Objective:To compare the effects of thoracoscopic anatomical segmentectomy and thoracoscopic lobectomy on patients' respiratory function.Methods:Retrospective analysis of 326 patients who underwent thoracoscopic surgery from July 2016 to July 2019(209 patients underwent anatomical segmentectomy, 117 patients underwent lobectomy). According to variables including gender, age, tumor location, smoking history and BMI, two propensity score-matched cohorts including 89 patients respectively were constructed. The patients’ baseline data and respiratory function date of the patients pre-operation and post-operation were analyzed. The measurement data that obey the normal distribution were described by mean±standard deviation, and the t-test was used for comparison between groups; the measurement data of non-normal distribution was described by the median value( P25, P75), and the Wilcoxon rank sum test was used for the comparison between groups; The data was described by frequency, and the chi-square test or Fisher's exact probability method was used for comparison between groups. Results:At the first-month follow-up after surgery, there was no significant difference in the variation of FVC[(0.48±0.40)L vs.(0.34±0.37)L, P=0.215)and FEV1[(0.52±0.46)L vs.(0.43±0.77)L, P=0.364), and in the change rate of FVC(%)[15.23(8.74, 21.25) vs. 14.58(7.75, 19.40), P=0.122], FEV1(%)[17.25(9.56, 22.78) vs. 16.42(9.15, 20.28), P=0.154]and DLCO(%)[18.54(10.88, 25.68)vs. 17.45(9.58, 23.75) P=0.245]. Between the segmentectomy group and lobectomy group, there was a significant difference in the alteration of FVC[(0.50±0.47)L vs. (0.29±0.31)L, P=0.031] and FEV1[(0.44±0.34)L vs.(0.24±0.23)L, P<0.001], the change rate of FVC(%)[14.27(7.87, 22.32) vs. 9.95(5.56, 17.24), P=0.008]、FEV1(%)[15.23(8.36, 22.17)vs. 10.05(5.15, 18.54), P<0.001]and DLCO(%)[13.74(6.24, 19.78) vs. 4.45(-2.32, 13.75), P=0.023]in the 6th month after surgery. The lobectomy group had a higher variation of FEV1[(0.34±0.49)L vs.(0.18±0.26)L, P=0.006] and change rate of FVC(%)[9.28(2.15, 18.94) vs. 5.24(0.52, 11.45), P=0.0032] and FEV1(%)[10.45(3.15, 21.32) vs. 6.50(1.55, 14.24), P<0.001] in the first year after surgery. However, the variation of FVC[(0.29±0.36)L vs.(0.21±0.24)L, P=0.176) and the change rate of DLCO(%)[8.35(2.15, 16.45) vs. 6.23(2.12, 14.54), P=0.143] didn't show a significant difference between the two groups. Conclusion:Whether in the short or the middle postoperative period, segmentectomy can preserve postoperative respiratory function than lobectomy.

Objective:To evaluate the technical aspects and examine patency rates of stent placement across the inguinal ligament for managing long-segment iliac venous obstruction.Methods:From Jan 2012 to Jan 2017, a total of 73 patients (42 cases of post-acute deep venous thrombosis(DVT) thrombolysis and 31 of post-thrombotic syndrome (PTS)) with long-segment iliac venous obstruction were treated with interventional surgery. All patients underwent balloon dilatation and placement of at least two stents extending below inguinal ligament.Results:The technical success rate was 100%. No serious perioperative complications occurred. The mean duration of the procedure in the DVT group was shorter than PTS group(35±12) min vs. (62±12) min, P<0.05). The mean number of stents did not differ between the two groups.Mean follow up periods was 28.34 months. Overall cumulative primary, assisted primary, and secondary stent patency rates were 100%, 100%, and 100% at 6 months and 87.7%, 95.9%, and 100% at 12 months and 75.8%, 85.1%, and 96.3% at 24 months, respectively(all P>0.05). Edema and pain alleviated significantly in the two groups. There was no stents compressed or fractured. Conclusions:Stenting across the inguinal ligament for treatment of long-segment iliac venous obstruction is a safe, effective, and feasible method.

