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Laparoscopic hepatectomy has been routinely used in all tumor types of the liver, but for tumors in the Ⅵ, Ⅶ and Ⅷ segments of the liver (referred to as tumors in a special position of the liver in this paper), laparoscopic hepatectomy has some difficulties in aspect of vision and operation due to the deep anatomical position. In the process of continuous experience accumulation, hepatobiliary surgeons have explored different surgical positions, surgical methods and surgical paths to solve the encountered difficulties. For tumors located in a special position of the liver, conventional laparoscopy, change of surgical posture, thoracoscopic or combined laparoscopy and retroperitoneal laparoscopy are effective and feasible. All of them have their own advantages.
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ObjectiveTo characterize the chemical constituents of Dayuanyin based on ultra-performance liquid chromatography-quadrupole/electrostatic field orbitrap mass spectrometry(UPLC-Q-Exactive Orbitrap MS). MethodThe detection was performed on a Thermo Acclaim™ RSLC 120 C18 column(2.1 mm×100 mm, 2.2 μm), the mobile phase was acetonitrile(A)-0.1% formic acid aqueous solution(B) for gradient elution (0-7.5 min, 10%-19%A; 7.5-12 min, 19%-22.5%A; 12-23 min, 22.5%-27%A; 23-27 min, 27%-56%A; 27-35 min, 56%-84%A; 35-36 min, 84%-90%A), the flow rate was 0.3 mL·min-1, and the column temperature was 30 ℃. The data were collected in the positive and negative ion modes by heated electrospray ionization(HESI), and the detection range was m/z 80-1 200. Combining the retention time of the reference substance, fragment ions, databases such as PubChem and related literature, Xcalibur 3.0 was used to identify the chemical constituents of Dayuanyin. ResultA total of 161 compounds were identified, including 14 alkaloids, 60 flavonoids, 16 terpenoids, 26 saponins, 18 phenylpropanoids, 16 organic acids and 11 others. ConclusionThe established method can effectively and quickly identify the chemical components in Dayuanyin, and clarify its chemical composition, which can provide a basis for the development of compound preparations of this famous classical formula.
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Objective:To investigate the effects of early sleep deprivation(SD) on depressive-like behavior and hippocampus synaptic plasticity in adult mice with chronic unpredictable mild stress(CUMS) model.Methods:Thirty 2-week-old clean grade male mice were randomly divided into control group (CON group), CUMS group and SD + CUMS group according to the random number table, with 10 mice in each group. The mice in SD + CUMS group were subjected with sleep deprivation for 4 hours once a day during puberty (3 ~ 6 weeks old), and then were stimulated by CUMS after adulthood (9 weeks old). The mice in CUMS group were subjected with CUMS at the age of 9 weeks. And the mice in CON group were not given any intervention.The depressive-like behavior was evaluated by body weight, sugar water preference, tail suspension test and forced swimming test.The density of dendritic spines of basal and apical neurons in hippocampal CA1 was measured by Golgi staining, the frequency and amplitude of miniature excitatory postsynaptic current(mEPSC) of pyramidal neurons in the hippocampal CA1 region of mice were measured by electro-physiological patch clamp technique.Graphpad prism 7.0 software was used for statistical analysis and mapping. One-way ANOVA was used for comparison among multiple groups, and Tukey test was used for further pairwise comparison.Results:(1) After stress modeling, there were significant differences in body weight, sugar water preference percentage, forced swimming immobility time and tail suspension time among the three groups ( F=71.63, 39.82, 44.13, 43.07, all P<0.01). Compared with CON group, the mice in CUMS group and SD+ CUMS group had lower body weight ((25.51±0.37) g, (22.92±0.31) g, (20.12±0.27) g, both P<0.01), lower sugar water percentage preference ((87.40±1.65) %, (63.42±3.33) %, (49.68±3.70)%, both P<0.01), longer immobile time of forced swimming ((34.30±5.32) s, (119.20±12.03) s, (153.80±9.17) s, both P<0.01) and longer immobile time of tail suspension test((115.20±8.19)s, (156.80±4.35) s, (192.00±4.12) s, both P<0.01). Compared with CUMS