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China is rich in antimony, boron, and vanadium mineral resources, which have been detected in environmental water bodies and drinking water. During the revision process of the "Standards for Drinking Water Quality (GB5749-2006)", research and evaluation are focused on three indicators: antimony, boron and vanadium. Vanadium is added and the limit value of boron is adjusted. This study reviews and discusses the technical contents related to the revision of the antimony, boron and vanadium, including the environmental presence levels, exposure status, health effects, and the revision of the standard limits of these three indicators. Suggestions are also made for the implementation of this standard.
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Humans , Antimony , Boron/analysis , China , Drinking Water , Vanadium , Water Pollutants, Chemical/analysisABSTRACT
Objective:To investigate the feasibility and safety of single-position robotic assisted laparoscopic anterograde bilateral inguinal lymphadenectomy for penile cancer.Methods:The clinical data of 6 patients with penile cancer admitted to our hospital from January 2019 to January 2020 were retrospectively analyzed. The mean age was (52.0±8.6)years old. The pathology was primary focal squamous cell carcinoma, with 2 cases of high differentiation, and 4 cases of medium differentiation. All the 6 patients underwent single-position robotic assisted laparoscopic anterograde bilateral inguinal lymphadenectomy. Preoperative physical and imaging examinations indicated bilateral inguinal lymph node enlargement, and no distant metastasis was found in all of the 6 patients. The supine position was taken, with the head low and feet high about 15°, the legs straight and separated as far as possible in the shape of "Chinese eight" . The da Vinci robotic patient cart was placed between legs of the patient, after inserting the trocars. The external boundary of bilateral inguinal lymph node dissection was the line between the anterior superior iliac spine and 20 cm lower, the inner boundary was the pubic tubercle and its 15cm medial lower measurement, and the line between the inner boundary and the external lower edge was the lower boundary.Results:All the 6 operations were successfully completed without transfer to open surgery. Both sides of the inguinal lymph nodes were dissected at the same time. The space establishment and trocar insertion were performed simultaneously. There was no need for mobile robotic arm system during the operation. The average operative time was (105.0±20.5) min, and the amount of intraoperative blood loss was less than 50ml, the average hospital stay was(7±3) days. An average of(15.0±2.5) lymph nodes were dissected on each side. Intraoperative freezing suggested single positive lymph nodein 2 patients and no positive lymph node in 4 patients. There was no skin necrosis, 1 case of delayed wound healing, and 2 cases of lymphatic leakage. All patients were cured by conservative treatment. The 6 patients were followed up for 12-14 months, and there was no recurrence or metastasis.Conclusions:Single-position robotic assisted laparoscopic anterograde bilateral inguinal lymphadenectomy can achieve the expected surgical outcome, and has fewer perioperative complications. The surgery is safe and effective.
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Objective:To explore the risk factors of adjacent segment diseases (ASDis) after lumbar fusion, summarize the prevention strategies and provide reference for clinical treatment.Methods:All of 258 patients who underwent lumbar interbody fusion from March 2014 to March 2019 were retrospectively analyzed, including 95 males and 163 females, the age of whom was 61.8±8.4 years (range, 39-77 years). The patients were divided into ASDis group and non-ASDis group according to whether ASDis occurred at the follow-up of 24 months after operation. The patient's individual factors [gender, age, body mass index (BMI), main diagnosis, preoperative paraspinal muscle fatty degree, etc.] and surgical factors (operation type, fixed segment, fusion segment, etc.), sagittal parameters [lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), PI-LL] were recorded. After univariate analysis of potential risk factors, the factors with P<0.05 were substituted into logistic regression model for multivariate analysis to determine the risk factors of ASDis after lumbar fusion. Results:ASDis occurred in 24 patients after lumbar fusion, with an incidence of 9.3% (24/258); univariate analysis showed that age ≥ 60 years old, complicated with osteoporosis, preoperative fatty degree of paraspinal muscle (GCS grade≥3), PLIF operation, suspension fixation, total laminectomy and multi-segment fusion (≥ 3 segments) were the potential risk factors for ASDis after operation (P<0.05); Gender, education level, partner status, type of work, BMI, obesity (BMI≥24 kg/m 2) , smoking, use of bisphosphonates, concomitant lumbar spinal stenosis, lumbar lordosis angle, pelvic incidence angle, pelvic tilt angle, sacral slope angle, and PI-LL had no significant correlation with ASDis. Logistic regression analysis showed that age ≥ 60 years ( OR=5.63, 95% CI: 1.56, 20.29, P=0.008), preoperative paravertebral muscle fatty GCS ≥ 3 ( OR=4.82, 95% CI: 1.36, 17.13, P=0.015), combined with osteoporosis ( OR=14.04, 95% CI: 2.53, 77.79, P=0.002), PLIF ( OR=9.69, 95% CI: 1.91, 49.03, P=0.001), and multi-segment fixation ( OR=9.36, 95% CI: 1.77, 49.41, P=0.008) were the risk factors for ASDis after lumbar fusion; Incomplete laminectomy ( OR=0.09, 95% CI: 0.02, 0.37, P=0.001) and suspension fixation ( OR=0.16, 95% CI: 0.02, 0.94, P=0.042) were the protective factors of ASDis after lumbar fusion. Conclusion:The patients with age ≥ 60 years old, osteoporosis and preoperative paraspinal muscle fatty degree ≥ 3 grade GCS should be more careful in choosing the surgical methods, and try to choose transforaminal interbody fusion, posterolateral fusion, short segment fusion, decompression with preservation of vertebral lamina, suspension fixation and other surgical methods to reduce the incidence of postoperative ASDis.
