OBJECTIVE To evaluate the efficacy， safety and cost-effectiveness of apixaban in the prevention and treatment of cancer-associated venous thromboembolism （CA-VTE）， and provide evidence-based reference for clinical treatment. METHODS Retrieved from PubMed， the Cochrane Library， CNKI， Wanfang， VIP database and other websites of health technology assessment （HTA）， systematic review/meta-analysis， pharmacoeconomic studies and HTA reports of apixaban in the prevention and treatment of CA-VTE were collected. After data extraction and quality evaluation， the results of the included study were analyzed descriptively. RESULTS A total of 23 literatures were included， involving 16 systematic review/meta-analysis and 7 pharmacoeconomic studies. In terms of efficacy， compared with placebo， prophylactic use of apixaban could significantly reduce the incidence of venous thromboembolism （VTE） in outpatient adult cancer patients receiving chemotherapy （P＜0.05）. Compared with low-molecular weight heparin （LMWH）， rivaroxaban and warfarin， there were no statistically significant differences in the incidence of VTE for apixaban （P＞0.05）； nevertheless， apixaban was ranked as the most preferable choice. For the treatment of patients with CA-VTE， compared with warfarin， apixaban could significantly reduce the recurrence rate of VTE （P＜0.05）. While compared with patients treated with LMWH， rivaroxaban， edoxaban and dabigatran， there were no statistically significant differences in the recurrence rates of VTE， deep venous thrombosis and pulmonary embolism among patients using apixaban （P＞0.05）. In terms of safety， compared with placebo， prophylactic use of apixaban showed a higher occurrence of major bleeding in outpatient adult cancer patients receiving chemotherapy （P＜0.05）， while compared withpatients treated with LMWH， rivaroxaban， and warfarin， there were no statistically significant differences in the incidence of major bleeding among patients using apixaban （P＞0.05）； despite this， apixaban was ranked as the most favorable option. For the treatment of patients with CA-VTE， compared with dalteparin， the incidence of major bleeding and all-cause mortality of apixaban were similar （P＞0.05）， while the incidence of clinically relevant non-major bleeding （CRNMB） was higher （P＜0.05）. Compared with edoxaban， the incidence of major bleeding of apixaban was reduced significantly （P＜0.05）， while there was no significant difference in the incidence of CRNMB， the incidence of clinically relevant bleeding and all-cause mortality （P＞0.05）. Compared with rivaroxaban， warfarin and dabigatran， there were no significant differences in the incidence of major bleeding， the incidence of CRNMB， the incidence of clinically relevant bleeding and all-cause mortality （P＞0.05）. In terms of cost-effectiveness， the researches in China showed that apixaban was cost-effective in preventing CA-VTE； foreign studies showed that apixaban was cost-effective in preventing and treating CA-VTE. CONCLUSIONS Apixaban is effective， safe and cost- effective in the prevention and treatment of CA-VTE.

Objective To determine the time point when porcine pancreatic elastase(PPE)induced abdominal aortic aneurysm(AAA)reaches the regression phase in mice and observe the histological characteristics of AAA in regression phase.Methods AAAs were induced by transient intraluminal infusion of PPE in C57BL/6J mice.The diameters of the mouse abdominal aortas were measured before PPE infusion and sacrifice time,day 14 for AAA progression phase or day 56 for regression phase after PPE infusion,respectively.The histological characteristics of the aneurysm lesion site on day 14 and day 56 after surgery were compared and analyzed.Results The diameters of the abdominal aortas were significantly increased in both day 14 and day 56 after PPE infusion groups(diameter growth rate 147％and 155％,respectively)as compared to the baseline diameters.In the day 14 group,the infused aortas showed typical AAA characteristics,such as elastin break/degradation,medial smooth muscle cells depletion,and inflammatory cell diffused infiltration.In the day 56 group after PPE infusion,although the artery diameter did not change significantly as compared to the day 14 group,histology showed that elastin was partially repaired,new smooth muscle cells were added to the damaged aorta media,the infiltrated inflammatory cells were significantly subsided,and the adventitia neovascularization was reduced,showing a significant feature of the disease regression phase.Conclusion In the PPE-induced mouse AAA model,day 56 after surgery is an appropriate time point for observing aneurysm regression,and the histological characteristics of the regression are obvious.

