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28 July 2020, Volume 40 Issue 07 Previous Issue    Next Issue
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Novel coronavirus article
Innovative research team achievement
Forum
Original article (Clinical research)
Review
Brief original article
Techniques and methods
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Novel coronavirus article

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Research progress of interaction between coronavirus disease 2019 and cardiovascular system ZHA Qiong-fang1, LI Hong-bo2, QIN Hui1 2020, 40 (07):  863-866.  doi: 10.3969/j.issn.1674-8115.2020.07.001 Abstract ( 698 )   PDF (6762KB) ( 217 )   Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2), has been spreading rapidly internationally. On the one hand, there is a certain correlation between the basic cardiovascular disease and the severity of COVID-19; on the other hand, the patients with severe and critical COVID-19 often have cardiovascular system-related clinical manifestations. This article reviews the interaction between COVID-19 and cardiovascular system, and the cardiovascular problems that may be encountered in the diagnosis and treatment of COVID-19. Related Articles | Metrics

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Analysis of emergency management measures in large public hospitals during corona virus disease 2019 epidemic prevention HU Cheng-fang1, 2, ZHU Jie1, LUO Li 2, 3, CAO Jian-wen2, 4, TAO Min-fang2, 5 2020, 40 (07):  867-872.  doi: 10.3969/j.issn.1674-8115.2020.07.002 Abstract ( 610 )   PDF (9159KB) ( 130 )   Objective · To analyze emergency management measures in large public hospitals during epidemic prevention of corona virus disease 2019 (COVID-19) in order to promote control efficiency and quality of COVID-19 in the emergency room of public hospitals. Methods · A retrospective analysis was made on the amount of emergency visits and management measures of Shanghai Sixth People's Hospital, Shanghai Jiao Tong University from January to February, 2020, including optimizing the process of emergency treatment during epidemic prevention, strengthening the management of key areas such as pre-examination and triage, emergency room, observation room, fluid room and the intensive-care unit and so on, enhancing the management and education of patients, optimizing the deployment model of medical staff, strengthening personal protection and other management measures. Results · During epidemic prevention, there was no missed diagnosis of COVID-19 in the hospital and no nosocomial cross infection in the emergency room. Conclusion · Enhancement of emergency management model in large public hospitals during COVID-19 epidemic prevention can improve the screening of possible patients and triage of patients so as to prevent nosocomial infection. Related Articles | Metrics

Innovative research team achievement

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Value of dynamic contrast-enhanced MRI in selecting sclerosants for endovascular sclerosis of venous malformation XIA Zhi-peng1, YUAN Ying2, YANG Xi2, GU Hao2, LIN Xiao-xi 2#, TAO Xiao-feng1# 2020, 40 (07):  873-880.  doi: 10.3969/j.issn.1674-8115.2020.07.003 Abstract ( 519 )   PDF (9177KB) ( 120 )   Objective · To evaluate the value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting the efficacy of foam sclerotherapy and selecting sclerosants for endovascular sclerosis of venous malformations. Methods · A retrospective analysis was conducted for 56 patients with venous malformations who underwent intravascular sclerotherapy and DCE-MRI examination from January 2018 to June 2019 in Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine. All the patients were firstly treated with foam sclerotherapy. During the surgery, the surgeons determined whether to subsequently use ethanol, depending on the immediate therapeutic effect of foam sclerotherapy. Among them the 40 cases were treated with foam sclerotherapy only (foam sclerotherapy group) and the other 16 cases (ethanol group) with subsequent ethanol. The basic characteristics and DCE-MRI parameters of the two groups were compared. Logistic regression was used to analyze the risk factors of selecting different sclerosing agents, and the receiver operator characteristic curve was applied to assess the efficacy of these risk factors. Results · There were no significant differences in the gender, age, lesion location, pre-treatment volume and presence or absence of phleboliths between foam sclerotherapy group and ethanol group. The lesion classification, maximum intensity time ratio (MITR) and peak enhancement percentage showed significant differences between the two groups. Multivariate Logistic regression analysis showed that the lesion classification and MITR were two independent factors for the selection of sclerosing agents. The area under curve (AUC) of MITR was 0.947, while the AUC of lesion classification was 0.844. After the combination of these two parameters, the AUC was 0.969 with the sensitivity of 93.8% and the specificity of 90.0%. Conclusion · DCE-MRI can be helpful for clinical selection of appropriate sclerosing agents to improve the effectiveness of venous malformations treatment. Related Articles | Metrics

