With the aging population, the burden of diseases such as atrial fibrillation and venous thrombosis is gradually increasing. Anticoagulant therapy has a positive significance in preventing ischemic stroke, pulmonary embolism, and other related conditions in these patients. However, anticoagulant therapy can have the opposite effect on diseases caused by intracranial hemorrhage, such as falls in the elderly, cerebrovascular accidents, and car accidents. It is still difficult to determine whether and when to restart anticoagulation after cerebral hemorrhage. Although most studies have shown that restarting anticoagulant therapy can reduce stroke risk without significantly increasing bleeding risk, they are mostly based on observational studies, so more high-quality research is needed to guide clinical decision-making. This article reviews the research progress on restart anticoagulation, aiming to provide some assistance for clinical applications.

Venous thromboembolism is a common comorbidity in neurosurgery department that can lead to life-threatening pulmonary embolism, endangering patient health. The unique characteristics of neurosurgical conditions often present a high risk of bleeding, which complicates the treatment of venous thrombosis. Although numerous observational studies and meta-analyses support the feasibility of initiating early anticoagulation prevention or treatment after hemorrhage stabilization in intracranial hemorrhagic conditions such as traumatic brain injury and cerebral hemorrhage, there is a lack of high-quality clinical research. As a result, neurosurgeons tend to adopt a conservative approach regarding pharmacological prophylaxis and anticoagulant treatment for venous thromboembolism. Key aspects such as the timing of prevention, monitoring, and discontinuation of treatment still require high-quality research to establish definitive guidelines.

Gastroesophageal reflux disease is a series of intraesophageal and/or extraesophageal symptoms caused by the reflux of gastric contents into the esophagus because of abnormal structure and function of gastroesophageal junction. Acid suppression therapy is the preferred treatment, but most patients with gastroesophageal reflux disease have poor symptom control or excessive dose for drug control, resulting in low quality of life. With the renewal of endoscopic equipment, endoscopic adjuvant therapy is attracting the attention of clinical physicians and patients owing to minimal trauma, rapid recovery, obvious symptom control, and few complications. This paper reviews endoscopic adjuvant therapy.

Objective:To explore the effect of early pulmonary rehabilitation management model in elderly critically ill patients with mechanical ventilation.Methods:Using convenience sampling, 64 elderly critically ill patients with mechanical ventilation in the Intensive Care Unit (ICU) of the First People's Hospital of Hefei from June to December 2019 were selected as the control group, and 64 elderly critically ill patients with mechanical ventilation in the ICU of the First People's Hospital of Hefei from January to July 2020 were selected as the experimental group. The control group carried out routine nursing, and the experimental group implemented the early pulmonary rehabilitation management model on the basis of routine nursing. The pulmonary function indicators, invasive mechanical ventilation time, ICU stay and cost, delirium incidence, ventilator associated pneumonia (VAP) incidence, outcome and satisfaction of patients and their families were compared between the two groups.Results:The pulmonary function indicators of patients in the experimental group were better than those in the control group, and the difference was statistically significant ( P<0.01) . The invasive mechanical ventilation time and ICU stay of the experimental group were shorter than those of the control group, and the ICU cost was lower than that of the control group, and the differences were statistically significant ( P<0.01) . The incidence of delirium and VAP in the experimental group was lower than those in the control group, and the number of outcome cases was more than that in the control group, and the differences were statistically significant ( P<0.05) . The satisfaction of patients and their families in the experimental group was higher than that in the control group with a statistically significant difference ( P<0.05) . Conclusions:The implementation of the early pulmonary rehabilitation management model can effectively improve the pulmonary function of the elderly critically ill patients with mechanical ventilation, reduce the occurrence of complications and the patient's family financial burden, and increase the satisfaction of patients and their families, which is feasible and extendable.

Gastroparesis is a neuromuscular disease characterized by nausea and vomiting, early postprandial satiety, abdominal pain and distention.Drug therapy mainly includes gastric motility drugs such as metoclopramide and domperidone.Most patients responded well to drugs in the early stage, and some patients developed severe drug-resistant symptoms.Based on the pathogenesis of gastroparesis and the development of endoscopy technology, the current treatment methods for drug-refractory gastroparesis include gastric electrical stimulation, botulinum toxin injection, pyloric stent, gastric per-oral endoscopic pyloromyotomy, etc.This article will briefly describe the endoscopy-assisted treatment of gastroparesis.

