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Objective To explore the application value of the extra-glissonian pedicle transection approach guided by arantius' ligament in laparoscopic left hemihepatectomy.Methods The retrospective cohort study was conducted.The clinical data of 57 patients who underwent laparoscopic left hemihepatectomy in the First Affiliated Hospital of Fujian Medical University from January 2015 to January 2018 were collected.There were 18 males and 39 females,aged from 29 to 75 years,with an average age of 57 years.Of the 57 patients,22 undergoing the laparoscopic left hemihepatectomy with extra-glissonian pedicle transection approach guided by arantius' ligament and 35 undergoing laparoscopic left hemihepatectomy with regular intra-glissonian pedicle transection approach were allocated into the extra-glissonian transection group and intra-glissonian transection group,respectively.Observation indicators:(1) intraoperative situations and postoperative short-term outcomes;(2) postoperative complications;(3) follow-up.Patients were followed up by outpatient examination and telephone interview to investigate postoperative recurrence of diseases up to June 2018.Measurement data with normal distribution were represented as Mean±SD and comparison between groups was analyzed using the t test.Count data were described as absolute number or percentage and comparison between groups was analyzed using the chi-square test.Results (1) Intraoperative situations and postoperative short-term outcomes:the operation time,dissection time of left hepatic pedicle,volume of intraoperative blood loss were (123± 37) minutes,(14± 5) minutes,(337± 169) mL in the extra-glissonian transection group and (148± 27) minutes,(22± 3) minutes,(495±203) mL in the intra-glissonian transection group,respectively,showing statistically significant differences between the two groups (t =2.992,7.733,3.045,P＜0.05).Cases with intraoperative blood transfusion,time of gastrointestinal recovery,time for postoperative drainage-tube removal,duration of postoperative hospital stay were 1,(1.8±0.9)days,(3.2±0.9)days,(8.2± 1.7)days in the extra-glissonian transection group and 4,(2.0± 0.8)days,(3.6±0.8)days,(10.0±4.0)days in the intra-glissonian transection group,respectively,showing no statistically significant difference between the two groups (x2 =0.171,t=1.304,1.857,1.622,P＞0.05).There was no uncontrolled hemorrhage or air embolism in the two groups.(2) Postoperative complications:3 patients had complications of Clavien-Dindo classification Ⅰ in the extra-glissonian transection group including 1 of pulmonary infection,1 of abdominal infection,1 of incisional infection and 7 had complications in the intraglissonian transection group including 2 of pulmonary infection,2 of liver sectional effusion,1 of subphrenic abscess,1 of biliary leakage,1 of incisional infection,showing no statistically significant difference between the two groups (x2=0.066,P＞0.05).Patients with postoperative complications were cured and discharged after symptomatic treatment.There was no perioperative death in the two groups.(3) Follow-up:57 patients were followed up for 5-41 months,with a median time of 23 months.Two and 1 patients had tumor recurrence and hepatolithiasis recurrence in the intra-glissonian transection group,without recurrence of hepatic hemangioma or cholangiocarcinoma.Five patients had tumor recurrence in the intra-glissonian transection group,without recurrence of hepatic hemangioma,hepatolithiasis or cholangiocarcinoma.The disease recurrence rate was 13.6％ (3/22) and 14.3％(5/35) in the extra-glissonian transection group and intra-glissonian transection group,respectively,showing no statistically significant difference between the two groups (x2 =0.104,P＞0.05).Conclusions Extraglissonian pedicle transection approach guided by arantius' ligament in laparoscopic left hemihepatectomy is feasible and effective,which can control hepatic blood inflow of left liver,simplify the surgery procedure and shorten dissection time of left pedicle,in order to save operation time and reduce volume of intraoperative blood loss.
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Objective To identify the correlation between doctors' job burnout and medical errors.Methods In stage 1,a cross-sectional retrospective survey on doctors' job burnout and medical errors was conducted for 300 doctors serving in the First Affiliated Hospital of Fujian Medical University,who were randomly sampled in June 2013.The survey covered basic demographic information,self-assessed job burnout and medical errors.In stage 2,231 doctors without medical errors in stage 1 were selected for a prospective study focusing on a follow-up on their medical errors within half a year.Results Medical errors were found to influence job burnout of doctors significantly.Multiple logistic regression analysis was made based on the three independent variables of A-emotional exhaustion,B-depersonalization,and C personal sense of accomplishment,and the dependent variables Y1 and Y2 indicating the occurrence or non-occurrence of common medical errors or serious medical errors,respectively.The calculation aims to identify if there is line relationship among the three independent variables.Conclusions This study suggests that all kinds of medical errors influence job burnout;scores of the three dimensions of job burnout may be predictors of occurrence of different medical errors.
