Objective To investigate the level of coagulation factor Ⅺ(FⅪ)in patients with venous thrombosis of lower limbs and its correlation with recurrence risk.Methods A total of 220 pa-tients with deep vein thrombosis(DVT)admitted in our hospital from February 2018 to February 2019 were enrolled as the study group,and another 50 healthy individuals taking physical exami-nation during same period served as the control group.After a 3 years followed,the study group ultimately included 197 cases,according to the results of restricted cubic spline(RCS),the study group was divided into low(FⅪ＜10.3 U/L,94 cases),medium-(10.3-12.1 U/L,52 cases)and high-level groups(＞12.1 U/L,51 cases).The plasma level of FⅪ was detected in the study group 1 month after the end of anticoagulant therapy,and the results were compared with those of the control group during physical examination.Cox model was used to analyze the influence of FⅪ on the recurrence of DVT,and RCS was employed to analyze the relationship between DVT recur-rence and FⅪ level.Kaplan-Meier curve was plotted to analyze the recurrence risk of DVT with different FⅪ levels.The patients from the study group were followed up for 3 years.Results The FⅪ level was significantly higher in the study group than the control group(P＜0.05).During fol-low-up period,33 patients(16.75％)had DVT recurrence.The Cox model analysis after adjust-ment of sex and age showed that FⅪ level was a risk factor for DVT recurrence(P＜0.05).When the FⅪ level was set into tertile and the risk ratio was calculated after adjustment,FⅪ＜10.3 U/L,and the average FⅪ level at this stage was 9.2 U/L,the risk ratio was 0.82(95％CI:0.673-0.984);Patients with FⅪ between 10.3 and 12.1 U/L,and the average FⅪ at this stage was 11.4 U/L,the risk ratio of 1.04(95％CI:0.813-1.432).The those with FⅪ＞12.1 U/L,and the average FⅪ at this stage was 13.8 U/L,hazard ratio of 1.38(95％CI:0.921-1.563).Kaplan-Meier curve analysis showed that the recurrence risk was 28.62％(95％CI:25.633-31.609),30.10％(95％CI:27.594-32.606)and 38.06％(95％CI:34.306-41.371),respectively for the low-,medium-,and high-level groups,with significant correlation among the three groups(x2=6.631,P=0.036).Conclusion Compared with healthy individuals,plasma FⅪ level is at a high level in the DVT patients.With the increment of FⅪ level,the risk of DVT recurrence increases.Two FⅪ levels,10.3 U/L and 12.1 U/L,can be used as reference points for the obvious increase of DVT recur-rence rate.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been reapproved for heart failure (HF) therapy in patients with and without diabetes. However, the initial glucose-lowering indication of SGLT2i has impeded their uses in cardiovascular clinical practice. A challenge of SGLT2i then becomes how to separate their anti-HF activity from glucose-lowering side-effect. To address this issue, we conducted structural repurposing of EMPA, a representative SGLT2 inhibitor, to strengthen anti-HF activity and reduce the SGLT2-inhibitory activity according to structural basis of inhibition of SGLT2. Compared to EMPA, the optimal derivative JX01, which was produced by methylation of C2-OH of the glucose ring, exhibited weaker SGLT2-inhibitory activity (IC₅₀ > 100 nmol/L), and lower glycosuria and glucose-lowering side-effect, better NHE1-inhibitory activity and cardioprotective effect in HF mice. Furthermore, JX01 showed good safety profiles in respect of single-dose/repeat-dose toxicity and hERG activity, and good pharmacokinetic properties in both mouse and rat species. Collectively, the present study provided a paradigm of drug repurposing to discover novel anti-HF drugs, and indirectly demonstrated that SGLT2-independent molecular mechanisms play an important role in cardioprotective effects of SGLT2 inhibitors.

