Persistent left superior vena cava is a rare venous variant that is often combined with cardiovascular malformations. In thoracic surgery, especially mediastinal tumor resection, neglect of this variant may make the surgery difficult and risky, and careful preoperative imaging interpretation and adequate preoperative evaluation play an important role in the perioperative safety of the patient. In this paper, we reported a case of a 17-year-old female patient with a persistent left superior vena cava combined with mediastinal tumors. She was successfully discharged 5 days after thoracoscopic surgery, and after 3 years of postoperative follow-up, no tumor recurrence was observed.

Objective To investigate the relationship between serum microRNAs(miRNAs,miR)-216b and miR-132 expressions and clinical prognosis in patients with gastric cancer.Methods From January 2018 to February 2020,87 gastric cancer patients who visited Jiamusi Central Hospital were selected as the gastric cancer group,while 87 healthy individuals who underwent physical examinations in the hospital were collected as the control group.Quantitative real-time PCR(qRT-PCR)was applied to detect the expression levels of miR-216b and miR-132 in serum.The relationship between the expression levels ofmiR-216b and miR-132 in the serum of gastric cancer patients and their clinical pathological characteristics was analyzed.According to the survival or death status of gastric cancer patients during the follow-up period,these patients were divided into a good prognosis group(survival,n=51)and a poor prognosis group(death,n=36).The predictive value of serum miR-216b and miR-132 expression levels on the prognosis of gastric cancer patients was analyzed using the receiver operating characteristic(ROC)curve.COX regression was applied to analyze factors affecting the prognosis of gastric cancer patients.Results Compared with the control group,the expression levels of miR-216b(0.69±0.20vs1.02±0.24)and miR-132(0.73±0.19 vs 1.01±0.22)in serum of gastric cancer group were decreased,and the differences were significant(t=9.853,8.984,all P＜0.001).The expression levels of miR-216b and miR-132 in serum of gastric cancer patients with low differentiation,TNM stages Ⅲ±Ⅳ,lymph node metastasis,and distant metastasis were significantly lower than those of gastric cancer patients with medium and high differentiation,TNM stages Ⅰ±Ⅱ,no lymph node metastasis and no distant metastasis,and the differences were statistically significant(t=6.266,3.412,2.890,2.723;4.999,3.734,4.180,5.502,all P＜0.05).Compared with the good prognosis group,the expression levels of miR-216b(0.56±0.16 vs 0.78±0.23)and miR-132(0.60±0.11 vs 0.82±0.25)in serum of gastric cancer patients in the poor prognosis group were decreased,and the differences were statistically significant(t=4.952,4.946,all P＜0.001).The areas under the cure(AUC)of serum miR-216b,miR-132 and their combination predicted the prognosis of gastric cancer patients was 0.797(95％CI:0.706～0.889),0.832(95％CI:0.745～0.918)and 0.900(95％CI:0.836～0.964),respectively.The sensitivity and specificity were 83.3％,68.6％;97.2％,62.7％and 79.4％,72.5％,respectively.When the cut-off values of serum miR-216b and miR-132 for predicting poor prognosis of gastric cancer patients were 0.66 and 0.76,respectively,the sensitivity of the prediction were relatively high.COX regression analysis showed that low expression of miR-216b and miR-132,poorly differentiated degree,TNM stage Ⅲ+Ⅳ,lymph node metastasis,and distant metastasis were risk factors for poor prognosis in gastric cancer patients(all P＜0.05).Conclusion MiR-216b and miR-132 were low expressed in the serum of gastric cancer patients,and they could serve as effective biomarkers for predicting the prognosis of gastric cancer patients.

Objective    To evaluate the prognostic value of preoperative inflammatory indexes in patients with local-advanced esophageal squamous cell carcinoma. Methods    We retrospectively analyzed the clinical and prognostic data of 150 local-advanced esophageal squamous cell carcinoma patients who were treated by esophagectomy in Guangyuan Central Hospital from July 2014 to July 2015. There were 128 males and 22 females with average age of 62.23±8.48 years. The optimal cutoff value was determined by receiver operation characteristics (ROC) curve analysis. Patients were grouped according to the optimal cutoff values (NLR=3.49, PLR=152.28, MLR=0.36). Log-rank test, and multivariate Cox logistic regression modelling were used to assess the simultaneous influences of prognostic factors for survival outcomes after esophagectomy. Results    The patients with higher ratio (NLR>3.49, PLR>152.28, MLR>0.36) had significantly shorter median progression free survival (PFS) and lower postoperative recurrent rate than those of the patients with lower ratio. The stratified analyses found that thelymph node staging and postoperative recurrent rate were positively correlated with the higher ratio. However, the tumor differentiation was negatively correlated with it. In univariate analyses, patients with preoperative NLR>3.49, PLR>152.28 and MLR>0.36 had a poorer prognosis. Furthermore, in multivariate analyses we found MLR>0.36 was also significantly associated with a decreased postoperative recurrent rate (HR=12.945, 95%CI 2.31 to 72.548, P=0.00). Conclusions    The preoperative NLR, PLR and MLR are useful prognostic markers in patients with stage ⅢA-ⅣA esophageal squamous cell carcinoma who conducted esophagectomy.

