Fingerprint establishment of Huangqin decoction and study on spectrum-effect relationship of its antidermatophytic activity in different phase states / 中国药房

OBJECTIVE To establish the fingerprint of Huangqin decoction （HQD）， to separate the phase states and screen the active phase states of antidermatophytic activity so as to study the spectrum-effect relationship. METHODS HPLC method was adopted using baicalin as reference， the fingerprints of 10 batches of HQD were drawn and the similarity evaluation was carried out using the Similarity Evaluation System of Chromatographic Fingerprint of TCM （2012 edition） to determine the common peak； the phase states of HQD were separated and characterized by high-speed centrifugation and membrane dialysis. The minimum inhibitory concentrations （MIC） of HQD and its different phase states against Trichophyton mentagrophytes were determined simultaneously. Using the peak area of 37 common peaks as independent variable， MIC as dependent variable， Pearson correlation analysis was performed by using SPSS 21.0 software. RESULTS A total of 37 common peaks were obtained in HPLC fingerprints of 10 batches of HQD， with the similarity higher than 0.99. Ten components were identified， such as albiflorin， paeoniflorin， liquiritin apioside， baicalin， melaleuca glycoside A， wogonoside， baicalein， glycyrrhizic acid， wogonin and oroxylin A. HQD was split into 3 phase states， such as precipitation phase （HQD-P）， solution phase （HQD-S） and nano phase （HQD-N）. The morphology of HQD-P was irregular granular， and the average particle size was 4.670-91.522 μm. The morphology of HQD-S was uniform flakes， and no particle size was detected. HQD-N was spherical in shape and the particle size was （129.0±12.9） nm. MIC values of each phase state of HQD against T. mentagrophytes in different phase states were HQD-N （4.64 mg/mL） ＜HQD （5.85 mg/mL） ＜HQD-P （7.37 mg/mL） ＜HQD-S （12.89 mg/mL） at the same dosage. Pearson correlation analysis showed that the peak area of 25 of the 37 common peaks （including identified components） was significantly negatively correlated with MIC （absolute values of correlation coefficient＞0.95 and P＜0.05）. CONCLUSIONS The chemical composition of 10 batches of HQD is consistent； HQD-N is the active phase state of HQD. Ten components such as paeoniflorin， liquiritin apioside and baicalin may be the main active components of HQD. The antidermatophytic effect of HQD is closely related to its component content and physical phase state.

Practice of relieving emergency overcrowding in Peking Union Medical College Hospital / 中华医院管理杂志

Peking Union Medical College Hospital, as one of the most stressful medical institutions in China, is facing the problem of emergency department overcrowding. In order to effectively alleviate the emergency overcrowding, improve the medical quality and patients′ medical experience, the hospital firmly grasped the two incremental links of " throughput" and " output" factors, established a multidisciplinary and multi-department cooperation team, constructed a close medical alliance cooperation mode, and innovated and explored a harmonious emergency overcrowding relief mode with the goal of unblocking the " exit" of patients. The practice showed that the comprehensive measures could effectively alleviate the problem of emergency overcrowding, and improve the medical environment and medical quality.

The Chinese guidelines for the diagnosis and treatment of pancreatic neuroendocrine neoplasms (2020) / 中华消化外科杂志

Pancreatic neuroendocrine neoplasms (pNENs) are highly heterogeneous, and the management of pNENs patients can be intractable. To address this challenge, an expert committee was established on behalf of the Chinese Pancreatic Surgery Association, Chinese Society of Surgery, Chinese Medical Association, which consisted of surgical oncologists, gastroenterologists, medical oncologists, endocrinologists, radiologists, pathologists, and nuclear medicine specialists. By reviewing the important issues regarding the diagnosis and treatment of pNENs, the committee concluded evidence-based statements and recommendations in this article, in order to further improve the management of pNENs patients in China.

