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Clinicopathological data of 15 patients with pyloric early cancer and precancerous lesions, who received endoscopic submucosal dissection (ESD) in Zhejiang Cancer Hospital from March 2011 to January 2020 were retrospectively analyzed. Postoperative pathology showed 7 cases of low-grade intraepithelial neoplasia, 3 cases of high-grade intraepithelial neoplasia, and 5 cases of early gastric cancer. R0 complete resection was achieved in all patients. The mean operation time was 55.2 min (35-78 min). One patient had delayed postoperative bleeding, and no other complications such as bleeding, perforation or abdominal pain occurred in other 14 patients. No recurrence, metastasis or pyloric stenosis was found during the follow-up of 31.3 months (1-106 months). ESD is safe and effective for early cancer and precancerous lesions in the pylorus.
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Three-dimensional (3D) printing technique has been improving the industrial process from uniform pipeline production procedure in manufacture into individualized production with distributed network. 3D printing technique also provokes these changes in the field of medicine, especially in orthopedics, stomatology and radiology. The role of 3D printing technique has been increasingly highlighted in tumor radiotherapy. Current studies and application mainly focus on personalized tissue compensato (bolus), brachytherapy (high-dose post-loading and particle implantation therapy), 3D printing personalized phantom and individualized fixtures, etc. In this article, research progresses on the application of 3D printing technique in radiotherapy at home and abroad were reviewed.
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Objective:To explore the safety and efficiency of a novel bipolar electric knife for endoscopic submucosal dissection.Methods:The thermal damage on tissue caused by the new bipolar knife and traditional monopolar knife were compared by finite element analysis. The vertical thermal damage to the porcine gastric wall caused by the two types of electric knife were analyzed in vitro animal experiments. In vivo animal experiments were used to compare operation related indexes of two types of electric knife, including en bloc resection rate and cutting efficiency in porcine digestive tract submucosal dissection. Results:Through overcoming deviation of experimental individuals and operator experience, the finite element model showed that the length, width and depth of thermal damage on tissue caused by the monopolar knife was 1.08 times, 1.12 times, and 1.23 times of that of the bipolar knife, respectively. Additionally, the bipolar knife caused less vertical thermal damage to the porcine gastric wall than the monopolar knife (433.25±42.58 μm VS 898.03±111.59 μm, t=6.740, P=0.003) in vitro animal experiments when charged for 1 s at the same power. Finally, in vivo animal experiments showed that the en bloc resection rates of the two kinds of electric knife systems were both 100.0%. In addition, the cutting area and cutting time of the bipolar knife was 229.58±185.29 mm 2 and 164.37±96.27 s, respectively. The corresponding indicators of the monopolar knife was 209.70±167.35 mm 2 and 162.65±69.97 s, respectively, and there was no significant difference (all P>0.05). Conclusion:The novel bipolar knife not only ensures the cutting efficiency but also reduces the thermal damage during endoscopic submucosal dissection in simulating experiment and animal experiment, which needs further verification in clinical trial.
