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@#Objective To compare the clinical effects of segmentectomy and lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections. Methods The patients with adenocarcinoma who received segmentectomy or lobectomy in multicenter from June 2020 to March 2021 were included. They were divided into two groups according to a random number table, including a segmentectomy group (n=119, 44 males and 75 females with an average age of 56.6±8.9 years) and a lobectomy group (n=115, 43 males and 72 females with an average of 56.2±9.5 years). The clinical data of the patients were analyzed. Results There was no significant difference in the baseline data between the two groups (P>0.05). No perioperative death was found. There was no statistical difference in the operation time (111.2±30.0 min vs. 107.3±34.3 min), blood loss (54.2±83.5 mL vs. 40.0±16.4 mL), drainage duration (2.8±0.6 d vs. 2.6±0.6 d), hospital stay time (3.9±2.3 d vs. 3.7±1.1 d) or pathology staging (P>0.05) between the two groups. The postoperative pulmonary function analysis revealed that the mean decreased values of forced vital capacity and forced expiratory volume in one second percent predicted in the segmentectomy group were significantly better than those in the lobectomy group (0.2±0.3 L vs. 0.4±0.3 L, P=0.005; 0.3%±8.1% vs. 2.9%±7.4%, P=0.041). Conclusion Segmentectomy is effective in protecting lungs function, which is expected to improve life quality of patients.
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Diabetic retinopathy (DR) is a common and important ocular complication of diabetes and has become one of the leading blindness diseases in China.Hydrogen sulfide is the third gas signaling molecule found after carbon monoxide and nitric oxide.Numerous studies have shown that hydrogen sulfide plays an important physiopathologic role in the nervous system, circulatory system, immune system and endocrine system.Recent studies have shown that hydrogen sulfide and its endogenous enzymes are involved in the pathological process of diabetes and diabetic complications.At present, the protective effect of hydrogen sulfide in the development and progression of DR has been verified by some cell experiments and animal experiments.The protective effect of hydrogen sulfide may be realized through inhibiting apoptosis, reducing oxidative stress and inflammation, inhibiting autophagy and neuroprotection.The role of hydrogen sulfide in the pathogenesis of DR was reviewed in this article so as to provide new ideas for the treatment of DR.
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Intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs is the main treatment for diabetic macular edema (DME), however, 30% of patients still respond poorly to its treatment. At present, imaging markers that can indicate the prognosis of anti-VEGF drug treatment include ischemic index, deep retinal capillary plexus foveal avascular zone area, number of microaneurysms, blood flow density, disorder of the inner retinal layer, outer membrane and/or the degree of damage to the ellipsoid zone, strong reflex foci, intraretinal cysts, subretinal fluid. Biomarkers include high-sensitivity C-reactive protein, neutrophil to lymphocyte ratio, anti-fumarase antibody, intraocular aqueous humor cell adhesion molecule-1, interleukin (IL)-6, IL-8, etc. Understanding these clinical markers that may predict and evaluate the prognosis of anti-VEGF drug therapy can be beneficial to adjust the treatment plan, and more effectively monitor, treat, and manage DME patients.
