Objective:To evaluate the impact of lymph node dissection in radical surgery on the prognosis for patients with stage T2b gallbladder cancer.Methods:Forty-seven patients undergoing radical surgery for T2b gallbladder cancer at Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from June 2009 to May 2020 were retrospectively analyzed, including 17 males and 30 females, aged 68(58, 72) years old. According to the extent of lymph node dissection, patients were divided into the regional lymph node dissection group ( n=28) and extended lymph node dissection group ( n=19). Clinical data including the level of carbohydrate antigen 19-9 (CA19-9), fashions of liver parenchymal resection, and postoperative complications were recorded. Survival follow-up was conducted through telephone or outpatient review. Survival analysis was conducted using Kaplan-Meier method and compared using the log-rank test. Cox regression analysis was used to identify the risk factors of overall survival. Results:Compared to regional lymph node dissection, the extended lymph node dissection group had a longer operative time [195(167, 220) min vs. 165(152, 175) min] and a greater number of lymph nodes dissected [12(9, 14) vs. 8(7, 9)] (both P<0.05). The postoperative complication rates of the two groups were 14.3%(4/28) and 21.1%(4/19), respectively ( P=0.697). The cumulative postoperative 1-, 3-, and 5-year survival rates were 96.4%, 59.4%, and 52.8% in regional lymph node dissection group, and 84.2%, 62.7%, and 43.0% in extended lymph node dissection group, respectively, with no significant difference ( P=0.643). Multivariate Cox regression analysis indicated that CA19-9>40 IU/ml ( HR=2.98, 95% CI: 1.24-7.18, P=0.014), wedge resection of the liver ( HR=4.01, 95% CI: 1.36-11.87, P=0.011), and positive lymph node ( HR=2.99, 95% CI: 1.22-7.34, P=0.016) were independent risk factors for poor prognosis in patients with stage T2b gallbladder cancer. Conclusion:Compared with regional lymphadenectomy, extended lymphadenectomy does not improve the overall survival of patients with stage T2b gallbladder cancer.

Objective To study the feasibility and safety of right ventricular angiography(RVG)to as-sist pacing in the left bundle branch region(LBBaP).Methods The retrospective study was adopted.A total of 67 patients receiving LBBaP in this hospital from January 2019 to June 2022 were included as the study sub-jects.The basic information of the patients was collected,including the sex,age,clinical diagnosis,EKG pa-rameters,etc.The RVG three-stage adjuvant LBBaP was adopted.The specific operation was to perform RVG under the right anterior oblique perspective of 30°.A straight line was connected between the highest point of the tricuspid valvular ring and the apex of the right ventricle,and then the straight line was divided into 3 e-qual parts.The proximal junction was the LBBaP electrode implantation area.The success of LBBaP operation was defined as the simultaneous satisfaction of right bundle branch block form of QRS wave in unipolar pa-cing,QRS wave width(QRSd)＜130 ms and peak time of left ventricular excitation＜90 ms.The operation related parameters and occurrence situation of complications were recorded.The follow up was conducted in 1,3,6,12 months.The electrode parameters,electrocardiogram and color Doppler ultrasound results were recor-ded.Results Among 67 patients,43 cases were males aged(65.0±8.0)years old;twenty-two cases(32.8％)were symptomatic sick sinus syndrome,and 45 cases(67.2％)were second-degree type Ⅱ and above atrioven-tricular block.The preoperative QRS width(QRSd)was(103.0±22.0)ms.The LBBaP operation success was in 61 cases(91.0％).The operation time was(134.6±32.3)min,and the X-ray exposure time was(43.6±12.6)min.The pace-making threshold value was(0.8±0.4)V,the R wave perception amplitude was(12.1±4.7)mV,and the impedance was(741.2±130.8)Ω.At 1 V pacing,the peak time of left ventricular activation in the lead V5 was(83.4±13.7)ms.The postoperative QRSd was(116.5±18.3)ms.During the operation,8 cases developed interventricular septal perforation and 1 case developed bundle branch injury.No other serious complications occurred.After 12 months of follow-up,all patients had stable electrode parame-ters.Conclusion RVG three-stage adjuvant LBBaP is a simple,feasible and safe physiological pacing method.

Radical cystectomy combined with pelvic lymph node dissection is the standard procedure for the treatment of muscle invasive bladder cancer and complex non-muscle invasive bladder cancer.Our department has routinely carried out laparoscopic radical cystectomy(ELRC)through the extraperitoneal approach in 340 cases.This article summarizes the establishment of the peritoneal space,the expansion of the peritoneal space,the operation steps of bladder resection and lymph node dissection through the peritoneal channel,and how to shorten the operation time and reduce the difficulty of the operation.During the surgery,the bladder is removed periperitoneally without destroying the peritoneum to preserve the functions of peritoneum support,secretion,protection and lubrication,which has little impact on the abdominal organs,reduces the incidence of complications,and provides favorable conditions for subsequent treatment.