Objective:To investiagte the ability of albumin-indocyanine green (ALICE) score, albumin-bilirubin (ALBI) score and Child-Pugh score in predicting postoperative liver failure (PHLF) in patients with hepatocellular carcinoma, and to determine the clinical value of ALICE score.Methods:The clinical data of 397 patients with hepatocellular carcinoma who underwent hepatectomy in the Department of Hepatobiliary and Pancreatic Surgery, Jinhua Hospital Affiliated to Zhejiang University from June 2015 to June 2021 were retrospectively analyzed, including 350 males and 47 females, aged (58.9±11.2) years. Univariate and multivariate logistic regression were used to analyze the risk factors of PHLF. The predictive ability of ALICE score for PHLF was evaluated by receiver operating characteristic (ROC) curve, and compared with ALBI score and Child-Pugh score.Results:There were 74 patients with PHLF and 323 patients without PHLF. Multivariate logistic regression analysis showed that Child-Pugh score ( OR=1.630, 95% CI: 1.251-2.486, P=0.034), ALBI score ( OR=1.863, 95% CI: 1.028-3.119, P=0.049) and ALICE score ( OR=1.759, 95% CI: 1.216-3.078, P=0.038) were independent risk factors for PHLF in patients with hepatocellular carcinoma, and the risk of PHLF increased with the increase of grade. The area under the ROC curve of ALICE score predicting PHLF in patients with hepatocellular carcinoma was 0.613 (95% CI: 0.564-0.662), the area under the ALBI score was 0.612 (95% CI: 0.563-0.661), and the area under the Child-Pugh score was 0.555 (95% CI: 0.505-0.605). The ALICE score was better than the Child-Pugh score, and the difference was statistically significant ( z=2.04, P=0.041). In small liver resection patients, ALICE score was better than Child-Pugh score ( z=2.61, P=0.009). There was no significant difference betwenn ALICE score and ALBI score ( z=0.06, P=0.954). Conclusion:ALICE score can predict the occurrence of PHLF in patients with hepatocellular carcinoma, especially in patients with small liver resection, its value is similar to ALBI score, but better than Child-Pugh score.

Objective:To evaluate the prediction value of preoperative Fibrinogen(FIB) in combination with neutrophil-lymphocyte ratio(NLR)for the prognosis of operable pancreatic cancer patients.Methods:The clinical data of 124 patients who underwent radical resection for pancreatic cancer in our hospital from Jan 2010 to Dec 2018 were retrospectively analyzed.The patients were divided into three groups according the high and low NLR, FIB value which defined by the receiver operating characteristic curve (ROC). The clinicopathological data and overall median survival time were compared between the three groups.Results:Univarate analysis showed that age, tumor stage, NLR, FIB and F-NLR score were associated with the prognosis( P<0.05), while multivariate analysis showed that high F-NLR score was the independent prognostic factor. The median survival time of patients with F-NLR scores 0, 1 and 2 group was 30.6, 20.3 and 13.9 months( P<0.05). The prognosis of high F-NLR score was significantly worse than that of low F-NLR score( P<0.05). Conclusions:A high preoperative F-NLR score was a promising predictor for the prognosis of pancreatic cancer patients after radical resection.

Objective:To compare the short-term results of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy in periampullary carcinoma patients.Methods:The clinical data of patients with periampullary carcinoma who underwent laparoscopic pancreaticoduodenectomy or open pancreaticoduodenectomy at Department of Hepatopancreatobiliary Surgery, Jinhua Hospital, Affiliated to Zhejiang University School of Medicine from January 2013 to February 2018 were collected. Totally 127 patients were included in the study. There were 73 males and 54 females, aged (61.2±9.4) years (range: 37-80 years). Propensity score matching method was used to perform 1∶1 matching between laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy. Perioperative outcomes and overall survival were compared between the two groups using t test, χ 2 test, Fisher exact probability, Kaplan-Meier curve and Log-rank test, respectively. Results:A total of 32 pairs of patients were successfully matched by propensity score matching. There were 21 males and 11 females in open pancreaticoduodenectomy group, aged (62.1±9.3)years, 21 males and 11 females in laparoscopic group, aged (63.7±9.4)years. Comparion with open pancreaticoduodenectomy, the laparoscopic group had longer operative time (381(47)minutes vs. 249(92)minutes)( t=-5.949, P=0.000), higher hospitalization cost ((64.8±7.2) thousand yuan vs. (56.0±9.2)thousand yuan, t=-3.464, P=0.001), but less in estimated blood loss ((249.38±91.40)ml vs.(329.69±120.26)ml) ( t=3.008, P=0.004), shorter in the time to first flatus ((3.39± 1.1)days vs. (5.03±1.65)days, t=5.316, P=0.000) and preoperative hospital stay((18.6±5.59)days vs. (21.9±5.5)days) ( t=2.242, P=0.018). There was no significant difference in vascular invasion, nerve invasion, number of lymph nodes dissected, perioperative complications and pathology (all P>0.05). After PSM, there was no significant difference found in 1-year overall survival rate (60.0% vs. 62.0%, P=0.729). Conclusions:Laparoscopic pancreaticoduodenectomy is safe and feasible for the treatment of periampullary carcinoma. It not only has advantages of less trauma and faster recovery, but also achieves similar of lymph node dissection and equivalent short-term prognosis when compared with open approach.

