Objectives:To observe the incidence of residual shunt post patent foramen ovale(PFO)closure and the effect of PFO closure in these migraine patients at one year after PFO. Methods:This retrospective study included patients who underwent PFO closure for migraine in the Second Affiliated Hospital Zhejiang University School of Medicine from January 2019 to June 2022,patients were divided into the grade 0 shunt group(n=67),the grade Ⅰ shunt group(n=10),the grade Ⅱ shunt group(n=13)and the grade Ⅲ shunt group(n=16)according to the results of contrast transthoracic echocardiography(cTTE)at 1 year after PFO closure.The incidence of postoperative migraine attacks among different groups of patients were compared.The risk factors of residual shunt after PFO closure were explored. Results:The mean age of enrolled 106 patients with migraine was(35.80±11.70)years,of which 83 patients(78.30%)were female.One year after PFO closure,the migraine attack and rating scale were significantly decreased compared to baseline in the grade 0 shunt group,in the grade Ⅰ shunt group and in the grade Ⅱ shunt group(all P<0.05),but not in the grade Ⅲ shunt group(P>0.05).The rate of significant and complete migraine was significantly higher in the grade 0 shunt group(58.21%),in the gradeⅠ shunt group(60.00%),in the grade Ⅱ shunt group(69.23%)as compared to the grade Ⅲ shunt group(18.75%,P=0.02)at one year after PFO.The rate of grade 0 shunt after PFO closure in patients with the microvesicles appearing in≥6 cardiac cycles in resting state before operation was significantly lower than in patients with the microvesicles appearing within 6 cardiac cycles and no microvesicles in resting state(24.00%vs.83.87%vs.70.00%,P=0.04).Logistic multivariate regression analysis showed that patients with microvesicles appearing beyond 6 cardiac cycles in resting state were more likely to have residual shunts in postoperative cTTE compared to the patients with negative cTTE and microvesicles appearing within 6 cardiac cycles in the cTTE in resting state before operation(OR=0.06,95%CI:0.02-0.23,P<0.01;OR=0.014,95%CI:0.05-0.41,P<0.01). Conclusions:Migraine patients who underwent PFO closure and with grade 0 to grade Ⅱ residual shunt at one year after PFO are most likely to have significant remission of migraine,while the incidence of migraine remission is low in patients with grade Ⅲresidual shunt.The incidence of residual shunt after PFO closure is higher in patients with the microvesicles appearing in 6 cardiac cycles in resting state in the cTTE before operation than in patients with the microvesicles appearing within 6 cardiac cycles and no microvesicles.

Objective To investigate the effect of Lumbricus protein on the phenotypic transformation of corporal cavernosum smooth muscle cells(CCSMC)and erectile function in diabetic erectile dysfunction(DMED)rats.Methods Sixty male SD rats with normal erectile function were randomly divided into a blank group,a model group,a Sildelafil group(5 mg·kg-1),and a Lumbricus protein low-,medium-,and high-dose group(45,90,and 180 mg·kg-1),with 10 rats in each group.The diabetic rat model was established by intraperitoneal injection of Streptozotocin(STZ,50 mg·kg-1)combined with high-fat feed feeding;after 8 weeks,the DMED rat model was prepared by neck injection of Apomorphine(APO,100 μg·kg-1).After successful modeling,the rats were administered with a dose of Apomorphine by gavage once a day for 4 weeks.The blood glucose levels and body mass of rats in each group were measured before modeling,on the third day of modeling,and after 4 weeks of drug administration.The intracavernous pressure(ICP)and carotid artery pressure(MAP)were measured by multi-channel physiological recorder,and the ICP/MAP ratio was calculated.The expressions of contractile markers α-smooth muscle actin(α-SMA),smooth muscle myosin heavy chain(SMMHC)and synthetic markers Collagen I and osteopontin(OPN)in corpus cavernosum were detected by immunohistochemistry.The mRNA expression levels of α-SMA,SMMHC and Collagen I in corpus cavernosum were detected by RT-PCR.The protein expression levels of α-SMA,Desmin,Collagen I and OPN in corpus cavernosum were detected by Western Blot.Results Compared with the blank group,the blood glucose levels of the rats in the model group were significantly increased on the third day of modeling and after 4 weeks of administration(P＜0.01),and the body mass was significantly decreased after 4 weeks of administration(P＜0.01).ICP and ICP/MAP ratio were significantly decreased(P＜0.01).The protein expression levels of α-SMA,SMMHC and Desmin in penile corpus cavernosum were significantly decreased(P＜0.01),and the protein expression levels of Collagen I and OPN were significantly increased(P＜0.01).The mRNA expression levels of α-SMA and SMMHC in corpus cavernosum were significantly decreased(P＜0.01),and the mRNA expression level of Collagen I was significantly increased(P＜0.01).Compared with the model group,there was no significant change in blood glucose and body mass of rats in the administration group(P＞0.05).ICP and ICP/MAP ratio were significantly increased(P＜0.01).The expression levels of α-SMA,SMMHC and Desmin in corpus cavernosum were significantly increased(P＜0.01),while the expression levels of Collagen I and OPN were significantly decreased(P＜0.01).The mRNA expression levels of α-SMA and SMMHC in corpus cavernosum were significantly increased(P＜0.01),and the mRNA expression level of Collagen I was significantly decreased(P＜0.01).Conclusion Lumbricus protein can improve the erectile function of DMED rats,and its mechanism may be related to the inhibition of CCSMC from'contractile'to'synthetic(proliferative)'transformation.

