Objective:To investigate the effect of bupivacaine liposome for erector spinae plane block on the quality of postoperative recovery in patients undergoing thoracoscopic lung resection.Methods:From July 2023 to January 2024, 128 American Society of Anesthesiologists Physical Status classification ⅠorⅡ patients of either sex, aged 18-75 yr, with body mass index of 18-32 kg/m 2, scheduled for elective thoracoscopic lung resection at the First Affiliated Hospital of Soochow University, were assigned to either bupivacaine liposome group (BL group) or bupivacaine hydrochloride group (BH group) using a random number table method, with 64 patients in each group. Patients received an ultrasound-guided erector spinae plane block following anesthesia induction. BL group received an injection of bupivacaine liposome 20 ml (266 mg) plus normal saline 10 ml, while BH group received an injection of bupivacaine hydrochloride 20 ml (100 mg) plus normal saline 10 ml. The primary outcome was the Quality of Recovery-15 (QoR-15) score at 24 h postoperatively. Secondary outcomes included the QoR-15 score at 3 days postoperatively, time to first patient-controlled analgesia press, and total opioid consumption within the first 3 days postoperatively. Other outcomes assessed were the time to ambulation, duration of chest tube placement, length of hospital stay, patient satisfaction scores at discharge, and development of adverse reactions during hospitalization. Results:Compared to BH group, QoR-15 scores were significantly increased at 24 h and 3 days postoperatively, the time to first patient-controlled analgesia press was significantly prolonged, the consumption of opioid was reduced within the first 3 days postoperatively, the time to ambulation was shortened, and patient satisfaction scores at discharge were increased in BL group ( P<0.05). There were no statistically significant differences between the two groups in terms of the chest tube duration, length of hospital stay, and incidence of adverse reactions during hospitalization ( P>0.05). Conclusions:Bupivacaine liposome for erector spinae plane block can improve the quality of postoperative recovery in patients undergoing thoracoscopic lung resection.

Objective:To investigate the diagnostic value of prenatal MRI in the detection of abnormal placental cord insertions (APCIs) comparing with prenatal ultrasound and pathological examination.Methods:A retrospective data collection was conducted on 440 patients who underwent both prenatal placental ultrasound and MRI at the Foshan Women and Children Hospital from December 2013 to December 2021. Among them, 37 cases were APCIs confirmed by surgery or pathology. The prenatal placental MRI findings were analyzed and compared with prenatal ultrasound diagnosis. The diagnostic efficacy of prenatal MRI and ultrasound in diagnosing APCIs was calculated.Results:Among the 37 cases of APCIs confirmed by surgery or pathology, 17 cases had marginal cord insertion (MCI), 13 cases had velamentous cord insertion (VCI), 5 cases had vasa previa (VP), and 2 cases had VCI combined with VP. The sensitivity and specificity of ultrasound diagnosis for APCIs were 59.5% (22/37) and 97.8% (394/403), respectively. The sensitivity and specificity of MRI diagnosis for APCIs were 86.5% (32/37) and 98.5% (397/403), respectively. Among the 37 cases of APCIs, prenatal MRI missed diagnosis of 2 cases of MCI, 2 cases of VCI, and misdiagnosed 1 case of VCI as an accessory placenta. MRI identified 10 cases of APCIs missed by ultrasound, including 5 cases of MCI, 2 cases of VP, 2 cases of VCI, and 1 case of combined VCI with VP. Additionally, ultrasound misdiagnosed 4 cases of APCIs, including 2 cases of VCI misdiagnosed as MCI and 2 cases of MCI misdiagnosed as VCI.Conclusions:For APCIs complicated with abnormalities of placental location or morphology, or placental accretion spectrum disease in late pregnancy, MRI has a higher diagnostic efficacy than ultrasound.

【Objective】 To establish an experimental method for detecting phagocytosis of sensitized red blood cells in vitro by flow cytometry. 【Methods】 Mononuclear cells were isolated from the peripheral blood of blood donors and cultured in a cell incubator for 1 hour, and then adherent monocytes were isolated and obtained. Di^b-positive red blood cells (RBCs) were labeled with PKH26 and then sensitized with IgG anti-Di^b. The sensitized RBCs were added to monocytes for in vitro phagocytosis assay. Monocytes were labeled with FITC anti-human CD14, then phagocytosis was measured by flow cytometry, and the phagocytic efficiency was calculated. The method was used to detect the phagocytic efficiency of monocytes on human IgG anti-D sensitized RBCs with different titers. 【Results】 The phagocytic efficiency of monocytes was averaged at 5% (1.2%~7.6%, SD 3.30) versus 81% (71.4%~92.7%, SD 8.65) in the negative versus positive control group, respectively. Phagocytic activity of monocytes mediated by anti-D was correlated with the antibody titer. The phagocytosis efficiency was within 10% when the antibody titer was lower than 32 and increased sharply when the titer was between 32 to 128, it entered a plateau and stabilized at 80% at the titer above 256. 【Conclusion】 A detection platform for detecting phagocytosis-sensitized RBCs in vitro by flow cytometry has been successfully established. It can be used to assess the clinical significance of red blood cell allotype or autologous IgG antibodies.