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Objective:To investigate the levels of urinary arsenic metabolites in arsenic-exposed people with different degrees of skin lesions.Methods:A cluster sampling method was used to select people with different degrees of skin lesions in the drinking water arsenic poisoning area of Bayannaoer City, Inner Mongolia Autonomous Region. According to the "Standard of Diagnosis for Endemic Arsenism" (WS/T 211-2001), the research subjects were divided into four clinical grading: normal, suspicious, mild, moderate and above on the basis of the degrees of skin lesions. Urine samples from any 1 middle section were collected, and the levels of urinary arsenic metabolites of different forms in different clinically graded people were detected by inductively coupled plasma mass spectrometry (ICP-MS).Results:A total of 522 people were included, including 309 males and 213 females; the age was (39.11 ± 12.38) years old, ranging from 11 to 65 years old. There were 337, 80, 31, 74 people in normal, suspicious, mild, moderate and above clinical grading, the levels of inorganic arsenic (iAs, medians: 15.46, 37.16, 104.46, 163.06 μg/L), monomethylarsonic acid (MMA, medians: 15.95, 33.27, 82.80, 123.84 μg/L), dimethylarsenic acid (DMA, medians: 78.16, 147.86, 301.28, 371.30 μg/L), total arsenic (tAs, medians: 113.90, 220.94, 501.25, 684.46 μg/L), iAs percentage (iAs%, medians: 15.66%, 15.53%, 21.67%, 21.65%), MMA percentage (MMA%, medians: 13.51%, 15.40%, 17.14%, 16.43%), DMA percentage (DMA%, medians: 70.37%, 67.98%, 63.25%, 61.23%), monomethylation rate (PMI, medians: 0.84, 0.84, 0.78, 0.78), dimethylation rate (SMI, medians: 0.84, 0.81, 0.79, 0.79), and ratio of MMA to DMA (MMA/DMA, medians: 0.20, 0.23, 0.27, 0.27) were compared in different clinically graded people, the differences were statistically significant ( H = 97.98, 96.44, 85.50, 95.08, 38.58, 29.94, 51.98, 38.58, 43.20, 43.20, P < 0.01). Compared with normal people, iAs, MMA, DMA, tAs, MMA%, and MMA/DMA levels significantly increased, and SMI level significantly decreased in suspicious, mild, moderate and above people ( P < 0.017); compared with normal people, iAs% level significantly increased, and DMA% and PMI levels significantly decreased in mild, moderate and above people ( P < 0.017). Conclusion:The levels of urinary arsenic metabolites in arsenic-exposed people with different degrees of skin lesions are different, showing a dose-response relationship.
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Objective To apply 3D printing technology to fabricate patient-specific silicone tissue compensators for the chest wall and compare the advantages and clinical characteristics between conventional bolus and 3D-printed PLA materials. Methods The chest wall data of two breast cancer patients undergoing mastectomy were obtained based upon the CT images. A patient-specific 3D printing silicone rubber bolus (3D-SRB) was designed and fabricated. The conformability of 3D-SRB,3D-PLA and conventional bolus to the chest wall were validated. Ecipse8. 6 planning system was adopted to statistically compare the dosimetric parameters of virtual plan with those after using three tissue compensators. Results The 3D-SRB was successfully designed and fabricated with a similar hardness to conventional bolus. During the process of validating conformability and radiotherapy planning,3D-SRB and 3D-PLA were superior to conventional bolus in terms of conformability to chest wall and planning dosimetric distribution.3D-SRB was advantageous in repeatability, conformability and comfortable experience compared with 3D-PLA. Regarding dosimetric parameters,3D-SRB yielded the highest repeatability with the virtual plan, followed by 3D-PLA and conventional bolus. Conclusion It is applicable to utilize 3D-SRB as the patient-specific compensators for the chest wall,which is of significance in clinical practice.
