A total of 47 cases (0.12%) did not obtain results because the concentration of fetal free DNA was lower than 4%. Only 16 cases (34%) chose invasive prenatal diagnosis. CONCLUSION Repeated detection of the gray area of Z value can reduce the false positive rate of NIPT and invasive prenatal diagnosis, and the feasibility of repeated detection is high. In the case of fetal free DNA concentration lower than 4%, the success rate of obtaining effective NIPT results by re-sampling and re-detection increases with the increase of gestational age, but may delay the diagnosis for fetal aneuploidies. Therefore, personalized estimation should be made according to gestational age and clinical indications. It is suggested that pregnant women should choose invasive prenatal diagnosis when they have failed in the retest.

Objective: To investigate the use of conventional MR imaging to guide treatment in patients with cholecystolithiasis and diffuse inflammatory thickening of gallbladder wall. Methods: The clinical data of patients who were treated in the Ningbo Huamei Hospital, University of the Chinese Academy of Sciences between January 2017 and January 2018 were analyzed. These patients were divided into two groups: patients with acute cholecystitis (n=139) and patients with viral hepatitis combined with cholecystolithiasis (n=67). Differences in the imaging signs in standardized upper abdominal contrast enhanced MRI examinations were retrospectively analyzed. Results: The imaging signs, including stone location, continuity of gallbladder mucosa, exudation in peri-gallbladder space, edema of intrahepatic portal area showed significant differences between the two groups (all P<0.05). On stratification analysis, the type of thickened gallbladder wall, background of liver parenchyma and extent of edema in intrahepatic catchment area also showed significant differences (all P<0.05). The imaging signs, including non-gallbladder neck ductal stones, concentric thickening of gallbladder wall, continuous mucous membrane in gallbladder and no peri-gallbladder space exudation but diffuse edema of intrahepatic catchment area supported the diagnosis of viral hepatitis combined with gallstones. The imaging signs, including discontinuity of gallbladder mucosa, exudation of peri-gallbladder space, diffuse edema of gallbladder wall without a cirrhotic background and edema in intrahepatic portal area supported the diagnosis of acute calculous cholecystitis of gallbladder. Conclusions Routine upper abdominal contrast enhanced MRI plays an important role in demonstrating the underlying cause of gallbladder wall diffuse edema thickening in patients with gallstones. It provides an important reference for the choice of clinical treatment pathway.

Objective: To evaluate the role of endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) in lymph node staging and resectability assessment of patients with non-small cell lung cancer (NSCLC). Methods: The clinical data of 154 patients with NSCLC who underwent EBUS-TBNA from March 2015 to December 2018 were collected. All accessible mediastinal and hilar lymph nodes were systematically explored and punctured using EBUS-TBNA. EBUS-TBNA and CT were used for preoperative staging and resectability evaluation. Results: The sensitivity, specificity and accuracy of EBUS-TBNA were 94.2%, 100.0% and 96.0%, respectively, while those of CT were 89.9%, 31.8% and 72.0%, respectively. The differences were statistically significant (P<0.05). The sensitivity, specificity and accuracy of EBUS-TBNA in lymph nodes with short diameter less than 15 mm were 92.4%, 100.0% and 96.0%, respectively, while those of CT were 80.7%, 34.8% and 60.1%, respectively, with statistical differences (P<0.05). The staging of 62 patients was changed, 27 cases were up-regulated and 35 cases were down-regulated. Among them, 32 cases had been changed to resectable. The evaluating resectability of EBUS-TBNA showed excellent consistency with that of pathological results (Kappa=0.95). The sensitivity and specificity were 100.0% and 97.2%, respectively. Conclusion EBUS-TBNA can systemically evaluate the metastatic status of NSCLC patients and improve the accuracy of preoperative lymph node staging and resectability assessment.