Objective:To explore the risk factors of bladder recurrence in patients with upper urinary tract urothelial carcinoma (upper tract urothelial carcinoma, UTUC).Methods:We retrospectively analyzed the data of 815 patients underwent radical nephroureterectomy for upper tract urothelial carcinoma between June 2009 to June 2019.There were 519 males and 340 females, aged from 26-93 years old(average 66.5±9.6 years old). 396 patients were renal pelvic caicinoma.463 patients were ureteral caicinoma.675 patients were accompanied with hydronephrosis.664 patients were accompanied with preoperative gross hematuria. Preoperative diagnostic ureteroscopy was performed in 323 cases.283 patients had the history of smoking.48 patients were con-comitant with bladder carcinoma at the first diagnosis. Univariate analysis and logistic multivariate regression analysis were used to investigate the risk factors for bladder recurrence after UTUC radical surgery.Results:Among the 859 patients, 407 (47.4%) had low-stage tumor (T is/T a/T 1), 452 (52.6%) had high-stage tumor (T 2-T 4), 110 (12.8%) had low-stage tumor (G 1/G 2), and 749 (87.2%) had high-stage tumor (G 3). 126 (17.2%) of 859 patients had relapse during the follow-up period, the average follow-up time was 17 months, the median recurrence time was 12 months, 101(80.1%) of the relapse occurred within 2 years after operation. In univariate analysis, lower tumor stage ( P=0.047), higher tumor grade ( P=0.043), preoperative hematuria symptom ( P=0.023) and preoperative diagnostic ureteroscopy ( P=0.002) were closely related to bladder recurrence. Taking the above factors into the logistic multivariate regression analysis showed that tumor staging T is/T s/T 1 ( B=0.476, P=0.019), tumor grade G 3( B=0.848, P=0.024), preoperative hematuria symptom ( B=0.521, P=0.048), preoperative diagnostic ureteroscopy( B=0.521, P=0.002) were independent risk factors of postoperative recurrence of bladder. Conclusion:lower tumor stage, higher tumor grade, preoperative hematuria symptom and preoperative diagnostic ureteroscopy are the independent risk factors of postoperative bladder recurrence in patients with UTUC. Routine intravesical chemotherapy should be performed in patients with UTUC with the above risk factors, and routine diagnostic ureteroscopy is not recommended.

Objective To study the biomechanical properties of porous titanium cages used for different lumbar interbody fusion surgeries. Methods The three-dimensional (3D) finite element model of the lumbar spine was constructed, and mechanical parameters of porous materials were obtained by mechanical test. The biomechanical properties of porous titanium cages in anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), direct lateral interbody fusion (DLIF) were compared. Results After lumbar interbody surgery, the predicted range of motion (ROM) and the maximum stress in cage of DLIF model and ALIF model were substantially lower than those of PLIF model and TLIF model. The maximum stress in endplate of DLIF model, ALIF model and TLIF model were obviously lower than that of PLIF model. Conclusions DLIF with the porous cage showed advantages in biomechanical properties, which was simple to operate and suitable for minimally invasive surgery in clinical practice. DLIF performed the superior comprehensive properties.

