Objective:To compare the clinical efficacy between radiofrequency ablation(RFA)and pulmonary metastasectomy in the colorectal cancer(CRC)patients with lung metastases after radical resection. Methods:The clinical data of 80 CRC patients with lung metastases after radical resection were analyzed retrospectively,and were divided into the surgery group(33 cases)and the RFA group(47 cases)according to the local treatment.The overall survival(OS)and progression-free survival(PFS)of the two groups were compared,as well as the prognostic factors of patients were analyzed. Results:The 3-year PFS and OS rates were 42.4％vs 31.9％and 75.8％vs 72.3％in the surgery group and the RFA group,respectively.There was no significant difference in PFS and OS between the two groups(P＞0.05).In multivariate analysis,maximum lung metastasis diameter,preoperative serum carcinoembryonic antigen(CEA)level and history of extrapulmonary metastasis were independent factors influencing OS in the CRC patients with lung metastases after radical resection(P＜0.05).In addition,preoperative serum carcinoembryonic antigen(CEA)level and history of extrapulmonary metastasis were also independent factors influencing PFS in the CRC patients with lung metastases after radical resection(P＜0.05). Conclusion:The short-term efficacy of RFA is comparable to that of pulmonary metastasectomy in the CRC patients with lung metastases after radical resection,and long-term follow-up studies are needed.

Objective:To investigate the clinical application value of argon-helium knife cryoablation combined with radioactive seed implantation in the treatment of non-small cell lung cancer(NSCLC).Methods:A total of 117 patients with NSCLC admitted to Oncology Department of Fifth Affiliated Hospital of Zhengzhou University from January 2015 to January 2017 were included in our study.And they were divided into the combination group(n=63)treated with CT guided argon-helium knife cryoablation combined with radioactive 125I seeds implantation and the control group(n=54)treated only with argon-helium knife ablation.The changes of blood routine indexes, tumor markers, tumor ablation target volume and CT value were observed before and 1, 3, 6 months after treatment.Adverse reactions during treatment and the evaluation results of efficacy were compared between the two groups.Patients were followed up for 24 months to observe the recurrence and survival rates between the two groups. Results:In the combination group, seeds of(12.49±4.91)were implanted, and the X-ray exposure was(123.16±42.75)Gy.There was no significant difference in general clinical data between the two groups before treatment( P>0.05). At 1, 3 and 6 months after treatment, as compared with control group the combination group showed the significantly decreased platelet count( t=3.154, 3.586, 2.233, P=0.027、0.019、0.034), while, there was no significant difference in white blood cell count, red blood cell count and hemoglobin level between the two groups(all P>0.05). The levels of carcinoembryonic antigen(CEA), neuron-specific enolase(NSE)and tumor volume were significantly lower in combination group than in control group at 3 and 6 months after treatment( t3=3.142, 2.926 and 4.281, t6=4.094, 5.382 and 4.535, all P<0.05), showing significant improvements of illness.While, the above levels showed no significant differences at 1 month after treatment between two groups( t=1.065, 1.037, P=0.197, 0.255). At each monitoring time, the CT value of tumor target area showed a steady downward trend( P<0.05). During the treatment, the incidence of thrombocytopenia was higher in the combination group than in the control group(47.6% or 30/63 vs.24.1% or 13/54, χ2=6.935, P=0.008), while there were no significant differences in the incidence of postoperative fever, pneumothorax, myoglobinuria, pain, bleeding and nausea and vomiting between the two groups(all P>0.05). After 6 months of treatment, the remission rate was higher in the combination group(73.0% or 46/63)than in the control group(48.1% or 26/54). The survival time and relapse-free time of the combination group were longer than those of the control group[(21.81±4.31)months vs.(18.93±5.94)months, (20.48±5.76)months vs.(16.93±7.14)months, Log Rank χ2=8.229 and 9.656, P=0.004 and 0.002)]. Conclusions:Argon-helium knife Cryoablation combined with radioactive seed implantation can effectively control the local progression of NSCLC, reduce the risk of tumor recurrence, and has high safety.

【Objective】 To investigate the clinical staffs′ knowledge about blood transfusion and their demands, so as to provide evidence for arranging the content for continuing education of blood transfusion medicine. 【Methods】 A self-designed questionnaire was used to investigate the blood transfusion related knowledge of 652 clinical staffs from other cities or counties/districts in Shaanxi Province, who came to our hospital to attend meetings, further training and study from July to August 2019. 【Results】 Clinical stsffs investigated lacked a deep understanding of blood transfusion and blood donation related knowledge, and even were ignorant of certain knowledge. The awareness rate of relevant knowledge was the highest among doctors, followed by laboratory technicians and the lowest among nurses. 【Conclusion】 The awareness rate of blood transfusion related knowledge among medical staffs is relatively low, suggesting the training of blood transfusion related knowledge should be enhanced.

