Effect of intercostal nerve block on postoperative analgesia and outcome of fast track surgery after thoracoscopic surgery: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective     To compare the pain relief and rehabilitation effect of intercostal nerve block and conventional postoperative analgesia in patients undergoing thoracoscopic surgery. Methods     China National Repository, Wanfang Database, VIP, China Biomedical Literature Database, Web of Science, Clinicaltrials.gov, Cochrane Library, EMbase and PubMed were searched from establishment of each database to 10 Febraray, 2022. Relevant randomized controlled trials (RCTs) of intercostal nerve block in thoracoscopic surgery were collected, and meta-analysis was conducted after data extraction and quality evaluation of the studies meeting the inclusion criteria. Results     A total of 21 RCTs and one semi-randomized study were identified, including 1 542 patients. Performance bias was the main bias risk. Intercostal nerve block had a significant effect on postoperative analgesia in patients undergoing thoracoscopic surgery. The visual analogue scale (VAS) score at 12 h after surgery (MD=–1.45, 95%CI –1.88 to –1.02, P<0.000 01), VAS score at 24 h after surgery (MD=–1.28, 95%CI –1.67 to –0.89, P<0.000 01), and VAS score at 48 h after surgery  significantly decreased (MD=–0.90, 95%CI –1.22 to –0.58, P<0.000 01). In exercise or cough state, VAS score at 24 h after surgery (MD=–2.40, 95%CI –2.66 to –2.14, P<0.000 01) and at 48 h after surgery decreased significantly (MD=–1.89, 95%CI –2.09 to –1.69, P<0.000 01). In the intercostal nerve block group, the number of compression of the intravenous analgesic automatic pump on the second day after surgery significantly reduced (SMD=–0.78, 95%CI –1.29 to –0.27, P=0.003). In addition to the analgesic pump, the amount of additional opioids significantly reduced (SMD=–2.05, 95%CI –3.65 to –0.45, P=0.01). Postoperative patient-controlled intravenous analgesia was reduced (SMD=–3.23, 95%CI –6.44 to –0.01, P=0.05). Patient satisfaction was significantly improved (RR=1.31, 95%CI 1.17 to 1.46, P<0.01). Chest tube indwelling time was significantly shortened (SMD=–0.64, 95%CI –0.84 to –0.45, P<0.001). The incidence of analgesia-related adverse reactions was significantly reduced (RR=0.43, 95%CI 0.33 to 0.56, P<0.000 01). Postoperative complications were significantly reduced (RR=0.28, 95%CI 0.18 to 0.44, P<0.000 01). Two studies showed that the length of hospital stay was significantly shortened in the intercostal nerve block group, which was statistically different (P≤0.05), and there was no statistical difference in one report. Conclusion     The relief of acute postoperative pain and pain in the movement state is more prominent after intercostal nerve block. Intercostal nerve block is relatively safe and conforms to the concept of enhanced recovery after surgery, which can be extensively utilized in clinical practice.

Value of perfusion parameters and histogram analysis of triphasic computed tomography in pre-operative prediction of histological grade of hepatocellular carcinoma / 中华医学杂志(英文版)

