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Objective:To analyze and summarize the oncological outcomes after laparoscopic radical trachelectomy (LRT) for early stage cervical cancer.Methods:The clinical data and follow-up results of 148 patients with early stage cervical cancer who underwent LRT in Renji Hospital, School of Medicine, Shanghai Jiao Tong University from July 2014 to June 2023 were collected, while tumor outcomes and postoperative pregnancy were analyzed retrospectively.Results:(1) General situation: the median age of 148 patients with LRT was 33 years (range: 19-42 years). Pathological type: 111 cases of squamous cell carcinoma, 36 cases of adenocarcinoma, 1 case of adenosquamous carcinoma. International Federation of Gynecology and Obstetrics (2018) stage: 17 cases of stage Ⅰa1 with lympho-vascular space invasion, 25 cases of stage Ⅰa2, 102 cases of stage Ⅰb1, and 4 cases of stage Ⅰb2. (2) Tumor outcomes: 148 patients were followed up regularly after LRT, and the median follow-up time was 59 months (range: 2-104 months). During the follow-up period, 5 cases of tumor recurred (including 1 death), and the median recurrence time was 10 months (range: 4-33 months). Among them, there were 3 cases of pelvic metastasis, 1 case of distant metastasis, and 1 case of both pelvic and distant metastasis. Both 3-year and 5-year disease-free survival rates of 148 patients were 94.5%, and the 5-year overall survival rate was 98.9%. (3) Postoperative pregnancy: among 148 patients with LRT, 67 patients had pregnancy requirements, followed up for 1 year, and 20 of them were pregnant, with a pregnancy rate of 29.9% (20/67). Among the 20 pregnant patients, 2 cases early abortion, 1 case mid-term abortion, and 17 cases gave birth (including 4 cases of premature birth and 13 cases of full-term birth).Conclusion:Under the condition of strict control of surgical indications, guaranteed surgical scope and tumor-free operation, LRT in patients with early cervical cancer has a good outcome.
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Objective:To investigate the effects of orlistat on the viability of human gall-bladder cancer (GBC) cells.Methods:The experimental study was conducted. The human GBC NOZ cells with high expression of FSAN was screened out through in vitro cultivating human GBC-SD, SGC-996 and NOZ cells. The cell proliferation assay, clone formation assay and protein detection experiment were used to analysis of the effects of orlistat on the viability of human GBC cells. Cell grouping: NOZ cells cultured with medium were set as the control group, cultured with medium + 10 μmol/L orlistat were set as the low-dose orlistat group, cultured with medium + 100 μmol/L orlistat were set as the high-dose orlistat group, respectively. Observation indicators: (1) expression of FASN protein in human GBC cells; (2) effects of orlistat on the proliferation of human GBC NOZ cells; (3) effects of orlistat on apoptosis of human GBC NOZ cells. Measurement data with normal distribution were represented as Mean± SD, the ANOVA test was used for comparison between groups and the least significant difference method was used for pairwise comparison. Results:(1) Expression of FASN protein in human GBC cells. Results of western blot showed that the relative expression of FASN protein in human GBC NOZ, GBC-SD and SGC-996 cells was 0.57±0.06, 0.12±0.04 and 0.10±0.02, respectively, showing a significant difference among them ( F=115.67, P<0.05). There were significant differences between the NOZ cells and the GBC-SD or the SGC-996 cells ( P<0.05), and there was no significant difference between the GBC-SD cells and the SGC-996 cells ( P>0.05). (2) Effects of orlistat on the proliferation of human GBC NOZ cells. ① Results of cell proliferation assay showed that the absorbance value of NOZ cells was 2.34±0.12, 1.57±0.08 and 1.07±0.13 in the control group, low-dose orlistat group and high-dose orlistat group, respectively, showing a significant difference among them ( F=205.88, P<0.05). ② Results of clone formation assay showed that the number of NOZ cells clones was 257±23, 153±11 and 83±11 in the control group, low-dose orlistat group and high-dose orlistat group, respectively, showing a significant difference among them ( F=92.64, P<0.05). ③Results of western blot showed that the relative expression of Cyclin-D1 protein of NOZ cells was 2.31±0.10, 1.52±0.05 and 1.23±0.11 in the control group, low-dose orlistat group and high-dose orlistat group, respectively, showing a significant difference among them ( F=120.73, P<0.05). The relative expression of CDK-4 protein of NOZ cells was 1.58±0.04, 1.21±0.02 and 1.19±0.04 in the control group, low-dose orlistat group and high-dose orlistat group, respectively, showing a signifi-cant difference among them ( F=110.45, P<0.05). (3) Effects of orlistat on apoptosis of human GBC NOZ cells. Results of western blot showed that the relative expression of Bcl-2 protein of NOZ cells was 1.07±0.03, 0.36±0.03 and 0.15±0.02 in the control group, low-dose orlistat group and high-dose orlistat group, respectively, showing a significant difference among them ( F=1 242.93, P<0.05). The relative expression of Bax protein of NOZ cells was 0.51±0.03, 0.38±0.05 and 1.38±0.04 in the control group, low-dose orlistat group and high-dose orlistat group, respectively, showing a signifi-cant difference among them ( F=583.51, P<0.05). Conclusion:Orlistat can inhibit the growth of human GBC NOZ cells and promote their apoptosis.
