Objective To investigate the relationship between gene mutation characteristics and immunological markers in patients with small cell lung cancer.Methods From January 2019 to 2020,155 patients with small cell lung cancer were admitted.Gene mutations were detected in these patients using target gene capture and sequencing method.Moreover,the tumor mutational burden(TMB)and expression of PD-L1 in some patients were detected.Results A total of 326 gene mutations were detected in the patients,the most significant of which were TP53 and RB1.Among the 8 genes with mutation frequency higher than 15％,patients with KMT2D,KMT2C,FAT1 and NOTCH1 mutations had higher TMB than those without mutation,and the difference was statistically significant(P＜0.05).Conclusion The most common mutated genes in patients with small cell lung cancer are TP53 and RB1.KMT2D,KMT2C,FAT1 and NOTCH1 may be potential markers for the efficacy of immunotherapy in small cell lung cancer.

Objective     To investigate the safety and feasibility of day surgery for patients with palmar hyperhidrosis based on the principles of enhanced recovery after surgery (ERAS). Methods     We retrospectively reviewed the medical records of consecutive patients who underwent endoscopic thoracic sympathicotomy (ETS) in the First Affiliated Hospital of Xi'an Jiaotong University from March 2020 to December 2021. Patients were divided into a day surgery group and a conventional group according to their perioperative management methods. The patients in the day surgery group underwent an optimized perioperative procedure under the guidance of ERAS, and were ventilated with a laryngeal or face mask during the operation. The patients in the conventional group completed the preoperative examination, operation and postoperative observation according to the conventional procedures, and were intubated with a single-lumen endotracheal tube. The demographic characteristics, operation time, hospital stay, postoperative complications, and hospitalization cost were compared between the two groups. Results     Finally 172 patients were collected, including 90 males and 82 females, with an average age of 25.97±7.43 years. There were 86 patients in each group. All patients ceased suffering from palmar sweating after surgery. No patient experienced massive bleeding or conversion to thoracotomy. There was no statistical difference in operation time between the two groups (P=0.534). Patients in the day surgery group were discharged within 24 hours. The average hospital stay in the conventional group was 2.09±0.41 days. Incidence of postoperative respiratory complications, and the hospitalization cost of the day surgery group were significantly lower than those of the conventional group (P<0.001). The satisfaction rate in both groups was greater than 95%. Conclusion     Day surgery for patients with palmar hyperhidrosis based on the principles of ERAS is safe and feasible, which can reduce postoperative complications, shorten the length of hospital stay and save the cost of hospitalization.

Objective:To investigate the correlation between 24 h blood pressure variability and early neurological improvement (ENI) in patients with large vessel occlusion (LVO) after endovascular thrombectomy (ET).Methods:Patients with LVO received ET in the Emergency Department, the Affiliated Hospital of Nantong University from January 2012 to February 2018 were enrolled retrospectively. During the first 24 h after ET, the blood pressure was recorded every 2 h, and blood pressure variability was evaluated by standard deviation (SD) and successive variation (SV). At 24 h after ET, the National Institutes of Health Stroke Scale (NIHSS) score was evaluated again. The re-evaluation of 0 point or a decrease of ≥4 from the baseline score was defined as ENI. Multivariate logistic regression analysis was used to evaluate the relationship between blood pressure variability and ENI. Results:A total of 74 patients with LVO received ET were enrolled, of which 39 (52.7%) had ENI. Univariate analysis showed that the proportion of patients with good recanalization in the ENI group after procedure were significantly higher than that in the non-ENI group ( P<0.05), while the average systolic blood pressure, average diastolic blood pressure, systolic blood pressure variability (SBPV) -SD and SBPV-SV within 24 h after ET and baseline total cholesterol level were significantly lower than those in the non-ENI group (all P<0.05). Multivariate logistic regression analysis showed that higher SBPV-SV was an independent risk factor for non-ENI (odds ratio 1.223, 95% confidence interval 1.038-1.440; P=0.016). Conclusion:Higher SBPV-SV after ET is associated with poor early neurological improvement in patients with LVO, and it is expected to be a potential target for blood pressure management in patients after ET.