Objective:To explore the application effect of ultrasound evaluation of atelectasis in general anesthesia.Methods:Eighty patients who underwent general anesthesia surgery at the Second Affiliated Hospital of Wannan Medical College from January 2019 to December 2020 were selected as the study subjects. The gold standard was chest CT diagnosis of perioperative atelectasis, and they were divided into atelectasis group (39 cases) and control group (41 cases). Twelve regional images, including left upper anterior chest, left lower anterior chest, right upper anterior chest, right lower anterior chest, left upper chest, left lower chest, right upper chest, right upper chest, right lower chest, right upper chest, right lower chest, right upper chest, right lower chest, right lower chest, right lower chest, left upper chest, right lower chest, left upper chest, right lower chest, left upper posterior region, left lower chest, left lower posterior region, left lower posterior region, right upper posterior region, and right lower posterior region, were collected by pulmonary ultrasound (LUS) at time points T 1 after entering the room, 30 minutes after tracheal intubation (T 2), 30 minutes after extubation (T 3), 24 hours after surgery (T 4), and 48 hours after surgery (T 5), And an improved semi quantitative scoring method for evaluating lung ventilation was used to compare the LUS scores of the two groups at 5 time points. Results:There was no statistically significant difference in LUS scores between the two groups of patients in different lung zones at T 1 (all P>0.05); There are varying degrees of differences in LUS scores for the same lung partition at different times (all P<0.05). There was no statistically significant difference in LUS scores between T 2 and T 5 for left upper anterior chest, left lower anterior chest, right upper anterior chest, left upper chest, right upper chest, left upper posterior region, and right upper posterior region (all P>0.05); The LUS scores of the T 2-T 5 atelectasis group in the lower left chest, lower right chest, lower left posterior area, and lower right posterior area were higher than those of the control group (all P<0.05). Conclusions:LUS can be used to evaluate atelectasis during general anesthesia and has broad clinical application and promotion value.

[Objective]To summarize the characteristics of MA Shi's refutations of WANG Bing's annotations in Suwen Zhuzheng Fawei(Commentaries and Discussions on Suwen of Yellow Emperor's Inner Canon),and analyze the relationship between MA's annotations and WANG's annotations.[Methods]After consulting the annotations of MA Shi refuting WANG Bing in Suwen Zhuzheng Fawei,this paper analyzes MA Shi's critical views on WANG's annotations,compares the different understandings of MA Shi and WANG Bing on scriptures,and summarizes the characteristics of MA's annotations from three aspects:expression of terms,method of interpreting scriptures and elucidation of medical theory.Finally it sums up the relationship between MA's annotations and WANG's annotations.[Results]When refuting WANG's annotations,MA Shi often used three types of words to express different degrees of refutation on WANG's annotations,which contained"opposed""superficial"and"lacking".The methods of interpreting scriptures can be summarized into five kinds of citation analysis and four levels of literary analysis,and the scriptures of Suwen and Lingshu were mostly cited as evidence.In the elucidation of medical theory,MA's annotations differed from WANG's in the understanding of theoretical scope,the analysis of theoretical connotation and the determination of acupoint position.[Conclusion]MA Shi used the more comprehensive interpretation methods,interpreted the scriptures from the broader theoretical level and refuted WANG's annotations,which not only formed a systematic way of interpreting the scriptures,but also inspired more possibilities of the meaning of the scriptures.MA's annotations had both critical inheritance and innovative development to WANG's annotations,which promoted the study of Suwen.