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Objective To investigate the arsenic methylation level of people chronically exposed to different levels of arsenic in drinking water.Methods A cluster sampling method was used to select 874 cases that had drank different concentration arsenic-contaminated water from arsenic endemic area in Bayannaoer City.They were divided into four groups according to arsenic exposure level:control (≤ 10 μg/L),low (＞ 10-50 μg/L),medium (＞ 50-200 μg/L) and high groups (＞ 200 μg/L),146,155,224,349 cases,respectively.The content of arsenic in drinking water and the arsenic species in urine were analyzed by inductively coupled plasma mass spectrometry (ICPMSS) and the results were expressed as median.Results The inorganic arsenic (iAs),monomethylarsonic acid (MMA),dimethylarsinic acid (DMA),and total-arsenic (tAs) in urine of low,medium and high groups increased following increasing of arsenic exposure level (x2 =605.08,609.96,615.83,628.64,all P ＜ 0.017) and iAs％,MMA％ and MMA/DMA significantly increased following increasing of arsenic exposure level (x2 =112.30,56.60,86.47,all P ＜ 0.017).DMA％,PMI and SMI significantly decreased following increasing of arsenic exposure level (x2 =125.80,112.30,86.47,all P ＜ 0.017).In the four groups,iAs％ of female were 11.39％,12.28％,13.47％ and 17.58％,they were significantly lower than those of male's (15.52％,16.19％,17.45％,21.86％,Z =-4.22,-3.79,-4.60,-6.71,all P ＜ 0.05);and DMA％ were 76.95％,74.05％,72.76％,and 68.64％ in the four groups respectively,and the PMI of female were 0.89,0.88,0.87,and 0.82,both DMA％ and PMI were significantly higher than those of male in each group (71.17％,69.39％,67.36％,61.29％,0.84,0.84,0.83,0.78,Z =-4.00,-3.34,-5.50,-7.24,-4.22,-3.79,-4.60,-6.71,all P ＜ 0.05).In control group,arsenic metabolites levels of people were not significantly different in the three age groups (all P ＞ 0.05).Compared to the ≤30 age group,the MMA,DMA and tAs of 31-45 age group increased and DMA,DMA％,PMI of ≥46 age group increased while iAs％ decreased in high group (μg/L:72.71 vs 109.13,307.90 vs 419.50,505.59 vs 684.60,307.90 vs 418.26;64.31％ vs 68.45％,0.79 vs 0.83,20.71％ vs 17.35％,x2 =10.72,10.24,8.20,10.24,9.89,20.96,20.96,all P ＜ 0.017).Compared to the 31-45 age group,DMA％ and PMI of ≥46 age group increased while iAs％ decreased (64.91％ vs 68.45％,0.80 vs 0.83,20.14％ vs 17.35％,x2 =9.89,20.96,20.96,all P ＜ 0.017).Conclusion There is a significant dose response relationship between arsenic metabolites and arsenic exposure level,and arsenic methylation is related to gender and age.
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OBJECTIVE:To investigate the situation of drug use in CHD inpatients,and to provide reference for relevant decision-making.METHODS:Medical records of CHD patients were collected by medical insurance system from 8 medical institutions of Mianyang area during Jan.2014-Dec.2016.Each 200 medical records were collected from each medical institution and then analyzed statistically by EXCEL 2007,ACCESS 2007,SPSS 19.0 software in respects of patient's gender and age,drug amount,drug type,drug combination.RESULTS:A total of 1 600 patients were included,involving 983 male and 707 female with average age of (73.9 + 10.2) years old.Drug cost ratio was 35.2％ of total hospitalization cost;CHD treatment drugs accounted for 72.4％ of the total drug cost.Among adjuvant therapy drugs,the cost of Chinese patent medicines and 4 chemical medicines containing TCM extracted component which could improve circulation accounted for 37.8％ of cardiovascular drug cost.Among main therapy drugs,the utilization rate of lipid-modulating drugs was 80.8％,and that of ACEI and ARB was 46.9％.The patients receiving antiplatelet drug combined with PPI accounted for 54.9％ of the patients receiving antiplatelet drug.Fourteen patients were treated with short-acting Nifedipine tablets.Forty-two patients were treated with clopidogrel and omeprazole.CONCLUSIONS:The utilization of adjuvant therapy drugs such as L-camitine show high cost ratio.ACEI or ARB,lipid-lowering drugs take up low proportion in CHD patients.The use of short-acting Calcium channel blocker (CCB) and dipyridamole are unreasonable.The indication control of PPIs is lax and the abuse of Chinese patent medicine is obvious.
