Objective To investigate the safety and feasibility of the combination of video-assisted thoracoscopic surgery(VATS) and electromagnetic navigation bronchoscopy(ENB)-guided microwave ablation(MWA) for synchronous multiple primary lung cancer(sMPLC).
Methods To retrospectively analyzed the clinical data of 13 patients with sMPLC in our hospital during the period from March 2017 to September 2020,who received VATS combined with ENB-guided MWA.
Results A total of 44 lesions were in 13 patients with sMPLC.Surgical resection was performed in 31 lesions,and ENB-guided MWA was performed in 13 lesions.Segmentectomy was the main surgical method,accounting for 46.2%.The mean size of main resected lesions was(22.2±12.8)mm.The mean size of lesions ablated by microwave was(10.2±5.8)mm.Mean drainage of postoperative first day was(177.7±93.3)ml.Mean chest drain duration was(2.8±1.8)d.Mean length of postoperative hospital stay was(3.7±1.8)d.Postoperative persistent air leakage for more than 7 days existed in 1 patient.No others complications occurred.The mean follow-up time was(10.6±10.5)months.No recurrence or death occurred up to now.
Conclusion VATS combined with ENB-guided MWA was a safe and feasible option for sMPLC.Accurate pathological staging was obtained by surgery to guide postoperative individualized treatment.Added ENB-guided MWA did not increase the patients' perioperative risk,could reduce the surgical resection scope and protected lung function to the maximum extent.

Objective To evaluate the efficacy and safety of colonoscopic placement of self-expandable metal stent without fluoroscopic monitoring for acute colorectal obstruction.
Methods The clinical data of 58 cases of acute colonic obstruction treated with metal stent in Shanghai Eighth People's Hospital from January 2017 to December 2019 were analyzed retrospectively.30 cases were operated under fluoroscopy,28 cases were operated without fluoroscopic monitoring.The differences in operation time,success rate and complications between the two groups were analyzed.
Results The operative time of fluoroscopy group was 15-135 minutes,with an average of(38±7.4) minutes,and that of non-fluoroscopy group was 20-75 minutes,with an average of(34±5.1) minutes,respectively.There was no significant difference between the two groups(P＞0.05).The cumulative fluoroscopy time of fluoroscopy group was 2-30 minutes,with an average of(4.2±2.8) minutes.The success rate of stent placement was 100%,the symptoms of colonic obstruction were relieved,and there were no surgical complications such as intestinal perforation.
Conclusion Colonoscopy guided placement of self-expandable metallic stents without fluoroscopic monitoring in emergence management for acute colorectal obstruction is effective and safe technique.

Objective Application system evaluation method to analyse foramen magnum decompression(FMD) and foramen magnum decompression combined with Syringo-subarachnoid Shunting(FMD+SSS) treatment of Arnold-Chiari malformation type1merger syringomyelia differences in therapeutic effect.
Methods We searched the documents about the foramen magnum decompression associated with foramen magnum decompression combined with Syringo-subarachnoid Shunting Arnold-Chiari malformation type1combined treatment of syringomyelia randomized,non-randomized controlled trial,strict quality assessment at the same time,the use of EndNoteX5,RevMan5.1,SPSS16.0 software for Meta-analysis included in the results of the study.
Results The results were incorporated into eight study accord with a standard(six in English and two in Chinese),a total of 441 were included in the analysis,Meta-analysis showed:the foramen magnum decompression comparative with foramen magnum decompression combined with syringo-subarachnoid shunting incidence of postoperative complications,surgical success rate,postoperative recurrence,postoperative pain symptoms improve the situation,improve postoperative movement,nerve nutritional disorders,and postoperative MRI observation hole there was no significant difference were syrinx in the reduced degree(P>0.05).Improve postoperative sensory disorder of simple decompression group is better than that of decompression + shunt group[ORmerge=8.24,95%CI:1.88～36.06,Z=2.80(P=0.005)],using the Bonferroni method to carry on the multiple hypothesis testing calibration results α＇=0.017,comparison between 0.017>0.005 had significant statistical significance.
Conclusion FMD and FMD+SSS treatment of Arnold-Chiari malformation type1 can achieve satisfactory therapeutic effect,but in comparison,simple foramen magnum 〖LM〗decompression improved postoperative sensory disorder has more advantages.