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Objective:To investigate the application value of hybrid approach in laparoscopic radical resection of left hemicolon cancer.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 96 patients with left hemicolon cancer who were admitted to Henan Provincial People′s Hospital between January 2015 and March 2018 were collected. There were 52 males and 44 females, aged from 29 to 75 years, with an average age of 61 years. Patients underwent laparoscopic radical resection of left hemicolon cancer. Observation indicators: (1) surgical situations and postoperative recovery; (2) postoperative pathological examination; (3) postoperative chemotherapy; (4) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival, tumor recurrence and metastasis of patients up to October 2019. Measurement data with skewed distribution were represented as M (range), and count data were described as absolute numbers. Results:(1) Surgical situations and postoperative recovery: all the 96 patients underwent laparoscopic radical resection of left hemicolon cancer with hybrid approach. Of 96 patients, 5 underwent laparoscopic multiple organ resection including 2 combined with splenectomy, 2 combined with gastric wall wedge resection, 1 combined with splenectomy and distal pancreatectomy; 7 underwent hand-assisted laparoscopic surgery including 5 undergoing multiple organ resection due to tumor invasion, 2 combined with terminal ileostomy due to poor exposure caused by severe obstruction in proximal intestinal canal; 84 underwent laparoscopic-assisted surgery. There was no intraoperative conversion to laparotomy. Of 96 patients, 3 received posterior ileum anastomosis, 2 received rotating ascending colon anastomosis, 91 received in situ anastomosis. Operation time, volume of intraoperative blood loss, and time to first flatus were 140 minutes (range, 70-250 minutes), 50 mL (range, 30-140 mL), 2 days (range, 1-4 days), respectively. Of 96 patients, 5 had postoperative incision infection, 5 had pulmonary infection, 3 had adhesive intestinal obstruction, 1 had anastomotic leakage, and they were cured after conservative treatment. Duration of postoperative hospital stay of the 96 patients was 8 days(range, 5-27 days). (2) Postoperative pathological examination: of the 96 patients, the number of lymph nodes dissected and length of surgical specimen were 19 (range, 13-25) and 35 cm (range, 25-50 cm). All the 96 patients had negative surgical margin. Pathological T staging of 96 patients: 5 patients were in pT1 stage, 46 in pT2 stage, 37 in pT3 stage, 8 in pT4 stage. Pathological N staging of 96 patients: 32 patients were in pN0 stage, 47 in pN1 stage, 17 in pN2 stage. Pathological types of 96 patients: 7 patients had mucinous adenocarcinoma, 16 had poorly differentiated adenocarcinoma, 46 had moderately differentiated adenocarcinoma, and 27 had well differentiated adenocarcinoma. (3) Postoperative chemotherapy: 68 of the 96 patients underwent standard chemotherapy of XELOX regimen, and 28 had no chemotherapy. (4) Follw-up: 86 patients were followed up for 19-58 months, with a median time of 11 months. During the follow-up, all the 86 patients survived, of which 82 had no tumor recurrence, 3 survived with tumor after detection of liver metastasis, and 1 survived with tumor after detection of liver and pulmonary metastasis.Conclusion:The hybrid approach is safe and feasible in the laparoscopic radical resection of left hemicolon cancer.
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Objective To evaluate the clinical curative effect and prognosis of hand-assisted laparoscopic (HALS) and laparoscopic assisted surgery for Siewert Ⅱ,Ⅲ gastroesophageal junction adenocarcinoma (AEG).Methods A retrospective analysis of 105 patients with advanced Siewert type Ⅱ and Ⅲ AEG between Jan 2012 and Jan 2013 was made on the operation time,amount of blood loss,number of lymph nodes dissected,postoperative complications,postoperative hospital stay and postoperative 5-year survival rate.Results HALS resulted in significantly shorter operation time and the average postoperative hospital stay [(203±54) min比(283±72) min,t=-4.902,P=0;(10±4) d 比(13±3)d,t=-0.939,P =0.002] for advanced Siewert type Ⅱ and Ⅲ AEG.There was no conversion to open surgery in HALS group,while there was 3 cases in laparoscopy assisted surgery group (x2 =4.118,P =0.042).5 year overall survival (OS) in HALS group was 46.7％ (95％ CI39.98-53.88),and it was 60.9％ for stage Ⅱ patients 37.8％ for stage Ⅲ.5 years OS rate was not significantly different between the two groups.Conclusion HALS compared with laparoscopy assisted surgery in the treatment of advanced Siewert type Ⅱ and type Ⅲ AEG has shorter operation time,higher safety operation,shorter postoperative recovery time.The number of patients with postoperative complications and the 5-year survival rate after surgery are not significantly different between the two groups.
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Diabetic macular ischemia (DMI) is one of the manifestation of diabetic retinopathy (DR).It could be associated with diabetic macular edema (DME),which may affect the vision of DR patients.FFA is the gold standard for the diagnosis of DMI,but with the advent of OCT angiography,a more convenient and diversified method for the evaluation of DMI has been developed,which makes more and more researchers start to study DMI.Intravitreal injection of anti-VEGF has become the preferred treatment for DME.When treating with DME patients,ophthalmologists usually avoid DMI patients.But if intravitreal anti-VEGF should be the contradiction of DME is still unclear.To provide references to the research,this article summarized the risk factors,assessment methods and influence of DMI.This article also analyzed the existing studies,aiming to offer evidences to a more reasonable and effective treatment decision for DME individual.