Objective:To analyze the fail mode of neoadjuvant therapy combined with surgery for locally advanced esophageal squamous cell carcinoma (ESCC) after long-term follow-up.Methods:Clinical data of consecutive 238 patients with locally advanced resectable ESCC who underwent neoadjuvant therapy combined with surgery in Zhejiang Cancer Hospital from September 2012 to October 2019 were retrospectively analyzed. The failure mode in the whole cohort was analyzed after long-term follow-up. The overall survival (OS) and disease free survival (DFS) rates were analyzed by Kaplan-Meier method. Survival differences were determined by log-rank test.Results:The pathological complete response (pCR) rate was 42.0% in 238 patients. After a median follow-up of 46.1 months, tumor progression occurred in 96 patients (40.3%), including 25 patients (10.5%) with local recurrence, 61 patients (25.6%) with distant metastases, and 10 patients (4.2%) with simultaneous local recurrence and distant metastases. The median OS and DFS were 64.7 months and 49.9 months. And the 3-, 5-, and 7-year OS and DFS rates were 70.0%, 52.8%, 36.4% and 63.5%, 42.5%, and 30.0%, respectively. The 3-, 5-, and 7-year locoregional recurrence-free survival rates and distant metastasis-free survival rates were 86.0%, 71.4%, 61.2% and 70.6%, 55.9%, 43.0%. Compared with non-pCR patients, the overall progression rate and distant metastasis rate of pCR patients were lower (26.0% vs. 50.7%, 16.0% vs. 32.6%, both P<0.05). And the 3-, 5-, and 7-year OS (83.0% vs. 60.2%, 69.7% vs. 41.7%, 50.4% vs. 27.7%, all P<0.001) and DFS rates (80.4% vs. 51.4%, 63.9% vs. 31.2%, 45.9% vs. 20.3%, all P<0.001) were significantly better in pCR patients. Conclusions:Distant metastasis is the main failure mode of patients with locally advanced ESCC after neoadjuvant therapy. Patients with postoperative pCR can achieve better long-term survival.

ObjectiveTo compare the efficacy and safety of acupuncture combined with auricular acupoints patches and nicotine transdermal patch in treating moderate to severe nicotine dependence. MethodsIn a rando-mized controlled trial， 64 quit smoking voluntary subjects with moderate to severe nicotine dependence were randomly divided at a ratio of 1∶1 into a treatment group and a control group， with 32 cases in each group. The treatment group was given acupuncture combined with auricular acupoints patches， twice weekly， four weeks as a course for two courses. The control group was given nicotine transdermal patch， one patch per day for 24 hours， 8 weeks. The cure rate was assessed after treatment and at follow-up （the 16th week after treatment）.The daily smoking volume， exhaled carbon monoxide （CO） value， Nicotine Dependence Scale （FTND）， Minnesota Nicotine Withdrawal Symptoms Scale （MNWS）， and Pittsburgh Sleepiness Index Inventory （PSQI） were evaluated before and after treatment and at follow-up， and adverse effects were recorded. ResultsIn terms of the cure rate， there were both six cured cases （20%） after treatment and at follow-up in the treatment group， while in the control group， seven （23.3%） and five （16.7%） patients were cured after treatment and at follow-up， respectively， with no statistically significant differences between the two groups both after treatment and at follow-up （P＞0.05）. The daily smoking volume and exhaled CO value significantly decreased after treatment and at follow-up in both groups （P＜0.05）， but were not significantly different between the groups after treatment and at follow-up （P＞0.05）. After treatment and at follow-up， FTND， MNWS， and PSQI scores were significantly reduced in both groups compared with those before treatment （P＜0.05）. There was no statistically significant difference in the FTND scale scores between the two groups after treatment and at follow-up （P＞0.05）， while the MNWS and PSQI scale scores were lower in the treatment group than in the control group （P＜0.05）. ConclusionAcupuncture combined with auricular acupoint patches for moderate to severe nicotine dependence has comparable effect with the first-line drug nicotine patch in terms of increasing the cure rate and decreasing the degree of nicotine dependence， and is superior to nicotine patch in terms of relieving withdrawal symptoms and improving sleep， with stable long-term effect.