Application value of machine learning algorithms for gauze detection in laparoscopic pan-creatic surgery / 中华消化外科杂志

Objective:To investigate the application value of machine learning algorithms for gauze detection in laparoscopic pancreatic surgery.Methods:The retrospective and descriptive study was conducted. The 80 intact laparoscopic pancreatic surgery videos from Peking Union Medical College Hospital of Chinese Academy of Medical Sciences with timing of July 2017 to July 2020 were collected. The training set was used to train the neural network, and the test set was used to test the ability of neural network for gauze detection under different difficulties. Under the supervision of two superior doctors, videos that containing gauze were selected and classified according to recognition difficulty into three difficulty level including easy, normal and hard difficulty, and further divided based on random number method into training set with 61 videos and test set with 19 videos in a ratio of 3:1 roughly. The minimum enclosing rectangle of the gauze were marked frame by frame. All images were input to the neural network model for training after normalization and preprocessing. For every image, the output of neural network is the predicted minimum enclosing rectangle of gauze. The intersection over union >0.5 was identified as positive result. Observation indicators: (1) video annotation and classification; (2) test outcomes of neural network for test set.Count data were represented as absolute numbers or percentages.Results:(1) Video annotation and classification: a total of 26 893 frames of images form 80 videos were annotated, with 61 videos including 22 564 frames of images as the training set and 19 videos including 4 329 frames of images as the test set. Of the training set, 19 videos including 5 791 frames of images were classifed as easy difficulty, 38 videos including 15 771 frames of images were classifed as normal difficulty, 4 videos including 1 002 frames of images were classifed as hard difficulty, respectively. Of the test set, 4 videos including 1 684 frames of images were classifed as easy difficulty, 6 videos including 1 016 frames of images were classifed as normal difficulty, 9 videos including 1 629 frames of images were classifed as hard difficulty, respectively. (2) Test outcomes of neural network for test set: the overall sensitivity and accuracy of gauze detection by neural network in the test set were 78.471%(3 397/4 329) and 69.811%(3 397/4 866), respectively. The sensitivity and accuracy of gauze detection by neural network were 94.478%(1 591/1 684) and 83.168%(1 591/1 913) in easy difficulty test set. The sensitivity and accuracy of gauze detection by neural network were 80.413%(817/1 016) and 70.859%(817/1 153) in normal difficulty test set, 60.712%(989/1 629) and 54.944%(989/1 800)in hard difficulty test set. The frame rate reached more than or equally to 15 fps. The overall false negative rate and false positive rate of gauze detection by neural network in the test set were 21.529%(932/4 329) and 30.189%(1 469/4 866), respectively. The false negative was mainly due to the existence of blurred images, too small gauze exposure or blood immersion of gauze. The false positive was caused by the reflection of connective tissue or body fluids.Conclusion:The machine learning algorithms for gauze detection in laparoscopic pancreatic surgery is feasible, which could help medical staff identify gauze.

A nationwide survey of perioperative nutritional management of patients undergoing pancreatoduo-denectomy: a report from 64 level A tertiary hospitals / 中华消化外科杂志