group, SD+ CUMS group had lower body weight ( P<0.01), lower sugar water preference percentage ( P<0.05), longer immobile time in forced swimming test( P<0.05) and longer immobile time in tail suspension test( P<0.01). (2) Golgi staining results showed that the densities of dendritic spines of apical neurons and basal neurons in hippocampal CA1 area of the three groups were significantly different ( F=38.41, 41.34, both P<0.01). The densities of dendritic spines of basal and apical hippocampal neurons in CUMS group and SD+ CUMS group were lower than those in CON group ((7.74±0.22)/10 μm, (6.58±0.27)/10 μm, (5.00±0.13)/10 μm, both P<0.01), ((8.90±0.23)/10 μm, (7.63±0.30)/10 μm, (6.01±0.14)/10 μm, both P<0.01). Compared with CUMS group, the mice in SD+ CUMS group had lower densities of dendritic spines of basal and apical hippocampal neurons(both P<0.01). (3) Electrophysiological results showed that there were significant differences in the frequency and amplitude of mEPSC in hippocampal pyramidal neurons of the three groups ( F=38.90, 63.37, both P<0.01). Compared with CON group, the frequency and amplitude of mEPSC in pyramidal neurons of CA1 in CUMS group and SD+ CUMS group were significantly lower ((0.39±0.03)Hz, (0.20±0.02)Hz, (0.07±0.02)Hz, both P<0.01; (9.98±0.31)pA, (7.74±0.21)pA, 6.36±0.13)pA, both P<0.01). Compared with CUMS group, the frequency and amplitude of mEPSC in SD+ CUMS group were lower (both P<0.01). Conclusion:Adolescent sleep deprivation aggravates depressive behavior and hippocampus synaptic plasticity impairment in adult CUMS model mice.
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Objective:To investigate the application value of spiral CT combined with a disintegrin and metalloproteinase 8 (ADAM8), neuron-specific enolase (NSE) and cytokeratin 19 fragment (CYFRA21-1) measurements in the clinical diagnosis of lung cancer.Methods:Fifty patients with lung cancer who received treatment in Shanxi Rongjun Hospital from February 2018 to December 2019 were included in the lung cancer group. Fifty patients with benign lung disease who concurrently received treatment in Shanxi Rongjun Hospital were included in the benign lung disease group. Fifty 50 healthy controls who concurrently received treatment in Shanxi Rongjun Hospital were included in the control group. Serum levels of ADAM8, NSE and CYFRA211 were compared among the three groups. Three groups received spiral CT scans. ADAM8-, NSE- and CYFRA211-positive detection rates were analyzed. The receiver operating characteristic (ROC) curve was used to analyze the efficacy of different methods in the diagnosis of lung cancer. Serum ADAM8, NSE and CYFRA211 levels in patients with lung cancer at different TNM stages were compared.Results:Serum levels of ADAM8, NSE and CYFRA211 in the lung cancer and benign lung disease groups were (381.69 ± 34.82) ng/L, (255.28 ± 30.48) ng/L, (16.87 ± 3.11) μg/L, (9.27 ± 2.11) μg/L,(13.54 ± 8.10) μg/L, (3.01 ± 1.34) μg/L, respectively, which were significantly higher than those in the control group [(225.83 ± 24.19) ng/L, (7.42 ± 2.35) μg/L, (1.78 ± 1.02) μg/L, t = 5.352, 25.994, 4.142, 17.142, 5.165, 10.186, all P < 0.05]. Serum levels of ADAM8, NSE and CYFRA211 in the lung cancer group were significantly higher than those in the benign lung disease group ( t = 19.316, 14.299, 9.069, all P < 0.05). The positive detection rate of lung cancer by spiral CT combined with ADAM8, NSE and CYFRA211 measurements was 92.00%, which was significantly higher than that by spiral CT combined with a single detection ( χ2 = 7.862, 9.000, 11.422, 9.000, all P < 0.05). The ROC curve analysis revealed that the area under the ROC curve, sensitivity and specificity of the combined method were 0.916, 0.920 and 0.900, respectively, which were significantly higher than those of spiral CT combined with a single detection. Serum ADAM8, NSE and CYFRA211 levels at TNM stages III-IV were (430.18 ± 36.43) ng/L, (20.05 ± 3.49) μg/L, (15.93 ± 8.22) μg/L, respectively, which were significantly higher than those at TNM stages I-II [(314.72 ± 30.85) ng/L, (12.49 ± 2.67) μg/L, (10.25 ± 6.35) μg/L, t = 11.777, 8.312, 2.644, all P < 0.05). Conclusion:Spiral CT combined with serum ADAM8, NSE and CYFRA211 levels can greatly increase the diagnostic sensitivity and specificity of lung cancer, which is worthy of clinical application.