Objective:To evaluate the clinical, radiological and arthroscopic outcomes after surgical repair for chronic lateral meniscus posterior root (LMPR) avulsion combined with anterior cruciate ligament (ACL) reconstruction.Methods:From July 2015 to June 2017, a total of 33 patients who underwent transtibial pull-out suture repair for chronic LMPR avulsion combined with anatomic single-bundle ACL reconstruction with hamstring graft were retrospectively reviewed. There were 30 males and 3 females with an average age of 27.7±7.5 years (range 17-45 years) and a mean BMI of 25.2±3.7 kg/m 2 (range 19.4-36.7 kg/m 2). All patients were available for at least two years of follow-up. A second-look arthroscopy was performed to evaluate the healing status of the repaired meniscus. Subjective knee function was assessed through Lysholm and Tegner scores. Objective knee stability was evaluated using KT-1000 arthrometer side-to-side difference (SSD) and pivot shift test under anesthesia. The tibiofemoral relationship was evaluated by anterior tibial subluxation (ATS) measured on axial MRI. Between patients with preoperative ATS ≥6 mm (18 patients in the ATS positive group) and <6 mm (15 patients in the ATS negative group), the postoperative ATS and the reduction of ATS was also compared. Results:After a mean follow-up of 27.5±4.0 months (range 24-39 months), the LMPR avulsion completely healed in 23 (70%) cases, partially healed in 9 (27%) cases, failed to heal in 1 (3%) case on second-look arthroscopy. The Lysholm score was increased from 60.4±13.6 to 82.7±11.1 at 1 year and to 91.4±9.1 at 2 years operatively ( F=155.996, P<0.001). The Tegner score was increased from 3(2, 5) to 4(3, 5) at 1 year and 6(4, 6) at 2 years postoperatively (χ 2=47.791, P<0.001). The KT-1000 SSD was decreased from 9.1±3.3 mm to 2.0±1.7 mm ( t=11.197, P<0.001). The result of pivot shift test was also improved (10 grade I, 20 grade II, 3 grade III, preoperatively vs 30 grade 0, 3 grade I, postoperatively, U=5.161, P<0.001). The ATS was reduced from 5.7±3.9 mm to 3.5±3.2 mm ( t=3.530, P=0.001). However, there was no statistically significant decrease in the ATS of the ATS negative group ( t=0.400, P=0.695). The ATS of the ATS positive group was reduced from 8.7±1.8 mm to 5.0±3.3 mm ( t=4.765, P<0.001), and the ATS reduction of the ATS positive group was greater than that of the ATS negative group (3.7±3.3 mm vs 0.3±2.8 mm, t=3.115, P=0.004). Conclusion:In patients undergoing ACL reconstruction, the transtibial pull-out suture repair for chronic LMPR avulsion yielded meniscus healing rate of 97% with improved subjective knee function and objective knee stability and better restored the tibiofemoral relationship for patients with excessive ATS.

Objective:To explore the risk factors of primary anterior cruciate ligament (ACL) reconstruction failure.Methods:From November 2015 to May 2017, a total of 178 consecutive patients with clinically diagnosed non-contact ACL injury were treated and followed-up more than 2 years. Twenty-five patients (post-operative failure group) who underwent completely ruptured ACL graft confirmed by MRI, positive pivot-shift test, more than 5 mm side-to-side difference (SSD) measured by KT-1000 arthrometer, more than 5 mm static anterior tibial translation (ATT) measured on MRI were determined to be ACL reconstruction failure. They were matched in a 1∶2 fashion to 50 non-failure patients (post-operative non-failure group), who showed intact ACL graft 2 years after ACL reconstruction. The sex, age, body mass index (BMI), affected side, meniscal injury side, time from injury to surgery, KT-1000 SSD, pivot shift test under anesthesia, follow-up duration, posterior tibial slope (PTS) and ATT measured on the pre-operative weight-bearing whole leg radiographs between the two groups were compared using univariate analysis. Moreover, the predictors of ACL reconstruction failure were assessed by multivariable conditional Logistic regression analysis.Results:Post-operative failure group had a significantly higher PTS and ATT values than those in the post-operative non-failure group (17.21°±2.20° vs 14.36°±2.72°, t=4.395, P<0.001; 8.29±3.42 mm vs 4.09±3.06 mm, t=5.504, P<0.001). The sex, age, BMI, affected side, meniscal injury side, time from injury to surgery, KT-1000 SSD, pivot shift test under anesthesia, follow-up duration between the two groups showed no significant difference ( P>0.05). Multivariable Logistic regressions indicated that PTS≥17° ( OR=15.62, P=0.002) and ATT≥6 mm ( OR=9.91, P=0.006) were independent risk factors for primary ACL reconstruction failure. However, sex, age, BMI, meniscal lesions, degree of pivot shift test, KT-1000 SSD were not the independent risk factors. Conclusion:PTS≥17° and ATT≥6 mm could increase the risk of primary ACL reconstruction failure.