Objective:To compare the short-term results of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy in periampullary carcinoma patients.Methods:The clinical data of patients with periampullary carcinoma who underwent laparoscopic pancreaticoduodenectomy or open pancreaticoduodenectomy at Department of Hepatopancreatobiliary Surgery, Jinhua Hospital, Affiliated to Zhejiang University School of Medicine from January 2013 to February 2018 were collected. Totally 127 patients were included in the study. There were 73 males and 54 females, aged (61.2±9.4) years (range: 37-80 years). Propensity score matching method was used to perform 1∶1 matching between laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy. Perioperative outcomes and overall survival were compared between the two groups using t test, χ 2 test, Fisher exact probability, Kaplan-Meier curve and Log-rank test, respectively. Results:A total of 32 pairs of patients were successfully matched by propensity score matching. There were 21 males and 11 females in open pancreaticoduodenectomy group, aged (62.1±9.3)years, 21 males and 11 females in laparoscopic group, aged (63.7±9.4)years. Comparion with open pancreaticoduodenectomy, the laparoscopic group had longer operative time (381(47)minutes vs. 249(92)minutes)( t=-5.949, P=0.000), higher hospitalization cost ((64.8±7.2) thousand yuan vs. (56.0±9.2)thousand yuan, t=-3.464, P=0.001), but less in estimated blood loss ((249.38±91.40)ml vs.(329.69±120.26)ml) ( t=3.008, P=0.004), shorter in the time to first flatus ((3.39± 1.1)days vs. (5.03±1.65)days, t=5.316, P=0.000) and preoperative hospital stay((18.6±5.59)days vs. (21.9±5.5)days) ( t=2.242, P=0.018). There was no significant difference in vascular invasion, nerve invasion, number of lymph nodes dissected, perioperative complications and pathology (all P>0.05). After PSM, there was no significant difference found in 1-year overall survival rate (60.0% vs. 62.0%, P=0.729). Conclusions:Laparoscopic pancreaticoduodenectomy is safe and feasible for the treatment of periampullary carcinoma. It not only has advantages of less trauma and faster recovery, but also achieves similar of lymph node dissection and equivalent short-term prognosis when compared with open approach.

Objective To investigate clinical effect of minimally invasive knotless bridge-suture technique for acute achilles tendon rupture.Methods The clinial data of 23 patients with acute achilles tendon rupture treated in Department of Orthopaedics,Shanghai Jiao Tong University Affiliated Sixth People's Hospital from August 2017 to February 2018 were analyzed retrospectively.There were 21 males and 2 females,aged (37.1 ± 5.6) years,with an age range of 29-51 years.Minimally invasive knotless bridge-suture technique was performed in all cases until the soft tissue condition of the patients improved.Patients were followed up by outpatient review at 3 weeks,6 weeks,3rd,and 6th months postoperatively,followed by every 3 months,followed up 12 to 18 months,and the deadline was April 2019.Ratio of perimeter of the affected lower extremity to that of the uninjuried,number of repetitions for one leg calf rise in one minute,American Orthopaedic Foot and Ankle Society (AOFAS) anklehind foot score,the achilles tendon total rupture score(ATRS) and time to return to work were investigated at last follow-up,as well as complications during the follow-up period.Results Twenty-three cases were followed up.At last follow-up,ratio of perimeter of the affected lower extremity to that of the uninjuried was (92.7 ± 1.8) ％,number of repetitions for one leg calf rise in one minute was (25 ± 2) times,AOFAS ankle-hind foot score was (91.5 ±2.2) scores,ATRS was (92.6 ±2.4) scores,time to return to work ranged from 6 to 9 weeks.All patients underwent first-stage healing.No skin necrosis,superficial infection and sural nerve injury occurred.No achilles tendon re-rupture was seen during the follow-up period.Conclusion Minimally invasive knotless bridgesuture technique for acute achilles tendon rupture is applied easily and less invasive,enabling patients to return to work earlier and proved to be a secure and effective treatment.