Objective:To explore the influence of different transport modes on the efficacy of direct percutaneous coronary intervention (PCI) in patients with acute ST‐elevation myocardial infarction (STEMI) .Methods :A total of 268 STEMI patients undergoing emergency PCI during Jan 2013 and Dec 2014 were selected .Among them ,there were 139 patients whose single‐time 12‐lead ECG results were scanned and sent to specified cardiologists ’ cellphones by ambulances or community doctors via wechat app (chest pain center mode exploration group ) and 129 patients who went to hospital by themselves (common treatment group) .The door to balloon dilatation time (D‐to‐B) ,the probability of D‐to‐B shorter than 90 minutes (target rate ) , the mortality during hospitalization , the incidence of heart failure , the average hospitalization days and hospitalization cost were compared between the two groups .Results:The results of comparison between the chest pain center mode exploration group and the common treatment group were shown as below :the D‐to‐B time ([86 .4 ± 4 .5] min vs .[97 .4 ± 10 .3] min ,P<0 .01) ,hospital during mortality (2 .9% vs9 .3% ,P<0 .05) ,the incidence of heart failure (4 .3% vs .11 .6% ,P<0 .05) ,the average hospitalization days ([8 .7 ± 3 .2] d vs .[10 .9 ± 4 .5] d ,P<0 .05] and hospitalization costs ([50 347 ± 19 310] yuan vs .[58 102 ± 41 178] yuan ,P<0 .05) .And all the differences were statistically significant .Conclusions :Regional chest pain center mode can shorten the reperfusion time and reduce the short‐term mortality for STEMI patients .

Objective To observe the clinical efficacy of acupuncture at the trigger points on the back in treating cardioneurosis. Methods Fifty patients with cardioneurosis were selected to receive syndrome differentiation of traditional Chinese medicine, and then were evaluated for the improvement of symptoms respectively after first acupuncture treatment at the trigger points on the back and after 3~5 acupuncture treatments. Results Of the 50 cardioneurosis patients, 30 showed marked effect, 14 showed effective, 6 failed in the treatment, and the total effective rate was 88.0%. The total effective rate was 96.2%in patients of deficient heart yang, and was 75.0%in those of excessive fire due to yin deficiency, 83.3%in those of qi stagnation due to liver depression, and 83.3%in those of deficient heart yin. The improvement rate of subjective symptoms after 3~5 treatments was significantly different from that after the first treatment (P<0.05). Conclusions Acupuncture at the trigger points on the back is an effective approach in treating cardioneurosis, and it can achieve a marked efficacy with successive 3~5 sessions.

Objective To investigate the relationship between the carotid calcification and the prognosis in patients with ischemic stroke. Methods A total of 522 patients with non-cardiac ischemic stroke registered in the Nanjing Stroke Registry Program (NSRP )from December 2009 to October 2012 were enrolled. All patients underwent head and neck CT angiography (CTA). The original data of CT scan were transmitted into the Siemens workstation. Calcium score measurement was performed using the same reconstruction conditions and Agatston calcium score to measure calcification score. The patients were divided into no (0),mild (0

Objective Analysis of MRI image of lateral ventricular subependymomas to improve our recognition of radiology manifestation of the disease. Methods Clinical data and MRI findings of 6 patients with subependymomas proved by surgical pathology, observed from January 2007 to June 2013, were analyzed retrospectively. Results Six patients (4 males and 2 females) presented with headache and dizziness. Among these 6 patients, tumor developed in right lateral ventri-cle in three patients, in left lateral ventricle in 2 patients and in frontal of dual lateral ventricle in one patient. In MRI image, tumors showed iso-intense to hypointense to normal white matter on T1-weighted and DWI images, hyperintense on T2-weighted and FLAIR. Mild or no enhancement was noted in most cases. MRS showed findings consistent with low-grade tu-mor, with a normal choline peak and depressed N-acetyl-aspartate peak. Conclusion Lateral ventricular subependymo-mas have characteristic MRI features and multi-direction images are helpful for diagnosis.

