Objective:To investigate the effect and quality of life after anterior chest wall reconstruction with titanium plate and mesh due to manubrium tumor resection.Methods:A retrospective analysis was performed from January 2012 to December 2016, a total of 13 patients with primary(11cases) or secondary(2 cases) manubrium tumor, aged 41-72 years(medium aged as 56), underwent oncological resection, following by immediate chest wall reconstruction with titanium plate and titanium mesh. The quality of life was evaluated by EuroQol five dimensions questionnaire (EQ-5D) and EQ-5D visual analogue scale (ED-VAS) before and 3 months after operation. Computed tomographic scan was taken 3 months after operation.Results:All the patients received successful operation. During the perioperative period, 12 cases recovered well without any complications, 1 patient experienced mild paradoxical movement within 9 days after operation and then recovered. The median follow-up period after surgery was 25 months (range from 7 to 41). Computed tomographic scans for the 13 patients showed neither dislocation nor deformation of the titanium plate and mesh 3 months after operation. One patient with chondrosarcoma died as a result of relapse 11 months after surgery. In pain/discomfort dimension, the pre-operation score was 1.85±0.80 and the post-operation score was 1.15±0.38, showing a significant difference( P=0.013). There was no significant difference in scores of other four dimensions between pre- and post-operation( P>0.05). The total score of EQ-5D decreased significantly after the operation (7.08±2.02 vs 5.45±0.52, P=0.010). The pre- and post-operation ED-VAS score was 85.69±7.58 and 92.54±2.53, with a significant difference( P=0.008). Conclusions:The immediate reconstruction of chest wall with titanium plate and mesh after oncological manubrium resection is effective and safe with improvement of the quality of life.

Objective:To investigate the effect and quality of life after anterior chest wall reconstruction with titanium plate and mesh due to manubrium tumor resection.Methods:A retrospective analysis was performed from January 2012 to December 2016, a total of 13 patients with primary(11cases) or secondary(2 cases) manubrium tumor, aged 41-72 years(medium aged as 56), underwent oncological resection, following by immediate chest wall reconstruction with titanium plate and titanium mesh. The quality of life was evaluated by EuroQol five dimensions questionnaire (EQ-5D) and EQ-5D visual analogue scale (ED-VAS) before and 3 months after operation. Computed tomographic scan was taken 3 months after operation.Results:All the patients received successful operation. During the perioperative period, 12 cases recovered well without any complications, 1 patient experienced mild paradoxical movement within 9 days after operation and then recovered. The median follow-up period after surgery was 25 months (range from 7 to 41). Computed tomographic scans for the 13 patients showed neither dislocation nor deformation of the titanium plate and mesh 3 months after operation. One patient with chondrosarcoma died as a result of relapse 11 months after surgery. In pain/discomfort dimension, the pre-operation score was 1.85±0.80 and the post-operation score was 1.15±0.38, showing a significant difference( P=0.013). There was no significant difference in scores of other four dimensions between pre- and post-operation( P>0.05). The total score of EQ-5D decreased significantly after the operation (7.08±2.02 vs 5.45±0.52, P=0.010). The pre- and post-operation ED-VAS score was 85.69±7.58 and 92.54±2.53, with a significant difference( P=0.008). Conclusions:The immediate reconstruction of chest wall with titanium plate and mesh after oncological manubrium resection is effective and safe with improvement of the quality of life.