Objective Reported and analyzed a case of “Spinal cord hypertension syndrome” in percutaneous intervertebral endoscopic surgery,with a view to early diagnosis and early treatment of this complication in future surgery.
Methods Retrospectively analyze the clinical data of a patient with lumbar disc herniation during the operation in the first hospital of Wuhan City in December 2019.
Results The main clinical manifestations of “Spinal cord hypertension syndrome” are sudden and severe pain in the head and neck,chest tightness,and tinnitus.Signs of sexual numbness,abdominal distension,increased intracranial pressure,or a sudden rise in blood pressure and increased heart rate.The patient in this case improved after active treatment such as lowering perfusion pressure and oxygen sedation.
Conclusion “Spinal cord hypertension syndrome” focuses on prevention,advocates early identification and discovery,and should be promptly and appropriately dealt with after the occurrence.

Objective To compare the safety and accuracy of the free-hand technique and 3D printing guide plate technique in the placement of cortical bone trajectory screws in the lumbar spine.
Methods The lumbar spine CT data of 9 patients in our hospital were selected,and the three-dimensional model of the lumbar spine was established using computer software and the drill guide plate was designed based on the cortical bone screw trajectory.A 3D printer was used to print 2 sets of lumbar spine models and 1 set of drill guide plates for each case.Three cases were randomly selected by three operators with different experience,and the screws were placed by free-hand and guide plate respectively.According to different screw placement methods,it is divided into free-hand group and guide plate group.Postoperative X-ray film examination,according to the screw contact cortical bone area,screw penetration position and penetration distance to evaluate the effect of screw placement.
Results 90 screws were placed in each group.In free-hand group,the success rate was 73.3%,and the acceptability rate was 85.6%;in guide plate group,the success rate was 92.2%,and the acceptability rate was 98.9%.Success rate and acceptability rate of the guide group were higher than that of the free-hand group(P<0.05).The success rate and acceptance rate of screw placement between operator 2 and operator 3 were both higher than that of operator 1,but there was no significant statistical difference between operator 2 and operator 3(P>0.05).
Conclusion Compared with freehand technique,3D printed guide plate technology is more safe and accurate in the placement of lumbar cortical bone trajectory screw.

Objective To analyze the correlation between Roussouly classification,spine-pelvic sagittal balance parameters with prognosis in patients with osteoporotic vertebral compression fractures(OVCF).
Methods A retrospective analysis of 162 cases of OVCF patients admitted to our hospital from February 2018 to December 2019 were treated with percutaneous kyphoplasty(PKP).The spine-pelvic sagittal position was analyzed by the front and lateral X-rays of the lumbar spine.The spine-pelvic sagittal balance parameters,Roussouly classification and the prognostic indicators before and after treatment were recorded.The correlation between spine-pelvic sagittal balance parameters and Roussouly classification and prognosis were calculated.
Results The pelvic tilt angle(PT),pelvic incidence angle(PI),and sacral tilt angle(SS) after treatment were significantly lower than before treatment(P＜0.05).The lumbar lordosis angle(LL) was significantly higher than before treatment(P＜0.05).The difference of the Roussouly before and after surgery the type difference was obviously significant(P＜0.05).After treatment,VAS score and CA were significantly reduced(P＜0.05),while BI was significantly increased(P＜0.05).Balance parameters and Roussouly classification had significant correlation with prognostic indicators(P＜0.05).PT,PI,and Roussouly classification were positively correlated with VAS score and Cobb angle(P＜0.05),and negatively correlated with BI respectively Relationship(P＜0.05),SS and LL were positively correlated with BI(P＜0.05),and negatively correlated with VAS score and Cobb angle(P＜0.05).
Conclusion OVCF can cause the patient's spine-pelvic sagittal parameter imbalance.Roussouly classification and spine-pelvic sagittal parameter are correlated with prognosis.PKP surgery can promote the recovery and improve the prognosis.

