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@#Objective To explore the feasibility of 5G remote robot-assisted pulmonary lobectomy through animal experiments. Methods In this research, the Toumai® surgical robot was manipulated remotely by the surgeon in the Control Center of the MedBot Company through the 5G network established by China Telecom, and the experimental pig underwent lobectomy in simulated operating room. Results The animal experiment surgery was successfully completed. The surgeon remotely manipulated the surgical robot to complete the lobectomy of right apical lobe and mediastinal lymph node dissection. The entire animal experiment took about 60 minutes, with an average round-trip network delay of 125 (110-155) ms, and no network interruption or robot malfunction occurred. Conclusion This animal experiment is the first attempt of 5G remote thoracic surgery, which preliminarily proves the feasibility of completing remote lobectomy through the Toumai® surgical robot 5G wireless network connection. The systematic surgical procedure is summarized, which lays a foundation for the subsequent experiments and clinical applications of 5G remote robot-assisted thoracic surgery.
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Objective:To investigate the risk factors for postoperative early recurrence of patients with single large hepatocellular carcinoma (HCC) (tumor diameter≥5cm).Methods:Clinical data of 135 single large HCC patients who underwent radical resection from Jan 2015 to Sep 2020 in Ningbo Medical Centre Lihuili Hospital were analyzed.Results:Seventy-five HCC patients suffered recurrence,among those 42 patients had early recurrence(within 12 months). Multivariate analysis showed that alpha-fetoprotein (AFP)≥400 ng/ml ( OR=3.510,95% CI: 1.528-8.064; P=0.003) and tumor microvascular invasion (MVI) ( OR=2.769,95% CI: 1.143-6.706; P=0.024) were independent risk factors for early recurrence of single large hepatocellular carcinoma. Survival analysis showed that early recurrence risk factors significantly reduced recurrence free survival (RFS)(AFP≥400 ng/ml, χ 2=23.038, P<0.001; MVI positive , χ 2=10.554, P=0.001) and overall survival (OS) (AFP≥400 ng/ml, χ 2=14.336, P<0.001; MVI positive, χ 2=10.481, P=0.001) in single large hepatocellular carcinoma patients. Conclusion:AFP≥400 ng/ml and MVI positive are independent risk factors for postoperative early recurrence in single large hepatocellular carcinoma patients.
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Objective:To analyse the risk factors of biliary leakage after surgical resection in patients with perihilar cholangiocarcinoma (PHCC).Methods:The medical data on 179 patients who underwent surgical resection for PHCC at the Department of Hepatopancreatobiliary Surgery, Ningbo Medical Centre Lihuili Hospital, Ningbo University from April 2000 to April 2020 were collected, and 160 patients were finally enrolled into this study. There were 86 males and 74 females, aged (63.4±10.8) years. The 44 patients with class B biliary leakage and the 5 patients with class C biliary leakage were classified into the biliary leakage group, while the remaining 111 patients were classified into the control group. Risk factors of biliary leakage were analysed by univariate and multivariate logistic regression analyses.Results:Operation time ≥360 min, resection and reconstruction of hepatic hilar vessels on the preserved side of liver and number of bile duct openings of >3 in remnant liver were significantly higher in the biliary leakage than the control group (all P<0.05). Multivariate analysis showed that resection and reconstruction of hepatic hilar vessels on the preserved side ( OR=2.322, 95% CI: 1.078-5.002, P=0.028) and 3 or more bile duct openings in the remnant liver ( OR=2.656, 95% CI: 1.198-5.892, P=0.016) were significantly associated with biliary leakage. Conclusion:Resection and reconstruction of hepatic hilar vessels on the preserved side of liver and 3 or more bile duct openings in remnant liver were independent risk factors for biliary leakage after PHCC resection.
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@#Objective To analyze the efficacy and safety of Toumai® endoscopic surgery robot in right upper lobe resection. Methods The clinical data of 2 patients with non-small cell lung cancer who received right upper lobe resection with Toumai® endoscopic surgery robot in Shanghai Chest Hospital, Shanghai Jiao Tong University in November 2021 were retrospectively analyzed. Both patients were male, aged 66 years and 44 years, respectively. Results The operation was successful in both patients with no conversion to thoracotomy, surgical complication or death. The operation time was 65 min and 48 min, and the amount of intraoperative bleeding was 80 mL and 50 mL, respectively. The postoperative hospital stay was 3 days. There was no blood transfusion during the perioperative period. Conclusion The application of Toumai® endoscopic surgery robot in lobectomy is preliminarily proved to be safe and effective. Compared with Da Vinci robotic surgery system, it has similar clear 3D vision and flexible and stable operation, which can become one of the important choices for the new generation of minimally invasive chest surgery.