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Objective:To assess the implementation of injection-related risk management based on WeChat platform for type 2 diabetic patients with the insulin self-injection.Methods:A total of 124 diabetic patients, who would receive insulin therapy by self-injection at home after discharge from the PLA 903 hospital during April 2017 to July 2018, were divided into the control group( n=62)and the study group( n=62). All patients were given routine education on insulin injection during the hospitalization,while the study group( n=62)received additional video and text education based on WeChat platform after discharge. The skill of self-injection and the status of blood glucose control were evaluated in both groups 4 weeks and 8 weeks after discharge, respectively. Results:The insulin injection skill, including skin disinfection [36(58%) vs. 11(18%),χ 2=21.42, P<0.01], exhaust before injection [62(100%) vs. 51(82%),χ 2=12.07, P<0.01], stay 10s after injection [60 (97%) vs. 47(76%),χ 2=11.52, P<0.01], disposal of used needle[49(79%) vs. 18(29%),χ 2=31.20, P<0.01], rotation of injection site [48(77%) vs. 35(56%),χ 2=6.16, P=0.01], insulin storage [62(100%) vs. 57(92%),χ 2=5.21, P=0.02], and the ability of correctly dealing with hypoglycemia [52(84%) vs. 38(61%),χ 2=7.94, P=0.01] in the study group were significantly better than those in the control group after 4 weeks of injection-related risk management. The fasting plasma glucose [(6.41±0.76) vs.(7.19±0.81)mmol/L, t=5.61, P<0.01], glycosylated hemoglobin A1c [(6.71±0.64)% vs. (7.37±0.78)%, t=5.18, P<0.01], incidence of hypoglycemia [6(10%) vs. 15(24%),χ 2=4.64, P=0.03] in the study group were significantly lower than those in the control group after 12 weeks of the management. Conclusion:The risk management based on WeChat platform can improve insulin self-injection skill and the ability of dealing with hypoglycemia,also promote effective blood glucose control for diabetes patients.
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Objective:To understand the health self-assessment and related influencing factors in the migrant workers who received of physical examination in Shanghai， so as to provide reference for formulating health service policies for migrant workers. Methods:Taking Shanghai "Intelligent Blue Collar" Health Science Popularization Service Station as the investigation site， 8，100 urban workers were surveyed by questionnaire. The questionnaire includes basic information， health self-assessment， basic medical insurance coverage and satisfaction， subjective well-being and so on. Results:There were significant differences between migrant workers and local workers in health self-assessment， two-week disease prevalence rate， and chronic disease prevalence rate（χ2=32.981，P<0.05；χ2=4.554，P<0.05；χ2=86.695，P<0.05）. The differences between migrant workers and local workers were also significant in the basic medical insurance coverage rate and the level of satisfaction （χ2=221.592，P<0.05；χ2=30.950，P<0.05）. There was no significant difference in subjective well-being between these two groups（χ2=8.787，P>0.05）. The health self-assessment of older migrant workers was significantly better than that of new generation migrant workers（β=0.062，P<0.05）， and was significantly worse in female migrant workers than that in male migrant workers（β=-0.120，P<0.05）. The health self-assessment was significantly better in migrant workers with agricultural household registration than that in non-agricultural household registration（β=0.060，P<0.05）. The higher the satisfaction of basic medical insurance，the higher the subjective well-being and the better the health self-assessment（β=0.148，P<0.05；β=0.422，P<0.05）. Conclusion:The health status of migrant workers in Shanghai who received physical examination is better than that of local workers， and the participation rate of basic medical insurance is lower than that of local workers. Age， gender and household registration are the important factors influencing the health self-assessment. Satisfaction with basic medical insurance level and subjective well-being is a significant factor to predict health self-assessment positively . We should further improve the fairness of medical insurance benefits for migrant workers， improve subjective well-being， and ensure the health fairness of the group.
