Objective     To explore the efficacy of prone positioning ventilation in patients with acute respiratory distress syndrome (ARDS) after acute Stanford type A aortic dissection (STAAD) surgery. Methods     From November 2019 to September 2021, patients with ARDS who was placed prone position after STAAD surgery in the Xiamen Cardiovascular Hospital of Xiamen University were collected. Data such as the changes of blood gas, respiratory mechanics and hemodynamic indexes before and after prone positioning, complications and prognosis were collected for statistical analysis. Results    A total of 264 STAAD patients had surgical treatment, of whom 40 patients with postoperative ARDS were placed prone position. There were 37 males and 3 females with an average age of 49.88±11.46 years. The oxygen partial pressure, oxygenation index and peripheral blood oxygen saturation 4 hours and 12 hours after the prone positioning, and 2 hours and 6 hours after the end of the prone positioning were significantly improved compared with those before prone positioning ventilation (P<0.05). The oxygenation index 2 hours after the end of prone positioning which was less than 131.42 mm Hg, indicated that the patient might need ventilation two or more times of prone position. Conclusion     Prone position ventilation for patients with moderate to severe ARDS after STAAD surgery is a safe and effective way to improve the oxygenation.

AIM: To investigate the role of histidine-rich glycoprotein(HRG)in the neovascularization of diabetic retinopathy in rats.METHODS: Streptozocin(STZ)-induced diabetic Sprague-Dawley(SD)rats were utilized as an experimental model, the protein expression of HRG and vascular endothelial growth factor(VEGF)in the retinas of normal(Wild type, WT)and diabetic(diabetic mellitus, DM)groups was detected using Western blot(WB). The protein expression of HRG in high-glucose-induced human retinal microvascular endothelial cells(hRMECs)was verified by WB after transfection with HRG small interfering RNA(siRNA)low-expression sequences. The optimal si-HRG#298 sequence was selected for further experiments. In the animal experiment, HRG gene silencing was achieved using an adeno-associated virus(AAV)vector, with AAV2-sh-NC and AAV2-sh-HRG#298 serving as the HRG gene silencing group and the HRG empty vector control group, respectively. The protein expression of HRG and VEGF in each group was then detected by WB following the verification of HRG protein expression. Retinal structural changes were observed by HE staining, and neovascularization changes were observed by PAS staining.RESULTS: HE staining found that the retinal structure in the DM group was disordered, the number of cells in the ganglion cell layer decreased, the number of cells in the inner and outer nuclear layers decreased, and the total retinal thickness also decreased(P<0.05); cellular capillaries were significantly increased in DM rats observed by PAS staining(P<0.05); the protein expression of HRG and angiogenesis factor VEGF was up-regulated in the retina of DM group(P<0.05); the protein expression of HRG was significantly downregulated in high glucose-induced hRMECs(P<0.05); the inhibition of neovascularization in diabetic retinas and the downregulation of VEGF protein expression were achieved through HRG gene silencing(P<0.05).CONCLUSION: HRG promotes neovascularization in the retinas of diabetic rats, and HRG gene silencing can inhibit neovascularization.