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Objective To compare effect between thyroid imaging reporting and data system (TI-RADS) and the Bethesda system for reporting thyroid cytopathology (TBSRTC) in the qualitative diagnosis of thyroid nodule. Methods The clinical data of 665 patients with thyroid nodule (1 598 nodules) from April 2013 to October 2016 were retrospectively analyzed. TBSRTC and TI-RADS were used for qualitative diagnosis of thyroid nodule before operation. Pathological diagnosis was performed after the operation. The diagnostic effect of TI-RADS and TBSRTC were assessed, and the factors leading to the diagnostic errors were analyzed. Results Of 1 598 thyroid nodules, the pathological diagnosis showed that benign nodules were in 202, and malignant thyroid nodules were in 1 396. The diagnostic sensitivity and 85.64%(173/202) vs. 74.75%(151/202) and specificity of malignant nodules by TBSRTC were significantly higher than that by TI-RADS: 91.76% (1 281/1 396) vs. 87.11% (1 216/1 396), and there was statistical difference (P＜0.01). The diagnosis positive rate of malignant nodules with diameter＜1 cm by TBSRTC was significantly higher than that by TI-RADS: 77.63% (59/76) vs. 47.37% (36/76), and there was statistical difference (P＜0.01); there was no statistical difference in diagnosis positive rate of malignant nodules with diameter ≥ 1 cm between 2 methods (P＞0.05). Univariate analysis result showed that the diameter of thyroid nodules in patients with TI-RADS false negative was significantly smaller than that in patients with benign thyroid nodules: (1.01 ± 0.48) cm vs. (1.51 ± 0.45) cm, the incidence of malignant thyroid nodules combined with other thyroid diseases was significantly higher than that in patients with benign thyroid nodules: 41.18% (21/51) vs. 11.32% (158/1 396), and there were statistical differences (P＜0.05); the rate of thyroid dysfunction in patients with TBSRTC false positive was significantly higher than that in patients with malignant thyroid nodules: 18.26% (21/115) vs. 6.93% (14/202), and there was statistical difference (P＜0.05). Conclusions The qualitative diagnosis of thyroid nodule requires the cross-reference of TI-RADS and TBSRTC, and the combination of other clinical indicators of patients can improve the detection rate of malignant thyroid nodules.
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Objective To investigate the feasibility and safety of hand assisted laparoscopic total gastrectomy with D2 lymphadenectomy for advanced cardiac cancer compared with open surgery.Methods 174 patients suffering cardiac,upper,middle or whole gastric cancer operated in our department from October 2013 to October 2014 were divided into open surgery group and laparoscopic group.Perioperative parameters were compared between the two groups.Results Patients in loparoscopic group were associated with significantly less operative blood loss [(110 ± 17) ml vs.(345 ± 95) ml,t =4.95,P =0.011],and shorter postoperative hospital stay [(8.7 ± 0.6) d vs.(14.3 ± 2.1) d,t =0.26,P =0.031],but longer operative time [(295 ± 37) min vs.(215 ± 23) min,t =3.78,P =0.004],compared with that of open surgery.There was no significant difference in the numbers of lymph node dissection between the two groups.Esophagus resection length in open group was (4.0 ± 1.2) cm,and that was (4.1 ±1.0)cm in laparoscopic group (t =0.95,P =0.147).Two patients in open group had positive margins and underwent thoracoabdominal resection.There was no difference in major complications between the two groups.Conclusion Hand assisted laparoscopic total gastrectomy for advanced cardiac carcinoma is a safe,feasible,and oncologically sound procedure compared to open procedure.
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Objective To evaluate the feasibility and safety of hand assisted laparoscopic total gastrectomy for gastric cancer by two different operative approaches.Methods 191 patients of proximal or gastric corpus cancer operated at our department from Jan 2015 to Dec 2017 were divided into two groups:by outer omental bursa approach group (OBA) and through inner omental bursa approach group (IBA).Operative time,estimated blood loss,number of lymph node retrieval,times of analgesic injection,time to the first flatus and postoperative hospital stay were compared between the two groups.Results Estimated blood loss,times of analgesic injection,time to the first flatus and postoperative hospital stay were not statistically different between the two groups.The operative time was significantly shorter in the IBA than the OBA.There were no significant differences in tumor size,retrieved lymph nodes,AJCC/UICC staging and resection margins between the two groups.Conclusion Hand assisted laparoscopic total gastrectomy by the outer omental bursa approach is technically feasible and safe,and allows for adequate lymphadenectomy.