Objective:To investigate the application of anterolateral thigh chimeric perforator flap in repairing complex soft tissue defects in lower extremities.Methods:From January, 2015 to June, 2019, 76 cases of complex soft tissue defects in lower extremities were repaired with free anterolateral thigh chimeric perforator flap pedicled with the descending branch of lateral circumflex femoral artery, including 29 cases in shank and 47 cases in ankle, and all had various tissue necrosis, infection, deep tissue defect and orthopaedic implant exposure. The size of the wound ranged from 15 cm×8 cm to 35 cm×20 cm, in which 45 cases associated with dead cavity formation, 62 cases with combined fractures at the same site, and 38 cases with combined fractures or other system injuries in other sites. After debridement, VSD treatment, good wound granulation and infection control, the chimeric perforator flap pedicled with the descending branch of the circumflex lateral femoral artery was designed and harvested. The perforator flap was used to repair most of the wounds with deep tissue exposures, the muscle flap was used to fill the dead cavity and (or) cover the wound around the flap, and free skin was grafted of the muscle flap at the first or second stage. Scheduled follow-up was conducted after the operation.Results:All 76 flaps survived, including vascular crisis occurred in 2 cases within 72 hours after surgery and ceased after immediate surgical exploration. One case had a further surgical operation due to excessive bleeding. Partial necrosis occurred at the distal end of the flap or the skin graft area of the muscle flap in 4 cases, of which 2 cases were treated with grafted skin again and the other 2 cases completely eliminated the wound after active dressing change. Other 16 cases of post-traumatic osteomyelitis with bone defect were repaired respectively with bone grafting, bone transportation or Masquelet technique in 3 to 6 months after wound healing. Among the 76 cases, 68 cases had primary wound healing while 8 cases delayed. Seventy-one cases were followed-up from 9 to 24 months, with an average of 16 months, while 5 cases lost. The appearance and function of the affected limbs recovered satisfactorily without recurrence of infection.Conclusion:With the anterolateral thigh chimeric perforator flap transplantation, the perforators flap can be conveniently used to repair the wound, and the muscle flap can be used to fill dead cavity and(or) deep wounds with free skin graft. Only the descending branch of lateral circumflex femoral artery is required to be anastomosed. It achieves a 3-dimensional effective reconstruction of the complex wound in extremities. It is a safe and effective technique to repair and reconstruct the complex wound in lower extremities and ideal in clinical applications.

OBJECTIVETo explore the role and mechanism of drug delivery systems using growth factor combined with gelatin sponge on accelerating the healing of jaw fracture and to seek better treatment of accelerating the maxillofacial fracture.

METHODSAbout 100 μg recombinant human bone morphogenetic protein (BMP)-2 was completely dissolved in 1 mL recombinant bovine basic fibroblast growth factor (bFGF), and the solution (40 μL) was dropped in gelatin sponge (0.5 cm×0.5 cm×1.0 cm). Then, it was freeze dried and prepared into bFGF/BMP/gelatin sponge delivery systems. The mandibular fracture model on two sides were prepared in 12 New Zealand rabbits and randomly divided into two groups. The left side was the control group, which was only fixed with titanium plates. The right side was the experimental group, in which bFGF/BMP/gelatin sponge delivery systems were put under the titanium plates. General observation, X-ray, and histological examination were taken at 2, 4, and 12 weeks after surgery.

RESULTSAfter 2 weeks, more fibrous tissues were seen between the fracture ends in the experimental group than in the control group. After 4 weeks, fibrous fracture callus were seen in the fracture gap in the experimental group. The ingrowths of fibrous tissue and blood vessels were seen in the control group. The fracture healing of the experimental group was significantly faster than the control group at 2 and 4 weeks. After 12 weeks, the experimental and control groups all healed completely.

