The impact of COVID-19 on the diagnosis and treatment of lung cancer / 中国胸心血管外科临床杂志

@#Lung cancer is a complex disease with its own challenges, and is considered to be one of the most common causes of cancer death worldwide. The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has exacerbated these challenges. The aim of this review is to explore the impact of the COVID-19 pandemic on the screening, diagnosis and treatment of lung cancer. We hope to provide some experience and help for the whole process management of lung cancer patients.

Burch Procedure: A Historical Perspective / Procedimento de Burch: Uma perspectiva histórica

Abstract Introduction The Burch procedure (1961) was considered the gold standard treatment for stress urinary incontinence (SUI) before the midurethral slings (MUSs) were introduced, in 2001. Objective This historical perspective of the Burch's timeline can encourage urogynecological surgeons to master the Burch technique as one of the options for surgical treatment of SUI. Search Strategy and Selection Criteria A bibliographic search was performed in the PubMed and National Library of Medicine (NIH) databases with the terms Burch colposuspension AND history AND stress urinary incontinence in the last 20 years. The original article by Burch (1961) was included. The references were read by three authors. The exclusion criterion was studies in non-English languages. Biomedical Library Special Collections were included as historical relevant search. Data Collection, Analysis and Main Results Some modifications of the technique have been made since the Burch procedure was first described. The interest in this technique has been increasing due to the negative publicity associated with vaginal synthetic mesh products. Twenty-nine relevant articles were included in the present review article, and numerous trials have compared Burch colposuspension with MUS. Conclusion This historical perspective enables the scientific community to review a standardized technique for SUI. Burch colposuspension should be considered an appropriate surgical treatment for women with SUI, and an option in urogynecological training programs worldwide.

Resumo Introdução O procedimento de Burch (1961) foi considerado o tratamento padrão ouro para a incontinência urinária de esforço (IUE) antes da introdução dos slings de uretra média (SUMs), em 2001. Objetivo Esta perspectiva histórica da linha do tempo do procedimento de Burch pode encorajar os cirurgiões uroginecológicos a dominar a técnica deste procedimento como uma das opções para o tratamento cirúrgico da IUE. Estratégia de busca e critérios de seleção A busca bibliográfica foi realizada nas bases de dados PubMed e National Library of Medicine (NIH) com os termos Burch colposuspension AND history AND stress urinary incontinence nos últimos 20 anos. O artigo original de Burch (1961) foi incluído. As referências foram analisadas por três autores com exclusão de estudos em idiomas diferentes do inglês. Coleções de bibliotecas biomédicas foram incluídas por ordem de relevância histórica. Coleta de dados, análise e principais resultados Algumas modificações de técnica foram realizadas desde que o procedimento de Burch foi inicialmente descrito. O interesse por essa técnica vem aumentando devido à publicidade negativa associada aos produtos de tela sintética vaginal. Vinte e nove artigos relevantes foramincluídos, e vários estudos compararam a colposuspensão de Burch com SUMs. Conclusão Essa perspectiva histórica possibilita à comunidade científica revisar uma técnica padronizada para a IUE. A colposuspensão de Burch pode ser considerada um tratamento cirúrgico adequado paramulheres com IUE, e uma opção emprogramas de treinamento uroginecológico em todo o mundo.

Isolated chylous ascites in preterm infants:a case report and literature review / 中华全科医师杂志

The clinical data of 5 cases of chylous ascites in preterm infants admitted in NICU of Peking Union Hospital from 2001 to 2021 were retrospectively analyzed. There were 3 boys and 2 girls with the gestational age of 29 +1 weeks, and birth weight of (1 122±323) g. No peritoneal effusion was found on prenatal ultrasound examination. All the five cases diagnosed with chylous ascites after the initiation of enteral nutrition on d4 to d10. All cases were resolved by conservative treatment, including fasting with total parenteral nutrition for 3 wks. The parenteral nutrition strategy was specified by high protein concentration (4 g·kg -1·d -1) and low lipid emulsion (2.0-2.5 g·kg -1·d -1). Formula containing 50% medium chain triglyceride or human milk was fed sequentially, and no feeding intolerance or abdominal distension were observed. All patients were discharged stable and followed up for 3-5 years,and no recurrence occurred. The PubMed and Wanfang database were searched for cases of chylous ascites in preterm infants, and 7 cases were reported in literature. Six cases were diagnosed by antenatal ultrasound between 21 and 23 weeks of gestational age. Three cases underwent radionuclide lymphoscintigraphy, and 2 of them demonstrated peritoneal lymphatic fistula or lymphatic dilatation. Five cases were treated with fasting plus intravenous infusion of octreotide. Three infants who failed to respond to conservative treatment underwent surgical treatment. Four cases were complicated with sepsis and needed intravenous antibiotic treatment.