Objective To develop a rapid and accurate Monte Carlo program(simplified code for dosimetry of carbon ions,SPEEDO)for carbon ion therapy.Methods For electromagnetic process,type Ⅱ condensed history simulation scheme and continuous slowing down approximation were used to simulate energy straggling,range straggling,multiple scattering,and ionization processes.For nuclear interaction,5 types of target nuclei were considered,including hydrogen,carbon,nitrogen,oxygen,and calcium.The produced secondary charged particles followed the same condensed history framework.The study simulated the transport of carbon ions in 4 materials(water,soft tissues,lung,and bone),and the calculated doses were validated against TOPAS(a Monte Carlo simulation software for radiotherapy physics),followed by a comparison with dose measurements in a water phantom from the HIMM-WW(a medical heavy-ion accelerator facility in Wuwei).Results SPEEDO's simulation results showed good consistency with TOPAS.For each material,in the voxel region where the physical dose was greater than 10％of the maximum dose point,the relative maximum dose error of both was less than 2％.At treatment energy of 400 MeV/u,SPEEDO's computation time was significantly less than that of TOPAS(13.8 min vs 105.0 min).SPEEDO's calculation results also showed good agreement with HIMM-WW measurements in terms of lateral dose distribution and integrated dose depth curve.Conclusion SPEEDO program can accurately and rapidly perform Monte Carlo dose calculations for carbon-ion therapy.

Objective To develop a GPU-based Monte Carlo dose calculation module for helical tomotherapy(TOMO),and integrate it into the commercial software ArcherQA to achieve fast and accurate dose verification in clinic.Methods The TOMO treatment head was modeled using TOPAS to obtain phase space files,and a fast weight tuning algorithm was used to simulate particle transport in multi-leaf collimator for improving computational efficiency,and finally,GPU-based Monte Carlo algorithms in ArcherQA were used to simulate particle transport in patients.To verify the model accuracy,the ArcherQA calculated results in water tank were compared with measured data for different open fields.In addition,multiple comparisons among ArcherQA results,TPS results and ArcCHECK results were conducted on 15 clinical cases(5 cases in the head and neck,5 cases in the chest and abdomen,and 5 cases in the whole body).Results In the water tank tests for 40 cm×5.0 cm,40 cm×2.5 cm and 40 cm× 1.0 cm radiation fields,the average global relative errors of the percentage depth dose,transverse dose distribution,and longitudinal dose distribution calculated by ArcherQA with the corresponding measured values were 0.72％,0.66％,and 0.54％,respectively.Over 98％of the voxels had a global relative error of less than 1％.As for 15 clinical cases,in 2％/2 mm criteria,the mean Gamma passing rate was 98.1％between ArcherQA and TPS,99.1％between TPS and ArcCHECK,and 99.4％between ArcherQA and ArcCHECK.The uncertainty of the simulation maintained less than 1％,and the average time taken for calculation based on patient CT vs ArcCHECK phantom was 87 s vs 64 s.Conclusion ArcherQA can be used for independent dose validation for TOMO plans for it can provide fast and accurate dose calculations.