CONCLUSIONSbFGF/BMP/gelatin sponge can accelerate and improve fracture healing; thus, it has better clinical application prospect.

Objective To explore the mediating effects of rumination and its subtypes on the relationship between negative life events and depressive symptoms in treatment-naive depressed patients.Methods Sixty-two treatment-naive depressed patients completed the center for epidemiologic studies depression scale (CESD),rumination response scale (RRS),and life event scale (LES).Results ① The scores of CESD were positively correlated with total score of RRS,brooding score of RRS,and negative LES score (NLES) in depressed patients (r=0.66,P＜ 0.01;r =0.50,P＜ 0.01;r =0.51,P＜ 0.01).The total score of RRS and brooding score of RRS were positively correlated with NLES(r=0.45,P＜0.01;r=0.47,P＜0.01).② The total score of RRS played a mediating role between NLES and CESD (indirect effect=0.12,95％ CI =0.04 ～ 0.23).③The brooding of RRS played a mediating role between NLES and CESD (indirect effect =0.07,95％ CI=0.02～0.15).Conclusion The RRS and the brooding of RRS exert mediation effects on the relationship between NLES and CESD in patients with depression.

Objective To evaluate the clinical efifcacy of sorafenib in preventing the recurrence of primary liver cancer after radical surgery. Methods Seventy patients with primary liver cancer undergoing radical surgery in the Third Affiliated Hospital of Sun Yat-sen University between June 2009 and June 2012 were enrolled in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval had been received. According to different postoperative therapies, the patients were divided into the sorafenib group (n=24) and control group (n=46). In the sorafenib group, there were 22 males and 2 females with a mean age of (48±10) years. A dose of 400 mg sorafenib was orally administered twice daily for consecutive 6 months. In the control group, there were 40 males and 6 females with a mean age of (48±11) years. The patients were orally administered with placebo. All patients received postoperative follow-up. Postoperative recurrence rate, survival rate and drug-induced adverse reactions were observed. Postoperative recurrence rate and incidence of adverse reactions of two groups were compared using Chi-square test or Fisher exact probability test. Postoperative survival rate was analyzed by Kaplan-Meier plot and Log-rank test. Results In the sorafenib group, the 1-, 2-and 3-year recurrence rates were 25%(6/24), 42%(10/24), 50%(12/24) respectively, and 28%(13/46), 46%(21/46), 53%(25/46) respectively in the control group. No signiifcant difference was observed between two groups (χ2=0.020, 0.102, 0.120;P>0.05). The 1-, 2-and 3-year cumulative survival rates in the sorafenib group were 95.83%, 87.50%and 70.83%, and no signiifcant difference was observed compared with 91.30%, 82.61%and 63.04%in the control group (χ2=0.078, P>0.05). In the sorafenib group, the incidence of hand-foot skin reaction, diarrhea, hypertension and erythema were 42%(10/24), 29%(7/24), 21%(5/24) and 25%(6/24), which were signiifcantly higher compared with 7%(3/46), 7%(3/46), 2%(1/46) and 4%(2/46) in the control group (χ2=10.663, 4.885, 4.828, 4.762;P<0.05). Conclusion Sorafenib can neither decrease postoperative recurrence of peimary liver cancer after radical surgery nor enhance the overall survival rate.

Objective To evaluate the effect of preoperative transarterial chemoembolization (TACE) for resectable hepatocellular carcinoma (HCC).Methods HCC patients undergoing up-front hepatectomy (group A) were compared with those receiving TACE before hepatectomy (group B).Results Tumor size decreased significantly after TACE (t =3.3 1,P =0.021).The rates of tumor encapsulation and liver adhesions were significantly more often seen in group B.There were fewer tumor-residual and more frequent necrosis in group B.Operative time in group B was longer (t =2.71 ,P =0.046).The average blood loss and complication rate were of no difference between the two groups.The occurrence of pleural effusion and intrahepatic recurrence rate in group A was higher than group B (x2 =3.85 ,P =0.031) (x2 =2.76,P =0.046).The overall survival rate from the second year postoperative in group B was higher than group A (x2 =3.37, P =0.043).Conclusions TACE could diminish tumor, advance encapsulation and reduce tumor-residual.Preoperative TACE does not improve 1-, 2-, and 3-year tumor-free survival rates but improve 1-, 2-, and 3-year overall survival rates.