OBJECTIVE: To investigate the effectiveness of finger reconstruction using nail flap anastomosing the nerve branch of the first toe nail bed. METHODS: Between January 2016 and December 2022, 18 patients (18 fingers) with thumb or finger nail bed defects were admitted. There were 12 males and 6 females, with an average age of 32 years (range, 19-42 years). Four cases were finger tip tissue damage caused by machine compression, and 4 cases were distal tissue necrosis after finger replantation. There were 9 cases of thumb injury, 3 cases of index finger injury, 5 cases of middle finger injury, and 1 case of ring finger injury. There were 11 cases of distal nail damage and 7 cases of distal nail root (including nail root) damage. The time from injury to admission was 1-5 hours, with an average of 2 hours. After debridement and anti-infection treatment for 5-7 days, the wounds in size of 1 cm×1 cm to 4 cm×3 cm were reconstructed by using nail flaps anastomosing the nerve branches of the first toe nail bed. The size of the nail flaps ranged from 1.5 cm×1.5 cm to 4.5 cm×3.5 cm. The donor sites were repaired with the flaps in 16 cases and skin graft in 2 cases. RESULTS: All nail flaps, flaps, and skin grafts survived after operation and the wounds healed by first intention. All patients were followed up 6-12 months (mean, 10 months). The nails of 18 cases were all grown, in which 16 cases had smooth nails with satisfactory appearances, 1 case had uneven nails, and 1 case had obvious scar hyperplasia around the suture opening. At 6 months after operation, the two-point discrimination of the skin flap was 4-8 mm (mean, 6 mm). Meanwhile, the skin grafts and flaps at the donor sites regained protective sensation, good abrasion resistance, and had no negative effect upon walking and wearing shoes. CONCLUSION The application of a nail flap that anastomoses the nerve branch of the first toe nail bed for finger reconstruction has minimal damage and can achieve good nail bed repair results.
Male ; Female ; Humans ; Adult ; Nails/injuries* ; Plastic Surgery Procedures ; Finger Injuries/surgery* ; Surgical Flaps/innervation* ; Skin Transplantation/methods* ; Toes/injuries* ; Soft Tissue Injuries/surgery* ; Treatment Outcome

【Objective】 To explore the safety and efficacy of a modified one-piece posterior laparoscopic total nephroureterectomy with cystic sleeve resection in the treatment of upper urinary tract uroepithelial carcinoma (UTUC). 【Methods】 A total of 24 patients treated during Jan. and Jun. 2022 were involved, including 16 males and 8 females, aged 62 to 90 (average 73) years. The UTUC was in the left side in 15 cases, and in the right side in 9 cases. There were 10 cases of renal pelvis tumor, 6 cases of upper ureteral tumor and 8 cases of lower ureteral tumor. 【Results】 All operations were successful without conversion to open surgery. The operation time ranged from 60 to 100 minutes, average (71.25±9.80) minutes. The intraoperative bleeding volume was 20 to 200 mL, average (30.03±8.13) mL. No significant intraoperative or postoperative complications occurred. The postoperative hospital stay was 4 to 7 days, average (5.83±1.44) days. Bladder perfusion chemotherapy was performed after surgery. 【Conclusion】 The modified one-piece posterior laparoscopic total nephroureterectomy plus cystic sleeve resection for UTUC is an effective and feasible procedure with satisfactory tumor control, which is worth further promotion in clinical practice.

Gallbladder cancer is the most common biliary malignancy and has a poor prognosis.How to effectively improve the prognosis of gallbladder cancer patients is still an urgent problem for surgeons to solve.The solution to the problem depends on the early screening and intervention of gallbladder cancer,precise surgical treatment plan and effective comprehensive treatment measures.However,there are still many controversies in these aspects,and more high-quality clinical research,basic research and basic-clinical transformation research are still needed to improve the diagnosis and treatment system of gallbladder cancer in the future.