BACKGROUND@#Pre-operative non-invasive histological evaluation of hepatocellular carcinoma (HCC) remains a challenge. Tumor perfusion is significantly associated with the development and aggressiveness of HCC. The purpose of the study was to evaluate the clinical value of quantitative liver perfusion parameters and corresponding histogram parameters derived from traditional triphasic enhanced computed tomography (CT) scans in predicting histological grade of HCC.@*METHODS@#Totally, 52 patients with HCC were enrolled in this retrospective study and underwent triple-phase enhanced CT imaging. The blood perfusion parameters were derived from triple-phase CT scans. The relationship of liver perfusion parameters and corresponding histogram parameters with the histological grade of HCC was analyzed. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal ability of the parameters to predict the tumor histological grade.@*RESULTS@#The variance of arterial enhancement fraction (AEF) was significantly higher in HCCs without poorly differentiated components (NP-HCCs) than in HCCs with poorly differentiated components (P-HCCs). The difference in hepatic blood flow (HF) between total tumor and total liver flow (ΔHF = HFtumor - HFliver) and relative flow (rHF = ΔHF/HFliver) were significantly higher in NP-HCCs than in P-HCCs. The difference in portal vein blood supply perfusion (PVP) between tumor and liver tissue (ΔPVP) and the ΔPVP/liver PVP ratio (rPVP) were significantly higher in patients with NP-HCCs than in patients with P-HCCs. The area under ROC (AUC) of ΔPVP and rPVP were both 0.697 with a high sensitivity of 84.2% and specificity of only 56.2%. The ΔHF and rHF had a higher specificity of 87.5% with an AUC of 0.681 and 0.673, respectively. The combination of rHF and rPVP showed the highest AUC of 0.732 with a sensitivity of 57.9% and specificity of 93.8%. The combined parameter of ΔHF and rPVP, rHF and rPVP had the highest positive predictive value of 0.903, and that of rPVP and ΔPVP had the highest negative predictive value of 0.781.@*CONCLUSION@#Liver perfusion parameters and corresponding histogram parameters (including ΔHF, rHF, ΔPVP, rPVP, and AEFvariance) in patients with HCC derived from traditional triphasic CT scans may be helpful to non-invasively and pre-operatively predict the degree of the differentiation of HCC.

Video essentials of minimally invasive McKeown esophagectomy with systematic lymph node dissection / 中国胸心血管外科临床杂志

@#（正）食管癌位于我国恶性肿瘤发病率第 5 位及死亡率第 4 位，每年大约有 10 万新增病例，占全球50% 以上。食管癌病因复杂，发病隐匿，目前公认的治疗方案是以手术为主、放化疗为辅的综合治疗。而传统开胸手术治疗创伤大，并发症多，恢复时间长，预后较差。经过多年的不断探索与发展以及腔镜技术的日益成熟，以三野清扫为目的的胸腹腔镜联合食管癌切除已成为一种趋势，其在切除范围、淋巴结清扫程度、切口疼痛程度、快速康复以及预后等方面较传统术式有明显优势，同时并发症发生率并未增加[1]。本视频旨在展示胸腹腔镜食管癌切除术的手术入路、操作要点及术后情况。

Impact of anterior cervical decompression and fusion on the upper cervical spine: A comparative study between single-, double- and multi-level surgery / 中华骨科杂志

Objective:To explore sagittal parameters change of upper cervical spine after anterior cervical decompression and fusion (ACDF) and analyze the influential factors by comparison between single-, double- and multi-level surgery.Methods:In this retrospective study, 126 patients (include 60 patients with radiculopathy, 41 patients with myelopathy and 25 patients with myeloradiculopathy) who underwent ACDF between December 2016 and December 2018, were followed up at least 1year ranged from14 to 38 months, with the average of 25.6±7.2 months. 20 patients were operated by single-level ACDF, 45 patients were operated by double-level ACDF and 61 patients were operated by 3- or 4-level ACDF. Standing radiographs of cervical spine and the flexion and extension cervical X-rays were obtained in all patients at 1week before, 3 months after and 1year after operation. The Japanese Orthopaedic Association (JOA) Scores, visual analogue scale (VAS) and neck disability index (NDI) were used to evaluate the clinical effectiveness. Cervical sagittal parameters were assessed with the following parameters: the platform angle of axis (C2Slope), the cobb angle and the range of motion (ROM) of C2-7, C0-1 and C1-2.Results:All the patients obtained satisfactory clinical effects. The mean operative time of single-, double- and multi-level group were 86.4±15.5 min, 117.6±15.6 min and 170.2±28.7 min, respectively. The intraoperative blood loss of 3 groups were 16.5±5.2 ml, 37.2±30.5 ml and 63.4±41.5 ml, respectively. There was statistically significant difference between the 3 groups ( P<0.05). In the single- and double-level groups, the changes of the cobb angle and ROM of upper cervical spine between 1 week before operation and 1 year after operation was no significant difference ( P>0.05). In the multi-level group, the ROM of atlantooccipital joint (C0-1) increased significantly from 11.5°±6.1° before operation to 16.1°±13.9° 3 months and 15.3°±4.8° 1 year after operation ( P<0.05). The cobb angle of upper cervical spine and C2Slpoe was decreased significantly from 21.0°±7.6°, 6.1°±6.7° before operation to 18.6°±7.7°, 4.3°±6.9° 3 months and 19.7°±7.2°, 5.6°±6.3° 1 year after operation respectively ( P<0.05). However, there was no significant difference of cobb angle ofatlantooccipital joint between 1 week before operation and 1 year after operation ( P>0.05). Conclusion:Single- and double-level surgery makes a better ability of preserving the restoration of cervical lordosis, with little impact on the upper cervical spine, meanwhile multi-level fusion shows a negative influence on the restoration and limits the range of motion, also increases risk of surgical operation and degeneration of the atlantooccipital joint, with the increased stress distribution and range of motion.