Objective    To compare the clinical effect of single mediastinal drainage tube and both mediastinal drainage tube and closed thoracic drainage tube for the patients who received thoracoscopic radical resection of esophageal carcinoma. Methods    We enrolled 96 esophageal carcinoma patients who received thoracoscopic radical resection from June 2016 to October 2018. Of them, 49 patients were indwelt with both mediastinal drainage tube and closed thoracic drainage tube (a chest & mediastinal drainage group, a CMD group) while the other 47 patients were indwelt with single mediastinal drainage tube (a single mediastinal drainage group, a SMD group). The total drainage volume, intubation time and incidence of postoperative complications (postoperative atelectasis, pulmonary infection, pleural effusion and anastomotic leakage) between the two groups were compared. The pain score and comfort score were also compared between the two groups. Results    The total drainage volume and intubation time in the SMD group were not significantly different from those in the CMD group (1 321±421 mL vs. 1 204±545 mL, P=0.541; 6.1±3.7 d vs. 6.4 ±5.1 d, P=0.321). The incidence of postoperative complications (postoperative atelectasis, pulmonary infection, pleural effusion and anastomotic leakage) in the SMD group was not significantly different from that in the CMD group (10.6% vs. 6.1%, P=0.712; 4.3% vs. 10.2%, P=0.656; 6.4% vs. 12.2%, P=0.121; 2.1% vs. 4.1%, P=0.526). The numerical rating scale (NRS) pain  scores on the first to the fifth day after surgery and during extubation in the SMD group were significantly lower than those in the CMD group (3.2±2.1 vs. 5.1±2.4, P=0.041; 2.8±0.6 vs. 4.8±1.4, P=0.015; 2.1±0.4 vs. 4.5±0.4, P=0.019; 1.7±0.7 vs. 4.0±0.8, P=0.004; 1.8±0.7 vs. 3.2±1.2, P=0.006; 1.4±0.2 vs. 2.5±3.4, P=0.012). The VAS comfort scores in the SMD group were significantly lower than those in the CMD group (3.6±1.7 vs. 6.6±3.7, P=0.018; 2.9±2.0 vs. 5.1±3.4, P=0.007; 2.1±1.4 vs. 5.5±2.4, P=0.004; 3.0±0.9 vs. 4.6±3.8, P=0.012; 1.8±1.1 vs. 4.2±2.7, P=0.003; 2.4±3.2 vs. 5.3±1.7, P=0.020). Conclusion    The clinical effect of single mediastinal drainage tube in thoracoscopic resection of esophageal carcinoma is similar to that of both mediastinal drainage tube and closed thoracic drainage tube, but it can significantly improve the comfort of the patients.

Objective To evaluate the surgical techniques and clinical outcomes of ankle distraction arthroplasty with platelet-rich plasma(PRP) injection for post-traumatic ankle arthritis.Methods From May 2012 to May 2017,32 patients with post-traumatic ankle arthritis were treated at Department of Orthopaedic Surgery,Shanghai Sixth Peopled Hospital.They were 22 males and 10 females,with an age of 32.6±5.8 years(from 18 to 40 years).Their course of disease was 14.0±2.8 months(from 6 to 24 months).After failure of the conservative management for at least 6 months,they received ankle distraction arthroplasty with PRP injection.American Orthopaedic Foot&Ankle Society(AOFAS) ankle-hindfoot score and visual analogue scale(VAS) were used to evaluate the final overall outcomes.Range of motion(ROM) of the ankle joint and complications were also recorded postoperatively.Results Pin tract infection occurred in 12 patients but responded to alcohol care.All the patients were followed up for an average of 36 months(from 18 to 60 months).The VAS score decreased significantly from preoperative 6.8±1.2 to postoperative 8±1.4;the AOFAS ankle-hindfoot score increased significantly from preoperative 38.5±6.2 to 80.3±8.1 at the final follow-up;dorsal expansion and plantar flexion of the ankle increased significantly from preoperative 8.3°±7.0° and 24.7°±6.4° to 12.8°±6.5° and 31.4°±5.3° at the final follow-up,respectively(all P<0.05).Two patients had to receive salvage arthrodesis after conservative management failed to relieve their symptoms or delay the progression of their post-traumatic arthritis.Conclusion Ankle distraction arthroplasty with PRP injection is an effective ankle preserving surgery which can relieve symptoms,improve functions and delay progression of post-traumatic ankle arthritis.

Objective To analyze the epidemiology and clinical characteristics of the children with measles. Methods Retro-spectively analyzed methods were applied to analyze the timing, and season of the break, age distribution, clinical manifestations and major complications of 3431 children with measles (<12 years) in the Second Hospital of Nanjing from 2008 to 2015. Results It found that there was a peak incidence of measles in children each in 2009, 2013, and 2015 , peaking in March to May. Onset age of measles mainly within the first year of life, and incidence increased with age within the first 8 months. Typical clinical manifestations are mainly fever, rash, cough, and catarrhal symptoms. The main complications of measles were pneumonia, laryngitis and heart failure. Conclusions Early diagnosis and effective treatment of the children with measles needs to be strengthened.