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Objective To explore the effect of minimally invasive pedicle screw fixation for the treatment of thoracolumbar spine fracture.Methods Totally 80 patients with thoracolumbar spinal fracture accepted pedicle screw internal fixation in our hospital from January 2012 to December 2015 were selected as the observation object.According to the operation mode,they were equally divided into minimally invasive surgery group and open surgery group.The operation effect,quality of life and the incidence of complications of the two groups were compared.Results The operation time of the two groups had no significant difference.The amount of blood loss and postoperative drainage volume in minimally invasive surgery group were less than those in open surgery group(P ＜ 0.05).The anterior and posterior Cobb's angles of the two groups had no significant difference.The anterior and posterior Cobb's angles of the two groups both decreased 3 months after operation,and it decreased more significantly in the minimally invasive surgery group compared with the open surgery group with statistically significant difference(P ＜0.05).The VAS and ODI scores between the two groups had no significant difference before operation.And the scores of the two groups all decreased 3 months after operation,but the reduction in the minimally invasive surgery group was more significant (P ＜ 0.05).The incidence rate of complications of the two groups had no significant difference (P ＞ 0.05).The quality of life of the two groups had no difference before surgery,and it increased 3 months after the operation both in the two groups,and the minimally invasive surgery group increased more significantly (P ＜ 0.05).Conclusion The minimally invasive pedicle screw internal fixation for thoracolumbar spine fracture has a better therapeutic effect,which can significantly improve the patients clinical symptoms,signs,and their quality of life.
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Objective To observe the expressions of Slug, BRAF V600E and STIP1 proteins in papillary thyroid carcinoma (PTC), and to explore their correlation with capsular invasion and regional lymph node metastasis. Methods Slug, BRAF V600E and STIP1 expressions in 107 cases of differentiated PTC were examined by immunohistochemical staining. The expressions of three proteins and clinicopathological data were statistically analyzed. Results Positive rates of Slug, BRAF V600E and STIP1 in PTC were 65.4 % (70/107), 61.7 % (66/107) and 66.4 % (71/107), respectively, and overexpression of Slug, BRAF V600E and STIP1 was significantly associated with capsular invasion and regional lymph node metastasis in PTC (P< 0.05). There are a significant correlation between expression of Slug and BRAF V600E in PTC (r= 0.235, P< 0.05). Conclusion Overexpression of Slug, BRAF V600E and STIP1 proteins is associated with capsular invasion and regional lymph node metastasis in PTC, which maybe useful for predicting regional lymph node metastasis and prognostic evaluation.
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Diabetic retinopathy (DR) is one of the microvascular complications of diabetes mellitus (DM).Like other macrovascular complications of DM,the development and progression of DR is influenced by a variety of systemic and local factors.It is essential to understand the importance of multidisciplinary collaboration.Systemic risk fators such as hyperglycemia,hypertension,dyslipidemia and diabetic nephropathy should be treated before effective DR management can be implemented.Through multidisciplinary collaboration,we can prevent the development of DR,slow the progression of DR,and improve the safety of perioperative care.Thereby enhancing the level of prevention and control of DM complications,including DR.
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Primary intraocular lymphoma (PIOL) is mostly composed by diffuse large B-cell lymphoma with a high degree of malignancy and often masquerades as uveitis.Moreover,it has a poor prognosis,therefore the early diagnosis and treatment are very important.Cytology,cytokine analysis,immunohistochemistry and genetic testing are often used in combination to improve the diagnosis rate of PIOL,however,eye tissue biopsy is the gold standard for diagnosis of PIOL.Currently,since there is no unified treatment program,the main treatment is given priority to local chemotherapy and orbital radiotherapy,and the use of multiple therapies can improve the efficacy of refractory PIOL.Base on these,this article reviews the current diagnosis and treatment for providing certain reference.