A retrospective analysis of factors related to diarrhea during early enteral nutrition in critically ill patients: a multicenter cross-sectional investigation and analysis / 中国中西医结合急救杂志

Objective To explore the related factors of diarrhea onset in critically ill patients during early enteral nutrition (EEN). Methods Thirty Zhejiang Provincial Emergency Intensive Care Units (EICU) and ICU to implement EEN support for critically ill patients from July 2016 to August were enrolled, and the incidence of diarrhea within 1 week after EEN administration was observed. The patients were divided into a diarrhea group and a non-diarrhea group according to whether diarrhea occurred or not during EEN. The basic status data [sex, age, body mass index (BMI), albumin, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), nutritional risk screening (NRS2002), major disease diagnosis], and EN status (feeding route, infusion method, EN type, amount of EN on days 4 and 7), and clinical treatment (applying following treatments or not: mechanical ventilation and its duration, vasoactive drugs, gastrointestinal motility drugs, probiotics) and clinical outcomes (survival after discharge or not) were collected in two groups. Multivariate Logistic regression analysis was performed on the indexes with statistically significant differences obtained from the univariate analysis to screen out the relevant risk factors of occurrence of diarrhea in critically ill patients during EEN administration. The receiver operating characteristic curve (ROC) was drawn to analyze the predictive value of each risk factor for occurrence of diarrhea in critically ill patients with EN therapy. Results Of the 510 critically ill patients who underwent EEN, 156 had diarrhea, 70.5% (110/156) had diarrhea within 4 days of EEN, most diarrhea lasts for 3 days and most frequency of diarrhea was 3-4 times a day. The univariate analysis showed that the age of patients in the diarrhea group was significantly higher than that in the non-diarrhea group (years:69.42±17.94 vs. 65.76±17.69), the mechanical ventilation time and ICU hospitalization time were significantly longer than those of non-diarrhea group [mechanical ventilation time (days): 8 (5, 14) vs. 8 (4, 9), ICU hospitalization time (days): 11.5 (8.0, 19.0) vs. 9.0 (6.0, 14.0)], the proportion of probiotics used and the proportion of feeding by nasal tube were significantly higher than those of non-diarrhea group [proportion of probiotics: 26.9% (42/156) vs. 14.4% (51/354), proportion of nasal tube feeding: [26.9% (42/156) vs. 14.4% (51/354)]. Multivariate Logistic regression analysis showed that the use of probiotics was a protective factor for diarrhea during EEN in critically ill patients [odds ratio (OR) = 0.447, 95% confidence interval (95%CI) = 0.273-0.730, P = 0.001]. ROC analysis showed that the area under the curve (AUC) of probiotics predicting diarrhea was 0.598 (95%CI = 0.554-0.640), P < 0.001, sensitivity was 35.9%, and because AUC was less than 0.7, the accuracy and sensitivity of predicting diarrhea with probiotics was considered to be relatively poor. Conclusion The incidence of diarrhea is high in EEN in critical illness patients and its occurrence is related to various factors. The addition of probiotics can reduce the incidence of diarrhea.

