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Objective:To investigate the application value of totally laparoscopic trans-abdominal-hiatal approach in the radical resection of Siewert type Ⅱ adenocarcinoma of esophago-gastric junction (AEG).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 45 patients with Siewert type Ⅱ AEG who were admitted to the Affiliated Hangzhou First People′s Hospital, Zhejiang University School of Medicine from May 2017 to December 2020 were collected. There were 28 males and 17 females, aged from 35 to 85 years, with a median age of 64 years. All patients underwent radical resection of AEG by totally laparoscopic trans-abdominal-hiatal approach with gastrointestinal anastomosis using proximal gastrectomy with double-tract anastomosis or total gastrectomy with esophagojejunointestinal anastomosis and digestive reconstruction using transdiaphragmatic-hiatal superior overlap esophagojejunostomy. Observation indicators: (1) surgical and postoperative situations; (2) postoperative histopathological examination; (3) follow-up and survival situations. Follow-up using outpatient examination and telephone interview was performed to detect survival of patients and tumor recurrence and metastasis up to March 2021. Measurement data with normal distribution were presented as Mean± SD and measure-ment data with skewed distribution were presented as M(range). Results:(1) Surgical and post-operative situations: all 45 patients underwent radical resection of AEG by totally laparoscopic transabdominal-hiatal approach successfully, including 35 cases undergoing total gastrectomy with esophagojejunointestinal anastomosis and 10 cases undergoing proximal gastrectomy with double-tract anastomosis. The total operation time, time of lower mediastinal lymph node dissection, time of superior overlap esophagojejunostomy, volume of intraoperative blood loss, time for initial out-of-bed activities, time to first flatus, time to initial liquid diet intake, time to drainage tube removal of the 45 patients were (235±32)minutes, (25±8)minutes, (45±10)minutes, (70±13)mL, (20±8)hours, (2.3±0.2)days, (2.6±0.8)days and (6.2±1.1)days, respectively. Eleven of 45 patients under-went postoperative complications and none of patient died during perioperative period. The post-operative duration of hospital stay of 45 patients was (10±3)days. (2) Postoperative histopatho-logical examination: all 45 patients had negative upper surgical margin. The length of proximal margin, tumor diameter, total number of lymph lodes harvested and number of lower mediastinal lymph nodes harvested were (2.5±0.5)cm, (2.9±0.8)cm, 35.0±4.0 and 2.4±0.8, respectively. Patholo-gical examination showed adenocarcinoma in all 45 patients with pTNM staging as 5 cases of stage ⅠB, 8 cases of stage ⅡA, 21 cases of stage ⅡB and 11 cases of stage ⅢA. (3) Follow-up and survival situations: 45 patients were followed up for 3 to 46 months, with a median follow-up time of 26 months. During follow-up, 8 of 45 patients died. Of the 37 patients survived, 3 cases underwent liver metastasis and 3 cases underwent bone metastasis, lung metastasis or peritoneal metastasis respec-tively.Conclusion:Total laparoscopic transabdominal-hiatal approach is safe and feasible in the treatment of Siewert type II AEG with a satisfactory clinical efficacy.
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Objective To explore the learning curve of the Tianji orthopedic robot in assisting percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCF).Methods A retrospective study was conducted of the consecutive 44 OVCF patients (71 fractured vertebrae) who had been treated with PKP assisted by the Tianji orthopedic robot from May 2018 to March 2019 at Department of Ortbopedics,The First Hospital of China Medical University.They were 2 men and 42 women,aged from 55 to 89 years (average,68.6 years).Their operations were performed by the same surgical team.The patients were divided into 4 even groups (n =11) according to the date of operation.The accuracy of robot-assisted puncture,total operation time,robot operation time,PKP operation time and complications were statistically analyzed and compared between the 4 groups.Natural logarithm regression analysis of total operation time,robot operation time and PKP operation time was conducted to determine the association between operation time and operation number [y =aln(x) + b,x indicating operation number and y operation time].Results The 4 groups were comparable due to insignificant differences in age,gender or operative segment between them (P ＞ 0.05).The total rate of accurate puncture was 95.8％ (68/71).The rates of accurate puncture were 92.9％ (13/14),94.4％ (17/18),94.7％ (18/19) and 100％ (20/20) for groups 1,2,3,and4,respectively,with no significant differences between groups (P ＞ 0.05).The total operation time for the 4 groups was respectively 56.6 ± 6.6 min,46.4 ± 8.5 min,40.2 ± 4.7 min and 40.4 ± 5.7 min and the robot operation time for the 4 groups was respectively 32.1 ±4.9 min,23.8 ±5.1 min,18.9 ±2.7 min and 19.6 ± 5.3 min,showing significant differences between the 4 groups (P ＞ 0.05) and a significant difference between groups 1 and 2 versus groups 3 and 4 (P ＞ 0.05) but no significant difference between group 3 and 4 (P ＞ 0.05).The natural logarithm regression analysis showed that the total operation time [y =-7.2861n(x) + 66.616,R2 =0.4889,P ＜ 0.001] and robot operation time [y =-5.6621n(x) +39.763,R2 =0.5196,P ＜ 0.001] decreased significantly with the increase of operation number but became stable in groups 3 and 4.There was no significant difference in PKP operation time among the 4 groups (P ＞ 0.05).The main intraoperative complication was leakage of bone cement in the anterior vertebral space and intervertebral space,with a total incidence of 8.5％ (6/71),showing no significant difference among the 4 groups (P ＞ 0.05).Conclusions The puncture accuracy of the Tianji orthopedic robot in assisting PKP for OVCF may not change with the increased operation number.The total operation time and robotic operation time decrease with the increased operation number.The learning curve of the Tianji orthopedic robot becomes stable very fast,indicating the surgical technique is easy to learn.