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Objective To discuss the safety and efficacy of straight light beam greenlight photoselective vaporesection of the prostate (PVRP) and photoselective vaporization of the prostate (PVP) in treatment of benign prostatic hyperplasia. Methods 113 cases of BPH were randomly divided into two groups, 62 cases in PVRP group and 51cases in PVP group. Clinical data was collected and compared between the two groups, including pre-operation and six month after operation international prostate symptom score (IPSS), quality of life (QOL), urine flow rate (Qmax), postvoid residual urine (PVR), as well as operational time, operative bleeding volume, bladder irrigation time, indwelling catheter time after operation and complications after operation. Results All the patients were operated successfully without serious complications. There was significant difference in operative time [(49.4 ± 18.9) min vs (75.1 ± 20.7) min (P 0.05). Conclusions Treatment of straight light beam greenlight PVRP and PVP are safe and effective for BPH. Straight light beam greenlight PVRP has the advantages of shorter operation time.
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Objective To investigate the effect of liver kinase B1(LKB1) on the radiosensitivity of subcutaneous xenograft tumor of lung cancer H460 cells in nude mice.Methods Human lung cancer H460 cells were implanted into female nude mice (BALB/c-nu) to establish a subcutaneous xenograft tumor model of lung cancer.A total of 24 female nude mice in which the model was successfully established were equally and randomly divided into four groups:pEGFP-Ctrl plasmid (empty vector plasmid) group, irradiation (IR)+pEGFP-Ctrl plasmid group, pEGFP-LKB1 plasmid (overexpressing LKB1) group, and IR+pEGFP-LKB1 plasmid group.The growth of xenograft tumors was observed and the tumor inhibition rate and enhancement factor (EF) were calculated.The expression of LKB1 in each group was measured by immunohistochemistry and Western blot to analyze the relationship between LKB1 and radiosensitivity.Results Compared with the pEGFP-Ctrl plasmid group, the IR+pEGFP-Ctrl plasmid group, pEGFP-LKB1 plasmid group, and IR+pEGFP-LKB1 plasmid group showed varying degrees of inhibition of tumor growth, particularly in the IR+pEGFP-LKB1 plasmid group, and the tumor inhibition rates were 31.30%, 14.78%, and 43.48%, respectively.The EF of LKB1 in the IR+pEGFP-LKB1 plasmid group was 1.18.The immunohistochemistry and Western blot showed that LKB1 could be effectively expressed in the pEGFP-LKB1 plasmid group and IR+pEGFP-LKB1 plasmid group, but not in the other two groups.Conclusions The subcutaneous xenograft tumor model of human lung cancer H460 cells has been successfully established in nude mice.LKB1 has a radiosensitizing effect on the subcutaneous xenograft tumor of lung cancer H460 cells in nude mice.
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Objective To evaluate the feasibility and efficacy of endoscopic push?radial dissection (EPRD)for benign esophageal stricture(BES). Methods Clinical data of 24 patients diagnosed as having BES who received EPRD were analyzed. The procedure and efficacy were evaluated. Results All 24 patients underwent EPRD successfully with mean operation time being 32 min(15?45 min).The mean esophageal stric?ture incision length was 3?? 2 cm (1?? 0?8?? 0 cm).No severe complications related to EPRD occurred, or trans?ferred for surgery. Patients were followed up for 1?5 months (mean 2?? 8 months). Dysphagia was relieved signif?icantly during the follow?up in 23 patients where endoscopy could go through smoothly. But dysphagia re?oc?curred in one patient 2 weeks after the operation, who underwent a second EPRD and stent implantation, then dysphagia was relieved. Conclusion EPRD is safe, feasible and effective for benign esophageal stricture.