Micro-implanted-anchorage safety: cortical bone thickness in the maxillary posterior region of skeletal class II malocclusion / Seguridad en el micro-implante de anclaje: espesor del hueso cortical en la región posterior del maxilar en maloclusión de clase esquelética tipo II

Cone Beam Computed Tomography (CBCT) measurement of cortical bone thickness and implantation angle in the maxillary posterior region was used to provide reference for the safety of Micro-Implanted-Anchorage (MIA) implantation in skeletal class II malocclusion. Twenty samples of CBCT images were collected from orthodontics patients (ages, 12-40 years) in Shanxi Medical University Stomatological Hospital, the thickness of cortical bone was measured at 45°, 60° and 90° from the alveolar crest, being at 4 mm, 6 mm and 8 mm, respectively. SPSS17.0 statistical software was used to analyze the data, and the one-way ANOVA and LSD method were compared. There was a significant difference in the thickness of the cortical bone obtained by implanting MIA at the same height of different angle (P≤0.05). The greater the inclination angle of the implanted MIA, the thicker the cortical bone. Also, the higher the implant site, the thicker the cortical bone thickness. Finally, the greater the thickness of the cortical bone in the maxillary posterior region of skeletal class II malocclusion, the greater the thickness of the cortical bone. At the same implantation height, implanted MIA with a tilt angle of 45º to 60º, 90º to obtain the best cortical bone thickness.

La medición del grosor del hueso cortical y del ángulo de implantación en la región posterior del maxilar por tomografía computarizada de haz cónico (TCHC) se utilizó para proporcionar una referencia para la implantación y el anclaje seguros de un Micro-Implante de Anclaje (MIA) en la maloclusión de clase esquelética tipo II. Veinte muestras de imágenes de TCHC fueron obtenidas de pacientes de ortodoncia (12-40 años) en el Hospital Estomatológico de la Universidad Médica de Shanxi. Se midió el grosor del hueso cortical a 45°, 60° y 90° de la cresta alveolar, encontrándose a 4 mm, 6 mm y 8 mm, respectivamente. Se utilizó el software estadístico SPSS 17.0 para analizar los datos, y se compararon con los métodos ANOVA y LSD de un factor. Hubo una diferencia significativa en el grosor del hueso cortical obtenido al implantar el MIA a la misma altura en diferentes ángulos (P <0,05). Cuanto mayor es el ángulo de inclinación del MIA implantado, más grueso es el hueso cortical. También, cuanto más alto es el sitio del implante, más grueso es el grosor del hueso cortical. Finalmente, cuanto mayor sea el grosor del hueso cortical en la región posterior del maxilar, en la maloclusión de clase esquelética tipo II, mayor será el grosor del hueso cortical.

Morphological changes of skeletal class III malocclusion in mixed dentition with protraction combined activities / Cambios morfológicos en maloclusión de la clase esquelética III en dentición mixta con actividades combinadas de protracción

The objective of the study was to investigate the morphological changes of skeletal class III malocclusion in mixed dentition with light force protraction combined activities. Randomly selected 30 cases of orthodontics in Shanxi Medical University orthodontics patients (ages: 6-10 years) of the lateral cephalograms. Using the oral maxillary casting type of pre-traction device, according to the condition of maxillary dentition to select the corresponding activities of the movable expansion appliance, each side of the force of about 150-200 g, requiring patients to wear 10-12 hours a day, the appliance should be removed after reaching normal occlusion. The correlation cephalometric profile of the cranial lateral radiographs before and after orthodontic treatment was measured. All patients with skeletal class III malocclusion were improved, concave type became direct type, measurements SNA, ANB, A-Ptm, MP-SN, ANS-Me/N-Me increased, maxillary advancement and reconstruction are more obvious; mandible rotates clockwise; the increase of lip inclination of anterior teeth compensatory changes, lower anterior tooth inclination changes smaller; upper lip forward, nasolabial angle decreased, improved appearance significantly. Light force protraction combined activities can make the mixed dentition of skeletal class III malocclusion in patients with significant improvement in profile appearance.