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OBJECTIVE@#To explore the renal pathology and cytogenetic features in the multiple myeloma (MM) patients with renal impairment.@*METHODS@#The clinical data of newly diagnosed MM patients with renal impairment in our hospital from January 2009 to January 2019 were analyzed retrospectively, and the relationship between FISH results and results of renal pathological exanimation was analyzed statistically by using SPSS 20.0.@*RESULTS@#A total of 20 patients underwent renal biopsy, included 12 males and 8 females. FISH result showed that out of 20 patients, 7 cases presented interstitial nephritis, among which 3 cases were negative for FISH, and in the remaining cases the rate of IgH rearrangement, 1q21 amplification, RB1 deletion, D13S319 deletion, and P53 deletion detection was 42.86%, 28.57%, 28.57%, 28.57% and 14.29% respectively, the detection positive rate was statistically significantly lower as compared with total probe positive rate (P＜0.01). There were 6 cases of cast nephropathy, among which IgH rearrangement, the rate of 1q21 amplification, RB1 deletion, D13S319 deletion, and P53 deletion detection was 66.67%, 50%, 66.67%, 50% and 0% respectively. Compared with the total probe positive rate, there was no statistical significance (P＞0.05). There were 4 cases of acute tubular necrosis, among which the detection rates of IgH rearrangement, 1q21 amplification, RB1 deletion, D13S319 deletion, and P53 deletion was 100%, 50%, 50%, 25% and 25%, respectively. Compared with the total probe positive rate, there was no statistical significance (P＞0.05). There were one case of amyloidosis, and one case of tubular nephropathy with amyloidosis, the detection with 5 probes were all positive. One case of light chain deposition disease was positive for RB1 gene deletion + D13S319 gene deletion.@*CONCLUSION@#FISH in the MM patients with different renal pathological changes is characterized by heterogeneity, which can be used to predict the risk of renal damage and speculate possible renal pathological types to guide prognosis.
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Female , Humans , Male , Chromosome Aberrations , Cytogenetic Analysis , Cytogenetics , In Situ Hybridization, Fluorescence , Multiple Myeloma , Retrospective StudiesABSTRACT
Objective:To discuss the effect and experience of laparoscopic vesicovaginal fistula repairs though inferior of bladder longitudinal incision.Methods:54 patients were included in this study. Clinical data of patients collected from our hospital since January 2010 to October 2019 who underwent laparoscopic vesicovaginal fistula repair. The median age is 49.5 (8-80) years old. Main complaints were urine flows out through the vagina. 14 cases (25.9%) and 23 cases (42.6%)were post-hysterectomy of benign lesions and gynecological malignant tumors. The symptoms presented at 11 (1-20) days post urinary catheter removal. There were 11 cases (20.4%) of cervical malignant tumors, symptoms presented at 10 (5 to 25) months after radiotherapy. The symptoms of rest of cases 6 (11.1%)presented at 21 (3 to 50) days. One of them had rectal fistula, another had ureteral injury, 6 had bladder contracture, 2 patients had bilateral hydronephrosis. Preoperative CT examination revealed that 4 cases had no obviously hydroureter at upper urinary tract, and 2 cases had mild hydronephrosis in bilateral kidneys. The diameter of the fistula was 0.5-4.0 cm. There were 50 cases of single fistula and 4 cases of multiple fistula. The urine pad test evaluated the degree of urine leakage in patients reveals that 7 and 42 cases with mild and moderate, rest of 5 cases presented with severe result. 37 cases performed with vesico-vaginal fistula repair for the first time; 13 and 2 cases had once and twice vesico-vaginal fistula repair history and there were other two patients had vesico-vaginal fistula repair history for three and four times. All patients underwent general anesthesia under the laparoscopic bladder bottom longitudinal incision bladder vaginal fistula repair, 8 cases performed with Da Vinci robotic assist surgery system. Main steps of the operation include: ①search for bladder and vaginal fistula, assessed the size, number, and location of the fistula; ②To set single J stents in the bilateral ureter; ③Fully separated the bladder and vaginal wall, remove scar tissue, and suture the bladder incision with low or no tension way; ④To use great omentum; for patients with low, complex, and mixed bladder vaginal fistulas, recommend to use bladder wall flaps (6 cases), bladder enlargement (3 cases), and ureteral replantation (6 cases). The clinical data of the patients were collected, and a univariate analysis was performed on the cure rate.Results:The mean of blood boss and duration in operation were (33.3±26.5) ml and 85 (60-240) minutes. Mean of hospitalization was (11.3±8.2)days. The postoperative urinary indwelling time were (20.8±8.3)days. 50 cases were completed recovered and 4 cases failed, the curative ratio was 92.6% (50/54). It revealed that the curative ratio of vesicovaginal fistula repair had correlation with history of surgical interventions before operation. The curative effect was reduced ( P=0.00) when the patient had previous laparoscopic vesicovaginal fistula repairs. Patients with multiple fistulas (≥2) had a lower cure rate than single fistulas ( P=0.00). In addition, patients with fistulas above the triangle of the bladder had a higher cure rate than fistulas outside the triangle of the bladder and the urethra ( P=0.00). There was no statistically significant difference in the cure ratio of Age ( P=0.79), operation time ( P=0.06), intraoperative bleeding ( P=0.78), post-operative hospitalization ( P=0.73), indwelling catheterization time ( P=0.30), and size of fistula ( P=0.31). Conclusions:The operation could be effective with fewer complications procedure, which could fix mixed fistula and bladder contracture at the same time.