Objective:To study the SUV3 gene role during the process of occurrence and advancement of hepatocellular carcinom.Methods:The The differences in SUV3 expression between hepatocellular carcinoma tissues and normal liver tissues were compared by analyzing transcriptome sequencing data from TCGA and GTEx databases. SUV3 knockdown in different hepatocellular carcinoma cells was performed using RNA interference technology. Overexpression vectors were constructed to overexpress SUV3 in different hepatocellular carcinoma cells. The SUV3 regulatory effect was studied on proliferation, migration, and invasion of hepatocellular carcinoma cells. A subcellular fraction isolation approach was used to investigate whether SUV3 knockdown resulted in the release of mitochondrial DNA into the cytoplasm. Quantitative reverse transcription PCR was applied to investigate whether SUV3 knockdown affected PD-L1 expression. The two groups were compared using a two-tailed t-test. Results:The TCGA database analysis revealed that SUV3 expression was higher in hepatocellular carcinoma tissues than in normal liver tissues, and the prognosis of patients with high SUV3 expression in hepatocellular carcinoma tissues was poor. The quantitative RT-PCR results showed that SUV3 expression was higher in hepatocellular carcinoma tissues than that in paracancerous liver tissue. The MTS assay showed that with SUV3 knockdown, the proliferation rate was significantly lower in hepatocellular carcinoma cells than that of the control hepatocellular carcinoma cells ( P<0.01). The proliferation rate was significantly higher in SUV3-overexpressed hepatocellular carcinoma cells than that of control hepatocellular carcinoma cells ( P<0.01). Cell scratch assay and cell migration and invasion assay showed that SUV3 knockdown inhibited the migration and invasion of hepatocellular carcinoma cells ( P<0.01), while SUV3 overexpression promoted the migration and invasion of hepatocellular carcinoma cells ( P<0.05). SUV3 Knockdown led to a decrease in the overall level of mtDNA ( P<0.01) in accompanied by an increase in mtDNA level in the cytoplasm ( P<0.01), indicating that SUV3 knockdown led to mitochondrial DNA leakage into the cytoplasm. SUV3 knockdown resulted in elevated PD-L1 expression ( P<0.001), and overexpression of TREX1 in SUV3 knockdown cells decreased mtDNA levels in the cytoplasm and inhibited SUV3 knockdown, resulting in elevated PD-L1 expression, indicating that SUV3 knockdown induced PD-L1 expression by increasing cytoplasmic DNA levels. Conclusions:The SUV3 gene may play an oncogenic function in hepatocellular carcinoma cells.

Objective:This study aimed to reveal the distribution and course of the branches of the infraorbital nerve(IN),its communication relationship between the branches of the infraorbital nerve and facial nerve,so as to provide morphological basis for clinical implementation of accurate infraorbital nerve trunk in the infraorbital canal,regional facial anesthesia and facial surgery,so as to improve the success rate of maxillofacial surgery.Methods:25 adult cada-vers with formalin immobilized semi-face were selected.Exclude facial defect samples caused by tumor,trauma,deformity,surgery,etc.The length and diameter of the trunk of the infraorbital nerve and the length of the infraorbital canal were measured.The total number of infraorbital nerve and the number of branches were counted,and the course,distribution and communication relationship between infraorbital nerve and facial nerve were investigated.Results:The length of infraorbital nerve trunk ranged from 19.61 to 44.47 mm,with an average length of(23.33±4.95)mm.The length of infraorbital canal ranged from 9.49 to 31.21 mm,with an average length of(12.87±3.99)mm.The number of infraorbital nerve branches ranged from 5 to 12,and the average number was(7.29±2.29).The number of upper labial branches was the widest,ranging from 1 to 5,while the distribution area of eyelid branches was the narrowest.There are(were)a large number of intersections and anastomoses between the infraorbital nerve and the facial nerve,forming a complex multi-layer network structure.Conclusion:The infraorbital nerve trunk and the infraorbital canal va-ry in length.The number and distribution range of infraorbital nerve branches are not constant,and the communication relationship between infraorbital nerve and facial nerve is complicated.