Objective:To assess the current practice in perioperative nutritional managament of patients undergoing pancreatoduodenectomy from 64 level A tertiary hospitals in China, and investigate nutritional managament strategies.Methods:The cross-sectional survey was conducted. From March 31 st to April 13 th, electronic questionnaires of perioperative nutritional management of patients undergoing pancreatoduodenectomy were sent to the members of Youth Club of Chinese Pancreatic Surgery Association and some pancreatic surgeons from other level A tertiary hospitals in China. The questionnaires were issued by online Wechat platform. Observation indicators: (1) general data; (2) preoperative nutritional management; (3) intraoperative nutritional management; (4) postoperative nutritional management; (5) comparison of nutritional management among medical centers with different surgical amount. Measurement data with normal distribution were represented as Mean± SD. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Results:(1) General data: a total of 96 questionnaires from 64 level A tertiary hospitals in 35 cities of 22 provinces were retrieved. There were 94 males and 2 females, aged (42±7) years, with a range from 29 to 59 years. (2) Preoperative nutritional management. ① Preoperative nutritional evaluation and screening: 62.5%(60/96) of surgeons evaluated preoperative nutritional status for patients. For preoperative screening, 41.7%(40/96) of surgeons performed nutritional screening in every patient, and 54.2%(52/96) performed nutritional screening when considering nutritional support. For screening tools, Nutritional Risk Screening 2002 was used in 66.7%(64/96) of surgeons. For selection of non-tool evaluation parameters, 97.9%(94/96) chose two or more indicators for comprehensive evaluation, 92.7%(89/96) chose Albumin as the evaluation parameter. ② Preoperative nutritional support: there were 13.5%(13/96) of surgeons conducting nutritional support regularly. For preoperative nutritional support methods, nutritional support based on diet was conducted by 94.8%(91/96) of surgeons. For timing of perioperative nutritional support, 43.8%(42/96) of surgeons determined the time according to the surgical time. Based on the theory of enhanced recovery after surgery, 24.0%(23/96)of surgeons routinely gave liquid diet or carbohydrate load at the preoperative 2 hours. (3) Intraoperative nutritional management. ① Intraoperative jejunostomy management: 8.3%(8/96) of surgeons performed routine jejunostomy. ② Intraoperative nutrition line management: the nasojejunal tube was placed intraoperatively by 30.2%(29/96), and the nasogastric tube was placed intraoperatively by 78.1%(75/96). Of the above surgeons, 38.7%(29/75) determined the time to nasogastric tube removal based on gastric volume, and 32.0%(24/75) removed the nasogastric tube after flatus in patients. (4) Postoperative nutritional management. ① Postoperative nutritional support methods: 84.4%(81/96) of surgeons gave nutritional support, in which 56.8%(46/81) mainly gave the parenteral nutrition and transition to diet. Total parenteral nutrition at the postoperative first day or complementary parenteral nutrition was the first choice in 78.1%(75/96) of surgeons, oral feeding at postoperative 7 days was the first choice in 86.5%(83/96) of surgeons. ② Postoperative nutritional management for complications: 63.5%(61/96) of surgeons chose enteral nutritional support through percutaneous endoscopic gastrojejunostomy, nasogastric tube or nasojejunal tube for grade B or C pancreatic fistula, 72.9%(70/96) chose enteral nutritional support through percutaneous endoscopic gastrojejunostomy or nasojejunal tube for delayed gastric emptying. (5) Comparison of nutritional management among medical centers with different surgical amount: of the 96 surgeons, surgeons in medical centers with surgical amount >100 cases a year had the nasogastric tube placement rate of 66.7%(32/48), and surgeons in medical centers with surgical amount ≤100 cases a year had the nasogastric tube placement rate of 89.6%(43/48), showing a significant difference between the two groups ( χ2=7.375, P<0.05). Conclusions:There is no uniform standards for indications, routes, or timing of perioperative nutritional management of patients undergoing pancreatoduodenectomy among surgeons from level A tertiary hospitals in China. In patients undergoing pancreatoduodenectomy, the theories and practice of perioperative nutritional management and enhanced recovery after surgery are diverse, which urgently require prospective study with nutritional management strategy as intervention and expert consensus on perioperative nutritional managament in pancreatic surgery accorded with clinical practice in China.

The effect of para-aortic lymph node metastasis on the resectability of pancreatic cancer / 中华外科杂志

Pancreatic cancer has poor prognosis and lymph node metastasis is a poor prognostic factor in patients with resectable pancreatic cancer. The metastatic prevalence of para-aortic lymph node (PALN) ranges from 9.1% to 26.5% and it is listed as the distant metastatic group in pancreatic cancer. Nevertheless, it is controversial whether PALN metastasis is the contraindication of surgery in resectable pancreatic cancer for the shortage of level Ⅰ evidence.This study concluded that PALN metastasis indicated poor prognosis in patients with pancreatic cancer, but some patients with PALN metastases could benefit from surgery and their survival could be much improved after the combination of surgery and adjuvant therapy. Therefore, it is not wise to refuse surgery for all pancreatic cancer patients with PALN metastasis and the clinicians can cautiously choose the patients to do surgery. Besides, there are mainly retrospective studies rather than prospective and multicenter studies to explore the prognosis of pancreatic cancer patients with PALN metastasis. Thus, more prospective and multicenter studies are needed to decide whether PALN metastasis is an independent prognostic factor in patients with resectable pancreatic cancer.