Deep brain stimulation is widely used for treatment of neuropsychiatric diseases, showing its unique advantages in the treatment of central nervous diseases, such as epilepsy, Parkinson's disease, essential tremor, drug-refractory psychiatric diseases, drug-refractory pain, improvement of arousal and cognitive functions, and addiction diseases. After more than 30 years of clinical research, animal experiments and material research, the scopes and modes of DBS use have been fully developed, and important progress has been made in seeking better stimulation targets and modes. The complexity and individuality of the disease lead to differences in the response of each patient to DBS treatment, so it is necessary to further clarify its mechanism of action and explore better therapeutic targets and parameters to meet higher clinical requirements. This paper reviews the clinical application of DBS as follows.

Objective To compare the effectiveness and safety of ultramini percutaneous nephrolithotomy (UMP) and retrograde intrarenal surgery (RIRS) in treatment of moderate-sized (about 1-2 cm) renal lower caliceal calculi.Methods From March 2015 to December 2016,patients in our hospital scheduled for surgery due to renal lower caliceal calculi with the greatest diameter of 10-22 mm were prospectively analyzed.Patients were randomized into two groups according to the random number table.Group UMP's operational channel was only F14 and the nephroscope's diameter was 1 mm.200 μm holmium laser lithotripsy was used to break the stones which was rushed out by eddy cuurent.In Group RIRS,all patients needed placing a F6 double J stent preoperatively for two weeks.A flexible ureteroscope sheath required imbedding intraoperatively.The stones were smashed by 200 μm holmium laser lithotripsy through the WOLF flexible ureteroscope.The intraoperative and postoperative datas including stone-free status and the complications were compared.Results 100 patients were enrolled in the study 50 patients in Group UMP,28 were male and 22 were female,mean age was 43.4 ± 7.9 years old.Mean stone size was 14.5 ±3.0 mm(range 10-22 mm).Among them,18 cases were complicated with mild and moderate hydronephrosis.The other 50 cases were allocated to Group RIRS,including 31 males and 19 females.Their mean age was 44.5 ± 8.3 years old and mean stone size was 13.7 ± 3.1 mm (range 10-21 mm).Among them,16 cases were complicated with mild and moderate hydronephrosis.No statistically significant difference were seen between the two groups (P ＞ 0.05).After three months' follow-up,one-time stone free rate(SFR) of UMP group was 94.0％ (47/50),which was significantly more superior than the 72.0％ (36/50) of the RIRS group(P ＜ 0.05).The intraoperative decrease in hemoglobin were (7.8 ± 3.3) g/L vs.(3.1 ± 3.4) g/L,and operating time(26.5 ± 6.1) min vs.(43.3 ± 6.3) min.Significant differences were also seen between the two groups(P ＜0.05).There was more blood loss and less operating time in the group of UMP.The hospital stay,delayed hemorrhage and postoperative fever between the UMP and RIRS groups were (4.3±1.3)d vs.(3.24 ± 1.21)d,8.0％ (4/50)vs.0(0/50),16.0％ (8/50)vs.12.0％ (6/50) respectively.No significant differences were seen (P ＞ 0.05).Conclusions Both UMP and RIRS procedures are effective and safe in the treatment of moderate-sized renal lower caliceal calculi.Compared with RIRS,UMP may be more effective and has less operating time,however wtih more intraoperative blood loss.