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Energy devices have been widely used in gynecological surgeries. From the overall development trend, energy devices improve the efficiency of surgery. The continuous updating and upgrading of energy devices also reduces surgical complications and improves the safety of surgery. The injury caused by energy devices is not only related to the complexity of the operation or the disease itself, but also closely related to whether the operator can reasonably choose and master the use of energy instruments, as well as the surgical skills and experience of the operator. Surgeons should establish the concept of " prevention is better than remedy" when using energy instruments. We should take the initiative to learn and master the working principle of different energy devices, understand the design characteristics of each product and improve the skills of device use, so as to minimize the complications caused by various energy instruments and bring real benefits to doctors and patients.
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Objective:To evaluate the clinical effectiveness and safety of Jiuwei-Zhuhuang San plus amoxilcillin sodium and sulbactam sodium in the treatment of bacterial pneumonia in children. Methods:A total of 120 patients with bacterial pneumonia in children from 1 year to 14 years old were randomly divided into the study group ( n=90) and the control group ( n=30) with ratio 3 to 1, the random sequence created by SAS software. Both groups were treated with amoxilcillin sodium for basic treatment, the observation group was treated with Jiuwei-Zhuhuang San. Both groups were treated for 1 week and followed up for 1 week. The cough frequency, clinical effective rate, symptoms and signs score, Traditonal Chinese medicine (TCM) pattern scores and adverse event rate were observed. Results:Eighteen cases were dropped and eliminated in the observation group, and 4 cases were dropped and eliminated in the control group, so 72 of observation group and 26 of control group were analyzed. After treatment, the clinical effective rate of the observation group was 27.8% (20/72), and the control group was 0% (0/26), where the difference was significant ( χ2=7.445, P=0.006). The difference of TCM syndrome score before and after treatment in the observation group (-16.8 ± 8.2 vs. -11.0 ± 5.8, t=-3.858) was lower than that of the control group ( P<0.01). There was significant difference between the two groups ( Z=-2.347, P= 0.019) in the TCM syndrome. The cough frequency of the observation group was 41.7% (30/72), and the control group was 26.9% (7/26). There wasn’t any significant differences in the cough frequency between two groups ( P>0.05). There was no statistical difference in symptoms and signs score or adverse event rate between two groups ( P>0.05). Conclusion:On the basis of amoxicillin sodium and sulbactam sodium, combined use of Jiuwei-Zhuhuang San can improve the clinical effectiveness of children with bacterial pneumonia.
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Objective:To investigate the value of positron emission tomography/computed tomography (PET/CT) in diagnosis of retroperitoneal lymph node metastasis for early cervical cancer.Methods:Retrospectively analyze the preoperative PET/CT examination results and postoperative pathological results of patients with early cervical cancer who underwent surgical treatment from May 5, 2019 to August 31, 2020, and analyze the clinical characteristics, so as to explore the high risk factors of PET/CT in the diagnosis of retroperitoneal lymph node metastasis.Results:The accuracy, sensitivity, specificity and area under the curve (AUC) of PET/CT in the diagnosis of retroperitoneal lymph node metastasis were 75.2%, 60.0%, 81.3% and 0.707, respectively. Univariate analysis showed that 2009 International Federation of Gynecology and Obstetrics (FIGO) stage, tumor diameter >4 cm, lymphovascular space involvement (LVSI) positive, depth of invasion, high squamous cell carcinoma antigen (SCC-Ag) level and cytological grade were important factors for PET/CT in the diagnosis of retroperitoneal lymph node metastasis ( P<0.05); Multivariate analysis showed that tumor diameter >4 cm was an independent risk factor for PET/CT diagnosis of retroperitoneal lymph node metastasis ( P=0.015). Conclusions:PET/CT has a certain diagnostic value in the evaluation of retroperitoneal lymph node metastasis, but it can not fully reflect the facticity of lymph node metastasis; tumor diameter > 4cm is an independent risk factor for PET/CT in the diagnosis of retroperitoneal lymph node metastasis.