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[Summary] The cytomorphological features of 17 cases of confirmed MTC were analyzed. cytomorphological features were moderate to marked cellularity, isolated cells alternate with clusters in variable proportions, plasmacytoid, polygonal, round, and(or) spindle-shaped cells, mild to moderate pleomorphism, finely or salt and pepper-like chromatin, frequent binucleation/ multinuleation, rare bizarre giant cells may be seen, nuclear pseudoinclusions are occasionally noted, unremarkable nucleoli, cytoplasm is granular and variable. Amyloid is often present. MTC could be adequately diagnosed by FNA, According to the clinical characteristics and cellblock immunochemical staining can be helpful in diagnosis of MTC.
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Objective To explore the clinical significance of Slug expression in papillary thyroid carci-noma(PTC). Methods Employed Ventana immunohistochemistry assay to determine the expression of Slug in 107 cases of PTC and para-tumorous normal tissue. The relationship with Slug expression in PTC and clinico-pathology data were also analyzed. Results Expression of Slug in PTC (65.4%, 70/107)and para-tumorous nor-mal tissue (14.0%,15/107)were statistically different (P < 0.001). Overexpression of Slug in PTC was signifi-cantly associated with capsular invasion and lymph node metastasis (P < 0.05). Conclusion Overexpression of Slug in PTC is associated with capsular invasion and lymph node metastasis , these may suggest some clinical significance of Slug expression in PTC in predicting lymph node metastasis and prognosis.
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Objective To evaluate hand-assisted laparoscopic distal gastrectomy for the treatment of advanced gastric cancer.Methods From Oct 2013 to Oct 2014, 77 advanced gastric carcinoma patients underwent hand-assisted laparoscopic total gastrectomy with regional lymph node dissection.Results The overage operating time was (295 ± 3) min and the amount of blood loss was (110 ± 17)ml.Postoperative oral feeding began at (3.6 ± 0.4) d.Postop hospital stay was (8.7 ± 0.6) d.The average dissected lymph node was (49.2 ± 1.3).Postopatrative complications developed and cured conservatively in 11 cases.After 4-16 mos follow-up no local recurrence nor metastasis was found.Conclusions Hand-assisted laparoscopic D2 total gastrectomy for advanced gastric cancer is both technically feasible and safe.
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With the rapid development of medical and health sciences,the pressure on the new skills learning for health professionals has also increased.Advanced training has become important opportunity for the career development of the health professionals.This study takes a third—grade class —A hospital to conduct a case study,using the questionnaire to collect information and analyzed the factors that might affect the pressure for advanced training.This paper also discussed how to improve the quality of advanced training by reduce the pressure of the medical staff from the view point of hospital and individuals.
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In the current situation,how to adapt to the new medical reform and determine its development goal has become the primary concern of the managers of No.1 Affiliated Hospital of Hebei North University.The internal and external conditions were analyzed by the method of SWOT and the advantages,disadvantages,opportunities and challenges facing the hospital were also observed.Finally,a series of countermeasures were put forward in accordance with the strategies by SWOT.
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Proliferative vitreoretinopathy (PVR)is a serious causing-blindness disease.It is intimately associated with retinal detachment (RD),proliferative diabetic retinopathy (PDR)and penetrating ocular injury with the complicated course and aggravating outcome.Proteomics is a science about investigating the total proteins in cellular level or organism level.The study of proteomics is helpful for reinforcing the cognition and understanding of pathogenesis and development of PVR.So proteomics study about PVR is becoming a new topic.The study progress in the mechanism of PVR,the study background and technique of proteomics,the application of proteomics study in PVR and relative ocular diseases mentioned above are reviewed in this paper.
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OBJECTIVE@#To explore the clinical characteristics of infectious mononucleosis (IM) in adults.@*METHOD@#Medical records of 50 adult IM patients admitted in hospital were analyzed retrospectively.@*RESULT@#Diagnosis delayed group contained 16 patients (32% of total patients) and was significantly different from the diagnosis in-time group in typical symptoms, signs and laboratory findings of IM.@*CONCLUSION@#The clinical manifestations of adult IM are rather complicated and nonspecific to diagnosis. History collection and physical examination in detail are helpful for early diagnosis.