With the optimization of surgical technologies and postoperative management regimens, the number of lung transplantation has been significantly increased, which has become an important treatment for patients with end-stage lung disease. However, due to the impact of comprehensive factors, such as bronchial ischemia and immunosuppression, the incidence of airway stenosis after lung transplantation is relatively high, which severely affects postoperative survival and quality of life of lung transplant recipients. In recent years, with the improvement of perioperative management, organ preservation and surgical technologies, the incidence of airway stenosis after lung transplantation has been declined, but it remains at a high level. Early diagnosis and timely intervention play a significant role in enhancing clinical prognosis of patients with airway stenosis. In this article, the general conditions, diagnosis, treatment and prevention of airway stenosis after lung transplantation were reviewed, aiming to provide reference for comprehensive management of airway stenosis after lung transplantation and improving clinical prognosis of lung transplant recipients.

Objective:To establish a risk assessment model for recurrence and metastasis in patients with advanced nasopharyngeal carcinoma.Methods:A survival follow-up study was conducted using a COX regression model to analyze 242 patients with advanced nasopharyngeal carcinoma who were treated for the first time in the Fudan University Shanghai Cancer Center from March 1, 2012 to August 31, 2020. The mean age was (48.33±11.13) years, with 178 males and 64 females. The mean survival was (3.39±1.42) years. According to the random number table method, the enrolled subjects were divided into two groups, including 192 cases in the modeling group and 50 cases in the validation group. Venous blood was collected from patients before treatment, after the first treatment and during the follow-up period after treatment. The blood cell classification and blood biochemical indicators were analyzed. T test and Chi-square test were used to analyze the difference in indicators in prognosis of patients with recurrence and metastasis as the outcome of the study. Multivariate COX regression analysis was used to screen out the independent prognostic factors affecting the recurrence and metastasis of nasopharyngeal carcinoma patients, and the Nomogram models of recurrence and metastasis risk of patients in 2 years, 4 years and 6 years were constructed. The model C-Index of the modeling group and the validation group were calculated to evaluate the performance of the predictive model.Results:White blood cells ( P=0.028), lymphocyte counts ( P<0.001), neutrophils ( P=0.001), platelets ( P=0.046), albumin ( P<0.001), neutrophil/lymphocyte ratio ( P<0.001), platelet/lymphocyte ratio ( P<0.001), lymphocyte/monocyte ratio ( P<0.001), systemic immune inflammatory response index ( P<0.001), systemic inflammatory response index ( P<0.001), and prognostic nutritional index ( P=0.004) had statistically significant differences in the efficacy monitoring of patients; through multivariate COX regression analysis, it was found that the platelet/lymphocyte ratio ( HR 2.537, 95% CI 1.439-4.473) and the prognostic nutritional index ( HR 0.462, 95% CI 0.236-0.903) are important factors to predict the risk of recurrence and metastasis of patients. Combining the above indicators, the Nomogram risk assessment model was established. The C index of the modeling group was 0.698, and the C index of the validation group was 0.739. The calibration curves of the two groups showed good consistency. Conclusion:The Nomogram evaluation model can accurately predict the risk of recurrence and metastasis in patients with nasopharyngeal carcinoma, and provide a theoretical basis for evaluating the prognosis of clinical treatment.