Peri-implantitis and Practical Management: A Review

ABSTRACT@#At present, with an increasing number of implants placed, peri-implant diseases are also increasing. The inclusion of peri-implant disease in the latest classification of periodontal disease shows the global significance of the disease in addition to periodontal disease. Management for peri-implantitis is more complicated and similar to periodontitis, and bone loss is irreversible. Numerous studies throughout the decades were conducted using various techniques investigating the best method in treating peri-implantitis. Therefore, this article will explore the latest evidence for peri-implantitis and its management.

Therapy experience and clinical features of patients with acute type A aortic dissection involving coronary malperfusion / 中华胸心血管外科杂志

Objective:To investigate the clinical characteristics, surgical methods and prognosis of patients with acute type A aortic dissection combining coronary artery involvement.Methods:415 patients diagnosed with acute type A aortic dissection from October 2016 to September 2019 were included in the study.Among them, 358 were males and 57 were females; aged(51.2±10.7) years old.According to the results of intraoperative coronary probes, 342 patients in the group were without coronary involvement, and the other 73 were with coronary involvement.Data on the coronary involvement classification, site, and treatment methods of the coronary involvement group were collected by consulting the ward medical record system.Meanwhile, preoperative baseline data, surgical data and prognostic results were retrospectively collected between the two groups. The data of the two groups were compared by chi- square test, t-test and Mann- Whitney U test. Results:Coronary involvement group: Among 73 (17.6%, 73/415) patients with coronary involvement, 8 (11.0%) in the left coronary, 48 in the right (65.8%), and 17 (23.3%)cases with involvement of both left and right coronary arteries. Classification of coronary artery(90) involvement: Neri A in 47(52.2%, 47/90), 33 with Neri B (36.7%, 33/90), and 10 with type Neri C (11.1%, 10/90). Type Neri B/C coronary artery involvement was mostly treated with artificial vascular coronary artery replacement or coronary artery bypass grafting. Comparison between the two groups show, patients in the coronary involvement group had higher preoperative levels of CK-MB, D-dimer and more severe aortic valve regurgitation compared to the coronary non-involvement group. The comparison of surgical data suggests that the coronary involvement group had a higher proportion of aortic root treatment, longer operation time, cardiopulmonary bypass time and aortic clamping time. A higher percentage of intimal tear located in the ascending aorta or aortic root was found in the coronary involvement group. The mortality rate in the coronary involvement group was significantly higher than that of the non-involvement group (12% versus 4%), and it was more likely to combine heart failure (5% versus 1%) and renal failure (26% versus 13%).Conclusion:Compared with pure type A dissection, patients with coronary artery involvement are more common in patients whose primary intimal tear were found at the proximal aorta, and are more prone to severe aortic valve regurgitation. Coronary artery treatment procedures include direct suture and fixation, coronary artery replacement, and coronary artery bypass grafting. Among them, Neri A coronary involvement can mostly be fixed with direct suture and stabilization, while the Neri B / C type mostly requires artificial vascular replacement of the affected coronary artery or coronary artery bypass. Patients with coronary artery involvement have a higher proportion of deaths and confer relatively higher risk of post-operative renal/cardiac failure.