Objective:To investigate the safety of minimally invasive liver resection for resectable hepatocellular carcinoma (HCC) complicated with portal hypertension.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 807 patients with resectable HCC who underwent minimally invasive liver resection in 8 medical centers, including Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine et al, from June 2011 to November 2022 were collected. There were 670 males and 137 females, aged 58(50,66)years. Of the 807 patients, 173 cases with portal hypertension were divided into the portal hypertension group, and 634 cases without portal hypertension were divided into the non-portal hypertension group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) intraoperative and post-operative situations; (3) subgroup analysis. Propensity score matching was done by the 1:1 nearest neighbor matching method, with the caliper setting as 0.001. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the rank sum test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was constructed using the non-parameter rank sun test. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of the 807 patients, 268 cases were successfully matched, including 134 cases in the portal hypertension group and 134 cases in the non-portal hypertension group. The elimination of the tumor diameter and robot-assisted surgery confounding bias ensured comparability between the two groups after propensity score matching. (2) Intraoperative and postoperative situations. The occlusion time of porta hepatis, cases with intraoperative blood transfusion, cases with postoperative complication, cases with complication >Ⅱ grade of Clavien-Dindo classification, cases of Clavien-Dindo classification as Ⅰ grade, Ⅱ grade, Ⅲ grade, Ⅳ grade, cases with liver related complication were 27.0(15.0,43.0)minutes, 33, 55, 15, 13, 29, 14, 1, 37 in the portal hypertension group, versus 35.0(22.0,60.0)minutes, 17, 25, 5, 14, 9, 4, 1, 13 in the non-portal hypertension group, showing significant differences in the above indicators between the two groups ( Z=-2.15, χ2=6.30, 16.39, 4.38, 20.72, 14.16, P<0.05). (3) Subgroup analysis. Results of subgroups analysis showed that in cases with major live resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 243.5(174.6,296.3)minutes, 200.0(150.0,600.0)mL, 7.5(6.0,13.0)days in the portal hypertension group, versus 270.0(180.0,314.5)minutes, 200.0 (75.0,450.0)mL, 7.0(5.5,10.0)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-0.54, -1.73, -0.92, P>0.05). In cases with non-major live resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 170.0(120.0,227.5)minutes, 100.0(50.0,200.0)mL, 8.0(5.0,10.0)days in the portal hypertension group, versus 170.0(120.0,227.5)minutes, 100.0(50.0,200.0)mL, 7.0(5.5,9.0)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-1.39, -0.10, 1.05, P>0.05). In cases with anatomical liver resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 210.0(150.0,285.0)minutes, 150.0(50.0,200.0)mL, 8.0(6.0,9.3)days in the portal hypertension group, versus 225.5(146.3,306.8)minutes, 100.0(50.0,250.0)mL, 7.0(6.0,9.0)days in the non-portal hypertension group, showing no significant difference in the above indica-tors between the two groups ( Z=-0.75, -0.26, -0.91, P>0.05). In cases with non-anatomical liver resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 173.5(120.0,231.5)minutes, 175.0(50.0,300.0)mL, 7.0(5.0,11.0)days in the portal hyper-tension group, versus 186.0(123.0,262.5)minutes, 100.0(50.0,200.0)mL, 7.0(5.0,9.5)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-0.97, -1.12, -0.98, P>0.05). Conclusion:Minimally invasive liver resection or even major liver resection is safe and feasible for screened HCC patients complicated with portal hyper-tension, but attention should be paid to the prevention and treatment of postoperative complications.

There is currently a huge worldwide demand for donor kidneys for organ transplantation. Consequently, numerous marginal donor kidneys, such as kidneys with microthrombi, are used to save patients' lives. While some studies have shown an association between the presence of microthrombi in donor kidneys and an increased risk for delayed graft function (DGF) (McCall et al., 2003; Gao et al., 2019), other studies have demonstrated that microthrombi negatively impact the rate of DGF (Batra et al., 2016; Hansen et al., 2018), but not graft survival rate (McCall et al., 2003; Batra et al., 2016; Gao et al., 2019). In contrast, Hansen et al. (2018) concluded that fibrin thrombi were not only associated with reduced graft function six months post-transplantation but also with increased graft loss within the first year of transplantation. On the other hand, Batra et al. (2016) found no significant differences in the DGF rate or one-year graft function between recipients in diffuse and focal microthrombi groups. To date, however, the overall influence of donor kidney microthrombi and the degree of influence on prognosis remain controversial, necessitating further research.
Humans ; Thrombotic Microangiopathies ; Transplantation, Homologous ; Tissue Donors ; Kidney ; Allografts

Schizophrenia(SZ)is a serious mental illness,and traditional diagnostic methods are prone to missed and misdiagnosis.Using machine learning(ML)algorithms can extract SZ relative features from functional MRI(fMRI)data,hence being helpful for diagnosing and predicting treatment response of SZ.The research progresses of ML based on fMRI for diagnosis and treatment of SZ were reviewed in this article.

Neuroendocrine neoplasm (NEN) is a type of heterogeneous tumor that originates from peptidergic neurons and neuroendocrine cells. The presence of over-expressed somatostatin receptors (SSTR) on the surface of NEN tumor cells has led to the administration of radiolabeled somatostatin analogs (SSA) in combination with over-expressed SSTR, which is called peptide receptor radionuclide therapy (PRRT). The 1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetraacceticacid- D-Phe1-Tyr3-Thr8-octreotide (DOTATATE)-based α/β radionuclide therapy is one of the representative therapeutic methods of PRRT. This article reviews the progress of research on α/β radionuclide therapy based on DOTATATE and its related combination therapy, drug toxicity and safety, as well as expectation for modalities with clinical value for NEN treatment.