Objective:To investigate the clinical effect of self-designed modified rhomboid flap in repairing rhomboid, round, and teardrop-shaped wounds on the face.Methods:A retrospective observational study was conducted. From August 2018 to April 2020, 30 patients with facial lesions admitted into Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the People's Hospital of Jianchuan County in Yunnan province met the inclusion criteria, including 16 males and 14 females, aged 23 to 88 years. The wound area ranged from 1.0 cm×1.0 cm to 7.0 cm×5.0 cm, with 10 cases of rhomboid wounds, 12 cases of round wounds, and 8 cases of teardrop-shaped wounds. The self-designed modified rhomboid flaps were applied to repair the wounds and after that, the patients were followed up for 1 to 18 months to record the survival of flaps, wound tension, scar formation and complications after surgery.Results:No necrosis or blackening was observed at the tip of the flaps after surgery. All the flaps survived and the wounds healed well with little tension, minimal scars, and no complications.Conclusions:The self-designed modified rhomboid flap is especially suitable for facial wounds with multiple important organs, multiple anatomical subunits, and areas with large changes in soft tissue tension, which can reduce not only the rotation of the flap, but also unnecessary excision of normal skin and soft tissue.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can cause acute respiratory distress syndrome, hypercoagulability, hypertension, and multiorgan dysfunction. Effective antivirals with safe clinical profile are urgently needed to improve the overall prognosis. In an analysis of a randomly collected cohort of 124 patients with COVID-19, we found that hypercoagulability as indicated by elevated concentrations of D-dimers was associated with disease severity. By virtual screening of a U.S. FDA approved drug library, we identified an anticoagulation agent dipyridamole (DIP) , which suppressed SARS-CoV-2 replication . In a proof-of-concept trial involving 31 patients with COVID-19, DIP supplementation was associated with significantly decreased concentrations of D-dimers ( < 0.05), increased lymphocyte and platelet recovery in the circulation, and markedly improved clinical outcomes in comparison to the control patients. In particular, all 8 of the DIP-treated severely ill patients showed remarkable improvement: 7 patients (87.5%) achieved clinical cure and were discharged from the hospitals while the remaining 1 patient (12.5%) was in clinical remission.

Paraneoplastic neurological syndromes (PNS) are a rare group of immune-mediated disorders that affect the central and peripheral neuromuscular system in association with cancer.If the limbal lobe system of the brain is involved,it will show paraneoplastic limbal encephalitis(PLE).The discern of patients with PNS is challenging since tumors causing paraneoplastic neurologic disorders are often asymptomatic and sometimes occult.We report a case of PLE with double positive anti-Hu and Yo antibodies,and further analyze and discuss it in conmbination with relevant literature to improve the understanding of the disease.

Objective·To establish a reliable alcoholic liver disease mouse model (ALDNM) that mimics the drinking pattern of alcoholic liver disease (ALD) patients.Methods·Using the self-designed feeding tubes and liquid diet,ALDNM model was developed through chronic feeding combined with acute gavage of ethanol based on Lieber-DeCarli model and Gao-Binge model.C57BL/6 mice were administered with control liquid diet for adaptation for first 5 d,and then divided into pair-fed group and ethanol-fed group (10 mice each group).Ethanol-fed mice were fed with the liquid diet in which ethanol accounts for 30％ of total energy,while the pair-fed mice were fed with the control diet for 10 d.At the 16th day,ethanol-fed mice and pair-fed mice were respectively gavaged a single dose of 31.5％ ethanol or isocaloric maltose dextrin,and euthanized 9 h later.Sera and livers were collected.The general physiological condition,hepatic tissue pathological changes and serum indexes between Lieber-DeCarli models and ALDNM models were compared.The liver lipids of ALDNM mice were determined by Oil red O (ORO) staining and hepatic triacylglyceride (TAG) test.Meanwhile,the mRNA levels of interleukin-6 (IL-6),tumor necrosis factor α (TNF-α),fatty acid synthase (Fas),long chain fatty acid elongase 6 (Elovl6) and stearyl-CoA desaturase (Scdl) were detected by real-time PCR in ALDNM models.Western blotting was used to detect the changes of phosphorylated signal transduction and transcriptional activator (p-STAT3) in the livers.Results·Lieber-DeCarli model mice were generally in poor condition,and there was no significant change in serum glutamic-pyruvic transaminase (GPT) and glutamic-oxaloacetic transaminase (GOT) compared to pair-fed group.However,in ALDNM models,H-E staining showed that the hepatocytes of ethanol-fed mice were extremely swollen with round volume,increased cytoplasm and filled with large amounts of fat vacuoles.ORO staining analyses showed obvious microsteatosis in the liver cells from all ethanol-fed mice.The hepatosomatic index,liver TAG content,serum GPT and GOT of ALDNM models were significantly higher than those in the pair-fed group,while the serum HDL significantly decreased compared to the pair-fed group.Moreover,the expression levels of both lipid synthesis pathways and inflammatory signaling pathways related genes in livers significantly increased in the ethanol-fed mice of ALDNM model.Conclusion·ALDNM model was successfully constructed.This model is cost-and time-efficient.Moreover,ALDNM model mimics the drinking pattern and pathogenesis of ALD patients with the advantages of stable food intake,good repeatability,and obvious liver damage.