Objective    To investigate the clinical effect of 3D computed tomography bronchial bronchography and angiography (3D-CTBA) and guidance of thoracoscopic anatomic pulmonary segmentectomy by Mimics software system. Methods    A retrospective analysis was performed on patients who underwent thoracoscopic segmentectomy in the Department of Thoracic Surgery of Affiliated People's Hospital of Jiangsu University from June 2020 to December 2022. The patients who underwent preoperative 3D-CTBA using Materiaise's interactive medical image control system (Mimics) were selected as an observation group, and the patients who did not receive 3D-CTBA were selected as a control group. The relevant clinical indicators were compared between the two groups. Results    A total of 59 patients were included, including 29 males and 30 females, aged 25-79 years. There were 37 patients in the observation group, and 22 patients in the control group. The operation time (163.0±48.7 min vs. 188.8±43.0 min, P=0.044), intraoperative blood loss [10.0 (10.0, 20.0) mL vs. 20.0 (20.0, 35.0) mL, P<0.001], and preoperative puncture localization rate (5.4% vs. 31.8%, P=0.019) in the observation group were better than those in the control group. There was no statistically significant difference in the thoracic tube placement time, thoracic fluid drainage volume, number of intraoperative closure nail bin, postoperative hospital stay, or postoperative air leakage incidence (P>0.05) between the two groups. Conclusion    For patients who need to undergo anatomical pulmonary segmentectomy, using Mimics software to produce 3D-CTBA before surgery can help accurately identify pulmonary arteriovenous anatomy, reduce surgical time and intraoperative blood loss, help to determine the location of nodules and reduce invasive localization before surgery, and alleviate patients' pain, which is worthy of clinical promotion.

Objective:To preliminarily discuss the difference of ovary anti-miillerian hormone ( AMH) when cyclophosphamide is used in different time during menstrual cycle .Methods:Totally 30 young female patients with average age of (36 ±6.39) diagnosed as glomerular disease were treated with cyclophosphamide .According to the medication time , the patients were divided into follicular phase group and secretory phase group based on the property of menstrual cycle .Follicular phase group was treated with cyclophospha-mide during the first day and the eighth day of menstrual cycle .Secretory phase group was treated with cyclophosphamide after ovulato-ry time, namely the 14th day-the 16th day of menstrual cycle.AMH was detected before the drug treatment and 1st, 3rd, 6th and 10th cycles after cyclophosphamide treatment in the two groups .Results: AMH in the five periods had no statistic difference between the groups (P>0.05).There was significant difference in AMH before the treatment and after one-month treatment in the same group(P<0.05).AMH in different age groups showed statistic difference (P<0.05).Conclusion:There is no significant difference in AMH when cyclophosphamide is administrated in different time of menstrual cycle .However , ovarian function is impaired just by low dose cyclophosphamide (0.8g) with the first administration and will be recovered slowly at least half a year after the drug withdrawal .

OBJECTIVE:To analyze the blood concentration monitoring data of 4 commonly used antiepileptic drugs(AEDs, sodium phenytoin,carbamazepine,sodium valproic acid,oxcarbazepine)in order to provide reference for rational use of drugs in the clinic. METHODS:415 patients underwent 4 AEDs blood concentration monitoring were selected from our hospital during 2014-2015,and the results of blood concentration monitoring were analyzed statistically. RESULTS:There were 680 cases of AE-Ds blood concentration monitoring in total. The main objects of serum concentration monitoring were young and middle-aged(range from 19 to 60),involving 449 cases in total(66.03%). 360 cases were in the normal range(52.94%). Among 361 patients receiving single drug therapy,the rates of serum concentration in the normal range were 80.77%for carbamazepine,which was higher than oth-er 3 AEDs(30.00% for sodium phenytoin,47.40% for sodium valproic acid and 40.38% for oxcarbazepine),with statistical signifi-cance(P<0.05). Among 54 patients receiving combination therapy,the serum concentration monitoring data of 67.65%patients treat-ed with double-combination therapy and 100%patients treated with triple-combination therapy deviated from normal range. CONCLU-SIONS:The rate of AEDs blood concentration reaching the normal range are in low level in our hospital. It’s necessary to strengthen medication education for patients to improve the compliance of patients;clinical efficacy of AEDs is evaluated on the basis of blood concentration monitoring and clinical symptom,and combination therapy should be avoided as much as possible.