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Inflammatory bowel disease (IBD) is a group of intestinal chronic non-specific inflammatory disease with unknown etiolog~ including ulcerative colitis and Crohn's disease.The risk factors associated with pathogenesis of IBD include environmental factors,genetic factors,and immune factors.Among them,the environmental factors include smoking,drugs,diet,infection and psychological factors.
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Objective To assess the efficacy of whole body diffusion weighted imaging (WB-DWI) in detecting pediatric primary and metastatic malignant tumor. Methods WB-DWI was performed in 62 healthy pediatric volunteers and 40 pediatric patients with confirmed malignant tumors. The healthy volunteers were divided into three groups: 0 to 12 months, more than 12 months to 5 years and more than 5 to 15 years. The characteristics of WB-DWI imaging were analyzed. McNemar test was used to compare the difference of detection on metastasis between WB-DWI and WB-DWI combined with MRI, CT. The mean apparent diffusion coefficient ( ADC ) values of primary tumors and metastases were measured by using paired t test and compared with those of corresponding body regions of control group. Results WB-DWI imaging shows that signal intensity of metaphysis gradually reduces with increasing age in the normal pediatric group. On WB-DWI primary malignant tumors showed 100％ (40/40) high signal intensity and metastases showed high signal intensity in 89.2％ (58/65) on WB-DWI, with a positive predictive value of 90. 6％ (58/64). The detecting rate for metastases increased to 95.4％ (62/65) when WB-DWI was combined with MRL/CT, with a positive predictive value of 95.4％ (62/65) there was no statistically significant difference ( x2 = 2. 25, P ＞ 0. 05 ). The ADC values of primary malignant tumor sites in head ( n = 5), liver(n=6), kidney(n=8), adrenal(n=ll) were (0.76 ±0. 19) ×10-3 , (0. 97 ±0.29) × 10-3,(0. 81 ±0. 12) × 10-3 and (0. 93 ±0. 28) × 10-3mm2/s and those of corresponding body regions of control group were (1.02 ±0. 11) × 10-3,(1.57 ±0.58) × 10-3, (1.19 ±0. 15) × 10-3 and (2.03 ±0.42) ×10-3mm2/s respectively, there were statistically significant difference( t values were 3.54,3. 84,7. 02 and 12. 57 ;P ＜ 0. 05 ). The A DC values of metastases sites in head ( n = 9 ), liver ( n = 13 ), kidney ( n = 17 ),bone(n =7) and lymph node(n =6) were (0. 88 ±0. 12) × 10-3, (0. 98 ±0. 10) × 10-3, (0. 89 ±0. 11 ) × 10-3, (0. 96 ±0. 15) × 10-3 and (0. 83 ±0. 14) × 10-3mm2/s, and those of corresponding body regions of control group were (1.01 ±0.09) × 10-3, (1.45 ±0.39) × 10-3, ( 1.31 ±0.27) × 10-3, ( 1.34 ±0. 20) × 10 -3 and ( 0. 99 ± 0. 08 ) × 10 -3 mm2/s, there were statistically significant difference ( t values 4. 09,45.50,6. 95,14. 00 and 9. 27 ;P ＜ 0. 05 ). Conclusions Increased signal intensity is more frequently observed in metaphysis of long bone in normal children on WB-DWI. With a high detection rate for primary and metastatic malignant tumors, WB-DWI combined with conventional CT; MRI can significantly improve their sensitivity.