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Objective To evaluate the effect of lysine hydrochloride and zinc gluconate granules combined with montmorillonite powder and live combined bifidobacterium and lactobacillus granules in the treatment of infantile diarrhea.Methods 80 cases of children with infantile diarrhea in our hospital from May 2014 to May 2016 were selected and randomly divided into the combined treatment group ( lysine hydrochloride and zinc gluconate granules combined with montmorillonite powder and live combined bifidobacterium and lactobacillus granules ) , and conventional treatment group ( montmorillonite powder and live combined bifidobacterium and lactobacillus granules ) two groups with 40 cases in each group, the clinical curative effects, adverse reactions, stool frequency recovery normal time, stool normal time, abdominal pain disappeared time, temperature recovery time, vomiting disappeared time of the two groups were statistically analyzed.Results The total treatment effective rate of the combined treatment group 97.5%(39/40) was significantly higher than the conventional treatment group 72.5% (29/40), the difference was statistically significant (P<0.05), the stool frequency recovery normal time, stool normal time, abdominal pain disappeared time, temperature recovery time, vomiting disappeared time were significantly shorter than the conventional treatment group, the difference was statistically significant (P<0.05).Conclusion The effect of lysine hydrochloride and zinc gluconate granules combined with montmorillonite powder and live combined bifidobacterium and lactobacillus granules in the treatment of infantile diarrhea is better than montmorillonite powder and live combined bifidobacterium and lactobacillus granules .
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Centering on medical human spirit that holds life in awe and esteem, the paper formulates a framework for medical humanities in terms of categories, scopes, problematics and skills, and designs a setup regarding the goals, curricula, and pedagogies for teaching practice.It is intended to inspire education reform for mnedical humanities in China by providing such a problem-based and competence-oriented education guide.
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Medical Education in the United States and Canada released by the Carnegie Foundation in 1910,known as The Flexner Report,laid scientific foundations and set excellent standards for American medical education.However,the 20th century reality fell behind the professional ideals advanced in the report.In 2010,the Carnegie Foundation released Educating Physician:A Call for Reform of Medical School and Residency,called The Flexner Report 2,which recommends four goals for medical education in the 21st century:standardization of learning outcomes and individualization of the learning process;integration of formal knowledge and clinical experience;development of habits of inquiry and innovation;and focus on professional identity fornation.
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Objective To investigate the correlation between bronchial provocation tests and the onset of the disease.Methods One hundred and seven patients who hospitalized in General Hospital of China Aviation from 2013-2014 were selected as our subjects.They all were with unexplained symptoms such as cough and asthma suppress.All the patients were performed bronchial provocation tests.In accordance with the onset time,patients were divided into acute (< 3 weeks),subacute (3-8 weeks) and chronic (> 8 weeks) groups.The positive rates of bronchial provocation test of three groups were compared.Results Of all 107 patients,36 patients were positive and 71 were negative in terms of bronchial provocation test.The cases with acute,subacute and chronic disease history were 16,36 and 55 respectively.The positive rate of bronchial provocation tests in different onset were 56.3% (9/16),36.1% (13/36),23.6% (13/55) respectively,and there was statistics significant difference(x2 =6.275,P < 0.05).The positive rate of bronchial provocation tests in acute group was higher than that in chronic group (x2 =6.165,P < 0.05).There was positive correlation between the positive rate of bronchial provocation tests and the onset,and the correlation coefficient Pearson was 0.239 (P <0.05).Conclusion There is a correlation between the positive rate of bronchial provocation tests and the onset.We should strengthen the monitoring in patients with acute onset and follow-up.
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Objective To investigate the differences in the safety of the operation of different hepatic vascular exclusion for liver surgery. Methods Sixty patients with liver resection were grouped by different hepatic blood flow blocking methods, and given pre-operative assessment prior to surgery. Results On the first day after surgery, the average levels of ALT and AST were (395.0 ± 220.2) U/L and (415.3±311.0) U/L in patients who received Pringle’s method (110.2±53.0) U/L and (125.6±78.5) U/L in patients who received regional hepatic vascular exclusion, (98.9±32.2) U/L and (96.2 ±66.5) U/L in patients who didn't receive hepatic vascular exclusion, respectively. Postoperative liver function damage was more serious in patients who received Pringle's method than patients who received regional hepatic vascular exclusion or patients who didn't receive hepatic vascular exclusion, the difference was statistically significant (P<0.05) .Conclusion Regional hepatic vascular exclusion or not can not only reduce the incidence of postoperative complications, but also expand the indications for liver resection.