To investigate the clinical efficacy of sorafenib in the treatment of primary hepatic carcinoma (PHC) and its effects on serum vascular endothelial growth factor receptor -2 (VEGFR -2) and placental growth factor (PLGF) levels.Methods A total of 110 patients with a confirmed diagnosis of PHC who received treatment in Jinshan Hospital Affiliated to Fudan University from July 2014 to March 2016 were randomly and equally divided into observation group and control group .The control group was given routine treatment, while the observation group received sorafenib in addition to the routine treatment .Serum levels of VEGFR -2 and PLGF were measured by ELISA.Liver function parameters, aspartate aminotransferase (AST), prothrombin time (PT), total bilirubin (TBil), albumin (Alb), and alanine aminotransferase (ALT), were also recorded.Comparison of continuous data between groups was made by independent samples t -test, and the changes in continuous data after intervention in each group were evaluated by paired samples t -test.Comparison of categorical data between groups was made by chi -square test.Results The observation group showed significant reductions in serum VEGFR -2 and PLGF levels after treatment (VEGFR -2: 7053.2 ±1836.1 ng/L vs 8721.4 ±2427.8 ng/L, t =4.089, P <0.001; PLGF: 468.4 ±136.5 pg/ ml vs 656.8 ±191.4 pg/ml, t =5.975, P <0.001).After treatment, the observation group had significantly lower serum VEGFR -2 and PLGF levels than the control group (VEGFR -2: 7053.2 ±1836.1 ng/L vs 8097.5 ±2325.4 ng/L, t =2.64, P <0.05; PLGF: 468.4 ± 136.5 pg/ml vs 643.3 ±195.8 pg/ml, t =2.48, P <0.05).The observation group showed significant changes in serum AST and ALT lev - els after treatment (t =4.302 and 3.097, both P <0.05).After treatment, the observation group had significantly lower serum AST and ALT levels than the control group (t =2.56 and 2.39, both P <0.05).Compared with the control group, the observation group had better follow -up results, with a significantly increased disease control rate (27.3% vs 47.3% , χ2 =4.705, P =0.030), and had a significantly higher survival rate at 40 months after treatment (43.6% vs 69.1%, χ2 =7.245, P =0.007).Conclusion Sorafenib is effective in the treatment of PHC patients, as it can significantly reduce the serum levels of VEGFR -2 and PLGF, prolong the survival time of patients, and improve the prognosis of patients.

Objective To explore the relationship between the orbital fat volume and the age,gender,orbital anteroposterior and transverse diameter in healthy person.Methods 210 healthy person (105 males and 105 females)were enrolled and equally divided into 7 groups according to the age.The area of the orbital fat,orbital anteroposterior and transverse diameter in all the above groups were measured in axial CT images.Then the volume of the orbital fat were computed using equation.The relationship between the orbital fat volume and the age,gender,orbital anteroposterior and transverse diameter were analyzed in the different gender and age groups.Results The volume of orbital fat was symmetrical in all age groups,and the mean fat volume of bilateral orbital was(18 957±4 143)mm3,in which adults (age＞20 years old)had the average orbital fat volume (20 340±3 514)mm3.The mean values of the orbital anteroposterior and transverse diameter were (5.16±0.37)mm and (3.74±0.23)mm,respectively.The orbital fat volume in male was greater than that in female in all age group,in addition,it was positively correlated with the age,orbital oranteroposterior and transverse diameter (P＜0.001).Conclusion The orbital fat volumes are associated with the age,gender,orbital anteroposterior and transverse diameter in healthy person.In addition,the orbital fat volume in male is greater than that in female.

Objective: Vascular endothelial growth factor A (VEGFA) was investigated as the key protein which might promote the specific metastasis progress of nasopharyngeal carcinoma. Methods: Sixteen specimens of pulmonary metastasis carcinoma and counterparts in primary nasopharyngeal carcinoma tissue were collected from patients. The expression of VEGFA through immunohistochemistry was investigated.VEGFA was knocked down by siRNA in two cell lines of nasopharyngeal carcinoma (CNE-1 and 5-8F), MTT and Transwell test were used to explore the role of VEGFA in praxiology. Then shRNA was used to cultivate the stable CNE-1 cell line with down-regulated-expression of VEGFA. The nude mice models were built through tail vein injection of specific nasopharyngeal carcinoma cells, and lungs were collected to perform further metastasis analysis. Results: Previous genetic studies showed that VEGFA had higher expression in metastasis tissue, and the result was validated in the present study using immunohistochemistry. The percentage of positive cells was 84.8% in pulmonary metastasis group, 51.5% in primary tissue group (t=8.639, P<0.05), average optical density was 0.154 in pulmonary metastasis group, 0.061 in primary tissue group (t=18.791, P<0.05). Low expression of VEGFA inhibited cell viability of optical density value of CNE-1 in siRNA gourp was 0.715, 0.902 in control group (t=7.274, P<0.05); 5-8F in siRNA group was 0.715, 0.935 in control group (t=7.751, P<0.05). Number counting suppressed migration of CNE-1 in siRNA group was 52 per high-power lens, 124 per high-power lens in control group (t=29.380, P<0.05), 5-8F in siRNA group was 65 per high-power lens, 155 per high-power lens in control group (t=18.181, P<0.05). Number counting invasion of CNE-1 in siRNA gourp was 38 per high-power lens, 86 per high-power lens in control group (t=27.665, P<0.05), 5-8F in siRNA group was 52 per high-power lens, 116 per high-power lens in control group (t=40.972, P<0.05) in vitro. Furthermore, knock-down of VEGFA in nasopharyngeal carcinoma reduced the pulmonary metastasis in vivo. Number counting of tumor volumes in shRNA group was 2.4, and 11.0 in control group (t=6.143, P<0.05); average optical density of immunohistochemistry in shRNA group was 0.033, and 0.176 in control group (t=15.734, P<0.05). Conclusions Results above reveal the overexpression of VEGFA in nasopharyngeal carcinoma can facilitate the pulmonary metastasis. Targeting VEGFA may provide a new biomarker of clinical study.