Uso de probióticos como adición al tratamiento periodontal no quirúrgico en pacientes con periodontitis / Use of probiotics as an adjunctive therapy to non-surgical periodontal treatment in patients with periodontitis

RESUMEN Introducción: El tratamiento periodontal no quirúrgico corresponde a la terapia estándar para la periodontitis crónica. En este contexto, se ha propuesto que el uso de probióticos orales como complemento al tratamiento estándar podría mejorar los resultados obtenidos clínicamente, sin embargo no existe claridad respecto a su efectividad. Métodos: Se realizó una búsqueda en Epistemonikos: base de datos de revisiones sistemáticas en salud mantenida mediante el cribado de múltiples fuentes de información, la cuál incluye MEDLINE, EMBASE, Cochrane, entre otras. Se extrajeron los datos desde las revisiones identificadas y un análisis de los datos de los estudios primarios. Se realizó un metanálisis y se preparó una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Se Identificaron seis revisiones sistemáticas que en conjunto incluyeron 14 estudios primarios, todos correspondientes a ensayos aleatorizados. De los resultados analizados se concluye que el uso de probióticos orales como complemento al tratamiento no quirúrgico de periodontitis crónica probablemente resulta en nula o poca diferencia en la reducción de la profundidad de sondaje, el sangrado al sondaje y una ganancia de nivel de inserción clínico en los sitios afectados. Por otro lado, no se encontraron estudios que evaluaran el riesgo de presentar halitosis en pacientes sometidos a terapia periodontal no quirúrgica con adición de probióticos.

ABSTRACT: Introduction: Non-surgical periodontal treatment is the standard treatment to chronic periodontitis. It has been proposed that the use of oral probiotics as an adjunctive therapy may improve clinical outcomes, however there is no clarity regarding its effectiveness. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified six systematic reviews including 14 studies overall, of which all were randomized trials. We concluded that the addition of probiotics to non-surgical periodontal treatment probably results in little or no difference in probing depth reduction, clinical attachment level gain and reduction in bleeding on probing. No studies were found evaluating halitosis in patients undergoing non-surgical periodontal treatment with the addition of probiotics.

Tumor glómico subungueal en el meñique y utilización de ecografía en su diagnóstico: presentación de un caso / Subungual glomus tumor in the little finger and use of diagnostic ultrasound: a case report

RESUMEN Se presenta el caso de un paciente de 50 años que refería un dolor crónico localizado debajo de la uña del dedo meñique, sin antecedente traumático, con cinco años de evolución y que limitaba su actividad laboral. El tumor glómico es de naturaleza benigna y se caracteriza por un dolor agudo circunscrito a región subungueal que se acrecienta a la presión y al frío, síntomas objetivos para sospecharlo. La mayor incidencia se observa en los adultos, aunque aparece con poca frecuencia, por lo que su identificación suele retardarse. El diagnóstico debe incluir exámenes de imágenes, entre los que destaca la ecografía, que es una excelente alternativa y muy accesible en diferentes poblaciones. En nuestro caso, la ecografía mostró la tumoración con nitidez, lo que fue determinante para elegir la exéresis quirúrgica como tratamiento. La evaluación anatomopatológica informó la existencia de tumor glómico. Luego de la cirugía, se comprobó alivio de los síntomas.

ABSTRACT We present the case of a 50-year-old patient who reported chronic pain under the nail of the little finger for five years, with no trauma history and which restricted his work activity. The glomus tumor is a benign neoplasm characterized by an acute and circumscribed pain in the subungual region that increases with pressure and cold, which are objective symptoms to suspect this condition. The highest incidence of glomus tumors occurs in adults; however, as it is infrequent, delayed diagnosis is common. The diagnosis must include imaging scans, especially ultrasound, which are an excellent and very accessible alternative in different populations. In our case, the tumor was clearly observed on the ultrasound images, which was crucial to choose the surgical excision as treatment. The anatomopathological evaluation revealed a glomus tumor and the subsequent relief of symptoms were confirmed after the surgery.

Clinical study design of a multicenter, prospective, randomized controlled clinical trial on clinical efficacy of Toripalimab adjuvant therapy on esophageal squamous cell carcinoma patients with post-neoadjuvant positive lymph node staging / 中华消化外科杂志

Neoadjuvant therapy has become the first choice for locally advanced esophageal carcinoma. Patients with post-neoadjuvant positive lymph node staging (ypN+) have poor prognosis, and there is no effective adjuvant therapy. Programmed death protein-1 (PD-1) antibody can obtain better clinical efficacy in the treatment of advanced esophageal cancer. The authors designed a multicenter, prospective, randomized controlled clinical trial of Toripalimab (PD-1 antibody) adjuvant therapy on esophageal squamous cell carcinoma patients with ypN+ after the treatment of neoadjuvant chemotherapy combined with surgical resection, in order to provide clinical practices for the adjuvant treatment of ypN+ patients.

