Objective To discuss the application of 3D printing technology in the adjuvant treatment of complex Stanford type B aortic dissection(SBAD)and abdominal aortic aneurysm.Methods The clinical data of 64 patients with complex SBAD and 64 patients with abdominal aortic aneurysm,who were admitted to the Mianyang No.404 Hospital of China from January 2022 to January 2024,were retrospectively analyzed.Of the 64 patients with complex SBAD,33 received preoperative 3D printing adjuvant treatment(observation group Ⅰ)and 31 received preoperative routine examination(control group Ⅰ).Of the 64 patients with abdominal aortic aneurysm,32 received preoperative 3D printing adjuvant treatment(observation group Ⅱ)and 32 received preoperative routine examination(control group Ⅱ).The changes in left-right diameter(LR)and anterior-posterior diameter(AP)of anatomical structure in observation group Ⅰ and observation group Ⅱ were analyzed.The perioperative situations were compared between observation group Ⅰ and control group Ⅰ,as well as between observation groupⅡ and control group Ⅱ.Results In patients with complex SBAD,LR of descending aorta diaphragm in S2(STL model)was significantly higher than that in S1(CTA image)and S3(plastic model,P＜0.05),and AP of descending aorta diaphragm in S2 was higher than that in S3(P＜0.05).LR of brachiocephalic trunk in S3 was significantly lower than that in S1 and S2(P＜0.05),AP of brachiocephalic trunk in S3 stage was significantly higher than that in S1 and S2(P＜0.05),and AP of brachiocephalic trunk in S2 was higher than that in S1(P＜0.05).LR of left common carotid artery in S3 was significantly higher than that in S1 and S2(P＜0.05),LR of left common carotid artery in S2 was higher than that in S1(P＜0.05),and AP of left common carotid artery in S3 was lower than that in S1(P＜0.05).LR and AP of left subclavian artery in S3 were significantly higher than those in S1 and S2(P＜0.05).In patients with abdominal aortic aneurysm,LR and AP of tumor neck in S3 were significantly higher than those in S1(P＜0.05),and AP of aneurysm neck in S3 was significantly higher than that in S2(P＜0.05).LR and AP of aneurysm in S3 and S2 were significantly higher than those in S1(P＜0.05),and LR and AP of aneurysm in S3 were significantly higher than those in S2(P＜0.05).LR of abdominal aortic bifurcation in S3 and S2 was significantly higher than that in S1(P＜0.05),LR of abdominal aortic bifurcation in S3 was significantly higher than that in S2(P＜0.05),and AP of abdominal aortic bifurcation in S3 was significantly lower than that in S1(P＜0.05).AP of left common iliac artery in S3 was significantly lower than that in S1(P＜0.05).In the observation group Ⅰ,the operation time,endovascular operation time and length of hospital stay were significantly shorter than those in the control group Ⅰ(P＜0.05),and the intraoperative blood loss and used dosage of contrast agent were lower than those in the control group Ⅰ(P＜0.05).In observation group Ⅱ,the operation time,endovascular operation time and length of hospital stay were significantly shorter than those in the control group Ⅱ(P＜0.05),and the intraoperative blood loss and used dosage of contrast agent were lower than those in the control group Ⅱ(P＜0.05).In patients with complex SBAD or abdominal aortic aneurysm,there was no internal leakage or stent displacement at 6 months after surgery.Conclusion Adjuvant treatment with 3D printing technology is helpful for improving anatomical structure measurement of lesion sites in patients with complex SBAD and abdominal aortic aneurysm.Preoperative 3D plastic model preview surgery is helpful for shortening the operation time and length of hospital stay and reducing the used dosage of contrast agent without affecting surgical treatment effect.