Objective To investigate the efficacy of low rate,low energy of holmium laser combined with ureteral catheter in ureteroscopic lithotripsy to treat upper ureteral calculi.
Methods The clinical data of 120 patients with upper ureteral calculi performed with ureteroscopic lithotripsy from Sep.2017 to Sep.2019 was retrospectively alalyzed.The patients were divided into routine lithotripsy group(without catheter drainage，52 cases) and catheter drainage group(68 cases).The catheter drainage group was divided into high rate,high energy group(33 cases) and low rate,low energy group(35 cases).The operation time was statistically analysed.The postoperative stone shift rate and the postoperative stone-residual rate were also compared.
Results The operation time of the catheter drainage group[(35.4±5.5)min] was statistically lower than that of the routine lithotripsy group[(37.6±5.9)min](P<0.05).The postoperative stone shift rate in the catheter drainage group was statistically lower than that in the routine lithotripsy group:17.6% vs 34.6%(P<0.05).The postoperative stone shift rate in the low rate,low energy group was also statistically lower than that in the high rate,high energy group:11.4% vs 24.2%(P<0.05).
Conclusion Low rate,low energy of holmium laser combined with ureteral catheter is an effective method in ureteroscopic lithotripsy to treat upper ureter calculi,which reduces postoperative shift rate of stone and postoperative stone-residual rate,also shortens the operation time.

Objective To investigate the efficacy of retrolaminar block(RLB) for postoperative analgesia in patients undergoing modified radical mastectomy.
Methods Fifty female patients,scheduled for modified radical mastectomy,were randomly divided into 2 groups(n=25 each):group RLB and control group(group C).Retrolaminar block were performed on the side of operation with 0.5% ropivacaine 20 ml in group RLB after surgery.All the patients received patient controlled intravenous analgesia(PCIA) with sufentanil after operation.The total consumption of sufentanil,the number of demand times and requirement for rescue analgesic within 24h after surgery were recorded.Visual analogue scale(VAS) scores and Ramsay sedation scores were registered at 2,4,6,12,and 24h after surgery.All adverse reactions were recorded.
Results The amount of sufentanil consumed and the number of PCIA attempts in group RLB were(20±4) μg and(13±4) time,which were less than(29±3) μg and(19±3) time of group C after surgery(P<0.05).The VAS scores at rest in group RLB were(1.9±0.5),(2.1±0.5),(1.9±0.7) at 4,6,12 h after surgery,which were lower than(2.6±0.6),(2.5±0.5),(2.3±0.5) of group C(P<0.05).There were no significant difference in Ramsay sedation scores at different time points after operation(P>0.05).The incidence of nausea and vomiting in group RLB was 16%,which was lower than 44% of group C(P<0.05).The other adverse effects were no significant difference on two groups(P>0.05).RLB-related complications were not found in all patients.
Conclusion Retrolaminar block is a safe and effective technique that reduces the postoperative opioid consumption and the occurrence of nausea and vomiting,enhances the efficacy of postoperative analgesia in patients undergoing modified radical mastectomy.

Objective To analyze the related factors of pulmonary changes and fever after cervical lymph node dissection for thyroid cancer.
Methods A total of 46 patients with thyroid cancer undergoing cervical lymph node dissection were collected.The effects of gender,age,smoking history,body mass index(BMI),surgical method and other factors on postoperative pulmonary changes and fever were analyzed statistically.
Results There were 10 cases of left neck dissection,24 cases of right neck dissection,and 12 cases of bilateral neck dissection.There was statistical significance in the incidence of lung changes among patients with different dissection methods(P<0.05).Postoperative pulmonary changes were positive in 8 patients,including 4 patients with postoperative fever(50%),and negative in 38 patients,including 1 patient with postoperative fever(2.6%).There was statistically significant difference in the incidence of postoperative fever(P<0.05).There were 4 cases of thinness,25 cases of normal weight,13 cases of overweight and 4 cases of obesity.There was no statistically significant difference in the incidence of lung changes among patients with different body mass indexes(P>0.05),but there was statistically significant difference in the incidence of postoperative fever(P<0.05).
Conclusion Lung changes are more likely to occur after bilateral cervical lymph node dissection than after unilateral cervical lymph node dissection for thyroid cancer,and patients with lung changes are more likely to have postoperative fever.Patients who are lean or obese are more prone to pulmonary changes and postoperative fever.

Objective To analyze the characteristics of perioperative infection and related factors of perioperative infection in elderly patients with breast cancer(age≥65 years).
Methods One hundred elderly patients with breast cancer were enrolled.The infection,positive bacteri,and the factors affecting perioperative infection was observed.
Results A total of 19 cases(19.0%) of perioperative infection occurred,wound infection has the highest rate with 9 cases(47.4%)，followed by respiratory tract infection(5 cases,26.3%).A total of 28 bead pathogens were detected,with Gram-negative bacteria being the most common(17 cases,60.7%).The age,lymph node metastasis,operation time,diabetes,preoperative hemoglobin level,preoperative albumin level,hospital stay,drainage tube drainage,and surgical procedure were statistically significant between two groups(P<0.05).Age,operative time,diabetes mellitus,preoperative hemoglobin level,preoperative albumin level,and surgical procedure were independent factors influencing perioperative infection of elderly breast cancer(P<0.05).
Conclusion Age >75 years,operation time>2h,with diabetes,preoperative hemoglobin level ≤70g/L,preoperative albumin level ≤35g/L,surgical procedure are risk factors for perioperative infection in elderly patients with breast cancer.