El objetivo de este estudio fue investigar los cambios morfológicos de la maloclusión clase esquelética III, en la dentición mixta, con actividades combinadas de protracción de la fuerza ligera. Se seleccionaron aleatoriamente 30 casos de ortodoncia en pacientes de ortodoncia de la Universidad Médica de Shanxi (edades: 6-10 años) a partir de cefalogramas laterales, utilizando el tipo de dispositivo de pretracción de vaciado maxilar oral, de acuerdo con la condición de la dentición maxilar para seleccionar las actividades correspondientes del dispositivo de expansión móvil, cada lado con fuerza de alrededor de 150-200 g, requiriendo que los pacientes los utilizaran de 10 a 12 horas al día. El dispositivo debía ser retirado después de alcanzar la oclusión normal. Se midió el perfil cefalométrico de correlación de las radiografías laterales craneales, antes y después del tratamiento ortodóncico. Se observó mejoramiento en todos los pacientes con maloclusión de clase esquelética. Las mediciones SNA, ANB, APtm, MP-SN, ANS-Me / N-Me aumentaron, el avance y la reconstrucción maxilar fueron los cambios más significativos; la mandíbula giró en el sentido de las agujas del reloj, se observó un aumento de la inclinación labial de los dientes anteriores. Fue reducida la inclinación anterior del diente inferior, el ángulo nasolabial disminuyó y en general mejoró significativamente la apariencia. Las actividades combinadas de protrusión de la fuerza radiante pueden llevar a una mejora signficativa en el perfil de pacientes con dentición mixta de maloclusión clase III.

Study on the morphology of micro-implant-bone interface cells and bone histomorphology under different implantation / Estudio sobre la morfología de las células de la interfaz microscópica implante-hueso y la histomorfología ósea bajo diferentes implantaciones

SUMMARY: Micro-implant stability has always been the focus of orthodontic clinical research.In the experiment, the morphological changes of bone tissue around the micro-implants in self-tapping and assisting implantation were investigated to explore the effect of different implantation on the osseointegration of micro-implants in order to provide some theoretical basis for clinical practice. Six adult male Beagle dogs were selected,three implants were implanted into the left and right maxillary bone of Beagle dogs at the 0th, 4th and 6th week, respectively. One side to self-tapping implantation, the opposite side to assisting implantation. At the 8th week of the experiment, the animals were sacrificed and the micro-implant-bone tissue specimens with the healing time of 8w, 4w and 2w were obtained.The specimens were stained with Toluidine Blue (TB) and photographed under 100X, 200X microscope. Morphology of microimplant- bone interface cells was observed under light microscope. In self-tapping group, there were some fibrous tissues surrounding the micro-implants at the 2th week, the formation of osteoblasts and osteoid was observed at the 4th week, the wavy and lamellar bone tissues were seen at the 8th week.In assisting group,more collagen fibers were deposited around the micro-implant at the 2th week, there were a large number of osteoid-like cells, and the collagen was gradually replaced by the bone tissue at the 4th week, the osteoblasts were active and the osteoblasts were linear arrange and form a laminate bone at the 8th week.Whether implanted self-tapping or assisted implantation, micro-implant-bone interface reconstruction can occur. If the clinical need for early loading force, micro-implant try to choose selftapping implantation. By appropriately prolonging the healing time, the initial stability of the micro-implant under assistive implantation can be improved.

RESUMEN: La estabilidad del microimplante siempre ha sido el foco de la investigación clínica en ortodoncia. En este trabajo se investigaron los cambios morfológicos del tejido óseo alrededor de los microimplantes autorroscantes y se ayudó a la implantación para explorar el efecto de diferentes implantes en la osteointegración de microimplantes con el fin de proporcionar alguna base teórica para la práctica clínica. Se seleccionaron seis perros Beagle machos adultos, y se colocaron tres implantes en los huesos maxilares izquierdo y derecho en la 0ª, 4ª y 6ª semana, respectivamente. De un lado se colocó el implante autorroscante, y del otro lado el implante asistido. En la octava semana, se sacrificaron los animales y se obtuvieron las muestras de microimplante-hueso con el tiempo de cicatrización de 8, 4 y 2 semanas. Las muestras fueron teñidas con azul de toluidina (TB) y fotografiadas bajo aumento de 100X, y microscopio de 200X. La morfología de las células de la interfaz microimplante-hueso se observó bajo microscopio óptico. En el grupo autorroscante, había tejido fibroso que rodeaba los microimplantes a la 2ª semana, se observó la formación de osteoblastos y osteoide a la 4ª semana y de tejido óseo ondulado y lamelar a la 8ª semana. En el grupo asistido, se depositaron más fibras de colágeno alrededor del microimplante en la 2ª semana, hubo un gran número de células similares a osteoide, y el colágeno fue reemplazado gradualmente por el tejido óseo en la 4ª semana; los osteoblastos estaban activos y se ubicaron linealmente formando un hueso laminado en la 8ª semana. Ya sea que el implante sea con autoasistencia o con implantación asistida, puede ocurrir la reconstrucción de la interfaz microimplante-hueso. Si existe la necesidad clínica de una fuerza de carga temprana, el microimplante de elección sería la implantación autorroscante. Al prolongar apropiadamente el tiempo de curación, se puede mejorar la estabilidad inicial del microimplante bajo implantación asistida.