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Objective:To explore the feasibility of technological modification and innovation of full-left/full-right liver splitting in situ for donors and examine the safety of clinical application for liver transplantation (LT).Methods:From March 2021 to June 2022, clinical and surgical data are retrospectively reviewed for 27 donors undergoing full-left/full-right liver splitting in situ and the corresponding 49 recipients undergoing full-left/full-right LT.According to the split liver technique used in donor liver surgery, they are divided into conventional split group(group A, 13 cases)and innovative split group(group B, 14 cases). The corresponding recipients are divided into two groups of recipient C(25 cases)and recipient D(24 cases). General profiles, intraoperative findings, type of vascular allocation and short-term outcomes in two groups are compared.After full-size split liver transplantation(fSLT), follow-ups continued until the end of September 2022.Results:There are 23 males and 4 females in donors.The causes of mortality for donors are traumatic head injury(12 cases)cerebrovascular accident(13 cases)and anoxia encephalopathy(2 cases). Baseline characteristics of two groups indicate that body weight and body mass index(BMI)are higher in group B and blood sodium level is lower than that in group A( P<0.05). No statistical differences exist for the others.Liver splitting time is significantly shorter in group B than that in group A(175 vs.230 min, P=0.022). No significant inter-group difference exists in type of vascular allocation.Retrohepatic inferior vena cava(IVC)is split in one case in group A and 10 cases in group B( P=0.001). Among 20 cases of right hemiliver requiring a reconstruction of segment Ⅴ/Ⅷ venous outflow, 12 cases in group A and 3 cases in group B are reconstructed with conventional independent bridging method(independent type)while another 5 cases in group B reconstruct with innovated technique by bridging Ⅴ/Ⅷ vein for splitting IVC with iliac vessel and molding all outflows as one for anastomosis(combined typ e). There is significant inter-group difference( P=0.004). No significant differences exist in operative duration, anhepatic phase or blood loss between groups C and B, except for T tube retaining in 7 cases of group A and 14 cases of group D( P=0.032). Twelve cases developed a total of 26 instances of≥Clavien-Dindo grade Ⅲ complications.Of which, 7 cases in group C and 5 cases in group D show no significant difference in postoperative morbidity.However, for serious biliary complications(≥Clavien Dindo grade Ⅲ), there are 6 cases in group C versus none in group D( P=0.016). Two cases died from postoperative complication with a postoperative mortality rate of 4.1%.Postoperative hospital stay is similar in two groups.And accumulates 6/12-month survivals were 95.9% and 87.7% for grafts and 95.9% and 92.4% for recipients respectively. Conclusions:Operative duration of full-left/full-right liver splitting in situ tends to shorten with an accumulation of a certain amount of cases.Technological modification and innovation in IVC splitting and segment Ⅴ/Ⅷ vein reconstruction should be further validated as both feasible and safe by short-term outcomes of the corresponding recipients.
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Objective:To evaluate clinical and pathological factors related to the actual 5-year survival of patients with hilar cholangiocarcinoma (HCC).Methods:A total of 94 HCC patients who underwent radical surgery at the Department of Hepatobiliary and Pancreatic Surgery, Li Huili Hospital of Ningbo Medical Center from Jan 2000 to Jun 2015 were enrolled in this study.Patients were divided into two groups: postoperative survival group beyond 5 years and death group within 5 years. The clinical and pathological features of the two groups were analyzed.Results:Of the 94 patients, 19 (20.2%) had a postoperative survival time of more than 5 years. The actual 5-year overall survival rate of HCC patients (20.2%) was lower than that estimated by Kaplan-Meier survival analysis (22.2%). Gender, age, CEA value, CA199 value, total bilirubin, Child-Pugh classification, Bismuth classification and preoperative jaundice reduction were not significantly different between the two groups nor there were significant difference between two groups in operation time, blood loss, surgical procedure, combined caudate lobectomy, combined pancreaticoduodenectomy, combined resection of surrounding organs, vascular reconstruction and number of bile duct orifices in remnant liver surface. There were significant differences between two groups in the variables of pathological phenotype ( P=0.012), lymph node metastasis ( P=0.001) and resection level ( P=0.048). Conclusion:Non-papillary type, lymph node metastasis and R 1 resection are the independent risk factors of the actual 5-year survival.