Objective:To analyze the risk factors for lymph node metastasis in breast cancer patients with axillary lymph node metastasis after neoadjuvant chemotherapy.Methods:The data of 94 female patients with invasive breast cancer in Dongguan People′s Hospital of Guangdong Province from January 2017 to December 2019 were retrospectively analyzed.All patients planned to receive 4-8 cycles of neoadjuvant chemotherapy.After chemotherapy, modified radical mastectomy was performed.Estrogen receptor(ER), progesterone receptor(PR) and human epidermal growth factor receptor 2(HER-2) appeared for the first time in Chinese and English abstracts and texts positive patients received endocrine or targeted therapy.The rest patients received 2-4 cycles of adjuvant chemotherapy or radiotherapy according to the situation.Lymph node metastasis after neoadjuvant chemotherapy was analyzed.The relationship between lymph node metastasis after neoadjuvant chemotherapy and clinicopathological features was analyzed.Risk factors for lymph node metastasis after neoadjuvant chemotherapy were analyzed by Logistic regression.Results:After neoadjuvant chemotherapy, the positive rate of axillary lymph node was 74.47%(70/94). The number of positive axillary lymph nodes, ER status, HER-2 status and cell proliferation-associated human nuclear antigen(Ki67), the completion of chemotherapy cycle, the pathological remission of axillary lymph nodes after chemotherapy and the T stage of tumor after neoadjuvant chemotherapy were associated with lymph node metastasis in patients with positive axillary lymph nodes after neoadjuvant chemotherapy(χ 2=30.053, 10.233, 6.303, 7.666, 18.162, 10.148, 12.418; all P<0.05). More than 3 positive axillary lymph nodes( OR=2.788, 95% CI 1.253-5.318), ER positive( OR=3.298, 95% CI 1.744-7.837), Ki67 positive( OR=2.469, 95% CI 1.184-4.301)and pathological pPR( OR=4.197, 95% CI 2.168-13.788) were independent risk factors for lymph node metastasis after neoadjuvant chemotherapy(all P<0.05). Conclusion:Axillary lymph node-positive breast cancer patients have a high positive rate of axillary lymph nodes after neoadjuvant chemotherapy.More than 3 positive axillary lymph nodes before operation, ER positive, Ki67 positive, and axillary lymph node pPR after neoadjuvant chemotherapy are independent risk factors for lymph node metastasis after neoadjuvant chemotherapy.

Objective:To investigate effects of implantation of pectoralis major fascia combined with serratus anterior fatty fascia flap prosthesis on breast reconstruction after early breast cancer surgery.Methods:A total of 62 patients with early breast cancer undergoing breast reconstruction in Dongguan People's Hospital of Guangdong Province from July 2017 to December 2019 were selected and randomly divided into two groups, 31 cases in each group. The control group was treated with pectoralis major fascia covering prosthesis for breast reconstruction, and the observation group was treated with pectoralis major fascia combined with serratus anterior fatty fascia flap covering prosthesis for breast reconstruction. The clinical data of the two groups were recorded, the postoperative aesthetic appearance of breast was evaluated. According to the function assessment of cancer therapy-breast cancer (FACT-B) was used to evaluate the score of quality of life before and after operation, and postoperative complications were also observed.Results:In the control group and the observation group, the intraoperative blood loss was (82.61±12.38) ml, (88.76±13.57) ml, respectively; and drainage tube extubation time was (3.51±0.62) d and (3.64±0.58) d, respectively; there was no statistically significant difference between the two groups ( t value was 1.864, 0.853, respectively, all P > 0.05). The operation time of the observation group was longer than that of the control group [(2.59±0.29) h vs. (1.72±0.32) h, t = 11.217, P < 0.001]. The amount of drainage of the control group was higher than that of the observation group [(215.45±47.69) ml vs. (151.36±31.67) ml, t = 6.233, P < 0.001]; the length of hospital stay of the control group was longer than that of the observation group [(14.51±2.32) d vs. (10.79±1.86) d, t = 6.965, P < 0.001]. The excellent and good rate of postoperative breast appearance of the observation group was higher than that of the control group [96.77% (30/31) vs. 74.19% (23/31), χ 2adjusted=4.679, P = 0.031]. There were no statistical differences in all items including health, emotion, function, society/family and other conditions scores of FACT-B and total scores in both groups before the operation (all P > 0.05); all items scores and total scores of both groups after the operation were higher than those before the operation (all P < 0.001), and the sores after the operation of the observation group were higher than those of the control group (all P < 0.001). The total incidence of postoperative complications was 6.45% (2/31) of the observation group, 22.58% (7/31) of the control group, and the difference was not statistically significant (χ 2adjusted=2.080, P = 0.149). Conclusion:Breast reconstruction with implantation of pectoralis major fascia combined with serratus anterior fatty fascia flap prosthesis after early breast cancer surgery can shorten the postoperative hospital stay, improve the aesthetic appearance of breast, improve the long-term quality of life, and has a high safety.

Objective To investigate the application of fundamental cause in the preparation of surgical instruments.Methods The fundamental cause analysis method was used to analyze the situations of improper preparation of surgical instruments in the operation room to analyze the fundamental causes and work out countermeasures.The preparation of surgical instruments before and after the implementation was compared.Result The qualification rate of surgical instruments increased from 96.0％ before the implementation to 98.6％ after the implementation,with statistically significant difference (P＜0.001).Conclusion The fundamental cause analysis can help the operation room to find out the problems in the surgical equipment preparation process so as to improve the working procedures and the qualification rate of prepared surgical instruments.