Objective:To explore the efficacy of a flat ground exoskeleton robot in improving the walking ability of stroke survivors.Methods:Fifty-eight stroke survivors with mobility difficulties were randomly divided into a robot group ( n=29) and a control group ( n=29). In addition to routine rehabilitation, the control group received conventional walking training, while the robot group underwent exoskeleton robot-assisted gait training. The 30-minute training sessions were held twice a day, 5 days per week for 5 weeks. Before as well as after 2 and 4 weeks of treatment, everyone′s walking ability was tested using the 6-minute walk test (6MWT) and functional ambulation scale (FAC). General lower limb motor function was quantified using the Fugl-Meyer Lower Extremity assessment (FMA-LE). Moreover, gait analysis was conducted before and after 4 weeks of treatment. Results:After 2 and 4 weeks of treatment, the average 6MWT times of both groups were significantly better than before the treatment, with the improvement of the robot group significantly greater than that of the control group after 2 weeks. After 2 and 4 weeks the average FMA-LE and FAC scores of both groups had improved significantly compared with before treatment. After 4 weeks the stride frequency and gait cycle of both groups had improved significantly.Conclusions:Exoskeleton robot-assisted gait training can improve walking ability and lower limb motor function of stroke survivors about as well as conventional walking training.

Objective:To compare the clinical effect of buttress plate fixation and cannulated screw fixation of Regan-Morrey type II ulnar coronoid fractures.Methods:A retrospective case control study was made on 53 patients with Regan-Morrey type II ulnar coronoid fractures admitted to Wuxi No.9 People 's Hospital from April 2015 to January 2018，including 36 males and 17 females，aged from 21 to 63 years［（36.3±7.1）years］. Among them，24 patients were treated using buttress plates（plate group），and 29 patients using cannulated screws（screw group）. The operation time and fracture healing time were documented. The visual analogue score（VAS），range of motion of elbow flexion and extension and forearm rotation and Mayo elbow performance score（MEPS）were assessed at postoperative 1，3，6 months and at the last follow-up. The incidence of complications was observed as well. Results:All patients were followed up for 15-18 months［（15.9±1.3）months］. The operation time in plate group［（150.6±24.2）minutes］was longer than that in screw group［（126.8±18.3）minutes］（ P<0.05）. There was no significant difference in fracture healing time or VAS between the two groups（ P>0.05）. After 1，3，6 months and during the last follow-up，the range of motion of elbow joint flexion and extension in plate group［（87.2±5.8）°，（109.2±7.1）°，（121.3±6.2）°，（127.3±5.4）°］was higher than that in screw group［（70.5±9.1）°，（90.2±4.5）°，（108.3±5.1）°，（116.2±4.6）°］，the range of motion of forearm rotation in plate group［（78.3±9.1）°，（98.7±8.6）°，（130.2±7.1）°，（139.2±6.7）°］was higher than that in screw group［（60.1±5.1）°，（80.6±8.7）°，（116.1±5.5）°，（127.3±4.1）°］，and the MEPS in plate group［（30.6±7.6）points，（68.1±6.1）points，（90.2±4.3）points，（95.2±2.1）points］was higher than that in screw group［（27.2±8.1）points，（54.1±7.1）points，（82.1±5.3）points，（88.2±5.2）points］（all P<0.05）. In plate group，one patient sustained superficial wound infection at postoperative 1 week，which was healed uneventfully after surgical debridement and antibiotic therapy；two patients had heterotopic ossification without addition surgery. In screw group，three patients presented screw loosening and fracture redisplacement during early movement，which was healed by reducing the intensity of elbow functional exercise and prolonging the protection time of brace；four patients had heterotopic ossification，among which one combined with elbow stiffness showed improved range of motion of the elbow after elbow release at postoperative 12 months. The incidence of complications in plate group［13%（3/24）］was lower than that in screw group［26%（7/29）］（ P<0.05）. Conclusion:For Regan-Morrey type II ulnar coronoid fractures，the buttress plate fixation is superior to the cannulated screw fixation in fixation strength，recovery of elbow function and incidence of complications in regardless of longer operation time.