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Research hotspots and trends of breast cancer stem cells LIU Jie, QIU Xiao-chun 2020, 40 (07):  881-888.  doi: 10.3969/j.issn.1674-8115.2020.07.004 Abstract ( 534 )   PDF (9697KB) ( 258 )   Objective · To give a retrospective bibliometric analysis of documents about the breast cancer stem cell (BCSC) and reveal the hotspots and trends of global output. Methods · Articles about the research of BCSC between 2014 and 2019 were retrieved in PubMed and Scopus databases, and SciVal was used to evaluate the global scholarly output and identify the most active factors, such as publications, countries, institutions, and top journal percentile, from the indicators of Field-Weighted Citation Impact (FWCI), CiteScore (CS), keywords and topic prominence percentile. Research hotspots and trends were discussed in detail. Results · A total of 4 700 publications on the research of BCSC from 2014 to 2019 were retrieved in this study with FWCI 1.73. The USA was the top country with a total of 1 742 publications and National Institutes of Health was the top institution both in total citation and FWCI. Non-coding RNA (ncRNA), mesenchymal stem cells, and immunotherapy were the most frequently used topics in BCSC. Conclusion · Researches on the correlation of BCSC and ncRNA, tumor microenvironment, and immunotherapy are the hotspots and trends in BCSC. Related Articles | Metrics

Original article (Clinical research)

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Correlation between serum vitamin D and coronary artery lesion severity and short-term prognosis in patients with coronary artery disease FAN Yi-bo1,2, YAO Tian-bao1, MA Jun1, YUAN An-cai1, DU Yong-pin1, SHAO Qin1, BU Jun1 2020, 40 (07):  889-893.  doi: 10.3969/j.issn.1674-8115.2020.07.005 Abstract ( 523 )   PDF (6709KB) ( 200 )   Objective · To explore the relationship between serum vitamin D level and coronary artery lesion severity and short-term prognosis in coronary artery disease (CAD) patients. Methods · A total of 323 CAD patients diagnosed according to coronary angiogram were selected and the coronary artery lesion severity was evaluated by using Gensini score. Clinical data was collected and serum level of vitamin D and other indicators were determined for statistical analysis. Results · All patients were divided into tertile according to Gensini score. The level of serum vitamin D concentration was significantly different from the lowest tertile to the highest tertile (P=0.000). Serum vitamin D level was negatively correlated with Gensini score in CAD patients (r=-0.182, P=0.001). Multivariate linear analysis showed that vitamin D level was an independent predictor of Gensini score (β=-0.795, P=0.000). There was no difference in the incidence of major advanced cardiovascular events between vitamin D deficiency patients and normal vitamin D level patients (2.05% vs 3.17%, P=0.202) after (18.14±3.04) months' follow-up. Conclusion · There is an independently negative correlation between serum vitamin D and coronary artery lesion severity in CAD patients. Related Articles | Metrics

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Establishment of a nomogram model predicting risk factors of postoperative complications after radical gastrectomy for gastric cancer LÜ Heng-yu, HUANG Chen, XIA Xiang, ZHAO Gang 2020, 40 (07):  894-900.  doi: 10.3969/j.issn.1674-8115.2020.07.006 Abstract ( 530 )   PDF (8504KB) ( 206 )   Objective · To explore the risk factors of postoperative complications after radical gastrectomy + D2 lymphadenectomy and establish a predictive nomogram model. Methods · From July 2016 to June 2019, 1 705 patients who received radical gastrectomy + D2 lymphadenectomy in the Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine were collected. According to Clavien-Dindo grading system, the postoperative complications were graded, and the risk factors of postoperative complications ≥grade Ⅱ were analyzed by χ2 test. Multivariate Logistic regression was used to analyze the independent risk factors of postoperative complications ≥grade Ⅱ. According to the selected independent risk factors, the nomogram model was established. For verification, above patients were used as the training set, and 612 patients undergoing the same operation in this department from July to December 2019 were used as the validation set. Results · A total of 416 (24.4%) gastric cancer patients had postoperative complications. Multivariate Logistic regression analysis showed that male (OR=1.507, P=0.002), age ≥60 years old (OR=1.962, P=0.001), maximum diameter of tumor ≥5 cm (OR=1.456, P=0.002) and total gastrectomy (OR=1.313, P=0.026) were independent risk factors for postoperative complications ≥ grade Ⅱ . Based on these independent risk factors, the nomogram was established and presented good discrimination and predictive consistency in training set and validation set. Conclusion · The nomogram based on these four independent risk factors has a good predictive performance in predicting postoperative complications after radical gastrectomy for gastric cancer, and has a certain clinical application and reference value. Related Articles | Metrics