Objective To investigate the expression of serum amyloid A (SAA) in patients adipose tissue with gestational diabetes mellitus (GDM) and the correlations between SAA and insulin resistance (IR) and body mass index (BMI).Methods A total of 60 single full-term pregnant women underwent cesarean section from June 2013 to December 2013 was enrolled in this study (GDM group,n =30;control group,n =30);serum SAA level was detected with Enzyme-Linked Immunosorbent Assay (ELISA);and mRNA expression of SAA1 in adipose tissue was determined by reverse transcription PCR (RT-PCR);SPSS software was used to compare these markers,and the correlations between SAA and HOMA-IR,BMI were analyzed with Pearson correlation method.Results SAA,mRNA expressions in omental and subcutaneous fat in GDM group (0.447 ± 0.069,0.291 ± 0.067) were significantly higher than those in control group (0.194 ± 0.070,0.231 ± 0.068,P ＜ 0.01).Serum SAA levels [(21.038 ± 6.648) mg/L] and homeostasis model assessment of insulin resistance(HOMA-IR) (4.168± 2.416) in GDM group were significantly higher than those in control group [(14.384 ± 12.770) mg/L,2.045 ± 1.008,P ＜ 0.05];SAA1 mRNA expression levels in omental and subcutaneous fat were positively correlated with serum SAA (r =0.353,0.342,P ＜ 0.01).SAA1 mRNA expression levels in omental were positively correlated to pregestational BMI,late gestational BMI,weight gain in pregnancy and HOMA-IR (r =0.543,0.644,0.340,0.473,P ＜ 0.01),and SAA1 mRNA expression levels in subcutaneous fat were positively correlated to pregestational BMI,late gestational BMI,and HOMA-IR (r =0.788,0.693,0.504,P ＜ 0.01),but was no correlation with weight gain in pregnancy(r =0.013,P ＞ 0.05).Conclusions SAA mRNA expressions in omental and subcutaneous fat in GDM group and serum SAA levels increase,which is positively correlated with BMI and the degree of insulin resistance,SAA may participate in the formation of GDM by increasing insulin resistance.SAA may be used as a new monitor of GDM.

Objective To investigate the therapeutic effect and safety of microneurosurgery associated with Gamma Knife radiosurgery on the large meningiomas in sellar region, and to clarify its clinical curative effect. Methods The clinical data of 34 patients with large meningiomas in sellar region underwent microsurgery were retrospectively analyzed.All of them underwent microsurgery,and then treated with Gamma Knife radiosurgery in one month after operation if there were residual tumors.The tumor removal of situation,complication,rate of symptom remission,and recurrence rate were analyzed.Results Among the 34 patients,total resection (7 cases of Simpson grade Ⅰ and 12 cases of Simpson grade Ⅱ)was achieved in 19 cases (55.9%),subtotal resection (Simpson grade Ⅲ )in 14 cases (41.2%), and partial resection (Simpson grade Ⅳ )was achieved in 1 case (2.9%).The major complications were cranial nerve injuries (such as oculomotor nerve, trochlear nerve and abducens nerve,n=6),the contralateral limb paresis (n = 2),postoperative bleeding (n = 1),CSF leak with infection (n=3),and secondary epilepsy (n = 3 ); no death occurred postoperatively. All these patients were followed up for about 3 to 48 months.Postoperative headache disappeared in 24 cases (80%),and 6 cases were alleviated (20%);postoperative vision improved in 12 cases (80%),remained unchanged in 2 cases (13.3%)and deteriorated in 1 case (6.7%); postoperative olfactory function improved in 5 cases (62.5%) and 3 cases unchanged (37.5%); 5 cases recoverd from the ocular motility disorder (71.4%), and 2 cases unchanged (28.6%);7 cases recoverd from thehemiplegia (100%).One of the total resection cases (5.2%)and two of the non-total resection (13.3%)suffered from tumor recurrence.All of the non-total resection cases were treated with Gamma Knife radiosurgery.Conclusion The clinical effect of microneurosurgery associated with Gamma Knife radiosurgery in treatment of large meningiomas in sellar region is satisfactory.

