Multidrug resistant organism refers to bacteria that are insensitive to three or more antibiotics commonly used in clinic, including Pseudomonas aeruginosa, Acinetobacter Baumannii and Klebsiella pneumoniae, etc. MDRO infection is a major factor affecting the survival rate after lung transplantation (LTx), accounting for 30% of the causes of death in the first year after transplantation. Antibiotic treatment has low specificity and is prone to drug resistance. The development of new drugs has a long cycle and high cost, with significant limitations. Phage has high specificity for bacteria, which can proliferate in large quantities in the infected lesion and co-evolve with bacteria during the action process. Phage also have a good killing effect on MDRO, which is expected to make up for the deficiencies of existing antibiotic therapy. This article reviews the development background and mechanism of action of phage therapy, and summarizes its application status and early clinical trial results in the field of LTx, in order to providing new thinking paths for clinical work.

Diagnosis and treatment of refractory hydrocephalus are the keys in reflecting the overall level of diagnosis and treatment of hydrocephalus. However, there is currently no clear definition of refractory hydrocephalus; moreover, treatment of these patients is difficult, with high failure rate. This article focuses on the definition, common causes and classification of refractory hydrocephalus, the treatment strategies of infectious refractory hydrocephalus, the treatment dilemmas of negative pressure or low-pressure hydrocephalus, and treatment future directions of refractory hydrocephalus, in order to attract attention of clinicians to the diagnosis and treatment of refractory hydrocephalus.

Diagnosis and treatment of refractory hydrocephalus are the keys in reflecting the overall level of diagnosis and treatment of hydrocephalus. However, there is currently no clear definition of refractory hydrocephalus; moreover, treatment of these patients is difficult, with high failure rate. This article focuses on the definition, common causes and classification of refractory hydrocephalus, the treatment strategies of infectious refractory hydrocephalus, the treatment dilemmas of negative pressure or low-pressure hydrocephalus, and treatment future directions of refractory hydrocephalus, in order to attract attention of clinicians to the diagnosis and treatment of refractory hydrocephalus.

Objective:To evaluate the clinical feasibility, safety, and advantages of small lateral cervical incision for parathyroid exploration and resection.Methods:A total of 31 consecutive patients who underwent parathyroidectomy with a small lateral cervical incision, in the Department of Endocrinology and Breast Surgery of the First Affiliated Hospital of Chongqing Medical University from Apr. to Nov. 2021, including 11 males and 20 females, aged (49.32±13.79) years, ranging from 28 to 86 years, were selected to make retrospective statistical analysis of the surgical time, hospital stay, intraoperative blood loss, postoperative drainage and postoperative complications of the patients. All patients were injected with carbon nanoparticles suspension injection guided by color ultrasound to locate the enlarged parathyroid gland before surgery. EXCEL 2019 software was used for statistical analysis.Results:Thirty-one patients underwent parathyroidectomy through a small lateral cervical incision. Primary hyperparathyroidism was performed in 19 cases (including 2 cases with bilateral small lateral cervical incision, 2 cases with unilateral excision of thyroid mass combined with parathyroidectomy, 1 case with resection of huge parathyroid adenoma, and 1 case with local anesthesia) . Twelve patients with secondary hyperparathyroidism underwent total parathyroidectomy through bilateral small lateral cervical incision and forearm autogenous parathyroid transplantation (including bilateral thyroid mass resection combined with bilateral total parathyroidectomy and forearm autogenous parathyroid transplantation in 2 cases, local anesthesia and cervical plexus nerve block in 2 cases, and ectopic parathyroid gland in thyroid in 1 case) . Among them, the average operative time of patients with primary hyperparathyroidism was (54.74±27.71 & 74.14±31.73) min, the average intraoperative blood loss was (8.11±5.05 & 14.43±10.94) ml, the average postoperative drainage was (14.37±24.64 & 26.36±32.87) ml, the average postoperative parathyroid hormone was (11.59±16.46 & 26.65±56.38) pg/ml, the average hospital stay was (10.00±5.09 & 10.96±4.55) d, and the postoperative complication rate was (3.2% & 0%) .Conclusions:Parathyroid gland exploration and resection through small lateral cervical incision is a safe and effective surgical method and can also complete thyroid exploration and parathyroidectomy at the same time. Appropriate anesthesia should be selected after a full assessment of the patient’s basic condition.