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Predictive value of dynamic contrast-enhanced MRI of original plaque on carotid artery in-stent restenosis GE Xiao-qian1, LI Xiao2, ZHAO Hui-lin2, SUN Bei-bei2, XU Jian-rong2, LIU Xiao-sheng2 2020, 40 (07):  901-907.  doi: 10.3969/j.issn.1674-8115.2020.07.007 Abstract ( 629 )   PDF (8157KB) ( 118 )   Objective · To explore the value of dynamic contrast-enhanced MR imaging (DCE-MRI) of original plaque to predict carotid artery in-stent restenosis (ISR). Methods · Forty cases of the patients with carotid atherosclerosis who were to undergo the carotid artery stenting (CAS) were included in this study. All participants underwent vessel wall MR imaging (VW-MRI) and DCE-MRI within one week before CAS. Carotid digital subtraction angiography (DSA) were performed at the sixth month to reassess the stenosis of stent. The correlation between DCE-MRI and ISR was evaluated. Results · The level of Ktran in ISR group was significantly higher than that in non-ISR group (P=0.000), and so was the vP (P=0.037). Ktrans could independently predict ISR (OR=1.43, 95%CI 1.17-1.56, P=0.012), and the cut-off value of Ktrans was 0.09 min-1 (sensitivity=100%, specificity=87.5%). Conclusion · Intraplaque inflammation may lead to excessive intimal hyperplasia after ISR. Ktrans could be a risk predictor of ISR with high sensitivity and specificity. DCE-MRI could be an effective tool to predict ISR. Related Articles | Metrics

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Establishment and validation of predictive model of pregnancy loss in patients with systemic lupus erythematosus WU Jia-yue, JIANG Meng, LIN Si-han, DI Wen 2020, 40 (07):  908-914.  doi: 10.3969/j.issn.1674-8115.2020.07.008 Abstract ( 538 )   PDF (7452KB) ( 139 )   Objective · To establish and verity predictive model of pregnancy loss in systemic lupus erythematosus (SLE). Methods · A total of 338 SLE pregnant patients admitted to Renji Hospital, Shanghai Jiao Tong University School of Medicine from Sept. 2011 to May 2017 (model development group) and 131 SLE pregnant patients admitted from Jun. 2017 to Jun. 2018 (model validation group) were selected. Multivariable Logistic regression model was used to determine the predictive variables and their coefficients of pregnancy loss in model development group. The predictive model was established, the risk score classification was performed, and model validation group was used for external validation. Results · Multivariate Logistic regression analysis showed that unplanned pregnancy (P=0.032), low complement C3 (P=0.002) and 24 h urinary protein ≥ 1.0 g (P=0.000) were the risk factors of the predictive model of SLE pregnancy loss. When the risk score of the model was 0-3, the risk of SLE pregnancy loss was low, and when the risk score is more than 3, it is high risk, with a sensitivity and specificity of 60.5% and 93.3%, respectively. The model was used in the model validation group for external validation, and the prediction accuracy of SLE pregnancy loss was 90.1%. Conclusion · The predictive model of SLE pregnancy loss can help clinicians efficiently screen the high-risk population of SLE pregnancy loss in order to take relevant measures as soon as possible to obtain better pregnancy outcomes. Related Articles | Metrics

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Analysis of clinical efficacy of modified cross-puncture vertebroplasty in the treatment of osteoporotic vertebral compression fracture LI Zhi-kun, LI Yi-fan, WANG Yi, YU Rong-hua, ZHANG Xiang-yang, ZHU Xiao-dong, XU Wei 2020, 40 (07):  915-922.  doi: 10.3969/j.issn.1674-8115.2020.07.009 Abstract ( 480 )   PDF (10474KB) ( 229 )   Objective · To compare the clinical efficacy of cross puncture technique with traditional puncture technique in the treatment of osteoporotic vertebral compression fracture (OVCF). Methods · Patients with OVCF treated with percutaneous vertebroplasty (PVP) were selected. According to the puncture method, the patients were divided into cross puncture group and traditional puncture group, with 70 cases in each group. The clinical data, imaging parameters, pain score, dysfunction score, overall satisfaction and related complications of the two groups were compared before and after operation, and the clinical efficacy of the two groups was evaluated. Results · Compared with the traditional puncture group, the wedge angle in the cross puncture group decreased at 6 and 12 months after operation (both P=0.000), while the leading edge height increased (P=0.012, P=0.000). During the follow-up, there was no significant difference in pain score and dysfunction score between the two groups. Compared with the traditional puncture group, the proportion of the excellent and great grades (Odom standard) of patients in the cross puncture group was higher (P=0.000, P=0.003), and the incidence of vertebral collapse, kyphosis deformity and spinal stenosis were lower (P=0.000, P=0.002, P=0.031). Conclusion · At 6 and 12 months after operation of cross puncture PVP, the follow-up changes of wedge angle and leading edge height of vertebral body were smaller than those of traditional puncture technique, that is, more stable. The incidence of vertebral collapse was lower, and the overall satisfaction of the curative effect was higher. Related Articles | Metrics