Objective To evaluate the short-term and long-term elinical effect of hepatectomy using Tissue-Link & Cusa,compared to the Pringle maneuver.Methods Clinical data of 87 HCC patients who had received hepatectomy by the Pringle's Maneuver (group A) or Tissue-Link & Cusa (group B) were retrospectively analyzed.Results The average amount of bleeding in Group A was more than group B (t =2.030,P =0.023).The time of operation in group A was shorter than group B (t =-2.896,P =0.006).The postoperative supplement of albumin in group A was more than group B,the level of serum total bilirubin on 7th day after operation was higher than group B (P ＜ 0.05).There was no significant difference in postoperation complications and the time in hospital (P ＞0.05).The rate of incisional recurrence and the rate of metastasis in or out of the liver in group A were higher than group B (P =0.029,0.021,0.016).The 2-and 3-year tumor-free survival rates and the 3-year overall survival rates in group A were lower than that in group B (P =0.047,0.036,0.042).Conclusions Hepatectomy using Tissue-Link & Cusa is superior to the Pringle's maneuver for the treatment of primary hepatocellular carcinoma.It has a clear operative field,less operative bleeding,less damage to liver function and a lower relapse rate of incisional margin.

Objective To evaluate pigtail catheter mashing thrombosis combined with catheter directed thrombolysis in the treatment of acute iliofemoral venous thrombosis complicated by Cockett syndrome in the left lower limbs.Method Data of 137 cases of acute iliofemoral venous thrombosis complicated with Cockett syndrome in left lower limb by interventional therapy from January 2007 to October 2012 were analyzed retrospectively.Inferior vena cava filters were placed in all of the patients.Patients were divided into two groups:Group A (n =81) treated with catheter directed thrombolysis only,Group B (n =56) treated with pigtail catheter mashing thrombosis combined with catheter directed thrombolysis.After operation,patients were treated by anticoagulation with urokinase and heparin calcium,and then warfarin for 6 to 1 2 months.Results The thrombolysis time in group B was significantly shorter than that in group A (P ＜0.01),the dosage of urokinase was significantly less than that in group A(P ＜ 0.01).The venous patency score in group B after therapy was significantly better than in group A (P ＜ 0.01).121 patients were followed up for 10-60 months.There were no pulmonary embolism.Conclusions Pigtail catheter mashing thrombosis combined with catheter directed thrombolysis in the treatment of acute iliofemoral venous thrombosis complicated with Cockett syndrome in left lower limb can improve thrombolytic efficiency,shorten thrombolysis time,reduce the use of urokinase.

Objective To investigate the mechanism and effect of thalidomide on gastrointestinal bleeding of angiodysplasia. Methods The endothelial cells of human umbilical vein were cultured in vitro to exponential phase of growth, then were divided into blank control, solvent control and different concentrations (10- 100 μg/ml) of thalidomide incubated with or without basic fibroblast growth factor (bFGF). The cell proliferation was measured by MTT assay 72 h after stimulation. The expressions of vascular endothelial growth factor (VEGF) and tumor necrosis factor-α (TNF-α) were detected by ELISA and real-time PCR, respectively. Results The proliferation of endothelial cells of human umbilical vein was inhibited by thalidomide (≥40 μg/ml) both in presence or absence of bFGF. The expression of VEGF could be inhibited by 20 μg/ml of thalidomide in the absence of bFGF and 10 μg/ml in the presence of hFGF. No expression of TNF-α was detected. Conclusions The in vitro study reveals that thalidomide can inhibit the proliferation and the expression of VEGF, which may treat gastrointestinal bleeding of angiodysplasia by suppressing the angiogenesis.