【Objective】 To compare the histological characteristics of porcine pancreatic elastase （PPE） induced abdominal aortic aneurysms （AAA） and angiotensin Ⅱ （AngⅡ） induced AAA in mice. 【Methods】 In the PPE group， the mouse abdominal aorta segment from the infrarenal abdominal aorta to the iliac artery was isolated and its branch arteries were ligated to avoid leakage during PPE perfusion. We perfused the isolated aorta segment with a PPE solution at a concentration of 1.5 U/mL for 5 min and then closed the abdominal cavity. The diameter of the abdominal aorta was measured before and 14 days after the surgery， and the perfusion segment of the arteries was collected at day 14 after the surgery. The histological characteristics of the aneurysm were analyzed and graded by histological and immunohistochemical methods. In the AngⅡ group， ten apolipoprotein E knockout mice were prepared， and AngⅡ [1 000 ng/(kg·min)] was infused with osmotic pumps for 28 days. The aorta was separated and the aneurysm aorta segment was analyzed. The wild type mice were used as normal health controls. 【Results】 In the PPE group， the diameter of the PPE perfused aorta segments increased and was significantly larger than the basal diameter ［（0.52±0.02） mm vs. （1.23±0.11） mm］ at day 14 after surgery. All the ten mice developed AAA after PPE application. The histological results showed typical pathological features of AAA in PPE perfused mice， such as elastic fiber breakage， smooth muscle exhaustion， and increased inflammation. Six of the ten mice developed aneurysms after AngⅡ infusion （6/10）. The aneurysms/dilatations were mostly in the suprarenal abdominal aorta， but also in the thoracic aorta and aortic arch. The histology analysis showed that the formation of arterial dissection was common after AngⅡ infusion， and the typical vascular “false lumen” was found. The breakage of elastic fibers， the exhaustion of smooth muscle damage， and the inflammatory response were not as typical as the PPE model in AngⅡ perfused animals. 【Conclusion】 The histological characteristics of PPE induced AAA are very typical and well present the inflammatory process in the development of aneurysm. The AngⅡ model is suitable for the study of aneurysms combined with aortic dissection. Both models have their own advantages and can complement each other.

OBJECTIVE：To systematic ally ev aluate the efficacy and safety of benralizumab in the treatment of severe eosinophilic asthma ，and to provide evidenced-based reference for clinical treatment. METHODS ：Retrieved from PubMed ， Embase，Cochrane Library ，ClinicalTrials.gov，CNKI，VIP and Wanfang database ，randomized controlled trials （RCTs）about benralizumab+routine treatment （trial group ）versus placebo+routine treatment （control group ）were collected during the inception to Dec. 2020. The relevant references were also retrieved manually. After data extraction ，the quality of included literatures was evaluated with bias risk evaluation tool 2.0 recommended by Cochrane systematic evaluator manual 6.1. Meta-analysis was conducted by using Rev Man 5.4 software. RESULTS ：Totally 5 studies involving 2 646 patients were included. Results of Meta-analysis showed that acute exacerbation rate of asthma [RR ＝0.67，95％ CI（0.61，0.74），P＜0.000 01]，asthma control questionnaire score [MD ＝－0.29，95％CI（－0.37，－0.21），P＜0.000 01] and the incidence of severe adverse event [RR ＝0.67，95％CI （0.53，0.84），P＝0.000 6] in trial group were significantly lower than control group. FEV 1[MD＝0.13，95％CI（0.09，0.17），P＜0.000 01] and asthma quality of life questionnaire score [MD ＝0.23，95％CI（0.13，0.33），P＜0.000 01] in trial group were significantly higher than control group. There was no statistical significance in the incidence of adverse event between 2 groups [RR ＝0.97，95％CI （0.92，1.02），P＝0.28]. CONCLUSIONS ：Benralizumab is effective and safe in the treatment of severe eosinophilic asthma. Due to the relatively limited data ，this conclusion needs to be confirmed by more studies.

Objective To investigate the clinical application value of fluorescence laparoscopy in radical resection of hepatocellular carcinoma (HCC).Methods Data of totally 113 patients with HCC in Henan Provincial People's Hospital between June 2016 to June 2018 were retrospectively analyzed.Among the 113 patients,46 patients underwent laparoscopic hepatectomy (LLR),and 67 patients underwent fluorescence guided laparoscopic hepatectomy (FLLR).Results No significant differences were observed between LLR group and FLLR group in terms of age,male proportion,liver function classification,surgical resection methods,and operation time (P＞0.05).The positive ratio of specimen surgical margin in LLR group was significantly higher than that in FLLR group,13.0％ vs.3.0％,and the difference was statistically significant (P＜0.05).In the FLLR group,22 patients received fluorescence guided anatomic hepatectomy with indocyanine green (ICG),10 with positive staining and 12 with negative staining,and fluorescence imaging was observed 2 minutes after ICG injection.There was no significant difference in operation time,hospitalization cost and length of stay between positive and negative staining (P＞ 0.05).Conclusion Fluorescence laparoscopy has certain advantages in hepatectomy,and can display the boundary of hepatocellular carcinoma in real time to ensure the safe margin of tumor resection.