Investigation on the Cultivation Ways of Medical Students'Socialist Core Values in the Mobile Internet Era / 中国医学伦理学

The traditional cultivation ways of socialist core values among medical students existed many short-comings in the aspects of attraction, innovation, influence and so on. The medical students' basic attitude to social-ist core value was positive, but there were some characteristics of lack of initiative, lack of practice force, lack of awareness and so on. The construction of new cultivation ways need the combination of the traditional education and the emerging Internet media, especially mobile Internet terminals and thought, construct the education network of the combination of the school, family and society, and make medical students' socialist core values internalized in the mind and externalized in the practice truly.

Analysis of Volatile Components in Kaempferia Galanga Linn. from Different Habitats / 中国药师

Objective:To lay the material foundation for the research of subsequent pharmacological activities by the analysis of volatile components in Kaempferia galanga Linn. from different origins. Methods:It was the first time that headspace solid-phase microextraction and gas chromatography mass spectrometry (HS-SPME/GC-MS) technique was used to extract and analyze the volatile chemical components in Kaempferia galanga Linn. from Guangxi, Guangdong and Yunnan, and the area normalization method was used to calculate the mass fraction of each component. Results:Totally 42 chemical constituents were identified,mainly terpenoids,hydrocarbons,esters and aromatic compounds. A total of 41 chromatographic peaks were isolated from the volatile substances in Guangxi and 38 chemical constituents were identified,which accounted for 99.78% of the total of the volatile components. Totally 37 chromatographic peaks were isolated from the volatile substances in Guangdong, and 26 chemical constituents were identified, which accounted for 80.49% of the total of the volatile components. A total of 31 chromatographic peaks were isolated from the volatile compounds of Yunnan,and 24 chemical constituents were identified,which accounted for 64.72% of the total of the volatile components.Conclusion:The volatile components in Kaempferia galanga Linn. from Guangxi,Guangdong and Yunnan show little difference,and the characteristic components of the three habitats are methoxy cinnamate ethyl cinnamate, ethyl cinnamate and pentadecane, however, the relative contents of the three characteristic components from the three areas are much different,which are 45.02%,17.18% and 9.08% for Guangxi,41.08%,16.25% and 8.04% for Guangdong,and 30.78%,15.66% and 7.89% for Yunnan. One of the main active components in Kaempferia galanga Linn. is methoxy cinnamate ethyl cinnamate,which can be inferred that the quality of Kaempferia galanga Linn. from Guangxi and Guangdong is better than that from Yunnan. This experiment also provides evidence for the geoherbalism of Kaempferia galanga Linn.,and provides reference for the further development of the herb.

Tumor-induced osteomalacia

Tumor-induced osteomalacia (TIO), also known as oncogenic osteomalacia, is a rare paraneoplastic syndrome characterized by hypophosphatemia resulting from decreased tubular phosphate reabsorption, with a low or inappropriately normal level of active vitamin D. The culprit tumors of TIO could produce fibroblast growth factor 23 which plays a role in regulating renal Pi handling and 25-hydroxyvitamin D 1α-hydroxylase activity. Chronic hypophosphatemia could eventually lead to inadequate bone mineralization, presenting as osteomalacia. The diagnosis should be considered when patients manifest as hypophosphatemia and osteomalacia, or rickets and needs to be differentiated from other disorders of phosphate metabolism, such as the inhereditary diseases like X-linked hypophosphataemic rickets, autosomal dominant hypophosphataemic rickets, autosomal recessive hypophosphataemic rickets and acquired diseases like vitamin D deficiency. Localization of responsible tumors could be rather difficult since the vast majority are very small and could be everywhere in the body. A combination of thorough physical examination, laboratory tests and imaging techniques should be applied and sometimes a venous sampling may come into handy. The technology of somatostatin-receptor functional scintigraphy markedly facilitates the localization of TIO tumor. Patients undergoing complete removal of the causative neoplasm generally have favorable prognoses while a few have been reported to suffer from recurrence and metastasis. For those undetectable or unresectable cases, phosphate supplements and active vitamin D should be administrated and curative intended radiotherapy or ablation is optional.