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Objective To discuss outcome and safety after implementation of enhanced recovery after surgery(ERAS) protocols to patients who underwent robotic assisted radical cystectomy (RARC) with intracorporeal orthotopic "U" shaped ileal neobladder creation using STAPLER technique.Methods Between October 2014 and April 2019,71 patients(59 males and 12 females)with MIBC (Muscle Invasive Bladder Cancer) who underwent RARC with intracorporeal urinary diversion using orthotopic "U" shaped ileal neobladder in Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College) were studied retrospectively.They had an average age of (65.2 ± 5.6)y and BMI of (22.18 ± 3.75) kg/m2.The median age-adjusted charlson comorbidity index (aCCI) was 4,median ASA score was 2.All patients underwent these inspections pre-RARC:chest Xray,vascular ultrasound (jugular vein included),abdominal ultrasound,CT urography,cystoscopy with biopsy or TURBT(trans-urethral resection of a bladder tumour).All patients were pathological diagnosed with MIBC,with no evidence of systemic metastasis and no history of radiotherapy,systemic chemotherapy and open abdominal surgery before RARC.All 71 patients received RARC with intracorporeal orthotopic "U" shaped ileal neobladder creation using STAPLER technique.Between October 2014 and September 2016,37 cases (29 males and 8 females) were managed without ERAS protocols perioperatively.They had an average age of (65.3 ±5.7)y and BMI of (23.66 ± 3.47)kg/m2.The median aCCI was 4,median ASA score was 2.Between October 2016 and April 2019,another group of 34 cases (30 males and 4 females) were managed with ERAS protocols including nutritional assessment,thrombosis prevention,pain assessment and management,perioperative diet management etc.They had an average age of (64.5 ± 4.3) y and BMI of (21.87 ± 4.85) kg/m2.The median aCCI was 4,median ASA score was 2.There were no statistical significance between the two groups with regard to general information.Surgical and follow-up data were collected for all patients.Results Surgeries were successful in all 71 cases with postoperative follow up for 3-51 months.In ERAS group,there were 22 cases in pT2 and 12 cases pT3 according to classification of malignant tumours:with 2 cases of incidental prostate cancer (IPCa).In non-ERAS group,pT2 in 25 cases and pT3 in 12 cases:with 1 case of IPCa.Statistical significance were observed between groups with regard to the first anal exhaust time [(20.5 ± 18.7) h vs.(29.9 ± 17.4)h,P =0.032],the first defecation time [(72.6 ±27.1)h vs.(88.7 ±35.8)h,P =0.004],length of hospital stay after surgey [(14.1 ± 3.3) d vs.(16.2 ± 4.8) d,P =0.037],numeric rating scales (NRS) Pain Score 8.0,24.0,48.0 h after surgery [(3.2 ±0.5)vs.(3.6 ±0.8),P =0.015;(1.9 ±0.3) vs.(2.2 ± 0.6),P =0.011;(1.3 ± 0.4) vs.(1.6 ± 0.7),P =0.032],respectively.There were no significance between groups with regard to operating time [(290 ± 65) min vs.(282 ± 46) min,P =O.549],intraoperative blood loss [(190.5 ± 235.6) ml vs.(221.1 ± 250.3) ml,P =0.438],transfusion rate [5.9％ (2/34) vs.8.1％ (3/37),P =0.922],readmission within 30 days after surgery [2.9％ (1/34) vs.5.4％ (2/37),P =0.940],early severe complications(within 30 days) [2.9％ (1/34) vs.2.7％ (1/37),P =0.940],late severe complications (after 30 days) [5.9％ (2/34) vs.8.1％ (3/37),P =0.922].Conclusions The implementation of ERAS protocols to patients who underwent RARC with intracorporeal orthotopic "U" shaped ileal neobladder using STAPLER technique is safe and effective.It can reduce postoperative pain and hospital stay,shorten bowel recovery time,improve early functional recovery without increasing major complications.This adoption should be encouraged.