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Clinical characteristics and risk factors of acute otitis media in infants under one-year-old NI Kun1, ZHAO Li-min1, LI Xiao-yan1, SHI Hai-bo2 2020, 40 (07):  923-928.  doi: 10.3969/j.issn.1674-8115.2020.07.010 Abstract ( 451 )   PDF (7615KB) ( 171 )   Objective · To analyze the symptoms and signs of acute otitis media (AOM) in infants under one-year-old and the risk factors of AOM. Methods · Care information and clinical characteristics of a total of 304 full-term delivery infants with normal hearing who were examined in Shanghai Children's Hospital from January to December 2018 were included in the analysis. All infants were followed up to one-year-old and the clinical characteristics of AOM infants were collected. χ2 test was used to analyze whether there was a statistically significant difference between the AOM group (AOM infants) and the control group (infants without AOM) in terms of feeding status, daily care, going out, living environment, pneumococcal vaccination, and so on. Logistic regression model was used to explore the risk factors for AOM in infants under one-year-old. Results · In 304 infants, 177 developed AOM, and the age of AOM infants was (5.65±2.03) months. Compared with the control group, AOM group had higher rates of spitting up milk (P=0.000), frequent ears digging (P=0.021), participation in early education activities (P=0.000) and recurrent respiratory infection (P=0.000), and lower rate of pneumococcal vaccination (P=0.000). Logistic regression analysis showed that vomiting (OR=2.774, P=0.002), participation in early education activities (OR=3.785, P=0.000) and recurrent respiratory infection (OR=3.638, P=0.000) were risk factors for AOM in infants, and pneumococcal vaccination was a protective factor (OR=0.320, P=0.000). Conclusion · AOM is a high-incidence disease in infants under one-year-old in Shanghai. Insisting on scientific feeding position, reducing spitting and paying attention to the extra protection when participating in public activities such as early education may reduce the occurrence of AOM. Pneumococcal vaccination may help prevent AOM. Related Articles | Metrics

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Change of left ventricular torsion function and systolic synchronization in children with hypertrophic cardiomyopathy JIANG Xun-wei, SUN Xing-hua, ZHANG Han, XIAO Ting-ting, ZHANG Yong-wei, XIE Li-jian 2020, 40 (07):  929-935.  doi: 10.3969/j.issn.1674-8115.2020.07.011 Abstract ( 530 )   PDF (8849KB) ( 131 )   Objective · To assess left ventricular torsion function and systolic synchronization in children with hypertrophic cardiomyopathy (HCM) by using two-dimensional speckle tracking echocardiography (2D-STI), so as to provide theoretical basis for early clinical evaluation of cardiac function in children. Methods · Twenty-nine children with HCM in Shanghai Children’s Hospital, Shanghai Jiao Tong University from October 2018 to March 2019 were divided into two groups according to whether having clinical symptoms, i.e., asymptomatic HCM group (n=17) and symptomatic HCM group (n=12). Thirty normal children were also enrolled in the normal control group. All subjects underwent echocardiography, and the torsion-and strain-related data of the whole and different myocardial segments in the cardiac sections of left ventricle were obtained by 2D-STI. Results · Left ventricular strain analysis showed that the left ventricular longitudinal strains of both HCM groups decreased significantly compared with the normal control group (P<0.05), while the radial and circumferential strains increased significantly (P<0.05). The maximum difference of peak time in different segments on six cardiac sections in the symptomatic HCM group was significantly higher than that in the normal control group (P=0.000), while the difference between the asymptomatic HCM group and the normal control group was not significant. Left ventricular torsion function analysis showed that the global peak twists of left ventricle and positive peaks of rotation velocity in both HCM groups were significantly higher compared with the normal control group (P<0.05), standardized times to peak were longer (P<0.05), and negative peaks of rotation velocity and the untwisting rates were lower (P<0.05). Conclusion · In the children with HCM, the left ventricular torsion function is enhanced and diastolic function is weakened. In the symptomatic children, the left ventricular systolic synchrony is poor. Related Articles | Metrics