Objective To research the activated brain areas of decision making under uncertainty reward processing on healthy volunteers.Method The E-Prime programs were presented 3 kinds of tasks of the decision under uncertain reward processing.15 right-handed healthy volunteers made a response after receiving the task.At the same time,the GE 3.0T magnetic resonance scanner scanned the brains areas of subjects.Individual analysis and group analysis was done with SPM8 software,then the brain activating regions and the peak intensity were gotten.Results Orbitofrontal cortex was activated in certainty,peak intensity 2.4328 ± 0.1949 (P ＜ 0.05).Prefrontal cortex,occipital lobe,parietal lobe,posterior lobe of cerebellum,limbic lobe and midbrain were activated under the risk reward processing,peak intensity 2.4228 ± 1.3762 (P ＜ 0.05).When under ambiguity reward processing,prefrontal cortex,temporal lobe,occipital lobe,left inferior frontal gyrus and posterior lobe of cerebellum were activated,peak intensity 2.4056 ± 0.4222 (P ＜ 0.05).Compared with the task under certainty,posterior lobe of cerebellum,gyri subtemporalis and gyri fusiformis,inferior parietal lobule,anterior central convolution,orbitofrontal cortex,ventrolateral prefrontal cortex,both frontopolar and supramarginal gyrus were activated in task under risk (P ＜0.05) ;and both frontopolar were activated in task under ambiguity (P ＜ 0.05).Compared with the task under risk,dorsolateral prefrontal cortex and posterior lobe of cerebellum were activated in task under ambiguity (P ＜ 0.05).Conclusion There are differences in different types of reward processing of decision making.

Objective To analyze the cost-effectiveness of integrated pharmaceutical care (IPC) in community-based patients with chronic obstructive pulmonary disease (COPD).Methods The COPD patients were divided randomly into intervention group (group A,n =79) and control group (group B,n =71).Group A received the IPC intervention measures,including serial lectures of pharmaceutical knowledge,home supervision and web-based communications for while group B group had none.Results As compared with group B,group A obviously improved on the knowledge of pharmaceutical treatment effect and side effect (95.1％,67.4％ vs.63.1％,21.9％,x2 =12.445,P=0.000 vs.x2 =55.557,P=0.000).There were notable differences between two groups [ ( 1.77 ± 1.23 ) vs.( 2.42 ± 1.66 ) s,t =2.583,P=0.011],pulmonary rales [ (0.01 vs.0.01)s,Z =2.370,P=0.018],6-min walk distance (6 MWD) [ (457 ± 67 ) vs.(425 ± 72) m,t =2.760,P =0.007 ],vital capacity ( VC ) [ ( 1.60 ± 0.25 ) vs.( 1.49 ± 0.23 ) L,t =2.718,P =0.007 ) ] andquality-of-life items ( 48 ± 10 vs.52 ± 11,t =2.624,P =0.010) after intervention.Analyze of cost-effectiveness show that groupA was superior to group B [ total effect total cost(TE/TC =764.6/4936,15.49％ )vs.(TE/TC =1509.4/4708),32.06％,x2 =6.183,P ＜ 0.01 ].Conclusion IPC can improve the disease condition and achieve excellent cost-effectiveness for community-based COPD patients.

Objective To evaluate vascular surgery and interventional technique applied in Takayasu's arteritis. Methods Data of 26 patients of Takayasu's arteritis admitted between January 2006 and December 2009 were retrospectively analyzed. The sex ratio(M/F) was 1: 4. 2, age averaged at (27±15)y. There were 16 cases of type Ⅰ , 7 cases of type Ⅱ and 3 cases of type Ⅲ according to Lupi-Herrera classification. 25 patients received surgery including 16 patients undergoing pecutaneous transluminal angioplasty operations, 9 patients doing traditional bypass surgery, and one patient was treated conservatively. Results 23 case-times of percutaneous transluminal angioplasty (PTA) were performed in 16 patients, including 12 cases of balloon angioplasty and 4 cases of stent angioplasty. Four significantly stenotic and occluded carotid arteries were revascularized successfully in 5 patients. Thrombosis of the carotid artery was found in one patient after balloon angioplasty. There were 4 patients in which repeated PTA treatment up to a total of 11 times were needed to guarantee vessel patency. Open surgery succeeded in 9 patients, and clinical symptoms were relieved in all cases during peri-operative period. 22 patients were followed up for 12 -46 months,one patient died of cerebral hemorrhage 3 months post-operation, one patient was found pseudoaneurysm at anastomotic stoma, and 2 patients suffered from anastomotic restenosis.Conclusions Vascular surgery played important role in the therapy of Takayasu's arteritis. PTA can be used repeatedly. Surgical bypass operation is difficult in technology, and can be used in cases that fail to response to PTA or in patients with severe cerebral ischemia.