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Objective:To summarize the preliminary experiences of utilizing complete peritoneal externalization for donation after cardiac death (DCD) robot-assisted kidney transplantation (RAKT) and observe the effect of RAKT versus open kidney transplantation (KT) under the same donor kidney during the same period.Methods:From February 2019 to July 2020, 40 patients scheduled for kidney transplantation were divided into two groups of robot ( n=20) and open surgery ( n=20). Donor for DCD had the same blood type. Preoperative data, intraoperative findings and postoperative outcomes were analyzed. Results:No significant inter-group difference existed in age, body mass index (BMI) or dialysis time. Both groups completed operations successfully. As compared with open group, operative duration, blocking time, venous anastomotic time and ureteral anastomosis time were longer in robot group. And the incidences of lymphatic fistula/cyst was higher in robot group than that in open group. Robot group was superior to open group in terms of hospitalization time, ventilation time, pain disappearance time and time to ambulate. No statistically significant inter-group difference existed in iliac vascular separation time, arterial anastomotic time, volume of blood loss and postoperative recovery of renal transplant function.Conclusions:RAKT is both safe and feasible at advanced surgical centers. Early evidence indicates that RAKT can accelerate the recovery of patients and achieve the same renal function recovery as open surgery. As surgeons become more proficient in RAKT technology, operative duration will be gradually shortened.
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Neoadjuvant chemotherapy (NAC) has been widely used in ⅡA, ⅡB, ⅢA stage and locally advanced breast cancer. The best way to evaluate NAC effect is to detect the changes in total tumor lesion volume by three-dimensional reconstruction under magnetic resonance imaging (MRI). At present, it is a hotspot for many scholars to effectively evaluate the efficacy of NAC and the impact of shrinkage modes on the evaluation after NAC in breast cancer by combination of multiple parameters, such as the area under receiver operating characteristic curve (ROC), time-intensity curve (TIC) type and minimum apparent diffusion coefficient (ADC). To provide more practical and accurate means and methods in evaluating the effect of NAC in breast cancer for clinic is the medical researchers′eternal target.
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Objective We invented mammary lump skin-positioning membrane (named scare membrane) to facilitate localization of mammary lump during ultrasound scan.This study is to measure the radius of mammary of Chinese adult women for designing different types of skin-positioning membrane.MethodsThe radius of mammary glands in 236 cases of adult females was detected with color Doppler ultrasound at 5 different clock positions:12:00,3:00,6:00,9:00 and 10:30 or 1:30.SPSS 16.0 statistical software was used to analyze the data.The cut-off values of mammary glands radius at 99％,95％,75％ and 50％ were calculated.Paired t tests or nonparametric tests (relative sample rank sum tests) were used to verify the consistency of mammary gland radius between left and right sides.ResultsThe cut-off value of 95％ mammary gland radius was:7.700cm at 12:00,7.810 cm at 13:00,8.100 cm at 3:00,5.330 cm at 6:00 and 6.300 cm at 9:00 for left mammary gland ; 7.500 cm at 12:00,6.015 cm at 3:00,5.500 cm at 6:00,8.510 cm at 9:00 and 7.930 cm at 10:30 for right mammary gland.In comparison of left and right mammary gland radius,the difference had statistical significance between the group of left side at 1:30 and right side at 10:30,the group of left side at 3:00 and right side at 9:00(P ＜0.05).The right mamma was relatively larger.The cut-off values of the right mamma at the above two clock points were taken as radius of scale membranes while the average of percentage cut-off values at 12:00,3:00 of both mammas,left side at 9:00 and right side at 3:00 are taken as radius of scale membranes.ConclusionsAccording to the cut-off values of 99％,95％,75％ and 50％ radius of adult female mammary glands,mammary lump skin-positioning membrane radius can be classified into 4 size-types:extra large,large,medium and small.The precise classification of radius of mammary scale membranes according to mammary glands of adult females provides convenience for production,manufacture and clinical application of mammary lump skin-positioning membrane.