Objective:To figure out the structure and relevant data measurements of zygomatic ligament by cadaver anatomy and review of previous studies.Methods:From July 2018 to January 2020, the zygomatic areas of 20 Chinese frozen fresh cadaver hemifaces were dissected in the Department of Anatomy, Health Science Center of Hangzhou Normal University. Then the structures of zygomatic ligaments were shown. The characters of the ligament and the relationship with adjacent tissue were described and measured. And 16 previous studies were reviewed to get a comprehensive description about the characters of zygomatic ligaments.Results:Zygomatic ligaments were even and dense fibrous tissue structures distributed vertically between the skin and the subcutaneous tissue. Under the SMAS plane, the ligaments divided into two bundles. The origin of major bundle located beyond the origin of the zygomatic major muscle on the periosteum, and the origin of minor bundle located between the origin of the zygomatic minor and major muscle.Conclusions:The anatomy of the zygomatic ligament has a regular pattern, and its anatomical data has certain directive significance for clinical application.

Objective:To investigate the cryopreservation effects of vitrification and programmed freezing protocol on ovarian tissue of macaque.Methods:Fresh macaque ovarian tissues were randomly divided into three groups: control group (fresh ovarian issue), vitrification freezing group and programmed freezing group. HE staining, preantral follicle classification and immunostaining were performed in the three groups. The morphology of follicles, the normal rate of follicles at different stages and the difference in the expression of phosphohistone H3 (PHH3) in three groups of ovarian tissues were compared.Results:1) HE staining showed that there were no significant differences in the normal rate of primary follicles and primordial follicles among the three groups ( P>0.05). The normal rate of single-layer secondary follicles in the programmed freezing group [40.6% (28/69)] was lower than that in vitrification freezing group [53.5% (38/71)] and control group [60.7% (34/56)], and the difference was statistically significant ( P=0.044), but there was no significant difference between vitrification freezing group and control group ( P>0.05). The normal rate of multi-layer secondary follicles in vitrification freezing group [23.4% (11/47) and the programmed freezing group [16.7% (7/42)] was significantly lower than that of control group [57.3%(39/68)] ( P<0.001). The normal rate of multi-layer secondary follicles in vitrification freezing group was higher than that in programmed freezing group, but the difference was not statistically significant ( P>0.05). 2) Comparison of isolated follicles: the normal morphology of primary follicles in the vitrification freezing group and the programmed freezing group was close to control group, the difference was not statistically significant ( P>0.05). The normal rate of secondary follicles in vitrification freezing group [38.2% (34/89)] and programmed freezing group [23.7% (23/97)] was obvious lower than that in control group [56.4% (61/108)]. The difference was statistically significant ( P<0.001). The normal morphology of secondary follicles in vitrification freezing group was significantly higher than that in programmed freezing group ( P<0.001). 3) PHH3 staining: compared with fresh ovarian tissue, the positive expression rate of PHH3 in granulosa cells of vitrification freezing group was close to that of control group ( P>0.05), while the positive expression rate of PHH3 in follicular granulosa cells of programmed freezing group (58.72%±12.31%) was significantly lower than that of control group (67.58%±8.45%, P=0.04) and vitrification freezing group (62.87%±9.94%, P=0.03). Conclusion:Both vitrification and programmed freezing protocol can effectively preserve ovarian tissue, but the morphological damage of follicles and granulosa cells during vitrification and thawing is significantly lower than that of programmed freezing, which is more suitable for the next study of human ovarian tissue cryopreservation.