Objective: To observe the expression of long-chain non-coding RNA (lncRNA) RP3-340N1.2 in breast cancer tissues and its effect on proliferation and migration of breast cancer MCF-7 cells, and to explore the possible mechanism. Methods: 13 pairs of breast cancer tissues and adjacent tissues from breast cancer patients, who underwent radical surgery at the Cancer Center of theAffiliated People’s Hospital of Hubei University of Medicine from Jan. 2017 to Sep. 2017, were collected for this study. qRT-PCR was used to detect the differential expression of RP3-340N1.2 in collected tissue samples and breast cancer cell lines and normal breast epithelial cell line. RP3-340N1.2 plasmid (experimental group) and the negative control plasmid (control group) were transfected into breast cancer MCF-7 cells using Lipofectamine 3000. Cell counting (CCK-8) and Transwell migration assay were used to examine the effect of RP3-340N1.2 over-expression on proliferation and migration of MCF7 cells, the effect of RP3-340N1.2 over-expression on the mRNA expression of miR-134-5p and OPCML was detected by qRT-PCR, and Western blotting was used to detect the expression of OPCML protein. Results: The expression of RP3-340N1.2 in breast cancer tissues was significantly lower than that in adjacent tissues ( P <0.01), and the expression of RP3-340N1.2 in breast cancer cell lines was significantly lower than that in normal breast epithelial cells ( P < 0.01). Up-regulation of RP3-340N1.2 decreased the proliferation and migration of MCF7 cells (all P <0.05). After over-expression of RP3-340N1.2 in MCF7 cells, the expression of miR-134-5p obviously decreased ( P <0.01); moreover, the mRNA and protein expressions of OPCML significantly increased ( P <0.01) while the expressions of cell cycle regulatory proteins (CDK4, Cyclin D2) and cell migration regulatory proteins (Vimentin and N-cadherin) decreased significantly (all P <0.01). Conclusion: RP3-340N1.2 is low expressed in breast cancer tissues and cell lines. Up-regulation of RP3-340N1.2 expression can lead to decreased expression of miR-1345p and increased expression of OPCML gene, thereby inhibiting the proliferation and migration of breast cancer cells.

Objective This study was to analyze the early and long-term effect of completion pneumonectomy.Methods Retrospective analysis was made on the patients who underwent completion pneummonectomy in Shanghai Chest Hospital.Results There were totally 56 cases patients underwent completion pneumonectomy during January 2003 to July 2013.Among them,45 patients received CCP,and other 11 patients received RCP.CCP refers to the complete removal of lung tissue remaining after an initial ipsilateral partial pulmonary resection.RCP refers to the complete removal of residual lung due to the severe complications after pneumonectomy.The mortality and morbidity rate of CCP were 4.4％ and 33.3％ respectively.In the case of CCP,the incidence of benign lesions is significantly higher than the incidence of malignant tumor(80.0％ vs 27.5％,P =0.04).The mortality and morbidity rate of RCP were 27.3％ and 90.9％ respectively.In the case of RCP,higher postoperative mortality often occurs in aged patients (P =0.046) and patients with preoperatie mechanical ventilation (P =0.03).Overall five-year survival rate for patients with benign lesions was 80％,and for malignant lung cancer patients,the number was 30％.Survival time differs according to the TNM staging(a median of 60.0 months,35.0 months,10.0 months,stage Ⅰ,stage Ⅱ,stage Ⅲ,P ＜0.01),and survival rate was higher when the time interval(between the initial pulmonary resection and the completion pneumonectomy) ＞ 2 years(a median of 60.0 months,18.0 months,P ＜ 0.01).Conclusion Completion pneumonectomy is a high-risk surgery,especially RCP.Advanced age and preoperative mechanical ventilation are associated with higher postoperative mortality rate for RCP.As for CCP,higher postoperative risk exists in patients with benign lesions,but the survival rate is also higher.In patients with malignant lung tumor,survival rate is higher when the time interval (between the initial pulmonary resection and the completion pneumonectomy) ＞2 year.

The shortage of donor lung remains one of the major problem for lung transplantation?With the development of modern lung preservation and repair technique, increasing marginal lung donors have been re?assessed and finally utilized for transplantation? The ex vivo lung perfusion technique ( EVLP ) was designed and has been developed for evaluation and repair of the lung? Nowadays, the indication of EVLP and the standard of qualified donor lung have reached a consensus according to the foreign publications? The EVLP system could be classified into three categories: the Toronto technique, the Lund technique and Hannover?Madrid technique? The major differences between the Toronto technique and the other two technique are the open left atrium status, the use of Steen solution mixed with erythrocyte and the perfusion at flows correspondent to 100% of the donor predicted cardiac output? With the accumulating experience, researchers have tried to imply some drugs in the circulation, modify the ventilation gas and delivery of adenoviral vector gene in order to improve the lung quality? But these are still in the research phase? Recently, the portable EVLP device has been developed and the lung preservation, assessment and repair could be conducted during transportation? So it could prolong the preservation time and expand the transportation distance of donor lung.