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Objective To investigate the insula and its related network of schizophrenia patients and its correlation to behavior performance with functional magnetic resonance imaging.Methods Fourteen patients with paranoid schizophrenia and sixteen normal subjects received blood oxygenation level dependent functional magnetic resonance imaging(BOLD-fMRI) examinations based on resting state and digital 2-back working memory task.The fMRI data were processed and analyzed with SPM2,AFNI and Matlab software packages (thresholded at P =0.005,uncorrected).Medial prefrontal cortex (MPFC,BA10) was placed as region of interest (ROI).Results The functional connectivity positively or negatively correlated with MPFC was lower for patient group than that for control group in resting and task states.In resting state,the brain areas negatively correlated with MPFC mainly included the bilateral superior temporal gyrus (BA22),cuneus (BA 18/19),inferior parietal lobule (BA40),right parahippocampus for patient group and the bilateral insula/superior temporal gyrus(BA22),inferior parietal lobule(BA40),paracentral lobule,parahippocampus for control group.The brain areas positively correlated with MPFC mainly included the pineal gland areas for patient group and the left anterior nucleus thalamus,bilateral medial superior frontal gyrus (BA6),right inferior corpus callosum (BA34) and the cerebellar vermis for control group in resting state.In 2-back task,the brain areas negatively correlated with MPFC mainly included the right cerebellar hemisphere,left superior parietal lobule/precuneus (BA7),left superior frontal gyrus (BA6) for patient group and the left medial dorsal thalamus,bilateral lateral premotor area (BA6),left inferior parietal lobule/precuneus (BA7),right cerebellar hemisphere for control group.The accuracy of reaction was lower in patient group than that in control group((78.30 ± 8.76) % vs (89.89 ± 8.05) %,P =0.01) and the correlation between the accuracy and the left medial dorsal thalamus had statistical significance (r =-0.52,P =0.04).Conclusion The altered functional connectivitv of the bilateral insula and its related network indicates functional disintegration of the limbic system in patients with schizophrenia.Widespreadly reduced functional connectivity and the functional disconnection of left medial dorsal thalamus mav be one of the reasons for poor behavior performance in schizophrenia patients.
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Objective To investigate the clinical features of aged patients with acute hemorrhage arising from vascular malformation of colon and the efficacy of endoscopic placement of hemoclip in treatment of hemorrhage. Methods Fifty-six patients were diagnosed with acute bleeding arising from vascular malformation of colon by colonoscopy. Patients were assigned to aged group (n = 31,≧60 years of age) and control group (n = 25, <60 years of age). The clinical manifestations and the efficacy of emergent endoscopic treatment with hemoclip application were compared between two groups. Results The complications including hypertension, coronary heart disease and diabetes were higher in aged group [80. 6% (25/31)] than in control group [40. 0% (10/25) ] with significant difference (P<0. 01). The effusive bleeding accounted for 45. 2% (14/31) in aged group and 16. 0% (4/25) in control group (P<0. 05). Endoscopic treatment with hemoclip was performed in 18 and 6 patients in aged group and control group, respectively. Initial hemostasis was achieved in 17 and 6 patients in the aged group and control group, respectively (P<0. 05). Recurrent hemorrhage occurred in 2 patients in the aged group and none in the control group (P>0. 05). The mean number of hemoclips application was 5. 3 ± 2. 4 in aged group and 3. 1 ± 1. 3 in control group (P<0. 05). Conclusions The hemorrhage is more serious in aged patients with acute hemorrhage, because they often complicate with cardiovascular diseases and diabetes. The lesion of hemorrhage can be found and precisely localized using colonoscopy. Promptly endoscopic placement of hemoclip is quite effective in treatment of acute hemorrhage.
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The present paper analyzes common mistakes in exemplification in the writing part of Band 4 College English Test.It discusses pertinence,appropriateness,typicality,logic and novelty of exemplification instead of dwelling on mistakes in spelling,wording and grammar,and offers some practical strategies of exemplification.