Objective:To investigate the cryopreservation effects of vitrification and programmed freezing protocol on ovarian tissue of macaque.Methods:Fresh macaque ovarian tissues were randomly divided into three groups: control group (fresh ovarian issue), vitrification freezing group and programmed freezing group. HE staining, preantral follicle classification and immunostaining were performed in the three groups. The morphology of follicles, the normal rate of follicles at different stages and the difference in the expression of phosphohistone H3 (PHH3) in three groups of ovarian tissues were compared.Results:1) HE staining showed that there were no significant differences in the normal rate of primary follicles and primordial follicles among the three groups ( P>0.05). The normal rate of single-layer secondary follicles in the programmed freezing group [40.6% (28/69)] was lower than that in vitrification freezing group [53.5% (38/71)] and control group [60.7% (34/56)], and the difference was statistically significant ( P=0.044), but there was no significant difference between vitrification freezing group and control group ( P>0.05). The normal rate of multi-layer secondary follicles in vitrification freezing group [23.4% (11/47) and the programmed freezing group [16.7% (7/42)] was significantly lower than that of control group [57.3%(39/68)] ( P<0.001). The normal rate of multi-layer secondary follicles in vitrification freezing group was higher than that in programmed freezing group, but the difference was not statistically significant ( P>0.05). 2) Comparison of isolated follicles: the normal morphology of primary follicles in the vitrification freezing group and the programmed freezing group was close to control group, the difference was not statistically significant ( P>0.05). The normal rate of secondary follicles in vitrification freezing group [38.2% (34/89)] and programmed freezing group [23.7% (23/97)] was obvious lower than that in control group [56.4% (61/108)]. The difference was statistically significant ( P<0.001). The normal morphology of secondary follicles in vitrification freezing group was significantly higher than that in programmed freezing group ( P<0.001). 3) PHH3 staining: compared with fresh ovarian tissue, the positive expression rate of PHH3 in granulosa cells of vitrification freezing group was close to that of control group ( P>0.05), while the positive expression rate of PHH3 in follicular granulosa cells of programmed freezing group (58.72%±12.31%) was significantly lower than that of control group (67.58%±8.45%, P=0.04) and vitrification freezing group (62.87%±9.94%, P=0.03). Conclusion:Both vitrification and programmed freezing protocol can effectively preserve ovarian tissue, but the morphological damage of follicles and granulosa cells during vitrification and thawing is significantly lower than that of programmed freezing, which is more suitable for the next study of human ovarian tissue cryopreservation.

Objective: To evaluate the effect of the Thyroid Imaging Report and Data System proposed by American Radiological Society (ACR-TIRADS) for differential diagnosis in thyroid nodules, and compare ACR-TIRADS to the TIRADS proposed by Kwak et al.(K-TIRADS) and the ultrasound-based risk stratification system evaluated by American Thyroid Association (ATA-Risk Stratification). Methods: The clinical data of 1 760 patients with 1 912 thyroid nodules from 8 hospitals in Jiangsu province were retrospectively analysed. All of them were categorized based on ultrasound-based risk stratification systems. The ROC curve was established to assess and compare the diagnostic value of the systems. Results: The area under the ROC curve (AUC) of ACR-TIRADS was 0.830, with high sensitivity and negative predictive value (86.9% and 87.5%, respectively), and relatively low specificity and positive predictive value (64.1% and 62.9%, respectively). The sensitivity and specificity of K-TIRADS were up to 84.9% and 76.1%, respectively. The AUC of ATA-Risk Stratification was 0.852, with relatively high specificity (83.4%), and low sensitivity (79.4%). There were significant differences in the AUC among the three ultrasound-based risk stratification systems, of which K-TIRADS was the highest (P<0.001). There was no significant difference in sensitivity of ACR-TIRADS and K-TIRADS (P=0.137), but significantly higher than that of ATA-Risk Stratification (P<0.001). There were significant differences in the specificity among the three systems, of which ATA-Risk Stratification was the highest (P<0.001). In addition, there were 109 nodules (5.7%) couldn′t be classified based on ATA-Risk Stratification, with high malignancy rate of 31.2%. Conclusions The diagnostic efficiency of ACR-TIRADS is good, but lower than K-TIRADS and ATA-Risk Stratification. ACR-TIRADS has the highest sensitivity, and ATA-Risk Stratification has the highest specificity, while the overall diagnostic efficiency of K-TIRADS is the best.

Objective To investigate the effects of ropivacaine on proliferation,apoptosis and cell cycle of MDA-MB-231 Cells. Methods The cultured MDA-MB-231 cells were treated with different concentrations of ropivacaine. The proliferation of MDA-MB-231 cells was detected by MTT method. Cell apoptosis and cell cycle were detected by Annexin V-FITC/PI and flow cytometry. Results After ropivacaine administration,MDA-MB-231 cells proliferation inhibition ratio increased significantly.Annexin V-FITC/PI and flow cytometry showed ropiva-caine had no significant effects on cell apoptosis and cell cycle.Conclusion Ropivacaine can inhibit the prolifera-tion of MDA-MB-231 cells,but can′t induce apoptosis and block cell cycle.