Clinical and microbiological evaluation of surgical and nonsurgical treatment of aggressive periodontitis

Abstract The present study aimed to evaluate clinical and microbiological effects of surgical and nonsurgical periodontal therapy in generalized aggressive periodontitis (GAgP) treatment. Sixteen GAgP patients were included in this randomized split-mouth design clinical trial. Maxillary quadrants were allocated into two groups: Nonsurgical Therapy (NST) and Surgical Therapy (ST). The following clinical parameters were assessed: plaque index (PI), bleeding on probing index (BoP), probing depth (PD), clinical attachment level (CAL) and gingival margin position (GMP). Concentrations of Porphyromonas gingivalis (Pg) and Aggregatibacter actinomycetemcomitans (Aa) in the subgingival biofilm were also determined. Clinical and microbiological parameters were assessed at baseline (n=16), 3 (n=15), 6 (n=15) and 12 months (n=8) after treatment. ST was able to promote higher PD reduction compared to NST in deep pockets at 12 months (p<0.05) and in posterior teeth at 6 months (p<0.05). In addition, higher gingival recession was observed in posterior teeth of the ST group at the 6th month (p<0.05). However, ST failed to promoted additional CAL gain in any timepoint (p>0.05). Moreover, microbiological evaluation showed no statistical difference in levels of Aa and Pg for both groups at all follow-up periods. Surgical therapy promoted similar clinical benefits to GAgP therapy. Moreover, both therapies failed to reduce Aa and Pg levels at different follow-up times.

Resumo O presente estudo teve como objetivo avaliar os efeitos clínicos e microbiológicos de terapia periodontal cirúrgica e não cirúrgica no tratamento da periodontite agressiva generalizada (PAgG). Dezesseis pacientes portadores de PAgG foram incluídos neste estudo clínico, prospectivo, randomizado, de boca dividida. Os quadrantes superiores de cada paciente foram alocados em dois grupos: um grupo de terapia não-cirúrgica (NST) e um grupo de terapia cirúrgica (ST). Os parâmetros clínicos avaliados foram: índice de placa (PI), sangramento à sondagem índice (BoP), profundidade de sondagem (PD), nível clínico de inserção (CAL) e posição da margem gengival (GMP). Também foram determinadas as concentrações de Porphyromonas gingivalis (Pg) e Aggregatibacter actinomycetemcomitans (Aa) no biofilme subgengival. Os parâmetros clínicos e microbiológicos foram avaliados no início, 3, 6 e 12 meses após o tratamento. A terapia cirúrgica foi capaz de promover maior redução de PD em comparação com NST em bolsas profundas aos 12 meses (p<0,05) e em dentes posteriores aos 6 meses (p<0,05). Além disso, houve maior recessão gengival nos dentes posteriores do grupo ST no 6° mês (p<0,05). Entretanto, ST não promoveu ganho adicionais de inserção (CAL) em nenhum período do avaliação. A avaliação microbiológica não mostrou diferença estatística nos níveis de Aa e Pg, para ambos os grupos, em todos os períodos de acompanhamento. O tratamento cirúrgico promoveu benefícios clínicos similares ao tratamento não cirúrgico em pacientes com PAgG. Além disso, ambas as terapias não conseguiram reduzir os níveis Aa e Pg após terapia.

Present treatment situation of hepatocellular carcinoma with extrahepatic metastasis / 中华外科杂志

With the development of diagnostic and screening technologies, the incidence of hepatocellular carcinoma (HCC) with extrahepatic metastasis is increasing. It is a kind of refractory disease with extremely poor prognosis. Currently, there is no standard therapy. The existing guidelines only recommend targeted therapy, systemic chemotherapy or best supportive care for HCC patients with extrahepatic metastasis, but have not mentioned surgical therapy.Several studies have shown that the majority of HCC patients with extrahepatic metastasis died of progressive intrahepatic tumor leading to hepatic failure, but not extrahepatic metastases; and primary tumor resection may have a favorable impact on the prognosis of these patients with resectable primary tumors.Furthermore, the role of resection of metastatic tumors for HCC patients with extrahepatic metastasis remains unclear so far.Majority of experts think that resection of lung metastases has survival benefit when the hepatic lesion is resected or controlled, whereas resection of lymph nodes, bone metastases, adrenal gland lesions, or brain metastases does not prolong survival, which may be recommended when the goal is to relieve symptoms or improve quality of life.Therefore, surgical treatment is important for HCC patients with extrahepatic metastasis, and surgical therapy combined with personalized systemic treatment shows survival benefit for selected patients.