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Objective To investigate the application value of breast scale membrane marking method to locate breast tumor lesion in neoadjuvant chemotherapy.Methods Before neoadjuvant chemotherapy for 120 cases of breast cancer,adopt scale membrane marking method was used to mark the position and boundaries of breast tumor lesion in the mean time.For non-protuberant breast tumor lesion,scale membrane was adhered directly to the breast and positive mark was made.For tumor lesion with vague boundaries,its boundaries was defined under the direction of ultrasound.For protuberant breast tumor lesion,scale membrane was only adhered to normal mammary skin beyond the tumor lesion and reverse mark was made.After two courses of treatment of TEC scheme,mark was made again and combined with ultrasound,molybdenum target and MRI results to comprehensive judgment of clinical curative efficacy so as to decide whether operation or change to TP scheme for continuous chemotherapy.Before operation,the first marking results were reset and then operation was conducted according to the position and boundaries of the marked tumor lesion.Results There were 26 cases of complete remission,76 cases of partial remission,10 cases of stabile disease and 8 cases of progressive desease.According to mark by scale membrane,breast conserving operations were conducted in 24 cases of complete remission and in 18 cases of partial remission according to position+ boundaries of the tumor lesion and tumor lesion position+ 1.5-2.0 cm beyond the original boundaries of tumor lesion marked by scale membrane,respectively.The simplified radical mastectomy was conducted in other 78 cases according to boundaries of the tumor lesion marked by scale membrane,in which 13 cases had insufficient locally advanced skin edges and adopted abdominal full-thickness free skin flap to cover the wound.Conclusion Tumor lesion location in neoadjuvant chemotherapy for breast cancer and scale membrane positioning method have the advantage of precision and non-invasion,which effectively save normal breat tissues and skin around tumor lesion with high patient compliance and tremendously outmatches traditional coordinate method,body surface tattoo method and mental marker method.Scale membrane marking method is easy to be operated with low cost,which is convenient for popularization and generalization.
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The damage to the barrier of colonic mucosal epithelial cells is the fundamental cause of bacterial translocation.The tight junction among epithelial cells forms the most important constituent part of the mechanical barrier of the organism to prevent bacterial translocation from happening in the intestinal canal.The para-colonic-mucosal-epithelial-cell space is closed by protein complexes which are considered to be used for regulating the permeability between cells.ZO-1,Claudin-1 and Occludin are the most representative among the numerous protein complexes.They have become the important index to judge the damage degree of the barrier of colonic mucosal epithelial cells in test.The endotoxin is the product released by bacteria.Anti-endotoxin is one of the methods to protect the colonic mucosal barrier,to prevent and treat bacterial translocation.There are anti-endotoxin drugs.However,there has not been any drug widely recognized clinically up to now.Qingyi Decoction and Chaiqin Chengqi Decoction are the traditional Chinese medicine with the function of protecting the intestinal mucosal barrier and suppressing the transloeation of enteric bacteria.Oxymatrine has many pharmacological effects such as anti-bacterial,anti-inflammatory and immunoragulation.The recent animal experiments showed that oxymatrine has protective effect on the intestinal mucosa during severe infection.However,the mechanism of the drug action has not been completely known and needs to be studied in depth.Our traditional Chinese medicine applies extensively in clinical application of the prevention of the damage to the colonic mucosal epithelial cells during severe infection.
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Objective To explore the significance of palpation-negative breast tumor resection with ultrasound-guided methylene blue labeling and percutaneous suture traction.Methods 46 cases of small breast tumors with the diameter from 0.5 cm to 1.0 cm were double labeled with methylene blue under the guide of ultrasound l hour preoperatively.The tumors were fixed,drew outward with percutaneous suture and resected accurately.All the 46 cases were rechecked by ultrasound to verify whether residual or false resection occurred 1 month later.Results All the 58 tumors of the 46 patients were accurately resected.No residue or false resection occurred.The average operation duration was 10 min to 20 min.Conclusion Palpable-negative breast tumor resection with ultrasound-guided methylene blue labeling and percutaneous suture traction has the advantages of small invasion,accurate positioning and short operation duration.