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Synchronous multifocal osteosarcoma (SMOS) was analyzed for its predisposing age, sex, location, oncology characteristics, and survival time with different treatment. The key words about "multifocal osteosarcoma" had been used to search articles which includ Synchronous multifocal osteosarcoma patients databases from 1949 to 2020. The articles have been filtratedby title, abstract and full text. There were 80 articles used for thisstudy. All the patients were objects of thisstudy. Butthe same patients' data in different articles had not been used repeatedly. The patients' data had been collected as much aspossible, including age, location, treatment, survival timeand so on. All the patients' data had been used forsystematic analysis. All of the 80 articles and 264 patients had been studied. The mean onset age was 16.17 years old and the peak age of onset was 10-20 years old. The gender difference had been uncovered and the sex ratio was 1.76∶1. The incidence site of 188 patients (92.16%) was located in the extremities. Alkaline phosphatase was elevated in 135 patients (95.10%). The pathological type was osteoblastic osteosarcoma in 134 patients (76.14%). There were 3 patients with hypocalcemia and 2 patients with anemia. The mean survival time of 15 patients (15/58) who gave up treatment was 4.51 months. The mean survival time of 23 patients with chemotherapy was 8.97 months. The mean survival time was 16.17 months in 11 patients with preoperative chemotherapy and surgical treatment. Nine patients with neoadjuvant chemotherapy, surgery and postoperative chemotherapy had an average survival time of 23.28 months. Multiple osteosarcoma of the same type was rare, with high degree of malignancy and poor prognosis. The age of high incidence was 10-20 years old. Currently, the most effective treatment was neoadjuvant chemotherapy, surgery and postoperative chemotherapy.
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Objective To evaluate the efficacy of prosthetic replacement for bone tumors and devitalization and replantation after resection of tumor segment for the treatment of patients with extremity osteosarcoma. Methods A total of 54 patients with Enneking stage Ⅱ extremity osteosarcoma who underwent limb-salvaging surgery in the Second Hospital of Shanxi Medical University from December 2010 to June 2017 were analyzed. Kaplan-Meier survival analysis was performed on the prosthetic replacement for bone tumors group and devitalization and replantation after resection of tumor segment group, the 5-year survival rate and distant metastasis rate between the two groups were compared. The χ 2 test and t test were used to compare the local recurrence rate, occurrence of local infection, and postoperative functional recovery between the two groups. Results Forty-six patients were followed up with the period ranging from 3 to 84 months. The prosthetic replacement for bone tumors group had 35 cases and the devitalization and replantation after resection of tumor segment group had 11 cases. The postoperative 5-year survival rate and 5-year distant metastasis rate were compared between the prosthetic replacement for bone tumors group and devitalization and replantation after resection of tumor segment group by using the Kaplan-Meier method (52.5％ vs. 59.4％, 38.5％ vs. 35.7％), and the differences were not statistically significant (χ 2 values were 0.084 and 0.013, both P > 0.05). For local recurrence rate and the risk of postoperative infection, the patients in devitalization and replantation after resection of tumor segment group showed higher results than those in prostheticreplacement for bone tumors group [36.4％ (4/11) vs. 8.6％ (3/35), 36.4％ (4/11) vs. 11.4％ (4/35)], and the differences were statistically significant (χ 2 values were 4.181 and 5.020, both P < 0.05). For 6 months postoperative functional reconstruction score, the patients in devitalization and replantation after resection of tumor segment group showed worse result than that in prosthetic replacement for bone tumors group [(17.4± 2.5) points vs. (24.3±4.8) points], and the difference was statistically significant (t = -4.911, P < 0.05); but this index tended to show better result at 18 months after surgery as compared with prosthetic replacement for bone tumors group [(27.3±2.7) points vs.(24.8±4.6) points], but the difference was not statistically significant (t= 1.811, P > 0.05). Conclusion The efficacy of prosthetic replacement for bone tumors is considered better than that of devitalization and replantation after resection of tumor segment, and it could be used as the preferred surgical option for limb-salvaging treatment in patients with extremity osteosarcoma at present.