Background and purpose: Platelet to lymphocyte ratio (PLR) is an important factor reflected systematic inflammation. The clinical value of PLR has not been confirmed. The present study was to explore the value of preoperative PLR in predicting clinical stage and prognosis in upper tract urothelial carcinoma. Methods:Patients who underwent surgical therapy with postoperative pathology upper tract urothelial carcinoma without metastasis from Jan. 2007 to Mar. 2012, were collected. Following up was done by telephone and clinic work, 150 vs 1 was taken as the threshold value of PLR, and the association of PLR with tumor stage, whether suffered bladder cancer as comorbidity, recurrent or metastasis, overall survival, tumor lesion, preoperative hematuria, gender and age was analyzed. We further analyzed the association difference of disease free survival (DFS) time and overall survival (OS) time between different PLR groups. Results:Fifty-one cases of UTUC were collected, and the postoperative mean following up time is 21 (9–51) months. Twenty cases recurred or metastasis and 9 cases died. The mean DFS time was 15 (2–51) months,and the mean OS time was 21 (9–51) months. One-factor analysis of variance showed that preoperative PLR was associated with tumor stage, overall survival rate, hematuria and gender, and the P value were 0.028, 0.008, 0.045, 0.036 respectively. High PLR group was intended to be non-organ confined disease, the sensitivity was 57%and the specificity was 74%. Survival analysis by Kaplan-Meier method showed there is no statistical difference in DFS between high and low PLR groups (P=0.155). But OS time in high PLR group was significantly less than that in low PLR group (P=0.006). Cox regression confirmed that only tumor stage is an independent prognostic factor of OS (P=0.029). Conclusion:PLR has potential clinical value in predicting advanced stage disease and Cox regression confirmed that only tumor stage is an independent prognostic factor of OS.

Objective To summarize the successful experience of three cases of heart-lung transplantations performed in our institute.Methods From July 2003 to August 2012,three patients,with diagnosis of end-stage heart-lung diseases,received heart-lung transplantation in our institute.One case was diagnosed as congenital atrial septal defect,Eisenmanger syndrome,NYHA class Ⅳ; one was dilated cardiomyopathy with moderate/severe pulmonary arterial hypertension,NYHA class Ⅲ-Ⅳ,one was diagnosed as double outlet left ventricle (DOLV) with ventricle septal defect and stenosis of pulmonary artery and its left and right branches,NYHA class Ⅲ-Ⅳ.Donor hearts were preserved with UW solution,donor lungs were preserved with Euro-Collin solution in case one and with low potassium dextran containing prostaglandin E1 in the others.Extensive disinfection and strict scrutiny were implemented postoperatively.Immunosuppressive therapy included administration of zenapax or basiliximab preoperatively,methylprednisolone during the operation,and cyclosporine a/tacrolimus + prednisone + mycophenolate postoperatively.Surgical hemostasis is of great importance,as the total pleural effusion reaches 14 640 ml within 31 days postoperatively in case two.Strict postoperative disinfection and isolation were implemented,and management of the respiratory tract was intensified.Therapeutic bronchoscopy was performed frequently for sputum suction.In case two,bronchoscopy was used thirteen times within 40 days after transplantation.Broad-spectrum antibiotics and antifungal antibiotics were used for infection control.Results All three patients were discharged after recovery from operation.Case one died of obstructive bronchitis and lung failure caused by chronic rejection four years and ten months postoperatively.Case two died of sudden cerebrovascular accident 68 days after operation.Case three survives more than one year postoperatively so far and is still alive.Conclusion Proper preservation of the donor heart and lung,perfect surgical hemostasis,strict infection control,frequent application of bronchoscopy and appropriate immunosuppressive management are critical to the success of heart-lung transplantation.