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Study of quantitative flow ratio-guided surgical coronary revascularization ZHU Yun-peng1*, ZHU Jia-xi 1*, ZHANG Wei 2, CHEN An-qing1, WAGN Zhe 1, LIU Jun1, ZHOU Mi 1, YE Xiao-feng1, TU Sheng-xian 3#, ZHAO Qiang1# 2020, 40 (07):  936-942.  doi: 10.3969/j.issn.1674-8115.2020.07.012 Abstract ( 587 )   PDF (9344KB) ( 158 )   Objective · To analyze the feasibility, safety and preliminary clinical results of quantitative flow ratio (QFR)-guided surgical coronary revascularization. Methods · From Jan 2018 to June 2019 at the Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, patients undergoing elective cardiac surgery with any coronary stenosis ≥ 50%, evaluated by preoperative coronary angiography visualization, were enrolled consecutively. There were 82 patients with 174 coronary artery vessels. Coronary artery bypass grafting (CABG) was recommended with a QFR value ≤ 0.8. The data of baseline characteristics, surgical procedure and perioperative outcomes were collected and analyzed. Results · QFR analysis was successfully carried out in 82 patients and 174 coronary artery vessels. QFR was detected positive ( ≤ 0.8) in 53 vessels (30.5%) and negative (>0.8) in the remaining 121 vessels (69.5%). As guided with QFR, 39 patients (47.6%) with 62 vessels (35.6%) proceeded to surgery for primary heart disease with concomitant CABG as planned, while the remaining 43 patients (52.4%) with 112 vessels (64.4%) changed revascularization strategy or spared CABG. Fifteen patients with simple coronary artery disease avoided CABG and discharged. Among the remaining 67 patients operated on, there were 2 deaths, 4 hemodialysis for new renal failure, 1 perioperative myocardial infarction and 1 stroke within 30 d. No unplanned revascularization was observed. The composite adverse events occurred in 6 cases (9.0%). Conclusion · QFR-guided surgical coronary revascularization is feasible and safe. This strategy could reduce the unnecessary bypass grafting. Further follow-up and prospective clinical trials are warranted to evaluate the effectiveness. Related Articles | Metrics

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Prevalence of chronic periodontitis in peritoneal dialysis patients and its correlation with dialysis adequacy DENG Hai1, TONG Yan1, Kristine SUN2, XIA Xin-yi2, LI Pu1, ZHANG Chun-li1, HU Chun1, SONG Zhong-chen2, LIU Ying-li1 2020, 40 (07):  943-949.  doi: 10.3969/j.issn.1674-8115.2020.07.013 Abstract ( 447 )   PDF (9098KB) ( 177 )   Objective · To analyze the prevalence of chronic periodontitis (CP) in the peritoneal dialysis patients based on a single-center population, and explore the correlation between the severity of CP and the adequacy of peritoneal dialysis. Methods · A total of 57 patients undergoing peritoneal dialysis in the Department of Nephrology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from December 2018 to December 2019 were included in the study. Baseline data, indicators of dialysis adequacy, including Kt/V, creatinine clearance rate, etc., and other related biochemical indicators were collected, and at the same time the CP-related indicators including clinical attachment loss, gingival index and probing depth were collected. The indicators of dialysis adequacy or their control rates of the patients with different severity of CP were compared. Pearson correlation analysis and linear regression analysis were used to explore the correlation between CP-related indexes and the indicators of dialysis adequacy. Results · All the patients undergoing peritoneal dialysis included in this study have moderate to severe CP. The prevalence of moderate CP was 24.6%, and the prevalence of severe CP was 75.4%. The proportion of moderate to severe anemia in the severe CP group was higher than that in the moderate CP group (28.0% vs 14.3%), but the difference was not statistically significant (P>0.05). Between the moderate and severe CP group, there was no statistical difference in the indicators of dialysis adequacy and their control rates (P>0.05). And there was no correlation between CP-related indexes and the indicators of dialysis adequacy as well (P>0.05). Conclusion · The prevalence of moderate to severe CP is very high in the peritoneal dialysis patients, in whom those with severe CP may have a tendency to develop moderate to severe anemia. There is no correlation between the severity of CP and dialysis adequacy. Related Articles | Metrics