Clinical study of postoperative adjuvant radiotherapy and postoperative concurrent chemoradiotherapy for locally advanced hypopharyngeal squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective@#Using propensity score matching method (PSM) to investigate the clinical effect of postoperative adjuvant radiotherapy and postoperative concurrent chemoradiotherapy for locally advanced hypopharyngeal squamous cell carcinoma.@*Methods@#From July 2007 to July 2018,174 postoperative patients with locally advanced hypopharyngeal squamous cell carcinoma were enrolled in pre-PSM cohort, including 168 males and 6 females, the median age was 60 years old (ranged from 37 to 79 years old).Loco-regional control (LRC),progression-free survival (PFS) and overall survival (OS) were compared and analyzed between the patients treated with postoperative adjuvant radiotherapy and postoperative concurrent chemoradiotherapy (cisplatin was given in a dose of 80 mg/m2 on days 1, 22, and 43). After the propensity score matching (PSM), 61 sub-pairs of 122 patients were generated in post-PSM cohort. Survival rate were assessed with Kaplan-Meier method and Log-rank test.@*Results@#After the propensity score matching(PSM), 61 sub-pairs of 122 patients were generated in post-PSM cohort.The patients were followed up for 3-135 months, the median follow-up was 42 months. No significant differences in 3-year and 5-year LRC, PFS, OS were observed between the two groups (P>0.05) . For postoperative patients who had high-risk factors (extracapsular extension of nodal disease, and/or vascular embolism, and/or lymph node metastasis≥2, and/or positive surgical margin, and/or perineural infiltration),there were significant differences between the two groups in 3-year PFS (60.99% vs 84.49%,P<0.05), 5-year PFS (35.47% vs 56.97%,P<0.05) and 5-year LRC (41.02% vs 68.50%, P<0.05), but no significant difference was found in OS between the two groups (P>0.05).@*Conclusion@#Postoperative concurrent chemoradiotherapy was more efficacious than postoperative radiotherapy alone in terms of loco-regional control and PFS for high-risk postoperative patients with locally advanced hypopharyngeal squamous cell carcinoma.

Thoughts and strategies on ethical issues in clinical research of surgery / 中华消化外科杂志

Medical ethics has a long history and rich connotations.It has developed from the simple "medical morality" of ancient times to the modem medical ethics.The basic principles of medical ethics include autonomy,non-maleficence,beneficence,justice,and so on.Researchers often conduct clinical researches in the balance between achievements and ethical norms.Clinical researchers of surgery should have a deep understanding of medical ethical principles and strictly abide by medical ethics.Ethics committee should strictly perform their duties and play the role of inspection and supervision.Modem medical knowledges should be popularized throughout the society to make clinical research correctly understood.Adhering principles of ethics first,people orientation and cooperation practice,with patients' benefit as evaluation criteria,balance of surgical "Dao" and "Shu" can be achieved.

Imaging anatomy and clinical significance of the inferior pancreaticoduodenal veins / 中华消化外科杂志