Objective:To evaluate the accuracy of serum surfactant protein concentration in predicting postoperative pulmonary complications (PPCs) in the patients at moderate risk for PPCs undergoing abdominal surgery.Methods:Fifty-eight patients of both sexes, with the predicted ARISCAT score of 26-44 points, scheduled for elective abdominal gastrointestinal surgery, were studied.Central venous blood samples were collected before operation (T 0), at 30 min after extubation (T 1) and at 1 day after surgery (T 2) for determination of serum surfactant protein A (SP-A) and surfactant protein B (SP-B) in serum by enzyme-linked immunosorbent assay.The occurrence of PPCs during the postoperative hospitalization was recorded.The patients were divided into PPCs group and non-PPCs group according to whether PPCs occurred. The receiver operating characteristic curve was used to analyze the accuracy of serum SP-A and SP-B concentrations in predicting PPCs. Results:Compared with the baseline value at T 0, the serum SP-B concentrations were significantly increased at T 1 in group PPCs, and the concentrations of serum SP-A and SP-B were significantly decreased at T 2 in both groups ( P<0.05). The concentrations of serum SP-A and SP-B were significantly decreased at T 2 than at T 1 in both groups ( P<0.05). Compared with non-PPCs group, the serum concentrations of SP-A at T 0 and SP-B at T 1 were significantly increased in group PPCs ( P<0.05). The area under the receiver operating characteristic curve of serum SP-B concentrations in predicting PPCs at T 1 was 0.908 (95% confidence interval 0.821-0.996), and the cut-off value was 26.3 ng/ml, sensitivity 0.90, and specificity 0.81. Conclusion:The accuracy of serum SP-B concentrations measured at 30 min after extubation in predicting PPCs is higher in the patients at moderate risk for PPCs undergoing abdominal surgery.

Purpose: Whether craniospinal irradiation (CSI) could be replaced by limited-field radiation in non-metastatic bifocal germinoma remains controversial. We addressed the issue based on the data from our series and the literature. Methods: Data from 49 patients diagnosed with non-metastatic bifocal germinoma at our hospital during the last 10 years were collected. The Pediatric Quality of Life Inventory 4.0 was used to evaluate health-related quality of life (HRQOL). Additionally, 81 patients identified from the literature were also analyzed independently. Results: In our cohort, 34 patients had tumors in the sellar/suprasellar (S/SS) plus pineal gland (PG) regions and 15 in the S/SS plus basal ganglia/thalamus (BG/T) regions. The median follow-up period was 52 months (range, 10 to 134 months). Our survival analysis showed that patients treated with CSI (n=12) or whole-brain radiotherapy (WBRT; n=34) had comparable disease-free survival (DFS; p=0.540), but better DFS than those treated with focal radiotherapy (FR; n=3, p=0.016). All 81 patients from the literature had tumors in the S/SS+PG regions. Relapses were documented in 4/45 patients treated with FR, 2/17 treated with whole-ventricle irradiation, 0/4 treated with WBRT, and 1/15 treated with CSI. Survival analysis did not reveal DFS differences between the types of radiation field (p=0.785). HRQOL analysis (n=44) in our cohort found that, compared with S/SS+PG germinoma, patients with BG/T involvement had significantly lower scores in social and school domains. However, HRQOL difference between patients treated with CSI and those not treated with CSI was not significant. Conclusion In patients with non-metastatic bifocal germinoma, it is rational that CSI could be replaced by limited-field radiation. HRQOL in patients with BG/T involvement was poorer.

Objective This retrospective,single-center study evaluated short-and mid-term results of minimally invasive surgery to occlude ventricular septal defects(VSDs) through right subaxillary approach.Methods The procedure was performed on 624 children,224 boys and 205 girls;aged(2.4 ± 2.2) years;mean weight(12.3 ± 10.2)kg between January 2014 to December 2017 at the Children' s Heart Center of Henan Province People' s Hospital.An approximately 2 cm right subaxillary incision was made between the third and fifth ribs.The right atrium or ventricle was punctured under the guidance of transencephalographic echocardiography(TEE).The VSD was occluded under TEE guidance.Results The mean size of VSDs was(4.2 ±0.9)mm,and the occluder measured(5.2 ± 1.2)mm.Asymmetrical occluders were used in 28 patieuts and symmetrical occluders in 596 patients.The operative time was(58.5 ± 20.2) minutes,and the time in the intensive care unit (ICU) was(19.4 ±6.7) h.Blood loss was(10.4 ±9.5) ml.There were no deaths among these patients.Occluder displacement occurred in two cases.The complications such as Ⅲ degree atrioventricular block,new aortic regurgitation,reoperation foi massive bleeding,and serious infection were not observed.All patients were followed up for 6-48 months.There were 15 cases of residual shunt after operation.Eight cases were self-closed during follow-up,and 5 cases were still followed up.No complications such as reoperation,aortic regurgitation,atrioventricular block or occluder abscission was observed during the follow-up period.Conclusion Occluding VSDs using the right subaxillary approach is safe and effective.Short-term and midterm results are satisfactory.Further follow-up is required regarding long-term results.