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OBJECTIVE： To systematically evaluate therapeutic efficacy of Zinc preparation for radiation-induced oral mucositis （ROM） in head and neck cancers， and to provide evidence-based reference for clinical treatment. METHODS： Retrieved from PubMed， Medline， Embase， the Cochrane library， CJFD，VIP and Wanfang database， RCTs about additional use of Zinc preparation （trial group） in adjunctive treatment of ROM in head and neck cancers base on routine treatment or blank control （control group） were collected during database establishment to Dec. 2018. After data extraction and quality evaluation with Cochrane system evaluator manual 5.1.0， Meta-analysis was carried out for the incidence of ROM within 2 weeks after medication， total incidence of ROM and the incidence of serve ROM by using Rev Man 5.3 statistical software. RESULTS： A total of 8 RCTs were included， involving 550 patients. Results of Meta-analysis showed that there was no statistical significance in the incidence of ROM within 2 weeks [OR＝0.55， 95％CI（0.26，1.17）， P＝0.12]， total incidence of ROM [OR＝0.59， 95％CI（0.08，4.39）， P＝0.60] or the incidence of serve ROM [OR＝0.58， 95％CI（0.23，1.47）， P＝0.25] between 2 group. CONCLUSIONS： Based on routine therapy or blank control， additional use of Zinc preparation can not reduce the incidence and control the development of ROM in head and neck cancers.
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Background and purpose:Aberrant expressions of microRNAs (miRNA, miR)are reported in various cancers and may associate with cancer occurrence, development, invasion and metastasis, thereby functioning as either tumor suppressors or oncogenes. This study attempted to observe the expression of miR-214 in pancreatic cancer and to explore its clinical signiifcance.Methods:Real-time PCR was used to detect the miR-214 expressions between pancreatic cancer tissues and matched adjacent tissues. The correlations of miR-214 expression with clinic-pathological features and clinical prognosis were analyzed.Results:MiR-214 expression was up-regulated in 69.4%(25/36) of tumor tissue specimens. The relative expression level of miR-214 was signiifcantly higher in tumor tissues than in matched adjacent tissues (3.45vs 1.52,P<0.01). Higher miR-214 level was strongly associated with T3-T4 stage (P=0.018). The Kaplan-Meier analysis revealed that patients with higher expression of miR-214 had a shorter survival time (P=0.032).Conclusion:The expression of miR-214 is associated with clinic-pathological features and patient’s clinical prognosis, so it may be used as a potential diagnostic biomarker and a prognostic predictor in patients with pancreatic cancer.
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Objective To obtain the concentrations and daily intakes of 15 rare earth elements in foods for adult men in four areas in China.Methods With duplicate portion study,120 mixed diet samples were collected from adult men in cities of Tianjin,Chengdu,Zhenjiang and Taiyuan,which belong to 4 areas with different dietary types in China.The concentrations of cerium,dysprosium,erbium,gadolinium,lanthanum,lutetium,holmium,neodymium,praseodymium,scandium,samarium,terbium,thulium,yttrium and ytterbium in these samples were determined by Inductively Coupled Plasma Mass Spectrometry(ICP-MS) after pretreatment,and the daily intakes of them were also calculated.Results The concentrations of 15 rare earth elements and their daily intakes in foods for adult men were obtained.Conclusions The concentrations of these elements in each area are consistent with normal distribution.The total rare earth element concentration in the diet of adult men ranges from 24.68 to 109.27 μg/g.The daily intake of total rare earth elements is about 24 μg/d.Reference values of the rare earth element concentrations in the diet and daily intake of Chinese adult men were updated.
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Ketosis-prone diabetes is most commonly seen in type 1 diabetic patients. Long-term of glycemic control not depending on insulin is one of the characteristics of type 2 diabetes.Patients with both of the manifestations may form a new group other than type 1 or type 2 diabetes mellitus.
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Objective To study the association of single nucleotide polymorphism (SNP) of the protein tyrosine phosphatase-1B (PTP-1B) gene with type 2 diabetes mellitus and obesity in Chinese. Methods SNPs in the PTP-1B gene were detected by direct sequencing to PCR products, and the detected SNPs were genotyped in case-spouse samples with the technique of fluorescence real-time PCR. Results Totally 6 SNPs were found in PTP-1B gene. Three SNPs (I5/37 C→A,I6/82 A→G, I7/301 C→T) were in the intron regions and the other 3 (E8/45 C→T, E9/35 G→A, E10/372 G→A)in the exon regions. Among them, E9/35 G→A was a newly found mutation site. The A allele frequency of I5/37 C→A, T allele frequency of I7/301 C→T and G allele frequency of I6/82 A→G in type 2 diabetes were significantly higher than those in the normal spouse group (P
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The relationships of therapeutic regime, glycemic control and quality of life with depression were observed in 193 type 2 diabetic patients. The results showed that 46.6% of the diabetic patients manifested depression in various degrees; the depression status was correlated with age or duration of diabetes; the patients under insulin treatment showed more marked depression than the other patients (P
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The cardiovascular system is closely associated with sex hormones. The risk factors of the cadiovascular diseases or related events, such as lipid metabolism, coagulatory function and vascular endothelium function are affected by sex hormones and their analogues by a number of pathways. Consensus is generaly reached about hormone replacement therapy (HRT) among menopausal women except the effects on cardiovascular system, which removined to be controversial. It is recommended that women should consult their doctors for their individulized administration of HRT.