Objective To investigate the imaging anatomy and clinical significance of the inferior pancreaticoduodenal veins (IPDVs).Methods The retrospective and descriptive study was conducted.The clinicopathological data of 42 patients with pancreatic head ductal adenocarcinoma who were admitted to Peking Union Medical College Hospital from January to June 2018 were collected.There were 24 males and 18 females,aged from 41 to 78 years,with an average age of 61 years.Patients received preoperative contrast-enhanced computed tomography (CT) examination with 1 mm slice thickness,and underwent corresponding surgery according to the preoperative evaluation.Observation indicators:(1) results of preoperative CT examination;(2) surgical situations.Normality of measurement data was analyzed using Shapiro-Wilk test.Measurement data with skewed distribution were described as M (QR) or M (range),and comparison between groups was analyzed by the Mann-Whitney U test.Count data were described as absolute number or percentage,and comparison between groups was analyzed by the chi-square test.Results (1) Results of preoperative CT examination:42 patients received preoperative contrast-enhanced CT examination with 1 mm slice thickness.① The first jejunal venous trunk was identified in all the 42 patients.The first jejunal venous trunk crossed dorsal to the superior mesenteric artery (SMA) in 34 patients and ventral to the SMA in 8 patients.② Of 42 patients,2 showed no IPDV,and 40 showed IPDV including 23 with 1 IPDV,13 with 2 IPDVs,3 with 3 IPDVs,and 1 with 4 IPDVs.A total of 62 IPDVs were identified in the 42 patients,with an average IPDV number of 1 (range,0-4).There were 43 IPDVs drained into first or second jejunal venous trunks and 19 IPDVs drained into superior mesenteric vein (SMV).③ Of 42 patients,type Ⅰ IPDV was identified in 32 patients including 20 with 1 IPDV drained into jejunal venous trunk at dorsal side of SMA,7 with 2 IPDVs drained into jejunal venous trunk at dorsal side of SMA,2 with 3 IPDVs drained into jejunal venous trunk at dorsal side of SMA,and 3 with 1 IPDV drained into jejunal venous trunk at ventral side of SMA,and non-type Ⅰ IPDV was identified in 10 patients;type Ⅱ IPDV was identified in 18 patients including 17 with 1 IPDV drained into SMV and 1 with 2 IPDVs drained into SMV,and non-type Ⅱ IPDV was identified in 24 patients.Some patients can simultaneously had type Ⅰ and type Ⅱ IPDV.(2) Surgical situations:42 patients underwent pancreatoduodenectomy,14 of which underwent laparoscopic surgery and 28 underwent open surgery.There were 5 cases with SMV or portal vein reconstruction,and 18 with intraoperative blood transfusion.All the 42 patients were diagnosed as pancreatic ductal adenocarcinoma by postoperative pathological examination,including 30 of R0 resection and 12 of R1 resection.The volume of intraoperative blood loss,cases with intraoperative blood transfusion,cases with R0 and R1 resection (situation of surgical margin),cases with SMV or portal vein reconstruction were 650 mL(853 mL),15,20,12,4 in the 32 patients with type Ⅰ IPDV,aod 475 mL (480 mL),3,10,0,1 in the 10 patients with non-type Ⅰ IPDV;there were significant differences in the volume of intraoperative blood loss and situation of surgical margin (Z=94.000,x2=5.250,P＜ 0.05).There was no significant difference in the cases with intraoperative blood transfusion,cases with SMV or portal vein reconstruction between patients with type Ⅰ and non-type Ⅰ IPDV (x2 =0.045,0.886,P＞0.05).Conclusions IPDVs can be distinguished on the contrast-enhanced CT with slice thickness,and classified as IPDVs drained into SMV or jejunal venous trunk.It is necessary to carefully deal with IPDVs drained into jejunal venous trunk in the pancreaticoduodenectomy due to its more volume of intraoperative blood loss and lower R0 resection rate.

Current diagnosis and treatment progress of small pancreatic neuroendocrine neoplasm / 中华外科杂志

Small(≤2 cm)pancreatic neuroendocrine neoplasm(pNEN) is a very special subgroup of pNEN featuring a small size, concealed pathogenesis, indolent course and remarkable heterogeneity.Differences in its diagnosis and interventional criteria have evolved from routine pNEN.During recent years, the incidence of small pNEN has increased sharply, while optimal management strategy of this subgroup still remains controversial.In this paper, the biological characteristics, pathological classification, diagnosis, intervention indication and therapeutic principles of small pNEN are reviewed based on recent researches, and current situations of diagnosis and treatment of small pNEN are summarized.

A retrospective study on combined modality therapy with or without surgery for advanced hypopharyngeal squamous cell carcinoma: an analysis of 119 cases / 中华耳鼻咽喉头颈外科杂志

Objective@#To compare the treatment outcomes for locally advanced hypopharyngeal carcinoma between surgery plus radio(chemo) therapy(SRT) and non-surgery chemoradiotherapy(CRT).@*Methods@#A total of 119 patients diagnosed with advanced hypopharyngeal carcinoma without distant metastases between 2010 and 2014 were identified in the Chinese People′s Liberation Army General Hospital, and they were divided into 2 groups: 42 cases in SRT group and 77 cases in CRT group. Patients′ clinical information was collected. Survival rates and prognostic factors were analyzed by the Kaplan-Meier method with SPSS 23.0 software. The survival rates, laryngeal preservation rates and complication rates were compared between the two groups using the chi-square test.Among the 119 patients, 112 were males and 7 were females. Age ranged from 27 to 78 years, with an average age of 57 years.@*Results@#There were no significant difference between the SRT and CRT group for five-year disease-free survival (DFS, 53.9% vs. 45.1%, χ2=1.251, P=0.263) and overall survival (OS, 54.9% vs. 45.6%, χ2=1.749, P=0.186). Compared to SRT group, CRT group did not showed the significant increase of treatment complications (χ2=0.858, P=0.354), with a higher laryngeal preservation rate (50.0% vs. 71.4%, χ2=6.493, P=0.011).@*Conclusions@#Advanced hypopharyngeal carcinoma is of high malignancy and poor prognosis. Combined modality treatment is a main approach for advanced hypopharyngeal cancer. SRT offers disease-free survival and overall survival rates equivalent to CRT, but with a higher laryngeal preservation rate.