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Objective To evaluate the efficacy and safety of endoscopic versus open component separation technique (CST) for abdominal hernia.Methods Systematic review was carried out to identify the controlled clinical studies comparing endoscopic CST with open CST for abdominal hernia.The Meta-analysis was performed with RevMan 5.2 software.Results The selection criteria was met in five studies.A total of 185 patients with abdominal hernia were included.Analysis of the data suggested that there was no significant differences in recurrence rate between endoscopic CST and open CST(P =0.84,risk difference =-0.01,95％ CI-0.12 to 0.10).However,endoscopic CST compared with open CST was associated with a significant reduction of postoperative wound complications (P ＜ 0.000 1,odds ratio =0.19,95％ CI 0.09 to 0.41).And there was no significant differences in operation time,intraoperative blood loss and postoperative hospital stay (all P ＞ 0.05).Conclusions As compared to open CST,endoscopic CST show equivalent clinical effects with similar recurrence rate.However,endoscopic CST was associated with a significant reduction of postoperative wound complications,and there was no significant differences in in operation time,intraoperative blood loss and postoperative hospital stay.
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Objective To Investigate the value of HPV genotyping in diagnosis of cervical intraepithelial neoplasia(CIN).Methods From July 2012 to February 2013,200 women from Tianjin Medical University General Hospital and 244 women from Affiliated Hospital of the Chinese People's Armed Forces Logistics College were selected to be HPV genotyping test and thin liqid-based cytology test.Consequently,132 samples were performed colposcopy test and cervical biopsy.Results HPV prevalence was 26.4％ (117/444) in this study.The infection of one type HPV was more common.The top 5 of HPV types were HPV16,58,33,18,and 52.The top 5 of the risk for CIN Ⅱ and above followed HPV16,33,39,52 and 18.There was no significant difference between age and HPV positive rate (x2 =0.948,P ＞ 0.05).Multiple infection and cervical lesions rank correlation analysis(r =0.132,P ＞0.05).For CIN Ⅱ and above disease,cytology positive rate was 90％ (44/49),and HPV positive rate was 96％ (47/49) cytology combine HPV positive rate was 98％ (48/49,x2 =0.063,P ＞ 0.05).Conclusions HPV infection should increasing trends with age.Cytology test and HPV genotyping test had good consistency.The combination of them can improve the sensitivity for high-grade lesions.
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Objective To analyze the clinical laboratory characteristic of Candida albicans caused antibiotic-associated diarrhea (AAD) .Methods 100 cases of AAD were selected .Based on the results ,they were divided into Candida albicans group and non-Candida albicans group .The levels of sodium ,potassium ,fasting blood-glucose and albumin ,investigation of antimicrobial usage were compared in two groups .Results Candida albicans were detected in 42 cases .The levels of sodium ,potassium and fasting blood-glucose in the Candida albicans group were significantly higher than those in non-Candida albicans group(P<0 .01) ,and al-bumin were significantly lower than that in non-Candida albicans group(P< 0 .01) .The rate of two or more antibiotic usage in Candida albicans group was significantly higher than that in non-Candida albicans group(P<0 .05) .The drug resistance rates of fluconazole ,itraconazole ,voriconazole ,amphotericin B and flucytosine in Candida albicans group were significantly lower than those in non-Candida albicans group(P<0 .05) ,and the antibiotic sensitive rates of fluconazole ,itraconazole ,voriconazole ,amphotericin B and flucytosine in Candida albicans group were significantly higher than those in non-Candida albicans group(P<0 .05) .The drug resistance rates of vancomycin and macrodantin in Candida albicans group were significantly higher than those in non-Candida al-bicans group(P<0 .01) ,and the antibiotic sensitive rates of vancomycin and macrodantin in Candida albicans group were signifi-cantly lower than those in non-Candida albicans group(P<0 .01) .Conclusion For AAD cases ,the fecal culture can provide exper-imental basis for clinical treatment and avoid the abuse of antibiotics .
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Background and purpose: Sorafenib, a multiple targeted agent, can inhibit proliferation and induce apoptosis of diverse tumor cell in vitro. It has extensive biological activities, but the pancreatic cancer effect of monotherapy is poor. This may be related to nuclear factor-kappa B (NF-κB) pathway activation in cancer. Therefore, it is necessary to combine with Pyrrolidinedithiocarbamate (PDTC, a NF-κB activation inhibitor) to enhance curative effect. To investigate the influences of cell proliferation, cell cycle and expression of NF-κB via their acting on human pancreatic cancer PANC-1, and explore their possible mechanism. Methods:The experiment groups were divided into sorafenib group with different concentrations (1.5, 3.0, 6.0, 12.0 μmol/L), PDTC group with different concentrations (10.0, 25.0, 50.0, 100.0 μmol/L) and combination group with low concentration (3.0 μmol/L sorafenib+25.0 μmol/L PDTC). The proliferative activity of PANC-1 of each group was measured by MTT assay at different time points of 24
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EEG Synchronization is considered the conformity of the brain functional areas. Advanced brain function requires many nervous systems with a specific function in relevant brain regions (areas) to achieve integration and coordination at different levels. In this paper, a new method for phase synchronization analysis-Mutually Approximate Entropy is proposed to process different frequency band of EEG signal during audio-visual stimulation and get Similar results with the method of Synchronization Index and Mutual Information Entropy. This showed that the Mutually Approximate Entropy can lead to a good indication of the phase synchronization between two leads. The paper also explored the brain reaction zone by the results of the phase synchronization analysis. The research work lays the foundation for the brain-computer interface design.