Objective:To explore the effect of coronary injection of recombinant human prourokinase (rhPro-UK) during PCI for ST-segment elevation acute myocardial infarction (STEMI) patients.Methods:A total of 124 STEMI patients treated in Tangshan Gongren Hospital, Hebei Province from November 2018 to November 2019 were selected as the research objects.They were simply randomized by random number table method into the observation group(63 cases) and the control group(61 cases). Thrombus aspiration was used.The control group was treated with 25 μg/kg tirofiban, and the observation group was injected with 20 mg rhPro-UK into the coronary arteries.After that, both groups underwent emergency PCI treatment.The bleeding degree, myocardial microcirculation indexes, plasma fibrinolytic factor changes, vascular recanalization, ST segment fall of electrocardiogram and changes in left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular ejection fraction (LVEF), cardiac index (CI) were recorded.Results:The peak value of creatine kinase isoenzymes MB (CK-MB) (184.64±21.47) U/L and the peak time of CK-MB (14.32±2.02) h in the observation group were significantly lower than those in the control group((258.94±31.64) U/L, (16.58±2.09) h), the differences were statistically significant ( t=15.345 and 6.123, all P<0.001). After treatment, human tissue plasminogen activator (t-PA) (0.85±0.28) kU/L in the observation group was significantly higher than that in the control group (0.74±0.24) kU/L, human plasminogen activator inhibitor (PAI-1) (0.16±0.05) kU/L.compared with the control group (0.32±0.08) kU/L significantly decreased ( t=2.345, P=0.021; t=13.401, P<0.001); 77.78% (49/63) of the ST-segment complete fall in observation group was significantly higher than 54.10% (33/61) of the control group ( Z=7.758; P=0.005), and 4.76% (3/63) in the observation group without a fall in ST segment was significantly lower than 19.67% (12/61) of the control group ( Z=6.480; P=0.011). The LVEDD at 7 days, 14 days and the LVESD at 7 days and 14 days in the observation group were (49.37±3.14) mm, (48.34±3.03) mm, (33.19±2.23) mm and (32.05±2.23) mm respectively, which were significantly lower than those in the control group at 7 days, (50.64±3.03) mm, (49.66±2.83) mm, (34.86±1.73) mm and 14 days, (33.74±1.97) mm respectively ( P<0.05 or P<0.001). The LVEF of 7 days and 14 days after treatment were (56.32±4.97)% and (59.23±5.11)%, which were significantly higher than those of the control group (54.46±4.87)% and (57.18±4.33)% ( P<0.05 or P<0.001). CI at 7 days and 14 days after treatment were (3.65±0.22) L/ (min·m 2) and (3.76±0.21) L/(min·m 2), which were significantly higher than those of the control group (3.48±0.25) L/(min·m 2) and (3.56±0.24) L/(min·m 2)( P<0.05 or P<0.001). Conclusion:STEMI patients treated by intraoperative coronary injection of Rhpro-UK versus tirofeban, can further improve the total bleeding rate and the vascular recanalculation rate, and also significantly improve plasma fibrinolysis factor, myocardial microcirculation and cardiac function.This provides an alternative to the treatment of myocardial infarction in patients with STEMI.

The COVID-19 outbreak in China has been gradually controlled. At present, the management and risk assessment of asymptomatic infected cases has become an urgent problem to be addressed. Asymptomatic case is mainly detected by close contact screening, cluster epidemic investigation, infection source tracking investigation, and active detection of target population. Currently, research on the spread risk from asymptomatic cases was limited, and lacking the data relates to the distribution of asymptomatic cases in large community population. Pathogen detection using PCR is suitable for screening in close contacts of confirmed cases and should be started as early as possible. The antibody test is more suitable for screening in general population where the source of infection is unclear. The management of asymptomatic cases now in China focuses on isolation and medical observation according to the guideline of 'early detection, early report, early isolation and early treatment' .