Repair soft tissue defects of extremities with the perforator flap based on the first perforating artery of Profunda artery / 中华整形外科杂志

Objective@#To investigate the feasibility of repairing soft tissue defects of extremities with the perforator flap based on the first perforating artery of profunda artery.@*Methods@#From January 2015 to December 2018, 9 patients with soft tissue defects of extremities were treated in the Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University. 5 males and 4 females; aged 29-48 years, average 36 years old. The causes of injury were traffic accident injury (4 cases), heavy object crush injury (3 cases) and mechanical injury (2 cases). There were 3 cases of soft tissue defect of upper limb, 6 cases of soft tissue defect of lower extremity, 2 cases of tendon and nerve rupture, 2 cases of fracture, 1 case of tendon and 1 case of bone exposure. All soft tissue defects were repaired with the perforator flap based on the first perforating artery of Profunda artery. After debridement, The range of soft tissue defect was 10 cm×5 cm-16 cm×10 cm. The intraoperative flap area was 12 cm×6 cm-18 cm×11 cm. The vascular anastomosis was performed in the area, the flap covered the wound surface and the donor site directly pulled the suture or grafted skin.@*Results@#All flaps survived completely and there were no complications such as vascular crisis. Follow-ups were performed in various forms for 6 to 12 months. These flaps were satisfactory in appearance and function and had a good texture.@*Conclusions@#The perforator flap based on the first perforating artery of profunda artery can repair the defects of the limbs in the soft group. The donor site of the flap is hidden, the amount of tissue available is relatively large and the repair effect is good.

New concept of surgical treatment for biliary dilatation / 中华消化外科杂志

At present,it is not uncommon for patients with biliary dilatation who have failed to undergo multiple operations in clinic.Dong's classification has a definite guiding significance for choosing appropriate surgical methods.Active hepatectomy with "tailor-made" treatment can cure refractory biliary dilatation involving intrahepatic bile ducts.At present,there are still some controversies about the range of hepatectomy and the management of type D lesions in children.At the same time,we should pay close attention to the long-term complications after dilated bile duct resection.

Multidisciplinary treatment of adenocarcinoma of esophagogastric junction / 中华消化外科杂志

The incidence of adenocarcinoma of esophagogastric junction (AEG) is increasing,but its treatment strategy is still controversial.Surgery is the main strategy of multidisciplinary treatment.Siewert classification and TNM staging play a decisive role in the choice of operative approach,clinical decision and prognosis.Perioperative chemoradiotherapy plays an important role in the multidisciplinary treatment of AEG,and more researches support neoadjuvant therapy in patients with AEG.What's more,targeted therapy has become an integral part of multidisciplinary treatment of AEG with the constantly emergence of targeted drugs.In addition,the particularity of AEG determines that its treatment requires multidisciplinary cooperation,and the multidisciplinary team is expected to improve the prognosis of AEG patients.

Influence of periodontal non-surgical therapy on serum interleukin 6 expression and carotid artery wall in rats with periodontitis and type 2 diabetes mellitus / 华西口腔医学杂志