Objective To detect the expressions of phosphatidylinositol 3-kinase(PI3K) P110 α and PI3Kp110β in thyroid papillary carcinoma and their relationships with prognosis.
Methods From January 2008 to July 2013,60 cases of thyroid papillary carcinoma(thyroid papillary carcinoma group),60 cases of nodular goiter(nodular goiter group) and 60 cases of other non cancerous cases were collected;the 5-year survival of papillary thyroid carcinoma group was followed up.The expressions of PI3Kp110α and PI3Kp110β protein were detected by immunohistochemistry,Kaplan-Meier survival curve was used to analyze the survival of PI3Kp110α,PI3Kp110β positive and negative groups,and Spearman method was used to analyze the correlation between PI3Kp110α and PI3Kp110β.
Results Compared with the normal group and nodular goiter group,the positive rates of PI3Kp110α and PI3Kp110β were higher in papillary thyroid carcinoma group(P<0.05).The positive expressions of PI3Kp110α and PI3Kp110β were significantly correlated with tumor size,lymph node metastasis and TNM stage(P<0.05).Single factor analysis showed that PI3Kp110α,PI3Kp110β,lymph node metastasis and TNM stage were all risk factors for poor prognosis of thyroid papillary carcinoma;multivariate analysis showed that PI3Kp110α,PI3Kp110β,lymph node metastasis and TNM stage were independent risk factors for poor prognosis of thyroid papillary carcinoma.A total of 14 cases of 60 patients had relapse,and no cases were missed.The positive cumulative survival rates of PI3Kp110α and PI3Kp110β were significantly lower than those of PI3Kp110α and PI3Kp110β(P<0.05).Spearman analysis showed that there was a positive correlation between PI3Kp110α and PI3Kp110β(P＜0.05).
Conclusion The positive rates of PI3Kp110α and PI3Kp110β in thyroid papillary carcinoma are increased,which are independent risk factors for poor prognosis,and they are closely related.

Objective This study analyzed the relationship between the sentinel lymph node(SLN) 1-2 positive early invasive breast cancer non-sentinel lymph node(NSLN) status and preoperative neutrophil-to-lymphocyte ratio(NLR).
Method A retrospective analysis of the clinicopathological indicators and preoperative blood routine data of patients with positive SLN1-2 positive and further axillary dissection for early invasive breast cancer who were admitted to the Affiliated Cancer Hospital of Zhengzhou University from October 1,2015 to December 1,2019.The NLR application value was evaluated by the receiver working curve and the area under the curve.Univariate and multivariate analysis was used to analyze the clinicopathological indicators and the relationship between preoperative NLR and NSLN status.
Result A total of 213 cases met the inclusion criteria.The best cut-off value of NLR is 1.8,the area under the curve is 0.718,the sensitivity is 68.7%,and the specificity is 73.1%.Univariate analysis found Her-2 status,SLN positive ratio and NLR and NSLN status(P<0.05),multivariate analysis showed SLN positive ratio(SLN positive ratio R=1,0.5≤R<1 compared with SLN positive ratio R<0.05 OR were 6.756 and 1.891,respectively,with NLR(OR:6.154,95% CI:3.130-12.100,P<0.001) were independent predictors of NSLN.
Conclusion Preoperative NLR is an effective predictor of NSLN status,but further research is needed to confirm its clinical value.