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Objective To investigate the risk factors for hemorrhagic transformation(HT)of different subtypes of acute cerebral infarction in elderly patients.Methods A total of 415 elderly hospitalized patients aged ≥60 years with acute cerebral infarction were selected from a hospital in Changsha from January 2014 to December 2016 for the study.Among them,56 had hemorrhagic transformation(observation group)and 359 had no hemorrhage transformation(control group).The general demographic information,past medical history,physical examination and laboratory indicators,cranial CT/MRI examination,admission treatment and the National Institutes of Health Stroke Scale (NIHSS) score on admission were analyzed and compared between two different subtypes.Multivariate Logistic regression was used to analyze the influencing factors for HT of different subtypes of acute cerebral infarction in elderly patients.Results The incidence of HT was 26.61％(29/109)for largeartery atherothrombosis,47.50％ (19/40)for cardiac embolism and 3.12％ (8/257)for small-artery occlusion with a statistically significant differences among the three subtypes (x2 =77.923,P =0.000).The incidence of HT was 0％ (0/7)for unknown type,and 0％ (0/2)for other types.Multivariate logistic regression showed that female was the protective factor(OR =0.171,95％ CI:0.037-0.790),but high level of glycated haemoglobin A1c(HbA1c)and large infarct size were the risk factors(OR =5.949 and 20.619,95 ％CI:1.199-29.509 and 2.869-148.207)for HT due to largeartery atherothrombosis.A high score of NIHSS and high level of matrix metalloproteinase-9 (MMP-9)were the risk factors for HT due to cardioembolism(OR =20.254 and 91.200,95％CI:1.605-255.625 and 4.044-2056.710,respectively).A high level of homocysteine(Hcy) and large infarct size were the risk factors for HT due to small-artery occlusion(OR =10.231 and 15.251,95 ％ CI:1.202-87.108 and 3.371-68.995,respectively).Conclusions The incidence of HT due to cardioembolism is the highest.Influencing factors for HT due to different subtypes of acute cerebral infarction are different in the elderly.It is important for clinicians to know that gender,HbA1c levels and infarct size are associated with HT due to large-artery atherothrombosis,NIHSS score on admission and MMP-9 concentration associated with HT due to cardioembolism,and Hcy level and infarct size associated with HT due to small-artery occlusion.
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Objective To investigate the roles of long noncoding RNA-myocardial infarction-associated transcript (MIAT) on lens epithelial cells (LECs) fibrosis induced by transforming growth factor-β2(TGF-β2).Methods LECs line (SRA01/04) was cultured in conventional DMEM (normal control group) and DMEM containing 10 ng/ml TGF-β2(TGF-β2 induced group) for 48 hours.The morphology of the cells was observed under the optical microscope,and the relative expression levels of M IAT,E-cadherin (E-cad),α-smooth muscle action (α-SMA),collagen Ⅰ (Coll Ⅰ) in protein level and mRNA level were detected by real-time fluorescence quantitative PCR and Western blot,respectively.The cells cultured in DMEM or DMEM containing 10 ng/ml TGF-β2 were transfected by siNRA empty carrier (siNRA group,siNRA+TGF-β2 group) and siRNA-MIAT (siRNA-MIAT group,siNRA-MIAT+ TGF-β2 group) for 48 hours,and the morphology of the cells was observed under the optical microscope,and the relative expression levels of MIAT,E-cadherin (E-cad),α-smooth muscle action (α-SMA),collagen Ⅰ (Coll Ⅰ) in protein level and mRNA level were detected by real-time fluorescence quantitative PCR and Western blot.Results The cells in the normal control group showed the round and polygon in shape,and those in the TGF-β2 induced group showed the spindle-like.Compared with the normal control group,the relative expression levels of MIAT mRNA,α-SMA mRNA and Coll Ⅰ mRNA were significantly elevated (2.497 ± 0.644 vs.0.827 ± 0.062;2.951 ±0.146 vs.1.085±0.517;2.115 ±0.090 vs.1.002 ± 0.088),and the expression of E-Cad mRNA was significantly reduced (0.102±0.027 vs.1.020±0.262) in the TGF-β2 induced group (P =0.045,0.004,0.000,0.025).The expressions of MIAT,α-SMA,Coll Ⅰ and E-Cad showed a similar trend between two groups.The relative expressions of MIAT protein and mRNA were evidently reduced in the SiRNA-MIAT group compared with the siRNA empty vector group (all at P＜0.05).Compared with the siRNA+TGF-β2 group,the relative expressions of α-SMA and Coll Ⅰ in protein and mRNA levels were significantly reduced,and the expressions of E-cad protwin and mRNA were elevated in the siRNA-MIAT+TGF-β2 group (all at P＜0.01).Conclusions MIAT might participate in TGF-β2-induced LECs-EMT.The down-regulation of MIAT in the LECs inhibits the fibrosis of LECs.