OBJECTIVE@#To study the effect of periodontal non-surgical treatment on serum interleukin-6 (IL-6) expression and carotid vascular wall in a rat model of chronic periodontitis (CP) with type 2 diabetes mellitus (T2DM).@*METHODS@#Twenty-eight 6-week-old SD rats were randomly divided into group A (control group, 7 rats) and group B (T2DM+CP group, 21 rats). According to different intervention measures, group B was randomly subdivided into B1 (natural process), B2 (periodontal mechanical treatment), and B3 (periodontal mechanical treatment + 2% minocycline hydrochloride + systemic metronidazole plus amoxicillin). Serum IL-6 was measured by enzyme-linked immunosorbent assay, and carotid tissue was observed under light microscopy after hematoxylin-eosin (HE) staining.@*RESULTS@#The carotid artery wall of group A was normal. In group B1, the endothelial cells disappeared, the elastic fibers of the middle membrane were disordered, the local necrosis of smooth muscle tissue was amorphous particles, a small amount of calcium salt was deposited, and the wall thickening was obvious. The endothelial cells in groups B2 and B3 disappeared, and the smooth muscle cells in the middle membrane underwent denaturation. No significant thickening of the vessel wall was noted. The serum IL-6 level in group B1 continually increased with time, and it was higher than that in group A (P<0.001). The IL-6 levels of groups B2 and B3 peaked a week after the first intervention. Subsequently, IL-6 levels gradually decreased. At the last point (five weeks after the second intervention ), the IL-6 levels of groups B2 and B3 were significantly lower than that of group B1 (P<0.001).@*CONCLUSIONS@#For rats with periodontitis and diabetes, periodontal mechanical treatment may elevate serum IL-6 levels in the short term but might reduce the whole inflammatory state in the long term. Thus, this treatment might be valuable to the improvement of vascular disease. The adjunctive benefits of systemic metronidazole and amoxicillin in non-surgical periodontal therapy are decreased serum IL-6 expression and normal carotid artery.

Escalation surgical therapy approaches for complicated intra-abdominal infection / 中国实用外科杂志

Complicated intra-abdominal infections(cIAIs)is always associated with high mortality,invasive open surgery cannot improve patients' prognosis.With the spread of the concept of minimally invasive surgery(MIS)and damage control surgery(DCS),the authors propose the escalation surgical therapy approaches to better manage cIAIs with less operative damange.These approaches include minimally invasive drainage(percutaneous drainage,endoscopic drainage),MIS(minimally invasive operative drainage,enterostomy)and open surgery(relaparotomy on demand,planned relaparotomy,open abdomen).These treatments cause increasing trauma stress,longer recovery period and higher morbidity rates to patients successively.Due to the increased use of planned relaparotomy in treating cIAIs,abdominal packing and open abdomen were applied more frequently.However,the prevention of open abdomen-associated morbidies,including enterocutaneous fistula and abdominal wall defect,should be paid attention to.In clinical practice,use of escalation surgical therapy approaches to treat cIAIs is not fixed,doctors should choose appropriate management according to patients' conditions.Meanwhile,good resuscitation,appropriate choice of antibiotics and nutritional support are essential to improve the outcome of patients with cIAIs.

Operation timing of severe ulcerative colitis / 中华消化外科杂志

Acute severe ulcerative colitis (ASUC) is a potentially life-threatening condition.Inappropriate salvage therapy might delay the surgery and increase the mortality and postoperative complications in ulcerative colitis (UC).Timely surgical intervention for UC is the key to reduce the rate of mortality and postoperative complications via evaluating the effect of therapy combining with characters of patients' history,clinical symptoms,biochemical markers,radiological and endoscopic criteria.

Opportunities and challenges for the progress of Chinese gastric cancer surgery / 中华消化外科杂志

Prevention,diagnosis and treatment of gastric cancer have always been one of the focus of cancer work in China.Currently,the challenges,from the applications of minimally invasive surgical techniques,practices of enhanced recovery after surgery (ERAS),interdisciplinary and resource integration,and innovation of education and training system of talent development,have being bringing new opportunities to the development of gastric cancer surgery in China.There has been a good working basis for total laparoscopic surgery for gastric cancer and navigation surgery,but surgeons urgently need to conduct further clinical researches,select operative indications and accumulate evidence-based medicine proofs.On the strength of new research methods,ERAS should further select and optimize clinical strategies,and reduce the barriers to entry for application and dissemination.The artificial intelligence and big data technology will meet tremendous opportunities for gastric cancer and interconnection.Talent is the key to breakthrough,nevertheless,further opening research field,using the international advanced training system and training high-quality international talents will always be a cornerstone of the future developments.Gastric cancer surgery in China will make steadily progress toward the precision medicine only if grasping historical opportunities,continuing to promote innovations of technologies and ideas and guaranteeing patients' benefits would be carried out.