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Objective To study the relationship between hair selenium content and arsenism among population from endemic arsenism area caused by coal combustion in the southern of Shaanxi Province.Methods Four high-arsenic-exposed villages in southern Shaanxi Province were selected as the study area,and the nonarsenic-exposed villages nearby were selected as the control area,90 hair samples of residents exposed to high arsenic in the study area and 14 hair samples of residents in the control area were collected.Inductively Coupled Plasma Mass Spectrometry (ICP-MS) was used to determine the contents of arsenic and selenium in hair samples.Selenium/hair arsenic (Se/As) value was calculated,and the relationship between selenium content in hair samples and arsenicosis was analyzed.Results The geometric mean of selenium concentration in hair from the study area was 8.72 mg/kg,which was significandy higher than that from the control area (0.54 mg/kg,t =9.811,P ＜ 0.05).However,selenosis case was not found in the study area.Selenium content in hair was not obviously correlated with arsenism (r =0.075,P ＞ 0.05),while the Se/As value was negatively associated with the grade of arsenism (P ＞ 0.05).The geometric mean of selenium content in hair of female from the study area was 12.79 mg/kg,which was higher than that in hair of male (6.5 mg/kg,t =1.738,P ＜ 0.01).Meanwhile,the Se/As value in hair of female from the study area (1.15) was significantly higher than that in hair of male (0.65,t =3.218,P ＜ 0.05).Conclusions The environment of the study area is polluted by arsenic and selenium derived from stone-coal burning.Antagonism between arsenic and selenium might reduce the toxicity of selenium.Therefore,selenosis is not found in the study area.In addition,antagonism between arsenic and selenium might also induce lower prevalence of arsenism for female in the studly area.
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Objective To compare the similarities and differences between the esophageal mucosa lesion pathology before and after endoscopic submucosal dissection (ESD).Methods A total of 110 patients diagnosed as having esophageal mucosal lesions by endoscopic biopsy were treated with ESD at Zhejiang cancer hospital from 2013 to 2014.The results of preoperative and postoperative pathology were compared.Results The consistency rate of preoperative biopsy and postoperative pathologic diagnosis was 61.8％ (68/110).Compared with preoperative pathology,the postoperative pathological results underestimated accounted for 30％ (33/110),the postoperative pathological results overestimated accounted for 8.2％ (9/110).In early esophageal cancer group,consistency rate of preoperative biopsy and postoperative pathologic diagnosis was 75.0％ (18/24),which was higher than that of intraepithelial neoplasia group[58.1％ (50/86)] with significant difference (P ＜ 0.05).Conclusion Preoperative biopsy is not necessarily consistent with postoperative pathology.Though preoperative pathological diagnosis has certain value,it can not completely represent the nature of the lesions.The patients with intraepithelial neoplasia should be actively treated with ESD combined with clinical experiences to get the accurate diagnosis.
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Objective To investigate the differences of measurement of gross target volume (GTV)between endoscopic ultrasonography ( EUS )-based ( GTVEUS ) and computed tomography ( CT ) -based (GTVCT) method for thoracic esophageal squamous cell carcinoma. Methods EUS was performed on 36consecutive patients with thoracic squamous cell carcinoma, and the superior and inferior boarders of the tumor defined by EUS were marked with hemoclips. The CT planning scan was then performed with the patient in supine position, and the GTVCT and GTVEUS were contoured respectively. The lengths ( LCT and LEUS) and spatial locations of longitudinal GTVCT and GTVEUS were compared. Results The mean LCT and LEUS were (7. 79 ± 3. 15 ) cm and (7. 42 ± 2. 72) cm, respectively ( t = 0. 82, P ＞ 0. 05 ), with a correlation coefficient of 0. 61 (P ＜0. 001 ). Locations of longitudinal GTVCT and GTVEUS were compared in 34cases, with 2 excluded for invisualization on CT. The mean conformal index (CI) was (0. 79 ± 0. 18 ), and spatial variations were found in 71% patients, with 8 patients at proximal end and 21 others at distal end.There was no clip placement associated complication. Conclusion Endoscopic hemoclips placement is safe and reliable. EUS can provide additional information to CT in defining longitudinal GTV in thoracic esophageal squamous cell carcinoma, especially in superficial and submucosal carcinomas.