Research advances in diagnosis and treatment of duodenal varices / 中华全科医师杂志

Duodenal varices are an uncommon disease which occurs along the entire gastrointestinal tract outside the esophagus or stomach.Among ectopic varices,duodenal varices are the most common one.Cirrhosis,hepatic portal hypertension,extrahepatic portal vein occlusion and vasculitis contribute to the pathogenesis of ectopic variceal formation.The unusual pathophysiology,location,diversity and uncertain curative effect of DV are associated with its low detection rate and high mortality of patients.Therefore,the diagnosis and treatment of DV is one of the tough problems in clinical practice.This article reviews the current research advances in pathophysiology,diagnosis and treatment of duodenal varices to provide reference for clinical practice.

Impact of the 2016 new definition and classification system of pancreatic fistula on the evaluation of pancreatic fistula after pancreatic surgery / 中华外科杂志

Objective@#To discuss the impact of updated definition and classification system of pancreatic fistula published in 2016 on the postoperative classification of pancreatic fistula.@*Methods@#Retrospective analysis was made on patients who underwent pancreatic surgery at ward 1 in Department of General Surgery, Peking Union Medical College Hospital from January 2015 to December 2016.A total of 408 patients were included in this retrospective study, male/female was 184/224, aged from 9 to 81 years with mean age of 51.6 years.One hundred and fifty-two cases were performed pancreaticoduodenectomy, 125 cases for distal pancreatectomy, 43 cases for spleen preservation distal pancreatectomy, 61 cases for partital pancreatectomy or enucleation, 8 cases for middle pancreatectomy, 6 cases for pancreaticojejunostomy and 13 cases for other procedures.Clinical data including postoperative drainage fluid volume, amylase concentration, duration of hospitalization and drainage were obtained, revaluated and re-analyzed, classified grounded on 2005 edition and 2016 edition, respectively.t-test was adopted for data analysis.@*Results@#According to the previous standards, the incident rate of pancreatic fistula was 57.4%, and the incident rate of B-level plus C-level pancreatic fistula was 35.8%, which decreased to 13.7% based on 2016 edition.Nine patients who received percutaneous puncture or endoscopic drainage was regraded from C-level to B-level. The average duration of postoperative hospitalization of patients without pancreatic fistula was (12.5±6.0)days, demonstrating no significant difference compared to (14.1±7.7)days, duration of postoperative hospitalization of A-level(under 2005 edition of criteria) pancreatic fistula group(t=1.66, P=0.09) and (12.4±6.1)days, duration of postoperative hospitalization of biochemical leakage group(t=0.14, P=0.89). Nevertheless, there was statistical significant difference between the average postoperative duration of hospitalization(30.7±16.9) days of B-level(under 2016 criteria) pancreatic fistula patients and pancreatic fistula-free patients as well as the biochemical leakage group patients (t=7.10, 7.13; both P<0.01).@*Conclusions@#Based on the new diagnostic criteria, the incidence of postoperative pancreatic fistula decreased dramatically.New classification system downgraded part of cases graded C-level pancreatic fistula to B-level and some B-level to biochemical fistula.The new diagnostic classification and criteria facilitated clinical practice, accomplished better conformity to clinical reality and potentially enacted clinical outcome.