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Effect of different reinforcement methods on anastomotic leakage after laparoscopic double stapled technique JIANG Tian-yu, LIU Hai-shan, MA Jun-jun, ZANG Lu, LU Ai-guo, DONG Feng, FENG Bo, ZONG Ya-Ping, SUN Jing, HE Zi-rui, HONG Xi-zhou, ZHENG Min-hua 2020, 40 (07):  950-956.  doi: 10.3969/j.issn.1674-8115.2020.07.014 Abstract ( 564 )   PDF (7752KB) ( 159 )   Objective · To investigate the effect of different suture reinforcement methods on anastomotic leakage (AL) after laparoscopic double stapled technique (DST). Methods · Data were collected from patients undergoing laparoscopic radical resection of colon-rectal cancer from July 2017 to September 2018 in the Department of Gastrointestinal Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine (Shanghai Minimally Invasive Surgery Center). Patients were divided into 3 groups according to the different ways of suture reinforcement: intermittent suture reinforcement group (n=41), continuous suture reinforcement group (n=41) and non-reinforcement group (control group, n=41). The intraoperative and postoperative conditions of the three groups were compared. One-way ANOVA, χ2 test, Fisher's test and non-parametric test were used for statistical analysis. Results · A total of 124 patients were included in this study. There were no statistically significant differences in operation time, intraoperative blood loss, postoperative hospital stay, postoperative gastrointestinal exhaust time and postoperative fluid intake time of two experimental groups compared with control group. Nine subjects were clinically diagnosed with anastomotic leakage. The incidences of serious AL of intermittent suture reinforcement group and continuous suture reinforcement group were lower than that in the control group. The average length of stay in patients with AL in the intermittent suture reinforcement group was 31 (19-42) d, and the continuous suture reinforcement group was 41 (37-43) d, which were significantly lower when compared with the control group of 64 (54-74) d. In addition, the average treatment cost of the intermittent suture reinforcement group was (71 142.6±2 849.3) yuan, and the continuous suture reinforcement group was (71 360.1±2 072.3) yuan, which were significantly lower than the control group of (91 386.0±9 151.7) yuan. Conclusion · Laparoscopic DST using intermittent suture and continuous suture can reduce the incidence of serious AL, shorten the length of hospital stay and reduce the cost of treatment without increasing the difficulty of surgery and other postoperative complications. Related Articles | Metrics

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Analysis of clinicopathological factors of spread through air spaces in stage Ⅰ A lung adenocarcinoma CHEN Liang, WANG Zhe-xin, YAO Feng 2020, 40 (07):  957-961.  doi: 10.3969/j.issn.1674-8115.2020.07.015 Abstract ( 1297 )   PDF (6047KB) ( 430 )   Objective · To investigate the clinicopathological risk factors of spread through air space (STAS) in stage Ⅰ A lung adenocarcinoma. Methods · The clinical data of patients with stage Ⅰ A lung adenocarcinoma who underwent lung surgery in Shanghai Chest Hospital, Shanghai Jiao Tong University from Jan. 2018 to Oct. 2019 were retrospectively collected. According to whether STAS happened, the patients were divided into STAS group and non-STAS group. Univariate analysis and binary Logistic regression analysis were used to analyze the risk factors of STAS in stage Ⅰ A lung adenocarcinoma between the two groups. Results · A total of 1 365 patients with stage Ⅰ A lung adenocarcinoma were included, including 1 312 patients without STAS and 53 patients with STAS. Univariate analysis showed that there were significant differences in gender and major subtypes of lung adenocarcinoma between the two groups (both P=0.000), but there was no significant difference in T stage between the two groups. Binary Logistic regression analysis showed that male and non-lepidic subtypes were independent risk factors. Conclusion · For the treatment of stage Ⅰ A lung adenocarcinoma, especially those with micropapillary subtype, the clinicians should pay attention to the possibility of STAS. Related Articles | Metrics

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Cerebral structural abnormalities and cognitive function in end-stage renal disease patients undergoing maintenance hemodialysis ZHOU Yue-ling, DING Wei, AI Hong-lan, LU Jian-xin, DING Feng, HU Chun 2020, 40 (07):  962-967.  doi: 10.3969/j.issn.1674-8115.2020.07.016 Abstract ( 522 )   PDF (8093KB) ( 209 )   Objective · To explore the patterns of cerebral structural abnormalities and cognitive function alterations in end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis, and the underlying correlative factors. Methods · Thirty-seven ESRD patients undergoing maintenance hemodialysis without prior stroke in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine were selected. All patients underwent brain magnetic resonance imaging (MRI) and assessment of cognitive function by using Mini-Mental State Examination (MMSE). Patients were divided into lacunar infarction group (n=33) and non-lacunar infarction group (n=4), or white matter hyperintensities (WMH) group (n=14) and non-WMH group (n=23). The difference of demographic characteristics, past history, blood parameter and dialysis adequacy between patients and their controls were analyzed by t test, Mann-Whitney U test, χ2 test and Fisher exact test. Spearman correlation analysis were performed to explore the relationship between clinical features, cerebral structural abnormalities and cognitive function. Results · Nineteen male and eighteen female patients participated in the study. The mean age was (59.4±12.3) years. The incidences of lacunar infarction and WMH were 89.2% and 37.8%, respectively. 24.3% of the participants were diagnosed as cognitive impairment. Patients with lacunar infarction were elder, who had lower level of hemoglobin, hematocrit, serum albumin and serum total protein, while parathyroid hormone (PTH), erythrocyte sedimentation rate, tumor necrosis factor-α and interleukin-6 were elevated. Patients with WMH were also significantly elder, lower in transferrin saturation and higher in PTH. The differences between the two groups were statistically significant (all P<0.05). Spearman correlation analysis showed MMSE score had a negative correlation with age (r=?0.471, P=0.003) and had positive correlations with education status (r=0.355, P=0.031) and hypertension (r=0.358, P=0.030). The study did not find the relationship among lacunar infarction, WMH and MMSE score; however, recall function was found negatively correlated with lacunar infarction (r=?0.357, P=0.030). Conclusion · ESRD patients undergoing maintenance hemodialysis have a high prevalence of cerebrovascular disease and cognitive impairment. Older age, anemia, inflammation status, chronic kidney disease-mineral and bone disorder may be the influencing factors of the cerebral structural abnormalities and cognition decline. Related Articles | Metrics