BACKGROUND:Both high glucose and lipopolysaccharide have been proved to promote the apoptosis of human periodontal ligament fibroblasts (HPLFs), but their interactions on the HPLF apoptosis in vitro have not yet been reported. OBJECTIVE:To investigate the effect of different concentrations of lipopolysaccharide and high glucose on the proliferation, apoptosis and the expression levels of Bax and Bcl-2 in HPLFs in vitro. METHODS:The primarily cultured HPLFs were identified. The 5-8 generations of HPLFs were col ected and used in the subsequent experiment. The HPLFs were cultured in different concentrations of glucose (5.5 and 25 mmol/L) and lipopolysaccharide (0, 1 and 10 mg/L) for 24 and 48 hours, respectively. RESULTS AND CONCLUSION:Lipopolysaccharide (10 mg/L) could significantly inhibit the cel proliferation, promote the cel apoptosis, upregulate the expression levels of Bax and Bcl-2 mRNA and induce a significant decrease in Bcl-2/Bax ratio in the cel s cultured with 5.5 mmol/L glucose (P<0.05). The lipopolysaccharide-induced suppression of cel proliferation, cel apoptosis, the expressions of Bax and Bcl-2 mRNA as wel as decrease in Bcl-2/Bax ratio were significantly strengthened in the HPLFs treated with 25 mmol/L glucose (P<0.05). Analysis of variance found that high glucose and lipopolysaccharide had a significant interaction on the cel apoptosis (P<0.05). These results reveal that lipopolysaccharide-induced suppression of cel proliferation, cel apoptosis and the expressions of Bax and Bcl-2 mRNA are augmented in HPLFs cultured under high glucose condition, indicating lipopolysaccharide and high glucose interactively act in inducing cel apoptosis.

Objective The aim of this study was to investi-gate the changes of brain function in patients with drug-naive idiopath-ic epilepsy ( DNIE ) using resting-state functional MRI ( rs-fMRI ) amplitude of low-frequency fluctuation ( ALFF) , analyze the correlation of abnormal brain regions with the clinical variable ( disease course) , and gain a deeper insight into the pathophysiological mechanisms of idiopathic epilepsy. Methods This study included 25 cases of DNIE (15 males and 10 females) and 34 cases of drug idiopathic epilepsy (DIE, 22 males and 12 females).Another 25 healthy volunteers matched with the DNIE patients in sex, age, education and handedness were recruited as normal controls.The rs-fMRI data obtained from all the subjects were processed, subjected to ALFF analysis, and compared among the DNIE, DIE, and nor-mal control groups.The correlation was evaluated between the ALFF statistical brain mapping and the course of disease. Results Obvious differences were found in ALFF among the DNIE, DIE and control subjects.Compared with the normal controls, the DNIE pa-tients showed increased ALFF in the right inferior temporal gyrus, right lingual gyrus and right cuneus, but decreased ALFF in the right insula, left hippocampus, right midbrain, right middle frontal gyrus, left anterior cingulated gyrus, left middle cingulate gyrus and right inferior parietal lobule.In comparison with the DIE patients, those of the DNIE group exhibited increased ALFF in the left inferior occipital gyrus, right middle occipital gyrus and left middle occipital gyrus, but decreased ALFF in the right inferior frontal gyrus, left insula, right superior temporal gyrus and right middle frontal gyrus.In the DNIE patients, the disease course was found to be correlated positively with ALFF in the right cerebellum posterior lobe, left cerebellar tonsil, right lingual gyrus, left orbital gyrus, left middle oc-cipital gyrus, left corpus callosum, left caudate nuclear, left superior frontal gyrus, left medial frontal gyrus, right precuneus and left middle frontal gyrus, but negatively with ALFF in the right parahippocampal, right superior temporal gyrus, left superior temporal gyrus and right post-central gyrus. Conclusion The ALFF of resting-state cerebral function is abnormal in DNIE patients.The correlation between ALFF and the clinical variable ( disease course) provides a new insight into the pathophysiological mechanisms of epilepsy.