Objective To investigate the major clinical manifestations and their effect on prognosis in patients with posterior circulation stroke (PCS).Methods The clinical data of 129 consecutive hospitalized patients with acute PCS confirmed by clinical and imaging were registered prospectively,and they were followed up for 3 months.The patients were divided into a good prognosis group (modified Rankin scale [ mRS] score ≤ 2) and a poor prognosis group (mRS score ≥ 3) according to their mRS scores.Results 90.7％ patients had 4 to 12 symptoms and signs,only 1 presented an isolated symptom.The most common symptoms and signs were unilateral.Crossed paralysis (1.6％) or quadriplegia (0.8％ ) was rare.Univariate analysis showed that the symptoms of unilateral limb weakness (relative risk [RR] 1.262,95％ confidence interval [ CI] 1.030-1.546; P =0.030),slurred speech (RR 1.434,95％CI 1.133 - 1.816; P=0.004),dysphagia (RR 2.216,95％ CI 1.131 -4.341; P =0.017),and the signs of decreased unilateral muscle strength (RR 1.288,95％ CI1.047-1.583; P=0.021),central facial/tongue paralysis (RR 1.467,95％CI 1.164- 1.850; P=0.002),dysarthria (RR 1.468,95％CI 1.154- 1.867; P=0.002),ocular motor dysfunction (RR 3.073,95％CI1.346 - 7.017; P =0.005),and conscious disturbance (RR 5.736,95％ CI 1.268 - 25.946; P =0.023) were the risk factors for poor prognosis,while ataxia (RR O.478,95％ CI 0.284 -0.804; P =0.002) was associated with good prognosis.Multivariate logistic regression analysis demonstrated that after adjusted for all risk factors,the baseline National Institutes of Health Stroke Scale (NIHSS) (odds ratio [ OR] 1.513,95％ CI1.107-2.066; P=0.009),dysarthria (OR,7.11,95％ CI 1.207-41.877; P=0.030),ocular motor dysfunction (OR 8.653,95％ CI 1.230- 60.887; P=0.030),and large-artery atherosclerotic stroke (OR5.482,95％ CI 1.008 -29.803; P =0.049) were the independent risk factors for poor prognosis in patients with PCS,while ataxia (OR 0.251,95％ CI 0.067- 0.941; P=0.040) was independently associated with good prognosis of the patients.Conclusions The clinical manifestations in patients with PCS are complex,the majority of their symptoms and signs are unilateral.Most of the patients showed a variety of symptoms,and the isolated symptoms axe rare.Some symptoms and signs may indicate the prognosis of patients.

Objective To respectively analyze the patterns and possible predictors of recurrent strokes among patients with initial ischemic stroke.Methods Three hundred and sixty-one patients with recurrent strokes (acute ischemic stroke or intracerebral hemorrhage) after initial ischemic strokes were collected from Jan 2004 to Dec 2009.The data about conventional risk factors such as smoking,heavy alcohol drinking,hypertension,diabetes,hyperlipidemia,heart diseases,head trauma,migraine,family history of cardiovascular disease,and the use of preventive medications were collected and analyzed among patients with different types of recurrent strokes.Results Patients (n =361) were divided into ischemic stroke group (n =321) and hemorrhagic stroke group (n =40) according to the recurrent stroke type.The ischemic stroke group was further divided into the anterior circulation stroke subgroup (n =234),the posterior circulation stroke subgroup (n =75) and watershed cerebral infarction or multiple infarction subgroup (n =12).Multivariate logistic regression analysis revealed that older age at initial stroke onset (OR =1.036,95 ％ CI 1.006-1.067,P =0.02) and hyperlipidemia (OR =2.253,95 ％ CI 1.092-4.647,P =0.028) were both the independent risk factors for the recurrent ischemic stroke.Comparing the subgroups,multivariate logistic regression analysis showed that atrial fibrillation (OR =4.217,95％ CI 1.489-11.942,P =0.007) was the independent risk factor for the recurrent ischemic stroke in the posterior circulation territory.Conclusion Aging and hyperlipidemia are possible predictors of recurrent ischemic stroke after the initial ischemic stroke which would be useful for individualized secondary prevention of stroke.