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Clinical progress of noninvasive follicular thyroid neoplasm with papillary-like nuclear features ZENG Su, XU Pei-pei, GUO Ming-gao 2020, 40 (07):  968-973.  doi: 10.3969/j.issn.1674-8115.2020.07.017 Abstract ( 1162 )   PDF (9333KB) ( 218 )   In 2015, the United States and Canadian Academy of Pathology re-evaluated noninvasive encapsulated follicular variant of papillary thyroid carcinomas (NI-EFVPC), and then the new terminology of "noninvasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP) was initially introduced to replace NI-EFVPTC. In 2017, the World Health Organization also used NIFTP in the endocrine tumor classification. NIFTP is an encapsulated or clearly delimited noninvasive neoplasm with a follicular growth pattern and nuclear features of papillary thyroid carcinoma. Ultrasonography, cytology examination and genetic test are helpful to identify NIFTP, but the results overlap with invasive encapsulated follicular variant of papillary thyroid carcinoma. This paper mainly reviews the latest research in the clinical features, diagnosis and treatment features and prognosis of NIFTP. Related Articles | Metrics

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Research progress on the risk factors and treatment of consecutive esotropia after exotropia surgeries ZHANG Liu-hui, ZHANG Xu, WANG Jia-lu, KANG Xiao-li 2020, 40 (07):  974-979.  doi: 10.3969/j.issn.1674-8115.2020.07.018 Abstract ( 589 )   PDF (8765KB) ( 121 )   Consecutive strabismus refers to the secondary manifest strabismus right after or a period after strabismus surgeries, including consecutive esotropia and consecutive exotropia. It is reported that the incidence of consecutive esotropia is 6%-20%. Consecutive esotropia may lead to increased risks of amblyopia and visual deficiency in children and diplopia in adults. As the multiformity and complexity of continuous esotropia, there exist many challenges for clinicians to know the risk factors well and select appropriate treatment. The article reviews the latest research progress on the risk factors and treatment strategies of consecutive esotropia, aiming to help better evaluate the risks of continuous esotropia after exotropia surgeries, adjust the operation plans, and provide references to select the appropriate treatment plan. Related Articles | Metrics

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Advances in anesthesia research of modified electroconvulsive therapy JIA Yu-ping, JIANG Jiang-ling, XIAO Wen-bin, LI Chun-bo 2020, 40 (07):  980-984.  doi: 10.3969/j.issn.1674-8115.2020.07.019 Abstract ( 551 )   PDF (7977KB) ( 199 )   Modified electroconvulsive therapy (MECT) is a fast and effective physical therapy method currently widely used in psychiatry. The anesthesia target of this treatment is to calm the patients, relax the muscles and maintain stability in histodynamics during treatment, meanwhile avoiding affecting efficacy, because too deep anesthesia can inhibit discharge of the cerebral cortex. However, current anesthetic drugs in MECT, including muscle relaxants, intravenous anaesthetics, inhalation anaesthetics, analgesics, etc., lack the best compatibility of anesthesia induction. This review discusses the application and compatibility of these drugs in MECT in recent years, in order to provide reference for the best anesthesia induction protocol for MECT. Related Articles | Metrics