Objective:To explore the operative effect and treatment strategies for the low distal humerus fracture.Methods:A retrospective analysis was conducted on the clinical data of 16 patients with the low distal humerus fracture between January 2016 and January 2018 at Department of Orthopaedics, Shanghai Tongji Hospital Affiliated to Tongji University.All fractures were coronal fractures of humeral head, partly combined fractures of humeral trochlea or posterior part. Fractures were classified according to Dubberley classification as 9 cases in type Ⅰ, 3 cases in typeⅡ and 4 cases in type Ⅲ.Selection of the kind of operative approach and internal fixation was made according to the fracture type and shape. For simple coronal fractures of humeral head or combining humeral trochlea fractures, which were relatively stable, single or multiple countersunk screws fixation by the lateral approach were chosen.For humeral head coronal fractures, which combining obviously displaced comminuted humeral trochlea factures, posterolateral locking plates and countersunk screws internal fixation by the olecranon osteotomy approach were chosen. The incision and elbow soft tissues were observed within 2 weeks after operation.The radiographic evaluation of fracture reduction, bone healing, internal fixation, arthritis and elbow range of motion were made at 3, 6, 12 months after operation. The Mayo elbow functional scores were documented for analysis of elbow joint function, and compared between different surgery groups by Kruskal-Wallis H test. Results:The follow-up time was (22.1±9.2)months(range: 15 to 39 months). The incisions healed well in 2 weeks after operation without soft tissue infection, necrosis or vascular complications. There was no fracture reduction loss or internal fixation loosening according to radiographic evaluation 3 months after operation. One case of ectopic ossification was observed 6 months after operation and inhibited by the treatment of non steroidal anti-inflammatory drugs.One case of ulnar neuritis occurred after operation and released after removing the long screw and loosing the ulnar.Osteoarthritis images were observed at the end of follow-up.Arc of motion was (120.4±11.2) ° in flexion and (5.5±1.9) ° in extension. The Mayo score was 88.7±9.1, including 11 excellent, 4 good, and 1 fair.The Mayo score was 90.1±3.7 in Dubberley classification type Ⅰcases, 89.7±4.6 in type Ⅱ cases and 84.5±5.8 in type Ⅲ cases. There were no significant differences in Mayo scores between 3 types cases according to Kruskal-Wallis H test. Conclusion:Choosing the appropriate surgical approach and composite internal fixation according to the fracture types and shapes of low distal humerus fracture, anatomic reduction of the articular surface and early functional exercise are the keys to obtain ideal curative effect.

Objective:To explore the operative effect and treatment strategies for the low distal humerus fracture.Methods:A retrospective analysis was conducted on the clinical data of 16 patients with the low distal humerus fracture between January 2016 and January 2018 at Department of Orthopaedics, Shanghai Tongji Hospital Affiliated to Tongji University.All fractures were coronal fractures of humeral head, partly combined fractures of humeral trochlea or posterior part. Fractures were classified according to Dubberley classification as 9 cases in type Ⅰ, 3 cases in typeⅡ and 4 cases in type Ⅲ.Selection of the kind of operative approach and internal fixation was made according to the fracture type and shape. For simple coronal fractures of humeral head or combining humeral trochlea fractures, which were relatively stable, single or multiple countersunk screws fixation by the lateral approach were chosen.For humeral head coronal fractures, which combining obviously displaced comminuted humeral trochlea factures, posterolateral locking plates and countersunk screws internal fixation by the olecranon osteotomy approach were chosen. The incision and elbow soft tissues were observed within 2 weeks after operation.The radiographic evaluation of fracture reduction, bone healing, internal fixation, arthritis and elbow range of motion were made at 3, 6, 12 months after operation. The Mayo elbow functional scores were documented for analysis of elbow joint function, and compared between different surgery groups by Kruskal-Wallis H test. Results:The follow-up time was (22.1±9.2)months(range: 15 to 39 months). The incisions healed well in 2 weeks after operation without soft tissue infection, necrosis or vascular complications. There was no fracture reduction loss or internal fixation loosening according to radiographic evaluation 3 months after operation. One case of ectopic ossification was observed 6 months after operation and inhibited by the treatment of non steroidal anti-inflammatory drugs.One case of ulnar neuritis occurred after operation and released after removing the long screw and loosing the ulnar.Osteoarthritis images were observed at the end of follow-up.Arc of motion was (120.4±11.2) ° in flexion and (5.5±1.9) ° in extension. The Mayo score was 88.7±9.1, including 11 excellent, 4 good, and 1 fair.The Mayo score was 90.1±3.7 in Dubberley classification type Ⅰcases, 89.7±4.6 in type Ⅱ cases and 84.5±5.8 in type Ⅲ cases. There were no significant differences in Mayo scores between 3 types cases according to Kruskal-Wallis H test. Conclusion:Choosing the appropriate surgical approach and composite internal fixation according to the fracture types and shapes of low distal humerus fracture, anatomic reduction of the articular surface and early functional exercise are the keys to obtain ideal curative effect.