Objective:It is yet to be clarified whether pylorus-preserving gastrectomy (PPG) for early gastric cancer will bring the risk of radical tumor resection, whether it will increase the incidence of postoperative complications, and how much is the benefit of the quality of life for patients after surgery, these issues are not clear. This meta-analysis aims to evaluate the efficacy and safety of pylorus-preserving gastrectomy (PPG) for early middle gastric cancer.Methods:The Chinese and English literatures about PPG and distal gastrectomy (DG) for early gastric cancer were searched from PubMed, Embase, The Cochrane Library, Web of Science, CNKI net and Wanfang database. Literature inclusion criteria: (1) Prospective or retrospective cohort study of PPG and DG for early middle-third gastric cancer published publicly; (2) Patients with early middle-third gastric cancer; (3) The enrolled literatures include at least one of the following outcome indicators: the efficacy indicators include gallstone, residual gastritis, bile reflux, delayed gastric emptying, dumping syndrome, reflux esophagitis and overall complication; the long-term prognostic indicators include 5-year survival rate and 5-year tumor recurrence. Literature exclusion criteria: (1) Reviews, case reports, conference summaries and other non-control studies; (2) Repeated published studies, incomplete studies and unextractable studies; (3) The depth of tumor invasion exceeding submucosa. The search time ended in July 2020. The basic information and evaluation indicators included in the article were extracted. The retrospective study was evaluated using Newcastle-Ottawa literature quality evaluation scale. The prospective randomized controlled study was evaluated using Jadad modified scale. Meta-analysis was performed using Review Manager 5.3. Publication bias was assessed using funnel map. Publication bias was tested using Egger tools.Results:A total of 717 literatures were retrieved, and 17 literatures were enrolled finally, including 2 randomized controlled trials and 15 retrospective studies. A total of 2427 patients were enrolled, including 948 in PPG group and 1479 in DG group. The meta-analysis of the efficacy indicators showed that there were significant differences in gallstones incidence (OR=0.42, 95% CI: 0.28-0.65, P<0.001), residual gastritis incidence (OR=0.50, 95% CI: 0.32-0.77, P=0.002), bile reflux incidence (OR=0.30, 95% CI: 0.20-0.45, P<0.001), delayed gastric emptying incidence (OR=2.40, 95% CI:1.67-3.45, P<0.001), and postoperative dumping syndrome incidence (OR=0.28, 95% CI: 0.15-0.51, P<0.001), while there were no significant differences in postoperative overall complications (OR=0.97, 95% CI: 0.69-1.35, P=0.840), reflux esophagitis incidence (OR=0.79, 95% CI: 0.39-1.61, P=0.520) between the two groups. The meta-analysis of the long-term prognostic indicators showed that no significant differences of 5-year survival (OR=1.02, 95% CI: 0.61-1.71, P=0.940) or 5-year tumor recurrence (OR=0.77, 95% CI: 0.36-1.68, P=0.520) were observed between the two groups. Conclusion:The incidences of gallstone, residual gastritis, dumping syndrome, bile reflux are lower after PPG in early gastric cancer, while the postoperative overall complications and long-term survival are comparable between PPG and DG, indicating that PPG is quite safe and feasible.

Objective:It is yet to be clarified whether pylorus-preserving gastrectomy (PPG) for early gastric cancer will bring the risk of radical tumor resection, whether it will increase the incidence of postoperative complications, and how much is the benefit of the quality of life for patients after surgery, these issues are not clear. This meta-analysis aims to evaluate the efficacy and safety of pylorus-preserving gastrectomy (PPG) for early middle gastric cancer.Methods:The Chinese and English literatures about PPG and distal gastrectomy (DG) for early gastric cancer were searched from PubMed, Embase, The Cochrane Library, Web of Science, CNKI net and Wanfang database. Literature inclusion criteria: (1) Prospective or retrospective cohort study of PPG and DG for early middle-third gastric cancer published publicly; (2) Patients with early middle-third gastric cancer; (3) The enrolled literatures include at least one of the following outcome indicators: the efficacy indicators include gallstone, residual gastritis, bile reflux, delayed gastric emptying, dumping syndrome, reflux esophagitis and overall complication; the long-term prognostic indicators include 5-year survival rate and 5-year tumor recurrence. Literature exclusion criteria: (1) Reviews, case reports, conference summaries and other non-control studies; (2) Repeated published studies, incomplete studies and unextractable studies; (3) The depth of tumor invasion exceeding submucosa. The search time ended in July 2020. The basic information and evaluation indicators included in the article were extracted. The retrospective study was evaluated using Newcastle-Ottawa literature quality evaluation scale. The prospective randomized controlled study was evaluated using Jadad modified scale. Meta-analysis was performed using Review Manager 5.3. Publication bias was assessed using funnel map. Publication bias was tested using Egger tools.Results:A total of 717 literatures were retrieved, and 17 literatures were enrolled finally, including 2 randomized controlled trials and 15 retrospective studies. A total of 2427 patients were enrolled, including 948 in PPG group and 1479 in DG group. The meta-analysis of the efficacy indicators showed that there were significant differences in gallstones incidence (OR=0.42, 95% CI: 0.28-0.65, P<0.001), residual gastritis incidence (OR=0.50, 95% CI: 0.32-0.77, P=0.002), bile reflux incidence (OR=0.30, 95% CI: 0.20-0.45, P<0.001), delayed gastric emptying incidence (OR=2.40, 95% CI:1.67-3.45, P<0.001), and postoperative dumping syndrome incidence (OR=0.28, 95% CI: 0.15-0.51, P<0.001), while there were no significant differences in postoperative overall complications (OR=0.97, 95% CI: 0.69-1.35, P=0.840), reflux esophagitis incidence (OR=0.79, 95% CI: 0.39-1.61, P=0.520) between the two groups. The meta-analysis of the long-term prognostic indicators showed that no significant differences of 5-year survival (OR=1.02, 95% CI: 0.61-1.71, P=0.940) or 5-year tumor recurrence (OR=0.77, 95% CI: 0.36-1.68, P=0.520) were observed between the two groups. Conclusion:The incidences of gallstone, residual gastritis, dumping syndrome, bile reflux are lower after PPG in early gastric cancer, while the postoperative overall complications and long-term survival are comparable between PPG and DG, indicating that PPG is quite safe and feasible.