Effects of trabecular metal augments for the reconstruction of Paprosky type Ⅲ acetabulum bone defects / 中华外科杂志

Objective@#To investigate the methods and short-time clinical results of reconstruction of Paprosky type Ⅲ acetabulum bone defects by using tantalum augments.@*Methods@#A total of 17 patients (17 hips) with Paprosky type Ⅲ acetabulum bone defects, treated with tantalum augments in revision of total hip arthroplasty at Department of Orthopedics Surgery in General Hospital of Chinese People′s Liberation Army were retrospectively analyzed from March 2014 to May 2016.There were 6 males and 11 females aged from 23 to 74 years with an average of (50.2±16.3) years. Tantalum augments or TM-Cup augment (the cup-on-cup technique) were used to reconstruct the defects.The TM-Cup augment was the tantalum revision cup which was removed titanium ring. The cup-on-cup technique combined TM-Cup augment and biological acetabulum cup. Augments were served as the nonresorptive structural allograft in revision of total hip arthroplasty. Harris hip score was used to evaluate clinical effects. The vertical position of the rotation center was measured and analyzed. Radiographic assessments of the acetabular components were performed by DeLee-Charnley and the Anderson criteria and recorded postoperative complications.@*Results@#All the patients were followed up from 3 to 29 months with an average of (16.2±5.4) months, tantalum augments and biological acetabulum cup were used in 13 patients, the TM-Cup augment and biological acetabulum cup were used in 4 patients. At the time of the latest follow-up, the mean Harris hip score increased compared to preoperatively (86.8±8.3 vs. 30.0±12.0) (t=12.78, P<0.01), the average vertical location of the center of rotation was decreased ((25.3±9.8) mm vs.(47.6±10.5)) mm (t=4.95, P<0.01). All the tantalum augments and biological acetabulum cups were stable, there were no infection, dislocation and other complications.@*Conclusions@#The use of tantalum augments could be considered as an effective management of Paprosky type Ⅲ defects providing good clinical and radiographic outcomes in the short term.The cup-on-cup technique which was used in reconstruction of severe superior-invagination acetabular bone defects and restoration relatively normal center of rotation had special application value.

Effective analysis of non-surgical combined treatments for laryngeal organ preservation in locally advanced laryngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the therapeutic effects, larynx preservation and adverse events of non-surgical combined treatments for laryngeal organ preservation in locally advanced laryngeal squamous cell carcinomas(SCCs).</p><p><b>METHODS</b>Forty-six patients with locally advanced laryngeal carcinoma (T2-4, N0-N3) were treated individually with non-surgical combined treatments for larynx preservation (LP). These treatments included concurrent chemoradiotherapy (CCRT)(±epidermal growth factor receptor (EGFR) inhibitor), induction chemotherapy (ICT) followed by CCRT(± EGFR inhibitor), or concurrent radiotherapy and EGFR inhibitor. Radiation therapy was given to a total dose of 60-70 Gy. The Kaplan-Meier method was used to determine the overall survival. Side-effects were evaluated with the established Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 criteria.</p><p><b>RESULTS</b>The average follow-up time was 31.8 months (range 6-95 months). All patients completed the planned radiotherapy without treatment breaks, and 45(97.8%) of 46 patients completed the planned chemotherapy.The 3-year and 5-year overall survival rates were 87.3%and 67.2%, respectively.The 5-year larynx preservation rate was 100.0%. The 3-year and 5-year progression free survival rates were 95.1% and 87.7%, respectively. The most common acute side effect in grade 3 was oropharyngeal mucositis. After treatment, tracheotomy was still required in 2 patients with glottis cancer for laryngeal edema or stenosis. No patient depended on a percutaneous gastrostomy and experienced speech impairment.</p><p><b>CONCLUSION</b>Patients with locally advanced laryngeal cancer can be offered non-surgical combined treatments for laryngeal preservation and the high quality of life, showing a higher laryngeal preservation survival rate with minimal toxicities.</p>

Retrospective study on post-operative glucose level and insulin dose in patients undergoing total pancre-atectomy / 中华临床营养杂志