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Social and interpersonal dysfunction of patients with major depressive disorder LIN Qing-qing, QIU Jian-yin 2020, 40 (07):  985-989.  doi: 10.3969/j.issn.1674-8115.2020.07.020 Abstract ( 644 )   PDF (8255KB) ( 212 )   Major depressive disorder is usually associated with social and interpersonal dysfunction, which significantly affects the patients' daily life. This paper introduces problems of social and interpersonal interaction in the patients with major depressive disorder, and briefly reviews their abnormalities and neural mechanism in facial expression processing, social decision-making and social feedback processing, so as to give new ideas for the future research on intervention and treatment. Related Articles | Metrics

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Effect analysis of partial transposition of vertical rectus combined with medial rectus recession under microscope on treatment of complete abducens nerve palsy esotropia LI Bin1, LI Chao1, XU Qing1, NIU Yan2 2020, 40 (07):  990-994.  doi: 10.3969/j.issn.1674-8115.2020.07.021 Abstract ( 534 )   PDF (6581KB) ( 145 )   Objective · To investigate the clinical effect of partial transposition of the vertical rectus combined with medial rectus recession on the treatment of abducens nerve palsy esotropia under the microscope. Methods · Nine patients with abducens nerve palsy esotropia were treated in Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine from March 2015 to June 2017. The strabismus surgery was performed under the microscope, with partial transposition of the vertical rectus combined with medial rectus recession. Postoperative follow-up was performed to observe the effect. Results · After 1 week, 7 patients’ primary position were orthotopic(within ±10Δ), and 2 patients were undercorrection (+15Δ and +20Δ). Abduction function of all the patients improved significantly. The eyes could cross the midline. After 1 month, 6 patients’ primary position were orthotopic (within ±10Δ), 3 patients were undercorrection(respectively +15Δ, +15Δ and + 30Δ). After 1 year, 5 patients’ primary position were almost orthotropia (within ±10Δ), and 4 patients were undercorrection (respectively +15Δ, +15Δ, +30Δ and +40Δ). Conclusion · Partial transposition of the vertical rectus combined with medial rectus recession under the microscope is a safe and effective surgical method in treatment of complete abducens nerve palsy esotropia. It can not only improve the ocular position, but also effectively improve the abduction function of the paralytic eye. However, it is easy to be undercorrection in the long-term. Related Articles | Metrics

Techniques and methods

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Discussion on value of medical records-structured specialized disease database based on artificial intelligence in clinical research RONG Wen-wen1, WANG Gang1, ZHU Qi-li2 2020, 40 (07):  995-1000.  doi: 10.3969/j.issn.1674-8115.2020.07.022 Abstract ( 724 )   PDF (5661KB) ( 350 )   Objective · To explore the value support of medical records-structured specialized disease database established by using unstructured electronic medical record text information in clinical research. Methods · The information of patients who were admitted to a Grade A specialist hospital in Shanghai from Oct. 2007 to Sept. 2019 were collected. By using artificial intelligence (AI) engine and other information methods, the electronic medical record text information were structured into a structured database, and compared with the traditional structured database. Results · The information of 82 584 patients were collected, and the structured number of hospital records was 253 000. The specialized disease databases of lung cancer, esophageal cancer and mediastinal tumor were established. Compared with the traditional structured database, the specialized disease database expanded the scope of data retrieval and improved the efficiency of data retrieval. Conclusion · The construction of medical records-structured specialized disease database based on AI reduces the burden of clinician data retrieval, and provides valuable statistical data for clinical research. Related Articles | Metrics

Case report

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Continuous splenogonadal fusion: a case report and review of literature LI Xiao-xi1, XIE Hua1, HUANG Yi-chen1, LÜ Yi-qing1, LIANG Yan1, CHEN Fang1, 2, 3 2020, 40 (07):  1001-1004.  doi: 10.3969/j.issn.1674-8115.2020.07.023 Abstract ( 481 )   PDF (4985KB) ( 221 )   A 4-year-old boy with a painless mass for 3 years in the left scrotum was admitted to the hospital. Three testicle-like substances could be palpable one by one from groin to scrotum on the left side during physical examination. The upper and middle parts were slightly hard, while the lower part was slightly soft. The splenogonadal fusion (SGF) in the left side was found by laparoscopy after admission. Accessory splenectomy was performed with preservation of the left testicle. Postoperative follow-up was 18 months. The testicles were well developed without atrophy, and abdominal B-ultrasound showed no abnormality in liver, gallbladder and spleen. SGF was a rare congenital abnormality, which was difficult to diagnose preoperatively. During the operation, if the SGF was found, accessory splenectomy with testicle-sparing should be performed. Laparoscope can be used as an effective diagnosis and treatment method to improve the understanding of SGF, and avoid unnecessary orchiectomy. Related Articles | Metrics