Surgical treatment of pregnancy complicated with aortic dissection / 中国胸心血管外科临床杂志

@#Objective To summarize the characteristics and management of pregnancy complicated with aortic dissection, and to explore the reasonable diagnosis and treatment plan. Methods The clinical data of 10 patients of pregnancy complicated with aortic dissection in Wuhan Tongji Hospital from January 2011 to June 2017 were collected. Their age was 25.2 (21-29) years. Results In the 10 patients, the majority (8 patients) were primipara, and most of them were in the late stages of pregnancy (5 patients) and puerperal (4 patients). Among them, 1 patient had gestational hypertension, and the blood pressure of the left and right upper extremities was significantly abnormal (initial blood pressure: left upper limb blood pressure: 90/60 mm Hg, right upper limb blood pressure: 150/90 mm Hg). The major clinical manifestations were severe chest and back pain which happened suddenly, with D-dimmer and C-creative protein increased which may be associated with inflammatory reaction. All patients were diagnosed by thoracoabdominal aortic CTA, including 5 patients of Stanford type A dissection and 5 patients of Stanford type B dissection. In the 10 patients, 1 patient refused surgery and eventually died of aortic rupture with the death of fetus before birth. And the remaining 9 patients underwent surgical treatment, 3 patients of endovascular graft exclusion for thoracic aortic stent graft, 2 patients underwent Bentall operation, 1 patient with Bentall + total aortic arch replacement + vascular thoracic aortic stent graft, 1 patient with Bentall operation combined with endovascular graft exclusion for thoracic aortic stent graft, 1 patient with Bentall + coronary artery bypass grafting, 1 patient of thoracoabdominal aortic vascular replacement. Among them, 1 patient underwent endovascular graft exclusion for thoracic aortic stent graft died of severe postoperative infection, and the remaining 8 patients were discharged from hospital. Nine patients were single birth, among them 5 newborn patients had severe asphyxia, 4 patients had mild asphyxia. Finally, 3 neonates died of severe complications, and the remaining 6 survived. Conclusion The ratio of pregnancy with Stanford type A aortic dissection is far higher than in the general population, the possibility of fetal intrauterine asphyxia is larger, but through active and effective surgical and perioperative treatment, we can effectively save the life of mother and fetus.

Progress of clinical medication for differentiated thyroid carcinoma / 医学研究生学报

The main treatment model for differentiated thyroid cancer is surgery -based individualized treatment .Due to the in-ert cancer characteristics of DTC , drug therapies such as thyrotropin suppressive therapy , molecular targeted therapy, neoadjuvant chemotherapy and Chinese medicine treatment have become the current research hotspots .Here, we reviewed the progress of clinical medication for DTC to improve the understanding of DTC drug therapy .

Extended hepatectomy in the treatment of type Ⅲ and Ⅳ hilar cholangiocarcinoma / 中华肝胆外科杂志

Objective To study the effect of extended hepatectomy for hilar cholangiocarcinoma (HCCA) of the Bismuth-Corlette type Ⅲ and Ⅳ.Methods The clinical data of 73 patients with HCCA of the Bismuth-Corlette type Ⅲ and Ⅳ treated in our department from January,2008 to June,2016 were analyzed retrospectively.The extended hepatectomy group of patients consisted of 29 patients who underwent hepatectomy with half or more than half of the liver removed or/and combined with hepatic caudate lobectomy.The limited hepatectomy group consisted of 44 patients who underwent non-anatomical hepatectomy around the hepatic hilar region.Results Compared with the limited hepatectomy group,patients in the extended hepatectomy group had significantly longer operations with significantly more intraoperative blood loss.However,the complication rate was significantly lower than that of the limited hepatectomy group.There was no perioperative death in the extended hepatectomy group,while 3 perioperative deaths occurred in the limited hepatectomy group.The R0 resection rate was 93.1％ (27 of 29) for the extended hepatectomy group,while it was 54.6％ (24 of 44) for the limited hepatectomy group (P＜0.05).The 1-,3-and 5-year survival rates or the extended hepatectomy group were 81.4％,51.4％ and 19.3％,respectively while the corresponding rates for the limited hepatectomy group were 70.5％,24.4％ and 8.7％,respectively (P＜0.05).Conclusions After adequate preoperative radiological assessments on tumor resectability,and the residual liver volumes,with preoperative biliary drainage to improve liver function,extended hepatectomy effectively increased R0 resection and survival rates with improved prognosis for patients with HCCA of Bismuth-Corlette type Ⅲ and Ⅳ.