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Objective To explore the practicability and safety of the application of Percutaneous Vertebroplasty puncture (PVP) needle as a saw guide in the Total En-bloc Spondylectomy (TES) of thoracic and lumbar tumor through single posterior approach.Methods From June 2017 to March 2018,four patients with thoracic and lumbar vertebral neoplasms were analyzed retrospectively.They included 2 males and 2 females,which aged 50-77 years with an average age of 63.75 years.There were 1 case of Tomita 5 grade T7 lymphoma,1 case of Tomita 3 grade T5 metastasis of lung cancer,1 case of Tomita 5 grade T9 metastasis of prostate cancer and 1 case of Tomita 4 grade L2 metastasis of renal cancer.The PVP needle combined with the modified "3-step" method was applied in TES for 4 cases through posterior approach.The operative time and intraoperative blood loss were recorded.The integrity of excised vertebra and postoperative complications were observed.The visual analogue score (VAS) was evaluated to assess the pain improvement.The ASIA classification was evaluated for the assessment of neurological function of thoracic vertebral tumor cases and the muscle strength grades was evaluated for the assessment of neurological function of lumbar vertebral tumor cases.Results In all 4 cases,the vertebra was removed entirely.The average operation time was 4.9 h (4.0-6.5 h)and average blood loss was 3 200 ml (800-9 000 ml).No pachymeninx injury,cerebrospinal fluid leakage,iatrogenic spinal cord injury or vascular injury occurred.During the surgery,the saw-cutting plane is firmly located in the intervertebral disc and no slippage of the cutting plane was observed.Postoperatively,the pain was significantly alleviated.The VAS score decreased to average 1.75 points (1-2 points) after surgery,average reduction of 5.75 points (5-7 points).The neurological deficit was not aggravated in all patients.The neurological improvement of one grade was observed in 3 patients.Two cases of thoracic vertebral tumor had a grade of ASIA classification improved from grade B to grade C.One case of lumbar vertebral tumor had a grade of lower limb muscle strength improved from grade 3 to grade 4.No recurrence of tumor was observed at average 8.1 months (3.5-12 months) followup and 1 case of bone metastasis of lung cancer had intermittent intercostal neuralgia.Conclusion It is feasible and safe to apply PVP puncture needle as a saw guide in TES of thoracic and lumbar tumor through single posterior approach,on the basis of this,the "3-step" intervertebral disc truncation technique is developed,which has good practicability and high safety.
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Objective To compare the safety and efficacy between flexible ureteroseope lithtripsy (FURS) and super-mini-percutaneous Nephrolithotomy (SMP) in the treatment of lower calyx calculus.Methods From Mar 2015 to Apr 2017,120 male and 75 female patients were accepted FURS (n =112)or SMP(n =83) in our hospital.Their average age was 45 years old,ranged from 19 to 68 years old.The cumulative stone diameter ranged from 15-24 mm (mean 20.3 ± 3.9 mm) in FURS group and ranged from 15-28 mm (mean 20.7 ± 3.2mm) in SMP group.There were no significant differences between the groups FURS and SMP in the stone size (P ＞ 0.05).Operative duration,postoperative hospital stay,complication rate,and stone-free rate(one day or one month after procedure) were recorded and compared.Results The operative time ranged from 28 to 62 min (mean 55.3 ± 7.3min) in FURS group and ranged from 15 to 55 min (mean 40.5 ± 6.8 min) in SMP group (P ＜ 0.05).One day after the operation,CRP was 7.4-29.1 (mean 17.2 ± 7.1) mg/L in group SMP,which was lower than that in group FURS 6.9-37.8 (mean 26.4 ± 6.4) mg/L (P ＜ 0.05).And the procalcitonin and peripheral leukocyte count was 0.1-1.2 (mean 0.6± 0.3)ng/ml and 6.3-18.1(mean 12.6± 3.2) × 109/L respectively,which was lower than that in group FURS O.2-1.4 (mean 0.9 ± 0.4) ng/ml and 9.5-21.7 (mean 14.8 ± 2.9) × 109/L respectively (P ＜ 0.05).One day after the operation,the stone free rate was 80.4％ (90/112) in group FURS,which was lower than that in group SMP 89.2％ (74/83) (P ＜ 0.05).And one month after the operation,the stone free rate was 85.7％ (96/112) in group FURS,which was lower than that in group SMP 96.4％ (80/83) (P ＜ 0.05).Postoperative hospitalization stay ranged from 2 to 5 days (mean 2.3 ± 1.2 days) and ranged from 3 to 6 days (3.7 ± 1.6 days) in FURS and SMP group,respectively (P ＜ 0.05).The scores of Visual Analogue Scale (VAS) ranged from 0 to 3 (mean 2.1 ± 0.4) and ranged from 0 to 3 (mean 1.9 ± 0.5) in FURS and SMP group,respectively (P ＜ 0.05).And the scores of Bruggrmann comfort scale (BCS) ranged from2to4 (mean 3.2 ±0.7) and ranged from 2 to4 (2.8 ±0.5) in FURS and SMP group,respectively(P ＜ 0.05).Conclusions Both SMP and FURS are efficacy and safe surgical alteration for patients with renal and renal lower calyx calculus of CSD about 2cm.The SMP could have some advantages such as the better stone free rate and acceptable complieation rate.