Objective To discuss the safety and efficacy of using ExoSealTM vascular closure device to obtain rapid hemostasis of puncture site in interventional procedure via retrograde femoral artery access.Methods The clinical data of 124 patients,who were admitted to authors' hospital during the period from March 2016 to April 2016 to receive interventional procedure via retrograde femoral artery access,were retrospectively analyzed.During the performance of intervention,ExoSealTM vascular closure device (ExoSealTM group,n=52) or manual compression (MC group,n=72) was employed to make femoral artery puncture point hemostasis.The time spent for hemostasis,the manual compression time,the limb immobilization time,the amount of blood loss during compression process,and the procedure-related complications were recorded and the results were compared between the two groups.Results Technical success rate in ExoSealTM group was 98.1％(51/52).In ExoSealTM group and MC group,the time spent for hemostasis was (0.28±0.08) min and (5.83±1.46) min respectively,the manual compression time was (2.65 ±0.57) min and (7.70± 1.88) min respectively,the limb immobilization time was (2.72±0.43) h and (6.15±0.69) h respectively;all the differences between the two groups were statistically significant (P＜0.01).In ExoSealTM group subcutaneous hemotoma occurred in one patient,while in MC group subcutaneous hemotoma occurred in 3 patients and pseudoaneurysm in one patient;the complication rates were 1.92％ (1/52) and 5.56％ (4/72) respectively,but the difference was not statistically significant (P＞0.05).In MC group the amount of blood loss during compression process was (1.11±0.86) ml,which was remarkably less than (7.83±2.08) ml in ExoSealTM group,the difference between the two groups was statistically significant (P＜0.01).Conclusion For hemostasis of puncture site in interventional management via retrograde femoral artery access,the use of ExoSealTM vascular closure device is safe and effective.

OBJECTIVETo explore the material basis of conduction along meridian.

METHODSSixty SD rats(30 males,30 females) were randomly assigned into a normal group,an acupuncture group,a verapamil blocking group and a 0.9%NaCl blocking group(control group),15 rats in each one. Fluo 3-AM(calcium fluorescence probe) was injected at the observation part in femoral stomach meridian of foot-(meridian part) and the approaching femoral meridian part(non-meridian part) in the normal group and the acupuncture group,and then incubation was applied. In the verapamil blocking group,verapamil was injected at local meridian part and non-meridian part,and in the control group 0.9%NaCl was injected. Then Fluo 3-AM was injected at the meridian part and non-meridian part in the two groups,and incubation was implemented. Caimaging changes in cells were recorded for more than 20 min after injection of every part in each group respectively. After the above operations in the last three groups,acupuncture was used at "Zusanli"(ST 36) immediately,with electroacupuncture for one min,then Caimaging changes in cells at the meridian and non-meridian parts were recorded for more than 20 min.

RESULTSIn the normal group, Cafluorescence intensity at the meridian part was higher than that at the non-meridian part. In the acupuncture group,after acupuncture Cafluorescence intensity at the meridian part was obviously higher than before,but the change before and after acupuncture was not apparent at the non-meridian part. After verapamil blocking local calcium channel and acupuncture,the Cafluorescence of the meridian part did not strengthen,and the change of that before and after acupuncture at the non-meridian part was not obvious. In the control group,after injecting 0.9%NaCl at local part,Cafluorescence intensities of the meridian and non-meridian parts showed no obvious change,so was that before and after acupuncture.

CONCLUSIONSThe voltage-gated calcium channel at the meridian part is highly correlated with its tissue cells exciting conduction.

Objective To evaluate the correlation of epicardial adipose tissue volume (EATV)with coronary plaques in patients with a coronary artery calcium score of zero.Methods 183 patients with a coronary artery calcium score of zero were selected.They were divided into plaque group and control group according to the findings of CT coronary angiography.Independent t test was used to analyze the difference of EATV between two groups.Results ①EATV was significant higher in plaque group than that in control group (P <0.05).②EATV was non-significant higher in plaque group than that in control group for female individuals (P >0.05), while it was significant higher in plaque group than that in control group for male individuals (P <0.05).③EATV was significant higher in plaque group than that in control group for the individuals with age< 50 years (P <0.05 ),meanwhile it was significant higher in plaque group than that in control group in age≥50 years(P <0.05).Conclusion EATV is correlated with coronary plaques in male patients with a coronary artery calcium score of zero while there is no correlation with female patients.EATV is correlated with coronary plaques in different age patients with a coronary artery calcium score of zero.