Objective To analyze prognosic factors for patients with hormone refractory prostate cancer (HRPC) after chemotherapy of docetaxel/mitoxantrone plus prednisone and to explore the relationship between prostate specific antigen (PSA) parameters and prognosis. Methods Data from 68 patients with CRPC after chemotherapy were collected and analyzed retrospectively.The median age of these patients were 65 years old with 28 cases of biopsy Gleason score ＜ 8 and 35 cases of ≥ 8.The median serum PSA at diagnosis,nadir and pre-chemotherapy baseline were 142 ng/ml,0.5 ng/ml and 33.0 ng/ml,respectively.There were 38 patients in docetaxel group and 30 in mitoxantrone group.PSA doubling time ( PSADT),progression free survival (PFS) and overall survival (OS) was calculated.Chi square test was used in analysis of chemotherapy effect and Cox proportional hazards regression model was applied to identify the predictors for PFS and OS.The median value of continuous variable as cutoff point was used to divide patients into two groups to compare.Risk ratio and 95％ confidence interval (CI) was calculated. Results 38 (55.9％)patients experienced effective chemotherapy. The effective rate were 33％ and 74％ for PSADT ＜ 1.6 months and ≥ 1.6 months group,85％ and 49％ for M0 and M1 stage group,and 69％ and 40％ for docetaxel and mitoxantrone group,(P ＜ 0.05).The median PFS was (3.5 ± 0.5) months for all patients,which were (2.7 ±0.4) months and (5.9 ±0.6) months for patients with PSADT ＜ 1.6 months and ≥ 1.6 months group,(5.0 ± 0.6) months and (2.7 ± 0.5 ) months for patients with docetaxel and mitoxantrone group,and (5.7 ± 0.8) months and ( 3.4 ± 0.6) months for patients with Gleason score ＜ 8 and ≥ 8 group (P ＜0.05).26 case died in the end and the median OS was (28.3 ± 2.6) months for these patients,which were (15.7 ± 3.4) months and (31.6 ± 1.2) months for patients with PSADT ＜ 1.6 months and ≥1.6 months group,(29 ± 4.1 ) months and (28 ± 3.2) months for patients with docetaxel and mitoxantrone group,and (28.7 ± 2.6) months and (24.3 ± 5.6) months for patients with Gleason score ＜ 8 and ≥ 8 group (P ＜ 0.05). Conclusions The effective rate of chemotherapy was related with PSADT,chemotherapy strategy and M stage.PSADT,chemotherapy strategy and Gleason score may be independent predictors for patients with HRPC taking chemotherapy.Patients with PSADT ≥ 1.6 months,docetaxel chemotherapy and Gleason score ＜ 8 will have longer PFS and OS.

ObjectiveTo study the mechanism of myocardial dielectric property changes in radio frequency during hypothermic preservation and explore myocardial viability evaluative method. Methods Hybrid young pigs (20-30 kg) were used in the experiment. Heart arrest was induced with GIK solution. According to preservative temperature, the animals were divided into three groups: group A (4 ℃),group B (15 ℃) and group C (25 C). The heart was preserved in saline for 12,6 and 4 h respectively. Myocardial dielectric properties and ATP content were tested every 5 and 30 min during hypothermic preservation respectively. The relationship between tanoδm and ATP content was analyzed. ResultsTanδm of three groups was decreased significantly at the beginning, most slightly in group A and most obviously in group C. There was no significant difference in Tanδm between group B and group C with group A at 1 h,but there was obvious difference at 2,3 and 4 h (P＜0. 05,P＜0. 05,P＜0. 01 ). There was correlation between tanδm and ATP in the three groups. ConclusionTanδm in three groups is dropped with preservation time and temperature, and tanδm had a correlation with ATP content. Detection of myocardial dielectric property in radio frequency is a kind of quick, accurate and noninvasive method.

Objective To investigate the efficacy of Sunitinib in treating metastatic non-clear cell renal cell carcinoma (RCC).Methods Twenty-two metastatic non-clear cell subtype renal cell carcinoma patients with a median age of 46 years (29 -76 years) were treated with Sunitinib.Fourteen cases were found have metastasis post radical nephrectomy,and the remaining eight cases with metastasis received cytoreductive surgery.Pathological diagnosis showed 12 papillary RCCs,one chromophobe RCC,three collecting duct RCCs,and six unclassified RCCs.The metastatic lesions were located in the lung,lymph nodes,adrenal gland,bone,liver,and thyroid gland.The patients were given the treatment of sunitinib 50 mg qd four weeks on and two weeks off.The median time of treatment was 11 months (4.5 - 24 months).Results The objective control rate was 73％.Three papillary RCC and one chromophobe RCC reached partial remission (PR) and 12 cases maintained stable disease (SD) for more than 12 weeks.And the remaining six cases progressed (PD).Conclusions Sunitinib has definitive efficacy in metastatic papillary RCC,chromophobe RCC,collecting duct RCC and unclassified RCC.Metastatic lesions in lungs and lymph nodes might be more sensitive to Sunitinib.