Objective    To analyze the effect of different drainage modes on the postoperative thoracic drainage after video-assisted thoracoscopic surgery for radical resection of lower lung carcinoma. Methods    A total of 183 patients with non-small cell lung cancer who received biportal thoracoscopic anatomical lower lobectomy combined with mediastinal lymph node dissection in the First Affiliated Hospital of Xi'an Jiaotong University from August 2017 to August 2019 were enrolled, including 113 males and 70 females, aged 31-77 (56.5±6.4) years. The patients were randomly divided into three groups, including an anterior axillary line group, a mid-axillary line group and a modified anterior axillary line group. Clinical efficacy of the three groups was compared. Results    No significant difference among these three groups in terms of gender, age, surgical site, pathological type, pathological staging, postoperative chest wall subcutaneous emphysema, postoperative pain score, and postoperative hospital stay was found (P>0.05). There were significant differences among the patients in terms of postoperative pleural effusion, re-insertion of chest tube or aspiration, total liquid quantity of thoracic drainage, drainage time and chest wall incision stitches time (P<0.05). The anterior axillary line group had higher risk of postoperative pleural effusion than the other groups (P<0.05). The occurrence of postoperative pleural effusion and rate of reposition of chest tube or aspiration were significantly reduced in the modified anterior axillary line group (P<0.05). Conclusion    Chest drainage tube with large diameter (24F) in the 5th intercostal space of the anterior axillary line combined with another micro-tube (8.5F) in the 7th or 8th intercostal space of the inferior scapular angle line can shorten drainage time to reduce postoperative pain, reduce the occurrence of postoperative pleural effusion, and shorten the time of surgical incision stitches.

Objective:The extensive development of anatomical pulnonary segmentectomy requires thoracic surgeons to be familiar with the anatomical variations of the lung segment. The purpose of this study is to analyze the anatomical patterns of the right upper lobe lung segment using three-dimensional reconstruction, and to count rare variant types.Methods:From October 2017 to March 2020, 101 patients with small pulmonary nodules who were undergo segmental resection in our center were subjected to preoperative three-dimensional reconstruction of the lung structure, and the reconstruction data was retained for the statistics and analysis of the anatomical structure in the right upper lung lobe.Results:The right upper lobe bronchus is the most common with three branches(77/101), followed by two branches(16/101) and four branches(7/101). The two branches(70/101) of the right upper lobe pulmonary artery are the most common, followed by single branch(19/101) and three branches(11/101). In rare cases, four branches(1/101 cases) can be seen. The two branches(63/101) of the right upper pulmonary vein were the most common, followed by three branches(32/101) and single branch(6/101). In addition, a total of 12 rare mutations were counted. There were 2 variants in the bronchus, totaling 2 cases; 4 rare variants in the pulmonary artery, 13 cases total; 6 rare variants in the pulmonary vein, 10 cases total.Conclusion:The lung anatomy is complex and has many variations. The surgeon should fully grasp the anatomical structure of the lung segment of the patient's operating area before surgery, the data in this article will be a valuable reference for thoracic surgeons to carry out the upper right lobe segmentectomy.

Objective:To explore whether the deep deltoid ligament (DL) rupture affects the mid-term clinical efficacy of pronation-external rotation (PER) ankle fracture or not.Methods:A ret-rospective study was conducted to analyze the clinical data of 50 patients with ankle fracture of PER type Ⅲ or Ⅳ who had been treated at Department of Orthopedic Trauma, Beijing Jishuitan Hospital from January 2013 to December 2014.They were 37 males and 13 females with an average age of 30.2 years(from 16 to 68 years). According to their type of medial ankle injury, the patients were divided into 2 groups.The experimental group, consisting of 28 patients with deep DL rupture but no medial ankle fracture, did not undergo DL repair operation; the control group, consisting of 22 patients with supracollicular medial malleolar (SMM) fracture but no deep DL rupture, underwent open reduction and internal fixation (ORIF) for SMM.Both groups were treated with ORIF of fibular fracture in addition to syndesmosis screw fixation.The 2 groups were compared in terms of the medial malleolus space and distal tibiofibular space on the imaging exams at more than 6 months, and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and visual analog scale (VAS) pain scores at the mid-term follow-ups.Results:The differences between the 2 groups in gender, age and mode of concomitant subluxation or dislocation were statistically significant ( P<0.05), but there were no sig-nificant differences between the 2 groups in injury violence, height of fibular fracture line, presence of total dis-location, rate of posterior malleolus fracture, rate of posterior malleolus fixation, implant removal, or operation time ( P>0.05).Imaging exams were conducted for 38 patients at 6 or more months after surgery.The medial malleolus space was 3.7 mm and the distal tibiofibular space 4.5 mm for the 21 cases in the experimental group; the medial malleolus space was 3.4 mm and the distal tibiofibular space 4.4 mm for the 17 cases in the control group.The 3-year follow-up AOFAS scores of the experimental group and the control group were 98.3 and 94.6 respectively; VAS scores were 0.4 and 1.5; the 5-year follow-up AOFAS scores of the experimental group and the control group were 97.1 and 93.6 respectively,and VAS scores were 0.5 and 1.2 respectively.Logistic regression analysis of ordered multi-classification showed that the AOFAS and VAS scores at 3-year and 5-year follow-ups had no significant correlation with the deep DL rupture for the patients<45 years old( P>0.05).Patient age was correlated with the 5-year follow-up AOFAS scores ( P=0.021). Conclusion:In ankle fracture of PER type Ⅲ or Ⅳ treated with lateral malleolar and syndesmosis screw fixation, nonoperative treatment of the deep DL rupture may not influence the mid-term clinical efficacy for the patients less than 45 years old.