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Studies have shown that embryonic stem cells and neural stem ceils could be induced to differentiate into motor neurons by adding inducing factors to the culture to improve differentiation proportion of motor neurons. The development and maturation process of motor neurons in vitro culture is similar to that in embryo, involving participation of Pax6, Nk×6.1, Olig2 and HB9. Moreover, cells with HB9 as separation mark almost differentiate into motor neurons in vitro. In addition, other types of protein marks have been used for identification of motor neuronal induced differentiation, such as neuron mark MAP-2, β-tubulin-Ⅲ, cholinergic cell mark ChAT, VAChT, Schwann cell mitogen REG2, and voltage-dependent calcium ion channel 11.2 subunit. The identification of induced differentiation of motor neurons also involves detection of function of differentiated motor neurons by two methods. One method is to detect the function of in vitro cultured motor neurons, and the other is to detect the function of transplanted motor neurons in vivo. Although induced differentiation of stem cells into motor neurons becomes mature, many issues remain in clinical application, such as cell sources of induced differentiation of motor neuron, efficiency of induced differentiation, purification of differentiated motor neurons, and function of motor neurons.
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Objective To study the influence of pharmacy intravenous admixture servers(PIVAS)on human resource prioritized allocation.Methods We compared the time consumption and efficiency of drug dispensing as well as the human resource allocation before and after the establishment of PIVAS.The influence of PIVAS on the human resource allocation of nursing and pharmacy staff and work efficiency were analyzed.Results Nursing human resource were economized and we realized human resource prioritized allocation after the establishment of PIVAS.Conclusions Establishment of PIVAS facilitated the human resource prioritized allocation of nursing and pharmacy staff.It can promote the development of nursing cause and possesses wide application value.
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Objective To explore the correlative factors of ovulation-failure induced with clomiphene(CC) in polycystic ovary syndrome(PCOS).Methods The relationship between ovulation rate(OR),ovulation cycle rate(OCR) among 178 cases,569 taking medicine cycles and clinical features,endocrine markers were retrospectively analysed.Results OR was 73.0%,OCR was 45.3%,OCR of both the dysfunctional uterine bleeding(DUB) and anovulatory menstruation groups were markedly higher than those of secondary amenorrhea group(P＜0.005，0.05)，OCR of the DUB group was significantly higher than that in oligomenstruation group too(P＜0.05).OR of the nonpilosity and nonobesity groups were markedly higher than that of pilosity and obesity groups respectively(P＜0.01，0.005).OCR of the unmarried group was significantly higher than infertility and fertilized groups(P＜0.025，0.005).OCR of LH/FSH≥3 and serum testosterone(T) level-normal groups were respectively higher than LH/FSH＜3 and serum T level-elevated group(P＜0.05～0.025).There was markedly correlation among LH/FSH radio,T level,BMI and OR,OCR,PRL levels and OR(P＜0.05～0.01).Conclusions The findings suggest that effect of the ovulation induced with CC in PCOS relate to types of menstruation,pilosity,status of marry-fertility,levels of LH/FSH,T,PRL.
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Objective To explore the correlative factors of ovulation-failure induced with clomiphene(CC) in polycystic ovary syndrome(PCOS).Methods The relationship between ovulation rate(OR),ovulation cycle rate(OCR) among 178 cases,569 taking medicine cycles and clinical features,endocrine markers were retrospectively analysed.Results OR was 73.0%,OCR was 45.3%,OCR of both the dysfunctional uterine bleeding(DUB) and anovulatory menstruation groups were markedly higher than those of secondary amenorrhea group(P
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Objective To explore the effect of insulin-like growth factor-1(IGF-1) on the growth of muscle-derived stem cells(MDSCs). Methods MDSCs were isolated from the hindlimb muscle of new born mice through serial preplates.DMEM with 2% fetal bovine serum was used to induce MDSCs to differentiate into skeletal muscle lineage.The expression of stem cell marker Sca-1 or skeletal muscle cell marker ?-sarcomeric actin was examined by immunocytochemistry SP method.MTT colorimetric microassay was conducted to determine the effect of IGF-1 on MDSCs proliferation.The relationship between functioning and culture time and the relationship between functioning and IGF-1 concentration were studied. Results MDSCs were successfully isolated from the hindlimb of neonatal mice.Over 90% of the MDSCs showed Sca-1 positive immunoreactivity.MDSCs could give rise to ?-sarcomeric actin positive myotubes in differentiation cultures.The proliferative effect of IGF-1 on MDSCs increased gradu ally with prolonged culture time.The elevation of IGF-1 concentration also increased the proliferative effect until it came to a saturation point.Conclusion IGF-1 can promote the proliferation of in vitro cultured MDSCs.