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OBJECTIVE:To provide information for carrying out pharmaceutical care for future emergency relief work. METHODS: Based on our own experiences,the pharmaceutical care-related work involved in the medical relief in "May?12" Wenchuan earthquake was investigated and analyzed summarily. RESULTS: Scientific emergency plan could create order for the busy relief work,and creative work could make up the deficiency of the plan. It is advisable to attach great importance to the role of the clinical pharmacists in the earthquake relief work. Good command and powerful measures contribute to the smooth proceeding of emergency medical rescue. CONCLUSION: The pharmaceutical care plays an important role in the emergency medical rescue.
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OBJECTIVE:To study the bacteria strains and susceptible drugs in open wound in patients with earthquake injury. METHODS:Bacteriological test and the drug susceptibility test were conducted for earthquake injury patients with open wound and the results of bacterial culture and the drug susceptibility test were analyzed using Excel 2003. RESULTS:Of the 1 172 earthquake injury cases,the patients with trauma / wounds represented 93.9%,the wound had obvious infection in 132 cases; of the infected cases,the proportions of patients with open fractures,soft tissue injuries and traumatic brain injury accounted for 63%,28% and 9%,respectively. The positive rate of the bacterial culture was 69%,and gram-negative of bacteria which accounted for 85.6% took the lead,chiefly Acinetobacter baumanii,Enterobacter cloacae and Escherichia coli. The results showed bacterial drug resistance was on the high side. CONCLUSION:The open wounds in patients with earthquake injury are likely to be infected with gram negative organisms. Debridement and correct choice of anti-infective drugs are needed to reduce the risk of wound infection,
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OBJECTIVE:To establish a RP-HPLC method for the determination of the concentration of moxifloxacin in human serum.METHODS:The separation of sample was performed on Gemini C18 column with a fixed sample injection volume of 20?L.The mobile phase was methanol-water-triethylamine(112.5∶208.9∶0.06) at a flow rate of 1mL?min-1.The UV detective wavelength was set at 289nm;the column temperature was 25℃ and the sensitivity was 0.01AUFS.RESULTS:In the range of 0.312 5～10?g?mL-1(r=0.999 8),moxifloxacin showed a good linear relation in HPLC.The recoveries of moxifloxacin at three concentrations(10,2.5,0.625?g?mL-1) were 99.46%,103.12%,and 96.14%,respectively,with intra-day RSD at 3.27%,3.35%,0.92%,respectively and inter-day RSD at 7.19%,6.25%,6.68%,respectively.CONCLUSION:This method is simple,rapid,accurate and sensitive,and it can be used for the concentration determination and the pharmacokinetic study of moxifloxacin.
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OBJECTIVE:To establish the method for the determination of total alkaloid in cultivated BulBus Fritillariae Cirrhosae. METHODS:Spectrophotography was used to determine the content of total alkaloids with kashmirine as control,bromocresol green as colored indicator at detection wavelength of 416 nm. RESULTS:The linear range of kashmirine were 4.5～14.5 ?g?mL-1 (r=0.999 6) with an average recovery of 98.76%(RSD=2.5%,n=6).CONCLUSION:The method is simple,accurate and relia-ble for the quality control of cultivated BulBus Fritillariae Cirrhosae.
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OBJECTIVE:To study the feature of fungus infection and the drug susceptibility for the fungus in our hospital.METHODS:Fungi were cultured and isolated by routine procedure and identified by VITEK microbe automatic system.Drug susceptibility test was performed using Rosco paper disk diffusion and broth dilution method with NCCLS M27-A.RESULTS:519 strains of fungi were all Blastocystis,with Monilia albicans making up 70.3%.Mycostatin showed the highest susceptibility,followed by amphotericin B.Fluconazol and itraconazole showed poor susceptibility.CONCLUSION:The resistant strains to common antifungal drugs experienced an obvious increase in clinical practice;therefore,it is imperative to monitor the drug susceptibility of fungi.