Objective: To evaluate the application of panning axial turnover in placement of surgical positions before thoracic surgery. Methods: From June 2017 to September 2017, altogether 140 patients who underwent thoracic surgery were enrolled in and randomly divided into two groups: the observation group and the control group. The control group was treated with traditional turnover method, while the observation group were treated with axial turnover. Results: No significant changes were found in blood pressure, heart rate and respiratory rate (P>0.05) after turning over. There was no significant difference between the observation group and the control group about turn over time, (7.06±0.78)s vs. (7.01±0.81)s (P>0.05). The subjective evaluation results of the medical staff in the observation group were significantly better than those of the control group (Z=-7.111, P<0.01) and the shift rate of double-lumen endotracheal tube in the observation group was 3.7% (2/54), which was significantly lower than 21.6% (11/51) of the control group (χ²=6.158, P<0.05). Conclusions The panning axial turnover properly guided the turn-over work with the principle of human body mechanics, which was more labor-saving and requires less operators. Besides, the panning axial turnover effectively reduced the double-lumen tracheal intubation shift rate. It′s worthy of clinical promotion.

A type of designated hospitals in Medicare is referred to as Long-Term Care Hospital (LTCH). LTCH is one of Post-Acute Care settings(I. e. Intermediate care)and the only facilities certified by length of stays. This article reviewed the milestones and payment methods of Medicare Long-Term Care Hospital payment system, for perfection of the medical insurance and construction of China′s intermediate care system.

Objective To summarize the experience of perioperative treatment of lung transplantation for end-stage lung disease. Methods Perioperative clinical data of 7 recipients undergoing lung transplantation were retrospectively analyzed, including 3 cases with bilateral lung transplantation and 4 cases with unilateral lung transplantation. The perioperative status and clinical prognosis of lung transplantation recipients were observed. Results The operation time of 7 lung transplantation recipients was (344±133) min. Cold ischemia time was (236±74) min in 4 cases of single-lung transplantation and (480±120) min in 3 cases of bilateral-lung transplantation. The length of Intensive care unit(ICU) stay was 21 (13-25) d and the length of hospital stay was 101 (64-117) d. In the first 3 d after surgery, the daily fluid output was significantly larger than the fluid input (all P < 0.05). The arterial oxygen partial pressure (PaO₂) of lung transplantation recipients in the first 3 d after surgery was significantly elevated than preoperative level (all P < 0.05), whereas the arterial carbon dioxide pressure (PaCO₂) did not significantly change (all P > 0.05). All recipients had pulmonary bacterial infection after lung transplantation, including 3 cases complicated with fungal infection. One recipient underwent exploratory thoracotomy for hemostasis due to active thoracic bleeding after operation, 1 recipient suffered from primary graft dysfunction (PGD) and 4 recipients received secondary endotracheal intubation. Two cases died after operation, 1 case died of septicemia caused by multidrug-resistant acinetobacter baumannii, the other case died of rejection reaction after self-terminating use of immunosuppressive agents. The remaining 5 cases were successfully discharged and recovered well. The longest survival period was 3.1 years. Conclusions In the perioperative management of lung transplantation, it has great significance to hold the surgical indications, monitor and manage postoperative refined fluid and hemodynamics, implement the strategy of protective pulmonary ventilation, and early diagnose and treat severe postoperative complications for the recipients of lung transplantation to safety through the perioperative period.

Objective    To evaluate the clinical role of video-assisted mediastinoscopy and its safety and effectiveness in the diagnosis of thoracic disease. Methods    We reviewed the clinical data of consecutive 40 patients (25 males and 15 females with an average age of 54.6 years) who received video-assisted mediastinoscopic surgery in our department of thoracic surgery from December 2011 to November 2016, including mediastinal lymph node biopsy in 27 patients, mediastinal primary lesions biopsy in 8, bronchial cystectomy in 3 and esophageal dissection in 2. Results    The histological results were positive in 20 patients (73.1%) in mediastinal lymph node biopsy, including granulomatous mediastinitis in 14 and metastasis in 6 (non-small cell lung cancer in 4, Ewing sacoma in 1 and small cell lung cancer in 1) and reactive proliferation in 7 (26.9%). In mediastinal primary lesions biopsy, the accuracy rate of diagnosis was 100.0%. The pathologic results were malignant in all patients, including small cell lung cancer in 5, adenoid cystic carcinoma in 1, squamous carcinoma in 1 and adenocarcinoma in 1. In patients who received the bronchial cystectomy, no recurrence was found during at least 2 years follow-up. There was one patient with severe complication (innominate artery injury). Two patients suffered transient laryngeal recurrent nerve palsy with hoarseness and two patients incision secretion. Conclusion    Video-assisted mediastinoscopic surgery is effective and safe and dissection should be careful in granulomatous mediastinitis to avoid the great vessel injures.