Objective To investigate the clinical effect of polyvinyl alcohol (PVA) particles combined with chemoembolization using chemotherapeutic agents or chemotherapeutic agents lipiodol emulsion (CALE)in the treatment of hepatocellular carcinoma (HCC) complicated by hepatic arteriovenous shunt (HAVS) and related prognostic factors.Methods A retrospective analysis was performed for the clinical data of 133 patients with HCC complicated by HAVS.HAVS was classified into slow-flow HAVS,intermediate-flow HAVS,and high-flow HAVS,which were treated with 300-500 μm,500-710 μm,and 710-1000 μm PVA particles,respectively.The patients with slow-flow and intermediate-flow HAVS underwent embolization with PVA combined with chemotherapeutic agents followed by CALE,while those with high-flow HAVS underwent the treatment with PVA combined with chemotherapeutic agents alone.The survival time,progression-free survival time,and postoperative complications were followed up and analyzed.The Kaplan-Meier method was used to calculate cumulative survival rate and the Cox proportional hazards model was used to determine prognostic factors.Results The median overall survival (OS) of 133 patients was 9.1 months,and the 6-,12-,and 24-month survival rates were 73.7％,36.2％,and 10.2％,respectively.The median OS of slow-flow group (36 patients),intermediate-flow group (58 patients),and high-flow group (39 patients) were 7.3,9.1,and 10.8 months,respectively.And the 6-and 12-month survival rates were 69.2％/19.0％,72.4％/39.2％,and 77.8％/42.7％,respectively.There was no significant difference in survival time between the patients with different types of HAVS (x 2 =2.865,P =0.239).The incidence rates of postoperative gastroesophageal variceal bleeding and acute liver failure were 1.1％ and 0.4％,respectively.The results of Cox regression analysis showed that preoperative alpha-fetoprotein level ≥ 400 ng/ml (HR =2.105,P =0.006) was an independent risk factor,while multiple embolizations (H7 =0.482,P =0.011),tumor remission (HR =0.431,P =0.041),and multimodality therapy (HR =0.416,P =0.004) were independent protective factors.Conclusion PVA particles combined with chemotherapeutic agents or CALE is safe and effective in the treatment of HCC complicated by HAVS.Patients with multiple embolizations,tumor remission,and multimodality therapy tend to have good prognosis,while those with a high level of alpha-fetoprotein before embolization often have poor prognosis.

Objective To observe the effects of hyperbaric oxygen (HBO) on learning and memory ability and on the level of myelin basic protein (MBP) in the brain tissue of rats with delayed neurological sequelae (DNS) after acute carbon monoxide poisoning (COP).Methods Forty-eight male SD rats had their cognitive performance assessed with the Morris water maze.After basic training with the Morris water maze and screening,the rats were randomly divided intoanormalcontrol (NC) group (n=11),a COP group (n=17) and an HBO group (n=17).Pure CO gas was injected intraperitoneally to establish acute COP in the latter two groups.The NC group received a similar injection of air.The HBO group was given HBO therapy.The rats in each group were tested for changes in their learning and memory abilities using the Morris water maze.On the 21 st day after the treatment,paraffin tissue sections of the rats' brains were subjected to immunohistochemical (IHC) examination and Western blotting (WB) was used to detect any expression of MBP in the brain tissue.Results After 21 days,morbidity among the COP group was 64.3％,while it was 26.7％ in the HBO group,a significant difference.The average maze escape latency in the COP group was significantly longer than in the HBO group.IHC staining and Western blotting showed that MBP in the hippocampal tissue of the COP group was significantly lower than that in the HBO group.In gray scale comparisons of the rats' brain tissue,that from the NC group was significantly better than that from the COP and HBO groups,but that from the HBO group was significantly better than that from the COP group.Conclusion HBO can effectively reduce DNS after acute COP,mitigate the severity of DNS,reduce demyelination of brain tissue and thus play an important role in protecting brain cells.