Establishment of a genetic transformation system for hairy root culture of Erigeron breviscapus / 中国中药杂志

The electroporation method was performed to transfer plasmid DNA of PBI-1300 carrying GFP gene into Agrobacterium rhizogenes C₅₈C₁ strains. Mediated by A. rhizogenes C₅₈C₁, the GFP gene were transformed into Erigeron breviscapus aseptic leaves by leaf disc method, then the hairy roots were induced and the infected hairy roots were screened by hygromycin resistance. The chromosomal DNA of the hairy root was used as the templates for the PCR amplification with the GFP-specific primers and then the expected amplified DNA bands appeared, the green fluorescent of GFP in the cut hairy roots was observed by two-photon microscope. These results indicated that GFP gene was integrated into the genome of E. breviscapus and was expressed stably. This study laid the groundwork for foreign gene high-efficiency expression inthe genetic transformation system for hairy root culture of E. breviscapus.

Shilajit-The Important Traditional Medicine / 中国药学杂志

Shilajit, as a natural exsiting organic matter, mainly distributed in mountains area along the silk road. Shilajit mainly contains humus, as a kind of adaptogen, with pharmacological effects of anti-oxidation, anti-inflammatory, immune regulation and so on. It mainly treats urogenital diseases, digestive dysfunction and neurological diseases. The research of shilajit is still in the initial stage, and its source, composition, effective material basis and quality control of shilajit are worth further study. It is believed that after the systematic arrangement and further research, shilajit will become one of important traditional medicine.

Application of three-dimensional visualization technology in preoperative assessment of hilar cholangiocarcinoma / 中国肿瘤临床

Objective:To investigate the application of three-dimensional visualization technology in preoperative assessment of hilar cholangiocarcinoma. Methods:Thirty-eight patients with hilar cholangiocarcinoma who underwent surgery from March 2014 to April 2016 were enrolled in the retrospective study. Among the cases, an observational group of 18 patients had preoperative three-dimensional visualization surgical planning, while a control group of 20 patients did not have the visualization surgical plan. The preoperative diagnostic results were analyzed with the actual intraoperative findings. Related surgicall indicators between the two groups were compared. Results:No significant difference in the accuracy rates of longitudinal and vertical infiltration of cholangiocarcinoma between was observed the observational group and control group. While the vascular and ductal branching pattern of all patients are consistent with intraoperative findings, the coincidence rate was higher in the observational group than that in the control group (100%vs. 70%, P<0.05). The estimated liver volumes were also exactly consistent with the actual liver volume (r=0.986, P<0.001). In comparison with the control group, the average intraoperative blood loss and operative time of the observational group were significantly lower. However, the potential curative resection between the two groups exhibited no significant difference. Conclusion:Three-dimensional visualization technology can accurately complete the preoperative evaluation of hilarcholangiocarcinoma.

Application of Appreciative Inquire in Medical Humanities Education / 中国医学伦理学

Through expounding the definition of appreciate inquire,this paper discussed its principles when usedin medical humanities education including constructionism,simultaneity,poetry,preconception and optimism.Guided by optimistic themes,the benign development of medical humanistic education was realized by 4D circulation mode (discovery,dream,design,andrealization) of appreciative inquiry summit talks.

Current situation of medical imaging retrieval techniques / 中华医学图书情报杂志

Medical imaging plays a more important role in diagnosis and treatment of diseases with the rapid development of big data technologies and hospital information systems.It is thus quite necessary to develop the effective and accurate medical imaging retrieval systems.The key techniques for text-based, contents-based and semantic-based medical imaging retrieval methods were thus elaborated and analyzed with the prospects put forward for the future development direction of medical imaging retrieval techniques.