OBJECTIVE: To explore the diagnostic value of magnetic resonance imaging(MRI) in anal fistula. METHODS: A total of 2160 patients were clinically diagnosed with anal fistula at the Sixth Affiliated Hospital of Sun Yat-sen University from March 2010 to September 2015. Among them, 232 cases with operative history at other hospital, 218 with Crohn's disease, 6 with rectum cancer and 8 with other disease were excluded, and 1696 patients were finally enrolled and retrospectively analyzed. The saggital FSE T2WI imaging was confirmed based on the midline of body, and then the coronal and axial scanning line were confirmed. The key point was that the coronal scanning line must parallel and the axial scanning line must be perpendicular to the major axis of anal canal. The characteristics of anal fistula were recorded, and anal fistula were classified as five types, including intersphincteric, transphincteric, suprasphincteric, extrasphincteric and superficial fistula according to the Parks classification and our experience. The distribution of internal opening was described by using lithotomy position clock method. RESULTS: Of 1696 patients, 1456 were males and 240 females with median age of 26.5 (0.2 to 87.0) years. Age of 8.4% (143/1696) cases was under 20 years old, of 57.4%(973/1696) cases was between 20 to 40, of 28.4%(482/1696) cases was between 40 to 60, of 5.8%(98/1696) cases was over 60. The 1696 MR examinations included 1128 on 1.5T MR and 568 on 0.5T MR. Of all the anal fistulas was 29.0%(492) high position and 71.0%(1204) was low position. Among the 1696 patients, 1057 were intersphincteric fistulas(62.3%), 407 were transphincteric fistulas(24.0%), 68 were suprasphincteric fistulas(4.0%), 54 were extrasphincteric fistulas (3.2%), 67 were superficial fistulas(4.0%), and 43(2.5%) were difficult to classify. A total of 1996 internal openings were found and most of them were located around the dentate line of 5-7 o'clock in lithotomy position(47.7%, 952/1996). CONCLUSIONS Anal fistula mainly occur in young men, and the most common type is intersphincteric fistula. MRI can accurately classify anal fistulas and clearly demonstrate internal openings, and provide reliable evidence for clinical treatment and surgery.
Adult ; Aged ; Aged, 80 and over ; Anal Canal ; diagnostic imaging ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Rectal Fistula ; classification ; diagnostic imaging ; Retrospective Studies ; Young Adult