Objective To determine whether the complete clinical response(cCR) of  primary tumor evaluated by Magnetic resonance imaging(MRI)can predict a pathological complete response(pCR)results of axillary lymph nodes in biopsy-proven node-positive breast cancer following neoadjuvant chemotherapy(NAC).
Methods Patients with pathologically confirmed T1-3,N1-2 breast cancer underwent axillary lymph node dissection(ALND) after NAC were collected between October 2016 and October 2019.The response of NAC assessed by MRI of breast primary tumor in predicting axillary lymph node status was analyzed.
Results 95 consecutive node-positive breast cancer patients were collected.After NAC,the cCR rate of primary tumor was 41.1%(39/95) and the pCR rate of axillary lymph nodes was 47.4%(45/95).The sensitivity,specificity,negative predictive value and false negative rate of MRI were 82.0%(95%CI:68.1%-91.0%),66.7%(95%CI:50.9%-79.6%),76.9%(95%CI:60.3%-88.3%) and 18.0%(95%CI:9.0%-31.9%),respectively.However,the stratified analysis showed that the negative predictive value of the primary tumor MRI were 95.8%(95%CI:76.9%-99.8%) in Her-2 overexpression and triple negative patients,What's more,the false negative rate was 7.1%(95%CI:0-14.9%).
Conclusion The complete clinical response of breast primary tumor evaluated by MRI after NAC for node-positive breast cancer can not accurately predict a Negative pathological status of ALN.However,the stratified analysis shows that Her-2 overexpression and triple negative patients who achieve cCR can obtain a high negative predictive value and a low false negative rate.

Objective To evaluate the safety and therapeutic effects of applied in a three plane fashion laparoscopi -assisted resection of the right colon for right colon cancer.
Methods Form 2014.11 to 2018.6,44 patients were randomly divided into two groups,20 patients in the study group were treated with three plane radical operation for right colon cancer.Applied in a three plane fashion to laparoscopy-assisted resection of  the right colon was performed on 20 patients with right colon cancer.The upper colon was the first plane.The outside of duodenum is the second plane.The anterior pancreaticoduodenal space is the third plane.In the control group,24 cases were treated by traditional middle approach.The section of the right colon and end to end anastomosis of the residual bowels were performed through a small incision in the abdomen.The intraoperative and postoperative conditions, the number of dissected lymph nodes and complications were compared between the two groups.
Results Most patients completed laparoscopic operation except one case.In the study group,the operation time of laparoscopy was (66.8±6.5)minutes and the intraoperative blood loss was (25.3±2.5)ml.In the Control group,laparoscopic operation time was (90.4±15.8)minutes,intraoperative blood loss was (40.2±6.9)ml.The operation time and blood loss of the study group were better than those of the control group（P＜0.05）.There was no significant difference between the two groups in the number of lymph nodes,the average length of auxiliary incision,the average length of postoperative hospital stay,incision infection,puncture complications,intestinal fistula and abdominal infection（P＞0.05）.
Conclusion Three plane operation which is to divide into three planes was applied for resection of the right colon cancer.Thus,the difficulty of operation is reduced,at same time,which is more accessible to young surgeon.

Objective To investigate the clinicopathological characteristics,diagnosis and differential diagnosis of lymphocyte aggregation lesions.
Methods The immunohistochemical Ventana Bench Mark method was used to detect 9 cases of lymphocyte aggregation lesions and follow up closely.
Results 9 cases of lesion sites:4 cases of tonsils,2 cases of pharynx,2 cases of breast,1 case of duodenal mucosa.The course of the disease was 2 weeks to 2 months,and the follow-up was 4 to 78 months.No recurrence was found.Except for the duodenum,which was polyp-like,the others were flat and raised lesions.The histology showed that lymphocytes were gathered under the epithelium and filled In the lumen of each lymphatic vessel,the blood vessels around the lymphatic vessel proliferate obviously,and the surrounding interstitium has obvious fibrotic structure.Immunophenotype:T lymphocyte markers CD3,CD5,CD43 diffuse and strong positive,CD4,CD8 partial cells are positive,B lymphocyte markers show scattered cells are CD20 positive,judged as negative.
Conclusion The accumulation of a large number of lymphocytes in the lymphatic vessels shows a benign lymphocytic proliferation disease,with chronic inflammation and interstitial fibrosis,which may lead to local lymphatic duct compression and lymphocyte retention;the histology is similar to intravascular lymph The tumor showed a single and diffuse T lymphocyte immunohistochemical results,but the cells did not have atypical characteristics,and the patient's clinical symptoms showed isolated inflammatory changes without obvious malignant biological behavior.This performance is conducive to differential diagnosis.

Oligometastatic prostate cancer is the intermediate state of cancer between localized disease and widespread metastases.Optimizing the treatment strategy of this malignancy is always the concerns from the clinic.It's controversial whether surgery could benefit overall survival of the patients with oligometastatic prostate cancer,however,retrospective and population-based studies support a role for radical prostatectomy.Thus,we discuss the definition of oligometastases and current evidence base for primary tumor directed cytoreductive surgery.