Objective To evaluate hepato-intestinal anastomosis in the treatment of complex stricture of high bile duct.Methods From Jan 2010 to Dec 2016,43 patients undergoing traditional biliary-intestinal anastomosis were grouped into control,45 patients undergoing hepato-intestinal anastomosis were allocated into study group.Results (1) Control vs study grounp,the operative time was (24 ±3)min vs.(15 ± 3)min,intraoperative blood loss and blood transfusion were (384 ± 51)ml vs.(280 ± 41) ml,(649 ± 3) ml vs.(454 ± 8) ml,number of patients with intraoperative blood transfusion,and liver resection were 10 vs.3,and 8 vs.3 respectively,with statistically differences (t =12.48,10.46,144.65,x2 =43.68,49.50,all P ＜ 0.05).(2) Postoperatively efficacy:fever was in 7 vs.3 cases,incision infection in 5 vs.3 cases,abdominal infection was in 5 vs.2 cases,biliary fistula was in 7 vs.3 cases,number of un-planed readmission was in 7 vs.3 cases,and postoperative hospital stay were (14.3 ± 1.5) d vs.(10.7 ± 0.7) d,respectively,between the control group and the study group,with statistically differences (x2 =52.55,58.91,62.23,52.55,52.55,t =16.28,all P ＜0.05).(3) Follow-up situation:all the 88 patients were followed-up for 6 to 96 months (median time,30 months).Biliary restenosis occurred in 5 vs.1 patients between the control group and the study group,respectively,with statistically differences (x2 =65.64,P ＜ 0.05).Conclusions Hepato-intestinal anastomosis is effective in the treatment of complex stricture of high bile duct.

Objective To study the anterior versus the posterolateral approach for laparoscopic splenectomy for patients with chronic pancreatitis-induced regional portal hypertension (PRPH).Methods The retrospective cohort study was carried out on 62 patients who underwent laparoscopic splenectomy for PRPH at the Peoples' Hospital of Zhengzhou University from Jan 2010 to Jun 2016.The patients were divided into 2 groups:the anterior approach group and the posterolateral approach group,and to compare the differences.Results The operation time,amounts of intraoperative non-splenic blood loss,duration of recovery of intestinal peristalsis,duration of drainage,and duration of postoperative hospital stay were (135.0 ± 12.8) minvs (126.0± 13.1) min,(323.7±50.9) ml vs (245.1 ±35.0) ml,(25.5±2.5) h vs (23.5±3.3) h,(5.7±1.0) dvs (3.2±1.3) dand (9.3±1.5) dvs (7.3±1.2) d in the anterior approach laparoscopic splenectomy group versus the posterolateral approach laparoscopic splenectomy group.These differences were significantly different (all P ＜0.05).On follow-up of the 62 patients,improvements in the varicose veins of the lower esophagus and fundus of stomach at 3 month postoperatively were observed.All these patients recovered well from surgery.Conclusion The posterolateral approach laparoscopic splenectomy approach significantly improved the treatment results in patients with chronic pancreatitis-induced regional portal hypertension.