Objective: To analyze the distribution of HCV genotype in eastern Zhejiang Province and its correlation with sex, age, viral load, antiviral effect and so on. Methods: A total of 501 cases of HCV infection seen in Ningbo No. 2 hospital from January 2011 to April 2018 were included. The HCV genotypes and HCV RNA were detected by gene chip method and RT-PCR respectively. The liver function and blood routine tests were performed and the APRI index was calculated. The factors affecting the SVR were analyzed for the patients who were partially treated with pegylated interferon and ribavirin (PR). Results: The HCV genotypes of 501 cases were 1b、6、2a、3a、3b、1a from the higher to lower ranks, and genotype 1b was more than 50%.The distribution of HCV genotypes in different age groups was significantly different (χ²=95.433, P<0.001). The age of patients with 1a, 1b and 2 A was significantly higher than that of 3a, 3b, and type 6 (F=11.879, P<0.001). There were significant differences in viral load, AST, PLT and APRI index among different genotypes (F=2.920, χ²=12.400, F=6.294, χ²=12.700, all P<0.013), but ALT had little difference (χ²=7.994, P>0.157); 179 patients with PR standard regimen were followed up. The result showed that there was no significant difference in the overall efficacy of different genotypes (χ²=6.598, P=0.252), but the rate of sustained virological response in type 3 A was significantly higher than that of the 1b type (χ²=4.193, P=0.041). Conclusions The HCV genotypes are mainly 1b and 6 in eastern Zhejiang Province. There were significant differences in age, viral load, AST, PLT and APRI indices among patients with different HCV genotypes, and the therapeutic effect of PR regimen was better for genotype 1b than that of 3a.

Objective: To investigate the protective effects of matrine combined with glycyrrhizic acid on chronic liver injury induced by carbon tetrachloride, and explore the protective mechanism from the points of energy metabolism and CYP enzyme.Methods: The chronic hepatic injury model of rats was induced by CCl4.The changes of activity of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in serum were measured to observe the protective effect of the two drugs and their combination.The contents of glutamate dehydrogenase (GLDH) in serum and adenine nucleoside three phosphate (ATP), adenosine diphosphate (ADP) and adenine monophosphate (AMP) in liver tissue were determined to evaluate the regulation effect on hepatic energy metabolism and mitochondrial function.The levels of CYP1A2, CYP2E1 mRNA and protein in liver tissue were detected by real-time PCR and Western Blot to evaluate the two drugs and their combination on the regulation function of liver CYP enzyme.Results: Matrine (72.8 mg×kg-1)and glycyrrhizic acid(43.4 mg·kg-1)could decrease the serum activities of ALT and ALT in chronic hepatic injury model, and the combination (matrine 36.4 mg·kg-1+glycyrrhizic acid 21.7 mg·kg-1) had the most significant protective effect (P＜0.05).Matrine (72.8 mg·kg-1)and glycyrrhizic acid(43.4 mg·kg-1)could decrease GLDH in serum,and restore the content of ATP in liver (P＜0.05).Matrine (72.8 mg·kg-1) had no effect on the expression of CYP1A2 and CYP2E1mRNA, and glycyrrhizin (43.4 mg·kg-1) could inhibit the expression of CYP1A2, CYP2E1mRNA and protein (P＜0.05).Conclusion: Matrine combined with glycyrrhizin has obvious regulation effect on mitochondrial function and liver protective effect in chronic hepatic injury model.

Objective To explore the diagnostic value of contrast-enhanced ultrasound (CEUS) in detecting small liver metastasis (SLM) from breast cancer. Methods A total of 92 cases diagnosed as breast cancer by surgical pathology and suspected SLM by conventional ultrasonography were included in this study. CEUS was used to check liver lesion in patients. The biopsy operation was used as the gold standard. The coincidence rate of benign and malignant pathology was used to compare the consistency between CEUS and biopsy pathology. Results In 92 cases suspected liver metastases of breast cancer by routine ultrasound, there were 54 cases were diagnosed as benign by pathology, and all 92 cases were diagnosed as benign by CEUS. Thirty-eight cases were diagnosed as metastasis by pathology, in which 36 cases were correctly diagnosed by CEUS. The sensitivity of CEUS for the diagnosis of liver metastases of breast cancer was 94.74%(36/38), specificity was 100%(54/54), positive predictive value (PPV) was 100%(36/36) and negative predictive value (NPV) was 96.43%(54/56). Conclusion CEUS has a higher diagnostic value in SLM of breast cancer, and has clinical practical value.