Objective To investigate the CT imaging features of pneumonic type Bronchio-loalveolar carcinoma(BAC) and the value of CT-guided percutaneous puncture biopsy in pneumonic type BAC.Methods Twenty-five cases of suspected pneumonic type BAC were biopsied with CT-guided percutaneous puncture.GE 64-slices plain and post contrast CT scans were performed in all patients.Two radiologists finished imaging determination.Site of puncture was selected in suspicious areas of the tumor.The negative pressure aspiration needle were used to be biopsy in the ideal location after vertically into the needle and again performed CT scanning were performed to observe the complications such as hemorrhage,pneumothorax.Specimens were fixed by formalin.Results Twenty-five samples were successfully got from 25 patients.Pathology data showed that 14 cases were pneumonia with BAC,6 cases with pneumonia,2 cases with offungus infection,and 3 cases with caseous pneumonia.Of 14 cases (71.4％) with pneumonia type BAC,CT images of 10 cases showed air bronchogram of lung tissue,5 cases(35.7％) with alveolar gas cavity or cavity of lung tissue,5 cases(35.7％) with ground glass opacity and multiple nodules.Enhanced CT scanning the area of consolidation showed that 11 cases(78.6％) were with mixed low density area angiography and the mean peak time was 90 s,9 cases (64.2％) were with the time density curve of speed up and slow down type.Conclusion The method of CT guided lung biopsy combined with typical imaging findings can enhance early diagnosis rate of pneumonia type BAC.Meanwhile CT feature of pneumonia type BAC shows honeycomb air cavity,void,angiographic sign,dead branches syndrome,multiple peripheral acinar nodules and ground glass density.Enhanced scan area of consolidation shows visible angiogran sign,slow drop type of time density curve of a fast rise.

Objective To explore the influence of hyperbaric oxygen(HBO)on the life-spans of tumor-bearing mice. Methods Twenty-eight male Balb/c mice were randomly and evenly divided into:a celiac-tumorgroup(inoculated with tumor cells in the abdominal cavity);a celiac-tumor-HBO group(inoculated and then ex-posed to hyperbaric oxygen);a back-tumor group(inoculated under the skin of the back);and a back-tumor-HBOgroup(inoeulatedunder the skin of the back and then exposed to hyperbaric oxygen).S-180 carcinoma cells were in-oeulated,and then HBO was administered once a day.The life-spans and any skin ulceration were observed. Re-sults The average life-spans were(27.6±4.5)days in the celiac.tumor group,(24.0±2.9)days in the celiac-tumor-HBO group,(63.0±21.8)days in the back.tumor group and(35.0±8.9)days in the back-tumor-HBOgroup.The difference in average life-span between the celiac-tumor group and the celiac-tumor-HBO gmup was not significant.The difference in life-span between the back-tumor group and the back.tumor.HBO group was significant.Ulcers occurred in 4 mice in the back-tumor group and 4 in the back-tumor-HBO group.The times of ulcer formation were significantly different between the back-tumor group and the back-tumor-HBO group. Conclusions The life-spans of mice in the back-tumor-HBO group were shortened by HBO exposure,but life-spans in celiac-tumor-HBOgroup were not.Ulcer formation was postponed by HBO in the back-tumor-HBO group.

SUMMARY Bleeding is a rare but fatal complication after radiotherapy for nasoparyngeal carcinoma ( NPC ) . In this article , we report an NPC case treated with radiotherapy complicated with bleeding of the common carotid artery (CCA) . A 44-year-old man with NPC was treated with external radiotherapy 19 years ago, and a second course of treatment to the same field was administrated because of local nasoparyngeal recurrence 4 years ago. The patient was admitted to our hospital for massive bleeding. Conservative therapy including routine medication, blood transfusion and local compression showed almost no effect. Emergency carotid angiography revealed bleeding from the left CCA, and a self-expanding covered stent was deployed through percutaneous transluminal femoral approach. After the placement of the covered stent , angiography showed the bleeding was successfully controlled. So self-expanding covered stenting may be a safe, effective and minimal-invasive option for bleeding of the carotid artery . Longterm follow-up is required for further evaluation.