Objective To evaluate the post-operative glucose level and insulin dose of patients undergoing total pancreatectomy.Methods From September 1980 to September 2014, 21 patients underwent total pancrea-tectomy in Peking Union Medical College Hospital, who were enrolled in our study.We reviewed the changes in their insulin dosage and glucose levels after operation, also summarized type and dose of insulin as well as glucose level in stable period.Results The required insulin dose reached peak within 4 days after surgery ( maximum dose 300 U/d).The average dose was (143.5 ±62.8) U/d and decreased gradually.During the perioperative period (needing parenteral nutrition), the blood glucose level fluctuated markedly (1.52-29.06 mmol/L) and the average level was (11.18 ±0.95) mmol/L.During the stable period ( without parenteral nutrition) , patients on average had (5.3 ±2.0) U of preprandial rapid-acting insulin and (8.1 ±2.9) U of long-acting insulin be-fore sleeping;the average fasting blood glucose was (6.69 ±1.48) mmol/L, 2 h postprandial blood glucose was (9.08 ±2.84) mmol/L, bedtime blood glucose was (9.66 ±2.49) mmol/L, and blood glucose level at night was (8.15 ±2.78) mmol/L.67%of the patients had 13 hypoglycemic episodes monthly on average.For those five followed-up patients, the average hemoglobin A1c was (6.15 ±1.20)%.Conclusions Patients undergoing total pancreatectomy may experience marked fluctuation of blood glucose level and short-term increase of insulin need which gradually decreases afterwards.After entering the stable period, the glucose level could be well-con-trolled but with frequent hypoglycemia.There is no diabetic ketoacidosis.

Research progress of endoscopic submucosal dissection with traction / 中华胃肠外科杂志

Endoscopic submucosal dissection (ESD) is a widely accepted treatment for early gastrointestinal cancer. However, the steep learning curve of standard ESD procedures makes it less widely applied in clinical practice. Therefore, various traction devices and techniques have been applied previously to facilitate ESD, such as clip-with-line method, Spring-assisted method, S-O clip method, magnetic anchor method, and robot-assisted method. These methods create a clear field of vision and allow dissections to be performed more quickly and safely. In this article, we will discuss various techniques for achieving tractions during ESD on clinical decision, and their advantages and disadvantages.

Combination of intraoperative ultrasonography for localizing insulinoma under Da Vinci robotic surgical system: experience of a single center in 50 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect and safety of enucleation of insulinoma under the Da Vinci robotic surgical system combination with intraoperative ultrasonography(IOUS) for the localization.</p><p><b>METHODS</b>The clinical materials of 50 insulinoma cases which underwent IOUS and assisted by the robotic surgical system from September 2012 to September 2014 in Peking Union Medical College Hospital were reviewed retrospectively. The patients were followed up by outpatient review and telephone until October 2014. The diagnostic accuracy rate, operation time, blood loss, complications and cure rate were analyzed by t-test.</p><p><b>RESULTS</b>The locations of tumors were 13 in the head, 21 in the body and 13 in the tail of pancreas, 2 were multiple insulinoma, 1 was ectopic to mesenterium.The average operation time was 142 minutes; the average blood loss was 165 ml.Three(6.0%) patients were transformed to open.One patient experienced postoperative bleeding about 300 ml on the 7(th) day after operation and no infection and perioperative death.Thirty-five cases were of class A and 14 of class B according to the clinical grading of postoperative pancreatic fistula.The blood glucose 60 minutes after tumor dissection was significantly elevated than that before operation ((6.2±1.8)mmol/L vs.(3.7±1.2)mmol/L)(t=-6.89, P<0.01). The cure rate was 100% as all the patients' symptoms were disappeared during follow-up time.</p><p><b>CONCLUSIONS</b>Combination IOUS is a highly sensitive method for the localization of insulinoma, which is helpful in localizing tumors precisely in insulinoma cases assisted by robotic surgical system and shortening operation time.It is safe and effective for insulinoma enucleation.</p>

Research progress on diagnosis and treatment of gastrointestinal endoscopy in pregnancy / 中华全科医师杂志

Gastrointestinal endoscopy plays a major diagnostic and therapeutic role in most gastrointestinal disorders.However,limited data of clinical safety is available in pregnant patients.Large studies,preferably prospective,with follow-up of fetal outcome are needed to determine fetal safety of endoscopy.This article briefly analyzed the literature on the research progress of gastrointestinal endoscopy during pregnancy,which offered an evident base for diagnosis and treatment in digestive diseases.

Comparative study on curriculum program of general education in China and U.S / 中华医学教育探索杂志

Based on reviewing briefly the development of the general education both in China and United States,selecting respectively a university as the example,the article has analyzed comparatively curriculum programs of general education between the two schools.Aimed at existing problem,from curriculum content carding,structure optimizing,teaching operating and evaluation of the effect,the article has proposed new thinking of reform on the general education of higher institutions.