Objective: To investigate the clinical efficacy of enhanced recovery after surgery(ERAS) in atrial caval shunting (ACS) for type Ⅱ Budd-Chiari syndrome(BCS). Methods: The clinical data of patients underwent ACS for type Ⅱ BCS in the Henan Province People′s Hospital from January 2014 to June 2016 were prospectively analyzed.Randomized and single-blind, controlled study was performed among the patients, and all of them underwent ACS and were divided into control group (patients underwent traditional perioperative management) and ERAS group (patients underwent ERAS perioperative management) based on a random number table.Operational and postoperative data, levels of inflammatory cytokines, stress state evaluation and postoperative complications were observed.The comparison between the two groups was evaluated with an independent sample t test.The trend analyses for variables were done using repeated measures ANOVA.The count data were analyzed using the chi-square test or Fisher exact. Results: Eighty-two patients were screened for eligibility, and allocated into the control group (40 patients) and the ERAS group (42 patients). All patients underwent ACS successfully with no death.Comparison of intraoperative status: operation time, volume of intraoperative blood and number of patients receiving blood transfusion were (211.0±12.9) minutes vs. (207.7±10.7) minutes, (167.5±28.3) ml vs. (165.0±28.4) ml and 3 cases vs. 1 case between the control group and the ERAS group, respectively, showing no difference between the two groups (t=0.90, 0.29, χ²=0.32, all P>0.05). Comparison of postoperative status: time of gastric tube removal, time of catheter removal, time of chest tube, time to flatus, time of food intake, duration of postoperative infusion, duration of postoperative hospital stay and numeric rating scale were (3.7±0.5)days vs. (0.0±0.0)days, (2.3±0.7)days vs. (1.4±0.5)days, (3.7±0.7)days vs. (2.3±0.5)days, (75.2±3.8)hours vs. (46.6±4.2)hours, (75.7±4.7)hours vs. (21.4±2.1)hours, (10.0±1.0)days vs. (5.8±0.9)days, (11.4±1.0)days vs. (7.8±0.6)days, 2.9±0.4 vs. 1.9±0.6 between the control group and the ERAS group, respectively, with statistically differences (t=35.03, 4.36, 8.10, 22.89, 47.78, 14.75, 14.22, 6.13, all P<0.05). Stress state evaluation: the levels of IR were (2.7±0.1) vs.(2.7±0.1), (8.8±0.7) vs. (5.2±0.3), (11.0±0.5) vs. (7.3±0.5), (4.9±0.2) vs. (3.9±0.1), and the levels of C-reaction protein were (14.6±1.3)mg/L vs.(14.6±1.1) mg/L, (101.2±13.6) mg/L vs. (89.5±6.9) mg/L, (62.7±8.6) mg/L vs. (56.4±8.4) mg/L, (46.4±6.7) mg/L vs. (40.0±5.6) mg/L from pre-operation to postoperative day 1, 3 and 5 between the control group and the ERAS group, respectively, with statistically significant differences in changing trends(F=136.61, 4.97, both P<0.05). Comparisons of levels of inflammatory cytokines: the levels of IL-6 were (43.1±2.7) ng/L vs. (43.6±3.6) ng/L, (135.1±6.4) ng/L vs. (117.4±5.7) ng/L, (145.4±6.7) ng/L vs. (128.5±5.5) ng/L, (93.3±3.7) ng/L vs. (88.0±3.9) ng/L, and the levels of TNF-α were (10.4±0.3)mmol/L vs. (10.4±0.3) mmol/L, (14.4±0.4) mmol/L vs. (12.6±0.4) mmol/L, (15.6±0.4) mmol/L vs. (13.8±0.4) mmol/L, (12.3±0.7) mmol/L vs. (11.4±0.6) mmol/L from pre-operation to postoperative day 1, 3 and 5 between the control group and the ERAS group, respectively, with statistically significant differences in changing trends (F=15.15, 21.45, both P<0.05). Comparison of postoperative complications: incidence of complications was 30.0%(12/40) in the control group and 11.9%(5/42) in the ERAS group, and the numbers of patients with nausea and vomiting, respiratory complications and cardiovascular complications were 4, 3, 5 cases in the control group and 3, 1, 1 case in the ERAS group, respectively, showing statistically differences in the incidence of complications(χ²=4.08, P<0.05). All the 82 patients were followed up for 2 to 22 months (median time, 12 months), no patients received reoperation or re-admitted to the hospital duo to complications. Conclusion ERAS management in the perioperative period of ACS for BCS is beneficial to postoperative recovery of patients, and can relieve postoperative stress state and inflammatory response, reduce the duration of hospital stay, and incidence of postoperative complications.