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Objective To explore the outcomes of the oncology, the fertility and pregnancy on patients with early-stage cervical cancer after undergoing fertility-sparing treatments, and to investigate its value on clinical treatment. Methods A total of 29 patients with cervical cancer (stage Ⅰa2-Ⅰb1) who had undergone the fertility-sparing treatments in Renji Hospital, School of Medicine, Shanghai Jiaotong University from February 2010 to September 2015 were analyzed retrospectively. Surgical procedures included transvaginal cervical cold knife conization (CKC)+laparoscopic pelvic lymphadenectomy (PLD) or total laparoscopic uterine cervix extensive resection (RT; contains PLD); 48 patients with early cervical cancer under going laparoscopic uterine extensive resection (RH; contains PLD) by the same group of physicians in the same period were chosen as the control group. The perioperative related indicators, postoperative specimen examination, pregnancies after surgery and postoperative tumor follow-up results were retrospectively analyzed and compared between the two groups. Results (1) Among these 29 patients in the study group, 26 cases were underwent the fertility-sparing surgery quick frozen pathological examinations were positive in 3 cases, which underwent total laparoscopic RT eventually. (2) The perioperative related indicators: compared with the study group and the control group, the operation time [(182 ± 21), (147 ± 24) minutes, respectively] has significant difference (t=6.563, P0.05) in intra-operative blood loss [(102±26), (99±34) ml], postoperative aerofluxus time [(1.3±0.4), (1.1±0.9) days], the average length of hospital stay [(11.2 ± 2.1), (10.6 ± 3.5) days], rate of urine retention [10%(3/29), 10%(5/48)] and rate of postoperative infection [3%(1/29), 2%(1/48)]. (3)Postoperative specimen examination:compared with the study group and the control group, there were no significant difference (P>0.05) innumber of removed lymphatic nodes (23.4 ± 4.1, 22.8 ± 3.9), length of cardinal ligament [(2.9 ± 0.5), (3.0 ± 0.6) cm], lengthof uterosacral ligament [(2.6±0.7), (2.8±0.4) cm], length of removed vaginal [(3.4±0.3), (3.5±0.3) cm]. (4) Pregnancies after surgery and postoperative tumor follow-up results:in the study group, only 14 patients had fertility requirement after treatments. Pregnancies occurred in 5 women (5/14), which included1 case of full-term labor, 1 case of preterm labor, and 3 cases of spontaneous abortion. The Average follow-up time in postoperative patients of the study group and control group was 29.4, and 30.2 months respectively. In follow-up period, compare with study group and the control group, there was no significant difference (χ2=0.004, P>0.05) in the recurrence rate [4%(1/26), 4%(2/48)]. Conclusion Fertility-sparing surgery of early-stage cervical cancer is safe but the outcome of the fertility and pregnancy is still need toimprove.