ABSTRACT
Objective To compare the safety and efficacy between flexible ureteroseope lithtripsy (FURS) and super-mini-percutaneous Nephrolithotomy (SMP) in the treatment of lower calyx calculus.Methods From Mar 2015 to Apr 2017,120 male and 75 female patients were accepted FURS (n =112)or SMP(n =83) in our hospital.Their average age was 45 years old,ranged from 19 to 68 years old.The cumulative stone diameter ranged from 15-24 mm (mean 20.3 ± 3.9 mm) in FURS group and ranged from 15-28 mm (mean 20.7 ± 3.2mm) in SMP group.There were no significant differences between the groups FURS and SMP in the stone size (P ＞ 0.05).Operative duration,postoperative hospital stay,complication rate,and stone-free rate(one day or one month after procedure) were recorded and compared.Results The operative time ranged from 28 to 62 min (mean 55.3 ± 7.3min) in FURS group and ranged from 15 to 55 min (mean 40.5 ± 6.8 min) in SMP group (P ＜ 0.05).One day after the operation,CRP was 7.4-29.1 (mean 17.2 ± 7.1) mg/L in group SMP,which was lower than that in group FURS 6.9-37.8 (mean 26.4 ± 6.4) mg/L (P ＜ 0.05).And the procalcitonin and peripheral leukocyte count was 0.1-1.2 (mean 0.6± 0.3)ng/ml and 6.3-18.1(mean 12.6± 3.2) × 109/L respectively,which was lower than that in group FURS O.2-1.4 (mean 0.9 ± 0.4) ng/ml and 9.5-21.7 (mean 14.8 ± 2.9) × 109/L respectively (P ＜ 0.05).One day after the operation,the stone free rate was 80.4％ (90/112) in group FURS,which was lower than that in group SMP 89.2％ (74/83) (P ＜ 0.05).And one month after the operation,the stone free rate was 85.7％ (96/112) in group FURS,which was lower than that in group SMP 96.4％ (80/83) (P ＜ 0.05).Postoperative hospitalization stay ranged from 2 to 5 days (mean 2.3 ± 1.2 days) and ranged from 3 to 6 days (3.7 ± 1.6 days) in FURS and SMP group,respectively (P ＜ 0.05).The scores of Visual Analogue Scale (VAS) ranged from 0 to 3 (mean 2.1 ± 0.4) and ranged from 0 to 3 (mean 1.9 ± 0.5) in FURS and SMP group,respectively (P ＜ 0.05).And the scores of Bruggrmann comfort scale (BCS) ranged from2to4 (mean 3.2 ±0.7) and ranged from 2 to4 (2.8 ±0.5) in FURS and SMP group,respectively(P ＜ 0.05).Conclusions Both SMP and FURS are efficacy and safe surgical alteration for patients with renal and renal lower calyx calculus of CSD about 2cm.The SMP could have some advantages such as the better stone free rate and acceptable complieation rate.
ABSTRACT
Intraductal papillary mucinous neoplasm (IPMN) is a kind of epithelial neoplasms of mucin-producing cells arising in the main duct and/or branch ducts of the pancreas,and it is one of the precancerous lesions of the pancreatic cancer.With the development of pathology and radiology,the diagnostic rate of IPMN has been gradually increased and given a new understanding on the pathological characteristics,clinical diagnosis and treatment of IPMN.This review overviewed the classification,diagnosis,management and prognosis of IPMN,aiming to deepen the understanding of IPMN and improve the level of diagnosis and treatment.