Objective To analyze retrospectively the impact of different heart rates on image quality and radiation dose of coronary angiography using 640-slice dynamic volume CT.Methods A total of 461 patients with suspected coronary artery disease or referred to health check underwent coronary angiography with 640-slice dynamic volume CT.Two groups were created according to their heart rates:Group A had heart rate < 65 beats per minute (n=337)and Group B had heart rate between 65 to 122 beats per minute (n=124).Image quality was assessed by analyzing the 1 5 segments of the main coronary branches using 3-grade scale (grade I-good,grade Ⅱ-acceptable,grade Ⅲ-poor).Effective radiation dose was also evaluated.Results Patients in both A group and B group performed successful CT coronary angiography with a total of 6 91 5 coronary segments.Among them,coronary segments that could be evaluated reliably accounted for 94.5% (6 535/6 91 5)while 5.5% (380/6 91 5)were too small (≤1.5 mm)to be assessed. For the image quality,Group A and Group B had grade I in 90.5% (305/337)vs 74.2% (92 /124),grade Ⅱ in 9.5% (32/337)vs 21.0% (26 / 124)and grade Ⅲ in 0 % (0 / 337 )vs 4.8% (6 / 124),respectively.Image quality was significantly different be-tween Group A and Group B (P <0.001).In addition,32 patients (9.5%)in Group A had slight cardiac motion artifacts but with-out affecting image quality,whereas 26 patients (21.0%)in Group B had higher degree of cardiac motion artifacts thus graded as grade Ⅱ.Stair-step artifacts were not found in all patients.The effective radiation dose was higher in Group B than in Group A by 32.05%(7.91±0.34 mSv vs 5.99±0.17 mSv).Conclusion Coronary angiography using 640-slice dynamic volume CT can guarantee excellent image quality when heart rate < 65 beats per minute.Although the image quality would decrease in some extent it is still diagnostic when heart rate is between 65 to 122(include 65 and 122)beats per minute.

Objective To investigate the protective effect and cytosolic phospholipase A2 (cPLA2) associated mechanism of panax notoginseng saponins (PNS) in spinal cord hemisection injured rats. Methods 55 adult Sprague-Dawley rats were randomly divided into three groups: sham group (n=5), spinal cord injury group (n=25) and PNS group (n=25). The rats were evaluated with BBB score, pathology and immunohistochemistry 1 d, 3 d, 7 d, 14 d and 21 d after intervention. Results Compared to the spinal cord injury group, motor recovery was significantly better in PNS group 3 d, 7 d, 14 d and 21 d after intervention (P<0.05). Nissl staining showed less neuron necrosis and more integrated neural cells in morphology in PNS group 7 d, 14 d and 21 d after intervention. Cytosolic phospholipase A2 (cPLA2) expression was inhabited, and less number of positive cells were found in PNS group 7 d, 14 d and 21 d after intervention. Conclusion PNS can inhibit the expression of cPLA2 after spinal cord injury, which may be one of the mechanisms of its effect on promoting motor recovery.

Objective To investigate the protective effect and associated mechanism of PNS in spinal cord hemisection injury.Methods fifty-five adult SD rats were randomly divided into three groups,sham group(n =5),spinal cord injury group(n =25),PNS group(n =25).The rats were evaluated in behavioral test with BBB score,pathology and immunohistochemistry at 1 d,3d,7d,14d,21d after the procedures.Results Motor recovery was significantly better in PNS group than the spinal cord injury group at 3d,7d,14d and 21d.Nissl staining showed less neuron necrosis and more integrated neural cells in morphology.cPLA2 expression was inhabited in PNS group,and less number of positive cells were found in the group.Conclusion PNS can inhibit the expression of cPLA2 after spinal cord injury,which may be one of the mechanisms of its effect on promoting motor recovery.

Objective To investigate the effect of Tenascin-C on remodeling of ventricle in mice with chronic autoimmune myocarditis.Methods Seventy-five specific pathogen-free BALB/c mice were divided into experimental group(n=45)and control group(n=30).Animals in experimental group were immunized with an emulsion of polypeptides(myhc-? 614-629)and complete Freund's adjuvant(CFA)on day 1 and day 8,while those in control group with equal volume of mixture of phosphate buffer solution(PBS)and CFA.Groups of mice were sacrificed respectively on day 21,day 75 and day 120 after the first immunization.Hematoxylin and eosin(H-E)staining was used to identify the areas of inflammation,and Masson staining was used to identify the areas of fibrosis.The Tenascin-C protein expression in myocardium was detected by Western blotting.The content of serum procollagen type-Ⅲ amino-terminal propeptide(PⅢNP)was measured by radioimmunoassay.The correlation between Tenascin-C protein expression and content of serum PⅢNP was analyzed.Results On day 21,inflammatory infiltration in the myocardium was remarkable,with slight deposition of collagen in the interstitial tissue.On day 75 and day 120,inflammatory infiltration in myocardium was markedly reduced,but with more marked deposition of collagen.The Tenascin-C protein expression in myocardium and the content of serum PⅢNP were significantly higher in experimental group than in control group(P