OBJECTIVE: To identify the subtype of transient receptor potential (TRPs) channel involved in stretch-induced injury of human brain microvascular endothelial cells (HBMEC) and to explore the mechanism responsible for eNOS expression.
 METHODS: TRPs expression was examined by Western blot and immunocytofluoresence in the cultured HBMEC. Mechanical stretch was performed by mini-type multi-functional bio-impact machine. The levels of free calcium ion in cells were examined by the flow cytometry. The eNOS expression was detected by Western blot.
 RESULTS: The mRNA and protein expression of TRPV4 was detected in HBMEC by qRT-PCR, Western blot and immunocytofluoresence. The levels of free calcium ion in the stretch-treated HBMEC was significantly decreased in the presence of TRPV4 specific inhibitor (P<0.001), but there was no difference in calcium levels between the stretch and the control or unspecific inhibitor group (P=0.072 or 0.308). The levels of eNOS protein in the stretch-treated HBMEC were reduced in the presence of TRPV4 specific inhibitor or NOS inhibitor (P<0.05), but it was not changed compared with that in the control group (P>0.05).
 CONCLUSION The eNOS expression is up-regulated under the condition of mechanic stretch, which is related to the activation of TRPV4, resulting in the influx of calcium.
Brain ; cytology ; Calcium ; metabolism ; Cells, Cultured ; Endothelial Cells ; physiology ; Humans ; Nitric Oxide Synthase Type III ; metabolism ; Stress, Mechanical ; TRPV Cation Channels ; physiology

Objective To observe the effect of local injections of Pseudomonas Aeruginosa Preparation joint compres-sion bandage in lymph leakage after breast carcinoma operation. Methods A total of 60 patients of lymph leakage after breast carcinoma operation were randomly divided into the observation group and the control group , the pations of ob-servation group was treated with pseudomonas aeruginosa preparation joint compression bandage treatment ,while the pations of control group was treated with the puncture pumping local joint compression bandage treatment , the clinical efficacy of two groups were compared. Results The treatment group cure rate was 76.7%, effective rate was 96.7%, control group 20.0%, 66.7% respectively. The difference was statistically significant (P<0.05).After treatment, KPS score of the observation group was significantly better than the control group, drainage time, hospitalization time was shortened (P<0.05), the expected survival was not significantly different (P>0.05).There were no serious adverse reac-tionsin two groups. Conclusion Pseudomonas Aeruginosa Preparation joint compression bandage has definite clinical effect in lymph leakage after breast carcinoma operation,less adverse reaction.

OBJECTlVE To establish Tg(-6.3CYP3A65∶EGFP) transgenic zebrafish for quick, intuitive detection of heavy metals ( copper, cadmium and zinc) , dioxin-like PCBs ( PCB126) and other environmental pollutants. METHODS Tol2 transposon system was used to generate transgenic zebrafish lines Tg(-6.3CYP3A65∶EGFP) in which CYP3A65 promoter regualated labeled fluorescence. The effect of heavy mentals ( copper, cadmium and zinc ) and PCB126 on the relative amounts of CYP3A65 gene expression was determined by observing the change in fluorescence intensity. RESULTS The relative gene expression of CYP3A65 was significantly increased after 96 h exposure to copper 0.1 and 0.2μmol·L-1 , cadmium 0.35 and 0.7μmol·L-1 , zinc 1.5 and 3μmol·L-1 , and PCB126 2-32μmol·L-1 , respectively ( P<0.01) , but decreased after 96 h exposure to copper 0. 9 μmol·L-1 , cadmium 2. 7 and 5.4 μmol·L-1 , and zinc 24μmol·L-1 , respectively( P<0.01) . CYP3A65 gene expression was significantly increased after 168 h exposure to copper 0.1 and 0.2 μmol·L-1 , cadmium 0.35 and 0.7 μmol·L-1 , zinc 1.5 and 3 μmol·L-1, and PCB126 2-32 μmol·L-1, respectively(P<0.01), but decreased after 168 h exposure to copper 0.9 μmol·L-1, cadmium 2.7 and 5.4 μmol·L-1, and zinc 12 and 24 μmol·L-1( P<0.05) , in a concentration-dependent manner. CONCLUSlON The results suggest that zebrafish CYP3A65 gene expression and the CYP3A65 labeled fluorescence lines can be another candidate biomarker for detecting environmental pollutants.