Status quo of knowledge expression model of clinical guidelines / 中华医学图书情报杂志

Clinical guidelines,coming into being with the development of evidence-based medicine,are of great significance in reducing medical malpractice and regulating medical behaviors.However,more effective and intelligent measures should be taken for their development and application due to their low utilization and poor compliance of doctors in their implementation.The emergence and structure of clinical guidelines were elaborated with related problems summarized.The knowledge expression models of digital clinical guidelines were analyzed and compared with the challenges faced by the current knowledge expression models of clinical guidelines pointed out.

Clinical outcomes of implant-retained overdentures:A retrospective study / 实用口腔医学杂志

Objective:To evaluate the clinical outcomes of implant-retained overdentures.Methods:57 patients treated by implant-retained overdentures were included.Parameters for peri-implant tissue conditions (e.g.peri-implant probing depth,plaque index,bleeding on probing,mucosal hyperplasia,peri-implant marginal bone loss) and prosthetic complications were examined and recorded.The precentage of satisfaction of the patients was assessed using the visual analog scale (VAS).Results:After an average follow-up of (48±11.3) months,the survival rate of the implants was 98.1%,the marginal bone loss was (1.38±0.74) mm.There was no statistically difference among the different attachment groups(bar,magnet and ball) regarding the peri-implant marginal bone loss or bleeding on probing(P>0.05).The peri-implant probing depth and plaque index in patients with magnet and ball attachments were lower than those in patients with bar attachments(P0.05),except that magnet and ball attachments were much easier to clean compared with bar attachments(P<0.05).Conclusion:Implant-retained overdenture is a successful and satisfactory treatment option for patients with edentulous jaw.The patients should been given regular clinical examinations to keep peri-implant tissue health and reduce the complications,especially those with bar attachments.

Efficacy and safety of ultrasound-guided laparoscopic RFA in the treatment of hepatic hemangioma / 中国现代普通外科进展

Objective:To evaluate the laparoscopic joint comeback guided radiofrequency ablation for hepatic hemangioma clinical application and evaluation of efficacy and safety.Methods:The clinical data were treated from August 2010 to August 2015 period 81 cases of hepatic hemangioma (HCH) patients analyzed.Patients met the inclusion criteria were divided into 33 cases of laparoscopic radiofrequency ablation(LRFA) group,laparoscopic resection(LR) group 22 cases,26 cases of open surgery group.Changes were detected before and after surgery of liver function;record the operation time and hospital stay,blood loss,postoperative complications and compared.Results:Effect of three groups of liver function are transient in nature.LRFA complication rate (15.2％) was significantly lower than the LR group (36.4％) and surgical resection group (50.0％),the difference was statistically significant (P＜0.05.Open surgery operative time,hospital stay was significantly longer than the other two groups;and LRFA group of patients had no bleeding,no blood transfusion cases,significantly lower than the LR and open surgical resection group.Conclusion:LRFA treatment HCH,both advantages and laparoscopic radiofrequency ablation,combined with joint endoscopic ultrasonic guidance makes it more secure and less complications,is a safe and effective method of treatment of hepatic hemangioma,worthy of promotion.

Diagnosis and treatment of solid-pseudopapillary tumor of pancreas / 中国现代普通外科进展

Objective:To explore the clinical characteristics,imaging features,biological characteristics,treatment and prognosis of solid-pseudopapillary tumor of pancreas(SPT).Methods:Retrospectively reviewed and analyzed clinical and pathological data of 49 cases of SPT from 2007.3 to 2017.3.Results:Among 49 SPT patients,11 males and 38 females,male-to-female ratio was 1∶3.5,with a mean age of (31.4 ± 13.2)years old.There was nonspecific symptoms among patients.Preoperative imaging help to determine the location of the tumor and make the correct diagnosis,but the nature of the tumor remains to be pathologically confirmed.All of patients renceived surgery,47 patients were treated by radical tumor resection,21 patients presented with postoperative complications,the most common complication was pancreatic fistula.Conclusion:Solid pseudopapillary tumor(SPT) is a rare low grade malignancy more frequent in young women with non-specific clinical characteristics.Preoperative imaging has important significance in the preoperative and differential diagnosis.Most of patients can receive radical resection and have good prognosis.