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ObjectiveTo discuss the clinical efficacy of low dose heparins and low molecular weight heparins (LMWHs) in the treatment of severe traumatic disseminated intravascular coagulation (DIC).MethodsA total of 77 trauma patients (APACHE Ⅱ score for 5-10) with secondary DIC in ICU were included and randomly assigned to three groups,ie,Group A (26 patients,subcutaneously injected with LMWHs at doses of 75-150 U · kg-1 · d-1,with the average incipient dose of 4 000 U/d),Group B (25 patients,subcutaneously injected with heparins at doses of 100-250 U · kg-1 · d-1,with the average incipient dose of 5000 U/d and control group (26 patients,supplemented with simple blood coagulation factor).The injection volume was adjusted according to the level of antithrombin Ⅲ ( ATⅢ ) in each group.Within 28 days in ICU,the three groups were compared in aspects of deaths,hospital day,bleeding rate,thrombin time (TT),prothrombin time (PT),activation part thrombin time ( APTT),fibrinogen (Fg),antithrombin Ⅲ ( AT Ⅲ ) and D-dimer.Results ( 1 ) The differences of mortality were both insignificant in the control group comparel with Group A and Group B respectively at day 28 ( P ＜ 0.05 ).(2) The ICU stay of three groups showed significant differences ( P ＜ 0.01 ),with longer stay of Groups A and B than control group ( P ＜ 0.01 ) and longer stay of Group A than Group B ( P ＜ 0.05 ).( 3 ) Except for AT Ⅲ ( P ＜ 0.01 ),other blood coagulation indices showed no significant difference among three groups.(4) The differences of bleeding rate were not significant between Group A and control group (P ＞ 0.05),but significant between Group B and control group (p ＜ 0.05 ).(5) Related factor analysis indicated significant relationship between AT Ⅲ level and bleeding rate (P ＜0.01 ).ConclusionsLow dose heparins and LMWHs are beneficial to controlling traumatic DIC,but the heparin therapy adjusted by the level of AT Ⅲ with marked correlation bleeding rate shows lower bleeding rate as compared with LMWHs.
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OBJECTIVE@#To observe the feasibility and effect of improved standard facial translocation approach in treating anterior-lateral benign tumor in middle cranial fossa base.@*METHOD@#We excised 10 cases of benign tumor originating from pharynx nasals of pterygopalatine fossa and expanding toward the cavernous sinus of middle cranial fossa, infratemporal fossa or pterygo-maxillary space. We ameliorated, facial incision, maxilla disassembled, reestablishment, fixation,maxillary mucosal option and remained lateral wall of nasal cavity to some extent.@*RESULT@#The mean time of following-up was 38 month postoperatively without complications of bleeding, infection and necrosis or prolapse of displacing bones. Nine patients were treated successfully, one died.@*CONCLUSION@#Reforming facial translocation approach in treating anterior-lateral benign tumor in middle cranial fossa base was safe and obtained ideal curative effect in near future.
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Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Cranial Fossa, Middle , Pathology , General Surgery , Craniotomy , Methods , Skull Base Neoplasms , Pathology , General Surgery , Treatment OutcomeABSTRACT
Professor ZHANG Lei is one of the most renowned doctors in traditional Chinese medicine. He is good at treating miscellaneous disease of internal medicine, and summarizes eight clinical therapy from long-term clinical practice, and cleaning turbidity therapy is one of the most characteristic therapy. Cleaning turbidity therapy is founded under today's improvement of living standards and changes of lifestyle where more and more turbidity syndromes are caused. Qianjin Weijing Decoction is used as main prescription and modified according to different zang-fu where turbidity syndromes are located. On account of cleaning turbidity therapy is one of the eliminating pathogens therapy, strengthening healthy qi must be used according to power of healthy qi, especially healthy qi of spleen and stomach.
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Objective To study the effects of exogenous hormones,gibberellin(GA3)and indole-3-acetic acid(IAA),on growth and tanshinones accumulation in the radix of Salvia miltiorrhiza.MethodsThe herb characters and contents of tanshinones(cryptotanshinone,tanshinone Ⅰ,and tanshinone ⅡA)in the radix of S.miltiorrhiza with different hormone treatments were investigated and compared in the combination of trail pot and indoor analysis.Results It promoted aboveground biomass in the radix of S.miltiorrhiza increasing with single GA3.But it inhibited underground biomass increasing.The exogenous addition of low-level and high-level GA3 was benefit for tanshinones accumulation,whereas the middle-level GA3 wasn't.The aboveground and underground biomass in the radix of S.miltiorrhiza increased indistinctively with the increasing of IAA concentration and then decreased.And the IAA solutions also increased plant height and root length indistinctively.in a whole,it was benefit for tanshinones accumulation when applying low-level IAA(0.5 mg/L)singly.With the increasing of IAA concentration,the content of cryptotanshinone increased,but the contents of tanshinone Ⅰ and tanshinone ⅡA decreased.It promoted S.miltiorrhiza radix growth and three tanshinones contents increasing obviously with the combined application of two low-level hormones.Conclusion The applying of GA3 and IAA is benefit for the growth and three tanshinones accumulation in the radix of S.miltiorrhiza.