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Objective: To observe the clinical efficacy of Xingnao-Kaiqiao acupuncture("醒脑开窍"针法) on patients with cerebral infarction.Methods: Sixty-three patients with the disease were randomly divided into treatment group(n=32) treated with Xingnao-Kaiqiao acupuncture and control group(n=31) with(traditional) acupuncture.In addition,routine medicine therapies were given to the two groups(including(dehydration),(decrease) of intracranial pressure,enhancement of nerve nutrition and supportive treatment).(Xingnao-)(Kaiqiao acupuncture) was used and adjusted the number of points with different syndromes in the treatment group,main points were as follows: Neiguan(内关PC6),(Rengzhong)(人中GV26),Sanyinjiao((三阴交)SP6) and vice points were Jiquan(极泉HT1),Chize ((尺泽LU5)),Weizhong(委中BL40),Fengchi(风池GB20),Yintang (印堂EX-HN3),Shangxing((上星DU23)-through-Baihui)(百会GV20).Traditional acupuncture was used in the control group.Points at the upper limbs were Jianjing(肩井GB 21),Quchi(曲池LI 11),Waiguan(外关(S)51),Hegu(合谷LI 4) and at the lower limbs were Zusanli(足三里ST36),Yanglingquan(阳陵泉GB34),Huantiao(环跳GB30),Fenglong(丰隆ST40),Kunlun(昆仑BL60) etc..Acupuncture was given twice a day for 15 days in both groups.Before and after therapy,the hemorrheology,blood lipid,blood,urine,stool and biochemical routine examinations,white blood cell (WBC) count in(peripheral) blood and neurological deficit score(NDS) were(determined).Curative effects of two groups after treatment were observed.Results: After treatment,the total effective power was 93.75% in the treatment group,while it was 67.74% in the control group,the difference being significant (?~2=4.85,P
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The present paper is a study on the use of English movies in the teaching of college English,focusing on the design and interactive teaching process of the course "The Appreciation of English Movies".The paper argues that English movies play a positive role in creating an authentic communicative situation and acquainting students with western culture.
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Objective:To study the identification method and extract of Nodus Nelumbinis Rhizomatis.Methods:The identification of Nodus Nelumbinis Rhizomatis was carried out by TLC and the extract was determined by 65% alcohol.Results:The relevant spots on TLC plates were clear,and it was feasible to determine the extract of Nodus Nelumbinis Rhizomatis with 65% alcohol.Conclusion:Nodus Nelumbinis Rhizomatis can be identificated by 3-epibetulinic acid and ?-sitosterol as reference substance,there were differents on quantity of the extract of Nodus Nelumbinis Rhizomatis,which bought from different districts.
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Objective To obtain the most effective preventive management for corticosteroid-induced osteoporosis by the evidence-based medicine approach.Methods We attempted to find the current best evidence for the prevention of corticosteroid-induced osteoporosis by searching ACP Journal Club(1991-Sep.2005),USA Agency for Healthcare and Research evidence report,Cochrane Library(Issue3,2005)and MEDLINE(1990-Sep.2005),and further critically appraised the available evidence.Results We found that VitD or its analogues with calcium and bisphosphonates could improve bone mineral density significantly.But the effects on reducing the development of fracture were not concluded.Conclusion VitD or its analogues with calcium can be the preferential method as prevention for corticosteroid-induced osteoporosis,while bisphosphonates may be an alternative way.
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Objective To establish a method for the content determination of c hlorogenic acid in Yinren Granules. Methods The content of chlorogenic acid wa s detected by HPLC. HPLC was performed with Shim- Pack CLC- ODS column(150? 6.0 mm, 5 ? m) at room temperature, 3 % methyl alcohol- methanol( 79 ∶ 2 1) as mobile phase, the detection wavelength at 327 nm, the flow rate being 1. 2 mL/min and sample loop volume being 10 ? L. Results Chlorogenic acid has a good linearity within 0.102~ 1.02? g (r=0.999)and the average recovery was 98. 17 % with RSD being 1.31 % . Conclusion This method is simple, accurate and can be used for the quality control of Yinren Granules.